Contribution of Imagery in the Diagnosis of Multisystemic Sarcoidosis in the Service Radiology Department of the Mother and Child Hospital “Le Luxembourg” in Bamako: A Case Report

The aim of this study was to report a case of multi-visceral sarcoidosis at the Mother-Child Hospital Center (CHME) “Le Luxembourg” in Bamako, Mali. Observation: This is a patient aged 62 at the time of consultation, a housewife, residing in the Banconi district, who was referred to us for thoracic-abdominopelvic imaging for chronic liver disease. After several diagnostic errors, the thoracic-abdominopelvic CT scan and liver MRI performed in our center showed, at the thoracoabdominal level, bilateral diffuse pulmonary micronodules and bilateral mediastinal-hilar lymphadenopathy;on the abdominal level, a dysmorphic liver with plaques of steatosis and a granular appearance of the liver parenchyma without periportal fibrosis. These imaging data combined with those from the liver nodule biopsy and biology confirmed the diagnosis of sarcoidosis type II. Treatment with corticosteroids gave satisfactory results and the patient recovered after 18 months. Clinical and CT monitoring 2 years from the start of the disease and 2 months from the end of treatment showed complete resolution of the lesions. Conclusion: The multi-visceral location of sarcoidosis is an entity whose diagnosis remains difficult;diagnostic and interventional imaging has an important place in its management.

External Otitis: Epidemiological, Clinical, Etiological, and Therapeutic Aspects at the Oto-Rhino-Laryngology Department of Mamou Regional Hospital

Introduction: External otitis (OE) is an acute or chronic inflammation or infection of the external ear resulting from an imbalance in the external auditory canal secondary to microtrauma, maceration, eczema, or a foreign body in the external auditory canal. Objective: To study cases of external otitis at the Mamou Regional Hospital. Materials and Methods: This was a prospective descriptive study conducted over a period of six (6) months from July 1st to December 31st, 2016. It included all patients admitted to the ENT department of the Mamou Regional Hospital. Results: During the study period, 712 patients were admitted to the department for various pathologies, of which 103 met our selection criteria, representing a frequency of 14.46%. The mean age of the patients was 33.74 years with a range of 1 to 90 years. Males predominated in the sample, accounting for 59.22%. The vast majority of patients resided in urban areas, constituting 61.17% of the sample. In our study, all patients consulted for otalgia (100%), and over half (53.39%) for hypoacusis. We formally identified rhinitis in 66.66% of cases, while diabetes was found in only 4 patients (11.11%). Otomycosis was the most commonly identified condition (53.39%), followed by furuncles (33.98%). Ear drops containing antibiotics were administered to all patients, although 66.60% received antibiotic therapy. Conclusion: External otitis is a relatively common condition, particularly among children and the elderly. Diagnosis can be made based on pain upon traction of the pinna and pressure on the tragus.

Epidemiological Aspects and Anatomopathological of Ear Nose and Throat (ENT) and Cervico-Facial (CF) Cancers at the Military Hospital of Nouakchott

This retrospective study, the first of its kind in Mauritania, was carried out at the military hospital of Nouakchott. We sought to approximate the epidemio-logical, anatomopathological profile of Ear, Nose and Throat (ENT) and cervico-facial (CF) cancers in Mauritania. Over a period of two years, from January 1, 2019 to December 31, 2020, we noted 36 histologically confirmed cases, they represented 15.47% of all patients consulted in ENT and CF cancers affected the age group between 25 and 70 years, the age group most affected was that of 50 and 59 years, with 33.33% of cases. More affected in the proportion of 2 men to women, which can be explained by the risk factors mainly found in men, including smoking. First rank was cancers of the upper aero-digestive tract, the pharyngolarynx in head. Histologically, ENT and CF cancers were dominated by squamous cell carcinomas 78%, well ahead of papillary carcinomas 8% and vesicular thyroid carcinomas 5%, UCNTs, adenosquamous carcinomas and lymphomas each represented 3%.

