[Does aspirin have a place in primary cardiovascular prevention by the polypill ? Simulation study on a realistic virtual population]

BACKGROUND

The polypill strategy could become widely accepted in cardiovascular prevention due to reduced costs and its simplicity, which promote compliance. Aspirin is often included as a component of the polypill for primary prevention, but three powerful recent trials failed to show any favorable net benefit even in high-risk subgroups. Our objective is to estimate the net benefit associated with aspirin in primary cardiovascular prevention.

METHODS

We simulated the impact of different polypill compositions combining pravastatin, ramipril, hydrochlorothiazide, with or without aspirin, on a realistic French virtual population between 35 and 65 years old. We assessed how this impact on myocardial infarction and stroke varied according to gender, diabetes, and arterial hypertension. We identified the subgroup of individuals whose specific benefit from aspirin was greater than twice the risk of serious bleeding it induced.

RESULTS

The absolute benefit associated with aspirin was reduced by co-prescriptions. No subgroup of women benefited from aspirin, and the subgroup of women with a clear net benefit represented 128 women out of 529,421. Men at high risk of cardiovascular death, or with diabetes and hypertension, had a benefit from aspirin exceeding the risk of bleeding induced, but this risk represented more than half of the benefit. No subgroup analyzed did show a benefit greater than twice the risk of bleeding. The proportion of men whose expected benefit from aspirin was greater than twice the risk of bleeding represented 3% of all men. An optimal polypill strategy in primary prevention between the ages of 35 and 65, combining three drugs but not aspirin, can hope to save two out of three strokes and more than one out of two myocardial infarctions. It would prevent a major cardiovascular accident every 16 to 193 individuals treated according to the subgroups considered.

CONCLUSION

Until proven otherwise, aspirin has only a limited place in individuals between 35 and 65 years without a cardiovascular history. We showed how simulating therapeutic strategies on a realistic virtual population could be used for best applying available evidence.

Do drugs interact together in cardiovascular prevention? A meta-analysis of powerful or factorial randomized controlled trials

AIM OF THE STUDY

To explore whether preventive cardiovascular drugs (antihypertensive, antiplatelet, lipid lowering and hypoglycemic agents) interact together in cardiovascular prevention.

METHODS

We searched PubMed®, Web of science™, Embase and Cochrane library for powerful randomized placebo-controlled trials (>1000 patients). We explored whether drug effect on major vascular events changed according to cross-exposure to other drug classes or to cardiovascular risk factors (hypertension or type 2 diabetes), through a meta-analysis of relative odds ratio computed by trial subgroups. A significant interaction was suggested from confidence intervals of the ratio of odds ratios, when they excluded neutral value of 1.

RESULTS

In total, 14 trials with 178,398 patients were included. No significant interaction was observed between co-prescribed drugs or between these medications and type 2 diabetes/hypertension status.

CONCLUSIONS

Our meta-analysis is the first one to evaluate drug-drug and drug-hypertension/type 2 diabetes status interactions in terms of cardiovascular risks: we did not observe any significant interaction. This indirectly reinforces the rationale of using several contrasted mechanisms to address cardiovascular prevention; and allows the combination effect prediction by a simple multiplication of their odds ratios. The limited availability of data reported or obtained from authors is a strong argument in favor of data sharing.

Physicochemical factors affecting the diversity and abundance of Afrotropical Culicoides species in larval habitats in Senegal

Biting midges of the genus Culicoides (Diptera: Ceratopogonidae) are the biological vectors of arboviruses of global importance in animal health. We characterized the physicochemical parameters that determine the density and composition of the main Culicoides species of veterinary interest in larval habitats of the Niayes region of Senegal. For this purpose, we combined larval and substrate sampling in the field in different habitat types with adult emergence and physicochemical analyses in the laboratory. Three major habitat types were identified, conditioning the predominant species of Culicoides and pH and the amount of organic matter were positively correlated with the abundance of larvae and emerging Culicoides, as opposed to salinity. The diversity of emerging Culicoides was positively correlated with pH while it was negatively correlated with salinity. Culicoides distinctipennis was the predominant species in the larval habitat group of freshwater lake edges. In the larval habitat group of pond and puddle edges, C. oxystoma and C. nivosus were predominant; both species were again most abundant in the larval habitat group of saltwater lake edges. These variabilities in physicochemical parameters support the distribution of different Culicoides species in different habitat groups. These results make it possible to implement effective, selective and environmental-friendly control measures but also to improve current models for estimating the abundance of adult vector populations at a local scale.

