The dark side of drug repurposing. From clinical trial challenges to antimicrobial resistance: analysis based on three major fields.

Drug repurposing is a strategic endeavor that entails the identification of novel therapeutic applications for pharmaceuticals that are already available in the market. Despite the advantageous nature of implementing this particular strategy owing to its cost-effectiveness and efficiency in reducing the time required for the drug discovery process, it is essential to bear in mind that there are various factors that must be meticulously considered and taken into account. Up to this point, there has been a noticeable absence of comprehensive analyses that shed light on the limitations of repurposing drugs. The primary aim of this review is to conduct a thorough illustration of the various challenges that arise when contemplating drug repurposing from a clinical perspective in three major fields-cardiovascular, cancer, and diabetes-and to further underscore the potential risks associated with the emergence of antimicrobial resistance (AMR) when employing repurposed antibiotics for the treatment of noninfectious and infectious diseases. The process of developing repurposed medications necessitates the application of creativity and innovation in designing the development program, as the body of evidence may differ for each specific case. In order to effectively repurpose drugs, it is crucial to consider the clinical implications and potential drawbacks that may arise during this process. By comprehensively analyzing these challenges, we can attain a deeper comprehension of the intricacies involved in drug repurposing, which will ultimately lead to the development of more efficacious and safe therapeutic approaches.

Financial inclusion and improved water usage among households in Ghana.

BACKGROUND: In Ghana, about 76% of households are at risk of drinking water polluted with faecal matter, hence, poor sanitation and unsafe water are responsible for 80% of all diseases in the country. Given this, some studies have been carried out concerning the factors that determine access and use of improved water among households in Ghana. However, although financial inclusion can make it easy for households to afford and hence, use improved water, it has received very little attention. This study, thus, examines the effect of financial inclusion on the use of improved water among households in Ghana. METHODS: The Ghana Living Standards Survey round 7 (GLSS7) is used as the data source while the binary logit regression is employed as the main empirical estimation technique. RESULTS: The results show that households with financial inclusion (employing an indicator which has not been disaggregated into formal and informal financial inclusion) have a higher likelihood of using improved water sources relative to those without financial inclusion. The results are robust using formal financial inclusion as well as a combined index of financial inclusion. CONCLUSION: Enhancing financial inclusion, especially formal financial inclusion can be utilised as a major policy instrument towards increasing access and use of improved water sources among households in Ghana.

Case Report: Transcatheter aortic valve implantation using balloon-expandable bioprosthesis in patients with severe pure aortic regurgitation on noncalcified native valves: a series of cases.

Background: For individuals with pure aortic regurgitation (AR), transcatheter aortic valve implantation (TAVI) is cautiously recommended only for those with a high or prohibitive surgical risk. We aimed to describe the results of a case series of transcatheter implantation of a balloon-expandable aortic valve bioprosthesis (BEV) for the treatment of noncalcified native valve AR. Methods: From February 2022-November 2022, we performed TAVI in patients with severe pure AR. Cases were indicated on the basis of symptoms, high/prohibitive surgical risk, or patient refusal of conventional treatment. Results: Five patients underwent successful TAVI. The mean age was 81.9 ± 6.6 years, 3 (60%) female and 5 (100%) in NYHA class III or IV. The baseline echocardiogram showed an ejection fraction of 49.0 ± 10.6% and left ventricular end-systolic diameter 28.5 ± 4.7 mm/m². The average area of the aortic annulus was 529.1 ± 47.0mm² and the area oversizing index was 17.6 ± 1.2%. In the 30-day follow-up, there were no cases of prosthesis embolization, annulus rupture, stroke, acute myocardial infarction, acute renal failure, hemorrhagic complication or death. One patient required a permanent pacemaker and another had a minor vascular complication. The clinical follow-up were 19.8 months (16.7-21.8). During this period, all patients remained alive and in NYHA class I or II. One of the patients developed a moderate paravalvular leak. Conclusion: TAVI with a BEV proved to be safe and effective in this small case series of patients with noncalcified native valve AR in a follow-up longer than 1 year.

A rare case with melatonin-induced on top of alcohol intoxication Brugada type 2 pattern.

