CHU De Research Articles

The clinical evolution of patients with idiopathic spinal cord herniation: a case series

Study designRetrospective case series of 48 patients.ObjectivesThis study’s primary objective was to provide a clinical description of a group of individuals with a working diagnosis of idiopathic spinal cord herniation (ISCH). The secondary objectives were to appreciate the natural history of these patients and describe their clinical evolution with conservative or surgical management.SettingThe study was carried out at l’Hôpital de l’Enfant-Jésus, CHU de Québec (Québec, Canada), a tertiary care university hospital.MethodsThis case series study is based on routinely collected data. Forty-eight (48) cases were identified as having an ISCH on MR imaging, between 2009 and 2019. Their medical files have been searched retrospectively. Patient characteristics were described according to their asymptomatic or symptomatic status.ResultsThe mean age of patients at the time of diagnosis was 52.5 years. Most of the patients identified were asymptomatic (69%) and followed clinically. The main neurologic presentation for the symptomatic group was Brown-Séquard-like syndrome. 20% of the symptomatic patients were rapidly treated surgically after consultation with the neurosurgeon. The mean follow-up duration was 56 months for asymptomatic patients and 51 months for symptomatic patients. Most of our patients (41 out of 45) were considered stable or unchanged at follow-up. There was no neurological progression in all asymptomatic patients.ConclusionsOur study shows that ISCH and its variants are not always symptomatic and may be a fortuitous finding. As the natural history may be non-progressive, it is probably appropriate to treat some cases expectantly.

Hemoperitoneum: Frequency, Management and Prognostic Factors in the General Surgery Department Hospital National Ignace Deen, CHU de Conakry, Guinea

<i>Aim</i>: To report our experience in the management of haemoperitoneum in the general surgery department of the Ignace Deen National Hospital. <i>Patients and methods</i>: This was a retrospective descriptive and analytical study, covering a period of 5 years, from January 2017 to December 2021, carried out in the general surgery department of the Ignace Deen National Hospital. All records of patients admitted for hemoperitoneum were included. <i>Results</i>: During the five (5) years, 120 cases of hemoperitoneum were collected, representing 1.1% of all abdominal surgical emergencies. The mean age of the patients was 24 ± 16.83 years. The patients were predominantly male, with a sex ratio M/F: 1,05. The average admission time was 32.1 hours. Haemoperitoneum was traumatic in 58.33% of cases. Road traffic accidents accounted for 35.83% of cases. Treatment was surgical in 81 patients (69.23%). The main anatomopathological lesions found were: rupture of ectopic pregnancy (33.33%), rupture of the spleen (17.5%). The procedures performed were: salpingectomy (61.72%), splenectomy (23.45%). The prognostic factors were: age greater than 30 years, admission time greater than 48 hours, large haemoperitoneum. Post-operative management was straightforward in 92.50% of cases with a death rate of 4.17%. <i>Conclusion</i>: Hemoperitoneum is a frequent occurrence in the department. Treatment was surgical with hemostasis, salpingectomy and splenectomy. Prognostic factors were age, admission time and quantity of hemoperitoneum.

Impact on survival of sarcopenia, systemic inflammatory response and anthropometric factors after pancreatectomy for resectable pancreatic adenocarcinoma

IntroductionPancreatic adenocarcinoma (PDAC) is becoming a public health issue with a 5-years survival rate around 10%. Patients with PDAC are often sarcopenic, which impacts postoperative outcome. At the same time, overweight population is increasing and adipose tissue promotes tumor related-inflammation. With several studies supporting independently these data, we aimed to assess if they held an impact on survival when combined.MethodsWe included 232 patients from two university hospitals (CHU de Lille, Institut Paoli Calmette), from January 2011 to December 2018, who underwent Pancreaticoduodenectomy (PD) for resectable PDAC. Preoperative CT scan was used to measure sarcopenia and visceral fat according to international cut-offs. Neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) were used to measure inflammation. For univariate and multivariate analyses, the Cox proportional-hazard model was used. P-values below 0.05 were considered significant.ResultsSarcopenic patients with visceral obesity were less likely to survive than the others in multivariate analysis (OS, HR 1.65, p= 0.043). Cutaneous obesity did not influence survival. We also observed an influence on survival when we studied sarcopenia with visceral obesity (OS, p= 0.056; PFS, p = 0.014), sarcopenia with cutaneous obesity (PFS, p= 0.005) and sarcopenia with PLR (PFS, p= 0.043). This poor prognosis was also found in sarcopenic obese patients with high PLR (OS, p= 0.05; PFS, p= 0.01).ConclusionSarcopenic obesity was associated with poor prognosis after PD for PDAC, especially in patients with systemic inflammation. Pre operative management of these factors should be addressed in pancreatic cancer patients.

