The Prevalence of Trachomatous Trichiasis in People Aged 15 Years and Over in Six Evaluation Units of Gaoual, Labé, Dalaba and Beyla Districts, Guinea.

PURPOSE: Trachoma is a public health problem in 42 countries. Inflammation associated with repeated ocular infection with Chlamydia trachomatis can cause the eyelid to scar and turn inwards, resulting in the eyelashes rubbing against the eyeball, known as trachomatous trichiasis (TT). In Guinea, baseline surveys conducted in 2013 reported inflammatory trachoma prevalences below the World Health Organization (WHO) threshold for elimination, but TT prevalences above threshold. Given this epidemiological context and time since baseline survey, TT-only surveys were conducted in selected districts to determine current TT prevalence. The results of this study provide critical data for assessing Guinea's achievement of trachoma elimination targets. METHODS: Four health districts, consisting of six evaluation units (EU), were surveyed. In each EU, field teams visited 29 clusters with a minimum 30 households included in each. Participants aged≥15 years were examined by certified graders trained to identify TT and determine whether management had been offered. RESULTS: A total of 22,476 people were examined, with 48 TT cases across the six EUs identified. Five of six EUs had an age-and-gender adjusted TT-prevalence unknown to the health system less than 0.2%, whereas one EU, Beyla 2, had an adjusted TT prevalence of 0.24%. CONCLUSION: These TT-only surveys, along with findings from other trachoma interventions, suggest that Guinea is close to achieving elimination of trachoma as a public health problem. This study demonstrates the value of undertaking TT-only surveys in settings where baseline surveys indicated active trachoma prevalences below WHO elimination threshold, but TT prevalences above it.

Notas sobre o objeto psicanalítico na obra de Wilfred Bion / Notes on the psychoanalytic object in the work of Wilfred Bion / Notas sobre el objeto psicoanalítico en la obra de Wilfred Bion / Notes sur l'objet psychanalytique dans l'œuvre de Wilfred Bion

Este artigo trata da evolução do conceito de objeto psicanalítico no decorrer da obra de Wilfred R. Bion, trazendo questionamentos clínicos e ilustrações com trechos de sua autobiografia e uma vinheta clínica.

This article deals with the evolution of the concept of Psychoanalytic Object during the work of Wilfred R Bion bringing clinical questions and illustrations with excerpts from his autobiography and a clinical vignette.

Este artículo trata sobre la evolución del concepto de Objeto Psicoanalítico durante el trabajo de Wilfred R Bion trayendo preguntas clínicas e ilustraciones con extractos de su autobiografía y una viñeta clínica.

Cet article traite de l'évolution du concept d'objet psychanalytique au cours des travaux de Wilfred R Bion apportant des questions cliniques et des illustrations avec des extraits de son autobiographie et d'une vignette clinique.

Controlled cobalt doping in biogenic magnetite nanoparticles.

Cobalt-doped magnetite (CoxFe3 -xO4) nanoparticles have been produced through the microbial reduction of cobalt-iron oxyhydroxide by the bacterium Geobacter sulfurreducens. The materials produced, as measured by superconducting quantum interference device magnetometry, X-ray magnetic circular dichroism, Mössbauer spectroscopy, etc., show dramatic increases in coercivity with increasing cobalt content without a major decrease in overall saturation magnetization. Structural and magnetization analyses reveal a reduction in particle size to less than 4 nm at the highest Co content, combined with an increase in the effective anisotropy of the magnetic nanoparticles. The potential use of these biogenic nanoparticles in aqueous suspensions for magnetic hyperthermia applications is demonstrated. Further analysis of the distribution of cations within the ferrite spinel indicates that the cobalt is predominantly incorporated in octahedral coordination, achieved by the substitution of Fe(2+) site with Co(2+), with up to 17 per cent Co substituted into tetrahedral sites.

Progress towards the eradication of Tsetse from the Loos islands, Guinea.

