4 research outputs found

    Etiologies des insuffisances surrenaliennes au Niger

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    Dans le but de contribuer Ă  l’amĂ©lioration de la prise en charge de l’insuffisance surrĂ©nalienne Ă  l’HĂ´pital national de Niamey, nous avons rĂ©alisĂ© une enquĂŞte prospective de 12 mois portant sur les patients, de tout âge, admis pour une insuffisance surrĂ©nalienne dans le service de mĂ©decine interne de l’HĂ´pital National de Niamey. Au terme de notre enquĂŞte, nous avons colligĂ©s 31 cas d’insuffisance surrĂ©nalienne. Le sex ratio Ă©tait de 0,069. L’âge moyen de survenue Ă©tait de 39,1±9,6ans avec des extrĂŞmes allant de 12 Ă  62 ans. Les principaux signes retrouvĂ©s Ă©taient : l’asthĂ©nie (100%), les douleurs articulaires ou musculaires (83,9%), l’amaigrissement (67,7%) et l’anorexie (58,1%). Le dosage de la CortisolĂ©mie de 8h Ă©tait la clĂ© du diagnostic et avait rĂ©vĂ©lĂ© un taux moyen de 54,01±54,16 nmol/l. Le taux moyen de l’ACTH plasmatique Ă©tait de 47,38±42,33 pg/ml. Les troubles Ă©lectrolytiques Ă©taient prĂ©sents dans 48,4% des cas. L’insuffisance corticotrope touchait 87,1% des patients et l’insuffisance surrĂ©nalienneprimaire (12,9%). L’hormonothĂ©rapie par l’hydrocortisone nous avait permis d’avoir une normalisation dans 64,5% des cas, et la guĂ©rison dans 6,5% des cas. Une insuffisance surrĂ©nale aiguĂ« (ISA) Ă©tait survenue dans 16,1% des cas. L’insuffisance surrĂ©nalienne est une pathologie assez rare. Le dosage de la CortisolĂ©mie de 8h permet de poser le diagnostic le plus souvent. Une bonne prise en charge et une Ă©ducation thĂ©rapeutique permet une Ă©volution favorable. Mots clĂ©s : Insuffisance surrĂ©nalienne chronique, CortisolĂ©mie de 8h, Insuffisance corticotrope, Niamey. English Title: Etiologies of adrenal insufficiency in Niger With objective to contribute to improving the management of adrenal insufficiency at the Niamey National Hospital, we have realized an 12-month prospective investigation of patients of all ages admitted for adrenal insufficiency in the Internal Medicine Department of the National Hospital of Niamey. At the end of our investigation, we collected 31 cases of adrenal insufficiency. The sex ratio was 0.069. The mean age of onset was 39.1 ± 9.6 years with extremes ranging from 12 to 62 years. The main signs found were: asthenia (100%), joint or muscle pain (83.9%), weight loss (67.7%) andanorexia (58.1%). The determination of 8-h cortisolemia was the key to the diagnosis and revealed an average rate of 54.01 ± 54.16 nmol / l. The mean plasma ACTH levelwas 47.38 ± 42.33 pg / ml. Electrolyte disorders were present in 48.4% of cases.  Corticotropic insufficiency affected 87.1% of patients and primary adrenal insufficiency (12.9%). Hormonal therapy with hydrocortisone allowed us to have normalization in 64.5% of cases, and healing in 6.5% of cases. Acute adrenal insufficiency (ISA) occurred in 16.1% of cases. Adrenal insufficiency is a rather rare pathology. The determination of the cortisolemia of 8h makes it possible to pose the diagnosis most often. Good care and a therapeutic education allows a favorable evolution. Keywords: Chronic adrenal insufficiency, Cortisol level, corticotropic insufficiency, Niamey

    Natural history of malaria infections during early childhood in twins.

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    BACKGROUND: The frequency and clinical presentation of malaria infections show marked heterogeneity in epidemiological studies. However, deeper understanding of this variability is hampered by the difficulty in quantifying all relevant factors. Here, we report the history of malaria infections in twins, who are exposed to the same in utero milieu, share genetic factors and are similarly exposed to vectors. METHODS: Data were obtained from a Malian longitudinal birth cohort. Samples from 25 twin pairs were examined for malaria infection and antibody responses. Bayesian models were developed on the number of infections during follow-up. RESULTS: In 16/25 pairs, both children were infected and often developed symptoms. In 8/25 pairs, only one twin was infected, but usually only once or twice. Statistical models suggest this pattern is not inconsistent with twin siblings having the same underlying infection rate. In a pair with discordant hemoglobin genotype, parasite densities were consistently lower in the child with hemoglobin AS, but antibody levels were similar. CONCLUSIONS: By using a novel design, we describe residual variation in malaria phenotypes in naturally-matched children and confirm the important role of environmental factors, as suggested by the between twin pair heterogeneity in malaria history
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