Sante (Montrouge, France)最新文献

{"title":"[Sickle cell disease is one century old: what about therapeutics?].","authors":"Dominique Labie","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":" ","pages":"171-3"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40144083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Leadership and vision in the improvement of universal health care coverage in low-income countries].","authors":"Ziemlé Clément Meda,&nbsp;Lassina Konate,&nbsp;Hyacinthe Ouedraogo,&nbsp;Moussa Sanou,&nbsp;David Hercot,&nbsp;Issiaka Sombie","doi":"10.1684/san.2011.0268","DOIUrl":"https://doi.org/10.1684/san.2011.0268","url":null,"abstract":"<p><p>In Burkina Faso, as in most developing countries, the operational level of the health system is made up of Health Districts (HDs), the activities of which are typically coordinated by the District Team (DT). Assessing the the core functions of DTs, as described by WHO, shows two important weaknesses. Firstly, instructions from \"above\" are often implemented rather passively: DTs tend not to display much leadership. Secondly, the current organisation, based on input financing and centralised planning, does not sufficiently promote either the vision or research functions of DTs. In this article, we report our experience in the Orodora HD in Burkina Faso, where the DT's leadership and vision proved to be essential ingredients for effective health action in the district. Our description of six interventions implemented between 2004 and 2008 shows how DT leadership and vision have improved outputs at the HD level. Until 2004, the district applied static health planning. The health system was insufficiently financed and performed poorly. Faced with this situation, the DT decided to set up several priority interventions based on health care access criteria and patient concerns, while respecting and contextualizing national norms and objectives. Six interventions were then implemented. The first was ensure that quality blood (meeting transfusion security norms) was available at the District Hospital (DH), by picking blood up from the regional blood transfusion center weekly. This speeded up care at the DH, reduced the number of cases referred to the regional hospital for transfusion, and reduced neonatal and maternal mortality. The second intervention sought to improve the skills of health workers in managing emergency cases and to improve relationships with the referral hospital through the reintroduction of counter-referral procedures. This led to a decrease in unnecessary referrals and also reduced the mortality rates of serious cases. The third intervention, by implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a \"culture\" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"178-84"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30428125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Parental administration of unprescribed antimalarial drugs to treat febrile children in Gabon].","authors":"Denise Patricia Mawili-Mboumba,&nbsp;Marielle Karine Bouyou-Akotet,&nbsp;Maryvonne Kombila","doi":"10.1684/san.2011.0267","DOIUrl":"https://doi.org/10.1684/san.2011.0267","url":null,"abstract":"<p><p>Resistance by Plasmodium falciparum to antimalarial drugs has strongly hampered strategies for malaria control and elimination. Therefore, one of the goals of the World Health Organisation's new malaria control strategies is the rational and appropriate use of antimalarial drugs and in particular of artemisinin-based combination therapy (ACTs), currently used for the treatment of uncomplicated malaria; in order to delay the appearance of drug-resistant parasites. The unprescribed use of antimalarial drugs (self medication and parental administration to children) is a key component in the development of antimalarial drug resistance and must be controlled among patients living in malaria-endemic areas. The aim of our study was to estimate the frequency of this parental administration among febrile children and to identify the specific drugs used. Data were collected in two studies evaluating the proportion of malaria cases and the performance of rapid drug tests among febrile children seen in 2008-2009 at 3 hospitals, one in a rural area, one in an urban area, and the third in a semi-urban area. This parental medication administration was found among 21.4% of the 2543 children included in the studies. It was most common at the rural hospital (29%), which is also where malaria prevalence was highest (39%). Of the 548 children \"medicated\", 421, that is, almost 80%, were not infected. The antimalarial drugs used most frequently were ACTs (43.8%) and quinine (12%). In Gabon, as in other sub-Saharan countries, use of antimalarial drugs before consultation is common and is an obstacle to malaria control. Therefore, improving the rational use of these drugs by the population requires active outreach to the community about the risks of unprescribed medication.