Height and weight development of low-birth-weight infants at 9 months.

BACKGROUND: Low birth weight (LBW) is defined as a birth weight <2500 g at birth, regardless of the term of pregnancy. The objective of this study was to evaluate the height and weight development of LBW infants from 0 to 9 months of corrected age (CA) in Senegal. METHOD: This was a prospective, descriptive, and analytical cohort follow-up of up to 9 months of CA including all live newborns of LBW hospitalized and followed up from 1 August 2019 to 31 May 2020. World Health Organization growth charts were used to assess height and weight growth. RESULTS: During the study, 136 LBW newborns were included. The mean gestational age was 32 weeks of amenorrhea. At discharge, 46 children (33.82%) were exclusively breastfed. At birth, the mean weight was 1487 g (3rd-10th percentile) and the mean height was 41.52 cm (10th-25th percentile). At 9 months of CA, the mean weight was 8119 g (median) and the mean height was 74 cm (median). The children had achieved satisfactory growth in weight (84%) and height (89%). At 9 months of CA, 27% of the children were behind in one of the four areas of psychomotor development. CONCLUSION: At the end of 9 months of CA, height and weight were normal.

Beyond QuantiFERON-TB Results, the Added Value of a Weak Mitogen Response.

Introduction: While QuantiFERON-TB gold (QFT) is frequently used, little attention is paid to the mitogen response. How it could be impacted and associated with outcomes is poorly known. Methods: Retrospective, case-control study in hospitalized patients who underwent QFT testing in two hospitals between 2016 and 2019. We defined two groups of cases with either negative [interferon (IFN)-γ ≤ 0.5 IU/ml, official threshold] or weak (0.5-2 IU/ml) mitogen response, and one group of controls with normal (>2 IU/ml) mitogen response. Results: A total of 872 patients were included. An ongoing infection was independently associated with both a negative (RR = 4.34; 95% CI = 2.94-6.41) and a weak mitogen response (RR = 2.44; 95% CI = 1.66-3.58). Among tuberculosis patients, a weak mitogen response was associated with a false-negative QFT result (75%) compared to a normal response (20%). Decreasing mitogen response (normal, weak and negative, respectively) was associated with increasing length of hospital stay [median (interquartile range) 5 (3-13), 11 (5-21) and 15 (10-30) days; p < 0.001] and increasing hospital mortality (3, 7, and 15%; p < 0.001). Conclusion: Clinicians should take notice of the mitogen response since IFN-γ concentrations lower than <2 IU/ml were associated with false-negative QFT results in tuberculosis patients, independently associated with ongoing infections, and could be associated with worse prognosis.

A Cross-Sectional Reproducibility Study of a Standard Camera Sensor Using Artificial Intelligence to Assess Food Items: The FoodIntech Project.

Having a system to measure food consumption is important to establish whether individual nutritional needs are being met in order to act quickly and to minimize the risk of undernutrition. Here, we tested a smartphone-based food consumption assessment system named FoodIntech. FoodIntech, which is based on AI using deep neural networks (DNN), automatically recognizes food items and dishes and calculates food leftovers using an image-based approach, i.e., it does not require human intervention to assess food consumption. This method uses one-input and one-output images by means of the detection and synchronization of a QRcode located on the meal tray. The DNN are then used to process the images and implement food detection, segmentation and recognition. Overall, 22,544 situations analyzed from 149 dishes were used to test the reliability of this method. The reliability of the AI results, based on the central intra-class correlation coefficient values, appeared to be excellent for 39% of the dishes (n = 58 dishes) and good for 19% (n = 28). The implementation of this method is an effective way to improve the recognition of dishes and it is possible, with a sufficient number of photos, to extend the capabilities of the tool to new dishes and foods.

AQP1 Promoter Variant, Water Transport, and Outcomes in Peritoneal Dialysis.

