[Management Of Blader Exstrophy In Children At The CHU Gabriel Touré]. / Prise En Charge De l'Exstrophie Vesicale Dans Le Service De Chirurgie Pediatrique : CHU Gabriel Toure.

AIMS: To describe the clinical and evolutionary aspects of the primary closure of exstrophy at the CHU Gabriel Touré. MATERIALS AND METHODS: This was a retrospective and prospective study carried out from January 2014 to December 2019 in all the children admitted and operated on for bladder exstrophy at the CHU Gabriel Touré. RESULTS: We collected 35 cases of exstrophy, ie25 boys and 10 girls. The mean age at diagnosis was 4.8 months. The bladder plate was both normal and budded, ie 28.6% of cases. Plaque infection was found in 45.7%. A malformation was associated in 34.3% of cases. Primary plaque closure was achieved in all of our patients. Postoperative morbidity was 28.6% of cases and mortality 11.4% of cases. CONCLUSION: Bladder exstrophy is a rare malformation of the urogenital sphere, its management is complex and its mortality is not null.

OBJECTIFS: Décrire les aspects cliniques et évolutifs de la fermeture primaire de l'exstrophie au CHU Gabriel Touré. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude rétrospective et prospective réalisée de janvier 2014 à décembre 2019 chez tous les enfants admis et opérés pour exstrophie vésicale au CHU Gabriel Touré. RÉSULTATS: Nous avons colligés 35 cas d'exstrophie soit 25 garçons et 10 filles. L'âge moyen au moment du diagnostic était de 4,8 mois. La plaque vésicale était au tant normale que bourgeonnée soit 28,6 % des cas. Une infection de la plaque a été retrouvée dans 45,7%. Une malformation était associée dans 34,3% des cas. La fermeture primaire de la plaque a été réalisée chez tous nos patients. La morbidité post opératoire était de 28,6% des cas et la mortalité, 11,4% des cas. CONCLUSION: L'exstrophie vésicale est une malformation rare de la sphère urogénitale, sa prise en charge est complexe et sa mortalité n'est pas nulle.

[Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré]. / Bourse aiguë de l'enfant en chirurgie pediatrique du chu Gabriel Toure.

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages. OBJECTIVES: Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects. MATERIALS AND METHOD: This was a retrospective descriptive study from January 1, 2010 to December 31, 2015 on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré. RESULTS: In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main aetiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases. CONCLUSION: Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality.

La bourse aiguë est une urgence médico-chirurgicale de part ses nombreuses étiologies menaçant le pronostic fonctionnel des testicules et leurs annexes. OBJECTIFS: Identifier les causes des bourses aiguës de l'enfant et décrire leurs aspects cliniques et thérapeutiques. MATÉRIELS ET MÉTHODE: Il s'agissait d'une étude descriptive retroprospective allant du 1er janvier 2010 au 31 Décembre 2015 portant sur tous les enfants âgés de 0 à 15 ans reçus et traités pour bourse aiguë dans le service de Chirurgie Pédiatrique du CHU Gabriel Touré. RÉSULTATS: En 6 ans, nous avons enregistré 42 patients soit une fréquence de 1,4% des urgences chirurgicales. L'âge moyen était de 2,98 ans (24jours-14 ans).La prématurité a représenté 11,9 % des cas. La tuméfaction scrotale douloureuse était le principal motif de consultation (76,2%), Les principales étiologies étaient la HISE (90,5%), le traumatisme scrotal (4,7%), l'orchiépididymite (2,4%) et la torsion testiculaire (2,4%).Le traitement était chirurgical dans 97,6% des cas. L'évolution après 3 mois était simple dans 97,6% des cas. CONCLUSION: La bourse aigue de l'enfant est une pathologie peu fréquente touchant surtout les nourrissons. La hernie inguino-scrotale étranglée était la principale étiologie. Le diagnostic doit être précoce et le traitement adéquat afin de reduire la morbi-mortalité.

