[Management of pre-term labor: use of nifedipine in Conakry, Guinea]

This purpose of this prospective and descriptive study was to evaluate the utility of a calcium-channel inhibitor, i.e. nifedipine, for management of preterm labor in our work setting in terms of safety and cost-effectiveness in comparison with betamimetics classically used for this indication. Study was carried out over a six-month period in the department of Gynecology-Obstetrics Department of Ignace Deen National Hospital in Conakry, Guinea. Pregnant women meeting the following criteria were included: 28 to 33 weeks of amenorrhea, six days of hospitalization either for preterm labor or for another diagnosis that was associated with the occurrence of preterm labor during hospitalization, and absence of contraindications for tocolysis using nifedipine. A total of 42 women were included. Pregnancy was extended for more than 48 hours after the first dose of nifedipine in 86.8% of cases. Administration of nifedipine failed in 5 cases including one case in which it was necessary to change the tocolytic and 4 cases in which delivery occurred less than 48 hours after the first dose of nifedipine. In 68% of cases, 90 mg of nifedipine were sufficient to stop uterine contractions within 48 hours. In 39.5% of cases, no side effects were observed. Adverse effects in the other cases were dizziness (39.5%) and headache (18.4%). The mean term of delivery was 36 weeks +/- 5 days of amenorrhea with a mean extension of 6.2 weeks. Apgar score was low in 30.5% of the newborns and normal in 69.5%. One newborn (2.8%) died. The results of this study indicate that nifedipine is an effective, economical and safe drug for tocolysis and that it can be used as an alternative to betamimetis in countries with limited resources. An information campaign is needed to promote use of nifedipine as a tocolytic in obstetrical facilities of 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 .

[Clinical and medico - legal aspects of sexual aggressions at Gabriel Toure teaching hospital]

AIM

The sexual aggressions pose an important medico - legal problem. The implication of several services is often indispensable to determine the future of this aggression. Our survey objectives were to determine epidemiological and clinical characteristics of sexual aggressions and to specify the judicial continuations.

MATERIAL AND METHODS

We did historical cohort survey while recruiting all cases of consultation in the service for sexual aggressions. This survey spreads on a period of 60 months going from January 2004 to December 2008. A systematic health evaluation (HIV test, vaginal screeming, lever inflammatory deseases) is asked to every sexual abuse patients.Data have been recorded from patients' clinical files, cards of requisition and accounts returned of verbal suit of auditions and police custodies. khi 2 test has been used to appreciate relationship between variables, significativity doorstep P value < 5%.

RESULTS

The sexual aggression frequency in relation to admissions to emergencies is 3.12%. The age group <15 years were the more represented with 59.18%. The police authority referred the patients with a requisition in 65.17% of cases (p<0,005). Presumed aggressor was known by the patient in 63.67% of cases (p<5%) and in 72.28% of cases the aggression has been made by night (p=0,001) It was about one aggressor in 65.54% of cases; they were 2 and 3 numbers in 17.23%. (p=0,002). We noted a sexual penetration notion in 80.52% of cases against 19.48% of sexual attouchements. The threat has been noted in any case: 40.82% by weapon and 30.71% by stroke of point. More of the half of the patients (60.30%) had had sexual intercourse before the aggression. The clinic exam was normal in 76.40% of cases (P<5%). The main types of lesions were: hymeneal injuries (13.48%), vulva injuries (7.87%). The judicial continuations have been marked by 10.48% of condemnations, 46.06% of acquittal and 40.06% of friendly regulation (P<5%).

CONCLUSION

The number of sexual aggressions, although under valued, is raised in our country. The collaboration between the judicial, police and medical services should permit to reduce the frequency of these aggressions.

[Brain trauma at the Teaching Hospital Gabriel Touré]

AIMS

To evaluate mortality and morbidity related to brain trauma.

PATIENTS AND METHODS

It was about a descriptive study done on brain trauma patients admitted to the emergency of the teaching hospital Gabriel Touré from January to august 2004. Every patient admitted for brain trauma with ornote associated lesions was included. A p < 0.05 was considered significant. RESULTS During 8 months time 324 patients have been admitted for brain trauma. The male to female ratio was 3.1. School age and academic populations have represented 79 patients (24.4%). Brain trauma has happened in 268 cases (82.8%) in a context of public way accident. These accidents have concerned pedestrian in 42% of cases (auto-pedestrian or motorcycle-pedestrian). The morbidity rate was 11 %. Conclusion Intracerebral lesion are mostly seen in brain trauma. Being a pedestrian in an accident context may expose to brain trauma.

[Adverse events of anesthesia in pediatric surgery scheduled at Gabriel Toure hospital]

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia.

PURPOSE

To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled.

STUDY TYPE

Descriptive non-randomized study.

PATIENTS AND METHODS

Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period.

RESULTS

Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P < 0.05. All adverse events have received support except tachycardia, late revival but all developed positively.

CONCLUSION

This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

[Assessment of a rapid diagnostic test for malaria in rural health care facilities in Senegal]

PURPOSE

The aim of the study was to determine the accuracy of a rapid diagnostic test in confirming presumptive malaria diagnosis in a rural zone of Senegal. Thick blood smear was used as the reference technique for comparison. METHOHDOLOGY: Testing was conducted on children between the ages of 1 and 14 years at three health care facilities located in the Niakhar are from August 2006 to June 2007. If malaria was suspected by the nurse based on clinical findings, two thick smears and one rapid diagnostic test (Core Malaria Pf) were performed. Blood slides were stained in Niakhar and read in Dakar.

