Etiopathogenic Factors Research Articles

Study of phenolic compounds of umbellate wintergreen herb and their influence on biochemical indicators of blood and urine in the rat model of chronic kidney disease

Diseases of the kidneys and urinary tract are a common problem in people of all ages. Kidneys filter blood, removing water-soluble waste from the body, maintain water-salt balance, stabilize blood pressure and PH level. Intoxication, hypothermia, injuries and other causes lead to problems with the kidneys - inflammatory disease, urolithiasis, etc. Therefore, the development of effective herbal remedies that affect the etiopathogenic factors of diseases is urgent. The aim. Study of the profile of phenolic compounds of umbellate wintergreen, study of antioxidant and nephroprotective properties of umbellate wintergreen extract on the model of chromate-induced renal failure (chronic kidney disease) in rats. Materials and methods. Phenolic compounds were analyzed by high-performance liquid chromatography (HPLC) using a Waters e2695 Alliance HPLC system in combination with a 2998 PDA detector (Waters, Milford, MA, USA). Study of in vitro antioxidant activity by HPLC method for 50 % extract of umbellate wintergreen herb. A Waters 2695 chromatograph (Waters, USA) equipped with a Waters 996 diode-matrix detector was used. To determine the nephroprotective effect, 60 outbred sexually mature rats (males), divided into six groups, were studied. Based on the results of biochemical studies, creatinine clearance and urea clearance were calculated in experimental animals. Results. 8 phenolic compounds - apigenin, hyperoside, quercitrin, rutin, quercetin, gallic acid, guaiaverine and isoquercetin - were identified and quantified in umbellate wintergreen by HPLC. Based on the results of a preliminary assessment of the antioxidant contribution of individual phenolic compounds to the overall effectiveness of the umbellate wintergreen grass extract, a significant effect of caffeic acid derivatives and quercetin was determined. The use of Chimaphila umbellata extract in experimental animals was marked by the normalization of diuresis, a decrease in the total protein content of urine by 1.8 times. The effect of the use of umbellate wintergreen extract was expected to be dose dependent. Conclusions. The profile of umbellate wintergreen phenolic compounds was investigated by HPLC, and their antioxidant effect was determined. In the conditions of the development of renal failure in rats, the studied extract of Chimaphila umbellata improved the physical condition of the animals, reduced their mortality, improved the excretory function of the kidneys, normalized nitrogen and protein metabolism, contributed to the protection of the structure of the kidney tissue, and therefore had a positive effect on the course of nephropathy

A comparative exploration of immunohistochemical markers in patients with papulopustular rosacea undergoing treatment with oral isotretinoin versus doxycycline.

Rosacea is a chronic inflammatory disease, and doxycycline is a widely recommended treatment for it due to its anti-inflammatory action. Oral isotretinoin reduces sebaceous gland activity and modulates toll-like receptors, reducing inflammation. Our aim was to investigate the effect of these two drugs on the expression of cutaneous immunohistochemical biomarkers related to etiopathogenic factors involved in rosacea. We conducted a randomized, comparative, and evaluator-blinded trial, including 40 participants with moderate and severe papulopustular and ocular rosacea. Participants were treated with doxycycline (DOXY) 100 mg or isotretinoin (ISO) 0.3 mg/kg daily. Immunohistochemistry at baseline and after 4 months was used to demonstrate the expression of the biomarker on the affected skin. The following changes were detected: a reduction in the vessel count after using VEGF with DOXY (P = 0.010); a decrease in VEGF intensity with ISO (P < 0.001) and DOXY (P = 0.020); a reduction of nitric oxide synthase enzyme with both drugs in the inflammatory infiltrate (ISO P < 0.001; DOXY P = 0.003); however, only with ISO was there a significant (P = 0.030) decrease at the level of the sebaceous glands, indicating a reduction of nitric oxide synthesis; a reduction of TRPV-1 expression at the level of the sebaceous glands was observed only with DOXY (P = 0.041); a decrease of cathelicidin LL37 expression, a key antimicrobial peptide in the etiopathogenesis of rosacea, was noted with both drugs, although at the level of sebaceous glands, only with DOXY (P = 0.007). Oral isotretinoin and doxycycline have modified the expression of cutaneous biomarkers related to rosacea etiopathogenesis, demonstrating their role in controlling inflammatory and vascular processes.

