An innovative strategy for personalised medicine in a CFSPID case that evolved with time

We present a challenging case that illustrates how the clinical manifestations in children with CFTR mutations of uncertain significance may change over time. This case highlights the evolution of confirming a diagnosis of CF and emphasises the importance of regular review and monitoring of this patient cohort.

Exposure, hazard, and vulnerability all contribute to Schistosoma haematobium re-infection in northern Senegal

Background

Infectious disease risk is driven by three interrelated components: exposure, hazard, and vulnerability. For schistosomiasis, exposure occurs through contact with water, which is often tied to daily activities. Water contact, however, does not imply risk unless the environmental hazard of snails and parasites is also present in the water. By increasing reliance on hazardous activities and environments, socio-economic vulnerability can hinder reductions in exposure to a hazard. We aimed to quantify the contributions of exposure, hazard, and vulnerability to the presence and intensity of Schistosoma haematobium re-infection.

Methodology/Principal findings

In 13 villages along the Senegal River, we collected parasitological data from 821 school-aged children, survey data from 411 households where those children resided, and ecological data from all 24 village water access sites. We fit mixed-effects logistic and negative binomial regressions with indices of exposure, hazard, and vulnerability as explanatory variables of Schistosoma haematobium presence and intensity, respectively, controlling for demographic variables. Using multi-model inference to calculate the relative importance of each component of risk, we found that hazard (Ʃw_{i =} 0.95) was the most important component of S. haematobium presence, followed by vulnerability (Ʃw_i = 0.91). Exposure (Ʃw_i = 1.00) was the most important component of S. haematobium intensity, followed by hazard (Ʃw_i = 0.77). Model averaging quantified associations between each infection outcome and indices of exposure, hazard, and vulnerability, revealing a positive association between hazard and infection presence (OR = 1.49, 95% CI 1.12, 1.97), and a positive association between exposure and infection intensity (RR 2.59–3.86, depending on the category; all 95% CIs above 1)

Conclusions/Significance

Our findings underscore the linkages between social (exposure and vulnerability) and environmental (hazard) processes in the acquisition and accumulation of S. haematobium infection. This approach highlights the importance of implementing both social and environmental interventions to complement mass drug administration.

While the impacts of natural hazards tend to be described in terms of social determinants such as exposure and vulnerability, the risk for infectious disease is often expressed in terms of environmental determinants without fully considering the socio-ecological processes that put people in contact with infective agents of disease. In the case of schistosomiasis, risk is determined by human interactions with freshwater environments where schistosome parasites circulate between people and aquatic snails. In this study, we quantified the relative contributions of exposure, hazard, and vulnerability to schistosome re-infection among schoolchildren in an endemic region of northern Senegal. We find that hazard and vulnerability influence whether a child becomes infected, while exposure and hazard influence the burden of worms once infection is acquired. Increasing numbers of worms is known to be positively associated with increasing severity of disease. Our findings underscore the importance of evaluating social and environmental determinants of disease simultaneously; omitting measures of exposure, hazard or vulnerability may limit our understanding of risk.

Land use impacts on parasitic infection: a cross-sectional epidemiological study on the role of irrigated agriculture in schistosome infection in a dammed landscape

Background

Water resources development promotes agricultural expansion and food security. But are these benefits offset by increased infectious disease risk? Dam construction on the Senegal River in 1986 was followed by agricultural expansion and increased transmission of human schistosomes. Yet the mechanisms linking these two processes at the individual and household levels remain unclear. We investigated the association between household land use and schistosome infection in children.

Methods

We analyzed cross-sectional household survey data (n = 655) collected in 16 rural villages in August 2016  across demographic, socio-economic and land use dimensions, which were matched to Schistosoma haematobium (n = 1232) and S. mansoni (n = 1222) infection data collected from school-aged children. Mixed effects regression determined the relationship between irrigated area and schistosome infection presence and intensity.

Results

Controlling for socio-economic and demographic risk factors, irrigated area cultivated by a household was associated with an increase in the presence of S. haematobium infection (odds ratio [OR] = 1.14; 95% confidence interval [95% CI]: 1.03–1.28) but not S. mansoni infection (OR = 1.02; 95% CI: 0.93–1.11). Associations between infection intensity and irrigated area were positive but imprecise (S. haematobium: rate ratio [RR] = 1.05; 95% CI: 0.98–1.13, S. mansoni: RR = 1.09; 95% CI: 0.89–1.32).

Conclusions

Household engagement in irrigated agriculture increases individual risk of S. haematobium but not S. mansoni infection. Increased contact with irrigated landscapes likely drives exposure, with greater impacts on households relying on agricultural livelihoods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00816-5.

