FRI0185 DIAGNOSTIC SIGNIFICANCES OF BOTH MICRORNA-146A AND KALLIKREIN-1 IN PATIENTS WITH LUPUS NEPHRITIS

Background:

Lupus nephritis (LN) is one of the most critical complications of systemic lupus erythematosus (SLE). Approximately 30–50% of SLE patients develop LN with 5-year survival rate of about 70-80%. Thus, finding reliable non-invasive biomarkers at the early stages of SLE is of great interest (1). Many studies focused on the association between microRNAs and the risk of LN. miRNA-146a (miR-146a) was one of the most promising circulating markers which was suggested recently for early diagnosis of SLE but its diagnostic relevancies regarding LN have not been extensively investigated.

Objectives:

This study aims to test the expression of miR-146a in patients with LN in relation to Kallikrein-1 as another widely investigated diagnostic marker for LN along with other conventional measures.

Methods:

One hundred and thirty subjects were enrolled in this study. They were divided into forty six patients with LN, forty four patients with SLE but without nephritis and forty healthy controls. The expression levels of miR-146a in peripheral blood mononuclear cells (PBMCs) were detected via RT-qPCR analysis. Besides, serum Kallikrein-1 levels were determined by ELISA. The diagnostic role of miR-146a and Kallikrein-1 in LN was evaluated by Receiver operating curve (ROC). The impact of miR-146a and Kallikrein-1 on renal disease was compared to albumin creatinine ratio, renal biopsy findings as well as renal SLEDAI.

Results:

Levels of miR-146a were significantly lower in the plasma of LN patients than both patients of SLE without LN and normal controls (p < 0.05). However, serum levels of Kallikrein-1 were significantly higher in LN patients when compared to SLE patients and normal population (p < 0.05). ROCs were conducted to assess the diagnostic values of both miR-146a and kallikrein-1. They revealed good diagnostic values with AUC of 0.888 and 0.913 respectively. Also, plasma miR-146a was observed to be negatively associated with serum creatinine, proteinuria as well as SLEDAI score (p < 0.01) while serum Kallikrein-1 was positively correlated with them (p < 0.05) and inversely correlated with miR-146a (p < 0.01).

Conclusion:

The expression levels of miR-146a are reduced in SLE patients with more reduction with LN. Therefore, miR-146a could be considered as potential biomarker for detecting LN either alone or in combination with Kallikrein-1. However, more studies are required.

References:

[1]Soliman S. And Mohan C. Lupus nephritis Biomarkers.Clin Immunol.2017 Dec; 185: 10-20.

Disclosure of Interests:

None declared

[Not Available]

Massive influx of burns (thermal, chemical or electrical) is a potential crisis situation in the world in peacetime. In fact, burn is one of the most frequently encountered injuries following natural or human disasters. The management of a massive influx of burn victims is considered to be a real challenge, not only from a medical point of view but also from a logistical and organizational point of view. It is an exceptional event requiring exceptional organization and planning in advance, including systematically training medical and paramedical personnel, without forgetting ambulance and fire workers as they will be the first to arrive at the scene. Planning must necessarily include equipment for fast and effective support. We will present our experience in managing a massive influx of burns from a juvenile detention centre. We share it in order to help establish a better plan to deal with these rare but challenging situations.

Integrating obstetrical simulation into the medical curriculum: one more gap in women's health for low-income countries

Low-income countries do not have well-established simulation centers; introduction of simulation-based learning in obstetrics faces many cost-associated difficulties. Simulation-based learning yield many benefits that are reported in many studies such as improved maternal and neonatal outcomes, social stature of medical teachers, and better management of difficult situations. Though low-income countries do not have established surgical simulations, centralization, and cooperation amongst the educational institutions and local and regional hospitals for maintenance of medical educational practices and financial supplementation through both established and newly created entities will provide the potential for improved patient outcomes and maintenance of quality of education, that is, comparable to the medical education found in higher income countries.

Consecutive aquatic jump-gliding with water-reactive fuel

Robotic vehicles that are capable of autonomously transitioning between various terrains and fluids have received notable attention in the past decade due to their potential to navigate previously unexplored and/or unpredictable environments. Specifically, aerial-aquatic mobility will enable robots to operate in cluttered aquatic environments and carry out a variety of sensing tasks. One of the principal challenges in the development of such vehicles is that the transition from water to flight is a power-intensive process. At a small scale, this is made more difficult by the limitations of electromechanical actuation and the unfavorable scaling of the physics involved. This paper investigates the use of solid reactants as a combustion gas source for consecutive aquatic jump-gliding sequences. We present an untethered robot that is capable of multiple launches from the water surface and of transitioning from jetting to a glide. The power required for aquatic jump-gliding is obtained by reacting calcium carbide powder with the available environmental water to produce combustible acetylene gas, allowing the robot to rapidly reach flight speed from water. The 160-gram robot could achieve a flight distance of 26 meters using 0.2 gram of calcium carbide. Here, the combustion process, jetting phase, and glide were modeled numerically and compared with experimental results. Combustion pressure and inertial measurements were collected on board during flight, and the vehicle trajectory and speed were analyzed using external tracking data. The proposed propulsion approach offers a promising solution for future high-power density aerial-aquatic propulsion in robotics.

