Hernies Ombilicales Étranglées De L’enfant Au Centre Hospitalier Régional De Ziguinchor (Sénégal)

The umbilical hernia is a well-known pathology even though, its strangulation has been subject to much controversy. The aim of this work is to report our experience in the management of strangulated hernia of the child at the Ziguinchor regional hospital and to compare our results with those of the literature through a retrospective and descriptive study over a four years period. During the study period 24 patients with high male predominance were received. The mean age of the patients was 2.1 years. 45% of patients had a chronic cough. The average time for consultation was 27.6 hours. A notion of abdominal abrupt was found in 45% of the cases. The vast majority of patients arrived at the hospital during the dry season. Abdominal pain and vomiting were the main symptoms. An occlusive syndrome was present in about half of the patients. The diameter of the collar of the hernia varied between 1.5 and 2.5 cm and no intestinal necrosis was found during exploration. The surgery was simple in the majority of cases. Umbilical hernia is a reality in under-developed environment some factors promotes its complications

Primary squamous cell carcinoma of the kidney in southern Senegal (Ziguinchor): case report and review of the literature

The kidney's primary squamous cell carcinoma is a rare tumor, representing 0.5-0.8% of malignant renal tumors and 4% of upper urinary tract tumors. This pathology often occurs after a long past history of renal lithiasis and repeated untreated or poorly treated urinary tract infections. The delay in diagnosis resulting from an insidious symptomatology, without specific signs, often leads to a pejorative development, especially in poor countries. A seventy-nine-year-old Senegalese woman, with no past history of lithiasis nor recurrent urinary tract infection and urinary schistosomiasis, was received for a recurrent total hematuria associated with left lumbar pain. Clinical examination revealed a mobile tender left lumbar mass, with lumbar contact and renal sloshing. The left renal tumor´s diagnosis was retained on clinical and scannographic arguments, justifying an enlarged left total nephrectomy, by laparotomy. The anatomopathological examination of the surgical sample made it possible to make the diagnosis of primary invasive squamous cell carcinoma of the left kidney and to find foci of carcinoma in-situ on squamous metaplasia in the calyxes. Unlike the typical case of primary squamous cell carcinoma of the kidney, our patient did not have a long past history of renal lithiasis nor untreated or poorly treated recurrent urinary tract infections and urinary schistosomiasis. Primary squamous cell carcinoma of the kidney may not be related to a past history of recurrent urinary tract infections and lithiasis, but to any other cause of squamous metaplasia of the urothelium. Surgery remains the best option for this entity

Prévalence de l’hypertension artérielle en milieu du travail : Cas du groupe Alucam au Cameroun: Prevalence of hypertension among workers : A case of the Alucam group in Cameroon