[Attitude of psychiatrists and psychiatry residents in Lebanon towards restraint and informed consent]. / Attitude des psychiatres et internes en psychiatrie au Liban vis-à-vis de la contention et du consentement éclairé.

OBJECTIVES: Psychiatry differs from the rest of medical specialties by the unique character of its pathologies, which makes ethical reflection difficult, including the collection of informed consent and the use of restraint and the seclusion-room. This reflection can be affected by subjectivity and a variety of influences, hence the interest of studying the attitude of psychiatrists and residents in psychiatry in Lebanon with regard to restraint and informed consent. METHODS: We collected data using an anonymous questionnaire that we sent as a Google form to Lebanese psychiatrists and psychiatry residents by email and phone messages. The descriptive analysis was done using Microsoft Excel software, and the analytical analysis was done using the SPSS software and the following statistical tests: independent-sample test and the Mann Whitney U test. RESULTS: Forty people responded, including 19 men and 21 women (16 psychiatric interns, 15 university psychiatrists and 9 non-university psychiatrists). Concerning the questions related to the use of restraint, 70% did not find that it is being commonly used in hospital practice. However, 92.5% would use it to counter the patient's dangerousness and 60% to help deliver treatment. 57.5% did not find the repeated usage of restraint as a dehumanization of care, but the majority (70%) agreed with the need for temporal limitation of any form of restraint. As for the ability to consent, 90% considered a patient in a psychotic state as unfit to consent. CONCLUSIONS: Restraint is considered uncommon by psychiatrists and psychiatric residents in Lebanon and must remain an option of last resort with efforts being made upstream in order to avoid situations where the use of restraint becomes mandatory. Post critical thinking is paramount, and restraint should never respond to a lack of manpower or a security goal. Informed consent is one of the most important guarantors of the principle of autonomy, and must be sought in each patient, individually. Finally, no significant difference was found between the subgroups, which would therefore become a single population. Ethical reflection would therefore be directly linked to the population. Mental illnesses are becoming more common and an important source of morbidity worldwide. It is our role to ensure the dignity of the mentally ill. The introduction of the Psychiatric Nurse Diploma, an increase in the relational approach to the training of psychiatrists in Lebanon, and an increase in the number of health care teams may help to maximize the ability of capacity.

Congenital Malaria and Its Associated Factors at Issaka Gazobi Maternity of Niamey in Niger.

BACKGROUND: Congenital malaria is a serious and common infection in tropical Africa. It has multiple consequences on the newborn and the mother. OBJECTIVE: The objective of this study is to calculate the prevalence of congenital malaria, describe its clinical signs, and analyze its associated factors. Methodology. It is a cross-sectional and prospective study, conducted at Issaka Gazobi Maternity of Niamey, from June 1 to November 30, 2017. The diagnosis was made by microscopy of a thick and thin blood smear of mother, newborn, and umbilical cord. RESULTS: Two hundred and forty-nine (249) consecutive newborn/mother pairs were included. The prevalence of congenital malaria infection was 26.51% (66/249) with a parasite density of 101 P/µl (SD: 47.3; [80; 320]). The prevalence of congenital malaria disease was 14.06% (35/249) with a parasite density of 108 P/µl (SD: 32.6; [40; 200]. All patients were infected with Plasmodium falciparum. 43% (18/35) of neonates had hyperthermia and did not have a sucking reflex, 8.5% (3/35) were anaemic, 11.42% (4/35) had convulsed, 20% (7/35) had a coma, and 45.71% (16/35) had a low birth weight. No deaths were recorded, and only the nonuse of bed nets was significantly associated with congenital malaria (p = 0.04). CONCLUSION: In Niger, one out of four newborns is infected with Plasmodium. Infection can progress to congenital malaria disease. The use of mosquito nets and intermittent preventive treatment would reduce the incidence of congenital malaria.

Dissociating the contributions of reward-prediction errors to trial-level adaptation and long-term learning.

