Geriatric in Patient Profile at the Department of Internal Medicine at Niamey National Hospital, Niger

Background: The ageing population in developing countries has brought a demographic and an epidemiological transition, with the impact of chronic diseases resulting from life style changes on the health status of the population. Objective: To describ a profile geriatrics patient, specifically to identify epidemiologic, clinical, etiologic and outcome of this group at the department of internal medicine to NNH Patients and method: Medical records of all geriatric patients aged ≥65 years admitted at the department of NNH Between January 2012 and December 2015 were retrieved and reviewed retrospectively. Results: A total of 6074 admissions at the internal medicine department of NNH over three years were reported and 1130 (18, 6%) were geriatrics patients, the average age was 75, 95 years and more than half were men (50,7%). 80 % of patients were in the young old group (65-74 years), 13% in the old group (75-84 years) and 7% in the oldest old group (≥85 years). High blood pressure was the frequent comorbidity (12, 3%) and the most symptoms caused hospitalization were stroke (17, 6%), fevers (16, 5%) and worst health (13, 1%). Frequent illnesses were cardiovascular diseases (38.4%), infections, (19.2%) and endocrine diseases (11%). The average length of hospital stays was 8, 7 days. The mortality rate was 18, 2% and the worst outcomes factors were female sex, frail elderly group in 75 to 84 years and high blood pressure. Conclusion: Chronic diseases were responsible of morbidity and mortality for the majority elderly’s patient

In Vitro Anticholinesterase and Inhibitory Effects of the Aqueous Extract of Combretum molle (Combretaceae) Leaf on Rabbit Breathing

Purpose: In previous studies, the aqueous extract of Combretum molle was shown to inhibit disturbances of breathing induced by acetylcholine. The aim of this study was to elucidate the mechanism of this inhibition. Methods: The aqueous extract of Combretum molle and an anti-asthmatic, salbutamol (reference), were tested at varying concentrations for their inhibitory effects on breathing. Acetylcholinesterase (AChE) was extracted from rabbit duodenum and its activity determined by Ellman’s assay using acethylthiocholine iodide (ACTH) as substrate. The rate of hydrolysis of acetylcholinesterase was spectrophotometrically monitored at 412 nm.Results: The results indicate that in the presence of C. molle extract, a considerable reduction in the variation of breathing amplitudes occurred. Furthermore, the extract probably contains anti-AChE substances. C. molle exerted non-competitive inhibition of acetylcholinesterase with Michaelis-Menten constant (KM) of 192 μM and velocity at maximal concentration of substrate (Vmax) of 4444 μM/min. Conclusion: These results support the use of C. molle leaf in the Pharmacopoeia of Ivory Coast as an anti-asthmatic, in view of its inhibitory effect on breathing disturbances.Keywords: Combretum molle, Acetylcholinesterase, Breathing disturbances, Salbutamol, Anti-asthmati

High resolution melting: a useful field-deployable method to measure dhfr and dhps drug resistance in both highly and lowly endemic Plasmodium populations

Background: Emergence and spread of drug resistance to every anti-malarial used to date, creates an urgent need for development of sensitive, specifc and feld-deployable molecular tools for detection and surveillance of validated drug resistance markers. Such tools would allow early detection of mutations in resistance loci. The aim of this study was to compare common population signatures and drug resistance marker frequencies between two populations with diferent levels of malaria endemicity and history of anti-malarial drug use: Tanzania and Sénégal. This was accomplished by implementing a high resolution melting assay to study molecular markers of drug resistance as compared to polymerase chain reaction–restriction fragment length polymorphism (PCR/RFLP) methodology. Methods: Fifty blood samples were collected each from a lowly malaria endemic site (Sénégal), and a highly malaria endemic site (Tanzania) from patients presenting with uncomplicated Plasmodium falciparum malaria at clinic. Data representing the DHFR were derived using both PCR–RFLP and HRM assay; while genotyping data representing the DHPS were evaluated in Senegal and Tanzania using HRM. Msp genotyping analysis was used to characterize the multiplicity of infection in both countries. Results: A high prevalence of samples harbouring mutant DHFR alleles was observed in both population using both genotyping techniques. HRM was better able to detect mixed alleles compared to PCR/RFLP for DHFR codon 51 in Tanzania; and only HRM was able to detect mixed infections from Senegal. A high prevalence of mutant alleles in DHFR (codons 51, 59, 108) and DHPS (codon 437) were found among samples from Sénégal while no mutations were observed at DHPS codons 540 and 581, from both countries. Overall, the frequency of samples harbouring either a single DHFR mutation (S108N) or double mutation in DHFR (C59R/S108N) was greater in Sénégal compared to Tanzania Conclusion: Here the results demonstrate that HRM is a rapid, sensitive, and feld-deployable alternative technique to PCR–RFLP genotyping that is useful in populations harbouring more than one parasite genome (polygenomic infections). In this study, a high levels of resistance polymorphisms was observed in both dhfr and dhps, among samples from Tanzania and Sénégal. A routine monitoring by molecular markers can be a way to detect emergence of resistance involving a change in the treatment policy

Discrepant Prevalence and Incidence of Leishmania Infection between Two Neighboring Villages in Central Mali Based on Leishmanin Skin Test Surveys

