[Evaluation of Physical Integrity and Biological Efficacy of Two Types of LLINs Aged 5 to 36 Months Sampled in 11 Districts of Senegal]. / Évaluation de l'état physique et de l'efficacité biologique de deux types de moustiquaires imprégnées à longue durée d'action utilisés depuis 5 à 36 mois et collectés dans 11 districts du Sénégal.

The long-lasting insecticidal nets (LLINs) have been promulgated to compensate the low re-impregnation rate of conventional mosquito nets. Today, the cornerstone of the fight against malaria vectors is based on a large distribution of these LLINs for universal coverage. Despite this promotion, the question of their effective life in operational conditions remains unresolved. Between September and October 2013, a survey was conducted in 11 districts of Senegal where LLINs were sampled and routed to the laboratory for assessing their physical integrity and biological effectiveness. A total of 207 LLINs that were sampled in the 11 districts have been monitored during this study. Our results showed that Olyset® Net and PermaNet® 2.0 are the most represented brands in the districts. These two major brands have a good biological efficiency providing a high rate of knockdown despite their failing physical integrity.

Les moustiquaires imprégnées à longue durée d'action (MILDA) ont été promues pour pallier le faible taux de réimprégnation des moustiquaires conventionnelles. Aujourd'hui, la pierre angulaire de la lutte antivectorielle repose sur une forte distribution de ces MILDA pour une couverture universelle. En dépit de cette promotion, la question de leur durée de vie effective en conditions opérationnelles reste toujours posée. Entre septembre et octobre 2013, une enquête a été menée dans 11 districts du Sénégal. Des MILDA y ont été échantillonnées et acheminées au laboratoire pour évaluer leur intégrité physique et leur efficacité biologique. Au total, 207 MILDA ont été collectées dans les 11 districts suivis au cours de cette étude. Nos résultats ont montré que les deux marques majoritairement distribuées présentaient une bonne efficacité biologique, car induisant un taux élevé de knock-down malgré leur état détérioré.

[Aseptic process validation and stability study of an injectable preparation of fructose (5%)-glycerol (10%) as part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract]. / Validation du procédé aseptique et étude de stabilité d'une préparation injectable de fructose (5 %)-glycérol (10 %) dans le cadre d'un programme hospitalier de recherche clinique portant sur le traitement curatif endoscopique des lésions néoplasiques épithéliales précoces du tube digestif.

INTRODUCTION: As part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract, a new hospital sterile and non-pyrogenic preparation of fructose (5%)-glycerol (10%) was realized. Under pharmaceutical legislation, the provision of this hospital preparation involves of aseptic process validation and achieve a stability study. MATERIALS AND METHODS: After the aseptic process validation with Mediafill Test, the preparation was made under aseptic conditions associated with a sterilizing filtration according to the good practices preparation. Prepared flexible bags (100mL of solution) were stored for one year in a climatic chamber (25±2°C). To assess stability, the physicochemical controls (fructose concentration, glycerol concentration, hydroxy-methyl-5 furfural [5-HMF] concentration, sodium concentration, pH measure, osmolality and sub-visible particles count) and microbiological (bioburden, bacterial endotoxin and sterility) were performed at regular intervals for one year. RESULTS: Neither significant decrease of fructose concentration, glycerol concentration and sodium concentration nor pH, 5-HMF, osmolality variations out of specifications were observed for one year. The sub-visible particles count, the bacterial endotoxin and sterility were in accordance with the European pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation. DISCUSSION AND CONCLUSION: The hospital preparation was stable over one year at 25±2°C, ensuring safe administration in humans within the framework of this clinical research.

[Advantages and special features of hospital preparations of parenteral nutrition in neonatalogy]. / Avantages et spécificités des préparations hospitalières de nutrition parentérale en néonatalogie.

