[Recurrence of palpebral basal cell carcinoma according to histological margins]

BACKGROUND

Basal cell carcinomas (BCCs) represent 90% of malignant tumors of the eyelids, which can be locally invasive and destructive. The observation of histological safety margins (MHS) allows for the prevention of recurrence while maintaining a fair compromise between aesthetics and functionality. However, to date, there is no consensus or national recommendations concerning the MHS to be observed according to the various histological subtypes of BCCs.

METHODS

Through a retrospective analysis of patient records and corresponding excisional slides, we studied the 6-year recurrence rate of 98 patients who underwent surgery for palpebral BCC.

RESULTS

MHS were mostly absent in the excisional specimens of recurrent BCCs and significantly more narrow than in non-recurrent BCCs, on average over 2mm.

CONCLUSION

The results of our study suggest that an average MHS greater than 2mm prevents most recurrences.

Internally displaced persons in Mali facing the COVID 19 pandemic: A qualitative study

Introduction

The COVID-19 pandemic has exacerbated an already existing security crisis leading to massive population displacements that have been taking place since 2012.

Purpose of research

This study aims to explore the representations of internally displaced persons (IDPs) about the existence of COVID-19 and their knowledge about its signs, symptoms, modes of transmission and prevention measures.

Methods

The study was qualitative and exploratory. Individual and group interviews were used to collect data from 52 IDPs in six sites in Bamako and Segou. All interviews were recorded and transcribed. Thematic content analysis and N-Vivo software were used.

Results

The majority of IDPs believed in the existence of COVID-19 and had good knowledge of the signs, symptoms, modes of transmission and prevention measures against the disease. However, this was not sufficient for the adoption of public health measures. Among those who believed in its existence, some thought that it was a disease of the white and rich. Finally, a group of participants believed in conspiracy theories and claimed that the government and humanitarian organizations were only trying to make money through these campaigns.

Conclusion

To our knowledge, this is the first study in Mali to explore IDPs’ beliefs and knowledge about COVID-19. These results could inform policies, strategies, and interventions to combat COVID-19 in IDP sites and in the general population.

[Treatment of cancer pain in Mali: Experience of the mother-child medical oncology service of the CHU in Bamako]

Two hundred patients were refereed for advanced cancer to the oncology department of Luxembourg Hospital in Bamako. All these patients reported intense pain (88 %) which was only treated before admission by OMS level 1 analgesics. It clearly shows that cancer pain is undertreated in Malian peripheral sanitary structures. After evaluation of the pain by analog visual and verbal scales patients, the appropriate analgesic drugs such as morphine (OMS level 3) were given. A control of the pain was obtained in all the patients (100 %) with a dramatic improvement in quality of life. This study emphasizes the need for a pain control program at the Malian state level with a basic education of care givers, hospital-centric networks and access to morphine and opioids at the different levels involved in cancer management.

Efficient Synthesis of Immunomodulatory Drug Analogues Enables Exploration of Structure-Degradation Relationships

The immunomodulatory drugs (IMiDs) thalidomide, pomalidomide, and lenalidomide have been approved for the treatment of multiple myeloma for many years. Recently, their use as E3 ligase recruiting elements for small-molecule-induced protein degradation has led to a resurgence in interest in IMiD synthesis and functionalization. Traditional IMiD synthesis follows a stepwise route with multiple purification steps. Herein we describe a novel one-pot synthesis without purification that provides rapid access to a multitude of IMiD analogues. Binding studies with the IMiD target protein cereblon (CRBN) reveals a narrow structure-activity relationship with only a few compounds showing sub-micromolar binding affinity in the range of pomalidomide and lenalidomide. However, anti-proliferative activity as well as Aiolos degradation could be identified for two IMiD analogues. This study provides useful insight into the structure-degradation relationships for molecules of this type as well as a rapid and robust method for IMiD synthesis.

[Factors linked to late diagnosis in breast cancer in Sub-Saharan Africa: case of Côte d'Ivoire]

OBJECTIVE

To identify in Ivorian environment, reasons involved in late diagnosis of breast cancer.

