Echocardiographic screening for rheumatic heart disease: Age matters

Background

Echocardiography is emerging as a screening tool for rheumatic heart disease (RHD) in endemic regions. The vast majority of surveys have been limited to children. We ought to appreciate the interest of including adolescents in their late teens in such school screening programmes.

Methods

School-based echocardiography cross-sectional survey conducted in Dakar, Senegal (March 2010). A total of 2004 school attendees were randomly selected and enrolled in the study, among which 1116 were aged 5–15 years old (group 1), and 888 were 16–18 years old (group 2). Case detection rates and phenotype of RHD were compared according to age groups.

Results

A total of 22 youngsters were suspected by on-site echocardiography, 12 in group 1 and 10 in group 2. Among the 12 RHD cases suspected on-site in group 1, 6 (50%) were eventually considered as confirmed RHD, compared to 9 out of 10 (90%) in group 2, giving prevalence rates of 5.4 (CI 95% 2.0–11.7) and 10.1 (CI 95% 4.6–19.2) per 1000 in group 1 and group 2, respectively. The proportion of marked/advanced lesions was 33% in group 1, and 89% in group 2 (p = 0.08). Mean concordance rates between the 3 reviewers were 40% for group 1, compared to 93% in group 2 (p = 0.05).

Conclusions

Extension of screening to adolescents in their late teens should be considered with interest in the light of the higher prevalence of the disease and relative clarity of subclinical cardiac lesions that could be more easily detected in the field.     

Corps étranger du rectum : à propos d’une observation

Rectal foreign bodies are uncommon in our practice. In adult, foreign bodies are mostly inserted into the rectum for sexual gratification. We report the case of 49 years old man, who present to the emergency department with constipation following accidental insertion of a deodorant bottle in the rectum. Nonoperative treatment based on laxatives allow the expulsion of the foreign body. Through this case, we discuss diagnosis and therapeutic aspects of rectal foreign bodies.     

Patterns of daily activity and time spent in bed of adult women and adolescent and preadolescent girls from a rural community in Senegal, West Africa

BACKGROUND: In rural Africa, women and adolescent girls sustain a high burden of domestic and agricultural tasks. This could result in energy imbalance and impair their nutritional status. OBJECTIVE: The aim of the study was to investigate activity during the day and time spent in bed during the night for adult women and adolescent and preadolescent girls living in the same household. The hypothesis was that more prolonged physical inactivity and time spent in bed could be an efficient means for lowering energy expenditure and hence maintaining an adequate nutritional state. METHODS: Physical activity during the day was qualitatively recorded using 'spot observation' (Super 1989), and quantitatively using accelerometers. A total of 110 females--55 adult women, 45 adolescents and 10 preadolescents--were included in the study. Anthropometric measurements (weight, height and four subcutaneous skinfolds) served as indicators of nutritional status. RESULTS: Day-to-day reliability of accelerometry counts was acceptable (average intraclass correlation coefficient = 0.73). Differences in daytime activity varied according to age group. Adolescent and preadolescent girls had higher overall activities than adults (p < 0.01). Preadolescent girls went to bed earlier and for longer periods than adult women (p < 0.001). There existed significant relationships between time spent in bed and activity during the day in adult women but not in adolescent or preadolescent girls. A significant relationship between nutritional status and physical activity indices was observed in preadolescent and adolescent girls, but not in women. CONCLUSIONS: The findings partially support the hypothesis of some compensation of daytime activity by time spent in bed in adult women, but not in adolescent or preadolescent girls.     

Role of Pfmdr1 in In Vitro Plasmodium falciparum Susceptibility to Chloroquine,Quinine, Monodesethylamodiaquine,Mefloquine, Lumefantrine,and Dihydroartemisinin

The involvement of Pfmdr1 (Plasmodium falciparum multidrug resistance 1) polymorphisms in antimalarial drug resistance is still debated. Here, we evaluate the association between polymorphisms in Pfmdr1 (N86Y, Y184F, S1034C, N1042D, and D1246Y) and Pfcrt (K76T) and in vitro responses to chloroquine (CQ), mefloquine (MQ), lumefantrine (LMF), quinine (QN), monodesethylamodiaquine (MDAQ), and dihydroartemisinin (DHA) in 174 Plasmodium falciparum isolates from Dakar, Senegal. The Pfmdr1 86Y mutation was identified in 14.9% of the samples, and the 184F mutation was identified in 71.8% of the isolates. No 1034C, 1042N, or 1246Y mutations were detected. The Pfmdr1 86Y mutation was significantly associated with increased susceptibility to MDAQ (P = 0.0023), LMF (P = 0.0001), DHA (P = 0.0387), and MQ (P = 0.00002). The N86Y mutation was not associated with CQ (P = 0.214) or QN (P = 0.287) responses. The Pfmdr1 184F mutation was not associated with various susceptibility responses to the 6 antimalarial drugs (P = 0.168 for CQ, 0.778 for MDAQ, 0.324 for LMF, 0.961 for DHA, 0.084 for QN, and 0.298 for MQ). The Pfmdr1 86Y-Y184 haplotype was significantly associated with increased susceptibility to MDAQ (P = 0.0136), LMF (P = 0.0019), and MQ (P = 0.0001). The additional Pfmdr1 86Y mutation increased significantly the in vitro susceptibility to MDAQ (P < 0.0001), LMF (P < 0.0001), MQ (P < 0.0001), and QN (P = 0.0026) in wild-type Pfcrt K76 parasites. The additional Pfmdr1 86Y mutation significantly increased the in vitro susceptibility to CQ (P = 0.0179) in Pfcrt 76T CQ-resistant parasites.     

Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal)

This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were: puerperal sepsis and other infections (51 cases), haemorrhage (32 cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio [OR] = 55.0), late referral (OR = 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR = 2.5), and low level of education (OR = 1.6). Implications for policy are discussed.