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Evaluer l’efficacite et la tolerance de la tritherapie par omeprazole, amoxicilline et clarithromycine (OAC) dans la maladie ulcereuse duodenale (MUD) non compliquee de l’adulte associee a Helicobacter pylori. Il s’agit d’une etude retrospective et descriptive realisee entre le 31 octobre 2001 et le 18 mars 2004 a l’hopital Principal de Dakar. Ont ete inclus dans cette etude tous les patients âges de plus de 15 ans qui avaient beneficie d’une endoscopie digestive haute avec mise en evidence d’une lesion duodenale (ulcere ou equivalent d’ulcere) active ou quiescente et un test a l’urease positif. Les patients inclus etaient traites par OAC: omeprazole 40 mg en deux prises quotidiennes, amoxicilline 2 g en deux prises quotidiennes et clarithromycine 1 g en deux prises quotidiennes pendant sept jours. Certains patients avaient recu un traitement complementaire par omeprazole 20 mg par jour pendant trois semaines en raison de la persistance des symptomes. Une endoscopie digestive haute etait realisee au moins quatre semaines apres la fin du traitement avec un test a l’urease, deux biopsies antrales et deux biopsies fundiques pour un examen histologique. Au total, 117 patients etaient inclus dans l’etude. L’âge moyen etait de 39 ans, le sex-ratio de 3. La MUD etait active chez 89,5 % des patients (102/114). L’ulcere representait 73,7 % des lesions. Quatre-vingt-douze patients (78,6 %) etaient traites par OAC pendant sept jours et 25 patients (21,4 %) avaient beneficie d’un traitement complementaire par omeprazole. Le taux de succes du traitement sur la symptomatologie fonctionnelle etait de 95,9 % (94/98) en analyse per protocole et de 80,3 % (94/117) en intention de traiter (ITT). L’efficacite du traitement sur les lesions endoscopiques etait evaluee a 86,4 % (76/88) en per protocole et a 72,4 % (76/105) en ITT. Le taux d’eradication etait de 79,3 %(73/92) en per protocole et de 68,9 % (73/106) en ITT. L’observance du traitement etait bonne dans tous les cas ou cette information etait renseignee (90/117). Neuf patients sur 76 (11,8 %) avaient signale des effets secondaires mineurs n’ayant pas necessite une interruption therapeutique. Cette etude a demontre l’efficacite et la bonne tolerance de la tritherapie par OAC chez les patients senegalais souffrant de MUD non compliquee associee a H. pylori.

Resume Une etude retrospective a ete conduite de janvier 2000 a decembre 2003 pour evaluer la resistance de Mycobacterium tuberculosis aux antituberculeux et ses consequences sur le resultat du traitement. Deux cent deux dossiers-patients sont etudies (âge moyen : 36 ans ; sex-ratio : 1,7). La tuberculose est pulmonaire (85,7 %) ou extrapulmonaire (14,3 %). Le statut VIH est negatif (71,3 %), positif (10,8 %) ou inconnu (17,9 %). Le taux global de guerison est de 60,7 % (61,4 % chez les VIH− ; 46,1 % chez les VIH+), celui des echecs therapeutiques est de 2,7 % (1,1 % chez les VIH− ; 15,4 % chez les VIH+), celui des deces dus a la tuberculose est de 6,3 % (2,3 % chez les VIH− ; 23,1 % chez les VIH+), et le taux des patients perdus de vue est de 30,3 % (35,2 % chez les VIH− ; 14,2 % chez les VIH+). Une hepatotoxicite survenant au cours du traitement est observee dans 14,3 % des cas (guerison : 56,2 % ; echec : 6,2 % ; perdus de vue : 18,8 %). Quatre-vingt-quatre pourcent des patients n’ont jamais recu de traitement antituberculeux (groupe A) versus 15,8 % de patients ayant deja recu un ou plusieurs medicaments antituberculeux (groupe B). Les taux de resistance a l’isoniazide sont de 6,4 % (A) et de 12,5 % (B), a la rifampicine de 1,7 % (A) et 12,5 % (B), a l’ethambutol de 0,5 % (A) et 0 % (B), a la streptomycine de 24,1 % (A) et de 46,8 % (B). Le pourcentage de souches multiresistantes est de 1 % chez les patients non traites auparavant et de 11 % chez ceux ayant deja recu un traitement antituberculeux. Lorsque les patients sont porteurs d’une souche sensible au traitement administre, le taux de guerison est de 64,2 % versus 46,7 % chez les patients dont la souche est resistante a au moins un des traitements administres.