High photodegradation and antibacterial activity of BN–Ag/TiO2 composite nanofibers under visible light

To develop material with good photocatalytic properties for organic compound degradation and bacterial removal, we produced Ag/TiO₂ and BN–Ag/TiO₂ composite nanofibers that included controlled amounts of boron nitride (BN) nanosheets and silver (Ag).

Intraperitoneal rupture of hydatid cysts

PURPOSE

Hydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication.

METHODS

A retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence.

RESULTS

Our study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection).

CONCLUSIONS

Hydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

Introduction

Many studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.

Aims of the study

Describe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.

Methodology

A retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.

Results

Age average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.

Conclusion

The knowledge of risk factors improves the management and allows us better prevention of violence among our patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorders: Factors related to schizophrenia evolution

Introduction

Acute psychotic disorders are described as a clinical syndrome characterized by Acuteness of the installation, the intensity and the polymorphism of delirium.

Aim

Describe the demographic characteristics of a population of patients with an acute psychotic disorder and identify factors correlated with evolution to schizophrenia.

Methods

This is a retrospective, descriptive and analytic study conducted on hospitalized patients in psychiatric department EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. A study of the recurrence time was performed by Kaplan–Meier and Cox test was used to identify factors correlated with evolution to schizophrenia.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 39.6% of patients had family history of psychiatric disorders, including schizophrenic disorders and bipolar disorder were the most common with rates of 63.6 and 18.4% of cases. For our patients, 38.7% progressed to schizophrenia. Four risk factors were significantly predictive of progression to schizophrenia: male gender (P = 0.026), subacute or progressive onset disorders (P = 0.003), partial remission of the disorder (P = 0.023) and the prolonged duration of untreated psychosis (P = 0.027).

Conclusion

The evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related to the risk of developing schizophrenia or mood disorder. Attention is paid in recent years to recognize and seek most precociously as possible factors associated with this evolution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Socio-demographic, clinical and therapeutic features of patients treated for schizoaffective disorder using cannabis

Introduction

Psychotic disorders were formerly associated with cannabis use. It could accelerate the course of the illness and thus, constitutes a severity factor in terms of prognosis.

Objectives

To define the socio-demographic, clinical and therapeutic profiles of patients suffering from schizoaffective disorder (ASD) and who are consuming cannabis.

Methods

A retrospective study of 16 patients diagnosed with ASD, who were hospitalized at the psychiatric department of Tahar Sfar Mahdia's hospital, and whose toxicology test results during the hospitalization came back positive for tetrahydrocannabinol.

Results

Sixteen patients were gathered, all male, the average age was 26 years. The average age of first hospitalization was 25 years, 41.9% were unemployed; 76.3% of our sample were single. Three quarters of patients were hospitalized without consent. The average hospital stay was 30.33 days. Our patients had required during their stay an average dosage of antipsychotic, equivalent to chlorpromazine, of 752.42 ± 342.79 mg. The average scores of psychometric scales were: BPRS = 55.72 ± 14.11, SAPS = 41.5 ± 14.80 and 42.11 ± 18.88.

Conclusion

Currently, it is recognized that prolonged use of cannabis is an exogenous risk factor. The association between cannabis and schizoaffective disorder may amend the treatment modalities. It requires, thereby, an integrated and simultaneous treatment of schizophrenia and addictive behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression in people with multiple sclerosis

Introduction

Depression is the most common syndrome associated with Multiple Sclerosis (MS) with a high prevalence during a lifetime.

Objectives

To assess the prevalence of depression in patients treated in neurology for MS.

Methods

We performed a retrospective study on 17 patients diagnosed with MS and confirmed with the criteria of Mac Donalds 2010 with a follow-up in the neurology department of the EPS Mahdia for a period of nine years (2006–2014), then addressed to a psychiatric consultation for depression.

Results

In total 17 patients were hospitalised in the neurology department during the study. Ages ranged from 20 to 39 years with an average of 33 years. The average course of the disorder is 5 years. We objectified a female predominance with 82%, a professional activity was found in 76% of patients. The comorbidities found are mainly hypertension, diabetes and asthma, respectively in 11%, 5% and 5%. Depression was clinically confirmed in 9 patients, that to say, 52% of our sample addressed in the psychiatric consultation, whose 6 received an antidepressant (fluoxetine) and 3 received paroxetine. An anxiolytic was given to the half of these patients.

Conclusion

The association between MS and depression would, therefore, be neither fortuitous nor only related to non-specific factors of any chronic disease. Specifying the relative share of these explanatory factors is probably one of the challenges for future researches in this area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorder: Which future?

Introduction

At present, in absence of reliable clinical and evolutionary data, it is difficult to determine what the consequences of an acute psychotic disorder, specifically if it is a mode of entry into schizophrenia, a mood disorder or a short-lived episode.

Aim

The objective of this study was to describe the sociodemographic characteristics and evolutionary modalities of a population of patients with a first psychotic episode.

Methods

This is a retrospective descriptive study, which involved patients admitted to psychiatric ward EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. Data collection was conducted from archived observations and through a predetermined sheet.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 52.3% were from urban, 73% of patients were single, 33.3% were from a consanguineous marriage. Among those patients with a first acute psychotic episode, 43 patients (38.7%) progressed to schizophrenia, 15.3% to bipolar disorder, 23, 4% to recovery while 22.5% were lost view.

