Increased Rheumatoid Factor production in patients with severe COVID-19

BACKGROUND

Searching for Rheumatoid Factors (RF) in patients with coronavirus disease (COVID-19) has rarely been described.

OBJECTIVES

To investigate the association between RF isotypes (IgM, IgA, and IgG) and different clinical presentations of COVID-19 in a series of Tunisian patients.

STUDY DESIGN

Eighty-two COVID-19 patients were enrolled in this study. Symptomatic cases were recruited from the Department of COVID-19 and the intensive care unit (ICU) of the University Hospital of Mahdia, Tunisia, from January 2021 to March 2021. Different RF isotypes were assessed using a commercial enzyme-linked immunosorbent assay (ELISA).

RESULTS

Forty-one patients (50%) had RF of any isotype. Thirty-two patients (39%) were tested positive for RF-IgM. Symptomatic forms of the disease were associated with RF-IgM positivity (p = 0.005). The mean concentration of RF-IgM was higher in the severe form than in the moderate and asymptomatic forms (p = 0.006).

CONCLUSIONS

Our study suggests that the production of RF-IgM isotype is increased in patients with severe COVID-19.

Quality of Life Among Women With Breast Cancer

Introduction

Breast cancer (BC) is the most common cancer in women all over the world. Its physical consequences and psychosocial distress had adverse effect on quality of life (QOL).

Objectives

Evaluate the QOL among women with BC.

Methods

Descriptive cross-sectional study of BC patients, carried out during a period of 5 years. Socio-demographic and medical data was collected based on a pre-established synoptic sheet. The European Organization for Research and Treatment Quality of Life Questionnaires (EORTC QLQ-C30) and EORTC QLQ-BR23 were used to assess the QOL.

Results

A total of 100 patients were included. The mean age was 52 ± 8 years. The mean overall health score was 77.5 ± 25.5. The mean scores of physical and emotional functioning were 82 ± 25.1 and 90 ± 19.5 respectively. The QLQ-BR23 objectified a body image score of 63 ± 23.9, an average score for sexual functioning of 87.3 ± 22 with loss of sexual enjoyment in 75% of cases. The increase in mean overall health score and physical functioning was significantly associated with type of treatment (p = 0.01). The mean score of emotional functioning was correlated with the feeling of support (p = 0.04). The increase in the patient’s body image score was significantly associated with age (p <10-3), marital status (p = 0.01) and having had a mastectomy (p <10-3).

Conclusions

Our results underline the importance of psychosocial care, which must be an integral part of oncological care in women with BC, in order to improve their quality of life.

Disclosure

No significant relationships.

Prolonged pregnancy, incidence and morbidity

Background

The classic term for a pregnancy is between 37 and 42 weeks of amenorrhea. In fact, the literature has shown that exceeding the term (LD, 42WG) is the cause of many maternal-fetal complications despite close monitoring and appropriate management. A new rigorous and adapted management is essential in view of the materno-fetal prognosis.

Objectives

To describe the complications and risks associated with exceeded pregnancies and to propose a new strategy indicating an appropriate course of action.

Patients and Methods

This is a retrospective study of 50 women who gave birth at 42 WG or more at the Maternity of the Farhat Hached University Hospital Center in Sousse.

Results

the average age of our patients was 30.56 years old, 70% of which were primiparous, 82% of our patients were monitored between 41 and 42 WG. Fetal complications demonstrated in our results were increased by macrosomia in 54% of cases, pathological FHR during labor in 48% of cases, fetal distress in 26% of cases. In addition, maternal complications were increased by cesarean delivery in 48% of cases, perineal tears in 40% of cases and forceps delivery in 20% of cases.

Conclusions

By comparing the expectation under supervision to induction of labour at 41WG, we concluded that induction of labour reduces maternal-fetal outcomes in a remarkable way. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis.

Key messages

Exceeding the classic term for a pregnancy may cause maternal and fetal complications. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis.

Pregnancy and epilepsy: a retrospective study of 100 pregrancies

Introduction

Epilepsy is a common neurological disorder in obstetric practice it's prevalence is estimated around 0.3 to 0.7%. Pregnant women with epilepsy are commonly considered to be at high risk for complications during pregnancy or delivery therefore requires targeted and appropriate management.

Objectives

This study evaluated obstetric and neonatal outcome in epileptic pregnant women and to assess targeted management of pregnancy and childbirth.

Methods

Across sectional study was conducted among 100 epileptic patients who gave birth between 2015 and 2019 at the Maternity and Neonatology departments of both Farhat Hached and Monastir University Hospitals.

Results

The mean age of our patients was 29.87 years and 33.7% were primiparous. Only 19% of patients had a planned pregnancy and 71% had at least the 5 recommended prenatal follow-up. Overall 86% of our patients were under and antiepileptic medication and 52% received Folic acid supplementation. The fetal complications were advanced term in (17.85%); premature birth (5.5%); fetal death in utero (2%), low birth weight (4.3%) and macrosomia (8.7%). A significant statistical association was found between poly-therapy, low birth weight (P = 0.01) and fetal death in utero (P = 0.025). A statistical association was found between the use of Larnotrigine and gestational diabetes (p = 0.002).

