Ultrahigh-quality factor resonant dielectric metasurfaces based on hollow nanocuboids.

In this work, a dielectric metasurface consisting of hollow dielectric nanocuboids, with ultrahigh quality factor, is theoretically proposed and demonstrated. The variation of the hole size of the cuboid allows for the tuning of the resonant anapole mode in the nanoparticles. The metasurface is designed to operate in two complementary modes, namely electromagnetically induced transparency and narrowband selective reflection. Thanks to the non-radiative nature of the anapole resonances, the minimal absorption losses of the dielectric materials, and the near-field coupling among the metasurface nanoparticles, a very high quality factor of Q=2.5×106 is achieved. The resonators are characterized by a simple bulk geometry and the subwavelength dimensions of the metasurface permit operation in the non-diffractive regime. The high quality factors and strong energy confinement of the proposed devices open new avenues of research on light-matter interactions, which may find direct applications, e.g., in non-linear devices, biological sensors, laser cavities, and optical communications.

Are guidelines on the management of non-tuberculous mycobacteria lung infections respected and what are the consequences for patients? A French retrospective study from 2007 to 2014.

Diagnosis and treatment of lung infections caused by non-tuberculous mycobacteria (NTM) remain challenging. Adherence of the clinicians to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) 2007 guidelines is often incomplete. Between 2007 and 2014, in Grenoble Alpes University Hospital, France, 132 patients had NTM-positive cultures from lower respiratory tract (LRT) samples. We retrospectively collected diagnosis, treatment, and outcome data of patients, and evaluated the adherence of clinicians to ATS/IDSA guidelines and the consequences of patients' prognoses. Using the ATS/IDSA definitions, 31 out of 132 patients (23.5%) were considered infected, 57 out of 132 patients (43.2%) were considered colonised, 33 out of 132 (25%) were contaminated and 11 (8.4%) had missing data. Among the 31 NTM-infected patients, M. avium (23 out of 31, 74.2%) was most frequently involved. The main risk factor for NTM lung infection was underlying lung disease (30 out of 31, 96.8%). Treatment was not appropriate according to current guidelines in 58.1% of infected patients (18 out of 31). Mainly, the antibiotic treatment was installed based on radiological signs (p = 0.0006), sputum results and bronchoalveolar lavage results (p < 0.0001 and p = 0.003 respectively). Most antibiotic regimens included a macrolide (83.4%). Patients receiving appropriate treatment had the same cure rates as those receiving inappropriate treatment (p = 0.22) and similar relapse rates (p = 0.92). Current medical practices for the treatment of NTM lung infections in our institution are not consistent with the ATS/IDSA guidelines. This could potentially affect the prognosis of these patients and favour the emergence of macrolide resistance in NTM species.

[Knowledge, attitudes and practices of healthcare providers on suspected Ebola cases in Guinea]. / Connaissances, attitudes et pratiques des prestataires de soins de santé de face aux cas suspects d'Ebola en Guinée.

BACKGROUND: Developing a more resilient health system to Ebola Virus Disease (EVD) is a necessity in Guinea. This implies having information on the knowledge and practices that health staffs had during the preceding the EVD outbreak. The objective of this study was to compare the knowledge, attitudes and practices of routine healthcare providers on suspected EVD cases in the affected and non-affected districts in Guinea. METHODS: A cross-sectional analytic study was conducted from December 6th to 30th, 2014 with health staffs and community health workers from 120 health facilities, in four health districts more affected by the EVD and four others less affected. RESULTS: Health staffs who declared being able to identify a suspected EVD case were represented more in the more affected districts (95.2%) than in the less affected districts (78.7%, P<0.01). The main practice towards a suspected case in the more affected districts was referral to the Ebola treatment centre (79.2%, versus 20% in the less affected districts, P<0.05), while in the less affected districts, cases were first tested for malaria prior to treatment or referral (3 cases out of 5). Community health workers who declared being able to identify a suspected EVD case were significantly more represented in the more affected districts (73%) than in the less affected districts (38.1%, P<0.001). CONCLUSION: This study suggests that health system managers should prioritize capacity building of health providers in EVD affected as well as in non-affected districts to ensure better preparation for and response to EVD outbreaks.

Prospective Evaluation of a New Aspergillus IgG Enzyme Immunoassay Kit for Diagnosis of Chronic and Allergic Pulmonary Aspergillosis.

Anti-Aspergillus IgG antibodies are important biomarkers for the diagnosis of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA). We compared the performance of a new commercial enzyme immunoassay (EIA) (Bordier Affinity Products) with that of the Bio-Rad and Virion\Serion EIAs. This assay is novel in its association of two recombinant antigens with somatic and metabolic antigens of Aspergillus fumigatus In a prospective multicenter study, 436 serum samples from 147 patients diagnosed with CPA (136 samples/104 patients) or ABPA (94 samples/43 patients) and from 205 controls (206 samples) were tested. We obtained sensitivities of 97%, 91.7%, and 86.1%, and specificities of 90.3%, 91.3%, and 81.5% for the Bordier, Bio-Rad, and Virion\Serion tests, respectively. The Bordier kit was more sensitive than the Bio-Rad kit (P < 0.01), which was itself more sensitive than the Virion\Serion kit (P = 0.04). The Bordier and Bio-Rad kits had similar specificity (P = 0.8), both higher than that of the Virion\Serion kit (P = 0.02). The area under the receiver operating characteristic (ROC) curves confirmed the superiority of the Bordier kit over the Bio-Rad and the Virion\Serion kits (0.977, 0.951, and 0.897, respectively; P < 0.01 for each comparison). In a subset analysis of 279 serum samples tested with the Bordier and Bio-Rad kits and an in-house immunoprecipitin assay (IPD), the Bordier kit had the highest sensitivity (97.7%), but the IPD tended to be more specific (71.2 and 84.7%, respectively; P = 0.10). The use of recombinant, somatic, and metabolic antigens in a single EIA improved the balance of sensitivity and specificity, resulting in an assay highly suitable for use in the diagnosis of chronic and allergic aspergillosis.

[Hepatitis B: cross-sectional study of knowledge and immunization among students at University of Cocody, Ivory Coast]. / Connaissance et couverture vaccinale contre l'hépatite virale B (HVB) : étude transversale parmi les étudiants de l'université de Cocody, Côte d'Ivoire.

BACKGROUND: To evaluate knowledge about hepatitis B and vaccination coverage among students at Cocody's University, Ivory Coast. MATERIALS AND METHODS: A cross-sectional study was conducted during the academic year 2005-2006 (2557 students). Parameters were collected by interview using a survey chart. Factors influencing knowledge and vaccination against hepatitis B were analyzed by logistic regression. RESULTS: The majority of students (n=1174, 69.4% [95% CI 68-71]) knew about hepatitis B. Only 17.5% and 26.1% of students respectively were aware of sexual and blood transmission. None of the students were aware of maternal-fetal transmission. Factors associated with knowledge of hepatitis B were enrollment in health sciences (Odds Ratio=24.19 [95% CI 8.65-76.63]) and having a scholarship (Odds Ratio=2.34 [95% CI 1.54-3.56]). Vaccination coverage against hepatitis B was low (Odds Ratio=3.7% [95% CI 3-4]). Factors associated with vaccination were: knowledge of hepatitis B (Odds Ratio=6.83 [95% CI 4.57-10.27]), enrollment in health sciences (Odds Ratio=3.59 [95% CI 2.60-4.96]), marriage (Odds Ratio=2.04 [95% CI 1.13-3.64]) and having a scholarship (Odds Ratio=1.60 [95% CI 1.09-2.35]). CONCLUSION: Knowledge and vaccination coverage against hepatitis B among students at Cocody's University is low. Students should be given information about hepatitis B and access to free vaccination. Students enrolled in health sciences should be vaccinated before admission because of specific risks of contamination, for themselves and for their patients.

