Balneotherapy Together with a Psychoeducation Program for Benzodiazepine Withdrawal: A Feasibility Study.

Benzodiazepines should be prescribed on a short-term basis, but a significant proportion of patients (%) use them for more than 6 months, constituting a serious public health issue. Indeed, few strategies are effective in helping patients to discontinue long-term benzodiazepine treatments. The aim of this study was to assess the feasibility and the impact of a program including cognitive behavioural therapy, psychoeducation, and balneotherapy in a spa resort to facilitate long-term discontinuation of benzodiazepines. We conducted a prospective multicentre cohort study. Patients with long-term benzodiazepine use were recruited with the aim of anxiolytic withdrawal by means of a psychoeducational program and daily balneotherapy during 3 weeks. The primary efficacy outcome measure was benzodiazepine use 6 months after the program, compared to use at baseline. A total of 70 subjects were enrolled. At 6 months, overall benzodiazepine intake had decreased by 75.3%, with 41.4% of patients completely stopping benzodiazepine use. The results also suggest a significantly greater improvement in anxiety and depression symptoms among patients who discontinued benzodiazepines compared to patients who only reduced their use. Our findings suggest that balneotherapy in association with a psychoeducative program is efficient in subjects with benzodiazepine addiction.

Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic.

ETHNOPHARMACOLOGICAL RELEVANCE: The recent outbreak of Ebola virus infections has mostly remained confined to the West African countries Guinea-Conakry, Sierra-Leone and Liberia. Due to intense national and international mobilizations, a significant reduction in Ebola virus transmission has been recorded. While international efforts focus on new vaccines, medicines and diagnostics, no coherent national or international approach exists to integrate the potential of the traditional health practitioners (THPs) in the management of infectious diseases epidemics. Nevertheless, the first contact of most of the Ebola infected patients is with the THPs since the symptoms are similar to those of common traditionally treated diseases or symptoms such as malaria, hemorrhagic syndrome, typhoid or other gastrointestinal diseases, fever and vomiting. MATERIALS AND METHODS: In an ethnomedical survey conducted in the 4 main Guinean regions contacts were established with a total of 113 THPs. The socio-demographic characteristics, the professional status and the traditional perception of Ebola Virus Disease (EVD) were recorded. RESULTS: The traditional treatment of the main symptoms was based on 47 vegetal recipes which were focused on the treatment of diarrhea (22 recipes), fever (22 recipes), vomiting (2 recipes), external antiseptic (2 recipes), hemorrhagic syndrome (2 recipes), convulsion and dysentery (one recipe each). An ethnobotanical survey led to the collection of 54 plant species from which 44 identified belonging to 26 families. The most represented families were Euphorbiaceae, Caesalpiniaceae and Rubiaceae. Literature data on the twelve most cited plant species tends to corroborate their traditional use and to highlight their pharmacological potential. CONCLUSIONS: It is worth to document all available knowledge on the traditional management of EVD-like symptoms in order to evaluate systematically the anti-Ebola potential of Guinean plant species.

Ethnobotanical survey on medicinal plants used by Guinean traditional healers in the treatment of malaria.

ETHNOPHARMACOLOGICAL RELEVANCE: The objective of the present study was to collect and document information on herbal remedies traditionally used for the treatment of malaria in Guinea. MATERIALS AND METHODS: The survey was carried out from May 2008 to September 2010 and targeted traditional medical practitioners and herbalists. The questionnaire and oral interviews were based on the standardized model which was prepared by the "Centre de Recherche et de Valorisation des Plantes Médicinales (CRVPM) - Dubréka". RESULTS AND DISCUSSION: A total of 258 people (141 males and 117 females) from which 150 traditional healers and 108 herbalists were interviewed. The age of informants ranged from 28 to 82 years old. 57% (149/258) of the interviewees were more than 50 years old. The respondents had good knowledge of the symptoms of malaria, and a fairly good understanding of the causes. One hundred thirteen plant species were recorded, out of which 109 were identified. They belonged to 84 genera and 46 families. The most frequently cited plants were Vismia guineensis, Parkia biglobosa, Nauclea latifolia, Harungana madagascariensis, Terminalia macroptera, Crossopteryx febrifuga, Terminalia albida, Annona senegalensis, and Nauclea pobeguinii. The leaves were most frequently used (80/113 species), followed by stem bark (38/113 species) and roots (4/113 species). The remedies were mostly prepared by decoction (111 species), followed by maceration (seven species). Only one species was prepared by infusion. CONCLUSION: The present study showed that traditional healers in Guinea have a consistent knowledge of antimalarial plants. Further research should be carried out to compare the anti-malarial activity of the different species, and to check if their use against malaria can be scientifically validated.

