Facteurs favorisant la douleur postopératoire aiguë après césarienne au Centre Hospitalier Universitaire Androva, Mahajanga, Madagascar / Risk factors for acute postoperative pain after caesarean section at the Androva University Hospital, Mahajanga, Madagascar

Une douleur aiguë postopératoire peut être source de complications à court voire à long terme si elle est sous-évaluée et sous traitée. Plusieurs facteurs interviennent à l'exacerbation de cette douleur. Notre objectif était de déterminer les facteurs cliniques influençant la sévérité de la douleur post opératoire immédiate après une césarienne. Méthodes : Une étude type cas-témoin portant sur les patientes césarisées était réalisée en salle de soins post-interventionnels du Centre Hospitalier Universitaire Professeur Zafisaona Gabriel Mahajanga allant de janvier 2019 au décembre 2019. L'étude statistique a été réalisée avec le logiciel Epi-Info® 3.5.4 de l'Organisation Mondiale de la Santé Genève et CDC Atlanta. Les mesures d'association ont été mesurées par le calcul d'Odds ratio. Le seuil de signification statistique (p) a été fixé à une valeur < 0,05. Résultats : Nous avons retenu 32 cas pour 64 témoins. La population d'étude était jeune et la majorité appartenait dans la tranche d'âge de 16 à 29 ans. Les facteurs qui interviennent sur l'intensité de la douleur postopératoire étaient surtout des facteurs liés à la patiente tels que le jeune âge (OR= 3,46 [1,17 - 10,18]; p=0,009), la gestité en l'occurrence la primigestité et la paucigestité (OR=2,77 [1,33 - 5,79]; p=0,002), la primiparité et la pauciparité (OR=5,67 [2,16 - 14,94]; p=< 0,001), l'anxiété préopératoire (OR=5,04 [1,99 - 12,74]; p=0,0003) et l'appartenance à la classe 2 selon la classification de l'American Society ofAnesthesiologists (OR=4,2 [1,49 - 11,76]; p=0,004). Conclusion : La connaissance de ces fac

Troubles de la conscience au service de réanimation polyvalente du Centre Hospitalier Universitaire Analakininina, Toamasina, Madagascar / Impaired consciousness in the intensive care unit at Analankininina Teaching Hospital of Toamasina, Madagascar

La survenue d'un coma ou de troubles de la conscience en réanimation est très fréquemment observée et leur présence est associée à un pronostic sévère. Nos objectifs étaient de décrire le profil épidémio-clinique des patients admis pour coma et trouble de la conscience ainsi que les principales étiologies de ces manifestations cliniques. Méthodes : Il s'agissait d'une étude prospective, descriptive, longitudinale de Juin à Novembre 2019. Le cadre de notre étude était le service de réanimation polyvalente du centre hospitalier universitaire (CHU) Analakininina Toamasina. Résultats : Nous avions recensé 77 patients dont 37 femmes et 40 hommes (sex ratio de 1,081). La moyenne d'âge était de 39 +/-17 ans. La majorité des patients soit 67% présentait un trouble de la conscience, le reste (31%) était comateux. La principale étiologie des troubles rencontrés était l'AVC (53%) dont 61% était hémorragiques, 17% ischémiques, et 22% non étiquetés. Plus de la moitié des patients avaient évolué vers le décès (61%). Conclusion : Pour l'amélioration du pronostic des patients, il serait nécessaire de connaitre les étiologies fréquentes afin d'adapter la prise en charge

Dyspnée récidivante révélatrice d'un syndrome de Kartagener: à propos d'un cas / Recurrent dyspnea revealing a Kartagener Syndrome: About one case

La triade bronchectasies, sinusites et situs inversus caractérisent le syndrome de Kartagener. Sa transmission est autosomique récessive. Le cas de cette jeune fille de 19 ans que nous rapportons permet de déterminer la place de l'imagerie dans la démarche diagnostique de cette pathologie. La patiente présentait un syndrome clinique respiratoire récidivant depuis sa naissance. Le diagnostic a été posé par l'examen scannographique. L'évolution de la maladie dépend de la précocité du diagnostic.

