[Pharmacovigilance among dentists: a survey of practitioners in Dakar, Senegal]

AIM

Since 1968, the World Health Organization has used an international pharmacovigilance programme to monitor and examine the effects of drugs. The purpose of this study was to assess the knowledge and attitudes of dentists toward pharmacovigilance.

METHODS

The paper presents the results of a cross-sectional descriptive study of 103 dentists in Senegal, based on an exhaustive selection process. Data were collected on the dentists' sociodemographic characteristics and their knowledge and attitudes toward pharmacovigilance.

RESULTS

Over 50% of the sample were general practitioners. The average number of years of professional experience was 9 years. Painkillers (41.9%) were the most widely prescribed drugs, followed by antibiotics, which were particularly involved in the onset of adverse effects (41.8%). Adverse effects were observed by just 3.8% of the sample. Almost 90% of the participants were not aware of the existing pharmacovigilance system.

CONCLUSION

The results suggest that pharmacovigilance training and education sessions for dentists are needed to improve their knowledge of pharmacovigilance and to foster positive attitudes toward adverse effects.

Low-level environmental exposure to lead and renal adverse effects: a cross-sectional study in the population of children bordering the Mbeubeuss landfill near Dakar, Senegal

This study deals with the health effects within a child population, neighbouring a landfill. After detecting metals in soil and air samples collected in the surroundings of the landfill and in a control site, we have studied: (i) levels of lead (Pb) and exposure biomarkers in blood and urine, (ii) oxidative stress biomarkers and (iii) renal injury by applying a set of early effect biomarkers. Levels of Pb were higher in the exposed site (i.e. 1129 mg/kg and 640 ng/m(3) in soil and air samples, respectively) versus those in the control site (i.e. 14.3 mg/kg and 9.3 ng/m(3) in soil and air samples, respectively). Pb impregnation and levels of delta-aminolevulinic acid in urine were influenced by the living site that shows the prevailingly alarming situation in the Mbeubeuss landfill. Malondialdehyde changes indicated Pb-induced excessive production of reactive oxygen species. Lactate dehydrogenase activities and proteinuria were found to be higher in the children living in the exposed site. These evidences may reveal the usefulness of these two effect biomarkers to monitor the kidney injury entailed by relatively low-environmental exposure to Pb. Overall, these results show that the Mbeubeuss landfill constitutes a real source of environmental and health risk, be it living or working on site, of the surrounding population, predominantly for children.

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'

BACKGROUND

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.

PATIENTS AND METHODS

We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.

RESULTS

Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].

CONCLUSION

ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Osteogenesis imperfecta in a pediatric surgical center in dakar, senegal: clinical and radiological aspects

INTRODUCTION

Osteogenesis imperfecta presents with a set of constitutional disorders of varying severity, genetically determined and characterized by an abnormal production of collagen and matrix of the bone leading to bone fragility responsible for multiple fractures and many skeletal deformities. The aim of our study was to analyze the clinical and radiological aspects of the pathology.

PATIENTS AND METHODS

This was a retrospective study of 10 cases of children with osteogenesis imperfecta who consulted the Pediatric Surgery Unit of the University Center Aristide Le Dantec Hospital over a period of 6 years. The parameters analyzed were the reasons for consultation, physical examination findings and findings on standard radiographs. After collecting all the data, children were divided according to the classification of Silence and Glorieux.

RESULTS

Pain was the reason for consultation in eight children. The saber blade deformity of the legs was found in nine children. Physical examination found tenderness in 80% of cases. Blue sclera was found in one child. The teeth were normal in eight patients. Standard radiographs showed an osteopenic skeleton with multiple fractures (3.7 fractures on the average) associated with vicious callus formation and deformity. According to the classification of Silence and Glorieux, six children were type VI, two children type IV, a child type III and one type I.

CONCLUSION

Osteogenesis imperfecta is a rare disease. In our environment, the diagnosis is made late - a stage associated with deformity. Of these, the occurrence of sabber deformity of the lower limbs is the most common. Radiological aspects are dominated by vicious callus formation, deformed bones and osteopenia. Moderate forms are predominant. Parents need to be educated about the risk of repeat fractures and the need to present deformed children to hospital early.

