Implementation of the WHO core components of an infection prevention and control programme in two sub-saharan African acute health-care facilities: a mixed methods study.

BACKGROUND: The coronavirus pandemic again highlighted the need for robust health care facility infection prevention and control (IPC) programmes. WHO guidelines on the core components (CCs) of IPC programmes provides guidance for facilities, but their implementation can be difficult to achieve in resource-limited settings. We aimed to gather evidence on an initial WHO IPC implementation experience using a mixed methods approach. METHODS: A five-day training on the WHO IPC CCs was conducted at two reference acute health care facilities in the Democratic Republic of Congo and Burkina Faso. This was accompanied by a three-part mixed-methods evaluation consisting of a: (1) baseline and follow-up survey of participants' knowledge, attitudes and practices (KAP), (2) qualitative assessment of plenary discussion transcripts and (3) deployment of the WHO IPC assessment framework (IPCAF) tool. Results were analysed descriptively and with a qualitative inductive thematic approach. RESULTS: Twenty-two and twenty-four participants were trained at each facility, respectively. Baseline and follow-up KAP results suggested increases in knowledge related to the necessity of a dedicated IPC focal person and annual evaluations of IPC training although lack of recognition on the importance of including hospital leadership in IPC training and hand hygiene monitoring recommendations remained. Most participants reported rarely attending IPC meetings or participating in IPC action planning although attitudes shifted towards stronger agreement with the feeling of IPC responsibility and importance of an IPC team. A reocurring theme in plenary discussions was related to limited resources as a barrier to IPC implementation, namely lack of reliable water access. However, participants recognised the importance of IPC improvement efforts such as practical IPC training methods or the use of data to improve quality of care. The facilities' IPCAF scores reflected a 'basic/intermediate' IPC implementation level. CONCLUSIONS: The training and mixed methods evaluation revealed initial IPC implementation experiences that could be used to inform stepwise approaches to facility IPC improvement in resource-limited settings. Implementation strategies should consider both global standards such as the WHO IPC CCs and specific local contexts. The early involvement of all relevant stakeholders and parallel efforts to advocate for sufficient resources and health system infrastructure are critical.

Inflammatory myofibroblastic tumors: A short series with an emphasis on the diagnostic and therapeutic challenges.

BACKGROUND: Inflammatory myofibroblastic tumors (IMTs) are a distinct entity of mesenchymal tumors. We present the challenges in their diagnosis and management. MATERIALS AND METHODS: A retrospective study with detailed clinical, radiological, and histopathological (HPE) features along with management and outcome of 10 biopsy-proven patients with IMT, between 2001 and 2020. RESULTS: The location included intracranial (5), orbital (4), and spinal (1) with M : F = 7 : 3. The mean age of onset was in the third decade. The commonest symptom was headache, while proptosis and blurred vision occurred in orbital IMTs. HPE revealed diffuse infiltration of mixed inflammatory cells over proliferating myofibroblasts. Smooth muscle antigen immunoreactivity was noted in fibroblastic spindle cells of all IMTs. However, we did not find anaplastic lymphoma kinase expression in any of our cases, as this is only found in ~ 50% of all IMTs. Tumor infiltration into adjacent tissue was noted in 4 patients. Surgical excision was limited to orbital IMTs, as most central nervous system (CNS) tumors were not amenable for resection. Steroid administration showed moderate improvement in the IMT-CNS patients but also required additional immunomodulation. Four patients had a median long-term follow-up of 7 years. Two patients had recurrent lesions demonstrated by imaging after 2 years of initial presentation. CONCLUSION: IMTs are rare and ambiguous tumors of unknown etiology that can occur anywhere in the body. Clinical and radiological features may not be specific to determine the diagnosis, but it should be considered as a differential diagnosis. Extensive thorough workup with histopathology along with the help of immunohistochemistry is conducive to better clinical outcomes. Surgical biopsy with extensive and total resection of these tumors along with steroid and radiotherapy may enhance the survival outcomes.

Signal-to-signal neural networks for improved spike estimation from calcium imaging data.