BACKGROUND: Variability in ultrafiltration influences prescriptions and outcomes in patients with kidney failure who are treated with peritoneal dialysis. Variants in AQP1, the gene that encodes the archetypal water channel aquaporin-1, may contribute to that variability. METHODS: We gathered clinical and genetic data from 1851 patients treated with peritoneal dialysis in seven cohorts to determine whether AQP1 variants were associated with peritoneal ultrafiltration and with a risk of the composite of death or technique failure (i.e., transfer to hemodialysis). We performed studies in cells, mouse models, and samples obtained from humans to characterize an AQP1 variant and investigate mitigation strategies. RESULTS: The common AQP1 promoter variant rs2075574 was associated with peritoneal ultrafiltration. Carriers of the TT genotype at rs2075574 (10 to 16% of patients) had a lower mean (±SD) net ultrafiltration level than carriers of the CC genotype (35 to 47% of patients), both in the discovery phase (506±237 ml vs. 626±283 ml, P = 0.007) and in the validation phase (368±603 ml vs. 563±641 ml, P = 0.003). After a mean follow-up of 944 days, 139 of 898 patients (15%) had died and 280 (31%) had been transferred to hemodialysis. TT carriers had a higher risk of the composite of death or technique failure than CC carriers (adjusted hazard ratio, 1.70; 95% confidence interval [CI], 1.24 to 2.33; P = 0.001), as well as a higher risk of death from any cause (24% vs. 15%, P = 0.03). In mechanistic studies, the rs2075574 risk variant was associated with decreases in AQP1 promoter activity, aquaporin-1 expression, and glucose-driven osmotic water transport. The use of a colloid osmotic agent mitigated the effects of the risk variant. CONCLUSIONS: A common variant in AQP1 was associated with decreased ultrafiltration and an increased risk of death or technique failure among patients treated with peritoneal dialysis. (Funded by the Swiss National Science Foundation and others.).

PREVALENCE OF PARASITIC INFECTIONS IN CHILDREN OF BOKE, GUINEA.

Helminthic and intestinal protozoan infections and malaria infections are common in children less than 15 yr old in sub-Saharan Africa, but little is known about these infections in Guinea. The aim of this study was to determine the prevalence of parasitic infections in children aged less than 15 yr and the relationship of these infections with anemia. The cross-sectional study was done in Dabbis sub-prefecture in the Boke region of Guinea from 18 to 26 March 2017. A simple random sampling at the household level was performed, and 1 child under the age of 15 was included per eligible household. A total of 392 children were included in the analysis. Clinical and parasitological information were assessed, including anthropometric measures (weight and height), disease symptoms, hemoglobin level, and malaria parasitemia. Helminthic and protozoan intestinal infections were present in 59.7% of the children surveyed. Malaria infection prevalence was 45.5% when assessed by microscopy and 43.6% when assessed by a rapid diagnostic test. Plasmodium falciparum, accounting for 84.2% of malaria infections, was the main malaria species infection. Gastrointestinal parasites were present in 19.1% of children. The main gastrointestinal parasites present included Entamoeba coli (5.4%) and Giardia intestinalis (5.1%). There was no association between the presence of anemia and the parasitic status of the children. Parasitic screening and mass treatment in this age group, as well as household awareness raising, would reduce cases of parasitic infections in rural Guinea.

[Effect of COVID-19 on routine immunization schedule in Senegalese hospitals]. / Impact de la COVID-19 sur la vaccination de routine en milieu hospitalier au Sénégal.

INTRODUCTION: the COVID-19 pandemic has pushed the world to implement drastic prevention methods based on limiting population movements that have an impact on public health policies, such as vaccination. The purpose of this work was to assess the effect of these preventive measures on routine immunization schedules in hospitals after the outbreak of this pandemic in Senegal. METHODS: we conducted a retrospective cross-sectional study in the Vaccination Unit of the Abass NDAO hospital center in August 2020. We compared data from the Vaccination Unit over the period March-August of the last three years (2018, 2019 and 2020). The parameter studied was the number of vaccine doses administered in the different periods according to the expanded immunization program. RESULTS: in April, the number of doses of vaccines given at 6 weeks was 36 in 2018, 29 in 2019 and 15 in 2020, reflecting a decrease of 50% compared to March. In July, the number of doses given was 40 in 2018, 35 in 2019 and 15 in 2020, reflecting a reduction of 42% compared to 2019. CONCLUSION: measures to combat this pandemic should not affect routine immunization programmes, especially in our resource-constrained country. It is essential to continue vaccination schedule for children and to identify children who have missed vaccine doses in order to implement catch-up vaccination.