Infections sévères vue au service des urgences du Centre Hospitalier Universitaire Mahavoky Atsimo: Facteurs pronostics et Issue / Severe infections at the emergency department of the Mahavoky Atsimo teaching hospital: prognosis factors and outcome

: Une infection sévère constitue une situation préoccupante, car elle s'accompagne d'un taux élevé mortalité dans le monde. L'objectif de cette étude était de déterminer les facteurs pronostiques des infections sévères vues dans le service Accueil­triage­Urgence (ATU) du Centre Hospitalier Universitaire (CHU) Mahavoky Atsimo. Méthodes : Il s'agit d'une étude rétrospective et analytique réalisée dans le service ATU du CHU Mahavoky Atsimo durant 24 mois (Janvier 2020-Décembre 2021). Nous avons inclus tous les patients avec une infection sévère, âgés de 15 et plus ayant un score qSOFA≥2. Résultats : la prévalence d'infection sévère était de 9,8% dont 68,3% de sepsis et 31,7% de choc septique. Les principales étiologies étaient la pneumopathie (26,8%), le paludisme (22%), les méningites (14,6%). Le taux de létalité était de 43,9%. L'âge moyen des patients était de 48,34ans ±2,46 avec une majorité masculine (61%). Les facteurs prédictifs d'un mauvais pronostic étaient : l'HTA (p=0,009), la présence de cardiopathie (p=0,001), l'antécédent d'infection urinaire (p=0,000), le score de Glasgow (p=0,006), le score qSOFA (p=0,010), l'extrémité froide (p=0,000), la présence des signes de lutte (p = 0,005), les râle s crépitants (p = 0,005), la VS élevée (p=0,002), l'élévation de la procalcitonine (p<0,0005), le traitement par quinolone (p=0,048), l'utilisation d'amine Vasopressive (p=0,040), la durée longue de perfusion de catécholamines (p=0,039), l'oxygénothérapie (p= 0,014) et l'utilisation de canule oropharyngée (p=0,003). Conclusions: L'infection sévère est une situation difficile à maîtriser. Le pronostic reste dépendant à la fois de la rapidité du diagnostic et de l'instauration rapide d'un traitement adapté au germe en cause

Clinical spectrum of Tuberculosis Otitis Media (TBOM) and management outcomes

Objectives@#To determine the initial clinical diagnoses of patients with tuberculous otitis media (TBOM), to determine the value of PCR test, biopsy, and ancillary diagnostic procedures in detecting middle ear TB infection, and to establish the differences in treatment outcomes. @*Methods@#The clinical records of twenty-eight patients identified with middle ear TB infection by PCR test and biopsy, from January 2010 to December 2016, were reviewed to determine their initial clinical diagnoses. The positivity rates of PCR test and biopsy were compared. The records of 12 patients included in a previous publication were revisited and included in the present study population. The combined cases were classified according to clinical diagnosis to constitute a summary of demographic characteristics, clinical diagnoses, laboratory tests, and treatment outcomes. Results of diagnostic and surgical procedures were reviewed and analyzed. Clinical findings and hearing test results before and after treatment were compared. @*Results@#Of the 28 patients, eight different clinical diagnoses of patients confirmed with middle ear TB were determined. PCR test diagnosed most cases belonging to the early and chronic stages of the disease process. Biopsy diagnosed mostly the chronic cases but failed to diagnose acute cases and late cases with diagnosis of chronic suppurative otitis media with cholesteatoma. By including the twelve cases that were published in 2011, the range of clinical diagnoses was expanded and an outcome of eleven clinical diagnoses confirmed with TB infection was established. Analysis of treatment outcomes showed that the clinical and hearing outcomes were better for patients managed at the early stage of the disease than for those presenting at the late stages of the disease process who underwent more complicated surgical procedures. @*Conclusion@#Our study supports the concept of tuberculous otitis media (TBOM) clinical spectrum, implying a paradigm shift in the established thinking that TBOM presents only as a chronic disease. The combined use of PCR and biopsy is a potential diagnostic tool to improve case detection rate, further broaden the scope of the clinical spectrum, and develop better control and preventive strategies for TBOM.

