<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health pract...<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>展开更多
Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University...Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.展开更多
Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevale...Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.展开更多
Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patie...Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patients at the Abass Ndao National Hospital in Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from January 01, 2010 to December 31, 2021. It focused on hospitalized type 1 diabetic patients. Epidemiological, clinical and evolutionary data were evaluated. Results: Six hundred and fifty-nine (659) patients were enrolled, representing a frequency of 11.5%. The mean age was 29.47 years, giving a sex ratio (m/f) of 0.95. Average hospital stay was 6.1 days. One hundred and forty-four (144) patients (21.8%) had inaugural diabetes. The average consultation time was 14.89 days. Acute metabolic complications were ketoacidosis in 353 patients (56%), and hypoglycemia in 1.2%. Simple hyperglycemia was noted in 113 patients (18.0%). Infection was present in 522 patients (58.3%), of whom 95 (28.2%) had a skin infection.55 patients (16.3%) had a respiratory infection. 12.3% had a dietary imbalance.176 cases (27.7%) had no imbalance.26 patients (3.9%) died, with infectious pathologies accounting for the majority of decompensation factors among the deceased (57.7%). Conclusion: Type 1 diabetes is a cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.展开更多
Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutio...Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of macroangiopathy in diabetic patients in the internal medicine department of the Abass Ndao hospital. Patients and methods: This was a descriptive and analytical cross-sectional study. Our investigations were recruited over a 7-year period (January 1, 2016 to December 31, 2022). Results: Three hundred and fifty-nine (359) patients (10.22%) were enrolled. The mean age was 62.83 years, with extremes ranging from 17 to 98 years. The [60 - 69] age group was more representative (37.32%). Women accounted for 180 cases (50.1%), with a sex ratio (m/f) of 0.99. The average duration of diabetes was 11.86 years. Average consultation time was 38.07 days, with extremes ranging from 1 to 368 days. Average hospital stay was 7.65 days. Inaugural diabetes was noted in 12 cases (3.34%). Type 2 diabetes accounted for 95.82% (n = 344) of patients. Hypertension was present in 150 patients (41.8%). Patients with 2 risk factors accounted for 173 cases (48.18%). Nineteen patients had already had a stroke (5.29% of cases). Fourteen (14) patients (4.2%) were amputees. Obliterative arteriopathy of the lower limbs (AOMI) was noted in 193 patients (54%). Stroke was noted in 101 patients (28%). Ischemic heart disease (IHD) was noted in 38 patients (11%). AOMI was more common in males (110 patients, 57%) than in females (43%). Seventy-three (73) patients (20.3%) died. Predictors of death were age over 60 and the existence of more than two cardiovascular risk factors. Conclusion: Diabetic macroangiopathy is a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.展开更多
Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive a...Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02;p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient’s management.展开更多
Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine t...Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine the clinical and immunovirological characteristics as well as the acceptance of antiretroviral drugs in this patient population. This is a cohort study of the files of PLHIV (People living with HIV) aged 50 years or more, followed in the Internal Medicine Department of the Point G University Hospital between January 2007 and December 2012. Results: Out of 161 HIV-infected patients in the cohort, 38 were aged 50 years or older, of whom 11 met the criteria and were included. The median age was 55 years, 90.9% of whom were in the [50 - 59 years] age group, with 63.6% being women (sex ratio = 0.57). At admission, 3 patients (27.3%) had prurigo and 2 (18.2%) had oral-pharyngeal candidiasis. At inclusion, 45.5% of patients were classified as WHO stage 2 and one as WHO stage 4. All were on ARVs, including 10 on 1st line HIV-1 and 1 on HIV-2. On triple therapy, the average weight gain was 5.1 kg at D15 and 6.84 kg at M6. However, at M12 there was a weight loss of 1.04 kg. The mean CD4 T cell gain was +102/mm<sup>3</sup> at M6 and +188/mm<sup>3</sup> at 12 months. At D0, mean viral load = 565024.75 copies/mm<sup>3</sup> [99 - 1100000] in 4/11. At M12, two patients had undetectable viral loads. Conclusion: The prevalence of HIV in elderly subjects is certainly underestimated. Thanks to triple antiretroviral therapy, PLHIV are aging with HIV but screening is not systematically proposed during consultations in elderly subjects. It is necessary to reinforce communication about HIV at all ages.展开更多
