[Diagnosis and treatment of preeclampsia: overview of international recommendations]. / Empfehlungen zur Diagnostik und Behandlung der Präeklampsie im internationalen Vergleich: Was ist neu?

The new german guidelines for the treatment of hypertensive disorders in pregnancy have some important differentiations. The aim of the new guidelines is to avoid the early premature birth and to reduce the fetal and maternal morbidity and mortality. For the first time there ist the possibility and the recommendation for the prolongation of pregnancy. This means that the treatment of hypertensive disorders should start not before a blood pressure of >or=170/110 mmHg; thus the nutrition of the fetus will not be worsened and the worse perfusion of the placenta will be avoided. Further more the selection of antihypertensive treatment has changed: the first choice is not longer Dihydralazin (Nepresol) but Nifedipin (Adalat). In the treatment of HELLP-Syndrom there ist only one difference to the treatment of preeclampsia: the use of glucocorticosteroids. In the treatment of both hypertensive disorders in pregnancy there is the aim to finish the fetal lung mature induction before the delivery is planned or necessary. A new point of view in the german guidelines is the possibility of prediction and prevention of hypertensive disorders in pregnancy: patients who had already a hypertensive disorder in the pregnancy before or patients who have a pathologic flow in the Art. uterinae have a significant higher risk for a preeclampsia in this pregnancy. They should receive a preventive therapy with ASS. Because of these changes in the german guidelines the prolongation of pregnancy and the reduced rate of premature birth becomes more importance and helps to avoid a high rate of neonatal mortality and morbidity.

[Effectiveness of syndromic approach for management of urethral discharge in Senegal]. / Evaluation de l'efficacité du traitement des écoulements urétraux au Sénégal selon l'approche syndromique.

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

[Mutations in the dihydropyrimidine dehydrogenase gene and their role in 5-fluororuracil intolerance]. / Mutationen im Dihydropyrimidindehydrogenase-Gen als Ursache von 5-Fluororuracil-Intoleranz.

Cancer patients developing severe side effects upon chemotherapy with 5-fluorouracil (5-FU) are assumed to display reduced activity of the enzyme dihydropyrimidine dehydrogenase (DPD). Meanwhile over 20 different mutations are known in the dihydropyrimidine dehydrogenase gene (DPYD) which could be associated with a loss of enzyme function. For most of these genetic alterations, however, clear genotype-phenotype relations are still lacking. We are conducting a population study using a German cohort to determine the frequency of DPD defects in the German population and to detect new toxicity-associated mutations. Our aim is to develop a sensitive and efficient screening of tumor patients to identify patients with mutations in the DPYD gene which might be related to 5-FU-toxicity. For this purpose we analysed the whole coding region of DPYD by the technique of denaturing HPLC (DHPLC). The DHPLC analysis turned out to be a reliable method for the investigation of large samples in an acceptable cost and time range. To further elucidate the molecular basis of the DPD deficiency syndrome we will continue to analyse a patient panel receiving 5-FU.

Prevalence and risk factors of cervicovaginal HIV shedding among HIV-1 and HIV-2 infected women in Dakar, Senegal.

OBJECTIVES: To assess the risk determinants and prevalence of cervicovaginal shedding of HIV-1 and HIV-2 among women in Dakar, Senegal. METHODS: We conducted a cross sectional study of 153 HIV seropositive female sex workers (FSW) and another 142 HIV seropositive women attending an infectious diseases unit, based on an interview, physical examination, and laboratory screening for major sexually transmitted infections (STI). Cervicovaginal lavage fluid was tested for HIV-RNA by means of nested PCR. Links between cervicovaginal shedding of HIV-1 and HIV-2 and sociodemographic, clinical, and laboratory variables were identified by using odd ratios and 95% confidence intervals. Logistic regression analysis was used to identify independent links with HIV shedding. RESULTS: The detection rate of HIV-RNA in cervicovaginal lavage fluid was low among FSW, with no difference between HIV-1 (7/90: 8%) and HIV-2 (3/48: 6%). The rate was far higher among the other women (41%, 48/117; 33%, 7/21 for HIV-1 and HIV-2, respectively). In multivariate analysis, high plasma viral load (>40 000 copies/ml) (AOR = 2.4 (1.0-5.6) p = 0.04) and basic vaginal pH (AOR = 2.2 (1.3-3.7) p = 0.002) were independently associated with HIV-1 shedding. For HIV-2 a CD4 count < 200 cells x 10(6)/l was the only factor associated with the shedding of HIV-2 (AOR = 9.0 (0.9-93)). The genital shedding rate was higher with HIV-1 than with HIV-2 (OR = 2.1 (0.9-4.8), but this difference disappeared after adjustment for the CD4+ cell count (AOR = 1.2 (0.5-2.9)). CONCLUSION: Advanced disease stage and immunosuppression are the major risk determinants for shedding of both HIV-1 and HIV-2. Basic vaginal pH is also a risk determinant for HIV-1 shedding.

Religion and protective behaviours towards AIDS in rural Senegal.