Active learning improves on-task behaviors in 4th grade children

While increased opportunities for physical activity (PA) are a critical, public health need for children, school-based interventions often place teachers in the position to choose between PA and time spent on academic lessons. Active learning is designed to overcome this by combining PA with academic material. Moreover, teachers are likely to be more responsive to change in academic-related outcomes than in PA. This study utilizes a large, cluster randomized control trial in which student attention, or time on task (TOT) and accelerometer-based PA is assessed in conjunction with active learning. Participants were 2716 children (46% male, 46% white) from 28 elementary schools in Central Texas that were assigned to either: 1) active learning (math n = 10; spelling n = 9); or 2) traditional, sedentary academic lessons (n = 9). PA was measured with accelerometers. TOT was measured through a momentary time sampling protocol. A series of three-level (student, classroom, school) regression models estimated the effect of the intervention. The intervention lead to significantly increased TOT. Moreover, the dose of PA (steps) during the intervention was positively associated with the increase in TOT. In contrast, a greater dose of PA was associated with reduced TOT for students in control schools. Race, gender, and SES did not moderate these effects. Planned PA - as a part of an active, academic lesson - positively impacted TOT. In contrast, a traditional, sedentary lesson was associated with lower TOT. This differential impact offers intriguing possibilities to better understand the relationship between PA and academic performance.

Optimal strengthening of particle-loaded liquid foams

Foams made of complex fluids such as particle suspensions have a great potential for the development of advanced aerated materials. In this paper, we study the rheological behavior of liquid foams loaded with granular suspensions. We focus on the effect of small particles, i.e., particle-to-bubble size ratio smaller than 0.1, and we measure the complex modulus as a function of particle size and particle volume fraction. With respect to previous work, the results highlight a new elastic regime characterized by unequaled modulus values as well as independence of size ratio. A careful investigation of the material microstructure reveals that particles organize through the network between the gas bubbles and form a granular skeleton structure with tightly packed particles. The latter is proven to be responsible for the reported new elastic regime. Rheological probing performed by strain sweep reveals a two-step yielding of the material: The first one occurs at small strain and is clearly attributed to yielding of the granular skeleton; the second one corresponds to the yielding of the bubble assembly, as observed for particle-free foams. Moreover, the elastic modulus measured at small strain is quantitatively described by models for solid foams in assuming that the granular skeleton possesses a bulk elastic modulus of order 100 kPa. Additional rheology experiments performed on the bulk granular material indicate that this surprisingly high value can be understood as soon as the magnitude of the confinement pressure exerted by foam bubbles on packed grains is considered.

[Profil course of SC sickle-cell patients in Dakar: a case-control study with SS sickle cell form]

AIMS

The study aim to describe the epidemiological, clinico-biological and evolutionary aspects of SC sickle cell patients compared to SS sickle cell disease.

PATIENTS AND METHODS

We realized a case-control study of 12 months duration including 98 major sickle cell patients (49 SC and 49 SS sickle cell patients). SS sickle cell patients were randomly selected according to age and sex. Socio-demographic, clinico-biological and evolutionary data were noted for each patient.

RESULTS

Mean age was 24.7 years (5 - 53). Sex ratio was 0.8. Mean number of transfusions was 0.06 of SC patients and 0.34 for SS patients (p=0.0008). Mean number of vaso-occlusive crisis per year was 2.24 of SC patients and 2.37 of SS patients (p=0.3). Mean basic hemoglobin level was 10.8 of SC patients and 7.8 of SS patients (p=0.0000). Priapism was found in 2.04% of SC patients and 4.04% of SS patients (p=0.3) and acute anemia in 2.04% of SC and 24.48% of SS patients (p=0.003); 26.53% of SC patients had a chronic complication compared to 18.36% of SS patients (p=0.0001).

CONCLUSION

This study shows that SC sickle cell patients are less symptomatology compared to SS patients, however they would develop more chronic complications from where the utility for regular follow-up.

Exposition par réalité virtuelle : une approche plus sereine pour nos patients ?

