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La maladie de Sjögren est une affection auto-immune complexe qui persiste à poser d'importants défis malgré les progrès de la recherche. Il s'agit d'une maladie rare dont la prévalence est estimée entre 0,01 % et 0,05 %. Son incidence est variable selon les pays mais pourrait être en augmentation sur les deux dernières décennies. Les facteurs de risque, incluant les antécédents familiaux, le stress et les expositions hormonales, demeurent incomplètement élucidés. La maladie de Sjögren peut coexister avec d'autres maladies auto-immunes en particulier avec les thyroïdites auto-immunes, la polyarthrite rhumatoïde, le lupus érythémateux systémique et la sclérodermie systémique. C'est la maladie auto-immune au cours de laquelle l'augmentation du risque de lymphome est la plus importante. Il pourrait également y avoir, comme au cours d'autres maladies auto-immunes telles que la polyarthrite rhumatoïde ou le lupus, une augmentation du risque cardiovasculaire, bien que les preuves à ce sujet restent à consolider. Les recherches actuelles révèlent l'existence de divers sous-groupes de patients, définis par leurs symptômes, leurs paramètres clinico-biologiques, et/ou leur origine géographique. Cette variabilité est à l'origine de profils évolutifs différents et d'un risque de mortalité très fortement influencé par la présence ou non de lymphome, la survenue ce dernier étant particulièrement lié à l'activité systémique de la maladie. Cette revue générale abordera les bases épidémiologiques, l'hétérogénie phénotypique et pronostique soulignant la nécessité d'une approche thérapeutique individualisée au cours de la maladie de Sjögren. Sjögren disease is a complex autoimmune disorder with ongoing challenges despite research advances. It is a rare disease with an estimated prevalence between 0.01% and 0.05%. Its incidence varies by country but could be increasing over the last two decades. Risk factors, including family history, stress, and hormonal exposures, remain incompletely understood. Sjögren disease can coexist with other autoimmune diseases, particularly autoimmune thyroid disease, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. It is the autoimmune disease with the highest increased risk of lymphoma. There may also be, as in other autoimmune diseases such as rheumatoid arthritis or lupus, an increased risk of cardiovascular disease, although evidence remains to be consolidated. Current research reveals the existence of various patient subgroups, defined by their symptoms, clinical presentation, biological parameters, and/or geographic origin. This variability leads to different evolutionary profiles and a risk of mortality strongly influenced by the presence or absence of lymphoma, the occurrence of which is particularly linked to the systemic activity of the disease. This general review will address the epidemiological foundations, phenotypic and prognostic heterogeneity, highlighting the need for an individualized therapeutic approach in Sjögren disease. [ABSTRACT FROM AUTHOR]

Self-immolation represents a relatively frequent cause of burn, especially in Tunisia after the revolution, with high costs at the individual and societal level. In this retrospective study, we report epidemiological, clinical and evolutionary characteristics of burns by immolation at the CTB of Tunis over a period of 10 years. The study involved 755 patients over the 10 years. The mean age was 33.38 years with a sex ratio of 4.5:1 (618 M/ 137F). Half of the patients (51%) were single, 2/3 (74.3%) had an unfavourable or medium socioeconomic level, 35.8% were unemployed. The educational level was secondary in 46% of cases and primary in 33.9%. Secondary transfer was noted in 53.6% of cases with agreement in 57.8%. The patients came from all regions of Tunisia with a predominance of those from the Tunis area (37.8%). One third of our patients had a psychiatric history, with the notion of a previous suicide attempt in 5.1% of cases. Alcoholism and/or drug addiction was reported in 17.7% of cases. The act of self-immolation was performed in a public place in 59.2% of cases. TBSA was 41.48%. Burns were deep in 66.2% of cases. Facial involvement was noted in 90% of patients. ABSI was 7.35 and Baux index 78 +/- 50. The average length of stay was 17.64 days. 2/3 of patients (72.1%) required intubation and mechanical ventilation. The mortality rate was 57.2%. [ABSTRACT FROM AUTHOR]

The lack of reliable biomarkers for the prognosis and radiotherapy efficacy in esophageal cancer (EC) necessitates further research. The aim of our study was to investigate the predictive utility of plasma cell-free DNA (cfDNA) kinetics in patients with EC. We retrospectively analyzed the clinical data and cfDNA levels (pre-radiotherapy [pre-RT] and post-radiotherapy [post-RT]) and the cfDNA kinetics (cfDNA ratio: post-RT cfDNA/pre-RT cfDNA) of 88 patients. We employed Kaplan-Meier curves to examine the relationship between cfDNA and overall survival (OS) as well as progression-free survival (PFS). Univariate and multivariate Cox regression analyses were executed to ascertain the independent risk factors in EC. The pre-RT cfDNA levels were positively correlated with clinical stage (P = 0.001). The pre-RT cfDNA levels (cutoff value = 16.915 ng/mL), but not the post-RT cfDNA levels, were linked to a diminished OS (P < 0.001) and PFS (P = 0.0137). CfDNA kinetics (cutoff value = 0.883) were positively associated with OS (P = 0.0326) and PFS (P = 0.0020). Notably, we identified independent risk factors for OS in EC treated with RT, including cfDNA ratio (high/low) (HR = 0.447 [0.221–0.914] P = 0.025), ECOG (0/1/2) (HR = 0.501 [0.285–0.880] p = 0.016), and histological type (esophagal squamous cell carcinoma [ESCC]/non-ESCC) (HR = 3.973 [1.074–14.692] P = 0.039). Plasma cfDNA kinetics is associated with prognosis and radiotherapy effect in EC undergoing RT, suggesting potential clinical application of a cheap and simple blood-based test. [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]

Revue de littérature sur les facteurs pronostics cliniques et urodynamiques de complications urinaires chez les patients blessés médullaires (BM). Les articles traitant des complications urinaires du BM et de leurs facteurs pronostics cliniques et urodynamiques ont été recherchés dans la base de données Pubmed jusqu'en mars 2024, les articles en anglais ou en français ont été inclus et analysés. Trente-huit articles publiés entre 1965 et 2024 ont été inclus dans cette revue, l'incidence des complications urinaires a considérablement diminué depuis les années soixante. Les facteurs pronostics cliniques de complications urinaires sont une lésion médullaire cervicale, une lésion complète, l'âge ou le mode mictionnel, la sonde urinaire à demeure étant le plus à risque. Les facteurs urodynamiques sont un trouble de la compliance (< 20), de hautes pressions détrusoriennes (>40 cm d'eau), une dyssynergie vésico-sphinctérienne et un résidu post-mictionnel. Les complications urinaires chez le BM sont fréquentes, il est nécessaire de connaître leurs facteurs pronostics afin de les dépister et les prendre en charge précocement pour les limiter. Literature review on the prognostic clinical and urodynamic factors of urinary complications in spinal cord injury (SCI) patients. Articles dealing with SCI urinary complications and their prognostic clinical and urodynamic factors have been searched in the Pubmed database until march 2024, articles in english or in french were included and analysed. Thirty-eight articles published between 1965 and 2024 were included in this review, the incidence of urinary complications has decreased considerably since the 60s. Clinical prognostic factors are a cervical or complete SCI, age, voiding mode, the indwelling catheter most at risk. Urodynamics factors are compliance disorder (< 20), high detrusor pressure (> 40 cm of water), detrusor sphincter dyssynergia and a postvoid residual volume. Urinary complications in SCI patients are frequents, it is necessary to know the prognostic factors in order to have an early detection and management to limit them. [ABSTRACT FROM AUTHOR]

