Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa

1. Download high-res image (192KB)
2. Download full-size image

     

Pulmonary manifestations associated with malaria

Pulmonary manifestations are frequently observed in children, pregnant women and travellers with malaria. The pathophysiology of these pulmonary manifestations is poorly understood but would appear to be secondary to an interaction between the parasitized red cells and the pulmonary capillary endothelium. Bronchitis and pneumonia do not directly compromise outcome but, left unrecognized, the delay in diagnosis and treatment may be fatal. Acute respiratory distress in children is the first cause of overmortality, coming before neurological involvement. The acute respiratory distress caused by severe malaria has no specific characteristics. Iatrogenic complications and pulmonary superinfections must be differentiated. The prevention of pulmonary manifestations associated with malaria can easily be accomplished by limiting water intake and carefully monitoring urinary output and weight. Treatment is the same as for acute flare-ups in combination with symptomatic respiratory treatment when required.     

Endocardite infectieuse aortopulmonaire d’évolution fatale : à propos d’un cas

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.     

Myiase scrotale chez l’enfant : à propos d’un cas

We present observations of a 4-year-old child, who was received for an inflammatory and pruritic scrotal swelling that had been evolving for 7 days. The physical examination found a scrotal mass centered by a whitish opening evoking a fistulized abscess or a furunculoide lesion. The bidigittal compression of the tumefaction had allowed the extraction of a maggot with the help of forceps leaving an 8 mm wound in place. The review parasitologist had concluded to a larva of anthropophaga cordylobia. The patient had received anti-inflammatory and antibiotic treatments associated with local care. This trend was favorable after a two-week decline. We will study the epidemiological, diagnostic and therapeutic aspects of this condition so rare in children simulating a furunculoide lesion or parietal abscess.     

Good Clinical Practice in Resource-Limited Settings: Translating Theory into Practice

A Good Clinical Practices (GCPs) course, based on the combination of theoretical modules with a practical training in real-life conditions, was held in 2010 in Burkina Faso. It was attended by 15 trainees from nine African, Asian, and Latin American countries. There were some discrepancies between the average good results at the end of the theoretical phase and the GCP application during the first days of the practical phase, underlying the difficulties of translating theoretical knowledge into good practices. Most of the findings were not unexpected and reflected the challenges commonly faced by clinical investigators in resource-poor contexts (i.e., the high workload at peripheral health facilities, the need to conciliate routine clinical activities with clinical research, and the risk of creating a double standard among patients attending the same health facility [free care for recruited patients versus user fees for non-recruited patients with the same medical condition]). Even if limited in number and time, these observations suggest that a theoretical training alone may not be sufficient to prepare trainees for the challenges of medical research in real-life settings. Conversely, when a practical phase immediately follows a theoretical one, trainees can immediately experience what the research methodology implicates in terms of work organization and relationship with recruited and non-recruited patients. This initial experience shows the complexity of translating GCP into practice and suggests the need to rethink the current conception of GCP training.     

A randomized, placebo-controlled trial of intermittent preventive treatment with sulphadoxine-pyrimethamine in Gambian multigravidae

We investigated the ability of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine/pyrimethamine to prevent anaemia and low birthweight in Gambian multigravidae. Between July 2002 and February 2004, 2688 multigravidae living in a rural area of The Gambia received SP (1346 women) or placebo (1342 women) up to four times during pregnancy and were followed until 6-weeks post-partum. Shortly after delivery, 10.7% of women in the intervention group and 8.8% in the control group were severely anaemic [Hb < 7 g/dl, risk difference = 0.02 (95% CI -0.01, 0.04), P = 0.17]. The overall mean birthweight of infants born to women who had received SP (3103 g) was very similar to that observed in infants born to women in the control group [3075 g; difference = 28 g (95% CI -11 g, 67 g), P = 0.16]. However, among women who did not use a bednet (either insecticide treated or untreated), infants born to women who had received SP weighed more than infants born to women in the control group [3147 g vs. 3044 g; difference 143 g (95% CI 53 g, 232 g), interaction test P < 0.001]. This study did not show that IPTp with SP benefited Gambian multigravidae overall but that it may benefit a sub-group of women who do not use a bednet. In areas such as The Gambia, provision of insecticide-treated bednets to multigravidae may provide an adequate means of protection against malaria in pregnancy without the need for additional IPTp.     

Results of emergengy colectomy in the management of the colon volvulus in Dakar hospital

PURPOSE: The aim of this study was to evaluate the results of emergency colectomies for the management of colon volvulus. PATIENTS AND METHODS: This retrospective study was undertaken on 50 cases of colon volvulus operated in the Surgical Department of the Aristide Le Dantec teaching hospital of Dakar from January 1994 to December 2000. It concerned 42 men and 8 women with an mean age of 42 years. All patients presented an occlusive syndrome suggestive of colon volvulus, which required a laparotomy, through a xypho-pubic incision. The patients were divided into two groups. Group I concerned 13 patients who underwent an ideal colectomy and group II, 37 patients in whom we performed a colectomy associated with a temporary colostomy with either Bouilly-Volkman procedure (n = 23) or Hartman procedure (n = 14) followed one month later by intestinal continuity restoration. Mortality and morbidity were compared in the two groups. RESULTS: The overall mortality rate was 12% (6/50). The mortality rate was 31% (4/13) in group I and 5 % (2/37) in group II. The overall morbidity rate was 14%. In group I, the morbidity rate was 15 % (2/13) and 13,5% (5/37) in group II. CONCLUSION: In our study the mortality rate was higher after colectomy with primary anastomosis than after colectomy with temporary colostomy followed by secondary anastomosis. We recommend colectomy without anastomosis for the emergency management of the colon volvulus in Africa.     

Short term evaluation of 24 cases of endodontic retreatment]

This study shows and evaluates the quality of the new root canal filling and periapical healing about 24 cases of endodontic retreatment, equivalent of 7.76% of endodontic treatments done at the clinic. The main consultation purposes were pain (54.17%) and pre-prosthetic control (40.90%) on these patients. 75% of teeth were treated in a single session attempt to 45 minutes. The root canal filling is performed in 91.65% of cases, with the safe apical limit reached in 88.13% and 94.11% per apical healing toward a short term results.