Depuis une vingtaine d’années, on assiste au développement de la réalité virtuelle dans le domaine de la psychopathologie. Elle se définit comme une application permettant à un utilisateur de naviguer et d’interagir en temps réel avec un environnement en trois dimensions généré par un ordinateur [1]. Grâce à cette technologie, les difficultés rencontrées dans les techniques d’exposition de TCC habituelles peuvent être contrées. L’environnement virtuel permet, par exemple, de contrôler les imprévus, d’être exposé à certaines peurs pouvant être difficiles à reproduire en situation réelle, et garantit une meilleure confidentialité [2]. Nous avons acquis, il y a peu un logiciel de thérapie par réalité virtuelle pour les troubles anxieux. Le patient est plongé dans un environnement virtuel relativement proche des situations anxiogènes réelles. Il est progressivement désensibilisé par une exposition virtuelle répétée, prolongée et complète. De nombreuses études ont déjà prouvé l’efficacité de ce genre d’exposition [3]. Nous pensons que cet outil permettrait aux patients d’aborder de manière plus sereine les séances d’exposition. Notre projet d’étude est de présenter à des anxieux sociaux deux techniques d’exposition : in vivo et in virtuo. Dans les deux situations, les sujets sont amenés à faire face à un groupe de personnes : « réelles » (groupe thérapeutique dans la clinique où a lieu l’étude) ou « virtuelle » (salle de classe avec des étudiants, dans l’environnement virtuel). Leur niveau d’anxiété avant chaque séance est évalué grâce à l’inventaire d’anxiété état-trait de Spielberger. Ce poster présente les premiers résultats de l’étude, qui est en cours.

Macroscopic discontinuous shear thickening versus local shear jamming in cornstarch

We study the emergence of discontinuous shear thickening (DST) in cornstarch by combining macroscopic rheometry with local magnetic resonance imaging measurements. We bring evidence that macroscopic DST is observed only when the flow separates into a low-density flowing and a high-density jammed region. In the shear-thickened steady state, the local rheology in the flowing region is not DST but, strikingly, is often shear thinning. Our data thus show that the stress jump measured during DST, in cornstarch, does not capture a secondary, high-viscosity branch of the local steady rheology but results from the existence of a shear jamming limit at volume fractions quite significantly below random close packing.

[The primary pulmonary MALT lymphoma: a rare lung tumor]

The primary pulmonary lymphoma is a rare disease, representing 0.5 to 1% of the malignant lung tumors. In our countries, in spite of the increasing prevalence of the pulmonary tumors, aggravated by smoking and environmental factors, any case report of the primary pulmonary lymphoma is notified. We report a confirmed case of MALT lung lymphoma that is managed in our hospital. Mr. S.B., 68-year-old man, not smoking, without particular professional exhibition, is admitted for a chronic cough with blood-streaked sputum, dyspnea, chest pain and loss of weight. His symptomatology is evolving for 4months. In the examination, the general health was passable and he presented a pulmonary condensation syndrome at right. The physical examination of others systems was normal. There was a biological inflammatory syndrome. The bacteriological examinations of the bronchial expectorations were negative. The chest CT showed bilateral alveolar opacities at the upper, with attraction of the fissures, without nodes. The bronchoscopy showed anomalies of the bronchial mucous membrane in 2 superior lobes. The perendoscopiques biopsies confirmed a MALT lung lymphoma. We did not find other localizations. Chemotherapy was proposed to our patient with favorable evolution. The MALT primary lung lymphoma must not be underestimated. Clinical manifestations and radiological characteristics are no specific and it's necessary to eliminate a lung cancer or tuberculosis in our countries. The difficulties of their diagnostic are intensified by the not availability of an adequate technical tray.

Sliding friction on wet and dry sand

We show experimentally that the sliding friction on sand is greatly reduced by the addition of some-but not too much-water. The formation of capillary water bridges increases the shear modulus of the sand, which facilitates the sliding. Too much water, on the other hand, makes the capillary bridges coalesce, resulting in a decrease of the modulus; in this case, we observe that the friction coefficient increases again. Our results, therefore, show that the friction coefficient is directly related to the shear modulus; this has important repercussions for the transport of granular materials. In addition, the polydispersity of the sand is shown to also have a large effect on the friction coefficient.

Closed loop obstruction: pictorial essay

Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis.

Dissipation in quasistatically sheared wet and dry sand under confinement

We investigated the stress-strain behavior of sand with and without small amounts of liquid under steady and oscillatory shear. Since dry sand has a lower shear modulus, one would expect it to deform more easily. Using a new technique to quasistatically push the sand through a tube with an enforced parabolic (Poiseuille-like) profile, we minimize the effect of avalanches and shear localization. We observe that the resistance against deformation of the wet (partially saturated) sand is much smaller than that of the dry sand, and that the latter dissipates more energy under flow. This is also observed in large-amplitude oscillatory shear measurements using a rotational rheometer, showing that the effect is robust and holds for different types of flow.

[Assisted reproductive technoloy: indications and perceptions among couples presenting for infertility at Dakar University Hospital]

AIMS

To identify, among the cases of sterility, the indications for assisted reproductive technology to analyze the knowledge, attitudes and perceptions regarding ART among patients consulted for infertility

PATIENTS AND METHODS

A retrospective analysis of 1718 files of infertile patients, selecting the cases likely to recover from ART completed by an individual and anonymous survey assessing knowledge regarding ART techniques among 209 patients seeking infertility consultation.

