[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]. / Prevalence de la maladie renale au service des urgences de l'hopital Fousseyni Daou de Kayes.

INTRODUCTION: Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study. OBJECTIVES: to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes. METHODOLOGY: Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found. RESULTS: the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension. CONCLUSION: kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

INTRODUCTION: La maladie rénale (MR) définie comme l'ensemble des anomalies rénales fonctionnelle, morphologique et histologique. Elle est un véritable problème mondial de santé publique. Sa prévalence serait 50 fois celle de l'insuffisance rénale terminale (IRT). A Kayes, il n'existe pas de donnée sur la prévalence de la maladie rénale, d'où l'intérêt de cette étude. OBJECTIFS: déterminer la prévalence de la maladie rénale, ses principales causes et les principaux facteurs d'aggravation de cette pathologie dans le service des urgences de l'hôpital Fousseyni DAOU de Kayes. MÉTHODOLOGIE: Etude transversale rétrospective réalisée du 1er janvier 2014 au 1er février 2015. Etaient inclus, tous les patients hospitalisés chez qui au moins un marqueur d'atteinte rénale (élévation de la créatinine plasmatique, anomalie du sédiment urinaire, anomalie échographique ou histologique et une protéinurie significative) a été retrouvé. Les paramètres analysés étaient socio-épidémiologiques, cliniques et para-cliniques. Nous avons exclu tous les patients dont les dossiers médicaux étaient inexploitables. RÉSULTATS: la prévalence de la maladie rénale était de 9,9% (109/1099). Quatre-vingtneuf répondaient aux critères d'inclusion. La population d'étude était composée de 47 femmes (52,8%) et de 42 hommes (47,2%), avec un sex-ratio de 0,89 en faveur des femmes. La moyenne d'âge était de 40,09 ans avec une prédominance des patients de la tranche d'âge [40-59]. Les principaux motifs de consultation étaient hypercréatininémie (48,3%), syndrome œdémateux (16,9%), douleur lombaire (10,1%). L'hypertension artérielle (55,1%) et œdème des membres inférieurs (46,1%) étaient les antécédents pathologiques fréquemment retrouvées dans notre étude. La maladie rénale retrouvée était par ordre de croissance : insuffisance rénale chronique (51%) ; insuffisance rénale aigue (28%) ; protéinurie (16%), hématurie (3%), anomalie morphologique des reins (2%). La néphropathie tubulo-interstitielle représentait 64% des insuffisances rénales aiguës avec P= 0,000306. La néphropathie vasculaire constituait 46,7% des insuffisances rénales chroniques avec P= 0,000251. Aucun cas de néphropathie glomérulaire n'a été retrouvé chez les patients de plus de 60 ans.Les causes les plus fréquentes étaient représentées par les causes toxiques (médicaments néphrotoxiques) ; infectieuses ; l'hypertension artérielle et le diabète. Les facteurs d'aggravations les plus observés sont la phytothérapie, l'infection urinaire, l'hypoperfusion rénale et l'HTA non équilibrée. CONCLUSION: la maladie rénale n'est pas rare aux urgences de l'hôpital Fousseyni Daou de Kayes. Les causes les plus fréquemment rencontrées sont les médicaments néphrotoxiques, l'HTA et le diabète.

[Radiochemotherapy for the treatment ofmuscle invasive bladder tumors in a west african radiotherapy service]. / Radiochimiotherapie pour le traitement des tumeurs de vessie infiltrant lemuscle dans un service de radiotherapie ouest africaine.

