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Ankle Fracture Associated with a Tillaux Fracture in Adults - A Case Report
Get PDFWe report a particular case of a rare lesion association of ankle fracture occurring after an open trauma of the right ankle, and which associates a bimalleolar fracture, a Tillaux fracture, and interposition of the posterior tibial tendon in syndesmosis. We treated it surgically with a good clinical and radiological evolution. The objective of this study is to draw attention to this clinical and radiological variety
Gender Differences in In-Hospital Mortality Rates Among Hispanic Patients with Acute Myocardial Infarction
Get PDFAcute myocardial infarction (AMI) is a leading cause of death in the United States with over three million cases per year. Since the mid-1970s, the total number of deaths related to AMI in the United States has not declined. Studies suggest that women with AMI have worse outcomes compared to men. However, there is limited information regarding this topic among Hispanics.This study was a secondary analysis of the Puerto Rican Heart Attack Study, which reviewed the records of Hispanic patients of Puerto Rico hospitalized for AMI at 21 academic and/or non-teaching hospitals in 2007, 2009, and 2011. This study set examined the differences in in-hospital mortality rates between genders. A p-value of 0.2 was used to select possible confounders and the chi-square test was used to examine associations between categorical variables. Factors associated with in-hospital mortality rates were identified using logistic regression. Collinearity was assessed using Pearson correlation coefficients. The 95% confidence interval and a p-value of 0.05 were used to determine the statistical significance of odds ratios. Analysis was restricted to patients with ICD-9-CM code 410-414 who are above 18 (n = 2265).In our sample, there were more men than women (1291 versus 974, respectively). Men were younger and smoked more compared to women. Compared to men, women were older and suffered more comorbidities, such as stroke and congestive heart failure (CHF). Women had higher rates of in-hospital mortality compared to men (OR = 1.4, p = 0.040). Factors associated with higher rates of in-hospital mortality included age and CHF (p<0.001). Patients with CHF showed higher rates of in-hospital deaths compared to patients who did not have CHF (OR = 1.6, p = 0.026). Patients over the age of 86 showed higher odds of in-hospital death compared to younger patients (OR = 10.5, p <0.001).Significant disparities existed by gender in this sample of Hispanic AMI patients, with women showing higher in-hospital mortality compared to men. Women over 50 should perform regular checkups and discuss hormone replacement therapy or follow other preventive measures as suggested by their healthcare provider
New perspectives in radiation therapy
Get PDFNew developments and new technologies in radiation therapy are concerning the anatomical definition of the targets which are to be treated and of the critical organs which should be spared. These objectives can be reached by using modern imaging techniques: (US, PET Scan, CT Scan, MRI) allowing image-guided Radiation Therapy (IGRT). Modern concepts of dose distribution (inverse dosimetry) lead to the tri-dimensional conformal Radiation Therapy (3D - CRT), intensity-modulated Radiation Therapy (IMRT), and technological applications as helicoïdal tomotherapy, radiostereotaxy. New dose distribution techniques are also in progress: high dose rate (HDR), pulsed-dose-rate (PDR) brachytherapy, intraoperative Radiation Therapy, and new medical applications of neutrons, protons, ions carbone. Moreover, improvements in radiation therapy administrations are expected by using biological investigations to know in real-time tumor radiosensitization and radio tolerance of normal tissues in order to choose the most appropriate fractionation mode of the radiation treatment. These technical and biological developments are also associated with a better concept for using radiation therapy in a global strategy that has to be adapted to each patient and each clinical situation
Primary Breast Leiomyosarcoma in Male - A Case Report
Get PDFPrimary Sarcomas of the breast account for less than 1% of breast tumors. Leiomyosarcomas are less common. Only 51 cases have been reported in the literature, which only 4 cases in men. We present a new case of male breast leiomyosarcoma and discuss the management and therapy of these unusual neoplasms. The confirmation of diagnosis was obtained by immunohistochemical study of surgical biopsy. The patient underwent a radical mastectomy and axillary lymphadenectomy. Adjuvant radiotherapy was indicated. Two years after surgery the patient is still in life without recurrence
Aortic Valve Replacement for Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction - Mortality Risk Factors
Get PDFSevere left ventricular dysfunction increases the surgical risk of aortic valve replacement on aortic valvular stenosis. Several risk factors of hospital mortality have been reported in heterogeneous series.The aim of this study was to identify mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. To avoid biases of associated diseases, our study has been focused on isolated aortic stenosis.46 patients, with AS and severe left ventricular dysfunction who underwent AVR, were enrolled in this retrospective study. The mean age was 59 ± 12.70 years. 69.6% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.3 ± 5.3%, and the mean EuroSCORE was 12.20 ± 8.70. The hospital mortality was 15.20%. The morbidity was marked mainly by low output syndrome in 30.4% of cases. Logistic regression in univariate analysis reveals functional class, renal failure, congestive heart failure, and LVEF as factors related to the risk of hospital mortality. Multivariate logistic regression analysis found renal failure (OR = 11.94, CI [2.65 -72.22], p = 0.03) and congestive heart failure (OR = 25.33, CI [3 43 -194.74], p = 0.009) as independents risk of hospital mortality. The mean follow-up was 59.6 ± 21 months. Late mortality was 5%. Congestive heart failure and preoperative renal failure are the main independent hospital mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. Late mortality might be inversely related to LV recovery
