The application of the attitudes towards suicide questionnaire (ATTS) in Tunisian elderly

Introduction

According to WHO, suicide is a major public health problem and the most affected age group by suicide in Tunisia is that of over 70 years.

Aims

To study the perception of the Tunisian elderly of suicide.

Methods

A cross-sectional study was conducted during a 3-month period from October to December 2015. Fifty persons aged at least 65 years participated to the study. We used an anonymous questionnaire with a specific scale: “Attitudes Towards Suicide Questionnaire” (ATTS).

Results

The mean age of our patients was 67.5 years. Sex ratio was 1.27. Most of the participants were married (82%), unemployed (63.2%), with a secondary or high educational level (62%), and low income (73.5%). All participants were believers. As for religious practice, 74.5% of the recruited elderly made the fast and 73.5% were prayers. Among women, 70.8% wore the veil. Concerning the perception of suicide, it was on the dimension of “permissiveness” (M = 1.88) that our participants agreed less. Those who made prayers had lower scores of “permissiveness” (P = 0.032). Women who wore the veil had higher scores on the field of “incomprehensibility” than the unveiled ones (P = 0.047). Furthermore, 68% of our participants believed that suicide is stigmatizing.

Conclusions

It might be time to try to lift the taboo and stigma through information and sensitizing campaigns on suicide. In this direction, studies of perception help to identify, somehow, “automatic thoughts” regarding representations of suicide and to try to develop an “alternative thinking” in the general population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A nanofibrous electrospun patch to maintain human mesenchymal cell stemness

Mesenchymal stem cells (MSCs) have been extensively investigated in regenerative medicine because of their crucial role in tissue healing. For these properties, they are widely tested in clinical trials, usually injected in cell suspension or in combination with tridimensional scaffolds. However, scaffolds can largely affect the fates of MSCs, inducing a progressive loss of functionality overtime. The ideal scaffold must delay MSCs differentiation until paracrine signals from the host induce their change. Herein, we proposed a nanostructured electrospun gelatin patch as an appropriate environment where human MSCs (hMSCs) can adhere, proliferate, and maintain their stemness. This patch exhibited characteristics of a non-linear elastic material and withstood degradation up to 4 weeks. As compared to culture and expansion in 2D, hMSCs on the patch showed a similar degree of proliferation and better maintained their progenitor properties, as assessed by their superior differentiation capacity towards typical mesenchymal lineages (i.e. osteogenic and chondrogenic). Furthermore, immunohistochemical analysis and longitudinal non-invasive imaging of inflammatory response revealed no sign of foreign body reaction for 3 weeks. In summary, our results demonstrated that our biocompatible patch favored the maintenance of undifferentiated hMSCs for up to 21 days and is an ideal candidate for tridimensional delivery of hMSCs. The present work reports a nanostructured patch gelatin-based able to maintain in vitro hMSCs stemness features. Moreover, hMSCs were able to differentiate toward osteo- and chondrogenic lineages once induces by differentiative media, confirming the ability of this patch to support stem cells for a potential in vivo application. These attractive properties together with the low inflammatory response in vivo make this patch a promising platform in regenerative medicine.

H.E.S.S. Limits on Linelike Dark Matter Signatures in the 100 GeV to 2 TeV Energy Range Close to the Galactic Center

A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S.

RESULTS

No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.

Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26}  cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26}  cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.

In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss

BACKGROUND

Little information is available on the risk factors for graft loss in kidney transplant recipients with BK polyomavirus (BKPyV) nephropathy (BKVN) in the presence or absence of antibody-mediated rejection (AMR).

METHODS

We examined the risk factors for graft loss in consecutive kidney allograft recipients with biopsy-confirmed BKVN, with or without concomitant AMR.

