Modulatory effects of extract of Heinsia crinita against fructose/streptozotocin-induced oxidative stress in diabetic rat models.

Oxidative stress plays a crucial role in the development of type 2 diabetes and the associated microvascular and cardiovascular complications. In the study, we have investigated the effects of Heinsia crinita (H. crinita) extracts on lipid peroxidation and oxidative stress responses using diabetic rats. Type 2 diabetes was induced with 10 % fructose/40 mg/kg body weight streptozotocin (STZ). H. crinita extract was administered at 200 and 400 mg/kg body weight twice daily for 21 days, in addition to metformin (MET: 500 mg/kg body weight) control. Molecular docking analysis was performed to determine the binding affinity of H. crinita extracts to the DNA binding domains of peroxisome proliferator-activated receptor (Ppar) and retinoid x receptor (Rxr) protein crystal structures, showing different binding affinities for putative active compounds from the plant. Fasting blood glucose (FBG), body and organ weight changes were determined showing that H. crinita extract induced an anti-hyperglycemic effect in the treated animals, with changes (either decrease or increase) in liver and kidney weights. A decrease in mRNA expression of peroxisome proliferator-activated receptors (ppar), sterol regulatory element-binding protein 1 (srebp-1c), liver x-receptor (lxr), retinoid x receptors (rxr), cytochrome p45041 (cyp4a1) and acyl-CoA oxidase (acox1) in diabetic animals were observed, compared to the control. A dose-specific decrease or increase in antioxidant enzymes (superoxide dismutase: SOD, catalase: CAT, reduced glutathione: GSH, glutathione peroxidase: GPx) transcripts and activity levels were also observed. We also observed exposure-specific decrease or increase of malondialdehyde (MDA) levels. Our data suggested that H. crinita extract possesses protective effects against diabetes-induced oxidative stress. These effects might be attributed to their binding and activation of nuclear receptors, indicating their cellular mode of action that is comparable to MET.

Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system.

Safety-net health systems are a primary source of care for socioeconomically disadvantaged individuals who may be eligible for HIV pre-exposure prophylaxis (PrEP) and are priority groups under the Ending the HIV Epidemic (EHE) initiative. Nevertheless, little evidence is available about barriers to PrEP implementation in safety-net settings. We aimed to assess the association between PrEP knowledge and prescribing practices, and to ascertain unmet knowledge needs to implement PrEP. In 2019, we surveyed primary care providers (PCPs) in a safety-net health system that serves an EHE priority jurisdiction located in North Texas. Our questionnaire ascertained self-reported prescribing practices, knowledge, and training needs related to PrEP. We used penalized logistic regression to estimate odds ratio (OR) and 95% posterior limits (PL) for the association between provider self-rated knowledge of PrEP and PrEP prescribing. Our study population comprised 62 primary care providers, of whom 61% were female, 60% were non-Hispanic White, 76% were physicians (76%), 57% had ≥ 10 years of practice experience, 45% reported low self-rated PrEP knowledge, and 35% prescribed PrEP in the past year. Providers with low PrEP knowledge had 69% lower odds of prescribing PrEP within the past year (OR = 0.31, 95% PL: 0.12, 0.82). Eligibility for PrEP, side effects and adherence concerns were key unmet knowledge needs. Our findings suggest that low provider PrEP knowledge may be a barrier to PrEP prescribing among safety-net PCPs. Our results provide insight about specific educational needs of PCPs in a safety-net health system, which are amenable to educational intervention.

* Harnessing External Cues: Development and Evaluation of an In Vitro Culture System for Osteochondral Tissue Engineering.

Over the last decade, engineered structures have been developed for osteochondral (OC) tissue regeneration. While the optimal structure design is yet to be determined, these scaffolds require in vitro evaluation before clinical use. However, the means by which complex scaffolds, such as OC scaffolds, can be tested are limited. Taking advantage of a mesenchymal stem cell's (MSC's) ability to respond to its surrounding we harness external cues, such as the cell's mechanical environment and delivered factors, to create an in vitro culture system for OC tissue engineering with a single cell source on a gradient yet integrated scaffold system. To do this, the effect of hydrogel stiffness on the expression of human MSCs (hMSCs) chondrogenic differentiation was studied using histological analysis. Additionally, hMSCs were also cultured in different combinations of chondrogenic and osteogenic media to develop a co-differentiation media suitable for OC lineage differentiation. A uniquely graded (density-gradient matrix) OC scaffold with a distal cartilage hydrogel phase specifically tailored to support chondrogenic differentiation was cultured using a newly developed "simulated in vivo culture method." The scaffold's culture in co-differentiation media models hMSC infiltration into the scaffold and subsequent differentiation into the distal cartilage and proximal bone layers. Cartilage and bone marker staining along with specific matrix depositions reveal the effect of external cues on the hMSC differentiation. As a result of these studies a model system was developed to study and culture OC scaffolds in vitro.

[Whole-blood transfusion for hemorrhagic shock resuscitation: two cases in Djibouti]. / Transfusion de sang total pour la réanimation du choc hémorragique: à propos de deux cas à Djibouti.

Hemorrhagic shock requires early aggressive treatment, including transfusion of packed red blood cells and hemostatic resuscitation. In austere environments, when component therapy is not available, warm fresh whole-blood transfusion is a convenient treatment. It provides red blood cells, clotting factors, and functional platelets. Therefore it is commonly used in military practice to treat hemorrhagic shock in combat casualties. At Bouffard Hospital Center in Djibouti, the supply of packed red blood cells is limited, and apheresis platelets are unavailable. We used whole blood transfusion in two civilian patients with life-threatening non-traumatic hemorrhages. One had massive bleeding caused by disseminated intravascular coagulation due to septic shock; the second was a 39 year-old pregnant woman with uterine rupture. In both cases, whole blood transfusion (twelve and ten 500 mL bags respectively), combined with etiological treatment, enabled coagulopathy correction, hemorrhage control, and satisfactory recovery.

[Imported malaria at Desgenettes Military Hospital in Lyon, France: a retrospective study of 115 cases from 2006 to 2008]. / Le paludisme d'importation à l'hôpital d'instruction des armées Desgenettes de Lyon en 2006-2008 : étude rétrospective de 115 cas.

PURPOSE: The purpose of this report is to describe the clinical, epidemiologic, and parasitological features and therapeutic modalities associated with cases of imported malaria managed at the Desgenettes Military Hospital in Lyon, France. MATERIAL AND METHODS: Review of the files of all patients treated for imported malaria in the emergency and travel medicine departments of the Desgenettes Military Hospital from January 1, 2006, through December 31, 2008. RESULTS: The study included 115 patients (13 of them French armed forces personnel). Most cases (75.6%) were due to falciparum malaria. Only 28.7% of patients had taken proper malaria prophylaxis. Severe symptoms were seen in none of the ambulatory care patients versus 22.7% of the hospitalized patients. Quinine treatment was used for 67% of ambulatory care patients and 89.4% of those hospitalized. CONCLUSIONS: The epidemiologic features observed in the patients described here are similar to those reported by the French national reference center for imported and autochthonous malaria. The frequent use of quinine for ambulatory treatment was not consistent with current guidelines recommending first-line treatment with atovaquone-proguanil or artemether-lumefantrine.

[Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis]. / Ulcération du talon chez une Djiboutienne: carcinome epidermoïde avec lymphangite carcinomateuse.

The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh.

[Rare cause of heart failure in an elderly woman in Djibouti: left ventricular non compaction]. / Une cause rare d'insuffisance cardiaque chez une djiboutienne. Non compaction ventricule guache (NCVG).

The purpose of this report is to describe the first case of left ventricular non compaction diagnosed in Djibouti. The patient was a 74-year-old Djiboutian woman with symptomatic heart failure. Echocardiography is the key tool for assessment of left ventricular non compaction. This rare cardiomyopathy is probably underdiagnosed in Africa.

