Search

Aim: Depression is prevalent in patients with type 2 diabetes. It may have a negative impact on the management of diabetes mellitus and could affect weight. The main aim of the investigation was to evaluate the effect of antidepressant treatment (sertraline) on anthropometric variables and glycemic control in depressed type 2 diabetic patients., Methods: Thirty three type 2 diabetic outpatients depressed received open-label sertraline therapy for up to 12 weeks. Clinical outcome measures included the 17-item Hamilton depression rating. Changes in the anthropometrics variables were evaluated by measuring weight, waist circumference and by calculating body mass index at three, six and 12 weeks of treatment. In addition, fasting, postprandial plasma glucose level, glycosylated hemoglobin-A 1C measures, lipid and renal profile were obtained before and during sertraline therapy., Results: Weight decreased significantly (-2kg; p=0.000) and body mass index decreased from 30.41kg/m 2 to 29.6kg/m 2 (p=0.000). Patients lost on average seven centimeters in waist circumference (p=0.000). We also observed a modest, non-significant reduction in fasting, postprandial and glycosylated hemoglobin. We observed a significant reduction in mean score according to the Hamilton depression scale (p=0.000) CONCLUSION: Our study results suggested that sertraline produced a benefic effect on weight, body mass index and waist circumference at 12-week follow up., (Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Introduction: matricide is the murder of the mother. In this study, we report through a clinical case the circumstances of matricide and we underlined the predictive elements of the acting out., Clinical Case: mister S, 31 years old had low socioeconomic conditions. He was a single man, unemployed and consumed alcohol. He was followed for a paranoid schizophrenia, but his therapeutic observance was bad, and he was aggressive with his mother. This aggressiveness was fostered by persecution and filiations' delusions. At the moment of the crime, his mother had appeared to him as so terrifying form that he had to kill her to defend itself. This clinical case confronts us with the difficulty of matricide prevention. If the short term prediction of the violence act was possible, the medium and long terms were harder., Conclusion: the regular evaluation of psychotic patients' dangerousness is needed to reduce the acting out risqué.

Aim: to study the prevalence of depression in type 2 diabetes and to seek for a relationship between glycemic control and treatment adherence., Methods: This cross-sectional study was carried out at the outpatient department of the Tunis nutrition institute. A total of 100 diabetic patients followed for Type 2 diabetes were randomly recruited. We used a structured questionnaire to collect patients' socio-demographic, clinical and therapeutic data. The treatment adherence was assessed by using MAS, Glycemic control according to blood glucose and glycated hemoglobin (HbA1c) levels and depression and anxiety by administering a dialectal Arabic validated version of Hospital Anxiety and Depression Scale (HAD). Finaly we also used the modules on mood disorders of the mini international neuropsychiatric interview (MINI)., Results: The prevalence of depression in T2DP was 38% according to the HAD scale with severe forms in 18%. The anxiety prevalence was 31%. However, 18% of T2DP had anxious-depressive co morbidity. According to the MINI, 31% of T2DP had a mood disorder. Dysthymia was noted in 14% of cases, an isolated depressive episode in 6%. Depressed T2DP have a poor glycemic control than those no depressed. Macro-angiopathy, irregular followed-up, poor treatment adherence and unbalanced diet were associated with depression., Conclusion: The detection of depression related to somatic pathology in particular diabetes, seems essential. As a result, depression treatment may improve the overall prognosis of the associated somatic diseases.

Introduction: Adherence to psychotropic medications is affected by factors related to the treatment, to the physician, to the environment and to the patient himself. The purpose of the present study was to investigate the influence of affective temperaments on treatment adherence., Methods: Thirty six stabilized outpatients were recruited from the aftercare consultation of Psychiatry to perform Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire version (TEMPS-A) for affective temperaments and the Medication Adherence Rating Scale (MARS) for treatment adherence., Results: The total MARS score was negatively correlated with the irritable temperament score. The MARS's score relative to the attitude of patients to psychotropic medications and their negative side effects was negatively correlated with the cyclothymic, the irritable and anxious temperaments. Patients having a diagnosis of psychotic disorder had a significantly greater medication adherence and behaviour toward medication score compared to those having a diagnosis of affective disorder. A greater MARS's score for the negative side effects and attitudes to psychotropic medication was associated with medication by neuroleptics with prolonged action., Conclusion: The results of the present study suggest that patients with irritable temperament may have more difficult to follow psychotropic medications, and that patients with cyclothymic, irritable and anxious temperaments may be more attentive and sensitive toward psychotropic medications and their negative side effects., Competing Interests: The authors declare no competing interest.