Conclusion

The long-term evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related primarily to the risk of developing a schizophrenic disorder or a mood disorder. In this context, attention is paid in recent years to recognize and seek the earliest possible factors associated with this development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychoaffectives Repercussions of Autism on Parents

Introduction

Caring for a child with autism is a stressful experience for parents. The daily stress of this handicap has a major impact and triggers in the parents a series of adverse psychological reactions.

Aim

To reveal sociodemographic characteristics of parents of autistic children and to estimate the prevalence of anxiety and depressive symptoms among these parents.

Methods

A cross-sectional study conducted among parents of autistic children supported by four of autistic children rehabilitation centers under the Tunisian Association for the Promotion of Mental Health. Data were collected through a questionnaire to explore the sociodemographic data of parents of autistic children. Depressive symptoms were assessed by the Beck scale and anxiety symptoms by the Hamilton scale.

Results

Fifty-two parents were collected. The middle age was 35.73 years. They lived in an urban area in 96% of cases. The majority had an average socioeconomic level (88.4%). The respective rates of depressed or anxious parents as Beck scales and Hamilton were 48% and 23%. The association between depressive and anxious symptoms was found in 19%. In addition, depression was more common in mothers (P < 10−4) and anxiety was also more evident among mothers (P = 0.01).

Conclusion

The presence of an autistic child causes profound changes in families and can be a source of tension and stress. The anxious and depressive impact on parents is important and frequent. The intervention that designs the psychiatrist to help children with autism should necessarily include an action for parents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder and life quality

Introduction

schizoaffective disorder is a nosographic entity characterized by a combination of symptoms of schizophrenia with mood episodes. The fact that its diagnosis is difficult, and often oscillates between schizophrenia and bipolar disorder raises the problem of its care and the outcome of patients who suffers from it.

Objective

To evaluate the quality of life of treated patients with schizoaffective disorder.

Materials and methods

This is a cross-sectional study realized at the psychiatric consultation of Mahdia hospital during a 6month period. Data were collected from patients and from their medical records using a predefined questionnaire.

Results

A total of 52 patients were included, the average age was 38 years. The majority of patients (63.5%) were unemployed. The use of psychoactive substances was noted in 63.5% of patients. Multiple linear regression analysis allowed us to find that 12 factors were more significantly associated with impaired quality of life which were, in descending order of importance: the EAS score > 39, the EGF score ≤ 70, the null or partial adherence, the presence of side effects seriously affecting daily activity, the depressive subtype, the lack of employment, the socio-economic level, the lack of stable budgetary resources, an age > 60years, the widowed and divorced marital status, the PANSS score (≥ 45) and negative symptomatology (PANSS).

Conclusion

The diagnosis of schizoaffective disorder has a triple relevance: clinical, prognostic and therapeutic. Identifying a schizoaffective disorder and the risk factors that may affect the quality of life provides a significant practical impact for the patient's benefit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder and life events

Introduction

The schizoaffective disorder is multifactorial. Several factors almost unquestioned, even indisputable, participate in the episodes’ decompensation and affect various fields: biological, pharmacological or neurobiochemical.

Objectives

Draw up the sociodemographic and clinical profile of patients treated for schizoaffective disorder and determine the role of life events in the onset of the disorder.

Methods

This is a retrospective study of 52 patients hospitalized in the psychiatric department of Mahdia diagnosed with schizoaffective disorder according to DSM-IV-TR during the period from January 2014 until June 2014. The information was collected using a preset sheet with 35 items.

Results

A total of 52 records was gathered. The average age was 38 years. The sample was predominantly male, of rural origin in 61.5% of cases. The level of education was low in 59.6% of cases. More than half were without profession and single in 46.2% of cases. The mean age at onset of the disorder was 25.2 years. The presence of life events preceding the onset of the disorder was noted in 22 patients, that to say, 42.3% of the sample. Family and emotional events were most frequently encountered with respective rates of 48.2 and 24.7%, followed by the professional events (20%) and social ones (6%).

Conclusion

Life events are due to chance but also to the environment. The complexity of the “event” concept was again underlined in a new perspective, breaking social rhythms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Major Depressive Disorder: Recurrence Risk Factors

Introduction

In spite of the frequency and the gravity of the depressive episodes, the major depressive disorder (MDD) is diagnosed and treated today insufficiently and the risk factors of its recurrence are little approached.

Aims of the study

Describe the socio–demographic, clinical and therapeutic characteristics of patients with MDD and identify the factors involved in the recurrence risk.

Methodology

This is a retrospective study carried out in the university hospital of Mahdia, Tunisia during two years. We have included patients with a follow up for at least two years and diagnosed with MDD, isolated episode or MDD, recurrent episode according to the DSM-IV-TR criteria. Data collection was performed using two pre-established questionnaires respectively with 51 and 92 items. We have estimated the time to recurrence with the Kaplan-Meier estimator.

Results

We have collected 150 patients. The time to recurrence was 109 months. Five factors were associated with recurrence: early age at onset of the disorder, family history of mood disorders, severity of the index major depressive episode, persistent residual symptoms and ceasing treatment.