In recent years, with the development of artificial intelligence, deep learning has been gradually applied to clinical treatment and research. It has also found its way into the applications in radiotherapy, a crucial method for cancer treatment. This study summarizes the commonly used and latest deep learning algorithms (including transformer, and diffusion models), introduces the workflow of different radiotherapy, and illustrates the application of different algorithms in different radiotherapy modules, as well as the defects and challenges of deep learning in the field of radiotherapy, so as to provide some help for the development of automatic radiotherapy for cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have been conducted on breast cancer despite its high burden in our context. Therefore, this study aimed to: (1) specify the sociodemographic and clinical characteristics of breast cancer; and (2) determine the factors associated with breast cancer survival at Gabriel Touré University Hospital (CHU). Methods: This was a retrospective cohort study conducted at CHU Gabriel Touré between January 1st 2018 and 31st, December 2022. Histologically confirmed cases of breast cancer were included and divided into three anatomoclinical groups (non-T4 tumor [NT4], locally advanced cancer [LAC] and inflammatory breast cancer [IBC]). We used Pearson's Chi-square or Fisher's Exact tests to compare proportions. The frequency distributions using density plots were constructed for the three breast types. They were compared using the Kruskal Wallis statistic. Kaplan-Meier curves were estimated for the survival analysis and Cox regression was used to identify factors associated with breast cancer survival. Adjusted hazard ratios (AHRs) and their 95% confidence intervals (95% CIs) were computed. Results: A total of 255 cases of breast cancer were included in this study. The mean age was 46.9 years old. Whatever the anatomoclinical type, the density plot curve peaked before the age 40. NT4 and LAC were more frequently observed on the right breast, while IBC occurred on the left breast (p < 0.001). Comorbidity rates were comparable between the three groups. The median survival time was 9 months, and the overall 5-year survival rate was < 40%. Infertility history and IBC had a significant influence on survival, with AHRs of 1,63 [1,01 - 2,63] and 1,52 [1,04 - 2,22] respectively. Conclusion: Breast cancer at Gabriel Touré University Hospital is characterized by an early onset and a poor prognosis, suggesting that particular emphasis should be placed on early diagnosis and the quality of management. [ABSTRACT FROM AUTHOR]

Introduction: to help reduce neonatal mortality in Burkina Faso, we identified the prognostic factors for neonatal mortality at the Sourô Sanou University Hospital. Methods: we conducted a cross-sectional and analytical study in the neonatal department from July 25, 2019 to June 25, 2020. Patients' medical records, consultation and hospital records were reviewed. Prognostic factors for neonatal mortality were identified using a Cox model. Results: data from 1128 newborn babies were analysed. Neonatal mortality was 29.8%. Most of these deaths (89%) occurred in the early neonatal period. The mean weight of newborns at the admission was 2,285.8 ± 878.7 and 43.6%. They were at a healthy weight. Four out of five newborns had been hospitalized for infection or prematurity. The place of delivery (HR weight <1000g = 5.45[3.81 -7.79]) and the principal diagnosis (HR asphyxiation= 1.64[1.30-2.08]) were prognostic factors for neonatal mortality. Conclusion: improving technical facilities for the etiological investigation of infections and an efficient management of low-weight newborns suffering from respiratory distress would considerably reduce in-hospital neonatal mortality in Bobo-Dioulasso. [ABSTRACT FROM AUTHOR]

La rupture utérine est une complication obstétricale redoutable. Le but de notre travail est d'étudier les caractéristique épidémiologiques, les éléments de pronostic maternel et foetale ainsi que les différentes modalités thérapeutiques de la rupture utérine survenue sur utérus sain et cicatriciel. Nous avons mené une étude rétrospective monocentrique descriptive et analytique, portant sur 60 cas de rupture colligées au service de gynécologie obstétrique du centre de maternité et de néonatologie de Monastir, s'étalant de 2017 jusqu'en 2021. Les patientes ont été classées selon la présence ou non d'une cicatrice utérine. Soixante patientes ont été incluses. La majorité des cas de rupture étaient survenus sur utérus cicatriciel (n=55). Le signe clinique le plus retrouvé a été l'anomalie de rythme cardiaque foetal. Aucun décès maternel n'a été enregistré et le taux de mortalité périnatale a été de 11%. Nous avons trouvé un indice de masse corporelle (IMC) moyen et un taux de macrosomie foetale et une parité moyenne significativement plus élevés dans le groupe utérus sain que celui dans le groupe utérus cicatriciel (p=0,033, 0,018 et 0,013 respectivement). Les complications maternelles étudiées (hémorragie du post partum, hystérectomie, transfusion sanguine, hospitalisation prolongée) ont été significativement plus fréquentes en cas de rupture utérine (RU) sur utérus sain (p=0,039; p=0,032; p=0,009; p=0,025 respectivement). La rupture utérine est un accident obstétrical mettant en jeu le pronostic foetal et maternel. L'anomalie de rythme cardiqaue d'un foetus (RCF) est le signe révélateur le plus fréquemment trouvé. Le traitement est conservateur dans la majorité des cas. Le pronostic est meilleur en cas d'utérus cicatriciel. [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]

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]

To evaluate the prognostic and Survival of patients with locally advanced nasopharyngeal carcinoma with opticpathways involvement, treated by intensity-modulated radiotherapy (IMRT) and concomitant Cisplatin, with or without induction chemotherapy. We retrospectively reviewed data for 40 consecutive patients treated by IMRT in the radiotherapy departement of Salah azeiez hospital in Tunisia, between 2014 and 2018. The mean patient age at diagnosis was 42,65 years (19-81) and the sex ratio was 1,85. All patients had undifferentiated carcinoma of the nasopharynx (UCNT) and were staged T4 according to the seventh edition of the American Joint Committee on Cancer (AJCC) staging system. Patients presented a variety of ocular symptoms, along with other signs such as; diplopia (28,2%), proptosis (10,3%), exophtalmie (5,1%) and oculomotor nerve pulsy (5,1%).Symptomatic orbital invasion by tumor occurred in 19 of the 40 patients (48,7%). Ocular signs, but no orbital invasion, was present in 13 patients (32,5%). The CT scan showed orbital involvement in 21 cases (52,5%), sphenoidal involvement in 32 cases (80%), ethmoidal involvement in 22 cases (55%) and skull base invasion in 38 cases (95%). Neoadjuvant chemotherapy was adminisered to 22 patients (55%). All patients underwent concomitant cisplatin based chemoradiotherapy. The median follow-up was 48,5 months (24 to 83 months), 20 patients (50%) died and 20 (50%) were still alive. A total of 18 (45%) patients experienced failures (30%) and distant metastases (25%). Locoregional failures were seen in 12 (30%) patients. 10 patients (25%) experienced local failure and 2 (5%) patients experienced a nodal failure. Three patients (7,5%) presented unilateral blindness which might be resulted from radiation-induced optic neuropathy. At last follow-up, 19 out of 40 patients (47,5%) were alive without any disease The mean overall survival (OS) was 40,22 months (HR=4,161, 95%CI 32,070-48,382). The 5-year rate of OS was 47,4%. The mean disease free survival (DFS) was 37,740 months (HR=4,754, 95%CI 28,421-47,058). The 5-year rate of DFS was 49 %. The univariate analysis revealed that orbital involvement did significantly affect overall survival (P=0,000). Orbital involvement was also identified as an independent prognostic factor for OS (hazard ratio 0,159; 95 % CI 0.043-0.588; P = 0.006). However, Tumor volume higher than 100 cm3 (hazard ratio=0,130; 95 % CI 0,022 - 0,771; P = 0,025) and dose at CTVp1 lower than 66 Gy (hazard ratio=0,137; 95 % CI 0,028-0,665; P = 0,014) were identified as an independent prognostic factors for DFS. T4 non metastatic locally advanced NPC with optic pathways involvement is uncommon and it confers a particular bad prognosis. Indeed, the IMRT modality provides adequate local-regional control for T4 NPC. However, even with the most sophisticated treatment techniques, the clinical outcome remains low for this subgroup. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus is a systemic disease in which various organs are affected. Cardiac involvement in lupus is a frequent and serious manifestation. Our aim in this study was to characterise lupus patients with cardiac involvement from a demographic, clinical, biological and prognostic point of view, and to identify factors predisposing to this type of involvement. Materials and methods: We analysed a single-centre retrospective cohort of 269 patients with systemic lupus from January 2012 to December 2020. The patients included met the criteria of the American College of Rheumatology (ACR) [18], or the classification criteria of the Systemic Lupus International Collaborating Clinics (SLICC) [19]. Induced lupus and pure cutaneous lupus were excluded from the study. Cardiac manifestations were analysed. Results: Of the 269 patients followed for systemic lupus, 83 had cardiac involvement (32 %). 72 women and 11 men, sex ratio F/M 6.54. The mean age at diagnosis was 35 ± 12.4 years [16-70]. The various cardiac manifestations during lupus are: pericarditis in 22 % of cases (n = 61), myocarditis in 5.2 % of cases (n = 14), endocarditis in 0.7 % of cases (n = 2), pulmonary arterial hypertension (PAH) in 2.6 % of cases (n = 7), while coronary artery disease specific to lupus was observed in 1.1 % of cases (n = 3). The risk factors for cardiac involvement according to our study were: male sex (OR = 3.75, CI95 % 1.4-10.07), the presence of pulmonary involvement, especially pleurisy (OR = 4.77, CI95 % 2.48-9.16), the presence of psychiatric disorders (OR 3.37, CI95 % 1.23-9.19) and high disease activity with a SLEDAI greater than 12 (OR 3.8, CI 95 % 1.98-7.31). When analysing the involvement of the different cardiac manifestations in the death of lupus patients, myocarditis could have an impact on the prognosis of the disease (p = 0.08), but the other manifestations (pericarditis, endocarditis, coronary artery disease and PAH) were not associated with death. Conclusion: The risk factors for cardiac involvement in our series are: male sex, the presence of pulmonary involvement, especially pleurisy, the presence of psychiatric disorders and high disease activity with a SLEDAI of more than 12. Given its frequency and severity, this condition should be systematically investigated. [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]

