[Lymphocytic meningitis in Bamako, Mali]

We conducted a prospective survey from January 2001 to March 2002. Our objective was to study etiologic, clinic, and prognostic aspect of lymphocytic meningitis in hospital of Point G to Bamako. We included 35 patients with 25 male (71. 4%) and 10 female (28. 6%), sex - ratio (M / F) equal 2. 5. The median age was of 35 ± 25.4 years (range, 16 - 66 years). HIV serology was positive 26 cases (83. 9%). Clinical presentations were different. We observed 15 cases of encephalitis, 12 cases of meningoencephalitis, 2 cases of meningitis and 6 cases of febrile syndrome. Mean duration of hospitalization was 32. 6 ± 68 days. Mean of lymphocyte was 85.3 ± 25.9% among leukocytes in cerebrospinal fluid of 31 patients. Analysis of cerebrospinal fluid (CSF) identified in 9 cases Cryptococcocus neoformans. In 16 cases etiology was determination based on indirect arguments. In 9 cases viral meningoencephalitis diagnosis was made by exodiagnosis. It concerned 2 cases of TB meningitis, 1 case of cerebral toxoplasmosis, 1 case of decapitate bacterial meningitis and 1 case of cerebral tumor. Malaria thick smear permits to diagnosticate 1 case of cerebral malaria and 1 case of uncomplicated malaria. There are still 10 cases in which the cause remained unknown during study. HIV infection provides principally lymphocytic meningitis. Co morbidity with HIV is associated to lethality at 75%. But no statistical difference with patients without HIV (p = 0.52). Our work puts in exergue all problematic and hold correct of lymphocytic meningitis in our country.

[Stoma use in the general surgery service of CHU Gabriel Touré]

OBJECTIVES

Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma.

MATERIAL AND METHODS

It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P < 0.05.

RESULTS

We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%.

CONCLUSION

The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

Randomized, multicentre assessment of the efficacy and safety of ASAQ--a fixed-dose artesunate-amodiaquine combination therapy in the treatment of uncomplicated Plasmodium falciparum malaria

Background

The use of artemisinin derivative-based combination therapy (ACT) such as artesunate plus amodiaquine is currently recommended for the treatment of uncomplicated Plasmodium falciparum malaria. Fixed-dose combinations are more adapted to patients than regimens involving multiple tablets and improve treatment compliance. A fixed-dose combination of artesunate + amodiaquine (ASAQ) was recently developed. To assess the efficacy and safety of this new combination and to define its optimum dosage regimen (once or twice daily) in the treatment of uncomplicated P. falciparum malaria, a multicentre clinical study was conducted.

Methods

A multicentre, randomized, controlled, investigator-blinded, parallel-group study was conducted in five African centers in Cameroon, Madagascar, Mali and Senegal from March to December 2006. Efficacy and safety of ASAQ were assessed compared to those of artemether + lumefantrine (AL). The WHO protocol with a 28-day follow-up for assessing the drug therapeutic efficacy was used. Patients suffering from uncomplicated P. falciparum malaria were randomized to receive ASAQ orally once daily (ASAQ1), ASAQ twice daily (ASAQ2) or AL twice daily (AL) for three days. The primary outcome was PCR-corrected parasitological cure rate and clinical response.

Results

Of 941 patients initially randomized and stratified into two age groups (<5 years, and ≥5 years), 936 (99.5%) were retained for the intent to treat (ITT) analysis, and 859 (91.3%) patients for the per protocol (PP) analysis. Among ITT population, up to D28, PCR-corrected adequate parasitological and clinical response rates were 95.2% in the ASAQ1 group, 94.9% in the ASAQ2 group and 95.5% in the AL group. Moreover, the cure rate evaluated among PP population was ≥98.5% in both ASAQ therapeutic arms. Therapeutic response rates did not display any significant differences between age groups or between one geographical site and another. Altogether, this demonstrates the non-inferiority of ASAQ1 regimen compared to both ASAQ2 and AL regimens. During follow-up mild and moderate adverse events including gastrointestinal and/or nervous disorders were reported in 29.3% of patients, with no difference between groups in the nature, frequency or intensity of adverse events.

Conclusion

The non-inferiority of ASAQ compared with AL was demonstrated. The fixed-dose combination artesunate + amodiaquine (ASAQ) is safe and efficacious even in young children under 5 years of age. Whilst administration on a twice-a-day basis does not improve the efficacy of ASAQ significantly, a once-a-day intake of this new combination clearly appears as an effective and safe therapy in the treatment of uncomplicated P. falciparum malaria both in adults and children. Implications of such findings are of primary importance in terms of public health especially in African countries. As most national policies plan to strengthen malaria control to reach the elimination of this disease, anti-malarial drugs such as the artesunate + amodiaquine fixed-dose ACT will play a pivotal role in this process.

