The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study.

BACKGROUND: In healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country. METHODS: This prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants' knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS). RESULTS: Among the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call. CONCLUSION: Our pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Cornual pregnancy as a rare entity of ectopic pregnancy: A case report.

INTRODUCTION AND IMPORTANCE: Cornual pregnancy, an infrequently reported form of ectopic pregnancy occurring in the uterine horn, is inadequately documented in medical literature, with an incidence below 2 %. This condition poses a substantial risk to maternal health due to delayed diagnosis and the potential for life-threatening bleeding after rupture. CASE PRESENTATION: We present a case report following the SCARE guidelines that details a 32-year-old woman with abdominal pain and abnormal uterine bleeding. Clinical examination, ß-HCG levels, and endovaginal ultrasound confirmed the presence of a 4 cm unruptured right cornual pregnancy. The patient underwent a minilaparotomy, which revealed the ectopic pregnancy, followed by a successful cornuostomy and right salpingectomy. Postoperative recovery was uneventful. CLINICAL DISCUSSION: Cornual pregnancy, comprising around 2 % of ectopic pregnancies, is associated with increased risks of rupture and maternal morbidity. Major risk factors include a history of pregnancy termination, miscarriage, STIs, and smoking. Diagnosis is often delayed, leading to an increased risk of bleeding. Pelvic pain is a common presenting symptom, and sonographic findings aid in accurate diagnosis. CONCLUSION: Cornual pregnancy, though rare, represents a serious condition with a significant risk of maternal morbidity and mortality. A timely diagnosis is crucial for effective treatment, with ultrasound playing a pivotal role, complemented by the essential contribution of laparoscopy. This case underscores the importance of prompt intervention to mitigate the associated risks and improve patient outcomes.

Arginase is upregulated in healthy women infected by oncogenic HPV types.

INTRODUCTION: The implication of arginase enzyme in Human Papillomavirus (HPV) infections has not been clearly elucidated. The present study investigates whether HPV infection is correlated with changes in plasmatic arginase activity and cervical ARG1 and ARG2 mRNA expression among infected women negative for intraepithelial lesions (NIL). MATERIEL AND METHODS: The present study included 300 women. The plasmatic arginase activity was evaluated by a colorimetric assay. Cervical HPV was detected by real-time PCR. The circulating viral load and ARG1 and ARG2 mRNA expression quantification were performed by quantitative real-time PCR. RESULTS: A significant increase in plasma arginase activity and ARG1 and ARG2 mRNA expression levels in cervical cells was observed among HPV-positive women compared to the HPV-negative group. The highest levels were significantly associated with oncogenic HPV, and increased arginase activity was associated with a high HPV circulating viral load. Moreover, the highest levels of arginase activity were observed in oncogenic HPV-positive inflammatory smears. DISCUSSION: These data suggest that HPV could modulate arginase activity and expression, which may restrict arginine bioavailability and inhibit this amino acid's antiviral properties. CONCLUSION: Our findings revealed that arginase activity and isoform gene expression were upregulated in women with HPV infection, particularly the oncogenic HPV types.

Ruptured mature ovarian teratoma: A case report.

INTRODUCTION: Dermoid cysts, or also known as mature cystic teratomas, are one of the most common benign ovarian tumors. Spontaneous rupture of this tumor is rare and can be suspected on imaging. CASE REPORT: we report a case of ruptured mature ovarian teratoma. A 21 years old previously healthy woman presented with recurrent pelvic pain, the diagnostic of rupture was made by imaging. The patient underwent surgery with a good follow up. DISCUSSION: Dermoid cysts are the most common benign ovarian neoplasm and its rupture is rare due to its thick capsule. Imaging has a major role in the diagnosis of dermoid cyst and in the detection of its rupture. CT scan is the most requested modality imaging especially in acute abdominal pains. MRI can performed for further characterization. CONCLUSION: the aim of the study is to report a new case of ruptured mature ovarian teratoma and to describe the imaging signs suggesting dermoid cysts rupture.

Complicated COVID-19 in pregnancy, maternal and neonatal outcomes: a case report.

The novel coronavirus disease 2019 (COVID-19) has exposed vulnerable populations, including pregnant women, to an unprecedented public health crisis. According to recent data, pregnancy in COVID-19 patients is associated with increased hospitalization, admission to the intensive care unit (ICU) and intubation. It has been suggested that pregnancy induced immune responses and cardiorespiratory changes can exaggerate the course of the COVID-19. The present is a case of a pregnant woman who presented with critical respiratory failure secondary to COVID-19 resulted in her admission to the ICU and mechanical ventilator support. After childbirth, maternal outcomes were marked by disseminated intravascular coagulopathy and cardiopulmonary arrest on day thirty-four of admission. As to the neonatal outcome, a preterm female baby was transferred to the neonatal intensive care unit (NICU) and intubated immediately due to progressive respiratory distress. She was diagnosed with bacterial pneumonia with no evidence of COVID-19 and recovered after twenty-one days after NICU stay. This case showed that the maternal COVID-19 may lead to acute respiratory distress syndrome, coagulation dysfunction and preterm delivery. The risk of vertical transmission by SARS-CoV-2 is probably very low.

