Dermatophytic mycetoma of the scalp due to an atypical strain of Microsporum audouinii identified by MALDI-TOF MS and ITS sequencing.

Dermatophytic mycetoma of the scalp is a rarity, especially when not associated with tinea capitis. Here, we report a case of dermatophytic mycetoma of the scalp, that was not associated with tinea capitis, caused by an atypical Microsporum audouinii strain. To our knowledge, this is the second reported case, thirty-eight years after the first that was published in 1980.

MAPK inhibitors differently modulate TGF-ß/Smad signaling in HepG2 cells.

The aim of this study was to investigate the mitogen-activated protein kinase (MAPK) pathway, which crosstalk with TGF-ß/Smad signaling via linker phosphorylation of Smad2/3 to promote hepatocarcinogenesis. After DEN-induced hepatocellular carcinoma (HCC) in rats showed increased phosphorylation of JNK1/2, p38, and ERK1/2, we next antagonized TGF-ß1-induced phosphorylation of JNK1/2, p38, ERK1/2, Smad2/3 signaling in HepG2 cells using SP600125, SB203580, and PD98059, respectively. Cell proliferation and invasion were assessed by MTT assay and transwell invasion chambers, respectively. Smad2/3, Smad4, and Smad7 expressions and PAI-1 messenger RNA (mRNA) transcription were measured by using immuno-precipitation/immuno-blotting and real-time RT-PCR, respectively. All the MAPK-specific inhibitors suppressed cell invasion, while all but PD98059 suppressed cell proliferation. Both SP600125 and SB203580 blocked pSmad2C/L and oncogenic pSmad3L. PD98059 blocked pSmad2L but had no effect on elevated pSmad2C and oncogenic pSmad3L. All but PD98059 blocked Smad2/3/4 complex formation and restored Smad7 expression, while all the three MAPK-Specific inhibitors repressed PAI-1 mRNA transcription. Both SP600125 and SB203580 inhibited HepG2 cells' proliferation and invasion by blocking oncogenic pSmad3L and Smad2/3/4 complex formation. PD98059 repressed PAI-1 mRNA by an unknown mechanism.

[Severe acute colitis: two fatal cases in Dakar]. / La colite aiguë grave : deux observations mortelles à Dakar.

OBJECTIVE: Severe acute colitis (SAC) is one of the major complications of inflammatory bowel disease (IBD), especially ulcerative colitis, and it is life-threatening. Although IBD is considered rare in sub-Saharan Africa, we report 2 fatal cases of SAC in Senegalese patients with ulcerative colitis in Dakar. CASES: One patient was a 73-year-old man and the other a 35-year-old woman. In both cases, the diagnosis was preceded by a chronic dysenteric syndrome (febrile in the woman). Despite antibiotic treatment for potential infectious colitis, both patients' condition worsened. Second-line treatment of parenteral corticosteroids did not prevent the occurrence of intestinal perforation for the man, who developed multiorgan failure. The woman developed toxic megacolon during antibiotic treatment, and it was fatal despite bolus corticosteroids: cardiovascular collapse with shock (case 2) occurred before emergency surgery could begin. Conclusion: in subtropical zones where infectious colitis predominates, it is important to consider the diagnosis of SAC in patients with ulcerative colitis and to begin appropriate treatment despite the fear of infection and the difficulty of accessibility to endoscopic exploration.

Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial.

AIMS: Diagnosis IMprovement in PrimAry Care Trial (D-IMPACT) was a prospective, multicentre epidemiological study in three European countries to identify the optimal subset of simple tests applied in primary care to diagnose benign prostatic hyperplasia (BPH) in men who spontaneously present with lower urinary tract symptoms (LUTS). METHODS: Consecutive male patients aged ≥ 50 years who spontaneously attended their regular general practitioner (GP) office with LUTS were eligible for inclusion if they had not previously undergone BPH diagnostic tests or received treatment for BPH. Patients were assessed on three occasions, twice by their regular GP (visits 1 and 2) and once by a urologist (visit 3). The diagnostic accuracy of each variable was determined using the urologists' final BPH diagnosis (at visit 3) as gold-standard. Independent variables analysed were as follows: age; BPH diagnosis performed by GP in visit 1 (yes/no); probability of BPH diagnosis assessed by GP in visit 1; urinalysis (normal/abnormal); prostate-specific antigen (PSA); International Prostate Symptom Score (IPSS); diagnosis of BPH performed by GP in visit 2 (yes/no); and probability of BPH diagnosis assessed by GP in visit 2. Statistically significant variables (p < 0.1) were included in a logistic regression model to identify the best algorithm and describe each test contribution. RESULTS: The most frequent spontaneously reported LUTS were nocturia and weak urinary stream. BPH study prevalence was 66.0% (95%CI: 62.3-69.5) and 32% of patients were at risk of BPH progression (PSA > 1.5 ng/ml and prostate volume ≥ 30 cm(3)). Among the independent variables analysed, only age, IPSS and PSA showed a statistically significant relationship with BPH diagnosis. In a logistic regression model including age, IPSS, PSA and probability of BPH (based on physical examination and symptoms), positive predictive value (PPV) was 77.1%. Exclusion of BPH probability resulted in a PPV of 75.7%. CONCLUSIONS: A diagnostic algorithm including only objective variables (age, IPSS and PSA), easily implemented in any GP office, allows GPs to accurately diagnose BPH in approximately three-quarters of patients spontaneously reporting LUTS.

