Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study.

BACKGROUND: Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS: In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS: At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS: The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.

Hypothesized life cycle of the snow algae Chlainomonas sp. (Chlamydomonadales, Chlorophyta) from the Cascade Mountains, USA.

Chlainomonas (Chlamydomonadales, Chlorophyta) is one of the four genera of snow algae known to produce annual pink or red blooms in alpine snow. No Chlainomonas species have been successfully cultured in the laboratory, but diverse cell types have been observed from many field-collected samples, from multiple species. The diversity of morphologies suggests these algae have complex life cycles with changes in ploidy. Over 7 years (2017-2023), we observed seasonal blooms dominated by a Chlainomonas species from late spring through the summer months on a snow-on-lake habitat in an alpine basin in the North Cascade Mountains of Washington, USA. The Bagley Lake Chlainomonas is distinct from previously reported species based on morphology and sequence data. We observed a similar collection of cell types observed in other Chlainomonas species, with the addition of swarming biflagellate cells that emerged from sporangia. We present a life cycle hypothesis for this species that links cell morphologies observed in the field to seasonally available habitat. The progression of cell types suggests cells are undergoing both meiosis and fertilization in the life cycle. Since the life cycle is the most fundamental biological feature of an organism, with direct consequences for evolutionary processes, it is critical to understand how snow algal life cycles will influence their responses to changes in their habitat driven by climate warming. For microbial taxa that live in extreme environments and are difficult to culture, temporal field studies, such as we report here, may be key to creating testable hypotheses for life cycles.

Patchy and Pink: Dynamics of a Chlainomonas sp. (Chlamydomonadales, chlorophyta) algal bloom on Bagley Lake, North Cascades, WA.

Snow algal blooms frequently occur throughout alpine and polar environments during spring and summer months; however, our understanding of bloom dynamics is limited. We tracked a recurrent bloom of Chlainomonas sp. on Upper Bagley Lake in the North Cascade Mountains, USA, to assess the spatiotemporal dynamics in bloom color intensity, community photophysiology, and community composition over eight weeks. We found that the algae biomass had a dynamic patchy distribution over space and time, which was decoupled from changes in community composition and life-cycle progress averaged across the bloom. The proportional representation of Chlainomonas sp. remained consistent throughout the study while the overall community composition shows a progression through the bloom. We found that community photophysiology, measured by the maximum quantum yield of PSII (Fv/Fm), decreased on average throughout the bloom. These findings suggest that the Chlainomonas sp. community on Bagley Lake is not simply an algal bloom with rapid increase in biomass followed by a population crash, as is often seen in aquatic systems, though there is a physiological trajectory and sensitivity to environmental stress. These results contribute to our understanding of the biology of Chlainomonas sp. and its response to environmental stress, specifically an extreme warming event.

Midbrain and pons MRI shape analysis and its clinical and CSF correlates in degenerative parkinsonisms: a pilot study.

OBJECTIVES: To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates. METHODOLOGY: We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light chain (NfL) levels in 84 participants: 11 CS, 12 with Parkinson's disease (PD), 26 with multiple system atrophy (MSA), 21 with progressive supranuclear palsy (PSP), and 14 with corticobasal degeneration (CBD). RESULTS: MSA featured the most extensive and significant brainstem shape narrowing (that is, atrophy), mostly in the pons. CBD presented local atrophy in several small areas in the pons and midbrain compared to PD and CS. PSP presented local atrophy in small areas in the posterior and upper midbrain as well as the rostral pons compared to MSA. Our findings of planimetric MRI measurements and CSF NfL levels replicated those from previous literature. Brainstem shape atrophy correlated with worse motor state in all parkinsonisms and with higher NfL levels in MSA, PSP, and PD. CONCLUSION: Atypical parkinsonisms present different brainstem shape patterns which correlate with clinical severity and neuronal degeneration. In MSA, shape analysis could be further explored as a potential diagnostic biomarker. By contrast, shape analysis appears to have a rather limited discriminant value in PSP. KEY POINTS: • Atypical parkinsonisms present different brainstem shape patterns. • Shape patterns correlate with clinical severity and neuronal degeneration. • In MSA, shape analysis could be further explored as a potential diagnostic biomarker.

