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Background: Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB). Method: An observational, cohort retrospective study was conducted over an 8-year period (2010–2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value 120 bpm (OR = 2.91 [1.04–8.14], p = 0.041), and ascites (OR = 3.80 [1.85–7.81], p

Introduction. Penetrating wounds of thorax are frequent and require specific cares. The target of this study is to describe the epidemiological, clinical, therapeutic and progressive aspects of penetrating wounds of thorax by stabbing. Material and methods. This is a retrospective study of 73 patients with thoracic wounds by stabbing hospitalized at the Thoracic Surgery Department of University Hospital Center Joseph Ravoahangy Andrianavalona, Madagascar, from January 01, 2015 to January 31, 2018. Results. The mean age was 31.5 years, with a male predominance (89.04%). Most of the patients were in the tertiary sector (56.16%). Most of the cases were criminal assaults (by an unknown person = 91.78%). The thoracic lesions seen were fluid effusion in 58.9%, mixed in 32.88% and air in 6.85%. The association with limb trauma was the most common (16.44%). Chest drainage was performed in 67.12% of cases, thoracotomy in 1.37%. Evolution was favourable for most of the cases (90.41%). We found complications in 9.59% of the patients. Conclusions. Penetrating thoracic wounds by stabbing are frequent and represent an emergency, but patients often arrive late due to remoteness, financial problems, and neglect of chest wounds.

Résumé Introduction. La dénutrition préopératoire reste un facteur de risque indé-pendant des complications postopératoires, en chirurgie digestive. Une des clés de voûte de cette prise en charge reste l’anticipation de l’assistance nutritionnelle. Objectif. L’objectif était de déterminer le profil évolutif des patients, sous assistance nutrition-nelle (AN), selon la durée de cette dernière, en chirurgie digestive. Matériel et méthodes. Il s’agissait d’une étude observationnelle, rétrospective, mono-centrique de patients, sous assistance nutritionnelle, hospitalisés, en vue d’une chirurgie digestive, au CHU-JRA (2015-2017). L’échantillonnage était exhaustif. Les variables étudiées compre-naient les caractéristiques démographiques, le type et la durée de l’AN, l’indication chirurgicale, l’évolution à court et à moyen terme. Le critère de jugement principal était l’évolution du patient. Le critère de jugement secondaire était la durée de l’AN. Le test de corrélation Spearman a été utilisé, avec une valeur de p < 0,05 considérée comme significative. Résultats. Cinquante deux patients étaient retenus. L’âge médian était de 52,5 [16-82] ans, avec une répartition égale des genres (sex ratio = 0,5). L’AN de longue durée (d’au moins 6 jours) était constatée chez 12 cas (23%), contre 76% (39 cas), pour celle de courte durée (moins de 6 jours). La chirurgie carcinologique représentait 83% des patients sous AN de longue durée. La durée médiane de séjour en réanimation était de 3,5 [1-31] jours, avec une corrélation significative avec la durée de l’AN (R= 0,4 ; p=0,00541). La mortalité postopératoire était de 6% et la morbidité non chirurgicale était de 9% dans un tableau de défaillance respiratoire sévère. onclusion. L'assistance nutritionnelle à court terme, avec une alimentation précoce, a permis de réduire le nombre de complications postopératoires et de réduire la durée du séjour à l'hôpital. Néanmoins, un manque de réapprovisionnement pourrait prédire une com-plication précoce en chirurgie digestive. [Abstract Introduction. Preoperative malnutrition remains an independent risk factor for postoperative complications, in digestive surgery. The nutritional assistance (A) anticipation is primary. Objective. This study aimed to determine the evolutionary profile of patients undergoing NA, and according to its duration, in digestive surgery. Material and Methods. Observational, retrospective, single-center study was conducted on patients undergoing NA, hospitalized for digestive surgery, at CHU-JRA (2015-2017). Sampling was exhaustive. The studied variables included demographic characteristics, type, and NA duration, surgical indication, short- and medium-term outcome. The primary endpoint was the patient evolution. The secondary endpoint was the NA duration. The Spearman correlation test was used, with a p value < 0.05 considered as significant. Results. Fifty-two patients were selected. The median age was 52.5 [16-82] years, with an equal gender distribution (sex ratio = 0.5). Long term NA (at least 6 days) was observed in 12 cases (23%), compared to 76% (39 cases), for the short-term (less than 6 days). Oncological surgery accounted for 83% of long-term nutritional patients. The median duration of stay in ICU was 3.5 [1-31], with a significant correlation with the NA duration (R = 0.4 ; p = 0.00541). Postoperative mortality was 6%, and non surgical morbidity was 9%, in a severe respiratory failure chart. Conclusion. Short term nutritional assistance, with early feeding, results in fewer post-operative complications, and reduced the hospital stay duration. Nevertheless, a failure of replenishment could predict an early complication in digestive surgery.]