Pneumocephalie sous durale expansive apres une ventriculo- cisternostomie endoscopique

La pneumocéphalie sous durale est une complication classique de la ventriculo-cisternostomie endoscopique (VCE). Il s’agit le plus souvent d’une pneumocéphalie simple sans traduction clinique. . Nous rapportons le cas d’une femme de 38 ans, ayant subi une VCE pour une hydrocéphalie par sténose de l’aqueduc du mésencéphale. Elle a développé une hémiparésie gauche postopératoire avec un retard de réveil. Le scanner cérébral de contrôle a montré une importante pneumocéphalie sous-durale expansive (signe du Mont Fuji) prédominante à droite. Une surveillance en position TRENDELENBURG, une réhydratation et une oxygénation au masque ont permis d’obtenir une régression complète de l’hémiparésie et la résorption de la pneumocéphalie sur le scanner à J3 postopératoire.Mots clés : Ventriculocisternostomie ; Pneumocéphalie ; Complication

La syringomyelie foraminale : a propos de 4 cas

Introduction La syringomyélie foraminale est une cavité intramédullaire habituellement cervicale remplie de liquide cérébrospinal consécutive à une perturbation de sa circulation extra-médullaire due à un obstacle. La clinique permet de rattacher les symptômes à la souffrance de la moelle cervicale. Compte tenu de nos condition de travail, le diagnostic peut errer longuement ce d’autant plus que l’IRM qui est le principal élément diagnostique n’est pas demandé de façon routinière du fait son coût élevé. Le traitement est essentiellement chirurgical et plusieurs attitudes ont été proposées.Objectif Rapporter l’expérience de notre service dans la prise en charge de cette affection.Methodologie Il s’agit d’une étude rétrospective portant sur tous les cas de syringomyélie foraminale pris en charge dans le service de neurochirurgie de Dakar de janvier 2009 à Juin 2010.Resultats Quatre cas ont été relevés : 1 patient de sexe masculin et 3 de sexe féminin. Les âges étaient respectivement de 18, 22, 30 et 38 ans. Trois (3) patients ont présenté un syndrome lésionnel suspendu ; 3 un syndrome sous lésionnel ; 2 un syndrome sus-lésionnel et 2 des troubles trophiques. L’IRM a montré une cavité syringomyélique associée à une malformation de d’Arnold Chiari type 1 dans tous les cas. Le traitement chirurgical a consisté en une décompression osseuse occipito - C1 dans 2 cas et à une décompression ostéo durale occipito - C1 dans les 2 autres cas.Conclusion La syringomyélie est une affection relativement rare qui se révèle à l’âge adulte bien qu’il s’agisse d’une malformation congénitale (malformation d’Arnold Chiari). Dans notre contexte de travail, les patients consultent le plus souvent à un stade avancé et le syndrome lésionnel peut manquer (probablement masqué par les autres syndromes) ce qui rend le diagnostic clinique de syringomyélie difficile. L’IRM doit être réalisée le plus tôt possible devant toute symptomatologie de souffrance médullaire cervicale car le scanner du rachis cervical est peu contributif.Mots clés : syringomyélie, malformation de Chiari, syndrome lésionnel, décompression chirurgicale

Potential applications of wastes from energy generation particularly biochar in Malaysia.

In Malaysia, abundant agricultural wastes are generated yearly. Therefore it is beneficial to discover new ways to utilize the wastes and employ the carbon source in different industries. Biochar are produced through many heat treatments such as combustion, gasification and pyrolysis for energy generation. The characteristics of these stable carbons such as the physical properties, chemical composition, surface area and surface chemistry determine the effectiveness of the cabon in different applications. Biochar has the ability to retain carbon and this condition is advantageous to prevent the release of carbon back to the atmosphere in the form of carbon dioxide. Application of biochar to soil helps to improve soil fertility and raise agricultural productivity. Biochar also has the ability to reduce carbon dioxide in the flue gas system. There have only been a few studies that discuss on the potential applications of this agriculture waste. The biochar's potential application as carbon sequester for soil application, energy production and dye sorption is being explored in this paper

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease

Productive Hepatitis C Virus Infection of Stem Cell-Derived Hepatocytes Reveals a Critical Transition to Viral Permissiveness during Differentiation

Primary human hepatocytes isolated from patient biopsies represent the most physiologically relevant cell culture model for hepatitis C virus (HCV) infection, but these primary cells are not readily accessible, display individual variability, and are largely refractory to genetic manipulation. Hepatocyte-like cells differentiated from pluripotent stem cells provide an attractive alternative as they not only overcome these shortcomings but can also provide an unlimited source of noncancer cells for both research and cell therapy. Despite its promise, the permissiveness to HCV infection of differentiated human hepatocyte-like cells (DHHs) has not been explored. Here we report a novel infection model based on DHHs derived from human embryonic (hESCs) and induced pluripotent stem cells (iPSCs). DHHs generated in chemically defined media under feeder-free conditions were subjected to infection by both HCV derived in cell culture (HCVcc) and patient-derived virus (HCVser). Pluripotent stem cells and definitive endoderm were not permissive for HCV infection whereas hepatic progenitor cells were persistently infected and secreted infectious particles into culture medium. Permissiveness to infection was correlated with induction of the liver-specific microRNA-122 and modulation of cellular factors that affect HCV replication. RNA interference directed toward essential cellular cofactors in stem cells resulted in HCV-resistant hepatocyte-like cells after differentiation. The ability to infect cultured cells directly with HCV patient serum, to study defined stages of viral permissiveness, and to produce genetically modified cells with desired phenotypes all have broad significance for host-pathogen interactions and cell therapy

