Retentissement des pleurésies exsudatives sur les activités professionnelles

La pleurésie est une affection fréquente en Afrique, d'origine souvent infectieuse. Le but de notre travail était d'évaluer le retentissement de la pleurésie sur les activités professionnelles. Il s'agit d'une étude transversale, réalisée dans un service de médecine physique et réadaptation fonctionnelle, sur une durée de 9 mois. Etaient inclus les patients présentant une pleurésie avec ou sans atteinte parenchymateuse, menant une activité professionnelle. Les données pleuropulmonaires, l'état psychiatrique, et les capacités professionnelles ont été étudiés. 25 patients ont été inclus, d'âge moyen de 37,4ans et le sex-ratio de 2,1. Les travailleurs de force était plus représentés (60 %). Le syndrome d'épanchement pleural persistait dans 60% des cas. (60%). L'anxio-dépression était associée chez 92% des patients. Les autres signes associés à la pleurésie sont les réveils nocturnes (56%), la somnolence diurne (40%) et la fatigue (40%). Une répercussion sur les activités professionnelles (48% ) a été notée. Les facteurs déterminants de cette reprise d'activités sont la douleur(p=0,04), l'existence de céphalées matinales (p=0,03), les réveils nocturnes (p=0,09) et la rééducation (p=0,034). Conclusion : La limitation de ces conséquences professionnelles de la pleurésie, nécessite une prise en charge de la douleur sur tous ces aspects et de l'état psychologique

Serologic classification of acute viral hepatitis at San Lazaro Hospital, Manila, Philippines.

Sixty-four out of 189 jaundiced patients at San Lazaro Hospital were defined as acute viral hepatitis cases. Of this number, 22 (34.4%) were positive for hepatitis A markers while 26 (40.6%) were positive for hepatitis B markers. Hepatitis D infection accounted for 1.6%, while non-A, non-B hepatitis accounted for 21.9%.

Comparison of washed and unwashed specimens in the Plasmodium falciparum in vitro microculture drug assay.

The dose response of Plasmodium falciparum isolates in the standard in vitro assay for drug resistance was compared using blood specimens which were centrifuged and washed before cultivation. Washing of the cultures increased the success of cultivation by greater than 100%. Eight cultures which grew using both methods gave similar results in the determination of resistance or sensitivity. The ED50 as determined by probit analysis, was approximately 50% higher in parasites which had been washed before cultivation.

In vitro drug response of Plasmodium falciparum in the Philippines: increased resistance to amodiaquine.

A long term study was carried out at San Lazaro Hospital, Manila, Philippines, monitoring the in vitro response of Plasmodium falciparum to chloroquine, amodiaquine, mefloquine, and quinine. The in vitro effective dose giving 50% inhibition of schizogony was: 0.68 X 10(-6) M/liter blood for chloroquine; 0.18 X 10(-6) for amodiaquine; 0.2 X 10(-6) for mefloquine; and 1.12 X 10(-6) for quinine. The percent of isolates determined to be resistant in vitro was 85.2% for chloroquine, and 1.2% for both mefloquine and quinine. These figures were relatively unchanged over the course of 3 years studied. The in vitro resistance rate to amodiaquine increased from 5.1% in 1982 to 22.2% in 1984.

HLA antigens and malaria at San Lazaro Hospital Manila, Philippines.

Human leucocyte antigens (HLA) were used as genetic markers in an attempt to determine possible host genetic susceptibility or resistance to malarial infections. HLA-A and B typing on lymphocytes from 68 confirmed P. falciparum and 77 P. vivax cases was compared with that found in 66 control subjects with no known history of malaria. A significant deviation was observed in the distribution of HLA-B27. This phenotype was absent in the P. falciparum group although found present in the P. vivax group (10%) and the control group (11%). Also, the combination of A9(w24) and B5 was significantly higher among the P. falciparum group than that found in the P. vivax and control groups. These findings require confirmation but do suggest the possibility of genetic susceptibility and that extensive genetic studies might be worth investigating.

Chloroquine resistant Plasmodium falciparum: effect of rabbit serum and incubation time on the in vitro (microtechnique) prediction of in vivo resistance.

A study of chloroquine resistance of 54 isolates of Plasmodium falciparum is reported. Sixty-four percent of the isolates tested produced schizonts in vitro (micro-technique), whereas the remaining 36 percent did not. The accuracy of the in vitro test to predict in vivo resistance was increased when the primary parasite isolates were cultured in the presence of rabbit serum and when the cultures were allowed to incubate for more than 48 hours. Thirteen isolates of P. falciparum that showed in vitro resistance were confirmed in vivo resistant. Eleven of these cases were identified as R-I and two as R-II. Only one case of in vivo resistance (R-II) was observed among the 19 isolates that failed to produce schizonts in vitro.