Lumbar hernias are rare conditions and about 300 cases have been reported since the first description by Barbette in 1672. Therefore strangulation or incarceration are also exceptionally encountered. We present a 62 -year-old-man who had strangulated left lumbar hernia and consequent mechanical small-bowel obstruction, alongside with a non strangulated right lumbar hernia. Through a median laparotomy, an intestinal necrosis was found. A bowel resection with end to end anastomosis was performed and the lumbar hernias were repaired on both sides. The recovery was uneventfull. To the best of our knowlwdge thanks to the litterature review presented here, this is the 19th case of incarcerated or strangulated spontaneous lumbar hernia described in the surgical litterature since 1889.
Despite the enormous progress in prevention and treatment, tuberculosis disease remains a leading cause of death worldwide and one of the major sources of concern is the drug resistant strain, MDR-TB (multidrug resistant tuberculosis) and XDR-TB (extensively drug resistant tuberculosis). In this work, we extend the standard SEIRS epidemiology model of tuberculosis to include MDR-TB. For that, we considered compartments of susceptible, exposed, infected, resistant to a first line of treatment and recovered humans and we modeled the natural growth, the interactions between these populations and the effects of treatments. We calculate the basic reproduction number, 0 , using the next generation method. The DFE and the EE are established and their stability analysis done to show that they are locally and globally asymptotically stable. Numerical analysis for the model with and without delay is done and demonstrated that in the case of patients with both active tuberculosis and MDR tuberculosis, both strains will still persist due to lack of permanent immunity to tuberculosis while the recovered can still lose their immunity to become susceptible again.
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