Improvement in health perception but not quality of life with an antiseizure medication intervention in people with epilepsy in Guinea: A cohort study

BACKGROUND

This study assesses perceptions of quality of life (QOL) and overall health in people with epilepsy (PWE) in Guinea after a clinical intervention providing modified and new antiseizure medicine (ASM) regimens.

METHODS

Participants 12 years and older diagnosed with active epilepsy were prospectively and consecutively enrolled at two health centers in the Republic of Guinea (one urban, one rural) in 2022. 95% of participants were prescribed new/increased ASM doses, and interviewed for QOL and overall health perceptions at enrollment and three- and six-month follow ups. Univariate and linear mixed models were used to evaluate effects on QOL and overall health over time.

RESULTS

The mean QOLIE-31 score (±SD) among 148 Guinean PWE (82 male, 66 female; mean age 27.3; 137 with >1 seizure in prior year) was 51.7 ± 12.8 at enrollment, 57.6 ± 16.0 after three months (n = 116), and 52.2 ± 9.9 after six months (n = 87). Overall health scores were 53.1 ± 26.9, 72.6 ± 21.5, and 65.7 ± 20.2 respectively. After three months, PWE had improved overall health and QOLIE-31 scores (p<0.0001, p = 0.003), but these improvements persisted for overall health and not QOLIE-31 after six months (p = 0.001, p = 0.63). Seizure freedom (prior 30 days) was 26% initially, and 62 (42%) of the remaining PWE experiencing seizures achieved seizure freedom at either the first or second follow-ups.

CONCLUSIONS

A noticeable discrepancy exists between Guinean PWE's self-rated perceptions of QOL and overall health. Purely clinical interventions may not be sufficient to improve QOL, especially in people that experience severe, previously-untreated epilepsy in lower income settings.

Application of the Kvaal method with cone beam for the determination of a local formula for the age estimation of adult African melanoderma subject, Côte d'Ivoire

BACKGROUND

Age estimation by invasive dental methods is a destructive, costly and time-consuming approach, whereas, age estimation methods using dental radiographs are simple, non-destructive and provide reliable information. Age estimation by the Kvaal radiographic method has proven to be a reliable method, but possible ethnic variations may limit its uses in other populations. The objective of this study was to reproduce the original Kvaal method with CBCT for the estimation of the age of the adult melano-African subject in Côte d'Ivoire, in order to propose an age estimation formula, specific to our study population, by taking into account the measurements of tooth and pulp ratios.

METHODS

A cross-sectional study used 102 radiographic data from a CBCT Planmeca® examination in a private dental clinic in Abidjan. It was data from subjects of at least 18 years of age. Dental measurements in length and width of the entire tooth, root and pulp were performed on maxillary central incisors and the different ratios were calculated according to the Kvaal method. The correlation between age and ratios was also assessed. Age estimated using the Kvaal formula was compared to the chronological age. A linear regression equation was developed using ratios and age predictive factors to evaluate the accuracy of the Kvaal formula.

RESULTS

In all, a total of 102 radiographs of 102 subjects, of whom 55 (53.9%) were females, were analyzed. The median age was 51 years (inter-quartile range [IQR] 41- 58). Using the Kvaal formula, the Standard error of the estimated age was higher in the African melanoderma population compared to the Kvaal population. The new formula derived from that of the Kvaal formula was developed and applied to our study population (Age = 84.7- 114.2 (M) - 29.4 (W - L) gave more than double the standard error of estimated age by Kvaal (26.03).

CONCLUSION

Our study showed that the measurements made by Kvaal are reproducible with CBCT and there is a correlation between age and the dental parameters studied. However, the age estimation formula determined by Kvaal et al. is not valid for African melanoderma subjects living in Côte d'Ivoire.

Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry

Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0–2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28–1.43], 2.1 [1.16–3.8] and 1.01 [1.01–1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1–0.85] and 0.25 [0.14–0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.

High SARS-CoV-2 Seroprevalence among Healthcare Workers in Bamako, Mali

In Mali, a country in West Africa, cumulative confirmed COVID-19 cases and deaths among healthcare workers (HCWs) remain enigmatically low, despite a series of waves, circulation of SARS-CoV-2 variants, the country’s weak healthcare system, and a general lack of adherence to public health mitigation measures. The goal of the study was to determine whether exposure is important by assessing the seroprevalence of anti-SARS-CoV-2 IgG antibodies in HCWs. The study was conducted between November 2020 and June 2021. HCWs in the major hospitals where COVID-19 cases were being cared for in the capital city, Bamako, Mali, were recruited. During the study period, vaccinations were not yet available. The ELISA of the IgG against the spike protein was optimized and quantitatively measured. A total of 240 HCWs were enrolled in the study, of which seropositivity was observed in 147 cases (61.8%). A continuous increase in the seropositivity was observed, over time, during the study period, from 50% at the beginning to 70% at the end of the study. HCWs who provided direct care to COVID-19 patients and were potentially highly exposed did not have the highest seropositivity rate. Vulnerable HCWs with comorbidities such as obesity, diabetes, and asthma had even higher seropositivity rates at 77.8%, 75.0%, and 66.7%, respectively. Overall, HCWs had high SARS-CoV-2 seroprevalence, likely reflecting a “herd” immunity level, which could be protective at some degrees. These data suggest that the low number of cases and deaths among HCWs in Mali is not due to a lack of occupational exposure to the virus but rather related to other factors that need to be investigated.

