Symptomatic progestin-associated atypical grade II meningioma. A first case report.

BACKGROUND: Long-term use of high-dose progestin is known to promote the development of meningioma. Atypical meningioma in a patient under progestin has not previously been reported. CASE REPORT: A 53-year-old right-handed woman presented with focal onset seizures, without impaired consciousness. Medical history featured endometriosis, treated successively by cyproterone acetate 25mg/day for 2 months then 50mg/day for 101 months, and chlormadinone acetate 5mg/day for 68 months then 10mg/day for 83 months. Brain MRI revealed multiple extra-axial lesions suggestive of left central meningioma associated with anterior skull base meningiomatosis. Surgical resection of the left central meningioma was achieved and progestin was withdrawn. Neuropathology diagnosed grade II atypical meningioma. Close clinical and imaging monitoring was implemented without adjuvant oncological treatment. At 25 months, imaging follow-up showed no recurrence of the left central meningioma and a significant regression of all other lesions, except for the right frontal lesion. CONCLUSIONS: Neurosurgeons should be aware of the possible aggressiveness of meningioma in patients under progestin, and particularly those treated by different types of progestin over a long period of time without interruption. This may require systematic close monitoring, to adapt neurosurgical management.

[Epidemiology and mortality factors of acute intoxication in intensive care in Bouaké (Ivory Coast) from 2015 to 2018]. / Epidemiologie et facteurs de mortalite des intoxications aiguës en reanimation a Bouake (Cote d'Ivoire) de 2015 a 2018.

INTRODUCTION: Acute poisoning is a common reason for admission to intensive care. OBJECTIVE: To describe the epidemiological profile, to analyze the mortality factors of patients admitted to intensive care for acute intoxication. PATIENTS AND METHODS: A retrospective, descriptive and analytical study covering four years (from January 1, 2015 to December 31, 2018) .Includes patients admitted to intensive care in Bouaké for acute intoxication. The variables studied were: socio-demographic characteristics, intoxication characteristics, clinical, therapeutic, evolutionary and prognostic characteristics. RESULTS: Of a total of 1476 admissions during the study period, 131 patients were admitted for acute intoxication, with a hospital prevalence of 8.8%. The average age was 19 (range: 1 month to 70 years). The sex ratio was 0.84. The majority of poisonings occurred at home (94%). Psychiatric history was present in 11% of patients. The poisoning occurred in urban areas in 72% of cases. The place of intoxication was the family home in 94% of cases. The nature of the intoxication and the type of poison toxin depended on the age of the intoxicated patients. The average admission time was 7.38 hours ± 12 hours (range: 30 minutes to 72 hours). The poisoning was symptomatic in 93% of the patients. The clinical symptoms observed were: gastrointestinal (70%), respiratory (62%) and neurological (43%). Vomiting attempts associated with self-medication were performed in 69% of patients. The substances used for self-medication were: palm oil (80%) and milk (20%). The treatment in intensive care was initially symptomatic then secondarily adapted to the nature of the incriminated or suspected toxin. The use of tracheal intubation and mechanical ventilation was necessary for 10% of the patients. The average stay in hospital was 1.64 ± 1.5 days (range: 1 to 10 days). The lethality was 8%. The factors of poor prognosis were the existence of a cardiovascular collapse (p <0.001), the presence of a deep coma (p <0.001) and the use of mechanical ventilation (p <0. 001). CONCLUSION: Acute intoxication is a public health problem in Bouaké and requires preventive action.

