Epidemiological, Clinical, Bacteriological Profile of Urinary Tract Infection in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.

Etiological and Evolutionary Profile of Anemia in Patients Hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all anemic patients hospitalized during the study period. Results: We identified 91 cases of anemia out of 200 patients admitted to the Unit that is a hospital prevalence of 45.5%. The age group of 26 to 35 years was the most represented, that is to say 29 cases (31.87%) with an average age of 43.55 years ± 17.48 years, the female sex predominated, 51 cases (56.04%) with a sex ratio of 0.78. Housewives represented 41 cases (45.05%). The majority of patients resided in rural areas 48 cases (52.75%). The main manifestations were: asthenia 75 cases (78.02%), vertigo 68 cases (74.72%), dyspnea 62 cases (68.13%), headaches 59 cases (64.83%), palpitations 55 cases (60.44%), conjunctival pallor 53 cases (58.24%), tachycardia 43 cases (47.25%), systolic murmur 18 cases (19.78%) and IMO 11 cases (12.09%). The associated pathologies were: infected diabetic wounds 25.27%, followed by bacterial pleuro-pneumopathy 18.68%. Biologically, microcytic anemia was the most frequent 49 cases (53.84%), followed by normocytic anemia 35 cases (38.46%) and macrocytic anemia 7 cases (7.7%). Anemia was hypochromic, 53 cases (58.24%) were more encountered compared to normochromic anemia 38 cases (41.76%). The anemia was: severe in 43 cases (47.25%), moderate 29 cases (31.87%) and mild 19 cases (20.88%). Inflammatory anemia is the most common etiological diagnosis in 60% of cases, followed by vitamin B12 deficiency anemia observed in 21% of patients and then blood diseases in 7.33% of cases. The main causes of death were HIV (50%) and kidney failure (33.33%). Conclusion: Anemia is a frequent symptom in internal medicine. It constitutes a real diagnostic challenge for the internist and this sometimes in an emergency context. The use of specialized examinations and labile blood products is essential in our hospital.

Profile of Autoimmune Polyendocrinopathies at the Medical Clinic II of the Abass Ndao Hospital: About 40 Cases

Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.

Physician versus Patient Perception of Physician Hospital Discharge Communication: A Preliminary Study

Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions communication is better than patient perception. Objective: In a preliminary study, to compare patient and physician perception of communication at discharge. Design: Observational, survey-based. Setting: 330-bed adult teaching hospital. Participants: Surveys were mailed to 100 patients discharged home and 49 internal medicine physicians responsible for those patients’ care. Each physician had between 1 and 4 patients surveyed. Measurements: Patients and physicians received anonymous 5-item questionnaires concerning physician communication at discharge. Patient surveys inquired about their physicians’ communication at the specific physician encounter, while physician surveys asked about the physicians’ overall self-perception of discharge communication skills. Results: Completed questionnaires were returned by 59 patients and 40 physicians. Physicians reported a noticeably better perception of communication than their patients regarding spending adequate time reviewing the discharge plan (83% vs. 61%, P = 0.027), speaking slowly enough to understand (98% vs. 80%, P = 0.013), using wording that could be easily understood (100% vs. 68%, P P = 0.008). Perception of discharge communication improved with physician experience for several survey items. Conclusions: This study provides evidence suggesting that physician perception of communication at discharge is better than patient perception. Future studies of larger sample size and direct patient-physician pairing focusing on patient satisfaction and outcomes are needed.

Severe hypernatremia in hyperglycemic conditions;managing it effectively:A case report

BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.

Role of gut microbiota in cardiovascular diseases

The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human physiology.Deleterious changes to the composition of gut microbiota,referred to as gut dysbiosis,has been linked to the development and progression of numerous diseases,including cardiovascular disease(CVD).Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression.Most CVD risk factors,including aging,obesity,dietary patterns,and a sedentary lifestyle,have been shown to induce gut dysbiosis.Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier,which in turn increases circulating levels of bacterial structural components and microbial metabolites,including trimethylamine-N-oxide and short-chain fatty acids,that may facilitate the development of CVD.This article reviews the normal function and composition of the gut microbiome,mechanisms leading to the leaky gut syndrome,its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention.As CVD is the leading cause of deaths globally,investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.