Potential use of densified polymer-pastefill mixture as waste containment barrier materials

Mining activities generate a large amount of solid waste, such as waste rock and tailings. The surface disposal of such waste can create several environmental and geotechnical problems. Public perception and strict government regulations with regards to the disposal of such waste compel the mining industry to develop new strategies which are environmentally sound and cost effective. In this scenario, recycling of such waste into mining or civil engineering construction materials have become a great challenge for the mining and civil engineering community. Hence, in this study, taking advantage of the inherent low hydraulic conductivity of paste tailings (pastefill), small amounts (0.05, 0.1, 0.2, 0.5%) of a super absorbent polymer (SAP) are added to the latter after moisturizing the tailings. The resulting densified polymer-pastefill (PP) materials are compacted and submitted to permeability tests at room temperature and performance tests under cyclic freeze-thaw and wet-dry conditions to evaluate their suitability as a barrier for waste containment facilities. Valuable results are obtained. It is found that the hydraulic conductivity of the proposed barrier material (PP) decreases as the amount of SAP increases. Hydraulic conductivity values as low as 1 × 10(-7) and 6 × 10(-9)cm/s are obtained for PPs which contain 0.1-0.5% SAP, respectively. The PP material also shows relatively good resistance to cyclic freeze-thaw and wet-dry stresses. The results show that negligible to acceptable changes in hydraulic conductivity occur after five freeze-thaw and six wet-dry cycles. None of the changes reach one order of magnitude. As a final step, a cost analysis is undertaken to evaluate the economical benefits that could be drawn from such a proposed barrier material. When compared to a conventional compacted sand-bentonite barrier with 12% bentonite concentration, it is found that the benefit realized could be estimated to 98, 96 and 90% when using PP material that contains 0.10, 0.20 and 0.5% of SAP. From this study, it can be concluded that PP materials show encouraging performance properties for barrier design.

Exploring the influence of operational parameters on the reactivity of elemental iron materials

In an attempt to characterize material intrinsic reactivity, iron dissolution from elemental iron materials (Fe(0)) was investigated under various experimental conditions in batch tests. Dissolution experiments were performed in a dilute solution of ethylenediaminetetraacetate (Na(2)-EDTA - 2mM). The dissolution kinetics of 18 Fe(0) materials were investigated. The effects of individual operational parameters were assessed using selected materials. The effects of available reactive sites [Fe(0) particle size (<or=2.0mm) and metal loading (2-64 g L(-1))], mixing type (air bubbling, shaking), shaking intensity (0-250 min(-1)), and Fe(0) pre-treatment (ascorbate, HCl and EDTA washing) were investigated. The data were analysed using the initial dissolution rate (k(EDTA)). The results show increased iron dissolution with increasing reactive sites (decreasing particle size or increasing metal loading), and increasing mixing speed. Air bubbling and material pre-treatment also lead to increased iron dissolution. The main output of this work is that available results are hardly comparable as they were achieved under very different experimental conditions. A unified experimental procedure for the investigation of processes in Fe(0)/H(2)O systems is suitable. Alternatively, a parameter (tau(EDTA)) is introduced which could routinely used to characterize Fe(0) reactivity under given experimental conditions.

Outcome of HER2-Positive (HER2+) Metastatic Breast Cancer Patients (MBC) Treated with Trastuzumab (T): An Institutional Based Review

Background: HER2+ status is associated with poor prognosis, high incidence of visceral and brain metastasis. However the addition of trastuzumab to chemotherapy (CT) significantly improves survival in early and advanced breast cancer. The purpose of this retrospective study was to explore the pattern of outcome in a cohort of MBC patients treated with T-based chemotherapy in a single institution. T was approved in Europe in 2000 and in 2001 all pts had access to T according HER2+ status. Methods: Women with de novo or recurrent breast cancer treated with trastuzumab at Institut Curie between 2001 and 2006 with HER2+ status (IHC 3+ or FISH +) were identified from the Institut Curie database. Disease was classified in two groups: patients who received T upfront and those who received T after one or several CT regimens. Overall survival (OS) was defined as the time from the date of the first metastasis to the date of death or last follow-up and was estimated using the Kaplan-Meier product method. Results: The final analysis included 244 patients. Median age was 53.4 yrs (29-80). Median time from primary and first metastasis was 22 mths (0-238). Visceral metastasis were present in 153 pts (63%) and 125 pts (51%) presented multiple sites. One hundred pts (42%) developed brain metastasis during the course of disease. One hundred and sixty five pts (68%) received T as first line, 79 pts (32%) after a median of one line of CT (median 1, range 1-5). One hundred and twenty four pts (52%) received more than 3 regimens. The median overall survival was 53 mths (4-113), similar in both groups. However there is a major bias: pts with very aggressive disease not treated upfront with T not have not been offered delayed T and don't appear in the analyzed population. Patients who developed brain metastasis had a median survival of 41 mths (11-90). Complete characteristics of pts will be presented. Conclusions: The introduction of T has altered the natural history of HER2+disease. Even outside a clinical trial, our results show that the addition of T to CT improves the prognosis of MBC patients with HER2+ disease. Prolongation of T after progression with other CT appears beneficial, even in pts with a high disease burden. The high incidence of brain metastases remains an issue in such a population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5107.

