Spatial Distribution of PCR-Identified Species of Anopheles gambiae senu lato (Diptera: Culicidae) Across Three Eco-Vegetational Zones in Cross River State, Nigeria.

Anopheles gambiae sensu lato complex (An. gambiae s.l.) describes a group of nine morphologically indistinguishable members that vary in their distribution, ability to transmit malaria, and susceptibility to pyrethroids. Here, we recorded the spatial patterns of PCR-identified An. gambiae s.l. complex species collected from four sites in Cross River State, Nigeria that represented three different ecological zones. Trapping was conducted between October 2015 and June 2016. Anopheles gambiae s.l. complex species identification was performed using species-specific primers followed by An. gambiae and An. coluzzii differentiation using the restriction fragment length polymorphism (RFLP) method. Bivariate and multivariate logistic regression models were used to identify ecological and seasonal variables closely associated with An. coluzzii and An. gambiae distribution. Out of 1,388 An. gambiae s.l. successfully amplified, 1,074 (77.4%) were An. coluzzii, 278 (20%) were An. gambiae, and 25 (1.8%) were hybrids (An. coluzzii/An. gambiae). A very small number of An. arabiensis (0.8%, n = 11) were also collected. Statistical analysis indicated that An. coluzzii is predominant in Guinea-savannah and tropical rainforest, and is highly associated with rainy seasons, while, An. gambiae is prevalent in mangrove swamp forest during dry seasons. Only 13 An. gambiae s.l. females were infected with Plasmodium falciparum (P. falciparum). The sporozoite infection rate was higher in mangrove swamp forest (53.8%, n = 7) than in rain forest (38.5%, n = 5) followed by Guinea-savannah (7.7%, n = 1) ecological zones. These results provide important insights for strategic planning of malaria control programs in Nigeria.

Ecological niche modeling for predicting the potential geographical distribution of Aedes species (Diptera: Culicidae): A case study of Enugu State, Nigeria.

Arbovirus transmission by Aedes mosquitoes has long been a significant problem in Africa. In West Africa, Aedes vector management faces significant challenges; lack of recent Aedes distributional data and potential distributional modeling hinder effective vector control and pose serious public health issues. In this study, larval and adult mosquitoes were collected from four study sites in Enugu State, Nigeria every other month between November 2017 and September 2018. A total number of 2997 Aedes mosquitoes were collected and identified, and 59 positive field occurrence points for both Aedes adult and larvae were recorded. A total of 18 positive occurrence points were used for modeling. Ecological Niche Models (ENMs) were used to estimate the current geographic distribution of Aedes species (spp.) in Enugu State, south-east Nigeria, and mosquito presence was used as a proxy for predicting risk of disease transmission. Maximum Entropy distribution modeling or "MaxEnt" was used for predicting the potential suitable habitats, using a portion of the occurrence records. A total of 23 environmental variables (19 bioclimatic and four topographic) were used to model the potential geographical distribution area under current climatic conditions. The most suitable habitat for Aedes spp. was predicted in the northern, central, and southeastern parts of Enugu State with some extensions in Anambra, Delta, and Edo States in the west, and Ebonyi State in the east. Seasonal temperature, precipitation of the wettest month, mean monthly temperature range, elevation, and precipitation of the driest months were the highest estimated main variable contributions associated with the distribution of Aedes spp. We found that Aedes spp. prefer to be situated in environmental conditions where precipitation of wettest month ranged from 265 to 330 mm, precipitation of driest quarter ranged from 25 to 75 mm while precipitation of wettest quarter ranged from 650 to 950 mm. Aedes mosquitoes, such as Ae. aegypti and Ae. albopictus, pose a significant threat to human health, hence, the results of this study will help decision makers to monitor the distribution of these species and establish a management plan for future national mosquito surveillance and control programs in Nigeria.

The impact of cinnarizine and griseofulvin on juvenile and adult stages of Schistosoma mansoni.