Conclusions

A significant association of epilepsy, exposure to antiepileptic drugs, and adverse outcomes exists in pregnancy. Management at early stage of pregnancy, or even preconception, seems necessary in view of planning the pregnancy, studying the risks and re-evaluating the effectiveness of the treatment previously used.

Key messages

Pregnant women with epilepsy are commonly considered to be at high risk for complications during pregnancy or delivery. health professionals must planthe pregnancy, studying the risks and re-evaluating the effectiveness of the treatment.

Profile of unobservant women regarding contraception in Sousse (Tunisia)

Background

The contraceptive prevalence rate in Tunisia is estimated around 62.5%meanwhile the rate of voluntary termination of pregnancy is constantly increasing. The aim of this study was to define the profile of unobservant women regarding contraception and to assess their knowledge about oral contraception.

Methods

A cross-sectional study was conducted during the month of March 2018 at the Obstetrics and Gynecology Service in Sousse (Tunisia). This study included 100 women who had undergone voluntary termination of pregnancy. All the participants were using contraceptive means.

Results

Roughly 49% of participants were aged between 30 and 38 years, 64% came from an urban environment, 68% had low socio-economic status and 34% had a secondary level of education. Most of them (98%) were using progestin-only pills. Approximately 40 % did not know what ‘back-up' measures they should take after missing a dose of the contraceptive pill.

Conclusions

We cannot extrapolate these results to the whole Tunisian women but we are facing a lack of minimal knowledge about contraception among at least this category of women. Those patients should be more educated and monitored by the prescribers of contraception such as midwives.

Key messages

The rate of voluntary termination of pregnancy is constantly increasing. Patients should be more educated and monitored by the prescribers of contraception such as midwives.

The impact of obesity on maternal-fetal prognosis through a comparative study

Objectives

To clarify the impact of obesity on the course of pregnancy and childbirth by specifying maternal and fetal complications.

Materials and Methods

This is a comparative case-control study, conducted over a period of two months from February 1 to March 31, 2019, which included patients who gave birth in the Farhat Hached Sousse University Hospital and the Maternity and Neonatology Hospital of Monastir. Patients meeting the inclusion criteria were divided into two groups according to body mass index (BMI) at the end of pregnancy: group I: normal weight 18,5≤ BMI &lt;25 and group II BMI greater than or equal to 30.

Results

Pregnancies of women in Group II were more frequently complicated by gravidic hypertension 8% against 1%, 3% pre-eclampsia against 0% and gestational diabetes 14% against 3%, as well as infections. In obese patients, there were more labor abnormalities with a 17% vs. 3% cesarean section rate and higher instrumental delivery rate 15% vs. 7%. Post-partum follow-up was marked by the occurrence of infectious maternal complications, anemia with breastfeeding difficulties. The newborns of group II women were born with a lower Apgar score and had more neonatal complications such as trauma 6% versus 0% meconium inhalation 6% versus 2% and hypoglycemia 4% versus 0%.

Conclusions

Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and her baby throughout pregnancy, childbirth and post-partum. The management of obese or overweight pregnant women must be early and adapted to each case with close obstetrical surveillance.

Key messages

Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and baby. The management of obese or overweight pregnant women must be early.

Health related quality of life measured by in Tunisian female patients with breast cancer

Background

Breast cancer is a worldwide public health issue. In Tunisia It is the leading cause of cancer mortality and morbidity and accounts for 20-25% of malignant tumors in women in all age groups. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors

Aim

To assess the quality of life of women with breast cancer in remission.

Methods

A cross-sectional study was conducted among women with breast cancer, treated at the maternity ward of the University Hospital Farhat Hached in Sousse during the period from January 1, 2013 to December 31; 2017. The patients were surveyed 24 to 60 months after their cancer diagnosis. The quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23).

Results

100 breast cancer patients were recruited with a mean age of 52 ± 8 years. The mean Global Health Status was 77.5 (SD = 25.5). From the QLQ-C30, the mean score in the functioning scale was highest for ‘social functioning' (93; SD = 16.3), while the mean score in the symptom scale was highest for ‘Pain' (39, SD = 20.5). From the QLQ-BR23, the mean score for functioning scale was highest for ‘Sexual Pleasure' (88.33; SD = 21.9) while the mean score in the symptom scale was highest for ‘upset by hair loss' (56; SD = 15.2). The global health Status was significantly associated with professional category; health condition; age and type of treatment.

Conclusions

The results of the present study demonstrated the importance of a global therapeutic management that specifically targets the physical and psychological needs of breast cancer survivors. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies.

