Clinical selectivity of antidepressants with pharmacological specificity still remains under debate.

In the open trial presented below, the effects of fluoxetine, a selective serotonin re-uptake inhibitor (SSRI), were compared across two groups of depressive inpatients contrasted on their symptomatological expression (agitated/anxious versus retarded/blunted affect). Sixteen patients (8 in each groups) were included in the 4-weeks treatment period and submitted to a weekly-based evaluation. Global depression, retardation, emotional blunting, agitation, anxiety and mood profile were assessed.

Significant improvements of the HDRS and MADRS scores were observed in both groups. Although no group x treatment interaction was found on the global scores of depression, a differential effect according to the group was observed on anxiety, agitation, irritability and emotional lability.

These preliminary results support the hypothesis that the effect of fluoxetine on positive clinical dimensions could lead to a differential effect in patients with agitation/anxiety when compared with patients with retardation/blunted affect.

The university transition life is the most frequent source of problems. These problems results from stress academic and family relationship dysfunction. These stress factors can pose a risk in student's mental and physical health.

However, stress is the result of a transaction between the person and the environment.

Of this work is to validate the specific scale of perceived stress among Tunisian students.

To evaluate the perceived stress among students, we used the specific scale of perceived stress (Boujut E, Bruchon-Schweitzer M, 2003). This scale was constructed and validated on French students.

The scale is as a self-administered questionnaire consisting of 25 items.

The validation was made on a representative sample of university students (n = 500) randomly selected.

The main properties studied were: acceptability, reliability (Pearson’s coefficient ‘r’), face validity and content validity (Cronbach's alpha).

The acceptability of the questionnaire was good, less than 10% of students were unable or unwilling to complete the questionnaire. The Pearson coefficient showed good reliability for this scale r = 0.98, p < 0.05. The Cronbach's alpha was acceptable for all items of the scale α = 0.81.

The specific scale of perceived stress is valid among Tunisian students. It is now available for clinicians to measure the level of perceived stress among students.

Gaining access to university is a potential stressful situation. This stress results from external factors such as lifestyle change, academic stress and family relationship dysfunction but also other factors of personal vulnerability as neuroticism. These factors may represent a risk in student's mental and physical health.The objective of this work is to extract the various predictors of stress among Tunisian students.

To evaluate the perceived stress among students, we used the specific scale of perceived stress (Boujut E, Bruchon-Schweitzer M, 2003). Neuroticism among students was evaluated using the Neuroticism scale of the NEO-PI-R (Costa and McCrae, 1985).Both scales have been validated among Tunisian students.Students also answered a general questionnaire with questions relating to conditions of life like the type of lodgment and socio-economic status of parents.Our study was conducted on a representative sample of university students (n = 500) randomly selected.The correlation between perceived stress and neuroticism and between perceived stress and the various issues was measured by Pearson's ‘r’.

The Pearson coefficient showed a weak correlation between the total score of perceived stress and neuroticism score r = 0.42.The correlation between the total score of perceived stress and some questions of the questionnaire was good ;like the type of housing, socio-economic level, the means of transport used to go to school ; p < 0.05 for each of these issues.

Stress among Tunisian students is due to external factors rather personal factors.

Neuroticism is one of the five fundamental dimensions of personality based on the model of the Big Five. It is defined as the general tendency to experience unpleasant emotions such as hostile emotions, feelings of anxiety or depression.

The objective of this work is to validate the Neuroticism scale of the NEO-PI-R (Costa and McCrae, 1985) among Tunisian students.

Neuroticism among students was evaluated using the Neuroticism scale of the NEO-PI-R (Costa and McCrae, 1985). This scale provides an overall score of Neuroticism Lire phonétiquement Dictionnaire - Afficher le dictionnaire and also different scores for each of the six Neuroticism facets are: anxiety, depression, anger / hostility, impulsivity, social shyness and vulnerability to stress.

The validation was made on a representative sample of university students (n = 500) randomly selected.

The main properties studied were: acceptability, reliability (Pearson’s coefficient ‘r’), face validity and content validity (Cronbach’s alpha).

