Détermination de la tortuosité pour la détection des rétinopathies vasculaires sur les images d''angiographie rétinienne

Les rétinopathies vasculaires peuvent être accompagnées d'une modification de la forme des vaisseaux. Les patients atteints courent le risque de perdre la vue. Jusqu'ici, les méthodes utilisées par les ophthalmologistes pour analyser ces modifications sont qualitatives. Nous proposons une méthode nouvelle d'analyse de la tortuosité des vaisseaux de la rétine en vue d'élaborer par la suite un outil d'aide au diagnostic des rétinopathies vasculaires. La première étape de la méthode est une représentation symbolique de la structure vasculaire de la rétine. La deuxième étape appelée reconstitution 2D est la classification des entités vasculaires en gros vaisseaux (artères ou veines) et en petits vaisseaux (artérioles ou veinules) en utilisant la moyenne du diamèetre et du niveau de gris des segments de vaisseau comme paramètres discriminants. La dernière étape consiste à calculer l'excentricité des vaisseaux pour décrire leur tortuosité. Pour s'assurer de la capacité de l'excentricitéà décrire les petites modifications de forme, un second paramètre a été défini à titre comparatif. Les résultats obtenus permettent de quantifier les modifications de forme des vaisseaux.     

Hemolytic and uremic syndrome after heart transplantation

Two cases of hemolytic and uremic syndrome in heart transplant recipients are reported. Among solid organ transplantations, this complication mainly occurred in renal transplantation and only 1 case was reported in heart transplantation in the literature. Cyclosporine was the only etiologic factor found. The renal outcome was severe with end-stage renal failure and no recovery of the renal function despite stopping cyclosporine, corticoids and plasma exchange.     

Évaluation d’un test de diagnostic rapide pour le diagnostic de la toxoplasmose chez les femmes enceintes à Cotonou (Bénin)

The aim of the study was to evaluate the performance of the ImmunoComb® Toxo IgG and ImmunoComb® Toxo IgMassays (rapid diagnostic test) in the laboratory diagnosis of toxoplasmosis in pregnant women in Cotonou. We interviewed 266 pregnant women, who first answered an epidemiological questionnaire, and collected blood samples for measurement of IgG and IgM anti T. gondii antibodies with the ImmunoComb toxo assays and with the ARCHITECT CIMA method. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated to determine the performance of the rapid test. The seroprevalences of IgG against T. gondii by CIMA technique and rapid test were respectively 48.9% and 48.5%. The prevalence increased with age. Performances for IgG were: sensitivity 97%, specificity 100%, PPV 100%, NPV = 97.10%. For IgM, Sensitivity: 33.3% Specificity: 100%, PPV 100%, NPV = 99.2%. Seroprevalence obtained shows that about half of the study population is not immune against T. gondii and requires regular serological monitoring until delivery. According to these results, and given the needs of toxoplasmosis diagnosis on the field characterized by an important decrease of immunized women, this test may be recommended in the laboratory diagnosis of toxoplasmosis in peripheral levels of the health pyramid.     

A new approach for rapid detection and typing of serum monoclonal components

When used independently, none of the routine methods to explore serum monoclonal components (MC), including: serum protein electrophoresis (SPE), immunoelectrophoresis (IEP), kappa to lambda ratio (KLR) and immunofixation (IFE), provides a comprehensive quantitative and qualitative identification of the MC. In the past few years the concept of 'protein profile', based on immunonephelometric quantifications of serum proteins, has become widely used. It consists of a qualitative and quantitative graphic representation of numerous serum proteins including immunoglobulins. Aim of study was to develop a multidimensional model based exclusively on protein profiles labeled the protein profile prediction method (PPPM) to improve routine MC detection and typing. Serum samples from 127 hospitalized patients and 99 healthy blood donors were submitted to all of the following: SPE, IFE, KLR and a protein profile (which included IgM, IgA, IgG, kappa and lambda chain detections and quantification). The presence of a MC using IFE was chosen as the gold standard. Healthy donors and patients were randomly divided into two groups defined as testing and validation groups. A logistic model was designed based on the protein profiles of the testing group leading to the determination of a threshold value (called Z(r)) for MC detection. It was then tested to detect MC in the validation group. Using IFE, 73 MC were found in the 127 hospitalized patients. Using the threshold value for MC detection of Z(r)=1.86, the PPPM showed greater sensitivity (94.6%) in detecting a MC compared to either SPE (64.8%) or KLR (89.2%). This result was obtained without diminished specificity (80.8%). The association of SPE or KLR to PPPM did not significantly increase the sensitivity of the PPPM. In the validation group, for samples which had a high predictive probability of a MC using PPPM, the correct MC typing was identified in up to 77% of sera using PPPM only. These results may be interesting in helping to determine when supplementary IFE analysis is required to qualitatively analyze a MC. PPPM allows MC detection with great sensitivity. The immune protein profile dramatically increases the sensitivity of either SPE and/or KLR in detecting MC and may also allow heavy and light chain typing.     

Hyperhomocysteinemia among ischemic stroke victims in the teaching hospital of Lomé

Hyperhomocysteinemia is an independent vascular risk factor involved in ischaemic stroke. Aim of this study was to evaluate the prevalence of hyperhomocysteinemia and the role of the metabolic determinants in ischaemic stroke. The study concerned 183?patients in the Department of neurology of the teaching hospital of Lome. The diagnosis of stroke was made on clinical and brain CT scan arguments. The dosage of homocysteinemia was carried out by the immunoenzymatic method (Abbott Diagnostic). Among 183?patients, 111 (61%) had a hyperhomocysteinemia. The total average homocysteinemia was of 22.0 μmol/L. The average homocysteinemia among men was of 22.4 μmol/L (5.2-198.0) and 18.80 μmol/L (4.2-50) among women with a positive correlation (P = 0.049 and 0.01) between homocysteinemia and the age among the men and women. The average homocysteinemia was of 17.2 μmol/L in the large ischaemic stroke; 23.0?μmol/L when associated with lacunes and 32.8 μmol/L when associated with lacunes and leucoaraiosis (p = 0.001). In conclusion, the hospital prevalence of the hyperhomocysteinemia was of 61%. Hyperhomocysteinemia was the second vascular risk factor after arterial hypertension in term of prevalence, probably from nutritional cause.     

Frequency of CCR5 variants among rural populations with low HIV-1 prevalence in Cameroon

Among rural populations in Cameroon, HIV-1 prevalence is low and the genetic diversity broad. An unusual population-level genetic background may modulate this pattern of HIV infection. We examined HIV-1 prevalence, CCR5Delta32 and CCR5 promoter -2459 G genotype frequency among 1390 rural inhabitants. No individual was identified with the CCR5Delta32 allele, but homozygotes for the CCR5 promoter variant -2459G (27.5%) were relatively common. A seroprevalence of 3.1% of HIV-1 was reported.     

Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial

Context  Nonoxynol-9 has been suggested as a vaginal microbicide to protect against common sexually transmitted infections. Objective  To compare nonoxynol-9 gel and condom use (gel group) vs condom use alone (condom group) for the prevention of male-to-female transmission of urogenital gonococcal and chlamydial infection. Design and Setting  Randomized controlled trial conducted at 10 community clinics and 10 pharmacies in Yaoundé, Cameroon, between October 1998 and September 2000, with 6 months of follow-up. Participants  High-risk population of 1251 women (excluding sex workers) being treated for or who had symptoms of sexually transmitted infections. Three were excluded from the gel group (0.5%) and 7 from the condom group (1%) because of no follow-up data. Interventions  Nonoxynol-9 gel (100 mg) and condoms or condoms only. Main Outcome Measure  A positive test result for gonococcal or chlamydial infection by the ligase chain reaction assay; secondary outcome measure was a positive test result for human immunodeficiency virus (HIV). Results  The rate ratio (RR) for new urogenital infections was 1.2 for the gel group vs condom group (95% confidence interval [CI], 0.9-1.6; P = .21). The gel group had 116 diagnosed gonococcal infections, chlamydial infections, or both for a rate of 43.6 per 100 person-years, and the condom group had 100 infections for a rate of 36.6 per 100 person-years. The RR for gonococcal infection in the gel group vs the condom group was 1.5 (95% CI, 1.0-2.3) and for chlamydial infection was 1.0 (95% CI, 0.7-1.4). There were 5 new cases of HIV infections in the gel group and 4 in the condom group. Three women in each group became pregnant during the study. Conclusion  Nonoxynol-9 gel did not protect against urogenital gonococcal or chlamydial infection.      

Inhibition of secretory phospholipase A2. 1-design, synthesis and structure-activity relationship studies starting from 4-tetradecyloxybenzamidine to obtain specific inhibitors of group II sPLA2s

Starting from 4-tetradecyloxybenzamidine (PMS815), a non-specific inhibitor of GI and GII PLA2s, we report in this work the discovery of the specificity through design, synthesis and structure-activity relationships studies of different kinds of PMS815 derivatives. The leading compound, 4,5-dihydro-3-(4-tetradecyloxybenzyl)-1,2,4-4H-oxadiazol-5-one (9b, PMS1062) exhibits a micromolar IC50 towards three group II PLA2s, while inactive towards four group I and one group III enzymes in two in vitro enzymatic assay conditions. It is also able to block the PLA2-II activities induced by LPS and IL-6 in HepG2 cell line and no cytotoxicity is observed when PMS1062 is tested up to a concentration of 100 microM in two different cell lines (A549 and LLC-PK1).