Accouchement de jumeaux conjoints de découverte fortuite au cours du travail au CHU de Dakar

L’objectif de cette étude était de rapporter 3 cas de jumeaux conjoints, discuter de l’importance du diagnostic anténatal et de décrire les particularités diagnostiques, thérapeutiques et évolutives. Sur 45700 accouchements du 1er Février 2009 au 31 Décembre 2011, 3 cas de jumeaux conjoints ont été enregistrés, soit 1 cas pour 15000 accouchements. Ces cas ont été diagnostiqués au cours du travail au décours d’une dystocie mécanique ou d’une césarienne réalisée pour une autre indication. Il s’agissait d’un cas de jumeaux conjoints thoraco-omphalopages, un cas de diprosopes et un cas de dicéphales. L’accouchement dans les trois cas était fait par voie haute permettant d’extraire des mort-nés frais. Nous insistons sur l’intérêt d’un diagnostic anténatal précoce par le recours à l’échographie afin d’éviter les accidents mécaniques d’un accouchement qui ne saurait s’accomplir par voie basse.Key words: Jumeaux conjoints, diprosopes, dicéphales, thoraco-omphalopage

NALP3 inflammasome upregulation and CASP1 cleavage of the glucocorticoid receptor cause glucocorticoid resistance in leukemia cells

Glucocorticoids are universally used in the treatment of acute lymphoblastic leukemia (ALL), and resistance to glucocorticoids in leukemia cells confers poor prognosis. To elucidate mechanisms of glucocorticoid resistance, we determined the prednisolone sensitivity of primary leukemia cells from 444 patients newly diagnosed with ALL and found significantly higher expression of CASP1 (encoding caspase 1) and its activator NLRP3 in glucocorticoid-resistant leukemia cells, resulting from significantly lower somatic methylation of the CASP1 and NLRP3 promoters. Overexpression of CASP1 resulted in cleavage of the glucocorticoid receptor, diminished the glucocorticoid-induced transcriptional response and increased glucocorticoid resistance. Knockdown or inhibition of CASP1 significantly increased glucocorticoid receptor levels and mitigated glucocorticoid resistance in CASP1-overexpressing ALL. Our findings establish a new mechanism by which the NLRP3-CASP1 inflammasome modulates cellular levels of the glucocorticoid receptor and diminishes cell sensitivity to glucocorticoids. The broad impact on the glucocorticoid transcriptional response suggests that this mechanism could also modify glucocorticoid effects in other diseases

Relationship between Exposure to Vector Bites and Antibody Responses to Mosquito Salivary Gland Extracts

Mosquito-borne diseases are major health problems worldwide. Serological responses to mosquito saliva proteins may be useful in estimating individual exposure to bites from mosquitoes transmitting these diseases. However, the relationships between the levels of these IgG responses and mosquito density as well as IgG response specificity at the genus and/or species level need to be clarified prior to develop new immunological markers to assess human/vector contact. To this end, a kinetic study of antibody levels against several mosquito salivary gland extracts from southeastern French individuals living in three areas with distinct ecological environments and, by implication, distinct Aedes caspius mosquito densities were compared using ELISA. A positive association was observed between the average levels of IgG responses against Ae. caspius salivary gland extracts and spatial Ae. caspius densities. Additionally, the average level of IgG responses increased significantly during the peak exposure to Ae. caspius at each site and returned to baseline four months later, suggesting short-lived IgG responses. The species-specificity of IgG antibody responses was determined by testing antibody responses to salivary gland extracts from Cx. pipiens, a mosquito that is present at these three sites at different density levels, and from two other Aedes species not present in the study area (Ae. aegypti and Ae. albopictus). The IgG responses observed against these mosquito salivary gland extracts contrasted with those observed against Ae. caspius salivary gland extracts, supporting the existence of species-specific serological responses. By considering different populations and densities of mosquitoes linked to environmental factors, this study shows, for the first time, that specific IgG antibody responses against Ae. caspius salivary gland extracts may be related to the seasonal and geographical variations in Ae. caspius density. Characterisation of such immunological-markers may allow the evaluation of the effectiveness of vector-control strategies or estimation of the risk of vector-borne disease transmission

Cytogenetic and Molecular Predictors of Outcome in Acute Lymphocytic Leukemia: Recent Developments

During the last decade a tremendous technologic progress based on genome-wide profiling of genetic aberrations, structural DNA alterations, and sequence variations has allowed a better understanding of the molecular basis of pediatric and adult B/T- acute lymphoblastic leukemia (ALL), contributing to a better recognition of the biological heterogeneity of ALL and to a more precise definition of risk factors. Importantly, these advances identified novel potential targets for therapeutic intervention. This review will be focused on the cytogenetic/molecular advances in pediatric and adult ALL based on recently published articles

Fetal and infant origins of asthma

Previous studies have suggested that asthma, like other common diseases, has at least part of its origin early in life. Low birth weight has been shown to be associated with increased risks of asthma, chronic obstructive airway disease, and impaired lung function in adults, and increased risks of respiratory symptoms in early childhood. The developmental plasticity hypothesis suggests that the associations between low birth weight and diseases in later life are explained by adaptation mechanisms in fetal life and infancy in response to various adverse exposures. Various pathways leading from adverse fetal and infant exposures to growth adaptations and respiratory health outcomes have been studied, including fetal and early infant growth patterns, maternal smoking and diet, children’s diet, respiratory tract infections and acetaminophen use, and genetic susceptibility. Still, the specific adverse exposures in fetal and early postnatal life leading to respiratory disease in adult life are not yet fully understood. Current studies suggest that both environmental and genetic factors in various periods of life, and their epigenetic mechanisms may underlie the complex associations of low birth weight with respiratory disease in later life. New well-designed epidemiological studies are needed to identify the specific underlying mechanisms. This review is focused on specific adverse fetal and infant growth patterns and exposures, genetic susceptibility, possible respiratory adaptations and perspectives for new studies

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency–Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research

Factors affecting mortality in severe traumatic brain injury in adults at a teaching hospital in Dakar

Objective: To assess factors contributing to mortality of adult patients admitted to intensive care units for severe traumatic brain injury (TBI).Patients and methods: This is a retrospective, descriptive and analytical study. Included in the study were all adults patients admitted for severe TBI. From the hospital records, socio-demographic, clinical, and paraclinical data was collected. Data on handling by the intensive care unit and the complications that occurred during this period were also collected. The Epi-data software was used to enter the data and the Epi-info software for the data analysis. The Chi 2 test and Fisher exact test were used for data analysis for probability testing where appropriate. A p-value < 0,05 was considered as statistically significant.Results: Over the period of the study, 124 severe TBI were admitted in the neurological resuscitation unit of the Dakar Fann Teaching Hospital, representing 39.2% of all TBI. The average age of the patients was 41.6 years [15-74 years]. The Glasgow score was between 7 and 8 for 74 patients (60.3%) and between 3 and 6 for 50 patients (39.7%). Mortality rate was at 63.2%. Age ≥” 60 years, low blood pressure, hypoxaemia, and hypernatremia were the factors associated with an increased mortality.Conclusion: Prognosis for severe TBI is narrowly tied to the occurrence of secondary brain attack factors from a systemic origin. Their early prevention and handling should be a primary concern for resuscitation specialists.Keywords: Severe TBI, Secondary brain attacks of systemic origin, Factors affecting Mortalit

Cas Clinique: Occlusion du grêle par hématome pariétal : à propos d’un cas.

L’hématome pariétal du grêle est une complication rare du traitement anticoagulant. Son traitement est médical, conservateur. Nous rapportons un cas traité chirurgicalement après échec du traitement médical. Il s’agit d’un patient de 32 ans reçu aux urgences chirurgicales de l’Hôpital Aristide Le Dantec pour un syndrome subocclusif évoluant depuis deux jours. Il était sous traitement anticoagulant depuis cinq mois pour maladie thromboembolique.Ason admission le bilan d’hémostase retrouvait un taux de prothrombine (TP) à 21 % et un International Normalized Ratio (INR) à 3,94. Le scanner retrouvait un épaississement pariétal circonférentiel d’une anse grêle. L’évolution sous traitement médical avait été marquée par une amélioration du bilan d’hémostase mais persistance et aggravation du tableau occlusif. La laparotomie exploratrice avait permis de retrouver un hématome obstructif du grêle étendu sur 15 cm. Par ailleurs on retrouvait un hématome du sigmoïde non obstructif et un hémopéritoine. Une résection-iléale avec anastomose termino-terminale était réalisée. Le patient décédait en postopératoire immédiat d’un choc cardiogénique. Mots clés : hématome ; anticoagulant ; grêl