[The challenge of intersectorality in the formulation of policies favourable to the health of older persons in west africa: the case of Burkina Faso]. / Le defi de l'intersectorialite dans la formulation des politiques favorables a la sante des personnes agees en afrique de l'ouest : cas du Burkina Faso.

AIM: The aim of this study was to contribute to a better development of health policies for the elderly in Burkina Faso. MATERIAL AND METHODS: We have done a qualitative cross-sectional study from February to September 2018 in 4 ministerial departments of Burkina Faso (health, human rights, public service and national solidarity). The interviews included non-governmental organisations, associations, technical and financial partners. Inductive approach has used to produce results. RESULTS: A total of 24 key informants were included in the study. Various interventions were implemented differently by the departmental departments. The study identified non-functional interdepartmental consultation frameworks as mechanisms for consultation. These frameworks have not been used in the formulation or implementation of policies for the elderly. CONCLUSION: National coordination of public policies for the elderly in high level of decision-making is important. The activation of interdepartmental consultation frameworks is a necessity for formulating holistic and complementary interventions for the elderly and even beyond this target group.

BUT: Le but de cette étude était de contribuer à une meilleure élaboration des politiques publiques de santé en faveur des personnes âgées au Burkina Faso. MATÉRIELS ET MÉTHODES: il s'est agi d'une étude transversale qualitative de Février à Septembre 2018 dans 4 départements ministériels du Burkina Faso (la santé, les droits humains, la fonction publique et la solidarité nationale). Les entretiens ont inclus des organisations non gouvernementales, des associations, des partenaires au développement. L'approche inductive a été utilisée pour produire les résultats. RÉSULTATS: Au total 24 informateurs clés étaient inclus dans l'étude. Diverses interventions étaient mises en œuvre différemment par les départements ministériels. L'étude a mis en évidence des cadres de concertations interministériels non fonctionnels. Ces cadres n'ont pas été utilisés ni dans la formulation, ni dans la mise en œuvre des politiques en faveur des personnes âgées dans les différents ministères. CONCLUSION: L'absence de coordination interministérielle entre les ministères chargés des politiques publiques en faveur de la santé des personnes âgées et le faible engagement de l'Etat et des partenaires au développement étaient des limites relevées dans cette étude. La définition d'une politique publique de santé des personnes âgées à dimension intersectorielle s'avère nécessaire au Burkina Faso.

[Prevalence and factors associated with missed opportunities for vaccination at Niamey, Niger]. / Prevalence et facteurs associes aux occasions manquees de vaccination (OMV) a Niamey au Niger.

AIM: determine the prevalence and factors associated with missed opportunities for vaccination of children 0-23 months old in the health district Niamey 2 (Niger) in 2018. MATERIALS AND METHODS: It was a cross - sectional study conducted in the health district of Niamey 2 in 2018. All children aged of 0 - 23 months which had parents aged more than 15 years old, who accepted to answer our questions were included. RESULTS: The prevalence of the missed opportunities immunization was 42.8%. Parent's perception on health services, the long waiting time, the refusal of immunization, the date of next appointment were the factors associated with the missed opportunities immunization. CONCLUSION: Taking into consideration the results of this study, the missed opportunities immunization remain important public health problems in Niger. Some actions need to be taken to improve the sensitization of communities about children immunization completeness.

BUT: déterminer la prévalence et les facteurs associés aux occasions manquées de vaccination selon la communauté (OMV) chez les enfants de 0 - 23 mois. MATÉRIELS ET MÉTHODES: Il s'est agi d'une étude descriptive transversale à visée analytique chez les enfants de 0 à 23 mois et leurs parents dans le district sanitaire Niamey 2 du 01 juin au 31 août 2018. Etaient inclus tous les enfants de 0 - 23 mois et leurs parents âgés de plus de 15 ans, acceptant de répondre à nos questions. RÉSULTATS: La prévalence des OMV était de 42,8%. Les perceptions des parents vis-à-vis des services de vaccination, le long temps d'attente, le refus de vaccination, la courtoisie des agents en demandant le carnet de vaccination des enfants, la date du prochain rendez ­ vous de même que la satisfaction des parents des services de vaccination étaient statistiquement liés aux occasions manquées de vaccination. CONCLUSION: Au regard de nos résultats, les occasions manquées de vaccination demeurent un problème de santé publique au Niger. Il revient donc aux autorités sanitaires la mise en œuvre des programmes d'intensification de sensibilisations communautaires pour assurer aux enfants une bonne complétude vaccinale.

Effect of Papacarie and Alternative Restorative Treatment on Pain Reaction during Caries Removal among Children: A Randomized Controlled Clinical Trial.

