Sociodemographic and clinical profile of attempted suicide patients

Introduction

Suicide attempts are common and constitute a serious problem for public health.Thus, it is very important to evaluate risk factors for suicidal behavior.

Objectives

The purpose of this study was to explore the socio-demographic and clinical profile of attempted suicide patients consulting in the psychiatry department in Gabes (southern of Tunisia).

Methods

It was a retrospective descriptive and analytical study covering all patients who had attempted suicide during the period from the 1st of May, 2009 to September 25th, 2020 and who were referred to the psychiatry department in the regional hospital of Gabes. Sociodemographic and clinical data of the patients as well as characteristics of the suicide attemptswere assessed.

Results

Socio-demographic profile of the suicidal consultant in psychiatry department corresponded to a single (73.4%) female (78.8%), with a mean age of 26 years, from an urban area (46%). Suicide attempts were most often by the intentional drug ingestion (67.8%), committed between March and August in 54% of cases. At most of the time, the suicidal person was alone (85%) at home (94%) when he committed his suicidal attempt. He did not communicate his intention to commit suicide in 46% of the cases and only 22 cases (7.9%) notified a person before the suicide attempt and 12.6% afterwards. Suicide behavior was impulsive in 79.5% of the cases and a verbal expression of a desire to die was only noted in 24.5% of cases.

Conclusions

Our results suggest a systematic and specific psychiatric evaluation of any patient who attempts suicide.

Conflict of interest

No significant relationships.

Socio-demographic and clinical features of patients with dementia attended in the psychiatry department

Introduction

Dementia’s prevalence increases due to population aging, it has become a major public health concern.

Objectives

To estimate the incidence of dementia and to describe the socio-demographic and clinical profile of patients attended in the psychiatry department of Gabes (Southern of Tunisia).

Methods

It was a retrospective descriptive study including all the patients who attended for the first time in the psychiatry department of Gabes, from the 1st January, 2010 to December 31, 2018, and who were diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Socio-demographic and clinical data were assessed. The Mini Mental State Examination (MMSE) was used as a neuropsychological examination.

Results

We included 98 patients. The mean annual hospital incidence of dementia was 2.38%. The mean age was 76.5 ± 9.8 years. Patients were married (68%), illiterate (68%) and jobless (42.9%). A family history of dementia was noted in 39.8% of patients. The common cardiovascular comorbidity was high blood pressure (41.8%). Among our patients, 30 (30.6%) were smokers. The mean age of onset of dementia was 73 ± 11 years. The mean duration of untreated dementia was 3 years [3 months to 11 years]. First symptoms were mainly memory disorders (57.3 %) and behavioral disorders (17.3%) The mean MMSE score was 14 ± 4.8. Alzheimer’s disease was the most frequent etiology of dementia (80 cases, 82.7%).

Conclusions

Our study shows a high incidence of dementia and made it possible to draw up a socio-demographic and clinical profile of dementia patients.

Disclosure

No significant relationships.

Vaginismus: Sociodemographic profile and cultural aspects

Introduction

Vaginismus is the most common reason for unconsummated marriages in Tunisia.

Objectives

To describe the socio-demographic profile and to explore the clinical and cultural aspects of sexual functioning of women with vaginismus.

Methods

It was a cross-sectional study established over a period of 3 months from the November 1st, 2019 to January 31st, 2020. This study focused on a population of women with vaginismus recruited from outpatient consultations of the hospital’s gynecology and psychiatry departments at the regional hospital of Gabes. We used a pre-established sheet exploring socio-demographic data, medical and gyneco-obstetric history and informations concerning the partner, the marital relationship and the woman’s sexual activity.

Results

35 women were included. They had a mean age of 30 years, jobless (54.5%) and with a secondary or university education (91.1%). The mean duration of marriage was 2.4 years. Partner had mean age of 36 and suffering from sexual dysfunction (21.3%). Among women, 12.5% had been sexually abused, 51.6% had suffered “Tasfih”, 70% had attended discussions about painful defloration. Vaginismus was primary in 85.7% and total in 50% of the cases. About the received thoughts of the women, 40% thought that vaginismus requires medical treatment, 13 of them (40%) thought that the disorder could be resolved spontaneously and 20% believed in a story of witchcraft. 85% consulted a physician and 24.2% a traditional therapist.

Conclusions

Vaginismus seems to be influenced by psychological and sociocultural factors so that a good psychoeducation of brides could reduce the incidence of this sexual disorder.

Conflict of interest

No significant relationships.

Warning signs of suicide attempts and risk of suicidal recurrence

Introduction

Detecting warning signs of suicide attempts is a particular difficult task. However, people who plan to commit suicide almost always announce it to someone in some way.

Objectives

Aims of this study were to describe signs preceding the suicide attempt in a group of suicidal persons and its links with suicidal recurrence.

