Main Reason For Consultation Research Articles

Testicular Evaluation Using Shear Wave Elastography (SWE) in Patients with Varicocele.

To assess the possible influence of the presence of varicocele on the quantification of testicular stiffness. Ultrasound with shear wave elastography (SWE) was performed on 48 consecutive patients (96 testicles) referred following urology consultation for different reasons. A total of 94 testes were studied and distributed in three groups: testes with varicocele (group A, n = 19), contralateral normal testes (group B; n = 13) and control group (group C, n = 62). Age, testicular volume and testicular parenchymal tissue stiffness values of the three groups were compared using the Kruskal-Wallis test. The mean age of the patients was 42.1 ± 11.1 years. The main reason for consultation was infertility (64.6%). The mean SWE value was 4 ± 0.4 kPa (kilopascal) in group A, 4 ± 0.5 kPa in group B and 4.2 ± 0.7 kPa in group C or control. The testicular volume was 15.8 ± 3.8 mL in group A, 16 ± 4.3 mL in group B and 16.4 ± 5.9 mL in group C. No statistically significant differences were found between the three groups in terms of age, testicular volume and tissue stiffness values. Tissue stiffness values were higher in our control group (healthy testicles) than in patients with varicocele.

Clinical, Diagnostic and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune I-Bamako

Acute appendicitis is the most frequent abdominal surgical emergency in the world. The aim of this study was to analyse the results of surgical management of acute appendicitis. Methodology: This was a prospective study from January 2020 to December 2020 in the reference health centre in Commune I of Bamako. Results: During this period, we operated on 108 patients for acute appendicitis, including 78 men and 30 women, for a sex ratio of 2.5. The mean age was 26.92 years, ranging from 5 to 70 years. Abdominal pain was the main reason for consultation. Physical signs were dominated by a positive Blumberg's sign in 99.1% of cases, right iliac fossa defensiveness in 97.2% of cases, Rovsing's sign in 50% of cases, psoitus (Psoitis) in 18.5% and pain on the right in the cul de sac of Douglas in 69.4%. This physical examination enabled the diagnosis to be made in the majority of cases. In some doubtful cases, we requested an abdominal ultrasound scan. Locoregional anaesthesia was the most commonly used anaesthetic technique (63.9%). Classic Mac Burney appendectomy with burial of the stump was the surgical technique most frequently used. Postoperative recovery was straightforward in 97.2% of cases. However, we recorded one case of death. Conclusion: Acute appendicitis remains the most frequent abdominal surgical emergency in the community. Early diagnosis and rapid management improve prognosis. Treatment is essentially surgical.

Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study.

Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.

Male Breast Cancer: About 05 Cases

Male breast cancer is a rare disease (about 1% of breast cancers) with a poor prognosis. The diagnosis is most often late and lesions are treated in advanced stages. The aim of this study was to analyze the clinical, histological, therapeutic and prognostic characteristics of male breast cancer. This was a retrospective study of 05 patients collected in the thoracic surgery department of the Marrakech military hospital. The average age of our patients was 66.2 years. The average consultation time was 11.8 months, and self-care of a breast nodule was the main reason for consultation in 60% of cases. Invasive ductal carcinoma was the predominant histological type in 66.7% of cases. Multimodal therapeutic management consisted of mastectomy followed by adjuvant treatment with chemotherapy, radiotherapy and/or hormone therapy depending on the stage of the tumor and histological characteristics. The hormone dependence of these tumors is proven in 60% of cases. Five-year survival is currently being evaluated. Node invasion, invasion of the dermis and the TNM, clinical stage are factors that significantly influence the occurrence of metastases. None of these risk factors were found to be significant in terms of overall survival.

Braquimetatarsia. Propuesta de tratamiento en base a técnicas de alargamiento. A propósito de dos casos

Brachymetarsal is the abnormal shortening of one or more metatarsals. It has an incidence of 0.02%-0.05%, predominantly in women from 25 to 1. In 72% it can be bilateral. The etiology is not clear, but premature closure of the physis is suggested, giving growth retardation. Most of the time it presents symptoms caused by an alteration in the mechanics of the metatarsal parabola, such as pain and hyperkeratosis. There may be metatarsalgia and add additional digital deviations in the evolution. The main reason for consultation is aesthetic. The objective of the work is to show the surgical technique and the clinical results using the AOFAS score, in addition to the imaging results with up to 5 years of follow-up. Two patients are described and two different surgical techniques to lengthen the metatarsals are analyzed. These are acute lengthenings with intercalary graft interposition, in one case using the S.Gianini procedure with an iliac crest graft and in the other with an adjacent metatarsal graft with modification of the length of the second and third metatarsals, restoring in both cases the metatarsal parabola. We obtained good results. results as well as numerous series and can be recommended in similar cases.

