Results of treatment with CMA, a low intermediate regimen, in endemic Burkitt lymphomas in sub-Saharian Africa: experience of Côte d’Ivoire

African Burkitt lymphomas (BL) are highly aggressive lymphomas mainly affecting children and young adults in Africa. This lymphoma was marked by its high sensitivity to chemotherapy in comparison to Sporadic Burkitt lymphoma. In this study, we evaluated the treatment response and survival of patients with CMA protocol. Eighty-five of the 105 children registered were evaluated for response; there were 46 boys and 39 girls, whose age at diagnosis ranged from 3 to 18 years (median 11 years), admitted to the Hematology National Teaching Hospital of Abidjan in the period 1998–2008 with a diagnosis of BL on histological review and who were given CMA chemotherapy with curative intent are included in this analysis. CMA protocol is a low intermediate regimen of 3 drugs [Cytarabin (ara-C), Methotrexate (MTX), and Cyclophosphamide] with CNS-directed treatment by intrathecal MTX, ara-C and corticosteroid. Fifty-five of 85 patients obtained CR after induction therapy and 10 after 3 supplementary cycle because of partial response. The overall complete remission was 76%. Fifty-three of patients were alive in first CR at a median survival rate period of 2 years (range 82 days to 9 years) and are continuously disease free from Burkitt lymphomas. Twelve patients relapse after CR and died of lymphoma progression. More than 32 patients died, as a result of lymphoma progression. Among the 32 dead, 10 were in Murphy stage IV and all the patients who presented bone marrow involvement died. The projected 5-year overall survival rate was 62%. In conclusion, CMA protocol shows the high sensitivity of African Burkitt lymphoma. This can be considered as a successful result for people living in poor socio-economic conditions with no health insurance.     

Molecular analysis of archived blood slides reveals an atypical human Trypanosoma infection

In 2003, a 10-month-old Ghanaian boy recovered from a Trypanosoma brucei infection, although the patient was not treated with antitrypanosomal drugs. Only T. brucei gambiense and T. brucei rhodesiense are able to infect humans, causing human African trypanosomiasis. The disease is considered 100% fatal if left untreated. The identity of the trypanosome was determined by DNA extraction from the archived stained blood slides followed by sequential application of polymerase chain reactions (PCRs) that are specific for the order, subgenus, species and subspecies, followed by genotyping with microsatellite PCR. Molecular analysis indicated that the parasites observed in the patient's blood in 2003 belong to the T. brucei subspecies brucei, which is normally not infectious to humans. Next to the clinical message, this article provides technical information to extract successfully DNA from archived blood slides for subsequent molecular analysis and to identify a trypanosome by taxon-specific PCRs and microsatellite genotyping.     

Effects of the insect growth regulator pyriproxyfen in a two-generation test with Chironomus riparius

Pyriproxyfen a juvenile hormone analoga (JHA) was used in a two-generation test with Chironomus riparius (Diptera). The protocol is an extension of the OECD test methods to test duration from first-instar larvae in the parental (P) generation to emergence of midges in the filial (F1) generation. Test species were exposed to concentrations ranging from 0.001 to 0.1 mg/L. The results showed significant adverse effects compared to the solvent control for emergence rate (p<0.001), development rate (p<0.001), fecundity (p<0.05) and fertility of egg ropes but not for the sex ratio. No observed effect concentrations (NOEC), respectively, lowest observed effect concentration (LOEC) values were lower for emergence rate and development rate in the F1 (0.003 mg/L, respectively, 0.01mg/L each) than in the P generation (0.01 mg/L, respectively, 0.03 mg/L). The two-generation test provided additional information, which might be useful in the risk assessment of agrochemicals with potential endocrine effects.     

Immunological aspects of a case of extragenital endometriosis localized in the mouth

To appreciate the role of the immune system in transportation and development of endometer cells in mouth, authors reported the results of immunological parameters analysis in one patient suffering to a mouth localisation healed endometriosis out of hormonal therapy in experimental and analytic study. Immunoglobulin A, G, M and C3, C4 complement fractions were measured by Mancini radial immunodiffusion. The count of CD4+, CD8+and B Cell was performed by BD FASCalibur flow cytometer. Autoimmune diseases were searched after by measuring autoantibodies using agglutination and immunofluoresence methods. The results showed any antibodies detected and the count of CD4, CD8 and B cells was normal. However, IgG and IgA increased. But C3, C4 factions and IgM decreased. This seems an immunological disorder which could be more explored in NK cells and cytokines study.     

Sudden death during worker transportation due to massive pulmonary thromboembolism: a case report

This is a report on a 30-year-old black man who suddenly died in the worker transportation vehicle in which he had been quietly sitting for thirty minutes. No information about his medical or surgical history or any family history has been obtained. This case is intended to highlight the fact that forensic autopsy is a valuable tool to recognize the cause of death and that fatal pulmonary thromboembolism still remains a post-mortem diagnosis. In this case report, the autopsy found a fresh saddle pulmonary thromboembolus associated with partially organized thrombi of the inferior vena cava. Can a prolonged seated position encourage thrombus formation? We think that seat-related factors and especially patient-related factors intervene together in the development of thromboembolic events. In our medico-legal unit, having no means to search for these factors, we speculated on the various causes that could be involved in the occurrence of venous thromboembolism in our subject. We emphasize the importance of focusing research on genetic factors and the impact of traditional medicine in African people.     

Pseudokyste hémorragique du pancréas révélé par une hémorragie digestive récidivante

Gastrointestinal bleeding in pancreatic pseudocysts is uncommon. It is caused by extravasation of intracystic haemorrhage or rupture of postpancreatitis aneurysm in the digestive tract. We describe the case of a 50-year-old woman, with a history of having been involved in a road traffic accident, who presented epigastric pain associated with hematemesis and melena. An abdominal scan showed a pancreatic pseudocyst with intracystic bleeding. Diagnosis and management of such haemorrhages remains difficult in our practice.     

Molecular and cellular determinants of arterial stiffness: role of cell-matrix connections]

Increased large artery stiffness is believed to be a cardiovascular risk factor independent from mean arterial pressure. The mechanical properties of large arteries depend not only on the amounts of their main constituents (elastin, collagen, and smooth muscle cells) but also on the spatial organization and mechanical interactions among these components. These interactions may be mediated by extracellular matrix adhesion proteins and their membrane receptors or integrins. From a mechanical viewpoint, a key element may be the dense plaque, which is composed of cytoskeletal proteins linked to matrix proteins via membrane integrin receptors. Integrin expression in normal and diseased blood vessels is currently the focus of active research. In humans, hypertension-related arterial hypertrophy is not associated with an increase in intrinsic arterial wall stiffness. Aortic fibronectin expression is increased in spontaneously hypertensive rats (SHRs). By increasing cell-matrix anchoring, fibronectin may contribute to protect arterial wall components from the increased mechanical loads associated with hypertension. In atherosclerosis, the increase in cell-matrix anchoring plays a key role in preventing atheroma plaque rupture. To determine the exact role of adhesion molecules in arterial stiffness, there is a need for studies involving use of specific anti-integrin agents and of transgenic animal models.