[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.

Medical and Surgical Approaches for a Non-functioning Pituitary Adenoma During Pregnancy.

Non-functioning pituitary adenomas (NFPA) are most commonly found in post-menopausal women and men above the age of 50. They are mainly revealed by a tumor syndrome. The incidence of symptomatic NFPA during pregnancy is rare, with only nine documented cases in the literature. The patient was 39 years old with no previous medical or surgical history and was 17 weeks pregnant. A large pituitary macroadenoma measuring 17 x 18 x 19 mm was discovered radiologically in the presence of a pituitary tumor syndrome. Clinical examination revealed no signs of hormone deficiency or hypersecretion. A corticotropic and thyrotropic deficit was ruled out following a hormonal workup. Ophthalmological examination revealed reduced visual acuity and bilateral visual field damage. Treatment with cabergoline at a dose of 3 mg/week was initiated following written consent from the patient. The patient underwent vaginal delivery of a healthy newborn at term. Hormonal assessment at three months postpartum definitively ruled out hormonal hypersecretion. She underwent transsphenoidal surgery, with a histological examination of the resection specimen revealing a pituitary adenoma binding adrenocorticotrophic hormone (ACTH), prolactin (PRL), and growth hormone (GH). The postoperative evaluation revealed a corticotropic and somatotropic deficit with the presence of an adenomatous residue on imaging. Substitutive treatment was then initiated along with therapeutic education. To the best of our knowledge, this is the third case in which cabergoline treatment was initiated. Cabergoline treatment enabled the pregnancy to continue, improved the patient's clinical condition, stabilized the size of the adenoma, and prevented potential apoplexy.

Dysmenorrhea in Tunisian high school adolescent girls: frequency, effects, and absence from school.

OBJECTIVES: Dysmenorrhea is a known phenomenon and not just recently, and investigations conducted recently have shown that female adolescents are very susceptible to this condition. Our goal is to determine the prevalence of dysmenorrhea in Tunisia, its risk factors, its impact on truancy rates, and the therapeutic attitudes of girls attending high school about this illness using an epidemiological survey. METHODS: This eight-month study, which spans from October 2022 to May 2023, focuses on 160 high school girls between the ages of 13 and 21. It is a transversal descriptive study. The required data is gathered through the distribution of a self-administered questionnaire. RESULTS: The mean age of female adolescent participants is 16.44 years and 68 % of them reported dysmenorrhea. The most common symptoms of the pain were headaches (40.0 %). There is a notable prevalence of absenteeism during the menstrual cycle. There seems to be a trend toward self-medication. CONCLUSIONS: In Tunisia, primary dysmenorrhea is a common cause of school absenteeism among female adolescents. Girls' attitudes toward dysmenorrhea indicate a lack of knowledge, which is why it is crucial for midwives and physicians to educate teenage girls about the condition.

Seizures in the third trimester of pregnancy- A rare case of Wernicke's encephalopathy mimicking Eclampsia.

Unless otherwise demonstrated, seizures during pregnancy that happen after 20 weeks of gestation are typically caused by eclampsia. In our clinical case we report the diagnostic challenge of Wernicke's encephalopathy occurring at 34 weeks and mimicking an eclamptic attack. This is about a 30-year-old female patient who suffers from hyperemesis gravidarum during her pregnancy. she has no known history of epilepsy .The patient was brought to the emergency room by medical transport at 34 weeks of gestation due to a seizure at home. The initial diagnosis was eclampsia. Emergency high-level extraction under general anesthesia was decided for maternal rescue. However, after extubation, the patient's condition deteriorated, with the onset of a confusion syndrome characterized by agitation, temporal-spatial disorientation, attention and vigilance disorders, and challenging communication. Angio MRI was performed, revealing signs consistent with Wernicke's encephalitis.

[Gyneco-obstetrical emergencies at the obstetrics and gynecology department of Sousse: epidemiological study and becoming of the consultants]. / Les urgences gynéco-obstétricales au service de gynécologie obstétrique de Sousse: étude épidémiologique et devenir des consultants.