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"127-31"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30427018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the antimalarial drugs ferroquine and artesunate on Plasmodium yoelii yoelii gametocytegenesis and vectorial transmission.","authors":"Kamla Mustfa,&nbsp;Irène Landau,&nbsp;Alain-Gabriel Chabaud,&nbsp;Jean-Marc Chavatte,&nbsp;Jacques Chandenier,&nbsp;Thanh Hai Duong,&nbsp;Dominique Richard-Lenoble","doi":"10.1684/san.2011.0261","DOIUrl":"https://doi.org/10.1684/san.2011.0261","url":null,"abstract":"<p><p>Chemistry still has a role in the management of malaria, alongside the mosquito netting soaked in insecticide that is used increasingly, as we continue to await the long anticipated vaccine. During its cycle, the hematozoon parasite develops through three major periods. The first, malarial infection, corresponds to the intrahepatic development of infective forms from the mosquito vector; this period is not sensitive to treatment and is often asymptomatic. The period of erythrocytic schizogony is the most urgent, and treatment activity is primordial. Finally, the phase of sexual reproduction, when gametocytes develop within the erythrocytes ensures the perpetuation of the species when these reach the blood-feeding female anopheles mosquitoes. The aim of our work was to study the effect on gametocytes of drugs known to be effective on the asexual blood forms of the protozoan and thus the potential repercussions on malaria transmission. This experimental study was conducted with an animal model whose parasite cycle and modes of transmission are close to those of human malaria: Plasmodium yoelii, maintained on Swiss mice, with the Anopheles stephensi vector (maintained in an animal facility at the National Museum of Natural History in Paris). Two drugs were tested: ferroquine (a chloroquine derivative with a ferrocene molecule at the lateral carbon chain that restores its efficacy against chloroquine-resistant strains) and artesunate (a derivative of artemisinin, from ginghao, a Chinese plant also known as artemisia annua, or sweet wormwood), a treatment of choice in the combined therapies recommended by WHO. The efficacy of these drugs, prescribed at doses subcurative for the asexual forms, were tested against gametocyte production, quantitatively by counting them in the blood and qualitatively by counting the quantity of oocysts developed on the mosquito's midgut, which are indicators of gametocyte activity. The mice that were parasite-infected and then treated served as their own controls: lots of 30 mosquitoes fed on each mouse before treatment and then 90  minutes and 5  hours after treatment. Quantitatively, the comparison of the blood parasite level and the gametocyte index shows that treated mice had a higher level of circulating gametocytes than untreated parasite infested mice, regardless of drug or dose (5 or 10  mg/kg). For artesunate at 5  mg/kg, we noted that the blood gametocyte level was almost double that of the controls. On the other hand, qualitatively, the first results obtained with optical and electronic microscopy showed morphologic alterations of the circulating gametocytes (pigment clumping and lateralisation within red blood cells) and reduced infectivity of the gametocytes for the mosquitoes that fed at 1 and 5  hours after treatment. We were able to demonstrate statistically that the infectivity of gametocytes, measured by the quantity of oocysts counted in the mosquito midgut, was reduced by 70% for those treated wi","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"133-42"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30427019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevalence and etiology of amblyopia of children in Yaoundé (Cameroon), aged 5-15 years].","authors":"Christelle Domngang Noche,&nbsp;Giles Kagmeni,&nbsp;Assumpta Lucienne Bella,&nbsp;Emilienne Epee","doi":"10.1684/san.2011.0254","DOIUrl":"https://doi.org/10.1684/san.2011.0254","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the frequency of amblyopia and identify its causes in a population of children aged 5-15 years in Cameroon.