Erysipèle de jambe du nourrisson: Une observation dans l’unité dermatologie de l’hôpital régional de Gao (mali)

L’érysipèle est une dermohypodermite bactérienne aiguë non nécrosante, affectant le plus souvent les membres inférieurs. Les facteurs favorisant sa survenue sont l’existence d’une porte d’entrée (plaies traumatiques négligées, intertrigo), le lymphœdème, l’obésité et la dépigmentation volontaire. La complication la plus fréquente est la récidive. Les autres complications incluent notamment abcédassions, la fasciite et les bactériémies. Nous rapportons une première observation malienne d’érysipèle chez un nourrisson de 8 mois, de sexe féminin, amené en consultation dans l’unité dermatologique de l’hôpital régional de Gao pour l’installation brutale d’une grosse jambe rouge plus notion de fièvre et de frissons. Le diagnostic a été porté devant une tuméfaction du membre inférieur droit rouge, chaude et douloureuse surmontée de bulles tendues associée à une adénopathie inguinale et une leucocytose à l’hémogramme. Un traitement à base d’antibiotique associé à un pansement et le repos a été instauré. L’évolution a été émaillée par la disparition des lésions en dix jours. Le diagnostic positif est fondé sur la clinique renforcé par la recherche de l’origine streptococcique

Epilepsie du sujet âgé : expérience du service de Neurologie du CHU Gabriel Touré de Bamako, Mali

Background: Epilepsy is a common condition in the elderly, although it is poorly documented in our context. This work aims at determine the epidemiological and clinical characteristics of epilepsy in elderly people. Patients and Methods: This was a prospective study over a period of one year in the Department of Neurology of Gabriel Toure Teaching Hospital (CHU) in Mali. Were eligible, all subjects aged 50 years or older that had at least two documented seizures, recorded and reported by the patient or his family. For the diagnosis of the seizure, we used validated form of Limoges Institute. Results: During the study period, 1753 patients were admitted to the neurology department of CHU Gabriel Touré, 39 cases of epilepsy in the elderly have been diagnosed, i.e. 2.2% of patients in the department. The average age was 63 years, ranging from 50 to 84 years. Partial seizures were the most represented with 43.6% of cases. Symptomatic epilepsy was found in 82.1% of patients, 18% of patients had no definite etiology. The causes were dominated by vascular epilepsyin 25 cases (64.1%). Treatment was started in all patients with a success after 6 months. Sodium valproate was the most prescribed as first-line therapy 51.3% (20 patients), followed by carbamazepine (41%). Conclusion: This prospective study of epilepsy in the elderly confirms the high prevalence of this  disease in this age group. With the multiple illnesses in the elderly, this condition will require a multidisciplinary management.Introduction : La prévalence élevée de l’épilepsie chez le sujet âgé est bien documentée. L’épilepsie chez la personne âgée reste très peu rapportée dans notre contexte. Ce travail a pour objectif de déterminer les caractéristiques épidémiologiques et cliniques de cette pathologie chez le sujet âgé. Patients et Méthodes : Il s’agissait d’une étude prospective réalisée sur une période d’un an dans le service de Neurologie du Centre Hospitalier Universitaire (CHU) Gabriel Touré au Mali. Ont été éligibles, tous les sujets âgés de 50 ans ou plus qui ont présenté au moins deux crises épileptiques documentées, constatées et rapportées par le patient et /ou son entourage. Pour le diagnostic de la crise, nous avons utilisé le questionnaire validé de L’Institut de Neurologie et Epidémiologie Tropicale de Limoges. Résultats : Durant la période d’étude, 1753 patients ont été admis dans le service de Neurologie du CHU Gabriel Touré ; 39 cas d’épilepsie du sujet âgé ont été diagnostiqués, soit 2,2% des malades dans le service. L’âge moyen était de 63 ans avec des extrêmes de 50 à 84 ans. Les crises partielles étaient les plus représentées, soit 69,2% des cas. Une épilepsie symptomatique a été retrouvée chez 82,1% des patients ; 18% des patients n’avaient pas d’étiologie bien déterminée. Les étiologies étaient dominées par les causes vasculaires, soit 64,1% (25) des cas. Un traitement a été mis en route chez tous nos patients avec un succès après 6 mois. Le Valproate de sodium (VPA) a été la molécule la plus prescrite en première intention soit 51,3% (20) des patients, suivi de la Carbamazépine (41%). Conclusion : Au vu de la poly pathologie, l’épilepsie du sujet âgé nécessite une prise en charge pluridisciplinaire

