Clinical and spirographic features of bronchial asthma in schoolchildren depending on the different regimens of basic anti-inflammatory therapy.

OBJECTIVE: The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. PATIENTS AND METHODS: Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 µg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 µg per day). RESULTS: Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/FVC) was worse in patients receiving high doses of ICS. CONCLUSION: Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

[What role for paraclinical investigations within clinical trials conducted in psychiatric patients?] / Quel est le rôle des tests et examens complémentaires dans un essai clinique en psychiatrie ?

As in the usual care of patients, paraclinical investigations have today only a very modest role in clinical trials in psychiatry, mainly to complete the pre-therapeutical assessments prior to inclusion of subjects or to monitor treatment tolerance. Yet, the accumulation of data in neurosciences suggests the next emergence of biomarkers, whose interest is that they are closely associated to the biological disturbances underlying psychiatric illnesses, and that they are accessible by means of technological tools such as imaging devices. These tools allow to explore the effects on brain of psychotropic medications, such as antidepressants, antipsychotics, or mood stabilizers, in relation to their therapeutic action. The obtained results allow to consider the use of such biomarkers in clinical trials in addition to more conventional approaches. In particular, they could be used as targets to measure brain response to treatment in association with clinical response, to predict a therapeutic response from the neurofunctional characteristics of patients, or to establish the safety profile of drugs on the nervous system. The use of such biomarkers in clinical trials would help to better define the explored populations and their characteristics, as well as the variables to assess, and to better measure the impact of the treatments and their potential harmful effects on the nervous system.

Effects of adjuvant ozone autohemotherapy combined with routine treatment on clinical and paraclinical features of mechanically ventilated COVID-19 patients in the intensive care unit: a pilot randomized controlled trial.

Until the availability of an effective and practical vaccine, there is a serious need to recognize alternative treatments for coronavirus disease 2019 (COVID-19). This study aimed to determine whether major ozonated autohemotherapy (MOAH) can improve the clinical and paraclinical parameters in critically-ill patients with COVID-19 requiring mechanical ventilation. In this controlled trial, we enrolled 40 critically ill COVID-19 patients receiving invasive mechanical ventilation. The enrolled patients were then randomized into the MOAH and control groups. The patients in the MOAH group received MOAH three times per week (10 times in total) in addition to routine treatment and standard critical supportive care. Patients in the control group were only given regular treatment and standard critical supportive care. The patients in the MOAH group had more days of breathing with no aid than those in the control group. Moreover, the length of stay in the intensive-care unit was significantly lower in the MOAH group than in the control group. MOAH resulted in higher ventilation-free days and less intensive-care unit stay compared with the control treatment. In COVID-19 patients undergoing mechanical ventilation, MOAH with routine treatment resulted in more ventilator-free days and less intensive-care unit stay compared with the standard therapy.

Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective.

Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.

Comparing clinical presentation, viremia, and immunological factors at various severity presentations in hospitalized children affected by COVID-19: A cross-sectional study.

Background and Aims: Although SARS-CoV-2 infection usually leads to mild COVID-19 in children, sometimes it causes serious complications, especially in those with underlying diseases. Several factors have been identified in determining disease severity in adults, and limited studies have been conducted in children. The prognostic implications of SARS-CoV-2 RNaemia as an important factor in determining disease severity in children are not well understood. Methods: In this study, we aimed to prospectively assess the relationship between disease severity and immunological factors and viremia in 47 COVID-19 hospitalized children. In this research, 76.5% of children experienced mild and moderate COVID-19, while 23.5% experienced severe and critical forms of the disease. Results: The presence of underlying diseases in different groups of pediatric patients differed significantly from each other. On the other hand, clinical symptoms such as vomiting and chest pain as well as laboratory parameters including erythrocyte sedimentation rate were significantly different in different groups of patients. Viremia was seen in only two children, and this had no significant relationship with the severity of COVID-19. Conclusion: In conclusion, our data confirmed that COVID-19 severity differed in SARS-CoV-2 infected children. Some clinical presentation and lab data parameters were different in various presentation of patients. Viremia was not associated with severity in our study.

