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.

Acute acalculous cholecystitis in hospitalized patients in intensive care unit: study of 5 cases.

Background: Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder with no evidence of gallstones. It occurs mostly in patients in intensive care units and is associated with several risk factors (fasting, parenteral nutrition, mechanical ventilation) leading to ischemia of the gallbladder wall. Methods: This is a retrospective multiple cases study of five cases of AAC in patients hospitalized in the Medical Intensive Care Unit at Tahar Sfar Hospital in Mahdia over a 4-year period between January 2016 and December 2020. Results: The mean age of our patients was 62.5 years (±8) with a male predominance (sex ratio 4/1). The mean Charlson comorbidity index was 4. Four patients were under invasive mechanical ventilation and total parenteral nutrition. Three patients were under vasoactive drugs. All patients had fever, the patient who was conscious presented with abdominal pain and vomiting with right hypochondrium tenderness, while two patients presented with abdominal bloating and bowel obstruction. All patients had a biological inflammatory syndrome, two patients had cytolysis, and only one patient had cholestasis. All patients had a thickening of the gallbladder wall greater than 3mm on ultrasound. Treatment was based on broad-spectrum antibiotic therapy followed by early (<72 h) cholecystectomy. Only one patient had postoperative peritonitis. All patients had gangrenous cholecystitis. Three patients died of multi-visceral failure. Conclusion: This study, in spite of its small sample size, gave us an idea of patients at risk of developing this disease, on the difficulty of diagnosis and on the importance of surgical treatment.

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.

Retrorectal epidermoid mistaken for perirectal swelling: A case report.

INTRODUCTION AND IMPORTANCE: Epidermoid cysts are developmental cysts of the retrorectal space. They are benign lesions resulting from ectodermal inclusion during neural tube closure. Generally, they are misdiagnosed given that symptoms are often vague and nonspecific. They have a high infection rate (up to 30%) and can be easily mistaken for perirectal abscesses. CASE PRESENTATION: We present a case of an epidermoid cyst in a 58-year-old woman with a retrorectal cyst mistaken for a perianal abscess, which was initially incised and drained and then, after MRI investigation, an anterior resection was performed. CLINICAL DISCUSSION: Epidermoid cysts have a high infection rate (up to 30%). Infected cysts can be easily mistaken for perirectal abscesses, pilonidal disease, or fistulae in ano. CT (computed tomography) used in conjunction with MRI (Magnetic Resonance Imaging) is the gold standard for establishing the diagnosis. A biopsy is never indicated. Surgery is the best treatment, even for asymptomatic lesions. CONCLUSION: Epidermoid cysts are rare and generally misdiagnosed. In fact, symptoms are often vague and nonspecific. Radiologic imaging (especially MRI) is essential for surgical planning and biopsy should be avoided. Once a presacral lesion is diagnosed, even if the patient is asymptomatic, complete resection remains the treatment of choice because of the risk of infection.

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.

[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.

Complete cervical agenesis: successful surgical treatment: one case report.

Cervical agenesis is a rare congenital pathology linked to an abnormality in the development of the Mullerian system, the mechanism of this anomaly is unknown. We reported a case of complete cervical agenesis in a 17-year-old girl who underwent a successfully utero-vaginal anastomosis.

[COVID-19 infection in pregnancy: about a case]. / Infection COVID-19 chez la femme enceinte: à propos d'un cas.

The recent COVID-19 pandemic has led to an unprecedented global health crisis. The susceptibility of pregnant women to infections has raised many questions about the risk of transmission, teratogenic risk and maternal and fetal complications. The speed at which the infection advanced as well as the ambiguity effects on pregnancy, due to the absence of scientific data, led obstetricians to adapt their practice according to pragmatic approach. We focused on this subject declared by the WHO as a global pandemic in early March 2020 to develop a plan for obstetric management of SARS-CoV-2 infected patients on the basis of current data. Based on the literature and the case of a patient hospitalized in our Department of Gynecology in Mahdia, the purpose of this study was to describe the possible clinical manifestations of COVID-19 infection in pregnant women and to develop principles of management of patients with COVID-19 infection.

Postpartum Treatment of a Herniation of the Anterior Uterine Wall due to Remains of Placenta Increta.

