Levetiracetam (LEV) is frequently prioritized in epilepsy management due to its minimal drug-drug interactions and perceived metabolic neutrality. However, its potential involvement in severe electrolyte disturbances remains scarcely documented. We describe a 36-year-old male admitted for status epilepticus and initiated on a dose-escalated LEV regimen (2000 mg/day). The clinical course was complicated by the development of severe, recalcitrant hypokalemia (nadir 2.8 mmol/L). This electrolyte depletion proved remarkably refractory to intensive parenteral and enteral potassium chloride supplementation. A systematic diagnostic workup successfully excluded extrarenal losses, primary hyperaldosteronism, and renal tubular acidosis. Given the specific temporal alignment with drug intensification, LEV was substituted with phenobarbital. This intervention led to a rapid and sustained restoration of potassium homeostasis within seven days post-withdrawal. Causality was evaluated as highly probable (I5; C2S3). This case, corroborated by recent large-scale epidemiological findings, highlights LEV as a potential trigger for refractory potassium depletion in the adult population. Unlike other antiepileptics, LEV lacks carbonic anhydrase inhibition, suggesting alternative mechanisms such as iatrogenic transcellular shifts or interference with renal ion conductance. We emphasize the necessity of rigorous metabolic monitoring during LEV dose escalation and advocate for an update to official safety labeling to include this metabolic risk, ensuring earlier clinical detection and improved patient safety.

High-intensity physical exercise induces oxidative stress, muscle damage, and changes in immune markers. However, these parameters' acute and delayed responses to the 5-m shuttle run test (5-m SRT) and their relationship with performance have yet to be assessed. This study evaluated the effects of the 5-m SRT on acute and delayed responses related to antioxidants, oxidative stress markers, muscle damage, and immunity, and their relationship with performance in rugby players. Sixteen amateur rugby players completed the 5-m SRT with performance measured by distance covered and the rating of perceived exertion (RPE) was recorded 30-min post-test. Blood samples were collected before, immediately after, and at 24-, 48-, and 72-h post-exercise. Delayed onset of muscle soreness (DOMS) was assessed before the test, at 24, 48, and 72 h. The 5-m SRT significantly increased white blood cells (WBC) and neutrophils (NEU) 5-min post-exercise, with levels decreasing over 72 h. Lactate dehydrogenase (LDH) and creatine kinase (CK) peaked at 5min and subsequently declined at 24 and 48 h. Antioxidants and oxidative stress markers peaked 5-min post-exercise, while DOMS was highest at 72 h. Significant correlations were found between performance and NEU response (p = 0.001, r = 0.74) and changes in lymphocytes (LYM) from 5 min to 48 h (p = 0.005, r = – 0.66) and 72 h (p = 0.004, r = – 0.67). The 5-m SRT affects post-exercise immune function, oxidative stress, and muscle damage responses, needing 72 h for recovery to baseline levels. Despite correlations between performance and changes in NEU and LYM, these markers stayed within normal ranges, indicating that their fluctuations may not directly influence performance.

Background:Cervical cancer is the second most common gynecological cancer in Tunisia. The HPV vaccine is a crucial tool for preventing and controlling this disease. Training healthcare providers and equipping them with adequate knowledge is essential. This study aimed to evaluate the effectiveness of an educational intervention video (EIV) on the knowledge and perceptions of HPV, cervical cancer, and the HPV vaccine among Tunisian female students. Methods:A quasi-experimental study involving a single interventional group was conducted among 158 female students. Participants were interviewed before and after watching the EIV. The chi-square test using McNemar's method assessed variations between pre- and post-intervention responses. A p-value <0.05 was considered statistically significant. Results:The average age of participants was 19.74±1.7 years. The EIV had a positive impact on the scores for knowledge and perceptions related to HPV and cervical cancer. A significant difference was observed between the intention to receive the HPV vaccine and perceived severity of HPV, perceived benefits of vaccination, and perceived barriers. Notably, 50.6% of female students believed the HPV vaccine should be available upon request and covered by health insurance, while 46.2% thought it should be included in the Tunisian vaccination schedule. Conclusion:The EIV improved students' knowledge and perceptions about HPV, cervical cancer, and the HPV vaccine. Tailored educational strategies may enhance vaccine acceptance, especially when integrated early in academic training.