[Quality control of antibiotics used in Senegal]

To slow the spread of bacterial resistance and promote safety in the use of medicines, development of quality control tools is indispensable. The purpose of this study was to evaluate the quality of several antibiotic agents used in Senegal and to assess the utility of the mini laboratory as a quality control tool. The mini laboratory and all materials necessary for this study were provided by the German Pharma Health Fund. A total of 34 antibiotic samples were submitted to a battery of tests including physical and visual inspection, disintegration, and thin layer chromatography designed for identification and semiquantitative evaluation. Non-conformities detected by physical and visual inspection were found mainly in products from the illicit sector (80%) but some non-conformities were also found in products from licit private sector (20%). Based on thin layer chromatography findings, non-conformities in product identity and dosage involved mainly erythromycin (45%) followed by amoxicillin and ciprofloxacin (22% each). Again this type of non-conformity was most frequent in products from the illicit sector (45%) but it was also observed in products from the private and public sectors (33% and 22% respectively). These findings show that follow-up is necessary to ensure the quality of medicines, especially antibiotics. In this study the mini laboratory was a highly useful quality control tool.

Reflex mechanisms for bladder inhibition

Continence of urine requires ability of the bladder to maintain a low intravesical pressure at increasing filling, in order to preserve a positive urethral-bladder pressure gradient. During micturition the conditions are reversed: the bladder has to generate pressures exceeding the urethral pressure, which also presupposes that the urethra opens and remains open as long as is required for all urine to be expelled. These events are made possible by a complicated pattern of central and peripheral neural responses, affecting the bladder-urethral unit. The pioneer work of determining the reflex mechanisms involved in the regulation of the lower urinary tract was done at the beginning of this century. Recently, further studies have been made and by means of electrophysiological investigations previous data have been confirmed. In this communication some important observations are reviewed and one example is given of how bladder inhibitory reflexes are utilized in therapy.

[Risk factors for neonatal mortality. The pediatric surgery service, Aristide Le Dantec University Hospital, Dakar]

OBJECTIVES

To determine neonatal mortality factors at the paediatric surgeon service in Aristide Le Dantec University Hospital in Dakar.

PATIENTS AND METHODS

It is a retrospective study of 245 cases collected between January 1997 and December 2006 at the paediatric surgeon service, the surgery emergency and intensive care unit of Aristide Le Dantec University Hospital. We studied the age, sex, geographical origins, consultation time, weight at birth, evacuation means to the reference medical structure, consultation motives, clinical diagnosis, associated malformations, treatment methods, surgery follow ups and death causes.

RESULTS

The neonatal death rate at the paediatric surgery service was 36.7 %. Our patients' average age was eight days. A masculine predominance was observed with a 1.57 sex ratio. The average admission time was 08 days. Sixty-five per cent (65%) of our patients came from suburbs. Thirty-eight per cent were transported by an ambulance from a health centre. Fifty-three per cent (53%) weighed less than 2,500 grams at birth. The occlusive syndrome was the commonest reason for consultation (38.5 %). The most frequently observed pathology was the ano-rectal malformations. Associated malformations were observed in 12% of the cases. The majority of the patients (52%) died before the surgical operation after an average duration of 5 days. The commonest causes of death are the digestive malformations (66%).