Abdominal Surgical Emergencies at the Fana Reference Health Centre

Introduction: Surgical abdominal emergencies are abdominal pain evolving for a few hours or a few days (less than 3 days) which can be traumatic or non-traumatic which are related to a surgical pathology. Purpose: Studying surgical abdominal emergencies at the Fana reference health center (Csref). Methodology: This was a prospective study carried out at the csref of Fana from January 1, 2022 to December 31, 2022. Results: During the study we identified 121 cases of surgical abdominal emergencies including 76 men and 45 women with a sex ratio of 1.68, the average age was 29.95 years ± 18.71. These were 6 surgical emergencies which are: Acute appendicitis (45 cases), Intestinal obstruction (32 cases), Acute peritonitis (30 cases), Traumatic hemoperitoneum (06 cases), GEU (05), Evisceration (3). Abdominal pain was the main reason for consultation. The physical examination made it possible in the majority of cases to make the diagnosis. Faced with certain doubtful cases, we requested paraclinical examinations (ultrasound in 26 cases, ASP in 56 cases and grouping/rhesus in all cases). The morbidity rate was 12.4% and mortality 6.66%. Conclusion: The frequency of surgical abdominal emergencies is high at the Csref of Fana with 20.20%. The clinical picture is polymorphous. The causes are many and varied; dominated by acute appendicitis, intestinal obstruction and peritonitis.

Epidemiological, Clinical and Therapeutic Aspects of Acute Otitis Media in the Otorhinolaryngology and Cervicofacial Surgery Department of the Sikasso Hospital / Mali

Acute otitis media (AOM) is a viral or bacterial infection of the middle ear most often following nasopharyngitis. It is seen at any age, but particularly common in children. The aim of this work is to describe the main clinical and therapeutic epidemiological aspects of acute otitis media.in the ENT department of Sikasso hospital. This is a prospective and descriptive study carried out in the ENT department of Sikasso hospital over a period of 04 months. Two hundred and ten patients were included in this study. The following variables: Ages, sex, residence, reason for consultation, time to consultation, risk factors, clinical and therapeutic aspects were collected. The study population consisted of patients seen in the service in whom the diagnosis of AOM was retained and who gave their verbal consent/assent. We identified 210 cases of AOM in 04 months out of 1716 consultations, i.e. a prevalence of 12.20%. The average age of the patients was 14 years old, with extremes of 24 days to 75 years old, children under 05 years old accounted for 46.02%. We recorded a female predominance of 51.90%. The majority of patients 82.90% resided in the city Sikasso. I'otalgia was the main reason for consultation with 50.48%, followed by otorrhea 25.24%, hearing loss with or without tinnitus in 17.61%, the presence of foreign bodies 5.71% and traumatic causes 0.96% of cases. The average consultation time was less than one week in 74.29% of cases. Among the predisposing factors, nasopharyngitis and purulent rhinitis were associated with AOM in 64.30% of cases, followed by adenotonsillitis in 23.33%, passive smoking in 4.76% and 1 case (0.47%) of soft palate. The AOM was congestive in 57.14%, suppurative in 42.86 of which 32.38% were perforated. Treatment was with antibioticsin 90.95% of cases. The evolution under treatment was favorable at 07 days in 81.42% of cases. Two cases of paracentesis were made. Acute otitis media affects all ages, particularly common in children under .....

High risk of psychosis, condition or diagnosis? About a case.

