Need for standardization and compliance to treatment protocols for COVID-19 within the African Region of the World Health Organization

COVID-19 pandemic changed the face of global health and brought about new issues in global health security and economy. The World Health Organization published guidelines for clinical management of COVID-19 four months after declaration of COVID-19 as a pandemic. Scholarly reviews and studies from member states within WHO AFRO reveals significant deviation from the WHO published protocols on COVID-19. Assessment of national treatment protocols of 30 of 47 WHO AFRO member states showed widespread inappropriate use of antimicrobial agents for patients, which may worsen the global and concerning threat of antimicrobial resistance. There is need for adopting interventions that optimize antimicrobial use in the context of pre- and post-pandemic preparedness to ensure long-term effectiveness and sustainability for antimicrobials. Treatment guidelines are to be adopted or adapted depending on best clinical evidence available. Non-compliance with guidelines might lead to mismanagement of infectious diseases with attendant negative consequences including antimicrobial resistance and misdirection of critical resources and supplies amongst others.

La pandémie de COVID-19 a changé le visage de la santé mondiale et a soulevé de nouveaux problèmes en matière de sécurité sanitaire et d'économie mondiale. L'Organisation mondiale de la santé a publié des lignes directrices pour la gestion clinique du COVID-19 quatre mois après la déclaration du COVID-19 comme pandémie. Les revues scientifiques et les études des États membres de l'OMS AFRO révèlent un écart significatif par rapport aux protocoles publiés par l'OMS sur le COVID-19. L'évaluation des protocoles nationaux de traitement de 30 des 47 États membres de l'OMS AFRO a révélé une utilisation inappropriée et généralisée d'agents antimicrobiens chez les patients, ce qui pourrait aggraver la menace mondiale et préoccupante de résistance aux antimicrobiens. Il est nécessaire d'adopter des interventions qui optimisent l'utilisation des antimicrobiens dans le contexte de la préparation pré et post-pandémique afin de garantir l'efficacité et la durabilité à long terme des antimicrobiens. Les directives thérapeutiques doivent être adoptées ou adaptées en fonction des meilleures preuves cliniques disponibles. Le non-respect des directives pourrait conduire à une mauvaise gestion des maladies infectieuses avec des conséquences négatives qui en découlent, notamment la résistance aux antimicrobiens et une mauvaise orientation des ressources et fournitures essentielles, entre autres.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study

Abstract Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. Methodology Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. Results Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. Conclusion RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

Literature Review on Prevalence, Risk Factors and, Evaluation of Acute Lower Back Pain

Background: Acute back pain is any pain located at the back that lasts for less than 4 weeks duration. Theprevalence is fair with as many as 84% of the adult population around the globe experience back pain at somepoint in life and is often self-limiting. However, in few selected patients it may serve as indicator of a seriousunderlying disease making it crucial to properly evaluate, characterize and address this concern. Objectives: Inthis review we intend to explore the prevalence, risk factors and highlight the available methods using diagnosticimaging modalities to evaluate and address this condition. Materials and Methods: A review of relevant articlespublished from 1987 onwards in English language was done using the electronic databases of PubMed Pico and,Google Scholar with preset keywords. Conclusion: Acute back pain prevalence range between 22 to 48 percentand risk factors are non-modifiable such as advanced age and female gender while modifiable risk factors areobesity, smoking, low education, sedentary lifestyle, etc. Employment related factors such as physically strenuouswork also increase the risk of developing back pain. Notably, under-appreciated risk factors includingpsychological risk factors such as anxiety should be screened for while evaluating patients. Evaluation of backpain mostly relies on comprehensive history and physical examination, as most cases are self-limited. Diagnosticimaging is only recommended in cases presenting with red flag symptoms.

Hypertension Diagnosis and Management Approach

Background: Hypertension is one of the most common diseases nowadays. It affects about 25% of the adult globalpopulation and can lead to highly morbid cardiovascular or cerebrovascular complications. However, whenrecognized early, appropriate lifestyle-related measures and occasionally pharmacologic interventions can helpgreatly reduce its risks. Objective: In this study, we aim to provide summarized, yet comprehensive review paperfocusing on diagnosis and management of hypertension. Methods: We searched PubMed using keywords such ashypertension, its screening, diagnosis, and treatment, and family medicine. Conclusion: Essential hypertensionis a systemic disease that can kill the affected people silently. Nevertheless, knowing a lot about its risk factorsand how they can be tackled to prevent it or even to greatly reduce its effects once it develops is of highimportance; and here the major role of a family physician is revealed.

