Nutritional approach to management of Buruli ulcer in Côte d'Ivoire.

Children in developing tropical countries are frequently undernourished. In rural areas, they are also often affected by Buruli ulcers. The treatment of this mutilating disease is sometime long and difficult for malnourished patients. Moreover, the eating behavior of patients with Buruli ulcers does not promote its quick healing, with numerous foods prohibited. They eat fewer fruits and legumes, which are rich in vitamins and minerals. Our survey in two health centers showed that only 8% ate fruits and legumes, and 29% leafy greens. This food deprivation increases their nutritional deficiencies. We conducted a nutritional intervention among Buruli ulcer patients (30 patients) in one center, and compared their healing with that of Buruli patients without nutritional care (n = 21). Those patients who received the intervention spent less time at the hospital (less than six months). Our study shows the association between the healing of Buruli ulcers in Côte d'Ivoire and good nutritional status: those with the intervention healed faster and presented fewer disabilities than the control patients.

[Is too much money harmful for innovation?]. / Recevoir trop d'argent nuit-il à l'innovation ?

Significant sums have been allocated to countries to enable them to make measurements of HIV viral load available at the level of districts and departments. Wanting to make this examination available to all HIV-infected patients appears fair, but it is possible to envision other strategies for decentralizing this process. It is generally agreed that every additional examination entails loss to follow-up and thus to treatment. On the other hand, a lack of resources induces more innovation, as demonstrated over the last half century for short courses of tuberculosis treatment, combined vaccines, and essential and generic drugs. Body weight is the best indicator for monitoring HIV viral load. We sought to determine if it is possible to raise awareness of this measurement that requires simple resources and provides an immediate result, available to healthcare providers in outlying areas. Specifically, we studied the measurement of body fat percentage, which appears to be a promising choice. A trial conducted in Casamance with an impedance meter incorporated into a commercially available scale yielded negative results for this specific task (measurement irregularities due to the condition of the soles of the patients' feet). It seems important to us to study scientifically the interest of this indicator scientifically and its performance in the field pragmatically, with more accessible measurement methods, such as skinfold (a method that has been demonstrated its efficacy in physical anthropology and in the domain of sports).

[Mid-aortic syndrome: case studies from a paediatric nephrology department]. / Síndrome de aorta media.

INTRODUCTION: Mid-aortic syndrome (MAS) describes a narrowing segment of the abdominal aorta and the branches arising from there. This narrowing frequently involves the renal arteries, with the only clinical sign being arterial hypertension. OBJECTIVE: To review the cases of MAS diagnosed in the Paediatric Nephrology Department of the Vall D'Hebron Hospital (Barcelona). METHODS AND MATERIALS: A retrospective study was conducted on 5 patients aged from 8 days to 12 years old. We analysed the onset, diagnostic examinations, treatment and outcome. RESULTS: Hypertension was the common reason behind the study. In two of the five cases, it was associated with renal failure. The definitive diagnostic was made using angiography and angio-MR, observing, in all the cases, that the renal arteries were affected (in 3 cases unilateral). The treatment was by medication in 3 cases, 1 required surgery and 1 died at 7 months. CONCLUSIONS: MAS, although uncommon, is a very important cause of AHT in infancy. Angiography is the only technique to diagnose it. It is important to rule out cerebral involvement, which could lead to a fatal outcome. Hypertension is very difficult to control through medication. Surgery is required only when the hypertension is not controllable through medication, when there is intermittent claudication, intestinal angina, and renal hypoperfusion. Ideally, it is better to opt for medication as treatment, as the narrowing is progressive up to the end of puberty, after which, the narrowing stabilises.

[Safety and efficacy of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children]. / Seguridad y eficacia del polietilenglicol 3350 con electrolitos en el tratamiento del estreñimiento funcional en niños.

INTRODUCTION: Polyethylene glycol 3350 plus electrolytes (PEG+E) efficacy has been validated in some studies, but not many have evaluated its safety in children. The aim of our study was to evaluate the safety; renal, malabsorption or excessive production of gas and efficacy of PEG+E treatment in our paediatric population. PATIENTS AND METHODS: Fifteen patients who suffered functional constipation (Rome III criteria) were evaluated. Median age was 6.2 years (r 2-9). All patients had normal renal function. PEG+E were administered for 4 weeks (4WP). The mean dose was 0.44 g/kg/day, titrated according to age, weight and response. Urine screens (sodium and osmolality) were performed at the beginning and 4WP. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed at 4WP. To analyse the efficacy of the treatment, the number of stools per week and stool form type (Bristol stool scale) were recorded. RESULTS: The number of stools per week was higher after 4 weeks (2.46 ± 0.71 vs 5.29 ± 1.68, P<.001), as well as the stool form score (2.47 ± 1.24 vs 4.5 ± 0.91, P<.001). No statistical differences were obtained between urine sodium and urine osmolality values at the beginning and 4WP. After 4WP the NIRA median values were normal in all patients [fat 4.45% (range (r) 3.6-7.09); nitrogen 0.78% (r 0.4-1); sugars 1.4% (r 0.47-2.35) and water 68% (r 59-74)]. Median breath hydrogen test was 7 ppm (r 2-18). CONCLUSIONS: No adverse effects on biochemistry values or gastrointestinal disturbances were observed. PEG+E can be recommended for the treatment of functional constipation in children.

[Survey of diarrhoea survey in Kosovo Mitrovica. August 2001]. / Etude sur les diarrhées à Mitrovicè (Kosovo) en août 2001.