Reward positivity (RewP) is an EEG component reflecting reward-prediction errors. Using multilevel models, we measured single-trial RewP amplitude from trial-to-trial, while reward and prediction varied during learning. Sixty participants completed a category-learning task in either engaging or sterile conditions with the RewP time-locked to feedback. Sequential analysis of single-trial RewP showed its relationship to current and previous accuracy, and the probability of changing one's response to subsequent stimuli. Simulations show these effects can be explained in detail by the dynamics of participants' expectations according to principles of reinforcement learning. The single-trial RewP findings were consistent with previous literature linking RewP to reward-prediction error under reinforcement-learning theory. In contrast, the aggregate RewP was unrelated to the engagement manipulation or to delayed retention performance. Thus the present results provide a detailed computational account how RewP relates to acute adaptation, but suggest RewP plays little role in long-term learning.

Système National de Pharmacovigilance au Niger : a propos d'un cas de syndrome de Lyell associé au Cotrimoxazole

A partir de 2015, le programme national de lutte contre le paludisme (PNLP) du Niger a mis à grande échelle la chimioprévention du paludisme saisonnier (CPS) avec la sulfadoxine pyriméthamine plus amodiaquine(SPAQ). Le Ministère de la santé publique a saisie l'opportunité pour renforcer le système national des vigilances (SNV).Nous rapportons un cas de syndrome de Lyell dû au cotrimoxazole (Triméthoprime sulfaméthoxazole)dans son aspect clinique, pronostic et thérapeutique.Il s'agissait d'une patiente de soixante ans, soufrantd'une diarrhée et admise au centre de santé intégré (CSI) de Maijirgui au Niger. Elle a été traitée avec du cotrimoxazole. Quelques jours après, elle était léthargique et les yeux enfoncés. L'examen du système cutanéo-phanérien, laisse apparaitre un vaste décollement cutané faisant le tour du thorax, s'étendant à toutl'abdomen et prenant les deux membres thoraciques.Cette perte de l'épiderme laissait découvrir un derme rouge suintant à nu. Tout ceci réalisait un décollement épidermique en « linges mouillées » avec une atteinte de plus 70% de la surface corporelle. A l'examen des muqueuses, on note au niveau buccal des ulcérations muqueuses recouvertes de croutes. On notait également une érosion des paupières supérieures et une conjonctivite diffuse. Malgré son évacuation à l'hôpital national de Zinder, elle fut décédée à l'admission.Le syndrome de Lyell ou nécrolyse épidermique toxique est une dermatose bulleuse grave et rare, le plus souvent d'origine médicamenteuse. Toute distribution de masse de médicaments doit s'accompagner d'un renforcement du SNV pour rechercher, documenter et prendre en charge rapidement les évènements indésirables

[Brachial Plexus: Dissection At The Laboratory Of Anatomy Of Bamako]. / Plexus Brachial : Dissection Au Laboratoire D'Anatomie De Bamako.

INTRODUCTION: The brachial plexus consists of the ventral twigs of the last four cervical nerves and the first thoracic nerve. It ensures the motor and sensitive innervations of the thoracic limb. AIM: Our goal was to describe the brachial plexus of the cervical region to the middle third of the arm. METHODOLOGY: We conducted a prospective study at the anatomy Laboratory of the Faculty of Medicine and Dentistry in Bamako from September 2016 to October 2017. We dissected the brachial plexus (PB) of 13 fresh adult corpses on both sides. The inclusion criteria were: Fresh adult corpses with cervical regions and brachial without scarring. The injected or scar-carrying corpses were not included in the cervical and brachial regions. RESULTS: Twenty-six brachial plexus of which 18 bp in men and 8 bp in women were dissected. The average age of the subjects was 42 years (extreme: 18 and 70 years). We noted nerve block variations in 3.8%, fascicular in 3.8% and late terminal in 73.1%. The involvement of the anterior branch of the fourth spinal nerve (C4) was found in 46.2%. CONCLUSION: The brachial plexus is the seat of many anatomical variations whose knowledge is indispensable to treat its lesions.

