Senegal's Grand Magal of Touba: Syndromic Surveillance during the 2016 Mass Gathering.

The Grand Magal of Touba (GMT) is an annual 1-day Muslim religious event that takes place in Touba in Senegal. The city of Touba swells from 800,000 to four million people during the GMT. All patients who attended one of the 154 dedicated medical care public healthcare structures of the medical region of Diourbel during the GMT were included in a cross-sectional survey from November 16 to November 21, 2016. Demographic, morbidity, and mortality data were collected on a daily basis using a standardized article form that allows data to be recorded in a free-text format. Data were obtained from a total of 20,850 healthcare encounters, and 30.9% patients were aged ≤ 15 years. The most frequent conditions were gastrointestinal and respiratory diseases. Most frequent gastrointestinal symptoms were abdominal and gastric pain, nausea and vomiting, and diarrhea, suggesting that most patients suffered gastroenteritis. The predominance of cough, rhinitis, influenza-like illness, and sore throat among patients with respiratory symptoms suggests that most patients suffered from upper respiratory tract infections. Other frequent symptoms were headaches and pain in various organs. Three percentage of patients were considered to have malaria, 29.8% of patients were prescribed antibiotics and 2.6% antimalarial drugs, and 1.5% of patients were hospitalized. Only one death was recorded. Preparedness of the medical infrastructure should target these syndromic features, in terms of diagnostic tools and specific treatments, including pediatric formulations. It is also essential to improve the quality and rapid availability of data to enable real-time analysis of medical events at the GMT and to implement a rapid response, if necessary.

Investigating ROS sources in male infertility: a common end for numerous pathways.

Reactive oxygen species (ROS) are active byproducts of aerobic metabolism. Although they are constantly produced during normal cellular activities in the mitochondria, their action is counteracted by inherent antioxidant systems. This equilibrium is distorted in the case of acute or chronic inflammation, which results in increased ROS production and, ultimately, oxidative stress. In sperm, ROS are produced by both spermatozoa and circulating leucocytes and may be part of normal adaptive reactions, such as the capacitation process. However, a number of external toxicants may also contribute to ROS production in the testis and epididymis, leading to a decrease in sperm viability and motility and, therefore, an increased onset of the male factor of infertility. Such pro-oxidative conditions include, among others, exposure to radiation, extreme temperature, certain drugs, toxins, heavy metals, smoking and biological hazards. The current review paper summarizes the available evidence incriminating ROS and oxidative stress as the underlying pathophysiological mechanism leading to the onset of reproductive toxicity in each of these settings.

Sertoli cell proliferation in the fetal and neonatal rat testis: a continuous phenomenon?

Sertoli cell population kinetics, as evidenced by semi-quantitative immunolabeling for proliferating cell nuclear antigen (PCNA) and Ki-67, in developing Wistar rat male gonads of embryos and neonates [14.5 days post conception (dpc)-7 days post partum (dpp)], was investigated. Throughout the examined period a gradual increase of immunolabeled Sertoli cell number, associated with intense mitotic activity, was observed. PCNA labeling index of Sertoli cells increased from 66.67 (at 14.5 dpc) to 89.74 (at 18.5 dpc) and then dropped to 75.24 (at 20.5 dpc). At birth, the percentage of PCNA immunoreactive Sertoli cells reached 98.70% and remained high thereafter, attaining a peak value of 99.90% at 7 dpp. The percentage of Ki-67 immunoreactive Sertoli cells in the fetal testis increased from E14.5 (43.95%) to E20.5 (77.40%). The proliferation rate did not alter considerably in the neonatal testis until 5 dpp. At this point, a significant increase of the Ki-67 labeling index was observed and a peak value of 95.76% was reached at 7 dpp. The pattern of Sertoli cell proliferation with age and the establishment of the final Sertoli cell number in vivo established in the present study was compared to the results from earlier investigations reported in the literature and the observed fluctuation of dividing cell numbers, associated with immunolabeling results throughout the examined period, complements and extends existing data. An appraisal of the timing of Sertoli cell proliferation in other species, namely mouse and man, is presented. The current investigation may be useful in evaluating the potential influence of factors interfering with normal mitotic activity of Sertoli cells, including cell selection mechanisms, such as apoptosis, senescence, DNA repair and hormonal/paracrine growth modulation.