Assessment of Radiofrequency in Otorhinolaryngology at the Military Hospital of Ouakam (MHO)

Introduction: Coblation® is a low temperature-controlled tissue ablation technique widely used in human surgery. Its development in otorhinolaryngology has allowed a spectacular advance in the management of diseases of the nasal and oral cavities. The objective of our work was to study the indications for radiofrequency in ENT, to describe the technical aspects and to evaluate the results of his practice at the HMO. Patients and Methods: This is a retrospective study carried out in the ENT and Head and Neck Surgery department of the Ouakam Military Hospital (MHO) over a period of 3 years (from January 2015 to the end of December 2017), involving 37 patients who received radiofrequency treatment in the ENT sphere. Results: The study was carried out on 37 patients. The sex ratio of 0.19. The mean age of the patients was 33.3 years. The indications were dominated by chronic caseous cryptic tonsillitis with or without halitosis with 24 cases (64.9%) followed by recurrent tonsillitis in 5 cases (13.5%) then we have obstructive hypertrophy of the palatal tonsils with syndrome sleep apnea (OSAS) in 4 cases (10.8%) followed by nasal obstruction (hypertrophy of the inferior turbinates) and hypertrophy of the soft palate and uvula in 2 cases (5.4%). The complication rate was 8.1% and dominated by transient dysgeusia in 1 case or 2.7%, uvula edema in 1 case or 2.7% and bleeding in 1 case or 2.7%. The postoperative follow-up was done one week, 1 month, 3 months, 6 months and 12 months after radiofrequency. Volumetric reduction begins to set in from 1 month (62.5%) and becomes maximum in 3 months (74.3%). Conclusion: Coblation® is a controlled tissue ablation technique at low temperature, patented by ArthroCare® Corporation in 1997. Very widespread in human surgery. Its development in otorhinolaryngology was later, but allowed a spectacular advance in the management of diseases of the nasal and oral cavities.

Pronostic Factors and Survival of Colorectal Cancer in Cameroun: A Retrospective Hospital-Based Study

Background: Colorectal cancer represents a major health problem in the world today, the 3rd most common cancer and the 2nd in terms of mortality. Despite of the fact that the incidence rate remains the lowest in Africa, it is still a provider of a stronger lethality in most western countries. In Cameroon according to WHO 2018, 421 new cases (4.5% of all cancers) and 451 deaths (4.3% of all cancers) were registered. Objective: Determine the prognostics factors and the survival of patients suffering from colorectal cancer followed up in Douala. Patients and Method: This was a retrospective cohort study over a period from January 1st, 2009 to December 31st, 2018. All patients with histologically proven colorectal cancer, at the gastroenterological, oncological, anatomopathological, radiotherapy and surgery Department of Laquintinie and General Hospitals of Douala were included. The data collected were recorded and analyzed by SPSS version 25 and Excel 2016 statistical computer software. Survival was determined by the Kaplan Meier method and the search for prognostic factors was carried out using the Cox proportional hazards model. The significance level was p = 0.05. Results: The median survival was 43 months CI: [35,255 - 50,745]. Survival at 1 year, 2 years, 3 years, 4 years and 5 years was 79.6%, 61.5%, 46.3%, 22.6%, 12.2% respectively. In multivariate analysis, the low degree of differentiation (HR = 16.278, p = 0.007), the presence of synchronous metastases or stage IV patients (HR = 42.004;p = 0.011) were independent factors of poor prognosis while curative surgery (HR = 0.172;p = 0.001) was an independent factor of good prognosis. Conclusion: In our study, the median overall survival was 43 months and the survival at 1 year, 2 years, 3 years, 4 years and 5 years was respectively;79.6%, 61.5%;46.3%;22.6%;12.2%. The low degree of differentiation and the presence of synchronous metastases were factors of poor prognosis while curative surgery is a factor of good prognosis.

Cardiovascular and Cerebrovascular Prognosis at 5 Years of Patients Who Presented with an Ischemic Stroke at Principal Hospital of Dakar

Aims: To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. Methods: We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 2019 for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. Results: Overall, one hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%, with a sex ratio of 1.28. Patients’mean age was 66.33 ±13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0.6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes ranging from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting for 0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ± 9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty-five (35) accounting for 39% were female patients and fifty-five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known as dyslipidemia, physical inactivity, obesity and recurrent ischemic stroke. Conclusion: Long-term prognosis of ischemic stroke remains unclear in Senegal. Therefore, a strategy for primary prevention is highly crucial and it requires the control of risk factors in general and that of high blood pressure in particular.