OBJECTIVE: To compare the effect of Papacarie and Atraumatic Restorative Treatment (ART) on pain and discomfort during caries removal among children. STUDY DESIGN: Fifty healthy, 4-8 year-old children were equally and randomly allocated to Papacarie and ART to remove caries from decayed primary teeth. A randomized, controlled, blinded, two parallel-arms clinical trial was conducted in the clinic of the Pediatric Dentistry and Dental Public Health Department, Alexandria University, Egypt in March 2014. Pain and discomfort were assessed blindly by two independent investigators watching videotaped treatment sessions using the Sound, Eye and Motor scale (SEM). Their reliability was assessed using Kappa statistics. The effect of caries removal methods, time spent to remove caries and other confounders on SEM score was assessed using regression analysis. RESULTS: Mean time to remove caries using Papacarie and ART was 5.8 and 4.8 minutes, P= 0.005. Median Paparie and ART scores for the S, E and M components were 1, 1, 1 and 3, 2, 3. Adjusted mean SEM score= 3.6 and 7.8, P <0.0001. Method of caries removal was the only factor significantly affecting pain and discomfort. CONCLUSION: Papacarie is associated with minimal pain during caries removal from primary teeth compared to ART, although it has longer working time.

A unique approach to thoracic duct leak after esophagectomy.

Chylothorax is a severe complication of esophagectomy. Those who do not respond to conservative measures require reoperation. We have described a minimally invasive technique to control a late postoperative chyle leak. A 41-year-old patient underwent an Ivor-Lewis esophagectomy. Day 4 after surgery he was found to have an esophageal leak. He underwent thoracotomy and esophageal stent insertion. On day 20, a radiologic drain was placed to control a small supradiaphragmatic collection. The collection was found to be chyle, and 2.5 L was drained per day. As this was 3 weeks after thoracotomy, a technique of sinus track dilatation and cavity visualization was carried out with clipping of the chyle channel. The patient recovered well from the procedure. He was extubated postoperatively and only required simple analgesia.

Elevated plasma CD105 and vitreous VEGF levels in diabetic retinopathy.

Diabetic retinopathy is the leading cause of blindness in the industrialized world. Hyperglycaemia induces retinal hypoxia that upregulates a range of vasoactive factors which may lead to macular oedema and/or angiogenesis and hence potentially sight threatening retinopathy. In this study, we have focused on the association of CD105 and vascular endothelial growth factor (VEGF) with the development and progression of diabetic retinopathy by means of quantifying their expression in the plasma and vitreous of diabetic patients. CD105 levels were quantified in the plasma of 38 type I diabetic patients at various stages of retinopathy and 15 non-diabetic controls. In an additional cohort of 11 patients with advanced proliferative retinopathy and 23 control subjects, CD105 and VEGF were measured in the vitreous. The values were expressed as median (range) and statistical analysis was carried out using the non-parametric Mann-Whitney U test. Plasma CD105 levels were significantly increased in diabetic patients [1.8 (1.1-2.4) ng/ml] compared with non-diabetic controls [0.7 (0.3-1.8) ng/ml] (p<0.01). Plasma CD105 levels were elevated in diabetic patients with all stages of retinopathy, the highest level was observed in background retinopathy [2.3 (2.1-2.5) ng/ml] followed by proliferative retinopathy [2.1 (0.9-2.8) ng/ml] and advanced proliferative retinopathy [1.4 (0.6-1.8) ng/ml]. Vitreous contents of CD105 did not differ between controls and patients with advanced proliferative retinopathy, but vitreous levels of VEGF were elevated by approximately 3-fold in patients with advanced proliferative retinopathy [7.2 (1.90-15.60) ng/ml] compared with the control subjects [1.80 (1.10-2.210)] (p<0.01). These observations indicate that plasma levels of CD105 and vitreous levels of VEGF are associated with diabetic retinopathy, suggesting that CD105 and the angiogenic factor VEGF may play a critical role in the development and progression of diabetic retinopathy. Further studies are required to determine whether circulating CD105 levels could serve as a surrogate marker for early stage retinopathy and for monitoring disease progression.

Application of threshold-based acceleration change index (TACI) in heart rate variability analysis.

