Frontal Sinus Fractures: Management at the Yalgado Ouedraogo University Hospital Centre (Burkina Faso)

Introduction: Frontal sinus fractures are potentially serious. They are defined as a solution of continuity, open or closed, of one or both bone tables of the frontal sinus. This study aims to report on the management of them at the Yalgado OUEDRAOGO University Hospital Centre. Methodology: It is a descriptive cross-sectional study with retrospective collection from January 01, 2016 to December 31, 2018. Patients with frontal sinus fractures were managed at the Yalgado OUEDRAOGO University Hospital Centre through CT-scan proof. Results: Over three years, a total of 102 cases of frontal sinus fractures were collected with 29.9 years as average age. There were 96 men. Workers in the informal sector and pupils/students represented 58.90% of patients. The residence of the patients was urban in 68.80% of cases and rural in 31.40%. Road traffic accidents (RTAs) happened in 90.20%, and involved 2-wheelers in 98.20%. None of these drivers was wearing a helmet. The type III frontal fracture of Ioannides et al. represented 51.9% of cases. In 89.21% of cases, other facial and/or cranioencephalic injuries were compounded to frontal sinus fractures. No surgical management was observed in 82 (80.39%) patients and surgical management in 20 (19.61%) patients. The outcome was favourable, but sequelae and/or complications were noted in 10 patients who had surgery and 30 patients who did not. Conclusion: These results enforce helmet wearing for all riders of two-wheeled machines. In addition, vaccinations to prevent meningitis in frontal sinus fractures with dural breach should be systematic.

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Psychomotor Development of Low Birth Weight Infants at the “Mère-Enfant” University Hospital Centre (UHC) of Libreville

Introduction: Low birth weight is a key indicator of newborn health. The objective of this study was to contribute to the reduction of low birth weight-related morbidity and mortality. Patients and Methods: cohort study conducted from January 2019 to July 2020 at the “Mère-Enfant” University Hospital Centre (UHC) of Libreville. All newborns with a birth weight 2500 g were included. The clinical data of patients were studied. They were followed over a period of 12 months and assessed psychomotorly by the Brunet-Lézine scale. Results: 1260/9035 births of low birth weight (14.0%) were observed, and 300 among them were included. The mortality rate was 27.0% (81) and 219 were followed for 12 months. The sex ratio was 0.8, the average birth weight was 2008.6 ± 215.2 g. The average gestational age was 34 ± 12 weeks with 75.3% prematurity. An infant disease was observed in 61.6% of cases and respiratory pathologies were more observed except at 3 months of age where the proportion of digestive pathologies was 20.5%. At the time of the last consultation at 12 months of life, 76.2% of infants had no pathology. The quotients of postural development, language and coordination were normal (between 110 - 70) respectively in 75.4%, 99.1% and 68% of cases at the age of 12 months. The psychomotor development quotient was correlated with the birth weight in the language area r = 0.15 (p = 0.024), posture r = 0.15 (p = 0.015) and coordination r = 0.15 (p = 0.026) respectively. Conclusion: Low birth weight is a public health problem at UHCME-JEF. Despite the fact that psychomotor development can be said to be satisfactory, many efforts remain to be made to reduce low birth weight levels and improve survival.

Epidemiological and Clinical Aspects of Abnormal Movements in Children from 2 Months to 15 Years in the Pediatric Department of Gabriel Toure University Hospital Centre of Bamako

Introduction: Abnormal or involuntary movements correspond to a disorder in the programming and/or execution of movement. They have two characteristics;they are hardly or not at all controlled by the will and occur in the absence of any paralysis. Objective: To determine the epidemiological, clinical and etiological characteristics of abnormal (involuntary) movements in children aged 2 months to 15 years. Patients and Methods: This was a prospective, descriptive study from January 2016 to December 2018 of children aged 2 months to 15 years seen in neuropediatric consultations for abnormal movements. Results: During the study period 1920 children were seen in neuropediatric consultations and 57 presented with abnormal movements, i.e. a frequency of 2.96%. Children aged between 6 and 60 months were the most affected (54.4%). The sex ratio was 1.53. Movement abnormality was the most common reason for consultation (45.7%), followed by apyretic convulsions (28%), and laxity (5.3%). The onset was progressive in 68.4% of children. The main types of abnormal movements were chorea (31.6%), dystonia (26.3%), myoclonus (17.5%), tremor in 10.5%. The causes were infectious (73.68%). Conclusion: Abnormal movements are rare in paediatric practice. They have multiple causes and their management is urgent in certain situations that can jeopardise the future of children.