PATIENTS AND METHODS

Retrospective study over 4 years (January 2008 to December 2011) including 350 patients with breast adenocarcinoma. A questionnaire was created and filled according to the medical files of the patients. Linear regression analysis applied to the data showed concordance between the factors and the delay before diagnosis.

RESULTS

Thus 78.9% of the patients sought for care above 10 months with inflammatory cancers (54%) and necrotic ulcerations (18%). Factors found during interview were the lack of financial means (36%), cultural habits with first intent traditional treatment (41.1%), misdiagnosis (7.1%) and lack of therapeutic care. Yet, when comparing each of these factors to the delay, no significant link was found. Chemotherapy was the first therapeutic method.

CONCLUSION

In our context, the conjunction of ignorance, poverty and socio-cultural habits were the key factors in late diagnosis of breast cancers in Côte d'Ivoire.

Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa

BACKGROUND

HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons.

OBJECTIVES

To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal.

STUDY DESIGN

Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated.

RESULTS

The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/μl or above.

CONCLUSION

HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.

Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990-2009

We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.

[Floating elbows: anatomo-clinical aspect and review of treatment method]

INTRODUCTION

Floating elbows are rare pathologies that cause a number of problems to manage. The current treatment tendency is surgical. The orthopedic treatment is a good management option when the technical plateau is limited.

METHODS

We performed an 18-month prospective study that included patients with floating elbows. Two treatment methods were used and chosen following predefined indication criteria. The final evaluation was made on average 10 months (minimum 6 and maximum 18 months) according to the functional classification of the mayo clinic.

RESULTS

In 18 months, we treated 8 patients with floating elbow, who were all victims of traffic accidents. On an anatomo-clinical level, real floating elbows accounted for 37.5% of all cases, the rest were derived pathologies. Among these derived pathologies, the association of diaphyseal fracture of the humerus with a lesion of one or both forearm bones represented 50% of the cases. Regarding skin condition, open fractures were present in 37.5% of all patients. At the final evaluation we obtained two unsatisfactory results in patient treated surgically. No orthopedic treatment achieved an excellent final result, but they ranged between good and fair.

CONCLUSION

This study shows that the orthopedic treatment maintains its position as valid treatment for floating elbows. Nevertheless it is important to master the technique and recognize its limits.

[Extension of cervix cancer screening by visual methods to the community health centres in the district of Bamako]

Cervix cancer remains a public health problem in developing countries. These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid (VIA) and lugol's iodine (VILI). The aim of this study is to determine the feasibility and the impact of this screening in the community health centres "CSCOM" in the district of Bamako. It was a prospective and multicentric study through 8 CSCOM, 3 Reference Centres "CSRéf", Hôpital Gabriel Touré (HGT) and National Institute of Public Health (INRSP) in Bamako. During 28 months, 5016 women aged through 25-49 years were screened. After their consent and questionnaire filling, the patient is comfortably settled for visual test. The repartition of screened patients by health level is: CSCOM (19.24% : 965/5016), CSRéf (48.64% : 2440/5016), HGT (32.12% : 1611/5016). In general, the positivity of tests was: 5.2% (VIA) and 6.8% (VILI). The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy, possible biopsy or care. At all 177 biopsies were done, and histological diagnosis were: 67 dysplasias, 3 early invasive carcinomas, 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects. Patients with dysplasias or cancers were treated by cryotherapy, loop electrosurgical excision procedure (LEEP), cold-knife conization or surgery. This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level. We wish a large diffusion of the method to the whole of the country.

[Using CT to diagnose brain tumors at the Point G Hospital in Mali]

The authors report 27 cases of cerebral tumours in 22 men and 5 women age 1 to 81. Clinical symptoms were dominated by cranial hypertension (59.3%), focal motor impairment involving cranial nerves (51.9%.) and seizures due to epilepsy (44.4%). The main tumors detected with CT scan include glyoma (.5 cases), craniopharyngioma (3 cases), adenoma (3 cases), medulloblastoma (3 cases), and metastasis (3 cases). The supra tentoriel was predominant (76.9%). Neurosurgery was performed in 6 patients and 21 cases received medical treatment. We fund 13 cases of death. In conclasion, cerebral tumours are very severe pathologies because of the high mortality associated with. CT scan has contributed to diagnose the lesions, show their topography and to determinte the histological nature. Neurosurgery is necessary for the treatment of these lesions.

