[Prescription And Delivery's Survey Of Benzodiazepines In The Occurrence Of Addictions At Mbour's District]

Impact of the prescription and delivery of benzodiazepines in the occurrence of addictions in the district of Mbour.

INTRODUCTION

Benzodiazepines (BZD) are widely used nowadays and are at the origin of an addiction.

OBJECTIVES

The objective was to evaluate the quality of benzodiazepine prescribing and delivery in the Mbour department of Senegal and subsequently to implement an addictovigilance strategy. Thus, we studied the prescribing habits, the quality of delivery and identified the consumption habits of these drugs.

MATERIALS AND METHODS

It was a cross-sectional, prospective study with two questionnaires: addressed to patients and prescribers, conducted in pharmacies, hospitals, districts and Mbour health posts.

RESULTS

44% of BZD prescriptions were prescribed by doctors and especially general practitioner. 31.1% did not comply with the rules of prescription (marketing authorization). As for the dispensing rules, (85.3%) were dispensed without a prescription. The level of consumption was high in the 30-40 age group (43.95%) predominantly female (59%). Insomnia predominated as a reason for prescription (16.4%) on anxiety (11.94%) with (65.5%) dependence.

CONCLUSION

The abuses observed in the prescription, the delivery and consumption of BZD, constitutes a real health problem. Half of the consumers become addicted, hence the need for a national addictovigilance program.

[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.

[Analize of the determinants of microscopy's quality in the context of tuberculosis fighting within the health centers laboratories in Dakar Region]

INTRODUCTION

In order to improve the quality of the microscopy in the context of tracking and following-up the pulmonary tuberculosis patients, a study of the determinants of the quality of microscopy was carried out in the laboratories of the health centres in Dakar Region, Senegal.

MATERIALS AND METHODS

We did an epidemiologic study, transversal type which proceeded during April 19th at May 05th, 2004. It consisted of a series of observations, interviews, review of the registers of laboratory and with a second reading and re staining, on the level of the National Laboratory of Reference of the National Programme of fight against Tuberculosis (LNR), of 50 blades collected blindly in the health centres of Dakar.

RESULTS

It comes out from this study that there was no statistically significant link between the factors of risk of errors such as the overload of work, the bad condition of the microscope, the lack of competence and the errors observed in certain laboratories. On the other hand the aspect of the smears, the thickness of the smears and the presence of crystals could deteriorate the quality of microscopy because it was found that there was a statistically significant connection between the quality of microscopy and these various determinants. In addition we noted a good agreement of the results of these laboratories with those of the LNR (Kappa test = 0,981, p < 0,0001).

CONCLUSION

According to these results, we recommend: a reinforcement of competences (training/recycling) regular of the laboratory assistants, and an installation of a system of quality control of microscopy, interns within the laboratories but also external by the National Laboratory of Reference.

Extraneural metastasis in a child with atypical teratoid rhabdoid tumor of the central nervous system

Atypical teratoid rhabdoid tumor is a distinctive brain tumor appearing in infancy and early childhood. Leptomeningeal dissemination is common, both at presentation and relapse. Extracranial metastases of the central nervous system tumors are rarely seen. To our knowledge there is only one report with an atypical teratoid rhabdoid tumor metastasizing via a ventriculoperitoneal shunt. We describe the first case of atypical teratoid rhabdoid tumor of the central nervous system who developed lung metastasis without the presence of a shunt.

Neurotrophic and neuroprotective actions of ginsenosides Rb(1) and Rg(1)

The ginsenosides have many pharmacological actions, including various actions on the nervous system. Our previous studies have demonstrated that two ginsenosides, Rb(1) and Rg(1) improve performance in a passive avoidance-learning paradigm and enhance cholinergic metabolism. The present study was designed to examine the cellular neurotrophic and neuroprotective actions of two pure ginsenosides in two model systems. PC12 cells were grown in the absence or presence of nerve growth factor (NGF) as a positive control, and different concentrations of Rb(1) or Rg(1). To assess neurotrophic properties, neurite outgrowth was quantified for representative fields of cells. After 8 days in culture, both ginsenosides enhanced neurite outgrowth in the presence of a sub-optimal dose of (2 ng/ml) NGF, but did not significantly stimulate neurite outgrowth in the absence of NGF. However, after 18 days in culture, both ginsenosides increased neurite outgrowth in the absence of NGF. SN-K-SH cells were grown in the absence or presence of MPTP or beta-amyloid to assess neuroprotection. Rb(1) and Rg(1) both reversed MPTP-induced cell death. beta-Amyloid-induced cell death was not reversed by either ginsenoside, but Rg(1) produced a modest enhancement of cell death in this model. These results suggest that these two ginsenosides have neurotrophic and selective neuroprotective actions that may contribute to the purported enhancement of cognitive function.

Rapid susceptibility testing of Mycobacterium tuberculosis by the Mycobacteria Growth Indicator Tube (MGIT AST SIRE)

OBJECTIVE

To evaluate the reliability of the Mycobacteria Growth Indicator Tube (MGIT AST) for susceptibility testing of Mycobacterium tuberculosis.

METHODS

Seventy strains of M. tuberculosis were tested for susceptibility to streptomycin, isoniazid, rifampicin and ethambutol by comparing MGIT AST results to those obtained by the method of proportion (MOP) on Lowenstein-Jensen (LJ) and Middlebrook 7H10 media. The 7H10 MOP was considered the method of reference.

RESULTS

The turnaround time for MGIT AST was 6.2 days (5-10 days) and for MOP it was 18-21 days. With rifampicin, MGIT AST agreed for all isolates with both MOP. For streptomycin, MGIT AST and 7H10 MOP agreed for 64 isolates (91.4%); 61 were susceptible and three resistant. LJ MOP and 7H10 MOP agreed for 64 isolates (92.2%); 62 were susceptible and three resistant. With isoniazid, both MOP agreed for all isolates, while MGIT AST and 7H10 MOP had two discrepancies. For ethambutol, MGIT AST and 7H10 MOP were concordant for 66 isolates; 65 were susceptible and one resistant. Both MOP were concordant for 67 isolates; 66 were susceptible and one resistant.

CONCLUSIONS

Based on these results, MGIT AST is a time-saving method and can be used as an alternative to the BACTEC System. MGIT AST is reliable as far as rifampicin and isoniazid are concerned; however, additional studies are needed for streptomycin and ethambutol.

[Improvement of tuberculosis diagnosis by the Mycobacteria Growth Indicator Tube (MGIT) in a developing country laboratory]

In order to improve tuberculosis diagnosis in a developing country (Senegal), we evaluated a new liquid-based medium and nonradioactive system, Mycobacteria Growth Indicator Tube (MGIT), with individual clinical specimens collected in Dakar. The main purpose was to compare the time to detection and the rate of recovery of Mycobacterium tuberculosis complex and to determine its importance with respect to Lowenstein-Jensen (LJ), a liquid-based-medium for isolation of M. tuberculosis complex. 531 specimens were processed with Mycoprep kit containing NaOH-N-acetyl L-cystein and inoculated on both LJ and MGIT and incubated at 37 degrees C for 60 days. For each medium, the recovery rate and the time to detection were recorded. Among the 531 specimens, of which 121 smears were positive, 32.5% (173/531) grew the M. tuberculosis complex. Of these, 103 were smear positive (S+) and 70 smear negative (S-). LJ recovered 54.9% (95/173) and MGIT recovered 91.9% (159/173). Disagreements were observed with 92 isolates, LJ failed to recover 78 while MGIT failed to recover 14. The overall mean time to detection was 20.1 days for LJ and 10.5 days for MGIT. MGIT has shown a better sensitivity in isolation with significant reduction in reporting culture for M. tuberculosis complex. As a simple and a nonradiometric system, it could be used in conjunction with egg-based media in developing countries laboratories.

A comparison of fluorescence microscopy with the Ziehl-Neelsen technique in the examination of sputum for acid-fast bacilli

SETTING

National Tuberculosis Reference Laboratory in Dakar, Senegal.

OBJECTIVES

Comparison of results with fluorescence and bright-field microscopy for acid-fast bacilli.

METHODOLOGY

Two smears from 2,630 consecutive sputum specimens between January 1996 and June 1998 were prepared for blinded examination of one smear each by the Ziehl-Neelsen technique and fluorescence microscopy at 1,000x magnification. The time required to declare a slide as negative was determined for both techniques in a sample of 68 slides.

