Fungemia in the French department of Mayotte, Indian Ocean: A 10 years survey.

OBJECTIVE: This study aimed at providing original data on fungemia in the Centre Hospitalier de Mayotte in terms of prevalence, epidemiological characteristics of infected patients, yeast species distribution and profile of in vitro antifungals susceptibility. METHODS: A total of 223 positive blood cultures for yeasts were retrospectively reported during the period April 2010-April 2020. RESULTS: Ninety-five episodes were identified corresponding to an incidence rate of 3.7 cases/100,000 inhabitants. The average age of patients was 33.5 years, and 63.3% patients were hospitalized in intensive care unit. The main co-morbidities were surgery in the 30 days prior to fungemia (27.8%), neoplasia (22.8%), parenteral nutrition (17.7%), diabetes (16.5%) and immunosuppressive medications (31.6%). Candida spp accounted for the majority of isolates (92.4%) with a predominance of non-albicans species (55.8% vs 33.7%), including C. albicans (33.7%), C. tropicalis (30.5%) and C. parapsilosis (20%). The antifungal susceptibility profiles did not differ from expected results for each species and did not change significantly over time. DISCUSSION: Fungemia remain frequent hospital infections associated with high mortality in Mayotte. The vast majority of fungemia was due to Candida spp. Non-albicansCandida species reach half of the Candida isolates with a high percentage of C. tropicalis. Surprisingly, no case of candidemia due to C. glabrata were identified. The management of candidemia remains satisfactory and the treatment was adapted according to the international recommendations. However, the high susceptibility of Candida spp. isolates to fluconazole may invite to reconsider the use of this molecule as empirical and first-line treatment of candidemia in Mayotte.

Screening and management of HIV infection in pregnant women in Dakar.

OBJECTIVES: To assess the feasibility and results of the implementation of systematic HIV screening of pregnant women and antiretroviral (ARV) treatment for those found to be HIV-positive and their newborns at the IHS Gynecology-Obstetrics Department in Dakar, Senegal. PATIENTS AND METHODS: This cross-sectional prospective study took place in 2014-1016 and examined the results of screening pregnant women for HIV during their prenatal consultations and treating those found to be HIV-positive and their infants with ARV. RESULTS: HIV screening was routinely proposed to the 1616 pregnant women attending antenatal clinics, and 93.9 % accepted. The test was positive for 5 of these women, for an HIV prevalence of 0.3 % of pregnant women. In addition, another 23 HIV-positive pregnant women were referred to the IHS for their prenatal care and delivery, for a total of 28 women with HIV. Their mean age was 30 years, their mean parity 1.6, and all had HIV-1. Triple therapy was initiated for all HIV-positive pregnant women, in line with the WHO guidelines' "B + option", currently adopted by Senegal. During follow-up, only 35.7 % of the women had access to a viral load assay. The outcome of pregnancy was favorable in 91.6 % of cases; 72.2% of the women had vaginal deliveries. All live-born infants were given antiretroviral prophylaxis at birth. The mode of breastfeeding used was mainly exclusive protected breastfeeding (72.2 %). During postnatal follow-up, 2 of the 17 live-born infants were lost to follow-up, and 15 had PCR testing for HIV, which was positive in only 1 case, for a transmission rate of 6.6 %. CONCLUSION: The systematic offer and performance of HIV testing in all pregnant women is feasible and acceptable. Good organization of care can provide ARV treatment for all HIV-positive pregnant women and their newborns. The accessibility of viral load testing and of PCR screening for neonates still requires improvement.

Short bowel syndrome: difficulties of management in rural areas.

INTRODUCTION: The causes of short bowel syndrome are multiple, but most often in sub-Saharan Africa they result from extensive surgical resection that leaves less than 200 cm. Intestinal failure appears rapidly with a major hydroelectrolytic deficiency and malabsorption. Management requires parenteral nutrition that can be life-long. OBSERVATION: A 53 year-old patient underwent surgery in 1986 for peptic ulcer disease and recovered successfully. He was admitted in July 2015 for acute bowel obstruction of more than 8 hours duration. Intraoperative exploration showed irreversible ischemia in the small bowel, related to tight adhesions. An extensive resection leaving 110 cm of bowel was carried out. Postoperatively, nutritional monitoring and oral supplementation were prescribed and associated with proton pump inhibitors and antidiarrhea drugs. Parenteral feeding was not available. The postoperative period was characterized by temporary stability followed by a significant weight loss, then by two hospitalizations for severe malnutrition and intercurrent infection. Death occurred 7 months after the operation. CONCLUSION: Parenteral nutrition is essential in short bowel syndrome. Availability, especially for a long-term use, is a major problem in our context, and alternatives are rare.

