Microbiological and molecular screening of Candida spp. isolated from genital tract of asymptomatic pregnant women.

Introduction. Candida spp. may cause opportunistic infections called vulvovaginal candidiasis (VVC), which is estimated to be the second most common cause of vaginitis worldwide.Gap Statement. Under various circumstances, VVC could compromise pregnancy outcomes. Emerging data suggests that VVC during pregnancy may be associated with increased risk of complications and congenital cutaneous candidiasis.Aim. To assess the prevalence of Candida spp. in asymptomatic pregnant women and determine the susceptibility of the isolates to antifungal drugs.Methodology. In a prospective cohort, 65 high vaginal swab samples of consented pregnant women. Candida isolates were identified using both microbiological and molecular tools and drug susceptibilities were profiled.Results. The prevalence of VVC among our study participants was 37 %, 24 of the 65 asymptomatic pregnant women show Candida spp. colonization. C. albicans was the most common species 61 %, followed by C. glabrata 39 %. In addition, a significant fraction of the isolated colonies showed resistance to Fluconazole, with a ratio of 63 % for C. albicans isolates and 16 % for Candida glabrata isolates. Moreover, relative quantification of genes related to resistance to fluconazole, CDR1, ERG11 as well as HWP1, showed a significant change compared to controls.Conclusion. Monitoring of vaginal Candida colonization before the third trimester of pregnancy, that could reduce congenital Candida colonization and risk of pregnancy complications.

[Psychological impact of COVID-19 on women's wellbeing during pregnancy: about 2 cases]. / Impact psychologique des femmes enceintes atteintes du COVID-19: à propos de 2 cas cliniques.

This study is based on a psychoanalytically inspired psychological investigation of two pregnant women with COVID-19 at different stages of pregnancy in the Department of Obstetrics and Gynaecology A at the Charles Nicolle Hospital. Our study was conducted between 2020 and 2021, until deliveries. Two young Tunisian women aged 28 and 30 years were tested positive for COVID-19 during pregnancy. They suffered from emotional shock. In this study, we discuss the different points of collision between life and death by describing, in detail, the experiences of these two women during their confinement.

[A case of neonatal gastrointestinal duplication]. / Duplication digestive: à propos d´un cas néonatal.

Gastrointestinal duplications are defined as tubular or cystic malformations of a segment of the digestive tract, from the oral cavity to the anus. They are rare. Prenatal diagnosis ca be made in patients with a voluminous cyst. We here report the case of a 33-year-old primiparous woman with no previous medical-surgical history who was poorly screened. She just underwent ultrasound scan at 8 weeks of amenorrhea (WA). During the third trimester of pregnancy ultrasound showed anechoic nonvascularized cyst measuring 3cm located in the upper pelvis. It was anteriorly located; the kidneys and the bladder were not involved. Then magnetic resonance imaging (MRI) of the fetus was performed to better interpret ultrasound results. This showed well-defined cyst in contact with the small bowel loops along the mesenteric side. The diagnosis of gastrointestinal duplication was strongly suspected. C-section was done at 39 weeks' gestation because the woman had a history of primary infertility (7 years). Delivery proceeded without complications. Postnatal ultrasound results reinforced the hypothesis of gastrointestinal duplication, showing a cystic mass with a multi-bulkhead-like structure at the level of the left hypochondrium, measuring 45 mm x 19 mm, which could be consistent with gastrointestinal duplication. The new-born was referred to the Paediatric Surgery for better management and surgery in the first 6 months of life. The discovery of fetal anechoic cyst poses a challenge in etiology and diagnosis on the one hand and of follow-up and postnatal management on the other hand.

The methylene blue test, a risky intervention: A case report.