Introduction: Autoimmune diseases are characterized by a very large clinical polymorphism that can lead to a diagnostic wandering. So, we aimed to determine their epidemiological profile outside the context of Dakar (...Introduction: Autoimmune diseases are characterized by a very large clinical polymorphism that can lead to a diagnostic wandering. So, we aimed to determine their epidemiological profile outside the context of Dakar (capital of Senegal) where the technical plateau is more elevated. Methodology: We conducted a retrospective descriptive and observational study from January 1, 2007 to December 31, 2017. All patients admitted or followed in outpatient in the Internal Medicine departments of the Saint Jean de Dieu and Regional Hospitals of Thiès as well as in the dermatology department of the CHRT (Regional Hospital Center of Thiès), and who met the MAI criteria (autoimmune diseases) have been included. The data were collected on a standardised sheet and analysed by EPI INFO version 7.2. Results: A total of 121 patients were included out of 25951 records i.e a prevalence of 0.46% in internal medicine departments. In dermatology, out of 31973 patients, 95 had MAIS (systemic autoimmune diseases): 0.29% as hospital prevalence. The average age was 40.7 years in internal medicine departments compared to 37.66 years 14.8 years in the dermatology department. Patients aged 30 to 59 years represented 57.89% of the study population. The sex ratio (H/F) was 0.3 in the internal medicine departments compared to 0.17 in the dermatology department. Circumstances of discovery were incidental in 16.52% and clinical in 3.30%. Biermer disease accounted for 29.75% of organ-specific MAI. Concerning systemic presentations, rheumatoid arthritis (RA) was present in 23.14%. Lupus was more representative in dermatology (65.2%) as well as systemic scleroderma (21%), dermatomyositis (6.3%). Cytopenia was found in 105 patients, showing in detail anemia (42.9%);leukopenia (14.8%);thrombocytopenia (2.4%). Autoantibodies were tested in 58 patients (47.9%). Skin histology was contributory in all cases of systemic scleroderma and in 5 cases of lupus. The main therapy prescribed was corticosteroid therapy alone or in combination with an immunosuppressant. Conclusion: In addition of infectious diseases, Subsaharan Africa is under the era of changing face of its epidemiology, and cardiovascular diseases shows signs of emergence, like auto-immune presentations. However, the difficult apprehension of these so subtle last diseases suggests that they are few reported. Technical tools in regions should be enhanced associated to a non-binding capacity building system targeting such diseases with an emphasis on good record keeping.展开更多
Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in ad...Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.展开更多
Introduction: The metabolic syndrome according to the IDF (International Diabetes Federation) is at the origin of the double global epidemic of type 2 diabetes and cardiovascular diseases. This work aims to study the ...Introduction: The metabolic syndrome according to the IDF (International Diabetes Federation) is at the origin of the double global epidemic of type 2 diabetes and cardiovascular diseases. This work aims to study the metabolic syndrome in the internal medicine department of CHU Point G. Methodology: This was a descriptive study of patients who presented a metabolic syndrome according to the definition of the IDF definition, hospitalized in the internal medicine department of the CHU du point G for the period from January 1 2010 to December 31, 2019. Results: During the study period, 4189 patients were hospitalized, including 60 with metabolic syndrome, representing a hospital frequency of 1.43%. The sex ratio was 0.36. The age group of 50 and 60 years accounted for 28.3%. Forty-six point six percent (46.6%) of our patients were diabetic, 45% obese, 60% hypertensive, 70% sedentary and 10% smokers. Our patients had in 53.3% of cases a blood pressure figure ≥ 130/85 mmHg, abdominal obesity in 100%, hypertriglyceridemia in 33.3%, HDL-C less than 0.40 g/l in 62.5% of men and less than 0.50 g/l in 77.27% of men, blood sugar ≥ 1 g/l in 88.3%. Conclusion: The metabolic syndrome, in view of the entities that compose it, is a real cardiovascular risk factor and therefore a major public health issue.展开更多
Introduction: Haemolytic anaemia (HA) is defined as a decrease in haemoglobin (Hb) levels below baseline due to excessive and premature destruction of red blood cells (RBCs) in the periphery resulting in a shortened l...Introduction: Haemolytic anaemia (HA) is defined as a decrease in haemoglobin (Hb) levels below baseline due to excessive and premature destruction of red blood cells (RBCs) in the periphery resulting in a shortened life span of less than 120 days. Haemolysis can be corpuscular or extra-corpuscular. The aim of our study was to investigate the factors associated with it for optimal management of patients hospitalised in internal medicine at the Douala General Hospital (DGH). Methodology: We conducted an analytical cross-sectional study, including all patients admitted to the internal medicine department of the DGH from 11 February to 20 May 2022, and excluding patients with non-compliant samples. The search for haemolytic anaemia was carried out by means of blood count, reticulocyte count, blood smear, unconjugated bilirubin, lactate dehydrogenase and direct Coombs test. Sociodemographic, clinical and biological parameters were collected and analysed. Correlation was defined for a p value 0.05. Results: This study included 147 patients, 50.34% of whom were men, for a sex ratio of 1.01. The mean age was 52 ± 17.9 years. The most represented age group was 56 - 70 years (n = 49;33%) with extremes from 15 to 90 years. We counted 29.3% cases of haemolytic anaemia (HA) and 13.9% cases of autoimmune haemolytic anaemia (AIHA). Haemolytic anaemia (HA) was present in 54.14% of men for a sex ratio of 1.38;the most represented age group was 40 - 55 years, 37.2%. HA was associated with jaundice (OR: 3.74, CI: [1.70 - 8.22], p = 0.001), HIV - AIDS (OR: 2.72, CI: [0.98 - 7.53], p = 0.05), thrombocytopaenia (OR: 3.53, CI: [1.58 - 7.89], p = 0.02). LDH was elevated (OR: 2.86, CI: [1.30 - 6.26], p = 0.00) as well as elevated reticulocyte count (OR: 3.84, CI: [1.75 - 8.44], p = 0.01). Unconjugated bilirubin was elevated in all these patients. In multivariate analysis, factors associated with HA were a history of HIV/AIDS, jaundice, thrombocytopaenia and elevated reticulocyte count. Conclusion: Hemolytic anaemia is common in internal medicine and is significantly associated with thrombocytopenia, HIV/AIDS infection and jaundice.展开更多
