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The aim of this study is to provide a comprehensive review of the current therapeutic approaches to severe burn injuries. The study will cover the epidemiology of burn injuries, treatment options and adjunctive therapies. It will also emphasize the importance of a multidisciplinary approach in treatment options and discuss current challenges and future directions for research in the treatment of burns. This study aims to provide updated, evidence-based information and guidelines for medical professionals involved in the management of severe burn injuries, and to improve care and outcome for patients affected by these injuries. The WHO states that burn injuries are a major public health concern worldwide, with an estimated 180,000 deaths annually, with the majority of these deaths occurring in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Because Systemic Lupus Erythematosus (SLE) is a rare disease, and due to the significant prognostic impact of early management, a diagnosis confirmed by a physician with experience in SLE is recommended, for example from an expert center. Once the diagnosis is confirmed, existing manifestations should be identified in particular, renal involvement by an assessment of proteinuria, disease activity and severity should be determined, potential complications anticipated, associated diseases searched for, and the patient's socioprofessional and family context noted. Therapeutic management of SLE includes patient education on recognizing symptoms, understanding disease progression as well as when they should seek medical advice. Patients are informed about routine checkups, treatment side effects, and the need for regular vaccinations, especially if they are receiving immunosuppressive treatment. They are also advised on lifestyle factors such as the risks of smoking, sun exposure, and dietary adjustments, especially when they are receiving corticosteroids. The importance of contraception, particularly when teratogenic medications are being used, and regular cancer screening are emphasized. Support networks can help relieve a patient's isolation. The first-line medical treatment of SLE is hydroxychloroquine (HCQ), possibly combined with an immunosuppressant and/or low-dose corticosteroid therapy. The treatment of flares depends on their severity, and typically involves HCQ and NSAIDs, but may be escalated to corticosteroid therapy with immunosuppressants or biologic therapies in moderate to severe cases. Because there is no curative treatment, the goals of therapy are patient comfort, preventing progression and flares, and preserving overall long-term health and fertility. The frequency of follow-up visits depends on disease severity and any new symptoms. Regular specialized assessments are necessary, especially when treatment changes, but a frequency of every 3 to 6 months is recommended during periods of remission and monthly during active or severe disease, especially in children. These assessments include both clinical and laboratory tests to monitor complications and disease activity, with specific attention to proteinuria. [ABSTRACT FROM AUTHOR]

Our aims were to assess cognitive impairment in bipolar patients in remission compared with healthy controls, and to study its connection to clinical and therapeutic factors. This was a case-control study of patients with bipolar disorder (BD) in remission and matched healthy controls. It was carried out at the Hédi Chaker University Hospital in Sfax, Tunisia. The Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to assess cognitive function in patients and controls. This scale comprises subtests for verbal learning with immediate (VLT-I) and delayed (VLT-D) recall, working memory (WMT), verbal fluency (VFT) and information processing speed (PST). We recruited 61 patients and 40 controls. Compared with controls, patients had significantly lower scores on the overall SCIP scale and on all SCIP subtests (p < 0.001 throughout) with moderate to high effects. In multivariate analysis, the presence of psychotic characteristics correlated with lower scores on the overall SCIP (p = 0.001), VLT-I (p = 0.001) and VLT-D (p = 0.007), WMT (p = 0.002) and PST (p = 0.008). Bipolar II correlated with lower LTV-I scores (p = 0.023). Age of onset and duration of the disorder were negatively correlated with PST scores (p < 10−3 and p = 0.007, respectively). Predominantly manic polarity correlated with lower VFT scores (p = 0.007). Our study showed that bipolar patients in remission presented significantly more marked cognitive impairments, affecting various cognitive domains, than the controls. These cognitive impairments appear to be linked to clinical and therapeutic factors that are themselves considered to be factors of poor prognosis in BD. [ABSTRACT FROM AUTHOR]

Over the last decades, the use of artificial intelligence, machine learning and deep learning in medical fields has skyrocketed. Well known for their results in segmentation, motion management and posttreatment outcome tasks, investigations of machine learning and deep learning models as fast dose calculation or quality assurance tools have been present since 2000. The main motivation for this increasing research and interest in artificial intelligence, machine learning and deep learning is the enhancement of treatment workflows, specifically dosimetry and quality assurance accuracy and time points, which remain important time-consuming aspects of clinical patient management. Since 2014, the evolution of models and architectures for dose calculation has been related to innovations and interest in the theory of information research with pronounced improvements in architecture design. The use of knowledge-based approaches to patient-specific methods has also considerably improved the accuracy of dose predictions. This paper covers the state of all known deep learning architectures and models applied to external radiotherapy with a description of each architecture, followed by a discussion on the performance and future of deep learning predictive models in external radiotherapy. [ABSTRACT FROM AUTHOR]

Les gastro-entérites sont le plus souvent d'origine virale, rotavirus et norovirus étant les virus les plus fréquemment en cause chez les jeunes enfants. Les PCR multiplex effectuées à partir des selles permettent de détecter des bactéries, des virus ou des parasites responsables ou non de la gastro-entérite. Si le profil étiologique de ces infections digestives a grandement bénéficié de la PCR, la présence de pathogènes potentiels ne justifie pas de traitement anti-infectieux en dehors de pathologies sous-jacentes. En effet, parmi les causes bactériennes, très peu nécessitent un traitement antibiotique en dehors des shigelloses, des formes graves de salmonellose et une partie des infections à Campylobacter sp. L'évolution de la résistance aux antibiotiques des salmonelles, shigelles et campylobacter est préoccupante dans le monde, limitant les options thérapeutiques. Les antibiotiques proposés dans ce guide sont en accord avec les recommandations communes de l'European Society of Pediatric Infectious Diseases et l'European Society of Pediatric Gastroenterology and Nutrition. L'azithromycine est préférentiellement utilisée pour traiter les infections à Shigella sp. ou à Campylobacter sp. La ceftriaxone et la ciprofloxacine sont recommandées pour traiter les salmonelloses nécessitant une antibiothérapie. Les traitements empiriques, sans identification bactérienne, ne sont pas indiqués en dehors d'un sepsis sévère ou chez des sujets à risque (drépanocytose par exemple). La prescription de métronidazole pour une amibiase intestinale aiguë ne doit être faite qu'après confirmation microbiologique. Gastroenteritis is usually due to viruses mainly Rotavirus and Norovirus. Among the bacterial causes, very few warrant systemic antibiotic treatment including Shigella , Vibrio cholerae , Campylobacter (only if diagnosed early) and severe cases of Salmonella infections. The antimicrobial treatments proposed in this guide are consistent with the latest recommendations of the European Society of Pediatric Infectious Diseases and the European Society of Pediatric Gastroenterology and Nutrition. Azithromycin is the preferred antibiotic for infections due to Shigella and Campylobacter. Ceftriaxone and ciprofloxacin are recommended for Salmonella infections that must be treated. Empirical treatment without bacteriological documentation should be avoided. The prescription of metronidazole for acute intestinal amebiasis should only be made after microbiological confirmation. [ABSTRACT FROM AUTHOR]

Electrical burn injuries (EBI) affect both adults and children and are responsible for a very high number of major limb amputations. Their management is still a major challenge. This retrospective review concerns 42 children, admitted to an intensive burn care department in Tunisia for high electrical burns, from January 2016 to September 2022. The average age of our patients was 12 years, with a male predominance (90.5%). Electrotrauma was accidental in the majority of cases (93%) and secondary to a domestic accident in 54.8% of cases. Total body surface area was 19%. Burns were second degree in 2/3 of cases and third degree in 1/3 of cases. The most affected areas were distal extremities in 2/3 of the cases. Rhabdomyolysis was observed in 93% of cases and troponins were elevated in half of the patients. Escharotomy was required in 38% of cases. Amputation was performed in 18 children (43%): one limb (n=10); 2 limbs (n=6) and 3 limbs (n=2). The outcome was favorable in 9 children (21.4%); functional and cosmetic sequelae with an impact on schooling and psychology were reported in 25 cases. Mortality was 16.7%. [ABSTRACT FROM AUTHOR]

