Photodissociation of the CH2Br radical: A theoretical study.

Bromine atom (Br) reactions lead to ozone depletion in the troposphere and stratosphere. Photodegradation of bromocarbons is one of the main sources of bromine atoms in the atmosphere. Here, we use high-level ab initio methods, including spin-orbit effects, to study the photodissociation of the CH2Br radical. All possible fragmentation pathways, namely CH2Br + hν → CH2 + Br, HCBr + H, and CBr + H2, have been analyzed. Potential-energy curves of the ground and several excited electronic states along the corresponding dissociating bond distance of each pathway have been calculated. Considering the actinic fluxes of solar irradiation in the troposphere and in the stratosphere in the relevant range of frequencies, it is found that the first five excited states of CH2Br can be accessed from the ground state. Analysis of the potential curves shows that the pathways producing CH2 + Br and HCBr + H can proceed through a fast direct dissociation mechanism, while the pathway leading to CBr + H2 involves much slower dissociation mechanisms like internal conversion between electronic states, predissociation, or tunneling through exit barriers. The main implications are that the two faster channels are predicted to be dominant, and the slower pathway is expected to be less relevant. The tropospheric and stratospheric solar actinic fluxes also allow for further dissociation of the HCBr and CBr fragments, generating additional Br atoms, provided that they survive possible collisions with other atmospheric reagents. Finally, we discuss the possible effect of each of the three CH2Br dissociation pathways on the depletion of atmospheric ozone.

[Sexuality of Tunisian women: Involvement of religion and culture]. / Sexualité de la femme tunisienne : entre le religieux et le culturel.

INTRODUCTION: Culture and religion carry several prohibitions and taboos, especially in the Arab-Muslim societies, and are therefore involved in the sexual behavior and its perception, particularly that of women. OBJECTIVES: To assess the married population's knowledge and opinion about female sexuality, and to estimate the impacts of religious and cultural factors on women's life experience and sexual practice in the Tunisian society. SUBJECTS AND METHODS: Our study is in an inquiry. We targeted 55 men and 55 women agreeing to participate in the study. They responded to an anonymous self-administered questionnaire comprising 18 items related to the influence of religion and culture on female sexuality. Among these items, some were binary responses (yes or no) assessing knowledge about female sexuality in the Tunisian religious and cultural context; 8 others explored the opinions of participants about female sexuality. Statistical analysis was performed using SPSS software (15th version). Pearson's chi-square test and Fisher's exact association test were used for comparative study (P<0.05). RESULTS: The rate of participants who did not manage to reach the threshold of 50% of responses compliant with religious precepts and morals in the Tunisian context was 48.19%. According to 61.8% of participants, the woman should consider sex as a religious duty, and according to 79.1%, she always ought to have sex with her husband even when she did not wish to. This assertion was more frequently reported by women (P<0.001). Among the participants, 35.5% did not approve of the idea that women had the right to reach sexual pleasure, like men. Men recognized this right less often than women did (P<0.001). With reference to social morals, 43.6% of participants thought that the woman should always remain passive when having sex. This opinion was more common to women (P<0.001). There were 71.8% who thought that premature ejaculation was not a limiting factor for female pleasure. Virginity was considered by 63.6% of respondents as a feminine virtue to preserve. This response was statistically more frequent among males (P<0.001). For 55.5%, in addition to sodomy, a man could not afford all the sexual practices with his wife. This response was significantly more frequent in males (P<0.001). Regarding the subjective perception of female sexuality, the percentage of those who thought that women might simulate orgasm was 70.9%. Women thought more frequently than men that such a behavior could be justified to avoid hurting the man's pride (P<0.001). CONCLUSION: The experience of sexuality within the Tunisian population is hampered by the prohibitions related to religion and culture, at least in some of its aspects. The reasons for that may be the ignorance of religious texts or their misinterpretation and the biased cultural transmission not followed by questioning or seeking deeper knowledge. The introduction of sex education in school programs could play a crucial role in the fight against the obstacles surrounding sexuality, in order to promote the welfare of woman, and thereby, that of the couple and the family.