Cerebrospinal fluid inflammatory cytokine profiles of patients with neurotropic parasitic infections

@#The pathogenesis of chronic parasitic central nervous system (CNS) infections, including granulomatous amoebic meningoencephalitis (GAE), cerebral toxoplasmosis (CT), and neurocysticercosis (NCC), is primarily due to an inflammatory host reaction to the parasite. Inflammatory cytokines produced by invading T cells, monocytes, and CNS resident cells lead to neuroinflammation which underlie the immunopathology of these infections. Immune molecules, especially cytokines, can therefore emerge as potential biomarker(s) of CNS parasitic infections. In this study, cerebral spinal fluid (CSF) samples from suspected patients with parasitic infections were screened for pathogenic free-living amoebae by culture (n=2506) and PCR (n=275). Six proinflammatory cytokines in smear and culture-negative CSF samples from patients with GAE (n = 2), NCC (n = 7), and CT (n = 23) as well as control (n = 7) patients were measured using the Multiplex Suspension assay. None of the CSF samples tested was positive for neurotropic free-living amoebae by culture and only two samples showed Acanthamoeba 18S rRNA by PCR. Of the six cytokines measured, only IL-6 and IL-8 were significantly increased in all three infection groups compared to the control group. In addition, TNFa levels were higher in the GAE and NCC groups and IL-17 in the GAE group compared to controls. The levels of IL-1b and IFNg were very low in all the infection groups and the control group. There was a correlation between CSF cellularity and increased levels of IL-6, IL-8, and TNFa in 11 patients. Thus, quantifying inflammatory cytokine levels in CSF might help with understanding the level of neuroinflammation in patients with neurotropic parasitic diseases. Further studies with clinico-microbiological correlation in the form of reduction of cytokine levels with treatment and the correlation with neurological deficits are needed.

High prevalence of HPV 18 and multiple infections with oncogenic HPV genotypes in women at risk of cervical cancer examined in Manaus, Brazil

Cervical cancer is a serious public health problem in Brazil, especially in Manaus (Amazonas), the city with the highest incidence rate of cervical cancer in the country. Persistent infection with oncogenic human papillomavirus (HPV) genotypes is the cause of disease development. The aim of this study was to investigate the prevalence of oncogenic genotypes in women at high risk for cervical precancer examined in two policlinics in Manaus. One hundred and two patients who underwent colposcopy took part in the research. The DNA samples obtained from the cervical epithelium were analyzed by PCR with type-specific primers for the detection of eight oncogenic genotypes, which were chosen based on previous studies. The presence of HPV virus was detected in all samples. The most prevalent oncogenic genotypes were 18 (47.1%) and 16 (45.1%). Interestingly, HPV 18 was considered uncommon in this region. In addition to these, genotypes 31 (19.6%), 58 (19.6%), 33 (18.6%), and 45 (15.7%) also had a relatively high frequency in this population. Fifty-six women (54.9%) had multiple infections with up to five oncogenic types. Also, the presence of genotypes other than 16 and 18 was observed in most samples (57.8%), which also deserves attention since they are not covered by currently available vaccines against HPV in Brazil. The high prevalence and multiple infections with several oncogenic HPV genotypes in association with precursor lesions for cervical cancer highlighted the need to improve strategies to prevent this disease in Amazonas.

ULTRASONIC VELOCITIES, DENSITIES AND EXCESS THERMODYNAMIC PROPERTIES OF BINARY MIXTURES OF O - CHLOROPHENOL WITH HIGHER ALKANOLS FROM 303.15 TO 318.15K

The ultrasonic velocities U, densities ? of Binary Mixtures of O - Chlorophenol with 1- hexanol, 1- heptanol and 1- octanol from 303.15 to 318.15K. Excess molar volume (VE), deviation in adiabatic compressibility (??ad) and excess intermolecular free length (LfE) have been calculated from the measured experimental data. The values of VE, ??ad and LfEhave been fitted to Redlich – Kister polynomial equation to estimate binary coefficients and standard deviation between the experimental and computed values.

