<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health pract...<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>展开更多
Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening sev...Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.展开更多
BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While th...BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.展开更多
BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan...BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.展开更多
Background and aim: Esophagogastroduodenoscopy is an innovative method used in order to diagnose esophagus, stomach, and duodenum diseases. Esophagogastroduodenoscopy is fundamental for the prognosis of various benign...Background and aim: Esophagogastroduodenoscopy is an innovative method used in order to diagnose esophagus, stomach, and duodenum diseases. Esophagogastroduodenoscopy is fundamental for the prognosis of various benign and malign upper gastrointestinal diseases, as well as for therapy or disease follow-up. The aim of the present study is to classify endoscopy results according to indications and to reveal which indications and results are most commonly seen. Materials and methods: The Esophagogastroduodenoscopy results of 6243 patients were evaluated retrospectively;all patients had applied to the Gaziosmanpa?a Taksim Education and Research Hospital Department of Internal Medicine from 2010 to 2015 on either an outpatient or inpatient basis. Results: In our study, 2548 of the patients were male and 3695 were female. The mean age of the patients was 49.37 ± 16.90 years. The indications for Esophagogastroduodenoscopy were dyspeptic symptoms for 72.8% of females and 70.4% of males. Anemia was the indication for 12.1% of females and 11.8% of males. Other indications included gastrointestinal bleeding, dysphagia, nausea and vomiting, gastroesophageal reflux disease symptoms and weight loss. Peptic ulcer disease was the result of Esophagogastroduodenoscopy for 55.7% of females and 50.6% of males. Gastric ulcer (15.2% of females and 16% of males), reflux esophagitis (8.1% of females and 10.1% of males), and duodenal ulcer (6.8% of females and 10.1% of males) were the other results. Malignancy was mostly observed in patients whose indications were anemia. Conclusion: The upper gastrointestinal system endoscopy continues to be an up-to-date method of displaying the effectiveness of diseases to assist in the diagnosis and treatment of the symptoms and complaints of the gastrointestinal system, particularly in the evaluation of patients having persistent symptoms.展开更多
Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due...Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.展开更多
Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University...Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.展开更多
Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patie...Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patients at the Abass Ndao National Hospital in Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from January 01, 2010 to December 31, 2021. It focused on hospitalized type 1 diabetic patients. Epidemiological, clinical and evolutionary data were evaluated. Results: Six hundred and fifty-nine (659) patients were enrolled, representing a frequency of 11.5%. The mean age was 29.47 years, giving a sex ratio (m/f) of 0.95. Average hospital stay was 6.1 days. One hundred and forty-four (144) patients (21.8%) had inaugural diabetes. The average consultation time was 14.89 days. Acute metabolic complications were ketoacidosis in 353 patients (56%), and hypoglycemia in 1.2%. Simple hyperglycemia was noted in 113 patients (18.0%). Infection was present in 522 patients (58.3%), of whom 95 (28.2%) had a skin infection.55 patients (16.3%) had a respiratory infection. 12.3% had a dietary imbalance.176 cases (27.7%) had no imbalance.26 patients (3.9%) died, with infectious pathologies accounting for the majority of decompensation factors among the deceased (57.7%). Conclusion: Type 1 diabetes is a cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.展开更多
Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutio...Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of macroangiopathy in diabetic patients in the internal medicine department of the Abass Ndao hospital. Patients and methods: This was a descriptive and analytical cross-sectional study. Our investigations were recruited over a 7-year period (January 1, 2016 to December 31, 2022). Results: Three hundred and fifty-nine (359) patients (10.22%) were enrolled. The mean age was 62.83 years, with extremes ranging from 17 to 98 years. The [60 - 69] age group was more representative (37.32%). Women accounted for 180 cases (50.1%), with a sex ratio (m/f) of 0.99. The average duration of diabetes was 11.86 years. Average consultation time was 38.07 days, with extremes ranging from 1 to 368 days. Average hospital stay was 7.65 days. Inaugural diabetes was noted in 12 cases (3.34%). Type 2 diabetes accounted for 95.82% (n = 344) of patients. Hypertension was present in 150 patients (41.8%). Patients with 2 risk factors accounted for 173 cases (48.18%). Nineteen patients had already had a stroke (5.29% of cases). Fourteen (14) patients (4.2%) were amputees. Obliterative arteriopathy of the lower limbs (AOMI) was noted in 193 patients (54%). Stroke was noted in 101 patients (28%). Ischemic heart disease (IHD) was noted in 38 patients (11%). AOMI was more common in males (110 patients, 57%) than in females (43%). Seventy-three (73) patients (20.3%) died. Predictors of death were age over 60 and the existence of more than two cardiovascular risk factors. Conclusion: Diabetic macroangiopathy is a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.展开更多
Background and Objective: Hepatocellular carcinoma (HCC) is a public health problem due to its high incidence and high mortality rate. The epidemiology and prognosis of this disease is poorly documented in Bouake. The...Background and Objective: Hepatocellular carcinoma (HCC) is a public health problem due to its high incidence and high mortality rate. The epidemiology and prognosis of this disease is poorly documented in Bouake. The aim of the study was to describe the epidemiological aspects and identify the predictors of death in patients hospitalized for HCC in the Internal Medicine Department of the Bouake University Hospital in order to improve patient management. Material and Methods: We conducted a cross-sectional study from 1 January 2020 to 31 December 2022 in the Internal Medicine Department of Bouake University Hospital, involving 160 patients. Results: The prevalence of HCC was 3.6%, the mean age was 48.86 ± 14.5 years with extremes of 14 and 90 years and the sex ratio was 2.90. Viral hepatitis B was observed in 81% of patients, with HBs Ag positivity in 71.2%. The performance status of WHO was ≥ 2 in 93.2% of cases. HCC was discovered at advanced stage respectively in 51% for BCLC C and 47.8% for BCLC D stage. The nodules were multiple (89.3%), and superior to 3 cm. The hospital mortality was 20% and BCLC D stage of HCC was significantly associated with death (p = 0.04) in the univariate analysis. The BCLC D stage of HCC was significantly associated with death. Length of stay inferior to 5 days (OR = 0.77;CI 95: 0.61 - 0.96) and hepatic encephalopathy (OR = 1.39;CI 95: 1.10 - 1.77), were the two independent predictors of mortality. Conclusion: HCC mainly affected young men infected with chronic viral hepatitis B. Short length of stay and hepatic encephalopathy were independent predictors of mortality.展开更多
Regulation of neurosteroid biosynthesis is primarily mediated by the steroidogenic acute regulatory(StAR,commonly known as STARD1)protein.The StAR protein,by mobilizing the transport of intra-mitochondrial cholesterol...Regulation of neurosteroid biosynthesis is primarily mediated by the steroidogenic acute regulatory(StAR,commonly known as STARD1)protein.The StAR protein,by mobilizing the transport of intra-mitochondrial cholesterol,mediates the rate-limiting step in neurosteroid biosynthesis.The first steroid produced by the action of cytochrome P450 cholesterol side-chain cleavage enzyme(CYP11A1),at the mitochondrial inner membrane,is pregnenolone(the precursor of all neurosteroids),which is then converted to various steroids by tissue-specific enzymes.展开更多
Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine t...Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine the clinical and immunovirological characteristics as well as the acceptance of antiretroviral drugs in this patient population. This is a cohort study of the files of PLHIV (People living with HIV) aged 50 years or more, followed in the Internal Medicine Department of the Point G University Hospital between January 2007 and December 2012. Results: Out of 161 HIV-infected patients in the cohort, 38 were aged 50 years or older, of whom 11 met the criteria and were included. The median age was 55 years, 90.9% of whom were in the [50 - 59 years] age group, with 63.6% being women (sex ratio = 0.57). At admission, 3 patients (27.3%) had prurigo and 2 (18.2%) had oral-pharyngeal candidiasis. At inclusion, 45.5% of patients were classified as WHO stage 2 and one as WHO stage 4. All were on ARVs, including 10 on 1st line HIV-1 and 1 on HIV-2. On triple therapy, the average weight gain was 5.1 kg at D15 and 6.84 kg at M6. However, at M12 there was a weight loss of 1.04 kg. The mean CD4 T cell gain was +102/mm<sup>3</sup> at M6 and +188/mm<sup>3</sup> at 12 months. At D0, mean viral load = 565024.75 copies/mm<sup>3</sup> [99 - 1100000] in 4/11. At M12, two patients had undetectable viral loads. Conclusion: The prevalence of HIV in elderly subjects is certainly underestimated. Thanks to triple antiretroviral therapy, PLHIV are aging with HIV but screening is not systematically proposed during consultations in elderly subjects. It is necessary to reinforce communication about HIV at all ages.展开更多
Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevale...Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.展开更多
Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the...Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.展开更多
BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to...BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.展开更多
Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicin...Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicine department of the “G” Point University Hospital in Bamako. Included were all records of hospitalized patients with a central temperature greater than 37°C in the morning and 37°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment. We include all the patients of the study period with fever greater than 37.5°C in the morning and 37.8°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment, which have more than 21 days and measured on several occasions. The data were collected on a survey sheet. Data entry and analysis was done on SPSS software. Results: We recorded 243 fever cases out of 2155 hospitalizations, a prevalence rate of 11.2%. There were 128 men and 115 women with an average age of 43 years (range, 15 to 84 years), a modal class of 37 to 47 years, and a sex ratio of 1.11. The infectious etiologies accounted for 81% followed by neoplastic causes 09.6% and inflammatory 01.2% of cases. HIV infection was found in 26.4% of patients, malaria 13.5% and urinary tract infections 10.2%). Gram negative bacilli 88% consisted mainly of Escherichia coli (56%) and Klebsiella pneumoniae (20%).展开更多
Alzheimer’s disease-associated transcriptomic landscapes have been defined in brain tissue.However,changes in blood RNA and their clinical relevance remain poorly understood.In this study,we developed an RNA profile ...Alzheimer’s disease-associated transcriptomic landscapes have been defined in brain tissue.However,changes in blood RNA and their clinical relevance remain poorly understood.In this study,we developed an RNA profile based on 1468 blood samples from both human and mouse studies,which include bulk RNA sequencing(RNA-seq),microRNA-seq,and single-cell RNA-seq data.We developed a comprehensive analysis pipeline that conducted over 11 million comparisons and correlations to identify more than 20,000 blood features.With these findings,we established a blood RNA database related to Alzheimer’s disease,RNAs in Blood of AD(RBAD,http://www.bioinform.cn/RBAD/).Using RBAD,we initially validated well-established Alzheimer’s disease-related pathways,including olfactory transduction.We then observed a decrease in both the proportion and functionality of erythroid cells,likely attributed to their elevated CD45 levels and interactions with GZMK^(+)CD8^(+)T cells.Furthermore,we identified 449 blood RNAs linked to patients’overall survival,along with two mRNAs(H4C3 and CTU1)associated with cognitive decline.In summary,RBAD is the first web-based analysis platform dedicated to investigating blood RNA changes in Alzheimer’s disease,and provides valuable insights into potential peripheral biomarkers and pathogenic mechanisms related to Alzheimer’s disease.展开更多
INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitte...INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitted for adenopathy in order to identify their specificities. METHODS: This was an observational study of a transverse and descriptive type, which took place from 1 July 2015 to 30 June 2016 in the internal medicine department of the Aristide Le Dantec national hospital in Dakar. RESULTS: We identified 84 patients, consisted of 46 male and 38 female. The sex ratio was 1.2. The mean age was 37.5 years. The consultation period was on average 2 months with extremes of 1 month and 1 year. The mean hospital stay was 29. 