Infection with the defective hepatitis D virus (HDV) co-infects or superinfects a patient carrying hepatitis B virus (HBV). Delta virus infection is relatively common. The seriousness of infection with the hepatitis D...Infection with the defective hepatitis D virus (HDV) co-infects or superinfects a patient carrying hepatitis B virus (HBV). Delta virus infection is relatively common. The seriousness of infection with the hepatitis D virus (HDV), a virus defective in a patient carrying the hepatitis B virus (HBV), lies in its aggravating effect on the associated viral hepatitis B. Our aim was to study the serological profile of HDV in HBsAg-positive patients. As this study was fragmentary, we initiated this study with the aim of investigating the serological profile of HDV in HBsAg-positive patients. This was a descriptive and analytical cross-sectional study that ran from March 2019 to February 2020, a 12-month period. It focused on the population of patients seen and screened positive for HBsAg. We obtained a frequency of 10%. The mean age of our patients was 41.8 ± 13.09 years. The sex ratio was 4.5. VHD RNA was detected in 50% of patients. In 100% of cases, the presence of VHD RNA was associated with advanced fibrosis according to the APRI score, but without any statistically significant link. All HBV-infected patients should be screened for anti-HDV Ac. HDV infection leads to rapid progression to complications of liver disease.展开更多
The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trial...The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trials such as FOWARC(J Clin Oncol 2019;37:3223-3233),NCT04165772(N Engl J Med 2022;386:2363-2376),and PROSPECT(N Engl J Med 2023;389:322-334).In this review,we comprehensively assess these pivotal trials and offer additional insights into the evolving role of pelvic radiation in contemporary oncology.展开更多
Introduction: Biermer’s disease is an autoimmune disease characterized by a lack of absorption of vitamin B12 in connection with the production of antibodies (A) destroying the intrinsic factor (IF) which allows the ...Introduction: Biermer’s disease is an autoimmune disease characterized by a lack of absorption of vitamin B12 in connection with the production of antibodies (A) destroying the intrinsic factor (IF) which allows the absorption of vitamin B12 (cobalamin). These clinical manifestations are polymorphic and severe in our context. The objective of this work is to identify the epidemiological-clinical, therapeutic and evolutionary characteristics of Biermer’s disease in Guinean population. Materials and methods: This was a retrospective of patient files followed for Biermer’s disease at the internal medicine department of Donka National Hospital from January 2012 to December 2021. Results: Eight patients were included including 5 women and 3 men. The average age of the patients was 48 years old. The diagnostic delay was 3.6 years on average. All our patients had bioclinical anemia (8 cases, i.e. 100%) followed by epigastralgia in 4 cases (50%), neurological damage such as sensitive polyneuropathy in 3 cases (37.5%). Four patients had acquired melanoderma (50%). Hypovitaminosis B12 was found in 4 patients. The myelogram performed in three patients (37.5%) found medullary megaloblastosis. One patient had Hashimoto’s disease associated with Biermer’s disease in endoscopy, (FOGD) found fundica trophy on macroscopy in 4 cases (50%). Treatment consisted of B12 vitamin therapy in all cases with a favorable clinical and biological outcome. Conclusion: Biermer’s disease remains common in Africa and is characterized at a younger age in addition to the severity of clinical and biological manifestations. The care consists of taking vitamin B12 which remains accessible in our context.展开更多
Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicin...Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicine department of the “G” Point University Hospital in Bamako. Included were all records of hospitalized patients with a central temperature greater than 37°C in the morning and 37°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment. We include all the patients of the study period with fever greater than 37.5°C in the morning and 37.8°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment, which have more than 21 days and measured on several occasions. The data were collected on a survey sheet. Data entry and analysis was done on SPSS software. Results: We recorded 243 fever cases out of 2155 hospitalizations, a prevalence rate of 11.2%. There were 128 men and 115 women with an average age of 43 years (range, 15 to 84 years), a modal class of 37 to 47 years, and a sex ratio of 1.11. The infectious etiologies accounted for 81% followed by neoplastic causes 09.6% and inflammatory 01.2% of cases. HIV infection was found in 26.4% of patients, malaria 13.5% and urinary tract infections 10.2%). Gram negative bacilli 88% consisted mainly of Escherichia coli (56%) and Klebsiella pneumoniae (20%).展开更多