Combined CSF α-SYN RT-QuIC, CSF NFL and midbrain-pons planimetry in degenerative parkinsonisms: From bedside to bench, and back again.

INTRODUCTION: Differential diagnosis between Parkinson's disease (PD) and atypical parkinsonisms (APs: multiple system atrophy[MSA], progressive supranuclear palsy[PSP], corticobasal degeneration[CBD]) remains challenging. Lately, cerebrospinal fluid (CSF) studies of neurofilament light-chain (NFL) and RT-QuIC of alpha-synuclein (α-SYN) have shown promise, but data on their combination with MRI measures is lacking. OBJECTIVE: (1) to assess the combined diagnostic ability of CSF RT-QuIC α-SYN, CSF NFL and midbrain/pons MRI planimetry in degenerative parkinsonisms; (2) to evaluate if biomarker-signatures relate to clinical diagnoses and whether or not unexpected findings can guide diagnostic revision. METHODS: We collected demographic and clinical data and set up α-SYN RT-QuIC at our lab in a cross-sectional cohort of 112 participants: 19 control subjects (CSs), 20PD, 37MSA, 23PSP, and 13CBD cases. We also determined CSF NFL by ELISA and, in 74 participants (10CSs, 9PD, 26MSA, 19PSP, 10CBD), automatized planimetric midbrain/pons areas from 3T-MRI. RESULTS: Sensitivity of α-SYN RT-QuIC for PD was 75% increasing to 81% after revisiting clinical diagnoses with aid of biomarkers. Sensitivity for MSA was 12% but decreased to 9% with diagnostic revision. Specificities were 100% against CSs, and 89% against tauopathies raising to 91% with diagnostic revision. CSF NFL was significantly higher in APs. The combination of biomarkers yielded high diagnostic accuracy (PD vs. non-PD AUC = 0.983; MSA vs. non-MSA AUC = 0.933; tauopathies vs. non-tauopathies AUC = 0.924). Biomarkers-signatures fitted in most cases with clinical classification. CONCLUSIONS: The combination of CSF NFL, CSF RT-QuIC α-SYN and midbrain/pons MRI measures showed high discriminant ability across all groups. Results opposite to expected can assist diagnostic reclassification.

Virgibacillus doumboii sp. nov., a halophilic bacterium isolated from the stool of a healthy child in Mali.

A moderately halophilic and strictly aerobic bacterium was isolated from a human stool as part of a study on the diagnosis of childhood malnutrition in Mali. Strain Marseille-Q1616T is a Gram-stain-positive, rod-shaped, catalase-positive and oxidase-negative bacterium. It has a genome size of 3.91 Mbp with 39.79% G+C content, which contains 3954 protein-coding genes including genes encoding phosphomycin resistance and Listeria monocytogenes, 16 rRNA genes and 64 tRNA genes. Strain Marseille-Q1616T exhibited a 96.3% 16S rRNA gene sequence similarity and shared an OrthoANI value of 70.64% (the highest observed) with Virgibacillus kekensis, the phylogenetically closest validly published species. Based on phenotypic and phylogenetic evidence and genomic average nucleotide identity values, we suggest the creation of a new species within the Virgibacillus genus, named Virgibacillus doumboii sp. nov., type strain Marseille-Q1616T (= CSURQ1616).

Removal of Disperse Blue 56 from synthetic textile effluent using ionic flocculation.

The textile industry is one of the main generators of industrial effluent due to the large volumes of water containing a wide variety of pollutants, including dyes. Thus, the present study aimed to remove the Disperse Blue 56 dye present in synthetic textile effluent using ionic flocculation through surfactant flocs produced from animal/vegetable fat, assessing the system at different surfactant concentrations and temperatures. The process kinetics, adsorption mechanism and equilibrium were evaluated. The results show that the kinetics was better described by the Elovich model when compared to pseudo-first order and pseudo-second order models, indicating that chemical adsorption occurs during the process. The study of the adsorption mechanism obtained lower outer layer diffusivities than their intra-particle counterparts, demonstrating that the dye transport to the surfactant floc is controlled through the outer layer. The Langmuir isotherm was suitable for equilibrium data and the separation factor calculated showed that the isotherm is classified as favorable. Dye removal efficiency reached 87% after 360 minutes of contact between the effluent and the surfactant flocs, indicating that ionic flocculation is an efficient alternative in the treatment of textile effluent containing disperse dye.

