Centre Hospitalier Universitaire Research Articles

Gastrointestinal Symptomatology as a Predictor of Esophagogastroduodenoscopy Findings in the Bariatric Population: a Retrospective Cohort Study with Review of the Literature.

Esophagogastroduodenoscopy (EGD) is a useful test to diagnose significant pathologies before bariatric surgery. Controversy remains about its role in the preoperative workup of asymptomatic patients. This study aims to describe findings and changes in the management related to EGD. A secondary objective was to review the existing literature on the subject to analyze the role of patients' gastrointestinal symptomatology as an indication to undergo a preoperative EGD. A retrospective chart review of patients operated at the Centre hospitalier universitaire de Sherbrooke (CHUS) since the opening of the Clinique médico-chirurgicale du traitement de l'obésité (CMCTO) was conducted, alongside a review of the literature. Pathologic findings on EGD were classified into 4 groups (groups 0 to 3). Results of this study were combined with literature to calculate weighted averages of global sensitivity, specificity, positive/negative predictive values, and likelihood ratios of gastrointestinal symptomatology as a predictor of pathologic endoscopy findings. A total of 737 patients were included in the study. Of those, 236 (35,7%) were considered symptomatic. Significant pathologic findings on EGD (group 2 and 3) were present for 270 patients (36.6%). Changes in medical management occurred in 22.8% of cases and in surgical management in 3.5% of cases. When combining past studies with the present one, the presence of symptoms had a sensitivity of 57.4% and a specificity of 82.4% for findings on EGD. Considering that this exam is relatively safe, that it allows uncovering a great number of pathologies altering management, and that symptoms are not a good screening test to decide of its indication, the authors recommend that all bariatric surgery patients undergo an EGD in their preoperative workup.

Isolated rhinorrhea in the presentation of SARS-CoV-2 infection among preschool- versus school-aged children.

ObjectivesRapid identification and isolation of SARS-CoV-2 cases are priorities in school and child care settings to prevent further outbreaks. The objective of this study was to compare the clinical presentation of SARS-CoV-2 infections among preschool (<5 years) versus school-aged (≥5 years) children diagnosed with SARS-CoV-2 infection, and, specifically, the probability of presenting with an isolated symptom, such rhinorrhea or sore throat.MethodsRetrospective study of children (≤18 years of age) diagnosed with SARS-CoV-2 in the outpatient COVID-19 clinic or the Emergency Department at the Centre Hospitalier Universitaire Sainte-Justine (Montreal, Quebec, Canada) February through May 2020.ResultsOf 3,789 children tested, 105 (3%) were positive for SARS-CoV-2, and 104 included in the analysis (n=49 age <5 years and n=55 age ≥5 years). While fever was the most common presenting symptom across both age groups, in the absence of fever, the presence of a combination of two or more symptoms identified the majority (92%) of cases. Isolated single symptom presentations were uncommon (<5% of cases). Most importantly, not a single child in either age group presented with isolated rhinorrhea or sore throat.ConclusionsWhile there are differences in the clinical manifestations of COVID-19 in preschool- versus school-aged children, in both age groups, isolated rhinorrhea was not a manifestation of SARS-CoV-2 infection. These results could help further guide testing criteria and exclusion criteria in child care and school settings.

Utilisation of peripheral vasopressor medications and extravasation events among critically ill patients in Rwanda: A prospective cohort study.

IntroductionIn high-income settings, vasopressor administration to treat haemodynamic instability through a central venous catheter (CVC) is the preferred standard. However, due to lack of availability and potential for complications, CVCs are not widely used in low- and middle-income countries. This prospective cohort study evaluated the use of peripheral vasopressors and associated incidence of extravasation events in patients with haemodynamic instability at the Centre Hospitalier Universitaire Kigali, Rwanda.MethodsPatients ≥18 years of age receiving peripheral vasopressors in the emergency centre (EC) or intensive care unit (ICU) for >1 hour were eligible for inclusion. The primary outcome was extravasation events. Patients were followed hourly until extravasation, medication discontinuation, death, or CVC placement. Extravasation incidence with 95% confidence intervals (CI) were calculated using Poisson exact tests.Results64 patients were analysed. The median age was 49 (Interquartile Range [IQR]:33-65) and 55% were female. Distributive shock was the most frequent aetiology (47%). Intravenous (IV) location was most commonly antecubital fossa/upper arm (31%) and forearm/hand (43%). IV gauges ≤18 were used in 58% of locations. Most patients were treated with adrenaline (66%) and noradrenaline (41%), and 11% received multiple vasopressors. The median treatment duration was 19 hours (IQR:8.5-37). Treatment discontinuation was predominantly due to mortality (41%) or resolution of instability (36%). There were two extravasation events (2.9%), both limited to soft tissue swelling. Extravasation incidence was 0.8 events per 1000 patient-hours (95% CI:0.2-2.2).ConclusionExtravasation incidence with peripheral vasopressors was low, even with long use durations, suggesting peripheral infusions may be an acceptable approach when barriers exist to CVC placement.