Acute and Sub-Acute Toxicity Studies of Plumeria alba Linn. (Apocynaceae) Hydroalcoholic Extract in Rat.

Plumeria alba Linn (Apocynaceae) is used in Togolese traditional medicine to treat diabetes mellitus and wounds. The present investigation was carried out to evaluate the toxicity of hydroalcoholic extract of Plumeria alba roots in Sprague Dawley rats. The acute toxicity test was conducted by administering orally dose of 5 g/Kg. General behavior and mortality were examined for up to 14 days. The sub-acute toxicity test was performed by daily gavage at 250, 500 and 1000 mg/Kg for 28 days. Body weight and blood glucose were measured weekly. Hematological and biochemical parameters, relative organ weight were determined at the end of the 28 days administration. In acute study, no adverse effect of the extract was observed at 5.0 g/Kg. Sub-acute oral administration of the extract at the dose up to 1000 mg/Kg did not induce death or significant changes in body weight, relative weight of vital organs, hematological parameters and was not associated with liver and kidney toxicity.

[Management of pre-term labor: use of nifedipine in Conakry, Guinea]. / Menaces d'accouchement prématuré: utilisation de la nifédipine à Conakry, Guinée.

This purpose of this prospective and descriptive study was to evaluate the utility of a calcium-channel inhibitor, i.e. nifedipine, for management of preterm labor in our work setting in terms of safety and cost-effectiveness in comparison with betamimetics classically used for this indication. Study was carried out over a six-month period in the department of Gynecology-Obstetrics Department of Ignace Deen National Hospital in Conakry, Guinea. Pregnant women meeting the following criteria were included: 28 to 33 weeks of amenorrhea, six days of hospitalization either for preterm labor or for another diagnosis that was associated with the occurrence of preterm labor during hospitalization, and absence of contraindications for tocolysis using nifedipine. A total of 42 women were included. Pregnancy was extended for more than 48 hours after the first dose of nifedipine in 86.8% of cases. Administration of nifedipine failed in 5 cases including one case in which it was necessary to change the tocolytic and 4 cases in which delivery occurred less than 48 hours after the first dose of nifedipine. In 68% of cases, 90 mg of nifedipine were sufficient to stop uterine contractions within 48 hours. In 39.5% of cases, no side effects were observed. Adverse effects in the other cases were dizziness (39.5%) and headache (18.4%). The mean term of delivery was 36 weeks +/- 5 days of amenorrhea with a mean extension of 6.2 weeks. Apgar score was low in 30.5% of the newborns and normal in 69.5%. One newborn (2.8%) died. The results of this study indicate that nifedipine is an effective, economical and safe drug for tocolysis and that it can be used as an alternative to betamimetis in countries with limited resources. An information campaign is needed to promote use of nifedipine as a tocolytic in obstetrical facilities of our country.

In vitro and in vivo antiplasmodial activity of 'saye', an herbal remedy used in Burkina Faso traditional medicine.

'Saye', a traditional medicine used in Burkina Faso, which consists of extracts of Cochlospermum planchonii (rhizome), Cassia alata (leaf) and Phyllanthus amarus (whole plant), showed a significant effect against Plasmodium falciparum and Plasmodium berghei parasites grown in vivo (IC(50) = 80.11 +/- 3.40 microg/mL; ED(50) = 112.78 +/- 32.32 mg/kg). In vitro the activity was lower.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine.

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.

Etude de la phytochimie et des activites biologiques de syzygium guineense Will D (Myrtaceae)

Notre travail a porte sur l'etude de la phytochimie et des activites biologiques de la poudre de feuilles de Syzygium guineense qui est une plante de la famille des Myrtacees. Elle est caracteristique des rivieres et des forets galeries en zone soudano-guineene. Les grands groupes chimiques ont ete determines par les reactions en tubes et confirmes par la CCM. Nous avons realise des extractions hydro-alcooliques et organiques. Les extractions avec les solvants a polarite croissante ont ete realisees au Soxhlet. Nous avons dose la teneur en eau et des cendres. L'activite antioxydante a ete observee dans tous nos extraits. Avec le decocte aqueux; nous avons note une legere diminution des globules blancs chez la souris. Ce decocte aqueux a la dose 200 mg/kg a donne une activite moins elevee que l'indometacine a la dose 8 mg/kg. L'etude de toxicite a revele une tolerance de l'extrait aqueux chez les souris

Etude des plantes medicinales de Niafunke (Region de Tombouctou). Phytochimie de et pharmacologie de maerua crassifolia Forsk (Capparidaceae)