</p><p><strong>Subjects and methods: </strong>This retrospective study examined the files of children aged 5-15 years seen in a private eye clinic in Yaounde from January 2008 through December 2010. The subjects underwent a complete ophthalmic examination including assessment of the best corrected visual acuity on a LogMAR chart, cycloplegic refraction measurements, and an orthoptic examination. The slit-lamp microscope and eye fundus examinations made it possible to rule out organic diseases. Statistical analysis was performed with Epi Info software, version 3.5.3, to analyze the the frequency and laterality of amblyopia according to age, sex, and refractive errors.</p><p><strong>Results: </strong>Twenty-eight of the 314 patients studied had amblyopia, for a frequency of 8.9 % in the study population and 10.3 % in the subjects with ametropia (n = 271). The average age of children with amblyopia was 9.9 + / - 3 years. The frequency of amblyopia was higher among boys, but the difference was not statistically significant (p=0.3679). In order of frequency, the causes were refractive errors, for 93 % (26/28) of the children, and strabismus for 7 % (2/28). Astigmatism was the most frequent cause of ametropic amblyopia. Amblyopia had an anisometropic origin in 43 % (12/28) of cases. It was unilateral in 39.2 % (11/28) and bilateral in 61 % (17/28) of cases, severe in 18 %, moderate in 18 %, and mild in 64 %.</p><p><strong>Conclusion: </strong>Ten percent of the subjects in our series had amblyopia, mainly due to refractive errors. Amblyopia was most frequently bilateral and mild. A systematic ophthalmological examination in childhood could provide early detection and management of refractive errors that cause ocular morbidity.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"159-64"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30428120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cervical lymph node tuberculosis in Libreville: epidemiology, diagnosis, and therapy].","authors":"John Florent Mouba,&nbsp;Jérôme Miloundja,&nbsp;Mylène Mimbila-Mayi,&nbsp;Florent Tchouansi Ndjenkam,&nbsp;Léon N'zouba","doi":"10.1684/san.2011.0269","DOIUrl":"https://doi.org/10.1684/san.2011.0269","url":null,"abstract":"<p><strong>Objectives: </strong>To analyse the epidemiological, diagnostic and therapeutic aspects of cervical lymph node tuberculosis (TB) in Libreville.</p><p><strong>Material and methods: </strong>This retrospective descriptive multicentre study included all 140 patients with complete files who were treated for cervical lymph node TB from 2001 through 2006, regardless of whether TB was found at any other site.</p><p><strong>Results: </strong>A slight predominance of men was observed. The infected lymph nodes were most often located at the posterior triangle of the neck. Histological proof was obtained for 81 patients. We recorded 94 cures, 4 cases of therapeutic failure, 34 patients lost to follow-up and 8 deaths.</p><p><strong>Conclusion: </strong>Cervical lymph node tuberculosis is a common ailment. Excisional lymph node biopsy has a twofold interest -therapeutic and diagnostic. It is based on histological examination, which must henceforth be systematic. Tuberculosis is a major HIV-related opportunistic infection and must be screened for or monitored at every HIV check-up.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"165-8"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30428122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hematologic and immunologic signs of lupus: the experience of the hospital of Dakar].","authors":"Fatou Samba Diango Ndiaye,&nbsp;M M Ka,&nbsp;Seynabou Fall,&nbsp;Awa Dioum,&nbsp;Abdoulaye Pouye,&nbsp;Thérèse Moreira-Diop","doi":"10.1684/san.2011.0265","DOIUrl":"https://doi.org/10.1684/san.2011.0265","url":null,"abstract":"<p><strong>Introduction: </strong>The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immune pathology, characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The circumstances of discovery are variable and polymorphic. The hematologic signs and the immunological disorders constitute criteria of diagnosis of lupic disease.</p><p><strong>Methodology: </strong>It is a multicentric retrospective study from January 1, 1997 to September 30, 2006. Patients were followed up in Internal medicine of Dakar. We appreciate the hematologic and immunological aspects appreciate their prognosis prevalence and their implications with the course the lupic disease.