Cancer de la prostate localisé à haut risque de récidive:résultats de la prise charge

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Maladie de Lapeyronie: Aspects cliniques et thérapeutiques à propos de 17 cas

Buts: rapporter les aspects cliniques et thérapeutiques de la maladie de Lapeyronie (MLP).Matériel et méthodes: étude descriptive monocentrique recrutant 17 cas de MLP dans un service d’urologie au Sénégal entre janvier et décembre 2012. L’âge des patients, les motifs de consultation, le délai de consultation, l’examen des plaques de fibrose, le degré de courbure, le traitement et ses résultats ont été analysés.Résultats: l’âge moyen était de 58,2 ans (33 et 80 ans). La courbure était la plainte la plus observée (13 patients/17) et isolée chez 4 patients. La douleur pénienne était observée chez 4 patients et la dysérection chez 7 patients. Le délai de consultation moyen était de 21,2 mois (1 et 72 mois). Le grand axe moyen des plaques de fibrose était 2,8 cm (0,5 et 7,5 cm). Le degré de courbure de la verge moyen était de 31,6 (0 et 95). Neuf patients ont rec¸u un traitement à base de vitamine E et des infiltrations de corticoïdes dans la plaque. Il a été efficace chez 3 patients vus à la phase inflammatoire. Un redressement satisfaisant de verge par plicature de l’albuginée des corps caverneux selon Nesbit a été réalisée chez 5 malades en phase de séquelle. Trois patients n’ont pas pu être opérés.Conclusion: la MLP a une faible prévalence et la plupart des patients consultent en phase de séquelle. Le traitement médical a été efficace à la phase inflammatoire et la chirurgie a permis de régler la courbureMots Clés: maladie de Lapeyronie; douleur; courbure; dysfonction érectile; Sénéga

Impacts of 1.5 versus 2.0 °c on cereal yields in the West African Sudan Savanna

To reduce the risks of climate change, governments agreed in the Paris Agreement to limit global temperature rise to less than 2.0 °C above pre-industrial levels, with the ambition to keep warming to 1.5 °C. Charting appropriate mitigation responses requires information on the costs of mitigating versus associated damages for the two levels of warming. In this assessment, a critical consideration is the impact on crop yields and yield variability in regions currently challenged by food insecurity. The current study assessed impacts of 1.5 °C versus 2.0 °C on yields of maize, pearl millet and sorghum in the West African Sudan Savanna using two crop models that were calibrated with common varieties from experiments in the region with management reflecting a range of typical sowing windows. As sustainable intensification is promoted in the region for improving food security, simulations were conducted for both current fertilizer use and for an intensification case (fertility not limiting). With current fertilizer use, results indicated 2% units higher losses for maize and sorghum with 2.0 °C compared to 1.5 °C warming, with no change in millet yields for either scenario. In the intensification case, yield losses due to climate change were larger than with current fertilizer levels. However, despite the larger losses, yields were always two to three times higher with intensification, irrespective of the warming scenario. Though yield variability increased with intensification, there was no interaction with warming scenario. Risk and market analysis are needed to extend these results to understand implications for food security

Efficacy and tolerability of four antimalarial combinations in the treatment of uncomplicated Plasmodium falciparum malaria in Senegal

<p>Abstract</p> <p>Background</p> <p>In view of the high level of chloroquine resistance in many countries, WHO has recommended the use of combination therapy with artemisinin derivatives in the treatment of uncomplicated malaria due to <it>Plasmodium falciparum</it>. Four antimalarial drug combinations, artesunate plus amodiaquine (Arsucam^®), artesunate plus mefloquine (Artequin^®), artemether plus lumefantrine (Coartem^®; four doses and six doses), and amodiaquine plus sulphadoxine-pyrimethamine, were studied in five health districts in Senegal.</p> <p>Methods</p> <p>This is a descriptive, analytical, open, randomized study to evaluate the efficacy and tolerability of these four antimalarial combinations in the treatment of uncomplicated falciparum malaria using the 2002 WHO protocol.</p> <p>Results</p> <p>All drug combinations demonstrated good efficacy. On day 28, all combinations resulted in an excellent clinical and parasitological response rate of 100% after correction for PCR results, except for the four-dose artemether-lumefantrine regimen (96.4%). Follow-up of approximately 10% of each treatment group on day 42 demonstrated an efficacy of 100%.</p> <p>The combinations were well tolerated clinically and biologically. No unexpected side-effect was observed and all side-effects disappeared at the end of treatment. No serious side-effect requiring premature termination of treatment was observed.</p> <p>Conclusion</p> <p>The four combinations are effective and well-tolerated.</p