Strengthening human genetics research in Africa: report of the 9th meeting of the African Society of Human Genetics in Dakar in May 2016.

The 9th meeting of the African Society of Human Genetics, in partnership with the Senegalese Cancer Research and Study Group and the Human Heredity and Health in Africa (H3Africa) Consortium, was held in Dakar, Senegal. The theme was Strengthening Human Genetics Research in Africa. The 210 delegates came from 21 African countries and from France, Switzerland, UK, UAE, Canada and the USA. The goal was to highlight genetic and genomic science across the African continent with the ultimate goal of improving the health of Africans and those across the globe, and to promote the careers of young African scientists in the field. A session on the sustainability of genomic research in Africa brought to light innovative and practical approaches to supporting research in resource-limited settings and the importance of promoting genetics in academic, research funding, governmental and private sectors. This meeting led to the formation of the Senegalese Society for Human Genetics.

Le 9ème congrès de la Société Africaine de Génétique Humaine, en partenariat avec le Groupe d'Etude et de Recherche sur le Cancer (GERC) et le Consortium H3Africa, s'est tenu à Dakar, au Sénégal. Le thème était «Renforcer la recherche en Génétique Humaine en Afrique¼. Les 210 participants sont venus de 21 pays africains et de six non africains. L'objectif était de valoriser la génétique et la génomique à travers l'Afrique avec comme but ultime d'améliorer la santé des populations, et de promouvoir les carrières des jeunes chercheurs Africains. Une session sur la pérennité de la recherche génomique a révélé des approches innovantes et pratiques supportant la recherche dans des contextes de ressources limitées et l'importance de promouvoir la formation universitaire en génétique, le financement de la recherche par les gouvernements et le privé. Ce congrès conduisit à la création de la Société Sénégalaise de Génétique Humaine.

A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal.

OBJECTIVE: To evaluate the effectiveness and safety of an ultra-low-cost uterine balloon tamponade package (ESM-UBT™) for facility-based management of uncontrolled postpartum haemorrhage (PPH) in Kenya, Sierra Leone, Senegal, and Nepal. DESIGN: Prospective multi-centre case series. SETTING: Facilities in resource-scarce areas of Kenya, Sierra Leone, Nepal, and Senegal. POPULATION: Women with uncontrolled postpartum haemorrhage in 307 facilities across the four countries. METHODS: A standardised ESM-UBT package was implemented in 307 facilities over 29 months (1 September 2012 to 1 February 2015). Data were collected via a multi-pronged approach including data card completion, chart reviews, and provider interviews. Beginning in August 2014, women who had previously undergone UBT placement were sought and queried regarding potential complications associated with UBT use. MAIN OUTCOME MEASURES: All-cause survival, survival from PPH, and post-UBT use complications (surgery, hospitalisation, antibiotics for pelvic infection) associated with UBT use. RESULTS: 201 UBTs were placed for uncontrolled vaginal haemorrhage refractory to all other interventions. In all, 38% (71/188) of women were either unconscious or confused at the time of UBT insertion. All-cause survival was 95% (190/201). However, 98% (160/163) of women survived uncontrolled PPH if delivery occurred at an ESM-UBT online facility. One (1/151) potential UBT-associated complication (postpartum endometritis) was identified and two improvised UBTs were placed in women with a ruptured uterus. CONCLUSIONS: These pilot data suggest that the ESM-UBT package is a clinically promising and safe method to arrest uncontrolled postpartum haemorrhage and save women's lives. The UBT was successfully placed by all levels of facility-based providers. Future studies are needed to further evaluate the effectiveness of ESM-UBT in low-resource settings. TWEETABLE ABSTRACT: Evidence for ESM-UBT as a clinically promising and safe method to arrest uncontrolled PPH and save women's lives.

[Unmet obstetrical needs for major obstetric interventions in Dakar]. / Besoins obstétricaux non couverts pour les interventions obstétricales majeures à Dakar (Sénégal).