[Intradetrusor injections of botulinum toxin A to treat urinary incontinence due to bladder overactivity during idiopathic Parkinson's disease]

INTRODUCTION

During idiopathic Parkinson's disease (IPD), lower urinary tract symptoms and dysfunctions are frequent, dominated by overactive bladder and detrusor overactivity (OAB, DO). Intradetrusor Injection (IDI) of Botulinum Toxin A (BTA) is recommended as second-line treatment for neurogenic urinary incontinence related to DO in multiple sclerosis or spinal cord injury patients. However, there is little data on BTA IDI to treat incontinence owing to OAB and DO during idiopathic Parkinson's disease. The objective of this study is to evaluate efficacy and tolerance of BTA IDI in patients suffering IPD.

PATIENTS AND METHODS

We conducted a retrospective study in IPD patients treated with BTA IDI from 2012 to 2018. For each patient we compared patient clinical and urodynamic data at baseline before the first injection and 8 weeks following the injection. We defined 3 levels of effects (perfect, improved, failure), corresponding to 3-dimension composite criteria: clinical, quality of life (Likert scale), urodynamics.

RESULTS

Sixteen patients were included from 2012 to 2018. The median age was 73 (70-78.25). The median number of micturition/day before and after TBA was 13 (10-16) and 9 (6.75-13.25) (p=0.022). The median number of pad used/day before and after BTA was 5.4 (2-5) and 1 (0-5) (p=0.035). Median USP scores for OAB was 15.5 (11.75-20) and 14 (6.75-15.25). Median score on the Likert scale was 1 (0-1.5) meaning "slight improvement" felt by the patient. The median maximum cystometric capacity raised from 130cm³ (41.25-187.75) to 217cm³ (165-376.75) (p=0,013). Among the patients, 20% had a perfect result, 40% were significantly improved and in 40% TBA injections failed. After TBA 4/14 patients (28%) needed intermittent self-catheterization. No severe side effect was observed.

CONCLUSION

In this retrospective study we observe some short-term efficacy of TBA IDI to treat urinary incontinence owing to OAB/DO in patients with IPD in 60% of patients. These results are consistent with findings from previous retrospective studies. Prospective data coming from larger cohorts are now tremendously needed to clarify the best patient responders profiles, the actual TBA dose, and eventually to define TBA IDI place in the therapeutic algorithm of IPD patients' incontinence.

LEVEL OF EVIDENCE

4.

Individual exposure level following indoor and outdoor air pollution exposure in Dakar (Senegal)

The consequences of indoor and outdoor air pollution on human health are of great concern nowadays. In this study, we firstly evaluated indoor and outdoor air pollution levels (CO, CO₂, NO, NO₂, PM₁₀) at an urban site in Dakar city center and at a rural site. Then, the individual exposure levels to selected pollutants and the variations in the levels of biomarkers of exposure were investigated in different groups of persons (bus drivers, traders working along the main roads and housemaids). Benzene exposure levels were higher for housemaids than for bus drivers and traders. High indoor exposure to benzene is probably due to cooking habits (cooking with charcoal), local practices (burning of incense), the use of cleaning products or solvent products which are important emitters of this compound. These results are confirmed by the values of S-PMA, which were higher in housemaids group compared to the others. Urinary 1-HOP levels were significantly higher for urban site housemaids compared to semirural district ones. Moreover, urinary levels of DNA oxidative stress damage (8-OHdG) and inflammatory (interleukin-6 and -8) biomarkers were higher in urban subjects in comparison to rural ones. The air quality measurement campaign showed that the bus interior was more polluted with PM₁₀, CO, CO₂ and NO than the market and urban or rural households. However, the interior of households showed higher concentration of VOCs than outdoor sites confirming previous observations of higher indoor individual exposure level to specific classes of pollutants.

