Advances in General Practice of Medicine <p><a title="Registered Journal" href="" target="_blank" rel="noopener"><img class="journalreviewercredits" src="/journal/public/site/images/jasongong/Logo_ReviewerCredits-journal.jpg" alt="ReviewerCredits" align="right"></a><strong>Advances in General Practice of Medicine (AGPM) (ISSN:2529-8127)</strong> is an open access, continuously published, international, refereed&nbsp; journal to promote comprehensive, coordinated and continuing care for the community members. This journal encourages submissions of original research, review&nbsp;article, clinical case study, clinical trial, commentary, perspective, opinion in the field addressed.</p> <p>Topics of interest include, but are not limited to, the following:<br>• Medical education and training<br>• Medical management and evaluation<br>• Clinical research<br>• Health policy and guideline development<br>• Whole person care<br>• Health economics<br>• International experiences and evolutions<br>• Family doctor service model<br>&nbsp;• Diagnostic and therapeutic<br>• Basic medicine system<br>• Health information technologies</p> SyncSci Publishing Pte. Ltd., Singapore en-US Advances in General Practice of Medicine 2529-8127 <p>Authors contributing to&nbsp;<em>Advances in General Practice of Medicine</em>&nbsp;agree to publish their articles under the&nbsp;<a href="">Creative Commons Attribution-Noncommercial 4.0 International License</a>, allowing third parties to share their work (copy, distribute, transmit) and to adapt it, under the condition that the authors are given credit, that the work is not used for commercial purposes, and that in the event of reuse or distribution, the terms of this license are made clear.</p> Gender-specific anterior cruciate ligament – gait forces <p>The purpose of this study was to investigate gender-based differences in gait biomechanics and to evaluate those effects on forces generated on the ACL during walking. Estimation of gender-specific ACL forces in the frontal plane can provide a better understanding of the biomechanical patterns underlying higher female injury risk. The present study used a sample from the Fels Longitudinal Study to test the hypothesis that there are significant gender-differences in frontal plane ACL loading during walking. A cross-sectional sample of 178 participants, including 79 males and 99 females was used to evaluate differences in gait kinetics. Females walked at higher cadence with narrower steps (P &lt; 0.05). No difference was observed in the peak flexion force and knee rotation moment between males and females (P = 0.51 and 0.07), respectively. Peak abduction moment was significantly lower among females than in males (P = 0.05). A regression equation was developed which considers a person’s weight and height in addition to forces which could give better estimate of the forces acting on the ligament. The peak force acting on the ACL during walking reaches as high as 0.44 of BW, regardless of gender.</p> Bharadwaj Cheruvu Amy Neidhard-Doll Tarun Goswami ##submission.copyrightStatement## 2022-05-18 2022-05-18 4 1 42 47 10.25082/AGPM.2022.01.002 Antimicrobial resistance of Salmonella enterica Typhi in the Western and Southern Regions of the Democratic Republic of the Congo: Phenotypic profile and molecular characterization of isolates associated with epidemics of Typhoid Fever <p><strong>Background:</strong> This study has its foundation following the emergence of the phenomenon of antimicrobial resistance of <em>Salmonella enterica enterica</em> Typhi associated with severe complications, such as intestinal perforations with a significant lethality.<br> <strong>Objectives:</strong> Of this antimicrobial resistance, to determine the phenotypic profile, to detect the chromosomal molecular markers (CMMs) such as the class 1 integrons (<em>intl-</em>1) and ESBLs (<em>bla</em><sub>TEM-1</sub>, <em>bla</em><sub>OXA-1 </sub>and <em>bla</em><sub>CTX-M-1</sub>) and to measure the association between the phenotypic profile and CMMs of typhoid isolates in concerned areas.