The Lipstick.

1L. Rapp is PhD student, Maintain Aging Research team, and researcher, INSERM Centre for Epidemiology and Population Health Research, Université Toulouse III Paul Sabatier; member, Cancer Ageing and Rejuvenation (CARe) Graduate School; and doctor of dental surgery, Conservative and Restorative Dentistry Department, Geriatric Dentistry, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; e-mail: [email protected]; ORCID: 0000-0003-0908-694X. 2J.-N. Vergnes is full professor, Maintain Aging Research team, INSERM Centre for Epidemiology and Population Health Research, Université Toulouse III Paul Sabatier, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; and adjunct professor, Oral Health and Society Division, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; ORCID: 0000-0001-7322-6551; Twitter:@JnVergnes. Acknowledgments: The authors are attached to the Inspire Platform, which is supported by grants from the Region Occitanie/Pyrénées-Méditerranée (Reference number: 1901175) and the European Regional Development Fund (ERDF) (Project number: MP0022856); the Inspire Chairs of Excellence are funded by grants from the Alzheimer Prevention in Occitania and Catalonia (APOC), EDENIS, KORIAN, Pfizer, and Pierre-Fabre and to the CARe Graduate School, which is funded through the grant EUR CARe N°ANR-18-EURE-0003 in the framework of the Programme des Investissements d'Avenir.

Commentary on "The Lipstick".

1L. Rapp is a PhD student, Maintain Aging Research team, and researcher, INSERM Centre for Epidemiology and Population Health Research, Université Toulouse III Paul Sabatier, member, Cancer Ageing and Rejuvenation (CARe) Graduate School, and doctor of dental surgery, Conservative and Restorative Dentistry Department, Geriatric Dentistry, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; email: [email protected]; ORCID: 0000-0003-0908-694X. 2J.-N. Vergnes is full professor, Maintain Aging Research team, INSERM Centre for Epidemiology and Population Health Research, Université Toulouse III Paul Sabatier, Centre Hospitalier Universitaire de Toulouse, Toulouse, France, and adjunct professor, Oral Health and Society Division, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; Twitter: @JnVergnes; ORCID: 0000-0001-7322-6551. See facing page for “The Lipstick,” by Lucie Rapp, DDS, and Jean-Noel Vergnes, DDS, PhD. Commentary first published online March 29, 2022.

Evaluating the Increased Burden of Cardiorespiratory Illness Visits to Adult Emergency Departments During Flu and Bronchiolitis Outbreaks in the Pediatric Population: Retrospective Multicentric Time Series Analysis.

BackgroundCardiorespiratory decompensation (CRD) visits have a profound effect on adult emergency departments (EDs). Respiratory pathogens like respiratory syncytial virus (RSV) and influenza virus are common reasons for increased activity in pediatric EDs and are associated with CRD in the adult population. Given the seasonal aspects of such challenging pathology, it would be advantageous to predict their variations.ObjectiveThe goal of this study was to evaluate the increased burden of CRD in adult EDs during flu and bronchiolitis outbreaks in the pediatric population.MethodsAn ecological study was conducted, based on admissions to the adult ED of the Centre Hospitalier Universitaire (CHU) of Grenoble and Saint Etienne from June 29, 2015 to March 22, 2020. The outbreak periods for bronchiolitis and flu in the pediatric population were defined with a decision-making support tool, PREDAFLU, used in the pediatric ED. A Kruskal-Wallis variance analysis and a Spearman monotone dependency were performed in order to study the relationship between the number of adult ED admissions for the International Classification of Diseases (ICD)-10 codes related to cardiorespiratory diagnoses and the presence of an epidemic outbreak as defined with PREDAFLU.ResultsThe increase in visits to the adult ED for CRD and the bronchiolitis and flu outbreaks had a similar distribution pattern (CHU Saint Etienne: χ23=102.7, P<.001; CHU Grenoble: χ23=126.67, P<.001) and were quite dependent in both hospital settings (CHU Saint Etienne: Spearman ρ=0.64; CHU Grenoble: Spearman ρ=0.71). The increase in ED occupancy for these pathologies was also significantly related to the pediatric respiratory infection outbreaks. These 2 criteria gave an idea of the increased workload in the ED due to CRD during the bronchiolitis and flu outbreaks in the pediatric population.ConclusionsThis study established that CRD visits and bed occupancy for adult EDs were significantly increased during bronchiolitis and pediatric influenza outbreaks. Therefore, a prediction tool for these outbreaks such as PREDAFLU can be used to provide early warnings of increased activity in adult EDs for CRD visits.