School Screening for Scoliosis among Male Adolescents in Abha City, Southwestern Saudi Arabia

Aim: To study the prevalence of scoliosis and its associated factors among male adolescents in Abha city intermediate and secondary schools, Aseer Region, Southwestern Saudi Arabia. Methods: Through a cross-sectional study, students were interviewed about personal and demographic data, method of back-bag carriage, and regular practice of any physical exercise. Body mass index (BMI) was measured and student’s bag weight/BMI ratio (%) was computed. Screening for scoliosis was performed using inspection of the vertebral column and Adam’s Forward Bending Test (FBT). Using scolimeter a reading equal or exceed 5 degrees was considered positive. Results: Out of 417 screened adolescents, 90 students were positive giving a prevalence rate of scoliosis of 19.1% (95% CI: 15.7- 23.0). Using multivariable logistic regression analysis, the probability of positive scoliosis was significantly higher in secondary school (aOR=2.304. 95% CI: 1.447-3.676) and obese and overweight (aOR=2.433. 95% CI: 1.565-3.787) adolescents. On the other hand, regular practicing of physical exercises was significantly negatively associated with scoliosis (aOR=0.469, 95% CI: -316-0.695). Conclusion: The present study identified scoliosis as a substantial problem among adolescents. School health authorities need to foster a screening program for scoliosis, particularly among secondary school adolescents. School health promotion programs should address overweight and promote physical exercise to deal with this problem.

Prevalence and preventability of sentinel events in Saudi Arabia: analysis of reports from 2012 to 2015

This study aimed to assess the pattern of sentinel events reported to Ministry of Health of Saudi Arabia from January 2012 to June 2015. Sentinel event reports were examined for patient characteristics, type of event, outcome, cause and preventability. There were 433 sentinel events: 58.2% were deaths, 14.8% were unexpected loss of a limb or a function, 7.4% major medication errors and 7.4% retained instruments or sponges. Among the reported events, 44% were associated with surgical interventions and most were classified as preventable [91.6%]. Age 19-64 years was significantly associated with death as an outcome [P = 0.02]. Non-preventable sentinel events were significantly more likely among women than men [P = 0.01]. Unavailability of policy and procedures and/or failure to implement them [55%], and lack of proper communication [35%] and training [33%] were the main causes for the adverse events. Efforts should focus on enhancing the National Sentinel Events Reporting System, adopting criteria for effective reporting and ensuring availability and implementation of policies and procedures

Microorganisms and viruses causing diarrhea in infants and primary school children and their relation with age and sex in Zakho city, Kurdistan Region, Iraq.

Background: Diarrheal diseases in children are a major public health concern in developing countries. Diarrheal infection spreads through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. This study was conducted to investigate the incidence of different microorganisms associated with diarrhea in infants and primary school children and their relation to sex and age in Zakho city, Kurdistan region, Iraq. Methods: During the period from September 2013 to May 2014, 600 diarrheic samples were collected from both sexes and different ages (<2 to 12) years; these samples were subjected to various diagnostic tests in the Microbiology Laboratories/Biology Department/Faculty of Science/University of Zakho. Results: Out of 600/479 were positive for one or more types of microorganisms including 265 (55.32%) males and 214 (44.67%) females. Among the positive 479 samples, the highest rate of prevalence was with both bacteria and parasites (57.33and 57.00%, respectively), followed by viruses (10.33%) and only1.16% with fungi. The most prevalent enteric microorganisms were found to be E. coli (62.5%), followed by E. histolytica (46.19%), G. lamblia (42.10%) and the lowest H. nana (0.87%). The mixed prevalence were documented in 179 (37.36) cases, with the most common correlation between bacteria and parasites in 76 (42.45 %) cases. All ages showed high rates of prevalence with both bacteria and parasites, the highest bacterial cases being among ages >4-8 years (65.38 and 64.07%), while parasites were among >6-10 years (64.67 and 60.11%). High viral prevalence were recorded among ages <2 to 6 years with the peak among <2 years (40.54%). Conclusions: From this study we conclude that about 57% of diarrheal cases were associated with bacteria, parasites, and viruses with E. coli, E. histolytica, G. lamblia and rotavirus as leading microorganisms. The mixed prevalence with two or more microorganisms was documented in 179 (37.36%) out of 479 positive samples and the rate of microbial prevalence was found to be gender and age dependent.

