[Etiology and prognosis of acute mechanical intestinal obstructions at the National Hospital of Zinder: Cross-sectional study of 171 patients]

Acute mechanical intestinal obstruction (AIO) is one of the most frequent pathologies in emergency digestive surgery. The objective of this study was to describe the etiologic and prognostic features of acute mechanical intestinal obstruction at the National Hospital of Zinder (HNZ), Niger. We conducted a cross-sectional study including all the patients operated for AIO over a period of 24 months (January 2013 - December 2014) Mechanical intestinal obstructions represent 24.50% (n=171) of digestive surgical emergencies (n=622). The median age was 25 years (range: 1 day-95 years). The sex ratio was 3.5 in favour of men. Children accounted for 38.60% (n=66). The seat of the obstacle was at the level of the small bowel in 60.82% (n=104), colonic in 21.63% (n=37) and mixed in 17.54% (n=30). The mechanism of strangulation accounted for 88,89% (n=152), among these strangulated hernias were detected in 49,70% (n=85) of patients and acute intestinal invaginations in 19,88% (n=34) of patients. Anorectal malformations and tumors were the main cause of obstruction in 7.02% (n=12) and 3.51% (n=6) of cases respectively. Intestinal resection was performed in 52 cases (30.41%). Septic complications prevailed (n=39/53); among these parietal suppuration (n=23). The average length of stay in hospital was 7.82 days. The overall mortality rate was 11.70% (n=20). This was statistically correlated to intestinal necrosis (p=0.01) and to delayed hospital admission (p=0.04). There are many causes of AIO which are dominated by strangulated hernia. The high morbidity and mortality rate from AIO might be prevented by early treatment performed before intestinal necrosis occurs.

ADHD matures: time for practitioners to do the same?

Attention deficit and hyperactivity disorder (ADHD) is not restricted to children. Abundant evidence from follow-up studies accumulated since the 1970s supports the concept of ADHD in adulthood. Genetic research points to a heritability of 76%, and neuroimaging studies have reported structural and functional brain abnormalities in patients with ADHD. Contrary to popular belief, ADHD is not a culturally bound disorder and has been described worldwide. ADHD has a cost for society, as adults with this disorder suffer from increased rates of unemployment and psychiatric comorbidity, including substance use disorders. Studies undertaken in forensic populations describe high rates of ADHD in these groups, particularly amongst young offenders. One of the main issues in the diagnosis of ADHD in the adult is the fact that most clinicians have not been educated to diagnose and treat ADHD. Effective pharmacological treatments for ADHD are available and should be prescribed for these patients. The National Institute for Health and Clinical Excellence (NICE) and the British Association for Psychopharmacology (BAP) guidelines established a benchmark for service development required to treat ADHD adequately in the adult population. However, the implementation of new services has been slow. More resources are needed to effectively assess and treat ADHD in the adult.

Erotomania induced by venlafaxine: a case study

OBJECTIVE

To describe a never previously reported case of erotomania induced by venlafaxine and highlight the effect of antidepressants on the dopaminergic system.

METHOD

A case of erotomania is described.

RESULT

Erotomania occurring in two separate occasions developed after treatment with high doses of venlafaxine. The episode remitted only after lowering the dose of the venlafaxine.

CONCLUSION

Erotomania may occur with agents such as antidepressants. The dopamine neurotransmission of mood can provide further evidence for the development of newer classes of antidepressants.