RESULTS

A total of 1904 kidney transplants were performed at our institution during 2005-2011. Of these, 330 (17.33%) were diagnosed with BKPyV viremia, and 69 were diagnosed with BKVN (3.6%). Eleven patients had a concomitant diagnosis of AMR. Patients with AMR were characterized by significantly higher peak panel-reactive antibody, retransplant rates, and desensitization preconditioning at the time of transplantation, as well as microvascular inflammation (MVI = glomerulitis + peritubular capillaritis), C4d score, and donor-specific antibody at the time of diagnosis (P ≤ 0.01). Treatment with plasma exchange, intravenous immunoglobulin, and cidofovir was more prevalent in this group (P ≤ 0.02). Univariate analyses assessing the risk factors for graft loss in all patients with BKVN, identified an independent association of African-American race, deceased-donor transplantation, serum creatinine (Scr), MVI, and early disease (BKVN within 6 months of transplant) with poor outcomes. Multivariate analyses retained only 3 variables: Scr >2 mg/dL (hazard ratio [HR] = 4.3, 95% confidence interval [CI] 1.9-9.7, P = 0.0004), early BKVN (HR = 2.7, 95% CI 1.3-5.3, P = 0.004), and MVI (HR = 1.8, 95% CI 1.2-2.8, P = 0.008).

CONCLUSIONS

These observations suggest that, in patients with BK infection, early BKVN, Scr >2, and MVI are predictors of poor outcomes. Further studies are needed to determine effective treatment strategies for BKVN, with or without AMR.

Outpatient Management of Delayed Graft Function Is Associated With Reduced Length of Stay Without an Increase in Adverse Events

Delayed graft function (DGF) is a common and costly complication of kidney transplantation. In July 2011, we established a multidisciplinary DGF clinic managed by nurse practitioners to facilitate early discharge and intensive management of DGF in the outpatient setting. We compared length of stay, 30-day readmission, acute rejection, and patient/graft survival in 697 consecutive deceased donor kidney transplantations performed between July 2009 and July 2014. Patients were divided into three groups: no DGF (n = 487), DGF before implementation of the DGF clinic (n = 118), and DGF clinic (n = 92). Baseline characteristics including age, gender, panel reactive antibody, retransplantation rates, HLA mismatches, induction, and maintenance immunosuppression were not significantly different between pre- and post-DGF clinic groups. Length of stay was significantly longer in pre-DGF clinic (10.9 ± 6.2 vs. 6.1 ± 2.1 days, p < 0.001). Thirty-day readmission (21% vs. 16%), graft loss (7% vs. 20%), and patient death (2% vs. 11%) did not differ significantly between pre- and post-DGF clinic. Patients in the DGF clinic were less likely to develop acute rejection (21% vs. 40%, p = 0.006). Outpatient management of DGF in a specialized clinic is associated with substantially shorter hospitalization and lower incidence of acute rejection without significant difference in 30-day readmission or patient and graft survival.

A novel missense mutation in ATRX uncovered in a Yemeni family leads to alpha-thalassemia/mental retardation syndrome without alpha-thalassemia

BACKGROUND

Intellectual disability (ID) features in numerous heritable medical conditions that result from ATRX mutations. Alpha-thalassemia mental retardation syndrome (ATR-X syndrome) is the most notable manifestation of ATRX dysfunction. In addition to ID, genitourinary and craniofacial abnormalities are regularly observed with or without alpha-thalassemia.

AIMS

The study sought to characterize two cases of ATR-X in a Yemeni family clinically and molecularly.

METHODS

PCR amplification and Sanger sequencing were used to study the ATRX gene in a Yemeni family. Also, methylation-sensitive PCR was used to perform X-inactivation studies. CADD, SNAP2 and PolyPhen-2 helped to predict the functional consequences of the variant.

RESULTS

Molecular testing revealed a novel hemizygous missense mutation (c.5666T>G) in the ATRX gene in the two Yemeni brothers. This mutation was found in a heterozygous state in the mother, with the chromosome harboring the mutated allele being under strongly skewed X-inactivation.

CONCLUSIONS

The mutated gene is predicted to have a disrupted SNF-2 domain at a conserved residue; p.Leu1889Trp, which is deemed functionally damaging. This report offers, for the first time, full clinical and molecular characterization of a novel ATRX variant in an Arab family.