RESULTS

Among women, cervico-vaginal (26.7%) and tubal (20.9%) etiological factors were the predominating causes of infertility. Among men, azoospermatozoa was the predominant cause of infertility (24.5%). The indications for ART were estimated at 98.8% of cases: 3.14% indicated for artificial insemination, 95.7% for in-vitro fertilization. Around 18.21% of couples could have conceived with the assistance of these methods, compared to 3.8% of pregnancies obtained without ART. Among interviewed couples, a favorabl, perception of ART was found: although the majority of patients (78.9%) were ready to resort to ART, only 24.9% of interviewed women were in a position to mobilize required resources.

CONCLUSION

Advocacy for the feasibility of ART in the public hospital setting should be supported by the potential indications of modern technology demonstrated in this study.

Procalcitonin for early prediction of survival outcome in postoperative critically ill patients with severe sepsis

BACKGROUND

Identification of postoperative patients at high risk of dying early after intensive care unit (ICU) admission through a fast and readily available parameter may help in determining therapeutic interventions or further diagnostic procedures that could have an impact on patients' outcome. The aim of our study was to assess the utility of procalcitonin (PCT) and other readily available parameters, as useful early (days 1-3) predictors of mortality in postoperative patients diagnosed with severe sepsis within 24 h preceding their operation.

METHODS

More than a period of 2 yr, subsets of 69 postoperative patients admitted with severe sepsis and 890 non-septic ICU patients were investigated. PCT, C-reactive protein (CRP) and sequential organ failure assessment (SOFA) score were recorded over the duration of ICU stay.

RESULTS

PCT area under receiver operating characteristic (ROC) curve was 0.78 on day 3 and was highly predictive of fatal outcome (0.90) at day 6. Area under ROC curve of SOFA score was 0.85 on day 3 and remained in this range until day 6. Area under ROC curves on day 3 of CRP (0.61) was non-predictive and remained non-predictive over the duration of ICU stay.

CONCLUSIONS

PCT exhibited no discriminative power early after ICU admission for prediction of mortality in critically ill patients with severe sepsis, compared with a high predictive power of SOFA score on day 3. However, using PCT could still serve as a useful complementary comparator for prediction of survival outcome using the SOFA score.

Public-health impact of accelerated measles control in the WHO African Region 2000-03

BACKGROUND

In 2000, the WHO African Region adopted a plan to accelerate efforts to lower measles mortality with the goal of decreasing the number of measles deaths to near zero. By June, 2003, 19 African countries had completed measles supplemental immunisation activities (SIA) in children aged 9 months to 14 years as part of a comprehensive measles-control strategy. We assessed the public-health impact of these control measures by use of available surveillance data.

METHODS

We calculated percentage decline in reported measles cases during 1-2 years after SIA, compared with 6 years before SIA. On the basis of data from 13 of the 19 countries, we assumed that the percentage decline in measles deaths equalled that in measles cases. We also examined data on routine and SIA measles vaccine coverage, measles case-based surveillance, and suspected measles outbreaks.

FINDINGS

Between 2000 and June, 2003, 82.1 million children were targeted for vaccination during initial SIA in 12 countries and follow-up SIA in seven countries. The average decline in the number of reported measles cases was 91%. In 17 of the 19 countries, measles case-based surveillance confirmed that transmission of measles virus, and therefore measles deaths, had been reduced to low or very low rates. The total estimated number of deaths averted in the year 2003 was 90,043. Between 2000 and 2003 in the African Region as a whole, we estimated that the percentage decline in annual measles deaths was around 20% (90,043 of 454,000).

INTERPRETATION

The burden of measles in sub-Saharan Africa can be reduced to very low levels by means of appropriate strategies, resources, and personnel.

[Doctors belonging to the Senegalese Association of Sport Medicine and doping in sports: survey on knowledge and attitudes]

