Lessons learned about the management of a traffic road accident victim with abdominal seatbelt sign: Case report

The abdominal seatbelt sign is well described in the literature as an indicative of intra-abdominal visceral injuries; it is considered rare because it is difficult to detect with no single observation providing reliable diagnosis. Consequently, it often presages a delayed diagnosis. We here report lessons from management of 44 year-old man professional driver, victim of a road traffic accident who underwent a damage control laparotomy and whose abdominal seatbelt sign was diagnosed late. To our knowledge, abdominal seatbelt sign has never been reported in a context of rural hospital with low technical facilities. The assessment of the injury revealed haemoperitoneum, rupture of the rectus abdominis, rupture of the appendix and the bowel loop with mesenteric tears. The patient had a second surgery due to a postoperative complication - a postoperative peritonitis with a parietal abscess; this resulted in a digestive fistula which was treated with twice-daily dressing. We learned from the management of this case that presence of an abdominal seatbelt sign in patient with good parameters should lead to paraclinical exploration. So, when faced with the presence of severe abdominal trauma, clinicians should always remember the principles of damage control laparotomy, regardless of the constraints encountered.

Inflammatory biomarkers and prediction of insulin resistance in Congolese adults

Several studies have shown that low levels of adiponectin (ADP) and high levels of alpha tumor necrosis factor (NFT) increase the risk or severity of many cardiometabolic diseases associated with insulin resistance. The main objective of this study was to evaluate the association between plasma adipokines and IR measured by HOMA-IR. The secondary objective was to determine the biomarker of the potential inflammation to predict IR in Congolese melanoderm subjects residing in Brazzaville. This cross-sectional study was conducted on 234 apparently healthy participants over the age of 18. Socio-demographic and clinical data were collected. Biological data, including the total ADP and NFT dosage, were measured using the ELISA method. Participants were categorized into two groups according to HOMA-IR ≥ 2.5. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for insulin resistance. An optimized model was obtained after the logistic regression. The analysis of the receptor's operating characteristics (OCR) was performed to determine the optimal threshold value and diagnostic characteristics, as well as the area under the curve (ASC). ADP averages were significantly low (11.49 ± 7.61 ng/mL; P < 0.001) while those of TNF were significantly higher (96.03 ± 44.09 pg/mL) in the HOMA-IR group ≥ 2.5. There was a positive and significant correlation (p < 0.05) between BMI, TT, CRPhs, TNF and HOMA-IR. And a negative and significant correlation was noted between ADP and HOMA-IR (r = - 0.39; P < 0.01). Similarly, a negative and significant correlation (p < 0.01) was noted between BMI, TT, TNF, CRPhs and ADP. The optimal threshold value of the total ADP for predicting IR was 17.52 ng/mL with a sensitivity of 89% [IC 95% (0.83-0.95)], 56% specificity [IC 95% (0.47-0.65)] and a CSA of 0.76 [IC 95% (0.69-0.81)]. After logistic regression, the CSA of the optimized model was 0.84 [IC 95% (0.79-0.89)]. ADP can be used as a highly plausible IR prediction biomarker.

Wnt/beta-catenin and PI3K/Akt/mTOR Signaling Pathways in Glioblastoma: Two Main Targets for Drug Design: A Review

Glioblastoma (GBM) is the most common and malignant astrocytic glioma, accounting for about 90% of all brain tumors with poor prognosis. Despite recent advances in understanding molecular mechanisms of oncogenesis and the improved neuroimaging technologies, surgery, and adjuvant treatments, the clinical prognosis of patients with GBM remains persistently unfavorable. The signaling pathways and the regulation of growth factors of glioblastoma cells are very abnormal. The various signaling pathways have been suggested to be involved in cellular proliferation, invasion, and glioma metastasis. The Wnt signaling pathway with its pleiotropic functions in neurogenesis and stem cell proliferation is implicated in various human cancers, including glioma. In addition, the PI3K/Akt/mTOR pathway is closely related to growth, metabolism, survival, angiogenesis, autophagy, and chemotherapy resistance of GBM. Understanding the mechanisms of GBM's invasion, represented by invasion and migration, is an important tool in designing effective therapeutic interventions. This review will investigate two main signaling pathways in GBM: PI3K/Akt/mTOR and Wnt/beta-catenin signaling pathways.

