Aspects cliniques et pronostiques des accidents vasculaires cérébraux en réanimation au Cameroun / Clinical and prognostic aspects of stroke in a Cameroonian intensive care unit

Introduction. L'accident vasculaire cérébral (AVC) est une pathologie fréquente. Le but de l'étude était de décrire les aspects pronostiques des AVC en réanimation. Patients et Méthodes. Il s'agissait d'une étude longitudinale descriptive et analytique, qui s'est déroulée de janvier à avril 2019. Nous avons recruté dans les services de réanimation de trois hôpitaux universitaires de Yaoundé. Etait inclus, tout patient hospitalisé en réanimation pour prise en charge d'un AVC, ayant réalisé un scanner cérébral. Le consentement était obtenu auprès du patient ou d'un parent. Les variables étaient les données sociodémographiques, les données cliniques et pronostiques.Les données étaient analysées à partir du logiciel Epi info 3.5.4 et Microsoft Office Excel 2013. Les proportions étaient comparées par le test de Chi carré ou le test exact de Fisher. Les médianes étaient comparées par le test de MannWhitney. La survie était représentée par une courbe de Kaplan Meier. Résultats. Au total, 34 patients étaient inclus. L'âge moyen était de 59,9±9,7 ans. Le sex-ratio était de 0,7. Le délai moyen d'admission était de 4,5±4,84 jours. L'hypertension artérielle était le facteur de risque dominant (42,5%). Une altération de la conscience était fréquente (73,5%). L'hémiplégie constituait le principal signe neurologique focal. L'AVC hémorragique était retrouvé chez 58,8% des patients. Deux patients étaient intubés (5,88%). Dix-huit décès étaient enregistrés (52,9%). La durée moyenne du séjour était de 21,8±19,4 jours. Les facteurs pronostiques étaient le score de Glasgow <8 (P=0,01), le score de NIHSS≥15 (P=0,001), l'hyperthermie (P=0,04), la présence de trouble de la déglutition à l'entrée (P=0,01) et l'effet de masse au scanner cérébral (P=0,01). Conclusion. Les AVC restent une affection fréquente dans notre pays. La mortalité est élevée.Elle est liée à la gravité clinique et la survenue des complications

Background. Stroke is a frequent pathology. The aim of the study was to describe the clinical, and prognostic aspects of stroke in the intensive care unit (ICU). Patients and Methods. This was a longitudinal descriptive and analytical study, which took place from January to April 2019. We recruited from the intensive care units of three university hospitals in Yaoundé. Any patient hospitalised in the ICU for stroke management who had undergone a brain scan was included. Consent was obtained from the patient or a relative. The variables were socio-demographic data, clinical data, therapeutic data and outcome. Data were analysed using Epi info 3.5.4 and Microsoft Office Excel 2013. Proportions were compared using the Chi-square test or Fisher's exact test. Medians were compared by the Mann-Whitney test. Survival was represented by a Kaplan Meier curve. Results. A total of 34 patients were included. The mean age was 59.9±9.7 years. The sex ratio was 0.7. The mean time to admission was 4.5 days ±4.84. Hypertension was the dominant risk factor (42.5%). Altered consciousness was common (73.5%). Hemiplegia was the main focal neurological sign. Hemorrhagic stroke was found in 58.8% of the patients. All patients received general measures. Two patients were intubated (5.88%). Eighteen deaths were recorded (52.9%). The average length of stay was 21.8±19.4 days. Prognostic factors were Glasgow score <8 (P=0.01), NIHSS score≥15 (P=0.001), hyperthermia (P=0.04), presence of swallowing disorder at admission (P=0.01) and mass effect on brain scan (P=0.01). Conclusion. Stroke remains a frequent condition in our country. Mortality is high. It is related to the clinical severity and the occurrence of complications.

Epidemiological and Clinical Study of Scabies over the Last 4 Years in the North-west Gyeonggido Province: Focus on the Treatment Effect and Comparison between Inpatients and Outpatients / 대한피부과학회지