The acceptability of the questionnaire was good, less than 10% of students were unable or unwilling to complete the questionnaire. The Pearson coefficient showed good reliability for this scale r = 0.96, p < 0.05. The Cronbach’s alpha was acceptable for all items of the scale α = 0.73.

The Neuroticism scale of the NEO-PI-R (Costa and McCrae, 1985) is valid in Tunisian students. It is now available for clinicians to measure the level of neuroticism among students.

Sleep apnea (SA) is a common chronic disease that leads to higher morbidity and mortality; however, illness perceptions (IP) in patients with SA remain not well explored.

We aimed to assess the IP in patients with SA and to correlate them with the level of sleepness, the severity of the disease and the existence of a concomitant depression.

Sixty four untreated patients investigated for sleep apnea (mean age: 54 years, sex ratio = 2/3) participated in our study.

Excessive daytime sleepness (EDS) was assessed by the ESS, the severity of the disease by the apnea/hypopnea index (AHI) and the depressive symptoms by the HADs. Illness representation was measured by the Brief Illness Perceptions Questionnaire (B-IPQ); High scores reveal a more threatening perception of the illness.

In terms of cognition, our patients feel quite bothered by their symptoms (7/10) and enable to control their illness (1.3/10), but they believe that their treatment will be effective (7/10). Emotionnally, they feel pretty concerned (6/10) and negatively affected by their disease (6.1/10).

We also observed that the score of the B-IPQ (6/10 ± 1.5) was positively correlated to EDS (p = 0.004), the severity of the disease (p = 0.02) and the coexistence of a depression (p = 0.005).

Several factors seem to have an impact on the vision of the sleep-apnea's patients towards their disease and their life as well. The study of the IP seems interesting to better understand the coping behaviour of such patients so that their adherence to the treatment would be improved.

Psychiatric disorders have a remarquable frequency in multiple sclerosis. The leading group of these disorders consists of affective disorders. These psychiatric conditions can worsen the outcome of multiple sclerosis, thus contributing to increase the burden of the disease to both patients and relatives. Managing such a complicated situation needs a focus on the underlying links between affective disorders and multiple sclerosis.

To examine the hypotheses proposed to explain the high prevalence of affective disorders in patients with multiple sclerosis.

Literature was reviewed using the Medline database and the following keywords “bipolar disorder” “affective disorder”, “mania” and “multiple sclerosis”.

PubMed research returned 13 results. After manual inspection, 10 articles were retained and examined. The cause of the high comorbidity between multiple sclerosis and mood disorders is regarded as being multifactorial: the medication used in multiple sclerosis possibly inducing/exacerbating mood disturbances, the demyelinazing brain lesions which could bring about depression or mania, genetic overlapping with affective disorders and last the psychological reactions and adjustment difficulties to the neurological handicap.

Despite the fact that the higher prevalence of affective disorders in multiple sclerosis is well established, these disorders still remain underdiagnosed and undertreated. A shift towards a better assessment of the psychiatric comorbidity in multiple sclerosis patients and the optimal treatment of those disorders is fundamental.

The authors have not supplied their declaration of competing interest.

Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis.

An observational retrospective cross-sectional study including neonates, small infants, and children who underwent balloon pulmonary valvuloplasty in the period from 2007 to 2016 in the cardiac catheterisation unit of the paediatric cardiology department in Cairo University. Multivariable models were built to report the predictors of the outcome of balloon pulmonary valvuloplasty and its complications.

A total of 1200 patients were included in the study and divided according to age into 3 groups: neonates and early infants (n = 282), infants (n = 362), and children (n = 556). Procedural success, defined as a drop pressure gradient across the pulmonary valve to less than or equal to 50% of the baseline measurements, was achieved in 82.7% of the patients. Multivariate analysis revealed that only infundibular pulmonary stenosis (p value 0.032), supravalvular in association with valvular pulmonary stenosis (p value <0.001), and pulmonary valve diameter by angiogram (p value <0.001) were significant predictors of success. The presence of supravalvular in association with valvular pulmonary stenosis (p value <0.001) was associated with a lower weight (p value 0.007) and higher right ventricular pressure before the intervention (p value <0.001), and a minor immediate drop in the pressure gradient post-intervention (p value <0.001) was found to be the most significant predictor of the occurrence of complications.

