88 research outputs found
Bacteriologie de lâotite moyenne suppuree chronique de lâenfant au mali
Introduction: Lâotite moyenne suppurĂ©e chronique est une affection frĂ©quente chez lâenfant. Plusieurs facteurs peuvent favoriser lâinstallation dâun tel processus infectieux (rhinopharyngites, otites mal traitĂ©es âŠ). Lâidentification du germe causal de lâotite est une Ă©tape essentielle pour mener un traitement adĂ©quat. But : DĂ©terminer lâĂ©cologie bactĂ©rienne des otites purulentes chroniques de lâenfant dans notre unitĂ©. Patients et mĂ©thodes : LâĂ©tude menĂ©e de novembre 2010 Ă octobre 2011 a concernĂ© 76 jeunes patients (40 filles et 36 garçons ĂągĂ©s de 6 Ă 180 mois avec une moyenne dâĂąge de 52,73 mois) prĂ©sentant une otite moyenne suppurĂ©e chronique. LâotorrhĂ©e purulente des 76 patients (80 oreilles) a Ă©tĂ© prĂ©levĂ©e. Celle-ci Ă©tait recueillie Ă lâoreille dâun Ă©couvillon stĂ©rile aprĂšs nettoyage du conduit auditif externe et conduit le mĂȘme jour au laboratoire pour examen bactĂ©riologique. RĂ©sultats : 94,74% des prĂ©lĂšvements Ă©taient positifs et 5,26% Ă©taient stĂ©riles. Parmi les prĂ©lĂšvements positifs 75% Ă©taient monomicrobiens et 25% plurimicrobiens. Staphylococcus aureus (41,31%), proteus mirabilis (34,79%) sont les principales espĂšces bactĂ©riennes responsables dâotite moyenne suppurĂ©e chronique chez lâenfant dans notre unitĂ©. Conclusion : Ainsi le rĂŽle pathogĂšne de staphylococcus aureus est prĂ©pondĂ©rant dans les otites moyennes suppurĂ©es chroniques de lâenfant dans notre unitĂ©. Mots-clĂ©s : bactĂ©riologie - otite moyenne suppurĂ©e chronique - enfant.
Les traumatismes vertebro-medullaires par chute de la hauteur dâun arbre a propos de 73 cas au Mali.
Introduction Les chutes du haut dâun arbre sont des accidents graves et frĂ©quents au MALI.Objectif Analysez les facteurs Ă©pidĂ©miologiques, Ă©tiologiques et circonstanciels des chutes de la hauteur des arbres MatĂ©riels et mĂ©thodes Il sâagit dâune Ă©tude prospective continue dâoctobre 2007 Ă septembre 2009 Ă lâhĂŽpital Gabriel TourĂ© de Bamako (Mali). Elle a concernĂ© tous les cas de chute du haut dâun arbre pendant cette pĂ©riode.RĂ©sultats Au cours de cette Ă©tude, nous avons recensĂ© 73 patients dont les Ăąges Ă©taient compris entre 5 et 65 ans. Les couches socioprofessionnelles les plus atteintes ont Ă©tĂ© les cultivateurs et les bergers aux conditions socioĂ©conomiques dĂ©favorables. Pendant les mois de dĂ©cembre Ă mai 79,45% (58 patients) des patients ont Ă©tĂ© enregistrĂ©s. Cette pĂ©riode correspondait Ă la traite des fruits et Ă la saison sĂšche avec le manque de pĂąturages pour les animaux. Lâintervention chirurgicale a concernĂ© 32 patients. La mortalitĂ© a Ă©tĂ© de 12,32% (9 patients) tous traumatisĂ©s cervicaux.Conclusions Les accidents par chutes dâarbres sont en rapport avec les conditions socio-Ă©conomiques et climatiques au Mali.Mots clĂ©s : Arbre, Accident, Chute, Mali, Rachis, Traumatism
Prise En Charge Des Victimes Du Conflit Armé Du Nord Mali Dans Les HÎpitaux De Niamey
Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included ùge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality
AbcÚs de la prostate de découverte fortuite : A propos de deux cas
Introduction : lâabcĂšs prostatique est une pathologie de plus en plus rare. Sa symptomatologie nâest pas spĂ©cifique. LâĂ©chographie endorectale et le scanner pelvien occupent une place de choix dans le diagnostic. Le traitement repose sur lâantibiothĂ©rapie adaptĂ©e et sur le drainage percutanĂ© par voie transpĂ©rinĂ©ale, transrectale ou endoscopique. Observation : nous rapportons deux cas dâabcĂšs de prostate, lâun des patients est ĂągĂ© de 47 ans et lâautre 61 ans. Dans les deux cas, le diagnostic a Ă©tĂ© de dĂ©couverte fortuite en per opĂ©ratoire. Le scanner abdominopelvien a posĂ© le diagnostic de kyste de prostate chez lâun et une hypertrophie bĂ©nigne de la prostate chez lâautre par une Ă©chographie rĂ©no-vĂ©sico-prostatique. Le traitement a consistĂ© en un drainage par chirurgie ouverte avec une antibiothĂ©rapie adaptĂ©e. LâĂ©volution a Ă©tĂ© favorable dans les deux cas. Conclusion : lâabcĂšs prostatique est une pathologie rare et sa symptomatologie clinique nâest pas spĂ©cifique. Dans notre cas, le diagnostic nâa pu ĂȘtre confirmĂ© quâen peropĂ©ratoire et le traitement par chirurgie ouverte avec un bon rĂ©sultat