Brugada syndrome (BrS), a genetically inherited ion channelopathy, has been linked to a considerable number of unexplained sudden cardiac deaths in patients without structural heart defects, and Brugada phenocopy (BrP) is a condition where there is an identical electrocardiogram (ECG) pattern to a congenital BrS, but this is due to other reversible etiologies. A 37-year-old male patient with a documented history of hypertension presented with vomiting after taking 43, 10 mg, melatonin pills and binge drinking locally made alcohol 2 days before. ECG showed right ventricular conduction delay with a "saddleback" appearance, with the J point elevated more than 2 mm and the terminal portion of the ST-segment elevated more than 1 mm in leads V1 and/or V2. Which returned to normal after a few hours. The association between the use of melatonin and the finding of the Brugada pattern (BP) in a patient with normal heart structure or abnormal ECGs has been documented in much literature, and although no official melatonin dosage is recommended for adults, melatonin has been reported to cause and protect from arrhythmias through different mechanisms. In our patient, after alcohol intoxication was ruled out as a cause, melatonin was the only significant risk factor related to his ECG findings. The BP can be found in patients with otherwise normal heart structure and ECG records, and an overdose of melatonin, which is used as an over-the-counter sleep medication, was found to be a possible cause of finding this pattern in these patients after excluding other known causes.

Biogenic Preparation and Characterization of Silver Nanoparticles from Seed Kernel of Mangifera indica and Their Antibacterial Potential against Shigella spp.

Shigellosis is a serious foodborne diarrheal disease caused by the Shigella species. It is a critical global health issue. In developing countries, shigellosis causes most of the mortality in children below 5 years of age. Globally, around 165 million cases of diarrhea caused by Shigella are reported, which accounts for almost 1 million deaths, in which the majority are recorded in Third World nations. In this study, silver nanoparticles were synthesized using Mangifera indica kernel (MK-AgNPs) seed extracts. The biosynthesized M. indica silver nanoparticles (MK-AgNPs) were characterized using an array of spectroscopic and microscopic tools, such as UV-Vis, scanning electron microscopy, particle size analyzer, Fourier transform infrared spectroscopy, and X-ray diffractometer. The nanoparticles were spherical in shape and the average size was found to be 42.7 nm. The MK-AgNPs exhibited remarkable antibacterial activity against antibiotic-resistant clinical Shigella sp. The minimum inhibitory concentration (MIC) value of the MK-AgNPs was found to be 20 µg/mL against the multi-drug-resistant strain Shigella flexneri. The results clearly demonstrate that MK-AgNPs prepared using M. indica kernel seed extract exhibited significant bactericidal action against pathogenic Shigella species. The biosynthesized nanoparticles from mango kernel could possibly prove therapeutically useful and effective in combating the threat of shigellosis after careful investigation of its toxicity and in vivo efficacy.

Natural Intelligence as the Brain of Intelligent Systems.

This article discusses the concept and applications of cognitive dynamic systems (CDS), which are a type of intelligent system inspired by the brain. There are two branches of CDS, one for linear and Gaussian environments (LGEs), such as cognitive radio and cognitive radar, and another one for non-Gaussian and nonlinear environments (NGNLEs), such as cyber processing in smart systems. Both branches use the same principle, called the perception action cycle (PAC), to make decisions. The focus of this review is on the applications of CDS, including cognitive radios, cognitive radar, cognitive control, cyber security, self-driving cars, and smart grids for LGEs. For NGNLEs, the article reviews the use of CDS in smart e-healthcare applications and software-defined optical communication systems (SDOCS), such as smart fiber optic links. The results of implementing CDS in these systems are very promising, with improved accuracy, performance, and lower computational costs. For example, CDS implementation in cognitive radars achieved a range estimation error that is as good as 0.47 (m) and a velocity estimation error of 3.30 (m/s), outperforming traditional active radars. Similarly, CDS implementation in smart fiber optic links improved the quality factor by 7 dB and the maximum achievable data rate by 43% compared to those of other mitigation techniques.

Medical ultrasound image speckle reduction and resolution enhancement using texture compensated multi-resolution convolution neural network.

Ultrasound (US) imaging is a mature technology that has widespread applications especially in the healthcare sector. Despite its widespread use and popularity, it has an inherent disadvantage that ultrasound images are prone to speckle and other kinds of noise. The image quality in the low-cost ultrasound imaging systems is degraded due to the presence of such noise and low resolution of such ultrasound systems. Herein, we propose a method for image enhancement where, the overall quality of the US images is improved by simultaneous enhancement of US image resolution and noise suppression. To avoid over-smoothing and preserving structural/texture information, we devise texture compensation in our proposed method to retain the useful anatomical features. Moreover, we also utilize US image formation physics knowledge to generate augmentation datasets which can improve the training of our proposed method. Our experimental results showcase the performance of the proposed network as well as the effectiveness of the utilization of US physics knowledge to generate augmentation datasets.

Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis.

Background: Intussusception (ISN) post-COVID-19 infection in children is rare but can occur. SARS-CoV-2 may play a role in the pathogenesis of ISN and trigger immune activation and mesenteric adenitis, which predispose peristaltic activity to "telescope" a proximal bowel segment into the distal bowel lumen. Objectives: To estimate the prevalence of SARS-CoV-2 infection in ISN children and analyze the demographic parameters, clinical characteristics and treatment outcomes in ISN pediatric patients with COVID-19 illness. Methods: We performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting on the incidence of ISN post-SARS-CoV-2 infection in children, published from 1 December 2019 until 1 October 2022, in PROQUEST, MEDLINE, EMBASE, PUBMED, CINAHL, WILEY ONLINE LIBRARY, SCOPUS and NATURE, with a restriction to articles available in the English language, were included. Results: Of the 169 papers that were identified, 34 articles were included in the systematic review and meta-analysis (28 case report, 5 cohort and 1 case-series studies). Studies involving 64 ISN patients with confirmed COVID-19 (all patients were children) were analyzed. The overall pooled proportions of the ISN patients who had PCR-confirmed SARS-CoV-2 infection was 0.06% (95% CI 0.03 to 0.09, n = 1790, four studies, I2 0%, p = 0.64), while 0.07% (95% CI 0.03 to 0.12, n = 1552, three studies, I2 0%, p = 0.47) had success to ISN pneumatic, hydrostatic and surgical reduction treatment and 0.04% (95% CI 0.00 to 0.09, n = 923, two studies, I2 0%, p = 0.97) had failure to ISN pneumatic, hydrostatic and surgical reduction treatment. The median patient age ranged from 1 to 132 months across studies, and most of the patients were in the 1−12 month age group (n = 32, 50%), p = 0.001. The majority of the patients were male (n = 41, 64.1%, p = 0.000) and belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000. The reported ISN classifications by location were mostly ileocolic (n = 35, 54.7%), and few children experienced ileo-ileal ISN (n = 4, 6.2%), p = 0.001. The most common symptoms from ISN were vomiting (n = 36, 56.2%), abdominal pain (n = 29, 45.3%), red currant jelly stools (n = 25, 39.1%) and blood in stool (n = 15, 23.4%). Half of the patients never had any medical comorbidities (n = 32, 50%), p = 0.036. The approaches and treatments commonly used to manage ISN included surgical reduction of the ISN (n = 17, 26.6%), pneumatic reduction of the ISN (n = 13, 20.2%), antibiotics (n = 12, 18.7%), hydrostatic reduction of the ISN (n = 11, 17.2%), laparotomy (n = 10, 15.6%), intravenous fluids (n = 8, 12.5%) and surgical resection (n = 5, 7.8%), p = 0.051. ISN was recurrent in two cases only (n = 2, 3.1%). The patients experienced failure to pneumatic (n = 7, 10.9%), hydrostatic (n = 6, 9.4%) and surgical (n = 1, 1.5%) ISN treatment, p = 0.002. The odds ratios of death were significantly higher in patients with a female gender (OR 1.13, 95% CI 0.31−0.79, p = 0.045), Asian ethnicity (OR 0.38, 95% CI 0.28−0.48, p < 0.001), failure to pneumatic or surgical ISN reduction treatment (OR 0.11, 95% CI 0.05−0.21, p = 0.036), admission to ICU (OR 0.71, 95% CI 0.83−1.18, p = 0.03), intubation and placement of mechanical ventilation (OR 0.68, 95% CI 0.51−1.41, p = 0.01) or suffering from ARDS (OR 0.88, 95% CI 0.93−1.88, p = 0.01) compared to those who survived. Conclusion: Children with SARS-CoV-2 infection are at low risk to develop ISN. A female gender, Asian ethnicity, failure to ISN reduction treatment (pneumatic or surgical), admission to ICU, mechanical ventilation and suffering from ARDS were significantly associated with death following ISN in pediatric COVID-19 patients.

Evidence of in-vivo myofascial force transfer in humans- a systematic scoping review.

