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To report our experience with the practice of day surgery in the general surgery department of the Ignace Deen National Hospital. This was a prospective, descriptive and observational study covering a period of six (06) months from (January 2023 to June 2023), focusing on operated patients whose post-operative follow-up did not require observation for more than twelve hours or an overnight stay in the general surgery department of the Hôpital National Ignace Deen. Over a period of six (6) months, we recorded 168 cases of ambulatory surgery, representing 39.6% of all surgical procedures (n=424) performed in the department. The average age of patients was 24.7 years, with extremes of 1 and 68 years. The predominance of women was 67.4% (n=93), with a sex ratio of 0.8. Pupils/students made up 66.67% (n=112) of the sample. Acute appendicitis (64.3%, n=108) and inguinal hernia (19.05%, n=32) were the most common surgical indications. General anaesthesia was the most common anaesthetic technique (89.7%). Immediate post-operative effects were dominated by nausea and vomiting (8.33%, n=14), and no deaths were recorded. The satisfaction rate was 98.4%. The practice of outpatient surgery is steadily increasing in our department, and is dominated by appendectomy and hernia repair. Procedures are mainly performed under general anesthesia. [ABSTRACT FROM AUTHOR]

Résumé: Helicobacter pylori (H. pylori) est un bacille gram négatif qui colonise exclusivement la muqueuse gastrique. La contamination se fait dans l'enfance. Une fois l'infection établie, elle persiste sans possibilité d'éradication spontanée. L'infection par H. pylori est répandue, atteignant près de la moitié de la population mondiale et 20-30 % de la population française. L'infection par H. pylori est le plus souvent asymptomatique bien qu'elle soit responsable d'une gastrite d'abord aiguë puis chronique. Son rôle pathogène a été clairement démontré concernant les ulcères gastro-duodénaux et le cancer de l'estomac. À ce titre, H. pylori est considéré comme une bactérie pathogène stricte et un carcinogène du groupe 1. Néanmoins, H. pylori peut coexister de façon prolongée avec son hôte sans être responsable d'évènement cliniquement significatif. Dans cette revue, nous proposons de revoir les indications formelles de recherche et d'éradication d' H. pylori au regard des données récentes de la littérature. Certaines indications restent indiscutables et indiscutées comme la maladie ulcéreuse gastro-duodénale, la prévention du cancer gastrique et le lymphome gastrique du MALT. D'autres nécessitent parfois une réflexion plus poussée. Helicobacter pylori (H. pylori) is a gram-negative bacillus that colonizes the gastric mucosa. Once H. pylori colonizes the gastric mucosa, it can persist for a lifetime without any spontaneous eradication. Although more than half of the world's population is infected by H. pylori, H. pylori prevalence ranges between 20% to 30% in France. Although infection is mostly asymptomatic, the early phase of H. pylori infection elicits an acute gastritis that evolve to a long-standing chronic gastritis. Helicobacter pylori infection is formally recognized as an infectious disease and a class 1 carcinogen responsible for gastroduodenal ulcer, gastric cancer, and gastric MALT lymphoma. However, H. pylori infection could be lifelong asymptomatic and, in some cases, maintain a symbiotic relationship with its host. The aims of this review were to present and discuss recommended indications of H. pylori eradication according to recent data. Some indications remain obvious while some others could be discussed on a case-by-case basis. [ABSTRACT FROM AUTHOR]

The double Marxist and phenomenological approach to the problem of indication and to the origin of meaning put forward by Trần Đức Thảo is confronted here with the ideas of the Dutch linguist and philosopher Hendrik Pos. Harking from a theoretical framework that is both similar and distinct, Pos’ position highlights the originality and conceptual potential of Thảo’s approach. It also demonstrates the diversity of the historical encounters of phenomenology and Marxism, as well as their role in the elaboration of a phenomenology of language.

INTRODUCTION: Ciprofloxacin is a second-generation fluoroquinolone, which has been used as one of the top three antibacterial agents prescribed in Ethiopia. However, its use has deviated from the recommendation of standard treatment guidelines resulting in a gradual increase in antimicrobial resistance. Therefore, this study aimed to evaluate the annual use of ciprofloxacin in 2016 based on the standard Ethiopian treatment and World Health Organization guidelines, in governmental hospitals, in Eastern Ethiopia from 1st May to 30th June 2018. METHODS: a hospital-based retrospective cross-sectional study was conducted to evaluate medical records of patients who had taken ciprofloxacin in 2016. The total sample size (n=522) was proportionally allocated to each hospital based on the respective consumption data. A simple random sampling method was employed to collect the required sample. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS: in this study, 522 medical records were reviewed, with a male to female ratio of 1.03:1. Ciprofloxacin was indicated in 478 (91.6%) participants whose age was greater than eighteen years. The majority were treated in the medical and emergency outpatient departments (n=477, 91.4 %). Urinary tract infections (n=224, 42.9%), acute febrile illnesses (n=68, 13.0%), and typhoid fever (n=54, 10.4%) were the top indications to which ciprofloxacin was prescribed. NSAIDs (n=241, 34.7%) and antimicrobials (n=135, 19.6%) were among the most frequently co-indicated agents. Based on the standard Ethiopian treatment guidelines, therapy was appropriate in 30% (n= 159) of patients. The major reason for inappropriate utilization (95%) was the wrong duration of antibiotic use (n=228). Evaluation based on World Health Organization criteria showed that indication, dose, and frequency were in line with the recommendation. CONCLUSION: ciprofloxacin was primarily indicated for urinary tract infections. The drug was appropriately used in less than one-third of patients, with the wrong duration being the main reason for overall inappropriate utilization. This trend may potentially impose a high risk to the emergence of drug-resistant microorganisms. To this end, further studies addressing the susceptibility pattern of bacterial isolates towards ciprofloxacin should be carried out.