<strong>Introduction:</strong> The chronic nephropathies constitute a real global public health concern due to the constant increase in the prevalence estimated between 10% and 15%. In Sub-Saharan Africa, ...<strong>Introduction:</strong> The chronic nephropathies constitute a real global public health concern due to the constant increase in the prevalence estimated between 10% and 15%. In Sub-Saharan Africa, this prevalence has been estimated at 13.9%. This study will allow knowing the epidemiological, clinical, paraclinical and etiological aspects of chronic kidney disease in the internal medicine department of CHU-SO Lomé. <strong>Method:</strong> This was a cross-sectional, retrospective and descriptive study. It concerned all the patients suffering from a chronic kidney disease, hospitalized between the 1st of January 2014 and the 31st of December 2018, for a duration of 5 years. <strong>Results:</strong> During our study, 330 cases of chronic nephropathy were identified. The prevalence of chronic kidney disease was 8.3% of admissions. The mean age of the patients was 46.3 years with extremes of 19 and 86 years and a sex ratio of 1.32. A low socio-economic level of patients was observed in 63.9% with an urban origin in 69.7%. The main risk factors for renal impairment were hypertension (55.2%), diabetes mellitus (29.1%), obesity (20.6%), use of nephrotoxic products (19.4%), HIV infection (17%) and smoking (16.1%). The causes were dominated by nephroangiosclerosis (33.3%), followed by diabetic nephropathy (25.5%) and HIV-associated nephropathy (17%). Chronic renal failure was present in 95.8% of cases and was end stage in 69.7% of cases. Anemia was the main complication during the evolution of chronic kidney disease (98.2%). Mortality was 57.3% during hospitalization. <strong>Conclusion:</strong> Chronic kidney disease is a fairly common reason for hospitalization in the internal medicine department. Emphasis should therefore be placed on preventive measures for hypertension, diabetes and HIV.展开更多
Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was u...Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.展开更多
Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values ...Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values were obtained from a systematic search of studies published in 4 sport and exercise databases(PubMed,Embase,SPORTDiscus(EBSCOhost),and Scopus)and a review of articles included in the 2011 Adult Compendium that measured PA in older adults.MET values were computed as the oxygen cost(VO_(2),mL/kg/min)during PA divided by 2.7 m L/kg/min(MET_(60+))to account for the lower resting metabolic rate in older adults.Results:We identified 68 articles and extracted energy expenditure data on 427 PAs.From these,we derived 99 unique Specific Activity codes with corresponding MET_(60+)values for older adults.We developed a website to present the OA Compendium MET_(60+)values:https://pacompendium.com.Conclusion:The OA Compendium uses data collected from adults>60 years for more accurate estimation of the energy cost of PAs in older adults.It is an accessible resource that will allow researchers,educators,and practitioners to find MET_(60+)values for older adults for use in PA research and practice.展开更多
Towards the end of 2019,a novel coronavirus pneumonia(coronavirus disease 19,COVID-19)caused by SARS-CoV-2 infection emerged in Wuhan.The SARS-CoV-2 virus quickly spread across the globe,seriously affecting public hea...Towards the end of 2019,a novel coronavirus pneumonia(coronavirus disease 19,COVID-19)caused by SARS-CoV-2 infection emerged in Wuhan.The SARS-CoV-2 virus quickly spread across the globe,seriously affecting public health and economic development of countries worldwide.Currently,antiviral drugs developed for COVID-19 lack strong clinical trial support and the high mutation rate of the virus causes difficulties in vaccine development,thus a complex and delayed large scale role out of an efficacious vaccine.Traditional Chinese medicine(TCM)has been used for treating various conditions for thousands of years and has a unique systems theory.It can be individualized into specific therapeutic regimens according to the patients’physical condition,clinical symptoms,and other distinguishing factors.In addition,TCM often has different effects at different disease stages,thus contributing to disease prevention,treatment,and rehabilitation.Existing evidence shows that TCM has efficacy in the treatment of COVID-19.The active ingredients of TCM have various pharmacological properties,including antiviral,anti-inflammatory,and immunomodulatory activity,with clinical trials showing that these prescriptions reduce symptoms of COVID-19,promote viral clearance,and ultimately improve survival in infected patients.This article discusses the advantages and mechanisms of TCM in the treatment of COVID-19,hoping to provide a reference platform in the fight against the disease.展开更多
The incidence of atrial fibrillation(AF)and deep vein thrombosis/pulmonary embolism(DVT/PE)has increased in the last decades as a consequence of global aging and th refinement of diagnostic techniques;thus,the consump...The incidence of atrial fibrillation(AF)and deep vein thrombosis/pulmonary embolism(DVT/PE)has increased in the last decades as a consequence of global aging and th refinement of diagnostic techniques;thus,the consumption o anticoagulant drugs has increased significantly.[1,2]Prescription of direct oral anticoagulants(DOACs)have overtaken thos of vitamin K antagonists(VKA)since the mid-2010s.[3]Consequently,the incidence of these drugs’side effects has also increased;the most relevant side effect in terms of morbidity and mortality is bleeding.In addition to critically ill bleeding patients,another indication of anticoagulant reversal therapy is the need for emergency surgery or for a procedure with high risk of bleeding.展开更多
文摘<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>
文摘Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.