Analysis of the etiopathogenic factors of lumbar disc disease and kinetic approach to stabilize the somato-functional status

Analysis of the etiopathogenic factors of lumbar disc disease and kinetic approach to stabilize the somato-functional status

Correlations between Etiopathogenic Factors and Persistence on Anti-IL-17 Therapies in Patients with Psoriasis Vulgaris

With recent advances in the understanding of psoriatic disease, it is increasingly considered a systemic inflammatory condition rather than limited to the skin and joints. A variety of biologics are available today for the treatment of psoriasis, but with them, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities differ. We designed an observational, non-interventional, retrospective study of patients with severe psoriasis receiving biologic treatment with IL-17 inhibitors and aimed to investigate the correlations between etiopathogenic factors and the efficacy and persistence of these therapies in a group of psoriasis patients from Romania. Study results show that patients treated with ixekizumab had better persistence and high adherence compared to those treated with secukinumab. In this study, ixekizumab demonstrated lower risks of non-persistence, discontinuation, and switching and a higher likelihood of high adherence compared with secukinumab. This study contributes to the understanding of the persistence of anti-IL17 biologic therapies in psoriasis and the factors that may influence it.

Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches.

This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.

Prevalence of Malocclusions among Schoolchildren from Southwestern Romania.

Malocclusions have a continuously increasing prevalence from one generation to another as a result of climate change, soil, atmosphere, and water pollution. All of these aspects have unfavorable consequences for the nutritional scheme. Thus, nutrition, together with other etiopathogenic factors, contributes to complex alterations in the somatic development of the entire organism and, implicitly, of the cephalic extremity. The study group included 4147 children from randomly selected schools from Vâlcea County, Romania. The aim of this study is to determine the prevalence of malocclusions in schoolchildren in Vâlcea County, Romania, according to the three main classes of malocclusions (according to Angle's classification), age groups (from 6 to 10 years old and from 11 to 14 years old), gender (male and female), and place of origin (rural and urban). For Angle class I malocclusions, we recorded the highest prevalence (48.78% of the total number of schoolchildren with malocclusions), followed by Angle class II malocclusions (45.85% of the total number of schoolchildren with malocclusions), and for Angle class III malocclusions we found the lowest prevalence (5.37% of the total number of schoolchildren with malocclusions). According to gender, we found the highest prevalence in the female gender (29.90% of the total number of female subjects), while in the male gender, we recorded a prevalence of 27.70% of the total number of male subjects. Regarding the place of origin, there is a higher prevalence of malocclusions in urban areas (29.16%). The study subgroup included 140 children randomly selected from the total number of subjects in the study group. They were included in a more advanced study. The aim is to find potential associations between the presence of malocclusions and various oral variables. Categorical variables were expressed as numerical values and percentages, and their association was evaluated with either the Chi-square test of association or homogeneity, or the Fisher Exact test. The acquired data were incorporated into a binomial logistic regression model to assess the likelihood of developing malocclusions in relation to the following variables: defective phonation, bruxism, frequency of teeth brushing, onychophagia, oral respiration, infantile deglutition, placing objects between the maxillaries, thumb sucking, and salivary aspects. It is also aimed at comparing the results obtained with similar ones from the specialized literature.

Putative Roles and Therapeutic Potential of the Chaperone System in Amyotrophic Lateral Sclerosis and Multiple Sclerosis.

The putative pathogenic roles and therapeutic potential of the chaperone system (CS) in amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are reviewed to provide a bibliographic and conceptual platform for launching research on the diagnostic and therapeutic applications of CS components. Various studies suggest that dysfunction of the CS contributes to the pathogenesis of ALS and MS, and here, we identify some of the implicated CS members. The physiology and pathophysiology of the CS members can be properly understood if they are studied or experimentally or clinically manipulated for diagnostic or therapeutic purposes, bearing in mind that they belong to a physiological system with multiple interacting and dynamic components, widespread throughout the body, intra- and extracellularly. Molecular chaperones, some called heat shock protein (Hsp), are the chief components of the CS, whose canonical functions are cytoprotective. However, abnormal chaperones can be etiopathogenic factors in a wide range of disorders, chaperonopathies, including ALS and MS, according to the data reviewed. Chaperones typically form teams, and these build functional networks to maintain protein homeostasis, the canonical role of the CS. However, members of the CS also display non-canonical functions unrelated to protein homeostasis. Therefore, chaperones and other members of the CS, if abnormal, may disturb not only protein synthesis, maturation, and migration but also other physiological processes. Thus, in elucidating the role of CS components in ALS and MS, one must look at protein homeostasis abnormalities and beyond, following the clues emerging from the works discussed here.

