Contribution of Imagery in the Diagnosis of Multisystemic Sarcoidosis in the Service Radiology Department of the Mother and Child Hospital “Le Luxembourg” in Bamako: A Case Report

The aim of this study was to report a case of multi-visceral sarcoidosis at the Mother-Child Hospital Center (CHME) “Le Luxembourg” in Bamako, Mali. Observation: This is a patient aged 62 at the time of consultation, a housewife, residing in the Banconi district, who was referred to us for thoracic-abdominopelvic imaging for chronic liver disease. After several diagnostic errors, the thoracic-abdominopelvic CT scan and liver MRI performed in our center showed, at the thoracoabdominal level, bilateral diffuse pulmonary micronodules and bilateral mediastinal-hilar lymphadenopathy;on the abdominal level, a dysmorphic liver with plaques of steatosis and a granular appearance of the liver parenchyma without periportal fibrosis. These imaging data combined with those from the liver nodule biopsy and biology confirmed the diagnosis of sarcoidosis type II. Treatment with corticosteroids gave satisfactory results and the patient recovered after 18 months. Clinical and CT monitoring 2 years from the start of the disease and 2 months from the end of treatment showed complete resolution of the lesions. Conclusion: The multi-visceral location of sarcoidosis is an entity whose diagnosis remains difficult;diagnostic and interventional imaging has an important place in its management.

Iatrogenic Urethral Stenoses: Epidemiological Aspects Clinics and Therapeutic in the Urology Department of the National Hospital of Conakry

The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1st 2012, to December 31st 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.

Prevalence and Factors Associated with HIV Serodiscordance among Infected Couples in the City of Parakou (Benin)

Introduction: Achieving the goal of “zero new human immunodeficiency virus (HIV) infections by 2030” requires the elimination of HIV transmission within serodiscordant couples. In Benin, the phenomenon of HIV serodiscordance remains poorly documented. Objective: the aim of this study was to determine the prevalence of HIV serodiscordance and its associated factors among infected couples in the city of Parakou. Study Framework and Method: This was a descriptive cross-sectional study with an analytical focusing on qualitative and quantitative plans. It was carried out on thirty approved sites in the city of Parakou between July and December 2022. We used a non-exhaustive convenience sample of people living with HIV (PLHIV) whose partner’s status was known. Data collection took place in two phases: an interview phase during which sociodemographic, economic, behavioral and marital/social data were collected. The second phase focused on clinical and therapeutic data which were collected from the patients’ personal records. Results: A total of 417 study subjects were recruited. The average age (SD) of the subjects was 38.17 (±10.25) years [37.19 - 39.16]. Females accounted for the largest proportion (79.62%). Most respondents (74.11%) were married. Monogamous unions were the most frequent, involving 67.87% of participants, most of whom (44.60%) had been infected for between 1 and 5 years. Couples in union for less than 10 years were the most numerous (218 people or 52.28%). The respondent was head of household among only 140 respondents (33.57%) of which 84 men (60.00%) and 56 women (40.00%). Female heads of household were mainly divorcees and widows. Around 75% of PLHIV had monthly incomes of less than 50,000F CFA (81.16 USD). Prevalence of HIV serodiscordance was 71.70%. It was 70.91% [65.54% - 76.28%] at care sites and 73.24% [65.95% - 80.52%] at sites involved in preventing mother-to-child transmission (PMTCT sites). Potential predictors of HIV serodiscordance were: household head status;serostatus of last child;duration of relationship;multiple and occasional sexual partners;sharing serostatus with spouse;duration of couple relationship;spouse’s extramarital relationships and strained relations with children. Conclusion: Response strategies against the HIV pandemic need to be reshaped to better supervise the follow-up of HIV serodiscordant couples in the city of Parakou specifically and in Benin in general.

Antibiotic Resistance Profile of Enterococcus faecalis and Enterococcus faecium Isolates from Urine and Pleural Fluid in Two Hospitals of Cameroon

