The Clinical Relevance of Antifibrillarin (anti-U3-RNP) Autoantibodies in Systemic Sclerosis.

Systemic sclerosis (SSc) is a heterogeneous autoimmune disease associated with several antinuclear autoantibodies useful to diagnosis and prognosis. The aim of the present multicentric study was to determine the clinical relevance of antifibrillarin autoantibodies (AFA) in patients with SSc. The clinical features of 37 patients with SSc positive for AFA (AFA+) and 139 SSc patients without AFA (AFA-) were collected retrospectively from medical records to enable a comparison between AFA- and AFA+ patients. Antifibrillarin autoantibodies were screened by an indirect immunofluorescence technique using HEp2 cells and identified by an in-house Western blot technique and/or an EliA test. Comparing AFA+ and AFA- patients, AFA+ patients were significantly younger at disease onset (36.9 versus 42.9; P = 0.02), more frequently male (P = 0.02) and of Afro-Caribbean descent (65% versus 7.7%; P < 0.001). At diagnosis, the Rodnan skin score evaluating the cutaneous manifestations was higher (13.3 versus 8.7; P = 0.01) and myositis was also more common in the AFA+ group (31.4% versus 12.2%; P < 0.01). Patients with AFA+ were not associated with diffuse cutaneous SSc or with lung involvement and no difference in survival was observed. Antifibrillarin autoantibodies are associated with patients of Afro-Caribbean origin and can identify patients with SSc who are younger at disease onset and display a higher prevalence of myositis.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]. / Infections du site operatoire en chirurgie generale du Centre Hospitalier Universitaire Bocar Sidy Sall de Kati.

INTRODUCTION: Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics. MATERIALS AND METHODS: This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018. RESULTS: During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days. CONCLUSION: Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

INTRODUCTION: Les infections du site opératoires (ISO) sont fréquentes et redoutables, au service de chirurgie. Elles représentent une hantise pour le chirurgien. Les objectifs étaient de déterminer la fréquence des ISO et les facteurs de risque, d'identifier les germes et étudier leur sensibilité aux différents antibiotiques. MATÉRIELS ET MÉTHODES: il s'agissait d'une étude transversale avec recueil prospectif des données, réalisée au service de chirurgie générale du Centre Hospitalier Universitaire Bocar Sidy Sall (CHU BSS) de Kati allant de janvier 2015 à décembre 2018. Elle a concerné tous les patients opérés dans le service pendant cette période d'étude. N'ont pas été inclus dans cette étude les cas de biopsie. RÉSULTATS: Au cours de cette période d'étude nous avons enregistré 55 cas d'ISO sur 650 malades opérés soit une fréquence de 8,46%. 450 malades ont été opérés au programme opératoire à froid (69,23%) et 200 malades en urgence (30,77%). L'âge moyen était de 39 ans, le sex-ratio à 2,66. Parmi les 55 cas d'ISO, 60% de ces malades ont été opérés en urgence et 40% au programme opératoire. Les différentes souches les plus retrouvées étaient l'Escherichia coli (E. coli) dans 38,3% des cas, le staphylococcus aureus dans 23,4%, klebsiella pneumonia dans 13,3%. Le taux d'hémoglobine était normal dans 70% des cas. 4 de nos patients soit 7,27% étaient diabétiques. Nous n'avions pas enregistré de cas d'obésité. Parmi les 55 cas des ISO, 66 % étaient de classe 3 et 4 d'Altemeier, 59% étaient de score ASA 2 et ASA 3, 55% étaient de score 2 de NNISS (National Nosocomial Infection Surveillance System), 5,45% étaient de score 3 de NNISS soit 3 cas et ces 3 cas ont développé des ISO. Les ISO étaient pariétales dans 49 cas soit 89%. Les germes retrouvés étaient sensibles à 100% à l'imipénème. Les interventions les plus pourvoyeuses des ISO étaient les péritonites 25 cas (45,45%), les occlusions intestinales 12 cas (21,82%), les abcès appendiculaires 8 cas (14,55%). Nous avions enregistré 2 cas de décès soit 3,64%, la durée moyenne d'hospitalisation a été de 13 jours. CONCLUSION: L'Escherichia coli était le germe fréquemment rencontré dans les ISO en chirurgie générale au CHU BSS de Kati. La résistance aux antibiotiques usuels doit susciter des actions préventives efficaces.

