Endocardite infectieuse en milieu cardiologique Dakarois: étude descriptive à propos de 39 cas

L’endocardite infectieuse est une complication fréquente des cardiopathies rhumatismales. L’objectif de ce travail était de faire une étude descriptive de l’endocardite infectieuse, en milieu hospitalier Dakarois. Il s’agit d’une étude rétrospective, descriptive, réalisée à la clinique cardiologique de l’hôpital Aristide Le Dantec, durant la période allant de Janvier 2004 à Décembre 2008. Etaient inclus tous les patients hospitalisés et traités pour endocardite infectieuse certaine ou probable, selon les critères de Durack. Nous avons étudié les paramètres épidémiologiques, cliniques, biologiques et échocardiographiques. Le nombre total d’admissions dans le service durant la période d’étude était de 3746 patients, dont 870 pour valvulopathies rhumatismales. Nous avions enregistré 39 cas d’endocardite infectieuse soit une prévalence de 1,04% et 4,48% valvulopathies rhumatismales. L’âge moyen de nos patients était de 24 plus ou moins 11,5 ans avec des extrêmes de 6 et 52 ans. Plus de la moitié des patients soit 58,9 % (23 patients) avaient moins de 25 ans. On notait une légère prédominance féminine avec un sex-ratio homes/femmes de 0,95. La porte d’entrée était essentiellement bucco-dentaire 40%. L’anémie était constante avec un taux d’hémoglobine moyen à 8,4g/dl. Les hémocultures étaient positives chez 6 patients et le Staphylococcus Aureus était le germe le plus retrouvé. L’électrocardiogramme avait montré des troubles du rythme et de la conduction respectivement dans 69,2 et 10,2% des cas. L’échographie cardiaque mettait en évidence des végétations chez tous les patients, une rupture de cordage dans 6 cas et un abcès chez trois patients. L’endocardite infectieuse constitue encore une réalité dans nos régions. Elle survient habituellement sur cardiopathie rhumatismale. Son diagnostic repose sur les hémocultures et l’échocardiographie

Faible taux de succès du sevrage tabagique à court et moyen termes au décours d’un infarctus aigu du myocarde dans un service de cardiologie de Dakar au Sénégal

Introduction:Le tabagisme est un puissant facteur de risque cardio-vasculaire. Son sevrage semble moins bien pris en compte chez les coronariens. Les objectifs de ce travail étaient d’évaluer la prévalence du tabagisme et le sevrage tabagique au décours d’un infarctus du myocarde dans un service de cardiologie au Sénégal. Méthodes: Il s’agit d’une étude transversale et descriptive réalisée entre janvier 2008 et juin 2010. Nous avons recruté les patients hospitalisés pour infarctus du myocarde puis les fumeurs actifs ont été inclus dans notre enquête. Les malades étaient sensibilisés pour l’arrêt du tabac puis suivis à 3 mois, 6 mois et 12 mois pour évaluer le sevrage tabagique. Résultats: Nous avons recensé 82 patients hospitalisés pour un infarctus du myocarde, parmi eux 26 sujets (25 hommes) étaient fumeurs (31,7%). L’âge moyen des sujets fumeurs était de 56 ± 11,5 ans. La consommation moyenne de tabac était de 32 ± 14 paquets-année et le score moyen de Fagerström de 8. Tous les patients ont arrêté le tabac pendant l’hospitalisation. Après un suivi de 3 mois, 45% des patients ont repris le tabac, 65% à 6 mois et 85% à 12 mois. Conclusion: Le tabagisme est assez fréquent chez les patients sénégalais présentant un infarctus du myocarde. Le taux de sevrage tabagique à court et moyen termes est faible. Le sevrage tabagique devrait alors constituer un objectif privilégié dans la prévention des maladies cardio-vasculaires.Key words: Tabagisme, sevrage, coronaropathie, risque cardio-vasculaire, Senega

Hypertension artérielle pulmonaire au cours de la sclérodermie: à propos de 12 cas