IntroductionA person with “high-risk mental status (HRMS)” indicates that the person, usually young people between the ages of 14 and 25, is more likely to develop psychosis. These people have attenuated psychotic symptoms without reaching the intensity or frequency of a frank psychotic episode. It is suggested that psychological trauma could favor neurochemical and psychopathological changes in a vulnerable individual. It would be interesting to study the role of psychotherapeutic interventions in the course of high-risk mental states and their possible evolution to a psychotic disorder. We present the case of an 18-year-old adolescent whose diagnosis was high risk of psychosis.ObjectivesThis work has several objectives. On the one hand review current information on high-risk mental status (EMAR). On the other hand, develop a discussion about whether the EMAR category should be a diagnostic entity or just a condition.MethodsA bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed in order to expose its own experience in this field, defining specific interventions as well as results.ResultsThe case presented is of an 18-year-old female patient.She states that the main reason for consultation is something that happened last Sunday, at which time he had “an identity crisis” in which he did not know if he was a girl or a boy. The reasoning behind this fact is that “as Pablo Alborán likes him, perhaps he is a boy”. Given the bizarreness of the explanation and the patient’s particular contact, I explore a previous psychopathological situation. She says that since last year she feels more insecure, with diffuse fear that it is difficult to specify or nominate something specific: “in class and that is very difficult for me, public presentations”, she says that “everything scares me”, she says that she has a non-specific fear that has been maintained even increasing over the months and that has led him to have greater anguish. Even though the patient dates the beginning of the picture on Sunday, it is noteworthy that the previous Thursday she had requested a consultation with psychology in the private circuit that although she does not know how to specify the reason “because of fears” it seems that the anguish resulting from this fear had been increasing, having greater difficulties for the presentations in class. The contact is psychotic and the situation that the patient describes is typical of a “treme” situation, cataloged in the current literature as a High-Risk Mental State.ConclusionsHigh-risk mental states are not a diagnostic category according to current classifications, although it is necessary to reach a consensus on what the diagnosis implies and what would be the way to proceed when a patient presents these symptoms.Disclosure of InterestNone Declared

Functional Results of Small Incision Cataract Surgery at the Nianankoro FOMBA Hospital in Segou, a Second Reference Centre in Mali

Introduction: Cataract is the leading cause of curable blindness in the world. Its treatment is surgical. The aim was to evaluate the functional results of cataract surgery in a second referral centre in Mali (Nianankoro FOMBA Hospital in Ségou) with reference to the quality standards of the World Health Organisation. Patients and methods: Prospective descriptive study conducted between October 2018 and September 2019 in the ophthalmology department of the Nianankoro FOMBA hospital in Ségou, in patients aged 40 years and over with cataract. Results: During the study, 954 eyes were operated on, of which 522 (54.7%) were female. The average age was 64.28 years. The occupation of housewife was 52.7%. The main reason for consultation was the decrease in visual acuity with 96.1%. Hypertension and diabetes were 20.1% and 5.7% respectively. The initial uncorrected distance visual acuity was less than 1/10 in 94.2% of cases. At 30 days postoperatively, the good, average and poor results were respectively 82.92%, 12.01% and 5.06% without optical correction, decreasing to 92.56%, 4.51% and 2.93% respectively after optical correction. Discussion: These results met the World Health Organization standards which recommend a value greater than or equal to 80% without correction and greater than 90% with correction for good results and a value of less than 5% for poor results with correction. Conclusion: Cataract surgery with Phaco A is a simple solution that gives good results and is well adapted to our socio-economic context.

Sténose hypertrophique du pylore en chirurgie pédiatrique du Centre Hospitalier Universitaire Sylvanus Olympio LoméTogo

Objective-the aim of this study was to determine the hospital frequency of hypertrophic pyloric stenosis and the socio-demographic characteristics of patients with HPS, to describe the clinical and therapeutic aspects and to evaluate the operative follow-up. Methods-This was a retrospective descriptive study conducted over aperiod of 06 years and 06 months (January 2014 to June 2020) in the pediatric surgery department of the Sylvanus Olympio Teaching Hospital in Lomé. Complete records of patients from 0 days to 30 months of age hospitalized and managed for HPS during the study period were included. Epidemiological, anamnestic, clinical, paraclinical, therapeutic and evolutionary data were studied. Results-a total of 17 patients were collected in the department. The hospital incidence of HPS was approximately 3 cases per year. The predominance was male. The mean age of the patients was 40.4 ± 15.1. Vomiting of curdled milk was the main reason for consultation. Ultrasound was performed in all patients and was diagnostic in the majority of patients (15 patients). The ionogram was disturbed in 14 patients, hypochloremia being the mostcommon ion disorder. Management consisted on open Fredet and Ramstedt extramucosal pylormyotomy in all patients. The supra-umbilical approach was the most commonly used. All patients had a favourable outcome. Conclusion-hypertrophic pyloric stenosis was characterised by a delay in consultation with a clinical picture dominated by vomiting causing ionic disorders. However, the encouraging therapeutic results noted could be improved.