The Five Years Surveillance and Trends of Antibiotic Resistance in Some Common Gram Negative Bacteria at the Vietnam Military Hospital

The study is to identify trends and levels of antibiotic resistance of some common Gram-negative strains over time. The samples were collected from Vietnam Military Hospital 103 between 2014 and 2019. A total of 405 Acinetobacter baumannii., 528 Pseudomonas aeruginosa, 741 Escherichia coli, and 352 Klebsiella pneumoniae strains were identified and antimicrobial susceptibility was by Vitek system and Etest method. The multi-drug resistance (MDR) was major proportion of four common bacteria. In particular, there is a tendency to shift from MDR to Extended drug resistance (XDR) or possibly Pan drug resistant (pPDR). A. baumannii had the highest level of antibiotic resistance, namely, carbapenem (61.5% - 82.5%) and cephalosporin (72.7% - 88.7%). P. aeruginosa resisted most of commonly antibiotics, ranging from 50% to 70%. E. coli had a high resistance with antibiotics like ampicillin (87.2% - 97.6%) and the 3rd generation cephalosporins (up to 79.6%). K. pneumoniae resisted carbapenem from 14.7% to 44.4%, and other antibiotics with the higher rate of 40%. The collected data will be a prerequisite for further studies on mechanisms and factors related to antibiotic resistant bacteria, in order to find out a rational and effective using strategy of antibiotics.

Bacterial Isolates and Their Antibiotic Susceptibility Pattern among Patients with Infected Wounds Admited in Orthopaedic and Trauma Ward in Tertiary Care Hospital North-Eastern Tanzania

The hospital environment contributes to wound infections. Effects of such infections include prolonged hospitalization, increased morbidity, potential for antibiotics resistance and mortality due to sepsis. An updated knowledge of antibiotics susceptibility profiles of clinical isolates will assist both in choosing the most appropriate antibiotic treatment for wound infections and help in curbing the escalation of drug resistance. Cross sectional hospital based study, analysis of 125 pus samples collected from January 2018 to December 2020 was conducted. Identification and characterization of isolates were performed on the basis of Gram staining, microscopic characteristics, colony characteristic, and biochemical tests using standard microbiological methods. Antibiotic susceptibilities of bacterial isolates were determined by Kirby Bauer disc diffusion. A total of 125 pus samples were studied, 94 (75%) were from male patients, mean age was 38.5 (SD ± 19) years. Single bacterial isolates were recovered from 120 (96%) samples, 67 (53.6%) shows Multiple Drug Resistance (MDR) pattern, 74 (59.2%) were gram negative, the predominant organism isolated was Staphylococcus aureus 46 (36.8%). Gram negative isolates showed high resistance to ampicillin and cephalosporins. Gram positive isolates showed high resistance to erythromycin. Both gram positive and negative were found to be highly susceptible to gentamicin, amikacin, clindamycin, ciprofloxacin and amoxicillin/clavulanic acid. The study showed that Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are the major bacteria isolated from pus samples. High proportion (53.6%) of the isolates was MDR. In the light of these findings, a change in antibiotic prescription policy is required at this hospital.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Burn Management at the 37 Military Hospital—A Tertiary Hospital in Accra, Ghana

Burn injuries have been and remain a very significant source of mortality and morbidity in low- and middle-income countries. As a country in this category, Ghana, is not exempted. Ghana has a population of 31 Million with only 21 Plastic Reconstructive and Burn surgeons. Moreover, the country can boast of only 3 major Burn centres. This notwithstanding the country in particular and Africa, in general, carries an extraordinary burden of Burn injuries with devastating consequences. Burn data from the 37 Military Hospital were analyzed from March 2018 to September 2019—a period of 18 months. In all, 217 burn cases were seen representing about 2.1% of all trauma and surgical cases. Our burn data analyzed the peculiarities of epidemiology, types of burn, the pattern of injuries, and the outcome of burn care at the 37 Military Hospital. Flame is emerging as the predominant cause of burns, most frequently occurring from the use of Liquid Petroleum Gas. In the pediatric population, however, the most frequent cause of burns is hot water burns. The mortality rate among the burn population was 1.8% (4 mortalities). This paper aims to point out management methods adopted by our unit which helped to improve burn outcomes and to reduce mortality.

