[Safety and Efficacy of Artemether-Lumefantrine and Artesunate-Amodiaquine in Niger]. / Étude de l'efficacité thérapeutique et de la tolérance de l'artéméther­luméfantrine et de l'artésunate­amodiaquine au Niger.

This study aims to evaluate the therapeutic efficacy and tolerance of two ACTs widely used for the treatment of uncomplicated malaria due to Plasmodium falciparum in Niger. The study was conducted from September to November 2017, at the Integrated Health Centers of Dogondoutchi and Birni N'Gaouré, in patients aged from 6 months to 15 years, with uncomplicated malaria due to Plasmodium falciparum. They were treated with either Artemether-Lumefantrine (AL) or Artesunate-Amodiaquine (ASAQ). The primary endpoint was the appropriate clinical and parasitological response (RCPA) to D28, after PCR correction. The secondary criteria were the clearing time of fever, parasites, and gametocytes and then the occurrence of adverse events. A total of 459 patients were examined, of whom 312 patients met the inclusion criteria for therapeutic efficacy evaluation. We have followed 299 patients up to J28 including 146 in the AL arm and 153 in the ASAQ arm. After PCR correction at J28, RCPA were 95.8% and 96% (P = 0.7185) for arms AL and ASAQ, respectively, compared to 93.1% and 94.1% respectively before PCR correction (P = 0.7892). The number of patients on AL and ASAQ treatment who developed an adverse reaction were 6 (7.6%) and 23 (28%) respectively. AL and ASAQ associations are effective and well tolerated. No serious adverse event was noted. However, their monitoring must continue to detect possible resistance.

Cette étude vise à évaluer l'efficacité thérapeutique et la tolérance de deux combinaisons thérapeutiques à base d'artémisinine (CTA), largement utilisées pour le traitement du paludisme non compliqué à Plasmodium falciparum au Niger. L'étude a été conduite de septembre à novembre 2017, au niveau des centres de santé intégrée (CSI) de Dogondoutchi et de Birni N'Gaouré, chez des patients âgés de 6 mois à 15 ans, atteints de paludisme non compliqué. Ils ont été traités par l'artéméther-luméfantrine (AL) ou l'artésunate­amodiaquine (ASAQ). Le critère de jugement principal était la réponse clinique et parasitologique adéquate (RCPA) à j28, après correction PCR. Les critères secondaires étaient le temps de clairance de la fièvre, des parasites et des gamétocytes puis la survenue des événements indésirables. Au total, 459 patients ont été examinés : 312 patients répondaient aux critères d'inclusion, 299 patients ont été suivis jusqu'à j28 dont 146 dans le bras AL, 153 dans le bras ASAQ. Les RCPA après correction PCR à j28 étaient de 95,8 et 96 % (p = 0,7185) respectivement pour AL et ASAQ alors qu'elles étaient respectivement de 93,1 et 94,1 % avant correction PCR (p = 0,7892). Le nombre de patients sous traitement AL et ASAQ ayant développé une réaction indésirable sont respectivement de 6, soit 7,6 %, et 23, soit 28 %. Les associations AL et ASAQ sont efficaces et bien tolérées, la première étant mieux tolérée. Aucun événement indésirable grave n'a été noté. Cependant, la surveillance des effets indésirables et de l'efficacité doit se poursuivre.Cette étude vise à évaluer l'efficacité thérapeutique et la tolérance de deux combinaisons thérapeutiques à base d'artémisinine (CTA), largement utilisées pour le traitement du paludisme non compliqué à Plasmodium falciparum au Niger. L'étude a été conduite de septembre à novembre 2017, au niveau des centres de santé intégrée (CSI) de Dogondoutchi et de Birni N'Gaouré, chez des patients âgés de 6 mois à 15 ans, atteints de paludisme non compliqué. Ils ont été traités par l'artéméther-luméfantrine (AL) ou l'artésunate­amodiaquine (ASAQ). Le critère de jugement principal était la réponse clinique et parasitologique adéquate (RCPA) à j28, après correction PCR. Les critères secondaires étaient le temps de clairance de la fièvre, des parasites et des gamétocytes puis la survenue des événements indésirables. Au total, 459 patients ont été examinés : 312 patients répondaient aux critères d'inclusion, 299 patients ont été suivis jusqu'à j28 dont 146 dans le bras AL, 153 dans le bras ASAQ. Les RCPA après correction PCR à j28 étaient de 95,8 et 96 % (p = 0,7185) respectivement pour AL et ASAQ alors qu'elles étaient respectivement de 93,1 et 94,1 % avant correction PCR (p = 0,7892). Le nombre de patients sous traitement AL et ASAQ ayant développé une réaction indésirable sont respectivement de 6, soit 7,6 %, et 23, soit 28 %. Les associations AL et ASAQ sont efficaces et bien tolérées, la première étant mieux tolérée. Aucun événement indésirable grave n'a été noté. Cependant, la surveillance des effets indésirables et de l'efficacité doit se poursuivre.

