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The 7SK ribonucleoprotein (RNP) is a dynamic and multifunctional regulator of RNA Polymerase II (RNAPII) transcription in metazoa. Comprised of the non-coding 7SK RNA, core proteins, and numerous accessory proteins, the most well-known 7SK RNP function is the sequestration and inactivation of the positive transcription elongation factor b (P-TEFb). More recently, 7SK RNP has been shown to regulate RNAPII transcription through P-TEFb-independent pathways. Due to its fundamental role in cellular function, dysregulation has been linked with human diseases including cancers, heart disease, developmental disorders, and viral infection. Significant advances in 7SK RNP structural biology have improved our understanding of 7SK RNP assembly and function. Here, we review progress in understanding the structural basis of 7SK RNA folding, biogenesis, and RNP assembly.

Fulgurites have been documented in geological deposits from throughout Earth's history. They have also been assigned a potential role in prebiotic chemistry as a source of reactants. Fulgurites are generated in nature by cloud-to-ground lightning strikes. The unpredictability in space and time of the occurrence of lightning events has limited the investigation of both the mechanisms by, and the conditions under, which fulgurites form. A laboratory-based approach can ameliorate this. Here, we describe experimentally generated fulgurites generated from Laacher See volcanic ash. We employ a DC source with a trigger-pulse setup in a high voltage laboratory, whose capabilities enable experimental conditions that correspond closely to the electrical characteristics of natural lightning strikes. The experimentally generated fulgurites closely resemble naturally-occurring fulgurites in both state and texture. These experimental investigations yield a high reproducibility of the characteristic of fulgurites generated under well-constrained conditions, enabling some inferences to be made regarding the processes involved in the generation of fulgurites in nature. This work provides a basis for a systematic characterization of experimental fulgurites and the characteristic of lightning discharges.

INTRODUCTION: The gynecological tumors of the patient aged over 70 constitute heterogeneous entities by their oncological and geriatric clinical presentations, which frequently expose to the proposal of “non-standard”, “adapted” or “exceptional” therapies. In Sub-Saharan Africa, cancer is a scourge whose characteristics remain to be clarified, marked by very limited means, and especially by the context of practice in rural areas. We describe in this clinical case the particularity of the management in a rural context of a case of endometrial tumor in an 83-year-old patient at stage IB. OBSERVATION: This is Mrs. M.G., aged 83 4G 4P 4 children, postmenopausal for 30 years who consults for postmenopausal metrorrhagia evolving for 3 months. A diagnostic hysteroscopy was performed showing an ulcerated mass of the uterine cavity bleeding on contact, a biopsy was performed, the result of which was a low-grade endometrial stromal sarcoma. The abdominopelvic CT scan, which demonstrates thickening of the endometrium without damage to surrounding structures, classified as stage IB endometrial tumor. The patient underwent a total hysterectomy with bilateral pelvic dissection. The postoperative course was simple. The patient was discharged on the 7th postoperative day. The result of the histological report: well-differentiated and infiltrating endometroid carcinoma invading the isthmus and the cervix. Parameters and the 4 right and left lymph nodes are unharmed. The histo-prognostic stage was pT2N0Mx. CONCLUSION: The management of endometrial cancer is possible in the rural context in elderly patients. The prognosis is good if the diagnosis is made at an early stage. Surgery could still be offered even for subjects over 80 with less comorbidity. KEYWORDS: Endometrial tumors; Elderly patient; Senegal.

Resume Introduction La deshydratation hypernatremique du nouveau-ne (DHNN) est une situation frequente, particulierement dans les pays en developpement. L’objectif etait d’evaluer la frequence, la clinique, les facteurs de risque et le pronostic de la DHNN dans une unite de soins intensifs neonatals de reference au Senegal. Patients et methode Etude retrospective descriptive et analytique, du 1er janvier 2013 au 31 decembre 2017 (5 ans). L’hypernatremie etait definie par une natremie ≥ 150 mmol/L. Les donnees etaient recueillies sur Excel et analysees a l’aide du logiciel R 3.5.0. Resultats Nous avons recense 235 cas, soit 8,6 % des admissions, avec un âge moyen de 10,2 jours et un sex-ratio de 0,91. La majorite (70 %) des cas etait survenue entre juin et novembre, periode chaude de l’annee et 63 % des enfants recevaient un allaitement maternel exclusif. La symptomatologie clinique etait dominee par la fievre (68,9 %), le refus de teter (51,9 %) et les signes neurologiques (26,8 %). La perte de poids moyenne etait de 13,9 % du poids de naissance. Les principales complications etaient detresse respiratoire (25 %), le choc hypovolemique (11 %), les convulsions (15 %). L’hypernatremie etait superieure a 170 mmol/L dans 25,1 % des cas. Les anomalies biologiques associees etaient l’insuffisance renale (17 %), l’hyperkaliemie (28,9 %) et l’hypoglycemie (10,6 %). L’echec de l’allaitement maternel representait 62 % des circonstances etiologiques. Dans 68,9 % des cas, la vitesse de correction de la natremie etait inferieure a 0,5 mmol/L/h. La letalite etait de 26,8 % (63 deces). Conclusion La DHNN est associee a une morbi-mortalite elevee et doit etre prevenue par des mesures de promotion de l’allaitement maternel et une surveillance ponderale dans les premiers jours de vie.