[Psychodynamic and forensic approach of constitutional mythomania: a case report]. / Approche psychodynamique et médicolégale de la mythomanie constitutionnelle: à propos d'une observation.

INTRODUCTION: Constitutional mythomania presents several diagnostic, aetiopathogenic and forensic problems for the doctor. We have discussed these aspects through the analysis of a case report. CASE REPORT: The case report relates to a 43 year-old man, who was subjected to a penal expertise following the emission of cheques without provision. During the examination, he pretended being both a doctor and a lawyer at the same time. He was in charge, among other things, of sale contracts dealing sometimes with high value transactions, obviously without following the required legal procedure. He was pursued subsequently for many other affairs of swindle. Data collected from his medical file indicated that he was the only boy of his family. Since his father had suffered from psychotic episodes, his grandfather had reared him; which he did it in a strictly religious way. He spent his childhood isolated. He was 15 years old when his grandfather died. He had then expressed religious and megalomaniac ideas that had motivated psychiatric management. Later on, he expressed imaginative ideas evoking unsystematized delusion (he pretended to have made a trip to America and to have seen a fish flying and turning into a woman). DISCUSSION: From a psychodynamic point of view, constitutional mythomania is considered as a borderline personality. It reflects an important narcissisic cleavage. The deceitfulness of the mythomaniac allows him to keep in touch with reality and to avoid mental disintegration. The recognition, by others, of these delusions allows the mythomaniac to have access to his proper level of existence. For a while, to the experts our patient appeared to be suffering from schizophrenia. Therefore, we can apply the Maleval theory to him, which identifies four periods as delusion structuring levels in psychosis : P0 (consequence of the phallic signification deficiency, it includes anxiety, annihilation, perplexity, interrogative attitude), P1 (stage of paranoid delusion), P2 (stage of paranoiac delusion) and P3 (ambitious stage evoking paraphrenia and squaring with mythomaniac behaviour). According to the Maleval theory, our patient would have experimented a repetitive cycle: he tried to escape instable and anxious positions (P0, P1) by committing sacrificial acting out (offence), or by reaching stable positions which are P2 and P3. The mythomaniac behaviour would appear during the latest period. The delusional decompensation would indicate a return to the first two periods. On the other hand, the personal myth might be seen as the result of the failure of the assimilation of actual experiences. Several psychoanalysts consider the use of myths by some psychotics as an attempt to reduce their ego disintegration. The mythomaniac may create his own myth in order to reduce the psychotic anxiety. The personal myth does not represent the pain of the patient but his remedy against his disorders. Therefore, identifying a personal myth may help the psychotic to turn his delusion into supportable logic of life. Myth may also be used in less deep pathologies such as borderline context, where it dominates the clinical picture. CONCLUSION: On the forensic level, we could a priori postulate that the mythomaniac sufficiently perceives reality to be considered as lucid. In fact, he hardly masters the totality of his intentions, being guided by an irrepressible mechanism that makes mythomania a "serious" and handicapping illness; its prima victim being the patient him/herself. No measures could actually prevent the latter from infringing the law, except, perhaps, a permanent administrative control; but this would not be without practical and ethical problems.

[Evaluation of the knowledge concerning women's sexuality in Tunisia]. / Évaluation des connaissances relatives à la sexualité de la femme en Tunisie.

OBJECTIVES: Our objectives were to evaluate the theoretical knowledge about women's sexuality in a Tunisian population and to compare it according to the participant's gender. PATIENTS AND METHODS: Our study consisted in investigating 55 men and as many women. Those surveyed had answered an anonymous autoquestionnaire comprising items related to woman's body anatomy, foreplay, women's attitudes during sexual intercourse, female orgasm and contraception. RESULTS: Fifty percent of the participants did not manage to reach the level of 50% of proper answers. Men had answered more incorrectly than had women (P<0.001). They had more erroneous answers than women concerning the importance of the knowledge of female anatomy and of the foreplay for the sexual satisfaction in women (P<0.001). Eighty percent thought that the simultaneity of the orgasm was obligatory for the sexual satisfaction of the couple. DISCUSSION AND CONCLUSION: Men had more erroneous answers than women, concerning the importance of the knowledge of the female anatomy, by both partners, for the sexual satisfaction of the woman. A good knowledge of the women body and of the importance of foreplays allows one to be conscious of the erotegenic zones and of knowing all the resources, which lead to physical pleasure. Awareness's campaigns contribute to fight against deficiencies surrounding women's sexuality, which would favor the opening out of the woman and the family.