Methylene blue is used to check tubal patency during laparoscopy. We report the case of a 28-year-old patient who presented a blue coloring of the skin, mucous membranes and nails after methylene blue test during laparoscopy for infertility.  The oxygen saturation was 82%. The patient was hospitalized for 48 hours in the intensive care unit and spectrophotometric analysis revealed a methemoglobin level of 8.9%, thus confirming the diagnosis of methemoglobinemia. The suites were simple with normalization of the saturation. It is important to know the complications of the injection of methylene blue in order to prevent them and ensure adequate monitoring for the patients.

Contribution of ultrasound in the study of ovarian fibrothecomas: a series of 47 cases.

INTRODUCTION: Ovarian fibro-thecoma are rare presenting 1 to 4, 7%of ovarian organictumors. These tumors are of stromal origin and contain varied proportion of fusiform connective tissue cells and theca cells. They mainly affect menopausal or perimenopausal women. This tumor is benign in most cases and may be responsible for hormone secretion. OBJECTIVES: Study the epidemiological and clinical data of patients with ovarian fibro-thecoma, analyze ultrasonographic characteristics of these tumors,and evaluate the sensitivity and specificity of pelvic ultrasound in ovarian fibro-thecoma approach. METHODS: A retrospective study of 47 patients who underwent surgical treatment for ovarian fibro-thecoma was performed. Data were collected in our department of gynecologyand obstetrics A within Charles Nicole hospital in Tunis, over a period of 18 years between January 1994 and December 2012. For each of our observations, we analyzed the clinical and para-clinical data, including U.S. characteristics and available MRI data with confrontation to the final histological results. RESULTS: The average age of patients was 45.2 years. The average gravidity was 4 and the mean parity was 3. . Thirty-eight of our patients were postmenopausal (80.85%). Ovarian tumor was discovered incidentally in 11 cases and on the occasion of functional symptoms in 36 cases including pelvic pain in 18 cases. Physical examination revealed a pelvic mass in 17 patients and pelvic-abdominal in 14 patients. All patients underwent a pelvic ultrasound. . Ultrasound identified 49 tumors (2 cases of bilateral tumors). Average size of tumors was 10, 05 cm (4 to 30 cm). ) . Ovarian tumor was echogenic in 9 cases (18.36%), hypoechoic in 14 cases (28.47%), mixed in 14 cases (28.47%) and anechoic in 12 cases (24.49%). The tumor was found to be solid in 27 cases (55.1%); cystic in 8 cases (16.3%) and solido cystic in 14 cases (28.6%).It was compartmentalized in 10 cases. Extra cystic vegetations were found in 2 patients. The tumor was nonvascularized at color Doppler in 47 cases (95.9%) and slightly vascularized in 2 cases (4.1%). Intra peritoneal effusion was objectified in 15 cases. The diagnosis of ovarian fibro-thecoma was raised based on U.S in 25 cases (51.02%) before surgery .MRI was performed in four cases. All patients underwent surgery. We performed laparotomy in 36 cases and laparoscopy in 11 cases. By laparotomy were performed a total hysterectomy with bilateral oophorectomy in most cases (26 patients). By laparoscopy we did lumpectomy in all cases. . The final pathologic examination revealed 19 fibromas, 14cystadénofibromas and 14 fibrothecomas. CONCLUSION: The paraclinical exploration of ovarian fibro-thecoma isbased, as all ovarian tumors, on ultrasound examination. The most typical features are images of solid tumors with regular contours, echogenic or mixed with the presence of streakedshadows.

[Parauterine solitary fibrous tumor: about a case]. / Tumeur fibreuse solitaire parautérine: à propos d'un cas.

Solitary fibrous tumors of the female genital tract are extremely rare. We report the case of a 78-year old patient presenting with a pelvic mass. Surgical exploration showed parauterine tumor. Anatomo-pathological examination confirmed the diagnosis of malignant solitary fibrous tumor. The evolution was marked by the death of the patient. It is important to be able to detect these tumors whose evolution can be poor. Long-term follow-up of patients with resectable tumor should be recommended.