A total of 684 Hisex Brown day-old chicks were studied. The chicks were randomly assigned into three groups as follows: (1) chicks with immediate feed access; (2) chicks with 48 h delay in feed access, and (3) chicks with 72 h delay in feed access. For each group, chicks were assigned into 4 replications of 57 birds each. Prior to feed access, the chicks were weighed. Samples of chicks were used to weigh yolk sac at 1, 3 and 7 days and to collect blood at 1, 3, 7, 14 and 56 days. Also, reared chicks were weighed weekly. The results indicated that chick weights decreased during the holding period. Yolk sac utilisation was similar between groups, while morbidity and mortality increased linearly with the duration of delay in feed access. At 56 days, chicks having delayed access to feed were lighter than those without delay in feed access. Serum concentration of glucose up to 14 days and of total protein and triglycerides until 56 days decreased with the increasing duration of delay in feed access. It can be concluded that delayed feed access is detrimental to the juvenile performance of layer-type chicks and has a negative age-related effect on the serum concentrations of glucose, triglycerides and total protein.

1. Because CO(2) during the second half of incubation is known to influence air cell and blood gases, and embryo development, it is postulated that post-hatch development and ascites sensitivity could also be influenced. 2. An ascites susceptible (A) and an ascites resistant (E) broiler line were incubated under standard incubation or high CO(2) conditions (up to 4%) from embryonic day (ED) 10 onwards. The embryonic development and the hatching process of these two lines were compared when incubated under standard or high CO(2) conditions from over the second half of incubation. 3. The A line, selected for high post-hatch growth rate, exhibited a higher relative embryo weight from ED10 until ED16, which was supported by a higher air cell pCO(2), lower air cell pO(2), higher corticosterone and thyroid hormones and earlier hatching time. 4. Incubation under high CO(2) increased air cell pCO(2), retarded yolk consumption, and decreased glycogen concentration in the liver at hatch. Hatchability decreased in both lines when incubated under high CO(2), due to an increased late mortality of embryos that died before IP. 5. These results suggest that the development and metabolism of CO(2)-incubated embryos differ from control incubated embryos.

Il s’agit de decrire les aspects epidemiologiques, cliniques, paracliniques, therapeutiques et evolutifs de la tuberculose peritoneale au Senegal. Il s’agit d’une etude retrospective ayant inclus tous les cas de tuberculose peritoneale recenses a l’hopital Principal de Dakar, entre le 1er janvier 1996 et le 30 juin 2006, soit pendant dix ans et six mois. Soixante et un cas de tuberculose peritoneale ont ete inclus. L’âge moyen des patients etait de 36 ans, le sexratio de 0,9. L’ascite febrile etait la principale circonstance de decouverte. Le liquide d’ascite etait exsudatif dans 92,4 %, lymphocytaire dans 90,5 %. La tuberculose peritoneale etait isolee dans 70,5 % des cas, associee a une atteinte pleurale dans 21 % des cas, a une atteinte pulmonaire dans 13 % des cas et a une atteinte hepatique dans 3,2 %. La serologie VIH etait positive chez 4,5 % des patients testes. Le diagnostic de certitude a repose sur la laparoscopie associee a des biopsies peritoneales qui montraient des lesions granulomateuses dans 70,5 % des cas. L’evolution etait favorable dans tous les cas sous traitement antituberculeux. La tuberculose peritoneale atteint l’adulte jeune avec une discrete predominance feminine dans cette serie. Elle doit etre evoquee devant toute ascite febrile, lymphocytaire et exsudative. Le diagnostic de certitude repose sur la laparoscopie associee a des biopsies peritoneales. L’evolution est generalement favorable sous traitement antituberculeux bien conduit.

