Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome.

Admissions and deaths in a pulmonary medicine ward in Abidjan, Cote d'Ivoire, West Africa, were evaluated over a 6-month period in 1989 with systematic autopsies on all patients who died. Of 473 patients admitted, 38% were HIV-1 seropositive, 4% were HIV-2 seropositive, and 14% reacted to both viruses. A total of 100 patients (21%) died, and deaths were twice as frequent in HIV-seropositive compared with HIV-negative patients. The pathology of 78 autopsies showed that the predominant cause of death in HIV-seropositive patients was disseminated tuberculosis (40%). Cancer was the cause of death in 64% of HIV-negative patients. Pneumocystosis was found in only 9% of HIV-seropositive autopsies. Since Pneumocystis carinii is an uncommon cause of death in this population, prophylaxis for P. carinii pneumonia is not warranted for HIV-infected patients in Africa. In contrast, research on chemoprophylaxis for tuberculosis is urgently required.     

三叶因子1在乙醇诱导的大鼠急性胃黏膜损伤中的表达

背景:三叶因子具有胃黏膜保护作用,但其在乙醇诱导的大鼠胃黏膜损伤中黏膜保护作用的研究较少.目的:观察短期灌注不同浓度乙醇大鼠胃黏膜三叶因子(TFF)1的表达情况,探讨TFF1与胃黏膜保护的相关性.方法:采用不同浓度乙醇直接灌胃制备急性胃黏膜损伤大鼠模型,以0.9%NaCl溶液灌胃作为对照,分别在肉眼和光学显微镜下观察胃黏膜形态学变化并评估黏膜损伤指数(LI),逆转录聚合酶链反应(RT-PCR)检测大鼠胃黏膜TEF1 mRNA的表达.结果:40%、70%、100%乙醇灌胃2 h后大鼠胃黏膜LI分别为38.38±6.37、70.00±8.02和118.75±14.82,显著高于对照组(P均＜0.01).在40%乙醇和70%乙醇组大鼠胃黏膜中TFF1/β-actin光密度比值分别为1.27±0.10和1.07±0.13,显著高于对照组的0.93±0.10(P均＜0.01),100%乙醇组TFF1/β-actin光密度比值为0.68±0.09,显著低于对照组(P＜0.01).结论:胃黏膜损伤程度与乙醇浓度呈正相关,乙醇浓度越高,胃黏膜损伤越严重;一定程度的胃黏膜损伤TFF1 mRNA表达升高,严重胃黏膜损伤TFF1 mRNA表达反而下降.一定程度的损伤刺激能使TFF1产生胃黏膜保护作用.     

Tuberculin skin testing to assess the occupational risk of Mycobacterium tuberculosis infection among health care workers in Abidjan, C?te d'Ivoire.

SETTING: Tuberculin skin test (TST) survey of health care workers (HCWs) in selected clinical services in Abidjan, C?te d'Ivoire. OBJECTIVE: To assess whether HCWs in Abidjan are at increased risk for occupationally acquired Mycobacterium tuberculosis infection. DESIGN: From October 1996 to January 1997, consenting HCWs from four services where tuberculosis (TB) prevalence among patients was high and two services where it was low were evaluated with a questionnaire, TST (including evaluation of anergy) and chest radiograph. RESULTS: Of the 512 participants, 405 (79%) had a TST reaction of > or =10 mm, eight (2%) were anergic, five (1%) had a radiograph compatible with TB, and two had confirmed TB. Using a cut-off of 10 mm, we found a higher prevalence of TST positivity in services with high TB prevalence than in those with low TB prevalence (92% vs 72%; odds ratio [OR] 4.3; 95% confidence interval [CI] 2.3-8.0]) and among HCWs with direct (87%; OR 2.9; 95%CI 1.6-5.1) and indirect patient contact (80%, OR 1.7; 95%CI 1.0-2.3) than among those with minimal patient contact (69%). CONCLUSION: These findings indicate that TST positivity among HCWs is related to level of exposure to TB patients, and suggest that HCWs in Abidjan are at risk for the nosocomial transmission of TB.     

Contraceptive use,protected sexual intercourse and incidence of pregnancies among African HIV-infected women. DITRAME ANRS 049 Project,Abidjan 1995-2000

The aim of this paper is to describe the adherence of African HIV+ women to the counselling provided after announcement of the result of the HIV test during pregnancy, focusing on early weaning to reduce post-natal transmission, protected sexual intercourse to avoid sexual transmission, and contraceptive use to avoid unexpected pregnancies. In 1999-2000, a questionnaire on sexual and reproductive behaviours was administered to 149 HIV+ women followed in post-partum, informed and counselled in the ANRS 049 DITRAME project in Abidjan. C?te d'Ivoire. Duration of breastfeeding, post-partum amenorrhea and abstinence, contraceptive use and condom use were measured. Incidence of pregnancies during the first 24 months post partum was estimated and modelled by a Cox regression model. Average duration of breastfeeding was 7.9 months, average duration of post partum abstinence was 12.0 months, and 39% of women used contraceptives at the time of the survey. Frequency of condom use was 13%. Incidence of pregnancies was 16.5 per 100 women-years at risk. Half of these pregnancies were not desired and a third were terminated by induced abortion. The significant determinants of the pregnancy occurrence were the death of the previous child, the cessation of breastfeeding, the cessation of the post partum abstinence, and higher education. In conclusion, if counselling on early weaning can be followed by the HIV+ women, it is not easily the case for condom and contraceptive use. Hence, pregnancy incidence in the post-partum follow-up was high. The main strategy of these HIV+ women to avoid unexpected pregnancies as well as sexual transmission of HIV seems to be an increase of the duration of post-partum abstinence. The most educated women who cannot easily adopt this strategy are particularly exposed to unwanted pregnancies.     

In vitro and in vivo antimalarial activity of derivatives of 1,10-phenanthroline framework

A series of trisubstituted 1,10-phenanthrolines was prepared. These compounds exhibited mild to high biological activities in vitro both toward chloroquino-resistant FcB1-Columbia and FcM29-Cameron strains and Nigerian chloroquino-sensitive strain of Plasmodium falciparum. Cytotoxicity of the most active compounds was estimated showing that one compound (10) exhibited a selective activity against malaria parasite (selectivity indexes of 52 and 144). Antiplasmodial activity of this derivative was optimized by N-10 alkylation and the phenanthrolinium salt (15) submitted to an in vivo study using mice infected by P. vinckei petteri showing an ED50 of 7.86 mg/kg/day.