Facteurs associés à l'hospitalisation prolongée et à la mortalité au niveau du service de néphrologie de l'hôpital Aristide Le Dantec de Dakar / Factors associated with prolonged hospitalization and mortality in the nephrology department of the Aristide Le Dantec hospital in Dakar

Introduction : L'hospitalisation en néphrologie n'avait pas fait l'objet de plusieurs études au Sénégal et les données sont limitées. Notre travail avait pour but de déterminer les facteurs associés à l'hospitalisation prolongée et à la mortalité en néphrologie. Patients et méthodes : Il s'agissait d'une étude observationnelle prospective de 5 mois incluant tous les patients hospitalisés dans le service durant au moins 24H. La durée d'hospitalisation (la période allant du jour d'admission dans la chambre d'hospitalisation au jour de sortie du patient) était dite prolongée si > 12 jours. Résultats : Quatre-vingt-dix-neuf patients ont été analysés durant cette période avec une durée moyenne en hospitalisation de 11,14 ± 9,89 jours. L'âge moyen était de 45,22 ± 18,03 ans avec un sex-ratio (H/F) de 0,62. Les anomalies biologiques étaient : l'hyponatrémie (62,36%), l'hypokaliémie (23,91%), l'hypocalcémie (25%), l'hyperphosphatémie (51,21%), l'anémie (92,30%), la CRP élevée (90,90%) et l'hypoalbuminémie (80,76%). La protéinurie moyenne était de 3,38 ± 3,35 g/24h avec 34,61% de protéinurie néphrotique. La mortalité hospitalière était de 25,25%. En analyse univariée, l'hospitalisation prolongée était associée à l'âge ≤ 45 ans (p = 0,018), aux patients non dialysés chroniques (p=0,034), à la transfusion sanguine (p=0,008) tandis que la mortalité était liée à l'âge de plus de 45 ans (p=0,032), le diabète (p=0,014), l'hypokaliémie (p=0,045) et l'hospitalisation prolongé (p=0,007). En analyse multivariée, les patients présentant des œdèmes et ceux ayant été transfusés avaient respectivement 2,89 et 3,9 fois plus de risque d'avoir une hospitalisation prolongée. Les patients diabétiques avaient 4,63 fois plus de risque de décès et ceux ayant été hospitalisés de plus de 12 jours avaient 0,14 fois de risque de décès. Conclusion : La durée d'hospitalisation était relativement prolongée avec une mortalité élevée. Cependant l'impact de certains facteurs a été démontré permettant ainsi de réduire la durée d'hospitalisation et le nombre de décès.

Introduction: Hospitalization in nephrology had not been the subject of several studies in Senegal and the data are limited. Our work aimed to determine the factors associated with prolonged hospitalization and mortality in nephrology. Patients and methods: This was a 5-month prospective observational study including all patients hospitalized in the department for at least 24 hours. The duration of hospitalization (the period from the day of admission to the hospital room to the day of the patient's discharge) was said to be prolonged if > 12 days. Results: Ninety-nine patients were analyzed during this period with an average hospital stay of 11.14 ± 9.89 days. The mean age was 45.22 ± 18.03 years with a sex ratio (M/F) of 0.62. The biological abnormalities were: hyponatremia (62.36%), hypokalemia (23.91%), hypocalcemia (25%), hyperphosphatemia (51.21%), anemia (92.30 %), elevated CRP (90.90%) and hypoalbuminemia (80.76%). The mean proteinuria was 3.38 ± 3.35 g/24h with 34.61% nephrotic proteinuria. Hospital mortality was 25.25%. In univariate analysis, prolonged hospitalization was associated with age ≤ 45 years (p = 0.018), chronic non-dialysis patients (p = 0.034), blood transfusion (p = 0.008) while mortality was related to age over 45 (p=0.032), diabetes (p=0.014), hypokalaemia (p=0.045) and prolonged hospitalization (p=0.007). In multivariate analysis, patients with edema and those who had been transfused were respectively 2.89 and 3.9 times more likely to have prolonged hospitalization. Diabetic patients had a 4.63 times greater risk of death and those who had been hospitalized for more than 12 days had a 0.14 times greater risk of death. Conclusion: The duration of hospitalization was relatively prolonged with high mortality. However, the impact of certain factors has been demonstrated, thus making it possible to reduce the duration of hospitalization and the number of deaths

Complications after Dynamic Hip Screw Osteosynthesis of Proximal Femoral Fractures at Army Instructional Hospital-Libreville.

