Micropenis Associated or Not with Cryptorchidism in the Endocrinology Department of Yopougon University Hospital in Ivory Coast: Epidemiological, Clinical, Paraclinical and Therapeutic Aspects

Background: Congenital malformations such as micropenis and cryptorchidism do not have immediate dramatic consequences. However, the diagnosis is often unknown at birth, and therefore late. In Ivory Coast, there are few studies on cryptorchidism and micropenis. We conducted this study to identify the epidemiological, clinical, etiological and therapeutic characteristics of the micropenis associated or not with cryptorchidism at Yopougon University Hospital. Methods: We conducted a retrospective descriptive study in the Department of Endocrinology-Diabetology of the Yopougon University Hospital carried out over 13 years from January 2005 to December 2018. All patients were included regardless of the presence of a micropenis associated or not with cryptorchidism in the clinical or paraclinical examination. Results: A total of 14 micropenis were reported associated in 6 cases with cryptorchidism. It was unilateral cryptorchidism in 4 patients or 66.66% of cases. The average age of affected patients was 21.32 years with extremes ranging from 10 months to 48 years. The reason for consultation was micropenis in 12 out of 14 cases or 85.75%. The associated signs apart from cryptorchidism were obesity in 42.86% of cases, gynecomastia in 35.71% of cases. The aetiology was dominated by idiopathic causes. Treatment with testosterone enanthate was more effective in pre-pubertal children than in adults. Conclusion: The diagnosis of micropenis associated or not with cryptorchidism is late because of the frustrations, taboos and psycho-social states that it causes. However, drug treatment is effective when treatment is started early.

Epidemiological Aspects of Obesity, Overweight and Cardiovascular Risk Factors at Associes in Semi-Urban Areas (Case of Sébikotane)

Introduction: Obesity and overweight are a public health problem. The general objective was to determine the epidemiological aspects of obesity, overweight and associated risk factors in a semi-urban environment. Patients and Methods: This was a cross-sectional, descriptive study conducted on November 28 and 29, 2023 in Sébikotane. It focused on volunteers for screening for chronic non-communicable diseases. Epidemiological and clinical data were evaluated. Results: One hundred and twenty-nine cases of obesity were recorded (28%). Two hundred and eighty-two cases were overweight or obese (61.3%). The mean age was 49.55 years, with a standard deviation of 12.41 years. The age group [40 - 49 years] was the most representative, with 85 cases (30.1%), and the majority were female, with 264 cases (93.6%). Primary education was the most common, with 75 cases (46.3%). Grade 1 obesity concerned ninety-seven cases (75.2%), and diabetes was present in thirty cases (23%). Hypertension was present in ninety-five cases (33.7%). Obesity was more marked in the age group [40 - 49 years] with 45 cases (36%). Conclusion: Obesity and overweight are a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.

Survey on Knowledge of Cardiovascular Disease Risk Factors in the Dakar Region

Introduction: Non-communicable diseases constitute a major public health problem, due to their morbi-mortality. The aim was to study knowledge of cardiovascular risk factors among residents of Dakar. Patients and Methods: This was a descriptive cross-sectional study. Our investigations were recruited over a six-month period (October 17, 2021 to March 21, 2022). Results: Two hundred and twenty-six (226) patients were enrolled. The mean age was 45.9 years. The under-40 age group was the most represented with 37.2%. There were 129 men (57.1%), giving a male/female sex ratio of 1.33. The highest level was represented by 159 people (70.4%). Those who responded (heart disease) were in the majority (38.1%). Hypertension was the most common CVD for 101 people (44.7%). One hundred and ninety (190) people (84%) knew the risk factors for CVD. Good knowledge of risk factors concerned 103 people (54.2%). Obesity was the best-known risk factor in 156 cases (69%). The media was the most important source of information for 121 people (53.5%). Hypertensives were the most represented with 8.4%. One hundred and thirty (130) people (57.5%) had previously paid attention to these FDRCVs. Awareness campaigns were the most effective means of communication for 170 cases (75.2%). Sixteen (16) people (35.6%) were taking antihypertensive medication. Walking was the most popular physical activity for 102 people (45%). People with a balanced diet were in the majority, with 174 respondents (77.0%). Conclusion: NCDs are a major cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.