[Reticence towards electroconvulsive therapy: a study of 120 caregivers in a teaching hospital in Tunisia]. / De la réticence face à l'électroconvulsivothérapie : enquête auprès de 120 personnels soignants dans un centre hospitalo-universitaire en Tunisie.

INTRODUCTION: Electroconvulsive therapy (ECT) is rarely practiced in Tunisia. We have tried to explain this lack of use by studying theoretical knowledge, the perception and the attitudes of health professionals towards ECT. METHODS: We conducted a survey in the region of Sfax in Tunisia. It included 120 participants. The latter were divided into four groups, composed of 30 members, in order to compare them: group 1 (psychiatrists); group 2 (neurologists and anaesthetists); group 3 (psychiatric nurses); group 4 (paramedics in the neurological and anaesthesia wards). The surveyed people answered an auto-questionnaire including essentially 16 items: 11 had binary answers (true or false) related to theoretical knowledge about ECT, and five others explored the perception and attitudes concerning this therapy. RESULTS: Concerning the items exploring theoretical knowledge, 67.5% of people were not able to answer, in conformity with the consensual scientific data, a minimum of 75% questions. The rates were significantly lower among the paramedics (P<0.001) and those who work outside the psychiatric wards (P=0.003). The answers of psychiatric caregivers were less frequently incorrect compared to those of non psychiatric ward workers. The latter more frequently thought that the psychiatrists easily resorted to ECT (P=0.003). The paramedics perceived, more frequently than doctors, the ECT as a violent therapeutic means (P=0.001), and more frequently refused to give their consent to apply ECT to a relative (P=0.044). The rate of doctors who refused to give their consent to apply ECT to a relative was statistically higher in group 2 than in group 1 (P=0.017). Doctors with higher scores in theoretical knowledge, consent more frequently to apply ECT to a member of their families (P=0.001). DISCUSSION: The comparison of theoretical knowledge between the two groups of doctors (group 1 versus group 2) revealed significantly more frequent incorrect answers among non-psychiatrists. The latter more frequently had erroneous ideas: that ECT was performed without anaesthesia; that it wasn't possible to apply it to pregnant women, nor to people suffering from Parkinson's disease, nor as a preventive treatment of recurrence, and that the vital risk was higher with ECT than medical treatments. Compared to the caregivers of group 3, group 4 had significantly more frequent negative attitudes toward ECT; concerning the application without anaesthesia, the lack of tolerance and the over-mortality rate related to ECT. This therapy seems to create an apprehension and a reticence among health professionals, mainly the paramedics and the non-psychiatrists. The lack of valid scientific knowledge concerning ECT allows prejudiced ideas to tarnish the image of this therapy. CONCLUSION: Information and training would play a primordial role in the improvement of the perception and attitudes concerning ECT, and lower the reticence towards this therapy, which in spite of its proven efficacy, always maintains a pejorative image.

[Evaluation of affective temperaments in the postpartum depressive symptomatology]. / Evaluation des tempéraments affectifs dans la symptomatologie dépressive du post-partum.