INTRODUCTION: Les intoxications aiguës constituent un motif fréquent d'admission en réanimation. OBJECTIF: Décrire le profil épidémiologique, analyser les facteurs de mortalité des patients admis en réanimation pour intoxications aiguës. PATIENTS ET MÉTHODES: Etude rétrospective, descriptive et analytique, portant sur quatre ans (du 1er janvier 2015 au 31 décembre 2018).Etaient inclus les patients admis en réanimation à Bouaké pour une intoxication aiguë. Les variables étudiées étaient: les caractéristiques sociodémographiques, les caractéristiques de l'intoxication, les caractéristiques cliniques, thérapeutiques, évolutives et le pronostic. RÉSULTATS: Sur un total de 1476 admissions durant la période d'étude, 131 patients ont été admis pour une intoxication aiguë, soit une prévalence hospitalière de 8,8 %. L'âge moyen était de 19 ans (extrême : 1 mois et 70 ans). Le sex-ratio était de 0,84. La majorité des intoxications avaient eu lieu au domicile (94 %). Les antécédents psychiatriques étaient présents chez 11% des patients. Les intoxications avaient lieu en milieu urbain dans 72% des cas. Le lieu de l'intoxication était le domicile familial dans 94% des cas. La nature de l'intoxication et le type de toxique incriminé était fonction de l'âge des patients intoxiqués. Le délai moyen d'admission était de 7,38 heures ± 12heures (extrêmes: 30 mn et 72 heures). Les intoxications étaient symptomatiques chez 93% des patients. Les symptômes cliniques observés étaient : gastro-intestinaux (70%), respiratoires (62 %) et neurologique (43%). Des tentatives de vomissements associées à une automédication ont été réalisées chez 69% des patients. Les substances utilisées pour l'automédication étaient : l'huile de palme (80 %) et de lait (20%). Le traitement en réanimation était initialement symptomatique puis secondairement adapté à la nature du toxique incriminé ou suspecté. Le recours à l'intubation trachéale et à la ventilation mécanique a été nécessaire chez 10% des intoxiqués. Le séjour moyen en hospitalisation a été de 1,64±1,5 jours (extrêmes : 1 et 10 jours). La létalité était de 8 %. Les facteurs de mauvais pronostic étaient : l'existence d'un collapsus cardiovasculaire (p <0,001), la présence d'un coma profond (p <0,001) et la réalisation d'une ventilation mécanique (p <0,001). CONCLUSION: Les intoxications aiguës constituent un problème de santé publique à Bouaké et nécessite des actions de prévention.

Efficacy and safety of tranexamic acid in orthopaedic trauma surgery: a meta-analysis.

OBJECTIVE: To systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, Embase and Cochrane Library databases. The search time was incepted to February 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias. Then, meta-analysis was performed using RevMan 5.3. RESULTS: A total of 10 studies were included, with 936 patients. The pooled results indicated that TXA group was superior to control group in the total blood loss [MD=-157.61, 95%CI (-250.09, -65.13), p=0.0008], blood transfusion [OR=0.59, 95%CI (0.43, 0.81), p=0.001], and the wound complications [OR=0.59, 95%CI (0.43, 0.81), p=0.001]. There was no significant difference in risk of thromboembolic events [OR=1.27, 95%CI (0.78, 2.12), p=0.35] and the mortality [OR=0.79, 95%CI (0.35, 1.78), p=0.57] between TXA and control group. CONCLUSIONS: TXA could effectively reduce blood transfusion, total blood loss, and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of the included studies, more high-quality works are required to verify the above conclusions.

[Klippel-Trenaunay Syndrome In Black African: Clinical And Therapeutic Particularities About One Cas Report]. / Syndrome De Klippel-Trenaunay Du Noir Africain : Particularites Cliniques Et Therapeutiques A Propos D'Un Cas.

The authors report a case of a syndrome of KlippelTrenaunay revealed by the venous malformations and osteoalodystrophyof the rightlower limb in the Teaching Hospital of Bouake. Surgery consisted in a vast stripping associated with a right crossectomy. The histological examination of the venous maze was favorable to an angioma. Postoperative outcome was simple. After a drop of 14 months, the patient presents an occasional myalgia arising in the effort. This observation raises the problem of the post-operative evolution of the congenital varicose veins.

Les auteurs rapportent un cas d'un syndrome de Klippel-Trenaunayrévélé par des malformations variqueuses systématisées et une ostéodystrophieavec un reflux ostial important du membre inférieur droit au CHU de Bouaké. La chirurgie classique a consisté à un éveinage étendu associé à une crossectomie droite. L'examen histologique des lacis veineux était favorable à l'existence d'un angiome. Les suites opératoires ont été simples. Après un recul de 14 mois, le patient présente une myalgie intermittente survenant à l'effort de marche. Cette observation pose le problème de l'évolution postopératoire des varices congénitales.

Syndrome de Klippel-Trenaunay du noir africain : particularités cliniques et thérapeutiques à propos d'un cas

Les auteurs rapportent un cas d'un syndrome de Klippel­Trenaunayrévélé par des malformations variqueuses systématisées et une ostéodystrophie avec un reflux ostial important du membre inférieur droit au CHU de Bouaké. La chirurgie classique a consisté à un éveinage étendu associé à une crossectomie droite. L'examen histologique des lacis veineux était favorable à l'existence d'un angiome. Les suites opératoires ont été simples. Après un recul de 14 mois, le patient présente une myalgie intermittente survenant à l'effort de marche. Cette observation pose le problème de l'évolution postopératoire des varices congénitales

Angioedème bradykinique d'évolution fatale suite à une prise d'énalapril. A propos d'un cas