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials

BACKGROUND AND OBJECTIVES

Statins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure.

RESULTS

Statins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients.

CONCLUSIONS

Statins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new evidence is available, this study supports the 2013 ACCF/AHA guidelines to not systematically prescribe statins in "only" HF patients, which should help avoid unnecessary polypharmacy.

Prevention of isoniazid toxicity by NAT2 genotyping in Senegalese tuberculosis patients

Isoniazid (INH), recommended by WHO (World Health Organization) in the treatment of tuberculosis (TB), is metabolized primarily by the genetically polymorphic N-acetyltransferase 2 (NAT2) enzyme. The human population is divided into three different phenotypic groups according to acetylation rate: slow, intermediate, and fast acetylators. The objective of this study was to explore the relationship between NAT2 genotypes and the serum concentrations of INH. Blood samples from 96 patients with TB were taken for the analysis. NAT2 polymorphisms on coding region were examined by polymerase chain reaction (PCR) direct sequencing; the acetylation status was obtained by measuring isoniazid (INH) and its metabolite, acetylisoniazid (AcINH) in plasma was obtained by using the liquid chromatography coupled to mass spectrometry. TB patients were distributed into two groups of fast and slow acetylators according to the acetylation index calculated based on the plasma concentration of INH in the 3rd hour (T3) after an oral dose. Our PCR analysis identified several alleles, where NAT2*4, NAT2*5A, NAT2*6A, and NAT2*13A were the most important. The concentrations of INH varied between 1.10 mg/L and 13.10 mg/L at the 3rd hour and between 0.1 and 9.5 mg/L at the 6th hour. The use of the acetylating index I₃ allowed the classification of tested patients into two phenotypic groups: slow acetylators (44.3% of TB patients), and rapid acetylators (55.7%). Patient’s acetylation profile provides valuable information on their therapeutic, pharmacological, and toxicological responses.

Environmental lead exposure and its relationship to traffic density among Senegalese children: a pilot study

In Senegal, as in many developing countries, traffic density is increasing in urban areas; in Dakar more than 50% of vehicles use gasoline. Yet the extent and real magnitude of the problem has neither been recognized nor assessed in these countries. Systemic data assessment of lead pollution and people's exposure are not well known in Senegal. This study was also designed to determine the impregnation levels of the lead released by the exhaust of cars and the changes of some early biological markers in Senegalese children. Blood lead (BPb) levels showed that all the children enrolled were exposed. However, lead exposure levels (from 34.7 to 145.8 mg/L) were less important for children living in rural areas (60.99-18.3 mg/L) than for those living in urban areas (106.79-16.9 mg/L). These changes could be correlated to the difference in the automobile traffic between both these regions (P B-0.001). BPb mean levels found in boys were higher than those in girls (P B-0.05). Despite elevated BPb levels, all values for blood zinc protoporphyrin and urine delta-aminolevulinic acid were within physiological ranges. In addition, variations in some biological markers of oxidative stress and renal disorders were seen; however, they must be confirmed by a future epidemiological study.

Environmental lead exposure and its relationship to traffic density among Senegalese children: a cross-sectional study

