[Correction of cardiodynamic disorders in experimental diabetes by omega-3 polyunsaturated fatty acids].

In experiments on rat hearts in vivo with the system for pressure-volume registration "Millar Instruments" cardiodynamic disorders were studied in experimental diabetes for their correction with omega-3 polyunsaturated fatty acids (PUFAs). The application of omega-3 PUFAs in animals with diabetes may improve cardiodynamic parameters--pump and diastolic function.

[Study of the impact of omega-3 PUFA on fatty acid composition of heart, respiration and swelling of mitochondria of the heart in diabetes].

We studied the influence of omega-3 polyunsaturated fatty acids (PUFAs) on respiration, swelling of rat heart mitochondria and changes in rat heart fatty acid composition in tissue homogenate in rats with streptozotocin induced diabetes mellitus (diabetes), which was induced by single intraperitoneal administration of 55 mg/kg streptozotocin. We found that application of these acids increased parameters of active mitochondrial respiration V3 at 63.7%, controlled breathing V4 at 30.7% and the rate of phosphorylation by 18.9% in animals with experimental diabetes. We proved their ability to reduce swelling of mitochondria in heart at streptozotocin induced diabetes. In addition, we established changes of fatty acid composition of cell membranes in hearts under diabetic conditions with omega-3 PUFAs influence. The obtained results allow to conclude that the omega-3 PUFA have a positive effect on functional parameters of mitochondria due to stabilization cell membranes of rat heart with diabetes.

Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit.

Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P<0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P<0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries.

[Effect of coordination germanium compounds on biosynthesis and activity of proteases in Bacillus sp. and Yarrowia lipolytica].

The paper deals with the capacity of the coordination germanium compounds with citric acid in a complex with some aminoacids (aspartic acid, methionine, cysteine, threonine, phenylalanine, L-glutamic acid) as bioligands to affect synthesis and activity of the proteolytic enzyme complex of Bacillus sp. 27 and Yarrowia lipolytica 2061. Thus, biscitrategermanium acid H2[Ge(H4Citr)2] and its complex with aspartic acid (HAsp)2 [Ge(H4Citr)2] can be used with success for inducing biosynthesis ofcaseinolytic (182.1 and 197.4%) and elastase (182.6 and 383.3%) activities of Bacillus sp. 27, respectively. Biscitrategermanium acid can be used to induce biosynthesis of caseinolytic (182.1 and 197.4%) and elastase (182.6 and 383.3%) activities (respectively) of Bacillus sp. 27. Biscitrategermanium acid with methionine induced biosynthesis of caseinolytic (127.6%) and haemoglobinolytic (110.0%) activities of Y. lipolytica 2061. The tested coordinative compounds could not induce activity ofproteolytic complexes of both microorganisms. The capacity of complexes of citrategermanium acid with aspartic acid, methionine, cysteine, threonine, phenylalanine in concentration of 0.1% to inhibit activity of proteolytic complex of Y. lipolytica 2061 can be used in further studies of the catalytic centre of enzymes.

[Influence of different sources of carbon and nitrogen on the biosynthesis of proteolytic complexes by Bacillus circulans 693, Bacillus sp. 27 and Yarrowia lipolytica 2061 strains].

The influence of different factors on the biosynthesis of extracellular proteolytic complexes by strains-producers Bacillus circulans 693, Bacillus sp. 27 and Yarrowia lipolytica 2061 at submerged cultivation has been investigated. It has been shown that ammonium hydrocarbonate and gelatin with glucose were optimum carbon and nitrogen sources for synthesis of proteolytic activity of B. circulans strain 693, gelatin with arabinose--for Bacillus sp. 27, gelatin and glycine with sorbose--for Y. lipolytica 2061. It has been established that the cultivation of producers on optimal sources of carbon and nitrogen increased protease activity of cultural liquid of B. circulans 693 3.8 times, Bacillus sp. 27--2.7 times, Y. lipolytica 2061--3.4 times. It has been found that the usage of different protein substrates in cultural medium permitted to obtain the proteolytic enzymes with various specificity with respect to globular and fibrillar proteins.

[Screening of microorganisms--producers of proteases].

Screening of producers of proteases among 367 strains of microorganisms has been carried out. A capacity to synthesize the enzymes was revealed in 25% of the studied strains of Bacillus genus (from 0.0054 to 0.892 un./mg of protein) and in 35% of the yeasts of Yarrowia genus (0.95 to 1.349 un./mg of protein). Elastase, gelatinase, caseinolytic, fibrinolytic and haemoglobinolytic activities were found in culture liquid of 7 the most active strains, their values depended on time of producer cultivation.

