Bacteriological Profile of Infections Encountered in a Pneumology Service in a Moderate-Income Country [Pneumology Department of CHU Cocody (Côte d’Ivoire)]

Introduction: Infections represent a real public health problem aggravating the morbidity and mortality of hospitalized patients. Methods: This was a retrospective study with descriptive purposes over a period of 05 years, in the Pneumology Department of the University Hospital of Cocody. Results: The average age in our population was 42 years. We observed a male predo- minance of 64.5%, with a sex ratio of 1.8. Medical history was dominated by HIV infection (23.5%), followed by tuberculosis (15.6%). Concerning lifestyle, smoking was found in 38% of cases. Symptoms progressed chronically in 80% of cases. An infectious syndrome was found in 75% of cases. Microbial culture was positive in 42% of cases. Pseudomonas aeruginosa and Klebsiella pneumoniae were encountered in 26.4% of cases each, followed by Echerichia coli in 10.4% of cases. Klebsiella pneumoniae in the first three years topped the list, but gradually. Pseudomonas aeruginosa maintained its leadership over the last three years. Pseudomonas aeruginosa isolates expressed a resistance rate of 9.8% to ceftazidime and 8.1% to imipenem;to aztreonam (36%), ticarcillin (33.3%) and levofloxacin. These strains were susceptible to fosfomycin (100%), mero- penem (96.6%) and amikacin (96%). For isolated strains of Entero- bacteria- ceae, resistance was observed about ticarcillin (83.3%) and amoxicillin clavula- nic acid (71.2%). Streptococcaceae showed resistance to tetracycline (69.2%) and erythromycin (50%). Over the years there has been an increase in re- sistance to amoxicillin-clavulanic acid ceftriaxone. The death rate was 14%. Conclusion: The bacterial profile of infections is dominated by germs respon- sible for nosocomial infection with significant mortality.

Maternal Knowledge of Tuberculosis and Bacillus Calmette Guerin Vaccination in Pediatric Health Services in Kinshasa

Introduction: To participate effectively in the fight against tuberculosis (TB), mothers need to have a good knowledge of TB and its prevention. The objective of this study was to evaluate the knowledge of mothers about TB and Bacillus Calmette Guérin (BCG). Methods: This was a cross-sectional survey performed from September to December 2015 in 4 health care facilities of Kinshasa. It concerned mothers of children who received BCG vaccine. The frequencies and chi-square of Pearson were used to report results. Results: A total of 380 couples of the children and their mothers were recruited. The median age of children was 16 months (ranges: 6 days to 59 months);224 (58.9%) of them received BCG during the period recommended;62 (16.3%) experienced a side effect. There was a significant association (p = 0.00) between sides effects and the delayed vaccination. The average age of the mothers was 29.3 ± 6.4 years;352 (92.6%) had heard about TB;28 (7.4%) never heard about it;168 (44.2%) knew that TB is a contagious disease;only 111 (29.2%) knew the mode of transmission;87 (22.9%) did not know any signs of TB, and 54 (14.2%) knew about prevention with the BCG vaccine. Factors significantly associated with the mothers’ lack of knowledge were a low level of education (p = 0.01), young age (p = 0.02), and place of residence (p = 0.04). Conclusion: There is an urgent need to improve the education of the population, particularly those who lives in poor conditions and who are uneducated.

Non-alcoholic fatty liver disease in patients with intestinal, pulmonary or skin diseases: Inflammatory cross-talk that needs a multidisciplinary approach

