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Human monkeypox virus is spreading globally, and more information is required about its epidemiological and clinical disease characteristics in endemic countries. We report the investigation of an outbreak in November 2021 in Central African Republic (CAR). The primary case, a hunter, fell ill after contact with a non-human primate at the frontier between forest and savannah. The ensuing investigation in a small nearby town concerned two families and four waves of inter-human transmission, with 14 confirmed cases, 11 suspected cases and 17 non-infected contacts, and a secondary attack rate of 59.5% (25/42). Complications were observed in 12 of the 19 (63.2%) confirmed and suspected cases with available clinical follow-up data: eight cases of bronchopneumonia, two of severe dehydration, one corneal ulcer, one abscess, two cutaneous superinfections, and six cutaneous sequelae (cheloid scars, or depigmentation). There was one death, giving a case fatality ratio of 1/25 (4.0%) for confirmed and suspected cases. This outbreak, with the largest number of confirmed cases ever described in CAR, confirms the potential severity of the disease associated with clade I monkeypox viruses, and highlights the need for rapid control over virus circulation to prevent the further national and international spread of infection.
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BACKGROUND: Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS: We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS: Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION: INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.
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Hiperbilirrubinemia Neonatal/epidemiología , Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos/complicaciones , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Hospitalización , Humanos , Hiperbilirrubinemia Neonatal/complicaciones , Hiperbilirrubinemia Neonatal/mortalidad , Hiperbilirrubinemia Neonatal/terapia , Recién Nacido , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/terapia , Mianmar/epidemiología , Fototerapia , Estudios Retrospectivos , Factores de Riesgo , Tailandia/epidemiologíaRESUMEN
The authors report a case of cavernous hemangioma of the kidney, a rare benign tumor. The interest of this case is probably to be the only one reported with MRI: an high signal intensity T2 in weight sequence could represent in the future a good information for the diagnosis. Endoscopic methods are useful for the diagnosis, but cannot be used for therapy. The treatment is surgical. Selective embolisation could be a good alternative in the future.
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Hemangioma Cavernoso/diagnóstico , Neoplasias Renales/diagnóstico , Adulto , Femenino , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/cirugía , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Imagen por Resonancia Magnética , Nefrectomía/métodosRESUMEN
The authors report their experience of a rare tumor of the kidney : papillary renal cell-carcinoma. This tumor was composed of papillary vegetations sometimes with infiltrating macrophages. They report the pathological and clinical features and the hypovascularized appearance of this tumor. The prognosis is better than that of clear cells adenocarcinoma.
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Cistadenocarcinoma/patología , Neoplasias Renales/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Cistadenocarcinoma/mortalidad , Femenino , Humanos , Neoplasias Renales/mortalidad , Masculino , Persona de Mediana EdadRESUMEN
The authors report their experience of a rare tumor of kidney : oncocytoma. This tumor was made of polygonal cells separated by an endocrinoid stroma. They report pathological feature and clinical course and pronostic who is better than in carcinoma. Other names have been given : proximal tubular adenomas, true kidney hypernephroma, Riopelle tumor.
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Adenoma/patología , Neoplasias Renales/patología , Adenoma/mortalidad , Adenoma/cirugía , Adulto , Anciano , Femenino , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía , PronósticoRESUMEN
The authors report a case of rupture of the renal pelvis in a young man, the course of which was spontaneously favourable over a period of a few days. No aetiology was determined, despite complete clinical, biological, pyelographic and arteriographic studies. The patient recovered completely without surgical or urological treatment. This condition is rare, 50 cases having been published in 1975.
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Abdomen Agudo/etiología , Enfermedades Renales/diagnóstico , Pelvis Renal , Humanos , Enfermedades Renales/fisiopatología , Enfermedades Renales/terapia , Pelvis Renal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Remisión Espontánea , Rotura EspontáneaRESUMEN
New knowledge on arterial blood supply of the 3rd and 4th parts of theduodenum. Injection of the digestive arterial system in 15 adult subjects allows the study of the blood supply of the 3rd and 4th parts of the duodenum. Although the duodeno-pancreatic arches are constantly found, the authors showed that the branches to the duodenum have a variable layout. On the right of the superior mesenteric artery, the distribution of the branches is always regular on both sides of the 3rd part of the duodenum. On the other hand, on the left of this artery, there is sometimes a vascular hiatus which may extend to the duodeno-jejunal angle. Although in 60 per cent of the cases, this part of the duodenum is well supplied with blood on both surfaces, in 40 per cent of the cases on the other hand, there exists an avascular area on both sides. This lay-out is not favorable for division and anastomosis of this segment of the digestive tract.
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Arteria Celíaca/anatomía & histología , Duodeno/irrigación sanguínea , Arterias Mesentéricas/anatomía & histología , Duodeno/cirugía , HumanosRESUMEN
The authors studied the blood supply of the 3rd and 4th parts of the duodenum in 15 adult subjects. Although the duodeno-pancreatic arches are constantly found, the branches to the duodenum have a variable lay-out. On the right, the superior mesenteric artery, the distribution of which is always regular on both sides of the 3rd part of the duodenum. On the other hand, on the left, the superior mesenteric artery, there is sometimes a vascular hiatus which may extend to the duodeno-jejunal angle. Although in 60 p. cent of cases this part of the duodenum is well supplied with blood on both surfaces, in 40 p. cent of cases on the other hand, there exists an avascular area on both sides. This lay-out is not favourable for division and anastomsis of this segment of the digestive tract.