Les pathologies ORL chez les sujets diabétiques : une étude de 281 patients à l'hôpital national Donka

Introduction et objectifs. L'association du diabète aux pathologies oto-rhino-laryngologiques est un fait classique. Cette association constitue par la difficulté thérapeutique et la gravité de ses complications, un problème clinique et thérapeutique. Notre étude avait pour but de décrire la prise en charge des pathologies ORL chez les diabétiques à l'Hôpital National Donka. Méthodologie. Il s'agit d'une étude transversale descriptive effectuée au mois de mai 2015. Elle a concerné tous les patients diabétiques vus en ambulatoires ou hospitalisés aux services ORL-CCF et d'Endocrinologie-Diabétologie de l'Hôpital National Donka, présentant un signe ORL et ayant accepté de participer à l'étude. Résultat. La prévalence des pathologies ORL chez les diabétiques était de 33%. Les sujets âgés d'au moins 56 ans étaient les plus représentés (75%) avec un écart type de 15 et des extrêmes de 2 et 90 ans. Les patients sans revenu étaient les plus atteints (58,6%). 78,9% des patients vivaient en zone urbaine. La quasi- totalité des patients ont été examiné en ambulatoire (92,9 %). Le diabète de type II a dominé la série (94,6%). L'hypertension artérielle représentait 51,6% des pathologies associées. L'hyperglycémie à jeun a été retrouvée chez 84,6% des patients (P=0,01). La rhino sinusite était la pathologie la plus fréquente (72,3%). Les antibiotiques, l'antalgique, la corticothérapie ont été les plus utilisés. Conclusion. Chez le sujet diabétique avec affection ORL, le diabète est le plus souvent mal contrôlé. La rhinosinusite est la pathologie la plus fréquente

Les corps étrangers en otorhinolaryngologie : analyse de 192 cas au centre hospitalier universitaire de Conakry

Introduction. La survenue d'un corps étranger (CE) est un motif fréquent de consultation en ORL. Le but de notre étude était d'analyser les données épidémiologiques, cliniques et thérapeutiques des sujets porteurs de corps étrangers à l'Hôpital National Ignace Deen (CHU de Conakry). Matériels et méthodes. Il s'agit d'une étude prospective de type descriptif, étalée de Janvier ­à décembre 2015 (un an), portant sur tous les cas de corps étrangers des conduits auditifs externes et des voies aérodigestives supérieures colligés au service d'ORL de l'Hôpital National Ignace Deen. Nos variables d'intérêt étaient les données épidémiologiques, cliniques et thérapeutiques Résultats. Durant la période d'étude, 192 cas de CE ont été colligés parmi les 2177 consultations, soit une fréquence de 8,82%. L'âge des patients variait de 2 à 60 ans avec une prédominance des enfants de moins de 10 ans (42,71%). Le sex-ratio homme/femme était de deux. Le délai moyen d'admission était de 48h avec des extrêmes de 0 à 30 jours. Les circonstances de survenue des CE étaient représentées par les jeux dans 54,17 % des cas. Le conduit auditif externe était la localisation la plus fréquente (64,58%). La nature des CE était inorganique dans 76,56 % des cas et organique dans 23,44 % des cas. Tous les CE ont été extraits par la voie d'introduction, le plus souvent au fauteuil de consultation (90,10 % des cas). L'évolution a été favorable chez tous les patients. Conclusion. Les corps étrangers ORL constituent un motif fréquent de consultation et affectent surtout les enfants de sexe masculin.ils sont habituellement inorganiques et affectent surtout le conduit auditif externe. L'évolution est en règle favorable après extraction

[Impact of Gleason score on biochemical recurrence free survival after radical prostatectomy with positive surgical margins]. / Impact du score de Gleason sur la survie sans récidive biologique après prostatectomie totale pour cancer avec marges chirurgicales positives.