Arginase is involved in cervical lesions progression and severity.

BACKGROUND: Little is known about the relationship between arginase, an immunosuppressive enzyme, and cervical lesions. The present study is aimed at evaluating arginase activity in plasma and mRNA arginase isoforms expression in cervical cells of patients with abnormal cytology and identifying their relationship with Human papillomavirus (HPV) related parameters such as: HPV type, HPV circulating viral load and anti-HPV16 IgG. METHODS: This study included 77 women with cervical lesions and 95 matched controls. Arginase activity was detected by colorimetric assay. Arginase mRNA expression and HPV viral load were evaluated by quantitative real time PCR and anti-HPV16 antibodies were assessed by ELISA. RESULTS: Compared to controls, the arginase activity was higher among women with cervicitis / low grade squamous intraepithelial lesions (LSIL) (OR: 1.872, 95% CI: 0.833-4.210), and also among women with high-grade squamous intraepithelial lesions (HSIL) / squamous cell carcinoma (SCC) (OR: 3.358, 95% CI: 1.670-8.910). Compared to controls, mRNA expression was significantly upregulated in women with cervical cervicitis and SIL for ARG1, and in women with cancer lesions for ARG2. Arginase activity was positively correlated to ARG2 mRNA expression but not to ARG1. High arginase activity was associated with HPV16, high levels of HPV viral load, and low levels of anti-HPV16 antibodies. CONCLUSIONS: Our findings demonstrated that arginase activity and isoforms expression were enhanced in women with HPV-related precancerous lesions and cervical cancer. Further studies are needed to identify how arginase enzyme induces disease progression and severity.

Acute abdomen during pregnancy: appendicular deciduosis-a case report.

Despite the fact that it is rarely found in the appendix during pregnancy, ectopic decidua can, in some cases, cause the occlusion of the appendicular lumen by extrinsic compression due to the expansion of endometrial tissue or due to decidua polyp formation. This condition consequently leads to appendicular inflammation. We report the case of a 27-year-old primigravida woman, 32 weeks of gestation, who presented to our facility with a 2-day history of isolated right iliac fossa pain. The diagnosis of an acute appendicitis was suspected and a planned appendectomy was performed. Microscopical examination showed appendicular deciduosis.

Primary Echinococcus Hydatid Cyst of the Uterus: An Unusual Location.

Hydatidosis is a widespread anthropozoonosis. It can affect almost any part of the body, but it occurs most commonly in the liver (75%) and the lungs (15%). Its occurrence in female genital tract, especially the uterus, is very rare. Diagnosing hydatid disease at these unusual locations can be difficult. Hereby, we report two cases of primary hydatid cyst of the uterus. The first case is that of a 62-year-old woman, G7P5A2, who presented with an eight-month history of chronic pelvic pain. Clinical examination and radiological explorations revealed the presence of a uterine fibroid and a serous cystadenoma of the left ovary. She underwent a hysterectomy and a bilateral adnexectomy. Anatomopathological examination concluded that a serous cystadenoma of the left ovary was a calcified subserous hydatid cyst of the uterine fundus. The second case is that of a 69-year-old woman, G6P4A2, who consulted for chronic pelvic pain that had been evolving for 3 months. The clinical examination and radiological explorations doubted a hydatid cyst of the uterus, with a positive hydatid serology. She underwent a resection of the salient dome. The anatomopathological examination was in favor of a hydatid cyst of the uterus. Hydatid disease is endemic in Tunisia. The pelvic region is rarely affected with an incidence ranging from 0.3 to 0.9%, 80% of which involves the genitals. The uterus is more rarely affected than the ovaries. Most often, it is a contamination secondary to the intra-abdominal rupture of a hydatid cyst of the liver. However, primary uterine hydatid cysts have been reported. Surgery is the Gold Standard for the treatment of uterine hydatid cysts. Exploration of the abdominal cavity is essential in the search for other localizations, particularly hepatic. Postoperative medical treatment with Albendazole can be discussed. The ideal approach to deal with this public health concern is to emphasize the need for improved preventive measures. Modern imaging techniques have significantly improved the detection rates of hydatid cysts in atypical localizations. Indeed, the preoperative diagnosis of uterine hydatidosis requires a meticulous approach which is necessary to initiate an adequate treatment and thus guarantee a better management of the patient.

[Ovarian pregnancy case study and literature review]. / La grossesse ovarienne à propos d'un cas et revue de la littérature.