Context and objective. Hypertension (HTN), a silent killer, is a major global public health problem. Its magnitude remains however unknown in a professional environment. The objective of this study was to evaluate the frequency and risk factors associated with HTN among workers from the Alucam group in Cameroon. Method. A descriptive and analytical cross-sectional study of an exhaustive sample of workers from the Alucam Socatral industrial plant in Cameroon was conducted between January and September 2015. Parameters of interest included data on the determinants of the individual, the company, and Karasek’s psychosocial risk assessment as well as clinical data (measurement of blood pressure, height and weight). The Chi-square tests of Pearson and De Snedecor were used to compare the proportions. Odds ratio (OR) was used to assess risk factors associated to HTN. The statistical significance level was set at 5% (p < 0.05). Results. 637 employees were enrolled. Their average age was 52 years old and all were male. The prevalence of HTN was 14.3%. We noted a very significant hypertension prevalence among older workers compared to younger (OR = 16.95, p< 0.0001). HTA was significantly related to obesity (OR = 4.7, p < 0.0001). Almost all of the workers (90%) had not changed their service since being hired with a seniority of more than 30 years in 54% of the cases. Active workers accounted for 91% of all HTNs. According to psychosocial risk, the majority of workers (63%) was in the dial “job strain”, of which 70% were operators. Social support and decision latitude decreased as psychological demand increased. Conclusion. One in seven workers in this company is hypertensive. Age, obesity and shift work are associated with hypertension in the present study population. Contexte & objectif. L’hypertension (HTA), tueur silencieux, est un problème majeur de santé publique à travers le monde. Son ampleur reste cependant inconnue en milieu professionnel. L’objectif de la présente étude était d’évaluer la fréquence et les facteurs associés à l’HTA chez les travailleurs du groupe Alucam, au Cameroun. Méthodes. Nous avons conduit une étude transversale descriptive et analytique auprès d’un échantillon exhaustif des travailleurs de l’établissement industriel Alucam Socatral, entre janvier et septembre 2015, au Cameroun. Les paramètres d’intérêt englobaient les données relatives aux déterminants de l’individu, de l’entreprise et l’évaluation du risque psychosocial par le modèle de Karasek ainsi que les données cliniques (mesure de la pression artérielle, taille et poids). Les tests Khi² de Pearson et de De Snedecor ont été utilisés pour comparer les proportions. Odds ratio (OR) a permis d’évaluer les facteurs associés à l’HTA. Le seuil de signification statistique a été fixé à 5% (p < 0,05). Résultats. 637 employés ont été enrôlés. Leur âge moyen était de 52 ans et tous étaient du sexe masculin La prévalence de l’HTA était de 14,3 %. On notait une prévalence d’HTA très significative chez les travailleurs âgés par rapport aux plus jeunes (OR = 16,95, p < 0,0001). L’HTA était significativement liée avec l’obésité (OR 4,7, p = 0,0001). La quasi-totalité des travailleurs (90 %) n’avait pas changé de service depuis l’embauche avec une ancienneté de plus de 30 ans dans 54% des cas. Les travailleurs actifs constituaient 91 % des HTA. Selon le risque psychosocial, la majorité des travailleurs (63%) était dans le cadran « job strain », parmi lesquels 70 % étaient opérateurs. Le soutien social et la latitude décisionnelle diminuaient alors que la demande psychologique augmentait. Conclusion. Un travailleur sur sept de cette entreprise est hypertendu. L’âge, l’obésité et le travail posté sont associés à l’HTA dans notre population d’étude

Improving Antiretroviral Therapy Adherence in Resource-Limited Settings at Scale: a Discussion of Interventions and Recommendations

INTRODUCTION: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. METHODS: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. RESULTS AND DISCUSSION: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. CONCLUSION: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS

HBV continuum of care using community- and hospital-based screening interventions in Senegal: Results from the PROLIFICA programme

BACKGROUND & AIMS: Strategies to implement HBV screening and treatment are critical to achieve HBV elimination but have been inadequately evaluated in sub-Saharan Africa (sSA). METHODS: We assessed the feasibility of screen-and-treat interventions in 3 real-world settings (community, workplace, and hospital) in Senegal. Adult participants were screened using a rapid HBsAg point-of-care test. The proportion linked to care, the proportion who had complete clinical staging (alanine transaminase [ALT], viral load, and FibroScan®), and the proportion eligible for treatment were compared among the 3 intervention groups. RESULTS: In 2013-2016, a total of 3,665 individuals were screened for HBsAg in the community (n = 2,153) and in workplaces (n = 1,512); 199/2,153 (9.2%) and 167/1,512 (11%) were HBsAg-positive in the community and workplaces, respectively. In the hospital setting (outpatient clinics), 638 HBsAg-positive participants were enrolled in the study. All infected participants were treatment naïve. Linkage to care was similar among community-based (69.9%), workplace-based (69.5%), and hospital-based interventions (72.6%, p = 0.617). Of HBV-infected participants successfully linked to care, full clinical staging was obtained in 47.5% (66/139), 59.5% (69/116), and 71.1% (329/463) from the community, workplaces, and hospitals, respectively (p <0.001). The proportion eligible for treatment (EASL criteria) differed among community- (9.1%), workplace- (30.4%), and hospital-based settings (17.6%, p = 0.007). Acceptability of antiviral therapy, adherence, and safety at 1 year were very good. CONCLUSIONS: HBV screen-and-treat interventions are feasible in non-hospital and hospital settings in Senegal. However, the continuum of care is suboptimal owing to limited access to full clinical staging. Improvement in access to diagnostic services is urgently needed in sSA. LAY SUMMARY: Hepatitis B infection is highly endemic in Senegal. Screening for infection can be done outside hospitals, in communities or workplaces. However, the hepatitis B continuum of care is suboptimal in Senegal and needs to be simplified to scale-up diagnosis and treatment coverage

Toxicity of Malaysian Medicinal Plant Extracts Against Sitophilus oryzae and Rhyzopertha dominica

