Forecast analysis of the incidence of tuberculosis in the province of Quebec

BACKGROUND: While the overall population prevalence of tuberculosis in Quebec has been declining for many years, tuberculosis is still disproportionately more prevalent among the immigrant and Inuit communities. As such, the aim of this study was to forecast the incidence of tuberculosis in the Province of Quebec over time in order to examine the possible impact of future preventative and treatment programs geared to reducing such disparities. METHODS: A compartmental differential equation based on a Susceptible Exposed Latent Infectious Recovered (SELIR) model was simulated using the Euler method using Visual Basic for Applications in Excel. Demographic parameters were obtained from census data for the Province of Quebec and the model was fitted to past epidemiological data to extrapolate future values over the period 2015 to 2030. RESULTS: The trend of declining tuberculosis rates will continue in the general population, falling by 42% by 2030. The incidence among immigrants will decrease but never vanish, and may increase in the future. Among the Inuit, the incidence is expected to increase, reaching a maximum and then stabilizing, although if re-infection is taken into account it may continue to increase. Tuberculosis among non-indigenous Canadian born persons will continue to decline, with the disease almost eradicated in that group in the mid 21st century. CONCLUSIONS: While the incidence of tuberculosis in the Province of Quebec is expected to decrease overall, certain populations will remain at risk

Calcinose pseudo-tumorale primitive chez l’enfant

La calcinose pseudo-tumorale est une tumeur bénigne relativement rare, elle se caractérise par un dépôt de matériel calcique dans les tissus mous péri-articulaires. Nous rapportons un cas de calcinose tumorale primitive de la hanche gauche découvert chez un enfant de 15 ans avec une revue de la littérature. La patiente a été opérée avec une exérèse totale de la masse, les suites postopératoires étaient simples. 6 mois après l’intervention il n’y a pas de récidive tumorale.Mots clés: Calcinose tumorale primitive, masse du tissu mou, enfantEnglish Title: Primary pseudotumoral calcinosis in childrenEnglish AbstractPseudotumoral calcinosis is a relatively rare benign tumor, characterized by calcium deposition in peri-articular soft tissues. We here report the case of a 15-year old boy with primary tumoral calcinosis of the left hip as well as a literature review. The patient underwent total mass resection. The postoperative course was simple. The patient showed no recurrence at 6-month follow-up.Keywords: Primary tumoral calcinosis, soft tissue mass, chil

Le pseudokyste du pancréas chez l’enfant: à propos de 7 cas

Le pseudokyste du pancréas est une affection bénigne, rare, en particulier chez l'enfant. Ce sont des collections de suc pancréatique, dépourvues de revêtement épithélial, et dont la localisation peut être intra ou extra pancréatique. Nous rapportons une étude rétrospective de 7 enfants colligés au service de chirurgie pédiatrique du centre hospitalier universitaire Hassan II de Fès, durant une période de 11 ans, allant du 1er janvier 2005 au 31 décembre 2016. Tous les enfants étaient de sexe masculin, l'âge moyen était de 6,6 ans (15 mois-12 ans). Un antécédent de traumatisme abdominal était retrouvé dans 4 cas, le ballonnement abdominal, la douleur, les vomissements et les troubles du transit étaient les principaux motifs de consultation. L'examen clinique retrouvait chez tous les enfants une sensibilité épigastrique et une altération de l'état général, l'échographie abdominale et le scanner abdominal réalisés respectivement ont permis de poser le diagnostic de pseudo kyste du pancréas avant l'intervention chirurgicale. Six malades sur sept ont été opérés ; Nous avons opté pour la dérivation interne (anastomose gastro-kystique) dans 4 cas, une dérivation externe dans 2 cas, et l'abstention thérapeutique dans le dernier cas. Les Pseudo kystes du pancréas sont des affections rares, néanmoins, ils sont de loin les plus fréquents (80% des lésions kystiques du pancréas étant des pseudo kystes, et sont la conséquence d'une pancréatite aigüe et/ou chronique, d'un traumatisme pancréatique, ou d'une obstruction canalaire pancréatique

Appendicite aigue sur hernie de Claudius Amyand chez un nouveau-né dans un tableau d’occlusion neonatale