BACKGROUND: The fascial system not only enables the body to operate in an integrated manner but modifies its tension in response to the stress on it. Recent animal, cadaveric and in-vitro trials have shown that "myofascial force transmission" (MFT) can play a major role in homeostasis, musculoskeletal function and pain. Human evidence for the in-vivo existence of MFT is scarce. OBJECTIVE: This scoping review attempts to gather and interpret the available evidence of the in-vivo existence of MFT in humans, its role in homeostasis, and musculoskeletal function. METHOD: A search of major databases using the keywords 'myofascial force transmission' and 'epimuscular force transmission' yielded 247 articles as of November 2021. For the final analysis, only original in-vivo human studies were considered. In-vitro human studies, cadaveric or animal studies, reviews, and similar studies were excluded. A qualitative analysis of the studies was conducted after rating it with the Oxford's Center for Evidence -based Medicine (CEBM) scale. RESULT: Twenty studies ranging from randomized controlled trials (RCTs) to case studies covering 405 patients have been included in this review. The analysed trials were highly heterogeneous and of lower methodological quality meddling with the quantitative analysis. The majority of the appraised studies demonstrated a higher probability of MFT existence, while two studies revealed a lower probability. CONCLUSION: Our search for proof of the in vivo existence of MFT in humans has led us to support such an existence, albeit prudently. Previous research on animals and human cadavers reinforces our finding. We are optimistic that the forthcoming studies on the topic will pave the way for the unraveling of several musculoskeletal riddles that are currently unknown or less well-known.

Sleepwalking, sleep-related eating disorder and sleep-related smoking successfully treated with topiramate: a case report.

We describe a 45-year-old married woman with sleepwalking, sleep-related eating disorder, and sleep-related smoking behavior, but without restless legs syndrome. The patient had a history of mild obstructive sleep apnea with an AHI of 12.6/hour with an oxygen saturation nadir of 95%, which resolved after bariatric surgery. Treatment with topiramate 100mg at bedtime controlled all three parasomnias for ten months at the latest follow-up, with relapse occurring whenever topiramate was stopped. To our knowledge, this is the first reported successful treatment of sleep-related smoking. Clinicians are encouraged to inquire about other types of parasomnias, and other sleep disorders such as narcolepsy, in patients presenting with a complaint of one parasomnia.

What might COVID-19 patients experience after recovery? A comprehensive review.

OBJECTIVES: The objective of this review was to describe the COVID-19 complications after recovery. METHODS: The researchers systematically reviewed studies that reported post-COVID-19 complications from three databases: PubMed, Google Scholar and the World Health Organization (WHO) COVID-19 database. The search was conducted between 21 November 2020 and 14 January 2021. Inclusion criteria were articles written in English, with primary data, reporting complications of COVID-19 after full recovery. The review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. KEY FINDINGS: This review included 69 studies with 146 725 patients from 22 countries related to post-COVID-19 complications. Thirty-six studies reported post-cure respiratory complications, ranging from dyspnoea to residual pulmonary fibrosis. Cardiac symptoms were reported in nine studies, including palpitation, chest pain and diastolic dysfunction. Neurological complications included post-traumatic stress syndrome, anxiety, depression, memory issues, insomnia and sleeping disturbance, cognitive impairments and stigma. Gastrointestinal symptoms included nausea, vomiting, diarrhoea and acute liver injury. The physical decline was the most common symptom reported in the musculoskeletal complications. CONCLUSION: COVID-19 may cause several types of complications after recovery (testing negative PCR). The identified complications include respiratory, neurological/mental, cardiovascular, gastrointestinal tract, urinary tract, musculoskeletal and miscellaneous complications. However, the key impairments were pulmonary consequences, psychological problems and exercise intolerance. Thus, COVID-19 patients may need long-term follow-up.

Antibacterial Mechanisms of Zinc Oxide Nanoparticle against Bacterial Food Pathogens Resistant to Beta-Lactam Antibiotics.

The increase in ß-lactam-resistant Gram-negative bacteria is a severe recurrent problem in the food industry for both producers and consumers. The development of nanotechnology and nanomaterial applications has transformed many features in food science. The antibacterial activity of zinc oxide nanoparticles (ZnO NPs) and their mechanism of action on ß-lactam-resistant Gram-negative food pathogens, such as Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi, Serratia marcescens, Klebsiella pneumoniae, and Proteus mirabilis, are investigated in the present paper. The study results demonstrate that ZnO NPs possesses broad-spectrum action against these ß-lactamase-producing strains. The minimal inhibitory and minimal bactericidal concentrations vary from 0.04 to 0.08 and 0.12 to 0.24 mg/mL, respectively. The ZnO NPs elevate the level of reactive oxygen species (ROS) and malondialdehyde in the bacterial cells as membrane lipid peroxidation. It has been confirmed from the transmission electron microscopy image of the treated bacterial cells that ZnO NPs diminish the permeable membrane, denature the intracellular proteins, cause DNA damage, and cause membrane leakage. Based on these findings, the action of ZnO NPs has been attributed to the fact that broad-spectrum antibacterial action against ß-lactam-resistant Gram-negative food pathogens is mediated by Zn2+ ion-induced oxidative stress, actions via lipid peroxidation and membrane damage, subsequently resulting in depletion, leading to ß-lactamase enzyme inhibition, intracellular protein inactivation, DNA damage, and eventually cell death. Based on the findings of the present study, ZnO NPs can be recommended as potent broad-spectrum antibacterial agents against ß-lactam-resistant Gram-negative pathogenic strains.