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

The objective of this study is to determine the outcome of pulmonary embolism [PE] and the clinico-radiological predictors of mortality in a university hospital setting. A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients [49.9 +/- 18.7 years] with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge. Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery [35.2%], obesity [34.3%] and immobility [30.5%]. The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients [25%] had evidence of right ventricular strain and 14 [13.3%] were hypotensive. Multivariate analysis revealed that heart failure [Beta = -0.53, P< 0.001], palpitation [Beta = -0.24, P= 0.014] and high respiratory rate [Beta = 0.211, P < 0.036] were significant predictors of mortality. There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors. The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death

GC-MS analysis and antifungal activity from galls of Guiera senegalensis J F Gmel (Combretaceae).

Guiera senegalensis is a well known medicinal plant which is used as a drug in Burkina Faso. The aim of this study was to investigate the chemical composition and antifungal activity from galls of Guiera senegalensis against different kinds of fungi in vitro. The chemical composition of the Guiera senegalensis volatile compounds obtained from the galls was analysed using gas chromatograph (GC)-flame ionization detectors (FID) and GC-MS. Thirteen (13) components were identified for hexane-acetone (50:50) column fraction of hydroacetone extract and twenty one (21) compounds for hexane-acetone (50:50) column fraction of aqueous decoction extract. This composition differed according to the kind of extract. The ethyl acetate fraction extract from hydroacetone extract (EAF/HAE) exhibited the highest of flavonol content (0.56 ± 0.01 mg QE/100 mg of fraction). The G senegalensis exhibited an interesting antifungal activity against all strains tested.

Predicting tobacco use among high school students by using the global youth tobacco survey in Riyadh, Saudi Arabia

To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia [KSA]. A cross-sectional study was conducted among high school students [grades 10-12] in Riyadh, KSA, between April 24, 2010, and June 16, 2010. The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1-2 puffs, was 43.3% overall. This behavior was more common among male students [56.4%] than females [31.3%]. The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% [31.3% and 8.9% for males and females, respectively]. "Ever smoked" status was associated with male gender [OR = 2.88, confidence interval [CI]: 2.28-3.63], parent smoking [OR = 1.70, CI: 1.25-2.30] or other member of the household smoking [OR = 2.11, CI: 1.59-2.81] who smoked, closest friends who smoked [OR = 8.17, CI: 5.56-12.00], and lack of refusal to sell cigarettes [OR = 5.68, CI: 2.09-15.48]. Several predictors of cigarette smoking among high school students were identified

prevalence and characteristics of water-pipe smoking among high school students in Saudi Arabia

To identify the prevalence and predictors of the water-pipe [WP] smoking epidemic in the Kingdom of Saudi Arabia [KSA]. A cross-sectional study conducted with 16-18 year-old high school students in Riyadh, Saudi Arabia. Of the 1272 participants, 414 [33.0%] reported having tried WP smoking. Of this group, 141 [34.1%] were female and 273 [65.9%] were male. Further, 129 [10.2%] students were current WP smokers who had used at least one rock in the past month; 20 were female [1.6%] and 120 were male [8.6%]. Regarding age, 276 [68.1%] students who tried WP smoking at least once began when they were over 11 years of age, whereas 129 [31.9%] began WP smoking at or before 11 years of age. Adjusted odds ratios showed that trying WP smoking at least once was associated with smoking after the age of 11 [p = 0.021, OR 7.7; CI: 1.4-43.6] and accepting water-pipes from a friend [p = 0.024, OR 10.6; CI: 1.4-83.4]. A high prevalence of WP smoking exists among male and female high schools students in Riyadh, KSA. WP smoking was reported to begin in early adulthood. WP smoking [water-pipe smoking], KSA [Kingdom of Saudi Arabia], STS [Saudi Thoracic Society], GYTS [Global Youth Tobacco Survey], CI [confidence interval]

