Doctoral theses at the medical faculty of Tunis from 2015 to 2017: Scientific publication rates and associated factors.

INTRODUCTION: Medical doctoral thesis publication is a way to ensure knowledge dissemination and to increase the scientific research visibility. AIM: To determine thesis-related publication's rate at the Faculty of Medicine of Tunis (FMT), and identify associated factors. METHODS: Cross-sectional retrospective study including medical theses registered at the FMT over the study period (2015-2017). All publications related to the defended thesis were collated by scanning Scopus and Google scholar databases, up to April 2022. Binary logistic regression was performed to assess associated factors to publication. Adjusted Odds Ratios (AOR) were presented with 95% confidence interval. RESULTS: Out of 878 defended theses, 11.8% (n=104) were published. Out of 130 publications in total, 90 (69.2%) interested Scopus-indexed journals with a mean Scimago Journal Rank (SJR) of 0.70. The publication was in English in 73.1% of cases. The median time between the thesis defense and the first scientific publication was 15 months. In multivariable analysis, associated factors to "at least one thesis-related publication" were the resident status of the candidate (AOR=2.35 [1.2-4.7]) and the grade assistant professor of the thesis supervisor (AOR=2.48 [1.1-5.6]). CONCLUSION: Compared to the number of defended theses, the thesis-related publication's rate at the FMT is relatively low. Thus, enhanced support for doctoral students to optimize their engagement in research and to consequently promote scientific publication is highly recommended.

Publication of pediatric theses defended at the Tunis Faculty of Medicine: A 15-year study.

INTRODUCTION: The valorisation of thesis through its publication is necessary to enhance its visibility. Few data exist concerning the characteristics of theses defended at the Tunis faculty of medicine. AIM: Examine the publication rate of pediatric theses and identify factors associated with an increased publication rate. METHODS: We conducted a cross-sectional descriptive bibliometric study of pediatric theses defended at the Faculty of Medicine of Tunis over 15 years, from 2006 to 2020. Theses were retrieved from the catalog of the faculty library. Publications had been searched in databases "Pub Med ", and "Google Scholar" until December2021. RESULTS: The study involved 235 pediatric theses. Sixty-eight theses were published, representing 29% of the total. The main topics of published theses were neonatology (16%) and hematology (15%). The language of publication was French and English in 55% and 45% of cases, respectively. All publications in Q1 and Q2 journals were written in English. The only independent factor predicting publication of theses was the very honourable mention with congratulations of the jury and proposal for the thesis prize (p=0,007). CONCLUSION: Additional assessments will be necessary to identify the obstacles to the publication of theses.

The diagnostic performance of micro-RNA and metabolites in lung cancer: A meta-analysis.

BACKGROUND: The diagnosis of lung cancer is based on the microscopic exam of tissue or liquid. During the recent decade, many biomarkers have been pointed to have a potential diagnostic role. These biomarkers may be assessed in blood, pleural effusion or sputum and they could avoid biopsies or other risky procedures. The authors aimed to assess the diagnostic performances of biomarkers focusing on micro-RNA and metabolites. METHODS: This meta-analysis was conducted under the PRISMA guidelines during a nine-year-period (2013-2022). the Meta-Disc software 5.4 (free version) was used. Q test and I2 statistics were carried out to explore the heterogeneity among studies. Meta-regression was performed in case of significant heterogeneity. Publication bias was assessed using the funnel plot test and the Egger's test (free version JASP). RESULTS: According to our inclusion criteria, 165 studies from 79 articles were included. The pooled SEN, SPE and dOR accounted, respectively, for 0.76, 0.79 and 13.927. The AUC was estimated to 0.859 suggesting a good diagnostic accuracy. The heterogeneity in the pooled SEN and SPE was statistically significant. The meta-regression analysis focusing on the technique used, the sample, the number of biomarkers, the biomarker subtype, the tumor stage and the ethnicity revealed the biomarker number (p = 0.009) and the tumor stage (p = 0.0241) as potential sources of heterogeneity. CONCLUSION: Even if this meta-analysis highlighted the potential diagnostic utility of biomarkers, more prospective studies should be performed, especially to assess the biomarkers' diagnostic potential in early-stage lung cancers.

Assessment of theory of mind in Tunisian verbal children with autism spectrum disorder.

