Disease course and treatment outcomes of Crohn's disease patients with early or late surgery - A Danish nationwide cohort study from 1997 to 2015.

BACKGROUND: Studies on early surgery among Crohn's disease patients are few and focus on ileocolonic resections. AIM: The aim of this nationwide cohort study was to investigate the disease course in all Crohn's disease patients who underwent early and late major abdominal surgery. METHODS: In a Danish nationwide cohort of Crohn's disease patients from 1997 to 2015 we included 493 patients (group 1) resected within 29 days, 472 patients (group 2) resected between 30 and 180 days, and 1,518 patients (group 3) resected after 180 days of diagnosis. Re-operation, hospitalisations and medications were analysed. RESULTS: The cumulative risk of re-operation was lower among patients from group 1 (five-year risk: 16.5% vs. group 2: 18.2% and group 3: 21.2%, p = 0.004). Fewer patients from group 2 and 3 required hospitalisations (269 (56.5%) and 803 (52.8%) vs. group 1: 329 (66.8%) p<0.001). Patients from group 3 had a higher cumulative use of immunomodulators in the first three years after initial surgery (one-year risk: 24.6% vs. group 1: 19.4% and group 2: 17.0%, p<0.001). CONCLUSION: Crohn's disease patients resected within 29 days of diagnosis had a lower cumulative risk of re-operation and a lower cumulative exposure to immunomodulators in the initial years after surgery.

Impact de la pandémie de COVID-19 sur le suivi des maladies systémiques: enquête transversale multicentrique à Dakar / How the outbreak of COVID-19 did affected the follow-up of patients known for an autoimmune or autoinflammatory systemic diseases in Dakar

Introduction : La pandémie de covid-19 a eu un impact sur les systèmes de santé, entravant la prise en charge optimale des maladies chroniques. L'objectif de notre étude était d'évaluer son impact sur le suivi des pathologies systémiques. Patients - Méthodes : Nous avons mené une enquête transversale multicentrique dans les services de Médecine Interne, de Rhumatologie et de Néphrologie à Dakar. Les patients étaient inclus en accord avec les critères de consensus internationaux. L'enquête a porté sur les dossiers concernant 13 questions et a été complétée par un entretien téléphonique avec 38 questions potentielles. Les réponses étaient collectées grâce à une application Web puis exportées et analysées avec le logiciel SPSS 26.0. Résultats : Du 1er Août au 31 Octobre 2021, 131 patients ont été inclus avec un âge moyen de 41,5 ans (+/-12,4) et un sex-ratio de 0,08. Les pathologies inflammatoires étaient dominées par la polyarthrite rhumatoïde (47,3%) et le lupus systémique (22,9%). Les patients ont rapporté avoir raté un ou plusieurs rendez-vous de suivi dans 45% des cas. Les motifs étaient dominés par une difficulté d'obtenir un rendez-vous de suivi (18,6%) et la peur de fréquenter les hôpitaux (16,9%). Une rupture médicamenteuse a été notée dans 33,6% des cas et concernait notamment l'hydroxychloroquine (40,9%) ou le méthotrexate (47,7%) avec comme raison principale les ruptures de stock en pharmacie et les difficultés économiques. Une poussée de la maladie systémique a été rapportée dans 31% des cas corrélée à la rupture médicamenteuse. Onze (11) patients ont présenté une infection confirmée à SARS CoV-2. Conclusion : La pandémie de covid-19 a eu un impact non négligeable sur le suivi des patients atteints de maladies inflammatoires systémiques. Elle a mis en exergue l'intérêt de la réorganisation de la prise en charge de ces patients en période de crise sanitaire, l'éducation thérapeutique des patients et le recours à la télémédecine pour assurer la continuité des soins.