Cholesterol metabolism in cholestatic liver disease and liver transplantation:From molecular mechanisms to clinical implications

The aim of this review is to enlighten the critical roles that the liver plays in cholesterol metabolism. Liver transplantation can serve as gene therapy or a source of gene transmission in certain conditions that affect cholesterol metabolism, such as low-density-lipoprotein(LDL) receptor gene mutations that are associated with familial hypercholesterolemia. On the other hand, cholestatic liver disease often alters cholesterol metabolism. Cholestasis can lead to formation of lipoprotein X(Lp-X), which is frequently mistaken for LDL on routine clinical tests. In contrast to LDL, Lp-X is non-atherogenic, and failure to differentiate between the two can interfere with cardiovascular risk assessment, potentially leading to prescription of futile lipid-lowering therapy. Statins do not effectively lower Lp-X levels, and cholestasis may lead to accumulation of toxic levels of statins. Moreover, severe cholestasis results in poor micellar formation, which reduces cholesterol absorption, potentially impairing the cholesterol-lowering effect of ezetimibe. Apolipoprotein B-100 measurement can help distinguish between atherogenic and non-atherogenic hypercholesterolemia. Furthermore, routine serum cholesterol measurements alone cannot reflect cholesterol absorption and synthesis. Measurements of serum non-cholesterol sterol biomarkers- such as cholesterol precursor sterols, plant sterols, and cholestanol- may help with the comprehensive assessment of cholesterol metabolism. An adequate cholesterol supply is essential for liver-regenerative capacity. Low preoperative and perioperative serum cholesterol levels seem to predict mortality in liver cirrhosis and after liver transplantation. Thus, accurate lipid profile evaluation is highly important in liver disease and after liver transplantation.

Trends and characteristics of congenital ectopia lentis in China

AIM： To elucidate the trends and characteristics of congenital ectopia lentis（CEL） in southern China.METHODS： CEL patients from China admitted to Zhongshan Ophthalmic Center（ZOC） from January 2006 to December 2015 were recruited in our study. Residence, gender, hospitalization time, age at surgery, and the presence of other ocular abnormalities and system disease were statistically analyzed in different subgroups.RESULTS： Four hundred and thirty-seven hospitalizations（306 in-patients） diagnosed with CEL from a total of 283 308 hospitalizations were identified, which accounted for 0.15% of the total in-patients. Of the identified CEL in-patients, the total ratio of boys to girls was 2.22：1. Based on a subgroup analysis according to age, patients aged 12-18 years old constituted the highest proportion（31.70%） of all hospitalized CEL patients, and those 0-3 year old constituted the lowest proportion（8.82%） of the total number. The number of CEL increased from 18 to 72 and the hospital based prevalence increased from 8.60% to 18.10% from 2006 to 2015, and the average age at surgery decreased from 9 years old in 2006 to 7.6 years old in 2015. CONCLUSION： The results reveal upward trends in both the number of CEL hospitalizations and hospital based prevalence of CEL in this 10-year study period, but a reduction in the age at surgery, which may reflect the increase of public awareness of children＇s eye care in China.

Prognostic and Predictive Value of Pretreatment Derived Neutrophil-to-Lymphocyte Ratio in Non-Small-Cell Lung Cancer Patients Treated with an Immune Checkpoint Inhibitor

Background: Immune checkpoint inhibitors produce prolonged responses in select non-small cell lung cancer (NSCLC) patients, however the identification of patients most likely to benefit is difficult. Pretreatment derived neutrophil-to-lymphocyte ratio (dNLR) is an easily calculated marker available in routine clinical care that has shown prognostic value in many cancer treatment settings, but its association with survival in NSCLC patients treated with immune-checkpoint inhibitors is less understood. Patients and Methods: We retrospectively reviewed 72 NSCLC patients receiving either nivolumab or pembrolizumab between 3/1/15 and 3/1/17 with a median follow-up time of 5.1 months. Patients were compared using Cox proportional hazards models to detect an association between pretreatment dNLR 3 vs ≥3 on overall survival (OS), progression-free survival (PFS) and overall response rate. Results: Median age was 65 (range: 41 - 86), 65% were male, 40% received ≥ 2 prior systemic therapies and 14% had an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 2. Pretreatment dNLR ≥ 3 was independently associated with shortened OS (median 3.6 vs 8.5 months;HR: 5.4;95% CI: 2.0 - 14.6;p = 0.001) and PFS (median 2.1 vs 3.4;HR: 2.3;95% CI: 1.1 - 4.8;p = 0.027). Conclusion: Pretreatment dNLR ≥ 3 was independently associated with inferior survival in NSCLC treated with immune checkpoint inhibitors in routine practice. Prospective verification of this marker is warranted as it could serve as an inexpensive and widely-available marker for identifying NSCLC patients most likely to benefit from PD-1 inhibitors.