INTRODUCTION: The care of premature infants requires specific, suitable parenteral nutrition, in which the dosage must be frequently adjusted. METHOD: A comparative analysis of four industrial standard parenteral nutrition formulations NP 100®, Pediaven AP-HP Nouveau-né 1®, Pediaven AP-HP Nouveau-né 2® and Numetah G13% E® and of two hospital preparations made specifically in hospital pharmacies produced by two separate university hospitals (Nutrine® HCL and Formule standardisée début de nutrition) was conducted. The comparison between the formulations focused on electrolytic compositions and protein/energy ratio. RESULTS: Formule standardisée début de nutrition and Pediaven AP-HP Nouveau-né 1® are free from (i) sodium and potassium, (ii) potassium respectively. Almost equivalent sodium concentration (19-27 mM) and more variable potassium concentration (∼9-26 mM) characterize the other formulations. Protein/energy ratio of Numetah G13% E®, Nutrine® HCL and Formule standardisée début de nutrition is 58% higher than that of NP 100®, Pediaven AP-HP Nouveau-né 1® and Pediaven AP-HP Nouveau-né 2®. DISCUSSION: Formule standardisée début de nutrition and Pediaven AP-HP Nouveau-né 1® are in accordance with the recommendations about hydro-electrolytic supplies during transition phase. Nutrine® HCL complies best to the recommendations about hydro-electrolytic account during stabilization phase. CONCLUSION: Hydro-electrolytic composition and protein/energy ratio of standard hospital parenteral nutrition formulations comply best to nutritional needs of premature infants.

[Injectable hospital preparation of valine labeled with the carbon 13 and nitrogen 15 (5 mg/mL) for a clinical trial on the brain tumor metabolism: Pharmaceutical control of active pharmaceutical ingredient and stability study of the finished product]. / Préparation hospitalière injectable de valine marquée au carbone 13 et à l'azote 15 (5mg/mL) pour un essai clinique sur le métabolisme tumoral cérébral : contrôle pharmaceutique de la substance active et étude de stabilité du produit fini.

INTRODUCTION: The L-Valine labeled (L-[U-(13)C,(15)N] Val) is a stable isotopic tracer administered by parenteral route within the framework of a new clinical research program concerning the brain tumor metabolism. To meet regulatory requirements and have ready to use solution with an expiration date, a pharmaceutical control of active pharmaceutical ingredient followed by stability study of hospital preparation were realised. MATERIALS AND METHODS: After the pharmaceutical control of the L-[U-(13)C,(15)N] Val, the hospital preparation was prepared according to the good manufacturing preparation. Prepared bottles were stored at 5°C±3°C and 25°C±2°C for six months. The stability of the preparation was determined by physico-chemical controls (pH, osmolality, sub-visible particles, L-[U-(13)C,(15)N] Val concentration, sodium concentration, isotopic enrichment) and microbiological (bacterial endotoxin and sterility). RESULTS: Concentrations of L-[U-(13)C, (15)N] Val and sodium does not significantly decrease during the stability study. In parallel, no change in pH and osmolality were highlighted. Isotopic enrichment higher than 99.9% reflected the stability of labeling of L-valine molecule. The sub-visible particles, the bacterial endotoxin and sterility were in accordance with the European Pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation. DISCUSSION AND CONCLUSION: The stability of this hospital preparation of L-[U-(13)C, (15)N] Val has been demonstrated for six months at 5°C±3°C and 25°C±2°C, ensuring a parenteral administration as part of the clinical trial.

