Ibn Tofail University Hospital is one of the major hospitals of Marrakesh, Morocco. In February 2001 the Moroccan Government signed an $8 million loan agreement with The OPEC Fund for International Development to help improve medical services in and around Marrakech, which led to expansions of Ibn Tofail and Ibn Nafess Hospital. Seven new buildings were constructed, with a total floor area of 43,000 square metres (460,000 sq ft). New radiotherapy and medical equipment was provided and 29,000 square metres (310,000 sq ft) of existing hospital space rehabilitated.
Primary adenocarcinoma of the base of the tongue is an exceptionally rare malignancy, accounting for only a small proportion of oropharyngeal tumors. Diagnosis is challenging due to nonspecific symptoms and overlap with more common squamous cell carcinomas and salivary-type neoplasms. We report the case of a 59-year-old Moroccan woman presenting with progressive dysphagia and referred otalgia. Nasofibroscopy revealed a right-sided base of the tongue mass extending to the vallecula. Magnetic resonance imaging confirmed a 28 × 19 mm lesion with ipsilateral cervical lymphadenopathy. Biopsy demonstrated an undifferentiated invasive adenocarcinoma. Immunohistochemistry was positive for CK7 and CK20 and negative for p16. The patient underwent transmandibular resection with bilateral neck dissection, followed by adjuvant radiotherapy. At 6-month follow-up, she remained disease-free with good functional outcomes. A narrative systematic review was conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting primary base of the tongue adenocarcinoma were included. A total of 12 publications describing comparable cases were identified. Most patients presented with dysphagia and cervical lymphadenopathy. Surgery followed by radiotherapy was the most commonly reported management strategy. Prognosis appeared favorable in low-grade salivary-type tumors and more variable in high-grade or nonsalivary primaries. Primary base of the tongue adenocarcinoma is rare and requires a high index of suspicion and appropriate immunohistochemical evaluation. Multimodal management offers good oncologic control. Long-term follow-up is necessary due to uncertain metastatic potential.
Primary large-vessel vasculitis encompasses conditions that, despite sharing many common features, constitute distinct entities that have their own prognostic implications. These conditions include giant cell arteritis and Takayasu arteritis, with isolated aortitis being increasingly recognised in the literature and studied within this disease spectrum. Epidemiological studies have evidenced a worldwide distribution of Takayasu arteritis. In giant cell arteritis, distinct clinical phenotypes with specific outcomes (ie, cranial and large vessel forms) have been recognised. The advancements that have been made in vascular imaging have enabled improvement in diagnosis and classification of these diseases, although their value in follow-up continues to be assessed. Targeted therapies that can induce clinical remission with reduced glucocorticoid exposure are emerging. However, many patients develop vascular damage over time, highlighting the need for further understanding of the pathophysiological link between inflammation, vascular injury, and remodelling.
INTRODUCTION:Percutaneous nephrolithotomy is the gold standard for large renal stones, with prone and supine positions offering distinct advantages and disadvantages. This meta-analysis compares the efficacy and safety of these two approaches. METHODS:This meta-analysis registered in PROSPERO (CRD42024603670) followed PRISMA and AMSTAR guidelines, including RCTs, cohort, and case-control studies comparing SP and PP PCNL for renal stones. It assessed demographic data, stone-free rate, operative time, hospital stay, complications and hemoglobin drop, with bias risk evaluated using Cochrane and ROBINS-I tools and statistical analysis performed in Jamovi. RESULTS:Forty-three studies with 11,774 patients were included. No significant differences were found in patient characteristics, SFR (RR=0.9945, P=0.7008), hemoglobin drop (P=0.0800), or hospital stay duration (P=0.1942). The SP group showed shorter OT (SMD=-0.3895, P=0.0084), fewer overall (RR=0.8692, P=0.0026) and major complications (RR=0.7461, P=0.0151). SP also had lower rates of visceral injury (RR=0.8485, P=0.1581), transfusion (RR=0.8514, P=0.1497), sepsis (RR=0.7880, P=0.1304), urinary leakage (RR=0.7699, P=0.2681), and pleural effusion (RR=0.5564, P=0.0898), but these were not statistically significant. CONCLUSION:This meta-analysis found no significant differences between SP and PP in demographics, stone size, SFR, hospital stay, or hemoglobin drop. However, SP was associated with shorter OT, fewer complications and major complications, suggesting it is a viable alternative.
Chloride plays a considerable role in physiology. This study aimed to assess the association between serum chloride and prognosis in the population of adults with acute medical conditions. A prospective cohort study was conducted in an acute medical unit. Chloride levels at admission were the main exposure factor, categorized into hypochloremia, normochloremia, and hyperchloremia. The outcomes were in-hospital mortality and length of hospital stay (LOHS). A total of 798 patients were included. The mean age was 57.3 ± 18.3 years. The prevalence of dyschloremia was 40.9%. Restricted cubic splines revealed a linear association between hypochloremia and in-hospital mortality, as well as between hypochloremia and LOHS. After adjusting for age, sex, heart failure, diabetes, sodium, bicarbonates, creatinine, and diuretic use, hypochloremia was significantly associated with in-hospital mortality (OR = 2.23; 95% CI: 1.29, 3.86, p = 0.006), but not hyperchloremia (p = 0.57). Similarly, it was associated with a longer LOHS (β = 2.19; 95% CI: 0.01, 4.39, p = 0.05), but not hyperchloremia (p = 0.8). The interaction between chloride and sodium levels was not significant (p = 0.61). Subgroup analysis showed that the effect of hypochloremia on in-hospital mortality was consistent across subgroups. The prevalence of dyschloremia in this study was high at 40.9%. Hypochloremia increased the risk of in-hospital mortality and extended the LOHS. Differentiating the effects of chloride levels from those of sodium can enhance clinical risk stratification and enable a more targeted management approach for acutely ill patients. Recognizing this distinction is essential for optimizing prognostic assessment and tailoring treatment strategies accordingly.
Caroli disease is an uncommon congenital condition characterized by non-obstructive intrahepatic bile duct dilation. When coupled with liver fibrosis or cirrhosis, it is termed Caroli syndrome. This disorder can lead to the development of gallstones, inflammation of the bile ducts, and an elevated susceptibility to cholangiocarcinoma. Typically, Caroli disease presents with involvement in less than 20