INTRODUCTION: Le plexus brachial est constitué des rameaux ventraux des quatre derniers nerfs cervicaux et du premier nerf thoracique. Il assure l'innervation motrice et sensitive du membre thoracique. BUT: Notre but était de décrire le plexus brachial de la région cervicale au tiers moyen du bras. MÉTHODE: nous avons réalisé une étude prospective au laboratoire d'anatomie de la Faculté de Médecine et d'Odontostomatologie de Bamako de septembre 2016 à octobre 2017. Nous avons disséqué des deux côtés les plexus brachiaux (PB)de 13 cadavres frais d'adultes. Les critères d'inclusion étaient : cadavres frais d'adulte avec les régions cervicale et brachiale sans cicatrice. N'ont pas été inclus les cadavres injectés ou porteurs de cicatrice au niveau des régions cervicale et brachiale. RÉSULTATS: Vingt-six plexus brachiaux dont 18 PB chez les hommes et 8 PB chez les femmes ont été disséqués. L'âge moyen des sujets était de 42 ans (extrême : 18 et 70 ans). Nous avons noté des variations tronculaires dans 3,8%, fasciculaires dans 3,8% et en fin terminales dans 73,1%. La participation du rameau antérieur du quatrième nerf spinal cervical (C4) a été trouvée dans 46,2%. CONCLUSION: Le plexus brachial est le siège de nombreuses variations anatomiques dont la connaissance est indispensable pour traiter ses lésions.

Anesthésie pour séparation d'un Craniopagus parasiticus

Le jumeau parasite est un type de siamois chez lequel un des jumeaux est représenté par une formation rudimentaire parasitant le jumeau principal. L'incidence des siamois est estimée de 1:50.000 à 1:100.000 naissances vivantes. Les siamois sont décrits en fonction des organes conjoints ou éventuellement partagés. La classification de Spencer est la plus classique. La séparation chirurgicale -si envisagée et réalisable- relève d'une prise en charge multidisciplinaire.La séparation d'un jumeau parasite est une intervention à risque per et post-opératoire élevé, nécessitant une exploration clinique, radiologique et physiologique notamment en ce qui concerne les organes conjoints ou fusionnés. Le risque anesthésique porte particulièrement sur l'intubation difficile, l'hémorragie, la transfusion massive, les troubles métaboliques. Pour partager notre expérience et discuter les principes de prise en charge, nous rapportons un cas d'anesthésie pour la séparation d'un cas de Craniopagus parasiticus réussi avec des suites post-opératoires sans complications

Leucémie lymphoïde chronique au Niger: une étude de 99 cas au service d'onco-hématologie de l'hôpital national de Niamey

Introduction. Le but de l'étude est de décrire les caractéristiques épidémiologiques et cliniques de la leucémie lymphoïde chronique (LLC) au Niger. C'est la première étude nigérienne spécifiquement consacrée à cette maladie. Méthodologie. Nous avons mené une étude rétrospective couvrant la période de janvier 2000 à décembre 2011 (12 ans) dans le service d'Onco-Hématologie de l'HNN. Le diagnostic de LLC était retenu sur la base d'une hyper lymphocytose sanguine > 15 000/mmᶾ associée à une infiltration médullaire de plus de 40% de lymphocytes mâtures. Les données ont été recueillies dans les dossiers de malades. Nos variables d'étude étaient les aspects épidémiologiques, cliniques et évolutifs de la maladie. Résultats. Au cours de la période d'étude, 99 patients ont été colligés soit une fréquence d'environ huit cas par an. Le sex ratio était de 0,47 et la moyenne d'âge des patients de 53,25 ans (extrêmes: 30 à 82 ans). L'échantillon était constitué de 89 % de paysans (cultivateurs, éleveurs femmes au foyer). La durée moyenne des troubles avant la première consultation était de 24 mois. Les principaux motifs de consultation étaient: la splénomégalie (81,8%), les adénopathies (38,4%) et l'anémie (21,2%). Les principaux signes physiques étaient: les adénopathies (84,8%); la splénomégalie (80,8%); la pâleur cutanéo-muqueuse (31,3%); la fièvre (29,3%) et l'hépatomégalie (25,3%). Selon la classification anatomo-clinique de Binet, 39 patients (39,4%) étaient au stade A, 16 cas (16,2%) au stade B et 44(44,4%) au stade C. Conclusion. À Niamey, la LLC est une maladie de l'adulte jeune diagnostiquée souvent à un stade avancé du fait du retard de la première consultation

Work-Related musculoskeletal pain among lebanese dentists: An epidemiological study.

