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A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities

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Military medical Research 2024年第2期11卷 228-267页

作者： Miguel A.Ortega Oscar Fraile-Martinez Cielo García-Montero Sergio Haro Miguel Ángel Álvarez-Mon Diego De Leon-Oliva Ana M.Gomez-Lahoz Jorge Monserrat Mar Atienza-Pérez David Díaz Elisa Lopez-Dolado Melchor Álvarez-Mon department of medicine and medical specialities University of Alcala28801 Alcala de HenaresSpain Ramón y Cajal Institute of Sanitary Research(IRYCIS) 28034 MadridSpain department of Psychiatry and Mental Health Hospital Universitario Infanta Leonor28031 MadridSpain Service of Rehabilitation National Hospital for Paraplegic PatientsCarr.de la PeraledaS/N45004 ToledoSpain Immune System Diseases‑Rheumatology Service and Internal medicine University Hospital Príncipe de Asturias(CIBEREHD)28806 Alcala de HenaresSpain

Spinal cord injury(SCI)is a devastating and disabling medical condition generally caused by a traumatic event(primary injury).This initial trauma is accompanied by a set of biological mechanisms directed to ameliorate neural damage but also exacerbate initial damage(secondary injury).The alterations that occur in the spinal cord have not only local but also systemic consequences and virtually all organs and tissues of the body incur important changes after SCI,explaining the progression and detrimental consequences related to this ***(PNIE)is a growing area of research aiming to integrate and explore the interactions among the different systems that compose the human organism,considering the mind and the body as a *** initial traumatic event and the consequent neurological disruption trigger immune,endocrine,and multisystem dysfunction,which in turn affect the patient's psyche and *** the present review,we will explore the most important local and systemic consequences of SCI from a PNIE perspective,defining the changes occurring in each system and how all these mechanisms are ***,potential clinical approaches derived from this knowledge will also be collectively presented with the aim to develop integrative therapies to maximize the clinical management of these patients.

关键词： Spinal cord injury(SCI) Psychoneuroimmunoendocrinology(PNIE) Secondary injury Immunoinflammatory dysfunction Gut microbiota Translational opportunities

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New insights on portal hypertension’s screening in people with cystic fibrosis

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 894-897页

作者： Luigi Colecchia Federico Ravaioli Giovanni Marasco Elton Dajti Antonio Colecchia department of medical and Surgical Sciences(DIMEC) University of BolognaBolognaItaly department of Visceral Surgery and medicine InselspitalBern University HospitalBernSwitzerland Gastroenterology Unit Department of Medical Specialities(CHIMOMO)University of Modena and Reggio EmiliaModenaItaly

Cystic fibrosis-associated liver disease(CFLD)is a significant cause of morbidity and mortality affecting people with cystic fibrosis(PwCF)(1).Approximately 40%of PwCF have liver involvement,defined as the existence of any hepatic manifestation,including biochemical liver abnormalities(2).In a small percentage of these patients,liver involvement may ultimately result in the development of portal hypertension(PH)and its *** presence of at least two of the following variables-abnormal liver tests,abnormal liver ultrasound(US),abnormal physical examination with hepatosplenomegaly or histologic evidence of liver disease-were historically the basis for the European criteria to define CFLD(3).Nevertheless,the emergence of a new approach for liver assessment as liver elastography has led to the proposal of its inclusion in new diagnostic criteria(4).

关键词： Porto-sinusoidal vascular disease(PSVD) portal hypertension cystic fibrosis liver stiffness spleen stiffness

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Cardiac Surgery at Yaoundé General Hospital by a Local Team: Activity Report from September 2022 to January 2024

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World Journal of Cardiovascular Surgery 2024年第6期14卷 87-94页

作者： Laurence Carole Ngo Yon Charles Mve Mvondo Hermann Nestor Tsague Kengni Zephanie Kobe Fokalbo Sépolin Lowe Mireille Dakleu Alain Patrick Menanga William Ngatchou Djomo Vincent De Paul Djientcheu department of Cardiothoracic and Vascular Surgery Yaound General Hospital Yaound Cameroon department of Surgery and specialities Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon department of Clinical Sciences Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon department of Surgery and specialities Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon

Introduction: The practice of cardiac surgery (CS) in sub-Saharan Africa faces a number of challenges. We report on the surgical activities of the first 17 months of the program launched at the Yaoundé General Hospital (YGH), describing the types of interventions and the early results. Patients and Methods: This was a descriptive cross-sectional study including patients who underwent CS from September 2022 to January 2024 at the YGH. Clinical, operative and postoperative data were collected and analysed retrospectively by R software. Results: A total of 37 patients underwent CS during the study period, divided into 23 (62.2%) open-heart and 14 (37.8%) closed-heart cases. Males predominated (sex ratio 1.17). The median age and interquartile range (IQR) were 36 years (9 - 51). Isolated valve surgery, in 15 (40.5%) cases, was the most common procedure in open-heart surgery cases. Closed-heart surgery involved closure of the patent ductus arteriosus in 9 (24.3%) cases, coronary artery bypass grafting in 3 (8.1%) cases, and pericardectomy in 2 (5.4%) cases. The median duration of extracorporeal circulation and aortic cross-clamping was 101 min (IQR 84 - 143) and 74 min (IQR 54 - 112) respectively. The median duration of mechanical ventilation was 2 hours (IQR 2 - 3). The median intensive care unit stay and median hospital stay were 2 days (IQR 2 - 3) and 7 days (IQR 5 - 8) respectively. Operative mortality was 2 (5.4%). Conclusion: Cardiac surgery remains a major challenge for African populations. The early results achieved by the local team are satisfactory. An increase in surgical activity should be strongly encouraged to facilitate local training and ensure the sustainability of the activity.

关键词： Cardiac Surgery Sub-Saharan Africa Cameroon

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Endometriosis beyond the Pelvis: A Case Series of Cutaneous Endometriosis and Literature Review

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 77-88页

作者： Tompeen Isidore Nkoro Ombédé G. Anita Mendouga Menye Coralie Belinga Etienne Noa Ndoua Cyrille Foumane Pascal department of Gynecology and Obstetrics Faculty of Medicine and Biomedical Sciences The University of Yaoundé I Yaounde Cameroon department of Internal medicine and specialities Faculty of Medicine and Biomedical Sciences The University of Yaoundé I Yaounde Cameroon department of Morphologic Sciences and Anatomopatology Faculty of Medicine and Biomedical Sciences The University of Yaoundé I Yaounde Cameroon department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences The University of Ebolowa Ebolowa Cameroon

Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.

关键词： Endometriosis Cutaneous Endometriosis Umbilical Endometriosis Cyclic Umbilical Swelling Cameroon

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Thoracoscopy in Cameroon: Indications, Technics and Short Term Results

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Surgical Science 2024年第4期15卷 278-288页

作者： Guy Aristide Bang Richard II Mbele Fabrice Stephane Arroye Betou Arlette Joelle Moukitek Banaken Amos Bella Ela Charles Mve Mvondo Arthur Essomba department of Surgery and specialities Faculty of Medicine and Biomedical Sciences Yaound&#233 I University Yaound&#233 Cameroon department of Surgery and specialities Yaound&#233 Teaching Hospital Yaound&#233 Cameroon General Surgery Service Mvog-Ada District Hospital Yaound&#233 Cameroon department of Cardiothoracic and Vascular Surgery Laquintinie Hospital Douala Cameroon department of Cardiothoracic and Vascular Surgery Yaound&#233 General Hospital Yaound&#233 Cameroon Cardiac Center Shisong St. Elizabeth Catholic General Hospital Shisong Kumbo Cameroon

Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This was a descriptive study that collected both retrospective and prospective data over 57 months across four hospitals in Cameroon. It included 13 patients and focused on variables such as socio-demographic factors, clinical profiles, surgical procedures, and postoperative follow-up. Results: Thirteen patients, predominantly male (84.6%, n = 11), with a mean age of 37.5 ± 16 years, were enrolled. Alcohol use (61.5%) and smoking (38.5%) were the most common past histories. The major complaints were dyspnea (84.6%) and chest pain (58.3%). The primary surgical procedure was clot-free thoracoscopy in 30.8% of cases, mainly for persistent hemothorax (41.8%). Most surgeries were elective (76.9%) and performed under general anesthesia with selective intubation (61.5%). The most common approach was single-port thoracoscopy (U-VATS) (76.9%), with no reported difficulties;however, one intraoperative incident occurred and was successfully treated. Drainage was performed systematically in all patients, and one case required conversion to open surgery. Postoperative complications were minor (Clavien-Dindo grade I) and mainly consisted of pain, with a mortality rate of 15.4%. No significant association was found between risk factors and the occurrence of complications or postoperative mortality. Conclusion: Thoracoscopy, a novel approach in our context, primarily focuses on minor thoracic surgeries.