OBJECTIF: The aim of this study was to describe the results of radiochemotherapy in patients after transurethral resection of muscle invasive bladder tumors. MATERIAL AND METHODS: A retrospective study from May 2014 to May 2016 in the radiotherapy department of the Mali Hospital. Have been included, all patients with bladder cancer infiltrating the muscle. Secondary cancers of the bladder and metastatic forms have been excluded from our study. Transurethral resection of bladder was performed. Neoadjuvant chemotherapy with paclitaxel- carboplatin was administered every three weeks in all patients, then external phototherapy 6 MV at a dose of 66 Gy due to 2 Gy of 5 sessions per week 6MV photon of external beam radiotherapy at a dose of 66 Gy due to 2 Gy of 5 sessions per week associated with concomitant cisplatin at dose of 40mg / m2 / week. RESULTS: Eight patients were included in ourstudy. The average age of 53.75 ± 14.84 years. The male sex was predominant 87.5% (n = 7). The history of chronic smoking wasfound in four patients. The main carcinogenic risk factor identified in our patients was urogenital bilharzia (6 cases / 8).The histological type found was urothelial carcinomain 12.5% (n = 1) and invasive squamous cell carcinomain 87.5% (n = 7). Transurethral resection of the tumor was performed in 62.5% (n = 5). Endoscopic biopsy was performed in 37.5% (n = 3). The tumor was classified pT2N0M0 in 50% (n = 4), pT3aN0M0 in 37.5% (n = 3) and pT3bN0M0 in 12.5% (n = 1). Neoadjuvant chemotherapy with paclitaxel - carboplatin every three weeks was administered to all patients. The results of radiochemotherapy (see Table: evolution). CONCLUSION: Concomitant radiochemotherapy is a conservative curative treatment that can be proposed as a replacement for cystectomy, for non-metastatic infiltrating tumors after the most complete endoscopic resection.

OBJECTIF: Le but de cette étude était de décrire les résultats d'une radiochimiothérapie chez les patients après résection transurétrale des tumeurs de vessie infiltrant le muscle. MATÉRIEL ET MÉTHODES: Une étude rétrospective allant de mai 2014 à mai 2016 au service de radiothérapie de l'hôpital du Mali. Ont été inclus, tous les patients présentant un cancer de vessie infiltrant le muscle. Les cancers secondaires de la vessie ainsi que les formes métastatiques ont été exclus de notre étude. La résection transurétrale de vessie a été réalisée. La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine a été administrée toutes les trois semaines. La radiothérapie externe au photon 6MV à la dose de 66 Gy en raison de 2 Gy de 5 séances par semaine associée à la chimiothérapie concomitante à base de cisplatine (CDDP) 40mg/m2/semaine a été réalisée. RÉSULTATS: Au total huit patients ont été inclus dans notre étude. L'âge moyen de 53,75±14,84 ans. Le sexe masculin était prédominant 87.5% (n=7). L'antécédent de tabagisme chronique était retrouvé chez quatre patients. Le principal facteur de risque cancérigène identifié chez nos patients était la bilharziose urogénitale (6cas/8). Le type histologique retrouvé était le carcinome urothelial dans 12.5% (n=1) et le carcinome épidermoïde infiltrant dans 87.5% (n=7). La résection transurétrale de la tumeur a été réalisée dans 62.5% (n=5). La biopsie par voie endoscopique été réalisée dans 37.5% (n=3). La tumeur été classée pT2N0M0 dans 50% (n= 4), pT3aN0M0 dans 37.5% (n=3) et pT3bN0M0 dans 12.5% (n= 1). La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine chaque trois semaines a été administrée chez tous les malades.Les résultats de la radiochimiothérapie (cf. Tableau: évolution). CONCLUSION: La radiochimiothérapie concomitante est un traitement curatif conservateur qui peut être proposée en remplacement à la cystectomie pour les tumeurs infiltrantes non métastatiques après une résection endoscopique la plus complète possible.

French prenatal Vitamin D recommended supplementation: Enough or not?

