Prise en charge des complications de la chirurgie partielle du larynx

Introduction : Le cancer du larynx est un cancer fréquent occupant la première place des cancers des voies aéro-digestives chez l’homme en Tunisie. Le tabac est le principal facteur favorisant surtout s’il est associé à l’éthylisme chronique. Il s’agit le plus souvent d’un carcinome épidermoïde plus ou moins différencié. Son pronostic est généralement bon, en raison de son développement dans un tube rigide bien limité et d’un traitement chirurgical actuellement bien codifié. La chirurgie partielle du cancer du larynx est une chirurgie à risque de complications postopératoires nécessitant une prise en charge adéquate.Patients et méthodes : Notre série comprend 54 patients ayant bénéficié d’une chirurgie partielle du larynx au sein du service de chirurgie carcinologique de l’institut Salah Azaiez sur une période de 15 ans (1997-2011).But : Présenter notre expérience en matière de prise en charge des complications de la chirurgie partielle du larynx.Résultats : La moyenne d’âge de nos patients était de 54,9 ans avec des extrêmes allant de 33 à 69 ans. La prédominance masculine était nette avec un sex-ratio de 26. La consommation tabagique était notée dans 92,6% des cas et la dysphonie était présente chez 40 patients porteurs d’une tumeur à localisation glottique. Six types d’interventions ont été pratiqués: cordectomie (9 cas), laryngectomie fronto-latérale (4 cas), laryngectomie frontale antérieure reconstructive type Tucker (10 cas), laryngectomie partielle supra-cricoïdienne avec crico-hyoïdopexie (CHP) (4 cas), laryngectomie partielle supra-cricoïdienne avec crico-hyoïdo-épiglottopexie (CHEP) (24 cas) et laryngectomie horizontale supra-glottique (3 cas). Une antibioprophylaxie était administrée chez 79,6% des patients pour une durée moyenne de 7 jours. Les complications postopératoires ont été analysées et discutées en fonction du type de la chirurgie partielle pratiquée et du type d’antibiothérapie utilisée. Ces complications étaient les suivantes: infection du trachéostome (20,4%), infection de paroi (5 cas), complications respiratoires (29,6%), emphysème sous cutané (7,4%), fistule salivaire (1 cas) et pancréatite aigüe (1 cas).Conclusion : Cette étude montre dans l’ensemble des bons résultats tant sur le plan infectieux que respiratoires, justifiant ainsi l’importance de la prise en charge des complications de la chirurgie partielle du cancer du larynx.Introduction : Laryngeal cancer is a common cancer occurring mainly in men. Smoking is the main risk factor especially if associated with chronic alcoholism. Squamous cell carcinoma is the most common histologic type. Prognosis is generally good, due to the development of the tumor in a very limited rigid tube and to a well-codified surgical treatment. Partial surgery of laryngeal cancer is characterized by postoperative complications requiring an adequate management.Methods : Our series includes 54 cases of laryngeal cancer treated with partial laryngectomy in the ENT department of Salah Azaiez Institute over a period of 15 years from 1997 to 2011.Objective : To present our experience in the management of partial laryngeal surgery complications.Results : Average age of our patients was 54.9 years ranging from 33 to 69 years. Male predominance was marked with a sex ratio of 26. Tobacco abuse was found in 92.6%. Dysphonia was the most common symptom found in 40 patients with glottic cancer. Six varieties of partial laryngectomy were performed: cordectomy (9 cases), fronto-lateral laryngectomy (4 cases), fronto-anterior reconstructive laryngectomy (10 cases), partial supra-cricoid laryngectomy with CHP (4 cases), partial supra-cricoid laryngectomy with CHEP (24 cases) and supra glottic horizontal laryngectomy (3 cases). 79.6 % of our patients received prophylactic antibiotics for an average of 7 days. Postoperative complications were analyzed and discussed in terms of the type of surgery performed and the antibiotic used. Complications observed were: infection of the tracheostoma (20.4%), parietal infection (5 cases), respiratory complications (29.6%), subcutaneous emphysema (7.4%), salivary fistula (1 case) and acute pancreatitis (1 case).Conclusion : This study shows overall good results for partial laryngeal cancer surgery with minimal post-operative complications and oncologic failure justifying the importance of an early management of these complications

Management of bipolar disorder in the intercontinental region: an international, multicenter, non-interventional, cross-sectional study in real-life conditions

Most of the existing data on real-life management of bipolar disorder are from studies conducted in western countries (mostly United States and Europe). This multinational, observational cohort study aimed to describe the management and clinical outcomes of bipolar patients in real-life conditions across various intercontinental countries (Bangladesh, Egypt, Iran, Israel, Tunisia, and Ukraine). Data on socio-demographic and disease characteristics, current symptomatology, and pharmacological treatment were collected. Comparisons between groups were performed using standard statistical tests. Overall, 1180 patients were included. The median time from initial diagnosis was 80 months. Major depressive disorder was the most common initial diagnosis. Mood stabilizers and antipsychotics were the most common drugs being prescribed at the time of the study. Antidepressants (mainly selective serotonin uptake inhibitors [SSRIs]) were administered to 36.1% of patients. Patients with bipolar I disorder received higher number of antipsychotics and anxiolytics than those with bipolar II disorder (p < 0.001). Presence of depressive symptoms was associated with an increase in antidepressant use (p < 0.001). Bipolar disorder real-life management practice, irrespective of region, shows a delay in diagnosis and an overuse of antidepressants. Clinical decision-making appears to be based on a multidimensional approach related to current symptomatology and type of bipolar disorder

