Abstract
Cancer care in Benin is still in its inception in Benin. The first cancer registry was created in Benin in 2014. In the study of Egué et al, published in 2019, there were 1086 cases of ...cancer recorded in the cancer registry in Benin from 2014 to 2016, including 18 cases of nervous system cancer representing 2.3% and 1.2% of cancers in men and women respectively. When compared to other types of cancers including liver and prostate in men and cervix and breast in women, brain cancers appear very low. However, there is no structure dedicated to the treatment of nervous system cancers since there are no neuro-oncologist in Benin and many patients diagnosed with brain tumors are frequently refer outside our country for treatment. Rare patients undergo surgery in our country for brain tumors. Therefore, we can assume that brain tumors statistics are not really indicative of the burden of morbidity and mortality related to nervous system cancer in Benin. The need to organize the management of patients suffering from nervous system tumors is therefore necessary. In order to meet this need, we plan to set up a neuro-oncology unit in Benin in order to improve the neurosurgical management of patients with intracranial tumors at the CNHU HKM Cotonou and also to initiate research projects related to brain tumor care in Benin.
Abstract
BACKGROUND
Prolactinomas can acquire an invasion feature and challenge the management. Many features of invasive pituitary adenomas have been investigated in the literature, from ...radiological, histopathological to molecular perspectives. Here, we have decided to focus on serum prolactin level and evaluate its behavior in invasive prolactinoma patients.
METHODS
It is a retrospective and consecutive view of 75 prolactinomas patients registered at the Hassan II University Hospital of Fez in Morocco. Patients were categorized into two groups: invasive and noninvasive prolactinoma. A non-parametric predicted ROC curve was performed to investigate the sensitivity and specificity of serum PRL level according to the invasiveness.
RESULTS
A total of 31 patients (41.3%) represented the invasive group and the mean age was 35.6 years old compared to the group of noninvasive (34,1 years old). Males are more likely to be affected by invasive tumor than women (<0,00001). Serum PRL level was higher (2048.6 ± 1882.4) in invasive prolactinoma (p=0.001) and almost all invasive tumors had a PRL level greater than 1000 ng/ml. The predicted ROC curve of the distribution of the serum PRL levels showed an area under curve (AUC) of 89.8% and the calculated value of the threshold to fit a good sensitivity of 80% and false positive rate of 11.6% was estimated to 900 ng/ml.
CONCLUSION
Based on clinical manifestations, hyperprolactinemia and MRI scan, the prolactinoma patients – especially men – presenting a larger tumor size and serum PRL level higher than 900ng/ml, should be considered as an invasive prolactinoma patient. As a matter of fact, with those patients an appropriate treatment should begin as soon as possible.
Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African ...Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas.
This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions.
The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care.
A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.
Although the evidence about coronavirus disease 2019 (COVID-19) has increased exponentially since the beginning of the pandemic, less is known about the direct and indirect effects of the pandemic in ...humanitarian settings. In the Democratic Republic of the Congo (DRC), most studies occurred in Kinshasa and other cities. Limited research was conducted in remote conflict-affected settings. We investigated the COVID-19 epidemiology, health service utilisation, and health care-seeking behaviour during the first year of the pandemic (March 2020-March 2021) in the Mweso health zone, North Kivu, DRC.
This mixed-methods study includes a descriptive epidemiological analysis of reported COVID-19 cases data extracted from the provincial line list, interrupted time series analysis of health service utilisation using routine health service data, qualitative perceptions of health care workers about how health services were affected, and community members' health care seeking behaviour from a representative household survey and focus group discussions.
The COVID-19 epidemiology in North Kivu aligns with evidence reported globally, yet case fatality rates were high due to underreporting. Testing capacity was limited and initially mainly available in the province's capital. Health service utilisation showed different patterns - child measles vaccinations experienced a decrease at the beginning of the pandemic, while outpatient consultations, malaria, and pneumonia showed an increase over time. Such increases might have been driven by insecurity and population displacements rather than COVID-19. Community members continued seeking care during the first months of the COVID-19 pandemic and visited the same health facilities as before COVID-19. Financial constraints, not COVID-19, were the main barrier reported to accessing health care.
