[Evaluation of a new polyvalent antivenom against snakebite envenomation (Inoserp® Panafricain) in two different epidemiological settings: Northern Benin and Maritime Guinea]. / Évaluation d'un nouvel antivenin polyvalent contre les envenimations ophidiennes (Inoserp(®) Panafricain) dans deux contextes épidémiologiques: le Nord Bénin et la Guinée Maritime.

OBJECTIVES: The authors evaluated the safety and efficacy of Inoserp(®) Pan Africa, a new polyvalent antivenom composed of highly purified and lyophilized fragments of F(ab')2 immunoglobulins, recently registered in Benin and Guinea. METHODS: We treated 100 patients in northern Benin (Atacora) and 109 in Maritime Guinea (Kindia) with confirmed envenomation. Treatment consisted of intravenous administration of 1 vial for uncomplicated envenomation, and 2 vials for hemorrhagic or neurotoxic envenomation. The dose was repeated when bleeding or signs of neurotoxicity persisted or appeared. RESULTS: In Atacora, on arrival at the hospital, 90% of patients had incoagulable blood, and 50% were bleeding. The resolution of these bleeding disorders was obtained in less than 3 hours for 50% of the patients and in less than 24 hours for 98%. Four patients died. In Kindia, 96 patients (88%) presented viper bites with pain + edema and 13 (12 %) others showed elapid (ptosis, dyspnea) envenomation. One patient bitten by a member of the Elapidae family, died despite early treatment. In Benin, protocol deviations for 60% of patients led to significant underdosing of the antivenom; the proportion was much lower (2%) in Guinea. Signs of intolerance after Inoserp(®) Pan Africa administration were reported in 8% of patients. All these symptoms were mild and disappeared rapidly after an antihistamine or corticosteroid treatment. CONCLUSION: Treatment using intravenous Inoserp(®) Pan Africa appeared to be well tolerated and effective against snakebite envenomation in both epidemiological settings.

[Clinical study of tolerance and effectiveness of a F(ab')(2) polyvalent antienom for African snake bites in Kindia, Guinea]. / Étude clinique de la tolérance et de l'efficacité d'un sérum anti-ophidien polyvalent F(ab')(2) pour l'Afrique à Kindia, Guinée.

An open, pragmatic, phase IV clinical trial was undertaken to measure tolerance and assess the effectiveness of Antivipmyn® Africa, antivenom composed of lyophilized F(ab')(2) fragments of immunoglobulin G in field conditions. The study was conducted at the Institut Pasteur of Guinea (IPG) from August 2009 to February 2010. Two hundred twenty-eight victims of snakebites presented at the processing center of the IPG during this period, including one hundred fifty (65.8%) envenomations, mostly young men. One hundred twenty-four of them (82.7%) suffered from viper envenomations and 26 (17.3%) from elapid ones. All patients were treated by intravenous Antivipmyn® Africa, averaging 1.4 (± 1.0) vials, more in patients with neurotoxic envenomation than others (P < 10(-5)). Four patients (2.7%), showing cobralike envenomation, died shortly after their arrival at the IPG despite the administration of the antivenom. Ten patients showed mild side effects (rash or pruritus), out of which 5 (3.3%) were probably due to treatment. This study confirms the efficacy and safety of Antivipmyn® Africa.

[A survey on the venomous snakes of the vicinity of Kindia (Guinea) and considerations on the treatment of snakebite]. / Etude epidémiologique des serpents venimeux et prise en charge des envenimations a Kindia (Guinée).

Between June and December 2004, snake collections were undertaken in eight villages of the vicinity of Kindia, an area of Guinea Conakry where the incidence of snakebite is among the highest reported in the world. A total of 916 specimens were collected, including 90 Elapidae (9.8 %) and 174 Viperidae (19.0%). The Black Mamba Dendroaspis polylepis was represented by eight specimens, i.e. almost 1% of the snakes collected. This species, which is considered as very rare in West Africa, appears common in this area of Guinea. The current difficulties for the treatment of snakebite due to the high increase of the cost of antivenom therapy are discussed.

