Impaired Retinal Capillary Function in Patients With Alzheimer Disease.

BACKGROUND: Extensive evidence indicates that vasculopathy, especially the level of microcirculation, contributes to neurodegeneration in Alzheimer disease (AD). However, it is not easy to directly monitor cerebral microcirculation. The retinal microvasculature has been proposed as a surrogate measure to study cerebral vascular changes. Indeed, decreased retinal microvascular network densities were reported in patients with AD. We sought to determine the retinal capillary function (RCF, the efficiency of blood flow transferring in the capillary network) in patients with AD. METHODS: Twenty patients (age 60-84 years, mean ± SD: 72.8 ± 7.7 years) with AD and 14 age-matched cognitively normal controls (CN, age 62-81 years, mean ± SD: 68.6 ± 6.7 years.) were recruited. There were no differences in vascular risk factors, including smoking, hypertension, hyperlipidemia, Type 2 diabetes, and cardiovascular disease, between the groups. One eye of each subject in both groups was imaged. Retinal blood flow (RBF) was measured using a retinal function imager, and retinal capillary density (RCD, expressed as fractal dimension Dbox) was measured using optical coherence tomography angiography. RCF was defined as the ratio of RBF to RCD. RESULTS: RCF was 1.62 ± 0.56 nl/s/Dbox (mean ± SD) in the AD group, which was significantly lower than that (2.56 ± 0.25 nl/s/Dbox, P < 0.01) in the CN group. The change of RCF in the AD group represented 28% lower than in the CN group. RCF was significantly and positively correlated with RBF in the AD group (r = 0.98, P < 0.05) and in the CN group (r = 0.65, P < 0.05). CONCLUSIONS: Our study is the first to demonstrate impaired retinal capillary function in patients with AD. The alteration of RCF was mainly due to decreased retinal blood flow, which is transferred by the capillary network. The RCF may be developed as a biomarker of impaired cerebral microcirculation in patients with AD.

[Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital]. / Dispositif intra-utérin mis en place en cours de césarienne. Étude pilote réalisée au centre hospitalier universitaire de Dakar.

OBJECTIVES: To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety. PATIENTS AND METHODS: This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates. RESULTS: Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%. CONCLUSION: The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

[Inclusion of hepatitis B vaccination in the Expanded Program of Immunization: feasibility study in the medical region of Kolda (Senegal)]. / Inclusion de la vaccination contre l'hépatite B dans le programme élargi de vaccination: étude de faisabilité dans la région médicale de Kolda (Sénégal).

Hepatitis B is highly endemic in Senegal. The prevalence of hepatitis B antigens in the population was estimated to be 10 to 12% in 1982. According to the WHO recommendations, a hepatitis B vaccination program (HBV) was launched in 10 medical centers in the Kolda medical region to assess the feasibility of including HBV in the EPI. The epidemiological impact of HBV was also investigated by comparison of the vaccinated zone (VZ) to a control non vaccinated zone (NVZ). HBV coverage had a pattern similar to that of DPT-IPV, but at a lower level: the overall coverage with HBV was only 37.5%, and the drop out rate for HBV1-3 was only 34.4%. In addition, the coverage of the under one year age group was insufficient: 45% for HBV3 as compared to 78% for DPT3 (p < 0.0001). Routine vaccination records in the medical centers in the VZ were consistent with the findings of cluster surveys. Hepatitis B markers were less prevalent among vaccinated that non vaccinated children (8 versus 18.5%, p < 0.001). HB antigenemia was significantly less frequent in the VZ than the NVZ (3.9 versus 10.9, p < 0.0001), and the difference was even larger for all hepatitis markers (7.4 versus 23.7%, p < 0.0001). This study therefore suggests that the inclusion of HBV in the EPI should be continued and strengthened in less accessible regions by an adapted social mobilization program. HBV could then be extended to the whole medical district of Kolda in association with regular epidemiological and serological surveillance.

[Epidemiological study of HIV seroprevalence in a leprosy patient population in Senegal]. / Etude épidémiologique de la séroprévalence de l'infection par le VIH dans une population hansénienne au Sénégal.

We report the findings of an epidemiological study conducted between June 1989 and February 1990 on a population of leprosy patients in southern Senegal (Bignona major endemic disease sector). Two types of population were studied: patients living in urban areas and inmates of leprosaria. The global HIV seroprevalence (HIV 2 in all cases) of the leprosy-patient population was 1.15% (3/257): 0.8% (1/130) for the urban group and 1.5% (2/127) for the leprosaria. The seroprevalence rate does not differ significantly from that for the control group studied and for blood donors (1/221). The diagnosis of leprosy in the seropositive subjects had been established before 1980. None of them showed any sign of relapse. The immunodepression associated with the presence of HIV was only moderate: it was reflected in a lowering of the CD4 count and of the CD4/CD8 ratio, but with no clinical sign of AIDS.