Facteurs prédictifs de décès au cours de la TB pulmonaire chez les PvVIH au CNHU Fann de Dakar

Objectives: In sub-Saharan Africa, tuberculosis is the first pulmonary-located opportunistic infection and the leading cause of death among people living with HIV (PLWHA). This paper focuses on studying the predictive factors of death in people co-infected with pulmonary tuberculosis and HIV at the Ibrahima DIOP MAR clinic for infectious and tropical diseases at the CHNU Fann in Dakar. Materials and Methods: This was a retrospective, descriptive, and analytical study conducted from 1st January 1998 to 31st December 2009. It has been of interest to all patients with a successful pulmonary tuberculosis diagnosis and positive HIV status. Epidemiological, clinical, para-clinical, and progressive parameters were studied. Results: A total of 665 cases of tuberculosis/HIV co-infection were observed during the study period, of which 207 deaths or lethality (31.37%) was recorded. The average age of patients was 39±9 years with extremes of 5 and 74 years. The average length of hospitalization was 31.67 ± 20.67 with extremes of 4 and 312 days for surviving patients compared to 19.00 ± 16.42 with extremes of 1 to 90 days for deceased patients. Immunosuppression was significantly associated with death (p=0.001) with a median CD4 of 32.50 elts/mm3. Lethality was significantly elevated in the presence of dyspnea (p= 0, 00014), consciousness disorder (p=10-6 ), motor deficit (p= 0.008), and hemoptysis (p= 0.03). Conclusion: Tuberculosis/HIV co-infection is a common association in Africa. Here, we are talking about a deadly duo. Taking it requires a good knowledge of the factors of poor prognosis and a good integration of the two programs

Transmitted drug resistance, selection of resistance mutations and moderate antiretroviral efficacy in HIV-2: Analysis of the HIV-2 Belgium and Luxembourg database

BACKGROUND: Guidelines established for the treatment of HIV-1 infection and genotype interpretation do not apply for HIV-2. Data about antiretroviral (ARV) drug efficacy and resistance mutations is scarce. METHODS: Clinical data about HIV-2 infected patients in Belgium and Luxembourg were collected and the effect of ARV therapy on plasma viral load and CD4 counts were analysed. Viral RNA encoding for protease (PR) and reverse transcriptase (RT) from ARV-naive and treated patients were sequenced. RESULTS: Sixty-five HIV-2 infected patients were included in this cohort. Twenty patients were treated with 25 different ARV combinations in a total of 34 regimens and six months after the start of ARV therapy, only one third achieved viral load suppression. All of these successful regimens bar one contained protease inhibitors (PIs). Mean CD4 gains in the group of viral load suppressors and the group of patients treated with PI-containing regimens were respectively significantly higher than in the group of non-suppressors and the group of PI-sparing regimens. The most frequent mutations selected under therapy (compared to HIV-2 ROD) were V71I, L90M and I89V within PR. Within RT, they were M184V, Q151M, V111I and K65R. All of these mutations, except K65R and M184V, were also found in variable proportions in ARV-naive patients. CONCLUSION: Despite a high rate of ARV treatment failure, better virological and immunological results were achieved with PI-containing regimens. The analysis of polymorphic positions and HIV-2 specific mutations selected during therapy showed for the first time that transmission of drug resistant viruses has occurred in Belgium and Luxembourg. The high heterogeneity in ARV combinations reflects a lack of guidelines for the treatment of HIV-2 infection

Utilisation du procédé combiné déshydratation osmotique-friture pour la valorisation de la mangue

RÉSUMÉ. Des chips de mangues (Mangifera indica) ont été préparés en utilisant un procédé combiné déshydratation osmotique-friture. Les influences de la concentration en sucre et du temps d'immersion de la déshydratation osmotique ont été étudiés. Ensuite les facteurs affectant le comportement de l'échantillon pendant la friture ont été analysés : température du bain d'huile, teneur en huile et température à l'intérieur de l'échantillon, transformation structurale. Les investigations ont permis de déterminer les conditions opératoires donnant les meilleurs résultats pour la production de chips de mangue. La qualité du produit final montre que le procédé est bien adapté pour la valorisation de la mangue. ABSTRACT. Combined process osmotic dehydration–deep fat frying is used to produce mangoes (Mangifera indica) chips. First, the influences of sucrose concentration and soaking time of dewatering-impregnation soaking process (DISP) are studied. Secondly, the factors affecting the behaviour of the sample during deep fat frying are analysed: oil bath temperature, water loss, oil content, temperature inside slices and structural transformation. Investigations allow determining operating conditions giving the best results for chips production. The quality of final product shows that this process is really suitable for the valorisation of mangoes. MOTS-CLÉS : Manfifera indica, déshydratation osmotique, friture, transfert de matière, transfert de chaleur. KEYWORDS: Mangifera indica, osmotic dehydration, deep fat frying, mass transfer, heat transfer. Journal des Sciences Pour l'Ingenieur No.4 2004 : 43-4

Indications et résultats des thyroïdectomies réalisées au sein d’un service de chirurgie générale. A propos de 402 patients opérés.