PURPOSE: Research of predictive factors of biochemical recurrence to guide the establishment of an adjuvant treatment after radical prostatectomy for cancer with positive surgical margins. METHODOLOGY: A retrospective cohort of 1577 afro-caribbean patients undergoing radical prostatectomy operated between 1st January 2000 and 1st July 2013 was analyzed. In this cohort, 406 patients had positive surgical margin, we excluded 11 patients who received adjuvant therapy (radiotherapy, hormonotherapy, radio-hormonotherapy) and 2 patients for whom histological analysis of the surgical specimen was for a pT4 pathological stage. After a descriptive analysis, we used a Cox model to look for predictors of survival without biochemical recurrence then, depending on the significant variables, we separated our population into six groups: stage pT2 with Gleason score≤3+4 (group 1), stage pT2 with a score of Gleason≥4+3 (group 2), stage pT3a with a Gleason core≤3+4 (group 3), pT3a stage with a score of Gleason≥4+3 (group 4), stage pT3b with a Gleason score≤3+4 (group 5) and stage pT3b Gleason≥with a score of 4+3 (group 6) and compared survival without biochemical recurrence using a log rank test. After radical prostatectomy with surgical margins with an anatomopathological stage≤pT3b, a Gleason score≥4+3 had a pejorative survival without biochemical recurrence than pathological stage (P<0.001). RESULTS: In multivariate analysis, predictors of survival without biochemical recurrence after radical prostatectomy with positive surgical margins were the majority Gleason postoperative (P<0.0001), pathological stage (P=0.049) adjusted preoperative PSA (P=0.826), with the body mass index (BMI) (P=0.59) and tumor volume (P=0.95). CONCLUSION: A high postoperatively Gleason score (≥4+3) has a better predictive value of biochemical recurrence than pathological stage pT2 or pT3 at the patients having been treated for prostate cancer by radical prostatectomy with positive surgical margins. LEVEL OF EVIDENCE: 4.

[The significance of PSA density as predictive factor in Afro-Caribbean patients eligible for active surveillance by the French protocol criteria]. / Intérêt de la densité du PSA comme facteur prédictif chez les patients afro-caribéens éligibles à la surveillance active du cancer de prostate selon les critères du protocole français.

OBJECTIVES: Study the interest of addition of PSA density (PSAD), to the selection criteria of the French protocol for inclusion patients Afro-Caribbean on active surveillance prostate cancer. METHODS: A retrospective analysis of 1505 patients who had, in turn, a radical prostatectomy for cancer between 2000 and 2012, in a single reference center. One hundred and forty-one patients was eligible, at the time of their diagnosis, for active surveillance by the criteria of the French protocol. This population was divided into 2 groups according to the histological analysis of the prostatectomy specimen confirmed indolent cancer or overturned. The median PSAD of each group was calculated to be compared. Secondarily, the most discriminating PSAD was investigated by the method of ROC after constitution tables intrinsic validity in this population. This threshold has secondary conducting a comparative analysis of the underestimation of cancer in terms of aggressiveness and/or extension between patients selected according to the criteria of the French protocol and "on-selected" patients according to these criteria and their PSAD. RESULTS: Of the 141 patients identified for analysis, histological examination of the prostatectomy specimen has to show that 42 patients (29.7 %) were actually more aggressive cancer (20.6 % of Gleason ≥ 7), wider (4.2 % ≥ pT3) or larger and more aggressive (4.9 %) than foreshadowed criteria French protocol. The median PSAD these 42 patients were significantly higher than the median PSAD patients correctly estimated (0.18 vs. 0.14, p-value=0.046). The application of the most discriminating threshold: 0.15 ng/ml/cm(3) in this population allowed to significantly improve the selection of candidates of the 79 "on-selected" patients, six (20.2 %) were actually more aggressive cancer (13.9 % of Gleason ≥ 7), wider (2.5 % ≥ pT3) or larger and more aggressive (3.8 %). CONCLUSION: The criteria for the French protocol for active surveillance, applied to the Caribbean population underestimate 29 % of non-latent cancers. Adjuvants criteria that must be inexpensive, sensitive and specific seem necessary in this population. A PSAD<0.15 ng/ml/cm(3) could be one of these criteria.

Cost-effectiveness of novel first-line treatment regimens for tuberculosis.

