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Biomedical subjects

J Delmont

Publications and source records attributed to J Delmont.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Antimalarial drugs and their ways to use in the African milieu].

In the tropical African environment, malaria is both a major public health problem and a problem of socioeconomic development. It is caused by various agents, the most virulent and only lethal one of which is Plasmodium falciparum. This parasite is controlled by the appropriate use of antimalarial drugs and methods of individual and collective protection. The principal drugs used to treat bouts of malaria without vomiting caused by P. falciparum are amino-4-quinoleines, essentially chloroquine. This is based on the level of resistance of P. falciparum to drugs in most African countries, particularly those of Central and West Africa. Malawi is the only country of southern Africa to have replaced chloroquine by sulfadoxine-pyrimethamine for this indication, in 1993. In cases of bouts of benign malaria with vomiting, but that are not serious, and severe malaria caused by P. falciparum (suspected or confirmed) with or without drug resistance, quinine should be given intravenously for at least three days. Once the patient regains consciouness or the digestive problems cease, quinine treatment should be given orally for 5 to 7 days. Sulfadoxine-pyrimethamine can be given as an alternative to quinine. The other antimalarial drugs currently on the African market (halofantrine, mefloquine, artemisinine and its derivatives) are often used inappropriately and should be used only in exceptional cases of severe bouts of complicated P. falciparum malaria, with suspected or confirmed resistance to amino-4-quinoleines. Individual protection against the Anopheles mosquito, the principal vector of malaria in Africa, is based largely on the use of mosquito nets impregnated with pyrethroid insecticide and the use of aerosols. Collective protection involves essentially environment-based measures.

Africa↗
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[Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects].

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.

Acute Disease↗
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[Tuberculous allergy in a population of 3-to-23-month-old children in Bangui (Central African Republic)].

In 1986, vaccinal allergy has been looked for by tuberculin RT 23 intradermal reaction within a random group of 354 Central African Children aged of 3 to 23 months and immunized in the Mother and Child Care Services in Bangui in the framework of the Enlarged Vaccination Program, with the same B.C.G. strain during their postnatal period. Percentage of intradermal reactions equivalent or superior to 6 mm get down with time, of progressive but fast mode from 56.2 p.c. in the age group of 3 to 5 months to 20.2 p.c. in the ones of 12 to 23 months. Nevertheless, the authors recommend B.C.G. immunization in urban milieu during the postnatal period because of the strong vaccinal protection one get, but recommend also a systematic booster injection during the second year of childhood.

BCG Vaccine↗
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[Degenerative angiodysplasia of the ascending colon: a new entity frequently responsible for intestinal hemorrhage in the elderly].

The authors report a case of degenerative angiodysplasia of the right side of the colon. Regarding this they describe the two clinical features peculiar to this new nosological anatomo-clinical entity: hypochromic anaemia associated with low iron, and intestinal haemorrhage. The improvement of selective arteriography is the method which permits its description and underlines the frequence. But the authors believe that coloscopy in the presence of these lesions, should become beneficial and hold a place of special importance: in the diagnosis and concerning treatment of this disease. In effect the patients most prone to this condition are, by definition, elderly and hardly suitable subjects for surgery.

Aged↗
PubMedDate not supplied

[The value of needle biopsy of the liver in the differential diagnosis of cholestatic jaundice. A clinico-pathologic study of 101 cases (author's transl)].

The examination of needle biopsy of the liver has permitted the identification of the aetiology of cholestatic jaundice in eighty five cases out of a series of one hundred-and-one patients, leaving eight without definite diagnosis and eight false diagnosis. The characteristic histopathologic lesions of lobular hepatitis and of obstructive jaundice are reviewed. The problems of identification of particular microscopic forms (obstructive jaundice with minimal portal tracts alterations, residual stage of hepatitis, cholangiolitic and hypercholestatic forms of hepatitis) are discussed.

Adenoma, Bile Duct↗
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[Plasmodial indices and malarial placentopathy in 299 parturients in Central Africa].

229 parturients were screened for malaria by blood smear test and examination of placenta (placental apposition and anatomopathological examination). Primiparous show higher sensibility to infection, with a weight deficit for newborn as a consequence of it. Placenta examination enables to diagnose twice as much malarial infestation than blood smear. Placental apposition appears to be an interesting indicator from the point of view of diagnosis and epidemiology.

Adult↗
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[Pregnancy and blood parasite indices of Plasmodium falciparum (results of a study in Bangui (Central African Republic))].

In Bangui (C.A.R.), a comparative survey about infestation by Plasmodium falciparum was carried out in 250 pregnant women and 250 non-pregnant women. Both groups were matched by age, and none of them had taken any chemoprophylaxis or anti malarial treatment for the month before the survey. Parasitic indices were significantly higher in pregnant women, and higher in primigravidae than multigravidae; the highest malarial indices were noted in the 15/20 age group. On the contrary, no significant differences were found according to the three first months of pregnancy. As a final result of this survey, the authors recommend a regular anti malarial chemoprophylaxis for pregnant women, and particularly for primigravidae, as they all constitute a group at high risk versus malarial infestation and considering the consequential effects on foetus.