The absence of infundibular and supravalvular stenosis and a large pulmonary valve diameter were the most significant predictors of success.

The use of ultrasound for assessing diaphragmatic dysfunction after paediatric cardiac surgery may be under-utilised. This study aimed to evaluate the role of bedside ultrasound performed by an intensivist to diagnose diaphragmatic dysfunction and the need for plication after paediatric cardiac surgery.

We carried out a retrospective cohort study on prospectively collected data of postoperative children admitted to the paediatric cardiac ICU during 2013. Diaphragmatic dysfunction was suspected based on difficulties in weaning from positive pressure ventilation or chest X-ray findings. Ultrasound studies were performed by the paediatric cardiac ICU intensivist and confirmed by a qualified radiologist.

Out of 344 postoperative patients, 32 needed diaphragm ultrasound for suspected dysfunction. Ultrasound studies confirmed diaphragmatic dysfunction in 17/32 (53%) patients with an average age and weight of 10.8±3.8 months and 6±1 kg, respectively. The incidence rate of diaphragmatic dysfunction was 4.9% in relation to the whole population. Diaphragmatic plication was needed in 9/17 cases (53%), with a rate of 2.6% in postoperative cardiac children. The mean plication time was 15.1±1.3 days after surgery. All patients who underwent plication were under 4 months of age. After plication, they were discharged with mean paediatric cardiac ICU and hospital stay of 19±3.5 and 42±8 days, respectively.

Critical-care ultrasound assessment of diaphragmatic movement is a useful and practical bedside tool that can be performed by a trained paediatric cardiac ICU intensivist. It may help in the early detection and management of diaphragmatic dysfunction after paediatric cardiac surgery through a decision-making algorithm that may have potential positive effects on morbidity and outcome.

To establish normative dimensions for the depth of the olfactory fossa, the length and angulation of the lateral lamella of the cribriform plate, and the height of the ethmoid roof, in adult males and females.

The study assessed 300 high resolution, multislice computed tomography scans of the paranasal sinuses, which were evaluated using Merge Efilm software (version 2.0.0, build 37).

According to the original Keros classification, the type II olfactory fossa was the commonest type in men (66.7 per cent), while the type I fossa was commonest in women (53 per cent). A difference of 3 mm or more between the depths of the right and left olfactory fossae was present in 11 per cent of men and 2 per cent of women. The lateral lamella of the cribriform plate was significantly shorter and less oblique in men than in women. The length of the lateral lamella was greater anteriorly than posteriorly in both sexes. There was a statistically significant difference between the angle of the lateral lamellae, comparing right and left sides. The ethmoid roof was lower in women than men.

The observed differences between men and women and between the right and left sides are of surgical importance, and should alert surgeons to the need for thorough, systematic pre-operative evaluation of computed tomography scans.

La selectividad clínica de los antidepresivos con especificidad farmacológica se sigue debatiendo todavía.

En el ensayo abierto presentado más adelante, se compararon los efectos de la fluoxetina, un inhibidor selectivo de la recaptación de la serotonina (SSRI), a través de dos grupos de pacientes internos depresivos que contrastaban en su expresión de síntomas (agitados/ansiosos frente a pacientes con retardo/embotamiento afectivo). Dieciséis pacientes (8 en cada grupo) fueron incluidos en el período de tratamiento de 4 semanas y sometidos a una valoración semanal. Se evaluó la depresión global, el retardo, el embotamiento emocional, la agitación, la ansiedad y el perfil de estado de ánimo.

Se observaron mejorías significativas de las puntuaciones en la HDRS y la MADRS en ambos grupos. Aunque no se encontró interacción grupo tratamiento en las puntuaciones globales de depresión, se observó un efecto diferencial sobre la ansiedad, la agitación, la irritabilidad y la labilidad emocional según el grupo.

Estos resultados preliminares apoyan la hipótesis de que el efecto de la fluoxetina sobre las dimensiones clínicas positivas podría llevar a un efecto diferencial en los pacientes con agitación/ansiedad, comparados con los pacientes con retardo/embotamiento afectivo.