Schistosomiasis affects millions globally. There is no vaccine, and treatment depends entirely on praziquantel (PZQ). Field isolates exhibit reduced susceptibility to PZQ, and resistance has been experimentally induced, suggesting that reliance on a single treatment is particularly dangerous. The present study investigated the value of cinnarizine and griseofulvin against Schistosoma mansoni through their in vitro effects on adult worms and oviposition as well as in vivo evaluation in early and late infection, compared to PZQ, in a preliminary experimental model. In vitro, both cinnarizine and griseofulvin showed uncoupling, sluggish worm movement and complete absence of ova at 100 µg/ml. In early infection, cinnarizine showed a significant reduction in the number of porto-mesenteric couples compared to the griseofulvin and control groups, a finding similar to PZQ. Remarkably, cinnarizine significantly exceeded PZQ and griseofulvin in reducing the total worm burden. In late infection, cinnarizine and griseofulvin showed results similar to PZQ by significantly reducing the numbers of hepatic and porto-mesenteric couples and total worm burden compared to controls. Cinnarizine performed better than griseofulvin by reducing hepatic and intestinal ovum counts, and it led to complete disappearance of the first two immature stages. The current work suggests the possibility of using cinnarizine and griseofulvin, mainly in late S. mansoni infection, especially cinnarizine, which showed similar results to PZQ and surpassed it in early infection. Further studies are required to elucidate their exact mechanisms of action and particularly their synergistic effect with PZQ.

Molecular xenomonitoring (MX) and transmission assessment survey (TAS) of lymphatic filariasis elimination in two villages, Menoufyia Governorate, Egypt.

Lymphatic filariasis (LF) is focally endemic in Egypt where the female mosquito, Culex pipiens, is responsible for its transmission. The aim of the study was to investigate the impact of implementation of the 13th round of MDA in two Egyptian villages in the Menoufyia Governorate area after failing the transmission assessment survey (TAS) in 2005 using two methods, and to decide whether it is safe to stop MDA in these, as well as in similar implementation units (IUs). To achieve this aim, both the immunochromatographic card test (ICT) and molecular xenomonitoring (MX) techniques were employed. A cross-sectional study was carried out in the villages in 2014 with two sections: Section (1): a school-based survey where all the primary school entrants (6-7) years of age were tested by ICT. Section (2): a mosquito-based survey where a total of 152 mosquito pools collected from Samalay and 167 from Kafr El-Tarainah were tested for the presence of the gDNA of Wuchereria bancrofti microfilaria by real-time PCR assays. The results revealed that all primary school children in both villages were 100% negative for antigenemia. Also, all mosquito pools were 100% negative for the microfilarial gDNA.

Surveillance of lymphatic filariasis 5 years after stopping mass drug administration in Menoufiya Governorate, Egypt.

The World Health Organization recommends that before lymphatic filariasis elimination in an area can be confirmed, an additional survey should be performed at least 5 years after stopping mass drug administration. The current study aimed to determine the status of lymphatic filariasis 5 years after cessation ofthe mass drug administration in 3 sentinel Egyptian villages in Menoufiya Governorate. The rapid immunochromatographic card test (ICT) and a new commercial antibody detection kit (CELISA®) were used. All 1321 primary-school children aged 6-7 years old were ICT negative but 27 children were antibody positive. All households surveyed in one village with the highest antibody prevalence were ICT negative, indicating an absence of lymphatic filariasis. The CELISA antibody kit needs more standardization and development to be useful under field conditions. We conclude that lymphatic filariasis is no longer a public health problem in these villages and other villages with similar epidemiological conditions.

Surveillance of lymphatic filariasis 5 years after stopping mass drug administration in Menoufiya governorate, Egypt

