Prevalence of malaria-helminth co-infections among children living in a setting of high coverage of standard interventions for malaria and helminths: Two population-based studies in Senegal.

Background: Concurrent infections of Plasmodium falciparum with Soil Transmitted Helminths (STH) and Schistosoma spp are still a major public health problem among children living in Sub-Saharan Africa. We conducted two prospective studies among children living in urban and rural settings of Senegal, where control programmes for malaria, STH and schistosomiasis have been sustained, to determine the prevalence of malaria-helminth co-infection. Methods: We enrolled 910 children aged 1-14 years from Saraya and Diourbel districts of Senegal in June and November 2021, respectively. We collected finger-prick blood samples from the children for malaria parasite detection using microscopy and PCR methods. Stool samples were also collected and Kato-Katz and PCR methods were used to detect STH and S. mansoni; and Merthiolate-iodine-formalin (MIF) test for other intestinal protozoans. Urine samples were analyzed using a filtration test, Point of Care Circulating Cathodic Antigens (POC-CCA) and PCR methods for detection of S. haematobium. Statistical analyses were performed to compare the continuous and categorical variables across the two study sites and age groups, as well as using the adjusted Odds ratios (aOR) to explore risk factors for malaria-helminth co-infections. Results: The overall prevalence of polyparasitism with P. falciparum, STH, S. haematobium and S. mansoni among children in the two study sites was 2.2% (20/910) while prevalence of P. falciparum-S. haematobium co-infection was 1.1% (10/910); P. falciparum-S. mansoni 0.7% (6/910) and P. falciparum with any intestinal protozoan 2.4% (22/910). Co-infection was slightly higher among 5-14 year old children (17/629, 2.7%; 95% CI: 1.43-3.97) than 1-4 years (3/281, 1.1%; 95% CI: -0.12-2.32) and, in boys (13/567, 2.3%; 95% CI: 1.27-3.96) than girls (7/343, 2.1%; 95% CI: 0.52-3.48). Children aged 5-14 years (aOR = 3.37; 95% CI: 0.82-13.77, p = 0.09), who were boys (aOR = 1.44; 95% CI: 0.48-4.36, p = 0.51) and lived in Saraya (aOR = 1.27; 95% CI: 0.24-6.69, p = 0.77) had a higher risk of malaria-helminth co-infection than other age group, in girls and those who lived in Diourbel. Living in houses with spaces between the walls and roofs as well as frequent contacts with water during swimming were statistically significant risk factors for malaria-helminth co-infection. Conclusions: The prevalence of malaria-helminth co-infection is low in two districts in Senegal, possibly due to sustained implementation of effective control measures for malaria and NTDs. These findings could help to develop and implement strategies that would lead to elimination of malaria and helminths in the study areas.

Fatigue-resistant high-performance elastocaloric materials made by additive manufacturing.

Elastocaloric cooling, a solid-state cooling technology, exploits the latent heat released and absorbed by stress-induced phase transformations. Hysteresis associated with transformation, however, is detrimental to efficient energy conversion and functional durability. We have created thermodynamically efficient, low-hysteresis elastocaloric cooling materials by means of additive manufacturing of nickel-titanium. The use of a localized molten environment and near-eutectic mixing of elemental powders has led to the formation of nanocomposite microstructures composed of a nickel-rich intermetallic compound interspersed among a binary alloy matrix. The microstructure allowed extremely small hysteresis in quasi-linear stress-strain behaviors-enhancing the materials efficiency by a factor of four to seven-and repeatable elastocaloric performance over 1 million cycles. Implementing additive manufacturing to elastocaloric cooling materials enables distinct microstructure control of high-performance metallic refrigerants with long fatigue life.

[An unusual cause of jaundice]. / Une cause inhabituelle d'ictère.

Hepatic impairment is common during hyperthyroidism. It is most often asymptomatic. Hyperthyroidism revealed by jaundice has been rarely described in the literature. We here report the case of a 52-year old patient in Dakar (Senegal) presenting with jaundice associated with pruritus. Laboratory tests showed elevated alanine aminotransferases (1.1 N), aspartate aminotransferase(1.5 N), alkaline phosphatases (3 N), gamma glutamyl transferases (1.3 N) and bilirubinemia (22 N). Abdominal ultrasound was normal. A toxic or drug-related cause, bile duct obstruction, viral or autoimmune hepatitis as well as primary biliary cholangitis were excluded. The dosage of thyroid hormones showed elevated free T4, 24 ng/dL (9-20 ng/dL) and undetectable plasma TSH less than 0.01µUI/mL (0,35-4,94 IU/mL). TSH receptor antibodies were positive 7.04 IU/L (n < 1.75 IU/L). Thyroid ultrasound objectified diffuse homogeneous hypervascular goiter. The diagnosis of hepatic impairment secondary to Graves-Basedow disease without cardiac dysfunction was retained. Clinical outcome and laboratory test results were favorable under carbimazole. Jaundice can be an indicator of hyperthyroidism. An investivation of clinical signs and laboratory parameters for hyperthyroidism is essential in patients with unexplained jaundice.

