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Pyelonephritis in Adult Women with Homozygous Sickle Cell Disease: about 42 Cases
Sekongo Yassongui Mamadou,
Abisse Agba,
Tolo-Diebkile Aissata,
Konan Sidoine,
Kouamenan Sidonie,
Danho Nanho Clotaire,
Dora B.,
Kassougue Kadidia,
N’Guessan Koutoua Parfait,
Konate Seidou,
Galacteros F.
Issue:
Volume 2, Issue 2, March 2014
Pages:
10-14
Received:
3 February 2014
Published:
10 March 2014
Abstract: Sickle cell disease is a condition with 3 parts of speech including infectious complications. They are essentially encapsulated bacterial organisms. There is a significant incidence of urinary infections to adults with sickle cell disease most particularly among women. The frequency and characteristics of pyelonephritis in women with sickle cell disease is poorly understood to this day, it seemed interesting to analyze over a period of one year, the profile of sickle cell patients followed in the genetic disease unit of red blood cell Hospital Henri Mondor, Créteil, and who took at least one episode of pyelonephritis. Patients and Methods: This study was conducted in the genetic disease unit of red blood cell (UMGGR) Hospital Henri Mondor in Créteil (France). This is a retrospective descriptive and analytical study on patients with homozygous sickle cell disease, females, aged 18 years or more. The selection was conducted over a period of one year from February 2007 to February 2008. Data were collected from medical records and from reports of record of each patient. We considered the clinical, paraclinical and therapeutic latest episode of pyelonephritis. Data processing was done using the software Statview. Results: The prevalence of pyelonephritis in women with sickle cell disease aged over 15 years was 6.12% annually. The median age at first episode of pyelonephritis was 23.5 years. The majority (71.42%) was the first episode after 20 years. Among the factors predisposing to pyelonephritis, pregnancy has been implicated in 16.7% of cases. The symptoms of cystitis, with 52.4%, were the fact favoring predominant. The average number episodes of pyelonephritis to our patients were 2. The risk of recurrent pyelonephritis was significantly correlated statistically with the presence of cholelithiasis (p = 0.04). Fever was the clinical symptoms that prompted the consultation in 95.24% cases. The consequences of sickle cell disease were important. We identified 16.7% cases of sepsis and 16.7% of worsening anemia requiring transfusion. The causative agent was E. coli in 85.7% of patients. 61.9% of patients received combination therapy. The intravenous therapy as first-line was found in 81%. Fluoroquinolones were the molecules widely used in 71.4% of cases. The rate of clinical failure at 3 days of antibiotics was 4.76%. The average time for obtaining apyrexia was 3 days. The average duration of treatment was 15 days. We observed no cases of death secondary to the episode of pyelonephritis. Conclusion: This preliminary work has highlighted the incidence of pyelonephritis in women adult with sickle cell and the the potential impact on sickle cell disease. Despite being underestimated because of the retrospective nature and short duration (1 year) of study, this frequency must motivate strategy to encourage more active educational preventive towards patients and early diagnosis of urinary tract infections to women with sickle cell disease.
Abstract: Sickle cell disease is a condition with 3 parts of speech including infectious complications. They are essentially encapsulated bacterial organisms. There is a significant incidence of urinary infections to adults with sickle cell disease most particularly among women. The frequency and characteristics of pyelonephritis in women with sickle cell di...
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Prevalence of Eosinophilic Esophagitis in Patients with Refractory Gastro-esophageal Reflux Disease Symptoms
Mohamed El malatawy,
Hanan Badawy,
Nanees Adel,
Behnam Tahmasebpour,
Reham Al Swaff
Issue:
Volume 2, Issue 2, March 2014
Pages:
15-19
Received:
16 February 2014
Published:
10 March 2014
Abstract: Background and Aim: Eosinophilic esophagitis is an inflammatory disorder of the esophagus that is being increasingly diagnosed in the adult population. The present study aimed to determine the prevalence of eosinophilic esophagitis among Egyptian patients presenting with refractory GERD symptoms. Methods: 40 consecutive adult Egyptian patients with refractory GERD symptoms were enrolled in the study. Upper GIT endoscopy was done for all participants with at least 3 biopsies taken from 2 different sites in the esophagus including the distal and either mid or proximal esophagus even if the esophagus appeared endoscopically normal. Gastric and duodenal biopsies were also taken along with esophageal biopsies. All biopsies were examined histopathologically by blinded gastrointestinal pathologists. An esophageal eosinophilic count > 15/HPF, along with normal gastric and duodenal biopsies, substantiated the diagnosis of eosinophilic esophagitis. Results: The prevalence of eosinophilic esophagitis in this cohort was 2.5% (1/40). The affected participant was a 27 year old female patient who had a history of bronchial asthma (type 1 hypersensitivity reaction) for which she was treated with ,on demand, inhaled bronchodilators (short acting β agonist). The endoscopic examination of the affected participant showed furrows and plaques which are strongly suggestive of eosinophilic esophagitis. Conclusion: the low prevalence rate of eosinophilic esophagitis among the current small cohort of Egyptian patients with refractory GERD symptoms strongly mandates the search for additional data concerning the indications for esophageal biopsy in this subset of patients. History of atopy may warrant suspicion of eosinophilic esophagitis in this subset of patients.