Conclusion

Depression is a very common mental illness that is highly recurrent in individuals. There is great interest in the development of strategies that might reduce the recurrence of depression.

Major depressive disorder: Recurrence risk factors

Introduction

Despite the frequency and the severity of depressive episodes, the major depressive disorder (MDD) is today inadequately diagnosed and treated, and the risk factors for its recurrence are not well elaborated. The objectives of this study were to describe the sociodemographic, clinical evolutionary and therapeutic features of this disorder and to identify the factors involved in the risk of its recurrence.

Methods

This is a retrospective, descriptive and analytical study, involving 150 patients with MDD, isolated episode or recurrent major depressive disorder (RMDD) with a follow-up for at least two years. Data collection was performed using two pre-established questionnaires for the MDD isolated episode and for the RMDD respectively with 51 and 92 items. A study of the recurrence period was performed by Kaplan–Meier method. The Cox-test was used to determine the survival curves and to look for the risk factors significantly associated with MDD recurrence.

Results

A total of 150 patients was gathered, predominantly female, married and from urban origin. The average age at the beginning of the disorder was 35 years. The recurrence period was 109 months and the factors associated with recurrence were the early age of onset of the disorder, family history of mood disorders, the severity of MDE index, residual symptoms and discontinuation of treatment.

Conclusion

The study of factors involved in MDD recurrence is of a particular importance since it allows not only to know the group of patients at risk but also to improve their therapeutic care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Therapy initiation during a first acute episode psychosis in the psychiatric department of Mahdia

Introduction

The quality of the therapeutic care during a first episode psychosis (FEP) determines the middle- and long-term prognosis.

Objectives

The aim of our study is to describe the therapeutic attitudes in front of a FEP and discuss them according to current international recommendations.

Methods

This is a retrospective descriptive study. All patients with a FEP, hospitalized in the psychiatric department of the university hospital, Mahdia during the period from 15 May 2000 to 31 December 2013 have been included.

Results

We recruited 111 patients. The average age was 27 years, a male predominance was noted. Initially, the majority of patients were treated in monotherapy (55.9%) and mostly with typical antipsychotic drugs (80.2%), by injection. Among those under association, 63.4% received corrective treatment and 26.8% a benzodiazepine. The prescription of a mood stabilizer and an antidepressant was noted in respectively 5.6 and 2.8% of cases. The majority of patients received typical antipsychotic drugs (53.1%) while 39.6% were under atypical antipsychotic. The follow-up period, after which a reduction of the antipsychotic dose was decided, ranged from 1 to 66 months with an average of 8.26.

Conclusion

The progression to a chronic psychosis, still has a severe connotation. The Early and adequate therapeutic care in accordance with the international recommendations, determines the prognosis and constitute a decisive moment in the evolutionary trajectory of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Hyperinsulinism as evidence of munchausen syndrome by proxy: A case report

Introduction

Hyperinsulinism is one of the most important causes of hypoglycemia. Rarely, drug toxicity can be a reason. In the context of Munchausen syndrome by proxy (MSBP), toxicity usually occurs in children due to drug administration by a parent or caregiver.

Methods

we report a case of a 2-year-old girl with hyperinsulinaemic hypoglycaemia due to insulin injections by her mother.

Case report

Mrs. W. is a 28-year-old mother of three children. In her medical history, she was diagnosed with gestational diabetes and treated briefly with insulin. She was hospitalized several times for hypoglycemia and she was diagnosed with factitious disorder. Lately, her youngest daughter aged 2 years old was hospitalized in the pediatric department for repeated unexplained loss of consciousness. The hospitalization lasted 2 months with recurrence of severe hypoglycemia. A full metabolic screen revealed no abnormalities. The mood of the mother appeared quite discordant with the situation. Strict monitoring of maternal behavior showed that the mother gives insulin injections to her daughter. She denied deliberately injecting insulin, and then she accused the health workers. She was referred to our psychiatric department and we diagnosed the MSBP.

Conclusion

MSBP should be considered particularly in patients who have been evaluated by more than one hospital and have discordant test results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mentally ill Patients Who Committed Sexual and Physical Assaults: A Study About 37 Cases of Expertise Reports

Introduction

Several studies suggest the existence of a relationship between major mental disorders and crime. However, it is important to emphasize that violent behaviors do not affect all patients and that issues of criminality among mentally ill persons only represents a small proportion.

Aims

The objective of this study is to establish the general and clinical profile of perpetrators of sexual and physical assaults.

Methods

This is a retrospective study of the records of forensic psychiatric expertise, conducted in the psychiatry department of the University Hospital of Mahdia during the period from May 1st 2000 to May 31st 2013.

Results

The general profile of the population the study was characterized by a mean age of 39 years, a sex ratio of 8.25, unemployment in 73% of cases and by the presence of a psychiatric personal history 54% of cases. Sexual and physical assaults accounted for 54.5% of cases. It was essentially in descending order: assault and battery (65%), rape (16.2%) and incest (5.4%). As for the clinical profile, schizophrenia and epilepsy were recorded each in 13.5% of cases, major depressive disorder in 8.1% of cases, bipolar disorder in 5.4% and substance abuse in 5.4% of cases. A personality disorder was observed in 48.6% cases, essentially antisocial personality (55%). Comorbidity with addictive behavior was observed in 56.7% of cases.

