Are French local health contracts promising in addressing determinants of diet and physical activity?

Background

There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA). Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors. In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies. We examined how LHCs take into account the environmental determinants of HE and PA.

Methods

Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants. To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes. We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results.

Results

Out of 53 LHCs, 42 included at least one action on HE or PA. For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%). For the latter, actions on interpersonal determinants (e.g. family) were the most common. However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability). Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations.

Conclusions

LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours. A key feature of this instrument is its capacity to develop intersectoral strategies. Further research will show if LHCs deliver on their action plan.

Key messages

• Local health contracts facilitate the mobilisation of a broad diversity of NGOs and agencies.

• This makes it a promising device for addressing the environmental determinants of HE and PA, provided adequate resources are devoted to stakeholder engagement and local government capacity-building.

[Mosquitoes, Distribution and Specific Richness in Eight Countries of Africa: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad]

Mosquitoes (Diptera, Culicidae) form a family of insects of considerable public health importance. Mention of their presence/absence was tackled in the literature and by specialized websites for eight African countries: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad. In total, 216 species have been recorded belonging to 13 genera: Anopheles (48 species), Aedeomyia (2), Aedes (62), Coquillettidia (6), Culex (54), Culiseta (1), Eretmapodites (7), Ficalbia (3), Lutzia (1), Mansonia (2), Mimomyia (7), Toxorhynchites (4) and Uranotaenia (19). The presence of these species in the study area is certain except for three species whose presence is doubtful. This specific richness represents 6% of the world's richness. The countries with the highest specific richness are Burkina Faso (162 species), Senegal (143) and Mali (110); the country with the lowest richness is Cape Verde (11). This richness is lower in the north in hyper-arid climate and higher in the south in sub-humid climate. Chad is the least well inventoried country. All species are considered native, with the exception of Ae. (Stegomyia ) albopictus (the Asian tiger mosquito) introduced in 2016 into Mali and possibly Ae. (Ochlerotatus ) caspius into Mauritania and Ae. (Stg. ) aegypti introduced into Nouakchott, Mauritania. This synthesis of the knowledge may be useful for vector control, public health, and future research.

[Epidemiological and prognostic aspects of obstructive renal deficiency in the nephrology department of the Point "G" hospital, Bamako, Mali]

INTRODUCTION

Obstructive renal failure or obstructive uropathy is an entity defined by the simultaneous presence of impaired renal function and dilated urinary excretory pathways in medical imaging. It accounts for 2 to 10% of the causes of acute renal failure (ARF). The purpose of this work was to evaluate the prevalence of this condition in our department.

METHOD

This was a retrospective study conducted from January 1, 2017 to June 30, 2018 in the said department. The parameters studied were age, sex, etiology, type of renal failure, actions performed, surgical results of the procedure, creatinine level before and after management, and death rate.

RESULTS

obstructive renal failure accounted for 7.32% of all hospitalizations during the study period. The sex ratio was 1.86 in favor of men. The average age was 48.99 ± 6.81 years with extremes of 7 and 102 years. The etiologies were dominated by lithiasis (43.4%). Renal failure was acute and chronic in 20.5% and 54.2% of cases, respectively. It was indeterminate in 25.3% of cases. The obstructive character of renal failure has been confirmed in medical imaging. Lithiases accounted for 43.4% of cases. For therapeutic management, our patients received urinary catheterization (38.6%), nephrostomy (34.9%), urological surgery (22.9%) and hemodialysis (22%). The evolution was favorable in 59% of the cases.

CONCLUSION

Obstructions of the upper urinary tract are becoming more frequent in our medical practice. They occur mainly in patients with lithiasis. There is a large proportion of kidney failure requiring hemodialysis.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]

INTRODUCTION

Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study.

OBJECTIVES

to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes.

METHODOLOGY

Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found.

RESULTS

the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension.

CONCLUSION

kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

[Contribution of the University Clinical Research Center's laboratoryin the diagnosis of SARS-CoV-2 in Mali]

INTRODUCTION

The rapid diagnostic capacities of laboratories in Mali have been an essential element in the response to COVID-19. The University Clinical Research center (UCRC) diagnosed the first cases of Mali COVID-19.

OBJECTIVE

The objective was to describe the contribution of the UCRC in the diagnosis of Covid-19 and to clinically and epidemiologically characterize the patients tested in the UCRC laboratory.

MATERIALS AND METHODS

A cross-sectional study was conducted during eight months of intense activity. The samples were sent from the National Institute of Public Health (INSP) to the UCRC.

RESULTS

The UCRC tested 12,406 contacts and suspected samples and confirmed the diagnosis in 1091 patients, or 9%. The most common symptoms were cough (48.78%), headache (34.14%), fatigue / weakness (34.14%), while (33.33%) of the patients were asymptomatic. The sample positivity rate among new cases decreased from May to September 2020, despite almost 230% of the number of samples tested.

CONCLUSION

The laboratory played a major role in the response and there may be a low transmission of the virus in the Malian community.

Oral microbiota and atherothrombotic carotid plaque vulnerability in periodontitis patients. A cross-sectional study

BACKGROUND

An increased risk of atherothrombotic vascular events has been reported in periodontitis patients. Periodontitis is associated with dysbiotic subgingival biofilms and bacteremia.

OBJECTIVE

We hypothesized (a) that the oral microbiome is associated with the carotid microbiome and (b) that periodontitis could contribute to plaque vulnerability. The aim of this study was to determine the associations between periodontitis, the carotid microbiome, and the local innate immune response in carotid atherothrombotic plaques vulnerable to rupture.

