[Psycho-social and economic reintegration of women operated for urogenital fistula]. / Réinsertion psycho-sociale et économique des femmes opérées pour fistules obstétricales et non obstétricales au Congo.

OBJECTIVE: To study the psycho-social and economic reintegration of women operated for genital fistula in Congo. MATERIAL AND METHODS: This was a descriptive observational study conducted in Brazzaville and Ewo, Republic of Congo, from April 1 to October 31, 2018. It included patients operated for genital fistula between 2008 and 2017. Variables of interest were socio-demographic, reproductive and clinical characteristics. The analysis was performed using the SPSS 20 software. RESULTS: The overall, 34 patients were studied, with age ranging from 29 to 65 years old with a median of 43 (39, 50) year. The context of fistula occurrence was obstetrical in 24 women (70%). The Practice of an income-generating activity before, during and after fistula was 76%; 32% and 64% (P=0.0007). Concerning the psychological status, in these women, self-esteem went from 26% to 73% (P=0.0003) and the prevalence of suicidal thoughts went from 29% before fistula treatment to 0% after (P=0.0009). The tendency to isolate themselves went from 44% before fistula cure to 3% after (P=0.00008). With regards to reproductive life, 54% of women had no desire for maternity and 17% did not have a desire of sexual intercourse. Only 26% of women benefited from the psychologist. Support. CONCLUSION: In this series, we observed a resumption of income-generating activities in women operated for a treatment of urogenital fistula and a psychological recovery with an increase in self-esteem and a decrease in suicidal thoughts. LEVEL OF EVIDENCE: 4.

[Obstetrical vesico-vaginal fistula in Guinea: Data analysis of three sites of treatment at Engender Health ONG]. / Fistules vésico-vaginales obstétricales en Guinée : analyse des données de 3 sites de prise en charge de l'ONG Engender Health.

OBJECTIVE: To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea. PATIENTS AND METHODS: It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months. RESULTS: The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases. CONCLUSION: Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication. LEVEL OF EVIDENCE: 5.

[Comparative study of the outcome of surgical management of vesico-vaginal fistulas with and without interposition of the Martius graft: A Cameroonian experience]. / Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius: une expérience camerounaise.

INTRODUCTION: This study aimed to investigate whether Martius' graft has an effect on the outcome of the surgical management of genitourinary fistula. PATIENTS AND METHODS: This was a retrospective comparative study of all cases of genitourinary fistula that underwent curative surgery in two Cameroonian hospitals. Patients were all operated between January 2005 and July 2011 in the gynecology unit of the Maroua Regional Hospital and the University Hospital Centre of Yaoundé by a well-trained surgeon. The characteristics of women with fistulas operated without graft of Martius were compared with those of women operated with graft of Martius. RESULTS: Among the 81 genitourinary fistulas operated, 28 (34.6%) had benefited from graft of Martius. Depending on the characteristics of obstetric fistula, the two groups (that of patients who had a cure with, and that of patients who had a cure without interposition of graft of Martius) were similar: there was no difference in the proportion of rigid edges (89.3% vs. 73.6%, P=0.0989); in the proportion of vaginal flanges (78.6% vs. 60.4%, P=0.0986), in the proportion of cervical localization (42.9% vs. 28.3%, P=0.3762), in the proportion of fistulas with a size greater than 2 cm (64.3% vs. 39.6%, P=0.0702), nor in the proportion of recurrent fistulas (28.6% vs. 41.5%, P=0.2523) between the two groups. Similarly, both groups were comparable according to the results of surgery: there was no difference in the overall closure rate (85.7% vs. 79.2%, P=0.347) nor in the closure of fistula with continence (60.7% vs. 67.9%, P=0.260) between the two groups. The use of graft of Martius had no effect on the overall closure of genitourinary fistula in our series [OR: 1.57; 95% CI: 0.4 to 6.6; P=0.680]. CONCLUSION AND INTERPRETATION: The Martius graft does not seem to affect the outcome of the surgical management of genitourinary fistula. These results need to be confirmed by studies on a larger population.

Willingness to vaccinate children against COVID-19 declined during the pandemic.

OBJECTIVES: To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). RESULTS: Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). CONCLUSIONS: COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

[Knowledge, attitude and perception about obstetric fistula by Cameroonian women]. / Connaissance, attitude et perception vis-à-vis des fistules obstétricales par les femmes camerounaises Une enquête clinique conduite à Maroua, capitale de la province de l'extrême Nord du Cameroun.

