Transcutaneous canine breast cancer detection in Tunisia: a pilot study.

BACKGROUND: Breast cancer in Tunisia is often diagnosed at a late stage with long delay in time to consultation and to diagnosis.The aim of this study is to estimate the sensitivity and specificity of the transcutaneous breast cancer detection by canine olfactionin Tunisian women and to identify the potential confounding factors. METHODS: This is a diagnostic case control study that took place from October 2021 to November 2022 in the Department of Medical Oncology at the University Hospital Farhat Hached of Sousse and in the security and training dog center located in Sousse (K9 Dog Center Security & Training). A two-year-old male Belgian Malinois was trained to detect breast cancer on skin secretion samples in compresses that had been worn overnight by women on their breast and then a double-blind testing was performed. There was no contact between women and the dog. From the mentioned responses of the dog, four parameters were calculated: sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). RESULTS: Two hundred women were included in this trial: 100 breast cancer (BC) patients recruited from Farhat Hached University Hospital of Sousse and 100 healthy volunteers (HV).The calculated sensitivity was 84% (95% CI 78-89%) and the calculated specificity was 81% (95% CI 75-86%). The calculated predictive values were: PPV = 83,51% (95% CI 78,37-88,65%) and NPV = 81,55% (95% CI 76.17-86.93%). In the multivariate study, only four confounding factors of test's sensitivity were retained: age (OR = 1.210 [95% CI = 1.085-1.349]; p = 0.001), history of diabetes(OR = 0.017 [95% CI = 0.001-0.228]; p = 0.002), sampling at hospital (OR = 0.010 [95% CI = 0.003-0.464]; p = 0.010) and testing during chemotherapy courses (OR = 0.034 [95% CI = 0.003-0.404]; p = 0.007).For test's specificity, we retained the three following confounding factors: age (OR = 1,104 [95% CI = 1.021-1.195]; p = 0.014), history of benign mastopathy (OR = 0.243 [95% CI = 0.074-0.805]; p = 0.021)and history of arterial hypertension (OR = 0.194 [95% CI = 0.053-0.707]; p = 0.013). CONCLUSION: This is a pilot study that opens new avenues in developing a reliable cancer diagnostic tool that integrates the dog's olfactory ability to detect breast cancer using a transcutaneous sampling method. It could be a pre-test to select patients who are eligible to a screening mammogram, especially in low-income countries where there is no national mammography screening program. PACTR. ORG IDENTIFIER: PACTR202201864472288, registration date 11/01/2022.

New Born Screening of Hemoglobinopathies in a Center Tunisian Population.

Sickle cell diseases, ß-thalassemia, and other hemoglobinopathies are common in Africa. Their distribution differs from one region to another. There are higher frequencies in Western and Northern Africa. Their clinical complications presented a real public health problem in each country. For this, early treatment can improve the severity of these diseases. Hemoglobinopathies targeted by screening are associated with SCD, ß, and α thalassemia. Our study aim is to report our experience with newborn screening for hemoglobinopathy in Tunis. The 156 newborn's cord blood was collected at the time of childbirth in the center region (Farhat Hached Hôspital). We opted for hemoglobin exploration to achieve maximum efficiency and effectiveness in screening. After that, all patients suspected to have hemoglobinopathies are affected by molecular investigation. Our findings showed the presence of some hemoglobinopathies such as ß-thalassemia and α-thalassemia with the following frequencies: 12% and 0.33%. The molecular results show the presence of HBB: c.93-21G>A, IVS-I-110G>A, HBBc. -106G>A -56G>C, HBBc.404T>C, Hb Yaounde described for the first time in Tunisia and α 3,7 . In conclusion, newborn screening diagnoses neonates with different examples of hemoglobinopathies, which will be beneficial not only for the care of the child but also for genetic counseling of the potential risk's parents.

Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals.

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

Additional evidence for the role of chromosomal imbalances and SOX8, ZNRF3 and HHAT gene variants in early human testis development.