Pemphigus foliaceus (PF) is a bullous autoimmune skin disease diagnosed through sera and skin analyses. PF severity is associated with maintained anti‐Dsg1 sera levels and its prognosis is unpredictable. MicroRNA (miRNA), dynamic regulators of immune function, have been identified as potential biomarkers for some autoimmune diseases. This study aimed to assess the miRNA expression of miR‐17‐5p, miR‐21‐5p, miR‐146a‐5p, miR‐155‐5p and miR‐338‐3p using quantitative real‐time PCR in peripheral blood mononuclear cells (PBMC) and lesional skin samples from untreated and treated PF patients (both remittent and chronic) over 3 months. Overall, miRNA expression was significantly higher in PBMC than in biopsy samples. Blood miR‐21 expression was increased in untreated patients compared to controls and had a diagnostic value with an AUC of 0.78. After 6 weeks, it decreased significantly, similar to anti‐Dsg1 antibodies and the PDAI score. In addition, a positive correlation was observed between cutaneous miR‐21 expression and the disease activity score. Conversely, cutaneous expressions of miR‐17, miR‐146a and miR‐155 were significantly higher in treated chronic patients compared to remittent ones. The cutaneous level of miR‐155 positively correlated with pemphigus activity, making it a potential predictive marker for patients' clinical stratification with an AUC of 0.86.These findings suggest that blood miR‐21 and cutaneous miR‐155 can be used as supplemental markers for PF diagnosis and activity, respectively in addition to classical parameters. [ABSTRACT FROM AUTHOR]

Background: Various similarities have been observed between gingival crevicular fluid (GCF) and peri-implant sulcular fluid (PISF). This has resulted in research that has evaluated similar biological fluid markers that are similar to those present within the gingival sulcus. These biomarkers have high sensitivity and are a reliable biological tool when compared to clinical and/or radiographic examination and aid in diagnosis as well as monitoring the progression of periodontal disease surrounding teeth as well as the implants. Aim: The study aimed to compare the effectiveness of periostin in peri-implant sulcular and gingival crevicular fluids. Materials and Methods: This experimental prospective in vitro analysis was done following clearance by the institutional ethical committee. A total of 100 patients were selected. They were categorized into two groups: (I) Group A patients had peri-implant disease (n = 50), whereas (II) Group B patients had periodontitis (n = 50). Clinical loss of attachment score was noted in six sites around natural teeth and four sites around the implants. Presterilized filter paper strips were inserted within the sulcus/pocket till pressure was felt for 60 s. Periostin concentration levels in GCF and PISF samples were measured by the enzyme-linked immunosorbent assay technique. Statistical analysis of data collected was performed using Shapiro-Wilk statistical tool for normally distributed numerical data. Results: Mean ± standard deviation concentration of periostin in gingival crevicular fluid from periodontitis cases was recorded as 20.15 ± 2.76 ng/30sn, whereas in PISF was 19.23 ± 1.89 ng/30sn. On statistical analysis, no statistically significant differences were seen after comparing the concentration of periostin in periodontitis as well as peri-implantitis groups (P > 0.05). Conclusion: The present study analyzed periostin levels in gingival crevicular fluid obtained from patients diagnosed with periodontitis and sulcular fluid obtained from the sulcus around implants. Early biological markers or indicators of inflammation should be studied to determine the prognosis of treatment apart from the clinical assessment for the patient's benefit. [ABSTRACT FROM AUTHOR]

De très nombreux biomarqueurs des maladies neurodégénératives (MND) détectables dans le liquide céphalorachidien (LCR) ont été proposés mais un petit nombre sont validés cliniquement et informatifs pour les cliniciens. Il s'agit principalement de la protéine tau (et ses formes phosphorylées [p-tau] en particulier en position 1 81) et des peptides amyloïdes (Aß40, Aß42) qui sont actuellement intégrés aux examens biologiques en routine pour le diagnostic de la maladie d'Alzheimer et des pathologies apparentées. Les méthodes analytiques permettant la quantification de ces biomarqueurs ont considérablement évolué ces dernières années, assurant une haute sensibilité de leur détection y compris à des stades précoces des maladies où les altérations de ces biomarqueurs sont encore très faibles et donc difficilement quantifiables. Parmi les autres biomarqueurs décrits (ceux de souffrance neuronale, réactionnels, inflammatoires, etc.), les chaînes légères des neurofilaments (NfL) sont aussi prometteuses pour le diagnostic et le pronostic de différentes MND. Cet article a pour objectif de présenter la valeur informative des biomarqueurs diagnostiques actuels du LCR pour les MND (en particulier t-tau, p-tau, Aß40, Aß42), ainsi que des NfL. Biomarkers of neurodegenerative diseases (ND) detected in cerebrospinal fluid (CSF) are numerous but only a few of them are validated and informative for clinicians. Only two biomarkers are currently included in routine clinical parameters: tau protein (and its phosphorylated forms [p-tau] in particular at position 181) and amyloid peptides (Aß40, Aß42). Analytical methods allowing the quantification of these biomarkers have evolved considerably in recent years, ensuring a high sensitivity of their detection even in the early stages of the disease where the alterations of these biomarkers are still very weak and therefore difficult to quantify. Various candidate biomarkers are also being studied (markers of neuronal suffering, reaction, inflammation, etc.), in particular neurofilament light chains (NfL), which seems to be particularly promising for the diagnosis and prognosis of various ND. The aim of this article is to present the informative value of current ND CSF diagnostic biomarkers (including t-tau, p-tau, Abß0, Aß42) and NfL. [ABSTRACT FROM AUTHOR]

Introduction: pulmonary embolism is a real public health problem because of its high morbidity and mortality rate. The purpose of this study is to evaluate the impact of PESI score on the prognosis of pulmonary embolism. Methods: we conducted a retrospective study of 146 cases of formally confirmed embolism. Pulmonary embolism severity index (PESI) score was calculated for the entire study population. The patients were divided into 2 groups: a low-risk group (LR) comprising patients in risk classes I and II: 83 patients; a high-risk group (HR) comprising patients in risk classes III, IV and V: 63 patients; the primary endpoint of the study (MACE) was the occurrence of shock, the need for mechanical ventilation, and the occurrence of in-hospital death. Results: total inhospital mortality was 15.1%, significantly higher in the HR group (25.4% versus 7.2%, p=0.001). In logistic regression analysis, being in the HR group (OR=5.1; 95% CI: [1,637 - 16,093]; p=0.005)) and having renal impairment (OR=4.5; 95% CI: [1.457 - 14.075]; p=0.009) were the independent factors for the occurrence of MACE. After a mean follow-up of 18 ± 8 months, there were more deaths in the HR group (68.4% versus 33%, p=0.004). Conclusion: the results of our study show that the PESI score is correlated with the severity of PE. This should encourage the widespread use of this risk score. [ABSTRACT FROM AUTHOR]

