Biliary drainage surgery before or after 3 months of life versus primary liver transplantation in children with biliary atresia: comparative cohort study

BACKGROUND

Early biliary drainage surgery (BDS; Kasai) is associated with longer transplant-free survival in biliary atresia. However, evidence is lacking on whether an age limit can be established at which liver transplantation should be performed as first-line treatment for children with a delayed diagnosis of biliary atresia. The aim of the current study was to compare the outcome of a large cohort of children with biliary atresia who underwent BDS after 90 days of life with those who underwent early BDS (before 90 days) and those who did not receive BDS and were directly referred for primary liver transplantation.

METHODS

All patients with biliary atresia treated at Bicêtre, Paris-Saclay University Hospital between 1995 and 2017 were analysed in this STROBE-compliant study. Three groups were defined: BDS before 90 days of life (early BDS); BDS after 90 days of life (late BDS); and patients without BDS who were referred for primary liver transplantation (no BDS). Patient characteristics, overall survival, and native liver survival were compared.

RESULTS

Of 424 children with biliary atresia, 69 patients (16 per cent) were older than 90 days when they underwent BDS. Twenty-five patients had no BDS and were referred for primary liver transplantation (6 per cent). The main reason for not performing BDS was manifest portal hypertension (18/25). Two- and 5-year transplant-free survival were significantly higher in patients with late BDS compared with no BDS (53.5 versus 12.0 per cent respectively for 2-year data and 30.4 versus 4.0 per cent respectively for 5-year data, P < 0.001). Five- and 10-year overall survival did not differ between early BDS (92 and 91 per cent respectively), late BDS (88 and 83 per cent respectively) and no BDS (80 and 80 per cent respectively, P = 0.061).

CONCLUSION

Age alone should not routinely be considered a contraindication to BDS in patients older than 90 days. Liver transplantation in infancy (less than 12 months) could be avoided in 88 per cent of cases with late diagnosis of biliary atresia and is delayed significantly even when BDS is performed after 3 months. Overall survival is at least equal to patients who are referred for primary liver transplantation.

Tinea capitis in school children from Mauritania: A comparative study between urban and rural areas

INTRODUCTION

In Mauritania, only an investigation carried out 26 years ago allows to report epidemiological findings about tinea capitis in Nouakchott. The objective of this study was to reactualize the tinea capitis epidemiological, clinical and mycological profile in school children and to compare this profile in urban and rural area.

PATIENTS AND METHODS

All subscribed students in targeted schools and present during the investigation were examined clinically before samples collection. Mycological diagnosis was made by direct examination and culture in Sabouraud Dextrose Agar with chloramphenicol and supplemented with cycloheximide. The results were considered positive when culture with the presence of dermatophytes was obtained.

RESULTS

Prevalence of tinea capitis among school children was 10.50% and it was more important in rural area (12.21%) than in urban area (9.52%). The age group ranged between 6 and 8 years was the most affected (13.58%). According to the gender, male (11.46%) were more affected than female (9.62%). Trichophytic tinea were predominant and Trichophyton soudanense was more isolated followed by Trichophyton rubrum, Trichophyton schoenleinii and Microsporum audouinii.

MALDI-TOF MS identification of Malassezia species isolated from patients with pityriasis versicolor at the seafarers' medical service in Dakar, Senegal