INTRODUCTION: Postpartum depression (PPD) is a frequent psychiatric condition, but little is known about its potential bipolar nature and the implication of affective temperaments. The goal of this study is to estimate the prevalence of PPD and assess the affective temperamental profile of those affected. METHOD: The study was conducted in the department of gynecology and obstetrics of the CHU of Sfax, Tunisia. The selected population included all 213 consecutive admissions (mean age=29 years). Postpartum depressive symptomatology (SPPD) was assessed during the first week after delivery by using the Postnatal Edinburgh Scale Depression (EPDS) in its Arab version. The Arabic version of the Temperaments Auto-questionnaire of Memphis, Pisa, Paris, and San Diego (TEMPS-A) was simultaneously filled out by subjects. The subjects were divided into two subgroups, depressed (D+) versus not depressed (D-), for comparative analyses. For affective temperaments, dimensional (mean scores) and categorical (quartiles) approaches were used. RESULTS: Forty-one women (19,2%) had a score higher than 9 on the EPDS (group D+). Lower educational level, lower social and family support, dysfunctional marital relationship, problems with accepting the pregnancy and prior psychiatric disorders were significantly more present in the D+ group. The majority of the affective temperaments, excepting hyperthymic, were correlated between them. The EPDS scores were correlated with all temperamental scores, except for hyperthymic. Higher scores on the depressive, irritable, anxious and cyclothymic temperaments were observed in the group D+. Women belonging to the 3rd and 4th quartiles of the depressive, cyclothymic and irritable temperaments and those belonging to the 4th quartile of the anxious temperament were significantly more depressed. Cyclothymic and depressive temperaments seemed to influence the pregnancy acceptance. Other interactions were observed between SPPD, temperamental profiles and quality of marital relation, and family support. The opposite seems true for the hyperthymic temperament, which could be protective against SPPD through better psychosocial conditions. Multivariate regression analysis showed that cyclothymic and anxious temperaments are significant risk factors independently from psychosocial factors, such as problems with accepting the pregnancy, which seemed to be the most important risk factor. CONCLUSION: PPD represents a frequent disorder, which needs to be correctly screened and recognized especially with its temperamental attributes, a mixture of anxious, irritable, depressive and cyclothymic traits. This complex unstable temperament should be considered as a predisposing factor, which interacts also with other common risk factors.

[Cervical spondylodiskitis revealed by retropharyngeal abscess]. / Spondylodiscite cervicale révélée par un abcès rétropharyngé.

INTRODUCTION: Spondylodiskitis is rare in the cervical vertebrae. We report a case of cervical spondylodiskitis revealed by a retropharyngeal abscess caused by a pyogen agent. The aim of our work was to shed light on the diagnosis and therapeutic difficulties of spondylodiskitis associated with a retropharyngeal abscess. CASE REPORT: A 70-year-old patient was admitted to the emergency department for a progressive laryngeal dyspnoea of 3 months duration. Clinical examination showed severe dyspnoea. Oropharynx and pulmonary exams were unremarkable. Failure of medical treatment led to the performance of an emergency tracheotomy after which the patient developed a flaccid quadriparesis. Medullar MRI revealed a spondylodiskitis with medullary compression and a retropharyngeal abscess. Surgical biopsy concluded to a pyogen osteitis. Treatment in the form of antibiotics and cervical immobilisation was instituted. Evolution was marked with septicaemia, multiple organ failure and ionic disturbance leading to death. COMMENTS: Cervical spondylodiskitis is rare. Its revelation by retropharyngeal abscess is also rare. MRI is the tool of choice for diagnosing discovertebral infections and its prevertebral extensions. Treatment is medical and surgical.

[Study of the prevalence of postpartum depression among 213 Tunisian parturients]. / Etude de la prévalence de la dépression du post-partum auprès de 213 parturientes tunisiennes.

OBJECTIVE: The objective of our study was to estimate the prevalence of the depression in postpartum in a population of Tunisian parturients. PATIENTS AND METHODS: Prospective study, in two stages: first week then between sixth and tenth week of the postpartum. The study was done at CHU Hédi Chaker in Sfax, Tunisia. For tracking postpartum depression, we used the Arab version of Edinburgh Postnatal Scale Depression (EPDS). An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. RESULTS: In T(1), 213 women were examined. In T(2), 136 were reexamined (63, 8% of the initial population). In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postpartum depression was 13, 2%. DISCUSSION AND CONCLUSION: The postpartum depressions are frequent among Tunisian parturients. The difference in the rates of prevalence between the two stages of evaluation was noted in other studies. This leads us to think that the relatively high rate in the first stage would be contaminated by an intense postpartum blues. However, a high rate persists at the sixth to tenth week, indicating the importance of tracking postpartum depression. This became possible by using EPDS, available in an Arab version and which should be generalized for the new mothers. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the mother-newborn relationship and, later, for the psychological equilibrium of the child.