The clinical and paraclinical manifestations of tuberous sclerosis complex in children.

Tuberous sclerosis complex (TSC) is an autosomal-dominant, multi-system, neurocutaneous disorder characterized by hamartomas in multiple organs. This study aimed to evaluate the clinical and paraclinical manifestations of children with TSC. The clinical and paraclinical characteristics of 79 children with TSC were evaluated and the possible correlations between the factors were calculated. Among the studied children which composed of 41 females (51.9%) and 38 males (48.1%), skin manifestations as hypopigmented macules as well as the brain involvement as cortical tubers in all (100%) cases, seizure in 74 (93.7%), and sub-ependymal nodules in 73 (92.4%) patients were the most common findings. The renal angiomyolipoma was diagnosed in 36 (70.6%) out of 51 patients. Subependymal giant cell astrocytoma in 25 (3/54%) out of 46 patients, retinal hamartoma in 15 (42.9%) out of 35 patients, and cardiac rhabdomyoma in 17 (41.3%) out of 46 patients were diagnosed. Furthermore, 50 (63.3%) out of 79 patients had psychological disorders that had a significant correlation with the prevalence of seizures (p = 0.002). Given the multi-systemic involvement of TSC, it is necessary that all organs of the patients even without any related clinical symptom or sign be examined regularly for proper therapeutic intervention and prevent disease progression. The growth of hamartomas in the brain and kidneys can be life-threatening; therefore, these organs have more importance to be regularly followed up and examined.

Visceral Leishmaniasis in Ardabil Province, Northwest of Iran: A Retrospective Epidemiological, Clinical and Paraclinical Study (1985-2018).

Background: We aimed to investigate the epidemiological, clinical and paraclinical aspects of Visceral Leishmaniasis in Ardabil Province, from 1986 to 2018. Methods: The disease has been diagnosed by a serological validate test as Direct Agglutination Test, parasitological methods, and clinical manifestations. The data were collected and then analyzed. Results: Overall, 2824 out of 69007cases (4.1%) had anti-Leishmania antibodies at titers≥1:3200. The majority of VL cases belonged to Meshkin-Shahr, and then Germi County. The percentages of both male and female cases were 52.8 % and 46.6%, respectively. Approximately 78.1% of cases were less than 5 yr old. The high incidence rate of the disease was recorded in the years 1987 and 2003. 48.6%, 3.2%, and 1.9% of the patients had low titer (1:3200), high titer (1:102400), and suspicious titer (1:1600), respectively. Out of 1200 bone marrow aspiration, 23% were positive, and 77% were negative. Fever, paleness, and hepatosplenomegaly were the main symptoms in patients. Moreover, abdominal swelling, edema, weight loss, lymphadenopathy and jaundice were some other symptoms in the patients. Among biochemistry factors, the levels of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, triglyceride and cholesterol have been increased. The death rate was estimated to be 2.8%, mainly related to the Ardabil and Germi cases. Conclusion: Kala-Azar is still one of the most important infectious diseases in Ardabil Province, and is responsible for considerable death rate in infants. More attention should be done to parasite control and early diagnosis.

Complex Regional Pain Syndrome or Limb Pain: A Plea for a Critical Approach.

Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a "deliberate diagnosis" for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of "other diseases that would better explain the signs and symptoms" are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest "non-CRPS" limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.

Effects of L-carnitine supplementation in patients with mild-to-moderate COVID-19 disease: a pilot study.

