Resistance profile and treatment outcomes in HIV-infected children at virological failure in Benin, West Africa.

Background: In Africa a high percentage of HIV-infected children continue to experience HIV treatment failure despite enormous progress. In Benin (West Africa), there are currently no data on HIV drug resistance at failure in paediatric populations. Objectives: To assess the frequency and patterns of HIV drug resistance among children with virological ART failures. Methods: Dried blood spots from 62 HIV-infected children with virological failure were collected at the paediatric clinic of the National Hospital Center in Cotonou for genotyping and plasma drug concentration determination. Results: Characteristics of the population show a median age of 10 years (IQR 6-13) and a median duration on ART of 5 years (IQR 3-7). Viruses from 53 children were successfully amplified. Of these, 76% of patients were on an NNRTI-based regimen and 24% on a boosted PI-based regimen. NRTI, NNRTI and dual-class resistance was present in 71%, 84% and 65% of cases, respectively. Only 4% of the children had major resistance mutations to PIs and none had major resistance mutations to integrase inhibitors. Among the participants, 25% had undetectable antiretroviral concentrations. Conclusions: Our results showed that the development of drug resistance could be one of the main consequences of high and continuous viral replication in HIV-infected children in Benin. Thus, inadequate attention to monitoring lifelong ART in children may prevent achievement of the goal of the United Nations Program on HIV and AIDS (UNAIDS) of 90% viral suppression among patients receiving ART.

Thumb basal joint arthritis: New classification, diagnostic and therapeutic algorithm.

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

Paediatric tuberculosis at the national teaching hospital CNHU-HKM of Cotonou, Benin: a retrospective study.

UNLABELLED: BACKGROIUND: Tuberculosis (TB) is a public health problem. Knowing its patterns could help address it more efficiently. OBJECTIVE: To determine the hospital incidence, presentation, management, and outcome of TB in our setting. METHODS: We conducted a chart review of children with TB during a five-year period at the University Hospital CNHU-HKM, Cotonou, Benin. RESULTS: Hospital prevalence of TB among hospitalised children was 0.2%. The mean age was six years, with a male:female ratio of 1.4:1. The common clinical features were: cough (78.1%), long standing fever (81.2%), growth retardation (65.6%), pulmonary consolidation (53.1%) and hepatosplenomegaly (34.4%). The skin tuberculin test was positive in only 40.6% of cases. Co-infection with HIV was present in 51.8% of cases. Mycobacterium tuberculosis could be identified in only 21.8% of cases. Twenty-six (81.2%) pulmonary tuberculosis (PTB) cases were diagnosed, eight (25%) of which were associated with extra pulmonary TB. Six (18.7%) presumed isolated extra PTB were also diagnosed. Eight-month treatment regimen was used in most patients, with mortality rate of 9.3%. CONCLUSION: Although TB hospital prevalence seems low in our setting, management needs to be improved according to guidelines.

[About a case of congenital hypothyroidism]. / A propos d'un cas d'hypothyroïdie congénitale.

A boy presented at birth dyspnea, jaundice, meteorism and hypospadias; biochemical testing revealed hyponatremia. He benefited on day 4 of neonatal screening for hypothyroidism and congenital adrenal hyperplasia (CAH) and assays showed high concentrations of 17-OHP and TSH. Because of clinical features and hyponatremia, the diagnosis of CAH was plausible. A serum control (17-OHP and TSH) carried out on day 8 showed a normal concentration of 17-OHP and a persistently elevated concentration of TSH confirmed by a second assay a few days later. A 131I scan of neck revealed an ectopic lingual thyroid. The considerable progression of false positive screening tests for CAH is mainly due to the increasing number of premature babies. We show by a retrospective analysis (7 yrs), that children with hypothyroidism also present frequently higher concentrations of 17-OHP than normal children. However, whatever the aetiology (apart from CAH), the concentrations of 17-OHP rapidly normalise.

[Recurring pulmonary embolism despite the presence of a vena cava filter: a case report from the CNHU Cotonou-Benin]. / Embolie pulmonaire récidivante malgré la présence d'un filtre cave définitif: á propos d'un cas observé au CNHU de Cotonou-Bénin.

A 50-year-old man presents several clinical signs of pulmonary embolism, but this diagnosis was excluded due to the lack of venous thrombosis of the lower limbs and because the presence of a vena cava filter. The same signs reoccurred a few months later, leading to the diagnosis of venous thrombosis of the lower limbs with severe successive pulmonary embolism. This clinical case illustrates the potentially incomplete efficacy of vena cava filters for the prevention of pulmonary embolism.

Resistance of female guinea pig fertility to efficient iso-immunization with spermatozoa autoantigens.

Virgin female guinea pigs received two courses of immunization with S, P or T spermatozoa autoantigens and Freund's complete adjuvant and were mated from 1 up to 18 weeks after the end of each course. The immunizations were efficient as judged by the titers of circulating antibodies to S, P or T, the existence of antibodies to the corresponding immunizing antigen in cervico-vaginal secretions and by cutaneous reactions of delayed hypersensitivity. In spite of this successful immunization, the fertility rate was 100% after the first course and only slightly decreased after the second one. The only significant events were a delay in the time of fertilization and a high rate of intrauterine death (as already observed following anti-S immunization). The absence of fertility impairment was not due to a lack of a relevant antigen in the injected preparations since immunizing female guinea pigs with either epididymal spermatozoa or crude water-soluble extract also did not decrease the fertility. The mechanisms responsible for such a resistance remain to be elucidated; they may involve spermatozoa coating substances, enhancing antibodies or sperm immunosuppressive factors.

Antibodies to spermatozoa and seminal plasma antigens detected by various enzyme-linked immunosorbent (ELISA) assays.

Various ELISA methods have been applied by different research centers to test the efficiency of this approach for the diagnosis of sperm-immune infertility cases. The antigens used were either whole spermatozoa or solubilized spermatozoal membrane preparations and were immobilized on microtiter plates, except in one case where plastic beads were employed. Polyvalent second antibodies or protein-A labelled with enzymes served as tracers. A high frequency of positive sera was found in all groups including fertile controls with tests using whole spermatozoa as antigen. The methods using solubilized antigen preparations showed fewer positives on the whole and correlated better with the various clinical categories of the WHO sera. Whilst there was some agreement in the results between the various laboratories on a few sera, most of the positive sera found by one laboratory were reported as negative by others. More investigative work is needed to improve reproducibility between different laboratories and to reduce non-specific reactions with normal controls. A more precise definition of the proper cut-off levels for positives and negatives is also needed. Despite these short-comings, the development of an ELISA for the diagnosis of sperm-immune infertility cases seems to be justified in the long term.

Giant sigmoid diverticulum.

A 49-year-old man was seen with an unusual complication of diverticulitis--a giant sigmoid diverticulum. This patient had undergone an extensive workup during a 5-year period, ranging from multiple extensive gastroenterology evaluations and procedures to an eventual psychiatric evaluation to rule out the possibility of a functional cause for his chronic, intermittent abdominal pain. Later, an accurate diagnosis of a giant sigmoid diverticulum resulted in an en bloc resection of the sigmoid colon and cyst. The patient had an uncomplicated recovery with no return of his previous symptoms. The authors review the many proposed causes of the giant sigmoid diverticulum and possible differential diagnoses. Initially, the diagnosis is usually missed as plain roentgenograms, upper and lower gastrointestinal x-ray studies, and computed tomography scans generally show no abnormality. Management methods are also discussed.

[Histopathology of Anopheles gambiae s.l. Giles, 1902 (Diptera, Culicidae) subjected to the larvicidal activity of the aqueous extract of Persea americana Miller, 1768 (Lauraceae)]. / Histopathologie d'Anopheles gambiae s.l. Giles, 1902 (Diptera, Culicidae) soumis à l'activité larvicide de l'extrait aqueux de Persea americana Miller, 1768 (Lauraceae).

Larvae of Anopheles gambiae treated with an aqueous extract of Persea americana suffer important damages of the midgut. The first epithelial cells to be affected are those at the posterior part of the midgut which become hypertrophic after only 30 min. After one hour most of the cells in this part lyse. The cytoplasmic material is then rejected towards the lumen gut, between the peritrophic membrane and the midgut epithelium. Subsequently, an almost total cell degeneration is observed. Cells of gastric caeca and cells at the intermediary and anterior parts of the midgut undergo the same histopathology, albeit after a longer period.

[Prevention of HIV mother to child transmission in Cotonou: child follow-up]. / Suivi de l'enfant de mère infectée par le VIH dans le cadre de la prévention de la transmission mère-enfant à Cotonou (Bénin).

UNLABELLED: The aim of this survey was to analyse the constraints of implementing on a larger scale the protocol of prevention of HIV/AIDS from mother to child by Nevirapine intake. This survey takes stock of the components of the children medical care follow-up. PATIENTS AND METHODOLOGY: Here is a straight line survey on 231 newborns from 222 screened mothers during pregnancy in 36 Health Centres in Cotonou and suburbia. Nevirapine has been administered in a single dose of 200 mg to mothers during labour and a dosage of 7 mg to the infant at birth. These infants have been steadily followed-up from 13 June 2000 to 30 April 2002. Exclusively feeding either on artificial milk or breastfeeding and a premature weaning at four months of age have been recommended. PCR screening has been conducted at one and six months of age or one month after the effective weaning. Cotrimoxazole has been systematically administered at six weeks. RESULTS: HIV/AIDS sero prevalence was globally evaluated at 4% in the screened pregnant women. One hundred and ninety seven mothers and children have effectively benefited from nevirapine intakes and this protocol has been adequately observed in 51% cases. The medical check-up rate was 18.5%. The average age of children under medical care was 10.8 months at the end of the study. The mother to child transmission rate was globally estimated at 20.4% and 7% in an optimal situation (the protocol was observed and the rate of CD4 above 500). In case of breastfeeding exclusively followed by a premature weaning in most cases, the average age of effective weaning was 8.3 months. Twenty-three children died during medical care follow-up basically from dehydration brought about by diarrhea and vomiting during weaning period. CONCLUSION: The survey confirms the potency of nevirapine in preventing HIV transmission from mother to child in non immunosuppressed women and lays emphasis on real problems for which appropriate solutions should be found before the implementation on a larger scale of this protocol.

[An original procedure for cement diaphyseal extraction. The segmental cement extraction system or SEG-CES]. / Un procédé original d'extraction des gaines cimentées diaphysaires. Le segmental ciment extraction system ou SEG-CES.

PURPOSE OF THE STUDY: We report our first eleven uses of a new cement mantle extraction system. The basis of this technique relies on a cement bone interface with a lower strength compared to the old cement-new cement interface. MATERIAL AND METHODS: The first stage of the procedure consists in a specific preparation of the inner surface of the old cement, mantle. It should be clean and dry after being abraded with a stainless steel wire brush. Then a thin cement syringe filled with low Viscosity PMMA cement, is injected in the old mantle in a retrograde fashion. A threaded rod with nuts is centered within the cement sheath to the bottom and held until the injected cement has fully polymerised. Then the threaded rod is unscrewed from the femur; nuts are established along the entire length of the cement column. To prevent trochanteric fracture occurring upon cement extraction, its is important to clear away sufficient bone from the lateral aspect of the canal. A series of extraction rods are then used to sequentially remove the cement mantle. The removal rod is screwed back into the threaded channel at a distance of every one to three nuts, and then attached to the slap hammer via a quick release connection. Cement extraction is performed using deliberate slaps of the slap hammer. The last segment is drilled with the use of a distal plug drill centering sleeve. After having inserted the plug removal rod, the last segment is extracted. We used this technique eleven times in 8 hips for 5 loosening of femoral component and 3 revisions hip arthroplasties without loosening and 2 revisions knee arthroplasties without loosening (an extraction system for the femur and the tibia). RESULTS: For the 5 loosening cases extraction was easy. In 2 cases, cement mantle was removed as a single "en bloc" piece. In the 3 other cases, the extraction was segmental only in the distal third of the cement mantle. Without loosening, the extraction was completely segmental. In all cases, cement mantles were successfully removed. There was no fracture and no loss of bone stock. There was only one "fissuration" alpha the great trochanter and we only made one distal window. All hip arthroplasties were replaced and arthrodesis were performed after removal of the knee arthroplasties. DISCUSSION: The cement-assisted mantle removal technique appears to be a simple, quick and effective methods for cement mantle removal. Perforation and diaphyseal window can be avoided by the technique even when loosening does not exist. However, it is necessary to establish a thorough preoperating plan in order to eliminate contraindications such as too narrow or too curved sheath. CONCLUSION: It appears that this new procedure will facilitate future reoperations which are reputed to be difficult and dangerous.

[Creation of emergency care services in developing countries: luxury or necessity?]. / Creer un service d'aide medicale d'urgence dans un pays en developpement: luxe ou necessite?

Organization of emergency care services prior to hospital admission has progressed at a satisfactory pace in developed countries. A performance model in this field is the French emergency service called service d'aide médicale d'urgence (SAMU). Socioeconomic conditions prevailing in developing countries have pushed authorities to give priority to preventive medicine. However numerous patients especially young people and women during childbirth die as a result of inadequate facilities for transportation from hospitals and dwellings in outlying areas to major medical centers where the best medical equipment and staff are available. As a result, it may be asked if emergency care services is really a luxury. The authors base their conclusion on analysis of the conditions and outcome of emergency patient care in three African countries in which it is essentially a requirement.

Behçet's disease in Portugal.

During the last decades 156 patients with Behçet's disease were diagnosed and studied in Portugal. Until 1966 only two cases were referred in Portugal. In 1978 we reported 23 cases (18 males and 5 females) with multisystemic involvement, not different from that reported in other publications elsewhere. In 1987, 17 cases were reported from the Oporto region, diagnosed during a period of 5 years. In the region of Coimbra 15 cases were diagnosed (6 males and 9 females). In the Lisbon area from 1969 until 1990, 123 cases were studied altogether, 76 during the last decade (35 males and 41 females). All the cases studied had oral ulcerations and a high incidence of ocular involvement (clinical and sub-clinical, 87%). HLA-B5 was detected in 50% of the patients. At least four cases were fatal, three died with neuro-Behçet. Steroids, colchicine and thalidomide were the main form of treatment, for the patients in the Lisbon area, but in some cases chlorambucil, cyclophosphamide, azathioprine, cyclosporine-A, fibrinolytic therapy, plasmapheresis and isovolemic hemodilution were also used.

Functionalization of titanium surface with chitosan via silanation: 3D CLSM imaging of cell biocompatibility behaviour.

INTRODUCTION: Biocompatibility ranks as one of the most important properties of dental materials. One of the criteria for biocompatibility is the absence of material toxicity to cells, according to the ISO 7405 and 10993 recommendations. Among numerous available methods for toxicity assessment; 3-dimensional Confocal Laser Scanning Microscopy (3D CLSM) imaging was chosen because it provides an accurate and sensitive index of living cell behavior in contact with chitosan coated tested implants. OBJECTIVES: The purpose of this study was to investigate the in vitro biocompatibility of functionalized titanium with chitosan via a silanation using sensitive and innovative 3D CLSM imaging as an investigation method for cytotoxicity assessment. METHODS: The biocompatibility of four samples (controls cells, TA6V, TA6V-TESBA and TA6V-TESBAChitosan) was compared in vitro after 24h of exposure. Confocal imaging was performed on cultured human gingival fibroblast (HGF1) like cells using Live/Dead® staining. Image series were obtained with a FV10i confocal biological inverted system and analyzed with FV10-ASW 3.1 Software (Olympus France). RESULTS: Image analysis showed no cytotoxicity in the presence of the three tested substrates after 24 h of contact. A slight decrease of cell viability was found in contact with TA6V-TESBA with and without chitosan compared to negative control cells. CONCLUSION: Our findings highlighted the use of 3D CLSM confocal imaging as a sensitive method to evaluate qualitatively and quantitatively the biocompatibility behavior of functionalized titanium with chitosan via a silanation. The biocompatibility of the new functionalized coating to HGF1 cells is as good as the reference in biomedical device implantation TA6V.

[Profile of HIV-infected children at the National University Hospital of Cotonou (CNHU)]. / Profil des enfants infectes par le vih suivis au centre National Hospitalier et Universitaire (CNHU) de Cotonou.

OBJECTIVE: To describe the profile of HIV-infected children. METHODS: This was a cross-sectional, descriptive and analytic study involving 317 infected children, monitored from January 1st, 2002 to July 31st, 2010 at CNHU of Cotonou. RESULTS: The average age was 89.1 months with a sex ratio of 0.91. Orphans of at least one parent represented 31.3% of cases. Vertical transmission was predominant (86.1%). Only 9.5% of patients benefited from PMTCT. They were all infected with HIV 1. According to the WHO classification, 52% were at stage 3 or 4 and 56% had advanced to severe immunodeficiency. 61% had suffered from opportunistic infections, and 53% had benefited from antiretroviral therapy. Following the study, 54% of participants had continued follow-up visits, 23% lost contact with the CNHU, 18% died and 5% were referred to another site. Factors associated with outcome were antiretroviral therapy (p < 0.0001), clinical (p < 0.0001) and immunological stage (p = 0.0042) on admission. CONCLUSION: Our findings suggest strengthening the PMTCT program, screening and early management of an HIV infection.

OBJECTIF: Décrire le profil des enfants infectés par le VIH. PATIENTS ET MÉTHODES: Etude transversale, descriptive et analytique portant sur 317 enfants infectés, suivis de Janvier 2002 à Juillet 2010. RÉSULTATS: L'âge moyen des enfants était de 89,1 mois ; le sex ratio de 0,91. Ils étaient orphelins d'au moins un parent dans 31,3% des cas. La transmission était essentiellement verticale (86,1%). Seulement 9,5% avaient bénéficié d'une prophylaxie antirétrovirale pour la PTME. Ils étaient tous infectés par le VIH 1. Selon la classification de l'OMS, 52% étaient à un stade clinique 3 ou 4 et 56% avaient un déficit immunitaire important ou sévère. 61% avaient souffert d'infections opportunistes, et 53% avaient bénéficié du traitement antirétroviral. Quant à leur devenir, 54% avaient continué le suivi, 23% étaient perdus de vue, 18% étaient décédés et 5% transférés sur un autre site de prise en charge. Les facteurs associés au devenir étaient le traitement antirétroviral (p < 0,0001), les stades clinique (p < 0,0001) et immunologique (p = 0,0042) à l'admission. CONCLUSION: Ce profil suggère le renforcement du programme de la PTME, un dépistage et une prise en charge précoces.

[Drug eruptions in children in Cotonou, Benin]. / Toxidermies Chez Les Enfants A Cotonou, Benin.

INTRODUCTION: The aim of this study was to investigate the epidemiological aspects of drug eruptions in children in hospital area in Cotonou. PATIENTS AND METHOD: A retrospective study was carried out in the Department of Dermatology of Cotonou (Benin) from 1998 to 2009. All cases of drug eruption occurred, during the study period, in children under 16 years old were selected for the study. The diagnosis of the drug eruption was based on clinical findings. The Identification of culprit drugs was based on the criteria as defined by the French Group of Pharmaco-vigilance. RESULTS: From 1998 to 2009, 232 cases of drug eruption were diagnosed in the Department of Dermatology. Of this, 35 cases occurred in children under 16 years old. The patient mean age was 6.6 years with a sex ratio of 0.94. 4 patients were HIV positive. The culprit drug was identified in 21 patients (60%): sulfonamides 52.38% (11/21 cases), penicillin 9.52% (2 cases), vaccine 9.52% (2 cases), acetaminophen 9.52% (2 cases), acetyl salicylic acid 4.76% (n = 1), quinine 4.76% (n = 1), phenobarbital 4.76% (n = 1) and ceftriaxone 4.76% (n = 1). The main clinical patterns were: fixed drug eruption 45.71% (16/35), maculopapular rash 17.14% (n = 6), Stevens-Johnson syndrome 17.14% (n=6), and urticaria 8.57% (n = 3), 1 case of toxic epidermal necrolysis was seen and one patient died. CONCLUSION: Skin reactions caused by drug intake are a rare disorder among children and fixed drug eruption is the main clinical presentation of the disease in Cotonou (Benin).

[Usefulness of neonatal exams at Cotonou University Hospital, Benin]. / Utilite De L'Examen Systematique Du Nouveau-Ne Au CNHU De Cotonou Au Benin.

AIM: To determine the rate of systematic examination completion, the characteristics of the newborns and the diseases that they bore. METHOD: It was a cross-sectional and descriptive study conducted on newborns that were received for systematic examination from January 1rst 2008 through December 31rst 2009. Consultations were performed by pediatricians. The data that were collected, included in details the rate of implementation of the systematic examination, the neonates demographic characteristics, detected diseases and risk factors. RESULTS: In 2 years, 1325 infants were seen for systematic examination in the neonatal unit of National Teaching Hospital of Cotonou. The global completion rate was estimated to 52%. Newborns were categorized as healthy, at risk of illness or ill in respectively 35.54%, 11% and 53% of cases. The diseases that were found encompassed jaundice (78%), neonatal infections (15%), antenatal growth retardation (12%), prematurity (10%) and birth defects (4.50%). Out of 707 sick newborns, 139 had been hospitalized with a fatal outcome in only one. CONCLUSION: The newborns systematic examination is useful. We do think that it should be generalized if we hope to reduce the neonatal mortality rate in Sub-.Saharan African countries.

Human and guinea-pig cross-reacting spermatozoa autoantigens and autoantibodies.

Cross-reactivity between human and guinea-pig spermatozoa autoanigens has been studied in two systems: (1) guinea-pig anti-autoantigens S, P and T immune sera reacting on human spermatozoa and (2) activity of human anti-sperm sera on guinea-pig spermatozoa. These assays, as well as the results of cross-absorptions in the two systems, revealed a close antigenic relationship between the two species of spermatozoa concerning the guinea-pig autoantigen S. However, there were some differences in its localization and serological manifestations in both species. The guinea-pig autoantigen T bore a more distant, though definite, relationship with human spermatozoa. No clear evidence of cross-reactivity between the two species was found for autoantigen P. At variance with autoimmune (or isoimmune) human antibodies, 'natural' human antibodies active on guinea-pig spermatozoa were absorbed by guinea-pig spleen cells.