[Pyrethroid and DDT resistance of Anopheles gambiae s.s. (Diptera: Culicidae) in five agricultural ecosystems from Côte-d'Ivoire]

The promotion of pyrethroid impregnated bednets among the populations is a major activity of the National Malaria Vector Control Programs in African tropical countries. However pyrethroid resistance in Anopheles gambiae, a major malaria vector, has been observed in several parts of Côte-d'Ivoire since 1993. As insecticides used in agriculture against pests are frequently considered as important factors responsible for resistance in malaria vectors, we have evaluated insecticide resistance of An. gambiae populations taking into account the main crops cultivated in Côte-d'Ivoire. Five areas were selected according to the use of insecticide either in agriculture or for domestic purposes: a urban area where vegetables and rice are main crops, a rural rice growing area, a rural area of coffee/cocoa production, a rural area of fruit farming and a rural area without any use of agricultural insecticide. Susceptibility tests were carried out using WHO diagnostic test kits. About 6500 females of An. gambiae were exposed to insecticide impregnated papers (permethrin 1%, deltamethrin 0.05%, DDT 4%) for one hour. Results confirmed that both mortality rates and knockdown time analysis were important to study the resistance data. By using mortality rates, populations of An. gambiae were found to be resistant to pyrethroids and DDT in four of the five areas. Resistance was the highest in urban area, lower in fruit and coffee/cocoa areas and at low level in rice growing area. An. gambiae from area without agricultural treatment was found susceptible to pyrethroids but slightly resistant to DDT A significant increase of knockdown time was observed in all areas with the 3 insecticides. These results agreed with previous studies showing that kdr mutation was the main resistance mechanism to pyrethroids in An. gambiae populations in Côte-d'Ivoire. They also agreed with knockdown time which is an early indicator of resistance development for the population in area without agricultural treatment. In this population the frequency of homozygous resistant individuals was probably too low to have a significant decrease of mortality rates to pyrethroids.

[Vectorial transmission of malaria in shrubby Savannah area at Ganse, Ivory Coast]

A longitudinal entomologic study was carried out in the village of Ganse located in the Northeastern Ivory Coast from July 2000 to July 2001. The threefold purpose of the study was to index Plasmodium-carrying Anopheles species by capturing mosquitoes on human volunteers, collecting larvae in different dwelling types, and evaluating the involvement each species in the malaria transmission. A total of 4 species belonging to the Anopheles genus were collected in the village. Identification of circumsporozoite protein using the ELISA technique demonstrated that three species were plasmodium vectors. These species belonged to the An. gambiae complex (An. gambiae s.s. 100%), to the An. funestus group (An. funestus s.s. 95.6%) and to the An. nill group (An. nili s.s. 100%). The estimated mean sporozoite index was 5.9% for An. gambiae s.l., 4.3% for the An. funestus group and 2.6% for the An. nili group. The main larva breeding sites were standing water such as puddles for An. gambiae s.l., streams with tall plants for the An. funestus group and the Comoe River for An. nili group. Because peak breeding of these three species occurs at three successive times; i.e., in May, September and July respectively, transmission of P. falciparum is continuous throughout the year. The transmission rate is high since we recorded up to up to 410 infected bites per person per year. In addition to showing the presence of An. rivulorum-like, our findings in the area demonstrates the important role of An. nili s.s. in the transmission and the complexity of the vectorial system.

[Chemotherapy in advanced rectal cancers]

AIM OF THE STUDY

The aim of this retrospective study was to specify the therapeutic strategy in the management of locally advanced rectal cancers in our practice in front of lack of radiotherapy.

PATIENTS AND METHODS

This study had concerned 52 patients suffering from locally advanced rectal cancers, with mean age of 44 years old (range: 22-68). Evaluation for down staging was based on clinical, CT scan and intraoperative features. Patients were classified as T4NXM0. Thirty one patients (57,7%) had left iliac colostomy associated with a neoadjuvant chemotherapy, 12 had a left iliac palliative colostomy and 9 had chemotherapy only.