Functionality of Cordia and Ziziphus Gums with Respect to the Dough Properties and Baking Performance of Stored Pan Bread and Sponge Cakes.

The functionality of hydrocolloids of different origins, gum Cordia (GC), and gum ziziphus (GZ) on pan bread and sponge cake quality and their potential use in retarding the staling process have been studied. The effects of the gums were determined by assessing the pasting qualities of wheat flour slurry, dough properties, and the finished product. After 24 and 96 h of storage, investigations were conducted on the finished product. Micro-doughLab was used to assess dough mixing qualities, and a texture profile analysis (TPA) test was used to assess the texture. A hedonic sensory test of texture, scent, taste, color, and general approval was also conducted. The type of gum used had a significant impact on the physical properties of the bread and cake and their evolution through time. Reduced amylose retrogradation was demonstrated by the lower peak viscosity and substantially lower setback of wheat flour gels, which corresponded to lower gel hardness. Gums were superior at increasing the bread loaf volume, especially GZ, although gums had the opposite effect on cake volume. After both storage periods, the hardness of the bread and cake was much lower than that of the control. Except when 2% GC was used, adding GC and GZ gums to bread and cake invariably increased the overall acceptability of the product. In terms of shelf-life, GZ was able to retain all texture parameters, volume, and general acceptability close to the control after storage.

Broad-Spectrum Antimicrobial, Antioxidant, and Anticancer Studies of Leaf Extract of Simarouba glauca DC In Vitro.

The current study aimed to screen the preliminary phytochemicals in the leaf extract of the medicinal plant Simarouba glauca and to analyze its potential antimicrobial, antioxidant and anticancer properties. The phytochemical profile of the methanol extract was analyzed, and bioactive compounds were identified using chromatography, FTIR and GCMS. Antimicrobial activity and Minimum Inhibitory Concentration (MIC) were determined against 14 bacterial and 6 fungal strains. Moreover, the synergistic effect of a plant extract with commercially available antibiotics was also evaluated using the checkerboard method. The ethanolic and methanolic extracts showed exclusive activity against S. aureus and profound activity against E. coli and S. marcescens. Upon comparing breakpoints, methanolic extract demonstrated higher antimicrobial activity with a MIC value of 3.2 mg/mL against the test pathogens. Furthermore, the extracts demonstrated potential antioxidant activity; methanol extract had higher antioxidant potential compared to the ethanol extract. The major proactive bioactive compound with maximum antioxidant capacity was observed to be terpenoids. The methanol extract of S. glauca showed significant cytotoxicity against the MCF-7 breast cancer cell line with an IC50 value of 16.12 µg/mL. The overall results of our work provide significant evidence for the usage of methanolic extract of S. glauca as an efficient ethnomedicinal agent and a potential candidate for relieving many human ailments.

Exploring Work Satisfaction and Characteristics of Iraqi Pharmacist Workforce

Abstract The objectives of this study were to describe work characteristics of Iraqi pharmacists, to compare pharmacist job satisfaction between private and public sectors and to assess factors influencing job satisfaction level. This cross-sectional study of pharmacists, their work sites and work satisfactions used an electronic questionnaire that was posted on Facebook pharmacy professional group from June to September 2018. The participants included pharmacists from all 18 Iraqi provinces. We used multiple linear regression to identify predictors of general job satisfaction among 13 pharmacist characteristics. We received 658 usable surveys. Approximately half (47.24%) of respondents indicated dissatisfaction with their primary workplace. Job performance, patient contact, satisfaction with manager, income and expectation satisfactions were significantly related with work satisfaction. Pharmacists working in the private sector had significantly more control over their workplace and higher satisfaction with manager, income and general satisfactions compared to those working in public sector. Pharmacists work in diverse settings across the public healthcare system, community pharmacies, private drug bureaus and academia. About half of them are dissatisfied with their primary workplace. The private sector has more satisfaction rate compared to the public sector. Thus, officials need to improve job environments in the public sector.

