<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of th...<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of the University Hospital Center (CHU) Point G in Bamako-Mali. <strong>Methodology:</strong> This was an analytical study from January 01, 2018 to December 31, 2018 in the CHU Point G cardiology department, including all patients hospitalized during this period. <strong>Results:</strong> Of 1379 hospitalized patients, 19 patients were concerned by pulmonary embolism of the young person. The prevalence of pulmonary embolism of the young person was 1.37%. The most affected age group was 21 - 30 (47.4%) of patients. The predominance was female (89.47%) with a gender ratio of 0.11 in favour of women. The average age in the series was 29.79 years with extremes of 16 years and 40 years. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1%, respectively. The dominant signs were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Pulmonary embolism was unlikely in 60.52% according to the Geneva and Wells score simplified. At the thoracic angioscanner, the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients;in 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) and left ventricular dilation (40%). Hyper leucocytosis (47.4%), anemia and low prothrombin rate (TP) (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI (Pulmonary Embolism Severity Index) score. The average hospital stay was 10 days. Hospital mortality was 10.5%. <strong>Conclusion:</strong> The pulmonary embolism of the young person is a frequent, serious and multifactorial pathology and the female sex is most affected especially during peri partum periods, hence the need for preventive measures. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation review in our context.展开更多
Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University ...Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University Center in Bamako—Mali. Methodology: It was a descriptive cross-sectional study from January 2010 to February 2017 in the CHU Point G cardiology department, including all patients hospitalized during this period. Results: Of 6912 hospitalized patients, 23 patients were concerned by aortic dissection. The prevalence of aortic dissection was 0.33%. The most affected age group was 50 - 69 (43.5%) of patients. The predominance was male with a sex ratio of 4.75. The cardiovascular risk factors were high blood pressure (73.9%) and smoking (60.9%). The major functional signs were chest pain (65.2%) and dyspnea (65.2%). Asphygmy (56.5%) and breath of aortic insufficiency (60.9%) were the dominant physical signs. The electrocardiogram recorded sinus tachycardia with 86.9% of patients. The radiographic of the frontal thorax showed mediastina widening (73.9%). At echocardiography, dilatation of the ascending aorta was described with 73.9% and the intimal veil (47.8%). Pericardial effusion was observed with 26.1% of patients. In the thoracic angioscan, the aortic dissection gave 43.5% for type A and 56.5% for type B. The aneurysm of the aorta was abdominal with 21.7%, ascending portion (13.0%) and descending with 8.7%. Complications were dominated by heart failure (47.8%) and aneurysm of the aorta (34.8%). The lethality was 52.2%. Conclusion: Aortic dissection is a medical and surgical emergency with poor prediction.展开更多
Objective: The purpose of this study was to describe the prognostic factors associated with aortic dissection with the cardiology intensive care unit of the Point “G” Hospital University Center. Methodology: This wa...Objective: The purpose of this study was to describe the prognostic factors associated with aortic dissection with the cardiology intensive care unit of the Point “G” Hospital University Center. Methodology: This was a descriptive transversal study from January 2010 to February 2017 that included all inpatients during this period. Results: Of 6912 patients admitted, 23 patients were admitted for an aortic dissection, a frequency of 0.33%. Of these, (6) six were under age 50 (26.1%) and the majority age group was 50 - 69 years old. Cardiovascular risk factors were high blood pressure, smoking, and diabetes with 73.9%, 60% and 13% of cases, respectively. At the clinic, chest pain and dyspnea were the main symptoms with respectively 65.2% and 52.2% and with 56.5% asphygmy was associated with pain. Para-clinically, renal failure and anemia were the major laboratory abnormalities found with respectively 43.75% and 31.25% of cases. Doppler echocardiography revealed lesions associated with aortic dissection. In the thoracic angioscan, the aortic dissection was type A (43.5%) and 56.5% type B. The co-morbidities, the associated lesions and the hemodynamic state of the patient indicate the degree of urgency. The treatment was medical. The evolution was full of complications with 52.2% of deaths including 7 (seven) type A patients. Intra-hospital death was 26.1%. Other complications were heart failure (47.8%), the renal failure (43.75%) and an aortic aneurysm (34.8%). Conclusion: Aortic dissection is a life-threatening medical and surgical emergency.展开更多
<strong>Introduction:</strong> The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview...<strong>Introduction:</strong> The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview about the reasons why the elderly come for consultation in the internal medicine department of the HKM-NHUC in Cotonou. <strong>Methodology:</strong> This was a retrospective, descriptive, and analytical study, which included all patients aged 65 years and over, who came for the first time for consultation in the Internal Medicine Department of the CNHU-HKM between January 1<sup>st</sup> and December 31<sup>st</sup>, 2017. <strong>Results:</strong> Among the 680 new patients received in internal Medicine consultations during the study period, 118 people were aged 65 and over, representing a hospital frequency of 17.35%. The sex ratio was 0.9 with a mean age of 73 ± 7 years. Hypertension was the main comorbidity of the patients (69%). Cough (11.3%) and low back pain (8.2%) dominated the reasons for consultation. The three main nosological groups of pathologies were, in descending order, diseases of the osteo-articular system (17.5%), diseases of the respiratory system (16.5%) and diseases of the circulatory system (12.4%). Pneumonia (11.3%) and lumbosacral spondylarthrosis (10.3%) were the most frequent pathologies in patients whose health needs remain quite varied. <strong>Conclusion:</strong> The elderly become gradually an important part of the population in southern Sahara. A better understanding of the health needs of this category of the population is necessary to deal effectively with the health challenges that will accompany this phenomenon.展开更多
Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of ...Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.展开更多
Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine ...Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine the therapeutic modalities. Materials and Methods: Descriptive cross-sectional retrospective study carried out at the University Hospital Center of Bouake over a period of 9 years (From January 2015 to December 2023). We identified all malignant oculo-adnexal and orbital tumors whose histopathological diagnosis was confirmed;monitoring the sorting of squamous cell carcinomas of the conjunctiva among these cancers and studying the different parameters linked to them. Results: The average age of patients is 44.3 years. Male predominance with a sex ratio of 1.12. HIV was the majority ATCD with 64.7%. The main reason for consultation was exophthalmos (36.11%). The average consultation time was 10 months 13 days. Invasive differentiated conjunctival squamous cell carcinoma was predominant at 55.56%. Enucleation was the most performed surgical method. Conclusion: Squamous cell carcinoma of the conjunctiva is a malignant ocular tumor of the elderly whose frequency increases in young adults infected with HIV-AIDS. Invasive differentiated forms are increasingly encountered, limiting treatment to mutilating surgery.展开更多
Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to...Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to analyze the epidemiological, clinical, therapeutic and evolving aspects of hemorrhoidal disease at the stage of surgical treatment at the University Hospital Center of Brazzaville. Patients and Methods: We conducted a retrospective and descriptive study carried out from January 2020 to December 2021, a 24 months period, in the Digestive surgery department of the University Hospital Center of Brazzaville. It concerned patients who underwent a surgical procedure for hemorrhoidal disease. Results: 21 cases were collected, representing a hospital frequency of 2.3%, with a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9 years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding. We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%) of hemorrhoidal prolapse including 12 cases requiring manual integration (Goligher grade III) and four irreducible permanent cases (Goligher grade IV). The Grade III prolapse was associated with a polyp in one patient and with posterior anal fissure in another patient. Out of the 21 patients, 14 underwent a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients underwent mono- and bipedicular hemorrhoidectomy with resection of associated lesions and five patients underwent emergency thrombectomy. The outcome was favorable for all our patients. The average length of hospital stay was 1.5 ± 2.1 days. Conclusion: In the event of failure of medical and instrumental treatment, the hemorrhoidal cure according to Milligan and Morgan is the surgical treatment of reference for hemorrhoidal disease at the University Hospital Center of Brazzaville.展开更多
Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diab...Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]展开更多
Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and...Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.展开更多
Several studies report the problem of cardiovascular tolerance of treatments with neuroleptics, given the important number of morbidities in patients with mental illnesses. This preliminary work aimed to describe the ...Several studies report the problem of cardiovascular tolerance of treatments with neuroleptics, given the important number of morbidities in patients with mental illnesses. This preliminary work aimed to describe the epidemiological and biological profile of patients taking neuroleptics and followed in the psychiatry department of Brazzaville University Hospital, from the angle of cardiovascular risk. Fifty (50) patients (17 men and 33 women), with a mean age of 33.9 10.7 years, were included. Epidemiological data (sex, age, tobacco or alcohol consumption) were collected on pre-established survey forms. Biochemical (total cholesterol, HDL-c, triglycerides and atherogenicity index) and inflammatory parameters (ultra-sensitive CRP, troponin I and NT-ProBNP) were investigated using enzymatic and indirect immunofluorescence technical, respectively. The results obtained showed that 54% of patients were obese, 94% were non-smokers, and 12% had high blood pressure. 10% of patients had high total cholesterol levels and 90% had HDL cholesterol levels below 60 mg/dl. Triglycerides and atherogenicity index were significantly elevated in relation to Body Mass Index (BMI). Ultrasensitive CRP was elevated in 38% of patients. In conclusion, this study revealed an association between lipid parameters (triglycerides and atherogenicity index) in relation to BMI in patients taking neuroleptics followed in the Psychiatry Department of University Hospital Center of Brazzaville.展开更多
Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney di...Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney disease (CKD) in Morocco. The aim of our study is to describe the clinical, paraclinical and management aspects of renal lithiasis in our patients, to determine the factors of recurrence of renal lithiasis and to identify the factors of progression of renal failure. Materials and Methods: This is a retrospective, descriptive and analytical study conducted in the nephrology department of CHU IBN Sina in Rabat, over a 3-year period from 2020 to 2023. We included 160 patients with renal lithiasis having a follow-up in our training. We analyzed their epidemiological, clinical, paraclinical and therapeutic profile. Results: The mean age of our patients was 56 +/− 16.6 years, with a M/F sex ratio of 1.02. Lithiasis was expressed by renal colic in 71% of cases, and by stone emission in 31% of cases, although discovery was incidental in 16% of cases. At the time of the first consultation, 59% of patients had renal failure (RF), 15% of whom were at the stage of chronic end-stage renal disease. Crystalluria and