Evaluation of immunohistochemical markers of germ cells' proliferation in the developing rat testis: a comparative study.

Germ cells' proliferation during testicular organogenesis in Wistar rat embryos and neonates [14.5, 18.5, 20.5 days post conception (dpc), birth (day 0), 1, 3, 5, 7 days post partum (dpp)] was evaluated via immunohistochemistry, using the PCNA and Ki-67 nuclear antibodies. Estimation of the reactive/total cell ratio, per visual field [labeIing index (LI)] was achieved using the Image Pro Plus Software. Immunostaining of the fetal testis, with both antibodies, revealed increasing germ cells' numbers between 14.5 dpc and birth. From birth onwards, a sharp decline of germ cells' population was observed in the first 3 days of postnatal life. Then, a transient increase of the LI, between 3 and 5 dpp, was noted. Afterwards, proliferation of germ cells ceased. These results indicate that, during fetal and neonatal life, two peaks of proliferative activity of germ cells are noticed. Following estimation of the LI for both PCNA and Ki-67, a prominent labeling for the first antibody was observed throughout the examined period. Ki-67 staining follows a similar pattern, showing, however, significant fluctuation in the obtained values, in comparison to PCNA. The significant differences observed don't seem to be simply a result of the different half lives of the two markers, but rather a consequence of additional underlying cellular activity associated with PCNA, such as DNA repair.

Solid-state NMR study of antimicrobial peptides from Australian frogs in phospholipid membranes.

Antimicrobial peptides, isolated from the dorsal glands of Australian tree frogs, possess a wide spectrum of biological activity and some are specific to certain pathogens. These peptides have the capability of disrupting bacterial membranes and lysing lipid bilayers. This study focused on the following amphibian peptides: (1) aurein 1.2, a 13-residue peptide; (2) citropin 1.1, with 16 residues; and (3) maculatin 1.1, with 21 residues. The antibiotic activity and structure of these peptides have been studied and compared and possible mechanisms by which the peptides lyse bacterial membrane cells have been proposed. The peptides adopt amphipathic alpha-helical structures in the presence of lipid micelles and vesicles. Specifically 15N-labelled peptides were studied using solid-state NMR to determine their structure and orientation in model lipid bilayers. The effect of these peptides on phospholipid membranes was determined by 2H and 31P solid-state NMR techniques in order to understand the mechanisms by which they exert their biological effects that lead to the disruption of the bacterial cell membrane. Aurein 1.2 and citropin 1.1 are too short to span the membrane bilayer while the longer maculatin 1.1, which may be flexible due to the central proline, would be able to span the bilayer as a transmembrane alpha-helix. All three peptides had a peripheral interaction with phosphatidylcholine bilayers and appear to be located in the aqueous region of the membrane bilayer. It is proposed that these antimicrobial peptides have a "detergent"-like mechanism of membrane lysis.

Bacterial sepsis-induced rhabdomyolysis.

OBJECTIVE: To describe the syndrome of rhabdomyolysis during bacterial sepsis with regard to incidence, blood bacteriology and complications and to examine the association between hyperosmolal state and rhabdomyolysis, evaluating the relationship between plasma osmolality (Posm) and serum creatine phosphokinase (CPK) levels. DESIGN: Prospective study including all patients admitted to the intensive care unit (ICU) for sepsis with positive blood culture and rhabdomyolysis over a 3-year period. SETTING: Seven-bed medical/surgical ICU of a teaching hospital. PATIENTS: 35 patients (group 1) with bacterial sepsis-induced rhabdomyolysis (15 males, 20 females; mean age 71+/-13 years) and 122 (group 2) bacteraemic septic patients without rhabdomyolysis (49 males, 73 females; mean age 68+/-15) were studied. Patients with rhabdomyolysis were divided into gram(+) and gram(-) subgroups according to the blood culture growth. RESULTS: From 491 patients recorded, 35 fulfilled the inclusion criteria for bacterial sepsis-induced rhabdomyolysis (7.1%). Gram-positive bacteria predominated in group 1 (69%), while gram-negative predominated (60%) in group 2. There was a correlation between CPK and Posm levels in the rhabdomyolysis Group (r = 0.52, R2 = 0.27, p = 0.003). There was a stronger correlation between these two variables (r = 0.67, R2 = 0.45, p = 0.001) in the gram(+).subgroup. Acute renal failure (68.5%) and electrolyte disorders such as hyperkalaemia (34%) and hypocalcaemia (48.5%) were the major complications in the rhabdomyolysis group. Sixteen (45.7%) patients in group 1 and 49 (40%) in group 2 died during their stay in the ICU from sepsis and multiple organ failure. Rhabdomyolysis was not considered a contributing factor to their death, as none of our patients died during or immediately after the syndrome. CONCLUSION: Bacterial sepsis-induced rhabdomyolysis results from certain types of microorganisms, mainly gram-positive and to a lesser extent gram-negative. Hyperosmolality is a predisposing mechanism for rhabdomyolysis during bacteraemic sepsis from any type of bacterial microorganism.