[Injectable preparation of labeled leucine with the carbon 13 for a clinical research program on the Alzheimer disease: pharmaceutical control of raw materials and the finished product and stability study]. / Préparation injectable de leucine marquée au carbone 13 pour un programme de recherche clinique sur la maladie d'Alzheimer : contrôle pharmaceutique des matières premières et du produit fini et étude de stabilité

INTRODUCTION: The L-leucine labeled (L-[U-(13)C] Leu) is a stable isotopic tracer administered by parenteral route within the framework of a new clinical research program concerning the diagnosis of the Alzheimer's disease. To meet regulatory requirements and have ready to use solution with an expiration date, a pharmaceutical control of raw materials and the finished product followed by a stability study were realised. MATERIALS AND METHOD: After the pharmaceutical control of raw materials, the solution of L-[U-(13)C] Leu was prepared according to the good practices preparation. Prepared bottles were stored for 1 year of a share in a climatic chamber (25 °C±2 °C) and the other in a refrigerator (5 °C±3 °C). To assess stability, the physicochemical controls (pH, osmolality, sub-visible particles, L-[U-(13)C] Leu concentration, sodium concentration, isotopic enrichment) and microbiological (bacterial endotoxin and sterility) were performed at regular intervals for 1 year. RESULTS: Neither significant decrease of L-[U-(13)C] Leu concentration and sodium concentration nor pH and osmolality variation were observed for 1 year. Isotopic enrichment higher than 99.9% reflected the stability of labelling of L-leucine molecule. The sub-visible particles, the bacterial endotoxin and sterility were in accordance with the European pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation. DISCUSSION AND CONCLUSION: The injectable preparation of L-[U-(13)C] Leu was stable after 1 year for two preservation conditions, ensuring to safety for administration for human within the framework of this clinical research.

[Depyrogenation test regarding inox and glass containers in the preparation of parenteral nutrition mixtures]. / Test de dépyrogénation des conteneurs en inox et en verre pour la préparation des mélanges pour nutrition parentérale.

INTRODUCTION: The preparation of parenteral nutrition mixture (PNM) in an open chamber requires the use of intermediate containers sterile and non-pyrogenic. A sterilization of containers by moist heat in large autoclaves is the suitable method. However, sterilization by moist heat is not a depyrogenation method. In our study, we report the validation of a sterilization and depyrogenation method for containers by dry heat using a convection oven. MATERIALS AND METHODS: Sterilization and depyrogenation of material by dry heat have been audited by the reduction of at least three logarithms of original endotoxin rate. The containers were initially artificially contaminated with a suspension of endotoxin for 16 hours. Contaminated containers were placed in an oven with revolving heat at 250 °C for 1 hour. After treatment with dry heat, the residual endotoxin levels in the containers were determined by a kinetic chromogenic method. RESULTS: After treatment with dry heat, the average log reductions of endotoxin levels were respectively, for glass and steel containers, 4.78 ± 0.07 and 4.87 ± 0.03. DISCUSSION AND CONCLUSION: The present validation study confirms the effectiveness of treatment with dry heat for sterilization and depyrogenation of glass and steel containers. This method of sterilization and depyrogenation meets the microbiological quality requirements for the preparation of MNP.

[Validation of pharmaceutical quality of a [6,6-(2)H(2)]-glucose parenteral solution used for insulin-resistance measurement during human clinical trials]. / Validation de la qualité pharmaceutique de préparations de [6,6-(2)H(2)]-glucose en solution aqueuse administrées par voie parentérale pour la mesure de l'insulino-résistance dans le cadre d'essais cliniques.

INTRODUCTION: Deuterated glucose ([6,6-(2)H(2)]-glucose) is a stable isotopic tracer administered parenterally in healthy volunteers, obese or diabetic patients in clinical trial to study glucose metabolism during euglycemic hyperinsulinemic clamps. In accordance with the Health Authorities on drug safety, we evaluated the pharmaceutical quality of this preparation for biomedical research with a stability study. METHODS: After pharmaceutical qualification of the raw material, the [6,6-(2)H(2)]-glucose was dissolved in water for injection, then sterile, filtered under positive pressure of nitrogen and then autoclaved. Two batch products (500mg/10mL and 2g/15mL) were sampled to evaluate glucose alteration, isotope shift, limpidity, apyrogenicity and sterility at regular intervals for 2 years. Deuterated glucose solutions were stored in the dark, at +2°C+8°C, in type II glass bottles. RESULTS: Neither significant decrease of glucose concentration nor pH variation were observed for 2 years. The 5-hydroxymethylfurfural concentration was below the human harmful levels, attesting a non-generation of metabolites during autoclaving. Isotopic enrichment higher than 99% reflected the stability of deuterated label on the 6-carbon of glucose molecules. The non-visible particle concentration below the minimal permissible concentration tolerated by the European Pharmacopoeia and the absence of bacterial endotoxin and bacterial growth attested limpidity, apyrogenicity and sterility of the [6,6-(2)H(2)]-glucose solutions. CONCLUSION: After the 2-year study, 500mg/10mL and 2g/15mL deuterated glucose solutions stored in the dark at +2°C+8°C were stable in aqueous solution, allowing to ensure safety administration for human clinical trials using euglycemic hyperinsulinemic clamps.