Pityriasis versicolor (PV) is a superficial mycosis caused by yeast of the genus Malassezia. The most common isolated Malassezia species in PV lesions differ among M. furfur, M. globosa and M. sympodialis. We purpose to determine the distribution of Malassezia species in PV patients at the seafarers' medical service in Dakar, Senegal and to examine whether any association between identified Malassezia species and patients' profile. From May 2017 to August 2017, first a questionnaire was filled to get informative data before collection of skin scrapings taken from most scaly site using sterile scalpel blade and application of scotch^® for direct examination (DE). At the laboratory, DE, culture and identification by MALDI-TOF MS were done. One hundred patients with PV - all men - were included with a mean age of 34 years. Among seafarers, 81% were sailors. Clinical prevalence of PV was highest in aged adults patients with ages of 31 to 60 years (56%). Seafarers with high level of education were less representative with only 2%. The mean duration of the PV was 26.83 months. 20% of subjects suffered lesions in more than one location. The chest was the most affected anatomical site. Furthermore, possible predisposing factors associated with PV were also detected. DE was positive in 95% but culture growth only in 46%. MALDI-TOF MS analysis of the positive cultures could be performed in 84.8% (39/46). Only M. furfur was identified in 100% (39/39). In definitive, M. furfur is the only causative agent of PV in Dakar.

[Vulvovaginal candidiasis in pregnant women in the Mère et Enfant Hospital center in Nouakchott, Mauritania]

AIM

To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania.

PATIENTS AND METHOD

The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media.

RESULTS

Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy.

CONCLUSION

This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.

[Interdigital tinea pedis resulting from Fusarium spp. in Dakar, Senegal]

INTRODUCTION

Fungal interdigital tinea pedis (ITP) is a common pathology mainly due to dermatophytes and yeasts. Fusarium sp. is rarely incriminated in the genesis of intertrigo. In Dakar, a recent study conducted in 2016 on fungal ITP showed that Fusarium were more involved in the etiology of ITP than dermatophytes, coming just after yeasts dominated by Candida. Following this, we wanted to draw attention to the increasing incidence of ITP resulting from Fusarium spp., in Dakar, Senegal, and to analyze the epidemiological and mycological particularities of these ITP due to Fusarium spp.

PATIENTS AND METHODS

A retrospective study including all patients received at the laboratory for suspicion of ITP between January 1st, 2014 and June 30th, 2017 was conducted. Diagnosis was based on mycological examination, including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat.

RESULTS

Twenty-nine cases of Fusarium ITP accounting for 44.6% of all ITP in the study period were diagnosed in 15 men and 14 women. The mean age of the patients was 48.4 years. Fusarium ITP were diagnosed in immunocompetent patients except in two diabetics. The mean duration of the lesions was 6.83 years. The most frequent species isolated belonged to the Fusarium solani complex with 19 cases.

CONCLUSION

Fusarium ITP in a healthy subject requires regular monitoring because any subsequent decrease in immune defenses could lead to fatal hematogenous spread.

[Causative agents of superficial mycoses isolated in Dakar, Senegal: Retrospective study from 2011 to 2015]

INTRODUCTION

Superficial fungal infections, particularly of the skin, scalp and nails are very common and have been reported worldwide. The most common causative agents of these mycoses are dermatophytes, yeasts and molds. However, these agents vary with time and depend on many factors including the geography. The objective of this study was to identify the causative agents of superficial mycoses diagnosed at the Le Dantec University Hospital in Dakar (Senegal).

MATERIAL AND METHODS

The study concerned 1851 outpatients received in the parasitological and mycological laboratory of Le Dantec hospital during the period from January 2011 to December 2015. Every patient benefited from direct examination and mycological culture.

RESULTS

Among the 1851 patients, 633 were confirmed with superficial mycoses and the prevalence was 34.2 %. The age of patients ranged from two months to 81 years with a mean age of 31 years. Superficial mycoses were found more in women (70.3 %) than men (29.7 %) and a little more than thirty-nine percent (39.3 %) were adults. The causative agents identified were: dermatophytes (58 %), yeast (36.7 %) and non-dermatophytic filamentous fungi (NDFF, 5.3 %). The most isolated species were: Candida albicans (26.9 %), Trichophyton soudanense (24.9 %) and T. rubrum (13.7 %). These fungi were responsible for different clinical aspects, isolated and other associated. Among the isolated clinical aspects, those affecting hair (tinea capitis) were by far the largest with 44.8 %, followed by tinea unguium (34.5 %). Associations were especially type of tinea capitis and tinea manuum (2.4 %) and toenails onychomycosis associated with interdigital tinea pedis (2.7 %). Tinea capitis agents were exclusively dermatophytes and the predominant agent was T. soudanense with 47,8 %. Tinea unguium agents were yeast (79 %), dermatophytes (18 %) or NDFF (3 %) and the most found species was C. albicans (63.9 %). Dermatophytes, yeasts and molds were respectively found more in children and young adults, older adults and young adults and older adults and the elderly.