Introduction: the objective of this work was to establish the clinical profile of patients consulting in gyneco-obstetrical emergencies and identify the reasons for consultation and the becoming of the consultants. Methods: a one-center retrospective descriptive observational study was performed including patients who consulted between January 1st and December 31st, 2018. Obstetric emergencies after 36 weeks of amenorrhea were not included. We drew lots 4 months of the year 2018 (one month per season). Then we drew lots 2 weeks of each month. A data collection sheet was developed for the purposes of this work. Results: a total of 2007 patients were included in our study among 15,553 gynecological emergency room consultants during 2018. We found that the largest number of consultants was recorded at the start of the week and between 7 am and 7 pm. The most frequently obstetric reasons observed for consultation were pelvic pain (39.6%), bleeding (23.8%) and vomiting (8.7%). The most frequently gynecological reasons for consultation were pelvic pain (54.2%), then metrorrhagia (18.8%) and mastodynia (7.1%). Of the study participants, 66.82% received an ultrasound, 23% received a beta HCG test. The majority of emergency room consultants were referred to their home. Conclusion: the majority of patients visiting the emergency room do not have any emergency-related pathologies.

Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study.

OBJECTIVE: To determine the predictive factors of nebulized morphine (nMOR) failure in patients with chest trauma. RESEARCH DESIGN AND METHODS: This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nMOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nMOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nMOR failure, respectively). RESULTS: Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031-0.443]; p = 0.002), number of fractured ribs > 4 (RR: 0.317 [0.092-0.543]; p = 0.006), bilateral injury (RR: 0.114 [0.037-0.349]; p < 0.001), flail chest (RR: 0.120 [0.037-0.386]; p < 0.001), hemothorax (RR: 0.203 [0.062-0.660]; p = 0.008), pulmonary contusion (RR: 0.202 [0.069-0.589]; p = 0.003), and pain at admission > 7 (RR: 0.363 [0.147-0.579]; p = 0.004) were predictors of nMOR failure. CONCLUSION: Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nMOR. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT03580187.

Ovarian Cancer Was Discovered in Sister Mary Joseph's Nodule.

Introduction: Sister Mary Joseph's nodule (SMJN) is a rare illness characterized by an umbilical mass caused by tumor metastases in the abdomen or pelvis. The most common main site of SMJN in women is ovarian cancer. Case Presentation. A 73-year-old woman with no pathological history came to our emergency room with a one-month history of umbilicus enlargement. A 9-centimeter uncomfortable umbilical swelling with hard consistency was discovered during a clinical examination. An ovarian tumor with several local expansions was seen on an abdominal CT scan. It was linked to peritoneal metastases, one of which extends via a supraumbilical hernial orifice and into intestinal tissues in the same hernia sac. The umbilical tumor was removed from the patient. A moderately differentiated serous carcinoma with ovarian origin was identified in a periumbilical site on histological testing. Conclusion: The presence of an SMJN is a rare but significant issue that clinicians must examine because it is associated with a bad prognosis. Early detection and diagnosis of the original lesion can lead to more effective treatment and a higher rate of survival.

Refeeding syndrome after radical cystoprostatectomy: A case report.

Described as a potentially lethal condition that occurs in undernourished patients, refeeding syndrome (RFD) is a severe electrolyte disturbance that includes low intracellular serum concentrations of phosphor, magnesium and potassium in patients undergoing inappropriate oral or parenteral renutrition. We report a case of RFD in a 50-year-old male patient that occurs 22 days after a radical cystoprostatectomy. The patient was anorexic after the surgery, the body mass index decreased to 12,36 kg/m2. The concentrations of albumin, magnesium, phosphor, and calcium were low. The Patient was admitted into the intensive care unit for severe cachexia and poor general condition 24 after introduction of parenteral nutrition (1500 Kcal/day). The evolution was lethal with multiple organ failure.

[Delivery of twin pregnancy and materno-fetal prognosis in a level 3 Tunisian University Center: a retrospective study about 399 cases]. / L´accouchement des grossesses gémellaires et pronostic materno-fœtal dans un Centre Universitaire Tunisien de niveau 3: étude rétrospective à propos de 399 cas.