Diabetes causes peripheral neuropathy with loss of sensitivity of feet to pain, predisposing diabetic patients to a high risk of severe burns. Our retrospective study aimed to look at epidemiological, clinical, therapeutic and outcome characteristics of feet burns occurring in patients with diabetes, hospitalized in the burn trauma center of Tunis over 4 years (from 2019 to 2022). We included 34 patients, among which 9 had only feet burns. Their mean age was 60 years (range: 41-83 years), with male predominance (sex ratio = 1.83). A quarter of patients (n=9) were on oral antidiabetic drugs (OADs) and more than half (n=18) were at the stage of degenerative complications. At admission, blood glucose level was higher than 10 mmol/l in 73% of patients. TBSA was 19%. Twenty-two patients had deep feet burns, among which 5 patients underwent aponerrotomy for deep, circular burns. Amputation was done in 15 patients: toes (n=9), one limb (n=3) and two limbs (n=3). Duration of ICU stay was 18.3 days and mortality was 20.58%. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumours (PanNETs) are rare malignancies, but their incidence is increasing. Although about 50% of PanNETs are associated with metastases, mainly hepatic, they are associated with a relatively favourable prognosis (50% to 75% 5-year survival rate) due to their relatively slow growth. Metastatic PanNETs are most often sporadic and diagnosed incidentally or in the presence of nonspecific clinical signs related to tumour locations. Symptoms related to the hypersecretion of a hormone by functional PanNETs are present in less than 20% of cases but should be treated as a priority. The extension work-up is based on thoraco-abdominopelvic CT scan, liver MRI and 68Ga-DOTATOC-PET/CT, possibly supplemented by FDG PET. The choice of treatment is based on prognostic markers (histoprognostic grade, metastatic extension, progressive slope, resectability) and rare predictive markers (MGMT status, somatostatin receptor expression). Complete resection of metastases is the standard treatment if feasible. Otherwise, treatment options include chemotherapy, targeted therapies (sunitinib, everolimus), somatostatin analogues, hepatic chemoembolization, and peptide-receptor radionuclide therapy. The choice of the best therapeutic strategy in patients with metastatic PanNETs is complex and should be systematically discussed during multidisciplinary tumour boards. [ABSTRACT FROM AUTHOR]

Télémédecine (TLM) et télépsychothérapie (TLPT) se développent depuis plus d'une dizaine d'années à travers le monde mais les évaluations de cette nouvelle modalité de soin sont encore trop rares. Ce changement de cadre thérapeutique est-il satisfaisant ? Les résistances à cette évolution se situent-elles du côté du praticien ou du patient ? Le COVID-long, pathologie chronique apparue après la crise sanitaire de 2020, peut-il bénéficier de cette forme de thérapie ? C'est l'une des questions à laquelle cet article tente de répondre. Structuré en deux parties, cet article présente tout d'abord une revue détaillée des travaux passés et actuels en télépsychiatrie (TLP) et TLPT. Puis, les auteurs explorent des pistes de prise en charge de la symptomatologie psychopathologique du COVID-long, qui se caractérise essentiellement par des troubles anxiodépressifs ainsi qu'un état de stress post-traumatique (ESPT). La pluridisciplinarité s'impose dans la prise en charge du COVID-long. Thérapie cognitivo-comportementale (TCC) et psychothérapie interpersonnelle (IPT) se dégagent en tant que méthodes de traitement efficaces pour les troubles psychopathologiques. La réalité virtuelle ainsi que la réalité augmentée semblent également indiquées dans les TLPT des syndromes post-traumatiques. Quels que soient le modèle théorique sous-jacent aux actes et les modalités de la TLPT, ce dispositif exige l'acceptation du cadre sans réticence. Le changement de cadre est à prendre en considération, mais la qualité de l'alliance thérapeutique semble renforcée par l'aspect rassurant des consultations depuis le lieu de vie habituel du patient, et au-delà des thérapies en « visio », les thérapies épistolaires par échanges de courriers électroniques semblent particulièrement intéressantes. Telemedicine and virtual psychotherapy have been developing worldwide for over a decade, but evaluations of this new treatment modality are still too rare. Is this evolution in therapeutic treatment protocols satisfactory? Does resistance to this development come from the practitioner or the patient? Can long-term COVID, a chronic pathology that emerged after the pandemic of 2020, benefit from this approach to therapy? This article seeks to answer that question. Structured in two parts, this article first presents a detailed review of past and current work on telemedicine, and virtual psychotherapy. In the second part, the authors explore ways of treating the psychopathological symptomatology of long COVID, which is essentially characterized by anxiety-depressive disorders as well as post-traumatic stress disorder (PTSD). Multidisciplinarity is essential in the management of long COVID. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have proved to be effective treatment methods for the psychopathological disorders inherent in long COVID. Virtual reality, as well as augmented reality, also seems to be indicated as effective in virtual psychotherapy treatment of post-traumatic stress disorder (PTSD). Whatever the theoretical model underlying the actions and methods of virtual psychotherapy, it is important to accept without hesitation the framework. It would appear that the transferential and counter-transferential components of therapeutic relationships are not affected by the change of setting. The quality of the therapeutic alliance is strengthened by the reassuring aspect of consultations from the patient's usual place of residence. In addition to videoconference therapies, epistolary therapies using email exchanges seem also to be particularly interesting. [ABSTRACT FROM AUTHOR]

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. The ubiquitous and vital nature of the functions performed by these vitamins explains the wide variety of clinical manifestations and their potential seriousness, particularly in cases of deficiency, but also in cases of excess or hypervitaminosis. We present here the main symptoms of hypervitaminosis. [ABSTRACT FROM AUTHOR]

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. As a result, deficiencies in fat-soluble vitamins are rarer in industrialised countries than in countries with limited resources. However, even in the latter, certain groups of individuals are affected, such as newborns or growing children, pregnant or breast-feeding women and elderly or isolated subjects. Vitamin A, D, E and K deficiencies are also relatively common in people with digestive tract disorders, in patients suffering from chronic pathologies or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical symptoms. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet and treatment of the cause. [ABSTRACT FROM AUTHOR]

Objectives: Many people who are diagnosed with bipolar disorder also have comorbid personality disorder. Few studies have explored how personality disorder may influence pharmacological treatment outcomes. The aim of this study was to conduct a secondary analysis of data from a clinical trial of adjunctive nutraceutical treatments for bipolar depression, to determine whether maladaptive personality traits influence treatment outcomes. Methods: Scores on the Standardised Assessment of Personality – Abbreviated Scale screener were used to classify participants as having bipolar disorder with (n = 119) and without (n = 29) above threshold personality disorder symptoms (personality disorder). Outcome measures included: The Montgomery Åsberg Depression Rating Scale, Clinical Global Impressions and Improvement Severity Scales, Patient Global Impressions–Improvement scale, Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, Social and Occupational Functioning Assessment Scale and Quality of Life and Enjoyment Scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). Generalised estimated equations examined the two-way interactions of personality disorder by time or treatment and investigated personality disorder as a non-specified predictor of outcomes. Results: Over time, the Patient Global Impressions–Improvement scores were significantly higher in those in the personality disorder group. No other significant differences in the two-way interactions of personality disorder by treatment group or personality disorder by time were found. Personality disorder was a significant but non-specific predictor of poorer outcomes on the Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, regardless of time or treatment group. Conclusions: This study highlights the potential impact of maladaptive personality traits on treatment outcomes and suggests that the presence of comorbid personality disorder may confer additional burden and compromise treatment outcomes. This warrants further investigation as does the corroboration of these exploratory findings. This is important because understanding the impact of comorbid personality disorder on bipolar disorder may enable the development of effective psychological and pharmacotherapeutic options for personalised treatments. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is one of the main causes of morbidity and mortality in Africa and Mali and its prognosis remains serious with very low survival. We initiated this study to determine the overall and specific survival rate by treatment type. Patients and Methods: This was a cross-sectional study from January 1, 2016 to October 31, 2021. It concerned all women who had been seen in the obstetric gynecology department of the teaching hospital Luxembourg in Bamako during the study period. We conducted a multivariate analysis of the factors influencing survival after logistic regression according to the Cox model. Results: We recorded 70 cases of breast cancer among 41613 gynecological consultations or 0.16%. Over the months there is a very rapid decrease in survival. The chemotherapy improves survival, surgery and radiotherapy greatly contribute to the improvement. Concerning hormone therapy, it protects subjects with a statistically significant probability (P < 0,05). Conclusion: Breast cancer survival remains very low in the department, the need for well-organized screening campaigns and early and multidisciplinary case management. [ABSTRACT FROM AUTHOR]

