Outcomes in orthopedic device infections due to Streptococcus agalactiae: a retrospective cohort study

BACKGROUND

Group B streptococci (Streptococcus agalactiae) (GBS) is a rare cause of prosthetic joint infection (PJI) occurring in patients with comorbidities and seems to be associated with a poor outcome. Depiction of GBS PJI is scarce in the literature.

METHODS

A retrospective survey in 2 referral centers for bone joint infections was done Patients with a history of PJI associated with GBS between 2014 and 2019 were included. A descriptive analysis of treatment failure was done. Risk factors of treatment failure were assessed.

RESULTS

We included 61 patients. Among them, 41 had monomicrobial (67%) infections. The median duration of follow-up was 2 years (interquartile range 2.35) Hypertension, obesity, and diabetes mellitus were the most reported comorbidities (49%, 50%, and 36% respectively). Death was observed in 6 individuals (10%) during the initial management. The rate of success was 63% (26/41). Removal of the material was not associated with remission (p = 0.5). We did not find a specific antibiotic regimen associated with a better outcome.

CONCLUSION

The results show that S. agalactiae PJIs are associated with high rates of comorbidities and a high treatment failure rate with no optimal treatment so far.

A172 THE LACK OF CHROMOGRANIN A PROTECTS THE COLONIC EPITHELIAL BARRIER FUNCTIONS FROM COLITIS IN MALE MICE AND EXACERBATES COLITIS IN FEMALE MICE

Background

Ulcerative colitis (UC) is associated with compromised mucosal barrier function and colonic epithelial repair in a sex-dependent manner. Chromogranin A (CHGA), a pro-hormone, correlates positively with UC disease severity. In male mice, deletion of CHGA has been shown to decrease the inflammatory process; however, the effect of CHGA on mucosal barrier function and colonic epithelial repair between males and females is unknown.

Purpose

We investigated whether the lack of CHGA modulates gut barrier function, mucosa integrity, and colonic epithelial repair between males and females in a mice model of colitis.

Method

Male and female wild-type (WT) and CHGA (CHGA^-/-) deficient mice (13-17 weeks old) were given 5% dextran sulfate sodium (DSS) to induce colitis or water for 5-days (n=5-8 mice per group). The disease activity index (DAI) was assessed. Colons were collected, and tumor necrosis factor (TNF)-α and IL-25 concentrations were measured by ELISA. Expression of structural and functional markers specific to epithelial cells, namely, colonocytes (Na-K-Cl cotransporter [Nkcc]1), goblet cells function (resistin-like molecule [Relm]β), and mucin [MUC]2) and stem cells (reserve Hopx, fast-cycling Lgr5, and fetal-like Ly6a cells) were evaluated by qRT-PCR.

Result(s)

Colitic male CHGA^-/- did not show significant changes in DAI compared to WT mice. Conversely, female CHGA^-/- mice demonstrated a trend toward higher susceptibility to colitis compared to female WT mice with increased weight loss and bleeding. This was associated with elevated levels of colonic TNF-α and IL-25 (p<0.05) in CHGA^-/- females compared to CHGA^-/- males. TNF-α levels were not different between female groups at baseline and during colitis. While colitic CHGA^-/- female had elevated Relmβ expression (p<0.01) compared to WT mice. No significative change was noted in Relmβ expression between female WT mice at baseline and during colitis. Similarly, Nkcc1 and Muc2 expression was not different between female groups. By contrast, male CHGA^-/- were less susceptible to colitis than male WT mice with elevated Nkcc1and a lower Relmβ and Muc2 expression (p<0.01). In colitis, expression of stem cell markers, Hopx and Lgr5, was markedly reduced in all groups, while male WT, CHGA^-/-, and female WT had elevated Ly6a expression. However, the magnitude of Hopx and Ly6a expression was associated with sex. Thus, colitic male CHGA^-/- mice had a higher Hopx expression than male WT and female CHGA^{-/ -} mice, with a lower reduction of 1.9 compared to 4.9 and 6.6, respectively (p<0.05, 0.01, and 0.0001). While colitic male CHGA^-/- mice had elevated Ly6a expression (p<0.05) in contrast to female CHGA^-/- mice (p=0.5). The magnitude of the decrease in Lgr5 expression was not different between all groups.

Conclusion(s)

In the absence of CHGA, male mice preserved their colonic mucosa integrity and repair potential, while female mice suffered significant loss of mucosa integrity and repair potential during colitis.

Disclosure of Interest

None Declared

Characterization of the Achromobacter xylosoxidans Type VI Secretion System and Its Implication in Cystic Fibrosis

Bacteria of the genus Achromobacter are environmental germs, with an unknown reservoir. It can become opportunistic pathogens in immunocompromised patients, causing bacteremia, meningitis, pneumonia, or peritonitis. In recent years, Achromobacter xylosoxidans has emerged with increasing incidence in patients with cystic fibrosis (CF). Recent studies showed that A. xylosoxidans is involved in the degradation of the respiratory function of patients with CF. The respiratory ecosystem of patients with CF is colonized by bacterial species that constantly fight for space and access to nutrients. The type VI secretion system (T6SS) empowers this constant bacterial antagonism, and it is used as a virulence factor in several pathogenic bacteria. This study aimed to investigate the prevalence of the T6SS genes in A. xylosoxidans isolated in patients with CF. We also evaluated clinical and molecular characteristics of T6SS-positive A. xylosoxidans strains. We showed that A. xylosoxidans possesses a T6SS gene cluster and that some environmental and clinical isolates assemble a functional T6SS nanomachine. A. xylosoxidans T6SS is used to target competing bacteria, including other CF-specific pathogens. Finally, we demonstrated the importance of the T6SS in the internalization of A. xylosoxidans in lung epithelial cells and that the T6SS protein Hcp is detected in the sputum of patients with CF. Altogether, these results suggest for the first time a role of T6SS in CF-lung colonization by A. xylosoxidans and opens promising perspective to target this virulence determinant as innovative theranostic options for CF management.

Profuse telangiectasias in an immunocompetent patient misleading presentation revealing a hepatosplenic‐Tγδ‐cell lymphoma

Here we present the case of an hepato‐splenic‐Tγδ‐cell lymphoma interestingly occurring in a non‐immunocompromised patient, with profuse telangiectasias giving originally misleading orientation towards the diagnosis of B angiotropic lymphoma.

