[Impact of a targeted technical assistance to improve vaccine coverage in Cameroon, Côte d'Ivoire, and Mauritania in 2014]. / Effets d'une assistance technique ciblée pour l'amélioration de la couverture vaccinale au Cameroun, en Côte d'Ivoire et en Mauritanie en 2014.

Within the framework of its strategic goal of vaccine coverage (VC) improvement, GAVI, The Vaccine Alliance has entrusted the Agence de médecine préventive (agency for preventive medicine, AMP) with technical assistance services to Cameroon, Cote d'Ivoire (Ivory Coast), and Mauritania. This support was provided to selected priority districts (PDs) with the worst Penta3 coverage performances. In 2014, PDs benefited from technical and management capacities in vaccinology strengthening for district medical officers, supportive supervisions and technical assistance in health logistics, data management and quality. We analyzed the effects of the AMP technical assistance on the improvement of the cumulative Penta3 coverage, which is the key performance indicator of the expanded programme on immunization (EPI) performance. We compared Penta3 coverage between PDs and other non-priority districts (NPDs), Penta3 coverage evolution within each PD, and the distribution of PDs and NPDs according to Penta3 coverage category between January and December 2014. Technical assistance had a positive effect on the EPI performance. Indeed Penta3 coverage progression was higher in PDs than in NPDs throughout the period. Besides, between January and December 2014, the Penta3 VC increased in 70%, 100% and 86% of DPs in Cameroon, Côte d'Ivoire and Mauritania, respectively. Furthermore, the increase in the number of PDs with a Penta3 coverage over 80% was higher in DPs than in NPDs: 20% versus 8% for Cameroon, 58% versus 29% for Côte d'Ivoire and 17% versus 8% for Mauritania. Despite positive and encouraging results, this technical assistance service can be improved and efforts are needed to ensure that all health districts have a VC above 80% for all EPI vaccines. The current challenge is for African countries to mobilize resources for maintaining the knowledge and benefits and scaling such interventions in the public health area.

Light and electron microscopic immunolocalization of L-asparaginase in the rat central nervous system.

The investigation on the localization of L-asparaginase, the enzyme involved in the synthesis of L-aspartic acid, has been carried out using the immunohistochemical method. Antibodies against this enzyme were obtained immunizing BALB/c mice with purified Escherichia coli L-asparaginase. Light microscopic observation revealed positive immunoreactivity in the great majority of neurons and glial cells, and electron microscopic analysis demonstrated immunological localization of the enzyme in the cytosol. The ubiquitous distribution of L-asparaginase suggests its involvement in many important functions of the central nervous system.

Immunolocalization of meprobamate-like molecules in rat cerebellar cortex.

The localization of meprobamate-like (MPB-like) molecules in the cerebellar cortex of the rat was investigated with the peroxidase-antiperoxidase (PAP) immunocytochemical method using an antiserum raised in rabbits. The positive immunoreaction for MPB in several nervous structures and in the wall of blood capillaries suggest the presence of endogenous MPB-like molecules.

Synaptic and non-synaptic immunolocalization of GABA and glutamate acid decarboxylase (GAD) in cerebellar cortex of rat.

The existence of a large number of GABA receptors in the cerebellar molecular layer, and the observation of numerous punctate immunoreactive deposits of GABA synthesizing enzyme (GAD) throughout this layer, could indicate the existence of numerous axon terminals that may be involved in neurotransmission modulated by GABA. These axon terminals may be different from those considered classically as cerebellar GABAergic axon terminals. Therefore, we have reinvestigated the localization of GABA- and GAD-immunoreactivities in the cerebellar cortex of the rat with the PAP method, using different antisera obtained from rabbits immunized with GABA, baclofen and GAD. The results observed in our investigation have demonstrated GABA- and GAD-immunoreactivities in the axon terminals considered classically as GABAergic, as well as in others which, until now, have not been considered GABAergic. This fact leads us to think that the distribution of GABA or molecules structurally similar to GABA is far more extended than previously thought in the cerebellum. We have also observed both GABA- and GAD-immunoreactivities within dendrites and glial cells. These facts suggest us a possible extrasynaptic release of GABA.

Axonal and non-axonal immunolocalization of cytosolic aspartate aminotransferase (cAATase), GABA and glutamic acid decarboxylase (GAD) in the rat cochlear nucleus.

The localization of both cAATase activity, by histoenzymological method, and the immunoreactivity against cAATase, were investigated in the cochlear nucleus of rats. The immunohistochemical determination of cAATase was carried out using the PAP method, with an antiserum obtained from rabbits immunized with porcine cAATase. It was also studied both the immunolocalization of GABA-like and GAD-like substances. Our observations, with light microscope, revealed weak cAATase activity in the small neurons, and a more intense one in the fibers surrounding neuronal bodies. The large neurons presented a very weakly activity within their neuronal bodies and dendrites, but it was strongly found in granulations that surround the perikaryon and dendrites. cAATase immunoreactivity presents the same distribution as the enzymological activity. In the same way, we have investigated the pattern of distribution of both GABA- and GAD-like substances. Immunolocalization of these substances was similar to that found for cAATase. In the control sections incubated with Gostatin (0.05 mM), cAATase activity was absent. The immunoreactivity was also negative in every immunohistochemical control sections. These facts suggest that aspartate could intervene as a co-neurotransmitter or neuromodulator in the rat cochlear nucleus, and that axonic endings could contain cAATase, GABA and GAD. It was also found immunoreactivity against cAATase, GABA and GAD, in neuronal bodies, dendrites and glial processes, in close association with capillary wall. These observations have led us to suggest the possible co-localization and co-release of both GABA and aspartate from synaptic and non-synaptic sites in the cochlear nucleus.