[Geophagy associated with severe anemia in non-pregnant women: A case series of 12 patients]. / Géophagie associée à une anémie sévère chez la femme non gravide : à propos de 12 cas.

INTRODUCTION: Geophagy or soil eating is mostly described in pregnant women from Sub-Saharan Africa, South America. Here, we report 12 cases of geophagy associated with severe anemia in non-pregnant Nigerian women. RESULTS/CASE REPORTS: The median age at diagnosis was 34.5 years. The socioeconomic level was average for all patients. The median hemoglobin level at admission was 6.9g/dL (3.3-8.6), median corpuscular volume was 78.3fL (63-106) and median serum ferritin was 9.2ng/mL (3.6-11.2). The reasons of this practice were "desire" (5/12) and tradition (4/12). All patients received psychotherapy and supplementation with intravenous iron. CONCLUSION: Geophagy is an underestimated practice in developed countries and in non-pregnant women. It can be the cause of severe iron deficiency and must be discussed in patients with anemia, including non-pregnant patients, and in Africa as well as in migration areas, where the practice can be exported.

[Evaluation of the benefit of different complementary exams in the search for a TB diagnosis algorithm for HIV patients put on ART in Niamey, Niger]. / Évaluation du bénéfice apporté par des examens complémentaires pour le diagnostic de la tuberculose chez des patients infectés par le VIH mis sous ARV à Niamey, Niger.

In Niger, the tuberculosis (TB) screening among people living with human immunodeficiency virus (HIV) (PLHIV) is nonsystematic and the use of additional tests is very often limited. The objective of this research is to evaluate the performance and the cost-effectiveness of various paraclinical testing strategies of TB among adult patients with HIV, using available tests in routine for patients cared in Niamey. This is a multicentric prospective intervention study performed in Niamey between 2010 and 2013. TB screening has been sought in newly diagnosed PLHIV, before ART treatment, performing consistently: a sputum examination by MZN (Ziehl-Nielsen staining) and microscopy fluorescence (MIF), chest radiography (CR), and abdominal ultrasound. The performance of these different tests was calculated using sputum culture as a gold standard. The various examinations were then combined in different algorithms. The cost-effectiveness of different algorithms was assessed by calculating the money needed to prevent a patient, put on ART, dying of TB. Between November 2010 and November 2012, 509 PLHIV were included. TB was diagnosed in 78 patients (15.3%), including 35 pulmonary forms, 24 ganglion, and 19 multifocal. The sensitivity of the evaluated algorithms varied between 0.35 and 0.85. The specificity ranged from 0.85 to 0.97. The most costeffective algorithm was the one involving MIF and CR. We recommend implementing a systematic and free direct examination of sputum by MIF and a CR for the detection of TB among newly diagnosed PLHIV in Niger.

[Amyotrophic Lateral Sclerosis (ALS) in the 10 last years in CHU Campus of Lomé (TOGO)]. / Sclerose Laterale Amyotrophique (SLA): Rapport de 10 ans d'activites en service de neurologie du CHU Campus de Lome (TOGO).