Kaposi’s Disease or Kaposi’s Sarcoma (SK ) is a multifocal malignant proliferation induced by viral growth factors, including interleukin 6 of human herpes virus type 8 (HHV8). We describe four forms of this disease who poses a real public health problem in East and Central Africa. The purpose of our observation was to report a rare condition in a Senegalese HIV-positive child. It was an 11-year-old girl from a region in central Senegal. She was an orphan of both parents, tested and monitored since the age of 5 for HIV infection 1. She was on the 1st line protocol. Due to a lack of support and good observance, she was referred to us at the age of 11 for follow-up in our structure in the suburbs of Dakar. The initial follow-up assessment showed a very low CD4 count and a very high viral load. Before the lack of clinical and immune-virological response, a genotypic resistance test was performed and showed immunological and virological failure. The initial development was marked by the appearance of lesions which were highly suggestive of Kaposi’s disease. She was on 2nd line treatment. The histopathological aspect of cutaneous biopsy was very suggestive of Kaposi’s disease. The subsequent course after ART and bleomycin treatment was clinically marked by regression of skin lesions. Virologically, it was marked by a fall in the viral load. Immunologically there was a gradual recovery of CD4 levels which came back to normal. Our observation demonstrates that absence of effective antiretroviral therapy for HIV increases the risk to develop Kaposi’s sarcoma.

Reliability of power electronics is one most critical challenge to face in order to improve the reliability of wind turbine system (WTS). As the power of the wind turbine is increasing, different topologies of power converters are developed for wind turbine applications. The three-level Neutral-Point Clamped (NPC) converter is widely used in WTS, since it has many advantages like a large output capacity, high output voltage and low current Total Harmonic Distortion (THD). However, the topology of these converters has a large number of switches which are fragile components. Open circuit is one of the most common failures in these converters and causes considerable economic damage in wind power systems. This paper presents an open-circuit fault diagnosis method for a three-level NPC inverters based on current and charge distortion in the output of the inverter. The operation of the NPC inverter under normal and open-circuit fault are analyzed. Simulations results of the converter control and the fault diagnosis method are presented and discussed.

The load flow into hybrid grid needs to manage the level of electrical power generations and storage energy. The efficient control of energy storage to match the fluctuation of load demand and estimated generation of wind energy is the main contribution of this paper. The strategy used to control the constant time of frequency approach applied to batteries depend on the operation condition of wind farm turbine system. The charge and discharge of batteries is consider on the control strategy to keep its state of health and deliver the energy at bad weather conditions. The obtained results of proposed control are adopted to manage the efficient performance of the hybrid wind system.

Introduction: Adequate glycemic control with intravenous insulin therapy in the postoperative period of coronary artery bypass grafting (CABG) in an intensive care unit (ICU) reduces unfavorable clinical outcomes, such as mortality, acute kidney injury (AKI), arrhythmias and nosocomial infection. After discharge from ICU, even still hospitalized, adherence to consensus on inpatient insulin therapy is low, and about 50% of patients do not receive adequate subcutaneous insulin therapy in the ward, consequently in-hospital hyperglycemia (IH) is frequent. Medical apps are increasingly facilitating the medical routine. InsulinAPP is a digital protocol for inpatient glycemic management and already validated. A 16% reduction in blood glucose (BG) has been demonstrated in clinical patients with this protocol. Method: Prospective randomized trial was performed on diabetic patients in CABG postoperative period, after discharge from ICU. The groups were randomized according to the glycemic control protocol: InsulinAPP group (APP) or protocol defined by the assistant team (ST - standard group). The aim is to compare the groups regarding the composite outcome of AKI, nosocomial infection and atrial fibrillation. Results: A total of 41 patients were evaluated (15 in APP and 26 in ST). There was no difference between APP vs. ST group in age (65.1±9.8 vs. 65.1±9.8 years), female gender (40 vs. 46%), body mass index (28.5±4.9 vs. 27.3±5.1 Kg/m2) and estimated glomerular function (68.0±24.1 vs. 69.1±24.5 mL/min, respectively). APP had better BG than ST group (162±28.6 mg/dL vs. 183±34.4 mg/dL, respectively; p = 0.036). Besides, in APP there was a significant reduction of the composite outcome (27% vs. 77%, p=0.002), infection (20% vs. 61%, p Conclusion: The InsulinAPP protocol was more effective in glycemic control and in reducing unfavorable outcomes in the postoperative period of cardiac surgery after discharge from the ICU. Disclosure A. B. Camara de souza: None. M. T. Toyoshima: None.

Resume Le but de notre travail etait d’evaluer le taux de couverture de la supplementation en vitamine A pour les enfants âges de 6 a 59 mois au Senegal apres deux passages d’intensification en 2011 dans 12 regions du Senegal a l’exception de Ziguinchor et Sedhiou. La base de sondage etait constituee des enfants de 0 a 5 ans denombres par le service national des statistiques et de l’information sanitaire (SNIS) en 2011 dans son dernier rapport d’activites avec une repartition de la population par region et par district. Sur cette base, un echantillonnage aleatoire par grappe a deux degres a ete choisi. Dans chaque region, la taille minimale de l’echantillon a ete calculee grâce au logiciel Ena Alpha. C’est ainsi qu’un echantillon de 303 menages correspondant aux 30 grappes de 11 menages par region ont ete obtenus (soit un total de 3636 menages pour 360 grappes pour les 12 regions retenues). Dans chaque menage une mere d’enfants de 6 a 59 mois a ete choisie au hasard. Nos resultats montrent que la couverture en vitamine A des enfants âges de 6 a 59 mois au niveau des 12 regions etait de 90,4 % en juin 2011 et 93,5 % en decembre 2011. Considerant l’objectif de 95 % de couverture recommandee par le plan national strategique de survie de l’enfant, seules les regions de Fatick et de Kaolack avaient des taux satisfaisants pour la vitamine A aux 2 JLS de 2011. Par ailleurs 88 % des enfants dans les 12 regions avaient recu la vitamine A aux deux passages des journees locales de supplementation.