INTRODUCTION: This study seeks to identify what the women who live in Maroua Cameroon know and think about obstetric fistula. POPULATION AND METHOD: It is a single hospital, cross-sectional, descriptive and comparative study. Ninety-nine women in the maternity service of the Maroua Provincial Hospital were interrogated on obstetric fistula between May and July 2005, by enquirers who were trained health agents using a questionnaire which required both closed and open answers. RESULTS: The women who had no previous knowledge of it were generally the illiterate (41.7% compared to 18.8%). More than a third of the women who had an idea of the fistula do not know that there is a surgical treatment for it. Whether they had the previous information on fistula or received it from us, one-tenth of the women suggested that suicide was the solution to fistula where as one-third of the women suggested that a patient suffering from fistula should be isolated. CONCLUSION AND INTERPRETATION: Illiteracy contributes significantly to the lack of knowledge of this affection. The population has a poor perception and a strong negative attitude towards obstetric fistula as they see isolation or suicide as the solution to it.

Structure-function relationships in scorpion neurotoxins. Identification of the supperreactive lysine residue in toxin I of Androctonus australis Hector.

In a previous article (Habersetzer-Rochat, C. and Sampieri, R. (1976) Biochemistry 15, 2254--2261) it was demonstrated that the toxin I of the North African Scorpion Androctonus australis Hector was inactivated after reaction with iodoacetate; the toxicity loss in mice was correlated with the carboxymethylation of one superreactive residue. In the present work, alkylation of toxin I was performed with iodo[14C]-acetate. Hence, it was possible, after reduction, S-methylation and chymotryptic hydrolysis of this toxin, to isolate the peptide containing the labelled lysine residue. By automatic Edman degradation, this residue was identified as being the penultimate lysine at position 56 in the primary sequence. Comparison of three primary structures of scorpion neurotoxins and comparison in different kinds of activity seem to indicate that this lysine residue is mainly important for toxicity in mice.

Crystal structure of toxin II from the scorpion Androctonus australis Hector refined at 1.3 A resolution.

The crystal structure of toxin II from the scorpion Androctonus australis Hector has been refined at 1.3 A resolution using restrained least-squares methods. The final R-factor is 0.148 for the 13,619 reflections between 7.0 A and 1.3 A resolution with F > 2.5 sigma (F) and the bond length standard deviation from ideality is 0.017 A. Although minor changes have been introduced relative to the model previously refined at 1.8 A resolution, the use of higher-resolution data has allowed the modelling of some discrete disorder. Thus, three residues (including a disulphide bridge) have been built with multiple conformations. Occupancies were refined for the 106 solvent molecules included in the model, nine of them with explicit multiple sites. There is well-defined electron density for some of the protein hydrogen atoms in the final difference Fourier map. A detailed description of the toxin structure is presented, along with a comparison with the high-resolution structure of the related variant-3 scorpion toxin.

Reduction of beta-adrenergic receptors by tertatolol: an additional mechanism for beta-adrenergic blockade.

Tertatolol is a potent new beta-blocker with no intrinsic sympathomimetic activity or beta 1/beta 2-receptor subtype selectivity. When given at therapeutic doses (5 mg/day) to human subjects it induced a reduction in the beta-adrenergic receptor number measured by 3H-CGP 12177 specific binding, without any change in the affinity on intact lymphocytes. This reduction was seen 7 hours (54%), 24 hours (35%), and 48 hours (30%) after a single drug dose. A similar receptor reduction was observed 7 hours (42%), 24 hours (37%), and 48 hours (15%) after 14 doses of the drug. In parallel, the pharmacologic efficacy of the drug was evident from the reduction in supine and upright heart rates and after submaximal exercise; heart rate was reduced to the same extent after single or repeated drug doses. The reduction of receptor number correlated well with the reduction in heart rate in the supine (P less than 0.001) and upright (P less than 0.01) positions and after exercise (P less than 0.02). In in vitro competitive binding experiments tertatolol was found to be a competitive inhibitor of beta-adrenergic receptors. However, on intact human lymphocytes preincubated with this drug, tertatolol reduced the density of beta-adrenergic receptors. We conclude that tertatolol, besides competitively inhibiting beta-adrenergic receptors, induced a marked and lasting decrease in the beta-adrenergic receptor number. This effect may be important for its beta-blocking effects.

Evidence of a preferential role of brain serotonin in the mechanisms leading to naloxone-precipitated compulsive jumping in morphine-dependent rats.