Asthenopia as the presenting symptom in advance allergic fungal sinusitis

A 14-year-old male presented to the ophthalmology clinic with a history of asthenopia. Laboratory, radiological and histopathol-ogical studies confirmed the diagnosis of allergic fungal sinusitis resulting in lateral displacement of the medial rectus muscles. Symptoms improved and near point of convergence recovered after surgical endoscopic decompression of the ethmoidal and maxillary sinuses

Age at Menarche among School Girls in Sokoto; Northern Nigeria

Background/Objectives: Menarche; the first menstrual period; is influenced by many factors including socio-economic status and rural or urban dwelling. The aims of the study were to compare the age at menarche between rural and urban girls and evaluate the anthropometric indices at menarche. Materials and Methods: A cross-sectional study of rural secondary school girls and urban school girls. A structured questionnaire was used to obtain information on their age at menarche and other relevant data. Their weights and heights were measured using computerized scales and calibrated walls. Results: Two hundred and twenty eight (228) rural girls and four hundred and eighty (480) urban girls that had attained menarche within a year were studied. Mean age at menarche for all the girls was 15.26 years. Mean menarcheal age for the rural and urban girls were 15.32 years and 15.20 years; respectively. Mean weight and height were 47.6 kg and 156.76 cm; respectively for the rural girls and 48.12 kg and 156.8 cm; respectively for the urban girls. There was no significance difference in age of menarche among the groups (P 0.05). Conclusion: The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required

Knowledge on adherence and safety of the oral contraceptive pill in Saudi women

To assess knowledge regarding adherence and safety of oral contraceptive pills [OCP] in Saudi women. We conducted a cross-sectional prospective study in an outpatient pharmacy at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from April to September 2011. Participants were healthy women aged >/= 18 years with an OCP prescription for contraception. We used a validated questionnaire to assess their knowledge regarding adherence and safety of OCPs. Four hundred and sixty women participated. Most [79%] knew to take an extra pill if they missed one in less than 12 hours, but only 6.5% knew they also had to use extra protection for the next 7 days if it was more than 12 hours. Multiple logistic regression analyses indicated that years of contraceptive use and educational level are predictive factors of better knowledge regarding adherence. Few were aware of the action if they experienced diarrhea for more than 12 hours [10%] or vomiting within 2 hours [13.5%] of taking an OCP. Only 30% knew of the adverse effects of smoking while on OCPs. Weight gain [51%] was the most commonly reported side effect. Most Saudi women taking OCPs have limited knowledge of its correct use regarding missing pills, vomiting and diarrhea, and poor awareness of the effects of smoking while using OCPs.

Antiacetylcholinesterase and antioxidant activity of essential oils from six medicinal plants from Burkina Faso

In this investigation, we evaluated essential oils from six medicinal plants from Burkina Faso for their antiacetylcholinesterase and antioxidant abilities. The chemotype of most active were also determined. The best antiacetylcholinesterase activities were recorded for the essential oils of Eucalyptus camaldulensis (IC50 18.98 µ g/mL) and Ocimum canum (IC50 36.16 µ g/mL). Their chemotype have been related to the 1,8-cineole one. Both essential oils demonstrated a linear mixed non competitive inhibition. The essential oil of Ocimum basilicum which belong to the linalool-eugenol chemotype exhibited the best radical scavenging activity (IC50 3.82 µ g/mL) and reducing power (531.75 mg AAE/g). In comparison with gallic and ascorbic acids, O. basilicum essential oil evidenced interesting antioxidant activities. The antiacetylcholinesterase and antioxidant activities of essential oils were discussed in regard with their chemical composition.

Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study

The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients [non-ICU]. The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use. A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines. A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU [71.7%] than in ICU [19.8%] patients [P=0.01]. The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis [SUP]. In ICU patients, appropriate indicators for IV PPI were SUP [47.9%], PUD [11.5%], and the UGIB [20.8%]. There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost [drug acquisition cost] for inappropriate use of IV PPI during the study period was 11,000 US dollars. Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use

Effect of sodium valproate on bone profile in children in Al Jahra area [Kuwait]

