Association of BMI Category Change with TB Treatment Mortality in HIV-Positive Smear-Negative and Extrapulmonary TB Patients in Myanmar and Zimbabwe

OBJECTIVE: The HIV epidemic has increased the proportion of patients with smear-negative and extrapulmonary tuberculosis (TB) diagnoses, with related higher rates of poor TB treatment outcomes. Unlike in smear-positive pulmonary TB, no interim markers of TB treatment progress are systematically used to identify individuals most at risk of mortality. The objective of this study was to assess the association of body mass index (BMI) change at 1 month (±15 days) from TB treatment start with mortality among HIV-positive individuals with smear-negative and extrapulmonary TB. METHODS AND FINDINGS: A retrospective cohort study of adult HIV-positive new TB patients in Médecins Sans Frontières (MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to estimate the association between BMI category change and mortality. A cohort of 1090 TB patients (605 smear-negative and 485 extrapulmonary) was followed during TB treatment with mortality rate of 28.9 per 100 person-years. In multivariable analyses, remaining severely underweight or moving to a lower BMI category increased mortality (adjusted hazard ratio 4.05, 95% confidence interval 2.77-5.91, p<0.001) compared with remaining in the same or moving to a higher BMI category. CONCLUSIONS: We found a strong association between BMI category change during the first month of TB treatment and mortality. BMI category change could be used to identify individuals most at risk of mortality during TB treatment among smear-negative and extrapulmonary patients

Strength and creep behavior of geomaterials for building with tannin addition

International audienceA clay mined in Djénné (Mali) was used to elaborate geomaterials, with tannins addition from Parkia biglobosa pods (Néré). The compressed blocks of clay-sand mixtures show a composite microstructure. The clay contains significant quantities of kaolinite, illite, pyrophyllite, quartz and iron minerals as goethite and ferrihydrite. Quantitative mineralogical composition was assessed by X-ray diffraction and DTA/TG analyses. When tannin extract is added, the formation of a chemical complex with clay-iron hydroxides is evidenced by IR spectroscopy, which reveals specific bands. The compressive strength and creep behavior under 0.2 MPa during 20 days evidence different behaviors depending on humidity and tannin contents. Creep curves exhibit successive stages which can be described by the Granger model. The multi stage creep is explained by the visco-plastic behavior of clay constrained between large sand grains, where local and delayed deformation may occur with micro-cracking. Tannin addition has proved to increase the macroscopic strength, and reduce micro-cracking

Strength and creep behavior of geomaterials for building with tannin addition

International audienceA clay mined in Djénné (Mali) was used to elaborate geomaterials, with tannins addition from Parkia biglobosa pods (Néré). The compressed blocks of clay-sand mixtures show a composite microstructure. The clay contains significant quantities of kaolinite, illite, pyrophyllite, quartz and iron minerals as goethite and ferrihydrite. Quantitative mineralogical composition was assessed by X-ray diffraction and DTA/TG analyses. When tannin extract is added, the formation of a chemical complex with clay-iron hydroxides is evidenced by IR spectroscopy, which reveals specific bands. The compressive strength and creep behavior under 0.2 MPa during 20 days evidence different behaviors depending on humidity and tannin contents. Creep curves exhibit successive stages which can be described by the Granger model. The multi stage creep is explained by the visco-plastic behavior of clay constrained between large sand grains, where local and delayed deformation may occur with micro-cracking. Tannin addition has proved to increase the macroscopic strength, and reduce micro-cracking

Evaluation de Ia pratique transfusionnelle en urgence obstetricale et gynecologique au Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou (Burkina Faso)