2 days with extremes of 1 week and 2 months. The etiologies found were classified into 6 groups. Hemopathies (30.9%) were dominated by acute leukemia in 8 patients (9.52%), non-Hodgkin’s lymphoma in 9 patients (9.5%), Hodgkin’s disease in 5 patients (5.9%). Chronic lymphocytic leukemia was retained in 3 patients (3.5%) and Castleman disease in 1 patient. Systemic diseases (11.9%) were divided into lupus disease in 4 patients and rheumatoid arthritis in 4 patients, one case of Sj?gren’s syndrome and one case of sarcoidosis. Infections were very frequent in our study, found in 34 patients (40.4%). Tuberculosis was more frequent (27.3%). The association with HIV was noted in 4 patients. The other infections were pyogenic in 3 patients (3.5%), HIV in 6 patients (7.1%), Borrelia and toxoplasma in 1 patient respectively. Cancers (8.3%) were metastatic of primary tumors including the esophagus, lung, prostate, cavum, stomach, pancreas and breast, one case each. One patient presented lymphadenopathy with inguinal localization, the etiology of which was found to be thrombophlebitis of the right lower limb. The hystiocytic pathologies (3.5%) were all related to lymphohystiocytic activation syndrome (LHAS) secondary to tuberculosis in 2 patients and pyomyositis in 1 patient. The difficulties encountered were mainly the inaccessibility of certain complementary examinations and the delay in obtaining the results. CONCLUSION: Adenopathies are a very common reason for consultation in internal medicine. This study allowed us to draw up the etiological profile of adenopathies in our practice but also to identify the main difficulties which are among other things the inaccessibility of certain complementary examinations.展开更多
Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
<strong>Introduction:</strong> Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study wi...<strong>Introduction:</strong> Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. <strong>Methods:</strong> This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. <strong>Results:</strong> During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, <i>i.e. </i> 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, <i>i.e. </i> a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton’s disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). <strong>Conclusion:</strong> It appears from our study that autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women and preferably between 25 and 44 years of age with very disparate distribution. We also observed a predominance of organ-specific autoimmune diseases over systemic ones, and “organ-specific” polygenic autoinflammatory diseases over “systemic” ones.展开更多
文摘<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>
文摘Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.
文摘BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.
基金approved by the National Medical Center Institutional Review Board(approval No.NRC-2023-10-109).
文摘BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.
文摘Background and aim: Esophagogastroduodenoscopy is an innovative method used in order to diagnose esophagus, stomach, and duodenum diseases. Esophagogastroduodenoscopy is fundamental for the prognosis of various benign and malign upper gastrointestinal diseases, as well as for therapy or disease follow-up. The aim of the present study is to classify endoscopy results according to indications and to reveal which indications and results are most commonly seen. Materials and methods: The Esophagogastroduodenoscopy results of 6243 patients were evaluated retrospectively;all patients had applied to the Gaziosmanpa?a Taksim Education and Research Hospital Department of Internal Medicine from 2010 to 2015 on either an outpatient or inpatient basis. Results: In our study, 2548 of the patients were male and 3695 were female. The mean age of the patients was 49.37 ± 16.90 years. The indications for Esophagogastroduodenoscopy were dyspeptic symptoms for 72.8% of females and 70.4% of males. Anemia was the indication for 12.1% of females and 11.8% of males. Other indications included gastrointestinal bleeding, dysphagia, nausea and vomiting, gastroesophageal reflux disease symptoms and weight loss. Peptic ulcer disease was the result of Esophagogastroduodenoscopy for 55.7% of females and 50.6% of males. Gastric ulcer (15.2% of females and 16% of males), reflux esophagitis (8.1% of females and 10.1% of males), and duodenal ulcer (6.8% of females and 10.1% of males) were the other results. Malignancy was mostly observed in patients whose indications were anemia. Conclusion: The upper gastrointestinal system endoscopy continues to be an up-to-date method of displaying the effectiveness of diseases to assist in the diagnosis and treatment of the symptoms and complaints of the gastrointestinal system, particularly in the evaluation of patients having persistent symptoms.
