[Review of parenteral nutrition practices in four university hospital's pharmacies in Auvergne-Rhône-Alpes region]. / État des lieux des pratiques de nutrition parentérale dans quatre pharmacies à usage intérieur de centre hospitalier et universitaire de la région Auvergne-Rhône-Alpes.

OBJECTIVES: To carry out an assessment of parenteral nutrition (PN) practices in hospital pharmacies of the Auvergne-Rhône-Alpes region in order to explore a harmonisation of practices and a collaboration between the different centres. METHODS: Status of practices was carried out on the basis of an observational study inspired by the survey of the General Inspectorate of Social Affairs. It was carried out in Auvergne-Rhône-Alpes region in four university hospital pharmacies with a production unit of PN. It focused on the different stages of the PN process: prescription, formulation, compounding and quality control. It also covered the support processes such as the quality assurance system and the management of premises and equipment. RESULTS: Most preparations made in the region are individualized parenteral nutritional admixtures for paediatric and neonatal hospitalization departments. The production units of PN of each centre are located in premises in compliance with Good Preparation Practices. However, compounding equipment and raw materials used are heterogeneous in the four centres. All centres control the quality of their finished preparations. But, the performance of analytical control is disparate in terms of equipment and specifications. CONCLUSION: This assessment explains the similarities and differences in PN practices between various university hospitals in the Auvergne-Rhône-Alpes region and thus makes possible to provide a collective regional work to harmonise practices.

Pediculosis capitis in Abidjan, Côte d'Ivoire: Epidemiological profile and associated risk factors.

Pediculosis capitis (PC) is a parasitic infestation, common in children's communities caused by Pediculus humanus capitis. Various factors including infestation-related stigma, treatment cost and health risks make this infestation deserves special attention. This study aims to determine epidemiological profile of pediculosis capitis twenty years after the last study in Abidjan, Côte d'Ivoire. An epidemiological cross-sectional survey was carried out from April to June 2018 across 40 public primary schools in the ten districts of Abidjan. Data from schoolchildren and parents and/or guardians were collected using a pretested questionnaire after agreement and signature of the informed consent form. Head lice were identified visually with a magnifying glass, and then collected using fine combs and hairbrushes. The positive diagnosis was made by the detection of living lice in the hair. Of the 4, 805 included participants, 28 (0.58%) were hosting living lice in hair. Analysis of associated factors showed that gender related-status was associated with PC. In this case, girls were more affected than boys (p=0.018). Plateau, Treichville and Port Bouët municipalities were the most affected (p=0.018). The length hair was associated with the occurrence of PC (p<0,001). Schoolchildren from families with low monthly income was most infected by PC (p=0.023). Some parameters such as promiscuity and collective use of washing facilities and bedding, were not found to be associated to head lice infestation. This study shows a drastic decrease of PC prevalence in Abidjan corresponding to 97%. This could be due to the improvement in the quality of life and education of the population of Abidjan. The establishment of hygiene committees and the teaching of basic hygiene practices from the first school years have contributed to these achievements. Maintaining these measures will contribute to the sustainable elimination of CP among children in Abidjan.

Recurrent vulvo-vaginal candidiasis in Abidjan (Côte d'Ivoire): Aetiology and associated factors.

Recurrent vulvovaginal candidiasis (RVVC) is a major health problem for sexually active women because of its severe effect on their quality of life. A thorough knowledge of their epidemiology leads to their efficient management. Therefore, a cross-sectional study was conducted in 2014 in women with leucorrhoea associated or not with other clinical signs. Recurrence was based on the occurrence of at least four annual episodes of Candida vulvo-vaginitis. An individual interview based on a questionnaire was conducted to identify the socio-demographic parameters that could be associated with the RVVC. Vaginal samples were collected at the obstetrical gynaecology department of the University Hospital of Cocody and at the Pasteur Institute of Côte d'Ivoire. On each sample, a direct examination and culture on Sabouraud-chloramphenicol medium with or without actidione were performed. Yeast identification was performed using chromogenic media (CandiSelect®4 [Bio-Rad]) and the study of sugar assimilation using the Auxacolor® 2 gallery (Bio-Rad). A total of 400 patients were included. The average age was 29.2 years (SD=7.2 years). Of these, 94 had recurrent vulvovaginal candidiasis, with a prevalence of 23.5% (CI95%: 19.49-28.02). Five species of the genus Candida have been identified: Candida albicans (59.6%), Candida glabrata (19.1%), Candida tropicalis (16%), Candida krusei (4.2%) and Candida inconspicua (1.1%). Some factors such as education level, history of sexually transmitted infection, type of underwear used, frequency of personal hygiene and type of product used for these hygiene have been associated with the occurrence of RVVCs. The occurrence of RVVCs is relatively high in our study population. Non-albicansCandida species occupy a significant place in this disease epidemiology. By addressing the factors associated with the occurrence and/or persistence of RVVCs, it will be possible to reduce their incidence in sexually active women.