A questionnaire-based study on knowledge and awareness about clinical trials among medical students

Background: Clinical trials (CTs) play a significant role in timely enhancement of health-care quality. It aids us to find an effective and safe treatment. Clinical research is rapidly developing in India and more graduates from medical, paramedical, and other scientific fields are enrolling for clinical research training. Aims and Objectives: The aims of this study were to know the knowledge and awareness of CT among undergraduate medical students. Materials and Methods: This was a cross-sectional and questionnaire-based study conducted among medical students at a tertiary care hospital in South India from January to February 2022. These questions were designed for assessing knowledge and awareness about CT. After validation, students were administered the questionnaire through the Google form. The data were recorded and analyzed using Microsoft Excel (2019 version) and the results are explained in frequency and percentage. Results: A total of 296 students were sent Google form-based questionnaire, out of which 278 responded with completely filled up questionnaire, giving a response rate of 94%. About 82% reported correctly that healthy normal human volunteers participate in phase 1 of CT. Majority of the students (95%) were aware what is informed consent. Only 98 (35%) students were aware that the request for authorization to conduct CT is given in form 44 as per drugs and cosmetics act. Around 43.16% responded correctly about the time period taken for completion of CT, majority of the students (90%) knew who is responsible for conduction of CT. One hundred and seventy (61.15%) reported correctly that adverse drug effects and new indication or use of the drug is studied in phase 4 and majority were aware that phase 4 is also known as post marketing surveillance. In the study, 204 (73.4%) students were aware that innovatory company of a new drug has to take approval from Institutional Review Board or Institutional Ethics Committee before phase 0 of clinical trial. Majority 240 (86.33%) of the students were aware what is pharmacovigilance. The last question in our study was to assess student’s interest in taking up clinical research in future, only 41% of students showed interest in choosing clinical research as a career option. Conclusion: In the present study, undergraduate medical students’ knowledge regarding clinical trial was average and limited number of students expressed their interest in conduct of CT. A scientifically conducted research helps in evidence-based medicine, which, in turn, improves the patient care and promotes health. A great number of medical students may pursue research in future; hence, it is crucial for medical students to be knowledgeable about clinical research. Therefore, formal, educative, and regular training of medical students is required for choosing clinical research as a career option and conduct high-quality research.

SNORE (Sleep Deprivation Among Night Shift Health Staff on Rotation Evaluation) Study Protocol

Background: SNORE (Sleep deprivation among Night shift health staff On Rotation-Evaluation) study is conceptualized to study the effects of sleep deprivation on healthcare professionals working night shifts on rotation. Materials and Methods: A comparative cross-sectional study is devised including health-care profes-sionals working night shifts on rotation at a tertiary level health-care facility, using a semi-structured questionnaire which can test sleep deprivation, cognitive ability, and quality of life. The process is to ap-proach 309 probable study participants based on stratified random sampling, after exclusion of health-care professionals with other factors which may interfere with sleep deprivation testing. Discussion: The study protocol was set in such a way as to randomly include participants from all cadres of healthcare providers as per population proportion. By measuring the effects on cognitive effect and quality of life necessary steps can be taken to provide better quality of life and to decrease cognitive im-pairment, especially among health care professionals working night shifts.

Esthetic management of a patient with cleft lip and palate

Esthetic rehabilitation of cleft lip and palate patients presents a myriad of challenges and requires interdisciplinary coordination. In the present case report, a 22-year-old male patient with a cleft palate and alveolus was treated. Comprehensive multidisciplinary treatment planning and management, along with a clinician-friendly process of smile designing and of creating mock-ups using digital technology, helped overcome the esthetic challenges faced in this case.