文摘Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.
文摘Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.
文摘Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patients at the Abass Ndao National Hospital in Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from January 01, 2010 to December 31, 2021. It focused on hospitalized type 1 diabetic patients. Epidemiological, clinical and evolutionary data were evaluated. Results: Six hundred and fifty-nine (659) patients were enrolled, representing a frequency of 11.5%. The mean age was 29.47 years, giving a sex ratio (m/f) of 0.95. Average hospital stay was 6.1 days. One hundred and forty-four (144) patients (21.8%) had inaugural diabetes. The average consultation time was 14.89 days. Acute metabolic complications were ketoacidosis in 353 patients (56%), and hypoglycemia in 1.2%. Simple hyperglycemia was noted in 113 patients (18.0%). Infection was present in 522 patients (58.3%), of whom 95 (28.2%) had a skin infection.55 patients (16.3%) had a respiratory infection. 12.3% had a dietary imbalance.176 cases (27.7%) had no imbalance.26 patients (3.9%) died, with infectious pathologies accounting for the majority of decompensation factors among the deceased (57.7%). Conclusion: Type 1 diabetes is a cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.
文摘Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of macroangiopathy in diabetic patients in the internal medicine department of the Abass Ndao hospital. Patients and methods: This was a descriptive and analytical cross-sectional study. Our investigations were recruited over a 7-year period (January 1, 2016 to December 31, 2022). Results: Three hundred and fifty-nine (359) patients (10.22%) were enrolled. The mean age was 62.83 years, with extremes ranging from 17 to 98 years. The [60 - 69] age group was more representative (37.32%). Women accounted for 180 cases (50.1%), with a sex ratio (m/f) of 0.99. The average duration of diabetes was 11.86 years. Average consultation time was 38.07 days, with extremes ranging from 1 to 368 days. Average hospital stay was 7.65 days. Inaugural diabetes was noted in 12 cases (3.34%). Type 2 diabetes accounted for 95.82% (n = 344) of patients. Hypertension was present in 150 patients (41.8%). Patients with 2 risk factors accounted for 173 cases (48.18%). Nineteen patients had already had a stroke (5.29% of cases). Fourteen (14) patients (4.2%) were amputees. Obliterative arteriopathy of the lower limbs (AOMI) was noted in 193 patients (54%). Stroke was noted in 101 patients (28%). Ischemic heart disease (IHD) was noted in 38 patients (11%). AOMI was more common in males (110 patients, 57%) than in females (43%). Seventy-three (73) patients (20.3%) died. Predictors of death were age over 60 and the existence of more than two cardiovascular risk factors. Conclusion: Diabetic macroangiopathy is a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.
文摘Background and Objective: Hepatocellular carcinoma (HCC) is a public health problem due to its high incidence and high mortality rate. The epidemiology and prognosis of this disease is poorly documented in Bouake. The aim of the study was to describe the epidemiological aspects and identify the predictors of death in patients hospitalized for HCC in the Internal Medicine Department of the Bouake University Hospital in order to improve patient management. Material and Methods: We conducted a cross-sectional study from 1 January 2020 to 31 December 2022 in the Internal Medicine Department of Bouake University Hospital, involving 160 patients. Results: The prevalence of HCC was 3.6%, the mean age was 48.86 ± 14.5 years with extremes of 14 and 90 years and the sex ratio was 2.90. Viral hepatitis B was observed in 81% of patients, with HBs Ag positivity in 71.2%. The performance status of WHO was ≥ 2 in 93.2% of cases. HCC was discovered at advanced stage respectively in 51% for BCLC C and 47.8% for BCLC D stage. The nodules were multiple (89.3%), and superior to 3 cm. The hospital mortality was 20% and BCLC D stage of HCC was significantly associated with death (p = 0.04) in the univariate analysis. The BCLC D stage of HCC was significantly associated with death. Length of stay inferior to 5 days (OR = 0.77;CI 95: 0.61 - 0.96) and hepatic encephalopathy (OR = 1.39;CI 95: 1.10 - 1.77), were the two independent predictors of mortality. Conclusion: HCC mainly affected young men infected with chronic viral hepatitis B. Short length of stay and hepatic encephalopathy were independent predictors of mortality.
