Digestive Signs Research Articles

Ultrasonographic assessment of the normal ileocecocolic junction in dogs.

The ultrasonographic appearance of the ileocecocolic junction (ICCJ), comprising the ileocolic junction (ICJ) and the cecocolic junction (CCJ), has not been established in dogs. The purpose of this prospective study was (1) to evaluate the feasibility and technique of systematic ultrasonographic evaluation of the ICJ and CCJ and (2) to describe its ultrasonographic features. Abdominal ultrasound was performed in 102 fasted dogs, free of digestive signs. The time required to identify the ICJ using a standardized method was recorded for each operator and compared among four experienced ultrasonographers (ECVDI certified and associated member ECVDI) and two previously trained ECVDI residents to evaluate the feasibility of the technique. Measurements were obtained for the ICJ wall thickness. Evaluation of the contents and peristalsis of the ICJ was recorded for descriptive purposes. The easiest way to identify the ICJ was to follow the colon proximally from the urinary bladder to the ICJ. The probe was then rotated anticlockwise and shifted slightly laterally while increasing the pressure to obtain a longitudinal section of the ICJ. The ICJ was identified in less than 2min in 98% of cases by experienced ultrasonographers and in 86% of cases by ECVDI residents. The canine ICJ appears as a short invagination of the ileum into the colon, whereas the CCJ appears as a small opening of the colon within the cecum. This study suggests that it is possible to nearly systematically identify the ICCJ with ultrasound in dogs using the described method and provides reference values for its ultrasonographic measurements.

Endoscopic mucosal phenotypes and endoscopic Sydney system gastritis assessment in relation to Helicobacter pylori infection and upper digestive clinical signs: A 2‐year study among patients with gastroduodenal disorders in Cameroon

AbstractBackground and AimHelicobacter pylori represents the major pathogen in the pathophysiology of diverse gastrointestinal conditions. This study sought to determine the endoscopic aspect of the gastric mucosa in relation to H. pylori infection in Cameroon.MethodsThis study was conducted in three reference health facilities in Cameroon from October 2020 to October 2022. The study enrolled 494 consecutive volunteer dyspeptic patients attending to the gastroenterology department of the selected health facilities. A description of the aspect of gastric mucosa of all participants was performed during endoscopy examination, and biopsies were collected for H. pylori detection using rapid urease tests.ResultsGastritis, ulcerated lesions, duodenitis, esophagitis, normal mucosa aspect, bulbitis, and gastric neoplastic lesions were found in 40.1, 22.3, 10.9, 10.3, 9.7, 6.3, and 0.40% of biopsy samples, respectively. Erythematous/exudative (45.9%) and enterogastric reflux (12.2%) were the main gastritis types recorded. H. pylori was present in 58.1, 46.3, 87.1, 66.7, and 61.8% in gastritis, duodenitis, bulbitis, esophagitis, and ulcerated lesions, respectively. A positive relationship was noticed between the presence of H. pylori and gastritis (1.037 [0.720–1.493]; P = 0.845), bulbitis (4.237 [1.602–11.235]; P = 0.004), esophagitis (1.515 [0.822–2.793]; P = 0.183), ulcerated lesions (1.233 [0.798–1.904]; P = 0.345), erythematous/exudative gastritis (1.354 [0.768–2.389]; P = 0.295), and enterogastric reflux gastritis (1.159 [0.492–2.733]; P = 0.736).ConclusionGastritis and erythematous/exudative gastritis are the most frequent gastrointestinal pathophysiology conditions in dyspeptic patient in our milieu. H. pylori infection is responsible for 94.8% of the gastrointestinal pathophysiology conditions with bulbitis as the condition is significantly associated with this bacterium infection.

Retrospective Study of 25 Cases of Acorn Intoxication Colitis in Horses between 2011 and 2018 and Factors Associated with Non-Survival.

