Epidemiological, clinical and evolutionary aspects of hypotrophic newborns at term at the Mother and Child University Hospital of N'Djamena

Introduction: Hypotrophy is a public health problem in developing countries. Its etiology is multifactorial and it may be associated with high morbidity and mortality. The objective of this study was to describe the epidemiological, clinical and evolutionary profile of hypotrophic newborns at term. Methodology: this was a prospective, descriptive and analytical study conducted in the neonatology department of the MCUH of N'Djamena from 01/06/2018 to 31/05/2019. It involved 109 hypotrophic newborns at term hospitalized. Results: The frequency of hypotrophy was 7.8%, the risk factors were: housewife status (81.7%), low level of education (67%), poor pregnancy follow-up (59.7%), malaria (40.4%), urogenital infections (22%) and anemia (22%) during pregnancy. Hypotrophy was harmonious in 58.7% of cases, the sex ratio was 1.14 and visible congenital malformations were observed in 12.7% of cases. The main reasons for hospitalization were neonatal infections (64.2%), perinatal asphyxia (14.7%) and hypothermia (11.9%). Lethality was 16.5% and associated with multiparity, poor pregnancy follow-up, vaginal delivery, home delivery, pathological Apgar score, notion of resuscitation, existence of malformation, respiratory distress and perinatal asphyxia. Conclusion: Better monitoring of pregnancy, use of family planning by couples, delivery in an institutionalized setting, and reinforcement of the technical platform of the neonatology department will reduce neonatal morbidity and mortality related to hypotrophy.

Comparison of laboratory diagnostic methods for urogenital infections caused by Chlamydia trachomatis

According to the Russian-Swedish project there was performed a comparison of methods used for Chlamydia trachomatis detection in cervical samples, obtained from 397women and urethral samples from 253 men. All specimens were examined by direct immunofluorescence (DIF), polymerase chain reaction (PCR) and cell culture (CC). In high-prevalence group (group I) chlamydiae were detected in 17,8% and 28,0% of cases in men and women, respectively. Ingroup II containing patients who were subjected to screening examination, chlamydiae were found in 5% of cases both in men and women. PCR was shown to be the most sensitive when cervical samples in group I and cervical and urethral samples in group II were investigated. When urethral samples in group I were tested, DIF proved to have the highest sensitivity. All the methods used were found to be high specific. The search for standards of genital chlamydial infection diagnosis is in progress.

Liposomal Encapsulation Increases the Efficacy of Azithromycin against Chlamydia trachomatis

Chlamydia trachomatis (C. trachomatis) is an obligate intracellular bacterium linked to ocular and urogenital infections with potentially serious sequelae, including blindness and infertility. First-line antibiotics, such as azithromycin (AZT) and doxycycline, are effective, but treatment failures have also been reported. Encapsulation of antibiotics in liposomes is considered an effective approach for improving their local effects, bioavailability, biocompatibility and antimicrobial activity. To test whether liposomes could enhance the antichlamydial action of AZT, we encapsulated AZT in different surface-charged elastic liposomes (neutral, cationic and anionic elastic liposomes) and assessed their antibacterial potential against the C. trachomatis serovar D laboratory strain as well as the clinical isolate C. trachomatis serovar F. A direct quantitative polymerase chain reaction (qPCR) method was used to measure chlamydial genome content 48 h post infection and to determine the recoverable chlamydial growth. All the liposomes efficiently delivered AZT to HeLa 229 cells infected with the laboratory Chlamydia strain, exhibiting the minimal inhibitory concentrations (MIC) and the minimal bactericidal concentrations (MBC) of AZT even 4–8-fold lower than those achieved with the free AZT. The tested AZT-liposomes were also effective against the clinical Chlamydia strain by decreasing MIC values by 2-fold relative to the free AZT. Interestingly, the neutral AZT-liposomes had no effect on the MBC against the clinical strain, while cationic and anionic AZT-liposomes decreased the MBC 2-fold, hence proving the potential of the surface-charged elastic liposomes to improve the effectiveness of AZT against C. trachomatis.

