Choanal atresia: Diagnosis and management

Objective: Choanal atresia (CA) is a rare congenital malformation caused by the obliteration of the posterior choanae by an atretic plate. The aim of our study is to describe the diagnosis and management modalities of CA and to determine the factors associated with recurrence. Materials and methods: This is a retrospective study based on the medical records of patients with CA managed in our department in the period between 2002 and 2021. We studied the clinical features and management modalities of each patient. For patients who developed a recurrence, we determined the factors associated with recurrence based on a bivariate analysis. Results: We studied the medical records of 26 patients with either a bilateral (n=8) or a unilateral (n=16) form of CA. The median age at surgery was two days for bilateral forms and 5 years and 4 months for unilateral forms. At computed tomography scan, CA was mixed (n=20), bony (n=4) or membranous (n=2). All patients underwent intranasal endoscopic surgical treatment using cold instruments alone in membranous forms and combined to the drilling of the atretic plate in bony and mixed forms. The surgical management included the resection of the posterior part of the vomer bone and the placement of nasal stents in 10 and 16 patients respectively. We recorded 6 cases of recurrence requiring a surgical re-intervention. The presence of associated cranio-facial malformations was the only factor associated with recurrence (p=0,001). Conclusion: Choanal atresia diagnosis was based on nasal endoscopy and CT scan. Surgical treatment using transnasal endoscopic approach was an effective and safe technique. Associated local malformations was a factor associated with re-stenosis

Pterygium surgeries at a tertiary hospital, southwest Nigeria: a four-year review

Background: Over the years several pterygium surgical techniques have been developed with the aim of having the least possible recurrence rate. This has been from bare sclera excision which had an unacceptable recurrence rate to the current use of conjunctiva autograft with or without various adjuncts. This study was to review the current practice in a typical multi-specialist ophthalmic department. Method: The ophthalmic theatre operating register was retrospectively reviewed to obtain information on all patients who had pterygium excision at the University College Hospital, Ibadan, over a 4-year period from January 1, 2014, to December 31, 2017. Results: A total of 324 pterygium surgeries were performed and final analysis was on 249 (76.9%) surgeries which met the inclusion criteria, male to female ratio of 0.96:1. The commonest surgical technique was excision + 5-Flourouracil (5FU) + conjunctival autograft accounting for 187(75.1%) eyes. In total, postoperative recurrence was recorded in 40 (16.1%) eyes. The subgroup of excision + 5FU + autograft had the least recurrence rate of 18 (9.6%) eyes. Conclusion: A significant majority of the excision was with conjunctiva autograft with an acceptable low recurrence rate compared with most studies

Functional status and its associated factors in Nigerian adults with serious mental illnesses

Patients with serious mental illness may be less likely to achieve functional goals than the general population. Assessment of the functional impact of the illness is useful to determine severity of illness, evaluate remission, and achieve optimal treatment success. The aims of this study are to determine and compare the prevalence of low functional status among outpatients with major axis 1 psychiatric disorders, assess the risk factors for low functional status, and determine the proportion of the variance in low functional status explained by low self-esteem and non-adherence to medication. A descriptive cross-sectional study was conducted among 308 outpatients of the psychiatric unit of a tertiary hospital. The Global Assessment of Functions (GAF), Morisky Medication Adherence Scale (MMAS-8) and the Rosenberg's Self-esteem Scale were used to collect data, which were analyzed using version 20 of SPSS. Level of statistical significance was set at 5% (P < 0.05). The overall prevalence of low functional status was 40.6%. Patients with schizophrenia had the highest prevalence of low functional status (53.4%). Educational attainment, employment status, self-esteem, medication adherence, and comorbidity had significant association with functional status. Poor medication adherence had the largest relative contribution (35.4%) to the variance in functional status, while self-esteem had an insignificant relative contribution of 3.4%. An appreciable proportion of the patients in this study had low functional status with more schizophrenic patients having impairment than patients with mood disorders. Poor medication adherence, among other variables, contributes significantly to low functional status. Physicians should give as much attention to functional recovery as they give to symptom resolution in the management of psychiatric patients