Resume Entre 2001 et 2004, trois militaires francais en operation en ex-Yougoslavie sont rapatries pour respectivement : suspicion de pneumopathie droite, epanchement pleural apres appendicectomie, hemoptysie et abces hepatiques. Tous ont deja effectue une ou plusieurs missions en Afrique et/ou en Amerique du Sud. A leur arrivee en France, le premier diagnostic est rapidement redresse. Il s’agit dans deux cas d’une amibiase hepatique avec manifestations respiratoires reactionnelles, et dans un cas d’une amibiase pleuropulmonaire. L’evolution de ces trois cas est secondairement favorable sous traitement anti-parasitaire adapte. Nos observations illustrent les manifestations de contiguite d’un abces amibien hepatique (surelevation de la coupole diaphragmatique, epanchement pleural reactionnel) et un cas exceptionnel d’amibiase pleuropulmonaire avec fistule hepatobronchique. Ces observations tirent leur originalite de la diversite des presentations cliniques et surtout de la difficulte et du retard du diagnostic d’une amibiase hepatique se declarant en Centre Europe. L’amibiase doit etre evoquee en toutes circonstances chez le voyageur comme chez le militaire ayant frequente une zone de forte endemie, meme si le sejour est ancien.

Resume Objectif Devant une pleuresie lymphocytaire exsudative inexpliquee, la mise en route d’un traitement antituberculeux presomptif est courante a l’Hopital Principal de Dakar. Materiel et methode Pour analyser cette demarche therapeutique, nous avons etudie retrospectivement les patients hospitalises ayant recu un traitement antituberculeux presomptif a l’Hopital Principal de Dakar, entre janvier 2002 et decembre 2002, et presentant une pleuresie lymphocytaire exsudative, sans documentation bacteriologique et sans signe clinique d’orientation vers une autre etiologie. Une evaluation radio-clinique etait effectuee en debut et fin du traitement antituberculeux presomptif. Resultats Trente-huit patients etaient inclus, dont 23 hommes : âge moyen de 36 ans, 1 cas d’infection VIH. Le cliche thoracique montrait une pleuresie de grande (n = 14), moyenne (n = 18) ou faible (n = 6) abondance. Le test tuberculinique etait mesure entre 12 et 24 mm. Toutes les pleuresies presentaient une lymphocytose superieure a 80 % et un taux de protides superieur a 50 g/L. Aucun sujet n’etait perdu de vue. Le suivi realise chez 37 patients (1 deces cardiaque) montrait une evolution favorable avec une normalisation du cliche thoracique dans 82 % des cas ou la persistance d’un emoussement du cul pleural 16 % des cas. Conclusion Au Senegal, la nature exsudative lymphocytaire d’une pleuresie inexpliquee pourrait justifier un traitement antituberculeux presomptif.

Les colites parasitaires au cours des immunodeficiences sont surtout observees lors de deficits de l’immunite cellulaire, domines en frequence par l’infection par le virus de l’immunodeficience humaine. Les parasitoses en cause sont des protozooses digestives (amibiase, blastocystose, balantidiose, dientamoebiase, cryptopsoridiose, isosporose), plus rarement extra-digestives (leishmaniose viscerale, toxoplasmose, pneumocystose). La strongyloidose est l’unique helminthiase concernee. Ces colites ont une connotation pejorative pour plusieurs raisons: intensite du deficit immun sous-jacent; colite d’expression clinique grave, compliquee ou prolongee; dissemination de la parasitose et frequente association a d’autres agents pathogenes ou manifestations tumorales, induits egalement par l’immunodeficit et qui modifient les tableaux cliniques; difficultes diagnostiques justifiant une cooperation entre le clinicien, le biologiste et l’endoscopiste digestif; traitements souvent en echec justifiant le recours a des alternatives inconstamment validees.

Background and Purpose— Basic stroke features are hardly known in sub-Saharan countries, and no data are available in Senegal. Methods— We performed a retrospective hospital-based study in Dakar, Senegal, to assess risk factors and etiology of stroke. Patients were recruited from January 1, 2003, to July 31, 2004, at the Hôpital Principal, Dakar. Strokes had to be ascertained by computed tomography. Results— A total of 107 patients were studied. Seventy percent of strokes were of ischemic nature. For ischemic strokes, mean age was 64.2 years. Hypertension was the main risk factor, occurring in 68%, and diabetes was encountered in 37.3%. Lacunar strokes and cardioembolism accounted for 20% and 13.3%, respectively. Because of the lack of systematic investigations, two thirds of strokes were of undetermined origin. Mortality within 1 month was 38%. For hemorrhagic strokes, mean age was 51 years and 1 month mortality was 56%. Conclusion— Hypertension is the main risk factor for both ischemic and hemorrhagic strokes in this hospital-based study.