Doping in sports is as old as sports, but it grew considerably during the 20th century with the arrival in stadiums during the 1990s of amphetamines and anabolic steroids as well as such peptide hormones as erythropoietin. The international fight against doping took a giant step forward in 1999 with the creation of the world antidoping agency (WADA). This study is part of that fight. It follows an earlier survey of retail pharmacists in Senegal and aims to evaluate the knowledge about doping of doctors belonging to the Senegalese Association of Sports Medicine and to assess their attitude towards this phenomenon. Its goal is to determine how best to involve them in preventive actions. We conducted a survey in 2001 and randomly selected and interviewed 60 of the 92 doctors in the association. The questionnaire focused on three areas: their knowledge of doping, their attitudes to it, and the means of prevention that they proposed. The results showed that only 11 of the 60 doctors knew the definition of doping and 15% of doctors could not cite any family of doping products. They were aware mainly of testosterone and other anabolic steroids (84.3%), then amphetamines and other stimulants (64.7%), and finally peptide hormones (58.8%). The subjects mentioned blood doping and pharmacological manipulations as forbidden methods. They considered that the four groups of drugs most often used by athletes for doping were, in descending order, anabolic steroids, stimulants, peptide hormones and corticoids. Eighty per cent of doctors think that Senegalese athletes use doping products and that the sports most involved are football, wrestling, track and field and basketball. They also think that doping is a form of drug addiction and a public health problem. Eleven doctors (18%) said they had been contacted for information on use of doping products. The interviewees consider that the three best methods of prevention include information about side effects, unannounced urine and blood tests, and sanctions. This work shows that Senegalese athletes may use doping; it contains no direct proofs but many indirect indicators. Success against doping requires preventive activities that should be conducted jointly for trainers, sports federations and doctors of the Senegalese Association of Sports Medicine and then by all of them for athletes, who are the primary targets of any prevention campaign.

[Effects of Ramadan fast on weight, performance and glycemia during training for resistance]

INTRODUCTION

Pysical activity and sports training can be proved exhausted for the organism during normal alimentation period. These sensations may go on more pronounced during Ramadan, period of complete fast marked by an absence of energetic and hydroelectrolytic supply. Our propose was to evaluate the impact of Ramadan on weight, performance and glycaemia during a training for resistance.

MATERIALS AND METHODS

Ten Senegalese males 200 and 400 meters runners aged 24.4 +/- 6 years old had two training sessions, one during the Ramadan and the other during normal non fast time. The 200 meters runners had executed each one two series of 3 x 150 m, and the 400 meters runners executed one serie of 3 x 250 m. These parameters have been measured respectively by a SECA scales, a PC 70 A chronometer, and a capillary glycaemia reader.

RESULTS

During Ramadan the weights a nd performances of our athletes decreased significantly (0.01 > p > 0.001) with race intensities equal to or slightly higher than those of competition, requiring anaerobic glycolysis. We found severe hypoglycaemia mainly before the training session, 10 hours after the last meal. We found no severe hypoglycaemia in normal non-fast time. Therefore all differences in average glycaemia rates in each testing case (except between the morning and after training in time of complete fast) a nd between them, a re significant. The performance fall is the conjugation of the blood sugar rate collapse a nd recovery.

CONCLUSION

A balance diet with high content of carbon hydrates is a dvisable to prevent h ypoglycaemia that c an a dversely affect the health of fasting sportsman training for resistance.

EphA/ephrin-A interactions during optic nerve regeneration: restoration of topography and regulation of ephrin-A2 expression

During visual system development, interactions between Eph tyrosine kinase receptors and their ligands, the ephrins, guide retinal ganglion cell (RGC) axons to their topographic targets in the optic tectum. Here we show that Eph/ephrin interactions are also involved in restoring topography during RGC axon regeneration in goldfish. Following optic nerve crush, EphA/ephrin-A interactions were blocked by intracranial injections of recombinant Eph receptor (EphA3-AP) or phospho-inositol phospholipase-C. Topographic errors with multiple inputs to some tectal loci were detected electrophysiologically and increased projections to caudal tectum demonstrated by RT-97 immunohistochemistry. In EphA3-AP-injected fish, ephrin-A2-expressing cells in the retino-recipient tectal layers were reduced in number compared to controls and their distribution was no longer graded. The findings, supported by in vitro studies, implicate EphA/ephrin-A interactions in restoring precise topography and in regulating ephrin-A2 expression during regeneration.

Human water contacts patterns in Schistosoma mansoni epidemic foci in northern Senegal change according to age, sex and place of residence, but are not related to intensity of infection

In an epidemic focus in northern Senegal, adults had lower intensities of infection than adolescents, a phenomenon that could not be attributed to immunity acquired over the previous 10-15 years of exposure to the parasite because all age groups had had the same number of years' experience of the worm. This article considers whether this pattern could have been because of higher levels of exposure to the parasite in younger age groups. Personal contact with infected water was recorded using a questionnaire in Schistosoma mansoni foci not more than 3 years old and in another, 10-year-old focus. Many aspects of contact (e.g. frequency, duration or time of day of contact) may contribute to the number of encounters with infective cercariae (true exposure), so various assumptions regarding the relationship between water contact and true exposure were tested resulting in a range of exposure indices. People reported a mean of 4.4 separate contacts, and spent a median of 57 min per day in water. Patterns of water contact differed depending on the exposure index used, e.g. considering duration, males spent a longer time in water than females (P < 0.001). But using frequency, females had more contacts with water than males in most villages (P < 0.001). Generally, exposure levels dropped as people become aged (P < 0.001) and residents of the older focus were more exposed than residents of other foci (P < 0.002). Intensity of (re)infection was not related to exposure either alone or in models incorporating age, sex and/or village irrespective of the index used. There is therefore evidence that age, sex and place of residence determine exposure but none to suggest that exposure had an influence on the relationship between these factors and intensity of infection. We propose therefore that in this population other factors have principal importance in determining intensity of infection.