176 Changes in Brain and Spine Trauma Volume, Management, and Outcomes During the COVID-19 Pandemic in Kigali, Rwanda

INTRODUCTION: During the COVID-19 pandemic, lockdown policies, movement restriction, and healthcare resource reallocation impacted traumatic brain injury (TBI) and spinal cord injury (SCI) incidence and treatment patterns. However, these trends have not been characterized in the Sub-Saharan Africa setting. METHODS: The study setting was Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda’s national referral hospital. Adult injury patients presenting to the CHUK Emergency Department were prospectively enrolled from 1/27/20-6/28/20, excluding a cessation in research activities from March-May due to pandemic restrictions. Study personnel collected data on demographics, injury characteristics, treatments, and clinical outcomes. Differences in patients admitted before (1/27/20-3/22/20) and during (6/1/20-6/28/20) the COVID-19 pandemic were queried using chi-squared and Mann-Whitney tests. RESULTS: 216 neurosurgical trauma patients at CHUK were included for analysis. 83.8% had TBI, 8.3% had SCI, and 7.9% had both TBI and SCI. The mean age was 34.1 (standard deviation = 12.5) and most patients were male (77.8%). Patients predominantly experienced injury following road traffic accident (65.7%). Weekly volumes for TBI (mean = 16.5 vs. 17.1, P = 0.819) and SCI (mean = 2.0 vs. 3.4, P = 0.086) did not change during the COVID-19 period. Patients during this period had lower Glasgow Coma Scale scores (mean = 13.8 vs. 14.3, P = 0.068) and Kampala Trauma Scores (mean = 14.0 vs. 14.3, P = 0.083) at admission, both denoting higher injury severity, but these differences did not reach significance. Patients admitted during the pandemic were significantly more likely to undergo brain CT imaging (65.7% vs. 50.0%, P = 0.030), with higher rates of documented hemorrhage, contusion, or fracture (35.7% vs. 19.2%, P = 0.008). Craniotomy rates also significantly increased during the pandemic (22.7% vs. 11.4%, P = 0.036). ED discharge (44.8% vs. 53.7%, P = 0.231) and mortality rates (2.9% vs. 4.9%, P = 0.505) did not change during this period. CONCLUSION: Neurosurgical trauma volume did not change significantly at CHUK during the COVID-19 pandemic, but presenting patients had higher injury severity and craniotomy rates. To the best of the authors’ knowledge, this is the first such TBI and SCI analysis conducted in Africa.

