18 research outputs found
La différence épidémiologique des hémorragies digestives hautes entre les hommes et les femmes
Introduction: Des diffĂ©rences Ă©pidĂ©miologiques, Ă©tiologique voire pronostique des hĂ©morragies digestives hautes (HDH) entre les deux sexes opposĂ©s ont Ă©tĂ© citĂ© par diffĂ©rentes Ă©tudes. MĂ©thodes: Nous avons essayĂ© de dĂ©celer ces diffĂ©rences Ă travers une analyse rĂ©trospective nichĂ©e sur une Ă©tude prospective sur les hĂ©morragies digestives hautes ayant inclus 945 patients.RĂ©sultats: Six cents trente-sept patients Ă©taient des hommes (67,4% Vs 32,6%). Un antĂ©cĂ©dent dâHDH Ă©tait trouvĂ© chez 24,2% des cas sans diffĂ©rence significative entre les deux sexes. LâĂąge de survenue de lâhĂ©morragie Ă©tait plus Ă©levĂ© chez les femmes que chez les hommes : 51,5 ans ± 18,8 Vs 47,8 ans ± 18,3 (p : 0,003). Les Ă©tiologies de lâHDH Ă©taient diffĂ©rentes entre les deux sexes. Alors que lâhĂ©morragie liĂ©e Ă lâHTP Ă©tait la premiĂšre cause chez la femme (38 % Vs 23,5 % chezlâhomme, p<0,0001), câest la pathologie ulcĂ©reuse qui venait en premier chez lâhomme (62 % Vs 36,7 % chez la femme, p <0,0001). Un besointransfusionnel Ă©tait notĂ© chez 42,4 % des patients de sexe masculin contre 35,4 % des patientes avec un p = 0,03. Le taux de rĂ©cidive et de dĂ©cĂšs global Ă©taient de 7,5 % et de 5,7 % des cas respectivement, sans diffĂ©rence significative entre les deux sexes.Conclusion: LâĂ©tude trouve un profil Ă©pidĂ©miologique, clinique et Ă©tiologique diffĂ©rent selon le sexe des patients.Key words: HĂ©morragie digestive haute, Ă©pidĂ©miologie, sexe masculin, sexe fĂ©minin, endoscopie, ulcĂšre gastroduodĂ©nal, hypertension portal
Iron for Africa-Report of an Expert Workshop.
Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue
Endovascular management of iatrogenic renal vascular injuries complicating percutaneous nephrolithotomy: Role of renal angiography and embolization; an analysis of 159 cases
Objective: To describe the use of renal angiography in the detection of renal vascular injuries following percutaneous nephrolithotomy and to assess the efficacy of endovascular management of these complications. Materials and Methods: This was a retrospective review of 159 consecutive patients over a period of 12 years from 2005 to 2016 who presented with significant post nephrolithotomy hemorrhage and who were evaluated by renal angiography as a first-line diagnostic study, followed by embolization of identified renal vascular injuries in the same session. The parameters assessed for each patient included type of renal vascular injury identified, type of embolic material and therapeutic outcome. Results: Renal vascular lesions identified in 119 patients were treated with embolization with complete resolution of hemorrhage, no further clinical deterioration and preservation of renal function. Conclusions: Renal vascular injury is a rare complication of percutaneous nephrolithotomy. Early renal angiography and selective embolization can play an integral diagnostic and therapeutic role
Contamination microbiologique résiduelle des endoscopes digestifs
Les endoscopes sont des dispositifs médicaux qui
ne peuvent faire lâobjet de mesures de stĂ©rilisation en raison
de leur caractÚre complexe et notamment de la sensibilité
Ă la chaleur de certains de leurs constituants. La
complexité de leur structure rend possible une accumulation
de souillures organiques ou minérales qui peuvent
elles-mĂȘmes renfermer des agents infectieux. Une frĂ©quence
ou une qualité insuffisante de la procédure de
dĂ©sinfection peut aboutir Ă la formation dâun biofilm.
Lâobjectif de notre travail est de faire une Ă©valuation de
la contamination microbiologique des endoscopes aprĂšs
dĂ©sinfection dans une unitĂ© dâendoscopie du service dâhĂ©pato-
gastro-entérologie du CHU Hassan II de FÚs, Maroc.
Les prélÚvements ont concerné 13 endoscopes. Ils ont
Ă©tĂ© rĂ©alisĂ©s en deux phases : lâinjection dâune solution de
dĂ©crochage dans les canaux de lâendoscope, et lâĂ©couvillonnage
de lâembout distal, puis insufflation et aspiration.
Lâeau du rinçage terminal ainsi que la solution de
désinfection ont également été contrÎlées.
Les résultats obtenus ont montré une contamination
résiduelle de la flore mésophile aérobie totale (FMAT) de
lâordre de 3,6.103 UFC/endoscope. Nous avons identifiĂ©
60 micro- organismes. Pseudomonas sp. est la bactérie la
plus fréquemment rencontrée dans nos prélÚvements
(35 %), Acinetobacter sp. (13 %), Micrococcus sp. (17,5 %),
Escherichia sp. (15 %), Staphylococcus sp.et Streptococcus
sp. (11 %), Bacillus sp. (6 %), et Candida sp. (3 %).
La modification dans la procédure de désinfection
adoptée dans le service a permis de ramener la contamination
Ă un niveau cible (FMAT < 10 UFC/endoscope).
Le respect des principes de bases de lâhygiĂšne hospitaliĂšre
et lâapplication de procĂ©dures de nettoyage et de
désinfection rigoureuses sont des éléments majeurs dans
la prévention et la lutte contre les infections nosocomiales
Comparaison clinico-pathologique et moléculaire entre les cancers du cÎlon droit et du cÎlon gauche dans la population de FÚs, Maroc
Burden of celiac disease in the Mediterranean area
AIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost. METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries. RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550 000 symptomatic adults and about 240 000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about âŹ4 billion (âŹ387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortal ity: about 600 000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls. CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone. © 2011 Baishideng. All rights reserved
Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: A real life prospective study
Background: We assessed how the diagnosis of Celiac Disease (CD) is made and how the new ESPGHAN guidelines can be applied in children from countries with different resources. Methods: A real life prospective study was performed in 14 centres of 13 different Mediterranean countries. Participants were asked to apply the usual diagnostic work-up for CD according to their diagnostic facilities. Results: There were 1974 patients enrolled in the study, mean age 4 years, 10 months; 865 male, 1109 female. CD was confirmed in 511 (25.9%) and was unconfirmed in 1391 (70.5%) patients; 14 patients were diagnosed as having CD according to the new ESPGHAN guidelines, 43 patients were classified as having potential CD. In all participating countries the diagnosis of CD relied on histology of duodenal biopsy; in 5 countries, HLA, and in one country endomysial antibodies (EMA) were not available. Symptoms did not add a significant increase to the pre-test probability of serological tests. The positive predictive value of tissue transglutaminase type 2 (tTG) antibodies performed with different kits but all corresponding to those recommended by ESPGHAN was 96.1% (95% CI 94-97.9%) in presence of tTG > 10xULN. In 135 patients with tTG >10xULN, HLA genotyping was performed and in all it was compatible with CD. Conclusions: The results of our study show that CD diagnosis still relies on intestinal biopsy in the Mediterranean area. New ESPGHAN criteria are not applicable in 5 countries due to lack of resources needed to perform HLA genotyping and, in one country, EMA assay. Further simplification of the new ESPGHAN guidelines might be made according to what preliminarily the present results suggest if confirmed by new prospective studies. © 2017 The Author(s)