Leaded-gasoline is probably the primary source of lead (Pb) exposure in Dakar (Senegal). The present cross sectional study was undertaken to investigate the levels of Pb in Senegalese children and to present helpful data on the relationship between Pb levels and changes in biological markers of heme biosynthesis and oxidative stress. A total of 330 children, living since birth either in rural or urban areas (ie, Khombole (n=162) and Dakar (n=168), respectively) were included. During this cross sectional study, the mean blood (B)-Pb level in all children was 7.32±5.33 ųg/dL, and was influenced by the area of residence and gender. In rural children, 27 subjects (16.7%), 18 boys (19.6%) and nine girls (12.9%), had a B-Pb level >10 ųg Pb/dL, whereas 99 urban children (58.9%), respectively, 66 boys (71.8%) and 33 girls (43.4%), had alarmingly high B-Pb levels. Accordingly, urine delta-aminolevulinic acid levels were higher in children living in the urban area than in the rural areas (P B±0.001), and closely correlated with the B-Pb levels (P B±0.01). Moreover, glutathione peroxidase (GPx) activity, selenium (Se) level, glutathione reductase (GR) activity, and glutathione status were significantly influenced by area of residence and/or by gender. GPx activity and Se level were not only negatively correlated with B-Pb levels, but also positively correlated together (P B±0.01). Taken together, the present results allow us to conclude that urban children have higher B-Pb levels than rural children, and that of these children, boys have higher B-Pb levels than girls, leading thereby to alterations of heme biosynthesis and pro-oxidant/antioxidant balance. We also suggest that exposure to Pb and the Pb-induced adverse effects merits attention and that the development of preventive actions are of increasing importance in Senegal.

Foraging range of arthropods with veterinary interest: New insights for Afrotropical Culicoides biting midges (Diptera: Ceratopogonidae) using the ring method

The identification of blood meal source of arthropod vector species contributes to the understanding of host-vector-pathogen interactions. The aim of the current work was to identify blood meal source in Culicoides biting midge species, biological vectors of internationally important arboviruses of livestock and equids, using a new ecological approach. We examined the correlation between blood meal source identified in engorged Culicoides females collected in a suction light trap and the available vertebrate hosts along four rings (200, 500, 1000 and 2000 m) centered at the trap site and described the foraging range of the three main vector species of veterinary interest present in the study area, Culicoides imicola, Culicoides kingi and Culicoides oxystoma. The study was performed in four sites localized in the Niayes region of Senegal (West Africa) where recent outbreaks of African horse sickness occurred. Blood meal source identification was carried out by species-specific multiplex PCRs with genomic DNA extracted from the abdomen of engorged females collected during nine night collections for twenty-six collections. The four most abundant hosts present in the studied area (horse, cattle, goat and sheep) were surveyed in each ring zone. The blood meal source varied according to Culicoides species and host availability in each site. C. oxystoma and C. imicola females mainly fed on horses readily available at 200 m maximum from the trap location whereas females of C. kingi fed mainly on cattle, at variable distances from the traps (200 to 2000 m). C. oxystoma may also feed on other vertebrates. We discuss the results in relation with the transmission of Culicoides-borne arboviruses and the species dispersion capacities.

Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Objectives

Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects.

Methods

We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia).

Results

Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67–0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74–0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70–0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66–0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76–0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74–0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71–0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77–0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74–0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased.

Conclusion

Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.

[Tooth decay: epidemiological and therapeutic aspects in dental service of University Teaching Hospital Yalgado Ouedraogo and Municipal Centre of Oral Health]

INTRODUCTION

In order to improve the prevention and treatment of dental caries in Burkina Faso, we conducted a study on the epidemiological and therapeutic aspects of dental caries in the dental services of University Teaching Hospital Yalgado Ouedraogo and in the Municipal Centre of Oral Health of Ouagadougou.

MATERIAL AND METHODS

A prospective and descriptive study from October, 15th 2012 to January, 15th 2013 was conducted on a sample of 191 patients. The variables recorded were: patient's identity, age, sex, area of residence, food mode, socioeconomic level, reason for consultation, oral hygiene, DMFT index, degree of tissue damage, the topography of the carious lesions and the applied therapy.

RESULTS

Caries prevalence was 93.19% more female consultations, with sex ratio at 0.77. The average age was 31 years for a sample often engaged in trade and the informal sector. Carious lesions were usually limited to less than 4 teeth. The main motivation for the consultation was pain at 82.20%.

CONCLUSION

The use of preventive care is quite low in our population. Extractions still occupy an important part of treatment. We need to improve oral hygiene and show to patients the necessity of routine visits to the dentist every year for early treatment.