BACKGROUND: Forty-six ,XY Differences/Disorders of Sex Development (DSD) are characterized by a broad phenotypic spectrum ranging from typical female to male with undervirilized external genitalia, or more rarely testicular regression with a typical male phenotype. Despite progress in the genetic diagnosis of DSD, most 46,XY DSD cases remain idiopathic. METHODS: To determine the genetic causes of 46,XY DSD, we studied 165 patients of Tunisian ancestry, who presented a wide range of DSD phenotypes. Karyotyping, candidate gene sequencing, and whole-exome sequencing (WES) were performed. RESULTS: Cytogenetic abnormalities, including a high frequency of sex chromosomal anomalies (85.4%), explained the phenotype in 30.9% (51/165) of the cohort. Sanger sequencing of candidate genes identified a novel pathogenic variant in the SRY gene in a patient with 46,XY gonadal dysgenesis. An exome screen of a sub-group of 44 patients with 46,XY DSD revealed pathogenic or likely pathogenic variants in 38.6% (17/44) of patients. CONCLUSION: Rare or novel pathogenic variants were identified in the AR, SRD5A2, ZNRF3, SOX8, SOX9 and HHAT genes. Overall our data indicate a genetic diagnosis rate of 41.2% (68/165) in the group of 46,XY DSD.

Prevalence of antibodies against a cyclic peptide mimicking the FG loop of the human papillomavirus type 16 capsid among Tunisian women.

BACKGROUND: In the past decade, cervical cancer has gone from being the second to the fourth most common cancer in women worldwide, but remains the second most common in developing countries. This cancer is most commonly caused by high-risk types of human papillomavirus (HPV), mainly type 16 (HPV16), which are sexually transmitted. This study aimed to investigate the usefulness of a cyclic synthetic peptide designed from the major L1 capsid protein of HPV16 for detecting anti-HPV16 antibodies. METHODS: We designed and synthetized a peptide that corresponds to the full sequence of the surface-exposed FG loop. We tested the antigenicity of the linear and the cyclic peptides against HPV16 L1 monoclonal antibodies. We used ELISA to detect anti-peptide antibodies in sera and cervical secretions of 179 Tunisian women, and we applied polymerase chain reaction and direct sequencing methods to detect and genotype HPV DNA. RESULTS: Both the linear and the cyclic peptides were recognized by the same neutralizing monoclonal antibodies, but the cyclic peptide was more reactive with human sera. The prevalence of the anti-peptide antibodies in sera was higher in women with low-grade squamous intraepithelial lesions (LGSIL) than in women with high-grade squamous intraepithelial lesions (HGSIL) (44% and 15%, respectively). This contrasts with HPV16 DNA prevalence. Compared to women from the general population, systemic IgG prevalence was significantly higher among sex workers (25%; P = 0.002) and women with LGSIL (44%; P = 0.001). In addition, systemic IgA and cervical IgG prevalence was higher among sex workers only (P = 0.002 and P = 0.001, respectively). We did not observe anti-peptide IgG antibodies in women with a current HPV16 infection. CONCLUSION: Anti-peptide IgG in sera or in cervical secretions could be markers of an effective natural immunization against HPV16. This may open novel perspectives for monitoring vaccinated women and for the design of synthetic peptide-based vaccines.

Evaluation of Daily Laurus nobilis Tea Consumption on Lipid Profile Biomarkers in Healthy Volunteers.

Introduction:Laurus nobilis is known in the field of herbal medicine and in vitro studies that it has beneficial effects such as antibacterial, antifungal, antidiabetes, and anti-inflammatory properties.Objective: We investigated whether L. nobilis tea consumption affects the plasma levels of lipid biomarkers in healthy volunteers.Methods: Thirty healthy Tunisian volunteers aged between 20 and 57 years old consumed L. nobilis infusion, prepared from 5 g of dried L. nobilis leaves in 100 ml boiled water, once a day during 10 days. Plasma concentrations of serum low-density lipoprotein (LDL) cholesterol, triglycerides and HDL (high-density lipoprotein) cholesterol were measured by Beckman Coulter D × 600 analyzer before L. nobilis consumption and at the end of the experiment.Results:L. nobilis tea consumption significantly increased the concentration of HDL cholesterol ([HDL cholesterol] D0 = 1.34 ± 0.25 pg/mL, D11=1.42 ± 0.29, p = 0.01). However, a slight decrease that was statistically non-significant in LDL cholesterol and triglycerides levels was observed (p < 0.05).Conclusions: These findings highlight the improving blood lipidic profiles, which means a possible positive effect on reducing the risk of cardiovascular disease of L. nobilis tea consumption in healthy volunteers. However, more powerful studies with an extended treatment period are required.