[Epidemiology and prognosis aspects of upper gastrointestinal bleeding of NianankoroFomba hospital in segou]. / Aspects epidemiologiques et pronostiques des hemorragies digestives hautes a l'hôpital Nianankoro Fomba(HNF) de segou.

AIMS: The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital. PATIENTS AND METHODS: This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage. RESULTS: Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%. CONCLUSION: upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

BUT: Le but de notre travail était de préciser lesaspects épidémiologiques, cliniques, étiologiques et pronostiques de l'hémorragie digestive haute à l'Hôpital Régional de Ségou(HRS). PATIENTS ET MÉTHODES: Cette étude transversalequi s'était déroulée du 1eroctobre 2017 au 31 septembre 2018 a concernéles patients hospitalisés pour hémorragie digestive. RÉSULTATS: Les hémorragies digestives hautes ont représenté 9,7% de l'ensemble des hospitalisations. L'âge moyen des patients était de 50,94 ± 21,6 ans avec un sex ratio de 1,6 en faveur des hommes. Les femmes au foyer et les cultivateurs étaient représentés dans 37,7% et 34% des cas. Les principaux modes de révélation étaient l'hématémèse et le méléna. L'évolution était favorable avec une mortalité de l'ordre de 34%. CONCLUSION: Hémorragie digestive haute est relativement fréquente dans notre contexte. Cependant, la mortalité élevée est liée à un retard de prise en charge.

Directionality in scattering by nanoparticles: Kerker's null-scattering conditions revisited.

Since the first studies made by Kerker in the 1970s stating the conditions for null light scattering in certain directions by particles, such conditions have remained unquestioned. The increasing interest in scattering directionality by tuning the optical properties of materials demands a new analysis of this problem. In addition, as has been shown recently, one of Kerker's statements does not comply with the optical theorem. We propose corrected expressions for the null-scattering conditions that satisfy the optical theorem.

[Prescription errors in a pediatric hospital department in Dakar, Senegal]. / Les erreurs de prescription médicamenteuse dans un service hospitalier pédiatrique a Dakar, Sénégal.

Prescription is the main source of medication error in daily medical practice. The purpose of this study was to determine the distribution and cost of drugs used and causes of prescription errors in one department of the Albert Royer National Children's Hospital Center in Dakar, Senegal. Study was focused on patients admitted from December 1 to March 3, 2009. Based on 792 expected hospitalizations, 1 out of 2 patients was randomly selected to obtain a cohort of 400 patients for whom a total of 1267 prescriptions were written by pediatricians and interns on duty. Prescriptions were evaluated by pediatric professors to identify errors. The types of errors taken into account in this study involved indication, dosage schedule, and treatment duration. A total of 216 (17.0%) errors were identified including 121 cases (9.5%) involving indication mainly for antibiotics (30.5%) and antimalarial drugs (28.9%). Dosage schedule errors were observed in 58 cases (4.5%) involving antibiotics (24.1%) and antifungals (25.8%). These findings confirm the need for an intensive information campaign to prevent medication misuse in countries such as Senegal. Campaigns should be based on training of relevant therapeutic staff to optimize health care and improve availability for everyone.

Differentiation of canine adipose mesenchymal stem cells into insulin-producing cells: comparison of different culture medium compositions.

