Use of topical glucocorticoids: a population-based cohort study.

BACKGROUND: Little is known about the prescriptions of topical glucocorticoids in the general population. OBJECTIVES: To report an overall picture of topical glucocorticoid prescriptions in France. METHODS: This study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1/97th random sampling of the French population covered by the main national healthcare insurance system (approximately 90% of the whole population). All patients prescribed topical glucocorticoids over a 5-year period (1 January 2011 to 31 December 2015) were identified using a specific code list for topical glucocorticoids. RESULTS: Over the 5-year study period, 662 531 individuals were recorded for at least 1 day in the EGB. Among them, 220 345 (33.3%) were prescribed at least once topical glucocorticoid. The prevalence of topical glucocorticoid prescription increased regularly from 2011 (11.7%) to 2015 (12.5%). A total of 922 026 tubes of topical glucocorticoids were dispensed, mainly high-potency glucocorticoids, and were mainly prescribed by general practitioners (73.1%). A total of 1713 (0.8%) patients were prescribed at least 24 tubes over a calendar year. These patients were more frequently men (P < 0.001) and older (P < 0.001) than the overall population of patients prescribed topical glucocorticoids. The 124 844 tubes prescribed to these patients had stronger potency than those prescribed to the overall population (P < 0.001) and were mostly prescribed by general practitioners (68.1%). The reasons for prescription were available for only 371 patients (21.7%) and were mainly psoriasis, auto-immune bullous dermatoses and eczema. CONCLUSION: About 12% of the French general population is prescribed topical glucocorticoids at least once each year. Most prescriptions are issued by general practitioners, dermatologists being the prescribers in less than one-quarter of cases.

Cold-associated perniosis of the thighs histopathologically mimicking lupus. Six observations.

BACKGROUND: Equestrian cold panniculitis has been described since 1980 in horse riders or in stable employees. Histological aspect is underdescribed. PATIENTS AND METHODS: We describe clinical and histological features of six horse riding or stable employees patients presenting with upper lateral thigh lesions during the winter months between 2014 and 2016 in our dermatological department. RESULTS: Six horse riding or stable employees ladies without any known disease presented with similar symptoms. They had urticarial or violaceous, slightly pruritic, sometimes necrotic lesions of the upper lateral thighs. Clinically, equestrian cold panniculitis, insect bite or a caustic dermatitis was suspected. Four of these patients had a cutaneous biopsy. They all showed a similar histological appearance resembling lupus erythematosus, combining dermo-epidermal lesions, with foci of interface dermatitis, an abundant dermal lymphocytic infiltrate and a dermal mucinosis. Hypodermal infiltration was present on samples including subcutis. Laboratory workup for systemic disease was unremarkable for two patients and not performed for the four others, having no other clinical sign of lupus. All patients improved rapidly with very high potent topical steroids. CONCLUSION: Cold-associated perniosis of the thighs should be considered whenever a histopathological appearance of lupus is associated with lesions of the upper lateral thighs in patients practicing horse riding. This disease belongs to the spectrum of miscellaneous cold-induced dermatoses in which histopathological lesions identical to lupus can be encountered.

Imaging low-mass planets within the habitable zone of α Centauri.

Giant exoplanets on wide orbits have been directly imaged around young stars. If the thermal background in the mid-infrared can be mitigated, then exoplanets with lower masses can also be imaged. Here we present a ground-based mid-infrared observing approach that enables imaging low-mass temperate exoplanets around nearby stars, and in particular within the closest stellar system, α Centauri. Based on 75-80% of the best quality images from 100 h of cumulative observations, we demonstrate sensitivity to warm sub-Neptune-sized planets throughout much of the habitable zone of α Centauri A. This is an order of magnitude more sensitive than state-of-the-art exoplanet imaging mass detection limits. We also discuss a possible exoplanet or exozodiacal disk detection around α Centauri A. However, an instrumental artifact of unknown origin cannot be ruled out. These results demonstrate the feasibility of imaging rocky habitable-zone exoplanets with current and upcoming telescopes.

[Spitting cobras: description of 2 cases in Djibouti]. / Cobras cracheurs: 2 observations à Djibouti.

The purpose of this report is to describe two cases involving ophthalmic exposure to venom from spitting cobras. Based on these cases, readers are reminded that eye injury can be prevented by low-cost treatment consisting of prompt, prolonged saline irrigation. This treatment also reduces pain.