INTRODUCTION: The aim of this study was to evaluate the prevalence of musculoskeletal disorders and identify their associated factors among a group of Lebanese dentists. MATERIALS AND METHODS: A total of 314 Lebanese, dentists completed an anonymous questionnaire that focused on occupational health problems. This study was approved by the ethics committee of Saint-Joseph University of Beirut, Lebanon. The statistical analyses were performed using SPSS for windows. The alpha error was set to 0.05. RESULTS: The mean age of the participants was 39.2 (±11.66) years. The results showed that 61.5% of the surveyed dentists complained of spinal pain: 31.6% of cervical pain, 22.3% of lumbar pain and 13.0% of dorsal pain. Moreover, the pain was continuous in 20.7% and, occasional in 65.8%. Our statistics showed that 7.6% had a problem with the carpal tunnel. A total of 22.3% suffered from tendinitis and 9.2% from arthritis of shoulder, elbow, wrist and hand. The frequency of headaches was 30.6%. Concerning sports activity, 49.7% practiced it occasionally and 3.6% did so frequently. CONCLUSIONS: The occurrence of musculoskeletal pain in the upper extremities is a serious concern that affects Lebanese dentists. Most of them often complained of tendinitis and headaches because they do not practice sports; thus, encouraging them to practice sports may reduce or solve such health problems. Issuing brochures that include exercises to perform and hiring trained assistants could help reduce the risk of musculoskeletal disorders. Finally, these occupational health problems should be highlighted at all clinical and research symposia to increase awareness.

[Geophagy associated with severe anemia in non-pregnant women: A case series of 12 patients]. / Géophagie associée à une anémie sévère chez la femme non gravide : à propos de 12 cas.

INTRODUCTION: Geophagy or soil eating is mostly described in pregnant women from Sub-Saharan Africa, South America. Here, we report 12 cases of geophagy associated with severe anemia in non-pregnant Nigerian women. RESULTS/CASE REPORTS: The median age at diagnosis was 34.5 years. The socioeconomic level was average for all patients. The median hemoglobin level at admission was 6.9g/dL (3.3-8.6), median corpuscular volume was 78.3fL (63-106) and median serum ferritin was 9.2ng/mL (3.6-11.2). The reasons of this practice were "desire" (5/12) and tradition (4/12). All patients received psychotherapy and supplementation with intravenous iron. CONCLUSION: Geophagy is an underestimated practice in developed countries and in non-pregnant women. It can be the cause of severe iron deficiency and must be discussed in patients with anemia, including non-pregnant patients, and in Africa as well as in migration areas, where the practice can be exported.

[Frequency of glucose-6-phosphate dehydrogenase deficiency (A-376/202) in three Malian ethnic groups]. / Fréquence du déficit en glucose-6-phosphate déshydrogénase (A-376/202) dans trois groupes ethniques vivant en zone d'endémie palustre au Mali.

Erythrocyte G6PD deficiency is the most common worldwide enzymopathy. The aim of this study was to determine erythrocyte G6PD deficiency in 3 ethnic groups of Mali and to investigate whether erythrocyte G6PD deficiency was associated to the observed protection against malaria seen in Fulani ethnic group. The study was conducted in two different areas of Mali: in the Sahel region of Mopti where Fulani and Dogon live as sympatric ethnic groups and in the Sudanese savannah area where lives mostly the Malinke ethnic group. The study was conducted in 2007 in Koro and in 2008 in Naguilabougou. It included a total 90 Dogon, 42 Fulani and 80 Malinke ethnic groups. Malaria was diagnosed using microscopic examination after Giemsa-staining of thick and thin blood smear. G6PD deficiency (A-(376/202)) samples were identified using RFLP (Restriction Fragment Length Polymorphism) assay and analysis of PCR-amplified DNA amplicon. G6PD deficiency (A-(376/202)) rate was 11.1%, 2.4%, and 13.3% in Dogon, Fulani, and Malinke ethnic group respectively. Heterozygous state for G6PD (A-(376/202)) was found in 7.8% in Dogon; 2.4% in Fulani and 9.3% in Malinke ethnic groups while hemizygous state was found at the frequency of 2.2% in Dogon and 4% in Malinke. No homozygous state was found in our study population.We conclude that G6PD deficiency is not differing significantly between the three ethnic groups, Fulani, Dogon and Malinke.

