The 6th international conference on envenomation by snakebites and scorpion stings in Africa : a crucial step for the management of envenomation

During the 6th International Conference on Envenomation by Snakebites and Scorpion Stings in Africa held in Abidjan, from 1 to 5 June 2015, the measures for the management of envenomation were discussed and new recommendations were adopted by the participants. The high incidence and severity of this affliction were confirmed by several studies conducted in African countries. The poor availability of antivenom, particularly because of the cost, was also highlighted. Some experiences have been reported, mainly those regarding the financial support of antivenom in Burkina Faso (more than 90 %) and Togo (up to 60 %) or the mandatory reporting of cases in Cameroon. Key recommendations concerned: improvement of epidemiological information based on case collection; training of health workers in the management of envenomation; policy to promote the use of effective and safe antivenom; and antivenom funding by sharing its costs with stakeholders in order to improve antivenom accessibility for low-income patients

COMPLICATIONS RETINIENNES DES ANTIPALUDEENS DE SYNTHESE. A PROPOS DE 2 CAS

Treatment with the antimalarials chloroquine or hydroxychloroquine is frequently used in dermatology and rheumatology. However irreversible retinal damage can occurs, that’s why intensive monitoring is still required. We report 2 cases of females patients aged of 33 and 42 years old, treated by antimalarials for polyarthritis and sclerodermia. After 4 years of treatment without ophthalmologic examination, they complain of decreased vision. The fundoscopic exam found a bilateral bull's eye appearence confirmed by fluorescein angiography. Even after cessation of treatment the visual acuity didn’t increase.Ocular toxicity of antimalarials treatment is rare but it can occurs. The retinopathy is the major concern. We found three stages: asymptomatic, obvious maculopathy and advanced retinopathy. Appropriate examinations (color vision, automatic visual field and electroretinogram) should be performed regularly. The frequency of screening should be based on patients’ classification.Les antipaludéens de synthèse sont largement utilisés en rhumatologie et en dermatologie pour leur action anti-inflammatoire. Ils exposent toute fois à des complications rétiniennes irréversibles d’où la nécessité d’une surveillance ophtalmologique régulière. Nous rapportons l’observation de deux patientes âgées de 33 et 42 ans, mises sous antipaludéens de synthèse respectivement pour une polyarthrite rhumatoïde et une sclérodermie. Elles ont poursuivies leur traitement pendant 3 à 4 ans sans surveillance ophtalmologique avant de consulter pour une baisse importante de l’acuité visuelle. L’examen ophtalmologique a retrouvé une acuité visuelle inférieure à 2/10ème dans le premier cas et une acuité visuelle inférieure à 6/10ème dans le deuxième cas ; avec au fond d’oeil un aspect de maculopathie bilatérale en oeil de boeuf typique confirmée par l’angiographie rétinienne à la fluoresceine. Malgré l’arrêt des antipaludéens de synthèse, l’acuité visuelle est restée stationnaire dans les deux cas. L’intoxication clinique aux antipaludéens de synthèse est rare mais possible. Elle prédomine dans la région maculaire et évolue en 3 stades: asymptomatique, maculopathie confirmée et stade de rétinopathie évoluée. Un bilan ophtalmologique initial doit être fait systématiquement, avant le début du traitement avec réalisation d’examens paracliniques (vision des couleurs, champs visuel automatisé, électrorétinographie maculaire). Au terme des ces examens les patients seront classés en trois groupes permettant ainsi de déterminer leur rythme de surveillance