Methods

It was a retrospective study that included all the patients who attempted suicide during the period from May 1st, 2009 to September 25th, 2020 and who were referred to the psychiatry department of the regional hospital of Gabes. Sociodemographic and clinical data as well as suicidal attempts characteristics were assessed.

Results

278 patients were included (female=78.1%), with mean age of 26. The common suicidal attempt method was intentional drug intoxication (67.8%). At least, one clinical manifestation was reported by 75.2% of suicide patients. The most common signs were the tendency to isolation (47.1%), a change in character or behavior (46.6%), thoughts of death (29.6%), anxiety or agitation (24.8%) and recent worsening of the pre-existing psychiatric symptoms (24.3%). Suicidal recurrence affected 24.8% of patients. It was correlated to the presence of a mental disorder (p<10-3), the presence of reflections on death (p=0.02), the onset of a state of anxiety or agitation (p<10-3), recent worsening of pre-existing psychiatric symptoms (p = 0.001) and verbal expression of suicidal thoughts (p<10-3).

Conclusions

The pre-suicidal syndrome is frequently heralded by changes in the patient’s character or behavior. Some suicidal warning signs are associated with the risk of suicidal recurrence.

Conflict of interest

No significant relationships.

Covid19 pandemic impacts on mental health of tunisian health care workers

Introduction

Covid19 pandemic in Tunisia has disturbed the health system. Health care workers, who were in the frontline to face this disease, had experienced reactions of anxiety, depression and distress.

Objectives

To assess the level of anxiety and depression among health care workers of regional hospital of Gabes (south of Tunisia) and its associated factors.

Methods

We conducted a cross-sectional study, from April 19, 2020, to May 5, 2020 on healthcare workers in Gabes regional Hospital. All hospital departments and units were included. We used a self-administered anonymous questionnaire containing sociodemographic and clinical data. Hospital Anxiety and Depression Scale (HAD) validated in the Tunisian dialectal version was used to assess anxiety and depression.

Results

Among the 289 responding participants, 100 (34.6%) were frontline health care workers directly engaged in managing patients with coronavirus disease. Our study revealed that 43.6% of health care workers were suffering from anxiety and 44.3 % from depression. There was a significant association between anxiety and female gender (p<0.001), being married (p=0.006), mental health conditions (p<0.001) especially anxiety disorders (p<0.001) and depressive disorders (p=0.03), personal medical history of dysthyroidism (p=0.013) and smoking (p=0.005). Nurses experienced more likely anxiety symptoms than other occupation (p=0.021). There was significant relationship between depression and female gender (p<0.001), married status (p=0.02), age under 50 (p=0.032) and mental health conditions (p<0.001) such as anxiety disorders (p=0.001) and depressive disorders (p=0.013).

Conclusions

It is crucial to provide care for health care workers with mental health problems during their struggle with covid19.

Sleep disorders among health care workers practicing in emergency department in south tunisia

Introduction

Sleep disorders are the most common health problem among the health care staff, mainly those who perform night shifts.

Objectives

To assess the prevalence of sleep disorders among health care workers in emergency department and to determine its associated factors.

Methods

It was a cross-sectional study, including health care workers assigned to emergency ward and intensive care unit of Hedi Chaker and Habib Bourguiba hospitals in Sfax and regional hospital of Kebili, during the first six months of 2017. We used an anonymous and confidential self-administered questionnaire. We used hospital anxiety and depression scale (HAD) to assess anxiety and depression. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and day time sleepiness by the Epworth Sleepiness Scale.

Results

240 nurses were included. Mean age was 37 years-old, 59.2% were female and 64.2% were married and 79.2% assured night shifts. The prevalence of sleep disorders was 70.4%. Sleep difficulties were significantly correlated with anxiety (p=0.001) and depression (p=0.02). In multivariate study, sleep disorders were related to the absence of leisure activity (OR=0.42 [0.19-0.94]; p=0.035) and anxiety (OR=3 [1.4-6.1]; p=0.002). 40.8% of nurses experienced drowsiness. Sleepiness was significantly correlated with the absence of leisure activities (p=0.04) and with psychiatric family history (p=0.02). In the multivariate study, sleep disorders were correlated with female gender (OR=0.43 [0.19-0.9]; p=0.042) and with no leisure activity (OR=2.6 [1.2-5.6]; p=0.01).

Conclusions

Sleep disorders were common among emergency nurses, in order of that; working conditions should be improved to provide less stressful conditions for nurses.

Conflict of interest

No significant relationships.

Standardized risk management in catheterization procedures for non-ST-segment elevation myocardial infarction: associations with in-hospital clinical outcomes

Introduction and purpose

Patient risk in non-ST-segment elevation myocardial infarction (NSTEMI) depends on clinical setting, individual patient variables and procedural characteristics. Standardized risk-adjusted periprocedural management for catheterization procedures using a Standard Operating Procedure (SOP) was investigated to evaluate associations with in-hospital clinical outcomes.