Addition of Insulin to Treatment Regimen in Type 2 Diabetes: The Significance of Age and Duration among Sudanese Diabetic Patients

Background: Type 2 diabetes is a progressive disease and as the result of patient’s age and diabetes duration, β-cell ability for insulin secretion deteriorates continually and finally fails to meet body requirement. Intensification of treatment drug regimen including addition of insulin is critical to maintain glycemic target and reduce developing of long-term complications. Objective: The main purpose of this study was to investigate the effect of diabetes duration and patients’ age on addition of insulin to treatment regimen. Methods: A single centre, cross-sectional hospital-based study was done among 351 diabetes Mellitus (DM) patients visiting Ribat University Hospital Diabetic Clinic, Khartoum State, Sudan. Data was collected using constructed, validated and multiple-choice questionnaire. Results: From 351 patients enrolled in the study, female were 65.8% and male 34.2%. About 64.4% were on oral anti-diabetic;35.6% on insulin;about 31.6% shifted to insulin when their ages above 40 years;and 22.8% when diabetes duration was above 5 years. Co-morbidity was 54.4% and 60.2% of patients had hypertension. Conclusion: Interactions between age and longer duration of diabetes were mostly significant reasons for transferring patients to insulin. Percent of insulin users and co-morbidity was within international range.

Diagnostic and Therapeutic Challenges of De Quervain Thyroiditis in Sub-Saharan Africa: Illustration with Two New Cases in Dakar

Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.

Knowledge, Attitudes and Practices Survey in Management of Type 2 Diabetes by General Practitioners in Dakar

Introduction: Considering the global burden of diabetes and lack of specialist in diabetology in our subsaharian area, general practitioners (GPs) play a major role as first referent for care of diabetic people. The aim of this work was to describe knowledge, attitudes and practices of GPs related to management of type 2 diabetes. Patients and Methods: It was about a transversal and descriptive survey held between July 14, 2015 and November 1st, 2015 in the medical districts and public corporations of health of Dakar in Senegal. Results: The population of study was made of 107 males and 40 females GPs. The majority (82.8%) was graduated since less than five years. Hygienic and dietetic measures (HDM) were known and commonly recommended by 77.60% of GPs in their daily practice. The caloric intakes were known by 21.1%. The 30 min of physical activity per day three times in the week was advised by 91.20%. Monotherapy with metformine associated with HDM was prescribed by 76.90%. Bitherapy with metformine and sulfonylureas associated to HDM were prescribed by 39.50%. Concerning insulin therapy, mixed insulin twice daily associated with rapid insulin before lunch was prescribed by 49.7%. Use of rapid acting insulin with three injections before each meal was prescribed by 36.10%. Treatment of the other cardiovascular risk factors was addressed by 97.30%. Smoking cessation was advised by 37.40%. Use of sweetened drink and intravenous glucose were most adopted in case of hypoglycemia, and use of glucagon was adopted by 23.10%. To improve the diabetic retinopathy 61.2% of GPs recommended tight control of other cardiovascular risk factors. Rigorous glycemic control and regular physical activity were recommended for painful neuropathy beside analgesics. Smoking cessation was also recommended by 61.90% for that. Against obstructive arterial disease of the lower extremities, tight control of blood pressure was recommended by 69.40% Conclusion: It comes out from these results the need for reinforcing post graduate trainings on diabetes for our GPs. Moreover, there’s an urgent need to elaborate and disseminate adapted guidelines and recommendations for improving efficient and standardized strategies for day to day management of type 2 diabetic people in our country.