[Pertinence of the 2000 WHO criteria in non-immune children with severe malaria in Dakar, Senegal ]. / Pertinence des critères OMS 2000 de paludisme grave chez l'enfant non immun à Dakar, Sénégal.

UNLABELLED: The relevance of World Health Organization (WHO) criteria for severe malaria has not been assessed in non-immune children. The objectives of this study were (i) to evaluate the significance of 1990 WHO definition reconsidered in 2000 on distribution and lethality of severe cases in children admitted with falciparum malaria, and (ii) to contribute to the study of relevance of the WHO severe criteria in Dakar, an hypoendemic area in Senegal. PATIENTS AND METHODS: The 1990 WHO criteria, respiratory distress and platelet counts were prospectively collected in 1997-99 from children admitted to Hôpital Principal de Dakar, Senegal, with falciparum malaria diagnosed on a thick blood film. This method allowed also the definition of severe cases according to 2000 WHO criteria. RESULTS: Among 311 patients (median age: 8 years old), according to the 2000 WHO criteria, the frequency of severe malaria cases was increased by 23% (75% versus 52%) and case-fatality rates thereof were decreased by 5% (17% versus 12%) compared with 1990 WHO definition. One death occurred among cases defined as severe on admission only according to criteria modified by WHO in 2000. A multivariate logistic regression model identified several independent prognostic factors: cerebral malaria, hypoglycaemia, respiratory distress, renal failure, collapse, abnormal bleedings, pupillary abnormalities and thrombocytopaenia defined as a platelet count below 100,000/mm3. A significant association (p < 0.001) was observed between platelet count increase and consciousness level improvement, evaluated on day of first platelet count control (time from admission: 1-7 d). Among survivors, a lesser improvement in coma score was associated with a decrease in platelet counts (p < 0.04). CONCLUSIONS: The 1990 WHO criteria, which predicted death among malaria cases in children living under stable falciparum transmission, are relevant in this series of non-immune children living in a low and seasonal transmission. Nevertheless new WHO criteria showed poor prognostic significance. However, the 2000 WHO definition was highly sensitive to detect severe malaria cases. These findings should be considered for managing severe malaria in migrant children.

[Decompensated post-schistosomiasis portal hypertension in Richard-Toll, Senegal: first case treated by splenorenal anastomosis in Dakar]. / Hypertension portale post-bilharzienne décompensée à Richard-Toll au Sénégal: premier cas traité à Dakar par anastomose splénorénale.

UNLABELLED: Since the Diama dam on the Senegal river became operative in 1986, an exceptional outbreak of intestinal schistosomiasis occurred in northern Senegal. This is the first case report from this region of a splenorenal derivation performed in Dakar to cure decompensated portal hypertension due to Schistosoma mansoni. CASE REPORT: In June 1998, a 16-year old boy, native from Richard-Toll in the Senegal River Basin, was admitted to the paediatric department of Hôpital Principal, Dakar, Senegal, with a 3 years of recurrent hematemesis. Blood transfusions were required despite propranolol and multiple oesophageal varices sclerotherapies. On admission he weighed 33 kg and was noted to have pallor and moderate hepatosplenomegaly. Lab work included normal liver function tests, a Hgb of 58 mg/L, negative HBs antigen, and high titers of schistosomiasis antibodies (> 1/2000 by the hemagglutination method). Ultrasound revealed an homogeneously enlarged liver, periportal fibrosis and spleen with a grade 2 portal hypertension (WHO score). Endoscopy showed stage 3 oesophageal varices with red spots but no active haemorrhage. After transfusions, a Warren distal splenorenal anastomosis was performed. During the operation, a liver biopsy was obtained, showing periportal fibrosis and schistosomiasis granulomas. The patient was discharged without complication. After 4 years he remains free of any recurrence of his upper gastrointestinal haemorrhage and haemoglobin rate is normal. COMMENTS: Before the inauguration of the dam in 1986, S. mansoni infection was never reported from the Senegal River Basin. But as early as 1988, the first cases of intestinal schistosomiasis began to show up. A few years later, this focus had dramatically extended and in 1991 the first cases of hepatic fibrosis were detected in ultrasonography surveys. The present case involves the first patient from northern Senegal who required surgery for haemorrhagic complications of schistosomiasis induced by liver disease. Considering the high prevalence in this area, and the difficulties of medical management, the need for porto-systemic derivations is likely to rise. These operations are difficult and require specially trained surgeons. They have been largely unavailable in Senegal until now. This case report, involving a child only 10 years after the beginning of the epidemic, underlines the acute need for improving both prevention and medical treatment in order to avoid progression to clinical stages of hepatic schistosomiasis where surgery is unavoidable. In addition, the training of local surgical teams able to deal with these complications is urgently needed in Senegal.