Heart rate variability (HRV) analysis is a non-invasive and reliable means to assess an autonomic nervous system (ANS) function. Heart rate is a non-stationary signal that may contain indicators of current diseases and sometimes warnings about impending diseases. In this paper, we have proposed the threshold-based acceleration change index (TACI) for HRV analysis, which is calculated from the sign of differences of RR time series characterizing the dynamics of threshold crossings. It was found that TACI is robust in classifying various groups under different physiological and pathological conditions. We have studied the behavior of TACI for simulated time series (uncorrelated random data, sinusoidal time series and logistics map time series) and its robustness in the presence of artifacts for RR time series. The performance of TACI is evaluated for classifying normal sinus rhythm (NSR), congestive heart failure (CHF) and atrial fibrillation (AF). An unpaired Student's t-test was used to check significant differences between these groups and the degree of separation between these groups was quantified by using the area of a receiver operator curve.

Ara-C affects formation of cancer cell DNA synthesome replication intermediates.

PURPOSE: An intact and fully functional multiprotein DNA replication complex (DNA synthesome) from human as well as from murine mammary carcinoma cells was first isolated and characterized in our laboratory. The human cell synthesome supports the in vitro origin-specific simian virus 40 (SV40) DNA replication reaction in the presence of the viral large T-antigen using a semiconservative mechanism and has been shown to contain all the proteins and enzymes required to support DNA synthesis. We are currently using the DNA synthesome as a unique model for analyzing the mechanism of action of anticancer drugs affecting DNA replication. The purpose of this study was to further investigate the mechanism of action of ara-C using the DNA synthesome isolated from the human breast cancer cell line MDA MB-468. METHODS: Synthesome-mediated SV40 DNA replication was performed in the presence of various concentrations of ara-CTP (the active metabolite of ara-C) and the types of daughter DNA molecules produced were analyzed lusing neutral and alkaline gel electrophoresis. We also examined the effect of ara-C on intact MDA MB-468 cell DNA synthesis and on cell proliferation. In addition, we studied the effect of ara-CTP on the activity of some of the synthesome target proteins (the DNA polymerases alpha and delta). RESULTS: Full-length daughter DNA molecules were obtained in the presence of low concentrations of ara-CTP while at higher concentrations, there was an inhibition of full-length daughter DNA synthesis. The findings suggest that specifically the initiation phase of DNA synthesis was inhibited by ara-CTP since the production of the short Okazaki fragments was suppressed at all concentrations of the drug above 10 microM. In addition, it was found that the IC50 of ara-CTP for inhibition of synthesome-mediated in vitro DNA replication was comparable to that required to inhibit intact cell DNA synthesis. Further experimentation has shown that ara-CTP preferentially inhibits the activity of the synthesome-associated DNA polymerase alpha enzyme while the DNA polymerase delta seems to be resistant to the inhibitory effect of that drug. CONCLUSIONS: Our results indicate that ara-C's action on DNA replication is mediated primarily through DNA polymerase alpha and suggest that this enzyme plays a key role in DNA synthetic initiation events. The results also provide definitive support for the use of the DNA synthesome as a unique and powerful model for analyzing the mechanism of action of anticancer drugs which directly affect DNA replication.

Effects of gemcitabine and araC on in vitro DNA synthesis mediated by the human breast cell DNA synthesome.

PURPOSE: Gemcitabine (dFdC) and cytarabine (araC) are both analogs of deoxycytidine. Gemcitabine is a relatively new drug that has been shown in both clinical trials and in vitro systems to have more potent antitumor activity than araC. We have previously isolated a fully functional multiprotein DNA replication complex from human cells and termed it the DNA synthesome. Using the DNA synthesome, we have successfully examined the mechanism of action of several anticancer drugs that directly affect DNA synthesis. In this study, we compared the effects of dFdC and araC on in vitro DNA synthesis mediated by the DNA synthesome with the effects of these drugs on intact MCF7 cell DNA synthesis. METHODS: We examined the effects of dFdC and araC on intact MCF7 cell DNA synthesis and clonogenicity. We also performed in vitro SV40 replication assays mediated by the MCF7 cell-derived DNA synthesome in presence of dFdCTP and araCTP. The types of daughter molecules produced in the assay were analyzed by neutral and alkaline agarose gel electrophoresis. Finally, we examined the effects ofdFdCTP and araCTP on the synthesome-associated DNA polymerase alpha and delta activities. RESULTS: Our results showed that dFdC was more potent than araC at inhibiting intact MCF7 cell DNA synthesis and clonogenicity. [3H]Thymidine incorporation was inhibited by 50% at a dFdC concentration of 10 microM, which was about tenfold lower than the concentration of araC required to inhibit intact cell DNA synthesis by the same amount. As examined by clonogenicity assay, dFdC was also significantly more cytotoxic than araC after a 24-h incubation. In vitro SV40 replication assays using the DNA synthesome derived from MCF7 cells demonstrated that the formation of full-length DNA along with replication intermediates were inhibited by dFdCTP in a concentration-dependent manner. Full-length DNA was produced in the in vitro DNA replication assay even when the dFdCTP was incubated in the assay at concentrations of up to 1 mM. We observed that in the presence of 10 microM dCTP, 3 microM dFdCTP and 60 microM araCTP were required to inhibit in vitro SV40 DNA synthesis by 50%. Although dFdCTP is more potent than araCTP at inhibiting in vitro SV40 DNA synthesis, there was no significant difference between the inhibitory effect of these two drugs on the activity of the MCF7 synthesome-associated DNA polymerases alpha and delta. It was found that the drug concentrations required to inhibit 50% of the synthesome-associated DNA polymerase delta activity were much higher than those required to inhibit 50% of DNA polymerase alpha activity for both dFdCTP and araCTP. CONCLUSION: Taken together, our results demonstrated that: (1) dFdC is a more potent inhibitor of intact cell DNA synthesis and in vitro SV40 DNA replication than araC; (2) the decrease in the synthetic activity of synthesome-mediated in vitro SV40 origin-dependent DNA synthesis by dFdCTP and araCTP correlates with the inhibition of DNA polymerase alpha activity; and (3) the MCF7 cell DNA synthesome can serve as a unique and relevant model to study the mechanism of action of anticancer drugs that directly affect DNA synthesis.