Conclusion

It is necessary to characterize a subgroup of patients with mental disorders, likely to commit violent crimes, in order to prevent acting out behaviors and adapt their management.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical predictors of clozapine response

Introduction

Schizophrenia is a chronic, severe, and disabling mental disorder. An evaluation of clinical predictors to clozapine was described.

Object

Identify clinical predicting factors to clozapine.

Methods

This is a cross-sectional study including patients diagnosed with schizophrenia or schizoaffective disorder according to the DSM 5 criteria and treated with clozapine.

Results

Of the 33 patients, 78.8% were males and 69.7% of them were single. The mean age was 36 years old. The mean age at the onset of the disorder was 24 years old. The mean number of hospitalizations was 6. The beginning of the mental disorder was acute in 21.2% of the cases. The mean duration of the disease course before starting clozapine treatment was 11 years. The mean duration of treatment was 19 months. The diagnosis according to DSM 5 criteria was schizophrenia in 87.9 and schizoaffective disorder in 12.1% of cases. The outcome was assessed by PANSS and BPRS scales with a symptomatic remission in 63.63% of cases. The analytical study revealed a significant correlation between favorable evolution and the latest onset of the disorder (P = 0.04), the number of previous hospitalizations (P = 0.009), disorder's duration (P = 0.032), male sex (P = 0.0004) and secondary resistance (P < 10−3).

Conclusion

The evaluation of clinical factors is important in our practice in order to improve the response to clozapine. Otherwise, adherence to treatment and quality of insight are determining factors of the treatment response.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute Psychotic Disorder and Forensic Acts: About 25 Cases

Background

The aim of this study was to identify the socio-demographic status and clinical features of patients with acute psychotic disorder and who committed a medicolegal act, seek acute psychosis implicated and raise the characteristics of this medicolegal acts.

Methods

We performed a retrospective study of 25 male patients with acute psychotic disorder. They were involuntary hospitalized in the medicolegal department of Razi, according to Article 29 of Law after committing a medicolegal act because of dementia within the meaning of article 38 of the Tunisian Penal Code.

Results

It was about a young person, average age of 27.32 years, family cohesion was often present (80%), with forensic history (20%), violence history (20%) and substance abuse (40%), having a personality disorder (25%), having a precipitating factor (32%), having an acute psychotic episode (72%), repetitive acute psychotic episode (16%), a first manic episode (8%) and drug-related psychotic disorder (4%). They had committed by order of frequency serious physical assault (43.5%), attempted murder, assault and injury followed by attacks against property (40%). The victim was mostly a family member (40%), without determination, under the influence of toxic substances (16%) and motivated by delusions of persecution (51%). The acting out was recognized (68%). The majority was indifferent (92%) and does nothing (68%).

Conclusion

The first-episode psychosis have a high-risk of acting out, early treatment may prevent some medicolegal acts. Preventing of acting out in the psychotic involves the identification of risk factors and an early treatment of mental disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Risque de récidive de violence chez le patient schizophrène

Introduction

La violence fait partie intégrante de la psychiatrie, que ce soit à travers des actes auto-agressif ou hétéroagressifs. Évaluer le risque de récidive chez les patients schizophrènes semblerait, alors, primordial.

Objectif

Évaluer le risque de récidive d’un groupe de patients suivis pour schizophrénie.

Méthodologie

C’est une étude transversale réalisée auprès de 51 schizophrènes hospitalisés au service de psychiatrie de Tahar Sfar à Mahdia. Un questionnaire préétabli a permis d’explorer les données générales et cliniques de l’échantillon. Le risque de récidive de violence a été exploré à l’aide d’une échelle actuarielle VRAG.

Résultats

Les caractéristiques générales de l’échantillon étaient : une prédominance masculine (84,3 %), un âge moyen de 37 ans et un statut de célibataire (76,5 %). Dix patients avaient des antécédents judiciaires et 6 ont été examinés dans le cadre d’une expertise pénale. Environ 80,4 % des patients ont été hospitalisés selon le mode d’office. Le diagnostic de schizophrénie indifférenciée (35,3 %) était le plus fréquent, suivi de la forme paranoïde (25,5 %) et désorganisée (21,6 %). Une personnalité antisociale a été retenue chez seulement 2 patients. L’âge moyen au début des troubles était de 26 ans. Le score moyen à l’échelle VRAG était de –4,96 ± 6,83 attestant d’un risque faible de récidive. L’étude analytique a retrouvé des liens significatifs entre un score VRAG plus élevé et : le sexe masculin (p = 0,042) ; l’âge jeune (p = 0,002) ; le célibat (p = 0,006) et l’âge précoce au début des troubles (p = 0,021).

Conclusion

L’évaluation de la dangerosité implique un regard longitudinal et qualitatif sur le risque de violence. Identifier les facteurs de risque de violence est nécessaire pour prévenir les récidives.