Le syndrome douloureux régional complexe de type I, SDRC I du pied et de la cheville, anciennement appelé algodystrophie, est une affection douloureuse polymorphe articulaire et périarticulaire pouvant atteindre le pied et la cheville. Les symptômes cliniques se caractérisent par une douleur souvent mal systématisée, accompagnée de troubles de la sensibilité, vasomoteur, sudoromoteur, musculaire et trophique locaux, à extension possible régionale, survenant dans les suites d'un traumatisme, même mineur, ou spontanément. Malgré les avancées dans sa compréhension, la physiopathologie demeure partiellement élucidée, suggérant des altérations complexes au niveau du système nerveux sympathique, du système nerveux central ainsi que des phénomènes inflammatoires locaux. L'évolution est imprévisible dans le temps, et peut entraîner un handicap fonctionnel parfois sévère ainsi qu'une altération de la qualité de vie. Le diagnostic est avant tout clinique. Il existe un consensus pour utiliser les critères de Budapest pour le diagnostic de SDRC I permettant d'uniformiser la pratique clinique quotidienne. Le traitement repose avant tout sur la réadaptation fonctionnelle. D'autres options thérapeutiques, notamment l'administration de bisphosphonates par perfusion, sont envisageables selon les cas, en prenant en compte les différents symptômes, la sévérité du handicap fonctionnel et les contraintes spécifiques de prise en charge. The complex regional pain syndrome type I, CRPS I in the foot and ankle, also known as algodystrophy, is a polymorphous pain articular and peri-articular condition. It is characterized by poorly systematized neuropathic regional pain, accompanied by sensory, vasomotor, sudomotor, muscular and trophic disorders. It is often triggered by a traumatic event (fracture, sprain, surgery). Despite advances in our understanding of its pathophysiology, it remains only partially elucidated, suggesting complex alterations in the sympathetic and central nervous systems, as well as local inflammatory phenomena. Its risk is prolonged evolution, leading to joint stiffening and functional disability. Diagnosis is primarily clinical, supported by Budapest criteria. Treatment is primarily based on rehabilitation. Analgesics are used to make rehabilitation tolerable and acceptable. Other treatment options, such as infusion of bisphosphonates, may be considered on a case-by-case basis, taking into account the stage of the disease, the severity of functional impairment and specific management constraints. [ABSTRACT FROM AUTHOR]

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment. [ABSTRACT FROM AUTHOR]

La sclérodermie systémique (ScS) est une connectivite rare caractérisée par de l'inflammation, de la fibrose, et de l'auto-immunité. Parent pauvre de la recherche clinique pendant plusieurs années comparativement aux autres maladies auto-immunes, la ScS a bénéficié d'un regain d'intérêt depuis une dizaine d'années et de très nombreux essais cliniques sont en cours. Nous présentons ici les résultats des essais publiés dans les 5 dernières années au cours de la ScS en fonction des critères de jugements choisis et décrivons les essais en cours ou attendus dans les années à venir. Systemic sclerosis (SSc) is a rare connective tissue disease characterized by inflammation, fibrosis, and autoimmunity. Despite few clinical trials when compared to other autoimmune diseases, SSc has benefited from renewed interest over the past ten years and a large number of clinical trials have been performed or are underway. We present here the results of the trials published in the last 5 years in ScS according to the chosen endpoint criteria and describe the trials in progress or expected in the years to come. [ABSTRACT FROM AUTHOR]

Prosthetic joint infection (PJI) is a devastating complication that can occur following hip arthroplasty. We report the technical therapeutic adaptations and results of a short case series of hip PJI at the Yaoundé General Hospital (YGH), Cameroon. All patients admitted and treated for PJI at the YGH from January 2020 to December 2022, and followed-up for at least one year, were included in this retrospective study. The primary endpoint was the rate of persistence of infection or recurrence of infection at a minimum follow-up of one year. The secondary endpoints were the rate of reoperation of the same hip, loosening, mortality, Postel Merle d'Aubigné (PMA) functional score. In total, 8 patients presenting 9 episodes of PJI were included. PJI occurred early in 4 cases, delayed in 2 cases, and late in 3 cases. All patients received surgical treatment associated with probabilistic antibiotic therapy, then adapted to bacterial culture for at least 6 weeks. The techniques performed were debridement and implant sterilization (DAIS) then reimplantation in a single surgery in 4 cases, debridement and implant retention (DAIR) in 1 case, debridement and implant exchange (DAIEX) in one stage in 1 case, the DAIEX in 2 stagesin 1 case and debridement and implant removal (Girdlestone intervention) in 02 cases. Apart from the patient treated with DAIR who evolved toward persistence of PJI, then successfully managed secondarily by DAIS, infection was controlled in all patients at a median follow-up of 26 months. No patient has required re-operation on the same hip during followup to date. Two cases of death were observed during the follow-up period. The functionalresult was satisfactory, with a median PMA score of 15 (11- 17) and all patientssaid they were very satisfied with the treatment of their PJI. Thisshort case seriesfinds that the treatment of hip PJI by DAIS, DAIEX, and Girdlestone gives good results in our environment. In limited-resources settings where it is not always possible for a patient who developed PJI to purchase a new prosthesis, DAIS seems to be a relevant and reliable alternative [ABSTRACT FROM AUTHOR]

Oral ulcerations caused by aphtous lesions, leukoplakia, scarlet fever, syphilis, NOMA, mucormycosis herpetic lesions, candidiasis, discoid lupus erythematous, ulcerative lichen planus, mucous membrane pemphigoid, spongy nevus, oral submoucs fibrosis and pemphigus vulgaris are treated in a step-up fashion that may include topical, intralesional, and systemic pharmaceutical treatment. This page discusses the most often used therapy agents, methods, and dosages. Although the emphasis is on local pharmacologic therapy, systemic illnesses that frequently occur with such oral lesions are briefly discussed, as is the appropriate care. [ABSTRACT FROM AUTHOR]

Osteoid osteoma is a benign osteogenic tumour traditionally treated by surgical excision or percutaneous CT-guided procedures. We describe three cases of osteoid osteomas of which the locations were difficult to access, or for which the procedure was potentially unsafe, involving treatment with zoledronic acid infusions. We report here three male 28 to 31-year-old patients with no medical history who had osteoid osteomas located at the second cervical vertebra, the femoral head, and the third lumbar vertebra respectively. These lesions were responsible for inflammatory pain requiring daily treatment with acetylsalicylic acid. Given the impairment risk, all of the lesions were ineligible for surgical or percutaneous treatment. Patients were successfully treated by 3 to 6 monthly zoledronic acid infusions. All patients experienced complete relief of their symptoms allowing aspirin discontinuation, without any side effects. In the first two cases, CT and MRI control showed nidus mineralization and bone marrow oedema regression, correlating with the pain decrease. After 5 years of follow-up there had been no recurrence of the symptoms. Monthly 4 mg zoledronic acid infusions seem to be safe and effective in the treatment of inaccessible osteoid osteomas. [ABSTRACT FROM AUTHOR]