Isoniazid preventive therapy in child household contacts of adults with active TB in Bamako, Mali

BACKGROUND AND OBJECTIVE

Isoniazid preventive therapy (IPT) is known to reduce the risk of developing active TB in about 59% in children aged ⩽15 years. We assessed adherence, completion and adverse events among children who were household contacts of a newly diagnosed adult with smear-positive TB in Bamako, Mali.

METHODS

Children aged <15 years living in the same house with an adult smear-positive index case were enrolled in the study in the Bamako Region after consent was obtained from the parent or legal guardian. Adherence was assessed based on the number of tablets consumed during 6 months.

RESULTS

A total of 260 children aged <15 years were identified as household contacts of 207 adult patients with smear-positive TB during the study period. Among all child contacts, 130/260 (50.0%) were aged 0-4 years and were eligible for IPT; 128/130 (98.5%) were started on IPT and 83/128 (64.8%) completed with good adherence at the end of the 6 months, and without any significant adverse events.

CONCLUSION

We successfully implemented IPT with good acceptance, but low completion rate. The Mali National TB Program and partners should expand this strategy to reach more children in Bamako and the whole country and create greater awareness in the population.

Synthesis of organic-inorganic hybrids via a high-pressure-ramp process: the effect of inorganic nanoparticle loading on structural and photochromic properties

Organic polymerization remains a limiting step in the preparation of organic-inorganic hybrid materials with a strong concentration of the inorganic component. In this work, a high-pressure-ramp process was applied to achieve pHEMA-TiO₂ nanoparticulate solids with an unprecedentedly high concentration (12 mol l^-1) of the inorganic component, which is four times higher than that obtained after radical polymerization induced thermally or by photons. The inorganic nanoparticles underwent morphological and structural changes with an increase of Ti concentration above 1.5 mol l^-1: they slightly coarsen and crystallize into an anatase polymorph. The material possesses a strong photochromic response related to the electron-hole separation at the organic-inorganic interface and can store 1e^- per 5 Ti atoms. The electron storage capacity of the titania nanoparticles decreases upon crystallization.

A New Route for High-Purity Organic Materials: High-Pressure-Ramp-Induced Ultrafast Polymerization of 2-(Hydroxyethyl)Methacrylate

The synthesis of highly biocompatible polymers is important for modern biotechnologies and medicine. Here, we report a unique process based on a two-step high-pressure ramp (HPR) for the ultrafast and efficient bulk polymerization of 2-(hydroxyethyl)methacrylate (HEMA) at room temperature without photo- and thermal activation or addition of initiator. The HEMA monomers are first activated during the compression step but their reactivity is hindered by the dense glass-like environment. The rapid polymerization occurs in only the second step upon decompression to the liquid state. The conversion yield was found to exceed 90% in the recovered samples. The gel permeation chromatography evidences the overriding role of HEMA2(••) biradicals in the polymerization mechanism. The HPR process extends the application field of HP-induced polymerization, beyond the family of crystallized monomers considered up today. It is also an appealing alternative to typical photo- or thermal activation, allowing the efficient synthesis of highly pure organic materials.

Laser-assisted high-pressure-induced polymerization of 2-(hydroxyethyl)methacrylate

We report on a successful room-temperature polymerization of 2-(hydroxyethyl)methacrylate (HEMA) under high pressure. The polymerization is observed in a limited range of pressures 0.1 to 1.6 GPa without the use of any initiator. When the compressed sample is irradiated at 488 or 355 nm by a laser, the polymerization reaction rate is increased by a factor of 10 or 30, respectively. Moreover, the shift of the laser wavelength to the UV improves the polymerization yield of the recovered sample to 84%. The catalysis of the polymerization process by light results from a one-photon-assisted electron transfer to π* antibonding states of the monomer molecule. The observed polymerization is irreversible and almost complete, which makes this synthesis process suitable for applications.

[Satisfaction with obstetrical care: development and validation of a scale on quality of care]

OBJECTIVES

To develop and validate a subjective and multidimensional scale to measure satisfaction in obstetrical care (SSO) during labour, delivery and two hours postpartum, which is relevant to the French-speaking context.

PATIENTS ET METHODS

Forty partially directed patient interviews during the 48 hours after delivery and four care-giver interviews were conducted to build up the questionnaire. After a prior feasibility study on 40 patients, the psychometric validity of the questionnaire was evaluated by calculating the Cronbach coefficient of reliability for 432 patients.