Assessment of Liver Fatty Acid Binding Protein (L-FABP) as a Diagnostic Marker in Non-Alcoholic Fatty Liver Disease

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disease worldwide, it causes chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. We aimed to assess the value of liver fatty acid binding protein (L-FABP) in the diagnosis of non-alcoholic fatty liver disease in comparison to ultrasonography. Patients and Methods: Ninty subjects were enrolled in this study who attended the Hepatology, Gastroenterology and Internal medicine clinics in Benha University Hospitals between January 2017 and January 2018 and divided into group I included 70 consecutive patients with non-alcoholic fatty liver disease who were diagnosed by ultrasound with or without elevated liver enzymes and group II included 20 healthy control subjects without NAFLD (by ultrasound) with normal liver enzymes. Serum levels of L-FABP were determined by enzyme-linked immunosorbent assay. Results: NAFLD patients were slightly older than healthy subjects as mean age in group I was (37.74 ± 11.7) while in group II was (36.5 ± 11.31). There was a slight increase in NAFLD in males, there was a high prevalence of NAFLD in the urban population. L-FABP levels in NAFLD patients were higher than in the control group (levels were 188.6 ± 34.94 and 137.7 ± 13.05 ng/l respectively). A strong correlation was found between L-FABP and ALT, AST, BMI and glucose levels. Analysis of ROC curve revealed that at a level 151.1 ng/sensitivity, specificity, PPV, NPV and accuracy were 83.3%, 71.8%, 31.3%, 96.6% and 73.3% respectively with AUC 0.839 and at a level 189.5 ng/sensitivity, specificity, PPV, NPV and accuracy were 90%, 90%, 95.4%, 95.4%, 88.9% with AUC was 0.950. Conclusion: Serum L-FABP could be used as a new diagnostic biomarker for detecting NAFLD.

Challenges in management of recurrent and refractory Clostridium difficile infection

Clostridium difficile infection(CDI) is the most common nosocomial infection in the United States and is associated with a high mortality. One quarter of patients treated for CDI have at least one recurrence. Spore persistence, impaired host immune response and alteration in the gastrointestinal microbiome due to antibiotic use are factors in recurrent disease. We review the etiology of recurrent CDI and best approaches to management including fecal microbiota transplantation.

Effects of Metoclopramide Orally Disintegrating Tablet in Optimizing Late Outpatient Endoscopy: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Aims: Metoclopramide has been used as a gastro-kinetic agent but the safety and effects of different preparations of metoclopramide on preparation for outpatient endoscopy are largely unknown. The study aimed to evaluate the (1) Safety of using ODT (orally disintegrating tablet) or TT (traditional tablet) metoclopramide pre-endoscopy in non-fasting patients compared with placebo (2) Impact of ODT or TT metoclopramide on sedation and recovery times compared with placebo. Methods: A double blind randomized placebo-controlled trial with 3 arms;Metoclopramide ODT (n = 43), Metoclopramide TT (n = 43) and Placebo (n = 43). Results: Metoclopramide ODT had fewer adverse events compared with TT or placebo. Recovery time was significantly shorter with use of either metoclopramide versus placebo (P < 0.001) & total sedation time was also significantly shorter in the metoclopramide groups versus placebo (P < 0.001). Conclusion: Metoclopramide ODT is safe and beneficial in endoscopic procedures requiring limited access to food and liquid.

Unexpected Association of HIV, Hepatitis C Virus Infection, Lymph Node Tuberculosis, and Sickle Cell Disease: A Case Report in a 35-Year-Old Woman from Cameroon

Introduction: HIV infection is a public health issue. Developing countries are facing the challenge of patient populations that remain undiagnosed and under-served in combined antiretroviral treatment (cART) leading to opportunistic infections. Lymph node tuberculosis is one of the most common. His firm diagnosis is not always easy in resources limited country. Case Presentation: We report a case of a 35-year-old woman known HIV for the past 10 years but not on treatment. She presented with a four-month history of fatigue, weight loss and pain in the right flank. The diagnosis of lymph node tuberculosis, hepatitis c virus infection and sickle cell disease was done. After 6 months of treatment, there was a favourable clinical evolution. Conclusion: This case report highlights the necessity to screen for opportunistic and non-opportunistic co-infection in HIV infected patient.