RESULTS

A total of 474 patients were examined. Three-fourths (75%) of these patients were seen during the rainy season. Malaria was suspected in 335 patients (71%). Rapid tests and thick smears were obtained in 330 of these patients with positive results in 194 (59%) and 180 (55%) respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the rapid test were 96%, 87%, 90% and 95% respectively.

CONCLUSION

Our data show that the rapid diagnostic test used in this study exhibits good sensitivity and positive predictive value. Despite its cost this test could be helpful in confirming malaria diagnosis in outlying health care facilities without the necessary resources to perform blood smears. Confirmation is necessary to avoid unwarranted prescription of malaria treatment due to inaccurate clinical diagnosis

The elimination of the onchocerciasis vector from the island of Bioko as a result of larviciding by the WHO African Programme for Onchocerciasis Control

The island of Bioko is part of the Republic of Equatorial Guinea and is the only island in the World to have endemic onchocerciasis. The disease is hyperendemic and shows a forest-type epidemiology with low levels of blindness and high levels of skin disease, and the whole population of 68,000 is estimated to be at risk. Control of onchocerciasis began in 1990 using ivermectin and this yielded significant clinical benefits but transmission was not interrupted. Feasibility and preparatory studies carried out between 1995 and 2002 confirmed the probable isolation of the vector on the island, the high vectorial efficiency of the Bioko form of Simulium yahense, the seasonality of river flow, blackfly breeding and biting densities, and the distribution of the vector breeding sites. It was proposed that larviciding should be carried out from January to April, when most of the island's rivers were dry or too low to support Simulium damnosum s.l., and that most rivers would not need to be treated above 500 m altitude because they were too small to support the breeding of S. damnosum s.l. Larviciding (with temephos) would need to be carried out by helicopter (because of problems of access by land), supplemented by ground-based delivery. Insecticide susceptibility trials showed that the Bioko form was highly susceptible to temephos, and insecticide carry was tested in the rivers by assessing the length of river in which S. damnosum s.l. larvae were killed below a temephos dosing point. Regular fly catching points were established in 1999 to provide pre-control biting densities, and to act as monitoring points for control efforts. An environmental impact assessment concluded that the proposed control programme could be expected to do little damage, and a large-scale larviciding trial using ground-based applications of temephos (Abate 20EC) throughout the northern (accessible) part of the island was carried out for five weeks from 12 February 2001. Following this, a first attempt to eliminate the vectors was conducted using helicopter and ground-based applications of temephos from February to May 2003, but this was not successful because some vector populations persisted and subsequently spread throughout the island. A second attempt from January to May 2005 aimed to treat all flowing watercourses and greatly increased the number of treatment points. This led to the successful elimination of the vector. The last biting S. damnosum s.l. was caught in March 2005 and none have been found since then for more than 3 years.

[Assessing the reliability of clinical malaria diagnosis in children consulting in three peripheral health care facilities, in Niakhar rural area, Senegal]

A demographic survey site has been implemented in Niakhar rural zone in Senegal since the 1960s and many epidemiological and demographic studies have been conducted in this context. In this Sahelo-Sudanese area, malaria transmission is mesoendemic and mainly seasonal. In health care facilities, malaria real burden is poorly known as malaria diagnosis only relies on patients' clinical signs. The aim of our study was to measure the reliability of malaria diagnosis in these health centres by performing a parasitological confirmation of presumptive malaria cases and by assessing the validity of diagnosis according to child's age. A cross-sectional study was conducted in August-December 2006 (rainy season) and in February-June 2007 (dry season) in three health care facilities of the area (2 public centres and one private dispensary). Children aged 1 to 14 years old and accompanied by an adult were included. Two thick blood smears were carried out for each patient. A total of 474 children were included; among them 208 (43.9%) had a positive blood smear. Among the 335 (70.7%) presumptive malaria cases, 182 (54.3%) were confirmed by thick smear. Sensitivity specificity positive and negative predictive values were respectively 87.5%, 42.6%, 55.3% and 80.7%. Clinical signs which were predictive of confirmed malaria were vomiting and body temperature > or =38 degrees C. Clinical diagnosis performances decreased significantly during the dry season and in children under the age of two. The proportion of true malaria cases (54.3%) confirms the results of previous studies described in literature and shows a consistency for the last twenty years. Malaria is the main diagnosis attributed to patients by health care agents, regardless of the child's age or the season, whereas thick smear results are predominantly negative among children aged less than 2 and during dry season. A better knowledge of malaria morbidity in these health care facilities is an asset for setting up further epidemiological studies in this area and implementing interventions aiming at improving patients' care.

[Morbillivirus infections of ruminants: the nearly eradicated rinderpest and the "peste des petits ruminants", an expanding disease in the South and a threat for Europe]

Rinderpest (RP) and peste des petits ruminants (PPR) are contagious viral diseases of domestic and wild ruminants producing high mortality. They are caused by viruses belonging to the Morbillivirus genus, Paramyxoviridae family. Control tools (vaccines and specific diagnostic tests) exist for these two diseases. They have been successfully used during the global rinderpest eradication programme (GREP) and the disease is expected to be eradicated by 2010. In contrast, a similar programme does not exist for PPR, which is still spreading in Africa and Asia. The persistence of PPR in Turkey and its recent introduction in Morocco, make the disease a real threat for Europe. Improvement of control measures against PPR would benefit from the development of a marker vaccine and its companion serological test, thus allowing the differentiation between infected and vaccinated animals (DIVA vaccines and tests). The recent development of reverse genetics for morbilliviruses offers this new possibility.