Trial registration

The protocol was registered with the www.clinicaltrials.gov open clinical trial registry under the identifier number NCT00316329.

The JAK2(V617F) tyrosine kinase mutation identifies clinically latent myeloproliferative disorders in patients presenting with hepatic or portal vein thrombosis

Clinically latent myeloproliferative disorders (MPDs) are important causes of what would otherwise be considered idiopathic hepatic (HVT) or portal vein thrombosis (PVT). They may be difficult to diagnose initially because the peripheral blood count may be normal at the time of thrombosis. A strong association between an activating mutation of the gene encoding one of the Janus kinase family of tyrosine kinases (JAK2(V617F)) and the Philadelphia chromosome-negative MPDs has been identified. We have studied 19 patients with unexplained HVT or PVT and tested for JAK2(V617F). Fourteen (74%) of the 19 patients were heterozygous for JAK2(V617F) but did not meet diagnostic criteria for a MPD at the time of presentation with thrombosis. Prolonged follow-up established the presence of an overt MPD in 13 of the 14 patients after a median duration of 38 months. We recommend testing for JAK2(V617F) in all patients with unexplained HVT or PVT, to identify latent MPDs and prevent potential complications.

Fumonisin exposure and the sphinganine/sphingosine ratio in urine, serum and buccal cells in adults from Burkina Faso, West Africa

Fumonisins are mycotoxins that frequently contaminate maize, a dietary staple in Burkina Faso. Fumonisins have been linked with both the incidence of oesophageal cancer, and to neural tube defects. However, epidemiological studies of these associations are hampered by lack of validated exposure biomarkers. One candidate biomarker is the sphinganine/sphingosine (Sa/So) ratio in biological samples. Twenty husband-wife pairs aged 20-40 were recruited from Dingasso-1, western Burkina Faso. Plate ready food was sampled over three consecutive days (day one to three) for fumonisin B1 and B2, to provide a measure of total fumonisin intake. The Sa/So ratio was determined in (1) first morning urines taken on days two to four, (2) buccal cells and (3) serum on days one and four only. Fumonisin intake was moderate (mean 0.81 µg/kg bw/day (range 0.01-2.40 µg/kg bw/day) compared to exposures reported in China and South Africa. For each person the mean fumonisin intake over three days was compared to the mean Sa, So and Sa/So ratio in urine, buccal cells and serum. A modest positive trend between mean fumonisin intake and mean serum Sa/So was observed (P=0.067). When individuals were dichotomised based on the median fumonisin intake (<0.75 µg/kg bw/day), the serum Sa/So ratio was moderately higher (P=0.044) in the high intake group (geometric mean 0.64; 95% CI: 0.54, 0.75) compared to the low intake group (0.49; 95% CI: 0.41, 0.59). Neither urinary nor buccal cell Sa/So ratio was associated with mean fumonisin intake. Neither mean individual Sa nor So level for urine, buccal cells or urine was associated with mean individual fumonisin intake. The study population was exposed to moderate levels of fumonisin with limited evidence of altered Sa/So ratio. Further work on serum Sa/So ratio is merited in comparison with other biomarker approaches such as urinary fumonisin B1 or sphingolipid 1-phosphate metabolites.

Multivariate analyses on morphological traits of goats in Burkina Faso

Abstract. A total of 10,147 female goats from Burkina Faso were scored for 7 body measures and 12 qualitative traits. Sampling included the three main environmental areas and goat breeds of Burkina Faso: the Sahel area (Sahelian goat), the Sudan-Sahel area (Mossi goat) and the Sudan area (Djallonké goat). Overall, the Sahelian goat had the highest values for the all the analysed body measures. Differences between the Sudan and the Sudan-Sahel goat were little. The Burkina Faso goat is mainly spotted (61.92 %) with horns type “Spanish Ibex” (84.05 %), frequent absence of beard (75.33 %) and wattles (70.92 %) and poorly developed udder (73.72 %). The Sahelian population included most individuals with dropping (95.60 %) and curled (73.62 %) ears, whilst most Sudan-Sahel individuals had horizontal ears (73.14 %) and most Sudan individuals had vertical ears (97.88 %). The largest Mahalanobis distance was found between the Sahelian and Sudan areas (7.50) whilst the Sudan and the Sudan-Sahel populations were poorly differentiated (1.15). Discriminant analysis showed that most Sahel and Sudan-Sahel individuals were classified into their source population (79.29 % and 82.69 %) whilst the Sudan individuals (93.40 %) were classified as Sudan-Sahel individuals. Both the canonical and the correspondence analyses showed that the Sahelian and Sudan individuals tended to cluster separately whilst the Sudan-Sahel individuals showed an intermediate distribution but clearly biased toward the Sudan individuals. The Sudan-Sahel (Mossi) population can be considered a result from the genetic contact between Sahelians and Sudan goats.