[Urological emergencies in paediatric surgery: a survey of 40 cases]

AIMS

The objective of this study is to report our experience on the epidemiology of urological emergencies in pediatric surgery, and to analyze the diagnosis and therapeutic process.

MATERIALS AND METHODS

It was a prospective survey which was carried out between January 2010 and June 2011 in the pediatric service of Aristide Le Dantec Hospital (HALD). All the children who came for a urological emergency consultation were included in the study.

THE RESULTS

the urological emergencies accounted for forty cases which represented 2.57% of pediatric surgery emergencies. The average age of our patients was 4.5 years with extremes of 10 days and 15 years of age. 29 cases of severe big bursae were observed and among them there were strangulated hernia and ten cases of suspicious spermatic cord torsion. The other admission motives consisted of three cases of urine retention, two pyelonephritis cases, two cases of post circumcision glans sections, two paraphimosis cases, one tight phimosis case, one case of penis traumatism provoked by a game incident. The scrotum ultrasound performed on six patients helped find out a specificity of 66.6%. 60% of strangulated hernia have been reduced through under sedation taxis. In case of confirmed torsion, a detorsion followed by an orchidopexy were performed. Two orchidectomy were performed for a testicular necrosis.

CONCLUSION

the painful big bursa is the number one cause for a urology pediatric consultation. It implies a fast and adequate diagnosis and treatment so as not to miss a digestive or testicular pain.

Low-level environmental exposure to lead and renal adverse effects: a cross-sectional study in the population of children bordering the Mbeubeuss landfill near Dakar, Senegal

This study deals with the health effects within a child population, neighbouring a landfill. After detecting metals in soil and air samples collected in the surroundings of the landfill and in a control site, we have studied: (i) levels of lead (Pb) and exposure biomarkers in blood and urine, (ii) oxidative stress biomarkers and (iii) renal injury by applying a set of early effect biomarkers. Levels of Pb were higher in the exposed site (i.e. 1129 mg/kg and 640 ng/m(3) in soil and air samples, respectively) versus those in the control site (i.e. 14.3 mg/kg and 9.3 ng/m(3) in soil and air samples, respectively). Pb impregnation and levels of delta-aminolevulinic acid in urine were influenced by the living site that shows the prevailingly alarming situation in the Mbeubeuss landfill. Malondialdehyde changes indicated Pb-induced excessive production of reactive oxygen species. Lactate dehydrogenase activities and proteinuria were found to be higher in the children living in the exposed site. These evidences may reveal the usefulness of these two effect biomarkers to monitor the kidney injury entailed by relatively low-environmental exposure to Pb. Overall, these results show that the Mbeubeuss landfill constitutes a real source of environmental and health risk, be it living or working on site, of the surrounding population, predominantly for children.

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'

BACKGROUND

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.

PATIENTS AND METHODS

We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.

RESULTS

Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].

CONCLUSION

ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Osteogenesis imperfecta in a pediatric surgical center in dakar, senegal: clinical and radiological aspects

INTRODUCTION

Osteogenesis imperfecta presents with a set of constitutional disorders of varying severity, genetically determined and characterized by an abnormal production of collagen and matrix of the bone leading to bone fragility responsible for multiple fractures and many skeletal deformities. The aim of our study was to analyze the clinical and radiological aspects of the pathology.

PATIENTS AND METHODS

This was a retrospective study of 10 cases of children with osteogenesis imperfecta who consulted the Pediatric Surgery Unit of the University Center Aristide Le Dantec Hospital over a period of 6 years. The parameters analyzed were the reasons for consultation, physical examination findings and findings on standard radiographs. After collecting all the data, children were divided according to the classification of Silence and Glorieux.

RESULTS

Pain was the reason for consultation in eight children. The saber blade deformity of the legs was found in nine children. Physical examination found tenderness in 80% of cases. Blue sclera was found in one child. The teeth were normal in eight patients. Standard radiographs showed an osteopenic skeleton with multiple fractures (3.7 fractures on the average) associated with vicious callus formation and deformity. According to the classification of Silence and Glorieux, six children were type VI, two children type IV, a child type III and one type I.

CONCLUSION

Osteogenesis imperfecta is a rare disease. In our environment, the diagnosis is made late - a stage associated with deformity. Of these, the occurrence of sabber deformity of the lower limbs is the most common. Radiological aspects are dominated by vicious callus formation, deformed bones and osteopenia. Moderate forms are predominant. Parents need to be educated about the risk of repeat fractures and the need to present deformed children to hospital early.

Potential use of densified polymer-pastefill mixture as waste containment barrier materials

Mining activities generate a large amount of solid waste, such as waste rock and tailings. The surface disposal of such waste can create several environmental and geotechnical problems. Public perception and strict government regulations with regards to the disposal of such waste compel the mining industry to develop new strategies which are environmentally sound and cost effective. In this scenario, recycling of such waste into mining or civil engineering construction materials have become a great challenge for the mining and civil engineering community. Hence, in this study, taking advantage of the inherent low hydraulic conductivity of paste tailings (pastefill), small amounts (0.05, 0.1, 0.2, 0.5%) of a super absorbent polymer (SAP) are added to the latter after moisturizing the tailings. The resulting densified polymer-pastefill (PP) materials are compacted and submitted to permeability tests at room temperature and performance tests under cyclic freeze-thaw and wet-dry conditions to evaluate their suitability as a barrier for waste containment facilities. Valuable results are obtained. It is found that the hydraulic conductivity of the proposed barrier material (PP) decreases as the amount of SAP increases. Hydraulic conductivity values as low as 1 × 10(-7) and 6 × 10(-9)cm/s are obtained for PPs which contain 0.1-0.5% SAP, respectively. The PP material also shows relatively good resistance to cyclic freeze-thaw and wet-dry stresses. The results show that negligible to acceptable changes in hydraulic conductivity occur after five freeze-thaw and six wet-dry cycles. None of the changes reach one order of magnitude. As a final step, a cost analysis is undertaken to evaluate the economical benefits that could be drawn from such a proposed barrier material. When compared to a conventional compacted sand-bentonite barrier with 12% bentonite concentration, it is found that the benefit realized could be estimated to 98, 96 and 90% when using PP material that contains 0.10, 0.20 and 0.5% of SAP. From this study, it can be concluded that PP materials show encouraging performance properties for barrier design.

Exploring the influence of operational parameters on the reactivity of elemental iron materials

In an attempt to characterize material intrinsic reactivity, iron dissolution from elemental iron materials (Fe(0)) was investigated under various experimental conditions in batch tests. Dissolution experiments were performed in a dilute solution of ethylenediaminetetraacetate (Na(2)-EDTA - 2mM). The dissolution kinetics of 18 Fe(0) materials were investigated. The effects of individual operational parameters were assessed using selected materials. The effects of available reactive sites [Fe(0) particle size (<or=2.0mm) and metal loading (2-64 g L(-1))], mixing type (air bubbling, shaking), shaking intensity (0-250 min(-1)), and Fe(0) pre-treatment (ascorbate, HCl and EDTA washing) were investigated. The data were analysed using the initial dissolution rate (k(EDTA)). The results show increased iron dissolution with increasing reactive sites (decreasing particle size or increasing metal loading), and increasing mixing speed. Air bubbling and material pre-treatment also lead to increased iron dissolution. The main output of this work is that available results are hardly comparable as they were achieved under very different experimental conditions. A unified experimental procedure for the investigation of processes in Fe(0)/H(2)O systems is suitable. Alternatively, a parameter (tau(EDTA)) is introduced which could routinely used to characterize Fe(0) reactivity under given experimental conditions.