A182 THE LACK OF CHROMOGRANIN A IMPACTS COLONIC EPITHELIAL CELLS MARKERS IN AN EXPERIMENTAL MODEL OF ULCERATIVE COLITIS

Background

Ulcerative colitis (UC) is a chronic and acute inflammatory disorder of the colon linked to dysregulated gut mucosal immune response and compromised colonic epithelial barrier function and integrity. Chromogranin-A (CHGA), a pro-peptide secreted by enteroendocrine cells, is highly expressed in colonic tissues of patients with UC. Elevated CHGA has been shown to correlate with UC disease activity and severity. Moreover, complete deletion of CHGA was shown to result in a diminution of pro-inflammatory markers known to disrupt the colonic epithelial barrier function and gut mucosal healing process. However, little is known about the effect of the absence of CHGA on colonic epithelial barrier function and gut mucosal integrity.

Aims

Here, we characterized the impact of the lack of CHGA on the colonic mucosa and epithelial barrier structure and function using CHGA knockout (CHGA-/-) mice treated with dextran sulfate sodium (DSS) to induce colitis.

Methods

13–17 weeks old male C57BL/6 wild-type (CHGA+/+) and C57BL/6 CHGA-/- mice were treated for 5 days with 5% DSS to induced acute colitis, control mice received regular water. CHGA mRNA expression, disease activity index (DAI), and macroscopic score (MS) were analyzed. Distal colonic tissues were isolated, and mRNA expression of markers associated with regenerative stem cells (fast-cycling stem cells [Lgr5+] and reserve stem cells [HOPX+] and [LY6a+], Goblet cells functions mucus barrier mucin 2 [MUC2], resistin-like molecule β [RELMβ], WAP 4-disulphide core domain 2 [WFDC2]) and trefoil factor 3 (TFF3) was evaluated by qRT-PCR.

Results

We validated a beneficial effect of the Lack of CHGA on colitis severity, associated with significantly lower DAI and MS. In colitic CHGA+/+ and CHGA-/- mice, Lgr5+ and HOPX+ were both highly down-regulated, although, compared to CHGA+/+, CHGA-/- mice presented a 10.5fold higher expression of HOPX+. Compared to non-colitic states, Ly6a+ expression was significantly elevated in both colitic CHGA+/+ and CHGA-/- mice, however, no differences in Lgr5+ and Ly6a+ expression were noted between CHGA+/+ and CHGA-/- mice in all conditions. In CHGA+/+ mice, inflammatory conditions led to higher MUC2 and RELMB expression, although, compared to CHGA+/+, these markers were significantly lower in CHGA-/- mice. In colitic conditions, compared to CHGA+/+, CHGA-/- had a significant increase of WFDC2. In non-colitic conditions, mRNA expressions of all markers evaluated between CHGA+/+ and CHGA-/- in this study were unaltered. Finally, no differences were observed in TFF3 gene expression.

Conclusions

These results indicate in the absence of CHGA, the colonic epithelial barrier integrity and function are maintained through the modulation of goblet cells functions and elevated gut mucosa regenerative potential, thus enhancing the mucosal protection to colitis damage.

Funding Agencies

CIHR

[Epidemiology and prognosis aspects of upper gastrointestinal bleeding of NianankoroFomba hospital in segou]

AIMS

The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital.

PATIENTS AND METHODS

This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage.

RESULTS

Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%.

CONCLUSION

upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

Fatal Enterovirus-related Myocarditis in a Patient with Devic's Syndrome Treated with Rituximab

Enteroviruses are a frequent source of infection and among the most common central nervous system viral pathogens. Enteroviruses – in particular, the Coxsackie B viruses – are a known cause of myocarditis. Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody. Many reports in the literature suggest a higher risk of infection following repeated rituximab therapy, including viral infection. However, observations of enterovirus-related myocarditis in the context of rituximab treatment are scarce. The authors describe the case of a patient with neuromyelitis optica spectrum disorder who developed severe and fatal enterovirus-related myocarditis after rituximab therapy with a difficult differential diagnosis of autoimmune or giant-cell myocarditis. This case highlights the importance of complete diagnostic workup in difficult cases of myocarditis, including endomyocardial biopsies.

A212 CHROMOFUNGIN PROTECTS AGAINST DSS-INDUCED COLITIS BY REGULATING P-53 APOPTITIC PATHWAY

Background

Development of ulcerative colitis is associated with epithelial apoptosis mediated by p53-apoptotic pathway through the activation B-cell lymphoma 2 (Bcl-2), Bcl-2 associated-X protein (BAX) and Bcl-2 antagonist/killer-1 (BAK1) proteins. Chromofungin (CHR), a chromogranin-A derived peptide expressing a cell penetrating peptide motif, decreased the severity of colitis via the suppression of mucosal and pro-inflammatory macrophages-related p53-dependent apoptosis.

Aims

We aimed to investigate a) whether the gene profile expression of apoptosis could be extended to other p53-associated genes; b) whether the gene expression of some of the p53-apoptosis marker could be confirmed by protein analysis; and c) whether due to the cell penetrating peptide motif, CHR could enter into peritoneal macrophages.

Methods

UC-related colitis was induced in C57BL/6 mice (7 weeks) by administering dextran sulfate sodium (DSS) (5%, 5 days). Preventive CHR (2.5 mg/kg/day) or vehicle treatment started 1-day before colitis induction and lasted for 5-days. Profiler™ PCR Array was performed to screen a panel of 84 genes representative of the p53 signal pathway in colitic whole mucosa distal colonic samples treated or not with CHR. Western blot analysis was performed to confirm individual protein changes. Naïve macrophages were plated overnight and nonadherent cells were removed the next day. Cells were incubated with rhodamined CHR (4 ul) for 5, 10, 20, 30 min before washing and fixing them, detection was made via confocal microscopy.

Results

In colitic conditions, an up regulation of 26 genes associated to the p53-dependent apoptosis pathway were detected including Apaf1, Bax, Bbc3, Bcl2, Cradd, Fadd, Cul9, Pmaip1, Tnfrsf10b. In vivo CHR treatment decreased significantly the colitis and was associated with a significant downregulation of 19 genes including the 9 aforementioned when compared with biopsies from colitic groups. Compared to untreated groups, colitic mice treated with CHR demonstrated a significant decrease of BAX and BAK protein and the apoptotic ER stress inducer marker, X-Binding Protein 1. A large number of peritoneal macrophages displayed rhodamine within the all intracellular compartment. The presence of the peptide inside the cell can be visible as early as 5 min and the signal gradually increases.