RESULTS

Hundred and eighty items were initially obtained after content analysis of the patient interviews. Expert meetings finally selected 49 items classified within 5 dimensions. The feasibility study showed that the questionnaire was easily accepted and understood with a mean time of 15 minutes to answer it. Cronbach coefficients were respectively at 0.941, 0.949, 0.808, 0.814 et 0.869 for the 5 dimensions.

DISCUSSION AND CONCLUSION

SSO questionnaire is a reliable and relevant scale to measure immediate postpartum quality of care in French.

The long journey: a brief review of the eradication of rinderpest

In 2011, the 79th General Session of the World Assembly of the World Organisation for Animal Health (OIE) and the 37th Food and Agriculture Organization of the United Nations (FAD) Conference adopted a resolution declaring the world free from rinderpest and recommending follow-up measures to preserve the benefits of this new and hard-won situation. Eradication is an achievable objective for any livestock disease, provided that the epidemiology is uncomplicated and the necessary tools, resources and policies are available. Eradication at a national level inevitably reflects national priorities, whereas global eradication requires a level of international initiative and leadership to integrate these tools into a global framework, aimed first at suppressing transmission across all infected areas and concluding with a demonstration thatthis has been achieved. With a simple transmission chain and the environmental fragility of the virus, rinderpest has always been open to control and even eradication within a zoosanitary approach. However, in the post-1945 drive for more productive agriculture, national and global vaccination programmes became increasingly relevant and important. As rinderpest frequently spread from one region to another through trade-related livestock movements, the key to global eradication was to ensure that such vaccination programmes were carried out in a synchronised manner across all regions where the disease was endemic - an objective to which the European Union, the United States Agency for International Development, the International Atomic Energy Agency, the African Union-Interafrican Bureau of Animal Resources, FA0 and OIE fully subscribed. This article provides a review of rinderpest eradication, from the seminal work carried out by Giovanni Lancisi in the early 18th Century to the global declaration in 2011.

[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]

INTRODUCTION

Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality.

METHOD

A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05.

RESULTS

Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021).

CONCLUSION

It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.

Sigmoid volvulus in pregnancy

A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality.

Dengue virus seroprevalence among febrile patients in Bamako, Mali: results of a 2006 surveillance study

BACKGROUND

Dengue viruses (DENV) are endemic in over 100 countries worldwide, and annually 50 to 100 million people are infected by one of the four DENV serotypes, whereas over 2.5 billion people are at risk for infection. West African countries lack the surveillance to determine the true incidence of dengue; hence, this disease is likely significantly underestimated. In Mali, ?14 million people are potentially at risk of acquiring a dengue infection.

METHODS AND FINDINGS

A serosurvey for DENV was conducted on 95 human serum samples obtained from the Institute National de Recherche en Sante Publique in 2006. DENV-specific IgM and IgG enzyme-linked immunosorbent assays were performed on all samples, and a subset was tested using the plaque-reduction neutralization test against the DENV and yellow fever virus (YFV). Samples collected during the acute infection (0-5 days postonset of symptoms) were tested for dengue NS1 antigen and reverse-transcriptase polymerase chain reaction for Flaviviruses, Alphaviruses, and Bunyaviruses RNA. A total of 87 (93%) of samples were positive for anti-DENV IgG antibodies. Of a subset of 13 IgG positive samples, 2 samples neutralized monotypically against DENV-1 and -2, whereas 3 others neutralized broadly against YFV and multiple DENV. Although no polymerase chain reaction positives were found, DENV NS1 was detected in 1 of the 20 acute samples tested.

CONCLUSIONS

Of the 93 human serum samples tested, the dengue prevalence based on dengue IgG enzyme-linked immunosorbent assay results was 93%. Three DENV specific positive samples and two YFV positives were identified by plaque-reduction neutralization test. Finally, one sample tested positive for dengue NS1, thus suggestive of an acute infection within 14 days of obtaining the sample from the patient. Based on these serological data from this study, YFV and DENV appear to be co-circulating in Mali.

[Prevention of mother to child HIV transmission in an African hospital, Bamako-Mali]

AIM

Pregnant women HIV infection has main risk the contamination of newborn. MTCT actions permit to reduce that risk.

MATERIAL AND METHODS

Our survey has been realized in Gabriel Touré teaching hospital gynecology and obstetrics and pediatric departments. It is about an observational prospective and descriptive survey that spreads on a period from January 2005 to December 2008. Has been included in the study all the HIV positive pregnant women followed in our service and their babies that had received ARV prophylaxis and 18 months of life serology.