The aim of this study is to describe clinical data associated with acorn intoxication and to find variables associated with survival. Data from horses presented at CISCO-ONIRIS from 2011 to 2018 with a diagnosis of acorn intoxication were included. Diagnosis was based on the following: season, the presence of acorns in the environment, clinical and hemato-biochemical parameters suggestive of a digestive/renal disease, the co-morbidity of companion animals, and post-mortem findings. Statistical analysis was completed using Student's t-test for mean comparisons and a Chi-square test for group comparisons (p < 0.05). A total of 25 horses were included, and seasonality suggests that the intoxication may vary from year to year. Clinical signs associated with acorn intoxication were signs of circulatory shock (lethargy, tachycardia, abnormal mucous membrane, tachypnea), digestive signs (diarrhea, ileus, colic), and abnormal temperature. Clinical pathological findings included increased hematocrit, WBC, creatinine, BUN, GGT, AST, CK and decreased albumin. Overall, 44% (11/25) of horses survived. The majority (13/14) of non-survivors died, or were euthanized, during the first 48 h. Findings significantly associated with non-survival were age, heart rate, hemorrhagic diarrhea, ileus, hematocrit, creatinine, blood lactate, and thickness of the colon wall at ultrasonography. This study provides equine practitioners with valuable prognostic information in cases of acorn intoxication.

Prospective Monitoring of Small Intestinal Bacterial Overgrowth After Gastric Bypass: Clinical, Biological, and Gas Chromatographic Aspects.

Obesity is a predisposing factor for small intestinal bacterial overgrowth (SIBO). The aim of this study was to prospectively evaluate the prevalence of SIBO as well as its clinical, biological, and nutritional aspects before and up to 24months after a Roux-en-Y gastric bypass (RYGB) surgery. Fifty-one patients (mean BMI 46.9kg/m2, 66.7% women) requesting RYGB were included between 2016 and 2020. Each patient underwent a glucose breath test, a standardized interrogation on functional digestive signs, a dietary survey, a blood test, a fecalogram, and anthropometric data gathering. These investigations were carried out before surgery and at 1, 3, 6, 9, 12, 18, and 24months after RYGB. Before surgery, we found a prevalence of 17.6% of SIBO (95% CI = [8.9%; 31.4%]). After RYGB, at the end of 24months of follow-up, 89.5% of patients developed SIBO. Anal incontinence appeared to be very frequent after surgery, affecting 18.8% of our population 18months after surgery. We observed positive steatorrhea after surgery with an average of 11.1g of lipids/24h despite a significant limitation of dietary lipids (p = 0.0282). Our study corroborates data in the literature on the prevalence of SIBO in severe obesity patients. For the first time, we observed the sudden appearance of SIBO after RYGB, with a correlation between exhaled hydrogen on a breath test and lipid malabsorption on the fecalogram. As a result, these patients develop fatty diarrhea, with frequent fecal incontinence.

Association between Food-Specific Immunoglobulin G4 Antibodies in Adults with Self-Reported Signs and Symptoms Attributed to Adverse Reactions to Foodstuffs.

Signs and symptoms attributed to adverse reactions to foodstuffs (ARFS) need tools for research and evaluation in clinical practice. The objectives of this study were (a) to evaluate the most frequent self-reported signs and symptoms attributed to ARFS in Spanish adults, (b) to determine the prevalence of food-specific IgG4 antibody reactions (AbRs), and (c) to investigate the association between self-reported ARFS symptomatology and food-specific IgG4 AbRs. Food-specific IgG4 AbRs against 57 common food and beverages (AESKUCARE-T2FA® in vitro point-of-care test kit, Aesku.Diagnostics GmbH, Germany) were determined in capillary blood samples of 205 volunteers living in the Region of Madrid (Spain). The most frequent self-reported signs and symptoms were related to skin (43%), digestive (41%), and nervous system (NS, 33%) problems. The prevalence of food-specific IgG4 AbRs was cow's milk (73%), sheep's milk (70%), casein (66%), and goat's milk (56.10%). Positive IgG4 AbRs against tomato had a profile consisting of 3/4 of skin problems, more than half of digestive, and 2/5 of NS self-reported signs and symptoms. In conclusion, at least 1/3 of the studied sample reported skin, digestive, and NS signs and symptoms. The most frequent food-specific IgG4 AbRs were related to dairy. Skin problems were more frequent in positive tomato IgG4 AbRs.

Management of Accidental Ingestions of Caustic Products in Emergency Departments in Dakar : About 31 Cases

Background: Caustics are corrosive substances whose ingestion causes tissue damage that can range from mucosal irritation to total necrosis or even perforation of the affected digestive or bronchial segment. Ingestion is often accidental in children and a real public health problem in low and middle income countries, particularly in Africa.&#x0D; Aims: The main objective of this study was to describe the epidemiological, diagnostic, therapeutic and scalable aspects of accidental ingestions of caustics in the medical emergency department of the National Children's Hospital Center Albert Royer (NCHCAR) in Dakar.&#x0D; Methods: This is a descriptive and analytical study over a 12-month period, from March 2020 to February 2021. The study population was children aged 0 to 15 years who were seen in consultation or hospitalized following a caustic product ingestion.&#x0D; Results: During the study period, we included 31 children for accidental ingestion of caustics out of a total of 900 hospitalized children, i.e., a hospital frequency of 3.44% (31/900). The mean age of the children was 21.29±13.10 months and the extremes were 8 and 60 months. The age group [12-18 months] was the most represented (25.81%). Boys were predominant (51.61%) with a sex ratio of 1.07. Sodium hypochlorite (bleaching water) was the main product ingested (64.52%); caustic soda concerned 22.58% of children. More than half (77.45%) of the children were symptomatic with mainly digestive signs including oral ulcerations (41.93%) and vomiting (38.71%). The oesogastroduodenal fibroscopy performed in 19 of the 31 children (61.29%) was normal in 14 children (73.68%). Five children had endoscopic lesions of which 2 cases were stage I and 3 cases stage IIa of the Zargar classification. Initial management was exclusively medical with antisecretory drugs (70.97%), analgesics (38.71%) and corticosteroids (35.48%). The evolution was favorable for the majority of patients. One child presented a dysphagia to solids after 4 weeks of evolution treated by endoscopic dilatation. &#x0D; Conclusion: Accidental ingestions of caustics are frequent in emergency departments. They generally affect children under 24 months of age. The management is medical in the uncomplicated forms which are more and more predominant. Prevention is based on education and awareness of the dangers of caustic products.

Diabetes and COVID-19 in a Moroccan Hospital

SARS-CoV-2 infection named COVID-19 is an infectious disease that emerged in December 2019 in Wuhan, Hubei Province, China. The infection has spread rapidly internationally and has had devastating consequences by producing large numbers of infected people and deaths as well as a negative socioeconomic impact. As for diabetes, it is a chronic, insidious, multi-factorial disease. In Morocco it is a major public health problem. This pandemic has raised questions about the risk of chronic diseases. Among them, diabetes; one of the most frequently reported comorbidities in patients with COVID-19. Our work consisted of a retrospective descriptive and analytical study of 72 cases of COVID- 19 associating Diabetes and COVID-19, collected at the Military Hospital Avicenne of Marrakech, during a period of 4 months between June 2021 and September 2021. The aim of this work was to define the clinical, paraclinical, therapeutic and evolutionary profile of the association between diabetes and COVID19, to identify the risk factors associated with the death of these patients through an analytical study and to propose recommendations for the management of diabetic patients with COVID-19. Hypertension was the most frequent comorbidity 44.4% followed by heart disease in 18.1%. The average age of our patients was 67 ±10 years with a male predominance (62.5%). The majority of our patients were vaccinated (70.8%). The presence of fever, as a clinical sign of Covid19 infection, was observed in the majority of patients (56 patients or 77.8%) followed by dyspnea in 56 patients or 77.8%. RT-PCR was positive in 68.1%, CRP was increased in 97.6%. Ferritinemia was increased in 83.3%. Blood glucose was increased in 89.7%. The extension of the lesions on thoracic CT of 25-50% was predominant in 48.4% of cases. In our study, the parameters of evolution, whose statistical variation was significantly associated with an unfavorable evolution were age&gt;60 years, presence of digestive signs, ...

Frequency of Irritable Bowel Syndrome in Medical Students

Introduction: Irritable bowel syndrome (IBS) represents a real public health problem. It is a very common gastrointestinal disorder which has significant impact on the quality of life of patients. The aim of this study is to determine the frequency of irritable bowel syndrome according to the criteria of Rome III and to identify the determining factors. Methods: We carried out a prospective cross-sectional observational study with a descriptive aim among students of the Faculty of Medicine and Pharmacy of Marrakech. Forty eight students were collected in our study. Results: The prevalence of IBS is estimated at 23.07%. The average age was 22.5 years with ages ranging from 19 to 26 years. A clear predominance of females was noted with a sex ratio of 0.5 (32 females / 16 males). According to the criteria of Rome III, the subtype with predominant constipation presents 60% (N = 21), the subtype with predominant diarrhea presents 54.28% (N = 19), and the mixed form presents 14.25% (N = 5). The most common association was abdominal pain with constipation. Most of the students had intermittent minimal chronic pain, mostly epigastric, accentuated by stress and calmed by stool emission. In association with digestive signs, asthenia was present in 97.14% of patients. The majority of cases had an incorrect lifestyle: 62.5% had an unbalanced diet, and 87.5% did not practice regular physical activity. Conclusion: Irritable bowel syndrome is relatively frequent in the active population. Our study objectified that IBS represents a significant percentage within our target population. They are determined principally by stress especially during exams, gender, genetic profile and unhealthy lifestyle.