BACKGROUND: The present single-center clinical trial was designed to evaluate the potential benefits of L-carnitine supplementation in patients with COVID-19 disease. METHODS AND PATIENTS: The study was conducted on 75 patients with mild-to-moderate COVID-19 hospitalized in Shahid Beheshti Hospital-Hamadan, IRAN. The participants were randomly divided into intervention (n = 32) and control groups (n = 43). The control group received their standard hospital treatment only. In addition to standard medications, the intervention group received 3000 mg oral L-carnitine daily in three divided doses for five days. The blood samples were collected and para-clinical parameters were measured at the beginning and end of the treatment. Clinical outcomes were also recorded, and data were analyzed using χ2 and t-tests. RESULTS: Higher means of O2 saturation were observed in the intervention rather than in the control group. Mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly lower in the intervention group. Furthermore, mean alkaline phosphatase (ALP) activity and lactate dehydrogenase (LDH) were lower in the intervention group. Also, lower mean serum creatine phosphokinase (CPK) was observed in the intervention group. No significant differences were observed in terms of clinical symptoms; however, six patients (14%) in the control group died due to the complications of COVID-19, while all patients in the intervention group survived. CONCLUSION: Taken together, L-carnitine can be considered as a drug supplement in patients with COVID-19.

COVID-19 paraclinical diagnostic tools: Updates and future trends.

MOTIVATION: COVID-19 is one of the most widely affecting pandemics. As for many respiratory viruses-caused diseases, diagnosis of COVID-19 relies on two main compartments: clinical and paraclinical diagnostic criteria. Rapid and accurate diagnosis is vital in such a pandemic. On one side, rapidity may enhance management effectiveness, while on the other, coupling efficiency and less costly procedures may permit more effective community-scale management. METHODOLOGY AND MAIN STRUCTURE: In this review, we shed light on the most used and the most validated diagnostic tools. Furthermore, we intend to include few under-development techniques that may be potentially useful in this context. The practical intent of our work is to provide clinicians with a realistic summarized review of the essential elements in the applied paraclinical diagnosis of COVID-19.

Diabetes care during COVID-19 lockdown at a tertiary care centre in India.

Providing scheduled consultations to persons with diabetes during the COVID-19 induced lockdowns posed a major challenge. With the clinicians occupied in COVID management, a strategy of using telemedicine and engaging a team of para-clinical doctors was devised. Telephonic follow up consults were given and diabetes care was efficiently delivered.

[Clinical and paraclinical examination in genital prolapses]. / Examen clinique et bilan paraclinique en cas de prolapsus génital.

The clinical evaluation of a prolapse has several components: a precise interrogation, a careful clinical examination, the evaluation of its maintenance on the quality of life. It must take into account the urinary, genital and anorectal spheres. From this clinical evaluation will depend the choice and interpretation of paraclinical investigations that may be requested. But the complementary examinations must never replace the interrogation and the clinical examination. Only symptomatic genital prolapses should be treated.

L'évaluation clinique d'un prolapsus comporte plusieurs volets : un interrogatoire précis, un examen clinique minutieux, l'évaluation de son retentissement sur la qualité de vie. Elle doit prendre en compte les sphères urinaire, génitale et anorectale. De cette évaluation clinique dépend le choix et l'interprétation des investigations paracliniques qui peuvent être demandées. Mais les examens complémentaires ne doivent jamais remplacer l'interrogatoire et l'examen clinique. Il convient de ne traiter que les prolapsus génitaux symptomatiques.

The demographic and paraclinical characteristics of patients with hepatitis B presenting to Shahid Mohammadi Hospital and Clinic and other private clinics in Bandar Abbas, Iran.