[Complicated parathyroïd adenoma. A case report]

Parathyroid adenoma is the first etiology of primary hyperparathyroidism althrough the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder. There are patients who have a more aggressive disorder. We report a case of 41 years old man whose primary hyperparathyroidism was discovered through exploration of recurrent ureteral stone associated with severe hypertension. The diagnosis was set up on high level serum calcium and low serum phosphorus with very elevated level of parathyroid hormone. Adenome was localised by ultrasound examination. The patient underwent successfully surgery and the pathological study confirm the diagnosis. This case illustrate the importance of investing earlier ureteral recurrent stone to prevent severe complications of primary hyperparathyroidism.

[Bicycle test: measure of anaerobic power, heart rate and blood lactic acid]

Seven sportsmen, 100 meters and 400 meters runners are submitted to an effort test of 30 seconds. The subjects are on average 23.7 +/-2 years old. The purpose of our work is to study on the one hand the evlution of the anaerobic power. the heart rate and the lactic acid in blood during and after a bicycle test. and their relation, and on the other hand. to know the suitable pratical importance of the heart rate and the lactic acid in blood in connection with the intermittent efforts recovery aiming the anaerobic power developpement. These physiological parameters have been measured by a Monark bicycle 864, a sport-tester PE 3000 and a spectrophotometer JASCO 7800 UV/VIS. The power and the heart rate increase quickly in the 5 first seconds. Our subjects reach their average maximal anaerobic power at the 10th second, and then this power decreases progressively, while the heart rate continues to increase, without being maximal at the end of te test. Five minutes later it decreases in a half, while the lactic acid level calculated at the 30th second is continuing significantly. We have not found a significant relation between the measured parameters at the test stopping and during the recovery period (except between the lactic acid and the recovery index of the heart rate at the 25th minute). The lactic acid in blood would inform better about a good recovery during an interval training effort.

Single-tube and nested reverse transcriptase-polymerase chain reaction for detection of Rift Valley fever virus in human and animal sera

Rift Valley fever (RVF) is an anthropozoonosis caused by a Phlebovirus (Bunyaviridae family) that has re-emerged recently in East and West Africa in 1997-1998. This emphasizes the need for early and rapid detection of the virus and an efficient surveillance system. To this goal, a single tube or a nested reverse transcriptase-polymerase chain reaction (RT-PCR) method focusing on the NSs coding region of the S segment was developed and used to detect the RVF virus (RVFV) genome, resulting respectively in the synthesis of 810 and 662 bp DNA amplimers. The assay was specific for RVFV and did not amplify any other phleboviruses known to circulate in sub-Saharan Africa. When serial dilutions of RVFV were artificially mixed with human normal serum, the minimal detection limits were 50 and 0.5 plaque forming units respectively using the simple and the nested RT-PCR. The RT-PCR method was efficient for the detection of RVFV RNA in the blood from experimentally RVFV-infected mice and lamb and the nested RT-PCR was found more sensitive than the virus isolation method. Additionally, this detection method was applied successfully for the diagnosis of human cases during the 1998 Mauritanian outbreak.

Cryptosporidium spp. in domestic dogs: the "dog" genotype

Genetic and phylogenetic characterization of Cryptosporidium isolates at two loci (18S rRNA gene and heat shock gene) from both Australian and United States dogs demonstrated that dog-derived Cryptosporidium isolates had a distinct genotype which is conserved across geographic areas. Phylogenetic analysis provided support for the idea that the "dog" genotype is, in fact, a valid species.

Investigation of the child with interstitial lung disease

Many disorders can affect the pulmonary interstitium in children. Although individual interstitial lung diseases are rare, the range of conditions encountered is wide. Interstitial disease is also seen increasingly as a consequence of the treatment of children having other primary problems including cancer, immunodeficiency and haemotological diseases, as well as in recipients of solid organ and bone marrow transplants. The management and prognosis of individual conditions is highly variable, thus it is essential to search for a precise diagnosis in every patient. High resolution computerised tomography (HRCT) and other less invasive investigations may be helpful in the management of patients. However, it is unusual to be able to make a firm diagnosis without a lung biopsy.

