[The teachings of the Center for Education and Research in Tropical Medicine and Health. Analysis and pedagogic developments]. / Les enseignements du Centre de Formation et de Recherches en Médecine et Santé Tropicales. Analyse et développements pédagogiques.

Three different types of education and teaching are offered by the Education and Research Center in Tropical Health and Medicine: To 7th and 8th year students in medicine, given morning and afternoon over a period of 13 weeks, this type of education in tropical health and medicine requests a high degree of participation from the student; it is very well structured in its objectives and program with more than 50% of directed studies and guided training. Evaluation is carried out both in and at the end of sylabuses. To male and female nurses, teaching is given morning and afternoon over a period of 5 weeks. From year to year, the increased number of participants attests the success of such a teaching. To students at the end of their University programmes, whatever they may be. This multidisciplinary education is given over a period of two years, twice a month, late in the afternoon.

[Pancreatic pathology in black Africans (excluding diabetes)]. / La pathologie pancréatique du Noir african (à l'exclusion du diabète).

Number of cases of pancreatitis obviously increases in african Black not so much acute forms but mainly chronic calcifying forms of which ethylism represents the main etiology. As in cancers and pancreatic cysts, symptomatology shows no particular characteristic in Negroes. Moreover, because some deficiencies in the sanitary network, lethality remains at a high level. A special form, principally identified in Kerala and Java, is met in some african areas: the juvenile tropical pancreatitis syndrom, with diabetes as main symptom, of which no explanation can be given up to now.

[Nutritional problems among adults in the Sahel]. / Les problemes nutritionnels des adultes en zone sahélienne.

A definite list of nutritional diseases can be ascribed to the adult people who live in the Sahel. It results from a food consumption rate which, though a decent energetic or caloric level, remains of little values because of some protein, trace element and vitamin deficiencies. Subclinical diseases that can only be detected through routine mass-examinations, are prevalent. But on the other hand, clinical diseases, the most typical and the most frequent of which is nutritional anemia, are of very frequent occurrence too. The usual disturbing factors of the precarious states of nutrition are pregnancy and lactation, the season of the gap and the associated infections.

[The danger of infection and common medical pathology among adults in the Sahel. Niger as an example]. / Le péril infectieux et la pathologie médicale courante chez l'adulte, dans les régions sahéliennes. L'exemple du Niger.

In Niger, the infectious risk is of real concern in the field of the pathology of the adult, mainly caused by the major endemic diseases: Parasitic diseases such as malaria, bilharziasis, cutaneous leishmaniasis and recently visceral leishmaniasis, Bacterial diseases such as enterobacterial diseases, amibiasis, meningococcal diseases, tuberculosis, leprosy and treponematosis, Virus diseases such as arbovirus diseases and probably viral hepatitis. On the whole, the rate of occurrence and prevalence are not more significant than those in the neighbouring countries. On the other hand, diseases prevailing all over the world do not save the indigenous. Some recent hospital statistics demonstrate that the disease of the liver and the digestive system (28.8 pc), the respiratory diseases (16.49 pc), and the cardiovascular diseases (14.63 pc) are prevalent.

[Primary liver cancer in the tropical environment. Classical and current data]. / Le cancer primitif du foie en milieu tropical. Données classiques et récentes.

In most cases, primary liver carcinoma in tropical areas remains an hepatoma. The high incidence of this malignant tumor of the liver in some regions, and especially in black Africa, is still unexplained. As compared with the form found either in the European or in the North-African, this hepatoma shows special features since it occurs in younger people (35 years), follows a bursting-out course and is precipitously associated not to an alcoholic cirrhosis but to a post-hepatitic one. An humoral syndrome leading to a presomptive diagnosis consists of hypoglycemia, hypercholesterolemia, hyperlipemia, and high blood level of alcaline phosphatases. In 85% of the cases, these tumors secrete an alpha fetoprotein determined by radioimmunoassay. A major etiologic factor is the oncogenous activity of hepatitis virus B which could be either an induction factor or a "co-factor" which would initiate, facilitate or increase the activity of the carcinogen. In this respect, aflatoxin has to be regarded as a "co-factor" too. The best treatment, when it is possible, is an exeresis carried out through a partial hepatectomy. If such a surgical intervention is unadvisable, chemotherapy is the only possibility. Immunization against viral hepatitis has raised hope for the prophylaxis of hepatoma. But it will not be possible to evaluate it before the year 2.000.

