Transradial approach for coronary angiography and angioplasty]

The transradial approach of coronary angiography and angioplasty is now become a good alternative to the femoral approach in patients with normal Allen test results, because low rate of access site complication, improved patient comfort and early ambulation. This approach is particularly interesting in obese patients, aortoiliac disease or in patients under anticoagulation treatment or thrombolytics.     

Infection due to hepatitis delta virus in Africa: report from Senegal and review.

A review of the literature shows strong variations in the prevalence of hepatitis delta virus (HDV) among Africans seropositive for hepatitis B surface antigen (HBsAg). In Senegal, West Africa, prevalence of antibodies to HDV among asymptomatic HBsAg carriers appears to be linked to regional and/or socioeconomic factors. Antibodies to HDV were found in 22 (47%) of 47 HBsAg-seropositive patients with liver disease who were hospitalized in the main hospital of Dakar and in 4% to 44% of asymptomatic HBsAg carriers. Eight (36%) of 22 patients with liver disease were seropositive for IgM antibodies to HDV, whereas none of 18 asymptomatic subjects were seropositive (P less than .01). According to studies conducted in Europe and the United States, the presence of this marker may constitute support for the argument that HDV plays a role in the development of HBsAg-associated liver diseases in Senegal and, presumably, within the African continent.     

Evaluation of Intratumoral Injection of Poly(d,l-lactide) Cisplatin Microspheres in Rats with Breast Tumors Using [131I]lodomisonidazole (IMISO)

This study utilized [¹³¹I]iodomisonidazole (IMISO) to examine changes in tumor hypoxia after therapy of breast cancer with poly(d,l-lactide) cisplatin microspheres (PLA-CDDP MSs) by an intratumoral injection technique. PLA-CDDP MSs were prepared by a solvent evaporation process. Breast tumor cells were inoculated into the thighs of rats. After therapy with CDDP or PLA-CDDP MSs (6 mg/kg, subcutaneously, single injection), the tumor volume and blood chemistry of breast tumor-bearing rats were measured and compared daily with those of a control group given saline alone for 16 days. A group of rats were administered [¹³¹I]IMISO (50 μCi per rat, intravenously, n = 3) on day 5 and planar scintigraphy was then acquired at 2 h after injection. The percentage of tumor uptake (region of interest) was quantitated by a computer image analyzer and expressed as percentage of injected dose (ID) per pixel. PLA-CDDP microspheres (50-100 (Jim) contained 40.04% (w/w) cisplatin and produced sustained-release properties in vitro. The tumor volume decreased as a function of time after therapy with CDDP. The PLA-CDDP MS group had significantly less renal toxicity than the CDDP group. In rats treated with PLA-CDDP MS followed by [¹³¹I]IMISO, tumor %ID/pixel decreased 40% from 0.039 ± 0.001 to 0.024 ± 0.002. There was also a 40-50% decrease in tumor size after therapy with PLA-CDDP MSs. The results indicate that intratumoral injection of PLA-CDDP MSs can significantly reduce renal toxicity with the same therapeutic result as that of CDDP and its response could be monitored by [¹³¹I]IMISO.     

Robust HIV type 2 cellular immune response measured by a modified anthrax toxin-based enzyme-linked immunospot assay

Evaluation of immune mechanisms responsible for control of viral replication is critical to understanding HIV-2 attenuated biological characteristics in pathogenesis and transmission. Evaluation of the cellular immune response is often based on labor-intensive techniques that limit the scope of most studies performed. A simple and rapid anthrax toxin-based ELISPOT method to assess HIV-2 cellular immune response was developed. The modified anthrax toxin-based antigen presentation process performed better than a recombinant vaccinia system and the ELISPOT method significantly enhanced the ease and simplicity of the assay. Using this method, a robust HIV-2 cellular immune response directed toward the p26 core protein was exhibited in 21 of 24 (87.5%) infected women, and all 8 seronegative subjects were negative in both assays. Cellular immune responses were associated with low HIV-2 viral load. This simple and rapid modified anthrax toxin-based ELISPOT method allowed us to demonstrate, strong cellular immune responses that may be critical determinants in the HIV-2 attenuated phenotype.     

Particularités des syndromes coronariens aigus chez la femme en Afrique subsaharienne

Introduction

Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar.

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014–2015 outbreak in Guinea

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014–2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p?<?0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p?=?0.035), and seven clinical symptoms on admission, i.e., fever (p?=?0.003), hiccups (p?<?0.001), vomiting (p?=?0.003), diarrhea (p?<?0.001), cough (p?=?0.001), sore throat (p?=?0.016), and unexplained bleeding (p?=?0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR?=?1.06; 95%CI?=?1.03–1.09; p?<?0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.     

Short- and long-term outcomes of kidney donors: a report from Tunisia

Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri-operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.     

Randomized Study Comparing a Reusable Morcellator with a Resectoscope in the Hysteroscopic Treatment of Uterine Polyps: The RESMO Study

Study ObjectiveTo compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps.DesignSingle-center randomized prospective single-blind trial (resectoscope-morcellator study).SettingCentre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France.PatientsAll patients presenting with a single endometrial polyp of size 1 cm or larger.InterventionsAfter consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection. Secondary outcomes: total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods.Measurements and Main ResultsNinety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HM < SR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HM < SR] = .985), number of device insertions (1.50 vs 6; p [HM < SR] > .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HM < SR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HM < SR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HM > SR] = .999) as was visualization (4 vs 3.7; p [HM > SR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HM < SR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy.ConclusionThe reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.