文摘Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.
文摘Introduction: Type 1 diabetes can have acute complications, sometimes requiring hospitalization. The aim of this study was to describe the epidemiological, clinical and evolutionary aspects of type 1 diabetes in patients at the Abass Ndao National Hospital in Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from January 01, 2010 to December 31, 2021. It focused on hospitalized type 1 diabetic patients. Epidemiological, clinical and evolutionary data were evaluated. Results: Six hundred and fifty-nine (659) patients were enrolled, representing a frequency of 11.5%. The mean age was 29.47 years, giving a sex ratio (m/f) of 0.95. Average hospital stay was 6.1 days. One hundred and forty-four (144) patients (21.8%) had inaugural diabetes. The average consultation time was 14.89 days. Acute metabolic complications were ketoacidosis in 353 patients (56%), and hypoglycemia in 1.2%. Simple hyperglycemia was noted in 113 patients (18.0%). Infection was present in 522 patients (58.3%), of whom 95 (28.2%) had a skin infection.55 patients (16.3%) had a respiratory infection. 12.3% had a dietary imbalance.176 cases (27.7%) had no imbalance.26 patients (3.9%) died, with infectious pathologies accounting for the majority of decompensation factors among the deceased (57.7%). Conclusion: Type 1 diabetes is a cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.
文摘Introduction: Macroangiopathy plays an important role, with a high prevalence of morbidity and mortality in diabetic patients. The aim was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of macroangiopathy in diabetic patients in the internal medicine department of the Abass Ndao hospital. Patients and methods: This was a descriptive and analytical cross-sectional study. Our investigations were recruited over a 7-year period (January 1, 2016 to December 31, 2022). Results: Three hundred and fifty-nine (359) patients (10.22%) were enrolled. The mean age was 62.83 years, with extremes ranging from 17 to 98 years. The [60 - 69] age group was more representative (37.32%). Women accounted for 180 cases (50.1%), with a sex ratio (m/f) of 0.99. The average duration of diabetes was 11.86 years. Average consultation time was 38.07 days, with extremes ranging from 1 to 368 days. Average hospital stay was 7.65 days. Inaugural diabetes was noted in 12 cases (3.34%). Type 2 diabetes accounted for 95.82% (n = 344) of patients. Hypertension was present in 150 patients (41.8%). Patients with 2 risk factors accounted for 173 cases (48.18%). Nineteen patients had already had a stroke (5.29% of cases). Fourteen (14) patients (4.2%) were amputees. Obliterative arteriopathy of the lower limbs (AOMI) was noted in 193 patients (54%). Stroke was noted in 101 patients (28%). Ischemic heart disease (IHD) was noted in 38 patients (11%). AOMI was more common in males (110 patients, 57%) than in females (43%). Seventy-three (73) patients (20.3%) died. Predictors of death were age over 60 and the existence of more than two cardiovascular risk factors. Conclusion: Diabetic macroangiopathy is a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.
文摘Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02;p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient’s management.
文摘Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine the clinical and immunovirological characteristics as well as the acceptance of antiretroviral drugs in this patient population. This is a cohort study of the files of PLHIV (People living with HIV) aged 50 years or more, followed in the Internal Medicine Department of the Point G University Hospital between January 2007 and December 2012. Results: Out of 161 HIV-infected patients in the cohort, 38 were aged 50 years or older, of whom 11 met the criteria and were included. The median age was 55 years, 90.9% of whom were in the [50 - 59 years] age group, with 63.6% being women (sex ratio = 0.57). At admission, 3 patients (27.3%) had prurigo and 2 (18.2%) had oral-pharyngeal candidiasis. At inclusion, 45.5% of patients were classified as WHO stage 2 and one as WHO stage 4. All were on ARVs, including 10 on 1st line HIV-1 and 1 on HIV-2. On triple therapy, the average weight gain was 5.1 kg at D15 and 6.84 kg at M6. However, at M12 there was a weight loss of 1.04 kg. The mean CD4 T cell gain was +102/mm<sup>3</sup> at M6 and +188/mm<sup>3</sup> at 12 months. At D0, mean viral load = 565024.75 copies/mm<sup>3</sup> [99 - 1100000] in 4/11. At M12, two patients had undetectable viral loads. Conclusion: The prevalence of HIV in elderly subjects is certainly underestimated. Thanks to triple antiretroviral therapy, PLHIV are aging with HIV but screening is not systematically proposed during consultations in elderly subjects. It is necessary to reinforce communication about HIV at all ages.