Epidemiological and Clinical Profile of Breast Cancer at Bamako Radiotherapy Center

Breast cancer is a major public health problem because of its incidence and mortality. Purpose: To establish the epidemiological and clinical characteristics of breast cancer seen at the radiotherapy center at the Mali Hospital of Bamako. Patients and methods: It was a retrospective, descriptive study of data from patients seen for breast cancer at the Center of Radiotherapy of Mali Hospital between April 2014 and December 2016. The parameters studied were: age, sex, family history of breast cancer, menopausal status, parity, breast tumor location, histological type, histological grade, cancer classification stage. Results: 134 cases of breast cancer were collected, with a frequency of 15%. The sex ratio (H/F) of 0.007. The patient’s mean age was 47 ± 11 years old. The most represented age groups were 33 - 47 years old with 45.5% and 48 - 62 years old with 39%. Three percent (3%) of patients had a family history of breast cancer. Fifty (50%) of the patients were menopausal. The main clinical signs found were : mammary nodules (98%), mastodynia (65%), nodes (67%). Invasive ductal carcinomas were found in 94% of patients, followed by infiltrating lobular carcinomas with 3.7% and metaplastic carcinomas with 1.7%. SBR Grades II and III were mostly found with 37% and 23%. The average tumor size was 87 mm ± 43. Stage III was predominantly represented with 72%, followed by Stage II with 24% and Stages I and IV with 2% each. Conclusion: Breast cancer is common and reaches both before and after 50 years;the diagnosis is usually late;hence it is the importance of raising awareness and screening before the age of 50 and popularizing some complementary tests to better understand the prognosis of this disease and promote more targeted and conservative treatments that will improve survival.

Knowledge, Attitudes and Practices of Diabetic Patients on Ocular Complications of Diabetes in Lomé(Togo)

Introduction: The frequency and severity of eye complications from diabetes make patient education essential, which is the basis for adequate management. What is the level of education of diabetic patients in Lomé? The aim of this study was to assess the knowledge, attitudes and practices of diabetic patients on the ocular complications of diabetes in Lomé. Methods: We conducted a cross-sectional study by surveys on diabetic patients from April 1 to June 31, 2020, in 6 diabetes management centers in Lomé. The correct response rate was established for each component. Knowledge: poor (≤ 50%), low (50% - 65%), medium (65% - 85%) and good (≥ 85%). Attitudes: harmful (≤ 50%), erroneous (50% - 65%), approximate (65% - 85%) and fair (≥ 85%). Practice: harmful (≤ 50%), inadequate (50% - 65%) and adequate (>65%). Results: Over the study period, 150 patients were enrolled. The mean age was 56.98 ± 13.37 years with a sex ratio of 1.1 (79 men/71 women). The overall level of knowledge was insufficient (50.6%) with 65.5% for general knowledge about diabetes and 35.8% for ocular complications of diabetes. Attitudes were approximate (68.7%). In the case of hyperglycemia, 31.3% of patients would confide in a diabetologist and 22.0% in a general practitioner. If decrease in vision, 84.3% of patients would contact the ophthalmologist. The level of practice was harmful (20.4%). For diabetic follow-up, 36.7% of patients have already seen an ophthalmologist, 41.3% have performed a fundus examination, 17.3% retinal angiography, 4% laser retinal photocoagulation and 2.7% intravitreal injection (IVT). An awareness session on the ocular complications of diabetes was followed by 52.7% of patients and 50.7% of patients followed a therapeutic education session. Conclusion: This study has shown that the level of knowledge was poor, attitudes approximate and practices harmful. It is therefore important to raise awareness about diabetes and its ocular complications with the aim to change behavior.

Insulin Sensitivity and Gynaecological Features of Infertile Cameroonian Females with Polycystic Ovary Syndrome: A Cross-Sectional Study

