Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel.

OBJECTIVE: To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition. DESIGN: The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal. SETTING: Senegal, West Africa. PARTICIPANTS: A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study. RESULTS: Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children). CONCLUSIONS: Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

Binary vanadium pentoxide carbon-graphene foam composites derived from dark red hibiscus sabdariffa for advanced asymmetric supercapacitor.

The development of advanced electrode materials derived from biomass for the next generation of energy storage devices, such as supercapacitors with high specific energy and specific power coupled with a good cycle stability, is required to meet the high demand for electric vehicles and portable devices. In this study, sustainable binary vanadium pentoxide carbon-graphene foam composites (V2O5@C-R2HS/GF) were synthesized using a solvothermal method. The X-ray diffraction, Raman and FTIR techniques were used to study the structural properties of the composites (V2O5@C-R2HS/20 mg GF and V2O5@C-R2HS/40 mg GF). The SEM micrographs displayed an accordion-like morphology resulting from the graphene foam-modified V2O5@C-R2HS composite. The V2O5@C-R2HS, V2O5@C-R2HS/20 mg GF and V2O5@C-R2HS/40 mg GF composites were evaluated in a three-electrode configuration using 6 M potassium hydroxide (KOH) as an aqueous electrolyte. Furthermore, a two-electrode device was carried out by fabricating an asymmetric device (V2O5@C-R2HS/GF//AC) where V2O5@C-R2HS/20 mg GF was used as a positive electrode and activated carbon (AC) as a negative electrode at a cell voltage of 1.6 V in 6 M KOH. The V2O5@C-R2HS/GF//AC showed a high specific energy and specific power values of 55 W h kg-1 and 707 W kg-1, respectively, at a specific current of 1 A g-1. The asymmetric device presented a good stability test showing 99% capacity retention up to 10 000 cycles and was confirmed by the floating time up to 150 h with specific energy increasing 23.6% after the first 10 h. This article is part of the theme issue 'Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 2)'.

Wrist opener splint: An effective way to treat chronic wrist flexion contracture.

In Senegal, patients are seen an average of 16 months after their injury in a specialized hand and upper limb surgery department. Because of this lengthy delay, these patients have severe functional sequelae, such as wrist flexion contracture, averaging 45 degrees in our case series (range, 35 to 90 degrees). After reviewing the literature, we did not find any splint that was well suited to these patients. Inspired by the general splinting rules set out by Schultz, MacConaill and Brand, we constructed a volar/dorsal splint to reduce these contractures. We have been using this serial static splint for 2 years. We performed a prospective study of 17 wrists to evaluate its therapeutic benefit, describe its use and outline its optimal application.

Effect of porosity enhancing agents on the electrochemical performance of high-energy ultracapacitor electrodes derived from peanut shell waste.

In this study, the synthesis of porous activated carbon nanostructures from peanut (Arachis hypogea) shell waste (PSW) was described using different porosity enhancing agents (PEA) at various mass concentrations via a two-step process. The textural properties obtained were depicted with relatively high specific surface area values of 1457 m2 g-1, 1625 m2 g-1 and 2547 m2 g-1 for KHCO3, K2CO3 and KOH respectively at a mass concentration of 1 to 4 which were complemented by the presence of a blend of micropores, mesopores and macropores. The structural analyses confirmed the successful transformation of the carbon-containing waste into an amorphous and disordered carbonaceous material. The electrochemical performance of the material electrodes was tested in a 2.5 M KNO3 aqueous electrolyte depicted its ability to operate reversibly in both negative and positive potential ranges of 0.90 V. The activated carbon obtained from the carbonized CPSW:PEA with a mass ratio of 1:4 yielded the best electrode performance for all featured PEAs. The porous carbons obtained using KOH activation displayed a higher specific capacitance and the lower equivalent series resistance as compared to others. The remarkable performance further corroborated the findings linked to the textural and structural properties of the material. The assembled device operated in a neutral electrolyte (2.5 M KNO3) at a cell potential of 1.80 V, yielded a ca. 224.3 F g-1 specific capacitance at a specific current of 1 A g-1 with a corresponding specific energy of 25.2 Wh kg-1 and 0.9 kW kg-1 of specific power. This device energy was retained at 17.7 Wh kg-1 when the specific current was quadrupled signifying an excellent supercapacitive retention with a corresponding specific power of 3.6 kW kg-1. These results suggested that peanut shell waste derived activated carbons are promising candidates for high-performance supercapacitors.

