Monitoring the efficacy and safety of three artemisinin based-combinations therapies in Senegal: results from two years surveillance

BACKGROUND: Malaria remains a major public health problem in developing countries. Then in these countries prompt access to effective antimalarial treatment such as Artemisinin based-Combination Therapies (ACT) proves to be an essential tool for controlling the disease. In Senegal, since 2006 a nationwide scaling up program of ACT is being implemented. In this context it has become relevant to monitor ACT efficacy and provide recommendations for the Senegalese national malaria control program. METHODS: An open randomized trial was conducted during two malaria transmission seasons (2011 and 2012) to assess the efficacy and safety of three combinations: dihydro-artemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). The primary end point of the study was represented by a PCR adjusted adequate clinical and parasitological response (ACPR) at day 28. Secondary end points included: (i) a ACPR at days 35 and 42, (ii) a parasite and fever clearance time, (iii) ACTs safety and tolerability. The 2003 WHO’s protocol for antimalarial drug evaluation was used to assess each outcome. RESULTS: Overall, 534 patients were randomized selected to receive, either ASAQ (n = 180), AL (n = 178) or DHAPQ (n = 176). The PCR adjusted ACPR at day 28 was 99.41% for the group ASAQ, while that was 100% in the AL and DHAPQ groups (p = 0.37). The therapeutic efficacy was evaluated at 99.37% in the ASAQ arm versus 100% in AL and DHAPQ arm at day 35 (p = 0.37). At day 42, the ACPR was 99.27% in the ASAQ group versus 100% for both AL and DHAPQ groups, (p = 0.36). No serious adverse event was noted during the study period. Also a similar safety profile was noted in the 3 study groups. CONCLUSION: In the context of scaling up of ACTs in Senegal, ASAQ, AL and DHAPQ are highly effective and safe antimalarial drugs. However, it’s remains important to continue to monitor their efficacy. TRIAL REGISTRATION: PACTR 201305000552290

Efficacy and tolerability of a new formulation of artesunate-mefloquine for the treatment of uncomplicated malaria in adult in Senegal: open randomized trial

BACKGROUND: Prompt treatment of malaria attacks with arteminisin-based combination therapy (ACT) is an essential tool for malaria control. A new co-blister tablet of artesunate-mefloquine (AM) with 25 mg/kg mefloquine has been developed for the management of uncomplicated malaria attacks. This non-inferiority randomized trial, was conducted to evaluate the efficacy and safety of the new formulation of AM in comparison to artemether-lumefantrine (AL) for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in Senegal. METHODS: The study was carried out from September to December 2010 in two health centres in Senegal. The study end points included (i) PCR corrected adequate clinical and parasitological response (ACPR) at day 28, (ii) ACPR at days 42 and 63, (iii) parasites and fever clearance time, (iv) incidence of adverse events and patients biological profile at day 7 using the WHO 2003 protocol for anti-malarial drug evaluation. RESULTS: Overall, 310 patients were randomized to receive either AM (n = 157) or AL (n = 153). PCR corrected ACPR at day 28 was at 95.5% in the AM arm while that in the AL arm was at 96.7% (p = 0.83). Therapeutic efficacy was at 98.5% in the AM arm versus 98.2% in the AL group at day 42 (p = 1). At day 63, ACPR in the AM and AL arms was at 98.2% and 97.7%, respectively (p = 0.32). The two treatments were well tolerated with similar biological profile at day 7. However, dizziness was more frequent in the AM arm. CONCLUSION: Artesunate-mefloquine (25 mg/Kg mefloquine) is efficacious and well-tolerated for the treatment of uncomplicated P. falciparum malaria in adult patients

Contribution of Dehydration and Malnutrition to the Mortality of Children 0-59 Month of Age in a Senegalese Pediatric Hospital

In-hospital mortality is an indicator of the quality of care. We analyzed the mortality of under five years children of Pediatric ward of Aristide Le Dantec teaching hospital to update our data, after an previous study conducted ten years earlier.Methods: This was a retrospective study involving children 0-59 months of age, hospitalized from January 1, 2012 to December 31, 2012.For each child, nutritional status was assessed according to 2006 World Health Organization growth standards; clinical and biological data were recorded. The outcome of the disease was specified. Bivariate and multivariable were used to identify risk factors for death.Results: 393 children were included. Overall mortality rate was 10% (39/393). Factors associated with death were severe wasting [OR = 8.27, 95% CI [3.79-18], male gender (OR = 2.98, 95% CI [1.25-7.1]), dehydration (OR = 5.4, 95% CI [2.54-13.43]) in the model using the weight-for- height z score, male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in using the height- for- age z score, male gender (OR = 2.7, 95% CI [1.19-6.24]), dehydration (OR = 7.5, 95% CI [3.39-16.76]), severe underweight (OR = 2.4, 95% CI [1.11-5.63]), in the model using the weight-for- age z score, and male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in that using MUAC.Dehydration and malnutrition are two independent factors of mortality. Our management protocols of dehydration and malnutrition have to be updated. Screening malnutrition has to be done systematically for each child by anthropometric measurements using WHO growth standards