Factors Influencing the Resumption of Postpartum Female Sexuality in Women Who Have Given Birth Once or Several Times at the Ignace Deen Maternity Hospital of the Conakry University Hospital Centre (Guinea)

Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.

Endovascular Repair of Symptomatic （Non-ruptured） Abdominal Aortic Aneurysm in the University Hospital Centre Split

The aim of this study is overview of endovascular University Hospital Centre Split. The sAAA refers to a number sAAA （symptomatic abdominal aortic aneurysm） treatment in the of symptoms associated with aneurysm. EVAR （endovascular aortic repair） is increasingly used as an alternative to an open method that cmTies a number of advantages. Between January 2016 and February 2017, eight patients were admitted to the University Hospital Centre Split due to sAAA, following clinical and diagnostic treatment by a team of vascular surgeons and emergency radiologists, and ultimately treated with EVAR. Two patients had femoral endarterectomy. One patient had fistula of the right external iliac artery with left common iliac vein. After EVAR with embolization of the right internal iliac artery, the fistula was resolved. Also, one patient had occluded left external iliac artery and femoral-femoral bypass graft was made. After the procedure, two patients had endoleak of type II. Perioperative mortality was zero. On control examinations, all patients were with good general condition and without complications. A prompt diagnosis of sAAA and good team working will result of emergency endovascular procedure and resolve the risk for abdominal aortic aneurysm rupture.

Management of Traumatic Injuries of Road Traffic Accident Victims in the City of Ouagadougou at the University Hospital Trauma Emergency Department-Yalgado Ouédraogo

Purpose: To evaluate the management of traumatic injuries of accident victims in the city of Ouagadougou admitted to the trauma emergencies of the University Hospital of Ouagadougou. Material and Method: This was a descriptive prospective study of road traffic accident victims in the city of Ouagadougou on their arrival at trauma emergencies and on the 7th and 30th day after their discharge. A total of 991 patients were identified. The sex ratio was 1.94 with a male predominance. The average age of the patients was 31.5 years. The ratio of caregivers to patients on a 24-hour shift was 7/47, excluding patients hospitalized in the corridors. Results: We note that 81.94% of patients were transported by the fire brigade. The average time to first contact with a caregiver was 11 minutes. Upon admission, accident victims were accompanied in 84% of cases. The combination of paracetamol and néfopam was the most prescribed analgesic (50.2%). The average time between admission and X-ray completion was 101 minutes. Benign skin lesions were the most frequent (48.82%), followed by osteoarticular lesions of the limbs (fractures and dislocations). Ceftriaxone, and the combination of Amoxicillin + Clavulanic Acid, were the most prescribed antibiotics. Dressings and sutures (44.63%) were the most commonly performed treatments, followed by orthopaedic restraints (37.88%) and open fracture areas in 14.34%. The average time between admission and orthopaedic and/or surgical treatment was 04 hours 25 minutes. Patients discharged against medical advice accounted for 10.80% of cases. In 95% of cases, patients were satisfied with their management. Conclusion: The management of patients admitted to trauma emergencies is satisfactory, but difficulties remain in terms of delays in management. It is imperative to take into account certain factors involving both staff and working conditions in order to reduce the time required to provide care and improve user satisfaction in this emergency unit.

Absence of Dressing versus Dressing in Gynaecological and Obstetrical Surgery at the University Hospital of Brazzaville

Objective: To compare the evolution of the operative site in the presence or absence of an occlusive skin dressing. Patients and methods: Prospective, comparative study that took place at the University Hospital of Brazzaville from January 1st to August 31st, 2016. 120 patients were randomly recruited divided into two groups: A study group consisting of 60 patients without a dressing and a control group consisting of 60 patients. Results: Sociodemographic characteristics were similar in both groups, as well as pre- and intraoperative characteristics. Postoperative complications included parietal infection (3 vs. 4 cases, p > 0.05), one case of disunion, and one case of skin irritation by the plaster in the study group. The duration of healing was shorter in the control group compared to the study group (11 ± 2 days vs. 12 ± 2, p > 0.05). The average cost of care equipment was 3.5 times higher for the group with dressing (5120 FCFA vs. 18620 FCFA, p 0.05). In the study group, only one patient was afraid of seeing her wound. Patients in the control group were less satisfied, indeed they dreaded the time of removal of the plaster because of the pain.

Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. Conclusion: Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.

Relevance of Chest CT Scan Requests in Two University Teaching Hospitals in a Developing Country

Chest investigation is common in hospital practice. Chest X-ray is readily available and usually the first chest investigation. Thoracic CT scan constitutes an alternative and complimentary chest investigation. It is currently the most efficient investigation for the chest and its contents. Objectives: To evaluate the relevance of chest CT Scan requests in two university teaching hospitals in Cameroon. Material and Methods: We conducted a cross-sectional, retrospective and descriptive study at the Radiology and imaging units of the Yaounde Central Hospital and the Yaounde University Teaching Hospital Centre. Included in our study were files of patients who had a chest CT scan investigation during three years. Results: We had a study population of 323 subjects. The age interval was 23 months to 91 years old. Pulmonologist were the most prescribers with 27.2%. We had 80% conformity of indications with French Society of Radiology (FSR) standards. 50 over of 323 indications were not recommended by the FSR. Conclusion: There is a conformity rate of 80% between indications and the FSR recommendations.

Contribution and Relevance of Transfontanellar Ultrasound in Newborns in Ouagadougou: Multicentre Study on 1000 Cases

Objectives: To demonstrate the contribution and relevance of ETFs through the study of 1000 examination reports carried out in the medical imaging departments of the OUAGADOUGOU CHU. Material and method: Analytical descriptive study with retrospective collection, extended from 1st January 2020 to 1st January 2022. Results: Of the 1000 transfontanellar ultrasound reports, the mean age of patients was 7.61 +/ 7.5 days, with extremes of zero and 28 days. Sex was specified in 989 cases. Males accounted for 54.49% and females for 45.51%. 555 transfontanellar ultrasound were performed in 2020. 441 in 2021 and 4 in 2022. 61.9% of transfontanellar ultrasound were performed at the Bogodogo University Hospital, 205 at Charles de Gaulle and 176 at Tengandogo. Indications for transfontanellar ultrasound were dominated by neonatal distress (65.8%), followed by convulsions (10.2%) and prematurity (9.1%). Transfontanellar ultrasound was normal in 570 cases (57%) and abnormal in 430 cases (43%). Abnormalities were dominated by haemorrhage and ischaemic lesions in 66.28% (285) and 21.63% (93) of cases respectively. In the group of normal transfontanellar ultrasound, neonatal distress represented 59.65% of indications and prematurity 10.7% of indications. As for abnormal transfontanellar ultrasound, neonatal suffering accounted for 73.95% of indications and convulsions for 12.56%. The average age ofpatients with an abnormal transfontanellar ultrasound was 8.74 days +/ 7.89 days. The indication for investigations was relevant in 42.2% of cases and irrelevant in 57.8%;of the transfontanellar ultrasound with relevant indications, 0.71 were normal and 99.29 abnormal;of the transfontanellar ultrasound with irrelevant indications, the transfontanellar ultrasound was normal in 98.1% and abnormal in 1.9%. Conclusion: Transfontanellar ultrasound is an important part of ultrasound in current practice. Haemorrhage, anoxic-ischaemic lesions and hydrocephalus are the most frequent pathologies found by this technique in newborns. Whether or not the examinations were normal depended on the appropriateness of the prescription.

Post-Stroke Epilepsy within a Teaching Hospital in Cotonou, Benin

Seizures occurring after stroke are risk factors for the onset of ensuing epilepsy. However, the incidence of vascular epilepsy is low. The purpose of this study was to study vascular epilepsy features in a teaching university. It was a retrospective, descriptive and analytical study, conducted from 1st January 2015 to 31st December 2016 in Cotonou Teaching Hospital (CNHU-HKM), Benin. It involved 35 patients brought together through comprehensive sampling. Vascular epilepsy hospital attendance rate was 2%. There were simple partial seizures in 74.28% of cases while cerebral ischemia was recorded in 44.44% of patients. Neurological consultation after stroke occurrence was a protective factor against the occurrence of vascular epilepsy with significant p at 0.001.