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

Phospholipase A2 enzymes PLA2G2A and PLA2G12B as potential diagnostic and prognostic biomarkers in cholangiocarcinoma

BACKGROUND Phospholipase A2(PLA2)enzymes are pivotal in various biological processes,such as lipid mediator production,membrane remodeling,bioenergetics,and maintaining the body surface barrier.Notably,these enzymes play a significant role in the development of diverse tumors.AIM To systematically and comprehensively explore the expression of the PLA2 family genes and their potential implications in cholangiocarcinoma(CCA).METHODS We conducted an analysis of five CCA datasets from The Cancer Genome Atlas and the Gene Expression Omnibus.The study identified differentially expressed genes between tumor tissues and adjacent normal tissues,with a focus on PLA2G2A and PLA2G12B.Gene Set Enrichment Analysis was utilized to pinpoint associated pathways.Moreover,relevant hub genes and microRNAs for PLA2G2A and PLA2G12B were predicted,and their correlation with the prognosis of CCA was evaluated.RESULTS PLA2G2A and PLA2G12B were discerned as differentially expressed in CCA,manifesting significant variations in expression levels in urine and serum between CCA patients and healthy individuals.Elevated expression of PLA2G2A was correlated with poorer overall survival in CCA patients.Additionally,the study delineated pathways and miRNAs associated with these genes.CONCLUSION Our findings suggest that PLA2G2A and PLA2G12B may serve as novel potential diagnostic and prognostic markers for CCA.The increased levels of these genes in biological fluids could be employed as non-invasive markers for CCA,and their expression levels are indicative of prognosis,underscoring their potential utility in clinical settings.

Diabetic Retinopathy: Diagnostic Challenges and Impact of Physical Activity

Introduction: Diabetes represents a major public health challenge, affecting over 463 million people according to the World Health Organization (WHO). Among its complications, diabetic retinopathy stands out as the leading cause of blindness in industrialized countries. Physical activity is now recognized as a cornerstone of diabetes management, and its impact on diabetic retinopathy is of growing interest. Observation: Mr. A.E, a 54-year-old man, presents with progressive deterioration of his vision. Family history of diabetes and hypertension is noted. He engages in one hour of physical activity daily, including treadmill running and indoor cycling. Despite recent optical correction, his visual acuity remains at 3/10 unimproved. Ocular imaging, notably fluorescein retinal angiography and optical coherence tomography, reveals proliferative diabetic retinopathy with bilateral macular edema. Blood tests, performed after physical activity, show normal values of blood glucose and HbA1c, delaying the initiation of treatment and promoting the progression of retinopathy. Despite appropriate management, no significant improvement in visual function is observed during follow-up. Conclusion: The management of diabetic retinopathy requires an approach integrating physical activity. A better understanding of the interaction between physical activity and diabetic retinopathy is needed to optimize prevention and treatment strategies.

Birth Defects of the Child Optic Disc: Diagnostic Challenges and Prospects for Care

Introduction: Congenital optic disc anomalies in children refer to structural variations of the optic nerve head present from birth. These deformations involve the size, shape, color, and vessels of the optic disc. Although often asymptomatic, these anomalies can impact the visual development of the child, underscoring the importance of a thorough fundus examination for early detection and appropriate medical follow-up. We present two cases of congenital optic disc anomalies in children, illustrating the diagnostic challenges and complexity of their management. Case 1: A 3-year-old girl presented with a white spot in her left eye present since birth. Uncorrected distance visual acuity was 2/10 in the right eye, while she could perceive hand movements at 2 meters with the left eye. Normal examination in the right eye showed leukocoria, microphthalmia, and a white mass at the center of the optic disc on fundus examination in the left eye. Ocular imaging, including ultrasound and optical coherence tomography (OCT), confirmed the diagnosis of persistent hyperplastic primary vitreous (PHPV) in its mixed form in the left eye. Management included prescribing full optical correction and functional rehabilitation, without resorting to surgery. The course was marked by persistent amblyopia leading to a poor prognosis. Case 2: A 7-year-old girl consulted for vision disturbance in her right eye. Visual acuity was finger counting at 2 meters in the right eye and 10/10 in the left eye. Anterior segment examination revealed no abnormalities in both eyes. However, fundus examination highlighted a large funnel-shaped excavation associated with central glial proliferation, wheel spoke vessels, and neuroretinal ring atrophy in the right eye. Optical coherence tomography (OCT) of the right eye confirmed the diagnosis of isolated unilateral Morning Glory syndrome. Management included full optical correction and orthoptic rehabilitation. The course was marked by the absence of ocular complication and maintenance of visual stability in the right eye. The prognosis seemed favorable. Conclusion: Congenital optic disc anomalies in children exhibit great clinical variability and require an individualized diagnostic and therapeutic approach.