Les tumeurs du sein sont les tumeurs les plus fréquentes chez la femme, mais représentent un groupe très hétérogène. D'une part, il existe les carcinomes canalaires et lobulaires du sein, représentant 90 % des tumeurs, dont les caractéristiques cliniques et pathologiques sont bien connues. D'autre part, il y a les tumeurs rares du sein, dont chacune représente moins de 1 %, rendant plus difficile leur étude à travers de larges séries. L'objectif de ce travail était de collecter, mettre à jour et synthétiser les connaissances portant sur ces tumeurs rares. Une revue de la littérature a été effectuée sur les bases de données Medline et Google Scholar. Nous présentons ici une sélection de plusieurs tumeurs rares, en apportant des données actualisées aux niveaux épidémiologiques, histopathologiques, génétiques, cliniques et radiographiques, pronostiques et thérapeutiques en prenant en compte la place de la radiothérapie. Chaque histologie tumorale est singulière et possède des caractéristiques propres, la prise en charge doit donc être adaptée et discutée en réunion de concertation pluridisciplinaire. Breast tumours are the most common tumours in women but represent a very heterogeneous group. On the one hand, there are ductal and lobular carcinomas of the breast, representing 90% of tumours, whose clinicopathologic characteristics are well known. On the other hand, there are rare breast tumours, each of which represents less than 1% that limits their study through large cohorts. The objective of this work was to collect, update and synthesize knowledge on these rare tumours. A literature review was performed on the Medline and Google Scholar databases. We present here a selection of several rare tumours, providing updated data at the epidemiological, histopathological, genetic, clinical and radiographic, prognostic and therapeutic levels, taking into account the place of radiotherapy. Each tumour histology is unique and has its own characteristics, the management must therefore be adapted as much as possible and decided in a multidisciplinary meeting. [ABSTRACT FROM AUTHOR]

La maladie de Kawasaki (MK) est la vascularite la plus fréquente chez l'enfant de moins de 5 ans. Elle constitue une urgence diagnostique et thérapeutique. Sa gravité est liée à l'atteinte coronarienne qui survient chez 3–5 % des patients traités. Le défi de cette maladie est de deux types : (1) sa reconnaissance rapide, (2) la réduction de l'incidence des anévrismes coronariens (AC). Nous reprenons dans cette revue la prise en charge thérapeutique de cette maladie et notamment l'adjonction dans le cas de MK sévère d'un traitement adjuvant par corticothérapie qui semble réduire l'incidence des AC notamment dans les populations asiatiques. D'autres traitements (anti-TNF, anti-IL-1, ciclosporine) peuvent également apporter un bénéfice, mais les données sont à ce jour limitées et ne permettent pas leur indication en 1re intention mais seulement en cas de MK réfractaires après une ou deux doses d'IgIV. Kawasaki disease (KD) is the most common vasculitis in children under 5 years of age. It is a diagnostic and therapeutic emergency. Its severity is related to its coronary involvement, which occurs in 3–5 % of patients treated. The challenge of this disease is twofold: (1) its rapid recognition, (2) the reduction of the incidence of coronary aneurysm (CA). In this review, we discuss the therapeutic management of this disease and in particular the addition of adjuvant corticosteroid therapy in severe KD, which seems to reduce the incidence of CA, particularly in Asian populations. Other treatments (anti-TNF, anti-IL-1, ciclosporin) may also be of benefit, but the data are scarce and do not allow their indication as first-line treatment but only in cases of refractory MK after one or two doses of IVIG. [ABSTRACT FROM AUTHOR]

La maladie associée aux IgG4 est caractérisée par une ou plusieurs atteintes d'organes pseudotumorales pouvant atteindre virtuellement tous les organes, et partageant des lésions histologiques communes. Dans cette monographie, nous proposons une revue de la littérature synthétisant les différentes atteintes d'organes possibles, les principales caractéristiques biologiques et histologiques retrouvées chez ces patients, ainsi que les critères diagnostiques et de classification à disposition des cliniciens. Un focus est également réalisé sur les exceptionnelles atteintes articulaires de la maladie ainsi que sur les rares formes secondaires/de chevauchement avec d'autres maladies systémiques. Enfin, les récentes avancées dans la compréhension physiopathologique de la maladie sont présentées, ainsi que les principales recommandations et avis d'experts concernant la prise en charge thérapeutique de ces patients. IgG4-related (IgG4-RD) disease is a rare multi-organ fibro-inflammatory condition characterized by mass lesions and strictures, that can affect virtually all organs with characteristic histological lesions. In this review, we purpose an overview of the different organ involvements, biological and histological characteristics of the patients, as well as a literature review on diagnostic and classification criteria available for physicians. A specific focus on anecdotal IgG4-related arthritis/synovitis and rare "secondary" IgG4-RD associated with other systemic immune-mediated conditions is also purposed for rheumatologists. Finally, recent advances on pathophysiology are presented, as well as main expert consensus and recommendations on IgG4-RD management. [ABSTRACT FROM AUTHOR]

Les sclérites et épisclérites sont des maladies inflammatoires oculaires rares mais qui méritent d'être connues des internistes du fait de leur association fréquente à des maladies systémiques auto-immunes ou inflammatoires. Leur distinction par l'interrogatoire et l'examen ophtalmologique est importante car leur prise en charge, leur pronostic et leurs complications potentielles sont très différents. L'épisclérite représente une inflammation oculaire superficielle, de bon pronostic visuel avec un traitement souvent local, habituellement sans complication. Elle est très rarement associée à une maladie systémique auto-immune. En revanche, la sclérite est une atteinte ophtalmologique potentiellement grave qui peut menacer le pronostic visuel en l'absence de traitement systémique adapté. Elle est associée à une maladie sous-jacente dans 40 à 50 % des cas, en particulier une maladie systémique auto-immune (25 à 35 % des cas) ou une cause infectieuse (5 à 10 % des cas). La polyarthrite rhumatoïde et les vascularites systémiques, en particulier les vascularites associées aux anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA), sont les principales causes auto-immunes de sclérites et d'épisclérites. Les sclérites peuvent constituer une porte d'entrée révélatrice de la maladie auto-immune sous-jacente et imposent des explorations étiologiques systématiques. Elles nécessitent dans les formes agressives, compliquées, réfractaires ou associées à une maladie systémique auto-immune, le recours à une corticothérapie générale, voire un traitement immunosuppresseur, ainsi qu'une étroite collaboration entre ophtalmologues et internistes. L'avènement des biothérapies offre de nouveaux outils thérapeutiques efficaces dans la prise en charge de ces cas difficiles. Scleritis and episcleritis are rare ocular inflammatory diseases but deserve to be known by internists because of their frequent association with systemic autoimmune diseases. It is important to distinguish them between because their prognosis, therapeutic management and potential complications are very different. Episcleritis represents a superficial ocular inflammation with usually benign visual prognosis, no complication with local treatment, and is associated with a systemic autoimmune disease in rare cases. In contrast, scleritis is a potentially serious ophthalmological condition that can threaten the visual prognosis in the absence of appropriate systemic treatment. It is associated with an underlying disease in 40–50% of cases, in particular a systemic autoimmune disease (25–35% of cases) or an infectious cause (5–10% of cases). Rheumatoid arthritis and systemic vasculitides, particularly antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides, are the main autoimmune causes of scleritis and episcleritis. Scleritis can reveal the underlying autoimmune disease and requires systematic etiological investigations. Aggressive, complicated, refractory forms or those associated with a systemic autoimmune disease require glucocorticoids or even immunosuppressants, and close collaboration between ophthalmologists and internists is required. The development of biologic agents offers new effective therapeutic tools in the management of these difficult cases. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infections (CDI) are a heterogeneous entity with -multiple clinical presentations. The incidence of CDI has significantly increased over the last 30 years with the emergence and dissemination of hypervirulent and -hyperepidemic clones which extend to the community environment. Prevention is based on reducing inappropriate antibiotic consumption, early identification of patients at risk of CDI and those who may progress to severe and/or recurrent forms. Fidaxomicin was an important therapeutic innovation and is now used as first line therapy. Oral metronidazole has no place in current therapeutic algorithms. Finally, fecal microbiota transplantation is today the treatment of choice of the 2nd recurrence. Beztoloxumab can be used in cases of ICD with a high risk of recurrence or first recurrence. [ABSTRACT FROM AUTHOR]

Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex. l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disease affecting almost 1% of children, starting the first months of life. In some journals, this prevalence is reported to be between 0.4 and 0.7%. We are reporting a case of childhood psoriasis in a 2-year-old patient. The case was observed in the Dermatology unit at the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM). The case clinical description will allow us to show the difficulties in establishing a diagnosis and how little are the treatment choices available in our clinical settings. [ABSTRACT FROM AUTHOR]

La clozapine est le traitement de référence dans la schizophrénie résistante. Cette molécule, bien qu'ayant prouvé son efficacité dans de nombreuses études, reste largement sous-prescrite dans son indication principale. La réalisation de programmes d'éducation thérapeutique du patient (ETP) centrée sur cette molécule pourrait permettre, d'une part, de favoriser la prescription de cette molécule et, d'autre part, de favoriser l'adhésion thérapeutique des patients à ce traitement via une meilleure connaissance de celui-ci. Cet article présente le programme d'ETP « Vivre avec la clozapine » élaboré pour l'initiation et le suivi des patients sous clozapine. Clozapine is the reference treatment for resistant schizophrenia. Although its efficacy has been widely demonstrated in numerous studies, it remains largely under-prescribed in its main indication. Therapeutic patient education (TPE) programs focused on clozapine could, on the one hand, promote the prescription of this drug and, on the other, encourage patients to adhere to the treatment schedule by improving their knowledge of its effectiveness. This article presents the TPE program entitled " Living with clozapine " developed to support the initiation and follow-up of patients being treated with clozapine. [ABSTRACT FROM AUTHOR]

For more than 30 years, suicide has been the second cause of death among 15-24 year olds and the 5th cause of death among those under 13. In 2016, 26 deaths by suicide were recorded among those under 15 and 352 among those aged 15-24, i.e. respective rates of 0.3 and 4.5 per 100,000 inhabitants [1]. In a first file [2] we saw the different types of interventions to prevent the risk of suicide among adolescents and the effectiveness of collective prevention approaches. In this second file we address the identification and treatment in general medicine consultation. [ABSTRACT FROM AUTHOR]

Il existe très peu de données cliniques françaises sur les modalités de prise en charge médicale des enfants et adolescents transgenres alors que le sujet vient très régulièrement sur le devant de la scène médiatique. Nous proposons dans cet article de décrire de manière rétrospective l'ensemble des enfants et adolescents reçus depuis 2012 dans la plus importante consultation spécialisée identité de genre enfants et adolescents d'Île-de-France. Outre leurs caractéristiques sociodémographiques, nous étudions la présence ou non d'une incongruence de genre selon les critères de la CIM 11, les vulnérabilités psychiatriques et sociales des sujets et décrivons les principales modalités de prise en charge proposées : la transition sociale, le blocage pubertaire, les transitions hormonales et/ou les rares transitions chirurgicales. Ces trois dernières propositions sont discutées en réunion de concertation pluridisciplinaire (RCP). Nous avons colligé 239 jeunes âgés de 3 à 20 ans. L'âge moyen auquel les jeunes et leur famille sont vus au premier rendez-vous est de 14,5 ans (± 3,16). Au total, 91 % de l'échantillon présentent une incongruence de genre, 32 % ayant exprimé cette incongruence avant la puberté. Deux-tiers sont des jeunes assignés de sexe féminin à la naissance (p < 0,05). En termes de psychopathologie, les troubles dépressifs et anxieux, ainsi que la suicidalité arrivent largement avant les autres cooccurrences psychiatriques. L'ostracisme et le rejet scolaire sont fréquents. Par rapport à la population adolescente générale, les jeunes de la consultation spécialisée sont beaucoup plus exposés aux discriminations et aux insultes, voire aux agressions sexuelles dans l'espace public, que leurs pairs et l'internalisation de la transphobie par ces jeunes est particulièrement importante. Au total, 40 % des jeunes ont effectué une transition sociale avant le premier rendez-vous et 74 % et 61 % d'entre elles/eux l'on fait au sein de la famille et à l'école (l'âge moyen de la transition sociale à l'école = 15,13 ans). Au total, 35 % des jeunes ont officialisé en mairie le changement de prénom (l'âge moyen = 16,26 ans). La prise de bloqueurs de puberté concerne 11 % des jeunes qui ont atteint la puberté (âge moyen = 13,9 ans, délai moyen avant instauration du traitement = 10 mois). Au total, moins de la moitié des jeunes (44 %) ont reçu un traitement hormonal masculinisant ou féminisant par hormones sexuelles (âge moyen = 16,9 ans, délai moyen avant l'instauration = 14 mois). Au total, 8,7 % des jeunes ayant reçu un traitement hormonal par hormones sexuelles ont réalisé une préservation de fertilité. Les demandes de chirurgie avant 18 ans restent très rares. Les plus fréquentes sont les torsoplasties (20 %) réalisées à l'âge moyen de 18,44 ans et jamais avant 16 ans. Les résultats de cette cohorte sont proches de ceux rapportés par d'autres centres européens pour ce qui concerne la proportion plus élevée de jeunes assignés de genre féminin à la naissance. En revanche, ils diffèrent avec des chiffres plus bas en termes de recours à des traitements hormonaux. La transition sociale est dans notre centre la demande la plus fréquente mais elle n'est pas systématique. Nous discuterons la place de la parole dans notre accompagnement pour expliquer ces différences. French clinical data on the medical management of transgender children and adolescents are scarce. Yet, the topic regularly comes to the forefront of the media. In this article, we propose to retrospectively describe all the children and adolescents received since 2012 in the largest specialized gender identity consultation for children and adolescents in Île-de-France. In addition to their sociodemographic characteristics, we study the presence or not of gender incongruence according to the ICD 11 criteria, the psychiatric and social vulnerabilities, and describe the main management modalities proposed: social transition, puberty blockage, hormonal transitions and/or rare surgical transitions. These last three proposals were discussed in multidisciplinary concertation meetings. We collected 239 youths aged 3 to 20 years. The mean age at which youth and their families were seen at the first appointment was 14.5 years (± 3.16). In all, 91% of the sample had gender incongruence, with 32% expressing gender incongruence before puberty. Two-thirds were youth assigned female at birth (P < 0.05). In terms of psychopathology, depressive and anxiety disorders, as well as suicidality, came well ahead of other psychiatric co-occurrences. School ostracism and rejection were common. Compared to the general adolescent population, the young people in the specialized consultation are much more exposed to discrimination and insults, and even sexual aggression in the public space, than their peers, and the internalization of transphobia by these young people is particularly important. In all, 40% of the young people made a social transition before the first consultation and 74% and 61% of them did so within the family and at school (the average age of social transition at school = 15.13 years). In all, 35% of the young people made the name change official at the town hall (the average age = 16.26 years). Puberty blockers were used by 11% of the youths who had reached puberty (mean age = 13.9 years, mean time to initiation = 10 months). In total, fewer than half of the youths (44%) received masculinizing or feminizing sex hormone treatment (mean age = 16.9 years, mean time to initiation = 14 months). In all, 8.7% of the young people who received sex hormone treatment underwent fertility preservation. Requests for surgery before the age of 18 remain very rare. The most frequent are torsoplasties (20%) performed at a mean age of 18.44 years and never before 16 years. The results of this cohort are close to those reported by other European centers in terms of the higher proportion of young people assigned female at birth. However, they differ with a lower proportion of hormonal treatment. Social transition is the most frequent request in our center, but it is not systematic. We wonder whether the place of narration while in our care may explain these differences. [ABSTRACT FROM AUTHOR]

This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is a chronic autoimmune disease involving vascular thrombosis and/or obstetric morbidity and persistent antibodies to phospholipids or certain phospholipid-associated proteins. It is a rare condition in adults and even rarer in children. The diagnosis of APS can be facilitated by the use of classification criteria based on a combination of clinical and biological features. APS may be rapidly progressive with multiple, often synchronous thromboses, resulting in life-threatening multiple organ failure. This form is known as "catastrophic antiphospholipid syndrome" (CAPS). It may be primary or associated with systemic lupus erythematosus (associated APS) and in very rare cases with other systemic autoimmune diseases. General practitioners and paediatricians may encounter APS in patients with one or more vascular thromboses. Because APS is so rare and difficult to diagnosis (risk of overdiagnosis) any suspected case should be confirmed rapidly and sometimes urgently by an APS specialist. First-line treatment of thrombotic events in APS includes heparin followed by long-term anticoagulation with a VKA, usually warfarin. Except in the specific case of stroke, anticoagulants should be started as early as possible. Any temporary discontinuation of anticoagulants is associated with a high risk of thrombosis in APS. A reference/competence centre specialised in autoimmune diseases must be urgently consulted for the therapeutic management of CAPS. [ABSTRACT FROM AUTHOR]