Conclusions

CHR decreases the inflammatory process via the suppression of a large number of p53-related apoptotic proteins. CHR quickly enters the macrophage but the exact mechanism of entrance needs to be further defined. Targeting functional analysis of CHR may lead in the future to novel therapeutics for UC.

Funding Agencies

CCCNSERC

A260 THE LACK OF CHROMOGRANIN-A MODIFIES THE GUT MICROBIOTA COMPOSITION AND REGULATES EXPERIMENTAL COLONIC INFLAMMATION

Background

Ulcerative colitis (UC)is characterized by distinct changes in the gut microbiome and elevated chromogranin-A (CHGA) level, which seem to be a relevant pathogenetic mechanism.CHGA, a prohormone produced by enterochromaffin (EC) cells and cleaved into several bioactive peptides, regulates experimental colonic inflammation. In the rodent, intra-rectal infusion of catestatin, a Chga-derived peptide, alters the distal colonic microbial composition. However, the interplay between CHGA, as a pro-hormone, and the gut microbiome remains elusive.

Aims

in homoeostatic and pathophysiologic conditions, we investigated the functional consequences of the lack of Chgaon the distal colonic microbiota.

Methods

Acute colitis (5 % dextran sulfate sodium [DSS], 5 days) was induced in Chga-C57BL/6-deficient (Chga-/-) and wild-type (Chga+/+)mice. Feces and mucosa-associated microbiota (MAM) samples were collected and the V4 region of 16s rRNA was subjected to Miseq Illumina sequencing. Alpha diversity was calculated using Shannon’s diversity index. OTU abundances were summarized using the Bray-Curtis index and non-metric multidimensional scaling (NMDS) analysis to visualize microbiome similarities and a permutational analysis of variance (PERMANOVA) to test the significance of groups were performed respectively.

Results

In non-colitic homoeostatic condition, the absence of Chga (Chga-/) significantly increased the bacterial richness and modified the bacterial community composition at the genera level between the groups, represented by increased abundance of Lactobacillus species and reduced abundance of Helicobacter& Oscillospira species compared to Chga+/+mice in fecal and colonic MAM. Moreover, the absence of Chga (Chga-/-) resulted in a significant change in the alpha-diversity of fecal and colonic MAM compared to Chga+/+mice. DSS induced-colitis resulted in a significant microbial dysbiosis in Chga+/+mice, however, deletion of Chgaprotected against DSS-induced colitis and reduced the microbial dysbiosis, reduced the family of Rikenellaceaeand maintained the abundance of Bacteroides species, compared to wild-type (Chga+/+).

Conclusions

The lack of CHGA regulates the biodiversity and the composition of the colonic gut microbiota suggesting a cross-talk between the EC cell and the microbiome. Therefore, targeting CHGA could provide a novel therapeutic strategy by regulating the gut microbiome in physiological and pathophysiological conditions.

Funding Agencies

CIHR

[Superior lumbar hernia or hernia of GRYNFELTT, a case study]

The superior lumbar hernia or hernia of GRYNFELTT is a rare pathology. It accounts for less than 1.5% of all hernias in the abdomen. An 84 year-old man with upper right lumbar swelling. The clinical examination revealed a right upper lumbar swelling of 5 cm in diameter, soft, gurgling, reducible, impulsive to cough and expansive to intra-abdominal hyperpressure. There was no history of trauma, surgery, tuberculosis or dysuria. The diagnosis of an uncomplicated upper lumbar hernia was retained. Intra-operatively, the sac was dissected up to the hernia opening, separated from the edges of the hernia orifice and discharged. The repair was performed by suturing the back of the hernia opening with a non absorbable thread. The patient was released on day 1 postoperatively. The suites were simple.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]

INTRODUCTION

Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics.

MATERIALS AND METHODS

This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018.

RESULTS

During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days.

CONCLUSION

Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

[Fracture of the penis at teaching university hospital Luxemburg in Mali : two cases report]

The fracture of the penis is a rare andrological emergency. We report 2 cases of fracture of the penis including one by false-no coitus. These were young adults aged 34 and 40 respectively. The painful swelling with deviation of the penis was the dominant symptomatology of the clinical picture of the 2 patients. Surgical management was performed with favorable functional results in both cases. The long-term functional prognosis of the fracture of the penis depends on the speed of its management.

[Knowledge and practices of hypertension in nursing staff of the Hospital Gabriel Touré and Point G]

OBJECTIVE

This work aimed to study the quality of diagnosis and management of high blood pressure (HBP) by the practitioners of the Gabriel TOURÉ and point G teaching hospitals of Bamako.

MATERIALS AND METHODS

It was a descriptive and analytical, cross-sectional study during the study period from 1st March 2009 to 28 February 2010. It included all physicians and paramedics of the teaching hospital of the Point G and Gabriel TOURÉ in Bamako.

RESULTS

A total of 283 practitioners (physicians and the paramedics) from both teaching hospitals have accepted our questionnaire, including 133 doctors and 185 paramedics. CHU Gabriel TOURÉ accounted for 55.1%, the majority came from the department of cardiology with 18.4%. Doctors accounted for the largest square with 47.0%. The majority of our practitioners (59%) say it takes at least one session during three medical consultations to diagnose the HBP. Only 29,60% define the HBP from 140/90 mm Hg. With a blood pressure goal of 58, 30% and 57.20% of practitioners claimed to retain 140/90 mm Hg, respectively for the diabetic and the renal-insufficient patients. A considerable number of our practitioners (27.9%) still used in pregnant women the triplet diuretic/IEC/diet without salt. The information of patients on some important aspects of the pathology prior to any therapeutic strategy had been conducted in 63.6.

CONCLUSION

The high blood pressure must be a major concern for medical and paramedical staff today.

[Social integration of women operated for obstetric urogenital fistula]

OBJECTIVE

To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula.

PATIENTS AND METHOD

Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database.

RESULTS

Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts.

CONCLUSION

The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.

