Historical origins of current IBD concepts

INTRODUCTIONThe“nonspecific” inflammatory bowel diseases ,ulcerative colitis and Crohn,s represent a group of heterogeneous inflammatory and ulcerative disases of the small and large intestines of unknown etiology ,associated with many gastrointestinal and systemic complications .Appearing initially as isolated cases in Great Britain and northern Europe during the 19th and early 20th centuries ,they have steadily increased numerically and geographically and today are recognized worldwide.

The treatment of the“untreatable”patient-revisited

The limits of medicine have not yet been reached. Numerous human illnesses initially thought to be incurable are reversible under unique and unpredictable individual circumstances.This paper, and the preceding companion publication,describes instances of the successful treatment of patients previously labeled as untreatable, including instances of severe ulcerative colitis and Crohn's disease.

Clinical Efficacy of Prolonged First-Line Treatment against Helicobacter pylori in Ouagadougou

Background: Helicobacter pylori (H. pylori) infection is a public health concern. In fact, due to bacterial resistance, treatment strategy is a challenge. It is then more recommended to prolong first-line treatment. In order to be acceptable, the clinical efficacy of treatment must be higher than 90%. Aim: We aimed to assess the outcome of prolonged first-line treatment among adults. Patients and Methods: The study was cross-sectional among adults and patients were treated for H. pylori eradication for the first time during 10 to 14 days. Recruitment was made from March 2019 in six private polyclinics and two hospitals of the city of Ouagadougou. We used monoclonal antigen (Ag) test on the stool samples for diagnostic and for the patients follow up. Chi squared (X2) tests and ANOVA for the comparison of percentages and means were determined using with STATA® software program in the bilateral 95% confidence interval for the statistical analysis. Results: In the different medical centers for 19 months, 365 patients were compiled. The sex-ratio was 0.64. The average age was 43.55 years. The treatment efficacy was 92.88%. Treatment efficacy was better with p-value <10-3 depending on prescriber: gastroenterologist (94.07%), general practitioner (75%);compliance before treatment: excellent (95.88%) or bad (50%);number of consultations: ≥four (94.35%), three (96.32%), two (78.85%). Triple therapies efficacy was 90.81%;p = 0.19. Quadritherapy efficacy was 95%;p = 0.5. Conclusion: This research is a contribution to the advent of national or African recommendations.

Epidemiological and Clinical Profile of Cervix Cancer at Bamako Radiotherapy Center

Cervical cancer remains a major public health problem in Africa, particularly in Mali. The goal of this work was to investigate the epidemiological and clinical aspects of cervix cancer seen at the radiation therapy center. This was a descriptive study on the retrospective collection of data on patients found in the Radiation Therapy Centre of Bamako, for invasive cervical cancer be-tween April 2014 and April 2017. The average age of our population was 52 ± 12.5 years with extremes ranges from 18 to 95 years. The most represented age group was [50 - 65 years] with 44.2%. The predominant histological type was squamous carcinoma (CE) with 94.2%. Bleeding were found in almost all patients, most often associated with foul smelling hydrorrhea;80.3% of our patients were stage III and 12.9% of stage IV according to the IFGO classifi-cation. Cervix cancer remains a major public health problem in Mali. The di-agnosis is often late, therefore, resulting in late care and unfavorable progno-sis. Sensitization, vulgarization of vaccination and systematization of screen-ing could be helpful in the fight against this cancer.

Blossoming of gastroenterology during the twentieth century

Awareness of the digestive system began with the dawn of civilization, when man observing the feeding habits of animalsin the surrounding environment, experimented with foods, edible and inedible. Identity came with discoveries of the digestive organs during the 16^th and 17^th centuries. Function was revealed by physiologic studies of digestion, absorption and secretion, metabolism, and motility during the 18^th and 19^th centuries. Diagnostic access improved with the technological advances of the 20^th century. Understanding of gastrointestinal (GI) disease followed growth of the basic sciences and gastroenterology's increased involvement in scientific research during the 20^th century.

Inflammatory bowel diseases: From the mystical to the cellular and now the molecular

It is of interest in an era of increasing biomedical sophisticaton to recall that a relatively short time ago, early in the 20th century, ‘simple' ulcerative colitis was an obscure ‘medical curiosity' emerging slowly from an unknown past. Crohn's disease was yet unidentified as a separate entity although careful review of the IBD literature documented its early presence, masquerading as ‘intestinal tuberculosis'. Into the 1930s, the etiology and pathogenesis of ulcerative colitis and Crohn's disease were unknown, and investigative hypotheses were scarce. Therapeutic resources were limited and treatment was primitive. At a time of limited biomedical knowledge and minimal clinical awareness, unsubstantiated views prevailed, including ‘vague reactions to foods' (sugar,margarine, corn flakes), deficiency of a ‘protective factor'in pig intestine, and psychiatric disease.

Community-Acquired Severe Sepsis:A Prospective Cohort Study

Severe sepsis (SS) is one of the principal causes of admission in intensive care units (ICU), with an associated high morbidity and mortality. This study intends to characterize epidemiology of community-acquired SS (CASS) with special emphasis in the prevalence of multidrug resistant organisms and independent prognostic factors associated with ICU mortality. Methods: A prospective cohort study was conducted over 3.5 years, including all consecutive adult patients with CASS admitted to a mixed ICU, in a 600-bed university-affiliated hospital. Results: 1221 patients were admitted into the ICU, 25% with CASS. The mean age was 59 years and the mean SAPS (simplified acute physiological score) was II 48. Most had septic shock (67%). Respiratory (57%), intra-abdominal (22%) and urinary tract (8%) infections were the main sources of infection. The overall isolation rate was 56%. The most common identified microorganisms were Streptococcus pneumoniae (27%), Escherichia coli (22%), Staphylococcus aureus methicillin sensitive (8%) and Haemophilus influenzae (7%). The median ICU and hospital length of stay were 8 and 16 days, respectively. The ICU mortality rate was 33. Independent risk factors associated with higher mortality were older age, higher SAPS II, septic shock and chronic hepatic disease. Female gender was independently associated with lower mortality. The type of microorganism was not significantly associated with prognosis. Conclusion: CASS was highly prevalent among ICU admissions. Independent risk factors associated with ICU mortality included older age and previous comorbidities, but mainly severity of acute illness reinforcing the need for early recognition and treatment. Multidrug resistant organisms were implicated in considerable proportion of community-acquired sepsis.