Medecine tropicale et sante internationale最新文献

Introduction-objective: Acute coronary syndromes (ACS) are the leading cause of death among the elderly in sub-Saharan Africa. The aim of this study was to analyze the characteristics of ACS among the elderly at the Abidjan Heart Institute.

Materials and methods: Cross-sectional study from January 1, 2015, to December 31, 2019. All patients aged 18 or more admitted to the Abidjan Heart Institute for ACS were included. These patients were divided into two groups: elderly (≥ 65 years old) and non-elderly (< 65 years old). Clinical data, management and outcomes were compared and analyzed in both groups.

Results: A total of 570 patients were included, of which 137 (24%) were elderly. Sixty percent (60%) of elderly patients presented with ST Segment Elevation Myocardial Infarction (STEMI). Percutaneous coronary intervention (PCI) was less performed among elderly patients (21.1% vs 30.2%, p = 0.039). Heart failure was the most important complication among the elderly group (56.9% vs 44.6%, p = 0.012). In-hospital mortality was 8% among the elderly. Predictive factors for in-hospital mortality were history of hypertension (HR 2.58; CI95% 1.10-6.08) and STEMI presentation (OR 11.60; CI95% 2.70-49.76). PCI was a protective factor for in-hospital mortality (OR 0.14; IC95% 0.03-0.62).

Conclusion: ACS occur with increasing frequency with age. Poor outcomes among the elderly are determined by the clinical presentation and comorbidities. PCI appears to significantly reduce in-hospital mortality.

At the end of his professorial mandate at the Val de Grâce hospital, Alphonse Laveran, who was Chief Doctor, was appointed to Lille and then Nantes. These assignments however deprived him of a hospital service where he could carry on his research. In 1896, faced with the inflexibility of his military hierarchy, he applied for early retirement; he was then 50 years old. Dr Roux welcomed him to the Pasteur Institute as a honorary department head, where he started a second career as a volunteer. He would spend the following 25 years there, addressing the great protozoology issues. Together with Félix Mesnil, he undertook the study of trypanosomiasis and leishmaniases. In 1907 he was awarded the Nobel Prize in physiology and medicine to honor "his work on the role of protozoa as pandemic vectors". He allocated a large part of his prize money to set up a parasitology laboratory at the Pasteur Institute, where all the discoveries and observations carried out in the colonies would converge. In 1908, he funded the Society of Exotic Pathology. He authored no less than 600 publications where his memorable research is recorded. Despite his somewhat outwardly rigid appearance, the man proved to be of amiable approach thanks to "the simplicity of his manners, his amenity and his great heart".

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.

Mayotte is a French overseas department and one of the 4 islands of the Comoros archipelago in the Indian Ocean, located between Madagascar and the eastern coast of Africa. Malaria, mainly by Plasmodium falciparum, is endemic to the archipelago and remained a major public health problem until recent years. To control and then eliminate the disease, major strategies have been established in Mayotte since 2001. Preventive measures, diagnostic testing, treatment and disease surveillance were introduced or improved.From 2002 to 2021, 4819 autochthonous cases were reported in Mayotte where the annual incidence decreased from 10.3 per 1,000 population in 2002 (1649 cases) to less than 0.01 per 1,000 population in 2020 (2 cases). The incidence has been below 1 per 1,000 population since 2009. In 2013, WHO classified Mayotte as a territory in malaria elimination phase. In 2021, no locally acquired malaria cases were reported on the island. During this period 2002-2021, 1898 imported cases were observed. They mainly came from the Union of Comoros (85.8%), Madagascar (8.6%) and sub-Saharan Africa (5,6%). Since 2017, the annual number of locally acquired cases was less than 10 and decreased steadily (9 cases in 2017, 5 in 2018, 4 in 2019 and 2 in 2020). The distribution of these rare locally acquired cases both in time and space suggests that they were introduced and not indigenous cases. A study of the genotypic profile of the plasmodial strains of these cases observed from 2017 to 2020 (17 cases analysed out of 20 diagnosed) confirms that these were certainly introduced cases related to imported cases from the neighboring Comoros.Malaria indigenous transmission seems to be eliminated in Mayotte, but the island remains under threat of reintroduction via cases imported from neighbouring countries. It is time to develop a local plan to prevent reintroduction and to implement a proactive policy of regional cooperation in the fight against malaria.

WHO defines vaccine hesitancy as delay in acceptance or refusal of vaccines despite the availability of vaccine services. It is a complex phenomenon that varies through time, place and vaccines. In this comment, we highlight the context-specific variation of Covid-19 vaccine hesitancy in Tanzania. We suggest Covid-19 hesitancy in Tanzania is influenced with high burden of infectious disease, poor testing capabilities and demographic characteristics.