The present study examined performance in Theory of Mind (ToM) in a group of 31 Arabic-speaking verbal children (7-12 years-old) with autism spectrum disorder (ASD), in comparison with neurotypical controls (NT) matched for age and for cognitive abilities. An innovative task in a digital format named "The Tunisian Social Situations Instrument" (TSSI) was used and allowed us to study four different subdomains of ToM: attribution of intention and epistemic ToM (cognitive ToM), affective ToM, and detection of faux pas (advanced ToM). Our study showed impairments in ToM in children with ASD, similar to those reported in the literature. Our findings additionally suggested that affective and advanced ToM, specifically the detection of faux pas, might be more challenging for ASD children than other components of ToM. Future studies with larger number of children may lead us to specify which subdomains are the most impaired in order to develop specific tools targeting these specific impairments.

Publication of preventive and community medicine theses: Faculty of medicine of Tunis from 2012 to 2017.

AIM: to describe the publication rates of the theses in preventive and community medicine supported at the medical university of Tunis from 2012 to 2017 and to determine factors affecting their publication in scientific journals. METHODS: descriptive and retrospective study on defended theses in preventive and community medicine listed in the library of the medical university of Tunis. We considered as published thesis, works published as an article or as a published abstract. A multivariate analysis was performed to study the determinants of thesis publication. RESULTS: The study concerned 84 preventive and community medicine theses. Thirty theses were published (35.7%), including 19 theses (63.3%) as research papers, in scientific journals. Almost two-thirds (67.8%) of publications were in French. The publications were mainly submitted (22/56) in two journals: « Revue d'Épidémiologie et de Santé Publique ¼ and « La Tunisie Médicale ¼. The student's name was mentioned in 63.4% of published works. The determinants of publication in multivariate analysis were the the status of the thesard (p=0.001), the degree of the supervisor (p=0.038), and the formulation of recommendations (p=0.005). CONCLUSION: The proportion of publications from preventive and community medicine theses was relatively modest. This is why we must encourage more doctoral students and supervisors to participate in educational seminars on article writing, in order to enrich scientific production by improving the writing quality of their theses.

Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition.

Autism spectrum disorder (ASD) is associated with neurocognitive impairment, including executive dysfunctioning and social cognition (SC) deficits. Cognitive remediation (CR) is a behavioral training-based intervention aiming to improve cognitive processes. Its first use in psychiatry interested patients with schizophrenia, in whom promising results have been shown. Integrated CR programs targeting both social and non-social cognition have demonstrated to be effective in improving both cognitive domains and functional outcomes. CR studies in children and adolescents with ASD are still new, those regarding CR approaches combining social and executive functioning remediation are scares. One study examining the efficacy of cognitive enhancement therapy (CET) for improving cognitive abilities in ADS adults, showed significant differential increases in neurocognitive function and large social-cognitive improvements. Therefore, taking into account the overlap between ASD and schizophrenia, and considering the close link between executive functions (EF) and SC, we suggest that integrative approach in ASD could result in better outcomes. The present perspective aimed to highlight cognitive remediation (CR) programs contributions in ASD (especially in children and adolescents), and to discuss the value of combining social and non-social programs.

Diabetic patient satisfaction on the quality of outpatient health care services.

AIM: To assess the degree of satisfaction of diabetic patients with health care services and to determine the factors that influence it. METHODS: It was a cross sectional study conducted in 2018 among diabetic outpatients of the department of endocrinology of the university hospital La Rabta. Patients general characteristics were noted. Each patient responded to a questionnaire, asked orally, in Tunisian dialect, by two physicians, about health care services including 20 questions grouped into three items. Each question was scored from 1 to 4 according to the degree of satisfaction. The global score as well as the scores of the items were calculated by adding the scores of the corresponding questions. RESULTS: 150 diabetic patients responded to the questionnaire; mean age: 58.9±12.2 years [18-88], sex-ratio: 0.51. Cronbach coefficient was 0.78. The overall score was 62.2±6.5 [46-80]. Ninety-seven patients (64.7%) had a score ≥60. The item concerning 'human contact and communication' was considered good in 98% of cases. The item concerning 'premises, cleanliness, comfort and safety' was considered intermediate in 64% of cases. Patients were very satisfied with the accessibility of the department inside the hospital (76.7%), the attitude of the agents during the administrative formalities (74%) and particularly the behaviour of the doctor (96%). However, they were dissatisfied with the noise (72%) and overcrowding (67.4%) of the waiting room. There were no statistically significant associations between the overall score and the studied data. CONCLUSION: The diabetic patients were overall satisfied with the provided services. Actions must be taken to reduce overcrowding and long waiting times.