Soursop (Annona muricata L.) Fruit Peels as Source of Phenolic Constituents and Annonacin with Biological Activities

Aims: In this study, chemical constituents and biological activities of the Annona muricata L. fruit peels were evaluated using methanol extract (MEAM) and hexane (HFAM), dichloromethane (DFAM), ethyl acetate (EFAM), and butanol (BFAM) fractions. Place and Duration of Study: All the experiments were done in the Department of Pharmaceutical Sciences and Department of Biochemistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36026-900, Brazil, between January 2012 and July 2016. Methodology: Phytochemical screening (specific chemical reactions), total phenolic and flavonoid contents (Spectrophotometric methods) and chemical compounds were assessed (High performance liquid chromatography analysis). The antioxidant activity was determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP), beta-carotene, and thiobarbituric acid assays. The inhibitory effect against digestive enzymes (lipase, ?-amylase and ?-glucosidase) was measured by spectrophotometric assays and and toxicity by the brine shrimp lethality bioassay. Results: Tannins, flavonoids, coumarins, terpenes and steroids, saponins, and alkaloids were detected. EFAM had the highest values of total phenolic and flavonoids, while a similar compound to annonacin was found in MEAM by HPLC. EFAM was also more active in DPPH and FRAP assays, and HFAM was effective in inhibiting the linoleic acid oxidation and the malondialdehyde. MEAM and fractions blocked lipase, ?-amylase and ?-glucosidase, while HFAM and DFAM were toxic against Artemia salina. Conclusion: The results showed that the A. muricata fruit peels have important biological effects, which can bring great benefits to human and animal health.

Could paraprobiotics be a safer alternative to probiotics for managing cancer chemotherapy-induced gastrointestinal toxicities?

Clinical oncology has shown outstanding progress improving patient survival due to the incorporation of new drugs. However, treatment success may be reduced by the emergency of dose-limiting side effects, such as intestinal mucositis and diarrhea. Mucositis and diarrhea management is symptomatic, and there is no preventive therapy. Bacterial and fungal-based compounds have been suggested as an alternative for preventing the development of diarrhea in cancer patients. Using probiotics is safe and effective in immunocompetent individuals, but concerns remain during immunosuppressive conditions. Paraprobiotics, formulations composed of non-viable microorganisms, have been proposed to overcome such limitation. The present literature review discusses current evidence regarding the possible use of paraprobiotics as an alternative to probiotics to prevent gastrointestinal toxicity of cancer chemotherapy.

Prescription de l'oxygène dans le service d'urgence d'un hôpital de référence de Mahajanga

Introduction : L'oxygène est un médicament. Une prescription non appropriée peut occasionner une insuffisance ou un excès d'apport source de dépenses hospitalières dans les pays en développement. L'objectif était d'évaluer la prescription de l'oxygénothérapie dans un service d'urgence et de soins intensifs et d'observer les modalités d'utilisation pour permettre d'ajuster les objectifs et les cibles thérapeutiques en prenant comme référence les recommandations. Matériels et Méthodes : Il s'agit d'une étude prospective descriptive sur trois mois, en 2018, de la prescription de l'oxygène au service des urgences et de soins intensifs dans un hôpital de référence de Mahajanga. Quatre obus et quatre extracteurs étaient les sources d'oxygène pour 18 lits d'accueil, de déchoquage et de soins intensifs. Ni un générateur d'oxygène ni des matériels de ventilation spécifique n'étaient disponibles. L'étude statistique a été réalisée avec le logiciel SPSS® v.20, le test Khi2 utilisé pour la comparaison des valeurs avec un seuil de signification p˂0,05. Résultats : Sur 599 admissions, 244 patients (40,7%) bénéficiant d'un apport en oxygène ont été inclus dans l'étude. L'âge moyen était de 47,6 ans avec prédominance masculine (sex-ratio de 1,4). Une saturation d'au plus 90% a été retrouvée dans 25% des cas. Les 40% des patients ont été référés pour une « oxygénothérapie ¼. Les pathologies en cause étaient neurologiques dans 34,4% des cas, touchant la tranche d'âge de 40 à 60 ans (p=0,006), respiratoires pour 21,7% et cardio-vasculaires dans 13,9%. Les lunettes à oxygène étaient utilisées à 71,7%, l'obus à oxygène à 69,3% dans les premières 24 heures (p=0,001). La mortalité était de 22,5% avec 60,6% des patients décédés qui avaient une saturation en oxygène de 90% au maximum (p=0,05). Conclusion : Un algorithme standard avec une saturation pulsée en oxygène ciblée et des techniques plus appropriées auraient permis d'économiser l'oxygène hospitalier et de réduire la mortalité.