Diversity of human African trypanosomiasis epidemiological settings requires fine-tuning control strategies to facilitate disease elimination

In 2001, the World Health Organization (WHO) established a public-private partnership to fight human African trypanosomiasis (HAT). As a result of this continuous collaboration, and in addition to the coordination with nongovernmental organizations and bilateral cooperation agencies, the number of new cases of HAT annually reported by the WHO has strikingly decreased. In 2012, HAT was included in WHO's roadmap on neglected tropical diseases with a 2020 target date for elimination. Although the prevalence of HAT is decreasing and its elimination is targeted, control approaches must be adapted to the different epidemiological patterns in order to adopt the most adequate strategies to maintain their cost-effectiveness. These strategies must be flexible and dynamic in order to be adapted to the disease progression, as well as to the changes affecting the existing health facilities in transmission areas, including their accessibility, their capabilities, and their involvement in the elimination process. Considering the different patterns of transmission (Trypanosoma brucei (T.b.) rhodesiense HAT) and transmission intensity (T.b. gambiense HAT), different settings have been defined. In the case of T.b. rhodesiense, this form exists primarily where wild animals are the main parasite reservoir, and where the main parasite reservoir is cattle. In T.b. gambiense, this form exists in areas with high intensity transmission, areas with moderate intensity transmission, and areas with low intensity transmission. Criteria and indicators must be established to monitor and evaluate the actions implemented toward the elimination of HAT.

[Chronic kidney failure at subclinical stage in hypertensive patients in the cardiology department of the Gabriel TOURE university hospital]

OBJECTIVE

This work aimed to describe the epidemiological, clinical, biological and ultrasound aspects of the subclinical renal failure in hypertensive patients in the department of cardiology of the Gabriel TOURÉ University Hospital of Bamako.

PATIENTS AND METHODS

The study was cross-sectional and prospective from 1 January 2007 to 31 December 2007 in the cardiology department of the Gabriel Touré University Hospital. These were all patients who achieved at least the basic test for renal impairment such as serum creatinine, 24h proteinuria, renal ultrasound.

RESULTS

Total of 114 patients with kidney failure without evocative clinical symptoms have been included, among them 60 men and 54 women, average age of 57 years. In the hypertensive population, the beginner to moderate chronic renal failure had a frequency of 12.9% (114/880), the sex ratio was 1.11 in favor of men. Patients aged less than 60 years were more numerous with a frequency of 61.5%. Dyspnea (38.6%), and headache (36.8%) were the main manifestations of the high blood pressure (HBP). Renal disease characterized by microalbuminuria was predominant compared to the macro-albuminuria: 25.5% versus 7%. Renal ultrasound was abnormal in 14.1% with a predominance of stage 0 (86%), stages 1 and 2 were each 7%, we have not found any stage 3.

CONCLUSION

Chronic renal failure is a frequent complication of the hypertension. Some biological tests are necessary for the diagnosis. Renal ultrasound remains a useful test for its assessment. The optimal treatment of high blood pressure is essential, as it not only reduces the overall cardiovascular risk of patients, but also slows or even stabilizes the worsening of renal function.

FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso

FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.

Avian influenza and Newcastle disease in three risk areas for H5N1 highly pathogenic avian influenza in Mali, 2007-2008

Our survey aimed to investigate avian influenza (AI) and Newcastle disease (ND) prevalence and risk factors in three areas of Mali at risk for occurrence of H5N1 highly pathogenic avian influenza. Blood samples and cloacal and oropharyngeal swabs were collected from 1470 birds between February 2007 and May 2008 and were tested by commercial enzyme-linked immunosorbent assay to detect antibodies and real-time reverse-transcription (rRT)-PCR to detect virus. Risk factors associated with seropositivity or positive rRT-PCR were identified by random effect logistic regression. AI seroprevalence was significantly lower in birds from commercial farms (0%) than in village backyard birds (3.1%). For backyard birds, no individual risk factors (species, age, sex) were identified, but birds in the Mopti area in the Sahelian zone, where millions of wild birds migrate, were more seropositive than in the Sikasso area in the Sudano-Guinean zone (odds ratio [OR] = 2.0, P = 0.051). Among backyard birds nonvaccinated against ND, ND seroprevalence was 58.4%, and the odds of seropositivity was 2.0 higher in chickens than in ducks, 1.7 higher in females than in males, 3.1 higher in adults than in young birds, and 3.0 higher in poultry from the Sikasso area than from the Mopti area (P < 0.01 in all cases). Prevalence established by rRT-PCR was low for both AI virus (1.1%) and ND virus (2.6%) and was associated with no risk factors for AI but was higher in chickens than in ducks (OR = 5.3, P = 0.05) and in the Sikasso area than in the Mopti area (OR = 3.4, P = 0.027) for ND. For AI and ND, prevalence assessed by serology or rRT-PCR varied over time, although seasonal and interannual variation could not be clearly distinguished. The intracluster correlation coefficient for serologic data was low for AI (0.014) and higher for ND (0.222). These results are useful to optimize surveillance and control strategy for notifiable avian diseases in African countries with similar agroecological and resource-limited contexts.

[Efficacy of artemether-lumefantrine in the treatment of uncomplicated malaria in children living in a rural area of Burkina Faso in 2009]

In order to implement community case management of malaria strategy in a rural area of intense transmission, of children using artemether-lumefantrine combination, we assessed the therapeutic efficacy of the medicine. We conducted an open label and uncontrolled clinical trial in an unique centre from September 2009 to December 2009 in children 6-59 months old who consulted at health facilities for uncomplicated malaria. The primary endpoint was clinical and parasitological cure rate at day 28 corrected by PCR. In total 106 children were enrolled. Parasite clearance at day 2 was 99.04% and the adequate clinical and parasitological response corrected by PCR at day 28 was 90.5%. Our results confirm that artemether-lumefantrine combination is still effective.

[Prevalence and risk factors of hepatitis C virus infection in chronic hemodialysis patients at the University Hospital of Point G, Bamako, Mali]

The objective of this prospective study conducted in November 2008, was to determine the prevalence and the factors associated with Hepatitis C Virus (HCV) infection in chronic hemodialysis patients. The study was carried out in the hemodialysis unit of the university teaching hospital of Point G. Serum samples were tested for anti-HCV antibody, anti-HIV antibody and HBs Ag using enzyme immunoassay methods (ELISA) at the laboratory of immunology of the National Blood Transfusion Service of Bamako. The following parameters were assessed: initial nephropathy, duration of the dialysis, history of blood transfusion, number of blood units transfused since the beginning of the dialysis, history of nosocomial exposure. A total of 66 patients were enrolled. The mean age of the patients was 42,27±14, 8 years, with a male to female sex-ratio of 1,44. Anti-HCV antibodies were found in 13 chronic hemodialysis patients, leading to a prevalence of 19,7%. A significant association was found between the bearing of HCV and the duration of the dialysis. These results indicate that hepatitis C is frequent in the chronic hemodialysis patients of the university teaching hospital of Point G, and that the duration of dialysis constitutes the main factor associated with the contamination by the HCV.

