Phylogeny and Classification of Human Papillomavirus (HPV)16 and HPV18 Variants Based on E6 and L1 genes in Tunisian Women with Cervical Lesions

Background: High-risk human papillomavirus (HPV) types are the main etiological factors for cervical cancer. HPV16 and HPV18 are generally the most common forms associated with development of high-grade cervical lesions. This study was undertaken to identify intratypic variants of HPV16 and HPV18 among women with cervical lesions in Tunisia. Materials and Methods: DNA was extracted from cervical samples collected from 49 women. using a PureLinkTM Genomic DNA mini Kit (Invitrogen). E6 and L1 open reading frames (ORF) were amplified by PCR and viral DNA amplicons were subjected to automated sequencing using Big Dye Terminators technology (Applied Biosystems). The obtained sequences were analyzed using an appropriate software program to allow phylogenetic trees to be generated. Results: HPV16 and HPV18 were detected in 15 and 5 cases, respectively. HPV16 E6 sequences clustered with the European German lineage (A2) whereas one isolate diverged differently in the L1 region and clustered with the African sub-lineage (B1). HPV 18 E6 sequences clustered with the European sub-lineage (A1) but L1 sequences clustered as a new clade which diverged from A1-A5. Conclusions: Our results suggest that the distribution of HPV16 and HPV18 sequences in women with cervical lesions in Tunisia is mainly related to European epidemiological conditions and point to the presence of recombinant HPV forms.

[Neu-Laxova syndrome: Three case reports and a review of the literature]. / Syndrome de Neu-Laxova : rapport de trois cas et revue de la littérature.

INTRODUCTION: The Neu-Laxova syndrome (NLS) is a rare autosomal recessive and early lethal disorder. It is characterized by severe intra-uterine growth retardation, abnormal facial features, ichthyotic skin lesions and severe central nervous system malformations, especially microlissencephaly. Others characteristic features associated with fetal hypokinesia sequence, including arthrogryposis, subcutaneous edema and pulmonary hypoplasia, are frequently reported in NLS. PATIENTS AND METHODS: The clinicopathological characteristics of NLS are described in three cases with striking prenatal diagnostic findings and detailed post-mortem examinations. A review of the literature is undertaken with a focus on molecular basis. RESULTS: We present three new patients with NLS: one stillbirth male and two female newborns, delivered at 29, 35 and 40 weeks of gestational age, respectively. Characteristic ultrasound findings included hydramnios, severe intra-uterine growth restriction, craniofacial and cental nervous system anomalies. The cytogenetic study, performed in one case, was normal. The post-mortem examination revealed characteristic abnormalities in all three cases, that allowed to make a prompt diagnosis of the NLS. Data from these patients suggest that the NLS represents a heterogeneous phenotype. This feature has been highlighted in the literature. CONCLUSION: The SNL is a lethal developmental disorder characterized by phenotypic heterogeneity with striking neurological defects. It is underpinned by genetic heterogeneity. It can be caused by mutations in all three genes involved in de novo L-serine biosynthesis: PHGDH, PSAT1 and PSPH. Hence, the NLS constitutes the most severe end of already known human disease, i.e. serine-deficiency disorder.

Incidence and risk factors of postpartum anal incontinence: a prospective study of 503 cases.

BACKGROUND: Background: Anal incontinence is a devastating functional postpartum complication. it can cause deep deterioration in the quality of life. AIM: To assess the incidence of postpartum anal incontinence (PPAI) and the major risk factors predisposing for it in the short and middle terms. METHODS: This prospective observational study was conducted in the department of Obstetrics and Gynecology B in the Maternity and Neonatology Center of Tunis between March 1st and july 31st, 2009. RESULTS: Five hundred and three women were included. PPAI was 4.2% on the fourth day postpartum and 4% between weeks 6 and 8 postpartum. Predisposing factors to 4th day PPAI were forceps delivery (p<0.001), prolonged second stage of labor> 5hours (p=0.047), expulsion phase > 20mn (p<0.001), uterine revision (P=0.001) and first degree perineal lacerations (p<0.001). Between 6 and 8 weeks postpartum, identified risk factors were Shoulder dystocia (p<0.001), anu-vulvar distance < 2cm, perineal scars and transverse abdominal diameter >105mm (p<0.001). CONCLUSION: Preventive measures must be implemented in patients with PPAI risk factors.

[Laparoscopic management of ovarian masses during pregnancy]. / Prise en charge coelioscopique des masses ovariennes au cours de la grossesse.

BACKGROUND: The diagnosis of an adnexal mass associated with pregnancy is increasingly common with the routine use of ultrasound during prenatal care. AIM: To assess the feasibility, advantages and limiting factors of laparoscopy in the management of ovarian masses during pregnancy. METHODS: Rretrospective study of a series of 34 pregnant women operated by laparoscopy for adnexal masses during a period of 14 years. RESULTS: The mean age of patients was 29 years. Fifty percent of patients were nulliparous. In 62% of cases, patients were asymptomatic. Laparoscopy was performed at a mean gestational age of 15 weeks. Open laparoscopy was performed in 58.8% of cases. Intraperitoneal cystectomy was performed in 28 cases (72%). In two cases (5 %), it was a borderline ovarian tumor requiring further surgery outside of pregnancy. Fetal loss was noted at a term of 16 weeks. CONCLUSION: Laparoscopic management of adnexal masses during pregnancy appears to be safe and reproducible procedure with few maternal and fetal complications.

[Iron status in pregnant women and its changes during preeclampsia]. / Statut du fer chez la femme enceinte et ses variations au cours de la prééclampsie.