Considering the crucial importance of hepatitis B and its high prevalence in the society, the present study was conducted to examine the demographic and paraclinical characteristics of patients with chronic hepatitis B. This descriptive cross-sectional study examined 180 patients with hepatitis B presenting to Shahid Mohammadi Hospital and Clinic and other private clinics in Bandar Abbas, Iran, in 2016-17. The patients were divided into three main groups: chronic hepatitis, liver cirrhosis, and healthy carriers. Parametric and nonparametric tests were used to analyze the relationship between the quantitative variables in terms of their normal or nonnormal distribution (P < 0.05). About 13.5% of the patients had cirrhosis, 35.4% were healthy carriers, and 51.12% had chronic hepatitis. The number of male patients in the cirrhosis group and the number of female participants in the healthy carrier group were higher. The difference in gender distribution between the three groups was statistically significant. According to the results of this study, male and married people constitute a high percentage of the population of patients with chronic hepatitis B. The clinical symptoms of chronic hepatitis B often do not occur until the patient's progress to advanced stages and cirrhosis, and most of the population is asymptomatic. Contact with a person suspected to have hepatitis B is one of the major risk factors of this disease.

Altered Proteome of Extracellular Vesicles Derived from Bladder Cancer Patients Urine.

Proteomic analysis of extracellular vesicles (EVs) from biological fluid is a powerful approach to discover potential biomarkers for human diseases including cancers, as EV secreted to biological fluids are originated from the affected tissue. In order to investigate significant molecules related to the pathogenesis of bladder cancer, EVs were isolated from patient urine which was analyzed by mass spectrometry based proteomics. Comparison of the EV proteome to the whole urine proteome demonstrated an increased number of protein identification in EV. Comparative MS analyses of urinary EV from control subjects and bladder cancer patients identified a total of 1,222 proteins. Statistical analyses provided 56 proteins significantly increased in bladder cancer urine, including proteins for which expression levels varied by cancer stage (P-value < 0.05). While urine represents a valuable, noninvasive specimen for biomarker discovery in urologic cancers, there is a high degree of intra- and inter-individual variability in urine samples. The enrichment of urinary EV demonstrated its capability and applicability of providing a focused identification of biologically relevant proteins in urological diseases.

Prevalence of Adverse Drug Reactions to Highly Active Antiretroviral Therapy (HAART) among HIV Positive Patients in Imam Khomeini Hospital of Tehran, Iran.

OBJECTIVE: The present study assessed the prevalence of adverse drug reactions (ADRs) among HIV positive patients taking antiretroviral therapy referred to Imam Khomeini Hospital in Tehran, Iran. METHODS: This is a cross sectional study regarding side effects of Highly Active Antiretroviral Therapy (HAART) in HIV positive patients referred to Voluntary Counseling and Testing (VCT) center in Imam Khomeini Hospital of Tehran, Iran during a period of the year 2009 to 2010. Two hundred patients under antiretroviral treatment evaluated for the side effects of drug based on available records, face to face interviews and written lab data. RESULTS: Data was collected from a sample of 200 HIV positive patients (72% male). Injection drug use was the most common route of HIV transmission. Co-Infections with Hepatitis C virus (HCV) found in the majority of patients (60.5%). Tuberculosis was the most prevalent opportunistic infection. One hundred eighty eight (94%) patients experienced at least one adverse drug reaction. The most frequent clinical and paraclinical findings were skin rash (28%) and abnormal liver function tests (36%). CONCLUSION: Given the high prevalence of adverse drug reactions among HIV positive patients taking antiretroviral therapy (ART) in this study, clinicians should be aware of ADRs at the initiation of ART as complications can affect patients' adherence to the therapy.

A comparison of clinical-scenario (case cluster) versus stand-alone multiple choice questions in a problem-based learning environment in undergraduate medicine.