Introduction: Breastfeeding is the benchmark for feeding infants during the first months of life, regardless of their birth weight. The objective of our study was to compare the weight growth of a cohort of low birth weight (LBW) newborns in the first 6 months of life according to the type of breastfeeding adopted by the mother. Methodology: It was a prospectiveand analytical study of a cohort of newborns from LBW. It took place over a period of 17 months at the level of a reference structure in Dakar. We have included all newborns born “in-born” weighing less than 2500 g with a threshold of 1000 g. The data was analyzed with SPSS version 17 software. Results: The average birth weight of newborns was 1821.8 g with extremes ranging from 1000 g to 2400 g and the median weight of 1840 g. The majority of our population had a birth weight ≥ 1500 g (83%) with more than half of them being premature (58.9%). Depending on the type of breastfeeding adopted by the mother, 33/112 newborns were on exclusive breastfeeding (EBF). During the first 6 months of life, the average weight gain was significantly better in infants on EBF (747.9 g) compared to infants on mixed breastfeeding (728.9 g) and artificial breastfeeding (676.6 g). Conclusion: Better awareness of mothers should be made during hospitalization and during follow-up consultations for newborns of LBW to encourage the continuation of the EBF which remains the best food for this infant population.

Hypoxaemia is a predictor of pneumonia-related mortality. WHO published recommendations for oxygen therapy based on clinical signs which state that, when oxygen is plentiful, it should be given to children with central cyanosis, inability to drink, severe chest indrawing, RR >70 breaths/min, grunting with every breath (in young infants) or those who display head nodding. These guidelines, however, are based on a few studies only. To assess the accuracy of combinations of clinical signs which predict hypoxaemia in pre-school children aged 2 months to 5 years with acute respiratory distress in hospitals in Switzerland and Senegal. This observational study was conducted in four emergency units, two in Switzerland and two in Senegal. Patients aged 2 months to 5 years with acute respiratory distress were eligible for inclusion. Clinical signs were compared with transcutaneous blood saturation levels (SaO 2 ). About 111 children were assessed, 67 in Switzerland and 44 in Senegal. The prevalence of hypoxaemia was 13%. Twelve models of combined symptoms were analysed. The WHO model, for when oxygen supply is ample, had the highest diagnostic performance with a sensitivity of 0.93 and a specificity of 0.60. Clinical signs alone are unreliable for the detection of hypoxaemia. The current WHO model, for ample oxygen supply proved to be the best clinical predictor, although a great number of non-hypoxaemic children were unnecessarily treated because of the low specificity of this model.

Introduction La rehabilitation respiratoire est desormais largement reconnue comme etant l’une des prises en charge les plus efficaces pour ameliorer les symptomes et la qualite de vie des patients atteints de BPCO. Il a ete montre que les benefices cliniques de la rehabilitation sont ameliores par l’utilisation d’une monotherapie bronchodilatatrice de longue duree d’action. Le but de cette etude est de determiner si l’utilisation d’une double bronchodilatation permet d’augmenter les benefices cliniques de la rehabilitation pulmonaire versus une monotherapie. Methodes OBALPA est une etude observationnelle prospective, incluant 94 patients BPCO (stade 2-3 de GOLD), comparant des patients traites par mono ou double bronchodilatation, apres qu’ils aient beneficie de 20 seances de rehabilitation respiratoire. Le critere de jugement principal etait l’evolution de scores de qualite de vie. Les criteres de jugement secondaires etaient l’evolution du perimetre de marche au test de marche de 6 minutes, de la dyspnee, du score d’activite physique (Ricci-Gagnon), et du score de BODE. Resultats Comme attendu, la rehabilitation respiratoire a permis d’ameliorer de maniere significative la qualite de vie, la dyspnee, la distance au test de marche, et l’index de BODE des patients BPCO. Cependant, cette amelioration clinique n’etait pas significativement differente, que les patients soient traites par un ou deux bronchodilatateurs. Conclusion Bien que l’utilisation d’un bronchodilatateur de longue duree d’action impacte significativement les resultats cliniques de la rehabilitation, les resultats de cette etude suggerent qu’une association anticholinergiques et β-2 agonistes de longue duree d’action n’est pas associee a un benefice clinique supplementaire.

International audience; This paper deals with the presentation of some of the issues and perspectives of electrification in West Africa. Due to poverty and technological weakness, the electrical grid is made of a dispersed low density of consumption points, in a very vast geographical area. Many solutions including Renewable Energy Source (RES) intended to solve the access to energy for people have been implemented. But common solutions in terms of power availability and quality are not effective, especially in rural areas. The opportunity given by renewable energy resources integration, is not yet effective, considering novelty of the approaches of distributed generation and micro grid applications. The inventory of operational power plants and the planned ones in West Africa is discussed. A state of the art of the potentialities of microgrid (MG) thought as efficient solutions to those issues in the literature are presented.; Cet article traite de la présentation de certains enjeux et perspectives de l'électrification en Afrique de l'Ouest. En raison de la pauvreté et de la faiblesse technologique, le réseau électrique est constitué d'une faible densité dispersée de points de consommation, dans une zone géographique très vaste. De nombreuses solutions dont les sources d'énergie renouvelables (SER) destinées à résoudre l'accès à l'énergie des personnes ont été mises en œuvre. Mais les solutions communes en termes de disponibilité et de qualité de l'énergie ne sont pas efficaces, en particulier dans les zones rurales. L'opportunité offerte par l'intégration des ressources d'énergie renouvelable n'est pas encore effective, compte tenu de la nouveauté des approches de production distribuée et des applications de micro-réseaux. L'inventaire des centrales électriques opérationnelles et celles prévues en Afrique de l'Ouest est discuté.