La hernie de Claudius Amyand est définie par l'incarcération de l'appendice vermiculaire à travers le sac herniaire. La première appendicectomie fut réalisée en 1735. C'est une pathologie très rare chez l'enfant. De ce fait; la fréquence de cette pathologie est non encore établie. Nous rapportons l'observation d'un nouveau-né de 22 jours porteur d'une hernie inguino scrotale simple non suivi admis aux urgences dans un tableau de syndrome occlusif fait d'arrêt des matières et des gaz avec tuméfaction inguino-scrotale d'allure inflammatoire et des vomissements bilieux installés sur 2 jours. La prise en charge a consisté a une mise en condition et un bilan pré-anesthésique. L'exploration per opératoire a mis en évidence un appendice boudiné nécrosé dans sa moitié distale avec présence de fausses membranes. Le geste a comporté une appendicectomie et la fermeture du sac herniaire. L'évolution a été marquée par une reprise de transit 24h de post opératoire

Prise En Charge Des Dermo-Hypodermites Nécrosantes Au Centre Hospitalier Régional De Diffa, Niger

Introduction : la dermo-hypodermite nécrosante (DHN) est une affection redoutable, responsable d’une morbi-mortalité importante constituant un véritable problème de santé publique dans la région de Diffa. L’objectif de cette étude est décrire la prise en charge des DHN dans le service de chirurgie du Centre Hospitalier Régional (CHR) de Diffa. Patients et méthodes : Il s’est agi d’une étude rétrospective descriptive, menée dans le service de chirurgie du CHR de Diffa, et incluant les dossiers des cas de DHN, pris en charge de Janvier 2017 à Décembre 2018. Résultats : 132 cas ont été enregistrés. L’âge médian était de 25 ans (extrêmes : 10 jours et 87 ans). Tous les patients ont bénéficié d’une antibiothérapie et dans 91,8% un traitement chirurgical était nécessaire. Le nombre de passage au bloc opératoire était compris entre 2 et 36. Une greffe de peau a été réalisée dans 25,7% des cas. Le taux d’amputation de membre était de 9,1%. La durée moyenne de séjour hospitalier était de 32,3 jours (extrêmes : 17 jours et 189 jours). La mortalité intra hospitalière était de 3,8% (n=5). Conclusion: la dermo-hypodermite nécrosante est une affection grave, fréquente dans la région de Diffa dont la prise en charge médico-chirurgicale est lourde, grevée d’un mauvais pronostic. Un accent devrait être mis sur la recherche étiologique et le contrôle des facteurs prédisposant et aggravant de la maladie. Introduction: Necrotizing dermo-hypodermatitis (NHD) is a dreaded condition, responsible for a significant morbi-mortality constituting a real public health problem in the region of Diffa. The objective of this study is to describe the management of NHD in the surgical department of the Regional Hospital Center (CHR) of Diffa. Patients and methods: This was a descriptive retrospective study, conducted in the surgery department of the CHR of Diffa, and including the records of NHD cases, taken in charge from January 2017 to December 2018. Results: 132 cases were recorded. The median age was 25 years (extremes: 10 days and 87 years). All patients received antibiotic therapy and in 91.8% of cases surgical treatment was required. The number of visits to the operating theatre ranged from 2 to 36. A skin graft was performed in 25.7% of cases. The limb amputation rate was 9.1%. The average length of hospital stay was 32.3 days (extremes: 17 days and 189 days). Intra-hospital mortality was 3.8% (n=5). Conclusion: Necrotizing dermo-hypodermatitis is a serious condition, frequent in the region of Diffa, with a poor prognosis and heavy medical and surgical management. Emphasis should be placed on etiological research and control of predisposing and aggravating factors of the disease

Cholécystectomies Laparoscopiques Pour Cholécystite Aigue Lithiasique Versus Lithiase Vésiculaire Symptomatique