Cyto-colpo-histologic correlation: about an analytical study of 120 colposcopies.

PROBLEM: Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear. AIM OF THE WORK: To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy. METHODS: A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012. RESULTS: The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients. CONCLUSION: Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.

Cyto-colpo-histologic correlation: about an analytical study of 120 colposcopies.

PROBLEM: Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear. AIM OF THE WORK: To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy. METHODS: A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012. RESULTS: The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients. CONCLUSION: Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.

Perinatal-lethal Gaucher disease presenting as hydrops fetalis.

Perinatal-lethal Gaucher disease is very rare and is considered a variant of type 2 Gaucher disease that occurs in the neonatal period. The most distinct features of perinatal-lethal Gaucher disease are non-immune hydrops fetalis. Less common signs of the disease are hepatosplenomegaly, ichthyosis and arthrogryposis. We report a case of Gaucher's disease (type 2) diagnosed in a newborn who presented with Hydrops Fetalis.

[Medical treatment of endometriosis]. / Traitement medical de l'endométriose.

PREREQUISITES: Pathogenesis and pathophysiology of endometriosis, pharmacodynamics of oral contraceptives, progestagens, antiprogestagens, danazol, GnRh agonist and non-steroidal antiinflammatory. PURPOSE OF REVIEW: The aim of this paper is to systematically review the literature evidence of medical treatments for endometriosis and to summarize recently published recommendations. METHODS: Literature and recently published recommendations review via bibliographic research using Pubmed/Medline, Google scholar and Cochrane database. RESULTS: Endometriosis is an estrogen-dependent gynecological disease. Medical treatement of endometriosis induce an estrogen deprivation situation. The Oral contraceptives reduce the rate of postoperative endometrioma recurrence and should be considered an essential part of long-term therapeutic strategies.New agents promise a distinct perspective in endometriosis treatment. CONCLUSIONS: The effectiveness of medical treatmentis well established in the management pelvic pain and infertility associated with endometriosis and constitutes an important alternative or complement to surgery.

Pre-vaccination prevalence and genotype distribution of human papillomavirus infection among women from urban Tunis: a cross-sectional study.

BACKGROUND: To estimate the pre-vaccination distribution of human papillomavirus (HPV) types among women from urban Tunis. MATERIALS AND METHODS: A total of 611 women aged 18-69 years were enrolled in three local gynaecological outpatient departments. All underwent a gynaecological examination with Pap test and dry swab for HPV detection and typing performed by linear array genotyping test (Roche). Cytological examination was conducted on conventional Pap smears. RESULTS: HPV DNA was found in 6.5% of the women; the most frequent HPV types were HPV 16 and HPV 11 at 3.27% and 1.96%, respectively. The second most frequent high risk (HR) HPV type was HPV 58 (0.82%) followed by HPV 18, HPV 31 and HPV 33 found in only 0.33% of women. Single infections with HPV types, targeted by the quadrivalent vaccine (6, 11, 16, and 18), were detected in 3.6 % of the study patients (55% of positive women). HPV infection was found in 3.83% of women with normal cytology and in 47.4% of women with cytological abnormalities. No statistically significant trend in prevalence by age group emerged for any HPV type or for high or low risk types. CONCLUSIONS: These data show a relatively low prevalence of HPV infection in women from urban Tunis with a high proportion of HPV16 and HPV58. This should be considered in the upcoming screening programs and vaccination strategy.

[Medical treatment of ectopic pregnancy]. / Traitement médical de la grossesse extra-utérine.

