Nephroblastoma in Adults about a Clinical Case

Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. These are tumors that remain and remain unstudied in Mali because they are common in adults in our context. Its annual incidence is estimated at approximately 1/10,000 births. Nephroblastoma is a rare or even exceptional tumor in adults. The clinical manifestation was a large swelling of the right hypochondrium;abdominal pain for a year;unquantified fever, hypertension, initial hematuria associated with burning during urination and anemia. The main clinical manifestation remained fever and abdominal pain. This renal tumor posed a diagnostic problem which was previously labeled as a mesenteric tumor in our general surgery department. The diagnosis was made by imaging: CT and magnetic resonance imaging. The treatment is multidisciplinary and combines chemotherapy, surgery with or without radiotherapy. The prognosis is poor due to late diagnosis and less effectiveness of chemotherapy compared to the child. Survival did not exceed a year and a half because the renal tumor in our patient was surgically overcome. We report a case of nephroblastoma in an 86-year-old patient with unfavorable histology (hematogenous metastases), operated on in the general surgery department and whose postoperative course was simple and who was referred to oncology for treatment.

A Cross-Sectional Survey on Non-Communicable Diseases and Risk Factors in the Senegalese Army

Background: The non-communicable diseases (NCDs) have become a public health priority. The objectives of this study were to measure the prevalence and to assess the risk factors of NCDs among the Senegalese military population to initiate an intervention program. Methods: A cross-sectional survey was conducted in 2014. Two-level stratification was used to sample participants. Data were collected following the protocol recommended by the World Health Organization. Data were managed using Epi-Info 6 software and analyzed using R software. Results: A total of 1224 participants were recruited, of whom 96.9% were men. Their ages ranged from 25 to 60 years with a mean of 39.7 ± 9.2 years. Of participants, 17.2% were active smokers. Average duration of active smoking was 19.9 ± 9 years. The prevalence of current alcohol consumption was 11.5%, with an average of 4 ± 2.7 glasses a day. 97.17% of participants consumed fewer than 5 servings of fruits and vegetables a day. 18.63% had insufficient physical activity. The overall prevalence of high blood pressure was 26.9%. The proportion of those who were overweight was 27.2%;3.3% were obese. 3.0% of participants had diabetes and 44.1% had hypercholesterolemia. After adjusting for waist circumference, the risk of high cholesterol was 2.42 in the 35 - 44 age group and 2.86 in the 45 - 60 age group in comparison with the 25 - 34 age group. 32% were classified as having stage 2 chronic kidney. Conclusions: The findings of this study indicate the importance of risk factors for NCDs in the Senegalese military population. Intervention based on prevention and health promotion is needed.

Epidemiological, Clinical, Bacteriological Profile of Urinary Tract Infection in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.

Etiological and Evolutionary Profile of Anemia in Patients Hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all anemic patients hospitalized during the study period. Results: We identified 91 cases of anemia out of 200 patients admitted to the Unit that is a hospital prevalence of 45.5%. The age group of 26 to 35 years was the most represented, that is to say 29 cases (31.87%) with an average age of 43.55 years ± 17.48 years, the female sex predominated, 51 cases (56.04%) with a sex ratio of 0.78. Housewives represented 41 cases (45.05%). The majority of patients resided in rural areas 48 cases (52.75%). The main manifestations were: asthenia 75 cases (78.02%), vertigo 68 cases (74.72%), dyspnea 62 cases (68.13%), headaches 59 cases (64.83%), palpitations 55 cases (60.44%), conjunctival pallor 53 cases (58.24%), tachycardia 43 cases (47.25%), systolic murmur 18 cases (19.78%) and IMO 11 cases (12.09%). The associated pathologies were: infected diabetic wounds 25.27%, followed by bacterial pleuro-pneumopathy 18.68%. Biologically, microcytic anemia was the most frequent 49 cases (53.84%), followed by normocytic anemia 35 cases (38.46%) and macrocytic anemia 7 cases (7.7%). Anemia was hypochromic, 53 cases (58.24%) were more encountered compared to normochromic anemia 38 cases (41.76%). The anemia was: severe in 43 cases (47.25%), moderate 29 cases (31.87%) and mild 19 cases (20.88%). Inflammatory anemia is the most common etiological diagnosis in 60% of cases, followed by vitamin B12 deficiency anemia observed in 21% of patients and then blood diseases in 7.33% of cases. The main causes of death were HIV (50%) and kidney failure (33.33%). Conclusion: Anemia is a frequent symptom in internal medicine. It constitutes a real diagnostic challenge for the internist and this sometimes in an emergency context. The use of specialized examinations and labile blood products is essential in our hospital.