Foreign body aspiration in children: A review of prevention guidelines by analyzing choking episodes in Eastern Québec from 2006 to 2020

BACKGROUND Many associations have published prevention guidelines to advise parents and health professionals about the risks of choking episodes and their complications. Yet, every year, many children are admitted following a choking episode that requires a bronchoscopy under general anesthesia. OBJECTIVES The objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if they are still adequate. METHODS This retrospective study included all patients, from 0 to 17 years old, who presented to the Center Mère-Enfant Soleil du CHU de Québec - Université Laval, between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected and compared to the prevention guidelines. RESULTS Of the 101 patients included, 64.9% of them were boys with a mean age at presentation of 31.5 months. Food was the most common type of foreign body (73.3%) involving mostly nuts, seeds or raw vegetables. Choking episodes happened mostly at home (84.5%) and the majority (79.4%) happened under parental surveillance. A general increase in the number of admissions for choking episodes was noted. CONCLUSION Choking episodes requiring hospital admission were on the rise mostly due to a lack of adherence or knowledge of national prevention guidelines. These findings highlight the need for better parental education by addressing choking hazards during medical visits.

Comparison of Weekly Paclitaxel Regimens in Recurrent Platinum-Resistant Ovarian Cancer: A Single Institution Retrospective Study.

Weekly paclitaxel (WP) is a chemotherapeutic cornerstone in the management of patients with platinum-resistant ovarian carcinoma. Multiple WP dosing regimens have been used clinically and studied individually. However, no formal comparison of these regimens is available to provide objective guidance in clinical decision making. The primary objective of this study was to compare the cumulative dose of paclitaxel delivered using 80 mg/m2/week, administered using either a 3 weeks out of 4 (WP3) or a 4 weeks out of 4 (WP4) regimen. The secondary objective was to evaluate the clinical outcomes associated with both regimens, including efficacy and toxicity parameters. Our retrospective cohort comprised 149 patients harboring platinum-resistant ovarian cancer treated at the CHU de Québec from January 2012 to January 2023. WP3 and WP4 reached a similar cumulative dose (1353.7 vs. 1404.2 mg/m2; p = 0.29). No significant differences in the clinical outcomes were observed. The frequency of dose reduction was significantly higher for WP4 than WP3 (44.7% vs. 4.9%; p < 0.01), mainly due to treatment intolerance from toxicity (34.0% vs. 3.9%; p < 0.01). Our data suggest that a WP3 regimen delivers a similar cumulative dose to WP4, hence offering a better tolerability profile without compromising efficacy.

Epidemiology and Management of Anal Suppuration at the Donka National Hospital, Chu De Conakry, Guinea

Introduction: Anal suppurations (fistula and abscess) correspond to two progressive phases of the same disease, characterised by an infection of cryptic origin in the anal canal. The objectives of this study were to determine the hospital frequency, to describe the clinical aspects and to determine the therapeutic modalities of anal suppurations in the department. Methodology: This was a one-year dynamic descriptive study of patients admitted to and operated on for anal suppuration in the Department of Visceral Surgery, Donka National Hospital, Conakry University Hospital. Results: Out of a total of 351 patients operated on, we recorded 21 cases of anal suppuration, i.e. 5.98%. Anal suppuration accounted for 45.65% of all proctological disorders. The average age was 43.09 years. There was a clear male predominance (95.23%) with a sex ratio of 20:1. The clinical picture was dominated by anal discharge and evidence of skin orifices. Retroviral serology, haemogram, HBsAg and blood glucose were performed in all patients. All patients were treated surgically. Post-operative management was straightforward in 95.23% of cases, with complications occurring in 4.76%. Conclusion: Anal suppuration remains by far the most frequent proctological disease in our practice. They constitute a real public health problem because they are underestimated in the African population due to socio-cultural factors. Diagnosis is essentially clinical and treatment is surgical.