BACKGROUND: The ectopic pregnancy (EP) is a public health problem and its frequency has doubled in most industrialized countries in 20 years. aim: To evaluate the effectiveness of medical treatment of ectopic pregnancy with methotrexate (MTX) intramuscularly (IM). METHODS: prospective study supported between October 2006 and December 2010. The selected patients received methotrexate IM (1 mg per kg). The monitoring was based on: the kinetics of plasma HCG, clinical examination and ultrasound. A second injection was performed if hCG on day 4 was increased by more than 25% or J7> the initial rate. Healing corresponded to obtain a zero rate of HCG in a stable manner. RESULTS: We used the first-line medical treatment in 122 patients. The average age of patients was 31.94 years. A haematosalpinx was found in 87.70% of cases. The initial rate of HCG plasma varied between 40 IU/ml and 4088 IU / ml, with an average of 805.88 m IU / ml. The primary success rate obtained after a single injection of intramuscular MTX was 67%. The high success rate obtained after two injections of MTX was 27%. The overall success rate after 1 or 2 injections of MTX was 82%. 17 patients underwent surgical treatment after a first injection of methotrexate. 5 patients underwent surgery after receiving two doses of methotrexate. The period of normalization of plasma levels of h CG was 24 days on average, with extremes ranging from 4 to 43 days for 67 patients cured after a single injection of MTX. This period was 33 days on average, with extremes ranging from 8 to 62 days for patients healed after two injections of MTX. CONCLUSION: Medical treatment applied to 38% of ectopic pregnancies diagnosed in our department is effective in 82% of cases if the inclusion criteria are strictly adhered to. Successful treatment is limited by patient compliance and demanding nature of monitoring.

[Postmenopausal bleeding. Comparison between ultrasonography, hysteroscopy and histology results]. / Les métrorragies post ménopausiques. Confrontation des résultats échographiques, hystéroscopiques et histologiques.

BACKGROUND: Post-menopausal bleeding are frequently found in gynaecological consultations and requires the search of an organic cause AIM: To value the profit and the performances of the transvaginal ultrasonography and the hysteroscopy in the determination of the causes of post-menopausal bleeding. METHODS: 80 patients presenting abnormal uterine bleeding in post menopause period have been explored in our department with transvaginal ultrasonography and hysteroscopy. The findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. We have calculated in our study the sensitivity, the specificity, the positive and negative predictive values of transvaginal ultrasonography and hysteroscopy. RESULTS: The sensitivity, the specificity, the positive and negative values predictive of the transvaginal ultrasonography is respectively 93, 75%, 87, 5%, 83, 3% and 95, 45%. In the other part, hysteroscopy seems more performant in the diagnosis of intrauterine abnormalities with the respective values: 100%, 95, 83%, 94, 11% and 100%. CONCLUSION: The initial investigation in front of all mennorhagic patients must be the transvaginal ultrasonography but we also need the hysteroscopy because its highly accurate means in the diagnosis of the causes of excessive uterine bleeding in post menopausal period.

[Correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy]. / Corrélation entre signes vitaux et hémopéritoine au cours des grossesses extra-utérines rompues.

BACKGROUND: Ectopic pregnancy (EP) is a medical-surgical emergency. Rupture of an ectopic pregnancy is a serious complication and may develop severe life-threatening to the patient. AIM: To determine correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy and the association between abnormal vital signs and tubal rupture. METHODS: Via a retrospective study we have considered a sample of 32 patients of ruptured ectopic pregnancy. All patients were diagnosed at the Gynecology and Obstetrics Unit Aat Charles Nicole Hospital, Tunisia. RESULTS: Mean minimum systolic (SBP) 109 mmHg (range 70-150), mean maximum (HR) 81.5 beats/min (range 70-140). Mean volume of hemoperitoneum 693.75 mL (range 100 -2000 mL).Correlation between vital signs and volume of hemoperitoneum was poor (R 2 = 0.279 for HR, R 2= 0.267 for SBP). Hypotension was associated with blood loss of at least 1280 ml. Association of tachycardia with hypotension was observed in only 2 cases.Correlation between HR and SBP was not significant and poor (p=0.23, R 2= 0.05) CONCLUSION: Normal vital signs alone are poor predictors of ruptured ectopic pregnancy and do not correlate well with volumes of hemoperitonieum.