Introduction: La survenue de l’hypertension artérielle pulmonaire (HTAP) est un tournant dans l’évolution de la sclérodermie. L’objectif de cette étude est de décrire les aspects épidémiologiques et évolutifs de l’HTAP au cours de la sclérodermie systémique.Méthodes: Nous avons réalisé une étude descriptive concernant des patients suivis pour sclérodermie systémique, au service de Dermatologie de l’hôpital Aristide Le Dantec entre Janvier 2000 et Août 2009. Ces patients étaient inclus dans l’étude après exploration cardio-vasculaire (ECG, échocardiographie-Doppler). Nous avons étudié les paramètres épidémiologiques, cliniques, paracliniques et évolutifs des patients. Résultats: Nous avons enregistré 12 cas d’hypertension artérielle pulmonaire parmi les 83 patients atteints de sclérodermie systémique soit une prévalence de 14,45%. L’âge moyen des patients était de 43,58 ans ± 12,5 ans et le sex-ratio (H/F) de 0,33. Sur le plan clinique, la dyspnée était quasi constante (75%) et la douleur thoracique présente dans 25% des cas. Le syndrome de Raynaud était observé chez 8 patients soit 66,67% de nos patients. L’électrocardiogramme montrait des signes de surcharge droite chez 4 malades (33,33%) et la radiographie thoracique en faveur d’une fibrose pulmonaire chez 4 patients. L’échocardiographie-Doppler notait une insuffisance tricuspide importante dans 58, 33% des cas (7 patients), une pression artérielle pulmonaire systolique (PAPs) en moyenne de 66,25 ± 29,3 mmHg, une dilatation des cavités cardiaques droites dans 5 cas et un mouvement paradoxal du septum interventriculaire chez 3 malades (33,33%). Il était également noté 3 cas (25%) d’épanchement péricardique. Nous avons déploré 4 décès (33,33%).Conclusion: L’hypertension artérielle pulmonaire est une complication fréquente et grave de la sclérodermie. Son dépistage, grâce à l’échocardiographie- Doppler systématique, constitue une étape fondamentale de la prise en charge

Hepatitis B virus (HBV) infection amongst children in Senegal: current prevalence and seroprotection level

Introduction: hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal. Methods: between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels ≥ 10 IU/l) were considered as seroprotected against HBV. Results: during the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb ≥ 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb ≥ 100 IU/L. Conclusion: our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal

Multicentric assessment of the efficacy and tolerability of dihydroartemisinin-piperaquine compared to artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa

<p>Abstract</p> <p>Background</p> <p>The choice of appropriate artemisinin-based combination therapy depends on several factors (cost, efficacy, safety, reinfection rate and simplicity of administration). To assess whether the combination dihydroartemisinin-piperaquine (DP) could be an alternative to artemether-lumefantrine (AL), the efficacy and the tolerability of the two products for the treatment of uncomplicated falciparum malaria in sub-Saharan Africa have been compared.</p> <p>Methods</p> <p>A multicentric open randomized controlled clinical trial of three-day treatment of DP against AL for the treatment of two parallel groups of patients aged two years and above and suffering from uncomplicated falciparum malaria was carried out in Cameroon, Côte d'Ivoire and Senegal. Within each group, patients were randomly assigned supervised treatment. DP was given once a day for three days and AL twice a day for three days. Follow-up visits were performed on day 1 to 4 and on day 7, 14, 21, 28 to evaluate clinical and parasitological results. The primary endpoint was the recovery rate by day 28.</p> <p>Results</p> <p>Of 384 patients enrolled, 197 were assigned DP and 187 AL. The recovery rates adjusted by genotyping, 99.5% in the DP group and 98.9% in the AL group, were not statistically different (p = 0.538). No Early Therapeutic Failure (ETF) was observed. At day 28, two patients in the DP group and five in AL group had recurrent parasitaemia with <it>Plasmodium falciparum</it>. In the DP group, after PCR genotyping, one of the two recurrences was classified as a new infection and the other as recrudescence. In AL group, two recurrences were classified after correction by PCR as recrudescence. All cases of recrudescence were classified as Late Parasitological Failure (LPF). In each group, a rapid recovery from fever and parasitaemia was noticed. More than 90% of patients did no longer present fever or parasitaemia 48 hours after treatment. Both drugs were well tolerated. Indeed, no serious adverse events were reported during the follow-up period. Most of the adverse events which developed were moderate and did not result in the treatment being stopped in either treatment group.</p> <p>Conclusions</p> <p>Dihydroartemisinin-piperaquine was as effective and well-tolerated as artemether-lumefantrine in the treatment of uncomplicated falciparum malaria. In addition, dihydroartemisinin-piperaquine, a single daily dose, could be an advantage over artemether-lumefantrine in Africa because of better treatment observance.</p

