The Gluteus Deep Investing Fascia Compartment Block: A Novel Technique for Posterior Femoral Cutaneous Nerve Block.

Purpose: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the "Gluteus-Deep Investing Fascia compartment Block (GDIF block)" for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the 'Gluteus Deep Investing Fascia Compartment'. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named "CLEFT Block." This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Patients and Methods: Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. Results: The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. Conclusion: The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

Combined Supra-Inguinal Fascia Iliaca, Sciatic Nerve, and Posterior Femoral Cutaneous Nerve Blocks in Austere Settings for Hemodynamically Unstable Patients with Vascular Injuries from Weapon Wounds: A Case Series.

Purpose: The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique-sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks -in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments. Patients and Methods: Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine. Results: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia. Conclusion: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.

Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey.

BACKGROUND: Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS: In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS: All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION: This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.

[Care of covid-19 patients at the dermatology hospital of Bamako]. / Prise en charge des patients covid-19 a l'hopital de dermatologie de Bamako.

AIM: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). METHODS: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. RESULTS: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statistically significant difference was observed between the mean duration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managed at hospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). CONCLUSION: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce.

OBJECTIF: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. RÉSULTATS: Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel-Cox, p= 0,060). CONCLUSION: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé.

SOFIA catheter for direct aspiration of large vessel occlusion stroke: A single-center cohort and meta-analysis.

BACKGROUND AND PURPOSE: Direct aspiration (DA) using large-bore distal aspiration catheters is an established strategy for the endovascular thrombectomy (EVT) of large-vessel occlusion stroke (LVOS). However, the performance of individual catheters like SOFIA has yet to be examined. METHODS: We present a cohort of 144 consecutive patients treated with first-line DA and SOFIA 6 F Plus catheter for LVOS. We also conducted a systematic review of the literature searching multiple databases for reports on thrombectomy with DA and SOFIA catheters and performed a meta-analysis of recanalization, safety, and clinical outcomes. RESULTS: In the study cohort a successful recanalization (mTICI 2b-3) rate of 75.7% was achieved with DA alone, the global rate for functional independence (90-day mRS 0-2) was 40.3%. For the metanalysis we selected nine articles that included a total of 758 patients treated with first-line thrombectomy with the SOFIA catheters. The mTICI 2b-3 rate was 71.6% (95%CI, 66.3-76.5%) while a rescue stent-retriever was used in 24.1% (95%CI, 17.7-31.9%) of cases. The overall mTICI2b-3 rate after DA and rescue therapy was 88.9% (95%CI, 82.6-93.1%). We found a pooled estimate of 45.6% (95%CI, 38.6-52.8%) for functional independence, a mortality within 90 days of 19% (95%CI, 14.1-25.0%) and a rate of 5.8% (95%CI, 4.2-8.0%) of symptomatic intracranial hemorrhage. CONCLUSION: The DA approach for LVOS with the SOFIA catheters is highly effective with an efficacy and safety profile comparable to those found in contemporary thrombectomy trials and observational studies that use other devices or approaches.

In the era of humanitarian crisis, young women continue to die in childbirth in Mali.

Maternal mortality occurs mostly in contexts of poverty and health system collapse. Mali has a very high maternal mortality rate and this extremely high mortality rate is due in part to longstanding constraints in maternal health services. The central region has been particularly affected by the humanitarian crisis in recent years, and maternal health has been aggravated by the conflict. Sominé Dolo Hospital is located in Mopti, central region. In the last decade, a high number of pregnant or delivering women have died in this hospital.We conducted a retrospective and exhaustive study of maternal deaths occurring in Mopti hospital. Between 2007 and 2019, 420 women died, with an average of 32 deaths per year. The years 2014-2015 and the last 2 years have been particularly deadly, with 40 and 50 deaths in 2018 and 2019, respectively. The main causes were hypertensive disorders/eclampsia and haemorrhage. 80% of these women's deaths were preventable. Two major explanations result in these maternal deaths in Sominé Dolo's hospital: first, a lack of accessible and safe blood, and second, the absence of a reference and evacuation referral system, all of which are aggravated by security issues in and around Mopti.Access to quality hospital care is in dire need in the Mopti region. There is an urgent need for a safe blood collection system and free of charge for pregnant women. We also strongly recommend that the referral/evacuation system be reinvigorated, and that universal health coverage be strengthened.