Background We evaluated the short-term spontaneous fluctuations of HBV DNA and HBsAg levels in Senegalese patients with chronic infection with hepatitis B virus and normal ALT and determined factors related to these fluctuations. Method A total of 87 patients with persistent normal ALT values were enrolled in the study. Serum samples were obtained at three different visits, with an interval of 2 months (M0, M2, and M4), and without initiating anti HBV treatment. Levels of HBV DNA, quantitative HBsAg, ALT and AST, genotyping and viral DNA mutations were analyzed. Results Among the 87 patients, genotype E was predominant (75%). The median HBV DNA level was 2.9 log10 IU/mL [2.2-3.4], 2.7 log10 IU/mL [2.1-3.6] and 2.7 log10 IU/mL [2.1-3.4] at M0, M2 and M4, respectively. The values ranged from

Resume Les localisations osseuses de la tuberculose sont dominees par le mal de Pott, mais des atteintes peripheriques restent possibles au niveau du poignet, du femur, du pied ou de l’epaule, comme dans notre observation. Du fait d’une presentation clinique volontiers aspecifique et indolente, le diagnostic et la mise sous traitement antituberculeux sont tardifs et ne permettent pas de prevenir des atteintes osteolytiques irreversibles.

L’hetocarcinome est un fleau important sous les tropiques ou il represente une cause majeure de mortalite par cancer. Son diagnostic est souvent tardif et les moyens therapeutiques ne sont que palliatifs. Les facteurs determinants de la carcinogenese hepatique sont domines par le virus de l’hepatite B dont la carte mondiale de prevalence se calque sur celle du cancer du foie. Il existe une susceptibilite genetique dans la survenue de ce cancer. D’autres facteurs sont importants ou adjuvants: le virus de l’hepatite C, l’alcool, la surcharge en fer et l’aflatoxine dont les effets mutagenes ont ete prouves. Seule la suppression du facteur principal (le virus B) par la vaccination de masse pourra reduire la prevalence de cette tumeur decimant une population jeune dans ces pays en voie de developpement.

We report a highly probable case of moderately severe blackwater fever. A French woman, living in Guinea Bissau, was used to taking self-medication halofantrine for malaria. On this occasion, she felt unusual chills and pyrexia after a non documented bout of malaria, followed by nausea, then jaundice with dark-red urines despite another treatment with halofantrine. A sepsis was eliminated by two negatives thick peripheral blood drop examinations. Hemolysis was noted with 8.1 g/dl of hemoglobin, Coombs positive, and LDH at 1,452 IU/l, associated to renal failure with 34 ml per minute of clearance. The outcome was favourable with rehydration. Blackwater fever has been described with the three aminoalcohols, but mainly in severe presentations. Clinicians are not familiar with this disease, even though it has major therapeutic implications: quinine, halofantrine, and mefloquine become strictly contra-indicated. Moderate forms may be unknown, and this observation should be taken into account to prevent mistreatment in future patients.

La bilharziose, troisieme endemie parasitaire mondiale, a la particularite d’avoir une focalisation colique pour les cinq especes pathogenes pour l’homme. L’atteinte colique est l’expression des granulomes bilharziens cernant les œufs dans la paroi intestinale. Elle se traduit cliniquement par des douleurs, de la dysenterie ou des rectorragies. L’endoscopie colique montre des lesions evocatrices d’aspect parfois specifique. Elle permet la pratique de biopsies dont l’examen a l’etat frais met en evidence les œufs du parasite beaucoup plus souvent que l’examen parasitologique des selles. Le traitement medical est actuellement simple grâce au praziquantel. La prevention repose sur l’interdiction de l’immersion cutanee dans l’eau douce en zone d’endemie. Le gastroenterologue doit connaitre cette pathologie qu’il peut rencontrer quel que soit son lieu d’exercice.