文摘Introduction: Autoimmune diseases are characterized by a very large clinical polymorphism that can lead to a diagnostic wandering. So, we aimed to determine their epidemiological profile outside the context of Dakar (capital of Senegal) where the technical plateau is more elevated. Methodology: We conducted a retrospective descriptive and observational study from January 1, 2007 to December 31, 2017. All patients admitted or followed in outpatient in the Internal Medicine departments of the Saint Jean de Dieu and Regional Hospitals of Thiès as well as in the dermatology department of the CHRT (Regional Hospital Center of Thiès), and who met the MAI criteria (autoimmune diseases) have been included. The data were collected on a standardised sheet and analysed by EPI INFO version 7.2. Results: A total of 121 patients were included out of 25951 records i.e a prevalence of 0.46% in internal medicine departments. In dermatology, out of 31973 patients, 95 had MAIS (systemic autoimmune diseases): 0.29% as hospital prevalence. The average age was 40.7 years in internal medicine departments compared to 37.66 years 14.8 years in the dermatology department. Patients aged 30 to 59 years represented 57.89% of the study population. The sex ratio (H/F) was 0.3 in the internal medicine departments compared to 0.17 in the dermatology department. Circumstances of discovery were incidental in 16.52% and clinical in 3.30%. Biermer disease accounted for 29.75% of organ-specific MAI. Concerning systemic presentations, rheumatoid arthritis (RA) was present in 23.14%. Lupus was more representative in dermatology (65.2%) as well as systemic scleroderma (21%), dermatomyositis (6.3%). Cytopenia was found in 105 patients, showing in detail anemia (42.9%);leukopenia (14.8%);thrombocytopenia (2.4%). Autoantibodies were tested in 58 patients (47.9%). Skin histology was contributory in all cases of systemic scleroderma and in 5 cases of lupus. The main therapy prescribed was corticosteroid therapy alone or in combination with an immunosuppressant. Conclusion: In addition of infectious diseases, Subsaharan Africa is under the era of changing face of its epidemiology, and cardiovascular diseases shows signs of emergence, like auto-immune presentations. However, the difficult apprehension of these so subtle last diseases suggests that they are few reported. Technical tools in regions should be enhanced associated to a non-binding capacity building system targeting such diseases with an emphasis on good record keeping.
文摘Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.
文摘Introduction: The metabolic syndrome according to the IDF (International Diabetes Federation) is at the origin of the double global epidemic of type 2 diabetes and cardiovascular diseases. This work aims to study the metabolic syndrome in the internal medicine department of CHU Point G. Methodology: This was a descriptive study of patients who presented a metabolic syndrome according to the definition of the IDF definition, hospitalized in the internal medicine department of the CHU du point G for the period from January 1 2010 to December 31, 2019. Results: During the study period, 4189 patients were hospitalized, including 60 with metabolic syndrome, representing a hospital frequency of 1.43%. The sex ratio was 0.36. The age group of 50 and 60 years accounted for 28.3%. Forty-six point six percent (46.6%) of our patients were diabetic, 45% obese, 60% hypertensive, 70% sedentary and 10% smokers. Our patients had in 53.3% of cases a blood pressure figure ≥ 130/85 mmHg, abdominal obesity in 100%, hypertriglyceridemia in 33.3%, HDL-C less than 0.40 g/l in 62.5% of men and less than 0.50 g/l in 77.27% of men, blood sugar ≥ 1 g/l in 88.3%. Conclusion: The metabolic syndrome, in view of the entities that compose it, is a real cardiovascular risk factor and therefore a major public health issue.