Le bilan de l’activite du centre de traitement Ebola (CTE) de Forecariah (Guinee maritime) du 23 avril au 5 juin 2015 est ici presente. La charge virale du virus Ebola a ete evaluee par la mesure du cycle threshold (Ct). Cent trente personnes ont fait l’objet d’un triage, 24 (18,5 %) ne repondant pas aux criteres de l’OMS d’une fievre hemorragique n’ont pas ete admises au CTE. Parmi les 106 patients admis au CTE, 72 (67,9 %) ont ete declares non-cas a l’issu de la negativite de deux PCR pratiquees a 48 heures d’intervalle. Trente-quatre patients etaient atteints de maladie a virus Ebola (MVE): 19 femmes et 15 hommes (sex-ratio: H/F = 0,78), âge moyen: 33,51 ± 20,1 ans (extremes 42 jours a 70 ans), dont six enfants de moins de huit ans. Leur Ct initial median etait de 21,6 ± 6,3 cycles. La notion de contact n’a ete retrouvee que chez 20 d’entre eux (58,8 %). Treize patients ont gueri: six hommes et sept femmes, d’âge moyen 31,8 ans (extremes: 4–52 ans), presentant a l’admission un Ct median egal a 21,88 ± 6,2 cycles (extremes: 17,6–31,7). Parmi les six enfants de moins de huit ans, un seul a survecu. Vingt et un patients avec MVE sont decedes (61,76 %): 9 hommes et 12 femmes, d’âge moyen 34 ± 24 ans (extremes: 42 jours–70 ans), presentant a l’admission un Ct median egal a 18 ± 7 cycles (extremes: 12–24). Le seul facteur associe a la mortalite etait le Ct a l’admission (p = 0,0004). Il ressort de cette analyse statistique que plus la charge virale est elevee, plus la probabilite d’avoir une forte letalite est presente. L’âge, le sexe, la notion de contact, le delai entre l’apparition des symptomes et l’admission n’etaient pas predictifs de la survenue du deces dans cette serie.

La maladie a virus Ebola (MVE) occasionne une forte letalite, meme prise en charge dans un centre de traitement Ebola (CTE). Des examens de laboratoire de base peuvent aider a mieux en comprendre la physiopathologie, a guider le traitement et a etablir des conduites a tenir simples sur la base de protocoles adaptes a l’exercice de la medecine en milieu precaire et dangereux pour les soignants. Base sur quelques cas cliniques de patients pris en charge au CTE de Forecariah en Guinee, tenu par la Croix-Rouge francaise, cet article decrit les difficiles conditions d’exercice de la medecine aupres des patients atteints de MVE. Il a pour objectif de participer a la reduction des pertes de chance de survie des patients, par l’instauration d’une confrontation clinico-biologique simple et par l’amelioration de la formation des personnels de sante.

Introduction Varicose veins represent the non-reversible extension and elongation that occurs through profound pathological alterations of the venous wall and valve system. The interest in the issue of varicose veins is probably due to the lack of previous studies, but also the frequency of them in our service. The purpose of our work is to determine the epidemiological, clinical profile of varicose veins and to assess their management. Methodology This is a descriptive retrospective study from 1 June 2017 to 31 December 2018. All patients with varicose veins with complete records, treated medically and/or surgically during our study period were included in our study. Results In our work, lower limb varicose veins occupy 2.18% with a male predominance of 0.85. The average age was 30.82 with extremes: 19 and 74. A peak occurred between 45 and 54 years of age (26.92% of patients) and between 55 and 64 years of age (23.07% of patients); 26.91% of patients were under 36 years of age. We had 23 cases of essential varicose veins (88.46%) including 7 cases with a family history of member varicosity (26.92%) and 9 cases (34.61%) with no risk factors. Lower extremity pain was found in all patients and 80.79% of patients had varicose thrombosis. The large vein was affected in 26 cases (76.47%), the external saphenous vein (2.94%), the accessory saphenous vein (4.05%) and the leg perforating veins in 7 cases (20.58%). Internal crossectomy and saphenous deworming were the most common 50% (17 cases), followed by tiered ligatures combined with internal saphenomy 32.35% (11 cases). Stripping was the technique of choice in the surgical management of our patients given our context. Conclusion Varicose veins are becoming increasingly common in the adult population.Their treatment by conventional surgery combined with elastic restraint remains topical alongside cryosurgery, cryoventing, more recently the hemodynamic conservative cure of venous insufficiency in ambulatory.

Background:Vitamin D (VD) deficiency affects individuals of different ages in many countries. VD deficiency may be related to several diseases, including cancer.Objective:This study aimed to review the relationship between VD deficiency and cancer.Methods:We describe the proteins involved in cancer pathogenesis and how those proteins can be influenced by VD deficiency. We also investigated a relationship between cancer death rate and solar radiation.Results:We found an increased bladder cancer, breast cancer, colon-rectum cancer, lung cancer, oesophagus cancer, oral cancer, ovary cancer, pancreas cancer, skin cancer and stomach cancer death rate in countries with low sunlight. It was also observed that amyloid precursor protein, ryanodine receptor, mammalian target of rapamycin complex 1, and receptor for advanced glycation end products are associated with a worse prognosis in cancer. While the Klotho protein and VD receptor are associated with a better prognosis in the disease. Nfr2 is associated with both worse and better prognosis in cancer.Conclusion:The literature suggests that VD deficiency might be involved in cancer progression. According to sunlight data, we can conclude that countries with low average sunlight have high cancers death rate. New studies involving transcriptional and genomic data in combination with VD measurement in long-term experiments are required to establish new relationships between VD and cancer.

