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A significant number of preventable deaths occur during pregnancy and childbirth in developing countries where maternal mortality ranges from 500 to 1000 per 100,000 live births; for every woman who dies, an estimated 16 to 30 more survive with preventable complications. Obstetric fistula can be considered the most tragic complication during childbirth. WHO estimates that there are about 2 million cases of VVF worldwide and 50,000 to 100,000 new cases each year. [5, 6] The vast majority of cases are reported in sub-Saharan Africa and Southeast Asia where qualified obstetric assistance is random. Obstetric fistulas are thus a major public health problem in poor countries. Obstetric fistula is an abnormal communication between the urinary tract (the ureter, bladder and urethra) and/or digestive (rectum), on the other hand the genitals (the uterus and vagina) occurring during delivery. Various types of fistula are distinguished: uretero-vaginal fistulas, vesico-uterine fistulas and vesico-vaginal fistulas (VVFs). These take into account uretro- vaginal fistulas. RVF, associated or not with a VVF, is a communication between the rectum and the vagina. The most common are VVFs. Many etiologies are recognized in VVFs, but studies in Africa have shown that in the majority of cases, are of obstetric cause. Obstetric Fistula occurs as a result of obstructed labor characterized by prolonged delivery without the possibility of caesarean section. Uretero-vaginal fistula is characterized by the ectopic drainage of the ureter in the vagina causing a permanent flow of urine through the vagina. Although the congenital origin is rare, iatrogenic etiology remains common during a caesarean section or poorly performed hysterectomy. It results from a ligation or damage of the ureter at its crossing with the uterine artery. The ureter attached to the vaginal wall eventually drains urine into the vagina within a few hours or days of the procedure. Duplicity and uretero-pyelic bifidity are rare abnormal uropathies whose surgical discovery is the most common diagnostic method in developing countries where high-tech diagnostic method is not affordable. The rarity of the pathology and the non-systematic prescription of certain analysis (as IVU) for the preoperative assessment of urogenital fistulas justify the paucity of the literature on this subject.

Objectives. The implementation of antimicrobial stewardship programs (ASPs) has become a usual practice in hospital settings. However, the method for monitoring antimicrobial use in accident and emergency departments (ED) is not yet adequately defined. Thus, the objective of this review is to describe antimicrobial use indicators used by ASPs implemented in ED. Material and methods. A systematic review was performed based on studies found in the following academic research databases: MEDLINE, EMBASE, Web of Science, and Scopus (Period: January 2000 to December 2019). Controlled clinical trials, before-and-after studies, interrupted time series, and repeated measures studies assessing the impact of ASPs on antimicrobial use in ED were included; studies published in languages other than English or Spanish were excluded from this review. Results. Twenty-six studies met the inclusion criteria and were included in this systematic review. In total, 15 (62.5%) studies described the ASP team members who collaborated with the ED staff. Most (21; 80.8%) studies used the percentage of patients with an antibiotic prescription as an indicator. Four (15.4%) studies included defined daily dose data. The antibiotic treatment duration was reported in four (15.4%) studies. Only two studies assessed the impact of the ASP using microbiological indicators, both of which used the incidence of infection with Clostridioides difficile as the indicator. Conclusions. The reports of experiences in implementing ASPs in ED show heterogeneous antimicrobial use indicators, which makes it difficult to compare results. Therefore, antimicrobial use indicators for ASPs must be standardised between hospital units.

Background and purpose: Early radiation-induced esophageal toxicity (RIET) is one of the major side effects in patients with non-small cell lung cancer (NSCLC) and can be a reason for treatment interruptions. As the age of patients with NSCLC and corresponding comorbidities continue to increase, primary radiotherapy alone is a commonly used alternative treatment in these cases. The aim of the present study is to compare dosimetric and clinical parameters from the previously reported CHARTWEL trial for their ability to predict esophagitis and investigate potential differences in the accelerated and conventional fractionation arm. Material and methods: 146 patients of the Dresden cohort of the randomized phase III CHARTWEL trial were included in this post-hoc analysis. Side effects were prospectively scored weekly during the first 8 weeks from start of radiotherapy. To compare both treatment arms, recorded dose-volume parameters were adjusted for the different fractionation schedules. Logistic regression was performed to predict early RIET for the entire study group as well as for the individual treatment arms. Differentdosimetric and clinical parameters were tested. Results: Patients receiving the accelerated CHARTWEL schedule experienced earlier and more severe esophagitis (e.g. 20.5% v . 9.6% ≤ grade 2 at week 3, respectively). In contrast, the median time period for recovery of grade 1 esophagitis was significantly longer for patients with conventional fractionation compared to the CHARTWEL group (median [range]: 21 [12-49] days vs. 15 [7-84] days, p=0.028). In univariable logistic regression none of the dose-volume parameters showed a significant correlation with early RIET grade  2 in the conventional irradiation group. In contrast, for patients receiving CHARTWEL, the physical dose-volumes parameters V40 and V50; and re-scaled values VEQD2,50 and VEQD2,60 were significant predictors of early RIET grade  2. Dose-volume parameters remained different between CHARTWEL and conventional fractionation even after biological rescaling. Conclusion: Our results show a more dominant dose-volume effect in the CHARTWEL arm compared to conventional fractionation, especially for higher esophageal doses. These findings support the notion that dose-volume parameters for radiation esophagitis determined in a specific and time dependent setting of field arrangements can not be easily transferred to another setting. In clinical practice esophageal volumes receiving 40 Gy or more should be strictly limited in hyperfractionated accelerated fraction schemes.

Gestational diabetes mellitus is the most commonly observed endocrine disorder during pregnancy. It results in severe fetal and maternal complications that can increase the fetal morbidity and mortality and the risk for overt diabetes in women. Identification of pregnant women at high risk for gestational diabetes mellitus is therefore needed for early detection in order to reduce its consequences for the mother, the fetus and the newborn. The objective of the study was to identify risk factors for gestational diabetes in a reference maternal health care centre in southern Benin. This was a case-control study carried out from 1st February 2015 to 31st July 2017 in reference maternal health care centre at the University Hospital of Porto-Novo. All pregnant women with a gestational age of 24 to 28 weeks of amenorrhea, who utilized antenatal care service of University Hospital of Porto-Novo, were screened for gestational diabetes mellitus. The chi-square test was used to identify risk factors for gestational diabetes mellitus. The statistical significance was fixed at p < 0.05. Of the 967 pregnant women participated in the study, 73 cases of gestational diabetes mellitus, were detected (7.5%). Risk factors of gestational diabetes identified were: maternal age ≥ 35 years [OR 7.82 CI 95% (4.75-12.89)], body mass index ≥ 25 kg/m2 [OR 9.56 CI 95% (5.17-17.70)], family history of diabetes at 1st degree [OR 2.78 CI 95% (1.53-5.06)], a history of fetal macrosomia [OR 7.25 CI 95% (3.11-16.92)], a history of stillbirth [OR 2.98 CI 95% (1.78-5.00)], an antecedent of more than two spontaneous miscarriages [OR 1.93 CI 95% (1.19-3.12)] and the personal history of hypertension [OR 3.91 CI 95% (1.52-10.07)]. This study confirmed the influence of maternal age and some medical and obstetric histories as risk factors of gestational diabetes mellitus. These pregnant women at high risk of gestational diabetes mellitus should benefit from early detection.