Particularités du cancer du larynx chez le sujet jeune / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

Discuter à travers une étude descriptive ainsi qu'une revue de la littérature, les particularités cliniques, démographiques et pronostiques des patients de moins de 45 ans, ayant un cancer du larynx. Materiels et Methodes: Il s'agit d'une étude rétrospective descriptive portant sur des patients atteints d'un cancer du larynx, âgés de moins de 45 ans suivis dans le service d'ORL et de chirurgie cervico-faciale du CHU Habib Bourguiba Sfax durant la période s'étendant de 1989 à 2018. Resultats: Nous avons trouvé 31 patients avec une prédominance masculine. Un cancer dans la famille a été trouvé dans 16,12% des cas sans corrélation statistique avec le stade avancé de la maladie. Une importante intoxication tabagique a été trouvée (96%). Trois patients avaient une laryngite chronique et un patient une papillomatose laryngée avec des lésions de dysplasie. Les motifs de consultation étaient dominés par la dysphonie (87%). La maladie a été classée en stades avancés dans 70% des cas. Le traitement chirurgical était préconisé chez 87% des patients et la préservation fonctionnelle chez 38,7%. Le taux de survie globale et sans maladie étaient respectivement, à un an de 96% et 84%, à 3 ans de 87% et 76%, et à 5 ans de 77% et 75% Conclusion: Notre travail n'a pas permis de retenir de différence en termes de données cliniques, de l'évolution de la maladie, de l'algorithme thérapeutique ni du pronostic entre les jeunes patients et les plus âgés

Inconclusive results with HIV serodiagnosis algorithms, and HIV-1 and HIV-2 co-infection in North-eastern Democratic Republic of Congo

Background:Inconclusive serodiagnosis of HIV infection is particularly frequent in Central Africa. The aims of this study were to: (i) determine the rate of inconclusive results with the two-test algorithm that the WHO proposed in 1997 (WHO II) versus the three-test algorithm (revised in 2012 and consolidated in 2015 by WHO) for HIV testing, and (ii) determine the prevalence of HIV-1 and HIV-2 co-infection in the north-eastern region of the Democratic Republic of the Congo (DRC).Methods:A multicentre cross-sectional study was performed between March and June 2016 in Kisangani and Bunia, the capital cities of Tshopo and Ituri provinces respectively. Alere Determine HIV-1/2 (Alere Medical Co. Ltd., Japan), Uni-GoldTM HIV (Trinity Biotech Manufacturing Ltd., Ireland) and recomLine HIV-1 and HIV-2 IgG (Biosynex, France) were the first, second and third tests in the serial algorithm.Results : The rate of inconclusive results was 1.1% (95% CI: 0.4 to 3.1) with the two-test algorithm and 0.4% (95% CI: 0.1 to 2.1) with the three-test algorithm (p less than 0.001). The prevalence of HIV-1 and HIV-2 co-infection among HIV positive sera was 16.7% (95% CI: 4.7 to 44.8).Conclusion:The three-test algorithm HIV testing strategy significantly reduces the rate of inconclusive results. In addition, the prevalence of HIV-1 and HIV-2 co-infection is higher in a context where HIV-2 infection is poorly documented. Large-scale research is essential to clarify these results

Algorithmic processing to aid in leukemia detection

Background: I present our medical context with some basic concepts in order to understand the results of our work, and then I begin the explanation of mathematical morphology. I will conclude by the description of algorithmic processing propose in this paper. Cancers, including leukemia and lymphoma, can cause uncontrolled growth of an abnormal type of blood cell in the bone marrow, resulting in a greatly increased risk for infection and or serious bleeding.Methods: We present detailed steps of our proposed systems, to obtain a final result that shows the detection of abnormal cells. It typically starts with a median filter pre-processing step and then applies different morphologic operator, which allows us to segment the original image and detect cancerous cells. The basic idea behind all the operators in the mathematical morphology is to compare the set of objects to analyze another object of known form, which is called a structuring element. The structuring element is a geometric figure, simple to form, known or arbitrary, and can be a circle, segment, square, or triangle.Results: We show the different results obtained after testing carried out in algorithmic processing using MATLAB: To ameliorate the visualization of the abnormal blood cells, we have applied the elements basis morphological operations in a different way. We have performed an opening by reconstruction and a closing by reconstruction. The obtained result show that we have obtained an efficient detection of the targeted objects (abnormal blood cells or leukemia).Conclusion: In this paper, we have utilized the operators of the mathematical morphology with the aim to detect abnormal cells for diagnostic aid and transmission of accurate and precise clinical information, which helps specialists in medicine (hematologists) to distinguish abnormal cells or cancerous and to follow the evolution of leukemia. The algorithmic processing presented in this article has been able to perform the task of detection of cancerous cells with success; it has produced remarkable and satisfactory results. We think of the future concept as a system of aid for diagnosis from microelectronics integration to the base of reconfigurable technologies applied to cells for the goal of quantification of the cancer region

Potential for false-positive HIV test results using rapid HIV testing algorithms

Background: In order to scale up access to HIV counselling and testing in Nigeria; an HIV diagnostic algorithm based on rapid testing was adopted. However; there was the need to further evaluate the testing strategy in order to better assess its performance; because of the potential for false positivity.Objectives: The objective of this study was to compare positive HIV test results obtained from the approved rapid testing algorithm with results from western blot tests performed on samples from the same patient.Methodology: A retrospective review was conducted of HIV screening and confirmatory results for patients seen between 2007 and 2008. Rapid test and western blot results were extracted and compared for concordance. Discordant results were further reviewed using a combination of HIV-1 RNA viral load and CD4+ cell count test results and clinical presentation from medical records. Results: Analysis of 2228 western blot results showed that 98.3% (n = 2191) were positive for HIV-1; 0.4% (n = 8) were positive for HIV-2 and 0.3% (n = 7) were dual infections (positive for both HIV-1 and HIV-2); 0.6% (n = 13) were indeterminate and 0.4% (n = 9) were negative. Further investigation of the 13 indeterminate results showed nine to be HIV-1 positive and four to be HIV-negative; for a total of 13 negative results. The positive predictive value of the HIV counselling and testing algorithm was 99.4%.Conclusion: Using the rapid testing algorithm alone; false positives were detected. Therefore; effective measures such as training and retraining of staff should be prioritised in order to minimise false-positive diagnoses and the associated potential for long-term psychological and financial impact on the patients

The development of an emergency sepsis care algorithm in Botswana

Introduction :Sepsis is a common cause of morbidity and mortality in populations with a high prevalence of HIV; but the full package of early goal directed therapy (EGDT) for sepsis is not feasible in most low and middle-income countries. The objective was to develop emergency adult sepsis care guidelines for Botswana appropriate to available resources and local epidemiology in referral hospitals and in lower levels of care. Methods : The individual components of guidelines from the Surviving Sepsis Campaign were compared with available resources for their applicability in a tertiary referral hospital in Botswana. Antibiotics were chosen based on the hospital antibiogram; national antibiotic guidelines; and the cost and availability of antibiotics. The preliminary algorithm was presented to emergency centre medical officers in a referral hospital for feasibility and acceptability of implementation. The referral hospital guideline was further modified as part of a National Guidelines Project for suitability to all levels of care: Results :An acceptable and feasible sepsis algorithm was developed and implemented in a referral hospital in Botswana in accordance with the established hospital process. In turn; it served as the basis for the development of a national guideline. Discussion The principles of EGDT are adaptable to Botswana; and are likely to be adaptable to a variety of low- and middle-income countries on the basis of local resources and epidemiology. Further research is needed to study adherence and outcome related to the modified guidelines