OBJECTIVE: To evaluate the cost-effectiveness of novel first-line treatment regimens for tuberculosis (TB). DESIGN: Using decision analysis, we projected the costs and effectiveness, from the health care perspective, of treating a patient cohort in the public sector for active TB without known or suspected resistance to first-line drugs. We compared standard (6-month) treatment to hypothetical regimens of equal efficacy, higher cost and shorter duration. RESULTS: For every 100 TB patients treated, replacing standard treatment with shorter-course regimens would avert an estimated 2-4 failures/relapses, 0.2-0.4 deaths and 8-14 disability-adjusted life years (DALYs), or 6-11% of all DALYs suffered. We identified three primary determinants of cost-effectiveness: drug price, continuation phase treatment delivery costs and deaths averted through fewer relapses. In a high treatment cost scenario (similar to Brazil), averted delivery costs outweighed higher drug costs, making novel regimens cost-saving. In a low treatment cost scenario (similar to the Philippines), a 4-month regimen with a drug price of $1/day cost $66 per patient, or $840 per DALY averted, and became cost-saving if the drug price dropped below $0.37/day. CONCLUSION: Although they avert a small proportion of total DALYs, novel, shorter-course first-line regimens for TB are likely to be cost-effective or cost-saving in most settings.

[Radiotherapy with androgen deprivation in high-risk prostate cancer: what outcomes on a Caribbean population?]. / Radiohormonothérapie dans le cancer de la prostate à haut risque : quels résultats sur une population Antillaise ?

OBJECTIVE: To analyze in a Caribbean population at 90% of African descent, the results of radiotherapy with androgen deprivation (AD) in high-risk prostate cancer (PCa). PATIENTS AND METHODS: Fifty-nine consecutive patients with a high-risk PCa as defined by the D'AMICO classification and treated by radiotherapy with AD between January 2003 and April 2009 in our center were analyzed. The median dose of radiation and the median duration of AD were 70Gy and 37months respectively. Biochemical recurrence (BF), as primary outcome was defined according to the PHOENIX criteria (nadir PSA+2ng/mL). Multivariate analysis was performed to identify predictive factors of BF. The median follow-up was 47months. RESULTS: Eight (13.6%) patients had BF and four (6.8%) developed metastases. Six (10.2%) died during the follow-up. The 5years acturial biochemical disease-free survival was 79.7%. Multivariate analyses have shown that Gleason sum (GS) superior to 7 (P=0.029), AD duration less than 24months (P=0.004) and the rate of Nadir PSA greater or equal to 0.5ng/mL (P=0.011) were independent predictive factors of BF. CONCLUSION: This study was the first to our knowledge, to provide that radiotherapy associate with AD for HRPC among Caribbean men is effective as observed in other populations. Patients with GS superior to 7 could be considered for more aggressive treatments in clinical trials.

[Prostate cancer in Guadeloupe (French West Indies): incidence, mortality and clinicopathological features]. / Cancer de la prostate en Guadeloupe : incidence, mortalité, caractéristiques cliniques et anatomopathologiques.

In mainland France, as in most Western countries, prostate cancer is the most frequent cancer in men. However, the incidence of this cancer is highly variable, depending on the region of the world. This variability is largely accounted for by differences in access to care, but also by environmental conditions and the ethnogeographic origins of the populations. The French West Indies--the archipelago of Guadeloupe and the island of Martinique--are unique in terms of their geography, environment and the lifestyle and origins of their populations. We report the incidence and mortality rates for prostate cancer in the French West Indies and also provide the first description of the major clinical and anatomical characteristics of this disease in this region.

Which anaesthesia should be recommended for prostate biopsy?

