IntroductionAcute kidney injury (AKI) is one of the most common problems seen in the pediatric intensive care unit (PICU), with an overall 27% incidence. Besides many other factors, nephrotoxic medications  are also responsible for a large proportion of potentially avoidable pediatric AKI, directly accounting for 16% of AKI events.ObjectiveTo assess potential associations between nephrotoxic drugs and the risk of developing AKI in children admitted in PICU.Material and methodsThis is a retrospective cross-sectional study. Children (aged 1 month - 18 years) admitted to the PICU, with a length of stay >24 hours, were included. AKI was defined as according to KDIGO  criteria. Mild AKI was defined as a rise in creatinine value of 0.3 mg/dl from presenting value at a 24-hour interval. Patients were grouped according to the presence or absence of AKI. All medications administered in the ICU were assessed for nephrotoxicity through a review of adverse reactions mentioned in the Pediatric Dosage Handbook, along with consultation with a clinical pharmacist.ResultsAmong 752 patients, the mean age was 4.8 years ± 4.37. There were 57.3% male and 42.7% female children. Among the exposed children, 37.4% received one drug, 32.4% received two drugs and 12.1% had high nephrotoxin exposure. The most commonly used drug was vancomycin (16.8%), as a single Ntx; vancomycin/colistin (12.9%), in dual nephrotoxic combination; and vancomycin/colistin/amphotericin (2.9%) in highly exposed children . Overall, the incidence of AKI was 14.9%.ConclusionNephrotoxins are potentially avoidable risk factors in critically ill children. Whenever a combination of medications is required, it’s advisable to review all medications for better protection of kidneys and preventing of acute kidney injury. Acute kidney injury (AKI) is one of the most common problems seen in the pediatric intensive care unit (PICU), with an overall 27% incidence and has been found a low prognostic factor with increase mortality and length of stay . BesidesMore recently, medication-associated nephrotoxicity and the concept of nephrotoxic burden have come to attention. Nephrotoxic medications  may lead to AKI, as 16% of AKI events in one study . The preThe aim of our study is to assess potential associations between nephrotoxic drugs and the risk of developing AKI in children admitted to PICU. Therefore, we aimed to find the incidence of AKI after exposure to Ntx in critically ill children of a lower-middle-income country.This is a retrospective cross-sectional study with a chart review from January 2017 till January 2020, conducted in the PICU of a tertiary-care hospital in Pakistan after approval from the ethical review committee. All children (aged one month - 18 years) admitted to the PICU, with a length of stay >24 hours were included. Children with known chronic illness taking any Nephrotoxins, creatinine with more than 1 mg/dl at presentation, expire in 24 hours of admission, and end-stage renal disease was excluded from the study.Demographic and clinical data were collected from patients’ medical records. Renal function was defined as the first serum creatinine measurement within 24 hours of ICU admission. Serum creatinine was recorded at presentation, 24 hours, and 48 hours interval. KDIGO  criteria were used to define the AKI with rise in creatinine value of 0.3 mg/dl within 24 hours as mild AKI. Patients were labeled as AKI present or not.All medications administered in the ICU were assessed for nephrotoxicity through a review of adverse reactions mentioned in the Pediatric Dosage Handbook, along with consultation with a clinical pharmacist . NephrotThe primary outcome was the occurrence of AKI with the degree of nephrotoxic exposure.Age was categorized as infants (1-12 months), toddlers (1-4 years), children (5-11 years), and adolescents (>12-18 years). Continuous data were summarized with descriptive statistics (mean ± standard deviation). While statistical differences between the mean values were compared using Student's t-test. Categorical variables were summarized using frequency and proportion. Statistical analyses were performed using SPSS version 23.0 . A p-value < 0.05 was considered statistically significant.We collected the data of 871 children admitted in PICU and excluded 88 patients who presented with creatinine more than 1 mg/dl at presentation. We also excluded 31 patients who expired within 24 hours of admission. Among 752 patients, the mean age was 4.8 years ± 4.37. There were 57.3% male and 42.7% female children. A total of 451 patients (60%) were admitted from the emergency room. While 616 children (81.9%) received at least one nephrotoxic drug, 136 children (18.1%) received no nephrotoxic drug from the list shown below (Table We counted 14 drugs that were used in 60 various combinations in our settings Table .Single commonly used drugs were vancomycin (16.8%), tazobactam/piperacillin (12.9%), levetiracetam and colistin (1.2%). In dual nephrotoxic combination, vancomycin/colistin (12.9%), vancomycin/levetiracetam (5/9%) and vancomycin/tazobactam/piperacillin 3.3%) were used. In highly exposed children, vancomycin/colistin/amphotericin (2.9%), vancomycin/levetiracetam/phenytoin (2.9%), vancomycin/colistin/levetiracetam (1.7%) were used  did not receive the nephrotoxic drug while 41 (36.6%) received one drug, 39 (34.8%) two, and 10 (8.9%) three or more drugs.Usage of medications with nephrotoxicity is highly prevalent in intensive care units. Additionally, 44.5% of patients were exposed to two or more nephrotoxic medications. Among these patients, we found that 12.1% received higher nephrotoxins than other studies, in which 3.3% of patients received nephrotoxins -11. Our The incidence of AKI was 14.9% in the exposed group. Although that was contrary to other studies in which the incidence was relatively high, like Uber et al. . This stVancomycin was found to be the most frequently used nephrotoxic medication in our PICU. Totapally et al. have reported a high blood urea nitrogen (BUN): Creatinine ratio with exposure to nephrotoxic drugs . Among these, vancomycin was associated with AKI .We did find an independent association between single exposure to the drug and the development of AKI. As drugs were used collectively, there was an increased incidence of AKI, although the statistical association was less significant. It may be explained by the involvement of co-factors like mechanical ventilation and inotropes that were used with the increased severity of critical illness. As in one study conducted by Uber et al., ketorolac was the most common drug used, and the incidence of AKI occurred more commonly in those with more than three drugs, but it was not significant because of confounders .Critically ill patients have constantly fluctuating pharmacokinetics because of changing serum creatinine and alterations in fluid status, which makes medication dosing tricky and adds to the risk of AKI . MeanwhiAs mechanical ventilation has been considered an independent risk factor for AKI , we calcHealth outcomes of pediatric patients may be improved by identifying patients at risk for medication-associated AKI. Monitoring strategies and medication selection may need to be altered to prevent poor outcomes or minimize the risk caused by nephrotoxic medications.We took the data of the last two years, and a large number of patients gave us a broad way to find a significant correlation. In many other studies, the group of patients was small ,13.Acute dialysis quality initiative (ADQI) work group has started to develop a consensus for the design of automated AKI detection systems to produce real-time AKI alerts using electronic networks . We alsoWe have a few limitations to our study. It was a retrospective study conducted on admitted patients in two years. While our research finds a weak statistical association between exposure to Ntx and AKI, but this entity needs more extensive multi-center trials. Regardless, our data suggest that nephrotoxin use remains a modifiable AKI risk factor.Utilization and combinations of nephrotoxins in PICU is quite high. Some combinations are more toxic than others. Also, Ntx have been found to correlate with the occurrence of AKI. Whenever a combination of medications is required, it is advisable to review all medications for better protection of kidneys.Among children who were on inotropic support or on mechanical ventilation, we have found a more incidence of AKI.


