Delays in the Surgical Pathway in Breast cancer Patients in Tunisia: A Descriptive Prospective Study.

Objectives: Describe the surgical pathway and identify the different waiting times to surgery of women with a breast cancer in the Gynecology Department of the University Hospital of Sousse in Tunisia. Methods: It is a descriptive prospective study based on an assessment of professional practices using the process approach method. The study focused on the surgical management of women with breast cancer followed and scheduled for surgical treatment.The data were collected using a data collection sheet, developed according to a literature review. Results: The sample consisted of 77 women. Ten waiting times have been calculated. Global time to first treatment (surgical treatment) was 78.5 days with an interquartile range (IIQ) of [55.5-113.25 days]. The information period was 10 days with an IIQ of 3-19 days. The global time of access to surgery was 43.5 days with an IIQ of 40-54.75. Conclusion: Delays in access to care appear to be a potential marker of inequalities in access to care and an indicator of the performance of the healthcare system and can influence patient prognosis. The reduction of these delays must be integrated into a continuous quality improvement approach.

The effect of Origanum majorana tea on motor and non-motor symptoms in patients with idiopathic Parkinson's disease: A randomized controlled pilot study.

AIMS: The effect of Origanum majorana tea consumption on motor and non-motor symptoms was investigated in patients with idiopathic Parkinson's disease, measured by validated tools. METHODS: Sixty patients with idiopathic Parkinson's disease and under conventional medication were enrolled voluntarily in the study. All participants were randomized on double-blind to placebo or Origanum majorana. Clinical assessment with validated tools (UPDRSIII, NMSS, and BDI) was done before Origanum majorana or placebo consumption (Day 0) and at the end of the experiment (Day 30). RESULTS: The treatment groups were similar at baseline on demographic and clinical variables. During the course of study, nine participants withdrew for reasons of noncompliance and inability to follow-up. Fifty-one participants completed the study. Upon completion of 30 days of treatment, Origanum majorana tea consumption did not decrease the UPDRSIII score ([UPDRSIII] D0 = 18.76 ± 8.58, D30 = 16.52 ± 7.96, p = 0.069) at the p value was 0.07. However, a statistically significant improvement was noted in NMSS and BDI scores (p < 0.0001 and p < 0.0001, respectively). Assessment of the UPDRSIII, NMSS and BDI scores of the patients did not reflect any improvement with placebo. No side effect was detected during the study. CONCLUSION: These findings show improvement of depressive and non-motor signs in patients with Parkinson's disease in the group that consumed Origanum majorana tea in combination with conventional therapy. Improvement of motor signs may need an extended treatment period. However, more research with a large number of participants and lasting longer than 1 month is needed to argue these findings.

Clinical and Pathological Response to Neoadjuvant Anthracycline Based Chemotherapy in women with breast cancer.

BACKGROUND: Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. The aim of this study was to evaluate the predictive value of different histologic factors in breast cancer treated with neoadjuvant anthracycline chemotherapy in Tunisian women. METHODS: A total of 109 stage II and III breast cancer patients who received neoadjuvant anthracycline chemotherapy were enrolled in this study. Using pretreatment biopsy materials, histologic grade was recorded and immunohistochemical studies were performed for estrogen receptor, progesterone receptor and Her2neu. We analyzed the associations among this histologic factors and clinical and pathological complete response. Statistical analysis used is SEM logiciel. RESULTS: The overall clinical response was 63% (clinical partial response in 49% of cases and clinical complete response in 14% of cases). The pCR was 7%; in univariate analysis, clinical response rate by each factors were as follows: 63% in ER-positive tumors, 84% in ER-negative (P = 0.2), 59% in PgR-positive, 62% in PgR-negative (P = 0.3), 64% in HER2-positive, 62% in HER2-negative (P = 0.6), 60% in tumors of low nuclear grade and 63% in ones of high nuclear grade (P = 0.9). CONCLUSIONS: Biological markers that reliably predict clinical and pathological response to primary systemic therapy may have considerable clinical potential. The future of neoadjuvant therapy lies in tailoring treatment to individual patients by identifying response predictors.

[Pronostic factors in squamous cell carcinoma of the vulva. About 35 cases]. / Les facteurs pronostiques du carcinome epidermoide de la vulve. A propos de 35 cas.

OBJECTIVE: To evaluate the pronostic factors of the vulvar cancer. STUDY DESIGN: This is a retrospective study, of 35 cases of squamous cell carcinoma of the vulva diagnosed and treated at Farhat Hached Hospital (Sousse) between January 1991 and December 2002. The study of the pronostic factors is based on analysis of the following parameters obtained after a period varyinf from 6 months to 5 years: clinical data, pre-therapeutique and therapeutic evaluation, pathologic data, outcome and survival rate. RESULTS: The diagnostic was often late with a delay for consultation superior to 6 months in 60% of cases. 80% of the patient wete in stages III and IV of FIGO with an average tumorous size of 3.8 cm and palpable lymph node in 74.2% of the cases. 22 patient underwent vulvectomy with bilateral inguinal node dissection. Adjuvant therapy was carried out in 8 cases. The rate of relapses was 22.7%. The global survival at 5 years of the operated patients was of 40%. The main prognostic factors were: the size tumorale, the degrees of stromal invasion and the lymph node invasion. CONCLUSION: Early detection fo vulvar concer by regular gynecologic examinations and a biopsy of all suspect lesions, allows an early treatment consequently a better prognosis.