基金supported in part by funding from the Department of Internal Medicine and The CH Foundation(to PRM).
文摘Regulation of neurosteroid biosynthesis is primarily mediated by the steroidogenic acute regulatory(StAR,commonly known as STARD1)protein.The StAR protein,by mobilizing the transport of intra-mitochondrial cholesterol,mediates the rate-limiting step in neurosteroid biosynthesis.The first steroid produced by the action of cytochrome P450 cholesterol side-chain cleavage enzyme(CYP11A1),at the mitochondrial inner membrane,is pregnenolone(the precursor of all neurosteroids),which is then converted to various steroids by tissue-specific enzymes.
文摘Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine the clinical and immunovirological characteristics as well as the acceptance of antiretroviral drugs in this patient population. This is a cohort study of the files of PLHIV (People living with HIV) aged 50 years or more, followed in the Internal Medicine Department of the Point G University Hospital between January 2007 and December 2012. Results: Out of 161 HIV-infected patients in the cohort, 38 were aged 50 years or older, of whom 11 met the criteria and were included. The median age was 55 years, 90.9% of whom were in the [50 - 59 years] age group, with 63.6% being women (sex ratio = 0.57). At admission, 3 patients (27.3%) had prurigo and 2 (18.2%) had oral-pharyngeal candidiasis. At inclusion, 45.5% of patients were classified as WHO stage 2 and one as WHO stage 4. All were on ARVs, including 10 on 1st line HIV-1 and 1 on HIV-2. On triple therapy, the average weight gain was 5.1 kg at D15 and 6.84 kg at M6. However, at M12 there was a weight loss of 1.04 kg. The mean CD4 T cell gain was +102/mm<sup>3</sup> at M6 and +188/mm<sup>3</sup> at 12 months. At D0, mean viral load = 565024.75 copies/mm<sup>3</sup> [99 - 1100000] in 4/11. At M12, two patients had undetectable viral loads. Conclusion: The prevalence of HIV in elderly subjects is certainly underestimated. Thanks to triple antiretroviral therapy, PLHIV are aging with HIV but screening is not systematically proposed during consultations in elderly subjects. It is necessary to reinforce communication about HIV at all ages.
文摘Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.
文摘Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.
文摘BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.
文摘Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicine department of the “G” Point University Hospital in Bamako. Included were all records of hospitalized patients with a central temperature greater than 37°C in the morning and 37°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment. We include all the patients of the study period with fever greater than 37.5°C in the morning and 37.8°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment, which have more than 21 days and measured on several occasions. The data were collected on a survey sheet. Data entry and analysis was done on SPSS software. Results: We recorded 243 fever cases out of 2155 hospitalizations, a prevalence rate of 11.2%. There were 128 men and 115 women with an average age of 43 years (range, 15 to 84 years), a modal class of 37 to 47 years, and a sex ratio of 1.11. The infectious etiologies accounted for 81% followed by neoplastic causes 09.6% and inflammatory 01.2% of cases. HIV infection was found in 26.4% of patients, malaria 13.5% and urinary tract infections 10.2%). Gram negative bacilli 88% consisted mainly of Escherichia coli (56%) and Klebsiella pneumoniae (20%).
基金supported by Research and Innovation Foundation of Wuhan Asia General Hospital,No.2022KYCX1-B10(to FH)the Natural ScienceFoundation of Hubei Province,No.2023AFB550(to FH)+2 种基金the National Natural Science Foundation of China,Nos.32400554(to FH),82371444(to YZ)theGuiding Project of the Scientific Research Program of the Department of Education of Hubei Province,No.B2021016(to FH)the Natural Science Foundationof Hubei Province,No.2024AFB853(to QW).