Cyclophosphamide versus cyclosporine in children with frequent-relapsing and steroid-dependent nephrotic syndrome in Khartoum State, Sudan

Background: in children with frequent-relapsing and steroid-dependent (FR/SD) nephrotic syndrome (NS) remission can be achieved with either cyclophosphamide (CPM) or cyclosporine(CSA). Our objective was to compare the efficacy and safety of these agents.Methodology: Records of all children with FR/SD NS who received CPM or CSA at the Pediatric Renal Unit, Soba Hospital, Khartoum, during the period 2005­2015 were retrospectively reviewed.Main outcomes were: remission rate, relapse rate, and renal outcome.Results: We studied 82 children with FR/SD NS treated with CPM (59.8%) or CSA (40.2%). Males were 69.5% and females 30.5%. The mean admission age was 5 ± 3.10 years. At 6 months,77.6% children on CPM and 60.3% on CSA were in complete remission (CR), (P=0.012) whereas 22.4% versus 39.4% relapsed respectively (P=0.012). At 12 months, 57.5% on CPM and 72.7%on CSA were in CR, (P=0.013) whereas 42.5% versus 27.3% relapsed respectively, (P=0.013). At 24 months, 16.6% on CPM and 29% on CSA were in CR, (P=0.030) whereas 83.4% versus 71%relapsed respectively, (P=0.030). The mean number of relapses per 24 months were 1.7± 0.86 inCPM group versus 2.2 ±0.85 in CSA group, (P=0.72). Mild complications were recorded in 12.4% of patients on CPM group versus 33.3% on CSA, (P=0.031). At the latest follow- up, there was no significant change from basal levels of TWBC, mean serum creatinine, GFR, or BMI, (P>0.05 for all parameters). Conclusion: In children with FR/SD NS, both CPM and CSA were effective and safe in achieving remission with less risk of serious side- effects. However, long-term remission was less stable with both agents

Impact of preoperative patient characteristics on posturethroplasty recurrence: The significance of stricture length and prior treatments

Introduction: Urethral strictures are common in urologic practice of Sub-Saharan Africa including Nigeria. We determine the rate of stricture recurrence following urethroplasty for anterior urethral strictures and evaluate preoperative variables that predict of stricture recurrence in our practice. Subjects and Methods: Thirty-six men who had urethroplasty for proven anterior urethral stricture disease between February 2012 and January 2015 were retrospectively analyzed. Preoperative factors including age, socioeconomic factors, comorbidities, etiology of strictures, stricture location, stricture length, periurethral spongiofibrosis, and prior stricture treatments were assessed for independent predictors of stricture recurrence. Results: The median age was 49.5 years (range 21-90), median stricture length was 4 cm (range 1-18 cm) and the overall recurrence rate was 27.8%. Postinfectious strictures, pan urethral strictures or multiple strictures involving the penile and bulbar urethra were more common. Most patients had penile circular fasciocutaneous flap urethroplasty. Following univariate analysis of potential preoperative predictors of stricture recurrence, stricture length, and prior treatments with dilations or urethrotomies were found to be significantly associated with stricture recurrence. On multivariate analysis, they both remained statistically significant. Patients who had prior treatments had greater odds of having a recurrent stricture (odds ratio 18, 95% confidence interval [CI] 1.4-224.3). Stricture length was dichotomized based on receiver operating characteristic (ROC) analysis, and strictures of length ≥5 cm had significantly greater recurrence (area under ROC curve of 0.825, 95% CI 0.690-0.960, P = 0.032). Conclusion: Patients who had prior dilatations or urethrotomies and those with long strictures particularly strictures ≥5 cm have significantly greater odds of developing a recurrence following urethroplasty in Nigerian urology practice

La gale humaine : profil sociodemographique; distribution lesionnelle et types de lesions