[Maternal and infant prognosis of emergency cesarean section: prospective study of the Principal Hospital in Dakar, Senegal]. / Pronostic maternel et pédiatrique des césariennes en urgence: etude prospective à l'Hôpital Principal de Dakar, Sénégal.

The prognosis of emergency cesarean section is poor for both the mother and child in developing countries. The respective impact of obstetrical and surgical factors has rarely been analyzed. This prospective study was carried out in 370 women (mean age, 30.5 years) who underwent emergency cesarean section at Principal Hospital in Dakar, Senegal, between January 1 and December 31, 1997. Fifty percent of these women had been transferred from an outside maternity clinic. Indications related to the mother (75% of cases) or fetus (25% of cases) were divided into two groups according to degree of emergency: absolute (n = 163) and relative (n = 207). Placental hematoma (n = 64) and fetus-pelvis size mismatching (n = 49) were the main indications in both groups. The technique chosen for initial anesthesia performed by a specialized nurse in most cases was either spinal anesthesia if there were no contraindications (50.8%) or general anesthesia (49.2%). There were 5 complications including 1 that was fatal (aspiration during intubation for general anesthesia). The postoperative maternal morbidity rate was low (n = 7) and outcome was favorable. A total of 7 patients (1.9%) died due to anesthesia-related events in 1 case and obstetrical factors in 6. Mortality in the absolute emergency group was significantly higher for women who were transferred from other clinics (p < 0.02). Child mortality (n = 87) occurred prior to delivery in two thirds of cases and after delivery in one third. Child mortality was significantly higher in the absolute emergency group (RR = 5.4; IC95% = 3.2-8.9, p < 10(-6)). Mother and child mortality rates were correlated with the severity of obstetrical manifestations and delay of care. Findings also showed that a well-organized care system lowers the operative risk of emergency cesarean section even in developing countries.

[Evaluation of long-term outcome of Senegalese children sent abroad for cardiac surgery]. / Evaluation au Sénégal du devenir des enfants transférés pour chirurgie cardiaque.

The incidence of childhood heart disease in developing countries is high, but access to cardiac surgery is limited. This mismatch has given rise to numerous humanitarian programs aimed at sending children abroad for surgical treatment. However little is available about the long-term outcome of these interventions. In 1999 we conducted a retrospective study of 168 Senegalese children undergoing follow-up at the Principal Hospital in Dakar after being transferred to Europe or the Ivory Coast for surgical treatment thanks to the Terre des Hommes Association. A total of 85 children presented congenital heart disease (CHD) and 83 presented acquired heart disease (AHD). Fifteen patients did not undergo surgery due to either contraindications or preoperative death. At the end of study, 23 children had been lost to follow-up mostly from the CHA group and presumably some were cured. Outcome was verifiable in the remaining 145 patients with a median follow-up of 5.6 years. Ninety-seven patients were cured or undergoing surveillance. Quality of life was better in the CHD group (p = 0.047). Forty-eight patients died including 16 in the CHD group and 32 in the AHD group. Perioperative mortality (n = 19) was lower and late mortality (n = 29) was higher in the AHD group (p = 0.005). In the AHD group compliance with surveillance was better for children with valve prostheses. In children treated for isolated mitral valve insufficiency, late mortality was higher after valve replacement than valve repair (p = 0.04). In absence of comparative study data, high mortality was due in part to the long delay between the decision to send the patient abroad and the actual evacuation. These findings support humanitarian action to promote cardiac surgery in developing countries.

[Epidemiology and prognosis of childhood cancers in Dakar, Senegal]. / Epidémiologie et pronostic des affections malignes de l'enfant à Dakar, Sénégal.

Childhood cancer has often been considered as a problem mainly affecting industrialized countries. In reality more than half of cases occur in developing countries where management and diagnosis are major issues. This retrospective study includes 130 children (0.3% of admissions) between the ages of 0 and 15 years hospitalized for malignant disease at the Principal Hospital in Dakar, Senegal between January 1, 1990 and December 31, 2000. Mean age was 97 months and M/F sex ratio was 1.2. Mean delay for admission was 3 months. The five most frequent cancers, accounting for 75% of cases, were leukemia (n = 28), lymphoma (n = 21), nephroblastoma (n = 21), retinoblastoma (n = 16) and osteochondrosarcoma (n = 10). Treatment was completed in 18% of cases. Half of patient were lost from follow-up. The cure rate was 10% overall and 50% for patients receiving complete treatment. The highest cure rate was achieved for nephroblastoma, i.e., 58% of cases treated. Management of childhood cancer in Africa is confronted with numerous problems, namely, paucity of specialized staff, absence of expert centers, shortage of anticancer drugs, lack of financial resources, and delay in treatment. These factors associated with frequent malnutrition and recurrent infectious diseases, greatly lower cure rates in comparison with industrialized countries.