Background: Oxygen is a drug. An inappropriate prescription can lead to insufficient or excessive intake, which is a source of hospital expenditure in low-income countries. The aim of the study was to assess the prescription of oxygen therapy in an emergency and intensive care unit and to observe the modalities of its use to allow adjustment of the therapeutic objectives and targets according to the current recommendations. Materials and Methods: We conducted a prospective descriptive study over three months, in 2018, of the prescription of oxygen in the Emergency and Intensive Care Department, of a referral hospital in Mahajanga. Four oxygen cylinder and 4 concentrators were available as oxygen sources for 18 beds intended for patient reception, destock and intensive care. The hospital did not have an oxygen generator or specific ventilation equipment. The statistical study was carried out with SPSS® v.20 software, the Khi2 test used for the comparison of values with a significance level p˂0.05. Results: Of 599 admissions, 244 patients (40.7%) receiving oxygen were included in the study. The average age was 47.6 years with a male predominance (sex ratio : 1.4). Oxygen saturation ≤90% was found in 25% of cases. The 40% of patients were referred for "oxygen therapy". The main disease were neurological in 34.4%, affecting the age group of 40 to 60 years (p=0.006); respiratory for 21.7% and cardiovascular in 13.9%. Nasal cannulas were used in 71.7%, the oxygen cylinder in 69.3% in the first 24 hours (p=0.001). Mortality was 22.5% of which 60.6% had oxygen saturation ≤90% (p=0.05). Conclusion: Using a standard algorithm with targeted SpO2 and more appropriate techniques would have saved hospital oxygen and reduced mortality.

Central nervous system infections caused by pathogenic free-living amoebae: An Indian perspective

@#Pathogenic free-living amoebae (FLA), namely Acanthamoeba sp., Naegleria fowleri and Balamuthia mandrillaris are distributed worldwide. These neurotropic amoebae can cause fatal central nervous system (CNS) infections in humans. This review deals with the demographic characteristics, symptoms, diagnosis, and treatment outcomes of patients with CNS infections caused by FLA documented in India. There have been 42, 25, and 4 case reports of Acanthamoeba granulomatous amoebic encephalitis (GAE), N. fowleri primary amoebic meningoencephalitis (PAM), and B. mandrillaris meningoencephalitis (BAE), respectively. Overall, 17% of Acanthamoeba GAE patients and one of the four BAE patients had some form of immunosuppression, and more than half of the N. fowleri PAM cases had history of exposure to freshwater. Acanthamoeba GAE, PAM, and BAE were most commonly seen in males. Fever, headache, vomiting, seizures, and altered sensorium appear to be common symptoms in these patients. Some patients showed multiple lesions with edema, exudates or hydrocephalus in their brain CT/MRI. The cerebrospinal fluid (CSF) of these patients showed elevated protein and WBC levels. Direct microscopy of CSF was positive for amoebic trophozoites in 69% of Acanthamoeba GAE and 96% of PAM patients. One-fourth of the Acanthamoeba GAE and all the BAE patients were diagnosed only by histopathology following autopsy/biopsy samples. Twenty-one Acanthamoeba GAE survivors were treated with cotrimoxazole, rifampicin, and ketoconazole/amphotericin B, and all eleven PAM survivors were treated with amphotericin B alongside other drugs. A thorough search for these organisms in CNS samples is necessary to develop optimum treatment strategies.