A neutralizing antibody against human DNA polymerase epsilon inhibits cellular but not SV40 DNA replication.

The contribution of human DNA polymerase epsilon to nuclear DNA replication was studied. Antibody K18 that specifically inhibits DNA polymerase activity of human DNA polymerase epsilon in vitro significantly inhibits DNA synthesis both when microinjected into nuclei of exponentially growing human fibroblasts and in isolated HeLa cell nuclei. The capability of this neutralizing antibody to inhibit DNA synthesis in cells is comparable to that of monoclonal antibody SJK-132-20 against DNA polymerase alpha. Contrary to the antibody against DNA polymerase alpha, antibody K18 against DNA polymerase epsilon did not inhibit SV40 DNA replication in vitro. These results indicate that DNA polymerase epsilon plays a role in replicative DNA synthesis in proliferating human cells like DNA polymerase alpha, and that this role for DNA polymerase epsilon cannot be modeled by SV40 DNA replication.

Blood flow in a chronic entrapment neuropathy model in the rabbit sciatic nerve.

A model of chronic entrapment neuropathy in the rabbit sciatic nerve was developed to try to elucidate the pathogenesis of chronic nerve entrapment. A non-compressive Silastic cuff was wrapped around the nerve at the mid-thigh level in eight rabbits. A sham operation that only elevated the sciatic nerve was performed in seven control rabbits. Six months later, the blood flow in the cuffed and the control sciatic nerves was determined with intra-arterially injected microspheres. Blood flow was significantly reduced in the entrapped nerve, compared to control nerves, but only in the segment proximal to the cuff. After surgical release of the cuff, the blood flow significantly increased in the proximal segment. This suggested that decreased blood flow may occur, but not necessarily at the site of nerve entrapment. Nerve conduction velocity changes were also consistent with an entrapment neuropathy. However, there were no significant quantitative morphometric changes at the nerve entrapment site, that is, in myelin thickness/nerve diameter ratio, distribution of axon sizes, and mean nerve fiber diameter. This indicates that only a mild entrapment was created.

Avulsion injuries of the thumb: survival factors and functional results of replantation.

Twenty-seven cases of replantation for avulsion injuries of the thumb from 1979 to 1987 were analyzed retrospectively. Inclusion criteria required all thumbs to have tendinous attachments (either the extensor pollicis longus or the flexor pollicis longus) to the amputated part. Thirteen replants survived for an overall survival rate of 48%. Avulsions at or proximal to the metacarpophalangeal joint had a survival rate of 83% compared with a 38% survival rate distal to the metacarpophalangeal joint. This difference was not statistically significant. Of the 13 patients with surviving replanted thumbs, 11 (85%) achieved protective sensation only and 2 attained a two-point discrimination <10 mm. Of the 13 replanted thumbs that survived, 7 were treated with primary arthrodesis, 4 at the level of the interphalangeal joint and 3 at the metacarpophalangeal joint. The other 6 thumbs were treated with primary or secondary tendon transfers. In a literature review of thumb avulsion injuries, survival rates range from 26% to 100%. In this study, tendon transfers and primary arthrodesis were useful adjuncts in the management of thumb avulsions, and the majority of patients with successfully replanted thumbs attained protective sensation only. Larger studies are needed to better define statistically significant relationships affecting replantation survival.