Outcome of HER2-Positive (HER2+) Metastatic Breast Cancer Patients (MBC) Treated with Trastuzumab (T): An Institutional Based Review

Background: HER2+ status is associated with poor prognosis, high incidence of visceral and brain metastasis. However the addition of trastuzumab to chemotherapy (CT) significantly improves survival in early and advanced breast cancer. The purpose of this retrospective study was to explore the pattern of outcome in a cohort of MBC patients treated with T-based chemotherapy in a single institution. T was approved in Europe in 2000 and in 2001 all pts had access to T according HER2+ status. Methods: Women with de novo or recurrent breast cancer treated with trastuzumab at Institut Curie between 2001 and 2006 with HER2+ status (IHC 3+ or FISH +) were identified from the Institut Curie database. Disease was classified in two groups: patients who received T upfront and those who received T after one or several CT regimens. Overall survival (OS) was defined as the time from the date of the first metastasis to the date of death or last follow-up and was estimated using the Kaplan-Meier product method. Results: The final analysis included 244 patients. Median age was 53.4 yrs (29-80). Median time from primary and first metastasis was 22 mths (0-238). Visceral metastasis were present in 153 pts (63%) and 125 pts (51%) presented multiple sites. One hundred pts (42%) developed brain metastasis during the course of disease. One hundred and sixty five pts (68%) received T as first line, 79 pts (32%) after a median of one line of CT (median 1, range 1-5). One hundred and twenty four pts (52%) received more than 3 regimens. The median overall survival was 53 mths (4-113), similar in both groups. However there is a major bias: pts with very aggressive disease not treated upfront with T not have not been offered delayed T and don't appear in the analyzed population. Patients who developed brain metastasis had a median survival of 41 mths (11-90). Complete characteristics of pts will be presented. Conclusions: The introduction of T has altered the natural history of HER2+disease. Even outside a clinical trial, our results show that the addition of T to CT improves the prognosis of MBC patients with HER2+ disease. Prolongation of T after progression with other CT appears beneficial, even in pts with a high disease burden. The high incidence of brain metastases remains an issue in such a population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5107.

[Quality control of antibiotics used in Senegal]

To slow the spread of bacterial resistance and promote safety in the use of medicines, development of quality control tools is indispensable. The purpose of this study was to evaluate the quality of several antibiotic agents used in Senegal and to assess the utility of the mini laboratory as a quality control tool. The mini laboratory and all materials necessary for this study were provided by the German Pharma Health Fund. A total of 34 antibiotic samples were submitted to a battery of tests including physical and visual inspection, disintegration, and thin layer chromatography designed for identification and semiquantitative evaluation. Non-conformities detected by physical and visual inspection were found mainly in products from the illicit sector (80%) but some non-conformities were also found in products from licit private sector (20%). Based on thin layer chromatography findings, non-conformities in product identity and dosage involved mainly erythromycin (45%) followed by amoxicillin and ciprofloxacin (22% each). Again this type of non-conformity was most frequent in products from the illicit sector (45%) but it was also observed in products from the private and public sectors (33% and 22% respectively). These findings show that follow-up is necessary to ensure the quality of medicines, especially antibiotics. In this study the mini laboratory was a highly useful quality control tool.

Reflex mechanisms for bladder inhibition

Continence of urine requires ability of the bladder to maintain a low intravesical pressure at increasing filling, in order to preserve a positive urethral-bladder pressure gradient. During micturition the conditions are reversed: the bladder has to generate pressures exceeding the urethral pressure, which also presupposes that the urethra opens and remains open as long as is required for all urine to be expelled. These events are made possible by a complicated pattern of central and peripheral neural responses, affecting the bladder-urethral unit. The pioneer work of determining the reflex mechanisms involved in the regulation of the lower urinary tract was done at the beginning of this century. Recently, further studies have been made and by means of electrophysiological investigations previous data have been confirmed. In this communication some important observations are reviewed and one example is given of how bladder inhibitory reflexes are utilized in therapy.

[Risk factors for neonatal mortality. The pediatric surgery service, Aristide Le Dantec University Hospital, Dakar]

OBJECTIVES

To determine neonatal mortality factors at the paediatric surgeon service in Aristide Le Dantec University Hospital in Dakar.