METHODS

In this cross-sectional study, 45 patients admitted for carotid endarterectomy underwent a preoperative periodontal examination. The volume of intraplaque hemorrhage reflected by the hemoglobin level released in carotid-conditioned media was considered as a criterion of carotid plaque vulnerability. Levels of antibodies against periodontal bacteria were determined in sera. The signature of the oral microbiota was assessed by microbial whole-genome sequencing, nested PCR, and immunostaining in carotid plaque samples. Markers of neutrophil recruitment (leukotriene B4), neutrophil activation (myeloperoxidase, defensins), and cytokines were measured in carotid-conditioned media and/or plasma.

RESULTS

All patients exhibited periodontitis. One hundred and forty-four bacterial genera were detected in the carotid microbiome. While Streptococcus was found in 84% of the carotid samples, periodontitis-associated genera were detected in 21%. P. gingivalis DNA and gingipains were also identified in carotid samples. There were significant inverse correlations between periodontal attachment loss/serum anti-P. gingivalis Immunoglobulin A and cytokine inhibiting neutrophils (all P < .01). There were also significant positive correlations between lipopolysaccharides, myeloperoxidase/human neutrophil peptides1-3, and hemoglobin levels (all P < .01).

CONCLUSIONS

In patients at risk of stroke, the carotid plaque microbiome was highly diverse and compatible with an oral origin. Periodontitis was significantly associated with neutrophil activation markers and plaque vulnerability to rupture.

Local health contracts as instruments of cross-sectoral collaboration: the French CLoterreS study

Background

Although recognised as essential, the role of local governments in promoting health remains under investigated. Yet their mandate directly impacts living conditions and promotes SDGs. In France, 'local health contracts' (LHCs) mobilise local decision-makers in 4 areas: health promotion, prevention, health care and social care. The CLoterreS study assesses the extent to which LHCs foster health-promoting actions through cross-sectoral collaboration.

Methods

We conducted 49 semi-structured interviews with staff from all Regional health agencies (RHAs) and local stakeholders. We analysed the action plans of a stratified random sample of 53 LHCs from the 165 signed between 2015 and March 2018. We used a validated multidimensional coding tool based on WHO's Essential Public Health Operations and other consensus documents.

Results

LHC's contribution to health promotion through cross-sectoral collaboration depends on a mix of factors. Among barriers, the improvement of access to health care is often a primary driver for local elected officials. However, political will and past experience in establishing 'win-win' relationships with other sectors is an advantage, as well as the fact that RHAs generally make LHCs an instrument to coordinate health promotion efforts instead of ad hoc funding of isolated actions. Overall, 73% of LHCs' actions address living conditions, health promotion or primary prevention. LHCs frequently target behavioural determinants such as physical activity or diet (44 out of 53) with an emphasis on individual or interpersonal targets. A few innovative actions situated at the intersection of urban planning, transportation, recreational or food environments illustrate the potential for further cross-sectoral action on living conditions.

Conclusions

LHCs are vehicles for health promotion. Reinforcing cross-sectoral action implies leadership, resource mobilisation, training and coordination of sectors whose health is not a core priority.

Key messages

In France, Local health contracts (LHCs) are significantly used for health promotion. Cross-sectoral collaboration in this area implies further capacity building beyond the health care sector at the regional and local levels.

Impact of seasonal malaria chemoprevention in children aged 3 to 59 months in the Kangaba and Kolokani health districts between 2013 and 2015

INTRODUCTION

Malaria is a public health problem in Mali. Seasonal chemo prevention (SCP) is of particular importance, hence its introduction by the WHO since 2012 in children aged 3 to 59 months from the start of the transmission season. This study aims to demonstrate the impact of SCP on malaria in the health districts of Kangaba and Kolokani.

MATERIALS AND METHODS

Our retrospective study was carried out from 2013 to 2015 in the health districts of Kangaba and Kolokani using the databases of the NGO AMCP / ALIMA. Data from 2014 and 2015 were compared to data from 2013.

RESULTS

The number of malaria cases in children under 5year in the area covered by the SCP shows a considerable decrease in Kangaba of 52% in 2014 and 49% in 2015, compared to the reference period being the year 2013. In Kolokani the decrease is 57% in 2014 and 40% in 2015 compared to the year 2013. Compared to deaths, a decrease of 50.5% was recorded in 2014 and 60.4% in 2015 compared to the year 2013, i.e. 51 and 61 fewer deaths compared to 2013, respectively, in health facilities.

CONCLUSION

The SCP had made it possible to reduce significant mortality and malaria morbidity in the two health districts of Kangaba and Kolokani.

[Epidemiological, clinical profile and outcomes of chronic hemodialysis patients in the Nephrology and Hemodialysis Department of the CHU du Point "G"]

AIM

Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis.

PATIENTS AND METHODS

In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value.

RESULTS

The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality.

CONCLUSION

The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

[Mortality in the hemodialysis unit of the Gavardo hospital in sebenikoro]

INTRODUCTION

Chronic kidney disease (CKD)is a serious public health problem in Africa with regard to mortality associated with it. According to global hospital data, CKD is involved in 4-22% of deaths in tropical Africa. In Mali, epidemiological studies are infrequent.Thus, this work is under taken with the objective of studying the epidemiological aspects and the factors associated with the mortality of hemodialysis patients in the hemodialysis unit of the Mali Gavardo Hospital (HMG) in Sébenikoro.