Spiking information of individual neurons is essential for functional and behavioral analysis in neuroscience research. Calcium imaging techniques are generally employed to obtain activities of neuronal populations. However, these techniques result in slowly-varying fluorescence signals with low temporal resolution. Estimating the temporal positions of the neuronal action potentials from these signals is a challenging problem. In the literature, several generative model-based and data-driven algorithms have been studied with varied levels of success. This article proposes a neural network-based signal-to-signal conversion approach, where it takes as input raw-fluorescence signal and learns to estimate the spike information in an end-to-end fashion. Theoretically, the proposed approach formulates the spike estimation as a single channel source separation problem with unknown mixing conditions. The source corresponding to the action potentials at a lower resolution is estimated at the output. Experimental studies on the spikefinder challenge dataset show that the proposed signal-to-signal conversion approach significantly outperforms state-of-the-art-methods in terms of Pearson's correlation coefficient, Spearman's rank correlation coefficient and yields comparable performance for the area under the receiver operating characteristics measure. We also show that the resulting system: (a) has low complexity with respect to existing supervised approaches and is reproducible; (b) is layer-wise interpretable, and (c) has the capability to generalize across different calcium indicators.

Functional parcellation of mouse visual cortex using statistical techniques reveals response-dependent clustering of cortical processing areas.

The visual cortex of the mouse brain can be divided into ten or more areas that each contain complete or partial retinotopic maps of the contralateral visual field. It is generally assumed that these areas represent discrete processing regions. In contrast to the conventional input-output characterizations of neuronal responses to standard visual stimuli, here we asked whether six of the core visual areas have responses that are functionally distinct from each other for a given visual stimulus set, by applying machine learning techniques to distinguish the areas based on their activity patterns. Visual areas defined by retinotopic mapping were examined using supervised classifiers applied to responses elicited by a range of stimuli. Using two distinct datasets obtained using wide-field and two-photon imaging, we show that the area labels predicted by the classifiers were highly consistent with the labels obtained using retinotopy. Furthermore, the classifiers were able to model the boundaries of visual areas using resting state cortical responses obtained without any overt stimulus, in both datasets. With the wide-field dataset, clustering neuronal responses using a constrained semi-supervised classifier showed graceful degradation of accuracy. The results suggest that responses from visual cortical areas can be classified effectively using data-driven models. These responses likely reflect unique circuits within each area that give rise to activity with stronger intra-areal than inter-areal correlations, and their responses to controlled visual stimuli across trials drive higher areal classification accuracy than resting state responses.

[Diabetes mellitus and high blood pressure over risk in HIV-infected people followed at Souro Sanou University Hospital Day Hospital, Bobo-Dioulasso 2018]. / Sur-risque de diabète sucré et d'hypertension artérielle chez les personnes infectées par le VIH suivies à l'hôpital de jour du CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, 2018.

BACKGROUND: Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS: A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS: A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION: Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.

[Factors associated with the occurrence of acute respiratory distress and death in patients with COVID-19 in Burkina Faso]. / Facteurs associés à la survenue de la détresse respiratoire aiguë et au décès chez des patients atteints de COVID-19 au Burkina Faso.

INTRODUCTION: The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso. METHODS: This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19. RESULTS: Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days. CONCLUSIONS: Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.

Data-driven measurement of precision of components of pitch curves in Carnatic music.

Carnatic music (CM) is characterized by continuous pitch variations called gamakas, which are learned by example. Precision is measured on the points of zero-slope in gamaka- and non-gamaka-segments of the pitch curve as the standard deviation (SD) of the error in their pitch with respect to targets. Two previous techniques are considered to identify targets: the nearest semitone and the most likely mean of a semi-continuous Gaussian mixture model. These targets are employed irrespective of where the points of zero-slope occur in the pitch curve. The authors propose segmenting CM pitch curves into non-overlapping components called constant-pitch notes (CPNs) and stationary points (STAs), i.e., points where the pitch curve outside the CPNs changes direction. Targets are obtained statistically from the histograms of the mean pitch-values of CPNs, anchors (CPNs adjacent to STAs), and STAs. The upper and lower quartiles of SDs of errors in long CPNs (9-15 cents), short CPNs (20-26 cents), and STAs (41-54 cents) are separable, which justifies the component-wise treatment. The CPN-STA model also brings out a hitherto unreported structure in ragas and explains the precision obtained using the previous techniques.

Time Warping Solutions for Classifying Artifacts in EEG.

The most common brain-computer interface (BCI) devices use electroencephalography (EEG). EEG signals are noisy owing to the presence of many artifacts, namely head movement, and facial movements like eye blinks or jaw movements. Removal of these artifacts from EEG signals is essential for the success of any downstream BCI application. These artifacts influence different sensors of the EEG. In this paper, we devise algorithms for detection and classification of artifacts. Classification of artifacts into head nod, jaw movement and eye-blink is performed using two different varieties of time warping; namely, linear time warping, and dynamic time warping. The average accuracy of 85% and 90% is obtained using the former, and the later, respectively.