Background: Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction, polycystic ovary(PCO),hyperandrogenism and insulin resistance is the commonest endocrine disorder in women of reproductive age. It is an intriguing pathology that involves the perpetuation of a vicious circle with reproductive, endocrine and metabolic components. We aimed to assess the reproductive features and insulin sensitivity (IS) in infertile women with or without PCOS. Materials and Methods: We carried out a cross-sectional analytic study at the outpatient Obstetrics and Gynaecology Department of the Yaounde Gyneco-obstetric and Pediatrics Hospital, Cameroon from September 1st 2012 to March 31st 2013 giving total study duration of 07 months. Laboratory analyses were carried out at the National Obesity Centre(NOC)of the Yaounde Central Hospital, Cameroon. Results: Overall, 36 infertile females were enrolled, which included 15 diagnosed cases of PCOS according to Rotterdam consensus meeting of 2003 and 21 non PCOS subjects as control. PCOS women were younger than non PCOS women (28.8 ± 5.5 vs. 35.0 ± 4.2 years;p = 0.0004). The majority of the women in the PCOS group were spaniomenorrheic (11/15), and ultrasonographic findings were typical of PCOS. Hirsutism score was higher in the PCOS group with a median of 9 (7 - 13). Insulin sensitivity was impaired in two-thirds of the study population, with 12 women found to be insulin resistant(6 PCOS, 6 non PCOS), 12 patients had intermediate insulin sensitivity(2 PCOS, 10 non PCOS)and 12 insulin sensitive(7 PCOS, 5 non PCOS). Apart from blood glucose levels (p = 0.007), all other anthropometric and biological parameters were not significant. Spearman’s correlation identified fasting plasma glucose and total cholesterol as factors associated with insulin sensitivity in females with PCOS. Impaired fasting glucose was observed in 13 patients with 08 from the PCOS group. Conclusion: We conclude that young age, spaniomenorrhea and hirsutism are common findings in PCOS. Furthermore, our findings suggest that PCOS may be more of systemic metabolic disease than solely a purely gynecologic disorder as described hitherto. Despite normal fasting plasma glucose levels, a good proportion of these women has impaired insulin sensitivity and it is associated with a metabolic syndrome.

Exercise as Component of Standard Diabetes Management, the Challenges to Improve Performance among Sudanese Type 2 Diabetes

Background: Exercise is important component of diabetes management. Regular exercise improves blood glucose, reduces hazard of cardiovascular diseases, decreases weight, increases insulin sensitivity and strengthens patients’ general health. Regular exercise can prevent or delay type 2 diabetes in those of high-risk populations. Although there are great benefits of regular exercise, unfortunately majority of people with type 2 diabetes are not active. Objectives: The main goal of this study was to assess patients adherence to regular exercise among type 2 diabetes Mellitus (T2DM) attending Ribat University Hospital Diabetic Clinic (RUHDC) Khartoum state, Sudan. Methods: Analytical cross sectional hospital based study was carried out among 351 patients from August 2012 to February 2013. Structured questionnaire and patients cards were used to collect data. Results: Out of 351 patients, female were 65.8% and male 34.2%. Patients older than 60 years 48.4%, illiterate 21.0%, only 44.2% had basic educational level, house wife 56.1% and retired 18.5%. Majority had irregular exercise program (80.1%), 12.1% specified lack of time whilst 87.9% did not specify any other reasons as barrier for regular exercise “no reason”. Daily activity was the main type of physical activity (59.8%). Although insignificant, irregular exercise was higher among female patients, their age above 60 years, patients had low education levels and those had financial problems. Conclusion: Regular exercise was low in this study. Lack of time, female, patients older than 60 years, had low education levels, and had financial problems, which were the main barriers of regular exercise. Family support, tailored patients’ education and reduction of patients’ use of technology and modern living can improve the patients’ activity.

Management of Pheochromocytoma in Dakar: Diagnostic and Therapeutic Advances throughout 16 Cases

Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.

Epidemiological and Clinical Profile of Cervix Cancer at Bamako Radiotherapy Center

Cervical cancer remains a major public health problem in Africa, particularly in Mali. The goal of this work was to investigate the epidemiological and clinical aspects of cervix cancer seen at the radiation therapy center. This was a descriptive study on the retrospective collection of data on patients found in the Radiation Therapy Centre of Bamako, for invasive cervical cancer be-tween April 2014 and April 2017. The average age of our population was 52 ± 12.5 years with extremes ranges from 18 to 95 years. The most represented age group was [50 - 65 years] with 44.2%. The predominant histological type was squamous carcinoma (CE) with 94.2%. Bleeding were found in almost all patients, most often associated with foul smelling hydrorrhea;80.3% of our patients were stage III and 12.9% of stage IV according to the IFGO classifi-cation. Cervix cancer remains a major public health problem in Mali. The di-agnosis is often late, therefore, resulting in late care and unfavorable progno-sis. Sensitization, vulgarization of vaccination and systematization of screen-ing could be helpful in the fight against this cancer.

