Aïnhum: Aspects cliniques, radiographiques et thérapeutiques à propos de 3 cas

The ainhum or spontaneous dactylolysis is a rare pathologic condition in which a hyperkeratosis necking groove is formed around the proximal portion of the fifth toe leading to its auto-amputation. They were three all male patients, aged 32-52 years, without concept of smoking, or similar family pathology, no notion of barefoot walking long distances or previous trauma. They consulted for pain of the fifth toe or for a desire of amputation of the fifth toe. Disease duration ranged from 18 months to 6 years. On examination, the patient was in good condition without fever. We noted a keratotic consistency constriction ring loose or tight enclosing the base of the right fifth toe. The other ends were free from any constriction. Radiography of the foot noted constriction adjacent soft parts in all patients and bone involvement in 2 patients. The diagnosis of aïnhum was made. A surgical treatment with Z-plasty or amputation was performed. The outcome was favorable with no uncommitted functional prognosis. The ainhum spontaneous is a rare disease, the diagnosis is clinical. The prognosis after surgical treatment is favorable. These observations by their diversity show different aspects of aïnhum

First results of phase 3 trial of RTS,S/AS01 malaria vaccine in african children

Background An ongoing phase 3 study of the efficacy, safety, and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries. Methods From March 2009 through January 2011, we enrolled 15,460 children in two age categories - 6 to 12 weeks of age and 5 to 17 months of age - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. The primary end point of the analysis was vaccine efficacy against clinical malaria during the 12 months after vaccination in the first 6000 children 5 to 17 months of age at enrollment who received all three doses of vaccine according to protocol. After 250 children had an episode of severe malaria, we evaluated vaccine efficacy against severe malaria in both age categories. Results In the 14 months after the first dose of vaccine, the incidence of first episodes of clinical malaria in the first 6000 children in the older age category was 0.32 episodes per person-year in the RTS,S/AS01 group and 0.55 episodes per person-year in the control group, for an efficacy of 50.4% (95% confidence interval [CI], 45.8 to 54.6) in the intention-to-treat population and 55.8% (97.5% CI, 50.6 to 60.4) in the per-protocol population. Vaccine efficacy against severe malaria was 45.1% (95% CI, 23.8 to 60.5) in the intention-to-treat population and 47.3% (95% CI, 22.4 to 64.2) in the per-protocol population. Vaccine efficacy against severe malaria in the combined age categories was 34.8% (95% CI, 16.2 to 49.2) in the per-protocol population during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalized convulsive seizures after RTS,S/AS01 vaccination was 1.04 per 1000 doses (95% CI, 0.62 to 1.64). Conclusions The RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619 .