calculus spectrophotometry were performed in only 30% and 22% of patients respectively. All patients benefited from hygienic and dietary measures according to the nature of the stone, as well as additional urological management. Recurrence of renal lithiasis was reported in 36% of cases. In univariate analysis, advanced age, male gender, diabetes, hypertension and the presence of recurrent urinary tract infection were factors in the progression to CKD (OR = 0.979, p = 0.035;OR = 0.527, p = 0.48;OR = 4.127, p = 0.015;OR = 1.926;p = 0.015, OR = 2.5 p = 0.019, respectively). In multivariate analysis, only diabetes and high baseline creatinine were factors in the progression to CKD. Recurrence of renal lithiasis was reported in 36.5% of cases. Only the presence of a history of familial lithiasis and of renal cysts on imaging were significantly associated with a risk of renal lithiasis recurrence in univariate analysis. (OR = 3.06, p = 0.035;OR = 5.27, p = 0.017, respectively). Conclusion: Renal lithiasis is a disabling pathology that can be complicated by recurrence and chronic end-stage renal failure. Early diagnosis and identification of factors leading to the recurrence and progression of chronic renal failure could improve management.展开更多
Introduction: Biometrics therefore corresponds to the measurement of the morphological elements of humans. One of the most common ultrasound requests by clinicians is the assessment of liver size. The aim of our study...Introduction: Biometrics therefore corresponds to the measurement of the morphological elements of humans. One of the most common ultrasound requests by clinicians is the assessment of liver size. The aim of our study was to study liver biometry using ultrasound in healthy adult subjects. Material and Methods: This was a prospective, descriptive and analytical study, carried out at CHU Point-G over a period of 7 months. A liver ultrasound was performed on 100 individuals without lesions, by a doctor in his final year of specialization in radiology and medical imaging. For each subject, we determined the height and anteroposterior diameter of the right liver and the left liver. Results: The mean age was 39.05 ± 16.86 years. The body mass index (BMI) 18.5 - 24.9 group was the most represented with 58%. The mean height of the right liver was 138.40 ± 14.85 mm. It was 136.81 ± 14.70 mm in men and 139.92 ± 14.99 mm in women (P = 0.306). That of the left liver was 95.55 ± 14.34 mm, in men, it was 91.79 ± 13.51 mm and 99.16 ± 14.31 mm in women (P = 0.019). We found a significant correlation between right liver height and BMI (P = 0.013). Conclusion: The mean values of liver biometry were established in our series. There was a significant correlation between right liver height and BMI. Liver ultrasound remains a reliable technique for liver biometry.展开更多
Introduction: Sinonasal polyposis (SNP) is a chronic inflammatory disease of the mucosa of the nasal cavities and facial sinuses. It is characterized by an oedematous, multifocal and bilateral degeneration of the naso...Introduction: Sinonasal polyposis (SNP) is a chronic inflammatory disease of the mucosa of the nasal cavities and facial sinuses. It is characterized by an oedematous, multifocal and bilateral degeneration of the nasosinus mucosa, which originates in the lateral masses of the ethmoid, where it causes the formation of smooth, gelatinous, translucent and pyriform polyp lesions. The objective of this study was to review epidemiological, clinical, paraclinical data and evaluate the results of endoscopic surgical treatment. Patients and Methods: This is a retrospective study on 60 patients followed at the ENT department of the Fann National University Hospital Center, from January 2010 to December 2015. All patients with sinonasal polyposis were included in the study. Results: The average age of our patients was 38 years and the sex ratio (M/F) was 0.8. In the patients’ histories, we found 18% asthma and 10% Widal’s disease. The average consultation time was 8.5 years. All patients had consulted for nasal obstruction;rhinorrhea was bilateral and found in 67.7% of cases, with olfactory disorders accounting for 50%. The CT scan performed in 58% of cases made it possible to specify the extent of the lesions;the involvement of the ethmoidal sinus was constant and extended to the other sinuses except in 2 cases. All patients had received medical treatment with local corticosteroids. Endoscopic surgical treatment was initiated in 43% of cases after failure of corticosteroid-based medical treatment. The evolution under treatment marked by the reappearance of symptoms that increased each month. At one month postoperatively, all clinical symptomatology had improved with the exception of olfactory disorders, which persisted in 3 patients. At 12 months we noted 12 cases of reappearance of nasal obstruction. Conclusion: SNP is a disease of little known etiology. The diagnosis is almost always clinical. Endoscopic surgery remains a recourse to medical treatment. For good local control, patients should be more respectful of good compliance with corticosteroid therapy.展开更多
Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obs...Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obstetrical violence. The aim of this study is to contribute to improving the quality of maternal health care. Patient and Method: This was a cross-sectional study with a quantitative component carried out in the obstetrics and gynecology department of the Maman Elisabeth Domitien University Hospital from November 1 to 30, 2024. All women in childbed seen for postnatal consultations within 42 days of delivery were included. Results: We included 109 women. Age ranged from 16 to 44 years with a mean of 26.9 (±6.02). The majority of women were living in common-law unions with 79.8% and 57.8% of mothers having a secondary education level. More than half of the participants (52.9%) said that they had not been prepared for childbirth during prenatal follow-up and 44.0% had not freely chosen their path of delivery. The vaginal route was the most observed route of delivery (97.3%). Of all vaginal deliveries, episiotomy was performed in 21.7% and uterine revision in 66.0%. For episiotomies, 26.1% of women in childbed were informed about its performance and 87.0% had had a bad experience with this event. For women who had undergone a uterine revision, 52.9% had been informed of its performance and 77.1% had a bad experience with the event. Women in childbed had been victims of inappropriate acts and verbal aggression in 18.4% and 14.7% respectively. Of all the participants, 45.0% said they had experienced the birth episode badly. Conclusion: This study has given us an idea of the subject. However, a large-scale study will enable us to understand the different facets of this subject.展开更多
AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity ...AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.展开更多
BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitop...BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedu...BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.展开更多
Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 -...Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 - 15 years. Patients and Methods: This was a prospective cross-sectional study from April 1, 2021 to March 31, 2022 and affected all children aged 0 to 15 years old with a temperature of 39˚C or higher (≥), having less than five days and hospitalized in the pediatric department of the Gabriel Touré University Hospital. Results: During the study period, 150 children were included, the sex-ratio was 0.85. Children aged 0 - 5 years represented 71.4% of the sample. References represented more than half of the sample, or 58% of cases. Body temperature was above 40˚C in 18.7% of cases. Functional signs were dominated by respiratory signs in 28% and digestive signs in 18%. Clinical pallor was found in 55.3% of children associated with signs of respiratory struggle in 70% of cases and tachycardia in 40% of patients. Anemia was present in 65.3% of patients. Hyperleucocytosis and leukopenia were found in 45.3% and 43.3% of patients respectively. The C-reactive protein was positive in 44.7% of patients and Cytobacteriological Examination and Chemistry of Cerebrospinal Fluid was positive in 8.7% of cases. The thick drop was positive in 44.7% of patients and blood cultures grew in 6 patients. Etiology was dominated by severe malaria 54 cases (36%), pneumonia (19.3%), meningitis (12.6%), and in those under one month it was bacterial neonatal infection (8.6%). In our study, slightly more than one patient out of three died during hospitalization, 36% (54 cases/150) and among these 70% (38 cases/54) were under 5 years old. The most lethal pathologies were severe malaria (36%), bacterial pneumonia (19.3%), meningitis (12.6%), bacterial neonatal infections (8.6%) and measles complicated by pneumonia (5.3%). Mortality during hospitalization was 36% of deaths (54 out of 150 patients) and 70.3% (38/54) of the deceased patients were under 5 years old. Conclusion: This study shows that fever is a frequent symptom and a sign of serious and very lethal pathologies. The cause of fever can be a diagnostic challenge for health workers. However, early identification of children at risk for serious illness could allow for prompt and appropriate management in appropriate settings.展开更多
BACKGROUND Several trace minerals have been shown to be associated with thyroid cancer.Democratic Republic of Congo(DRC)is deemed the most mineral-rich country globally.Data on the characteristics of thyroid nodules i...BACKGROUND Several trace minerals have been shown to be associated with thyroid cancer.Democratic Republic of Congo(DRC)is deemed the most mineral-rich country globally.Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.AIM To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.METHODS We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga,South Kivu and Kinshasa between 2005 and 2019.Of these three provinces,Katanga and South Kivu have the highest mineral density with the DRC.RESULTS Mean patient age was 44.2 years±14.6 years with a female predominance,with a female to male ratio of 5.4.The 66.5%of patients had a family history of thyroid disease.Total 74 patients had simple nodules,and the remaining 455 patients had multiple nodules.The 87.7%of patients were euthyroid.The nodules exhibited varying characteristics namely hypoechogenicity(84.5%),solid echostructure(72.2%),macronodular appearance(59.8%),calcifications(14.4%)and associated lymphadenopathy(15.5%).The 22.3%of the nodules were malignant.Factors independently associated with malignancy were older age(≥60 years)[adjusted odds ratio(aOR)=2.81],Katanga province(aOR=8.19),solid echostructure(aOR=7.69),hypoechogenicity(aOR=14.19),macronodular appearance(aOR=9.13),calcifications(aOR=2.6)and presence of lymphadenopathy(aOR=6.94).CONCLUSION Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant.Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.展开更多
Background:Breast cancer remains a leading cause of morbidity and mortality among women worldwide,with significant geographic disparities in its impact.While human epidermal growth factor receptor 2(HER2)-targeted the...Background:Breast cancer remains a leading cause of morbidity and mortality among women worldwide,with significant geographic disparities in its impact.While human epidermal growth factor receptor 2(HER2)-targeted therapies,such as trastuzumab,have improved outcomes for HER2-positive breast cancer,challenges like therapy resistance persist,highlighting the need for novel treatments.Recent developments in antibody-drug conjugates(ADCs),particularly disitamab vedotin(RC48),show promising efficacy in targeting both HER2-positive and HER2-low expression tumors,warranting further investigation through real-world studies to assess its broader clinical applicability.Method:This retrospective,multicenter observational study evaluated the real-world efficacy and safety of RC48 in patients with HER2-positive or HER2-low breast cancer across three medical centers in China.Patient demographic characteristics,treatment patterns,sequential use of ADCs,and treatment-related adverse events were recorded and analyzed.Result:The median progression-free survival(mPFS)for the overall population(n 96)was=4.31 months,with HER2-positive patients demonstrating significantly longer mPFS(5.26 months)compared to HER2-low patients(3.45 months;p<0.044),while subgroup analyses revealed no significant differences in mPFS based on=estrogen receptor(ER),progesterone receptor(PR),or hormone receptor(HR)status.Safety data indicated that adverse events were consistent with prior reports,with no new safety concerns identified during the study period.Conclusion:This real-world study demonstrates the efficacy of RC48 in both HER2-positive and HER2-low breast cancer.Notably,combination therapy significantly improved outcomes in HER2-low patients.展开更多
