The Burden of Caregivers of Patients with Alzheimer

Introduction

The Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.

Goal

It is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.

Methodology

This is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.

Results and discussion

Thirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59.9 + 16 3. We observed that 33% have absent to light burden (score <21), 10% have a light to moderate burden (between 21 and 40), 36, 66% have moderate to severe burden (between 41 and 60) and 50% have a severe burden (>60), according to the classification proposed by Zarit. Sex, kinship and cohabitation with the patient were not associated with a higher burden.

Conclusion

The study of factors correlated with high levels of burden aims at finding ways of intervention and support to fight against the isolation of caregivers and the occurrence of anxiodepressive complications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Substance use among male forensic patients

There is a widespread use of substances abuse which might cause violence, suicide, interpersonal conflicts, lawsuits, psychiatric commitment, and even crimes. Psychiatrists are under increasing pressure to develop strategies to address the problem of coexisting criminal behaviour, addiction, and mental illness. The aim of this study was to examine the association between demographic profile, psychiatric symptomatology and substance use in forensic psychiatric inpatients, and to consider the treatment needs and opportunities for intervention among the same sample.

Methodology

A retrospective study was done on patients admitted to the department for Forensic Psychiatry at the Razi Hospital from 1996 to 2016, initially jailed for detention and drug consumption and judged irresponsible by reason of insanity. Data were collected by record review.

Results

Thirty-two patients were included in the study. Mean age was 27.81 years. Thirty-six percent of the participants were illiterate and 45% were single. More than half of the subjects (54%) had personal psychiatric history and 27, 27% had family history of psychiatric problems. About one third (31.81%) of participants had judicial background: 33% were arrested for public drunkenness, 44% were arrested for violence, and 22% were arrested for theft. Concerning the diagnosis, 45% were suffering from schizophrenia, 22.77% were diagnosed with personality disorder and 27.27% of them would not have any mental trouble. About 50% of the patients did not follow up with treatment.

Conclusion

Addictive disorders are authentic psychopathological disorders. Effective treatment is hindered by the paucity of research on clinical application of treatment models for addictive disorders in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Incest in the Schizophrenic patient: Case report

Introduction

Incest may be defined as sexual relations between close blood relatives. Legally, incest and sexual aggression toward minors are classified as a criminal behaviour. Tunisia is among the countries from which incest cases are rarely reported.

Objectives and method

The aim of this study is to investigate the relationship between the psychotic structure and incest, and to describe the individual, clinical, and criminal traits of the incestuous father through clinical observation.

Case report

Mr T.G is 46 years old. He is married and has six daughters. His wife appears to be passive, and largely dependent on her husband. Mr T.G has had incestuous relationships, initially, with his two eldest daughters. The acts were followed by the mother's complicit silence and the non-denunciation of the daughters. Two years later, he starts an incestuous behavior with his third daughter. Incest took place in the context of delusion. The patient was convinced that he is responsible of his daughters’ sexuality education. He develops an incoherent theory of purification with a tendency towards morbid rationalism. It is only after four years of insufferable paternal incestuous relationships that the third daughter filed a complaint to the police. A psychiatric expertise concluded that the accused is exempt from criminal responsibility.

Conclusion

Incest is a multi-faceted phenomenon, which makes its approach, comprehension, and treatment quite complex. For a psychotic patient incest is a means to deny alterity by crushing other. It also allows him to find, in this complete power, control over his annihilation anxiety.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Virtual sexuality of the Tunisian teenagers

Introduction

The digital boom and the media coverage of the sexuality urge the youngest to expose itself more and more via the social networks and other digital applications.

Aims/objective

To explore the virtual sexuality of the Tunisian teenagers.

Methods

It's a cross-sectional study made in August 2015, including 104 Tunisian teenagers from different social backgrounds and living in Tunis, chosen aimlessly. An auto-railing drafted in Arabic, anonymous and carrying on various items was distributed.

Results

We included 52 boys and 52 girls. Seven of them (6.1%) was not schooled and 68.3% (n = 71) were at high school. Ninety-one of the teenagers (87.5%) reported not have sexual education at school and 74% (n = 77) have already turned to web sites to inquire about sexuality. A regular practice of cybersex at the rate of at least once a week, was founded at 36.5% (n = 36) and 41 teenagers (39.4%) have reported to have already undressed in front of their webcam. The candidates have already consulted a pornographic site at least once in their life in 76.9% (n = 80) of the cases. The allocated time for these virtual activities is made to the detriment of the sleep in 75% of the cases (n = 27). The connection was accompanied with a masturbatory activity in 38.9% (n = 14).