A high energy density asymmetric supercapacitor utilizing a nickel phosphate/graphene foam composite as the cathode and carbonized iron cations adsorbed onto polyaniline as the anode.

This work presents the effect of different contents of graphene foam (GF) on the electrochemical capacitance of nickel phosphate Ni3(PO4)2 nano-rods as an electrode material for hybrid electrochemical energy storage device applications. Pristine Ni3(PO4)2 nano-rods and Ni3(PO4)2/GF composites with different GF mass loadings of 30, 60, 90 and 120 mg were synthesised via a hydrothermal method. The electrochemical behavior of pristine Ni3(PO4)2 and Ni3(PO4)2/GF composites were analysed in a three-electrode cell configuration using 6 M KOH electrolyte. The Ni3(PO4)2/90 mg GF composite sample exhibited the highest specific capacity of 48 mA h g-1 at a current density of 0.5 A g-1. The electrochemical behavior of the Ni3(PO4)2/90 mg GF composite was further analysed in a two-electrode hybrid asymmetric device. A hybrid asymmetric device was fabricated with Ni3(PO4)2/90 mg GF as the cathode and carbonized iron cations (Fe3+) adsorbed onto polyaniline (PANI) (C-FP) as the anode material (Ni3(PO4)2/90 mg GF//C-FP) and tested in a wide potential window range of 0.0-1.6 V using 6 M KOH. This hybrid device achieved maximum energy and power densities of 49 W h kg-1 and 499 W kg-1, respectively, at 0.5 A g-1 and had long-term cycling stability.

Correction: A high energy density asymmetric supercapacitor utilizing a nickel phosphate/graphene foam composite as the cathode and carbonized iron cations adsorbed onto polyaniline as the anode.

[This corrects the article DOI: 10.1039/C7RA12028A.].

IL6R haplotype rs4845625*T/rs4537545*C is a risk factor for simultaneously high CRP, LDL and ApoB levels.

Interleukin 6 receptor (IL-6R), mediating IL-6's biological functions, plays an important role in different diseases such as diabetes, obesity and cardio-vascular diseases. In this study, we investigated the effects of two single nucleotide polymorphisms (SNPs), within the IL-6R loci, previously associated with C-reactive protein (CRP) and coronary heart diseases risk, and with controversial effects on lipids traits: SNP rs4845625 and SNP rs4537545. The results showed that both investigated SNPs were antagonistically related with CRP levels; the minor rs4845625*T allele was associated with increased CRP levels (P-value=0.011), while the minor rs4537545*T allele was associated with decreased CRP levels (P-value=0.009). Interestingly, the minor rs4845625*T allele was significantly associated with higher low-density lipoprotein cholesterol (LDL-C) and ApoB levels (P=0.007 and P=0.009 respectively). Haplotype analysis showed that the TC haplotype, having the minor rs4845625*T allele, was related simultaneously with increased levels of CRP, LDL-C and ApoB levels, thus could be considered as a risk factor. Our investigation detects for the first time an independent effect of rs4845625 on LDL-C and ApoB traits, explaining an important range of those traits variability (3.49 and 5.57% respectively). Our findings might be of high clinical significance in pharmacogenomics studies of tocilizumab for which IL-6R is target.

[Non-antiretroviral drugs uses among HIV-infected persons receiving antiretroviral therapy in Senegal: Costs and factors associated with prescription]. / Médicaments non antirétroviraux chez les personnes vivant avec le VIH sous traitement antirétroviral au Sénégal : coûts et facteurs associés à la prescription.

