BackgroundLittle is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women.MethodsCross-sectional study was performed on 494 Tunisian women visiting Women’s Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene.ResultsThe overall HPV prevalence was 34% (95% CI: 30–38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76–92%) and 24.5% (95% CI: 20–29%) respectively. The distribution of HPV prevalence according to women’s age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37–67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22–45%) among women with SIL and 9.2% (95% CI: 6–12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0–5%) among women with SIL and 0.3% (95% CI: 0–1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76–95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64–99%, and 88%, 95% CI: 77–100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1–36% and 6%, 95% CI: 2–14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL.ConclusionHPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.

Misoprostol as used in this protocol is more effective than cervical dinoprostone gel application in the cervical ripening and labour induction. There is a tendency for an increase in the rate of tachysystole and hyperstimulation syndrome.

Highlights The clinical presentaion of early abdominal pregnancy is similar to that of tubal ectopic pregnancy in the majority of cases. Surgical laparoscopy must be the first choice in management of early abdominal pregnancy. Medical treatment should be reserved when a surgical intervention is deemed to be potentially very hemorrhagic.

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Background:Preeclampsia (PE) is a pregnancy-associated hypertensive disorder and a leading cause of maternal and neonatal morbidity and mortality. While its pathogenesis remains ill defined, several candidate genes for PE have been identified, but results remain inconclusive. We investigated the association of the angiotensinogen (AGT) gene variants M235T and T174M with PE, and we analyzed the contribution of both variants to the severity of PE.Methods:This case-control study enrolled 550 Tunisian pregnant women: 272 with PE, of whom 147 presented with mild, and 125 with severe PE, along with 278 unrelated age- and ethnically matched control women. AGT genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism.Results:Significantly higher M235T minor allele frequency (MAF) was associated with increased risk of PE (p < 0.001). Decreased frequency of heterozygous T174M genotype carriers were found in control women (p = 0.015), suggesting a protective effect of this genotype (odds ratio (95% confidence interval) = 0.51 (0.29–0.89)). Two-locus haplotype analysis demonstrated MM and TT haplotypes to be negatively and positively associated with PE, respectively. MAF of M253T, but not T174M, was higher in the severe PE group, and carrying M235T or T174M minor allele was associated with increased body mass index (p < 0.001) among unselected PE women.Conclusions:AGT M235T and T174M variants contribute to an increased risk of developing PE, and for M235T to PE severity.