Placental infection by Plasmodium falciparum in an urban area of Senegal

OBJECTIVES: This study aimed at describing the burden of malaria at delivery in a urban maternity in Senegal. We measured the prevalence of placental malaria infection. We described the association between placental malaria and low birth weight and the impact of chemoprophylaxis. STUDY AREA: Guediawaye is the most important suburb of the city of Dakar, Senegal, surrounded by a permanent marsh (niayes). Malaria in this area is hypo endemic transmission: 1 infective bite/person/year. An. arabiensis is the principal vector and P. falciparum (98%) the most frequent species. The Maternité Roi Baudoin in Guediawaye is the gynecologic and obstetrical reference centre of this area with more than 6000 deliveries/year. METHODS: We carried out an exhaustive survey from August 98 to December 99 at the maternité Roi Baudoin in Guediawaye. The socio-demographic data, the clinical data and information about prophylaxy were collected by questionnary. For each woman at delivery, one placental apposition was carried out. Presence of trophozo?tes or schizontes indicated malaria placental infection. RESULTS: 8310 women were included in the study. They were from 13 to 49 years old with an average age of 26.1; 28% were primigravidae. The prevalence of placental malaria infection was 8.1% (674/8310) [Ic95: 7.4-8.8%]. Schizontes were present in 80.5% of infected placenta. The prevalence was 8.8% within primigravidae group and 7.4% in the other parity groups, p = 0.28 (NS). Placental infection was present all the year long. However, there were important seasonal variations. The risk of placental infection increased during seasonal transmission (> 10%) compared to the period of low transmission (3%). The prevalence of placental malaria was lower in the group of women who declares regular chloroquine intake compared with those who declared taking no prophylaxy or irregular prophylaxy (RR = 0.78 [0.62-0.98]). The risk of low birth weight was of 1.9 [1.6-2.1] when the placenta was infected compared with non infected placenta. CONCLUSION: This study indicates that placental malaria infection is frequent in this low transmission area where more than 70% of women declared taking regular chloroquine. This observation could be explained by a resistance of P. falciparum to chloroquine or a poor observance of chemoprophylaxis.     

Efficacy and tolerance of ivermectin in human onchocerciasis

Initial clinical studies in 32 Senegalese subjects have demonstrated the efficacy of ivermectin in Onchocerca volvulus infection (river blindness). Although O. volvulus microfilariae in skin snips were not reduced in number after single oral doses of 5 micrograms or 10 micrograms/kg body-weight, they were greatly reduced in all subjects after single oral doses of 30 micrograms or 50 micrograms/kg and were eliminated completely in 6 of th 8 subjects who received the 50 micrograms/kg dose. All subjects tolerated the drug well. Transient pruritus which did not require treatment was observed on the day the dose was given in 2 of the 8 subjects after the 30 micrograms/kg dose and in 4 of the 8 who received the 50 micrograms/kg dose. Ivermectin produced no abnormal laboratory results.     

Dairy product consumption,calcium intakes,and metabolic syndrome–related factors over 5 years in the STANISLAS study

ObjectiveWe assessed the associations of total dairy products; milk, yogurt, and cottage cheese; cheese; and calcium with 5-y changes in components of the metabolic syndrome.MethodsTwo hundred eighty-eight men and 300 women 28 to 60 y of age from the suivi temporaire annuel non invasif de la santé des lorrains assurés sociaux (STANISLAS) cohort completed at baseline a 3-d dietary record. Statistics were performed using multivariate regression analysis.ResultsIn men, no relation was found between the four dietary indices and components of the metabolic syndrome measured at baseline. Conversely, the consumption of milk, yogurt, and cottage cheese at entry was inversely associated with 5-y changes in glucose levels (P ≤ 0.05, P ≤ 0.01 for sex interaction) and positively with 5-y changes in high-density lipoprotein cholesterol (P ≤ 0.05). Higher calcium intakes were significantly related to a lower 5-y increase of the body mass index (BMI) and waist circumference in men (P ≤ 0.01, P ≤ 0.05 for sex interaction). In addition, changes in diastolic blood pressure were inversely associated with the consumption of milk, yogurt, and cottage cheese only in men with a normal BMI (P ≤ 0.05 for BMI interaction). In women, unlike men, associations were shown for some components measured at baseline: total dairy positively related to BMI and waist circumference; total dairy, milk, yogurt, and cottage cheese, and calcium were positively related to triacylglycerols and negatively to high-density lipoprotein cholesterol. However, no significant association was found for any 5-y-changes.ConclusionIn men only, a higher consumption of dairy products was associated with positive changes in the metabolic profile in a 5-y period; a higher calcium consumption was associated with a lower 5-y increase of the BMI and waist circumference.     