Our study of the most representative case series of children and teenagers with thyroid cancer in Morocco (22 cases) aimed to highlight the characteristics of this cancer among children and teenagers and to compare results with those in the international literature. We conducted a retrospective, descriptive study of patients with differentiated thyroid cancer, hospitalized in the Department of Otolaryngology-Head and Neck Surgery at the Hospital in Casablanca, Morocco, over the period January 1995-March 2015. We collected data about 22 cases that met our inclusion criteria. The average age of our patients was 14 years, sex-ratio was 3.4, most of our patients presented with thyroid nodule associated, in 22.7% of cases, with cervical lymphadenopathy and in 9.1% of cases with signs of compression. All patients underwent total thyroidectomy followed by lymph node dissection in 31.82% of cases. The diagnosis of thyroid cancer was based on anatomo-pathological examination of the surgical specimen which confirmed the diagnosis of papillary carcinoma in 95.4% of cases and of vesicular carcinoma in 4.5% of cases. 100% of cases received I-131 RAI treatment followed by thyroid hormone replacement therapy. Close supervision and regular monitoring enabled the detection of nodal metastasis in 3 patients and of distance metastases in 4 patients. Differentiated thyroid cancer among children and teenagers is rare but aggressive, its treatment is based on surgery associated with iratherapy enabling excellent prognosis. [ABSTRACT FROM AUTHOR]

Jusqu'à tout récemment, la population générale avait tendance à croire qu'une femme ne pouvait être l'auteur de comportements sexuels coercitifs. Tandis qu'il est difficile d'identifier les éléments ayant pu alimenter cette croyance, il est possible que celle-ci soit associée à des conceptions erronées concernant les comportements féminins (exemple : une femme est rarement violente, elle est plutôt la cible de violences) et/ou les agressions sexuelles (exemple : une agression sexuelle consiste en un viol, cela implique nécessairement une pénétration vaginale pénienne). Cependant, la recherche a mis en évidence ces dernières années que les femmes sont aussi capables de commettre des infractions sexuelles (exemple : attouchements), seules ou avec un partenaire, parfois sous la contrainte et d'autres fois de leur propre initiative. Qui sont donc ces femmes ? Dans le cadre de cet entretien avec Jean-Pierre Bouchard, c'est à cette question qu'Alexandre Gauthier, Ingrid Ménard, Tamsin Higgs et Jonathan James tentent de répondre, en abordant : les fausses croyances entourant cette forme de délinquance et leurs impacts sur les taux de prévalence ; le profil type de la délinquante sexuelle, en distinguant celles qui agissent seules de celles qui agissent avec un partenaire ; et les principaux modèles explicatifs de cette forme de délinquance. Les chercheurs terminent en présentant les principaux paramètres à prendre en considération dans la prise en charge de ces femmes dans un contexte thérapeutique. Until recently, the general population tended to believe that a woman could not be the perpetrator of coercive sexual behavior. While it is difficult to identify what may have fueled this belief, it may be associated with misconceptions about female behavior (example: a woman is rarely violent, but rather the target of violence) and/or sexual assault (example: a sexual assault is rape, which necessarily involves penile vaginal penetration). However, research in recent years has shown that women are also capable of committing sexual offenses (example: touching), alone or with a partner, sometimes under duress and other times on their own initiative. Who are these women? During this interview with Jean-Pierre Bouchard, Alexandre Gauthier, Ingrid Ménard, Tamsin Higgs, and Jonathan James attempt to answer this question by addressing: the false beliefs surrounding this form of delinquency and their impact on prevalence rates; the typical profile of female sexual offenders, distinguishing between those who act alone and those who act with a partner; and the main explanatory models of this form of delinquency. The researchers conclude by presenting the main parameters to be considered in the management of these women in a therapeutic context. [ABSTRACT FROM AUTHOR]

L'hyper-médicalisation de nos sociétés et notre confiance sans borne envers la médecine curative nous ont fait peu à peu perdre le sens profond des mots des maux. Nombreux sont aujourd'hui ceux qui interpellent les pouvoirs publics afin que soit promue une « politique du Care ». Le recours aux anglicismes est assurément « tendance » mais opposer le « cure » et le « care » ne fait pas sens. Nous invitons le lecteur à tenter de recouvrer la signification et la valeur du verbe soigner et du mot soin(s), pluriel et pourtant si singulier. Pour mener cette quête nous porterons notre attention sur quelques œuvres d'art qui peut-être nous permettrons, en trois temps, de (re)découvrir le sens profond de la relation de soins. The hyper-medicalization of our societies and our absolute confidence in curative medicine have made us gradually lose the deep meaning of the words of ailments. Many are now calling on the public authorities to promote a "policy of Care". The use of anglicisms is certainly "trendy" but opposing "cure" and "care" does not make sense. We invite our readers to try to recover the meaning and the value of the verb to treat and the word care(s), plural and yet so singular. To carry out this quest, we will focus our attention on a few works of art which will perhaps allow us, in three stages, to (re)discover the deep meaning of the care relationship. [ABSTRACT FROM AUTHOR]

Sjögren's disease (SD), also known as Sjögren's syndrome (SS) or Gougerot-Sjögren's syndrome in France, is a rare systemic autoimmune disease in its primary form and is characterised by tropism for the exocrine glandular epithelia, particularly the salivary and lacrimal glands. The lymphocytic infiltration of these epithelia will clinically translate into a dry syndrome which, associated with fatigue and pain, constitutes the symptom triad of the disease. In about one third of patients, SD is associated with systemic complications that can affect the joints, skin, lungs, kidneys, central or peripheral nervous system, and lymphoid organs with an increased risk of B-cell lymphoma. SD affects women more frequently than men (9/1). The peak frequency is around the age of 50. However, the disease can occur at any age, with paediatric forms occurring even though they remain rare. SD can occur alone or in association with other systemic autoimmune diseases. In its isolated or primary form, the prevalence of SD is estimated to be between 1 per 1000 and 1 per 10,000 inhabitants. The most recent classification criteria were developed in 2016 by EULAR and ACR. The course and prognosis of the disease are highly variable and depend on the presence of systemic involvement and the severity of the dryness of the eyes and mouth. The current approach is therefore to identify at an early stage those patients most at risk of systemic complications or lymphoma, who require close follow-up. On the other hand, regular monitoring of the ophthalmological damage and of the dental status should be ensured to reduce the consequences. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the initial results of our different treatments of open humeral shaft fractures. Method: This was a retrospective study conductecd in Abidjan (Ivory Coast) over a period of 10 years, involving 16 open humeral shaft fractures. It included 10 men and six women with a mean age of 32.8 years (Extremes: 21 and 61). The skin opening was classified according to Cauchoix and Duparc. Fractures were either treated by trimming followed by a brachial-ante-brachial cast, or treated with a screwed plate or external fixator. Patients were followed according to a strict protocol. Overall results were assessed by Stewart and hundley functional scoring. Results: At a minimum follow-up of 24 months, all patients had consolidated. There was one case of local infection, three cases of elbow stiffness and four reversible cases of radial nerve palsy. The functional results according to the Stewart and Hundley score were very good in 11 cases, good in four cases and fair in one case, with no poor result. Conclusion: Depending on the therapeutic indications, the initial results are satisfactory both clinically and functionally. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify ways of improving the germination capacity of Stereospermum kunthianum seeds for domestication in Chad. Aqueous pre-treatments by soaking mature seeds selected using the ordinary viability test, were carried out at three different temperatures (tap water (Er=0°C), heated (E50° C) and boiled (E100° C). Soaking lasted 24 hours for all seeds. Seedlings were sown in transparent germinators lined with hydrophilic paper. After dormancy was lifted, explants were transplanted onto five substrates: black earth (Tn), fine sand (Sf), sawdust (Scb), 1/1 mixtures of sawdust/black earth (Scb/Tn) and sawdust/fine sand (Scb/Sf). The results obtained compared with the control (T0) show that Er and E50° C induce a remarkable reduction in latency time (62h/6 days (T0)), germination time (3 days/7 days (T0)) and significantly improve germination rate (100%). Poor radicle orientation and the chemical nature of the substrate could reduce this rate. S. kunthianum seeds showed an epigeic germination pattern. On transplanting, the 1/1 mixed substrates of Scb/Tn (98.789%) and Scb/Sf (88.89%) performed best. Domestication of S. kunthianum is therefore possible through seed pre-treatment. [ABSTRACT FROM AUTHOR]

