Formulation of malaria treatment policy for children in C?te d'Ivoire as chloroquine resistant Plasmodium falciparum spreads into west Africa

To develop a malaria treatment policy for children with Plasmodium falciparum, an in vivo and in vitro chloroquine (CQ) sensitivity study was conducted in C?te d'Ivoire in September 1986. The efficacy of a single dose of CQ (10 mg base kg-1, C10) was tested with assessment of subjects on Days 2 and 7 after treatment; 108 (99%) of 109 children were aparasitaemic on Day 7. Of 33 isolates of P. falciparum tested in vitro, two (6%) were resistant to CQ. Although C10 appeared effective clinically and parasitologically in C?te d'Ivoire, a treatment dose of 25 mg of CQ base kg-1 (C25), over three days, was recommended as first-line therapy for malaria. This was because in vivo CQ-resistance will soon spread into other West African countries including C?te d'Ivoire, the C25 dose still retains clinical effectiveness in most partially-immune persons living in areas with low-level chloroquine resistance, and alternate drugs are more expensive.     

Responses to sympathetic stimulation and tilting during antihypertensive treatment with nisoldipine.

Nisoldipine is a calcium antagonist of the dihydropyridine group under investigation for treatment of hypertension. The authors have assessed the cardiovascular response to adrenergic stimulation by isometric exercise, cold pressor test and 70 degrees head-up tilt on four occasions: following placebo, acute and chronic administration of nisoldipine 5 mg or 10 mg o.d. in eighteen mild to moderately hypertensive patients (13 M, 5 F; age range 28-69 years). Blood pressure and heart rate were measured by automatic recorder. Blood pressure was significantly decreased at 2 h after administration of nisoldipine. Blood pressure maximal response at 3 min during isometric exercise following nisoldipine 10 mg chronic was significantly lower, compared to placebo as well as to a 5 mg dose (172/105 +/- 13/8 with 10 mg vs. 182/116 +/- 21/14 with 5 mg and 182/113 +/- 18/11 with placebo; p less than 0.05). Cardiovascular response to the cold pressor test showed a similar pattern; head-up tilt did not cause hypotension. The results of this study suggest that administration of nisoldipine in hypertensive patients slightly attenuates the pressor response to sympathetic stimulation by isometric exercise.     

Antihypertensive and cardiovascular effects of nitrendipine: a controlled study vs. placebo

The antihypertensive and cardiovascular effects of nitrendipine, a calcium entry blocker similar to nifedipine, have been evaluated in a double-blind, placebo-controlled study in 20 patients with hypertension. At baseline and at the end of the 8-week period (nitrendipine, 20 mg once a day, or placebo, 1 tablet once a day) the following parameters were measured: systolic and diastolic blood pressure (BP) and heart rate (HR) at rest by an automatic recorder; BP, HR, and cardiac workload (systolic BP X HR) during exercise testing on a bicycle; left ventricular mass (LVMe according to the method of Devereux) and cross-sectional area (CSA), and main parameters of systolic function (end diastolic volume, end systolic volume [ESV], and ejection fraction [EF]) by M mode echocardiography. There was a significant decrease in BP at rest (163/108 vs. 144/92 mm Hg; P less than 0.001) and during exercise in subjects receiving nitrendipine, while placebo did not modify these parameters. LVMe (from 195 to 188 gm; P less than 0.01) and CSA (from 20.2 to 19.8 cm2; P less than 0.05) were reduced by nitrendipine, which also improved cardiac performance (ESV fell from 44 to 38 ml [P less than 0.001] and EF fell from 62% to 66% [P less than 0.01]). No effect was observed in the placebo group. Our results indicate that nitrendipine is a powerful antihypertensive agent that also improves cardiac performance and slightly but significantly reduces left ventricular mass.     

Effet hypotenseur d’un extrait aqueux de <Emphasis Type="Italic">Combretum micranthum</Emphasis> G. Don (Combretaceae)

The phytochimic analysis of an aqueous extract from Combretum micranthum (COM) frequently used by the population contained sterols and polyterpenes, polyphenols, saponins, flavonoids, tannin, quinone and alkaloids. The richness of this extract in phytochimic components is compatible with the full traditional use of thismedicinal plant. The toxicological study of COM has permitted to determine respectively byMiller and Tainter’s method and Dragsted and Land’s method a LD50 of 1,258 ± 72.84 mg/kg of body weight (b.w) and 1,500 ± 89.12 mg/kg b.w. These values showed that this natural extract is not toxic. For doses ranging from 1.66 × 10^?3 to 6 × 10^?1 g/kg b.w, this aqueous extract induced a dose-dependent sustained hypotension similar to that induced by acetylcholine at doses ranging from 5.6 × 10^?7 g/kg b.w to 5.5 × 10^?4 g/kg b.w. It reduced the hypertension induced by adrenalin at the dose of 2.5 × 10^?5 g/kg b.w. These results showed that the aqueous extract of COM is a hypotensive substance. These results also justified the traditional use of this plant in the management of arterial hypertension. The inhibition of hypotension effect induced by COM caused by atropine, a competitive antagonist of muscarinic cholinomimetic receptor, suggested the presence in the aqueous extract of active principles of muscarinic cholinomimetic.     

