Facteurs predictifs de mortalite par accident vasculaire cerebral (AVC) a la Clinique Neurologique du chu de Fann, Dakar - Senegal

Description Les AVC constituent un problème de santé publique avec une mortalité élevée. Objectif Identifier les facteurs prédictifs de mortalité par accidents vasculaires cérébraux à la Clinique Neurologique du CHU de Fann, Dakar. Méthodes Il s’agit d’une étude rétrospective du 1er Janvier 2001 au 01 Novembre 2003 portant sur des patients avec AVC et ayant eu un examen tomodensitométrique cérébral. Les données sociodémographiques, les antécédents médicaux et chirurgicaux, les signes de gravité associés au tableau neurologique et le pronostic vital ont été collectés. Des analyses uni, bi et multivariées par la régression logistique multiple ont été effectuées. Résultats La population de patients (314) était composée de 56,1% de femmes avec une moyenne d’âge de 61,3 ans (±13,8), un délai moyen d’admission de 8,4 jours (±23,5). Les facteurs de risque d’AVC étaient dominés par l’HTA, l’antécédent d’AVC et le diabète. Les AVCI représentaient 60,2%. Un coma et une HTA étaient associés au tableau neurologique. Soixante dix huit (78) patients sont décédés soit un taux de létalité de 24,8%. Lors de l’analyse de régression logistique multivariée, seuls les antécédents d’AVC et l’existence de coma étaient associés de manière indépendante à la mortalité par AVC. Conclusion Ces résultats démontrent la nécessité d’une amélioration de la prise en charge des patients en unité de soins intensifs et la prévention des récidives d’AVC par une éducation sanitaire des malades.Mots-clés: accident vasculaire cérébral, mortalité, pronostic, Sénégal

Exposition à un risque d’infection rabique à l’unité de prévention du service de maladies infectieuses et tropicales du CHNU de Fann à Dakar: Caractéristiques et prise en charge thérapeutique

Objectif: Décrire les caractéristiques épidémiologiques et les modalités de prise en charge préventive des patients. Résultats : Cent cinquante-deux (152) patients ont consulté suite à une exposition au risque d’infection rabique principalement à la suite d’une morsure par un chien (133cas/152). Aucun animal mordeur n’a été mis en observation. La majorité (90%) provenait de Dakar. L’âge médian était de 22 ans [1 - 90 ans] et les hommes étaient les plus touchés avec un sex ratio (H/F) de 1,8. Les blessures de catégorie II étaient les plus fréquentes (100 cas). Près de deux tiers des personnes exposées ont été prises en charge dans les 48 heures. La quasi-totalité des patients avaient bénéficié du protocole Zagreb mais environ 41% d’entre eux avaient abandonné leur prophylaxie post exposition (PPE) en cours de suivi, soit un taux de complétude de 59%. Conclusion : Composante essentielle de la lutte contre la rage, la prophylaxie post exposition doit être améliorée par la sensibilisation et la collaboration avec les services vétérinaires. Tout ceci dans l’esprit du one health ou santé unique ainsi que l’amélioration de l’accessibilité financière des vaccins et des immunoglobulines antirabique

Epilespie de l’enfant et de l’adolescent au Senegal

Introduction L’épilepsie constitue un problème de santé publique au Sénégal avec une prévalence de 8,3 à 14/1000. Elle concerne principalement les enfants. L’objectif de ce travail est d’étudier les aspects biographiques, phénotypiques et évolutifs de la maladie épileptique dans une cohorte d’enfants au Sénégal.Méthodologie Il s’agit d’une étude rétrospective de dossiers d’enfants épileptiques suivis régulièrement au CHU de FANN et à l’Hôpital d’Enfants Albert Royer, de Juillet 2003 à décembre 2010. Les critères d’inclusion étaient: épileptiques âgés de moins de 18 ans, régulièrement suivis depuis au moins 3 ans, ayant un traitement adapté, à dose efficace, avec une bonne observance thérapeutique.Résultats Nous avons colligé 522 enfants, âgés de 3 mois à 16 ans, avec un sex-ratio de 1,7 en faveur des garçons. L’épilepsie était idiopathique chez 57% des enfants et non idiopathique chez 43% des patients. Les facteurs étiologiques étaient dominés par la consanguinité parentale, les anomalies de la grossesse et de l’accouchement, les infections du système nerveux central. Dans le groupe des épilepsies idiopathiques la consanguinité parentale et l’épilepsie familiale étaient retrouvées respectivement chez 64 enfants (21,62%) et 20 enfants (6,75%). Neuf enfants (3%) présentaient un trouble du langage isolé, alors qu’un seul enfant (0,33%) avait un déficit cognitif global. Dans le groupe des épilepsies non idiopathiques, les signes associés à l’épilepsie étaient les troubles du langage (15,70%), du comportement (15%) et des déficits moteurs (10,32%). 22,41% des enfants scolarisés avaient des difficultés d’apprentissage menant parfois à des redoublements scolaires ou une exclusion.Conclusion La classification syndromique à l’épilepsie est nécessaire pour une bonne prévision pronostique et thérapeutique. Le caractère idiopathique ou non en est pour une grande place, corrélé le plus souvent à une épilepsie familial ou une consanguinité ou affection périnatal ou infectieuse du système nerveux central.Mots clés : Epilepsie, syndrome épileptique, Sénégal