L'angiœdème bradykinique est une maladie rare et grave qui constitue une complication exceptionnelle du traitement aux Inhibiteurs de l'Enzyme de Conversion (IEC). Elle engage le pronostic vital des patients dans 75% des cas et représente une urgence médicale majeure. L'évolution de cette affection est totalement imprévisible avec un risque de décès par asphyxie. Les auteurs rapportent l'observation d'une patiente de 70 ans hypertendue qui a présenté un angiœdème bradykinique d'évolution fatale deux jours après l'initiation de son traitement antihypertenseur par les IEC. Au travers cette observation, les auteurs voudraient mettre en lumière cette affection mortelle, de diagnostic difficile souvent méconnue

[Efficiency Analysis of EX16+10Y Kit on Detection of the Uygur Population in Xinjiang Province].

OBJECTIVES: To analyse the efficiency of EX16+10Y kit on the forensic detection of the Uygur in Xinjiang province. METHODS: The blood samples were extracted from 4 620 male individuals of Uygur in Xinjiang province, and amplified by EX16+10Y kit. The typing of amplification products was performed by 3130xl genetic analyzer. RESULTS: The genotyping graphs of 15 autosomal STR loci and 10 Y-chromosomal STR loci from 4 620 male individuals of Uygur in Xinjiang province were acquired completely. The genotype distribution of 15 autosomal STR loci was consistent with Hardy-Weinberg equilibrium. The heterozygosity, polymorphism information content and discrimination power of STR loci were 0.637-0.838, 0.580-0.860 and 0.811-0.978, respectively. There were 766 haplotypes in 10 Y -chromosomal STR loci. CONCLUSIONS: The test results of EX16+10Y kit is accurate and trustworthy, which can simultaneously be used for the individual identification and the screening of paternal pedigree in practical work.

[Acute respiratory distress syndrome secondary to a viper envenomation in children]. / Syndrome de détresse respiratoire aiguë secondaire à une envenimation vipérine chez l'enfant.

Viper envenomation is responsible for inflammatory disorders, hemorrhagic complications, and local or extended necrosis. The occurrence of respiratory complications such as Acute Respiratory Distress Syndrome (ARDS) is exceptional. We report on the case of a 15-year-old with no particular history who had, 24h after a viper bite, swelling of the right lower limb associated with blood dyscrasia. Despite the administration of antivenom treatment, the progression was marked by the onset of ARDS and the patient's death within 48h.

[Bilateral vestibulopathy].

The leading symptoms of bilateral vestibulopathy (BVP) are postural imbalance and unsteadiness of gait, deficits of spatial memory and navigation. The etiology of BVP remains unclear in more than 50% of patients: in these cases neurodegeneration is assumed. Frequent known causes are ototoxicity mainly due to gentamicin, bilateral Menière's disease, autoimmune diseases, meningitis and bilateral vestibular schwannoma, as well as an association with cerebellar degeneration. The diagnosis of BVP is based on a bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR). Head impulse test (HIT), video-oculography system (vHIT), crvical/ocular vestibular-evoked myogenic potentials (c/oVEMP) and dynamic visual acuity is an additional test supporting the diagnosis. There are four different subtypes of BVP depending on the affected anatomic structure and frequency range of the VOR deficit: impaired canal function in the low-and/or high-frequency VOR range only and/or otolith function only; the latter is very rare. There are four treatment options: first, detailed patient counseling to explain the cause, etiology, and consequences, as well as the course of the disease; second, daily vestibular exercises and balance training; third, if possible, treatment of the underlying cause, as in bilateral Menière's disease, meningitis, or autoimmune diseases; fourth, if possible, prevention, i.e., being very restrictive with the use of ototoxic substances, such as aminoglycosides.

[Correlation analysis between 18F-FDG uptake features and the prognosis in patients with pathologic stage â lung adenocarcinoma].