P.131 Comparison of interhemispheric and transcortical approaches for resection of colloid cysts of the third ventricle

Background: Colloid cysts are rare benign lesions of the third ventricle that can cause hydrocephalus and intracranial hypertension. Their primary treatment is surgical removal. Although open surgery presents the best opportunity for total resection of the cyst, there is no consensus regarding the optimal choice between the interhemispheric and the transcortical approaches. We aim to compare these two approaches in regard of the radicality of excision, the recurrence rate, and the surgical imprint. Methods: Retrospective cohort study on all patients who underwent surgical resection of colloid cyst between 2003 and 2023 at CHU de Québec. Data on demographics, symptoms, complications, and imaging was gathered. Results: In a cohort of 28 patients (17 interhemispheric, 11 transcortical), the preliminary results demonstrate prolonging operative time (270min. vs. 187min.) and increasing blood loss (193cc vs 100cc) associated with the interhemispheric approach. Despite these results, the hospitalization duration remains similar (p=0.734). However, the interhemispheric approach results in significantly lower surgery-induced encephalomalacia (1.1cc vs. 4.4cc, p=0.006). Conclusions: The interhemispheric approach could lead to potentially lesser consequences due to the reduced volume of encephalomalacia left by the surgical intervention, at the cost of prolonged operating time and higher blood loss.

Abstract PO4-17-03: Neoadjuvant chemotherapy in invasive lobular carcinoma of the breast: A retrospective study on survival outcomes

Abstract Background: Neoadjuvant chemotherapy (NAC) is a well-established component of breast cancer management. Invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are often treated similarly, but many studies are demonstrating a major difference in treatment responses according to the histopathological type of cancer. Aim: To evaluate the overall survival of patients with ILC after NAC compared with adjuvant chemotherapy. Methods: This retrospective cohort study included patients treated for breast ILC between 1998 and 2016 at the Center for Breast Diseases of de CHU de Québec – Université Laval, a tertiary breast cancer center. The primary outcomes were the overall survival (OS) and the recurrence-free survival (RFS) of ILC patients receiving NAC compared with patients who received only adjuvant chemotherapy. The follow-up was censored at the last hospital contact. The secondary outcomes were the locoregional recurrence, pathological complete response (pCR), and pCR impact on survival. Results: During the study period, 265 women were treated for ILC, of which 72 had NAC, and 193 had adjuvant therapy. No significant differences were observed regarding the patient’s characteristics (age, BMI, smoking, menopausal status, and use of hormonal replacement therapy). A T4 disease was found in 29.2% of the NAC group (vs. 0 in the adjuvant group), but the N2-3 rate was lower in the NAC group (5.6% vs. 22.3%, P=0.011). More patients in the NAC group underwent mastectomy (65.3% vs. 29.5%, P&amp;lt; 0.0001) and axillary dissection (80.6% vs. 50.8%, P&amp;lt; 0.0001). Three (4.2%) patients in the NAC group achieved a pCR. The rates of radiotherapy (P=0.851) and hormonal therapy (P=0.694) were similar between the two groups. The mean follow-up was 8 years. After adjustment for age, T, N, surgery type, radiotherapy, and hormonal therapy, the NAC group showed significantly lower 10-year OS (56.2% vs. 80.7%, P&amp;lt; 0.0001) and RFS (51.8% vs. 72.7%, P=0.0004) compared with the adjuvant group. There were no differences in the 10-year local recurrence rate (90.6% vs. 93.5%, P=0.11). In a Cox regression analysis of RFS considering the previously mentioned covariables, more events in the NAC group (OR=2.52, 95%CI: 1.39-4.58, P=0.002) and patients with N2-N3 (OR=3.68, 95%IC: 2.00-6.80, P&amp;lt; 0.01). Conclusion: Despite the general belief that ILC and IDC should be treated similarly, this study strongly suggests that ILC seems to have a poorer response to NAC. Patients diagnosed with ILC might benefit from a more aggressive surgical approach followed by adjuvant chemotherapy, no matter the severity of the disease. Additional long-term prospective comparative studies are needed to support this statement and improve the management of these patients. Citation Format: Virginie Gauthier, Anne-Julie Simard, Christine Desbiens, Brigitte Poirier, Julie Lemieux, Dominique Boudreau, Dominique Leblanc, Claudya Morin, Jean-Charles Hogue, Éric Poirier. Neoadjuvant chemotherapy in invasive lobular carcinoma of the breast: A retrospective study on survival outcomes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-03.