[Post traumatic air tamponade under assisted ventilation. Case report from Dakar, Senegal]. / Une ventilation mortelle.

Compressive pnemopericardium is an uncommon cause of shock after blunt trauma. The purpose of this report is to describe a case of air tamponnade observed during management of a patient with thoraco-abominal injuries in Dakar, Senegal. Diagnosis was suspected based on chest x-rays and subsequently confirmed by CT-scan. Clinical features included shock syndrome, small heart sign, and constant deterioration under assisted ventilation. Despite initial improvement after needle aspiration, the patient died due to probable recurrence of air tamponnade. Based on their review of the literature, the authors discuss the physiopathology of air tamponande and emergency treatment by needle aspiration that must be followed by surgery for creation of a pericardial window.

[Mitral valve repair for rheumatic valve disease in children in Senegal: a review of 100 cases]. / La plastie mitrale sur valve rhumatismale chez l'enfant au Sénégal: 100 observations.

Mitral valve repair is a better therapeutic alternative than valve replacement for rheumatic valve disease in children. Repair procedures are especially well suited to developing countries where heart prostheses and life-long anti-coagulation therapy are largely unaffordable. The purpose of this study was to evaluate medium-term outcome of mitral valve repair in children in Senegal. A retrospective review was conducted in a cohort of 100 patients who underwent mitral valve repair for rheumatic mitral lesions over the 8-year period from 1999 to 2007. Mean age was 12 +/- 5 years (range, 7 to 17 years). The most common symptom of valve disease was dysypnea (stage IV in 26 cases and stage III in 74). Valve lesions were complex with anterior leaflet prolapse in 62 cases, posterior leaflet restriction in 35, commissural fusion in 30, and fusion of chordaes in 54. Repair procedures consisted of transfer and shortening of chordaes in 73 cases in association with commissurotomy in 22 cases and cleft closure in 17. Ring annuloplasty was performed in 84 patients. Hospital mortality was 2%. Postoperative morbidity was characterized by residual mitral regurgitation in four cases. Mean follow-up was 5 years. No late deaths were observed. Outcome was satisfactory in 84 patients with low-grade mitral regurgitation (grade I-II). Reduction of left ventricle diameter was statistically significant during systole and diastole, i.e., from 29.5 +/- 6.2 mm to 33.1 +/- 5.3 mm (p<0.05) and from 47.1 +/- 8.6 mm to 50.5 +/- 9.4 mm (p<0.05) respectively. Improvement in cardiac function was not significant, i.e., from 63.3 +/- 4.8% to 62 +/- 6.4% (p = 0.99). Mitral valve repair was successful in stabilizing myocardial function and remodeling the left ventricle. Outcome is dependent on careful patient selection and evaluation of lesions. Middle-term outcome is encouraging.

[Centipede bite in a woman with heterozygotous sickle cell disease]. / Morsure de scolopendre chez une drépanocytaire hétérozygote au Sénégal.

Although centipede bits can cause severe symptoms, they are seldom reported since outcome is generally favorable. The purpose of this report is to describe a case of centipede envenomation causing severe and prolonged symptoms in a woman with sickle cell trait.

[Study of oro-dental injuries during seizures in Senegalese children with epilepsy]. / Etude des traumatismes bucco-dentaires au cours de l'epilepsie chez l'enfant au Sénégal.

The objectives of this study were to study the prevalence of oral traumatisms and their relationship to epileptic seizures in Senegalese children. This study was undertaken in the Children's National Hospital of Dakar and deal with children with epilepsy. Sotf tissues and the teeth traumatisms that have occurred during epileptic seizures were recorded. We have also studied the relationship between the frequency of the seizures and the oral soft and hard tissues traumatisms. One hundred and eight children aged from 5 to 15 years with 67 boys and 41 girls with an average age of 8.16+/-2.86 years were enrolled. Several types of epileptic seizures were observed during which 44.5% of the children presented oral traumatisms of soft tissues (27.8%) and the teeth (16.7%). There is no significant relationship between the number of seizures and the frequency of the dental traumatisms (p = 0.352). The tooth fractures are the lesions most frequently noticed and are observed in 24.4% of the children. The traumatisms of the maxillary central incisors account for 38% of the traumatisms, followed by the canines (2.7%) and the molars (1.9%). The lower central incisors are the least affected. The traumatisms of soft tissues were observed in 27.8% of the children: the lips are more often affected (44%), followed by the tongue (30%), the association between lip and tongue (18%) and the cheeks (8%). There is no significant relationship between the number of seizures and the frequency of the traumatisms of soft tissues (p = 0.35).