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that causes damage of upper motor neuron and lower motor neuron. Our objective was to describe the incidence and demographic characteristics of ALS and to analyze its diagnosis and management in Togo. MATERIALS AND METHODS: A retrospective and descriptive study of patient's observations was conducted in the department of neurology of the teaching hospital in Lomé during a 10 years period (2000 to 2009). The diagnosis of ALS was made according to the clinical classification of El Escorial. RESULTS: 5 cases of ALS were diagnosed, representing 0.049% of the hospitalizations in the department of neurology. The average age of patients was 49 years [range: 24 - 67 years] and the average evolution of the disease was 17.6 months [range: 6 - 36 months]. All the patients were men. The treatment was symptomatic in every case. Treatment with Riluzole was not delivered. During the follow-up, one patient died from respiratory complications. CONCLUSION: The El Escorial criteria should be made more accessible for a larger audience, as the availability and classification of care management relies heavily on diagnosed cases, namely early diagnosis.

La sclérose latérale amyotrophique (SLA) est une maladie dégénérative du motoneurone qui atteint les deux neurones de la voie motrice volontaire et qui est cliniquement définie. BUT: Avoir des données préliminaires au Togo concernant la SLA. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude rétrospective et descriptive sur les observations de patients en service de neurologie du CHU campus de Lomé sur une durée de 2000 à 2009. Sont inclus, les patients répondant aux critères de SLA certaine selon les critères d'El Escorial. RÉSULTATS: Cinq (5) cas de SLA ont été diagnostiqués, représentant 0,049% des hospitalisations du service. L'âge moyen était de 49 ans [24; 67 ans] avec une durée moyenne d'évolution de 17,6 mois [6; 36 mois]. Tous les patients étaient de sexe masculin. Le traitement a été symptomatique dans tous les cas. Le traitement au Riluzole n'a pas pu être institué. Un patient était décédé plus tard de complications respiratoires. CONCLUSION: Les critères d'El Escorial doivent être vulgarisés, car la disponibilité et la codification de la prise en charge dépendent du nombre des cas diagnostiqués et surtout de la précocité du diagnostic.

[Severe burn due to sulfuric acid: a report case at the National Hospital of Niamey]. / Brulure grave du visage par l'acide sulfurique: a propos d'un cas a l'Hopital National de Niamey.

Sulfuric acid is easy to obtain and leads to severe caustic burn. Caustic burns are increasingly common in homicides and suicide. We reported a case of sulfuric acid burn due to a family criminal act. Immediate skin washout was performed and avoided many complications like eyes lesion or their destruction. The skin lesion evolved in different stages of caustic burns: necrosis, tissue mortification then retractile and keloid scar. The treatment duration was 32 months.

L'acide sulfurique est facile à se procurer, et entraine de brûlure grave. Il est utilisé dans les actes criminels et d'autolyse. Nous rapportons le cas d'un patient victime d'un acte criminel pour des raisons familiales. Le lavage immédiat à grande eau a permis d'éviter certaines complications pouvant survenir notamment l'atteinte des yeux, ou leur destruction. Les lésions cutanées ont évolué par les différentes étapes d'une brûlure caustique: La nécrose, la mortification tissulaire et la cicatrisation de la peau laissant place à des lésions chéloïdiennes rétractiles. La prise en charge de ces lésions chéloïdiennes a duré 32 mois.

[Preparedness for influenza A/H5N1 pandemic in Niger: a study on health care workers' knowledge and global organization of health activities]. / Pandémie grippale A/H5N1 et niveau de préparation du Niger: une étude sur les connaissances des soignants et l'organisation générale des soins.

In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.

[Snake bites in the emergency unit of Niamey National Hospital, Niger]. / Morsures de serpent à l'hôpital national de Niamey: à propos de 53 cas.

This study was aimed at assessing envenomations caused by snakebite in Niamey National Hospital, between July 2005 and September 2006. We included 53 victims of snakebites. The wounded distribution indicated more wounded males than females (sex ratio = 1.78:1). The mean age was 29 ± 17 years. September to November seemed a period of higher risk. The snake was not identified in 60% of the cases. The bite occurred during March in 43% of the cases. Clinically, 6% of the patients showed no signs of envenomation and 7% presented bleeding disorders; 88% of the patients did not receive anti-venom. The lethality rate was 15%.

[First documented cases of rheumatoid arthritis in Niger]. / Premiers cas documentés de polyarthrite rhumatoïde au Niger.

The authors report the first eight documented cases of rheumatoid arthritis in Niger, all diagnosed during one year at the National Lamordé Hospital of Niamey. Systemic manifestations were rare.

[Plasmodium falciparum chloroquine and pyrimethamine resistance monitoring network with molecular tools in the Niger River valley, Republic of Niger]. / Réseau de surveillance moléculaire de la chimioré- sistance de Plasmodium falciparum a la chloroquine et a la pyriméthamine dans la vallée du fleuve Niger, au Niger.

Plasmodium falciparum resistance to chloroquine first arose in Africa 25 years ago. Nowadays most of African malaria control programmes have switched their first-line treatment of uncomplicated malaria cases towards artemisinin derivatives combination. After WHO guidelines, a survey network for malaria treatment resistance has been set up in the Niger valley around Niamey since December 2004. The association of the Niger national malaria control programme with the CERMES research center allowed collecting of samples from both health centers and hospitals of this region. Blood finger-pricks on filter papers were tested for detection of plasmodial antigen in health center without biological diagnosis capacity. Specimens found positive either in hospital laboratory or by using antigen method were tested by PCR/RFLP to detect K76T mutations on the pfcrt gene and S108N mutation on the pfdhfr gene. This simple procedure allows the screening of a large number of specimens. Moreover, a spatial distribution of mutations and evidence of resistance clusters were searched integrating the data in a geographic information system. The 76T mutation of pfcrt and 108N of pfdhfr were respectively found in 50.8% and 57% of the specimens tested. No statistically significant difference was found according to the level of sanitary formations or the age of the patients. No resistance cluster was identified and the prevalence of mutation seems homogeneous in the zone. By completing the clinical efficacy studies we think that our simple method for collecting and testing blood samples associated with clinical efficacy studies may be useful for building a network of malaria drug resistance in Africa.

[Prevalence of cryptosporidiosis in pediatric hospital patients in Niamey, Niger]. / Prévalence de la cryptosporidiose en milieu hospitalier pédiatrique à Niamey, Niger.

No data has been published, so far about the prevalence of cryptosporidiosis among children in Niger; a landlocked country of West Africa where malnutrition and diarrhoea are two major public health issues. The aim of the present study was to get a first evaluation of the prevalence of Cryptosporidium sp in the stools of hospitalized children in the National Hospital of Niamey (NHN) where we carried out a prospective descriptive study involving all children younger than 5 years of age in the paediatric department between February 21st and May 22nd, 2004. Direct stool examination and Ritchie technique were systematically performed, and evidence of Cryptosporidium oocysts was looked for by means of a smear from the sediment which was stained by the modified Ziehl-Neelsen technique. The weight/age ratio was calculated and analyzed with the Epi-Info software, based on the reference population defined by the US National Center for Health Statistics (NCHS). Malnutrition was defined as a weight/age ratio more than 2 SD below the NCHS's reference population. Malnutrition was considered moderate between -2 and -3 SD and severe below 3 SD. In the 3 months study 220 children were included (sex ratio = 1.18 and mean age = 20 months) showing that 65% of the children were suffering from malnutrition (moderate = 17.3%, severe = 47%). Diarrhoea was reported in 51.8% of the children. Cryptosporidium oocysts were detected in 12/220 children (5.5% of the studied population) and 7/114 (6. 1%) of those children were suffering from diarrhoea. 10 (83%) out of the 12 infected children were malnourished. This was the first study ever conducted in the paediatric department of the Niamey hospital, and it showed evidence of a 5.5% prevalence of cryptosporidiosis in the overall studied population, versus 6.1% among children with diarrhoea. 5 children without diarrhoea and 2 children under 6 months were also infected. Another study based on a larger number of patients would be necessary to address the impact of rainfall distribution on the incidence of the disease.

[The treatment of lower limb varices by stripping and cross sectioning of the saphenous vein at the National Hospital of Niamey: 31 operated limbs]. / Le traitement des varices des membres inferieurs par stripping et crossectomie de la grande et petite veine saphene a l'Hopital National de Niamey: a propos de 31 membres opérés.