[Humoral immune anti-Plasmodium falciparum AMA1 and MSP1 response in two ethnic groups living in sympatry in Mali]. / Réponse humorale anti-Plasmodium falciparum AMA1 et MSP1 dans deux groupes ethniques vivant en sympatrie au Mali.

Fulani of Mali are known for their lower susceptibility to Plasmodium falciparum malaria than their neighbours, the Dogon, despite similar transmission conditions. However, the mechanisms underlying these differences are poorly understood, particularly those concerning antigenspecific immune responses. The Apical Membrane Antigen 1 (AMA1) and the Merozoite Surface Antigen 1 (MSP1) are two malaria vaccine candidates, which play a pivotal role during the invasion of parasites into erythrocytes, and in the case of AMA1, of hepatocytes. Therefore, we analyzed the level of anti-AMA1 and anti-MSP1 antibodies (FVO and 3D7 alleles), by using ELISA (Enzyme Linked Immuno Sorbent Assay) to investigate whether there are differences between the two ethnic groups. Our results show that the splenic rate, the level of anti-AMA1 and anti-MSP1 were significantly higher in Fulani compared to Dogon; while the parasite rate was lower in Fulani group compared to Dogon. Our results suggest that the lower susceptibility of Fulani to malaria could be due to the higher specific humoral responses against AMA1 and MSP 1 in Fulani's ethnic group compared to Dogon.

[Relationship between malaria and anemia in two ethnic groups living in sympatry in Mali]. / Relation entre l'anémie et le paludisme dans deux groupes ethniques vivant en sympatrie au Mali.

Studies performed in Burkina Faso and Mali showed differences in susceptibility to malaria between the Fulani and other sympatric ethnic groups, the Mossi and Dogon. We carried out a longitudinal survey and three cross-sectional studies from 2003 to 2005 in order to assess the prevalence of anemia in Dogon and Fulani. The distribution of the study population by sex was comparable between the two ethnic groups (p = ns). The Fulani are mainly cattle breeders and the Dogons, farmers. They were exposed to similar entomological inoculation rates, and studies on "knowledge, attitude, and practices" showed no difference between the two ethnic groups. The cross-sectional studies were performed during the intense malaria transmission season (in September 2003 and 2005) and during the dry season (in March 2004). Longitudinal clinical follow-up studies were performed from August to December 2005 using the WHO 28 days in vivo test, after administration of a curative dose of antimalarial drugs to patients with mild malaria. During the cross-sectional studies, both Fulani men and women had significantly lower hemoglobin levels than their Dogon counterparts; this difference was most evident in the women (in 2005: 9.4 g/dl in Fulani vs 10.7 g/dl in Dogon, p = 0.0002). Clinical longitudinal follow-up data showed that Fulani children aged 10-14 years have lower hemoglobin levels than Dogon children. At day 0, the mean of hemoglobin level was 9.6 g/dl in Dogon children vs. 8.7 g/dl in Fulani children (p = 0.01). At day 28, after malaria treatment, we also observed a significant difference in hemoglobin levels in children (10.6 g/dl in Dogon vs 9.3 g/dl in Fulani, p < 0.001). A stronger association between anemia and spleen enlargement was found in the Fulani (53.2% with spleen enlargement) than in the Dogon (32.9%) [p = 0.005]. The Fulani suffer more from anemia than the Dogon, despite their lower susceptibility to malaria. The difference in anemia between Dogon and Fulani must be further investigated to determine possible factors involved in malaria susceptibility.