The aim of this study was to differentiate canine adipose-derived mesenchymal stem cells (ADMSCs) into insulin-producing cells by using culture media with different compositions to determine the most efficient media. Stem cells isolated from the fat tissues close to the bitch uterus were distributed into 6 groups: (1) Dulbecco's modified Eagle medium (DMEM)-high glucose (HG), ß-mercaptoethanol, and nicotinamide; (2) DMEM-HG, ß-mercaptoethanol, nicotinamide, and exendin-4; (3) DMEM-HG, ß-mercaptoethanol, nicotinamide, exendin-4, B27, nonessential amino acids, and l-glutamine; (4) DMEM-HG, ß-mercaptoethanol, and nicotinamide (for the initial 8-d period), and DMEM-HG, ß-mercaptoethanol, nicotinamide, exendin-4, B27, nonessential amino acids, l-glutamine, and basic fibroblast growth factor (for the remaining 8-d period); (5) DMEM-HG and fetal bovine serum; and (6) DMEM-low glucose and fetal bovine serum (standard control group). Adipose-derived mesenchymal stem cells from groups 1 to 5 gradually became round in shape and gathered in clusters. These changes differed between the groups. In group 3, the cell clusters were apparently more in numbers and gathered as bigger aggregates. Dithizone staining showed that groups 3 and 4 were similar in terms of the mean area of each aggregate stained for insulin. However, only in group 4, the number of insulin aggregates and the total area of aggregates stained were significantly bigger than in the other groups. The mRNA expression of PDX1, BETA2, MafA, and Insulin were also confirmed in all the groups. We conclude that by manipulating the composition of the culture medium it is possible to induce canine ADMSCs into insulin-producing cells, and the 2-staged protocol that was used promoted the best differentiation.

[Pediatric upper gastrointestinal endoscopy: experience in a hospital setting in Côte d'Ivoire]. / Endoscopie digestive haute pédiatrique: une expérience hospitalière en Côte d'Ivoire.

AIMS: The purpose of this report was to describe epidemiological aspects of endoscopic upper gastrointestinal endoscopy at a pediatric teaching hospital in Cocody, Côte d'Ivoire. MATERIALS AND METHODS: The records of all patients under 15 years of age who underwent upper gastrointestinal endoscopy in the gastrointestinal endoscopy unit of a teaching hospital of Cocody between January 1, 2000 and April 30, 2006 were reviewed. The following parameters were compiled: age, sex, indications, name of endoscopist, type of sedation, gastric biopsy to detect Helicobacter pylori, and endoscopic findings. RESULTS: Pediatric gastroscopy accounted for 1% of procedures performed in the upper gastrointestinal endoscopy unit. Patient ages ranged from 6 months to 15 years and M/F sex ratio was 0.88. The procedures were ordered by general practitioners in 55% of cases, gastroenterologists in 14%, and pediatricians in 10%. Sedation with intravenous midazolam 0.25 was used in 74% of patients (n = 38). No incident or complication was observed. Tolerance of the examination by the child was considered as poor by the operator in 96% of cases. The main indications for endoscopy were epigastralgia in 54% of cases, vomiting in 13.7%, and gastrointestinal bleeding in 13.7%. The procedure was performed or supervised by an operator with over ten years of experience in gastrointestinal endoscopy in 55.1% and 54.0% of cases respectively. The main endoscopic finding was duodenogastric bile reflux in 23.5% of cases. Gastroscopy was normal in 43% of patients. Gastric biopsy to detect Helicobacter pylori was performed in 23% of patients. CONCLUSION: Pediatric gastroscopy performed under mild sedation by experienced endoscopists is a safe procedure for detecting lesions and obtaining biopsies for histological examination.

Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension.

Bosentan has proven 4-month efficacy in patients with HIV-associated pulmonary arterial hypertension (PAH-HIV). Herein, the long-term outcome of unselected PAH-HIV patients treated with first-line bosentan is described. Data for 59 consecutive World Health Organization (WHO) functional class II-IV PAH-HIV patients treated with first-line bosentan between May 2002 and July 2007 were analysed. HIV status, 6-min walk distance and haemodynamics were assessed at baseline, after 4 months and every 6-12 months thereafter. After 4 months, 6-min walk distance increased from 358+/-98 to 435+/-89 m and pulmonary vascular resistance decreased from 737+/-328 to 476+/-302 dyn x s x cm(-5). At the final evaluation (29+/-15 months), 6-min walk distance remained stable and pulmonary vascular resistance decreased further to 444+/-356 dyn x s x cm(-5). Haemodynamics normalised in 10 patients. At their last evaluation, these 10 patients were in WHO functional class I, with a 6-min walk distance of 532+/-52 m. Overall survival estimates were 93, 86 and 66% at 1, 2 and 3 yrs, respectively. Bosentan was safe when combined with highly active antiretroviral therapy, with no negative impact on HIV infection control. The present data confirm the long-term benefits of bosentan therapy in HIV-associated pulmonary arterial hypertension patients with improvements in symptoms, 6-min walk distance and haemodynamics, and with favourable overall survival.