Correlation between umbilical resistance index and fetal growth: Pilot study.

AIM: To investigate normal pregnancies to determine whether there is a relationship between umbilical resistance and fetal growth. METHODS: This prospective study was conducted in three academic departments. Third trimester routine prenatal ultrasonography was used to estimate fetal weight and measure umbilical resistance index (RI). After delivery the birthweight was noted, along with the time interval between the ultrasound and the delivery, and then the weekly weight gain was calculated. These data were then used to determine the relationship between fetal growth and umbilical artery RI. RESULTS: Mean patient age was 32 ± 4.8 years; mean RI was 0.62 ± 0.07, and mean weight gain was 186.4 ± 63.9 g/week. Mean percentage weight gain relative to the estimated weight on third trimester ultrasound was 8.86 ± 3.8% per week. There was an inverse linear relationship between umbilical artery RI and fetal growth: percentage of weight gained per week relative to the estimated weight during third trimester ultrasound (%/week) = [31.3 - (36.1 × RI)] × 100. CONCLUSION: In normal pregnancies there seems to be a linear relationship between umbilical RI measured at 31-34 weeks of gestation and average fetal growth in the third trimester. The greater the resistance index, the lower the weight gain.

Maternal Near Miss and Quality of Obstetric Care in a Tunisian Tertiary Level Maternity.

This study aimed to determine the frequency and the nature of maternal near miss (NM) events in a population of women attending a tertiary level maternity hospital in Tunisia and to evaluate the care level of this institution according to indicators proposed by the World Health Organization (WHO). We opted for a retrospective medical chart review of cases of NM and maternal mortality that occurred in the year 2010 at the Farhat Hached Maternity University Hospital. NM cases were defined based on the WHO criteria 2009. There were 9957 deliveries, 58 NM events and one case of maternal death. Haemorrhagic (74.1%) and hypertensive disorders (20.7%) were the leading causes of NM. The study showed a low Maternal NM Ratio of 5.86/1000 live births, a relatively low mortality index of 1.7 % and Severe Maternal Outcome Ratio of 5.96/1000 live births. This was the first study to document NM in a Tunisian public maternity. The WHO approach allowed a systematic monitoring of quality of maternal health care. There is a low frequency of maternal morbidity and mortality at the level of this facility. But, more efforts are still needed to document NM events in other types of care facilities in Tunisia.

The influence of gonadotropins on clinico-biological ICSI outcome: a retrospective comparative study rFsH vs HP-hmg.

Objective To investigate the difference in the outcome of ICSI-ET cycles among respondents patients, taking into account the molecule inducer of controlled ovarian stimulation: HP-hMG ou rFSH. Patients and Methods A comparative retrospective study over 62 months including a total of 1005 infertile couples, divided into two groups: HP-HMG (n=125) and rFSH (n=880). Results - The average numbers of retrieved oocytes and matures oocytes were significantly higher in rFSH group rFSH (7,94 ± 2,49, HP-HMG vs 9,05 ± 3,40, rFSH, p=0.0001and  3±2,68, HP-HMG vs 6,65±3,05 , rFSH, p=0,02 respectively). There was no statistically significant difference in the endometrial thickness and estradiol level on hCG injection day, the total amount of administrated gonadotropin and the duration of stimulation. In addition, we did not find a significant difference between the two groups regarding the fertilization, the maturation, the cleavage, top quality embryo, implantation, clinical pregnancy, multiple pregnancies, live birth and miscarriage rates. There was no case of severe ovarian hyperstimulation syndrome. Conclusion - Inspite of a higher number of retrieved and mature oocytes obtained with rFSH, the latter showed no superiority over HP-hMG which seem to be equally efficient and safe for ICSI treatment cycles.

[Placenta accreta: a retrospective descriptive study of 46 patients treated in the Obstetrics and Gynaecology Department of the Farhat Hached University Hospital in Sousse, Tunisia]. / Placenta accreta: étude descriptive rétrospective de 46 cas pris en charge au Service de Gynécologie-obstétrique du Centre Hospitalier Universitaire Farhat Hached de Sousse, Tunisie.