Evaluating the Surgical Treatment of Mechanical Icterus in the General Surgery Department of the Hopital Ntional Ignace Deen, Chu De Conkry

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: The aim of this study was to report our experience in the surgical management of mechanical jaundice. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: This was a 10-year retrospective descriptive study (January 2011 to August 2022), carried out in the general surgery department of the Hôpital National Ignace Deen. Patients admitted for surgery for mechanical jaundice were included. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: We collected 22 cases of mechanical icterus out of a total of 4739 surgical procedures performed during the study period. The mean age was 46 years, with extremes of 9 and 80 years. All our patients were seen at the frank icterus stage. Ultrasound was performed in all patients. Etiologies were dominated by tumors of the pancreatic head (54.54%), and lithiasis of the main bile duct (18.18%). The average consultation time was 5.04 months, with extremes of 9 years and 80 years. Cholecystectomy was performed in over half the cases (54.54%), including three cases associated with stone extraction (13.63%). Bilio-digestive shunts were performed in 11 cases (50%), of the choledochoduodenal (13.63%) and cholecysto-jejunal (13.63%) types. Post-operative management was straightforward in 81.81% of cases, with 4 deaths (18.18%). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Palliative bypass, due to the delay in consultation, allows remission of the signs of cholestasis, but does not change the natural course of the pathology. Mortality depends on the etiology.

Automatic de-identification of French electronic health records: a cost-effective approach exploiting distant supervision and deep learning models

BackgroundElectronic health records (EHRs) contain valuable information for clinical research; however, the sensitive nature of healthcare data presents security and confidentiality challenges. De-identification is therefore essential to protect personal data in EHRs and comply with government regulations. Named entity recognition (NER) methods have been proposed to remove personal identifiers, with deep learning-based models achieving better performance. However, manual annotation of training data is time-consuming and expensive. The aim of this study was to develop an automatic de-identification pipeline for all kinds of clinical documents based on a distant supervised method to significantly reduce the cost of manual annotations and to facilitate the transfer of the de-identification pipeline to other clinical centers.MethodsWe proposed an automated annotation process for French clinical de-identification, exploiting data from the eHOP clinical data warehouse (CDW) of the CHU de Rennes and national knowledge bases, as well as other features. In addition, this paper proposes an assisted data annotation solution using the Prodigy annotation tool. This approach aims to reduce the cost required to create a reference corpus for the evaluation of state-of-the-art NER models. Finally, we evaluated and compared the effectiveness of different NER methods.ResultsA French de-identification dataset was developed in this work, based on EHRs provided by the eHOP CDW at Rennes University Hospital, France. The dataset was rich in terms of personal information, and the distribution of entities was quite similar in the training and test datasets. We evaluated a Bi-LSTM + CRF sequence labeling architecture, combined with Flair + FastText word embeddings, on a test set of manually annotated clinical reports. The model outperformed the other tested models with a significant F1 score of 96,96%, demonstrating the effectiveness of our automatic approach for deidentifying sensitive information.ConclusionsThis study provides an automatic de-identification pipeline for clinical notes, which can facilitate the reuse of EHRs for secondary purposes such as clinical research. Our study highlights the importance of using advanced NLP techniques for effective de-identification, as well as the need for innovative solutions such as distant supervision to overcome the challenge of limited annotated data in the medical domain.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial.

Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

A Single-Center 18-Year Series of 73 Cases of Metaplastic Carcinoma of the Breast.