METHOD

We conducted a descriptive retrospective cross-sectionalstudy of the hemodialysis unit of the HMG in Sébenikoro. Data were collected over a 12-month period from January to December 2017. Included were records of all hemodialysis patients for chronic renal failure who died, of either sex and anyage.

RESULTS

A total of 52 patients were dialysed during the study period among whom 12 died or a mortality rate of 23%. The average age of the patients was 59.16 years with extremes of 39 and 71 years. Patients aged 60 and over accounted for 58.3% of cases. There was a male predominance with a sex ratio M / F: 2. In terms of chronic diseases, 83.3% of patients were hypertensive, 50% diabetic, and 16.66% hadhepatitis C. Compared to the initial nephropathies : glomerular nephropathy: 58.3%, vascular nephropathy: 25.0%, undetermined nephropathy: 16.7%. For the management of anemia, 100% ofour patients received EPO and iron injection. Regarding the management of hemodialysis, 83.3% had an AVF as a vascular approach and 16.7% had a central venous catheter as a vascular approach. The patients were all regular at their hemodialysis session with a rhythm of two sessions of 04H of time per session and per week. The causes of death were dominated by cardiovascular pathologies: 5 cases, 41.7%, infectious diseases: 4 cases, 33.3%, indeterminate pathologies: 3 cases or 25%. Deaths occurred in 58.3% of cases before one year of dialysis and 41.7% after one year of hemodialysis treatment.

CONCLUSION

The mortality rate of hemodialysis patients is high in Mali, especially in the HMG of Sébénikoro. Cardiovascular causes have an important role in the mortality of hemodialysis patients, but other causes such as infections are not to be over looked.

[Spontaneous acute subdural hematoma of the chronic hemodialysis patient, a case study and review of the literature]

INTRODUCTION

The appearance of spontaneous subdural hematoma (SSDH) is a rare phenomenon in chronic hemodialysis and is burdened with significant morbidity and mortality. It's prevalence remains low in Sub-Saharan Africa, is 0.43%. We report a case of SSDH in a young hemodialysis patient with favorable outcome after medico-surgical management.

CLINICAL OBSERVATION

This is a 35-year-old patient who has been hemodialysed since June 2016 for chronic renal insufficiency of hypertensive origin. He was admitted on 18 July 2018 in the nephrology department of CHU Point G for intense headaches in a context of dysarthria. They associate themselves with speech disorders, photo-phonophobia, uncontrollable nausea and vomiting. It does not report any notion of head trauma. The physical examination noted dysarthria, a right pyramidal syndrome made of right Babinsky sign, right arm deficit at 4/5, and right hemicorporeal hyperkinesia. He weighed 62 kg for 165 cm, the blood pressure was 187 / 110 mmHg. The patient had clinical signs of extracellular dehydration. Non-injected cerebral CT showed an acute left sub-dural hematoma with peri-lesional cerebral hypodensity. Surgical evacuation of the hematoma through a trephine hole is performed under local anesthesia. The postoperative course was simple. His hemodialysis sessions were done without heparin from diagnosis until 23 days post operatively.

CONCLUSION

Spontaneous subdural hematoma is multifactorial and rare in the dialysis patient. Despite high morbidity and mortality, hemodialysis should not refute surgical management of subdural hematoma.

Smooth muscle of the male pelvic floor: An anatomic study

Knowledge of the anatomy of the male pelvic floor is important to avoid damaging the pelvic floor muscles during surgery. We set out to explore the structure and innervation of the smooth muscle (SM) of the whole pelvic floor using male fetuses. We removed en-bloc the entire pelvis of three male fetuses. The specimens were serially sectioned before being stained with Masson's trichrome and hematoxylin and eosin, and immunostained for SMs, and somatic, adrenergic, sensory and nitrergic nerve fibers. Slides were digitized for three-dimensional reconstruction. We individualized a middle compartment that contains SM cells. This compartment is in close relation with the levator ani muscle (LAM), rectum, and urethra. We describe a posterior part of the middle compartment posterior to the rectal wall and an anterior part anterior to the rectal wall. The anterior part is split into (1) a centro-levator area of SM cells localized between the right and left LAM, (2) an endo-levator area that upholsters the internal aspect of the LAM, and (3) an infra-levator area below the LAM. All these areas are innervated by autonomic nerves coming from the inferior hypogastric plexus. The core and the infra-levator area receive the cavernous nerve and nerves supplying the urethra. We thus demonstrate that these muscular structures are smooth and under autonomic influence. These findings are relevant for the pelvic surgeon, and especially the urologist, during radical prostatectomy, abdominoperineal resection and intersphincteric resection. Clin. Anat., 2019. © 2019 Wiley Periodicals, Inc.

Parental acceptance of an intranasal vaccine: Example of influenza vaccine

BACKGROUND

Influenza vaccination coverage of children with chronic disease is insufficient in France, although a nasal live attenuated influenza vaccine (LAIV) has been approved.

OBJECTIVE

We aimed to evaluate the acceptance of nasally administered vaccines by parents of children with chronic illness, by comparing LAIV vs. injectable inactivated influenza vaccine (IIV) acceptance.

METHODS

We performed a retrospective, observational study (December 2014 to April 2015) including parents of all children vaccinated with the LAIV during the 2013-2014 influenza vaccination campaign at our university hospital. It was an opinion survey on the tolerance and acceptance of the LAIV.