Methods

In 01/2018, our heart center established an SOP for coronary catheterization procedures in NSTEMI, targeting 1) standardized pre-procedural risk assessment using National Cardiovascular Data Registry (NCDR) risk models, and 2) standardized post-procedural risk-adjusted safety measures, including advanced patient monitoring (intermediate/intensive care) and use of vascular closure devices. All patients presenting with invasively-managed NSTEMI in 2018 were retrospectively evaluated for SOP-based pre-procedural risk scoring, SOP-based post-procedural management and in-hospital clinical outcomes of mortality, major bleeding (MB, according to BARC ≥3) and acute kidney injury (AKI, according to KDIGO).

Results

A total of 430 patients (age 72±12 years, 71% male, BMI 27±5) presenting with NSTEMI from 01 to 12/2018 were included, 9.8% presented in cardiogenic shock and 4.7% had suffered a preclinical cardiac arrest. Overall in-hospital mortality was 3.7%, MB occurred in 6.5%. 207 patients (48.1%, SOP+ group) had received both 1) pre-procedural risk assessment and 2) post-procedural risk-adjusted safety measures; the other 223 patients (51.9%, SOP- group) had not received either 1) or 2). There were no significant differences in baseline characteristics and prior-existing medical conditions between groups, however, significantly more patients in SOP- group were treated in emergency settings (39.9% vs. 21.7%, p=0.004). However, significantly more patients in SOP- were treated in emergency settings at higher risk (39.9% (SOP-) vs. 21.7% (SOP+); p&lt;0.001). In univariate analysis, all in-hospital clinical outcomes of mortality (1.4% (SOP+) vs. 5.8% (SOP-); p=0.016), MB (2.9% (SOP+) vs. 9.9% (SOP-); p=0.003) and AKI were significantly lower in the SOP+ group (15.9% (SOP+) vs. 24.2% (SOP-); p=0.033). After correction for the difference in risk between groups due to emergency settings by multivariate logistic regression analysis, MB remained significantly lower in SOP+ (p=0.02), while mortality (p=0.14) and AKI (p=0.19) were not significantly associated with SOP-status anymore.

Conclusion

Standardized risk management in invasively managed NSTEMI was associated with significantly lower rates of in-hospital major bleedings.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Junior Clinician Scientist Track, Medical faculty, Heinrich-Heine-University Düsseldorf, Germany

Quantification of cell surface proteins with bispecific antibodies

Flow cytometry is an established method for fast and accurate quantitation of cellular protein levels and requires fluorescently labeled antibodies as well as calibration standards. A critical step for quantitation remains the production of suitable detection antibodies with a precisely defined ratio of antigen-binding sites to fluorophores. Problems often arise as a consequence of inefficient and unspecific labeling which can influence antibody properties. In addition, the number of incorporated fluorophores necessitates a special normalization step for quantitation. To address these problems, we constructed different mono- and bivalent bispecific antibodies with binding site(s) for the cell surface antigens, cMET, EGFR1/HER1, ErbB2/HER2 or ErbB3/HER3 and with an additional digoxigenin-binding single-chain Fv fusion. The fluorophore Cy5 was covalently coupled to digoxigenin and quantitatively bound by the bispecific antibody. A panel of tumor cell lines was assessed under different culture conditions for absolute receptor expression levels of the indicated antigens and the data were set in relation to mRNA, gene count and immunoblot data. We could reproducibly quantify these receptors, omit the otherwise required normalization step and demonstrate the superiority of a 1 + 1 bispecific antibody. The same antibodies were also used to quantify the number of proteins in intracellular vesicles in confocal microscopy. The antibodies can be stored like regular antibodies and can be coupled with different digoxigenin-labeled fluorophores which makes them excellent tools for FACS and imaging-based experiments.

Opioid-induced constipation in advanced illness: safety and efficacy of methylnaltrexone bromide

Constipation, one of the major side effects of opiates used in palliative care, can impair patients’ quality of life to a point where it prevents sufficient pain control. Methylnaltrexone is a novel μ-receptor antagonist, which does not pass the blood brain barrier. It is licensed to treat opiate induced constipation for patients with advanced diseases. This review article presents an overview of pharmacology and safety of its application, evidence of its efficacy and economic aspects of its use in clinical practice. Available data are limited but strongly suggest that methylnaltrexone causes laxation in less than 24 hours for at least half of those patients over the first two weeks of usage without impairing pain control or causing serious adverse effects. To avoid danger of gastrointestinal perforation it is contraindicated for patients at risk for that complication. More research is needed to evaluate its long-term efficacy and economic impact.