文摘<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of the University Hospital Center (CHU) Point G in Bamako-Mali. <strong>Methodology:</strong> This was an analytical study from January 01, 2018 to December 31, 2018 in the CHU Point G cardiology department, including all patients hospitalized during this period. <strong>Results:</strong> Of 1379 hospitalized patients, 19 patients were concerned by pulmonary embolism of the young person. The prevalence of pulmonary embolism of the young person was 1.37%. The most affected age group was 21 - 30 (47.4%) of patients. The predominance was female (89.47%) with a gender ratio of 0.11 in favour of women. The average age in the series was 29.79 years with extremes of 16 years and 40 years. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1%, respectively. The dominant signs were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Pulmonary embolism was unlikely in 60.52% according to the Geneva and Wells score simplified. At the thoracic angioscanner, the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients;in 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) and left ventricular dilation (40%). Hyper leucocytosis (47.4%), anemia and low prothrombin rate (TP) (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI (Pulmonary Embolism Severity Index) score. The average hospital stay was 10 days. Hospital mortality was 10.5%. <strong>Conclusion:</strong> The pulmonary embolism of the young person is a frequent, serious and multifactorial pathology and the female sex is most affected especially during peri partum periods, hence the need for preventive measures. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation review in our context.
文摘Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University Center in Bamako—Mali. Methodology: It was a descriptive cross-sectional study from January 2010 to February 2017 in the CHU Point G cardiology department, including all patients hospitalized during this period. Results: Of 6912 hospitalized patients, 23 patients were concerned by aortic dissection. The prevalence of aortic dissection was 0.33%. The most affected age group was 50 - 69 (43.5%) of patients. The predominance was male with a sex ratio of 4.75. The cardiovascular risk factors were high blood pressure (73.9%) and smoking (60.9%). The major functional signs were chest pain (65.2%) and dyspnea (65.2%). Asphygmy (56.5%) and breath of aortic insufficiency (60.9%) were the dominant physical signs. The electrocardiogram recorded sinus tachycardia with 86.9% of patients. The radiographic of the frontal thorax showed mediastina widening (73.9%). At echocardiography, dilatation of the ascending aorta was described with 73.9% and the intimal veil (47.8%). Pericardial effusion was observed with 26.1% of patients. In the thoracic angioscan, the aortic dissection gave 43.5% for type A and 56.5% for type B. The aneurysm of the aorta was abdominal with 21.7%, ascending portion (13.0%) and descending with 8.7%. Complications were dominated by heart failure (47.8%) and aneurysm of the aorta (34.8%). The lethality was 52.2%. Conclusion: Aortic dissection is a medical and surgical emergency with poor prediction.
文摘Objective: The purpose of this study was to describe the prognostic factors associated with aortic dissection with the cardiology intensive care unit of the Point “G” Hospital University Center. Methodology: This was a descriptive transversal study from January 2010 to February 2017 that included all inpatients during this period. Results: Of 6912 patients admitted, 23 patients were admitted for an aortic dissection, a frequency of 0.33%. Of these, (6) six were under age 50 (26.1%) and the majority age group was 50 - 69 years old. Cardiovascular risk factors were high blood pressure, smoking, and diabetes with 73.9%, 60% and 13% of cases, respectively. At the clinic, chest pain and dyspnea were the main symptoms with respectively 65.2% and 52.2% and with 56.5% asphygmy was associated with pain. Para-clinically, renal failure and anemia were the major laboratory abnormalities found with respectively 43.75% and 31.25% of cases. Doppler echocardiography revealed lesions associated with aortic dissection. In the thoracic angioscan, the aortic dissection was type A (43.5%) and 56.5% type B. The co-morbidities, the associated lesions and the hemodynamic state of the patient indicate the degree of urgency. The treatment was medical. The evolution was full of complications with 52.2% of deaths including 7 (seven) type A patients. Intra-hospital death was 26.1%. Other complications were heart failure (47.8%), the renal failure (43.75%) and an aortic aneurysm (34.8%). Conclusion: Aortic dissection is a life-threatening medical and surgical emergency.
文摘<strong>Introduction:</strong> The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview about the reasons why the elderly come for consultation in the internal medicine department of the HKM-NHUC in Cotonou. <strong>Methodology:</strong> This was a retrospective, descriptive, and analytical study, which included all patients aged 65 years and over, who came for the first time for consultation in the Internal Medicine Department of the CNHU-HKM between January 1<sup>st</sup> and December 31<sup>st</sup>, 2017. <strong>Results:</strong> Among the 680 new patients received in internal Medicine consultations during the study period, 118 people were aged 65 and over, representing a hospital frequency of 17.35%. The sex ratio was 0.9 with a mean age of 73 ± 7 years. Hypertension was the main comorbidity of the patients (69%). Cough (11.3%) and low back pain (8.2%) dominated the reasons for consultation. The three main nosological groups of pathologies were, in descending order, diseases of the osteo-articular system (17.5%), diseases of the respiratory system (16.5%) and diseases of the circulatory system (12.4%). Pneumonia (11.3%) and lumbosacral spondylarthrosis (10.3%) were the most frequent pathologies in patients whose health needs remain quite varied. <strong>Conclusion:</strong> The elderly become gradually an important part of the population in southern Sahara. A better understanding of the health needs of this category of the population is necessary to deal effectively with the health challenges that will accompany this phenomenon.