Subspace techniques for task-independent EEG person identification.

There has been a growing interest in studying electroencephalography signals (EEG) as a possible biometric. The brain signals captured by EEG are rich and carry information related to the individual, tasks being performed, mental state, and other channel/measurement noise due to session variability and artifacts. To effectively extract person-specific signatures present in EEG, it is necessary to define a subspace that enhances the biometric information and suppresses other nuisance factors. i-vector and x-vector are state-of-art subspace techniques used in speaker recognition. In this paper, novel modifications are proposed for both frameworks to project person-specific signatures from multi-channel EEG into a subspace. The modified i-vector and x-vector systems outperform baseline i-vector and x-vector systems with an absolute improvement of 10.5% and 15.9%, respectively.

Level-wise Subject adaptation to improve classification of motor and mental EEG tasks.

Classification of various cognitive and motor tasks using electroencephalogram (EEG) signals is necessary for building Brain Computer Interfaces (BCI) that are noninvasive. However, achieving high classification accuracy in a multi-subject multitask scenario is a challenge. A noticeable reduction in accuracy is observed when the subjects between train and test are mismatched. Drawing a similarity from speaker adaptation approaches in speech, we propose a method to perform subject-wise adaptation of EEG in order to improve the task classification performance. A Common Spatial Pattern (CSP) approach is employed for feature extraction. Gaussian Mixture Model (GMM) based subject-specific models are built for each of the tasks. Maximum a-posterior (MAP) adaptation is performed, and an absolute improvement of 1.22-7.26% is observed in the average accuracy.

Spike Estimation from Fluorescence Signals Using High-Resolution Property of Group Delay.

Spike estimation from calcium (Ca2+) fluorescence signals is a fundamental and challenging problem in neuroscience. Several models and algorithms have been proposed for this task over the past decade. Nevertheless, it is still hard to achieve accurate spike positions from the Ca2+ fluorescence signals. While existing methods rely on data-driven methods and the physiology of neurons for modelling the spiking process, this work exploits the nature of the fluorescence responses to spikes using signal processing. We first motivate the problem by a novel analysis of the high-resolution property of minimum-phase group delay (GD) functions for multi-pole resonators. The resonators could be connected either in series or in parallel. The Ca2+ indicator responds to a spike with a sudden rise, that is followed by an exponential decay. We interpret the Ca2+ signal as the response of an impulse train to the change in Ca2+ concentration, where the Ca2+ response corresponds to a resonator. We perform minimum-phase group delay-based filtering of the Ca2+ signal for resolving spike locations. The performance of the proposed algorithm is evaluated on nine datasets spanning various indicators, sampling rates and, mouse brain regions. The proposed approach: GDspike, is compared with other spike estimation methods including MLspike, Vogelstein de-convolution algorithm, and data-driven Spike Triggered Mixture (STM) model. The performance of GDSpike is superior to that of the Vogelstein algorithm and is comparable to that of MLSpike. It can also be used to post-process the output of MLSpike, which further enhances the performance.

[Characteristics of Low-Level Persistent viraemias in HIV-1 Patients Treated with Second-Line ARVs at the Sourô Sanou Teaching Hospital of Bobo-Dioulasso (Burkina Faso)]. / Caractéristiques des virémies persistantes de bas niveau des patients VIH-1 sous traitement antirétroviral de deuxième ligne au CHU Sourô Sanou de Bobo-Dioulasso (Burkina Faso).

We describe the characteristics of patients infected with HIV-1 as second-line antiretroviral therapy, with persisting low-level viremia. This was a descriptive retrospective study, conducted from January 1, 2010 to December 31, 2016, from the Cohort of the Infectious Diseases Department of Bobo-Dioulasso University Hospital. Patients infected with HIV-1, a second line of stable ARV treatment, with ≥95% compliance for at least 12 months, asymptomatic with CVp between 50 and 1000 copies/ml in two consecutive samplings at least 3 months apart. Out of 244 patients in second-line therapy, 79 met our inclusion criteria. The mean age of the patients was 42±10.2 years. Women (35.8 years) were younger than men (43.8 years) (p=0.001). Most were married (48.1%), 23.5% of whom were polygamous. The majority of patients (38/79) in the study had a CD4 count of <200 cells/ mm3. The median duration of ARV therapy since the beginning of the therapeutic history has been 4.8 (2.5-11 years). CVp greater than 10,000 copies/ml at the start of second-line therapy (p=0.003) and TDF+FTC + DRV + RTV combination (p=0.001) were associated with persistent low viremia. A genotypic resistance test is needed for these patients in order to better adapt the ARV treatment.