La lombosciatique commune représente un problème de santé publique par son retentissement socioprofessionnelle. Le but de notre travail est d´étudier l´indication du traitement chirurgical et la place de chaque technique utilisé. Il s´agit d´une étude rétrospective réalisée au Service d´Orthopédie de Tataouine, concernant 44 patients présentant une lombosciatique commune et ayant eu un traitement chirurgical durant la période allant de 2013 à 2018. La fiche de renseignement a inclus les données épidémiologiques et les données cliniques. Les patients ont eu un bilan radiologique comportant une radiographie du rachis lombaire face et profil et une tomodensimétrie (TDM) lombaire qui a précisé l´étiologie de la sciatalgie commune. Le traitement chirurgical a été indiqué après échec d´un traitement médical, en cas de sciatique hyperalgique et en cas de complication neurologique. Dans notre étude, la hernie discale était la principale étiologie de lombosciatique (50% des cas) suivie par le canal lombaire étroit (25%), le spondylolisthésis (22,7%) et la méga apophyse transverse de L5 (2,3%). La dissectomie classique était la technique utilisée pour la cure chirurgicale des hernies discales. Huit patients présentant un spondylolisthésis ont bénéficié d´une laminectomie associée à une arthrodèse postérieure. Pour la cure chirurgicale de canal lombaire rétréci, on a pratiqué une laminectomie seule dans 54,54% des cas. L´évolution au recul a été favorable dans 90% des cas l´échelle visuelle analogique (3±1 au recul). Le choix des techniques chirurgicaux dépend de l´étiologie et des données de l´imagerie qui imposent le choix des étages de l´arthrodèse.

Lumbosciatica is a public health problem because of its socio-professional impact. The purpose of our study is to evaluate the indication for surgical treatment and the role of each technique used. We conducted a retrospective study in the Department of Or thopaedics in Tataouine. The study involved 44 patients with common lumbosciatica and having undergone surgical treatment over the period from 2013 to 2018. The information sheet included the epidemiological data and the clinical data. The patients underwent radiological assessment including lumbar spine x-ray (frontal and lateral views) and lumbar computed scan (CT) scan which clarified the cause of sciatica. Surgical treatment was indicated after medical treatment failure, in patients with hyperalgesia and in patients with neurological complication. In our study, herniated disc was the primary cause of lumbosciat ica (50% of cases) followed by lumbar spinal stenosis (25%), spondylolisthesis (22.7%) and transverse mega-apophysis of L5 vertebrae (2.3%). Traditional discectomy was the most used technique for surgical treatment of herniated disc. Eight patients had spondylolisthesis. They underwent laminectomy associated with posterior arthrodesis. Lumbar spinal stenosis was treated with laminectomy alone in 54.54% of cases. Outcome was favorable during the follow up period in 90% of cases (Visual Analog Scale 3±1 at follow-up). Surgical technique depends on etiology and imaging data on which to base the choice of arthrodesis stages. [ABSTRACT FROM AUTHOR]

Résumé L’examen clinique est la première étape de toute démarche thérapeutique médicale ou chirurgicale. Sa qualité est essentielle afin d’adapter le traitement à la demande du patient. Dans le cadre du rajeunissement facial, l’interrogatoire et la compréhension des motivations, photos anciennes à l’appui, participent à l’évaluation. La connaissance de l’anatomie et du processus de vieillissement facial facilite l’analyse. Il s’agit non seulement de déterminer le degré de ptôse tissulaire, mais aussi d’évaluer les variations volumétriques. Enfin, les tensions musculaires et la qualité cutanée participent à la genèse de rides distinctes. Ces modifications complexes aboutissent à un aspect fatigué ou triste, voire âgé. Les demandes des patients, souvent limitées à une seule région, ne doivent pas dispenser d’une analyse globale. Le rôle du praticien est aussi de faire prendre conscience au patient, avec tact, de l’incidence des autres régions sur l’impression générale. L’objectif sera d’obtenir un résultat harmonieux, naturel qui signe l’excellence du savoir-faire médicochirurgical. L’examen clinique doit, en outre, permettre de repérer les difficultés techniques. Enfin, un bilan photographique, voire vidéo, fixe l’analyse et permet de disposer d’éléments objectifs pour affiner le traitement, aider à sa compréhension et évaluer le résultat. Le temps passé à examiner et expliquer permet de statuer avec le patient sur les choix thérapeutiques et d’en préciser leurs limites. Il permettra ainsi d’accroître la satisfaction du patient qui doit s’approprier le résultat. Cet effort d’analyse est dès lors un acte opératoire, tout aussi important que la technique elle-même. Apporter un résultat « sur mesure », indispensable lorsqu’il s’agit de l’image de la personne, constitue enfin la garantie du plaisir à toujours vouloir améliorer notre pratique. Summary The first step to determine a medical or surgical intervention is the clinical exam. The clinical exam is the paramount step to provide a treatment plan that can be modified and individualized accounting the patient preferences. During the consultation for facial rejuvenation, attention should be paid to understand the patient's motivation and expectations. A thorough understanding of the anatomy and the natural history of ageing will facilitate the analysis of the face. Not only the degree of ptosis but also the degree of volume loss will need to be assessed, as well as the influence of the facial muscles, the skin quality, and the different causes of rythids. The comprehensive age-related anatomical changes are often perceived and described as tiredness or sadness. Patients very commonly only point out a single anatomical region. During the consultation, the surgeon should provide the patient with the information of the comprehensive interplay of the different anatomical regions and their individual ageing process. Obtaining a harmonious, natural appearing outcome is the result of excellent surgical skills and applied knowledge. The clinical exam should also find out traps and technical difficulties. Although standardized photographs allow a static evaluation of one's result, video may deliver additional information about the postoperative result, and may contribute to the understanding of the technique used. Spending the additional time by performing a thorough facial analysis and preoperative planning is well-invested time. Having a good understanding of the possible surgical improvements and limitations will be beneficial for both, the patient and the surgeon. Managing the expectations of the patient and careful preoperative planning will increase patient's satisfaction. At the same time, the surgeon will able to critically assess his/her own result and taking pleasure improving their own technique. [ABSTRACT FROM AUTHOR]

