Outcomes of surgical repair of Retinoschisis-associated retinal detachment compared to Rhegmatogenous retinal detachment

Background The aim of this study is to compare outcomes of primary retinal detachment (RD) repair in retinoschisis-associated RD (RSRD) and rhegmatogenous RD (RRD). Methods This is a retrospective observational cohort study. Charts of 2247 consecutive patients operated for RD repair at the Centre hospitalier universitaire de Québec – Université Laval between 2014 and 2018 were reviewed. Patients with RSRD and RRD were included to compare the visual and anatomical outcomes of both groups. Results There were 41 patients (1.8%) with RSRD and 1661 patients (74%) with RRD. RSRD patients had more primary repair failures (n = 9, 22%, vs. n = 166, 10%; p = 0.013). The primary anatomical success rates for pars plana vitrectomy with and without scleral buckle (PPV-SB vs. PPV) as primary repair method were similar in both RSRD patients (n = 11/14, 79% vs. n = 20/25, 80%; p = 0.92) and RRD patients (n = 751/827, 91% vs. n = 641/721, 89%; p = 0.21). At final follow-up, best corrected visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) was 0.30 [0.10, 0.88] and 0.18 [0.10, 0.40] (p = 0.03) in RSRD patients and RRD patients, respectively. Presence of retinoschisis was associated with worse final VA (β 0.082, p < 0.001). Other predictive variables included female sex, macula-off presentation, number of RD quadrants involved, longer symptoms duration, worse baseline VA, and primary repair failure. The greatest predictors were worse baseline VA, primary repair failure, and macula-off status at presentation. Presence of retinoschisis did not significantly increase risk of primary repair failure in multivariable analysis (OR 1.45, 95% CI: 0.50–4.17; p = 0.49). Symptoms duration was the greatest effect factor associated with for primary repair failure (OR 1.37, 95% CI: 1.12–1.69; p = 0.003). Conclusions RSRD is associated with more primary repair failure in univariate analysis, but not in multivariate analysis after adjusting for symptoms duration. It is however associated with worse final VA even after adjusting for primary repair failure. Both PPV and PPV-SB are valid repair methods for RSRD. However, RSRD remains a challenge to treat.

Therapeutic and evolutive aspects of diaphyseal leg fractures at the Joseph Ravoahangy University Hospital Center Andrianavalona Madagascar

La prise en charge d’une fracture de jambe est fonction de la classification de la lésion, du plateau technique et de l’expérience du chirurgien. Le but de notre travail est de déterminer les aspects thérapeutique et évolutif des fractures diaphysaires de la jambe prises en charge au Service de Traumatologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHU-JRA) Madagascar. Il s’agissait d’une étude descriptive de 74 patients hospitalisés dans le Service en 2017. Il y a une discrète prédominance des fractures ouvertes (52,7%) dont 41,01% étaient classés type II selon Gustilo Anderson. Les fractures concernaient les deux os dans 79,7%. Le traitement était orthopédique dans 74,7 % par un appareil plâtré cruro-pedieux précédé ou non d’une traction trans-calcanéenne. Parmi ceux qui ont été opérés, 47,4% ont bénéficié d’un enclouage centromédullaire type Kuntcher, 31,58% d’un fixateur externe et 21,02% d’une amputation transtibiale. L’évolution a été favorable dans 87,7%. Les complications étaient dominées par les infections (5,46%), lésions vasculo-nerveuses (4,09%) et les cals vicieux (1,36%). Le séjour hospitalier moyen étaient de 14 jours (1-86 jours). La prise en charge des fractures de jambe reste un challenge pour les chirurgiens dans les pays en voie de développement. L’optimisation de cette prise en charge passe par l’amélioration de l’accès aux soins et l’ajustement de la logistique hospitalière.

Respiratory Syncytial Virus and Metapneumovirus Infection Have Different Clinical Presentation in Children

Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV), members of Pneumoviridae family are common causes of acute respiratory tract infections (ARTI) among children. Study material includes routine nasopharyngeal samples obtained during 8-year period for hMPV and one single season for RSV in children aged 0 to 15 years at the Centre Hospitalier Universitaire (CHU) Saint Pierre in Brussels. Positive samples for RSV or hMPV identified by viral culture, lateral flow chromatography test for RSV or direct fluorescent assay for hMPV were selected retrospectively. The medical charts of these patients were reviewed. Hospitalization rate was 37% (219/591) and 39% (187/476) for hMPV and RSV respectively. Children hospitalized for RSV infection were significantly younger and more dyspneic, requiring more respiratory support, longer hospital stay and transfers in Pediatric intensive Care Units (PICU) than those hospitalized for hMPV infection. Pneumonia diagnostic and antibiotics therapies were more significantly associated with hMPV infections.In conclusion, despite their genetic similarities, RSV and hMPV present epidemiological and clinical differences in pediatric infections.

Prolapsus Muqueux de L’urètre au Centre Hospitalo-Universitaire Départemental de Borgou -Parakou, Bénin

Introduction: Le prolapsus muqueux de l’urètre est l’éversion circonférentielle de l’épithélium de la muqueuse urétrale congestive à travers le méat urinaire. L’objectif de cette étude était de rapporter la prise en charge des prolapsus muqueux de l’urètre. Méthodes: Il s’est agi de 7 dossiers de patientes prise en charge pour de prolapsus muqueux de l’urètre colligés rétrospectivement sur 4 ans dans le service de chirurgie du centre hospitalier universitaire départemental de Borgou à Parakou, au Nord du Bénin Résultats: L’âge moyen des patients, tous de sexe féminin, était de 4±0,8 ans avec des extrêmes de 2 ans et de 08 ans. Le principal motif de la consultation a été l’hémorragie génitale. A l’examen physique on retrouvait une tuméfaction sous-clitoridienne centrée par le méat urétral. La prise en charge a été chirurgicale. Nous avons procédé dans tous les cas en une excision de la muqueuse prolabée suivie d’une suture muco-muqueuse sur une sonde de Foley pour 48 heures. Les suites opératoires étaient simples et aucune récidive n'est observée après un recul moyen de 7 mois. Conclusion: Le prolapsus urétral est une affection rare qui se rencontre chez les fillettes prépubères. Le traitement chirurgical donne de résultats cliniques et esthétiques satisfaisants. Background: Mucosal prolapse of the urethra is the circumferential eversion of the epithelium of the congestive urethral mucosa across the urinary meatus. The objective of this study was to report our experience in the management of mucosal prolapse of the urethra. Methods: We reviewed 7 cases of patients treated for mucosal prolapse of the urethra, collected retrospectively over 4 years in the surgical department of the departmental university hospital of Borgou in Parakou, northern Benin. Results: The mean age of the patients, all female, was 4±0.8 years with extremes of 2 years and 08 years. The main reason for consultation was genital hemorrhage. Physical examination revealed a subclitoral swelling centered on the urethral meatus. The management was surgical. We proceeded in all cases with an excision of the prolapsed mucosa followed by a muco-mucosal suture on a Foley catheter for 48 hours. The postoperative course was simple and no recurrence was observed after a mean follow-up of 7 months. Conclusion: Urethral prolapse is a rare condition that occurs in prepubertal girls. The surgical treatment gives satisfactory clinical and aesthetic results.