We translated and adapted the WOMAC index into Arabic to suit Tunisian people. The translated questionnaire is reliable but not valid in its original form. We propose the use of a modified version of PF subscale of the WOMAC, although the psychometric properties of this instrument must be examined in a larger population.
Concerns about the worldwide decline in semen quality over the past 50 years are increasing. Western countries have shown a decline in semen quality. However, in non-Western countries studies are sparse. We investigated trends in semen parameters between 1996 and 2007 in the Sfax area of southern Tunisia in a sample of 2940 men in infertile relationships. Age at semen collection, duration of sexual abstinence, volume of seminal fluid, the sperm count, percentages of motile and morphologically normal spermatozoa, and semen leukocyte concentration were determined. Linear regression was used to examine trends over time in sperm count, sperm motility, normal morphology, and semen leukocyte concentration. Mean age and semen volume did not change between 1996 and 2007. Data adjusted for age and abstinence showed a decreasing trend in sperm count and percentage of normal morphology over the last 12 years (R 2 5 0.71, P 5 .0004, and R 2 5 0.87, P , .0001, respectively). There was no significant change in sperm motility. However, semen leukocyte concentration increased significantly over time (R 2 5 0.38, P 5 .03). These results coincide with the high prevalence of genital infectious diseases in the Sfax area, suggesting that infection may be a potential contributing factor in semen quality decline.
The Arabic version of the ODI adapted to the Saudi population has high metrological qualities. Further studies assessing its responsiveness to change should be conducted.
Translated into Arabic, the ASES index was found to possess high metrological qualities. While the index has been satisfactorily validated with regard to a Tunisian population, additional studies are needed to verify its applicability to other Arab populations.
Central nervous system involvement in hydatidosis is rare compared to other somatic localizations: 1-5%. It is schematically divided into two major types: cerebral involvement and spinal involvement. The brain is a rare localization of hydatid cyst accounting for only 2% of all hydatid disease. The psychiatric manifestations revealing cerebral hydatidosis remain exceptional and often unrecognized and neglected by practitioners despite their potential severity. We report two original observations of fatal cerebral hydatidosis revealed by behavior change (psychomotor agitation, aggressiveness, persecutory delusion, and auditory and visual hallucinations) insufficiently explored in two women aged 45 and 17. The possibility of cerebral hydatidosis must always be evoked in front of any psychiatric symptomatology that remains unexplained in endemic areas for echinococcosis.
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