A 7-year-old with extravaginal torsion of an undescended testicle in the left inguinal region: The first case report from Syria.

The incidence of undescended testicles torsion in a 7-year-old is rare, making it a clinically unusual occurrence. Emphasizing the importance of thorough urogenital assessments in children, particularly in underserved communities, is critical to prevent serious complications like testicular gangrene.

Determinants of mortality among hospitalized patients with COVID-19 during first and second waves of the pandemic: A retrospective cohort study from an isolation center in Kano, Nigeria.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as an important cause of morbidity and mortality worldwide. The aim of this study is to identify the clinical predictors of mortality among patients with COVID-19 pneumonia during first and second waves in a treatment center in northwestern Nigeria. METHODS: This was a retrospective cohort study of 195 patients hospitalized with COVID-19 between April 2020 to March 2021 at a designated COVID-19 isolation center in Kano State, Northwest Nigeria. Data were summarized using frequencies and percentages. Unadjusted odds ratios and 95% confidence intervals and p-values were obtained. To determine independent determinants of mortality, we performed a stepwise multivariate logistic regression model. RESULTS: Of 195 patients studied, 21(10.77%) patients died. Males comprised 158 (81.03%) of the study population. In the adjusted stepwise logistic regression analysis, age>64 years (OR = 9.476, 95% CI: 2.181-41.165), second wave of the pandemic (OR = 49.340, 95% CI:6.222-391.247), cardiac complications (OR = 24.984, 95% CI: 3.618-172.508), hypertension (OR = 5.831, 95% CI:1.413-24.065) and lowest systolic blood pressure while on admission greater than or equal to 90mmHg were independent predictors of mortality (OR = 0.111, 95%CI: 0.021-0.581). CONCLUSION: Strategies targeted to prioritize needed care to patients with identified factors that predict mortality might improve patient outcome.

USING THE POSITIVE REAPPRAISAL COPING INTERVENTION TO CHANGE STUDENTS APPRAISAL AND ATTITUDES TOWARD NURSING.

OBJECTIVE: The aim: This study aimed to evaluate the effect of positive reappraisal intervention model in changing nursing students' attitudes toward nursing profession. PATIENTS AND METHODS: Materials and methods: A quasi-experimental study design (one group pretest-posttest) to achieve the study objectives.The emotional regulation questionnaire (ERQ-10) and the students' attitudes scale were used pre and post applying the positive reappraisal intervention in a random sample of 165 undergraduate nursing students, male and female, in their sophomore level to senior level. The process of collecting student's data took place in July 2020 - February, 2021. RESULTS: Results: A statically significant difference in students' appraisal (t = -26.320, p < .0005) and their attitudes towards nursing (t = -15.460, p < .0001) were registered after applying (compared to the results before) the positive reappraisal intervention. CONCLUSION: Conclusions: The positive reappraisal coping intervention is proved as an easy model to apply and is highly effective in terms of changing students' cognitive appraisal, which in turns changes their attitudes toward nursing. This assumption is concluded, basing on the significant increase in the level of appraisal and attitudes of nursing students after applying the intervention model; their levels are increased to about (96%) positive appraisal and about (94%) positive attitude level.

Sexual Identity Disorder and Psychosis in Klinefelter Syndrome: A Synthesis of Literature and a Case Report.

Klinefelter syndrome (KS) 47, XXY is the most frequent chromosomal abnormality causing hypogonadism in humans. This chromosomal abnormality of number in its classical form called homogeneous (supernumerary X) is generally the result of a meiosis accident. Several studies have suggested that individuals with KS are at greater risk of developing various psychiatric disorders, including depression and schizophrenia. The diagnosis is made based on subnormal testosterone with high pituitary gonadotropins and confirmed by determining the karyotype on a blood simple. We did a literature review using an electronic search in three databases: Pubmed/MEDLINE, Google Scholar, and PsychInfo. We found that since 1989, seven case reports with KS and mental disorders with similar and different characteristics of our case illustration of a patient with KS and psychosis were published.

A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection.

BACKGROUND: An adjunctive topical therapy with gentamicin-sponges to systemic antibiotic therapy might improve the healing of infected diabetic foot ulcers (DFUI). METHODS: Single-center, investigator-blinded pilot study, randomizing (1:1) the gentamicin-sponge with systemic antibiotic versus systemic antibiotics alone for patients with DFUI. RESULTS: We included 88 DFUI episodes with 43 patients in the gentamicin-sponge arm and 45 in the control arm. Overall, 64 (64/88; 73%) witnessed total clinical cure, 13 (15%) significant improvement, and 46 (52%) showed total eradication of all pathogens at the final visit. Regarding final clinical cure, there was no difference in favour of the gentamicin-sponges (26/45 vs. 31/43; p = 0.16). However, the gentamicin-sponge arm tended to a more rapid healing. In multivariate analysis adjusting for the case-mix, the variable "gentamicin-sponge" was not significantly associated with "cure and improvement". Gentamicin-sponges were very well tolerated, without any attributed adverse events. CONCLUSIONS: The gentamicin-sponge was very well tolerated, but did not significantly influence overall cure. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01951768 ). Date 2 April 2013.