RESULTS

We recorded 211 HIV positive pregnant women on a total of 9291 childbirths (2.27%). We noted 90.52% of HIV-1 vs 7.11% of type 2. The mother treatment consisted in a tri therapy in 77.25 vs 0.47% of bi anti retroviral and 22.28% of mono anti retro viral therapy. Maternal viral load was undetectable at the moment of delivery in 78.20% of cases. We noted vaginal delivery in 84.36% vs 15.64% of caesarean section. Newborns respectively received 67.32%; 4.88% and 22.92% of bi, tri and mono therapy. They formula-fed in 98.98%. The mother to child HIV transmission rate was 1.98%.

CONCLUSION

HIV prevalence in pregnant patients is relatively height. HARRT in HIV positive mothers associated to bi therapy and formula feeding to their infants permit to obtain low vertical HIV transmission rate.

[Early oral feeding versus classic oral feeding after appendicectomy for acute appendicitis]

The appendectomies for acute appendicitis are the most frequent surgical interventions (43.6%) in our service. The recent studies demonstrated the feasibility and the economical gain of the early oral feeding vs. classic oral feeding, after elective digestive surgery. We wanted to spread these results therefore to the appendectomy for acute appendicitis. It is about a prospective survey carrying on 110 patients also left in two groups, and comparing the classic postoperative oral feeding vs. the early postoperative oral feeding on one year. The two groups were comparable and the studied parameters were : the length of the postoperative ileus, the hospitable morbidity, the length of the hospitalization and the cost of the hold in charge. The length of the postoperative ileus was not different in the two groups as well as the morbidity. The difference of the median length of hospitalization in the two groups was not meaningful. The cost of the hold in charge was meaningfully more elevated in the group with classic postoperative feeding. In conclusion, the early postoperative oral feeding in our survey doesn't reduce the length of the postoperative ileus and don't drag a morbidity anymore that the classic oral feeding. However if it doesn't shorten the length of the hospitalization, it drags a reduction of the cost of the hold in charge. There is a gain therefore precociously to nourish the patients after appendectomy for acute appendicitis.

[Neurologic disorders in pregnancy and post-partum period at the neurology service of Chu du Point-G and the referral center of the Commune V of Bamako]

The objective of the study was to describe epidemiological and clinical characteristic of acute vascular accidents, epilepsies and eclampsy, observed during the periods of pregnancy and post delivery. The study was prospective, conducted during 19 mouths from August 2005 to February 2007. Women aged from 15 to 45 years were considered, presenting neurological disorders. Among 6914 consulted patients, 37 were recruited and presenting required criteria of neurological disorders (3.02%). Most of the case (48.7%) were between the ages of 15 to 25 years. Epilepsy was detected in 51.40% of this group, acute vascular accidents 37.83% and eclampsy 13.51% of the cases. The evolution of the pregnancy was favorable eutopic delivery was frequent, only 1 caesarean has been registered.

[Epidemio-clinical and therapy study of femoral fractures in children]

OBJECTIVES

Evaluate the epidemio-clinical and therapeutic aspects of the femur's fracture of the child.

MATERIEL AND METHODS

It was about a prospective study done from October 1st, 2005 to September 30, 2006 on all children of 0 to 15 years old admitted for femur fracture, treated and followed in the trauma center of hôpital Gabriel Touré. Disappeared patients have not been included.

RESULTS

We brought together during a period of 12 months 47 cases of fracture in 45 children representing 26 % of the activities of trauma unit of hôpital Gabriel Touré. Among our patients 25 were boys and 20 girls. The average age was 7.5 yeras +/-4. The public highway accident was the first cause (68.8%) followed by domestic accident (22.2%), sportive (6.6%), obstetrical (2.2%). The treatment was orthopaedic in 52.17% and surgical in 47.83%. Complications were the following: residual pain in 6.6%, length disparity of the limbs in 4.4%, secondary slipping in 2.2% and hypertrophic callus in 2.2%. P>0.05. The results were good in 71.7 % of the cases, passable in 24 % and bad in 4.3% of the cases.

CONCLUSION

Femur fracture is a frequent affection by which the first cause remains the public highway accident.

[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.

[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.

[Socio-demographic and prognostic aspects of unfollowed pregnancies of patients admitted in the Department of Gynaecology-Obstetric of Gabriel Toure Hospital]

The prenatal followed up permit, on the one hand, to track down risk pregnancies, to appreciate the evolution of pregnancy and its repercussion on the maternal state, to finally make the prognosis of the childbirth and on the other hand to identify risk pregnancies and to assure a management outside emergency context. They contribute this fact to the meaningful reduction of the maternal mortality. The non followed up pregnancies are characterized by their important maternal and fetal mortality and morbidity. The aim of our survey was to determine the frequency of the unfollowed pregnancies, to describe the socio demographic profile of the women and to determine the prognosis of these pregnancies.

MATERIAL AND METHODS

Our survey had for setting the service of Gynecology and obstetrics of Gabriel Touré hospital. Center of cares, research and formation, this service that is 3rd level in the sanitary pyramid in Mali, receives emergencies from other motherhoods of lower level. Were include in this survey, women who delivered in the service and hadn't done any prenatal consultation. Criterias of non inclusion were next one: women having done at least a prenatal consultation, women having delivered in another sanitary structure, all cases of non assisted childbirths, women whose gestational age is lower to 28 weeks and/or fetal weight lower than 500 grams. Every case has been matched to a witness (consistent woman who has been followed and delivered in the service) according to criterias of age and parity. The statistical tests used to study associations between variables are the chi2 with a significativity doorstep of P = 0.05 and Odd ratio (OR).

RESULTS

We recorded 2173 childbirths and 286 non followed pregnancies been 13.16% of frequency. The middle age of our patient was 23 years with extremes of 16 and 44 years, nullipareses represented 25.9% of cases. The domestic helps were more numerous in the group of cases with 4.9% against 0.3% in the witness group (P = 0.0006, OR = 14.6; IC [2.01, 30.05]). The maternal prognosis is marked by 2.1% of death (P = 0.013). Fetal prognosis is bad with 10.9% of child stillborn (P = 0.0007; OR = 3.19) and 21.5% of morbid APGAR.

CONCLUSION

The absence of prenatal consultation is associated to a height maternal and fetal mortality and morbidity.

[Association of extrauterine and intrauterine pregnancy: 3 cases]

Extra uterine pregnancy (GEU) constitutes, by its frequency a problem of public health, by its gravity an obstetric emergency and a problem of fertility for the woman. It represents the chief reason of maternal death during the first quarter of pregnancy. The association of extra-uterine and intra-uterine pregnancy is a particular case of twin pregnancy said ditopic. It is rare, but non exceptional. The authors bring three cases to remind us of its existence.

[Relapse of pulmonary tuberculosis in the context of tuberculosis-HIV co-infection in Abidjan (Côte d'Ivoire). Short note]

A cohort study was carried out from October 2001 to March 2002, in order to analyze the main characteristics of 53 adults patients (38 HIV-positive and 15 HIV-negative), who had a relapse of pulmonary tuberculosis. The observance in the first period of the treatment of tuberculosis was regular in 79% of tuberculous patients infected by the HIV (30/38) and in 87% of tuberculous patients who where HIV-negative (13/15) (p = 0.7). The relapse occurred before one year after recovery in 74% among the HIV-positive (28/38) and in 33% among the HIV-negative patients (5/15) (p = 0.00). Most of the HIV-positive patients (74%) had CD4 counts under 200/mm3 and 80% of the HIV-negative patients had more than 500 CD4 counts/mm3 (p = 0.00). After two months of retreatment following the relapse diagnosis, the rate of improvement in patients was about 16% in HIV infected (6/38) and about 67% in HIV-negative patients (10/15) (p = 0.00).

Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire

OBJECTIVES

To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers.

METHODS

A cross-sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems.

RESULTS

Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less. Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider-client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them.

CONCLUSIONS

The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.

From hemorheology to vascular mechanobiology: An overview

Almost all of the cells of the human body are subjected to mechanical stresses. In endothelial cells, mechanical stresses can vary from some milli-Pascal (shear stress) to one ore more Pascal (hydrostatic pressure). Now it is know that mechanical stresses have a decisive part cellular physiology. However, if the main biological effects of mechanical stress are well related, the mechanisms allowed the relation between mechanical stress to physiological phenomenon remain nearly unknown (mechanotransduction phenomenon). In this work, through personal results and published works, the authors considers all the effects of mechanical stresses and the possible hypothesis.

[Noma: apropos of a case in a 9-year-old child at the Centre Hospitalier de Libreville (Gabon)]

The authors report the observation of a disease in fact the noma which one believed disappeared, it of it is nothing. This disease, summation of several factors, with frightening forecasts immediate and remote, must have before a whole preventive treatment by the improvement of the standard of living of the populations because its repair is so long, if difficult and so expensive that access will have well little there.

HLA-B allele frequencies in Côte d'Ivoire defined by direct DNA sequencing: identification of HLA-B*1405, B*4410, and B*5302

Direct automated DNA sequencing was used to analyze exons 2 and 3 of HLA-B alleles present in forty-four unrelated individuals residing in the village of Adiopodoume, Côte d'Ivoire (Ivory Coast). Of the 23 HLA-B alleles observed, the most frequently detected allele was HLA-B*5301 (22.7%), which is believed to confer resistance to severe Plasmodium falciparum malaria. B*4501 (9.1%), B*1503 (8.0%), B*0705 (5.7%), B*1510 (5.7%) and B*3501 (5.7%) occurred frequently in the population. A second allele of B53 was identified; B*5302 contains a single amino acid variation at residue 171 (Y-->H). Two additional novel alleles, B* 1405 (a single amino acid variant of B*1402) and B*4410 (a five amino acid variant of B*4403) were characterized.

