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BACKGROUND: Although the World Health Organization has called for mental health services to be integrated into primary care, mental health remains in most countries, and especially in low- and middle-income countries, one of the most neglected topics in the training curriculum of frontline health workers. As a result, primary healthcare professionals leave medical and nursing schools with insufficient knowledge, and often with negative attitudes towards mental disorders. AIM: We investigated the effect of a brief training intervention on schizophrenia and depression conducted among general practitioners and nurses in Armenia. METHODS: Training interventions were one-day, face-to-face, interactive workshops, including didactic presentations and discussions of case studies. We used a quasi-experimental design of the before/after type, to compare data on knowledge, attitudes and practices collected before and after the training sessions. RESULTS: Mean scores for knowledge, attitudes and practices increased significantly (p < 0.001) among both nurses and GPs for both schizophrenia (111 GPs and 167 nurses) and depression (459 GPs and 197 nurses). CONCLUSIONS: Our experience suggests that a brief training intervention can result in significant improvements in knowledge, attitudes and practices among primary healthcare workers and could help improve mental health services.

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Delayed delivery is designed to allow the remaining fetus(es) to develop after premature expulsion of the first twin in the second trimester of pregnancy. This decision is aimed to allow the remaining fetus(es) to reach full fetal growth. We here report a clinical case of delayed delivery in a patient with triple pregnancy in whom the time between the expulsion of the first twin and the birth of the third twin was 10 weeks. The purpose of this study was to highlight the benefit and indications for delayed delivery.

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Mirror syndrome or Ballantyne syndrome is a rare disease, characterized by the association between fetal anasarca and maternal generalized edema. This may be complicated by pre-eclampsia. The purpose of this study was to highlight the diagnostic and therapeutic features of this severe clinical entity, which, despite its rarity, should be suspected. We here report the clinical case of a 35-year-old parturient woman at 26 weeks of amenorrhea presenting to the Emergency Department with idiopathic mirror syndrome whose progression was rapidly marked by the occurrence of intrauterine fetal death and remission of maternal clinical-biological symptoms, once uterine vacuity was obtained. Indeed, a specific treatment in uterus is necessary, although in some severe idiopathic cases, only uterine vacuity can improve maternal and fetal prognosis.

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Peripartum cardiomyopathy (PP-CMP) or Meadows' syndrom, is a dilated cardiomyopathy which occurs during or following pregnancy. It is characterized by heart failure with a systolic left ventricle ejection fraction of less than 45%. It is rare and its pathophysiologic mechanism is poorly elucidated. From a clinical point of view, it is characterized by unespected heart failure with rapid onset of symptoms, unpredictable evolution and risk of refractory cardiogenic shock, justifying patient's management in Cardiovascular Unit. PP-CMP requires no specific treatment compared to other causes of heart failure. We here report the case of a 29-year old primip at 32 weeks of amenorrhea presenting with congestive heart failure associated with peripartum cardiomyopathy. The aim of this study was to highlight the features of this heart disease which, despite its rarity, should not be disregarded by obstetricians.

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We report the case of a 25-year old primipara whose pregnancy was complicated by idiopathic intracranial hypertension (ICHT) associated with visual impairment in the first quarter. She underwent lumboperitoneal shunt without obstetric consequences. This study aimed to determine the features of this rare pathological entity whose pathophysiological mechanism is poorly elucidated. It would be caused by poor absorption of cerebrospinal fluid (CSF) through the arachnoid granulations. Major risk factors are: obesity, polycystic ovary syndrome, thrombophilia and hyperfibrinolyse. Diagnosis is based on modified Dandy criteria after negative clinico-biological and radiological assessment. Visual prognosis is compromised, as in the case of « classical ¼ ICHT. However, there is no risk for cerebral involvements which could be life-threatening. In addition, this disease does not influence pregnancy outcome. This said, rapid and effective treatment should be implemented in order to preserve visual function in these patients.

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Struma ovarii is a rare tumor, which accounts for 2.7% of ovarian teratomas and 0.01% of ovarian tumors. It usually affects women in the fifth decades of life and is most often detected incidentally during ultrasound and then confirmed histologically. The gold standard treatment is surgery and prognosis is excellent. We here report the particular case of a young female patient with giant struma ovarii whose radiological features were classified as unusual presentation. We match patient's data with those from the literature.

