Micropenis Associated or Not with Cryptorchidism in the Endocrinology Department of Yopougon University Hospital in Ivory Coast: Epidemiological, Clinical, Paraclinical and Therapeutic Aspects

Background: Congenital malformations such as micropenis and cryptorchidism do not have immediate dramatic consequences. However, the diagnosis is often unknown at birth, and therefore late. In Ivory Coast, there are few studies on cryptorchidism and micropenis. We conducted this study to identify the epidemiological, clinical, etiological and therapeutic characteristics of the micropenis associated or not with cryptorchidism at Yopougon University Hospital. Methods: We conducted a retrospective descriptive study in the Department of Endocrinology-Diabetology of the Yopougon University Hospital carried out over 13 years from January 2005 to December 2018. All patients were included regardless of the presence of a micropenis associated or not with cryptorchidism in the clinical or paraclinical examination. Results: A total of 14 micropenis were reported associated in 6 cases with cryptorchidism. It was unilateral cryptorchidism in 4 patients or 66.66% of cases. The average age of affected patients was 21.32 years with extremes ranging from 10 months to 48 years. The reason for consultation was micropenis in 12 out of 14 cases or 85.75%. The associated signs apart from cryptorchidism were obesity in 42.86% of cases, gynecomastia in 35.71% of cases. The aetiology was dominated by idiopathic causes. Treatment with testosterone enanthate was more effective in pre-pubertal children than in adults. Conclusion: The diagnosis of micropenis associated or not with cryptorchidism is late because of the frustrations, taboos and psycho-social states that it causes. However, drug treatment is effective when treatment is started early.

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Geo-environmental parametric 3D models of SARS-CoV-2 virus circulation in hospital ventilation systems

The novel coronavirus, SARS-CoV-2, has the potential to cause natural ventilation systems in hospital environments to be rendered inadequate, not only for workers but also for people who transit through these environments even for a limited duration. Studies in of the fields of geosciences and engineering,when combined with appropriate technologies, allow for the possibility of reducing the impacts of the SARS-CoV-2 virus in the environment, including those of hospitals which are critical centers for healthcare. In this work, we build parametric 3D models to assess the possible circulation of the SARS-CoV-2 virus in the natural ventilation system of a hospital built to care infected patients during the COVID-19 pandemic. Building Information Modeling(BIM) was performed, generating 3D models of hospital environments utilizing Revit software for Autodesk CFD 2021. The evaluation considered dimensional analyses of 0°, 45°, 90° and 180°. The analysis of natural ventilation patterns on both internal and external surfaces and the distribution of windows in relation to the displacement dynamics of the SARS-CoV-2 virus through the air were considered. The results showed that in the external area of the hospital, the wind speed reached velocities up to 2.1 m/s when entering the building through open windows. In contact with the furniture, this value decreased to 0.78 m/s. In some internal isolation wards that house patients with COVID-19, areas that should be equipped with negative room pressure, air velocity was null. Our study provides insights into the possibility of SARS-CoV-2 contamination in internal hospital environments as well as external areas surrounding hospitals, both of which encounter high pedestrian traffic in cities worldwide.

The healthcare environment—The importance of aesthetic surroundings: Health professionals’ experiences from a surgical ward in Finland

There is a growing acceptance of the vital role patient centered design plays in shaping the environment. Art can be of use in every area of health care. It is within the power of each person to share and interpret experience by means of the arts, by viewing the work of others, and by using feelings and imagination. Health professionals [n = 24 of a total of n = 35], answered the Wheel Questionnaire test instrument. It measures structure, motivation/engagement, and degree of emotional investment in a situation. Participants were requested to describe, in their own words, their perception of the enrichment of the ward interiordesign and the double-sided photos with a short poetic text, and the photo-book placed at each patient room. The results demonstrate that participants are motivated, structured and emotionally engaged when describing the new enrichment. The domains and themes are: Social interaction domain;rising thoughts and conversations. Comfort domain;atmosphere. Aesthetic do main;enrichment of the working environment. It could be concluded that the surgical ward environmental enrichment stimulated conversations between health professionals and between health professionals and patients and should be regarded as an important aspect in hospital planning.