[Hemoglobinopathies and arterial pathology]. / Hémoglobinopathies et pathologie artérielle.

Mutation of the hemoglobin molecule which characterises sickle cell anemia causes the falciformation under conditions of slow oxygen pressure, an increase in blood viscosity and premature destruction of the red blood cells. The vascular disorders, which are of variable nature, intensity and gravity, influence to a great extent the disabling character of the disease. Vaso occlusive crises are often associated with intercurrent infection. The retinopathy (well demonstrated by fluorescein angiography) is the most typical arteriolar disorder. In homozygotic patients, stenosis of the proximal portions of the large arteries leads to cerebrovascular complications, probably related to microcirculatory defects, responsible for variable clinical problems and some Moya-moya syndromes of childhood. From the therapeutic point of view, early treatment (transfusion and rehydration) allows regression without sequelae. Prevention is based on patient education to avoid triggering factors and a number of investigations, none of which has yet provided an absolute solution.

[Ecology of a focus of cutaneous leishmaniasis in the Thiès region (Senegal, West Africa). 3. Evaluation of the endemicity in the human population]. / Ecologie d'un foyer de leishmaniose cutanée dans la région de Thiès (Sénégal, Afrique de l'Ouest). 3. Evaluation de l'endémicité dans la population humaine.

During their epidemiological survey of the cutaneous leishmaniasis focus fo Keur-Moussa, the authors try to evaluate the disease frequency by using various epidemiological indices. The incidence showed variations from year to year (from 3.31 p. 1,000 in 1976 to 0.26 p. 1,000 in 1978). A 12.4% prevalence rate was established from a systematic investigation in January 1978. During the same survey, 57.8% of the population had a positive leishmanin skin test. The value and significance of these different rates are then discussed.

[International health regulation and world epidemiological situation (author's transl)]. / Législation sanitaire internationale et situation épidémiologique mondiale.

The world epidemiological situation shows to day an important set back of past pandemic diseases. The International Health Regulation (IHR) will soon include only three diseases. The three others will be added to the diseases under international surveillance: poliomyelitis, epidemic influenza and malaria. These satisfactory results have been obtained partially by the the application of the IHR. Nevertheless, some other infectious diseases appear potentially dangerous (for instance, the viral african haemorrhagic fevers). Moreover, many residual forms of pestilential diseases are persisting and give them a renewed and present interest. Subjects to new arrangements in the form and in the mind, the maintenance of an international health legislation will be always a necessity. The face that this convention undergoes frequent infringements does not prevent that, contrary to the appearances, it is finally proving effective and necessary.

[Ecology of the focus of cutaneous leishmaniasis in the region of Thies (Senegal, West Africa). 3. Evaluation of the endemicity in the human population]. / Ecologie d'un foyer de leishmaniose cutanée dans la région de Thiès (Sénégal, Afrique de l'Ouest). 3. Evaluation de l'endémicité dans la population humaine.

During the epidemiological survey of the cutaneous leishmaniasis focus of Keur-Moussa, the authors try to evaluate the disease frequency by using various epidemiological indices. The incidence showed variations from year to year (from 3.31 p. 1,000 in 1976 to 0.26 p. 1,000 in 1978). A 12.4% prevalence rate was established from a systemic investigation in January 1978. During the same survey, 57.8% of the population had a positive leishmanin skin test. The value and significance of these different rates are then discussed.

[Eosinophilia in Europeans returning from tropical countries (apropos of 36 cases)]. / Etude des hyperéosinophilies sanguines chez l'Européen au retour des pays tropicaux (à propos de 36 cas).

The etiological investigation of hypereosinophilia in 36 Europeans having returned from tropical zones permitted, by direct and indirect paraclinical tests, the diagnosis of helminthiasis in 26 cases (72.2%). The parasites in cause were bilharziosis, filariosis, strongyloidiasis, ankylostomiasis and liver flukes. Certain subjects were polyparasited. The investigation remained negative for 6 patients (16.6%), even though a parasitism was strongly suspected in at least 5 cases. In the other cases (11.1%) the etiological investigation remained doubtful with the exception of a case of non parasitic eosinophilia (polymyositis). There still remains much progress to make in rendering the actual serological tests more specific, more constant and presenting less cross reactions.