Introduction: The covid-19 pandemic has had an impact on health systems, compromising the optimal management of chronic diseases such as systemic autoimmune and autoinflammatory diseases. The aim of our study was to assess its impact on the follow-up of systemic diseases in Dakar. Patients - Methods: We conducted a multicentre cross-sectional survey in the departments of Internal Medicine, Rheumatology and Nephrology in Dakar. Patients were included in accordance with international consensus criteria. The survey was based on records of 13 questions and was completed by a telephone interview with 38 potential questions. Responses were collected using a web-based application and then exported and analyzed using SPSS 26.0 software. Results: From 1 August to 31 October, 131 patients were included with a mean age of 41.5 years (+/-12.4) and a sex-ratio of 0.08. Inflammatory diseases were dominated by rheumatoid arthritis (47.3%) and systemic lupus erythematosus (22.9%). Patients reported missing one or more follow-up appointments in 45% of the cases. The reasons were dominated by difficulty in obtaining a follow-up appointment (18.6%) and fear of attending hospitals (16.9%). A drug shortage was also reported in 33.6% of the cases and concerned in particular hydroxychloroquine (40.9%) or methotrexate (47.7%), with the main reason being stock shortages in pharmacies and economic difficulties. A flare-up of the systemic disease was reported in 31% of the cases correlated with the drug rupture. Only 11 patients had a confirmed SARS CoV-2 infection. Conclusion: The covid-19 pandemic has had a significant impact on the follow-up of patients with systemic inflammatory diseases. It highlighted the interest of reorganizing the follow-up of these patients during a health crisis, the patient education and the use of telemedicine to ensure continuity of care

Infant sugar sweetened beverage and 100% juice consumption: Racial/ethnic differences and links with fathers' consumption in a longitudinal cohort.

The consumption of sugar-sweetened beverages (SSB) and 100% juice before age 12 months is discouraged. We examine racial/ethnic differences in SSB and 100% juice consumption when infants were 6- and 12-months old and examine links between fathers' and infants' beverage consumption. Participants were from a longitudinal cohort of infants and their parents (recruited 2016-2018), followed from birth until the child was 24 months. In 2020, we analyzed data collected when infants were 6- (N = 352 infants and 168 fathers) and 12-months (N = 340 infants and 152 fathers) old. Based on maternal report, 13% of infants consumed 100% juice at 6 months and 31% at 12 months. Two percent of infants consumed SSB at 6 months and 7% at 12 months. In models adjusting for income and education, Black/African American (Black/AA) and Hispanic infants were 5-6 times as likely at 6 months and 3 times as likely at 12 months to consume 100% juice compared with non-Hispanic white and Asian infants. At 12 months, Black/AA and Hispanic infants were 6-7 times as likely to consume SSB than non-Hispanic white and Asian infants after adjusting for covariates. In unadjusted models, infants were more likely to consume 100% juice and SSB at 12 months when their fathers were high consumers (>12times/month) of the beverage; effects were no longer significant after adjusting for income, race/ethnicity, education and maternal beverage consumption. Results highlight the need to implement culturally responsive interventions promoting healthy beverage consumption in infants prior to birth and should concurrently target fathers, in addition to mothers.

Comprehensive comparison between 222 CTLA-4 haploinsufficiency and 212 LRBA deficiency patients: a systematic review.

Cytotoxic T lymphocyte antigen 4 (CTLA-4) haploinsufficiency (CHAI) and lipopolysaccharide-responsive beige-like anchor (LRBA) deficiency (LATAIE) are newly identified inborn errors of immunity with shared molecular pathomechanisms and clinical manifestations. In this review, we aimed to provide differential comparisons regarding demographic, clinical, immunological and molecular characteristics between these two similar conditions. A literature search was conducted in PubMed, Web of Science and Scopus databases and included studies were systematically evaluated. Overall, 434 (222 CHAI and 212 LATAIE) patients were found in 101 eligible studies. The CHAI patients were mainly reported from North America and western Europe, while LATAIE patients were predominantly from Asian countries. In CHAI, positive familial history (P < 0·001) and in LATAIE, consanguineous parents (P < 0·001) were more common. In CHAI patients the rates of granulomas (P < 0·001), malignancies (P = 0·001), atopy (P = 0·001), cutaneous disorders (P < 0·001) and neurological (P = 0·002) disorders were higher, while LATAIE patients were more commonly complicated with life-threatening infections (P = 0·002), pneumonia (P = 0·006), ear, nose and throat disorders (P < 0·001), organomegaly (P = 0·023), autoimmune enteropathy (P = 0·038) and growth failure (P < 0·001). Normal lymphocyte subsets and immunoglobulins except low serum levels of CD9+ B cells (14·0 versus 38·4%, P < 0·001), natural killer (NK) cells (21 versus 41·1%, P < 0·001), immunoglobulin (Ig)G (46·9 versus 41·1%, P = 0·291) and IgA (54·5 versus 44·7%, P = 0·076) were found in the majority of CHAI and LATAIE patients, respectively. The most frequent biological immunosuppressive agents prescribed for CHAI and LATAIE patients were rituximab and abatacept, respectively. Further investigations into the best conditioning and treatment regimens pre- and post-transplantation are required to improve the survival rate of transplanted CHAI and LATAIE patients.