This research aimed to analyze the epidemio- clinical characteristic and the prognosis of patients with eclampsia admitted to the intensive care unit at the University Hospital of Point G.The clinical records of all patients admitted to intensive care for eclampsia from September 2009 to February 2011 were retrospectively collected. We analyzed the following parameters: age, parity, gravidity, the admission deadline, the beginning of eclampsia compared to the term of pregnancy, the number of seizure, mode of delivery, score of Glasgow, blood pressure, proteinuria, complications and evolution.Among 702 admissions, 158 patients, with a mean age of 20 ± 4 were hospitalized for eclampsia (22.5%). We recorded 106 cases of first pregnancies (67.1%) and 104 primiparous (65.8%). The admission period after the first seizure was over 6 hours for 90 patients (57%). The first seizure had occurred in ante-partum period for 69 patients, in per-partum period for 4 patients and in postpartum period for 85 patients.Ninety-three patients (59%) had consciousness disorders at admission, 12 patients received oxygen treatment .Vaginal delivery was the mode of delivery for 93 patients and cesarean section for 65 patients.Eclampsia was associated with renal failure in 25 patients, HELLP syndrome for 15 patients, the stroke for 5 patients, acute pulmonary edema for 3 patients, the coagulation disorders for one patient; and the sepsis for 6 patients. Maternal and perinatal lethality was 9.5% and 10.8% respectively.Eclampsia is a frequent medical and obstetric emergency in intensive care unit of the University Hospital of Point G and affects young patients during their first pregnancy and delivery. Maternal and perinatal lethality remains high, due to the delay in the cases management and the associated factors of gravity. Strong actions are needed to raise awareness for early medical visit and to prepare medical teams for better cases management.Analyser les caractéristiques épidémio - clinique et le pronostic de l'éclampsie en réanimation au centre hospitalier et universitaire (CHU) du Point G.Les dossiers cliniques de toutes les patientes hospitalisées en réanimation pour une éclampsie de septembre 2009 à février 2011 ont été colligés de façon rétrospective. Nous avons analysé les paramètres suivants: l'âge, la parité, la gestité, le délai d'admission, le délai de survenue de l'éclampsie par rapport au terme de la grossesse, le nombre de crise convulsive, le mode d'accouchement, le score de Glasgow, la pression artérielle, la protéinurie, les complications et l'évolution.Sur 702 admissions, 158 patientes, d'âge moyen 20 ans ± 4 ont été hospitalisées pour éclampsie (22,5%). Nous avons enregistré 106 dossiers de primigestes (67,1%) et 104 primipares (65,8%). Le délai d'admission après la première crise convulsive était supérieur à 6 heures chez 90 patientes (57%). La première crise convulsive était survenue en antépartum chez 69 patientes, en perpartum chez 4 patientes et en postpartum chez 85 patientes. Quatre vingt treize patientes (59%) avaient présenté des troubles de la conscience à l'admission, 12 patientes ont été mises sous assistance ventilatoire. La voie basse était le mode d'accouchement chez 93 patientes, et la césarienne chez 65 patientes. L'éclampsie était associée à l'insuffisance rénale chez 25 patientes, au HELLP-syndrome chez 15 patientes, à l'accident vasculaire cérébral chez 5 patientes, à l'œdème aigue du poumon chez 3 patientes, aux troubles de la coagulation chez une patiente; et une septicémie était retrouvé chez 6 patientes. La létalité maternelle et périnatale était respectivement de 9,5 % et de 10,8 %.L'éclampsie est une urgence médico — obstétricale fréquente au service de réanimation du CHU du Point G et touche les patientes jeunes primigesteset primipares. La létalité maternelle et périnatalereste élevée, liée au retard de la prise en charge et aux facteurs de gravité associés. Pour renverser cette situation il est nécessaire de sensibiliser les populations pour une consultation précoce mais aussi de mieux préparer les équipes médicales pour une meilleure prise en charge.

The aim of this study was to take stock of the practice of the loco-regional anesthesia (LRA) at the University Hospital Center of Point G from January 2004 to December 2008.This is a retrospective study, assessing the practice of LRA. The demographic data, the surgery, the technical characteristics of the procedure made, the type of local anesthetic used, adverse events were evaluated.The LRA involved 1261 patients - 8.30% of the total number of surgical procedures occurring during the studied period. The American Society of Anesthesiology (ASA) classification was used for the evaluation of patients in scheduled surgery. The patients belonged to class 1 (50.40%) and Class 2 (49.60%). The main surgical procedures were: 26.20% surgical prostatic adenomectomy, 23.80% of caesarean section, and the fistulogram test for 19.04%. The LRA techniques performed were: spinal anesthesia, 87.60%, epidural anesthesia, 12%. Three hundred and three adverse events (24%) have been reported, three (1%) of them have resulted in the death of the patient. The incidence of arterial hypotension was 94.40%, and 4.6% for bradycardia. The three heart attacks were fatal (0.024 ‰). Patients operated under spinal anesthesia and patients aged 60 years and older had more adverse events with 20% and 10.38% for p0.05 respectively. Sixty eight failures (5.4%) were observed.The practice of LRA at the University Hospital of Point G is characterized by adverse events and a low number of deaths. Patients operated under spinal anesthesia and patients aged 60 years and older are at greatest risk of adverse events.Etait de faire le point de la pratique de l'ALR au Centre Hospitalier Universitaire (CHU) du Point G, de janvier 2004 à décembre 2008.Il s'agissait d'une étude retrospective, évaluant la pratique de l'ALR. Les données démographiques, l'acte chirurgical, les caractéristiques techniques du geste effectué, le type d'anesthésique local utilisé, les événements indésirables ont été évalués.L'ALR avait concerné 1.261 patients, soit 8,30%. La classification de l'American Society of Anesthesiology (ASA) était utilisée pour l'évaluation des patients en chirurgie programmé. Les patients étaient de la classe ASA1 (50,40%) et de la classe ASA2 (49,60%). Les principaux actes chirurgicaux étaient: l'adénomectomie 26,20%, la césarienne 23,80% et la fistulorraphie 19,04%. Les techniques d'ALR réalisées étaient: la rachianesthésie, 87,60%, l'anesthésie péridurale, 12%. Trois cents trois événements indésirables soit 24% ont été rapportés, dont trois soit 1% ont entrainé le décès du patient. L'incidence de l'hypotension artérielle a été de 94,40%, la bradycardie de 4,6%. Les trois arrêts cardiaques ont été fatals (0,024‰). Les patients opérés sous rachianesthésie et les patients âgés de 60 ans et plus avaient présenté plus d'événements indésirables avec respectivement 20% et 10,38% pour un p0,05. Soixante huit échecs (soit 5,4%) avaient été constatés.La pratique de l'ALR au CHU du Point G est caractérisée par des événements indésirables et un nombre de décès faible. Les patients opérés sous rachianesthésie et les patients âgés de 60 ans et plus sont les plus exposés aux événements indésirables.