A geographical approach to identify sleeping sickness risk factors in a mangrove ecosystem

OBJECTIVES

To provide a better understanding of sleeping sickness transmission and spread in mangrove areas to optimize its control.

METHODS

In the Forecariah mangrove area, Guinea, 19 sleeping sickness cases and 19 matched controls were followed up in their living areas (at home, in fields and at water points). All occupational sites and pathways were mapped and then placed in their environmental context.

RESULTS

The sleeping sickness cases displayed a significantly broader and more diverse spatial occupation than the controls. They covered double the daily walking distances of controls and had on average two more occupational sites, most of which were located in mangrove forests. Activities with a higher transmission risk (rice culture, attendance of pirogue jetties) were identified as well as high-risk areas and pathways.

CONCLUSIONS

An entomological control strategy targeting transmission risk areas is proposed. Its implementation in a control programme would reduce by 86% the efforts needed for a classical vector control programme throughout the area. Medical surveys set up at specific locations, such as pirogue jetties and high-risk paths, should also enable better targeting of the population at highest risk.

[Major cardiovascular risk factors according to gender in the hospital environment]

AIM

The study aims to describe cardiovascular risk factor according to gender in hospital.

MATERIAL AND METHODS

Il was a prospective study from april 2007 to march 2008 including 146 highblood pressure patients from 2 medical centre in Bamako. Gathering and analysis were performed with SPSS 11.

RESULTS

67% were female, the mean age reached 48,82. the BMI was significantly higher in female (P <0,001). Female were mainly registered between 30 and 44 years, and male between 45-59 years. Overweight and obesity were more represented in female and obesity in 30-44 years old patients. Isolated highblood pressure was found in 58,90%, 7,53% of patients had the 3 major cardiovascular risk factor

CONCLUSION

Isolated highblood pressure was by far the most frequent. Although the cardiovascular risk rises with the others associations, they were rare and don't significantly differ in each gender. The tendency to overweight and obesity in female should be confirmed by others studies.

Humoral and cell-mediated immunity to MSP3 peptides in adults immunized with MSP3 in malaria endemic area, Burkina Faso

We performed a single-blind, randomized phase 1 trial of the long synthetic peptide (LSP) of merozoite surface protein-3 (MSP3) in adults living in Burkina Faso. Thirty eligible volunteers were randomized to receive either the MSP3-LSP candidate vaccine or tetanus toxoid vaccine as a control. A dose of each vaccine was administered on days 0, 28 and 112 and the vaccine was formulated with aluminium hydroxide. Humoral immune responses were assessed by ELISA at days 0, 28, 56, 112, 140, 252 and 365 and cell-mediated immune responses by lymphoproliferation assay and by ELISA on days 0, 56 and 140. IgG responses to four peptides of MSP3 were similar in both vaccine groups. Higher IgG concentrations were recorded after the beginning of malaria high transmission season in both vaccine groups. The lymphocyte proliferation and the production of IFN-γ in response to stimulation with the four overlapping peptides increased following vaccination in the MSP3-LSP vaccine group, but did not change appreciably in the control group. In contrast to natural infection, MSP3-LSP did not boost humoral responses to the four overlapping peptides of MSP3 to any detectable degree in our semi-immune adult. MSP3-LSP may be more immunogenic in young children with little or no acquired immunity.

HIV, HCV, HBV and syphilis rate of positive donations among blood donations in Mali: lower rates among volunteer blood donors

Good data on background seroprevalence of major transfusion transmitted infections is lacking in Mali. We gathered data on the rate of positive donations of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis among blood donations in Mali for calendar year 2007. Donations with repeatedly reactive results on screening enzyme immunoassay (EIA) were considered to be seropositive. Rate of positive donations per blood unit collected was 2.6% for HIV, 3.3% for HCV, 13.9% for hepatitis B surface antigen (HBsAg) and 0.3% for syphilis. For HIV, HBsAg and syphilis, rate of positive donations was significantly (p<0.001) higher among donations from replacement donors than those from volunteer donors, while HCV rate of positive donations was similar in the two groups. Rate of positive donations was also significantly (p<0.0001) lower in blood units from regular than from first-time donors. These data reinforce WHO recommendations for increasing the number of regular, volunteer blood donors in Africa.

Mapping sleeping sickness in Western Africa in a context of demographic transition and climate change

Human population growth, climate change and economic development are causing major environmental modifications in Western Africa, which will have important repercussions on the epidemiology of sleeping sickness. A new initiative, the Atlas of human African trypanosomiasis (HAT), aims at assembling and geo-referencing all epidemiological data derived from both active screening activities and passive surveillance. A geographic database enables to generate up-to-date disease maps at a range of scales and of unprecedented spatial accuracy. We present preliminary results for seven West African countries (Benin, Burkina Faso, Côte d'Ivoire, Ghana, Guinea, Mali and Togo) and briefly discuss the relevance of the Atlas for future monitoring, control and research activities.

[Change of antimalarial first-line treatment in Burkina Faso in 2005]

Burkina Faso has recently changed the antimalarial drug policy to artesunate/amodiaquine or artemether/lumefantrine as the first-line antimalarial drug and sulfadoxine/pyrimethamine for the intermittent preventive treatment in pregnant woman. Before the implementation of this new strategy we conducted an in vivo efficacy study with chloroquine or sulfadoxine/pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in urban area of Burkina from September to December 2003. Chloroquine (25 mg/kg over 3 days) or sulfadoxine/pyrimethamine (25 mg/kg + 0.025 mg/kg single dose) was administered respectively to 137 and 125 children aged from 6 to 59 months old in a randomized, opened study. Follow up extended over 28 days using modified WHO protocol. After adjusting the results by PCR, treatment failures rates were 63.4% (83/131) and 13.8% (17/123) respectively for chloroquine and sulfadoxine/pyrimethamine. These results with other observations have justified the change of malaria therapy policy in Burkina Faso in 2005.