关键词： Thoracoscopy Single-Port Hemothorax Cameroon

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Efficacy of a Diabetes Specific Nutrition Supplement on Glycemic, Anthropometric, Dietary and Gut Health Markers in Adults with Type 2 Diabetes: An RCT

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Food and Nutrition Sciences 2024年第8期15卷 846-867页

作者： Deepti Khanna Hema S. Gopalan Kuzhandaivelu Abirami Vasudevan Sudha Rajagopal Gayatri Kejal Joshi-Reddy Jaladhi Bhatt Raman Ganesh Jeevan Karthikeyan Parkavi Vadivel Deepika Manoj Pareek Ranjit Mohan Anjana Viswanathan Mohan R&D department Hindustan Unilever Limited Gurugram India department of Foods Nutrition & Dietetics Research Madras Diabetes Research Foundation Chennai India department of Diabetology Dr. Mohans Diabetes Specialities Centre Chennai India

With increasing incidence of diabetes, use of diabetes specific nutrition supplements (DSNS) is common for better management of the disease. To study effect of 12-week DSNS supplementation on glycemic markers, anthropometry, lipid profile, SCFAs, and gut microbiome in individuals with diabetes. Markers studied were glycemic [Fasting Blood Glucose (FBG), Post Prandial Glucose (PPG), HbA1c, Incremental Area under curve (iAUC), Mean Amplitude of Glycemic Excursions (MAGE), Time in/above Range (TIR/TAR)], anthropometry [weight, Body Mass Index (BMI), waist circumference (WC)], lipid profile, diet and gut health [plasma short chain fatty acids (SCFAs)]. N = 210 adults were randomized to receive either DSNS with standard care (DSNS + SC;n = 105) or standard care alone (SC alone;n = 105). After 12 weeks, significant differences between DSNS + SC versus SC alone was observed in FBG [−3 ± 6 vs 14 ± 6 mg/dl;p = 0.03], PPG [−35 ± 9 vs −3 ± 9 mg/dl;p = 0.01], weight [−0.6 ± 0.1 vs 0.2 ± 0.1 kg;p = 0.0001], BMI [−0.3 ± 0.1 vs 0.1 ± 0.1 kg/m2;p = 0.0001] and WC [−0.3 ± 0.2 vs 0.2 ± 0.2 cm;p = 0.01]. HbA1C and low-density lipoprotein (LDL) were significantly reduced in DSNS + SC [−0.2 ± 0.9;p = 0.04 and −5 mg/dl;p = 0.03] respectively with no change in control. Continuous Glucose Monitoring (CGM) reported significant differences between DSNS + SC versus SC alone for mean glucose [−12 ± 65 vs 28 ± 93 mg/dl;p < 0.01], TAR 180 [−9 ± 42 vs 7 ± 45 mg/dl;p = 0.04], TAR 250 [−3 ± 27 vs 9 ± 38 mg/dl;p = 0.05], iAUC [−192 (1.1) vs −48 (1.1) mg/dl;p = 0.03]. MAGE was significantly reduced for both DSNS + SC (−19 ± 67;p < 0.001) and SC alone (−8 ± 70;p = 0.04), with reduction being more pronounced for DSNS + SC. DSNS + SC reported a decrease in carbohydrate energy % [−9.4 (−11.3, −7.6) %;p < 0.0001] and amount [−47.4 (−67.1, −27.7) g;p < 0.0001], increased dietary fiber [9.5 (7.2, 11.8) g;p < 0.0001] and protein energy % [0.9 (0.5, 1.3) %;p < 0.0001] versus SC alone. DSNS + SC reported signi

关键词： Diabetes Specific Nutrition Supplement Standard of Care Diabetes Glycemic Markers HbA1C

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Modern approach to the clinical management of non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2014年第26期20卷 8341-8350页