OBJECTIVES: To compare stand-alone multiple choice questions (MCQs) and integrated clinical-scenario (case cluster) multiple choice questions (CS-MCQs) in a problem-based learning (PBL) environment. METHODS: A retrospective descriptive analysis of MCQ examinations was conducted in a course that integrates the subspecialties of anatomical pathology, chemical pathology, hematology, immunology, microbiology and pharmacology. The MCQ items were analyzed for their reliability (Kuder-Richardson-20, KR-20), level of difficulty (Pi), discrimination index (Di), item distractors and student performances. The statistical analysis of the results was extracted from the integrity online item-analysis programme. The results of the standard stand-alone and CS multiple choice questions were compared. RESULTS: KR-20 for the CS-MCQs and stand-alone MCQs was consistently high. KR-20 and Pi were higher for the CS-MCQs. There was no significant difference between the CS-MCQs and stand-alone MCQs in Pi and Di. A range of difficulty levels was found based on Bloom's taxonomy. The mean scores for the class were higher for the CS-MCQ examination. The compilation of the CS-MCQ examination was more challenging. CONCLUSIONS: CS-MCQs compare favorably to stand-alone MCQs and provide opportunities for the integration of sub-specialties and assessment in keeping with PBL. They assess students' cognitive skills and are reliable and practical. Different levels of item difficulty promote multi-logical and critical thinking. Students' scores were higher for the CS-MCQ examination, which may suggest better understanding of the material and/or better question clarity. The scenarios have to flow logically. Increasing the number of scenarios ensures the examination of more course content.

[Clinical and paraclinical profile of heart transplanted patients at the Thoracic and cardiovascular surgery service of the Pitié Salpétrière Hospital in 2009]. / Profil clinique et paraclinique des patients transplantes cardiaques dans le service de chirurgie thoracique et cardiovasculaire du groupe Hospitalier Pitie-Salpetriere (GHPS) en 2009.

OBJECTIVE: To determine the clinical and paraclinical profile of heart transplanted patients in 2009 in the Thoracic and Cardiovascular Surgery (TCVS) of the Pitié-Salpêtrière Hospital (PS). METHOD: It was a retrospective and descriptive study on heart transplantation patients between January 1 and December 31, 2009 in the TCVS of PS. Data collection was conducted from medical records, medical correspondence and pre-transplant assessment data and relevant laboratory tests, ultrasound, angiographic and operative reports. The collected data were entered and analyzed by Excel and analyzed by SPSS 12. RESULTS: The sample size was 63 patients or 50.6% of patients awaiting heart transplantation. The mean age of patients was 47.66 ± 12.79 years, sex ratio Male:Female 2.70. The circumstances of transplantation were: super-emergency (37%), non-emergency (63%) and in 1/3 of redux surgery. All patients were symptomatic (average VO2 max of 12.76 ± 3.20 ml/kg/min), with 85.7% having a left ventricular ejection fraction <30% and 100% diastolic dysfunction. The primary dilated cardiomyopathy was the main causal disease with 38.1% of cases. CONCLUSION: Heart transplantation as a last resort is practiced more and more with improved results and highlights dilated cardiomyopathy as the main cause. The clinical and paraclinical profile has not changed much over the last 5 years.

BUT: Déterminer le profil clinique et paraclinique des patients transplantés en 2009 Service de Chirurgie Thoracique et Cardiovasculaire (SCTCV) du Groupe Hospitalier Pitié-Salpétrière.( GHPS). MATÉRIEL ET MÉTHODES: L'étude était rétrospective descriptive sur les patients transplantés cardiaques entre le 1er janvier et le 31 décembre 2009 dans le SCTCV du GHPS.La collecte des données a été réalisée à partir des dossiers médicaux, des courriers médicaux et des données du bilan pré-greffe et a concerné les examens biologiques, échographiques, coronarographique et les comptes rendus opératoires. Les données recueillies ont été saisies et analysées par le logiciel Excel et analysées par SPSS 12. RÉSULTATS: La taille de l'échantillon était de 63 patients soit 50,6 % des patients en attente de transplantation. L'âge moyen des patients était de 47,66 ± 12,79 ans, le sex-ratio H: F de 2,70. Les circonstances de la transplantation étaient: en super-urgence (37%), hors-urgence (63%) et redux dans 1/3 des cas. Tous les patients étaient symptomatiques (VO2 max moyenne de 12,76 ±3,20 ml/Kg/min), 85,7% avec avaient une FE < 30% et 100% une dysfonction diastolique. La cardiomyopathie dilatée primitive représentait la principale pathologie causale avec 38.1% des cas. CONCLUSION: La transplantation cardiaque en tant qu'ultime recours se pratique de plus en plus avec une amélioration des résultats et fait ressortir les cardiomyopathies dilatées comme principale cause. Le profil clinique et paraclinique n'a pas beaucoup évolué par rapport aux 5 dernières années.