Adolescent↗
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[Severe jaundice during pregnancy].

Severe jaundice during pregnancy is exceptional; it rapidly compromises the maternal and fetal prognosis. The series of seven cases presented in this study (3 acute viral hepatitis, 3 acute steatosis of pregnancy, one uncertain diagnosis), demonstrates the rapid evolution and the major repercussion on the pregnancy (5 premature deliveries, four fetal deaths in 8 children). No maternal death occurred but the complications were practically constant (4 severe haemorrhages, 3 acute renal insufficiencies, one encephalopathy with convulsions). This study permits also to emphasize the difficulty of the diagnosis in the acute phase: laboratory tests are often not very significant and the needle biopsy of the liver is usually contra-indicated; a liver scan (3 cases) may be an interesting alternative. The treatment requires a collaboration between obstetrician and anesthetist. The obstetrical management rests on the condition of the fetus and the etiology since the current tendency is to deal rapidly with the pregnancy, in the presence of an Acute Steatosis.

Adult↗
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[Liver involvement in syphilis].

The authors report two cases of syphilitic hepatitis. In the first case, acute hepatitis occurred during the secondary stage of syphilis. The diagnosis was made without waiting for the hepatitis to respond to penicillin treatment, on the basis of the following signs: icterus involving inflammatory syndrome, moderate cytolysis, clear retention, eruption of papular syphilids and a strongly positive test for syphilis. The second case involved a female patient who had been treated 15 years earlier for bone syphilis with ulcerous gummas. The signs were sclerotic, gummatous, hepatic lesions revealed by a syndrome of calcified hepatic lesions. The serologic test for syphilis was negative in this patient. Laparotomy and biopsy were necessary before a firm diagnosis could be made. The authors examine literature data concerning this pathology.

Adult↗
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[Anti-malaria chemical prophylaxis in Europeans and anti-Plasmodium fluorescence antibodies].

The authors recorded clinical histories and tested serum for the presence of malaria fluorescent antibodies in 160 healthy Europeans who had been living for more than 4 weeks in West or Central Africa. Malaria or fever of unknown origin occurred in 37 of 50 subjects who were careless about taking prophylactic drugs while abroad. Out of 110 people regularly taking suppressive amino-4-quinoline therapy, 21 had presented febrile attacks but serological tests were only positive in 8 cases. Positive serological reactions at low titers were obtained in 3 subjects with no history of past infection and who had faithfully taken suppressive medications. These results confirm the value of the malaria immunofluorescence test for the detection of occult malaria in blood donors outside endemic areas, and explain the necessity to consider previous regular, irregular or absent chemoprophylaxis before interpreting the serological results of a febrile patient returning from overseas.

Africa↗
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[Overview of dermatophytes in Mali].

517 isolations of dermatophytes collected in Mali are reported. The various species are described and the main findings are: --Trichophyton species are more common (85.5% isolated from scalp lesions and 77.5% from skin scrapings) than Microsporum species. --Trichophyton verrucosum and Microsporum canis have been found found for the first time in Mali. --Ill-defined clinical forms of scalp lesions caused by either T. schonleinii or T. soudanense occur in the subsaharian areas of the country.

Adult↗
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Malaria and anemia of pregnancy in an African savanna zone. Epidemiological, hematological, biological and immunological study of 2 villages of the Bamako region, Republic of Mali.

An haematological, biological, parasitological and immunological study about anaemia of pregnancy was carried out in two rural village of Mali Republic, where P. flaciparum malaria is hyper-endemic. The 25 pregnant women found in the villages were compared with 23 controls. One could observe that anaemia more often normochromic and regenerative usually appears during the second trimestre of pregnancy. Only a few cases with haemaglobin levels below 8 g. % are hypochromic. Serum transferrin levels were slightly higher among pregnant. None among 31 bone marrows examined showed megaloblastic changes. Haptoglobin levels below 10 mg. % were observed in 3/4 of the pregnant women versus 1/4 in controls. Like some others, this study confirms the primary responsability of malaria haemolysis in the aetiology of anaemia of pregnancy and the interest of systematic chemoprophylaxis, at least from the third month of pregnancy. Vitamin and iron therapy is to consider therafter in hyper-endemic areas of P. falciparum malaria when nutritional problems are not predominant.

Adult↗
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[The cardiac liver].

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Heart Diseases↗
PubMedDate not supplied

[Imported malaria in the hospitals of Marseilles from 1973 to 1976: epidemiological characteristics].

Between 1973 and 1976, 96 confirmed hospital cases of imported malaria occurred in Marseille. The collected epidemiological data indicate the recent increase of the annual incidence and an equal number of cases in immigrants and in people returning from the tropics. Among them, tourists, servicemen and merchant seamen are the groups most at risk. A high proportion of infections are with P. falciparum, mainly from Africa, Malagasy and Comoros. The diagnosis is only confirmed on an average of 6 days after the first medical advice and 2 patients died from falciparum infections. Travellers to tropical countries are often careless about taking prophylactic drugs and the danger of imported malaria should be emphasized.

Adult↗