Objectives: To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. Method: A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. Results: The 1st stage of labour is divided in a latence phase and an active phase, which switch at 5 cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hours during the first part of the active phase, and blow 1 cm per 2 hours above 7 cm of dilatation. During the latent phase of the first stage of labour, i.e. before 5 cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labour to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrating. However, in the case of an extension of the second stage beyond 2 hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2 mUI/min, to respect at least 30 min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2 mUI/min intervals without surpassing a maximum IV flowrate of 20 mUI/min. The reported maternal adverse effects concern uterine hyper-stimulation, uterine rupture and postpartum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyper-stimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. Conclusion: The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file. [ABSTRACT FROM AUTHOR]

Résumé Du fait d’une extension de leurs indications, les antipsychotiques sont des molécules que tout praticien est amené à prescrire ou à reconduire, tant dans des situations aiguës telles que certains troubles du comportement, que dans le traitement de troubles psychiatriques caractérisés comme les troubles psychotiques ou le trouble bipolaire. La prescription de ces molécules nécessite une évaluation précise de la balance bénéfice/risque en tenant compte des particularités propres à chaque situation clinique. En effet, les antipsychotiques sont associés à une augmentation de la morbi-mortalité du fait de leurs effets secondaires parfois sévères, principalement neurologiques (syndrome extrapyramidal, dyskinésies, akathisie), métaboliques et cardiovasculaires. D’une manière générale, les antipsychotiques de seconde génération doivent être privilégiés aux antipsychotiques de première génération du fait d’un meilleur profil de tolérance, et ce particulièrement en cas de prescription prolongée. Ainsi, la surveillance du traitement, tant de son efficacité sur les symptômes ciblés, que de sa tolérance, est essentielle dans la prise en charge de patients traités par antipsychotiques. Antipsychotics are commonly prescribed in the general population since they have many indications. They can be used in acute care such as agitation or behavior disorders, or to treat more characterized psychiatric disorders like psychotic or mood disorders. Consequently, any practitioner will have to prescribe or renew a prescription of antipsychotics. These treatments require a benefit/risk balance assessment taking into account the specific context of each patient. Indeed, antipsychotics have many side effects, mainly neurological (extrapyramidal syndrome, dyskinesia, akathisia), metabolic and cardiac. If these complications are poorly controlled, they could dramatically increase the morbidity and the mortality. Second-generation antipsychotics should be preferred to first-generation antipsychotics because of their better safety profile, especially in case of prolonged prescribing. Treatment monitoring, including effectiveness on the targeted symptoms, tolerance and observance, are major issues in the management of patients treated with antipsychotics. [ABSTRACT FROM AUTHOR]

Materials and Methods: We carried out a retrospective and descriptive study on biopsies examined between January 2015 and December 2019, in the pathological departments of University Teaching Hospital of Bouaké and Cocody-Abidjan. The KB came from four countries (Côte d'Ivoire, Togo, Guinea-Conakry and Burkina Faso). Optical microscopy and/or direct immunofluorescence techniques were used. All biopsy samples including epidemiological, clinical and pathological data and an optical microscopy and/or direct immunofluorescence study were included. The parameters studied were indications for KB, epidemiological profile, clinic, proteinuria and pathological aspects., Results: Over the study period, we collected 179 KB, i.e. 35.8 KB/year. The mean age of the patients was 32.9 ±13.8 years (range 11-70 years). The sex ratio (M/F) was 1.03. Pure nephrotic syndrome was the main indication (64.2 %, n = 115) for KB, followed by impure nephrotic syndrome (11.7 %, n = 21), acute renal failure (ARF) (7.8 %, n = 14) and rapidly progressive glomerulonephritis (RPGN) (7.8 %, n = 14). Glomerulonephritis (GN) occurred in 86 % (n = 158), vascular nephropathy in 11.7 % (n = 21) and tubulointerstitial nephritis in 2.2 % (n = 4). The nephropathies were preferentially focal segmental glomerulosclerosis (34.6 %, n = 62), nephroangiosclerosis (10.6 %, n = 19), membranous GN (10 %, n = 18), post-infectious GN (8.9 %, n = 16) and lupus GN (7.3 %, n = 13)., Conclusion: The KB is an essential step in the diagnosis of nephropathies. Focal segmental glomerulosclerosis is frequent in our study. The establishment of a Kidney registry would allow better knowledge of renal pathologies in sub-Saharan Africa.