Imidacloprid (IMI) has been known to cause nephrotoxicity. Some reports claim that Urtica urens L. (U. urens) can reduce toxicity. The present study was undertaken to evaluate the protective effect of U. urens against this toxicity. Rats were divided into control group, three groups treated with IMI at 50, 200, or 300 mg/kg/day and three groups injected with IMI (50, 200, or 300 mg/kg/day) + 100 mg/kg/day of U. urens, for 60 days. Urine and blood samples were collected for dosage of biochemical levels. Kidneys were removed for oxidative stress and histological examination. IMI caused acute renal injury and increased the levels of biochemical and tissue MDA. It also decreased the levels of antioxidant enzyme activities. Urtica urens injection improved the histological and all biochemical parameters. IMI induced an acute renal injury accompanied with disturbance of oxidant status U. urens injection provided a significant protection thanks to antioxidant properties.

BACKGROUND:The effect of tacrolimus (TAC) on oxidative stress after kidney transplantation (KT) is unclear. This study aimed to evaluate the influence of TAC trough levels of oxidative stress status in Tunisian KT patients during the post-transplantation period (PTP). METHODS:A prospective study including 90 KT patients was performed. TAC whole-blood concentrations were measured by the microparticle enzyme immunoassay method and adjusted according to the target range. Plasma levels of oxidants (malondialdehyde (MDA) and advanced oxidation protein products (AOPP)) and antioxidants (ascorbic acid, glutathione (GSH), glutathione peroxidase (GPx), and superoxide dismutase (SOD)) were measured using spectrophotometry. The subjects were subdivided according to PTP into three groups: patients with early, intermediate, and late PT. According to the TAC level, they were subdivided into LL-TAC, NL-TAC, and HL-TAC groups. RESULTS:A decrease in MDA levels, SOD activity, and an increase in GSH levels and GPx activity were observed in patients with late PT compared to those with early and intermediate PT (p < 0.05). Patients with LL-TAC had lower MDA levels and higher GSH levels and GPx activity compared with the NL-TAC and HL-TAC groups (p < 0.05). CONCLUSION:Our results have shown that in KT patients, despite the recovery of kidney function, the TAC reduced but did not normalize oxidative stress levels in long-term therapy, and the TAC effect significantly depends on the concentration used.

Lancehead snakes of the genus Bothrops are responsible for 90% of the snakebites in Latin America. The objective of this study was to assess the LD50, physical, and hematological manifestations induced by B. atrox venom in male and female mice inoculated by different routes. B. atrox venom was inoculated in male and female mice by intramuscular (IM), subcutaneous (SC), intravenous (IV), and intraperitoneal (IP) routes. B. atrox venom LD50 was lower in male than female groups, regardless of the injection route. However, it was the lowest when the venom was inoculated by the IP route. Moreover, comparisons between male and female responses according to the injected venom dose showed higher edema-forming, local hemorrhagic, dermonecrotic, and myotoxic activities in male than in female mice. While the minimal hemorrhagic, and necrotic doses were not statistically different between the two groups, the difference between males and females was more pronounced at high venom doses. Hematological parameter changes were also more significant in male than in female mice. The venom decreased the levels of total leukocytes after 24 h of injection in male and female mice, with a more profound decrease in the male group. The micronucleus test, a tool for genotoxicity assessment, documented the mutagenic effects of B. atrox on leucocytes. We demonstrate the higher susceptibility of male mice to B. atrox venom than females. Sex differences must be considered when conducting experimental studies on snake venoms.

La sous-déclaration des effets indésirables médicamenteux (EIM) est un problème majeur en pharmacovigilance (PV) et de nombreuses études sur le sujet montre une faible participation des médecins généralistes. Notre objectif était d’évaluer le niveau de connaissance des médecins généralistes du secteur privé de la région de Sfax sur l’activité de la pharmacovigilance, de déterminer les causes de réticences à la déclaration des EIM et faire participer plus les médecins généralistes à l’activité de pharmacovigilance en vue d’une meilleure prise en charge des patients. Nous avons mené une étude transversale descriptive auprès des médecins généralistes exerçant dans le secteur privé à Sfax. Cette étude s’est déroulée entre le 02/09/2021 et le 29/11/2021. Nous avons obtenu 49 réponses au questionnaire. Le sex-ratio des médecins participants (homme/femme) était égale à 1,45. L’âge moyen des médecins généralistes était de 54 ans. Notre étude a montré que les médecins généralistes de la région de Sfax se sentent concernés par ces EIM et qu’ils ne déclarent pas à la PV, ainsi 45 % des médecins participants ont eu des EIM graves chez leurs patients et que 30 % des médecins n’ont jamais déclaré à la pharmacovigilance. La première cause de sous notification est le manque de renseignement sur le déroulement des enquêtes de pharmacovigilance (79 %). Les EIM attendus, peu graves ou très fréquents sont négligés par les médecins participants. Les autres EIM rares, graves et peu fréquents voir inconnus sont susceptibles d’être déclaré. Les pistes envisagées pour améliorer le taux de notification des EIM à la PV par les médecins généralistes sont principalement une meilleure information et formation en pharmacovigilance et la déclaration directe via le site internet.