[Chronic abdominal pain and fever in an Ivoirian woman: Mycobacterium avium-intracellulare duodenitis in an AIDS patient in Abidjan, Cote d'Ivoire]. / Douleurs abdominales chroniques et fièvre chez une ivoirienne.

Duodenal infection by Mycobacterium avium-intracellulare is a common opportunistic disease in HIV-infected patients. Individuals with CD4 counts <50 cells/mm3 are at highest risk. The main symptoms are diarrhea, abdominal pain, weight loss, and fever. Endoscopic examination shows various abnormalities including disseminated nodules that may be yellowish, whitish, or pinkish in color. Other mucosal lesions may be found such as erosion, erythema, or friable edematous aspect. Since these findings are non-specific, it is important to obtain biopsy specimens for histological and microbiological examination. The most common histologic features are atrophic mucosa resembling Whipple's disease with strongly positive PAS staining. The presence of BARR in macrophages is typical of MAI. Diagnosis is based on identification of the bacteria using either conventional culture techniques or polymerase chain reaction (PCR). Differential diagnosis includes other gastrointestinal infections associated with AIDS, i.e., microsporidiosis, cryptosporidiosis, giardiosis, anguillulosis, CMV, and isoporosis. The course of the disease is usually unfavorable even with antibiotic treatment. The purpose of this report is to describe a case of duodenitis due to atypical mycobacterial infection in a 30-year-old woman who was seropositive for human immunodeficiency virus. She was hospitalized due to fever with deterioration of her general condition (more than 10% of body weight loss) and chronic abdominal pain with inflammation. Diagnosis of MAI was confirmed by biopsy and Ziehl-Neelsen coloration. The patient was treated with rifampicine, isoniazide, ethambutol, and pyrazinamide in association with stavudine, lamuvidine and efavirenz. Despite improvement of general condition, fever persisted and the patient died after 40 days of treatment.

[Hyperreactive malarial splenomegaly: three clinical cases and literature review]. / Splénomégalie palustre hyperimmune : à propos de trois cas cliniques et revue de la littérature.

Hyperreactive malarial splenomegaly (HMS) is the chronic stage of a long-term stimulation of the immune system secondary to plasmodial infections, more frequently in genetically predisposed patients. HMS is a leading cause of large tropical splenomegaly in endemic zones but has been described in immigrants from Africa and in some European expatriates living in endemic countries. Diagnostic criteria include: long-term stay in a endemic zone, often large splenomegaly, high IgM titer, high antiplasmodial antibody titer, regression by at least 40% of splenomegaly six months after curative antimalarial treatment. In tropical settings, B-cell lymphoma and splenic lymphoma are the main differential diagnoses, which may be identified by a clonality analysis. Recent studies suggest that HMS can be treated by a short-term antimalarial therapy as long as the patient resides out of a malarial endemic country.

[Selection of lung transplant candidates in France in 2019]. / Sélection des candidats à la transplantation pulmonaire en France en 2019.

INTRODUCTION: In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time. BACKGROUND: The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment. OUTLOOK AND CONCLUSION: These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.

[Problem Of Diabetic Foot Amputations]. / ProbléMatique Des Amputations Du Pied Diabétique.