Many studies observed the significant effect antiepileptic medication on the bone profiles in epileptic patient. As well as many other known side effects [1]. Is to assess the laboratory effect of prolonged use of sodium valproate on bone profiles. This study was carried out in Al-Jahra hospital, Kuwait. Which is a general governmental hospital, serving more than 350000 population One hundred patients were included in this study [62 males and 38 females] with age ranging from 3-9 years with mean age 5.5 years. They were divided into 2 groups:-Group I [patients group] Fifty children [34 males and 16 females] with age ranging between 3-9 years, who are known to have epilepsy, were diagnosed based on clinical and EEG finding and started on sodium valproate. All patients who are bed ridden or have global developmental delays were excluded from the study. Also patient who are falling to thrive were excluded. Group 2 [control group]: Fifty healthy children [28 female and 32 male] with age ranging between 2-6 years. With no risk factor of epilepsy. Any child had any seizure disorder was excluded from the study Each group of the studied children was subjected to thorough clinical history taking as well as detailed clinical examination [general and neurrological examination] any patient have neurological deficit were excluded from the study. Both groups were subjected to the following laboratory tests to determine the effect of sodium valoprate on bone profile [Serum Calicum, phosphorus, alkaline phosphate] as well as vitamin D metabolite

Effect of concommitant Helicobacter pylori infection in patients with Giardiasis lamblia in Egypt

Giardiasis is one of the most common enteroprotozoal diseases; its association with Helicobacter pylori is a common clinical finding. This work studied the impact of such association. Fifty giardiasis patients were classified into two groups according to the concomitant presence of H. pylori and ten normal healthy controls were also included. All patients were subjected to complete history taking, thorough clinical and stool examination, endoscopy, and biopsy of gastric and duodenal mucosa as well as histopatological examination. Results revealed significant upper gastrointestinal symptoms [epigastric pain and anorexia] in giardiasis patients with H. pylori. Also, endoscopic and histopathologic examination showed significant gastric lesions in this group of patients as compared to those suffering only G. lamblia

laryngeal presentation of Churg-Strauss syndrome in childhood

A 10- year-old female, known to have bronchial asthma, presented with an unusual laryngeal lesion, eventually diagnosed as Churg-Strauss syndrome [CSS]. She was referred to our hospital with history of recurrent stridor. On endoscopyhe, the larynx showed signs similar to recurrent respiratory papillomatosis [RRP]. CSS is a systemic disorder and is now defined as one of the ANCA [antineutrophil cytoplasmic antibodies]-associated vasculitides. CSS is a systemic disease that may involve unusual sites like the larynx. Such an unusual presenatation of CSS should be kept in mind, especially in patients with history of asthma

Campylobacter jejuni induces diverse kinetics and profiles of cytokine genes in INT-407 cells

To examine the kinetic ability of embryonic human epithelial INT-407 cells to express messenger ribonucleic acid [mRNA] for various cytokines and chemokines in response to Campylobacter jejuni [C. jejuni] stimulation. In an experimental single-blind study, cultured embryonic human epithelial INT-407 cells were treated with different concentrations of viable C. jejuni, its sonicated, and filtered supernatant. A modified non-radioactive in situ hybridization using probe cocktails was used to measure mRNA levels for the pro-inflammatory cytokines interleukin [IL]- 1beta, IL-6, interferon-gamma [IFN-gamma], tumour necrosis factor [TNF]-alpha, transforming growth factor [TGF]-beta1, and IL-8, and the anti-inflammatory cytokines, IL-4 and IL-10. The study was carried out from September 2005 to March 2007 at the Department of Microbiology; Immunology, and Infectious Diseases, College of Medicine, Arabian Gulf University; Bahrain. Viable C. jejuni, sonicated bacteria and filtered supernatant induced high mRNA expression for the pro-inflammatory cytokines IL-1beta IL-6, IFN-gamma, TNF-alpha, TGF-beta1, and IL-8, which peaked at the 12 hours post stimulation. Anti-inflammatory cytokines IL-4 and IL-10 mRNA expression were induced maximally at 3 hours post stimulation mainly by sonicated bacteria and filtrated supernatant, however, not with living bacteria. Untreated embryonic human epithelial INT-407 cells expressed low amount of mRNA for the various cytokines and chemokines at all time points. For each cytokine, 4 samples were used per time hour. This study demonstrated that embryonic human epithelial INT-407 cells in response to viable C. jejuni or its cytotoxins can alter cytokine and chemokine mRNA expression patterns and kinetics suggesting a potential role for theses mediators in the immunopathogenesis of the infection caused by this pathogen, which might be relevant for future immunotherapeutic interventions during severe bacterial infections