[Cancers associated with HIV: epidemiological, clinical characteristics, and becoming patients in the infectious disease department of Bamako]. / Cancers associes a l'infection a VIH : caracteristiques epidemiologiques, cliniques, et devenir des patients dans le service de maladies infectieuses de Bamako.

INTRODUCTION: The association between HIV and cancer is becoming more and more frequent, given the increased life expectancy of HIV positive patients with triple antiretroviral therapy. This association had not been documented in our service, hence the aim of this work. Our objectives were to describe the epidemiological and clinical characteristics and to determine outcome of patients with both pathologies. METHODS: We conducted a retrospective study based on hospitalization records from the infectious diseases department of Point G University Hospital from 2009 to 2014. All patients aged 15 years and older, HIV positive with a diagnosis of cancer were included with usable medical records. Data entry and analysis were done on Epi Info version 3.5.3. The variables studied were sociodemographic, immunological, virological, clinical and outcome. RESULTS: 51 cancer files were collected on 2525 patients (prevalence of 2%), among them 42 had the combination of cancer and HIV (1.7%). The majority were young adults (mean age 40.5 ± 8.9 years), 88.1% of whom were under 50 years of age and the majority were female (54.8%). HIV-1 was the predominant serotype (90.5%). The average CD4 T cell count was 111±106 cells/µl and 77.4% had less than 200 CD4/µl of blood. The majority (83.8%) were on HAART. Cancers classifying AIDS were predominant (90.5%) including Kaposi's disease (71.4%), non-Hodgkin's lymphoma (NHL) (14.3%) and cervical cancer (4.8%). We recorded 69% of deaths. The case-fatality rates were 66.7% for kaposi's disease and NHL (66.7%) and 50% for cervical cancer, respectively. CONCLUSION: Our study provides an overview of the association between cancer and HIV in the service. Cancers attributable to viral infections are the most numerous. A targeted prevention program and early detection of HIV as part of the test and treat strategy are essential.

INTRODUCTION: L'association VIH et cancer apparaît de plus en plus fréquente, compte tenu de l'augmentation de l'espérance de vie des patients VIH positifs avec la trithérapie antirétrovirale. Cette association n'avait pas été documentée dans notre service, d'où le but de ce travail.Nos objectifs étaient de décrire les caractéristiques épidémio-cliniques et de déterminer le devenir à court terme des patients atteints de cancer au cours du VIH. MÉTHODOLOGIE: Nous avons conduitune étude rétrospective sur les dossiers d'hospitalisation du service des maladies infectieuses du CHU du Point G de 2009 à 2014. Tous les patients âgés de 15 ans et plus, VIH positif chez qui un diagnostic de cancer a été retenu avec dossier médical exploitable ont été inclus. La saisie et l'analyse ont été faites sur Epi Info version 3.5.3.Les variables étudiées étaient sociodémographiques, immunovirologiques, cliniques et évolutives. RÉSULTATS: Au total, 51 dossiers de cancers ont été colligés sur 2525 patients (prévalence de 2%), parmi eux 42 étaient atteints de l'association cancer et VIH (1,7%). Il s'agit en majorité d'adultes jeunes (âge moyen de40,5 ± 8,9 ans)dont 88,1% avaient moins de 50 ans et majoritairement de sexe féminin (54,8%). Le VIH-1 était le sérotype prédominant (90,5%). Le taux moyen de lymphocytes T CD4 est de 111±106 cellules/µl et 77,4% avaient moins de 200 CD4/µl de sang. La majorité (83,8%) était sous trithérapie antirétrovirale. Les cancers classant sida prédominaient (90,5%) dont la maladie de Kaposi (71,4%), le lymphome non hodgkinien (LNH) (14,3%) et cancer du col de l'utérus (4,8%). Nous avons enregistré 69% de décès. Les taux de létalités étaient respectivement de 66,7% pour la maladie de kaposi et le LNH(66,7%) et de 50% pour les cancers du col de l'utérus. CONCLUSION: Notre étude permet de faire un aperçu de l'association cancer et VIH dans le service. Les cancers associés à des infections virales sont les plus fréquentes. Un programme de prévention ciblée et de dépistage précoce du VIH dans le cadre de la stratégie tester et traiter sont indispensables.

Understanding Human Cerebral Malaria through a Blood Transcriptomic Signature: Evidences for Erythrocyte Alteration, Immune/Inflammatory Dysregulation, and Brain Dysfunction.

