Nuclear sperm integrity and ICSI prognosis in Tunisian patients with MMAF syndrome (multiple morphological abnormalities of the sperm flagella)

Multiple Morphological Abnormalities of the Sperm Flagella (MMAF) is a severe form of teratozoospermia associated with several sperm flagellar abnormalities. The study included 52 patients with MMAF syndrome and a control group of 25 fertile men. The impact of nuclear sperm quality on intracytoplasmic sperm injection (ICSI) results was studied in 20 couples. TUNEL assay was used to assess sperm DNA fragmentation and aniline-blue staining was used to assess chromatin condensation. To investigate chromosomal meiotic segregation, we used fluorescence in situ hybridization (FISH). Semen morphology analysis revealed a mosaic of multiple flagella morphological abnormalities, including 46.73% short flagella, 16.22% bent flagella, 22.07% coiled flagella, and 10.90% absent flagella, all of which were associated with a high percentage of sperm head abnormalities. The mean DNA fragmentation index was substantially higher in patients compared to controls (p = 0.001), whereas the rate of aniline blue-reacted spermatozoa was not significantly different. There was a significant difference in aneuploidy frequencies between the two groups (p < 0.05). Infertile males with MMAF syndrome had lower sperm nuclear quality, which affected ICSI results. As a result, better sperm selection procedures are being employed to increase the success rate of assisted reproductive technologies (ART).

Resilience And Coping: The Chicken and The Egg Paradox

Introduction

Since the outbreak of the 2019 coronavirus, healthcare workers found themselves on the front lines of an unprecedented battle. Being characterized by adversity, this experience represents a fertile ground for the study of resilience.

Objectives

Our study aims to clarify the phenomenon of resilience through its influence on perceived stress level and its connection with coping strategies.

Methods

A cross-sectional study was conducted involving 254 healthcare professionals in the region of Sousse during the pandemic. In addition to socio-demographic and professional characteristics, Resilience, perceived stress, and coping strategies were assessed using the Connor-Davidson Resilience Scale (CD-RISC), the PSS10 scale, and the Brief Cope questionnaire, respectively.

Results

The overall mean [±standard deviation (SD)] age of the participants was 32.9 ± 8.76 years with a sex ratio (M / F) of 0.51. The assessment of resilience among participants revealed a mean score of 64.99 ± 14.72. The majority of participants evinced a score> 50 (82.68%) and 39.76% had a score >70. Our results revealed that, on the one hand, problem-focused coping strategies were positive predictors of resilience (p<10^-3), accounting for 3.6% of its variance. On the other hand, coping strategies (problem-focused strategies and avoidance strategies) are also an integral part of the process by which resilience significantly influences the level of perceived stress (mediating factor).

Conclusions

Despite its complexity, the relationship between resilience and coping strategies is undeniable and it is a part of an important line of intervention opening the way to better identifications and care.

Disclosure

No significant relationships.

Thromboembolic events in inflammatory bowel disease

GOAL OF THE STUDY

Inflammatory bowel disease (IBD) is associated with an increased risk of thromboembolic events (TEE) during outbreaks, increasing morbidity and mortality. The aim of our study was to specify the prevalence of TEE in IBD patients and to determine their epidemiological, clinical and evolutionary characteristics.

MATERIEL AND METHODS

This is a retrospective study collecting all patients with IBD, who had a thromboembolic complication confirmed by imagery, between January 2012 and December 2018.

RESULTS

One hundred patients with IBD were diagnosed during the study period. A TEE occurred in 6 patients (5.9%). These patients had an average age of 41 years, divided into 4 women and 2 men. Five patients had Crohn's disease and one patient had ulcerative colitis. The IBD was active in all patients. Five patients were already hospitalized and under preventive heparin therapy. Patients had deep venous thrombosis of the lower limbs in 3 cases, associated with pulmonary embolism in 1 case, cerebral venous thrombosis in 2 cases and pulmonary embolism isolated in 1 case. Thrombophilia investigations were negative in all patients. Evolution under medical treatment was favorable in 4 patients and fatal in 2 patients.

CONCLUSION

In our study, the prevalence of TEE in patients with IBD was 5.9%. Thrombosis occurred during the active phase of IBD in all cases.