RESULTS

Thirty two patients (80%) suffered from digestive toxicity due to chemotherapy, 11 patients had hematologic toxicity and 4 other had skin and mucous toxicity. Between the thirty one patients who had colostomy and chemotherapy, 4 (12,9%) responded well and underwent to curative rectal resection, in the remaining patients, the colostomy stayed palliative. The median survey time was 9,5 months.

CONCLUSION

Our poor results confirmed the need of early detection and radiotherapy in the management of our patients.

[Epidemiological aspects of stroke in CT-scan department of the Point-G Hospital in Bamako, Mali]

The purpose of this prospective study conducted between January 2000 and December 2001 was to identify tomodensitometric aspects of stroke. The relationship between lesion type (hemorrhagic, ischemic, and transient ischemic) and prognosis was assessed. Axial sections were made through the posterior fossa (5 mm at 5mm intervals) and subtentorial region (10 mm at 10 mm intervals). The Virchow plan was used as the reference for sections. The chi square test was used to evaluate the correlation between lesion type and prognosis. A total of 159 stroke patients with a mean age of 44.5 years were enrolled during the study period. There were 90 men (56.6%) and 69 women (43.3%). In 118 patients (74.2%), CT scans showed cerebral abnormalities including ischemic lesions in 71 (44.6%) and hemorrhagic lesions in 47 (29.6%). Overall mortality was 45.7% (54/118). Hemorrhagic lesions were fatal in 51.1% (24/47) of cases and ischemic lesions in 35.2% (25/71). Transitory ischemic accidents were fatal in 0.12% of cases (5/41). This study demonstrates that CT scan is an important tool for stroke management by identifying the type and location of lesions.

[Value of computer tomography in the managment of brain injuries]

The purpose of this prospective study conducted from January 2001 to December 2001 was to ascertain the value of computer tomography for evaluation of brain injuries. Computer tomography was performed using a Toshiba X VID system with contiguous 5 mm axial sections through the posterior fossa and 10 mm contiguous axial sections through the subtentorial region without contrast injection. A total of 107 patients with brain injuries were enrolled over the one-year study period. These patients accounted for 0.8% of all admissions to surgical emergency unit of Gabriel Toure Hospital in Bamako, Mali. The predominant age group for brain injuries was the 20- to 29-year-old group (35 cases). The male-to-female sex ratio was 5:1. Vehicular accident was the most frequent cause of brain injury (76 cases). Trauma was severe in 48 patients with a Glasgow score less than 8. Coma occurred immediately after injury in 90 cases. Ventricular hemorrhage led to coma in 100% of cases whereas brain hemorrhage and hematoma led to coma in 93.3% and 83.3% of cases respectively. Treatment was medical in 99 cases and neurosurgical in 8. The mortality rate was 34% and the morbidity rate (permanent sequels) was 36%. Computer tomography is a valuable tool for therapeutic decision-making in medico-surgical emergencies involving brain injuries.

Évolution récente des ressources en eau de l'Afrique atlantique

Dans le contexte pluviométrique déficitaire de l'Afrique intertropicale, l'hydraulicité des fleuves soudano-sahéliens a beaucoup diminué depuis 25 ans. Les fleuves des régions humides, relativement épargnés jusqu'en 1980, montrent aussi, avec un retard de plusieurs années une hydraulicité qui baisse dans des proportions importantes, alors qu'un retour à la normale du régime des pluies paraît amorcé. Le déficit des apports est pour l'Afrique humide de 16% pour la décennie 80 (365 km3 an-1), contre 7% pour la décennie 70, et pour l'Afrique sèche de 27% (65 km3 an-1) pour la décennie 80 contre 13% pour la décennie 70. Les maximums annuels de crue sont systématiquement plus faibles dans la période récente. En régime équatorial, la crue de printemps est la plus affectée par le déficit hydrologique et la différence entre crue de printemps et crue d'automne a triplé entre les années 1950-1960 et les années 1980. L'ensemble de la région connaît des étiages exceptionnels répétés. En zone soudano-sahélienne, le tarissement s'est considérablement accéléré et montre une vidange des écoulements de base deux fois plus rapide dans la période récente. Le phénomène est également sensible en Afrique humide et traduit un amenuisement des réserves souterraines dû aux effets cumulés des déficits pluviométriques et décalé dans le temps, que l'on retrouve dans la baisse du niveau piezométrique des nappes phréatiques. Un effet mémoire est donc observé sur les écoulements de base, avec pour conséquence un un appauvrissement durable des ressources hydriques. Celui-ci restera indépendant, pour un temps, d'une éventuelle amélioration des conditions climatiques, comme le montrent les observations des années les plus récentes.