Spectrum of Meningitis in Adult at the Douala General Hospital

Objectives: Describe the clinical, aetiological and prognostic features of infectious meningitis in adults at the Douala General Hospital (DGH). Patients and Methods: We carried out a 5-year retrospective cross-sectional study at the DGH, on data from the registers of the bacteriology and biochemistry laboratories. Cases of meningitis were identified from the results of the cerebrospinal fluid (CSF) analysis, and the patient clinical file was obtained. Cases files of patients aged 15 years and above were included. For each patient, sociodemographic, clinical features and hospital mortality data were extracted. Results: During study period, 1877 CSF analyses were recorded and 135 were enrolled for data analysis. Up to 74 patients (55%) were male and the mean age was 40.04 ± 12.5 years. The time lapse between the onset of symptoms and consultation was 12.24 ± 11.16 days. The main clinical signs were meningeal syndrome (96.3%), neck stiffness (71.1%), reduced alertness (64.4%) and confusional states (55.6%). The main aetiology was bacterial (45.19%) withStreptococcus pneumoniae?(45.90%) and?Neisseria meningitis?(29.51%) leading. The other aetiologies were viral (21.48%), fungal with?Cryptococcus neoformans?(20%) and meningeal tuberculosis (13.33%). Fifty eight patients (42.9%) had a positive HIV serology. The mean duration of hospitalization was 9.05 ± 8.1 days, and the total in-hospital mortality was 25.18%. 117 patients (86.8%) had received antibiotherapy before diagnosis. Conclusion: The clinical features of meningitis in the DGH are as in classical description. However, the mortality is high and the major aetiologies appear to be associated with HIV infection at least in part. Prospective multi-centric studies are needed to provide more evidence for the development of staged management guidelines in our resource-limited settings.

Obstetric Emergencies: Frequency, Socio-Demographic Aspects and Risk Factors at the Labe Regional Hospital Maternity Unit (Guinea)

Introduction: Obstetric emergencies are clinical situations of a serious nature, often dangerous, which develop unexpectedly, threatening the vital prognosis of the mother and/or foetus in the short term. The aim of this study was to contribute to a review of obstetric emergencies at the Labé Regional Hospital maternity unit. Methods: This was a prospective descriptive and analytical study conducted over a period of 6 months in the maternity unit of the Labé Regional Hospital. It concerned all patients admitted to the department for obstetric emergencies. Results: Obstetric emergencies accounted for 20% of obstetric admissions. The mean age of the patients was 25.12 ± 7.15 years, with extremes of 14 and 45 years. The patients were housewives (42.52%), 42.86% did not attend school and 77.41% were from urban areas. The poor were the most numerous (43.52%). The ambulance was the means of transport in only 9% of cases. Acute foetal distress, pre-eclampsia, bony dystocia and post-partum haemorrhage were the most common types of emergency in our series, with frequencies of 27.57%, 22.59%, 17.94% and 10.63% respectively. The risk factors identified were age, origin, gestational age and the state of the maternal pelvis. Conclusion: Obstetric emergencies are frequent in our study site and represent a major concern for patients, providers and the community alike. In order to reduce the frequency of obstetric emergencies, young girls should be enrolled in school, the legal age for marriage should be respected, quality antenatal care should be provided in basic health facilities, and proper planning and spacing of pregnancies should be implemented.

Evaluation of Oxidative Status of Patients with Gout Attack in a Cameroonian Urban Hospital