Enterococcus faecalis and Enterococcus faecium rank among the leading causes of nosocomial bacteremia and urinary tract infections. They often persist on hospital surfaces due to their ability to withstand adverse environmental conditions (low or high temperatures, high pH, and high salinity). The global Enterococcus faecalis-Enterococcus faecium ratio is currently shifting towards Enterococcus faecium. Enterococci present variable levels of resistance to certain families of antibiotics. This is the case for aminoglycosides, beta-lactams and cephalosporins. In 2017, WHO ranked Enterococci among priority pathogens for research and development of new antibiotics. The objective of our study was to determine the antibiotic resistance profile of Enterococcus faecalis and Enterococcus faecium isolates from urine and pleural fluid in two hospitals in Cameroon. This cross-sectional and analytic study was carried out between June to August 2023 on hospitalized and day patients in which a cytobacteriological test of urine and pleural fluid was done. The samples were inoculated on CLED Agar for urine and on Chocolate + polyvitex and blood agar (prepared from Columbia agar) for pleural fluid samples and incubated at 37℃ for 18 to 24 hours. Identification of isolates was carried out using the API 20 STREP micro gallery (Biomerieux, France) and tested for antimicrobial susceptibility. The data on socio-demographical and potential risk factors were recorded using self-administered questionnaires and data from laboratory analyses of the specimen were collected in a data capture sheet. Potential risk factors associated with the presence of Enterococci, were evaluated using the logistic regression in univariate and multivariate analysis. P value < 0.05 was considered as significant. A total of 511 patients were recruited who were predominantly females. Enterococcus spp were isolated in 27.79% of our samples with Enterococcus faecalis mostly encountered. Enterococcus spp showed a high level of resistance to penicilline (99.3% to Ampicilline), macrolides (66.2% to Erythromycin) and cyclines (85.2% to Doxycycline). Hospitalisation, access to health facilities, contact with urine specimen and hand hygiene practices were risk factors related to infection with Enterococcus spp while hospitalisation, health facility and hand hygiene were related to glycopeptide resistant Enterococcus. Strict compliance with hygiene rules and appropriate antibiotic consumption could help in the fight against these infections.

Evaluation of the Maternal Health Indicators: An Ecological Study from 2000 to 2014

The aiming of this worksheet is to evaluate and to compare the quantity of prenatal appointment indicators;childbirth by kind of delivery;maternal mortality coefficient and maternal deaths number. It is about an ecological, descriptive and analytical study, made through the appreciation of secondary data related to the maternal mortality in Rio Grande do Norte, from 2000 to 2014. To that, it was used information from SISPACTO to compare real data to the estimated goals. The results show that there was an increase on the number of women who performed seven or more prenatal queries, in turn, there was an increase of alive newborns through cesarean, moreover, it is observed an oscillation on the maternal deaths number by residence during the studied period, achieving superior values to the agreed goals during the last two analyzed years. It is concluded that the maternal health, in Rio Grande do Norte, negative indicators are being presented concerning the maternal mortality, in spite of presenting an improvement on the prenatal access.

<i>Streptococcus pneumoniae</i>Upper Respiratory Carriage in Costa Rican Children with Otitis Media before the Introduction of the Heptavalent Conjugated Vaccine in the National Immunization Program

Objective: The aim of this study was to analyze the NP/OP S. pneumoniae serotype distribution and potential vaccine coverage in Costa Rican children with Otitis Media (OM) before the introduction of PCV-7 in the National Immunization Program (NIP). Methods: Between 2002 and 2006, NP and OP samples were obtained from 641 children from 6 to 79 months of age, at the time of OM diagnosis. S. pneumoniae serotyping and antimicrobial susceptibility were performed. Results: 386 S. pneumoniae isolates were recovered. The most common S. pneumoniae serotypes (ST) were: ST 6B, ST 14, ST 19F. Penicillin non-susceptibility was observed among 57% of the isolates obtained from children < 24 months of age. 15% strains were multidrug resistant. Potential vaccine coverage was: PCV-7: 60%;PCV-10: 62%;and PCV-13: 76% and against penicillin non-susceptible and multidrug resistant isolates was: PCV-7;59% and 83%, respectively;PCV-10: 60% and 85%, respectively and PCV-13: 74% and 96%, respectively. Conclusions: S. pneumoniae was isolated from the NP and/or OP in the majority (59%) of studied children with OM. At a statistical significant level, only serotype 3 was more frequently isolated among children >24 months of age. Antibiotic non-susceptibility and MDR were significantly higher in children <24 months of age. This study demonstrates that PCV-13 offers the highest potential vaccine coverage and serves to assess the impact of introduction of one of the conjugated vaccines in the NIP in Costa Rica.