</p><p><strong>Results: </strong>142 lupic patients were included with 125 women and 17 men; the sex ratio is 0.13. The average age was 34 years with extremes of 6 and 72 years. Our patients had hematologic manifestations average in 32,4 % of the cases and immunological in 76,8 % of the cases. The immunological tests showed the presence, of antinuclear antibodies in 97,9 % of the cases, of native antibody anti-DNA in 45,7 % of the cases, the anti-ECT in 86,95 % (with the anti-RNP in 78,3 % of the cases, anti-Sm in 56,5 % and of anti-SSA in 87 % of the cases). Antibodies anti-DNA and anti-ECT were associated with the hematologic demonstrations respectively in 92,0 % and 95 % of the cases (p = 0,08). Total survival in 96 % of the cases is estimated to 7 years.</p><p><strong>Conclusion: </strong>The circumstances of discovery of the lupic disease are variable. The hematologic signs constitute criteria diagnosis of lupic disease. The accessibility of the hematologic and immunological assessment is necessary for an early diagnosis and an early treatment.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"143-8"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30427020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Malaria and HIV infection in subSaharan Africa: another match made in hell?].","authors":"Eba François Aoussi,&nbsp;Koffi Aristophane Tanon,&nbsp;Eboi Ehui,&nbsp;Songda Ismaèl Ouattara,&nbsp;Kokou André Inwoley,&nbsp;Koffi Daho Adoubryn,&nbsp;Serge Paul Eholié,&nbsp;Emmanuel Bissagnéné","doi":"10.1684/san.2011.0255","DOIUrl":"https://doi.org/10.1684/san.2011.0255","url":null,"abstract":"<p><p>Malaria and HIV are the most important infections in subSaharan Africa, in terms of the morbidity and mortality they cause. Current data suggest a possible interaction between the two diseases. Cellular immunodeficiency due to HIV infection might increase the frequency and severity of malaria, as local populations in endemic areas become less resistant. Likewise, the onset and repetition of malaria episodes might activate HIV replication and thus decrease the number of CD4 lymphocytes and accelerate the disease course. Despite their geographical coincidence, the epidemiological profiles of malaria and HIV differ considerably. The entanglement of these two diseases has epidemiological, clinical and therapeutic consequences in subSaharan Africa that raise concerns that HIV with malaria, as with tuberculosis, is a match made in Hell.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"174-7"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30428123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Could the VAD protocol be the first line therapy for multiple myeloma in subSaharan Africa? The Brazzaville experience].","authors":"Alexis Elira Dokekias","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":" ","pages":"169-70"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40144080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Consumption of addictive substances by Gabonese teenagers: an epidemiological survey].","authors":"Mylène Mimbila-Mayi,&nbsp;Yolande Nzame Vierin,&nbsp;Arlette Biloghe,&nbsp;André Moussavou-Mouyama","doi":"10.1684/san.2011.0253","DOIUrl":"https://doi.org/10.1684/san.2011.0253","url":null,"abstract":"<p><strong>Objective: </strong>To study the characteristics of the consumption of addictive substances by adolescents in Gabon.</p><p><strong>Population and methods: </strong>For this cross-sectional, descriptive study, we used an anonymous questionnaire to collect information from 1469 adolescents aged 10 to 19  years in six cities in Gabon during 2008.</p><p><strong>Results: </strong>Alcohol was the addictive substance most often consumed (55.5%), followed by tobacco (21.5%) and illegal drugs (5%). In all, 47.6% of the teenagers reported having already been drunk. Combined consumption of these different substances was reported by 44.5%.</p><p><strong>Conclusion: </strong>Our results show the extent of the consumption of addictive substances among adolescents in Gabon and the existence of groups at risk of addiction and abuse. Prevention strategies must be set up.</p>","PeriodicalId":79375,"journal":{"name":"Sante (Montrouge, France)","volume":"21 3","pages":"149-52"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/san.2011.0253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30428119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}