Micro-computed tomographic assessment of dentinal microcrack formation in straight and curved root canals in extracted teeth prepared with hand, rotary and reciprocating instruments.

AIM: To compare microcrack formation in roots of extracted teeth after the shaping of straight and curved root canals with hand, rotary and reciprocating files using micro-computed tomographic (micro-CT) analysis. METHODOLOGY: Thirty straight mandibular incisors and 30 severely curved mesial roots of mandibular molars were randomly divided into 6 experimental groups (n = 10) according to the systems used for the root canal preparation and the root canal curvature: ProTaper Universal for Hand Use (Dentsply Sirona, Ballaigues, Switzerland), HyFlex EDM (Coltene-Whaledent, Altstätten, Switzerland) and Reciproc Blue (VDW, Munich, Germany) files used in mandibular incisors (straight canals) and mesial roots of mandibular molars (curved canals). The roots were imaged with micro-CT scanning at an isotropic resolution of 14 µm before and after root canal preparation, and the cross-sectional images generated were assessed to detect microcracks. RESULTS: All dentinal defects identified after root canal preparation were already present before instrumentation, and no new microcracks were detected. Dentinal microcracks were present in 19% (ProTaper Universal for Hand Use), 11% (Hyflex EDM) and 23% (Reciproc Blue) of the cross-sections when the instrumentation was performed in mandibular incisors. Instrumentation of mandibular molars revealed microcracks in 15% (ProTaper Universal for Hand Use), 16% (Hyflex EDM) and 17% (Reciproc Blue) of the cross-sections. CONCLUSIONS: Preparation of straight and curved root canals with ProTaper Universal for Hand Use, HyFlex EDM and Reciproc Blue systems did not produce microcracks in extracted teeth when evaluated with micro-CT.

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]. / Impact de la pandémie de COVID-19 sur les activités du service de cardiologie de l'hôpital national Ignace Deen du CHU de Conakry.

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

Virgibacillus ihumii sp. nov., a new bacterium isolated from the stool of healthy African children.

During a case-control study on severe acute malnutrition, strain Marseille-Q1233 was isolated. It is a Gram-positive, rod-shaped and halophilic bacillus isolated from a stool sample of Malian child under the age of 5. The fatty acid profile of the strain consisted of C15:0-anteiso and C14:0-iso as major components. Digital DNA-DNA hybridization and average nucleotide identity calculation showed 23.10% and 80.81% similarity respectively between strain Marseille-Q1233 and Virgibacillus siamensis strain Marseille-P2607, the phylogenetically closely related species with standing in nomenclature. On the basis of these results, we report the description of Virgibacillus ihumii sp. nov. strain Marseille-Q1233 as a new bacterial species.

Función renal al ingreso como marcador pronóstico en pacientes hospitalizados por un primer episodio de insuficiencia cardíaca. Resultados del estudio PREDICE / Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study