RESULTS

Concordancewas 96.9% and 92.3% for diagnostic and follow-up examinations, respectively. The yield was similar with both techniques for specimens with at least 10 bacilli per 100 fields, but higher with fluorescence microscopy in those with fewer than 10 bacilli per 100 fields. The mean time required by fluorescence microscopy before declaring a slide as negative with the same magnification was 3 minutes 34 seconds, compared to 7 minutes 44 seconds with the Ziehl-Neelsen technique.

CONCLUSIONS

The results obtained with one technique are highly reproducible by the other. Fluorescence microscopy appears to be more likely to detect bacilli in paucibacillary cases than bright-field microscopy, and it more than halves the required examination time.

American ginseng extract reduces scopolamine-induced amnesia in a spatial learning task

OBJECTIVE

To determine if HT-1001, an extract of American ginseng, affects scopolamine-induced memory and performance deficits in a spatial learning task, alters brain concentrations of aminergic neurotransmitters, and alters choline uptake in synaptosome preparations.

DESIGN

Animal study.

ANIMALS

48 Sprague Dawley rats.

INTERVENTIONS

Long-term oral administration of a test material or control solution. Intraperitoneal administration of scopolamine (2 mg/kg) 30 minutes before testing.

OUTCOME MEASURES

Performance on Morris water maze task, choline uptake, aminergic neurotransmitter analysis, in vitro monoamine oxidase analysis (of compounds).

RESULTS

HT-1001 protected against scopolamine-induced amnesia and increased choline uptake in synaptosomal preparations. HT-1001 did not alter brain concentrations of norepinephrine, dopamine, 5-HT (serotonin), 3,4-dihydroxyphenylacetic acid or 5-hydroxyindoleactic acid. HT-1001 had a very weak ability to inhibit monoamine oxidase activity in vitro.

CONCLUSIONS

HT-1001 demonstrates a capacity to protect against scopolamine-induced memory deficits.

[Preliminary experiment on selection of oral hygienic cleanser]

The effectiveness of three commercial chewing gums ("Hua Aikang","Cao Shanhu" and "Poli") and brushing with toothpaste on the elimination of dental plaque was observed in 31 healthy males (aged 19-25 years). Before and after chewing or brushing, evaluation of oral taste and examination of plaque were performed. The result showed that the oral taste after chewing, "hua aikang" was the best, then "po li" and "cao shanhu"; plaque indexes were substantially reduced by all four kinds of treatment (P < 0.001) as compared with the pretest values, however "hua aikang" demonstrated a better effectiveness (P < 0.001). It also indicates that plaque index is an important index revealing the hygiene status.

Evaluation of a standardized recording tool for sputum smear microscopy for acid-fast bacilli under routine conditions in low income countries

SETTING

Laboratories performing sputum smear microscopy for tuberculosis in Benin, Malawi, Nicaragua and Senegal.

METHODS

Analysis of computerized laboratory registers to ascertain workload, yield from serial smear examination, and demographic characteristics of examinees.

RESULTS

Data from more than 60,000 examinees in 42 laboratories showed that the average number of smears examined per day ranged from 4 to 19 (mean 6) per country. To find one case of tuberculosis, on average 21 smears of suspects were examined (range 8 to 50). Of all cases with ultimately at least one positive result, 87% were already positive on the first examination. Demographic characteristics of cases differed considerably by country and gender. In 35 of 42 laboratories, males were more frequently found to be cases than females, and with increasing age an increasingly larger number of female than male suspects had to be examined to identify one case.

CONCLUSIONS

This study demonstrates the usefulness of a standardized recording system for results of acid-fast microscopy in obtaining essential information for program management and on demographic characteristics of persons presenting for examination.

[Construction of shuttle vector containing delta-endotoxin gene of Bacillus thuringiensis]

The Bacillus thuringiensis toxin gene CryIA(c) was inserted into the shuttle vector pBE-2 to construct pAMY for expressing the B.t. gene in both Gram-negative and -positive bacterial systems. pAMY was introduced into wild type Bacillus cereus, B.brevis and B.subtilis by electroporation. Transformants containing delta-endotoxin gene produced proteins reacted with B.t. crystal protein antibody. Upon biological toxicity tests, the transformants gave a mortality of 100% against Ostrinia furnacilis, 58.8% against Heliothis armigera and 100% against Heliothis assulta. The ability of promoting plant growth of the original strains is retained.