Etude epidemiologique des serpents venimeux et prise en charge des envenimations a Kindia (Guinee)

De juin a decembre 2004 une collecte de serpents a ete organisee dans huit localites des environs de Kindia; une region de Guinee Conakry ou l'incidence des morsures de serpents et des deces qu'elles occasionnent sont parmi les plus elevees signalees dans le monde. Un total de 916 specimens a ete recolte; dont 90 Elapides (9;8) et 174Viperides (19;0). Le Mamba noir Dendroaspis polylepis etait represente par huit specimens; soit pres de 1de l'ensemble des serpents collectes. Cette espece consideree comme tres rare en Afrique de l'Ouest apparait comme frequente dans cette region de Guinee. Les difficultes actuelles de prise en charge des victimes de morsure de serpents provoquees par la forte augmentation du cout du traitement antivenimeux sont discutees

[Hypokalaemia and paralysis: think about the thyroid]. / Hypokaliémie et paralysie: penser à la thyroïde.

Periodic hypokalemic paralysis can be of genetic origin or secondary to other causes of hypokalaemia. The thyreotoxic hypokalemic periodic paralysis (THPP) usually occurs among asian subjects. It is a diagnostic and therapeutic emergency which may lead to life-threatening complications due to hypokalaemia and muscle weakness. The potassium supplementation is followed by a complete recovery after a few hours. We underlined the interest of thyroid assays in patients having an acute muscular paralysis associated with hypokalaemia.

[Erectile dysfunction and diabetes in Conakry (Guinea): frequency and clinical characteristics from 187 diabetic patients]. / Dysfonction érectile et diabète à Conakry (Guinée): fréquence et profil clinique à partir de 187 observations.

Sexual dysfunction is frequent in the diabetic population. In Africa, medical care for erectile dysfunction is underprovided, profoundly altering the quality of life of the patients. We report the prevalence of erectile dysfunction in 187 diabetic patients followed in the department of Endocrinology of the Conakry teaching hospital. Prevalence was estimated from the French version of the International Index of Erectile Function (IIEF). Erectile dysfunction concerned 90 patients (48%) of whom a severe form was observed in 54%, a moderate form in 35% and a mild form in 12%. The patients who presented erectile dysfunction were significantly older, displayed longer duration of diabetes with more complications (sensorial neuropathy and macroangiopathy) and often took drugs for associated cardiovascular diseases. In 28% of the cases, erectile dysfunction was associated with a decline in libido and in 26% with ejaculation disorders. In conclusion, erectile dysfunction is frequent and severe among diabetic patients in Guinea. The medical staff plays an essential role to initiate early diagnosis, promote psychological support and provide medication, if possible.

[Renal diseases--morbidity and mortality in Nephrology Service, National Hospital Donka]. / Morbidite et mortalite hospitalieres dans le Service de Nephrologie de l'Hopital National Donka.

It is a retrospective study of descriptive type on a 4 years period, from April 1, 1999 to March 31, 2003. The aim was to determine factors bound to morbidity and mortality of renal affections in the Conakry University Hospital Center Nephrology Unit. The study was based on 606 hospitalized patients of whom 21 dialysed. The study's references were age, sex, renal affections frequency, mortality, associated pathologies, hospitalization period, death hours and other factors of cardio-vascular risks (tobacco, alcohol). Patients having answered to the selection criteria were 365 men (60.23%) and 241 women (39.77%) with a sex ratio of 1.51. The average age was 44 +/- 17 years old with extremes of 15 and 95 years old; 16.34% of the patients were aged less than 25 years and 14.03% were more than 65 years old. According to the charge taking, 462 (76.24%) were at their neighbors' charge, only 144 (23.76%) could take themselves in charge for their medical care. According to the received treatment before hospitalization, 357 had consumed decoctions of leaves and roots, 86 consulted a health center. The average period of hospitalization was 13 +/- 9 days with extremes of 1 and 80 days. Nicotine addiction was observed with 183 patients of whom 181 were men and alcoholism with 134 patients of whom 122 were men. Renal affections were chronic renal failure (51%), arterial hypertension (30.36%), chronic kidney disease (8.09%), intense renal failure (7.59%), urinary infections (1.65%), intense kidney disease (0.99%) and kidney cancer (0.33%). Among them, 130 deaths were observed (21.45%). According to the period going on before the medical check up, 24 death occurred 2 weeks after the first symptom, and 106 after more than a month. Considering the hours, 33 death (25.38%) occurred between 8 a.m. and 4 p.m. and 63 deaths (48.47%) between 4 p.m. and 8 a.m.; in 34 cases, the hour was not specified. Mortality was due to chronic renal failure in 97 cases (74.61%), to arterial hypertension in 19 cases (14.62%) and to other affections in 14 cases (0.77%). Infections, diabetes, arterial hypertension and anemia sickle cells were renal risk factors. Morbidity and mortality factors were numerous and varied: medical check up delay, traditional cure, patients 'weak turnover, lack of medical care, lack of required equipment and the absence of popular health education.