Introduction: The aim of this work was to highlight the therapeutic and prognostic difficulties between a laparoscopic cholecystectomy for acute gallstone cholecystitis (CAL) and uncomplicated symptomatic vesicular lithiasis (LVS) as well as the reasons for conversion to laparotomy. Patients and Methods: This was a prospective comparative and analytic study over 18 months. Patients admitted and operated for CAL or LVS in the A Surgery Department of the National Hospital of Niamey (HNN) were included. Results: The study involved 61 patients divided into two groups. Group 1 (30 patients) corresponding to patients operated for CAL, group 2 (31 patients) corresponding to patients operated for LVS. Laparoscopic cholecystectomy accounted for 61% of all cholecystectomies performed and 1.45% of surgical activity during the same period. The average age in group 1 was 43.7 years with extremes of 14 and 61 years. In group 2, the average age was 38.9 years with extremes ranging from 12 to 55 years. Women were predominantly represented with 63.3% and 96.7% respectively for groups 1 and 2. Patients were overweight in 9 cases for group 1 (30% of cases) and 12 cases in group 2 (38%), 7% of cases). Hepatic colic was the main sign of appeal in all patients in both groups. In group 1; 26 out of 30 cases or 86.7% of cases had leukocytosis, whereas in group 2, leukocytosis was normal in 30 cases, ie 96.8% of cases. Accessibility of the vesicle was difficult in 73.3% of cases in group 1 against 22.6% of cases in group 2. The vesicle was distended and necrotic in groups 1 in 76.7% and 10 respectively. % of cases. On the other hand, in 25.8% of cases, the vesicle was distended and without any necrosis in group 2. The rate of conversion to laparotomy was 6.55% (4 cases) and exclusively concerned group 1. Operative follow-up immediate outcomes were simple in 98.34% of cases. The complications involved 2 patients in group 1 (1.66% of the total), including parietal suppuration and biliary leakage. Mean operative time was 68.7 min in group 1 versus 41.6 min in group 2. Mean duration of hospitalization was 4.3 days with extremes between 2 and 10 days in group 1 versus1,7 days with extremes ranging from 1 to 7 days in group 2. Mortality was zero. Conclusion: In recent years, laparoscopic surgery has made remarkable progress in Niger. Laparoscopic cholecystectomy seems to be more difficult to perform with significant morbidity in the case of CAL than LVS. The risk of per and postoperative complications can be estimated from the clinical data (acute cholecystitis or symptomatic vesicular lithiasis) and the surgeon's experience. In a cholecystectomy that lasts more than 2 hours, the cumulative risk of complications is highe

Facteurs prédictifs de décès au cours de la TB pulmonaire chez les PvVIH au CNHU Fann de Dakar

Objectives: In sub-Saharan Africa, tuberculosis is the first pulmonary-located opportunistic infection and the leading cause of death among people living with HIV (PLWHA). This paper focuses on studying the predictive factors of death in people co-infected with pulmonary tuberculosis and HIV at the Ibrahima DIOP MAR clinic for infectious and tropical diseases at the CHNU Fann in Dakar. Materials and Methods: This was a retrospective, descriptive, and analytical study conducted from 1st January 1998 to 31st December 2009. It has been of interest to all patients with a successful pulmonary tuberculosis diagnosis and positive HIV status. Epidemiological, clinical, para-clinical, and progressive parameters were studied. Results: A total of 665 cases of tuberculosis/HIV co-infection were observed during the study period, of which 207 deaths or lethality (31.37%) was recorded. The average age of patients was 39±9 years with extremes of 5 and 74 years. The average length of hospitalization was 31.67 ± 20.67 with extremes of 4 and 312 days for surviving patients compared to 19.00 ± 16.42 with extremes of 1 to 90 days for deceased patients. Immunosuppression was significantly associated with death (p=0.001) with a median CD4 of 32.50 elts/mm3. Lethality was significantly elevated in the presence of dyspnea (p= 0, 00014), consciousness disorder (p=10-6 ), motor deficit (p= 0.008), and hemoptysis (p= 0.03). Conclusion: Tuberculosis/HIV co-infection is a common association in Africa. Here, we are talking about a deadly duo. Taking it requires a good knowledge of the factors of poor prognosis and a good integration of the two programs

Prise En Charge Des Anévrismes Artériels Dans Un Centre Africain Non Spécialisée

Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases

Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days.

We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia