Cryptococcose neuroméningée et tuberculose osseuse chez un immunocompétent: un cas

Les auteurs rapportent un cas de cryptococcose neuroméningée (CNM) chez un patient de 39 ans, non infecté par le VIH suivi pour une tuberculose de hanche. Le tableau clinique était celui d'une méningite subaiguë. Le  diagnostic a été possible grâce à la mise en évidence de cryptocoques dans le LCR. L'évolution a été satisfaisante sous fluconazole

Serological Evaluation of Onchocerciasis and Lymphatic Filariasis Elimination in the Bakoye and Falémé foci, Mali

In Mali, ivermectin-based onchocerciasis elimination from the Bakoye and Falémé foci, reported in 2009–2012, was a beacon leading to policy shifting from morbidity control to elimination of transmission (EOT). These foci are also endemic for lymphatic filariasis (LF). In 2007–2016 mass ivermectin plus albendazole administration was implemented. We report Ov16 (onchocerciasis) and Wb123 (LF) seroprevalence after 24–25 years of treatment to evaluate if onchocerciasis EOT and LF elimination as a public health problem (EPHP) have been achieved

A double-masked placebo-controlled trial of azithromycin to prevent child mortality in Burkina Faso, West Africa: Community Health with Azithromycin Trial (CHAT) study protocol.

BACKGROUND:Biannual, mass azithromycin distribution has previously been shown to reduce all-cause child mortality in sub-Saharan Africa. Subgroup analysis suggested that the strongest effects were in the youngest children, leading to the hypothesis that targeting younger age groups might be an effective strategy to prevent mortality. We present the methods of two randomized controlled trials designed to evaluate mass and targeted azithromycin distribution for the prevention of child mortality in Burkina Faso, West Africa. METHODS/DESIGN:The Child Health with Azithromycin Treatment (CHAT) study consists of two nested, randomized controlled trials. In the first, communities are randomized in a 1:1 fashion to biannual, mass azithromycin distribution or placebo. The primary outcome is under-5 all-cause mortality measured at the community level. In the second, children attending primary healthcare facilities during the first 5-12 weeks of life for a healthy child visit (e.g., for vaccination) are randomized in a 1:1 fashion to a single orally administered dose of azithromycin or placebo. The primary outcome is all-cause mortality measured at 6 months of age. The trial commenced enrollment in August 2019. DISCUSSION:This study is expected to provide evidence on two health systems delivery approaches (mass and targeted treatment) for azithromycin to prevent all-cause child mortality. The results will inform global and national policies related to azithromycin for the prevention of child mortality. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT03676764. Registered on 19 September 2018; prospectively registered pre results

Integration agriculture elevage dans les exploitations agropastorales au Nord de la Cote d’Ivoire

Dans la région de Korhogo au nord de la Côte d’Ivoire, les systèmes agropastoraux et l’intégration agriculture-élevage sont de plus en plus privilégiés par les paysans afin de faire face à la croissance démographique, à la cherté des intrants chimiques, aux problèmes fonciers, etc.). Cette étude vise à analyser la diversité des exploitations agropastorales (EAP) selon les zones agro-écologiques, avec un focus sur l‘intégration agriculture-élevage au sein de l’unité de production. La méthodologie s’appuie sur la méthode active de recherche participative (MARP), des interviews et des enquêtes approfondies sur un échantillon de 82 EAP dans deux villages. Le zonage agro-écologique a été actualisé à dire d’acteurs du fait de la croissance démographique, et la diversification des activités. Cinq types (structurels et fonctionnels) d’EAP ont été définis. Les grandes et très grandes EAP (1/4 des EAP) intensifient sur coton et maïs (quantité élevée de fumure organique (FO) sur le coton et quantité élevée de NPK sur le maïs) ; elles sont plus représentées en zone moins dense (Tiébila). Les moyennes EAP mixtes agriculture-élevage (20 % des EAP) et les petites et moyennes EAP d’agriculteurs (55 % des EAP), plus représentées en zone dense (Moroviné), combinent des fertilisants organiques et minéraux sur coton et céréales. Cette étude conclue sur la nécessité de prendre en compte la saturation croissante de l’espace, les changements de pratiques agropastorales et la diversité des EAP pour mieux cibler et rendre plus pertinentes et efficaces les actions d’accompagnement des EAP. Un accent particulier doit être mis sur la gestion de la fertilité des sols et l’amélioration de la productivité des EAP dans une optique de conservation des ressources naturelles.Mots clés: Analyse, diversité, système agropastoral, Korhogo, Côte d’Ivoire, Intégration AgricultureélevageEnglish Title: Crop-livestock integration in the north of Ivory CostEnglish AbstractIn the area of Korhogo in the north of Ivory Coast, the agropastoral systems and the integration of crop and livestock are more and more privileged by the farmers to face population growth, high input cost, land problem, etc. This study aims at analyzing the diversity of agropastoral exploitations (EAP) according to agro-ecological zones, with an emphasis on the relations between crop and livestock. Methodology is based on the active participative research method (MARP), interviews and comprehensive investigations on a sample of 82 EAP in two villages. Agro-ecological zoning has been updated with the sayings of agropastoral actors according to population growth, and diversification of  activities. Five types (structural and functional) of EAP have been defined. Large and very large EAP (1/4 of the EAP) specialize on cotton and maize (more organic manure on the cotton and more mineral one on the maize); they are more represented in less dense zone (Tiébila). Average mixed crop and livestock EAP (20 % of the EAP) and the small and average of farmers (55 % of the EAP), more represented in dense zone (Moroviné), use on the same basis organic and mineral fertilizers on cotton and cereals. This study concluded on the need for taking into account the growing saturation of area and the diversity of EAP for better targeting the interventions of development, and making them more relevant and more effective, to reinforce the management of the fertility of the grounds and to ensure a greater productivity of the EAP, to accompany the EAP by taking into account their diversity for the conservation by the natural resources.Keywords: Analyze, diversity, agropastoral system, Korhogo, Ivory Coast, Crop-livestock Integratio

Neonatal azithromycin administration to prevent infant mortality: study protocol for a randomised controlled trial.

IntroductionBiannual mass azithromycin distribution to children aged 1-59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period.Methods and analysisThe Nouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8-27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit.Ethics and disseminationThis study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d'Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals.Trial registration numberNCT03682653; Pre-results

Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target

Spontaneous Calcium Release in Cardiac Myocytes: Store Overload and Electrical Dynamics

Heart disease is the leading cause of mortality in the United States. One cause of heart arrhythmia is calcium (Ca2+) mishandling in cardiac muscle cells. We adapt Izu\u27s et al. mathematical reaction-diffusion model of calcium in cardiac muscle cells, or cardiomyocytes implemented by Gobbert, and analyzed in Coulibaly et al. to include calcium being released from the sarcoplasmic reticulum (SR), the effects of buffers in the SR, particularly calsequestrin, and the effects of Ca2+ influx due to voltage across the cell membrane. Based on simulations of the model implemented in parallel using MPI, our findings aligned with known biological models and principles, giving us a thorough understanding of several factors that influence Ca2+ dynamics in cardiac myocytes. Specifically, dynamic calcium store will cap previous calcium blow-up seen in the model. Calcium channels located in spatial opposition of calcium release units produce more predictable intracellular calcium propagation. And we used multi-parametric calcium dynamics tables, which act as a multidimensional bifurcation diagram, to visualize parameter boundaries between different biophysical dynamics

Efficacy and safety of co-administered ivermectin and albendazole in school-aged children and adults infected with; Trichuris trichiura; in Côte d'Ivoire, Laos, and Pemba Island, Tanzania: a double-blind, parallel-group, phase 3, randomised controlled trial