Pistacia atlantica subsp. kurdica (baneh) essential oil on some important bacteria in food safety. Essential oil was derived using hydro-distillation method of the baneh fruits. Essential oil composition was determined using gas chromatography–mass spectrometry. The 2,2′-azinobis- and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods were used to evaluate antioxidant activity and Folin-Ciocalteu method was used to determine total phenolic content of essential oil. The antibacterial effect of the essential oil against six pathogen bacteria was determined using minimum inhibitory concentration, minimum bactericidal concentration and disc diffusion methods. Monoterpene and sesquiterpene hydrocarbons were main compounds of total identified constituents in the essential oil . The main compounds were α-pinene, myrcene, limonene, β-pinene and γ-terpineol, respectively. The mean concentration of essential oil providing 50.00% inhibition was 7.54 ± 0.01 mg mL-1. Dose-dependent and scavenging activities were seen in DPPH and ABTS tests and total phenolic content within test range of concentrations (0.0625 to 4.00 mg mL-1). The highest DPPH radical scavenging activity (48.67 ± 0.84%) was seen at a concentration of 4 mg mL-1. The responses of essential oil concentrations to ABTS assay were quite similar to the DPPH reaction, especially in higher concentrations. Both antimicrobial methods demonstrated that the essential oil had broader antibacterial effects against the Gram-positive bacteria than the tested Gram-negative bacteria. Essential oil of Pistachia atlantica subsp. kurdica can be one of the performing essential oils to be used as a preservative in food industry to increase food safety and reduce food pathogens risks. This study aimed to evaluate the composition, antioxidant capacity and antibacterial effects of  The P. atlantica subsp. kurdica is known as baneh (Ghazvan in Kurdish) distributing in the Mediterranean area especially western Zagros mountain belt of Iran. This distribution is lower in the eastern and central parts of Iran.8,9,11,12 Different parts of Pistacia trees and their derivatives such as fruit, leave and resin have been used in an extensive range of traditional medicine as a preservative and breath sweetener as well as to treat gastric ailments and digestive, hepatic and renal diseases.8 The fruits of P. atlantica subsp. kurdica (baneh) are used in different forms by aboriginal people of various parts of Iran including as a flavoring agent in doogh , as foods after milling and mixing with other compounds and as a nut after roasting and they are also used to make jam and pickles of unripe fruits. Its hull and kernel oils are used in food frying and gum or oleoresin of baneh trees is used as a main material of chewing gum in Iran known as Kurdish Saghez.10Pistacia trees are members of the Anacardiaceae family having more than 11 species and amongst them, P. atlantica species including leaves, fruits, hull and gum.10,11,13-19 Due to the scarcity of information about antioxidant and antibacterial activities of the P. atlantica subsp. kurdica fruits derived EO in the datasets, the aim of this study was to assess in vitro antioxidant capacity, antibacterial effects against some important foodborne pathogenic bacteria and chemical composition of this EO to present it as a natural food additive. There are several pharmaceutical studies on composition and antioxidant and antimicrobial activities of EO and extracts obtained from different parts of Collection of plant materials. Ripen fruits of P. atlantica subsp. kurdica were collected from different locations of Baneh city , Kurdistan, Iran at July-August 2016. Plants taxonomical identification was done in the Pharmacognosy and Pharmaceutical Department of Medicinal Plant Research Center, Institute of Medicinal Plants, Karaj, Iran. All fruits were washed and dried at room temperature in the shade for seven days.Chemicals. The 2,2′-azino-bis-(3-ethylbenzothiaziline-6-sulfonate) known as ABTS+ and 2,2-diphenyl-1-picrylhydrazyl (DPPH) were obtained from Sigma-Aldrich . Butylhydroxytoluene (BHT), Folin-Ciocalteu reagent and all other chemicals were purchased from Merck Company . Essential oil extraction. The dried fruits of P. atlantica subsp. kurdica were grinded using mixer grinder and subjected to hydro-distillation by a clevenger apparatus  at 100 ˚C for 3 hr. The distilled EO was isolated and dried with anhydrous sodium sulfate. The dried EO was filtered with 0.22 μm filters and stored in a dark glass sterile bottle at 4.00 ˚C until use.20Essential oil analysis. The EO composition was determined using gas chromatography–mass spectrometry (GC/MS) method according to Gandomi et al.21 The EO analysis was implemented using GC/MS method with a gas chromatography apparatus  equipped with a mass selective detector . Analytical conditions were as follows: Capillary column was 30.00 m × 0.25 mm × 0.25 µm and selective mass detector and injector temperatures were 230 and 250 ˚C, respectively. The oven temperature program was 40.00 ˚C at the start which held for 1 min. It raised up to 250 ˚C at a rate of 3.00 ˚C per min. This temperature was held isothermal for 20 min. Carrier gas was helium with 1.00 mL per min flow rate. Electron Ionization (EI) mode (70 eV) in a range of 40.00 - 450 m/z was used for mass spectra recording. The MSD chem Station software  was used for data processing combined with NIST MS Search (ver. 11.0) and the stored Wiley 7 n.1 Mass Computer Library  by compare acquired retention indices with mass spectra fragmentation. Standard spectra tune was used to obtain better correlation between library and experimental spectra. According to peak area in chromatogram, relative amounts of components were expressed as percentages.Antioxidant activity assays. Two radical scavenging methods were used to evaluate antioxidant activity.2, 2'- diphenyl-1-picrylhydrazyl radical scavenging method. The free radical scavenging ability was determined by the DPPH method described by Aminzare et al. with some modifications.7 Fifty microliter of provided concentrations  of EO and BHT as a reference antioxidant and control sample were added to tubes containing 2.00 mL of previously prepared methanolic DPPH solution (24.00 μg mL-1). The mixtures were shacked and left for 60 min in a dark place at room temperature and the absorbance was measured at 517 nm using methanol as a blank with a spectrophotometer . The DPPH radical inhibition percentage was calculated using the following formula:Inhibition (%) = (A control–A antioxidant/A control) × 10050) of EOs concentration was calculated using the graph by plotting percentage of inhibition versus each sample using Pharmacologic Calculation System (Pharm/PCS) software .The half maximal inhibitory concentration . One hundred fifty microliter of various concentrations of EO  and BHT as a reference antioxidant and control were added to 2.85 mL of the fresh ABTS+ solution and allowed to react for two hr in a dark place at room temperature. Then, the absorbance was measured at 734 nm and the percentage of radical scavenging activity (RSA) was calculated by following formula: (%) = (A control–A antioxidant/A control) × 100RSATotal phenolic determination. The total phenolic content of EO was evaluated using Folin-Ciocalteu methods developed by Hatamnia et al. and Raeisi et al. with some modifications.9,24 Briefly, 0.10 mL of different concentrations of EO  were added to a mixture of 1.30 mL distilled water plus 100 μL Folin-Ciocalteu reagent and mixed thoroughly. After 6 min, 1.00 mL Na2CO3 solution (7.00%) was added for neutralization of reaction. After that, it was incubated at room temperature for 90 min and absorbance of the mixtures was recorded at 750 nm using a spectrophotometer (Pharmacia LKB). Alcoholic solution of gallic acid and a mixture of distilled water with reagents were used as standard and blank solutions, respectively. Results were expressed as mg of gallic acid per gram of EO equivalent relative to obtained values of prepared standard curve using determined concentrations of gallic acid. Antibacterial assay. The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and disc diffusion methods were used to determine antibacterial activity of EO.Microbial strains. The reference bacterial strains used in this study were Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 15224), Pseudomonas aeroginosa (ATCC 15442), Listeria monocytogenesis (ATCC 13932), Shwanella sp. (PTCC 1711) and Salmonella enterica (ATCC 14028) provided from Department of Biotechnology, Iranian Research Organization for Science and Technology (IROST), Tehran, Iran. Intermediate cultures were prepared from the stock cultures according to preparation guideline of IROST to create fresh 18-24 hr cultures before each experiment. Fresh suspensions of tested bacteria were prepared by transfer a loopful from a stock culture to brain-heart infusion (BHI) broth (Merck) and incubation at 35.00 ˚C for 18 to 24 hr. Prepared suspensions were adjusted to an absorbance of 0.10 at 600 nm using a spectro-photometer . Bacterial enumeration and colony count were done by duplicate plating from tenfold serial dilution on BHI agar after incubation at 35.00 ˚C for 24 hr. The average number of bacteria in the optical density of 0.10 was obtained equal to 5.00 × 108 CFU mL-1.Estimation of MIC. The MIC was determined with broth micro-dilution method recommended by the Clinical and Laboratory Standards Institute (CLSI) with some modifications.21 Briefly, two-fold serial dilutions of the stock EO were prepared in BHI broth. Primary concentration of stock EO solution was prepared in 4.00 mg mL-1 The concentration of EO dissolved in 10.00% dimethyl sulfoxide (DMSO). To each well of a 96-well micro-plate, 160 μL of BHI broth, 20.00 μL of each inoculum (5.00 × 106 CFU mL-1) and 20.00 µL of stock EO solutions were added, respectively. The final concentration of bacteria in each well was 5.00 × 105 CFU mL-1. In each strip, a well was selected as a positive control contained 180 μL of BHI broth and 20.00 μL of the inoculum without EO and the last well contained 180 μL of BHI broth and 20.00 μL of EO without any inoculum was selected as a negative control. The micro-plates were incubated at 37.00 ˚C for 24 hr. The MIC is the lowest concentration of the EO preventing visible growth of the bacteria and the MBC is the lowest concentration of EO or an antimicrobial killing a micro-organism and preventing growth on the agar plate. In other word, MBC is the lowest concentration showing a pre-determined reduction (such as 99.90%) compared to MIC dilution. A well containing only the sterile BHI broth medium and a well containing the bacterial culture and DMSO without EO were considered as negative and positive controls, respectively.Disc diffusion method. Determination of microbial susceptibility and confirmation of MICs were performed using the disk diffusion method described in a previous study for pure EO with slight modifications.25 Sterile paper discs (6.00 mm diameter) were impregnated with 10.00 μL of each dilution of EO/DMSO  and placed on BHI agar plates within one hour after pouring of bacterial cultures. Inoculated plates were then incubated at 37.00 ˚C for 24 hr and the zones of growth inhibition were measured to the nearest mm. In this method, MIC is determined as the lowest concentration causing a visible inhibition zone around the discs compared to control discs (disks impregnated with sterile distilled water). Statistical analysis. All assays and tests were performed in triplicate. Statistical analysis of data was carried out using SPSS . Data were expressed as mean ± standard deviation of three replicates. Tukey and Duncan tests were used for pair wise comparing (mean ± SD) of the EO with controls.Chemical composition of EO. The dried Pistacia fruits yielded 0.30-0.40% (v/w) of EO. Thirty compounds were identified in EO as shown in Free radical-scavenging assay. DPPH and ABTS free radical scavenging capacities and total phenolic content of P. atlantica subsp. kurdica fruits EO are shown in -1 of EO, the DPPH and ABTS scavenging abilities were increased significantly (p ≤ 0.05) compared to BHT as a reference compound (82.38 ± 0.25%). The IC50 or efficient concentration value of the EO (the concentration of compound necessary to decrease 50.00% DPPH activity) was 7.54 ± 0.01 mg mL-1 which was calculated graphically (inhibition percent which is plotted versus the logarithm of antioxidant concentration in reaction system). The IC50 for the BHT antioxidant was 2.60 ± 0.47 mg mL-1. As expected, total phenolic content of EO was increased in higher concentrations of EO. The results showed that with increasing concentration from 0.125 to 4.00 mg mLAntibacterial activity. The MIC of EO and growth inhibition zone for inhibition of S. aureus, L. mono-cytogenesis, Shwanella sp., E. coli, P.aeroginosa and S. enterica were 0.125, 0.50, 0.25, 0.50, 0.25 and 0.50 mg mL-1 and 7.33 ± 0.58, 13.33 ± 0.57, 11.67 ± 0.57, 14.33 ± 0.58, 12.33 ± 0.57 and 22.33 ± 0.58 mm, respectively. The MBC of EO required to kill these pathogens and growth inhibition zone at these concentrations were 0.25, 1.00, 0.50, 1.00, 0.50 and 1.00 mg mL-1 and 19.20 ± 0.98, 15.67 ± 0.28, 21.33 ± 0.50, 16.67 ± 0.35, 14.33 ± 0.15 and 28.33±0.18 mm, respectively. P. atlantica subsp. kurdica showed that monoterpene and sesquiterpene hydrocarbons  were main compounds of the total identified constituents in the EO  was higher than cinnamon (13.02%), cumin (14.41%), black cumin (33.22%), horsemint (40.10%) and sage (25.11%), but it was lower than Zataria multifura (88.63%), clove (90.69%), spearmint (69.45%), coriander (57.72%) and ginger (63.25%) in the same concentration (4.00 mg mL-1).26 The lowest value of IC50 shows the highest antioxidant capacity of the substrate.4The EO of baneh exhibited dose-dependent and scavenging activities within the test range of concentrations. The highest DPPH radical scavenging activity (48.67 ± 0.84%) was seen at a concentration of 4 mg mL+ radicals are used to evaluate in vitro antioxidant activity of different substrates based on discoloration of intense green of ABTS radicals. Antioxidant activity of both water-soluble and lipid-soluble antioxidants is measurable with this method.27,28 According to our literature review, this research is the first study to determine ABTS radical scavenging ability of this EO. The responses of EO concentrations to ABTS assay were quite similar to the DPPH reaction especially in higher concentrations  than the tested Gram-negative bacteria . According to the results of disk diffusion assay, the EO was found to be effective against all tested bacteria at a 10.00 µL of MIC dose. Both methods demonstrated that the EO had broader antibacterial effects against the Gram- positive bacteria  on nine strains of Helicobacter pylori and some Gram-negative and Gram-positive bacteria with MIC ranging from 500 to 1000 mg mL-1.39 Rezaei et al. have shown significant antibacterial activities of P. atlantica subsp. mutica against S. aureus and E. coli with MIC value ranges of 6.00 - 12.50 μg mL-1, respectively.40 Relationship between