BACKGROUND: In addition to antiretroviral therapy, non-antiretroviral drugs are necessary for the appropriate care of people living with HIV. The costs of such drugs are totally or partially supported by the people living with HIV. We aimed to evaluate the overall costs, the costs supported by the people living with HIV and factors associated with the prescription of non-antiretroviral drugs in people living with HIV on antiretroviral therapy in Senegal. METHODS: We conducted a retrospective cohort study on 331 people living with HIV who initiated antiretroviral therapy between 2009 and 2011 and followed until March 2012. The costs of non-antiretroviral drugs were those of the national pharmacy for essential drugs; otherwise they were the lowest costs in the private pharmacies. Associated factors were identified through a logistic regression model. RESULTS: The study population was 61 % female. At baseline, 39 % of patients were classified at WHO clinical stage 3 and 40 % at WHO clinical stage 4. Median age, body mass index and CD4 cells count were 41 years, 18kg/m2 and 93 cells/µL, respectively. After a mean duration of 11.4 months of antiretroviral therapy, 85 % of patients received at least one prescription for a non-antiretroviral drug. Over the entire study period, the most frequently prescribed non-antiretroviral drugs were cotrimoxazole (78.9 % of patients), iron (33.2 %), vitamins (21.1 %) and antibiotics (19.6 %). The mean cost per patient was 34 Euros and the mean cost supported per patient was 14 Euros. The most expensive drugs per treated patient were antihypertensives (168 Euros), anti-ulcer agents (12 Euros), vitamins (8.5 Euros) and antihistamines (7 Euros). The prescription for a non-antiretroviral drug was associated with advanced clinical stage (WHO clinical stage 3/4 versus stage 1/2): OR=2.25; 95 % CI=1.11-4.57 and viral type (HIV-2 versus HIV-1/HIV-1+HIV-2): OR=0.36; 95 % CI=0.14-0.89. CONCLUSION: Non-antiretroviral drugs are frequently prescribed to people living with HIV in developing countries; mainly those infected with HIV-1 and those at an advanced clinical stage. Their costs can be a barrier to appropriate care and necessary efforts must made to make them available. However, early initiation of antiretroviral therapy and the registration of some non-antiretroviral drugs on the list of essential drugs, as well as social protection systems, should reduce their use and costs.

Aspects radiologiques de la tuberculose pulmonaire chez les patients infectés par le VIH hospitalisés au service des maladies infectieuses et tropicales de Fann de Dakar, Sénégal

Objectifs : Déterminer la prévalence de la tuberculose pulmonaire chez les personnes vivant avec le VIH et décrire ses aspects radiologiques. Patients et méthodes : Il s'agit d'une étude rétrospective et descriptive réalisée à partir de dossiers de patients infectés par le VIH/Sida et hospitalisés au service des maladies infectieuses et tropicales pour une tuberculose pulmonaire durant la période allant du 1er janvier 2011 au 31 décembre 2013. Résultats : Durant cette période d'étude, nous avons colligé 124 cas de co-infections tuberculose pulmonaire/VIH sur un total de 571 cas de tuberculose toutes formes confondues soit une prévalence de 21,7%. Le sexe masculin était prédominant avec un sex-ratio de 1,48. La notion de contage tuberculeux était retrouvée dans 8,9% des cas. Les signes cliniques classiques de la tuberculose pulmonaire ont été retrouvés notamment l'altération de l'état général (105 cas), la toux chronique (93 cas) et la fièvre chez (105 cas). L'intradermoréaction à la tuberculine était positive dans 7,3% des cas. Les crachats BAAR étaient réalisés dans 73,3% des cas et positifs dans 18,5% des cas. Le GeneXpert était réalisé chez 62 patients et positif dans 9,7% des cas. La radiographie thoracique était normale chez 35 patients et dans les autres cas les lésions radiologiques étaient dominées par : les infiltrats (20 cas); les miliaires (17 cas), infiltrat + opacités réticulo-nodulaires (15 cas), caverne + infiltrats (14 cas), opacités réticulo-nodulaires (13 cas). Dans la plupart des cas (63,7%), la localisation des lésions était diffuse. Conclusion : Les aspects radiologiques habituels de la tuberculose pulmonaire sont modifiés chez les patients infectés par le VIH avec atteintes parenchymateuses plus étendues

[Dental health status of 15 year-old schoolchildren in Comoros]. / Etat de santé dentaire des élèves de 15 ans aux Comores.

The epidemiological situation of decay evolves differently in the world. In industrialized countries, prevalence has declined significantly due to preventive measures, while in developing countries many studies have shown that caries was increasing. The aim of this study was to assess the state of dental health of schoolchildren aged 15 in Grand Comore (Comoros). This was a descriptive cross-sectional study on 15 year-old schoolchildren in colleges in Grande Comore who agreed to be examined. Four hundred schoolchildren were chosen by a stratified sampling weighted according to the area of living. Three groups of indicators of dental caries were used: the components D, M and F, the average DMFT and prevalence. The WHO modified questionnaire for the assessment of dental health was used to collect data; continuous data were compared by Student t test and qualitative ones by Chi-square test. Fifty two percent of schoolchildren were male and 63.5% lived in urban area. From the 888 teeth bearing the stigmata of decay, 83.2% were decayed, 12.5% missed and 4.3% filled. These components of DMF were associated with sex (p = 0.039) and not with area (p = 0.12). The 2.22 DMFT average was not associated with sex (p = 0.58) neither with area (p = 0.57). The caries prevalence was higher in rural than in urban areas (p = 0.001) and was not associated with sex (p = 0.61). These results suggest that schoolchildren need decay treatments. The dental programs will have much more success when they will be integrated into more comprehensive programs to promote schoolchildren health.

