Metformin overdose: A serious iatrogenic complication-Western France Poison Control Centre Data Analysis

INTRODUCTION: The prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the "gold standard" and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life-threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self-poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC). METHODS: Retrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC\u27s database (SICAP). The end-point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15). RESULTS: Of the 382 cases included, 197 concerned acute accidental exposures, 127 self-poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self-poisonings. High severity concerned 59 patients: 47 therapeutic accidents and 12 self-poisonings. T2D and age > 60 significantly increase the risk of high severity (OR 7.7, CI [1.54-38.41]; P = 0.013; OR 3.5, CI [1.60-7.84]; P = 0.002, respectively). CONCLUSIONS: Metformin may lead to MALA and severe poisoning in therapeutic accidents but also in self-poisoning circumstances. Among reported cases, T2D history and age >60 increase the risk of serious poisoning. Monitoring of their treatment should be taken seriously especially in the event of digestive symptoms such as diarrhoea

Key traveller groups of relevance to spatial malaria transmission: a survey of movement patterns in four sub-Saharan African countries

Background: As malaria prevalence declines in many parts of the world due to widescale control efforts and as drug-resistant parasites begin to emerge, a quantitative understanding of human movement is becoming increasingly relevant to malaria control. However, despite its importance, significant knowledge gaps remain regarding human movement, particularly in sub-Saharan Africa. Methods: A quantitative survey of human movement patterns was conducted in four countries in sub-Saharan Africa: Mali, Burkina Faso, Zambia, and Tanzania, with three to five survey locations chosen in each country. Questions were included on demographic and trip details, malaria risk behaviour, children accompanying travellers, and mobile phone usage to enable phone signal data to be better correlated with movement. A total of 4352 individuals were interviewed and 6411 trips recorded. Results: A cluster analysis of trips highlighted two distinct traveller groups of relevance to malaria transmission: women travelling with children (in all four countries) and youth workers (in Mali). Women travelling with children were more likely to travel to areas of relatively high malaria prevalence in Mali (OR = 4.46, 95 % CI = 3.42–5.83), Burkina Faso (OR = 1.58, 95 % CI = 1.23–1.58), Zambia (OR = 1.50, 95 % CI = 1.20–1.89), and Tanzania (OR = 2.28, 95 % CI = 1.71–3.05) compared to other travellers. They were also more likely to own bed nets in Burkina Faso (OR = 1.77, 95 % CI = 1.25–2.53) and Zambia (OR = 1.74, 95 % CI = 1.34 2.27), and less likely to own a mobile phone in Mali (OR = 0.50, 95 % CI = 0.39–0.65), Burkina Faso (OR = 0.39, 95 % CI = 0.30–0.52), and Zambia (OR = 0.60, 95 % CI = 0.47–0.76). Malian youth workers were more likely to travel to areas of relatively high malaria prevalence (OR = 23, 95 % CI = 17–31) and for longer durations (mean of 70 days cf 21 days, p < 0.001) compared to other travellers. Conclusions: Women travelling with children were a remarkably consistent traveller group across all four countries surveyed. They are expected to contribute greatly towards spatial malaria transmission because the children they travel with tend to have high parasite prevalence. Youth workers were a significant traveller group in Mali and are expected to contribute greatly to spatial malaria transmission because their movements correlate with seasonal rains and hence peak mosquito densities. Interventions aimed at interrupting spatial transmission of parasites should consider these traveller groups

Rapid susceptibility testing of Mycobacterium tuberculosis by the Mycobacteria Growth Indicator Tube (MGITAST SIRE)

ObjectiveTo evaluate the reliability of the Mycobacteria Growth Indicator Tube (MGITAST) for susceptibility testing of Mycobacterium tuberculosis.MethodsSeventy strains of M. tuberculosis were tested for susceptibility to streptomycin, isoniazid, rifampicin and ethambutol by comparing MGITAST results to those obtained by the method of proportion (MOP) on Lowenstein–Jensen (LJ) and Middlebrook 7H10 media. The 7H10 MOP was considered the method of reference.ResultsThe turnaround time for MGITAST was 6.2days (5–10days) and for MOP it was 18–21days. With rifampicin, MGITAST agreed for all isolates with both MOP. For streptomycin, MGITAST and 7H10 MOP agreed for 64 isolates (91.4%); 61 were susceptible and three resistant. LJ MOP and 7H10 MOP agreed for 64 isolates (92.2%); 62 were susceptible and three resistant. With isoniazid, both MOP agreed for all isolates, while MGITAST and 7H10 MOP had two discrepancies. For ethambutol, MGITAST and 7H10 MOP were concordant for 66 isolates; 65 were susceptible and one resistant. Both MOP were concordant for 67 isolates; 66 were susceptible and one resistant.ConclusionsBased on these results, MGITAST is a time-saving method and can be used as an alternative to the BACTEC System. MGITAST is reliable as far as rifampicin and isoniazid are concerned; however, additional studies are needed for streptomycin and ethambutol

