Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

OBJECTIVE: To compare the prevalence of dementia in two different time periods and two different studies. METHOD: Representative, random samples of the elderly (>65 years) in the Zaragoza Study or ZARADEMP-0 (n = 1080) completed the previous decade, and now in Wave I of the ZARADEMP Project or ZARADEMP-I (n = 3715) were interviewed. Standardized measures included the Geriatric Mental State and the History and Aetiology schedule. Cases of dementia were diagnosed according to DSM-IV criteria. RESULTS: Adjusted, global prevalence of dementia has not varied significantly: it was 5.2% (95% CI = 3.9-6.6) in ZARADEMP-0 and 3.9% (95% CI = 3.3-4.5) in ZARADEMP-I (prevalence ratio = 0.75; 95% CI = 0.56-1.02). However, the prevalence in ZARADEMP-I was significantly lower among men, particularly in all age groups between 70 and 84 years. CONCLUSION: Stability of the global prevalence of dementia in the elderly population has been documented. However, the decreased prevalence found in elderly men stimulated environmental hypotheses.     

Skoura – a genetic island for congenital insensitivity to pain and anhidrosis among Moroccan Jews, as determined by a novel mutation in the NTRK1 gene

Congenital insensitivity to pain with anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV is a rare, autosomal recessive neurologic disorder, characterized by absence of reaction to painful stimuli, mental retardation, self- mutilating behavior, anhidrosis, and recurrent episodes of hyperthermia. Mutations in the neurotrophic tyrosine kinase receptor 1, a receptor phosphorylated by nerve growth factor, have been documented in diverse ethnic groups. We identified the same novel nonsense mutation in two unrelated families of Moroccan Jewish descent, each with two affected siblings. This possible founder mutation may trace to the rural Jewish village in southern Morocco from where both these families originated. Genetic screening for the causative mutation among 300 unrelated Moroccan Jews did not reveal carriers for the causative mutation, thus excluding high risk for CIPA in this ethnic subpopulation.     

Dépistage tardif de l’infection à VIH à la clinique des maladies infectieuses de Fann,Dakar : circonstances de diagnostic,itinéraire thérapeutique des patients et facteurs déterminants

Background and methodology

The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment.

Results

One hundred patients were included, with a mean age of 39.5 ± 11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5 ± 4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a “traditional practitioner”, at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the “representation” or the “feeling of severity” of the disease were the principal justifications for consulting the “traditional practitioner” or the physician, respectively.

Conclusion

Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar.     

Incarcerated internal hernia through a breach of the broad ligament, a case report

We report a case of 44-year-old women presented with an acute small bowel obstruction revealated by tomodensitometry. Laparotomy showed an incarcerated internal hernia through the broad ligament. We performed liberation of the ileal segment and closed the hernial orifice. The patient evolution was excellent.     

Preliminary study of human Herpesvirus type 8 infection in pregnant women in Dakar (Senegal)]

HHV8 was discovered in 1994 and few studies on this virus have been conducted in Africa. The virus is related to Kaposi sarcoma, an opportunistic affection occurring during HIV infection. No studies have been carried out on this subject in Senegal, a country known for its low KS prevalence even among people living with HIV/AIDS. Thus it will be interesting to explore this field. The aim of our study has been first, to demonstrate the presence of HHV8; second, to evaluate sero-prevalence of the infection in Senegal and third, to determine the specificities of HHV8 infection in our country. We performed our study on 407 pregnant women whose average age was 29.24 years, the majority of whom were Senegalese. HIV serology was done by dot blot for the screening and western blot for the confirmation. For the diagnosis of HHV8 infection, we used the indirect immunofluorescence kit of ABI. HIV infection was low among this study population; 0.5% and no HIV1 infection was mentioned. Among the 407 women, 58 or 14.3% were HHV8 positive and there was no HHV8/HIVco-infection. Regarding marital status, no significant difference was found between HHV8 positive and HHV8 negative among unmarried, monogamous or polygamous women. However, women having had 4 to 5 children were more likely to test positive for HHV8. The difference is significant and a relationship has been established with a p value of 0.02. Regarding pregnancy, HHV8 infection is more closely related to abortion: 17.2% of women who had aborted were HHV8 positive versus 4.9% seronegative. The odds ratio calculation shows a strong correlation with a p value of 0.01. No correlation was found between HHV8 infection of the mother and neonate mortality or Apgar score. However, a relationship did show up between HHV8 infection of the mother and low birth weight. 29.2% of seropositive women had had a child with a birth weight under 2600 g whereas only 16.3% of seronegative women had had babies with low birth weight. We determined that HHV8 is indeed present in Senegal. Further studies should focus on transmission routes as well as the molecular epidemiology of this virus and diseases related to HHV8 infection in Senegal.     