Despite current workplace protection measures, chemical burn accidents are not uncommon. Among these, alkali burn isthe most challenging due to itssilent behaviour and aggressive mechanism. Characterized by its initial painless onset, allowing a prolonged exposure, it tends to result in deeper and more destructive burns, creating major reconstructive and therapeutic challenges. This case concerns a 53-year-old male who sustained a full thickness burn of hisleft instep foot after prolonged contact with an alkalisubstance. The wound wassubmitted to severalsurgical debridement procedures, with preservation of the major tendinous and vascular-nervousstructures. The skin defect wasthen repaired with skin graft. Early recognition and prompt management with copious and prolonged wound irrigation is paramount. As in this type of burn it is difficult to initially assessitstrue depth, even after initial surgical debridement, a more cautious approach is recommended. Chronic pain is associated with chemical burns and itshould be treated early in the process with the use of multimodal analgesia in order to prevent future complications. No matter the absence of major complaintsin the 4 week-postoperative evaluation, the possible long-term consequences are still unknown. Despite the prolonged exposure time and the initial presentation with a deep burn, after several surgical debridement procedures, preservation of major tendon and neurovascular structures was assured, which allowed a plain approach for reconstruction of the wound with a skin graft. The case illustrates different challenges associated with evaluation and treatment of patients with deep alkali burns. Also, usage auditing and awareness of regular users appear to be essential. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the existing scientific knowledge on Internet Gaming Disorder among young adults ranging from 18 to 30 years old. The phenomena’s evolution, the many definitions of the concept, the role of massively multiplayer online roleplaying games (MMORPG) and random reward mechanisms, known risk factors and consequences along with potential existing treatments are examined in the present review. Conclusions on the understanding of the disorder and its treatment are then drawn based on the current literature. Suggestions on where future research endeavors should be oriented are also made according to the drawn conclusions. [ABSTRACT FROM AUTHOR]

Acute generalized peritonitis is a surgical emergency and remains a public health problem in Africa. Our goal was to determine the epidemiological, diagnostic and therapeutic aspects of acute generalized peritonitis in the Ziguinchor Hospital. We carried out a retrospective study of 51 patient files received at the Ziguinchor hospital for acute generalized peritonitis during 2018. These were 37 men and 14 women (sex ratio = 2.67). The average age was 31.94 years old. Medico-surgical history wasfound in 13 patients. Abdominal pain was the main reason for consultation (96.07%). The average consultation time was 5.1 days. Sixty percent (60%) of patients presented with fever (T > 37.5ºc). Peritoneal irritation syndrome was present in 44 patients (86.27%). Twenty-nine (29) patients presented a predominantly neutrophilic hyperleucocytosis (59.18%), and the C reactive protein (CRP) was positive in 90% of cases. Plain abdominal x-ray was done in 18 patients, and showed the presence of pneumoperitoneum in 9 patients. 30 patients underwent an abdominal ultrasound (58.81%). CT scan was done in 7 patients. All of our patients underwent a midline laparotomy under general anesthesia. Appendicitis complicated by peritonitis wasthe main cause with 49.1% (N = 25) and gastrointestinal perforation accounted for 29.4% (N = 15). Antibiotic therapy was with ceftriaxone and metronidazole. The average length of hospital stay was 9.2 days with extremes ranging of 1 and 40 days. Morbidity was 14.9%, dominated by deep surgicalsite infection and a mortality of 7.84%. Acute generalized peritonitis was the 3rd surgical emergency in Ziguinchor, and the most common cause remains complicated appendicitis. [ABSTRACT FROM AUTHOR]

La stéatopathie non alcoolique (NAFLD) atteint 20 à 30 % de la population mondiale et est devenue la première cause de maladie chronique du foie. Cette prévalence en augmentation est en lien avec l'explosion de l'épidémie d'obésité et de syndrome métabolique. Le pronostic de la NAFLD est principalement lié au degré de fibrose hépatique, pouvant être évalué à l'aide de tests non-invasifs. L'objectif de la prise en charge thérapeutique est de limiter la progression, voire d'améliorer les lésions histologiques avec en premier lieu une résolution de la NASH et une régression de la fibrose. Cet objectif hépatique doit s'intégrer dans la problématique métabolique globale. Le traitement médical de la NAFLD repose sur une prise en charge pluridisciplinaire et personnalisée afin d'induire un changement du mode de vie et une réduction pondérale. En effet, une perte de poids de 7 à 10 % permet une amélioration des lésions histologiques, mais reste difficile à obtenir dans la pratique quotidienne. Aucun traitement n'est pour le moment recommandé dans le traitement de NAFLD mais de nombreuses molécules sont en développement. Les résultats concernant les molécules dont le développement est relativement avancé et disposant de suffisamment de données cliniques seront détaillés. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The high prevalence of NAFLD is related to rising rates of obesity and metabolic syndrome. NAFLD prognosis is most closely linked with fibrosis stage, which can be assessed using non-invasive tests. Therapeutic endpoints include NASH resolution and fibrosis improvement. This hepatic endpoint must be integrated into the overall metabolic issue. Therapeutic strategy is based on lifestyle interventions and weight loss. Indeed, weight loss of 7–10% can reverse liver fibrosis, but adherence to lifestyle changes remains a major problem in real life. There are currently no approved pharmacological treatments for NASH. However, several therapeutic agents are rapidly progressing through the different phases of clinical trials. We provide a summary of recent therapeutic options with most advanced results. [ABSTRACT FROM AUTHOR]