The first year of the COVID-19 pandemic in the Mweso health zone was characterised by low testing capacity and an underestimation of reported COVID-19 infections. The increase in health care utilisation should be further explored to understand the role of factors unrelated to COVID-19, such as insecurity, population displacement, and poverty, which remain major challenges to successfully providing health services and improving the population's health. Measles vaccination coverage dropped, which exacerbated the ongoing measles outbreak. Improved decentralised testing capacity will be crucial for future epidemics and enhanced efforts to maintain child vaccination coverage.
Le syndrome d´Ogilvie est une pseudo-occlusion colique aiguë, caractérisée par une distension colique avec risque de perforation caecale en absence de tout obstacle mécanique. C´est une pathologie ...très rare après une chirurgie rachidienne. Nous rapportons deux cas enregistrés dans le service de neurochirurgie du CHU de Guadeloupe. Il s´agit d´une femme de 79 ans en surpoids (IMC=27kg/m
2
) et un homme de 56 ans présentant des lombosciatagies bilatérales mal systématisées avec réduction du périmètre de marche évoluant depuis plusieurs mois chez qui l´IRM lombaire avait révélé un canal lombaire étroit et hernie discale, avaient subi une intervention chirurgicale de décompression par laminectomie lombaire. Ils ont présenté une constipation avec arrêt des matières et gaz 48h après la chirurgie et un ballonnement abdominal. Le scanner abdominal et la radiographie de l´abdomen ont montré une importante distension intestinale sans obstacle faisant évoquer un syndrome d´Ogilvie. Un traitement conservateur avait été suffisant pour traiter ce syndrome et les patients avaient complètement récupéré. Dans la survenue du syndrome d´Ogilvie, la pathologie la plus fréquente pour laquelle le geste chirurgical rachidien est en cause, est la hernie discale lombaire. La présentation clinique est classique avec un arrêt des matières et des gaz, un météorisme abdominal témoignant d´une distension intestinale volumineuse. Le traitement médical conservatoire reste le traitement de choix lorsque le diagnostic est fait tôt.
Ependymal cysts remain a very rare cause of neurological symptoms among intracranial cystic lesions. It differs from an arachnoid cyst, as it does not communicate with subarachnoid space.
A ...33-year-old woman was admitted in our neurosurgery department with history of headache, vomiting and right unilateral blindness. Neuroimaging studies showed an intraparenchymal cystic lesion in the right frontal lobe with radiologic characteristic as seen in the ependymal cyst or hydatic cyst. She underwent the neurosurgical procedure of marsupialization and was discharged on day 6 post op. At one month follow up, the patient presented with a decrease vision acuity on the left eye, and head CT scan showed a recurrence of the cyst hence, we performed a second surgery with shunt procedure. Histological examination of the resected tissue demonstrated that, it was an ependymal cyst.
Since there is often times a clinico-radiological discordance they are generally incidental findings in majority of cases. While complete surgical excision is the treatment of choice for the symptomatic cysts, cystic fluid diversion presents a better compromise nevertheless in cases where this may not be achieved.
•Ependymal cyst is a very rare case and we reported the 40th case•Our female patient was admitted with a curious clinical history which was a blindness in a controlateral side of the cyst•We showed that the marsupialization was not sufficient to manage this case•The 39 cases reported in literature were reviewed and presented in a table with emphasis of their characteristic•Histological exam is very helpful to diagnose this pathology
Ogilvie´s syndrome is an acute colonic pseudo-obstruction, characterized by massive colonic distension in the absence of mechanical cause. It is a very rare pathology after spinal surgery. We report ...two cases in the neurosurgery department of the University Hospital of Guadeloupe. A 79-year-old woman overweight (BMI= 27kg/m
) and a 56-year-old man experienced history of non-systematized bilateral lumbar and sciatic pain with reduction in walking perimeter for few months. MRI of lumbar spine had revealed a lumbar stenosis with disc herniation. They had undergone decompression surgery with laminectomy. The surgical intervention was uneventful perioperatively. By 48 hours after surgery, they had complained of constipation with cessation of fecal and flatus with resultant abdominal distension. Abdominal CT scan and X-rays showed significant bowel distension with no mechanical obstruction, suggestive of Ogilvie´s syndrome. Conservative treatment had been sufficient to treat this syndrome and the patients completely recovered. In the occurrence of Ogilvie´s syndrome, the most frequent pathology is the lumbar disc herniation. The clinical presentation is typical with a cessation of fecal and gas elimination, and abdominal distension. Conservative treatment remains the treatment of choice when diagnosis is made early.
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