Epigenetic studies in children at risk of stunting and their parents in India, Indonesia and Senegal : A UKRI GCRF Action Against Stunting Hub protocol paper

ASR provided research and organisational support within the Action Against Stunting Hub (AASH) epigenetics theme and drafted and revised the manuscript. MN led the AASH epigenetic theme in Senegal and oversees the implementation of the epigenetic protocol and contributed to the development of the protocol and critically revised the manuscript. RRK led the AASH epigenetic theme in India and oversaw the implementation of the epigenetic protocol, contributed to the development of the protocol and critically revised the manuscript. MKH led the AASH epigenetic theme in Indonesia and oversaw the implementation of the epigenetic protocol, contributed to the development of the protocol and critically revised the manuscript. DYD was responsible for monitoring evaluation and learning on the hub, critically reviewed the protocol and revised the manuscript. LFA managed the implementation of the study in India, critically reviewed the protocol and revised the manuscript. NLZ managed the implementation of the study in Indonesia, critically reviewed the protocol and revised the manuscript. AD managed the implementation of the study in Senegal, critically reviewed the protocol and revised the manuscript. DY, TCA and MN are epigenetic researchers in Indonesia, critically reviewed the protocol and reviewed the manuscript. MG, DS, SSV and MM are epigenetic researchers in India, critically reviewed the protocol and reviewed the manuscript. GWH advised on the statistical aspects of the protocol and the power calculation and reviewed the manuscript. UF is the AASH project lead in Indonesia, contributed to study design and coordination of the study and thematic linkages; supervised drafting of the manuscript. BF is the AASH project lead in Senegal, contributed to study design and coordination of the study and thematic linkages and supervised drafting of the manuscript. BK is the AASH project lead in India, contributed to study design and coordination of the study and thematic linkages and supervised drafting of the manuscript. PH is the AASH project deputy lead and epigenetic theme lead who designed the study, drafted and revised the manuscript, carried out the statistical calculations.Peer reviewe

Modulating the early-life gut microbiota using pro-, pre-, and synbiotics to improve gut health, child development, and growth

In children exposed to poor hygiene and sanitation, invasion of the gut by pathogenic microbes can result in a subclinical enteropathy termed “environmental enteric dysfunction” (EED) that contributes to undernutrition, growth faltering, and impaired organ development. EED may already be present by age 6–12 weeks; therefore, interventions that can be started early in life, and used alongside breastfeeding, are needed to prevent or ameliorate EED. A healthy gut microbiota is critical for intestinal development and repair, nutrient digestion and absorption, and resisting colonization or overgrowth by pathogens. However, its development can be impaired by several environmental factors. Dietary supplementation with pro-, pre-, or synbiotics may be a pragmatic and safe means of building the resilience of the developing gut microbiota against adverse environmental factors, thereby preventing EED

Safety and Immunogenicity of Malaria Vectored Vaccines Given with Routine Expanded Program on Immunization Vaccines in Gambian Infants and Neonates: A Randomized Controlled Trial.