Self-medication with antibiotics (SMA) becomes generally common practice due to multiple factors. This study aimed to identify the prevalence and factors associated with SMA among patients and medical students in Tunisia. A cross-sectional study was conducted between March 2018 and October 2018 on 752 subjects. The sample of this study consisted of 153 patients in the outpatient clinic of two Universities Hospitals (Habib Bourguiba and Hedi Chaker in Sfax, Tunisia) and 559 students in the Medical universities of Tunisia. The inclusion criteria included adult patients (≥18 years) who see in one of both hospitals during the study and Medical students who accepted to access the questionnaire on Google forms. Data were collected through a structured questionnaire reliable and validated by a pilot test in a subsample of participants. Data were analyzed using SPSS. Student’s t-test and Mann-Whitney U test were used to compare differences between quantitative variables. Pearson's chi-square test was carried out to evaluate associations between qualitative variables. Of 752 participants, 71.68% self-medicated (70.9% of patients and 72% of medical students). There were no significant differences in SMA between patients and medical students (P=0.738). Amoxicillin was the most commonly used antibiotic for SM by patients (67.6%) and medical students (74.5%) (P=0.149). Furthermore, the most common indications for the use of self-medicated antibiotics were angina, influenza-like illness, and fever were the most frequent indications for the use of self-medicated antibiotics by patients (56.5%, 60.2%, 28.7%) and medical students (60.1%, 40.8%, 17.9%) (P=0.494, P=0.001, P=0.012). Furthermore, for reasons following previous experience, time-saving, and easy availability of drugs from pharmacies, the difference was statistically different between the two groups, with an increase in medical students compared to patients. The major source of information was pharmacies. Ninety-seven patients (90%) and 364 students (88.8%) got their antibiotics based on pharmacist consultancy. SMA is a common practice among patients and medical students in Tunisia. This infers the need for interventions to prevent the SMA, such as the implementation of appropriate health organizations for public education concerning the risks and consequences for the health of SMA.

The present study aimed to evaluate the in vitro antibacterial and antioxidant activities and the in vivo wound healing performance of a polysaccharide isolated from Glycyrrhiza glabra named PSG. It was structurally characterized by Fourier transformed infrared (FT-IR) spectroscopy, which confirmed the presence of different polysaccharides functional bands. The antioxidant capacity of PSG was determined in vitro and evaluated in vivo through the examination of wound healing capacity. Thirty two rats were randomly divided into four groups: group I was treated with physiological serum (negative control); group II was treated with "CYTOL CENTELLA®"; group III was treated with glycerol and group IV was treated with polysaccharide. The response to treatments was assessed by macroscopic, histologic, and biochemical parameters. Data revealed that our sample exhibited potential antioxidant activities and accelerated significantly the wound healing process, after ten days of treatment, proved by the higher wound appearance scores and a higher content of collagen confirmed by histological examination, when compared with control and "CYTOL CENTELLA®". Overall, these findings proved that this polysaccharide isolated from Glycyrrhiza glabra could be considered as a natural bioactive polymer for therapeutic process in wound healing applications.

Introduction. - Multiple drug hypersensitivity (MDHS) is defined as confirmed drug hypersensi-tivity (DHS) to 2 or more drugs that are not chemically related. The objective of our study is to describe the cases of MDHS with antibiotics notified to the regional pharmacovigilance service (SRPV) of Sfax (Tunisia). Methods. - Our study is of a descriptive cross-sectional type, focusing on patients who consulted at the SRPV in Sfax during the period between 2013 and 2020 and who presented at least two episodes of DHS occurring at different times (at least one month apart). Results. - In our study, we included 29 patients (18 women and 11 men with a mean age of 59 years) who presented 69 sequential MDHS reactions documented either by a positive re -administration in 29 cases or by allergological exploration in 20 case, or by a highly suggestive clinical history in 20 cases. The frequency of MDHS was 1.13%. The drugs involved in the occurrence of these 69 DHS reactions were antibiotics in 55 cases (80%), antiepileptics in 6 cases (9%), NSAIDs in 4 cases (6%) and other drugs in 4 cases (6%) (one case with allopurinol, one case with strontium ranelate and two cases with gliclazide). Conclusion. - MDHS pose a real problem of therapeutic management. Indeed, these reactions can lead to a difficult choice of drugs with the impossibility of prescribing optimal first-line therapies. (c) 2022 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.

