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Biomedical subjects

A Wade

Publications and source records attributed to A Wade.

At least 73 records · Page 4Linked to original sources
PubMed1998

Diagnosis of sexually transmitted infections in female prostitutes in Dakar, Senegal.

OBJECTIVE: To study the validity and performance of a number of rapid indicators for the diagnosis of sexually transmitted infections (STIs) in female prostitutes in Dakar, Senegal; characteristics of these indicators were rapidly obtainable, easy to perform, accurate, useful at district level, and reasonable cost. METHODS: An STI prevalence study in female prostitutes (n = 374) seen at the STD clinic in Dakar, Senegal was done; a history, clinical examination, simple laboratory tests, and "gold standard" microbiological tests were performed. For a number of sociodemographic data, actual or past symptoms of STI, clinical signs, and rapid laboratory tests, validity variables, performance characteristics, and likelihood ratios for detection of gonococcal or chlamydial cervical infection were determined. RESULTS: Cervical infection (chlamydial or gonococcal) was present in 24.9% of prostitutes; 46% had trichomoniasis and 29.4% had syphilis. Young age, abnormal vaginal discharge, endocervical mucopus, a positive leucocyte esterase test on urine, and 10 or more leucocytes in Gram stained smears of vaginal, cervical, or urine samples were significantly associated with cervical STI. Some of the rapid indicators had high sensitivity, others high specificity but none had acceptable overall validity. None of the indicators had at the same time a sensitivity above 50% and a positive predictive value above twice the background prevalence of cervical infection. 10 or more leucocytes in the cervical smear had a likelihood ratio of 1.83 increasing pretest probability of 24.9% to post-test probability of 38%, the best result obtained by any of the rapid indicators. CONCLUSIONS: Rapid indicators of cervical STIs are insufficiently valid, which largely restricts their usefulness to high STI prevalence situations for instance, in prostitute populations and in STD patient management.

Adolescent↗
PubMed1998

[Idiopathic serous retinal pigment epithelial detachment (a case report)].

Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.

Adult↗
PubMed1998

[Risk reduction and intravenous drug use abstinence in patients with HIV infection. The SEROCO group].

BACKGROUND: Little is known about the complex stepwise process of giving up intravenous (i.v.) drugs. However, HIV risk reduction programs directed towards i.v. drug users have been accused by some opponents to encourage users to continue. In order to better assess the relationships between risk reduction and abstinence, we studied factors associated with abstinence in HIV-infected patients using i.v. drugs at enrollment in the SEROCO cohort (1988-1994). METHODS: 63 HIV-infected patients injecting i.v. drugs at enrollment were followed-up every 6 months with a clinical examination and a questionnaire concerning sexual and drugs practices since last consultation. Abstinence was defined as non injecting for at least 6 months. The 30 patients who became abstinent during a follow-up period of 3 years were compared to the 33 remaining. RESULTS: Abstinence during follow-up was not related to age at inclusion, duration of i.v. drug use, gender or marital status. However, patients who became abstinent were more likely to have a professional activity at inclusion than the remaining (70% vs 42%, p = 0.03). Before knowledge of HIV infection, frequency of injections, needle sharing and use of condoms did not differ between the 2 groups. During follow-up, behavioural changes occurred in the two groups, but were more marked in those who lately became abstinent. These latter were more likely to always inject with new needles/syringes (57% vs 18%, p = 0.003), and to use condoms with HIV-negative partners or of unknown status (73% vs 39%, p = 0.06). Professional activity and systematic use of new needles/syringes remained independently associated with abstinence in multivariate analysis. CONCLUSION: In this cohort, abstinence appeared as a stepwise process in which risk reduction preceded abstinence. This confirms that risk reduction programs do not work against those messages aimed at stopping i.v. drug use. Since this analysis selected particular subjects, enrolled in a cohort of HIV-infected patients, results should be confirmed in other samples of i.v. drugs users.

Adult↗
PubMed1998

[Methicillin-resistant Staphylococcus aureus in Dakar].