Placenta accreta is a rare but serious placental attachment abnormality. The aim of this study is to analyze the epidemiological, clinical, para-clinical and evolutionary features of placenta accreta, to investigate the therapeutic management and to assess maternal and neonatal morbidity and mortality. We conducted a retrospective, descriptive study of patients with histologically confirmed placenta accreta in the obstetrics and gynaecology department of the Farhat Hached University Hospital in Sousse, over a 4-year period from 1st January 2015 to 31st December 2019. The epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected from patients´ medical records and operative reports. In our series, we identified 46 cases of placenta accreta. The average age of our patients was 35±4.61 years. Each of our patients had a scarred uterus. The average term of delivery was 34 weeks of amenorrhoea and the mode of delivery was caesarean section for all our patients. First-line hysterectomy was performed in 40 patients and conservative treatment in 6. Sixteen patients developed maternal complications. No maternal death was observed. Placenta accreta is a rare condition associated with significant maternal and foetal morbidity.

Effect of Micronutrients and L-Carnitine as Antioxidant on Sperm Parameters, Genome Integrity, and ICSI Outcomes: Randomized, Double-Blind, and Placebo-Controlled Clinical Trial.

The evaluation of sperm DNA integrity is recommended in the sixth edition of the 2021 World Health Organization guidelines. Oxidative stress has been identified as a crucial factor leading to genome decay, lipid peroxidation, and nucleoprotein oxidation. This double-blind, placebo-controlled clinical trial aimed to assess the effect of oral antioxidant treatment (Fertilis), which contains L-carnitine and some micronutrients, in the improvement of conventional sperm parameters, sperm DNA integrity and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. A total of 263 participants were enrolled and randomly divided into two groups: 131 participants received the antioxidant treatment, while 132 participants received a placebo. The male partners in both groups underwent the antioxidant treatment or the placebo for a duration of three months. For each participant, we performed a hormonal test, an infectious test, a spermogram, a TUNEL assay for sperm DNA fragmentation, a toluidine blue staining for sperm DNA decondensation, and an IVF/ICSI procedure. Sperm characteristics analysis (volume, count, motility, and vitality), sperm DNA fragmentation, and sperm DNA decondensation were assessed and compared to the results preceding the antioxidant treatment. The study outcome revealed a significant decrease in the DNA fragmentation index and a significant increase in sperm motility after 3 months of treatment (p = 0.01 and p = 0.02, respectively). Additionally, a significant improvement in clinical pregnancy rate (p = 0.01) and life birth rate (p = 0.031) was observed. No significant changes were observed in conventional sperm parameters (volume, count, and vitality) or sperm DNA decondensation (SDI). Antioxidant therapy has a beneficial impact on achieving pregnancy, whether through spontaneous conception or assisted reproductive procedures (ART).

Psychometric properties of a French version of the Jefferson Scale of Empathy.

Objective: To assess the reliability and construct validity of a French version of the Jefferson Scale of Empathy-Students. Methods: A cross-sectional study was performed among undergraduate medical students in Tunisia. A total of 833 students completed a French version of the JSE-S using convenience sampling. To identify the internal consistency aspect of the reliability, Cronbach's alpha coefficient was computed. Moreover, to assess the construct validity, the sample was randomly divided into two groups. Data from the first group (n=415) were subjected to exploratory factor analysis (EFA), with principal axing factoring (PAF) and oblimin rotation, to re-examine the underlying factor structure of the scale. Data from the second group (n=419) were used for confirmatory factor analysis (CFA) to confirm its latent variable structure. Some goodness-of-fit indices were used to assess the hypothesized model. Gender groups were compared using a t-test to check the known-group validity. Results: Reliability analysis reported an acceptable level of internal consistency, with an overall Cronbach's alpha of 0.78 (95% CI [0.75,0.80]). EFA identified a two-factor structure, accounting for 27.4% of the total variance. The two-factor model produced good fit indices when item correlated errors were considered (χ2/df = 1.95, GFI = 0.92, CFI = 0.90, PCFI = 0.79, PGFI = 0.73 and RMSEA = 0.04). Female students had a statistically significant higher empathy scores than male students (t (830) = - 4.16, p < .001). Conclusions: The findings support the construct validity and reliability of a French version of the JSE for medical students. This instrument appears to be useful for investigating empathy among French-speaking populations.