Tsetse challenge, trypanosome and helminth infection in relation to productivity of village Ndama cattle in Senegal

Data on tsetse fly, and on village Ndama cattle collected over a 4-year period in southern Senegal, were analysed. A total of 431 Ndama cattle in four herds of three villages in the Upper Casamance area of southern Senegal were monitored monthly. Glossina morsitans submorsitans and Glossina palpalis gambiensis are present in the study area. Mean tsetse apparent density was 5.4 flies/trap/day. Trypanosome (Trypanosoma congonlense and Trypanosoma vivax) infection rate in flies was 2.4 (s.e. 0.37)%. Tsetse challenge index was 17.3 (s.e. 4.18). Mean monthly trypanosome prevalence in cattle was 2.5 (s.e. 0.51)%. Highest trypanosome prevalence occurred during the dry season, and animals less than 1-year old were more frequently infected than older animals. The linear relationship between the log10+1 tsetse challenge and the arcsine of the trypanosome prevalence was significant only when mean monthly values of these variables over the 4-year period were used with tsetse challenge preceding infection rate by 3 months. Mean monthly prevalence of strongyle, Strongyloides spp., Toxocara spp. and coccidia were 34.4 (s.e. 0.60), 2.1 (s.e. 0.18), 1.2 (s.e. 0.45) and 15.6 (s.e. 0.47)%, respectively. Calf mortality rate at 1,6 and 12 months of age was 2.1 (s.e. 2.1), 5.2 (s.e. 2.8) and 12.2 (s.e. 3.3)%, respectively. Calving interval (584 s.e. 58 days) was not influenced by trypanosome status of the cow during lactation. Calving interval was shorter by 167 days when the calf died before 1 year of age in comparison to calving intervals for which the calf survived beyond one year. Live weight at birth, 6 and 12 months of age were 15.8 (s.e. 0.54), 48.1 (s.e. 2.56) and 71.1 (s.e. 5.44) kg, respectively. Mean lactation length, total and daily milk offtake were 389 (s.e. 16) days, 231 (s.e. 15) litres and 0.69 (s.e. 0.037) litres, respectively. Trypanosome infection during lactation did not have a significant effect on the amount of milk extracted for human consumption nor did trypanosome status affect calf growth.

[Epididymal manifestations of urogenital tuberculosis]

The morbidity of tuberculous epididymitis is due to the risk of male infertility secondary to vasal or epididymal obstruction or testicular necrosis. The aim of this study was to emphasize the epidemiological, clinical and therapeutical aspects of tuberculous epididymitis in adult. About eleven cases of epididymal localisation of urogenital tuberculosis, it appears that the diagnosis of the condition is rather difficult and often necessitate pathological exam of a specimen of epididymectomy. In other aspects, if antituberculous drugs are always effective in initial stages, surgery is usually radical, and rarely conservative. The latter procedures are vasovasostomy or vasoepididymostomy whose results are very hazardous.

Yellow fever outbreak in Kaffrine, Senegal 1996: epidemiological and entomological findings

In November 1996 a yellow fever (YF) outbreak occurred near Kaffrine in the central part of Senegal. Thirty-six deaths were notified, all children under 15 years of age. The YF diagnosis was confirmed by MAC-ELISA or by virus isolation. The immune status against YF virus of a sample population of 449 individuals was determined, and 31 confirmed cases and 69 asymptomatic cases were reported. Distribution of YF cases and incidence rate decreased with age, while the attack rate was stable in all age groups. Larva indices were high and Aedes aegypti was common in all villages, causing man-to-man transmission. The greatest risk of YF disease was lack of immunity, especially in individuals <20 years of age. The outbreak was rapidly controlled by an emergency immunization campaign. YF epidemics occurred in Senegal over two consecutive years. The last outbreak reached the main road to Dakar and the risk of spread to urban areas has increased.

[Neurologic aspects of vesico-vaginal fistula of obstetrical origin]

OBJECTIVE

To study the electromyographic alterations of the urethral sphincter, perineal muscles and lower limbs observed in women with obstetric vesicovaginal fistula.

METHODS

We compared a group of 22 women with obstetric vesicovaginal fistula with a control group of 10 women without fistula. Each woman underwent a neurological examination of the perineum and lower limbs and electromyography of the lower limbs and urethral sphincter. According to the classification proposed by MENSAH, the fistulas were classified as simple (54.5%), complex (31.8%) and complicated (13.6%).