Programmed cell death-1 and programmed cell death ligand-1 antibodies-induced dysthyroidism.

BACKGROUND: Monoclonal antibodies blocking the programmed cell death-1 (PD-1) or its ligand (PD-L1) are a group of immune checkpoints inhibitors (ICIs) with proven antitumor efficacy. However, their use is complicated by immune-related adverse events (irAEs), including endocrine adverse events (eAEs). PURPOSE: We review the incidence, time to onset and resolution rate of dysthyroidism induced by PD-1/PD-L1 Ab, and the clinical, biological and radiological findings. We aim to discuss the potential mechanisms of PD-1/PD-L1 Ab-induced dysthyroidism, and to propose a management algorithm. METHODS: We performed a literature search of available clinical trials regarding PD-1/PD-L1 Ab in the PubMed database. We selected all English language clinical trials that included at least 100 patients. We also present selected case series or reports, retrospective studies and reviews related to this issue. FINDINGS: In patients treated with PD-1 Ab, hypothyroidism occurred in 2-10.1% and hyperthyroidism occurred in 0.9-7.8%. When thyroiditis was reported separately, it occurred in 0.34-2.6%. Higher rates were reported when PD-1 Ab were associated with other ICI or chemotherapy. The median time to onset of hyperthyroidism and hypothyroidism after PD-1 Ab initiation was 23-45 days and 2-3.5 months, respectively. Regarding PD-L1 Ab, hypothyroidism occurred in 0-10% and hyperthyroidism in 0.5-2% of treated patients. The average time to onset of dysthyroidism after PD-L1 Ab was variable and ranged from 1 day after treatment initiation to 31 months. CONCLUSION: Dysthyroidism occurs in up to 10% of patients treated with PD-1/PD-L1 Ab. Hypothyroidism and reversible destructive thyroiditis are the most frequent endocrine adverse events (eAE) in PD-1/PD-L1 treated patients. Immune and non-immune mechanisms are potentially involved, independently of the presence of thyroid antibodies.

[Endocrinopathies induced by immune checkpoint inhibitors]. / Endocrinopathies induites par les inhibiteurs de points de contrôle immunitaire.

Immune checkpoint Inhibitors are new immunomodulatory treatments that have proven their anti-tumor efficacy in several advanced cancers. Nevertheless, their use has paved the way for multiple immunological adverse effects that affect many systems and organs including endocrine glands such as the pituitary, thyroid, adrenal and pancreas. Hypophysitis is the most common complication of anti-CTLA-4 monoclonal antibodies, while anti-PD-1 and anti-PD-L1 antibodies cause more thyroid complications. Adrenal insufficiency and type 1 diabetes are relatively less common. Endocrinologists and primary care physicians as well as oncologists are likely to deal with these complications and as such, knowledge of these drugs and their side effects is essential for good practice.

Les inhibiteurs de points de contrôle immunitaire sont des nouveaux traitements immunomodulateurs qui ont prouvé leur efficacité antitumorale dans plusieurs cancers avancés. Néanmoins, leur utilisation a ouvert la voie à de multiples effets indésirables immunologiques touchant plusieurs systèmes et organes dont les glandes endocrines comme l'hypophyse, la thyroïde, les surrénales et le pancréas. L'hypophysite constitue la complication la plus fréquente des anticorps monoclonaux anti-CTLA-4, alors que ceux anti-PD-1 et anti-PD-L1 provoquent plus de complications thyroïdiennes. Les insuffisances surrénaliennes et le diabète de type 1 sont relativement moins fréquents. Les endocrinologues et les médecins de premier recours, tout comme les oncologues, sont susceptibles de prendre en charge ces complications et de ce fait, une connaissance spécifique de ces médicaments et de leurs effets indésirables est indispensable à la bonne pratique.

[The combination of GLP-1 analogs and SGLT2 inhibitors : new perspectives ?] / Association des analogues du GLP-1 et des inhibiteurs du SGLT2 : de nouvelles perspectives ?

Type 2 diabetes therapy has expanded considerably over the last decade. Two anti-diabetic therapeutic groups, which are GLP-1 (glucagon-like peptide-1) receptor agonists and SGLT2 inhibitors (sodium-glucose co-transporter-2), have shown efficacy not only on glycemic control but also on weight and other parameters that will be detailed in this article. Cardiovascular safety studies for two of these molecules were shown for the first time to decrease overall and cardiovascular mortality. The combination of these two therapeutic classes provides a logical solution due to their different mechanisms of action. The DURATION-8 study designed to demonstrate the benefits of this combination will also be discussed in this article.