The role of radiation therapy in mucosa-associated lymphoid tissue (MALT) lymphoma is poorly defined. The objective of this study was to explore the factors associated with the performance of radiotherapy and to assess its prognostic impact in patients with MALT lymphoma. Patients with MALT lymphoma diagnosed between 1992 and 2017 were identified in the US Surveillance, Epidemiology, and End Results database (SEER). Factors associated with the delivery of radiotherapy were assessed by chi-square test. Overall survival (OS) and lymphoma-specific survival (LSS) were compared between patients with and without radiotherapy, using Cox proportional hazard regression models, in patients with early stage as well as those with advanced stage. Of the 10,344 patients identified with a diagnosis of MALT lymphoma, 33.6% had received radiotherapy; this rate was 38.9% for stage I/II patients and 12.0% for stage III/IV patients, respectively. Older patients and those who already received primary surgery or chemotherapy had a significantly lower rate of receiving radiotherapy, regardless of lymphoma stage. After univariate and multivariate analysis, radiotherapy was associated with improved OS and LSS in patients with stage I/II (HR = 0.71 [0.65–0.78]) and (HR = 0.66 [0.59–0.74]), respectively, but not in patients with stage III/IV (HR = 1.01 [0.80–1.26]) and (HR = 0.93 [0.67–1.29]). The nomogram built from the significant prognostic factors associated with overall survival of stage I/II patients had a good concordance (C-index = 0.749 ± 0.002). This cohort study shows that radiotherapy is significantly associated with a better prognosis in patients with early but not advanced MALT lymphoma. Prospective studies are needed to confirm the prognostic impact of radiotherapy in patients with MALT lymphoma. [ABSTRACT FROM AUTHOR]

Introduction: Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP. Methodology: An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis. Results: A total of 50 patients were enrolled in the study. The mean age was 43.34 years. Total hospital stay was 9.02 ± 6.47 days, mean ward stay was 6.08 ± 2.73, and mean ICU stay was 2.94 ± 4.7 days. Five deaths were reported. There was a significant correlation between the necessity of ICU admission and grade of pancreatitis. There is significant correlation with age and ICU stay (r = 0.344, P = 0.014), age and ward stay (r = -0.340, P = 0.016), total duration of hospital stay and MCTSI score (r = 0.742, P = 0.000), duration of ward stay and MCTSI score (r = -0.442, P = 0.001), and strong correlation with duration of ICU stay and MCTSI score (r = 0.869, P = 0.000). A higher MCTSI score was significantly associated with the presence of local as well as systemic complications and with death (P = 0.0001). Conclusion: Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis. [ABSTRACT FROM AUTHOR]

D'importantes avancées cliniques et moléculaires ont permis de mieux comprendre la physiopathologie des leucémies aiguës myéloïdes (LAM), et d'affiner les critères diagnostiques, pronostiques et théranostiques. La classification de l'Organisation mondiale de la santé, qui servait jusqu'à présent de norme internationale pour le diagnostic et la classification des LAM, est concurrencée par un nouveau système de classification (ICC, International consensus classification) également publié en 2022. Ces deux nouvelles classifications, divergentes sur certaines définitions de LAM, apportent un signal négatif en termes d'homogénéisation des pratiques cliniques internationales. Pour les aspects pronostiques, la classification de l'European Leukemia Net 2022 intègre les nouvelles données moléculaires diagnostiques, l'évaluation de la maladie résiduelle, et les résultats issus d'essais récents. La complexité diagnostique et thérapeutique, avec les nouvelles thérapies ciblées et les combinaisons de traitements, rend les décisions cliniques parfois délicates. L'objectif de ces classifications est de prendre en compte les caractéristiques spécifiques de la LAM, en particulier génétiques, afin d'optimiser la prise en charge thérapeutique de chaque sous-groupe de LAM. Il est à espérer qu'une future classification harmonisée et unique voie le jour dans un avenir proche. Significant clinical and molecular advances have led to a better understanding of the pathophysiology of acute myeloid leukemias (AML), and to refinements in diagnostic, prognostic and theranostic criteria. The WHO classification, which has served as the international standard for AML diagnosis and classification until now, is challenged by a new classification system (ICC, International Consensus Classification) also published in 2022. Both new classifications, which differ on some definitions of AML, provide a negative message regarding the standardization of international clinical practices. For prognosis, the European Leukemia Net 2022 classification includes new molecular diagnostic features, measurable residual disease assessment, and recent trial results. Diagnostic and therapeutic complexity, with new targeted therapies and treatment combinations, renders clinical decisions more challenging. The objective is to consider the AML specific features, including genetics, to improve the treatment of each AML subgroup. It is hoped that a single, harmonized classification will be developed in the near future. [ABSTRACT FROM AUTHOR]

Despite advances in medical technology, mortality due to burn injuries remains significant. Scoring systems are aimed at allowing physicians to effectively and accurately predict the mortality of a given patient. Patients at a higher risk of death from burns include older patients over the age of 65, highseverity burn, presence of co-morbidities, and presence of inhalation injury. Constructing a burn prediction model also needs its own methodological standards. Hence, choosing a prediction model for predicting burn mortality requires careful analysis of its methodology. Attention towards mortality risk factors should be taken when treating burn patients. Tools such as burn prediction models prove helpful in aiding physicians to accurately and effectively predict a patient's mortality, stratify patient severity, and allocate resources appropriately, especially in settings where resources are scarce, such as natural disasters. Additionally, prediction models are used to monitor patient care and for research purposes. [ABSTRACT FROM AUTHOR]

La neurosarcoïdose est une manifestation rare mais potentiellement grave de la sarcoïdose, associée à une morbidité et mortalité significatives. Dans les différentes études, la mortalité était d'environ 10 % à 10 ans avec plus de 30 % des patients qui avaient un handicap significatif à la fin du suivi. Les atteintes les plus fréquentes sont les atteintes encéphaliques (50–60 %) avec en particulier une atteinte des paires crâniennes (nerfs VII le plus fréquemment puis nerfs optiques, oculomoteurs et vestibulaire), médullaires (20–30 %) et plus rarement du système nerveux périphérique (10–15 % environ). Tout l'enjeu du diagnostic est d'éliminer les diagnostics différentiels. Les présentations atypiques peuvent faire discuter la nécessité de biopsie cérébrale afin de mettre en évidence la présence de lésions granulomateuses tout en éliminant les diagnostics alternatifs notamment infectieux et tumoraux. La prise en charge thérapeutique repose sur la corticothérapie et les immunomodulateurs. Il n'y a pas d'étude prospective comparative permettant de statuer clairement sur le choix de l'immunosuppresseur en première intention et dans les formes réfractaires. Les immunosuppresseurs conventionnels tels que le méthotrexate, le mycophénolate mofétil et le cyclophosphamide sont couramment employés. Les données sont de plus en plus nombreuses sur l'utilisation des anti-TNFα (notamment l'infliximab) dans les formes réfractaires et/ou sévères. Des données supplémentaires sont nécessaires pour évaluer leur intérêt en première ligne chez les patients ayant une atteinte sévère et associée à un risque non négligeable de rechute. Neurosarcoidosis (NS) is a rare but severe form of sarcoidosis. NS is associated with significant morbidity and mortality. Mortality is about 10% at 10 years with more than 30% of patients who have a significant disability. The most frequent features are cranial neuropathy (the facial and optic nerve most commonly affected), cranial parenchymal lesions, meningitis, spinal corn abnormalities (20–30%) and more rarely peripheral neuropathy (approximately 10–15%). The challenge of diagnosis is to eliminate other diagnoses. Atypical presentations should make to discuss the need for cerebral biopsy in order to highlight the presence of granulomatous lesions while eliminating alternative diagnosis. Therapeutic management is based on corticosteroid therapy and immunomodulators. There are no comparative prospective study to allow us to define the first-line immunosuppressive treatment and the therapeutic strategy in refractory patients. Conventional immunosuppressants such as methotrexate, mycophenolate mofetil and cyclophosphamide are commonly used. Data on the efficacy of anti-TNFα (including infliximab) in refractory and/or severe forms are increasing during the last ten years. Additional data is necessary to assess their interest in first line in patients with severe involvement and a significant risk of relapse. [ABSTRACT FROM AUTHOR]

Cerebral veinous thrombosis: an update Cerebral venous thrombosis (CVT), a rare form of stroke, is characterized by a polymorphic presentation dominated by headache. The diagnosis is made on cerebral MRI most of the time. The causes are often multiple, risk factors are usually classified in permanent, such as genetic thrombophilia, and precipitant, such as combined contraception, pregnancy and especially postpartum. New risk factors have been identified in recent years, such as anemia and obesity. The management of patients from the acute phase by effective anticoagulation, the treatment of the risk factors and sometimes invasive therapies such as decompressive craniectomy, makes it possible to reduce the morbidity and mortality of this pathology. Prognosis of CVT is much better than ischemic stroke, especially for comatose patient with large parenchymal lesions. Anticoagulation with LMWH initially is replaced by oral anticoagulants for 3 to 12 months in general. Even if they are not currently recommended, more data are now available and reassuring concerning the use of direct oral anticoagulants rather than VKA in this indication. [ABSTRACT FROM AUTHOR]