Whole-Genome Characterization of SARS-CoV-2 Reveals Simultaneous Circulation of Three Variants and a Putative Recombination (20B/20H) in Pets, Brazzaville, Republic of the Congo.

Following the emergence of SARS-CoV-2, cases of pets infected with variants circulating among humans were reported. In order to evaluate the occurrence of SARS-CoV-2 circulation among pets in the Republic of the Congo, we conducted a ten-month study of dogs and cats living in COVID-19-positive households in Brazzaville and neighboring localities. Real-time PCR and the Luminex platform were used to detect SARS-CoV-2 RNA and antibodies to SARS-CoV-2 RBD and S proteins, respectively. Our results show for the first time the simultaneous circulation of several variants of SARS-CoV-2, including viruses from clades 20A and 20H and a putative recombinant variant between viruses from clades 20B and 20H. We found a high seroprevalence of 38.6%, with 14% of tested pets positive for SARS-CoV-2 RNA. Thirty-four percent of infected pets developed mild clinical signs, including respiratory and digestive signs, and shed the virus for about one day to two weeks. These results highlight the potential risk of SARS-CoV-2 interspecies transmission and the benefits of a "One Health" approach that includes SARS-CoV-2 diagnosis and surveillance of viral diversity in pets. This approach aims to prevent transmission to surrounding wildlife as well as spillback to humans.

Psychological impact of workplace violence towards nurses in the emergency department

IntroductionGrowing attention has been drawn to workplace violence in healthcare settings and toward healthcare workers. Emergency departments have always been vulnerable to workplace violence since its is usually associated to working with people in extreme distress. Healthcare workers facing numbers of situation with either verbal or physical abuse may face an impact on their mental health.ObjectivesDescribe the psychological impact of workplace violence towards nurses in the emergency departmentMethodsThis is a questionnaire-based cross-sectional study including nurses working in the emergency department of different hospitals of Tunis. The respondents’ data were collected from March 2022 to September 2022.ResultsWe included 164 nurses. They were mainly women (Sex ratio of 0.6) with a median of age was 30.7±7.6 years. Nineteen nurses had history of one or more mental disorders such as anxiety disorder (12 cases) and depressive disorder (11 cases). All nurses were victim of workplace violence, while most (104 nurses) were witness to at least one act of violence. Study population had different degrees of concern about safety in workplace, 29.8% had little to no concern while 29,9% were mildly concerned and 40.2% were severely concerned for which they felt their security compromised (14.6% often and 12.2% always). Violence in workplace had consequences on the quality of their service for 26.8% of nurses. Many (49.4%) felt prejudice on their mental health contrasting with little resort (14%) to mental health providers. Number of nurses presented nightmares (44 cases), avoidance (56 cases) or flashbacks (48 cases) about workplace violence. Psychosomatic symptoms were described by most of the study population (58.5%) such as throbbing (46 cases), nervousness (56 cases), aches (23 cases), fatigue (29 cases) or non-specific digestive signs (17 cases).ConclusionsWorkplace violence in emergency departments, first interface of the care chain, is a real problem with serious consequences. Healthcare workers are forced to provide care in situations that compromise their health and safety. Implementing a national action plan is essential in order to address this dangerous phenomenon.Disclosure of InterestNone Declared

Comparison of the Clinical Profile and Severity Factors of COVID-19 during the First 4 Waves in a Paediatric Population of Yaounde