Conclusion

Contrary to preconceived ideas, the computer screen does not protect from sexual risk behaviors. Therefore, a sexual education for the youngest is more than ever necessary to avoid such drift.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Halanaerobacter jeridensis sp. nov., isolated from a hypersaline lake

An obligatory anaerobic, moderately halophilic bacterium, designated strain CEJFG43T, was isolated from a sample of sediment collected below the salt crust on the hypersaline El Jerid lake, in southern Tunisia. The cells of this novel strain were Gram-staining-negative, non-sporulating, motile, short rods. They grew in media with 6–30 % (w/v) NaCl (optimum 15 %), at 20–60 °C (optimum 45 °C) and at pH 5.5–9.5 (optimum pH 8.3). The micro-organism fermented glucose, fructose, ribose, raffinose, galactose, mannose, sucrose, maltose, xylose, mannitol, pyruvate and glycerol. The products of glucose fermentation were lactate, ethanol, acetate, H2 and CO2. The genomic G+C DNA content of strain CEJFG43T was 33.3 mol%. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain CEJFG43T belonged in the genus Halanaerobacter and was most closely related to Halanaerobacter lacunarum DSM 6640T (95.3 % gene sequence similarity) and Halanaerobacter chitinivorans DSM 9569T (95.3 %). The predominant cellular fatty acids were non-branched (C16 : 0 and C16 : 1). Based on the phylogenetic and phenotypic evidence, strain CEJFG43T represents a novel species in the genus Halanaerobacter for which the name Halanaerobacter jeridensis sp. nov. is proposed. The type strain is CEJFG43T ( = DSM 23230T = JCM 16696T).

Du diagnostic au traitement de la rupture de la coiffe de hanche : à propos d'un cas

OBJECTIVE

To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain.

CONCLUSION

The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.

[The Oswestry index for low back pain translated into Arabic and validated in a Arab population]

OBJECTIVE

To translate into Arabic and validate the Oswestry index for low back pain in an Arab population.

BACKGROUND

No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available.

DESIGN

Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient.

RESULTS

Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2.

CONCLUSION

We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

Purification and sequence analysis of the atypical maltohexaose-forming alpha-amylase of the B. stearothermophilus US100

The maltohexaose-forming alpha-amylase, of B. stearothermophilus US100, was purified to homogeneity by a combination of osmotic shock, starch adsorption and anion exchange chromatography. This enzyme has a relative molecular mass of 59 kDa. The analysis of the nucleotide sequence, of the corresponding gene, allowed the identification of a single open reading frame encoding a 549 amino acid protein, exhibiting a large homology to the other B. stearothermophilus alpha-amylases. This homology reaches a maximum with those of DY-5 and DN1792 strains with respectively 3 and 4 aa different over 549. The relatively small differences, between Amy US100 and that of DN1792 strain, take in more importance since we have demonstrated that these enzymes differ essentially by their starch hydrolysis pattern.

[Effects of injectable nitroglycerin on atheromatous coronary stenoses]

The beneficial effects of glyceryl trinitrate (GTN) are the result of several mechanisms which reduce venous return, cardiac work and intraparietal tension, and redistribute blood flow to the subendocardial layer and ischaemic zones. A direct action on atheromatous coronary stenosis is disputed. The coronary angiogram of 45 patients with organic stenosis and no clinical or electrocardiographic signs of coronary spasm were studied under basal conditions and after intravenous injection of 1.5 mg of GTN. Eighty stenotic segments and the corresponding 80 prestenotic segments were traced for comparison after enlargement on a Vanguard retroprojector and calibrated with reference to the coronary angiographic catheter. Aortic pressure fell 2 minutes after the injection in all patients to return to initial values at the end of the investigation. The diameter of the stenosed segment increased in 17 cases, remained unchanged in 54 cases and decreased in 9 cases. When expressed as a percentage of stenosis, the narrowing increased in 25 cases, decreased in 16 cases and remained the same in 39 cases. In the cases aggravated by GTN the diameter of the stenosis decreased or remained the same, whilst the diameter of the prestenotic decreased; in the cases improved by GTN, the diameters of both stenotic and prestenotic segments increased and prestenotic segments showed only slight variations. There was no difference in the diameter of the prestenotic segments between the 3 groups, but the diameter of the stenotic segments was larger in the group aggravated by GTN in comparison with the other two groups. Different haemodynamic factors and neurotumoral and local metabolic autoregulatory mechanisms may be activated by GTN.(ABSTRACT TRUNCATED AT 250 WORDS)