Chinese expert consensus on the treatment of modern combat-related spinal injuries

The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Chinese expert consensus on echelons treatment of pelvic fractures in modern war

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level Ⅰ facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation Army(PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level Ⅰfacilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

HBsAg seroprevalence among Senegalese militaries

Background: Chronic hepatitis is a major public health problem. The hepatitis B virus is the primary cause, and Hepatitis B and C together are responsible for 60% of cirrhosis and 80% of hepatocellular carcinomas. This study measured the prevalence of HBsAg among Senegalese military to develop a strategy to prevent cirrhosis and hepatocellular carcinoma in the army.Methods: We conducted a descriptive cross-sectional study among Senegalese army staff aged 25 to 60 years and divided this group into three strata: 25-34, 35-44 and 45-60 years. A sample of 1224 participants was selected following a two-level stratification. The mark of surface HBs antigen(Ag) was performed on 1195 participants using chemiluminescence(qualitative Architect HBsAg of Abbott Diagnostics Laboratories Germany) and enzyme immunoassay(Determines HBsAg) methods. The presence of HBsAg was analyzed according to age, marital status, alcohol consumption and glomerular filtration rate. Epi-info6 and R software were used, respectively, for data capture and analyses. A Chi-square test was performed to compare proportions considering an alpha significance level of 5% and a confidence interval of 95%.Results: The average age was 39.8±9.2 years. Participants in the age groups of 25-34 years, 45-60 years and 35-44 years were 30.7%, 34.4% and 34.9% of the sample, respectively. Married persons accounted for 82.6% of participants, and 17.08% were single. Most participants were educated(99%), and 56% had reached at least the secondary school level. Alcohol consumption was at 11.5%. The HBsAg prevalence rate was 10.8% [9.1% to 12.7%] with a significant difference between age groups(P<0.001), which ranged from 5.6% for 45-60 years, 9.62% in the 25-34 years group and 16.9% for the 35-44 years group. Marital status and alcohol consumption did not affect the carriage of HBsAg. The prevalence of HBsAg was more common among participants who had a glomerular filtration rate greater than 90 ml/min. Transaminases rate exceeded the normal threshold in 43 participants(3.6%). The increase was 6.6% [2.7% to 11.8%] of HBsAg carriers and 3.2% [1.2% to 6.7%] of alcohol users.Conclusion: The high prevalence of HBsAg in the military requires the implementation of an accessible prevention and care program to reduce the risk of cirrhosis and hepatocellular carcinoma. This program will contribute to reducing the burden of communicable diseases, such as hepatitis and HIV/AIDS, and non-communicable diseases in the armed forces.

Unmet Needs for Family Planning among Adolescent Girls Giving Birth in Three Teaching Hospitals in Yaoundé

Many adolescent girls are pressured into having sex at an early age, which puts them at high risk of unwanted pregnancies and unsafe abortions. The overall objective of this study was to evaluate the unmet needs of adolescents who give birth. A descriptive cross-sectional study was carried out in three university hospitals in Yaoundé, Cameroon: Yaoundé Central Hospital, Yaoundé Gyneco-Obstetrics and Pediatric Hospital and the District Hospital of Biyem-Assi, from February 1, 2020 to June 30, 2020. Included were any teenage mothers speaking English or French. Data were entered using CSPRO 7.3, analyzed by Excel 2010 and SPSS version 23.0. The tools used to express our results were the number, the frequency, the mean, the odds ratio (OR) and the P. P was significant if less than 5%. Of a total of 2692 births recorded, 188 (7%) were from adolescents. Of these, 157 fulfilling our selection criteria were recruited and data analyzed. The average age of the participants was 17.9 ± 1.12 years with extremes of 13 and 19, the average parity was 1.2 ± 0.4 with extremes of 1 and 3. Out of 157 participants, 2 who fell in the age range of 10 to 14 years (100%) and 106 of 155 (68.4%) whose age ranged from 15 to 19 years had unmet need for family planning. Only unmarried participants had unmet needs after multivariate analysis [aOR 2.4 (1.1 - 5.3);p = 0.035)]. Being unmarried was independently associated with the occurrence of unmet needs. The intensification of campaigns for provider behavior changes communication and the creation of services dedicated to the sexual and reproductive health of adolescents would help to reduce the rate of unmet needs for family planning among adolescent girls.

Pediatric Eye Trauma: Epidemiological, Clinical and Therapeutic Aspects at CADESSO in Donka, Guinea

Introduction: Eye trauma represents all morbid lesions on the eyeball due to external violence. In children, they are an important cause of morbidity and the leading cause of monocular blindness. The aim of this study was to determine the sociodemographic, clinical and therapeutic characteristics of eye trauma in children aged 0 to 16 at the Application Centre for the Diploma of Specialized Higher Studies in Ophthalmology (CADESSO) in Donka, Guinea. Patients and Method: This was a prospective longitudinal study with descriptive purposes from January 1 to December 31, 2019 involving 205 children victims of eye trauma. Variables related to sociodemographic, clinical and therapeutic characteristics were studied. Informed consent from patients and/or their parents was sought and obtained. The confidentiality of the files was guaranteed. The data entry was done on EPI-Info version 7 and the analysis using the Stata software. The tables were made in Excel 2010. Pearson’s Chi2 test was used for the comparison of proportions. Results: Pediatric eye trauma accounted for 9.31% of pediatric visits and 30.92% of all eye trauma cases. There was a male predominance with a sex ratio of 1.59. Age groups from 0 - 4 years;5 - 8 years and 9 - 12 were the most affected with 26.8%, 28.8% and 27.3% respectively and a decrease in the number of cases in the 13 - 16 age group (17.1%). Gambling and sports accidents accounted for 33.2%, followed by domestic accidents for 16.6% and physical injury for 8.2%. Eye contusion was the most represented at 66.3% followed by wounds of the globe 23.9% and burns at 5.9%. One hundred and twenty-six patients had received a determination of visual acuity (VA) at admission;99 were assessed at discharge and 27 were lost to follow-up. The VA ≥ 5/10th increased from 43.4% at admission to 79.8% after treatment. We had found 67% of vision ≥ 5/10 in eye bruises against 5% in eyeball wounds. Anti-inflammatories (99.5%)) were almost used. The sequelae were dominated by corneal opacities (71.9%). Conclusion: Child eye trauma is a public health problem in Guinea. The best means of care remains prevention, which must be of interest to the child and his environment.