Assessment of sodium hyaluronate gel as vehicle for intracameral delivery of cefuroxime in endophthalmitis prophylaxis.

Sodium cefuroxime is a second-generation cephalosporin widely used at 10mg/mL for endophthalmitis prophylaxis after cataract surgery. Sodium cefuroxime solution is usually conditioned in pre-filled syringes then frozen for storage. In the present study, 0.2% sodium hyaluronate gel, natural extracellular polymer used in wound healing, was compared to conventional saline solution (0.9% sodium chloride) as drug delivery systems for cefuroxime loading in pre-filled syringes. Therefore, the temperature (4 and 25 degrees C) and time of storage (up to 21 days) varied in order to appreciate both cefuroxime and vehicle stability. Furthermore, the kinetics of drug release from both hyaluronate gel and saline solution were compared since in vitro sets of dialysis experiments. Results indicated that cefuroxime loaded in either saline solution or hyaluronate hydrogel was found stable in pre-filled syringes stored at 4 degrees C for 21 days, whereas cefuroxime degradations products appeared from the 2nd day of storage at 25 degrees C. Both drug delivery systems were found bioequivalent, although statistically slower cefuroxime dialysis was evidenced by using sodium hyaluronate vehicle. Noteworthy, cefuroxime concentration in drug delivery systems during dialysis experiment remained greater than the minimum inhibitory concentrations reported for resistant strains. In conclusion, the present stability and release study confirmed that sodium hyaluronate hydrogel is a promising vehicle for cefuroxime intracameral delivery in endophthalmitis prophylaxis.

[Perioperative management of laparoscopic cholecystectomy in children with homozygous sickle cell disease]. / Prise en charge périopératoire de la cholécystectomie par voie laparoscopique chez l'enfant drépanocytaire homozygote.

OBJECTIVE: Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. METHODS: from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. RESULTS: All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). CONCLUSION: Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.

Ivermectin in senegalese peulh sheep: influence of sex on plasma disposition.

The plasma disposition kinetics of ivermectin following a single subcutaneous administration of 0.2 mg/kg was investigated in male and female Senegalese Peulh sheep. Ten clinically healthy animals (5 males and 5 females) weighing 38-45 kg were used in this trial. Blood samples were collected by jugular puncture at different times between 0.5 h and 30 days post treatment. After plasma extraction and derivatization, samples were analysed by HPLC with fluorescence detection. Computerized kinetic analysis was carried out and mean parameters were statistically compared with the Mann-Whitney U-test. The area under the concentration-time curve (AUC) was significantly higher (p < 0.0027) in females than in males. Although the differences in maximum concentration (C (max)), mean residence time (MRT) and half-life of elimination (t (1/2el)) between males and females did not achieve statistical significance, values tended to be higher in females. Sex differences may be parallel with the level of storage in fat. Further investigations are required to improve the use of ivermectin in Senegalese sheep and findings may be used to predict optimal anthelmintic strategies for management of African species depending on the parasites present in a production system.

[Nosocomial infections: definition, frequence and risk factors]. / Les infections nosocomiales: définition, fréquence et facteurs de risque.