Introduction : La gale humaine est une ectoparasitose due a Sarcoptes scabiei; parasite humain obligatoire. Son diagnostic est essentiellement clinique. Plusieurs auteurs ont recemment decrit sa recrudescence. Ainsi avons-nous voulu etablir un profil socio-demographique; ressortir la distribution lesionnelle et le type de lesions de la scabiose rencontree au cours de nos consultations de Dermatologie a Yaounde (Cameroun). Methodologie : Nous avons mene une etude descriptive et analytique a Yaounde pendant 12 mois (Octobre 2011 a Septembre 2012). Les patients avec un diagnostic de gale humaine pose durant la consultation initiale etaient inclus dans cette etude ouverte au tout venant. Les donnees recoltees prospectivement etaient saisies et analysees sous le logiciel Epi infos version 3.5.3. Resultats : 255 patients etaient retenus dont 158 (62) de sexe masculin et 97 (38) de sexe feminin. L'age variait de 0 a 80 ans avec une mediane de 18; 151 (59.2) etaient contamines par un proche ; 176 (69) signalaient une notion de contage et on notait 42 cas (16;5) de recidive. Une a huit personnes dans l'entourage avait un prurit. Les lesions siegeaient aux plis sous fessiers (71;8); aux poignets (70;2); aux plis inter fessiers (56;5). Les points crouteux (82;4); les papules (69;8) et les papulo-vesicules (68;6) etaient observes. Conclusion : La scabiose reste d'actualite et sa tendance a la propension necessite une sensibilisation aussi bien des populations que des praticiens au diagnostic precoce et a la prise en charge dans un bref delai

Schizophrenia-Window-of-Hope.com: development of a psycho-educational internet resource for the South African setting

Psycho-educational programmes for families of persons with schizophrenia have been shown to reduce relapse rates; subsequently reducing the burden on the family as well as health care systems. Although various South African helplines and psycho-educational websites exist, none of these focused specifically on schizophrenia. The South African Depression and Anxiety Group SADAG was approached for assistance to enable us to develop a piggy-back schizophrenia service on their already established helpline. A multidisciplinary mental health team compiled a manual for use by SADAG helpline operators, but owing to the huge amount of information it was realised that the resource would be more efficient if both a helpline and an Internet resource could be created. The website (www.schizophrenia-window-of-hope.com) was then developed with the help of an IT professional. This site represents the first attempt to create an internet-based schizophrenia-specific educational resource for the South African setting. The next step will be to obtain formal feedback from helpline and website users in order to inform the ongoing development of the site

Psychosis and relapse in bipolar disorder are related to GRM3, DAOA, and GRIN2B genotype

Objective: Dysfunction in glutamate signalling is thought to play a role in the pathophysiology of bipolar disorder (BD). There is evidence of associations between single nucleotide polymorphisms (SNPs) in GRM3, GRIN2B, and DAOA genes and the diagnosis of BD. In this pilot study, we investigated the frequency of SNP variants in these 3 genes within South African population groups, and assessed interactions between genes and phenotypes of BD disease severity. Method: Multiplex SNaPshotTM PCR was used to genotype 191 case and 188 control samples. Cases comprised of 191 individuals in a South African cohort of mixed ancestry and Caucasians, with BD Type 1. Phenotypes of BD disease severity were: age of onset, number of illness episodes, number of hospitalisations for depression or mania and history of psychotic symptoms. Results: There were no significant difference in SNP allele frequencies between cases and controls. In the case-only analysis; the GRM3 rs6465084 heterozygote was associated with a 4-fold increased risk of lifetime history of psychotic symptoms, and the specific variants within the gene pair, DAOA and GRIN2B, had a significant interaction with the number of hospitalisations for mania, with lowest admission rates associated with both pairs of ancestral alleles. Conclusion: In BD, variations in glutamatergic genes may influence phenotypes related to the severity of illness. Speculatively; newly derived genes associated with various evolutionary advantages, may also increase the risk for more severe BD. These preliminary findings deserve validation in a larger cohort

Involutional Lower Eyelid Entropion: Combined Wheeler's and Wedge Resection of Tarsal Plate