Does Basal Metabolism Really Influence the Prognosis of Childhood Obesity?

Childhood obesity is one of the greatest social and health problems of the 21st century. Exogenous obesity consists in the pathological increase in body mass due to the imbalance between caloric intake and expenditure. Different studies and preventive protocols have been carried out with the aim of solving this health problem. Likewise, different etiopathogenic factors such as metabolism and various diagnostic methods such as bioelectrical impedance, have been described. The hypothesis is based on the assumption that a low basal metabolic rate in the context of a caloric imbalance could lead to an increase in the incidence of exogenous or primary obesity with an increase in fat mass. The objectives of the study are to carry out an epidemiological description of the variables of the database obtained on childhood obesity from the clinic. To investigate whether there is an inversely proportional relationship between basal metabolism and a patient’s fat mass. To check if there are differences between sex and age of the patients with respect to the variables under study (basal metabolism and fat mass). To analyse whether there is a directly proportional relationship between basal metabolism and lean mass. To investigate whether there are differences in basal metabolic rate between patients according to sex and whether there are differences in fat mass between patients according to sex. To determine whether there are differences in basal metabolism between patients according to age (7-10 years and 11-14 years) and whether there are differences in fat mass between patients according to age (7-10 years and 11-14 years). To stipulate whether patients with early detection (age range: 7-10 years) and late detection (age range: 11-14 years) of childhood obesity can have a better evolution in fat mass. Material and methods: A total of 19 articles were used as bibliographic references, obtained from different digital sources such as ScienceDirect, CNN, La Vanguardia, SciELO and Pubmed, and from organizations such as the Basque Government and the University of Cantabria Library. In addition, the certificate of authorization for the epidemiological exploitation of the OSI Araba database (code 01/2019) has been obtained. Excel and SPSS Stadistics 29.0.2.0 were used to perform the statistical analysis. Conclusion: An epidemiological description of the variables of the database obtained on childhood obesity from the clinic has been carried out. An inversely proportional relationship between basal metabolism and fat mass in a patient has not been found. There is no directly proportional relationship between basal metabolism and lean mass. Differences in basal metabolism between patients according to sex are described. There are no differences in fat mass between patients according to sex. There are differences in basal metabolism between patients according to age (7-10 years and 11-14 years). No differences in fat mass between patients according to age (7-10 years and 11-14 years) were described. Patients with early detection (age range: 7-10 years) and late detection (age range: 11-14 years) of childhood obesity have a better evolution in fat mass.

Portal thrombosis after surgical treatment of schistosomatic portal hypertension.

Several studies have investigated the correlation between the effects of different surgical treatments and laboratory exams for schistosomal portal hypertension, especially concerning portal system thrombosis. The etiopathogenic factors of this thrombosis are not fully understood. In this study, the correlation between surgical treatment for schistosomal portal hypertension and the occurrence of postoperative portal system thrombosis was investigated. A total of 61 patients who underwent surgical treatment for schistosomal portal hypertension were distributed into four groups: Patients in Group 1 (n=12) underwent portal variceal disconnection associated with splenic artery ligation and spleen preservation. Patients in Group 2 (n=20) underwent portal variceal disconnection and total splenectomy. Patients in Group 3 (n=20) underwent portal variceal disconnection with subtotal splenectomy, preserving the upper splenic pole supplied by the splenogastric vessels. Patients in Group 4 (n=9) underwent portal variceal disconnection with total splenectomy and autogenous splenic implants on the greater omentum. Late postoperative portal vein thrombosis was diagnosed using Doppler ultrasound. Over the 10-year follow-up, portal vein thrombosis occurred in 26 operated patients (42.6%), with no significant difference observed among the four surgical groups (p=0.217). Most of the thrombi only partially occluded the portal system veins. All the patients presented with a thrombus inside the portal vein. There was no difference in hematological and biochemical tests between groups with or without portal vein thrombosis. Portal vein thrombosis is often observed in the late postoperative period, irrespective of the surgical treatment employed, and is not associated with patient characteristics or any hematological and biochemical tests.