Effect of proton pump inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in patients with laryngopharyngeal reflux: A systematic review and meta-analysis

Objectives@#The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). @*Methods@#Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. @*Results@#Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). @*Conclusion@#This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.

Identification of microbial agents in culture-negative brain abscess samples by 16S/18S rRNA gene PCR and sequencing

@#Despite clinical suspicion of an infection, brain abscess samples are often culture-negative in routine microbiological testing. Direct PCR of such samples enables the identification of microbes that may be fastidious, non-viable, or unculturable. Brain abscess samples (n = 217) from neurosurgical patients were subjected to broad range 16S rRNA gene PCR and sequencing for bacteria. All these samples and seven formalin-fixed paraffin-embedded tissue (FFPE) samples were subjected to species-specific 18S rRNA PCR for neurotropic free-living amoeba that harbour pathogenic bacteria. The concordance between smear and/or culture and PCR was 69%. One-third of the samples were smear- and culture-negative for bacterial agents. However, 88% of these culture-negative samples showed the presence of bacterial 16S rRNA by PCR. Sanger sequencing of 27 selected samples showed anaerobic/fastidious gram negative bacteria (GNB, 38%), facultative Streptococci (35%), and aerobic GNB (27%). Targeted metagenomics sequencing of three samples showed multiple bacterial species, including anaerobic and non-culturable bacteria. One FFPE tissue revealed the presence of Acanthamoeba 18S rRNA. None of the frozen brain abscess samples tested was positive for 18S rRNA of Acanthamoeba or Balamuthia mandrillaris. The microbial 16/18S rRNA PCR and sequencing outperformed culture in detecting anaerobes, facultative Streptococci and FLA in brain abscess samples. Genetic analyses of 16S/18S sequences, either through Sanger or metagenomic sequencing, will be an essential diagnostic technology to be included for diagnosing culture-negative brain abscess samples. Characterizing the microbiome of culture-negative brain abscess samples by molecular methods could enable detection and/or treatment of the source of infection.

First molecular-based detection study of Leishmania infantum in the Tapirapé indigenous population in the Brazilian Amazon

Species of the genus Leishmania parasitize mammals and have life cycles that alternate between vertebrate and invertebrate hosts. Most species develop in a hematophagous arthropod and infect a specific vertebrate host that may belong to diverse orders and families. Visceral leishmaniasis is a chronic zoonosis with a wide geographic distribution, affecting 350 million people globally, mostly in areas with a high risk of infection. In Brazil, this disease not only has a high incidence but is also expanding to new areas, both in urban centers and rural areas, including territories with tribal communities, due to increasing human intervention. The objective of this study was to perform cathepsin L-like gene-based molecular diagnosis of Leishmania infantum in the indigenous Tapirapé ethnic group in the state of Mato Grosso. From the 372 individuals assessed, only 0.8% (3/372) tested positive for L. infantum, all from the same village (Urubu Branco). Despite the small number of infected individuals, this study demonstrates the first human cases of Leishmania infantum infection in this population, suggesting the need for regular monitoring of visceral leishmaniasis in the area and leading to a broad discussion on the planning and implementation of public health measures for the indigenous population, while respecting their distinctive territories and culture.

Descriptive electromyography signals analysis of equine longissimus dorsi, rectus abdominis and gluteus medius muscles during maneuvers used to activate the core / [Análise descritiva do sinal eletromiográfico dos músculos longuíssimo dorsal, reto abdominal e glúteo médio de equinos durante a realização de manobras utilizadas para ativação do core]