Acceptability of complementary foods and breads prepared from zinc-fortified cereal flours among young children and adults in Senegal.

We completed a series of studies to assess the acceptability of zinc-fortified, cereal-based complementary foods and zinc-fortified wheat breads. Young children and their caregivers completed acceptability tests with complementary foods fortified with iron only (60 mg iron as ferrous fumarate per kilogram cereal flour), or the same level of iron and zinc (240 mg zinc as zinc oxide per kilogram cereal flour), and the caregivers completed triangle taste tests to compare the same products. A separate group of adult participants completed acceptability tests with wheat breads fortified with iron and folic acid (15 mg iron as ferrous fumarate per kilogram flour and 1.5 mg folic acid per kilogram flour) or the same levels of iron-folic acid and 2 levels of zinc (63 mg zinc or 126 mg zinc as zinc oxide per kilogram flour). Finally, a threshold test was administered to another group of adult participants to compare nonfortified wheat bread to breads fortified with zinc in 80 mg increments ranging from 80 to 400 mg zinc as zinc oxide per kilogram flour. All products were acceptable when compared to non-zinc-fortified equivalents, and were well liked by the respective participants. For the triangle tests, caregivers were not able to detect significant differences between products. For threshold tests, adult participants detected differences in breads prepared from fortified wheat flour at 80 mg, 160 mg, and 320 mg zinc per kilogram flour, but not at 240 mg and 400 mg zinc per kilogram flour, respectively, when compared to nonfortified bread equivalents. Zinc fortification of cereal flours in the ranges of fortification that were tested does not adversely affect the acceptability of complementary foods and breads prepared from these flours. Practical Application: Fortification of staple food products is a low-cost approach to deliver additional micronutrients (including zinc) to large segments of a population. Determining the acceptability of products fortified with zinc is an important step in the development of zinc fortification programs.

[Water quality and personal hygiene in rural areas of Senegal]. / Qualité de l'eau et comportements hygiéniques des populations en milieu rural sénégalais.

INTRODUCTION: The high prevalence of diarrhea in developing countries is mostly due to poor water quality and hygiene practices. The purpose of this study was to assess water quality as well as hygiene practices and their determinants in Ngohé, i.e., a rural community (RC) in Senegal. METHOD: A combined approach consisting of a cross-sectional descriptive survey and bacterial analysis of water was used. Study was conducted in 312 randomly selected households. Data was collected through individual interviews with the assistance of a guide. Water for bacteriological analysis was collected from various sources, i.e., 3 modem borehole wells, 2 protected wells, and 10 traditional wells. Study points included home water treatment, drinking water source, latrine use, hand washing habits, and bacteria identified in water. A multiple regression model was used for data analysis. RESULTS: The household survey population was 59% male, 61% illiterate, and 93% married. Mean age was 44.8 +/- 18.1 years. Chlorination technique was inadequate in 62% of cases. Latrines were not restricted to adult use in 76% of homes. Hand washing was not performed at critical times in 94%. Drinking water was drawn from traditional wells in 48% of households, modem borehole wells in 45% and protected wells in 7%. Escherichia coli was found in water from all three sources and Vibrio cholerae was found in two traditional wells. Level of education, average monthly income, knowledge about chlorination techniques, and source of the water consumed were the main behavioral determinants (p < 0.05). CONCLUSION: Water treatment at the source and in the home as well as protection of water sources is necessary to ensure water quality. This will require effective public education campaigns and financial support for improvement of sanitary facilities.

[Seroprevalence of HBsAgs in patients with rheumatoid arthiritis in a hospital setting in Senegal]. / Séroprévalence de l'antigène HBs au cours de la polyarthrite rhumatoïde en milieu hospitalier Sénégalais.