Do antibody responses to malaria vaccine candidates influenced by the level of malaria transmission protect from malaria?

OBJECTIVES

To examine whether the humoural response to malaria vaccine candidate antigens, Plasmodium falciparum [circumsporozoite repetitive sequence (NANP)(5) GLURP fragments (R0 and R2) and MSP3] varies with the level of malaria transmission and to determine whether the antibodies (IgG) present at the beginning of the malaria transmission season protect against clinical malaria.

METHODS

Cross-sectional surveys were conducted to measure antibody response before, at the peak and at the end of the transmission season in children aged 6 months to 10 years in two villages with different levels of malaria transmission. A cohort study was performed to estimate the incidence of clinical malaria.

RESULTS

Antibodies to these antigens showed different seasonal patterns. IgG concentrations to any of the four antigens were higher in the village with high entomological inoculation rate. Multivariate analysis of combined data from the two villages indicated that children who were classified as responders to the selected antigens were at lower risk of clinical malaria than children classified as non-responders [(NANP)(5) (incidence rate ratio (IRR) = 0.65, 95% CI: 0.46-0.92; P = 0.016), R0 (IRR = 0.69, 95% CI: 0.48-0.97; P = 0.032), R2 (IRR = 0.73, 95% CI: 0.50-1.06; P = 0.09), MSP3 (IRR = 0.52, 95% CI: 0.32-0.85; P = 0.009)]. Fitting a model with all four antibody responses showed that MSP3 looked the best malaria vaccine candidate (IRR = 0.63; 95% CI: 0.38-1.05; P = 0.08).

CONCLUSION

Antibody levels to the four antigens are affected by the intensity of malaria transmission and associated with protection against clinical malaria. It is worthwhile investing in the development of these antigens as potential malaria vaccine candidates.

[Comparative impact of three malaria preventive regimens during pregnancy on maternal anemia due to malaria in Burkina Faso]

OBJECTIVES

The main objective of this study was to compare the efficacy of three regimens of malaria prevention during pregnancy for the reduction of anemia between the first and third antenatal consultations. The first treatment arm was the classical weekly chemoprophylaxis with chloroquine; the other two were the intermittent preventive treatment using either three doses of chloroquine or sulfadoxine-pyrimethamine.

DESIGN

We conducted an open, randomized, three-arm study in a rural district of Burkina Faso. A cohort was constituted by 648 pregnant women of any parity.

RESULTS

The hemoglobin gain was more significant with the intermittent preventive treatment using sulfadoxine-pyrimethamine compared to the other treatment arms. The hemoglobin increased from 10.3g/dl (at the first antenatal consultation) to 11.4 g/dl (at the third antenatal consultation). In the three arms of treatment, the chemoprophylaxis reduced the prevalence of moderate anemia and severe anemia. The reduction of moderate anemia was more substantial in the sulfadoxine-pyrimethamine arm (65.6 to 36.7%) at second antenatal consultation (p=0.069) and third antenatal consultation (p=0.014). Conversely, in the two chloroquine arms, there was no significant reduction either at second antenatal consultation (p=0.72) or third antenatal consultation (p=0.55). The prevalence of peripheral parasitemia decreased in all treatment groups. However, it was significantly higher in the sulfadoxine-pyrimethamine group (44.3%).

CONCLUSIONS

Intermittent preventive treatment with three doses of sulfadoxine-pyrimethamine is a more effective strategy to prevent maternal anemia during pregnancy in Burkina Faso.

[Risk factors for ischemic heart disease: a review of 162 cases in Bamako]

The determination of risk factors a low to prevent or to delay the apparition of certain diseases. Our study put out in Cardiology A of Hôpital du Point G. gold to determine the main risk factors of ischemic heart diseases between 162 patients. It appears that all classical risk factors (HBP, Diabetes, obesity, tobacco use, sedentary, menopause, contraceptives, dyslipidemia) were found among patients. It appears particularly that avoidable risk factors such tobacco use among young men, sedentary and obesity play important role in the beginning. So it is possible to deploy an efficient prevention politic.

[Geographic distribution and epidemiology of urinary schistosomiasis in Mali: implications for a control program]

A national survey was conducted in Mali between 1986 and 1990 to determine the geographical distribution of urinary schistosomiasis in order to define an ecologically based national schistosomiasis control programme. Fifty six thousand two hundreds and sixty five individuals randomly selected from 323 villages in the nine ecologically defined areas of the whole country were submitted to urine examination using Filtration Technique. In villages along the Niger and Senegal rivers, in the Dogon Plateau and Office du Niger areas, the prevalence of Schistosoma haematobium infection was the highest, respectively 41.8%, 53.1%, 59.4% et 62.9%. In these areas, more 70% of children aged 7 to 14 years were infected. In the Soudanian and North-Soudanian areas, the prevalence were below 10% and respectively only 5.3% and 11.5% of children aged 7 to 14 years were infected. It is concluded that Schistosoma haematobium infection is of public health importance in dam and irrigation areas and in areas along the Niger and Senegal rivers namely in Kayes, Koulikoro, Segou, Mopti regions and in Bamako district. These areas should be considered as priority areas for active control interventions. The interventions should include community-based mass chemotherapy with praziquantel after community diagnostic using urine examination in school aged children and a good monitoring system.

[Genetic diversity of P. falciparum and pathogenesis of the severe malarial anaemia in children under 5 years old in the province of Boulgou, Burkina Faso]

The clinical presentation of malaria mainly the severe form may be related to Plasmodium falciparum msp-2 (merozoite surface protein 2) specific family To verify this hypothesis, during the high malaria transmission season in 2001; we analyzed the allelic polymorphism of the msp-2 gene of P. falciparum in children under 5 years old with different presentation of malaria in the regional Hospital and at community level in the Boulgou Province (Burkina Faso). A total of 405 children (107 severe malarial anaemia cases, 102 severe malaria cases without severe anaemia and 196 non severe malaria cases) were enrolled in the study. The frequencies of the FC27 were 89.2% in severe malarial anaemia children group, then 89.7% and 86.9% respectively in severe malaria non anaemic children cases and non severe malaria cases (P = 0.4). The frequencies of the 3D7 were 72.5%; 84.1% and 77% respectively severe malaria non anaemic children, severe malarial anaemia cases and non severe malaria cases (P = 0.7). The complexity of the FC27 genotypes was significantly higher in children with severe malaria (with and without severe anaemia) compared to the non severe malarial children (P << 0.001). No significant difference was pointed up in the complexity of the 3D7 genotypes.