the anti-microbial effects of some EOs and presence of phenolic compounds such as monoterpens has been proven previously.41 Due to presence of phenolic compounds, sensitivity of the tested bacteria to this EO can be expected. However, attributing of antimicrobial effect of an EO to one or specific components is not appropriate.42Based on MIC, an acceptable antimicrobial characteristic was seen in the baneh EO in comparison with the other recognized EOs of some medicinal plants used in food systems . So far,1,3 Considering chemical composition and antioxidant and antimicrobial activities of the P. atlantica subsp. kurdica fruit’s EO and its moderate capacity to scavenge free radicals, it can be one of the performing EOs to be used as a preservative in food industry to increase food safety and reduce food pathogens risks. However, more studies are needed to evaluate its mode of action as well as pharmacological and organoleptic effects in food systems.Since natural compounds are considered increasingly in food industry, pharmaceuticals and cosmetics, finding alternatives for synthetic preservatives in food is one of the important interests in food science. Recently conducted studies have shown that EOs have particular functional properties as antioxidants and antimicrobial compounds.


ObjectivesTo investigate the prevalence of shoulder pain and its functional limitations among patients with uncontrolled diabetes mellitus (DM).MethodsThis is a cross-sectional study that was conducted over a period of four months from October 2019 to January 2020 and included all patients with uncontrolled DM (HbA1c > 9) who are visiting the diabetes clinic at Security Forces Hospital during the study period. Telephone interviews were held by a physician from the Family Medicine Department using a previously validated questionnaire, that is, the American Shoulder and Elbow Surgeons Evaluation Form.ResultsA total of 285 patients were included in the study; 156 (54.7%) were females and 129 (45.3%) were males. Most (51.1%) of the patients aged 45-64 years. The majority of the patients 58.9% had type II DM and 41.1% of them had type I DM. The mean HbA1c level was 10.56. Of the patients are having shoulder pain , 42.5% were between 45 and 64 years of age and 44.1% were between 65 and 96 of years. While 176 (61.8%) of the participants had no pain at all, 70.5% males and 54.5% females did not have shoulder pain (p<0.001). The mean shoulder pain intensity for all patients was 5.81(SD=3.21), ranging from 4.71 (SD=3.15) to 6.13 (SD=3.29), according to different age groups, and showed a significant correlation (p<0.05).ConclusionsIncreasing prevalence of shoulder dysfunction is making physicians alert regarding early diagnosis and management of the disease. Thus, it should be mandatory to include screening, prevention, and rehabilitation strategies for shoulder dysfunction in diabetic care programs to improve the daily lifestyle of the patients. Diabetes mellitus (DM) is a chronic disease that has turned into a major risk to human health in recent years. It possesses a variety of complications such as nephropathy, retinopathy, heart disease, and stroke. Musculoskeletal disease is also one of the important symptoms observed in diabetic patients, which presents as Dupuytren's contracture, stiff hand syndrome, tendinitis, adhesive capsulitis (frozen shoulder), and periarthritis of the shoulder -2. AmongThe prevalence of DM was observed to be around 151 to 171 million in the year 2000, and it is estimated that it will be three times by the year 2050  in 2011 It has been observed that the underlying pathophysiological processes of shoulder pain involve capsular inflammation following fibrosis. This manifestation is modulated by various mediators such as growth factors, enzymes, inflammatory cytokines, and matrix metalloproteinases (MMPs) -9.The function of the upper limb is primarily dependent on the shoulder joint. Past studies have shown a direct link between the duration of DM-associated shoulder pain and control of blood sugar levels. Studies have also observed the role of social, genetic, and environmental factors in this ailment -11. SincThus, this study was conducted with the aim to determine the prevalence of shoulder pain and its functional limitations among patients with uncontrolled DM at Security Forces Hospital using the American Shoulder and Elbow Surgeons (ASES) Evaluation Form.This is a quantitative cross-sectional study conducted over a period of four months from October 2019 to January 2020. We enrolled all patients with uncontrolled DM (HbA1c > 9) who visited the diabetes clinic at Security Forces Hospital over the study period by registering their telephone numbers. Also, we excluded all patients who had known to have psychiatric illness and thus incapable of answering questions, had gestational DM, were medically unstable, or were unwilling to participate. Then, telephone interviews were held by a physician from the Family Medicine Department using the ASES Evaluation Form.The ASES Evaluation Form is developed by the Committee of American Shoulder and Elbow Surgeons to facilitate the assessment of shoulder problems. It is a scoring tool for shoulder pain and its functional limitations; 100 points are the maximum score, and half of the score (50%) is driven from the shoulder pain and its intensity and the other half is a cumulative score driven by 10 questions about daily activity. Each question can be scored as an ordinal scale (from 0 to 3 points). As the ASES scores higher, it correlates with better function and less pain.The data were entered into a Microsoft Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) . All categorical variables, which include gender, marital status, smoking status, and educational level, were summarized and reported as frequency and percentage. Continuos variables were summarized as mean and standard deviation. p-Values of <0.05 were considered statistically significant.This study was approved by the Ethics Committee of the Security Forces Hospital. Verbal consent was obtained from all participants, after having a brief explanation about the aims of the study and the contents of this telephone interview. The identity of the patients as well as the raw data, which include personal information, were kept confidential.A total of 285 patients were included in the study. Most 51.1%) of the patients aged 45-64 years, whereas only 7% were younger than 18 years old. Of the patients, 156 (54.7%) were females and 129 (45.3%) were males, most (67.4%) of them were married, 16.5% were single, and only 1.8% were divorced. Most of the patients had a low level of education (79.3%), either secondary education or less. Also, 43.9% were unemployed, 9.8% were housewives, and only 3.2% were working in the private sector. Overall, 77.9% of the patients were never smokers and 12.3% were currently smoking. Type II D was prevalent in 58.9% and type I DM in 41.1%; the mean HbA1c level was 10.56. The duration of DM was more than 10 years in 82.1% of them, and 71.9% were on insulin injection treatment. Of the 285 patients, 109 (38.2%) had shoulder pain and the rest 176 (61.8%) had no pain at all. Concerning shoulder pain, 56.9% of patients between 45 and 64 years of age and 23.9% between 65 and 96 years stated that they have shoulder pain (p>0.05). Among males and females, 34.9% and 65.1%, respectively, had shoulder pain (p<0.001). Mostly, patients having more than secondary education did not have shoulder pain (p>0.05). The majority (75.2%) of participants who had shoulder pain never smoked (p<0.05). Of