Morbidité et mortalité hospitalières dans le service de nephrologie de l'Hôpital National Donka

Il s'agit d'une étude rétrospective de type descriptif sur une période de 4 ans, allant du 01Avril 1999 au 31 Mars 2003. L'objectif était de déterminer les facteurs liés à la morbidité et à la mortalité des affections rénales dans le service de Néphrologie du CHU de Conakry. L'étude a portésur 606 patients hospitalisés dont 21 dialysés. Les paramètres de l'étude étaient l'âge, le sexe, lafréquence des affections rénales, la mortalité, les pathologies associées, le délai de consultation, laprise en charge, le traitement reçu avant l'hospitalisation, la durée d'hospitalisation, les horaires de décès et certains facteurs de risque cardio-vasculaires (tabac, alcool). Les malades ayant réponduaux critères de sélection étaient 365 hommes (60,23%) et 241 femmes (39,77%) avec un sex-ratio de1,51. La moyenne d'âge était de 44 ± 17 ans avec des extrêmes de 15 et 95 ans ; 16,34% des patients étaient âgés de moins de 25 ans et 14,03% avaient plus de 65 ans. Selon la prise en charge, 462 (76,24%) étaient à la charge de leur entourage, seuls 144 (23,76%) pouvaient se prendre en charge pour les soins. Selon le traitement reçu avant l'hospitalisation, 357 avaient consommé des décoctions de feuilles et de racines, 86 avaient consulté un centre de santé. La durée moyenne d'hospitalisation a été de 13 ± 9 jours avec des extrêmes de 1 et 80 jours. Le tabagisme avait été observé chez 183 malades dont 181 hommes et l'alcoolisme chez 134 malades dont 122 hommes. Les affections rénales étaient l'insuffisance rénale chronique (51%), l'hypertension artérielle (30,36%), les glomérulonéphrites chroniques (8,09%), l'insuffisance rénale aiguë (7,59%), les infections urinaires (1,65%) les glomérulonéphrites aiguës (0,99%) et le cancer du rein (0,33%). Parmi eux, 130 décès avaient été observés soit 21,45%. Selon le délai écoulé avant la consultation, 24 décès étaient survenus 2 semaines après le premier symptôme et 106 après plus d'un mois.Suivant les horaires, 33 décès (25,38%) étaient survenus entre 8h et 16h et 63 décès (48,47%) entre 16h et 8h ; dans 34 cas, l'heure n'était pas précisée. La mortalité était due à l'insuffisance rénale chronique dans 97 cas, soit 74,61%, à l'hypertension artérielle dans 19 cas, soit 14,62% et aux autres affections dans 14 cas, soit 0,77%. Les infections, le diabète, l'hypertension artérielle et la drépanocytose étaient les facteurs de risque rénal. Les facteurs de morbidité et de mortalité étaient nombreux et variés à savoir : le retard à la consultation, le traitement traditionnel, le faiblerevenu des malades, l'absence de couverture sanitaire, le manque de prise en charge correct au cours des gardes, le manque d'équipement adéquat et l'absence d'éducation sanitaire populaire

[Impact of snakebites in rural environment: community survey in the rural development community (DRC) of Frilguiagbe, Republic of Guinea]. / Incidence des morsures de serpent: enquête communautaire dans la collectivité rurale de développement (CRD) de Frilguiagbe (République de Guinée).