[Epidemiology and prognosis of childhood injuries in Dakar, Senegal]. / Epidémiologie et pronostic des accidents de l'enfant à Dakar, Sénégal.

The impact of accidental injury on childhood morbidity and mortality in Africa is underestimated. The frequency and severity of accidents is high. This retrospective study includes 381 children (3% of admission) between the ages of 0 and 15 years hospitalized for accidental injury at the Principal Hospital in Dakar, Senegal, between January 1, 1997 and December 31, 2000. The annual incidence of childhood injury doubled over the 4-year study period. Mean age was 48 months and the M/F sex ratio was 1.7. The causes were trauma (n = 184) due to domestic accidents (n = 109 including 91 falls) or road accidents (n = 75), poisoning (n = 129 including 38 caustic soda burns), foreign body aspiration or ingestion (n = 30), burns (n = 18), and miscellaneous accidents (n = 20). Most fatalities (9%) were due to road accidents and falls. Rapid uncontrolled urbanization and problems of displaced rural populations in adapting to city living may account for the high frequency of falls from high buildings and road accidents. As in industrialized countries road accidents, though not the most frequent, are the most lethal. Lack of emergency services accounts for severity. Vigorous information campaigns and prevention action will be needed to lower the high morbidity and mortality of childhood injury in developing countries.

Severe falciparum malaria in children: a comparative study of 1990 and 2000 WHO criteria for clinical presentation, prognosis and intensive care in Dakar, Senegal.

The relevance of WHO criteria for severe and complicated malaria has been debated for a while, especially as regards children. Recent data led WHO experts to modify the definition of severe malaria. The objective of this study was to evaluate retrospectively the significance of the new definition on severity, lethality and intensive care distribution in children admitted with falciparum malaria (in 1997-99) to Hôpital Principal de Dakar, Senegal. We used the paediatric risk of mortality score (PRISM) to compare the 2 definitions, WHO 2000 and WHO 1990. Finally, we evaluated the impact of the new definition in terms of major therapeutic interventions (MTIs): mechanical ventilation, haemodynamic support, transfusion, haemodialysis, and the use of sedatives. Among 311 patients, the frequencies of severe malaria cases and case-fatality rates thereof were 52% (n = 161) and 17% (n = 28) respectively using the 1990 WHO criteria, and 75% (n = 233) and 12% (n = 28) using the 2000 WHO criteria. Mean PRISM score among severe cases decreased with the new definition (6.5 versus 8.6). Both definitions predicted neurological sequelae and deaths with 100% sensitivity. One or more MTIs were required in severe malaria cases in 86% (n = 139) under the 1990 criteria and 73% (n = 170) under the 2000 criteria. In this area of low and seasonal transmission, the 2000 WHO definition of severe malaria proved broader and less specific, but was easier to apply and retained the high sensitivity of the earlier definition in identifying life-threatening infections.

[Diagnostic and prognostic significance of urinary amylase in acute biliary pancreatitis]. / Diahnostychne ta prohnostychne znachennia vyiavlennia amilazuriï pry hostromu biliarnomu pankreatyti.

The diagnostic significance of amylasuria in the early period of an acute biliary pancreatitis (ABP) course was estimated in 70 patients. High sensitivity of the test during 3 days of the disease course was ascertained as well as a lack of specificity of the criterion concerning differential diagnosis with an acute cholecystitis. The interrelationship between the enzyme activity and lethality was not revealed. It is necessary to take into account the peculiarities of the amylasuria diagnostic-prognostical significance while substantiation of diagnostic program and the treatment tactics for ABP.

[The treatment of atypical manias with finlepsin-retard]. / Likuvannia atypovykh manii finlepsynom-retard.

The article presents results of clinical trial of finlepsine-retard. Objectivized parameters characterizing the time course of psychopathologic symptoms were studied in certain concentrations of finlepsine and beta-endrofin in blood serum. Atypical maniac states do not easily respond to therapies but finlepsine-retard gives the modern psychopharmacotherapy a new horizon.