Lymphome de Burkitt pédiatrique à révélation orl : quelle prise en charge en milieu sub sahélien ? réflexion sur trois cas

Le lymphome de Burkitt dans sa forme Africaine peut se manifester sous des signes d’emprunt ORL à type de tuméfaction orbito-maxillo-faciale. Le diagnostic peut être fait par les ORL à travers un faisceau de signes cliniques et une cytoponction. La prise en charge se fait dans des unités d’oncologie médicale ou le bilan d’extension et le lancement de la chimiothérapie sont des impératifs incontournables. Actuellement cette tumeur à potentiel très agressif répond à une poly chimiothérapie bien conduite.Mots-clés : Lymphome de Burkitt, cancer, voies aérodigestives supérieures, oncologie pédiatriqu

Diagnosis of biliary tract and ampullary carcinomas

Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither definite methods for early diagnosis nor specific markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice. Although rare, abdominal pain and pyrexia, as well as abnormal findings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases. On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure difficult. When gallbladder cancer is suspected, enhanced CT is carried out. Multidetector computed tomography (MDCT), in particular — one of the methods of enhanced CT — is useful for decision of surgical criteria, because MDCT shows findings such as localization and extension of the tumor, and the presence or absence of remote metastasis. Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients. However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer

Flowcharts for the management of biliary tract and ampullary carcinomas

No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Experimental investigation of laser-driven proton sheath acceleration in the ultra-short pulse, ultra-high intensity regime

The behaviour of high power laser driven ion generation at the extreme intensities available at state-of-the-art and next-generation laser facilities is an important topic for realising potential applications. One of the simplest schemes for proton sources for applications is sheath acceleration, for which different established models predict varying dependence on laser and target parameters, motivating experimental investigation. We will present experimental data investigating sheath driven proton acceleration using the ultra-high intensity, high contrast J-KAREN-P laser. A ~10 J, 40 fs pulse was focused to an intensity ~5x1021 Wcm-2, generating protons up to 50 MeV from freestanding ~μm foils, and up to 40 MeV at 0.1 Hz from a 5 μm tape target, with conversion efficiencies >1% into protons above 10 MeV. Scaling with different methods of laser intensity variation will be discussed. Simultaneous measurement of the electron distribution and optical probing of plasma formation on the rear target surface provide insights into electron absorption. In particular, target irradiation at 45º angle of incidence is shown to produce a systematic asymmetry in both rear surface sheath formation and resultant proton distribution due to the initial non-thermal electron distribution, causing the highest energy protons to be steered partly towards the laser axis.EAAC2017参

Asthme aigu grave de l’enfant : caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutifs au Sénégal : Severe acute asthma of the child: epidemiological, clinical, therapeutic and evolutive characteristics in Senegal

Context and objective. The lethality of asthma is related to the occurrence of severe acute asthma which is a crisis that does not yield under initial bronchodilator therapy. The objective of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary characteristics of children hospitalized for a severe acute asthma attack. Methods. We conducted a retrospective study of 11 years (from January 1st, 2005 and December 31st, 2015) at the Pediatric Emergency and Respiratory Department of the Albert Royer Children's Hospital (CHNEAR). 89 Children aged 0 to 15 years hospitalized for severe asthma or severe acute asthma were included. Results. The hospital prevalence of severe asthma attacks was 0.18%. The average age of the children was 44.21 months and the sex ratio was 1.69. The hospitalizations peaks have been registered during the months of July and December. 6.6% of patients were undergoing treatment and 17.9% had already been hospitalized for severe asthma attacks. The main biological abnormalities were: hypoxemia (79.7%), anemia (66.29%) and leukocytosis (44.9%). Radiological abnormalities were dominated by pulmonary over distension (60.7%) and bronchial syndrome (36%). All patients were under oxygen, salbutamol and corticosteroids. One death was encountered. The average hospital length of stay was 3.75 days. The complications were pneumo-mediastinum / cervico-mediastinal emphysema in 4 cases, pneumothorax in 2 cases and atelectasis in 1 case. Conclusion. Severe acute asthma is a relatively rare condition, but it is always associated with a significant morbidity. Contexte et objectif. La létalité de l’asthme est liée à la survenue d’asthme aigu grave qui est une crise qui ne cède pas sous traitement bronchodilatateur initial. L’objectif de cette étude était de décrire les caractéristiques épidémiologiques, diagnostiques, thérapeutiques et évolutives des enfants hospitalisés pour une crise d’asthme aigu grave.&nbsp;Méthodes. Nous avons conduit une étude documentaire portant sur une période de 11 ans (1 janvier 2005-31 décembre 2015) et réalisée aux services des urgences pédiatriques et de pneumologie du centre hospitalier national d’enfants Albert Royer (CHNEAR). Etaient inclus, 89 enfants de 0 à 15ans hospitalisés pour crise d’asthme sévère ou asthme aigu grave.&nbsp;Résultats. La prévalence hospitalière des crises d’asthmes sévère était de 0,18%. Leur âge moyen était de 44,2 mois et le sexe ratio 1,6. Les pics d’hospitalisations ont été enregistrés durant les mois de Juillet et Décembre. 6,6% des patients étaient sous traitement de fond et 17,9% avaient déjà été hospitalisés pour crises d’asthmes sévères. L’hypoxémie (79,7%), l’anémie (66,2%) et l’hyperleucocytose (44,9%) étaient les principales anomalies biologiques. Les signes radiologiques étaient dominés par l’hyperinflation pulmonaire (60,7%) et le syndrome bronchique (36%). Tous les patients étaient ont bénéficié de l’oxygène, le salbutamol et les corticoïdes. Sous cette attitude thérapeutique, un décès avait été déploré. La durée moyenne de l’hospitalisation était de 3,75 jours. Les complications enregistrées étaient le pneumo-médiastin/emphysème cervico-médiastinal dans 4 cas, le pneumothorax dans 2 cas, la rupture trachéale dans 1 cas et l’atélectasie dans 1 cas.&nbsp;Conclusion. L’asthme aigu grave semble peu fréquent mais reste toujours associée à une morbidité non négligeable