Protein crystals in adenovirus type 5-infected cells: requirements for intranuclear crystallogenesis, structural and functional analysis
Intranuclear crystalline inclusions have been observed in the nucleus of epithelial cells infected with Adenovirus serotype 5 (Ad5) at late steps of the virus life cycle. Using immuno-electron microscopy and confocal microscopy of cells infected with various Ad5 recombinants modified in their penton base or fiber domains, we found that these inclusions represented crystals of penton capsomers, the heteromeric capsid protein formed of penton base and fiber subunits. The occurrence of protein crystals within the nucleus of infected cells required the integrity of the fiber knob and part of the shaft domain. In the knob domain, the region overlapping residues 489â492 in the FG loop was found to be essential for crystal formation. In the shaft, a large deletion of repeats 4 to 16 had no detrimental effect on crystal inclusions, whereas deletion of repeats 8 to 21 abolished crystal formation without altering the level of fiber protein expression. This suggested a crucial role of the five penultimate repeats in the crystallisation process. Chimeric pentons made of Ad5 penton base and fiber domains from different serotypes were analyzed with respect to crystal formation. No crystal was found when fiber consisted of shaft (S) from Ad5 and knob (K) from Ad3 (heterotypic S5-K3 fiber), but occurred with homotypic S3K3 fiber. However, less regular crystals were observed with homotypic S35-K35 fiber. TB5, a monoclonal antibody directed against the Ad5 fiber knob was found by immunofluorescence microscopy to react with high efficiency with the intranuclear protein crystals in situ. Data obtained with Ad fiber mutants indicated that the absence of crystalline inclusions correlated with a lower infectivity and/or lower yields of virus progeny, suggesting that the protein crystals might be involved in virion assembly. Thus, we propose that TB5 staining of Ad-infected 293 cells can be used as a prognostic assay for the viability and productivity of fiber-modified Ad5 vectors
Impact of intermittent preventive treatment with sulphadoxine-pyrimethamine targeting the transmission season on the incidence of clinical malaria in children in Mali
<p>Abstract</p> <p>Background</p> <p>Recent studies have shown that intermittent preventive malaria treatment (IPT) in infants in areas of stable malaria transmission reduces malaria and severe anaemia incidence. However in most areas malaria morbidity and mortality remain high in older children.</p> <p>Methods</p> <p>To evaluate the effect of seasonal IPT with sulphadoxine pyrimethamine (SP) on incidence of malaria disease in area of seasonal transmission, 262 children 6 months-10 years in Kambila, Mali were randomized to receive either IPT with SP twice at eight weeks interval or no IPT during the transmission season of 2002 and were followed up for 12 months. Subjects were also followed during the subsequent transmission season in 2003 to assess possible rebound effect. Clinical malaria cases were treated with SP and followed to assess the <it>in vivo </it>response during both periods.</p> <p>Results</p> <p>The incidence rate of malaria disease per 1,000 person-months during the first 12 months was 3.2 episodes in the treatment group vs. 5.8 episodes in the control group with age-adjusted Protective Efficacy (PE) of 42.5%; [95% CI 28.6%â53.8%]. When the first 16 weeks of follow up is considered age-adjusted PE was 67.5% [95% CI 55.3% â 76.6%]. During the subsequent transmission season, the incidence of clinical malaria per 1000 persons-days was similar between the two groups (23.0 vs 21.5 episodes, age-adjusted IRR = 1.07 [95% CI, 0.90â1.27]). No significant difference was detected in <it>in vivo </it>response between the groups during both periods.</p> <p>Conclusion</p> <p>Two malaria intermittent treatments targeting the peak transmission season reduced the annual incidence rate of clinical malaria by 42.5% in an area with intense seasonal transmission. This simple strategy is likely to be one of the most effectives in reducing malaria burden in such areas.</p> <p>Trial Registration</p> <p>Clinicaltrials.gov NCT00623155</p