[The Ileal Neobladder With The Hautmann Technic At The Urology Depatment Of University Hospital Pr. Bocar S. SALL Of Kati]. / Le Remplacement De Vessie Selon La Technique De Hautmann Au Service D'Urologie Du Chu Pr. Bocar S. SALL De 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.

La cystectomie totale constitue le traitement de référence des tumeurs de vessie infiltrant le muscle vésical, pour les patients qui ont une tumeur sans envahissement des organes voisins et sans métastase. Après la cystectomie, la dérivation des urines est un challenge pour tout urologue. Le remplacement de vessie est un geste rarement réalisé dans notre pays. Un remplacement de vessie par l'intestin est recommandé chez ces patients. Nous rapportons un cas de remplacement de vessie chez une femme de 42 ans ayant une tumeur de vessie. Nous discutons les aspects cliniques, diagnostiques et thérapeutiques.

[Case study of renal oncocytoma at the Kati hospital]. / Oncocytome renal a propos d'un cas a l'hopital De Kati.

Renal oncocytoma is a rare benign tumor of the kidney. This benign tumor of epithelial origin represents 5% of renal tumors. Preoperative diagnosis is difficult. The final diagnosis can only be made on the anatomical part; even imaging result can often be evocative. We report the case of a 41 year old patient with renal oncocytoma confirmed after radical nephrectomy for renal tumor.

L'oncocytome rénal est une tumeur bénigne rare du rein d'origine épithéliale représentant 5% des tumeurs rénales. Le diagnostic préopératoire est difficile. L'imagerie est souvent évocatrice. Le diagnostic final ne peut être fait que sur la pièce anatomique. L'exploration chirurgicale demeure la règle en absence d'une biopsie rénale pour obtenir un diagnostic histologique précis. Nous rapportons l'observation d'un patient âgé de 41 ans ayant l'oncocytome rénal confirmé après néphrectomie élargie pour tumeur rénale.

Risk factors for contamination of ready-to-eat street-vended poultry dishes in Dakar, Senegal.

Our objective was to investigate the Salmonella and Campylobacter contamination of traditional ready-to-eat street-vended poultry dishes and to assess the association of some restaurant characteristics and cooking practices with the contamination of these meals. One hundred and forty-eight street-restaurants were studied from January 2003 to April 2004 in Dakar. A questionnaire was submitted to the managers, and samples of ready-to-eat poultry dishes were taken. Salmonella spp. was isolated in 20.1% of the 148 street-restaurants studied and in 10.1% samples of poultry dishes. The most prevalent serovars isolated were Salmonella hadar, Salmonella enteritidis and Salmonella brancaster. Campylobacter jejuni was detected in only 3 restaurants and 3 poultry dishes. Not peeling and not cleaning vegetables and other ingredients during meal preparation (OR=3.58), dirty clothing for restaurant employees (OR=4.65), reheating previously cooked foods (OR=5.2), and no kitchen and utensils disinfection (OR=3.47) were associated with an increasing risk of Salmonella contamination. Adequate cooking procedures decreased the risk of Salmonella contamination (OR=0.15).

HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso.

OBJECTIVE: To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso. RESULTS: Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001). CONCLUSIONS: Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.

PIP: Clinically, malnutrition appears as the last stage in pediatric AIDS. It is, however, difficult to determine the causes of malnutrition without diagnostic facilities and in the absence of differentiating clinical criteria. The authors therefore set out to determine the prevalence of HIV in children, to assess the various modes of infection in children, and to define a clinical profile indicative of HIV infection in malnourished children. They found that among children exhibiting severe malnutrition, HIV-seropositive children are distinguished by a high horizontal transmission rate, a high specific clinical profile, and a very poor prognosis. The study population consisted of 433 severely malnourished children of average age 19 months, in the range 4-48 months, admitted to the Sanou Souro National Hospital in Burkina Faso. 63% presented with marasmus, 13%% with kwashiorkor, and 24% with both forms of malnutrition. 13.8% of children older than 12 months were infected with HIV; HIV-1 in 95.8% of these cases. Mother-to-child transmission was proved in 77% of cases; in 10% of the observed pediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV, with its severity exacerbated by HIV infection. Adenopathy, oral candidiasis, skin disorders, and hepatomegaly appeared to be significantly related to HIV infection. Discriminant analysis, however, revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis defined a clinical profile of marasmus, adenopathies, and oral candidiasis as indicative of HIV infection in the population. The short-term clinical prognosis for the infants was poor and usually led to the death of the child when seropositive.