Presence of meprobamate-like molecules in rat neuromuscular junction. Immunohistochemical demonstration at light- and electron-microscopic levels.

The localization of meprobamate-like (MPB-like) molecules in the neuromuscular junction of rats has been investigated at light- and electron- microscopic levels with the peroxidase-antiperoxidase (PAP) immunohistochemical method, using a purified antiserum obtained from rabbits immunized with a meprobamate-bovine serum albumin (MPB-BSA) conjugate. The immunoreaction was found surrounding synaptic vesicles and in protuberant deposits situated in the post-synaptic membrane. These facts suggest the existence of endogenous MPB-like molecules in neuromuscular junction and that the immunostained protuberant deposits should mark the receptors of those molecules.

Rat neostriatal neurons especially able to catabolize pyruvate via cytosolic malic isoenzyme. Immunocytochemical study at light- and electron-microscopic levels.

The distribution of cytosolic malic isoenzyme in the neostriatum was investigated with the peroxidase-antiperoxidase immunocytochemical method, utilizing an antiserum obtained from the rabbit. Microscopic observations demonstrated a strong positive immunoreaction in some neurons and a very weak reaction in the remaining cells. The reaction was found in the cytosol of the perikaryon and dendrites. These observations suggest that in the rat neostriatum there are some neurons especially able to catabolize pyruvate via cytosolic malic isoenzyme.

Conducta conservadora en cáncer de mama operable: primeros resultados a 5 años / Conservative surgery in breast neoplasms: first results from 5 years

Se plantea los fundamentos para preservar la mama, con buenos resultados cosméticos y la mayor seguridad, en pacientes con Cáncer de Mama operable. Desde 1979 ingresan a nuestro protocolo 170 pacientes T1 T2 N0 N1 a M0. Todas fueron sometidas a cirugía limitada que incluye resección segmentaría de mama, extirpando el tumor rodeado por un mínimo de 2 cm. de tejido glandular sano y disección linfática axilar de los niveles glanglionares 1 y 2 por incisión separada. A los veinte días de la cirugía se inicia la telecobaltoterapia de 6.000 rads sobre la mama; se adiciona un boost de 1.000 rads sobre el lecho tumoral con Cs. 137 o radioterapia convencional. Se irradian las áreas glanglionares axila, supra e infraclavicular y las tres primeras estaciones de la cadena mamaria interna homolateral con 5.000 rads. Si la axila es anatomopatológicamente positiva, se agrega un boost axilar posterior de 1.000 rads más hormono-quimioterapia adyuvante con FAC-Tamoxifeno por 6 ciclos. Opcionalmente se efectuó el esquema de tratamiento del Instituto de Tumores de Milán, en algunas pacientes con tumores pequeños. Quince pacientes han superado los 5 años de seguimiento y todas viven: 13 libres de enfermedad, 1 con recidiva local y 1 con metástasis a distancia. De las restantes 155 pacientes el seguimiento promedio es de 28 meses: 151 viven libres de enfermedad aparente, 2 con recidivas locales y 2 con metástasis a distancia. Los resultados cosméticos son bastante buenos: con 40% de radiosecuelas leves, un 14% de moderadas y 1 sola paciente con radiosecuelas severa. Se discute algunos interrogantes sobre cuales serían las técnicas menos mutilantes, pero que conserven iguales índices de seguridad. Se concluye en considerar la efectividad del manejo conservador de los casos operables en cáncer de mama

Conducta conservadora en cáncer de mama operable: primeros resultados a 5 años / Conservative surgery in breast neoplasms: first results from 5 years

Se plantea los fundamentos para preservar la mama, con buenos resultados cosméticos y la mayor seguridad, en pacientes con Cáncer de Mama operable. Desde 1979 ingresan a nuestro protocolo 170 pacientes T1 T2 N0 N1 a M0. Todas fueron sometidas a cirugía limitada que incluye resección segmentaría de mama, extirpando el tumor rodeado por un mínimo de 2 cm. de tejido glandular sano y disección linfática axilar de los niveles glanglionares 1 y 2 por incisión separada. A los veinte días de la cirugía se inicia la telecobaltoterapia de 6.000 rads sobre la mama; se adiciona un boost de 1.000 rads sobre el lecho tumoral con Cs. 137 o radioterapia convencional. Se irradian las áreas glanglionares axila, supra e infraclavicular y las tres primeras estaciones de la cadena mamaria interna homolateral con 5.000 rads. Si la axila es anatomopatológicamente positiva, se agrega un boost axilar posterior de 1.000 rads más hormono-quimioterapia adyuvante con FAC-Tamoxifeno por 6 ciclos. Opcionalmente se efectuó el esquema de tratamiento del Instituto de Tumores de Milán, en algunas pacientes con tumores pequeños. Quince pacientes han superado los 5 años de seguimiento y todas viven: 13 libres de enfermedad, 1 con recidiva local y 1 con metástasis a distancia. De las restantes 155 pacientes el seguimiento promedio es de 28 meses: 151 viven libres de enfermedad aparente, 2 con recidivas locales y 2 con metástasis a distancia. Los resultados cosméticos son bastante buenos: con 40% de radiosecuelas leves, un 14% de moderadas y 1 sola paciente con radiosecuelas severa. Se discute algunos interrogantes sobre cuales serían las técnicas menos mutilantes, pero que conserven iguales índices de seguridad. Se concluye en considerar la efectividad del manejo conservador de los casos operables en cáncer de mama (AU)