BACKGROUND: Micronutrients or trace elements are minerals essential for growth and development of the body human. AIMS: To analyze changes in normal pregnancy and during preeclampsia, serum iron and its main proteins: ferritin and soluble transferrin receptors. METHODS: This is a prospective study of case- control study of 56 pregnant women and 30 non-pregnant women selected as controls. Pregnant women received a quarterly dosing paramètres. The same assays were performed once in controls. RESULTS: The comparative assay of various parameters in normal pregnancy and in control women showed a significant decrease in serum iron from 1 to the third quarter, a slight decline in reserves ferritin in 1st and 2nd quarter increases and becomes significant in the third quarter and an increase of soluble receptors trasferrine during pregnancy, which becomes significant in the third quarter. We noted a disturbance of these parameters in preeclampsia. CONCLUSION: Iron is essential for fetal development. His involvement in several maternal- fetal complications is not to dismantle .

[How to predict spontaneous resolution of early pregnancies?]. / Comment prédire la résolution spontanée des grossesses jeunes ?

BACKGROUND: Assessment of early pregnancy is indicated in women with suspected abnormalities. It is based on biochemical assessment and on trans vaginal sonography . AIM: To identify clinical, biological and ultrasonographic parameters that are predictive of spontaneous pregnancy resolution. methods: A prospective observational study was performed interesting women with a positive pregnancy test without visualization of the pregnancy on the initial scan. All parameters measured during the initial visit were tested by univariate and multivariate analysis to identify parameters predicting spontaneous resolution of pregnancy. RESULTS: A total of 2675 women were included in the study. In 94 cases (4 %) the location of pregnancy was unknown. Univariate and multivariate analysis showed that four parameters contributed significantly to the predictive power of the logistic model: Absence of pain (p =0,036), endometrial thickness < à 12 mm (p =0,021), initial serum ßhCG level < 1000 UI/l (p =0,015) and progesterone level < 29 nmol/l (p <0,001). CONCLUSION: Women with a high probability of spontaneous resolution of their pregnancies can benefit from a spaced monitoring until the rate of ß-hCG will be negative.

Does the mode of delivery affect neonatal morbidity and mortality in very low-birth-weight infants ?

BACKGROUND: Despite the great advances made in neonatal intensive care, one of the greatest challenges in perinatology today, remains the management of very low-birth-weight infants (VLWB). AIM: To evaluate the impact of the mode of delivery on very lowbirth- weight infants' survival and their outcome. METHODS: We performed a retrospective comparative study in the department "B" of gynecology-obstetrics in collaboration with the neonatology department of the same centre during a 12-month period. The study population included mothers giving birth to infants weighing between 500 and 1500 grams, at gestational age > 26 weeks and an Apgar score > 3 at one minute. All included cases were classified according to the way of delivery: vaginal delivery ( Group A) giving birth to neonates of group 1 and cesarean section ( group B) giving birth to neonates in group 2 . RESULTS: The study involved 69 women giving birth to 82 very lowbirth- weight infants. Both groups of parturients were homogeneous and similar in age, parity, prenatal care and gestational age. No statistically significant difference was noticed in terms of morbidity and mortality in the very low-birth-weight infants of the two groups. A higher rate of cesarean sections was noticed in breech presentations (74%). CONCLUSION: Systematic cesarean section does not guarantee better outcome for very low-birth-weight infants.

Prediction of ectopic pregnancy in early pregnancy of unknown location.

BACKGROUND: Women having pregnancies of unknown location (PUL) can be defined as those having positive pregnancy test when no pregnancy is visualized on transvaginal ultrasound (TVS). AIM: To identify diagnostic parameters which are predictive of ectopic pregnancies in women with early pregnancies of unknown location. METHODS: We undertook a prospective observational study of pregnant women with suspected early pregnancy complications. Ninety-four patients were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound; blood sample was taken on presentation to measure the serum human chorionic gonadotrophin (,-HCG) and progesterone levels. All collected data were tested by univariate analysis and then analyzed in a stepwise procedure to form a logistic model for predicting ectopic pregnancy. RESULTS: A total of 2675 women were referred for suspected early pregnancy complications. In 94 (4%) patients the location of the pregnancy was unknown. Three parameters were found to be statistically significant for predicting ectopic pregnancy:progesterone level, vaginal bleeding associated with pain and the presence of free fluid in the pouch of Douglas. The overall model described by these variables offer a sensitivity of 79 %and a specificity of 59% in the prediction of ectopic pregnancy. CONCLUSION: Logistic regression model can help in the clinical decision-making in women with pregnancy of unknown location.

[Pregnancy of unknown location]. / Les grossesses jeunes de localisation indéterminée

BACKGROUND: A pregnancy of unknown location is a descriptive term that can be defined after performing trans vaginal ultrasound. This situation includes patients with a positive pregnancy test but with no evidence of intra or extra uterine pregnancy on transvaginal sonography. AIM: To discuss different aspects of management of women with pregnancy of unknown location. METHODS: Review of the literature. RESULTS: Serum human chorionic gonadotrophin levels, progesterone levels and mathematical models are helpful in the prediction of final outcome of pregnancy: intra uterine pregnancy, ectopic pregnancy, spontaneous resolution or persistent pregnancy of unknown location. Active expectant management of asymptomatic women with a pregnancy of unknown location has been shown to be safe. CONCLUSION: Surgical intervention (diagnostic laparoscopy and uterine curettage) to diagnose the location of the pregnancy should be restrictive.