Sanitary Evacuations at the Maternity Unit of the Social Hygiene Institute (IHS) in Dakar in 2020

Objective: Determine the frequency of evacuations, specify the epidemiological and clinical characteristics of the evacuees, evaluate the data of the evacuation, the management and the maternal-fetal prognosis. Methods: Prospective and descriptive retrospective study concerning obstetrical evacuations received at the maternity ward of the Hospital of the Institute of Social Hygiene in Dakar between January 1 and December 31, 2020, i.e. a period of 12 months. Results: During the study period, we collected 1156 evacuees out of a total of 3507 patients treated in the Service, i.e. a frequency of 33%. The average age of the patients was 27.07 years with extremes of 14 and 46 years. Patients aged between 20 and 29 were the most represented (51.73%). The average parity was 1.6 with extremes of 0 and 10 pares. The nulliparous (46.37%) were the majority. The majority of evacuated patients (99.6%) resided in the Dakar region, including 58% in the suburbs and 42% in the city center. The patients received had performed an average of 3 prenatal consultations with extremes ranging from 0 to 9 CPN. They most often came from health centers (55.05%) or hospitals (29.09%). The reasons for evacuations were dominated by dystocia (21.54%) followed by premature rupture of membranes (17.21%) and premature deliveries (16.35%). On admission, only 176 patients (15.2%) had an evacuation sheet. Patients transited on average through two health structures (extremes ranging from 0 to 7 structures) before reaching the reception structure. The evacuation was most often done with a private vehicle on the patient’s own means (91.96%). The outcome of the evacuees was most often vaginal delivery or hospitalization (72.79%). The majority of patients (99.4%) had evolved favorably but we deplore one maternal death (0.09%) linked to a late puerperal infection. We recorded 74 perinatal deaths and 1041 live births, i.e. a stillbirth rate of 71.1‰ live births. The causes of death were dominated by prematurity (24.7%). Conclusion: Obstetrical evacuations are frequent in our practice but they should be better organized to improve the maternal-fetal prognosis.

High Blood Pressure and Pregnancy: Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Maternity Unit of the Institute of Social Hygiene of Dakar (Senegal)

Objectives: To specify the epidemiological and clinical profile of the patients, to determine the methods of management and to evaluate the maternal and perinatal prognosis in the association of arterial hypertension and pregnancy (HTA) at the Institute of Social Hygiene of Dakar. Material and Methods: This was a retrospective, descriptive and analytical study on the management of the association of hypertension and pregnancy in the maternity ward of the Institute of Social Hygiene of Dakar between January 1st, 2019 and on December 31st, 2020. Results: During the study period, we recorded 326 cases of hypertension associated with pregnancy among the 4290 pregnant women, i.e. a frequency of 7.6%. The epidemiological profile of the patients was that of a woman with an average age of 29, nulliparous (48.2%), married (99.1%), at a low socioeconomic level (61.3%) and with a personal history preeclampsia (14.4%). Most patients (83.1%) were evacuated or referred with pre-ec- lampsia as the main reason (40.8%). The average gestational age was 37 weeks of amenorrhea (SA) with extremes of 20 SA 6 days and 41 SA 5 days. Term pregnancies were the most represented (76.7%). Prenatal follow-up (CPN) was carried out in 319 patients (97.8%) with an average number of CPN of 3 and extremes of 1 and 9. Severe diastolic and severe systolic hypertension concerned respectively 19.3% and 16, 9% of patients. One hundred and eighty patients (55.2%) presented with oliguria. Strip albuminuria was performed in 235 patients (72.1%). It found 3 or more crosses in 38.3% of cases. We recorded 53 cases of anemia (16.3%), 16 cases of significant proteinuria (5%), hepatic cytolysis in 22 patients (6.7%), thrombocytopenia in 37 patients (11.3%), and 43 cases of hyperuricaemia (13.2%). Obstetric ultrasound found 36 cases of severe oligohydramnios (11%), 8 twin pregnancies (2.4%) and an umbilical Doppler anomaly in 10 patients (3.1%). Pre-eclampsia was the most common clinical form (70.5%), followed by chronic hypertension (15.1%) and pregnancy-induced hypertension (14.4%). In our study, 32 patients (9.8%) had received resuscitation. The most used anti-hypertensives were alpha methyl-dopa (46.1%) and nicardipine (24.5%). The obstetrical treatment consisted of uterine evacuation which was most often done by caesarean section (63.1%). Maternal complications were dominated by retroplacental hematoma (16.3%) followed by eclampsia (7.4%) and HELLP syndrome (6.7%). We have not recorded any maternal deaths. Prematurity (19.3%) and intrauterine growth restriction (IUGR) (16.3%) were the most common perinatal complications. Severe and moderate neonatal asphyxia concerned respectively 14.8% and 14.4% of newborns. The birth weight was on average 2400 grams with extremes of 400 and 4500 grams. Low birth weight accounted for 49.5% of the sample. One hundred and twelve newborns (34.4%) were referred to neonatology most often for neonatal asphyxia (29.2%). We recorded 37 fetal deaths in utero (11.3%) and 10 neonatal deaths (3.1%), representing a perinatal mortality of 168.5 per 1000 live births. During the postnatal follow-up, we noted a normalization of the blood pressure figures in 98.8% of the patients. Contraception was instituted in 150 patients (46.1%). These were most often progestogen implants (32.2%) or intrauterine device (IUD) (11.7%). The choice of delivery route was significantly associated with the clinical form. Indeed, caesarean section was more frequent in case of preeclampsia compared to pregnancy-induced hypertension (p = 0.03). Maternal and perinatal complications such as HELLP syndrome (86.4%), PRH (64.2%), eclampsia (79.2%) and UFID (23.6%) were more frequent in cases severe preeclampsia (p = 0.028, p = 0.0001). Conclusion: The association of hypertension and pregnancy is frequent in our practice. Its prognosis is marked by the risk of prematurity, IUGR and maternal complications.