Nous décrivons les caractéristiques des patients infectés par le VIH-1 en deuxième ligne de traitement antirétroviral, avec une virémie persistante de bas niveau. Il s'agissait d'une étude rétrospective à visée descriptive, menée du 1er janvier 2010 au 31 décembre 2016, à partir de la cohorte du service des maladies infectieuses du CHU de Bobo-Dioulasso. Ont été inclus les patients infectés par le VIH-1, en deuxième ligne de traitement ARV stable, ayant une observance ≥ 95 % depuis au moins 12 mois, asymptomatiques, avec une charge virale plasmatique comprise entre 50 et 1 000 copies/ml sur deux prélèvements consécutifs à au moins 3 mois d'intervalle. Sur 244 patients en deuxième ligne de traitement antirétroviral, 79 répondaient à nos critères d'inclusion. L'âge moyen des patients était de 42 ± 10,2 ans. Les femmes (35,8 ans) étaient moins âgées que les hommes (43,8 ans) (p = 0,001). La plupart des patients étaient mariés (48,1 %), parmis lesquels certains vivaient dans des régimes polygames (23,5 %). La majorité des patients (38/79) de l'étude avaient un taux de CD4 ≤ 200 cellules/mm3. La durée médiane du traitement ARV depuis le début de l'histoire thérapeutique était de 4,8 ans (2,5- 11 ans). La charge virale plasmatique supérieure à 10 000 copies/ml au début du traitement (p = 0,003), et la combinaison TDF+FTC+DRV+RTV (p = 0,001) étaient associées à la virémie persistante de bas niveau. La réalisation d'un test génotypique de résistance s'impose pour ces patients afin de mieux adapter le traitement antirétroviral.

Incidence et risque résiduel de transmission des virus de l'hépatite B et C par transfusion sanguine à Bobo-Dioulasso (Burkina Faso) : Étude de cohorte

l'objectif de notre étude était d'évaluer l'incidence et le risque de transmission des virus des hépatites B et C par transfusion. nous avons conduit une étude de cohorte rétrospective de janvier 2009 à décembre 2014 portant sur les dons de 12 969 donneurs bénévoles et réguliers de sang au Centre Régional de Transfusion Sanguine de Bobo-dioulasso. le diagnostic de l'infection par le VhC ou le VhB était obtenu par technique eliSa devant la présence dans le sérum des anticorps anti-VhC pour le VhC ou de l'antigène hBs pour ce qui est du VhB. le taux d'incidence du VhB était de 2,16 pour 100 donneurs-années et celui du VhC était de 2,59 pour 100 donneurs-années. le risque de transmission du VhB était estimé à 1 pour 302 dons et celui du VhC à 1 pour 213 dons. un renforcement de la sélection des donneurs de sang s'avère indispensable devant un risque élevé de transmission des virus de l'hépatite B et/ou C par don de sang provenant des donneurs bénévoles réguliers

17ß-Hydroxy-18-acetoxywithanolides from Aeroponically Grown Physalis crassifolia and Their Potent and Selective Cytotoxicity for Prostate Cancer Cells.

When cultivated under aeroponic growth conditions, Physalis crassifolia produced 11 new withanolides (1-11) and seven known withanolides (12-18) including those obtained from the wild-crafted plant. The structures of the new withanolides were elucidated by the application of spectroscopic techniques, and the known withanolides were identified by comparison of their spectroscopic data with those reported. Withanolides 1-11 and 16 were evaluated for their potential anticancer activity using five tumor cell lines. Of these, the 17ß-hydroxy-18-acetoxywithanolides 1, 2, 6, 7, and 16 showed potent antiproliferative activity, with some having selectivity for prostate adenocarcinoma (LNCaP and PC-3M) compared to the breast adenocarcinoma (MCF-7), non-small-cell lung cancer (NCI-H460), and CNS glioma (SF-268) cell lines used. The cytotoxicity data obtained for 12-15, 17, and 19 have provided additional structure-activity relationship information for the 17ß-hydroxy-18-acetoxywithanolides.

Safety of Microfocused Ultrasound With Visualization in Patients With Fitzpatrick Skin Phototypes III to VI.