To examine the clinical management of metaplastic breast cancer (MeBC), particularly the role of chemotherapy. This retrospective study included patients with MeBC (n = 73) from a tertiary breast cancer center: the "Centre des Maladies du Sein of the CHU de Québec-Université Laval." The specimens were reviewed by two pathologists. Patient and tumor characteristics, systemic therapy (neoadjuvant and adjuvant), disease-free survival (DFS), and overall survival (OS) were recorded. The median follow-up was 57.2 months. The mean tumor size was 39.5 ± 32.1 (range, 1-200) mm. Most were in grade 3 (75.3%), without evidence of clinical nodal involvement (75.3%), and triple-negative (79.5%). Chemotherapy was given to 49 (67.1%) patients. Thirty-seven patients (50.7%) underwent a mastectomy, and 22/37 (59.5%) received radiotherapy. Adjuvant chemotherapy was given to 36 patients (49.3%), and nine (12.3%) patients were treated with neoadjuvant chemotherapy. The 5-year OS and DFS rates were 60.2% and 66.8%. Among the nine patients who received neoadjuvant chemotherapy, three (33.3%) achieved a partial response, three (33.3%) had stable disease, and three (33.3%) had disease progression. The use of chemotherapy, especially in the adjuvant setting, had a significant positive effect on 5-year OS (P=0.003) and 5-year DFS (P=0.004). Nodal involvement was associated with worse OS (P=0.049) but similar DFS (P=0.157). Lumpectomy was associated with better 5-year OS (P < 0.0001) and DFS (P=0.0002) compared with mastectomy. MeBC represents a rare heterogeneous group of malignancies with poor prognosis. Adjuvant chemotherapy was associated with improved OS and DFS. Patients should be carefully selected for neoadjuvant chemotherapy.

Performance evaluation of the Hemotype SCTM rapid test for the diagnosis of sickle cell disease

Introduction: The use of Rapid Orientation Diagnostic Tests ("RODTs") could play an important role in the mass screening of certain diseases. It saves a great deal of time while managing the flow of samples and the difficulties associated with their storage. This study aimed to identify the impact of the delay between sampling and analysis on the analytical performance of the Hemotype RODT SCTM. Methods: This was a descriptive cross-sectional study conducted over one month. The Immunology-Hematology Department of the CHU de Cocody served as the study setting. The study population consisted of sickle cell patients and hemoglobin C carriers of all ages and sexes. We performed hemoglobin electrophoresis on all samples on the day of collection (D0) and the Hemotype SCTM rapid test on D0, D2, D4, and D6. Sensitivity and specificity were used to determine analytical performance, and the chi2 test was used to compare qualitative variables. Results: The study involved 102 patients with a median age of 16 years (IQR: 9-24). Half of the participants (56.96%) were SSFA2 homozygous sickle cell disease major. On average, 87.1% of RODT results were valid from D0 to D6. At D0, the RODT had a sensitivity of 75% and a specificity of 81.40% for Hb A; Hb S had a sensitivity of 79.80% and a specificity of 100%; Hb C had a sensitivity of 35.71% and a specificity of 98.65%. The sensitivity of Hb C and the specificity of Hb A had increased statistically significantly over time. Cross-referencing the RODT results from D0 to D6 with those of electrophoresis showed a concordance of 86.95% for the AA phenotype, 79.52% for AS; 88.52% for SS; and 95.45% for SC. Conclusion: The HemoTypeSC™ test, with a sensitivity of 75% and specificity of 98% is suitable in certain areas where access to electrophoresis is limited. This performance is not impaired on samples stored for 6 days

Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study.

The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective3; phase 3); and cost-consequence analysis and focus groups (integration of objectives1to3; phase 4). The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. DERR1-10.2196/50682.

