Tobacco use and associated risk factors in Burkina Faso: results from a population-based cross-sectional survey.

BACKGROUND: Tobacco is a leading preventable cause of non-communicable diseases (NCDs). Studies characterizing the prevalence of tobacco use in low-income countries are lacking. This study describes the prevalence of tobacco use in Burkina Faso and its associated factors. METHODS: Data from the 2013 Burkina Faso World Health Organization (WHO) Stepwise approach to Surveillance (STEPS) were analyzed. The prevalence of any tobacco product use, cigarette smoking, and other tobacco use was calculated. Logistic regression analyses identified factors associated with tobacco use. Overall, 4691 people were included in this analysis. RESULTS: The prevalence of any tobacco use was 19.8% (95% CI: 18.4-21.2). Tobacco use was higher for men (29.2% [27.0-31.5]) than women (11.8% [10.3-13.4]). The prevalence of smoked tobacco was 11.3% (10.3-12.4), with a significantly higher prevalence among men (24.5% [22.1-27.0]) than women (0.1% [0.01-0.3]). The overall prevalence of other tobacco use was 8.9% (7.4-10.7), with lower values for men (5.6% [4.1-7.2]) compared to women (11.7% [9.4-14.1]). Tobacco smoking among men was significantly associated with an increased age and alcohol consumption. The analysis of risk factors for other tobacco use stratified by gender showed that age, education, residence, and alcohol consumption were significantly associated with consumption for women, and age and alcohol consumption for men. CONCLUSION: Tobacco use is common in Burkina Faso. To effectively reduce tobacco use in Burkina Faso, a comprehensive tobacco control program should consider associated factors, such as gender, age, and alcohol consumption.

Emergency obstetric and neonatal care needs assessment: Results of the 2010 and 2014 surveys in Burkina Faso.

OBJECTIVE: To analyze and compare the availability, utilization, and quality of services for maternal and neonatal health in 2010 and 2014 in Burkina Faso. METHODS: A cross-sectional study of emergency obstetric and neonatal care services (EmONC) in all public and private health facilities in Burkina Faso in 2010 and a sample of 812 health facilities in 2014. The generic tools developed by the Averting Maternal Death and Disability (AMDD) program were used as the basic tools for evaluation. RESULTS: In 2010, 25 health facilities were considered as EmONC health facilities and there were 23 in 2014. In 2010 and 2014, the proportion of births in EmONC health facilities was low (4.5%). The cesarean delivery rate also remained very low, at 0.9% in 2010 and 1.13% in 2014. The proportion of obstetric complications supported in health facilities was 12.3% in 2010 and 17.1% in 2014. The direct complication case fatality rate in EmONC health facilities was 1.6% in 2010 and 1.3% in 2014. CONCLUSION: The two surveys did not show a significant improvement in the availability, utilization, and quality of maternal and neonatal healthcare services between 2010 and 2014.

Factors associated with fresh stillbirths: A hospital-based, matched, case-control study in Burkina Faso.

OBJECTIVE: To determine the risk factors for fresh stillbirths in hospitals in Burkina Faso. METHODS: A hospital-based, matched (1:1), case-control study was conducted from July to August 2014 in 50 hospitals across the country. All cases of stillbirth that occurred during this period in the participating facilities were included, and an appropriate control was selected for each case from the same health facility. Cases and controls were matched for gestational age. Conditional logistic regression with robust standard errors was used to compute both unadjusted and adjusted conditional odds ratios. RESULTS: Cases were 67% less likely to have been delivered by a midwife compared with a nonmidwife attendant (ACOR=0.33; 95% CI, 0.12-0.84; P=0.02). Use of a partograph to monitor labor lowered the odds of fresh stillbirth by 82% (ACOR=0.18; 95% CI, 0.05-0.61; P=0.006). Mothers who had been transferred from another health facility were five times more likely to experience a fresh stillbirth (ACOR=5.36; 95% CI, 2.02-14.23; P<0.001). CONCLUSION: Quality and timing of intrapartum obstetric care is key to preventing fresh stillbirths. Easy to implement and available interventions, such as use of a partograph for all laboring women and improving the referral system, have the potential to save the lives of many fetuses.

Examining the Correlates of Sexually Transmitted Infection Testing Among Men Who Have Sex With Men in Ouagadougou and Bobo-Dioulasso, Burkina Faso.

BACKGROUND: Men who have sex with men (MSM) are a population at risk for HIV acquisition and transmission and other sexually transmitted infections (STIs). In Burkina Faso, the prevalence of HIV among MSM is higher than that of other reproductive-aged adults. Early and frequent STI testing and treatment can help prevent HIV acquisition and transmission and may improve linkage to care. METHODS: A cross-sectional study used respondent-driven sampling of MSM in the urban centers of Ouagadougou and Bobo-Dioulasso, Burkina Faso, to complete a questionnaire and HIV and syphilis testing. The binary-dependent variable in these analyses was self-reported prior STI testing in the past 12 months. Independent variables included sociodemographic characteristics, sexual behaviors, and psychosocial factors, selected according to the modified social ecological model. Bivariate associations at the P<0.05 level were used to create a manual forward stepwise multivariable logistic regression. RESULTS: Seventy-six percent of participants (511/672) did not test for STIs in the last 12 months. Testing for STIs was associated with STI symptoms (odds ratio [OR], 2.56; 95% confidence interval [95% CI], 1.39-4.76) and independently associated with depressive symptoms (adjusted OR, 1.49; 95% CI, 1.01-2.20) and discussing HIV and STIs with main male partners (adjusted OR, 1.73; 95% CI, 1.23-1.76). CONCLUSIONS: These data suggest that periodic targeted STI screening for MSM in Burkina Faso may represent an important component of comprehensive HIV prevention programming. The relationship between depression and STI risks is well established, and these data further indicate that screening for depression may be warranted during these clinical encounters.

A delivery system of linezolid to enhance the MRSA osteomyelitis prognosis: in vivo experimental assessment.

Staphylococcus aureus, a major responsible microorganism of osteomyelitis, represents a challenge to treat because of the poor penetration of antibiotics in bone and increasing minimum inhibitory concentrations (MICs) to glycopeptides. The calcium-deficient apatites (CDA), closer to the biological components found in bone and other calcified tissues, have osteoconductive properties. So, to process severe osseous infections, CDA can be used to deliver in the infectious site antibiotics like linezolid. The acute experimental osteomyelitis due to methicillin-resistant Staphylococcus aureus (MRSA) was induced in rabbit's femurs and surgery mimicking human procedures was performed at day three after inoculation. Animals were randomly assigned to treatment groups: L((IV)) [4-day linezolid IV infusion, human-equivalent dose of 10 mg/kg/12 h], L((CDA50%)) (100 mg CDA with linezolid 500 µg/mg) and L((CDA50%)) + L((IV)). Surviving bacteria were counted in bone marrow (BM) and bone (Bo) at day 3 (before treatment), day 7 (4-day treatment) or day 17 (14-day treatment). L(iv) was effective after a 4-day treatment with a log(10)CFU/g decrease of -2.63 ± 1.92 and -2.17 ± 1.58 in bone marrow and bone, respectively. CDA loaded with linezolid enhance the efficacy of the IV linezolid regimen by more than one log(10)CFU/g.

In vitro characterisation of calcium phosphate biomaterials loaded with lidocaine hydrochloride and morphine hydrochloride.

Calcium phosphate substitutes drug delivery systems are well known substances used in minor bone void-filling to release their therapeutic agent in situ. Few studies associating anaesthetics and analgesics have been performed to date. The aim of this work was to study the association of the analgesic, morphine, and the local anaesthetic, lidocaine, with a calcium deficient apatite matrix. Three types of biomaterials i.e. powders, granules and blocks, were prepared by isostatic compression, wet granulation and a combination of the two, evaluated and compared. The chemical structure of the associated therapeutic agent was studied and the characteristics of the drug delivery systems were appraised in terms of drug release. The integrity of the lidocaine hydrochloride structure, as determined by RMN (1)H, was confirmed regardless of the formulation technique used (isostatic compression or wet granulation). However, analyses of morphine hydrochloride by RMN (1)H revealed slight structural modifications. The association and formulation techniques that were used made it possible to obtain an in vitro release time varying from 1 to 4 days for lidocaine hydrochloride and from 1 to 3 days for morphine hydrochloride.

In vivo assessment of the antimicrobial activity of a calcium-deficient apatite vancomycin drug delivery system in a methicillin-resistant Staphylococcus aureus rabbit osteomyelitis experimental model.

The antimicrobial activities of calcium-deficient apatite loaded with different concentrations (25, 100, and 500 microg/mg) of vancomycin as a filling biomaterial were evaluated in a methicillin-resistant Staphylococcus aureus (MRSA) rabbit acute osteomyelitis model. Bacterial counts in bone, bone marrow, and joint fluid samples treated with forms of the apatite were compared to those in tissue samples receiving a constant intravenous vancomycin infusion after 4 days. This study demonstrates that using a calcium-deficient apatite loaded with vancomycin dramatically decreases the bacterial counts in bone and marrow.

Biphasic calcium phosphate: a comparative study of interconnected porosity in two ceramics.

Interconnection, one of the main structural features of macroporous calcium-phosphate ceramics, contributes to the biological and physicochemical properties of bone substitutes. As no satisfactory method exists for evaluating this feature, analysis was performed to determine the permeability, tortuosity, and equivalent diameter of interconnecting channels, that is the parameters that appear to be representative of the way pores are linked. The testing of two ceramics with similar porosity levels revealed important differences in all three interconnection parameters. One ceramic showed poor permeability, corresponding to a small equivalent diameter for interconnecting channels in conjunction with a high tortuosity factor, while the other displayed high permeability, a large diameter for interconnecting channels, and a low tortuosity factor. The methodology used, which can be applied to the quantification of interconnection in all calcium-phosphate ceramics, constitutes the first step in a complete study of the role of this feature in cellular colonization of the ceramic, matrix dissolution, and drug release from the calcium-phosphate matrix.

Intensified dose of cyclophosphamide with G-CSF support versus standard dose combined with platinum in first-line treatment of advanced ovarian cancer a randomised study from the GINECO group.

ICON3 trial results have suggested that CAP and carboplatin-taxol regimens as first-line treatment of advanced ovarian cancer (AOC) yield similar survival. We explored the impact of increased dose of cyclophosphamide in a modified CAP regimen on the disease-free survival (DFS) and overall survival (OS) of AOC patients. From February 1994 to June 1997, 164 patients were randomised to receive six cycles every 3 weeks of either standard CEP (S) combining cyclophosphamide (C), 500 mg m(-2), epirubicin (E) 50 mg m(-2), and cisplatin (P) 75 mg m(-2) or intensive CEP (I) with E and P at the same doses, but with (C) 1800 mg m(-2) and filgrastim 5 mug kg(-1) per day x 10 days. Response was evaluated at second-look surgery. Patient characteristics were well balanced. Except for grade 3-4 neutropaenia (S: 54%, I: 38% of cycles), Arm1 presented a significantly more important toxicity: infection requiring antibiotics, grade 3-4 thrombocytopaenia, anaemia, nausea-vomiting, diarrhoea, mucositis. Median follow-up was 84 months. DFS (15.9 vs 14.8 months) and OS (33 vs 30 months) were not significantly different between S and I (P>0.05). Increasing cyclophosphamide dose by more than 3 times with filgrastim support in the modified CAP regimen CEP induces more toxicity but not better efficacy in AOC.

Towards a virtual fruit focusing on quality: modelling features and potential uses.

The fruit is a hierarchically organized organ composed of cells from different tissues. Its quality, defined by traits such as fruit size and composition, is the result of a complex chain of biological processes. These processes involve exchanges (transpiration, respiration, photosynthesis, phloem and xylem fluxes, and ethylene emission) between the fruit and its environment (atmosphere or plant), tissue differentiation, and cell functioning (division, endoreduplication, expansion, metabolic transformations, and vacuolar storage). In order to progress in our understanding of quality development, it is necessary to analyse the fruit as a system, in which processes interact. In this case, a process-based modelling approach is particularly powerful. Such a modelling approach is proposed to develop a future 'virtual fruit' model. The value of a virtual fruit for agronomists and geneticists is also discussed.

Developing a free supportive care program for cancer patients within an integrative medicine clinic.

The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.

Compactibility study of calcium phosphate biomaterials.

This study investigated the micromechanism responsible for the densification and consolidation of powders during dynamic compaction, an experimental process in which ceramic is formed without heating. Three calcium-deficient apatites (CDA: two powders and a fibrous compound) and a biphasic calcium phosphate (BCP) were studied to determine their aptitude (rheological and physical properties) for compactibility under various dynamic compaction pressures. Powders were investigated for their physicochemistry, particle size, and flow time, and compacts for their compaction rate, density, specific area, mechanical characteristics, and disintegration time. Powder particles showed different morphological features depending on the synthesis protocol used, specific area and rheological behaviour. Compacts were not obtained with BCP, regardless of the gas pressure used, whereas CDA produced compacts with good mechanical properties (high hardness and compression stress), particularly for the fibrous compound. The poor compressibility and compactibility of BCP powders were confirmed, whereas fibrous CDA powders showed good compactibility conducive to high-quality filling of biomaterials.

Association of vancomycin and calcium phosphate by dynamic compaction: in vitro characterization and microbiological activity.

Dynamic compaction has rarely been used to produce drug-delivery devices in granule form. This report considered four processes associating vancomycin and compared dynamic compaction with wet granulation, a classical method. In the wet granulation study, vancomycin was associated with biphasic calcium-phosphate (BCP) granules either by adsorption or incorporation with a new granulation. In the dynamic compaction study, BCP powder was compacted at 1.1, 1.5 and 1.9 MPa. The compacts obtained were crushed and sieved (200-500 microm), and the vancomycin solution was adsorbed on the resulting granules. After crushing and sieving, the compaction of BCP and vancomycin powders produced vancomycin-loaded granules. In each study, 4.76% of vancomycin was associated with BCP. Granules were characterized in terms of porosity, vancomycin release and vancomycin biological activity. Physicochemical studies of BCP and vancomycin showed their structural integrity after dynamic compaction, which prolonged vancomycin release time from 1 to 6 days. However, a microbiological assay indicated that vancomycin had been altered since only 27.7% was found to be active.

NO and the hypometabolic and hypothermic responses to hypoxia in the rat.

Nitric oxide (NO) has been identified as a possible mediator of the thermoregulatory and respiratory responses to hypoxia. The present study was designed to assess the effects of an NO donor (S-nitroso-N-acetylpenicillamine, SNAP) injected systemically (0.5-2.0 mg/kg) in unanesthetized adult rats studied at ambient temperatures (Ta) of 26, 24, and 15 degrees C. The metabolic rate (VO2), ventilation (V), and colonic temperature (Tc) were recorded while the animals were exposed to normoxia or to hypoxia (FI(O2)=0.11). During normoxia, at all values of Ta, SNAP increased VO2 and V and the decrease in Tc observed following saline injection was prevented or attenuated. However, SNAP did not modify the hypometabolic, hypothermic, and hyperventilatory responses to hypoxia. We concluded that, confirming previous studies, NO may play a role in the control of VO2 and V in normoxia. The failure to observe any effect following the systemic NO donor injection during hypoxia may indicate opposing actions of the drug at different sites resulting in no net changes in ventilatory and metabolic responses to hypoxia.

Vitamin B intake and status in healthy Havanan men, 2 years after the Cuban neuropathy epidemic.

A prospective epidemiological study was carried out over 1 year to evaluate vitamin B complex dietary intake and status in Cuba, 2 years after the Cuban neuropathy epidemic of 1993. Of the 199 healthy middle-aged men selected, 141 completed the study. Volunteers were followed up every 3 months for 1 year. Dietary intake and status of thiamin, riboflavin, vitamin B6, folate and vitamin B12 were assessed each time. The dietary intake of vitamin B complex was low, particularly in June and July (folate), and October (thiamin). A deficient status was observed for vitamin B complex, except for vitamin B6. Vitamin B complex intake and status varied over the year. However, dietary intake and status were poorly related. The results prove that healthy Cuban men represent a vulnerable population in terms of vitamin B complex status and stress the necessity to both promote preventive multivitamin supplementation and produce local food rich in vitamin B complex.

Intracellular pH determination of pristinamycin-producing Streptomyces pristinaespiralis by image analysis.

Intracellular pH (pH(i)) is an essential parameter in the regulation of intracellular processes. Thus, its measurement might provide clues regarding the physiological state of cells cultivated in vitro. pH(i) of the filamentous, pristinamycin-producing Streptomyces pristinaespiralis was determined by epifluorescence microscopy and image analysis using the pH-sensitive fluorescent probe BCECF-AM [2', 7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein, acetoxymethyl ester]. Staining cell culture samples (OD(660)=1) of S. pristinaespiralis with 20 microM BCECF at 28 degrees C for 30 min yielded a green/red fluorescence ratio (R:(527/600)) that correlated with the pH(i) of the cells for values ranging from 6.5 to 8.5. When S. pristinaespiralis was cultivated in pristinamycin-producing conditions (in batch mode, with a constant external pH of 6.8), the measured pH(i) varied between 6.3 and 8.7. In fact, pH(i) correlated with the excretion of pristinamycins and glucose consumption during the production process.

Influence of isostatic compression on the stability of vancomycin loaded with a calcium phosphate-implantable drug delivery device.

It is essential to prevent microbial infections after osteoarticular trauma or prosthesis implantation. As an alternative to antibiotic parenteral administration, antibiotic-loaded biomaterials allow high concentrations to be obtained in situ without systemic toxicity. Although the formulation of biphasic calcium-phosphate (BCP)-vancomycin granules by isostatic compression has recently been used to produce drug-delivery devices, the stability of vancomycin needs to be proven. In this study, vancomycin was associated with BCP powders by isostatic compression at 100, 140, or 200 MPa and then extracted or released by a rotating paddle system for 24 h. Vancomycin assays were performed by spectrophotometric and microbiological methods. The results show that all vancomycin associated with the material was recovered after extraction without degradation. Thus, vancomycin was not denaturated after application of 100, 140, or 200 MPa of isostatic compression. The results for vancomycin released from granules compressed at the three pressures were not significantly different (p =.01) whether assays were performed microbiologically or spectrophotometrically, indicating a good correlation between the two methods. This process involving high pressure appears to be a good means of developing drug delivery devices loaded with therapeutic agents without denaturating the components.

Body temperature regulation in the rat.

In loosely-restrained adult conscious rats exposed to stepwise changes in ambient temperature (T(a)) from 25 to 5 degrees C or from 20 to 35 degrees C, we have recorded body and tail temperatures, metabolic rate (VO(2)), shivering and ventilation (V). It was found that VO(2) and V vary with T(a) and show a nadir for a T(a) of 30 degrees C whereas shivering starts at 20 degrees C and increases progressively with cold exposure. T(tail) follows changes in T(a) whereas T(body) decreases slightly in cold and increases markedly in warm exposure. These results suggest that the control of T(body) interacts with the control of breathing in order to increase VO(2) during cold exposure and to facilitate evaporative respiratory heat dissipation during warm exposure.

Isostatic compression, a new process for incorporating vancomycin into biphasic calcium phosphate: comparison with a classical method.

Isostatic compression has rarely been used to load calcium-phosphate biomaterials with therapeutic agents. This report, concerning four processes associating vancomycin, compares isostatic compression with wet granulation, a classical method. In the wet granulation study, vancomycin was associated with biphasic calcium-phosphate (BCP) granules either by adsorption or incorporation with a new granulation. In the isostatic compression study, BCP powder was compressed at 100, 140 and 200 MPa. The blocks obtained were crushed and 200-500 microm, sieved; thus, the vancomycin solution was absorbed on these granules. Compaction of BCP and vancomycin powders gave, after crushing and sieving, granules loaded with vancomycin. In each study, 5% vancomycin was associated with BCP. Vancomycin release profiles were assessed by an in vitro culture chamber dissolution test. Physicochemical studies of BCP and vancomycin showed their structural integrity after isostatic compression. Isostatic compression prolonged vancomycin release time from 3 to 7 days and the release time became greater as isostatic pressure increased, probably because of the porosity decrease of the granules during compression.

Role of nitric oxide in hypoxic hypometabolism in rats.

Because it has been recently suggested that nitric oxide (NO) may mediate the effects of hypoxia on body temperature and ventilation, the present study was designed to assess more completely the effects of a neuronal NO synthase inhibitor (7-nitroindazole, 25 mg/kg ip), at ambient temperature of 26 and 15 degrees C, on the ventilatory (V), metabolic (O(2) consumption), and thermal changes (colonic and tail temperatures) induced by ambient hypoxia (fractional inspired O(2) of 11%) or CO hypoxia (fractional inspired CO of 0.07%) in intact, unanesthetized adult rats. At both ambient temperatures, 7-nitroindazole decreased oxygen consumption, colonic temperature, and V in normoxia. The drug reduced ambient or CO hypoxia-induced hypometabolism and ventilatory response, but the hypothermia persisted. It is concluded that NO arising from neural NO synthase plays an important role in the control of metabolism and V in normoxia. As well, it mediates, in part, the hypometabolic and the ventilatory response to hypoxia. The results are consistent with the notion that central nervous system hypoxia resets the thermoregulatory set point by decreasing brain NO.