OBJECTIVE: To determine the impact of current recommended vitamin D prenatal supplementation on blood cord 25(OH)D level in a French cohort and to determine population at risk of higher needs. DESIGN AND SETTING: An observational prospective study was conducted in teaching hospital including two large groups of newborns, one born after summer and another after winter period. PATIENTS AND METHODS: Three hundred and ninety-nine mother/newborns pairs were enrolled and blood cord results were available for 225 newborns in the post-summer group and 174 newborns in the post-winter group. Maternal supplementation during pregnancy was recorded from medical notes and questionnaires. RESULTS: 25(OH)D level were generally low with mean at 50.9±24.7nM. Vitamin D supplementation was prescribed in only 37.6% over all the study period. Studying general population, 25(OH)D was significantly higher in the supplemented group, but current recommended supplementation failed to cover the needs for most subgroups of newborns. After winter, 25(OH)D cord blood level was in deficiency range for 40.7% of the general population and in the pigmented mothers group the deficiency rates even rose up to 61.9%. DISCUSSION AND CONCLUSION: Vitamin D cord level is low in north of France as in other industrial countries. Despite national guidelines on vitamin D supplementation, the rates are currently insufficient. Beside, although the recommended 100,000IU single dose helps to limit deficiency in newborns, it fails to cover infant's needs for optimal status. Actually, benefit of this substitution is for children below the 10th percentile weight. A new recommendation with higher rate of vitamin D for all pregnant women after specific studies seems to be indicated.

Effectiveness, safety, and cost of partial exchange transfusions in patients with sickle-cell anemia at a sickle cell disease center in sub-Saharan Africa.

The partial exchange transfusions necessary for management of some sickle-cell complications raise the issue of effectiveness in the context of limited resources and inadequate blood safety. This study evaluated the effectiveness, safety, and cost of partial exchange transfusions in 39 patients with sickle-cell anemia in Lubumbashi, looking at the patients' age and gender and the tolerability and direct cost of the transfusions. Excel and SPSS 18 were used for data entry and analysis. Chi2 and Fisher exact tests were used for comparisons. A P-value ≤ 5% was considered statistically significant. The average age of patients was 8.6 ± 6.4 years, and the majority were girls. The most frequent indications were stroke, severe infections, severe vasooclusive crises, and acute chest syndrome. Partial exchange transfusions were effective in improving hemoglobin and hematocrit as well as the percentage of HbS. No acute accident was observed during any partial exchange transfusion; one anti-Kell alloimmunization and 2 cases of iron overload were observed. The annual cost of partial exchange transfusions per patient requiring (and able to afford) regular treatment was US $ 3,345 without iron chelation and more than US $ 5000 with chelation. Partial exchange transfusions are effective and tolerated, but financially inaccessible to the majority of our sickle cell patients. Thus, an assessment is needed of the economic burden of sickle cell complications that require partial exchange transfusions in the context of countries with limited financial resources.

Antioxidant activities and phenolic contents of extracts from Glinus oppositifolius aerial parts.

UNLABELLED: In Malian traditional medicine, aerial parts of Glinus oppositifolius are used in the treatment of many disorders, particularly inflammations and joint pains. AIM: The present study was initiated to investigate the antioxidant potential of Glinus oppositifolius. MATERIAL AND METHODS: Aqueous and ethanol extracts were prepared from the dried aerial parts. Both extracts were examined for the phenolic content and antioxidant activity. Total phenolic content was quantified by Folin-Ciocalteu method. Antioxidant activity was studied in vitro by evaluating the ability to scavenge different free radicals (ABTS, superoxide and hydroxyl radicals, nitric oxide) and to chelate ferrous ions. RESULTS: Aqueous extract was found to contain a higher level of total phenols than ethanol extract (1.27 +/- 0.04 vs. 0.94 +/- 0.05 g GAE/100 g extract). Both extracts lacked the ability to scavenge superoxide anion radical but scavenged ABTS and hydroxyl radicals, nitric oxide and chelated ferrous ions in a concentration-dependent manner. According to the EC50 values, aqueous extract showed stronger antioxidant effects than ethanol extract (174.32 +/- 1.49 vs. 276.76 +/- 1.52 microg/mL in ABTS radical cation scavenging assay, 119.91 +/- 1.70 vs. 240.57 +/- 0.97 microg/mL in nitric oxide scavenging assay, 1.99 +/- 0.01 vs. 6.54 +/- 0.08 mg/mL in ferrous ion chelating assay). In hydroxyl radical scavenging assay, aqueous extract had an EC50 value of 0.86 +/- 0.00 mg/mL while the EC50 value of ethanol extract was higher than the highest concentration that was tested (3.75 mg/mL). CONCLUSIONS: Our results clearly indicate the antioxidant potential of Glinus oppositifolius aerial parts and suggest that the antiinflammatory activity might be partly related to the antioxidant potential.

[Relationship between glomerular filtration rate, uric acid, and parathyroid hormone in children]. / Relation entre débit de filtration glomérulaire, parathormone et acide urique chez l'enfant.

INTRODUCTION: Parathyroid hormone (PTH) and uric acid (UA) levels increase early during chronic kidney disease (CKD). The objective of this study was to evaluate the relationship between these two parameters at different stages of pediatric CKD. PATIENTS AND METHODS: One hundred patients (range, 5-18 years) were included in this retrospective study: they had undergone renal exploration with a direct measurement of the glomerular filtration rate (GFR) using the reference standard (i.e., inulin clearance, Cin) and presented with increased circulating levels of PTH and/or UA. RESULTS: GFR was normal in 39% of patients, with UA increased in 44% and PTH in 75% of them. Interestingly, 29% of the children with increased PTH levels had a strictly normal GFR (i.e., above 90 mL/min/1.73 m(2)). An inverse association was found between UA and GFR (r=-0.452, P ≤ 0.0001) as well as between PTH and GFR (r=-0.226, P=0.024). The same negative relationships were found between UA and PTH (r=-0.266, P=0.007), and between UA and the phosphate reabsorption rate (r=-0.415, P<0.001). DISCUSSION: Since hyperuricemia was found at all stages of CKD, an early silent tubular impairment can be discussed to explain these findings. The early increase in PTH levels during CKD has not been described by all authors, with North American studies describing rather late increased PTH levels during CKD. Prospective studies are required to confirm these data and evaluate the role of UA in the pathophysiology of the mineral disorders observed during CKD.

Pectic polysaccharides isolated from Malian medicinal plants protect against Streptococcus pneumoniae in a mouse pneumococcal infection model.

The aim of this study was to investigate whether the pectic polysaccharides BP-II, Oc50A1.I.A and CC1P1 isolated from the Malian medicinal plants Biophytum petersianum, Opilia celtidifolia and Cola cordifolia, respectively, were able to protect against Streptococcus pneumoniae infection in mice. The pectin preparations were administered intraperitoneally 3 h before challenge with S. pneumoniae serotype 6B. Blood samples were obtained from all animals before and at 3 h, 24 h and 72 h after challenge with the pneumococci. The number of bacteria in blood was recorded and the blood concentration of a range of cytokines measured. The pretreatment with BP-II, Oc50A1.I.A and CC1P1 demonstrated a protective activity against S. pneumoniae serotype 6B infection, albeit at different range of concentrations. The pectins showed no direct antibacterial effects towards S. pneumonia; however, they induced the production of a range of cytokines and chemokines. We have previously shown that BP-II, Oc50A1.I.A and CC1P1 exhibit complement fixation activity and also that BP-II and Oc50A1.I.A stimulate macrophages to produce NO. The observed clinical effect might therefore be linked to the ability of the pectic polysaccharides to stimulate the innate immune system.

Chemical and biological characterization of polysaccharides from wild and cultivated roots of Vernonia kotschyana.

ETHNOPHARMACOLOGICAL RELEVANCE: In Malian traditional medicine the roots of Vernonia kotschyana are used for treating gastric ulcer and gastritis. In 2006, 9000kg of roots from Vernonia kotschyana were used to produce Gastrosedal, an ameliorated traditional medicine in Mali. Harvesting from the wild, the main source of raw material, is causing a growing concern of diminishing populations of the plant, and Vernonia kotschyana is now being cultivated in several areas around Mali. In the current study the structures and bioactive properties of isolated polysaccharides from wild and cultivated Vernonia kotschyana were compared. MATERIALS AND METHODS: Pectin- and inulin-type polysaccharides were isolated from the roots of cultivated and wild Vernonia kotschyana. The isolated polysaccharides were investigated regarding their chemical compositions, and for their abilities to fixate human complement and activate macrophages from a mouse macrophage cell line. RESULTS: No significant differences in the carbohydrate composition of the fractions isolated from the cultivated versus the wild roots were observed. A previously reported pectic arabinogalactan Vk2a was found in both the cultivated and the wild roots in this study, and exhibited potent complement fixation activity, and a moderate activation of macrophages. CONCLUSIONS: The present study has shown that the cultivated roots of Vernonia kotschyana contain the same types of bioactive polysaccharides as the wild roots. It is therefore preliminarily feasible for the cultivated roots of Vernonia kotschyana to be used as a herbal medicine to replace the wild roots.

Etude de la consommation des medicaments traditionnels ameliores dans Le district sanitaire de Kadiolo (region de Sikasso; Mali)

L'etude; qui a recu le soutien de la Direction du Developpement et de la Cooperation de la Confederation Helvetique dans le cadre du Programme d'Appui Socio-Sanitaire Mali Suisse; s'est deroulee de fevrier a mars 2004. Le but etait d'evaluer l'impact d'un atelier de formation des prescripteurs sur les Medicaments Traditionnels Ameliores (MTA); realise en octobre 2001; sur la consommation des MTA dans les structures sanitaires du District de Kadiolo. L'etude a demande la collecte des donnees de consommation; a partir des fiches de stock des annees 2001; 2002 et 2003 du Depot Repartiteur du Centre de Sante de Reference et des Depots de Vente des Centres de Sante Communautaires. Pour evaluer l'appreciation des MTA; des enquetes ont ete menees aupres des prescripteurs et des utilisateurs. La consommation totale des MTA dans le CSRef et dans les 16 CSCom du Cercle a connu une augmentation progressive; en passant de 2.565.480 F CFA en 2001 a 4.307.760 F CFA en 2003. La consommation des MTA pendant l'annee 2003 a ete de 27;83 F CFA par habitant. Les MTA ont ete en general bien apprecies par les prescripteurs et par les consommateurs. Les differentes projections des donnees de consommation relevees a Kadiolo nous ont permis d'estimer le marche potentiel des MTA actuellement disponibles au Mali a une valeur comprise entre 414 et 560 millions de F CFA

Antitussive activity of polysaccharides isolated from the Malian medicinal plants.

From the leaves of popular Malian medicinal plants Trichilia emetica (TE) and Opilia celtidifolia (OC), and fruits of Crossopteryx febrifuga (CF) water and water-ethanol soluble polysaccharide materials were isolated. The results of chemical analysis of the crude polysaccharides showed the dominance of the arabinogalactan ( approximately 54%) and the rhamnogalacturonan ( approximately 30%) in T. emetica leaves, the arabinogalactan ( approximately 60%), the rhamnogalacturonan ( approximately 14%) and the glucuronoxylan ( approximately 14%) in O. celtidifolia leaves, and pectic type of polysaccharides ( approximately 75%) with a lower content of the arabinogalactan ( approximately 17%) in C. febrifuga fruits. The plant polysaccharides showed various biological effects on the citric acid-induced cough reflex and reactivity of airways smooth muscle in vivo conditions. T. emetica and O. celtidifolia polysaccharides possessed significant cough-suppressive effect on chemically induced cough. Furthermore, values of specific airways resistance pointed on bronchodilatory property of polysaccharides isolated from O. celtidifolia. However, the crude extract from C. febrifuga in the same dose as T. emetica and O. celtidifolia did not influence the experimentally induced cough as well as reactivity of airways smooth muscle despite of the fact that the water-ethanol extract is recommended for cough therapy in Mali in the form of syrup.