The association between malaria parasitaemia, erythrocyte polymorphisms, malnutrition and anaemia in children less than 10 years in Senegal:a case control study

BACKGROUND: Malaria and anaemia (Haemoglobin <11 g/dl) remain frequent in tropical regions and are closely associated. Although anaemia aetiologies are known to be multi-factorial, most studies in malaria endemic areas have been confined to analysis of possible associations between anaemia and individual factors such as malaria. A case control study involving children aged from 1 to 10 years was conducted to assess some assumed contributors to anaemia in the area of Bonconto Health post in Senegal. METHODS: Study participants were randomly selected from a list of children who participated in a survey in December 2010. Children aged from 1 to 10 years with haemoglobin level below 11 g/dl represented cases (anaemic children). Control participants were eligible if of same age group and their haemoglobin level was >= 11 g/dl. For each participant, a physical examination was done and anthropometric data collected prior to a biological assessment which included: malaria parasitaemia infection, intestinal worm carriage, G6PD deficiency, sickle cell disorders, and alpha-talassaemia. RESULTS: Three hundred and fifty two children < 10 years of age were enrolled (176 case and 176 controls). In a logistic regression analysis, anaemia was significantly associated with malaria parasitaemia (aOR=5.23, 95%CI[1.1-28.48]), sickle cell disorders (aOR=2.89, 95%CI[1,32-6.34]), alpha-thalassemia (aOR=1.82, 95%CI[1.2-3.35]), stunting (aOR=3.37, 95%CI[1.93-5.88], age ranged from 2 to 4 years (aOR=0.13, 95%CI[0.05-0.31]) and age > 5 years (aOR=0.03, 95%CI[0.01-0.08]). Stratified by age group, anaemia was significantly associated with stunting in children less than 5 years (aOR=3.1 95%CI[1.4 – 6.8]), with, sickle cell disorders (aOR=3.5 95%CI [1.4 – 9.0]), alpha-thalassemia (or=2.4 95%CI[1.1–5.3]) and stunting (aOR=3.6 95%CI [1.6–8.2]) for children above 5 years. No association was found between G6PD deficiency, intestinal worm carriage and children’s gender. CONCLUSION: Malaria parasitaemia, stunting and haemoglobin genetic disorders represented the major causes of anaemia among study participants. Anaemia control in this area could be achieved by developing integrated interventions targeting both malaria and malnutrition

Assessment of the potential of Vachellia seyal and Prosopis chilensis for the reclamation of saline soil lands in the peanut basin production of Senegal

Soil properties and microbial activities are indicators that shape plant communities and evolution. We aimed to determine the interdependency between trees, belowground herbaceous plants, soil characteristics, and arbuscular mycorrhizal communities. Vachellia seyal and Prosopis chilensis and their associated herb layers were targeted. Soils sampled beneath the trees and outside the canopies were subjected to physicochemical and microbial characterization. Randomly collected living roots of trees and dominant herbs were checked for arbuscular mycorrhizal colonization. A tree seedlings nursery was conducted using black bags filled with the following substrates: natural soil 100%, soil mixed with leaf tree plants (LTPs) as organic matter at 10%, soil mixed with LTP at 20%, soil mixed with LTP at 30%, and soil mixed with LTP at 50%. As a result, the presence of trees improves both herb richness and diversity. Soil mycorrhizal inoculum potentials are higher beneath V. seyal than P. chilensis and decreased significantly with increasing distance from trees. The soil MIP decreased with increasing organic matter content for both tree species but was more pronounced for P. chilensis. Soil salinity is lower beneath V. seyal and higher under P. chilensis and outside the canopies. Soil fertility parameters such as carbon, nitrogen, and available phosphorus are higher beneath the trees and then decreased as the distance to the trees increases. We conclude that microbial communities, soil properties, and herb richness and diversity increased beneath the trees but decreased with increasing distance from the trees. This effect is tree species-dependent as P. chilensis increased soil salinity and decreased the belowground density of herbs

Safety and Efficacy of Adding a Single Low Dose of Primaquine to the Treatment of Adult Patients With Plasmodium falciparum Malaria in Senegal, to Reduce Gametocyte Carriage: A Randomized Controlled Trial.