Porphobilinogen deaminase gene in African and Afro-Caribbean ethnic groups: mutations causing acute intermittent porphyria and specific intragenic polymorphisms

Acute intermittent porphyria (AIP), the most common acute hepatic porphyria, is a low-penetrant autosomal dominant disorder caused by mutations in the porphobilinogen deaminase (PBGD) or hydroxymethylbilane synthase (HMBS) gene. Although AIP has been identified in all the main ethnic groups, little is known about PBGD gene defects in Africans, Afro-Caribbean and Afro-Americans. We have carried out PBGD gene screening among seven unrelated AIP families and 98 controls belonging to the Afro-Caribbean (French West Indies) and the sub-Saharan African (Morocco, Algeria, Cameroon, Mali, and Burkina Faso) populations. Using denaturing-gradient gel electrophoresis (DGGE) and direct sequencing we characterized six different mutations, including four novel, from the seven AIP families: three splicing defects (IVS 5+2 Ins G; IVS 7+1 G to A in two families; IVS 10-1 G to T); a small deletion (1004 Del G); and two missense mutations (R116 W; A270G). The allele frequencies of the 14 polymorphic sites, previously known in the normal Caucasian population, were similar in Africans and Afro-Caribbean control populations. Interestingly, two common new intragenic polymorphic sites, close to intron/junction boundaries, were identified only in blacks: 1) in intron 2, a single base-pair G deletion at position 3167 (G:0.88; delG:0.12); 2) in intron 10, a A/G dimorphism at position 7052 (A:0.56; G:0.44). These two single nucleotide polymorphisms (SNPs) were never encountered in 750 unrelated Caucasian subjects. The allele frequency distributions of populations within black ethnic groups (Africans and Afro-Caribbean) are similar. This study highlights differences both in PBGD gene mutations causing AIP and in SNPs between white and black peoples; the allele frequencies provided contribute to a better knowledge of the variability of these markers among the major population groups, especially in sub-Saharan West African and Afro-Caribbean populations.

Comparison of two methods of leprosy case finding in the circle of Kita in Mali

Kita is a health district of Mali, a leprosy-endemic country in West Africa. We conducted a comparative study of passive and active case finding of leprosy in this district in 1997. In May and June, a mobile team realized active case finding by visiting 32 villages of more than 1000 inhabitants. For 12 months, peripheral health center nurses did passive detection after information and education sessions about the signs of leprosy in the other 37 main villages of Kita. The active detection rate (4.31 per 10,000) was threefold higher than the passive rate (1.5 per 10,000) and allowed us to find earlier cases of leprosy. Active case finding identified children and single-lesion disease; the passive method did not. Cost for finding a new case was estimated at 72 US$ by mobile team detection and 36 US$ by passive case finding. Although the active method looked more expensive than the passive one, it was the only effective strategy to detect leprosy patients in remote and difficult-to-access areas. Based upon the results of the study, a flow chart is proposed for the choice of case-finding method when designing a leprosy elimination program.

Primary resistance to antituberculosis drugs: a national survey conducted in Côte d'Ivoire in 1995-1996. Ivoirian Study Group on Tuberculosis Resistance

SETTING

A national survey of resistance to the antituberculosis drugs used in Côte d'Ivoire was conducted in 1995-1996.

OBJECTIVE

To determine the rate of primary resistance to antituberculosis drugs.

METHODS

Consecutive new tuberculous patients with positive smear were recruited from tuberculosis centres and rural health centres. Drug susceptibility testing was performed according to the proportion method. Positive cultures were tested against streptomycin, isoniazid, rifampicin, and ethambutol. All resistant strains and 10% of all randomly sampled cultures were sent to an external laboratory for quality control. Human immunodeficiency virus (HIV) tests were performed for consenting patients at the tuberculosis centres.

RESULTS

Among the 430 samples, 320 were available for analysis. Primary resistance to antituberculosis drugs was observed for 13.4% of the patients (43/320); multidrug resistance (to at least isoniazid and rifampicin) was observed for 5.3% of the patients; 14.2% of HIV-negative and 16.2% of HIV-positive patients were resistant to at least one antituberculosis drug (P = 0.70).

CONCLUSION

This study is representative of antituberculosis drug resistance in Côte d'Ivoire. The rate of primary resistance is high and emphasises the need for a sentinel survey of tuberculous resistance. The National Tuberculosis Control Programme needs to make improvements in its management of tuberculosis cases.