The DHS system is an effective means of open reduction and internal fixation of proximal femur fractures. Postoperative complications are little described and deserve to be studied for better preventive and curative treatment. We report the observations of five (5) patients who presented postoperative complications specific to the DHS system at army instructional Hospital-Libreville. These described complications are related to deterioration of internal fixation leading to callus, nonunion, or infection. Those found are the cut out phenomenon, avascular necrosis of the femoral head, and the fracture of the DHS system. All these complications required surgical revision without functional repercussions at the last follow-up. Complications of internal fixation by the DHS system can be avoided by rigorous asepsis, adequate indications for surgery, and rigorous surgical techniques. Good management can restore hip function.

La morbimortalité du tétanos à l'hôpital Sominé Dolo de Mopti

Introduction. Le tétanos est un problème de santé publique. La létalité qui lui est associée est très élevée. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs du tétanos chez l'adulte. Méthodes. Il s'agissait d'une étude rétrospective des cas de tétanos à l'hôpital Sominé Dolo de Mopti. Les données ont été collectées à partir des dossiers des malades et portaient sur le nom, le sexe, l'âge, la profession, la provenance, le statut vaccinal, la porte d'entrée. Le score de Dakar a été utilisé pour évaluer le pronostic des patients. Résultats. Nous avons colligé 11 cas dont un tétanos obstétrical. La prévalence hospitalière était de 1,03% ; l'âge moyen de 41ans avec des extrêmes de 21 et 70 ans. La tranche d'âge de 20 - 30 ans était la plus affectée avec 36,36%. Aucun des patients n'avait été antérieurement vacciné contre le tétanos. La durée moyenne d'hospitalisation a été de 11,36 jours. Tous les patients ont présenté le trismus, dans plus de 50% des cas, la fièvre était associée aux paroxysmes. Nous rapportons un taux de létalité de 54,54% dont 83,33% sont survenus dans les quatre jours qui ont suivi l'hospitalisation. Le délai moyen de survenu du décès était de 4 jours. Conclusion. Le tétanos continue d'être une menace à l'atteinte de l'objectif de la couverture sanitaire universelle. Des efforts de sensibilisation et des programmes de vaccination plus inclusifs devraient permettre d'en réduire la morbimortalité

Superiority of 3 over 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine for the prevention of malaria during pregnancy in mali: a randomized controlled trial.

BACKGROUND: In 2003, Mali introduced intermittent preventive therapy in pregnancy (ITPp) with sulfadoxine-pyrimethamine (SP) for the control of malaria in pregnancy, consisting of 2 doses of SP given in the 2nd and 3rd trimester. This widely used regimen, although very effective, leaves many women unprotected from malaria during the last 4-to-8 weeks of gestation, which is a pivotal period for fetal weight gain. The aim of the study was to compare the efficacy and safety of 3-dose versus 2-dose IPTp-SP for the prevention of placental malaria and associated low birth weight (LBW). METHODS: We conducted a parallel-group, open-label, individually randomized controlled superiority trial involving 814 women of all gravidity, enrolled from April 2006 through March 2008. All women were seen at least 3 times and received either 2 (n = 401) or 3 (n = 413) doses of IPTp-SP. The primary endpoint measured was placental malaria, LBW, preterm births, and maternal anemia were secondary endpoints, and severe maternal skin reactions and neonatal jaundice were safety endpoints. RESULTS: Among the 96% of study subjects who were followed up until delivery, the prevalence of placental malaria was 2-fold lower in the 3-dose group (8.0%) than in the 2-dose group (16.7%); the adjusted prevalence ratio (APR) was 0.48 (95% confidence interval [CI], 0.32-0.71). LBW and preterm births were also reduced; the prevalence of LBW was 6.6% in the 3-dose group versus 13.3% in the 2-dose group (APR, 0.50; 95% CI, 0.32-0.79), and the prevalence of preterm births was 3.2% versus 8.9% (APR, 0.37; 95% CI, 0.19-0.71). No significant reductions in maternal anemia or differences in safety endpoints were observed. CONCLUSIONS: Adding a third dose of ITPp-SP halved the risk of placental malaria, LBW, and preterm births in all gravidae, compared with the standard 2-dose regimen, in this area of highly seasonal transmission with low levels of SP resistance. CLINICAL TRIALS REGISTRATION: ISRCTN 74189211.