INTRODUCTION: The diabetic foot wound is a real public health problem, 10% of the reasons for hospitalization. The risk of amputation is 10 to 30 times higher in diabetics than the general population. OBJECTIVE: To study the problem of amputations of the diabetic foot. METHOD: This was a descriptive and cross-sectional study that took place in the Department of Medicine and Endocrinology of the Mali Hospital from July 1st, 2016 to June 30th, 2017. RESULTS: Twenty-five (25) diabetic patients were enrolled in our study. The sex ratio was 0.66. At admission, 100% of our patients had arterial disease, 96% neuropathy, and mixed foot in 80%. Poor glycemic control in 64% of patients; osteitis in 52% of cases; 92% of the patients had a 100% amputation risk according to the University of Texas classification. Nearly half or 46% of patients had amputations in the leg. We recorded 1 death case that is 4%. CONCLUSION: The problem of amputation of diabetic feet is a function of the poor equilibrium and progressive neurological and vascular complications of diabetes.

INTRODUCTION: La plaie du pied diabétique constitue un réel problème de santé publique, 10% des motifs d'hospitalisation. Le risque d'amputation est de 10 à 30 fois plus élevé chez les diabétiques que la population générale. OBJECTIF: Etudier la problématique des amputations du pied diabétique. MÉTHODE: II s'agissait d'une étude descriptive et transversale qui s'est déroulée dans le service de médecine et d'endocrinologie de l'hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017. RÉSULTATS: Vingt-cinq (25) patients diabétiques ont été recrutés dans notre étude. Le sex ratio était de 0,66. A l'admission, 100% de nos patients avaient une artériopathie, 96% une neuropathie, et un pied mixte dans 80%. Un mauvais équilibre glycémique chez 64% des patients ; l'ostéite dans 52% des cas; 92% des patients avaient un risque d'amputation à 100% selon la classification de l'université du Texas. Près de la moitié soit 46% des patients ont été amputé au niveau de la jambe. Nous avons enregistré 1 cas de décès soit 4%. CONCLUSION: La problématique de l'amputation des pieds diabétiques est fonction du mauvais équilibre et des complications évolutives neurologiques et vasculaires du diabète.

Interaction of nanoparticles with substrates: effects on the dipolar behaviour of the particles.

In this work, we present a numerical analysis of the surface electric field of a metallic nanoparticle (either 2D or 3D) interacting with a flat substrate underneath. The influence of the distance to the substrate, particle size, the surrounding media and the substrate optical properties is analyzed as a function of the incident wavelength. We show that these are crucial factors that change the field distribution associated to the dipolar behavior of the particle. A useful parameter for illustrating the changes in the angular distribution is theta(max), the angle at which the maximum of the surface electric field is located.

[Infection due to Mycobacterium malmoense in an immunocompetent patient]. / Infection à Mycobacterium malmoense chez un patient immunocompétent.

INTRODUCTION: Mycobacterium malmoense (MM) is an atypical mycobacterium responsible for opportunistic infection. The clinical and radiological picture is non-specific. The infection develops most frequently in a dystrophic lung. CASE REPORT: A patient of 52 years was admitted with an extensive multifocal pneumonia which later proved to be due to infection with MM. Empirical treatment was started with the combination of rifampicin, isoniazid, pyrazinamide (rifater) and ethambutol (myambutol). Subsequently, cultures showed sensitivity to rifampicin, ethambutol, oxfloxacin, clarithromycin (MIC < 2 mg/l) and rifabutin (MIC < 0.5 mg/l). More than two weeks after the start of treatment, material aspirated at fibroscopy showed the persistence of numerous acid-alcohol fast bacilli, an increase, compared with the original examination, from 5 to 25 per field on day 2, to 20 to 100 per field on day 19. Despite the late addition of clarithromycin there was a progressive deterioration in the pulmonary condition. CONCLUSION: There is little correlation between the in vivo and in vitro sensitivities of MM to antibiotics. In our patient the progress was unfavourable, even though the mycobacterium was sensitive to the combination of antibiotics used, with the exception of isoniazid that was not tested. In vitro isoniazid does not seem to be active against MM. There is no consensus of opinion on the antibiotic treatment of MM infections.

