Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Strengthening psychosocial support and emergency response in Senegal : lessons from a tragic traffic accident: Strengthening Psychosocial Support and Emergency Response in Senegal: Lessons from a Tragic Traffic Accident

International audienceOn January 8, 2023, Senegal experienced a tragic traffic accident that claimed the lives of 42 people and left approximately 100 injured. During such events, the victims, their families, the first responders to arrive on the scene and the frontline personnel must benefit from medical and psychological care. Promptly, the Emergency Health Operations Center (EOC) acted, activating the Kaolack mobile psycho-social intervention and Support Team in addition to deploying mental health professionals in Kaffrine. On-site in Kaffrine, a medical-psychological emergency cell was established. This cell efficiently organized immediate and post-immediate care, offering individual and group counseling sessions tailored to the specific needs of each person affected. Approximately sixty direct or indirect victims received psychological assistance. Beyond the challenges inherent in managing such events and considering their increasing occurrence in our country, a vital lesson emerged-the necessity of formalizing Mobile Intervention and Psychosocial Support Teams in every region for the effective management of medical-psychological emergencies.Cet article rend compte du processus de création d’un dispositif d’urgence innovant au Sénégal, l’Équipe mobile d’intervention et de soutien psychosocial, en rappelant comment au début des années 2000 une tragédie bouleverse le pays et amorce la réflexion sur le suivi psychosocial dans un contexte politique assujetti à l’idiome de la résilience. La création de l’EMIS semble paradoxale, puisqu’elle requiert et valorise des compétences en psychologie et en psychiatrie qui en temps ordinaire sont peu soutenues par les politiques sociales et de santé

Imaginary Pregnancy as an Hysterical Disorder about a Senegalese Case Report

Ndiaye-Ndongo Ndèye Dialé, Fall Lamine, Sylla Aida, Lachina Nathalie and Thiam Mamadou HabibDepartment of Psychiatry University Hospital Fann, Assistant Professor, Cheikh Anta Diop University of Dakar, SenegalDOI: http://dx.doi.org/10.12970/2310-8231.2014.02.03.1Abstract: Imaginary pregnancy or pseudocyesis is a condition in which a woman without being pregnant is convicted of being in pregnancy and develops pregnancy signs. It is a relatively rare condition that admits as etiologic factors cultural, endocrine but also psychological factors.The diagnosis can be difficult. Nowadays, paraclinical gynecological investigations are a great contribution.This table is encountered most often in cases of conversion hysteria, or depression, and reflecting the entanglement body / psyche.We report the case of a young woman with the problem of imaginary pregnancy, occurring within the framework of his hospitalization. We discuss the possible relationship between such an event and a hysterical personality organization

Four-days-a-week antiretroviral maintenance therapy in virologically controlled HIV-1-infected adults: the ANRS 162-4D trial

International audienceBackground:Intermittent treatment could improve the convenience, tolerability and cost of ART, as well as patients' quality of life. We conducted a 48 week multicentre study of a 4-days-a-week antiretroviral regimen in adults with controlled HIV-1-RNA plasma viral load (VL).Methods:Eligible patients were adults with VL  90%, with a power of 87% and a 5% type 1 error. The study was registered with ClinicalTrials.gov (NCT02157311) and EudraCT (2014-000146-29).Results:One hundred patients (82 men), median age 47 years (IQR 40-53), were included. They had been receiving ART for a median of 5.1 (IQR 2.9-9.3) years and had a median CD4 cell count of 665 (IQR 543-829) cells/mm3. The ongoing regimen included PI/r in 29 cases and NNRTI in 71 cases. At 48 weeks, 96% of participants (95% CI 90%-98%) had no failure while remaining on the 4-days-a-week regimen. Virological failure occurred in three participants, who all resumed daily treatment and became resuppressed. One participant stopped the strategy. No severe treatment-related events occurred.Conclusions:Antiretroviral maintenance therapy 4 days a week was effective for 48 weeks in 96% of patients, leading to potential reduction of long-term toxicities, high adherence to the antiretroviral regimen and drug cost saving

Risques climatiques et agriculture en Afrique de l’Ouest

Le futur de l’Afrique de l’Ouest dépend de la capacité du secteur de l’agriculture à s’adapter pour garantir la sécurité alimentaire dans un contexte de changement climatique et de croissance démographique. Pour faciliter cette adaptation, la recherche a déployé d’importants efforts pour améliorer les connaissances sur les mécanismes climatiques et leurs impacts sur les systèmes agropastoraux. Or, ces avancées issues de la recherche ne sont que rarement prises en compte dans la planification et la prise de décision. Partant de ce constat, un projet de recherche « Agriculture et gestion des risques climatiques : outils et recherches en Afrique », soutenu par le ministère français des Affaires étrangères et du Développement international est mené entre 2016 et 2018 dans plusieurs pays d’Afrique de l’Ouest. Il a pour objectif d’élaborer des outils efficaces de gestion du risque climatique pour les agriculteurs, en co-construisant avec des réseaux de chercheurs et d’acteurs directement impliqués dans l’accompagnement de l’agriculture des stratégies innovantes basées sur les résultats de la recherche. Cet ouvrage restitue les principales avancées de cette recherche-action sur trois thématiques prioritaires : les services climatiques pour l’agriculture, la gestion des ressources en eau et l’intensification écologique. Il permet aux acteurs du secteur agricole (organisations paysannes, filières, secteur privé agricole, banques de développement agricole, fournisseurs d’intrants, services agricoles et de météorologie) de s’approprier de nouvelles connaissances et de nouveaux outils pour une meilleure prise en compte des risques climatiques dans la gestion des systèmes de production