Evaluation of Child Health by Basic Indicators of Health:Historical Series 2005-2014

The continuous assessment of child health services generates knowledge about the real needs of health services and actions in order to achieve better results and indicators. Thus, this study proposes to analyze child health indicators, based on the information systems of health services. This is a descriptive, ecological epidemiological study carried out using secondary data from the following information systems: Information System on Live Births and Mortality Information System, in a historical series of ten years (2005-2014) of the state of Rio Grande do Norte and its health micro regions. It was observed a decrease in infant, neonatal, preterm, late neonatal and postnatal mortality coefficients when compared to the first and last year of the observed period, as well as the concentration of these in micro-regions of health. There was also a positive association between the early neonatal component and infant death. In this perspective, it is important to evaluate the quality of prenatal care, childbirth, puerperium, the first week of integral health and follow-up of the child’s growth and development, as well as to relate the socio-demographic conditions that may be associated with infant morbimortality. Therefore, the importance of situational health assessment studies for the effectiveness of care provided is highlighted, identifying weaknesses and monitoring the effectiveness of strategies.

Antibacterial activity of Bixa orellana L.(achiote) against Streptococcus mutans and Streptococcus sanguinis

Objective: To evaluate the cytotoxic and antibacterial effect of Bixa orellana L.(B. orellana)(achiote) methanol extract against Streptococcus mutans(ATCC 25175)(S. mutans) and Streptococcus sanguinis(ATCC 10556)(S. sanguinis).Methods: Two methanol extracts of B. orellana were prepared in vitro, from the seeds and leaves. The antibacterial activity of extracts against S. mutans and S. sanguinis was evaluated using the cup-plate agar diffusion method. The minimum inhibitory concentration(MIC) was determined using the microdilution method and the cytotoxic activity was determinated by using the cell line MDCK.Results: A stronger antibacterial effect was observed with the leaves methanolic extract with an inhibition zone of(19.97 ± 1.31) mm against S. mutans and(19.97 ± 1.26) mm against S. sanguinis. The methanolic extract of the seeds had an activity of(15.11 ± 1.03)mm and(16.15 ± 2.15) mm against S. mutans and S. sanguinis, respectively. The MIC of the leaf and the seed extracts against S. sanguinis was 62.5 and 125 mg/m L, respectively,and the MIC of the leaf extract against S. mutans was 62.5 mg/m L, and for the seed extract it was 31.25 mg/m L. The 50% cytotoxic concentration was 366.45 and 325.05 mg/m L for the leaves and seeds extracts, respectively.Conclusions: The experimental findings demonstrated the antibacterial effect of the methanolic extract of B. orellana(achiote) on S. mutans and S. sanguinis. The extract of this plant is cytotoxic at high concentrations.

Antibacterial activity of Myrciaria dubia(Camu camu) against Streptococcus mutans and Streptococcus sanguinis

Objective:To evaluate the antibacterial and cytotoxic effect of Myrciaria dubia(Camu camu)(M.dubia) methanol extract,against Streptococcus mutans(ATCC 25175)(S.mutans) and Streptococcus sanguinis(ATCC 10556)(S.sanguinis).Methods:Two methanol extracts of M.dubia were prepared in vitro,from the seeds and pulp.Ten independent tests were prepared for each type of extract,using 0.12% chlorhexidine solution as positive control.Agar diffusion test was used by preparing wells with the experimental solutions cultivated in anaerobic conditions for 48 h at 37C.Meanwhile,the minimum inhibitory concentration and the cytotoxic effect over MDCK cell line was found.Results:A higher antibacterial effect was observed with the methanol seed extract with an inhibitory halo of(21.36 ± 6.35) mm and(19.21 ± 5.18) mm against S.mutans and S.sanguinis,respectively.The methanol extract of the pulp had an effect of(16.20 ± 2.08)mm and(19.34 ± 2.90) mm,respectively.The minimum inhibitory concentration of the pulp extract was 62.5 mg/mL for both strains,whereas for the seed antibacterial activity was observed even at low concentrations.The CC50 of the seeds extract was at a higher concentration than 800 mg/mL and 524.37 mg/mL for the pulp extract.Conclusions:The experimental findings demonstrated the antibacterial effect of the methanol extract of M.dubia against S.mutans and S.sanguinis.These extracts were not cytotoxic at high concentrations.

Detection of dengue virus serotype 3 in Cajamarca,Peru:Molecular diagnosis and clinical characteristics

Objective:To describe and molecularly characterize an outbreak of dengue virus(DENV)infection in Cajamarca,an Andean region in Peru.Methods:A total of 359 serum samples from patients with acute febrile illness were assessed for the presence of DENV via RT-PCR,ELISA NS1,Ig M and Ig G in Cajamarca,Peru from January 2017 to June 2017.The evaluation of the different diagnostic tests and their applicability was performed.Results:Dengue virus was detected in 24.7%of samples by RTPCR.Meanwhile,serological analysis detected 30.3%positive cases via ELISA NS1 antigen,16.7%via ELISA Ig G and 9.7%via ELISA Ig M.Most of the cases corresponded to DENV-3(77.5%).The use of RT-PCR performed better in primary infections(P<0.01),while detection of ELISA Ig M performed better in secondary infections(P<0.01).The combination of NS1 and Ig M performed better than the other assays in detecting primary(92.5%)and secondary infections(96.6%).The most frequent symptoms associated with fever were headaches,myalgias,and arthralgias across all groups.Conclusions:We report an important outbreak of dengue infection caused by DENV-3 in Cajamarca,Peru.Our findings encourage the use of NS1 antigen and Ig M co-detection.These findings demonstrate an increasing expansion of DENV-3 in Peru and highlight the importance of molecular diagnosis and serotype characterization among the clinically defined dengue cases to strengthen the Peruvian epidemiological surveillance.

<i>In vitro</i>activity and function of B7-H4-Ig fusion protein

B7-H4 has been shown to inhibit T cell proliferation, cytokine production and cell cycle in vitro. B7-H4 deficient mice develop exacerbated disease in the mouse models of Rheumatoid Arthritis (RA), Type 1 Diabetes (T1D) and Experimental Autoimmune Encephalomyelitis (EAE). On the other hand, B7-H4-Ig fusion protein has been documented to assuage the symptoms in mouse models of RA, T1D, and multiple sclerosis in vivo. In the present study, B7-H4-Ig bound to the majority of human peripheral blood monocytes and NK cells, but not to either normal or activated T cells. B7-H4-Ig fusion protein was assayed for its effects in allogeneic mixed lymphocyte culture (MLC) systems. Soluble B7- H4-Ig had no significant effect in the MLC, but with a tendency to promote allogeneic response. Immobilized, but not soluble B7-H4-Ig inhibited plastic bound anti-CD3 mediated activation of T cells. This inhibition however was largely due to B7-H4-Ig mediated displacement of anti-CD3 antibody from the plastic plate. Finally, B7-H4-Ig had no effect on the cytotoxicity mediated by NK and LAK cells in PBMC. Our findings thus caution against the interpretation of suppressive effect observed solely in plate-bound anti-CD3 mediated T cell co-stimulation in vitro.

Fluid resuscitation in acute pancreatitis: Normal saline or lactated Ringer's solution?

AIM: To investigate whether administration of Ringer's solution(RL) could have an impact on the outcome of acute pancreatitis(AP).METHODS: We conducted a retrospective study on 103 patients [68 men and 35 women,mean age 51.2 years(range,19-92 years)] hospitalized between 2011 and 2012. All patients admitted to the Department of Gastroenterology of the Central Clinical Hospital of the Ministry of Interior(Poland) with a diagnosis of AP who had disease onset within 48 h of presentation were included in this study. Based on the presence of persistent organ failure(longer than 48 h) as a criterion for the diagnosis of severe AP(SAP) and the presence of local complications [diagnosis of moderately severe AP(MSAP)],patients were classified into 3 groups: mild AP(MAP),MSAP and SAP. Data were compared between the groups in terms of severity(using the revised Atlanta criteria) and outcome. Patients were stratified into 2 groups based on the type of fluid resuscitation: the 1-RL group who underwent standard fluid resuscitation with a RL 1000 m L solution or the 2-NS group who underwent standard fluid resuscitation with 1000 m L normal saline(NS). All patients from both groups received an additional 5% glucose solution(1000-1500 m L) and a multi-electrolyte solution(500-1000 m L).RESULTS: We observed 64(62.1%) patients with MAP,26(25.24%) patients with MSAP and 13(12.62%) patients with SAP. No significant difference in the distribution of AP severity between the two groups was found. In the 1-RL group,we identified 22(55.5%) MAP,10(25.5%) MSAP and 8(20.0%) SAP patients,compared with 42(66.7%) MAP,16(24.4%) MSAP and 5(7.9%) SAP cases in the 2-NS group(P = 0.187). The volumes of fluid administered during the initial 72-h period of hospitalization were similar among the patients from both the 1-RL and 2-NS groups(mean 3400 m L vs 3000 m L,respectively). No significant differences between the 1-RL and 2-NS groups were found in confirmed pancreatic necrosis [10 patients(25%) vs 12 patients(19%),respectively,P = 0.637]. There were no statistically significant differences between the 1-RL and 2-NS groups in the percentage of patients who required enteral nutrition(23 patients vs 17 patients,respectively,P = 0.534). Logistic regression analysis confirmed these findings(OR = 1.344,95%CI: 0.595-3.035,P = 0.477). There were no significant differences between the 1-RL and 2-NS groups in mortality and the duration of hospital stay(median of 9 d for both groups,P = 0.776).CONCLUSION: Our study failed to find any evidence that the administration of RL in the first days of AP leads to improved clinical outcomes.