Comparison of sperm morphology and nuclear sperm quality in SPATA16- and DPY19L2-mutated globozoospermic patients

The aim of this study was to compare the sperm morphology and nuclear sperm quality (sperm aneuploidy and DNA fragmentation) in two groups of globozoospermic patients: DPY19L2-mutated patients (n = 6) and SPATA16-mutated patients (n = 2). Results for these two groups were also compared to a group of fertile men (n = 25). Fluorescence in situ hybridisation was performed for chromosomes X, Y and 18. Sperm DNA fragmentation was evaluated by TUNEL assay. Sanger sequencing was performed for mutations screening of DPY19L2 and SPATA16 genes. Sperm analysis revealed a classic phenotype of total globozoospermia in DPY19L2-mutated group and a particular phenotype characterised by a predominance of double/multiple round-headed (39.00 ± 4.2%) and multi-tailed spermatozoa (26.00 ± 16.97%) in SPATA16-mutated group. FISH analysis showed a significantly higher aneuploidy rate in globozoospermic patients compared to controls (p < 0.05), and a higher rate was observed in SPATA16-mutated group compared to DPY19L2-mutated group (p < 0.05). DNA fragmentation index was significantly higher in globozoospermic men compared to controls (p < 0.001), and there is no statistically significant difference between the two globozoospermic groups. We showed that SPATA16 defects could be associated with an abnormal meiosis leading to a particular morphological sperm defect of double/multiple round-headed and multi-flagella and a higher sperm aneuploidy rate than in case of DPY19L2-defects in classic globozoospermia.

Job satisfaction, burnout and coping strategies: Comparison between medical and surgical specialties

Introduction

Doctors have many constraints in their professional practice, which influence negatively the quality of their performance. This causes a psychological distress.

Aim

To compare job satisfaction (JS), burnout (BT), anxiety, depression and coping strategies among doctors of medical (DMS) and surgical specialities (DSS).

Method

Comparative and cross-sectional study conducted among 33 DMS and 63 DSS with different grades, in the university hospital Farhat Hached Sousse, Tunisia. We used job satisfaction scale (JSS) to determine the degree of JS, hospital anxiety and depression scale (HADS) to evaluate anxiety and depression, the Maslach burnout inventory to assess the BT and the brief cope to determine coping strategies.

Results

DMS were older than the DSS (P = 0.005). The MSC had more unsettled family life (P = 0.04) and more monthly guard (5.87 vs. 4.96, P = 0.03). DMS had more days of outpatient (P = 0.00), were more satisfied with the work schedule (P = 0.00), conditions of the guards (P = 0.02). Relationships with colleagues were more satisfactory among DMS (P = 0.001). DMS were less confronted to violent events (P = 0.03). The average score of JSS was higher among DMS (P = 0.014). The BT was more reported in the DSS (P = 0.049). An average sub-score HADS-D (depression) was higher in the DSS (P = 0.00). An avoidance-focused coping was more adopted by the DSS (P = 0.02).

Conclusion

DSS were generally less satisfied in their work than DMS with obvious psychological repercussions. This incites to intervene in factors that interfere with job satisfaction to improve the quality of physicians’ performance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Factors associated with job satisfaction among physicians in a university hospital

Introduction

Several professional and personal factors determine the degree of job satisfaction (JS) which is a necessary condition to ensure good quality work, especially for physicians working in university hospitals (UH).

Aims

To determine the degree of JS in a population of physicians working in UH and to determine the factors associated with the JS.

Method

Cross-sectional, descriptive and analytical study involving 96 physicians with different grades in Farhat Hached University Hospital, Sousse, Tunisia. We used Job Satisfaction Scale (JSS) to assess the degree of JS, Hospital Anxiety And Depression Scale to assess anxiety and depression, Maslach Burnout Inventory to determine burnout (BT).

Results

The average age was 28.15 ± 4.10 years. Doctors with medical specialty were the majority (65.6%). Most doctors were dissatisfied with their work (67.7%). The socio-demographic factor associated with ST was the young age (P = 0.00). Occupational factors associated with JS were: shorter time worked in the department (P = 0.02), lack of outpatient day (P = 0.01), a lower number of outpatient day (P = 0.02), dissatisfaction with the work schedule (P = 0.004), lack of safety (P = 0.00), salary (P = 0.00), non-operating skills (P = 0.00), the distribution of tasks (P = 0.00), the conditions of the guards (P = 0.00), ignorance of the laws governing the department (P = 0.00), BT (P = 0.01) and depression (P = 0.00).