Total body water percentage and 3rd space water are novel risk factors for training-related lower extremity muscle injuries in young males

Purpose:To identify the risk factors for training-related lower extremity muscle injuries in young males by a non-invasive method of body composition analysis.Methods:A total of 282 healthy young male volunteers aged 18-20 years participated in this cohort study.Injury location,degree,and injury rate were adjusted by a questionnaire based on the overuse injury assessment methods used in epidemiological studies of sports injuries.The occurrence of training injuries is monitored and diagnosed by physicians and treated accordingly.The body composition was measured using the BodyStat QuadScan 4000 multifrequency Bio-impedance system at 5,50,100 and 200 kHz to obtain 4 impedance values.The Shapiro-Wilk test was used to check whether the data conformed to a normal distribution.Data of normal distribution were shown as mean±SD and analyzed by t-test,while those of non-normal distribution were shown as median(Q1,Q3)and analyzed by Wilcoxon rank sum test.The receiver operator characteristic curve and logistic regression analysis were performed to investigate risk factors for developing training-related lower extremity injuries and accuracy.Results:Among the 282 subjects,78(27.7%)developed training injuries.Lower extremity training injuries revealed the highest incidence,accounting for 23.4%(66 cases).These patients showed higher percentages of lean body mass(p=0.001),total body water(TBW,p=0.006),extracellular water(p=0.020)and intracellular water(p=0.010)as well as a larger ratio of basal metabolic rate/total weight(p=0.006),compared with those without lower extremity muscle injuries.On the contrary,the percentage of body fat(p=0.001)and body fat mass index(p=0.002)were lower.Logistic regression analysis showed that TBW percentage>65.35%(p=0.050,odds ratio=3.114)and 3rd space water>0.95%(p=0.045,odds ratio=2.342)were independent risk factors for lower extremity muscle injuries.Conclusion:TBW percentage and 3rd space water measured with bio-impedance method are potential risk factors for predicting the incidence of lower extremity muscle injuries in young males following training.

Awake rabbit model of ischemic spinal cord injury with delayed paraplegia:The role of ambient temperature

Background:Paraplegia after spinal cord ischemia is a devastating condition in the clinic.Here,we develop an awake rabbit model of spinal cord ischemia with delayed paraplegia and explore the influence of ambient temperature on the outcomes after injury.Methods:A total of 47 male rabbits were involved in the present study.Transient spinal cord ischemia was induced by occluding the infrarenal abdominal aorta of awake rabbits at different ambient temperatures.To find the optimal conditions for developing delayed paraplegia,hindlimb motor function after ischemia was evaluated between experiments.Results:The onset and magnitude of ischemic injury varied with the ambient temperature maintained during the peri-i schemia period.More serious spinal cord injury occurred when ischemia was induced at higher temperatures.At 18°C,25-minute ischemia resulted in 74%of rabbits developing delayed paraplegia.At a temperature of 28°C or higher,most of the animals developed acute paraplegia immediately.While at 13°C,rabbits usually regained normal motor function without paraplegia.Conclusion:This awake rabbit model is highly reproducible and will be helpful in future studies of delayed paraplegia after spinal cord ischemia.The ambient temperature must be considered while using this model during investigation of therapeutic interventions.

Central nervous system injury meets nanoceria:opportunities and challenges

Central nervous system(CNS)injury,induced by ischemic/hemorrhagic or traumatic damage,is one of the most common causes of death and long-term disability worldwide.Reactive oxygen and nitrogen species(RONS)resulting in oxidative/nitrosative stress play a critical role in the pathological cascade of molecular events after CNS injury.Therefore,by targeting RONS,antioxidant therapies have been intensively explored in previous studies.However,traditional antioxidants have achieved limited success thus far,and the development of new antioxidants to achieve highly effective RONS modulation in CNS injury still remains a great challenge.With the rapid development of nanotechnology,novel nanomaterials provided promising opportunities to address this challenge.Within these,nanoceria has gained much attention due to its regenerative and excellent RONS elimination capability.To promote its practical application,it is important to know what has been done and what has yet to be done.This review aims to present the opportunities and challenges of nanoceria in treating CNS injury.The physicochemical properties of nanoceria and its interaction with RONS are described.The applications of nanoceria for stroke and neurotrauma treatment are summarized.The possible directions for future application of nanoceria in CNS injury treatment are proposed.