<br> <strong>Methods:&nbsp;</strong> <em>Salmonella</em> Typhi strains of typhoid epidemic areas were confirmed by serotyping tests. The antimicrobial susceptibility testing was conducted by disc diffusion method using the following commercial antimicrobials: Chloramphenicol-C, Ampicillin-AMP, Sulfamethoxazole-RL and Trimethoprim-W (former first-line antimicrobials), Ciprofloxacin-CIP or Cefotaxime-CTX, Ceftriaxone-CRO, Ceftazidime-CAZ (first-line antimicrobials), Tetracycline-TE, Amoxicillin-Potassium clavulanate-AMC, Nalidixic acid-NA, Cefoxitine-FOX, Gentamicin-CN (varied antimicrobials) and FEP-Cefepime (4GC). The phenotypic antimicrobial resistance profile was determined by Kirby-Bauer diffusion method on Mueller-Hinton agar. To perform the molecular characterization, the <em>Salmonella</em> Typhi isolates DNA has been extracted by Sigma Aldrich kit and the CMMs detection was performed by DNA Engine for PCR test. The association between phenotypic profile and CMMs has been measured by Pearson’s chi-square test.<br> <strong>Results:</strong> Out of 320 <em>Salmonella</em> Typhi isolates, 50 were identified conform. The phenotypic profile of antimicrobial resistance was 59.5% in all the Western and Southern regions and 61% in the provinces of Kinshasa City and Bas-Congo to the former antimicrobials of first intention and the mean of CMMs rates were 22.5% and 27.4%, respectively. Those isolates showed a significant resistance profile to AMP, C and RL in those last two provinces.<br> <strong>Conclusion:</strong> The rate of phenotypic multidrug-resistance of <em>Salmonella</em> Typhi isolates was more than 50% with the predominance of CMMs in Kinshasa and Bas-Congo. This study suggests to give up the use of AMP, C and RL in those two provinces. This may also indicate that the antimicrobial resistance surveillance system would be one strategy to manage food borne pathogens.</p> Kumel Kasongo Kumelundu Berthe Nkema Miwanda Ronald Ng'etich Samuel Njoroge Denis Kakongo Kandolo Michel Balaka Ekwalanga Emmanuel Mposhi Malangu Victor Ndibualonji Claude Lubobo Kazadi Philomène Anzwal Lungu Clément Numbi Kashindi Prosper Muenze Kalenga Léon Kafita Cibuabua John Kiiru Samuel Kariuki Jean-Jacques Tamfum Muyembe Christophe Mukena Nyembo ##submission.copyrightStatement## 2022-04-28 2022-04-28 4 1 28 41 10.25082/AGPM.2022.01.001 Impact of Coronavirus disease 2019 on macroeconomics and overall development in the Democratic Republic of Congo Oscar N. Luboya Olivier Mukuku Léon N. Kabamba Augustin M. Mutombo Paul M. Mawaw ##submission.copyrightStatement## 2020-12-30 2020-12-30 4 1 26 27 10.25082/AGPM.2020.01.003 Cryptococcus neoformans meningitis in an immunocompetent adult: A case report <p>Neuromeningeal cryptococcosis (NMC) is relatively rare in immunocompetent subjects. We report a Congolese case of NMC diagnosed in an apparently immunocompetent subject. A 35-year-old woman was admitted for acute meningoencephalitis. The cerebrospinal fluid (CSF) examination revealed cytological and biochemical abnormalities and the presence of <em>Cryptococcus neoformans</em> on direct examination with India ink and in culture. The serum dosage of cryptococcal antigens was titrated at 1:32. HIV and syphilis antibodies were negative and the blood CD4 lymphocyte count was 610/mm<sup>3</sup>. The patient had no other immunosuppressive factors, in particular no hematologic abnormalities, no solid tumor, or malnutrition. She was unsuccessfully treated with fluconazole intraveinously, and died after 10 days of treatment. This observation reminds us that NMC can occur in subjects without apparent immunosuppressive factor with a misleading clinical presentation. It is a rare infection with a severe prognosis even in immunocompetent patients.</p> Georges Yumba Numbi Berthe Kamalo Mwad Olivier Mukuku Claude Mulumba Mwamba ##submission.copyrightStatement## 2020-11-18 2020-11-18 4 1 23 25 10.25082/AGPM.2020.01.002 Acute renal failure as severe malaria complication in Lubumbashi: Management and follow-up in an under-equipped setting <p><strong>Purpose</strong> Acute renal failure (ARF) or acute kidney injury (AKI) is one of the major criteria for the severity of malaria according to WHO. The objective was to determine the frequency as well as to evaluate the management and follow-up of ARF during malaria in children in Lubumbashi. <strong>Material and methods</strong> This is a descriptive cross-sectional study over 48 months (January 1st, 2016 