The point on human rabies in Senegal from 1986 to 2005

Between 1986 and 2005, 54 patients were hospitalized for rabies in the infectious diseases clinic, with an average of 3 cases a year. The patients came from almost all regions of Senegal, Dakar (11 cases), Thiès (9 cases), and Fatick (9 cases). They were native of rural and suburban zones. The median age was 19 years (range 5-72). Children and teenagers between 5 and 15 years of age were the most concerned (53.7%). Stray dogs were the main vector (75% of cases) but a case of bite by a puppy and a case of bite by a jackal were noted. Bites were mostly located in limb extremities (98%). Only 12 patients consulted a health institution after the bite and among these cases, 4 were referred to the Dakar Pasteur Institute but consulted late. Incubation was 45 days on average (range 25 to 90 days). All our patients presented a furious form of rabies. The average duration of hospital stay was 6 days (range 1-15 days). The local investigation proved an under reporting of cases in a proportion of 1 case reported for 4 non-reported cases.     

螺旋藻改善铝中毒小鼠学习记忆障碍机制探讨

目的:探讨螺旋藻改善铝中毒小鼠学习记忆障碍的作用机制。方法:用口服氯化铝方法建立小鼠铝中毒学习记忆障碍模型,并用螺旋藻多糖灌胃进行实验性治疗。用跳台试验和避暗试验检测各组小鼠的学习记忆行为,并用免疫组化ABC法检测各组小鼠海马神经元型一氧化氮合酶(nNOS)的表达。结果:与对照组比较,模型组小鼠表现出明显的学习记忆障碍,海马nNOS表达下降。实验组的学习记忆能力较模型组有明显改善,海马nNOS表达增加。结论:螺旋藻对铝中毒小鼠的学习记忆障碍有明显的改善作用,其作用机制可能与增加nNOS的表达有关。     

术中球囊扩张胆囊管胆道镜检查的应用体会

目的：总结48例球囊导管扩张胆囊管纤维胆道镜检查的应用经验。方法：常规胆囊切除术后，球囊导管扩张胆囊管，经扩张胆囊管纤维胆道镜检查，结果：球囊导管扩张胆囊管48例，完成纤维胆道镜检查或取石44例。成功率92%，无残留结石发生。结论：球囊导管扩张胆囊管纤维胆道镜检查操作简便，安全，提高经胆囊管纤维胆道镜检查的成功率，是胆总管探查的重要辅助手段。获得可靠效果。     

Bionomics of malaria vectors and relationship with malaria transmission and epidemiology in three physiographic zones in the Senegal River Basin

Following the implementation of two dams in the Senegal River, entomological and parasitological studies were conducted in three different ecological zones in the Senegal River Basin (the low valley of Senegal River, the Guiers Lake area and the low valley of Ferlo) every 3 month in June 2004, September 2004, December 2004 and March 2005. The objective of this work was to study the influence of environmental heterogeneities on vector bionomics and malaria epidemiology. Mosquitoes were collected when landing on human volunteers and by pyrethrum spray catches. In the parasitological survey, blood samples were taken from a cohort of schoolchildren under 9 years during each entomology survey. Seven anopheline species were collected: Anopheles arabiensis, Anopheles gambiae M form, Anopheles funestus, Anopheles pharoensis, Anopheles coustani, Anopheles wellcomei and Anopheles rufipes. A. arabiensis, A. funestus and A. pharoensis were predominant in the low valley of the Senegal River, A. funestus in the Guiers Lake area and A. arabiensis in the low valley of Ferlo. Mosquito populations' dynamics varied temporally depending on the rainy season for each zone. The anthropophilic rates varied between 6 and 76% for A. gambiae s.l. and 23 and 80% for A. funestus. Only 4/396 A. pharoensis and 1/3076 A. funestus tested carried Plasmodium falciparum CS antigen. These results suggest the implication of A. pharoensis in malaria transmission. The related entomological inoculation rates were estimated to 10.44 in Mbilor and 3 infected bites in Gankette Balla and were due, respectively, to A. pharoensis and A. funestus. Overall, 1636 thick blood smears were tested from blood samples taken from schoolchildren with, respectively, a parasite and gametocyte average prevalence of 9 and 0.9%. The parasite prevalence was uniformly low in Mbilor and Gankette Balla whereas; it increased in September (16%) and then remained stable in December and March (22%) in Mboula where malaria transmission was not perceptible. However, significant differences were observed over time for parasite prevalence in Mbilor and Mboula villages whereas; it was only in Gankette Balla village where gametocyte prevalence was significantly different over time. Our study demonstrates the influence of ecological changes resulted from dams implementation in the Senegal River on the composition of vectorial system, malaria transmission and epidemiology. Such changes should be thoroughly surveyed in order to prevent any possible malaria outbreak in the Senegal River Basin.     

Determinants of unplanned antiretroviral treatment interruptions among people living with HIV in Yaoundé, Cameroon (EVAL survey,ANRS 12‐116)

Objective To identify correlates of self‐reported antiretroviral therapies (ART) interruptions among people living with HIV and AIDS (PLWHA) in Cameroon. Methods Analyses were based on data collected in the national survey EVAL (ANRS 12‐116) among 533 ART‐treated PLWHA in Yaoundé, the capital city of Cameroon, and its neighbourhood. Logistic regression models were used to identify factors associated with self‐reported ART interruptions longer than two consecutive days during the previous 4 weeks. Results ART interruptions were reported by 68 patients (12.8%). After adjustment for gender, education and household income, characteristics independently associated with interruptions were pharmacy stock shortages [OR (95%CI):3.25 (1.78–5.90)], binge drinking [2.87 (1.39–5.91)] and the number of self‐reported slimming symptoms [1.23 (1.02–1.48)]. Conclusion In poor‐resource settings where access to second and third‐line regimens is still limited, food supply programs and interventions to minimise ART shortage may reduce the risk of ART interruptions.     

No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation.

AIMS: Paroxysmal atrial fibrillation (PAF) is frequently encountered in pacemaker patients, most commonly in sick sinus syndrome. The combination of site-specific pacing in conjunction with an overdrive algorithm combined with antiarrhythmic drugs on the incidence of PAF in patients with a conventional indication for pacing is unknown. METHODS AND RESULTS: Patients with pacemaker indication and PAF received a DDDR-pacemaker, which included an automatic atrial overdrive (AO) algorithm. The atrial lead was implanted in either the right atrial appendage (RAA) (n = 83) or the right low-atrial septum (LAS) (n = 94). The algorithm was switched on or off in a 3 month, single blind crossover design and antiarrhythmic drugs were kept stable. A control group of 96 patients (LAS, n = 14; RAA, n = 84) without PAF served as controls to assess any proarrhythmic effect of overdrive pacing. Atrial fibrillation (AF) burden defined as cumulative time in mode switch was not reduced during automatic AO from either the RAA or from the LAS. The reduction was not effective both for AF of short (<24 h) and long (> or =24 h) duration. There was no atrial proarrhythmia induced by the overdrive algorithm in the control group. CONCLUSIONS: We could not demonstrate a reduction of AF burden defined as cumulative time in AF by the AO algorithm, in patients who are paced for standard indications and PAF, neither from the RAA nor from the LAS.