Therapy challenges in patients with Mycoplasma genitalium infection of the urogenital tract: clinical observations

Mycoplasma genitalium is a clinically significant intracellular bacterium from the family of genital mycoplasmas; it absolutely dominates in persistent/recurrent nongonococcal urethritis, causes chronic inflammatory diseases of the urogenital organs which dictates the necessity of treating this infection. The study presents observations of 2 patients with chronic recurrent urethritis caused by multiple drug resistant strains of M. genitalium. None of the administered schemes of antibacterial treatment covered in the international protocols on treatment of M. genitalium infection allowed to achieve clinical or microbiological cure in these patients. Practicing doctors require development and improvement of nucleic acid amplification methods with antimicrobial testing for M. genitalium resistance and new antimicrobial drugs with improved chemical and pharmacological characteristics for treatment of patients with intracellular urogenital infections.

Intravesical ichthyosis: a rare case report

Background Ichthyosis is a rare skin disorder, in which the shedding of squamous cells is altered. Intravesical ichthyosis is an extremely rare condition. There is evidence for an association with intravesical condylomata accuminata, caused by urogenital infections of the human papilloma virus. These lesions are generally benign but known to be of a carcinogenic potential and therefore should be treated immediately and followed-up closely. Case presentation We present the case of a 39-year-old woman who presented with recurrent urinary tract infections. During cystoscopy diffuse black pigmented flat bladder tumours were visualized. After transurethral resection the pathological report diagnosed an ichthyosis vesicae. Conclusion We recommend a complete resection with frequent clinical and cystoscopic follow-up. Furthermore, testing for the human papilloma virus should be performed and a vaccination should be offered to the patient. As ichthyosis vesicae is a rare phenomenon, there is an evident lack of clinical data regarding therapy, prognosis and follow-up. With our report, we want to emphasize the need for further research.

Collateral effects and mortality of kidney transplant recipients during the COVID-19 pandemic

Background: Collateral effects and consequences of the coronavirus disease 19 (COVID-19) pandemic on kidney transplant recipients remain widely unknown. Methods: This retrospective cohort study examines changes in admission rates, incidences of diseases leading to hospitalization, in-patient procedures, and maintenance medication in long-term kidney transplant recipients with functioning graft during the early COVID-19 pandemic in Germany. Data derived from a nationwide health insurance database. Analysis was performed from March 15th to September 30th and compared the years 2019 and 2020. Effects on mortality and adverse allograft events were compared to COVID-19 attributed effects. Results: 7,725 patients were included in the final analysis. Admissions declined in 2020 by 17% with a main dip during a 3-month lockdown (-31%) but without a subsequent rebound. Incidences for hospitalization did not increase for any investigated disease entities, while decreasing trends were noted for non-COVID-19 pulmonary and urogenital infections (incidence rate ratio 0.8, 95%-CI 0.62-1.03, and 0.82, 95%-CI 0.65-1.04, respectively). Non-COVID-19 hospital stays were 0.6 days shorter (p = 0.034) and not complicated by increased dialysis, ventilation, or intensive care treatment rates. In-hospital and 90-day mortality remained stable. Incidence of severe COVID-19 requiring hospitalization was 0.09 per 1,000 patient-days and in-hospital mortality was 9.2%. 31% of patients with calcineurin-inhibitor medication and without being hospitalized for COVID-19 reduced doses by at least 25%, which was associated with an increased allograft rejection risk (adjusted hazard ratios 1.29, 95%-CI 1.02-1.63). COVID-19 caused 16.9% of all deaths but had no significant association with allograft rejections. All-cause mortality remained stable (rate ratio 1.15, 95%-CI 0.91-1.46), also when restricting analysis to patients with no or outpatient-treated COVID-19 (0.97, 95%-CI 0.76-1.25). Conclusion: Despite significant collateral effects, mortality remained unchanged during the early COVID-19 pandemic. Considerable temporary reductions in admissions are safe whereas reducing immunosuppression results in increased allograft rejection risk.

