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Objective: The COVID-19 epidemic began in Tunisia in March 2020; health-care workers (HCWs) were suddenly confronted with a particularly stressful situation. The aim of this study was to assess the psychological responses of HCWs during the epidemic, determine the stressors and identify ways to cope.Methods: This cross-sectional study used an online questionnaire that included 62 questions. ANOVAs and t-tests were used to compare the responses between professional groups, age groups, and genders.Results: Questionnaires were completed by 368 HCWs. HCWs believed they had a social and professional obligation to continue working long hours (95.3%). They were anxious regarding their safety (93.7%) and the safety of their families (97.8%). Youthful age (p = 0.044) and female gender (ps <0.046) were identified as stressors. The availability of personal protective equipment (PPE; 99.7%) and good communication between colleagues (98.1%) and managers (91.6%) were important protective factors. Family and friend support (95.9%), following strict protective measures (99.4%), knowing more about COVID-19 (94.8%), adopting a positive attitude (89.6%), and engaging in leisure activities (96.1%) helped in dealing with this epidemic.Conclusion: This study highlights the importance of providing HCWs with infection control guidelines and adequate PPE. Communication and support within the team and maintaining family support help in coping with this stressful situation.

BackgroundAutoimmune diseases and schizophrenia share many common features. Association studies confirm a shared genetic association in the human leukocyte antigen (HLA) region between schizophrenia and most autoimmune diseases. To our knowledge, the simultaneous syndromes of Graves’ disease (GD) and type 2 diabetes (T2D) in schizophrenia are rare in Tunisia.Case presentationWe report a case of a 42-year-old woman admitted to the department of psychiatry for an acute relapse of chronic schizophrenia. Her medical history revealed that she was followed for Graves’ disease and for a type 2 diabetes mellitus. A low-resolution HLA typing was performed by polymerase chain reaction sequence-specific primer (PCR-SSP) techniques according to determine the patient’s haplotype.ConclusionsOur study suggests that the HLA DRB1*03 allele may explain a common etiology underlying the co-morbidity of Graves’ disease, type 2 diabetes, and schizophrenia in our patient.

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BACKGROUND AND OBJECTIVESThe hypothesis that human leukocyte antigens (HLAs) confer susceptibility to schizophrenic disorders has been tested by studying linkage and association in family samples. Our goal was to evaluate the role of HLA in the risk of developing schizophrenia in a Tunisian population.DESIGN AND SETTINGSBlood samples for this case-control study were collected from patients of the Department of Psychiatry at the Military Hospital of Tunisia between July 2012 and May 2013.METHODSA total of 140 patients with schizophrenia were recruited for genetic analysis. Controls included 100 persons matched for age, sex, and risk factors. Participants were tested for HLA class II alleles. HLA-DRB1 and HLA-DQB1 alleles were genotyped using polymerase chain reaction sequence-specific primers.RESULTSThis study indicates that the alleles most responsible for disease susceptibility are DRB1*03 (P<10−3) and DQB1*02 (P<10−3) (P denotes probability values). The most protective alleles are DRB1*13 (P=.013) and DQB1*05 (P<10−3). Further results revealed that DRB1*0301/DQB1*0201(P<10−3), DRB1*0401/DQB1*0301 (P<10−3) and DRB1*1101/DQB1*0301 (P<10−3) are haplotypes most conducive to disease susceptibility.CONCLUSIONThe present findings support an association between schizophrenia and the HLA-DR-DQ locus among a Tunisian population. To our knowledge, this is the first study performed to analyze the association of HLA DRB1/DQB1 alleles on schizophrenia susceptibility in Tunisia.

The way in which bones are affected in cases of sickle-cell anemia is well known. Nevertheless, advances in treatment and in methods of transfusion mean that we are increasingly seeing cases of older patients with this disease. A retrospective analysis of 222 cases of sickle-cell anemia demonstrates the radiological appearance of the skeleton in the disease and reveals the various bone segments which are particularly vulnerable at certain periods of life. Correlation of X-rays permits the discovery of lesions which are not clinically apparent. The frequency and characteristics of epiphyseal osteonecrosis and osteitis are studied. Aggravation of the bone lesions when corticoids are administered poses the problem of differential diagnosis of the disease, especially in comparison with rheumatic fever.

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IntroductionPsychosocial stressors are found in 40 to 80% of patients with psoriasis. The inability to cope with a stressful situation can induce a flare up of psoriasis. Several factors modulate our adaptive response to stress such as affective temperament (AT).ObjectivesThe objective of this study is to determine the dominant AT in patients with psoriasis and the correlation between AT and clinical features of the disease.MethodsIt was a descriptive cross-sectional study. A total of sixty five subjects and two examiners were recruited. The evaluation of temperament was made thanks the Tunisian version of TEMPS-A.ResultsHyperthymic temperament (HT) was the dominant temperament in patients with psoriasis (70%). Patients with poor response to treatment had a higher prevalence of cyclothymic (CT), depressive (DT), irritable (IT) and anxious (AT) temperament. The prevalence of CT (p=0.039), DT and AT (p=0.032) was higher in patient with joint pain and pruritus. The stressful situations induce more flare up of psoriasis in patient with AT (p=0.006) and DT (p=0.06). A patient with HT reported minimal discomfort, the patient with IT, CT, DT and AT had daily to major discomfort.ConclusionPatients with psoriasis have the same dominant temperament than general population. However, the patients with AT, CT, DT and IT have more poor response to treatment and more functionally disabling symptoms (pruritus, joint pain). The impact on quality of life and expressed discomfort would be greater.