[Medical care of post-operative pain in pediatric surgery: comparison of three protocols]

The gains of the struggle against the pain of the child are still fragile and poorly insured despite advances in both information and evaluate the degree of pain in the range of means at our disposal. The absence of systematic management of pain especially post-operative pain in pediatric surgery and the difficulty of obtaining a vein justify this study.

PURPOSE

The purpose was to compare analgesic effect of three protocols.

TYPE OF STUDY

prospective and comparative study.

MATERIAL AND METHOD

Our study was prospective and comparative. It took place in the services of anesthesia and intensive care and pediatric surgery of Gabriel Toure Hospital in Bamako during October 2003 to July 2004.Patients were randomized to three protocols: protocol A patients who received paracetamol suppository at a dose of 15 mg/kg,protocol B patients who received niflumique acid suppository at a dose of 13 mg/kg and protocol C patients who receiving combination paracetamol at a dose of 15 mg/kg with acid niflumique at a dose of 13 mg/kg per rectally. The first dose for each protocol was administered after anesthetic induction. In Protocol C paracetamol was administered immediately after induction and niflumique acid on awakening.

RESULTS

During the period, 202 patients were randomized to three protocols: protocol A (n = 65), protocol B (n = 69),protocol C (n = 68). Poignant pain has been observed with EVS ladder against none with the grid OPS.Patients of protocol C surgery for hernia had moderate pain with 4.40% of cases against 9.60% of patients in the protocol B with P = 0.0024 and 12% of patients in Protocol A, with P = 0.0018 in OPS. Patient's protocol C surgery for hernia showed no intensive pain against 14.20% of the patients in protocol B and 11.4% of patients in group A with EVS scale. No side effects related molecules have been observed in the three protocols.

CONCLUSION

Association of paracetamol and niflumique acid provides a quality analgesia by postoperative rectally in pediatric surgery.

[Coverage rate and satisfaction of populations after mass treatment with praziquantel and albendazole in Mali]

In Mali, schistosomiasis always remains a major public health problem. In 2005, mass treatment campaigns with praziquantel and albendazole have been organized in all endemic regions. The present study aimed to assess the impact of these mass treatment campaigns and the recipient's satisfaction in two endemic areas (Mopti and Ségou). It was a cross-sectional study with one passage from February to March 2006. The study carried out on political authorities (n=142), teachers and school administers (n=70), health workers (n=46), community distributors (n=33), community members (n=2170) and pupils (n=2480). We used Lot Quality Assurance Sample (LQAS) to determine treatment coverage and recipient's satisfaction. Two types of lots were considered, villages and schools. Questionnaires were used for investigation. In Ségou, the treatment rates varied from 100% at school level and in community in Bla district to 97.2% in the community of Ségou town. In Mopti, a treatment rate of 100% was observed in Bankass and Douentza both at school and in the community. The proportion of happiest individuals (to feel well) after the mass treatment campaign was 72.3% among pupils and 76.6% in the community. The results of this study suggest that the high treatment coverage rates observed during these campaigns should be sustained by a yearly chemotherapy strategy preceded by a community's health education programmes.

[Trauma and pregnancy: clinical and prognosis about 152 cases recorded into Gabriel Toure Teaching Hospital]

AIM

The objectives of our survey were to determine the frequency of trauma associated to pregnancy in our service, to describe types of lesions and the maternal and fetal complications.

MATERIAL AND METHODS

It is about a descriptive retrospective survey that spreads on a period of 63 months going from March 2002 to Jun 2007. We recorded all cases of trauma associated to pregnancy whatever the term of pregnancy. The parameters studied have been: admission mode, circumstances of intervening, gravida, parity, pregnancy age, delivery route and materno-fetal prognosis. We have used χ² test to appreciate relationship between variables studied, the significant doorstep has been P value < 5%.

RESULTS

During the period of the survey we recorded 152 cases of trauma associated to pregnancy and 8016 emergency consultations is a frequency of 1.90%. In 3 cases on 4 (115 cases, 75.66%), the age of pregnancy was at least equal to 12 weeks. We noted 13.16% of unevolutive pregnancy; 13.83% of case of abortion and 15.13% of childbirth witch 5 by cesarean section. The main lesions more associated were: bruises (41.28%), the fractures of the pelvic (25.64%), the rachis fractures (10.26%) and the cranial trauma (12.82%), 6.58% (10 cases) of patients are died.

CONCLUSION

Trauma in pregnant women often generate polymorphic lesions. Their complications can be serious dragging sometimes maternal and or fetal death. Their management is always multidisciplinary.

Fast visible imaging of turbulent plasma in TORPEX

Fast framing cameras constitute an important recent diagnostic development aimed at monitoring light emission from magnetically confined plasmas, and are now commonly used to study turbulence in plasmas. In the TORPEX toroidal device [A. Fasoli et al., Phys. Plasmas 13, 055902 (2006)], low frequency electrostatic fluctuations associated with drift-interchange waves are routinely measured by means of extensive sets of Langmuir probes. A Photron Ultima APX-RS fast framing camera has recently been acquired to complement Langmuir probe measurements, which allows comparing statistical and spectral properties of visible light and electrostatic fluctuations. A direct imaging system has been developed, which allows viewing the light, emitted from microwave-produced plasmas tangentially and perpendicularly to the toroidal direction. The comparison of the probability density function, power spectral density, and autoconditional average of the camera data to those obtained using a multiple head electrostatic probe covering the plasma cross section shows reasonable agreement in the case of perpendicular view and in the plasma region where interchange modes dominate.