to December 30th, 2019) carried out at the pediatric service of the University Clinics of Lubumbashi. All children with an ARF with a positive thick blood smear were included in the study. Data were analyzed with SPSS 19 software. <strong>Results</strong> During this period, 910 patients (49.1%) were admitted for malaria. Among them, 14 patients, i.e. an intra-hospital prevalence of 0.78%, of which 6 boys (42.9%) and 8 girls (57.1%) had ARF. The mean age is 7.9±3.5 years. The serum creatinine level was between 0.54 and 15.2 mg/dL with a mean of 5.7 mg/dL. Kidney dialysis was only effective in 3 patients (21.4%) and diuretics were given 100% in all children. The mean length of stay was 13.4±8.7 days (range: 1 day and 18 days). Mortality was 21.4%. <strong>Conclusion</strong> The present study shows that ARF in childhood malaria in Lubumbashi is infrequent but of high mortality in our environment with limited resources where care is lacking and monitoring difficult.</p> Deddy C. Kalonji Lebrun N. Kembo Matthieu I. Ngombe Stéphanie L. Ngimbi Alex K. Lumande Eva K. Bukasa Patient N. Mudait Olivier Mukuku Augustin M. Mutombo Michel N. Kabamba André K. Mutombo Stanislas O. Wembonyama Oscar N. Luboya ##submission.copyrightStatement## 2020-11-02 2020-11-02 4 1 19 22 10.25082/AGPM.2020.01.001 Current trends in targeted therapy of leukaemia and lymphoma <p>Decades of cancer and leukaemia research have provided priceless insight into the molecular mechanisms underlying the development and maintenance of malignancies. The ultimate goal of these findings was, and still is, discovering discriminating factors enabling detection or treatment of tumour cells. An important achievement in this field has been the integration of protein chemistry, fluorescence detectors, nanoparticles, optical devices and computational devolvement integrated in the field of flow cytometry, fluorescence activated cell sorting FACS, data analysis and visualisation. Especially important is the onset of computational data mining tools like T-distributed Stochastic Neighbor Embedding (t- SNE), developed by van der Maatenand Hinton and further continuous progress of the machine learning algorithms for visualization of the huge amount of data produced from single cell FACS or mass cytometry analysis.</p> Mariastefania Antica Josipa Skelin ##submission.copyrightStatement## 2019-08-23 2019-08-23 4 1 16 18 10.25082/AGPM.2019.01.005 A complex presentation of body dysmorphic disorder, social phobia and unresolved grief <p>This case is a complex presentation of Body Dysmorphic Disorder (BDD), social phobia and unresolved grief in a 23 year old male with no social support. He appears to have benefitted immensely from a combination of Cognitive Behavioral Therapy (CBT), antidepressant medication and Occupational Therapy. Identification of patients with BDD presenting in surgical and medical practices is essential and can be facilitated by validated screening tools such as the Body Dysmorphic Disorder Questionnaire (BDDQ). At the moment, the best evidence-based treatment is CBT and Selective Serotonin Reuptake Inhibitors (SSRIs). Nonetheless, novel approaches to therapeutic applications include the investigation of eye-tracking focus on body parts in BDD.</p> D.A. Lachmansingh ##submission.copyrightStatement## 2019-07-24 2019-07-24 4 1 13 15 10.25082/AGPM.2019.01.004 Quinine induced thrombotic microangiopathy and thrombocytopenia: A teaching hospital's perspective <p>Although quinine is an infrequently prescribed drug, with malaria treatment being its only FDA-approved indication, unwitting exposure via beverages (<em>e.g.</em>, tonic water), over the counter herbal remedies and illegal recreation drugs still occur. We present a unique case of a female patient who denied any known prior history of quinine exposure, who after being prescribed quinine tablets for restless leg syndrome, developed an immune-related thrombotic microangiopathy with thrombocytopenia and subsequent multi-organ failure. It was later elucidated that her only known potential source of prior quinine exposure was a remote history of crack-cocaine use. The patient survived this rare and severe inflammatory response with recovery of renal function and was able to discontinue dialysis.