IMPORTANCE: A microfocused ultrasound (MFU) system is a safe and effective aesthetic treatment for tightening and lifting skin in the facial and neck areas. This open-label, nonrandomized trial was performed to further demonstrate the safety of MFU for improving laxity of the skin of the face and neck in 52 adults with Fitzpatrick skin types III to VI. OBSERVATIONS: Before treatment with MFU, the skin tissue of each participant was assessed and ultrasound imaging was performed on the treatment area to ensure appropriate acoustic transducer coupling. Treatment was performed from March 23, 2011, to July 20, 2011. Following treatment, there were 3 reported adverse events described as raised areas of mild edema or welts (2 events) and moderately severe prolonged erythema with mild scabbing (1 event). All events resolved after 90 days without sequelae. Analysis was conducted from Janaury 18, 2012, to March 13, 2013. CONCLUSIONS AND RELEVANCE: The adverse events that occurred in this trial were temporary and associated with treatment technique. When performed by trained physicians, MFU is safe in patients with Fitzpatrick skin types III to VI. LEVEL OF EVIDENCE: 4. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01368965.

[Immuno-virologic dissociation in patients infected by HIV-1 under antiretroviral treatment at the Day hospital of Bobo-Dioulasso from 2008 to 2012 (Burkina Faso)]. / Dissociation immuno-virologique chez les patients infectes par le VIH-1 sous traitement antiretroviral a l'hopital de Jour de Bobo-Dioulasso de 2008 a 2012 (Burkina Faso).

OBJECTIVE: describe the sociodemographic, clinical, therapeutic, biological profile and the observance of treatment in cases of immuno-virologic dissociation response (IVDR) in HIV-1 patients at te 12 months of antiretroviral treatment (ARVT). METHODS: This was a historical cohort study with a descriptive and analytical focus from January 2008 to December 2012; covering the IVDR cases at the day hospital of Bobo Dioulasso. We collected the data during medical consultations by means of the ESOPE software and from medical records of the patients. RESULTS: Of 2078 patients on ARVT, 84 or 4% presented one IVDR, among which 56 women (66.7%) and 28 men (33.3%). The average age was 45 years [range: 45-55 years]. At the initiation of ARVT, most patients were in clinical stage 3 or 4 of the WHO classification (57.1%). The body mass index (BMI) average was 20.5kg/m2 [IQR = 18.5 and 23]. The average number of +CD4 T lymphocyte was 42 cells/mm3 [IQR = 12- 63]. During follow-up, the median gain in BMI was 3.2 kg/m2 [IQR = 1.2 to 4.3 kg/m2], the median gain was 76 cells/µl [IQR = 60 - 88]. The viral plasmatic load of the HIV-1 was undetectable with a rate of TCD4+ < 100 cells /µl in 12 months. Factors associated with IVDR were the age between 35 and 45 years (p = 0.0009), the number of +CD4 T cells (+CD4T≤50) at initiation of ARVT (p = 0.00045 ) and the WHO classification clinical stage 3. CONCLUSION: This study demonstrates the problem of IVDR management in Bobo-Dioulasso and reminds of the interest of care follow-up of people living with HIV-1 by viral load and not only by the rate of CD4+ T especially in the decentralized structures of coverage of HIV, where changes of therapeutic mechanisms operate disjointedly.

OBJECTIF: décrire le profil sociodémographique, clinique, thérapeutique, biologique et l'observance du traitement des cas de réponse immuno-virologique dissociée (DIV) chez les patients VIH-1 à 12 mois de traitement antirétroviral (ARV). MÉTHODES: Il s'agissait d'une étude de cohorte historique à visée descriptive et analytique de janvier 2008 à décembre 2012, portant sur les DIV suivis à l'hôpital de jour (HDJ) de Bobo- Dioulasso. Nous avons recueilli les données au cours des consultations médicales à l'aide du logiciel ESOPE et à partir du dossier médical des patients. RÉSULTATS: Sur 2078 patients sous ARV, 84 soit 4% présentaient une dissociation immuno-virologique (DIV), dont 56 femmes (66,7%) et 28 hommes (33,3%). L'âge médian était de 45 ans [EIQ = 45­ 55 ans]. A l'initiation du traitement ARV, la plupart des patients étaient aux stades cliniques 3 ou 4 de l'OMS (57,1%). La médiane de l'IMC était à 20,5kg/m2 [EIQ=18,5 et 23 ans]. La médiane du nombre de lymphocyte TCD4+ était de 42 cellules/mm3 [EIQ= 12­ 63]. Au cours du suivi, le gain médian en indice de masse corporelle était de 3,2 kg/m2 [EIQ=1,2­4,3 kg/m2], le gain médian en TCD4+ était de 76 cellules/µl [EIQ=60 ­ 88]. La charge virale plasmatique du VIH-1 était indétectable chez tous avec un taux de TCD4+ < 100 cellules/µl à 12 mois. Les facteurs associés à la réponse immunovirologique dissociée étaient l'âge compris entre 35 à 45 ans (p = 0,0009), un nombre de lymphocytes T CD4 (CD4≤50) à l'initiation du traitement ARV (p=0,00045) et le stade clinique OMS 3. CONCLUSION: Cette étude prouve la problématique de la gestion de la réponse immuno-virologique dissociée à Bobo-Dioulasso, et rappel tout l'intérêt du suivi des PvVIH par la charge virale et non seulement par le taux de TCD4+ surtout dans les structures déconcentrées de prise en charge du VIH, où des changements de régime thérapeutique s'opèrent à tord.

