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Background: Neoadjuvant chemotherapy (NAC) with either Gemcitabine-Cisplatin (GC) or Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (DD-MVAC) is a standard approach for muscle-invasive bladder cancer (MIBC). While efficacy is established, toxicity profiles may differ and impact treatment delivery. This retrospective study compares the toxicity of GC and DD-MVAC regimens at the Moulay Ismail Military Hospital in Meknes. Methods: We retrospectively analyzed the records of 21 patients with MIBC treated with NAC between January 2020 and December 2023 (Corrected Date): 14 received GC (Gemcitabine 1000 mg/m² D1, D8; Cisplatin 70 mg/m² D1, q21 days) and 7 received DD-MVAC (Methotrexate 30 mg/m² D1; Vinblastine 3 mg/m² D2; Doxorubicin 30 mg/m² D2; Cisplatin 70 mg/m² D2, q14 days with G-CSF support). Toxicities were graded according to NCI-CTCAE v5.0. Results were compared descriptively and contextualized with published data. Results: In the GC group (n=14), the most frequent grade ≥3 toxicities were neutropenia (21.4%), anemia (14.3%), and thrombocytopenia (7.1%). Grade 1-2 renal toxicity occurred in 21.4%. In the DD-MVAC group (n=7), grade ≥3 neutropenia (42.9%) and mucositis (28.6%) were predominant. Two cases (28.6%) of febrile neutropenia were observed in the DD-MVAC arm (Corrected Number). Grade 1-2 renal toxicity was noted in 28.6% of DD-MVAC patients, and one case (14.3%) of Grade 3 renal toxicity occurred. All patients completed their planned NAC regimen, except for one patient (DD-MVAC arm) who discontinued due to Grade 3 renal toxicity. Conclusion: In our small cohort, both NAC regimens induced significant toxicity. DD-MVAC appeared associated with higher rates of severe neutropenia and mucositis compared to GC. These findings, although limited by sample size, underscore the need for vigilant monitoring and proactive toxicity management for both regimens in our setting, potentially favoring GC in patients perceived as more vulnerable to

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Abstract: HER2-positive metastatic breast cancer represents a significant therapeutic challenge. Its prognosis has been altered thanks to significant advances in targeted anti-HER2 therapies. These treatments, such as trastuzumab and pertuzumab, have significantly improved the management of this pathology, enhancing patient survival, but are also responsible for adverse effects. Hypothyroidism, although less frequent than other complications, is an important side effect to recognize and manage. This clinical case presents a 47-year-old patient with HER2-positive metastatic breast cancer treated with chemotherapy combined with a dual anti-HER2 blockade using trastuzumab and pertuzumab, along with letrozole. After 52 cycles of dual blockade, the patient developed overt hypothyroidism. Levothyroxine replacement therapy improved her symptoms. This case illustrates the clinical importance of endocrine monitoring in patients receiving targeted anti-HER2 therapies, highlighting the need for a multidisciplinary approach to optimize the management of adverse effects and the quality of life of patients. A diagnostic delay of hypothyroidism can potentially impact the prognosis of the disease.

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Background: Peripheral arterial disease (PAD) is a disease of public health significance, ranging from asymptomatic to symptomatic presentation. The impact of PAD may be profound in many low to middle income countries (LMICs) where walking a substantial distance is required to obtain the daily basic needs. This study was conducted to determine prevalence of peripheral arterial disease and risk factors among diabetic patients attending an outpatient clinic in Northwestern Tanzania. Methods: A descriptive cross-sectional study carried out among adult patients attending a Diabetic Outpatient Clinic in Mwanza Tanzania. Demographic data and risk factors for PAD were recorded on a pretested questionnaire. Ultrasound guided ABI was measured using a standard mercury sphygmomanometer. Edinburgh Claudication Questionnaire (ECQ) was compared to the Fontaine Classification in PAD detection. Chi-square test, Fisher’s exact test and logistic regression analyses were used to test for significance of association between independent and dependent variables with a p-value (p) <0.05 considered statistically significant. Receiver operator characteristic (ROC) curve analysis was also utilized to determine performance of ABI against clinical grading of PAD. Results: A total of 386 participants were enrolled in this study with a mean age of 60.0 ± 12.3 years. There was a significant association between an abnormal ABI with HbA1c, family history of cardiovascular diseases, hypertension, cigarette smoking and claudication (p=0.04 to <0.001). Claudication [aOR (95% CI) = 6.30 (3.14-12.64), p<0.001] was independently associated with an abnormal ABI. Prevalence of PAD was slightly lower based on clinical grading of PAD (30.8%) in comparison to an abnormal ABI respectively (34.5%). ABI had a sensitivity of 64.7%, specificity of 79.0%, positive predictive value of 57.9%, negative predictive value of 83.4%, accuracy of 74.6%. Area under the ROC curve of ABI was 0.72 against clinical grading of PA