ANTECEDENTES Y OBJETIVO: La insuficiencia cardíaca (IC) es una enfermedad frecuente que deteriora la calidad de vida de los pacientes que la padecen y condiciona una elevada morbimortalidad. En los últimos años, se están desarrollando gran cantidad de trabajos para determinar qué factores influyen en el pronóstico de la IC. Sin embargo, son escasos los que evalúan el pronóstico de los pacientes hospitalizados por su primer episodio de IC. El objetivo de nuestro estudio es analizar el impacto pronóstico de la función renal en pacientes hospitalizados por un primer episodio de IC. MATERIALES Y MÉTODOS: Se recogió a 600 pacientes hospitalizados por un primer episodio de IC en 3hospitales españoles de tercer nivel. Se analizó el riesgo de mortalidad durante el primer año de seguimiento en función del grado de función renal en el momento del ingreso. RESULTADOS: Los pacientes con mayor grado de insuficiencia renal en el momento del ingreso presentaban edad más avanzada (p < 0,001) eran más frecuentemente mujeres (p = 0,01), presentaban un mayor grado de dependencia (p < 0,05) y mayor prevalencia de hipertensión arterial (p < 0,001), insuficiencia renal crónica (p < 0,001) y anemia (p < 0,001). En el análisis multivariante, el grado de insuficiencia renal al ingreso se mantuvo como predictor independiente de mayor riesgo de mortalidad durante el primer año de seguimiento. CONCLUSIONES: La presencia de insuficiencia renal en el momento del ingreso es un marcador de mal pronóstico en nuestra cohorte de pacientes hospitalizados por un primer episodio de IC

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS: We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS: The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS: The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF

[Detection of adverse events in thyroid and parathyroid surgery using trigger tool and Minimum Basic Data Set (MBDS)]. / Detección de eventos adversos en la cirugía tiroidea y paratiroidea utilizando la herramienta trigger y el Conjunto Mínimo de Datos Básicos (CMBD).

OBJECTIVES: To compare the ability of the trigger tool) and the Minimum Basic Data Set (MBDS) in detecting adverse events (AE) in hospitalized surgical patients with thyroid and parathyroid disease. METHODS: A descriptive, cross-sectional observational study, retrospective and cross-sectional study was conducted from May 2014 to April 2015 analysing retrospectively data on of patients submitted to thyroidectomy and parathyroidectomy in order to detect AE through the identification of triggers (an event often associated to an AE) and the MBDS. triggers and AE were located by systematic review of clinical documentation. The MBDS was got from the data base. Once an AE was detected, it was characterized. RESULTS: 203 AE were identified in 251 patients, being the 90.04% detected by trigger tool and 10.34% by MBDS. 126 patients had at least one AE (50.2%). Without the cases in which uncontrolled pain was the only AE, the percentage of patients that suffering AE was 38.65%. 187 AE were considered preventable and 16 AE were considered unpreventable. The trigger tool and the MBDS demonstrated a sensitivity of 91.27 and 13.49%, a specificity of 4.8 and 100%, a positive predictive value of 49,15 and 100%, and a negative predictive value of 35.29 and 53.42%, respectively. The triggers with more predictive power in AE detection were «antiemetic administration¼ and «calcium administration¼. CONCLUSIONS: Trigger tool shows higher sensitivity for detecting AE than the MBDS. All the detected AE were considered low severity and most of them were preventable.

Primary gastric rupture in 20 horses from Midwestern Brazil: case report / Ruptura gástrica primária em 20 equinos no Centro-Oeste do Brasil: relato de caso

An 11-year (2007-2018) survey of epidemiological, clinical and pathological findings of horses with primary gastric rupture (PGR) was conducted. Twenty horses presented PGR, nine (45%) horses were clinically evaluated, eleven (55%) were sent dead, and all animals were necropsied. PGR contributed to a prevalence of 0.31% (9/2,868) of all equid attendances, 1.83% (9/491) of colic cases, and 4.1% (20/487) of all equid necropsies. Highly fermentable feed (n=7), gastric impaction (n=4), and perforating gastric ulcer (n=1) were the main causes of PGR; whilst eight horses presented idiopathic gastric rupture. Clinically evaluated horses were tachycardic, tachypneic, febrile, dehydrated, with increased abdominal tension, abnormal mucous membranes and reduced to absent intestinal borborygmi. Improper dietary management, such as the ingestion of low-quality roughage and highly fermentable feedstuffs were detected as the main factors associated with PGR in Midwestern Brazil. It is important to raise awareness in horse owners about proper feed management to minimize PGR.(AU)