[Prevalence of urinary schistosomiasis in the school population in Senegal in 2002]

INTRODUCTION

The strong prevalence of schistosomiasis in the school population is correlated with underperformance in educational outcomes in Senegal. The geoclimatic conditions and bad socio-economic conditions facilitate transmission of these infections. This study was to define t he prevalence of these infections in sites throughout the country in school age children.

MATERIALS AND METHODS

This study was undertaken from November 2002 to January 2003 and included 63 schools; (n=2245) for an effectif of 30 000 pupils, means 7.4%. These pupils underwent urine examination for schistosomiasis in children with hematuria using millipore filtration method.

RESULTS

The results of the study are: overall there were 364 cases (16%). Prevalence rates: Tambacounda 27.8%, Bakel 21.5%, Kédougou 21.8%, Matam 13%, Podor 22.5%, Dagana 28.3%, and Saint-Louis 0%. This study demonstrates a high prevalence of parasites in school age children. Notably there is unique infection patterns in each village and this data will help direct public health interventions.

CONCLUSION

These results show a high rate prevalence of urinary schistosomiasis in school population in these departments. It explains the underperformance in educational outcomes in these a reas.

[Portal vein: echographic anatomy]

The principal descriptions of the portal vein are mainly on the results of the dissections of the corpses. The aim of the work was to determine the usual sizes of the portal vein on the alive subject by echography. From the same machine, 3 ultrasonographers studied the anatomy of the portal vein of the volunteers according to a standardized methodology. The study was about 60 old people from 11 to 82 years old, whom 31 were males (51.7%) and 29 females (48.3%). The transverse diameter of the portal vein, originally varied between 8 and 10 mms un 57.9% of cases. The average was 9.05 mms +/- 2.82 and the extremes varied from 5 to 16 mm. The transverse diameter of the portal vein, at the end varied between 8 and 10 mms. The average was 9.16 mms +/- 2.58 and the extremes varied between 6 and 16 mms. In 29.8% of cases, the length of the portal vein was between 61 and 70 mms and in 8.8% between 81 and 100 mms. The average was 58.0 +/- 22.3 mms. Before its entry into the liver, the portal vein is divided into 3 branches in 2 cases (3.3%). The study showed a significant change of the length of the portal vein according the age and sex.

[Defects in peroxidation of erythrocyte phospholipids in sickle cell trait]

The sickle cell disease pathophysiology is provided by several events including deoxyhemoglobin S polymerization and hemorrheological troubles. Classically, such disorders have been known to concern only the homozygous SS and heterozygous SC profiles. However, troubles are more and more described since early years in the sickle cell trait patients and the pathogenesis factors are unknown. Our study focussed on phospholipids which are the basic and functional constituent elements of erythrocyte plasmic membrane. Assaying the membrane lipids extracted by Folch method and lipid standards (cholesterol, phosphatidic acid, lysophosphatidyl-choline, phosphatidyl-choline, lysophosphatidyl-ethanolamine, phosphatidyl-ethanolamine, sphingomyelin) was carried out by HPLC among 91 sickle cell trait patients as compared to 78 healthy subjects. The main abnormalities observed were an empoverishement in phosphatidyl-choline contrasting with an accumulation of membrane lysophosphatidyl-choline, lysophosphatidyl-ethanolamine, phosphatidic acid and sphingomyelin in sickle cell patients. These results suggest that sickle cell trait harmlessness is not actual. The accumulation of lysophosphatidyl-choline, by its cytolytic biomembrane perturbing properties, predispose therefore the sickled red cell to the haemolysis phenomena and allow to forecast deeper disturbances among homozygous subjects. These morbid disorders attributable to lipid peroxidation would justify an antioxidant treatment during the sickle cell disease.