Pediatric Acute Renal Failure in Chad: Epidemiological, Clinical and Evolutionary Aspects

Introduction: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden and potentially reversible reduction in kidney function, as measured by glomerular filtration rate (GFR) affecting the exocrine functions of the kidney. It engages the short-term vital prognosis and the long-term renal function prognosis. It is an important cause of morbidity and mortality in sub-Saharan Africa. Our objective was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of acute renal failure in children at the Renaissance University Hospital Center and Mother and Child University Hospital in N’Djamena, Chad. Methodology: This was a descriptive and analytical cross-sectional study for six months from March to August 2020. All children aged 1 year to 15 years that were hospitalized in the emergency room of the Mother and Child University Hospital and went for follow-up consultations in the Nephrology and Dialysis Department of the Renaissance University Hospital Center with acute renal failure defined by the KDIGO 2012 criteria were included in the study. The data were analyzed by Excel 2019 and SPSS 18.0 with significance (p&lt;0.05). Results: Thirty children were included in the study with a hospital prevalence of 0.56%. The mean age was 8.33 years with a sex ratio of 3.28. The average consultation time was 10.1 days. Vomiting was the main reason for consultation (46.7%). About 27% of patients had oligoanuria. There were 86% of the cases that were anemic, half of which were severe. Mean serum creatinine was 434.02 µmol/l and the mean urea level was 26.86 mmol/l. Severe malaria was the main cause of AKI (33.3%). All patients suffering from malaria received antimalarials based on artemisinin derivatives. Intermittent hemodialysis was indicated in 22 patients (73.4%). The evolution was marked by a total recovery of renal function in 20 patients, 8 deaths and 2 transitions to chronic kidney disease. Deaths were statistically related to AKI severity, age range 1-5 years, femoral catheters and infections (p&lt;0.0000). Conclusion: Acute kidney injury is an uncommon pathology in pediatrics and in Chad. It is often linked to severe malaria and has a high mortality rate.

Iatrogenic Urethral Stenoses: Epidemiological Aspects Clinics and Therapeutic in the Urology Department of the National Hospital of Conakry

The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1st 2012, to December 31st 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.

Is the Use of Dialysis Associated With an Increased Risk of Death in COVID-19-Related Acute Kidney Injury?

Acute kidney injury (AKI) is frequently reported in the setting of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. The aim of our work is to evaluate the impact of acute dialysis use on mortality in patients with AKI during the coronavirus disease 2019 (COVID-19) pandemic. This is a retrospective study conducted in the Hassan II University Hospital of Fez, Morocco. From July 2020 to December 2021, we included all patients admitted to a COVID-19 unit with acute kidney injury defined according to Kidney Disease Improvement Global Outcomes 2012 (KDIGO 2012) criteria. Our patients were older than 18 years, and SARS-CoV-2 infection was confirmed by a positive RT-PCR test or thoracic CT scan imaging. Patients with end-stage renal disease (ESRD) and pregnant women were excluded from our study. The total number of patients hospitalized in the COVID-19 unit during the study period was 2560, including 206 in an intensive care setting. We included 61 patients with AKI, with an incidence in the intensive care unit (ICU) setting of 15.5%. Eighty percent of patients had respiratory distress on admission, which was the main reason for consultation. Stage 1 AKI was found in 1.6% of patients, 25.8% had stage II AKI, and 72.6% had KDIGO stage 3 AKI. The main etiology of AKI was acute tubular necrosis. Lung involvement secondary to infection was severe in 18 patients; 21 had moderate involvement. In our study, twenty-one of our patients (34.4%) were hospitalized in an ICU. Thirteen of our patients were intubated (21.1%). Twenty-one (34.4%) patients were hemodynamically unstable and were put on vasoactive drugs. Twenty-three (37.7%) of our patients received at least one session of conventional acute hemodialysis with an average duration of 2.1 hours ± 0.9 (1-3.5). The indication was overload (27%), severe metabolic acidosis (1.6%), threatening hyperkalemia (1.6%), and symptomatic hyperuremia (62%). The evolution was marked by a return to baseline renal function in two patients, partial improvement in 35 of them at discharge, and no improvement in 24 patients. We recorded a death rate of 34.4% (n=21). In a univariate analysis, we compared the demographic, clinical, paraclinical, and dialytic characteristics of the dialysis and non-dialysis groups. There was a significant difference between unstable, intubated patients and those hospitalized in the ICU in the dialysis group, with respective p-values of p=0.0001, p=0.0001, and p=0.01. We noticed there were more deaths in the dialysis group than in the non-dialysis group; this difference was statistically significant with a p-value of 0.005. In multivariate analysis, a logistic regression model was performed to test the relationship between dialysis and COVID-19 mortality while adjusting for other co-factors. The final model did not show a significant association between dialysis and mortality (p = 0.150, OR: 2.578 [0.710-9.364]). The only factor that remained independently significant was admission to the intensive care unit (p = 0.004, OR: 6.732 [1.847-24.540]). AKI is a frequently encountered complication in patients with COVID-19, especially those hospitalized in the ICU. In the context of the SARS-CoV-2 infection, the use of at least one dialysis session seems to represent an excess risk of mortality related to AKI.