An outbreak of Shigella sonnei that occurred in the ultra-Orthodox Jewish community (UOJC) was the subject of an investigation and response by the Montréal Regional Public Health Department (DRSP), who collaborated with several health and community partners. A total of 27 confirmed cases were reported in this outbreak, which lasted from February to June 2015. The epidemic curve was compatible with a point source with secondary person-to-person transmission. In 11 of the 27 cases, pulsed-field gel electrophoresis (PFGE) analysis of strains found a single PFGE pattern newly identified in Quebec. Almost all strains tested showed resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP/SMX). All the cases resided in Montréal Centre-West. Most of the cases were under 5 years old and attended a daycare centre, an environment recognized to be conducive to the transmission of enteric diseases. DRSP sent timely information to families, daycare and school stakeholders, community partners and synagogues in the UOJC, which helped reduce the transmission of shigellosis in the community.

Background Homeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by chronic lung allograft dysfunction, an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling. Objective This study assessed whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling posttransplantation. Methods Microbiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post lung transplantation. Expression of a set of 11 genes encoding either matrix components or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively) was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture. Results We identified 4 host gene expression profiles, among which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by proinflammatory bacteria (eg, Staphylococcus, Pseudomonas, and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (eg, Prevotella, Streptococcus, and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact host macrophage-fibroblast activation and matrix deposition. Conclusions Host-microbes interplay potentially determines remodeling activities in the transplanted lung, highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome., Graphical abstract

An outbreak of Shigella sonnei that occurred in the ultra-Orthodox Jewish community (UOJC) was the subject of an investigation and response by the Montreal Regional Public Health Department (DRSP), who collaborated with several health and community partners. A total of 27 confirmed cases were reported in this outbreak, which lasted from February to June 2015. The epidemic curve was compatible with a point source with secondary person-to-person transmission. In 11 of the 27 cases, pulsed-field gel electrophoresis (PFGE) analysis of strains found a single PFGE pattern newly identified in Quebec. Almost all strains tested showed resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP/SMX). All the cases resided in Montreal Centre-West. Most of the cases were under 5 years old and attended a daycare centre, an environment recognized to be conducive to the transmission of enteric diseases. DRSP sent timely information to families, daycare and school stakeholders, community partners and synagogues in the UOJC, which helped reduce the transmission of shigellosis in the community.

In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time.The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment.These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.

Background Lung transplant recipients require multidisciplinary care because of the complexity of therapeutic management. Clinical pharmacists are able to detect drug related problems (DRPs) and provide recommendations to physicians. The potential significance of pharmacists’ interventions (PIs) has never been studied by a multidimensional approach in lung transplantation (LT). Purpose We aimed to assess the clinical, economic and organisational impact of PIs on immunosuppressive management among lung transplant outpatients. Material and methods In our centre, PIs are comprehensively and prospectively collected on Act-IP database, a free access website observatory created by the French Society of Clinical Pharmacy (SFPC) from 2009 onward. Each PI includes patient features, a description of the DRP and the PI according to the SFPC classification. A retrospective analysis of the PIs was performed from 1 January 2009 to 31 December 2015 by an expert committee including a clinical pharmacist, pharmacovigilant and pneumologist. The impact of accepted PIs was assessed according to the validated multidimensional ‘CLEO’ scale, which includes three dimensions: CLinical (harmful, null, minor, moderate, major, lethal, non-determined), Economic (cost increase, no change, cost decrease, not determined) and Organisational impacts (unfavourable, null, favourable, not determined). Results Among the 1568 PIs performed over the 7 year period, 713 (45.5%) were related to immunosuppressive therapy for which the physician’s acceptance rate was 94.0%. The expert committee considered the clinical impact of PIs as major, moderate and minor in 9.6%, 67.0% and 22.8%, respectively. Major clinical impact was mainly related to drug–drug interactions between immunosuppressants and antifungals (56.0%). Wrong dose was the main cause of moderate clinical impact (75.0%). While 41.6% of PIs led to a cost increase due to dose increase or adding of drug monitoring, 44.8% of PIs helped a cost decrease due to dose decrease or drug discontinuation (44.8%). Most PIs did not have an organisational impact for healthcare professionals (99.1%). Conclusion This is the first study which has evaluated the clinical, economic and organisational impacts of PIs in lung transplant outpatients. Our findings show that clinical pharmacists play a key role in optimising immunosuppressive therapy management in LT. As experts in drug therapy, clinical pharmacists are able to detect and resolve DRPs to improve patient care. No conflict of interest

This research aimed to describe the epidemiological characteristics and to analyze predictive factors of clinical status severity for patients admitted to the emergency service of University Hospital of Point G. We used an prospective, descriptive and analytical study and followed up all patients admitted to the emergency service of University Hospital of Point G from July 2012 to June 2013.Data about their clinical status, diagnostic and evolution have been described. The severity of the clinical status of patients was determined by using the Clinical Classification of Patients in emergency. During the study period, 2254 files were collected. The median number of daily admissions per month was 26.83 ± 2.95 patients. The mean age was 49 ± 20 years. One thousand seven hundred seventy seven patients used one to three health structure(s) prior to their admission to the University Hospital. The disease"s evolution was ˃ 7 days in 52.9 % of cases, 59.5 % were referred and 25% had been transported by ambulance. The frequently complaints named at admission were physical asthenia / anorexia, fever / shiver and dizziness. One thousand five hundred ninety five patients (71 %) were "considered serious." The diseases diagnosed were noninfectious in 40 % of cases, infectious in 39% cases and unclear in 21 % of cases. Noninfectious disease was the reason for the University Hospital use for patients "judged sever" in 80 % of cases. The average hospital stay was 2.61 ± 5.30 days. Mortality rate (18.5%) was significantly higher in patients "judged sever" (p = 0.001). These results must push the health authorities to take communication actions toward the public for the promotion of best use of emergencies services.