[Place of malaria among febrile illnesses in two ethnic tribes living in sympatry in Mali from 1998 to 2008]. / Place du paludisme dans les syndromes fébriles dans deux groupes ethniques vivant en sympatrie au Mali de 1998 à 2008.

In Africa, malaria is responsible for 25-40% of all outpatient visits and 20-50% of all hospitalizations. In malaria-endemic areas, individuals do not behave the same toward the outcome of clinical malaria. The aim of this study is to determine the prevalence of malaria in the locality among the different ethnic groups, evaluate the place of malaria among febrile illnesses, and assess the relationship between fever and parasite density of Plasmodium falciparum. Studies on susceptibility to malaria between the Fulani and Dogon groups in Mali were conducted in Mantéourou and the surrounding villages from 1998 to 2008. We carried out six cross-sectional studies during the malaria transmission and longitudinal surveys (July to December depending on the year) during the 10-year duration. In longitudinal studies, clinical data on malaria and other diseases frequently observed in the population were recorded. It appears from this work that malaria is the leading cause of febrile syndromes. We observed a significant reduction in malaria morbidity in the study population from 1998 to 2008. The pyrogenic threshold of parasitaemia was 1,000 parasites/mm(3) of blood in the Dogon and 5,000 parasites/mm(3) of blood in the Fulani.We have also found that high parasitical densities were not always associated with fever. Malaria morbidity was higher among the Dogon than in Fulani. The immunogenetic factors might account for this difference in susceptibility to malaria between Fulani and Dogon in the area under study. With regard to this study, it is important to take into account the ethnic origin of subjects when interpreting data of clinical and malarial vaccine trials.

Isolation and characterization of 25 microsatellite DNA loci for Anopheles albitarsis sensu lato and inter-specific amplification in 5 congeneric species.

The Anopheles albitasis complex includes 6 species, and 3 are considered as malaria vectors in Brazil. Twenty-five polymorphic microsatellite DNA loci were isolated and characterized in 24-36 individuals from the neighborhood of Puraquequara, Manaus, Amazonas State, Brazil. The number of estimated alleles ranged from 2 to 10, the observed heterozygosity ranged from 0.182 to 0.897, and the expected heterozygosity ranged from 0.260 to 0.854. Eleven loci showed significant deviation from Hardy-Weinberg equilibrium. Eleven loci were cross-amplified successfully in 5 Anopheles species. These microsatellite loci will be useful in studies investigating population structure and evolutionary genetics in A. albitarsis sensu lato and other A. albitarsis complex species.

CD36 c.1264 T>G null mutation impairs acquisition of IgG antibodies to Plasmodium falciparum MSP119 antigen and is associated with higher malaria incidences in Tanzanian children.

Polymorphisms in genes that encode crucial signalling molecules have been proposed as factors that influence susceptibility to, and outcome of malaria. We studied the role of a mutation, c.1264 T>G, that causes CD36 deficiency on IgG responses to MSP-119 antigen and malaria incidence. Children were genotyped for the c.1264 T>G mutation at the beginning of the study using PCR-RFLP. IgG levels [optical density (OD) readings] and per cent seropositivity to MSP-119 were determined at baseline by ELISA. Children were followed for 12 months for acquisition of anti-MSP-119 IgG antibody and malaria incidence. We observed a significant increase in the production of anti-MSP-119 IgG antibody in normal and heterozygous children during the 12 months of follow-up, but not in homozygous mutants. Normal children had a significantly lower malaria incidence rate compared to other genotypes (χ² = 115.59; P < 0.01). We conclude that the presence of the c.1264 T>G mutation that leads to CD36 deficiency is closely associated with reduced IgG production and higher malaria incidence. It is most likely that deficiency of CD36 which is known to modulate dendritic cell function suppresses the production of protective IgG antibodies directed to Plasmodium falciparum MSP-119 antigen, which predisposes to the acquisition of clinical malaria in children.