CONCLUSION

In definitive, these epidemiological data should enable better diagnostic and therapeutic management of superficial mycoses.

[Efficacy of sodium hydroxide at 2.5 %, chlorhexidine gluconate at 0.5 % and calcium hydroxide against Candida albicans]

INTRODUCTION

Endodontic flora is dominated in the apical part of the channels by strict anaerobic and some facultative anaerobic bacteria but also by Candida yeasts, especially Candida albicans species that are involved in the maintenance and persistence of endodontic infections. Their elimination of the canal system in practice by chemo-mechanical methods of disinfection is not always guaranteed. Thus, this in vitro study was performed to determine the sensitivity of C. albicans with sodium hypochlorite (NaOCl) dosed at 2.5 %, the chlorhexidine digluconate 0.5 % and calcium hydroxide used in inter-session medication.

METHODS

The diffusion method was used initially to test the sensitivity of C. albicans strains with the above products. Then a dilution technique has allowed us to determine the minimum inhibitory concentration of these active products on C. albicans.

RESULTS

Strains from infected pulp teeth of patients showed a sensitivity of C. albicans to sodium hypochlorite to a minimum inhibitory concentration less than 70μg/mL and 30μg/mL for chlorhexidine.

CONCLUSION

This study demonstrated a sensitivity of C. albicans to sodium hypochlorite and chlorhexidine.

Fungal interdigital tinea pedis in Dakar (Senegal)

Fungal interdigital tinea pedis (FITP) is the most frequent dermatomycosis in industrial countries. In African tropics, it's a rare motive of consultation and is discovered while complicated. The aims of this article were: to determine the frequency of interdigital tinea pedis among overall mycological analysis in our laboratory; to study epidemiological, clinical and mycological aspects of FITP in outpatients attending the Le Dantec mycology laboratory in Dakar. A total of 62 males (60%) and 42 females (40%), mean age: 43.15 years (range: 11-81 years), were received from January 2011 to December 2015 for suspicion of FITP. Skin specimens were taken from all patients for microscopy and fungal culture. The frequency of ITP represents 5.6% (104/1851) among our overall mycological analysis. FITP was confirmed in 68 patients (SPI=65.38%), mainly located between the 4th and 5th toes and 71 fungal species were isolated (CPI=68.27%). Among patients with confirmed FITP, there were 38 males (56%) and 30 females (44%). The prevalence was highest in patients between 44 and 54 years (26%). Candida albicans, Fusarium solani and Trichophyton interdigitale were shown to be the most common pathogens respectively for yeasts (39%), non-dermatophytic filamentous fungi (NDFF; 21%) and dermatophytes (11%). So FITP isn't a common reason for consultation in Dakar but its simple parasitic index (SPI) is still very high and dermatophytes formerly the main causative agents are being relegated to third place behind yeasts and NDFF.

[Nondermatophytic and noncandidal fungi isolated in Le Dantec University hospital of Dakar in 2014: Epidemiological, clinical and mycological study]