A197 ACUTE ILEITIS IN ADULT PATIENT: A RETROSPECTIVE STUDY OF PATIENT OUTCOMES

BackgroundRising availability of medical imaging exams in the emergency room potentially leads to an increase of ileitis findings by imaging in a context of gastrointestinal symptoms. However, it can be difficult to determine the clinical significance of this radiological finding in an acute consultation setting and to establish the relevant investigations.AimsThe aim of this study is to describe the current management and the long-term outcome of patients with diagnostic of acute ileitis on imaging during an emergency consultation in our center, Centre Hospitalier Universitaire de Sherbrooke(CHUS).MethodsWe performed a retrospective study of all patients diagnosed with ileitis by abdominal ultrasound or computed tomography (CT scan) during a visit in our emergency department over the years 2010 and 2017. Patients with previous diagnosis of Crohn disease were excluded. Data collected were clinical, radiological and endoscopic at diagnostic and over at least 3 years following the initial visit.ResultsA total of 118 files were reviewed. The initial imaging modality was 43% ultrasound and 57% CT scan. 36% of patients had an ileocolonoscopy within one month of the initial visit. Of these, 60% demonstrated macroscopic endoscopic abnormalities. 51% of patients had follow-up imaging within 3 months of the initial consultation. 64% of these images demonstrated persistence of pathological changes in the ileal region. Only 48% had a stool culture at diagnosis. 72% of patients met a gastroenterologist and 45% saw a general surgeon. The most common cause of ileitis was an infectious origin at 44% predominantly with Yersinia enterocolitica and Campylobacter jejuni. 13% received a diagnostic of Crohn disease. 20% of ileitis remained undetermined. Among these, there was a case of Crohn’s disease which was eventually diagnosed 2 years later. The initial factors associated with a diagnosis of Crohn’s disease were family history of inflammatory bowel disease (OR 6.17 95% CI 1.67 to 22.781 p = 0.006), extra-digestive manifestations (OR 23.31 95% CI 2.255 to 240.92 p = 0.008), discontinuous impairment at initial imaging (OR 19.8 95% CI 4.284 to 91.52 p = 0.000), presence of stenosis at initial imaging (OR 14.429 95% CI 1.227 to 169.68 p = 0.034), the presence of abscess or collection on imaging (OR 11.54 95% CI 1.76 to 75.63 p = 0.011) and wall thickness in mm (1.22 95% CI 1.06 to 1.40 p = 0.005).ConclusionsOur study shows that the majority of acute ileitis found on imaging are of infectious origin. A portion of acute ileitis corresponded to the initial presentation of Crohn’s disease. Thus, we believe that it is preferable to offer at least clinical follow-up to patients with acute ileitis on imaging and to consider additional investigation by imaging and / or colonoscopy when symptoms persist and this particularly in presence of factors associated with Crohn’s disease.Funding AgenciesNone

The acceptability of two remote monitoring modalities for patients waiting for services in a physiotherapy outpatient clinic.

Access to public rehabilitation services for patients with non-urgent conditions - which suffer mainly from musculoskeletal disorders - is problematic around the world. Remote rehabilitation services are recognized as effective means to increase accessibility. Patient acceptability is an important element in the successful implementation of such clinical innovations and has not yet been studied thoroughly in this context. Thus, the aim of this study was to evaluate and compare the acceptability of two remote consultation modalities - phone and teleconsultation - for patients waiting for public outpatient non-urgent rehabilitation services. We conducted a qualitative descriptive study nested within a randomized clinical trial in which participants received either phone or teleconsultation follow-ups with a physiotherapist after a first systematic face-to-face evaluation. Semi-structured interviews were conducted with participants of both groups selected with purposive sampling. Sekhon's acceptability metaframework was used and interviews were transcribed and coded with thematic analysis. The research protocol was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS) (#2019-2919). Twenty participants were recruited. Results show both follow-up modalities have a good level of acceptability for participants; however, teleconsultation stands out because its visual dimension offers higher quality human contact and satisfactorily meets greater needs for support. Systematic in-person assessment and advice combined with telephone or teleconsultation follow-up can contribute to diversifying the services offered in physiotherapy outpatient clinics. Offering a range of service modalities with different resource requirements may shorten wait times. Such an approach seems to be well accepted by patients, especially with teleconsultation. gov ID: NCT03991858.

Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre

ObjectiveThis study aims to evaluate the impact of the implementation a mifepristone-misoprostol protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second- and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared with misoprostol alone (MISO), and to share the experience of a Canadian tertiary hospital concerning the feasibility and safety of such a protocol. MethodsThis is a single-centre retrospective pre–post cohort study carried out at the Centre Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction. Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to gestational age and the presence of previous uterine scars, while, in the MISO group, all patients received 400 μg of misoprostol vaginally every 4 hours. ResultsNinety-four patients were included in the MIFE/MISO group and 103 patients, in the MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and 82% of patient records, respectively (P < 0.001). Complication rates were similar between the 2 groups. ConclusionThe MIFE/MISO protocol is highly effective for second- and third-trimester induction for pregnancy termination or IUFD, without increasing complication rates and with fewer reported adverse effects. Its implementation is safe and feasible in a tertiary medical centre.