Ambulatory hernia repair: a study of 1294 patients in a single institution.

Introduction: ambulatory surgery is continuously expanding in global reach because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Methods: we conducted a monocentric retrospective cohort study on patients who had ambulatory groin hernia repair (GHR) and ventral hernia repair (VHR) in the general surgery department of the Habib Thameur Hospital in Tunis between January 1st, 2008 and December 31st, 2016. Clinicodemographic characteristics and outcomes were compared between the successful discharge and discharge failure groups. A p-value of ≤ 0.05 was considered significant. Results: we collected data from the record of 1294 patients. One thousand and twenty patients had groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3.0%) had unplanned admission (UA) and 7 patients (0.7%) had unplanned rehospitalization (UR). The morbidity rate was 2.4% while the mortality rate was 0%. On multivariate analysis, we did not identify any independent predictor of discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4.0%) had UA and 4 patients (1.5%) had UR. The morbidity rate was 3.6% and the mortality rate was zero. On multivariate analysis, we did not identify any variable predicting discharge failure. Conclusion: our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organizational advantages to healthcare structures.

Intermittent catheterisation: the common complications.

Intermittent catheterisation (IC) has been in practice for more than 40 years and is considered the gold standard in the management of urinary retention in the neurological bladder. IC has many advantages over indwelling urethral or suprapubic catheterisation, including reducing the risk of infection, protecting the bladder and improving quality of life. However, complications can be caused by the practice of this technique, the most common of which is infection. This review discusses some of the common complications that can occur with the use of intermittent catheterisation, including urinary tract infection (UTIs) and urethral complications. It also highlights the role of the nurse in the management of its complications.

Colorectal cancer mass screening, Tunisia 2019. Evaluation of a pilot program in the Tunis region (Tunisia, 2019).

INTRODUCTION: Colorectal cancer (CRC) is a real public health issue in Tunisia. A screening program based on fecal immunological occult blood test, followed in case of a positive test by colonoscopy, was launched in Tunis region in 2016. We aimed to evaluate this screening program in order to make recommendations for a better implementation of this program in years to come. METHODS: A mixed approach has been adopted with a quantitative component based on the production of indicators related to activity, monitoring and screening quality; and a qualitative component conducted through focus groups with frontline health care professionals (HCP) and individual interviews with those lost to follow-up after a positive screening test. SWOT analysis was then performed in order to assess main strengths, weaknesses, opportunities and threats of the program. RESULTS: This study showed a coverage rate of 41.2% [40.5-41.8] for population consulting the first line of care, and an effective participation rate estimated at 23.1% [22.6-23.6]. Out of 5856 tests performed, 6% (n=352) were non-treatable and 6.7 % (n=390) were positive. Only 18.6% (n=72) of those tested positive had undergone colonoscopy. A total of 26 polyps, 03 cases of cancer and 04 cases of dysplasia were recorded. SWOT analysis pointed out that the variable adherence of HCP, lack of awareness of general population regarding CRC screening, the non-acceptability of colonoscopy without sedation with a problem of affordability for its realization in the private sector, and long appointments delays in public sector, were main weaknesses and of this program. CONCLUSION: This evaluation underlined certain strengths regarding the program implementation and revealed, in return, several shortcomings which certainly impair the program's effectiveness and efficiency. The involvement of the national health insurance fund in CRC screening tests and colonoscopies reimbursement, as well as the establishment of a performance-based payment modality for HCP, constitute main key pillars to reach success and sustainability for any CCR mass screening program in Tunisia.

Attitudes towards plagiarism among academics of the faculty of Medicine of Tunis.

Assessing the extent of plagiarism within academics remains the first step in the fight against this behavior. The current study aimed to explore the attitudes of the Faculty of Medicine of Tunis (FMT)'s academics toward plagiarism. A cross-sectional study was conducted within the FMT during the 2018-2019 academic year. Data were collected using a questionnaire including the English version of the attitudes toward plagiarism questionnaire (ATPQ) which is composed of 29 statements divided into three attitudinal factors: positive, negative attitudes and subjective norms toward plagiarism. A total of 340 faculty members responded to the survey. The mean scores for both positive attitudes (28.8 ± 6.9) and subjective norms (24.6 ± 4.9) were between low to moderate and that of negative attitudes was moderate (22.4 ± 2.6). In multivariate analysis, participants with higher academic rank, those who had a good level of English or who attended English courses and those who attended workshops in scientific writing were less tolerant toward plagiarism. The implementation of courses on research practices as well as the introduction of medical English courses in the FMT's post graduate program could constitute relevant approaches to limit the extent of plagiarism.