In recent years, the incidence of superficial fungal infections involving nondermatophytic and noncandidal fungi increased considerably. The objective of this work was to analyze the epidemiological, clinical and mycological fungal infections due to nondermatophytic and noncandidal fungi diagnosed in the laboratory of parasitology-mycology of Le Dantec hospital in Dakar. With a retrospective study of the various cases of nondermatophytic and noncandidal fungi isolated in the laboratory of parasitology-mycology during the period of November 2013 to December 2014, we collected 22 cases of infections in 11 men and 11 women; age ranging from 17 to 75 years with a mean of 45.3 years (sex ratio=1): eight cases of intertrigo, seven cases of onychomycosis, four cases of palmoplantar keratoderma (KPP), a case of onychomycosis associated with interdigital intertrigo, a case of infectious myositis and one case of African histoplasmosis. We have isolated and identified a total of 22 nondermatophytic and noncandidal fungi: ten Fusarium, five Trichosporon, two Chrysosporium, two Geotrichum, one Rhodotorula, one Neoscytalidium dimidiatum and one Histoplasma capsulatum var. duboisii. So we are seeing the emergence of nondermatophytic and noncandidal increasingly isolated from superficial and local lesions. These fungi, generally contaminants or commensal, cause a problem regarding their direct involvement in pathological processes in which they are isolated. So we should respect the recommendations proposed for their involvement in pathological processes and, by a collaboration between clinician and biologist, demonstrate their real involvement through effective, targeted treatment.

[Tinea pedis due to Fusarium solani in Dakar]

A patient presented with intertrigo at the second, third and fourth interdigitals spaces lasting for four years in which Fusarium solani was highlighted. The search for contributing factors revealed a concept of foot washing with water at least five times a day for ablutions, associated with wearing closed shoes all day and the absence of immunosuppression and diabetes. The diagnosis of Fusarium was made on the basis of direct examination and culture. Combined treatment with griseofulvin oral and topical ciclopirox was introduced and allowed healing after 45 days at which an antifungal powder was prescribed for relay. This case adds to the rare cases of intertrigo Fusarium sp. and confirms the frequent practice of ablutions as favoring factor.

[Prevalence of dental caries among 12-year old schoolchildren in the Dakar region]

Oral diseases are considered as major public health problem. Dental caries restricts the school activities and are the dominant cause of dental morbidity. The aims of this survey were to determine prevalence of dental caries among pupils of Dakar and to study their food habits and oral hygiene. A descriptive transversal study was conducted from February 15th to May 07th, 2011 with respect of WHO directives (protocol of 1997) readjusted to Senegalese context. Our results showed a prevalence of 41.8%; a mean DMF index of 0.644; a proportion of teeth decayed of 65%, 32.2% for missing teeth and 2.7% of filled teeth. The multivariate logistic regression analysis showed that snacking, consumption of sweetened drinks far from meals and brushing teeth before the meals were significantly linked to the presence of dental caries. These results showed that the state of oral health and the prevention level of dental caries among these children were not so good. A new orientation of oral health policy based on messages regarding the main etiologic factors is imperative.

[Cryptosporidiosis in Senegalese children: prevalence study and use of ELISA serologic diagnosis]

This is a prospective, descriptive and analytic study conducted from July 2011 to September 2011 at the Children National Hospital Albert Royer of Dakar and at the Vélingara Health District. It was focused on children under 15 without reference to HIV status. For each child, a sample of stool was examined by the Ziehl-Neelsen modified staining and by ELISA using the "Cryptosporidium Antigen Detection Microwell ELISA kit" designed to detect Cryptosporidium spp antigens. The aim of our study was to determine the prevalence of cryptosporidiosis in rural and hospital areas and to measure the performance of the ELISA kit that we used. Out of the 375 stool examinations performed with the Ziehl-Neelsen modified staining, 17 had revealed the presence of Cryptosporidium spp (4.53%). The prevalence in rural areas was 2% while the hospital prevalence was 7.4%, of which 1.8% (1/57) were from urban areas and 9.8% (12/122) from suburban areas. No positive case was observed in children over 10 years. By ELISA, 23 positives cases were reported corresponding to a prevalence of 6.13% (1.8% in children living in urban areas, 13.1% in children from suburban areas and 3%living in rural areas).The correlation of this assay with the Ziehl-Neelsen modified staining, considered as the reference method, found that this assay had a sensitivity of 58.82% and a high specificity reaching 96.37%. The positive predictive value (PPV) was 43.4% while the negative predictive value was 98%. Cryptosporidiosis is a significant cause of parasitic infection among children in Senegal. Antigen detection of Cryptosporidium spp by ELISA in stool can be a complementary tool in the diagnosis of cryptosporidiosis.