OBJECTIVE: Although transrectal ultrasound-guided prostatic biopsies are associated with significant discomfort and pain, most urologists do not use any kind of anaesthesia. We therefore compared the efficacy of two local anaesthetics, namely, the rectal administration of lidocaine gel and lidocaine periprostatic infiltration prior to biopsies. DESIGN AND METHODS: Three hundred and fifty-six randomized patients received either 15 mL of 2% lidocaine gel administered intrarectally ten minutes before prostate biopsies in group 1 (180 patients) or 10 mL of 1% lidocaine given under ultrasound guidance in two periprostatic injections of 5 mL, four minutes before the biopsies in group 2 (176 patients). A visual analogue scale (VAS) was used to assess the pain score during anaesthesia (VAS 1), during the biopsies (VAS 2) and 30 minutes after them (VAS 3). RESULTS: Patients receiving lidocaine gel experienced statistically less pain than the lidocaine injection group for mean VAS 1 (0.1 vs 1.4, p < 0.0001) and mean VAS 3 (0.8 vs 1.4, p < 0. 001) but VAS 2 showed no statistically significant difference (2.0 vs 2.1). No major morbidity was noted with either anaesthetic. CONCLUSION: Rectal administration of lidocaine gel is both safe, simple and effective and results are more satisfactory than with lidocaine periprostatic infiltration.

Which anaesthesia should be recommended for prostate biopsy / ¿Qué Anestesia debe Recomendarse para la Biopsia de la Próstata?

OBJECTIVE: Although transrectal ultrasound-guided prostatic biopsies are associated with significant discomfort and pain, most urologists do not use any kind of anaesthesia. We therefore compared the efficacy of two local anaesthetics, namely, the rectal administration of lidocaine gel and lidocaine periprostatic infiltration prior to biopsies. DESIGN AND METHODS: Three hundred and fifty-six randomized patients received either 15 mL of 2 lidocaine gel administered intrarectally ten minutes before prostate biopsies in group 1 (180 patients) or 10 mL of 1 lidocaine given under ultrasound guidance in two periprostatic injections of 5 mL, four minutes before the biopsies in group 2 (176 patients). A visual analogue scale (VAS) was used to assess the pain score during anaesthesia (VAS 1), during the biopsies (VAS 2) and 30 minutes after them (VAS 3). RESULTS: Patients receiving lidocaine gel experienced statistically less pain than the lidocaine injection group for mean VAS 1 (0.1 vs 1.4, p < 0.0001) and mean VAS 3 (0.8 vs 1.4, p < 0. 001) but VAS 2 showed no statistically significant difference (2.0 vs 2.1). No major morbidity was noted with either anaesthetic. CONCLUSION: Rectal administration of lidocaine gel is both safe, simple and effective and results are more satisfactory than with lidocaine periprostatic infiltration

Objetivo: Aunque las biopsias prostáticas transrectales guiadas mediante ultrasonido se asocian con considerable malestar y dolor, la mayoría de los urólogos no usa cualquier tipo de anestesia. Por lo tanto, comparamos la eficacia de dos anestésicos locales, a saber, la administración rectal de gel de lidocaína y la infiltración con lidocaína del área periprostática antes de las biopsias. Diseño y métodos: Trescientos cincuenta y seis pacientes randomizados recibieron o bien 15 mL de lidocaína en gel al 2%, administrada intrarectalmente diez minutos antes de las biopsias de la próstata en el grupo 1 (180 pacientes); o alternativamente 10 mL de lidocaína al 1% administrada bajo la guía de ultrasonido en dos inyecciones periprostáticas de 5 mL, cuatro minutos antes de las biopsias en el grupo 2 (176 pacientes). Se usó una escala analógica visual (EAV) para evaluar el grado de dolor durante la anestesia (EAV 1), durante las biopsias (EAV 2) y 30 minutos después de realizarlas (EAV 3). Resultados: Los pacientes que recibieron lidocaína en gel, experimentaron menos dolor estadísticamente, que el grupo de la inyección de lidocaína, para la VAS 1 media (0.1 frente a 1.4, p <0.0001) y VAS 3 media (0.8 frente a 1.4, p <0.001). Sin embargo, la VAS 2 no mostró diferencia significativa alguna en términos estadísticos (2.0 frente a 2.1). No se vio morbosidad de consideración con ninguno de los anestésicos. Conclusión: La administración rectal de gel de lidocaína es tan segura y simple como efectiva, y siendo los resultados más satisfactorio que aquellos producidos con la infiltración periprostática de lidocaína..