文摘Alzheimer’s disease-associated transcriptomic landscapes have been defined in brain tissue.However,changes in blood RNA and their clinical relevance remain poorly understood.In this study,we developed an RNA profile based on 1468 blood samples from both human and mouse studies,which include bulk RNA sequencing(RNA-seq),microRNA-seq,and single-cell RNA-seq data.We developed a comprehensive analysis pipeline that conducted over 11 million comparisons and correlations to identify more than 20,000 blood features.With these findings,we established a blood RNA database related to Alzheimer’s disease,RNAs in Blood of AD(RBAD,http://www.bioinform.cn/RBAD/).Using RBAD,we initially validated well-established Alzheimer’s disease-related pathways,including olfactory transduction.We then observed a decrease in both the proportion and functionality of erythroid cells,likely attributed to their elevated CD45 levels and interactions with GZMK^(+)CD8^(+)T cells.Furthermore,we identified 449 blood RNAs linked to patients’overall survival,along with two mRNAs(H4C3 and CTU1)associated with cognitive decline.In summary,RBAD is the first web-based analysis platform dedicated to investigating blood RNA changes in Alzheimer’s disease,and provides valuable insights into potential peripheral biomarkers and pathogenic mechanisms related to Alzheimer’s disease.
文摘INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitted for adenopathy in order to identify their specificities. METHODS: This was an observational study of a transverse and descriptive type, which took place from 1 July 2015 to 30 June 2016 in the internal medicine department of the Aristide Le Dantec national hospital in Dakar. RESULTS: We identified 84 patients, consisted of 46 male and 38 female. The sex ratio was 1.2. The mean age was 37.5 years. The consultation period was on average 2 months with extremes of 1 month and 1 year. The mean hospital stay was 29. 2 days with extremes of 1 week and 2 months. The etiologies found were classified into 6 groups. Hemopathies (30.9%) were dominated by acute leukemia in 8 patients (9.52%), non-Hodgkin’s lymphoma in 9 patients (9.5%), Hodgkin’s disease in 5 patients (5.9%). Chronic lymphocytic leukemia was retained in 3 patients (3.5%) and Castleman disease in 1 patient. Systemic diseases (11.9%) were divided into lupus disease in 4 patients and rheumatoid arthritis in 4 patients, one case of Sj?gren’s syndrome and one case of sarcoidosis. Infections were very frequent in our study, found in 34 patients (40.4%). Tuberculosis was more frequent (27.3%). The association with HIV was noted in 4 patients. The other infections were pyogenic in 3 patients (3.5%), HIV in 6 patients (7.1%), Borrelia and toxoplasma in 1 patient respectively. Cancers (8.3%) were metastatic of primary tumors including the esophagus, lung, prostate, cavum, stomach, pancreas and breast, one case each. One patient presented lymphadenopathy with inguinal localization, the etiology of which was found to be thrombophlebitis of the right lower limb. The hystiocytic pathologies (3.5%) were all related to lymphohystiocytic activation syndrome (LHAS) secondary to tuberculosis in 2 patients and pyomyositis in 1 patient. The difficulties encountered were mainly the inaccessibility of certain complementary examinations and the delay in obtaining the results. CONCLUSION: Adenopathies are a very common reason for consultation in internal medicine. This study allowed us to draw up the etiological profile of adenopathies in our practice but also to identify the main difficulties which are among other things the inaccessibility of certain complementary examinations.
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘<strong>Introduction:</strong> Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. <strong>Methods:</strong> This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. <strong>Results:</strong> During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, <i>i.e. </i> 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, <i>i.e. </i> a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton’s disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). <strong>Conclusion:</strong> It appears from our study that autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women and preferably between 25 and 44 years of age with very disparate distribution. We also observed a predominance of organ-specific autoimmune diseases over systemic ones, and “organ-specific” polygenic autoinflammatory diseases over “systemic” ones.