Activite diuretique et salidiuretique d'une recette utilisee en medecine traditionnelle pour le traitement de l'hypertension arterielle

"Notre etude sur le traitement traditionnel de l'hypertension a porte sur la recette Nitrokoudang a base de Sclerocarya birrea et Vitex doniana. L'etude phytochimique par les reactions de caracterisation en tube et la chromatographie sur couche mince a permis de mettre en evidence des tanins; des flavonoides; des leucoanthocyanes; des oses et holosides. L'infuse a presente un grand nombre de substances anti-radical 1;1'diphenyl-2 picryhydrazyle (DPPH); ce qui presage un potentiel antioxydant de la recette; ceci est important dans la prise en charge de l'hypertension arterielle. Les extraits aqueux de la recette ont presente une activite diuretique dose dependante. L'infuse extemporane; prepare selon les indications du tradipraticien de sante; a presente le meilleur effet diuretique avec une excretion urinaire volumetrique de 170; le Furosemide a la dose de 20mg/kg; a presente 184. Chez les animaux traites par la recette; l'elimination du sodium a ete importante et le potassium a ete epargne. L'activite salidiuretique de l'infuse extemporanee a ete de 2 contre 2;62 pour le Furosemide et de 0;90 chez les souris traitees avec l'eau distillee. Ces proprietes de la recette ""Nitrokoudang"" justifient son utilisation dans la prise en charge de l'hypertension arterielle."

Screening of Malian medicinal plants for antifungal, larvicidal, molluscicidal, antioxidant and radical scavenging activities.

A total of 78 different extracts from 20 medicinal plants belonging to 14 plant families from Mali were tested for their antifungal, larvicidal, molluscicidal, antioxidant and radical scavenging activities. Dichloromethane, methanol, water and ethanol extracts were used. TLC autobiography for antifungal activity was run with Cladosporium cucumerinum and Candida albicans. Extracts were also tested on the larvae of the mosquitoes Aedes aegypti, Anopheles gambiae and Culex quinquefasciatus. Molluscicidal activities were established with the snails Biomphalaria glabrata, Biomphalaria pfeifferi and Bulinus truncatus. beta-Carotene and DPPH solutions sprayed on TLC plates were used for antioxidant and radical scavenging assays. Of the extracts investigated, 20% were antioxidant and radical scavengers, 19% fungicidal, 30% were larvicidal and 11% were molluscicidal. Three of the plant extracts, from Cussonia barteri (Araliaceae), Glinus oppositifolius (Aïzoaceae) and Lannea velutina (Anacardiaceae) gave positive responses in all four tests.

Effect of zinc supplementation on malaria and other causes of morbidity in west African children: randomised double blind placebo controlled trial.

OBJECTIVE: To study the effects of zinc supplementation on malaria and other causes of morbidity in young children living in an area holoendemic for malaria in west Africa. DESIGN: Randomised, double blind, placebo controlled efficacy trial. SETTING: 18 villages in rural northwestern Burkina Faso. PARTICIPANTS: 709 children were enrolled; 685 completed the trial. INTERVENTION: Supplementation with zinc (12.5 mg zinc sulphate) or placebo daily for six days a week for six months. MAIN OUTCOME MEASURES: The primary outcome was the incidence of symptomatic falciparum malaria. Secondary outcomes were the severity of malaria episodes, prevalence of malaria parasite, mean parasite densities, mean packed cell volume, prevalence of other morbidity, and all cause mortality. RESULTS: The mean number of malaria episodes per child (defined as a temperature >/=37.5 degrees C with >/=5000 parasites/microliter) was 1.7, 99.7% due to infection with Plasmodium falciparum. No difference was found between the zinc and placebo groups in the incidence of falciparum malaria (relative risk 0.98, 95% confidence interval 0.86 to 1.11), mean temperature, and mean parasite densities during malaria episodes, nor in malaria parasite rates, mean parasite densities, and mean packed cell volume during cross sectional surveys. Zinc supplementation was significantly associated with a reduced prevalence of diarrhoea (0.87, 0.79 to 0.95). All cause mortality was non-significantly lower in children given zinc compared with those given placebo (5 v 12, P=0.1). CONCLUSIONS: Zinc supplementation has no effect on morbidity from falciparum malaria in children in rural west Africa, but it does reduce morbidity associated with diarrhoea.

Polysaccharides from the roots of Entada africana Guill. et Perr., Mimosaceae, with complement fixing activity.