[Assessment of the level of urinary iodine deficiency in children of Senegalese central regions]

Iodine deficiency disorders (IDD) are a major public health problem in Senegal, where strategies of salt iodization were adopted in the southern and eastern regions. The aim of this study led in four districts (Koungheul, Bambey, Mekhe and Kebemer), was to estimate by a questionnaire, the women knowleges, attitudes and practices (KAP) concerning IDD, and to measure children urinary iodine excretion by the Sandell-Kolthoff method to assess a potential deficiency. Six hundred ninety eight households were selected covering 1336 women (age 15 to 49 years) and 400 children (age 6 to 12 years). Sixty three per cent of the women knew the goiter, 89% of them considered that it was a disease and only 0.6% knew the role of iodized salt in the treatment. On the other hand, 20% of the children presented a normal range of urinary iodine excretion superior to 100 microg/l, the deficiency was light (50 to 100 microg/l) in 38% of the children, moderate (25 to 50 microg/l) in 27% and severe (< 25 microg/l) in 15% of them. These results show that other Senegalese regions are concerned by iodine deficiency disorders and need information, education and iodine supplementation programmes, notably for children and young women.

[Protein profile of Senegalese children presenting with nephrotic syndrome]

In Senegal, nephrotic syndrome usually occurs upon malnutrition that confers it its specificity and has brought us to establish the proteinic profile of Senegalese children suffering from it, in the aim to improve its treatment. Twenty children on the average of six years, hospitalized for nephrotic syndrome, were chosen. They were compared to 20 healthy children of the same age group, and 20 other children hospitalized for a non-renal inflammatory syndrome. For each subject were dosed total blood proteins and albumin. The protein electrophoresis has permitted to evaluate the alpha-1, alpha-2, beta and gamma globulins. We have observed predominance of boys with a 2.33 sex ratio. Our patients presenting a nephrotic syndrome were about six years old; no case has been noted before two years. Total proteins and albumin have decreased respectively to 52.10 g/l and 16 g/l. This diminishing is essentially linked to the massive urinary escape of plasmatic proteins and would explain partly the increase of lipids. The alpha-1 globulins were equally lowered but the alpha-2 globulins were increased by 40% of total proteins. Beta globulins have decreased, following the evolution of gamma globulins. In Senegal, The early age of nephrotic syndrome occurrence and the biological perturbations of the proteinic profile, recommend global and quick treatment considering food recovery and nutrition. The correction of these parameters being able to constitute in one hand an element of accessible and reliable supervision, and one the other hand the basis of complete treatment.

[Phospholipid composition and content of the erythrocyte membrane in carriers of sickle cell trait]

By its frequency, but also by its morbidity and mortality, sickle cell disease is a real problem of public health in Senegal. It is an inherited disease of the red blood cell, characterized by vaso-occlusive manifestations in several organs, and chronic hemolytic anemia. Out of this work carried upon subjects presenting sickle cell trait (AS), we especially studied the membrane phospholipids. The aims of this study was to identify and to measure the major phospholipids of the red blood cell membrane (lecithin, lysolecithin, cephalin, lysocephalin and sphingomyelin). We noted a significant decrease of the lecithine rates, associated with significant accumulation of lysophosphatidyl choline implied in hemolysis disorders. We have also noted a significant increase of sphingomyelin which might be involved in the adhesive phenomena of the sickle cells. These preliminary results, allow to consider eventual new therapeutics, at least to reduce the clinical disorders of this painful disease.

[Effects of refeeding on serum immunoglobulin (IgA, IgG, IgM) concentrations in children with severe protein-energy malnutrition]

BACKGROUND

Published studies on the serum immunoglobulin concentrations of patients with protein-energy malnutrition (PEM) have been contradictory. This report describes such a study in 21 Senegalese children.