Résumé La protonthérapie est une technique optimisée de radiothérapie. Les améliorations techniques permettent d’obtenir aujourd’hui des machines fiables. Les indications thérapeutiques sont plus claires même si des essais thérapeutiques doivent confirmer les orientations actuelles. Une nouvelle organisation des soins permettra d’encadrer définitivement le nombre de patients pour lequel le traitement sera pertinent. Cette organisation préparera le développement futur de cette technique. Proton therapy is an optimized radiotherapy technique. Today, the technical improvement provides reliable machines. The therapeutic indications are clearer even though therapeutic trials should confirm the current guidelines. A better knowledge in radiobiology could be useful if it is integrated in the treatment planning system. A new organization of care will definitively stabilize the number of patients for which treatment will be relevant. This organization will prepare the future expansion of this technique. [ABSTRACT FROM AUTHOR]

Résumé But Évaluer la pratique transfusionnelle dans le service d’hépato-gastroentérologie du centre hospitalier universitaire campus Lomé. Méthodologie Il s’agit d’une étude rétrospective, descriptive et analytique menée du 1 er janvier au 31 décembre 2013 sur des dossiers d’observation de patients hospitalisés dans le service. Étaient inclus les dossiers des patients âgés de plus de 15 ans hospitalisés, ayant bénéficié d’une transfusion sanguine. Résultats Pendant la période d’étude, 849 patients ont été hospitalisés ; 136 ont été transfusés, soit un taux transfusionnel de 16,02 %. L’âge moyen des patients était de 48,25 ans avec des extrêmes de 15 et 90 ans. Le groupe sanguin rhésus le plus transfusé était O positif (36,76 %). Le culot globulaire était le produit sanguin le plus utilisé (94,12 %). La transfusion a été réalisée dans 58,82 % des cas en urgence. Les hémorragies digestives étaient les principales indications (55,88 %). L’hémoglobinémie pré-transfusionnelle moyenne était de 6,51 g/dL ± 1,67. L’hémoglobinémie post-transfusionnelle moyenne était de 8,95 g/dL ± 1,75. Les hépatopathies (cirrhose et carcinome hépatocellulaire) étaient le principal diagnostic associé à la transfusion sanguine (44,85 %). La quantité de sang à transfuser n’était pas calculée dans 100 % des cas. Dans 11,03 % des cas, le test de compatibilité n’a pas été fait au laboratoire. Des incidents au cours de la transfusion sanguine ont été notés dans 5 cas. Conclusion La transfusion sanguine est fréquente dans le service. Il existe une bonne observance des règles de sécurité transfusionnelle. Sa pratique reste toutefois à améliorer. Objective To evaluate transfusion practice in the hepatogastroenterology department of the Campus Teaching Hospital of Lomé. Methodology This is a respective, descriptive and analytical study conducted from January 1 to December 31, 2013 on cases of in-patients’ observation in the department. The cases of in-patients of more than 15 years old, having benefited from a blood transfusion were included. Findings During the study period, 849 patients were admitted; 136 were transfused, or blood transfusion rate of 16.02%. The average age of patients was of 48.25 years with extremes of 15 and 90 years. The most transfused rhesus blood group was O positive (36.76%). Red blood cell was the most frequently used blood product (94.12%). The transfusion was performed in 58.82% of cases as a matter of emergency. Gastrointestinal bleeding were the main indications (55.88%). The average pre-transfusion hemoglobinemia was 6.51 g/dL ± 1.67. The average post-transfusion hemoglobinemia was 8.95 g/dL ± 1.75. Liver disease (cirrhosis and hepatocellular carcinoma) were the main diagnosis associated with blood transfusion (44.85%). The quantity of blood to be transfused was not calculated in 100% of cases. In 11.03% of cases, the compatibility test has not been done in the laboratory. Incidents during blood transfusion were noted in 5 cases. Conclusion Blood transfusion is frequent in the department. There is a good observance of blood transfusion safety regulations. However, its practice remains to be improved. [ABSTRACT FROM AUTHOR]

Lung transplantation (LTx) is the last-resort treatment for end-stage respiratory insufficiency, whatever its origin, and represents a steadily expanding field of endeavor. Major developments have been impelled over the years by painstaking efforts at LTx centers to improve donor and recipient selection, and multifaceted attempts have been made to meet the challenges raised by surgical management, perioperative care, and long-term medical complications. The number of procedures has increased, leading to improved post-LTx prognosis. One consequence of these multiple developments has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. With these considerations in mind, the Francophone Pulmonology Society (Société de Pneumology de Langue Française [SPLF]) has set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force has examined the most recent literature and evaluated the risk factors that continue to limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Résumé: Nous présentons les différentes techniques de reconstruction de la joue en insistant plus particulièrement sur les plans superficiels. En plus du contexte clinique, la localisation et les dimensions de la lésion seront prises en compte afin de choisir le meilleur procédé pouvant garantir le meilleur résultat fonctionnel et esthétique avec le moins de séquelles possible. Les préoccupations majeures sont l’absence de déformation des orifices naturels périphériques, la localisation et l’orientation des cicatrices, la qualité du revêtement cutané et le respect des volumes. [ABSTRACT FROM AUTHOR]