[Disseminated histoplasmosis due to Histoplasma capsulatum var. duboisii in Senegal. A case in HIV-infected patient]

INTRODUCTION

Histoplasmosis, a disease due to Histoplasma capsulatum, is an invasive opportunistic fungal infection, endemic in Africa. So, the occurrence of african histoplasmosis associated with HIV infection has been rarely reported despite the high prevalence of both pathogens in this area. We report the first case of disseminated african histoplasmosis in an HIV-infected Senegalese patient.

OBSERVATION

A patient, 50-year-old has been admitted for umbilicate, necrotic and disseminated papulonodular lesions with oral infection, fever and reduction of total body mass. HIV1 test was positive, and CD4 count was 4/mm(3). Direct examination of ulcerated lesions shown extracellular, large, doubly contoured yeasts. After culture, we obtain brownish colonies, septate hyphae, echinulated chlamydospores characteristic of Histoplasma. Cutaneous biopsy revealed polymorphous granulomatous infiltrate, giant cells containing numerous large, doubly contoured, thick-wall yeast-bodies characteristic of H. capsulatum var. duboisii.

DISCUSSION

The association AIDS and histoplasmosis frequency is probably underestimated because the difficult diagnosis and the ignorance of the medical staff.

[Update on toxoplasmosis prevalence based on serological tests in pregnant women in Dakar, Senegal from 2002 to 2006]

The purpose of this study was to update data on toxoplasmosis antibody prevalence based on antenatal surveillance tests in pregnant women in Dakar, Senegal. The study population consisted of 941 pregnant women referred for diagnosis of toxoplasmosis in the Laboratory of Parasitology and Mycology at Le Dantec University Hospital Center from 2002 to 2006. Two tests using the solid-phase immunoenzymatic method were performed on venous blood samples collected at 3 weeks of interval (S1 and S2). This double testing technique was designed to detect increases in IgM and IgG antibody levels in order to confirm diagnosis of toxoplasmosis by ruling out immune response, acquired immunity or nonspecific antibody fixation. Comparison of S1 and S2 results in the 941 patients indicated a prevalence of 7.7% and 0% respectively for IgM+IgG- cases, 23.3% and 24.3% respectively for IgM+IgG-cases, and 11.3% and 10.2% respectively for IgM+IgG+ cases. The overall prevalence of toxoplasmosis antibodies was 34.5%. These data showing a high prevalence of toxoplasmosis among pregnant women in Dakar underscore the need to improve serological screening and follow up.

[Epidemiological study on lymphatic filariasis (Wuchereria bancrofti) in Sénégal]

The purpose of this descriptive study conducted in an area endemic for lymphatic filariasis was to update information on the prevalence, clinical aspects, and awareness of this parasitic disease. All consenting inhabitants over 10 years old in three selected sectors were included. An entomological investigation was carried out to estimate the rate of vector infection. Out of a total of 3.359 subjects examined, 57.3% reported familiarity with the disease and provided an accurate description. The prevalence of clinical manifestations, i.e., mainly adenopathy, attributable to the disease was 14.11%. The overall prevalence rate of parasites was 4.7% with significant variations between sectors. The only parasite species found was Wuchereria bancrofti. Parasite load was low with 68.8% of subjects having less than 10 microfilariae per microliter of blood. Data analysis identified the following risk factors: age with 77.2% of microfilariae carriers over the age of 45 years, sex with 61.4% of carriers being female, and duration of residence in endemic area with 80.4% of carriers living in the area for more than 10 years. Differences were statistically significant. Dissection of 511 female culicidae showed no microfilariae carriers. These data indicate a declining ten-dency in this endemic zone in Senegal.

