ABSTRACT
Recurrent urinary tract infection (rUTI) affects a large proportion of women after an initial episode and consumes a substantial share of community antibiotic prescribing, yet prevention remains unsatisfactory and recurrence incompletely explained. Approximately half of recurrences are caused by the strain responsible for the index infection, implying a host reservoir that antimicrobial treatment does not eradicate. That reservoir is the intestine. This review applies to that reservoir an established mechanism that governs its size. Depletion of butyrate-producing Clostridia reduces peroxisome proliferator-activated receptor gamma signalling in colonocytes, shifts epithelial metabolism away from beta-oxidation, raises luminal oxygen and nitrate availability and permits an aerobic expansion of Enterobacteriaceae, including Escherichia coli. Butyrate sustains the physiological hypoxia that restrains this expansion by stabilising hypoxia-inducible factor, and the pathway is pharmacologically reversible in animal models. Women with rUTI show depletion of richness and of butyrate-producing bacteria without a corresponding difference in E. coli abundance, an apparent paradox that the proposed mechanism resolves, because what is lost is the epithelial capacity to restrain expansion rather than the organism itself. At population scale, butyrate-producer abundance is inversely associated with hospitalisation for infection. Antibiotics deplete these taxa profoundly and for prolonged periods, which closes a plausible self-perpetuating loop. Restoration of the intestinal community by faecal microbiota transplantation reduces recurrence. Butyrate nevertheless does not appear among interventions evaluated in current syntheses of non-antibiotic prophylaxis. We set out the evidence, state the falsifiable predictions of the model, and outline the trial required to test it. We locate butyrate-directed intervention within the wider class of postbiotic and microbial-metabolite strategi

ABSTRACT
Megaloblastic anemia is a type of anemia characterized by the presence of large, immature red blood cells called megaloblasts. The classic clinical symptoms include fatigue, weakness, pallor, palpitations, and dizziness, reflecting the underlying anemia. Neurological signs, such as paresthesias, ataxia, and cognitive impairment, may also be present in cases of vitamin B12 deficiency. Physical examination may reveal signs of digestive involvement, like glossitis and intestinal motility disorders. The key laboratory findings in the diagnosis of megaloblastic anemia include macrocytic, normochromic anemia, the presence of megaloblasts and macrocytes on the blood smear, and decreased levels of vitamin B12 and/or folate. Elevated homocysteine and methylmalonic acid levels can also be observed in vitamin B12 deficiency. In cases of suspected malabsorption, further testing, such as the Schilling test, endoscopy, and intestinal biopsy, may be necessary to identify the underlying cause. A comprehensive clinical assessment and the interpretation of laboratory results are essential for the accurate diagnosis and appropriate management of megaloblastic anemia. Understanding the various clinical and laboratory aspects of this condition is crucial for healthcare professionals to ensure timely and effective diagnosis and treatment.

ABSTRACT
One among the commonest type 1 surgical offloading procedure is gastrocnemius-soleus recession which is performed to correct equinus in neuropathic foot ulcer as well as other foot and ankle pathologies. There are numerous techniques be it open, percutaneous or endoscopic, being performed in different parts of the world, depending upon availability and surgeons choice. This paper aims to review the open and percutaneous gastrocnemius-soleus recession/lengthening techniques.

ABSTRACT
Background: Heart failure (HF) is a major public health problem, responsible for numerous hospitalizations and a substantial economic burden. This study aimed to assess the direct cost of inpatient management of HF at the Abidjan Heart Institute. Methods: Prospective cross-sectional descriptive and analytical study conducted from January 1 to May 31, 2025. Adults ≥18 years hospitalized for HF in medical wards and intensive care units were included. Two hundred patients were interviewed; healthcare and associated costs were collected; indirect costs were excluded. The mean total cost incurred during hospitalization was estimated in West African CFA francs (XOF). Results: The mean total cost of inpatient care was 439,560.75 XOF (US$724.15), with values ranging from 303,171 XOF (US$499.45) to 1,340,306 XOF (US$2,200.10). The mean length of hospital stay was 7.1 ± 2 days. Medication costs averaged 169,038.15 XOF (38% of total cost). Diagnostic investigations accounted for 183,832.60 XOF (42% of total cost), and accommodation/hospitalization costs averaged 86,690 XOF (20% of total cost). In multivariable analysis, overall cost was significantly associated with underlying cardiac disease: ischemic heart disease (OR 3.20; 95% CI 1.6–6.5; p = 0.001) and valvular heart disease (OR 4.08; 95% CI 1.1–14.4; p=0.029). Conclusion: The direct cost of inpatient management of HF is substantial in our setting. Strengthening prevention and management of cardiovascular risk factors and improving access to health insurance may help reduce the financial burden associated with HF.

ABSTRACT
Magnetic resonance imaging (MRI) remains the modality of choice in the investigation of children with seizures especially in age groups that can no longer be examined using transfontanelle ultrasound. High-field MRI equipment, with at least a 1.5 Tesla magnetic field strength, is best used to evaluate these children. This research aimed to audit MRI findings in children (0–17 years) imaged in our department for seizures over a 2-year period (January 2024–January 2026). We retrospectively reviewed the Department of Radiology records at Babcock University Teaching Hospital, Ilishan-Remo, South-West Nigeria, which has a General Electric 1.5 Tesla MRI machine. The MRI findings were recorded in Microsoft Excel and then entered and analysed using SPSS version 25. The Babcock University Research Ethics Committee approved the study. Out of a total of one hundred and six (106) children who had brain MRI within the review period, there were thirty-seven (37) with seizures. Most children with seizures were adolescents (13-17 years, 59.46%), followed by school-aged children (6-12 years, 13.51%) and toddlers (1-3 years, 13.51%). The female-to-male ratio was 1:1.06. MRI abnormalities were found in 21 out of 37 (54.56%) of seizure cases, more in males. The main abnormal brain findings in children presenting with seizures were generalised cerebral atrophy (GCA), focal cortical dysplasia (FCD), mesial temporal sclerosis, infarcts, gliosis, and hypoxic-ischaemic encephalopathy (HIE). Our findings are comparable to those in previous studies. High-field Magnetic Resonance Imaging remains a valuable modality for evaluating seizures in children.