OBJECTIVES: To determine unmet needs formajor obstetric interventions and evaluatematernal and perinatal outcome in the region of Dakar in 2010. MATERIALS AND METHODS: This retrospective, descriptive, and analytic study of major obstetric interventions (MOI) for absolute maternal indications (AMI) in Dakar examined records in the reference health centers and public hospitals in Dakar for 2010. RESULTS: During the study period, we recorded 5 383 MOI. The epidemiological profile of patients was a woman with a mean age of 28 years, primiparous (41.1%), married (99.7%), and living more than 10 km from the clinic (51%). AMI accounted for 3 449 of the MOI. Cesarean deliveries were by far the predominant intervention (98.74%). Fetal-pelvic disproportion was the most frequent AMI in our study (75.85%). Because the expected number of MOI for AMI in Dakar was 2123, we estimated an unmet obstetric need (UON) of 1326 IOMs, that is, -62.45%of the excess number of IOMs, with disparities between districts. Of 22,349 deliveries, 47 mothers died (0.21%), mainly from antepartumand postpartum hemorrhages (59.6%) and preeclampsia/eclampsia (23.4%). In all, in 22,349 births, there were 442 deaths (2%). CONCLUSION: Obstetric needs are generally well supported in Dakar. However, this negative deficit recorded may mask a real obstetric need.

[Influenza sentinel surveillance network improvement in Senegal and results]. / Renforcement du réseau de surveillance sentinelle de la grippe au Sénégal et résultats.

Influenza surveillance in Senegal was initially restricted to the identification of circulating strains. The network has recently been enhanced (i) to include epidemiological data from Dakar and other regions and (ii) to extend virological surveillance to other respiratory viruses. Epidemiological data from the sentinel sites is transmitted daily by mobile phone. The data include those for other febrile syndromes similar to influenza-like illnesses (ILI), corresponding to integrated approach. Also, clinical samples are randomly selected and analyzed for influenza and other respiratory viruses. There were 180,192 declared visits to the 11 sentinel sites between week 11-2012 and week 52-2013; 24% of the visits were for fever syndromes and 25% of the cases of fever syndrome were ILI. Rhinoviruses were the most frequent cause of ILI (19%), before adenoviruses (18%), enteroviruses (18%) and influenza A viruses (13%). Co-circulation and co-infection were frequent and were responsible for ILI peaks. In conclusion, it is clear that the greatest advantage of this system is the ease with which it can be implemented, thanks to the availability of mobile phones and mobile phone networks. We recommend this solution for other African countries, because it performs very well and provides rapid benefits in terms of public health decision-making.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

OBJECTIVE: To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole. DESIGN: A retrospective review of data from a national gestational trophoblastic disease centre. SETTING: The Trophoblastic Disease Unit, Dakar, Senegal. SAMPLE: Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012. METHODS: The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined. MAIN OUTCOME MEASURES: Rate of occurrence of GTN after chemotherapy for hydatidiform mole. RESULTS: Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN. CONCLUSIONS: Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.

Biochemical and pharmacological effects of mitoxantrone and acetyl-L-carnitine in mice with a solid form of Ehrlich tumour.

BACKGROUND: Dysfunction of the carnitine system in non-tumour tissue following anticancer therapy has been reported. In this setting, supplementation with carnitine derivatives might increase the general metabolic activity of normal cells so that they might better withstand the adverse effects of chemotherapy aimed at tumour cells. Here we investigated the effect of acetyl-L-carnitine (ALC) alone and in combination with the antineoplastic agent mitoxantrone (MX) in an animal cancer model. METHODS: The effects of MX and MX-ALC were assessed based on gain or loss of body weight and on local growth of a solid form of Ehrlich tumour inoculated into mice. We also performed biochemical analyses like serum activities of some enzymes signalling the functioning of the liver, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Total protein, albumin and bilirubin were also determined in serum. Under favourable conditions, the Ehrlich tumour readily forms metastases, and this is the reason why we performed histological studies of samples of both the liver and heart in order to identify changes that may have mediated the observed effect of the treatment. In addition to those studies, the survival time of treated animals against controls was also noted. RESULTS: MX monotherapy was associated with lower body weight gain, fewer metastases, smaller tumour size, and lower dissemination. ALC alone promoted survival, but had no potentiating effect on MX therapy in terms of survival. Serum biochemistry changes associated with MX-ALC treatment consisted of a significant (p < 0.05) increase in AST with MX at 6 or 9 mg·kg(-1) plus ALC 200 mg·kg(-1) and a significant (p < 0.05) reduction in total protein compared to the corresponding MX group; serum albumin and bilirubin remained unchanged. CONCLUSION: ALC in combination with MX, regardless of the dose of MX, led to higher occurrences of metastases with dissemination to the kidneys, lungs, heart, and mediastinum compared to MX treatment alone. These histological findings indicate that ALC is inappropriate to combine with MX in the treatment of a solid cancer. The protective effect of ALC in combination therapy with the cytostatic drug MX was not supported in this study by our findings that the agent did not improve the therapeutic outcomes of MX therapy.