OBJECTIVE: The authors reported the results of surgical procedure of lower limbs varicose (LLV) by stripping and crossectomy of saphenous vein at the National hospital of Niamey. METHODS: It is a prospective study during 5 years and half from January 2001 to June 2006. It concerned the all the patients with LLV who underwent a stripping-crossectomy of the great saphenous vein (GVS) and short saphenous vein (SSV) and elastic stocking. The anaes's clinical classification is used. RESULTS: The series included 27 patients (31 limbs): 20 males and 7 females (Ratio: 2.8). The average age was 32.4 years (ranged: 21 to 58 years). The mean duration of symptoms was 4.2 years (ranged: 3 to 12 years). According the ANAES's classification we found 63% of patients in stage B, and 37% in stage C. We performed 35 stripping crossectomy (28 for GSV and 7 for SSV) with avulsions accessory veins in 6 cases (14%), incompetent perforator ligature in 2 cases (4.6%) and complementary sclerotherapy in 19 cases (61.3%). The postoperative complications including haematomas (9.7%), wound infections (6.5%) and paraesthesia of saphenous nerve (6.5%) were subsequently resolved with treatment. The mean duration of hospitalization was 11 days (ranged: 4 to 18 days). After a mean follow-up period of 3 years (ranged: 6 months to 6 years) the recurrent varices rate was 6.5% (2 cases) due to leg perforators in 1 case/2 and 4 cases (9.7%) of residual ankle oedema. CONCLUSION: The LLV concerned young people. The results were good and recurrent rate is low after stripping and crossectomy for varicose stage B and C according ANAES's classification. The surgical procedure needed minute clinical and paraclinical assessment.

Treatment of imported malaria in adults: a multicentre study in France.

BACKGROUND: Data about anti-malarial drugs prescription practices in Europe and the safety of imported malaria treatments are scanty. In 1999, a French consensus development conference published guidelines for the prevention and treatment of imported P. falciparum malaria. The impact of these guidelines has not been evaluated. AIM: To investigate the impact of these guidelines on the prescription of anti-malarials, and to evaluate the incidence of acute drug events (ADEs) leading to discontinuation of treatment. DESIGN: Cross-sectional survey. METHODS: Members of the medical staff in 14 French infectious and tropical disease wards completed a standardized form for each patient treated for imported malaria in 2001. A propensity score matching technique was used to estimate the risk of ADEs leading to discontinuation of the regimen. RESULTS: In the 474 patients studied, quinine was the first-line anti-malarial most often prescribed. Only 3% of patients received halofantrine. Mefloquine was associated with a RR of 4.9 (95%CI 3.2-7.4, p < 0.00001) risk of discontinuation of treatment due to ADEs. DISCUSSION: The very limited use of halofantrine indicates that the main practice recommendations of the guidelines have been taken into account. Mefloquine was associated with a substantial risk of discontinuing the treatment because of ADEs. This is a serious limitation for the use of mefloquine in the treatment of out-patients with imported malaria.

[The treatment of prostatitis]. / Le traitement des prostatites.

PURPOSE: Prostatitis are frequently recognized in general practice and often are a diagnosis and therapeutic challenge. We review here the updated knowledge on diagnosis and therapy of prostatitis. CURRENT KNOWLEDGE AND KEY POINTS: Prostatitis are divided into acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic prostatitis/ chronic pelvic pain syndrome (III) and asymptomatic inflammatory prostatitis. Chronic prostatitis/ chronic pelvic pain syndrome are divided into : inflammatory (IIIA) and noninflammatory (IIIB). Treatment of prostatitis should follow evidence based guidelines recently published. Acute prostatitis should be treated by ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or cotrimoxazole 960 mg bid for 4 weeks (CIII). When bacteremia occurs third generation cephalosporin with gentamicin should be used (CIII). In chronic bacterial prostatitis ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or norfloxacine 400 mg bid or cotrimoxazole 960 mg bid for 4 weeks may be used (BIII). FUTURE PROSPECTS AND PROJECTS: Molecular techniques should improve the etiological diagnosis of prostatitis and their treatment.