Success or failure of critical steps in community case management of malaria with rapid diagnostic tests: a systematic review

Background: Malaria still causes high morbidity and mortality around the world, mainly in sub-Saharan Africa. Community case management of malaria (CCMm) by community health workers (CHWs) is one of the strategies to combat the disease by increasing access to malaria treatment. Currently, the World Health Organization recommends to treat only confirmed malaria cases, rather than to give presumptive treatment. Objectives. This systematic review aims to provide a comprehensive overview of the success or failure of critical steps in CCMm with rapid diagnostic tests (RDTs). Methods. The databases of Medline, Embase, the Cochrane Library, the library of the \u27Malaria in Pregnancy\u27 consortium, and Web of Science were used to find studies on CCMm with RDTs in SSA. Studies were selected according to inclusion and exclusion criteria, subsequently risk of bias was assessed and data extracted. Results: 27 articles were included. CHWs were able to correctly perform RDTs, although specificity levels were variable. CHWs showed high adherence to test results, but in some studies a substantial group of RDT negatives received treatment. High risk of bias was found for morbidity and mortality studies, therefore, effects on morbidity and mortality could not be estimated. Uptake and acceptance by the community was high, however negative-tested patients did not always follow up referral advice. Drug or RDT stock-outs and limited information on CHW motivation are bottlenecks for sustainable implementation. RDT-based CCMm was found to be cost effective for the correct treatment of malaria in areas with low to medium malaria prevalence, but study designs were not optimal. Discussion. Trained CHWs can deliver high quality care for malaria using RDTs. However, lower RDT specificity could lead to missed diagnoses of non-malarial causes of fever. Other threats for CCMm are non-adherence to negative test results and low referral completion. Integrated CCM may solve some of these issues. Unfortunately, morbidity and mortality are not adequately investigated. More information is needed about influencing sociocultural aspects, CHW motivation and stock supply. Conclusion: CCMm is generally well executed by CHWs, but there are several barriers for its success. Integrated CCM may overcome some of these barriers

L\'hydrocephalie Chronique De L\'adulte : A Propos De 15 Cas

Introduction L\'hydrocéphalie chronique de l\'adulte (HCA), est une dilatation des cavités ventriculaires par trouble de l\'hydrodynamique du liquide cérébro-spinal (LCS), s\'exprimant cliniquement par la triade d\'Adams-Hakim. La cause peut être identifiable ou idiopathique. Objectifs L\'objectif de notre travail est de rapporter notre expérience dans la prise en charge d\'une telle affection. Patients et méthodes Il s\'agit d\'une étude rétrospective de 15 patients colligée de Janvier 1997 à Décembre 2003. Tous les patients ont bénéficié d\'une dérivation ventriculo-péritonéale (DVP), après un bilan clinique et tomodensitométrique. Nous avons retenu dans notre étude les patients présentant au moins un des éléments de la triade d\'Adams-Hakim, associée à des signes de dilatation ventriculaire. Ont été exclus les patients présentant un tableau d\'HCA secondaire à une affection connue intercurrente : abcès, tumeur. Résultats L\'âge moyen était de 65,8 ans. Le sexe masculin était prédominant, avec un sex-ratio (H/F) de 2. Les antécédents étaient : une hémorragie méningée dans 2 cas (13,3%), une macrocranie depuis l\'enfance dans 1 cas (6,7%), et une adénoméctomie prostatique par erreur diagnostic dans 1 cas (6,7%). 7 autres patients (46,6%) présentaient une HTA. Le délai moyen d\'hospitalisation était de 2,3 ans. Le syndrome d\'Adams-Hakim était complet dans 9 cas (60%), incomplet dans 6 cas (40%). La tomodensitométrie (TDM) cérébrale a été pratiquée chez tous nos patients, et permis de noter une dilatation tétra ventriculaire dans 12 cas (80%), une dilatation tri ventriculaire dans 3 cas (20%). La ponction lombaire soustractive a été réalisée chez 12 patients, avec amélioration de la symptomatologie. Tous nos patients ont bénéficié d\'une DVP. Le suivi était en moyenne de 1,25 ans. On a enregistré un bon résultat dans 6 cas (40%), un résultat moyen dans 3 cas (20%), un mauvais résultat dans 2 cas (13,30%), et 4 cas de décès (26,7%) (complications de décubitus). Conclusion L\'HCA, qualifiée de seule démence curable, reste encore une affection mal connue en Afrique sub-saharienne, et encore trop tardivement diagnostiquée. L\'enjeu aujourd\'hui est de bien sélectionner les patients sur des critères cliniques et para cliniques. Introduction Adult chronic hydrocephalus, which correspond to ventriculomegaly, because of cerebro-spinal fluid (CSF) disorder, show classical Adams-Hakim syndrom. The etiology may be known or idiopathic. Objectives The aim of our study, is to report our experience on this issue. Patients and methods On January 1997 to December 2003, we collected retrospectively 15 patients presenting a clinical picture of chronic hydrocephalus, which has been everytime assessed with a ventriculomegaly on brain CT scan. All our patients got ventriculo-peritoneal shunt (VPS). We excluded the patients presenting an adult chronic hydrocephalus secondary to intercurrent affection: abscess, tumor. Results The medium age was 65,8 years. The sex-ratio was coted 2. In the history of disease, we founded 2 patients with sub-arachnoïdal hemorrhage (13,3%), one progressive macrocephaly since childhood (6,7%), and one prostatic adenoma (6,7%), 7 patients had high blood pressure (46,6%). Overall time, time between the onset of the syndrom and the admission at the hospital was 2,3 years. Adams-Hakim syndrom was complet for 9 patients (60%), incomplet for 6 patients (40%). The brain CT scan had been done for all patients, and showed holoventriculomegaly for 12 patients (80%), and triventriculodilatation for 3 patients (20%). Lumbar puncture withdrawal test was positive for 12 patients. All our patients got (VPS). The follow up was 1,25 years. 6 patients (40%) improved, 3 patients (20%) had fair outcome, and 2 patients (13,3%) could be considere as bad result. 4 patients (26,7%) deaded (decubitus complications). Conclusion Adult chronic hydrocephalus, may be qualified as a curable demancia. In the sub-saharien countries, this condition is not well none, and the diagnosis is littly done. The problematic of this issue is to set accurate diagnosis criteria. Keywords: Adams Hakim, Africa, Adult chronic hydrocephalus , Hydrocephalus, Shunt, Senegal. African Journal of Neurological Sciences Vol. 26 (2) 2007: pp. 5-1