Foi realizado um levantamento de 11 anos (2007-2018) dos achados epidemiológicos, clínicos e patológicos de equinos com ruptura gástrica primária (RGP). Vinte equinos apresentaram RGP, dos quais nove (45%) foram avaliados clinicamente e 11 (55%) foram enviados mortos, sendo todos os animais necropsiados. A RGP contribuiu com prevalência de 0,31% de todos os atendimentos de equídeos (9/2.868), 1,83% (9/491) dos casos de cólica, e 4,1% (20/487) das necropsias em equídeos. Alimentos altamente fermentáveis (n=7), compactação gástrica (n=4) e perfuração de úlcera gástrica (n=1) foram as principais causas de RGP, enquanto oito equinos tiveram ruptura gástrica idiopática. Os equinos avaliados clinicamente apresentaram-se taquicárdicos, taquipneicos, febris, desidratados, com mucosas anormais, aumento da tensão abdominal e motilidade intestinal reduzida. O manejo inadequado da dieta, como a ingestão de forragens de baixa qualidade e alimentos altamente fermentáveis, foi o principal fator de risco associado à RGP no Centro-Oeste do Brasil. É importante aumentar a conscientização dos proprietários de equinos sobre o manejo alimentar adequado para minimizar a RGP.(AU)

Diagnosed diabetes and optimal disease control of prisoners in Catalonia.

OBJECTIVES: To determine the prevalence of diagnosed diabetes (DD) and its control amongst prisoners in Catalonia. MATERIALS AND METHODS: Transversal study carried out in four Catalan prisons between April and May 2016. The prevalence of DD in inmates was calculated by intentional sampling and collecting the following variables about: a) type of diabetes, value of glycosylated hemoglobin (HbA1c) and treatment; b) comorbidities; c) epidemiological and prison variables; knowledge of hyperglycaemia/hypoglycaemia, and e) participation in educational activities. Optimal control was considered to exist if Hb1A<7.5% and high risk if Hb1Ac >9%. Test x2 was used in order to study the association among qualitative variables. Multivariate analysis was carried out using logistic regression to determine variables associated with disease control. RESULTS: The study group considered 4,307 male patients, 50.2 years of average age. Ninety-three cases of DD were detected (prevalence 2.16%). 22.6% were treated with insulin, 51.6% with oral antidiabetics (OAD) and 25.8% with both. Type 1 users were younger, thinner, diagnosed at a younger age, heavy drug users and acknowledged to know how to act in the event of hyperglycaemia/hypoglycaemia. Optimal control was more common in type 2 diabetics, but multivariate analysis only associated it with OAD treatment. DISCUSSION: The prevalence observed in DD is much lower than that of the population outside prison and may be underestimated. Optimal control is low, and risk is very high, the results may be biased by the type of population, frequently drug-dependent and with few healthy habits. It is recommended to implement diabetes programmes or improve existing ones in order to increase the diagnosis and management of the disease.

[Ambulatory treatment of penile fracture at teaching hospital in Lomé]. / Traitement ambulatoire des fractures de la verge au centre hospitalier universitaire de Lomé.

OBJECTIVES: To study the feasibility of outpatient management of fractures of the penis and to identify factors that promote their occurrence. MATERIALS AND METHOD: This were a prospective, monocentric study of patients who received emergency treatment for fractured penises. It took place from January 2016 to January 2019. The data analyzed were circumstances of occurrence, time elapsed before management, clinic, type of anesthesia, functional outcomes (assessment based on IIEF5 questionnaire) and complications. RESULTS: Seven cases were recorded. The average age of the patients was 35 years. The diagnosis was clinical and surgical treatment in all our patients. Management was outpatient in 6 patients. Sexual function was normal in six patients with an IIEF-5≥21 with a normal erection and no pain at intromission. No complications were objectified. CONCLUSION: Emergency surgical management of patients with clinical and confirmed per-operative penis fractures may be outpatient without negative impact on functional outcomes and regardless of the cause of fracture. LEVEL OF EVIDENCE: 3.

Anxiety and depression among HIV patients of the infectious disease department of Conakry University Hospital in 2018.