those having shoulder pain, the vast majority (61.5%) have type II DM, whereas 38.5% had type I DM. The participants who exercised regularly represented the majority (59.6%) of patients with shoulder pain , ranging from 1.65 (SD=2.90) to 2.60 (SD=3.71), according to different age groups, and showed a significant correlation (p<0.05). And across gender, it was 1.46 (SD=2.61) in males 2.85 (SD=3.91) in females (p<0.001). Regarding different smoking status, the intensity of the pain ranged from 1.20 (SD=2.31) to 3.04 (SD=2.98), and regarding different durations of DM, it ranged from 1.20 (SD=1.98) to 2.39 (SD=3.52). The intensity was 1.93 (SD=3.25) in type I DM and 2.42 (SD=3.58) in type II DM , ranging from 77.82 (SD=31.08) to 92 (SD=16.55), according to different age groups, with 87.88 (SD=21.71) in males and 77.46 (30.28) in females (p<0.001). It ranged from 75.83 (23.58) to 89.66 (SD=19.39) with different smoking status and from 80.54 (SD=28.12) to 90.66 (SD=15.53) in different durations of DM, with 83.93 (SD=25.87) in type I DM and 80.96 (SD=28.09) in type II DM. The mean shoulder ASES score for all patients showed significant association with age, gender, and duration of DM (p<0.05), whereas other demographic variables did not show any association (p>0.05)  has risen from 4.7% in 1980 to 9.5% in 2018 . The shoIn this study, 38.2% of the diabetic patients suffered from shoulder pain, with 71% of them being females, especially in the age group of 45-64 years, whereas according to past studies -22, the Previously, studies have shown that the mode of anti-diabetic medications also affects the prevalence of shoulder pain. Non-insulin-dependent patients (type II) were 1.59 times more affected with shoulder pain than type I, and the results were comparable to past studies -24.Cagliero et al.  found hi Wong et al.  found thThe main limitation of the study is that due to the small sample size, no significant association between the results and the duration of DM was found. Moreover, it can be argued that the questions on smoking could be subjected to reporting bias. Due to its cross-sectional design, this study does not allow an analysis of prior glycemic control in the occurrence of pain and shoulder dysfunction.We encourage that future interventional trials or prospective cohort studies be conducted in order to verify the causality for the outcomes of this study, which could help in the development of new strategies to minimize the suffering of diabetic individuals and promote a good quality of life. This study is recent and addresses the current gap in the contemporary literature.A high prevalence of shoulder dysfunction in diabetic individuals will urge clinical practitioners to examine and identify musculoskeletal findings in diabetic patients. Early diagnosis and treatment of DM can reduce the development of shoulder pain that can cause impairment in the routine functioning of diabetic patients. Early identification of signs of musculoskeletal complications can prove to be a valuable finding in the comprehensive care of diabetic patients. The increasing prevalence of shoulder dysfunction is making physicians alert regarding early diagnosis and management of the disease. Thus, it should be mandatory to include screening, prevention, and rehabilitation strategies for shoulder dysfunction in diabetic care programs to improve the daily lifestyle of the patients.


To determine the feasibility of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium.One hundred and seventy (170) AVNeo  were performed from January 2017 through March 2019 in three centers. All the records were prospectively collected and retrospectively reviewed.2 and 0.4±0.2 cm2/m2 for patients with aortic stenosis before surgery, respectively. There was no conversion to prosthetic aortic valve replacement. Eight patients needed reoperation for bleeding, but no patient needed reoperation due to early infective endocarditis. There were five in-hospital deaths due to noncardiac cause. Compared to preoperative echocardiographic measurements, postoperative peak pressure gradient decreased significantly  and reached 11.2±5.6 mmHg, and mean pressure gradient also decreased significantly  and reached 6.0±3.5 mmHg. Accordingly, EOA and iEOA increased significantly 2.0 cm2 and 1.0 cm2/m2 (both P<0.001) to reach 2.7±0.6 cm2 and 1.4±0.3 cm2/m2 after surgery, respectively, with minimal significant aortic regurgitation (0.6% > mild).Most of the patients were older than 60 years and over 95% were operated for aortic stenosis. Preoperatively, pressure gradients were 69.9±21.3 mmHg for patients with aortic stenosis, and the surgical annular diameter was 21.0±2.0 mm for all patients. Effective orifice area (EOA) and indexed EOA (iEOA) averaged 0.7±0.3 cmAVNeo is feasible and reproducible with good clinical results. Hemodynamically, AVNeo produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are necessary to evaluate mid- and long-term evolution. Additionally, in patients with a small aortic annulus, AVR may be difficult and aortic root enlargement is necessary to implant the largest possible prosthesis in order to avoid postoperative PPM.Aortic valve replacement (AVR) is the gold standard treatment for aortic valve diseases. However, most of prosthetic valves have a stent structure for suturing and fixing to the aortic valve annulus, which culminates in less mobility and decrease of the annulus size and increase in the postoperative pressure gradients. Furthermore, there are also cases that result in prosthesis-patient mismatch (PPM) both in surgical AVR started to perform the aortic valve neocuspidization (AVNeo) procedure, which is a surgical procedure consisting of the complete resection of the aortic cusps and the direct suture of the glutaraldehyde-treated autologous pericardium to the aortic annulus. This technique has been applied to various aortic valve pathologies with good mid-term results-9.It has been over 10 years since Ozaki et al.In this study, we aimed to elucidate whether AVNeo is an acceptable and reproducible option by evaluating the immediate postoperative clinical and echocardiographic outcomes.-11. We carried out a prospective multicenter study in men and women with aortic valve diseases selected for AVNeo procedure. The study was approved by the local ethics committee of each participating institution. All patients who were willing to undergo AVNeo were evaluated for in-hospital clinical results. Detailed descriptions of the surgical techniques for AVNeo have been previously published2) was calculated with the continuity equation, with the use of stroke volume estimated by the left ventricular outflow tract diameter and velocity time integral within the left ventricular outflow tract. EOA was indexed (iEOA) by the body surface area (m2). Aortic regurgitation (AR) was graded using an integrative approach including structural, Doppler, quantitative, and qualitative parameters as recommended by the American Society of Echocardiography guidelines.All patients underwent an echocardiographic evaluation of the aortic valve before and after the procedure. Peak and mean gradient were calculated by the modified Bernouilli equation. Effective orifice area (EOA) . P-values < 0.05 were considered to indicate a statistically significant difference.Continuous data are presented as means ± standard deviation (SD) after confirming normal distribution with Shapiro-Wilk test. Categorical variables are expressed as numbers and percentages. Between-group differences were evaluated using the independent Student’s Among the patients, as