RESULTS

A standardized evaluation form was completed by 67/79 parents of all children who received the LAIV (mean age: 113±56 months; 64% with a chronic respiratory disease). The parents responded that vaccines in general were important (99%) but only 58% of them accepted the injectable route of administration. Of the 48 parents of children who had received both LAIV and IIV in the past, global opinion (P<0.0001) and tolerance (P<0.0001) were better for LAIV. For the future, 81% of parents would prefer LAIV, mainly because of needle absence and/or less painful character, and 18% IIV, mainly because of easier administration or habit.

CONCLUSION

The better acceptance of a nasally administrated vaccine could increase vaccination coverage in the future for nasal vaccines.

[The Ileal Neobladder With The Hautmann Technic At The Urology Depatment Of University Hospital Pr. Bocar S. SALL Of Kati]

Radical cystectomy is the standard treatment for bladder tumors infiltrating the bladder muscle, for patients who have tumors without invasion of neighboring organs and without metastasis. After radical cystectomy, the urinary diversion is a challenge for any urologist. Ileal neo bladder is a rare surgery in our country. The ileal neo bladder is recommended in these patients. We report a case of ileal neo bladder in a 42-year-old woman with a bladder tumor. We discuss the clinical, diagnostic and therapeutic aspects.

[Pregnancy In Chronic Hemodialysis, Case Study]

For a long time, pregnancy in chronic hemodialysis was considered medically contraindicated, because of the many maternal complications that it could cause. Its management is as heavy for the medical teams (nephrologist, obstetrician and neonatologist) as for the patient herself. We report here a case of pregnancy in a dialysis patient observed at the Madeleine clinic in Dakar, Senegal. This pregnancy is the first described with a birth of a living child having a normal birth weight without abnormal malformative thanks to the multidisciplinary follow-up nephrologist, obstetrician and neonatologist), the intensification of dialysis care, the correction of anemia, control of blood pressure and improvement of the mother status nutritional.

Impact of the Sofia® Influenza A+B FIA rapid diagnostic test in a pediatric emergency department

OBJECTIVE

The objective of this study was to evaluate the impact of a rapid diagnostic test for influenza (the Sofia^® Influenza A+B FIA rapid diagnostic test [RDT]) in a pediatric emergency department (PED).

METHODS

A retrospective, observational, cross-sectional study was conducted in the PED of the Lille University Hospital between 2013 and 2015. All patients under 18 years of age for whom influenza RDT was administered were included. Clinical data, management, and related hospitalizations were compared between positive and negative RDT groups. The length of stay in the PED (main outcome) and the number of additional tests (biological and radiographic tests) between the two groups were compared.

RESULTS

A total of 238 tests were reported: 119 positive, 110 negative, nine invalid. The mean length of stay in the PED was significantly lower in the positive RDT group: 4.0h vs. 7.4h (P<10^-6). Patients with positive RDT had significantly fewer biological tests (20% vs. 56%; P<10^-7) and radiographs (23% vs. 52%; P<10^-5). The prevalence of hospitalizations in a short-stay unit was significantly lower in patients with positive RDT (0.8% vs. 9.1%; P=0.009).

CONCLUSIONS

This study showed a significant medical impact of the use of Sofia^® Influenza RDT A+B FIA in a PED regarding the length of stay and the number of additional explorations.

Silver Nanoparticles Impair Retinoic Acid-Inducible Gene I-Mediated Mitochondrial Antiviral Immunity by Blocking the Autophagic Flux in Lung Epithelial Cells

Silver nanoparticles (AgNPs) are microbicidal agents which could be potentially used as an alternative to antivirals to treat human infectious diseases, especially influenza virus infections where antivirals have generally proven unsuccessful. However, concerns about the use of AgNPs on humans arise from their potential toxicity, although mechanisms are not well-understood. We show here, in the context of an influenza virus infection of lung epithelial cells, that AgNPs down-regulated influenza induced CCL-5 and -IFN-β release (two cytokines important in antiviral immunity) through RIG-I inhibition, while enhancing IL-8 production, a cytokine important for mobilizing host antibacterial responses. AgNPs activity was independent of coating and was not observed with gold nanoparticles. Down-stream analysis indicated that AgNPs disorganized the mitochondrial network and prevented the antiviral IRF-7 transcription factor influx into the nucleus. Importantly, we showed that the modulation of RIG-I-IRF-7 pathway was concomitant with inhibition of either classical or alternative autophagy (ATG-5- and Rab-9 dependent, respectively), depending on the epithelial cell type used. Altogether, this demonstration of a AgNPs-mediated functional dichotomy (down-regulation of IFN-dependent antiviral responses and up-regulation of IL-8-dependent antibacterial responses) may have practical implications for their use in the clinic.

[Prevalent Of Echocardiography Anomaly In Chronic Hemodialysis Patients At The Point G Hospital]

INTRODUCTION

Cardiovascular abnormalities are frequent and often early, severe and masked in patients with renal impairment. These cardiovascular complications are the main causes of death in hemodialysis patients. The diagnosis of these cardiovascular anomalies by cardiac ultrasound allows the individualization of patients at high cardiovascular risk. We conducted this study to evaluate the echo-cardiographic aspects of chronic hemodialysis in the nephrology and hemodialysis department of the G-Point CHU.