[Electrocardiographic and echocardiographic abnormalities in patients with cirrhosis due to viral hepatitis B: about 60 cases reported in the Hepatogastroenterologic Department at the Aristide Le Dantec Hospital in Dakar (HALD)]. / Anomalies électrocardiographiques et échocardiographiques au cours de la cirrhose virale b: à propos de 60 cas au service d'hepato-gastroenterologie de l'Hopital Aristide Le Dantec de Dakar (HALD).

This study aimed to evaluate the electrocardiographic abnormalities in patients with cirrhosis due to viral hepatitis B and to identify their determinants. We conducted a prospective study in the Hepatogastroenterologic Department and in the Department of Cardiology at the Aristide Le Dantec Hospital in Dakar over a period of 8 months. All patients with cirrhosis due to viral hepatitis B and without a history of heart disease were included in the study. We collected and analyzed the epidemiological, clinical, echographic, endoscopic, electrocardiographic, echocardiographic (2D and Doppler) data and laboratory data from all patients. Sixty patients were enrolled. The prevalence of cirrhosis due to viral hepatitis B was 3.4%. The average age was 41 years and the sex-ratio was 1.6 (37 men). Cirrhosis was classified as Child-Pugh B in 29 patients (49%), Child-Pugh C and Child Pugh A in 20 patients (33%) and 11 patients (18%) respectively. The most common electrocardiographic abnormalities included left ventricular hypertrophy and QTc interval prolongation detected in 27 patients (45%) and 24 patients (40%) respectively. Statistical analysis showed an association between prolonged QTc interval and the severity of cirrhosis (p = 0.01, RR = 2, CI = 0.24 - 0.341). Echocardiographic abnormalities were dominated by left ventricle dilatation (58.3%) and cardiac hyperoutput (43.3%), with an average output of 6.05 l/ min. Statistical analysis revealed a significant association between cirrhosis severity and cardiac hyperoutput (p = 0.003; CI: 95%, 2,883-38,58; RR = 2). A total of 14 patients (23.3%) had latent cirrhotic cardiomyopathy. Cirrhosis due to viral hepatitis B can cause a wide range of different cardiac abnormalities. These include morphological and/or electrophysiological abnormalities whose severity appears to be correlated with cirrhosis severity.

[Improving the quality of care after spontaneous abortions in rural Senegal]. / Amélioration de la qualité des soins après avortement (SAA) en zone rurale au Sénégal.

OBJECTIVES: To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal. PATIENTS AND METHOD: This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%. RESULTS: The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%. CONCLUSION: Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.

[Ectopic pregnancy in Senegal]. / Grossesse extra-utérine au Sénégal.

The objective of this prospective study was to analyse the epidemiology and prognosis of ectopic pregnancy in Senegal. From January 1 to December 31, 1996, 255 ectopic pregnancies were registered. The national rate of ectopic pregnancy was 0.6%. of expected pregnancies. However, rates differed greatly between areas in Senegal, with extremes ranging from 0.85%. in Dakar to 0.32%. in Thiès. The epidemiological profile was that of a young woman-mean age: 23 years old, mean parity=3, admitted with broken ectopic pregnancy (95%). A salpingectomy was performed in all cases. The maternal mortality rate was 1.20%, while morbidity, mainly due to post-operative infection, was found in 2.7% of the cases.

[Minilaparotomy with a mini-pfannenstiel incision for the early diagnosis of ectopic pregnancy in Africa]. / Intérêt du mini-pfannenstiel dans le diagnostic précoce de la grossesse extra-utérine en milieu africain.

OBJECTIVE: to evaluate the usefulness of an exploratory minilaparotomy under local anaesthesia in cases of suspected ectopic pregnancy. PATIENTS AND METHODS: Prospective study of the management of all cases of unruptured suspected ectopic pregnancy at the Gynaecological and Obstetrical Clinic at the Dakar University teaching hospital from 1 January, 2000, to 31 December, 2002. RESULTS: 44 unruptured ectopic pregnancies were recorded. The typical patient had no or few previous deliveries and was 30 years old; 27% of the patients presented risk factors for ectopic pregnancy. The principal motive for consultation was abnormal menstruation and pelvic pain; however, these symptoms together with a lateral uterine mass appeared in only 29.5% of the cases. Ultrasound examination was performed systematically and beta-HCG assessed for 36.8% of patients. The diagnostic was considered certain in 13.6% of the cases, probable in 36.3% and possible in 50%. Laparotomy was performed when the diagnosis was sure or probable, and an exploratory minilaparotomy was undertaken when the ectopic diagnosis was possible but uncertain. The diagnosis was confirmed in 79. 5% of the cases. The laparotomy failure rate was 18.7%, compared with 27.2% for the exploratory minilaparotomy, but the difference observed was not statistically significant (p=0.80). CONCLUSION: In view of the equipment problems that make beta-HCG assays and laparoscopy difficult to perform in Africa, the minilaparotomy under local anaesthesia is a useful alternative.