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INTRODUCTION: Prevalence of mental disorders is high worldwide. In Low-and-Lower-Middle-income countries (LALMICs) mental illnesses are already the second cause of burden in DALYs. As psychiatrists are extremely rare in LALMICs, addressing this issue calls for shifting mental health to primary care and consequently, training first line health care providers would be the next challenge. Via the FAST program, the World Asssociation of Social Psychiatry (WASP), Sanofi, Ministries of Health, academics, patients/families association and NGOs have joined forces to improve access to mental health care in LALMICs. The program is based on 3 pillars: (1) Mental health literacy, (2) health care professionals (HCP) training and (3) affordable quality medicines. OBJECTIVE: This study aims to develop a training curriculum and a set of materials to train HCP that is easily adaptable to the singularity of the local environment.METHODOLOGY: (1) A master-2 public health student conducted the project; (2) two domains were selected in priority: schizophrenia and unipolar mood disorders; (3) two main targets were identified: general practitioners and nurses / community healthcare workers; (4) professional's needs were assessed through a phone questionnaire; (5) WASP experts were in charge of drafting slides kits and other technical documents (6) to avoid any risk of conflict of interest, it was decided that training on medications will be based on the WHO mhGAP guide.RESULTS: For each disease and each category of HCP (1) a training of trainers manual; (2) a training curriculum; (3) a slide kit; (4) a training brochure; (5) videos of patients; (6) role-play scenarios; (7) clinical cases (8) pre and post assessment questionnaires, were made available.CONCLUSION: First feed-back indicated that these tools were of great added value for countries with limited human resources, even though, as anticipated, they will have to be adapted locally, especially role-play scenarios, clinical cases and patient's videos.

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INTRODUCTION: According to WHO about 80% of people living with a severe mental disorder in Low-and-Middle-income countries (LAMICs) do not have access to appropriate healthcare. Low literacy regarding mental disorders is one of the main barriers that prevent access to mental healthcare, which leads to stigma, socio economic exclusion, suffering of people with mental disorders and forces families to hide their relatives rather than to direct them to the community healthcare centre. To address this issue mental health, stakeholders from more than 20 countries joined forces with the World Association of Social Psychiatry and Sanofi in the FAST program, based on 3 pillars: (1) Mental health literacy, (2) health care professionals training and (3) affordable quality medicines.OBJECTIVE: This research aimed or develop Information-Education-Communication materials to improve mental health literacy in LAMICs.METHODOLOGY: Workshops with participants from different sectors (public, academic, associative, private) were set up to develop generic documentsbased on the experienced derived from malaria awareness programs. Then, for each country, documents were revised and adapted by a local working group.RESULTS: A flip chart, an educational comic book, a leaflet, a poster and a brochure on schizophrenia were made available with versions adapted to the local specificities of (a) Sub - Saharan Africa (b) North Africa (c) Eastern Europe and (d) Latin America. The main message of the educational materials was that: mental disorders are like any other disease i.e. they can be treated and people with mental disorders are like any other person. The following specific topics where covered: frequency of mental disorders, symptoms recognition, cause of disease, where to seek help, stigma. Recommendations on how to use these materials were also available.CONCLUSION: Improving mental health literacy in developing countries calls for relevant materials. A rigorous evaluation of the impact of the FAST documents is now required.

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Squamous cell carcinoma of the breast is a rare tumour of metaplasic origin; etiopathogeny is controversial; diagnosis is based on histological examination after eliminating the primary tumor; clinical and radiological examination is not specific; treatment is the same as for invasive ductal carcinoma; prognisis is poor due to tumor size and lymph node involvement. We report a case of breast squamous cell carcinoma in a 39 years old patient who was examined in the obstetrics and gynecology department of the military hospital in Rabat. Patient observation allowed us to specify the clinical characteristics of this entity which remains rare.

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Paraneoplastic syndromes are a heterogeneous group of clinical and biological manifestations caused by underling neoplasms. They can reveal ovarian teratoma which express neuroendocrine proteins, or contain mature or immature neural tissue inducing an autoimmune response. The etiological investigation is then crucial to early identification of the tumor in order to optimize the prognosis and to limit neurological sequelae. In case of ovarian teratoma, management is essentially based on surgical resection sometimes associated with immunotherapie. We report two new cases of ovarian teratoma revealed by paraneoplastic syndromes in young and menopausal woman.

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Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-neuroradiologic condition, not commonly reported in the literature. PRES is an uncommon complication of severe preeclampsia/eclampsia. We report the management of one patient with postpartum preeclampsia as an association of HELLP syndrome presenting with status-epileptics. Early diagnosis along with timely supportive therapy resulted in the successful management of this challenging case. Recent understanding on the pathophysiology of this uncommon condition is discussed. We highlight the importance to obstetricians, intensive-care physicians and anesthesiologists of recognizing such cases.

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Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

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