Impact of a tailored-care education programme on maternal and neonatal outcomes in pregnant women with gestational diabetes: a randomized controlled trial.

Introduction: patient education is a key component of positive pregnancy and childbearing experiences, especially in women with gestational diabetes (GDM). Scant studies assessed the impact of tailored self-care education on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). This study aimed to assess the effect of a tailored-care education programme on maternal and neonatal outcomes in pregnant women with GDM during pregnancy and at birth. Methods: this was a randomized controlled trial conducted in a university hospital in the centre of Tunisia, from October 2020 to May 2021. The intervention group (n=61) received a self-care education programme with the usual care plan for GDM, while the control group received only the usual care plan (n=60). This trial was registered in the Pan African Clinical Trials Registry under the registration number PACTR202106591503674. Results: at baseline, there was no significant difference between groups in terms of sociodemographic and clinical characteristics. The findings showed that the intervention significantly reduced maternal and neonatal hospitalizations (p=0.000), caesarean section (p=0.002), preterm labour (p=0.002), macrosomia (p=0.000), foetal distress (p=0.001), newborn respiratory complication (p=0.01) and hypoglycaemia (p=0.000). Conclusion: implementing a tailored-care education for pregnant women with GDM had a positive impact on mother and infant clinical outcomes. Midwives and endocrinologists should use this programme to reduce maternal and neonatal complications during and after pregnancy.

Correlation between Heterogeneous Expression of Sialyltransferases and MUC16 in Ovarian Tumor Tissues.

BACKGROUND: A number of glycoproteins such as CA125 are abnormally glycosylated in ovarian cancers. Most aberrant glycosylations are a result of altered sialyltransferase (ST) expression. The aim of this study was to evaluate the expression of 6 STs and MUC16, and their correlations in benign and malignant ovarian tissues. MATERIAL AND METHODS: mRNA expression of 6 STs and MUC16 was assessed in 16 human ovarian tumors (7 benign, 9 malignant) by real-time quantitative polymerase chain reaction (RTQ-PCR). RESULTS: mRNA of ST6GAL I and ST3GAL I was not significantly upregulated in ovarian cancer tissues, while ST6GAL II and ST3GAL IV were not significantly increased in benign tumors. There was no change between ST3GAL III and ST3GAL VI expression and tumor subtypes. MUC16 was significantly increased in carcinoma tissue. Significant correlation was found between ST3GAL III and ST3GAL IV. MUC16 correlated with ST3GAL VI and ST6GAL I. ST6GAL I correlated well with ST3GAL VI. ST6GAL II correlated significantly with ST3GAL III and ST3GAL IV. CONCLUSIONS: The given STs and MUC16 can be expressed at a heterogeneous level as a consequence of oncogenic transformation of the ovary. A strong correlation between MUC16 and STs may impact specifically on the glycosylation of MUC16.

[Assessment of quality of sexual life in women after breast cancer treatment: about 100 cases]. / Evaluation de la sexualité chez des femmes atteintes d'un cancer du sein après traitement: à propos de 100 cas.

Breast cancer is the most common neoplastic disease in women. Several treatment strategies are used: chemotherapy, radiotherapy, surgery and hormone therapy. Each of these treatments may affect sexual health of patients in the short or long term. The purpose of our study is to assess the quality of sexual life in women after breast cancer treatment. We made a quantitative descriptive estimate of 100 sexual active patients followed up for non-metastatic breast cancer, met during their consultations with a gynaecologist at the Farhat Hached hospital in Sousse. Data collection was carried out using an information sheet and two validated scales: RSS (relation Ship and sexual) and BESAA (Body EsteemScale for adolescents and Adults) to assess the quality of sexual life and body image. The average age of patients was 53.8 years. About half of patients (48%) had impaired sexuality due to the disease. The frequency of intercourse, sexual desire and the ability to reach orgasm were decreased in 65. 45, and 54 patients, respectively. The overall score for the three body image dimensions was 49.4. Women aged between 35 and 39 years were significantly more afraid of sexual intercourse (p=0.002) and less of sexual frequency (p=0.004). Adequate and enhanced training focused on the management of women with cancer and their sexual problems and multidisciplinary approach can improve women's psychological status.