Abstract: Targeted therapies have an increasing importance in digestive oncology. These new treatments have been authorized in colon cancer, gastric cancer, pancreatic cancer, endocrine cancer and gastrointestinal stromal tumors. The oncologist should develop high abilities to use these therapies especially concerning the indications, response''s biomarkers, toxicities and evaluation methods. [Copyright &y& Elsevier]

Summary: During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) , establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters. [Copyright &y& Elsevier]

Résumé En raison du coût relativement élevé des traitements antiviraux utilisés contre l’infection par le virus de l’hépatite C (VHC), une hiérarchisation de l’accès à ces médicaments est admise. Les indications, aujourd’hui restreintes aux patients atteints d’au moins une fibrose hépatique d’un stade modéré à sévère, sont amenées à s’élargir progressivement. La stratégie thérapeutique fait appel à un ou plusieurs antiviraux d’action directe de seconde génération, associant ou non de la ribavirine et/ou de l’interféron alpha pégylé. Summary Due to the relatively high cost of the antiviral therapies used to treat the hepatitis C virus (HCV), access to these medications is prioritised. The indications, currently restricted to patients with at least hepatic fibrosis at a moderate to severe stage, are set to gradually widen. The treatment strategy is based on one or several second generation direct-acting antivirals, combining or not ribavirin and/or pegylated interferon alpha. [ABSTRACT FROM AUTHOR]

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Résumé: Objectifs: Élaborer des recommandations sur l’intérêt de l’application d’une contention élastique adhésive (taping) dans la prise en charge thérapeutique de l’arthrose des membres inférieurs. Méthode: La méthodologie utilisée, proposée par la Société française de médecine physique et réadaptation (Sofmer), a associé une revue systématique de la littérature, un recueil des pratiques professionnelles et une validation par un panel pluridisciplinaire d’experts. Les critères d’analyse retenus ont concerné l’efficacité symptomatique du taping dans l’arthrose des membres inférieurs. Résultats: La faible utilisation en pratique courante en France et l’absence de données dans la littérature sur l’efficacité du taping dans l’arthrose de cheville, ne permettent pas de le recommander dans cette indication. L’efficacité du taping du genou dans la gonarthrose a été peu étudiée. Conclusions: La qualité méthodologique des travaux ne permettant pas d’avoir un niveau de certitude suffisant pour conclure à une possible efficacité et le faible recours au taping dans la pratique courante en France, ne permettent pas de recommander cette technique dans le traitement de la gonarthrose. La réalisation d’études de meilleure qualité méthodologique utilisant un taping rotulien modifiant les rapports entre la rotule et la trochlée est souhaitable afin de conclure à l’intérêt ou non de cette prise en charge dans la gonarthrose, en particulier fémoropatellaire. [Copyright &y& Elsevier]

Abstract: Introduction: Proton pump inhibitors (PPIs) are an efficient therapy, being widely used by physicians. In 2004, cost of PPIs'' therapy was as high as 748 millions of euros (for The Caisse primaire d''Assurance Maladie) in France. Although validated indications of PPIs are well known, numerous un-necessary prescriptions of PPIs are common. The aim of this prospective study was to evaluate PPIs'' prescriptions of patients in a department of internal medicine. Patients and methods: This is a 12-week assessment of medical charts of patients, receiving PPI therapy in patients in our Department of internal medicine. Data were collected by a standardized questionnaire, with regards to: PPIs'' nature and regimen, PPIs'' indications as well as duration of therapy. Results: The medical charts of 729 consecutive patients, with a mean age of 67 years, were collected. Two hundred (and) twenty-four patients (30.7%) received PPI therapy; 157 of these patients were given PPI before admission in our department. Omeprazole was used in 71% of patients. Duration of PPI therapy was over one year in 45% of cases. Thirty-five per cent of family physicians'' PPI prescription were validated and 23.8% of those of physicians working in the department of internal medicine. The main non-conform PPI''s indications, by family physicians and internists were as follows: prevention of hemorrhagic risk of anti-platelet agent (21 vs 16.4%), anticoagulant (17.8 vs 16.4%), steroids (8.3 vs 13.4%) or non-steroid anti-inflammatory therapy without risk factor (1.9 vs 9%). Finally, in patients receiving PPI therapy before admission, this therapy was maintained in 76% of cases. Conclusion: This prospective study confirms the frequent prescription of PPI therapy in a department of internal medicine (31% of patients). It also underscores the importance of PPIs'' use by family physicians and physicians working in a department of internal medicine; this series further highlights the difficulties to interrupt this well tolerated therapy. To date, PPI therapy should be prescribed with a cautious reweighted cost/benefit consideration. [Copyright &y& Elsevier]

Abstract: Step-cut shortening osteotomy of the ulna for impingment of the distal ulna relies on the principles enunciated by Desanfans 1953. We recommend the plate be placed on either the palmar or the dorsal aspect of the ulna. Used since 1990 this technique has enabled primarily bony healing by 6 months in all the 18 cases operated upon. A significant clinical improvement as measured by the scoring system of Chun and Palmer was noted at a median follow-up of 95.7 months. Shortening did not unfortunately, appear to stabilize the distal ulna and those patients with residual clinical radioulnar instability had significantly worse results. We conclude that the technique presented gives reliable bone healing. It is a versatile and simple technique that requires no special instrumentation but does demand skill and precision. [Copyright &y& Elsevier]