Program for expectant and new mothers: a population-based study of participation
<p>Abstract</p> <p>Background</p> <p>The Manitoba Healthy Baby Program is aimed at promoting pre- and perinatal health and includes two components: 1) prenatal income supplement; 2) community support programs. The goal of this research was to determine the uptake of these components by target groups.</p> <p>Methods</p> <p>Data on participation in each of the two program components were linked to data on all hospital births in Manitoba between 2004/05 through 2007/08. Descriptive analyses of participation by maternal characteristics were produced. Logistic regression analyses were conducted to identify factors associated with participation in the two programs. Separate regressions were run for two groups of women giving birth during the study period: 1) total population; 2) those receiving provincial income assistance during the prenatal period.</p> <p>Results</p> <p>Almost 30% of women giving birth in Manitoba received the Healthy Baby prenatal income supplement, whereas only 12.6% participated in any community support programs. Over one quarter (26.4%) of pregnant women on income assistance did not apply for and receive the prenatal income supplement, despite all being eligible for it. Furthermore, 77.8% of women on income assistance did not participate in community support programs. Factors associated with both receipt of the prenatal benefit and participation in community support programs included lower SES, receipt of income assistance, obtaining adequate prenatal care, having completed high school and having depressive symptoms. Having more previous births was associated with higher odds of receiving the prenatal benefit, but lower odds of attending community support programs. Being married was associated with lower odds of receiving the prenatal benefit but higher odds of participating in community support programs.</p> <p>Conclusions</p> <p>Although uptake of the Healthy Baby program in Manitoba is greater for women in groups at risk for poorer perinatal outcomes, a substantial number of women eligible for this program are not receiving it; efforts to reach these women should be enhanced.</p
Novel mutation in the NHLRC1 gene in a Malian family with a severe phenotype of Lafora disease
We studied a Malian family with parental consanguinity and two of eight siblings affected with late-childhood-onset progressive myoclonus epilepsy and cognitive decline, consistent with the diagnosis of Lafora disease. Genetic analysis showed a novel homozygous single-nucleotide variant in the NHLRC1 gene, c.560A>C, producing the missense change H187P. The changed amino acid is highly conserved, and the mutation impairs malin's ability to degrade laforin in vitro. Pathological evaluation showed manifestations of Lafora disease in the entire brain, with particularly severe involvement of the pallidum, thalamus, and cerebellum. Our findings document Lafora disease with severe manifestations in the West African population
Translating preventive chemotherapy prevalence thresholds for Schistosoma mansoni from the Kato-Katz technique into the point-of-care circulating cathodic antigen diagnostic test