This study was carried out at the Fann University Hospital Center in Dakar, Senegal between 1994 and 1996. The purpose was to assess the prevalence of methicillin-resistant Staphylococcus aureus and to propose alternative treatments. A total of 149 stains of Staphylococcus aureus were isolated from a variety of clinical specimens. Sensitivity to various antibiotics was tested by the disc diffusion technique (anti-biogram). Resistance to methicillin was evaluated by the oxacillin disc diffusion technique on Mueller-Hinton agar containing 5% NaCl. The prevalence of methicillin resistance was 66.4%. All strains of Staphylococcus aureus were sensitive to vancomycin. Other highly effective antibiotics included fucidic acid (94%), aminoglycosides (91%), cotrimoxazol (89.6%), and norfloxacin (84.5%). Most strains (70.6%) presented a wide profile against macrolides and related groups. The LSa phenotype (resistance to lincosamines and streptogramines) was the predominant resistant phenotype. The results of this study indicate that the prevalence of methicillin-resistant Staphylococcus aureus is increasing in Senegal. Since these strains respond well to chloramphenicol and cotrimoxazole, clinicians are advised to use these drugs as an alternative first-line treatment.

Methicillin Resistance↗
PubMed1998

[Vitreo-retinal complications of hemoglobinopathy SC].

Sickle hemoglobinopathies are frequent in black population. Double heterozygous SC gives less general symptoms but ocular complications are very common. Fluorescein angiography of 20 cases are reported. All the patients had hemoglobin electrophoresis showing double heterozygous SC. Clinical investigations included fundus examination and fluorescein angiography. Laser treatment or cryotherapy were realised regarding lesions features. Vascular retinal complications were found in 75% of cases, including vitreous hemorrhage (10% of cases). There was no correlation between fundus examination and fluorescein angiography. Fluorescein angiography is useful for early diagnosis and allows preventive laser treatment.

Adolescent↗
PubMed1998

[HLA-markers and diabetic retinopathy in the Senegalese population].

Patients with IDDM often develop severe forms of retinopathy, supposed to be associated to risk factors such as hypertension, poor glycemic control and nephropathy. A controversial intervention of a genetic marker was evoked so as some diabetic patients have retinopathy in the absence of known risk factors. HLA-DR and DQ markers were compared in two groups of patients with IDDM respectively constituted of patients with and without severe retinopathy. HLA typing was carried out by polymerase chain reaction (PCR) and restriction fragments of length polymorphism (RFLP). DR9 (p < 10(-4); O.R. = 8.36) and DQA1*0301 (p < 0.05; O.R = 2.92) alleles were positively associated to diabetic retinopathy, at the opposite of DR3 (p < 10(-3); O.R: 0.01) and DQA1* (p < 10(-9); O.R = 0.15). Furthermore, among the genotypes previously considered as risk markers of IDDM in senegalese people, only DR4: DQA1*0301:DQB1*0302/DR9: DQA1*0301: DQB1*0201 was often observed in retinopathy.

Adolescent↗
PubMed1997

The relation between pump flow rate and pulsatility on cerebral hemodynamics during pediatric cardiopulmonary bypass.

OBJECTIVES: Neurologic impairment, at least partly ischemic in origin, has been reported in up to 25% of infants undergoing cardiopulmonary bypass, with or without circulatory arrest. Controversy continues about the effect of pump flow, pulsatile or nonpulsatile, on the brain and in particular on cerebral blood flow. This study examines the relationship between pump flow rate and cerebral hemodynamics during pulsatile and nonpulsatile cardiopulmonary bypass. METHOD: Near-infrared spectroscopy was used to determine cerebral blood flow and cerebral blood volume (measured as concentration change) in a randomized crossover study. Pulsatile and nonpulsatile flow were used for six 5-minute intervals at each of three different pump flow rates (0.6, 1.2, and 2.4 L x m2 x min(-1)) in 40 patients, median age 2 months (range 2 weeks to 20 years 5 months). The relations between pulsatile flow, pump flow rate, cerebral blood flow, hemoglobin concentration change (cerebral blood volume), mean arterial pressure, arterial carbon dioxide tension, and hematocrit value were prospectively examined by means of multivariate analysis. RESULTS: Cerebral blood flow decreased 36% per L x m(-2) x min(-1) decrease in pump flow rate and was associated with changes in mean arterial pressure but did not differ according to pulsatility. Change in hemoglobin concentration was unrelated to changes in pulsatility of pump flow. CONCLUSION: Cerebral blood flow is related to pump flow rate. Pulsatile flow delivered with a Stöckert pump does not increase cerebral blood flow or alter hemoglobin concentration during cardiopulmonary bypass in children.

Blood Volume↗
PubMed1997

Urinary antimony in infancy.