[Metabolic syndrome and cardiovascular risk patients under antiretrovirals in a day hospital at Bobo-Dioulasso (Burkina Faso)]. / Syndrome métabolique et risque cardiovasculaire chez des patients sous antirétroviraux à l'hôpital de jour de Bobo-Dioulasso (Burkina Faso).

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

Development and evaluation of buccoadhesive tablet for selegiline hydrochloride based on thiolated polycarbophil.

Selegiline hydrochloride (SHCl), a monoamine oxidase B inhibitor, is used as an adjunct in the therapy of Parkinson's disease. This study is concerned with the preparation and evaluation of mucoadhesive buccal tablet for controlled systemic delivery of SHCl. Buccal absorption of selegiline can bypass its first-pass metabolism and improve bioavailability accompanied by greatly reduced metabolite formation, which is potentially of enhanced therapeutic value in patients with Parkinson's disease. Polycarbophil-cysteine (PCP-cys) conjugate, which is a thiolated derivative of the mucoadhesive polymer polycarbophil, was synthesized by 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride-mediated amide bond coupling. Tablets of SHCl based on native and thiolated polycarbophil were prepared. The prepared tablets were evaluated for drug content, swelling behavior, mucoadhesive strength, in vitro drug release, ex vivo permeation and in vitro cytotoxicity. PCP-cys tablets showed enhanced mucoadhesion and retarded drug release compared to polycarbophil tablets. Permeation data of SHCl from matrices prepared using the PCP-cys polymer revealed a significantly higher value of apparent permeability in comparison to polycarbophil, which supported the information in literature that thiolation imparts permeation enhancing properties to mucoadhesive polymers. In vitro cytotoxicity studies on PCP-cys using L-929 mouse fibroblast cell line indicated that conjugation with cysteine does not impart any apparent toxicity to polycarbophil. The results from the study indicate that the buccal delivery of SHCl using thiolated polycarbophil tablet could provide a way for improved therapy of Parkinson's disease.

Design and characterization of chitosan-alginate microspheres for ocular delivery of azelastine.

The use of mucoadhesive biopolymers is one of the best approaches to prolong the drug residence inside the cul-de-sac, consequently increasing the bioavailability. Thus, the focus of this work was to develop mucoadhesive microspheres to overcome the limitations of ocular drug delivery. The chitosan-sodium alginate microspheres of azelastine hydrochloride were fabricated using modified ionotropic gelation technique. The particle size, zeta potential, entrapment efficiency and drug release kinetics were evaluated and characterized by SEM, FT-IR, DSC, in vitro mucoadhesion and in vivo study. The microspheres had average particle size in the range of 3.55 to 6.70 µm and zeta potential +24.55 to +49.56 mV. The fabricated microspheres possess maximum drug entrapment of 73.05% with 65% mucin binding efficiency and revealed a controlled release over the 8-h period following a non-Fickian diffusion. SEM showed that microspheres were distinct solid with irregular shape. FT-IR and DSC results concluded the drug entrapment into microspheres. In vivo studies on ocular rat model revealed that azelastine microspheres had better efficacy. Chitosan sodium alginate microspheres prepared were in particle size range suitable for ocular purpose. In vitro release and in vivo efficacy studies revealed that the microspheres were effective in prolonging the drug's presence in cul de sac with improved therapeutic efficacy.