The reliability of surgeons to avoid traumatic insertion of dental implants into high-risk regions: a panoramic radiograph study.

BACKGROUND: The posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon's decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs. METHODS: Only implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded. RESULTS: The study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was < 2 mm in the majority of underestimated cases (73.9%); they were significantly (P < 0.01) more than sites with remaining bone ≥ 2 mm (26.1%). In the posterior mandible, overestimation was significantly higher than posterior maxilla. Five cases with transient paresthesia were reported in the mandibular overestimated implants. CONCLUSIONS: This study specified that surgeon's choice of implants length, based on panoramic radiographs, was reliable regarding the incapability to insert implants with further length in the majority of underestimated cases, the low percent of overestimated measurements, and the minor associated complications.

[Prevalence and severity of erectile dysfunction in patients with type 2 diabetes in the Department of Urology at the University Hospital Center Hassan II, Fez, Morocco: a cross-sectional study of 96 cases]. / Dysfonction érectile chez les patients diabétiques type 2, prévalence et gravité au Service d´Urologie du Centre Hospitalier Universitaire de Fès, Maroc: à propos de 96 cas (étude transversale).

INTRODUCTION: type 2 diabetes is a very common condition which, in some patients, may cause erectile dysfunction. The purpose of this study is to determine the prevalence and severity of erectile dysfunction in patients with type 2 diabetes attending the Department of Urology. METHODS: we conducted a cross-sectional and descriptive study in the Department of Urology at the University Hospital Center Hassan II in Fez using a self-administered questionnaire encompassing an "International Index of Erectile Function-5" test based on 5 questions with routine blood test results in diabetic patients. RESULTS: a total of 96 anonymous questionnaires were distributed over a 12-month period. The average age of patients was 53.5 years, 35% (n=34) of them were active smokers. Diabetes had progressed for over 10 years in 54% (n=52) of cases. Three patients were treated with diet alone, 32% (n=31) with oral antidiabetic drugs, 31% (n=30) with insulin therapy alone and 31% (n=30) with insulin and oral antidiabetic drugs. Only 11% (n=11) of patients had HbA1c below 7%. Patients reporting erectile dysfunction accounted for 70% (n=67) of surveyed patients. The proportion of patients with erectile dysfunction according to the International Index of erectile function-5 was 88% (n=84). The onset of erectile dysfunction had started more than 3 years earlier in 63% (n=60) of patients. Disorders started progressively in 90% (n=86) of patients. Screening rate was 37.5% (n=36), only 30% (n=29) of patients received phosphodiesterase type 5 inhibitors, then intracavernous injection or both. Forty-two per cent (n=40) of patients had either macro or micro-angiopathic complications. CONCLUSION: erectile dysfunction is a common but little suspected condition in diabetic men. Hence, the importance of systematic screening in any diabetic patient and of adequate treatment for sexual and cardiovascular disorders.

[Multiple stones of the prostatic urethra associated with anejaculation revealing spinal dysraphism such as tethered cord syndrome at the base of the spinal canal in a young man: about an exceptional case]. / Multiples lithiases de l'urètre prostatique associées à une anéjaculation révélant un dysraphisme spinal à type de syndrome de moelle bas attachée chez un jeune homme: à propos d'un cas exceptionnel.

Spinal dysraphism (or spina bifida) is a neurological disorder representing the first cause of congenital urological disability. It has several clinical manifestations, vesicosphincteric and sexual disorders are frequent and rarely isolated, belonging to motor disorders, orthopedic, sensory, digestive or even cognitive impairments. Tethered cord syndrome at the base of the spinal canal is a complication of spinal dysraphism. This disorder is often detected in children, may be asymptomatic and found in adults. Bladder sphincter disorders are the main cause of morbi-mortality due to uronephrologic complications with a significant alteration in quality of life. This justifies specific management and multidisciplinary and strict monitoring. We here report an exceptional case of spinal dysraphism such as tethered cord syndrome at the base of the spinal canal found incidentally in an adult patient during an etiological assessment of lithiasis of the prostatic urethra associated with anejaculation .

[Tuberculous vesicovaginal fistula complicated by bladder stones: about an exceptional case]. / Calculs vésicaux multiples compliquant une fistule vésico-vaginale d'origine tuberculeuse: à propos d'un cas exceptionnel.

Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.