BACKGROUND: Cerebral malaria (CM), a reversible encephalopathy affecting young children, is a medical emergency requiring rapid clinical assessment and treatment. However, understanding of the genes/proteins and the biological pathways involved in the disease outcome is still limited. METHODS: We have performed a whole transcriptomic analysis of blood samples from Malian children with CM or uncomplicated malaria (UM). Hierarchical clustering and pathway, network, and upstream regulator analyses were performed to explore differentially expressed genes (DEGs). We validated gene expression for 8 genes using real-time quantitative PCR (RT-qPCR). Plasma levels were measured for IP-10/CXCL10 and IL-18. RESULTS: A blood RNA signature including 538 DEGs (∣FC | ≥2.0, adjusted P value ≤ 0.01) allowed to discriminate between CM and UM. Ingenuity Pathway Analysis (IPA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) revealed novel genes and biological pathways related to immune/inflammatory responses, erythrocyte alteration, and neurodegenerative disorders. Gene expressions of CXCL10, IL12RB2, IL18BP, IL2RA, AXIN2, and NET were significantly lower in CM whereas ARG1 and SLC6A9 were higher in CM compared to UM. Plasma protein levels of IP-10/CXCL10 were significantly lower in CM than in UM while levels of IL-18 were higher. Interestingly, among children with CM, those who died from a complication of malaria tended to have higher concentrations of IP-10/CXCL10 and IFN-γ than those who recovered. CONCLUSIONS: This study identified some new factors and mechanisms that play crucial roles in CM and characterized their respective biological pathways as well as some upstream regulators.

[Embolization of a false arterial aneurysm in a patient living with one kidney: about a rare complication of percutaneous nephrolithotomy]. / Embolisation d'un faux anévrisme artériel sur rein unique: à propos d'une complication rare de la néphrolithotomie percutanée.

Percutaneous nephrolithotomy is a potentially invasive technique associated with a risk of complications, in particular bleeding. We report the case of a 70-year old female patient who had only left kidney and with a history of renal calculi treated with percutaneous nephrolithotomy. Persistent, average abundant haematuria had occurred two and a half months before, requiring computerized tomography (CT) scan. This had showed false iatrogenic intrarenal inferior polar aneurysm. It required effective selective embolization of biological glue.

[Recurrent retroperitoneal hematoma due to viperine envenomation: case study]. / Hématome rétro-péritonéal consécutif à une envenimation vipérine: à propos d'un cas.

Ophidian envenomations are a public health problem in Africa, causing 20.000 annual deaths. This mortality reflects the difficulties in the management of these complications, in particular of bleeding complications. We report the case of Mr SL, aged 35 years, farmer, victim of snake bite causing haemorrhagic syndrome followed by a progressive onset of acute abdomen. Ultrasound objectified high abundant effusion. Effusion puncture was performed which showed unclotting blood. Given the re-establishment of the hemoperitoneum after three doses of antivenin serum as well as the coagulation of the samples collected using drying tube, exploratory laparotomy was performed on day 9. It showed retroperitoneal hematoma, with bulging appearance, in the mesocolon which flowed in the peritoneal cavity. Aspiration of 1500ml of blood and rinsing with physiological serum were performed. The postoperative course was uneventful. The patient was transferred to the department of surgery three days after surgery and was discharged on day 19.

Exposure to Livestock Feces and Water Quality, Sanitation, and Hygiene (WASH) Conditions among Caregivers and Young Children: Formative Research in Rural Burkina Faso.

Livestock farming is common in low-income settings as a source of income and animal-sourced food. However, there is growing evidence of the harmful health effects of proximity of animals to infants and young children, especially through exposure to zoonotic pathogens. Poultry ownership is almost universal in rural Burkina Faso. Poultry feces are a significant risk factor for enteric diseases that are associated with child undernutrition. To investigate the extent of exposure to livestock feces among young children and caregivers, we conducted direct observations of 20 caregiver-child dyads for a total of 80 hours (4 hours per dyad) and recorded water quality, sanitation, and hygiene (WASH)-related behaviors. We also undertook in-depth interviews with these caregivers and focus group discussions with separate groups of men and women who were poultry farmers. Poultry and other livestock feces were visible in all 20 and 19 households, respectively, in both kitchen areas and in the household courtyards where children frequently sit or crawl. Direct soil ingestion by young children was observed in almost half of the households (45%). Poor handwashing practices were also common among caregivers and children. Although latrines were available in almost all households, child feces disposal practices were inadequate. This body of research suggests an urgent need to adapt conventional WASH and livestock interventions to reduce the exposure of infants and young children to livestock feces.