Dynamics of plasma blobs in a shear flow

The global dynamic of plasma blobs in a shear flow is investigated in a simple magnetized torus using the spatial Fourier harmonics (k-space) framework. Direct experimental evidence of a linear drift in k space of the density fluctuation energy synchronized with blob events is presented. During this drift, an increase of the fluctuation energy and a production of the kinetic energy associated with blobs are observed. The energy source of the blob is analyzed using an advection-dissipation-type equation that includes blob-flow exchange energy, linear drift in k space, nonlinear processes, and viscous dissipations. We show that blobs tap their energy from the dominant ExB vertical background flow during the linear drift stage. The exchange of energy is unidirectional as there is no evidence that blobs return energy to the flow.

Cross-field transport by instabilities and blobs in a magnetized toroidal plasma

The mechanisms for anomalous transport across the magnetic field are investigated in a toroidal magnetized plasma. The role of plasma instabilities and macroscopic density structures (blobs) is discussed. Examples from a scenario with open magnetic field lines are shown. A transition from a main plasma region into a loss region is reproduced. In the main plasma, which includes particle and heat source locations, the transport is dominated by the fluctuation-induced particle and heat flux associated with a plasma instability. On the low-field side, the cross-field transport is ascribed to the intermittent ejection of macroscopic blobs propagating toward the outer wall. It is shown that instabilities and blobs represent fundamentally different mechanisms for cross-field transport.

[Epidemiological, clinical and prognostic aspects of cryptococcal meningitis in hospital area of Bamako, Mali]

The cryptococcosis is a major mycosis of forecast holds during the AIDS. The objective of this study was to determine the frequency of this affection during the AIDS with the service of the infectious diseases of the teaching hospital of the Point G. On the whole 55 patients reached of AIDS were included in this study. They presented all of the evocative signs of meningitis attack. The analysis of the cerebral spinal fluid (CSF) allowed us to detect among this population 17 cases of cryptococcal meningitis means a frequency of 30.9%. The average age was 34 years with the extreme ones going from 18 to 60 years old. The clinical signs were as follows: disorder of the conscious in 4/17 cases (23.6%), fever in 2/17 cases (11.8%), signs of meningitis in 11/17 cases (64.7%). The CSF was clear as water of rock with a lymphocyte at 100% to all the patients. The examination with the Indian ink noted yeasts in capsular identified like the Cryptococcus ones. The treatment was based on amphotericin B intravenous. Lethality rate was 58.8% in 10/17 cas. The crytococcus constitutes a frequent etiology of the meningo-encephalitis demonstrations during the AIDS in this service. We recommend the search for cryptococcus in front of any sign of meningitis occurring during AIDS in Mali.

Experimental observation of the blob-generation mechanism from interchange waves in a plasma

The mechanism for blob generation in a toroidal magnetized plasma is investigated using time-resolved measurements of two-dimensional structures of electron density, temperature, and plasma potential. The blobs are observed to form from a radially elongated structure that is sheared off by the E x B flow. The structure is generated by an interchange wave that increases in amplitude and extends radially in response to a decrease of the radial pressure scale length. The dependence of the blob amplitude upon the pressure radial scale length is discussed.

[Factors affecting nosocomial infection in the surgery setting at the Hospital of Point "G"]

Nosocomial infections are a common and increasing problem globally, and particularly in Africa. The significant economic burden of these infections on the health care system as well as their impact on patient morbidity and mortality is well recognised within the medical communities.The goal of this study was to investigate factors that influence nosocomial infection in all in-patients from the surgery wards (surgery ward A and B, Gynoeco-obstetrics, urology and intensive care) at the national hospital of Point G in Bamako, Mali. We report the number of nosocomial infection during a prospective study between June 2003 and January 2004. Of 1043 in-patients, 102 had had a nosocomial infection with a global prevalence of 9.7% (8.0-11.4). Of 1024 patients with surgery, 101 had had a nosocomial infection, a post-surgery nosocomial infection rate of 9.8% (8.1-11.5). We observed different site of nosocomial infection such as suppuration sup-aponevrotics (41.2%), parietal infection sub-aponevrotics (32.4%), urinary infection (17.6%) and organ suppuration (3.9%). Other nosocomial infection observed were pneumonia (2.9%) and catheterisation (2.0%). The nosocomial infection rate was 10.3% in male while it was 7.3% in female. The difference between male and female was not statistically significative (chi2 = 2.33, p = 0.12). Nosocomial infection was more prevalent in patients after emergency surgery (15.1%) than in scheduled surgery patients (8.5%) (chi2 = 8.15, p = 0.004). The classes III and IV of ALTEMEIER had the higher proportion of nosocomial infection (35.9%) against 4.8% for the classes I and II (chi2 = 144.95, p < 0.001). The patients with ASA score I had a lower nosocomial infection rate than patients from the intensive care unit or patients of Class II + III + IV (chi2 = 13.2, p = 0.001). Patients classified according to the National Nosocomial Infection Surveillance System (NNISS) with a score 0 had a nosocomial infection rate less than patients classified as NNISS score 1, 2 or 3 (chi2 = 82.0, p < 0.001). The study results underline the need for further investigations of the role of microbial agents and antimicrobial resistance in the outcome of patients with nosocomial infection.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.