Heterotopic ossification.

Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. The acquired form of HO most frequently is seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury. For example, patients who have recently undergone total hip arthroplasty or have paraplegia after spinal cord injury are at risk for HO. The fever, swelling, erythema, and occasional joint tenderness seen in early HO can be difficult to distinguish from cellulitis, osteomyelitis, or thrombophlebitis. Bone scanning and other imaging tests frequently are used to distinguish between these diagnostic possibilities. As treatment or prophylaxis for HO, either a nonsteroidal antiinflammatory drug (such as indomethacin), a diphosphonate (such as ethane-1-hydroxy-1,1-diphosphate), or local radiation therapy is recommended. Before therapy begins, bone scanning may be requested to confirm the diagnosis of HO. In addition, surgical resection of HO is used to preserve joint mobility; however, HO is likely to recur and possibly progress if resection is undertaken before the lesion has become mature. With a view toward avoiding recurrent HO and other operative complications, serial quantitative bone scans are used as an aid to time surgical intervention.     

Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure

Purpose of the study Bilaterotricipital approach, triceps splitting and olecranon osteotomy are the three most common posterior approaches to the elbow. The aim of this study was to propose a simple technique to measure the exposure of distal articular surfaces of the humerus through these posterior surgical approaches. Materials and methods Each approach was performed on ten cadaver elbows. After the completion of each approach, the visible articular surface was painted yellow. The elbow was then disarticulated. The unexposed articulated surface (by the approach) was painted blue. The painted surfaces were then wrapped using a net with meshes. The articular percentage of exposure was measured by calculating the mesh occupied by each painted surface. Results The median exposed articular surface for the bilaterotricipital approach, the triceps splitting and the olecranon osteotomy was 26, 37 and 52%, respectively. Conclusion The method is easy to perform and is reproducible.     

Epidemiological and clinical features of HIV-2 infection in Dakar

OBJECTIVE: The aim of this article was to describe the epidemiological and clinical aspects of HIV-2 infection in Dakar. DESIGN AND METHODS: This retrospective study was made on 217 HIV-2 infected patients hospitalized between 1986 and 2003; the epidemiological, clinical, and paraclinical data was collected and analyzed using the Epi-Info software version 6.04. RESULTS: The mean age was 40 years+/-9.6 and the male to female sex ratio was 1.33. The mode of transmission was primarily heterosexual. Some risk factors (travel abroad, heterosexual multi-partners, and unprotected sexual intercourse) were more frequently observed in men while others (blood transfusion, HIV positive partners) were noted among HIV-2 infected women. The most frequent symptoms were weight loss (88%), diarrhea (77%), fever (72.4%), asthenia (70.5%), chronic cough, and dermatosis (50.7%). The main opportunistic infections were oral candidiasis (61.8%), tuberculosis (26.3%), intestinal parasitosis (20.3%). The lethality rate was 33.2% and it was correlated with a low CD4 rate. Meningoencephalitis and bacterial infections were associated with a high lethality rate. CONCLUSIONS: The epidemiological and clinical aspects of HIV-2 infection were the same as in HIV-1 infected patients. However the lethality rate remained high among patients hospitalized with a low CD4 cell count. Early HIV testing and improving the diagnostic approach for opportunistic infections remains a high priority.