[Clinical, paraclinical and epidemiological profile of erectile dysfunction in consultation at the urology department of the Point G University Hospital]. / Profil epidemiologique clinique et paraclinique de la dysfonction erectile en consultation dans le service d'urologie du CHU du Point G.

OBJECTIVE: To study the epidemiological, clinical and paraclinical profile of erectile dysfunction in outpatient urology. MATERIAL AND METHODS: It was a prospective longitudinal study from January to August 2012 (8 months) in the urology department of the Point G University Hospital. 72 patients were involved, and were consulting for erectile dysfunction. These patients underwent clinical and laboratory examinations. Erectile dysfunction was evaluated by the Massachusetts Male Aging Study self-assessment (Single question of Self report of Erectile Dysfunction Massachusetts Male Aging Scale). RESULTS: Frequency of erectile dysfunction was estimated at 9.6%, average age was 45 years, 71% of patients were polygamous, and 18% were monogamous. Most patients (82%) resided in Bamako; traders were most represented (34%). The deficit was moderate in 48.61% of patients. The average time of consultation was 2.5 years. Co-morbidity factors were found in 54.16% of patients, the most frequent risk factors were physical inactivity (34.72%). Blood glucose was elevated in 27.78% patients, cholesterol and triglycerides were elevated in 13.15% of patients, testosterone was low in three patients, prolactin was high in six patients. A Doppler ultrasound of the penis revealed a low perfusion of corpus cavernosum in six cases, and three cases of Peyronie's disease. CONCLUSION: At the end of the study the epidemiological, clinical and paraclinical profile is identical to that found in other countries. But a more serious study with specific evaluation scores will help to identify this profile.

OBJECTIF: Etudier le profil épidémiologique, clinique et paraclinique des patients présentant une dysfonction érectile reçus en consultation externe dans le service d'urologie. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude longitudinale prospective réalisée de Janvier 2012 à Aout 2012 (8 mois) dans le service d'urologie du Centre Hospitalier Universitaire du Point G. Elle a porté sur tous les patients qui ont consulté pour dysfonction érectile. Ces patients ont bénéficié d'examens cliniques et paracliniques. La dysfonction érectile a été évaluée par l'échelle de l'unique question d'auto-évaluation de la dysfonction érectile du Massachusetts Male Aging Study. (Single question of Self report of erectile dysfonction Massachusetts Aging Study). RÉSULTATS: La fréquence de la dysfonction érectile a été estimée à 9,6 %, l'âge moyen était de 45 ans; 71% des patients étaient polygames, 18% étaient monogames.La plupart des patients (82%) résidait à Bamako, les commerçants étaient les plus représentés (34%). Le déficit était modéré chez 48,61% des patients. Le délai moyen de consultation était de 2,5 ans. Des facteurs de Co-morbidités ont été retrouvés chez 54,16% des patients, le facteur de risque le plus fréquent a été la sédentarité (34,72%). La glycémie était élevée chez 27,78% patients, les cholestérols et les triglycérides étaient élevés chez 13,15% des patients, la testostérone était basse chez trois patients, la prolactine était élevée chez six patients. L'écho-doppler de la verge a révélé une faible perfusion des corps caverneux dans six cas, trois cas de Maladie de Lapeyronie. CONCLUSION: Au terme de notre étude le profil épidémio-clinique et paraclinique retrouvé reste identique à celui d'autres pays. D'autres études plus détaillées avec des scores d'évaluation précis permettront de mieux cerner ce profil.