BACKGROUND: Scabies is a common parasitic infestation that is an important public-health problem in many resource-poor regions. The incidence of scabies decreased during the past 20 years, but it has been increasing with the increase in the number of elderly people and nursing hospitals in Korea. OBJECTIVE: This study was performed to evaluate and compare the clinical aspects and etiologic factors between outpatients and inpatients diagnosed with scabies. Also, we tried to investigate the clinical efficacy of topical therapies for the treatment of scabies. METHODS: We conducted a retrospective analysis of the medical records of 200 patients who were diagnosed with scabies with a mineral oil test or skin biopsy between September 2009 and August 2013. RESULTS: Of 200 patients, 91 (45.5%) were men and 109 (54.5%) were women. The mean age of the patients was 59.2+/-26.6 years (men: 54.9+/-27.6 years/women: 62.8+/-25.2 years), and 61% of patients were aged >60 years. There was no seasonal variation in occurrence. Common primary lesions were papules and burrows in both inpatients and outpatients. Also, hyperkeratotic lesions were more commonly observed in inpatients (60%) than in outpatients (16.4%). The majority of the suspected routes of infection were transmissions through the nursing homes or hospitals (outpatients: 37.6%, inpatients: 71.4%). The mean time to diagnosis was 59+/-85.1 days (outpatients: 62.97+/-92.11 days, inpatients: 40.6+/-32.2 days) and to complete treatment was 31.87+/-49.2 days (outpatients: 35.3+/-53.14 days, inpatients: 14.8+/-13.87 days). CONCLUSION: We confirmed that nursing homes or hospitals are sources of herd infection. Therefore, dermatologists should educate the medical team and caregivers who work in nursing homes and hospitals about the clinical aspects and treatments of scabies.

A Report of Five Cases of Mixed Candida and Bacterial Keratitis

PURPOSE: To report the clinical manifestations and prognoses in 5 cases of mixed Candida and bacterial keratitis and present a literature review on mixed fungal and bacterial keratitis. CASE SUMMARY: Five eyes of 5 patients (1 male, 4 female) diagnosed as mixed Candida and bacterial keratitis by corneal smear and culture were included in the present study. Patient mean age was 62.80 years. All patients had preexisting ocular or systemic conditions as predisposing factors for mixed Candida and bacterial keratitis. The most common Candida species isolated was Candida albicans (3 eyes, 60%), while Staphylococcus (3 eyes, 60%) was the most common mixed bacterial species. The average size of ulceration was 7.02 mm2. In 2 eyes (40%), the lesions were located at the corneal center. The depth of the infiltration was significant in all cases, and hypopyon was present in 2 eyes (40%). On the initial visit, the visual acuity was counting fingers or worse in all cases. Four eyes (80%) unresponsive to the topical and systemic treatment underwent surgical intervention but only 1 eye (20%), which had responded to the topical and systemic treatment, showed acuity improvement of more than 1 line on the final visit. CONCLUSIONS: In managing chronically compromised cornea, the possibility of mixed infections with Candida and bacterial organisms should be considered as keratitis shows poor prognosis.

The Isotype of Antiperinuclear Factor in Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Antiperinuclear factor (APF)is regarded as a marker antibody with high sensitivity and specificity for rheumatoid arthritis (RA).However, the precise role of APF in the pathogenesis of RA has not yet been elucidated. Studying the isotype of APF may be a step in revealing the nature of this anti-body,but such studies have been rare,and none have been done in Korea.The present study is set out to identify the isotype of APF from sera of Korean patients with RA,and to determine whether certain isotypes are related to specific clinical aspects. METHODS: A total of 114 APF positive RA sera were tested against IgG,IgA and IgM separately by indirect immunofluorescence method,and the medical records were retrospectively reviewed. RESULTS: All 114 serum samples were positive for IgG-APF,100 positive for only IgG-APF (G group,87.7%),9 positive for IgG and IgA-APF (GA group, 7.9%),4 positive for IgG and IgM-APF (GM group,3.5%),and one sample was positive for IgG,IgA and IgM-APF (0.9%).The levels of rheumatoid factor (RF)and C-reactive protein (CRP)were different between the 3 groups (ANOVA test),and the RF and CRP of the GM group was higher than the other 2 groups (Bonferroni test). CONCLUSION: The APF identified in Korean patients with RA was always IgG-APF.IgM-APF may be used as a serological marker to assess disease activity in conjunction with CRP.The differences in the laboratory parameters between each isotype groups indicate the possibility of utilizing the isotype of APF to determine the disease activity or prognosis of RA.

Current Status of Tetanus in Korea: Observation from a Public Health and Clinical Aspect on the Past 10 Years

In order to obtain knowledge and information on tetanus occurrence in Korea, an analytical survey from a public health point of view and clinical aspect was carried out for hospitalized patients in four general hospitals in Korea from January 1, 1974, to December 31, 1983. The results showed that 175 among a total of 543 tetanus patients died m the hospitals, with a fatality rate of 24.1 percent. However, the patients discharged against the doctor's advice were not included in these death cases. Sex ratio of tetanus patients between male and female was 3:1. Home delivery in neonate tetanus patients and laceration, and abrasion in non-neonate tetanus patients were the dominant causes of death. Foot wound was the most dominant cause of death in the latter. Clinical features of tetanus patients on admission were sucking failure and dysphagia (50.8%), convulsion (53.8%) and trismus (50.8%). The tetanus patients expired mainly due to respiratory and cardiac failure. In the treatment of tetanus patients, airway (58.3%), intubation (45.3%) and tracheostomy (9.7%) were applied.