Demystifying airline syncope

Syncope forms a major part of medical in-flight emergencies contributing one-infour in-flight medical events accounting to 70%of flight diversions.In such patients,it is important to elucidate the pathophysiology of syncope prior to diversion.Postural hypotension is the most common etiology of in-flight syncopal events.However,individuals without any underlying autonomic dysfunction can still experience syncope from hypoxia also known as airline syncope.Initial steps in managing such patients include positioning followed by the airway,breathing and circulation of resuscitation.These interventions need to be in close coordination with ground control to determine decision for flight diversion.Interventions which have been tried for prevention include mental challenge and increased salt and fluid intake.The current paper enhances the understanding of airline syncope by summarizing the associated pathophysiologic mechanisms and the management medical personnel can initiate with limited resources.

Biomechanical Considerations in the Unruptured Cerebral Aneurysm Study (UCAS Japan): Rupture Risk and True Stress of Wall

When an unruptured aneurysm is found, deciding whether to operate or follow up is one of the most important issues. There are guidelines for making the best final decision on treatment, taking into account the effectiveness of diagnostic and therapeutic devices and the risk-benefit ratio of patients, caregivers, and healthcare professionals. The guidelines evidence-based of large clinical data for this purpose are presented by national medical societies. As one of the rupture risk indicators, there is the hazard risk ratio derived by the UCAS Japan research group based on the statistical method of 6697 aneurysms in 5720 patients with cerebral aneurysms of 3 mm or more. Therefore, we investigated the biomechanical significance of this hazard risk ratio using a spherical aneurysm model. It was revealed that 1) the reason why the frequency of aneurysm rupture is relatively high up to about 10 mm, 2) the UCAS hazard risk ratio corresponds to stress of the aneurysm wall, and the true stress can be calculated by multiplying the patient’s blood pressure, and 3) the factors that cause the daughter’s sac (irregular protrusion of the aneurysm wall). In addition, our two methods for measuring the strength of the blood vessel wall of an individual patient were described.

A highly selective electrochemical impedimetric sensor for imidacloprid determination based on WO_(3)/MoS_(2)nanosheets/molecularly imprinted polymer composite

In this study,an electrochemical impedimetric sensor was established for imidacloprid(IMI)detection based on WO_(3)/MoS_(2)and molecular imprinted polymer(MIP)composite.MIP layer was prepared on electrode surface by electropolymerization of o-phenylenediamine(o-PD)in the presence of IMI template,which ensured the specific rec-ognization toward IMI.

Resolvin-D1 inhibits interleukin-8 and hydrogen peroxide production induced by cigarette smoke extract in 16HBE cells via attenuating NF-κB activation

Background Cigarette smoke induced airway inflammation plays a role in pathogenesis of airway inflammation.Resolvin-D1 derived from omega-3 polyunsaturated fatty acids is an endogenous anti-inflammatory and proresolving lipid mediator.Resolvin-D1 ameliorated inflammatory responses in lung injury,asthma,peritonitis and atherosclerosis.We investigated whether resolvin-D1 suppressed the productions of chemokines and oxidative stress induced by cigarette smoke extract （CSE） in vitro and its possible mechanism.Methods We examined the proinfiammatory chemokine interleukin-8 and hydrogen peroxide （H2O2）productions induced by CSE in 16 human bronchial epithelial （16HBE）cells after resolvin-D1 treatment and their mechanisms.16HBE cells were treated with resolvin-D1 at up to 10 nmol/L,for 30 minutes before CSE up to 16％ （v/v） exposure.Release of interlukin-8 proteins was assessed by enzyme linked immunosort assay （ELISA） and its mRNA level by RT-PCR.We evaluated extracellular H2O2 expression in the supematant.Phosphorylation of NF-KB/p65 and degradation of Ⅰ-KB in 16HBE cells were determined by Westem blotting analysis and NF-KB DNA binding activity by electrophoretic mobility shift assay （EMSA）.Results 16HBE cells treated with 8％ CSE showed significantly higher interlukin-8 production.Resolvin-D1 pretreatment inhibited CSE induced intedukin-8 production （mRNA and protein） in a dose and time dependent manner.Extracellular H2O2 level decreased after resolvin-D1 treatment.Resolvin-D1 attenuated CSE triggered Ⅰ-KB degradation and NF-KB/p65 activation dose dependently and inhibited NF-KB DNA binding activity.Conclusion Resolvin-D1 inhibits CSE induced interlukin-8 and H2O2 production in 16HBE cells by modulating NF-KB activation and has therapeutic potential for pulmonary inflammation.