[Detection of complete common mesentery on CT scan for perforation in acute appendicitis]. / Découverte tomodensitométrique d'un mésentère commun complet par perforation d'une appendicite aiguë.

Complete common mesentery is a rare abnormality in midgut rotation. Its detection is exceptional during adulthood because, during this period, is very often asymptomatic and therefore not diagnosed. Complete common mesentery may be discovered incidentally in patients with ectopic appendicular syndrome, as in our case study. We here report the case of a 42-year old patient presenting with acute clinico-biological pelvic inflammatory disorder. CT scan allowed the diagnosis of complete common mesentery associated with acute appendicitis. Laparotomy confirmed the diagnosis of perforated acute appendicitis associated with intestinal malrotation. Appendectomy outcomes were favorable.

Barriers to Linkage to Care for Hepatitis B Virus Infection: A Qualitative Analysis in Burkina Faso, West Africa.

Hepatitis B virus (HBV) infection is a critical global health problem. The World Health Organization (WHO) has recently developed a global elimination strategy for HBV infection. Increasing access to screening, liver assessment, and antiviral treatment are crucial steps in achieving this goal. Little is known, however, about obstacles to linkage to care in low- and middle-income countries. Using a grounded theory approach, this qualitative study sought to characterize the diagnostic itineraries of people with chronic HBV infection in Burkina Faso, a west African country with high HBV prevalence, to identify barriers to linkage from screening to specialist care with hepatic assessment (alanine transaminase and hepatitis B e antigen or HBV DNA). We conducted 80 semistructured interviews with chronically infected people, their families, medical personnel, and traditional practitioners, and participant observation of HBV diagnostic announcements and consultations. Of 30 individuals diagnosed with chronic viral hepatitis, 18 inadvertently discovered their status through blood screening and 12 actively sought diagnosis for their symptoms. Only a quarter (8/30) were linked to care. Barriers included: 1) patients' ability to pay for testing and treatment; 2) a formal health system lacking trained personnel, diagnostic infrastructures, and other resources; 3) patients' familial and social networks that discouraged access to testing and HBV knowledge; 4) a well-developed demand for and provisioning of traditional medicine for hepatitis; and 5) a weak global politics around HBV. More training for medical personnel would improve linkage to care in sub-Saharan Africa. Developing effective communications between medical workers and patients should be a major priority in this elimination strategy.

Incertitude, Hepatitis B, and Infant Vaccination in West and Central Africa.

This comparative study explores incertitude about hepatitis B (HBV) and its implications for childhood vaccination in Bangui, Central African Republic, and the Cascades region, Burkina Faso. Anthropological approaches to vaccination, which counter stereotypes of "ignorant" publics needing education to accept vaccination, excavate alternative ways of knowing about illness and vaccination. We build on these approaches, evaluating different kinds of incertitude (ambiguity, uncertainty, ignorance) about infancy, HBV, health protection, and vaccination. Using interviews and participant observation, we find that Bangui and Cascades publics framed their incertitude differently through stories of infancy, illness, and protection. We locate different forms of incertitude within their historical contexts to illuminate why vaccination practices differ in the Cascades region and Bangui. A more nuanced approach to incomplete knowledge, situated in political, economic, and social histories of the state and vaccination, can contribute to more appropriate global health strategies to improve HBV prevention.

Genotype combinations of two IL4 polymorphisms influencing IL-4 plasma levels are associated with different risks of severe malaria in the Malian population.

We have previously found that children heterozygous for IL4 variable-number tandem repeat (VNTR) (rs8179190) or IL4-33 (rs2070874) variants were at risk for severe malaria (SM), whereas homozygous children were protected suggesting a complex genetic control. Hence, to dissect this complex genetic control of IL4 VNTR and IL4-33, we performed further investigation by conditional logistic regression analysis and found a strong interaction between both markers (p < 10(-6)). The best-fit model revealed three genotype combinations associated with different levels of SM risk. The highest risk (odds ratio (OR) = 4.8, 95% confidence interval (CI) = 2.0-11.5) was observed for subjects carrying at least one copy of both IL4-33 allele T and IL4 VNTR allele 1, who exhibited higher interleukin (IL)-4 plasma levels (p = 0.007). Children homozygous for IL4 VNTR allele 2 had a lower SM risk as well as lower IL-4 plasma levels. Our findings indicate that the genetic interaction between these two IL-4 variants is a key factor of SM susceptibility, probably because of its direct role in IL-4 regulation.