PATIENTS AND METHODS

It is a retrospective study of 245 cases collected between January 1997 and December 2006 at the paediatric surgeon service, the surgery emergency and intensive care unit of Aristide Le Dantec University Hospital. We studied the age, sex, geographical origins, consultation time, weight at birth, evacuation means to the reference medical structure, consultation motives, clinical diagnosis, associated malformations, treatment methods, surgery follow ups and death causes.

RESULTS

The neonatal death rate at the paediatric surgery service was 36.7 %. Our patients' average age was eight days. A masculine predominance was observed with a 1.57 sex ratio. The average admission time was 08 days. Sixty-five per cent (65%) of our patients came from suburbs. Thirty-eight per cent were transported by an ambulance from a health centre. Fifty-three per cent (53%) weighed less than 2,500 grams at birth. The occlusive syndrome was the commonest reason for consultation (38.5 %). The most frequently observed pathology was the ano-rectal malformations. Associated malformations were observed in 12% of the cases. The majority of the patients (52%) died before the surgical operation after an average duration of 5 days. The commonest causes of death are the digestive malformations (66%).

CONCLUSION

Male newborn babies, aged less than 8 days are the most vulnerable age group. The lack of hospital transportation means, the weak weight at birth, the caring time and the digestive pathologies are other factors of wrong diagnosis. A multidisciplinary collaboration, the improvement of the technical capacity and of the available emergency therapeutic means and the creation of an intensive paediatric care unit would certainly contribute to lower the mortality rate.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Toxicological study of emissions resulting from a diesel and a gazoline engine using an organotypic culture of lung slice]

INTRODUCTION

Many studies were carried out in vivo and/or in vitro for better understanding toxic effects of exhausts or particles emitted by Diesel vehicles. Few studies were interested in Gazoline engines when progress of metrology made it possible to highlight the presence of small particles with a strong capacity of penetration within pulmonary tissue. The aim of this study is to compare the toxic impact of the emissions of Diesel and Gasoline engines of recent technology.

MATERIALS AND METHODS

Biological material was constituted by an organotypic rat lung precision slice. It was exposed to a continuous flow exhausts thanks to a preparation and dilutions system of these emissions placed on the line of exhaust. A measurement of the biological markers involved in the process of the lung tissue reaction to the air-contaminants was carried out.

RESULTS

With Diesel exhausts, the results showed a stability of the rate of ATP and an increase in enzymatic activities of the antioxydant system (GPx and catalase). Gazoline emissions, as for them, were responsible for a cytotoxic attack of the pulmonary tissue defined by a reduction in the rate of ATP as well as a deterioration of the system of detoxication with reduction in the antioxydant enzymatic activities.

CONCLUSION

These results show that toxicological profiles obtained with this system of exposure depends on the engine technology used, highlighting thus the specific response of the model in relation with the type of atmospheres which it is exposed.

[Study of the contents in fat, in protein and in vitamin D of powdered milk varieties sold in Dakar]

INTRODUCTION

The powdered milk is a much appreciated food in Senegal. However no particular control is realized by authorities on the various marks of milk imported before their marketing. In the concern to protect the health of the consumers, but especially in front of the very big variety of the sources of supply in this product we determined the contents in fat, in protein and in vitamin D main variety show of marketed powdered milk Dakar.

MATERIAL AND METHODS

Chemical methods were operated to determine the fat contents and in proteins. The liquid chromatography in high performance was used to identify and measure the vitamin D.

RESULTS

The obtained results profits showed that all the studied samples of milk had contents in fat included between 25 and 31 g %, those in proteins were included between 23 and 25 g %. As regards the dosage of the vitamin D, a single sample had content weaker than that mentioned on the packaging by the manufacturer.

CONCLUSION

The results of this study allowed to notice most of the variety varieties of powdered milk marketed in Dakar were in accordance with the standards established for this food and are consequently good quality.

EAU Guidelines on Chronic Pelvic Pain

OBJECTIVES

On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of chronic pelvic pain patients were established.

METHOD

Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts.

RESULTS

The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain.

CONCLUSION

A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.