Hodgkin lymphoma at the paediatric oncology unit of gabriel touré teaching hospital, bamako, mali: 5-year experience.

Introduction. The aim of this retrospective, unicentric study over 5 years is to describe the epidemiologic, pathologic, clinic and therapeutic aspects of children treated for Hodgkin lymphoma in our paediatric oncology unit. Patients and Methods. From January 2005 to December 2009, all children under 18 years of age, with Hodgkin lymphoma were included in this study. The treatment protocol was the GFAOP (Groupe Franco-Africain d'Oncologie Pédiatrique) Hodgkin lymphoma treatment protocol. Results. During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (LH) (0.04%). The mean age was 11.7 years. The sex-ratio was 6/1. 4% (5/7) of patients were stage IIB and 28.6% (2/7) stage IIIB of Ann-Arbor classification. There were 3 cases (42.8%) of sclero-nodular subtype, 2 cases (28.6%) of lymphocyte-rich classical HL subtype, 1 case (14.3%) of mixed cellularity and 1 case (14.3%) of lymphocyte depleted subtype. With a median followup of 37 months, 5 patients (71.4%) are alive, and 2 patients (28.6%) died. Conclusion. Broader multicentric studies are needed for more accurate data on this malignancy.

Fasciola hepatica: the development of tissue lesions and their frequencies in naturally-infected Galba truncatula.

A total of 530 Galba truncatula were collected from the oasis of Tozeur (south-western Tunisia) between February and July 1997 to detect snails with active or abortive infections with Fasciola hepatica, and determine the frequencies of their tissue lesions. Histological examination of 290 snails with active infections showed the presence of a multifocal or generalized necrosis in six viscera (albumen gland, digestive gland, gonad, intestine, kidney, and oviduct) and the absence of epithelial reconstitution. Tunnel-shaped lacunae and fibro-amoebocytic granulomas were found in the foot of all snails. Hypertrophied areas of the subepithelial muscular layer were noted in 16.7-71.4% of mantles. In the 240 snails with abortive infections, necrosis only developed in the albumen gland and the digestive gland from snails sacrificed in May and July. Contrary to this, epithelial reconstitution was observed in the digestive gland, gonad, and the albumen gland. In the mantle, the hypertrophy of the subepithelial muscular layer increased in frequency from February to July. Comparison of these frequencies using ANOVA demonstrated that the type of Fasciola infection (active, or abortive) had a significant effect on these percentages. In contrast, the type of the tissue and the period of snail collection had no significant effects. These results might be explained by the succession of two snail generations over time (overwintering snails, and spring-born generation), and probably by the fact that snail infections would be plurimiracidial and/or repeated over time in the oasis of Tozeur.

Dietary psoralens induce hepatotoxicity in C57 mice.