Mapping the Peste des Petits Ruminants virus nucleoprotein: identification of two domains involved in protein self-association

For Mononegavirales, the template for transcription and replication is not the naked RNA but the nucleoprotein (N) encapsidated genomic and anti-genomic RNA. Because of this central role in the replication of these viruses, N has been the subject of numerous structural and functional mapping studies. Here, we report on the cloning of the Peste des Petits Ruminants virus (PPRV) N gene into the baculovirus vector and the expression of the protein in insect cells. By electron microscopy observation, we have shown that this recombinant PPRV N forms nucleocapsid-like particles in insect cells in the absence of other PPRV proteins, as reported for other paramyxoviruses. As it is known that the formation of these particles is first linked to the self-assembly of N, we have made several deletions in the PPRV N gene and expressed these mutants in insect cells. Analysis of these proteins by immunoprecipitation and electron microscopy observation enabled us to map the N-N interaction domains into two regions of PPRV N: aa 1-120 and 146-241. The fragment aa 121-145, which is not conserved within the morbillivirus group, is also required for the formation/stability of the nucleocapsid helical structure.

The threat of peste des petits ruminants: progress in vaccine development for disease control

Peste des petits ruminants (PPR) is a highly contagious animal disease caused by a virus in the genus Morbillivirus, family Paramyxoviridae. This infection is responsible for high morbidity and mortality in sheep and goats and in some small wild ruminant species. The huge number of small ruminants, which are reared in the endemic areas makes PPR a serious disease threatening the livelihood of poor farmers. Taking advantage of the closely relationship between rinderpest and PPR viruses, the attenuated rinderpest vaccine was used in the control of PPR. It is now replaced by the homologous attenuated PPR vaccine. Unfortunately, animals that have received this vaccine cannot be distinguished serologically from infected animals. With the advent of DNA recombinant technology, efforts are being made to develop effective PPR marker vaccines to enable such differentiation and which would allow countries to implement both vaccination and disease surveillance programmes at the same time.

Universal statistical properties of drift-interchange turbulence in TORPEX plasmas

A unique parabolic relation is observed to link skewness and kurtosis of around ten thousand density fluctuation signals, measured over the whole cross section of a toroidal magnetized plasma for a broad range of experimental conditions. All the probability density functions of the measured signals, including those characterized by a negative skewness, are universally described by a special case of the Beta distribution. Fluctuations in the drift-interchange frequency range are necessary and sufficient to assure that probability density functions can be described by this specific Beta distribution.

Seasonal variations and trends in weight and arm circumference of non-pregnant rural Senegalese women, 1990–1997

OBJECTIVE

To describe levels, monthly variations and trends in weight and arm circumference of non-pregnant lactating women living in the Sahel, characterized by one short yearly rainy season (July-October).

METHODS

A mixed unbalanced cross-sectional longitudinal observational study conducted at 3, 5, 7 and 10 months postpartum among 3869 women living in the Sine area in central Senegal who had brought their infants into dispensaries for immunization from January 1990 to February 1997, and 1-5 consecutive children per woman (26 106 visits).

RESULTS

Mean weight was 55.7 kg (s.d.: 7.1), but it varied by 2.5-3.9 kg each year, from high means during the dry season (March-May) to low means at the end of the rainy season (September-November). The prevalence of underweight, overweight and obesity (body mass index (BMI)<18.5, 25-29.9 and >30 kg/m(2), respectively) was 7.6% (95% confidence interval: 7.3, 7.9), 6.4% (6.1, 6.7) and 0.4% (0.3, 0.4), but varied strongly by season (P<0.0001 for all). Unlike weight, mean arm increased during the early rains, a peak season of agricultural work (+0.10 cm/month (s.d.: 0.6) from June to August vs -0.35 kg/month (s.d.: 1.1) for weight). BMI and arm circumference were positively associated with age (mean: 20.8 vs 22.2 kg/m(2) and 25.3 vs 27.4 cm, at 20-24 and 40-49 years, respectively, P<0.0001 for both).

CONCLUSIONS

Season was a major determinant of the anthropometric status of rural African women. Negative energy balance reduced body weight from the onset of agricultural labour, while arm circumference increased during early rains, probably due to high physical activity.

Mapping and structural analysis of B-cell epitopes on the morbillivirus nucleoprotein amino terminus

By analysing the antigenic structure of the morbillivirus nucleoprotein (N) using a competitive-binding assay of monoclonal antibodies (mAbs), six different antigenic sites were identified previously. By using Pepscan methodology complemented by analysis of truncated N proteins, a better characterization of five of these antigenic sites was provided: I, II, III, IV and VI. mAbs specific to Rinderpest virus, defining antigenic sites II, III and IV, and those common to four morbilliviruses, delineating sites I and VI, were analysed in the present study. It was found that all but one mapped to the same region, between aa 120 and 149 of N. However, the mAb 3-1 epitope was located in the carboxy-terminal region (aa 421-525). This result may indicate the high immunogenicity of the amino-terminal variable region, at least in the mouse. It was surprising that the epitope of mAb 33-4, antigenic site VI, which recognized all morbilliviruses so far tested, was located in one of the two non-conserved regions between morbillivirus N proteins. It is shown that the conserved amino acid motif (126)EAD(128)----(131)F-------(148)EN(149) is critical for epitope constitution and recognition.

Veterinary vaccines and their use in developing countries

The burden of infectious diseases in livestock and other animals continues to be a major constraint to sustained agricultural development, food security, and participation of developing and in-transition countries in the economic benefits of international trade in livestock commodities. Targeted measures must be instituted in those countries to reduce the occurrence of infectious diseases. Quality veterinary vaccines used strategically can and should be part of government sanctioned-programmes. Vaccination campaigns must be part of comprehensive disease control programmes, which, in the case of transboundary animal diseases, require a regional approach if they are to be successful. This paper focuses on the salient transboundary animal diseases and examines current vaccine use, promising vaccine research, innovative technologies that can be applied in countries in some important developing regions of the world, and the role of public/private partnerships.