Situation of Water, Hygiene and Sanitation in a Peri-Urban Area in Benin, West Africa: The Case of Sèmè-Podji

This study aimed to analyze the environmental factors related to health vulnerability in the municipality of Sèmè-Podji. For this study, 216 households were surveyed using questionnaires. Twelve key informants were enrolled for depth interviews and 18 water samples were collected from different sources used by the populations. It came out of our investigations that water from traditional sources used at Sèmè-Podji was contaminated by various microorganisms such as Escherichia coli and fecal coliforms. 66.38% of households reject domestic waste and 47.41% of them evacuate sewage in the yard. In addition, 93.05% drop stagnant water for natural infiltration. This municipality faces lack of sanitation. The main health problems experienced by people were malaria (46.35%), diarrheal diseases (15.88%). The study stated some results which could improve the help about health management in the area.

Profile of the Blood Count among People Living with HIV Monitored at the Institute of Social Hygiene and the Aristide Le Dantec Hospital in Dakar

Introduction: The human immunodeficiency virus (HIV) is a pandemic of concern to the World Health Organization. It is all the more worrisome because if not properly managed, it can be responsible for several complications, including abnormal blood counts. These abnormalities may also be related to treatment. Objectives: The main objective of this study is to show that adequate antiretroviral therapy can correct various abnormalities exerted by HIV on patients’ blood counts. The specific objective is to determine all the abnormalities we can see in blood count before and during HIV treatment. Materials and Methods: Our study was conducted in the hematology laboratory and the dermatology departments of the Aristide Le Dantec Hospital and the Institute of Social Hygiene. It took place from December 2009 to October 2011. It is a retrospective descriptive and analytical study involving HIV-positive patients (HIV 1 and 2) and under antiretroviral treatment (at least six months of treatment). We included 110 patients in the study. Blood counts were performed at the hematology laboratory of the Aristide le Dantec hospital using a KX21 automaton. Each patient received three blood counts during the first six months of treatment (M0, M3 and M6). A univariate analysis was performed to determine the profile of the abnormalities of the blood count and the chi 2 test was used and a threshold of p 0.05 was considered significant. Results: The mean age of the patients was 38.6 ± 8.6 years (extremes of 18 and 64 years) with a sex ratio of 0.42 (77 females and 33 males). The prevalence of anemia was 80% (n = 88) at M0, 53, 63% at M3 (n = 59), and 38.20% at M6 (n = 42) (p = 0.02). We noted a favorable evolution with treatment. For the other abnormalities, the evolution was favorable for leukopenia (p = 0.011) and thrombocytopenia (p = 0.007). Conclusion: Our study showed a correction of blood count abnormalities in PLHIV with antiretroviral treatment.