Health Consequences of Climate Change
Get PDFLe changement climatique est une réalité inéluctable pour les décennies à venir, compte tenu de l’inertie du système climatique. L’ampleur du changement est à ce stade incertaine au niveau planétaire, et plus encore localement. Cependant, des conséquences sont à prévoir dans tous les cas sur la santé humaine, considérée à l’échelle de la planète, avec des retentissements sanitaires directs (vagues de chaleur, inondations, pollution de l’air…) et surtout indirects sur la disponibilité de l’eau potable et des ressources alimentaires, la destruction de l’habitat. Ces impacts sont source potentielle de déplacement de populations, de violences, de conflits. Il est non seulement possible mais nécessaire de se préparer à répondre à l’incertitude et à l’inconnu par des politiques publiques volontaristes d’atténuation des émissions de gaz à effet de serre et d’adaptation aux impacts déjà en développement et à venir. Ces politiques doivent s’appuyer sur une interdisciplinarité scientifique mais aussi sur l’implication des populations
Nutrition Transition in Morocco
Get PDFMorocco is undergoing a food transition that affects the urban and rural environment. Urbanization, economic development, and globalization are at the origin of changes in nutritional habits. The Moroccan diet, “Mediterranean type”, is based on a large consumption of cereals and fruits, and vegetables. Food is gradually diversifying, especially for urban households and the wealthier classes. It includes more foods rich in micronutrients, but the consumption of animal-origin products remains very limited whereas the resources of the country, particularly in fish, are very important. Fast food becomes more prevalent in urban areas, encouraging the consumption of foods rich in sugar and fat. This evolution reflects the ongoing nutritionaltransition in rural as well as urban areas. Coupled with a reduction in physical activity, these changes lead to the progression of overweight and obesity in the adult populatio
Recommendations 2016 of the National Symposium on Diabetes and Nutrition
Get PDFThe Moroccan League for the fight against Diabetes, a member of the International Federation of Diabetes MENA Region, adopted during the year 2016 (National Symposium on Diabetes and Nutrition of Rabat on 13 and 14 May 2016 and the celebration of the World Day of Diabetes in Dakhla on 11, 12 and 13 November 2016) two important resolutions:1- The Declaration / Advocacy for the implementation of a national plan of action for a multisectoral legal regulation of the fight against diabetes and for the promotion and the protection of the rights of diabetics.2- The Dakhla Appeal 2016 for the implementation of the "International Charter of Rights and Responsibilities of People with Diabetes" in Africa announcing the establishment of an African Observatory for the Promotion and Protection of the Rights of Diabetics ".The 2016 recommendations and resolutions underscore the importance given by the Moroccan League to the continuous effort in the fight against the diabetic epidemic in Morocco, the MENA region, and Africa.The strong involvement and participation of the various partners, including the Ministry of Health, the National Council of the National Order of Physicians, Social Welfare Organizations, and the Moroccan Parliament, is a considerable achievement in this multisectoral and partnership approach.In this context, the right of diabetics constitutes a priority goal, enabling to engage as much the policies as all the partners concerned to improve not only the therapeutic management of the diabetic but also the right to information, education, and the right to social justice.On the other hand, the establishment of an African Observatory for the Protection and Promotion of Diabetes Rights will make it possible to follow the evolution of the Diabetes epidemic in the continent as well as the rights and achievements in this field
Académie Nationale de Médecine - Une Tradition Bicentenaire de Modernité
No full textC'est sous le signe de la modernité, qu’est fondée l'Académie nationale de médecine, au début du XIXème siècle, alors que notre discipline émerge d'une longue période d'obscurantisme.Après Bichat, mort prématurément, les pionniers, Laënnec, dont le stéthoscope permet pour la première fois d'écouter ce qui se passe à l'intérieur du corps humain , Larrey, le premier chirurgien des temps modernes , Pinel, le premier psychiatre... sont appelés à siéger dans la jeune académie fondée par Louis XVIII en 1820.Toujours sous le signe de la modernité, c'est à l'Académie de médecine que présentent leurs travaux révolutionnaires Pasteur et Marie Curie, deux figures emblématiques de la science, des découvreurs comme Laveran, prix Nobel de médecine, des novateurs comme Robert Debré, pédiatre éminent mais aussi inventeur des CHU. Alexander Fleming y fit connaître au monde sa découverte de la pénicilline...
Myeloid Sarcoma, a Rarity of the Head and Neck Region - A Case Report
Get PDFMyeloid sarcoma is a rare disease, where a mass (tumor) of either myeloblasts or immature myeloid cells conglomerate in extramedullary anatomic sites. It may arise de-novo or it may present in association with acute myeloid leukemia. It can also occur in patients with myelodysplastic syndromes, myeloproliferative disorders, and blast transformation in myeloproliferative neoplasia. Myeloid sarcoma of the head and neck area can pose a diagnostic challenge because of the low frequency of occurrence, and the vast diversity of tumors occurring from multiple lineages in this anatomic region. This can lead to a broad spectrum of various differential diagnoses. Therefore, a high index of suspicion is required when dealing with a possible case of myeloid sarcoma, as it is a time-sensitive diagnosis with various diagnostic dilemmas. Here, we report an example, a case of tonsillar myeloid sarcoma. We wish to highlight the investigations that helped us procure this diagnosis in a timely manner