Psoriasis of the external auditory canal: prevalence, clinical features and impact on quality of life.

Psoriasis of the external auditory canal (PsEAC) is often under-recognized. The aims of this study were to assess the prevalence of PsEAC, its association with a particular psoriasis subtype and its impact on quality of life (QoL). A prospective study was carried out in two Spanish university hospitals, enrolling consecutive patients who attended a consultation for psoriasis. The clinical features of psoriasis and PsEAC were recorded and the Dermatology Life Quality Index (DLQI) and Itch Numerical Rating Scale (Itch-NRS) were distributed to patients. Overall, 188 of 1000 patients (18.8%) included in the study had PsEAC, which was associated with severity of psoriasis, presence of inverse psoriasis and involvement of the scalp, nails and genitals, but not with obesity or psoriatic arthritis. PsEAC was the main reason for consultation in 27 patients, with itching being the main symptom. In this study, PsEAC had a prevalence of 18.8%. The occurrence of PsEAC was associated with poorer QoL, as measured by DLQI and Itch-NRS.

Obesity, Overweight, and Pituitary Stalk Interruption Syndrome in Children and Young Adults.

Pituitary stalk interruption syndrome (PSIS) is rare in the pediatric population. It combines ectopic posterior pituitary stalk interruption and anterior pituitary hypoplasia with hormonal deficiencies. The phenotype is highly heterogeneous and obesity/overweight seems to be underreported in the literature. To identify patients with PSIS and obesity or overweight, describe their phenotype, and compare them with patients with PSIS without overweight/obesity. Sixty-nine children and young adults with PSIS in a Toulouse cohort from 1984 to 2019 were studied. We identified 25 obese or overweight patients (OB-OW group), and 44 were nonobese/overweight (NO group). Then the groups were compared. All cases were sporadic. The sex ratio was 1.6. The main reason for consultation in both groups was growth retardation (61% in OB-OW group, 77% in NO group). History of neonatal hypoglycemia was more common in the OB-OW than in the NO group (57% vs 14%, P = .0008), along with extrapituitary malformations (64% vs 20%, P < 0001). The incidence of caesarean section was higher in the OB-OW group (52%) than in the NO group (23%), although not significant (P = .07). Patients with PSIS who are obese/overweight display interesting phenotypic differences that suggest hypothalamic defects. Studies are needed that include additional information on hormonal levels, particularly regarding oxytocin and ghrelin.

Epidemiological, Clinical and Therapeutic Study of Urolithiasis at the Fousseyni Daou Hospital in Kayes, About 111 Cases

The aim was to study the epidemiological, clinical, paraclinical and therapeutic aspects of obstructive urinary calculi of the urinary tract. This was a prospective and descriptive study of 111 patients admitted to the urology department over a period of 6 years (January 2016 to December 2021). All patients with obstructive (symptomatic) urinary stones over 1.5 cm in diameter were included. Treatment results were analyzed 6 months later. Surgery for urolithiasis represented 4.10% of the interventions performed over the study period. The average age of the patients was 41 years old, with extremes of 1 and 81 years old. The age group 21 to 30 years was predominant, i.e. 24.3% of cases. The M/F sex ratio was 2.26. Renal colic was the main reason for consultation, i.e. 72.1%. Staphylococci, E. coli and Enterococci were respectively 22.5%; 21.6% and 12.6%. The operative technique used was open surgery. The postoperative course was simple in 92.8% and complicated in 7.2%.