Postoperative Cardiac Arrhythmias in Pediatric and Neonatal Patients with Congenital Heart Disease-A Narrative Review.

Cardiac arrhythmias are a frequent complication in the evolution of patients with congenital heart disease. Corrective surgery for these malformations is an additional predisposition to the appearance of arrhythmias. Several factors related to the patient, as well as to the therapeutic management, are involved in the etiopathogenesis of cardiac arrhythmias occurring post-operatively. The risk of arrhythmias in the immediate postoperative period is correlated with the patient's young age and low weight at surgery. The change in heart geometry, hemodynamic stress, and post-surgical scars represent the main etiopathogenic factors that can contribute to the occurrence of cardiac arrhythmias in the population of patients with operated-on congenital heart malformations. Clinical manifestations differ depending on the duration of the arrhythmia, underlying structural defects, hemodynamic conditions, and comorbidities. The accurate diagnosis and the establishment of specific management options strongly influence the morbidity and mortality associated with arrhythmias. As such, identifying the risk factors for the occurrence of cardiac arrhythmias in the case of each patient is essential to establish a specific follow-up and management plan to improve the life expectancy and quality of life of children.

Work-Related Hand Eczema in Healthcare Workers: Etiopathogenic Factors, Clinical Features, and Skin Care

Work-related skin conditions, including work-related irritant and allergic contact dermatitis, rank as the second most prevalent among work-related diseases. The most commonly reported manifestation of these conditions is hand eczema, which develops due to exposure to various substances in the workplace. Understanding the origins and triggers of eczema and contact dermatitis enables healthcare professionals to educate themselves and their patients about effective preventive measures, such as avoiding specific irritants and allergens, using protective equipment, and maintaining proper skincare hygiene. Additionally, this knowledge facilitates the development of new recommendations to enhance skin protection in work-related settings, regulate the use of substances known to cause work-related skin diseases, and provide healthcare practitioners with the necessary training to recognize and manage these conditions. Given that approximately one in every five healthcare workers is considered to have hand eczema, the objective of this study was to review the existing literature regarding the characteristics of eczema in healthcare workers. Furthermore, this study aimed to comprehensively investigate environmental and constitutional factors (including years of work experience involving exposure to skin hazards, frequent glove use, regular handwashing and water contact, frequent use of disinfectants and detergents, and a history of previous allergies and atopic dermatitis) that influence the occurrence and progression of eczema.

Correlations between Immune Response and Etiopathogenic Factors of Medication-Related Osteonecrosis of the Jaw in Cancer Patients Treated with Zoledronic Acid.

Impairment of the immune response in MRONJ (medication-related osteonecrosis of the jaws) is one of the still unclear etiopathogenic mechanisms of this condition encountered in cancer patients treated with bisphosphonates, with negative effects on the patient's quality of life. The aim of the present study was to correlate the immune response with etiopathogenic factors via immunohistochemical evaluation of the maxillary tissues in zoledronic acid osteonecrosis. The retrospective study included a group of 51 patients with various types of cancers, diagnosed with stage 2 or 3 MRONJ at zoledronic acid and treated surgically. Immunohistochemical expressions of αSMA, CD3, CD4, CD8, CD20, CD79α, CD68, CD204, and tryptase were evaluated. Immunohistochemical markers expressions were statistically analyzed according to the duration of the treatment, the trigger factor, the location of the MRONJ, and the healing status. Analysis of the immune response included T lymphocytes, B lymphocytes, plasma cells, macrophages, and mast cells. The duration of treatment significantly influenced the immunohistochemical expression of most markers (p < 0.05). For an increasing trend in treatment duration, a decreasing trend in marker score was observed, suggesting an inverse correlation. The expression of the markers was different depending on the trigger factor, on MRONJ localization (maxilla/mandible), and the healing status, being more intense in patients cured per primam compared to those who had relapses. The patient's immune response was negatively influenced by the duration of the treatment, the trigger factor, the location of the lesion in the mandible, and the recurrence of MRONJ.