Management of Ulcerative Pyloric Stenosis in the General Surgery Department of the Ignace Deen National Hospital, CHU Conakry (Guinea)

Aim: was to contribute to the improvement of the management of ulcerative pyloric stenosis in the general surgery department of the Hôpital National Ignace Deen. CHU in Conakry. Patients and methods: This was a retrospective descriptive study, covering a period of 10 years (January 2013 to December 2022), on the consecutive records of patients operated on for ulcerative pyloric stenosis in the general surgery department of the Hôpital National Ignace Deen, CHU de Conakry. Results: Over a 10-year period, we recorded 81 cases of ulcerative pyloric stenosis, representing a hospital frequency of 2.03%. The mean age of patients was 48.96 ± 16.73 years, with extremes of 14 and 76 years. Males predominated (65.4%), with a sex ratio of 1.89. Housewives were the most represented (32.1%). The main reasons for consultation were vomiting (96.30%) and epigastralgia (95.06%). The surgical approach was median supra-umbilical laparotomy for 51 cases (62.96%) and median supra- and sub-umbilical laparotomy for 30 cases (37.04%). Gastrojejunal bypass was performed in 85.19% of cases, followed by pyloroplasty + vagotomy (8.64%) and pyloroplasty (6.17%). Postoperative outcome was favorable in 90.12% (n=73). We recorded 3 deaths (3.70%). Average hospital stay was 16.7± 5.2 days, with extremes of 6 and 29 days. Conclusion: Ulcerative pyloric stenosis is a sign of long-standing ulcerative disease, and remains frequent in our context.

Epidemio-clinical Aspects of Presbyopia at the University Hospital of Bouake

Aim of this study was to contribute towards a better understanding of presbyopia in the subject, with a view to improving its management. Materials and methods: This was a descriptive and analytical retrospective study of the medical records of patients who were received and followed up in the ophthalmology department of the CHU de Bouaké for presbyopia. It took place from January 1, 2013, to December 31, 2017, a period of 5 years. Results: The prevalence was 09.16%. %. The mean age of patients was 51.62 years with extremes of 40 and 86 years. Females predominated (55.61%), with a sex ratio of 0.8. Craftsmen were the most represented socio-professional group (30.49%). Of the total number of patients seen, 34.98% were already wearing corrective lenses. The age of first presbyopia correction was 50.39 years, with extremes of 40 and 82 years for males. For women, it was 51.49 years, with extremes of 40 and 86 years (Table 3). For the 637 male patients, the mean addition value for near vision was 2.02 diopters, with extremes of 1.00 and 5.00 diopters. For the 798 female patients, it was 2.11 diopters, with extremes of 0.75 and 7.50 diopters (Table 4). Presbyopia was isolated in 5.64% of patients.

Salvage therapy for BCG failure with intravesical sequential gemcitabine and docetaxel in patients with recurrent NMIBC.

Bacillus Calmette-Guérin (BCG) failure occurs in approximately 40% of patients with non-muscle-invasive bladder cancer (NMIBC) within two years. We describe our institutional experience with sequential intravesical gemcitabine and docetaxel (gem/doce) as salvage therapy post-BCG failure in patients who were not candidates for or declined radical cystectomy (RC). We retrospectively reviewed NMIBC patients with BCG failure who received gem/doce from April 2019 through October 2022 at the CHU de Québec-Université Laval. Patients received at least five weekly intravesical instillations according to published protocols. Patients who responded to gem/doce had maintenance instillations monthly for up to two years. Primary outcome was progression-free survival (PFS). Secondary outcomes included recurrence-free survival (RFS), cystectomy-free survival (CFS), cancer-specific survival (CSS), overall survival (OS), and treatment adverse events. Survival probabilities were estimated using the Kaplan-Meier method from the first gem/doce instillation. Thirty-five patients with a median age of 78 years old were included in the study. The median followup time was 21 months (interquartile range 10-29). More than 25% of patients received two or more prior BCG induction treatments. Overall and MIBC PFS estimates at one year were 85% and 88%, and at two years, 60% and 70%, respectively. Adverse events occurred in 37% of the patients, but only two patients didn't complete the treatment due to intolerance. Three patients underwent RC due to cancer progression. OS was 94% at two years. With 60% of PFS at two years, gem/doce appears to be a safe and well-tolerated option for BCG failure patients. Further studies are needed to justify widespread use.

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation.

1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0-3 months post-visit) and a Markov model (3-24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.

