Association between pancreatic cancer and diabetes: insights from a retrospective cohort study.

BACKGROUND: Studies investigating the prevalence of pancreatic cancer have revealed a heightened risk of 1.5 to 2.0 times among individuals with long-standing type 2 diabetes mellitus. AIMS: We aimed to estimate the prevalence of diabetes among patients with pancreatic cancer, and identify the factors associated with type 2 diabetes mellitus in this population. METHODS: This retrospective observational and analytical study was carried out in the Department of Gastroenterology of the Mohammed VI University Hospital over a period of 5 years, between 2018 and 2022, including all patients with confirmed cases of pancreatic adenocarcinoma. RESULTS: Out of the 197 patients, 38.1% had a history of diabetes, among them, 42.7% had new-onset diabetes, while the remaining 57.3% had long-standing diabetes. Diabetic patients were significantly older than nondiabetic patients (mean age of 67.2 vs. 63, P = 0.009). Diabetes was more prevalent among obese patients (66.7%, P = 0.01), and less frequent among individuals with chronic alcohol consumption (20% vs. 80%, P = 0.04), and tobacco smokers (24.4% vs75.6%, P = 0.03). Among patients with an ECOG score ≥ 3, DM, 54.5% were DM-patients (P = 0.033). The same significant association was found for the Nutritional Risk Index, Patients who had moderate or severe malnutrition were more likely to be diabetic 74.7% (P = 0.004). Diabetic patients were less likely to undergo surgery due to comorbidities and general health deterioration. However, no significant differences were observed in sex, tumor stage or location. CONCLUSION: Our study has shown an increased prevalence of diabetes in pancreatic cancer and highlights the importance of considering this cancer in cases of recent onset or uncontrolled diabetes, especially in elderly individuals.

Genome-Wide B Cell, CD4+, and CD8+ T Cell Epitopes That Are Highly Conserved between Human and Animal Coronaviruses, Identified from SARS-CoV-2 as Targets for Preemptive Pan-Coronavirus Vaccines.

Over the last two decades, there have been three deadly human outbreaks of coronaviruses (CoVs) caused by SARS-CoV, MERS-CoV, and SARS-CoV-2, which has caused the current COVID-19 global pandemic. All three deadly CoVs originated from bats and transmitted to humans via various intermediate animal reservoirs. It remains highly possible that other global COVID pandemics will emerge in the coming years caused by yet another spillover of a bat-derived SARS-like coronavirus (SL-CoV) into humans. Determining the Ag and the human B cells, CD4+ and CD8+ T cell epitope landscapes that are conserved among human and animal coronaviruses should inform in the development of future pan-coronavirus vaccines. In the current study, using several immunoinformatics and sequence alignment approaches, we identified several human B cell and CD4+ and CD8+ T cell epitopes that are highly conserved in 1) greater than 81,000 SARS-CoV-2 genome sequences identified in 190 countries on six continents; 2) six circulating CoVs that caused previous human outbreaks of the common cold; 3) nine SL-CoVs isolated from bats; 4) nine SL-CoV isolated from pangolins; 5) three SL-CoVs isolated from civet cats; and 6) four MERS strains isolated from camels. Furthermore, the identified epitopes: 1) recalled B cells and CD4+ and CD8+ T cells from both COVID-19 patients and healthy individuals who were never exposed to SARS-CoV-2, and 2) induced strong B cell and T cell responses in humanized HLA-DR1/HLA-A*02:01 double-transgenic mice. The findings pave the way to develop a preemptive multiepitope pan-coronavirus vaccine to protect against past, current, and future outbreaks.

Skin involvement as the presenting sign of a male breast cancer.

Male breast cancer is a rare disease with an unknown etiopathogenesis. We report a case of a 50-year-old man with a breast cancer revealed by skin involvement.

Peritonitis on sigmoidal perforation in a cocaine user: A rare case report.