توصي منظمة الصحة العالمية بإجراء مسوحات إضافية بعد مرور 5 سنوات على الأقل على إيقاف الإعطاء الجموعي للأدوية قبل تأكيد التخلص من داء الخيطيات اللمفاوي. وتهدف الدراسة الحالية إلى التعرف على الوضع الذي آل إليه داء الخيطيات اللمفاوي بعد مرور 5 سنوات على إيقاف إعطاء الأدوية الجموعي في 3 قرى خافرة في محافظة المنوفية في مصر. واستخدم الباحثون اختبار البطاقة السريعة للاستشراب المناعي ICT، وحقيبة تجارية لكشف الأضداد هي سيليسا [CELISA[R]. واتضح للباحثين أن جميع الأطفال في المرحلة الابتدائية والذين تتراوح أعمارهم بين 6 - 7 سنوات وعددهم 1321 طفا كانوا سلبيين، وأن هناك 27 طفلا لديهم إيجابية في الأضداد. كما أن جميع الأسر التي أجري المسح عليها في إحدى القرى التي كانت الأعلى من حيث معدل انتشار الأضداد كانوا سلبيين باختبار البطاقة السريعة الاستشراب المناعي، مما يشير إلى غياب داء الخيطيات اللمفاوي. أما حقيبة سيليسا التجارية فتحتاج إلى المزيد من المعايرة والتطور حتى تصبح مفيدة في العمل الميداني. واستنتج الباحثون أن داء الخيطيات اللمفاوي لم يعد من مشكلات الصحة العامة في هذه القرى وفي القرى الأخرى التي تشابهها في الظروف الوبائية

ABSTRACT The World Health Organization recommends that before lymphatic filariasis elimination in an area can be confirmed, an additional survey should be performed at least 5 years after stopping mass drug administration. The current study aimed to determine the status of lymphatic filariasis 5 years after cessation of the mass drug administration in 3 sentinel Egyptian villages in Menoufiya Governorate. The rapid immunochromatographic card test (ICT) and a new commercial antibody detection kit (CELISA®) were used. All 1321 primary-school children aged 6–7 years old were ICT negative but 27 children were antibody positive. All households surveyed in one village with the highest antibody prevalence were ICT negative, indicating an absence of lymphatic filariasis. The CELISA antibody kit needs more standardization and development to be useful under field conditions. We conclude that lymphatic filariasis is no longer a public health problem in these villages and other villages with similar epidemiological conditions.

RÉSUMÉ L'Organisation mondiale de la Santé recommande de mener une enquête supplémentaire au moins cinq ans après l'arrêt de l'administration massive de médicaments avant de confirmer l'élimination de la filariose lymphatique dans une zone donnée. La présente étude visait à déterminer le statut de la filariose lymphatique cinq ans après l'arrêt de l'administration massive de médicaments dans trois villages sentinelles égyptiens du Gouvernorat de Menoufiya. Le test immunochromatographique sur carte (ICT) rapide et un nouveau kit de détection d'anticorps commercial (CELISA®) ont été utilisés. L'ensemble des 1321 écoliers du primaire âgés de 6 à 7 ans avaient des résultats négatifs à l'ICT mais 27 enfants avaient des résultats positifs aux anticorps. Tous les ménages qui ont fait l'objet d'une enquête dans un village où la prévalence des anticorps était la plus élevée ont eu des résultats négatifs à l'ICT, ce qui indique une absence de filariose lymphatique. Le kit de détection d'anticorps CELISA doit faire l'objet d'un développement et d'une normalisation plus poussés pour être utile dans des conditions de terrain. Nous en concluons que la filariose lymphatique ne représente plus un problème de santé publique dans ces villages ainsi que dans d'autres villages ayant des conditions épidémiologiques similaires.

[Attitudes of teachers to tobacco smoking]. / Attitudes des enseignants à l'égard du tabagisme.

We aimed to evaluate the attitudes of teachers to tobacco smoking in Kalaa Kebira (a semi-urban region in the Tunisian Sahel). Data from 358 of 402 teachers surveyed were obtained using a self-completed questionnaire. The mean age of the teachers was 35.7 (SD 7.9) years. The prevalence of smoking was 29.3% (51.6% of men and 3.6% of women), and 79% of smokers were addicted to nicotine according to the Fagerström test. About 50% of the teachers were badly-informed about the dangers of smoking and 75.2% of smoking teachers did not refrain from smoking in front of their pupils. The lack of knowledge of teachers limits their role as a model and information source in the anti-tobacco struggle. It is essential to draw up an education programme for the teaching staff.

[Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia]. / Connaissances des patients diabétiques de type 2 sur leur maladie à Sousse (Tunisie).

We assessed the knowledge of 404 type 2 diabetic patients about their condition in order to evaluate the quality of diabetes education in primary health care units in Sousse in 2003. We found that knowledge was satisfactory in only 59% of the patients. Their knowledge about the definition of diabetes and its pathophysiology were the 2 main areas where knowledge was lacking: the proportion of correct answers were 62.6% and 50.3% respectively. More attention should be paid to educating diabetic patients within the chronic disease care national programme.

[Brugada syndrome and other cardiovascular abnormalities related to tricyclic antidepressants ans related drugs intoxication]. / Syndrome de Brugada et autres anomalies cardiovasculaires associées à l'intoxication par les antidépresseurs tricycliques et apparentés.

UNLABELLED: The aim of this paper is to report major cardiovascular complications related to intoxication due to tricyclic antidepressants (TCA) and related drugs, especially the stabilizing membrane effect (SME) and Brugada syndrome, and identify risk factors related to cardiac toxicity. POPULATION AND METHODS: A retrospective study (35 months), including all adult patients admitted for an isolated intoxication by a TCA or a related drug. The statistical analysis of clinical signs and history as well as ECG abnormalities included parameters recorded in emergency rooms. RESULTS: 65 patients without underlying cardiovascular history were retrieved (mean age 30 + 12 years). The intoxication was intentional in all cases, and the mean estimated taken dosage (ETD) was at 749 + 436 mg. Amitriptyline was the most common drug (66%) followed by clomipramine (29%). The cardiovascular examination noted a tachycardia in 63% of cases (mean HR - 108 + 13 bpm), followed by hypotension (SBP = 80 + 40 mmHg) in 11% of cases. The ECG showed a sinus tachycardia (63%), a PR prolongation (>200 ms) in 28% of cases, a MSE (15.4%) and a type-I aspect of Brugada syndrome (15.4%). The analysis of influence of ETD on HR showed a linear relationship, with the equation HR = 82.276 + 0.039 EDT (mg) (R2=0.138, p=0.001). Analyzing the influence of type of drug on ECG abnormalities revealed a more tachycardia effect of amitryptiline vs. clomipramine (p=0.047). CONCLUSION: Tachycardia is a frequent sign of intoxication, which can be expressed by a linear function depending on ETD. The MSE is more frequently noted with amitriptyline. The clinical aspect of type-I Brugada syndrome is as frequent as the MSE but does not seem prognostic. It is unclear whether it is related to an isolated electrical aspect or it hides a genetic mutation.

[Attitudes of teachers to tobacco smoking]

We aimed to evaluate the attitudes of teachers to tobacco smoking in Kalaa Kebira [a semi-urban region in the Tunisian Sahel]. Data from 358 of 402 teachers surveyed were obtained using a self-completed questionnaire. The mean age of the teachers was 35.7 [SD 7.9] years. The prevalence of smoking was 29.3% [51.6% of men and 3.6% of women], and 79% of smokers were addicted to nicotine according to the Fagerstrom test. About 50% of the teachers were badly-informed about the dangers of smoking and 75.2% of smoking teachers did not refrain from smoking in front of their pupils. The lack of knowledge of teachers limits their role as a model and information source in the anti-tobacco struggle. It is essential to draw up an education programme for the teaching staff

[Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia]

We assessed the knowledge of 404 type 2 diabetic patients about their condition in order to evaluate the quality of diabetes education in primary health care units in Sousse in 2003. We found that knowledge was satisfactory in only 59% of the patients. Their knowledge about the definition of diabetes and its pathophysiology were the 2 main areas where knowledge was lacking: the proportion of correct answers were 62.6% and 50.3% respectively. More attention should be paid to educating diabetic patients within the chronic disease care national programme

[Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care]. / Facteurs déterminants du contrôle glycémique des patients diabétiques de type 2 suivis en première ligne.