[Evaluation of serological tests of toxoplasmosis in pregnant women realized at the Laboratory of Parasitology and Mycology of Le Dantec Teaching Hospital in 2002]

INTRODUCTION

the toxoplasmosis can occur complications during pregnancy as serious repercussions on the foetus with the risks linked to this pathology such as abortion. However these complications can be avoided during the pregnancy by an early diagnosis. The objective of this study is to determine the prevalence of toxoplasmosis during pregnancy.

MATERIALS AND METHODS

we undertook this study on 109 pregnant women addressed to the laboratory of parasitology and mycology of the CHU Dantec for toxoplasmosis serological test on 2002. We used a immunoenzymatic technical in solid phase whose principle rests on the change of coloration in the presence of antibody of IgM or IgG; coloration whose intensity is function of the title of antibody. For that, two serological tests (S1 and S2), starting from two venous blood at 3 weeks of interval, are carried out among these pregnant women. This second serology will make it possible to confirm or cancel an evolutionary toxoplasmosis based on the variation of the title in antibody between the first (S1) and the second serology (S2). A control is carried out among these women among whom the diagnosis of the evolutionary toxoplasmosis was established.

RESULTS

they show that with the first (S1), from the 109 patients, 3% were positive with the antibodies IgM type, 22% positive with IgG, and 11% positive with IgG and IgM. 36% of the women present a positive diagnostic at the first serology (S1). The second serology (S2) shows that among the 36% of the women diagnosed positive with the first serology, 11% made an evolutionary toxoplasmosis.

CONCLUSION

This study shows a rather significant of serological toxoplasmosis discovered fortuitously among pregnant women at the time of their assessment of pregnancy.

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal]

BACKGROUND

Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up.

METHODS

We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities.

RESULTS

Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second.

CONCLUSIONS

The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

Defining the origin of Plasmodium falciparum resistant dhfr isolates in Senegal

We previously reported a high baseline prevalence of mutations in the dhfr and dhps genes of Plasmodium falciparum throughout Senegal. The highest prevalence of the triple dhfr pyrimethamine associated mutations were found in isolates obtained in the western part of the country near the capital city of Dakar. In this study, we sought out to determine the relatedness of dhfr wild type and mutated strains by analyzing three microsatellite regions upstream of the dhfr locus. Twenty-six of the 31 wild type strains had a unique microsatellite pattern. In contrast, of the 17 isolates containing the triple mutation in dhfr, 11 had an identical microsatellite pattern. Diverse geographical isolates in Senegal containing the triple dhfr mutation have arisen from a limited number of ancestral strains. In addition, we demonstrate that these isolates have shared ancestry with the previously reported triple mutation haplotype found in Tanzania, South Africa, and southeast Asia. This common ancestry may have implications for the malaria control strategy for reducing the spread of sulfadoxine-pyrimethamine resistance in Senegal and elsewhere in Africa.

Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase genes in Senegal

Senegal recently (2004) switched to sulfadoxine-pyrimethamine (SP) with amodiaquine as first line therapy for malaria in response to increasing chloroquine resistance. In anticipation of emerging resistance to SP as a result of this change in drug pressure, we set out to define the baseline prevalence of SP-associated mutations in the dhfr and dhps genes in Plasmodium falciparum using geographically diverse and longitudinally collected samples. A total of 153 blood samples were analysed from patients (5 years or older) with mild malaria after informed consent was obtained. Longitudinal samples were collected between 2000 and 2003 in Pikine, a suburb of Dakar. Geographically diverse site sampling was carried out in 2003. The mutation prevalence in DHFR codons 51, 59 and 108 is 65%, 61% and 78% in Pikine, 2003. The overall prevalence of the triple mutation that is associated with high-level pyrimethamine resistance is 61%. The mutation prevalence rate in DHPS codons 436 and 437 is 21% and 40%, respectively. There is significant geographic variation in genotypic resistance, as samples from Pikine in 2003 had higher mutation prevalence in the pfdhfr and pfdhps genes compared to samples from Tambacounda (P < 0.015). In summary, this study demonstrates a high background prevalence of SP resistance mutations already present in P. falciparum in Senegal.

