Diagnostic Étiologique Échographique des Douleurs Pelviennes Aigues de la Femme en Côte d’Ivoire

Introduction : les douleurs pelviennes aigues chez la femme sont fréquentes et objet d’exploration échographique systématique dans notre pratique quotidienne. Objectif : contribuer à la recherche étiologique des douleurs pelviennes aigues (DPA) de la femme dans une zone où l’outil échographique est pratiquement le seul moyen d’imagerie accessible. Patiente et méthodes : étude prospective d’une durée de 6 mois réalisée au centre hospitalo-universitaire de Yopougon (Abidjan-Côte d’Ivoire). Une série continue de 153 femmes chez qui nous avons réalisé une échographie pelvienne au motif de DPA ont été enrôlées. Les examens échographiques ont été réalisées à l’aide de 3 sondes (convexe, linéaire et endocavitaire) en mode B et Doppler. Résultats : l’âge moyen des patientes était de 30, 2 ans avec des extrêmes de 12 et 68 ans. Les échographies étaient normales dans 25,5% et objectivaient une pathologie dans 74,5 % des cas. Ces pathologies concernaient les organes génitaux internes dans 89,5% des cas et dans 10,5% des cas il s’agissait de pathologie extra-génitale. Les ovaires étaient les organes génitaux les plus concernés (64,1%) suivis de l’utérus (28,2%) et des trompes (7,7%). Les causes extra-génitales étaient la hernie inguinale (4 cas), l’appendicite aigüe (5 cas), la sigmoïdite (1 cas) et la lithiase du bas uretère (2 cas). Conclusion : une proportion non négligeable de causes extra-génitales des douleurs pelviennes, objectivée dans notre étude, impose un examen clinique minutieux de toute la sphère hypogastrique voire abdominale par les cliniciens. L’utilisation de la sonde linéaire de haute fréquence qui n’est pas toujours sollicitée par les échographistes, au cours de la prise en charge des DPA devrait être préconisée. Introduction: Acute pelvic pain in women is common and systematically explored by ultrasound in our daily practice. Objective: Contribute to the aetiological research of women's acute pelvic pain (APD) in an area where the ultrasound tool is practically the only means of accessible imagery. Patient and methods: A prospective study lasting 6 months was carrried out at the Yopougon University Hospital Center (Abidjan-Ivory Coast). A continuous series of 153 women who had a pelvic ultrasound for DPA were enrolled. Ultrasound examinations were performed using 3 probes (convex, linear and endocavitary) in B and Doppler mode. Results: The mean age of the patients was 30, 2 years with extremes of 12 and 68 years. About a quarter (25.5%) of the ultrasound examinations were normal and in 74.5% of cases, a pathology was objectified. These pathologies concerned the internal genital organs in 89.5% of the cases and in 10.5% of cases they were extragenital pathologies. The ovaries were the most affected genitals (64.1%)followed by the uterus (28.2%) and the fallopian tubes (7.7%). Extra-genital causes were inguinal hernia (4 cases), acute appendicitis (5 cases), sigmoiditis (1 case) and lithiasis of the lower ureter (2 cases). Conclusion: a significant proportion of extragenital causes of pelvic pain, objectified in our study, requires a careful clinical examination of the whole hypogastric or even all abdominal regions by clinicians and the use of the high frequency linear probe which is not not always solicited by sonographers, during the care of the DPA

Retroviral matrix and lipids, the intimate interaction

Retroviruses are enveloped viruses that assemble on the inner leaflet of cellular membranes. Improving biophysical techniques has recently unveiled many molecular aspects of the interaction between the retroviral structural protein Gag and the cellular membrane lipids. This interaction is driven by the N-terminal matrix domain of the protein, which probably undergoes important structural modifications during this process, and could induce membrane lipid distribution changes as well. This review aims at describing the molecular events occurring during MA-membrane interaction, and pointing out their consequences in terms of viral assembly. The striking conservation of the matrix membrane binding mode among retroviruses indicates that this particular step is most probably a relevant target for antiviral research

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Cutaneous leishmaniasis in a severely immunocompromised HIV patient in Kumbo, Northwest region of Cameroon: Case report

Background: Leishmaniasis is a rising opportunistic infection in individuals with human immunodeficiency virus (HIV). Cases of leishmania and HIV co-infection have been documented in several countries in the world with most reporting on the association between visceral leishmaniasis (VL) and HIV. We herein report the case of cutaneous leishmaniasis (CL) occurring in an HIV seropositive patient. Case presentation: A 28 year old Cameroonian female diagnosed with HIV for 6 months earlier, presented to our facility with a 3 months history of non-painful rash. Clinical examination revealed non prurigeneous papulo-nodular lesions on the face and thighs which later became crusty ulcerative lesions. Giemsa staining with examination under oil objective immersion identified amastigotes and a diagnosis of CL was made which was managed with amphotericine B (1 mg/kg of body weight) for 14 days with mild improvement of lesions. Patient developed hypokalemia due to the amphotericine B during admission which was corrected and died 1 month after discharge. Conclusions: Current evidence suggest higher incidence of VL in HIV, however we report the occurrence of CL in HIV. A high index of suspicion for CL is warranted among clinicians in Africa when faced with HIV patients with inconsistent cutaneous rash.Full Tex