Effect of Maternal DEHP Exposure on Lipid Metabolism in Adult Male Rats and the Antagonistic Effect of Genistein

Lipid metabolism refers to the biochemical processes involved in synthesising,storing,utilising,and breaking down lipids in living organisms.Lipids are essential for various physiological functions,including energy storage,insulation,protection of organs,and the formation of cell membranes.Aberrations in lipid metabolism can lead to a number of health issues,such as atherosclerosis,obesity,and type 2 diabetes,etc.[1].Environmental factors,genetics,and lifestyle factors are some of the factors that can contribute to the development of dyslipidemia.Currently,there is a growing academic interest in the impact of environmental factors.

Effects of forsythin extract in Forsythia leaves on intestinal microbiota and short-chain fatty acids in rats fed a high-fat diet

Forsythia suspensa,belonging to the deciduous shrubs of the Luteaceae family,a traditional Chinese medicine,has effects of alleviating swelling,clearing heat,detoxification and promoting blood circulation.The leaves of F.suspensa contain multiple chemical components and have a long history of use in folk medicines and health foods.The purpose of this study was to explore the effects of forsythin extract from F.suspensa leaves on intestinal microbiota and short-chain fatty acid(SCFA)content in rats with obesity induced by a high-fat diet.Forsythin extract in F.suspensa leaves increased the abundance of the intestinal microbiota,ameliorated intestinal microbiota disorders and inhibited the increase in total SCFA content in the intestinal tract in rats with obesity induced by a high-fat diet.These results suggested that forsythin extract in F.suspensa leaves may slow the development of obesity induced by a high-fat diet;thus,its active components and efficacy are worthy of further study.

Metabolite acetyl-L-carnitine participates in Bifidobacterium animalis F1-7 to ameliorate atherosclerotic inflammation by downregulating theTLR4/NF-κB pathway

This study aimed to explore the effect of Bifidobacterium animalis F1-7 on the improvement of atherosclerotic inflammation.Arteriosclerosis model ApoE^(-/-)mice were orally administered with B.animalis F1-7 for 12 weeks.The probiotic intervention reduced the plaque areas in aorta and the accumulation of macrophages,and downregulated the expression of toll-like receptor 4(TLR4)/nuclear factorκB(NF-κB)pathway to reduce the levels of inflammatory factors.The widely-targeted metabolomics analysis showed that acetyl-L-carnitine(ALC)in the intestine of atherosclerotic mice was significantly increased after B.animalis F1-7 intervention.Correlation analysis proved that ALC was associated with atherosclerotic inflammatory response.By using oxidized low density lipoprotein induced macrophage foam cells,we further verified that ALC could reduce lipid accumulation and inflammatory response in foam cells by downregulating the TLR4/NF-κB pathway.Finally,our results revealed that B.animalis F1-7 upregulated the metabolite ALC to downregulate the inflammatory responses,leading to the reduction of plaque accumulation of atherosclerosis.

Causal relationship between circulating vitamin C and 25-hydroxyvitamin D concentrations and common mental disorders-a Mendelian randomization study

Mental disorders seriously affect people’s health and social stability.This Mendelian randomization(MR)study was designed to investigate the causal relationship between circulating vitamin C(VC)or 25-hydroxyvitamin D(25(OH)D)levels and mental disorders.The data used for the MR analysis were derived from the summary genome-wide association studies(GWAS)database for VC and 25(OH)D and from the Finn Gen consortium for fourteen mental disorders.Based on the inverse variance weighted(IVW)method,we found a potential causal association between circulating VC and anxiety disorders(IVW:OR=1.139,95%CI:1.023-1.269,P=0.018).However,no causal association was found between VC or 25(OH)D and other mental disorders(P>0.05).In the reverse MR analysis,individuals with Alzheimer’s disease was causally associated with higher concentrations of circulating VC(P=0.012),while individuals with anxiety disorders had a negative association between the concentrations of 25(OH)D(P=0.012).However,the current evidence does not support a causal relationship between VC or 25(OH)D and other mental disorders.In addition,there was no causal association between circulating VC and 25(OH)D(P>0.05).Future studies are needed to confirm these findings and to elucidate the mechanisms of potential causality.