Risk factors for preterm delivery in Burkina Faso (west Africa).

The environmental and socioeconomic risk factors for preterm delivery were assessed in a West African urban population (Bobo-Dioulasso, Burkina Faso). The study population were 102 cases of preterm delivery matched with 102 controls obtained from 4124 sequential deliveries which occurred between May and October 1989 in the three maternity centres in the city. The univariate analysis identified the risk factors as age (< 20 years), primiparity, marital status (single), low frequency of antenatal visits, death of a previous child and level of education of the mother. The following risk factors identified by multivariate analysis (logistic regression) are consistent with those identified in previous studies: youth of the mother, primiparity (P = 0.01) and death of a previous child (P < 0.05). On the other hand, in this study, the level of education of the parent was identified as an independent risk factor (P < 0.001). This finding could be used to determine a target population for prevention programmes.

PIP: Between May and October 1989 in Burkina Faso, a pediatrician daily visited the clinic at the maternity hospital, the Farakan maternity clinic, and the Guimbi maternity clinic (the only 3 maternity clinics) in Bobo-Dioulasso to confirm the diagnosis of preterm delivery (gestational age 28-37 weeks) and to collect data on 102 deliveries and on 102 full-term deliveries occurring at the same time. The physician and epidemiologists conducted perhaps the first case control study of preterm delivery risk factors in West Africa. The incidence of preterm deliveries was 2.6%. The univariate analysis identified the following to be risk factors of prematurity: being 20 years old (odds ratio [OR] = 6.9 for 15-19 year olds vs. older women; p .01), primiparity (OR = 2.88; p = .03), being single (OR = 3.44; p .01), having less than 3 prenatal care visits (OR = 7.9; p .001), death of a previous child (OR = 3.1; p .01), and malaria prophylaxis (OR = 1.7; p = .05). Absence of schooling of parents appeared to be a protective factor (OR = .47; p .001). The multivariate analysis uncovered 3 significant risk factors of prematurity: young mother and primiparity (OR = 4.4; p = .01), less than 3 prenatal visits (OR = 9.3; p .001), and death of a previous child (OR = 2.2; p .05). Lack of schooling continued to have a protective effect when researchers adjusted for other variables (OR = .37; p .001). As a possible explanation for education being a risk factor of prematurity in Burkina Faso, the researchers suggested that educated parents are more likely to use motorized transport on bumpy roads for 6-7 hours at a time which caused intrauterine vibrations, resulting in preterm delivery. In developed countries, education reduces the risk of preterm delivery.

Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study.

OBJECTIVE: To investigate the association between where young children defecate, where stools are disposed of, and the presence of human stools on the ground in the compound and the rate of hospital admission with diarrhoea. DESIGN: This was a case-control study with two control groups. SETTING: The study took place in Bobo-Dioulasso, the second city of Burkina Faso in West Africa. PARTICIPANTS: Three groups of children aged 36 months and under, and living in Bobo-Dioulasso were studied. Cases were 757 children admitted to hospital with symptoms of diarrhoea or dysentery. The first control group comprised 757 neighbourhood control children approximately matched on age and date of recruitment, and the second, 631 children admitted to the same hospital without symptoms of diarrhoea or dysentery. MAIN RESULTS: There was no evidence of any association between where the child was reported to defecate and hospital admission with diarrhoea or dysentery (odds ratio = 1.10; 95% confidence interval (CI) 0.78, 1.57, cases v neighbourhood controls; odds ratio = 0.84; 95% CI 0.60, 1.18, cases v hospital controls). There was evidence of an association between where the mother reported disposing of the child's stools and hospital admission with diarrhoea or dysentery (odds ratio = 1.50; 95% CI 1.09, 2.06, cases v neighbourhood controls; odds ratio = 1.31; 95% CI 0.96, 1.79, cases v hospital controls). Human stools were more frequently observed in the yards of cases than controls (odds ratio = 1.38; 95% CI 0.98, 1.95, cases compared with neighbourhood controls; odds ratio = 1.33; 95% CI 0.96, 1.84, cases compared with hospital controls). CONCLUSIONS: The findings suggest that it is not where the child defecates that matters but how the mother then deals with the child's stools.