作者： Maria Del Ben Licia Polimeni Francesco Baratta Daniele Pastori Lorenzo Loffredo Francesco Angelico department of Internal medicine and medical specialities department of Public Health and Infectious Diseases Sapienza University

Non-alcoholic fatty liver disease (NAFLD) is the most common and emerging form of chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis, which may progress to cirrhosis, liver cancer, and liver mortality. Common metabolic diseases, which are well established cardiovascular risk factors, have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration. Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide. First-line management focuses on lifestyle modifications. Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended. Several therapeutic interventions have been proposed. These include insulin sensitizer agents, lipid lowering drugs, antioxidants such as vitamin E and supplementation of vitamin D3. However, therapeutic strategies have been largely empirical so far, and experimental trials have mostly been carried out in uncontrolled settings with small sample sizes. Metabolic conditions such as diabetes mellitus, obesity, hypertension and hyperlipidemia, should be strongly considered and a multidisciplinary approach should be personalized for individual patients. Treatment of co-morbidities should be regarded as of paramount importance in the management of these patients. The purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Insulin resistance Oxidative stress Cardiovascular risk Statins Vitamin D Vitamin E Pioglitazone

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Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu Kennedy Olivier Muluem Olivier Ngongang Theophile Nana Marie Ange Ngo Yamben DésiréAkaba Urich Tambekou Daniel Eone Handy department of Orthopaedics and Trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. department of Surgery and specialities University of Yaound&#233 1 Yaound&#233 Cameroon department of Orthopaedics and Trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon department of Orthopaedics and Trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting

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Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge

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World Journal of Gastroenterology 2014年第32期20卷 11443-11450页

作者： Carlos Alberto García López Fernando Laredo-Sánchez José Malagón-Rangel Miguel G Flores-Padilla Haiko Nellen-Hummel department of Internal medicine Specialities Hospital National Medical Centre "Siglo XXI" Mexican Social Security Institute Distrito Federal 06720 México

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus(SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.

关键词： Intestinal pseudo-obstruction Systemic lupus erythematosus Uretero-hydronephrosis Urinary tract infection Diagnostic challenge

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Epidemiology of Anemia at the Internal medicine department in Borgou departmental Hospital Center(DHC)in Parakou(Benin)

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Open Journal of Internal medicine 2018年第2期8卷 123-130页

作者： Comlan Albert Dovonou Adébayo Alassani Cossi Angelo Attinsounon Serge Ade Kadidjatou Sake Jivaterd Degla Séraphin Ahoui Moise Adegbindin Prosper Gandaho Djimon Marcel Zannou Fabien Houngbe Isidore Zohoun medicine department and medical specialities Medical FacultyParakou UniversityParakouBenin Internal medicine department Borgou Departmental Teaching HospitalParakouBenin medicine department and medical specialities of Cotonou Health Science ParakouBenin

Objective: To describe clinical and biological characteristics of anemia in the Internal medicine department of Borgou departmental Hospital Center (DHC). Methods: This was a transversal and descriptive study for an analytic purpose. All patients hospitalized in the Internal medicine department of Borgou DHC who had a hemogram for their care were included in the study. Anemia was defined as a hemoglobin level lower than 12 g/dL for men and lower than 11.5 g/dL for women. Results: Frequency of anemia was 61.8% (76 of 123 patients). Anemia was moderate in 47.4% of the cases and severe in 27.6% of the cases. Basing on the mean corpuscular volume, microcytic anemia accounted for 36.8%, anemia was normocytic in 46.1% and macrocytic in 17.1% of cases. According to the mean corpuscular hemoglobin concentration, normochromic anemia accounted for 81.6% of the series and hypochromic in 18.4%. The most common pathologies found in anemic patients came from digestive origin (17%), the renal causes were also found in 17% of the cases. Cardiac pathologies were responsible for anemia in 13% of cases. Malaria and pulmonary pathologies were responsible for anemia in respectively 12% and 9%. The main factors associated with anemia were young age (young adult) and neurological pathologies. Conclusion: Anemia hospital prevalence is very high in the Internal medicine department of Borgou DHC. Awareness of populations and practitioners for the early management of various pathologies which provide anemia could improve this presentation.

关键词： Anemia Internal medicine Parakou

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