Dr. Aicha Telmoudi, Dr. Rahma Guessmi and Dr. Zohra Sassi Jallali
Introduction: Baclofen is a structural analogue of Gamma-Aminobutyric Acid (GABA), which is the main inhibitory neurotransmitter of the central nervous system responsible for muscle relaxation. It is prescribed mainly in the symptomatic treatment of spastic contractures of cerebral origin and muscle spasticity occurring in spinal cord diseases. Baclofen toxicity has been described in the literature. The dose responsible varies according to the studies. Renal failure is a risk factor for the occurrence of baclofen toxicity. Materials and methods: Our case is an adult with chronic renal failure with a renal clearance of 16.5 ml/min who had accidental baclofen intoxication due to the mistaken taking of an inadequate dose of 60 g/day. Results: Mr. F.M., 52 years old, with a history of neurological bladder and chronic renal failure caused by chronic interstitial nephritis with renal clearance of 16 ml/min. The patient consulted with neurological disorders consisting of agitation, hallucinations and incoherent speech in context of apyrexia with the notion of a generalized tonic clonic seizure at home. Blood pressure was 112/70 mm Hg, pulse 79/min, temperature 37.1Â ℃ and arterial oxygen saturation on ambient air at 98%. There was no focal neurological deficit. Biological investigations showed: Blood glucose at 1 g/l, natremia at 135 mmol/l, HCO3 at 23 mmol/l, calcemia at 2.3 mmol/l, blood urea at 16 mmol/l, renal clearance at 16.5 ml/min and liver function tests (including transaminases, albumin, bilirubin and serum ammonia) were normal. The brain scan returned without anomalies. The resumption of the questioning allowed the diagnosis of baclofen toxicity, recently prescribed, to be retained, due to the mistaken taking of a dose of 60 mg instead of 15 mg per day for seven days. The patient benefited from four daily and prolonged hemodialysis sessions with progressive improvement until the neurological signs disappeared. The time for complete disappearance of the neurological signs of baclofen toxicity is seven days. Discussion: Baclofen is a gamma amino butyric acid receptor agonist of the nervous system prescribed for the treatment of neurological muscle spasticity. The clinical signs of toxicity are mainly due to depression of the central nervous system. It is eliminated mainly by the kidney, hence the importance of monitoring renal function. Severe forms of toxicity may involve acute renal failure, respiratory depression or a comatose state. Treatment is symptomatic in the absence of a specific antidote. Renal failure justifies hemodialysis. A comatose state requires hospitalization in intensive care and mechanical ventilation.
Moussa Diongole H*, Garba Abdoul Aziz, Moussa T. Zeinabou M, Seriba C. Idrissa, Dabo Ali S, Hanahi Z. Assoumane, Laouali Chaibou, Abdou Aliyu and Atanda Akinfenwa
Introduction: Nephrotic Syndrome (NS) is a common reason for consultation in nephrology, particularly in Niger. Kidney biopsy is an essential tool for the diagnosis and assessment of the prognosis of renal diseases especially those with nephrotic syndrome. Histological characterization allows for specific treatment to be instituted, thus facilitating better management of patients. However, there is paucity of reports from this part of the world. Our study aims to describe the histopathological aspects of nephrotic syndrome at the National Hospital of Zinder.
Methods: This was a descriptive cross-sectional study that took place over a 4-year period (between January 1, 2020 and August 31, 2023) in the Nephrology Department of the National Hospital of Zinder. Patients with NS who consented and had no contraindications underwent kidney biopsy following standard department protocol.
Results: We studied 62 patients over the study period. The mean age of the patients was 31.4 ± 16.56 years and age range of 15 and 34 years. The sex ratio was 1.81 in favor of men. The main medical history of the patients was arterial hypertension 33.87% of cases. The mean 24-hour proteinuria was 5.56 ± 3.33 g/24 h. The average number of glomeruli per biopsy core was 9 ± 6 with a range of 2 and 32. The histopathological lesions found were: Focal Segmental Glomerulosclerosis (FSGS) (25.81%), Membranoproliferative Glomerulonephritis (MPGN) (20.97%), MGL (19.35%), lupus GN (6.45%), GNA (3.23%), diabetic nephropathy (3.23%) and extra membranous glomerulonephritis EMG (2.6%).