METHODS

This is a retrospective study of chronic renal failure patients who have undergone extra-renal treatment for 6 months or more from January 1, 2011 to December 31, 2012. Results: During this study, 83 files were retained The sex ratio was 1.51 in favor of men. The average age of patients was 48 years old. HTA (59%) and tobacco (43.3%) remain the dominant risk factors. Vascular nephropathy was the leading cause of CKD, 44.6%. Echo-cardiac abnormalities are dominated by cavitary dilatation (78.3%), LVH (41%), cardiac dysfunction (83.2%), valvular lesion (30.1%), and pericarditis (22,9%). The cardiovascular complications were LVH (41%), hypertension (25.3%) and dilated cardiomyopathy (9.7%). The evolution was favorable for 73.5% of the patients, the mortality represented 8.4% with various complication (18.1%).

Targeting mannose receptor expression on macrophages in atherosclerotic plaques of apolipoprotein E-knockout mice using 111In-tilmanocept

Background

Atherosclerotic plaque phenotypes are classified based on the extent of macrophage infiltration into the lesions, and the presence of certain macrophage subsets might be a sign for plaque vulnerability. The mannose receptor (MR) is over-expressed in activated macrophages. Tilmanocept is a tracer that targets MR and is approved in Europe and the USA for the detection of sentinel lymph nodes. In this study, our aim was to evaluate the potential of ¹¹¹In-labelled tilmanocept for the detection of MR-positive macrophages in atherosclerotic plaques of apolipoprotein E-knockout (ApoE-KO) mouse model.

Methods

Tilmanocept was labelled with ¹¹¹In. The labelling stability and biodistribution of the tracer was first evaluated in control mice (n = 10) 1 h post injection (p.i.). For in vivo imaging studies, ¹¹¹In-tilmanocept was injected into ApoE-KO (n = 8) and control (n = 8) mice intravenously (i.v.). The mice were scanned 90 min p.i. using a dedicated animal SPECT/CT. For testing the specificity of ¹¹¹In-tilmanocept uptake in plaques, a group of ApoE-KO mice was co-injected with excess amount of non-labelled tilmanocept. For ex vivo imaging studies, the whole aortas (n = 9 from ApoE-KO and n = 4 from control mice) were harvested free from adventitial tissue for Sudan IV staining and autoradiography. Cryosections were prepared for immunohistochemistry (IHC).

Results

¹¹¹In radiolabelling of tilmanocept provided a yield of greater than 99%. After i.v. injection, ¹¹¹In-tilmanocept accumulated in vivo in MR-expressing organs (i.e. liver and spleen) and showed only low residual blood signal 1 h p.i. MR-binding specificity in receptor-positive organs was demonstrated by a 1.5- to 3-fold reduced uptake of ¹¹¹In-tilmanocept after co-injection of a blocking dose of non-labelled tilmanocept. Focal signal was detected in atherosclerotic plaques of ApoE-KO mice, whereas no signal was detected in the aortas of control mice. ¹¹¹In-tilmanocept uptake was detected in atherosclerotic plaques on autoradiography correlating well with Sudan IV-positive areas and associating with subendothelial accumulations of MR-positive macrophages as demonstrated by IHC.

Conclusions

After i.v. injection, ¹¹¹In-tilmanocept accumulated in MR-expressing organs and was associated with only low residual blood signal. In addition, ¹¹¹In-tilmanocept uptake was detected in atherosclerotic plaques of mice containing MR-expressing macrophages suggesting that tilmanocept represents a promising tracer for the non-invasive detection of macrophages in atherosclerotic plaques.

[Depression To The Chronic Hemodialysis Of the University Hospital OF Point G (Bamako-Mali)]

OBJECTIVE

Determine prevalence of the depression in a population of patients chronic hemodialysis. Look for the associated sociodemographic, clinical and biological factors.

METHOD

It was a transverse study. She concerned the at least 18-years-old patients, followed in the center of Hemodialysis of the CHU at the rate of 2 - 3 sessions a week. The patients having agreed, were in dialysis at least for 3 months and benefited from an individual interview through an index card of investigation based of Hamilton's scale French version in 17 items.

RESULTS

On a sample of 107 patients, the average age was 43, 24 ± 14 years old with extremes between 20 and 75 years. The average duration in dialysis was of ±40, 37 36, 5 months with extremes between 4 and 144 months. Prevalence of the depression was 88 %. The depression was light in 78, 5 %, moderated in 6,5% and severe in 3 %. The anemia was present at 94 patient's among whom 76 had a light depression.

CONCLUSION

We observed that prevalence of the depression remains high to the chronic hemodialysis.

[Epidemiology and maternal prognosis of eclampsia in the intensive care unit at the University Hospital of Point G, Bamako]

OBJECTIVE

This research aimed to analyze the epidemio- clinical characteristic and the prognosis of patients with eclampsia admitted to the intensive care unit at the University Hospital of Point G.

MATERIALS AND METHODS

The clinical records of all patients admitted to intensive care for eclampsia from September 2009 to February 2011 were retrospectively collected. We analyzed the following parameters: age, parity, gravidity, the admission deadline, the beginning of eclampsia compared to the term of pregnancy, the number of seizure, mode of delivery, score of Glasgow, blood pressure, proteinuria, complications and evolution.

RESULTS

Among 702 admissions, 158 patients, with a mean age of 20 ± 4 were hospitalized for eclampsia (22.5%). We recorded 106 cases of first pregnancies (67.1%) and 104 primiparous (65.8%). The admission period after the first seizure was over 6 hours for 90 patients (57%). The first seizure had occurred in ante-partum period for 69 patients, in per-partum period for 4 patients and in postpartum period for 85 patients.