Encephalitis with convulsive status in an immunocompetent pediatric patient caused by Bartonella henselae

Cat scratch's disease caused by Bartonella henselae, is known to be a self-limited benign process in immunocompetent children. The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment. A 7 years old male patient, without any immunocromised defect, presented an atypic presentation of the cat scratch disease. The patient came to the hospital in two opportunities in a status epilepticus, in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR(polymerase chain reaction) in cerebrospinal fluid and blood, as well as IFI(IgM, IgG) serology(indirect immunofluorescence). The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.

Thinking, educating, acting: Developing advanced practice nursing

Advanced practice nursing has emerged worldwide in response to the need for improved services and outcomes for specific priority groups,improved access to care,decreased wait times,and cost containment of health care[1].Advanced practice nursing(APN)is an umbrella term that encompasses various APN roles(based on country of origin)that share at their core direct care of patients and families[2,3].APN roles have expanded in numbers and scope of practice over the past several decades with APN roles being highly valued and an integral part of the health care system.Due to the benefits of APN in meeting the current and future health needs of patients,the concept of APN(and the components of the role)needs to be effectively identified in order to continue to ensure patient safety while expanding patient access to APN care.The International Council of Nurses(ICN)defines an APN role as a“registered nurse who has acquired the expert knowledge base,complex decision-making skills and clinical competencies for expanded practice,the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice[4].”However,there is still no international agreement with respect to minimum educational preparation for APN,title protection for various APN roles,education,scope of practice,and accreditation system,and performance evaluation system[5-10].

Reasons for HIV Testing among Polish Patients—Community versus Country Data

Background: Epidemiological data from each country can differ between cities and regions, for instance morbidity in HIV infection is four times higher in the south-west of Poland than in the east parts. Newly infected people are five times more often reported in the central part of our country than in the south-east. Methods: We assessed the main reasons for providing HIV tests among HIV-positive patients of The Department of Hepatology and Acquired Immunodeficiencies at the Medical University of Warsaw in comparison with the epidemiological situation in Poland. We designed a survey with baseline data and questions about the reasons for and place of HIV testing. Results: The main reason for HIV testing is risky sexual contacts, not intravenous drug use like several years ago. The main places where HIV infection is detected are hospitals, outpatients’ clinics and consultative and diagnostic points (PCDs). Conclusion: Our results are not strictly the same like in our Polish national data or data of the PCD’s but can give new epidemiologic insights into our patients’ situation.

Radiological Errors: Implications and Causes with a Focus on Mammographic Misdiagnosis

Radiological diagnostic errors may have serious clinical and medico-legal implications. Previous work has reported that radiology has a reasonable incidence of error, a number of which are resulted from observer mistakes. The radiologists’ interaction with the image is critical, and studying the types of diagnostic errors to improve patient and radiologist wellbeing, reduce cost and improve the public perception of the health care system is well justified. Therefore, the aim of current review is to consider the primary types of diagnostic errors in radiology, as well as their causes and implications with a focus on mammographic misdiagnosis.

不同种族人群高血压患者的靶器官损害

背景：高血压在不同种族的人群中可伴随不同的靶器官损害。以色列人口的多样性为评估不同种族人群高血压患者的靶器官损害提供了机会。方法和结果：从初级医疗诊所中收集高血压患者的计算机化医疗档案。对576例高血压患者进行分析：138例贝多因人（阿拉伯居民）、141例瑟法底犹太人（北非和中东移民）、152例亚裔-印度犹太人（印度移民）和145例阿肯纳西犹太人（欧洲、北美洲和南美洲移民）。在对已知的危险因素和种族校正后的多元Logistic回归分析中，亚裔-印度犹太人的脑血管疾病患病率最高（OR3．09，P=0．009）。