BACKGROUND: Involutional entropion; a common eyelid condition; has different methods of surgical correction and attendant variable recurrence rates; depending to a large degree on the method used. OBJECTIVE: To describe and evaluate a modified technique of entropion repair where the Wheeler's method is combined with wedge resection of the tarsal plate. METHODS: This was a chart review study of 49 patients who had the modified technique carried out to correct their involutional entropion. The technique essentially involves dissecting and separating the lower lid pre-tarsal orbicularis muscle from the tarsal plate; resecting a down-base triangular wedge of the tarsus followed by shortening the orbicularis and anchoring it to the tarsal plate superiorly. RESULTS: Over the three and a half-year review period; 54 eyelids of 49 patients underwent the procedure to correct their lower eyelid entropion. Of these; 28(57) were females and 21(43) males with a mean age of 73.5 years. The mean follow up period was 30.3 months. One (1.9) recurrence was recorded in all the cases during the follow-up period. Complications were minimal. CONCLUSION: The combined Wheeler and wedge resection of the tarsal plate produces very good post-operative results and can be used in primary involutional entropion or as the procedure of choice if an initial different surgical technique used fails

Importance de la chirurgie dans le traitement des dermatofibrosarcomes de Darier et Ferrand

Le dermatofibrosarcome de Darier et Ferrand est un fibrosarcome de bas grade et a developpement lent. Sa particularite et sa gravite sont liees a son agressivite locale. Ceci nous a incite a effectuer cette etude pour montrer l'importance de la chirurgie dans le traitement de ces dermatofibrosarcomes de Darier et Ferrand. C'est une etude retrospective sur les dossiers des patients porteurs de dermatofibrosarcome; pris en charge dans le service de chirurgie maxillo-faciale de l'Hopital Pellegrin du Centre Hospitalier Universitaire de Bordeaux (France). Nous avons evalue la localisation de la tumeur; l'extension tumorale; les marges de l'exerese et l'evolution apres la chirurgie. La tumeur siege sur le tronc dans 10 cas; au niveau de l'epaule dans 5 cas et au niveau cervico-cephalique dans 6 cas. La tumeur est localisee dans tous les cas. L'exerese tumorale a emporte une marge de tissus sains en superficie et une barriere saine en profondeur. Cette marge d'exerese est de 4;5cm au niveau du tronc et des membres et elle est de 2 a 4cm au niveau de la face. L'aponevrose constituait la barriere en profondeur sauf pour un cas de localisation jugale ou il s'agissait de la corticale externe osseuse. Les limites d'exerese sont toutes en zones saines sauf pour un cas au point de vue histologique. Aucun cas de recidive n'a ete repertorie apres un recul moyen de 2 ans

Statistical analysis of the factors influencing the recurrence of urinary bladder cancer after radical cystectomy

Objective To evaluate the risk factors influencing the recurrence of urinary bladder cancer; and to predict the probability of recurrence within two years after radical cystectomy. Patients and Methods Between 1986 and 1994; 857 patients were admitted at the Urology and Nephrology Center of Mansoura University; Egypt; for treatment of bladder malignancy by radical cystectomy. The number of male patients was 682 (80) versus 175 females (20) with a mean age of 49 years (range 18 - 90 years). The median follow-up period was 38 months (range 0.03-138 months). Histopathology revealed squamous carcinoma in 440 patients (51); transitional carcinoma in 223 patients (26); adenocarcinoma in 94 patients (11) and mixed (two or more) types in 100 patients (11.7). Most of the patients presented with advanced-stage disease (defined as P3 or P4): 611 patients (71) had stage P3; 68 patients (6) stage P4. Bilharzial ova were seen in 80of the specimens; while regional lymph nodes were involved in 16of the cases. Results Cancer-related mortality was encountered in 199 patients (23.2) and mortality from unknown causes in 54 patients (6.3). Fifty-five patients (6.3) were alive with recurrence. Univariate and multivariate analysis of the survival rates showed that lymph node involvement (P = 0.0000); tumor grade (P = 0.0017); pathological stage (P = 0.0008); sex (P = 0.0005); urinary diversion (P=0.0080) and histopathology (P=0.0253) significantly influenced the recurrence-free survival after radical cystectomy. The 5-year survival rate was 61.7; and the 5-year hazard rate was 48.3. Using the logistic regression model for estimating and predicting the probability of recurrence within two years after radical cystectomy; we found that only one variable (lymph node involvement) had a significant effect on the prediction of the probability of recurrence. Conclusion These findings suggest that positive lymph nodes; tumor grade; stage; sex; urinary diversion and histopathology of tumor cells are independent predictors of survival in patients with bladder cancer. Positive lymph nodes are the most important indicators for recurrence in general and especially for predicting the probability of recurrence within two years after radical cystectomy