LOCALISED JUVENILE SPONGIOTIC GINGIVAL HYPERPLASIA: A RARE CASE REPORT

Juvenile spongiotic gingival hyperplasia is a benign lesion was first described by Darling and Cols in 2007.Various etiopathogenic factors have been proposed for its presentation. It is characterized by being in the anterior attached gingiva of the maxilla, clinically can be appreciated as macular or elevated, with a papillary, granular, or smooth surface, bright red in color, and its presentation can be localized or generalized. It is an asymptomatic entity and is not associated with biofilm-induced inflammation. It is important for the dentist to recognize this entity and to make the different differential diagnosis and propose proper diagnosis and treatment planning.

From Newtonian Concepts To A Quantum Understanding: The Evolution Of Endocrinology And Metabolism.

Conventional endocrinology is based upon linear or Newtonian feedback mechanisms. Thisframework helpsin learning and sharing science in a lucid and simple manner, just as Newton's Laws clarified our understanding of physics. Modern endocrinology and metabolism are more confusing, as exemplified by the multifarious etiopathogenic factors that continue to be unearthed for various diseases, such as obesity and diabetes. These diseasestend to follow a modelsimilar to that of quantum physics. We propose a Quantum theory of baro-mechanics to help understand the complexity that surrounds metabolic disease, especially obesity. Hopefully, thisinsight will help mitigate the frustration that one encounters while managing these conditions.

A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management.

Dermatological disorders are among the most prevalent manifestations of HIV infection/acquired immunodeficiency syndrome (AIDS). In this review, we aimed to characterize the various dermatologic presentations among HIV-infected patients with a detailed categorization of the mucocutaneous signs and symptoms, their etiopathogenic factors, and clinical management. In fact, cutaneous manifestations of HIV are quite various, ranging from AIDS-specific skin eruptions (xerosis, pruritic papular eruptions, eosinophilic folliculitis, and acne), opportunistic infections (herpes simplex, molluscum contagiosum, cutaneous leishmaniasis, bacillary angiomatosis, disseminated histoplasmosis, disseminated cryptococcosis, and zoster) to AIDS-related malignancies (Kaposi's sarcoma, lymphoma, and nonmelanoma skin cancers) and antiretroviral therapy (ART)-associated drug eruptions. We tried to classify HIV-related cutaneous presentations which can help clinicians for a better understanding of the various specific and nonspecific features of AIDS-associated cutaneous manifestations and management of the condition.

Some notes on the phenomenology of psychological disorders: from the birth of Freudian psychoanalysis to the possible contribution of multiple etiopathogenic factors

ABSTRACT In this contribution, the author explores the shift from viewing psychological issues as ‘psychic pathology’ to adopting a perspective of ‘pathological psychology’. This transition underscores the need to consider the intricate interplay between individual and environmental factors in the development of psychological disorders. The author emphasizes the importance of understanding mental illness as a result of complex interactions and disruptions in equilibrium. Alongside neurobiological influences, life experiences and the environment also wield a pivotal role. A clinical case of a four-session-a week psychoanalysis illustrates the significance of the environment. This case highlights how the interplay between internal and relational-environmental factors is crucial not only in understanding symptoms but also in the interpretive process.

Assessment of tumoral and peritumoral inflammatory reaction in cutaneous malignant melanomas.

Skin cancer is one of the most common types of cancer, with an increasing worldwide incidence in recent decades. The main risk factor for increasing the skin cancer incidence is ultraviolet (UV) radiation. Of the two major forms of skin cancer (melanomas and non-melanotic cancers), the cutaneous melanoma (CM) is the most aggressive form, causing about 80% of the deaths resulted from this type of tumor. Malignant melanoma develops through malignant transformation of melanocytes in the skin because of prolonged exposure to solar or artificial UV. The malignant transformation of the melanocytes in the skin is accompanied by the presence of a local inflammatory reaction that, in the initial stages of carcinogenesis, would oppose to tumor development. Chronic exposure to UV or other etiopathogenic factors induces chronic inflammation, which, by producing inflammatory molecules (cytokines, chemokines, prostaglandins), constitutes a tumoral microenvironment that favors carcinogenesis, tumor invasion, metastasis, and the presence of neoplastic "mutant cells" that avoid the protective action of the immune system. Using immunohistochemistry techniques, we assessed the intra- and peritumoral inflammatory infiltrate cells in CM. The chronic inflammatory infiltrate presented more intense in the peritumoral stroma compared to the intratumoral one, heterogenous, more intensely composed of lymphocytes, plasma cells, macrophages, and mast cells (MCs), the most numerous cells in the inflammatory infiltrate being T-lymphocytes, plasma cells and macrophages; B-lymphocytes and MCs were in a small number, especially intratumorally. Inflammatory cells had a direct contact with tumor cells, blood vessels, connective matrix, suggesting that the inflammatory microenvironment plays an important role in carcinogenesis, tumor invasion, local angiogenesis, and tumor metastasis.