Office hysteroscopy before first in vitro fertilization. A randomized controlled trial.

BACKGROUND: Implantation failure remains a mystery since decades. This procedure needs a "top quality embryo" and a "normal" uterine cavity. To assess uterine cavity before first in vitro fertilization (IVF), many diagnostic tools could be used. Hysteroscopy remains the gold standard to diagnose and treat intra-uterine anomalies. However, it is not clearly recommanded to offer an office hysteroscopy before first IVF when transvaginal ultrasound (TVUS) and hysterosalpingography (HSG) were normal. PURPOSE: This study aimed to assess the role of office hysteroscopy before first IVF when no intra-uterine anomalies are suspected. BASIC PROCEDURES: We conducted a randomized controlled trial including 171 women scheduled for their first IVF. Women were assigned to either Group I: office hysteroscopy before IVF or Group II: immediate IVF. We included women aged less than 40 years, having regular cycles, FSH levels less than10UI/l, antral follicular count ≥12, normal TVUS and HSG. Their body mass index (BMI) ranged from 19 to 30 kg/m2. We excluded patients known having severe endometriosis, polycystic ovarian syndrome (PCOS) and oocyte receivers. The primary outcome were livebirth rate and clinical pregnancy rate. MAIN FUNDINGS: Between january 2016 and september 2017, we randomly assigned 171 women to either Group I (n = 84) or Group II (n = 87). Hysteroscopy was done in the mid-follicular phase immediately before IVF. Baseline characteristics and IVF features were comparable between groups except for the IVF protocol. Live birth rate was 23,9% in Group I versus 19,3% in Group II. (p = 0,607). Clinical Pregnancy rate was 32,4% in Group I versus 21,7% in Group II. (p = 0,326). No statistical significance was observed for neither miscarriage rate nor multiple pregnancy rate. Hysteroscopy showed 30% unsuspected intra-uterine anomalies: 11 intra-uterine adhesions, 7 polyps, 7 clinical endometritis and one fibroid print. Therapeutic hysteroscopy was done only for 6 intra-uterine adhesions and 3 polyps. Other anomalies did not require operative hysteroscopy. Visual analog score during hysteroscopy was 4,69 +/-2,892. 5 women (6%) of Group I experienced discomfort during diagnostic hysteroscopy. Only one patient had vagal syncope. No further complications were observed. PRINCIPAL CONCLUSIONS: Office hysteroscopy before first IVF seems not improve IVF results. Minimal intra-uterine anomalies not diagnosed by transvaginal ultrasound and hysterosalpingography do not seem to reduce IVF results.

Indocyanine Green Fluorescence-Guided Sentinel Node Biopsy in Breast Cancer Within a North African Population: A Retrospective Study.

OBJECTIVE: Radio isotopes and blue dyes alone or in combination are the most commonly used tracer agents in sentinel node (SN) biopsy for early breast cancer. Recent studies have found fluorescence method using indocyanine green (ICG) as a promising technology with fewer disadvantages. MATERIALS AND METHODS: Retrospective analysis of our database that included patients with clinically node-negative breast cancer scheduled for breast surgery and SN biopsy between 2016 and January 2021. Patients who underwent detection using fluorescence-ICG were included in this study. RESULTS: A total of 47 patients were included. Median age was 50 (range: 24-78) years. Mean tumor size was 3.4 ± 1.5 cm. All patients received ICG injection and 11 received a combination of ICG and blue dye. Forty-five successful SN identifications with ICG were performed and 99 nodes retrieved. Eleven procedures were undertaken after initial systemic therapy. Twenty-four patients had at least one positive SN for malignancy. Mean follow up was 29.2 months and no axillary recurrence was noted during the study period. CONCLUSION: ICG appears to be a feasible and accurate method for SN biopsy with high identification rate. This is the first study of ICG in sentinel node biopsy in a North African population.

Availability, utilization and quality of emergency obstetric care services in Sousse, Tunisia.

INTRODUCTION: emergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia). METHODS: a cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated. RESULTS: only the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%. CONCLUSION: raising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction.