RESUMO
OBJECTIVE: the study's objective was to determine impact of COVID-19 on the prognosis of pulmonary embolism. PATIENTS AND METHODS: An analytical multicenter cross-sectional study with retrospective data collection was carried out in three university hospitals and a private clinic in Ouagadougou from March, 2020 to July 2021. It included consecutive patients hospitalized for PE confirmed on chest CT angiography or by the association an acute cor pulmonale on echocardiography-Doppler with deep vein thrombosis on venous ultrasound-Doppler of the lower limbs and having carried out a COVID-19 test (RT-PCR or rapid diagnostic test). Control cases consisted of all COVID-19 negative PE cases. Data comparison was carried out using the Epi info 7 software. A univariate then multivariate analysis allowed the comparison of the prognosis of the two subpopulations. The significance level retained was p < 0.05. RESULTS: 96 patients with COVID-19+ and 70 COVID-19- PE were included. The prevalence of PE in patients hospitalized for COVID-19 was 7.05%. The average patient age was 61.5±17 years for COVID-19+ patients and 49.6±15.9 years for COVID-19- patients. Pulmonary condensation syndrome (p=0.007), desaturation (p=0.0003) and respiratory distress syndrome (p=0.006) were more common in COVID-19+ patients. The hospital death rate was 27.1% in COVID-19+ patients and 10% in COVID-19- patients (p=0.0024). Age > 65 years and COVID-19 pneumonia were the independent factors of death. CONCLUSION: COVID-19 is associated with clinical severity and excess mortality in patients with pulmonary embolism.
Assuntos
COVID-19 , Embolia Pulmonar , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , COVID-19/complicações , Estudos Retrospectivos , Estudos Transversais , Embolia Pulmonar/complicações , PrognósticoRESUMO
N-methyl-D-aspartate receptors (NMDARs) are crucial for neuronal development and synaptic plasticity. Dysfunction of NMDARs is associated with multiple neurodevelopmental disorders, including epilepsy, autism spectrum disorder, and intellectual disability. Understanding the impact of genetic variants of NMDAR subunits can shed light on the mechanisms of disease. Here, we characterized the functional implications of a de novo mutation of the GluN2A subunit (P1199Rfs*32) resulting in the truncation of the C-terminal domain. The variant was identified in a male patient with epileptic encephalopathy, multiple seizure types, severe aphasia, and neurobehavioral changes. Given the known role of the CTD in NMDAR trafficking, we examined changes in receptor localization and abundance at the postsynaptic membrane using a combination of molecular assays in heterologous cells and rat primary neuronal cultures. We observed that the GluN2A P1199Rfs*32-containing receptors traffic efficiently to the postsynaptic membrane but have increased extra-synaptic expression relative to WT GluN2A-containing NMDARs. Using in silico predictions, we hypothesized that the mutant would lose all PDZ interactions, except for the recycling protein Scribble1. Indeed, we observed impaired binding to the scaffolding protein postsynaptic protein-95 (PSD-95); however, we found the mutant interacts with Scribble1, which facilitates the recycling of both the mutant and the WT GluN2A. Finally, we found that neurons expressing GluN2A P1199Rfs*32 have fewer synapses and decreased spine density, indicating compromised synaptic transmission in these neurons. Overall, our data show that GluN2A P1199Rfs*32 is a loss-of-function variant with altered membrane localization in neurons and provide mechanistic insight into disease etiology.
Assuntos
Transtorno do Espectro Autista , Epilepsia , Animais , Humanos , Masculino , Ratos , Transtorno do Espectro Autista/metabolismo , Epilepsia/genética , Epilepsia/metabolismo , Neurônios/fisiologia , Receptores de N-Metil-D-Aspartato/genética , Receptores de N-Metil-D-Aspartato/metabolismo , Transdução de Sinais , Sinapses/fisiologiaRESUMO
OBJECTIVE: The relationship of preoperative memory deficits in patients with mesial temporal lobe epilepsy (mTLE) and hippocampal sclerosis (HS) to the distribution of neuronal loss is uncertain. Building on the material specificity theory, we tested the hypothesis that visual memory deficits are associated with posterior hippocampal atrophy, whereas verbal memory deficits are associated with anterior hippocampal atrophy. METHODS: We studied 22 adults with mTLE and HS, calculating hippocampal head, body, and tail volumes, correcting for estimated total intracranial volume, using automated segmentation. Preoperative memory ability was evaluated with the Wechsler Memory Scale (WMS-II: logical memory, verbal paired associates, family pictures, and faces subtests). We correlated memory ability with hippocampal division volumes using SPSS 26.1 (repeated measures ANOVAs, one-way ANOVAs, Pearson r correlations) for statistical analysis. RESULTS: We found a significant main effect of hippocampal subdivision, reporting volumetric differences between the head, body, and tail. Pairwise comparisons reported that the hippocampal head had significantly greater volume than both the body and tail (p < 0.001). For both left and right focus groups, the ipsilateral hippocampi were significantly smaller than the contralateral. Linear regression reported a left hippocampal model (head, body, and tail volumes) predicted performance on logical memory with the left hippocampal tail volume being the strongest predictor. A right hippocampal model (head, body, and tail volumes) predicted memory ability for family pictures and verbal paired associates at a trend level. CONCLUSIONS: Ipsilateral hippocampal head and tail seem more vulnerable to injury than the body in both the left and right mTLE. Our study suggests there may be functional differences along the hippocampal longitudinal axis, particularly for the left hippocampal tail with verbal memory. Our findings are consistent with material-specific right-left differences in memory processing.
RESUMO
Penetratin is a cell penetrating peptide (CPP) that can enter cells by direct translocation through the plasma membrane. The molecular mechanism of this translocation still remains poorly understood. Here we provide insights on this mechanism by studying the direct translocation of the peptide across model membranes based on Droplet Interface Bilayers (DIBs), which are bilayers at the interface between two adhering aqueous-in-oil droplets. We first showed with symmetric bilayers made of a mix of 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-(1'-rac-glycerol) (POPG) and 1,2-dioleoyl-sn-glycero-3-phosphocholine (POPC) that the translocation of penetratin required the presence of at least 40% of POPG on both leaflets. Interestingly when replacing POPG with another anionic lipid 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-l-serine (POPS), translocation was inefficient. To elucidate the lipid partners required at each step of the CPP translocation process, we then investigated the crossing of asymmetric bilayers. We found that POPG on the proximal leaflet and POPS on the distal leaflet allowed penetratin translocation. Translocation was not observed when POPS was on the proximal leaflet and POPG on the distal leaflet or if POPS on the distal leaflet was replaced with POPC. These observations led us to propose a three-step translocation mechanism: (i) peptide recruitment by anionic lipids, (ii) formation of a transient peptide-lipid structure leading to the initiation of translocation which required specifically POPG on the proximal leaflet, (iii) termination of the translocation process favored by a driving force provided by anionic lipids in the distal leaflet.
Assuntos
Peptídeos Penetradores de Células/química , Bicamadas Lipídicas/química , Fosfatidilcolinas/química , Fosfatidilgliceróis/química , Fosfatidilserinas/químicaRESUMO
INTRODUCTION: Locoregional complications of sinusitis are dominated by oculo-orbital and/or cranioencephalic manifestations that may be life-threatening or jeopardize functional prognosis. The aim of this study was to report epidemiological, diagnostic and therapeutic aspects. MATERIALS AND METHODS: A retrospective study included inpatients managed for sinusitis complications in the ENT and neurosurgery departments of the Fann university hospital center in Dakar, Senegal between January 1, 2005 and December 31, 2016. RESULTS: In all, 80 files were collected. Mean age was 18.5 years, with male predominance. Mean time to treatment was 18.2 days. Cranio-encephalic complications were the most frequent (54 cases; 67.5%): mainly subdural empyema (30 cases) and brain abscess (10 cases). Seventeen patients (21.25%) had oculo-orbital complications: mainly orbital cellulitis (52.9%) and preseptal cellulitis (29.4%). Nine patients (11.25%) had both cranioencephalic and oculo-orbital complications. Acute sinusitis (82.5%) was the main cause of complications. 52.5% of patients showed pansinus involvement. Medical treatment consisted in broad-spectrum antibiotic therapy combining third-generation cephalosporins, metronidazole and gentamycin in cranio-encephalic complications and clavulanic acid and metronidazole in oculo-orbital complications. Thirty-four patients (42.5%) underwent surgical sinus drainage. Neurosurgical drainage was performed in 35 cases (43.75%). Post-treatment course was marked by 6.25% mortality (5 cases) and 16.25% sequelae. CONCLUSION: With 6.25% mortality and a high rate of functional sequelae, complications of sinusitis are a serious concern in our region. Improving prognosis requires earlier management and better coordination between health professionals.
Assuntos
Sinusite/complicações , Doença Aguda , Adolescente , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/etiologia , Criança , Pré-Escolar , Ácido Clavulânico/uso terapêutico , Drenagem/estatística & dados numéricos , Empiema Subdural/epidemiologia , Empiema Subdural/etiologia , Encefalite/epidemiologia , Encefalite/etiologia , Feminino , Departamentos Hospitalares , Hospitais Universitários , Humanos , Masculino , Meningite/epidemiologia , Meningite/etiologia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Neurocirurgia , Celulite Orbitária/epidemiologia , Celulite Orbitária/etiologia , Otolaringologia , Estudos Retrospectivos , Senegal/epidemiologia , Sinusite/tratamento farmacológico , Sinusite/mortalidade , Sinusite/cirurgia , Adulto JovemRESUMO
OBJECTIVES: The aims of this study was to assess evolution profile of acute coronary syndrome (ACS) based on risk level by GRACE, TIMI and SRI scores in the cardiology department, Yalgado Ouedraogo university hospital. PATIENTS AND METHODS: This was a prospective study of 111 consecutive patients admitted for ACS (mean age 57.61 years, 77.5% male) between January 1st and 2010 to May 31st 2015 in the department of cardiology. For each patient, risk scores were calculated and they were divided into risk group. Global survival at one month was described by Kaplan Meier method and prognostic factors were analyzed by multivariable Cox regression. RESULTS: The prevalence of ACS was 4.2%. Patients were admitted for ST-elevation ACS and non-ST-elevation ACS in 88.3% and 11.7%, respectively. Nineteen patients (17.1%) were admitted before the 12th hour. Hospital mortality was 8.1% and increased to 16.2% in one month. After risk stratification, one-month survival of patients with high risk, was shorter than patients at low-risk regardless of the score GRACE (log-rank=9.93, P=0.007), TIMI (log-rank=14.91, P=0.001) and SRI (log-rank=10.01, P=0.006). GRACE score (HR=1.01; P=0.002), TIMI (HR=1.33; P=0.01) and SRI (HR=1.02; P=0.01) were major prognostic factors for overall survival. CONCLUSION: ACS remains a serious disease with high morbidity and mortality in the days following the initial accident. These risk scores are applicable tools in Burkina Faso as evidenced statistic C (GRACE=0.75, TIMI=0.78 and SRI=0.74).
Assuntos
Síndrome Coronariana Aguda/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Síndrome Coronariana Aguda/epidemiologia , Idoso , Burkina Faso/epidemiologia , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Prevalência , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores de TempoRESUMO
Hepatitis C is killing 350,000 persons per year worldwide, 60% of the cases being patients with genotype 1 (GT-1). The fixed-dose tablet combination of daclatasvir (30 mg)/asunaprevir (200 mg)/beclabuvir (75 mg), DCV-TRIO, is one of the latest drugs in the pipeline of interferon-free direct-acting antiviral hepatitis C virus (HCV) therapies. DCV-TRIO increases the genetic barrier to resistance by acting at the same time against three hepatitis C key viral proteins. Results from the UNITY 1, 2, 3 and 4 phase III clinical trials showed that DCV-TRIO exhibited high sustained virologic responses at 12 weeks (between 92% and 100% for HCV GT-1 treatment-naive patients). Furthermore, DCV-TRIO was well tolerated in all studies with reported adverse events (AEs) with an incidence of at least 10% mostly being headache, diarrhea, fatigue and nausea and few AE-related discontinuations. Further research should focus on more real-life data on DCV-TRIO and on developing a pill regimen that works on other HCV genotypes with high genetic barriers and that is available at a reduced cost.
Assuntos
Antivirais/administração & dosagem , Benzazepinas/administração & dosagem , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Imidazóis/administração & dosagem , Indóis/administração & dosagem , Isoquinolinas/administração & dosagem , Sulfonamidas/administração & dosagem , Antivirais/efeitos adversos , Benzazepinas/efeitos adversos , Carbamatos , Combinação de Medicamentos , Farmacorresistência Viral/genética , Genótipo , Hepacivirus/genética , Hepacivirus/patogenicidade , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Humanos , Imidazóis/efeitos adversos , Indóis/efeitos adversos , Isoquinolinas/efeitos adversos , Pirrolidinas , Sulfonamidas/efeitos adversos , Resposta Viral Sustentada , Resultado do Tratamento , Valina/análogos & derivadosRESUMO
OBJECTIVE: To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. PATIENTS AND METHODS: We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. RESULTS: Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. CONCLUSION: The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. LEVEL OF EVIDENCE: 4.
Assuntos
Anastomose Cirúrgica/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Adulto JovemRESUMO
ience in the management of differentiated thyroid carcinomas in a low- income country. Materials and Methods: We performed a retrospective study in our department where 21 cases of differentiated thyroid carcinomas were recorded from February 2001 to December 2010. Results: We performed 334 thyroidectomies for 326 patients. Of this group, 21 differentiated thyroid carcinomas were diagnosed. Differentiated thyroid carcinomas represented 6.4% of all thyroid neoplasm managed during the same period (n=326). Median age was 44 years (range 13 - 75 years). Male to female ratio was 1:20. Six (6) patients underwent primary hemithyroidectomy in other institutions while the fifteen left were entirely managed in our clinic. Of them, one patient was referred with positive fine needle aspiration cytology for papillary thyroid carcinoma (incidental detection by fine needle aspiration biopsy) and another had history of sinus pyriform fistula. Pathology of surgical specimens showed 13 cases of papillary thyroid carcinomas and 8 cases of follicular thyroid carcinomas with association to Hashimoto thyroiditis and Grave's disease in respectively in 1 case. Twenty cases were incidentally discovered by thyroid surgery and undergone completion thyroidectomy with prophylactic central neck dissection, completion thyroidectomy alone, modified lateral neck dissection alone and surveillance respectively in 13, 1, 1 and 6 cases. Complications of thyroid surgery were bilateral recurrent laryngeal nerve paralysis and hematoma respectively in 1 case. Median hospital stay was 5 days ranged from 3 to 15 days. During the follow-up period, most of our patients were lost of follow-up. Conclusion: Management guidelines of differentiated thyroid carcinomas are well established but not applicable to low- income country for several reasons. National guidelines, based on further researches, must then be implemented to improve our practice
Assuntos
Humanos , Pobreza/economia , Tireoidectomia , Neoplasias da Glândula Tireoide/complicações , Estudos Retrospectivos , Câncer Papilífero da Tireoide/complicaçõesRESUMO
Malaria remains a major health problem in sub- Saharan African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Vaccines candidates were mainly tested in rural endemic setting; however increasing proportion of the population is living in urban area. Evaluation of the qualitative or quantitative immune responses to key targets of anti-Plasmodium immunity requires further investigation in urban area. In a cohort of 144 patients with mild malaria living in Dakar, we analyzed IgG responses against target antigens of P. falciparum: CSP, LSA-3NR2 and GLURP by ELISA. A mean age of 15 yrs (4-65 yrs) was found and patients were separated in 59 adults (<15yrs) and 85 children (≤15 yrs). Parasites densities (0,01-15%) did not differ between the two age groups. In contrast, haemoglobin levels appeared lower in children (4.5-16.6 g/dl) (p<0.01). For the immune results, the most recognized antigens were GLURP and CSP compared to LSA-3NR2. Levels of IgG against these antigens were significantly different between the two age groups and they were positively correlated (rho = 0.32; p<0.001). In addition, levels of IgG anti-GLURP were associated with low parasitemia (≤1%) and absence of anemia (≥11g/dl), particularly in adults (p<0.001). In a multiple regression analysis, no significant relationship was found between parasite densities and IgG responses against all the tested antigens. Our study shows the implication of IgG anti-GLURP in humoral immune response against the parasite. The present work contributes to determine IgG levels that can be used as relevant immunologic biomarkers in urban clinical malaria.
Assuntos
Hemoglobinas/análise , Imunoglobulina G/análise , Vacinas Antimaláricas/imunologia , Malária Falciparum/sangue , Malária Falciparum/imunologia , Malária Falciparum/parasitologia , Carga Parasitária , Adolescente , Adulto , Idoso , Anticorpos Antiprotozoários/análise , Anticorpos Antiprotozoários/sangue , Antígenos de Protozoários/imunologia , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Parasitemia/sangue , Plasmodium falciparum/crescimento & desenvolvimento , Plasmodium falciparum/imunologia , Proteínas de Protozoários/imunologia , População Urbana , Adulto JovemRESUMO
Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.
Assuntos
Granuloma de Células Plasmáticas , Doenças da Bexiga Urinária , Adolescente , Feminino , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Uretra , Doenças da Bexiga Urinária/patologia , Doenças da Bexiga Urinária/cirurgiaRESUMO
Malaria remains a major problem in African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Studies for the evaluation of qualitative or quantitative Ab responses to key targets of anti-plasmodium immunity were mostly done in rural endemic setting compared to urban area. In a cohort of 200 patients with mild malaria and living in Dakar, we analyze total and subclasses IgG responses to a panel of P. falciparum blood stage antigens: MSP1p19, MSP3, EB200, GST-5 and R23. A mean age of 15 yrs (4 to 56 yrs) and parasitemia between 0.1 to 17% were found. Levels of IgG anti-MSP3 were higher in patients with low parasitemia (≤1%) and appear negatively correlated to parasite densities (Rho =. 0.54; p= 0.021). This correlation is more significant in children (≤ 15 yrs). In addition, an increase of IgG responses against MSP1p19 is highly observed in adults having a parasitemia less than 1%. In those patients, we find that IgG1 subclasses were predominant (p <0.01). Our study shows an association between Ab responses and parasitemia. This association is dependant to IgG anti-MSP3 in children and IgG anti-MSP1p19 in adults living in urban area.
Assuntos
Envelhecimento/imunologia , Antígenos de Protozoários/imunologia , Imunoglobulina G/sangue , Vacinas Antimaláricas/imunologia , Malária Falciparum/epidemiologia , Parasitemia/epidemiologia , Plasmodium falciparum/imunologia , Adolescente , Adulto , Envelhecimento/sangue , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Malária Falciparum/sangue , Malária Falciparum/imunologia , Malária Falciparum/prevenção & controle , Masculino , Pessoa de Meia-Idade , Parasitemia/sangue , Parasitemia/imunologia , Senegal/epidemiologia , Índice de Gravidade de Doença , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/µL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL). METHODS: Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT. RESULTS: One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/µL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74). CONCLUSION: SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , HIV-1 , Viremia/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Humanos , Incidência , Masculino , Desnutrição/epidemiologia , Casamento , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Senegal/epidemiologia , Resultado do Tratamento , Carga Viral , Viremia/sangue , Viremia/epidemiologia , Viremia/imunologiaRESUMO
OBJECTIVE: The pathology of the salivary glands focuses on that of the parotid gland. The purpose of this study is to clarify and explain the epidemiological features of parotid tumors in a Senegalese context, to highlight the importance of clinical examination when access to complementary investigations is limited, to discuss respective indications and finally to describe certain aspects of treatment in our context. MATERIALS AND METHODS: This retrospective study of 114 cases of parotidectomy spans 16 years, from 1992 to 2007. It was performed in the ENT department of University Hospital of Fann, Senegal. All patients operated on for chronic mass of the parotid region for whom histological results were available when initially included. Benign swellings were subsequently excluded. The study parameters were epidemiological, clinical, paraclinical and surgical. RESULTS: The 114 parotidectomies showed a predominance of benign tumours: 63 procedures (55.26%) essentially concerned pleomorphic adenoma; 30 cases (26.31%) concerned malignant tumours, mainly parotid adenocarcinoma. There were 21 cases of benign swelling (18.4%). The study focused on the series of 93 cases of benign and malignant tumours of the parotid gland. Both sexes were affected similarly. All age groups were concerned, from 5 to 89 years. A total of 97% of patients underwent surgery: conservative total parotidectomy in 75.51% of cases. CONCLUSION: Although there are features specific to the local context, the epidemiological profile of parotid tumours is well-known. Indications for complementary investigations are discussed, as availability in Senegal is restricted, highlighting the important role of clinical examination in the management of parotid tumours.
Assuntos
Neoplasias Parotídeas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/cirurgia , Estudos Retrospectivos , Senegal/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Depressed skull fractures are common and frequent among neurosurgical diseases of whose danger stem from the associated intracranial lesions. The aims of this study were to describe the epidemiological characteristics of depressed skull fractures, to determine their etiology, to describe the clinical signs, to highlight the complications and sequelae and to evaluate care management. PATIENTS AND METHODS: It was a retrospective and descriptive study from January to December 2013 including 72 patients admitted to the neurosurgical department of the Gabriel Toure hospital. RESULTS: The frequency was 14.7% and the male to female ratio was 13.4. The peak frequency of these injuries occurred in the 16-to 25-year-old age group accounting for 38.9% of cases. Road traffic accidents were the most common causes of depressed skull fractures (59.7%). Neurosurgical treatment was performed in 25 (34.72%) patients and the most common surgical technique performed was the craniectomy in (64%). Infection of the wound was found in 15.3% and the mortality rate was 1.39%. CONCLUSIONS: Depressed skull fractures are a frequent neurosurgical disease in the Gabriel Touré hospital. Young people are most affected and road traffic accidents involving motorbikes are the main cause the fractures. The infection of the wound is a poor prognostic factor. Therefore, an early management is required to expect a good outcome.
INTRODUCTION: Les Fractures embarrures constituent des affections fréquentes en neurochirurgie dont la gravité est liée aux lésions intracrâniennes associées. Les objectifs de ce travail sont les suivants : décrire les caractéristiques épidémiologiques des fractures embarrures du crâne, déterminer les étiologies, décrire les signes cliniques, dégager les complications et les séquelles et évaluer la prise en charge. PATIENTS ET MÉTHODES: il s'agissait d'une étude rétrospective descriptive portant sur 72 malades de janvier à décembre 2013 dans le service de neurochirurgie du CHU Gabriel Touré. La fréquence était de 14,7% avec une forte prédominance masculine (93% des cas). Les jeunes de 16-25 ans étaient les plus touchés soit 38,9%. Les AVP constituaient la principale étiologie avec 59,7% des cas. Le traitement neurochirurgical a été effectué chez 25 patients soit 34,72% et la craniectomie à os perdu était la technique la plus utilisés (64% des cas opérés). L'infection de la plaie a été la complication post opératoire dominante avec 15,3%. le taux de mortalité était de 1,39%.
RESUMO
INTRODUCTION: Lumbar stenosis is a disease caused by a conflict between the neural structures (spinal cord and nerve roots) and spinal structures (bones and ligaments). The objectives of this study were to highlight the frequency, the diagnosis and therapeutics options, and to evaluate the treatment outcomes. PATIENTS AND METHODS: It was a retrospective study from January 2012 to December 2012 including 24 patients admitted to the neurosurgical department of the Gabriel Touré Hospital. RESULTS: The frequency of lumbar stenosis was 6.19% of all neurosurgical diseases. The sex-ratio was 0.71. The age ranged from 28 to 81 years with an average of 52 years. The neurogenic claudication was found in 87.5%. The straight leg raising test was positive in 41.7% of cases. The most vertebras involved were L4 and L5. Lumbar disc herniation was associated in 70.83%. Degenerative lumbar stenosis was the most common form, found in 66.67% of cases. Surgical treatment was performed in 29.17% of cases. The outcome was good in 85.6% of cases. CONCLUSIONS: Lumbar stenosis is a prevalent disease that occurs typically occurs around 50 years of age. The diagnosis was confirmed by myelography and a post myelographic CT scan. Good outcomes are achieved with both surgical or medical treatments.
INTRODUCTION: Le canal lombaire étroit (C.L.E.) est une pathologie liée à un conflit entre le contenant (ostéo-discoligamentaire) et le contenu (moelle épinière et ses composantes). Les objectifs de ce travail étaient de déterminer la fréquence du CLE, de déterminer les méthodes de diagnostic et de traitement, d'évaluer les résultats du traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective portant sur 24 cas de canal lombaire étroit colligés entre le 1er Janvier 2012 et le 31 Décembre 2012% dans le service de Neurochirurgie du C.H.U Gabriel Touré. RÉSULTATS: le CLE constitue 6,19% de nos patients opérés. Le sexe féminin prédominait avec 58%. L'âge moyen était 52 ans avec les extrêmes de 28 ans et de 81 ans. La claudication était retrouvée à l'interrogatoire chez 87,5% des cas. le signe de Sonnette était retrouvé chez 41,7% des patients. Les vertèbres L4 et L5 étaient les plus touchés. La hernie discale était associée dans 70 .83%. Le CLE acquis représentait 66,67% des cas, la forme constitutionnelle,25% et celle congénitale, 8,33%. Le traitement a été médical dans 70,83% des cas et chirurgical 29,17%. Les résultats étaient bons dans 85,6%. CONCLUSION: le CLE est une affection fréquente se manifestant vers l'âge de 50 ans. La confirmation du diagnostic était faite par la saccoradiculographie couplée au myéloscanner. Le traitement médical ou chirurgical donne des bons résultats.
RESUMO
INTRODUCTION: Intracranial empyema is a frequent complication of ear-nose-throat (ENT) infections. Limited studies have been carried-out on cerebral empyema during recent years in Senegal. Despite new imaging techniques, diagnostic and therapeutic problems as well as outcome still remain in our regions. We report our experience compared to that of the literature. The study focused on epidemiological aspects, difficulties in diagnosis and treatment as well as prognosis of this condition. METHODS: This was a retrospective study conducted from January 2008 to December 2011 of 100 clinical cases. Diagnosis was made based on contrast CT-scan. Twenty-one percent of patients received medical treatment alone, while 79% underwent surgery. The duration of the treatment varied from 4 to 8 weeks. The follow-up was clinical and radiological with a mean follow-up time of 12 months. RESULTS: Cerebral empyema represented 44.4 % of all intracranial suppuration cases and the mean age was 21 years. The etiology was ENT in 35%, meningitis 10%, unknown 25%. Localization was sub-dural in 57%, extra-dural in 22%, inter-hemispheric in 10% of the cases. Empyema was associated with an abscess in 7 cases. One case was located in the posterior fossa. The evolution was favorable in 78% of the cases and in 12.5% some neurologic sequelae were observed. Eleven patients died and 3% of the patients had recurrences. CONCLUSION: The frequency of intracranial empyema is still high in Senegal. Difficulties in diagnosis, therapeutics and low economic incomes account for the gravity of intracranial empyema. In spite of these risks, early stage and effective treatment is necessary to reduce the morbi-mortality, especially in young aged children.
Assuntos
Encefalopatias , Empiema , Adolescente , Adulto , Idoso , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Encefalopatias/epidemiologia , Encefalopatias/terapia , Criança , Pré-Escolar , Empiema/diagnóstico , Empiema/diagnóstico por imagem , Empiema/epidemiologia , Empiema/terapia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Since its advent, endoscopic third ventriculostomy (ETV) has been an effective alternative to shunt placement for the treatment of hydrocephalus. The aim of this study was to report the results of our experience with this technique in children in Senegal. MATERIALS AND METHODS: This was a retrospective study of 70 cases of children aged between 5 months to 15 years who were treated by ETV in the Neurosurgery Department of Fann Hospital in Dakar, between January 2010 to December 2012. The results were evaluated based on the clinical criteria of Drake and the Canadian Pediatric Neurosurgery Study Group. The mean follow-up duration was 24 months (9-32 months). RESULTS: The mean age at diagnosis was 29 months. A male predominance (sex-ratio 1/3) was observed. We also noted a macrocephaly in 64.4 % of cases, psychomotor retardation in 40 % and decreased vision in 31.4 %. Headache and vomiting were found in 42.8 % and 61.4 % respectively. The main etiology was a stenosis of the mesencephalon aqueduct (30 %), followed by a Dandy-Walker malformation (25.7 %). Significant intraoperative bleeding was found in 2.8 % of patients. The most common postoperative complication was CSF leakage (18.6 %), followed by infections (14.2 %). The success rate according to the clinical criteria of Drake was 71.4 %. This success rate was influenced by the age of patients and the hydrocephalus etiology. No deaths occurred. CONCLUSION: The endoscopic third ventriculostomy is a simple, safe and effective technique. Its advantages in terms of quality of life and morbidity compared with bypass valves makes it the technique of choice, particularly in developing countries.
Assuntos
Hidrocefalia/cirurgia , Neuroendoscopia , Procedimentos Neurocirúrgicos , Terceiro Ventrículo/cirurgia , Ventriculostomia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/diagnóstico , Lactente , Masculino , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Senegal , Resultado do TratamentoRESUMO
PURPOSE: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE: 5.
Assuntos
Cistos/congênito , Cistos/cirurgia , Hérnia Inguinal/congênito , Hérnia Inguinal/cirurgia , Peritônio/anormalidades , Peritônio/cirurgia , Cordão Espermático , Hidrocele Testicular/congênito , Hidrocele Testicular/cirurgia , Adolescente , Criança , Pré-Escolar , Doenças dos Genitais Masculinos/complicações , Doenças dos Genitais Masculinos/cirurgia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto JovemRESUMO
Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.