Infection is nosocomial if it missed at the time patient admission in the health establishment. When infectious status of the patient on admission is unknown, infection is generally regarded as nosocomial if it appears after a time of at least 48 hours of hospitalization. For surgical site infection, the commonly allowed time is 30 days, or, in case of prosthesis or an implant, one year after surgical intervention. Nosocomial infections (NI) constitute major health care problem from their frequency, their cost, their gravity. Mortality related to NI can attempt 70% in certain units like intensive care units. Two ways of contamination are possible: the endogenous way is responsible of majority of hospital infections. The normally sterile sites are contaminated then colonized by the flora which is carrying the patient himself, with the favor of a rupture of the barriers of defense. The exogenic way is associated colonization, possibly followed by infection, of the patient by external bacteria, coming from others patients or from environment, transmitted in an indirect way (aerosols, manuportage, materials). Whatever its mode of transmission, apparition of nosocomial infection can be related to several supporting factors: age and pathology, certain treatments (antibiotic which unbalance patients' flora and select resistant bacteria, immunosuppressive treatments), invasive practices necessary to the patient treatment. The prevalence of nosocomial infections is higher in the intensive care units where certain studies bring back rates of 42.8% versus 12.1% in others services. The four sites of nosocomial infection most frequently concerned are: the respiratory site, urinary infections, bloodstream infections (Catheters related bloodstream infections in particular), and surgical sites infections. The relative proportion of these infections varies according to principal activity of the unity.

[Preventive measures and the strife against nosocomial infection]. / Les mesures préventives et la lutte contre les infections nosocomiales.

The nosocomial Infections are associated to an increase of the morbidity, of the mortality and costs. Their frequency stay on raised in our service of cares. Then it is recommended and broadly admitted what each hospital must dispose of a unity of nosocomial infections prevention and to dispose a staff specially vested in those duties. Of the fact the nosocomial infections frequency in reanimation, an imported part of the activity of this specialized staff will have to run out in services of intensive cares. The principal nosocomial infections feature observed is being directly or indirectly associated to engineerings of acting as invasives deputy used to palliate a vital lapse. Of a general manner, all sharp grave affection, as anything severe traumatism (accidental or surgical) drag a capacities reduction of defense against the infection, component so important factors of nosocomial infections installations. Preventive measures pass by the engineerings respect of hands hygiene, the harbour of clean conformable dress, the measures respect of isolation (septic or preventive), the cares grading, the upkeep of the hardware and the bedroom, the respect of the circuit of the linen salts and lastly the sorting and the losses management of activity of cares. For that it must a policy of strife against nosocomial infections with the placing in place of operational unities of hygiene in all hospitals and the redynamisation of the committee of strife against nosocomial infections already existed in different public establishments of health.

[Intensive care management of HELLP syndrome in Dakar]. / Prise en charge du HELLP syndrome en réanimation à Dakar.

OBJECTIVE: To evaluate the intensive management of HELLP syndrome in a intensive care unit in African setting. STUDY DESIGN: Descriptive and analytical retrospective study. PATIENTS AND METHODS: All patients hospitalized between June 1998 and June 2004 for HELLP syndrome were included in the study. Following parameters were studied: age, parity and gestity, term of pregnancy, delay before admission in ICU, data clinical, biological parameters, medical treatment, obstetrical treatment, maternal complications, maternal and foetal prognosis. RESULTS: Twenty patients of average age 26.3 years with seven primigeste and 13 pauci and miltigeste were admitted in ICU during the period of study for HELLP syndrome. The average time of admission was 1.35 days; 13 patients had HELLP syndrome in ante partum and seven patients in postpartum. Serious complications were noted at admission in the majority of patients with oligoanuric renal insufficiency in 11 cases, eclampsia in eight cases and intravascular coagulation disseminated in four cases. The mode of delivery in patients for HELLP syndrome occurring in ante partum was the Caesarean section under general anaesthesia in five cases and vaginal delivery in eight cases. All the patients for HELLP syndrome in the postpartum had been confined by low way. The maternal evolution was favourable in 13 cases. Seven patients of which five with HELLP syndrome who occurred in ante partum had died. The infant mortality was noted in eight cases primarily in cases of HELLP syndrome which occurred in ante partum.