HIV-1 subtypes and recombinants in the Republic of Congo.

To document the actual genetic diversity of HIV-1 strains in the Republic of Congo, 114 HIV-1 positives persons were sampled in 2003 and 2004 after their informed consent. They were attending the teaching hospital, the reference health center in Makelekele, Brazzaville and the regional hospital centers in Pointe-Noire, Gamboma and Ouesso. A total of 104 samples were genetically characterized by direct sequencing of the p24 gag region and 80 were also subtyped in the V3-V5 env region. The genetic subtype distribution of the Congolese strains showed the predominance of subtype A (36.5% and 32.5% in gag and env, respectively) and G (30.8% and 21.25%), whereas subtype D strains represented 12.5% and 15%. Subtypes C, F, H, J, K and the CRFs-01, -02, -05 -06, and also the recently characterized CRF18 were seen at lower rates. Finally, 4.8% (gag) and 6.25% (env) of the strains could not be classified. Moreover, a high intra-subtype diversity was observed in our study. Among 70 strains which have been characterized in the two genomic regions, 14 (20%) appeared to be unique recombinants. These data show a high genetic variability in the Republic of Congo, where all the subtypes have been documented together with certain subsubtypes and several CRFs.     

Rapid, field-deployable method for genotyping and discovery of single-nucleotide polymorphisms associated with drug resistance in Plasmodium falciparum

Despite efforts to reduce malaria morbidity and mortality, drug-resistant parasites continue to evade control strategies. Recently, emphasis has shifted away from control and toward regional elimination and global eradication of malaria. Such a campaign requires tools to monitor genetic changes in the parasite that could compromise the effectiveness of antimalarial drugs and undermine eradication programs. These tools must be fast, sensitive, unambiguous, and cost-effective to offer real-time reports of parasite drug susceptibility status across the globe. We have developed and validated a set of genotyping assays using high-resolution melting (HRM) analysis to detect molecular biomarkers associated with drug resistance across six genes in Plasmodium falciparum. We improved on existing technical approaches by developing refinements and extensions of HRM, including the use of blocked probes (LunaProbes) and the mutant allele amplification bias (MAAB) technique. To validate the sensitivity and accuracy of our assays, we compared our findings to sequencing results in both culture-adapted lines and clinical isolates from Senegal. We demonstrate that our assays (i) identify both known and novel polymorphisms, (ii) detect multiple genotypes indicative of mixed infections, and (iii) distinguish between variants when multiple copies of a locus are present. These rapid and inexpensive assays can track drug resistance and detect emerging mutations in targeted genetic loci in P. falciparum. They provide tools for monitoring molecular changes associated with changes in drug response across populations and for determining whether parasites present after drug treatment are the result of recrudescence or reinfection in clinical settings.     

Exploration of associations between phospholipase A2 gene family polymorphisms and AIDS progression using the SNPlex method.

Members of the secreted phospholipase A2 (PLA2) protein family can inhibit HIV-1 virus replication in vitro. To evaluate the impact of PLA2 gene polymorphisms on AIDS disease development, we studied 12 family members using SNPlextrade mark technology that permitted simultaneous typing of 70 tagging Single Nucleotide Polymorphisms (tagSNPs). The study utilized HIV-1 seropositive donors with slow progressor (n=168) or rapid progressor (n=54) status, plus 355 control subjects. All donors were Caucasian (total 577 individuals). Genetic associations yielded mainly 0.01相似文献   

Neurofibrome isolé du sinus maxillaire

ObjectiveTo illustrate the rarity and difficulty diagnosing maxillary sinus neurofibroma through a case report.Patients and methodsA 35-year-old female consulted our department for left cheek swelling evolving over 6 months, upper gum swelling, and a dental occlusion disorder.ResultsA computed tomography scan showed a tumor of the left maxillary sinus with bone destruction. Histological examination of a biopsy fragment found an in situ carcinoma. A maxillary resection was performed to excise the tumor. Histological examination of the specimen showed a neurofibroma. No sign of recurrence was noted after 8 months of follow-up.ConclusionThe difficulty diagnosing maxillary sinus neurofibroma is related to its nonspecific clinical and radiological signs. Consequently, the otorhinolaryngologist must keep this rare histological variety in mind within the range of tumors of the paranasal sinuses.     