Introduction: COVID-19 is an infectious disease that has been causing a global pandemic since 2019. Although clinical forms are generally less severe in children than in adults, children nevertheless present polymorphous clinical forms and severe cases that can lead to death. Objective: To describe the clinical presentations found in the different waves of COVID-19, and to highlight the different factors of severity. Materials and Methods: We conducted a cross-sectional study with retrospective and prospective data collection which lasted 7 months (from November 2021 to June 2022) and covered a study period from 6 March 2020 to 22 June 2022, i.e. 27 months. All patients aged 0 to 18 years, suspected of having COVID-19, confirmed by real-time RT-PCR or an antigenic Rapid Diagnostic Test or antibody were included. These patients were to be managed in the Mother and Child Centre of the Chantal Biya Foundation, as well as in the Specialised Centre for the Management of COVID patients, annex number II of the Yaoundé Central Hospital. The results were analysed using IBM SPSS.23 software. Results: We included 163 patients in our study. No paediatric patients were registered during the 3rd wave. The mean age of the patients in the study population was 13 ± 5 years with extremes from 15 days to 18 years. We had a female predominance with a sex ratio of 0.83. The most common comorbidity was asthma. The first wave presented mainly with respiratory symptoms such as dry cough and signs of respiratory distress. The second wave presented mainly with digestive symptoms such as diarrhoea, abdominal pain and vomiting. The fourth wave presented with ENT signs such as sore throat, and rhinorrhea. Factors associated with severity were mainly age less than five years (OR = 17.69), vomiting (OR = 6.50), presence of comorbidities (OR = 3.39), and alteration of vital parameters such as bradypnoea (OR = 19.68), bradycardia (OR = 6.34), tachycardia (OR = 3.73), oxygen saturation Conclusion: Clinical presentations varied between waves and the main risk factor was age under 5 years. The fourth wave was less severe than the second wave, which in turn was less severe than the first. (4th nd st) which allows us to humbly recommend more screening for patients under 18 years of age with respiratory, ENT and digestive signs and special attention for those under 5 years of age.

Epidemiological-Clinical and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune III (C.S.Ref CIII) of the District of Bamako

Objectives: It was to determine the epidemiological-clinical and therapeutic aspects of acute appendicitis at the Reference Health Center of Commune III of the district of Bamako. Methodology: This was a prospective study from January 1 to December 31, 2020 including patients operated for acute appendicitis and confirmed at histology and cases of abscess and appendicular plastron. Results: We collected 60 cases of acute appendicitis. They accounted for 17.29% of surgical indications. The average age of our patients was 25.5 years. The male sex was the most represented at 63% with a sex ratio of 1.72. The Pain in the right iliac fossa was the most represented reason for consultation with 76.7%. It was at the type of bite 70% of the cases. On physical examination the defense of the right iliac fossa was present in 96.7%. Digestive signs were marked by nausea 28.4% (17 patients) and vomiting 25% (15 patients). The digital rectal exam was painful to the right of the Douglas fir in 76.7% of our patients. In biology a complete blood count (CBC) performed in all our patients has objectified hyper leukocytosis in 80% of cases. The reactive protein (CRP) performed in 36 patients was elevated with values between 18 and 46 mg/ml. The imaging performed was an abdominal ultrasound that found a roundel image of the appendix with increased size in 65%. Surgical treatment consisted of classical Mac Burney appendectomy in 54 patients (90%). The gesture performed was an appendectomy in all our patients. All our appendectomy parts were sent for pathological examination. This examination classified the parts as non-specific appendicitis in 60%, phlegmonous appendicitis in 22% and catarrhal appendicitis in 18% of cases. Surgical follow-up was simple in 98.4% (59 patients) and morbidity was marked by digestive fistula in one patient. We recorded one case of death (1.6%). Conclusion: Acute appendicitis remains the most common surgical emergency in commune III of the district of Bamako. It is a pathology that can be found at all ages of life. Its morbidity and mortality are low subject to early diagnosis and management.

Using machine learning to detect sarcopenia from electronic health records.

Sarcopenia (low muscle mass and strength) causes dysmobility and loss of independence. Sarcopenia is often not directly coded or described in electronic health records (EHR). The objective was to improve sarcopenia detection using structured data from EHR. Adults undergoing musculoskeletal testing (December 2017-March 2020) were classified as meeting sarcopenia thresholds for 0 (controls), ≥1 (Sarcopenia-1), or ≥2 (Sarcopenia-2) tests. Electronic health record diagnoses, medications, and laboratory testing were extracted from the Indiana Network for Patient Care. Five machine learning models were applied to EHR data for predicting sarcopenia. Of 1304 participants, 1055 were controls, 249 met Sarcopenia-1 and 76 met Sarcopenia-2. Sarcopenic participants were older, with higher fat mass, Charlson Comorbidity Index, and more chronic diseases. All models performed better for Sarcopenia-2 than Sarcopenia-1. The top performing models for Sarcopenia-1 were Logistic Regression [area under the curve (AUC) 71.59 (95% confidence interval [CI], 71.51-71.66)] and Multi-Layer Perceptron [AUC 71.48 (95%CI, 71.00-71.97)]. The top performing models for Sarcopenia-2 were Logistic Regression [AUC 91.44 (95%CI, 91.28-91.60)] and Support Vector Machine [AUC 90.81 (95%CI, 88.41-93.20)]. For the best Logistic Regression Model, important sarcopenia predictors included diabetes mellitus, digestive system complaints, signs and symptoms involving the nervous, musculoskeletal and respiratory systems, metabolic disorders, and kidney or urinary tract disorders. Opioids, corticosteroids, and antihyperlipidemic drugs were also more common among sarcopenic participants. Applying machine learning models, sarcopenia can be predicted from structured data in EHR, which may be developed through future studies to facilitate large-scale early detection and intervention in clinical populations.

PECULIARITIES OF EATING BEHAVIOR IN CHILDREN WITH AUTISTIC SPECTRUM DISORDERS.

The aim: To determine of the nutrition peculiarities in children with ASD. Materials and methods: The study involved 37 children with ASD from 2 -12 years and thier mothers, in according to reveal its disorder effect on the clinical course of ASD in children. Results: It was shown role of irrational nutrition of the mother during pregnancy, peculiarities of family food traditions, problems of breastfeeding and com-plementary feeding. Eating behavior of mothers during pregnancy were: monotonous nutrition and an inadequate diet. The family food preferences were: varied and included both traditional and specific food preferences ( vegan, vegeterian, monotony diet). Conclusions: The analysis of the eating behavior in the ASD children, taking into account the age peculiarities, was carried out. Intolerance to certain products was noted. Also effectiveness of the elimination diet was shown. Elimination from the diet of the white flour products within 6 months has a positive result which evaluated by digestive and cognitive signs.

Nonalcoholic fatty liver disease as an endogenous factor of dysbiosis in the structure of oral microbiome

Objective — to study the dysbiotic impairment on the example of some aggressive periodontopathogens in the oral microbiome of patients with NAFLD.&#x0D; Materials and methods. The study involved 126 patients with NAFLD diagnosis against the background of I — III degrees of obesity or overweight (the main group) and 20 practically healthy subjects with normal body weight without clinical disorders of the digestive system and signs of liver steatosis (control group). All patients underwent investigation of the intestinal microbiota composition at the level of the main phylotypes by identifying total bacterial DNA and DNA of Bacteroidetes, Firmicutes and Actinobacteria by quantitative PCR. The dental examination was carried out according to the standard methods with determination of the OHI‑S hygienic index and periodontal indices. The following physical saliva indicators were evaluated: the salivation rate of unstimulated mixed saliva, viscosity and pH. To determine the periodontopathogens levels, material was collected from the periodontal pockets using paper endodontic absorbers by the real‑time polymerase chain reaction (PCR) method (qRT‑PCR) using universal primers. Determination of the concentration of gingipain K in the oral fluid was carried out by the immunoenzymatic method using the set of reagents.&#x0D; Results. Analysis of the intestinal microbiome (IM) structure demonstrated the presence of a dysbiotic shift in NAFLD patients towards the predominance of the Firmicutes phylotype over Bacteroides (p &lt; 0.01). The level of endotoxemia was significantly higher in patients of the main group (0.9 [0.6; 1.08], p = 0.000) in contrast to the control group (0.43 [0.12; 0.55], p = 0.000). Negative changes in the physical indicators of saliva/ oral fluid in patients of the main group were recorded, namely, a decrease in the rate of salivation and pH (0.26 ± 0.006; 6.46 ± 0.01, respectively) and an increase in viscosity (3.13 ± 0.05). The results’ difference between groups was significant (p = 0.000). The presence of a dysbiotic shift in the econiche‑gingival sulcus in patients of the main group with the prevalence of aggressive periodontopathogens of the first order — Porphyromonas gingivalis (5.49 [3.5; 6.37] LogGE/ mL) and Tannerella forsythia (5.09 [3.65; 6.45] LogGE/ mL) was revealed, which was also characterized by an increase in the level of endotoxin (33.5 [23.8; 52.3]) and gingipain (98.9 [84.2; 128.6]) in oral fluid. In 67.4 % of patients of the main group, periodontal disease of an inflammatory‑destructive nature — chronic periodontitis (CP) was detected. The level of quality of performing oral hygiene at home was unsatisfactory in patients of the main group and was, on average, 2.3 points according to the OHI–S index.&#x0D; Conclusions. The chronic inflammatory process is the basis of the pathogenesis of NAFLD and CP and has a comorbid nature, due to the mutual production of systemically active proinflammatory cytokines and endotoxin. The entry of periodontopathogens of the first order into the intestine biotope from the source of CP against the background of NAFLD and maintenance of a dysbiotic shift in it has isolated confirmation in experiments, but requires further, compatible, in‑depth scientific studies of dentistry and internal medicine.