Comparison of Abdominopelvic CT Diagnoses at Academic Teaching Hospitals in Rwanda and the United States

Purpose: The purpose of this study was to compare the disease processes encountered on abdominal and pelvic CT examinations at academic teaching hospitals in Rwanda and the United States and to highlight how these differences may impact a global radiology collaboration. Materials and Methods: In this retrospective study, we included 130 patients (mean 59 +/-17 years, range 20-91, F:M 74:56) who underwent abdominal/pelvic CT examinations between April 1st-12th, 2019. CT examinations were prospectively encountered in clinical work at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda, where the radiology report impression, patient age, gender, study indication, CT protocol, and clinical diagnosis were recorded when available. Abdominal/pelvic CT examinations at the Massachusetts General Hospital (MGH) in Boston, Massachusetts, United States were then retrospectively reviewed for the same information. Patient age and gender were compared using Student’s t-test and Chi-square statistic. Frequency of formal recommendations in radiology reports, available comparison of CT examinations, presence of known diagnoses, and intravenous and oral contrast media use were compared using Fisher’s exact test. Diagnostic categories were qualitatively compared. Results: A wide variety of pathology was encountered by abdominal/pelvic CT at both sites of imaging, with qualitative differences observed in cancer types, infectious agents, and how imaging guides care. Patients in Rwanda were older (p=0.0017), more likely to receive intravenous (p &lt; 0.05) and positive oral contrast (p &lt; 0.05) media and less likely to receive a formal recommendation in their radiology report (p &lt; 0.05). Patients in the United States were more likely to have an available prior abdominal/pelvic CT (p &lt; 0.05), to present for follow-up of a known diagnosis (p &lt; 0.05), and to receive a formal recommendation in their radiology report (p &lt; 0.05). Conclusion: Participation in global radiology collaborations is beneficial for radiologists by broadening exposure to pathologies and practice different from their own institution and region.

Outcomes of surgical repair of Retinoschisis-associated retinal detachment compared to Rhegmatogenous retinal detachment

BackgroundThe aim of this study is to compare outcomes of primary retinal detachment (RD) repair in retinoschisis-associated RD (RSRD) and rhegmatogenous RD (RRD).MethodsThis is a retrospective observational cohort study. Charts of 2247 consecutive patients operated for RD repair at the Centre hospitalier universitaire de Québec – Université Laval between 2014 and 2018 were reviewed. Patients with RSRD and RRD were included to compare the visual and anatomical outcomes of both groups.ResultsThere were 41 patients (1.8%) with RSRD and 1661 patients (74%) with RRD. RSRD patients had more primary repair failures (n = 9, 22%, vs. n = 166, 10%; p = 0.013). The primary anatomical success rates for pars plana vitrectomy with and without scleral buckle (PPV-SB vs. PPV) as primary repair method were similar in both RSRD patients (n = 11/14, 79% vs. n = 20/25, 80%; p = 0.92) and RRD patients (n = 751/827, 91% vs. n = 641/721, 89%; p = 0.21). At final follow-up, best corrected visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) was 0.30 [0.10, 0.88] and 0.18 [0.10, 0.40] (p = 0.03) in RSRD patients and RRD patients, respectively. Presence of retinoschisis was associated with worse final VA (β 0.082, p < 0.001). Other predictive variables included female sex, macula-off presentation, number of RD quadrants involved, longer symptoms duration, worse baseline VA, and primary repair failure. The greatest predictors were worse baseline VA, primary repair failure, and macula-off status at presentation. Presence of retinoschisis did not significantly increase risk of primary repair failure in multivariable analysis (OR 1.45, 95% CI: 0.50–4.17; p = 0.49). Symptoms duration was the greatest effect factor associated with for primary repair failure (OR 1.37, 95% CI: 1.12–1.69; p = 0.003).ConclusionsRSRD is associated with more primary repair failure in univariate analysis, but not in multivariate analysis after adjusting for symptoms duration. It is however associated with worse final VA even after adjusting for primary repair failure. Both PPV and PPV-SB are valid repair methods for RSRD. However, RSRD remains a challenge to treat.

