ABSTRACT
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.

ABSTRACT
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.

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Background: Wrist denervation is a palliative intervention aimed at alleviating painful symptoms while preserving joint mobility. However, the outcomes of this procedure remain controversial. Objectives: The purpose of our study is to assess the long-term results of wrist denervation. Design & Methods: Our experience involved 25 denervations performed between 2009 and 2019. Retrospective evaluation of results focused on pain (visual analog scale), function (Quick Dash), joint ranges of motion, and radiological control. Results: Our patients were middle-aged men (average age: 44 years) and one woman (age: 47 years); 16 of them were manual laborers. The dominant side was affected in 20 cases. The conditions treated included sequelae of scaphoid nonunion in 16 cases, severe scapholunate ligament injury in 5 cases, distal radius fracture in 3 cases, and Kienböck's disease in 1 case. Our surgical technique involved three approaches: dorsal, dorso-radial, and dorso-ulnar, with excision of the posterior interosseous nerve, anterior interosseous nerve, and articular branches of the radial sensory nerve and dorsal cutaneous branch of the ulnar nerve. Two patients were lost to follow-up. The average follow-up period was 43 months. Pain, assessed using a visual analog scale, averaged 3 at rest and 5 during activity. There was no change in wrist joint ranges of motion. The average postoperative Quick Dash score was 22.24/100. Only 5 patients showed no improvement. Radiological findings remained stable in the majority of cases. Complications included transient paresthesias (2 cases), algodystrophy (2 cases), and cold intolerance (2 cases). Only 5 patients required reclassification. Conclusions: The typical indication is a chronically painful wrist in a patient retaining useful strength and ranges of motion. This experience confirms the expected outcomes of this surgery: pain relief and preservation of mobility, following a technically precise yet simple procedure with few notabl

ABSTRACT
The incarceration of the vermicular appendage through the hernia sac is commonly referred to as Claudius Amyand's hernia. It is a rare and exceptional pathology in children providing an acute scrutum. We report the case of a 7-month-old boy with an acute scrotum due to a strangulated inguno scrotal hernia who admitted to pediatric emergencies. The management consisted in a conditioning and a preoperative assessment. An exploration having revealed in the hernia sac an appendix of normal appearance. An appendectomy and a closure of the hernia sac was done. Evolution was uneventful.

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Background: Neonatal sepsis is among the leading causes of neonatal mortality. Due to limited laboratory services, the diagnosis is mainly based on clinical presentation. Signs and symptoms of neonatal sepsis are multiple and nonspecific. Blood culture is the gold standard for the diagnosis of neonatal sepsis. The demographic and obstetric factors associated with neonatal sepsis vary in facilities and locations. Therefore, we conceptualized the study to determine the factors that can independently predict the occurrence of neonatal sepsis. Methodology: A prospective cross-sectional study was conducted by recruiting neonates admitted to the neonatal ward with signs and symptoms of sepsis. The blood sample was collected for culture, and isolates were identified using conventional methods. Descriptive analysis was presented as frequencies and proportions. Univariate logistic regression analysis was used to analyze the factors associated with laboratory-confirmed neonatal sepsis. Multivariable logistic regression was performed to determine the independent predictors of neonatal sepsis. A p-value of less than 0.05 was considered statistically significant. Results. Two hundred seventy-nine neonates were recruited; 161(57.7%) were aged less than four days. Fever was the most common complaint in 72.4% of neonates among the 13 clinical features used to determine the clinical diagnosis of neonatal sepsis. Of 279 blood cultures performed, 198(71.0%) were culture-positive. In bivariate analysis, birth asphyxia, vaginal delivery, and foul-smelling liquor had increased odds of neonatal sepsis. However, neonatal sepsis was independently associated vaginal delivery. Neonates born through vaginal delivery had 2.57 times the adjusted odds of getting neonatal sepsis than those born by cesarean section (aOR = 2.57, 95% CI = 1.3–28.2, p= 0.021) Conclusion: Vaginal delivery was the only factor independently associated with laboratory-confirmed neonatal sepsis. There is a need for evalua

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Introduction: Abdominal trauma is a shock of any kind exerted on the abdomen. It is quite frequent in childhood and is of type: abdominal bruises, and abdominal wounds. This study aimed to assess the epidemio-clinical and evolutionary aspects of abdominal trauma in childhood. Materials and Methods: The results, from a retrospective study covering children aged 0 to 15 years, treated in the Pediatric Surgery Service of Fousseyni Daou Hospital in Kayes from January 2021 to December 2023 for abdominal trauma. Results: Over a period of 2 years we collected 20, 16 boys and 4 girls cases, being a hospitalization frequency of 5.71%. The age bracket of 11 to 15 years was majority being 60% with a male predominance of 80%. Pupils were the majority with 60%. The predominant functional sign was abdominal pain in 100% of cases and one case of terminal hematuria, associated with a minimal pelvic fracture secondary to a seizure. Ultrasound imaging was performed in 80% of our patients. A laparotomy was performed in 35% (7). In our operated patients we recorded 1 case of parietal suppuration. Evolution was favorable in all our patients and one was reoperated for occlusion on flange. After a median retraction of 6 months, the mortality rate was 0%.

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Abstract: Since 2012, Mali has been experiencing a security crisis, characterized by armed attacks against civilians and soldiers; in the form of terrorist attacks or ambushes using various vulnerable agents. The injuries observed are often multiple and serious and can affect all organs to varying degrees. The penis is rarely hit by firearms due to its position, its volume relative to the rest of the body, and its mobility. We report a case of penile urethral section by firearm, initially treated in a primary structure, then referred to our structure for better management. The patient was a 13-year-old boy with no known medical or surgical history. He was traveling to their field with his older brother in a cart. Along the way, they were attacked by unidentified armed individuals. They were immediately rescued and taken back to their health facility, where the older brother succumbed to his injuries. There, he underwent an open cystostomy and a penile bandage, as he had no other associated injuries. A week later, he was referred to our facility for better care. On admission, he was hemodynamically stable and had a well-draining cystostomy catheter. Lateroventral penile degeneration was present, along with a section of the penile urethra over an infected wound. There were no lesions of the corpora cavernosa. Otherwise, there were no other unusual features. We initially initiated treatment with antibiotics, anti-inflammatories, and a daily dressing. He also received antitetanus serum. Three months later, we scheduled and performed an end-to-end urethroplasty of the penile urethra under a CH14 catheter. The postoperative course was uneventful.