[Evaluation of an immunoassay for calcitonin]. / Evaluation d'une methode de dosage de la calcitonine par chimio luminescence dans le suivi des cancers medullaires de la thyroïde.

INTRODUCTION: The calcitonin is the most specific and the most sensitive marker of medullary thyroid carcinoma (MTC) both for screening and postoperative follow-up of the patients. Its measurement is made either remotely , or after stimulation of pentagastrin secretion which the answer is amplified at the carrier of CMT. The aim of this study was to estimate a chimioluminescent method by comparing it with an immunoradiological method, manual, used as reference. Correlation study was done. MATERIALS AND METHODS: Two hundred and sixty three serums (263) were tested among which 64 resulting of healthy subjects and 199 resulting of patients affected) by medullary thyroid carcinoma. Statistical analysis of results was made by a study of correlation with the software OriginLab version 7.0. The manual technique used as reference method is radioimmunological (Elsa hCT, international Cisbio, Gif on Yvette, France). It was compared with a chimioluminescent technique (Nichols Advantage, Nichols Institute Diagnostics, CA, the USA). RESULTS: The coefficients of correlation obtained between both tests were: r = 0.76 (exactness study), r = 0.91 (after stimulation), r = 0.95 and 0.79 (staged samples), r = 0.99 (M TC patients). CONCLUSIONS: Both techniques correlate strictly and significantly. The correlation coefficients we obtained show us that Nichols Advantage Calcitonin is completely reliable and sensitive for the measurement of the hCT in the follow-up of the CMT.

[Comparison of three chemiluminescent methods with a radioimmunoassay for thyroglobulin measurement in the follow-up of differentiated thyroid cancer]. / Comparaison de trois methodes chimioluminescentes avec une methode radioimmunologique de dosage de la thyroglobuline dans le suivi des cancers differencies de la thyroide.

INTRODUCTION: Serum thyroglobulin measurements play an integral role in clinical evaluation of patients with thyroid cancer. Serum thyroglobulin is a highly specific and sensitive tumor marker for detecting persistent or recurrent thyroid cancer but also for monitoring clinical status. Actually, chemiluminescent methods gain ground on the radioimmunological methods because they offer the practical advantage of a shorter incubation time, a wider range of measured values and a reagent marked antibody more stable, less fragile than those used on radioimmunoassay. The aim of this study was to compare, by correlation study, three chemiluminescent methods to the reference radioimmunological method usually used in laboratories. MATERIALS AND METHODS: Thyroglobulin was measured in 203 patients by the 3 following analyzers: Nichols Advantage (Nichols Institute Diagnostics, CA, USA), Immulite 2000 ( DPC Roche, Siemens, Los Angeles, USA) and Elecsys 2010 (Roche Diagnostics, Manheim, Germany); and by manual method (SELco Tg (Medipan Diagnostica, Berlin, Germany). Correlation analysis with OriginLab software version 7.0 was performed in order to compare thyroglobulin distribution values measured by the different methods. RESULTS: Correlation coefficients obtained were for Medipan/ Immulite 2000: 0.95 (n = 80); for Medipan/Elecsys: 0.97 (n = 31); for Medipan/Advantage: r = 0.96 (n = 73). CONCLUSIONS: Chemioluminescent technics we studied could be validly used in patients without anti-thyroglobulin antibody. The correlation coefficients we obtained allow us to select one of these automated methods after their performance was studied.

Evaluation of the antineoplastic activity of mitoxantrone-L-carnitine combination therapy on an experimental solid form of ehrlich tumour in mice.