Impact of COVID-19 on the digestive system: A descriptive cross-sectional study

Background: Various digestive symptoms caused by COVID-19 are frequently reported. This study aims to describe the most frequent digestive signs in patients with COVID-19, the relationship between the severity of digestive symptoms and some serological markers associated with liver manifestation, the detection of SARS-CoV-2 in a stool sample, and the mortality rate of those patients. Materials and Methods: A descriptive cross-sectional study on 100 confirmed COVID-19 cases with digestive and hepatic manifestation in one center (Fallujah Teaching Hospital), Anbar governorate, Iraq, during a period of study. Questioner’s data were formed for all patients regarding age, sex, and comorbidities such as diabetes and hypertension. Liver function enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase, total bilirubin (TBIL), and direct bilirubin and haematological parameters such as ferritin D-dimer, C-reactive protein (CRP), albumin, amylase, leukocyte count, and prothrombin time were used. SARS-CoV-2 prevalence in stool is determined using reverse transcription polymerase chain reaction according to manufacturer’s instructions. The mortality rate of patients with COVID-19 was also determined. Data were followed up until April 22, 2022. Results: Patients with digestive symptoms who had COVID-19 had an average age of 45.03 (SD 20.078), 52 (52%) were men, and 48 (48%) were women. No statistically significant variances were observed in the severity of digestive symptoms among age groups. The three digestive symptoms that patients with COVID-19 experienced most frequently were fatigue, fever, and abdominal colic. SARS-CoV-2 was detected in the stool of 11% of the patients with COVID-19 with digestive signs. The COVID-19 mortality rate was 9%. Statistically, significant variance was observed in ALT (P value 0.01) and TBIL (P value 0.0027) levels between mild, moderate, and severe gastrointestinal (GI) diseases. The levels of CRP varied considerably among those with mild, moderate, and severe GI conditions (P value 0.0182, according to the findings). In mild, moderate, and severe GI disorders, ferritin levels differed considerably (P value 0.05). Conclusions: The faecal sample with a nasopharyngeal swab is needed to confirm COVID-19 diagnosis; hepatic manifestations are connected with increased COVID-19 mortality in individuals with digestive symptoms.

A multicentric prospective observational study of diagnosis and prognosis features in ICU mesenteric ischemia: the DIAGOMI study

BackgroundNon-occlusive mesenteric ischemia (NOMI) is a challenging diagnosis and is associated with extremely high mortality in critically ill patients, particularly due to delayed diagnosis and when complicated by intestinal necrosis. Plasma citrulline and intestinal-fatty acid binding protein (I-FABP) have been proposed as potential biomarkers, but have never been studied prospectively in this setting. We aimed to investigate diagnostic features, the accuracy of plasma citrulline and I-FABP to diagnose NOMI and intestinal necrosis as well as prognosis.MethodsWe conducted a prospective observational study in 3 tertiary ICU centers in consecutive patients with NOMI suspicion defined by at least two inclusion criteria among: new-onset or worsening circulatory failure, gastrointestinal dysfunction, biological signs and CT-scan signs of mesenteric ischemia. Diagnosis features and outcomes were compared according to NOMI, intestinal necrosis or ruled out diagnosis using stringent classification criteria.ResultsDiagnosis of NOMI was suspected in 61 patients and confirmed for 33 patients, with intestinal necrosis occurring in 27 patients. Clinical digestive signs, routine laboratory results and CT signs of mesenteric ischemia did not discriminate intestinal necrosis from ischemia without necrosis. Plasma I-FABP was significantly increased in presence of intestinal necrosis (AUC 0.83 [0.70–0.96]). A threshold of 3114 pg/mL showed a sensitivity of 70% [50–86], specificity of 85% [55–98], a negative predictive value of 58% [36–93] and a positive predictive value 90% [67–96] for intestinal necrosis diagnosis. When intestinal necrosis was present, surgical resection was significantly associated with ICU survival (38.5%), whereas no patient survived without necrosis resection (HR = 0.31 [0.12–0.75], p = 0.01).ConclusionIn critically ill patients with NOMI, intestinal necrosis was associated with extremely high mortality, and increased survival when necrosis resection was performed. Elevated plasma I-FABP was associated with the diagnosis of intestinal necrosis. Further studies are needed to investigate plasma I-FABP and citrulline performance in less severe forms of NOMI.

