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Introduction: Complex anal fistula (CAF) is a complex condition to treat because of the possibility of recurrence and impoverished continence. DLPL (Distal laser proximal ligation), is a novel approach to treating difficult anal fistula that involves suturing the proximal portion of the fistula tract close to the internal opening and using a diode laser to close the distal part of the fistula tract. This study aimed to evaluate the clinical efficacy and safety of DLPL Sphincter Saving Laser Surgery for Complex Anal Fistula. Aim of the study: The aim of this study was to evaluate the clinical efficacy and safety of DLPL Sphincter Saving Laser Surgery for Complex Anal Fistula - A Gold Standard Procedure in a study of 40 cases. Methods: This study was a prospective observational study that investigated the outcomes of DLPL (Distal Laser Proximal Ligation) for patients with complex anal fistula. The patients met clinical diagnosis of complex anal fistula according to the Parks classification, age of 10 years or more, and failure of previous conservative or surgical treatments. The patients were followed up at 3 and 6 months after the surgery, and assessed using fistulogram, endo anal ultrasound, MRI. Result: The study enrolled 40 patients (35 males and 5 females) with mean age being 31.25 years. 31 (77.50%) patients had non-specified histopathology. 2 (5.00%) patients had Chron’s disease, 2 (5.00%) patients had F.B Granuloma, and 5 (12.50%) patients had Tuberculosis. The patients were assessed using fistulogram, endo anal ultrasound, MRI. After 6 months, the patients were followed up and 38 (95.00%) patients had no recurrence, only 2 (5.00%) patients had recurrence. Conclusion: The results showed high success rate and low complication rate of DLPL for complex anal fistula. Therefore, this study concluded that DLPL is a safe and effective sphincter-saving technique for complex anal fistula, and that it may be considered as a gold standard procedure for this challenging c

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Introduction: The general definition of surgical site infections (SSI) includes any infection at the operated site, occurring within 30 days following the procedure or within one year if there has been placement of an implant or 'a prosthesis. Surgical site infection (SSI) represents one of the main healthcare-associated infections (HAI). Material and Methods: The general surgery department of the Mamou Regional Hospital (HRM) served as the setting for our study. This was a prospective, descriptive study lasting 6 months, from May 1 to October 31, 2016. The aim of the study was to help improve surgical site infections in the department. Results: We collected 175 interventions, 27 of which developed an SSI, or 15.42%. The average age of our patients was 33.52 years with extremes of 7 and 82 years, the most affected age group was between 11 and 20 years, i.e. a frequency of 29.63%. Patients in the dirty surgery class were the most represented with a rate of 44.44%. Deep surgical site infection was the most common with 48.15%. Conclusion: Infection of the surgical site remains one of the postoperative complications most feared by surgeons because it ruins the success of the surgical procedure and compromises the functional or vital prognosis. We found an average ISO frequency compared to the African series.

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Cutaneous metastases are phenomena typically more frequently observed in advanced stages of the disease. However, some cancers can remain clinically silent until the discovery of a cutaneous metastasis, often complicating the diagnosis of the primary tumor, especially if it's a rare tumor like breast cancer in men. It is in this context that we report a case of localized cutaneous metastasis on the scalp, without the presence of other associated clinical signs. Investigations revealed a metastatic breast carcinoma requiring extensive surgical intervention, complemented by adjuvant treatments.

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Objectives: Primary spontaneous pneumothorax is a public health problem because of its frequency and its occurrence in a population often young. It is a pathology which natural evolution is marked by the occurrence of recurrence. The purpose of the surgical treatment of PSP is to resect the apical bulla and bleb areas. In addition, various pleural adhesion procedures are recommended to prevent recurrence. Methods: Between 2015 and July 2021, the results of 289 operations performed patients with PSP were examined. The variables analyzed were age, sexe, risk factor, morbidity and mortality surgical results. The average patient follow-up rate is 26 months. Results: Recurrent PSP largely dominated the surgical indications with a rate of 73.8%. Complications were seen at a rate of 5.1%. These complications required revision surgery in 3 cases. The recurrence rate is around 1.7%. However, the residual postoperative pain is around 10.7%. The average length of stay is around 6.8 ±1.2. The mortality rate was nil. Conclusion: Surgery for primary spontaneous pneumothorax has shown encouraging results, during which it must be performed as soon as possible once the indication for surgery has been established.