Lipid Profile among the Diabetic and Non-Diabetic Obese Patients

Objective: To study the lipid profile among the diabetic and non-diabetic obese patients. Methods: It was a descriptive and prospective study carried out over a period of 9 months from March to December 2010. It concerned all the patients who came for consultation in endocrinology at the internal medicine of Point G University Hospital Center and at the National Center for Diabetes Research. All the patients were included without any gender or age difference, voluntary and with a BMI ≥ 30 kg/m2. Results: Out of the 1543 patients received in consultation, we had identified 178 obese people that is to say 11, 53% of the cases. Among these cases 60 abided by our criteria with 30 diabetic patients and 30 non-diabetic ones. The average age was 45.83 ± 14.68 years old;73.3% were more than 40 years old. The sex ratio was 0.07. Two third (66.7%) of our patients limited their eating diet to the three main meals/day and 61.7% were sedentary. The notion of family obesity was found in 93.4% of the cases, of family diabetes in 58.3% of the cases, of past personal medical history of hypertension in 43.3% of the cases. It was about an android obesity in 91% and Gynoid in 9% of the cases. The BMI was 55% of the cases comprised between 30 - 34.9 kg/m2. The lipid profile noticed was: A hypertriglyceridemia: 33% of diabetic patients and 10% of non-diabetic patients, a high LDL cholesterol: 37% of diabetic patients and 30% of our diabetic patients, a HDL hypocholesterolemia: 40% of the diabetic patients and 20% of the non-diabetic patients, a total hypercholesterolemia: 37% of the diabetic patients and 23% of non-diabetic patients. A hyperglycemia was noticed in 13.3% of non-diabetic patients. Conclusion: The frequency of metabolic troubles was higher in obese diabetic patients compared to non-diabetic obese patients mainly the hypertriglyceridemia.

Adherence to Lifestyle Advice and Treatments in Pakistani Patients with Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year duration of diabetes were included in the study. Results: Participants were aged between 32 and 92 years old with a mean age of 55.7 years old (SD ± 10.7). Mean duration of diabetes was 10.7 years old (SD ± 7.7). Majority (94%) of the patients were literate. Around half (47.3%) of the patients have had achieved glycemic target (HbA1c < 7%). Above target glycemic control was more common among patients with ischemic heart disease (68.1%), neuropathy (64.8%) and those on insulin (62.5%). Self-reported non-adherence for blood sugar monitoring (9.5%), physical activity (61.7%), tobacco use (43.4%) and foot care (43.9%) were noted. About 25% of the participants were not fully adherent to dietary advice. None of the patients from our study reported non-adherence to medications. Good adherence to physical activity was found in males with college degree. The highest percentage of tobacco use (33.3%) was reported among businessmen. Conclusion: We noted low adherence to advice for physical activity, tobacco use and SMBG, but a high adherence to prescribed medications and insulin. This was a selected group visiting a teaching hospital. This will need to be studied further in the community and efforts are required to motivate patients.