The psoralens are secondary plant metabolites found in many fruits and vegetables. Synthetic forms of 5-methoxypsoralen (bergapten) and 8-methoxypsoralen (xanthotoxin) have been used in combination with UV radiation in skin photochemotherapy for decades. However, handling or ingestion of psoralen-containing plants as well as medicinal use of these compounds have been shown to cause human health hazards. We evaluated the subacute toxicity of bergapten and xanthotoxin in a mammalian model by mixing individual chemicals into mouse diet at 0, 250, and 1000 ppm, and in combination at 500 ppm each. Feeding on individual dietary treatments at 1000 ppm significantly reduced total liver cytochrome P450 (CYP) levels in female mice compared with the control diet, but not in males. However, combining the two chemicals resulted in a significant induction of total CYP450 in both males and females. Both the combined diet and bergapten at 250 ppm caused a weak induction of CYP1A1. Weight gain was significantly less in males fed either the combined or 1000 ppm diets, while only the combined diet induced a significant weight reduction in females compared with the control diet. The psoralens also caused hypertrophy of centrolobular hepatocytes in livers of treated animals in a manner consistent with morphological alterations seen in rodent livers exposed to liver CYP-inducing agents. Neither bergapten nor xanthotoxin, however, induced a significant dose-dependent toxicity in either male or female mice, suggesting that mice may not represent a good laboratory animal model for evaluating the toxicological effects of psoralens.

Examination of psoralens-induced photodermatitis in Wistar rats under scanning electron microscopy.

The psoralens are photoactivated plant biosynthetic compounds which are found in several plant families, including common fruits and vegetables. Synthetic forms of the psoralens bergapten (5-methoxypsoralen) and xanthotoxin (8-methoxypsoralen) are extensively used in skin chemotherapy in combination with long-wave ultraviolet radiation (PUVA). Side effects of PUVA therapy are not, however, desirable, and this therapy has been linked with increased incidence of skin cancer in humans. The psoralens are known to be carcinogenic, mutagenic and teratogenic, and to cause photodermatitis. The main objective of this study was to document the effect of PUVA on the epidermis of rats. Female Wistar rats were administered dietary bergapten and/or xanthotoxin (0-200 mg/kg body) and exposed to UVA radiation (45 min./day) for four weeks. At the end of the four-week period the rats were sacrificed; skin samples were taken from the ears and the top part of the tail and fixed for examination by Scanning Electron Microscopy. The animals subjected to PUVA had significantly smaller scales on the tail epidermis (mean scale size for the control 926 mu vs. 725 to 805 mu for the psoralen treatment groups. The rats that received dietary psoralens also had significantly less hair on the ears compared with the control animals (mean number of hairs per millimeter over the ear edge for the control 54.9 vs. 2.00 to 10.7 for the treatment groups). The two compounds were synergistic in their ability to reduce scale size on the tail epidermis.

A novel group of ovarian toxicants: the psoralens.

The psoralens are naturally occurring metabolites found in many crop plants; synthetic forms of 5-methoxypsoralen (bergapten) and 8-methoxypsoralen (xanthotoxin) are widely used in skin photochemotherapy. Our previous research documented that dietary bergapten and xanthotoxin reduced birthrates in female rats when males and females were exposed to these chemicals. The present study was designed to determine the cause of this reduced birthrate and whether this resulted from direct impact on the females. The study demonstrates that bergapten and xanthotoxin administered, either alone or in combination to female rats (mated to undosed males), significantly reduced the number of implantation sites, pups, and corpora lutea in dosed females compared with control animals. Additionally, full uterine weight and empty uterine weight were significantly reduced. These compounds also significantly reduced circulating estrogen levels in a dose-dependent manner. Interestingly, the psoralens significantly induced mRNAs of liver enzymes typically induced by polycyclic aromatic hydrocarbons, CYP1A1 and UGT1A6; the higher the dose, the greater the induction. UGT 2B1 mRNA, typically induced by phenobarbital-like compounds, was not significantly affected. Thus, enhanced oxidative metabolism and conjugation of estrogens in psoralen-treated animals may provide a partial explanation for the effects observed. These findings are also consistent with psoralen-induced reduction in ovarian follicular function and ovulation.

Psoralen-induced growth inhibition in Wistar rats.

The linear furanocoumarins (or psoralens) are naturally occurring plant biosynthetic metabolites that have been used since ancient times in skin photochemotherapy. However, medicinal use of the psoralens has been linked with increased incidence of skin cancer in humans. To understand some of the mechanism of this toxicity, we tested increasing concentrations of the psoralens bergapten (5-methoxypsoralen) and xanthotoxin (8-methoxypsoralen) for toxicity against Wistar rats. As dietary concentrations of each compound increased, weight gain in both male and female rats decreased. Feeding on diet containing these chemicals also decreased rat birth rate, but did not significantly affect individual litter weight or date of birth. Xanthotoxin appeared to be more toxic than bergapten.