Potties, pits and pipes: explaining hygiene behaviour in Burkina Faso.

Stool disposal practices have been shown to be associated with childhood diarrhoea. However, efforts to promote improved hygiene behaviour are hampered by a lack of understanding of what determines those behaviours. Data from 2793 household interviews with mothers of children from the town of Bobo-Dioulasso in Burkina Faso were analyzed to examine what differentiated mothers who reported using safer stool disposal practices from those who did not. Three 'outcomes' were considered: where the child was reported to defaecate; where the mother reported disposing of the child stools; and whether excreta were observed in the compound. Regression models were developed to identify those factors with the strongest independent associations with the outcomes. There was a consistent association between the source of water and the outcomes. Mothers with access to a tap in the yard reported using safe hygiene practices three times more often than mothers using wells outside the compound and twice as often as mothers who used public standpipes or wells within the yard. The source of water showed a similar pattern of association with observations of faecal matter in the environment. Improved sources of water may contribute to safer stool hygiene by reducing the time spent on water collection or by encouraging mothers to conform to higher standards of hygiene. Other factors which played a role in predicting the hygiene behaviour of mothers were the husbands' occupation, the number of health education sessions that she had attended, her zone of residence and family ownership of certain valuable objects. These factors are likely to be related and to be, to some extent, proxies for the real determinants of her behaviour. A model of the cultural, psycho-social and infrastructural proximate determinants of hygiene behaviour is proposed. Data from focus group discussions suggested that the main purpose of hygienic behaviour is to conform to existing norms of social etiquette. Trials of interventions based on changing such norms are needed to test whether this is an effective means of promoting of safer hygiene practices.

Risk factors for Salmonella enterica subsp. enterica infection in senegalese broiler-chicken flocks.

Our objective was to assess the association of managerial practices, general hygiene and Salmonella infection in Senegalese broiler flocks. Seventy broilers farms were studied from January 2000 to December 2001 around Dakar. A questionnaire was submitted to the farmers and samples of fresh broiler droppings were taken. A 28.6% of the flocks were infected by Salmonella (mainly Hadar and Brancaster serovars). Salmonella infection of the previous flock (OR = 6.82) and of day-old chicks (OR = 3.73), frequent poultry farmers' visits (OR = 5.38) and keeping sick birds inside the farm (OR = 5.32) increased the risk of Salmonella infection. But, using antibiotics on day-old chicks (OR = 0.17) and a detergent for cleaning (OR = 0.16) decreased the risk.

Risk factors for Campylobacter spp. infection in Senegalese broiler-chicken flocks.

Our objective was to identify the risk factors for Campylobacter infection in Senegalese broiler flocks. Seventy broiler farms were studied around Dakar from January 2000 to December 2001 around Dakar. A questionnaire was administered to the farmers, and samples of fresh droppings were taken to assess the flocks' Campylobacter status. About 63% of the flocks were infected by Campylobacter spp.; Campylobacter jejuni was the most-prevalent species (P < 0.05). An elevated risk of Campylobacter infection was associated with other animals (mainly laying hens, cattle and sheep) being bred in the farm, the farm staff not wearing their work clothing exclusively in the poultry houses, uncemented poultry-house floors and the use of cartons that transport chicks from the hatchery to the farm as feed plates (rather than specifically designed feed plates). Alternatively, thorough cleaning and disinfection of poultry-house surroundings and manure disposal outside the farm were associated with decreased flock risk.

A commentary on Newman's theory of health as expanding consciousness.

This is an explication of Newman's theory of health. The authors provide concrete examples of its application and note its points of intersection with certain aspects of Eastern thought and alternative medicine. Ideas from other disciplines are brought in order to illuminate Newman's theory from a variety of perspectives. Certain aspects of the theory the authors find problematic also are noted.

[Risk factors for neonatal tetanus in western Burkina Faso. Case-control study]. / Facteurs de risque du tétanos néonatal dans l'ouest du Burkina Faso. Etude cas témoin.

A case control study was done in Bobo-Dioulasso (Burkina Faso) during a one year period (1989), to identify practices during the pregnancy and childbirth, environmental and sociocultural factors associated with the occurrence of neonatal tetanus.

[Sleeping sickness in children at Bobo-Dioulasso Hospital Center: apropos of 3 cases]. / La maladie du sommeil chez l'enfant au Centre hospitalier de Bobo-Dioulasso: à propos de 3 observations.