Excision in girls: Life-threatening acute complications in girls within 7 days of excision: Experience of the Pediatric Department of the University Hospital Gabriel Toure in Bamako, Mali

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice. Patients and methodsThis was a retrospective descriptive study over a period of 15 months including all girls aged 0–15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure. ResultsWe collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb <7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths). ConclusionThis study shows the seriousness of the immediate complications associated with the practice of excision.

La consultation médicale en urgence dans le parcours du patient en oncologie

Medical emergencies are defined at the medical level, whereas the use of emergency consultations is decided by the patient. Urgent oncology cares are specific due to clinical, therapeutic, technic and psychologic complexity. This descriptive retrospective study about 142consultations carried out at the unplanned medical unit, with an analyse of demographics, clinical characteristics, reason for medical appeal, deployed resources and oncological pathway for six months. Breast (48%) and lung (21%) cancer are the most common. 68% of patients present with a disease at a non-curative stage and 83% have received a cancer treatment within the previous two months. Pain is the main reason for consultation (19). 91% of patients benefit from diagnostic and therapeutic procedures. At three month, half of patients use an emergency system again. At six months, the tumour progression rate is 54%. The mortality rate is 33% regardless of the risk of immediate aggravation. The use of emergency consultation mainly concerns patients in a palliative situation, sometimes announcing the change of the trajectory towards the advanced phase. The organization of the emergency care pathway should evolve to better consider the needs of this population, by formalizing longitudinal monitoring, collaboration with palliative care teams and coordination with care providers in the city.

The lockdown effect: The impact of the COVID-19-related confinement on the nature of dental emergencies and the number of patients seen at the Geneva university hospital's dental clinic

PurposeThe aim of this retrospective case study was to evaluate the impact of the COVID-19 confinement on consultation number and nature of dental emergencies. Materials and MethodsThe investigators implemented a retrospective case-control study and enrolled a sample of patients who presented to the University Hospital of Geneva for dental emergencies during the COVID-19 confinement from March 16 to April 26, 2020. They were compared to a matched case-control group treated in 2018 and 2019. The predictor variable was the COVID-19 confinement. The outcome variables were consultation number and nature of dental emergencies. Other study variables included age, gender, socio-economic status, delay from symptoms to consultation and type of treatment. Descriptive and bivariate statistics were computed and significance level was set at ≤ 0.05. ResultsThe study sample was composed of 1104 patients, with 386 in the case-study and 718 in the control group. No significant change in patient numbers was observed. In the case-study group patients were significantly younger (P= 0.004), had a significantly higher proportion of acute toothache and dental infections (P= 0.01), the main reason for consultation was pain or swelling (P= 0.01) and the delay from first symptoms to consultation was shorter compared to the controls (P=0.008). ConclusionThe COVID-19 confinement had no impact on the consultation number of dental emergencies. However, changes in emergency type were noted, with an increase in acute toothaches and infections and patients waited less time between the onset of symptoms to consultation.

Pathological profile of patients received for consultation in the dental unit of the Mbanga’s District Hospital

ntroduction: Oral health is a fundamental right for the individual regardless of age or living environment. Given the repercussions that the alteration of oral health could make in the daily life of an individual. It was a question in this work of determining the oral state of the patients of the dental unit in the District hospital of Mbanga. Methodology: We carried out a cross-sectional descriptive study with an analytical aim carried out from April 12, 2021 to July 13, 2021 at the Mbanga District Hospital. It included any patient coming to consult the odontostomatology department who had given informed consent. A data sheet was used as a collection tool and data analysis was done on SPSS version 26. Results: We had a sample of 81 patients with a sex ratio of 1.4. The average age was 35 years old with the extremes of 2 years and 81 years. The main reason for consultation was dental pain 40.7%. The caries risk was 4.07. We had 62.5% of patients over the age of 45 years old had poor oral hygiene. Up to 88.9% of patients required a scaling. It was revealed that 29.6% needed a dental prosthesis and 55.6% a dental extraction. Conclusion: The oral state of the populations is approximate or even deleterious despite the presence of an equipped dental office in the locality. Action on certain determinants could positively influence the oral health of these populations.