Aspects échographiques du choriocarcinome gestationnel

PURPOSE

To describe the sonographic morphological features of gestational choriocarcinoma.

MATERIALS AND METHODS

Retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases.

RESULTS

The tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging.

CONCLUSION

Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.

[Prevalence of urinary schistosomiasis in the school population in Senegal in 2002]

INTRODUCTION

The strong prevalence of schistosomiasis in the school population is correlated with underperformance in educational outcomes in Senegal. The geoclimatic conditions and bad socio-economic conditions facilitate transmission of these infections. This study was to define t he prevalence of these infections in sites throughout the country in school age children.

MATERIALS AND METHODS

This study was undertaken from November 2002 to January 2003 and included 63 schools; (n=2245) for an effectif of 30 000 pupils, means 7.4%. These pupils underwent urine examination for schistosomiasis in children with hematuria using millipore filtration method.

RESULTS

The results of the study are: overall there were 364 cases (16%). Prevalence rates: Tambacounda 27.8%, Bakel 21.5%, Kédougou 21.8%, Matam 13%, Podor 22.5%, Dagana 28.3%, and Saint-Louis 0%. This study demonstrates a high prevalence of parasites in school age children. Notably there is unique infection patterns in each village and this data will help direct public health interventions.

CONCLUSION

These results show a high rate prevalence of urinary schistosomiasis in school population in these departments. It explains the underperformance in educational outcomes in these a reas.

[Assessment of management training for low-level community health workers providing care for children with acute respiratory infections in four districts of Senegal]

BACKGROUND

Acute respiratory infections are the leading cause of death in childhood and most child deaths in Senegal occur at home without qualified health care. Despite this situation, only qualified healthcare workers are authorized to prescribe antibiotics. A competency-based training program was developed to improve and assess management of acute respiratory infections in young children aged between 2 and 59 months by low-level educated community health workers (CHWs) in four districts of Senegal.

METHODS

In accordance with the strategy developed by the World Health Organisation, educated low-level community health workers in four district of Senegal were given a three-day course on the management of acute respiratory failure. We assessed the effects of the course by comparing pre-training and post-training skills with the Students t test.

RESULTS

The results showed that the educated low-level community health workers were capable of acquiring the skills needed to effectively manage children with acute respiratory failure.

CONCLUSION

Further evaluation is needed to determine the mid- and long-term effects of the course and supervised post-training activities.

[Treatment of Baume class IV pulp diseases with calcium hydroxide: a clinical experimental study in Dakar]

The calcium hydroxide used as intracanalar temporary medication in modern endodontics, is the aim of this clinical and radiographic appraisal of endodontic treatment during two sessions (HESS J. C. and all. 1990); on 22 mature permanent teeth with peri apical lesion. In this second Dakar serial study, the mediate disinfection during 6 weeks in average, was followed by a root canal filling for: 11 mono-radicular teeth by compactage of gutta percha, adjusted monocone for 11 pluri-radicular teeth; and so by definitive coronal restoration. The direct magistral preparations used in this study are not expensive, but simple and efficient; our endodontic processing (pre-treatment and treatment) end up at clinical silence and radiographic apical healing in 90.91% of cases after 9 months for 66.67% of root canal filling located at the safety apical limit.