BACKGROUND: Heterologous prime-boost vaccination with chimpanzee adenovirus 63 (ChAd63) and modified vaccinia virus Ankara (MVA) encoding multiple epitope string thrombospondin-related adhesion protein (ME-TRAP) has shown acceptable safety and promising immunogenicity in African adult and pediatric populations. If licensed, this vaccine could be given to infants receiving routine childhood immunizations. We therefore evaluated responses to ChAd63 MVA ME-TRAP when co-administered with routine Expanded Program on Immunization (EPI) vaccines. METHODS: We enrolled 65 Gambian infants and neonates, aged 16, 8, or 1 week at first vaccination and randomized them to receive either ME-TRAP and EPI vaccines or EPI vaccines only. Safety was assessed by the description of vaccine-related adverse events (AEs). Immunogenicity was evaluated using IFNγ enzyme-linked immunospot, whole-blood flow cytometry, and anti-TRAP IgG ELISA. Serology was performed to confirm all infants achieved protective titers to EPI vaccines. RESULTS: The vaccines were well tolerated in all age groups with no vaccine-related serious AEs. High-level TRAP-specific IgG and T cell responses were generated after boosting with MVA. CD8+ T cell responses, previously found to correlate with protection, were induced in all groups. Antibody responses to EPI vaccines were not altered significantly. CONCLUSION: Malaria vectored prime-boost vaccines co-administered with routine childhood immunizations were well tolerated. Potent humoral and cellular immunity induced by ChAd63 MVA ME-TRAP did not reduce the immunogenicity of co-administered EPI vaccines, supporting further evaluation of this regimen in infant populations. CLINICAL TRIAL REGISTRATION: The clinical trial was registered on http://Clinicaltrials.gov (NCT02083887) and the Pan-African Clinical Trials Registry (PACTR201402000749217)

Comparative study of the efficacy and tolerability of dihydroartemisinin - piperaquine - trimethoprim versus artemether - lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroon, Ivory Coast and Senegal

<p>Abstract</p> <p>Background</p> <p>The ACT recommended by WHO is very effective and well-tolerated. However, these combinations need to be administered for three days, which may limit adherence to treatment.</p> <p>The combination of dihydroartemisinin - piperaquine phosphate - trimethoprim (Artecom^®, Odypharm Ltd), which involves treatment over two days, appears to be a good alternative, particularly in malaria-endemic areas. This study intends to compare the efficacy and tolerability of the combination dihydroartemisinin - piperaquine phosphate - trimethoprim (DPT) versus artemether - lumefantrine (AL) in the treatment of uncomplicated <it>Plasmodium falciparum </it>malaria in Cameroon, Ivory Coast and Senegal.</p> <p>Methods</p> <p>This was a randomized, controlled, open-label clinical trial with a 28-day follow-up period comparing DPT to AL as the reference drug. The study involved patients of at least two years of age, suffering from acute, uncomplicated <it>Plasmodium falciparum </it>malaria with fever. The WHO 2003 protocol was used.</p> <p>Results</p> <p>A total of 418 patients were included in the study and divided into two treatment groups: 212 in the DPT group and 206 in the AL group. The data analysis involved the 403 subjects who correctly followed the protocol (<it>per protocol </it>analysis), i.e. 206 (51.1%) in the DPT group and 197 (48.9%) in the AL group. The recovery rate at D14 was 100% in both treatment groups. The recovery rate at D28 was 99% in the DPT and AL groups before and after PCR results with one-sided 97.5% Confidence Interval of the rates difference > -1.90%. More than 96% of patients who received DPT were apyrexial 48 hours after treatment compared to 83.5% in the AL group (p < 0.001). More than 95% of the people in the DPT group had a parasite clearance time of 48 hours or less compared to approximately 90% in the AL group (p = 0.023). Both drugs were well tolerated. No serious adverse events were reported during the follow-up period. All of the adverse events observed were minor and did not result in the treatment being stopped in either treatment group. The main minor adverse events reported were vomiting, abdominal pain and pruritus.</p> <p>Conclusion</p> <p>The overall efficacy and tolerability of DPT are similar to those of AL. The ease of taking DPT and its short treatment course (two days) may help to improve adherence to treatment. Taken together, these findings make this medicinal product a treatment of choice for the effective management of malaria in Africa.</p