Ferritin and iron status in Senegalese women.

Ferritin, iron status, and hematological parameters--Hb, hematocrit--were determined in 172 mature women at screening visits in first aid medical care units located in Senegal. Of the subjects 36.6, 39.5, 34.9% had Hb, hematocrit, and ferritin levels below accepted norms (i.e., Hb less than 11 g/dl, hematocrit less than 33%, serum ferritin less than 10 ng/ml). Serum iron level was normal (greater than 50 micrograms/dl) in 94.2% of the subjects, but 48.3% had marginal levels (51 to 100 micrograms/dl). The distribution curves of Hb level in the population indicates that about 58% of the women had Hb less than 12 g/dl. Furthermore, the very low serum ferritin levels (less than 20 ng/ml) encountered in 75.6% of subjects, demonstrate the small size of their iron stores. This precarious iron balance indicates that these women are at a high risk of nutritional anemia. Numerous factors such as pregnancy or parasitical infestation can dramatically modify this iron balance and increase the prevalence of anemia in this population.

Prevalence of malnutrition and vitamin A deficiency in the Diourbel, Fatick, and Kaolack regions of Senegal: feasibility of the method of impression cytology with transfer.

The evaluation of the prevalence of ophthalmological diseases and vitamin A deficiency in Senegalese preschool-aged children enabled us to confirm the method of impression cytology with transfer (ICT) and to assess the impact of ophthalmological diseases on the cytological appearance of conjunctival cells. A simplification of the ICT method consisted of transferring cells present on a strip of paper to a glass slide by finger pressure. Harris-Schorr staining of the sample papers confirmed the results obtained by the transfer. Inflammatory trachoma influenced the results of the test. This simple method will prove very helpful for detection of vitamin A deficiency in children in underdeveloped areas.

Prevalence of malnutrition and vitamin A deficiency in the Diourbel, Fatick, and Kaolack regions of Senegal: epidemiological study.

The purpose of our study was to determine the prevalence of protein-calorie malnutrition (PCM), ocular diseases, and vitamin A deficiency in preschool children selected at random in a rural zone of the groundnut belt of Senegal. The prevalence of PCM was 37.1% (95% CI 33.8-40.2%) according to the Waterlow classification, with a majority of stunting, and prevalence of hypovitaminosis A was estimated to be 11.4% (95% CI 9.3-13.5%) by using impression cytology. Furthermore, 19.4% (95% CI 15.8-22.0%) of the children might be defined at risk of deficiency. The prevalence of Bitot's spots was equal to 0.2% (95% CI 0.03-0.9%). A problem of PCM associated with a health-endangering vitamin A deficiency existed.

Prevalence of malnutrition and vitamin A deficiency in the Diourbel, Fatick, and Kaolack regions of Senegal: a controlled study.

Two hundred and six Senegalese preschool children included in an epidemiological study were selected by their results from impression cytology with transfer (ICT) for assessment of their nutritional state by means of biological variables and for assessment of the diagnostic values of the ICT. A problem of protein-calorie malnutrition existed (transthyretin and retinol-binding protein concentrations were low) associated with vitamin A deficiency (retinol concentrations were low). The sensitivity and specificity of the ICT defined with respect to retinol (threshold fixed at 0.35 mumol/L) varied with the classification criteria of ICT and seemed to be fairly insensitive but specific.

Post traumatic disruption of the laryngo-tracheal junction.

Of 43 tracheo-bronchial ruptures, 19 patients presented with disruption of the laryngo-tracheal junction which would appear to be a very specific anatomical lesion. The disruptions were secondary to blunt cervical trauma in 11 cases and strangulation in 8 cases. The disruption was complete in 14 cases and incomplete in 5. The lesion is very complex and involved the retraction of the lower part of the trachea into the mediastinum (14 cases), fracture of the cricoid ring (9 cases), bilateral recurrent nerve tears (14 cases), unilateral (4 cases) and retraction of the laryngeal mucosa with exposure of the cricoid cartilage in all cases. According to the complexity of the lesion, the treatment was: laryngo-tracheal resection and end-to-end anastomosis with treatment of the vocal cord palsy in 13 patients; simple end-to-end anastomosis in 4 patients who had an unilateral vocal cord palsy; 2 patients with a partial disruption were treated medically with endoscopic stenting and laser photocoagulation. All had restoration of airway patency and recovery of voice. The results contrast with the failures and reoperations reported in the literature and underline the necessity of complete evaluation and treatment of these complex lesions.