RESULTS

Twenty women with VVF presented a peripheral nerve lesion. Five of these patients had a clinical and electromyographic lesion; while the other fifteen patients had a subclinical lesion. 68.18% of the fistula patients presented a clinical neuropathy in the perineum. This lesion was detected on electromyography in all patients with fistula. The severity of this denervation lesion ranged from moderate (36.37%) to severe (63.63%). No neurological lesions were detected in the control group. The degree of denervation has more severe in young women (21-25 years) and in primiparous women. In contrast, the severity of denervation did not appear to be related to the history of the fistula. The risk of treatment failure increased proportionally to the severity of denervation. 73% of fistulas with severe denervation remained "unsuturable", or required multiple operations with disappointing results in the form of persistent vesicosphincteric dysfunction.

CONCLUSION

Although the psychosocial impairment and upper urinary tract repercussions have been well evaluated, the peripheral neurological lesion has always been underestimated in the management of obstetric vesicovaginal fistulas. The authors consider that the fistula is only the apparent manifestation of "neurovesical damage", which remains the decisive factor in the prognosis and which largely explains the high frequency of treatment failure.

[Malaria morbidity and therapeutic efficacy of antimalarials. Study conducted in the Dakar region]

During November and December 1992, the authors surveyed the malaria morbidity and the drugs efficiency in an urban area of Dakar region. Malaria represented 13.68% of the fevers in Dakar district and 12.4% in Pikine. The mean parasitic density was evaluated at 5000/mm3. Good efficiency of antimalarial drugs were noted but chloroquine-resistance is present with 24% of prevalence.

[Effect of water fasting on sport performances in the laboratory]

15 sport men heart rate and central temperature were measured at rest and at the end of a progressive maximal exercise. Maximum consumption of oxygen (VO2 max) was estimated after the effort. The experience began in the morning from 9 to 11 a.m. and the afternoon from 4 to 6 p.m. In the first time subjects had a normal alimentation and in the second they observed a rigorous fast. The comparison of the results doesn't show difference induced by fast on VO2 max and maximal heart rate. However heart rate at rest and capacity of work decrease during fast and permit to think that a more intensive and long exercise in more strenuous climates than this one should give significative modifications.

[Cylindroma of the epiglottis]

The observation of an exceptional laryngeal localization of an adenoid cystic carcinoma allows authors to review diagnostic, therapeutic and increasing problems of this glandular carcinoma. The reported case constitutes a histologic surprise. An economical removal has allowed to obtain a long remission without recurrence, nor metastasis; this never put back the principle of the broad surgery to institute when faced this type of cancer, but just emphasize the interest of an early treatment.

[Percutaneous transluminal balloon valvuloplasty and balloon angioplasty in congenital heart defects with left heart obstruction in childhood]

Balloon dilation was performed in 31 patients with congenital left heart obstructions. In 16 patients with aortic stenosis aged 2 days to 16.3 years (mean 10.03 +/- 4.79 years) the peak systolic gradient decreased significantly from 80 +/- 21 mmHg to 23 +/- 13 mmHg immediately after dilation, and remained low at the time of follow up (6 months to 3 years), namely 30 +/- 12 mmHg (p less than 0.0001). Mild aortic regurgitation (I degrees) was already present before the procedure in 56%, increased in 3 patients, and reached haemodynamic significance in 1 (III degrees). Half of the 14 patients with coarctation, aged 2 months to 16.75 years (mean 4.98 +/- 5.15 years), had undergone previous surgery 2 months to 7.9 years before the balloon dilation; coarctation was native in the remainder. Peak systolic gradient across the coarctation site was reduced from 46 +/- 10 mmHg to 5 +/- 5 mmHg, and was 9 +/- 7 mmHg at the time of follow up (6 months-3.6 years) (p less than 0.0001). Aneurysms were not detected. In a 6-year-old girl with congenital mitral stenosis the gradient fell from 13 mmHg to 7 mmHg immediately after the procedure. There were no serious complications. Peripheral arterial lesions required medical or surgical treatment in 16% of cases. Our report suggests that balloon valvuloplasty and angioplasty is a safe and well-tolerated procedure in childhood. It can reduce the gradient in congenital left heart obstructions with good short-term and intermediate-term results.

[A therapeutic concept for the treatment of inoperable esophageal carcinoma]

From 1/87 to 12/88, 20 patients with anatomically or functionally inoperable carcinomas of the esophagus (cT1-3/N0-2/M0-1) were treated by endoluminal Ir-192 HDR brachytherapy (1-3 sessions, each 5-7 Gy) and percutaneous irradiation (50-70 Gy/2 Gy). In 10 cases a bouginage or combined dilatation and retrograde Nd-Yag-laser debulking was done before irradiation. The response of the treatment was documented by endoscopy (degree of stenoses) and symptoms (dysphagia score according to De Meester). In 95% of all cases the degree of stenoses was diminished and an improvement of dysphagia was found in 100%. The mean duration of oral uptake of properly chewed food could be prolonged to 308 days.