INTRODUCTION AND IMPORTANCE: Cocaine, the second most abused drug in Morocco after cannabis, has been associated with multiple cardiac, pulmonary, neurological, and digestive complications. Colonic perforation following cocaine abuse is relatively lesser-known and requires attention as abuse rates are increasing, and existing evidence is scarce. Only a few cases have been reported in medical literature. CASE PRESENTATION: We report the case of a 42-year-old male cocaine addict who presented with acute peritonitis. A laparotomy revealed a 3 cm perforation in the sigmoid, The absence of radiological, biological, and pathological evidence confirms the toxic origin of the perforation. CLINICAL DISCUSSION: Cocaine-induced ischemic colitis is a rare occurrence in a surgeon's clinical experience. This condition is typically confirmed through colonoscopy and often resolves without the need for surgery, although a small number of cases may advance to peritonitis, necessitating surgical intervention. CONCLUSION: Cocaine's adverse effects should be taken into account in the differential diagnosis of acute ischemic events in young adults. A general understanding of the significant complications associated with cocaine can aid in achieving early diagnosis and prompt treatment.

Intestinal occlusion revealing Peutz Jeghers syndrome: A rare case report.

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant congenital disorder characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous lentiginosis. It is associated with an elevated risk of cancer and substantial morbidity related to polyps, notably intestinal intussusception during childhood. CASE PRESENTATION: We report the case of an 18-year-old female patient, who consulted for subocclusif syndrome with multiple pigmented spots on the face and lips. Abdominal computed tomography (CT) revealed an image of ileo-mesenterico-colic intussusception. The patient underwent a hemicolectomy involving the ileum, removing the intussusception and the ileal polyp. The pathologic examination confirmed the diagnosis of Peutz-Jeghers polyps without malignancy. DISCUSSION: The diagnosis of SPJ can be established in patients presenting one or more polyps and at least two of the associated clinical criteria: labial melanin deposits, family history of the syndrome and polyposis of the small bowel. Half of the cases present with small bowel obstruction. PJS is associated with an increased risk of gastrointestinal and non-gastrointestinal malignancies. Endoscopic or surgical polypectomy remains the preferred treatment options to prevent complications. CONCLUSION: Regular surveillance of the gastrointestinal tract is recommended both for cancer prevention and early detection, and to prevent polyp-related complications and certainly improve prognosis in these patients.

A Rare Case of Retroperitoneal Immature Teratoma in a Young Adult Male: A Case Report From Eastern Morocco.

Teratomas are classified as germ-cell tumors. They occur more frequently in the gonads, but extragonadal localization can also occur. Retroperitoneal teratomas are rare and require multidisciplinary management. We report the case of a 20-year-old patient who presented with an immature retroperitoneal teratoma. The patient initially underwent a retroperitoneal mass resection, which resulted in positive resection margins and a residual mass observed in post-operative imaging, necessitating treatment with platinum-based chemotherapy. The purpose of this publication is to highlight the characteristics of retroperitoneal teratoma, along with diagnostic criteria and treatment approaches.

Topological optimization of hip spacer reinforcement.

The use of an antibiotic-enriched hip spacer represents the optimal treatment for periprosthetic joint infections (PJI). The addition of reinforcement significantly enhances its mechanical properties. Employing the explicit method enables accurate prediction of the mechanical behavior of both the spacer and its reinforcement. Topological optimization of the reinforcement emerges as the most effective strategy to prevent bone demineralization, enhance antibiotic diffusion, and improve spacer resistance. The objective of this study is to conduct topological optimization of a validated numerical model of a reinforced hip spacer and to select, from the obtained topologies, the one that best improves mechanical properties and prevents stress shielding while minimizing volume. The results indicate that an 8 mm thick titanium reinforcement, optimized to 70% of its original volume, proves to be the most effective choice.

Appendiceal duplication: a case report of horseshoe-shaped appendix and implications for patient safety.

Appendiceal anomalies, particularly double appendices, are rare and mainly detected during non-appendiceal surgery in adults. Misrecognizing them can have serious consequences, both clinically and legally. It is critical that surgeons pay attention to the anatomical variations of the vermiform appendix, and always consider the possibility of duplicated appendix when diagnosing a right iliac fossa pain. Misdiagnosis can lead to life-threatening medical complications for the patient, with medico-legal implications.

Severe Sepsis Secondary to Toxic Megacolon Revealing an Inflammatory Bowel Disease.