Community case management in malaria: review and perspectives after four years of operational experience in Saraya district, south-east Senegal.

BACKGROUND: Despite recent advances in malaria diagnosis and treatment, many isolated communities in rural settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm), consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) in their villages, can address this disparity. METHODS: This study examined routine reporting data from a CCMm programme between 2008 and 2011 in Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT. RESULTS: There was a seven-fold increase in the number of LHWs providing care and in the number of patients seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a negative RDT or were never administered an RDT, and less than half of patients with absolute indications for referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs. DISCUSSION: This CCMm programme successfully increased the number of patients with access to RDT and ACT, but further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients with absolute indications. In contrast, previous widespread stock-outs in Saraya's CCMm programme have now been resolved. CONCLUSION: This study demonstrates the potential for CCMm programmes to substantially increase access to life-saving malarial diagnostics and treatment, but also highlights important challenges in ensuring quality

Hematome sous dural, complication du traitement chirurgical des hydrocephalies. Notre experience a Dakar

Introduction L\'hématome sous dural est une complication observée lors du traitement chirurgical de l\'hydrocéphalie. Avant l\'avènement de la tomodensitométrie à Dakar, une incidence de 0,8 % était trouvée. Objectif L\'objectif de notre travail est de réévaluer cette incidence à la lumière de cet examen et de déterminer les divers facteurs étiologiques. Patients et Methode Nos patients ont été opérés par dérivation ventriculo-péritonéale et sont âgés de 8 à 30 ans au moment du diagnostic. Quatre sont de sexe féminin. Le signe le plus fréquent est l\'hypertension intra-cranienne. La tomodensitométrie a établi le diagnostic dans tous les cas. Elle montrait dans 4 cas, un hématome unilatéral et dans deux cas, une forme bilatérale. D\'importantes calcifications sont retrouvées dans deux cas. Cinq patients ont été opérés et nous notons deux décès. Les valves utilisées sont à débit de drainage fixe. Resultat Il existe une augmentation de l\'incidence par rapport à notre première série datant de 12 ans. Par rapport aux autres systèmes de drainage, nous ne notons pas de différence significative. Aucun facteur étiologique déterminant n\'est retrouvé. Conclusion Cette complication pouvant pauci-symptomatique, la réalisation d\'examens tomodensitométriques systématiques permettrait de constater une plus grande fréquence de cette complication Introduction Subdural hematoma is a complication which can occur seen after setting a shunt for hydrocephalus. Prior to CT scan installation in Dakar, the incidence was 0,8%. Objective Our aim is to consider twelve years later this complication and others causal factors. Six patients were observed, between 8 and 30 years. Four of them were female. The main sign is increased intra cranial pressure. CT scan shows the hematoma : two bilateral and two calcified.Two patients deceased after surgical treatment. Results The frequency is not due to shunt type or any specific cause. Conclusion The complication may occur without clinical complain and CT scan for all surgically treated patient is mandatory Keywords: Afrique, dérivation ventriculo-péritonéal, hématome sous dural, hydrocéphalie, valve, Sénégal, Africa, subdural hematoma, hydrocephalus, shunt, Senegal African Journal of Neurological Sciences Vol. 24 (2) 2005: pp. 28-3