Introduction: More information is needed about the safety of low-dose primaquine in populations where G6PD deficiency is common. Methods: Adults with Plasmodium falciparum malaria were randomized to receive 1 of 3 artemisinin combination therapies (ACTs) with or without primaquine (0.25 mg/kg). Glucose-6-phosphate dehydrogenase (G6PD) status was determined using a rapid test. Patients were followed for 28 days to record hemoglobin concentration, adverse events, and gametocyte carriage. The primary end point was the change in Hb at day 7. Results: In sum, 274 patients were randomized, 139 received an ACT alone, and 135 received an ACT + primaquine. The mean reduction in Hb at day 7 was similar in each group, a difference in the ACT + PQ versus the ACT alone group of -0.04 g/dL (95% confidence interval [CI] -0.23, 0.31), but the effect of primaquine differed according to G6PD status. In G6PD-deficient patients the drop in Hb was 0.63 g/dL (95% CI 0.03, 1.24) greater in those who received primaquine than in those who received an ACT alone. In G6PD-normal patients, the reduction in Hb was 0.22 g/dL (95% CI -0.08, 0.52) less in those who received primaquine (interaction P = .01). One G6PD normal patient who received primaquine developed moderately severe anaemia (Hb < 8 g/dL). Dark urine was more frequent in patients who received primaquine. Primaquine was associated with a 73% (95% CI 24-90) reduction in gametocyte carriage (P = .013). Conclusion: Primaquine substantially reduced gametocyte carriage. However, the fall in Hb concentration at day 7 was greater in G6PD-deficient patients who received primaquine than in those who did not and one patient who received primaquine developed moderately severe anemia. Clinical Trial registration: PACTR201411000937373 (www.pactr.org)

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patient's functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good

Asphyxie Perinatale Au Service De Neonatologie De L’hopital De La Paix De Ziguinchor (Senegal)

Introduction: Perinatal asphyxia (PA) is one of the reasons for the transfer of the newborn to neonatal resuscitation services. The objective of this work was to study the epidemiological, obstetrical, clinical and evolutionary aspects of PA at the Ziguinchor Peace Hospital. Materials and methods: This was a retrospective study of cases of hospitalized HAs during the period 1 December 2015 to 31 May 2017. The diagnosis of PA was based on an anomaly of the rhythm Fetal heart rate and / or amniotic fluid abnormality; A score of Apgar &lt;7 at the 5th minute and / or the absence of an immediate cry at birth. We collected epidemiological, obstetric, clinical and evolutionary data. Results: We collected 153 cases of PA (90 boys and 63 girls) among 742 newborns, an incidence of 20.6% of neonatal hospitalizations. The mean age of mothers was 17.2 years; 82.0% of mothers were between 18 and 35 years of age and half (50.3%) had four or more NPCs. Anemia (37.0%), maternal infection (36.4%), hypertension (30.9%), premature rupture of membranes (RPM) (28.6%), eclampsia and Preeclampsia (9.9%) were the main obstetric complications. The delivery was performed by Caesarean section in 52.3% of cases and by low procedure in 47.7% of cases. The term of birth was between 37 and 41 SA in 53.3% of the cases. The amniotic fluid (LA) was tinted in 55.7% of the cases and meconium in 12.3%. At the 5th minute, 42.6% of the infants had an Apgar score &lt;7. One hundred percent of the children (n = 153) had been aspirated at birth and 24.8% (n = 38) had been ventilated To the mask. One hundred and twenty-three patients (80.3%) had anoxo-ischemic encephalopathy, of which 95 (77.2%) were in stage 1; 27 (22.0%) were in stage 2 and 1 (0.8%) was in stage 3 of the Sarnat classification. The main neurological signs were the anomalies of archaic reflexes (64.2%); Tone disorders (57.7%); Disorders of consciousness (22.8%); Convulsions (21.9%). The case fatality rate was 10.4% (16 deaths). Deaths were significantly associated with low birth, MMP, mask ventilation, respiratory distress, and convulsion. Conclusion: PA accounts for 20.6% of neonatal hospitalizations at the Ziguinchor Peace Hospital. Its lethality is 10.4%. It is associated with high morbidity

Puerperal uterine inversion: a new case report

Puerperal uterine inversion is a rare and severe affection which the uterine fundus collapses into the endometrial cavity. The diagnosis is essentially made on clinical examination, which also allows to determinate the gravity. The management must be done early, which can be surgical or non-surgical. Through a case study we will review the literature