OBJECTIVE: To determine whether antimony may be detected in the urine during infancy and early childhood and its association with passive exposure to tobacco smoke, as assessed by urinary cotinine. DESIGN: Analysis of spare aliquots of urine collected from infants participating in studies of respiratory function and passive smoking. Urinary antimony was assayed using inductively coupled plasma mass spectroscopy in 201 urine specimens collected at different ages throughout the first two years of life from 122 term and 26 preterm infants. Urinary cotinine was measured using gas liquid chromatography. MAIN OUTCOME MEASURE: Urinary antimony concentrations. RESULTS: Absolute antimony concentrations varied widely between infants, being below the laboratory detection limit of 0.02 microgram/l in 7% of samples, below 0.5 microgram/l in 90.5%, and above the reference value of 1 microgram/l reported for non-occupationally exposed UK populations in 4%. Creatinine standardised antimony values were unrelated to postnatal age or urinary cotinine concentrations and were highest in urine collected from preterm infants within 24 hours of birth (geometric mean (95% confidence interval): 2.3 ng/mg (1.5 to 3.4)). CONCLUSIONS: Although antimony is present at very low concentrations in urine during infancy and early childhood, the relevance to health is uncertain. The higher levels found in preterm infants may reflect prematurity or fetal assimilation of antimony. Tobacco is unlikely to be an important source of environmental exposure to antimony during infancy and early childhood.

Aging↗
PubMed1997

[Note on imported malaria in metropolitan France from 1993 to 1995].

Concerning malaria, the role of the Reference National Centre on the Imported Diseases is to observe the cases that occur on the continent in order to describe their characteristics, assess their annual incidence and objectify the secular trend. The aim is to provide annual indicators to help to advise travellers. This surveillance is based on a voluntary network providing standardised informations on the epidemiologic, prophylactic, clinical, parasitologic and therapeutic data. After a noticeable increase between 1987 and 1988, the occurrence of the imported malaria cases in France decreased since 1989 then became stable since 1991, between 3,500 and 4,000 cases per year. From one year to another the characteristics of the cases are stable for most of the parameters. However, it is interesting to note: a progressive increase in the ratio of foreigners with a decrease of the median age, the average five days delay between the first symptoms and the diagnostic, the same ratio of severe cases for French people and foreigners, the average time of the stay at the hospital of 4.5 days for non severe malaria cases and the preferential use of halofantrine in first line treatment. The delay of the diagnostic and more precisely the delay of treatment turn-out to be the main factors leading to severe malaria sometimes leading to death. The limited interpretation of data is due to the lack of corresponding denominators required for measuring the rates and density of the incidence as well as the identification of risk factors.

Adult↗
PubMed1997

[Trachomatous entropion trichiasis at the ophthalmologic clinic of Dantec CHU (apropos of 199 cases)].

In Senegal as well as others developing countries trachoma is a real public health problem. Entropion trichiasis is its most common and its most blinding complication. The authors made a retrospective study on 137 records of patients who underwent 199 surgical cures on a two years period. Epidemiologically, the average age is 49 years with a significative higher percentage of woman. Clinically, 51.5% of the patients had already complications, mostly on the cornea. The Trabut technique was the most used and its results was good in 82.4% cases. The authors underlined the duality of entropion trichiasis characterized by the ocular morbidity linked to the corneal damages and the simplicity of the surgical treatment which present definite advantages. Meanwhile they remind that the best treatment of the entropion trichiasis remains the prophylaxy of trachoma.

Adolescent↗
PubMed1996

Delayed maturation of Hering-Breuer inflation reflex activity in preterm infants.

We have previously shown that the strength of the Hering-Breuer inflation reflex (HBIR) diminishes between 2 and 12 mo of age in full-term babies. The purpose of this study was to determine whether the onset of this decline had commenced by 3 to 4 mo of age in healthy full-term infants and whether preterm delivery influences the pattern of maturation. Serial measurements of HBIR activity using the end-inspiratory occlusion technique were made in 25 preterm and 27 full-term infants at matched postnatal and postconceptional ages during the first 6 mo of life. Although similar levels of reflex activity were observed at birth (mean +/- SD of 101.2% +/- 42.4% in preterm, and 101.0% +/- 33.9% in full-term infants), by 40 wk postconceptional age (PCA) (i.e., term equivalent) HBIR activity (mean +/- SD) had increased to 121.7% +/- 51.2% in preterm infants, which was significantly greater than that in full-term infants of similar PCA (95% CI of difference: 0.2; 41.2%). By 15 wk postnatal age (PNA), HBIR activity had decreased to 68.8% +/- 26.6% in full-term infants, but remained significantly higher in those delivered prematurely (87.8% +/- 32.7%). However, when measurements were repeated at approximately 4 mo after the expected rather than actual date of delivery, these differences were no longer evident (95% CI difference preterm-full-term: -21.2; 3.8%). This study suggests that important transitions in respiratory control mechanisms occur between 8 and 15 wk PNA in full-term infants and that these changes are delayed in preterm infants.