Influence of speed variation and age on the intrasubject variability of ground reaction forces and spatiotemporal parameters of children's normal gait]

OBJECTIVE: To assess the effect of age and speed on the variability of ground reaction forces (GRF) and stride parameters of gait in normal children. MATERIAL AND METHOD: Forty-seven children aged 4-10 years were split into three age groups. Each child walked at three constant speeds on a treadmill. Thirty consecutive steps of each leg were recorded. For each child, the mean parameters of the 30 steps were calculated. The mean parameter of each child was taken to calculate the mean parameters of the group. The variability was evaluated by the coefficient of variation (CV). The influence of both age and speed on the variability was examined with a to-way analysis of variance. RESULTS: The cross effect of age and speed on the variability was not significant. The variability of the parameters decreased significantly with age between 4 and 8 years. The variability of vertical forces increased significantly with speed (between 2.7 and 4.5 km/h), while the variability of antero-posterior forces, the stride and the stance decreased between 2.7 and 3.6 km/h. However, the variability of double stance was not influenced by walking speed between 2.7 and 4.5 km/h. Except the time of production of the vertical force of propulsion (Tz3), the variability of temporal vertical parameters decreased significantly with speed between 2.7 and 4.5 km/h and the variability of temporal antero-posterior parameters decreased significantly between 2.7 and 3.6 km/h. DISCUSSION-CONCLUSION: The variability of the GRF and spatio-temporal parameters in children was influenced by age between 4 and 8 years old and by speed between 2.7 and 3.6 km/h. Moreover, the effect of age on the GRF persists up to 8 years. The variabilities of the time of production of the antero-posterior force of propulsion (Ty2) and stance duration were lower than the variabilities of the others parameters. These two variables could be the most reliable parameters when assessing gait in children aged 4-10 years, walking at speeds between 2.7 and 4.5 km/h.     

Genetic profiling in healthy subjects from the Stanislas cohort based on 24 polymorphisms: effects on biological variables.

BACKGROUND: The association of genetic profiles with biological or clinical assessments is not clearly established especially among apparently healthy subjects. METHODS: A multivariate statistical analysis was performed on 24 polymorphisms related to the main metabolic pathways involved in cardiovascular diseases (CVDs). They were collected among 1551 healthy subjects of the Stanislas cohort to obtain genetic profiles. Association with biological variables was then studied at baseline (t0) and 5 years later (t5). RESULTS: Six genetic clusters were identified with relevant profiles and five polymorphisms from the selectin, apolipoprotein C3 and lipoprotein lipase genes (SELE-98G/T, APOC3-3175C/G, APOC3-482C/T, APOC3-1100C/T, LPL-93T/G) were sufficiently characteristic to associate 99.6% of the subjects with their corresponding cluster. A 5-year follow-up showed that clinical and biological measurements in relation to CVD risk factors already differ with triglyceride (p=0.009 for t0 and p=0.005 for t5) and high-density lipoprotein cholesterol (p=0.014 for t0 and p=0.003 for t5) for these previous genetic clusters. CONCLUSIONS: This study presents the hypothesis that SELE could be protective, whereas APOC3 could be associated with risk. It remains to be seen whether these polymorphisms will be predictive of CVD events among the selected clusters of different metabolic subtypes after a 10-year follow-up.     

Efficacy and tolerability of artesunate‐amodiaquine (Camoquin plus®) versus artemether‐lumefantrine (Coartem®) against uncomplicated Plasmodium falciparum malaria: multisite trial in Senegal and Ivory Coast

Objective To compare, in a phase IV trial, the efficacy and tolerability of artesunate‐amodiaquine (Camoquin plus®) dosed at 300 and 600 mg of amodiaquine per tablet to artemether‐lumefantrine (Coartem®) for the treatment of Plasmodium falciparum uncomplicated malaria in Ivory Cost and Senegal. Method Multisite, randomised, open‐labelled study in patients over the age of 7 years. The primary endpoint for efficacy was adequate clinical and parasitological response (ACPR) at day 28. The secondary endpoints were fever and parasite clearance and gametocyte carriage in each treatment group. Drug tolerability was assessed comparing adverse events and modification of biological parameters between D0 and D7. Data were analysed on an intention‐to‐treat and per protocol basis. Results We included 322 patients; 316 patients completed the monitoring to D28 (155 in AS + AQ group and 161 in AL group). In ITT analysis, an ACPR corrected rate of 97.4% was observed in AS + AQ group versus 97% in AL group (P = 0.99). No parasite recrudescence was observed in AS + AQ arm. All patients in both groups had a fever and parasite clearance at D2. Gametocytes had disappeared by D14 in the AL group and by D21 in the AS + AQ group. No serious adverse events were observed. Minor adverse events were significantly more frequent in the AS + AQ arm. Biological parameters between D0 and D7 did not show any significant statistical variations except for anaemia. Conclusion This study demonstrates the efficacy and tolerability of AS + AQ for uncomplicated Plasmodium falciparum malaria treatment in African patients over the age of 7 years.