BACKGROUND: Preventive chemotherapy with albendazole or mebendazole remains one of the cornerstones of soil-transmitted helminth control. However, these drugs are less effective against Trichuris trichiura. Combined ivermectin-albendazole is a promising treatment alternative, yet robust evidence is lacking. We aimed to demonstrate superiority of co-administered ivermectin-albendazole over albendazole monotherapy in three distinct epidemiological settings. METHODS: We conducted a double-blind, parallel-group, phase 3, randomised controlled trial in community members aged 6-60 years infected with T trichiura in Cote d'Ivoire, Laos, and Pemba Island, Tanzania, between Sept 26, 2018, and June 29, 2020. Participants with at least 100 T trichiura eggs per g of stool at baseline were randomly assigned (1:1) using computer-generated randomisation sequences in varying blocks of four, six, and eight, stratified by baseline T trichiura infection intensity, to orally receive either a single dose of ivermectin (200 mug/kg) plus albendazole (400 mg) or albendazole (400 mg) plus placebo. Patients, field staff, and outcome assessors were masked to treatment assignment. The primary outcome was cure rate against T trichiura, defined as the proportion of participants with no eggs in their faeces 14-21 days after treatment, assessed by Kato-Katz thick smears, and analysed in the available-case population according to intention-to-treat principles. Safety was a secondary outcome and was assessed 3 h and 24 h after drug administration. The trial is registered at ClinicalTrials.gov, NCT03527732. FINDINGS: Between Sept 13 and Dec 18, 2019, Jan 12 and April 5, 2019, and Sept 26 and Nov 5, 2018, 3737, 3694, and 1435 community members were screened for trial eligibility in Cote d'Ivoire, Laos, and Pemba Island, respectively. In Cote d'Ivoire, Laos, and Pemba Island, 256, 274, and 305 participants, respectively, were randomly assigned to the albendazole group, and 255, 275, and 308, respectively, to the ivermectin-albendazole group. Primary outcome data were available for 722 participants treated with albendazole and 733 treated with ivermectin-albendazole. Ivermectin-albendazole showed significantly higher cure rates against T trichiura than albendazole in Laos (66% [140 of 213]vs 8% [16 of 194]; difference 58 percentage points, 95% CI 50 to 65, p<0.0001) and Pemba Island (49% [140 of 288]vs 6% [18 of 293], 43 percentage points, 36 to 49, p<0.0001) but had similar efficacy in Cote d'Ivoire (14% [32 of 232]vs 10% [24 of 235], 4 percentage points, -2 to 10, p=0.24). No serious adverse events were reported; observed events were mostly classified as mild (95% [266 of 279] in the albendazole group and 91% [288 of 317] in the ivermectin-albendazole group), and all were transient in nature. INTERPRETATION: Treatment with ivermectin-albendazole resulted in higher efficacy against trichuriasis than albendazole alone in Laos and Pemba Island but not in Cote d'Ivoire. We recommend implementation of this combination therapy for soil-transmitted helminth control in countries with high T trichiura prevalence and proven enhanced efficacy of this treatment, particularly where ivermectin is beneficial against other endemic helminthiases. FUNDING: Bill & Melinda Gates Foundation

Assessment of fecal calprotectin and fecal occult blood as point-of-care markers for soil-transmitted helminth attributable intestinal morbidity in a case-control substudy conducted in Côte d'Ivoire, Lao PDR and Pemba Island, Tanzania

Background: Infections with soil-transmitted helminths (STHs) may result in chronic inflammatory disorders affecting the human host. The objective of this study was to evaluate Fecal Calprotectin (FC) and Fecal Occult Blood (FOB) in individuals infected and non-infected with STHs to identify potential intestinal morbidity markers. Methods: Stool from participants diagnosed positive for Trichuris trichiura and concomitant STH infections from three countries was used to perform FC and FOB point-of-care assays. Simultaneously, identified STH negative participants underwent FC and FOB testing as controls. Potential associations between test results and determinants were analyzed using multivariable logistic regression. Findings: In total, 1034 T. trichiura infected cases (mostly light infections) and 157 STH negative controls were tested for FC and FOB. Among all participants tested, 18.5% had >/= 50 microg/g FC concentration, while 14 (1.2%) were positive for FOB. No statistically significant association was found between T. trichiura infection or Ascaris lumbricoides co-infection and FC concentration, while an inverse association (odds ratio (OR): 0.45, 95% credible intervals (CrI): 0.26, 0.75) was found between hookworm co-infection and FC concentration. In Lao PDR, the proportion of participants in the >/= 50 microg/g FC category was significantly higher in the oldest age category compared to the 5-11 years group (OR: 3.31, 95% CrI: 1.62, 7.24). Too few participants were found positive for FOB to derive any conclusions. Interpretation: Studies are needed to better understand the relationship between intestinal morbidity and STH infections. Suitable, standardized, low-cost markers of STH attributable morbidity to better monitor the impact of STH control interventions are necessary. Funding: BMGF (OPP1153928)