Effectiveness of ECG educational workshops among undergraduate medical students.

BACKGROUND: The electrocardiogram (ECG) remains one of the most important and commonly used diagnostic tools in medicine. At the faculty of Medicine of Tunis (FMT), teaching ECG interpretation to undergraduate medical students is an important part of the curriculum. AIMS: To assess the effectiveness of pedagogical workshops in ECG learning among students of First-year of the primary cycle of medical studies (PCMS 1). In addition, we aimed to assess the students' perceptions of the tutorials. METHODS: It was an exhaustive cross-sectional study that was carried out at the FMT during the academic year 2017-2018 and that included students from PCMS 1. All participants completed a pre-test, a workshop session and a post-test. Each of the tests consists of five Multiple Choice Questions (MCQs) covering the same topics. An evaluation of students' satisfaction with the tutorial was made at the end of the session. RESULTS: Ten workshops were held at the FMT, including 160 students. The overall score increased from 4 out of 10 points in the pre-test to 6.8 out of 10 points in the post-test (p <0.001). A statistically significant improvement was noted in all tests questions (p<0.001). Sixty-one learners (39.3%) were "Not satisfied" with the number of students per group. On the whole, 83.8% (n=130) of students found the session beneficial. CONCLUSIONS: Students indicated a positive attitude toward the workshop and its utility. More research among similar populations is needed to support these conclusions and to assess the effectiveness of medium- and long-term educational workshops on medical students.

Cognitive remediation therapy in autism spectrum disorder: Tunisian experience.

BACKGROUND: Cognitive dysfunctions associated with Autism spectrum disorder (ASD) are nowadays highlighted. These cognitive impairments include mainly executive dysfunctioning and are linked with academic difficulties, thus representing one of the treatment targets. Cognitive remediation therapy (CRT) is a new promising program aiming to remediate cognitive impairments by targeting executive functions. It attempts to teach information processing strategies through guided mental exercises. AIM: To assess the effectiveness of the cognitive remediation program CRT (Cognitive Remediation Therapy) on executive abilities and school results, in children and adolescents with ASD. METHODS: Cross-sectional study involving children and adolescents with ASD according to DSM-5. The CRT program was conducted individually at the rate of one session per week of 45 minutes each.  Outcome measures were intellectual abilities, cognitive flexibility, working memory and school performance. RESULTS: Of the 25/24 patients included, 16 had reached the end of the program. Their average age was 10.87 years. The mean number of sessions performed was 22.38. After completion of CRT, patients showed significant improvement on intellectual abilities (p<10-3), phonemic fluency (p=0.032), « animal ¼ category of semantic fluency (p=0.045), working memory (p=0.001 for forward digit-span and p=0.006 for backward digit span) and school results (p=0.001). Patients made more repetitive and intrusive errors in semantic fluency with significant increase in the "clothes" semantic category (p=0.019). CONCLUSION: Cognitive remediation enhances cognition directly and positively acts on clinical course. It appears to be a relevant new method in the management of ASD. Yet, further research is required in order to confirm the efficiency of this treatment and to better define its optimal settings.

Predictive value of shock index ≥ 1 in severe trauma patients in emergency department.

BACKGROUND: the shock index (SI) defined by the ratio of systolic blood pressure to heart rate was demonstrated as a simple tool in the triage and orientation of severe trauma patients to trauma centers. AIM: To assess the prognostic value of the SI ≥ 1 in terms of mortality in severe trauma patients admitted to the emergency room. METHODS: We performed a prospective, observational and descriptive study with the inclusion of severe trauma patients over the age of 18 years admitted to the Vital Emergency Room over a 21-month period. SI was calculated at admission: SI = heart rate / systolic blood pressure, a SI threshold value ≥1 was fixed to define two groups: SI<1 and SI≥1. RESULTS: A total of 290 trauma patients were included, 231 (79%) had a SI<1, whereas 59 (21%) had an SI≥1. Mean age was 43.5 ± 18 years, 82% were male. There was a significant difference in hospital mortality at 7 days and at 30 days between the two groups respectively (group SI<1 vs group SI≥1): [12% vs 40%; p <0.001 and 15% vs 47%; p <0.001]. In multivariate analysis, SI≥1 appears as an independent factor of hospital mortality at 7 days [OR = 2.03; 95% CI = 1.3-3.3; p =0.001] and at 30 days [OR = 2.69; 95% CI = 1.4- 5; p =0.002]. CONCLUSION: In severe trauma patients admitted to the emergency department; a SI ≥1 represents a predictive factor of hospital mortality at 7 days and one month.