Dementia and Diabetes Mellitus in Porto-Novo: Frequency and Determining Factors

Background: Chronic hyperglycemia promotes the development of degenerative diseases such as dementia. Our objective is to study dementia in diabetic patients in a hospital environment in Porto-Novo. Methods: This is a cross-sectional, prospective study with a descriptive and analytical aim that took place from May 18 to September 18, 2017, i.e. 4 months. The study population consists of all diabetic patients who consulted in the internal medicine departments of the Oueme-Plateau Teaching Hospital and at Saint Gérard clinic in Porto-Novo during the study period and who gave their enlightened consent. Results: The study included 246 patients with a mean age of 56.47 ± 11.97 years. There were 172 (69.9%) women, i.e. a sex ratio of 0.43. Diabetes had been known for less than 10 years in the majority (67.9%). Type 2 diabetics were in the majority (95.5%). Of the 246 patients, 42 (17.1%) had a Mini Mental State Examination (MMSE) less than or equal to 24. Of these 42 patients, 32 met the DSM V (Diagnostic and Statistical Manual disorders, 5th edition) criteria for dementias, i.e. a frequency of 13.0%. Of the 32 demented patients, 21 (65.6%) had vascular dementia and 34.4% had degenerative dementia. We did not note a mixed etiology. Dementia was severe in 15.6% of cases. In multivariate analysis, only age (OR = 10.09;95% CI [4.19 - 24.27];p < 0.001), arterial hypertension (OR = 7.10;95% CI [1.92 - 26.22];p = 0.003), and alcohol consumption (OR = 3.95;95% CI [1.29 - 12.15];p = 0.017) were statically associated with the onset of dementia in our diabetic patients. Conclusion: Screening for dementia should be systematic in diabetics, especially at old age.

Laparoscopic resection of gastrointestinal neuroendocrine tumors with special contribution of radionuclide imaging

The surgical treatment of neuroendocrine tumors(NETs) draws on experience and guidelines more than on prospective randomized trials. The incidence of NET is increasing in all parts of the gastrointestinal tract. A variety of classifications introduced over the last decade may have led to difficulties in judging clinical relevance and determining the right surgical strategy. The North American Neuroendocrine Tumor Society and the European Neuroendocrine Tumor Society have developed usable guidelines from the available literature. For more than 20 years laparoscopy has developed as the gold standard for various surgical indications. Nevertheless, few trials have compared open and laparoscopic surgery with regard to NET. This review summarizes the recent literature on surgery for NET and incorporates the evidence on laparoscopy for cancer which might be also applied for NET.

Effect of rapamycin on hepatic osteodystrophy in rats with portasystemic shunting

AIM： TO study if T-cell activation related to portasystemic shunting causes osteoclast-mediated bone loss through RANKL-dependent pathways. We also investigated if T-cell inhibition using rapamycin would protect against bone loss in rats. METHODS： Portasystemic shunting was performed in male Sprague-Dawley rats and rapamycin 0.1 mg/kg was administered for 15 wk by gavage. Rats received powderized chow and supplemental feeds to prevent the effects of malnutrition on bone composition. Weight gain and growth was restored after surgery in shunted animals. At termination, biochemical parameters of bone turnover and quantitative bone histology were assessed. Markers of T-cell activation, inflammatory cytokine production, and RANKL-dependent pathways were measured. In addition, the roles of IGF-1 and hypogonadism were investigated. RESULTS： Portasystemic shunting caused low turnover osteoporosis that was RANKL independent. Bone resorbing cytokine levels, including IL-1, IL-6 and TNFα, were not increased in serum and TNFα and RANKL expression were not upregulated in PBMC. Portasystemic shunting increased the circulating CD8＋ T-cell population. Rapamycin decreased the circulating CD8＋ T-cell population, increased CD8＋ CD25＋ T-regulatory cell population and improved all parameters of bone turnover. CONCLUSION： Osteoporosis caused by portasystemic shunting may be partially ameliorated by rapamycin in the rat model of hepatic osteodystrophy.