Maneuvers to activate the equine's core can make a difference in their physical and psychic health. Although these activities are recommended and practiced, there is little research proving their effectiveness. This article aims to describe, through surface electromyography, the occurrences, durations and sequences activity of longissimus dorsi, rectus abdominis and gluteus medius during thoracolumbar flexion (TLF), lumbar and lumbosacral flexion (LLSF), global flexion (GF), which is the combination of TLF and LLSF, and tail traction (TT). Seven healthy adult horses of three different breeds performed five repetitions of these movements for five seconds (sec). Electromyographic activity was captured with non-invasive superficial sensors positioned in the skin regions covering these muscles. The sequence was performed once per animal, muscle activity captured by surface electromyography, data from two replicates of each animal were selected, analyzed on matLab software and data tabulation were described during each maneuver. These maneuvers provoked punctual and transient activation of muscles mentioned above, confirming the ability to activate equine core muscles. However, responses were not standardized, which means there were variations of occurrence, duration and sequence, suggesting that for practical application of those maneuvers it is necessary to perform more repetitions with longer durations to activate more muscles.(AU)

Manobras para ativação da musculatura do core equino podem ser diferenciais para saúde física e psíquica dos animais, sendo recomendadas e praticadas, mas existem poucas pesquisas comprovando a eficácia delas. Este artigo tem como objetivo descrever, por meio da eletromiografia de superfície, as ocorrências, as durações e as sequências temporais da atividade muscular do longuíssimo dorsal, do reto abdominal e do glúteo médio durante a realização das manobras de flexão toracolombar, flexão lombar e lombossacra, flexão global (toracolombar e lombossacra) e tração de cauda. Para isso, sete equinos adultos e hígidos de três raças realizaram esses quatro movimentos clássicos para ativar o core equino, com cinco repetições e manutenção do estímulo reflexivo por cinco segundos. Durante a realização, a atividade eletromiográfica foi capturada com a utilização de sensores superficiais posicionados de forma não invasiva em regiões cutâneas referentes a cada músculo. O protocolo completo de manobras foi realizado uma vez por cada animal enquanto a atividade muscular era capturada. Posteriormente, duas repetições de cada animal foram triadas e submetidas ao software matLab para análise. Com base na tabulação dos dados, foram descritas as variáveis eletromiográficas de presença ou ausência de ativação muscular, a duração média dos picos eletromiográficos superiores ao RMS (root mean square) e a sequência da atividade muscular observada durante cada manobra. Essas manobras provocaram ativações pontuais e transitórias nos três músculos, o que confirma a capacidade de excitar músculos do core equino. Contudo, as respostas não foram padronizadas, sugerindo que, na prática dessa atividade, devem-se realizar mais repetições com durações superiores a cinco segundos, a fim de se buscarem maiores ativações.(AU)

Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis / [Estabilização em ponte de fraturas tibiais simples por osteossíntese minimamente invasiva com placa]

This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.(AU)

Objetivou-se avaliar a efetividade da estabilização em ponte de fraturas tibiais simples em cães utilizando-se a técnica de osteossíntese minimamente invasiva com placa (MIPO). Registros médicos e radiográficos de 29 cães com fraturas simples de tíbia, fixadas em ponte por meio da MIPO, foram retrospectivamente avaliados. O resultado clínico foi classificado com base na deambulação ao final do tratamento. Os ângulos articulares mecânicos da tíbia foram aferidos e comparados aos valores descritos na literatura. Adicionalmente, foram avaliadas a aposição dos fragmentos e a disposição dos implantes. Por meio da escala modificada de união radiográfica para fraturas de tíbia, determinou-se o momento de união clínica. Clinicamente, ao final do tratamento, apenas um animal apresentou claudicação ao trote. Não houve diferença significativa entre o alinhamento ósseo no plano frontal quando comparado com dados da literatura (P>0,05), enquanto, no plano sagital, o ângulo mecânico caudal proximal da tíbia foi significativamente maior (P=0,001). A mediana para aposição dos fragmentos foi considerada aceitável. As médias para relação placa em ponte, comprimento de trabalho da placa e densidade de parafusos da placa foram, respectivamente, 0,8; 0,57 e 0,48. A mediana para união clínica foi de 30 dias. A estabilização em ponte de fraturas tibiais simples resultou em rápida consolidação óssea, com baixas taxas de complicação.(AU)