Group peer review in psychiatry: the relationship to quality improvement and quality care.

OBJECTIVE: This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care. METHOD: Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored. RESULTS: The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review. CONCLUSIONS: Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.

Reversal of liver failure in sickle cell vaso-occlusive crisis.

A severe but unusual complication of sickle cell vaso-occlusive crisis is acute liver failure related to intrahepatic cholestasis. The outcome is usually fatal in adults. A case of reversible acute liver failure in a patient with s/beta+ thalassemia is reported. The patient was admitted to the intensive care unit because of major organ failure related to vascular occlusion phenomena. After blood-plasma transfusion and supportive therapy for acute liver failure, complete recovery was noted. A liver biopsy performed at the stage of recovery was compatible with intrahepatic cholestasis and sickling. Even though patients with s/beta+ thalassemia usually manifest milder symptoms, they rarely develop major organ failure such as acute liver failure.

Multiple systems organ failure from organophosphate poisoning.

A 68-year-old man was admitted to an intensive care unit after a suicidal ingestion of dimethoate with organophosphate poisoning. Despite temporary improvement, the patient's condition progressively deteriorated with the development of adult respiratory distress syndrome and acute renal failure. Hemodynamic measurements substantiated the evidence of non cardiogenic pulmonary edema, while renal indices the presence of acute tubular necrosis. Despite vigorous organ specific support the patient died on the 12th hospital day. An autopsy confirmed the presence of adult respiratory distress syndrome and acute tubular necrosis. Organophosphate poison can be added to the list of toxins that caused adult respiratory distress syndrome and acute tubular necrosis and provoked the development of multiple systems organ failure.

[Radium contact irradiation of vocal cord carcinoma--a possible treatment method?]. / Die Radiumkontaktbestrahlung des Stimmbandkarzinoms--eine mögliche Behandlungsmethode?

In the course of the use of carrier- bounded radioactive substances for the treatment of the vocal cord carcinoma, 113 patients with a vocal cord carcinoma were treated with radium contact irradiation after thyroid cartilage windowing at the ENT University Clinic Essen. The period of study extended from 1972 to 1983. 88,6% of the patients with vocal cord carcinoma, who showed a typical localisation for radium contact irradiation, became recurrence-free. About 88,0% of the patients, who were led through an irradiation treatment of extended indication, became recurrence-free. A normal vocal function was achieved in 71,7% of all cases.

Human apolipoprotein B: partial amino acid sequence.

A successful approach has been developed for the sequencing of apolipoprotein B based upon the procedure of Cleveland et al. [(1977) J. Biol. Chem. 252, 1102-1106] involving limited proteolysis in the presence of sodium dodecyl sulfate. Staphylococcus aureus protease was employed to produce large peptides which were isolated in relatively pure form by preparative gel electrophoresis. Two peptides were partially sequenced using spinning-cup microsequencing techniques. The sequences are: Peptide R2-5, -Ala-Leu-Val-Gly-Ile-Asn- Gly-Glu-Ala-Asn-Leu-Asp-Phe-Leu-Asn-Ile-Pro-Leu-Arg-Ile-Pro-Pro- Met-Arg-(Arg)-; Peptide R3-1, -Leu-Val-Ala-Lys-Pro-Ser-Val-Ser-Val-Glu- Phe-Val-Thr-Asn-Met-Gly-Ile-Ile-Pro-Lys-Phe-Ala-Arg-. Several stretches of residues suitable for the construction of oligonucleotide probes have been identified.