Despite obstetric and pediatric progress, twin pregnancy still represents nowadays a high-risk situation for both pregnancy and childbirth. It still remains a distressing situation for the obstetric team. The aim of this study was to describe the practice of twin pregnancy deliveries in the obstetrics and gynecology department of Sousse, the maternal and fetal prognosis and to analyze the factors that may influence it. A descriptive, retrospective study of twin pregnancies births was conducted over a period of two years. We included twin pregnancies that have reached at least 28 weeks of amenorrhea (SA) and women having a twin pregnancy complicated by fetal death in utero. Women with a twin pregnancy who gave birth before 28 weeks were excluded. Bi-chorionic bi-amniotic pregnancies represented 67% of cases, compared with only 11.5% of mono-chorial bi-amniotic pregnancies and 3% of mono-chorial mono-amniotic pregnancies. A total of 52 patients have scheduled caesareans. Spontaneous labor was noticed in 304 cases, and was initiated in 43 cases. A total of 178 women gave birth by vaginal delivery (44.6%) and 215 by cesarean (53.9%). The cesarean rate for the second twin was 1.5%. When the delivery was vaginal, 19 cases of complications were observed (10.7%). We analyzed the Apgar score of both the first and the second twin according to the mode of delivery. There was no statistically significant difference in the Apgar score between the two delivery routes. Perinatal morbidity and mortality is higher for the second twin than for the first twin. Maternal morbidity was higher in vaginal delivery than cesarean delivery. There are no significant differences in the Apgar score according to whether the infants were born by vaginal delivery or by caesarean.

Epidemiological situation of enterobacteriaceae resistant to cephalosporins third generation in the region of Mahdia, Tunisia (2002-2014).

OBJECTIVES: To determine the prevalence and to monitor the trends of resistance to broad-spectrum cephalosporins among various species of enterobacteria in the region of Mahdia (Tunisia) from 2002 to 2014. METHODS: A retrospective study was carried out in the microbiology laboratory at Tahar Sfar Teaching Hospital in Mahdia. Data concerning a thirteen-year period (2002-2014). All clinical isolates of enterobacteriaceae were identified with the API 20 E system. Antimicrobial susceptibilities were determined by disk diffusion on Mueller Hinton agar according to CA-SFM recommendations. RESULTS: During the study period, 25040 non-duplicate clinical strains of enterobacteriacae were identified. 2584 (10,3%) clinical isolates showed acquired resistance to third generation cephalosporins (3rdGC). The overall frequency of resistance increased from 8% in 2002 to 16,3% in 2014. This increase was statistically significant. High prevalence rates of 3rdGC resistance have been observed in pediatric (25,1%), in gynecologyobstetrics (21,9%) and medecine (17,4%). E. coli (21,6%), K. pneumoniae (28,6%) and E. cloacae (30,5%) showed high prevalence rates of broad-spectrum cephalosporin resistance. CONCLUSION: The resistance rates ERC3G in our region seems to be increasing. Implementation of infection control measures and identification of the mechanism responsible for third generation cephalosporins resistance are necessary to limit the spreading of these resistant enterobacteriaceae in hospitals and community settings.

Breast cancer in the Maghreb : epidemiology and control strategies. Review.

Breast cancer is the most common cancer diagnosed in women in the Maghreb and around the world. It's the most common cause of cancer deaths. It represents a major public health problem because of its frequency, morbidity and mortality that it generates as well as the cost of the therapies used. Epidemiological data are similar in the 3 countries of the Maghreb (Tunisia, Morocco, and Algeria). Currently, the incidence of breast cancer is lower than in developed countries, but is increasing steadily, and projections for the coming years predict that rates will be closer to the European ones. The diagnosis is often done at advanced stages compromising the prognosis of the patients. Strategies to combat this cancer remain insufficient and further efforts are needed to improve the situation.

Blunt chest trauma : clinical difficulties and limitations of radiological examinations.

Blunt chest trauma remains a public health problem due to the severity of caused injuries, diagnostic difficulties and therapeutic orientation. There is no correlation between the parietal lesions and endothoracic abnormalities. Instead radiological examinations are far from accurate. Through a study of 72 cases of closed chest trauma and a literature review we propose to identify risk factors of endothoracic lesions, to clarify the role of radiological examinations in the exploration of these injuries and propose a decisional algorithm.