Prevalence of Mood Disorders and Associated Factors at the Time of the COVID-19 Pandemic: Potocol for a Community Survey in La Manouba Governorate, Tunisia

Aims: The present survey aims to assess the overall mood disorder prevalence and identify associated socio-demographic and clinical factors in a Tunisian community sample, with special attention to the COVID-19 pandemic. Background: Mood disorders are one of the leading causes of all non-fatal burdens of disease, with depression being at the top of the list. The COVID-19 pandemic may have increased the prevalence of mood disorders, especially in Low and Middle-income countries (LMICs) and in vulnerable populations. Objective: 1/ Assess point and lifetime prevalence of depressive and bipolar disorders as well as subthreshold bipolarity in a representative population sample of La Manouba governorate and assess treatment patterns for these disorders; 2/Study socio-demographic and clinical correlates of mood disorders 3/ Assess the association between mood disorders and quality of life 4/ Study the impact of the COVID-pandemic on the prevalence of mood disorders 5/ Assess coping mechanisms to the COVID-pandemic and whether these mechanisms moderate the appearance of mood disorders or symptoms since the beginning of the pandemic Methods: This is a household cross-sectional observational survey to be conducted in La Manouba Governorate in a sample of 4540 randomly selected individuals aged ≥ 15 years. Data collection will be carried out by trained interviewers with clinical experience, through face-to-face interviews and the use of the computer assisted personal interviewing approach (CAPI). The following assessment tools are administered: Results: Structured clinical Interview for DSM IV-TR (Mood disorder section and Screening questions on Anxiety), Mood Disorder Questionnaire (MDQ), Suicide Behaviors Questionnaire-Revised (SBQ), 12-item Short Form Survey (SF-12), the Brief-COPE, and a questionnaire about a headache. In addition, socio-demographic and clinical data will be collected. Conclusion: This will be one of the very few household surveys in a general population sample to assess mental health problems and COVID-19-related variables since the beginning of the pandemic. Through this research, we aim to obtain an epidemiological profile of mood disorders in Tunisia and an estimation of the impact of the COVID-19 pandemic on their prevalence. Results should contribute to improving mental health care in Tunisia

Rural Malta : first results of the joint Belgo-Maltese survey project

The paper presents the first interdisciplinary results of a joint survey project in the north-west of Malta, with finds ranging from the Prehistoric till the Early Modern period. Three permanently inhabited sites were encountered dating to at least the late 6th or early 5th century BCE, with a clearer attestation in the Hellenistic/Roman and Late Antique periods. The resulting reconstructed settlement pattern of the Phoenician/Punic period suggests a managed landscape that seems to be a good reflexion of what is happening in North Africa and elsewhere in the central and western Mediterranean. At least from the Roman period on, these sites seem to have specialised on the production of olive oil.peer-reviewe

MRI monitoring of macaque monkeys in neuroscience: case studies, resource and normative data comparisons

Information from Magnetic Resonance Imaging (MRI) is useful for diagnosis and treatment management of human neurological patients. MRI monitoring might also prove useful for non-human animals involved in neuroscience research provided that MRI is available and feasible and that there are no MRI contra-indications precluding scanning. However, MRI monitoring is not established in macaques and a resource is urgently needed that could grow with scientific community contributions. Here we show the utility and potential benefits of MRI-based monitoring in a few diverse cases with macaque monkeys. We also establish a PRIMatE MRI Monitoring (PRIME-MRM) resource within the PRIMatE Data Exchange (PRIME-DE) and quantitatively compare the cases to normative information drawn from MRI data from typical macaques in PRIME-DE. In the cases, the monkeys presented with no or mild/moderate clinical signs, were well otherwise and MRI scanning did not present a significant increase in welfare impact. Therefore, they were identified as suitable candidates for clinical investigation, MRI-based monitoring and treatment. For each case, we show MRI quantification of internal controls in relation to treatment steps and comparisons with normative data in typical monkeys drawn from PRIME-DE. We found that MRI assists in precise and early diagnosis of cerebral events and can be useful for visualising, treating and quantifying treatment response. The scientific community could now grow the PRIME-MRM resource with other cases and larger samples to further assess and increase the evidence base on the benefits of MRI monitoring of primates, complementing the animals’ clinical monitoring and treatment regime

Cross-national variations in reported discrimination among people treated for major depression worldwide: The ASPEN/INDIGO international study

Background: No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. Aims: To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. Method: Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. Results: People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Conclusions: Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD

Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder

Background: Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about &gt; 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample. Methods: Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001. Results: The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6&nbsp;years. Of the onset locations, 34.0% had at least 1&nbsp;month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66&nbsp;years younger. Conclusion: UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p &lt; 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed

An Open Resource for Non-human Primate Imaging.

Non-human primate neuroimaging is a rapidly growing area of research that promises to transform and scale translational and cross-species comparative neuroscience. Unfortunately, the technological and methodological advances of the past two decades have outpaced the accrual of data, which is particularly challenging given the relatively few centers that have the necessary facilities and capabilities. The PRIMatE Data Exchange (PRIME-DE) addresses this challenge by aggregating independently acquired non-human primate magnetic resonance imaging (MRI) datasets and openly sharing them via the International Neuroimaging Data-sharing Initiative (INDI). Here, we present the rationale, design, and procedures for the PRIME-DE consortium, as well as the initial release, consisting of 25 independent data collections aggregated across 22 sites (total = 217 non-human primates). We also outline the unique pitfalls and challenges that should be considered in the analysis of non-human primate MRI datasets, including providing automated quality assessment of the contributed datasets