PURPOSE: To determine the factors associated with poor glycemic control in type 2 diabetic patients followed in primary care units in Sousse, Tunisia. METHODS: A cross-sectional study was conducted on a representative sample of type 2 diabetic patients followed at least two years in primary health care units in Sousse, Tunisia. Data were gathered from three sources: a self-administrated questionnaire, analysis of patient files and HbA1c level. HbA1c level was measured with turbidimetric immunoinhibition assay. Patients were considered well-controlled if glycated hemoglobin (HbA1c) was less than 7%, according to the American Diabetics Association (ADA) recommendations. RESULTS: The study enrolled 404 type 2 diabetic patients. The mean age was 60.5+/-10.89 years, sex-ratio was 0.5, and mean disease duration 8.7+/-6.1 years. ADA recommendations were met by 16.7% of patients. Multivariate analysis using variables in relation with the patient, his/her family, the disease, the treatment and the health care unit, showed that only poor geographic access to the care center (adjusted OR: 1.89, p=0.009) and Body Mass Index (BMI) less than 30 kg/m2 (adjusted OR: 2.21, p=0.034) were significantly and independently associated with poor glycemic control. CONCLUSION: Glycemic control in type 2 diabetic patients is poor. It depends strongly on geographic access to health care. Type 2 diabetic patients should be referred, as much as possible, to the nearest health care unit.

[Tobacco use among teachers in a district of the Tunisian Sahel]. / Le tabagisme des enseignants dans une commune du Sahel Tunisien.

INTRODUCTION: The aim of this study was to evaluate the scale of tobacco use among teachers in the district of Kalaa Kebira (a semi-urban region in the Tunisian Sahel). METHODS: The study design was descriptive and cross sectional, employing a self administered questionnaire given to 402 teachers. RESULTS: The response rate was 89%. The average age of respondents was 35.7 7.9 years. The global prevalence of smoking among teachers was 29.3% (men: 51.6%; women: 3.6%). 79% of smokers were addicted to nicotine according to the Fagerstrôm test. Half of the teachers were poorly informed about the hazards of smoking and 77.9% of smoking teachers didn't refrain from smoking in front of their pupils. CONCLUSIONS: The teachers' lack of knowledge limits their effectiveness both as a role model and information relay in the war against tobacco.

[Impact of antibiotic use and prescribing policy in a Tunisian intensive care unit]. / Impact d'une politique de prescription d'antibiotiques dans un service de réanimation Tunisien.

OBJECTIVE: The aim of this study was to assess the efficacy of local antibiotic policy in a Tunisian ICU. The predefined primary efficacy objectives were the decrease of antibiotic consumption, reduction of inappropriate antibiotic (ATB) use and antimicrobial resistance. DESIGN: This prospective intervention study lasted from January 2002 to December 2004. In the first study period or the baseline phase (from January to December 2002) we focused on physician education for ATB prescription practice. The second period concerned intervention (control of all ATB use). RESULTS: The number of infection episodes significantly decreased from 2002 to 2004; 198 infection episodes in 2002 (1.63+/-1.15 episodes/patient) versus 124 in 2003 (1.22+/-0.93) (P<0.0008) versus 121 in 2004 (1.23+/-0.8) (P1<0.0008). The number of ATB/prescription also significantly decreased from 1.85+/-1.3 in 2002 to 1.5+/-0.9 in 2003 (P=0.02) and 1.5+/-1.4 in 2004 (P1=0.05). Appropriateness of antibiotherapy improved during the intervention period: 65% in 2002 versus 86% in 2003 (P=0.0003) and 81% in 2004 (P1=0.02). The length of antibiotherapy in survivors was considerably reduced: 14.1+/-2.9 days in 2002 versus 11.9+/-1.2 days in 2003 (P<10(-5)) and 10.9+/-2.5 days in 2004 (P1<10(-5)) with a significant reduction of antibiotherapy cost and length of stay (20.4+/-9 days in 2002 versus 18.3+/-6 days in 2003 and 16.9+/-8 days in 2004; P=0.05; P1=0.02). There was a significant decrease of carbapenem resistant Enterobacteriaceae esbeta, Pseudomonas aeruginosa and Acinetobacter baumannii.

Extrapyramidal syndrome as a delayed and reversible complication of acute dichlorvos organophosphate poisoning.

We describe 4 cases of delayed extrapyramidal disorder following acute dichlorvos poisonings. All patients were seriously poisoned since all exhibited profound coma and respiratory failure, and they were all tracheally intubated and mechanically ventilated. On admission, plasma cholinesterase activity was greaty decreased, < 10 micromol/ml/h at 37 C in all patients (< 10% of normal for our laboratory). Extrapyramidal symptoms occurred between 5 and 15 d and were characterized by dystonia of arms and legs, resting tremor, cogwheel rigidity, and hypereflexia. With bromocriptine therapy the features of extrapyramidal syndrome disappeared progressively with complete recovery in all patients. Our observations suggest a delayed extrapyramidal syndrome should be taken into account during the course of acute dichlorvos organophosphate poisonings.

Acute iron poisoning.

Intoxications with ferrous compounds are uncommon but ferrous sulphate is most frequently involved. Ferrous fumarate is less toxic than ferrous sulphate. Two cases of ferrous fumarate poisoning that resulted in digestive mucosal lesions are reported.

Metformin associated acute pancreatitis.

Metformin poisoning is not common and is usually associated with lactic acidosis and acute hepatitis. A case of metformin-poisoning associated with acute pancreatitis is reported here for the first time.

[Graded classification of acute chloralose poisoning. 509 cases]. / Classification en grades des intoxications aiguës par le chloralose. 509 cas.

OBJECTIVE: The annual incidence of chloralose poisoning has exceeded 3 cases per 100,000 inhabitants in Tunisia since 1997. The purpose of this study was to analyze clinical features of chloralose poisoning. METHODS: We reviewed patients admitted to the intensive care unit during the last 5 years to search for chloralose poisoning. The identified cases were classed into 5 grades by clinical features: depth of coma, characteristics of the myoclonia, and cerebral trunk reflex response. RESULTS: We identified 509 cases of chloralose poisoning over the last 5 years. Seventy-five patients (14.7%) were in grade 1: drowsiness alone. Four hundred ten patients (80.8%) were in grades 2 and 3: hypertonic coma and myoclonus. The clinical course was favorable after sedation, tracheal intubation and mechanical ventilation. Twenty-three patients (4.6%) were in grades 4 and 5: hypertonic coma (Glasgow coma score = 3). Three of them died. CONCLUSION: The clinical features of chloralose poisoning depend on the ingested dose. Despite the gravity of the initial clinical presentation, prognosis is excellent if symptomatic treatment is given early, even in grade 5 cases which simulate brain death.

Endoscopic carbon dioxide laser turbinoplasty.

In the present work we describe the management of hypertrophied inferior turbinates using CO(2) laser in the UniPulse mode. The laser beam is delivered through the nasal probe delivery system, and the procedure is performed using the 0 degrees endoscope. The UniPulse mode allowed fine-tuned, char-free tissue ablation, and the nasal probes allowed delivery of laser energy to the posterior parts of the inferior turbinates. The procedure was performed on 149 patients. The one-year post-operative follow-up period revealed good functional results in 131 patients (88 per cent). The minimal nasal cross sectional area increased significantly from 0.52 cm(2) to 0.81 cm(2). The average decongestive effect, on the other hand, decreased from 0.26 cm(2) to 0.07 cm(2) indicating significant laser-induced fibrosis. The operation can be performed as an out-patient procedure with little or no morbidity.

[Septic shock complicating amniocentesis]. / Choc septique compliquant une amniocentèse.

Amniocentesis is a routine technique for prenatal diagnosis. The incidence of severe intra-amniotic infection is very low. We report a case of septic shock following an amniocentesis in a 34-year-old women. Patient admitted in intensive care unit and need mechanical ventilation and vasoactives drugs to control hemodynamic pertubation. Bacteriological data showed positive polymicrobial blood cultures to Klebsiella pneumoniae and Enterobacter. The patient gradually improved, however her renal function was still impaired and she was discharged three months after admission.