Repeated artemisinin-based combination therapies in a malaria hyperendemic area of Mali: efficacy, safety, and public health impact

Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.     

Plasmablastic lymphoma: a case report.

Plasmablastic lymphoma is a rare subcategory of non-Hodgkin lymphoma frequently associated with human immunodeficiency virus. It is a large B-cell lymphoma that has a predilection for the oral cavity. Clinically, plasmablastic lymphoma may mislead to a diagnosis of Kaposi's sarcoma. When infected, plasmablastic lymphoma may mimic an odontogenic cellulitis. Epstein-Barr virus and human herpesvirus 8 are very often associated. Awareness of this entity can prevent misdiagnosis with nonlymphoid malignancies, notably Kaposi's sarcoma, because this lesion does not express the conventional B-cell markers. Unfortunately, as for other high-grade lymphomas in patients with acquired immunodeficiency syndrome (AIDS), the prognosis is poor. The case of a heterosexual 42-year-old man referred for a right hemifacial neoplasm is reported.     

Epidemiology and therapy of malignant hemopathies in Senega

The objectives of this study were to determine the prevalence of malignant hemopathies among patients in Dakar hospital and to examine the current methods of treatment in Senegal. A retrospective analysis of patients diagnosed in Dakar hospitals from 1st January 1986 to 31st December 1992 revealed 210 cases of malignant hemopathies, but only 155 patient records were retrieved (73.8%). The prevalence of malignant hemopoathies was 7/1000 and males were predominant with a sex ratio of 1.6 (p = 0.0001). Acute leukaemias (AL) appeared mainly in young people with a mean age of occurrence of 18.8 years, while immunoproliferative syndromes (IS) and myeloproliferative syndromes (MS) were mostly found in adults with respective mean ages of occurrence of 38.9 and 38.7 years (p = 0.000004 AL vs IS, p = 0.00001 AL vs MS). Concerning therapy, 14.2% of patients died without treatment and 26.1% received only symptomatic treatment. Chemotherapy was employed in 61% of cases, complete remission being obtained in 20.6% of these patients but of no remission in the remaining 79.4%. Mean survival was 2 months for AL, 5 months for IS and 6 months for MS. Close collaboration between haematologists and clinicians and creation of a specialized clinical haematology department will be necessary to overcome current difficulties in the treatment of these affections.     

Presenting features at diagnosis and complications of hemophilia in Dakar: apropos of 25 cases

In order to describe the presenting features at diagnosis and complications of hemophilia in Dakar, we conducted a study of hospital records between October 1991 and January 1993. Twenty-five cases of hemophilia were identified. We found that only 4% of our patients were diagnosed in the first 6 months of life whereas 64% of patients were diagnosed between 6 months and 5 years of age, 32% were detected between 5 years and 14 years of age. The presenting feature at diagnosis was external bleeding in 60% of cases and internal bleeding in 40%. 92% of cases were hemophilia type A and only 8% hemophilia type B. 56% of patients had mild hemophilia, 40% moderate and only 4% severe disease. Hemophiliac arthropathy was present on radiography in 76%. Complications were dominated by repeated joint bleeding, which was present in 92% of patients, and repeated hematomas (80% of patients). A functional handicap was present in 60% of cases. 12% of transfused hemophiliacs developed an inhibitor and 4% of patients were HIV positive. Greater awareness of hemophilia amongst the medical community as well as continued efforts to improve care for hemophiliacs in Senegal are necessary.     

« Le syndrome du bébé secoué : les séquelles ? »

The Shaken Baby Syndrome (SBS) is a severe inflicted brain injury due to an adult violently shaking an infant. Diagnostic guidelines have been recently published by the “Haute Autorité de santé”. The mortality rate after SBS is 21.6 % and the long-term outcome is good for only 8 to 36 % patients followed over more than 5 years. The aim of this article is to describe sequelae after a SBS, their mechanisms, prognostic factors and recommendations for a better long-term care of the patients.     

Apolipoprotein A1 as an early index of protein-energy malnutrition.

Protein-energy malnutrition (PEM) is, together with infectious and parasitic diseases, a major cause of childhood illness in Africa. Diagnosis and treatment of PEM requires an accurate, simple and reliable method of assessing nutritional status from a blood sample. Plasma apolipoprotein (apo A1), prealbumin and albumin were measured in a group of Senegalese children suffering from PEM who had been hospitalized for refeeding, and in a group of control children. Statistical analysis of the results indicated that: (1) Plasma apo A1 was significantly correlated with prealbumin in assessing nutritional status (P less than 0.005 on day 8 of refeeding); (2) plasma apo A1 alone was sufficient for diagnosing and monitoring the dietary treatment of PEM; it was capable of detecting subclinical forms; (3) apo A1 could be used for differential diagnosis of forms of PEM; (4) plasma apo A1 concentration began to increase earlier (94% of control values at day 8) than did prealbumin (73% on day 8). We therefore propose apo A1 as an index of nutritional status in children living in areas where infectious and parasitic diseases are endemic.     

Contribution of ultrasound in the diagnosis of the complications of intramuscular injection in children

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).