Preventive effects of Bifidobacterium lactis Probio-M8 on ovalbumin-induced food allergy in mice

Food allergy is a significant public health concern globally.Certain probiotics have been found to enhance food allergy by regulating immune-microbe interactions in animal models and patients.However,the effects of Bifidobacterium lactis Probio-M8 on food allergy have not been thoroughly investigated.The present study examined the anti-allergic properties of Probio-M8,particularly in relation to immune response and gut microbiota composition.Results demonstrate that oral administration of Probio-M8 effectively mitigated the allergy symptoms triggered by ovalbumin(OVA)by ameliorating the morphological damage in the jejunum,reducing OVA-specific IgE and histamine levels in the serum,and suppressing Th2 cytokines(interleukin(IL)4 and IL-13)while increasing Th1 cytokines(interferon(IFN)γ)and regulatory T(Treg)cytokines(IL-10 and transforming growth factor(TGF)β1)in the culture supernatants of splenic cells.Furthermore,Probio-M8 effectively altered the diversity and composition of gut microbiota,particularly the relative abundances of Akkermansia_muciniphila in OVA-induced mice.Compared to the OVA group,the Probio-M8 group showed a decrease in the relative abundance of Akkermansia_muciniphila.In conclusion,Probio-M8 demonstrates the potential to alleviate food allergy by regulating the Th1/Th2 response and modulating gut microbiota,thereby offering a novel therapeutic strategy for patients with food allergy.

The link between dietary nutrients intake and cardiovascular diseases in cold regions

Background:The cold winter weather in northern China influences the dietary habits of its residents,contributing to a heightened risk of cardiovascular disorders,such as hypertension and coronary heart disease.Key factors include low vegetable consumption and high salt and fat intakes.This study aims to investigate the relationships between northern dietary nutrient intake in northern China and cardiovascular disorders during the winter season.Methods:A food frequency questionnaire tailored to the actual eating habits in northern China was designed.Retrospective data from 955 Chinese adults were collected from November to March between 2014 to 2023.Logistic regression was employed to analyze the relationship between dietary nutrients and cardiovascular diseases,with model performance assessed using receiver operating characteristic(ROC)curves.Results:Adjusted for gender,age,and body mass index(BMI),an inverse association was observed between vitamin A(OR=0.706,95%CI:0.550,0.907),nicotinic acid(OR=0.584,95%CI:0.447,0.762),phosphorus(OR=0.777,95%CI:0.608,0.994),selenium(OR=0.719,95%CI:0.560,0.923),zinc(OR=0.683,95%CI:0.531,0.880),methionine(OR=0.730,95%CI:0.569,0.936),arginine(OR=0.753,95%CI:0.588,0.964),lysine(OR=0.706,95%CI:0.550,0.907),aspartic acid(OR=0.730,95%CI:0.569,0.936)and hypertension.Additionally,a negative association was found between niacin(OR=0.752,95%CI:0.597,0.946)and coronary heart disease.Conversely,a positive association was identified between iodine and hypertension(OR=1.305,95%CI:1.020,1.669)and coronary heart disease(OR=1.301,95%CI:1.037,1.634).Conclusion:Our study suggests that maintaining a balanced dietary intake of vitamin A,niacin,phosphorus,selenium,zinc,methionine,arginine,lysine,and aspartic acid can be beneficial in preventing hypertension.Adequate niacin intake is associated with a lower risk of coronary heart disease.However,excessive iodine intake may contribute to hypertension and coronary heart disease.

Palmitoleic acid on top of HFD ameliorates insulin resistance independent of diacylglycerols and alters gut microbiota in C57BL/6J mice