Conclusion

The majority of our subjects were dissatisfied with their work. Several factors, especially the professional ones contribute to this state. It is necessary to take steps on these factors to improve the performance of doctors working in university hospitals to provide better care for patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Prevalence and correlates of major depressive episodes in Sousse primary care setting: assessment with the Tunisian version of CIDI]

BACKGROUND

Major depression is a mental disorder that is associated with high morbidity and significant mortality. It is common among primary care attenders. Few is known about major depression prevalence and associated factors, which would prevent general practitioners from diagnosing it in primary care centres and treating it adequately.

AIM

To determine prevalence and correlates of major depressive episodes (MDE) in a representative sample of primary care attenders in the area of Sousse (Tunisia).

METHODS

A random and representative sample of primary care attenders was obtained by a two-stage sampling procedure. First, 30 primary care centres (20 urban and 10 rural) were selected, with stratification according to residency location. Second, 1246 consenting participants were systematically recruited among those centres attenders. Participants were screened, by trained interviewers, with Tunisian version of « Composite International Diagnostic Interview » CIDI.2.1. After data entry in ishell program, MDE diagnosis was obtained according to ICD-10 criteria.

RESULTS

Mean age in our sample was 43.4 ± 17.62 years, with feminine (70.9 %) and urban (67.8 %) predominance. MDE was found in 26.4 % of participants. Associated factors were female gender, marital statute of widowed or divorced and rural residency.

CONCLUSION

This study provided data about high prevalence of MDE in the area of Sousse primary care centres and its correlated factors.

[Bilateral popliteal artery complications of multiple hereditary exostosis]

The osseous exostose is a rare benign tumor of the bone from which the vascular complications can be of venous or arterial order, are translated in various boards. We report the case of a young adult who presents a forgery aneurysm of the right popliteal artery with the popliteal artery booby-trapped to the left. The patient benefited from surgical treatment with good clinical and radiological evolution.

[Lupus hepatitis: a case series of 12 patients]

PURPOSE

Several liver manifestations have been reported in systemic lupus erythematosus (SLE) and are usually non specific. We report on our experience of lupus hepatitis.

METHODS

A retrospective monocenter study of 73 patients with SLE. The diagnosis of lupus hepatitis was established after exclusion of other causes of hepatitis and hepatic vein thrombosis.

RESULTS

Liver involvement was noted in 12 patients (16.4%). There were nine female and three male patients; the mean age of these patients was 29 years. In seven patients liver involvement was concurrent with the diagnosis of SLE and it occurred later during an exacerbation of the disease in the five remaining patients. In all patients, liver manifestations were associated with other organ involvement. Clinical manifestations were: hepatomegaly (n=4), jaundice (n=4), abdominal pain (n=3), ascites (n=2), portal hypertension (n=1) and hepatic failure with encephalopathy (n=1). Elevated liver enzyme was noted in 11 cases and liver cholestasis in eight cases. Presence of anti-ribosomal P antibodies was noted in one case. Liver biopsy was performed in five patients, and revealed chronic active hepatitis in three cases, chronic hepatic granulomas in one case and nonspecific inflammation in one case. The outcome was favorable in 11 patients without relapse, and one patient died of encephalopathy and liver failure.

CONCLUSION

Liver involvement associated with SLE is not uncommon. It is frequently asymptomatic and limited to liver test abnormalities. The role of anti-ribosomal P autoantibodies remains uncertain.

[Chorea revealing a polycytemia vera]

Neurological manifestations in polycytemia vera are common. However, chorea is an exceptionally revealing feature of this disease. We report a 78-year-old man who presented with headache and an abnormal movement disorder corresponding to chorea. Laboratory findings showed increased levels of hemoglobin at 20 g/dl and hematocrit at 62.3%. An elevated erythrocyte mass to twice the normal value demonstrated the absolute erythrocytosis. A JAK2 V617F gene mutation was identified. A diagnosis of polycytemia vera-associated chorea was obtained. Clinical and biological outcomes were favorable after therapeutic phlebotomy and treatment with hydroxyurea. We recommend a complete blood cell count in elderly patient presenting with chorea to eliminate a diagnosis of polycytemia vera.