The authors report three observations of trypanosomiasis in children aged 3 to 13 years from Ivory Coast and Burkina Faso. Two cases were imported from Côte d'Ivoire and one originated from an old endemic area of Bobo-Dioulasso region in Burkina Faso. Clinical features were comparable to classical descriptions in adults but neurological findings were dominant. Two children were at the lymphatic stage. Treatment with melarsoprol in two cases and eflornithine in one case led to complete recovery. Active epidemiologic surveillance of this zoonosis should be maintained and the devastating pandemic of the beginning of the century should be remembered.

[Diarrheic diseases in children. Rationalization of fecal test]. / Maladies diarrhéiques de l'enfant. Pour une rationalisation des examens de selles.

The level of diarrheic diseases among children in Burkina Faso is very high. The identification of aetiologic agents of diarrhoea in hospitalized children (0-36 months) is one of the objectives of the study. All children less than 37 months old admitted to the Pediatric Unit of the National Hospital Souro Sanou of Bobo-Dioulasso between January 1990 and March 1991, were investigated by a standardized clinical examination, and in addition, we do an analysis of a rectal swab at admission and a stool to identify aetiologic enteric agents. As a conclusion to the study: an agent was isolated in 56% of the children with diarrhoea, and in 40% of the children without diarrhoea; some germs (such Salmonella, Shigella, Entamoeba) are found in children both with and without diarrhoea; also, the total of these examinations comes to 20 US $ per episode, or 100 US $ per children/year in Burkina Faso where the number of bouts reaches 5 times per year per infant who is less than 5 years old. Stool samples are not beneficial for children with diarrhoea, neither for the diagnosis nor for the treatment. There fore these types of routine exams should not be used in Sub-Saharan Africa.

[Anti-Haemophilus influenzae b (Hib) natural immunity in children in Burkina Faso]. / Immunité naturelle anti-Haemophilus influenzae b (Hib) chez l'enfant au Burkina Faso.

BACKGROUND: Natural immunity to Haemophilus infection type b that is acquired by the mothers and passively transmitted to their newborns is not well-known in developing countries, where the frequency of Haemophilus meningitis in infancy is high. POPULATION AND METHODS: Blood samples (5 ml) were taken from 89 women at the time of delivery and from the cord of their babies. Blood samples were also taken from 290 infants and children, distributed into nine subgroups as a function of their age. Children with protein-calorie malnutrition and immune deficiency were excluded from the study. Antibodies against Haemophilus influenzae were measured by Elisa and radioimmunologic methods. Blood concentrations of 0.15 pg/ml or more were considered to be protective. RESULTS: All the blood samples of mothers and cords contained protective levels of antibodies, as did the samples from 30% of those infants aged 0-60 days (all the infants were less than 1 month). No infant in the subgroup 12-23 months had protective levels of antibodies. The incidence of Haemophilus meningitis was correlated with the absence of antibodies. CONCLUSION: Maternal immunity is gradually lost by babies during their first 2 months of life, earlier than in developed countries. Early vaccination, at 3 months of age, is mandatory.

[Acute respiratory infections in pediatric hospital at Bobo-Dioulasso (Burkina Faso)]. / Les infections respiratoires aiguës en milieu hospitalier pédiatrique de Bobo-Dioulasso (Burkina Faso).

BACKGROUND: Acute lower respiratory tract infections are the primary cause of morbidity in developing countries. POPULATION AND METHODS: Six hundred and sixty seven children (379 boys, 288 girls, aged 0-30 months) admitted for lower respiratory tract infections from January 1990 to March 1991 were included in the study. Immediate medical history was collected from the mother. The weight, height, temperature and clinical manifestations, plus the results of chest X-rays, parasitologic and bacteriological examination of stools, and blood smear for malaria were recorded for each patient. Sero-immunologic study for HIV infection of 473 of the patients aged 12-36 months and their mothers also took part in a sero-immunological study for HIV infection. RESULTS: Lower respiratory tract infections were the second major cause of admission (16.8%) after malaria (28.7%). Infections peaked between 6 and 11 months of age (29.5%). The main diseases were pneumonia and bronchial pneumonia (54%) followed by bronchiolitis (21.7%). Almost half the patients were admitted during the hot, dry season. Two hundred and eighty seven patients (43.4%) were referred only after they had been suffering from the disease for 3 to 9 days, partly explaining the high level of mortality. One hundred and twenty one patients (20.9%) died; the main cause of death was staphylococcal pneumonia (57.9%), followed by pneumonia and bronchial pneumonia (29.3%). Some criteria for severity could be identified, based on pulmonary signs and symptoms and associated manifestations (dehydration, malnutrition, convulsions, anemia). Twenty two patients were positive for HIV-1 infection. CONCLUSIONS: This study confirms that acute lower respiratory tract infections remain a public health problem. Early diagnosis and treatment are necessary to reduce mortality.