LES UVEITES DE L’ENFANT : A PROPOS DE 30 CAS

Uveitis is less frequent in children. The purpose of our study is to evaluate epidemiologic aspect, etiological profile and prognosis of children uveitis.We report 30 cases of uveitis in patients aged less than 16 years old followed in our department.Patients mean age is 9 years old (5 to 16 years) .We observed anterior uveitis in 46,7%, posterior uveitis in 26,7%, intermediate uveitis in 13,3% and panuveitis in 13,3%.Chronic juvenile arthritis is the main etiology followed by Behcet disease.Uveitis in children is rare but severe and can involve visual prognosis; it needs urgent diagnosis and adapted treatment. Principals etiologies are; idiopathic juvenile arthritis and spondiloarthropaties. Functional prognosis is variable and final visual acuity is less than 20/200 in 16 to 36% of cases.L’uvéite de l’enfant est rare. Le but de notre travail est d’évaluer le profil épidémiologique, étiologique et pronostic des uvéites de l’enfant.Nous rapportons 30 cas d’uvéites chez des patients d’âge inférieur à 16 ans et suivis dans notre unité.La moyenne d’âge des patients est de 9 ans (5 à 16 ans). Il s’agissait d’une uvéite antérieure dans 46,7% des cas, d’une uvéite postérieure dans 26,7%, d’une uvéite intermédiaire dans 13,3% et d’une panuvéite dans 13,3%. Les principales causes retrouvées sont l’arthrite juvénile idiopathique suivie par la maladie de Behçet.L’uvéite de l’enfant est rare souvent grave engageant le pronostic visuel et imposant un diagnostic précoce et un traitement adapté. Les principales étiologies sont l’arthrite juvénile idiopathique et les spondyloarthropathies. Le pronostic visuel est variable et l’acuité visuelle est inférieure à 20/200 dans 16 à 36% des cas

SYNDROME DE LA FENTE MEDIANE A PROPOS D’UN CAS

The median cleft syndrome is a complex facial dysmorphism. it may be associated with other malformations incompatible to life. Prenatal diagnosis is of major interest to prepare parents and to accept the child's disability. Through an observation collected in pediatric ophthalmology department, we present the characteristics of this disease. This is an infant of 5 months, the sole of his family,from a non-consanguineous marriage and consults for a facial dysmorphism. The ophthalmology test note a cyst dermoid bilateral interest blade, the conjunctiva, 2 / 3 of the cornea uncomfortable viewing eyes. The CT cranio-orbital showed a hypoplastic orbits with cerebral atrophy. The heart-ultrasound showed a perished ventricular , restrictive intercomminication. The caryotype study was normal. The ophthalmological treatement consisted to a surgical cure of both dermoid cysts. We discuss the clinical et paraclinical, etiopathogenic aspects of the slots medians and we stress the importance of antenatal diagnosis of this condition.Le syndrome de la fente médiane est une dysmorphie faciale complexe pouvant rentrer dans un cadre polymalformatif incompatible avec la vie. Le diagnostic anténatal revêt un intérêt majeur pour préparer les parents et l’entourage à l’accueil de l’enfant et son handicap. À travers une observation colligée au service d’ophtalmologie pédiatrique, nous présentons les caractéristiques de cette affection. Il s’agit d’un nourrisson de 5 mois unique de sa famille, issu d’un mariage non consanguin et consultant pour une dysmorphie faciale. L’examen ophtalmologique a noté un kyste dermoïde bilatérale intéressant le limbe, la conjonctive, les 2/3 de la cornée gênant la visualisation des yeux. Le bilan malformatif a montré à la TDM cranio-orbitaire une hypoplasie des orbites avec atrophie cérébrale. L’écho-coeur a montré une communication inter ventriculaire péri membraneuse restrictive. L’étude du caryotype était normale. La prise en charge ophtalmologique a consisté en une cure chirurgicale des deux kystes dermoïdes. Nous discutons les aspects cliniques, para cliniques, étiopathogéniques des fentes médianes et nous insistons sur l’importance du diagnostic anténatale de cette affection

Development of a short form of Mini-Mental State Examination for the screening of dementia in older adults with a memory complaint: a case control study