OBJECTIVE: To analyze the (18)F-FDG uptake features and the correlation between (18)F-FDG uptake and the prognosis in patients with pathologic stageⅠlung adenocarcinoma. METHODS: One hundred and seventeen patients with stageⅠlung adenocarcinoma proved by surgery, who underwent a preoperative (18)F-FDG PET-CT, were studied retrospectively. The tumors' SUVmax in different groups of clinicopathologic factors were compared. The correlations between the SUVmax and clinicopathologic factors were analyzed using Spearman rank correlation. The ROC was plotted to estimate the most discriminative cut-off point for SUVmax in predicting the recurrence or progression of tumor. The progression-free survival (PFS) in different clinicopathologic groups were estimated using the Kaplan-Meier method and Log-rank test. RESULTS: The SUVmax of pathologic stageⅠlung adenocarcinomas were significantly different in different groups of gender, tumor size, density, tumor differentiation grade and T staging, respectively (P<0.05 for all). Patients with a larger tumor size, a higher proportion of solid component, poorer grade of tumor differentiation had a higher SUVmax. The T1b group had a higher SUVmax than T1a and T2a groups. The male group had a higher SUVmax than the female group. The SUVmax was positively correlated with the size of the adenocarcinomas (P<0.01), and was negatively correlated with both the density and tumor differentiation grade (P<0.01). But there was no correlation between SUVmax and the T stage (P>0.05). The patients with an SUVmax of <3.0 had a much better PFS (75.1±3.0 month)than those with an SUVmax of ≥3.0 (52.7±5.9 month)(P<0.01). The tumor with a poorer differentiation grade was associated with reduced PFS (45.7±5.4 months) compared with those with well differentiated tumor (76.7±4.2 month)(P<0.05). The PFS showed no statistically significant differences in different gender, age, smoking history, tumor size, density and T staging groups (P>0.05). CONCLUSIONS: (18)F-FDG uptake is correlated with the tumor size, density, and differentiation grade, and has a prognostic value for predicting the PFS in the patients with pathologic stageⅠ lung-adenocarcinoma. Patients with an SUVmax of <3.0 have a much better PFS than those with an SUVmax of ≥3.0.

Progranulin and short-term outcome in patients with acute ischaemic stroke.

BACKGROUND AND PURPOSE: Stroke is a leading cause of death and severe disability worldwide. Serum biomarkers play a critical role in the assessment of the severity and prognosis in stroke patients. METHODS: In this prospective cohort study, the measurement of serum progranulin (PGRN) was conducted in 316 participants, including 216 patients with an identified diagnosis of acute ischaemic stroke and 100 normal control subjects. The primary end-point was defined as all-cause mortality for a short-term follow-up of 6 months. Adverse functional outcome (modified Rankin Scale score ≥3) was considered as the secondary end-point. RESULTS: The median value of serum PGRN for patients with acute ischaemic stroke was 64.2 ng/ml (interquartile range 54.6-73.7), which was significantly higher than the control group [59.7 (54.4-64.4) ng/ml; P < 0.001]. Multivariable linear regression suggested that PGRN levels were significantly correlated with body mass index, alcohol consumption, fasting blood glucose, total cholesterol, National Institutes of Health Stroke Scale (NIHSS) score and high-density lipoprotein cholesterol. Serum PGRN concentrations were independently associated with increased risks of all-cause mortality and adverse functional outcome after adjustment for clinical variables. In Cox proportional hazards models, PGRN levels were associated with the risk of mortality (hazard ratio 1.090, 95% confidence interval 1.033-1.150, P = 0.002). The net reclassification improvement of the model with added PGRN was 0.1902 (P = 0.0234) after adjustment for the variables in the Cox regression model for predicting all-cause mortality, and the integrated discrimination improvement was 0.1052 (P < 0.001). CONCLUSIONS: Serum PGRN levels independently predicted all-cause mortality and adverse functional outcome in the short term in stroke patients. The discriminative power was improved by PGRN on the basis of NIHSS score.

Diosgenin prevents bone loss on retinoic acid-induced osteoporosis in rats.

OBJECTIVE: To observe the preventive and therapeutic effects of diosgenin on retinoic acid-induced osteoporosis in rats. METHODS: A total 50 Sprague-Dawley rats were randomly divided into 5 groups: control group, model group (osteoporosis rats), low (10 mg kg(-1)), middle (30 mg kg(-1)), and high-dose diosgenin (90 mg kg(-1))-treated groups. The osteoporosis rats model was induced by retinoic acid. The BMD and physical parameters of femoral including length, wet weight, and dry weight in each group were measured. The hematoxylin-eosin staining was used for bone histomorphology analysis. Besides, the bone calcium (Ca) and phosphorus (P) contents were measured. In order to detect the biochemical index in different treatment groups, the serum tartrate-resistant acid phosphatase (TRAP), alkaline phosphatase (ALP), estradiol, and osteocalcin were compared among different groups. RESULTS: The osteoporosis rat model was successfully induced by retinoic acid. Compared with the model group, the lessening of femoral length and weight and the loss of BMD were significantly improved in diosgenin groups. Both contents of Ca and P were much more increased when induced by retinoic acid (p < 0.05). The estradiol and osteocalcin levels in the middle and high-dose treatment groups were significantly higher than that of the model group, while the ALP and TRAP levels were much lower than the model group (p < 0.05). CONCLUSION: Diosgenin can prevent the loss of bone in experimental rats. The mechanism may be that it improves the level of estrogenic hormone of estradiol and inhibits the high bone turnover.