Anxiety and depression continue to be significant comorbidities for people with human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of anxiety and depression disorder among HIV patients at Conakry, Guinea. In this cross-sectional study, we described socio-demographic, clinical and psychosocial data related to anxiety and depression in 160 HIV patients of the University Teaching Hospital, Conakry, Guinea. The Hospital Anxiety and Depression Scale (HADS) was used for measuring depression and anxiety in the prior month. The HADS score of ⩾8 was used to identify possible cases of depression and anxiety. Multivariate logistic regression analyses were performed to identify factors associated with symptoms of anxiety and depression. The prevalence of comorbid depression and anxiety among HIV patients was 8.1% and the prevalence of anxiety and depressive symptoms among HIV-infected patients was 13.8% and 16.9%, respectively. Multivariate analysis showed that individuals having BMI ⩽ 18 (AOR = 3.62, 95% confidence interval (CI) 1.37-9.57) and who did not receive antiretroviral treatment (AOR = 18.93, 95% CI 1.88-188.81) were significantly more likely to have depressive symptoms. Similarly, having age <40 years (AOR = 2.81, 95% CI 1.04-7.58) was also significantly associated with anxiety. Prevalence of symptoms of anxiety and depression was high in these HIV patients. This suggests a need for training on the screening and management of anxiety and depression among HIV patients.

[Surgery wound infection at surgery "A" department of the University Hospital Point G]. / Infection du site operatoire dans le service de chirurgie « A ¼ du CHU du Point G.

AIM: To determine the frequency of the surgery wound infection, its favoring factors, causative germs and its antibiotic treatment of choice in the surgery "A" department of the University Hospital Point G. METHOD: In a retrospective descriptive study over a 6-month period in the surgery "A" department of the University Hospital Point G, we enrolled all patients who underwent surgery necessitating at least 48 hours of hospital admission during our study period and in conformity with the Atlanta CDC criteria. Surgery patients with less than 48 hours postoperative hospital stay and those admitted to the hospital without surgery were not included.After the surgery, the nature and location of the infection have been clarified. In this work, ethical considerations have been respected and there is no conflict of interest. RESULTS: Two hundred and sixty-five (n=265) patient files were collected including 24 cases of surgery wound infection (a hospital frequency of 9%. The average age was 41.41 years (y.o) old with extremes of 7 y.o and 102 y.o. The sex ratio was 0.9 in favor of women. The commonly studied pathologies were digestive surgery in 52.8%, gynecological surgery in 24.5%, etc… Patients were seen in regular outpatient surgery visits in 75.8% and surgical emergencies in 24.2%. Of the patients urgently admitted, 26.5% presented an ISO; for those received in ordinary consultation it was 3.48%. Fifteen (15) cases were classified ASA III and two (2) ASA II. Based on the Altemeier classification, surgery was clean in 66.8% of our patients, contaminated clean in 12.4%, contaminated in 12.1%, and dirty in 8.7% (including half resulting in surgery wound infection). In total, 79% of patients whose surgeries lasted more than two (2) hours presented a surgery wound infection. Postoperative infection of patients was superficial in 58.3% and deep in 33.3%. In 8.3% of cases, it was a space infection. At the cytobacteriological examination of the pus from the operative site, Escherichia coli (E. coli) was the most common germ with 58.3%. E. coli was sensitive to amoxicillin-clavulanic acid in 57.14%. Surgically, a re-intervention was performed in 20.8% of cases, a secondary suture in 12.5%, and a single dressing in 66.7%. The average postoperative stay was 6.5 days with extremes of 2 days and 69 days. In 3 months postoperatively we recorded 4 cases of death. CONCLUSION: The surgery wound infection constitutes a major complication in a surgical environment starting with surgical act itself.Particular emphasis should be placed on prevention, which will reduce the risks of ISO occurrence.