Chronic inflammation increases the risk of development of human malignancies. iNOS is an enzyme dominantly expressed during inflammatory reactions and seems to play a critical role in tumorigenesis. Our aim was to assess the iNOS expression in four types of human tumors: breast, colorectal, nasopharyngeal, and melanoma, of Tunisian patients. The level of iNOS was measured by RT-QPCR in tumor specimens. We showed that the expression of iNOS was higher in breast compared to colorectal and nasopharyngeal tumors, whereas in melanoma, the level of iNOS expression was low. Significant associations were found when comparing the iNOS expression in cancers pairs such as melanoma versus colorectal (p < 0.0001), colorectal versus nasopharyngeal (p = 0.0072), and melanoma versus breast (p < 0.0001). Furthermore, iNOS expression correlated with the Breslow thickness, Clark level, and histological subtype in melanoma, while in nasopharyngeal carcinoma, significant association was seen with age at diagnosis, TNM, metastasis, response to treatment, and expression of COX-2. Furthermore, the expression of iNOS correlated with tumor size, TNM, tumor location, and histological type in colorectal cancer, and with tumor size, tumor stage, SBR grade, and triple negative cases in breast cancer. On the other hand, immunohistochemistry analysis shows that the expression of iNOS is observed in the stroma and tumor cells as well. Overall, our results highlight that iNOS is a reliable marker for advanced stage and aggressive behavior for the four types of cancer and might be a potential promising therapeutic target.

Background and Aims: β-Catenin and adenomatous polyposis coli (APC) are major components of the Wnt pathway. This study aimed to investigate the expression of β-catenin and APC in tumors and lymph nodes in colorectal cancer (CRC) patients and the mutational spectrum of the genes coding these proteins., Methods: Expression of APC and β-catenin was examined in 124 tumors and 41 lymph nodes. Exon 3 of CTNNB1 and the mutation cluster region (MCR) in exon 15 of the APC gene were screened for mutation by PCR-sequencing., Results: Nuclear/cytoplasmic immunostaining of β-catenin was detected in 58.1 and 48.8% in tumors and lymph nodes, respectively. In tumors, abnormal expression of β-catenin correlated with tumor size and with those in lymph nodes. Membranous β-catenin expression occurred in 41.9 and 14.6% of tumors and lymph nodes, respectively. In tumors, lack of membranous β-catenin correlated with high invasiveness and metastatic potential. Positive immunostaining for APC was observed in 2 and 14% of tumors and lymph nodes, respectively. Overexpression in nucleus/cytoplasm and lack of membranous β-catenin significantly correlated with a reduced overall survival. Among 25 tumors, four harbour mutation in Ser33 and Ser47 and overexpress the β-catenin in the nucleus/cytoplasm. Mutations were identified in the APC gene in 13 tumors and six mutations were novel., Conclusions: Positive association between aberrant expression of β-catenin in the nucleus/cytoplasm of tumors and lymph nodes was observed. Nucleus/cytoplasmic accumulation of β-catenin and loss of membranous expression are related to reduced survival and could serve as a candidate prognostic predictor., (Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.)

