Liver Stiffness Measurement and Biochemical Markers in Senegalese Chronic Hepatitis B Patients with Normal ALT and High Viral Load

Despite the high prevalence of chronic hepatitis B (CHB) in Africa, few studies have been performed among African patients. We sought to evaluate liver stiffness measurement by FibroScan® (LSM) and two biochemical scores (FibroTest®, Fibrometer®) to diagnose liver fibrosis in Senegalese CHB patients with HBV plasma DNA load ≥3.2 log(10) IU/mL and normal alanine aminotransferase (ALT) values.LSM and liver fibrosis biochemical markers were performed on 225 consecutive HBV infected Senegalese patients with high viral load. Patients with an LSM range between 7 and 13 kPa underwent liver biopsy (LB). Two experienced liver pathologists performed histological grading using Metavir and Ishak scoring.225 patients were evaluated (84% male) and LB was performed in 69 patients, showing F2 and F3 fibrosis in 17% and 10% respectively. In these patients with a 7-13 kPa range of LSM, accuracy for diagnosis of significant fibrosis according to LB was unsatisfactory for all non-invasive markers with AUROCs below 0.70. For patients with LSM values below 7 kPa, FibroTest® (FT), and Fibrometer® (FM) using the cut-offs recommended by the test promoters suggested a fibrosis in 18% of cases for FT (8% severe fibrosis) and 8% for FM. For patients with LSM values greater than 13 kPa, FT, FM suggested a possible fibrosis in 73% and 70%, respectively.In highly replicative HBV-infected African patients with normal ALT and LSM value below 13 kPa, FibroScan®, FibroTest® or Fibrometer® were unsuitable to predict the histological liver status of fibrosis

Cereal Domestication and Evolution of Branching: Evidence for Soft Selection in the Tb1 Orthologue of Pearl Millet (Pennisetum glaucum [L.] R. Br.)

BACKGROUND: During the Neolithic revolution, early farmers altered plant development to domesticate crops. Similar traits were often selected independently in different wild species; yet the genetic basis of this parallel phenotypic evolution remains elusive. Plant architecture ranks among these target traits composing the domestication syndrome. We focused on the reduction of branching which occurred in several cereals, an adaptation known to rely on the major gene Teosinte-branched1 (Tb1) in maize. We investigate the role of the Tb1 orthologue (Pgtb1) in the domestication of pearl millet (Pennisetum glaucum), an African outcrossing cereal. METHODOLOGY/PRINCIPAL FINDINGS: Gene cloning, expression profiling, QTL mapping and molecular evolution analysis were combined in a comparative approach between pearl millet and maize. Our results in pearl millet support a role for PgTb1 in domestication despite important differences in the genetic basis of branching adaptation in that species compared to maize (e.g. weaker effects of PgTb1). Genetic maps suggest this pattern to be consistent in other cereals with reduced branching (e.g. sorghum, foxtail millet). Moreover, although the adaptive sites underlying domestication were not formerly identified, signatures of selection pointed to putative regulatory regions upstream of both Tb1 orthologues in maize and pearl millet. However, the signature of human selection in the pearl millet Tb1 is much weaker in pearl millet than in maize. CONCLUSIONS/SIGNIFICANCE: Our results suggest that some level of parallel evolution involved at least regions directly upstream of Tb1 for the domestication of pearl millet and maize. This was unanticipated given the multigenic basis of domestication traits and the divergence of wild progenitor species for over 30 million years prior to human selection. We also hypothesized that regular introgression of domestic pearl millet phenotypes by genes from the wild gene pool could explain why the selective sweep in pearl millet is softer than in maize

Variation in Community Structure across Vertical Intertidal Stress Gradients: How Does It Compare with Horizontal Variation at Different Scales?

In rocky intertidal habitats, the pronounced increase in environmental stress from low to high elevations greatly affects community structure, that is, the combined measure of species identity and their relative abundance. Recent studies have shown that ecological variation also occurs along the coastline at a variety of spatial scales. Little is known, however, on how vertical variation compares with horizontal variation measured at increasing spatial scales (in terms of sampling interval). Because broad-scale processes can generate geographical patterns in community structure, we tested the hypothesis that vertical ecological variation is higher than fine-scale horizontal variation but lower than broad-scale horizontal variation. To test this prediction, we compared the variation in community structure across intertidal elevations on rocky shores of Helgoland Island with independent estimates of horizontal variation measured at the scale of patches (quadrats separated by 10s of cm), sites (quadrats separated by a few m), and shores (quadrats separated by 100s to 1000s of m). The multivariate analyses done on community structure supported our prediction. Specifically, vertical variation was significantly higher than patch- and site-scale horizontal variation but lower than shore-scale horizontal variation. Similar patterns were found for the variation in abundance of foundation taxa such as Fucus spp. and Mastocarpus stellatus, suggesting that the effects of these canopy-forming algae, known to function as ecosystem engineers, may explain part of the observed variability in community structure. Our findings suggest that broad-scale processes affecting species performance increase ecological variability relative to the pervasive fine-scale patchiness already described for marine coasts and the well known variation caused by vertical stress gradients. Our results also indicate that experimental research aiming to understand community structure on marine shores should benefit from applying a multi-scale approach