Pulmonary Embolism in Hospitalization in the Department of Cardiology of Gabriel Toure University Hospital

Objective: The aim of this study was to describe the epidemiological, clinical and Para clinical characteristics in patients hospitalized for pulmonary embolism in the cardiology department of Gabriel Toure University Hospital. Methodology: It was a retrospective and descriptive study from January 2011 to December 2014 and involved all patients hospitalized during the study period. Results: The study included 21 patients out of 1738 hospitalized patients, with a prevalence of 1.21%. The mean age was 38.57 years with extreme ages of 18 and 64 years. The sex ratio was 0.40. Risk factors found in the study were oral contraception (19.05%), overweight (19.05%), smoking (14.28%), HIV (4.76%) and heart failure (4, 76%). 61.90% (n = 13) had isolated pulmonary embolism, 38.09% (n = 8) had venous thrombosis and pulmonary embolism association. Through the chest angio-CT, 28.57% of obstructions were located at the left branch of the pulmonary artery, 9.52% at the right branch and 61.90% were bilateral obstructions. Four deaths were recorded, all in a context of massive pulmonary embolism, with a fatality rate of 19.05%. Conclusion: Pulmonary embolism is a serious and common disease, often difficult to diagnose. It is a cardiovascular emergency and requires immediate and adequate care.

Doppler Ultrasound Abnormalities of the Lower Limbs in Patients with Diabetic Foot at the Yopougon University Hospital in Ivory Coast

Background: Diabetic foot is a frequent complication of diabetes, of multifactorial origin, associating nervous and/or circulatory disorders to which infection is often added. Its care is multidisciplinary and requires coordination between different actors. In this context, arterial doppler ultrasound is essential in the diagnosis of diabetic arteriopathy and participates in therapeutic decision-making. The aim of this study was to describe the abnormalities found on Doppler ultrasonography of patients hospitalized for the diabetic foot in the Ivory Coast. Methods: We conducted a retrospective descriptive study including 235 patients hospitalized for the diabetic foot in the Endocrinology department of the Yopougon University Hospital from February 2002 to December 2015. All records of patients who performed arterial Doppler ultrasound of the lower limbs were selected and the various abnormalities were described. Results: The sex ratio (M/F) was 1.1 (124 men to 111 women). The predominant age group was 61.2 years. Type 2 diabetes was found in 97.4% of cases. The average evolution of diabetes was 8.9 years with extremes of 1 and 32 years. Wet gangrene was the most common type of lesion found in 75.8% of cases. On ultrasonography, 98.7% of the patients had an arterial abnormality of the lower limbs. It was bilateral in 62.2% of cases, dominated by atheromatous overloads and mediacalcosis in 46.4% and 43.8% of cases, respectively. Arterial stenosis was lesions hemodynamically found in 76.3% of cases and arterial occlusions in 32.7% of cases. The amputation rate was 72.7%. Conclusion: This study shows the high frequency of arterial abnormalities in patients with the diabetic foot with a predominantly distal involvement. Arterial Doppler ultrasound of the lower limbs remains an essential tool in the care of diabetic foot. This easily accessible, non-invasive examination has a key role in therapeutic decision-making.

Interleukin-19 is cardioprotective in dominant negative cyclic adenosine monophosphate response-element binding protein-mediated heart failure in a sex-specific manner

AIM To investigate the role of interleukin-19(IL-19) in a murine model of female-dominant heart failure(HF).METHODS Expression of one copy of a phosphorylation-deficient cyclic adenosine monophosphate response-element binding protein(dn CREB) causes HF, with accelerated morbidity and mortality in female mice compared to males. We assessed expression of IL-19, its receptor isoforms IL-20 R α/β, and downstream IL-19 signaling in this model of female-dominant HF. To test the hypothesis that IL-19 is cardioprotective in dn CREB-mediated HF, we generated a novel double transgenic(DTG) mouse of dn CREB and IL-19 knockout and assessed cardiac morbidity by echocardiography and survival of male and female mice.RESULTS IL-19 is expressed in the murine heart with decreased expression in dn CREB female compared to male mice. Further, the relative expression of the two IL-19 receptor isoforms manifests differently in the heart by sex and by disease. Male DTG mice had accelerated mortality and cardiac morbidity compared to dn CREB males, while female DTG mice showed no additional detriment, supporting the hypothesis that IL-19 is cardioprotective in this model. CONCLUSION Together, these data suggest IL-19 is an important cytokine mediating sex-specific cardiac(dys) function. Ongoing investigations will elucidate the mechanism(s) of sex-specific IL-19 mediated cardiac remodeling.