1. The aim of this study was to investigate if genetic predisposition to ascites interacts with changed incubation conditions, and how this might affect the post-hatch performance and ascites susceptibility. 2. An ascites sensitive (A) and resistant (E) broiler line were incubated under standard or high CO(2) conditions (up to 4%) from embryonic d 10 onwards. After hatch, chicks were exposed to cold from the 15th day of the rearing period to increase the incidence of ascites. 3. The A line had a higher post-hatch body weight from week three, higher blood pCO(2) from d 21, higher haematocrit at d 35 and d 42, and higher plasma corticosterone concentration from d 21 onwards, compared with the E line, regardless of incubation conditions, supporting the given selection criteria. Ascites mortality did not, however, differ between lines. 4. Incubation under high CO(2) conditions during the second half of incubation increased the ascites mortality, decreased body weight from week 4 onwards, affected venous blood pCO(2), decreased blood pO(2) from d 31, increased haematocrit at d 35 and d 42, and lowered the thyroxine and triiodothyronine concentrations at most sampling days. These effects were observed in both lines. The results suggested a metabolic programming of CO(2) incubated chickens which affected ascites susceptibility.

La localisation de metastases au tube digestif est rare. Leur siege est plus souvent jejuno-ileal. Les auteurs rapportent un cas de metastase d’un carcinome epidermoide de l’œsophage chez un homme de 47 ans qui avait ete traite par radiochimiotherapie puis chirurgie deux mois auparavant. Une revue de la litterature retrouve le caractere exceptionnel de ces metastases duodenales.

A prospective study was carried out in two tertiary hospitals in Dakar to determine the main causes of sputum acid-fast bacillus (AFB) smear-negative pneumonia in HIV-infected patients. All clinical and microbiological records were reviewed by experts. Seventy patients were finally enrolled. Most of them were hospitalized at an advanced stage of AIDS. The median CD4 cell count was 62/mm(3) and the median body mass index (BMC) was 18 kg/m(2). Thirty-one patients (44 %) were known as seropositive for HIV infection prior to admission. Radiological opacities were localized in 70 % of patients and diffuse in 21 %. Fiberoptic bronchoscopy was performed in 50 patients (71 %). A definite or probable diagnosis was obtained in 55 patients (79 %). Bacterial pneumonia (usually due to Enterobacteriaceae and Pseudomonas aeruginosa), tuberculosis, Pneumocystis pneumoniae and other causes (Kaposi's sarcoma, atypical mycobacteria) were diagnosed in 67 %, 24 %, 5 %, and 13 % of these patients respectively. In conclusion, pneumonia of bacterial origin and tuberculosis can be incriminated in the majority of cases of AFB negative pneumonia observed in HIV patients in Dakar.

Diseases always have a significant impact during military deployments. We evaluated the operational impact of health problems observed in a French infantry battalion (n = 690) during a 4-month assignment in Ivory Coast. In all, 55.7% of soldiers consulted at least once and sought care for 608 health problems. A total operational incapacity was observed in 22.2% of cases (7.6/1,000 person-days). The 5 diseases causing the greatest operational incapacity were diarrhea (2.1 days lost/1,000 person-days), musculoskeletal diseases and injuries (53.7 days), malaria (29 days), dental diseases (30.9 days), and fevers of undetermined origin (7 days). The incidence of diarrhea and skin infections was higher in rank-and-file troops than among noncommissioned officers. It was also higher during the mission's first month, when individual susceptibility to infections is suspected to be highest. Some diseases that are not serious nonetheless have a significant operational impact and should be better studied to determine preventive measures.

Despite thorough selection during the last decade, the incidence of ascites is still high in modern broiler strains. Although ascites occurs mostly at the end of the rearing period, there are indications that the etiology of this problem may have started during embryonic development. Recent studies have shown that the post-hatch performance of the broiler chick might be influenced by changing the environmental conditions in the incubator during embryonic development. This study investigated the effect of increasing incubator CO(2) concentration up to 0.7%, by nonventilation during the first 10 d of incubation, on the embryonic development of 2 commercial broiler strains (Cobb and SAS) differing in their susceptibility for ascites syndrome. The Cobb strain is suspected to be less susceptible than the SAS strain. Overall, the chick embryos of the Cobb strain had a faster development than those of the SAS strain as expressed by their higher BW from embryonic day (ED)10 until ED18. Nonventilation stimulated embryonic development resulting in higher embryonic BW, early hatch, and narrower spread of hatch in both strains. In the SAS strain, nonventilation improved hatchability by more than 10%. Gas composition of the air cell in the egg of the nonventilation groups (both Cobb and SAS) had higher partial pressure of CO(2) and lower partial pressure of O(2) from ED11 until ED14 compared with the ventilation groups. During the entire incubation period, partial pressure of CO(2) was higher in eggs of the Cobb strain compared with the SAS strain. Plasma triiodothyronine, thyroxine, and corticosterone levels were different at the end of the incubation period and during hatching due to nonventilation at the beginning of incubation. It is concluded that nonventilation during the first 10 d of incubation had a stimulatory effect on embryonic development of the 2 broiler strains with no effect of heart weights but with effects on hormone levels, air cell pressures, and hatching parameters.