Patients with inflammatory bowel disease can present with numerous infectious complications, including intra-abdominal abscess, perforations of the intestine, fistula formation, and the occurrence of septicemia. Toxic megacolon (TM) is a potentially fatal complication of inflammatory bowel disease (IBD) and is associated with high morbidity and mortality. In this case report, we report a 49-year-old male patient who was admitted to the intensive care unit for the management of severe sepsis that was secondary to an inaugural toxic megacolon complicating a silent inflammatory bowel disease, with a Lichtiger score of 11. Nonresponse to anti-bacterial therapy, noradrenaline, and intravenous corticosteroid therapy required an emergency total colectomy. After surgery, the patient died because of his unresolved septic shock. Correct management of this condition requires an accurate assessment of the patient's history, a correct physical examination, abdominal radiographs, and sigmoid coloscopy, and frequently requires surgery. The indications for surgery in cases of toxic megacolon, massive hemorrhage, perforation, peritonitis, or non-response to medical therapy are the most important ones. Patients with a history of inflammatory bowel disease are particularly prone to infectious complications since therapy for these inflammatory diseases is based on the use of immunosuppressive drugs and frequent abdominal surgeries.

Pancreatic cancer: experience from an emerging country in North Africa.

PURPOSE: Pancreatic cancer is a major global health problem, it's a highly aggressive and often has a poor prognosis. The aim of this work is to carry out a retrospective epidemiological study on pancreatic cancer in a university hospital in a North African country. METHODS: This is a monocentric, descriptive and analytical retrospective cohort study carried out in the Gastroenterology department of the Mohammed VI University Hospital of Oujda, Morocco, between January 2018 and December 2022. Analysis were performed using IBM SPSS Version 21.0 RESULTS: During this period, 197 cases of pancreatic cancers were collected, the median age was 64.6 years, the majority of patients (90.9%) were over 50 year's old. and there was no significant difference in gender distribution. Among the patients, several risk factors were prevalent, including chronic tobacco smoking (22.8%), alcohol consumption (12.7%), diabetes (38.1%), obesity (7.6%), and a family history of pancreatic cancer (3%). The most common symptoms at presentation were abdominal pain and obstructive jaundice. Imaging revealed that the majority of cases were located in the head of the pancreas (80.7%). Only 19.8% of the cancers were diagnosed at a resectable stage and adenocarcinoma was the predominant histological type (96.4%). Patients with advanced cancer stages showed higher levels of CA 19-9 and hypoalbuminemia. CONCLUSION: Our study aligns with previous research, indicating an increased incidence of pancreatic cancer among elderly individuals, particularly those with several risk factors such as chronic tobacco smoking, alcohol consumption, diabetes. A small proportion of cancer cases are deemed resectable at the time of diagnosis.

Abdominal Inflammatory Myofibroblastic Tumour Presenting as a Pancreatic Mass: A Case Report.

An abdominal inflammatory myofibroblastic tumor (AIMT), is a rare benign tumor composed of inflammatory and other mesenchymal cells. It can affect the entire body, predominantly in children and young adults. The diagnosis is challenging considering the wide clinical presentation and can often be mistaken for malignant tumors. We report a rare case of a 46-year-old female patient, who presented with intermittent abdominal pain weight loss, and an abdominal palpable mass. Abdominal ultrasound found a well-defined 18 cm, rounded mass, with solid and cystic components. Abdominal CT demonstrated a well-defined, hypodense, retro gastric mass of 20 cm, with thickened wall and heterogenous enhancement. The mass had contact with the pancreatic tail, transverse colon, spleen, left kidney pedicles, abdominal aorta, superior mesenteric vein, and mesaraic trunk with no invasion signs. The mass was initially thought to be pancreatic cancer, but given the large size, other diagnoses like sarcoma, lymphoma, or abdominal hydatid cyst were suggested. Endoscopic ultrasound found a rounded retro gastric mass of 18/12 cm, with a thickened wall and well-limited calcifications. The content was both cystic and solid with mobile vegetations, with no visible Doppler flow. The mass had contact with the body and tail of the pancreas, spleen hilum, the upper pole of the spleen, and the hepatic pedicle behind, with no invasion sign. After a multidisciplinary team meeting, a decision was taken to perform surgical resection with mass resection, distal splenopancreatectomy, and transverse and sigmoid colectomy. Pathological and immunostaining results were consistent with inflammatory pseudotumor. The postoperative recovery was uncomplicated. The patient remains asymptomatic with no obvious signs of metastasis or recurrence. AIMT represents a reel diagnostic challenge. Clinical symptoms are unspecific. Radiological and endoscopic features can often be mistaken for malignant tumors. Surgical management remains to be the best therapeutic option. We report a rare case of AIMT treated by surgery with complete resection. We suggested a long-term follow-up given the local recurrence risk.

Endoluminal Leiomyoma of the Gastric Antrum: a Report of a Rare Case.

Endoluminal gastric leiomyoma (GL) of the antrum is a rare benign tumor. In this paper, we report a case of a 72-year-old patient that presented for a 1-month episode of epigastric pain. Imaging found a well-limited tumor in the antrum with extrinsic compression on ulcerated congestive mucosa. A surgical resection based on Finsterer's antrectomy with end-to-side trans-mesocolic gastro-jejunal anastomosis was performed. The histopathological examination in combination with immunohistochemistry diagnosed GL and found a diffuse and marked staining of smooth muscle actin (SMA) and h-caldesmon (h-CD) and negative expression of CD117 and DOG1. The patient was discharged without post-surgical complications and is still alive at the time of this case report writing.

Deep endometriosis of ileocecum complicated by acute intestinal obstruction: a case report.

Endometriosis is a frequent gynecological pathology. Digestive localization complicated by acute intestinal obstruction is exceptionally rare. We herein report a case involving a 48-year-old woman who had a long-term history of endometriosis symptoms. She was diagnosed with endometriosis by ultrasound 1 month before her admission to the emergency room with acute intestinal obstruction. The diagnosis was confirmed by histopathological examination following surgical resection. Further medical management resulted in a satisfactory outcome.

Gastroenteric-anastomosis in the setting of marked stomach dilatation associated with gastric pyloric obstruction secondary to Sarcina ventriculi.

Sarcina ventriculi is an anaerobic gram-positive bacterium capable of surviving in the acidic environment of the stomach and causing gastrointestinal symptoms. We report the case of a 51-year-old patient with no notable medical history who presented with abdominal distension, nausea, and vomiting. Initial endoscopic evaluation revealed a distended stomach in stasis with pyloric stenosis. Biopsies revealed the presence of Helicobacter pylori and S. ventriculi. A therapeutic protocol was administered, but no symptomatic relief was observed. Subsequently, the patient was referred to our institution, where computed tomography imaging of the abdomen was performed. The results corroborated a presentation suggestive of a high obstruction attributable to a right anterior para-duodenal internal hernia. Ultimately, surgery was undertaken, ruling out the diagnosis of right para-duodenal internal hernia and resulting in gastroenteric anastomosis with satisfactory improvement in clinical symptoms.

Synovial sarcoma in the buttocks: an exceptional location - case report according to SCARE guidelines.

Pelvic pain is a frequent reason for consultation; the management is complex, given the differences in symptomatic and anatomical orientation. We present an exceptional case of intergluteal synovial sarcoma rarely described in the literature, with an incidence of about 1/1 000 000 and less than 10 cases of intergluteal location are published. Case Presentation: Through this publication, we present a very exceptional case of synovial sarcoma. It concerns a 44-year-old male followed for probable intergluteal lipoma for 3 months and admitted for intergluteal mass bleeding. The clinical examination revealed an intergluteal tumor mass, and the surgical resection was in favor of a synovial sarcoma.The objectives of this work are threefold: to enrich the poor literature with this new case; to underline the importance of multidisciplinary management; to recommend the obligation of anatomopathological evidence to make the diagnosis of lipoma in front of a soft tissue tumor. Discussion and Conclusion: Our case enriches the poor literature on intergluteal synovial sarcoma, where less than 10 similar reports are available. We hope through our presentation to highlight this exceptional etiology of gluteal tumor and to recall that there is no relationship between the name of this tumor and the synovium as an anatomical entity.

The Extracapsular Lymph Node Extension Predicts Outcomes in Colorectal Cancer: A Short Review.