Notre travail a porte sur l'etude ethnobotanique dans la ville de Niafunke region de Tombouctou. Cette etude nous a permis de choisir Maerua crassifolia Forsk. (Capparidacee). C'est une plante retrouvee dans la savane seche du desert; assez frequente en partie solitaire. Elle est traditionnellement utilisee pour la prise en charge des maladies telles que le paludisme; les diarrhees; l'inflammation; l'hypertension arterielle. Nous avons procede a un screening phytochimique et un criblage biologique. Du point de vue screening phytochimique nous avons effectue des extractions par des solvants a polarite croissante; des macerations a l'eau et a l'ethanol et des decoctions. S'agissant des reactions de caracterisation les composes les plus abondant dans les 3 organes de M. crassifolia etaient les coumarines; les carotenoides; les sterols et triterpenes et les saponosides. Le pourcentage des cendres etait tres eleve. Du point de vue criblage biologique; les activites antioxydante; antibacterienne; antifongique et anti-inflammatoire ont ete etudiees. L'activite antioxydante etait plus remarquable au niveau des feuilles. L'etude de l'activite antibacterienne a montre que les extraits diethyl ether; dichloromethane; methanolique; ethanolique et le decocte a 10p.100 etaient actifs sur les souches de Staphylococcus aureus; de Escherichia coli et de Salmonella enterica. Cependant; nous avons observe une importante activite sur Salmonella enterica par les extraits de feuilles. Pour le test antifongique l'activite a ete observee par l'extrait dichloromethane de extrait d'ecorces de troncs avec Rf (0.47). L'extrait du decocte a 10p.100 (100 et 200 mg/Kg) a reduit significativement l'odeme a la carrhagenine provoque sur la patte des souris avec P inferieur a 0.01. En effet les resultats obtenus au cours de la phytochimie et des tests biologiques ont permis de confirmer certaines utilisations traditionnelles de M. crassifolia

[Fractionation of the total extract of Khaya senegalensis Barks. Value of the formulation of an anti-inflammatory ointment]. / Fractionnement de l'extrait des ecorces de Khaya senegalensis: intérêt dans la formulation d'une pommade anti-inflammatoire.

The aim of this work was to compare the anti-inflammatory activity of the total extract of Khaya senegalensis Barks and its different fractions for optimizing the active ingredients which be used in the ointment formulation. For that, a fractionation was performed followed by anti-inflammatory tests based on the method of the croton oil induced oedema. Three fractions were obtained and the comparison of their activity with the one of the total extract has shown the following results: 37.10%, 45.65%, 22.30% and 22.36% respectively for the extract, fraction n1, fraction n2 and fraction n3. The statistical analysis ofthe results (Student Test; p = 0.05) have revealed that the fraction nl is significatively more active than the others. However, there was not a significant difference between the inhibition induced by the fraction n1 and the total extact one, even the mean value of this latter is lower. Therefore, it seems enough to use the total extract as active ingredient for developing an anti-inflammatory ointment.

[Contribution to the study of the anti-inflammatory activity of Moringa oleifera (moringaceae)]. / Contribution a l'etude de l'activite anti-inflammatoire de moringa oleifera (moringaceae).

Moringa oleifera is a bush of African savannah, used in folk Medicine for the treatment of rheumatic and articulary pain. We have tested the anti-inflammatory action of an aqueous extract of root in rats with weight between 120 and 160 g. We administered per os either distilled water (control group), the aqueous root extract (750 mg/kg or 1000 mg/kg) or indomethacin (10 mg/kg) 30 min before an oedema was induced in the rat-paw by subcutaneous injection of carrageenin. The rat-paw volume was measured 1, 3 and 5 hours after injection of carrageenin. At a dose of 750 mg/kg the Moringa oleifera treatment significantly inhibited the development of oedema at 1, 3 and 5 hours (reduction by 53.5, 44.6 and 51.1% respectively). Increasing the dose of Moringa oleifera to 1000 mg/kg did not increase the inhibitory effect on oedema development at 1 and 3 hours, whereas this dose potentiated the oedema at 5 hours. Treatment with indomethacin significantly inhibited the development of oedema 1, 3 and 5 hours (49.1, 82.1 and 46.9% respectively). These findings indicate that an aqueous root extract of Moringa oleifera at 750 mg/kg reduces the carrageenin induced oedema to similar extent as the potent anti-inflammatory drug indomethacin. Moreover, these results provide further evidence that the roots of Moringa oleifera contain anti-inflammatory principle that may be useful in the treatment of the acute inflammatory conditions.