We have commenced a series of experiments to evaluate the effect of carnitine derivatives on the antineoplastic activity of mitoxantrone (MX) on various animal cancers. This report describes the therapeutic effect of MX in combination with l-carnitine (LCAR) on the growth of a solid form of Ehrlich tumour inoculated into mice. LCAR was administered subcutaneously at doses of either 200 or 100mgkg(-1) on day 6 and 13 after tumour inoculation, 1h prior to the treatment with MX. Mitoxantrone was administered intravenously at doses of 3 or 6mgkg(-1). We found that LCAR had no potentiating effect on the efficacy of MX, in terms of either slowing tumour growth or increasing the survival of mice. Nevertheless, therapeutic effects can be assumed at higher doses of both drugs based on values calculated from an index of relative hazards.

[Transferrine soluble receptors' contribution to the assessment of iron status in homozygous drepanocytic anemia]. / Apport des récepteurs solubles de la transferrine dans l'évaluation du statut en fer au cours de la drépanocytose homozygote.

Sickle cell anemia does not cause martial deprivation per se, but may worsen when iron deficiency exists, notably in tropical zone where infectious diseases and malnutrition are endemic mainly during childhood. This study was aimed to assess iron deficiency prevalence among children with sickle cell disease (SCD) and to determine the best parameters for its diagnosis. In addition to classical parameters, we measured transferrine's soluble receptors which can reveal an iron deficiency, either isolated or associated to another condition since its level is not influenced by chronic anemia. Assays were carried out in 40 homozygous SCD patients, aged 3 to 18 years, having an hemoglobin level < 11 g/dL and in 30 age-paired controls assumed to be healthy and having a negative Emmel test and an hemoglobin level < 11 g/dL. The results showed hyposideremia (serum iron < 60 microg/dL) in 17.5% of the patients. Ferritinemia, transferrinemia as well as total iron fixation capacity were in the normal range for the majority of SCD patients in spite of the frequency of hyposideremia and microcytic anemia (20%). Transferrine's saturation coefficient was low in 22.5% of patients, which can be due to martial deprivation or to inflammatory status. These results confirm the limitations of usual biochemical parameters in the diagnosis of iron deficiency in homozygous drepanocytosis. Soluble receptors' levels were increased in 60% of controls; that proves that iron deficiency prevalence is high in our countries. Higher levels were found in 97.5% of patients. However, receptors' levels are increased during haemolysis, thus it is difficult to ascertain the origin of the increase, but taking into account its index value can reduces misinterpretation. In addition, considering simultaneously microcytosis, hypochromia, transferrine's soluble receptor level and its index, we can speculate that martial deficiency occurs in 20% of SCD patients, a percentage close to the 17.1% obtained by other authors using only the combination of microcytosis and hypochromia. It results from this study that associating microcytosis and hypochromia could validly assess iron deficiency during drepanocytosis.

The ISOBM TD-7 Workshop on hCG and related molecules. Towards user-oriented standardization of pregnancy and tumor diagnosis: assignment of epitopes to the three-dimensional structure of diagnostically and commercially relevant monoclonal antibodies directed against human chorionic gonadotropin and derivatives.