PURPOSE: Rheumatoid arthritis is the most common chronic inflammatory joint disease in adults. In Senegal, where biotherapy is unavailable, treatment of RA relies on a combination of glucocorticoids and disease-modifying antirheumatic drugs (DMARD). Since DMARD, particularly methotrexate, induce hepatotoxicity pretreatment assays of serum transaminase and albumin levels, as well as serological tests for the hepatitis B and C viruses is recommended. Hepatitis B virus (HBV) infection is endemic in Africa, particularly in Senegal. The purpose of this study was to assess the seroprevalence of the HBV surface antigen (HBsAg) for HBV in 258 patients with RA in Senegal as a basis for defining the least hepatotoxic DMARD for these patients and ensuring the most suitable monitoring. METHOD: This retrospective study was based on a review of the medical records of patients examined between January 2005 and December 2009 at the rheumatology outpatient clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal. All patients met the American College of Rheumatology criteria for RA. RESULTS: A total of 258 patients were tested for HBsAg. Tests were positive in 6 for a seroprevalence of 2.3%. All 6 positive patients were women with a mean age of 48.7 years (range, 16-79 years). Transaminase levels were normal in 5 patients. In the remaining patient, ASAT level elevation were twice normal and ALAT was normal. No patients had clinical evidence of liver disease. CONCLUSION: HBsAg seroprevalence in our population of patients with RA was lower than in the general population of Senegal: 2.3% versus 15%-18%. No evidence indicated that HBVinfection produced specific features in patients with RA. Based on these findings, widespread use of methotrexate in optimal dosages appears safe in patients with RA in Senegal. Treatment should be accompanied by careful attention to HBV prevention.

[The traffic elbow. A series of 9 cases]. / Le coude de portière. A propos de neuf observations.

"Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.

[Hyperthyroidism surgery: experience of ENT department of hospital center of Thies]. / Chirurgie de l'hyperthyroidie: experience du service d'ORL du centre hospitalier regional de Thies.

INTRODUCTION: The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications. PATIENTS AND METHODS: It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases. RESULTS: The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma) CONCLUSION: Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

[Evaluation of the cost of stroke management in Dakar, Senegal]. / Evaluation du coût de prise en charge des accidents vasculaires cérébraux à Dakar--Senegal.

The purpose of this one-year cross-sectional study conducted in 1997 was to estimate the direct cost of stroke management in the Neurology Department of Fann University Hospital in Dakar, Senegal. Data were collected about the type of care services required and related spending. Cost analysis was made in CFA Francs (CFAF), the Senegalese currency (1 USD = 500 CFAF in 1997). A total of 1260 patients were hospitalized in the department including 383 for stroke (30.4%). Mean age was 60.8 +/- 14.2 years and men accounted for 49.2% of the population. The mortality rate was 46.2% among hospitalized patients. A total of 33,573 medical acts were carried out including 12,052 (35.9%) for stroke management. The direct cost of stroke management was 32,614,442 CFAF with a mean cost of 78,426 CFAF per patient. The cost was 18,839 CFAF in the patient care unit (57.8%) and 4,954,635 CFAF in the neuroradiology unit (15.2%). The cost of health care personnel was 19,373,172 CFAF (59.4%) and the cost for drugs and other medical products was 8,253,246 CFAF. Health education programs aimed at increasing awareness of risk factors are needed to reduce the cost of stroke management in this difficult economic period.

Ectopic and abnormal hormone receptors in adrenal Cushing's syndrome.

The mechanism by which cortisol is produced in adrenal Cushing's syndrome, when ACTH is suppressed, was previously unknown and was referred to as being "autonomous." More recently, several investigators have shown that some cortisol and other steroid-producing adrenal tumors or hyperplasias are under the control of ectopic (or aberrant, illicit, inappropriate) membrane hormone receptors. These include ectopic receptors for gastric inhibitory polypeptide (GIP), beta-adrenergic agonists, or LH/hCG; a similar outcome can result from altered activity of eutopic receptors, such as those for vasopressin (V1-AVPR), serotonin (5-HT4), or possibly leptin. The presence of aberrant receptors places adrenal cells under stimulation by a trophic factor not negatively regulated by glucocorticoids, leading to increased steroidogenesis and possibly to the proliferative phenotype. The molecular mechanisms responsible for the abnormal expression and function of membrane hormone receptors are still largely unknown. Identification of the presence of these illicit receptors can eventually lead to new pharmacological therapies as alternatives to adrenalectomy, now demonstrated by the long-term control of ectopic P-AR- and LH/hCGR-dependent Cushing's syndrome by propanolol and leuprolide acetate. Further studies will potentially identify a larger diversity of hormone receptors capable of coupling to G proteins, adenylyl cyclase, and steroidogenesis in functional adrenal tumors and probably in other endocrine and nonendocrine tumors.