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Objective: To assess the determinants of referred patients for emergency surgical operation from second level hospitals to tertiary level hospital (MNH) in Dar es Salaam region, many surgical patients with surgical emergency conditions are referred to tertiary level hospitals; little information is documented for the determinants of referral of general surgery patients for emergency operations, instead of patients being operated at second level hospitals. Methodology: The study design was cross-sectional descriptive hospital-based study, conducted at emergency department of MNH in period of five months, from June – October, 2013. A total of 363 patients were referred from second level hospital to tertiary level hospital in Dar es Salaam region during the study period. Results: The determinants grouped into four main groups and several small sub groups in each main group. The main groups include type of Disease/diagnosis, Shortage or lack of medical personnel, Shortage or lack of equipment in the theatre and at the laboratory, and lastly the insufficient infrastructures. The data analysis showed that the majority of the referred patients require emergency surgical operations. The total of 363 patients referred, 62.5% of patients required urgent attention and the remaining 37.5% were cold cases. The musculoskeletal conditions was the leading referral disease 50.7%, about half of all referrals, followed by gastrointestinal diseases 26.7% and then neurological disease 11.3%. Lack or shortage of the health personnel were as follows; The leading shortage of personnel was about 36.6% referrals was due to the shortage of General Surgeons, 29.8% due to shortage of Orthopaedic Surgeons and 15.15% referrals due to shortage of Neurosurgeons. The leading factor in lack of equipment was lack of investigation services about 33.3% referrals, lack of sterile gauze at the operating theatre was about 24.8% and lack of sterile trays for surgeries was about 18.5%. The leading factor in

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Introduction: Esophageal atresia with tracheoesophageal fistula (EA/TEF), anorectal malformation (ARM), and pyloric atresia (PA) are rare congenital anomalies. Their simultaneous occurrence, especially in association with complex cardiac defects such as double outlet right ventricle (DORV), is exceedingly rare. Case presentation: A male neonate was delivered at 33 weeks of gestation via emergency cesarean section due to labor dystocia. Prenatal ultrasound had only identified cardiac anomalies. At birth, the 2000-gram infant presented with respiratory distress. Clinical examination revealed excessive salivation, absence of an anal opening with no visible perineal fistula, and inability to pass an orogastric tube. Chest and abdominal radiographs demonstrated the orogastric tube coiled in the upper esophageal pouch and a single dilated gastric bubble without distal bowel gas, consistent with EA/TEF and suggestive of proximal intestinal obstruction. Echocardiography confirmed the presence of DORV. A right thoracotomy confirmed EA with a distal tracheoesophageal fistula, which was ligated. Given the neonate’s hemodynamic instability, an esophageal anastomosis was deferred, and a staged approach was chosen, with cervical esophagostomy and feeding gastrostomy. During laparotomy, pyloric atresia with complete discontinuity between the stomach and duodenum was identified and managed with a gastro-duodenostomy. A colostomy was also performed for the high-type ARM. Despite initial postoperative stabilization, the infant deteriorated and died on day 15 from sepsis, persistent hypotension, and multi-organ failure. Conclusion: Although rare, patients with EA/TEF or ARM may present with associated pyloric atresia and complex cardiac anomalies. Early recognition and multidisciplinary approach are crucial for management of such challenging neonatal presentations.

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Infective endocarditis (IE) is a severe condition associated with high morbidity and mortality, particularly in resource-limited settings where access to timely medical and surgical management is often hindered. The development of complications such as systemic embolism further worsens the prognosis and complicates clinical management. We present the case of a 32-year-old male patient admitted for infective endocarditis complicated by severe aortic insufficiency and acute ischemia of the left lower limb during hospitalization, secondary to delayed surgical intervention. Despite multiple obstacles to care, including diagnostic delays and surgical inaccessibility, the patient experienced favorable clinical evolution. This case highlights the critical importance of early surgical intervention in IE and advocates for the development of alternative management pathways in low-resource healthcare settings to avoid devastating complications.

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Introduction: Behçet's disease (BD) is a systemic vasculitis with a triad of oral and genital aphthosis and hypopyon uveitis, potentially accompanied by various systemic manifestations. While venous thrombosis is common, cardiac involvement, including intracardiac thrombi (ICT), is rare. The occurrence of left ventricular thrombi (LVT) in BD presents significant diagnostic and therapeutic challenges. Observations and Patients: We present three cases of BD with LV thrombus diagnosed at the Cardiology Department of University Hospital Ibn Rochd, Casablanca. The patients, aged 28 to 54 years, included two men and one woman. All had a history of BD symptoms before cardiac issues were identified. Clinical examinations revealed oral and genital aphthae, skin lesions, and positive Pathergy tests in one patient. Cardiac imaging confirmed left ventricular thrombi in all patients, with varying degrees of left ventricular ejection fraction (LVEF) impairment. Treatment included corticosteroids, immunosuppressants, anticoagulants, and heart failure management. Two patients showed improvement, while one patient with severe multi-organ involvement unfortunately died. Discussion: Cardiac involvement in BD is rare, and ICTs are exceptional. These thrombi, typically adherent to the wall and less emboligenic are discovered primarily through echocardiography. The treatment is not standardized but generally involves anticoagulants, corticosteroids, and immunosuppressants. Early detection and treatment are crucial, as the prognosis is significantly influenced by cardiovascular involvement. Conclusion: ICT in BD, while rare, is a serious complication that requires careful diagnostic and therapeutic management. Echocardiography should be considered in the evaluation of BD, even in the absence of cardiac symptoms, due to the potential severity of cardiovascular involvement.