Cambios fisiológicos durante el embarazo normal / Physiological Changes During a Normal Pregnancy

Resumen: El organismo de la mujer experimenta una serie de cambios fisiológicos, a todos niveles, que tienen la finalidad de adaptarse y dar respuesta a la gran demanda que representan las 40 semanas de gestación que durará la formación un nuevo ser humano en su interior. Dichos cambios ocurren de manera gradual, pero continua, a lo largo de todo el embarazo y van desde cambios cardiovasculares, digestivos, pulmonares, hematológicos y endocrinos, los cuales al final también terminan por revertirse de manera paulatina durante el puerperio. Los cambios fisiológicos se relacionan con el desarrollo de distintos síntomas, signos y alteraciones en la mujer embarazada, así como cambios en los parámetros de los estudios paraclínicos, lo cual hace que resulte especialmente relevante que el médico general o de primer contacto esté familiarizado con estos cambios y el momento en el que ocurren en el embarazo, para que pueda realizar una oportuna identificación de las alteraciones que pueden representar estados patológicos que resulten una amenaza para el bienestar materno y fetal. Por todo lo anterior, el objetivo de la presente revisión temática fue recopilar y describir los principales cambios fisiológicos que ocurren en la mujer durante el embarazo normal, así como los cambios que se presentan en los estudios paraclínicos más comunes.

Abstract: The woman's body undergoes a series of physiological changes at all levels that hace the purpose of adapting and responding to the the 40 weeks of gestation. These changes occur gradually, but in a continuously, throughout the pregnancy and range from cardiovascular, digestive, pulmonary, hematological and endocrine changes, which at the end also end up gradually reversing during the puerperium. The physiological changes are related to the development of different symptoms, signs and alterations in the pregnant woman, as well as changes in the parameters of the paraclinical studies, which makes it especially relevant for the general practitioner or first contact doctor to recognize these changes and the moment in which they occur in pregnancy so that they can make a timely identification of the alterations that can represent pathological states that are a threat to maternal and fetal well-being. For all of the above, the objective of this thematic review was to collect and describe the main physiological changes that occur in women during a normal pregnancy, as well as the changes that occur in the most common paraclinical studies.

[Clinical and paraclinical prognostic factors in non-small cell lung cancer surgery]. / Facteurs pronostiques cliniques et paracliniques dans la chirurgie du cancer du poumon non à petites cellules.

INTRODUCTION: Lung cancer prognosis is mainly based on the TNM, histology and molecular biology. Our aim was to analyze the prognostic value of certain clinical and paraclinical variables. PATIENTS AND METHODS: We studied among 6105 patients operated on, divided during 3 time-periods (1979 to 2010), the following prognostic factors: type of surgery, pTNM, histology, age, sex, smoking history, clinical presentation, and paraclinical variables. RESULTS: Postoperative mortality was 4% (243/6105), rate of complications was 23.3% (1424/6105). The 5-year overall survival was 43.2% and 10-year was 27%. Best survival was observed after complete resection (R0) (P<10(-6)), lobectomy (P<10(-6)), lymph node dissection (P=0.0006), early pTNM stages (P<10(-6)), absence of a solid component in adenocarcinoma. Other pejorative factors were: male gender (P=10(-5)), age (P=0.0000002), comorbidity (P=0.016), history of cancer (P<10(-5)), postoperative complications (P=0.0018), FEV lower than 80% (P=0.0000025), time-periods (P<10(-6)). All these factors were confirmed by multivariate analysis, except gender. Smoking was not poor prognostic factor in univariate analysis (P=0.09) but became significant in the multivariate one (P=0.013). CONCLUSION: Medical and human factors, and the general physiological state, play an important role in prognosis after surgery. We do not know their exact meaning and, like studies on chemotherapy, they justify special research.