Epidemiological, Clinical and Anatomopathological Aspects of Cancers in Central African Republic Children

Objectives: To determine the epidemiological, clinical and anatomopathological aspects of childhood cancer in CAR. Patients and Methods: This was a retrospective study carried out from May 2015 to May 2018, at the Center Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). The study population consisted of patients aged under 15 followed in the UHOPB for malignant tumors on clinical, radiological or ultrasound suspicion of malignancy and confirmed or not by histology or biology. A questionnaire was used to collect the data which was analyzed using SPSS11.0 software. Results: During the study period, we collected 107 cases of childhood cancer. The annual hospital incidence was 1.27% in 2016; 1.93% in 2017 and 1.50% in 2018 The average monthly frequency of patients followed is 35.66. The intensity of pain assessed in the 99 patients ranged from 02/10 to 09/10 with an average of 5.41/10. The mean duration of the disease was 3.3 months with extremes at 1.2 months and 36 months. A predominance of comorbidity with HIV is 41.66%. Histologically diagnosed malignant tumors are dominated by 30.4% Burkitt’s lymphoma. Conclusion: Data on cancer incidence are scarce in developing countries and for the most part are hospital statistics. In CAR, it will be important to set up a national register for collecting information.

Epidemiological, Clinical and Etiological Aspects of Non-Traumatic Comas in Children at the Pediatric Teaching Hospital in Bangui

Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi2, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%; n = 110), meningitis-meningoencephalitis-encephalitis (30%; n = 111), sepsis (19.72%; n = 73) and acidosis Coma (5.40%; n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.

Upper Gastrointestinal Cancers in Rwanda: Epidemiological, Clinical and Histopathological Features in Patients Presenting to a Tertiary Referral Hospital

Background: Scant data on upper gastrointestinal cancers in Rwanda exist to guide potential prevention efforts. We evaluated the epidemiological, clinical and histopathological data among patients with gastric and esophageal tumors at a tertiary Referral Hospital in Rwanda. Methodology: We performed a retrospective review of histologically-confirmed esophageal and gastric cancers in adults age ≥ 18 yrs. old presenting to a university teaching hospital (Centre Hospitalier Universitaire de Butare) from 2014-2019. Variables included age at diagnosis, sex, clinical presentation, tumor location and histopathological type. Results: There were 149 upper gastrointestinal cancers, of which 137 (92%) were gastric and 12 (8%) were esophageal. Gastric cancer patients had a mean age at presentation of 56.9 ± 12.3 years (range 21 - 87). Presenting symptoms were epigastric pain (78.8%), weight loss (53.3%), post-prandial vomiting (52.6%), early satiety (29.9%), epigastric mass (24.8%), hematemesis (19.7%) and melena (16.8%). The location was antrum 50.3%, corpus 21.8%, fundus 8%, and cardia 8%. Tumor type was adenocarcinoma in 94.1%. Helicobacter pylori infection was present in 108 (78.8%). Esophageal cancer patients had a mean age of 54.4 ± 9.5 years (range 35 - 72). Presenting symptoms were dysphagia (100%) and weight loss (83%). The most common site was lower third esophagus (9/12), and adenocarcinoma cancer subtype accounted for 5/12 (41.6%) cases. Conclusion: Gastric adenocarcinoma was the most commonly diagnosed upper gastrointestinal cancers and was associated with a high prevalence of H. pylori infection. This study lays the foundation for future work to improve cancer outcomes in Rwanda.

Determinants of Low Birth Weight at the University Hospital Center of Brazzaville (Republic of Congo)

<i>Objective:</i> Analyze the determinants of low birth weight at the Center Hospitalier Universitaire de Brazzaville. <i>Methods:</i> Case-control study, conducted from January 01 to June 30, 2020, in the Gynecology-Obstetrics department of the Brazzaville University Hospital, comparing 200 mother and newborn couples with a birth weight < 2500g (Cases) and 200 other mother and newborn couples -born with birth weight ≥ 2500g (Controls). The variables studied were pre, per and post partal. The p-value of the probability was considered significant for a value less than 0.05. <i>Results:</i> The mothers were different in age (age < 20 years: ORa = 6.0 [2.6-13.7]; p < 0.05 and age > 35 years ORa = 2.6 [1.1-6.0]; p < 0.05) mostly single (OR = 1.6 [1.3-3.9]; p < 0.05) with a history of low birth weight (ORa = 6.1 [1.2- 13.5]; p < 0.05) and lean (ORa = 8.4 [4.7-15.0]; p < 0.05). Pregnancies were associated with malaria (ORa = 3.0 [1.7-5.4]; p < 0.05) and arterial hypertension (ORa = 8.3 [3.1-22.3]; p<0.05). Most of them gave birth vaginally (OR= 1.8 [1.1-3.0]; p < 0.05), before term [(90.0% vs 8.5%); p<0.05)]. <i>Conclusion:</i> Low birth weight is of multifactorial origin. Its prevention requires management of the risk factors associated with it.