Various drugs acting on brain serotonin or catecholamines were administered concurrently with morphine during the development of dependence or before naloxone-precipitated withdrawal syndrome. Of the various drugs only cyproheptadine, a serotonin antagonist, and piribedil, a dopamine agonist, reduced the frequency of jumping (but not of diarrhea or ptosis) when administered with morphine during development of dependence. When administered before naloxone, d-fenfluramine, a serotonin releaser, markedly reduced jumping, but not diarrhea and ptosis, and clonidine blocked these latter signs without affecting the frequency of jumping. Of the other drugs examined only phenoxybenzamine reduced diarrhea in morphine-abstinent rats. It is suggested that serotonin is involved in the mechanisms which lead to compulsive jumping during naloxone-precipitated withdrawal, whereas adrenergic sites on which clonidine acts are mainly involved in the expression of signs, such as ptosis and diarrhea. No clear evidence was obtained of a role for dopamine in the withdrawal signs studied.

Differences in the effects of d-fenfluramine and morphine on various responses of rats to painful stimuli.

The effects of d-fenfluramine and morphine on various nociceptive responses of rats were investigated. Unlike morphine, which inhibited all the responses examined, d-fenfluramine inhibited jumping and paw licking of rats on a hot plate, but did not increase the latency of tail withdrawal from hot water. The effects of d-fenfluramine on both responses on the hot plate were prevented by pretreatment with metergoline, a serotonin antagonist, whereas this pretreatment only reduced the effect of morphine on paw licking. The inhibition of tail withdrawal by morphine was also significantly reduced by metergoline treatment. The results confirm previous findings suggesting a role of serotonin in the mechanism by which morphine inhibits some nociceptive responses in rats. They also show that d-fenfluramine, a selective releaser and uptake inhibitor of serotonin at nerve endings, does not completely reproduce the antinociceptive effects of morphine in this species.

The efficacy and acceptability of amineptine versus fluoxetine in major depression.

The temporal dimension, particularly anticipation, appears to be a very important component in the understanding of depressed patients. In a 90-day multicentre study, the efficacy and acceptability of amineptine and fluoxetine were compared in 169 patients with major depression. Comparison of the two antidepressants was based on double-blind methods, after random allocation of the treatments between two parallel groups. The two drugs did not differ over the whole course of the study, but the improvement in scores on day 4 was globally more marked in the amineptine than the fluoxetine group. Intragroup analysis showed that amineptine was significantly superior to fluoxetine on the retardation pole of the mood, anxiety, retardation, danger scale. The positive effect of amineptine on anticipation may enable the depressed patient to make plans for the future. Anticipation may be a key dimension to be more precisely explored in specific psychopharmacological protocols with antidepressants.

Necrotizing herpetic retinopathies. A spectrum of herpes virus-induced diseases determined by the immune state of the host.

PURPOSE: Necrotizing herpetic retinopathies (NHR), a new spectrum of diseases induced by viruses of the herpes family (herpes simplex virus, varicella-zoster virus and cytomegalovirus), includes acute retinal necrosis (ARN) occurring in apparently immunocompetent patients and progressive outer retinal necrosis (PORN) described in severely immuno-compromised patients. Signs of impaired cellular immunity were seen in 16% of ARN patients in a review of 216 reported cases, indicating that immune dysfunction is not only at the origin of PORN but might also be at the origin of ARN. The aim of this study was to correlate clinical findings in NHR patients with their immunologic parameters. METHODS: Charts from patients with the diagnosis of ARN or PORN seen from 1990 to 1995 were reviewed. Clinical characteristics and disease patterns were correlated with immunological parameters taking into account CD4 lymphocyte rate in AIDS patients and blood-lymphocyte subpopulation determination by flow cytometry, cutaneous delayed type hypersensitivity testing and lymphocytic proliferation rate to seven antigens in HIV-negative patients. RESULTS: During the period considered, 11 patients and 7 patients fulfilled the criteria of ARN and PORN respectively. Immune dysfunctions were identified in most patients. Mild type of ARN and classical ARN were associated with discrete immune dysfunctions, ARN with features of PORN was seen in more immunodepressed patients and classical PORN was always seen in severely immunodepressed HIV patients. CONCLUSION: Our findings suggest that NHR is a continuous spectrum of diseases induced by herpes viruses, whose clinical expression depends on the immune state of the host going from mild or classical ARN at one end in patients with non-detectable or slight immune dysfunction to PORN in severely immunodepressed patients at the other end and with intermediary forms between these extremes.

[Vasodilator effect of tertatolol on isolated rat kidney]. / Action vasodilatatrice du tertatolol sur le rein isolé de rat.