[Case report of acute intoxication from intravenous injection of petroleum] . / A propos d'un cas d'intoxication aiguë par injection intraveineuse directe de pétrole.

A 18-year-old patient injected intravenously 2.5 mL of paraffin oil into the right upper limb. It caused a local thrombophlebitis with a slow evolution. A collapsus occurred on the sixth day. The authors obtained a clinical recovery of the limb after heparine and oral anticoagulation.

The Bamako Initiative in Benin and Guinea: improving the effectiveness of primary health care.

The objective of the health system revitalization undergone in Benin and Guinea since 1986 is to improve the effectiveness of primary health care at the periphery. Second in a series of five, this article presents the results of an analysis of data from the health centres involved in the Bamako Initiative in Benin and Guinea since 1988. Data for the expanded programme of immunization, antenatal care and curative care, form the core of the analysis which confirms the improved effectiveness of primary health care at the peripheral level over a period of six years. The last available national data show a DPT3 immunization coverage of 80% in 1996 in Benin and 73% in 1995 in Guinea. In the Bamako Initiative health centres included in our analysis, the average immunization coverage, as measured by the adequate coverage indicator, increased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased from 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utilization of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per capita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the different levels of effectiveness obtained in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. However, the geographical location of centres represents a constraint in that certain districts in both countries face accessibility problems. Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage.

[Evaluation of the risks of sexually transmitted diseases and HIV infection in a rural region of Senegal in 1991]. / Evaluation en 1991 des risques de MST et d'infection par VIH en zone rurale sénégalaise.

This study was performed in the Sereer region 150 km to the east of Dakar, the capital of Senegal. The population of the region is characterised by large seasonal migration, a high divorce rate (41% of marriages end in divorce) and frequent polygamy (1.8 married women per married man). We organised the medical centres in the region to monitor actively the epidemiology of HIV infection. Three populations were targeted: pregnant women presenting for their first prenatal consultation; patients presenting with STD; and people with chronic (more than three weeks) cough. The patients consulting for STD were recruited two ways: those presenting spontaneously and those identified during home interviews by the team performing a parallel sociological study of behaviour. Overall, the prevalence of HIV seropositivity was 0.2% of the women and 1.3% of the men (the difference is not significant). The seropositive individuals identified were 2 pregnant women and 5 patients (3 of 409 women and 2 of 84 men) with STD. There was no significant difference between the sex, age, marital status, or type of recruitment (spontaneous or identified by the sociological survey) of the HIV seropositive and seronegative individuals. The prevalence of treponema antibodies was 1.8% among pregnant women, 2% among STD patients and 2.4% among patients with chronic cough. There was no significant difference according to age, sex, marital status or motivation for consultation. More than half the patients consulting for STD presented biomedical disease. The majority of the STD patients were women: 70% of those spontaneous consulting; 90% of those identified by the survey; and 92% of those with biomedical disease were women.(ABSTRACT TRUNCATED AT 250 WORDS)

[Differed autologous blood transfusion in the "G" point hospital in Bamako. Prospective study apropos of 40 cases]. / Transfusion autologue différée à l'hôpital du point "G" à Bamako. Etude prospective portant sur 40 observations.

With a sample of 40 patients, the authors conducted a prospective case-control study on the feasibility of differed autologous blood transfusion at Point "G" National Hospital in Bamako, Mali. The method has been accepted by all the patients. No clinical nor biological trouble has been reported by the patients themselves. The authors recommend the use of autologous blood transfusion by other hospital units and the development of regulations governing its implementation.

Transfusion autologue différée à l'Hôpital du Point G à Bamako: Etude prospective portant sur 40 observations à l'Hôpital du Point G de Bamako

"Sur un échantillon de 40 patients; les auteurs ont réalisé une étude prospective cas-témoins sur la faisabilité de la transfusion autologue différée à l'Hôpital National du point G de Bamako (Mali). La technique a été acceptée par la totalité des patients. Elle n'a pas entrainé de troubles cliniques ou biologiques pouvant influer sur les suites post-opératoires ; le surcout de la technique a été négligeable et n'a pas été pris en charge par les patients. Les auteurs recommandent une adoption de l'autotransfusion différée par d'autres formations sanitaires ainsi que sa règlementation."

[Stopping persistent hiccups in the adult by endoscopic maneuver]. / Arrêt du hoquet persistant de l'adulte par manoeuvres endoscopiques.

Thirty-four patients with persistent hiccups (median duration 10 days) were treated by gentle endoscopic massage of the region of the cardia. Hiccups stopped in all cases. Its early recurrence in one patient only required a second massage, which was also effective. This simple technique is recommended for the treatment of persistent hiccups.