[Clinical and mycological characteristics of onychomycosis due to Candida at Institut Pasteur of Côte d'Ivoire]. / Caractéristiques cliniques et mycologiques des onychomycoses à Candida à l'Institut Pasteur de Côte d'Ivoire.

OBJECTIVE: This study aims to study the clinical and mycological characteristics of onychomycosis due to Candida in mycology unit of Institut Pasteur of Côte d'Ivoire. PATIENTS AND METHODS: This is a retrospective study which was carried out on patients from 1990 to 2016 for mycological diagnosis of onychomycosis and which socio-demographic characteristics, direct examination and culture results were recorded. RESULTS: In this study, 1898 patient files were selected. The average age of the patients was 31.69 years (standard deviation=15.11) with a sex ratio of 0.87. The frequency of Candida onychomycosis from patients received was 61.7%. Finger nails (67.7%) were more affected by this condition, followed by those of the toes (25.3%). Ninety cases of double localization of the nails of the hands and toes have been found. Candida albicans was the most frequent species accounting for 79.1% of isolated yeasts. Among the non-albicans, C. parapsilosis and C. tropicalis were isolated at the level of the toenails with frequencies rate of 11.2 and 9.6%. CONCLUSION: Onychomycosis due to Candida are relatively common in Abidjan and are dominated by C. albicans. The mycological confirmation of the fungal etiology in onychopathy and a good hygiene of the nails will allow a better management.

[Investigation surrounding a fatal case of yellow fever in Côte d'Ivoire in 1999]. / Investigation autour d'un cas mortel de fièvre jaune en Côte d'Ivoire en 1999.

Côte d'Ivoire is an endemic country for yellow fever, but no case was officially notified in recent years. In July 1999, however, one fatal case was reported. A German citizen was infected in the national park of Comoe, in the north eastern area of the country. In order to evaluate the extent of amaril virus circulation and the risk for local people, a virological, entomological and epidemiological investigation was carried out by the ministry of health, the OCCGE, the Côte d'Ivoire Pasteur Institute (IPCI) and the World Health Organisation in the area where the fatal case had been staying. 18 suspected and 24 confirmed mosquito catchers were identified by interview and a blood specimen was collected from each of them. In addition, 159 batches of mosquitoes from which 94 batches of potential vectors were collected; among the suspected cases, 22% were immunised against yellow fever. Serological and virological analyses were made at IPCI and the Paris Pasteur Institute by ELISA technique and isolation on cells cultures and newborn mice. All the suspicious sera and 87.5% of the catchers were positive for IgG anti-amaril virus. One catcher's serum was positive for IgM anti-amaril virus. 11 suspected sera were positive for IgG anti-dengue virus with 1 positive for IgM. 1 strain of amaril virus and 3 strains of Zika virus were isolated from mosquitoes at IPCI and confirmed by CRORA in Dakar. These results indicated that there is a yellow fever and dengue virus are prevalent among the human and vector populations in the study area. Preventive measures must be adopted to protect human beings at risk for amaril infection.

[Integration of new nurses in nursing units in a university hospital]. / L'intégration des nouvelles infirmières dans les unités de soins d'un hôpital universitaire.

The study presented in this article raises the problems of the integration of recently graduated nurses in the hospital from the point of view of a culture difference between the two socialisation worlds: more reflexive standards of behaviour and culture in the schools (emphasis on analysis, knowledge, care actions argumentation...) and more instrumental ones in the hospitals (emphasis on efficiency, work organisation, operationality...). An enquiry by means of interviews with recent graduates from different schools (open, semi-open and closed questions) enables to successively analyse the skills they consider to have acquired at school, the ones they consider as required by the hospital and the differences they feel between hospital and school concerning the enhanced skills. The results show a significant discrepancy between the ideal of the interviewed nurses and the reality of their work within the institutional constraints of the hospital.

[Treatment of rabies in man in Vaud and Fribourg before Pateu: therapeutic observations of Drs. Guisan and Schaller in the 19th century]. / Le traitement de la rage chez l'homme dans les campagnes vaudoises et fribourgeoises avant Pasteur: les observations thérapeutiques des Drs Guisan et Schaller au milieu du XIXe siècle.

The picture showing the little Joseph Meister being treated against rabies under Louis Pasteur's eyes, on July 6, 1885, has quickly become a symbol of the triumphant progress of medicine, even though diseases with high mortality like tuberculosis or diphtheria could still not be healed with efficient therapeutic means. But before the discoveries of Pasteur, what was actually, in daily practice, the kind of response an ordinary doctor could give to human rabies? A Swiss physician, Charles-Hector Guisan, developed a therapy based on the use of sodium arsenate, which he published in the columns of the Gazette des Hôpitaux civils et militaires in 1854. This arsenic therapy was to be put into practice on a larger scale in the canton of Fribourg by Dr Jean-Louis Schaller (1816-1880), who meticulously wrote observations in a notebook on the cases of 13 persons wounded by a rabid dog in 1855.

[In vitro susceptibility of vaginal Candida albicans to antifungal drugs in Abidjan (Ivory Coast)]. / Sensibilité in vitro des souches de Candida albicans d'origine vaginale aux antifongiques à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study was to evaluate in vitro susceptibility of vaginal Candida albicans to common antifungal drugs in Abidjan, Ivory Coast. PATIENTS AND METHODS: From January to September 2008, 150 women with leucorrhoea were sampled for vaginal mycosis at the Pasteur Institute (Ivory Coast). Samples were analyzed by direct examination, Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture. C. albicans was identified after blastesis, chlamydosporulation and auxanogram tests. The susceptibility of this fungus to amphotericine B, 5-fluorocytosine, fluconazole, itraconazole and voriconazole was evaluated by a semi-solid medium microdilution technique: ATB(®) Fungus 3. RESULTS: Among 62 yeasts strains isolated, C. albicans represented 45 cases or 72.6%. Vaginal itching (P=0.04) and urinary burning (P=0.002) was statistically correlated with vaginal candidosis. We observed a range of susceptibility of C. albicans strains to antifungals: 100% to amphotericine B (CMI90=0.5µg/mL); 98% to 5-fluorocytosine (CMI90=4µg/mL); 86.7% to voriconazole (CMI50=0.06µg/mL) and 80% to fluconazole (CMI50=2µg/mL and CMI90=32µg/mL). However, only 46.7% of C. albicans strains were sensitive to itraconazole (CMI50=0.125µg/mL). CONCLUSION: These results show that vaginal C. albicans remain sensitive to the most commonly antifungal drugs used in Abidjan. However, this susceptibility should be regularly monitored.

Storage of lactose-hydrolysed dried milk: effect of water activity on the protein nutritional value.

The retention of the protein nutritional value during storage of lactose-hydrolysed dried milk at different water activities (aw) was studied and compared with that of ordinary milk. In the lactose-hydrolysed milk biologically available lysine decreased much more rapidly than in the ordinary milk at all the different aw studied. Thus, at conditions normally accepted for ordinary dried milk (aw approximately 0.2; moisture approximately 4%) there was an available lysine loss in the hydrolysed milk of about 25% after 2 months and about 40% after 6-months storage at room temperature. This occurred without any visible browning. It is concluded that drying to very low aw (less than or equal to 0.11) is necessary to obtain good stability of the protein nutritional value (PNV) in lactose-hydrolysed milk. The drying, however, must be done so that losses in nutritional value are minimal during that process. It should also be noted that fat oxidation might be a problem at such low aw. A chemical method for available lysine assay (guanidination and assay of homoarginine) gave values in good agreement with the biological evaluations with rats.