[Acute myelitis related to hepatitis A after travel to Senegal]. / Myélite aiguë transverse révélatrice d'une hépatite virale aiguë A au retour du Sénégal.

Neurological complications are rare following hepatitis A. Acute myelitis is even more uncommon. The purpose of this report is to describe a case of acute myelitis related to hepatitis A virus (HAV) in a 43-year-old-woman returning from Senegal. Diagnosis of myelitis was confirmed by spinal MRI and detection of anti-HAV Ig M antibodies in serum. The patient made a spontaneous clinical recovery in one month. Spinal MRI findings were normal at three months. Hepatitis A should be considered in the diagnostic approach to acute myelitis in returning travelers and patients living in highly endemic countries where prophylactic vaccination is unavailable.

[Type 2 diabetes mellitus in children in black Africa: description of first five cases in Togo]. / Le diabète de type 2 de l'enfant en Afrique noire: cinq premiers cas au Togo.

The purpose of this report is to describe epidemiological, clinical and therapeutic features of the first five cases of childhood type 2 diabetes mellitus (T2DM) documented in Togo. The five children were admitted to either the Barruet Clinic (n=4) or Tokoin de Lomé University Hospital Centre (n=1) between 1999 and 2004. All presented one or more of the following risk factors for T2DM: obesity, familial history of T2DM, acanthosis nigricans, polycystic ovary syndrome, dyslipidemia, and high blood pressure. Age at diagnosis was 15 years in two cases and 13, 11 and 12 years in the other three cases (mean, 13.2 + 1.79 years). There were three females and two males. All five patients were obese and had risk factors for obesity (high fat intake, sedentary lifestyle and lack of physical exercise). All had a familial history of T2DM and two had Acanthosis nigricans. All five patients were treated initially with insulin that was gradually discontinued in favor of exercise and diet in four. These are the first reported cases of childhood T2DM in Togo. An education campaign is necessary to inform the population on about the risk factors for T2DM.

[Comparative diffusion of fusidic acid, oxacillin, and pristinamycin in dermal interstitial fluid after repeated oral administration]. / Diffusions comparées de l'acide fusidique, de l'oxacilline et de la pristinamycine dans le liquide interstitiel dermique après administration orale répétée.

OBJECTIVE: The aim of this study was to use the suction bullae technique to compare skin diffusion of 3 antibiotics commonly used for skin infections (fusidic acid, oxacillin, pristinamycin) and to estimate their potential activity at the site of skin infections. SUBJECTS AND METHODS: This comparative open study was conducted in 12 healthy volunteers using a repeated latin square experimental scheme. Antibiotic concentrations in serum and suction bullae fluid were measured by high performance liquid chromatography after 5.5 days of repeated oral administration of fusidic acid (1 g/d), oxacillin (2 g/d), and pristinamycin (2 g/d). RESULTS: Mean antibiotic concentrations in serum and interstitial fluid (suction bullae fluid) were highest for fusidic acid with a Cmax at 91.3 +/- 23.0 mg/l and 45.5 +/- 18.0 mg/l respectively (interstitial fluid/serum ratio=49 +/- 10 p. 100). For oxacillin, Cmax was 8.3 +/- 3.6 mg/l and 0.98 +/- 0.49 mg/l (ratio 13 +/- 5 p. 100). Pristinamycin concentrations were low with a Cmax at 0.51 +/- 0.40 and 0.26 +/- 0.15 mg/l (ratio 73 +/- 57 p. 100). Comparing the area under the interstitial fluid and the serum concentration-time curves showed that the best diffusion was obtained with pristinamycin (114 +/- 61 p. 100), followed by fusidic acid (57 +/- 13 p. 100) and oxacillin (48 +/- 25 p. 100). DISCUSSION: These data were used to calculate indicators of potential efficacy in the interstitial dermal fluid: inhibitor quotient (Cmax/MIC) and AUIC (ASC/MIC), indicator of the time antibiotic concentrations are maintained above the minimal inhibitor concentration (MIC). This showed that fusidic acid was potentially more active against all staphylococci. For streptococci, the observed interstitial concentrations of pristinamycin and of fusidic acid should theoretically inhibit streptococci A growth, but oxacillin was the most adapted antibiotic.