The ISOBM TD-7 hCG Workshop was established to characterize the molecular epitope structure and specificities of a panel of diagnostically relevant monoclonal antibodies (MAbs) directed against human chorionic gonadotropin (hCG) and its derivatives, and to consider how this information could be used to improve comparability of immunoassay results for these analytes. In this multicenter study, 27 MAbs have been characterized in detail as to their main and fine specificities by direct binding-, competitive- and sandwich-RIA, -ELISA, BIAcore and Western blotting. Antigens used in the study included the upcoming first WHO reference reagents for immunoassay, i.e. nick-free hCG (hCG), nicked hCG (hCGn), hCG alpha-subunit (hCGalpha), hCG beta-subunit (hCGbeta), nicked hCG beta-subunit (hCGbetan), hCG beta-core fragment (hCGbetacf), synthetic peptides of hCGbeta C-terminal peptide (hCGbetaCTP), and homologous hormones, luteinizing hormone (LH) and subunits (LHbeta) from various species. Correct classification of blinded internal controls demonstrated the reliability of the MAb referencing approach. Three-dimensional molecular epitope assignment was possible in many instances by comparing immunoreactivity of the ISOBM MAbs (n = 27) to a large panel of MAbs (n = 18) previously well characterized in the Innsbruck (P.B.) and Paris (J.M.B.) laboratories. All three major antibody specificities (alpha, n = 1; beta, n = 21; alphabeta, n = 5) were represented in the TD-7 MAb panel. HCGbeta MAbs could further be subdivided into (i) those recognizing hCGbeta only (epitopes: beta(6), n = 1; beta(7), n = 2; beta(14), n = 1) and (ii) those recognizing hCGbeta + hCG (beta1, beta2, beta4, beta5, n = 10; beta8 and beta9, n = 9). Members of the latter group were specific either for hCG + hCGbeta + hCGbetacf (beta1, n = 3) or hCG + hCGbeta + hCGbetaCTP (beta8, n = 6; beta9, n = 1) or in addition to hCG + hCGbeta + hCGbetacf recognized hLH/hLHbeta to a minor (beta2, n = 3; beta4, n = 3) or similar degree (beta5, n = 1). Epitopes were (i) located on the first and third loops protruding from the cystine knot of hCGbeta (beta2-beta6, aa hCGbeta20-25 and 68-77), (ii) presumably centered around the knot itself (beta1), or (iii) on hCGbetaCTP (epitope beta8 = hCGbeta141-144, beta9 = hCGbeta113-116). The ISOBM panel of MAbs represents all major epitope specificities suitable for the design of specific sandwich immunoassays. High analyte variability in serum and urine during the course of pregnancy and tumor development favors certain epitope combinations. For routine diagnostic purposes, assays recognizing a broad spectrum of hCG/hCGbeta variants such as hCG + hCGn + hCGbeta + hCGbetan + hCGbetacf + -CTPhCG + -CTPhCGbeta may be useful. Low cross-reactivity against related glycoprotein hormones (e.g. hLH) and their derivatives is mandatory. These criteria are best met by combinations of MAbs directed against epitopes located around the cystine knot (beta1) and against those encompassing the top of loops 1 and 3 on hCGbeta (beta2, beta4). The first WHO reference reagents for immunoassay of hCG and hCG-related molecules being prepared by the IFCC should facilitate characterization of what assays for 'hCG' are measuring. The next step towards improving between-laboratory comparability of measurements of hCG/hCG derivatives in pregnancy and oncology is provided by results of this TD-7 Workshop.

Effect of acetyl-L-carnitine on leukemia L1210 resistant to mitoxantrone.

Supportive care in tumour chemotherapy is a subject of intensive research. The complications of cytostatic therapy are a cause of extensive research of their pharmacological interactions and side effects. The immunologic and biochemical changes accompanying tumours are the factor that is most responsible for the worsening of the physiology of the host. Regimens containing carnitine and it's acetyl-derivative are used in many cases, among others even for preventing hepatotoxicity. Our hypothesis was to verify the supporting metabolic effects of acetyl-L-carnitine hydrochloride (ALC) in combined therapy with mitoxantrone (MX) and hepatotoxic cytostatic drugs including alkylating agents. This present report describes the effect of ALC in combination with MX on DBA/2 male mice bearing a transplantable L1210 leukemia resistant to MX. The criterion for evaluation of effect was the length of survival time of experimental animals. The proportional-hazards model quadratic in the drug dose (7) was used for survival time evaluation and optimal dose calculation. The hazard functions and the index of relative hazard were determined using Weibull distribution after logarithmic transformation of the entered data in each particular group. The dose-response curve was represented by a second-degree polynomial without absolute term. The combination therapy revealed that the optimal dose of ALC was 186 mg/kg s.c. This relation is shown in Fig.1. A significant effect of ALC (s.c.) in combined therapy with MX (6 mg/kg i.v.) given to animals bearing an experimental form of leukemia L1210/MX resistant to MX was proven at a level of probability p < or = 0.001. The effect of ALC in monotherapy was not demonstrable.

[Laboratory diagnosis of monoclonal gammopathies. Prospective study of 14 cases in Dakar, Senegal]. / Diagnostic au laboratoire des gammapathies monoclonales. Etude prospective de 14 cas à Dakar, Sénégal.

Monoclonal gammapathies are detected because of clinical symptoms and biological tests confirm their presence. Wishing to investigate these diseases, we carried out a series of biochemical tests on 14 patients from October 1995 to July 1996: protein, cryoglobulin, electrophoresis of proteins, proteinuria of BENCE JONES, C-reactive protein, weight measuring of immunoglobulins (Ig), immunofixation of Ig, creatinine and calcium. The results we obtained confirmed the presence of 14 cases of myeloma with: -9 IgG myelomas with 6 kappa light chains and 3 lambda light chains -4 IgA myelomas with 2 kappa light chains and 2 lambda light chains -1 IgG kappa, Ig lambda biclonal gammapathy united to a cryoglobulin of class I. We observed a predominance of the IgG over the others Ig and the kappa over the alpha light chains. The proteinuria of BENCE JONES was present among 3 patients, hypercalcemia among 4 patients and hypercreatininemia in 1 patient with chronic renal failure.

