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Tocilizumab: Efficacy and Tolerance in Rheumatoid Arthritis in Current Practice
No full textIntroduction: The aim of this study was to evaluate in “real life” the efficacy and the tolerance of Tocilizumab (TCZ) in the treatment of rheumatoid arthritis (RA).Materials and methods: A cross-sectional study including patients with RA patients treated with TCZ at the commended dose of 8 mg/kg/ 4 weeks. The therapeutic response was evaluated by the EULAR DAS 28 ‐CRP/ VS at month 3 and month 6 of treatment.Results: RA was in most cases severe (76,5 %), seropositive (88,2 %) and erosive (81,3 %). TCZ was prescribed as an alternative to a previous biotherapy in 23 % of the patients and in monotherapy in 76, 5 % of the patients. After treatment follow-up at 3 and 6 months, the different parameters observed were significantly improved including: VAS (visual analogue scale) pain (p=0,000), CRP (mg/L) p=0,000), ESR (mmH1) (p=0,000), DAS 28 CRP (p=0,000), and DAS 28 ESR (p=0,000). Apart from a worsening of renal function in a patient contraindicated continuation of tocilizumab, no serious side effects were noted.Conclusion: Our study confirmed the efficacy and tolerance of TCZ therapy in Moroccan patients suffering from RA.Keywords: rheumatoid arthritis, tocilizumab, efficacy, toleranc
Self-Retaining Freedom Proflor vs. Lichtenstein Mesh Repair for the Reduction of Postoperative Pain in Inguinal Hernia: A 1-Year Randomized Controlled Study
No full textIntroduction: Lichtenstein tension-free mesh repair (LMR), surgical procedure for inguinal hernia, associated with postoperative pain. The study was aimed to compare self-retaining Freedom ProFlor versus LMR for the reduction of postoperative pain in inguinal hernia.Methodology: A total of 60 patients with inguinal hernia undergoing mesh repair were randomized into two groups of 30 each: group A (Freedom ProFlor mesh repair) and group B (LMR). Demographic data and clinical findings of all the patients including duration of pain, lump size, cough impulse, and the position of hernia were noted. Recorded findings such as postoperative pain and operative time were subjected to statistical analysis.Results: Most (31) of the patients had a hernia on the right side. The operative time was significantly less in group A when compared to group B (P < 0.05). Significantly lower pain scores were observed in group A than in group B (P < 0.05). The mean postoperative pain was significantly lower in group A compared with group B during the fifth follow-up visit (0.2 ± 0.41 vs. 1.07 ± 1.28; P < 0.0001). Conclusion: The Freedom ProFlor mesh repair was better than the LMR regarding postoperative pain. Moreover, the dose of the analgesic needed in the Freedom ProFlor mesh repair group was less and for a shorter time when compared to the LMR group. However, further long-term studies are required for documenting hernia recurrences
Infantile Digital Fibromatosis : A Case Report
No full textIntroduction: Infantile digital fibromatosis (FDI) is a rare, recurrent, benign tumor that occurs in the fingers and toes at birth or in the first months of life. We report a new case. Case report: A 2 1/2-year-old girl had light-pink, non-painful, hard, solid tumor formations, sitting on the dorsal surface of the fifth metatarsal bilaterally and the 2nd phalanx of the 5th left finger, resulting in joint deformity and then functional discomfort. X-rays of the front and the profile of the fingers showed a chondroma of P2 of the 5th finger, without anomaly on the X-ray of the knees. On the ultrasound of the soft parts: the presence of soft masses very hypoechogene avascular compared to the 5th ray measuring 2.81cm on the right and 1.21cm on the left. The diagnosis of infantile digital fibromatosis was retained. Surgical treatment was undertaken.Conclusion: The FDI is a rare and often easy diagnostic entity. Its recognition is important to consider adequate treatment knowing that this lesion can regress spontaneously and that post-surgical recurrence are frequent
Non-Contiguous Multi-Visceral and Vertebral-Medullary Multifocal Tuberculosis in Immunocompetent Subject
No full textTuberculosis is an infectious disease caused by the bacillus of Koch (BK). The multifocal form is usually associated with the immunosuppression of HIV. In this regard, we report an unusual case of multifocal tuberculosis associating visceral foci with a non-contiguous cervical, dorsal and lumbar spinal tuberculosis, in an immunocompetent subject. The patient had a medical-surgical treatment. It is a disease with a difficult diagnosis. We will discuss, in this case, the clinical, diagnostic, and therapeutic characteristics of this clinical entity
Giant Mucinous Ovarian Cystadenoma - A Case Report
No full textMucinous ovarian cystadenoma is a benign tumor, which accounts for 15% of all ovarian tumors and when diagnosed, 80% are benign, 10% limitrophe, and 10% malignant. It is a cyst that arises from the ovary surface epithelium, presenting multilocular features with a plain surface. It is more common between 30- and 50-years old persons and clinical signs differ from other ovarian pathologies because they present rapid growth, reach large dimensions, and evolve with peritoneal pseudomyxoma, causing a significant increase in abdominal volume. Imaging methods such as ultrasonography and computed tomography, as well as the tumor markers CA-125 and CEA, are fundamental for its elucidation and therapeutic planning. We report a case of giant mucinous cystadenoma of the left ovary in a 61-year-old patient admitted to the emergency room
Towards the 9th Edition of the Tumour, Node and Metastasis Classification of Lung Cancer. A Historical Appraisal and Future Perspectives