文摘Introduction: Haemolytic anaemia (HA) is defined as a decrease in haemoglobin (Hb) levels below baseline due to excessive and premature destruction of red blood cells (RBCs) in the periphery resulting in a shortened life span of less than 120 days. Haemolysis can be corpuscular or extra-corpuscular. The aim of our study was to investigate the factors associated with it for optimal management of patients hospitalised in internal medicine at the Douala General Hospital (DGH). Methodology: We conducted an analytical cross-sectional study, including all patients admitted to the internal medicine department of the DGH from 11 February to 20 May 2022, and excluding patients with non-compliant samples. The search for haemolytic anaemia was carried out by means of blood count, reticulocyte count, blood smear, unconjugated bilirubin, lactate dehydrogenase and direct Coombs test. Sociodemographic, clinical and biological parameters were collected and analysed. Correlation was defined for a p value 0.05. Results: This study included 147 patients, 50.34% of whom were men, for a sex ratio of 1.01. The mean age was 52 ± 17.9 years. The most represented age group was 56 - 70 years (n = 49;33%) with extremes from 15 to 90 years. We counted 29.3% cases of haemolytic anaemia (HA) and 13.9% cases of autoimmune haemolytic anaemia (AIHA). Haemolytic anaemia (HA) was present in 54.14% of men for a sex ratio of 1.38;the most represented age group was 40 - 55 years, 37.2%. HA was associated with jaundice (OR: 3.74, CI: [1.70 - 8.22], p = 0.001), HIV - AIDS (OR: 2.72, CI: [0.98 - 7.53], p = 0.05), thrombocytopaenia (OR: 3.53, CI: [1.58 - 7.89], p = 0.02). LDH was elevated (OR: 2.86, CI: [1.30 - 6.26], p = 0.00) as well as elevated reticulocyte count (OR: 3.84, CI: [1.75 - 8.44], p = 0.01). Unconjugated bilirubin was elevated in all these patients. In multivariate analysis, factors associated with HA were a history of HIV/AIDS, jaundice, thrombocytopaenia and elevated reticulocyte count. Conclusion: Hemolytic anaemia is common in internal medicine and is significantly associated with thrombocytopenia, HIV/AIDS infection and jaundice.
文摘Infection with the defective hepatitis D virus (HDV) co-infects or superinfects a patient carrying hepatitis B virus (HBV). Delta virus infection is relatively common. The seriousness of infection with the hepatitis D virus (HDV), a virus defective in a patient carrying the hepatitis B virus (HBV), lies in its aggravating effect on the associated viral hepatitis B. Our aim was to study the serological profile of HDV in HBsAg-positive patients. As this study was fragmentary, we initiated this study with the aim of investigating the serological profile of HDV in HBsAg-positive patients. This was a descriptive and analytical cross-sectional study that ran from March 2019 to February 2020, a 12-month period. It focused on the population of patients seen and screened positive for HBsAg. We obtained a frequency of 10%. The mean age of our patients was 41.8 ± 13.09 years. The sex ratio was 4.5. VHD RNA was detected in 50% of patients. In 100% of cases, the presence of VHD RNA was associated with advanced fibrosis according to the APRI score, but without any statistically significant link. All HBV-infected patients should be screened for anti-HDV Ac. HDV infection leads to rapid progression to complications of liver disease.
基金National Science and Technology Council,No.NSTC 112-2314-B-039-048.
文摘The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trials such as FOWARC(J Clin Oncol 2019;37:3223-3233),NCT04165772(N Engl J Med 2022;386:2363-2376),and PROSPECT(N Engl J Med 2023;389:322-334).In this review,we comprehensively assess these pivotal trials and offer additional insights into the evolving role of pelvic radiation in contemporary oncology.
文摘Introduction: Biermer’s disease is an autoimmune disease characterized by a lack of absorption of vitamin B12 in connection with the production of antibodies (A) destroying the intrinsic factor (IF) which allows the absorption of vitamin B12 (cobalamin). These clinical manifestations are polymorphic and severe in our context. The objective of this work is to identify the epidemiological-clinical, therapeutic and evolutionary characteristics of Biermer’s disease in Guinean population. Materials and methods: This was a retrospective of patient files followed for Biermer’s disease at the internal medicine department of Donka National Hospital from January 2012 to December 2021. Results: Eight patients were included including 5 women and 3 men. The average age of the patients was 48 years old. The diagnostic delay was 3.6 years on average. All our patients had bioclinical anemia (8 cases, i.e. 100%) followed by epigastralgia in 4 cases (50%), neurological damage such as sensitive polyneuropathy in 3 cases (37.5%). Four patients had acquired melanoderma (50%). Hypovitaminosis B12 was found in 4 patients. The myelogram performed in three patients (37.5%) found medullary megaloblastosis. One patient had Hashimoto’s disease associated with Biermer’s disease in endoscopy, (FOGD) found fundica trophy on macroscopy in 4 cases (50%). Treatment consisted of B12 vitamin therapy in all cases with a favorable clinical and biological outcome. Conclusion: Biermer’s disease remains common in Africa and is characterized at a younger age in addition to the severity of clinical and biological manifestations. The care consists of taking vitamin B12 which remains accessible in our context.
文摘Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicine department of the “G” Point University Hospital in Bamako. Included were all records of hospitalized patients with a central temperature greater than 37°C in the morning and 37°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment. We include all the patients of the study period with fever greater than 37.5°C in the morning and 37.8°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment, which have more than 21 days and measured on several occasions. The data were collected on a survey sheet. Data entry and analysis was done on SPSS software. Results: We recorded 243 fever cases out of 2155 hospitalizations, a prevalence rate of 11.2%. There were 128 men and 115 women with an average age of 43 years (range, 15 to 84 years), a modal class of 37 to 47 years, and a sex ratio of 1.11. The infectious etiologies accounted for 81% followed by neoplastic causes 09.6% and inflammatory 01.2% of cases. HIV infection was found in 26.4% of patients, malaria 13.5% and urinary tract infections 10.2%). Gram negative bacilli 88% consisted mainly of Escherichia coli (56%) and Klebsiella pneumoniae (20%).