There are no studies on the association between high blood pressure and COVID-19 in South Kivu. to determine the influence of arterial hypertension on the clinical characteristics and prognosis of COVID-19 patients hospitalized in the city of Bukavu. Between June 2020 and June 2022, an open cohort of hypertensive and non-hypertensive COVID-19 patients admitted to two clinics in the city of Bukavu was formed. The primary endpoint was the occurrence of death. Thus, a prospective modeling of mortality by the Kaplan-Meier estimator was carried out. Among the 178 admissions for COVID-19, 68 (38.2%) patients were hypertensive. Compared to non-hypertensives, hypertensive patients were significantly older [61.0 (56.0–71.0) vs. 48.0 (32.7–64.0); p < 0,0001). During the observation period of 1059 patient-days, the incidence of death (3.2/100 patient-days) was non-significantly higher in hypertensive patients (4.3/100 patient-days) (p = 0.06). On the other hand, the independent predictors of death were Sepsis [adjusted HR = 3.7 (1.5–8.7)], CRP > 100 mg/L [adjusted HR = 3.0 (1.2–7, 0)] and SaO 2 < 90 % [adjusted HR = 3.9 (1.3–11.8)]. This study shows that hypertension was very common in patients admitted for COVID-19 in the city of Bukavu but did not influence the vital prognosis of the latter, thus confirming the finds of most authors who have addressed the question. [ABSTRACT FROM AUTHOR]

Cardiac magnetic resonance imaging (CMR) became over the last 30 years an essential tool in the management of patients with myocarditis. Noninvasive diagnosis of acute myocarditis relies on a clinical picture compatible with myocarditis and fulfilling of the updated 2018 Lake Louise criteria. These criteria include highlights of myocardial edema by conventional T2-weighted sequences or by T2 mapping in one hand and evidence of myocardial injury using late gadolinium enhancement sequences, T1 mapping or extra-cellular volume measurement in the other hand. It is recommended to perform basal examination in the 2 or 3 weeks following acute episode and to repeat CMR during follow-up. The literature reports excellent diagnostic accuracy, between 80% and 90%, making CMR a robust and reliable noninvasive alternative to endomyocardial biopsy. Besides, beyond its diagnostic performance, CMR can also help to identify patients with unfavourable long-term outcome. For instance, medio-ventricular and septal location of late gadolinium enhancement, degree of late gadolinium enhancement extent or high T2 mapping values are independent predictive factors of major cardio-vascular events. [ABSTRACT FROM AUTHOR]

This single-center retrospective study aimed to observe survival and prognosis of elderly patients with esophageal cancer receiving radical radiotherapy combined with S1 chemotherapy, and to preliminarily explore whether hematologic indicators or inflammatory indicators before radiotherapy are prognostic factors. We retrospectively collected data of 80 elderly patients with esophageal cancer who had received radical concurrent chemoradiotherapy from January 2015 to July 2018. The patients were older than 70 years. Radiation therapy was delivered with intensity-modulated irradiation therapy (IMRT) or volumetric modulated arc therapy (VMAT), while the chemotherapy regimen was S1 alone. Toxicities were evaluated in accordance with the criteria of the Radiation Therapy Oncology Group. Baseline hematologic basic nutritional indicators, such as hemoglobin (HGB), albumin (ALB), and prealbumin (PAB), along with inflammatory indicators, such as the ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), were collected to preliminarily analyze their relationship with progression and survival. The median follow-up time was 39 months (range 30–65 months). The median overall survival and progression-free survival times were 24 and 17 months, respectively. The 1-, 2-, and 3-year overall survival rates were 76.5%, 48.1%, and 31.3%, respectively. The 1-, 2-, and 3-year progression-free survival rates were 57.5%, 37.8%, and 29.4%, respectively. T stage, clinical staging, and lesion region were independent prognostic factors for OS. No significant associations with prognosis were observed either for baseline hematologic or for inflammatory indicators (all P > 0.05). The rates of esophagitis (grade 2 and above) and hematologic toxicity were 60% and 45%, respectively. Oral S-1 combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer has a significant survival benefit. The toxicities are well tolerated. It seems that prognosis does not correlate with baseline hematologic nutritional indicators and inflammatory indicators. [ABSTRACT FROM AUTHOR]

