Metabolic syndrome and the phenotype of multiple sclerosis.

BACKGROUND: Comorbidities, particularly vascular comorbidities, have been shown to exacerbate the progression of disability in multiple sclerosis (MS). Metabolic syndrome (MetS) is a cluster of conditions including abdominal obesity, insulin resistance, atherogenic dyslipidemia, and vascular dysfunction, which contribute to vascular morbidity and chronic inflammation. OBJECTIVE: To describe the characteristics of MetS in a cohort of MS patients and evaluate its relationship with the MS phenotype. METHODS: A monocentric cohort study was conducted on MS patients, collecting demographic, clinical, radiological, and therapeutic data, as well as metabolic data including waist circumference, blood pressure, serum triglycerides, high-density lipoprotein cholesterol, and fasting blood glucose. RESULTS: Among the 84 patients included in the study, 27% were diagnosed with MetS. MetS was found to be associated with secondary progressive MS (SPMS). Patients with SPMS had a higher prevalence of MetS compared to those with relapsing-remitting MS (RRMS), even after adjusting for disease duration. While MetS was associated with Expanded Disability Status Scale (EDSS) progression in the 3-year period according to univariate analysis, it did not show a significant association with disease activity. CONCLUSION: This study provides evidence supporting the connection between MetS and the progression of disability in MS, independent of disease relapse activity.

Assessing the presence of Wuchereria bancrofti in vector and human populations from urban communities in Conakry, Guinea.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis was launched in 2000 with the goal of interrupting transmission of lymphatic filariasis (LF) through multiple rounds of mass drug administration (MDA). In Guinea, there is evidence of ongoing LF transmission, but little is known about the most densely populated parts of the country, including the capital Conakry. In order to guide the LF control and elimination efforts, serological and entomological surveys were carried out to determine whether or not LF transmission occurs in Conakry. METHODS: The prevalence of circulating filarial antigen (CFA) of Wuchereria bancrofti was assessed by an immuno-chromatography test (ICT) in people recruited from all five districts of Conakry. Mosquitoes were collected over a 1-year period, in 195 households in 15 communities. A proportion of mosquitoes were analysed for W. bancrofti, using dissection, loop-mediated isothermal amplification (LAMP) assay and conventional polymerase chain reaction (PCR). RESULTS: CFA test revealed no infection in the 611 individuals examined. A total of 14,334 mosquitoes were collected; 14,135 Culex (98.6 %), 161 Anopheles (1.1 %) and a few other species. Out of 1,312 Culex spp. (9.3 %) and 51 An. gambiae (31.7 %) dissected, none was infected with any stage of the W. bancrofti parasite. However, the LAMP assay revealed that 1.8 % of An. gambiae and 0.31 % of Culex spp. were positive, while PCR determined respective prevalences of 0 % and 0.19 %. CONCLUSIONS: This study revealed the presence of W. bancrofti DNA in mosquitoes, despite the apparent absence of infection in the human population. Although MDA interventions are not recommended where the prevalence of ICT is below 1 %, the entomological results are suggestive of the circulation of the parasite in the population of Conakry. Therefore, rigorous surveillance is still warranted so that LF transmission in Conakry would be identified rapidly and adequate responses being implemented.

Les ruptures traumatiques de l'uretre posterieur : analyse de 87 cas au CHU de Conakry

Objectif : Rapporter notre experience dans la prise en charge des ruptures traumatiques de l'uretre posterieur. Patients et methodes : Quatre-vingt-sept patients presentant une rupture traumatique de l'uretre posterieur ont ete traites dans le service d'Urologie-Andrologie du CHU de Conakry de janvier 1988 a decembre 2004. Le contexte traumatique a ete un accident de la voie publique dans 68 (78;2) cas et un accident de travail dans 19 (21;8) cas. Seuls 32 (36;8) des patients ont ete recus dans les 72 heures qui ont suivi le traumatisme; les autres ont ete recus au stade de stenose uretrale constituee. Une fracture du bassin a ete notee chez 56 (64;4) patients. La symptomatologie clinique etait dominee par la retention d'urine dans 62 (71;3); l'uretrorragie dans 59 (67;8) et l'hematome perineal dans 23 (26;4) cas. Resultats : Le traitement a consiste en un realignement sur sonde uretrale en urgence; une reparation uretrale en urgence differee entre le 8e et le 10e jour et une uretroplastie tardive selon qu'il s'agissait d'une rupture recente ou ancienne de l'uretre. Les resultats therapeutiques ont ete bons dans 32 (36;8) et moyens dans 39 (44;8) cas. Une dysfonction erectile a ete notee chez 19 (21;8) patientsConclusion : Le traitement des ruptures de l'uretre posterieur demeure controverse; cependant pour nous; l'uretrorraphie termino-terminale en urgence differee reste la methode therapeutique de choix dans notre contexte devant l'impossibilite de pouvoir realiser un realignement endoscopique et en l'absence de lesions associees severes. Devant des lesions associees graves la refection uretrale passe au second plan cedant la priorite aux lesions engageant le pronostic vital