[Clinical profile of cryptosporidiosis in a pediatric hospital environment in Burkina Faso]. / Profil clinique de la cryptosporidiose en milieu hospitalier pédiatrique au Burkina Faso.

Data concerning Cryptosporidium parvum infection in Black Africa are highly fragmentary. A 12-month study was carried out on 1392 stool specimens from children under 36 months of age with (n = 756) or without diarrhea (n = 629) in the Pediatric Department of Bobo Dioulasso Hospital in Burkina Faso. In 558 children HIV blood tests were also performed. The phenicated fuchsin technique was used to identify Cryptosporidia oocysts. Results were positive in 72 of the 1392 stool specimens tested (5.2%) and in 59 of the 756 stool samples from children with diarrhea (7.8%). Oocysts were not detected in any child under the age of 6 months and the highest incidence of infection was between 6 and 23 months. Detection of oocysts during this year long study was significantly higher from April to June, which corresponds to the beginning of the rainy season in Burkina Faso. Occurrence of diarrhea was not significantly correlated with parasite density. Presence of oocysts was correlated with malnutrition (p < 0.01) and rotavirus infection (p < 0.05). Of the 558 children who underwent HIV testing, only one was positive. In contrast the incidence of HIV infections in the overall population tested was 7%. This study indicates that cryptosporidiasis is a major factor in development of diarrhea and dehydration in the pediatric hospital setting of Burkina Faso. Two other notable findings are that occurrence of cryptosporidiosis is closely linked to hygiene in the population but is not significantly correlated with HIV infection in the pediatric setting in Africa.

[Analysis of the genetic factors controlling malarial infection in man]. / Analyse des facteurs génétiques contrôlant l'infection palustre chez l'homme.

Genetic factors have clearly been shown to play a role in controlling malarial infection in animal models. There is now also increasing evidence for the genetic control of malaria in man. We carried out a segregation analysis based on blood parasite load phenotype for a population of the town of Bobo-Dioulasso (Burkina-Faso). This analysis demonstrated a strong genetic effect. Our results were not consistent with the segregation of a major gene and thus suggest that parasite load is under the control of minor genes. The genetic effect was stronger in children than in adults. We carried out a regression analysis in children and found that there was an association between the phenotype for blood parasite load and the q31-33 region of chromosome 5. We identified a gene in this region, Pfil1 (Plasmodium falciparum infection levels 1), which accounted for almost 50% of the variance in blood parasite load and which played a fundamental role in the control of infection. The 5q31-33 region contains several genes encoding cytokines that regulate T lymphocytes. The identification of genes controlling malarial infection opens up new possibilities for preventive and treatment strategies. It should be possible in the near future to identify individuals at risk of malaria, who would derive the greatest benefit from preventive and therapeutic measures. Finally, a deeper understanding of these genes controlling protective immune responses could be of value for the development of vaccines.

[Hysteria in children: Briquet's syndrome (a case report)]. / Hystérie de l'enfant: le syndrome de Briquet (à propos d'une observation).

In this case report, the authors studied the difficulties to set up the diagnosis of hysteria in the Briquet's Syndrome. The description presented here is about an eleven years old girl patient without any particular family background and who, after her tonsils have been out against her will, presented a hysteria in the form of Briquet's Syndrome. All the explorations showed no abnormalities. It is the questioning, and the analysis of facts from informations by the patient and her family which allowed to conclude the diagnosis of hysteria. She received a chemotherapy, associated with a psychotherapy and a family guidance. The course was favourable after two months. The authors compare these findings with some data of the literature and underline the diagnostic and therapeutic difficulties they faced. How physicians should approach such form of hysteria to set up the diagnosis is to proceed by elimination because the disease can simulate all sorts of medical or psychiatrical affections.