Abstract: Although sensitivity to hymenoptera venom is common, allergic reactions are relatively rare, occurring with a frequency of 1 to 3% in the general population. A decision to start immunotherapy quickly should be based on the severity of the reaction; anaphylactic shock is a certain indication. Mild reactions involving the skin and mucous membranes are not, a priori, an indication for immunotherapy. Knowing the risk for recurrence or worsening of a reaction following subsequent stings allows us to judge the need for immunotherapy in a particular patient. Whichever immunotherapy protocol is used, the most frequently recommended and most often used being the rush and rapid rush protocols, adverse reactions are not infrequent. However, there is little information that allows us to identify those patients who are at risk for such reactions. Antihistamines are only useful for treatment of local and/or regional reactions and very mild general reactions. Nevertheless, their administration during the dose-increasing phase of immunotherapy has been recommended as a means of increasing its efficacy. In most cases, booster doses should be at least 100 μg, although in some cases 200 μg should be given. The duration of immunotherapy should be at least five years. It may be terminated after three years if skin tests and serum IgE antibody assays are negative. On the other hand, it should be continued for more than five years in certain situations that carry greater risk for recurrence. [Copyright &y& Elsevier]

Objectifs. – Préciser les principes pharmacocinétiques régissant la vitesse et la qualité d''une induction au masque avec un agent halogéné seul ou en association avec un adjuvant. – Décrire les différentes techniques permettant d''obtenir une anesthésie de profondeur suffisante pour l''insertion d''un masque laryngé ou d''une sonde d''intubation. – Préciser les indications préférentielles, les contre-indications et les complications de cette technique.Sources de données. – Synthèse des données obtenues dans la banque de données Medline® et l''expérience clinique des auteurs. Synthèse des données. – L''induction au masque chez l''adulte permet d''obtenir une perte de conscience aussi rapide que par voie intraveineuse sous réserve d''utiliser de fortes concentrations de sévoflurane. Les délais de pose de masque laryngé ou d''intubation sont plus longs mais peuvent être raccourcis par l''adjonction de N2O et/ou une dose faible de morphinique. La place de la prémédication par benzodiazépine n''est pas établie mais est logique compte-tenu de la potentialisation de la CAM des halogénés. En l''absence d''adjuvant, l''induction au masque conserve mieux la ventilation spontanée ce qui justifie son intérêt en cas d''intubation difficile. Si la tolérance hémodynamique est considérée comme meilleure ou similaire à celle d''une induction par propofol, certains patients développent une tachycardie et une élévation tensionnelle, dangereuse chez les patients à risque cardiovasculaire. Ces phénomènes seraient liés à de trop fortes concentrations d''halogénés et contemporains de la survenue d''une activité électrique pointe–onde au niveau cérébral. Cette activité n''a jamais été associée à des séquelles neuropsychiques manifestes au réveil. Inversement, il est préférable chez le sujet âgé ou à risque cardiovasculaire élevé de réduire les concentrations de sévoflurane délivrées par le vaporisateur de 8 à 2 % soit d''emblée soit par paliers de 2 % toutes les minutes dès la perte du réflexe ciliaire. Cette technique est contre-indiquée chez les patients porteurs du gène HMS ou d''une myopathie, ayant un estomac plein, une symptomatologie active de reflux gastro-œsophagien ou une hypertension intracrânienne.Conclusion. – La technique d''induction par inhalation chez l''adulte reste une technique encore peu diffusée et utilisée. Son amélioration grâce à des adjuvants et l''éducation pratique des médecins anesthésistes–réanimateurs devraient permettre une plus grande diffusion de cette alternative efficace à la voie intraveineuse pour l''induction. [Copyright 2004 Elsevier]

La kine´sithe´rapie respiratoire chez l'enfant est connue en dehors de nos frontie`res sous le terme de la french physiotherapy. La me´thode utilise´e en France est celle des flux respiratoires appele´e encore acce´le´ration ou augmentation du flux expiratoire (AFE), elle recherche l'interphase air/mucus pour mobilise les se´cre´tions dans l'arbre trache´obronchique. Depuis de nombreuses anne´es, de multiples appareils se sont positionne´s pour faciliter, aider au de´sencombrement tout particulie`rement dans la mucovviscidose. Les affections concerne´es par la kine´sithe´rapie respiratoire sont: l'encombrement, les pathologies se´cre´tantes aigue¨s, les pathologies se´cre´tantes iduites, et les troubles de la me´canique externe. [Copyright 2003 Elsevier]

Weight loss surgery, after a long period of precaution -- some say reluctance -- from numerous doctors and patient associations, has inally earned a place of importance. Now indicated for the treatment in cases of morbid obesity that have been resistant to ongoing, multi-focal medical care, it may see its indications widen in the next few years. In certain countries, such as Switzerland, the indication criteria has widened towards less "stringent" levels of body mass index and severity of complications. It is true that its results, especially on quality of life, controlling type 2 diabetes and the reduction of many other comorbidities, have been increasingly and consistently documented. But for doctors and of course surgeons, bariatric surgery is not an insigniicant act. There are risks, post-operative and beyond, as well as side efects. The main objective for surgeons and doctors is to reduce mortality and morbidity linked to this surgery as much as possible. [ABSTRACT FROM AUTHOR]