CONCLUSION

Male newborn babies, aged less than 8 days are the most vulnerable age group. The lack of hospital transportation means, the weak weight at birth, the caring time and the digestive pathologies are other factors of wrong diagnosis. A multidisciplinary collaboration, the improvement of the technical capacity and of the available emergency therapeutic means and the creation of an intensive paediatric care unit would certainly contribute to lower the mortality rate.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Toxicological study of emissions resulting from a diesel and a gazoline engine using an organotypic culture of lung slice]

INTRODUCTION

Many studies were carried out in vivo and/or in vitro for better understanding toxic effects of exhausts or particles emitted by Diesel vehicles. Few studies were interested in Gazoline engines when progress of metrology made it possible to highlight the presence of small particles with a strong capacity of penetration within pulmonary tissue. The aim of this study is to compare the toxic impact of the emissions of Diesel and Gasoline engines of recent technology.

MATERIALS AND METHODS

Biological material was constituted by an organotypic rat lung precision slice. It was exposed to a continuous flow exhausts thanks to a preparation and dilutions system of these emissions placed on the line of exhaust. A measurement of the biological markers involved in the process of the lung tissue reaction to the air-contaminants was carried out.

RESULTS

With Diesel exhausts, the results showed a stability of the rate of ATP and an increase in enzymatic activities of the antioxydant system (GPx and catalase). Gazoline emissions, as for them, were responsible for a cytotoxic attack of the pulmonary tissue defined by a reduction in the rate of ATP as well as a deterioration of the system of detoxication with reduction in the antioxydant enzymatic activities.

CONCLUSION

These results show that toxicological profiles obtained with this system of exposure depends on the engine technology used, highlighting thus the specific response of the model in relation with the type of atmospheres which it is exposed.

[Study of the contents in fat, in protein and in vitamin D of powdered milk varieties sold in Dakar]

INTRODUCTION

The powdered milk is a much appreciated food in Senegal. However no particular control is realized by authorities on the various marks of milk imported before their marketing. In the concern to protect the health of the consumers, but especially in front of the very big variety of the sources of supply in this product we determined the contents in fat, in protein and in vitamin D main variety show of marketed powdered milk Dakar.

MATERIAL AND METHODS

Chemical methods were operated to determine the fat contents and in proteins. The liquid chromatography in high performance was used to identify and measure the vitamin D.

RESULTS

The obtained results profits showed that all the studied samples of milk had contents in fat included between 25 and 31 g %, those in proteins were included between 23 and 25 g %. As regards the dosage of the vitamin D, a single sample had content weaker than that mentioned on the packaging by the manufacturer.

CONCLUSION

The results of this study allowed to notice most of the variety varieties of powdered milk marketed in Dakar were in accordance with the standards established for this food and are consequently good quality.

Mutagenicity of benzyl chloride in the Salmonella/microsome mutagenesis assay depends on exposure conditions

Benzyl chloride (BCl) is a clear yellowish, volatile liquid that is widely used as an intermediate for the production of benzyl alcohol and benzyl compounds used in perfumery, dyes and pharmaceuticals. In previous studies BCl has shown weak and inconsistent mutagenicity in the Salmonella/microsome mutagenesis assay (Ames test). The aim of the present study was to investigate the potential mutagenic activity of BCl using modifications of the standard Ames test in order to adapt the method to the volatile nature of the test compound. Tests were performed using (a) the standard plate-incorporation method, (b) incubation of the treated plates in closed containers, (c) a vaporization-diffusion method to expose Ames test plates to volatilised BCl and (d) the pre-incubation method. Using the standard plate-incorporation method, BCl showed no (in the absence of metabolic activation) or very weak (in the presence of metabolic activation) mutagenic activity in Salmonella typhimurium tester strain TA 100. The use of the pre-incubation method did not improve detection of mutagenic activity of BCl. The use of closed containers significantly increased the response, but the most marked response was obtained by testing BCl in volatilised form in the vaporization-diffusion method. Using the latter approach there appeared to be less toxicity of the BCl treatments to the tester bacteria. Our findings suggest that BCl may show greater mutagenic activity in the gaseous phase. This work underlines the importance of using appropriate methods for the evaluation of volatile compounds. The modifications described here are easy to realize in practice and should prove useful for the investigation of other volatile materials or atmospheric contaminants.