Determination of In Vitro Antimicrobial Susceptibility for Lefamulin (Pleuromutilin) for Ureaplasma Spp. and Mycoplasma hominis

Lefamulin is the first of the pleuromutilin class of antimicrobials to be available for therapeutic use in humans. Minimum inhibitory concentrations of lefamulin were determined by microbroth dilution for 90 characterised clinical isolates (25 Ureaplasma parvum, 25 Ureaplasma urealyticum, and 40 Mycoplasma hominis). All Mycoplasma hominis isolates possessed lefamulin MICs of ≤0.25 mg/L after 48 h (MIC50/90 of 0.06/0.12 mg/L), despite an inherent resistance to macrolides; while Ureaplasma isolates had MICs of ≤2 mg/L after 24 h (MIC50/90 of 0.25/1 mg/L), despite inherent resistance to clindamycin. Two U. urealyticum isolates with additional A2058G mutations of 23S rRNA, and one U. parvum isolate with a R66Q67 deletion (all of which had a combined resistance to macrolides and clindamycin) only showed a 2-fold increase in lefamulin MIC (1–2 mg/L) relative to macrolide-susceptible strains. Lefamulin could be an effective alternative antimicrobial for treating Ureaplasma spp. and Mycoplasma hominis infections irrespective of intrinsic or acquired resistance to macrolides, lincosamides, and ketolides. Based on this potent in vitro activity and the known good, rapid, and homogenous tissue penetration of female and male urogenital tissues and glands, further exploration of clinical efficacy of lefamulin for the treatment of Mycoplasma and Ureaplasma urogenital infections is warranted.

Risk factors for neonatal intrauterine infection in pregnant women with urogenital infection

Objective. To determine the clinical and anamnestic risk factors for neonatal intrauterine infection (IUI) in pregnant women with urogenital infections (UGI).Materials and methods. 431 patients were examined: the main group (group 1) — 353 women with UGI during pregnancy (subgroup 1A — 215 women whose children were diagnosed with IUI, subgroup 1B — 138 women whose children were born without signs of IUI; the comparison group (group 2) — 78 women without UGI during pregnancy (subgroup 2A — 44 patients whose children were born with signs of IUI, subgroup 2B — 34 women whose children did not have IUI. We studied the obstetric and gynecological, somatic anamnesis of the patients, the course of their pregnancy.Results. The presence of gynecological and somatic diseases in the anamnesis of the pregnant women with UGI was associated with a signifcant increase of the risk for neonatal IUI (p = 0.003 and p = 0.005, respectively). Vaginitis (p = 0.041), background and precancerous diseases of the cervix (p = 0.027) were signifcantly most prevalent in the pregnant women with UGIs in their history. Pregnancy complicated by UGI proceeded with a recurrent miscarriage risk (p = 0.046) was most often accompanied by acute respiratory infection (p ˂ 0.001) and signifcantly most often ended in premature birth — 24.7% (p = 0.009).Conclusion. The search for objective criteria for the development of neonatal IUI is an important and complex task of modern obstetrics. The analysis of the anamnesis of pregnant women with urogenital infections, as well as timely diagnosis and adequate treatment of urogenital infection and acute respiratory infection will reduce the miscarriage rate and the incidence rate of neonatal IUI.

Optimisation of the magistral semisolid formulations with furazidine used in urogenital infections

Background: Urinary tract infections are the most common urogenital diseases, with an increased incidence in men and older people. Urogenital infections are caused by Gram-negative bacteria, in which Escherichia coli predominates with a share of 80%. The evolution of microbial resistance to preparations used in curative-prophylactic institutions, induces the need of the reintroduction of nitrofurans, noteworthy for their wide spectrum of antibacterial activity. Material and methods: For the study, suppositories with furazidine were prepared by hand rolling and by melting and molding methods. Quantitative analysis was performed spectrophotometrically on a UV-VIS Perkin Elmer Lambda 40 spectrophotometer. All solvents and reagents had the degree of purity ”pure for analysis” and ”chemically pure”. Results: Duble cast method was applied to identify the exact mass of hydrophobic (cocoa butter, suppocire) and hydrophylic (polyethylene glycol mixtures) excipients. All the formulated suppositories were subjected to quality tests and showed acceptable physical characteristics and uniformity of drug contents. The UV-VIS spectrophotometric method for quantitiative determination of furazidine was developed and validated. The validation results showed that the developed method is simple, fast, accurate and robust. Conclusions: Suppositories with furazidine were prepared by classic technological methods. Preparation of the suppositories with furazidine on cocoa butter excipient is a suitable alternative for individual medicinal prescriptions. The UV-VIS spectrophotometric dosing method for furazidine in suppositories was developed and validated