Over the past two decades, high-dose salvage re-irradiation (re-RT) has been used increasingly in the multimodality management of adults with recurrent/progressive diffuse glioma. Several factors that determine outcomes following re-RT have been incorporated into prognostic models to guide patient selection. We aimed to develop a novel four-tiered prognostic model incorporating relevant molecular markers from our single-institutional cohort of patients treated with high-dose salvage re-RT for recurrent/progressive diffuse glioma. Various patient, disease, and treatment-related factors impacting upon survival following salvage re-RT were identified through univariate analysis. Each of these prognostic factors was further subdivided and assigned scores of 0 (low-risk), 1 (intermediate-risk), or 2 (high-risk). Scores from individual prognostic factors were added to derive the cumulative score (ranging from 0 to 16), with increasing scores indicating worsening prognosis. A total of 111 adults with recurrent/progressive diffuse glioma treated with salvage high-dose re-RT were included. We could assign patients into four prognostic subgroups (A = 15 patients, score 0–3); (B = 50 patients, score 4–7); (C = 33 patients, score 8–10); and (D = 13 patients, score 11–16) with completely non-overlapping survival curves suggesting the good discriminatory ability. Post-re-RT survival was significantly higher in Group A compared to groups B, C, and D, respectively (stratified log-rank p-value <0.0001). There exists a lack of universally acceptable 'standard-of-care' salvage therapy for recurrent/progressive diffuse glioma. A novel four-tiered prognostic scoring system incorporating traditional factors as well as relevant molecular markers is proposed for selecting patients appropriately for high-dose salvage re-RT that warrants validation in a non-overlapping cohort. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumour, with a poor prognosis, ranking third for cancer mortality worldwide. HCC is a morphologically and molecularly heterogeneous tumour. This update aims to address this heterogeneity by describing the different histological and molecular subtypes of HCC. Morphologically, eight subtypes have been described according to the WHO classification: steatohepatitic, macrotrabecular massive (MTM), clear cell, chromophobe, scirrhous, fibrolamellar, lymphocyte-rich and neutrophil-rich. Other HCCs are classified as non-specific (not otherwise specified or NOS). These subtypes may be associated with a different prognosis, particularly the MTM, which displays a poorer survival than the other subtypes. Genomically, most HCCs present mutations in the TERT promoter, while other mutations occured later in carcinogenesis, such as TP53 and CTNNB1. TP53 mutated HCCs are associated with a poor prognosis and the MTM subtype. From a transcriptomic standpoint, two classifications are particularly noteworthy, as they are associated with both prognosis (proliferative vs. non-proliferative classification) and clinical, morphological and genomic tumour characteristics (G1-G6 classification). In conclusion, the morphological heterogeneity of HCC, directly linked to molecular heterogeneity, is associated with prognosis. This strongly supports the specification of the different HCC subtypes in our reports., Competing Interests: Déclaration de liens d’intérêts Les auteurs déclarent ne pas avoir de liens d’intérêts., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Bone marrow aplasia is a rare and serious hematologic disorder. Although benign, it is a hematologic disorder whose prognosis can be poor and whose spontaneous development can be fatal. Treatment is long, difficult and costly. In developing countries, the mortality rate is high due to the difficulties of therapeutic management, both supportive and specific. We conducted a retrospective study of 92 cases of AM identified in the Pediatric Hematology and Oncology Department of the 20 Août University Hospital in Casablanca over a 10-year period (January 2010-January 2020). In this work, we present an overview of the situation and highlight the difficulties encountered in the management of AM in the Pediatric Hematology and Oncology Department of the University Hospital of Casablanca. In our study, the mean age was 19 years, ranging from 3 months to 29 years, with a peak in the 15-20 age group. The sex ratio (M/F) was 2.06, with a male predominance of 67%. In our series, only 35% of patients had complete bone marrow failure. An anemic syndrome was present in 92% of patients, and hemorrhagic and infectious syndromes were present in 70% and 41% of patients, respectively. The median time from diagnosis to treatment was 82 days. According to the Camitta score, 31% of our patients had mild AM, 41% had severe AM, and 28% had very severe AM. After etiologic evaluation, we concluded that 90% of the patients had idiopathic bone marrow aplasia, 2% had constitutional bone marrow aplasia, and 8% of the patients were suspected to have secondary bone marrow aplasia: post-hepatitis (3 cases), toxic (2 cases), drug-induced (1 case), and aplastic PNH (1 case). Mortality in the first three months after diagnosis was 21%. Sixty-nine percent of our patients received specific treatment: 28 were treated with cyclosporin (CIS) alone as first-line therapy, 20 received a combination of antilymphocyte serum (ALS) and cyclosporin, 2 received hematopoietic stem cell transplantation (HSCT), while 3 were treated with androgens alone. The overall response rate was 30% with CIS, 42% with ALS+CIS and 100% with HSCT. In our study, the overall death rate was 44%, while the one-year survival rate was 40%. It is important to note that septic shock was the leading cause of death (53% of deaths), followed by hemorrhagic shock (24%). This highlights the lack of hemodynamic resuscitation and symptomatic treatment. Our multivariate study defined the following risk factors as predictive of worse survival: age greater than 16 years (RR: 3.28; CI: 1.29-8.33; P=0.012), PNN less than 200 or very severe bone marrow aplasia (RR: 3.01; 1.1-8.08; P=0.028), and failure to receive any specific treatment (RR: 4.07; 1.77-9.35; P=0.0003). The high overall mortality in our series was due to several factors: inaccessibility to effective therapies, delayed diagnosis, failure to initiate specific treatment, inadequate symptomatic treatment, and geographical and financial inaccessibility., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Les volumes tumoraux des carcinomes nasopharyngés avant et après la chimiothérapie d'induction peuvent être des indicateurs pronostiques permettant d'adapter la stratégie thérapeutique. L'objectif de notre étude était d'évaluer l'impact pronostique des volumes initiaux et après chimiothérapie d'induction pour les patients traités pour des carcinomes nasopharyngés localement aévolués. Étude rétrospective colligeant 52 patients atteints d'un carcinome nasopharyngé localement évolué traité par trois cures de chimiothérapie d'induction (TPF, docétaxel, cisplatine et 5-fluoro-uracile) suivis de radiothérapie conformationnelle avec modulation d'intensité associée à une chimiothérapie concomitante. Le volume total initial et celui après la chimiothérapie d'induction médians étaient respectivement de 92,3 et 41,5 mL. À 3 ans, les probabilités de survie sans récidive locorégionale, de survie sans maladie, de survie sans événement et de survie globale étaient respectivement de 85,9 %, 63,5 %, 56,8 % et 67,8 %. En étude multifactorielle, l'association d'un haut volume initial (> 100 mL) et après la chimiothérapie (> 35 mL) était un facteur indépendant pour la survie sans récidive locorégionale, de survie sans maladie, de survie sans événement et de survie globale. Le volume initial total avait une valeur pronostique prédictive pour la survie sans événement et la survie globale meilleure que celle du stade selon la classification TNM (8e édition). Le poids pronostique des volumes tumoral et ganglionnaire était plus important que le stade selon la classification TNM (8e édition). Les volumes tumoraux avant et après chimiothérapie d'induction permettent de sélectionner des sous-groupes de cancers à haut risque « haut volume initial et après la chimiothérapie », chez qui il serait judicieux de proposer des schémas thérapeutiques plus intensifs. The pre- and post-induction chemotherapy tumor volumes of nasopharyngeal carcinomas may be prognostic indicators for adapting the therapeutic strategy. The objective of our study is to assess the prognostic impact of pre- and post-induction chemotherapy volumes in patients treated for locally advanced nasopharyngeal carcinomas. This is a retrospective study including 52 patients with locally advanced nasopharyngeal carcinoma treated with 3 courses of induction chemotherapy (TPF) followed by intensity modulated radiotherapy associated with concomitant chemotherapy. The median initial and post induction chemotherapy total volumes were 92.3 and 41.5 mL, respectively. At 3 years, the LRFS, DMFS, DFS and OS were respectively 85.9%, 63.5%, 56.8% and 67.8%. In multivariate study, the combination of a high initial volume (> 100 mL) and post-chemotherapy volume (> 35 mL) was an independent factor for LRFS, DMFS, DFS and OS. The total baseline volume had a better predictive prognostic value for DFS and OS than the TNM classification (8th edition 2017). The prognostic weight of tumor and nodal volumes was greater than the TNM classification (8th edition). The pre- and post-chemotherapy tumor volumes allow selecting a high-risk patients' subgroup "high initial and post chemotherapy volumes" in which it would be advisable to offer more intensive treatment regimens. [ABSTRACT FROM AUTHOR]

Anaplastic thyroid carcinomas (ATC) are a heterogenous group of tumors of overall dismal prognosis. We designed models to identify relevant prognostic factors of survival of irradiated ATC patients including radiotherapy modalities (field size, dose). Between 2000 and 2017, 166 ATC patients' treatments were divided into surgery and postoperative radiotherapy (poRT) or definitive radiotherapy (RT). Multiple imputation approach was used for missing data. Prognostic factors were identified using Lasso-penalized Cox modelling and predicted risk scores were built. Patients undergoing RT (n = 70) had more adverse patient and disease characteristics than those undergoing poRT (n = 96). Corresponding median survival rates were 5.4 and 12.1 months, respectively. PoRT patients undergoing poRT more likely received extended-field radiotherapy with prophylactic nodal irradiation, but rather received platinum- vs. adriamycin-based chemoradiotherapy. Radiotherapy was conventionally fractionated, delivered > 60 Gy in 51.9% and 61.7% and used extended fields in 88.5% and 71.2% of patients with poRT or RT. Radiotherapy interruption rates for toxicity were similar in the two groups. The best poRT-group model identified age > 45yo, PS ≥ 1, pathologic tumor stage ≥ pT4b, > N1 and R2 resection as poor prognostic factors. The best RT-group model (C-index of 0.72) identified PS ≥ 3, > N1 and extended-field radiotherapy with prophylactic nodal irradiation (as opposed to tumour-bed irradiation only) as poor prognostic factors. In patients undergoing poRT, radiotherapy parameters had little influence over their survival irrespective of patient, disease characteristics, and quality of resection. In patients undergoing RT, extended-field radiotherapy improved survival in addition to PS and nodal stage. [ABSTRACT FROM AUTHOR]

To evaluate the impact of postoperative radiotherapy (PORT) on survival in olfactory neuroblastoma (ONB) patients with different tumor staging. Patients with ONB were selected in the Surveillance, Epidemiology and End Results (SEER) database from 2004–2016. Survival analyses were performed using Kaplan–Meier (K-M) method, Cox regression analysis, and competing risk model. A total of 513 patients were included in the study. Univariate and multivariate analysis results demonstrated that PORT was not an independent prognostic factor for overall survival (OS) of modified Kadish stage A and B patients (P = 0.699 and P = 0.248, respectively). Kadish stage C and D patients who underwent PORT had significantly better OS than those who did not undergo PORT (P = 0.03 and P < 0.0001). K-M curves revealed that the 5- and 10-year OS rates of patients who underwent PORT vs. non-PORT were 85.3% vs. 70.4% and 68.2% vs. 56.8% in stage C patients, respectively. For stage D patients, the 5-year OS rates were 70.7% and 42.6%, and 10-year OS rates were 53.4% and 29.5% in the PORT and non-PORT groups, respectively. The competitive risk model revealed that the 5-year cancer-specific cumulative mortality incidence decreased by 26.6% while the 10-year mortality incidence decreased by 41.4% in Kadish stage C patients who were treated using PORT; meanwhile, for Kadish stage D patients who were treated with PORT, the 5- and 10-year mortality incidences were reduced by 35.3% and 42.6%, respectively. Furthermore, we found that chemotherapy was not related to the prognosis of ONB patients (all P > 0.05). Our results indicate that PORT improved survival outcomes of modified Kadish stage C and D ONB patients. However, PORT may not affect survival for modified Kadish stage A and B individuals. Chemotherapy was not recommended for ONB; therefore, further studies are warranted to determine its therapeutic significance. [ABSTRACT FROM AUTHOR]

Ocular lesions in burns are common and diagnosis is often late, leading to functional impairment including loss of vision to these individuals. A retrospective study was conducted to assess ocular lesions in burns during ICU stay (01/01/2013 to 30/09/2020) in a 20-bed burn ICU in Tunis. Twenty-six cases combining burns and ocular lesions were reviewed. The average age was 26, with a sex-ratio 3.3/1. TBSA was 22±13%. Face was affected in 23 patients, and mechanical ventilation was required in 10 cases. Diagnosis of ocular lesion was noted at 4.5 H (1-33 H) after burn injury. Main clinical signs were: eye redness (n=5) and purulent eye discharge (n=5). Lesions were mainly corneal abscess and corneal ulcer. Treatment combined local antibiotics (n=16) associated to systemic antibiotics in 10 cases. Surgery was required in 2 cases. Loss of vision was noted in 2 patients. Risk factors of corneal abscess were: facial burn (p=0,01); burn depth (p=0,02) and mechanical ventilation (p=0,04). [ABSTRACT FROM AUTHOR]