Ovarian pregnancy is a rare entity among ectopic pregnancies. Its diagnosis and management are not always easy. It is a particular pathology, the clinician is confronted with a poor clinical semiology and a difficult ultrasound diagnosis. The surgical criteria remain difficult to prove. We have compiled a case of ovarian pregnancy. The patient consulted our emergency room for pelvic pain, metrorrhagia and amenorrhea of nine weeks. The preoperative diagnosis was evoked by ultrasound which showed a right latero uterine image of 7*8cm at the expense of the right ovary. An emergency laparotomy was performed. Surgical treatment was radical after the failure of conservative treatment. Ovarian pregnancy is a rare entity of ectopic pregnancy which presents certain semiological peculiarities. Its diagnosis is difficult and is based on intraoperative findings. Its therapeutic management remains for the treatment of ectopic pregnancies, despite the progress of medical and surgical treatment.

[Breast cancer treated with primary chemotherapy: predictive factors for radical treatment (retrospective study of 72 cases)]. / Cancer du sein traité par chimiothérapie première: facteurs prédictifs du traitement radical (étude rétrospective à propos de 72 cas).

Neoadjuvant chemotherapy has become the first-line treatment for locally advanced breast cancers. On the one hand, it allows for increasing options of breast conservation without an increased risk of recurrence, on the other hand it allows for locoregional control of patients with inoperable cancer. However, some clinical, radiological and histological factors are associated with an increased risk of mastectomy, such as microcalcifications, multifocality, SBR1 and 2 grade, cT3 and cT4 stages and overexpressed HER2. The purpose of this study was to determine the predictive factors for mastectomy after neoadjuvant chemotherapy (NAC), whether mastectomy was justified or not histologically and what were the predictors for unjustified mastectomy. We conducted a retrospective study of 72 patients with breast cancer treated by neoadjuvant chemotherapy in the Departments of Gynecology and Medical Oncology at the Fattouma Bourguiba Hospital in Monastir, Tunisia. The rate of conservative treatment was 18.1%; 63.15% for stage T2 tumors. Mastectomy was not justified by definitive histologic diagnosis in 26.3% of cases. In our study, unjustified mastectomy predictors were negative RH status and CT2 stage. This study led to reflection on our practice and its modifications. Conservative surgery should be considered as standard therapy and should be routinely suggested to all patients treated with neoadjuvant chemotherapy for breast cancer, including the cases with multifocality, large clinical tumor size, extensive microcalcifications, in order to significantly reduce the number of unjustified mastectomies.

[IPartial molar pregnancy with liveborn diploid fetus: case study and literature review]. / Grossesse molaire partielle avec fœtus diploïde vivant: à propos d'un cas et revue de la littérature.

Partial hydatiform mole (MHP) represents a spectrum of trophoblastic-related disorders occurring during pregnancy. Also known as embryonal mole, it is characterized by a recognizable ovum abnormality with vesicular transformation of villi but with recognizable placental appearance and amniotic cavity containing the fetus. First-trimester spontaneous abortion most commonly suggests the diagnosis. Partial moles rarely persist beyond the first trimester and are then a cause of maternal and fetal complications and diagnostic confusion. MHP of genetic origin is triploid with extra chromosome of paternal origin. The coexistence of normal fetal karyotype and MHP is exceptional. We report a rare case of partial molar pregnancy with liveborn diploid fetus in a 36-year-old woman diagnosed with threat of premature labour associated with placenta previa at 27 weeks of amenorrhea (WA).

Early primary abdominal pregnancy: Diagnosis and management. A case report.

INTRODUCTION: Abdominal pregnancy is a rare type of ectopic pregnancies associated with a high mortality rate. Symptoms are not specific and usually resemble the other types of ectopic pregnancies. Medical management is used in cases where a potentially lethal hemorrhage can be anticipated. Nowadays, laparoscopic surgery has become the most common choice especially in cases diagnosed during the first trimester. PRESENTATION OF CASE: A 35-year-old woman consulted for a pelvic pain and menstruation delay. She had a stable hemodynamic status and hypogastric tenderness during deep abdominal palpation. The ßHCG rate was at 16041 IU/l. Pelvic ultrasonography revealed a gestational sac next to the right adnexa of 1.2 cm. Laparoscopic exploration was performed finding normal fallopian tubes and ovaries with a 2 cm mass on the vesical peritoneum. Resection of ectopic pregnancy was successfully performed and patient was discharged the next day with no postoperative complications. DISCUSSION: To date, there is no therapeutic protocol that has been established and there are no predictive criteria of success concerning medical management for ectopic pregnancy. Surgery is the most common choice in the therapeutic management of ectopic abdominal pregnancy. Laparotomy was preferred to the laparoscopic surgery because of the high risk of perioperative hemorrhage which can be uncontrollable from the implantation site. Nowadays, laparoscopic surgery should be the first measure if the abdominal pregnancy is diagnosed at an early stage (< 12 weeks) or if the implantation site allows a non-hemorrhagic surgical excision. CONCLUSION: Laparoscopic management of abdominal pregnancies is an encouraging choice to laparotomy.