文摘Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.
文摘Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine the therapeutic modalities. Materials and Methods: Descriptive cross-sectional retrospective study carried out at the University Hospital Center of Bouake over a period of 9 years (From January 2015 to December 2023). We identified all malignant oculo-adnexal and orbital tumors whose histopathological diagnosis was confirmed;monitoring the sorting of squamous cell carcinomas of the conjunctiva among these cancers and studying the different parameters linked to them. Results: The average age of patients is 44.3 years. Male predominance with a sex ratio of 1.12. HIV was the majority ATCD with 64.7%. The main reason for consultation was exophthalmos (36.11%). The average consultation time was 10 months 13 days. Invasive differentiated conjunctival squamous cell carcinoma was predominant at 55.56%. Enucleation was the most performed surgical method. Conclusion: Squamous cell carcinoma of the conjunctiva is a malignant ocular tumor of the elderly whose frequency increases in young adults infected with HIV-AIDS. Invasive differentiated forms are increasingly encountered, limiting treatment to mutilating surgery.
文摘Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to analyze the epidemiological, clinical, therapeutic and evolving aspects of hemorrhoidal disease at the stage of surgical treatment at the University Hospital Center of Brazzaville. Patients and Methods: We conducted a retrospective and descriptive study carried out from January 2020 to December 2021, a 24 months period, in the Digestive surgery department of the University Hospital Center of Brazzaville. It concerned patients who underwent a surgical procedure for hemorrhoidal disease. Results: 21 cases were collected, representing a hospital frequency of 2.3%, with a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9 years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding. We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%) of hemorrhoidal prolapse including 12 cases requiring manual integration (Goligher grade III) and four irreducible permanent cases (Goligher grade IV). The Grade III prolapse was associated with a polyp in one patient and with posterior anal fissure in another patient. Out of the 21 patients, 14 underwent a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients underwent mono- and bipedicular hemorrhoidectomy with resection of associated lesions and five patients underwent emergency thrombectomy. The outcome was favorable for all our patients. The average length of hospital stay was 1.5 ± 2.1 days. Conclusion: In the event of failure of medical and instrumental treatment, the hemorrhoidal cure according to Milligan and Morgan is the surgical treatment of reference for hemorrhoidal disease at the University Hospital Center of Brazzaville.
文摘Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]
文摘Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.
文摘Several studies report the problem of cardiovascular tolerance of treatments with neuroleptics, given the important number of morbidities in patients with mental illnesses. This preliminary work aimed to describe the epidemiological and biological profile of patients taking neuroleptics and followed in the psychiatry department of Brazzaville University Hospital, from the angle of cardiovascular risk. Fifty (50) patients (17 men and 33 women), with a mean age of 33.9 10.7 years, were included. Epidemiological data (sex, age, tobacco or alcohol consumption) were collected on pre-established survey forms. Biochemical (total cholesterol, HDL-c, triglycerides and atherogenicity index) and inflammatory parameters (ultra-sensitive CRP, troponin I and NT-ProBNP) were investigated using enzymatic and indirect immunofluorescence technical, respectively. The results obtained showed that 54% of patients were obese, 94% were non-smokers, and 12% had high blood pressure. 10% of patients had high total cholesterol levels and 90% had HDL cholesterol levels below 60 mg/dl. Triglycerides and atherogenicity index were significantly elevated in relation to Body Mass Index (BMI). Ultrasensitive CRP was elevated in 38% of patients. In conclusion, this study revealed an association between lipid parameters (triglycerides and atherogenicity index) in relation to BMI in patients taking neuroleptics followed in the Psychiatry Department of University Hospital Center of Brazzaville.
文摘Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney disease (CKD) in Morocco. The aim of our study is to describe the clinical, paraclinical and management aspects of renal lithiasis in our patients, to determine the factors of recurrence of renal lithiasis and to identify the factors of progression of renal failure. Materials and Methods: This is a retrospective, descriptive and analytical study conducted in the nephrology department of CHU IBN Sina in Rabat, over a 3-year period from 2020 to 2023. We included 160 patients with renal lithiasis having a follow-up in our training. We analyzed their epidemiological, clinical, paraclinical and therapeutic profile. Results: The mean age of our patients was 56 +/− 16.6 years, with a M/F sex ratio of 1.02. Lithiasis was expressed by renal colic in 71% of cases, and by stone emission in 31% of cases, although discovery was incidental in 16% of cases. At the time of the first consultation, 59% of patients had renal failure (RF), 15% of whom were at the stage of chronic end-stage renal disease. Crystalluria and calculus spectrophotometry were performed in only 30% and 22% of patients respectively. All patients benefited from hygienic and dietary measures according to the nature of the stone, as well as additional urological management. Recurrence of renal lithiasis was reported in 36% of cases. In univariate analysis, advanced age, male gender, diabetes, hypertension and the presence of recurrent urinary tract infection were factors in the progression to CKD (OR = 0.979, p = 0.035;OR = 0.527, p = 0.48;OR = 4.127, p = 0.015;OR = 1.926;p = 0.015, OR = 2.5 p = 0.019, respectively). In multivariate analysis, only diabetes and high baseline creatinine were factors in the progression to CKD. Recurrence of renal lithiasis was reported in 36.5% of cases. Only the presence of a history of familial lithiasis and of renal cysts on imaging were significantly associated with a risk of renal lithiasis recurrence in univariate analysis. (OR = 3.06, p = 0.035;OR = 5.27, p = 0.017, respectively). Conclusion: Renal lithiasis is a disabling pathology that can be complicated by recurrence and chronic end-stage renal failure. Early diagnosis and identification of factors leading to the recurrence and progression of chronic renal failure could improve management.