Antibiotic Treatment of the Tick Vector Amblyomma americanum Reduced Reproductive Fitness

BACKGROUND: The lone star tick Amblyomma americanum is a common pest and vector of infectious diseases for humans and other mammals in the southern and eastern United States. A Coxiella sp. bacterial endosymbiont was highly prevalent in both laboratory-reared and field-collected A. americanum. The Coxiella sp. was demonstrated in all stages of tick and in greatest densities in nymphs and adult females, while a Rickettsia sp. was less prevalent and in lower densities when present. METHODOLOGY/PRINCIPAL FINDINGS: We manipulated the numbers of both bacterial species in laboratory-reared A. americanum by injecting engorged nymphs or engorged, mated females with single doses of an antibiotic (rifampin or tetracycline) or buffer alone. Burdens of the bacteria after molting or after oviposition were estimated by quantitative polymerase chain reaction with primers and probes specific for each bacterial species or, as an internal standard, the host tick. Post-molt adult ticks that had been treated with rifampin or tetracycline had lower numbers of the Coxiella sp. and Rickettsia sp. and generally weighed less than ticks that received buffer alone. Similarly, after oviposition, females treated previously with either antibiotic had lower burdens of both bacterial species in comparison to controls. Treatment of engorged females with either antibiotic was associated with prolonged time to oviposition, lower proportions of ticks that hatched, lower proportions of viable larvae among total larvae, and lower numbers of viable larvae per tick. These fitness estimators were associated with reduced numbers of the Coxiella sp. but not the Rickettsia sp. CONCLUSION/SIGNIFICANCE: The findings indicate that the Coxiella sp. is a primary endosymbiont, perhaps provisioning the obligately hematophagous parasites with essential nutrients. The results also suggest that antibiotics could be incorporated into an integrated pest management plan for control of these and other tick vectors of disease

Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Quinine remains an important anti-malarial drug almost 400 years after its effectiveness was first documented. However, its continued use is challenged by its poor tolerability, poor compliance with complex dosing regimens, and the availability of more efficacious anti-malarial drugs. This article reviews the historical role of quinine, considers its current usage and provides insight into its appropriate future use in the treatment of malaria. In light of recent research findings intravenous artesunate should be the first-line drug for severe malaria, with quinine as an alternative. The role of rectal quinine as pre-referral treatment for severe malaria has not been fully explored, but it remains a promising intervention. In pregnancy, quinine continues to play a critical role in the management of malaria, especially in the first trimester, and it will remain a mainstay of treatment until safer alternatives become available. For uncomplicated malaria, artemisinin-based combination therapy (ACT) offers a better option than quinine though the difficulty of maintaining a steady supply of ACT in resource-limited settings renders the rapid withdrawal of quinine for uncomplicated malaria cases risky. The best approach would be to identify solutions to ACT stock-outs, maintain quinine in case of ACT stock-outs, and evaluate strategies for improving quinine treatment outcomes by combining it with antibiotics. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

BACKGROUND: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. METHODS: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. FINDINGS: We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. INTERPRETATION: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. FUNDING: Wellcome Trust