A CASE OF SYSTEMIC SCLEROSIS SINE SCLERODERMA

Systemic sclerosis is an uncommon connective tissue disorder with multisystem involvement, heterogenous clinical manifestations and have a chronic, progressive course. Autoimmune damage, vasculopathy and extensive brosis are the key etiopathogenic factors. Patients have clinical manifestations ranging from skin thickening limited to distal extremities/face to widespread multiorgan involvement. All typical features of systemic sclerosis without skin thickening is dened as SYSTEMIC SCLEROSIS SINE SCLREODERMA Case presentation: We report a case of A 40 year old female patient presented to us with the chief complaints of ulcers at the tip of right index and middle ngers associated with pain and swelling over a period of 10 days.Past history of amputation of left distal phalanx 1year back for similar complaint. She had a history suggestive of Reynaud's phenomenon. She was diagnosed as hypothyroid 5 years back with irregular treatment and with GERD 2ys back. CT CHEST-bilateral ground glass opacities,Paratracheal lymphadenopathy,Mild thyromegaly ,Mild dilatation of oesophagus,COLOUR DOPPLER-Right upper limb -normal study ,ANA PROFILE -Anti scl -70 –positive ,Anti jo 1- borderline positive Systemic sclerosis sine scleroderma (ssSSc) is an CONCLUSION : infrequent SSc variant characterized by visceral and immunological manifestations of SSc in the absence of clinically detectable skin involvement with good prognosis compared to other variants

Dispositifs thérapeutiques à l’épreuve du dialogue entre réalité neurologique et réalité psychique