Reliability of Medical Imaging in the Pre-Therapeutic Assessment of Acute Intestinal Obstruction at the Centre Hospitalier Universitaire Du Point “G”

Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of imaging in the diagnosis of acute intestinal obstruction at the Point-G University Hospital. Patients and Methods: This was a prospective, descriptive and analytical study of 96 patients collected at the radiology and medical imaging department of CHU Point-G from January 2018 to January 2019. Results: The age of our patients varied from 11 to 86 years, with an average of 36 years old. There was a male predominance of 64.6% against 35.4% for women, i.e., a sex ratio of 1.82. Previous surgery was found in 61.5% of our patients. The pain was present in all patients. An unprepared abdominal X-ray was performed in 89.6% of patients. Hydroaerobic levels were found in 96.5% of patients. Abdominopelvic CT scans were performed on 12 patients, all of whom were diagnosed with occlusion. These positive diagnostic findings were consistent with intraoperative findings in 92% of cases. The causes were dominated by bridges in 46 patients and tumors in 9 patients. Signs of severity on CT were dominated by signs of distress of the upstream bile ducts in 8.3%. Exactly 8% of our patients spontaneously resumed transit, 91% received surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients (83.3%) and poor with death in 16 patients (16.7%). Conclusion: Acute intestinal obstruction remains a serious pathology for which the X-ray of the PSA is often the only radiological examination performed in an emergency. However, abdominopelvic CT seems to us to be widely indicated thanks to its contribution both to the positive diagnosis and to the diagnosis of severity and etiology. However, this imaging technique is widely underused in our practice because of its high cost and lack of availability.

Respiratory Distress Indicative of a Right Bochdalek Hernia in a Central African Newborn

Congenital cupola diaphragmatic hernia (CDH) is a congenital embryopathy which is defined by the absence of development of all or part of a diaphragmatic cupola. We report a case of posterolateral diaphragmatic hernia called right Bochdalek hernia in a three-day-old newborn hospitalized in the neonatology department of the Center Hospitalier Universitaire Pédiatrique de Bangui (CHUPB) for respiratory discomfort, vomiting and fever. Unsuccessful treatment for neonatal staphylococcal infection diagnosis of diaphragmatic hernia was suggested and confirmed on day 18 of life by computed tomography and intraoperatively.

Prevalence of cardiovascular diseases in HIV positive patients: A comparative study between seropositive and seronegative patients living in Libreville, Gabon

The profile of HIV-associated cardiovascular disease has changed with the high coverage of antiretroviral treatment (ART). Data are lacking in Gabon. To compare the type and the frequency of cardiovascular manifestations in hospitalized HIV-infected patients (PLHIV) and seronegative ones. This was a retrospective analytical study performed by analyzing the files of patients hospitalized for a cardiovascular diseases and who benefited from an HIV serology in the cardiology department of the centre hospitalier universitaire de Libreville from January 2015 to December 2018. The files of 82 PLHIV and 150 HIV negative were analyzed. The mean CD4 count in PLHIV was 189 ± 170/mm 3 and 45.1% were on ART. PLHIV were more frequently less than 50 years old (70.6% vs. 43.3% of HIV negative; P < 0.01) and they were more frequently female (67.1% vs. 36.0% of HIV negative; P < 0.01). Pericarditis (25.6% vs. 11.3% in seronegatives; P = 0.01) mainly due to tuberculous (85.2%), myocarditis (14.6% vs. 4.0% in seronegatives; P = 0.03) and repolarization disorders (32.9% vs. 15.3% in HIV negative; P < 0.01) predominated in PLHIV. Atheromatous vascular diseases were more frequent in HIV negative patients (23.1%) compared to seropositive (6.1%) ( P < 0.01). The death of PLHIV was mainly due to pericarditis (71.4%) while HIV negative patients died more frequently for heart failure (46.7%). The cardiovascular manifestations linked to HIV immunosuppression are still frequent in Libreville.

Safety of COVID-19 vaccination in patients with polyethylene glycol allergy: A case series

Safety of COVID-19 vaccination in patients with polyethylene glycol allergy: A case series