An exhaustive study has been carried out in the rural development community (DRC) of Frilguiagbe, located at 115 km from Conakry in the Conakry-Kindia highway. It concerns a population of 23,442 inhabitants divided into 3,047 households. The survey was carried out at three levels:--community level;--health centres;--traditional healers. In the household survey made between 2002 and 2003, 175 snakebites cases were recorded. In health centres, only two (2) cases were recorded from 1993 to 2003. On the other hand, 80% (=140) of the cases registered in the households have consulted a traditional healer. On the whole, there were 9 deaths (5%). Such a result shows that the collect of information from the consultation registers is not appropriate to appraise the importance of envenomations in our country.

[Envenomations of the Kindia prefecture treated in the Institut Pasteur of Guinea for one year (2003-2004)]. / Les envenimations de la préfecture de Kindia traitées à l'Institut Pasteur de Guinée durant un an (2003-2004).

After a broadcast information on the availability of antivenom serum in Guinea Pasteur Institute (GPI), 76 snakebites victims have been admitted to the health centre of GPI within 11 months (October 2003-September 2004), 48 of whom were in a serious condition. In addition, 13 deaths occurred during the transport of the victims, i.e. a total incidence of 89 cases. Among these cases, 84% of the bites occurred during farming works (clearing, weeding, harvesting). Among the 76 victims who came alive at GPI, 9 of them did not present any envenomation. The 67 other victims have systematically received antivenom serum with a 100% recovery rate.

[Problems with envenomations in Guinea]. / Problématique des envenimations en Guinée.

Only a few years after its creation, the Kindia Pasteur Institute (currently Institut de Recherche de Biologie Appliquée de Guinée, IRBAG), owing to its geographical situation, began regularly supplying the Paris Pasteur Institute with snake venom for manufacturing antivenom. The diversity of the biotopes in Guinea due mainly to the diversity of vegetation (savannah, forest, mangrove) and altitudes (coastal zone, mountains of Fouta-Djalon and mountain of High Guinea), induces a wide variety of the herpetological fauna. Envenomations are consequently a significant cause of morbidity and mortality in a country where agriculture is an important economic activity. Unfortunately, precise statistics for envenomations are unavailable. A retrospective study was performed based on IRBAG registers (1980-1990). A total of 584 snakebites were reported with a 2.2% case fatality rate. Between 1997 and 1999, 379 cases of snakebites were reported with 18.2% death, mainly due to the lack of antivenom, and 2.1% amputations. By combining the fang marks and victim or relative assessments, we were able to identify most of the snakes involved in the envenomations: Naja (21.3%), Bitis (15%), Dendroaspis (12.4%) and Causus (12.9%). In 38.2% of the cases, the snake was not identified. This survey confirmed that envenomations are a problem in Guinea. However, more studies are necessary to appreciate the real importance of the herpetological Guinean fauna and its consequences on morbidity and mortality in order to improve the management of envenomations.

[Malaria prevalence survey in 24 Guinean villages in the Kindia area]. / Etude de la prévalence du paludisme dans 24 villages de la Guinée.

The authors report the results of a survey of malaria prevalence carried out from October to December 1998 in 24 villages located upstream of the Garafiri dam, in the Kindia area. The parametre used for the assessment of prevalence was the Plasmodium index. The gametocyte and spleen indexes were also recorded. The prevalence observed (34,7%) confirms the presence in this area of stable malaria mostly transmitted by Anopheles gambiae in tropical Africa. This prevalence rate is compatible with the epidemiological data of the Ministry of Health.

[Contribution to the study of mosquitoes (Diptera: Culicidae) of Guinea: Fauna and distribution]. / Contribution à l'étude des moustiques (Diptera: Culicidae) de la Guinée. Faune et distribution.

The authors report the results of ten years of entomological research conducted in Guinea. During this period, 84,000 larvae and 66,000 adult mosquitoes belonging to 8 different genera were captured and identified according to species or species groups. Mosquito fauna in Guinea includes almost all the known vectors of malaria and filaria in West Africa (see tables I-IV) as well as many of the known vectors of arboviruses. Four methods were used for capturing the insects, the most efficient being the use of a net in vegetation which succeeded in trapping 83% of the species described.