Non-alcoholic fatty liver disease(NAFLD)is currently considered the most common cause of liver disease.Its prevalence is increasing in parallel with the obesity and type 2 diabetes mellitus(DM2)epidemics in developed countries.Several recent studies have suggested that NAFLD may be the hepatic manifestation of a systemic inflammatory metabolic disease that also affects other organs,such as intestine,lungs,skin and vascular endothelium.It appears that local and systemic proinflammatory/anti-inflammatory cytokine imbalance,together with insulin resistance and changes in the intestinal microbiota,are pathogenic mechanisms shared by NAFLD and other comorbidities.NAFLD is more common in patients with extrahepatic diseases such as inflammatory bowel disease(IBD),obstructive syndrome apnea(OSA)and psoriasis than in the general population.Furthermore,there is evidence that this association has a negative impact on the severity of liver lesions.Specific risk characteristics for NAFLD have been identified in populations with IBD(i.e.age,obesity,DM2,previous bowel surgery,IBD evolution time,methotrexate treatment),OSA(i.e.obesity,DM2,OSA severity,increased transaminases)and psoriasis(i.e.age,metabolic factors,severe psoriasis,arthropathy,elevated transaminases,methotrexate treatment).These specific phenotypes might be used by gastroenterologists,pneumologists and dermatologists to create screening algorithms for NAFLD.Such algorithms should include non-invasive markers of fibrosis used in NAFLD to select subjects for referral to the hepatologist.Prospective,controlled studies in NAFLD patients with extrahepatic comorbidities are required to demonstrate a causal relationship and also that appropriate multidisciplinary management improves these patients’prognosis and survival.

immunomodulatory effects of dexmedetomidine: from bench to clinic

Dexmedetomidine is a central alpha2-adrenergic receptor agonist with sedative and analgesic properties that has a proven safety profile. It has several beneficial effects such as decreasing sympathetic tone, leading to reduced opiate use and anxiolysis, making it an attractive option for sedation in the perioperative and intensive care unit setting. These effects also modify favorably the time spent on a ventilator, intensive care unit length of stay and development of delirium. Recent studies also suggest that dexmedetomidine possesses wide-ranging immunomodulating properties. It has been associated with reduced inflammatory cytokine release, modulation of inflammatory transcription factors, oxidative stress and inflammatory cells. These properties could be beneficial in the context of inflammatory conditions that require sedation, such as sepsis, ischemia-reperfusion injury and ventilator-associated lung injury, among many others. In this review, we propose specific clinical scenarios where these properties could turn out to be clinically relevant.

Autologous bone marrow mononuclear cells as neuroprotective treatment of amyotrophic lateral sclerosis

Amyothrophic lateral sclerosis（ALS）is a disorder characterized by the progressive degeneration of motoneurons and subsequent weakness of the skeletal muscles.Respiratory insufficiency is the most common cause of death for these patients,and it occurs approximately within three years.

Questions relating to premenstrual asthma

The study of asthma in fertile women needs to consider its potentially recurrent exacerbation in a specific phase of the menstrual cycle. Premenstrual asthma(PMA)refers to the deterioration of asthma in some women of fertile age during the premenstrual phase. Prevalence varies considerably according to studies(11%-47.44%) mainly because there is no standardized definition of the illness. There is a possible link between PMA and premenstrual syndrome, which is a set of physical and psychic manifestations that occur in some fertile women during the same premenstrual phase. This relation has been widely studied but there are still several unknowns. PMA etiopathogeny is not known. It involves possible causes such as hormonal variations in the premenstrual phase, the coexistence of atopy, variations during the cycle in substances related to inflammation, like LTC4 leukotrienes, catecholamines, E2 and F2α prostaglandins and certain cytokines. Also considered are psychological factors related to this phase of the menstrual cycle, a high susceptibility to infection or increased bronchial hyperreactivity prior to menstruation. Yet no factor fully explains its etiology, consequently no specific treatment exists. Researchers have investigated hormones, antileukotrienes, prostaglandin synthesis inhibitors, diuretics, phytoestrogens and alternative therapies, but none has been shown to be effective.

Face of the Myocardial Infarction and Diabetes: Epidemiological and Clinical Aspects in the Cardiology Department of the University Hospital Ignace Deen about 46 Cases

The purpose of this study was to describe myocardial infarction in diabetics at the Cardiology Department Ignace Deen. Introduction: New international recommendations defined myocardial infarction, any coronary syndrome accompanied by a modification of cardiac troponin even minimal Tc or Ic [1]. Then for diabetes is defined by the World Health Organization (WHO) a blood glucose greater than 1.10 g/l and/or capillary blood glucose greater than 2.26 g/l after eight hours of fasting [2].?Patients and Methods: Were eligible for both male and female patients at any age admitted to cardiology for myocardial infarction and receiving an ECG echocardiogram;A biological evaluation including blood glucose and troponin Tc or Ic. Discussion: The risk of myocardial infarction is clearly increased in diabetics and is a determinant of coronary heart disease severity and a potential test for other cardiovascular risk factors at the Ignatius Deen Cardiac Department with a frequency of 16.08%. Our result is lower than that of DIOUMM et al. in the Fanh cardiology department of Dakar, Senegal [6], which should reduce the frequency of 22.3%. The high frequency of this pathology in the study DIOUMM is related to the size of their sample on the one hand and secondly the duration of the study, the service capacity on the other hand that could be explained. Conclusion: Diabetes mellitus is a scary medium and long-term disease that causes complications. In addition to infectious and metabolic complications, heart and coronary heart attacks are becoming more common. The tare is dominated by atherosclerosis, which must be prevented through the analysis of diabetic responsibility, with cardiovascular control of risk factors and monitoring of myocardial ischemia, and good cooperation between diabetes specialists, cardiologists and patients.