Postmarketing pharmacokinetic and pharmacodynamic equivalence of generic and brand atenolol in Egypt

Concerns have been raised regarding the postmarketing quality of generic drugs. This study assessed the pharmacokinetic and pharmacodynamic equivalence of generic and brand atenolol tablets in 24 healthy male volunteers in a single-dose, open, randomized, two-period crossover study under fasting conditions. Blood samples were collected for 24 h post dosing and assayed for atenolol using HPLC. Blood pressure and heart rate were measured at baseline and throughout blood sampling. The mean plasma concentration-time curves for both products were similar. Pharmacokinetic and statistical analysis indicated bioequivalence based on the mean ratios of log-transformed Cmax and AUC values. Both products had similar time courses of pharmacodynamic activity with a significant fall in blood pressure and heart rate (maximum after ~5 h) followed by a gradual increase towards baseline. Both products were well tolerated. Both atenolol products were bioequivalent in the postmarketing setting and can be used interchangeably in clinical practice.

Identification of mosquito larvicidal bacterial strains isolated from north Sinai in Egypt

In the present study, two of the most toxic bacterial strains of Bacillus sphaericus against mosquito were identified with the most recent genetic techniques. The PCR product profiles indicated the presence of genes encoding Bin A, Bin B and Mtx1 in all analyzed strains; they are consistent with protein profiles. The preliminary bioinformatics analysis of the binary toxin genes sequence revealed that the open reading frames had high similarities when matched with nucleotides sequence in the database of other B. sphaericus strains. The biological activity of B. sphaericus strains varied according to growing medium, and cultivation time. The highest yield of viable counts, spores and larvicidal protein were attained after 5 days. Poly (P) medium achieved the highest yield of growth, sporulation, protein and larvicidal activity for all tested strains compared to the other tested media. The larvicidal protein produced by local strains (B. sphaericus EMCC 1931 and EMCC 1932) in P medium was more lethal against the 3rd instar larvae of Culex pipiens than that of reference strains (B. sphaericus 1593 and B. sphaericus 2297). The obtained results revealed that P medium was the most effective medium and will be used in future work in order to optimize large scale production of biocide by the locally isolated Bacillus sphaericus strains.

[Depressive disorders and quality of life: a cross sectional study including 360 depressive patients followed at the psychiatry consultation of the Mahdia university hospital]

INTRODUCTION

Depressive disorders affect many psychosocial and functional aspects, leading to a real social handicap and an alteration in quality of life.

AIM OF THE STUDY

Our purposes were to evaluate the depressive patient's quality of life and to identify the risk factors responsible for this deterioration.

DESIGN

Our cross sectional study lasted for four months, from 1st March to 30th June 2003, and included 360 depressive patients followed at the psychiatry consultation of the university hospital in Mahdia. The data were collected with a questionnaire composed of 60 items exploring the general characteristics of subjects, the clinical and evolutional characteristics of depressive disorder and providing information on the treatment. Quality of life was measured using the SF-36 (short form) generic scale. A global average score was calculated and it was considered that quality of life was altered if the score was less than 66.7, according to the threshold value of Léan [Arch Intern Med 159 (1999) 837-843]. Moreover, an average score was calculated for each dimension, thus permitting us to identify those most affected. We standardized initial average scores.

RESULTS

The assessment of quality of life revealed a global average score of 44.6 and an alteration in 81% of patients. The study of the dimensional average scores revealed that all dimensions were affected. The standardization also revealed deterioration in all the dimensions, with the mental component particularly more affected than the physical component with respectively estimated scores of 37.3 and 39.1. The analytic approach concerned the relationship between qualitative and quantitative variables and the occurrence of an alteration in quality of life. For this effect, a bivariate study displayed a statistically significant correlation between the eight dimensions of the SF-36 and 20 variables. In order to take into account the relationships which link each variable to the others, and to avoid the bias of the bivariate study, a logistic regression analysis was carried out. Only 12 variables with truly discriminating weight emerged from this analysis. According to the number of dimensions affected, the following factors were classified in decreasing order: the presence of at least two suicide attempts, the association of a psychotropic, the partial or absent observance, the feminine gender, the presence of somatic diseases, the absence of autonomy, the low social-economic level, the presence of a recent hospitalization (<12 months), the age greater than 45 years, the marital status of widow or separated, the number of children under charge greater than five and the presence of severe side effects.

CONCLUSION

This clinimetric approach permitted us to consider the whole life of each patient suffering from depressive disorder, rather than just the angle of their illness.

Effect of prophylactic cranial irradiation dose on CNS relapse, late cognitive decline and learning disabilities in children treated for acute lymphoblastic leukemia