shown in 2 and 0.4±0.2 cm2/m2 before surgery, respectively.One hundred sixty-two (95%) patients had aortic stenosis (AS), three patients had AR, and five had early infective endocarditis. Fifty-two (31%) patients had bicuspid aortic valve. Preoperative echocardiography showed an average peak pressure gradient through the aortic valve of 69.9±21.3 mmHg for patients with AS and a surgical annular diameter of 21.0±2.0 mm for all patients. EOA and iEOA averaged 0.7±0.3 cmA total of 94 (55%) patients had isolated AVNeo during the study period and the other 76 (45%) patients underwent concomitant procedures . There wP<0.001; and mean gradient: -36.8±1.1 mmHg, P<0.001) in comparison to preoperative measures (Average peak and mean pressure gradients were 11.2±5.6 mmHg and 6.0±3.5 mmHg (mean±SD), respectively, after surgery. Thus, both decreased significantly . After AVNeo procedure, 38 (22.3%) patients had a mild AR and one (0.6%) had moderate AR. The postoperative echocardiographic views are presented in EOA and iEOA averaged 2.7±0.6 cmmeasures . InteresThe main finding of our study was that AVNeo is a feasible procedure with: 1) good perioperative outcome , 2) low perioperative complications, and 3) excellent postoperative hemodynamic results . from the European Association for Cardio-Thoracic Surgery - EACTS, the Society of Thoracic Surgeons - STS, and the American Association for Thoracic Surgery - AATS Valve Labelling Task Force, these questions include: non-uniform or incomplete reporting of PHV materials and physical dimensions in the instructions for use; unclear definition of labeled valve size and inconsistencies between size dimensions and labeled valve size; non-uniform marking of PHV support structures; lack of robust information on in vivo hemodynamic performance and no information available regarding hemodynamic performance on package labels; lack of uniform tools backed by solid evidence to prevent PPM; and lack of good-quality, robust clinical data on PHV thrombogenicity.Whereas AVR with prosthetic heart valves (PHV) has been considered the best option for treatment of aortic valve diseases, many unanswered questions surround intraoperative sizing and labeling of these prostheses, making optimal intraoperative selection challenging. According to a documentThis situation has received many calls for action, but no solution has been achieved so far. In this scenario, AVNeo arises as an attractive option owing to its low cost, universal indications without any limit in annulus size nor any need for anticoagulation, and its potentially excellent hemodynamics.2/m2, which means no postoperative PPM. These observations might underlie the maintenance of the characteristics of the aortic annulus due to the absence of stent structures.The most important findings of our study were, in addition to low operative mortality, the statistically significant decreases in pressure gradients and increase in EOA and iEOA after AVNeo. We would like to highlight the fact that these findings were consistent regardless of the annulus size. We also found no patient in the postoperative period with values of iEOA < 0.85cm performed AVNeo for various aortic valve pathologies in 147 patients from December 2010 to October 2017. Of these patients, the aortic annulus dimensions were measured in 25 patients who underwent AVNeo for aortic valve disease as follow-up examination and compared with those measured in 15 patients who had normal aortic valves. No significant differences in the aortic annulus dimensions were observed between the patients who had undergone AVNeo and those who had normal aortic valves. The authors concluded that the movement of the aortic annulus after AVNeo is comparable with that of the aortic annulus of a normal aortic valve; thus, AVNeo can be regarded as a more physiological operation in that it maintains the characteristics of the aortic valve similar to those of a normal aortic valve (which in turn does not happen when patients undergo AVR).Iida et al. measured aortic annular dimensions using electrocardiography-gated multidetector computed tomography in 23 patients. The sample included eight patients who had undergone AVNeo, 10 patients with normal aortic valves, and five patients who had undergone AVR. Postoperative peak pressure gradients for the AVNeo and AVR groups were compared. No statistically significant differences in annulus variation were observed between patients who had undergone AVNeo and those with normal aortic valves. Annular area was larger during systole than during diastole in both groups. Postoperative peak pressure gradients were significantly lower in the AVNeo group than in the AVR group. The results of this study demonstrated that aortic annular dimensions after AVNeo are similar to the dimensions of normal aortic valves. Lower postoperative pressure gradients might underlie the observed differences.Similarly, Yamamoto et al. performed AVNeo for AS in 57 patients from December 2010 to June 2017. Their mean age was 77.5±8.8 years. Preoperative echocardiography revealed an average peak pressure gradient of 89±32.9 mmHg that decreased to 22±10.7 mmHg one week after the procedure and 19.2±9.7 mmHg 20 months after the procedure. There were no conversions to AVR. There were two noncardiac-related deaths. Two patients underwent reoperation owing to infective endocarditis and recurrent AR. The mean follow-up period was 30.4±20.8 months. The freedom from reoperation rates was 98.1 and 95.3% at 12 and 81 months of follow-up, respectively.In another study, Iida et al. carried out a prospective single-center study including 52 consecutive patients who underwent AVNeo between September 2015 and March 2017 using autologous pericardium in 16 patients. Most patients presented with AS or endocarditis. The mean age was 60±14 years. Early outcomes included one stroke, two patients needing short-term dialysis, and one death. During follow-up (mean 11.2±4.8 months), trace AR was observed in four patients; the mean pressure gradient was 6.8±2.9 mmHg. Three patients died later (of noncardiac reasons) and five patients needed reoperation due to endocarditis.Mourad et al. operated on 77 patients undergoing AVNeo following the Ozaki procedure between October 2016 and August 2018. Their mean age was 54.9±16.5 years; AS was present in 84.4% and insufficiency in 15.6% of the patients. At 1.76-year follow-up, freedom from reoperation was 97.4%. Two patients (2.6%) presented with moderate to severe aortic insufficiency after the procedure. Both received a prosthetic AVR within the same hospital stay. At discharge, mean pressure gradient was 9.3±4.2 mmHg, which decreased to a mean aortic gradient of 1.6±3.4 mmHg at six to 12 months. The authors concluded that AVNeo following the Ozaki procedure revealed excellent early hemodynamic results in terms of EOA, pressure gradients, and PPM. As we can see, surgeons from all over the world have achieved good initial results by reproducing this surgical procedure in their own populations, which makes AVNeo seem even more promising.Krane et al.The major limitation of the current study is the lack of mid- and long-term follow-ups. We will continue to monitor the results for a longer follow-up period with a larger number of patients.The AVNeo procedure is feasible and reproducible and it has shown good immediate results. Our findings show that aortic valve tricuspidization with glutaraldehyde-treated autologous pericardium produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are required to assess mid- and long-term evolution of the neo-aortic valve.


Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3−month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0−3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4−5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 , admission GCS <8 , and Hematoma volume >30 ml . Intraventricular haemorrhage was an additional poor outcome predictor . Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers. Spontaneous Intracerebral Haemorrhage (SICH) is the second most common cause of stroke and accounts for 7.5−30% of all strokes , 2. HaemIEC 209/2015). All patients above the age of 18 years who were presented to the Emergency Department between 1st January 2015 and 31st December 2018 with computerised tomography (CT) evidence of SICH were included in the study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, and aneurysms were excluded from the study. Demographic data, comorbidities, clinical, radiological data, and information about surgical interventions were recorded in an online registry. Volume of hematoma was measured using the axbxc/2 method [The study was approved by the Institute Ethics Committee, Manipal University , and 638 (70.5%) of them were males. Nearly one-third of the patients (266 patients 29.39%) were below the age of 50 years.n = 523) of patients. Of these 523 hypertensive patients, nearly one-third 36.3% (n = 190) were on irregular treatment, and their mean duration of hypertension was 5.23 ± 4.64 years. The remaining 333 patients were newly diagnosed hypertensive on presentation. A definitive history of diabetes was available for 245 (27.1%) patients with a mean duration of 7.1 years. The mean random blood glucose levels on admission were 162.49 ± 69.05 dl. At the time of the ICH, a total of 83 (9.2%) patients were on antiplatelet medications , contralateral weakness (57%) with a drop in sensorium. The median GCS on admission was 12 (IQR 8–14) and 233 patients presented with a GCS of <8. Mean systolic blood pressure on admission was 175.09 ± 59.08 mmHg and diastolic blood pressure was 99.49 ± 14.02 mmHg.n = 478), thalamic  followed by lobar , cerebellar , brainstem , and primary intraventricular haemorrhage   of patients. Only 46 patients (5.08%) had an increase in the size of hematoma on follow-up imaging. The most common location of the haemorrhage was capsuloganglionic  . ThalamiSurgical evacuation of the clot through craniotomy was performed in 147 (16.8%) patients. External ventricular drainage for intraventricular haemorrhage was performed in 56 (6.2%) patients.p = <0.001) . Of these, 116 (12.81%) patients succumbed during initial hospitalization, and 150 (16.57%) patients died within three months of follow up. For survivors at three months, the median mRS was 4 (IQR 3−6). Functional status at discharge and three months are presented in  <0.001) .Summary of the analysis of the various factors related to mortality and outcome are shown in Hemorrhagic stroke has devastating consequences. The need to identify potential risk factors, initiate corrective measures, and customize treatment cannot be overemphasized, especially in resources limited setting as in India. Published epidemiological studies related to hemorrhagic stroke from India are sparse. –18. ThisPrimary SICH is considered to be a disease of the elderly. The mean age of the study group in Hemphill et al.'s landmark paper was 66 years . The meap = 1.227). We do follow a policy of aggressive blood pressure reduction as it has been well proven that aggressive BP lowering is beneficial in reducing haematoma growth, however it seldom translates to the better clinical outcome [Hypertension is the most common risk factor in all the studies relating to SICH. Feldmann et al. have reported a relative risk of 3.9 for ICH in patients with hypertension . A defin outcome .It is proposed that high blood glucose at admission contributes to poor outcome, due to exacerbation of cerebral oedema and cerebral damage. A recent meta-analysis by Zheng et al. in 2018, concluded that hyperglycemia was associated with poor functional outcome in patients with ICH . HoweverOne of the most consistent predictors of poor outcome, in almost all published series, has been a Glasgow Coma Score of less than 8. Indian studies to have reported similar findings with Bhatia et al. and Namani et al. reporting a fatality of 72.9% and 100% respectively with poor GCS on admission . We obsep < 0.001). We dichotomized our supratentorial bleed patients into two groups of volume of 30 ml and observed that 125/234 (53.6%) with clot volume >30 ml were dead at three months. Hematoma expansion was seen in 46 (5.08%) patients in our study. The mean duration of time of onset to the first CT scan in these 46 patients was 6 : 20 hours (2–17 : 15 hours).The rate of expansion is lesser than other reported studies [Volume of the clot is also a crucial radiological predictor of outcome . It has  studies . The prep < 0.001).Infratentorial hematomas, especially brain stem hematomas, are known to carry a poor outcome compared to supratentorial hematoma. In our series, 17 of the 31 patients with brain stem hematoma expired, and the median mRS at 90 days for the remaining 14 patients was 6. Of the 61 patients with cerebellar hematoma 19 expired and the median mRS at 90 days for the remaining 42 patients was 3. In the INTERACT 2 trial, of the 2,066 patients included in the analyses, the involvement of posterior limb of internal capsule and thalamus and infratentorial sites increased risks of death or major disability . In our p < 0.001) and the presence of hydrocephalus lowered the likelihood of favourable outcome still further to 11.5% (p = 0.031) [p = 0.015). Hydrocephalus was observed in 236 patients (26.1%) in our group and was also an independent predictor of mortality (p = 0.014). This probably can be attributed to the significant number of small to moderate thalamic bleeds with IVE in our study.Intraventricular extension (IVE) is seen in around 40–60% of patients with spontaneous ICH and is known to be a significant predictor of 30-day mortality and long term outcome , 12, 21.= 0.031) . Delayed= 0.031) . In our p = 0.621).Role of surgery in SICH remains controversial. A meta-analysis published by Prasad et al. after the STICH 1 trail concluded that surgery added to medical management reduces the odds of being dead or dependent compared with medical management alone . In TrobSeveral scores for predicting functional outcome and mortality after ICH have been developed. The ICH score proposed by Hemphill has stood the test of time for prognosticating SICH . For SICLess than half of the patients with ICH survive one year, and less than a third survive five years . Poon etThe major limitations of our study are short follow up (90 days) and the fact that the outcome assessment is restricted to mRS. Other important parameters, including cognitive disability etc. have not been assessed. Biomarkers and other novel predictors like neurotophil—lymphocyte ratio was not evaluated.Spontaneous Intracerebral Hemorrhage predominantly affects a younger population in India in comparison to the Western population. Age > 70 years, GCS < 8 on admission, clot volume above 30 ml, and intraventricular extension and hematoma growth and hydrocephalus remain the most consistent predictors of death and poor outcome following spontaneous intracerebral hematoma. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate outcome after SICH using novel predictors, including bio markers.