Cutaneous bullous adverse drug eruptions are a dreaded complication of drug use.The purpose of this study was to document the epidemiological features, outcomes, and causes of these reactions, in particular, Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell disease), in a teaching hospital in Abidjan (Côte d'Ivoire).A retrospective study reviewed the records of severe cutaneous drug reactions in patients managed in the dermatology department of the University Hospital of Treichville (Abidjan) over a period of ten years (from September 2000 through August 2010).These diseases were diagnosed in 185 patients during the study period. Their mean age was 31.8 years (range: 2-70 years) and the M/F sex ratio was 0.6 The most frequent reactions, as expected, were Stevens-Johnson syndrome (73%) and toxic epidermal necrolysis (27%). The drugs most commonly involved were the antibacterial sulfonamides (22.1%), followed by the antiviral nevirapine (11.1%), and the antimalarial agent, sulfadoxine/pyrimethamine. The fatality rate was 22.5%, including 46% of the patients with toxic epidermal necrolysis and 14.6% of those with Stevens-Johnson syndrome. Respiratory distress (39.5%) and dehydration (23.4%) were the primary direct causes of death.Antibacterial sulfonamides are the leading drugs implicated in the occurrence of bullous drug eruptions in Abidjan.

This paper presents energy management improvement for a Hybrid Electric Boat (HEB) applications using frequency approach. A variable speed Diesel-Permanent Magnet Generator (Diesel-PMG) is assisted by the lithium-battery to satisfy energetic demand of HEB. The lithium-battery module is connected to DC-bus through a buck-boost converter, and that of the variable speed Diesel Generator, it is connected to DC-bus using three phase controlled rectifier. The two DC/AC converters connected to two electric motors are used as thrusters system which enables to emulate energetic demand of Hybrid Electric Boat (HEB) in propulsion operations. The power requirement of thrusters is added to embedded appliances demand to obtain load's profile. The contribution of this paper is focused on load's profile sharing between a variable speed Diesel Generator and Lithium-battery according to the dynamic responses of sources. The performances of proposed method are evaluated through some simulations using MATALB/Simulink software and experimental tests in reduced scale.

Resume La pratique de l’allaitement au sein est courante au Senegal. En effet, pres de 100 % des femmes donnent le sein a leur enfant. Cependant cette pratique s’accompagne de l’administration precoce d’eau avant le sixieme mois (42 %) et tres souvent des la naissance, du fait de representations socioculturelles. Notre travail avait pour objectif de decrire et d’analyser les connaissances et les pratiques d’un echantillon de femmes sur l’alimentation de leurs enfants, de la naissance a l’âge de six mois. Population et methodes Il s’agissait d’une etude transversale avec un recueil prospectif des donnees, basee sur des entretiens individuels semi-directifs realises du 1 er mai au 30 juin 2009. La population de l’etude concernait les meres de nourrissons âges de six a 12 mois, primipares ou non, qui frequentaient les deux sites de l’Institut de pediatrie sociale et preventive de l’universite Cheikh Anta Diop de Dakar (Senegal) : l’un etant dans la banlieue de Dakar a Pikine, et l’autre en milieu rural a Khombole. Differents themes etaient abordes : les connaissances generales sur l’alimentation du nourrisson de la naissance a l’âge de six mois, sur l’allaitement maternel exclusif et les difficultes rencontrees lors de sa pratique, les aliments introduits au cours de l’allaitement maternel exclusif (AME), et les facteurs associes a leur utilisation. Resultats L’etude a porte sur 44 meres. Le delai moyen de mise au sein a la naissance etait en moyenne de 6 ± 12 heures (extremes : une a 72 heures). Le premier aliment recu par le nouveau-ne etait le lait maternel pour 64 % des meres ( n = 28). Les 16 autres meres (36 %) avaient administre a leur nouveau-ne le « Tokental » avant la premiere mise au sein. Trente-huit meres detenaient des informations relatives a l’alimentation de l’enfant. La mise au sein precoce a ete realisee par 22 meres (50 %) et l’allaitement maternel exclusif (AME) jusqu’a six mois par 29 meres (66 %). Les raisons invoquees par les 15 autres meres pour le choix d’un autre aliment sont diverses. Parmi les facteurs influencant la pratique de l’AME, figurait le niveau d’instruction des meres, meme si la difference n’etait pas statistiquement significative. Conclusion La pratique de l’allaitement maternel exclusif et la mise au sein precoce ne semblent pas limitees par les connaissances, mais par les representations. Parmi les facteurs limitant la mise au sein precoce, le plus important semble etre le « Tokental ». Pour ameliorer les pratiques en matiere d’alimentation des enfants, il serait important de renforcer l’information par les professionnels de sante sur l’alimentation des nouveau-nes.

Resume Introduction En vue d’apprecier les facteurs de gravite lies au paludisme et les facteurs pronostiques de deces, nous avons mene une etude au centre hospitalier national d’enfants Albert-Royer (CHNEAR) de Fann a Dakar. Malades et methodes Il s’agissait d’une etude prospective du 1 er janvier au 31 decembre 2007 portant sur les enfants de 0 a 15 ans admis pour paludisme a Plasmodium falciparum avec une goutte epaisse positive et ayant au moins un des criteres de gravite du paludisme selon l’OMS en 2000. L’acidose n’a pas ete etudiee. Resultats La frequence hospitaliere du paludisme grave etait de 6,4 %, le sex-ratio de 1,4 et l’âge median des patients de 91 mois. Le pic de frequence etait observe au quatrieme trimestre (71,5 %). Les convulsions (52,5 %) et l’obnubilation (49,4 %) etaient les signes de gravite clinique les plus courants alors que nous avions l’hyperparasitemie (27,2 %) et l’anemie severe (21,6 %). Nous avons eu une letalite de 11,1 % et les principaux facteurs de risque de deces etaient le jeune âge ( p = 0,025), l’existence d’un coma ( p = 0,007), d’une detresse respiratoire ( p = 0,04) ou d’une hypoglycemie ( p = 0,001). Conclusion La reduction de la mortalite palustre en milieu hospitalier au Senegal reposera sur une prise en charge correcte de facteurs de mauvais pronostic tels que le coma, la detresse respiratoire et l’hypoglycemie.