Created at the 2010 G8, the French Muskoka Fund represents France's commitment to maternal and child health. This innovative coordination mechanism between four UN agencies (WHO, UN-Women, UNICEF and UNFPA) has helped improving the health and well-being of mothers, newborns, children, teenagers and young people in 9 countries of Western and Central Africa (Benin, Burkina Faso, Chad, Côte d'Ivoire, Guinea, Mali, Niger, Senegal, and Togo) for the past 11 years. This rare longevity can be explained by its innovative governance structure, its ability to adapt to the local context, its capacity to leverage through high-impact interventions, and its impact on the ground. As the French Muskoka Fund has been renewed for another five years by France in 2021, reflection has been launched to further enhance the catalytic effect of this effective and promising initiative.

Neuromeningeal cryptococcosis and pulmonary tuberculosis are respectively serious mycotic and bacterial infections occurring in a subject regardless of its HIV serological status. We report here a case of neuromeningeal cryptococcosis associated with pulmonary tuberculosis and malnutrition in an HIV-seronegative patient with a CD4 count of 750/mm³, to highlight some particularities opposed to certain literatures. This is an 18-year-old patient, housewife, from Bamako, admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako on March 13, 2022 for fever and impaired consciousness. Her symptomatology appears to have gradually set in over a month, preceded by headache resistant to paracetamol, jet vomiting and irregular dry cough, initially treated with ceftriaxone, artesunate and paracetamol for confirmed malaria and suspicion of bacterial meningitis before admission. In whom no known medical-surgical history, no use of topical corticosteroids, no immunosuppressive therapy, no alcohol or tobacco, and no immunosuppressive pathology was found. The diagnoses of neuromeningeal cryptococcosis, pulmonary tuberculosis and undernutrition were retained in view of clinical and microbiological arguments. Diabetes, sickle cell disease, viral hepatitis B and C, kidney failure and cancer, which are immunosuppressive pathologies, were not found. She was successfully treated with first-line oral antituberculous drugs and fluconazole infusion. Three interests are drawn from this clinical case: neuromeningeal cryptococcosis is not only the prerogative of HIV-positive subjects, a high CD4 count does not always mean immunocompetence and fluconazole is an effective therapeutic alternative for neuromeningeal cryptococcosis.

Background: The effectiveness of Long-Lasting Insecticidal Nets (LLINs) and indoor residual spraying (IRS) in controlling malaria vectors is hampered by the resistance of anopheles to insecticides. A good knowledge of the breeding sites and of the resistance profile of the vectors could facilitate the development of an appropriate control strategy. This study looks at the larval ecology and the susceptibility profile of An. gambiae s.l. to insecticides in urban and rural areas in Kribi, South Region of Cameroon.

Methods: Mosquito breeding sites were categorized and geo-referenced. For each site, larvae were collected and reared and physicochemical parameters were measured in situ. The susceptibility of anopheles to dichlorodiphenyltrichloroethane (DDT), deltamethrin and permethrin, after pre-exposure to piperonyl butoxide (PBO) or not, was evaluated on the reared larvae. The Kdr mutation was detected using the Hot Oligonucleotide Ligation Assay (HOLA).

Results: Natural breeding sites of An. gambiae s.l. were tyre tracks (12%, n=10), unbuilt wells (5%, n=4), pools of residual water (57%, n=48), foot and hoof prints, gullies, streams and the banks of the Kienké River (15%, n=13). Artificial breeding sites were abandoned dugouts (11%, n=9). Breeding sites in urban areas were characterized by higher mean values of temperature, conductivity, salinity and turbidity compared to the breeding sites in the rural area. The breeding sites of An. gambiae s.l. in urban Kribi were found to be sunnier than those in rural Kribi. A total of 4320 adults were used for testing, 1 440 mosquitoes from rural Kribi, 1 440 from urban Kribi and 1 440 specimens from the laboratory Kisumu strain. For DDT and deltamethrin, susceptibility tests showed that mortality was lower in a situation of no pre-exposure to PBO than in a situation of pre-exposure to PBO in the two study areas. The frequency of the resistant allele (R) was high for the Kdr West mutation in both urban (0.94) and rural areas in Kribi (0.93).

Conclusion: An. gambiae s.l. colonizes a wide range of breeding sites and develops metabolic and mutation resistance to recommended insecticides. The search of alternative molecules for vector control is a necessity.