Prise en charge chirurgicale des ameloblastomes mandibulaires : a propos d'une serie de 14 cas

Introduction : L'ameloblastome est une tumeur odontogene benigne mais localement invasive et potentiellement recidivante. L'objectif de notre travail est de demontrer l'efficacite du traitement radical a reduire ce risque de recidive. Materiel et methodes : Il s'agit d'une etude retrospective sur 14 patients operes pour ameloblastome mandibulaire dans le service entre 2001 et 2008. Une fiche de recueil a exploite plusieurs donnees notamment le type de chirurgie. Resultats : Il existait une nette predominance feminine (71;4 ).). L'age moyen etait de 30 ans. Dans notre etude. L'aspect radiologique kystique d'ameloblastome etait le plus vu dans 61;5 des cas. Le traitement conservateur en 1ere intention a ete realise chez 13 patients dont 61 ont eu une recidive. Discussion : Notre etude concorde avec les donnees de la litterature et confirme la superiorite de la chirurgie radicale face a la problematique du potentiel recidivant de l'ameloblsatome

Recrudescence et extension géographique de la peste à Madagascar de 1980 à 1999

Après avoir touché Madagascar en 1898, la peste a atteint Antananarivo en 1921 et s'est étendue sur les Hautes Terres Centrales où elle persiste jusqu'à nos jours. Une recrudescence des cas a été constatée depuis une vingtaine d'années pendant lesquelles, la peste a réemergé dans la capitale Antananarivo et, dans le port de Mahajanga après respectivement 28 et 63 ans de silence apparent. Le programme national de lutte et de surveillance a, de ce fait, été renforcé. L'évolution de l'endémie dans le temps et dans l'espace au cours de cette période a été analysée à partir de 2 982 cas bactériologiquement confirmés ou probables(sex-ratio H/F : 1,3/1). L'incidence annuelle moyenne des cas de peste confirmés ou probables est passée de 33 pendant la période 1980-1984 à 298 pendant la période 1995-1999. Cette augmentation s'est accompagnée d'une large extension géographique de la zone d'endémie, passant de 17 à 37 districts pour la plupart situés à plus de 800 m d'altitude, sauf le port de Mahajanga. Par contre, le taux de létalité a baissé pendant la même période, passant de 41,6% à 20,7%. Un des objectifs des recherches actuelles est une meilleure compréhension des différents cycles épidémiologiques de la peste à Madagascar, afin d'améliorer les stratégies de lutte

La peste : maladie réémergente à Madagascar

La peste est aujourd'hui considérée par l'OMS comme une maladie résurgente dans le monde. A Madagascar, on assiste à sa recrudescence : 150 à 250 cas par an sont notifiés confirmés ou probables. La peste sévit surtout sur les Hauts-Plateaux où 32 Services de Santé de District sont concernés. Parmi eux, le district d'Antananarivo-ville où 23 cas contrôlés ont été recensés en 1996. Sur les côtes, la maladie a réapparu en 1991, dans la ville portuaire de Mahajanga après 63 années de silence apparent; entre 1991 et 1997, 3 épidémies sont survenues : 180 cas ont été confirmés ou probables de peste. A Antananarivo, la surveillance de la population murine a montré une circulation intense du bacille pesteux. Fait préoccupant, les puces vectrices, Xenopsylla cheopis, récoltées des rats capturés ont montré une résistance aux principales familles d'insecticides dont les pyréthrinoïdes. Cette situation alarmante exige un système d'alerte et de riposte. La mise à disposition d'un test de diagnostic simple, très rapide et sûr aux services sanitaires périphériques devrait améliorer les mesures de riposte devant un cas confirmé de peste