Mustafa Jamal Ahmed*, Omer Ali, Mohamed H. Hassan, Ali AlSahow, Anas Al-Yousef, Nuria S. Perez Romano, Dawood Al Riyami, Hormaz Dastoor, Wafa A. Altuwaijri, Muhammad Ubaid Ullah and Mohammed Alshehri
Autosomal Dominant Polycystic Kidney Disease (ADPKD) constitutes one of the most common hereditary renal disorders, characterized by progressive cystic enlargement and a subsequent decline in renal function. Although the condition presents a significant health burden in regions with high rates of consanguinity, such as the Gulf Cooperation Council (GCC) and the Middle East and North Africa (MENA), comprehensive regional data on its prevalence, diagnosis and management remain limited. Tolvaptan, a selective antagonist of the vasopressin V2 receptor, is presently the sole disease-modifying therapy approved for decelerating the progression of ADPKD. This review is based on the synthesis of current literature amalgamated with the opinions of nephrologists (from the Kingdom of Saudi Arabia, Kuwait, Oman, Bahrain and the United Arab Emirates) convened to develop guidance on the utilization of Tolvaptan in ADPKD across the GCC/MENA region. The panel underscored the significance of establishing national and regional registries, deploying standardized imaging and diagnostic protocols, expanding access to genetic testing and counseling and ensuring the safe administration of Tolvaptan during Ramadan fasting. This review aims to bridge the gap between evidence and clinical practice, providing a structured framework to guide clinicians, facilitate early diagnosis and enhance therapeutic approaches for ADPKD patients throughout the GCC and MENA regions.
Njla Yehya Elhaj Wardgo
Introduction: Streptomycin is a first aminoglycoside synthesized as products of Streptomyces griseus and is inhibitor of protein synthesis. The resistant mutants obtained in vitro have abnormal ribosomes. In few clinical strains of staphylococcus aureus there is some evidence for plasmid locus or gene determining streptomycin resistance (ayliffe, 1970; grub band and oreilly,1971). The mechanism of resistance is uncertain. Since ancient time, naturally occurring plants have played an important role in the discovery of new therapeutic agents. Almost all antibiotics are subjected to the problem of bacterial resistance. Garlic (allium sativum Linn) has an important dietary and medicinal rule for centuries. Its typically pungent odor and bacterial activity depend on allicin, allicin, one of the active principles of freshly crushed garlic homogenates, has variety of antimicrobial activity.
Methods: Garlic powder was purchased from local market. The 70% of ethanol was prepared. Bacterial strain was inoculated on sterile nutrient broth and incubated at 37c for 24 h. Each culture was swabbed on the surface of sterile nutrient agar plate in duplicate. Standard streptomycin with different concentration was added.
Result: Mean zone of inhibition was expressed and compared with the control. The findings of this study reveal the distinct antibacterial profile of Allium sativum Linn. Solely and in streptomycin synergism against streptomycin-resistant S. aureus. Staphylococcus is a gram positive aerobic and nonaerobic, immobile. It is a catalase positive, and capable of mannitol fermentation. S. aureus is very sensitive to alcoholic extract. The antimicrobial activity of garlic is depending on allicin compound, which is more effective on gram positive bacteria much more than gram negative. Allicin is very important compound that create the antibacterial properties and limit the speed of RNA synthesis. Use of garlic extract solely is fruitful. Synergistic use can prevent the pathogenic organism grow their resistance against antibiotic.