Nail Involvement in Psoriatic Patients and Association with Onychomycosis: Results from a Cross-Sectional Study Performed in a Military Hospital in Tunisia.

Nail psoriasis has variable prevalence and heterogeneous aspects. Many of them could mimic onychomycosis (OM). It has been suggested that patients with nail psoriasis are at high risk of OM. The aim of our study was to determine the epidemiological and clinical characteristics of nail psoriasis and to estimate the frequency and the factors associated with OM in psoriatic patients. The studied group included 163 patients with psoriasis aged 18 years or older. Epidemiological and clinical data, as well as the severity of skin and nails disease by evaluating the Psoriasis Area Severity Index (PASI) and Nail Area Psoriasis Severity Index (NAPSI) scores were specified. Mycological testing was performed for patients with nail alterations. Nail involvement was found in 71.2% of patients. The most common nail alterations were subungual hyperkeratosis and onycholysis. The mean NAPSI score was 11.6. Mycological testing was performed in 104 patients with onychodystrophy. OM was diagnosed in 53% of the cases. Dermatophytes were the most isolated pathogens. OM was associated with male gender, but not with age, NAPSI, or PASI score. Psoriasis is one of the dermatoses that most commonly affect the nail. Available data about the association between nail psoriasis and OM are controversial. However, mycological testing should be routinely performed on psoriatic nails.

Pathways to mental health care for patients with severe mental illness in Tunisia.

INTRODUCTION: Schizophrenia, bipolar disorder and schizoaffective disorders are severe mental illnesses (SMI) associated with high levels of co-morbid psychopathology and premature mortality. Reducing delays in accessing services and providing early intervention are key strategies in preventing morbidity and mortality associated with these diseases. The pathways to psychiatric care have been studied in many countries worldwide. To the best of our knowledge, no study on this subject has so far been conducted in Tunisia. The purpose of the present study was to understand the pathways of care adopted by patients, to determine the care delay and to explore the relationship between delayed consultation and socio-demographic and clinical variables. METHODS: This is a cross-sectional descriptive study conducted at the Department Psychiatry A of Razi Hospital including patients with SMI consulting the outpatient clinic between January and March 2018. Data was collected by one medical investigator who conducted face-to-face interviews with patients using a questionnaire based on the World Health Organization's "Pathway Questionnaire". Data analysis was done using the SPSS software version 17. A multivariate analysis was performed to study the relation between delayed consultation and socio-demographic and clinical variables. RESULTS: A total of 232 patients responded to the questionnaire. The average age was 41.3 years ± 10.1 and the gender ratio was 1.2. More than the third of the study population consulted a traditional healer in the first place and sixty percent of the patients had recourse to a medical doctor. The average consultation delay was 15 months (±23.0) with a median of 6 months. The delay was more than 6 months in around half of the cases. The symptoms that motivated the first consultation were hallucinations, sleep disorders and aggressive behavior. The main reason of delayed consultation was lack of knowledge about psychiatric symptoms followed by illness beliefs and insidious onset of the illness. The multivariate analysis showed a significant relationship between aggressive behavior and non-delayed consultation. CONCLUSION: The principal recommendations are to strengthen public education and awareness about SMI in the Tunisian population and to implement an early detection program of these disorders.

Parecoxib in laparoscopic surgery for simple vesicular lithiasis.