In recent years, the incidence of placenta accreta and associated complications has increased significantly. The authors report the case of a pregnant woman in the 5th month of pregnancy for premature rupture of the membranes. The placenta was inserted low. The evolution was marked spontaneous work followed by the expulsion of the fetus. The delivery of the placenta was haemorrhagic and incomplete. Ultrasonic testing showed a placental fragment integrated in the thickness of the myometrium. Conservative treatment with methotrexate was published a few days later and MRI showed that the anterior uterine sac was filled with blood clots associated with pelvic effusion. A laparotomy was then performed to resect the pouch and the one-piece fragment. The follow-up was uneventful.

[Genital metastases from breast cancer: study of 3 cases and literature review]. / Métastases génitales du cancer du sein: étude de 3 cas et revue de la littérature.

Breast cancer is the most common cancer among women. Prognosis depends, in large part, on the presence of metastases. Liver, skeleton and lungs are the most frequent metastatic sites, whereas genital metastases are more rare and less known. The detection of an ovarian mass in a woman with a history of breast cancer raises the question of its primary or secondary origin. The frequency of ovarian metastases reported in the literature is approximately 20-30%. However, when an ovarian mass is detected in a woman with breast cancer, primary ovarian tumor is diagnosed three times more often than a metastasis. Cervical, uterine or corporeal metastases are even more rare. They are often diagnosed late, due to their clinical latency; transvaginal ultrasound coupled with Color Doppler and Pap smear must be performed as first-line examinations knowing that their screening performance in patients with ovarian masses is deemed low. An increase in CA 15-3 and CEA tumor markers must lead clinicians to investigate for metastases, but it doesn't provide diagnostic orientation toward a specific metastatic site. Finally, only anatomo-athological examination allows certain diagnosis. We here report 3 cases of genital metastases from primary breast cancer (two patients with ovarian metastases and one patient with cervico-uterine metastasis) in order to highlight the role of accurate and regular genital examination in the monitoring of patients with breast cancer and to discuss the predictive factors for their occurrence.

Factors Predictive of Quality of Life among Breast Cancer Patients

Background: Due to progress in medical care, the number of survivors from cancer has increased significantly during recent years and this raises the question of the quality of life (QoL), especially of the many women treated for a breast cancer. This paper focuses on correlations of QoL with anxiety and depression on the one hand and with socio demographic, anatomo-clinical and therapeutic parameters on the other. Methods: In this cross-sectional study, seventy patients were enrolled and filled in two auto-questionnaires, both in validated Arabic versions: The SF-36 for assessment of QoL and the Hospital Anxiety and Depression Scale (HAD-S) for evaluation of anxiety and depression. The statistical approaches used to determine predictive factors were bivariate correlations to determine relationships between quantitative variables, and T-tests and one-way Anova to analyze links between qualitative and quantitative variables. Results: The QoL of patients was altered with an SF-36 mean total score of 54.0 ± 22.7, and the alteration affects the different aspects. The mean scores for anxiety and depression in patients were 6.91 ± 4.72 and 6.24 ± 3.88, respectively. The results of this study suggested an association between the QoL and chemotherapy (p= 0.014) and its adverse effects (p=0.01), as well as anxiety (p= 0.0001) and depressive symptoms (p= 0.0001). Socio-demographic factors, the stage of the cancer, and surgery, radiotherapy or hormone therapy did not appear to have significant effects. Conclusion: The management of breast cancer patients needs a collaborative approach between oncologists, gynecologists, psychologist and psychiatrists.

Breast diseases in women over the age of 65 in Monastir, Tunisia.

As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.

[Verneuil's disease: a diagnosis that should be taken into consideration in patients with vulvar and perineal tumor-like lesion]. / Maladie de Verneuil: un diagnostic à ne pas méconnaitre devant une lésion tumorale vulvaire et périnéale.

We here report the case of a 58-year old nulliparous patient with a history of Niemann-Pick disease who presented with vulvoperineal, fluctuant, fistulized swelling measuring 10 cm associated with ulceration. The patient was febrile with impaired general state This mass caused some concern about necrotic and infected malignant tumor of the vulva associated with chronic dermatosis. Incision and purulent drainage associated with multiple biopsies excluded the presence of a neoplastic process. The diagnosis of suppurative hidradenitis or Verneuil's disease was based on the associations between lesions and their distributions. Then, the problem that arose was that of the choice between drug treatment and surgical procedures. This study, including a short review of the recent literature, aims to outline the diagnostic modalities, the complications and the therapeutic management of this disease.