Genetic complexity and gametocyte production of Plasmodium falciparum in Fulani and Mossi communities in Burkina Faso

We have examined Plasmodium falciparum gametocyte prevalence, density and their genetic complexity among children of 2 sympatric ethnic groups (Mossi and Fulani) in villages in Burkina Faso. The 2 groups are known to have distinct differences in their susceptibility and immune responses to malaria. We used RT-PCR and sequence-specific probes to detect and type RNA of the gametocyte-specific protein Pfs48/45. There were no differences in detection rates of asexual forms and gametocytes among the 2 groups, using PCR and RT-PCR, respectively. However, there were significant differences in densities of asexual forms and gametocytes, which were both higher among Mossi than Fulani. Both asexual forms and gametocyte densities were influenced by age and ethnicity. Multiple-clone infections with more than 1 gametocyte genotype were equally prevalent among Fulani and Mossi. These differences can most probably be attributed to genetic differences in malaria susceptibility in the 2 ethnic groups.

Impact of mass chemotherapy with praziquantel on Schistosoma haematobium and Schistosoma mansoni infections in Office du Niger, Mali

Aims This study was carried up to assess the impact of mass chemotherapy with praziquantel on the prevalence and intensity of Schistosoma haematobium and Schistosoma mansoni in Office du Niger. Materials and Methods It was a cross sectional study with two passages about which we compared a test group of 7 villages (n=2342) treated in 1989 to a control group of 7 villages (n=2263). Results One year after mass chemotherapy, baseline prevalence rates of Schistoosma haematobium, Schistoaoma mansoni and those of the double infection decreased by 50%, 54% and 62,9% respectively. The geometric mean egg counts of Schistosma haematobium (GMECSh) was reduced by 66.6% and that of Schistosoma mansoni (GMECSm) by 43.4%. However, in spite of mass treatment, the overall prevalence rates of Schistosoma haematobium and mansoni were always higher than 20% in young people aged of 6-19 years. Conclusion These data show that in irrigated area, efficacy of praziquantel is strongly affected by age. This persistance of infection in population raises up several questions according to host immunity, parasite biology and praziquantel efficacy.

In situ calibration and [H+] sensitivity of the fluorescent Na+indicator SBFI

Despite the popularity of Na+-binding benzofuran isophthalate (SBFI) to measure intracellular free Na+ concentrations ([Na+]i), the in situ calibration techniques described to date do not favor the straightforward determination of all of the constants required by the standard equation (Grynkiewicz G, Poenie M, and Tsien RY. J Biol Chem 260: 3440–3450, 1985) to convert the ratiometric signal into [Na+]. We describe a simple method in which SBFI ratio values obtained during a “full” in situ calibration are fit by a three-parameter hyperbolic equation; the apparent dissociation constant ( K d) of SBFI for Na+ can then be resolved by means of a three-parameter hyperbolic decay equation. We also developed and tested a “one-point” technique for calibrating SBFI ratios in which the ratio value obtained in a neuron at the end of an experiment during exposure to gramicidin D and 10 mM Na+is used as a normalization factor for ratios obtained during the experiment; each normalized ratio is converted to [Na+]i using a modification of the standard equation and parameters obtained from a full calibration. Finally, we extended the characterization of the pH dependence of SBFI in situ. Although the K d of SBFI for Na+ was relatively insensitive to changes in pH in the range 6.8–7.8, acidification resulted in an apparent decrease, and alkalinization in an apparent increase, in [Na+]i values. The magnitudes of the apparent changes in [Na+]ivaried with absolute [Na+]i, and a method was developed for correcting [Na+]i values measured with SBFI for changes in intracellular pH.

Making a public-private partnership work--an insider's view. Interview by John Maurice

In November 1999, Dr Amadou Diarra was appointed senior director of Bristol-Myers Squibb's Secure the Future Initiative. Launched 18 months ago, this public-private partnership is seeking, together with the governments of nine African countries, innovative ways of reducing the transmission and the impact of HIV/AIDS, especially on women and children, through interventions involving medical care, research, community outreach, and education. Diarra, who was brought up in West Africa, had previously worked for about a decade with the company's Africa division. Last November Bristol-Myers Squibb joined four other major pharmaceutical manufacturers and five intergovernmental agencies in supporting the UNAIDS initiative for Accelerating Access to HIV Care, Support and Treatment. Diarra played a significant role in laying the foundations for Bristol-Myers Squibb's commitment to both of these public-private partnerships. He shares with John Maurice his views on what it takes to make a successful partnership of this kind.

Anoxia-evoked intracellular pH and Ca2+ concentration changes in cultured postnatal rat hippocampal neurons

The ratiometric indicators 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein and Fura-2 were employed to examine, respectively, intracellular pH (pHi) and calcium ([Ca2+]i) changes evoked by anoxia in cultured postnatal rat hippocampal neurons at 37 degrees C. Under both HCO3-/CO2- and HEPES-buffered conditions, 3-, 5- or 10-min anoxia induced a triphasic change in pHi consisting of an initial fall in pHi, a subsequent rise in pHi in the continued absence of O2 and, finally, a further rise in pHi upon the return to normoxia, which recovered towards preanoxic steady-state pHi values if the duration of the anoxic insult was < or = 5 min. In parallel experiments performed on sister cultures, anoxia of 3, 5 or 10 min duration evoked rises in [Ca2+]i which, in all cases, commenced after the start of the fall in pHi, reached a peak at or just following the return to normoxia and then declined towards preanoxic resting levels. Removal of external Ca2+ markedly attenuated increases in [Ca2+]i, but failed to affect the pHi changes evoked by 5 min anoxia. The latency from the start of anoxia to the start of the increase in pHi observed during anoxia was increased by perfusion with media containing either 2 mM Na+, 20 mM glucose or 1 microM tetrodotoxin. Because each of these manoeuvres is known to delay the onset and/or attenuate the magnitude of anoxic depolarization, the results suggest that the rise in pHi observed during anoxia may be consequent upon membrane depolarization. This possibility was also suggested by the findings that Zn2+ and Cd2+, known blockers of voltage-dependent proton conductances, reduced the magnitude of the rise in pHi observed during anoxia. Under HCO3-/CO2-free conditions, reduction of external Na+ by substitution with N-methyl-D-glucamine (but not Li+) attenuated the magnitude of the postanoxic alkalinization, suggesting that increased Na+/H+ exchange activity contributes to the postanoxic rise in pHi. In support, rates of pHi recovery from internal acid loads imposed following anoxia were increased compared to control values established prior to anoxia in the same neurons. In contrast, rates of pHi recovery from acid loads imposed during anoxia were reduced, suggesting the possibility that Na+/H+ exchange is inhibited during anoxia. We conclude that the steady-state pHi response of cultured rat hippocampal neurons to transient anoxia is independent of changes in [Ca2+]i and is characterized by three phases which are determined, at least in part, by alterations in Na+/H- exchange activity and, possibly, by a proton conductance which is activated during membrane depolarization.