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Background: Prophylactic cranial irradiation is still standard in treatment of high risk childhood acute lymphoblastic leukemia. In this study we assessed the effect of cranial irradiation dose of 1,800 cGy and 1200 cGy on CNS relapse as well as the late cognitive decline and learning disabilities in both groups versus a control group using neurophysiologic and psychometric studies. Methods: 42 patients treated from acute lymphoblastic leukemia and categorized to be at high risk of relapse were assessed in this study. 28 patients received prophylactic cranial irradiation at a dose of 1,800 cGy and 14 received a dose of 1,200 cGy. A control group of 42 age and sex matched normal children was also assessed. Visual and auditory P300 studies were carried out to assess high visual and auditory processing functions. Several selected subscales of Wechsler Intelligence scale for children were applied to both subgroups as well as the control group. Results: Mean age at receiving irradiation was 5.7 years. Mean testing age was 10 years. Mean follow up period was 4.6 years.There was one CNS relapse in the group who received 1,800 cGy (3.5%) and one in the group who received 1,200 cGy (7%). As compared to the control group the group of patient who received 1,800 cGy showed a high statistically significant delay in the latency and significant reduction in the amplitude of the Visual P300 (p <0.001, =0.01 respectively). The Auditory P300 showed a significant delay in latency (p=0.01). In the group receiving 1,200 cGy only the latency of the visual P300 was significantly affected(p=0.01). The other parameters in the 1,200 cGy subgroup were not significantly affected. As for the psychometric studies there were significant differences in several subscales between controls and 1,800 cGy subgroup namely in similarities, total performance and picture compilation which were not found between controls and 1,200 cGy subgroup. Conclusions: These findings reflects that there is impairment in the intellectual abilities as well as visual and auditory processing functions in the subgroup receiving 1,800 cGy compared to the controls which was much less in the subgroup receiving 1,200 cGy at no significant increased protection from CNS relapse.

No significant financial relationships to disclose.

Stable isotopic characterization of active pharmaceutical ingredients

Stable isotopic characterization or "fingerprinting" of active pharmaceutical ingredients (APIs) is a highly-specific means of defining the provenance of these pharmaceutical materials. The isotopic analysts in this study were provided with 20 blind samples of four APIs (tropicamide, hydrocortisone, quinine HCL, and tryptophan) from one-to-five production batch(es) from one-to-five manufacturer(s). Only the chemical identity of the APIs was initially provided to the isotopic analysts. Depending on the API chemical composition, isotopic ratios of either three or four elements (13C/12C, 15N/14N, 18O/16O, and/or D/H) were measured by either elemental analyzer/isotope ratio mass spectrometry (EA/IRMS: carbon (delta13C) and nitrogen (delta15N)) or by thermal conversion-EA/IRMS (TCEA/IRMS; hydrogen (deltaD) and oxygen (delta15N)); in all cases, the isotopic results are reported in the standard delta-notation which represents part-per-thousand () variations from the isotopic ratios of international standards. The stable isotopic analyses of the four suites of APIs spanned broad ranges in absolute value (deltadelta) and in estimated specificity (a product of dynamic ranges (DR, unitless)--note that these are upper limits of specificity because some of these isotope values may be partially interdependent). The five samples of tropicamide from one production batch and one manufacturer demonstrated the narrowest ranges (deltadelta13C=0.13 ; deltadelta15N=0.52 ; deltadelta18O=0.24 ; deltadeltaD=2.8 ) and the smallest specificity of 1:30.9. By contrast, the five samples of tryptophan that came from five separate manufacturers had some of the widest isotopic ranges observed (deltadelta13C=21.32 ; deltadelta15N=5.26 ; deltadelta18O=22.07 ; deltadeltaD=55.3 ) and had the largest specificity of 1:19.6 x 10(6). The isotopic provenance of the four suites of APIs readily emerged from bivariate plots of selected isotope ratios, particularly deltaD versus delta18O.

A double-blind placebo-controlled evaluation of sublingual immunotherapy with a standardized ragweed extract in patients with seasonal rhinitis. Evidence for a dose-response relationship

BACKGROUND

There is a growing consensus on the benefits of sublingual-swallow immunotherapy in the treatment of allergic diseases.

METHODS

This randomized, double-blind placebo-controlled study was undertaken to assess the efficacy and safety of sublingual immunotherapy with standardized ragweed pollen extract tablets, in patients with an allergic rhinitis. A total of 110 outpatients were randomized (immunotherapy [I]: 55; placebo [P]: 55), of whom 99 were analyzable for efficacy (I: 48; P: 51) and 106 analyzable for safety (I: 53; P: 53). After a 28-day progression phase, the patients received a maintenance treatment during 6.5 months. Efficacy variables included a global assessment of efficacy (patient/ investigator), symptoms and medication scores as well as the frequency of asthma attacks.

RESULTS

In the active treatment group, 43 patients completed the study, versus 49 on placebo. During the whole period of pollination, the difference favoring immunotherapy was highly significant for the global assessment by the patient (p = 0.004) and by the investigator (p = 0.005). Adverse reactions were reported more often in the active treatment but mild or moderate, and they abated after dose adjustment. A subgroup analysis of those patients receiving the highest dose of immunotherapy (3 tablets 3 times a week) showed a highly significant response for rhinitis and conjunctivitis total scores by comparison to lower dosages.

CONCLUSION

This study confirms the efficacy and safety of sublingual immunotherapy and strongly suggests a dose-response relationship.

[Abdominal actinomycosis. Three cases]

BACKGROUND

Abdominal actinomycosis is a suppurating affection caused by a positive Gram germ, Actinomyces israelii. Manifestations of this rare disease are usually pseudotumoral syndromes leading to surgical exeresis. The diagnosis is obtained from the histologic report.

CASES REPORT

We report three cases in all of which this disease presents with tumoral symptoms. The first affected the sigmoïd, the second affected the mesentery and the last affected the greater omentum and abdominal wall. In no case, the diagnosis was done before surgery. In 2 of the cases reported here, the patients had an old, incontrolled intra-uterine device.