Longitudinal evaluation of three azithromycin distribution strategies for treatment of trachoma in a sub-Saharan African country, Mali

OBJECTIVES

Trachoma, caused by repeated ocular infections with Chlamydia trachomatis is an important cause of blindness. Mass azithromycin distribution is part of current recommended strategies for controlling trachoma. In order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in Mali between May 2000 and February 2002.

METHODS

Three azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy I), treatment of all children under 11 years of age and of women between 15 and 50 (strategy II), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy III). In a particular Malian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. According to the strategy allocation, adults were eventually given a single dose of 1g azithromycin, and children a unique dose of 20 mg/kg. Moreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. Ophthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. The outcome variable was clinically active trachoma frequency 12 months after intervention among children under 11 years of age. A descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies.

RESULTS

Among children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy I, from 20.8% to 6.8% in strategy II, and from 20.2% to 8.5% in strategy III. After adjustment on age (adjusted odds ratio [AOR] = 0.81; 95% confidence interval [95% CI]: 0.75-0.87) and on active trachoma occurrence at baseline (AOR = 3.81; [95% CI]: 2.70-5.39), the multiple logistic regression model showed that both strategies I and II gave similar results, while strategy III appeared significantly less effective (AOR = 1.56; [95% CI]: 1.00-2.43).

CONCLUSION

In mesoendemic trachoma areas, targeted treatment to all children under 11 years of age and women between 15 and 50 (strategy II) was as effective as indiscriminate mass distribution (strategy I) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy III). Strategy II could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy I).

Caractéristiques de la population prise en charge au Service de Psychiatrie du CHU Yalgado Ouédraogo de Ouagadougou (Burkina Faso) de 1990 à 2000

Mental disorders constitute an important portion of the world sickness ratio. In developing countries, in the absence of data on morbidity, hospital statistics are worthy of interest. Our study was carried out on a population of patients under care in the department of psychiatry of the Ouagadougou Hospital between January 1st 1990 and December 31st 2000, a period of 11 years. For each patient, we noted the sociodemographical features and the clinical diagnosis referring to the ICD-10 of the WHO. Within the scope of the study, 7 313 patients (60% men and 40% women) were analysed. The average age of the patients was 31.06 +/- 13.07 years. Among these patients, 80.60% had been exclusively under ambulatory care and 19.40% had been hospitalized at least once. The main categories of the available diagnoses were listed according to recurrence: acute psychotic disorders (20.68%), schizophrenia (17.25%) and depression (15.13%). In the men, the main diagnosis was acute psychotic disorders, whereas depression came top of the list for women. In the present state of socio-economic and cultural development in Burkina Faso, we note that only very serious mental disorders and/or those who cannot obtain favourable response with the traditional care system, come to medical centers. Therefore, there is a need to investigate the population as a whole, and to assess their need for medical care in this domain.

Prevalence of common gastrointestinal nematode parasites in scavenging pigs of different ages and sexes in eastern centre province, Burkina Faso

The range and infestation intensities of gastrointestinal parasitic nematode species depend on the type of swine production system. The present study focused mainly on nematodes of veterinary importance in scavenging pigs in Burkina Faso, and aimed at determining the prevalence of gastro-intestinal nematode parasites by means of faecal egg per gram (EPG) counts. Between November 2001 and October 2002, faecal samples from 383 pigs of different sexes and ages (< 5 months, 5-12 months and > 12 months) were collected from the rectum and examined for gastrointestinal nematodes parasites using the Mc Master method. Of the 383 pigs examined, 91% were infected by one or more parasites. Ascaris suum (40%; 100-1 400 EPG) was the most prevalent parasite followed by Strongyloides ransomi (21%; 100-4200 EPG), Oesophagostomum spp. (18%; 100-1000 EPG), Hyostrongylus rubidus (11%; 100-1 800 EPG), Globocephalus spp. (10%; 100-400 EPG) and Trichuris suis (1 %; 100-200 EPG). The prevalence was significantly higher in female pigs (n = 239) than in males. In addition, females excreted significantly (P < 0.05) more eggs in their faeces than males, except in the case of Globocephalus spp. The age of the animal had no effect on the prevalence of A. suum whereas there were significant differences in age categories concerning S. ransomi, H. rubidus, Oesophagostumum spp. and Globocephalus spp. Unexpectedly, the high prevalence of these common parasites was not accompanied by elevated EPG values, which suggests the existence of moderate infestations. The present work indicates that the common nematode infestations in pigs do not necessarily need a systematic herd anthelmintic treatment, as only a small number of worms is required to induce immunity. A further study is needed to formulate appropriate and cost-effective strategies for the control of gastro-intestinal nematode parasites in pigs in Burkina Faso.