Entada africana is a tree used in traditional medicine in Mali. The root is, for example, used for wound-healing. Since polysaccharides from other plants are thought to play a role in the wound-healing process, we wanted to study the polysaccharides present in the root of this species. The polysaccharides were extracted with water at 50 and 100 degrees C and were further separated by anion exchange chromatography. The acidic fractions were finally purified by affinity chromatography on a Con A column. The fraction denoted Ea100 acidic I had the highest activity in the complement fixation test system, while the other acidic fractions had minor activities and the neutral fractions were almost negative. Ea100 acidic I has a structure resembling the arabinogalactan-protein type II polymer, which also was demonstrated by the abilities to precipitate with the Yariv reagent. The biological activity was reduced considerably after removal of arabinofuranoside residues by weak acid hydrolysis. The main core of the other polysaccharides extracted with 100 degrees C were pectins resembling the rhamnogalacturonan type I. These fractions also contain arabinogalactan type II structures, shown by the formation of precipitates with the Yariv reagent.

[Hyperhomocysteinemia and pregnancy: a dangerous association]. / Hyperhomocystéinémie et grossesse : une association dangereuse.

Homocysteine results from the demethylation of the essential amino acid methionine. Its metabolism depends primarily on three enzymes and several vitamin cofactors (vit. B6, B9 and B12). Genetic abnormality in these enzymes or deficiency of these vitamins lead to Hyperhomocysteinemia. Hyperhomocysteinemia belongs among the congenital thrombophilies and is a long-known vascular disease risk factor. The discovery that hyperhomocysteinemia may also be responsible for several pregnancy complications has only recently been made. Studies in this area are still scarce and report on limited numbers of patients. It nevertheless appears clear that HHCh is associated with the syndromes of repeated miscarriage, pre-eclampsia, placenta abruptio, thromboembolic events, neural tube defects, and perhaps with fetal death-in-utero and intra-uterine growth retardation. Supplementation with vitamin B9 can reduce plasma HC levels, and is thus recommended in patients with HHCh. The prevention of thromboembolic events during pregnancy by anticoagulant treatment is also desirable in these patients.

Iron deficiency in pregnancy: effects on the newborn.

Iron deficiency during pregnancy affects a significant portion of women in countries with low economic wealth and is not uncommon in pregnant women in industrialized countries. Inadequate intake of iron related to diets poor in bioavailable iron is often responsible for iron deficiency before pregnancy, and metabolic adjustments (such as mobilization of iron stores and increased absorption) are insufficient to meet increasing needs during pregnancy. The effects of iron deficiency on the fetus are still controversial. Numerous measures, including the evaluation of erythrocyte ferritin, favor the hypothesis that the level of iron stores in newborns is related to maternal iron status and that the materno-fetal unit is dependent on exogenous iron, which is necessary to prevent iron deficiency in both mothers and infants. In industrialized countries, iron supplements should be prescribed for pregnant women in the third trimester, when the need for iron is prominent. In developing countries, supplementation should be initiated as soon as possible after conception because of the high prevalence of iron deficiency at the onset of pregnancy. The results of studies comparing intermittent with daily supplementation remain controversial.

[Erythrocyte indices and iron stores in cord blood]. / Paramètres érythrocytaires et réserves en fer dans le sang du cordon.

BACKGROUND: Reevaluation of normal red cell values in the cord blood is necessary since these values were established before the use of automated analysers and the introduction of iron supplementation during pregnancy. POPULATION AND METHODS: Cord blood samples from all healthy babies from Monday to Friday for 2 months have been analysed for red cell count and red cell indices, hemoglobin concentration, hemoglobin electrophoresis, serum and erythrocyte ferritin concentration. The results were compared for the mothers to age, parity and duration of iron supplementation and for the neonates to gestational age and birth weight. RESULTS: One hundred and fifty-nine neonates were studied; 87% of their 154 mothers had been given iron during pregnancy. Mean red cell indices were found to be slightly below those of previous reports in the literature. They were associated with mean ferritin concentrations of 135 micrograms/l and 348 ag/cell for plasma and erythrocytic ferritin, respectively. CONCLUSION: There were no correlations between red cell indices and ferritin values in such an iron-repleted population.