This study investigated the effect of high CO2 (4%) from embryonic day (ED)10 until ED16 on the acid-base balance and related parameters in the chicken embryo. From ED10 to ED16, blood was taken from a vein from the chorioallantois membrane and was analyzed for pH, partial pressure of CO2, partial pressure of O2 (pO2), [HCO3−], [K+], and [Ca2+]. Allantoic fluid was taken for measurement of pH, NH3-N, phosphate, and calcium concentration. The right tibia was ashed, and calcium was measured with atomic absorption spectroscopy. Embryos exposed to high CO2 showed a consistent higher blood pH than control embryos. Notwithstanding this alkalosis, bicarbonate concentration was significantly higher in the CO2 group from ED12 until ED16. Potassium concentration in the blood was significantly higher in the CO2 group from ED11 until ED16. The pH of the allantois was significantly higher on ED14 and ED15. Ammonia N concentration was significantly higher in the CO2-incubated embryos on ED12 and ED13, whereas phosphate did not differ between groups. Calcium per tibia dry weight did not differ between incubation conditions. We can conclude that embryos adapt to high CO2 during the second half of incubation by increasing blood HCO3−. It appears that this increase in HCO3− is mainly the result of the stimulated intracellular exchange of H+ with K+, although temporary reabsorption of HCO3− by the kidney cannot be excluded.

The emergence of thermoregulation in avian species is a complex matter in which neural as well as hormonal processes are involved. In a previous paper, the neural aspects of primary avian thermoregulation were discussed. In this paper the role of the hypothalamus-pituitary-thyroid axis (HPT-axis) and the hypothalamus-pituitary-adrenal axis (HPA-axis) in the ontogeny of avian thermoregulation is evaluated. The regulatory mechanisms and different important hormones of both axes, which have stimulatory or inhibitory effects, are discussed. Because the onset of functionality of the thermoregulatory system is of great interest, the ontogeny and functionality of the hormonal axes are clarified. There is a great difference between precocial and altricial birds in hormonal events as well as in neural processes which are involved in the emergence of thermoregulation. In precocial avian species the HPT-axis becomes functional during the mid- to late embryonic period while the same axis only becomes fully functional during the first week post-hatch in altricial avian species. As early as the sixties, the emergence of homeothermy in chickens was investigated. It was concluded that the thyroid gland plays an important role in the thermoregulatory mechanisms of newly hatched chicks. More recent studies however were not able to show any direct effect of the thyroid hormones on the thermoregulation of day-old chicks, although blocking the conversion of T4 to T3 caused a decrease in body temperature in young chicks. Thyrotropin releasing hormone (TRH) is known to act in thermoregulation in mammals and several authors have found an effect of TRH on the metabolism of young and older chicks. However, the exact mechanism still remains unclear. Because the HPT- and the HPA-axis show close relationships, the role of the HPA-axis in the ontogeny of thermoregulation is also taken into consideration in this review. In mammals as well as in birds, corticotropin releasing hormone (CRH) is involved in the primary thermoregulation. We conclude that the HPT-axis has an important role in the ontogeny of avian thermoregulation. The exact role of the HPA-axis remains largely unclear although at least CRH is definitely of some importance.