Mechanisms of Crystalloid versus Colloid Osmosis across the Peritoneal Membrane.

Background Osmosis drives transcapillary ultrafiltration and water removal in patients treated with peritoneal dialysis. Crystalloid osmosis, typically induced by glucose, relies on dialysate tonicity and occurs through endothelial aquaporin-1 water channels and interendothelial clefts. In contrast, the mechanisms mediating water flow driven by colloidal agents, such as icodextrin, and combinations of osmotic agents have not been evaluated.Methods We used experimental models of peritoneal dialysis in mouse and biophysical studies combined with mathematical modeling to evaluate the mechanisms of colloid versus crystalloid osmosis across the peritoneal membrane and to investigate the pathways mediating water flow generated by the glucose polymer icodextrin.ResultsIn silico modeling and in vivo studies showed that deletion of aquaporin-1 did not influence osmotic water transport induced by icodextrin but did affect that induced by crystalloid agents. Water flow induced by icodextrin was dependent upon the presence of large, colloidal fractions, with a reflection coefficient close to unity, a low diffusion capacity, and a minimal effect on dialysate osmolality. Combining crystalloid and colloid osmotic agents in the same dialysis solution strikingly enhanced water and sodium transport across the peritoneal membrane, improving ultrafiltration efficiency over that obtained with either type of agent alone.Conclusions These data cast light on the molecular mechanisms involved in colloid versus crystalloid osmosis and characterize novel osmotic agents. Dialysis solutions combining crystalloid and colloid particles may help restore fluid balance in patients treated with peritoneal dialysis.

[Heart failure with normal heart revealing complex arteriovenous malformation of the lower limb in a child: case study and literature review]. / Insuffisance cardiaque sur cœur normal révélant une malformation artériole-veineuse complexe du membre inferieur chez un enfant: à propos d'une observation et revue de la littérature.

Arteriovenous malformations (AVM) are congenital high-flow vascular defects. They are very rare in children. Diagnosis and treatment are often delayed due to their atypical place of occurrence and to their variable clinical manifestations. We report the case of a child treated at the National Centre Hospitalier Albert Royer Children, Dakar. A boy aged 9 years was referred from a health facility in rural areas for the treatment of heart failure. Admission clinical examination showed impaired general condition, global heart failure syndrome and voluminous right warm inguinocrural mass extended to the right abdominal wall (iliac fossa and right flank), with poorly defined limits. Auscultation of this mass showed a thrill and diffuse murmur. Cardiac ultrasound showed severe pulmonary arterial hypertension (PAH) with extensive impairement of the heart cavities, without cardiac structural involvement. The diagnosis of AVM was confirmed by doppler ultrasound of the mass complemented by angiography scan. They showed multiple arteriovenous fistulas within the mass. The diagnosis of complex stage IV AVM (according to Schöbinger classification) of the root of the right thigh was retained. Clinical treatment of heart failure was based on furosemide, spironolactone and captopril to obtain hemodynamic stabilization before possible surgical procedure. Arteriovenous malformations of the limbs, in particular of the proximal end of the lower limb in children are still largely unknown, hence frequent diagnostic errors and delays. Their evolution is unpredictable requiring early diagnosis and careful monitoring involving multidisciplinary interaction between pediatrics, surgeons and radiologists.

Mechanisms of acid-base regulation in peritoneal dialysis.