BACKGROUND: The tsetse fly Glossina palpalis gambiensis is the main vector of sleeping sickness (Human African Trypanosomiasis - HAT) in West Africa, in particular in littoral Guinea where this disease is currently very active. The Loos islands constitute a small archipelago some 5 km from mainland Guinea, where G. p. gambiensis is well known as a nuisance and potential disease vector by inhabitants of the three main islands, Fotoba, Room, and Kassa. The National Control Program against HAT of Guinea has decided to eradicate tsetse in Loos islands in order to sustainably protect humans and economic activities. After baseline data collection, tsetse control began on the islands in 2006. On each of the three islands a specific combination of control methods was implemented according to the entomological situation found. RESULTS: Starting densities before control operations were 10, 3 and 1 tsetse/trap/day in Kassa, Room and Fotoba respectively, but by July 2010, tsetse were no longer caught in any of the sentinel traps used for monitoring. The reduction rate was faster where several control methods were implemented as a combination (impregnated traps and targets ITT, selective groundspraying, epicutaneous insecticide treatment of pigs, and impregnated fences around pig pens), whereas it was slower when ITT were used as the only control method. CONCLUSIONS: This 100% suppression is a promising step in the eradication process, but G. p. gambiensis may still occur at very low, undetectable, densities on the archipelago. Next step will consist in assessing a 0.05 probability of tsetse absence to ascertain a provisional eradication status. Throughout these operations, a key factor has been the involvement of local teams and local communities without whom such results would be impossible to obtain. Work will continue thanks to the partners involved until total eradication of the tsetse on Loos islands can be declared.

The population structure of Glossina palpalis gambiensis from island and continental locations in Coastal Guinea.

BACKGROUND: We undertook a population genetics analysis of the tsetse fly Glossina palpalis gambiensis, a major vector of sleeping sickness in West Africa, using microsatellite and mitochondrial DNA markers. Our aims were to estimate effective population size and the degree of isolation between coastal sites on the mainland of Guinea and Loos Islands. The sampling locations encompassed Dubréka, the area with the highest Human African Trypanosomosis (HAT) prevalence in West Africa, mangrove and savannah sites on the mainland, and two islands, Fotoba and Kassa, within the Loos archipelago. These data are discussed with respect to the feasibility and sustainability of control strategies in those sites currently experiencing, or at risk of, sleeping sickness. PRINCIPAL FINDINGS: We found very low migration rates between sites except between those sampled around the Dubréka area that seems to contain a widely dispersed and panmictic population. In the Kassa island samples, various effective population size estimates all converged on surprisingly small values (10

Caesarean section using total intravenous anaesthesia in a patient with Ebstein's anomaly complicated by supraventricular tachycardia.

Ebstein's anomaly is a rare congenital cardiac defect associated with both displacement and incompetence of the tricuspid valve. The condition is commonly complicated by supraventricular tachycardias. We describe the management of a patient with this condition undergoing caesarean section. Propofol and remifentanil total intravenous anaesthesia resulted in haemodynamic stability and delivery of a healthy baby who breathed spontaneously after two minutes.

Genetic and morphometric evidence for population isolation of Glossina palpalis gambiensis (Diptera: Glossinidae) on the Loos islands, Guinea.

Allele frequencies at four microsatellite loci, and morphometric features based on 11 wing landmarks, were compared among three populations of Glossina palpalis gambiensis (Diptera: Glossinidae) in Guinea. One population originated from the Loos islands separated from the capital Conakry by 5 km of sea, and the two others originated from the continental mangrove area close to Dubreka, these two groups being separated by approximately 30 km. Microsatellites and wing geometry data both converged to the idea of a separation of the Loos island population from those of the mangrove area. Although occasional contacts cannot be excluded, our results support the hypothesis of the Loos population of tsetse flies being a completely isolated population. This situation will favor a sequenced intervention against human African trypanosomosis and the possibility of an elimination of tsetse from this island.

Pulmonary artery blood temperature and the measurement of cardiac output by thermodilution.

Thermodilution cardiac output measurement assumes that the temperature within the pulmonary artery is stable during the measurement period. This may not be achieved in clinical practice because of temperature changes that are not solely produced by the thermal indicator. Such temperature changes constitute thermal noise. Thermal noise and how it may interfere with measurement is discussed with reference to both the injectate and the thermal filament methods of thermodilution cardiac output measurement.

Medulloblastoma. Results of a sequential combined treatment.

Actuarial progression-free survival rate at 5 years of a series of 34 patients with medulloblastoma treated by combined surgery, radiotherapy, and chemotherapy was 71%. No relapses were observed in 14 patients followed for more than 5 years. Treatment consisted of a short postoperative course of vincristine (VCR) and intrathecal (IT) methotrexate (MTX) followed by irradiation to the entire cranio spinal axis. Maintenance chemotherapy (CCNU, VCR, and IT MTX) was then continued to encompass 2 years from surgery. Failure occurred in nine patients: four had local recurrence, four dissemination within the central nervous system, and one widespread skeletal metastases. Poor prognostic factors such as presence of malignant cells in the cerebrospinal fluid, non-radical surgery, young age, and radiation doses less than 50 Gy to the tumor bed, did not adversely affect the outcome of patients in this series. Long-term sequelae from the treatment program could be observed in all patients, and in 58% they were severe enough to interfere with normal, active life.