[Acute obstructive epiglottitis in intensive care unit: which airway management strategy?]. / Epiglottite aiguë obstructive en réanimation : stratégie pour une intubation à haut risque.

Acute epiglottitis is an infection of supraglottic structures, with a high risk of life-threatening respiratory obstruction. We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient.

[Acute renal failure related to urinary retention following haemorrhoidectomy performed under general anaesthesia and bilateral pudendal nerve block: a case report]. / Insuffisance rénale obstructive dans les suites d'une chirurgie hémorroïdaire réalisée sous anesthésie générale et bloc pudendal bilatéral: à propos d'un cas.

Anorectal surgery is associated with significant postoperative pain. Pudendal nerve blocks, formerly performed by surgeons, provides effective postoperative analgesia and allow a quicker recovery, which is quite important in the current concept of fast-track postoperative care. However, even for benign surgery with a safe anaesthetic technique, serious adverse events may occur. We report a case of acute renal failure related to urinary retention. Hidden by a prior history of urination difficulties, recognition of symptoms, following haemorrhoidectomy performed with bilateral pudendal block, was late. After complete recovery, electrophysiologic investigations found hypotonic, hypocontractile bladder.Therefore, before performing haemorrhoidectomy with regional anaesthesia, prior history of urination difficulties should be searched. The risk of urinary retention due to surgery and anaesthesia may be increased, as observed in this original case report.

Screening for multidrug-resistant bacteria as a predictive test for subsequent onset of nosocomial infection.

OBJECTIVE: To investigate whether carriage of multidrug-resistant bacteria is a risk factor for nosocomial infection and whether detection of carriage is predictive of subsequent onset of nosocomial infection. METHODS: In this observational cohort (study period, June 1998 through October 2002), nasal and rectal swab specimens from 412 consecutive patients admitted to the intensive care unit were tested for carriage of multidrug-resistant bacteria. Concomitantly, the bacteria responsible for any subsequent nosocomial infection, the date of infection, and some of the known clinical risk factors for nosocomial infection were noted. These factors were adjusted for potential confounders, using a Cox model stratified on the propensity score of multidrug-resistant bacteria carriage. The diagnostic characteristics of a carriage test, including the positive and negative diagnostic likelihood ratios, were calculated for all strata of the propensity score. RESULTS: Forty-two patients were carrying multidrug-resistant bacteria. Nosocomial infection occurred in 95 patients, of whom 16 (38%) were carriers, and 79 (83%) were noncarriers (P=.01). After adjustment for potential confounders, statistical analysis revealed that carriage remained a risk factor for nosocomial infection (relative risk, 2.08 [95% confidence interval {CI}, 1.13-3.81]). Receipt of antibiotic treatment at the time of intensive care unit admission was found to be protective against nosocomial infection. A positive result of test for detection of carriage seemed to be an efficient predictor of subsequent nosocomial infection (positive diagnostic likelihood ratio, 2.05 [95% CI, 1.15-3.66]), although a negative test result was not a predictor of subsequent nosocomial infection (negative likelihood ratio, 0.91 [95% CI, 0.73-1.11]). CONCLUSION: Carriage proved to be a risk factor for subsequent nosocomial infection. However, the carriage test was useful as a predictive tool only for patients with a positive test result.

[Hypokalaemic paralysis disclosing hyperthyroidism]. / Paralysie hypokaliémique révélant une hyperthyroïdie.

Thyrotoxic hypokaliaemic paralysis is a rare cause of severe hypokalaemia. We report the case of a 34-year-old Asiatic man who presented in our emergency department an episode of quadriplegia due to low plasma potassium levels. Biological test discovered a Basedow disease, confirmed thyrotoxic paralysis. Intravenously potassium treatment allowed complete recovery from paralysis. Also, the patient received specific medical treatment with antithyroid drugs and propranolol.