La presente etude a ete conduite dans le but de determiner et de comparer l’activite antifongique de deux huiles essentielles issues de Melaleuca quinquenervia L. et Eucalyptus platyphylla F. Muell. a celle de deux fongicides de synthese (le tebuconazole et la spiroxamine) sur Deightoniella torulosa (Syd.) Ellis, un champignon de la phyllosphere des bananiers et bananiers plantains cultives en Cote-d’Ivoire. Ces huiles ont ete additionnees au milieu de culture du champignon (PDA) a differentes concentrations. Elles se sont montrees toxiques sur le champignon en reduisant considerablement la croissance mycelienne et en inhibant la production de spores respectivement aux doses de 7 000 et 10 000 ppm. Les produits de synthese ont eu une activite elevee en fonction des concentrations utilisees. Ils sont hautement toxiques pour Deightoniella torulosa avec des CI50 largement inferieures a celles des huiles essentielles. Les huiles essentielles peuvent constituer un moyen de lutte biologique efficace contre Deightoniella torulosa.

Splenomegaly is common in sickle cell disease (SCD) and can lead to complications. In order to evaluate its prevalence and progression in Senegalese children ad adolescents with SCD, we analyzed the records of all patients followed-up at Albert-Royer Children's Hospital in Dakar, Senegal, from January 1991 to December 2005. Age, clinical course specifying size of the spleen beyond the costal margin, and disease progression were the main data recorded. We included 698 patients (94.6% SS, 4.4% SC and 1% S-beta-thalassemia). The subjects' mean age when included in the cohort was 6 years and 11 months. Splenomegaly was observed in 122 patients (17.5 %), measuring 1-17 cm beyond the costal margin (mean, 4.7 cm). Splenomegaly was more frequent in SC patients (32.3 %) compared to SS patients (16.5 %, p=0.025). The frequency was greater in infants aged 0-12 months (25.6 %) and increased from the 1- to 5-year-old age group to the 6- to 10-year-old, before it decreased further. The course of splenomegaly was marked by subsequent reduction in 17.3 % of cases, total reversal in 43.4 %, and no size variation in 39.3 %. Acute splenic sequestration occurred in 3 SS cases aged 27, 29, and 32 months and was managed with blood transfusion. Seven patients (6 SS and 1 SC) aged 4-13 years presented hypersplenism. Splenectomy was performed in 4 of these cases, while the complication reversed after 2 to 3 blood transfusions in the 3 remaining cases. The prevalence of splenomegaly is relatively low in Senegalese children with SCD. The risk of complications requires monitoring the spleen and teaching parents palpation of the baby's abdomen for early management of splenic sequestration.

Resume Au cours des consultations dans les structures sanitaires des auteurs, une carence martiale est souvent evoquee devant une anemie hypochrome microcytaire chez l’enfant, du fait de sa grande frequence et de son traitement souvent envisage en l’absence de toute confirmation biologique. Ce travail avait pour objectifs de determiner la frequence de l’anemie chez les enfants suivis en ambulatoire au centre hospitalier Albert Royer, de preciser la place de l’anemie hypochrome microcytaire et d’evaluer la reponse clinique, hematologique et biochimique au traitement martial, chez des enfants traites pour anemie supposee ferriprive. Il s’agit d’une etude prospective qui a comporte deux volets : une etude transversale au laboratoire portant sur un echantillon de 1000 patients presentant une prescription d’un hemogramme en ambulatoire ; une etude longitudinale portant sur 30 enfants traites et suivis pendant trois mois pour une anemie hypochrome microcytaire aregenerative, supposee ferriprive. La prevalence de l’anemie etait de 50 % chez les enfants suivis en ambulatoire ; elle etait plus importante chez les moins de cinq ans (76 %). L’anemie etait de type hypochrome microcytaire dans 78 % des cas. Chez les enfants traites et suivis pour anemie ferriprive sur la base de criteres hematologiques (microcytose, hypochromie, taux de reticulocytes faible, en l’absence de contexte inflammatoire), la carence martiale avait ete confirmee par le bilan martial (fer serique, transferrinemie et ferritine serique) dans 51,5 % des cas. La crise reticulocytaire, classiquement decrite, n’avait ete observee que dans 12 % des cas. Le taux d’hemoglobine avait regulierement augmente jusqu’a j60 avant de devenir stationnaire entre j60 et j90, vraisemblablement du fait d’une mauvaise observance du traitement apres la regression des signes cliniques ayant motive la consultation. Une bonne reponse au traitement martial avait ete observee dans tous les cas et constituait un argument en faveur d’une carence martiale probablement masquee par un syndrome inflammatoire infraclinique ou une malnutrition associee, lorsque le bilan martial n’etait pas contributif. Ces resultats confirment la sensibilite de la microcytose et de l’hypochromie comme critere de diagnostic d’une anemie ferriprive. Il est necessaire de bien informer et de sensibiliser les parents sur les modalites du traitement d’une anemie ferriprive afin d’obtenir de meilleurs resultats therapeutiques.

Malaria and HIV are two major public health issues, especially in sub-Saharan Africa. HIV infection increases the incidence of clinical malaria, inversely correlated with the degree of immunodepression. The effect of malaria on HIV infection is not as well established. Malaria, when fever and parasitemia are high, may be associated with transient increases in HIV viral load. The effect of subclinical malaria on HIV viral load is uncertain. During pregnancy, placental malaria is associated with higher plasma and placental HIV viral loads, independently of the severity of immunodeficiency. However, the clinical impact of these transient increases of HIV viral load remains unknown. Although some data suggests that malaria might enhance sexual and mother-to-child transmissions, no clinical study has confirmed this. Nevertheless pregnant women and children with malaria-induced anemia are also exposed to HIV through blood transfusions. Integrated HIV and malaria control programs in the regions where both infections overlap are necessary.