Hyperbolic relation between beta-cell function and insulin sensitivity for type 2 diabetes mellitus, malaria, influenza, Helicobacter pylori, Chlamydia pneumoniae, and hepatitis C virus infection-induced inflammation/oxidative stress and temporary insulin resistance in Central Africans

Background/aim: We calculated the homeostatic model assessment (HOMA) for estimating insulin sensitivity and beta-cell function in normal, healthy nondiabetics with infections (malaria, influenza, HIV, Helicobacter pylori, Chlamydia pneumoniae, and hepatitis C virus), type 2 diabetic black patients, and healthy controls from Kinshasa, DR Congo. Materials and methods: A case-control study was carried out between 2006 and 2007 for black Central African participants managed for HOMA.Results: In total, 219 patients and 110 healthy controls were matched for sex and age. The hyperbolic product for 85 infected patients occupied an intermediate position between the hyperbolic product for 110 controls and that of 134 type 2 diabetics. Inflammation/oxidative stress was present in all infected patients, as well as in the type 2 diabetics. Of the patients, 39.3% and 49.8% had insulin resistance and metabolic syndrome, respectively. Insulin resistance was more prevalent in nondiabetics with inflammation/oxidative stress (47.1%; P = 0.041) than in type 2 diabetics (34.3%). Type 2 diabetics had higher insulin sensitivity and lower beta-cell function but a similar HOMA-IR score. Conclusion: We recommend the assessment of insulin resistance in Central African patients with severe infections and type 2 diabetes.

Islet cell research brings hope for a diabetes cure: meeting report from the 6(th) annual islet society meeting in Stellenbosch, South Africa

The International Diabetes Federation predicts that, over the next twenty years, the largest increase in the prevalence of diabetes will be in the Africa region. Recognizing an unmet need for more focus on Africa and engagement with African scholars, the Islet Society held its 6th annual meeting July 20-21, 2014 in Stellenbosch, South Africa. Here, we present a report that covers the presentations and discussion points from that meeting. Work was presented on a variety of topics and included presentations by a significant proportion of Africa diabetes researchers. Overall, it was an excellent conference, with many new international collaborations initiated. We hope that other groups will also respond to the need for more conferences in Africa and focused on Africa.

Histomorphometric and radioimmunoassay studies of the rat endometrium following peanut oil treatment

BACKGROUND

The pregnancy rate during in-vitro fertilization (IVF) following progesterone supplement still remains very low at around 20%.

OBJECTIVE

To investigate the effects of peanut oil itself on the endometrial receptivity, the pregnancy success rate and fertility during the peri-implantation time in hyper stimulated and normal rats.

MATERIALS AND METHODS

Thirty-six adult Sprague Dawley rats with at least four regular oestrus cycles were randomly divided into 4 groups: two groups were hyper stimulated by human chorionic gonadotropin (hCG) and treated with progesterone or with peanut oil; the two other groups were not hyper stimulated and treated with saline solution or peanut oil. On day 5.5 of pregnancy, the uterine horns were removed and blood was collected for histomorphometric and serum progesterone evaluation. 12 rats were allowed to continue the presumed pregnancy to term. Analysis of variance (ANOVA) and student t-test were used to compare the means of morphometric and radioimmunoassay data between groups. p-values less than 0.05 were considered statistically significant.

RESULTS

The mean values of morphometric parameters and serum progesterone varied significantly between the groups (ANOVA, p<0.0001). The lowest values of progesterone parameters were observed in the hyperstimulated groups that did not deliver pups; both hyperstimulated groups had deleterious luminal epithelium with varying degrees of mucosal projections. There were isolated decidualised zones observed in hyper stimulated peanut oil group, whereas peanut oil group had the highest number of implantation sites and deliveries.

CONCLUSION

The results show that hype stimulation reduces the endometrial receptivity, while peanut oil increases endometrial receptivity, pregnancy rates and fertility by triggering decidualisation.