文摘Introduction: Biometrics therefore corresponds to the measurement of the morphological elements of humans. One of the most common ultrasound requests by clinicians is the assessment of liver size. The aim of our study was to study liver biometry using ultrasound in healthy adult subjects. Material and Methods: This was a prospective, descriptive and analytical study, carried out at CHU Point-G over a period of 7 months. A liver ultrasound was performed on 100 individuals without lesions, by a doctor in his final year of specialization in radiology and medical imaging. For each subject, we determined the height and anteroposterior diameter of the right liver and the left liver. Results: The mean age was 39.05 ± 16.86 years. The body mass index (BMI) 18.5 - 24.9 group was the most represented with 58%. The mean height of the right liver was 138.40 ± 14.85 mm. It was 136.81 ± 14.70 mm in men and 139.92 ± 14.99 mm in women (P = 0.306). That of the left liver was 95.55 ± 14.34 mm, in men, it was 91.79 ± 13.51 mm and 99.16 ± 14.31 mm in women (P = 0.019). We found a significant correlation between right liver height and BMI (P = 0.013). Conclusion: The mean values of liver biometry were established in our series. There was a significant correlation between right liver height and BMI. Liver ultrasound remains a reliable technique for liver biometry.
文摘Introduction: Sinonasal polyposis (SNP) is a chronic inflammatory disease of the mucosa of the nasal cavities and facial sinuses. It is characterized by an oedematous, multifocal and bilateral degeneration of the nasosinus mucosa, which originates in the lateral masses of the ethmoid, where it causes the formation of smooth, gelatinous, translucent and pyriform polyp lesions. The objective of this study was to review epidemiological, clinical, paraclinical data and evaluate the results of endoscopic surgical treatment. Patients and Methods: This is a retrospective study on 60 patients followed at the ENT department of the Fann National University Hospital Center, from January 2010 to December 2015. All patients with sinonasal polyposis were included in the study. Results: The average age of our patients was 38 years and the sex ratio (M/F) was 0.8. In the patients’ histories, we found 18% asthma and 10% Widal’s disease. The average consultation time was 8.5 years. All patients had consulted for nasal obstruction;rhinorrhea was bilateral and found in 67.7% of cases, with olfactory disorders accounting for 50%. The CT scan performed in 58% of cases made it possible to specify the extent of the lesions;the involvement of the ethmoidal sinus was constant and extended to the other sinuses except in 2 cases. All patients had received medical treatment with local corticosteroids. Endoscopic surgical treatment was initiated in 43% of cases after failure of corticosteroid-based medical treatment. The evolution under treatment marked by the reappearance of symptoms that increased each month. At one month postoperatively, all clinical symptomatology had improved with the exception of olfactory disorders, which persisted in 3 patients. At 12 months we noted 12 cases of reappearance of nasal obstruction. Conclusion: SNP is a disease of little known etiology. The diagnosis is almost always clinical. Endoscopic surgery remains a recourse to medical treatment. For good local control, patients should be more respectful of good compliance with corticosteroid therapy.
文摘Introduction: Access to the best quality of obstetrical care sometimes conceals acts and behaviors that fail to respect women’s physical, mental and social integrity. These negative experiences are referred to as obstetrical violence. The aim of this study is to contribute to improving the quality of maternal health care. Patient and Method: This was a cross-sectional study with a quantitative component carried out in the obstetrics and gynecology department of the Maman Elisabeth Domitien University Hospital from November 1 to 30, 2024. All women in childbed seen for postnatal consultations within 42 days of delivery were included. Results: We included 109 women. Age ranged from 16 to 44 years with a mean of 26.9 (±6.02). The majority of women were living in common-law unions with 79.8% and 57.8% of mothers having a secondary education level. More than half of the participants (52.9%) said that they had not been prepared for childbirth during prenatal follow-up and 44.0% had not freely chosen their path of delivery. The vaginal route was the most observed route of delivery (97.3%). Of all vaginal deliveries, episiotomy was performed in 21.7% and uterine revision in 66.0%. For episiotomies, 26.1% of women in childbed were informed about its performance and 87.0% had had a bad experience with this event. For women who had undergone a uterine revision, 52.9% had been informed of its performance and 77.1% had a bad experience with the event. Women in childbed had been victims of inappropriate acts and verbal aggression in 18.4% and 14.7% respectively. Of all the participants, 45.0% said they had experienced the birth episode badly. Conclusion: This study has given us an idea of the subject. However, a large-scale study will enable us to understand the different facets of this subject.