Abstract: Background. – Nitrates are frequently prescribed drugs, although their indications are limited. We studied nitrates'' prescription in elderly patients hospitalised in the internal medicine ward of a French teaching hospital. Methods. – Hospitalised patients aged 65 years and more and receiving nitrates in their usual treatment were identified prospectively. A standardised questionnaire was used during a structured medical interview conducted by the same physician for all patients. Informations regarding nitrates'' prescription were studied according to the actual recommendations for their use: angina in patients with contraindication to betablockers, acute myocardial infarction and acute pulmonary oedema. Results. – Among 256 hospitalised elderly patients, 49 (19% [IC95%: 15–25]) were under nitrates therapy, because of either angina pectoris, heart failure or unknown reason. Cardiologists prescribed nitrates in accordance with guidelines significantly more frequently than non-cardiologists. Transdermal treatment was used in 69% of patients. Discussion. – In hospitalised patients aged 65 years and more who are prescribed nitrates in their usual treatment, at least one quarter have no recommended indication for its use. As almost one fifth of patients are receiving nitrates in their usual treatment, the medicoeconomic impact of these useless prescriptions could be significant. Nitrates prescribing can be optimized by following guidelines for their use, and restraining from prescribing the transdermal treatment which is more costly and without evidence-based clinical benefit compared to the oral route. [Copyright &y& Elsevier]

Introduction: Tigecycline is a relatively new antibiotic that have very limited valid indications. When no other alternative is available, this drug is widely used off label with promising results. The objective of this study is to summarize the different off label uses of tigecycline so that we can decide when and how to prescribe it in the absence of guidelines., Material and Methods: This study a revue of the literature collecting all the articles concerning the off label uses of tigecycline., Results: Tigecycline was widely prescribed, off label, to treat infections with controversial results. Randomised clinical trials were conducted to evaluate its use to treat pneumonia. The results for this indication have a respectable level of evidence. For the other indications, the data collected was insufficient to support tigecycline prescription. In fact, different protocols were used which makes it hard to evaluate the efficacy and to conclude to the best treatment regimen. A tendency to prescribe high doses of the molecule was noted in different studies. When prescribed off label, tigecycline prescriptions were associated with a higher mortality and incidence of side effects., Conclusion: The tigecycline remains a valid option for the treatment of infections dues to multi-resistant bacteria especially when other alternatives are scarce or in cases of renal failure., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

This case reports the result of a positive nasal swab for the SARS Antigen FIA Quidel, during the start of the realization of the antigen test, in a 26 years old asymptomatic nurse without any factors of risk who had been in contact with a COVID-19 patient three days ago. The result of the antigen test was not confirmed by the RT PCR test, which had been practiced twice. This leads us to discuss the Positive Predictive Value of the rapid tests for guidance, depending on the prevalence of the disease in the population on which they are used. This has many practical consequences for performing this test in an asymptomatic population or when used in mass screening. Care should be taken to use this test according to the correct indications., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Indications for pulmonary excision are dominated by infectious pulmonary pathologies in developing countries. We conducted this study to describe the indications and results of pulmonary resections in the thoracic surgery department of the Mali hospital., Patients and Methods: This is a retrospective and descriptive study from January 2012 to December 2019, carried out in the thoracic surgery department of the Mali hospital. It involved 76 patients who had a pulmonary resection. The variables studied were the epidemiological data, the operating indications, the therapeutic data and the prognosis., Results: The mean age of the patients was 35.5 years. The sex ratio was 1.7. The average consultation time in thoracic surgery was 11.6 months with extremes of 7 days and 96 months. A history of pulmonary tuberculosis was noted in 46.1% of patients. The main indications for pulmonary resection were infectious parenchymal destruction in 64.5%, bullous dystrophy in 14.5%, bronchopulmonary cancer in 11.8% and thoracic trauma in 4% of the cases. The procedures performed were: a lobectomy (39.5%), atypical resection (36.8%), culminectomy (7.9%) and pneumonectomy (15.8%). Morbidity was dominated by thoracic empyema (9.2%) postoperative hemorrhage (5.2%), parietal suppuration (7.8%) and bronchopleural fistula (1.3%). The average length of hospital stay was 14.3 days. Mortality was 10.5%. There was a statistically significant correlation between pneumonectomy and deaths (P=0.01)., Conclusion: Infectious lung destruction is the main indication for pulmonary resection in Mali. The consultation period is quite long. Morbidity and mortality remains high., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