DISCUSSION

From a review of the literature, we observed that the diagnosis of abdominal actinomycosis remains difficult. The radiologic findings are nonspecific. Actinomycosis is treated with prolonged antibiotics, and surgery is only needed in abdominal abscess and fistula.

CONCLUSION

Theses observations illustrates the difficulties of the diagnosis of this rare unrecognized disease.

[Hydatid cyst of the thigh: three cases]

Three patients presented a benign soft tissue mass in the thigh muscles. Ultrasonography provided the diagnosis of hydatid cyst. Total pericystecomy was performed in all cases with no recurrence at 8 months, 3 years and 4 years. We point out the importance of preoperative diagnosis and the need for radical excision to avoid recurrence.

[Anxiety and depression in the hemodialysis patient]

Terminal renal failure and haemodialysis are precarious statute which put to the test capacities of adaptation of all patients. In this context, authors tempted to evaluate, using several instruments of measure, the importance and features of minor psychiatric disorders among 109 patients on chronic haemodialysis. Results of Goldberg test (GHQ) confronted to those of the medical interview reveal that anxio-depressive morbidity is frequent. According to results of the adaptation test to stress, our patients preserve a good mood but are often invaded by black ideas. In the field of the personal life, dissatisfaction concerns by decreasing order the lodging and the environment of the patient, the relation with parents, friends, the conjoined and medical care. This work, if it raises problems relatively unknown as much by the psychiatrist that by nephrology specialist, insist on the importance of multidisciplinary in order to assure holistic care and to improve the quality of life of patients on dialysis.

[Psychological aspects and details of care of patients on hemodialysis]

Chronic renal failure and periodic hemodialysis, by the physical reach and the therapeutic imperatives that they mislead disrupt by several ways the universe of the patient. This one is confronted to changes, or even to aggressions that undergo his body, his domestic and socio-professional life, which is accepted in general with difficulty. Indeed, our survey that concerned 109 patients on chronic hemodialysis shows that the minor psychiatric pathology is frequent and can represent a source of problems as well for the patients that for the medical and nursing staff. Besides the analysis of minor psychiatric specificities revealed by a known measure instrument (the GHQ), this work insists on the importance to take account of this aspects with the aim to enhance management and holistic care of these patients.

Activities and conformational fitting of 1,4-naphthoquinone derivatives and other cyclic 1,4-diones tested in vitro against Pneumocystis carinii

Atovaquone is a chemotherapeutic agent used to treat pneumonia caused by Pneumocystis carinii in some immunocompromised patients. A set of cyclic 1,4-diones were tested in vitro for ability to inhibit growth of P. carinii, including 22 variously substituted 1,4-naphthoquinones, one bis-1,4-naphthoquinone, and three other quinones. For comparison, the antipneumocystic primaquine and its 5-hydroxy-6-desmethyl metabolite were also tested. At 1.0 microg/ml, seven compounds inhibited growth by at least 39%, with atovaquone at 92%; of these seven, five are 2-hydroxy-1,4-naphthoquinones, while one is a 2-chloro- and another is a 2-methyl-1,4-naphthoquinone. At 0.1 microg/ml, however, the most active compound tested was the primaquine metabolite, which inhibited growth by more than 42% at this concentration. To ascertain a structure-activity relationship, all 1,4-naphthoquinones were compared conformationally by means of computer-based molecular modeling (Spartan) incorporating the Sybyl force field. Without exception, for all 21 monomers tested, the substituent at position 3 of the 1,4-naphthoquinone favored activity most strongly when it simultaneously occupied (i) space centered at about 3 A from position 3, without projecting steric bulk from the area encompassed by atovaquone's cyclohexyl ring, and (ii) roughly planar space at about 7.3 A from position 3, without projecting steric bulk perpendicularly. This structure-activity relationship may prove useful in the rational design of better antipneumocystis agents.

Antioxidant status, erythrocyte membrane lipid peroxidation and osmotic fragility in malignant lymphoma patients

We studied erythrocyte and leukocyte superoxide dismutase and catalase activities, erythrocyte malondialdehyde (MDA) and osmotic fragility and plasma L-ascorbic acid and L-dehydroascorbic acid levels in adult patients with acute lymphoblastic leukemia (ALL), Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) before and after treatment. SOD activity was elevated in leukocytes of ALL and HD patients before treatment, and borderlike-significantly elevated in leukocytes of the same patients after treatment in comparison to the control subjects. SOD activity was not changed in NHL patients before or after chemotherapy. Erythrocyte superoxide dismutase and catalase activities were elevated in the three groups of lymphomas before and after treatment. MDA level and osmotic fragility of red blood cells of patients with lymphomas were increased before and after treatment in comparison to the control group. Plasma L-ascorbic acid concentrations were decreased, whereas L-dehydroascorbic acid concentrations were increased in ALL, HD and NHL patients before and after treatment. There were also significant differences in the activities of the antioxidant enzymes, concentrations of antioxidants, MDA and osmotic fragility in the most of the malignant lymphoma patients. The present data suggest that hematological complications and autoimmune hemolytic anemia might be attributed to the oxidative stress produced by malignant lymphomas.