Laparoscopic promontory sacral colpopexy: is the posterior, recto-vaginal, mesh mandatory?

OBJECTIVE(S): The aim of our retrospective study was to determine if systematic placement of a posterior mesh, in addition to an anterior vesico-vaginal mesh, is necessary for laparoscopic treatment of pelvic organ prolapse. METHODS: A laparoscopic promontory sacral colpopexy was performed in 108 patients, including 55 patients with a concurrent laparoscopic Burch procedure (50.9%). We compared 33 patients treated with a single anterior mesh (SAM) and 71 treated with a double, anterior and posterior, mesh (DM). RESULTS: The difference between the SAM and DM groups was statistically significant in terms of posterior compartment failure (rectocele and/or enterocele): 31.3% and 5.9%, respectively (p=0.0006). This significant difference persisted in the Burch (B) group (p=0.001), but not in the non-Burch (NB) group (p=0.98). Among the SAM group, this difference between the B and NB groups, was significant (57.1% versus 0%; p=0.0015) and above all not a single posterior failure was observed in the NB group. CONCLUSION(S): The placement of a posterior mesh, if highly effective, appeared unnecessary in the absence of an associated Burch procedure or a patent posterior prolapse. The posterior mesh also increased risk of postoperative complications and side effects.

Organisation de la prevention dans les professions d'imprimerie a Abidjan

L'imprimerie est un ensemble de techniques utilisees pour imprimer un texte; un dessin sur un support donne ( papier; metal; tissu; plastique) a partir de differents procedes d'impression que sont la typographie; l'offset; l'heliogravure; la serigraphie et la flexograpflie. La prevention des risques professionnels doit faire partie des preoccupations quotidiennes des acteurs de sante et securite au travail. C'est donc; dans le but de contribuer a une meilleure organisation de la prevention des risques dans celle profession que nous avons fait cette etude transversale. L'enquete realisee dans 27 imprimeries; avec le responsable d'entreprise ou le directeur des ressources humaines; nous a permis de faire les constats suivants: *la predominance de petites imprimeries: 88;89pour cent emploient moins de 24 personnes. *le nombre d'imprimeries immatriculees a la CNPS est de 18(66;67pour cent). Elles font partie du SYNTDIPCI. *le CHSCT existe dans 3 imprimeries; mais n'est fonctionnel que dans une seule ou elle tient sa reunion une fois par trimestre. *l'hygiene generale des locaux demeure insuffisante. *les EPI utilises sont les blouses et les chaussures fermees dont l'entretien reste a la charge des travailleurs. *le service de sante n'existe que dans 07 imprimeries. *toutes les imprimeries utilisent les memes produits : solvants; diluants; encres et siccatif. *une seule imprimerie a un programme de formation et d'information sur les risques professionnels. *18 imprimeries beneficient des prestations des organismes de prevention. Au ternie de ce travail nous formulons des suggestions relatives a une meilleure organisation de la prevention des risques dans cette profession. A partir de ce travail; d'autres etudes pourraient etre menees de facon specifique aux risques

Rat Leydig cells use apolipoprotein E depleted high density lipoprotein to regulate testosterone production.

Rat HDL are known to increase testosterone production by cultured Leydig cells either following gonadotropin stimulation or cholesteryl ester depletion. However, rat HDL contain apolipoprotein E and have a high affinity for the members of the low density receptor family such as LDL receptor, LDL receptor related protein and VLDL receptor. In contrast with the adrenal cells, the contribution of apo A-I and apo E pathways in HDL cholesterol uptake has not been yet evidenced in rat Leydig cells. Recent data provided evidence that hCG stimulates scavenger receptor BI expression in testes. In order to investigate if testosterone production can be stimulated by apo E depleted HDL, we compared the level of testosterone stimulation by HDL with or without apo E first, in presence of saturating dose of hCG (1 IU/ml) and second, after depletion of cholesterol synthesis by pravastatin, an inhibitor of HMG-CoA reductase. In presence of hCG, HDL with or without apo E increased testosterone production respectively by 37 and 25%. Pravastatin at 100 microg/ml inhibited the cholesterol synthesis and the testosterone production by 25% and decreased the cholesteryl content by 25%. The addition of HDL with or without apo E (50 microg protein HDL/ ml) completely overcame the depletion of cellular cholesteryl esters and the inhibition of testosterone production induced by pravastatin. In the presence of heparin, apo E depleted HDL overcame the testosterone production induced by pravastatin, indicating that uptake of HDL without apo E via a secretion of apo E by the cells themselves was not involved. Therefore, in absence of apo E, it is suggested that rat Leydig cells used HDL to regulate steroidogenesis via an apolipoprotein A-I pathway.