[Neonatal thrombosis of the jugular veins: long-term repercussions on cerebral development (two cases)]. / Thrombose néonatale des veines jugulaires: retentissement à long terme sur le développement cérébral (à propos de deux cas).

Bilateral obstruction of the internal jugular veins is rare in the neonatal period and no long-term follow-up has been reported yet. We report two cases. The first developped an extensive thrombosis of superior veina cava related to a central veinous line, the second an unilateral thrombosis of the transverse-sigmoid sinus associated to a constitutional hypoplasia of the contralateral jugular vein. In the latter case, no cause or risk factor was noticeable, except for a forceps delivery. In both cases the clinical course was dominated by the development of a prominent collateral network of cervico-facial veins and by a progressive macrocrania. According to MRImaging, the latter was not related to a dilation of CSF spaces, but to a macro-encephaly, either by inflation of the vascular veinous compartment inside the parenchyma or by genuine brain's overgrowth. Long-term follow-up showed a grossly normal course, both from the neurological and the scholar point of view. However, slight neuropsychological anomalies were noticed, bringing some shade on the prognosis.

[Neurologic complications of varicella in adults]. / Les complications neurologiques de la varicelle chez l'adulte.

Three patients aged 32, 30 and 36 years, had chicken pox then developed acute cerebellar ataxia (for two) and acute polyradiculoneuritis. Cerebrospinal fluid (CSF) protein content was increased and varicella virus serology was positive in both blood and CSF. All three patients improved with aciclovir.

[Myocardial risk in patients undergoing carotid intervention. Medium-term follow-up]. / Risque myocardique chez le patient subissant une intervention carotidienne. Follow-up à moyen terme.

We have evaluated the cardiac risk for 212 patients who underwent internal carotid surgery (245 operations). The mean age at the time of operation was of 63 +/- 8 years. A complete pre-operative cardiac assessment was performed splitting the patients in two groups: one considered as having a coronary heart disease (CHD) and the other as "healthy heart" (HH). The peri-operative cardiac morbidity and mortality rate were low (CHD group: 16.88%; HH group: 2.22%). At a 2 years follow-up we notice 31% of cardiac problems in the CHD group (with a mortality rate of 5.7%) for 3.9% in the HH group (with a mortality rate of 3.9%). The 4 years follow-up gives similar results.

[Hepatitis B virus infection in the school milieu of Kiffa and Selibaby, Mauritania]. / Etude de l'infection du virus de l'hépatite B en milieu scolarie de Kiffa et Sélibaby, Mauritanie.

Our survey was concerned with searching for different markers of Hepatitis B virus infection in 267 primary and secondary school children in two Mauritanian sites in the south and south-east of the country. The results showed that for the surveyed subjects, 16.8% were carriers of HBs antigen, 21% of anti-HBs antibodies, 50.2% of anti-HBc antibodies and 45.4% of anti-HBe antibodies. Furthermore, 28.9% of the carriers of HBs antigen were also of HBe antigen. In all, 32.2% of the subjects had not been exposed to the Hepatitis B virus. These results confirmed the serious problem posed to public health by Hepatitis B infection and should prompt a programme to combat it.

[Effectiveness of syndromic approach for management of urethral discharge in Senegal]. / Evaluation de l'efficacité du traitement des écoulements urétraux au Sénégal selon l'approche syndromique.

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

[Effect and mechanism of action of Tinospora bakis roots on biliary secretion using in vivo models]. / Etude de l'effet et du mécanisme d'action des racines de Tinospora bakis sur la sécrétion biliaire àpartir de modèles in vivo.

The aim of this study is to determine the choleretic properties of lyophilized aqueous extract of Tinospora bakis roots. For thus, we have used healthy and cholestatic Wistar rats. After administration of the extract (4 mg/100 g of weight) biliary flow, biliary acids flow, biliary glutathione and glucose concentrations were measured by specific methods. Comparative results between treated rats and non treated rats show: For healthy rats: a significant increase of biliary flow, biliary acids flow in the group of treated rats versus non treated healthy rats. There were no significant difference in the glutathione and glucose concentrations. For cholestatic rats: we noted also significant increase of biliary flow, biliary acids flow and glutathione concentration in the treated rats group. These results suggest that Tinospora bakis has a choleretic effect in vivo which depends on biliary acids and/or glutathione concentration.