[Severe thrombocytopenic thrombotic purpura and pregnancy: a case report]. / Purpura thrombotique thrombocytopénique grave et grossesse: a propos d'un cas.

INTRODUCTION: Thrombotic thrombocytopenic purpura failure (TTP) is a micro angiopathy caracterized in its severe form by multivisceral involement and early death. The association with pregnancy is rare, the diagnosis is difficult, but imperative because that will allow an early specific management and will improve the diagnosis CASE: Our patient is a 25 years old woman admitted in intensive care unit after cesarian section for eclampsia at term. Clinical and biological assessement were in favor at Hellp syndrome. Toxemia complicated with eclampsia and Hell syndrome was the final diagnosis and appropriate treatment followed. However the treatment, diffuse purpuric petechia appeared associated with jaundice, thrombocytopenia. The diagnosis of T.T.P was considered and corticotherapy started at day 8. Patient responded within 48 h and healins was complete after 5 weeks. CONCLUSION: Authors emphasized on the importance of the diagnosis and specific management.

[Nosocomial ventilator-associated pneumonia in a tropical intensive care unit]. / Pneumopathies nosocomialesacquises sous ventilation mécanique dans un service de réanimation en milieu tropical.

INTRODUCTION: Nosocomial ventilator-associated pneumonia (VAP) occupy an important place among nosocomial infections and are responsible for a very high mortality. The objective of this work was to study epidemiologic, diagnostic and therapeutic aspects of ventilator-associated pneumonia in a tropical Intensive Care Unit and to release an adapted strategy of antimicrobial treatment. PATIENTS AND METHODS: It is a prospective descriptive study carried out from January to December 2002 in the polyvalent intensive care unit, in collaboration with the laboratory of bacteriology-virology of the CHU Dantec of Dakar. We included all the patients admitted and who presented radiological pulmonary infiltrates appearing after 48 hours of mechanical ventilation, associated to at least 2 clinic or biologic criteria and to a positive tracheal aspirate with a cut off value of 10(4) CFU/ml. RESULTS: Thirty two cases of VAP have been diagnosed among 446 patients admitted in our ICU. The incidence was 7.16 per 100 admitted patients and 50 per 100 ventilated patients. The reasons for ICU admission were dominated by trauma (44%). Microorganisms responsible of VAP were essentially Gram negative bacilli (GNB), 68% with in head the Pseudomonas. Acinetobacter strains were practically resistant to all usually used antibiotics. The more used antibiotics were gentamicine, 3rd generation cephalosporins and fluoroquinolones. Antibiotic treatment was appropriate in only 13 cases in 26 patients at whom intrinsic antibacterial activities of antimicrobial agents were examined. The mortality rate was of 81%. CONCLUSION: The improvement of the prognosis of these VAP require preventive measures with protocols of care, a qualified staff, diagnostic means and active antibiotics on the responsible pathogens.

[Diabetic ketoacidosis of the child revealed by a pseudo-surgical acute abdomen. A case report]. / Acidocétose diabétique de l'enfant révélée par un tableau d'abdomen aigu pseudo-chirurgical: a propos d'un cas.

Ketoacidosis is a frequent mode of revelation of diabetes of the child. Signs of diabetes are generally unperceived or are badly interpreted by the family entourage. We report a case of diabetic ketoacidosis in an eight-year-old child without particular medical history. The context of discovery was an acute abdomen by gastric dilatation in a severe context of dehydration. Evolution was quickly favourable after medical treatment with disappearance of acute abdominal signs (clinical and radiological). This observation enables us to recall, by the light of a review of the literature, that diabetic ketoacidosis can be revealed by pseudo-surgical acute abdomen and treatment is purely medical.