La thérapie du diabète de type 2 s'est considérablement élargie les dix dernières années. Deux groupes thérapeutiques antidiabétiques, qui sont les analogues du GLP-1 et les inhibiteurs du SGLT2 ont montré une efficacité non seulement sur le contrôle glycémique mais aussi sur le poids et sur d'autres paramètres cliniques et biologiques qui seront détaillés dans cet article. Les études de sécurité cardiovasculaire pour deux de ces molécules ont montré pour la première fois une baisse de la mortalité globale et cardiovasculaire. La combinaison de ces deux classes thérapeutiques offre une solution logique de par leurs différents mécanismes d'action. L'étude DURATION-8 conçue pour démontrer le bienfait de cette combinaison sera aussi discutée dans cet article.

[GLP-1 receptor agonists versus SGLT-2 inhibitors in obese type 2 diabetes patients]. / Analogues du GLP-1 versus inhibiteurs du SGLT-2 pour les diabétiques de type 2 obèses.

Who never had a type 2 obese diabetic patient, treated by several oral antidiabetic drugs and insulin, with consequent weight gain associated with the therapeutic escalation and uncontrolled diabetes? The arrival of GLP-1 agonists and SGLT-2 inhibitors allows to reevaluate the management of these patients, with their favorable effects on glycemic control, weight and the risk of hypoglycemia and their complementary mechanisms to conventional treatments. The vicious cycle of weight gain and increased need of insulin is limited. The choice between these two molecules must be based on several factors (glycemic target, weight, comorbidities, route of administration, side effects, etc.), and the balanced enthusiasm of these new treatments with the insufficient data regarding their long-term safety and their impact on micro- and macrovascular complications.

Restoration of adrenal function after bilateral adrenal damage due to heparin-induced thrombocytopenia (HIT): a case report.

INTRODUCTION: Patients with bilateral adrenal damage due to heparin-induced thrombocytopenia usually need lifelong steroid substitution. So far, no data exists about the natural evolution of such a condition, especially about adrenal function recovery and the real need for lifelong steroids. CASE PRESENTATION: An 81-year-old Caucasian woman with bilateral adrenal damage due to heparin-induced thrombocytopenia presented with fever and severe hypotension. Adrenal failure was confirmed biologically and radiologically. She eventually recovered her adrenal function, allowing for steroid withdrawal. CONCLUSIONS: This case report addresses the different mechanisms of adrenal damage due to heparin-induced thrombocytopenia and its natural evolution with potential recovery. This should encourage clinicians to evaluate the real necessity for lifelong corticosteroid substitution in such a condition.

[Hypertension In pregnancy: practical considerations]. / Hypertensions gravidiques: considérations pratiques.

Hypertension is the most frequent medical disorder of pregnancy. Whether in the form of a chronic hypertension or a pregnancy induced-hypertension, or preeclampsia, it is associated with major maternal and neonatal morbidity and mortality. Improvement of prenatal care allowed a reduction in the number of poor outcomes. However, our partial understanding of the origin of gestational hypertension and preeclampsia limits the establishment of robust prediction models and efficient preventive interventions. This review discusses actual considerations on the clinical approach to hypertension in pregnancy.

[Combined treatment of insulin and GLP-1 analogs: what do we expect?]. / Traitement combiné d'insuline et d'analogue du GLP-1: qu'en attendre?

Type 2 diabetes mellitus is a progressive and heterogeneous disease. The decrease in insulin secretion by pancreatic beta cells and the increase of glucagon secretion by pancreatic beta cells, are the two major pathophysiologic characteristics. The majority of type 2 diabetics will therefore require insulin in the evolution of their disease, with weight gain and hypoglycaemia as side effects. GLP-1 analogs are effective therapeutic alternatives due to their actions on glucagon and insulin secretion, on satiety and gastric emptying. For patients inadequately controlled with conventional antidiabetics, GLP-1 analogs, introduced as an alternative or in combination with insulin, can prevent or reduce the side effects associated with insulin. Indeed, the risk of hypoglycaemia is reduced and the vicious circle of weight gain secondary to insulin/need to increase insulin doses is limited.

[Chronic liver diseases and diabetes]. / Maladies hépatiques chroniques et diabète.

The presence of chronic liver diseases may drastically limit the use of anti-diabetic drugs. Chronic liver diseases increase insulin resistance, and in some risk groups promote the development of diabetes. Therefore, antidiabetic treatment should be adapted to the severity of liver disease. However, diabetes, notably when associated with obesity and dyslipidemia, participates in the development of nonalcoholic fatty liver disease and to steato-hepatitis that may progress to cirrhosis and hepatocellular carcinoma. Other relations between diabetes and chronic liver disease will be discussed in this article. Finally, the indications and limits of each anti-diabetic therapy group will be discussed according to the degree of liver damage.