Background Intervention guidelines against Schistosoma mansoni are based on the Kato-Katz technique. However, Kato-Katz thick smears show low sensitivity, especially for light-intensity infections. The point-of-care circulating cathodic antigen (POC-CCA) is a promising rapid diagnostic test detecting antigen output of living worms in urine and results are reported as trace, 1+, 2+, and 3+. The use of POC-CCA for schistosomiasis mapping, control, and surveillance requires translation of the Kato-Katz prevalence thresholds into POC-CCA relative treatment cut-offs. Furthermore, the infection status of egg-negative but antigen-positive individuals and the intensity-dependent sensitivity of POC-CCA should be estimated to determine its suitability for verification of disease elimination efforts. Methodology We used data from settings in Africa and the Americas characterized by a wide range of S. mansoni endemicity. We estimated infection intensity-dependent sensitivity and specificity of each test at the unit of the individual, using a hierarchical Bayesian egg-count model that removes the need to define a âgoldâ standard applied to data with multiple Kato-Katz thick smears and POC-CCA urine cassette tests. A simulation study was carried out based on the model estimates to assess the relation of the two diagnostic tests for different endemicity scenarios. Principal findings POC-CCA showed high specificity (> 95%), and high sensitivity (> 95%) for moderate and heavy infection intensities, and moderate sensitivity (> 75%) for light infection intensities, and even for egg-negative but antigen-positive infections. A 10% duplicate slide Kato-Katz thick smear prevalence corresponded to a 15â40% prevalence of â„ trace-positive POC-CCA, and 10â20% prevalence of â„ 1+ POC-CCA. The prevalence of â„ 2+ POC-CCA corresponded directly to single slide Kato-Katz prevalence for all prevalence levels. Conclusions/significance The moderate sensitivity of POC-CCA, even for very light S. mansoni infections where the sensitivity of Kato-Katz is very low, and the identified relationship between Kato-Katz and POC-CCA prevalence thresholds render the latter diagnostic tool useful for surveillance and initial estimation of elimination of S. mansoni. For prevalence below 10% based on a duplicate slide Kato-Katz thick smear, we suggest using POC-CCA including trace results to evaluate treatment needs and propose new intervention thresholds that need to be validated in different settings
Evidence for the Contribution of the Hemozoin Synthesis Pathway of the Murine Plasmodium yoelii to the Resistance to Artemisinin-Related Drugs
Plasmodium falciparum malaria is a major global health problem, causing approximately 780,000 deaths each year. In response to the spreading of P. falciparum drug resistance, WHO recommended in 2001 to use artemisinin derivatives in combination with a partner drug (called ACT) as first-line treatment for uncomplicated falciparum malaria, and most malaria-endemic countries have since changed their treatment policies accordingly. Currently, ACT are often the last treatments that can effectively and rapidly cure P. falciparum infections permitting to significantly decrease the mortality and the morbidity due to malaria. However, alarming signs of emerging resistance to artemisinin derivatives along the Thai-Cambodian border are of major concern. Through long-term in vivo pressures, we have been able to select a murine malaria model resistant to artemisinins. We demonstrated that the resistance of Plasmodium to artemisinin-based compounds depends on alterations of heme metabolism and on a loss of hemozoin formation linked to the down-expression of the recently identified Heme Detoxification Protein (HDP). These artemisinins resistant strains could be able to detoxify the free heme by an alternative catabolism pathway involving glutathione (GSH)-mediation. Finally, we confirmed that artemisinins act also like quinolines against Plasmodium via hemozoin production inhibition. The work proposed here described the mechanism of action of this class of molecules and the resistance to artemisinins of this model. These results should help both to reinforce the artemisinins activity and avoid emergence and spread of endoperoxides resistance by focusing in adequate drug partners design. Such considerations appear crucial in the current context of early artemisinin resistance in Asia
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