Crystal structure of tarocystatin–papain complex: implications for the inhibition property of group-2 phytocystatins

Tarocystatin (CeCPI) from taro (Colocasia esculenta cv. Kaohsiung no. 1), a group-2 phytocystatin, shares a conserved N-terminal cystatin domain (NtD) with other phytocystatins but contains a C-terminal cystatin-like extension (CtE). The structure of the tarocystatin–papain complex and the domain interaction between NtD and CtE in tarocystatin have not been determined. We resolved the crystal structure of the phytocystatin–papain complex at resolution 2.03 Å. Surprisingly, the structure of the NtD–papain complex in a stoichiometry of 1:1 could be built, with no CtE observed. Only two remnant residues of CtE could be built in the structure of the CtE–papain complex. Therefore, CtE is easily digested by papain. To further characterize the interaction between NtD and CtE, three segments of tarocystatin, including the full-length (FL), NtD and CtE, were used to analyze the domain–domain interaction and the inhibition ability. The results from glutaraldehyde cross-linking and yeast two-hybrid assay indicated the existence of an intrinsic flexibility in the region linking NtD and CtE for most tarocystatin molecules. In the inhibition activity assay, the glutathione-S-transferase (GST)-fused FL showed the highest inhibition ability without residual peptidase activity, and GST-NtD and FL showed almost the same inhibition ability, which was higher than with NtD alone. On the basis of the structures, the linker flexibility and inhibition activity of tarocystatins, we propose that the overhangs from the cystatin domain may enhance the inhibition ability of the cystatin domain against papain

The Disease Burden of Taenia solium Cysticercosis in Cameroon

Taenia solium cysticercosis is a zoonotic disease occurring in many developing countries. A relatively high prevalence in humans and pigs has been reported in several parts of the world, but insufficient data are available on the disease burden. Disease impact assessment needs detailed information on well-defined epidemiological and economic parameters. Our work conducted in West Cameroon over several years allowed us to collect the necessary information to estimate the impact of the parasite on the human and animal populations in this area using both cost and Disability Adjusted Life Year (DALY) estimations. This study identified the professional inactivity caused by the disease as the major loss factor in comparison to the cost of health care and losses due to infected pigs. These findings should allow a simpler estimation of the global disease burden based on information on salary levels and human cysticercosis prevalence in endemic areas of the world. In addition, the number of DALYs lost was higher than estimates already available for some other neglected tropical diseases in sub-Saharan Africa

A SNP and SSR Based Genetic Map of Asparagus Bean (Vigna. unguiculata ssp. sesquipedialis) and Comparison with the Broader Species

Asparagus bean (Vigna. unguiculata ssp. sesquipedialis) is a distinctive subspecies of cowpea [Vigna. unguiculata (L.) Walp.] that apparently originated in East Asia and is characterized by extremely long and thin pods and an aggressive climbing growth habit. The crop is widely cultivated throughout Asia for the production of immature pods known as ‘long beans’ or ‘asparagus beans’. While the genome of cowpea ssp. unguiculata has been characterized recently by high-density genetic mapping and partial sequencing, little is known about the genome of asparagus bean. We report here the first genetic map of asparagus bean based on SNP and SSR markers. The current map consists of 375 loci mapped onto 11 linkage groups (LGs), with 191 loci detected by SNP markers and 184 loci by SSR markers. The overall map length is 745 cM, with an average marker distance of 1.98 cM. There are four high marker-density blocks distributed on three LGs and three regions of segregation distortion (SDRs) identified on two other LGs, two of which co-locate in chromosomal regions syntenic to SDRs in soybean. Synteny between asparagus bean and the model legume Lotus. japonica was also established. This work provides the basis for mapping and functional analysis of genes/QTLs of particular interest in asparagus bean, as well as for comparative genomics study of cowpea at the subspecies level