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing Klebsiella pneumoniae among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Aim: The aim of the current study is to determine: (1) the prevalence of extended-spectrum β-lactamase-producing K. pneumoniae (ESBL-Kp) isolated from clinical samples and a hospital environment in Hassan II Hospital (Settat, Morocco);(2) the associated risk factors of ESBL-Kp infections;(3) the link between clinical and environmental isolates. Methods: During the study period (April 2010 to March 2011), all patients infected and hospital environment sites contaminated by K. pneumoniae were considered as the potential study population and environmental site. The clinical data were collected to identify risk factors for ESBL carriage of K. pneumoniae infection. Screening of ESBL-and carbapenemase-producing isolates was performed by using a double-disk synergy test and the modified Hodge test, respectively. ESBL-Kp isolates were tested for the presence of genes encoding β-lactamases and were investigated by PCR. The clonal relationship between ESBL-producing isolates was analysed by ERIC- and REP-PCR method. Results: The overall prevalence of ESBL-Kp among clinical and environmental K. pneumoniae isolates was 35.13% (13/37) and 4.04% (4/99), respectively. The main risk factors for carrying ESBL-Kp were renal disease (46.15%), recent surgery (53.84%), previous hospitalisation (76.92%), and the presence of many invasive devices (53.84%). All ESBL isolates were multidrug resistant. The blaCTX-M group1and blaSHV (70.58% for each) were the most prevalent followed by blaTEM (52.94%). Thirteen strains expressed at least two bla genes. One isolate was positive in the modified Hodge test and was a blaOXA-48 producer. ERIC and Rep-PCR methods revealed an epidemic clonal dissemination of these isolates. Conclusion: The emergence of OXA-48 carbapenemase, endemic clonal dissemination and multi-drug resistance of ESBL-Kp isolates in our institution is highly alarming.

Virulence Factors and Biofilm Formation in Vancomycin Resistant Enterococcus faecalis and Enterococcus faecium Isolates in Brazil

In this work, we evaluated biofilm formation of Vancomycin Resistant of E. faecalis and E. faecium (VRE) in different culture media and adhesion substrate, as well as cellular hydrophobicity and presence of virulence genes. For this, 35 isolates were collected from a public hospital in Recife, Pernambuco, Brazil and identified by the Matrix-Assisted Laser Desorption Ionization - Time-of-flight - Mass Spectrometry (MALDI-TOF-MS) technique. Biofilm formation was analyzed by the Crystal Violet (CV) method and fluorescence microscopy, cellular hydrophobicity by hydrocarbon interaction and the presence of gelE, esp and asa1 genes by Polymerase Chain Reaction (PCR). 12 isolates were identified as E. faecalis and 23 as E. faecium. Most were obtained in Coronary Units (40.0%) and Intensive Care Unit (31.4%). E. faecium isolates were more resistant to the antibiotics tested than E. faecalis;however, E. faecalis stood out as a biofilm producer. Regarding the presence and gene frequency, it was observed that gelE (54.3%) and esp (54.3%) were the most prevalent, followed by asa1 (22.9%). When comparing the gene frequency, it was observed that gelE and esp were predominant (48.6% for both species), while asa1 was more frequent in E. faecalis (20.0%). The data presented here are worrying, because they reveal the virulence potential of isolates VRE, which contributes to the dissemination and persistence of these pathogens in the hospital environment.

Transmission of ceftazidime-avibactam-resistant Escherichia coli among pets,veterinarians and animal hospital environment

Ceftazidime-avibactam (CZA) is a recently approved combination synthetic β-lactamase inhibitor used in human clinical medicine. Cases of CZA resistance in humans have already been reported, but limited research has investigated CZA resistance in pets. This study explored the prevalence and transmission of CZA-resistant Escherichia coli (CZAREC) among pets, their owners, veterinarians, and the environment in animal hospitals. A total of 5,419 clinical samples were collected from dogs and cats, along with samples from the environment (n = 5,843), veterinarians (n = 557), and pet owners (n = 368) in animal hospitals. From these samples, 760 Escherichia coli (E. coli) isolates were obtained, out of which 60 were identified as CZAREC. These included 34 isolates from the environment (9.14 %, n = 372), three from veterinarians (8.11 %, n = 37), and 23 from animals (6.82 %, n = 337). No CZAREC isolates were found in pet owners. The predominant sequence types of CZARECs were ST156 (n = 20), ST410 (n = 19) and ST101 (n = 7). Bayesian analysis revealed six clusters comprising 47 isolates from the hospital environment, pets, and veterinaries, displaying genetic relatedness of less than 100 core genome single nucleotide polymorphisms (cgSNPs) between any two isolates in each cluster. Some CZAREC isolates with high genetic similarity persisted in the same animal hospital for four to six months. Moreover, discriminant analysis of principal components indicated that most isolates from different hosts shared a genetic source in the human/dog/cat merged cluster. Overall, evidence of CZARECs transmission was found among pets, the environment, and veterinarians in animal hospitals. The findings emphasize the importance of monitoring CZARECs in the veterinary clinical setting to ensure the health of both pets and humans.