Evaluation of cholesteryl ester transfer in the seminiferous tubule cells of immature rats in vivo and in vitro.

Sertoli cells and germ cells are separated from the interstitial blood capillaries by an extracellular matrix and the peritubular cells, which constitute a barrier to the movement of plasma lipoproteins. The present study was undertaken to evaluate in vivo and in vitro the high density lipoprotein (HDL) cholesteryl ester transfer from plasma to seminiferous tubule cells in the testis of 30-day-old rats. Firstly, the transfer of HDL cholesteryl oleate from plasma to testicular compartments was evaluated and, secondly, the role of apolipoproteins A-I and E in the uptake of cholesteryl ester by Sertoli cells was investigated. At 2 h after the administration of HDL reconstituted with [3H]cholesteryl ester, dimyristoyl phosphatidylcholine and apolipoproteins, the tissue space in the interstitial cells (740 +/- 60 microliters g-1 cell protein) was fourfold higher than that in the seminiferous tubule cells (170 +/- 10 microliters g-1). Sertoli cells were isolated and incubated with [3H]cholesteryl ester HDL reconstituted with apolipoprotein A-I or E to evaluate the mechanisms of cholesteryl ester influx. At the same apolipoprotein concentration (50 micrograms apolipoprotein ml-1 medium), the uptake of [3H]cholesteryl oleate from phospholipid-apolipoprotein E vesicles was twofold higher than that with phospholipid-apolipoprotein A-I vesicles. The presence of heparin reduced the uptake of cholesteryl ester from apolipoprotein E vesicles but not with apolipoprotein A-I vesicles, indicating that uptake of apolipoprotein A-I vesicles via a secretion of apolipoprotein E by the cells themselves was not involved. These results demonstrate that plasma lipoprotein cholesterol is able to cross the testis lamina propria and that Sertoli cells take up cholesteryl ester for seminiferous tubule cell metabolism mainly via an apolipoprotein E pathway.

Etiologic study of genitourinary infections in women of childbearing age in Bobo-Dioulasso, Burkina Faso, 1992.

BACKGROUND AND OBJECTIVES: Genitourinary infections have a major impact on public health, especially in Africa. Relative distribution of the different pathogens is unknown in Bobo-Dioulasso. GOAL: To describe the etiology of genitourinary infections, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. STUDY DESIGN: Clinical and biologic diagnoses were performed on 223 women with genitourinary infections. RESULTS: Etiologies found were trichomoniasis (27.8%), chlamydia (26.9%), bacterial vaginosis (19.7%), candidiasis (16.6), and N. gonorrhoeae infection (10.9%). Human immune deficiency virus antibodies were present in 42% of the patients. Spectinomycin or ceftriaxone should be recommended for the treatment of gonorrhoeae in Bobo-Dioulasso. CONCLUSIONS: The prevalence of Chlamydia trachomatis is higher than that of N. gonorrhoeae in Bobo-Dioulasso. This should be taken into account in clinical management of sexually transmitted diseases in this setting.

PIP: Genitourinary infections have a major impact upon public health, especially in Africa. This paper describes findings from a study conducted to describe the etiology of such infections in Bobo-Dioulasso, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. The findings are based upon clinical and biologic diagnoses among 223 women with genitourinary infections. Study found the following etiologies: trichomoniasis in 27.8%, chlamydia in 26.9%, bacterial vaginosis in 19.7%, candidiasis in 16.6%, and Neisseria gonorrhoeae infection in 10.9%. HIV antibodies were present in 42% of patients. The authors recommend spectinomycin or ceftriaxone for the treatment of gonorrhea in Bobo-Dioulasso. Moreover, that the prevalence of Chlamydia trachomatis is higher than that of Neisseria gonorrhoeae should be taken into account when managing STDs in this setting.