[Quinquina and man]. / Du quinquina et des hommes.

Many great discoveries have been made by chance but some have been the result of human perseverance and ingenuity. A sterling example of the second case is quinquina that was discovered in Peru and is now produced in Java. Quinquina has gone through centuries without losing its medical efficacy that efficacy allowed the exploration and colonization of Africa and played a key role in the ability to conduct overseas military campaigns. Because of its strategic importance, it was a coveted resource. It led to the discovery of homeopathy and dyes, allowed the development of organic chemistry, and has been used to make alcoholic bitters and soft drinks.

[Evaluation of integrated management of childhood illness three years after implementation in a health care district in Senegal]. / Evaluation de la Prise en Charge Intégrée des Maladies de l'Enfant dans un district du Sénégal après 3 ans de mise en place.

The strategy of Integrated Management of Childhood Illness (IMCI) has been recommended by both WHO and UNICEF for first-level health facilities to control the main childhood diseases in developing countries. In Senegal, IMCI was adopted in 1996 and had been implemented in several pilot health districts by the year 2000. This study was conducted three years after implementation of IMCI in the Darou Mousty health district. The purpose was to evaluate determinant factors for implementation as well as the required skills of personnel. Evaluation was based on a review of IMCI records at health care facilities in the District and a survey to collect the opinion of healthcare workers involved in the program. All qualified personal, i.e. two doctors, eleven nurses and one midwife at the time of the survey, had received training in the IMCI approach. Although they all stated that this training improved their skills in managing paediatric patients, only 16 % used the approach on a regular basis. The most frequently reported reason for non-use was unwieldiness of IMCI procedures. According to IMCI guidelines, proper procedures were used in only 53 of the 1465 children (3.6%) who consulted during the study period. This low compliance rate was due to the inability of healthcare personnel to apply therapeutic protocols, plan appointments or identify emergency cases. These findings suggest that basic training and in-service courses must place greater emphasis on IMCI procedures and that regular supervision is needed to optimize this strategy in Senegal.

Maternal pneumococcal nasopharyngeal carriage and risk factors for neonatal carriage after the introduction of pneumococcal conjugate vaccines in The Gambia.

OBJECTIVES: Pneumococcal nasopharyngeal carriage occurs early in life. However, the role of vertical transmission is not well understood. The aims of this study were to describe carriage among mothers and their newborns, and to assess for risk factors for neonatal carriage. METHODS: In a nested retrospective cohort study, we analysed data from the control arm of a randomized controlled trial conducted in The Gambia 2 to 3 years after introduction of pneumococcal conjugate vaccine (PCV) 13. Nasopharyngeal swabs were collected from 374 women and their newborns on the day of delivery, then 3, 6, 14 and 28 days later. Pneumococci were isolated and serotyped using conventional microbiologic methods. RESULTS: Carriage increased from 0.3% (1/373) at birth to 37.2% (139/374) at day 28 (p <0.001) among neonates and from 17.1% (64/374) to 24.3% (91/374) (p 0.015) among women. In both groups, PCV13 vaccine-type (VT) serotypes accounted for approximately one-third of the pneumococcal isolates, with serotype 19A being the most common VT. Maternal carriage (adjusted odds ratio (OR) = 2.82; 95% confidence interval (CI), 1.77-4.80), living with other children in the household (adjusted OR = 4.06; 95% CI, 1.90-8.86) and dry season (OR = 1.98; 95% CI, 1.15-3.43) were risk factors for neonatal carriage. Over half (62.6%) of the neonatal carriage was attributable to living with other children in the same household. CONCLUSIONS: Three years after the introduction of PCV in The Gambia, newborns are still rapidly colonized with pneumococcus, including PCV13 VT. Current strategies for pneumococcal control in Africa do not protect this age group beyond the herd effect.