No full textSince 1966 the classification of anatomic extent of lung cancer, based on the primary tumour (T), the loco-regional lymph nodes (N), and the metastases (M) has been used in the management of lung cancer patients. Developed by Pierre Denoix, it was adopted by the Union for International Cancer Control and the American Joint Committee on Cancer. Clifton Mountain revised the second through the sixth editions based on a North American database of more than 5000 patients. For the seventh and the eighth editions, the International Association for the Study of Lung Cancer (IASLC) collected international databases of around 100,000 patients worldwide that allowed the introduction of innovations in both editions, namely the subdivision of the T and M categories based on tumour size and on the location and number of metastases, respectively. The revisions also showed the prognostic relevance of the quantification of nodal disease and proposed recommendations on how to measure tumour size for solid lung cancers, part-solid adenocarcinomas, and for lung cancers removed after induction therapy. Despite the innovations, prognosis based on the anatomic extent is limited, because prognosis depends on factors related to the tumour, the patient, and the environment. For the 9th edition, these factors, especially genetic biomarkers, will be combined in prognostic groups to refine prognosis at clinical and pathologic staging. To achieve this challenging objective, international cooperation is essential, and the IASLC Staging and Prognostic Factors Committee counts on it for the development of the 9th edition due to be published in 2024
Thoracic Manifestations of the Angiobehçet
No full textIntroduction: Vascular involvement in Behçet's disease affects 5 to 40% of patients. All vessels regardless of their type, size or location can be affected. This impairment is serious and can be life-threatening.Patients and methods: We collected 12 cases from January 2010 to January 2017. These were 11 men and 1 woman with an average age of 32.5 years. The venous involvement involved 11 patients with thrombosis of the upper vena cava (VCS) in 6 patients, thrombophlebitis of the lower limbs in 5 patients, and thrombosis of the lower vena cava and hepatic veins in 1 patient. The arterial involvement affected 9 patients (75%) with an aneurysm of the pulmonary arteries in 5 patients and a pulmonary embolism in 5 others. The cardiac involvement concerned half of the patients with pericarditis type in 3 patients and intra-cardiac thrombus in 4 patients.Conclusion: Thoracic involvement of the angiobehçet is frequent and severe, requiring rapid diagnosis and intense specific therapy to improve its prognosis
Neglected Oeso-Tracheal Fistula on Foreign Body: A Case Report
No full textThis patient is a 24-year-old student by profession and from a non-consanguineous marriage, 2nd of a sibship of 4, originally and resident in Marrakech of low socioeconomic level, having as antecedent an inhalation of a neglected metallic foreign body at the age of 2 years, which presents itself for chronic bronchorrhea which has been evolving for 5 years and of recurrent pulmonary infection with the notion of a false route during swallowing which appeared 6 months ago, in who underwent pleuropulmonary examination noted the presence of right basithoracic snoring rattles, thoracic CT and bronchial fibroscopy demonstrated a metallic foreign body at the level of the right bronchus strain with dilatation of the cylindrical type sequential bronchi interesting the associated middle lobe to an oesotracheal fistula of supraciliary topography. preoperative preparation with antibiotic therapy and bronchial drainage respiratory physiotherapy and a decision on thoracic surgical intervention with left selective intubation was taken and right posterolateral thoracotomy was performed with spotting and extraction of the foreign body by bronchotomy with dissection and liberation of the margins fistula and padding of the orotracheal fistula, the postoperative follow-up was simple and the course in the course, medium and long term was marked by a good clinical, biological and radiological improvement with a decline of 14 months
Ectopic Pregnancy: from Epidemiology to Management at the Regional Hospital of Ngaoundere (Cameroon)
No full textEctopic pregnancies constitute one of the principal complications of pregnancy. Their clinic is polymorphous with consequences such as infertility and death reliable to late diagnosis. The aim of this study was to determine the state of ectopic pregnancy in our context and to propose concrete actions that will permit a rapid diagnosis so as to ameliorate its management at the regional hospital of Ngaoundéré (RHN). As such, we carried out a descriptive cross-sectional, prospective, and retrospective design study going from January 2008 to August 2017 in the gyneco-obstetric unit of the RHN. We had a sample size of 373 cases of ectopic pregnancies within the study period. The data analysis was done by the means of the software’s Microsoft office tools and Sphinx Plus² v.5.1.0.6. A prevalence of 1.21% obtained and the most represented age group was that of 20 to 32 years with a rate of 69.1%. The most incriminated risk factor was a pelvic surgical history. Clinically the most revealing sign and the symptom was pelvic pain in 96.51%. The tubal rupture was observed in 72.39% of the cases and the treatment of these ectopic pregnancies was possible through radical surgery in 94.10%. No death report due to ectopic pregnancy throughout the study period
Odontogenic Myxoma of the Maxilla - A Case Report
No full textIntroduction: The odontogenic myxoma is a rare benign tumor of the maxilla, whose clinical and radiological manifestations are variable and nonspecific and can be confused with other radiolucent lesions. Its origin would be the embryonic mesenchyme of the dental follicle.Case report: We report the case of odontogenic myxoma of the right maxilla, discovered by chance in a 25-year-old patient. Clinically, the patient had painless, firm on palpation, swelling of the right maxilla, impeding chewing and speech. A facial CT scan showed an expansive osteolytic process blowing the right maxilla off. A biopsy was in favor of an odontogenic myxoma. The diagnosis was based on clinical, radiological, and especially anatomopathological arguments.Conclusion: The local aggressiveness of the odontogenic myxoma and its high rate of recurrence justify a radical treatment beyond the lesion’s boundaries and thus imply a postoperative repair