[Acute chloroquine poisonning in Le Dantec Teaching Hospital]. / Intoxication Aigue a la Chloroquine au Chu Le Dantec.

Chloroquine poisoning is an acute severe drug induce entity increasingly frequent in Senegal. This is due on one hand to its easy accessibility and its conditioning, on the other hand to its frequent use, in the voluntary attempt of ending pregnancy. The aim of this study is to assess the frequency and the severity of such poisoning in a senegalese intensive unit care. We undertook a descriptive retrospective study from January 1998 to December 2003 in the intensive care unit of Aristide Dantec Hospital. All patients admitted for voluntary or accidental acute intoxication to chloroquine were included. The parameters studied were: reason of admission, alledged ingested amount, delay of admission, hemodynamic modifications, therapeutic data and evolution. During the study period, forty-nine cases of chloroquine intoxication were listed out of 239 acute intoxications. Among these 49 cases, 16 files were not processable. These accounted for 1,48% of all admissions during this period. Women were more represented (78.78%). In 90.90% of the cases, the intoxication was voluntary, they were related to suicidal attempt in 57.57% of the cases. The willingness to end a course of a pregnancy was found in 33.33% of the cases. The average age was 22.69 years (11 years - 38 years). The average time of admission was 4 hours. with extremes of 1 and 8 hours. The clinical symptoms were dominated by hemodynamic, neuropsychiatric and respiratory disorders. Toxicological analysis was not carried out. Ionic disorders were dominated by hypokaliémies and electrocardiographic disorders by a widening of QRS. Symptomatic treatment systematic, was based on a vascular filling and the use of adrenalin. evacuation treatment consisted of a systematic gastric "lavage" and the use of activated charcol on (3.03%). Diazepam as treatment antidotic was seldom used. Psychiatric consultation was systematically carried out. Total mortality was 6%. The authors emphasize the nécessaty to: Inform the population on the absence of drugs being able to stop a pregnancy. Think on the urgency need to implement a medical emergency and reanimation departments (SMUR). Create poison control centers in Senegal.

[Management of thermal severe burns in children in Le Dantec University Teaching Hospital]. / Prise en charge des brûlures thermiques Graves de l'Enfant au CHU le Dantec.

INTRODUCTION: Bums in children are serious public health problem. Burns management in developing countries encounters huge problems at any stage. The goals of this study were to descrive the epidemiological, clinical and therapeutic characterics. MATERIALS AND METHODS: In the university Teaching Hospital of Dakar from January to December 2003, we conducted a retrospective survey of 41 patients less than 16 years admitted for severe thermal burns. We carried a year retrospective study in ICU and pediatric surgery unit of Aristide Le Dantec Hospital. Were involved all. The following parameters were studied: age, sex, mechanism and circumstances of the burns, period time between the injury and the admission, clinical status of the patient, management and outcome. RESULTS: The age range between 5 days and 13 years, 47.72% are less than 3 years. The average period before admission was 33 hours (2 hours to 7 days). The accident occurs in 75% of cases in the kitchen. Bum by hot water was the most frequent mechanism with a percentage of 62%. Areas interested the whole body with frequent face localisation (n=18) and the perineal region (n=22). Immediate complications were shock in 37% of children and acute respiratory failure in 7 patients. Fluids and electrolytes resuscitation using Parkland formula (75%) or Carvajal formula (25%). Feeding was done to enteral route. Spontaneous epitheliasation through secondary heeling was the main therapeutic attitude, skin grafting was performed in 10 childrens. Total mortality was 18.18%; These death concerns patients for whom the UBS score range between 75 and 140 UB and the ABSI score between 9 and 12. Sepsis was the direct main cause of death. Sequellaes were jointed a nd facial contractures. CONCLUSION: The authors emphasize on the need in setting up adequate preventive measures towards high risk population (under 3 years), and specialized unit for adapted management.