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Pulmonary aspergilloma is an infectious human disease caused by colonization of a pre-existing cavity in the lung by a fungus of the genus Aspergillus. The spores are transmitted through the air, without contagiousness between people and germinate in a cavity to form a “mycelial” ball. The disease can go unnoticed, especially in the early phases, but is often complicated by hemoptysis of variable abundance which can even be dramatic. Surgery is the treatment to stop the progression of the disease, but this surgery is burdened with significant morbidity and mortality. We report a study of 69 patients operated on for pulmonary aspergilloma. Our results in terms of better quality of life and prevention of complications are acceptable at the cost of reduced morbidity.

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Introduction: The circular umbilical cord corresponds to a winding of it in one or more turns of the whorl around the fetal neck. Case observation: She is a 25-year-old primigeste, married, a nurse by profession with no known medical-surgical history, who consulted for painful uterine contractions on pregnancy of 38 weeks of amenorrhea (AS). This is a pregnancy well followed by a gynecological-obstetrician with 06 quality antenatal consultations. The clinical and biological monitoring parameters were well documented in the antenatal diary and show no abnormalities. Conclusion: Fetal death in utero is a common pathology but association with umbilical cord circulars is rare. When the umbilical cord circular is double and tightened around the neck like a knot of the cord. It could be the cause of unexplained fetal death. It is always a tragedy for the parents and a failure for the obstetrician. It is necessary to reassure the woman and her family about the prognosis of subsequent pregnancies.

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Goal: Raise awareness among the population to be consulted early in the event of penile cancer and to accept the treatment proposed by the clinician, based on three observations of penile cancer treated in the urology department of the center of reference health Koutiala. Material and methods: This was a prospective review of three cases of penile cancer diagnosed and treated in the urology department of the Koutiala reference health center over a period of two years from January 1, 2021. As of December 31, 2022. The first case was a squamous cell carcinoma of the penile in a 67-year-old patient who suffered amputation of the glans during circumcision, having undergone an adenomectomy in December 2020. The second patient was 63 years old and circumcised; having had urinary bilharzia in childhood and also presenting squamous cell carcinoma. The third case was a 74-year-old circumcised patient with ulcerated swelling of the glans. A review of the literature made it possible to identify the frequency and risk factors and/or precancerous lesions of this cancer on both sides in the world in general and more particularly in Africa. Results: Over a period of two years, three cases of penile cancer were recorded and treated in the urology department of the Koutiala reference health center. The three patients were aged 67, 63 and 74 years respectively. They were all farmers, circumcised and one had his glans amputated during the circumcision. A cystotomy was performed in one patient but all refused amputation of the penis. No patient received radiotherapy or chemotherapy because they were all lost to follow-up. The histological type encountered in our patients was squamous cell carcinoma. Conclusion: Penile cancer remains the least common urological cancer in our practice, behind testicular cancer. Patients are seen late, at stages requiring penile amputation, which few patients accept.

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Background: The inability to conceive is emotionally distressing and indeed a very painful struggle in which the pain stays with the individual every day. Hormonal disorders are the leading cause of infertility globally. They do not only include the hypothalamic pituitary ovarian axis but also the none-reproductive endocrine glands. Hormonal management helps promote ovum maturation, which triggers ovulation, increasing the likelihood of conception. Case presentation: We report a 36-year-old African lady who presented with an inability to conceive for six years since marriage and it was associated with an irregular menstruation cycle length of twenty-four to thirty-six days. She had anovulatory cycles for seven years, and high Prolactin levels. Her body mass index was 34.4kg/m2. She had visited several hospitals in and outside Tanzania without success in conceiving. At Bugando Medical Centre we managed her case by diet, fertility awareness, and medical management. She conceived after three months of treatment. Conclusion: Anovulatory cycles with abnormal bleeding patterns are a major cause of infertility in reproductive woman. Basic hormonal profiles are essential to confirm where the problem is. Prolactinemia and insulin resistance affects ovulation. Fertility awareness, lifestyle changes, and medical management will bring back happiness to most women with subfertility secondary to hormonal disorders.