When using radiation therapy for adolescents and young adults (AYA), paediatricians, adults' oncologists and radiation oncologists need to keep in mind several particularities through the whole therapeutic process. They embrace the indication, target volumes, prescribed dose, treatment techniques and follow-up. Indeed, the young age and the cancer features that characterised this population influence the modalities of irradiation. This article highlights the key points of AYA care with radiation therapy., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: To study the cesarean section (c-section) practices in the French Centre-Val de Loire region: incidence of planned c-section and rate variations between maternities, incidence of potentially avoidable cesarean sections., Methods: The data were extracted from the 2016 regional birth register, which permitted classification of each planned c-section according to the pre-existing risk of c-section (high or low) as defined by the Robson classification. To enhance the data, especially the indications for c-section, which are not included in the register, a survey was conducted from September 2016 to February 2017 in all of the 20 maternities in the region., Results: In 2016, nearly 26,000 women gave birth in the CVL region, of whom 19.2% by c-section (7.0% planned c-sections). The planned c-section rate was higher for breech presentation and scarred uterus, and decreased according to level of the maternity (I 41% - II 35% - III 32%). Concerning the c-section indications, 1,979 c-sections were studied during the period (18.6% of births), including 762 planned c-sections (7.1% of births). Among them, 246 (32%) were potentially avoidable, mainly isolated indications of scarred uterus with only one previous c-section or breech presentation, and 17 due to unfavorable radiologic pelvimetry in nulliparous women., Conclusion: Specific actions were identified: targeted use of radiologic pelvimetry, targeted c-section on scarred uterus with only one previous cesarean section or breech presentation, as recommended by the national guidelines. The Robson classification should be widely used to evaluate and enhance practices, in particularly through painstakingly interpreted inter-maternity comparisons., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Sweat test is the gold standard of the diagnosis of cystic fibrosis (CF). The aim of our study was to identify the indications leading to perform a sweat test and those that led to the diagnosis of CF., Methodology: We collected data of all sweat tests performed between 2008, 1th of March and 2015, 28th of February. They were analyzed following Rosenstein diagnosis criteria (1998): clinical manifestations suggesting CF, positive neonatal screening (≥ 1 positive assay of immunoreactive trypsin) or familial history of CF., Results: We reviewed 1,208 sweat tests over this period. Patients were aged from 13 days to 79 years. Indications were: clinical events (94.0%), a positive neonatal screening (3.7%) and a family history (2.3%). Over the 20 newly diagnosed patients, a positive neonatal screening was the main indication for the sweat test (55%). A positive neonatal screening (p<0.0001), a family history (p<0.0001) and pulmonary signs associated with digestive signs (p=0.004) were more frequently found in these patients., Conclusion: Sweat test indications are mostly clinical and mainly pulmonary. This study confirms that a sweat test should be performed in case of pulmonary manifestations suggesting CF especially if these are associated with digestive manifestations.

L’EEG continue chez l’enfant et le nouveau-né connaît, comme chez l’adulte, ces dernières années un développement croissant tout particulièrement chez le patient gravement malade, très fragile [3] . Un consensus a été établi entre 17 centres de neurologie, pédiatrie ou d’épilepsie aux États-Unis en 2015 sur les indications de cette technique chez ces patients adultes comme enfants [1] . En effet, ces patients présentent, entre autres, un risque accru de crises qui sont essentiellement infracliniques en particulier après arrêt cardio-respiratoire, dans les premières 24 heures ; le début en dehors des heures ouvrables représentant 1 cas sur 2. Une evidence based review publiée en 2006 en Amérique du Nord, dénote l’intérêt du monitoring EEG vidéo pour la prise en charge de l’adulte car montre une mortalité inférieure pour une durée d’enregistrement et un coût identiques aux EEG standards. Les recommandations Françaises de 2014 soulignent l’importance des enregistrements continus chez l’enfant dans l’état de mal convulsif pour détecter des crises infracliniques surtout dans l’état de mal occasionnel. L’étude prospective de Lan et al. [2] relève l’importance de la vidéo-EEG continue par rapport à l’EEG continue sans vidéo en particulier dans les 72 premières heures après le début du coma pour la détection de ces crises infracliniques et ainsi contrer l’atteinte cérébrale secondaire à ces crises infracliniques. On élimine aussi tout artefact environnemental, de même le monitoring EEG vidéo présente une grande utilité pour l’évaluation pronostique par la réactivité aux stimuli. On peut ainsi évaluer selon ces études la profondeur du coma et guider vers un mauvais pronostic sur l’aspect et la réactivité de l’EEG, et une mauvaise architecture du sommeil. La plasticité cérébrale chez l’enfant incite à une intervention précoce pour améliorer le pronostic. Quelle est la faisabilité du monitoring EEG vidéo en France en 2016 ? À travers des exemples, différentes techniques disponibles de traitement du signal recueilli seront évoquées : aEEG, DSA, évaluation du « seizure burden »… ainsi que les limites de ces données en comparaison avec la lecture directe de l’EEG conventionnel. L’organisation médicale et paramédicale des unités de neurophysiologie clinique pour la pratique du monitoring EEG vidéo dans les heures ouvrables ou non sera discutée. La lecture de l’EEG, conventionnel ou non, sur place ou par prise de main à distance pose un problème organisationnel. Cette lecture doit-elle aboutir ou non à un compte rendu standardisé de l’EEG conventionnel toutes les 12 heures pour des adaptations thérapeutiques et des évaluations pronostiques rapides ? Comment valoriser et faire reconnaître cette activité ? Par une différenciation des actes technique et de lecture et par une évaluation du temps passé pour chaque acte ? Une enquête initiée par la SNCLF sur ces derniers points paraît souhaitable. [ABSTRACT FROM AUTHOR]

The ancient linguists and morphologists presented an effective form and proved its meanings. The indication of the rest of the things, the drugs and the sounds .... and it was clear to them that some formulas of (effective) alternate with (effective) in some meanings. I thought that I would study this formula, trying to find the relationship between these different meanings that I mentioned above. Especially the effective and active relationship. This necessitated that I collect effective formulas that I was able to find and classify them according to their universal meanings, in order to clarify the link between these meanings and an effective form, perhaps beyond that, highlighting the original significance of this formula. So that the learner can study the different connotations, which are different together, after they are divided into references and references in the order of their articles in alphabetical order. However, I excluded from my research effective formulas that exceed in their significance the original meaning into metaphorical meanings that may be related from near or far to the basic significance that I have proven for an action.