</p> Aaron J. Franke William Paul Skelton IV ##submission.copyrightStatement## 2019-05-16 2019-05-16 4 1 9 12 10.25082/AGPM.2019.01.003 Depression of the elderly revealing a primary hypothyroidism <p><span style="text-decoration: underline;"><strong>Introduction</strong></span>&nbsp; &nbsp; &nbsp; &nbsp;Psychiatric manifestations are exceptional during hypothyroidism and are not always easy to diagnose, especially since the clinical signs of hypothyroidism can be confused with those of the depressive syndrome. We report an original observation of depression of the elderly revealing an isolated primary hypothyroidism.&nbsp;<br> <span style="text-decoration: underline;"><strong>Observation</strong></span>&nbsp; &nbsp; &nbsp; &nbsp;A 78-year-old patient, followed for essential hypertension, well-balanced under monotherapy with calcium channel blockers, and without degenerative complications, was referred by her family doctor for depressive syndrome not improved by the specific treatment prescribed and correctly taken for six months. The clinical examination noted in particular macroglossia with dental impressions and dry and cracked skin. The biological assessment showed hypothyroidism with TSH at 28 μmol/l. Thyroid ultrasound showed atrophy of the thyroid gland. The thyroid autoimmunity (anti-thyroglobulin and anti-thyroperoxidase antibodies) was negative. The rest of the biological tests were in the normal range. The diagnosis of Riedel’s thyroiditis was retained and the patient was treated with levothyroxine in progressive doses until TSH normalization was achieved. The evolution on the psychiatric level was also favorable with disappearance of the signs of the depression and the anti-depressive treatment was discontinued.&nbsp;<br><span style="text-decoration: underline;"><strong>Conclusion</strong></span>&nbsp; &nbsp; &nbsp; &nbsp;Depression is rare, complicating only 4% of overt hypothyroidism and its diagnosis is not always easy, especially in the elderly. Hormone replacement therapy significantly improves the depressive syndrome and protects against cognitive decline. Thus, hypothyroidism screening seems appropriate for any depressive syndrome in the elderly.</p> Salem Bouomrani Mouna Guermazi Souad Yahyaoui Safa Trabelsi Latifa Ghanmi ##submission.copyrightStatement## 2019-02-09 2019-02-09 4 1 1 4 10.25082/AGPM.2019.01.001 Allopurinol-induced DRESS syndrome in the elderly: an exceptional form of iatrogenesis <p class="p"><strong>Introduction</strong>&nbsp;The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a very rare iatrogenic accident that is characterized by its difficult diagnosis due to its clinical latency and heterogeneous clinic. The form induced by allopurinol remains exceptional and often ignored by clinicians, although potentially fatal. We are reporting an original observation of allopurinol-induced DRESS syndrome in elderly. <br><strong>Observation</strong>&nbsp;A 64-year-old woman who had been treated with allopurinol for gout for three weeks, was hospitalized for a diffuse, erythematous and maculopapular cutaneous rash, associated with fever at 39°C, dyspnea, generalized lymphadenopathy, and a hyperkeratotic and desquamative plantar eruption. The biology showed eosinophilia at 860/mm<sup>3</sup> and cytolitic hepatitis without cholestasis or hepatocellular insufficiency with ASAT at 230 IU/l and alanine aminotransferase ( ALAT) at 280 IU/l. The infectious, immunological investigation, as well as the search for underlying malignant neoplasia or hematological malignancy were negative. The skin biopsy was inconclusive. The diagnosis of a DRESS syndrome induced by allopurinol was retained. The evolution was rapidly favorable after stopping allopurinol and treatment with systemic glucocorticoids. <br><strong>Conclusion</strong>&nbsp;The incidence of cutaneous reactions to allopurinol is estimated at 1.5/100,000 H/year. The DRESS syndrome, the most serious form of these reactions, remains exceptional. This particular form of toxicity deserves to be known by clinicians, especially since allopurinol is widely prescribed in the elderly.</p> Salem Bouomrani Fatma Rekik Safa Trabelsi Souad Yahyaoui Nesrine Belgacem ##submission.copyrightStatement## 2019-02-08 2019-02-08 4 1 5 8 10.25082/AGPM.2019.01.002