Leishmaniasis is a vector-borne disease transmitted to humans by the bite of an infected sand fly. Leishmaniasis is present in more than 88 countries and affects more than 12 million people. Depending on the species of Leishmania, the host can develop cutaneous leishmaniasis (CL), which is characterized by skin ulcers in uncovered parts of the body or a more severe form, visceral leishmaniasis, which affects the liver and spleen and is fatal if not treated. This study aims to establish the past and present infection with Leishmania parasites in two villages where recent cases have been diagnosed by the dermatology center (CNAM) in Bamako. This was achieved using a Leishmania-specific skin test that was administered annually to permanent residents of Kemena and Sougoula villages from 2006 to 2008. The results show that transmission of Leishmania is active and stable in these two villages. Moreover, despite sharing similar cultural and environmental features, the individuals from Kemena presented three times the risk of Leishmania infection compared with those from Sougoula. Our findings raise awareness of the continued presence of CL in Mali

Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal.

BACKGROUND: Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1-9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1-9 year-olds falls 1% in all districts. CONCLUSION: With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct

Quinine Treatment Selects the pfnhe-1 ms4760-1 Polymorphism in Malian Patients with Falciparum Malaria

Background. The mechanism of Plasmodium falciparum resistance to quinine is not known. In vitro quantitative trait loci mapping suggests involvement of a predicted P. falciparum sodium-hydrogen exchanger (pfnhe-1) on chromosome 13. Methods. We conducted prospective quinine efficacy studies in 2 villages, Kolle and Faladie, Mali. Cases of clinical malaria requiring intravenous therapy were treated with standard doses of quinine and followed for 28 days. Treatment outcomes were classified using modified World Health Organization protocols. Molecular markers of parasite polymorphisms were used to distinguish recrudescent parasites from new infections. The prevalence of pfnhe-1 ms4760-1 among parasites before versus after quinine treatment was determined by direct sequencing. Results. Overall, 163 patients were enrolled and successfully followed. Without molecular correction, the mean adequate clinical and parasitological response (ACPR) was 50.3% (n = 163). After polymerase chain reaction correction to account for new infections, the corrected ACPR was 100%. The prevalence of ms4760-1 increased significantly, from 26.2% (n = 107) before quinine treatment to 46.3% (n = 54) after therapy (P = .01). In a control sulfadoxine-pyrimethamine study, the prevalence of ms4760-1 was similar before and after treatment. Conclusions. This study supports a role for pfnhe-1 in decreased susceptibility of P. falciparum to quinine in the field.Howard Hughes Medical Institute [55005502]; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health; European and Developing Countries Clinical Trials Partnership [EDCTP IP_07_31060_002]info:eu-repo/semantics/publishedVersio

Identification by PCR of Non-typhoidal Salmonella enterica Serovars Associated with Invasive Infections among Febrile Patients in Mali

The genus Salmonella has more than 2500 serological variants (serovars), such as Salmonella enterica serovar Typhi and Salmonella Paratyphi A and B, that cause, respectively, typhoid and paratyphoid fevers (enteric fevers), and a large number of non-typhoidal Salmonella (NTS) serovars that cause gastroenteritis in healthy hosts. In young infants, the elderly and immunocompromised hosts, NTS can cause severe, fatal invasive disease. Multiple studies of pediatric patients in sub-Saharan Africa have documented the important role of NTS, in particular Salmonella Typhimurium and Salmonella Enteritidis (and to a lesser degree Salmonella Dublin), as invasive bacterial pathogens. Salmonella spp. are isolated from blood and identified by standard microbiological techniques and the serovar is ascertained by agglutination with commercial antisera. PCR-based typing techniques are becoming increasingly popular in developing countries, in part because high quality typing sera are difficult to obtain and expensive and H serotyping is technically difficult. We have developed a series of polymerase chain reactions (PCRs) to identify Salmonella Typhimurium and variants, Salmonella Enteritidis and Salmonella Dublin. We successfully identified 327 Salmonella isolates using our multiplex PCR. We also designed primers to detect Salmonella Stanleyville, a serovar found in West Africa. Another PCR generally differentiated diphasic Salmonella Typhimurium and monophasic Salmonella Typhimurium variant strains from other closely related strains. The PCRs described here will enable more laboratories in developing countries to serotype NTS that have been isolated from blood

Evaluation of the Human IgG Antibody Response to Aedes albopictus Saliva as a New Specific Biomarker of Exposure to Vector Bites

Aedes-borne viruses like dengue and chikungunya are a major problem in Reunion Island. Assessing exposure to Aedes bites is crucial to estimating the risk of pathogen transmission. Currently, the exposure of populations to Aedes albopictus bites is mainly evaluated by entomological methods which are indirect and difficult to apply on a large scale. Recent findings suggest that evaluation of human antibody responses against arthropod salivary proteins could be useful in assessing exposure to mosquito bites. The results indicate that 88% of the studied population produce IgG to Ae. albopictus saliva antigens in Reunion Island and show that this biomarker can detect different levels of individual exposure. In addition, little cross-reactivity is observed with Aedes aegypti saliva, suggesting that this could be a specific marker for exposure to Aedes albopictus bites. Taken together, these results suggest that antibody responses to saliva could constitute a powerful immuno-epidemiological tool for evaluating exposure to Aedes albopictus and therefore the risk of arbovirus infection