Evidence that SPROUTY2 functions as an inhibitor of mouse embryonic lung growth and morphogenesis

Experimental evidence is rapidly emerging that the coupling of positive regulatory signals with the induction of negative feedback modulators is a mechanism of fine regulation in development. Studies in Drosophila and chick have shown that members of the SPROUTY family are inducible negative regulators of growth factors that act through tyrosine kinase receptors. We and others have shown that Fibroblast Growth Factor 10 (FGF10) is a key positive regulator of lung branching morphogenesis. Herein, we provide direct evidence that mSprouty2 is dynamically expressed in the peripheral endoderm in embryonic lung and is downregulated in the clefts between new branches at E12.5. We found that mSprouty2 was expressed in a domain restricted in time and space, adjacent to that of Fgf10 in the peripheral mesenchyme. By E14.5, Fgf10 expression was restricted to a narrow domain of mesenchyme along the extreme edges of the individual lung lobes, whereas mSprouty2 was most highly expressed in the subjacent epithelial terminal buds. FGF10 beads upregulated the expression of mSprouty2 in adjacent epithelium in embryonic lung explant culture. Lung cultures treated with exogenous FGF10 showed greater branching and higher levels of mSpry2 mRNA. Conversely, Fgf10 antisense oligonucleotides reduced branching and decreased mSpry2 mRNA levels. However, treatment with exogenous FGF10 or antisense Fgf10 did not change Shh and FgfR2 mRNA levels in the lungs. We investigated Sprouty2 function during lung development by two different but complementary approaches. The targeted overexpression of mSprouty2 in the peripheral lung epithelium in vivo, using the Surfactant Protein C promoter, resulted in a low level of branching, lung lobe edges abnormal in appearance and the inhibition of epithelial proliferation. Transient high-level overexpression of mSpry2 throughout the pulmonary epithelium by intra-tracheal adenovirus microinjection also resulted in a low level of branching. These results indicate for the first time that mSPROUTY2 functions as a negative regulator of embryonic lung morphogenesis and growth.

Monoclonal antibodies to plasma high density lipoprotein (HDL) of eel (Anguilla japonica)

Six week-old female mice (Balb/c) injected intraperitonealy with 50 micrograms of eel high density lipoprotein (HDL) emulsified with equal volume of adjuvant three times every two weeks. Three weeks after the third injection, hyperimmunized mice were boosted by injection of 100 micrograms of HDL. After 5 days, the best responding mouse to injected HDL was sacrificed, and spleen cells were fused with mouse myeloma cells (Sp2/O-Ag14), and hybridomas were cultured in a selection medium. Monoclonal antibodies specific to apolipoprotein A-I or A-II (apoA-I or apoA-II) of HDL were obtained by cloning and recloning the hybridomas. Eighteen monoclonal antibodies specific to apoA-I and/or apoApII were isolated. Antibodies in the culture medium were purified by a HiTrap Protein G or an eel-HDL column. These purified antibodies belong to the subclass IgG1. The monoclonal antibodies specific to eel apoA-I and apoA-II secreted by clone 10D12 and 2G3, respectively, interact with serum proteins of some fish species such as red-sea bream and carp. The anti-eel apoA-I antibody of 10D12 did not bind to serum proteins of rat, rabbit, and chicken, while the anti-eel apoA-II of 2G3 antibody did.

A lipoprotein secreted by cultured hepatocytes of silver or yellow eel: comparison with their plasma lipoproteins

Cultured hepatocytes of silver eel actively secreted only chylomicron-like lipoprotein. The rate of secretion per mg cellular protein per 24 hr was 2.2 times higher compared with that by yellow eel hepatocytes. Silver eel hepatocytes secreted lipids 2.5 times higher through the lipoprotein than yellow eel hepatocytes. Main lipid was triacylglycerol in either secreted lipoprotein and composition of apolipoproteins of both secreted lipoproteins was the same. The incorporation of 3H-leucine into the lipoprotein secreted by silver eel hepatocytes was 2.4 times higher, but that of 14C-acetate was not significantly different. Protein and lipids composition of plasma lipoproteins of silver eel was significantly higher and lower compared with those of yellow eel, respectively. We suggest that the secreted lipoprotein of silver eel hepatocytes transport much more lipids to other tissues than that of yellow eel hepatocytes.