Ninety-three patients (59%) had consciousness disorders at admission, 12 patients received oxygen treatment .Vaginal delivery was the mode of delivery for 93 patients and cesarean section for 65 patients.Eclampsia was associated with renal failure in 25 patients, HELLP syndrome for 15 patients, the stroke for 5 patients, acute pulmonary edema for 3 patients, the coagulation disorders for one patient; and the sepsis for 6 patients. Maternal and perinatal lethality was 9.5% and 10.8% respectively.

CONCLUSION

Eclampsia is a frequent medical and obstetric emergency in intensive care unit of the University Hospital of Point G and affects young patients during their first pregnancy and delivery. Maternal and perinatal lethality remains high, due to the delay in the cases management and the associated factors of gravity. Strong actions are needed to raise awareness for early medical visit and to prepare medical teams for better cases management.

HDL and endothelial protection

High-density lipoproteins (HDLs) represent a family of particles characterized by the presence of apolipoprotein A-I (apoA-I) and by their ability to transport cholesterol from peripheral tissues back to the liver. In addition to this function, HDLs display pleiotropic effects including antioxidant, anti-apoptotic, anti-inflammatory, anti-thrombotic or anti-proteolytic properties that account for their protective action on endothelial cells. Vasodilatation via production of nitric oxide is also a hallmark of HDL action on endothelial cells. Endothelial cells express receptors for apoA-I and HDLs that mediate intracellular signalling and potentially participate in the internalization of these particles. In this review, we will detail the different effects of HDLs on the endothelium in normal and pathological conditions with a particular focus on the potential use of HDL therapy to restore endothelial function and integrity.

Antioxidant activities and phenolic contents of extracts from Glinus oppositifolius aerial parts

In Malian traditional medicine, aerial parts of Glinus oppositifolius are used in the treatment of many disorders, particularly inflammations and joint pains.

AIM

The present study was initiated to investigate the antioxidant potential of Glinus oppositifolius.

MATERIAL AND METHODS

Aqueous and ethanol extracts were prepared from the dried aerial parts. Both extracts were examined for the phenolic content and antioxidant activity. Total phenolic content was quantified by Folin-Ciocalteu method. Antioxidant activity was studied in vitro by evaluating the ability to scavenge different free radicals (ABTS, superoxide and hydroxyl radicals, nitric oxide) and to chelate ferrous ions.

RESULTS

Aqueous extract was found to contain a higher level of total phenols than ethanol extract (1.27 +/- 0.04 vs. 0.94 +/- 0.05 g GAE/100 g extract). Both extracts lacked the ability to scavenge superoxide anion radical but scavenged ABTS and hydroxyl radicals, nitric oxide and chelated ferrous ions in a concentration-dependent manner. According to the EC50 values, aqueous extract showed stronger antioxidant effects than ethanol extract (174.32 +/- 1.49 vs. 276.76 +/- 1.52 microg/mL in ABTS radical cation scavenging assay, 119.91 +/- 1.70 vs. 240.57 +/- 0.97 microg/mL in nitric oxide scavenging assay, 1.99 +/- 0.01 vs. 6.54 +/- 0.08 mg/mL in ferrous ion chelating assay). In hydroxyl radical scavenging assay, aqueous extract had an EC50 value of 0.86 +/- 0.00 mg/mL while the EC50 value of ethanol extract was higher than the highest concentration that was tested (3.75 mg/mL).

CONCLUSIONS

Our results clearly indicate the antioxidant potential of Glinus oppositifolius aerial parts and suggest that the antiinflammatory activity might be partly related to the antioxidant potential.

Impaired high-density lipoprotein anti-oxidant capacity in human abdominal aortic aneurysm

AIMS

Abdominal aortic aneurysm (AAA) is a particular form of atherothrombotic disease characterized by the dilation of the aortic wall and the presence of an intraluminal thrombus (ILT). The objective of the present study was to evaluate the pro-oxidant properties of the ILT and to characterize the anti-oxidant capacity of high-density lipoproteins (HDLs).

METHODS AND RESULTS

Our results show that ILT, adventitia, and plasma from AAA patients contained high concentrations of lipid and protein oxidation products. Mediators produced within or released by the thrombus and the adventitia were shown to induce reactive oxygen species (ROS) production by cultured aortic smooth muscle cells (AoSMCs) and to trigger the onset of apoptosis (an increase in mitochondrial membrane potential). Iron chelation limited these effects. Both concentration and functionality of HDLs were altered in AAA patients. Plasma levels of Apo A-I were lower, and small HDL subclasses were decreased in AAA patients. Circulating HDLs in AAA patients displayed an impaired capacity to inhibit copper-induced low-density lipoprotein oxidation and AoSMC ROS production. Western blot analyses of HDLs demonstrated that myeloperoxidase is associated with HDL particles in AAA patients.

CONCLUSION

ILT and adventitia are a source of pro-oxidant products, in particular haemoglobin, which may impact on the wall stability/rupture in AAA. In addition, HDLs from AAA patients exhibit an impaired anti-oxidant activity. In this context, restoring HDL functionality may represent a new therapeutic option in AAA.