<p>Abstract</p> <p>Background</p> <p>Primary care physicians need a brief and accurate screening test of dementia. The objective of this study was to determine whether a short form of Mini-Mental State Examination (SMMSE) was as accurate as the Mini-Mental State Examination (MMSE) in screening dementia.</p> <p>Methods</p> <p>Based on case control design study, SMMSE and MMSE were assessed in 184 community-dwelling older adults (mean age 81.3 ± 6.5 years, 71.7% women) with memory complaint sent by their primary care physician to a memory clinic. Included participants were separated into two groups: cognitively healthy individuals and demented individuals.</p> <p>Results</p> <p>The trade-off between sensitivity and specificity of the SMMSE for clinically diagnosed dementia was 4. Based on the cut-off value ≤ 4 for SMMSE and a cut-off value ≤ 24 for MMSE, the sensitivity of both tests was similar (89.5% for SMMSE versus 90.0% for MMSE), whereas the specificity, the positive predictive values (PPV) and the negative predictive values (NPV) were higher for SMMSE compared to MMSE (85.4 versus 75.5% for specificity; 95.5% versus 92.8% for PPV; 70.0 versus 68.9 for NPV). The positive and negative Likehood Ratio (LR) of SMMSE were higher than those of MMSE (respectively, 6.1 versus 3.7; 8.1 versus 7.7). In addition, odds ratio (OR) for dementia was higher for the SMMSE compared to the MMSE (OR = 49.8 with 95% confident interval (CI) [18.0; 137.8] versus OR = 28.6 with 95% CI [11.6; 70.3]).</p> <p>Conclusions</p> <p>SMMSE seems to be an efficient short screening test for dementia among community-dwelling older adults with a memory complaint. Further research is needed to confirm its predictive values among unselected primary care older patients.</p

Serum 25-Hydroxyvitamin D Concentrations and Season-Specific Correlates in Japanese Adults

Background: Several lines of evidence indicate an important role for vitamin D in the prevention of a range of diseases. Blood vitamin D levels show clear seasonal variation; however, data on the determinants of vitamin D status for each season are limited. We investigated the association between lifestyle and serum vitamin D concentration by season in Japanese workers. Methods: Subjects were 312 men and 217 women aged 21 to 67 years who worked in municipal offices in Northern Kyushu, Japan and participated in a periodic checkup in July or November. Multiple linear regression analysis was used to examine the association between serum 25-hydroxivitamin D concentrations and lifestyle factors for each season. Results: Mean serum 25-hydroxyvitamin D concentration was 27.4 ng/ml (68.4 nmol/L) and 21.4 ng/ml (53.4 nmol/L) for workers surveyed in July and November, respectively (P \u3c 0.001); the prevalence of vitamin D deficiency ( both sexes) and nonsmoking and physical activity (in men) were significantly associated with higher concentrations of serum 25-hydroxyvitamin D. In summer, fish/shellfish intake was associated with higher serum 25- hydroxyvitamin D concentrations in women. Conclusions: Vitamin D deficiency is common in Japanese workers during seasons with limited sunlight. The lifestyle correlates of favorable vitamin D status in November were physical activity, dietary vitamin D intake, and nonsmoking

Mutation Analysis of NR5A1 Encoding Steroidogenic Factor 1 in 77 Patients with 46, XY Disorders of Sex Development (DSD) Including Hypospadias

BACKGROUND: Mutations of the NR5A1 gene encoding steroidogenic factor-1 have been reported in association with a wide spectrum of 46,XY DSD (Disorder of Sex Development) phenotypes including severe forms of hypospadias. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the frequency of NR5A1 gene mutations in a large series of patients presenting with 46,XY DSD and hypospadias. Based on their clinical presentation 77 patients were classified either as complete or partial gonadal dysgenesis (uterus seen at genitography and/or surgery, n = 11), ambiguous external genitalia without uterus (n = 33) or hypospadias (n = 33). We identified heterozygous NR5A1 mutations in 4 cases of ambiguous external genitalia without uterus (12.1%; p.Trp279Arg, pArg39Pro, c.390delG, c140_141insCACG) and a de novo missense mutation in one case with distal hypospadias (3%; p.Arg313Cys). Mutant proteins showed reduced transactivation activity and mutants p.Arg39Pro and p.Arg313Cys did not synergize with the GATA4 cofactor to stimulate reporter gene activity, although they retained their ability to physically interact with the GATA4 protein. CONCLUSIONS/SIGNIFICANCE: Mutations in NR5A1 were observed in 5/77 (6.5%) cases of 46,XY DSD including hypospadias. Excluding the cases of 46,XY gonadal dysgenesis the incidence of NR5A1 mutations was 5/66 (7.6%). An individual with isolated distal hypopadias carried a de novo heterozygous missense mutation, thus extending the range of phenotypes associated with NR5A1 mutations and suggesting that this group of patients should be screened for NR5A1 mutations

Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview

Public Health and primary carePrevention and community carePrevention, Population and Disease management (PrePoD