The public health significance of urinary schistosomiasis as a cause of morbidity in two districts in Mali

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

Assessment of cure by detection of circulating antigens in serum and urine, following schistosomiasis mass treatment in two villages of the Office du Niger, Mali

Eight weeks after mass chemotherapy with 40 mg/kg praziquantel in two villages in Office du Niger (an irrigation area in Mali, endemic for both Schistosoma haematobium and Schistosoma mansoni) the circulating anodic (CAA) and cathodic (CCA) antigen detection assays were carried out on serum and urine samples. Both prior and post treatment highest prevalence was measured with the urine-CCA assay. Cure rates determined by antigen detection were almost half that of the egg counting methods. It was shown that the reduction in intensity should be preferentially assessed by the serum-CAA assay. Compared with egg detection, a single antigen detection assay gave a much better assessment of the impact of chemotherapy.

Circulating anodic and cathodic antigen in serum and urine of mixed Schistosoma haematobium and S. mansoni infections in Office du Niger, Mali

In Office du Niger, an area endemic for both Schistosoma haematobium and S. mansoni in Mali, circulating anodic (CAA) and cathodic (CCA) antigen detection assays were performed on pretreatment serum and urine samples from two villages, Rigandé and Siguivoucé, and compared with egg counting methods. The highest prevalence was obtained with the urine-CCA assay which also had the highest sensitivity to S. haematobium, S. mansoni or mixed infection. A single urine-CCA assay was as sensitive as repeated egg counts (one stool+two urine examinations per individual). When the different assays were tested in parallel, several combinations including assays on serum were found to be highly sensitive. As urine sampling is widely accepted, urine assays will be used for further monitoring these villages one and two years after chemotherapy.

Expression and characterization of recombinant rat parathyroid hormone-related peptide (1-141) and an amino-terminally-truncated analogue (38-141)

We have synthesized and purified recombinant parathyroid hormone related peptide (PTHrP (1-141)) and PTHrP (38-141) using an E. coli system that requires minimal purification. The cDNAs encoding PTHrP (1-141) and PTHrP (35-141) respectively were inserted into the multiple cloning site of the pTrcHis-B bacterial expression plasmid. The PTHrP encoded sequences were thereby fused at their NH2-termini to six histidine residues within the fusion protein. The recombinant plasmids were transfected into E. coli cells and PTHrP synthesis was induced by addition of 1 mM isopropyl-beta-D-thiogalactopyranoside (IPTG) at 37 degrees C. The recombinant fusion proteins were purified by binding of the histidine residues to a nickel column followed by gradient elusion and dialysis. PTHrP (1-141) was released from its fusion protein by cyanogen bromide cleavage, whereas PTHrP (38-141) was released by enzymatic digestion with enterokinase. This rapid isolation method resulted in pure PTHrP (1-141) and (38-141) as judged by SDS-polyacrylamide gel electrophoresis and NH2-terminal sequence analysis. PTHrP (1-141) stimulated cAMP accumulation and mobilized intracellular calcium ([Ca2+]i) in UMR106 osteoblast-like cells, and stimulated phosphate transport in OK/E renal cells, whereas PTHrP (38-141) was inert in these bioassays. Availability of PTHrP and its NH2-terminally truncated analogue, which lacks the sequence necessary for its hypercalcemic actions, will enable their biological activities to be examined in greater detail.

Comparison of the circulating anodic antigen detection assay and urine filtration to diagnose Schistosoma haematobium infections in Mali

The applicability of a circulating Schistosoma antigen detection assay for determining rates of infection and efficacy of chemotherapy was evaluated in Mali. Urine egg counts were compared to circulating anodic antigen enzyme-linked immunosorbent assay (CAA-ELISA) titres in serum, before and 6 weeks after treatment with a single dose of praziquantel (40 mg/kg), in 2 villages in Dogon Country, an area endemic for S. haematobium, the predominant schistosome infection in Mali. In Kassa, a village with a moderate prevalence of infection, the serological prevalence (48%) was significantly higher than the parasitological prevalence (31%). In Boro, a village with high parasitological prevalence (76%), no difference was observed between the results of both methods (prevalence by CAA-ELISA was 75%). Cure rates estimated by CAA-ELISA were lower than those determined parasitologically, suggesting that cure rates are overestimated by egg counting. The sensitivity of the CAA-ELISA was 78%. In both villages, before treatment, a positive correlation was found between the number of eggs in urine and serum CAA titres. It is concluded that, although further simplification and improvement of the sensitivity of the assay is needed, in its present ELISA format the antigen detection assay is useful for monitoring sentinel populations. Furthermore, the serum CAA assay performed adequately in a public health laboratory within an endemic country.

[The antioxidative activity of the tissues and lipids in rats of different ages]

The experiment on white Wistar rats 3-, 12- and 24 months old was carried out to study antioxidative activity in homogenates of the pancreas, adrenal glands, testes, muscles, heart and in lipids isolated from these tissues. The data were obtained in the model of thermal autooxidation of homogenates and lipids as well as during autooxidation of linethol in the presence of the samples studied. kinetics of peroxidation of tissue lipids, their effect on linethol oxidation rate and content of total lipids in the tissues were estimated. Contribution of the lipids to the total antioxidative activity of the tissue varies with age. Tissue properties of the parameters in question are observed as well as active participation of all the tissues studied in the support of the antioxidative homeostasis in the organism. Intensity of the participation depended on the age of animals.