OBJECTIVES: To describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention. DESIGN: A cross-sectional study conducted in a rural area in central Senegal. METHODS: Questionnaire-based interviews of a random sample of 858 adults from the general population aged 15-59 years and in-depth interviews of four religious leaders and 50 people. RESULTS: Seventy-six per cent of the respondents were Muslim, 24% Catholic, 1% Animist and 0.2% Protestant. A total of 86% of men and 87% of women reported religion to be very important to them. Important prevention-related variables were inversely associated with the importance of religion. Men who considered religion to be very important were less likely to cite AIDS as a major health problem [odds ratio (OR) 0.4, P = 0.008] and were less likely to feel at risk of getting HIV (OR 0.5, P = 0.0005). Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS (OR 0.2, P = 0.0001), less likely to report having discussed AIDS with others (OR 0.4, P = 0.01) and much more likely to feel at risk of getting HIV (OR 9.3, P = 10(-4)). Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS. CONCLUSION: These findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level.

Preventive attitudes towards the threat of AIDS: process and determinants in rural Senegal.

This report is intended to identify the determinants of preventive attitudes and thereby enable the further elaboration of effective prevention programs in a country where the HIV epidemic has remained controlled. Across-sectional survey using a standardized questionnaire was conducted among a sample of 866 adults of the general population of the rural area of Niakhar, Senegal. The analysis identified psychosocial determinants related to preventive attitudes and the influence of sociodemographic characteristics and of sources of AIDS information on these determinants. Psychosocial determinants of preventive attitudes differed according to gender: Among men, personal risk perception was associated with preventive attitudes. Among women, level of AIDS-related knowledge, communication about AIDS, and optimism about the future were associated with preventive attitudes. Sociodemographic factors and sources of information were similar for men and women: Preventive attitudes were adopted primarily by young, educated subjects who had been exposed to urban life. Religion appeared to be a major obstacle to preventive attitudes. Preventive messages broadcast on radio or television may be determinative. Our results call for a strengthened collaboration with religious leaders and a focus on risk perception to rationalize preventive actions. We also encourage the targeting of vulnerable populations, such as women in rural areas, by developing preventive messages to be delivered through national media (radio, television) and by staff from health centers, which most women visit, at least for prenatal care.

[Complement and serum immunoglobulins in homozygous and heterozygous sickle cell anemia in Senegal]. / Complément et immunoglobulines sériques chez des drépanocytaires homozygotes (SS) et héterozygotes (AS) au Sénégal.

Sickle cell disease is an hereditary hemoglobinopathy syndrome which provokes deglobulization crisis and infectious complications. These infectious diseases may be due to a permanent activation of the immune system. The aim of our study was to explore alternative pathway by measuring C3 complement and the classical pathway by C4 complement. The level of immunoglobulins IgA, IgG and IgM was also measured in the subjects sera. Thirty homozygous sickle cell anemia (SS), 25 heterozygous (AS) and 34 controls subjects (AA) were recruited in the Hôpital d'Enfants Albert Royer (HEAR), Fann hospital and Centre National de Transfusion Sanguine (CNTS). Radial Immunodiffusion (RID) technics using specific antisera for C3c, C4c, IgA, IgG and IgM were used in our study. Homozygous SS proved an increase level of IgA (50%, p < 0.003) and IgG (47%, p < 0.003), unlike of IgM level. The C3c complement decrease significantly in (27%) of homozygous SS patients (p < 0.0005) unlike of C4c level. This low level of C3 and IgG in sickle cell homozygous patients can explain the higher susceptibility to infection in these patients. Normal level of C4 and low level of C3 show activation of alternative pathway. Heterozygous AS showed a normal level of C4, C3 and immunoglobulins. Our results suggests a direct involvement of the complement system in sickle cell disease and the depletion of C3 registered was a possible cause of increased susceptibility to infections in patients with homozygous sickle cell anemia.

[Transverse study comparing certain physical characteristics of Senegalese children and adolescents from 7 to 13 years of age]. / Etude transversale--comparativé de certaines qualités physiques d'enfants et d'adolescents sénégalais âges de 7 a 13 ans.

350 boys and 350 girls 7 to 13 years of age that are equally divided into 7 age groups according to sex, have been submitted to action speed tests (pure speed), co-ordination-speed, pure-power, co-ordination-power, flexibility and balance. The objective of our study was to compare the average evolution of each of these qualities according sex and age. From 7 to 13 boys were more performing than the girls in the first four tests; it's the opposite when il comes to the last two ones. Yet, the differences shown on both sides were not altogether significant but in action--speed (except at 9) and in flexibility. The two sexes were significantly different at the age of 7 and from 9 to 10 in balance, from 10 to 13 in pure-power, from 11 to 13 in co-ordination-power and from 12 to 13 in co-ordination-speed. It is often from the age of 7 to 9 or 10 that the average yearly gains of the performances are significant. Among the girls, they undergo more noticeable reductions from 9 or 10 until 12, before to decrease between 12 and 13 (in pure speed, co-ordination-speed and pure power), whereas the boys', for all the above mentioned physical qualities, remain unchanged or increase in a more significant way (except in flexibility). These significant results suggest a diversification of motor learning contents for boys and girls of the same age, or of different age according to sex.

Satisfaire les besoins de sante des hommes qui ont des rapports sexuels avec d'autres hommes au Senegal

Ce document presente les resultats d'une etude sur les hommes qui ont des rapports sexuels avec d'autres hommes (MSM) au Senegal.La sexualite des MSM; leur vulnerabilite aux IST/VIH; le role de la violence et du stigmate ainsi que le manque de services de sante sexuelle et d'information disponible pour couvrir leurs besoins specifiques; y sont decrit