With the prevalence of obesity and obesity-related metabolic syndrome,such as insulin resistance in recent years,it is urgent to explore effective interventions to prevent the progression of obesity-related metabolic syndrome.Palmitoleic acid is a monounsaturated fatty acid that is available from dietary sources,mainly derived from marine products.P almitoleic acid plays a positive role in maintaining glucose homeostasis and reducing inflammation.However,it is still unknow the mechanism of palmitoleic acid in ameliorating insulin resistance.Here,we investigated the effects of palmitoleic acid on chow diet(CD)-fed and high-fat diet(HFD)-fed mice,which were fed CD or HFD for 12 weeks before administration.We administrated mice with BSA(control),oleic acid,or palmitoleic acid for 6 weeks on top of CD or HFD feeding.We found that palmitoleic acid only improved glucose homeostasis in HFD-fed obese mice by increasing glucose clearance and reducing HOMA-IR.Further study explored that palmitoleic acid changed the composition of gut microbiota by decreasing Firmicutes population and increasing Bacteroidetes population.In colon,palmitoleic acid increased intestinal tight junction integrity and reduced inflammation.Moreover,palmitoleic acid decreased macrophage infiltration in liver and adipose tissue and increase glucose uptake in adipose tissue.Diacylglycerol(DAG)in tissue(for example,liver)is found to positively correlated with HOMA-IR.HFD enhanced the levels of DAGs in liver but not in adipose tissue in this study.Palmitoleic acid did not reverse the high DAG levels induced by HFD in liver.Therefore,in HFD-fed mice,palmitoleic acid reduced insulin resistance by an independent-manner of DAGs.It might be associated with the beneficial effects of palmitoleic acid on altering the gut microbiota composition,improving of intestinal barrier function,and downregulating the inflammation in colon,liver,and adipose tissue.

Phlorizin alleviates deltamethrin-induced oxidative stress in brine shrimp Artemia

Deltamethrin(DEL),a commonly used pyrethroid pesticide,results in higher reactive oxygen species(ROS)levels in aquatic animals,which consequently unbalance the redox state.Phlorizin(PHL)is a flavonoid and a natural product promising to prevent or reduce pesticide-induced oxidative stress.Artemia is a micro-crustacean widely used in marine hatcheries and an experimental aquatic organism for environmental toxicology research.This research aimed to evaluate the toxicity of DEL on Artemia and the antioxidative effect of PHL against the toxicity.Results show that 0.08-mg/mL PHL exerted its antioxidative effects on hatching percentage of the cysts in 24-h incubation and on body length and survival rate of Artemia in 12-d culture.After 12-d culture,12-,24-,and 36-h DEL exposure showed significant drops in SOD,CAT,and GSH-Px enzyme activities,and significant increases in ROS and malondialdehyde(MDA)levels in Artemia(P<0.05).On the contrary,0.08-mg/mL PHL application improved the enzyme activities and decreased the ROS and MDA levels(P<0.05).Moreover,0.08-mg/mL PHL significantly increased mRNA expression levels of Cu/Zn SOD,CAT,GST,HO-1,NQO1,and Nrf2,and decreased mRNA expression level of Keap1 in the DEL-exposed Artemia(P<0.05).Therefore,DEL is toxic to Artemia,while PHL alleviates DEL-induced oxidative damage by possibly regulating the Nrf2signaling pathway.This study provided a theoretical basis for PHL to reduce pesticide-induced toxicity in aquatic animals.

Lecanemab Unveiled:Exploring Alzheimer’s Treatment Advancements,Assessing Strengths,Limitations,and Its Therapeutic Landscape Position

In the ever-evolving landscape of Alzheimer’s treatment,lecanemab(Leqembi)has emerged as a promising drug.Unlike conventional therapies that merely alleviate symptoms,lecanemab is a humanized monoclonal antibody with a distinct focus.It targets protofibrils,insoluble fibrils,amyloid oligomers,and soluble amyloid-beta protofibrils,which are known to be especially damaging to neurons,with high accuracy.