Key messages

Importance of a global therapeutic management tha target the quality of Life of cancer patients. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies.

AB0776 MULTIPLE AUTOIMMUNE SYNDROME

Background:

Multiple autoimmune syndrome (MAS) is a rare entity, defined by the association of three autoimmune diseases in the same patient. MAS can be classified into three groups.

Objectives:

The objective of this work was to describe the autoimmune diseases profile in MAS in An Internal Medicine Department.

Methods:

We report a retrospective analysis including 14 cases of MAS seen in The Internal Medicine Department at Taher Sfar Hospital, Mahdia, TUNISIA over a period of 10 years.

Results:

We followed 14 patients with MAS. They were 14 women. The mean age of patients was 52 years. SAM was type 3 in 12 patients (85%), type 2 in one patient (7.1%) and one patient satisfied both type 2 and type 3 MAS criteria (7.1%). No cases of MAS type 1 had been reported. We found 13 patients with 3 associated autoimmune diseases and one patient with 4 associated autoimmune diseases. The autoimmune diseases were: Sjögren’s syndrome in 14 patients (100%), Hashimoto’s thyroiditis in 11 cases (78%), systemic lupus erythematosus in 7 cases (50%), Addison’s disease in 4 cases (28, 5%), scleroderma, thymoma, vitiligo, Biermer and primary biliary cholangitis each in one case (7.1%).

Conclusion:

Multiple autoimmune syndrome remains a rare but probably under-diagnosed entity. Thus, in patients with autoimmune disease, initial investigation and follow-up of clinical signs and biological stigmas of other autoimmune diseases should be cautious.

Disclosure of Interests:

None declared

Sexually transmitted diseases: what is the knowledge of college students in Tunisia?

Introduction

In Tunisia sexuality education is a subject that is little discussed in institutions and schools, hence its marginal place in the school curriculum and even if it is addressed, it mainly concerns reproduction and risk prevention. The purpose of this study was to evaluate the knowledge, attitudes, and behaviors of law university students regarding sexually transmitted diseases.

Methods

A cross-sectional survey was conducted among 300 law school students in Sousse, Tunisia. The instruments used for assessment was a pretested questionnaire contained questions evaluating knowledge and attitude towards STD and AIDS. Questions had multiple responses from which each respondent was asked to select the most appropriate one.

Results

Our sample consisted of 300 students, the majority were female (75.3%). The mean age was 22.30 years old. More than 75% of surveyed students did not discuss the subject of sexuality with their parents. The main sources of information for the students were the internet 48.3% followed by media 47% and friends 20%; health professional represents only 10.3%. Concerning the identification of risky sexual behavior 56.6% of the students identified multiple partner's sex and 45.7% the non-use of the condom. AIDS comes first among the STD cited by the majority of students surveyed (92%) followed by syphilis (6%). Despite that the majority of our participants knew the signs of STD; such as genital ulcer, urethral / vaginal discharge. False beliefs persist such as chest pain (13.3%) and headache (13.1%). 60.7% f our student reported genital cancers as complication to STD, 32.7% infertility. Some minorities (2.7%) thought that STD could be complicated by blindness.

Conclusions

Despite the high prevalence of STD among young adults, most students knew very little about those infections. Implementing sexual educational programs and measuring their effectiveness should be a priority.

Key messages

There is a huge lack of knowledge about sexually Transmitted diseases among Tunisian college students. Implementing sexual educational programs and measuring their effectiveness should be a priority.

Breast self-examination: knowledge and practices among women in Sousse, Tunisia

Backgrounds and aims

Breast cancer is a major public health problem. In Tunisia, breast cancer is the first leading cause of cancer-related deaths. Different organizations and professionals advise women to learn how to perform breast self-examination (BSE) so that they can detect the slightest change as soon as it intervenes.

Objective

This study aims to determine the prevalence of women performing breast self-examination and to evaluate their practices.

Materials and Methods

A cross-sectional descriptive study was performed about women's knowledge, attitude and practice of breast cancer screening and breast self-examination. The study was conducted in the Reproductive Health Center of Sousse spread over a period of 2 months (February, March 2018). Self administered questionnaires were distributed to women.

Results

The mean age of the participants was 34 years with extremes ranging from 18 to 64 years. 47% of women surveyed have already performed breast self examination at least once during the last year. 14% of participants practiced breast cancer screening less than once a year. The first source of learning for breast cancer screening was health professionals in 27% of cases. The score of the practice of women surveyed was average; mostly, women have intermediate results for the technique of self-examination breast. No woman had a score of 15/15.

Conclusions

A better education of the practice of self-examination is essential in order to improve the screening program for breast cancer. The role of the gynecologist, general practitioner or midwife is therefore essential in education and training.

Key messages

A better education of the practice of self-examination is essential in order to improve the screening program for breast cancer. The role of the gynecologist, general practitioner or midwife is therefore essential in education and training.