Background: Peritoneal dialysis (PD) contributes to restore acid-base homeostasis in patients with end-stage renal disease. The transport pathways for buffers and carbon dioxide (CO2) across the peritoneal membrane remain poorly understood. Methods: Combining well-established PD protocols, whole-body plethysmography and renal function studies in mice, we investigated molecular mechanisms of acid-base regulation in PD, including the potential role of the water channel aquaporin-1 (AQP1). Results: After instillation in peritoneal cavity, the pH of acidic dialysis solutions increased within minutes to rapidly equilibrate with blood pH, whereas the neutral pH of biocompatible solutions remained constant. Predictions from the three-pore model of peritoneal transport suggested that local production of HCO3- accounts at least in part for the changes in intraperitoneal pH observed with acidic solutions. Carbonic anhydrase (CA) isoforms were evidenced in the peritoneal membrane and their inhibition with acetazolamide significantly decreased local production of HCO3- and delayed changes in intraperitoneal pH. On the contrary, genetic deletion of AQP1 had no effect on peritoneal transport of buffers and diffusion of CO2. Besides intraperitoneal modifications, the use of acidic dialysis solutions enhanced acid excretion both at pulmonary and renal levels. Conclusions: These findings suggest that changes in intraperitoneal pH during PD are mediated by bidirectional buffer transport and by CA-mediated production of HCO3- in the membrane. The use of acidic solutions enhances acid excretion through respiratory and renal responses, which should be considered in patients with renal failure.

[Idiopathic nephrotic syndrome (INS) in children in Dakar: about 40 cases]. / Le syndrome néphrotique idiopathique (SNI) de l'enfant à Dakar: à propos de 40 cas.

INTRODUCTION: This study aimed to analyze the diagnostic, therapeutic, and evolutionary features of nephrosis in children in a pediatric department in Dakar. METHODS: The study was carried out in the Department of Pediatrics at the Aristide Le Dantec Hospital. We conducted a retrospective study over a period of 3 years from 1 January 2012 to 31 December 2014. All patients aged 2-12 years with idiopathic nephrotic syndrome were included in the study. RESULTS: Forty cases of nephrosis were collected, that is to say a prevalence of 23% among patients with kidney disease treated in the Department of Pediatrics. The average age was 7.11 ± 3.14 years. 72.5% (n=29) of patients suffered from pure nephrotic syndrome. Lower limb edema was present in 100% of patients, oliguria in 55% (n=22) and high blood pressure (HBP) in 5% (n=2) of cases. Median proteinuria was 145,05 ± 85,54 mg/kg/24 hours. Median protidemia was 46,42 ±7.88 g/L and median albumin was 17.90 ± 7.15 g/L. Thirty nine patients were treated with prednisone-based corticosteroid therapy. Corticosensitivity was retained in 77% (n=30) patients and corticoresistance in 13% (n=5) of cases. The factor of poor response after corticosteroid therapy was initial proteinuria greater than 150 mg/kg/day (p = 0.024). Renal biopsy was performed in 18% (n=7) of patients which showed focal and segmental hyalinosis in 57.2% (n=4). Cyclophosphamide and azathioprine were associated with corticosteroids in 10% (n=4) of cases respectively. The overall remission rate was 89.8%. The evolution toward chronic renal failure was observed in three patients. CONCLUSION: Nephrosis accounted for almost one quarter of all cases of kidney disease treated in our Department. It has high overall remission rate. The only factor contributing to poor response after corticosteroid therapy was high levels of initial proteinuria. Focal and segmental hyalinosis was the most frequently found lesion diagnosed by renal biopsy.

The NLRP3 Inflammasome Has a Critical Role in Peritoneal Dialysis-Related Peritonitis.

Bacterial peritonitis remains the main cause of technique failure in peritoneal dialysis (PD). During peritonitis, the peritoneal membrane undergoes structural and functional alterations that are mediated by IL-1ß The NLRP3 inflammasome is a caspase-1-activating multiprotein complex that links sensing of microbial and stress products to activation of proinflammatory cytokines, including IL-1ß The potential roles of the NLRP3 inflammasome and IL-1ß in the peritoneal membrane during acute peritonitis have not been investigated. Here, we show that the NLRP3 inflammasome is activated during acute bacterial peritonitis in patients on PD, and this activation associates with the release of IL-1ß in the dialysate. In mice, lipopolysaccharide- or Escherichia coli-induced peritonitis led to IL-1ß release in the peritoneal membrane. The genetic deletion of Nalp3, which encodes NLRP3, abrogated defects in solute transport during acute peritonitis and restored ultrafiltration. In human umbilical vein endothelial cells, IL-1ß treatment directly enhanced endothelial cell proliferation and increased microvascular permeability. These in vitro effects require endothelial IL-1 receptors, shown by immunofluorescence to be expressed in peritoneal capillaries in mice. Furthermore, administration of the IL-1ß receptor antagonist, anakinra, efficiently decreased nitric oxide production and vascular proliferation and restored peritoneal function in mouse models of peritonitis, even in mice treated with standard-of-care antibiotherapy. These data demonstrate that NLRP3 activation and IL-1ß release have a critical role in solute transport defects and tissue remodeling during PD-related peritonitis. Blockade of the NLRP3/IL-1ß axis offers a novel method for rescuing morphologic alterations and transport defects during acute peritonitis.

Ultrafiltration Failure and Impaired Sodium Sieving During Long-Term Peritoneal Dialysis: More Than Aquaporin Dysfunction?

Fifteen years ago, our group reported the case of a 67-year-old man on peritoneal dialysis for 11 years, in whom ultrafiltration failure and impaired sodium sieving were associated with an apparently normal expression of aquaporin-1 (AQP1) water channels in peritoneal capillaries. At that time, AQP1 dysfunction was suggested as the cause of impaired free-water transport. However, recent data from computer simulations, and structural and functional analysis of the peritoneal membrane of patients with encapsulating peritoneal sclerosis, demonstrated that changes in the peritoneal interstitium directly alter osmotic water transport. In light of these insights, we challenge the initial hypothesis and provide several lines of evidence supporting the diagnosis of encapsulating peritoneal sclerosis in this patient and suggesting that severe peritoneal fibrosis accounted for the loss of osmotic conductance developed during the course of peritoneal dialysis.

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis.

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD) characterized by extensive fibrosis of the peritoneum. Changes in peritoneal water transport may precede EPS, but the mechanisms and potential predictive value of that transport defect are unknown. Among 234 patients with ESRD who initiated PD at our institution over a 20-year period, 7 subsequently developed EPS. We evaluated changes in peritoneal transport over time on PD in these 7 patients and in 28 matched controls using 3.86% glucose peritoneal equilibration tests. Compared with long-term PD controls, patients with EPS showed early loss of ultrafiltration capacity and sodium sieving before the onset of overt EPS. Multivariate analysis revealed that loss of sodium sieving was the most powerful predictor of EPS. Compared with long-term PD control and uremic peritoneum, EPS peritoneum showed thicker submesothelial fibrosis, with increased collagen density and a greater amount of thick collagen fibers. Reduced osmotic conductance strongly correlated with the degree of peritoneal fibrosis, but not with vasculopathy. Peritoneal fibrosis was paralleled by an excessive upregulation of vascular endothelial growth factor and endothelial nitric oxide synthase, but the expression of endothelial aquaporin-1 water channels was unaltered. Our findings suggest that an early and disproportionate reduction in osmotic conductance during the course of PD is an independent predictor of EPS. This functional change is linked to specific alterations of the collagen matrix in the peritoneal membrane of patients with EPS, thereby validating the serial three-pore membrane/fiber matrix and distributed models of peritoneal transport.

Quantification of osmotic water transport in vivo using fluorescent albumin.

Osmotic water transport across the peritoneal membrane is applied during peritoneal dialysis to remove the excess water accumulated in patients with end-stage renal disease. The discovery of aquaporin water channels and the generation of transgenic animals have stressed the need for novel and accurate methods to unravel molecular mechanisms of water permeability in vivo. Here, we describe the use of fluorescently labeled albumin as a reliable indicator of osmotic water transport across the peritoneal membrane in a well-established mouse model of peritoneal dialysis. After detailed evaluation of intraperitoneal tracer mass kinetics, the technique was validated against direct volumetry, considered as the gold standard. The pH-insensitive dye Alexa Fluor 555-albumin was applied to quantify osmotic water transport across the mouse peritoneal membrane resulting from modulating dialysate osmolality and genetic silencing of the water channel aquaporin-1 (AQP1). Quantification of osmotic water transport using Alexa Fluor 555-albumin closely correlated with direct volumetry and with estimations based on radioiodinated ((125)I) serum albumin (RISA). The low intraperitoneal pressure probably accounts for the negligible disappearance of the tracer from the peritoneal cavity in this model. Taken together, these data demonstrate the appropriateness of pH-insensitive Alexa Fluor 555-albumin as a practical and reliable intraperitoneal volume tracer to quantify osmotic water transport in vivo.

Hole doping by pressure on the 1111 pnictides CaFeAsF and SrFeAsF.

We determine the pressure phase diagram of the 1111 compounds CaFeAsF and SrFeAsF, up to 20 GPa and down to 4 K by electrical resistivity measurements and the change of structure up to 40 GPa at room temperature. The antiferromagnetic transition temperature, as determined by the derivative peak, shows a minimum at ~5 GPa (10 GPa) for the Ca (Sr) compound. For CaFeAsF, superconductivity appears at this minimum, coincident with the development of a previously reported monoclinic phase. For SrFeAsF, where the orthorhombic and the monoclinic phase were reported to coexist, superconductivity exists above P≥1 GPa. Both phase diagrams can be scaled by a shift of ~10 GPa pressure at which the volume of SrFeAsF and that of CaFeAsF at ambient pressure coincide. The difference of our phase diagram with that of electron-doped 1111 samples is accounted for by hole doping under pressure, which we verified through electron band structure calculations.

Maternal and perinatal outcomes by mode of delivery in senegal and mali: a cross-sectional epidemiological survey.

OBJECTIVE: In the context of rapid changes regarding practices related to delivery in Africa, we assessed maternal and perinatal adverse outcomes associated with the mode of delivery in 41 referral hospitals of Mali and Senegal. STUDY DESIGN: Cross-sectional survey nested in a randomised cluster trial (1/10/2007-1/10/2008). The associations between intended mode of delivery and (i) in-hospital maternal mortality, (ii) maternal morbidity (transfusion or hysterectomy), (iii) stillbirth or neonatal death before Day 1 and (iv) neonatal death between 24 hours after birth and hospital discharge were examined. We excluded women with immediate life threatening maternal or fetal complication to avoid indication bias. The analyses were performed using hierarchical logistic mixed models with random intercept and were adjusted for women's, newborn's and hospitals' characteristics. RESULTS: Among the 78,166 included women, 2.2% had a pre-labor cesarean section (CS) and 97.8% had a trial of labor. Among women with a trial of labor, 87.5% delivered vaginally and 12.5% had intrapartum CS. Pre-labor CS was associated with a marked reduction in the risk of stillbirth or neonatal death before Day 1 as compared with trial of labor (OR = 0.2 [0.16-0.36]), though we did not show that maternal mortality (OR = 0.3 [0.07-1.32]) and neonatal mortality after Day 1 (OR = 1.3 (0.66-2.72]) differed significantly between groups. Among women with trial of labor, intrapartum CS and operative vaginal delivery were associated with higher risks of maternal mortality and morbidity, and neonatal mortality after Day 1, as compared with spontaneous vaginal delivery. CONCLUSIONS: In referral hospitals of Mali and Senegal, pre-labor CS is a safe procedure although intrapartum CS and operative vaginal delivery are associated with increased risks in mothers and infants. Further research is needed to determine what aspects of obstetric care contribute to a delay in the provision of intrapartum interventions so that practices may be made safer when they are needed.

Correlates of condom use among sex workers and their boyfriends in three West African countries.

The aim of this study was to identify correlates associated with condom use at last intercourse between sex workers (SW) and their boyfriends (BF). The sample was derived as a convenience sample recruited through existing HIV prevention organizations in Benin, Guinea and Senegal. The Theory of Planned Behavior served as the conceptual framework. A total of 406 individuals (220 SW and 186 BF) participated in the study. Socio-demographic, behavioral and psychological variables were collected through a face-to-face administered questionnaire. Condom use at last intercourse was significantly associated with intention and perceived control among SW as well as their BF. With respect to intention, perceived control, attitude and moral norm explained 82 and 74% of intention of SW and BF, respectively. These results suggest that promoting condom use among SW and BF should be based primarily on the development of personal ability to overcome obstacles to condom use.