Transfer of cholesterol between high density lipoproteins and cultured rat Sertoli cells.

In the testes, the Sertoli cells are separated from the blood capillaries by the basement membrane, thereby excluding the passage of low density lipoproteins (LDLs) but allowing the passage of high density lipoproteins (HDLs). The present study examines first the capacity of Sertoli cells to uptake cholesterol from HDL and secondly the role of apolipoproteins (apo) A-I and E in cholesterol flux between HDL and cultured rat Sertoli cells. In the presence of HDL in cultured medium, rat Sertoli cells accumulated few amounts of esterified cholesterol. Incubation of [14C] cholesterol-labelled Sertoli cells with [3H]cholesterol-labelled HDL showed that the amount of cholesterol influx slightly exceeded its efflux, thus resulting in a net uptake of cholesterol from HDL to rat Sertoli cells. The amount of HDL-cholesterol converted to steroids by Sertoli cells was about 32% of influx. Uptake of cholesterol by Sertoli cells was three times higher with phospholipid-apo A-I vesicles and seven times higher with phospholipid- apo E vesicles than that with phospholipid vesicles without apolipoprotein. Phospholipid- apo A-I vesicles promoted cholesterol efflux at the same rate as native HDL and twice as efficiently as phospholipid- apo E vesicles. Thus, this study shows that rat Sertoli cells have the capacity to take up HDL-cholesterol for membrane renewal and steroid production mainly by apo E dependent pathways.

Sexually transmitted diseases and human immunodeficiency virus infection among women with genital infections in Burkina Faso.

This study reports the prevalence of sexually transmitted diseases (STDs) among gynaecological outpatients presenting at the Bobo-Dioulasso Hospital (Burkina Faso) with genital infections and examines the factors associated with HIV infection in this population. Of 245 eligible non-pregnant women, 220 consented to participate in the study. Seventy-seven per cent had sexually transmitted infections. The most common were: Trichomonas vaginalis (28%), Chlamydia trachomatis (27%), bacterial vaginosis (20%), Candida albicans (17%), Neisseria gonorrhoeae (11%). The prevalence of HIV infection was 42% (95% c.i. 35.3, 48.3). Logistic regression analyses revealed Neisseria gonorrhoeae to be the only STD significantly associated with infection with HIV (P = 0.04). A sedimentation rate greater than or equal to 100 mm in the first hour was also associated with HIV infection (P < 0.001). Women consulting for genital infections constitute a high risk group for HIV infection and other STDs. Management of these women should focus on the early diagnosis and treatment of STDs.

PIP: During May-October 1992 in the gynecology and obstetrics department at the National Central Hospital Souro Sanou in Bobo-Dioulasso, Burkina Faso, physicians conducted a physical examination of and took vaginal smears from 220 nonpregnant women of reproductive age who consented to take part in this study and who had clinical signs of a genital infection. The researchers wanted to determine the prevalence of sexually transmitted diseases (STDs) and the factors associated with HIV infection. 77% had an STD. The most common STDs were Trichomonas vaginalis (28%) and Chlamydia trachomatis (27%). 42% were HIV positive. HIV-positive women were significantly more likely than HIV-negative women to be infected with Neisseria gonorrhoeae (30.4% vs. 24.2%; p = 0.03). Risk factors associated with HIV infection among women presenting with genital infections included young age (25.5 vs. 27.5 years; p = 0.03), low gravidity (2 vs. 2.7; p = 0.04), a higher sedimentation rate in the first hour (75.3 vs. 54; p 0.001), and a low hemoglobin level (11.7 vs. 12.2 g/dl; p = 0.01). These findings indicate that women with genital infections are a group at high risk of HIV and other STDs and a target population for preventive interventions. Physicians should focus on detection and treatment of STDs when they manage cases with genital infections, and they should give appropriate advice on the prevention of HIV to all women presenting with genital infections.