[Can the frequency of color-coded duplex sonography in urgent examination of deep vein thrombosis be reduced by application of a clinical probability assessment?]. / Kann die Frequenz duplexsonografischer Notfalluntersuchungen der tiefen Beinvenenthrombose durch Anwendung einer klinischen Wahrscheinlichkeitsbewertung reduziert werden?

PURPOSE: Application and verification of the Wells score for pre-test probability of deep vein thrombosis in the lower limbs in clinical routine. The goal was to reduce the number of immediate diagnostic measures for excluding vein thrombosis during acute investigation. New parameters for upgrading or modification the existing score were checked. MATERIALS AND METHODS: In a period from March through November 2007, 333 patients were assigned to the department of radiology in order to exclude deep vein thrombosis. A standardized questionnaire was used to identify the probability of deep vein thrombosis. The patients were categorized as low, moderate, and high risk. The examination was conducted with colored-coded duplex sonography. RESULTS: In the patient population of 333, 41 (12 %) had deep vein thrombosis of the lower limb. The prevalence was approximately 3 % in the low risk group, 34 % in the moderate risk group, and 63 % in the high risk group. Categorization with the Wells score is an instrument with high sensitivity (99.6 %) and specificity (100 %). CONCLUSION: The pre-test probability with the Wells score represents a useful and established instrument in the clinical routine. Acute examinations, especially during stand-by, can be reduced without neglecting patient safety. Patients with a Wells score of 0 don't require an acute examination. An elective investigation should be targeted. Patients with a score between 1 and 8 needed to be treated (within the next 24 hours) with KS and FKDS. According to on our data records, therapy should be started immediately for patients with a high risk of deep vein thrombosis.

[Resistance of bacteria and antibiotic prescription in Fann University Teaching Hospital, Dakar]. / Résistance bactérienne et prescription d'antibiotiques au CHU de Fann, Dakar.

The objective of this study conducted in Fann University Teaching Hospital in Dakar, is to establish correlation beetwen the prescription and consummation of antibiotics in the one hand, and the susceptibility of strains isolated in this hospital on the other hand. An interview of medical practitioners and pharmacists was realised to appreciate the antibiotics used in the clinics, the bacteria taken aim, the criteria of choice, the place of antibiogram, the place of antibiotics in orders of medicines and pharmacists, the consummest family of antibiotics. In the lab, all of pathogen bacteria were tested by disc diffusion test (antibiogram) to appreciate the susceptibility to antibiotics. The results show that Enterobacteria represented 60.8% of isolates and among them, Escherichia coli (30.6%) was the most representative specie in hospitalized and non hospitalized patients. 52% of the strains of E. coli were susceptible to aminopenicillins in external patients, versus less than 35% in hospitalized. In Neurosurgery, Pseudomonas aeruginosa was the most frequent bacteria and all of the strains were susceptible to imipenem, dibekacin and ciprofloxacin. Beta-lactams were the most used drugs in the first place (78.8%), related to habits of prescription of medical staff and to avaibility of antibiotics. The choice of antibiotics must take the susceptibility of strains into account.

Photorefractive keratectomy in 176 eyes: one year follow-up.

Beginning in March 1992, 176 eyes from 176 patients underwent photorefractive keratectomy with the Summit Technology Eximed UV200LA. This study was designed to evaluate the efficacy of this method.

Marriage law and practice in the Sahel.

The legal systems of Sahelian African countries combine customary law, Islamic law, French colonial law, and civil law introduced since independence in 1960. Utilizing a framework developed by the Faculty of Law, University of Dakar, Senegal, and the Development Law and Policy Program, Center for Population and Family Health, Columbia University, the Sahel Institute undertook a comprehensive study of the legal and social status of women in Burkina Faso, Mali, Niger, and Senegal. Since 1960, Burkina Faso, Mali, and Senegal have replaced French family law with national marriage codes. Niger has not yet adopted a family code; the laws on the family inherited from the French remain in force. The postindependence marriage codes have attempted to give young women more say in choosing a husband, to regulate the practice of bride price, and to limit the practice of polygyny. They have done this by integrating customary law and government-passed civil law. Mali, Niger, and Senegal have repealed provisions in their codes prohibiting the distribution of contraception, based on a 1920 French law. Although it has taken no formal legal action, Burkina Faso has adopted family planning policies that effectively nullify the 1920 law.

Thyroid function in patients with Parkinson's disease.

Many of the symptoms of Parkinson's disease are similar to those seen in patients with hypothyroidism. The diagnosis of myxoedema may easily be overlooked when occurring together with Parkinson's disease. We studied 52 patients with Parkinson's disease and found normal thyroid values and TSH-levels in all patients except one, who turned out to have an incipient hypothyroidism.