Bilateral sequential and simultaneous rhegmatogenous retinal detachments: anatomic and functional outcomes

ObjectifAnalyser les résultats anatomiques et fonctionnels de la réparation chirurgicale des décollements de rétine rhegmatogènes bilatéraux (DRRB) séquentiels et simultanés. NatureÉtude de cohorte rétrospective. ParticipantsUn total de 218 yeux de 109 patients. MéthodesLes dossiers des patients qui ont reçu un diagnostic de DRRB entre 2014 et 2020 au Centre universitaire d'ophtalmologie du CHU de Québec–Université Laval ont été passés en revue. Les principaux paramètres de mesure étaient la réussite anatomique d'une seule chirurgie (SSAS, pour single-surgery anatomic success) et l'acuité visuelle (AV) au trou sténopéïque (TS) finale en logMAR. RésultatsSur les 109 patients, 86 (79 %) étaient de sexe masculin, et l’âge médian (Q1, Q3) lors de la visite initiale pour le premier œil était de 60 ans (fourchette : 54–66 ans). Dans 92 % des cas (n = 100), il s'agissait d'un DRRB séquentiel et dans 8 % des cas (n = 9), d'un DRRB simultané. La durée médiane (Q1, Q3) des symptômes était plus courte dans le cas du deuxième œil (premier œil : 7 jours [fourchette : 3–15 jours] vs deuxième œil : 4 jours [fourchette : 2–10 jours]; p = 0,028). Il y avait moins de déchirures rétiniennes dans le deuxième œil (premier œil : 2,94 ± 2,76 déchirures vs deuxième œil : 2,38 ± 1,79 déchirures; p = 0,031), et l'AV au TS médiane préopératoire était meilleure (premier œil : 0,46 logMAR [fourchette : 0,14–2,30 logMAR] vs deuxième œil : 0,24 logMAR [fourchette : 0,06–0,95 logMAR]; p = 0,012). La SSAS a été obtenue dans 100 (92 %) des premiers yeux et dans 101 (93 %) des deuxièmes yeux, respectivement (p = 1,00). L'AV au TS finale était meilleure dans le premier œil (premier œil : 0,14 logMAR [fourchette : 0,04–0,30 logMAR] vs deuxième œil : 0,20 logMAR [fourchette : 0,04–0,43 logMAR]; p = 0,010), mais comparable dans les deux yeux après 3 mois (premier œil : 0,30 logMAR [fourchette : 0,14–0,48 logMAR] vs deuxième œil : 0,34 logMAR [fourchette : 0,13–0,70 logMAR]; p = 0,36). ConclusionsLa SSAS était semblable dans les deux yeux. Le deuxième œil était plus susceptible d’être traité plus rapidement et de présenter des lésions moins avancées. Cela dit, l'AV au TS à 3 mois ne différait pas significativement entre les deux yeux. La différence au chapitre de l'AV au TS finale pourrait être attribuable à un suivi de plus longue durée dans le premier œil.

Volvulus of the Sigmoїde Colon: Epidemiological Aspects and Management in the General Surgery Department of the Hôpital National Ignace Deen, CHU de Conaky (Guinea)

Introduction: The aim of this study was to report our experience in the management of Volvulus of the sigmoїde colon in the general surgery department of the Ignace Deen National Hospital, CHU de Conaky, Guinea. Patients and Methods: This was a retrospective study, descriptive type, covering a 5-year period (January 2018 to December 2022), concerning the records of patients admitted and operated on for Volvulus of the sigmoїde colon at the general surgery department of the Ignace Deen National Hospital, Guinea. Results: We collected 72 cases representing 4% of digestive surgical emergencies (n=1800) and 25.35% of intestinal obstructions (n=284). The mean age was 49.4± 15.8 years (extremes: 18 and 74 years); we noted a male predominance (80.6%) with a sex ratio of 4.14. Merchants were predominant (34.7%). Abdominal pain was the main symptom in all patients. Ideal colostomy was performed in 84.7% of patients, followed by Hartmann colostomy (12.5%). Overall morbidity was 12.5%, with Surgical site infection was the only post-operative complication observed. Overall mortality was 2.8%. Average hospital stay was 11.5 ± 5.7 days. Conclusion: Volvulus of the sigmoїde colon is a common condition. Therapeutic methods are numerous, but ideal colectomy remains a procedure of choice in our context due to difficult socio-economic conditions.