将WHO《心理健康差距干预指南》应用于中国全科医学服务:一项德尔菲研究

背景中国全科医生越来越期望能够识别和预防抑郁障碍,但其接受的心理健康培训有限,社区卫生服务中心(CHCs)也缺乏针对抑郁障碍的诊断和服务规范。WHO《心理健康差距干预指南》第2版(mhGAP-IG.v2)是为非心理健康专业人员提供的决策支持工具,可用于评估、管理、随访精神障碍、神经疾病及物质使用障碍患者。鉴于mhGAP-IG.v2的通用性,其在中国的应用应根据抑郁障碍在不同文化下的差异性和中国心理健康系统特点进行调整。方法开展两轮基于网络的德尔菲(Delphi)调查。邀请来自深圳市的全科医生小组对mhGAP-IG.v2中涉及抑郁障碍的199条表述进行五分制的赞同程度打分,即“如要把该表述用在深圳市,是否赞同调整其内容和结构”。如果>80%的全科医生“有些/肯定赞同”调整某表述,则视为全科医生对调整该表述达成共识;如果>80%的全科医生“有些/肯定不赞同”调整某表述,则视为全科医生对不调整该表述达成共识。结果全科医生对79%的表述达成了需要调整的共识,平均得分为4.26分,即全科医生“有些赞同”对mh GAP-IG.v2中涉及抑郁障碍的相关表述进行调整。具体调整建议包括:抑郁评估方法应考虑更广泛的抑郁症状,并考虑病情的发展阶段;增加抑郁筛查工具的使用指南;明确全科医生的作用,以及家庭参与和跨部门服务的转诊途径;药物治疗建议应与中国用药规范保持一致;指南所有章节要强调预防自杀;情境化健康教育;强调“以人为本”的服务方法。全科医生认为,应维持mhGAP-IG.v2中对经历抑郁发作的双相障碍患者的诊断和治疗建议。结论对mhGAP-IG.v2抑郁部分的调整研究反映出对指南的评估应考虑文化和国情背景,包括中国特色的初级卫生保健系统、健康优先领域、治疗可得性,以及多样化的社会心理教育需要。调整后的mhGAP-IG.v2可以给中国全科医学教育和全科医疗服务提供参考,也可以为其他国家的非精神病学专业人员开展心理健康服务提供有益借鉴。

Evaluation of the Antibacterial and Antifungal Capacity of Nanoemulsions Loaded with Synthetic Chalcone Derivatives Di-Benzyl Cinnamaldehyde and Benzyl 4-Aminochalcone

With the increase in antimicrobial resistance,it has become necessary to explore alternative approaches for combating and preventing diseases.DB-cinnamaldehyde(CNM)and Benzyl4-amino(B4AM)are bioactive compounds derived from chalcones but with restricted solubility in aqueous media.Nanoemulsions can enhance the solubility of compounds and can be a promising alternative in the development of novel antimicrobials,with reduced side effects and prolonged release.The objective of this study was to evaluate the stability of oil-in-water nanoemulsions loaded with two distinct types of chalcones at two different dosages,to propose a stable formulation with antimicrobial properties.Results showed that nanoemulsions presented high encapsulation efficiency,low polydispersity index(PDI)and particle size below 200 nm,indicating that emulsification was a suitable method for nanoemulsion preparation.Nanoemulsions with higher dosages exhibited significant antimicrobial effects when compared to free chalcones and positive controls.Notably,B4AM nanoemulsions at higher dosages showed expressive activity against Salmonella minnesota,with a 420%greater inhibitory response compared to the free form and showing equivalence to the positive control.CNM nanoemulsions showed excellent inhibitory activity at the highest dosage,equivalent to the positive control against S.minnesota and Staphylococcus aureus.The greater number of conjugated bonds in CNM increased the antimicrobial activity in comparison with B4AM,and the formation of nanometric domains enhanced the bioavailability,being a promising alternative for antimicrobial applications.

Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients

BACKGROUND Bacterial infections(BI)negatively affect the natural course of cirrhosis.The most frequent BI are urinary tract infections(UTI),pneumonia,and spontaneousbacterial peritonitis(SBP).AIM To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables.METHODS We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center.BIs were classified as typical and atypical,and clinical as well as laboratory parameters were compared between the two groups.RESULTS In a cohort of 488 patients with cirrhosis,we identified 225 typical BI(95 UTI,73 SBP,72 pulmonary infections)and 74 atypical BIs,predominantly cholangitis and soft tissue infections(21 each),followed by intra-abdominal BIs(n=9),cholecystitis(n=6),head/throat BIs(n=6),osteoarticular BIs(n=5),and endocarditis(n=3).We did not observe differences concerning age,sex,or etiology of cirrhosis in patients with typical vs atypical BI.Atypical BIs were more common in patients with more advanced cirrhosis,as evidenced by Model of End Stage Liver Disease(15.1±7.4 vs 12.9±5.1;P=0.005)and Child-Pugh scores(8.6±2.5 vs 8.0±2;P=0.05).CONCLUSION Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease.Hence,the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.