Tertatolol, a non cardioselective beta-blocker, maintains or increases renal blood flow in animals and in man. In this work, we confirmed in vitro the renal vasodilator effect of tertatolol and we investigated its mechanism. The rat kidney was isolated and perfused at constant flox in an open circuit with a Krebs-Henseleit solution. A vascular tone was restablished by sequential bolus injections of serotonine (every 5 mn) at a dose increasing perfusion pressure by 40 mm Hg. Tertatolol and other drugs were perfused at increasing concentrations during successive periods of 15 mn. Any relaxation was expressed as percentage inhibition of the initial vaso-constriction induced by serotonine. Tertatolol (3 x 10(-7) to 3 x 10(-5) M) induced a concentration-dependent renal vasodilatation (CI50 = 4.6 +/- 0.4 x 10(-6) M, n = 5) with a maximum effect of nearly 100 p. 100 relaxation. (-) tertatolol and (+) tertatolol were respectively more and less active (CI50 = 1.7 +/- 0.3 x 10(-6) M and 10.6 +/- 2.5 x 10(-6) M, n = 5). Tertatolol metabolites (4-OH tertatolol and sulfoxytertatolol) were inactive, excluding a vascular effect of tertatolol related to its metabolism into vasoactive derivatives. Other beta-blocking drugs, (+/-) sotalol and (+/-) nadolol, were also inactive on the renal vasculature and (-) bunolol only induced renal vasodilatation at concentrations 40 fold higher than that of (-) tertatolol.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of the efficacy and acceptability of amineptine and fluoxetine in patients with major depression]. / Etude comparative de l'efficacité et de l'acceptabilité de l'amineptine et de la fluoxétine chez des patients dépressifs majeurs.

We compare two anti-depressant drugs, amineptine and fluoxetine, in a multicentric study. Amineptine is a dopamine reuptake inhibitor, and fluoxetine a serotonin reuptake inhibitor. Eighteen french centers participate in the study. One hundred and sixty nine outpatients were randomly assigned to either 200 mg of amineptine or 20 mg of fluoxetine during 90 days. They fulfilled the DSM III-R criteria of major depressive disorder. They were aged from 18 to 70. Minor tranquilizers were allowed during the study. The patients were evaluated at D0, D7, D21, D42 and D90. If possible, an additional evaluation was made at D4. Clinical evaluations included Clinical Global Investigation (CGI), Montgomery and Asberg Depressive Rating Scale (MADRS), HARD scale, Widlocher Retardation rating scale and Hopkins Symptom Check-list (HSCL). Somatic concerns were recorded at each visit. Among the 169 patients included in the study, only 141 ended it at D90. The two drugs had good antidepressive efficacy which was noticed as soon as D7 up to D90. If we compare the antidepressant activity, no statistical differences could be observed between the two drugs using different scales. The percentage of patients with an improvement of at least 50% of the global score at MADRS was 8.3% at D7; 41% at D21, 69.2% at D42 and 83.2% at D90 for the amineptine group. For the fluoxetine group, these percentages were, 7.7%; 37.8%; 78.9%; 82.1%. No statistical differences could be noticed between the two groups, and at any time of the study. We have tried to look for a rapid antidepressive action by a clinical evaluation at D4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anticipatory Cognitions Questionnaire (ACQ). Presentation and validation]. / Le questionnaire des cognitions anticipatoires (QCA). Présentation et validation.

The capacity of anticipation is fundamentally disturbed in depressed patients. These patients make negative predictions. Anticipation disturbances are reflected in different symptoms but also in the patient's cognitions. The cognitive approach is an operational way to deal with the concept of anticipation. The cognitive model of depression has been extensively studied and cognitive therapies have been validated as effective treatments of depression. A self-questionnaire has been elaborated, taking into account the different cognitive mechanisms disturbed in depressed patients. The "Anticipatory Cognitions Questionnaire" (ACQ) explores patient's cognitions in concrete daily life situations that require anticipation. The first version of this questionnaire contained 18 items. A previous study had led to reduce the number of items and to modify the form of the questionnaire. In its final version, the ACQ has 8 items. Each of them refers to a concrete situation (i.e. "I have no news from a loved one") and the patient is asked to say how a proposed cognition (i.e. "I will call him to get in touch") applies to him, choosing one of the four answers "true", "rather true", "rather wrong" and "wrong". The validation of this questionnaire has been carried out, in comparison with the MADRS and Pichot's QD2A. 151 subjects were included in this validation study, 72% of them meeting with the DSM III-R diagnostic criteria of clinical depression and 28% not having any psychiatric disorder. Statistical analysis shows that the ACQ is more sensible than the QD2A but less than the MADRS.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prostaglandin E1--the pharmacologic prosthesis]. / Prostaglandine E1--la prothèse pharmacologique.

The treatment of erectile failure has developed rapidly over the last decade with the introduction of intracavernosal self injection therapy, first with phenoxybenzamine, then with papaverine and paraverine-phentolamine. These drugs are now progressively replaced by prostaglandin E1 mainly because of its efficacy and fewer side effects. Prostaglandin E1 can induce a rigid erection even in case of severe arteriopathy and offers an excellent alternative to a prosthetic implant.