Intrahepatic cholangiocarcinoma on a hydatidic cyst

Cholangiocarcinomas are malignant tumors arising from the bile ducts. One of the factors associated with the development of malignancy is parasitic infections by helminths trematodes that cause liver fluke infections. This association is very common in south-east Asia, but association with liver hydatidosis has not been reported in the scientific literature. We report a case in which these two diseases were associated and required non-radical surgical treatment, since radiological findings were not suspicious for these entities.     

The "sclerodermic hand": a radiological and clinical study

ObjectiveTo assess the clinical and radiographic features of hand involvement in patients with systemic sclerosis (SSc).MethodsForty-one unselected Sardinian SSc patients (32 women, 9 men; mean age 58.9, range 31–81 years; mean disease duration 11.8 years, range 1–36 years) were evaluated in this observational cross-sectional study. Twenty-six patients had diffuse scleroderma (dSSc) and 15 limited scleroderma (lSSc). Radiological examination of the hands was performed and the films were read by two independent rheumatologists blinded to the diagnosis using a classification system of four predefined radiological patterns (normal/minimal changes, articular degenerative, articular inflammatory and periarticular pattern). Correlations between radiological pattern, clinical and serological features were assessed.ResultsThe skeletal and articular involvement of the hand was frequent in SSc, being clinically evident in 30/41 (73%) and radiologically in 33/41 (80%) of patients. The periarticular pattern (defined as the occurrence of bone resorption of ungueal tufts, soft tissue calcifications and/or flexion deformities) was the most frequent pattern detected (14/41, 34.1%) and finger flexion contractures and bone resorptions were significantly associated with interstitial lung disease, reduced FVC, oesophagus involvement and prostacycline therapy. Calcinosis (29.2%) was found to be associated with erosions, suggesting a pathogenic link. An inflammatory pattern was also radiologically frequent (8/41, 19.5%), but erosions, with the exception of those localized at distal interphalangeal joints, were demonstrated mainly in patients with clinical picture of rheumatoid arthritis overlapped with SSc. We found no significant differences in terms of radiographic findings between lSSc and dSSc with the exception of calcinosis, which was more frequent in patients with lSSc.ConclusionThis cross-sectional study confirms that the skeletal and articular involvement of the hand is frequent in SSc.     

Recovery of lung function after laparoscopic cholecystectomy: the role of postoperative pain

Objectives: Lung function has been shown to deteriorate after laparoscopic cholecystectomy (LC). The present study evaluated 1) the rate of recovery after LC, and 2) the pathogenic role of postoperative pain in functional deterioration. Design: Lung function was measured 24 hours before LC, upon hospital discharge (48-72 h after LC), and 10 days later. All patients received metamizol after LC until discharge (2 g every 6 h i.v.). Half the patients (analgesia group) received tramadol (150 mg i.m.) 30 minutes before lung function testing on the day of hospital discharge. The remaining patients constituted the control group. Patients: Twenty healthy subjects (53 4 years old) undergoing LC for gall bladder removal. All signed informed consent forms. Measures and outcomes: Patient characteristics and preoperative lung function results were similar in both groups. LC duration and postoperative course were also similar in both groups. All were discharged without complications within 72 hours after LC. Lung function upon discharge (FVC, FEV1, TLC, PaO2 and AaPO2) had deteriorated in both groups (p<0.001). Deterioration was less marked in the analgesia group (p < 0.05). Ten days later, lung function had normalized for all subjects. Conclusions: These results indicate that after LC, 1) lung function is still abnormal when the patient is discharged from hospital, 2) lung function has fully recovered within 10 days, and 3) postoperative pain contributes significantly to temporary deterioration in lung function.     

Résultats d’une enquête réalisée auprès des patients subissant une coloscopie au CHU de Cocody

Objectives

To study the degree of patient satisfaction after colonoscopy, depending on conditions of conducting the review to the teaching center hospital of Cocody.

Materials and methods

This was a cross-sectional prospective observational study six (6) months (1st December 2009 to May 30, 2010 inclusive). The 5 gastroenterologists had to complete two questionnaires: one before entering the patient into the examination room detailing the characteristics of the patient, the other two hours after the colonoscopy collecting the views of the patient.

Results

144 patients (94.7%) aged 16 to 86 years (average age 47 years) sex ratio of 1.09 agreed to participate in the study of the 152 who had a colonoscopy during the period study sixty five point three percent (n = 94) would accept a new endoscopy in the same conditions; 34.7% (n = 50) would accept if the conditions were different or would refuse a new endoscopy. The main factors negatively associated with acceptance under the same conditions were: pain during colonoscopy (OR = 0.11 [0,0141?C0,9324 IC95%]) and anxiety after colonoscopy (OR = 0.26 [0,0880?C0,7866 IC95%]).

Conclusion

Patient satisfaction after colonoscopy could be improved by improving the protocol for sedation and providing information to the patient before and after the colonoscopy in teaching hospital center. These improvements could enhance the acceptability of a future colonoscopy by the patient.