BACKGROUND: The extension of the metastatic lymph nodes through the capsule to the adipose tissue in the perinodal or extra-nodal defines the extra-nodal extension (ENE). ENE represents an important prognostic factor in multiple cancers, which is considered as a prognostic parameter in different tumor-node-metastasis (TNM) classifications. INTRODUCTION: Colorectal cancer (CRC) is ranked third in order of frequency, after successively lung and breast cancer. Lymph node metastasis has been validated as a significant negative prognostic factor for survival in colorectal cancer (CRC), which is improved by the adjuvant. Despite the use of ENE as an important and validated prognostic factor in multiple cancers, ENE is not yet taken into account in the CCR staging system. METHOD: The present short review aims to discuss the prognostic impact of ENE on CRC according to the emerging evidence. To conduct this study, we have reported the results of all available studies following the scientific rationale in three parts: retrospective studies, prospective studies, and meta-analyses. RESULT: ENE has a negative impact on the prognosis of colorectal cancer but is not yet used in practice in colorectal cancer. CONCLUSION: We, therefore, propose to carry out randomized clinical trials to study this subject better and strengthen its value in management strategies.

Primary hepatic origin of a neuroendocrine tumor: A rare case report.

Introduction: Neuroendocrine tumors are mainly located in gastrointestinal tract, pancreas and lungs. The primary hepatic origin of neuroendocrine tumors is extremely rare. Case presentation: A 57-year-old female with a history of cholecystectomy presented to our hospital for right upper abdominal pain lasting for 2 months. Abdominal computed tomography revealed a large exophytic soft-tissue mass in the left liver lobe. Tumor markers were within the normal range. Octreoscan confirmed the primary hepatic origin of neuroendocrine tumor. The patient underwent left hepatic resection. Pathological and immunohistochemical examination of the resected specimen showed a well-differentiated grade 2 neuroendocrine tumor. Clinical discussion: Primary hepatic neuroendocrine tumors represent rare hepatic tumors. These tumors may occur at any age with an average of 50 years. Diagnosis algorithm includes two key steps: firstly, the confirmation of the endocrine nature of the tumor and secondly the confirmation of its primary nature. Conclusion: Neuroendocrine tumors are a very rare entity. The primary hepatic location is exceptional. The diagnosis is based on pathological and immunohistochemical examination as well as the result of the octreoscan.

Gallbladder carcinosarcoma with two heterologous components: a case report.

Carcinosarcoma of the gallbladder is a rare cancer characterized by presence of a carcinomatous and a sarcomatous component. In our work, we report the case of a 66-year-old male patient, presenting with isolated abdominal pain evolving for more than 6 months. contrast-enhanced computed tomography enabled identification of a gallbladder mass, invading liver, duodenum and abdominal wall. A cholecystectomy, extended to liver, duodenum and abdominal wall was performed. The final diagnosis of gallbladder carcinosarcoma was obtained by pathological assessment. Gallbladder carcinosarcoma has a poor prognosis. Since it is rare, no established chemotherapy or radiation protocols exist. Further studies about case series are needed to establish better therapeutic protocols. Gallbladder carcinosarcoma is a rare cancer with a rapid progression making therapeutic decisions difficult. All these factors contribute to the poor prognosis of this cancer.

First case report of uterine perforation and bowel incarceration following a clandestine abortion in Morocco.

Uterine perforation is a rare complication of abortion. It becomes much rarer when associated with a small bowel incarceration at the uterine breach. Its diagnosis can be suspected clinically, but radiology remains more sensitive for diagnosis. Surgery is the cornerstone in treating this entity as it provides both diagnostic and therapeutic management. A multidisciplinary therapeutic approach should be immediately performed to ensure a good prognosis. In this report, we describe a case of small intestine incarceration in the breach of a uterine perforation that occurred in the weeks following a clandestine abortion.

A febrile occlusion revealing a biliary ileus.

Biliary ileus is a consequence of the migration of a gallstone from the gallbladder to the digestive tract, most often via a biliodigestive fistula that causes a bowel obstruction. The clinic is atypical and capricious, including bowel obstruction and signs of cholecystitis, causing a delay in diagnosis. The therapeutic objective is to remove the intestinal obstacle by an enterotomy with stone extraction, with or without treatment of the biliary pathology (cholecystectomy and biliary fistula cure). The surgery remains the treatment of choice; laparoscopy and endoscopy present a less invasive alternative and are beginning to prove their effectiveness. The morbi-mortality remains high for biliary ileus, this is principally caused by the delay in diagnosis.