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) : 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.Peer reviewe

How I do it Pancreas-Preserving Total Duodenectomy

Abstract The concept of operations to be 'as resective as necessary and as organpreserving as possible' has led to the novel technique of resection of the entire duodenum, with complete preservation of the head of the pancreas, as a better alternative to the classic pancreaticoduodenectomy. This operation requires meticulous technique and precise knowledge of pancreatic and peripancreatic anatomy. Indications include benign or premalignant conditions confined to the duodenal mucosa, usually familial adenomatous polyposis. When appropriately performed, pancreas-preserving total duodenectomy leads to shorter operative time, requires less and safer anastomoses, and optimizes postoperative endoscopic surveillance. The available long-term results are encouraging

Atypical fibromuscular dysplasia or carotid web revealed by cerebral infarction: A review of 2 cases

Atypical fibromuscular dysplasia of the bulb or carotid web is a nonatheromatous pathology more common in African and African-American populations. It is implicated in the occurrence of cerebral infarcts of unknown causes. Its diagnosis is made by angio-CT of the supra-aortic trunks and is characterized by a defect in the posterior wall of the bulb. Treatment with antiplatelet agents prevents the occurrence of stroke, but radical treatment remains surgical and endovascular. We report 2 observations of carotid web diagnosed and medically managed at the regional hospital of Saint Louis

Pylephlebitis complicating acute calculous cholecystitis: A case report

Pylephlebitis is a complication of intra-abdominal infections. Its occurrence during cholecystitis is a rare situation. We report the case of a 43-year-old female patient who presented with septic thrombosis of the right portal branch following acute calculous cholecystitis diagnosed on abdominal CT. The clinical evolution was favorable under antibiotic therapy and a cholecystectomy was scheduled

Evaluation Du Test De Diagnostic Rapide NOVA Utilisé Pour Rechercher L’antigène HBS de l’Hépatite B Chez Les Donneurs De Sang Au Centre Hospitalier National Mathlaboul Fawzaini De Touba

RésuméDans les pays en développement, les tests rapides immuno-chromatographiques sont couramment utilisés pour le dépistage du virus de l’hépatite B (VHB) au niveau des banques de sang. L’usage de ces tests nécessite une validation préalable. L’objectif de l’étude était d’évaluer les performances du test NOVA utilisé pour le dépistage de l’antigène HBs chez des donneurs de sang au Centre Hospitalier National Mathlaboul Fawzaini de Touba.En janvier 2019, des échantillons de sang provenant de donneurs avaient fait l’objet de dépistage du VHB avec le test rapide NOVA. Les résultats obtenus ont été comparés avec ceux de l’automate Cobas e-411 dont le principe consiste en un dosage par chimiluminescence. La sensibilité du test, la spécificité ainsi que les valeurs prédictives positive et négative ont été calculées pour vérifier la fiabilité du kit. Au total 111 échantillons ont été collectés. Les résultats des tests positifs obtenus avec le kit NOVA et le Cobas e-411 étaient de 17 et 19 respectivement. Par rapport à l’automate Cobas, les résultats ont donné une sensibilité et une spécificité du test NOVA de 89,47 % et 100 % respectivement ; les VPP et les VPN étaient respectivement de 100 % et 97,87 %.Les résultats obtenus montrent que le test NOVA a une bonne spécificité. Cependant la sensibilité est relativement faible pour un usage dans les banques de sang. La méthode chimiluminescente étant plus sensible et plus spécifique devrait être privilégiée dans le dépistage de masse pour plus de fiabilité et de qualité.Mots clés : Test rapide, Hépatite B, Donneurs de sangAbstractIn developing countries, rapid immuno-chromatographic tests are commonly used to screen blood banks for hepatitis B virus (HBV). The use of these tests requires prior validation. The objective of the study was to evaluate the performance of the NOVA test used to screen blood donors for HBs antigen at the National Hospital Center Mathlaboul Fawzaini in Touba.In January 2019, blood samples from donors were screened for HBV using the NOVA rapid test. The results obtained were compared with those of the Cobas e-411 automated chemiluminescent assay. Test sensitivity, specificity, and positive and negative predictive values were calculated to verify the fiability of the kit. A total of 111 samples were collected. The positive test results obtained with the NOVA kit and the Cobas e-411 were 17 and 19 respectively. Compared to the Cobas system, the results gave a NOVA test sensitivity and specificity of 89.47% and 100% respectively; PPV and NPV were 100% and 97.87% respectively.The results obtained show that the NOVA test has good specificity. However, the sensitivity is relatively low for use in blood banks. The chemiluminescent method being more sensitive and more specific should be preferred in mass screening for more reliability and quality.Key words: Rapid test, Hepatitis B, Blood donor