POPULATION AND METHODS

Twenty one Senegalese infants (mean age: 19 +/- 2 months) with severe PEM were included in the study. Their weight was less than 32% of the normal range-for-height and all had sparse, thin hair and dyspigmentation of the skin. They were all suffering from hypoproteinemia (less than 70% of normal) and hypoalbuminemia (less that 61% of normal). The presence or absence of edema, loss of subcutaneous fat and mental changes were used to classify them into three groups. 1) kwashiorkor: eight infants; 2) marasmus: eight infants; 3) kwashiorkor plus marasmus: five infants. The control group comprised 27 infants living in the same area and having the same dietary habits as the 21 sick infants. The 21 infants with malnutrition were refed for 3 weeks with a diet supplying 100-150 Kcal/kg/d and 5-8 g/kg/d protein. The plasma concentration of proteins, prealbumin and immunoglobulins was measured on days 0, 8, 15 and 21.

RESULTS

The only significant change was in the IgG concentrations of group 1, which increased to normal levels by day 15 as did the total protein and prealbumin.

CONCLUSION

Severe PEM can lead to a loss of one class of immunoglobulins, but this can be restored by refeeding.

[Etiology of splenomegaly in children in the tropics. 178 cases reviewed at the university hospital center of Abidjan-Cocody (Ivory Coast)]

Discovery of an enlarged spleen in a child requires steps to identify the etiology. One hundred and seventy-eight patients seen over a four-year period (1985-1988) at the Cocody Teaching Hospital were reviewed. The incidence of splenic enlargement among pediatric inpatients was 1.6%. Males (n = 106) were more often affected than females (n = 72). Slightly over half the children (54.49%) were 0 to 5 years of age. The main clinical presenting features were fever (90%), anemia (72%), a decline in general health (36.50%), enlargement of the liver (33.50%), jaundice (26.50%), and enlarged lymph nodes (7%). Type II of Hackett's classification accounted for most cases (61.80%), followed by Type III (14%). Main etiologies included malaria (53%), salmonella infections (15%), sickle cell anemia (14%), schistosomiasis (9%), AIDS (3%), and thalassemia (2%). Malignancies (leukemia, lymphoma) were relatively infrequent. More than one etiology was found in 13 cases. The distribution of etiologies by age group was determined and a strategy for investigating children with splenic enlargement in tropical countries was developed.

[Rational prescription if protein evaluation in the diagnosis and follow up of protein-energy malnutrition]

In our countries, a good prescription of analysis would help to reduce hospital costs without modifying the efficiency of the diagnosis approach. In this work, the authors establish a bond between medicos and biologists by a good indication of protein check-up in the diagnosis and follow up of protein-energy malnutrition (PEM). After a discriminant analysis of all the results of protein check-up, two groups of markers are individualized depending on whether the PEM is accompanied or not by inflammatory complications. Finally, they recommend a systematic prescription of the useful group in case of inflammation associated with PEM, because infectious and parasitic diseases are almost constant among our malnourished infants.

Apolipoprotein A1 as an early index of protein-energy malnutrition

Protein-energy malnutrition (PEM) is, together with infectious and parasitic diseases, a major cause of childhood illness in Africa. Diagnosis and treatment of PEM requires an accurate, simple and reliable method of assessing nutritional status from a blood sample. Plasma apolipoprotein (apo A1), prealbumin and albumin were measured in a group of Senegalese children suffering from PEM who had been hospitalized for refeeding, and in a group of control children. Statistical analysis of the results indicated that: (1) Plasma apo A1 was significantly correlated with prealbumin in assessing nutritional status (P less than 0.005 on day 8 of refeeding); (2) plasma apo A1 alone was sufficient for diagnosing and monitoring the dietary treatment of PEM; it was capable of detecting subclinical forms; (3) apo A1 could be used for differential diagnosis of forms of PEM; (4) plasma apo A1 concentration began to increase earlier (94% of control values at day 8) than did prealbumin (73% on day 8). We therefore propose apo A1 as an index of nutritional status in children living in areas where infectious and parasitic diseases are endemic.