Spirometric Reference Equations for Semi-Urban and Urban Bantu Cameroonians

Background: Spirometric reference values vary substantially across ethnic groups, and remain largely poorly characterized among Africans. We derived spirometric reference equations for adult Cameroonians and compared their performance with those derived from other ethnic groups. Methods: Spirometric variables according to the American Thoracic Society/European Respiratory Society 2005 guidelines were acquired in voluntary healthy non-smoker subjects in Yaounde (Capital City) and Foumbot (semi-urban area in West Region), in Cameroon during November 2011 to January 2012 (Yaounde) and August 2012 (Foumbot). Reference equations were derived separately for men and women from multiple linear regressions. Results: A total of 411 subjects (206 men) met the inclusion criteria. The mean age was 39.5 ± 16.1 years (min - max: 18 - 85 years) for men and 39.2 ± 14.1 years (18 - 90 years) for women. Age and height were the only variables significantly associated with spirometric values in the final linear regression models. Derived reference values were lower than those derived from Global Lung Initiative 2012 equations for different ethnic groups, except for the forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC ratio). The mean FEV1/FVC ratio was 0.88 ± 0.07 for Cameroonian men and 0.89 ± 0.07 for Cameroonian women. Variations in the performance of derived models in bootstrap internal validation were marginal. Conclusion: This study highlights the importance of deriving specific predictive equations for each ethnic group. The use of adjustment factors applied to Caucasian equations when compared with the values derived in our study leads to an overestimation of the values for FEV1 and FVC.

Association between vitamin D receptor polymorphisms and multiple sclerosis： systematic review and meta-analysis of case-control studies

Vitamin D receptor （VDR） polymorphisms have been studied as potential contributors to multiple sclerosis （MS）. However, published studies differ with respect to study design and the significance of the effects detected. The aim of this study was to quantify the magnitude of the risk associated with the Taql, Bsml, Apal and Fold VDR polymorphisms in MS using a meta-analysis approach. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search and meta-analysis of the literature. Subgroup analyses were performed to detect potential sources of heterogeneity from the selected study characteristics. The stability of the summary risk was evaluated using sensitivity analyses. The meta-analysis included a total of 3300 cases and 3194 controls from 13 case- control studies. There were no significant associations found between Taql and Bsml polymorphisms and MS risk. The association between the Apal polymorphism and MS risk was significant in the homozygous and codominant models （P=0.013 and P=0.031, respectively）, suggesting that the AA Apal genotype might be a significant MS risk factor. Publication year and age significantly affected the association between Taql polymorphisms and MS （P=0.014 and P=0.010, respectively）, which indicates a protective effect of the major T allele. The AA Apal and FF Fold genotypes are significant risk factors for MS. The association between the Taql polymorphism and MS risk is significantly affected by study characteristics.

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus(SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components.Dendritic cells(DCs)play a key role in the defense against viral infections,for instance plasmacytoid DCs(pDCs),have the capacity to produce vast amounts of interferon-alpha(IFN-α).In COVID-19 there is a deficit in DC numbers and IFN-αproduction,which has been associated with disease severity.In this work,we described that in addition to the DC deficiency,several DC activation and homing markers were altered in acute COVID-19 patients,which were associated with multiple inflammatory markers.Remarkably,previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+myeloid DCs and pDCs seven months after SARS-CoV-2 infection.Moreover,the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients,while no restoration of integrinβ7 and indoleamine 2,3-dyoxigenase(IDO)levels were observed.These findings contribute to a better understanding of the immunological sequelae of COVID-19.