[Endobronchial tuberculosis presenting as an obstructive tumor in an HIV-1-positive patient. Apropos of a case and review of the literature]. / Tuberculose endobronchique se présentant comme une tumeur obstructive chez une patiente VIH-1 positive. A propos d'un cas et revue de la littérature.

INTRODUCTION: A rare case report of endobronchial tuberculosis is reported in an HIV-1 positive patient of black African origin. EXEGESIS: A 38-year-old woman of Guinean origin, HIV-1 positive, presented with persistent right upper lobe opacity at chest X-ray. Computerized tomography of the chest after injection confirmed this finding and revealed right laterotracheal and Barety space adenopathy. Investigations of acid-fast bacilli in the biological media were negative. Fiberoptic bronchoscopy showed endobronchial lesion on the wall of the ventral part of the right upper lobe, which had the appearance of bronchogenic carcinoma, and infiltrates in the dorsal mucosa. Biopsy of the lesion revealed granuloma formation, but no evidence of caseation necrosis. Identification of Mycobacterium tuberculosis in sputum culture helped arrive at a diagnosis of endobronchial tuberculosis similar to obstructive bronchial tumor. CONCLUSION: This case of endobronchial tuberculosis is the first described in an HIV-1 positive patient of black African origin. Mediastinal lymph node revealed by chest computerized tomography after injection could be the site of spreading of mycobacteria by fistulization of tuberculosis lymph node into the right main bronchus. Only the histology of lesions carried out during bronchial fibroscopy permitted the exclusion of endobronchial neoplasia. In addition, the sensitivity of direct microscopy for acid-fast bacilli is poor. Identification of Mycobacterium tuberculosis by sputum culture helped guide the diagnosis which was further confirmed by a good therapeutic response. This case of endobronchial tuberculosis in an immunodepressed patient underlines the difficulty in determining the etiology of pulmonary opacities.

Oxamniquine cures Schistosoma mansoni infection in a focus in which cure rates with praziquantel are unusually low.

An outbreak of Schistosoma mansoni in northern Senegal was observed in 1988, and chemotherapy with praziquantel in this recently established focus resulted in very low parasitologic cure rates. Among other explanations, the emergence of a praziquantel-tolerant parasite strain was feared. To study this hypothesis further, 138 persons with endemic S. mansoni infection were randomly allocated to treatment with either 20 mg/kg oxamniquine or 40 mg/kg praziquantel. Parasitologic cure rates at 6 weeks were significantly higher in the oxamniquine group (79%) compared with those in the praziquantel group (36%; P = .0043). The reduction in egg counts was generally good, but 12% less reduced in the praziquantel group. These results confirm that cure rates with praziquantel were abnormally low, whereas oxamniquine performed satisfactorily, as in other areas in which S. mansoni is endemic. The possibility of a praziquantel-tolerant S. mansoni strain must therefore be studied carefully.

Therapeutic evaluation of two different dose regimens of praziquantel in a recent Schistosoma mansoni focus in Northern Senegal.

A therapeutic trial, involving 130 Schistosoma mansoni-infected children, with no previous history of antischistosomal treatment, was carried out to evaluate the efficacy of two different dose regimens of praziquantel. The study was carried out because low cure rates were described in this recently established (1990) S. mansoni focus in northern Senegal, following treatment with a standard dosage of 40 mg/kg. The subjects were randomly allocated into two groups: one group (1) received 40 mg/kg in one oral dose, the other group (2) was treated with two oral doses of 30 mg/kg at a 6-hr interval. Parasitologic examination and circulating anodic antigen (CAA) detection were performed before, 10 days, three, six, and 21 weeks after chemotherapy. No significant differences in cure rates were found between the two groups. Six weeks after treatment, 34% and 44% of the individuals were found to be stool negative in group 1 and group 2, respectively. However, only 10-15% became completely negative according to the serum CAA antigen assay. Mean egg counts were reduced by 99% in both groups. Antigen detection confirmed the parasitologic results. Fewer side effects were observed in the group treated with 2 x 30 mg/kg, which may be explained by split dosage administration. Our study shows that the low cure rates observed in this area could not be improved by using a higher dosage of praziquantel.