Anfal Nasreldin Bagal Serag
Introduction: Surgical site infections coincide and contribute to healthcare associated infections, therefore the definition of surgical site infections (SSIs) referred to infections that occur in the wound created by an invasive surgical procedure which were one of the most important causes of healthcare-associated infections (HCAIs). S. aureus, E. coli, P. aeruginosa, Klebsiella spp., etc. Gram positive bacteria were found to be more predominant in the postoperative wound samples compared to the Gram-negative organisms. Staphylococcus aureus, Escherichia coli were multidrug resistant (Chaudhary et al, 2017). Surgical Site Infection has been increased over the past few years. World Health Organization (WHO) documented that 66% of establishing countries have no imprinted data related to the burden of SSI and the data based on the surgical prophylaxis is insufficient. However, good quality of the microbiology laboratory practice is important, in Sudan, while searching in literature there no researches to date on this topic of laboratory diagnosis for surgical and nosocomial infections monitoring antibiotic resistance. In Alfasher, however, patients suffer from post-surgical infections and good quality in microbiology laboratory practice is mandatory. However, there will be no good laboratory practice without excellence in quality and professionalism. This study was proposed to apply quality in the medical microbiology laboratory using proper isolation system, culture for microorganisms, antibiotics sensitivity testing and DNA sequencing for bacteria resistant to antibiotics in surgical site infection.
Methods: We evaluated this study by using Molecular techniques in Microbiology laboratory, Bacterial DNA prepared for PCR according to the standard method. DNA concentration was determined using spectrophotometer, Antimicrobial susceptibility testing was performed by applying the agar diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations, Standard quality Measures, such as standard operation procedures, quality of environment, the Statistical Package for the Social Sciences (SPSS) is a software package used in statistical analysis of data.
Result: In total, 80 resistant isolates (18 Gram positive and 62 Gram negative). All S. aureus isolates were resistant to both penicillin and oxacillin. K. pneumoniae isolates were resistant to carbapenems. The molecular screening of carbanemase genes was based on a previously published multiplex PCR technique. Recent studies show that not only bacteria, but also bacterial genes can move freely among humans, animals and the environment (Oliveira P.H., et al, 2007). In our study the resistant Gram-negative rods (GNR) were a common finding, confirming their increased prevalence in hospital-associated drug-resistant infections. In conclusion, our results demonstrated the presence of important clinical pathogens in patients with post-surgical nosocomial infection, which are likely to be released in the environment
Mona Timan Idriss Gassab
Background: Influenza virus is a major public health and its control continues to be a challenge. One of the possible sources of anti-influenza active agents might be Rooibos teas (RT), with various pharmacological actions.
Methods: We searched for anti-influenza activity using standard in vitro antiviral assays such as Inhibition of virus induced cytopathic effect (CPE) assay, inhibition of viral plaques, and hemagglutination assay. Time-of-addition assay was performed to target an event in the virus life cycle.
Results: RT crude extract showed anti-influenza activity and the 50% effective inhibitory concentration (CC50) was 4%, while IC50 for A/WSN/33 was 0.13%, when they were measured with both Crystal violet and Water-soluble tetrazolium salt (WST-1) assays. The virus-induced cytopathic effects were thus significantly reduced. Plaque assays demonstrated that RT extracts reduced virus infectivity markedly in dose dependent manner, when the viruses were treated with RT extract before exposure and post exposure to MDCK cells. In contrast, pretreatment of MDCK cells with RT extracts before influenza virus infection did not affect virus infectivity. The inhibitory effect of RT extract was observed against influenza A/PR/8/34 (H1N1), A/WSN/33 and A/HK/8/68 (H3N2) and influenza B. Our results suggest that RT extract contains anti-influenza virus substances that directly affects influenza virus particles and disrupts the function of virus adsorption to host cells.
Conclusions: These results have exposed the capability of the extracted RT for strongly inhibit influenza virus replication and offers an opportunity for the development of a new anti-influenza virus agent.
Journal of Nephrology & Therapeutics received 784 citations as per Google Scholar report
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