AIM: To evaluate the contribution of parecoxib to the protocol of multimodal analgesia for simple vesicular lithiasis by laparoscopy. METHODS: A prospective, randomized, double-blind study was carried out at Habib Thameur Hospital (Tunis). We included 60 patients, ASA I or II, scheduled for cholecystectomy by laparoscopy. The patients were randomized to 2 groups. The parecoxib group (PG) receiving parecoxib 40 mg 30 minutes before the induction and the control group (CG) receiving physiological saline. Data were collected during hospitalization and a follow-up was done one year after the operation by a questionnaire. RESULTS: The pain scores at rest and at cough were significantly lower in the PG than in the CG during the first postoperative day (p < 10-3). Ten percent of the patients of the CG and no patient of the GP required Morphine in the recovery room (p = 0,07). The requirement of Tramadol was significantly less frequent in the PG (70 % of the PG, 16,6 % of the CG and p < 10-3). A chronic pain was found in 37,5 % and 8 %, respectively, in the GC and GP (p = 0,013). This pain was intense in 2 GC patients requiring analgesics and a work stoppage. CONCLUSIONS: The results of our study are in favor of the use of Parecoxib 40 mg 30 minutes before laparoscopic cholecystectomy for its effects on acute pain, opioid sparing and chronic pain.

Are our stethoscopes contaminated ?

BACKGROUND: Health care-associated infections are a real public health problem. Contaminated medical equipments such as stethoscopes are often an overlooked vector. In our study, we were interested in proving our doctors stethoscopes contamination and in studying the microbiological profile of isolated germs. METHODS: This was about a cross-sectional study that lasted 2 months (May and June 2014) including 39 personal stethoscopes of all grade doctors working in 8 different departments in Habib Thameur Hospital. The swabs were taken from the membranes of the stethoscopes and sent quickly to our bacteriology service. Then, the bacteriological samples were subcultivated on blood agar. The reading tooks place 24 hours later. Were considered positive the cultures that contained more than 104 colony forming units/ml. Then we proceeded to the identification of the germ. RESULTS: Fifteen samples from 39 were positive that was 38 %. The coagulase- negative Staphylococcus was the predominant germ. The pathogenic germs were found in 5 positive samples that was 12 % from all the samples. They were distributed as follows: 2 Methicillin-susceptible Staphylococci Aureus, 2 methicillin-resistant coagulase- negative Staphylococci and one Pseudomonas aerogenusa. The pathogenic germs were found in stethoscopes taken from cardiology and intensive care unit (ICU). In cardiology, 7/9 stethoscopes were positive (5 coagulase- negative Staphylococcus among them 2 resistant methicillin and 2 Staphylococcus aureus.) In ICU, 6/13 stethoscopes were positive among them one Pseudomonas aerogenusa. CONCLUSION: The stethoscopes constitute bacterial reservoirs. It is necessary to perform a procedure for the good practices of disinfection.

Bumetanide in the management of autism. Tunisian experience in Razi Hospital.

BACKGROUND: Autism is a multifactorial disease with multiple etiologic hypotheses. Some studies suggest changes in brain GABA mediated inhibition in autism, and a higher intracellular chlorine levels in autistic children. Given these data, clinical trials are conducted to test the efficacy of diuretics in improving clinical symptoms in autism. AIM: The aim of our study was to evaluate the effectiveness of Bumetanide in autistic children. METHODS: This is an experimental study of cross-type. We included children older than 5 years, with autistic disorder according to the diagnostic criteria of DSM- IV (Diagnostic and Statistical Manual of Mental Disorders, IV) and ADI-R (Autism Diagnostic Interview Revised), followed by the child psychiatry consultation Razi hospital. The subjects underwent assessment using the ADI-R, the behavioral scale CARS (Childhood autistic rating scale) and CGI (Clinical Global printing) prior to take diuretic (Bumetanide). In the protocol, the children received checks to day7, day14, day30, day60, day90 comprising: a clinical evaluation (weight gain, blood pressure, general examination for potential adverse effects); biological evaluation; and evaluations by scales (CARS and CGI) after every 3 months of evolution to objectively assess effectiveness. RESULTS: Twenty-nine children were included in our study. The average age was 7.9 years.Initiation of medication was carried out with a dose of    1 mg / day, in all children. The average duration of the protocol was 12 months. Sixteen children were excluded from the study for the following reasons: appearance of hypokalemia, poor tolerance of treatment, insufficient efficacy as estimated by parents. Measuring the effectiveness of diuretic, by studying correlations in the CARS showed an efficacy of this treatment at 3 months (p˂10-3), 6 months (p˂10-3), at 9 months (p = 0.010) and 12 months (p = 0.04), and this compared to the initial assessment. Significant improvement (p˂10-3) was found between the 3rd and 6th month. CONCLUSION: While our results seem to be promising. A larger sample and a medium and long-term evaluation after the end of treatment are needed.