ObjectivesClinical work with brain injuries (stroke, traumatic brain injury, tumor…) raises thorny questions from epistemological, clinical, and therapeutic points of view. The organization of a therapeutic setting for rehabilitation purposes often requires setting targeted objectives, but it is equally concerned with the patients and their psychical functioning as a whole. If the emphasis placed on the rehabilitation of disorders and deficits is important, the need to resist sacrificing the patient's psychical reality on the altar of the stimulation of cognitive functions, and of adaptive and performative concerns, remains a major clinical and ethical issue. MethodBased on their clinical experiences in neuropsychological rehabilitation, in private practice, and in psychotherapy in a rehabilitation department, the authors show how they were challenged by the movements inherent to therapeutic settings, seized by the singular psychical reality of their patients. Indeed, their lives disrupted by the experience of cerebral damage, as well as somatic and cognitive disorders, these patients are also confronted with the constraints of the setting of the rehabilitation work, with expectations in terms of efforts to be made, performances to be achieved, etc. At the same time, these patients are put to work both by the way their psychical reality is disturbed by this new and often unexpected event and by the way it deals with the trauma. Analyzing the changes observed in patients during rehabilitation or psychoanalytical psychotherapy sessions, the authors discern the way in which these different realities may collide, respond to each other, combine. ResultsThe diversity of the clinical situations shows how the present and material dimension of the trauma is not enough to account for the patients’ states of psychical suffering which may lead them, despite their good will, to mobilize behaviors of manifest opposition (aggressiveness) or latent opposition (depression) that interfere with the setting and the rehabilitation objectives. Indeed, the remobilization of past, unconscious psychical conflicts, linked to experiences of powerlessness, dependence, mastery, abandonment, plays a nodal role in the development of the therapeutic plan. These deferred actions make it possible to understand how cognitive difficulties are not reducible to neurological damage, and may be aggravated by the psychical conflicts reactivated during the proposed treatments. The reality of an accidental event meets the effects of internal motivations which may, unbeknownst to the patients, question their potential implication in the accident. Thus, clinicians can discover to what extent the neurological issue reinforces the psychical resistance to the potentialities of change and psychical elaboration, and vice versa. If not considered nor put to work, these psychical issues and defenses can constitute obstacles to the quality of the cognitive rehabilitation plan, to the rehabilitation of self-esteem, and even to the re-establishment of mental health. DiscussionCognitive disorders of cerebral origin encounter a psychical reality that is always singular, full of fragilities and resources. Only listening to the patients allows us to grasp what is bruised and revived in their psychical reality. This listening highlights the importance of a dialogue between neuropsychology and psychoanalysis, which cannot be totally separated from each other in a clinical context. Their combined perspectives allow the overcoming of a monolithic vision of the etiopathogenic factors and guarantee that the patient's subjectivity is taken into consideration. This is how therapeutic settings, challenged by the complexity of the patients’ cognitive and psychical functioning, allow the latter to put themselves to work by mobilizing a mental activity where both the cognitive disorders and the psychical processes treating anxiety and depression in particular are expressed. Thanks to their ability to use their psychical processes of elaboration of the trauma, the patients can soften their defenses and their resistances, thereby mobilizing themselves for the exercises of rehabilitation that remain necessary. ConclusionsAlthough different, and sometimes in disagreement, psychoanalysis and neuropsychology have as common object the singularity of each patient. The possibility of a dialogue allowing for a listening to the psychical causality while taking note of the brain injuries underlying the cognitive disorders proves to be a precious condition of clinicians’ capacity to accompany their patients in their torments and paradoxes. The quality of the care offered to these men and women, whose bodies and psyches have been damaged, depends on it: interdisciplinary dialogue within the same therapist or between two therapists is based on an alliance of theoretical and clinical rigor and flexibility, whatever the proposed setting.

PS-C30-13: GESTATIONAL HYPERTENSION AND PERIPARTUM CARDIOMYOPATHY: EPIDEMIOLOGICAL, CLINICAL AND EVOLUTIONARY PROFILE IN THE REFERENCE HOSPITALS OF YAOUNDE

Background: Peripartum cardiomyopathy (PPCM) is a primary dilated cardiomyopathy responsible for congestive heart failure that occurs in the last two months of pregnancy or during the first five months of postpartum. It is a rare pathology with unknown etiologies. Nevertheless, several etiopathogenic factors such as an history of gestational hypertension, black race, multiparity and poverty have been incriminated. However, the epidemiological and clinical data on peripartum cardiomyopathy are little known in Cameroon, thus justifying our descriptive study. Methodology: We carried out a prospective descriptive study over a period of six months. It was conducted in six reference hospitals in Yaounde. The study population was made of pregnant women with dyspnoea and women who had given birth with dyspnoea. Were included all pregnant or postpartum women (from the 32nd WA to the 5th months of postpartum) who had a LVEF &lt; 45% and/or a SF &lt; 30% associated or not with left ventricle dilation. They were placed on treatment with a follow-up over 3 months, where they had a second cardiac ultrasound to highlight the evolutionary profile. Results: We enrolled 10 patients from 26 women who were pregnant or had given birth and presented with dyspnoea within 6 months. The average age was 25.9 ± 4.9 years (range: 16–33 years). The average parity was 1.6 ± 1.17 (extreme 0–3). Multiparas were the most represented. The history of gestational hypertension was the main predisposing factor found (50%); followed by multiparity (30%), the notion of twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. Sinus tachycardia was constant; followed by signs of left ventricular hypertrophy and repolarization disorders on ECG assessment. The echocardiographic pattern depicted a hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with an average systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary edema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and one death (10%). The treatment mostly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of the patients) without forgetting the anticoagulation made with Rivaroxaban(n = 4) for some and aspirin (n = 6); and bromocriptine (initiated in 3 patients). Conclusion: PPCM is a cause of heart failure during pregnancy. It primarily arises during the postpartum period regardless of maternal age. It is a serious disease due to its (important morbi-mortality rate) and its complications, both hemodynamic and thromboembolic.\