Evaluation of the Use of Long-Lasting Impregnated Mosquito Nets (LLINs) in the Health District of Dimbokro (Center of Côte d’Ivoire)

The Dimbokro health district has one of the highest incidences of malaria in Côte d’Ivoire, despite numerous campaigns to distribute Long-Acting Impregnated Mosquito Nets (LLINs). Given this observation, what are the population’s attitudes towards LLINs that could explain the high endemicity of malaria in Dimbokro? The aim of this study is to assess the knowledge, attitudes and practices of people in the health area of Nofou, one of the villages in the Dimbokro health district where malaria is most prevalent, with a view to strengthening malaria control strategies. A collection of historical health data (malaria cases and LLIN usage rates) and a cross-sectional questionnaire survey was carried out from July 20 to August 03, 2022 in 400 households selected by systematic random sampling. Data were entered using Epi Info 7 and multivariate statistical analyses were performed using IBM SPSS 22 software. In the Dimbokro health district, the rate of LLIN use was negatively correlated (r = -0.771) with malaria incidence over the six years of historical data collection. Households had an average of 53% good knowledge, 68.6% good practices and 28.4% good attitudes towards LLINs. The study also revealed that the main factors explaining LLIN use in the Nofou health area are mosquito bite (ORa = 5.29 (1.12 - 25.04)), age of household members (ORa = 1.07 (1.01 - 1.14)) and marital status (ORa = 8.45 (1.70 - 45.02)). Awareness-raising on the use of LLINs should be intensified in the Dimbokro health district. Other control strategies, such as vector control and environmental sanitation, should be considered to combat malaria.

Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection

BACKGROUND Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection(ESD);however,the preoperative evaluation of tumor size is often different from histological assessment.Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD.METHODS This was a retrospective study conducted at a single institution.A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected.We first assessed the difference in size with an absolute per-centage of the scaling discrepancy.Subsequently,we compared the clinicopatho-logical characteristics of the correct scaling group(>-33%and<33%)with that of the incorrect scaling group(<-33%or>33%),which was further subdivided into the underscaling group(-33%or less of the discrepancy)and overscaling group(33%or more of the discrepancy),respectively.As secondary outcome measures,parameters on size estimation were compared between the underscaling and correct scaling groups,as well as between the overscaling and correct scaling groups.Finally,multivariate analysis was performed in terms of the following relevant parameters on size estimation:Pathological size,location,and possible influential factors(P<0.1)in the univariate analysis.RESULTS The mean of absolute percentage in the scaling discordance was 21%,and 91 lesions were considered to be incorrectly estimated in size.The incorrect scaling was significantly remarkable in larger lesions(40 mm vs 28 mm;P<0.001)and less experience(P<0.001),and these two factors were influential on the underscaling(75 lesions;P<0.001).Conversely,compared with the correct scaling group,16 lesions in the overscaling group were significantly small(20 mm vs 28 mm;P<0.001),and the small lesion size was influential on the overscaling(P=0.002).CONCLUSION Lesions indicated for colorectal ESD tended to be underestimated in large tumors,but overestimated in small ones.This discrepancy appears worth understanding for optimal procedural preparation.

Eco-Epidemiological Characteristics of Human Rabies in Côte d’Ivoire, 2012-2017

Introduction: Human rabies is a major public health problem in many African countries, including Côte d’Ivoire. The present work aims at describing the eco-epidemiological characteristics of human rabies cases recorded in Côte d’Ivoire. Methods: This was a retrospective and prospective cross-sectional descriptive study based on epidemiological surveillance data that ran from september 2014 to december 2017. The clinical data were extracted from the database of the human rabies epidemiological surveillance management service of the National Institute of Public Hygiene’s rabies centre. These data cover the period from 1 January 2012 to 31 December 2017. Results: Human rabies is endemic in Côte d’Ivoire, with most people exposed in the south and especially in the west of the country. There was no association between any of the climatological parameters (temperature, humidity, rainfall) and the occurrence of human rabies during the months of exposure to rabies infection. Conclusion: Ultimately, effective prevention and control of human rabies requires a thorough understanding of the links between climatological parameters and rabies. Health authorities must take ownership of these results if we are to achieve our goal of eliminating rabies by 2030.

Treatment of Synovial Cysts in Relation to the Tibial Tunnel of Anterior Cruciate Ligament Grafts by Filling the Tunnel with Acrylic Cement

Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.