Objectives:This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals.Methods:A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan (n = 32) and a physically active group (n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters.Results:Compared to before Ramadan, performance in executive function (p = 0.035), attention (p = 0.005), inhibition (p = 0.02), associative memory (p = 0.041), and recognition memory (p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased (p = 0.041), whilst performances in the remaining domains remained unchanged during Ramadan. Global PSQI, ISI, and ESS scores indicated both groups suffered from poor sleep quality and excessive daytime sleepiness, with significantly higher negative effects of RDIF observed in the sedentary group.Conclusion:Older adults who continue to train at least three times per week during Ramadan may improve their cognitive performance, despite the impairment of sleep quality. Future studies in older adults during Ramadan including objective measures of sleep (e.g., polysomnography, actigraphy) and brain function (e.g., functional magnetic resonance imaging) are warranted.

OBJECTIVE The aim of the study was to identify the possible benefits of physical activity program in improving the antioxidant enzymes activity and lipid profile among smokers. PATIENTS AND METHODS Fifteen cigarette smokers (CS), 14 hookah smokers (HS), and 14 non-smokers (NS) participated in the low-intensity continuous training (LCT). Eleven CS, 12 HS, and 12 NS participated in the moderate-intensity intermittent training (MIT). The LCT groups performed a 20 to 30-minute continuous exercise at 40% of the VO2max. The MIT groups performed 6 to 10 sets of 2-minute sprint at 70% of the VO2max interspersed by a 1-min recovery period. At baseline and after 12 weeks of intervention, the antioxidant defense activity and lipid profile were assessed. RESULTS The improvement in antioxidant capacity under the effect of MIT program is statistically more significant than after LCT. The increase of glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA) and α-tocopherol was higher in smoker subjects participating in the MIT program compared to those participating in the LCT. In contrast, the LCT program has favorably altered lipid and lipoprotein profile of smokers and thus reduced their cardiovascular risk. CONCLUSIONS The combination of the two training methods may have major implications in both defense and prevention programs.

Sepsis is a principal cause of human mortality. Tumor necrosis factor alpha (TNF-α) is a factor of the myocardial dysfunction induced by sepsis. The present study attempts to determine the role of the macroalga Alsidium corallinum (A. corallinum) from TNF-α-induced sepsis. The cardiomyocytes H9c2 exposed to A. corallinum extract, then these cells have treated with TNF-α. H9c2 viability and antioxidant defense like glutathione peroxidase, superoxide dismutase, catalase and glutathione were evaluated. Main results reported that TNF-α caused a morphological cell modifications and, a reduction in H9c2 viability, and an increase of antioxidant defense. A. corallinum-treatment reduced the toxicity induced by TNF-α. These results demonstrated the cytoprotector role of A. corallinum against oxidative stress.

Background: There has been increasing evidence and support for the use of digital technology in the cognitive health field. Despite the growing use of innovative digital technology to assess cognitive function, such technology remains scarce in Arabic countries, particularly in Tunisia. Objective: To investigate the effectiveness of a digitally delivered cognitive assessment battery in differentiating varying degrees of cognitive function in older Tunisian adults. Methods: One hundred fifty-five Tunisian older adults (age: 62.24±7.52 years) were assigned to one of four groups: healthy controls (HC), at-risk (AR), mild cognitive impairment (MCI), and Alzheimer’s disease (AD). Participants completed a translated version of the Neurotrack digital cognitive battery. Results: The AD group performed significantly lower on the associative learning ( p = 0.01) and associative memory assessments ( p = 0.002), than the HC and AR groups. The AD group also performed worse on the inhibition measure ( p = 0.008) than the HC, AR, and MCI groups. For recognition memory, the was a significant difference between all four groups ( p < 0.0005), with AD having the lowest scores followed by the MCI, AR, and HC groups, respectively. There were no significant differences observed on attention, executive function and processing speed performance between the four groups ( p > 0.05). Conclusion: The use of digital technology appears to be a viable solution to current cognitive assessment challenges for assessing cognitive function in a Tunisian population. These findings provide further support for the use of digital technology in cognitive assessment, particularly in understudied populations.