[Viper bite at the external genitalia in a child]. / Morsure de vipère des organes génitaux chez un enfant.

We report on a case of severe envenomation due to viper bites at the external genitalia in an 8-year-old child. The grade III poisoning involved hemostatic disorders and severe swelling. The patient consulted in a timely manner and recovered rapidly after antivenom FAV Africa(®) administration.

Rapid modulation of local neural activity by controlled drug release from polymer-coated recording microelectrodes.

We demonstrate targeted perturbation of neuronal activity with controlled release of neurochemicals from conducting polymer-coated microelectrodes. Polymer coating and chemical incorporation are achieved through individually addressable electrodeposition, a process that does not compromise the recording capabilities of the electrodes. Release is realized by the application of brief voltage pulses that electrochemically reduce the polymer and dissociate incorporated neurochemicals; whereby they can diffuse away and achieve locally effective concentrations. Inhibition of evoked synaptic currents in neurons within 200 µm of a 6-cyano-7-nitroquinoxaline-2,3-dione releasing electrode lasts for several seconds. Spiking activity of neurons in local circuits recorded extracellularly near the releasing electrode is silenced for a similar duration following release. This methodology is compatible with many neuromodulatory chemicals and various recording electrodes, including in vitro and implantable neural electrode arrays, thus providing an inexpensive and accessible technique capable of achieving sophisticated patterned chemical modulation of neuronal circuits.

A Chinese pedigree of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): clinical and radiological features.

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is a rare hereditary cerebral vascular disease thought to be confined to Japan. This paper reports a Chinese pedigree of CARASIL in which two patients exhibited all of the typical clinical features of the disease. The radiological features are also discussed and compared with those of CADASIL. These cases illustrate the unique clinical and radiological features of CARASIL and challenge the idea that CARASIL is limited to the Japanese population.

Evaluation de la derniere consultation prenatale a l'Hopital General d'Abobo

Notre etude qui est une enquete prospective transversale s'est deroulee a l'Hopital General d'ABOBO dans le service de gyneco obstetrique. Elle s'est etendue de fevrier a octobre 2003. Le but de cette etude etait d'evaluer la qualite de la derniere consultation prenatale effectuee par les sages-femmes de la CPN a l'Hopital General d'ABOBO; afin d'apprecier le niveau de la prise en charge des gestantes a ternie. Nous avons evalue 250 consultations de gestantes qui venaient pour leur derniere consultation c'est-a-dire les 15 premiers jours de leur neuvieme mois et qui avaient beneficiees d'au moins une consultation dans le service. Le taux de frequentation de la CPN par les gestantes de la commune etait de 91;6pour cent. La moyenne d'age de nos gestantes etait de 25;7 ans avec 70pour cent des gestantes se situant entre 21 et 28 ans. 42;4pour cent des gestantes etaient analphabetes et 37;2pour cent etaient celibataires. Les nullipares ont constitues la majorite des gestantes de notre etude (35;6pour cent). Parmi les antecedents obstetricaux; l'IVG etait le plus rencontre avec un taux de 35;2pour cent. La qualite de l'accueil est acceptable; en outre on note de nombreuses lacunes dans la conduite de l'examen des gestantes. *la taille n'a jamais ete mesuree ; *le bassin a ete explore que chez 5pour cent des gestantes ; *94; 4pour cent des gestantes n'ont recu aucune information sur le mode d'accouchement; le lieu d'accouchement et sur les signes d'entree en travail. A la lumiere de cette analyse; l'on peut dire que la qualite de la prise en charge de la gestante telle que effectuee en consultation prenatale de l'Hopital General d'ABOBO est peu satisfaisante et necessite d'etre considerablement ameliore

Expression of testis specific ankyrin repeat and SOCS box-containing 17 gene.

Human ASB-17 (Ankyrin Repeat and SOCS Box-containing 17) is a recently identified gene belonging to the ASB family, isolated from testis cDNA library. Human ASB-17 is expressed exclusively in testis among 16 tissues, revealed by Northern blot. Mouse Asb-17 was shown to be expressed from the third week post birth to adult by semi-quantitative RT-PCR analysis. In situ hybridization on frozen sections demonstrated that Asb-17 is expressed in spermatogenic cells in adult mouse, but not in Leydig cell and epididymis in adult mouse. ASB-17 proteins are highly conserved in mammals including human, mouse, rat, Canis familiaris and Macaca fascicularis.

Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire.

OBJECTIVES: To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers. METHODS: A cross-sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems. RESULTS: Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less. Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider-client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them. CONCLUSIONS: The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.