The upsurge of diarrhoea observed in children in Kosovo Mitrovica in the spring of 2001 led to a survey, jointly organized by the city health department, the GISPE association and the medical laboratory at the Val de Grâce Hospital (France). The available retrospective data showed an increase in cases of diarrhoea in which Giardia duodenalis was isolated. During the third week of August 2001, all children with diarrhoea consulting in the hospital south of city (n = 45) had a complete stool analysis. The analyses showed the presence of Giardia cysts and trophozoites in 40% of the cases, and no cases with helminthes or cryptosporidia. Moreover 3 strains of S. sonnei, a microorganism never previously identified, and different pathovars of E. coli in 11 patients were isolated. This "epidemic" appeared to be linked to the poor hygiene conditions that still prevailed 2 years after the events but not directly to the water supply, which was rehabilitated at the end of 1999. It is also necessary to strengthen the capacity of the public laboratories and health-care facilities of the province.

[Relative frequency of malignant and benign tumors in Arlit, Niger. Analysis of data from anatomopathological examinations over a 15-year period]. / Fréquence relative des tumeurs malignes et bénignes à Arlit (Niger): bilan de 15 ans d'examens anatomo-pathologiques.

The purpose of this study was to determine the frequency and distribution of cancer in the uranium-mining region of Arlit, Niger, based on extensive data from all the anatomopathological examinations performed at local hospitals over a 15-year period. The overall annual incidence, i.e., 26 per 100000, was similar to incidences reported elsewhere in Africa. The rate of examinations leading to diagnosis of malignancy decreased between 1991 and 1997 and, for unexplained reasons, varied from one practitioner to another. There was no evidence of a higher rate of any cancer that might result from possible exposure to radiation during mining operations. The distribution of cancer by organ was unremarkable, i.e., in order of frequency, womb and ovaries in women; skin and prostate in men; thyroid and lymphatic tissue in both genders.

[Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic]. / Intérêt de la Spiruline chez les personnes vivant avec le VIH a Bangui (RCA).

Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems.

Analysis of swimmers' velocity during the underwater gliding motion following grab start.

The purpose of this study was to determine the swimmers' loss of speed during the underwater gliding motion of a grab start. This study also set out to determine the kinematical variables influencing this loss of speed. Eight French national-level swimmers participated in this study. The swimmers were filmed using 4 mini-DV cameras during the entire underwater phase. Using the DLT technique and the Dempster's anthropometric data, swimmer's movement have been identified. Two principal components analysis (PCA) have been used to study the relations between the kinematical variables influencing the loss of speed. The swimmers reached a velocity between 2.2 and 1.9 ms(-1) after their centre of mass covered a distance ranging between 5.63 and 6.01 m from the start wall. For this range of velocity, head position was included between 6.02 and 6.51 m. First PCA show that the kinematical parameters at the immersion (first image at which the swimmers' whole body was under water) are included in the first two components. Second PCA show that the knee, hip and shoulder angles can be included in the same component. The present study identified the optimal instant for initiating underwater leg movements after a grab start. This study also showed that the performance during the underwater gliding motion is determined as much by variables at the immersion as by the swimmer's loss of speed. It also seems that to hold the streamlined position the synergetic action of the knee, the hip and the shoulder is essential.

[Ventricular tachycardia revealed by a left ventricular non-compaction]. / Tachycardie ventriculaire révélant un ventricule gauche non compacté.

We report a case of a 55-year-old woman who has a non-compaction of the left ventricular myocardium diagnosed after a cardiac arrest due to a polymorphic ventricular tachycardia. The patient was implanted with a cardioverter-defibrillator. A review of literature of this recently described cardiopathy is done.

Mycophenolic Acid reaches therapeutic levels whereas mycophenolate mofetil does not.

BACKGROUND: In kidney transplanted children, it is difficult to obtain blood levels of mycophenolic acid between 2 and 4 microg/mL, when mycophenolate mofetil doses up to 30 mg/kg/d are given two or three times a day. We proposed that using mycophenolic acid, instead of the salt mycophenolate mofetil, may help us to reach target levels. AIM: We sought to describe the pharmacokinetics of mycophenolic acid in eight kidney transplanted children over a period of 1.2 +/- 0.8 years. PATIENTS AND METHODS: Eight patients (5 boys and 3 girls) aged 7.0 +/- 1.8 years received cadaveric kidney transplantations. Induction with basiliximab was followed by cyclosporine (n = 4) or tacrolimus (n = 4), tapered steroids (withdrawal at 12 months in six cases and maintained at 0.15 mg/kg/d in two cases), and mycophenolate mofetil (25 to 30 mg/kg/d two or three times a day). For 1.0 +/- 0.3 years mycophenolic acid levels were between 0.8 +/- 0.3 microg/mL. When mycophenolic acid sodium tablets were available, all patients were switched to this drug. RESULTS: After the conversion, blood levels obtained at 8 +/- 3 days were 1.5 to 5.0 microg/mL (median, 3.2), which were far closer to the target 2 to 4 microg/mL. No gastrointestinal disorders were observed with the follow-up of 72 +/- 18 days. CONCLUSION: Mycophenolic acid sodium reaches therapeutic levels whereas mycophenolate mofetil does not. If mycophenolic acid were available in syrup form, it could be used in patients under 5 years of age. It is necessary to follow these patients to rule out enzymatic induction.