Multisystemic Inflammatory Syndrome in Children: A Retrospective Study

Introduction: Pediatric Multisystem Inflammatory Syndrome linked to temporal with SARS-Cov2 is a new hyper inflammatory disorder that affects children with Covid-19 infection. It usually occurs 2 to 6 weeks following illness or exposure.&#x0D; Materials and Methods: Descriptive retrospective study of a cohort of 11 patients with MIS-C treated in the pediatric department of the Mohamed V military hospital in Rabat between December 2020 and September 2021. We analyzed the epidemiological, clinical, biological, imaging, therapeutical and evolutionary data of our patients.&#x0D; Results: The average age is 9 years; the sex ratio is 1,2. The average exposure gap is 3.7 weeks. All patients presented with fever with multivisceral involvement, 81% presented digestive signs, 100% mucocutaneous signs, 63% cardiac signs and 54% neurological signs. Inflammatory markers were consistently high. Anemia (91%), neutrophilic leukocytosis (91%), lymphopenia (73%) are constant. The Covid-19 RT-PCR was negative and the SARSCov2 IgG serology testing was positive in all our patients. 54% of our cases have echocardiographic signs. Treatment was based on polyvalent intravenous immunoglobulins (IVIG) in all cases associated with corticosteroid therapy in 45% of cases and antiplatelet therapy in 91% of cases. The outcome was favorable in all of our patients.&#x0D; Conclusion: MIS-C should be considered in children with fever, rash, headache, tachypnea, and gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain. Cardiogenic shock is the main complication. IVIG and systemic corticosteroid therapy are the fundament of treatment.

Diagnostic d’un syndrome inflammatoire multi-systémique pédiatrique associé à la COVID-19

Following the spread of the 2019 coronavirus (COVID-19) pandemic, a new disease entity has emerged, defined as Pediatric Inflammatory Multisystemic Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). The purpose of this article is to detail the approach to establishing the diagnosis of pediatric multisystemic inflammatory syndrome (PIMS). PIMS is a rare and serious condition. This condition needs to be detected early to initiate emergency hospital management. PIMS should be considered in a child presenting with the following warning signs: high fever with marked deterioration in general condition and digestive signs. This syndrome should be considered in children with features of Kawasaki disease (typical or atypical) or toxic shock syndrome or in cases of acute heart failure/acute myocarditis. As this area is rapidly evolving, changes in the coming months are possible; as the pandemic progresses.

Severe Malaria in Adults at the Yalgado Ouédraogo University Hospital of Ouagadougou, Burkina Faso: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects

Aims: To describe the epidemiological, clinical, therapeutic and evolutionary characteristics of severe malaria in adults at the Yalgado Ouédraogo University Hospital from 2004 to 2021.&#x0D; Methodology: This was a cross-sectional study, with retrospective data collection covering the period from January 1, 2004 to December 31, 2021. Patients with severe malaria diagnosed on the basis of clinical and biological signs, with a positive thick blood drop were included.&#x0D; Results: During the study period, a total of 217 cases of severe malaria were recorded, representing a hospital prevalence of 2.1%. The mean age of the patients was 40 years ± 20 with extremes ranging from 18 years to 92 years. Females predominated (52.8%) compared to 47.2% for males, i.e. a sex ratio of 0.89. Thirty percent of the patients lived in urban areas, 24% in semi-urban areas and 46% in rural areas. They were mostly housewives, farmers, pupils or students. Clinically, the functional signs of our patients were dominated by neurological signs, digestive signs and respiratory signs. The physical examination noted a systemic inflammatory response syndrome and multivisceral failure in the majority of patients. Biological disturbances were dominated by renal failure, severe anemia, thrombocytopenia and metabolic acidosis. Comorbidities were dominated by arterial hypertension, HIV infection and diabetes. Under treatment, the evolution was marked by a case fatality of 29.5%.&#x0D; Conclusion: In clinical practice, severe malaria in adults is rare but potentially serious. It is frequently responsible for sepsis associated with multivisceral failure. Its prognosis depends on the rapidity of the diagnosis and the initiation of appropriate treatment.