BUT: déterminer la fréquence des infections du site opératoire (ISO), les facteurs favorisants la survenue des ISO, les germes responsables et les antibiotiques actifssur les infections du site opératoire dans le service chirurgie « A ¼ du CHU du Point G. MÉTHODE: Il s'agissait d'une étude rétrospective et descriptive sur une période de 6 mois réalisée dans le service chirurgie « A ¼ du CHU du Point G. Ont été inclus tous les patients ayant subi une intervention chirurgicale pendant cette période et hospitalisés au moins 48 heures après, et qui ont répondu aux critères du CDC d'Atlanta. N'ont pas été inclus, les patients opérés dont le séjour post opératoire a été inférieur à 48 heures, les patients hospitalisés dans le service mais non opérés, et ceux opérés dans le service et non hospitalisés. En postopératoire la nature et le siège de l'infection ont été précisées. Dans ce travail les considérations éthiques ont été respectées et il n'y a pas de conflit d'intérêt. RÉSULTATS: deux cent soixante-cinq dossiers de patients ont été colligés dont 24 cas d'ISO soit 9% des cas. L'âge moyen a été de 41,41 ans avec des extrêmes de 7ans et 102 ans. Le sex ratio a été de 0,2 en faveur des femmes. Les principales pathologies étudiées ont été la chirurgie digestive dans 52,8%, la chirurgie gynécologique dans 24,5%. La majorité des patients ont été reçus en consultation ordinaire dans 75,8% des cas, et en urgences dans 24,2 %. Parmi les patients reçus en urgence 26,5% ont présenté une ISO ; pour ceux reçus en consultation ordinaire elle a été de 3,48%.Parmi les patients infectés 15 étaient classés ASA III et 2 ASA II. Selon la classification Altemeier, la chirurgie propre a occupé 66,8% des patients, la chirurgie propre contaminée 12,4%, la chirurgie contaminée 12,1%, et la chirurgie sale 8,7%. Parmi les patients opérés de chirurgie sales 50% ont présenté une ISO.L'ISO était présente chez 79% des patients ayant effectué plus de 2 heures d'intervention.En postopératoire l'infection était superficielle chez 58,3% des patients, et profonde chez 33,3% des patients. Dans 8,3% des cas, il s'agissait d'une infection d'espace. A l'examen cytobactériologique du pus Escherichia coli (E coli) avec 58,3% a été le germe le plus fréquent sur le site opératoire. E coli était sensible à l'association amoxicilline - acide clavulanique dans 57,14%. Sur le plan chirurgical une réintervention a été réalisée dans 20,8% des cas, une suture secondaire dans 12,5%, et un pansement seul dans 66,7%. La durée moyenne de séjour post opératoire était de 6,5 jours avec des extrêmes de 2 jours et 69 jours. En 3 mois postopératoire nous avons enregistré 4 cas de décès. CONCLUSION: L'ISO constitue une complication majeure en milieu chirurgical compromettant l'acte chirurgical. Un accent particulier doit être mis sur la prévention qui diminuerai les risques de survenue de l'ISO.

Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. / Función renal al ingreso como marcador pronóstico en pacientes hospitalizados por un primer episodio de insuficiencia cardíaca. Resultados del estudio PREDICE.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS: We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS: The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS: The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.

Ebola virus disease in children in Conakry and Coyah Ebola treatment centers and risk factors associated with death.

OBJECTIVE: To study Ebola virus disease (EVD) in children aged 15 years and below, and to identify risk factors associated with death. PATIENTS AND METHODS: Retrospective, multicenter, descriptive, and analytical study of files of children aged 15 years and below in Ebola treatment centers (ETC) of Donka from March 2014 to May 2015. We included all files of children aged 15 years and below hospitalized for EVD in the two ETCs. RESULTS: A total of 739 patients hospitalized in both ETCs, 146 children aged 15 years and below (20%) were registered during the study period. The mean age of children was 6.73±4.26 years. Most children were aged above five years (65.8%) and the mean time to consultation was 4.34±3.21 days. The main clinical signs were asthenia (78.8%), fever (75.3%), anorexia (53.4%), headache (45.9%), vomiting (41.8%), abdominal pain (29.5%), and diarrhea (28.8%). The case fatality was 48%, including 54.3% in Coyah and 45% in Conakry. Older age (aOR=0.83, 95% CI [0.76-0.95]), fever (aOR=3.28, 95% CI [1.22-8.87]), diarrhea (aOR=2.98, 95% CI [1.19-4.48]), and hemorrhage (aOR=3.13, 95% CI [1.00-10.38]) were independently associated with death due to EVD. CONCLUSION: EVD remains serious especially in children, with high case fatality. Risk factors independently associated with death were young age, diarrhea, hemorrhage, and fever. Particular attention to these risk factors and vaccination will contribute to improving the prognosis of EVD in children.