文摘<strong>Introduction:</strong> The chronic nephropathies constitute a real global public health concern due to the constant increase in the prevalence estimated between 10% and 15%. In Sub-Saharan Africa, this prevalence has been estimated at 13.9%. This study will allow knowing the epidemiological, clinical, paraclinical and etiological aspects of chronic kidney disease in the internal medicine department of CHU-SO Lomé. <strong>Method:</strong> This was a cross-sectional, retrospective and descriptive study. It concerned all the patients suffering from a chronic kidney disease, hospitalized between the 1st of January 2014 and the 31st of December 2018, for a duration of 5 years. <strong>Results:</strong> During our study, 330 cases of chronic nephropathy were identified. The prevalence of chronic kidney disease was 8.3% of admissions. The mean age of the patients was 46.3 years with extremes of 19 and 86 years and a sex ratio of 1.32. A low socio-economic level of patients was observed in 63.9% with an urban origin in 69.7%. The main risk factors for renal impairment were hypertension (55.2%), diabetes mellitus (29.1%), obesity (20.6%), use of nephrotoxic products (19.4%), HIV infection (17%) and smoking (16.1%). The causes were dominated by nephroangiosclerosis (33.3%), followed by diabetic nephropathy (25.5%) and HIV-associated nephropathy (17%). Chronic renal failure was present in 95.8% of cases and was end stage in 69.7% of cases. Anemia was the main complication during the evolution of chronic kidney disease (98.2%). Mortality was 57.3% during hospitalization. <strong>Conclusion:</strong> Chronic kidney disease is a fairly common reason for hospitalization in the internal medicine department. Emphasis should therefore be placed on preventive measures for hypertension, diabetes and HIV.
文摘Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.
文摘Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values were obtained from a systematic search of studies published in 4 sport and exercise databases(PubMed,Embase,SPORTDiscus(EBSCOhost),and Scopus)and a review of articles included in the 2011 Adult Compendium that measured PA in older adults.MET values were computed as the oxygen cost(VO_(2),mL/kg/min)during PA divided by 2.7 m L/kg/min(MET_(60+))to account for the lower resting metabolic rate in older adults.Results:We identified 68 articles and extracted energy expenditure data on 427 PAs.From these,we derived 99 unique Specific Activity codes with corresponding MET_(60+)values for older adults.We developed a website to present the OA Compendium MET_(60+)values:https://pacompendium.com.Conclusion:The OA Compendium uses data collected from adults>60 years for more accurate estimation of the energy cost of PAs in older adults.It is an accessible resource that will allow researchers,educators,and practitioners to find MET_(60+)values for older adults for use in PA research and practice.
文摘Towards the end of 2019,a novel coronavirus pneumonia(coronavirus disease 19,COVID-19)caused by SARS-CoV-2 infection emerged in Wuhan.The SARS-CoV-2 virus quickly spread across the globe,seriously affecting public health and economic development of countries worldwide.Currently,antiviral drugs developed for COVID-19 lack strong clinical trial support and the high mutation rate of the virus causes difficulties in vaccine development,thus a complex and delayed large scale role out of an efficacious vaccine.Traditional Chinese medicine(TCM)has been used for treating various conditions for thousands of years and has a unique systems theory.It can be individualized into specific therapeutic regimens according to the patients’physical condition,clinical symptoms,and other distinguishing factors.In addition,TCM often has different effects at different disease stages,thus contributing to disease prevention,treatment,and rehabilitation.Existing evidence shows that TCM has efficacy in the treatment of COVID-19.The active ingredients of TCM have various pharmacological properties,including antiviral,anti-inflammatory,and immunomodulatory activity,with clinical trials showing that these prescriptions reduce symptoms of COVID-19,promote viral clearance,and ultimately improve survival in infected patients.This article discusses the advantages and mechanisms of TCM in the treatment of COVID-19,hoping to provide a reference platform in the fight against the disease.
文摘The incidence of atrial fibrillation(AF)and deep vein thrombosis/pulmonary embolism(DVT/PE)has increased in the last decades as a consequence of global aging and th refinement of diagnostic techniques;thus,the consumption o anticoagulant drugs has increased significantly.[1,2]Prescription of direct oral anticoagulants(DOACs)have overtaken thos of vitamin K antagonists(VKA)since the mid-2010s.[3]Consequently,the incidence of these drugs’side effects has also increased;the most relevant side effect in terms of morbidity and mortality is bleeding.In addition to critically ill bleeding patients,another indication of anticoagulant reversal therapy is the need for emergency surgery or for a procedure with high risk of bleeding.