In this study, broiler embryos were exposed during the second half of incubation [embryonic day (ED) 10 until ED18] to 4% CO(2). The CO(2) was set to reach 2% on ED11 and 4% from ED12 onward. Two experiments were conducted with the same setup. Embryo weight was measured and partial pressure of CO(2) and O(2) in the air cell was analyzed at several embryonic ages. Times of internal pipping, external pipping, and hatching were recorded. Chicks were raised until d 7 posthatch. Plasma corticosterone, triiodothyronine, and thyroxine concentrations were determined. Embryonic growth was not retarded and hatchability did not decrease in the CO(2)-incubated group, demonstrating that chicken embryos can tolerate high (4%) concentrations of CO(2) between ED10 and ED18. In the first experiment, partial pressure of CO(2) in the air cell was significantly higher in the CO(2) group on ED11, ED12, ED13, and ED14, but disappeared thereafter. This difference was not observed in the second experiment. A change in the hatching process of the CO(2) group was seen. Relative growths of newly hatched chicks until d 7 posthatch were equal in the CO(2) group and the control group. However, corticosterone and thyroxine concentrations were significantly higher in the CO(2)-incubated chicks on d 7 posthatch.

Recent studies show the importance of differential CO2 levels during the first half of incubation of chicken eggs on embryonic and postnatal growth. However, it is not known how external higher CO2 levels affect embryonic acid-base balance. In this study, the effect of an early rise in CO2, between 25th and 96th hour of incubation to 1.5% and maintained at that level until 240 h of incubation, was investigated on air cell gases, blood gas parameters from ED10 onwards and on embryonic growth and hatching parameters. Higher external CO2 concentrations resulted in a faster acidification of albumen resulting in a faster decrease of albumen pH with development, illustrating the capacity of albumen to cope with higher environmental CO2. Moreover, PCO2 in blood was higher in CO2 incubated embryos at embryonic day 10 and 11 but without a change in blood pH. The additional increase in plasma HCO3- concentration at day 10 and 11 was responsible for buffering the higher PCO2 in CO2 incubated embryos in order to stabilize pH. However, effects of hypercapnia on blood acid-base parameters extinguished 2 days after termination of high CO2 incubation. Embryonic growth was modestly accelerated which was reflected in higher embryonic weights at day 6 and 10 and a significant earlier hatching; hatchling weights were not different between treatment groups.

Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN-alpha2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN-alpha2b alone for 48 weeks (R1: 42 patients) or IFN-alpha2b plus ribavirin (600 mg/day) for 24 weeks and IFN-alpha2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN-alpha2b plus ribavirin for 24 weeks and then IFN-alpha2b alone for the next 24 weeks (R3: 104 patients) or IFN-alpha2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score6 and alanine aminotransferase pretreatment level3 x upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR.

A severe epidemic of serogroup A meningococcus meningitis occurred in the northwest Central African Republic from January to March 1992. Strains from 24 patients were characterized using serotyping, testing of susceptibility to antibiotics, and multilocus enzyme electrophoresis. In 23 of the 24 patients the causal strain was found to be 4:P1.9/clone III-1. These results indicate that such strains continue to spread in Africa and have taken hold in areas outside the “meningitis belt.” This may be a consequence of changing climatic conditions.

(1994). Efficacy of ivermectin treatment of Loa loa filariasis patients without microfilaraemias. Annals of Tropical Medicine & Parasitology: Vol. 88, No. 1, pp. 93-94.

Brain swelling (BS) is a kind of response observed in 15%–20% of severe head injury. Its pathophysiology is not well known yet, and its diagnosis is exclusively scanographic in emergency.

Systemic manifestations are described in chronic hepatitis C. Haddad et al have showed the prevalence of sicca syndrome with lymphocytic sialadenitis. We analysed prevalence in 50 patients suffering from chronic hepatitis C with histologic low rank. 50% of them have pronounced abnormality of lachrymal secretion without sialadenitis. It seems that sicca syndrome is present in low rank hepatitis. In that case xerophtalmia preceded xerostomia.

In an open study, the authors evaluate the efficacy and safety of Ivermectine (IVM) (oral doses of 200 microg/kg repeated after 1 month) in the treatment of Loa Loa infection without microfilar˦mia. All patients responded to the therapy. A recurrent œsinophilia occurred in 3 patients on the 8th month in the follow-up was well tolerated without any side effects.

The case of a 23 year old man with eosinophilic gastroenteritis and ascites is presented. The major clinical features of this rare and complex disease are reviewed with special reference to the long term prognostic.