Toxicity of linear furanocoumarins toSpodoptera exigua: Evidence for antagonistic interactions.

The linear furanocoumarins psoralen, bergapten, and xanthotoxin were tested for toxicity to the beet armywormSpodoptera exigua (Hübner) under short ultraviolet (UVB) radiation. Increased dietary concentrations of each furanocoumarin significantly decreased insect larval weight, extended generation time, and induced higher mortality. Xanthotoxin was the most toxic, followed by psoralen and bergapten. Combining psoralen with bergapten, xanthotoxin, or both resulted in significantly antagonistic effects on insect mortality. The combination of bergapten and xanthotoxin, however, produced additive effects. The implications of these observations forS. exigua resistance in the wild plant accession ofApium prostratum and the enigma the findings represent for plant-insect relationships are discussed.

[Introduction of migrants into the urban environment in the Sahel: the case of Mali]. / Insertion des migrants en milieu urbain au Sahel: le cas du Mali.

PIP: A study entitled "Integration of migrants into the urban environment of the Sahel: the case of Mali" will be conducted by the Center for Studies and Research on Population for Development (CERPOD) in Bamako, Mali. It will be part of the "Population and Development in the Sahel" program jointly executed by CERPOD and the Demography Department of the University of Montreal. The study is intended to elucidate the different survival strategies of migrants, who account for over half of urban growth in the Third World. Given the lack of success of previous urban development strategies, it is hoped that this study will provide date to support new policies in which the populations themselves are involved in creation and implementation of urban development programs. The study will stress the economic aspects of urban adaptation and the effects of both general and urban development policies on the sociodemographic conditions of production in urban areas, nuptiality and fertility, and health-related attitudes and behavior. The study assumes that the adaptation of migrants depends not only on their demographic and socioeconomic characteristics, but on their belonging to varying networks of solidarity whose efficacy influences their degree of adaptation. The study will seek to identify and explain different types of problems related to urban growth and the strategies developed by migrants and nonmigrants to confront urban problems. A household survey, a bibliographic analysis, and in-depth interviews will be used. The study is expected to take 4 years. Bibliographic research is underway, the pilot study is tentatively scheduled for June 1991, and the study itself is projected to begin in October 1991.^ieng

Comparative ultrastructure of Mycobacterium leprae and Mycobacterium lepraemurium cell envelopes.

The structural properties of the cell envelopes of Mycobacterium leprae and Mycobacterium lepraemurium were investigated by freeze-fracture, freeze-etching, and negative-staining techniques. Freeze-fracture split the cell wall and exposed the internal features of the peptidoglycolipid mycosidic filamentous network. The cell membrane was also split into two asymmetric faces. The external fracture face was characterized by linear arrays of intramembranous particles, whereas the protoplasmic fracture face showed randomly distributed clusters of particulate entities. Comparative analysis of the ultrastructural features observed in M. leprae and M. lepraemurium indicated that the organization of the cell envelope in these two species differed particularly with respect to the amount and complexity of the superficial peptidoglycolipid and mycosidic integument, which is poorly developed in the mycobacterium responsible for human disease.

Correlation between the mobility of inner plasma membrane structure and agglutination by concanavalin A in two cell lines of MOPC 173 plasmocytoma cells.

Both the distribution of the concanavalin A-binding sites and the rearrangement of the intramembranous particles revealed by the freeze-etching technique, have been studied by means of two variants of the same cell line issued from MOPC 173 murine plasmocytoma. One variant does not agglutinate even in presence of high lectin concentration. It has been shown that the number of binding sites and affinity are almost the same in the two variants. The clustered distribution of intramembranous particles is induced by the interaction of the concanavalin A and the cell surface only in the variant which is agglutinable. From these results it became apparent that the clustered distribution of the membrane particulate components is an acquired feature of the plasma membrane accompanying cell agglutination.