Objectives: This paper focus on studying the prevalence of alexithymia in diabetes type 1 and type 2 and its impact on diabetes's clinical and therapeutic characteristics. We also studied the relationship between alexithymia and emotional disorders in diabetics., Materials and Methods: The study involved a sample of 125 diabetic patients, among whom 50 had type 1 and 75 had type 2 diabetes mellitus compared with respectively 70 and 52 control subjects matched for age and sex. Alexithymia was assessed using the Toronto Alexithymia Scale, while emotional disorders were evaluated using the Hospital Anxiety and Depression Scale., Results: Type 1 diabetics were more alexithymic than controls while type 2 diabetics had higher cognitive component score than control subjects. Alexithymic type 1 diabetics had a higher average of fasting blood sugar than non-alexithymic patients did (P=0.021). Moreover, with type 1 diabetes, erectile dysfunction was associated with difficulties in identifying feelings (P=0.012). We found that the presence of depression was a predictor of alexithymia in type 1 diabetes (β=1.78, P=0.04) and the presence of psychiatric history was indicative of the presence of alexithymia in type 2 diabetes (β=2.09, P=0.042)., Conclusion: Given the impact of alexithymia on diabetes types 1 and 2, the detection and treatment of alexithymic subjects are important for a better prognosis of diabetic disease., (Copyright © 2014. Published by Elsevier Masson SAS.)

Background: Burnout is a syndrome which affects preferentially help professions, having a strong emotional interpersonal implication., Aim: To assess the prevalence of burn out in a sample of Tunisian nurses, and to determine its causes and perceived repercussions., Methods: In a first step, we assessed the work conditions, the perceived burn out and its possible consequences in 142 nurses from 12 different wards. In a second step, we used the Malasch Burn Inventory to assess the burn out symptoms in ours ample., Results: More than two thirds (69%) of our sample had a burn out. Forty five point eight percent of the affected professionals had a high level of emotional distress, 36.6% had a high level of depersonalization and 22.5% had a low level of professional fulfillment. The high caseload was the first cause of burn out (72.5% of professionals) and was associated to a moderate level of burn out (OR=3.80; 95%IC: 1.079-13.420 ; p = 0.038). Role ambiguity and undefined responsibilities were associated to a high level of emotional distress (p=0.04) and depersonalization (p=0.03), and a low level of professional fulfillment (p=0.0001). High scores of emotional distress were associated to a high number of work hours (p=0.006) and less than 10 years in carrier duration (p=0.008). In our study, feelings of uselessness were associated to high levels of emotional distress (p=0.05) and depersonalization (p=0.002) on the one hand, and to a lower level of personal fulfillment on the other hand (p=0.04). Moreover, we found that cases with suicide ideations had a higher level of burn out (p=0.04). Concerning physical symptoms, emotional distress was associated to multiples somatic complains., Conclusion: Our results corroborate partially with those of the literature and illustrate some parameters that can be the cause of burnout, such as working conditions, role ambiguity, and lack of experience among the young nurse. Therefore, it is important to take into consideration this various factors had their impact on quality of life of caregivers.

Objectives. To estimate the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) in a population aged over sixty years with type 2 diabetes and to study the impact of anxiety and depression on glycemic balance and disease outcome. Results. The prevalence of anxiety and depression in the 62 subjects included in the study was, respectively, 40.3% and 22.6%. We found a relationship between these disorders and complicated diabetes. The subjects having an imperfectly balanced diabetes had a higher average anxiety score than those having a good glycemic control (9.1 ± 4.2 versus 6.5 ± 3.1; P = 0.017). No relationship was found between diabetes balance and depression. Conclusion. Association between anxiety and depressive disorders and diabetes is frequent and worsens patients' outcome, in terms of diabetes imbalance as well as in terms of diabetic complications. Our study shows that there is need for physicians to detect, confirm, and treat anxiety and depressive disorders in elderly diabetic patients.

Few studies have looked into the impact of diabetes on the parents' quality of life. One study, carried out by a Tunisian team in 2011, assessed the anxiety, depression and quality of life of 70 parents of children with diabetes as well as the factors associated with these different parameters. It showed that psycho-affective difficulties are frequent among parents. Strategies must be developed and assessed to provide suitable psychological, medical and social support.