[Relationship between glomerular filtration rate, uric acid, and parathyroid hormone in children]

INTRODUCTION

Parathyroid hormone (PTH) and uric acid (UA) levels increase early during chronic kidney disease (CKD). The objective of this study was to evaluate the relationship between these two parameters at different stages of pediatric CKD.

PATIENTS AND METHODS

One hundred patients (range, 5-18 years) were included in this retrospective study: they had undergone renal exploration with a direct measurement of the glomerular filtration rate (GFR) using the reference standard (i.e., inulin clearance, Cin) and presented with increased circulating levels of PTH and/or UA.

RESULTS

GFR was normal in 39% of patients, with UA increased in 44% and PTH in 75% of them. Interestingly, 29% of the children with increased PTH levels had a strictly normal GFR (i.e., above 90 mL/min/1.73 m(2)). An inverse association was found between UA and GFR (r=-0.452, P ≤ 0.0001) as well as between PTH and GFR (r=-0.226, P=0.024). The same negative relationships were found between UA and PTH (r=-0.266, P=0.007), and between UA and the phosphate reabsorption rate (r=-0.415, P<0.001).

DISCUSSION

Since hyperuricemia was found at all stages of CKD, an early silent tubular impairment can be discussed to explain these findings. The early increase in PTH levels during CKD has not been described by all authors, with North American studies describing rather late increased PTH levels during CKD. Prospective studies are required to confirm these data and evaluate the role of UA in the pathophysiology of the mineral disorders observed during CKD.

[Loco-regional anesthesia practices in 1261 cases]

GOAL

The aim of this study was to take stock of the practice of the loco-regional anesthesia (LRA) at the University Hospital Center of Point G from January 2004 to December 2008.

MATERIALS AND METHOD

This is a retrospective study, assessing the practice of LRA. The demographic data, the surgery, the technical characteristics of the procedure made, the type of local anesthetic used, adverse events were evaluated.

RESULTS

The LRA involved 1261 patients - 8.30% of the total number of surgical procedures occurring during the studied period. The American Society of Anesthesiology (ASA) classification was used for the evaluation of patients in scheduled surgery. The patients belonged to class 1 (50.40%) and Class 2 (49.60%). The main surgical procedures were: 26.20% surgical prostatic adenomectomy, 23.80% of caesarean section, and the fistulogram test for 19.04%. The LRA techniques performed were: spinal anesthesia, 87.60%, epidural anesthesia, 12%. Three hundred and three adverse events (24%) have been reported, three (1%) of them have resulted in the death of the patient. The incidence of arterial hypotension was 94.40%, and 4.6% for bradycardia. The three heart attacks were fatal (0.024 ‰). Patients operated under spinal anesthesia and patients aged 60 years and older had more adverse events with 20% and 10.38% for p <0.05 respectively. Sixty eight failures (5.4%) were observed.

CONCLUSION

The practice of LRA at the University Hospital of Point G is characterized by adverse events and a low number of deaths. Patients operated under spinal anesthesia and patients aged 60 years and older are at greatest risk of adverse events.

Re-emergence of Rift Valley fever virus in Barkedji (Senegal, West Africa) in 2002-2003: identification of new vectors and epidemiological implications

The Rift Valley fever virus (RVFV) is a threat that must not be neglected, as the consequences of RVFV are dramatic, both for human and animal health. This virus is a zoonotic virus that already has demonstrated a real capacity for re-emerging after long periods of silence, as observed in Barkedji (Senegal, West Africa) in 2002. In this article we present the 2nd emergence in Barkedji after the 1st manifestation in 1993, and for the 1st time the circulation of RVFV during 2 consecutive years among mosquito populations in Senegal. As part of the entomological surveillance program undertaken since 1990 to detect circulation of the RVFV in Barkedji, 108,336 mosquitoes belonging to 34 species and 5 genera were collected in 2002-2003. Aedes vexans and Culex poicilipes, previously known to be vectors of RVFV in Senegal, comprised 88.7% of the total collection. In 2002, Ae. vexans was the most abundant mosquito, followed by Cx. poicilipes; the opposite situation was observed in 2003. In 2002, 29 and 10 RVFV isolates were obtained from Cx. poicilipes (minimum infection rate [MIR] = 0.13%) and Ae. vexans (MIR = 0.02%) pools, respectively and the MIR for the 2 species were significantly different (chi2 = 34.65; df = 1, P < 0.001). In 2003, 7 RVFV strains were isolated from Cx. poicilipes (3, MIR = 0.03), Mansonia africana (2, MIR = 0.08), Ae. fowleri (1), and Ma. uniformis (1, MIR = 0.05). The 3 latter species were found to be associated with RVFV for the 1st time in Senegal. A significant decrease in MIR was observed from 2002 to 2003 (chi2 6.28; df = 1, P = 0.01) for Cx. poicilipes, the only species involved in the transmission during the 2 sampling years.

Salivary proteome modifications associated with periodontitis in obese patients

AIM

To identify changes in the salivary protein/peptide profiles by differential proteomics in obese patients with or without periodontitis.

MATERIAL AND METHODS

Periodontal examinations and whole saliva samples were obtained from 38 obese patients (mean age: 45.1 ± 7.3 years, mean BMI: 49.3 ± 9 kg/m(2) ) including 13 periodontitis and 25 non-periodontitis subjects, and 19 healthy controls (mean age: 44.2 ± 6.4 years, mean BMI: 21.5 ± 2.1 kg/m(2) ). Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) was used to compare the whole saliva polypeptide profiles.