Prognosis Factors of Urinary Quality of Life in Parkinson Disease

Introduction: Quality of life in Parkinson disease is not necessary linked to motor symptoms. It’s correlated of overactive bladders and prostatic symptoms. Prognosis factors of urinary quality of life are unknown. Objectives: Our study aims to find prognosis factors of quality of life associated specifically of urinary disorders in PD. Patients and methods: We conducted a transversal, analytic and descriptive study in Physical Medicine, and Neurology departments, Fann Teaching Hospital, Dakar and included patients followed for treatment of PD. Urinary disorders, quality of life and functional autonomy were assessed respectively by Urinary Symptoms Profile (USP), Qualiven Short Form, Schwab and England Scale. Results: 38 patients presented PD, with a mean age of 60.89 ± 13.6 years and sex-ratio of 2.45. Mean duration of PD was 3.1 ± 2.9 years. Urinary disorders were found in 47.36% and dominated by incontinence (88.88%) and overactive bladders (88.88%) which were minor in more than 55%. Quality of life was impaired in 88.88% of cases. Minor forms (43.75%) were predominant and constraint dimension (50%) was the most severely altered. Prognosis factors for quality of life of urinary disorders were PD stages (0.046) and functional autonomy (0.042). Discussion and conclusion: Urinary disorders in PD are common, impaired quality of life, especially the constraint dimension, depends on stage of evolution of PD and functional autonomy of patients.

Cervical Myelopathy: Diagnostic Aspects, Surgical Treatment and Evolution of Patients Operated upon in Yaounde

Introduction: Although cervical myelopathy is the most common degenerative cervical spine pathology in adults, the indications and approaches of surgical treatment have not yet been clearly defined in the literature. Very few studies exist regarding these aspects in our setting, and they are mostly outdated. This study aimed to describe the diagnostic aspects, current surgical treatment with technical improvements, and progression in patients. Patients and Methods: We conducted a multicentre retrospective descriptive study over a 10-year period between January 2011 and January 2020 in three referral centres in Yaoundé. All patients who underwent surgery for cervical myelopathy were included. Results: Fifty-two patients were recruited. The rate of operated cervical myelopathies among all degenerative spinal pathologies was 14.05%. The M/F sex ratio was 3/1, and the average age was 52 ± 10 years. All included patients had gait problems, 90.38% demonstrated motor deficiency, and 67.30% experienced at least three levels of compression. Surgery was decided based on the Nurick grade;a posterior approach was applied to 86.54% of patients. Postoperative progression showed a neurological improvement of 82% with an average follow-up of 4 years. Conclusion: In this study, the patients who underwent surgery were relatively young, their clinical presentations were mostly advanced, and surgical management showed good results in well-selected cases.

Post Blast Tympanic Perforations, Clinical and Paraclinical Study at Six Yaounde Hospitals

Introduction: Post-blast tympanic perforations represent an entity of traumatic perforations;various mechanisms are at the origin of the latter, and the increase in conflicts and acts of violence are increasing the studies on this subject, but few data are available in our context. Objective: This paper aims to study post-blast tympanic perforations in Yaounde, specifically the epidemiological, clinical, and paraclinical aspects. Methodology: We conducted a descriptive cross-sectional study with retrospective and prospective data collection in six Yaounde hospitals over 63 months from January 1, 2018, to March 31, 2023. All patients with at least one post-blast tympanic perforation were included. Socio-demographic, clinical and paraclinical data were collected on a questionnaire and analysed using SPSS 28 software. Results: We included 124 patients. The prevalence of post-blast tympanic perforations was 0.1% of the consultations in the departments. 71 The average age was 28.6 ± 9.1 years, with extremes ranging from 7 to 49 years. The median consultation time was five days. The most frequent injury circumstances were physical aggression (81.45%) and armed conflict (10.5%). The injury mechanisms were slaps (75%), punches (21.74%) and grenades (4.8%). The main symptoms on admission were hearing loss (63.7%), tinnitus (58.1%) and otalgia (57.3%). The tympanic perforations were unilateral in all cases, the anterior-inferior location was more characteristic, and the deafness was conductive in 58.3% of cases, followed by mixed deafness in 23.3% of cases. Conclusion: Post-blast tympanic perforations are rare in consultation. The population is primarily male and from the second decade of life. The main circumstance is aggression.

Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure

AIM:To investigate the survival rates and prognostic factors in patients with hepatitis B virus-related acuteon-chronic liver failure(HBV-ACLF).METHODS:Clinical data in hospitalized patients with HBV-ACLF admitted from 2006 to 2009 were retrospectively analyzed.Their general conditions and survival were analyzed by survival analysis and Cox regression analysis.RESULTS:A total of 190 patients were included in this study.The overall 1-year survival rate was 57.6%.Patients not treated with antiviral drugs had a significantly higher mortality[relative risk(RR)=0.609,P=0.014].The highest risk of death in patients with ACLF was associated with hepatorenal syndrome(HRS)(RR=2.084,P=0.026),while other significant factors were electrolyte disturbances(RR=2.062,P=0.010),and hepatic encephalopathy(HE)(RR=1.879,P<0.001).CONCLUSION:Antiviral therapy has a strong effect on the prognosis of the patients with HBV-ACLF by improving their 1-year survival rate.HRS,electrolyte disturbances,and HE also affect patient survival.

Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function

AIM:To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy,with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.METHODS:All patients with symptomatic gallstones were included in the study.Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography.Patients with normal ultrasoundwere referred to magnetic resonance cholangiopancreatography.All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.RESULTS:Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations.Twenty-one point five percent had abnormal liver function tests,of which 52.8%had normal ultrasound results.This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2%of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%.It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2%of patients with abnormal liver function.CONCLUSION:This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography,in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.

Primary biliary cirrhosis-associated hepatocellular carcinoma in Chinese patients:Incidence and risk factors

AIM: To investigate the incidence, characteristics, and risk factors for hepatocellular carcinoma(HCC) in Chinese patients with primary biliary cirrhosis(PBC).METHODS: We reviewed the data of 52 PB Cassociated HCC patients treated at Beijing 302 Hospital from January 2002 to December 2013 and analyzed its incidence and characteristics between the two genders. The risk factors for PBC-associated HCC were analyzed via a case-control study comprising 20 PBC patients with HCC and 77 matched controls without HCC. The matched factors included gender, age, follow-up period and Child-Pugh scores. Conditional logistic regression was used to evaluate the odds ratios of potential risk factors for HCC development. A P < 0.05 was considered statistically significant. RESULTS: The incidence of HCC in Chinese PBC patients was 4.13%(52/1255) and was significantly higher in the males(9.52%) than in the females(3.31%). Among the 52 PBC patients with HCC, 55.76%(29/52) were diagnosed with HCC and PBC simultaneously, and 5.76%(3/52) were diagnosed with HCC before PBC. The males with PBC-associated HCCwere more likely than the females to have undergone blood transfusion(18.75% vs 8.33%, P = 0.043), consumed alcohol(31.25% vs 8.33%, P = 0.010), smoked(31.25% vs 8.33%, P = 0.010), had a family history of malignancy(25% vs 5.56%, P = 0.012), and had serious liver inflammation, as indicated by the elevated levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase(P < 0.05). Conditional logistic regression analysis revealed that body mass index(BMI) ≥ 25 [adjusted odds ratio(AOR) = 1.116, 95%CI: 1.002-1.244, P = 0.045] and history of alcohol intake(AOR = 10.294, 95%CI: 1.108-95.680, P = 0.040) were significantly associated with increased odds of HCC development in PBC patients. CONCLUSION: HCC is not rare in Chinese PBC patients. Risk factors for PBC-associated HCC include BMI ≥ 25 and a history of alcohol intake. In addition to regular monitoring, PBC patients may benefit from abstinence from alcohol and body weight control.