Les 3 principaux types d'amylose cardiaque sont la conséquence de dépôts organiques de deux précurseurs protéiques : d'une part l'amylose AL (AL), secondaire à des dépôts de chaînes légères d'immunoglobulines dans le cadre d'une gammapathie monoclonale (essentiellement de signification indéterminée ou d'un myélome), et d'autre part les amyloses à transthyrétine (ATTR), comprenant les amyloses à transthyrétine sauvages et les amyloses à transthyrétine héréditaires. La fréquence de ces maladies est probablement sous-estimée, comme le montrent les études récentes sur sa prévalence élevée dans des phénotypes cardiologiques courants (insuffisance cardiaque à fraction d'éjection préservée, rétrécissement aortique serré, cardiomyopathie hypertrophique). L'infiltration amyloïde myocardique concerne toutes les structures cardiaques et peut conduire à la survenue d'une insuffisance cardiaque, de troubles conductifs et d'évènements cardio-emboliques. La recherche des signes extracardiaques est une aide au diagnostic. L'électrocardiogramme, l'échocardiographie et l'IRM cardiaque permettent de suspecter l'amylose cardiaque. La confirmation diagnostique se fait sur l'application d'un algorithme simple incluant une recherche systématique de gammapathie monoclonale par un bilan protéique complet et une scintigraphie aux disphosphonates (traceur osseux DPD, HMDP, PyP). Une documentation histologique est impérative en cas d'AL ; elle sera également requise en cas d'ATTR s'il existe une immunoglobuline monoclonale et/ou un ratio anormal de chaînes légères afin d'initier le traitement spécifique. Compte tenu de l'âge tardif d'apparition de la maladie dans les formes héréditaires, la réalisation d'un test génétique est systématique en cas d'ATTR. Ces maladies n'étant plus perçues comme incurables depuis les récentes innovations thérapeutiques, une meilleure (re)connaissance de la maladie est plus que jamais nécessaire. The 3 main types of cardiac amyloidosis are linked to two protein precursors: AL amyloidosis secondary to free light chain deposits in the context of monoclonal gammopathy (mainly of undetermined significance or myeloma) and transthyretin amyloidosis (ATTR), comprising wild-type transthyretin amyloidosis (ATTRwt for wild type) and hereditary transthyretin amyloidosis (ATTRv for variant). These diseases are underdiagnosed and highly prevalent in common cardiac phenotypes in recent studies (heart failure with preserved ejection fraction, severe aortic stenosis, hypertrophic cardiomyopathy). Myocardial amyloid infiltration affects all cardiac structures and clinically promotes predominantly heart failure, conductive disorders and cardioembolic events. The search for extracardiac signs makes it possible to arouse diagnostic suspicion. Electrocardiogram, echocardiography and cardiac MRI can suspect cardiac amyloidosis. The diagnostic confirmation follows a simple algorithm including a systematic search for monoclonal gammapathy and a disphosphonate scintigraphy. Histological proof is necessary in case of AL or ATTR amyloidosis with concomitant monoclonal gammopathy in order to initiate specific treatment. Due to the late disease onset in ATTRv, genetic testing must be routine in all cases of ATTR. These diseases are no longer perceived as incurable since recent therapeutic innovations. A better knowledge of the disease is more than ever necessary. [ABSTRACT FROM AUTHOR]

Primary pulmonary salivary gland-type tumors are rare and characterized by a specific clinicopathological manifestation. They are proximal tumors affecting young subjects and not associated with smoking. For optimal management, it is important to distinguish them from other bronchopulmonary tumors, with which they don't share either biology or treatment and outcome. We conducted a retrospective study, including all primary malignant salivary gland-type tumors of the lung, over a period of 32 years, from January 1987 to December 2019. We collected data from the medical records of 10 patients: 5 men and 5 women (sex ratio 1). The average age of our patients was 47.4 years. In all cases radiological examinations showed proximally located nodular tumor ranging in size from 1 to 5.8 cm. Histological examination objectified mucoepidermoid carcinoma (6 out of 10 cases). All patients had localized or locally advanced tumors, with the exception of one case of metastatic mucoepidermoid carcinoma. Pulmonary salivary gland-type tumors correspond to a heterogeneous group of tumours. They are not very aggressive but are associated with a high frequency of recurrences and late metastases, requiring long-term monitoring. [ABSTRACT FROM AUTHOR]

Orbital cellulitis is a rare disease. Two anatomoclinical forms can be distinguished: a preseptal "benign" form and a retroseptal "severe" form. The purpose of this study was to analyze the epidemiological, clinical, therapeutic and prognostic profile of orbital cellulitis in a third-line Hospital in Tunis, Tunisia. We conducted a retrospective study involving 109 patients hospitalized for orbital cellulitis. Two groups were distinguished: the retroseptal cellulitis group including 42 patients (38.5%) and the preseptal cellulitis group including 67 patients (61.5%). The average age of patients was 27.1 ± 34.8 years. The sex ratio M/F was 0.84 (45.9% of male patients). Acute sinusitis was the most frequently identified portal for retroseptal cellulitis entry (35.7%, n=15), while acute dacryocystitis was the most common cause of preseptal cellulitis (23.9%, n=16). Diabetes, non-functioning eye and prior use of non-steroidal anti-inflammatory drugs were associated with retroseptal cellulitis (p=0.007, p=0.022 and p=0.014 respectively). All patients received systemic antibiotic therapy. Ten patients (23.8%) of the retro-septal cellulitis group and 5 patients (7.46%) of the preseptal cellulitis group underwent surgery. Nine cases of blindness (8.2%), a case of septic shock and a case of death were reported. Poor prognostic factors were a time of consultation > 7 days (aOR = 4.277, 95% CI = 2.504-32.426, p = 0.006) and Chandler stage>III (aOR = 7.009, 95% CI = 1.69-51.839, p = 0.029). In developing countries and especially in Tunisia, orbital cellulitis can be sight threatening or even life-threatening. Early management could lead to a favorable outcome without sequelae. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: L'artérite à cellules géantes (ACG) ou maladie de Horton est une artérite inflammatoire segmentaire et focale des artères de gros et moyen calibre du sujet de plus de 50 ans, avec un pic de fréquence chez le sujet très âgé entre 70 et 80 ans. Dans cette classe d'âge et au-delà de 80 ans, les données cliniques concernant l'AGC sont peu nombreuses. Notre objectif est de documenter ces dernières à travers une étude monocentrique menée sur une population avec une AGC avérée. Patients et méthode: Nous avons mené une étude rétrospective, monocentrique sur les dossiers médicaux de patients diagnostiqués artérite de Horton selon les critères de l'ASR entre 2012 et 2017 au CHU de Reims. Pour évaluer l'influence de l'âge sur le plan diagnostic, thérapeutique, du suivi et du pronostic, nous avons comparé des patients de 75 ans et moins (≤ 75 ans) à ceux de plus de 75 ans (> 75 ans) sur ces différents points. Résultats: Soixante-sept patients ont été inclus. L'âge moyen au diagnostic de ces patients était de 75,85 ± 8,5 ans ; 36 patients (53,7 %) étaient âgés de 75 ans ou moins (dont 22 femmes) et 31 patients (46,3 %) étaient âgés de plus de 75 ans (dont 21 femmes). La médiane de suivi était de 43,02 mois chez les patients ≤ 75 ans et de 30,99 mois chez les > 75 ans, soit près d'un an de différence, mais non significative (p = 0,620). Onze patients (16,4 %) étaient décédés au cours du suivi, 5 (13,9 %) chez les patients ≤ 75 ans et 6 (19,4 %) chez les patients de > 75 ans (p = 0,547). Les patients > 75 ans avaient significativement moins d'aortite (p = 0,0410). Il y avait une tendance à moins de rechute chez les patients de > 75 ans (p = 0,067). Pour les autres symptômes ou anomalies biologiques, les résultats de la biopsie d'artère temporale, la prise en charge thérapeutique, les complications iatrogènes et les décès, aucune différence significative n'était mise en évidence entre les deux groupes (p = ns). Conclusion: Notre étude montre peu de différence en ce qui concerne l'AGC entre les patients > 75 ans et ceux ≤ 75 ans. Toutefois, les patients > 75 ans ont moins d'aortite que les sujets plus jeunes. Il semble également y avoir une tendance à davantage de rechute chez les sujets les plus jeunes, sous réserve d'une durée de suivi plus courte d'un an, cliniquement pertinente, chez les sujets les plus âgés. Introduction: Giant cell arteritis (GCA) or Horton's disease is a segmental and focal inflammation of large and medium-sized arteries mostly seen in patients of 50 years and older. There is also a peak frequency in individuals between the ages of 70 and 80. However, clinical data is scarce in this age group and especially in patients over 80. Methods: A retrospective study comprised of patients diagnosed with Horton's arteritis between 2012 and 2017, according to the American Society of Rheumatology, was conducted at Reims University Hospital. Patients were assigned to two groups according to age (≤ 75 and < 75) in order to evaluate and compare the impact of age on diagnosis, treatment and prognosis. Results: A total of 67 patients were studied. The mean age upon diagnosis was 75,85 ±8.5 years; 36 patients (53.7%) 75 years or younger and 31 patients older than 75. There was a female predominance (43 patients), 22 patients aged 75 years or younger and 21 older than 75. The mean follow up duration was 43.02 months in patients aged 75 years or younger and 30.99 in patients older than 75. This represents a difference of more than one year in terms of follow up, but is not statistically significant (p = 0.620). Eleven patients (16.4%) died during follow up: 5 patients (13.9%) aged 75 years or younger and 6 patients (19.4%) older than 75 (p = 0.547). Aortitis was significantly less seen in patients older than 75 (p = 0.0410). Conclusion: Our study showed no significant difference in either age group. However, aortitis was less seen in patients older than 75 years. Patients aged 75 or younger seemed more prone to relapses, but their follow up periods were shorter. [ABSTRACT FROM AUTHOR]