Introduction: Alterations in different signaling pathways are involved in initiation and progression of colorectal carcinoma, such as those related to p53, MLH1, p16INK4a, Kras, etc., Aim: This study was conducted with the aim to investigate the expression of p16INK4a and p53 in colorectal cancer (CRC) and evaluated their correlation with major clinicopathologic features and patients' survival., Materials and Methods: The expression of p16INK4a and p53 were analyzed by immunohistochemistry on 70 paraffin specimens of CRC., Results: Positive immunostaining for p16INK4a and p53 was observed in 27 (38.6%) and 53 (80%) cases, respectively. Significant correlation between loss of p16INK4a expression and tumor size was found (P=0.008), whereas overexpression of p16INK4a correlated with favorable prognosis parameters, such as absence of lymph node metastasis (P=0.029) and early stage of CRC (P=0.027). Furthermore, p53 overexpression significantly correlated with distal tumor location (P=0.022) and was related to a better overall survival in the group of patients with distal colon carcinomas (P=0.002). Patients with p16INK4a-positive tumors had a significant longer overall survival time than patients with p16INK4a-negative carcinomas (P=0.033). In addition, Cox regression model showed that overexpression of p16INK4a is an independent factor for prognosis with depth of invasion, p53 accumulation, and coincident abnormal expression of p16INK4a or p53., Conclusion: Our data suggest that the assessment of both p53 and p16INK4a expression might be helpful in predicting prognosis in patients with colorectal cancer.

The methylation of CpG islands in the promoters is associated with loss of protein via repression of gene transcription. Several studies have demonstrated that tumour suppressor and DNA repair genes are often aberrantly hypermethylated in colorectal cancer. The present study was conducted to examine whether the methylation profile of p16INK4a and hMLH1 (human mutL homologue 1) promoters was associated with clinical features and patients' survival in CRC (colorectal carcinoma). Aberrant methylation of p16INK4a and hMLH1 promoters was found in 47.2 and 53.4% of tumours respectively. For adjacent non-tumoral mucosa, p16INK4a was fully unmethylated in 30% of the cases, whereas hMLH1 was predominantly unmethylated (76%). Methylation of p16INK4a correlated with gender and tumour size (P=0.005 and 0.035 respectively), whereas those of hMLH1 significantly correlated with overall survival (P log rank=0.007). Concomitant methylation of p16INK4a and hMLH1 was associated with TNM (tumour, lymph node and metastases) stage and tumour size (P=0.024 and 0.021 respectively). Our data show that loss of hMLH1 expression through aberrant methylation could be used as a marker of poor prognosis in CRC.

Silencing of gene expression by aberrant methylation at the CpG islands is common in human tumors, including colorectal cancer. This epigenetic alteration affects promoter of genes having crucial cellular functions such as tumor suppressor, DNA repair, apoptosis, cell adhesion, etc. We investigated the methylation status in the promoter regions of the RARβ2, RASSF1A, DAPKinase, and CDH1 genes in 73 colorectal carcinoma and 43 paired normal tissues of Tunisian patients using methylation-specific PCR assays. The association between methylation status and the clinicopathological features was evaluated. To determine whether aberrant methylation affects gene expression, we performed immunohistochemistry analysis for E-cadherin and COX-2, a target gene of RARβ2. The methylation frequencies vary from 80.8% for RARβ2 to 35.6% for RASSF1A while in non-tumor-paired samples; the frequencies of methylation are significantly lower for all the fourth genes tested. The methylation status did not correlate with any of the clinical features considered; however, aberrant methylation of RARβ2 was associated with a shortened overall patients' survival (p log rank = 0.026); nevertheless, it needs to be confirmed on larger sample size. Moreover, a significant inverse association was observed between methylation status of RARβ2 and COX-2 protein expression in tumor specimen (p = 0.014). On the other hand, we found that loss of E-cadherin expression was significantly associated with aberrant methylation of the CDH1 promoter (p = 0.005). Our findings showed that RARβ2 was frequently methylated in colorectal cancer and correlated with a worse prognosis and high expression of COX-2 suggesting a link between these two proteins in colorectal carcinogenesis. We also showed that epigenetic alteration of CDH1 is a major mechanism of the loss of E-cadherin protein expression in primary colorectal tumors.