[Endoscopic internal urethrotomy in the treatment of male urethral stenosis at the urology service of the CHU Ignace Deen]. / L'urétrotomie interne endoscopique dans le traitement des sténoses de l'urètre masculin au service d'urologie du CHU Ignace Deen.

The authors report a series of 157 stenoses of the urethra treated by endoscopic urethrotomy between 1991 and 1997. After a first urethrotomy the success rate is 51.8%, with a decline of one year. Mortality is zero, and the morbidity assessed at 9%. For these authors, the result is better when the urethrotomy concerns an uninfected, one-time, short (less than 2 cm) stenosis, whatever the etiology, located on the proximal urethra. The duration of the postoperatory catheter has been fixed at three days. Poor results (35.20%) have been reported in stretched stenoses located on the distal urethra. These poor results have been treated by another urethrotomy, with 25% good results. The remaining 10.2% have needed sessions of urethral dilatation, even a plasty.

[Early complications of transvesical prostatectomy for prostatic adenoma at the Conakry urologic department: report of 96 cases]. / Les complications précoces de l'adénomectomie prostatique transvésicale au service d'urologie de Conakry: à propos de 96 cas.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specific complications and 58.30% are non specific complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a urethral catheter placed before operation is the first interested by Hryntschak early complications.

[Penile prosthesis in case of impotence: 12 years of clinical experience]. / La prothèse pénienne en cas d'impuissance: 12 ans d'expérience clinique.

Among 95 patients who have received a penile prosthesis between 1982 and 1993 (mean follow up of 46 months), 21 (22%) presented complications requiring one or more reintervention(s). Only for two patients the problem was mechanical, in the majority, they were non mechanical. Five of those subjects (5.5%) presented such complications that definitive explanation of the device was necessary. The problems presented by the 9 remaining patients were fully satisfactorily managed. Presently 94.5 per cent of the patients are using the device. Follow-up study of our interdisciplinary group demonstrates the efficacity of the prosthesis for revitalisation of the couples. The definitive parameters of implantation acceptance are essentially the partner influence and the treatment cost. This clinical study shows that the implantation of a penile prosthesis is an effective therapy in the treatment of impotence in a selected population. Presently, the mechanical reliability of different device has been good to date.

The experience of the CHU Liège with conservative surgery in the management of upper urinary tract tumors.

A review of 20 cases of conservative surgery for urothelial tumors of the upper tract is presented. The morbidity is limited; the recurrence rate is around 15% in the ipsilateral urinary tract with a mean follow up of 41 months. Conservative surgery does not seem to carry a higher fatal risk as compared to more radical surgery. It has indications in some cases which are defined.

[Preliminary experience in laparoscopic nephrectomy]. / Expérience préliminaire de la néphrectomie laparoscopique.

The laparoscopic technic of nephrectomy and nephroureterectomy is presented. We discuss about the indications and contraindications of this technic. Then we present our results about our first 6 cases. We concluded that this new technic is very beneficial to the well selected patient concerning the post-operatory comfort and the early revalidation period.

Traditional healers in Casamance, Senegal.

As part of a long-standing effort to foster collaboration between Western and traditional health workers, the writers talked with six animist healers and marabouts about their work. They begin with some general information about traditional healing in Casamance, a region in southern Senegal.

[Retrocaval ureter (apropos of a case)]. / L'uretère rétrocave (a propos d'un cas).

The authors are reporting a case of lumbar pain secondary to a retrocaval ureter. Pathogeny, diagnostic implications and treatment of this entity is discussed.