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Copyright of Nouveau Praticien Vétérinaire - Équine is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early and late toxicity in patients infected with covid-19 treated at the same time for early-stage breast cancer. This is a monocentric prospective study of patients treated in our hospital between March and June 2020 who were diagnosed with covid-19 infection. The inclusion criteria were to be irradiated for early-stage breast cancer and to have a positive covid diagnosis on a polymerase chain reaction (PCR) test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. All of them needed 6 months follow-up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the Common Toxicology Criteria for Adverse Events (version 4.03). All 350 patients treated for early-stage breast cancer were studied. Of them, 16 presented clinical symptoms of covid-19 infection, and of them 12 had clinical, CT scan and PCR confirmation. This entire cohort of 12 patients with median age of 56 years (range: 42–72 years) underwent their radiotherapy. During the radiotherapy, nine patients presented radiodermatitis: eight grade 1 (66%) and one grade 2 (8%). Two patients with lymph nodes irradiation presented grade 2 oesophagitis. Late toxicity was evaluated 6 months after the end of the radiotherapy, and there was no radiation or covid lung sequel on the CT scans. One patient presented covid-related dyspnoea, and two had fibrosis. The half-year follow-up of prospective covid-19 cohort, treated for early-stage breast cancer demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the covid-19 infection does not appear to increase the side effects of radiotherapy. Therefore radiotherapy should not be delayed. [ABSTRACT FROM AUTHOR]

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Introduction: severe acute liver injury (SALI) formerly known as severe acute hepatitis is an acute inflammation of the liver with markers of liver injury (elevated transaminases) and signs of hepatocellular failure (jaundice and INR greater than 1.5) according to the latest definition of the European Association for the Study of the Liver (EASL). An important prognostic factor in SALI is the development of hepatic encephalopathy (HE) and thus its progression to acute liver failure (ALF), formerly known as acute severe hepatitis. The purpose of this study is to investigate factors predicting the development of hepatic encephalopathy during SALI. Methods: we conducted a retrospective study of patients treated for SALI between January 2000 and December 2019. We divided patients into two groups depending on whether hepatic encephalopathy occurred. We performed an analytical study comparing the two groups according to their epidemiological, biological and evolutionary data. Results: data from the medical records of fifty-nine patients were collected. A virus was the most frequent cause (63%). Hepatic encephalopathy occurred in 15 patients (25.4%). Factors predicting the development of HE in univariate analysis were a delay in consultation of more than 9 days, an INR level of more than 2.45, a bilirubin level of more than 230 µmol/l, creatinine greater than 60.5 µmol/l, urea greater than 5.5 mmol/l and MELD score greater than 26.5 (p=0.023, p=0.017, p=0.0001, p=0.049, p=0.0001, p=0.0001 respectively). Autoimmune hepatitis and an undetermined cause were associated with the development of HE (p=0,003 and p=0,044, respectively). In multivariate analysis, autoimmune aetiology and a urea level above 5.5 mmol/l were significantly associated with the occurrence of HE. No statistically significant differences were found between the two groups with regard to age, sex and diabetes. Conclusion: SALI is a rare disease, mainly due to a virus in our country. Predictive factors of HE are important for early identification of patients at risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the clinical, electrical, angiographic and therapeutic characteristics of young patients with acute myocardial infarction and to describe the prevalence of in-hospital complications. FromJanuary 2014 to May 2017, we retrospectively studied data of patients with acute myocardial infarction younger than 45 years old in the department of cardiology of Charles Nicolle hospital of Tunis. We enrolled 108 patients in the study. The prevalence of myocardial infarction in young patients was 8.5%. The mean age was 39.5 ± 5.5 years with a sex-ratio of 11. The most frequent cardiovascular risk factors were smoking (88%) and dyslipidaemia (51.9%). We reported 75 cases of ST segment elevation myocardial infarction. Primary angioplasty was performed in 41.3% of cases while lytic therapy was administered for the rest of the patients. It was successful in 75% of cases. Among 33 patients who presented with non-ST segment elevation myocardial infarction, percutaneous coronary angioplasty was performed in 60.6% of patients while 15.2% have undergone coronary artery bypass surgery and 24.2% received medical treatment only. In-hospital complications occurred in 39.8% of cases. In-hospital mortality was 1.9 %. Acute myocardial infarction in the young represents a serious health problem. Primary preventive measures aimed at preventing our youth from adopting tobacco use and developing dyslipidemia should be implemented to delay and even to avoid the onset of coronary artery disease. [ABSTRACT FROM AUTHOR]

La sarcoïdose est une maladie systémique granulomateuse, caractérisée par une atteinte médiastinopulmonaire, chez la majorité des patients et, plus rarement, par des atteintes extrapulmonaires, comme des atteintes oculaires, cutanées, des glandes exocrines, ganglionnaires et articulaires. Les atteintes neurologiques et cardiaques sont plus rares, mais font toute la gravité de la maladie. Les atteintes cardiaques concernent 5 à 20 % des patients, selon les séries, et touchent même plus de 25 % des patients dans les séries autopsiques. Cette revue vise à faire le point sur l'intérêt diagnostique des différentes techniques d'imagerie dans la sarcoïdose cardiaque et également détailler la prise en charge « interniste » et cardiologique de ces patients qui requièrent une prise en charge pluridisciplinaire. Sarcoidosis is a systemic granulomatous disease characterized by pulmonary involvement in most patients and more rarely by extrapulmonary involvement such as ocular, skin, salivary, lymph nodes and joints damages. Neurological and cardiac involvements are uncommon but are associated with increased morbidity and mortality. Cardiac sarcoidosis affects 5 to 20% of patients depending on the studies and autopsy studies even report cardiac involvement in 25% of sarcoidosis patients. This review aims to summarise main data on the diagnostic value of the different imaging techniques in cardiac sarcoidosis and to also detail the management of these patients who require a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

The consequences of child abuse can be multiple in terms of physical and mental health with the risk to compromise the future in adulthood. Neurosciences are beginning to provide details on the effects on the cognitive and cerebral development of child victims. There seems to be a link between abuse and in particular the reduction of intellectual capacities, a deficit of linguistic capacities and an alteration of executive functions. These cognitive alterations could be underpinned by the structural and functional modifications highlighted at the cerebral level. Studies, especially longitudinal, are still needed to better clarify the involvement of pre-existing genetic factors in environmental adversity and better identify prognostic factors in order to improve children's management. [ABSTRACT FROM AUTHOR]