[Ortner's syndrome and giant-cell vasculitis]. / Syndrome d'Ortner et maladie de Horton.

INTRODUCTION: Ortner's syndrome was first described as a left laryngeal nerve palsy caused by a dilated left atrium in mitral stenosis. Aortic aneurysm is another well-documented etiology. CASE RECORD: We report the case of a 90 year-old woman with temporal arteritis with recent onset hoarseness, and simultaneous discovery of aortic arch aneurysm and left vocal cord palsy. DISCUSSION: The occurrence of hoarseness and aortic aneurysm in Giant-cell vasculitis is discussed. We suggest to consider Horton's disease (GCA) as a possible etiology of Ortner's cardio-vocal syndrome.

Spleen enlargement and genetic diversity of Plasmodium falciparum infection in two ethnic groups with different malaria susceptibility in Mali, West Africa.

The high resistance to malaria in the nomadic Fulani population needs further understanding. The ability to cope with multiclonal Plasmodium falciparum infections was assessed in a cross-sectional survey in the Fulani and the Dogon, their sympatric ethnic group in Mali. The Fulani had lower parasite prevalence and densities and more prominent spleen enlargement. Spleen rates in children aged 2-9 years were 75% in the Fulani and 44% in the Dogon (P<0.001). There was no difference in number of P. falciparum genotypes, defined by merozoite surface protein 2 polymorphism, with mean values of 2.25 and 2.11 (P=0.503) in the Dogon and Fulani, respectively. Spleen rate increased with parasite prevalence, density and number of co-infecting clones in asymptomatic Dogon. Moreover, splenomegaly was increased in individuals with clinical malaria in the Dogon, odds ratio 3.67 (95% CI 1.65-8.15, P=0.003), but not found in the Fulani, 1.36 (95% CI 0.53-3.48, P=0.633). The more susceptible Dogon population thus appear to respond with pronounced spleen enlargement to asymptomatic multiclonal infections and acute disease whereas the Fulani have generally enlarged spleens already functional for protection. The results emphasize the importance of spleen function in protective immunity to the polymorphic malaria parasite.

Cell-cycle arrest in TrkA-expressing NIH3T3 cells involves nitric oxide synthase.

We have examined nerve growth factor (NGF)-triggered signaling in two NIH3T3 cell lines exogenously expressing the NGF receptor, TrkA. TRK1 cells cease to proliferate and extend long processes in response to NGF, while E25 cells continue to proliferate in the presence of NGF. These two cell lines express similar levels of TrkA and respond to NGF with rapid elevation of mitogen-activated protein kinase (MAPK) activity. MAPK activation is slightly more sustained for E25 cells than for TRK1 cells, although sustained activation of MAPK has been suggested to cause cell-cycle arrest. As judged by NADPH-diaphorase staining, nitric oxide synthase (NOS) activity is increased in TRK1 cells upon exposure to NGF. In contrast, diaphorase staining in E25 cells is unaffected by NGF treatment. Immunocytochemistry shows that levels of the brain NOS (bNOS) isoform are increased in TRK1, but not E25, cells exposed to NGF. Furthermore, Western blots show that NGF elevated cyclin-dependent kinase inhibitor, p21(WAF1), in TRK1 cells only. NGF-induced p21(WAF1) expression, cell-cycle arrest and process extension are abolished by N-nitro-L-arginine methyl ester (L-NAME), a competitive inhibitor of NOS. The inactive enantiomer, D-NAME, did not inhibit these responses. Furthermore, even though E25 cells do not respond to NGF or nitric oxide donors, they do undergo a morphological change in response to NGF plus a nitric oxide donor. Therefore, NOS and p21(WAF1) are induced only in the TrkA-expressing NIH3T3 cell line that undergoes cell-cycle arrest and morphological changes in response to NGF. These results demonstrate that sustained activation of MAPK is not the sole determining factor for NGF-induced cell-cycle arrest and implicate NO in the cascade of events leading to NGF-induced morphological changes and cell-cycle arrest.