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1.
Pan Afr Med J ; 38: 272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122699

RESUMO

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.


Assuntos
Serviços Médicos de Emergência/organização & administração , Serviços de Saúde Materna/organização & administração , Obstetrícia/organização & administração , Qualidade da Assistência à Saúde , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Feminino , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Serviços de Saúde Materna/normas , Mortalidade Materna , Obstetrícia/normas , Morte Perinatal , Gravidez , Tunísia
2.
J Gynecol Obstet Hum Reprod ; 50(7): 102109, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33727208

RESUMO

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.

3.
Pan Afr Med J ; 36: 178, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32952822

RESUMO

Introduction: malignant germ cell tumors of the ovary (TGMO) are rare ovarian tumors. Each histological type can have clinical and therapeutic particularities which it is important to know. The objective was to report and analyze the particularities of the epidemiological, diagnostic, anatomopathological, therapeutic and prognostic data of TGMO in Tunisian context. Methods: this study is a retrospective descriptive and analytical survey carried out at the Gynecology-Obstetrics departments of the CHU FARHAT HACHED in Sousse over a period of 21years collecting all the cases of patients having been treated for TGMO. Results: a total number of 30 files was eligible for our study. The average age of our patients was 22years. The majority of patients were in a period of genital activity. The reason for the consultation was mainly represented by abdomino-pelvic pain followed by an increase in abdominal volume. Abdominopelvic ultrasound was performed in 80% of our patients showing a suspicious appearance of malignancy in 100% of them. For our patients, 70% were approached by median laparotomy given the tumor volume and only 30% by laparoscopy. 76.7% had conservative treatment. The predominance of stage I was noted while there was no case in stage IV. The overall survival for all stages was 96.7% at 2years and 85.7% at 5years and 75.8% at 10years. The prognostic factors of the TGMOs isolated from our series were the consultation time greater than 6 months, the age greater than 30years, the tumor size greater than 20cm and the tumor stage. Conclusion: it would be more interesting to bring together the other cases of TGMO diagnosed in other cancer registries in the country in order to establish a national register of rare ovarian tumors.


Assuntos
Laparoscopia , Laparotomia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Dor Abdominal/etiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Dor Pélvica/etiologia , Prognóstico , Estudos Retrospectivos , Tunísia , Adulto Jovem
4.
J Transl Med ; 18(1): 288, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727491

RESUMO

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.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Anticorpos Antivirais , Capsídeo , Proteínas do Capsídeo , Feminino , Humanos , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Peptídeos Cíclicos , Prevalência , Neoplasias do Colo do Útero/diagnóstico
5.
J Am Coll Nutr ; 39(8): 733-738, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32213118

RESUMO

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.

7.
Pan Afr Med J ; 36: 237, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33708328

RESUMO

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.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez , Gravidez de Gêmeos , Adulto , Índice de Apgar , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Mortalidade Perinatal , Gravidez , Prognóstico , Estudos Retrospectivos , Tunísia , Gêmeos , Adulto Jovem
8.
Pan Afr Med J ; 33: 306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692846

RESUMO

Introduction: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods: A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results: Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion: The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Trabalho de Parto , Guias de Prática Clínica como Assunto , Gravidez , Atenção Terciária à Saúde , Tunísia , Adulto Jovem
9.
Pan Afr Med J ; 30: 236, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30574255

RESUMO

We report the observation of a 25-year-old pregnant patient of 39 weeks of amenorrhea proposed for elective cesarean section. This patient suffers from hypertrophic cardiomyopathy since the age of 12. She has an implantable cardioverter defibrillator (ICD). The peculiarities of the ICD in the parturient and the perioperative management of the patient are being reported in this paper.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Cesárea , Desfibriladores Implantáveis , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Cardiomiopatia Hipertrófica/terapia , Feminino , Humanos , Assistência Perioperatória/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
11.
Pan Afr Med J ; 30: 268, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30637053

RESUMO

Although it is known that breast cancer can metastasize to many organ sites, metastasis to the uterus is uncommon and usually occurs during widespread metastatic disease. Lobular carcinoma is not the most common histological subtypes of breast carcinoma, but it is the most frequent histologic type that causes gastrointestinal, gynecological and peritoneal metastases. The main symptoms of the uterine metastasis depend on the anatomic involvement site. Abnormal uterine bleeding is by far the most important symptom.We highlight the importance of the follow up of patient with breast cancer. A rapid endometrial sampling for confirmation of the diagnosis, should be performed when the routine gynecological follow-up revealed any abnormality. We report two original observations of endometrium metastases of invasive lobular carcinoma of the breast which we detected during follow-up.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Neoplasias do Endométrio/diagnóstico , Idoso , Neoplasias do Endométrio/secundário , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Hemorragia Uterina/etiologia
12.
J Obstet Gynaecol Res ; 43(5): 820-824, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28150366

RESUMO

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.