La chirurgie reste une option importante dans le traitement de certaines affections thyroïdiennes. But. Cette étude a pour objectif d’étudier les indications et les résultats des thyroïdectomies réalisées au sein d’un Service de Chirurgie Générale. Patients et méthode. Nous avons réalisé une étude rétrospective descriptive de Janvier 2000 à Décembre 2009, concernant 402 dossiers de patients ayant subit une thyroïdectomie durant cette période. Il s’agissait de 15 hommes et 387 femmes, soit un sex ratio de 0,04 avec un âge moyen de 39,9 ans. Les éléments suivants ont été étudiés : le traitement chirurgical ; la morbidité et la mortalité. Résultats. L’exploration chirurgicale retrouvait un goitre multinodulaire dans 203 cas, soit 50,5%; un nodule thyroïdien isolé dans 121 cas, soit 30,1% et un goitre diffus homogène dans 78 cas, soit 19,4%. La lobo-isthmectomie a été réalisée dans 38,6% des cas, la thyroïdectomie subtotale dans 39,8% des cas et la thyroïdectomie totale dans 12,7% des cas. Le drainage de la loge thyroïdienne a été effectué chez 98,8 % des patients. La morbidité était de 6,5% avec une atteinte récurrentielle transitoire dans 2,7% des cas, un hématome dans 1% des cas et une hypoparathyroïdie dans 0,7% des cas, entre autres complications. La mortalité était de 0,5%. Conclusion. Nous privilégions les thyroïdectomiespartielles aussi bien pour le goitre nodulaire que pour la maladie de Basedow dans notre contexte socio-economique. Les résultats sont satisfaisants du fait d’une technique chirurgicale bien codifiée.Mots-clés : Thyroïdectomies ; Indications ; Résultat

How COVID-19 impacted risky sexual behaviours of female sex workers in Senegal and its wider implications: Evidence from a cohort study

Background: The COVID-19 pandemic has the potential to be the most severe and long-lasting economic shock experienced by female sex workers (FSWs) globally due to the high and close contact nature of the profession. Given that there is a positive income premium attached to unprotected sex, FSWs may resort to adopting risky sexual behaviours as a means to cope with the decreased earnings resulting from COVID-19. / Methods: We used data from a cohort study of around 600 Senegalese FSWs in Dakar, Senegal. During the COVID-19 pandemic in June-July 2020, we elicited respondents’ perceptions of how COVID-19 has affected them. We also compared FSWs’ income and sexual behaviours in 2020 with that of previous survey waves in 2015 and 2017. For continuous variables, the mean, median, interquartile range (IQR), 10th and 90th percentiles were reported. A t-test was also carried out to test the differences between the means in 2017 and 2020. For categorical variables, bar charts were shown. Condom use was elicited via the list experiment method to overcome social desirability bias. Heterogeneity analyses were carried out to identify the channels through which COVID-19 affected condom use. / Findings: COVID-19 led to a 70·0% reduction in the number of clients seen in a week from 2017 levels. The steep fall in the number of clients led to a reduction in sex work earnings by 50·3%. Estimated condom use prevalence with the last client was similar in 2015 and 2017, but decreased by 13·1%-pts during the COVID-19 pandemic (p=0·014), corresponding to a drop of 16·8% compared to 2017. Condom use decline was concentrated amongst asset-poor FSWs (22·7%-pts drop (p=0·004); 27·0% reduction in condom use from 2017 levels). However, self-reported STI symptoms did not increase. Furthermore, a substantial proportion of FSWs reported that they have reduced visits to health facilities because of COVID-19, but there was no evidence that this was associated with decreased condom use. Mental health of FSWs has deteriorated, while experience of violence from clients or the police has remained largely unchanged. / Interpretation: Condom use has likely to have fallen to alleviate the economic shock brought about by COVID-19. While the plunge in the number of clients may have offset the transmission of HIV and other STIs for now, it remains to be seen whether condom use would resume once business improves, especially if the crisis were to be prolonged. Given the potential public health issue this may create, policies targeting FSWs to dampen the adverse economic impact of the COVID-19 crisis should urgently be considered as a strategy to prevent the transmission of HIV and other STIs

Phylodynamic analysis of HIV-1 subtypes B, C and CRF 02_AG in Senegal

Surveillance of HIV epidemics in key populations and in developing countries is often challenging due to sparse, incomplete, or low-quality data. Analysis of HIV sequence data can provide an alternative source of information about epidemic history, population structure, and transmission patterns. To understand HIV-1 dynamics and transmission patterns in Senegal, we carried out model-based phylodynamic analyses using the structured-coalescent approach using HIV-1 sequence data from three different subgroups: reproductive aged males and females from the adult Senegalese population and men who have sex with other men (MSM). We fitted these phylodynamic analyses to time-scaled phylogenetic trees individually for subtypes C and CRF 02_AG, and for the combined data for subtypes B, C and CRF 02_AG. In general, the combined analysis showed a decreasing proportion of effective number of infections among all reproductive aged adults relative to MSM. However, we observed a nearly time-invariant distribution for subtype CRF 02_AG and an increasing trend for subtype C on the proportion of effective number of infections. The population attributable fraction also differed between analyses: subtype CRF 02_AG showed little contribution from MSM, while for subtype C and combined analyses this contribution was much higher. Despite observed differences, results suggested that the combination of high assortativity among MSM and the unmet HIV prevention and treatment needs represent a significant component of the HIV epidemic in Senegal

Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d'Ivoire, Mali and Senegal.

BACKGROUND: The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d'Ivoire, Mali, and Senegal. During 2019-2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d'Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). METHODS: ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users. Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing. Coupons survey WP: an anonymous telephone survey of HIVST users. Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST. Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. DISCUSSION: ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO's Ethical Research Committee