Model-based evaluation of an on-line control strategy for SBRs based on OUR and ORP measurements

Application of control strategies for existing wastewater treatment technologies becomes necessary to meet ever-stricter effluent legislations and reduce the associated treatment costs. In the case of SBR technology, controlling the phase scheduling is one of the key aspects of SBR operation. In this study a calibrated mechanistic model based on the ASM1 was used to evaluate an on-line control strategy for the SBR phase-scheduling and compare it with the SBR's performance using no control strategy. To evaluate the performance, reference indices relating to the effluent quality, the required energy for aeration and the treated wastewater volume were used. The results showed that it is possible to maintain optimal SBR performance in the studied system at minimal costs by on-line control of the length of the aerobic and anoxic phases.

An on-line optimisation of a SBR cycle for carbon and nitrogen removal based on on-line pH and Our: the role of dissolved oxygen control

A pilot plant sequencing batch reactor (SBR) was applied in a wastewater treatment plant treating urban wastewater focused on carbon and nitrogen removal. From an initial predefined step-feed cycle definition, the evolution of the on-line monitored pH and calculated oxygen uptake rate (OUR) were analysed in terms of knowledge extraction. First, the aerobic phases of the SBR cycle were operated using an On/Off dissolved oxygen (DO) control strategy that concluded with a sinusoidal pH profile that made detecting the "ammonia valley" difficult. After changing to fuzzy logic control of the dissolved oxygen and by adding an air flow meter to the pilot plant, the pH evolution and on-line calculated OUR showed a clearer trend during the aerobic phases. Finally, a proposed algorithm for adjusting the aerobic phases of the SBR for carbon and ammonia removal is presented and discussed.

[Myocardial localization of a disseminated cysticercosis. Echocardiographic diagnosis of a case]

Cysticercosis (cysticercus cellulosoe) is a parasitic infestation of human by a larval form of Taenia solium. The localisations are mostly the central nervous system, skeletal muscles and subcutaneous tissue, but other organs can be concerned. Myocardial cysticercosis is an extremely rare infection. We report a case of myocardial cysticercosis in a 37 year old patient who presented a disseminated form. The myocardium involvement is diagnosed by echocardiography. The clinical and echographic evolution was favourable after a treatment with albendazole. The other cardiovascular manifestations described in the literature are discussed.

[Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso]

BACKGROUND

The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order

METHODS

A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained.

RESULTS

Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002).

CONCLUSIONS

These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.

[Pityriasis rosea in secondary schools in Ouagadougou, Burkina Faso]

BACKGROUND

Pityriasis rosea is a spontaneously regressive benign erythematous squamous dermatosis. A better understanding of this condition in developing countries would be useful.

PATIENTS AND METHODS

We conducted a cross section study based on one-day surveys in Ouagadougou, Burkina Faso, secondary schools. The stratified cluster sampling method described by Henderson was used. Six thousand pupils were examined to collect epidemiology and clinical data and to determine the presence of complications and results of complementary explorations performed.

RESULTS

Thirty-six cases of pityriasis rosea were observed (0.6 p. 100). Prevalence was higher in children from an unfavorable social and economic background. A typical eruption was often observed with classical localizations and morphology in 86.1 p. 100 of the cases. Pruritus was often observed with an inaugural lesion (61.1 p. 100) predominantly on the upper limbs (54.6 p. 100) and the trunk (31.8 p. 100) measuring 1 to 3 cm. A typical second eruption was found in most cases, situated on the trunk (75 p. 100), distal portions of the limbs (64.4 p. 100), proximal portions of the limbs (33.3 p. 100) and the neck (30.5 p. 100). The eruption evolved for 1 week to 1 month in most cases (61 p. 100). In 55.5 p. 100 of the cases, therapeutic abstention was the rule. Secondary treatment-related complications occurred in 38.9 p. 100 of the cases. Stool studies generally demonstrate ameba cysts. Syphilis serology was negative.

DISCUSSION

Our sampling technique in the secondary school setting provided a representative sample of the urban population of African cities. This work demonstrated the variability of prevalence by social and economic conditions and is in favor of an infections cause, demonstrating several similar features with other series reported in the literature. Generally, a stool study is not necessary and syphilis serology is negative in typical cases. Health care workers should be more aware of pityriasis rosea in order to avoid poorly adapted treatment.

1H-nmr study of water dynamics in hydrated collagen: transverse relaxation-time and diffusion analysis

Water proton transverse relaxation times (T2) and self-diffusion coefficients (D) were measured in randomly oriented hydrated collagen fibers. Three T2 relaxation times were discerned indicating the presence of at least three water fractions in the collagen sample. The D values associated with each water fraction were determined. The diffusion time dependence of D suggests water motion is restricted by macromolecular structure. The experimental results are discussed with reference to the structural properties of hydrated collagen fibers.