Dans des sous-groupes de patients, la consommation de tabac ainsi que la parodontite chronique (PC) jouent un rôle direct ou indirect dans le développement des rhumatismes inflammatoires chroniques (RIC) et dans l'exacerbation de leur activité voire de leur sévérité. Elles peuvent également influencer la réponse aux traitements de fond. Leur impact sur le devenir du rhumatisme est surtout documenté dans la polyarthrite rhumatoïde (PR) et à un moindre degré dans les spondyloarthrites (SPA) avec ou sans psoriasis. Bien qu'il soit encouragé par les professionnels de santé, l'arrêt du tabac est constaté dans une faible proportion de cas (10 à 30 %). Ce faible taux est lié à de nombreux freins. Les études ayant évalué l'efficacité de programmes visant à l'arrêt du tabac dans les RIC et/ou les effets de l'arrêt de la consommation de tabac sur l'activité et la sévérité de la maladie sont en nombre limité et de qualité moyenne. Elles concernent principalement la PR. Un arrêt précoce (dans la première année) du tabagisme après le début de la maladie semble avoir davantage d'impact sur l'activité de la PR qu'un arrêt tardif. Il est important d'identifier précocement une PC et de mettre en œuvre des actions curatives et préventives. L'impact des traitements de fond de la PR apparaît hétérogène sur la PC. Sous réserve de leur qualité méthodologique, plusieurs études ont montré les effets bénéfiques d'un traitement non chirurgical de la PC sur le statut clinique de la PR, notamment sur son activité clinique et échographique, sur certains paramètres parodontaux et possiblement sur le taux d'ACPA. En revanche, un programme d'hygiène bucco-dentaire chez les patients atteints de PR tout venant n'aurait pas d'impact direct sur l'activité de la PR sauf chez ceux ayant une PC ou une charge bactérienne parodontale importante. L'impact de l'arrêt du tabac et/ou du traitement médical de la PC n'a pratiquement pas été étudié dans les SPA avec ou sans psoriasis. In subgroups of patients, tobacco consumption and chronic periodontitis (CP) play a direct or indirect role in the development of chronic inflammatory rheumatism CIR) and in the exacerbation of their activity or even their severity. They can also influence the response to disease-modifying treatments (DMARDs). Their impact on the outcome of rheumatism is mainly documented in rheumatoid arthritis (RA) and to a lesser degree in spondyloarthritis (SPA) with or without psoriasis. Although it is encouraged by health professionals, smoking cessation is observed in a small proportion of cases (10 to 30%). This low rate is linked to many obstacles. Studies that have assessed the effectiveness of programs aimed at quitting smoking in CIRs and/or the effects of quitting smoking on the activity and severity of the disease are limited in number and of low or medium quality. They mainly concern RA. Early (within the first year) smoking cessation after disease onset appears to have a greater impact on RA activity than late cessation. It is important to identify a CP early and to implement curative and preventive actions. The impact of DMARDs for RA appears to be heterogeneous on CP. Subject to their methodological quality, several studies have shown the beneficial effects of non-surgical treatment of CP on the clinical status of RA, in particular on its clinical and ultrasound activity, on certain periodontal parameters and possibly on the rate of ACPA. On the other hand, an oral hygiene program in patients with RA would not have a direct impact on the activity of RA except in those with CP or a significant periodontal bacterial load. The impact of smoking cessation and/or medical treatment of CP has poorly been studied in SPAs with or without psoriasis. [ABSTRACT FROM AUTHOR]

Introduction: although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. The aim of this work is to study the clinical, paraclinical, therapeutic and evolutionary features of GIST. Methods: we conducted a descriptive retrospective, monocentric study (April 2017-April 2021) collecting data from the medical records of all patients with GIST treated at the medical oncology department of the University Hospital of Mostaganem. Results: we collected data from the medical records of 23 patients, with a median age of 54.4 years, sex ratio 1.8, over a period of 4 years. Abdominal pain was the most frequent symptom (78.3%, n=18); 47.8% of patients (n=11) had a tumor in the small bowel. The diagnosis was made at an early stage in 69.6% of cases (n=16). Surgical treatment was performed in 20 of the 23 patients, 18 of whom with R0. Of the 15 operated patients with a localized tumor, 13 received adjuvant medical treatment (Imatinib). Disease progression was reported in three patients treated with imatinib, then 2nd line therapy (Sunitinib) was started. During the study period, all patients were alive except two who died due to disease progression. Conclusion: the diagnosis of GIST is mainly based on histology and immunohistochemistry, which is often not performed by our pathologists. Molecular biology makes it possible to predict the prognosis and consequently adapt the therapies. The outcome of patients with GIST is often favorable but marked by recurrences despite a supposedly curative treatment requiring prolonged monitoring. [ABSTRACT FROM AUTHOR]

Abstract: Functional dyspepsia (FD) and irritable bowel syndrome (IBS), two common gastrointestinal entities with overlapping symptoms, should be diagnosed according to Rome IV criteria. This includes one or more of the following symptoms: in FD, postprandial fullness, early satiation, epigastric pain or burning; in IBS, recurrent abdominal pain associated with defecation, change in frequency of stool or form of stool. To exclude structural diseases, attention should be paid to alarm symptoms. As far as treatment is concerned, a stepwise scheme proves to be effective for both diseases. Step 1: doctor-patient discussion with explanation of diagnosis and prognosis as well as clarification of therapy goals; lifestyle adaptations; use of phytotherapeutics; step 2: symptom-oriented medication: for FD, PPIs or prokinetics; for IBS, antispasmodics, secretagogues, laxatives, bile acid sequestrants, antidiarrheals, antibiotics, probiotics; step 3: visceral analgesics (antidepressants). [ABSTRACT FROM AUTHOR]

Introduction: This systematic review examines the effectiveness of metformin treatment compared to insulin treatment for gestational diabetes within the context of a low-resource environment. Methods: Electronic data searches of Medline, EMBASE, Scopus and Google scholar databases from 1 January, 2005 to 30 June, 2021 were performed using medical subject headings: 'gestational diabetes or pregnancy diabetes mellitus' AND 'Pregnancy or pregnancy outcomes' AND 'Insulin' AND 'Metformin Hydrochloride Drug Combination/or Metformin/or Hypoglycemic Agents' AND 'Glycemic control or blood glucose'. Randomized controlled trials were included if: participants were pregnant women with gestational diabetes mellitus (GDM); the interventions were metformin and/ or insulin. Studies among women with pre-gestational diabetes, non-randomised control trials or studies with a limited description of the methodology were excluded. Outcomes included adverse maternal outcomes: weight gain, C-section, pre-eclampsia and glycaemic control and adverse neonatal outcomes: birth weight, macrosomia, pre-term birth and neonatal hypoglycaemia. The revised Cochrane Risk of Bias Assessment for randomised trials was used for the evaluation of bias. Results: We screened 164 abstracts and 36 full-text articles. Fourteen studies met the inclusion criteria. The studies provide moderate to high-quality evidence demonstrating the effectiveness of metformin as an alternative therapy to insulin. Risk of bias was low; multiple countries and robust sample sizes improved external validity. All studies were from urban centres with no rural data. Conclusion: These recent high quality studies comparing metformin to insulin for the treatment of GDM generally found either improved or equivalent pregnancy outcome and good glycaemic control for most patients, although many required insulin supplementation. Its ease of use, safety and efficacy suggest metformin may simplify the management of gestational diabetes, particularly in rural and other low-resource environments. [ABSTRACT FROM AUTHOR]

L'arthrose digitale a fait l'objet de très nombreuses publications ces dernières années. Dans le domaine de l'imagerie, il faut noter les très nombreux travaux conduits en IRM et en échographie. Ces derniers ont mis en évidence la bonne corrélation entre la présence de synovites et/ou d'un œdème sous chondral et la douleur articulaire arthrosique. L'arthrose digitale a surtout été un véritable laboratoire d'évaluation des biothérapies et des traitements de fond conventionnel des rhumatismes inflammatoires chroniques. Ainsi, pas moins de 6 essais randomisés contrôlés ont évalué l'efficacité symptomatique et pour certains, structurale, des traitements anti-IL-1β, anti-TNF-α ou Ac anti-IL-6R. Globalement, les résultats de ces essais sont décevants, aucun n'ayant démontré une supériorité par rapport au placebo. Il faut aussi citer deux essais négatifs avec l'hydroxychloroquine. Le seul essai finalement positif est celui ayant évalué une petite cortisonothérapie orale (10 mg/j) versus placebo durant 6 semaines chez des patients souffrant d'une arthrose digitale en poussée avec synovite échographique. Ce dernier essai vient confirmer le rôle de l'inflammation au cours de cette affection, mais ne doit évidemment pas inciter à utiliser la cortisone au long cours comme traitement symptomatique. Hand osteoarthritis (OA) has been the subject of numerous publications in recent years, notably in the field of imaging and therapeutics. Several RCTs have assessed the efficacy of biotherapies and conventional DMARDs in patients with symptomatic hand OA. No less than 6 randomized controlled trials have evaluated the symptomatic and, in some cases, structural efficacy of anti-IL-1, anti TNF or anti-IL-6 drugs. Overall, the results of these trials were disappointing, none of them having demonstrated superiority over placebo. There were also two negative trials with hydroxychloroquine. The only trial that was finally positive was the one that evaluated a small oral steroid therapy (10 mg/) versus placebo for 6 weeks in patients with relapsing digital osteoarthritis with ultrasound synovitis. This latest trial confirms the role of inflammation in this condition, but should obviously not encourage the use of long-term cortisone as a symptomatic treatment. [ABSTRACT FROM AUTHOR]