Tempérament affectif et alcoolo-dépendance : influence de la dépression

Contexte

Une étude préliminaire a évalué la fréquence des tempéraments affectifs décrits par Akiskal et al. [1] dans une population de patients alcoolo-dépendants [2]. Dans cette étude, le score moyen à la sous-échelle du tempérament dépressif était significativement plus élevé dans un groupe de sujets alcoolo-dépendants par rapport à un groupe de témoins [2]. Les objectifs de notre étude étaient :

– déterminer si la dépression pouvait influencer le lien entre tempérament dépressif et alcoolodépendance ;

– comparer les tempéraments entre un groupe de patients alcoolo-dépendants déprimés et un groupe de patients alcoolo-dépendants non déprimés.

Méthode

Cent dix-huit patients, consultant consécutivement, de juillet 2014 à mars 2015, dans le service d’addictologie de l’hôpital Sainte-Anne (Paris) pour alcoolo-dépendance, ont été inclus dans l’étude. Un groupe de sujets alcoolo-dépendants déprimés (n = 38) a été comparé à un groupe de sujets alcoolo-dépendants non déprimés (n = 80). Ils ont été évalués à l’aide de l’auto-questionnaire Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), à 39 items, explorant les cinq sous-échelles du tempérament affectif :

– cyclothymique ;

– dépressif ;

– irritable ;

– hyperthymique ;

– anxieux [3].

Les troubles psychiatriques associés ont été évalués à l’aide du MINI et de l’échelle de dépression de Beck, à 13 items.

Résultats

Le score total moyen à l’auto-questionnaire TEMPS-A était plus élevé dans le groupe des patients alcoolo-dépendants déprimés que dans le groupe des patients alcoolo-dépendants non déprimés (respectivement scores moyens : 19,24 ± 5,73 vs 14,25 ± 6, 41, p < 0,001). Les scores moyens aux sous-échelles dépressive, cyclothymique et anxieuse étaient significativement plus élevés dans le groupe de patients alcoolo-dépendants déprimés. En revanche, il n’y avait pas de différences significatives pour les sous-échelles irritable et hyperthymique.

Conclusion

La dépression peut constituer un facteur de confusion dans le lien retrouvé antérieurement entre tempérament dépressif et l’alcoolo-dépendance.

Non-Hodgkin lymphoma manifesting as massive malignant chylothorax: successful management with chemotherapy and ambulatory drainages using indwelling pleural catheter

Recurrent cancer-related chylothorax is generally managed by talc pleurodesis or indwelling pleural catheter in the palliative care setting to relieve symptoms and improve quality of life. In chylothorax associated with curable/treatable malignancies like lymphoma, there are scarce data regarding the efficacy and safety of indwelling pleural catheters. We report a case of recurrent massive chylothorax associated with non-Hodgkin lymphoma who demonstrated long-term remission of lymphoma and complete regression of chylothorax after treatment with combination chemotherapy and ambulatory drainages using indwelling pleural catheter.

Effect of honey on the reproductive system of male rat offspring exposed to prenatal restraint stress

Exposure to prenatal stress is associated with impaired reproductive function in male rat offspring. Honey is traditionally used by the Malays for enhancement of fertility. The aim of this study was to determine the effect of honey on reproductive system of male rat offspring exposed to prenatal restraint stress. Dams were divided into four groups (n = 10/group): control, honey, stress and honey + stress groups. Dams from honey and honey + stress groups received oral honey (1.2 g kg(-1) body weight) daily from day 1 of pregnancy, meanwhile dams from stress and honey + stress groups were subjected to restraint stress (three times per day) from day 11 of pregnancy until delivery. At 10 weeks old, each male rat offspring was mated with a regular oestrus cycle female. Male sexual behaviour and reproductive performance were evaluated. Then, male rats were euthanised for assessment on reproductive parameters. Honey supplementation during prenatal restraint stress significantly increased testis and epididymis weights as well as improved the percentages of abnormal spermatozoa and sperm motility in male rat offspring. In conclusion, this study might suggest that supplementation of honey during pregnancy seems to reduce the adverse effects of restraint stress on reproductive organs weight and sperm parameters in male rat offspring.