Postpartum febrile morbidity is relatively common, occurring in approximately 5–7% of births. Differentiating between potentially serious and benign causes of postpartum pyrexia (PP) is fundamental in curbing the mortality rate from sinister causes such as sepsis. The paucity of data on PP in Cameroon makes it difficult to access its actual burden. This study was aimed at determining the prevalence, risk factors and aetiologies of PP at a tertiary hospital in Douala, Cameroon.This was a 2 – year hospital – based retrospective cohort study carried out at the Douala General Hospital (DGH), during which medical records of all postpartum admissions between January 1st 2017 and December 31st 2018 were reviewed. The review consisted of collecting data on socio-demographic characteristics, clinical profile, investigations and final diagnoses. The collected data was analysed in SPSS 23.0. Chi-squared test was used to test the association between variables and a logistic regression analysis was fitted to identify risk factors associated to PP.E. coli was the most (49.3%) cultured germ isolated in positive cultures. Onset of PP was more common (85%) within the first 3 days postpartum and malaria (60%) was the leading aetiology within this period. Five or more vaginal examinations prior to delivery , perineal tears , and duration of labour > 18 h  were the most significant risk factors associated with PP.A total of 1520 postpartum files were reviewed. The prevalence of PP was 8.82%. The most frequent causes of PP were: malaria (46.7%), urinary tract infections (18.7%), puerperal sepsis (17.9%) and pneumonia (8.7%). . Malaria was the leading cause of PP at DGH especially for cases registered within 3 days postpartum. The risk factors identified were mostly associated to perinatal events, such as frequent vaginal examinations, perineal tears and prolonged labour. Efforts towards preventing identified risk factors thus becomes paramount in order to curb this high rate of PP in the DGH.Approximately 1 in every 12 postpartum cases in the DGH presents with PP Other significant causes of postpartum pyrexia include urinary tract infections, surgical wound infection, malaria, septic thrombophlebitis and mastitis [Postpartum pyrexia is any temperature rise above 38 °C maintained over 24 h or recurring between the end of the first to the end of the 10th day after childbirth . The lowmastitis , 10. ResThis was a hospital based retrospective cohort study, conducted between February and May 2019 in Douala general hospital (DGH), Cameroon. DGH is a tertiary hospital with four hospitalization units , and well equipped laboratory and radiology units with highly trained staff. It has a well-organized gynecological/obstetric unit with obstetricians and gynecologists who provide all facets of perinatal care. It also has a well-equipped and functioning theatre that handles all obstetric surgeries. The hospital functions as a parastatal and is found in the city of Douala, Littoral region of Cameroon. Douala is the largest city in Cameroon with a population of more than 3.5 million inhabitants .The study population was made up of postpartum women admitted at the DGH between January 1st 2017 and 31st December 2018. Medical records of women in postpartum follow-up  admitted in the DGH between 1st January 2017 and 31st December 2018 were analyzed. Incomplete files were excluded.Data was collected using a predesigned data collection sheet. The women were placed in a cohort, those with postpartum pyrexia and those without. Data collected included; socio-demographic characteristics, clinical profile, investigations and final diagnoses or causes of PP.P-value < 0.05 was considered significant.The collected data was entered into Microsoft excel and exported to SPSS version 24.0 for analysis. Chi-squared test was used to establish association between variables and risk factors were identified using a logistic regression analysis. The predictor variables were grouped into sociodemographic or obstetric. A o 2019/887–01/UB/SG/IRB/FHS). An administrative approval was obtained from the Directorate of the Douala General Hospital, Cameroon (No 090 AR/MINSANTE/HGD/DM/O2/19). To ensure confidentiality, all patient information was coded.The ethical clearance for this study was obtained from the institutional Review Board of the Faculty of Health Sciences, University of Buea  gave birth at the DGH, and 18 (1.2%) women were referred for postpartum care at the DGH following delivery in different hospitals.Table Of the1520 files reviewed, 134 were cases of postpartum pyrexia, 88 out of 1018 vaginal delivery and 46 of the 502 caesarean section. This gave an overall postpartum pyrexia prevalence of 8.82%, with rates of 9.16% following caesarean section and 8.64% following vaginal delivery.p < 0.001), perineal tears , duration of labour greater than 18 h , hemoglobin level <  8 g/dl prior to delivery , pre-eclampsia , grand multiparty ,less than 4 antenatal visits  and caesarean delivery  . Other causes identified included urinary tract infections, 28 18.7%), endometritis, 20 (13.3%), pneumonia, 13 (8.7%), perineal wound infection, 5 (3.3%), CS wound infection, 4 (2.7%), acute appendicitis, 2(1.3%), typhoid fever, 2 (1.3%), vaginal candidiasis, 2 (1.3%), venous thromboembolism (1.3%), bacterial vaginosis, 1 (0.7%) and cholecystitis, 1 (0.7%). 12 (9.0%) of women had both malaria and UTI, 3 (2.2%) had UTI and endometritis and 2 (1.4%) had endometritis and perineal wound infection.  was the leading cause of fever within the first 3 days postpartum. Between days 4 to 6, postpartum pyrexia was mainly caused by pneumonia 28.6% (6/21), UTI 23.8% (5/21), malaria 19.0% (4/21) and endometritis 9.5% (2/21). From day 7 and above, the main cause of postpartum pyrexia was endometritis 72.2% (13/18), perineal wound infection 16.7% (3/18) and venous thromboembolism 11.1% (2/18) (Table E. coli (51.5%) was the most isolated organism  had postpartum pyrexia, slightly edging the global prevalence of 5–7% . A simil studies , 22 whicterature , 21, 23.terature  in whichThe Douala General Hospital is a tertiary hospital with one of the highest standards and cost of care in Cameroon. High cost of care may have increased the probability of getting patients only from a certain class in the society. Hence the prevalence of postpartum pyrexia gotten from this study, may not be very reflective of the actual burden in the country, as majority of people seek care only in primary care centers where there are usually sub-standard infection control measures, and probably a higher prevalence of postpartum pyrexia. We recommend further research on this subject using prospective study designs, in primary secondary health facilities.E. coli, being the most implicated causative agent. The high rate of postpartum malaria noted in this study, is highly suggestive of poor adherence to preventive measures of malaria during pregnancy, such as the use of insecticide treated mosquito nets and intermittent preventive treatment of malaria. It is therefore fundamental that these women be sensitized during antenatal care on the importance of adhering to these measures, and also for the state to ensure that, these facilities are always available to these women free of cost. Also efforts towards preventing identified risk factors of PP thus become paramount in order to curb this high rate of postpartum pyrexia in our hospitals and community at large.In the Douala General Hospital, the prevalence of PP was 8.82% with a rate of 1 in every 12 postpartum admissions. The risk factors were mainly perinatal factors such as frequent vaginal examinations during labour, perineal tears and prolonged labour. Postpartum pyrexia was more prevalent on the first 3 days postpartum, and was most commonly due to postpartum malaria. UTI and puerperal sepsis, in keeping with data from other studies in Africa, were also very significant causes of postpartum pyrexia in DGH, with