Impact of previous immunisation on the incidence of meningococcal disease during an outbreak in a Sahelian area of Senegal

The occurrence of an outbreak of meningitis during three consecutive years in a study area under demographic and epidemiologic longitudinal surveillance allowed evaluating the impact of mass immunisation campaigns on the incidence of meningitis. During an outbreak of meningitis in the neighbouring region occurred 2 years before the first epidemic wave in the study area, 8 out of the 30 villages of the zone were immunised. The incidences of meningitis in these villages were compared with those of the villages that did not benefited from mass campaign. It appeared a very significant difference between the two groups of villages. More than a half of the cases of meningitis seemed to be avoided in the vaccinated villages compared to the others, suggesting that a previous immunisation limits the diffusion of the epidemic. After the second outbreak hit the study zone, a mass immunisation campaign concerned all the 30 villages. The incidences of meningitis were significantly different between villages according to the observed vaccine coverage. These results indicate that preventive immunisation could have a significant impact on meningitis outbreak diffusion.

Peste des Petits Ruminants (PPR) Outbreak in Tajikistan

The occurrence of outbreaks of peste des petits ruminants (PPR) in three districts of Tajikistan is described. The causal strain (PPR Tajikistan) was characterized and the sequence of its N gene was compared with that of 43 other strains isolated since 1968 in Africa, the Middle East and Asia. The study demonstrated (1) the value of the N gene as a target in comparing isolates obtained over an extended period of evolution, and (2) that clustering was related to the geographical origin of strains.

[Laparoscopic Hartmann's reversal procedure after volvulus of the sigmoid]

the authors report the result of their first experiment of re-establishment of continuity colic coelio-assisted after a stomy for volvulus of sigmoid at a 29-year-old patient. The technical realization of the intervention profited from the trade-guild of a team from Dijon (France). Since its creation in 2001 the center of coelio surgery of Bamako in MALI profits from such a support. Technically an separation of the left as of the its gastrosplenic fasteners, pancreatic angle colic and fascia of left TOLD were necessary. Anastomosis was mechanical extra body by minis the pelvic parotomy. The duration of the intervention was of 76 min. The operational continuations were simple. The duration of the hospital stay was 7 days against 10 in the event of traditional re-establishment of continuity in the service. This re-establishment of continuity coelio-assisted mark the beginning of the surgery colic with the young center of Bamako.

Early detection of viral excretion from experimentally infected goats with peste-des-petits ruminants virus

We observed 15 goats for 9 days after subcutaneous infection with 10(3) TCID(50) with isolates of peste-des-petits ruminants virus from Africa and India and five concurrent, uninfected control goats. Typical clinical signs of the infection were present in all 15 infected goats by day 8 and in most by day 6 and some signs were present by day 4. However, 6 out of 15 goats already have detectable virus shedding by day 3 and four more were shedding by day 4 and every goat had virus shedding for at least 1 day before the recognition of clinical signs. This experiment indicates that incubatory carriers therefore might play a role in the transmission of PPRV among small ruminants.

Development of a framework for international certification by the OIE of diagnostic tests validated as fit for purpose

Historically, the OIE has focussed on test methods applicable to trade and the international movement of animals and animal products. With its expanding role as the World Organisation for Animal Health, the OIE has recognised the need to evaluate test methods relative to specific diagnostic applications other than trade. In collaboration with its international partners, the OIE solicited input from experts through consultants meetings on the development of guidelines for validation and certification of diagnostic assays for infectious animal diseases. Recommendations from the first meeting were formally adopted and have subsequently been acted upon by the OIE. A validation template has been developed that specifically requires a test to be fit or suited for its intended purpose (e.g. as a screening or a confirmatory test). This is a key criterion for validation. The template incorporates four distinct stages of validation, each of which has bearing on the evaluation of fitness for purpose. The OIE has just recently created a registry for diagnostic tests that fulfil these validation requirements. Assay developers are invited to submit validation dossiers to the OIE for evaluation by a panel of experts. Recognising that validation is an incremental process, tests methods achieving at least the first stages of validation may be provisionally accepted. To provide additional confidence in assay performance, the OIE, through its network of Reference Laboratories, has embarked on the development of evaluation panels. These panels would contain specially selected test samples that would assist in verifying fitness for purpose.

[Analysis of evolution of vaccine coverage in Niakhar, a rural area of Senegal, between 1984 and 2003]

In Senegal, the Expanded Programme of Immunization started by 1986 as a routine programme targeting 7 diseases: tuberculosis, tetanus, diphtheria, pertussis, poliomyelitis, measles and recently yellow fever Immunization against hepatitis B and Haemophilus influenzae b are proposed since 2005, but not implemented yet. In addition, there are mass immunization campaigns, such as National Immunization Day organized every year since 1999 against poliomyelitis and, in case of outbreak, against meningitis or yellow fever. In a 30,000 inhabitants rural study zone, vaccine contacts of children under 15 years of age are updated regularly several times a year since 1984. We also performed yearly cross sectional surveys from 1999 to estimate vaccine coverage in children of 24 months of age. Immunization status was assessed by vaccination cards presented by the children's parents and registers of health centres. We compared the results from both longitudinal and cross sectional surveys, which showed some differences. The last method seemed to indicate higher immunization rates. The vaccine coverage was slightly but not significantly higher in the study zone compared to the general vaccine coverage in Senegal, excepted for measles immunization for which the coverage was significantly lower in Niakhar. However results showed that interventions of all types lead to a high vaccine coverage (up to 80%) but are not sustainable. In the intervals, vaccine coverage decreased dramatically (below 40%), due mainly to irregular supply of antigens and poor accessibility of health facilities. Other factors are mentioned.

[Sickle cell disease and retinal damage: a study of 38 cases at the African Tropical Ophthalmology Institute (IOTA) in Bamako]

The purpose of this prospective study was to evaluate retinal damage in patients with sickle cell disease and its links with the different genotypic forms of the disease in patients consulting at the African Tropical Ophthalmology Institute (IOTA). A total of 38 patients with the HbS gene were included over a 12-month study period. Retinal damage was assessed by a computerised angiofluorography in 31 patients. Of the 38 patients studied, 71% had sickle cell disease (SC), 21% had sickle cell trait (AS) and 8% had sickle cell anemia (SS). Sixty-eight percent of patients (n = 21) presented sickle cell retinopathy. The age group with the highest prevalence of proliferative neovascularisation was between 26 and 35 years. Retinopathy was more frequent in SC patients than AS patients: 90% (n = 19) versus 10% (n = 2). None of the 3 SS patients presented retinopathy. Retinal neovascularisation was the most common finding in the 27 affected eyes. This study confirms the frequency and severity of retinal damage in patients with the HbS haemoglobin, particularly among young people with double heterozygous disease (SC) in the tropical African environment. Treatment of this disorder is largely unavailable to patients in sub-Saharan Africa except at the major eye care centres. An early screening and management programme for retinal damage related to SC would reduce ocular complications and optimise visual efficiency in these young active patients.

Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal

OBJECTIVE

Early supplementation of breastfed infants may have consequences both for the mother and the child. We hypothesised that it would result in decreased maternal weight loss and in shorter durations of breastfeeding and birth intervals.

DESIGN

Controlled randomised population-based trial.

SETTING

Six villages in the Sine area of Senegal, West Africa.

SUBJECTS

Healthy breastfed infants and their mothers, 68 controls and 66 supplemented infants at randomization.

INTERVENTION

Supplementation with high-energy, nutrient dense food from 4 to 7 months of age, twice daily under supervision of field workers. Both controls and supplemented infants were free to eat other complementary foods. Maternal weight was measured monthly. Dates of breastfeeding cessation and of subsequent births were collected prospectively through weekly demographic surveillance, and were analysed using Cox's regression models and 'intent-to-supplement' approach.

RESULTS

Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group (+0.25 kg/months, 95% confidence interval (CI): -0.07, +0.57). Supplemented infants were breastfed for significantly longer durations than controls (medians: 24.9 and 23.7 months, respectively, P: 0.034). Their adjusted hazard ratio (HR) for breastfeeding cessation was 0.59 (95% CI: 0.40, 0.89). Their mothers had a lower risk of a new birth than mothers of controls (adjusted HR: 0.57, 95% CI: 0.36, 0.92).

CONCLUSIONS

Early short-term infant supplementation tended to decrease maternal postpartum weight loss, but it increased, rather than shortened, the duration of breastfeeding and birth interval.

SPONSORSHIP

This study was supported by a grant from the French Ministry of Research (Grant 92L0623).

[Factors linked to delayed diagnosis of tuberculosis in Conakry (Guinea)]

Untreated smear-positive pulmonary tuberculosis constitutes a reservoir of infection which is highly contagious. The present study was conducted in Conakry, Guinea, to determine the different options which are available when seeking treatment or care, and to ascertain the average delay in diagnosis of pulmonary tuberculosis and the main factors linked to the delay in diagnosis after the initial onset of symptoms. Through a cross-sectional study, 113 consecutive patients with smear-positive pulmonary tuberculosis were interviewed through the use of a questionnaire. The median total delay from the onset of symptoms of pulmonary tuberculosis until the diagnosis was 11 weeks. This delay period exceeded 4 weeks for 90 of the patients (80%). The average delay linked to the conventional health care system was double that of the one at the fault of the patient (6 weeks versus 3 weeks, respectively). 54% of the patients had initially resorted to non-conventional care. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills which train for one to better to detect tuberculosis and to sensitize the population to the subject matter and information on the illness and its symptoms.

[Hemorrhoids in Dakar: epidemiological, clinical and endoscopic aspects of 168 cases]

INTRODUCTION

haemorrhoidal disease symptoms lead frequently to medical consultation. The aims of our study were to determine its epidemiological, clinical and endoscopic characteristics in Dakar.

PATIENTS AND METHODS

we conducted a prospective multicentric study in the hospitals and in the private offices with endoscopic unit in Dakar from November 2nd 2003 to July 31 2004. A questionnaire with clinical and epidemiological features was applied to patients who presented haemorrhoid to the endoscopic exam. We included those who accepted the questionnaire.

RESULTS

We recruited 168 patients. The mean age was 39.6 years. The sex ratio was 1.66 (male to female). The mean duration of symptoms was 6 years (range 1 month - 32 years). The symptoms that lead to medical visit were mainly: rectal haemorrhage (50.5%), anal pain (23.2%), constipation (13.1%) and anal tumefaction (9.5%). At the anamnesis the most frequently symptoms noted were constipation (80.4%), anal tumefaction (74.4%), anal pain (73.8%), rectal haemorrhage (64.9%) and anal pruritus (58.3%). The haemorrhoids were internal in 116 cases and external in 52 cases. According to the endoscopic classification, 35% of patients were at the first stage, 43% at stage II, 18% at stage III and 4% at the stage IV. An anitis was noted in 29.1% cases. We noted as associated lesions 18 fistulas and 15 anal fissures.

CONCLUSION

The epidemiological, clinical and endoscopic characteristics of haemorrhoidal disease in Dakar are similar to those described in medical literature.

Development of a framework for international certification by OIE of diagnostic tests validated as fit for purpose

Historically, the OIE has focused on test methods applicable to trade and the international movement of animals and animal products. With its expanding role as the World Organisation for Animal Health, the OIE has recognised the need to evaluate test methods relative to specific diagnostic applications other than trade. In collaboration with its international partners, the OIE solicited input from experts through consultants' meetings on the development of guidelines for validation and certification of diagnostic assays for infectious animal diseases. Recommendations from the first meeting were formally adopted and have subsequently been acted upon by the OIE. A validation template has been developed that specifically requires a test to be fit or suited for its intended purpose (e.g. as a screening or a confirmatory test). This is a key criterion for validation. The template incorporates four distinct stages of validation, each of which has bearing on the evaluation of fitness for purpose. The OIE has just recently created a registry for diagnostic tests that fulfil these validation requirements. Assay developers are invited to submit validation dossiers to the OIE for evaluation by a panel of experts. Recognising that validation is an incremental process, tests methods achieving at least the first stages of validation may be provisionally accepted. To provide additional confidence in assay performance, the OIE, through its network of Reference Laboratories, has embarked on the development of evaluation panels. These panels would contain specially selected test samples that would assist in verifying fitness for purpose.

[Laparoscopic cholecystectomy. The first 30 cases in Bamako]

INTRODUCTION

The authors report the results of their short series of the laparoscopic cholecystectomy in the new center of coeliochirurgie of Bamako to Mali (West Africa).

MATERIAL AND METHOD

It is about a retrospective study over one 21 month period. All the patients carrying lithiasis symptomatic profited from this new technique in the service of surgery "A" of the hospital of the Point G Bamako.

RESULTS

30 patients were operated, that is to say 19 women and 11 men. The laparoscopic cholecystectomy accounted for 16,04% of the laparoscopic activity of the service for the same period. The pain of the hypochondre right was the reason for consultation for 96,7% of the cases (20 patients), and a defense of the hypochondre right was raised in 46,7% of the cases. The diagnosis of lithiasis vésiculaire was posed with echography in 100% of the cases. A standard hemoglobinopathy AS or SS was associated in 16,7% of the cases. The laparoscopic cholecystectomy was easy in 60% of the cases. Epiploïc adhérnces and grèles were the major per difficulty operational. Haemorrhages of the bed vésiculaire were noted among 3 patients. A patient is deceased continuations of embolism in post operational immediate. The duration of the operational act was on average of 76 min. The average duration of the hospital stay was 3,5 days. The cost of the laparoscopic cholecystectomy was lower than that of the conventional cholecystectomy in the service.

CONCLUSION

This study of the first 30 cases proved the feasibility and the reliability of the laparoscopic cholecystectomy under the conditions of developing country. The unquestionable benefit for the patient and the hospital forecasts of a beautiful future for this new procedure.

Serological markers of pulmonary tuberculosis and of response to anti-tuberculosis treatment in a patient population in Guinea

The aim of the study was to evaluate serological correlates of active tuberculosis and of response to antituberculosis treatment in a cohort of HIV-negative patients with pulmonary tuberculosis studied at diagnosis and during treatment at the Service de Pneumo-Phtisiologie, Centre Hospitalier-Universitaire Ignace Deen, Conakry, Republic of Guinea. Two similar cohorts of HIV-negative healthy households of patients and healthy community controls were included in the study. Plasma samples were obtained from 168 untreated tuberculosis patients, 167 healthy household controls, and 168 healthy community controls. Serial plasma samples were also obtained from the tuberculosis patients at 2 and 8 months after initiation of chemotherapy. IgG antibody levels were measured by an enzyme-linked immunosorbent assay (ELISA) using ten purified M. tuberculosis antigens. ELISA results were analysed by comparing geometric means of data. Of the ten antigens tested, five (14kDa Ag, 19kDa Ag, AlaDH, MS, and MPT83) elicited similar antibody responses in untreated TB patients and controls. In contrast, levels of three antibodies (ESAT-6, LAM, and 38kDa Ag) were higher in untreated TB patients than in household or community controls (p<0.0001). Levels were higher in untreated patients than in community controls also for the anti-Rv2626c antibody (p = 0.0001) and, at a lower significance level, for the anti-FdxA antibody (p<0.025). Antibody levels against ESAT-6 and Rv2626c decreased during therapy, while antibody levels to the 38 kDa antigen and LAM increased during therapy; FdxA antibody levels did not vary with treatment. Neither severity of presentation nor chest X-ray patterns affected levels of these antibodies before treatment. In contrast, after the 8-month therapeutic course, patients who presented with moderate/severe disease had higher levels of anti-ESAT-6, anti-FdxA, and anti-38kDa antibodies than those of patients with mild disease onset. Patients with bilateral lung lesions had significantly higher anti-38kDa and anti-LAM levels, both at diagnosis and after 8-month treatment, than patients with lesions involving only one lung. Antibodies to alanine dehydrogenase and malate synthetase measured at initiation of treatment were higher in tuberculosis patients who subsequently failed therapy than in those who were cured. The main conclusions of the study are: a) plasma levels of antibodies to a number of M. tuberculosis represent serological correlates of active disease; b) these correlates are affected in an antigen-specific fashion by anti-tuberculosis treatment; c) particular serological markers may be predictive of treatment outcome.