Background: Gout is the leading cause of microcrystalline arthritis worldwide and the most common cause of arthritis in adult men. The prevalence of cardiovascular disease, type II diabetes and metabolic syndrome is high among gout patients;one of the current hypotheses that may explain this relationship is based on oxidative stress;however, few studies have sought to investigate this relationship. Objective: The aim of this study was to determine the oxidative status of patients with gout attack. Methods: We conducted a case-control study over a 4 months period at the Rheumatology service of the Yaoundé Central Hospital. Cases were patients with an acute gout attack and controls were healthy subjects matched for sex and age. We evaluated uricemia, serum levels of Superoxide Dismutase (SOD), Glutathione Peroxidase (GPx), Catalase and Malondialdehyde (MDA). Oxidative stress was defined by an increase in MDA and/or a decrease in SOD, Catalase and GPx. Statistical analysis was performed by the S.P.S.S. 21.0 software. The Student’s T-test was used to compare means;the significance threshold was 0.05. Results: Sixty subjects were recruited of which 30 with an acute gout attack and 30 healthy subjects. The mean ages of the cases and controls were respectively 58 ± 8 years and 57.6 ± 8 years. Uricemia was statistically higher in cases (81 ± 20 mg/L) compared to controls (47 ± 11 mg/L) (p < 0.001). MDA levels were higher among cases (1.37 ± 0.46 mmol/L) compared to controls (1.14 ± 0.39 mmol/L) (p < 0.05). There was no significant difference in serum levels of catalase, SOD and GPx between cases and controls. Conclusion: Patients with gout attack have an elevated serum level of malondialdehyde but their oxidative status seems similar to that of normal individuals.

Sodium-dependent glucose transporter 2 inhibitors effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure

BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions of their mechanism of action.We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy.Two groups of patients were included in the study:the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.AIM To evaluate the outcomes regarding natriuretic peptide,oxidative stress,inflammation,blood pressure,heart rate,cardiac function,and body weight.METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain(GLS),N-terminal pro-brain natriuretic peptide,myeloperoxidase(MPO),high-sensitivity C-reactive protein(hsCRP),and systolic and diastolic blood pressure.To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up,a rise in stroke volume index,body mass index(BMI)decrease,and lack of heart rate increase,linear regression analysis was performed.RESULTS There was a greater reduction of MPO,hsCRP,GLS,and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up.Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI,while the predictor of stroke volume index increase was SGLT2i therapy itself.CONCLUSION SGLT2i affect body composition,reduce cardiac load,improve diastolic/systolic function,and attenuate the sympathetic response.Glycemic control contributes to the improvement of heart function,blood pressure control,oxidative stress,and reduction in inflammation.

Metformin and pancreatic neuroendocrine tumors:A systematic review and meta-analysis

BACKGROUND Most patients with advanced pancreatic neuroendocrine tumors(pNETs)die due to tumor progression.Therefore,identifying new therapies with low toxicity and good tolerability to use concomitantly with the established pNET treatment is relevant.In this perspective,metformin is emerging as a molecule of interest.Retrospective studies have described metformin,a widely used agent for the treatment of patients with type 2 diabetes mellitus(T2DM),to be effective in modulating different tumor-related events,including cancer incidence,recurrence and survival by inhibiting mTOR phosphorylation.This systematic review evaluates the role of T2DM and metformin in the insurgence and post-treatment outcomes in patients with pNET.AIM To systematically analyze and summarize evidence related to the diagnostic and prognostic value of T2DM and metformin for predicting the insurgence and posttreatment outcomes of pNET.METHODS A systematic review of the published literature was undertaken,focusing on the role of T2DM and metformin in insurgence and prognosis of pNET,measured through outcomes of tumor-free survival(TFS),overall survival and progression free survival.RESULTS A total of 13 studies(5674 patients)were included in this review.Analysis of 809 pNET cases from five retrospective studies(low study heterogeneity with I^(2)=0%)confirms the correlation between T2DM and insurgence of pNET(OR=2.13,95%CI=1.56-4.55;P<0.001).The pooled data from 1174 pNET patients showed the correlation between T2DM and post-treatment TFS in pNET patients(hazard ratio=1.84,95%CI=0.78-2.90;P<0.001).The study heterogeneity was intermediate,with I^(2)=51%.A few studies limited the possibility of performing pooled analysis in the setting of metformin;therefore,results were heterogeneous,with no statistical relevance to the use of this drug in the diagnosis and prognosis of pNET.CONCLUSION T2DM represents a risk factor for the insurgence of pNET and is a significant predictor of poor post-treatment TFS of pNET patients.Unfortunately,a few studies with heterogeneous results limited the possibility of exploring the effect of metformin in the diagnosis and prognosis of pNET.