The insecticidal activities of extracts from 22 Malaysian medicinal plant extracts from 8 botanical families were tested against rice weevil: Sitophilus oryzae (L.) and lesser grain borer: Rhyzopertha dominica (F.). The extracts were obtained using hexane, methanol, and dichloromethane to extract potential biopesticides from dried leaves. The toxicity levels were examined periodically based on antifeedant activity and contact toxicity assays using treated grain assay. Hexane extracts of Alpinia conchigera, Alpinia scabra, Curcuma mangga, Curcuma purpurascens, Goniothalamus tapisoides, Piper sarmentosum , and methanol extracts of Curcuma aeruginosa, C. mangga , and Mitragyna speciosa were the most potent extracts against S. oryzae and R. dominica with lethal concentration (LC50) values of ≤ 0.42 mg/mL and ≤ 0.49 mg/mL, respectively. The contact toxicity test results showed that methanol extracts of C. aeruginosa and C. mangga , dichloromethane extracts of Cryptocarya nigra , and hexane extracts of C. mangga, and C. purpurascens resulted in 100% mortality of both pests within 28 days exposure of 5 mg/cm2 concentration

Gametocyte carriage in uncomplicated Plasmodium falciparum malaria following treatment with artemisinin combination therapy: a systematic review and meta-analysis of individual patient data

BACKGROUND: Gametocytes are responsible for transmission of malaria from human to mosquito. Artemisinin combination therapy (ACT) reduces post-treatment gametocyte carriage, dependent upon host, parasite and pharmacodynamic factors. The gametocytocidal properties of antimalarial drugs are important for malaria elimination efforts. An individual patient clinical data meta-analysis was undertaken to identify the determinants of gametocyte carriage and the comparative effects of four ACTs: artemether-lumefantrine (AL), artesunate/amodiaquine (AS-AQ), artesunate/mefloquine (AS-MQ), and dihydroartemisinin-piperaquine (DP). METHODS: Factors associated with gametocytaemia prior to, and following, ACT treatment were identified in multivariable logistic or Cox regression analysis with random effects. All relevant studies were identified through a systematic review of PubMed. Risk of bias was evaluated based on study design, methodology, and missing data. RESULTS: The systematic review identified 169 published and 9 unpublished studies, 126 of which were shared with the WorldWide Antimalarial Resistance Network (WWARN) and 121 trials including 48,840 patients were included in the analysis. Prevalence of gametocytaemia by microscopy at enrolment was 12.1 % (5887/48,589), and increased with decreasing age, decreasing asexual parasite density and decreasing haemoglobin concentration, and was higher in patients without fever at presentation. After ACT treatment, gametocytaemia appeared in 1.9 % (95 % CI, 1.7–2.1) of patients. The appearance of gametocytaemia was lowest after AS-MQ and AL and significantly higher after DP (adjusted hazard ratio (AHR), 2.03; 95 % CI, 1.24–3.12; P = 0.005 compared to AL) and AS-AQ fixed dose combination (FDC) (AHR, 4.01; 95 % CI, 2.40–6.72; P < 0.001 compared to AL). Among individuals who had gametocytaemia before treatment, gametocytaemia clearance was significantly faster with AS-MQ (AHR, 1.26; 95 % CI, 1.00–1.60; P = 0.054) and slower with DP (AHR, 0.74; 95 % CI, 0.63–0.88; P = 0.001) compared to AL. Both recrudescent (adjusted odds ratio (AOR), 9.05; 95 % CI, 3.74–21.90; P < 0.001) and new (AOR, 3.03; 95 % CI, 1.66–5.54; P < 0.001) infections with asexual-stage parasites were strongly associated with development of gametocytaemia after day 7. CONCLUSIONS: AS-MQ and AL are more effective than DP and AS-AQ FDC in preventing gametocytaemia shortly after treatment, suggesting that the non-artemisinin partner drug or the timing of artemisinin dosing are important determinants of post-treatment gametocyte dynamics

The effect of dose on the antimalarial efficacy of artemether-lumefantrine: a systematic review and pooled analysis of individual patient data

Background: Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings. Methods: We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. Findings: We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4-97·9) at day 28 and 96·0% (95·6-96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86-0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5-96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3-96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0·92, 95% CI 0·85-0·99; p=0·037 for every 1 mg/kg increase in total artemether dose). Interpretation: The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups. Funding: Bill and Melinda Gates Foundation