Plasmodium falciparum clearance with artemisinin-based combination therapy (ACT) in patients with glucose-6-phosphate dehydrogenase deficiency in Mali

URL : http://www.malariajournal.com/content/9/1/332Background: Artemisinin-based combination therapy (ACT) is currently the most effective medicine for the treatment of uncomplicated malaria. Artemisinin has previously been shown to increase the clearance of Plasmodium falciparum in malaria patients with haemoglobin E trait, but it did not increase parasite inhibition in an in vitro study using haemoglobin AS erythrocytes. The current study describes the efficacy of artemisinin derivatives on P. falciparum clearance in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), a haemoglobin enzyme deficiency, not yet studied in the same context, but nonetheless is a common in malaria endemic areas, associated with host protection against uncomplicated and severe malaria. The impact of G6PD deficiency on parasite clearance with ACT treatment was compared between G6PD-deficient patients and G6PD-normal group. Methods: Blood samples from children and adults participants (1 to 70 years old) with uncomplicated P. falciparum malaria residing in Kambila, Mali were analysed. Study participants were randomly assigned to receive either artemether-lumefantrine (Coartem®) or artesunate plus mefloquine (Artequin™). A restriction-fragment length polymorphism analysis of PCR-amplified DNA samples was used to identify the (A-) allele of the gene mutation responsible for G6PD deficiency (G6PD*A-). 470 blood samples were thus analysed and of these, DNA was extracted from 315 samples using the QIAamp kit for PCR to identify the G6PD*A- gene. Results

Pre-hospital risk factors for inpatient death from severe febrile illness in Malian children.

BACKGROUND: Inpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality. METHODS: Prospective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period. FINDINGS: The case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome. INTERPRETATION: Aside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality

Sorghum head-bugs and grain molds in West and Central Africa: I. Host plant resistance and bug–mold interactions on sorghum grains

A regional sorghum head-bug and grain mold resistance trial was conducted in 1996 and 1997 at 15 and 13 research stations located in 10 West and Central African countries, respectively. Two cultivars namely IS 14384 and CGM 39/17-2-2 exhibited consistently high levels of resistance both to head-bugs and grain molds over years and localities. Eurystylus oldi was the dominant head-bug species at all localities except in Benin, Chad and Guinea. Sorghum grain mycoflora varied little between sites with genera Phoma and Fusarium dominating, followed by Curvularia. Efficiency of the insecticidal treatment on head-bug incidence partially confirmed the critical role played by head-bugs in aggravating mold infectio

<i>Gaia</i> Data Release 1. Summary of the astrometric, photometric, and survey properties

Context. At about 1000 days after the launch of Gaia we present the first Gaia data release, Gaia DR1, consisting of astrometry and photometry for over 1 billion sources brighter than magnitude 20.7. Aims. A summary of Gaia DR1 is presented along with illustrations of the scientific quality of the data, followed by a discussion of the limitations due to the preliminary nature of this release. Methods. The raw data collected by Gaia during the first 14 months of the mission have been processed by the Gaia Data Processing and Analysis Consortium (DPAC) and turned into an astrometric and photometric catalogue. Results. Gaia DR1 consists of three components: a primary astrometric data set which contains the positions, parallaxes, and mean proper motions for about 2 million of the brightest stars in common with the HIPPARCOS and Tycho-2 catalogues – a realisation of the Tycho-Gaia Astrometric Solution (TGAS) – and a secondary astrometric data set containing the positions for an additional 1.1 billion sources. The second component is the photometric data set, consisting of mean G-band magnitudes for all sources. The G-band light curves and the characteristics of ∼3000 Cepheid and RR-Lyrae stars, observed at high cadence around the south ecliptic pole, form the third component. For the primary astrometric data set the typical uncertainty is about 0.3 mas for the positions and parallaxes, and about 1 mas yr−1 for the proper motions. A systematic component of ∼0.3 mas should be added to the parallax uncertainties. For the subset of ∼94 000 HIPPARCOS stars in the primary data set, the proper motions are much more precise at about 0.06 mas yr−1. For the secondary astrometric data set, the typical uncertainty of the positions is ∼10 mas. The median uncertainties on the mean G-band magnitudes range from the mmag level to ∼0.03 mag over the magnitude range 5 to 20.7. Conclusions. Gaia DR1 is an important milestone ahead of the next Gaia data release, which will feature five-parameter astrometry for all sources. Extensive validation shows that Gaia DR1 represents a major advance in the mapping of the heavens and the availability of basic stellar data that underpin observational astrophysics. Nevertheless, the very preliminary nature of this first Gaia data release does lead to a number of important limitations to the data quality which should be carefully considered before drawing conclusions from the data