Introduction. L’utilisation excessive des pesticides pose un véritable problème de santé publique, non seulement pour les personnes qui y sont exposées, mais aussi pour l’écosystème. Objectif. Etudier la toxicité induite par le thiaméthoxame (TMX) sur les paramètres morphologiques et hématologiques et sur les marqueurs du stress oxydatif au niveau des érythrocytes. Matériel et méthodes. Des rats mâles de souche Wistar ont été traités par voie intra-péritonéale pendant 30 jours avec trois doses croissantes de TMX (100, 150 et 300 mg/kg de poids corporel). Résultats. L’exposition des rats au TMX a provoqué une perturbation du comportement des rats, de leur poids corporel et de leur consommation quotidienne de nourriture et de boisson. De plus, des modifications du profil hématologique caractérisées par une anémie accompagnée de thrombopénie généralement liée à un déficit immunitaire, ont été détectées. Toutes ces altérations du profil hématologique sont confirmées par l’observation microscopique du frottis sanguin des différents groupes de rats. De plus, une altération du système de défense antioxydante, caractérisée par une diminution du glutathion réduit (GSH), de l’activité la catalase (CAT), de la superoxyde dismutase (SOD) et de la glutathion pero-xydase (GPx), ainsi qu’une augmentation au niveau des marqueurs du stress oxydatif, tels que le malondialdéhyde (MDA) et les produits d'oxydation avancée des protéines (AOPP), est notée, témoignant de l’effet déstabilisant du TMX. Conclusion. Cette toxicité augmente avec l’élévation de la dose de TMX, reflétant que l’utilisation irrationnelle de cet insecticide peut affecter la santé des mammifères. [Introduction. The excessive use of pesticides poses a real public health problem, not only for the people who are exposed to them, but also for the ecosystem. Objective. To elucidate the effect of thiamethoxam-induced toxicity (TMX) on morpho-logical and hematological parameters, and on oxidative stress markers in erythrocytes. Material and methods. Male Wistar rats were treated intraperitoneally for 30 days with three increasing doses of TMX (100, 150 and 300 mg/kg body weight). Results. The exposition of the rats to TMX caused a disturbance in their behavior, their body weight, and their daily food and drink intake. In addition, a perturbation in the hematological profile was noted. In fact, anemia accompanied with thrombocytopenia usually related to an immune deficiency was also detected. All these alterations in the blood profile were ascertained by the microscopic observation of the blood smear for the different groups of rats. Moreover, an impairment of the antioxidant defense system characterized by a decrease in the reduced glutathione (GSH), the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx), and by an increase in the level of oxidative stress markers, such as malondialdehyde (MDA) and advanced oxidation products of proteins (AOPP), was noted testifying the destabilizing effect of TMX. Conclusion. This toxicity increases with enhanced doses of TMX, reflecting that the irrational use of this insecticide can affect the health of mammals.]

Background. - The accurate diagnosis of cross-reactive reactions (CRR) to nonsteroidal anti-inflammatory drugs (NSAIDs) depends on a careful history and oral drug challenge. In this study, we report the result of a new procedure implemented in Tunisian allergology center to explore CRR to NASIDs in patients with immediate hypersensitivity (IHS) to NSAIDs. Methods. - Our structured protocol using oral provocation tests (OPTs) was based on the latest advances in the literature. This protocol was tested in patients with a clinical history of IHS reactions to one or more NSAIDs and referred to the pharmacology department of Sfax (Tunisia) between 2012 and 2018. Patients were classified into 5 subgroups: an ASA subgroup, a multiple NSAIDs subgroup, a single non-selective NSAID subgroup, a paracetamol subgroup, and a celecoxib subgroup. Results. - A total of 34 patients were enrolled. Personal history of atopy was found in 26 (76.5%). A diagnosis of CRR to NSAIDs was made in 24 patients (70.6%): 6 patients in the ASA subgroup, 12 patients in the multiple NSAIDs subgroup, 4 patients in the single non-selective NSAID subgroup, 1 patient in the paracetamol subgroup and 1 patient in the celecoxib subgroup. Regarding safe alternatives in patients with CRR to NSAIDs (n = 24), prevalence of cross-reactivity to paracetamol or celecoxib was found in 20% and 27.3% of patients with confirmed CRR to NSAIDs, respectively. Conclusion. - Our structured protocol based on standardized oral provocation tests helps physicians to prescribe a suitable drug in patients with a history of IHS reactions to NSAIDs. (C) 2020 Elsevier Masson SAS. All rights reserved.