Kdr-based insecticide resistance in Anopheles gambiae s.s populations in

<p>Abstract</p> <p>Background</p> <p>The spread of insecticide resistance in the malaria mosquito, <it>Anopheles gambiae </it>is a serious threat for current vector control strategies which rely on the use of insecticides. Two mutations at position 1014 of the S₆transmembrane segment of domain II in the voltage gated sodium channel, known as <it>kdr </it>(<it>knockdown resistance</it>) mutations leading to a change of a Leucine to a Phenylalanine (L1014F) or to a Serine (L1014S) confer resistance to DDT and pyrethroid insecticides in the insect. This paper presents the current distribution of the <it>kdr </it>alleles in wild <it>Anopheles gambiae </it>populations in Cameroon.</p> <p>Results</p> <p>A total of 1,405 anopheline mosquitoes were collected from 21 localities throughout Cameroon and identified as <it>An. gambiae </it>(N = 1,248; 88.8%), <it>An. arabiensis </it>(N = 120; 8.5%) and <it>An. melas </it>(N = 37; 2.6%). Both <it>kdr </it>alleles 1014F and 1014S were identified in the M and S molecular forms of <it>An. gambiae </it>s.s. The frequency of the 1014F allele ranged from 1.7 to 18% in the M-form, and from 2 to 90% in the S-form. The 1014S allele ranged from 3-15% in the S-form and in the M-form its value was below 3%. Some specimens were found to carry both resistant <it>kdr </it>alleles.</p> <p>Conclusion</p> <p>This study provides an updated distribution map of the <it>kdr </it>alleles in wild <it>An. gambiae </it>populations in Cameroon. The co-occurrence of both alleles in malaria mosquito vectors in diverse ecological zones of the country may be critical for the planning and implementation of malaria vector control interventions based on IRS and ITNs, as currently ongoing in Cameroon.</p

Major Depletion of Plasmacytoid Dendritic Cells in HIV-2 Infection, an Attenuated Form of HIV Disease

Plasmacytoid dendritic cells (pDC) provide an important link between innate and acquired immunity, mediating their action mainly through IFN-α production. pDC suppress HIV-1 replication, but there is increasing evidence suggesting they may also contribute to the increased levels of cell apoptosis and pan-immune activation associated with disease progression. Although having the same clinical spectrum, HIV-2 infection is characterized by a strikingly lower viremia and a much slower rate of CD4 decline and AIDS progression than HIV-1, irrespective of disease stage. We report here a similar marked reduction in circulating pDC levels in untreated HIV-1 and HIV-2 infections in association with CD4 depletion and T cell activation, in spite of the undetectable viremia found in the majority of HIV-2 patients. Moreover, the same overexpression of CD86 and PD-L1 on circulating pDC was found in both infections irrespective of disease stage or viremia status. Our observation that pDC depletion occurs in HIV-2 infected patients with undetectable viremia indicates that mechanisms other than direct viral infection determine the pDC depletion during persistent infections. However, viremia was associated with an impairment of IFN-α production on a per pDC basis upon TLR9 stimulation. These data support the possibility that diminished function in vitro may relate to prior activation by HIV virions in vivo, in agreement with our finding of higher expression levels of the IFN-α inducible gene, MxA, in HIV-1 than in HIV-2 individuals. Importantly, serum IFN-α levels were not elevated in HIV-2 infected individuals. In conclusion, our data in this unique natural model of “attenuated” HIV immunodeficiency contribute to the understanding of pDC biology in HIV/AIDS pathogenesis, showing that in the absence of detectable viremia a major depletion of circulating pDC in association with a relatively preserved IFN-α production does occur

Regional research priorities in brain and nervous system disorders

The characteristics of neurological, psychiatric, developmental and substance-use disorders in low-and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low-and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.Fil: Ravindranath, Vijayalakshmi. Indian Institute of Science; IndiaFil: Dang, Hoang Minh. Vietnam National University; VietnamFil: Goya, Rodolfo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Bioquímicas de La Plata ; ArgentinaFil: Mansour, Hader. University of Pittsburgh; Estados Unidos. Mansoura University; EgiptoFil: Nimgaonkar, Vishwajit L.. University of Pittsburgh; Estados UnidosFil: Russell, Vivienne Ann. University of Cape Town; SudáfricaFil: Xin, Yu. Peking University; Chin