Extended LTA, TNF, LST1 and HLA Gene Haplotypes and Their Association with Rubella Vaccine-Induced Immunity

Recent studies have suggested the importance of HLA genes in determining immune responses following rubella vaccine. The telomeric class III region of the HLA complex harbors several genes, including lymphotoxin alpha (LTA), tumor necrosis factor (TNF) and leukocyte specific transcript -1 (LST1) genes, located between the class I B and class II DRB1 loci. Apart from HLA, little is known about the effect of this extended genetic region on HLA haplotypic backgrounds as applied to immune responses.We examined the association between immune responses and extended class I-class II-class III haplotypes among 714 healthy children after two doses of rubella vaccination. These extended haplotypes were then compared to the HLA-only haplotypes. The most significant association was observed between haplotypes extending across the HLA class I region, ten-SNP haplotypes, and the HLA class II region (i.e. A-C-B-LTA-TNF-LST1-DRB1-DQA1-DQB1-DPA1-DPB1) and rubella-specific antibodies (global p-value of 0.03). Associations were found between both extended A*02-C*03-B*15-AAAACGGGGC-DRB1*04-DQA1*03-DQB1*03-DPA1*01-DPB1*04 (p = 0.002) and HLA-only A*02-C*03-B*15-DRB1*04-DQA1*03-DQB1*03-DPA1*01-DPB1*04 haplotypes (p = 0.009) and higher levels of rubella antibodies. The class II HLA-only haplotype DRB1*13-DQA1*01-DQB1*06-DPA1*01-DPB1*04 (p = 0.04) lacking LTA-TNF-LST1 SNPs was associated with lower rubella antibody responses. Similarly, the class I-class II HLA-only A*01-C*07-B*08-DRB1*03-DQA1*05-DQB1*02-DPA1*01-DPB1*04 haplotype was associated with increased TNF-alpha secretion levels (p = 0.009). In contrast, the extended AAAACGGGGC-DRB1*01-DQA1*01-DQB1*05-DPA1*01-DPB1*04 (p = 0.01) haplotype was found to trend with decreased rubella-specific IL-6 secretion levels.These data suggest the importance of examining both HLA genes and genes in the class III region as part of the extended haplotypes useful in understanding genomic drivers regulating immune responses to rubella vaccine

Pf7: an open dataset of Plasmodium falciparum genome variation in 20,000 worldwide samples

We describe the MalariaGEN Pf7 data resource, the seventh release of Plasmodium falciparum genome variation data from the MalariaGEN network. It comprises over 20,000 samples from 82 partner studies in 33 countries, including several malaria endemic regions that were previously underrepresented. For the first time we include dried blood spot samples that were sequenced after selective whole genome amplification, necessitating new methods to genotype copy number variations. We identify a large number of newly emerging crt mutations in parts of Southeast Asia, and show examples of heterogeneities in patterns of drug resistance within Africa and within the Indian subcontinent. We describe the profile of variations in the C-terminal of the csp gene and relate this to the sequence used in the RTS,S and R21 malaria vaccines. Pf7 provides high-quality data on genotype calls for 6 million SNPs and short indels, analysis of large deletions that cause failure of rapid diagnostic tests, and systematic characterisation of six major drug resistance loci, all of which can be freely downloaded from the MalariaGEN website