Abstract: Background and Aim: Eosinophilic esophagitis is an inflammatory disorder of the esophagus that is being increasingly diagnosed in the adult population. The present study aimed to determine the prevalence of eosinophilic esophagitis among Egyptian patients presenting with refractory GERD symptoms. Methods: 40 consecutive adult Egyptian patients with...
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Chronic Pain in Multiple Sclerosis: An Overview
A. R. M. Saifuddin Ekram,
Ng Louisa,
Bhasker Amatya,
Fary Khan
Issue:
Volume 2, Issue 2, March 2014
Pages:
20-25
Received:
9 February 2014
Published:
20 March 2014
Abstract: The pathophysiology of pain in multiple sclerosis (MS) is poorly understood, but there are multiple schools of thought. Different mechanisms are associated with causation of this pain e.g. acute pain due to inflammation; chronic or intermittent neuropathic pain related to central nervous system (CNS) lesions; pain secondary to spasticity, spasms and muscle cramps from higher motor neuron lesions; and musculoskeletal pain from adopting maladaptive body positions and general physical deconditioning. Similarly evidence for treating pain in MS is limited. Treatment is often based on anecdotal reports and clinical experience as there is scarcity of randomized placebo-controlled trials for evidence of pharmacological treatment of pain in MS. The aim of this article is to provide a brief review of current concepts about the nature, causes and management of pain in MS.
Abstract: The pathophysiology of pain in multiple sclerosis (MS) is poorly understood, but there are multiple schools of thought. Different mechanisms are associated with causation of this pain e.g. acute pain due to inflammation; chronic or intermittent neuropathic pain related to central nervous system (CNS) lesions; pain secondary to spasticity, spasms an...
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Preventing the Progression of Diabetic Kidney Disease
Issue:
Volume 2, Issue 2, March 2014
Pages:
26-33
Received:
5 February 2014
Published:
20 March 2014
Abstract: Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end-stage renal disease (ESRD) causing increased morbidity and mortality. The objective of this review article is to discuss about recognition and treatment of early DKD to prevent its progression. Informations have been gathered from related clinical studies, research works, articles, abstracts, and guidelines of different organizations published in various journals. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the early stage of DKD. In addition to an earliest marker of kidney damage, microalbuminuria is an established high risk factor for cardiovascular morbidity and mortality. Patients with microalbuminuria who progress to macroalbuminuria are likely to progress to ESRD. There is general agreement that people with diabetes should be screened regularly to detect early markers of kidney damage. Albumin creatinine ratio in a morning urine sample is the preferred method of detecting microalbuminuria in diabetes. There is strong evidence that a number of interventions if initiated at early stage of DKD reduces the risk and slows the progression of kidney damage. People with diabetes and microalbuminuria should be treated with a multifactorial intervention approach to retard the progression of DKD. Studies have clearly demonstrated that the use of angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers with improved glycemic control, blood pressure control, lipid lowering, aspirin, smoking cessation, exercise programs and dietary intervention reduced the development of overt nephropathy and ESRD.
Abstract: Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end-stage renal disease (ESRD) causing increased morbidity and mortality. The objective of this review article is to discuss about recognition and treatment of early DKD to prevent its progression. Informations have been gathered from related clinical studies, res...
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Homozygous Familial Hypercholesterolemia: Case report and Review of Literature
Vinod Kumar Khurana,
Raj Kumar Mehta,
Kapil Chandra
Issue:
Volume 2, Issue 2, March 2014
Pages:
34-40
Received:
3 March 2014
Accepted:
9 April 2014
Published:
20 April 2014
Abstract: Familial hypercholesterolemia (FH) is a genetic disease presented by high levels of serum low density lipoprotein (LDL), xanthomas and early coronary artery disease (CAD). The diagnosis of Homozygous Familial Hypercholesterolemia (HoFH) is based on a family history of elevated cholesterol, persistent high LDL levels despite maximum medical treatment and the development of xanthomas and early atherosclerotic cardiac lesions such as aortic stenosis. Management of HoFH patients requires lifestyle modifications and medical therapy
Abstract: Familial hypercholesterolemia (FH) is a genetic disease presented by high levels of serum low density lipoprotein (LDL), xanthomas and early coronary artery disease (CAD). The diagnosis of Homozygous Familial Hypercholesterolemia (HoFH) is based on a family history of elevated cholesterol, persistent high LDL levels despite maximum medical treatmen...
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