Aging↗
PubMed1996

[Apropos of a case of incomplete cryptophthalmos].

A rare case of the cryptophtalmos syndrome is presented. It's an atypical form according to François' classification. There are three types of cryptophtalmos. The problems of surgical management using several operations are underlined.

Eye Abnormalities↗
PubMed1995

The maturation of linear acuity and compliance with the Sonksen-Silver Acuity System in young children.

The compliance and maturation of visual acuity of 1245 2 1/2- to nine-year-olds was investigated. Testing was undertaken as part of routine surveillance. Ability to letter match, to achieve a binocular measure and to achieve monocular measures for children under three years was 89, 78 and 37 per cent, for children aged three to four years 97, 91 and 66 per cent, and for children over four years 99.9, 99.9 and 99, respectively. A statistical model was developed to give acuity norms by age for use by surveillance and diagnostic teams.

Age Factors↗
PubMed1995

Measures of acuity in primary-school children and their ability to detect minor errors of vision.

492 five to nine year old children participated in a study of the ability of three tests of linear acuity --the Sonksen-Silver Acuity System (SSAS), the Sheridan Gardiner 7-letter chart and the Keelers MK2 chart to identify children requiring specialist visual examination. The ability of the three tests to detect children with visual defects at 6m and of the SSAS in several test test conditions (3m and 6m, monocular and binocular) was investigated at two acuity levels for referral (3/4.5 or 6/9 and 3/6 or 6/12). Although specificity was very high for all tests and test conditions using a 3/6 or 6/12 cut-off for referral, the sensitivity and yield were disappointingly low; higher levels of the latter were achieved at the expense of a degree of specificity using a 3/4.5 or 6/9 cut off. Similarly, sensitivity and yield were greater for the monocular than binocular condition and for the 6m than 3m condition. A test of near vision (SSAS) did not detect any children not already identified by a distance measure. The optometric and developmental rationale behind the differences is discussed.

Animals↗
PubMed1994

A randomised, double-blind, parallel group study to compare subcutaneous interferon alpha-2a plus podophyllin with placebo plus podophyllin in the treatment of primary condylomata acuminata.

OBJECTIVES: The primary objective was to determine if six weeks treatment with subcutaneous interferon alpha-2a (IFN) and podophyllin 25% W/V administered twice per week, preceded by IFN alpha-2a three times weekly for one week showed a greater complete response rate in patients with primary condylomata acuminata when assessed at week 10 than treatment with podophyllin and placebo injections in the same schedule. The secondary objective was to compare recurrence rates in complete responders at six months in the two treatment groups. DESIGN: Randomised, double-blind parallel group study. SETTING: Multicentre study in six genitourinary clinics within the U.K. PATIENTS: One hundred and twenty-four patients with primary anogenital warts. MAIN OUTCOME MEASURES: Complete response rate at week 10, and recurrence rate at week 26 in complete responders. RESULTS: At week 10 analysis of the efficacy population showed complete response in 36% (15/42 patients) of IFN-treated group and 26% (11/43 patients) in the placebo group (no significant difference). Analysis of the safety population at week 26 showed persistence of the complete response in 57% (8/14 patients) of the IFN-treated group and 80% (12/15 patients) of the placebo group (no significant difference). Adverse effects were more common in IFN-treated patients, involved particularly application site reaction and malaise but were generally mild. CONCLUSIONS: At the dose and with the regime described treatment with IFN alpha-2a in combination with podophyllin is no more effective in the treatment of primary anogenital warts than podophyllin alone and is associated with more adverse events.

Adolescent↗
PubMed1994

[Essential atrophy of the iris apropos of 1 case].

The authors report a case of bilateral essential iris atrophy syndrome in a twenty two years old man associated with unilateral cataract and glaucoma. They stress the rarity of the syndrome (first case in their section) and the uncommon bilateral case. The cataract unusually described in the syndrome would be directly linked to the important and durable ocular hypertension.

Adult↗