Les tuberculomes cerebraux de l’adulte immunocompetent: 21 cas a Setif-Algerie

Introduction: Les données sur les tuberculomes cérébraux sont limitées ; ceci fait que, malgré son ancienneté, cette pathologie souffre d’énormes problèmes diagnostiques et thérapeutiques. A cet effet, les auteurs rapportent leur expérience quant à la prise en charge des tuberculomes puis comparent leurs résultats à ceux de la littérature.Matériel et méthode: C’est une étude rétrospective sur dossiers de patients hospitalisés entre janvier 2005 et décembre 2016 pour tuberculomes cérébraux uniques ou multiples.Résultats: Les malades étaient en majorité des femmes (18/3), âgés en moyenne de 36,5 ans. Le début était subaigu chez l’ensemble des patients mais n’a dépassé 2 mois qu’une fois. Les signes neurologiques de focalisation (12 malades) étaient variés, dominés par les convulsions et les paralysies oculomotrices. L’atteinte neurologique n’était pas l’unique localisation chez 13 malades dont 11 avaient une atteinte pulmonaire. L’origine tuberculeuse était prouvée 5 fois au niveau neuro-méningé et 3 fois au niveau d’une localisation extra-neurologique. À l’imagerie cérébrale, tout le cerveau était touché et le nombre des tubeculomes a varié de la lésion unique à la forme miliaire diffuse. L’imagerie par résonance magnétique était plus contributive que la tomodensitométrie dans 85% des cas. La durée du traitement antituberculeux était entre 9 et 18 mois. Aucun décès n’a été déploré mais 6 malades ont gardé des séquelles neurologiques.Conclusion: Le caractère curable des tuberculomes impose d’évoquer ce diagnostic devant toute masse cérébrale en zone d’endémie. Leur aspect à l’imagerie par résonnance magnétique et la découverte d’une localisation extra-neurologique peuvent palier à la faible sensibilité du diagnostic microbiologique. Mots clés: Imagerie cérébrale, Tuberculomes cérébraux, TraitementEnglish Title: Cerebral tuberculomas in immunocompetent adult: 21 cases in Setif-AlgeriaEnglish AbstractIntroduction: Cerebral tuberculomas data are limited, so, despite it is very old, this makes the disease suffer from enormous diagnostic and therapeutic problems. For this purpose, in this work we report our experience in the management of cerebral tuberculomas and compare our results with those found in the literature.Material and method: We have done a retrospective study from files of patients hospitalized between January 2005 and December 2016 for single or multiple cerebral tuberculoma.Results: Our patients were predominantly female (18/3), with an average age of 36.5 years. The onset was all the time subacute but it exceeded 2 months only once. Focal neurological signs were noted in 12 patients, they were varied, dominated by convulsions and oculomotor paralysis. Neurological involvement was not the only localization in 13 patients, 11 of whom had pulmonary involvement. The tuberculous origin was confirmed 5 times at the neuro-meningeal level and 3 times in an extra-neurological localization. In cerebral imaging, whole brain was affected and the number of tuberculomas varied from the single lesion to the diffuse miliary form. In 85% of cases, magnetic resonance imaging was more contributory than computed tomography. The duration of the tuberculosis treatment was between 9 and 18 months; no deaths have been reported but 6 patients had kept neurological sequelae.Conclusion: The curability of tuberculomas imposes to discuss this diagnosis in front of any cerebral mass in endemic zone. Their appearance in magnetic resonance imaging and the discovery of an extra-neurological location can compensate the low sensitivity of microbiological diagnosis of tuberculoma.Keywords: Cerebral tuberculomas, Brain imaging, Treatmen

Hepatitis B Surface Antigen (HbsAg) Prevalence and Risk Factors in Women of Childbearing Age in Eastern Algeria

Background: Hepatitis B is the most common chronic viral infection and a significant contributor to morbidity and death globally. Based on the mother's hepatitis B e antigen (HBeAg) status, the probability of perinatal HBV infection in children delivered to mothers with HBV ranges from 10% to 85%.Aim: to determine the prevalence of hepatitis B virus infection among women of childbearing age in the eastern region of Algeria and investigate risk factors for infection to recommend ways to reduce the disease's impact on neonatal morbidity and mortality.Methods: We conducted a cross-sectional study in Sétif, Algeria, from 2005 to 2007 to assess the prevalence of Hepatitis B Surface Antigen among women of childbearing age. This study is the first and only one in Algeria. Data on risk factors, obstetrics, and sociodemographic were gathered using structured questionnaire; they were subsequently tested using an enzymelinked immunosorbent assay for HBsAg. The data collected were entered and processed using Epi info 3.3.2 software. Infection prevalence, sociodemographic, clinical, obstetric and risk factors variable frequency distributions were calculated. The student's t-test and Fisher's exact test were applied, at a significance level of 5%.Results: There are834 women of childbearing age's medical records were examined for this study. 1% of HBsAg test findings were positive. Positive HBsAg didn't significantly correlate with any other variables, including age, place of residence, municipality, marital status, occupation, parity, current pregnancy, reason for current consultation, transmission risk factors (blood transfusion, recent piercing, dental care, shared personal hygiene equipment, injection with multiple use equipment, tattoo, scarification, partner characteristics). However, history of jaundice has a significant protective effect against HBsAg positive.Conclusion: Although our results classify the two municipalities studied as low prevalence areas (< 2%). Prenatal HBsAg screening is strongly advised

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) &lt; 60&nbsp;ml/min/1.73&nbsp;m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72&nbsp;h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7&nbsp;days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7&nbsp;days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P &lt; 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P &lt; 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7&nbsp;days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors