HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso.

OBJECTIVE: To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso. RESULTS: Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001). CONCLUSIONS: Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis

Detection and Ranking of Vulnerable Areas to Urban Flooding Using GIS and ASMC (Spatial Analysis multicriteria): A Case Study in Dakar, Senegal

Dakar region is confronted in recent years with episodes of repetitive and devastating floods. The structures in charge of the matter, yet does not have enough knowledge of space and tools to preciselylocate vulnerable areas. It is in this particular context that we have through this study process by coupling GIS and ASMC techniques. We aim in this coupling, to develop an efficient tool for support decision making in terms of identification strategies, intervention or adaptation. The defined criteria for this are: the rainfall, the groundwater level, geology, topography, wetlands, population density, living standards and the type of habitat. We have used an analytical hierarchical process (AHP) by foursteps: a) the breakdown of problematic vulnerabilities; b) scanning and harmonization of layers factors (criteria); c) the weight assignment of different layers criteria according to the comparison procedure in pairs; d) and aggregation criteria layers, through the weighted superposition of the SOC software tool. This has helped us to hierarchically locate the vulnerable are as to flooding. The results have showed a very low vulnerability (1.67%), low vulnerability (50.53%), high vulnerability (43.66%) and a very high vulnerability (4.14%). Approximately, 50% of the Dakar region are vulnerable to flooding and particularly the suburban area concerning the departments of Pikine and Guediawaye. These informations are very useful for governments in the effective and sustainable flood management and identification of priority intervention areas

Infection par le VIH chez les patientes atteintes de cancer du sein en Guinée (Afrique de l’Ouest)

L'objectif était de déterminer la prévalence de l'infection à VIH chez les patientes atteintes de cancer du sein et de comparer les caractéristiques anatomocliques et thérapeutiques de ces cancers du sein par rapports aux patientes non infectées par le VIH. Il s'agissait d'une étude rétrospective et analytique comparant les dossiers de patientes atteintes de cancers du sein histologiquement confirmés, infectées ou non par le VIH à l'unité de chirurgie oncologique de Donka, CHU de Conakry, de 2007 à 2012. Nous avons colligé 278 patientes présentant un cancer du sein dont 14 (5,0%) infectées par le VIH et 264 (95,0%) non infectées par le VIH. Les différences observées entre ces deux groupes de patientes étaient respectivement: âge médian (36,8 vs 49,0 ans), la ménopause (21,4% vs 53,4%), le nombre des patientes traitées (50,0% contre 77,1%) et la survenue de décès (78,6% vs 50,8%). Aucune différence n'a été notée dans la présentation clinique, histologique et le retard de consultation. Dans notre étude, la prévalence de l'infection à VIH chez les patients atteints de cancer du sein est élevée. L'âge jeune des patients, la faible accessibilité au traitement et la mortalité élevée doivent être confirmés par une étude sur un échantillon plus large

Efficacy and safety of primaquine and methylene blue for prevention of Plasmodium falciparum transmission in Mali: a phase 2, single-blind, randomised controlled trial.

BACKGROUND: Primaquine and methylene blue are gametocytocidal compounds that could prevent Plasmodium falciparum transmission to mosquitoes. We aimed to assess the efficacy and safety of primaquine and methylene blue in preventing human to mosquito transmission of P falciparum among glucose-6-phosphate dehydrogenase (G6PD)-normal, gametocytaemic male participants. METHODS: This was a phase 2, single-blind, randomised controlled trial done at the Clinical Research Centre of the Malaria Research and Training Centre (MRTC) of the University of Bamako (Bamako, Mali). We enrolled male participants aged 5-50 years with asymptomatic P falciparum malaria. G6PD-normal participants with gametocytes detected by blood smear were randomised 1:1:1:1 in block sizes of eight, using a sealed-envelope design, to receive either sulfadoxine-pyrimethamine and amodiaquine, sulfadoxine-pyrimethamine and amodiaquine plus a single dose of 0·25 mg/kg primaquine, dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus 15 mg/kg per day methylene blue for 3 days. Laboratory staff, investigators, and insectary technicians were masked to the treatment group and gametocyte density of study participants. The study pharmacist and treating physician were not masked. Participants could request unmasking. The primary efficacy endpoint, analysed in all infected patients with at least one infectivity measure before and after treatment, was median within-person percentage change in mosquito infectivity 2 and 7 days after treatment, assessed by membrane feeding. This study is registered with ClinicalTrials.gov, number NCT02831023. FINDINGS: Between June 27, 2016, and Nov 1, 2016, 80 participants were enrolled and assigned to the sulfadoxine-pyrimethamine and amodiaquine (n=20), sulfadoxine-pyrimethamine and amodiaquine plus primaquine (n=20), dihydroartemisinin-piperaquine (n=20), or dihydroartemisinin-piperaquine plus methylene blue (n=20) groups. Among participants infectious at baseline (54 [68%] of 80), those in the sulfadoxine-pyrimethamine and amodiaquine plus primaquine group (n=19) had a median 100% (IQR 100 to 100) within-person reduction in mosquito infectivity on day 2, a larger reduction than was noted with sulfadoxine-pyrimethamine and amodiaquine alone (n=12; -10·2%, IQR -143·9 to 56·6; p<0·0001). The dihydroartemisinin-piperaquine plus methylene blue (n=11) group had a median 100% (IQR 100 to 100) within-person reduction in mosquito infectivity on day 2, a larger reduction than was noted with dihydroartemisinin-piperaquine alone (n=12; -6·0%, IQR -126·1 to 86·9; p<0·0001). Haemoglobin changes were similar between gametocytocidal arms and their respective controls. After exclusion of blue urine, adverse events were similar across all groups (59 [74%] of 80 participants had 162 adverse events overall, 145 [90%] of which were mild). INTERPRETATION: Adding a single dose of 0·25 mg/kg primaquine to sulfadoxine-pyrimethamine and amodiaquine or 3 days of 15 mg/kg per day methylene blue to dihydroartemisinin-piperaquine was highly efficacious for preventing P falciparum transmission. Both primaquine and methylene blue were well tolerated. FUNDING: Bill & Melinda Gates Foundation, European Research Council

Composition chimique d’un extrait aqueux de bridelia ferruginea benth. (euphorbiaceae) et études de ses effets toxicologique et pharmacologique chez les mammifères.

La caractérisation des constituants chimiques de l’extrait aqueux de Bridelia ferruginea (SEA) a révélé la présence de quinones, de tanins catéchiques et galliques, d’alcaloïdes, de stérols, de polyterpènes, de polyphénols, de composés réducteurs, de flavonoïdes et de saponosides.L’étude de la toxicité aiguë de SEA, réalisée sur des souris, a montré que l’extrait aqueux de Bridelia ferruginea administré par voie orale est modérément toxique (DL50 égale à 3568,88 ± 308,45 mg/kg PC). En revanche, la même substance est très toxique (DL50 égale à 111,38 ± 29,3 mg/kg PC) lorsqu’elle est administrée par voie intrapéritonéale. Pour des doses comprises entre 5.10-3 g/kg de PC et 4.10-2 g/kg de PC, SEA provoque une hypotension dose-dépendante chez le lapin. Cette hypotension étant inhibée par l’atropine, l’extrait aqueux de Bridelia ferruginea contiendrait probablement des substances cholinomimétiques de type muscarinique.Mots-clés : Bridelia ferruginea, toxicologie, phytochimie, pharmacologie

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

GATE : a simulation toolkit for PET and SPECT

Monte Carlo simulation is an essential tool in emission tomography that can assist in the design of new medical imaging devices, the optimization of acquisition protocols, and the development or assessment of image reconstruction algorithms and correction techniques. GATE, the Geant4 Application for Tomographic Emission, encapsulates the Geant4 libraries to achieve a modular, versatile, scripted simulation toolkit adapted to the field of nuclear medicine. In particular, GATE allows the description of time-dependent phenomena such as source or detector movement, and source decay kinetics. This feature makes it possible to simulate time curves under realistic acquisition conditions and to test dynamic reconstruction algorithms. A public release of GATE licensed under the GNU Lesser General Public License can be downloaded at the address http://www-lphe.epfl.ch/GATE/