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Background: As a leading global cause of death and disability, heart failure places a significant strain on the healthcare system. It has been observed that in some countries, there is a seasonal increase in the number of people admitted to hospitals with heart failure during winter. However, there is a dearth of population-based statistics for Southeast Asia and Bangladesh. with regards to this subject. Objective: To determine the number of patients with heart failure admitted during the winter and other seasons in Bangladesh's tertiary care hospitals. Materials and Methods: This study used a cross-sectional, observational design. The study was carried out at the Cardiology Department of Dhaka Medical College Hospital (DMCH). The research took place over the course of a year, from April 2015 to March 2016. Patients with heart failure who are admitted to the DMCH's Cardiology Department constitute the study population. This study made use of a systematic sampling strategy. All 584 patients who visited the hospital's cardiology department were counted. Patients' demographics, medical histories, symptoms, and test results were recorded on a standard data collection form. The statistical software package SPSS 22.0 was used to analyze the data (Statistical Package for Social Science). Results: Heart failure patients were most prevalent in the 41 to 60 age group, with 74.3% being men and 25.7% being women. The winter season saw the largest number of patient admissions (n=207, 35.5%). Compared to other seasons, the winter had higher concentrations of all risk variables. It is statistically significant, with the exception of thyroid issues and dyslipidemia (p-values of <0.222, <0.001, <0.001, <0.001, and <0.006). Conclusion: General practitioners might learn how to handle heart failure patients' responses to the cold and hone their abilities in this area. This research may also be useful for modifying the wintertime accessibility of hospital resources like emergency rooms.

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The Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs. Besides fat storage, omentum has key biological functions in immune-regulation and tissue regeneration. Omentum biological properties include neovascularization, haemostasis, tissue healing and regeneration and as an in vivo incubator for cells and tissue cultivation. Some of these properties have long been noted in surgical practice and used empirically in several procedures. we did 5 pedicular omental flap in 5 patients to prepare hemostasis in trauma with liver crash after resection and repairs.

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Introduction: Transverse fractures of the sacrum are rare and constitute less than 1% of all vertebral fractures. While the majority is longitudinal, only 3 to 5% are transverse fractures. Transverse fractures are usually seen following a fall by high-energy trauma, hence the name “Suicidal jumper’s fractures”. Neurological deficits involving the sacral roots are common and have been reported at rates of 96% to 100% in the literature. Material and Methods: We describe two uncommon cases of fracture-dislocation of the sacrum, the first at the S2-S3 level and the second at the S1-S2 level treated by isolated laminectomy without internal fixation with cauda equina syndrome, during the year 2020 in our department, including a review of the literature on the treatment of this type of fracture. Result: Our two patients on neurologically recovered at 7 months post laminectomy. Conclusion: Isolated decompression can be considered for patients who present a stable sacrum with non-displaced fracture or an old fracture that shows fracture healing. Favorable pelvic outcomes and neurological recovery, along with acceptable stability, can be acquired.

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Acute ischemia is a vascular emergency that involves the functional and sometimes vital prognosis of the patient, it can have several etiologies including infective endocarditis. We discussed an acute ischemia of the left lower limb secondary to infective endocarditis in a 17-year-old patient.

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Low birth weight is an important public health indicator because of the strong association between birth weight and infant mortality and morbidity. The objectives were to determine the frequency of low birth weight, to describe the sociodemographic characteristics, to determine the risk factors associated with low birth weight and to determine the neonatal prognosis in the gynaecology and obstetrics department of the reference health center in Commune I of the Bamako district. Material and Methods: This was a cross-sectional, descriptive and analytical study in the department from 31 December 2020 to 30 June 2022. We carried out exhaustive sampling, taking into account all live newborns with a low birth weight. All newborns born in the department weighing between 500g and 2499g during the study period were included. Results: We recorded 4,292 births, 180 of which were low birth weight, giving an overall incidence rate of 4.2%. Of the 180 low birth weight babies, we found 111 cases of prematurity (61.7%) and 69 cases of hypotrophy (38.3%). We found that the proportion of low birth weight babies was higher in the young mothers in our study, at 60.5% for the under-19 age group. Our study showed that the extreme ages of the mother were a factor favouring or even predisposing to the occurrence of low birth weight. We noted a high frequency of primiparous women (38.7%) followed by multiparous women (32.5%). Other maternal risk factors included hypertension (8%) and a body mass index of less than 18.5% kg/m2 in 41.2% of cases. Half of the new borns (47.8%) weighed between [1501-2000g]. Among the transferred newborns, 53.3% received kangaroo mother care and 6.8% of the newborns died during the first thirty days of life. We recorded a mortality rate of 6.8%. Conclusion: Low birth weight is a public health problem because of its high prevalence and its harmful consequences, especially for infants.