La transfusion est une pratique courante en milieu obstetrical et gynecologique. Le risque transfusionnel et post  transfusionnel encouru impose le recours a de bonnes pratiques. 11 s'est agit d'une etude prospective et transversale a visee descriptive qui s'est deroulee sur une periode de 3 mois dans le Service de Gynecologie et d'Obsretrique du Centre Hospitalier Universitaire Yalgado Ouedraogo a  Ouagadougou. La collecte des donnees a ere faite par une technique d' observation directe et de revue documentaire. Sur cette periode, la frequence de la transfusion dans le service etait de 11,08 % par rapport a 1' ensemble des malades  hospitalisees. Le delai moyen d' obtention des produits sanguins labiles etait de 2 h 46 minutes. Toutes les patientes transfusees ont beneficie de la determination du groupe sanguin. Sur !'ensemble des determinations de groupage sanguin et rhesus, seulement 7,87 % avaient un phenotypage et en meme temps Kell realise. Aussi, la recherche d'agglutines irregulieres n'a ete faite dans aucun cas. Les tests de compatibilite au lit du malade n'ont pas ete effectues dans 72,62% des cas et le controle de concordance n'a pas ete effectue dans 15,48 % des cas. La surveillance rapprochee de la transfusion pendant les dix premieres minutes n'a pas ete effectuee dans 83,33 % des cas. Le taux de transmission des fiches post transfusionnelles n'etait que de 16 %. Si la transfusion est une pratique courante dans  votre service, 1' etude a permis de montrer que des efforts doivent etre entrepris quant aux respects des bonnes pratiques transfusionnelles en vue de tirer le maximum de benefice pour les patientes eut egard aux risques encourus.Mots-cles : pratique transfusionnelle, urgence obstetricale et gynecologique, centre hospitalier universitaire, Ouagadougou.Transfusion is a common practice in obstetrical and gynecological service. The transfusion and post transfusion risks incurred, requires the use of best practices. This is a prospective, descriptive cross-sectional study referred to which took place over a period of three months in the gynecology and obstetrics department of University Hospital Y algado Ouedraogo in Ouagadougou. Data collection was made by a technique of direct observation and document review. During this period, the frequency of transfusion in the service was 11.08 % compared to all hospitalized patients. The average time to blood  availability was 2 hours 46 minutes. All patients received transfusions of blood typing. Of all blood grouping and Rh  determinations, only 7.87 % had performed phenotyping and yet Kell. Also the search of irregular agglutinins has been made in any case. Compatibility testing at the bedside has not been performed in 72,62 % of cases and control of agreement has not been performed in 15.48 % of cases. Close surveillance of transfusion during the frrst ten minutes was not performed in 83.33 %of cases. The transmission rate of post transfusion sheets was 16%. If transfusion is a common practice in our service, the study showed that efforts must be undertaken by respecting the transfusional best practice to pull the maximum of profit for the patients considered the incurred risks.Keywords: transfusion practice, obstetric and gynecological emergency, Teaching University Hospital, Ouagadougou.

Diarrhoeagenic Escherichia coli detected by 16-plex PCR in children with and without diarrhoea in Burkina Faso

AbstractThe importance of diarrhoeagenic Escherichia coli (DEC) in Africa is poorly understood, and is unknown in Burkina Faso. This study investigated the occurrence of five major DEC pathogroups in primary cultures of stool samples from 658 Burkinabe children under 5 years old using 16-plex PCR for virulence-associated genes. At least one DEC pathogroup was detected in 45% of 471 children with diarrhoea and in 29% of 187 children without diarrhoea (p <0.001). More than one DEC pathogroup was detected in 11% of children with and 1% of children without diarrhoea (p <0.00l). Enteroaggregative E. coli was the most common pathogroup in both children with diarrhoea (26%) and children without diarrhoea (21%). Enteropathogenic E. coli and enterotoxigenic E. coli were detected significantly more often in children with diarrhoea (16% and 13%) than in children without diarrhoea (5% and 4%; p <0.001 for both pathogroups). Shiga toxin-producing E. coli and enteroinvasive E. coli were detected only in children with diarrhoea (2% and 1%, respectively). Diarrhoeagenic E. coli, especially enteropathogenic and enterotoxigenic, may be important, unrecognized causes of childhood diarrhoea in Burkina Faso