Managing end-stage carcinoid heart disease:A case report and literature review

BACKGROUND Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare tumors,often diagnosed in an advanced stage when curative treatment is impossible and grueling symptoms related to vasoactive substance release by tumor cells affect patients’quality of life.Cardiovascular complications of GEP-NENs,primarily tricuspid and pulmonary valve disease,and right-sided heart failure,are the leading cause of death,even compared to metastatic disease.CASE SUMMARY We present a case of a 35-year-old patient with progressive dyspnea,back pain,polyneuropathic leg pain,and nocturnal diarrhea lasting for a decade before the diagnosis of neuroendocrine carcinoma of unknown primary with extensive liver metastases.During the initial presentation,serum biomarkers were not evaluated,and the patient received five cycles of doxorubicin,which he did not tolerate well,so he refused further therapy and was lost to follow-up.After 10 years,he presented to the emergency room with signs and symptoms of right-sided heart failure.Panneuroendocrine markers,serum chromogranin A,and urinary 5-hydroxyindoleacetic acid were extremely elevated(900 ng/mL and 2178µmol/L),and transabdominal ultrasound confirmed hepatic metastases.Computed tomo-graphy(CT)showed liver metastases up to 6 cm in diameter and metastases in mesenteric lymph nodes and pelvis.Furthermore,an Octreoscan showed lesions in the heart,thoracic spine,duodenum,and ascendent colon.A standard trans-thoracic echocardiogram confirmed findings of carcinoid heart disease.The patient was not a candidate for valve replacement.He started octreotide acetate treatment,and the dose escalated to 80 mg IM monthly.Although biochemical CONCLUSION Carcinoid heart disease occurs with carcinoid syndrome related to advanced neuroendocrine tumors,usually with liver metastases,which manifests as right-sided heart valve dysfunction leading to right-sided heart failure.Carcinoid heart disease and tumor burden are major prognostic factors of poor survival.Therefore,they must be actively sought by available biochemical markers and imaging techniques.Moreover,imaging techniques aiding tumor detection and staging,somatostatin receptor positron emission tomography/CT,and CT or magnetic resonance imaging,should be performed at the time of diagnosis and in 3-to 6-mo intervals to determine tumor growth rate and assess the possibility of locoregional therapy and/or palliative surgery.Valve replacement at the onset of symptoms or right ventricular dysfunction may be considered,while any delay can worsen right-sided ventricular failure.

Acute pancreatitis as a complication of acute COVID-19 in kidney transplant recipients

BACKGROUND Acute pancreatitis is a rare extrapulmonary manifestation of coronavirus disease 2019(COVID-19)but its full correlation with COVID-19 infection remains unknown.AIM To identify acute pancreatitis’occurrence,clinical presentation and outcomes in a cohort of kidney transplant recipients with acute COVID-19.METHODS A retrospective observational single-centre cohort study from a transplant centre in Croatia for all adult renal transplant recipients with a functioning kidney allograft between March 2020 and August 2022 to record cases of acute pancreatitis during acute COVID-19.Data were obtained from hospital electronic medical records.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection was proven by a positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction on the nasopharyngeal swab.RESULTS Four hundred and eight out of 1432(28.49%)patients who received a renal allograft developed COVID-19 disease.The analyzed cohort included 321 patients(57%males).One hundred and fifty patients(46.7%)received at least one dose of the anti-SARS-CoV-2 vaccine before the infection.One hundred twenty-five(39.1%)patients required hospitalization,141(44.1%)developed pneumonia and four patients(1.3%)required mechanical ventilation.Treatment included immunosuppression modification in 233 patients(77.1%)and remdesivir in 53 patients(16.6%),besides the other supportive measures.In the study cohort,only one transplant recipient(0.3%)developed acute pancreatitis during acute COVID-19,presenting with abdominal pain and significantly elevated pancreatic enzymes.She survived without complications with a stable kidney allograft function.CONCLUSION Although rare,acute pancreatitis may complicate the course of acute COVID-19 in kidney transplant recipients.The mechanism of injury to the pancreas and its correlation with the severity of the COVID-19 infection in kidney transplant recipients warrants further research.

Primary hyperparathyroidism-induced acute pancreatitis in pregnancy:A systematic review with a diagnostic-treatment algorithm

BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.