Ostéo-arthrites tuberculeuses inhabituelles multifocales chez une patiente immunocompétente

Les formes multifocales de la tuberculose, surviennent habituellement chez des sujets immunodéprimés. Dans les formes multifocales, certaines localisations osseuses sont rares. Les auteurs rapportent le cas d'une patiente de 58 ans, immunocompétente qui présentait une tuberculose multifocale associant une atteinte pulmonaire et des localisations osseuses et articulaires inhabituelles (l'épaule, la cheville et le pied homolatéral, la branche illio-pubienne). Le diagnostic a été histologique (biopsie ostéo-articulaire) et bactériologique (mise en évidence des BAAR dans les crachats). Le traitement a été médico-chirurgical

Sensitivity study of the regional climate model RegCM4 to different convective schemes over West Africa

Abstract. The latest version of RegCM4 with CLM4.5 as a land surface scheme was used to assess the performance and sensitivity of the simulated West African climate system to different convection schemes. The sensitivity studies were performed over the West African domain from November 2002 to December 2004 at a spatial resolution of 50 km × 50 km and involved five convective schemes: (i) Emanuel; (ii) Grell; (iii) Emanuel over land and Grell over ocean (Mix1); (iv) Grell over land and Emanuel over ocean (Mix2); and (v) Tiedtke. All simulations were forced with ERA-Interim data. Validation of surface temperature at 2 m and precipitation were conducted using data from the Climate Research Unit (CRU), Global Precipitation Climatology Project (GPCP) and the Tropical Rainfall Measurement Mission (TRMM) during June to September (rainy season), while the simulated atmospheric dynamic was compared to ERA-Interim data. It is worth noting that the few previous similar sensitivity studies conducted in the region were performed using BATS as a land surface scheme and involved less convective schemes. Compared with the previous version of RegCM, RegCM4-CLM also shows a general cold bias over West Africa whatever the convective scheme used. This cold bias is more reduced when using the Emanuel convective scheme. In terms of precipitation, the dominant feature in model simulations is a dry bias that is better reduced when using the Emanuel convective scheme. Considering the good performance with respect to a quantitative evaluation of the temperature and precipitation simulations over the entire West African domain and its subregions, the Emanuel convective scheme is recommended for the study of the West African climate system

Cellulite nécrosante descendante infectieuse d’origine dentaire à diffusion mammaire : Analyse de deux cas

Les cellulites nécrosantes descendantes d’origine dentaire sont graves et de prise en charge difficile. Leur diffusion se fait classiquement vers le médiastin, les cavités pleurales, voir le cerveau. La diffusion spécifique à la glande mammaire est atypique, rare et peu décrite. Nous rapportons 2 cas colligés en 15 ans de pratique de chirurgie thoracique. Il s’agissait de deux patientes, l’une âgée de 32 ans et l’autre de 25 ans toutes vivaient en milieu rural. Leurs itinéraires diagnostiques et thérapeutiques, les facteurs de risque, les moyens thérapeutiques utilisés et leurs pronostics ont été discutés. Le but de ce travail était de mettre l’accent sur la gravité de cette pathologie et inciter à la mise en œuvre d’une politique de prévention à l’échelle nationale

Criblage bioguidé de métabolites secondaires anti-AGEs des feuilles de Calophyllum flavo-ramulum (Clusiaceae)

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Correction to: Identification of novel Y chromosome encoded transcripts by testis transcriptome analysis of mice with deletions of the Y chromosome long arm.

Following publication of the original article [1], the following error was reported: The actin control panel in Fig. 3 of this paper is reproduced from Fig. 7 of Touré et al, 2004 [2] by kind permission of the Genetics Society of America. Touré et al, 2004 used Northern blotting to show that the Y-linked genes Ssty1 and Ssty2 have reduced expression in a range of mouse genotypes with deletions on the Y chromosome long arm. This paper shows that two novel genes, Sly and Asty are also present on mouse Yq and have reduced expression in these deleted genotypes. A further companion paper was published in Human Molecular Genetics (Ellis et al, 2005 [3]) showing that X-linked genes are upregulated in the various deleted genotypes. Since two of the genotypes concerned are sterile and very hard to generate, all the Northern blot experiments in these papers were performed on a single membrane that was stripped and re-probed with a range of different X- and Y-linked genes. The same beta-actin loading control image thus necessarily applies to all the data presented, and was shown in all three papers. We regret that this was not mentioned appropriately in the Methods and figure legends at the time of publication

Schistosomiasis — Assessing Progress toward the 2020 and 2025 Global Goals

BACKGROUND: With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS: We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS: All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS: These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.)