Assuntos
Desenvolvimento Fetal/fisiologia , Hemodinâmica/fisiologia , Artérias Umbilicais/diagnóstico por imagem , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
13.
Tunis Med ; 94(6): 167-177, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28051220

RESUMO

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.


Assuntos
Fármacos para a Fertilidade Feminina/uso terapêutico , Hormônio Foliculoestimulante/uso terapêutico , Hormônios/uso terapêutico , Menotropinas/uso terapêutico , Indução da Ovulação/métodos , Injeções de Esperma Intracitoplásmicas , Feminino , Fertilização In Vitro , Humanos , Recuperação de Oócitos , Gravidez , Proteínas Recombinantes , Estudos Retrospectivos
14.
Afr J Reprod Health ; 20(4): 44-50, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29566318

RESUMO

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.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Qualidade da Assistência à Saúde , Adulto , Cuidados Críticos/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Emergências/epidemiologia , Feminino , Maternidades , Humanos , Recém-Nascido , Mortalidade Materna , Gravidez , Complicações na Gravidez/epidemiologia , Taxa de Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Tunísia/epidemiologia , Adulto Jovem
16.
Int J Surg Case Rep ; 5(11): 787-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25290382

RESUMO

INTRODUCTION: Choriocarcinoma is a highly malignant trophoblastic neoplasm. Its association with ectopic pregnancy is very rare and usually with aggressive behavior. PRESENTATION OF CASE: We report a new case arising in an interstitial pregnancy occurring in a 46-year-old woman. The patient was admitted for severe pelvic pain and abundant metrorrhagia. One month ago, she had had a laparoscopic resection of an interstitial pregnancy subsequent to failure of chemotherapy by methotrexate. The raise of serum ßhCG level and the hyperechoic intrauterine mass were in favor of gestational trophoblastic disease. Urgent laparotomy was performed for circulatory collapse. Hysterectomy was done. Histological examination revealed a choriocarcinoma. The patient underwent chemotherapy. Two years later, neither metastasis nor recurrence was detected. DISCUSSION: Clinical diagnosis of primary interstitial choriocarcinoma is difficult, since it is rare and manifesting by non-specific abnormal vaginal bleeding. Imaging findings are also not helpful in ectopic location. The frequency of metastasis is related to the delayed diagnosis. Serial measurement of ßhCG level was the most useful marker of diagnosis and follow up. Histopathological examination remains the only tool of the precise diagnosis. Choriocarcinoma has a very good prognosis even in advanced stages, since it is very chemosensitive. CONCLUSION: The current trend of the treatment of ectopic pregnancy by conservative surgery requires adequate monitoring of ßhCG and careful examination of pathologic specimens to avoid misdiagnosis of ectopic gestational trophoblastic disease.

17.
Bull Cancer ; 101(7-8): 669-80, 2014.
Artigo em Francês | MEDLINE | ID: mdl-25091649

RESUMO

To analyze the clinical and pathological features of uterine sarcomas treated at our referral medical center. The aim of the study is also to analyze their prognosis factors. We performed a retrospective analysis of 40 women with uterine sarcoma treated at the Obstetrics and Gynecology department - Sousse - Tunisia between 1997 and 2010. Tumor stage was assessed according to the FIGO 1988 classification. Patient's outcomes were recorded and analyzed using SPSS 18.0 program. Forty patients were included in the study. Leiomyosarcoma represents 65% of cases (n=26) and carcinosarcoma 20 % (n=8). Mean age at the time of diagnosis was 53 years (range: 35-82 years). The most common symptoms were vaginal bleeding and pelvic pain (respectively 72.5% and 45%). Mean interval time from onset of symptoms and pathological diagnosis of sarcoma was 16 weeks (range: 0 to 96 weeks). Definitive diagnosis of sarcoma was achieved after pathological analysis in 62.5%. Most common histological type was leiomyosarcoma in 65 % of cases. A total of 36 patients underwent total hysterectomy with bilateral salpingo-oophorectmy. In four cases pelvic lymphadenectomy was also performed. 75% (n=30) were in FIGO stage I. Eleven patients underwent external pelvic radiotherapy and chemotherapy was administrated in three cases. At the time of study, mean follow up was 30.9 months (range: 0 to 120 months). The 5-year global survival and free survival were 17.5% and 15%, respectively. In multivariate analysis tumor stage was found to be the strongest prognostic factor. Mean survival was 71 months in FIGO stage I, 13.4 months in FIGO stage II, 10 months in FIGO stage III and 4,8 months in FIGO stage IV(p<0,001). Uterine sarcomas are rare. Leiomyosarcoma is the most common histological type. Pathological diagnosis is usually achieved after radical surgery. Prognosis is poor and is correlated with tumor stage.


