Relationship between entomological inoculation rate,Plasmodium falciparum prevalence rate,and incidence of malaria attack in rural Gabon

To assess the relationships between variations of Plasmodium falciparum transmission and those of peripheral parasitaemia prevalence or malaria attack incidence rates in regions with limited fluctuations of transmission, we conducted a follow-up in two Gabonese populations. Entomological surveys were carried out from May 1995 to April 1996 in Dienga, and from May 1998 to April 1999 in Benguia. In Dienga, malaria transmission was seasonal, being not detected during two 3-month periods. Mean entomological inoculation rate (EIR) was 0.28 infective bite/person/night. In Benguia, malaria transmission was perennial with seasonal fluctuations, mean EIR being 0.76 infective bite/person/night. In Dienga, 301 schoolchildren were followed from October 1995 to March 1996. Clinical malaria attack was defined as fever associated with >5000 parasites/microl of blood. P. falciparum prevalence varied from 28 to 42%, and monthly malaria attack incidence from 30 to 169 per thousand. In Benguia, the entire population (122 persons) was followed from November 1998 to April 1999. Prevalence varied from 22 to 50%, and monthly malaria attack incidence from 52 to 179 per thousand. In each area, entomological variations were not related to parasite prevalence, but preceded malaria attack incidence with 1- or 2-month time lag, corresponding to the pre-patency period that differs in the two populations, possibly according to differences in immunity related to parasite transmission.     

Reverse gyrase: a helicase-like domain and a type I topoisomerase in the same polypeptide.

Reverse gyrase is a type I DNA topoisomerase able to positively supercoil DNA and is found in thermophilic archaebacteria and eubacteria. The gene coding for this protein was cloned from Sulfolobus acidocaldarius DSM 639. Analysis of the 1247-amino acid sequence and comparison of it with available sequence data suggest that reverse gyrase is constituted of two distinct domains: (i) a C-terminal domain of approximately 630 amino acids clearly related to eubacterial topoisomerase I (Escherichia coli topA and topB gene products) and to Saccharomyces cerevisiae top3; (ii) an N-terminal domain without any similarity to other known topoisomerases but containing several helicase motifs, including an ATP-binding site. These results are consistent with those from our previous mechanistic studies of reverse gyrase and suggest a model in which positive supercoiling is driven by the concerted action of helicase and topoisomerase in the same polypeptide: this constitutes an example of a composite gene formed by a helicase domain and a topoisomerase domain.     

Aphasia in stroke patients: early outcome following thrombolysis

Background: Data on the early course of stroke-related aphasia after thrombolysis are scant.

Aims: The aim of this study was to describe recovery patterns of aphasia after thrombolysis in a large sample of stroke patients.

Methods & Procedures: Clinical and radiological data of consecutive stroke patients treated with thrombolysis over a 5-year period were routinely entered into prospective registries at two stroke units. Recovery was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at baseline, after 24 hr, and on day 7. Aphasia was defined as a score >0 on item 9 of the NIHSS (measurement of language skills), aphasia improvement as any decrease in the item-9 score, and aphasia resolution as an item-9 score of 0. To assess global motor and language impairments, we created a composite language score obtained by summing the scores for items 1b, 1c, and 9; and a composite motor score obtained by summing the scores for items 4, 5, and 6.

Outcomes & Results: Out of the 338 patients treated with thrombolysis, 137 (40.5%) had aphasia. In patients with both aphasia and motor deficits (n = 109), these two impairments showed similar recovery patterns. Aphasia recovered significantly better in patients without limb motor deficits (n = 28) than those with limb motor deficits (n = 109), both after 24 hr (p < 0.05) and after 7 days (p < 0.0001). These results were supported by findings from a group-based trajectory modelling methods (p < 0.005).

Conclusions: Language impairments and limb motor deficits show similar recovery after thrombolysis in a given patient. Aphasia recovery is significantly better in the absence of limb motor deficits.     

User fee exemption policies in Mali: sustainability jeopardized by the malfunctioning of the health system

In Mali, where rates of attendance at healthcare facilities remain far below what is needed, three user fee exemption policies were instituted to promote access to care. These related to HIV/AIDS treatment, as of 2004, caesarean sections, since 2005, and treatment of malaria in children under five and pregnant women, since 2007. Our qualitative study compared these three policies, looking at their implementation provisions, functioning and outcomes. In each healthcare facility, we analysed documentation and carried out three months of on-site observations. We also conducted a total of 254 formal and informal interviews with health personnel and patients.While these exemptions substantially improved users' access to care, their implementation revealed deep dysfunctions in the health system that undermined them all, regardless of the policy studied. These policies provoked resistance among health professionals that manifested in their practices and revealed, in particular, the profit-generation logic within which they operate today. These dysfunctions reflect the State's incapacity to exercise its regulatory role and to establish policies that are aligned with the way the health system really works.     

Digital Quantification Is More Precise than Traditional Semiquantitation of Hepatic Steatosis: Correlation with Fibrosis in 220 Treatment-Naïve Patients with Chronic Hepatitis C

Background  

Steatosis, as associated with chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD), has been considered a risk factor for development of fibrosis.     

Croyances mystiques et syndrome de l’intestin irritable chez le patient noir africain

Background

Black African patients with irritable bowel syndrome (IBS) were prompt to express mystic beliefs than patients with chronic constipation (CC) regarding their illness.

Aim

To compare clinical and sociological factors of IBS and CC.

Patients and methods

Cross-sectional study was conducted at Yopougon teaching hospital from April 2004 to January 2005 and enrolled 78 consecutive outpatients (51 females, 27 males, median age: 32.7 years) attending the gastroenterology unit for functional gastrointestinal disorders (IBS and CC). Each patient completed a questionnaire including Rome II criteria of IBS and CC, demographic and sociological parameters (past history of sorcery, bewitchment, intra familial conflict).

Results

Among these patients, 11 (13.4%) had IBS and 67 (81.7%) had CC. Patients with IBS were mainly males (72.7 vs 28.4%, P = 0.01), had long duration (in years) of symptoms (5 vs 1 year, P = 0.02) and expressed mystic belief (36.4 vs 6%, P = 0.02)than patients with CC in univariate analysis. In multivariate logistic regression analysis, males (OR = 4.7; CI 95%: [1.1–21.1]; P = 0.04) and mystic belief (OR = 5.9; CI 95 %: [1.1–32.1]; P = 0.04) were significantly associated with IBS.

Conclusion

Black African patients with IBS were mainly males and expressed mystic belief than those with CC. This finding may be helpful for identifying patients with IBS among those complaining with functional gastrointestinal disorders.