Diabetes diagnosticada y control óptimo de la enfermedad en presos de Cataluña / Diagnosed diabetes and optimal disease control of prisoners in Catalonia

OBJETIVOS: Determinar la prevalencia de diabetes diagnosticada (DD) y su control en presos de Cataluña. MATERIAL Y MÉTODOS: Estudio transversal realizado en cuatro prisiones catalanas de hombres, entre abril y mayo de 2016. Se calculó la prevalencia de DD mediante un muestreo intencional, recogiéndose: a) datos de diabetes: tipo, valor de hemoglobina glucosilada (HbA1c) y tratamiento; b) comorbilidades; c) variables epidemiológicas y penitenciarias; d) conocimiento sobre hiperglucemia/hipoglucemia; y e) participación en actividades educativas. Se consideró un control óptimo si la HbA1c era menor del 7,5%; y de alto riesgo si la HbA1c era mayor del 9%. Para estudiar la asociación entre variables cualitativas, se utilizó la prueba de chi cuadrado o Χ2. Para determinar las variables asociadas al control óptimo, se realizó un análisis multivariante mediante una regresión logística. RESULTADOS: Se estudiaron 4.307 pacientes, con una edad media de 50,2 años. Se detectaron 93 DD (2,16%), 23,7% diabetes tipo 1 (DT1) y 76,3% tipo 2 (DT2). El 22,6% mantenía tratamiento con insulina, el 51,6% con antidiabéticos orales (ADO) y el 25,8% con ambos. Los pacientes con DT1 eran más jóvenes, delgados, diagnosticados más jóvenes, más consumidores de drogas y decían saber actuar ante hiperglucemias/hipoglucemias. El control óptimo era más frecuente en la DT2, pero solo se asoció al tratamiento con ADO. DISCUSIÓN: La prevalencia de DD es muy inferior a la extrapenitenciaria y posiblemente está subestimada. El control óptimo es bajo, y el de riesgo, muy alto, probablemente por el tipo de población, frecuentemente drogodependiente y con pocos hábitos saludables. Se recomienda aplicar programas de diabetes o mejorar los actuales con objeto de incrementar el diagnóstico y optimizar el control de la enfermedad

OBJECTIVES: To determine the prevalence of diagnosed diabetes (DD) and its control amongst prisoners in Catalonia. MATERIALS AND METHODS: Transversal study carried out in four Catalan prisons between April and May 2016. The prevalence of DD in inmates was calculated by intentional sampling and collecting the following variables about: a) type of diabetes, value of glycosylated hemoglobin (HbA1c) and treatment; b) comorbidities; c) epidemiological and prison variables; knowledge of hyperglycaemia/hypoglycaemia, and e) participation in educational activities. Optimal control was considered to exist if Hb1A <7.5% and high risk if Hb1Ac >9%. Test χ² was used in order to study the association among qualitative variables. Multivariate analysis was carried out using logistic regression to determine variables associated with disease control. RESULTS: The study group considered 4,307 male patients, 50.2 years of average age. Ninety three cases of DD were detected (prevalence 2.16%).22.6% were treated with insulin, 51.6% with oral antidiabetics (OAD) and 25.8% with both. Type 1 users were younger, thinner, diagnosed at a younger age, heavy drug users and acknowledged to know how to act in the event of hyperglycaemia/hypoglycaemia. Optimal control was more common in type 2 diabetics, but multivariate analysis only associated it with OAD treatment. DISCUSSION: The prevalence observed in DD is much lower than that of the population outside prison and may be underestimated. Optimal control is low and risk is very high, the results may be biased by the type of population, frequently drug- dependent and with few healthy habits. It is recommended to implement diabetes programmes or improve existing ones in order to increase the diagnosis and management of the disease