Local excision for T1 rectal tumours: are we getting better?

AIM: The objective was to assess the effect of three different surgical treatments for T1 rectal tumours, radical resection (RR), open local excision (open LE) and laparoscopic local excision (laparoscopic LE), on overall survival (OS). METHODS: Adults from the National Cancer Database (2008-2016) with a diagnosis of T1 rectal cancer were stratified by treatment type (LE vs RR). We assumed that laparoscopic LE equates to transanal minimally invasive surgery (TAMIS) or transanal endoscopic microsurgery. The primary outcome was 5-year OS. Subgroup analyses of the LE group stratified by time period [2008-2010 (before TAMIS) vs 2011-2016 (after TAMIS)] and approach (laparoscopic vs open) were performed. RESULTS: Among 10 053 patients, 6623 (65.88%) underwent LE (74.33% laparoscopic LE vs 25.67% open LE) and 3430 (34.12%) RR. The use of LE increased from 52.69% in 2008 to 69.47% in 2016, whereas RR decreased (P < 0.001). In unadjusted analysis, there was no significant difference in 5-year OS between the LE and RR groups (P = 0.639) and between the two LE time periods (P = 0.509), which was consistent with the adjusted analysis (LE vs RR, hazard ratio 1.05, 95% CI 0.92-1.20, P = 0.468; 2008-2010 LE vs 2011-2016 LE, hazard ratio 1.09, 95% CI 0.92-1.29, P = 0.321). Laparoscopic LE was associated with improved OS in the unadjusted analysis only (P = 0.006), compared to the open LE group (hazard ratio 0.94, 95% CI 0.78-1.12, P = 0.495). CONCLUSIONS: This study supports the use of a LE approach for T1 rectal tumours as a strategy to reduce surgical morbidity without compromising survival.

OCTANE (Ontario-wide Cancer Targeted Nucleic Acid Evaluation): a platform for intraprovincial, national, and international clinical data-sharing.

Cancer is a genetic disease resulting from germline or somatic genetic aberrations. Rapid progress in the field of genomics in recent years is allowing for increased characterization and understanding of the various forms of the disease. The Ontario-wide Cancer Targeted Nucleic Acid Evaluation (octane) clinical trial, open at cancer centres across Ontario, aims to increase access to genomic sequencing of tumours and to facilitate the collection of clinical data related to enrolled patients and their clinical outcomes. The study is designed to assess the clinical utility of next-generation sequencing (ngs) in cancer patient care, including enhancement of treatment options available to patients. A core aim of the study is to encourage collaboration between cancer hospitals within Ontario while also increasing international collaboration in terms of sharing the newly generated data. The single-payer provincial health care system in Ontario provides a unique opportunity to develop a province-wide registry of ngs testing and a repository of genomically characterized, clinically annotated samples. It also provides an important opportunity to use province-wide real-world data to evaluate outcomes and the cost of ngs for patients with advanced cancer. The octane study is attempting to translate knowledge to help deliver precision oncology in a Canadian environment. In this article, we discuss the background to the study and its implementation, current status, and future directions.

A Canadian guideline on the use of next-generation sequencing in oncology.

Rapid advancements in next-generation sequencing (ngs) technology have created an unprecedented opportunity to decipher the molecular profile of tumours to more effectively prevent, diagnose, and treat cancer. Oncologists now have the option to order molecular tests that can guide treatment decisions. However, to date, most oncologists have received limited training in genomics, and they are now faced with the challenge of understanding how such tests and their interpretation align with patient management. Guidance on how to effectively use ngs technology is therefore needed to aid oncologists in applying the results of genomic tests. The Canadian guideline presented here describes best practices and unmet needs related to ngs-based testing for somatic variants in oncology, including clinical application, assay and sample selection, bioinformatics and interpretation of reports performed by laboratories, patient communication, and clinical trials.

Inter-laboratory proficiency testing scheme for tumour next-generation sequencing in Ontario: a pilot study.

Background: A pilot inter-laboratory proficiency scheme for 5 Ontario clinical laboratories testing tumour samples for the Ontario-wide Cancer Targeted Nucleic Acid Evaluation (octane) study was undertaken to assess proficiency in the identification and reporting of next-generation sequencing (ngs) test results in solid tumour testing from archival formalin-fixed, paraffin-embedded (ffpe) tissue. Methods: One laboratory served as the reference centre and provided samples to 4 participating laboratories. An analyte-based approach was applied: each participating laboratory received 10 ffpe tissue specimens profiled at the reference centre, with tumour site and histology provided. Laboratories performed testing per their standard ngs tumour test protocols. Items returned for assessment included genes and variants that would be typically reported in routine clinical testing and variant call format (vcf) files to allow for assessment of ngs technical quality. Results: Two main aspects were assessed:■ Technical quality and accuracy of identification of exonic variants■ Site-specific reporting practicesTechnical assessment included evaluation of exonic variant identification, quality assessment of the vcf files to evaluate base calling, variant allele frequency, and depth of coverage for all exonic variants. Concordance at 100% was observed from all sites in the technical identification of 98 exonic variants across the 10 cases. Variability between laboratories in the choice of variants considered clinically reportable was significant. Of the 38 variants reported as clinically relevant by at least 1 site, only 3 variants were concordantly reported by all participating centres as clinically relevant. Conclusions: Although excellent technical concordance for ngs tumour profiling was observed across participating institutions, differences in the reporting of clinically relevant variants were observed, highlighting reporting as a gap where consensus on the part of Ontario laboratories is needed.

[Vulvovaginal candidiasis in pregnant women in the Mère et Enfant Hospital center in Nouakchott, Mauritania]. / Candidoses vulvo-vaginales chez les femmes enceintes au centre hospitalier Mère et Enfant de Nouakchott (Mauritanie).

AIM: To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania. PATIENTS AND METHOD: The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media. RESULTS: Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy. CONCLUSION: This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.

Changes in Disease Behaviour and Location in Patients With Crohn's Disease After Seven Years of Follow-Up: A Danish Population-based Inception Cohort.

BACKGROUND AND AIM: Crohn's disease [CD] is a progressive inflammatory bowel disease that can lead to complications such as strictures or penetrating disease, and ultimately surgery. Few population-based studies have investigated the predictors for disease progression and surgery in CD according to the Montreal classification. We aimed to identify clinical predictors associated with complicated CD in a Danish population-based inception cohort during the biologic era. METHODS: All incident patients with CD in a well-defined Copenhagen area, between 2003 and 2004, were followed prospectively until 2011. Disease progression was defined as the development of bowel stricture [B2] or penetrating disease [B3] in patients initially diagnosed with non-stricturing/non-penetrating disease [B1]. Associations between disease progression and/or resection, and multiple covariates, were investigated by Cox regression analyses. RESULTS: In total, 213 CD patients were followed. A total of 177 [83%] patients had B1 at diagnosis. Patients who changed location had increased risk of disease progression (hazard ratio [HR] = 3.1, 95% CI: 1.12,8.52). Biologic treatment was associated with lower risk of change in location [HR = 0.3, 95% CI: 0.1-0.7]. Colonic involvement [L2 or L3 vs L1] was associated with a lower risk of surgery (HR = 0.34/0.22, 95% CI: [0.13,0.86]/[0.08,0.60]). All CD patients who progressed in behaviour or changed location had an increased risk of surgery [p < 0.05]. CONCLUSIONS: This population-based inception cohort study demonstrates that changes in disease location or behaviour in patients with CD increase their risk of resection. Our findings highlight the protective effect of biologic treatment with regard to change in disease location, which might ultimately improve the disease course for CD patients.

Systematic review and meta-analysis: assessment of factors affecting disability in inflammatory bowel disease and the reliability of the inflammatory bowel disease disability index.

BACKGROUND: The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). AIM: To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. METHOD: Systematic review of cross-sectional studies. Patients included had UC or CD and were classified as active, in remission, or needing surgery, biological and/or steroid treatment. We included studies assessing disability using the IBD-DI and that were captured by electronic and manual searches (January 2017). The possibility of bias was evaluated with the Newcastle-Ottawa Scale. RESULTS: Nine studies were included with 3167 patients. Comparatively, patients with active disease had higher disability rates than those in remission (SMD [CI95] = 1.49[1.11, 1.88], I2  = 94%, P<.01), while patients on biological treatment had lower disability rates than those receiving corticosteroid treatment (SMD [CI95] = -0.22[-0.36, -0.08], I2  = 0%, P<.01). Disease activity and unemployment were found to be associated factors. The IBD-DI scored "good" for internal consistency, "fair" to "excellent" for intra-rater reliability and "excellent" for inter-rater reliability. Construct validity was "moderately strong" to "very strong" and structural validity was found to be mainly unidimensional. The IBD-DI had excellent responsiveness, while its interpretability was only useful on a group level. CONCLUSIONS: This systematic review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability.

Predicting Outcome in Subarachnoid Hemorrhage (SAH) Utilizing the Full Outline of UnResponsiveness (FOUR) Score.

BACKGROUND: Existing scoring systems for aneurysmal subarachnoid hemorrhage (SAH) patients fail to accurately predict patient outcome. Our goal was to prospectively study the Full Outline of UnResponsiveness (FOUR) score as applied to newly admitted aneurysmal SAH patients. METHODS: All adult patients presenting to Health Sciences Center in Winnipeg from January 2013 to July 2015 (2.5 year period) with aneurysmal SAH were prospectively enrolled in this study. All patients were followed up to 6 months. FOUR score was calculated upon admission, with repeat calculation at 7 and 14 days. The primary outcomes were: mortality, as well as dichotomized 1- and 6-month Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) values. RESULTS: Sixty-four patients were included, with a mean age of 54.2 years (range 26-85 years). The mean FOUR score upon admission pre- and post-external ventricular drain (EVD) was 10.3 (range 0-16) and 11.1 (range 3-16), respectively. There was a statistically significant association between pre-EVD FOUR score (total, eye, respiratory and motor sub-scores) with mortality, 1-month GOS, and 6-month GOS/mRS (p < 0.05 in all). The day 7 total, eye, respiratory, and motor FOUR scores were associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS (p < 0.05 in all). The day 14 total, eye, respiratory, and motor FOUR scores were associated with 6-month GOS (p < 0.05 in all). The day 7 cumulative FOUR score was associated with the development of clinical vasospasm (p < 0.05). CONCLUSIONS: The FOUR score at admission and day 7 post-SAH is associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS. The FOUR score at day 14 post-SAH is associated with 6-month GOS. The brainstem sub-score was not associated with 1- or 6-month primary outcomes.

[Evaluation of malaria rapid diagnostic test Optimal-IT® pLDH along the Plasmodium falciparum distribution limit in Mauritania]. / Evaluation du test de diagnostic rapide du paludisme OptiMal-IT® pLDH à la limite de la distribution de Plasmodium falciparum en Mauritanie.

Performance of the malaria Rapid Diagnostic Test (RDT) OptiMal-IT® was evaluated in Mauritania where malaria is low and dependent on a short transmission season. Slide microscopy was considered as the reference method of diagnosis. Febrile patients with suspected malaria were recruited from six health facilities, 3 urban and 3 rural, during two periods (December 2011 to February 2012, and August 2012 to March 2013). Overall, 780 patients were sampled, with RDT and thick blood film microscopy results being obtained for 759 of them. Out of 774 slides examined, of which 200 were positive, P. falciparum and P. vivax mono-infections were detected in 63.5% (127) and 29.5% (59), while P. falciparum/P. vivax coinfections were detected in 7% (14). Both species were observed in all study sites, although in significantly different proportions. The proportions of thick blood film and OptiMal-IT® RDT positive individuals was 26.3% and 30.3% respectively. Sensitivity and specificity of OptiMal-IT® RDT were 89% [95% CI, 84.7-93.3] and 91.1% [88.6-93.4]. Positives and negative predictive values were 78.1% [72.2-83.7] and 95.9% [94.1-97.5]. These diagnostic values are similar to those generally reported elsewhere, and support the use of RDTs as the main diagnostic tool for malaria in Mauritanian health facilities. In the future, choice of RDTs to be used must take account of thermostability in a hot, dry environment and their ability to detect P. falciparum and P. vivax.

Efficacy of sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in southern Mauritania.

BACKGROUND: Until 2006, the Mauritanian Ministry of Health recommended chloroquine and sulfadoxine-pyrimethamine for first- and second-line treatment of uncomplicated malaria, respectively. This study assessed the clinical efficacy of sulfadoxine-pyrimethamine in Kobeni as first-line treatment. MATERIALS AND METHODS: This study included 55 patients with Plasmodium falciparum infections, who were treated with sulfadoxine-pyrimethamine and followed up for 28 days. Isolates were genotyped to distinguish between recrudescence and reinfection. Treatment success rates and survival were analysed per protocol to evaluate drug efficacy. RESULTS: After inclusion, 2 patients were excluded for protocol violations, and 3 patients were lost to follow-up. Of the remaining 50 patients (per protocol population), 43 (86%) had adequate clinical and parasitological responses. Of the 7 patients with treatment failure, 5 (10%) were early failures, while 2 (4%) had initially responded and had late clinical failure on day 7, associated with recrudescence. With the exception of one adult weighing 91 kg, all treatment failures occurred in children aged from 7 to 12 years. CONCLUSIONS: Sulfadoxine-pyrimethamine monotherapy was moderately effective but insufficiently reliable in view of the relatively high rate of early treatment failure. The high prevalence of chloroquine resistance found in earlier studies and the results of the present study on sulfadoxine-pyrimethamine justify the change in national policy and systematic use of artemisinin-based combination therapy for first-line treatment of P. falciparum malaria in Mauritania.

[Serological and Behavioral Survey on HIV/AIDS among prisoners in Nouakchott (Mauritania)]. / Enquête comportementale et sérologique sur le VIH/sida chez les détenus à Nouakchott (Mauritanie).

In Mauritania, epidemiological data estimate national HIV prevalence to less than 1%. Our study is the first joint survey on HIV/AIDS conducted among prisoners in Mauritania. It is a cross-sectional survey with anonymity and informed consent. The study covered a sample of 296 prisoners enrolled in a population of 706 prisoners held in Nouakchott. The sex ratio was 14.6. The refusal rate of blood sample was 4.7%. HIV prevalence in the sample was 3.9%. 53.37% of prisoners knew the concept of seropositivity but only 7.4% had a perfect knowledge of the ways of HIV transmission untainted by false beliefs. The results showed that 99% of prisoners knew that the condom is a means of protection against HIV infection, but they also showed many false beliefs about protection against HIV in the majority of prisoners. Indeed, 98.49% of respondents said they protected themselves by avoiding sex with strangers and 94.97% of them thought that sex with young girls or virgins are protection against HIV. Nearly one quarter of the prisoners did not have a good perception of risk of contracting HIV in prison although homosexual relations between prisoners have been reported. This study showed that prisoners in Mauritania are a vulnerable group to HIV because the prevalence of HIV in this group was higher than the national prevalence and this sub-population was unfamiliar with the disease and adopt risk behaviors.

Return of functional mobility after an open tibial fracture: a sensor-based longitudinal cohort study using the Hamlyn Mobility Score.

In this study we quantified and characterised the return of functional mobility following open tibial fracture using the Hamlyn Mobility Score. A total of 20 patients who had undergone reconstruction following this fracture were reviewed at three-month intervals for one year. An ear-worn movement sensor was used to assess their mobility and gait. The Hamlyn Mobility Score and its constituent kinematic features were calculated longitudinally, allowing analysis of mobility during recovery and between patients with varying grades of fracture. The mean score improved throughout the study period. Patients with more severe fractures recovered at a slower rate; those with a grade I Gustilo-Anderson fracture completing most of their recovery within three months, those with a grade II fracture within six months and those with a grade III fracture within nine months. Analysis of gait showed that the quality of walking continued to improve up to 12 months post-operatively, whereas the capacity to walk, as measured by the six-minute walking test, plateaued after six months. Late complications occurred in two patients, in whom the trajectory of recovery deviated by > 0.5 standard deviations below that of the remaining patients. This is the first objective, longitudinal assessment of functional recovery in patients with an open tibial fracture, providing some clarification of the differences in prognosis and recovery associated with different grades of fracture.

[Artificial skin depigmentation complications in Nouakchott, Mauritania]. / Etude des complications de la depigmentation artificielle a Nouakchott, Mauritanie.

In order to study the complications of artificial depigmentation (AD) in Mauritania, we conducted a descriptive cross-sectional study among women in the Dermatology Department of Nouakchott national hospital from July to September 2012. The objective of the study was to determine the prevalence of complications of AD. Of the 394 patients who consulted during the study period, we identified 164 users of depigmentation products. The average age of users of AD is 30.38 years, ranging from 13 to 70 years. The levels of study are most represented 40.2% in the primary and secondary in 41.5%. The majority of users are of the white Moorish ethnic group (34.8%) followed by the Fulani ethnic group (26.8%). 56% of patients were married, 24% were single. 52% of married patients say their spouses disapprove of this practice. 49.4% of patients are undergo artificial depigmentation to be beautiful. 96.3% of these users had one or more complications. Complications noted during this study are dermatophytes (30.5%), superficial or deep folliculitis (7.9%), bacterial dermohipodermitis (erysipelas: 2.4%), exogenous ochronosis (26. 2%), black spots (83.5%). The women's main motivation is aesthetic (49.4%). Among users, 73.8% know the side effects without this discouraging this practice. Most often these side effects do not motivate a consultation and are well tolerated by patients who accept them as ransom AD. Despite the high prevalence of light-skinned subjects, in Mauritania artificial depigmentation remains a common practice.

Dans le but d'étudier les complications de la DA en Mauritanie, nous avons mené une enquête transversale descriptive chez les femmes consultant dans le service de Dermatologie du CHN de Nouakchott de Juillet à Septembre 2012. L'objectif de l'étude était de déterminer la prévalence des complications de la DA. Sur les 394 malades ayant consulté durant la période d'étude, nous avons recensé 164 utilisatrices de produits dépigmentant. L'âge moyen des utilisatrices de DA est de 30,38 ans avec des extrêmes de 13 et 70 ans. Les niveaux d'étude les plus représentés sont le primaire dans 40,2% et le secondaire dans 41,5%. La majorité des utilisatrices sont de l'ethnie maure blanc dans 34,8% suivi de l'ethnie pulaar dans 26,8%. 56% des patientes sont mariées suivi des célibataires dans 24%. 52% des patientes mariées affirment que leurs conjoints désapprouvent cette pratique. 49,4% des patientes s'adonnent à la DA pour être belle. 96,3% de ces utilisatrices avaient une ou plusieurs complications. Les complications notées lors de cette étude sont à type de dermatophyties (30,5%), de folliculites superficielles ou profondes (7,9%), de dermohypodermites bactériennes (érysipèle : 2,4%), d'ochronose exogène (26,2%), de taches noires (83,5%. La principale motivation est esthétique (49,4%). Parmi les utilisatrices, 73,8% connaissent les effets secondaires sans que cela ne les dissuadent de cette pratique. Le plus souvent ces effets secondaires ne motivent pas une consultation et sont bien supportés par les patients qui les acceptent en tant que rançon de la DA. Malgré la prévalence élevée de sujets à peau claire en Mauritanie la DA reste une pratique courante.

Etude des complications de la peau a Nouakchott; Mauritanie

Dans le but d'etudier les complications de la DA en Mauritanie; nous avons mene une enquete transversale descriptive chez les femmes consultant dans le service de Dermatologie du CHN de Nouakchott de Juillet a Septembre 2012. L'objectif de l'etude etait de determiner la prevalence des complications de la DA. Sur les 394 malades ayant consulte durant la periode d'etude; nous avons recense 164 utilisatrices de produits depigmentant. L'age moyen des utilisatrices de DA est de 30;38 ans avec des extremes de 13 et 70 ans. Les niveaux d'etude les plus representes sont le primaire dans 40;2 et le secondaire dans 41;5. La majorite des utilisatrices sont de l'ethnie maure blanc dans 34;8suivi de l'ethnie pulaar dans 26;8. 56 des patientes sont mariees suivi des celibataires dans 24. 52 des patientes mariees affirment que leurs conjoints desapprouvent cette pratique. 49;4 des patientes s'adonnent a la DA pour etre belle. 96;3 de ces utilisatrices avaient une ou plusieurs complications. Les complications notees lors de cette etude sont a type de dermatophyties (30;5); de folliculites superficielles ou profondes (7;9); de dermohypodermites bacteriennes (erysipele : 2;4); d'ochronose exogene (26;2); de taches noires (83;5. La principale motivation est esthetique (49;4). Parmi les utilisatrices; 73;8 connaissent les effets secondaires sans que cela ne les dissuadent de cette pratique. Le plus souvent ces effets secondaires ne motivent pas une consultation et sont bien supportes par les patients qui les acceptent en tan t que rancon de la DA. Malgre la prevalence elevee de sujets a peau claire en Mauritanie la DA reste une pratique courante

Gait asymmetry detection in older adults using a light ear-worn sensor.

Measuring gait asymmetry is an important feature when characterizing functional imbalance between limbs. This could be due to pathologies, such as osteoarthritis, stroke, or associated with the effects of surgeries such as hip arthroplasty. Generally, the study of asymmetry or imbalance has required the use of a gait lab or force plates, which could be expensive and difficult to use in home settings. This work validates the use of a light weight ear sensor (7.4 g) with an instrumented treadmill for 64 subjects (age (60.04 (15.36)) including healthy subjects (14) as well as subjects who had been treated for hip (17), knee-replacement surgery (21) and knee osteoarthritis (12). Subjects performed treadmill walking at several speeds on flat surfaces, inclines and declines. Accelerometer data from the ear sensor were segmented into consecutive steps and temporal features were extracted. The measures of gait cycle time and step-period asymmetry obtained from the ear sensor matched well those of the treadmill for flat surfaces, inclines and declines. The key implication of the study is that the proposed method could replace expensive equipment for monitoring temporal gait features in clinics as well as free-living environments, which is important for monitoring rehabilitation after surgery and the progress of diseases affecting limb imbalance.

Optimisation of a functional mycobacterial growth-inhibition assay to improve its suitability for infant TB vaccine studies.

The development of vaccines against tuberculosis continues to be hindered by the lack of correlates of protection. Immunity to Mycobacterium tuberculosis (M.tb) infection relies predominantly on cell mediated response, which is routinely measured using a read-out of host cytokine profiles. However, to date none of the cytokine profiles have been found to predict protection. A number of functional in vitro approaches that measure growth of mycobacteria pre- and post-vaccination as a potential functional surrogate marker for vaccine take have been developed. The use of a reporter-gene tagged BCG-lux assay measuring the viability of mycobacteria in whole blood samples has previously been described by our group to assess vaccine immunogenicity. Since only very small blood samples are usually available in paediatric studies, we now report a modification of the BCG-lux assay to reduce the volume required and make it more field-friendly. Our results show that a 2-fold reduction in blood volume made no significant difference to bacterial growth ratios, used as the main read-out. These results confirm the suitability of the BCG-lux assay for functional studies of vaccine immunogenicity and immunopathogenesis in young children and could play a role in late-phase TB vaccine trials of novel candidates.