Assuntos
Doenças Raras , Sarcoma , Neoplasias Uterinas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinossarcoma/patologia , Carcinossarcoma/terapia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Leiomiossarcoma/patologia , Leiomiossarcoma/terapia , Pessoa de Meia-Idade , Prognóstico , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/patologia , Doenças Raras/terapia , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/epidemiologia , Sarcoma/patologia , Sarcoma/terapia , Tunísia/epidemiologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
18.
Int J Gynaecol Obstet ; 125(2): 134-7, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24568955

RESUMO

OBJECTIVE: To compare quality-of-life gender differences within infertile couples from Tunisia and between infertile couples and controls. METHODS: The present case-control study included 100 couples with primary infertility who, during 2009, underwent assisted reproductive technology at Farhat Hached Hospital in Sousse, Tunisia, and 100 control couples. The 36-item Short-Form Health Survey (SF-36) was administered to assess quality of life. RESULTS: Compared with male controls, men in the infertility group had lower scores in the mental dimension (P=0.020), social functioning (P=0.007), and role-emotional (P<0.001) categories of the SF-36. Women in the infertility group had lower mental and physical dimension scores (P<0.001) and lower vitality (P=0.022), social functioning (P<0.001), role-emotional (P<0.001), and mental health (P<0.001) scores than female controls. Within infertile couples, female partners had lower total (P=0.01) and mental dimension (P<0.001) scores than their spouses. Delay of the first consultation was correlated with bodily pain, vitality, and mental health among women in the infertility group. CONCLUSION: Women in infertile couples had a lower quality of life than their spouses, and infertile couples had a lower quality of life than controls. These findings confirm the need for psychological support for infertile couples.


Assuntos
Infertilidade/psicologia , Qualidade de Vida/psicologia , Adulto , Estudos de Casos e Controles , Emoções , Características da Família , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Saúde Mental , Dor/psicologia , Fatores Sexuais , Tunísia
19.
Pan Afr Med J ; 19: 188, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25848451

RESUMO

Mammary-like adenocarcinoma of the vulva associated to Paget's disease is exceedingly rare. So, it is very important to perform all the pathological and immunohistochemical investigations to achieve differential diagnosis from both a metastatic lesion from an orthotopic breast cancer and a vulvar adnexal tumor. This report describes a case of vulvar Paget's disease associated with underlying mammary-like adenocarcinoma diagnosed in the Department of Obstetrics and Gynecology of Farhat Hached university hospital of Sousse in Tunisia. We also review previously reported cases of primary breast-like carcinoma of the vulva with or without Paget's disease.


Assuntos
Adenocarcinoma/patologia , Glândulas Mamárias Humanas/patologia , Doença de Paget Extramamária/patologia , Neoplasias Vulvares/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Adulto , Feminino , Humanos , Doença de Paget Extramamária/diagnóstico , Tunísia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/etiologia
20.
Pan Afr Med J ; 19: 176, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25815097

RESUMO

Choriocarcinoma is a gestational trophoblastic tumor that mainly affects women of childbearing age. Cases of choriocarcinoma in postmenopausal women are exceptional. Through an observation and literature review, we propose to study the specific diagnosis and treatment features of this tumor in menopausal women. We report the observation of a pure uterine choriocarcinoma, which occurred in post-menopause. The diagnosis was made on the analysis of surgical specimens confirmed by measurement of hCG. Chemotherapy was started after a total hysterectomy and bilateral salpingo-oophorectomy first. The improvement was dramatic after 3 courses of chemotherapy and the patient is in complete remission after five years of monitoring. The primitive forms of pure choriocarcinoma in postmenopausal women are exceptional. Their etiology is poorly understood and their treatment based on chemotherapy.


Assuntos
Coriocarcinoma/patologia , Pós-Menopausa , Neoplasias Uterinas/patologia , Coriocarcinoma/diagnóstico , Coriocarcinoma/terapia , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Ovariectomia/métodos , Salpingectomia/métodos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
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