RESULTS

The SELDI-TOF-MS analysis detected eight putative markers. Six of them were increased and identified in obese subjects versus controls (albumin, α and β haemoglobin chains, α-defensins 1, 2 and 3). Alpha-defensins were less abundant in saliva of periodontitis obese patients (36.47 ± 19.84 μA) versus non-periodontitis obese patients (43.44 ± 30.34  μA), whereas α-defensins were more abundant in obese patients (40.99 ± 26.66  μA) versus controls (27.1 ± 23.98  μA).

CONCLUSIONS

Periodontal status modifies the salivary proteome in obese patients. Alpha-defensins may play a role in gingival inflammation, and be involved in the higher susceptibility of obese patients to periodontal diseases.

Chemical and biological characterization of polysaccharides from wild and cultivated roots of Vernonia kotschyana

ETHNOPHARMACOLOGICAL RELEVANCE

In Malian traditional medicine the roots of Vernonia kotschyana are used for treating gastric ulcer and gastritis. In 2006, 9000kg of roots from Vernonia kotschyana were used to produce Gastrosedal, an ameliorated traditional medicine in Mali. Harvesting from the wild, the main source of raw material, is causing a growing concern of diminishing populations of the plant, and Vernonia kotschyana is now being cultivated in several areas around Mali. In the current study the structures and bioactive properties of isolated polysaccharides from wild and cultivated Vernonia kotschyana were compared.

MATERIALS AND METHODS

Pectin- and inulin-type polysaccharides were isolated from the roots of cultivated and wild Vernonia kotschyana. The isolated polysaccharides were investigated regarding their chemical compositions, and for their abilities to fixate human complement and activate macrophages from a mouse macrophage cell line.

RESULTS

No significant differences in the carbohydrate composition of the fractions isolated from the cultivated versus the wild roots were observed. A previously reported pectic arabinogalactan Vk2a was found in both the cultivated and the wild roots in this study, and exhibited potent complement fixation activity, and a moderate activation of macrophages.

CONCLUSIONS

The present study has shown that the cultivated roots of Vernonia kotschyana contain the same types of bioactive polysaccharides as the wild roots. It is therefore preliminarily feasible for the cultivated roots of Vernonia kotschyana to be used as a herbal medicine to replace the wild roots.

[Study of the quality of life of hemodialysis patients at the University Hospital of Point G (CHU) in Bamako- the study of 30 cases]

AIMS

To assess the social and psychological state development of our patients six months after their dialysis treatment.

PATIENTS AND METHODS

It was about a prospective study within January to June 2006. The data collection was conducted on personal search records and a questionnaire "Choice Health Experience Questionnaire" (CHEQ). The CHEQ self managed assessed the mental health, the physical health, the sexual and social functioning, the concept of sleeping disorders, familial life, leisure's and education's level. The typing was done on Epi Info 6,0 and the analyse on SPSS10.

RESULTS

They where 20 men and 10 women or a ratio sex of 2. The average age was 40.36 years ±13.08. Twenty three patients (76.7%) were satisfied of their life in general. Four patients (13.3%) were depressed, two had sleeping disorders. Fifteen men (75%) had erection disorders.

CONCLUSION

Our patients' quality of life in iterative haemodialysis remains satisfactory. A better care taking of the anaemia is necessary because it plays an important role in the erection disorders.

[Tuberculosis in chronic hemodialysis patients at the Teaching Hospital of Point G (CHU) in Bamako]

AIMS

To determine the frequency and the diagnostic difficulties of tuberculosis of haemodialysis patients.

PATIENTS AND METHODS

The study was about a retrospective analyse of patients haemodialysis records treated for tuberculosis within January 2003 to April 2006. The tuberculosis check-up contained a questioning, a meticulous clinic examination, thorax radiography, a tuberculosis intra dermoreaction (IDR) and the search of Koch Bacillus (BK) in biological liquids.

RESULTS

Tuberculosis was identified to 15.52% of haemodialysis patients (10/95). The average age of our patients was from 44.3 years, with a ratio sex of 2.5 in favour of men. Tuberculosis infection happened on average 27.4 months after the beginning of the haemodialysis. We found out 50% of extra pulmonary tuberculosis (three peritoneales and two pleurales); and 50% of pulmonary tuberculosis. The IDR was positive in two cases (2/6). The search of BK didn't succeed. We reported three deaths.

CONCLUSION

The effect of tuberculosis to chronic haemodialysis patients is very high. The diagnostic is sometimes difficult and is based only on specific therapeutic test.

Evaluation of the efficiency of bird-baited traps for sampling potential West Nile fever mosquito vectors (Diptera: Culicidae) in Senegal

The efficiency of bird-baited traps and collection heights for sampling potential West Nile mosquito vectors was studied during the 2006 rainy season (between September 27 and November 26) in Barkedji area situated in the sahelian area of Senegal (West Africa). Each night, two traps were set on the ground-level and two on the canopylevel (approximately 3 m) each containing either a chicken or a pigeon, the traps being rotated the following nights. A total of 1,030 mosquitoes were collected using 66 traps-nights. Culex species were predominant and represented 92.2% of the fauna of which 63% belonged to Cx. neavei group Theobald whereas 23.8% were Cx poicilipes (Theobald). The species of the Cx. neavei group were mainly collected by the pigeon-baited trap at canopy while Cx. poicilipes was captured similarly by pigeons and chickens placed at the canopy and ground. The implication of these results in West Nile vectors surveillance is discussed.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.