Renal failure associated with hepatitis C virus infection. Improvement in renal function after treatment with interferon-alpha.

Hepatitis C virus infection can result in mixed cryoglobulinemia and associated clinical syndromes including membranoproliferative glomerulonephritis. Reports regarding the efficacy of interferon-alpha (IFN-alpha) in the treatment of patients with membranoproliferative glomerulonephritis and chronic hepatitis C infection have been inconclusive regarding improvement of renal function. We describe two patients with chronic hepatitis secondary to hepatitis C virus complicated by mixed cryoglobulinemia and membranoproliferative glomerulonephritis who developed severe renal failure which resolved after treatment with standard doses of IFN-alpha 2b.

V gamma (I) expression in human intestinal lymphocytes is restricted.

The majority of human intestinal intraepithelial lymphocytes (HIELS) express CD8+, and the T cell Receptor (TCR) alpha beta. A minority of HIELS utilize TCR gamma delta chains. V delta 1 is established as the TCR-delta expressed by most TCR gamma delta HIELS. Since V delta 1 is the dominant intestinal TCR and V gamma (I) family is preferentially used in forming a heterodimer, this study was conducted to characterize individual V gamma (I) utilization in HIELS. Intestinal lymphocytes were isolated from four samples of colonic epithelium obtained from patients undergoing colon resection or endoscopy. RNA was isolated and cDNA synthesized. PCR amplification was performed with consensus J gamma and V gamma primers in these regions. PCR products were cloned and sequenced. All samples had V gamma 4 transcripts, a majority V gamma 3 whereas V gamma 2 and V gamma 8 were less frequent. No V gamma 2 transcripts had any predicted TCR protein products. Similarly, very few potentially productive V gamma 3 transcripts were found. In contrast, almost all V gamma 4 transcripts were found to be in-frame and the only V gamma 8 transcript was in-frame. The CDR3 region of the gamma transcripts were small compared to published intestinal TCR delta recombinations. All CDR3 regions contained at least one charged amino acid. The limited number of functional transcripts adds evidence to the oligoclonality of intestinal TCRs expressing the TCR V gamma (I) family. The short CDR3 regions support the concept of limited antigen recognition by this lymphocyte population.

Stimulation of intestinal Na+/H+ exchange by cell volume changes during fasting and refeeding in rats.

Intestinal cell water was studied in rats that have been fasted then refed, two conditions that are known to decrease and increase, respectively, proliferation of the intestinal epithelium. Cell water decreased (15%) during fasting and returned to normal with refeeding. The amiloride-sensitive sodium uptake, which estimates uptake through the Na+/H+ exchange was higher in the ileum than the jejunum, but the jejunal uptake, unlike the ileal, was significantly increased in fasted/refed rats than in normally fed or fasted ones. Osmotic shrinkage of intestinal cells followed by restitution of their cell volume stimulated the Na+/H+ exchange in all of the three groups of animals, but the increase was most prominent in the fasted and the fasted/refed groups. Also, shrinkage of cultured jejunal crypt cells (IEC-6) by a hypertonic solution increased intracellular alkalinization that was inhibited by amiloride. The results provide evidence for a relationship between the change in intestinal cell size, such as that which occurs during fasting/refeeding, and the activation of the Na+/H+ antiport system. This may represent one of the signals that initiates intestinal proliferation in the fasting/refeeding state.

Toe-to-thumb transfer: a new technique.

Our technique combines the advantages of two proven techniques of the wraparound flap and vascularized joint transfer while offering a more normal thumb, both functionally and cosmetically. Its advantages are as follows: 1. A more normal-looking thumb with good length 2. Preservation of motion through joint transfer 3. Maintenance of growth potential through transfer of vascularized epiphyses 4. Minimal donor-site morbidity

Transfer of the trapezius for flail shoulder after brachial plexus injury.

Shoulder arthrodesis is often used to treat flail shoulder after a brachial plexus injury, but has a high complication rate and entails loss of passive mobility. We have reviewed 27 patients with brachial plexus injury treated by transfer of the trapezius to the proximal humerus at an average time from injury of 31.3 months. Pre-operatively, all 27 shoulders were subluxated, with an average abduction of 3.5 degrees. Postoperatively, shoulder abduction averaged 45.4 degrees, and subluxation was abolished. All patients were satisfied with their improvement in function. Trapezius transfer is recommended as a simple procedure that requires only a brief period in hospital, allows early rehabilitation, and gives a satisfactory outcome, while retaining passive mobility of the shoulder.