[Use of a questionnaire for quick identification of the principal foci of urinary bilharziasis in central Ivory Coast]

Simple questionnaires designed for use in schools have been used to identify communities at high risk for urinary schistosomiasis in several African countries but not in the Cote d'Ivoire. The primary purpose of this study was to assess the acceptance and feasibility of the school questionnaire approach in the Cote d'Ivoire. Questionnaires were distributed to 136 schools in central Cote d'Ivoire. Responses were obtained within 6 weeks from 124 schools (91.2%). A total of 12,479 school children were interviewed. At 60 schools, reagent stick tests were performed within two weeks to detect microhematuria by trained teachers. A biomedical team was sent to 14 selected schools to check results by reagent stick testing and urine filtration. Reagent stick tests showed high specificity (97%) and moderate sensitivity (67%). A strong statistical correlation was observed between responses to two key questions concerning "blood in urine" and "having had schistosomiasis" and the results of reagent stick testing (Spearman rank correlation, p < 0.0001). Our findings are in good agreement with previous reports. Using the data obtained, we were able to accurately map the distribution of urinary schistosomiasis in the study area. Use of this questionnaire for quick identification of high risk communities for urinary schistosomiasis was recommended as a preliminary step in the planned national control program and should allow better targeted of scarce resources.

The public health significance of urinary schistosomiasis as a cause of morbidity in two districts in Mali

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

Predictive value of monitoring parameters in fetal surgery

BACKGROUND/PURPOSE

The choice of monitoring parameters in fetal surgery has thus far been based on feasibility rather than on predictability. Ideally, monitoring should be noninvasive, have a rapid response time and high sensitivity, and be applicable to open and endoscopic techniques. Herein, the authors studied the response of several parameters to standardized episodes of fetal ischemia and stress.

METHODS

Eight time-dated fetal lambs (110 days, term, 145 days) were used. Under general anesthesia, a balloon occluder was placed around the umbilical cord. Pulse oximetry (POx + heart rate, HR), electrocardiography (ECG), direct oximetry (DOx), and blood pressure (BP) were recorded continuously. After stabilization, the umbilical cord was completely occluded for 5 seconds, then released. False-negative recordings were defined as failure of a parameter to respond to umbilical occlusion; false-positive episodes were defined as 10% change in value over < or = 10 seconds during stabilization (baseline) period.

RESULTS

The fetuses were monitored for an aggregate of 358 minutes. Baseline DOx was 64%+/-5%, POx, 66%+/-16%; HR, 141+/-18 beats per minute (bpm); systolic BP (SBP), 51+/-3 torr; and diastolic BP (DBP), 38+/-2 torr. During umbilical occlusion (n=15), SBP increased to 56+/-3 torr and DBP to 43+/-2 torr at 0.5 seconds, then returned to baseline at 8.0 seconds. A decrease was seen in DOx (start at 3.5s, maximum delta 9.9+/-1.5% at 10.5 seconds) and POx (start at 4.2 seconds, maximum delta 7.3+/-2.4% at 20.5 seconds). Heart rate showed <10% decrease (start at 8.5 seconds, nadir 131+/-14 bpm at 19.5 seconds). No ECG changes were noted. Sensitivity was 100% for DOx, POx, and BP, but only 14% for HR; specificity was 97% for DOx and 88% for POx; positive predictive value was 58% for DOx and 37% for POx; negative predictive value was 100% for DOx and POx.

CONCLUSIONS

Direct intravascular oximetry and blood pressure provide a prompt and reliable response to acute fetal stress, but are too invasive for routine use. Bradycardia is an insensitive and late sign of fetal distress. Pulse oximetry has a rapid response time (<5 seconds), high sensitivity, and negative predictive value. In addition, its application is noninvasive and has proven to be feasible in open and endoscopic fetal surgical procedures. It therefore appears to be the monitoring parameter of choice for fetal surgery.

Comparison of a rapid dipstick test and thick blood films for detecting parasites of plasmodium falciparum used under typical conditions at a semi-rural hospital in Cote d'Ivoire

This prospective study compares a rapid dipstick test (ParaSight-F) with thick blood films for the detection of parasites of P falciparum, under 'typical' conditions and constraints to be found in a semi-rural hospital in a tropical developing country in Africa. Eighty-two samples were tested using the two techniques and found to concur in 95.1% of cases. However, in four of the samples the results differed. The thick blood films of 60 samples were later re-read by a local reference laboratory. Of these 98.3% were in agreement with the reading performed at the hospital. Only one of the 60 slides differed. The rapid dipstick test proved to be both easy to use and free from many of the usual constraints such as a need for formally trained or experienced laboratory staff, laboratory equipment, and reliable water and electricity supplies. In an holoendemic area for P falciparum transmission, it would appear to be eminently suitable, in technical terms and ease of handling as well as on the basis of rapid results, for wider distribution within this region. Its main drawback remains financial.

Opioid peptide involvement in the bulbar inhibition of electrodermal activity in the cat

By analogy with supraspinal and spinal inhibitory controls of pain, it was hypothesized that an opioid mechanism could be involved in the bulbar inhibitory control of the electrodermal activity. This activity was evoked as skin potential responses on the footpads of 13 cats by the central tegmental field stimulation (control responses) and inhibited by the simultaneous stimulation of bulbar reticular formation (experimental responses). Then, naloxone, an opioid peptide antagonist, was injected intravenously or intrathecally and its effects were analyzed on both control and experimental responses. Intravenous injections of naloxone increased significantly the amplitude of experimental responses from 6 to 12 min after the injection and had no effect on the amplitude of control responses. Intrathecal injections of naloxone induced significant increases of amplitude of experimental responses from 6 to 42 min after the injection. These results showed that a spinal opioid peptide link could be involved in bulbar inhibition mechanisms of electrodermal activity.