文摘AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.
文摘BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.
文摘Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 - 15 years. Patients and Methods: This was a prospective cross-sectional study from April 1, 2021 to March 31, 2022 and affected all children aged 0 to 15 years old with a temperature of 39˚C or higher (≥), having less than five days and hospitalized in the pediatric department of the Gabriel Touré University Hospital. Results: During the study period, 150 children were included, the sex-ratio was 0.85. Children aged 0 - 5 years represented 71.4% of the sample. References represented more than half of the sample, or 58% of cases. Body temperature was above 40˚C in 18.7% of cases. Functional signs were dominated by respiratory signs in 28% and digestive signs in 18%. Clinical pallor was found in 55.3% of children associated with signs of respiratory struggle in 70% of cases and tachycardia in 40% of patients. Anemia was present in 65.3% of patients. Hyperleucocytosis and leukopenia were found in 45.3% and 43.3% of patients respectively. The C-reactive protein was positive in 44.7% of patients and Cytobacteriological Examination and Chemistry of Cerebrospinal Fluid was positive in 8.7% of cases. The thick drop was positive in 44.7% of patients and blood cultures grew in 6 patients. Etiology was dominated by severe malaria 54 cases (36%), pneumonia (19.3%), meningitis (12.6%), and in those under one month it was bacterial neonatal infection (8.6%). In our study, slightly more than one patient out of three died during hospitalization, 36% (54 cases/150) and among these 70% (38 cases/54) were under 5 years old. The most lethal pathologies were severe malaria (36%), bacterial pneumonia (19.3%), meningitis (12.6%), bacterial neonatal infections (8.6%) and measles complicated by pneumonia (5.3%). Mortality during hospitalization was 36% of deaths (54 out of 150 patients) and 70.3% (38/54) of the deceased patients were under 5 years old. Conclusion: This study shows that fever is a frequent symptom and a sign of serious and very lethal pathologies. The cause of fever can be a diagnostic challenge for health workers. However, early identification of children at risk for serious illness could allow for prompt and appropriate management in appropriate settings.
文摘BACKGROUND Several trace minerals have been shown to be associated with thyroid cancer.Democratic Republic of Congo(DRC)is deemed the most mineral-rich country globally.Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.AIM To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.METHODS We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga,South Kivu and Kinshasa between 2005 and 2019.Of these three provinces,Katanga and South Kivu have the highest mineral density with the DRC.RESULTS Mean patient age was 44.2 years±14.6 years with a female predominance,with a female to male ratio of 5.4.The 66.5%of patients had a family history of thyroid disease.Total 74 patients had simple nodules,and the remaining 455 patients had multiple nodules.The 87.7%of patients were euthyroid.The nodules exhibited varying characteristics namely hypoechogenicity(84.5%),solid echostructure(72.2%),macronodular appearance(59.8%),calcifications(14.4%)and associated lymphadenopathy(15.5%).The 22.3%of the nodules were malignant.Factors independently associated with malignancy were older age(≥60 years)[adjusted odds ratio(aOR)=2.81],Katanga province(aOR=8.19),solid echostructure(aOR=7.69),hypoechogenicity(aOR=14.19),macronodular appearance(aOR=9.13),calcifications(aOR=2.6)and presence of lymphadenopathy(aOR=6.94).CONCLUSION Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant.Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.
基金funded by the medical and health category of the Science and Technology Project of Shantou(No.230509116495542,Wu Haoming)National Natural Science Foundation of China(NSFC)Cultivation Project of the Cancer Hospital of Shantou University Medical College(No.2024GP002,Wu Haoming)National Natural Science Foundation of China(82203130,Ye Feng).
文摘Background:Breast cancer remains a leading cause of morbidity and mortality among women worldwide,with significant geographic disparities in its impact.While human epidermal growth factor receptor 2(HER2)-targeted therapies,such as trastuzumab,have improved outcomes for HER2-positive breast cancer,challenges like therapy resistance persist,highlighting the need for novel treatments.Recent developments in antibody-drug conjugates(ADCs),particularly disitamab vedotin(RC48),show promising efficacy in targeting both HER2-positive and HER2-low expression tumors,warranting further investigation through real-world studies to assess its broader clinical applicability.Method:This retrospective,multicenter observational study evaluated the real-world efficacy and safety of RC48 in patients with HER2-positive or HER2-low breast cancer across three medical centers in China.Patient demographic characteristics,treatment patterns,sequential use of ADCs,and treatment-related adverse events were recorded and analyzed.Result:The median progression-free survival(mPFS)for the overall population(n 96)was=4.31 months,with HER2-positive patients demonstrating significantly longer mPFS(5.26 months)compared to HER2-low patients(3.45 months;p<0.044),while subgroup analyses revealed no significant differences in mPFS based on=estrogen receptor(ER),progesterone receptor(PR),or hormone receptor(HR)status.Safety data indicated that adverse events were consistent with prior reports,with no new safety concerns identified during the study period.Conclusion:This real-world study demonstrates the efficacy of RC48 in both HER2-positive and HER2-low breast cancer.Notably,combination therapy significantly improved outcomes in HER2-low patients.