Schistosoma and geohelminth infections in Mali, west Africa

We report on the prevalence of schistosomiasis and geohelminth infections in Mali, Central West Africa, based on data from the National Schistosomiasis Control Programme of Mali (1982-1991) and from our recent surveys (1992-1993). Combined national figures and regional data are presented from both surveys. Schistosomiasis showed an overall prevalence of 30.1%, with lowest prevalence in Sikasso Region and highest prevalence in Segou Region. Ascaris lumbricoïdes (0.12%) and Trichuris trichiura (0.42%) were comparatively rare, but hookworm infections were more widespread (8.0%). No hookworm infections were detected in the arid northern Region and the highest prevalence (18.7%) was encountered in the humid south of the country. There was a significant positive relationship between the prevalence of hookworm infection and total annual rainfall per region. Overall the prevalence of concurrent infections with schistosomes and hookworms was significantly less than expected, although there were regional differences which were discussed in the light of local variations in climatic and other factors likely to affect transmission.

Lack of ultrasonographic evidence for severe hepatosplenic morbidity in schistosomiasis mansoni in Mali

The inhabitants of four villages endemic for Schistosoma mansoni in central Mali (n = 1,106 of both sexes, age range 2-80 years) and of two nonendemic villages in another part of the country were examined parasitologically and ultrasonographically to establish the prevalence of periportal liver fibrosis (PF) and other features of hepatosplenic schistosomiasis. The prevalence of S. mansoni infection ranged from 36% to 93% in the endemic villages. A severe infection (> 400 eggs/g of stool) was found in 16% of the infected individuals. No case of grade III PF (echogenic bands usually > 10 mm in diameter around the central part and major branches of the portal vein and streak-like fibrous bands that extended into the periphery of the liver) and only eight cases of grade II PF (echogenic bands usually > 10 mm in diameter around the central part and major branches of the portal vein) were found; no other signs of severe hepatosplenic disease were encountered. However, grade I PF (echogenic bands usually > 4 mm in diameter that were best visible in the area of the portal vein bifurcation and gall bladder neck) was detected in 21% of all individuals, mainly in adults. In the nonendemic villages, the prevalence of grade I PF in adults was 9%. Generally, there was no significant correlation between the grade of PF and S. mansoni egg output. In one village with a high endemicity level, however, the prevalence of grade PF I increased with the intensity of infection. Morphometric data revealed no significant influence of S. mansoni infection on portal vein stem diameter and spleen size.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of the effectiveness of oil and water solutions of alpha-tocopherol as radiation protection agent]

The change in alpha-tocopherol content (as an index of the antioxidative organism system mobilization) in the brain, liver, muscles and heart of rats prior to and after total gamma-irradiation with lethal dose has been studied. Prior to the irradiation alpha-tocopheryl-acetate (oil solution), alpha-tocopheryl-phosphate dipotassium salt (water solution), gammaphos (prepared WR 2721, water solution) were introduced into rats. It is shown that water-soluble form of vitamin E is more effective than gammaphos and much more efficient than oil form of alpha-tocopherol.

The anti-proliferative properties of 4-benzylphenoxy ethanamine derivatives are mediated by the anti-estrogen binding site (ABS), whereas the anti-estrogenic effects of trifluopromazine are not

We compared the anti-proliferative properties of 4-benzylphenoxy-N ethyl morpholine (morpho-BPE) and trifluopromazine (TFP) on both the human breast cancer cell lines, MCF7, and its tamoxifen-resistant variant RTx6. We found that the calmodulin antagonist trifluopromazine (TFP) which bound ABS weakly, inhibited MCF7 cell growth but did not follow the relationship observed for diphenylmethane derivatives between MCF7-inhibitory potencies and their Ki. Regarding the tamoxifen-resistant RTx6 cells, TFP but not morpho-BPE induced inhibition of the proliferation. Using a tritiated derivative of morpho-BPE, two distinct binding sites could be demonstrated. Indeed, a low affinity binding site was present in both cell lines whereas a high affinity binding site was mainly found in MCF7 cells although being in lower concentration (less than 10%) in RTx6 cells. Both tamoxifen and TFP displaced morpho-BPE from the two binding sites. The uptake and efflux of the tritiated drug were similar in the two cell lines. The drug did not appear to be metabolized. We concluded that TFP and morpho-BPE belong to distinct classes of molecules and that ABS mediates the anti-proliferative action of diphenylmethane derivatives but not the inhibitory effect of the calmodulin antagonist TFP.