Neurosarcoidosis tends to prolong the duration of treatment and may result in a decline in physical function requiring rehabilitation. Because of a rare disease, the adjustment of oral steroid ...dosage, which is the cornerstone of treatment, is highly dependent on professional experience in general. Therefore, the number of hospitals that can perform dosage adjustment is very limited, and it is difficult to provide concurrent intense rehabilitation at the same hospital over a long period of time, and there are no reports that mention this.
A 49-year-old man, who presented with impaired consciousness, dysphagia and right hemiplegia, was diagnosed with neurosarcoidosis based on a previous diagnosis of sarcoidosis, laboratory test results, and clinical symptoms. High-dose oral steroid therapy was initiated and he was transferred to our rehabilitation hospital for progressive disuse approximately 2 months after the disease onset.
This case was diagnosed as "probable" neurosarcoidosis.
The steroid dose was not reduced during rehabilitation treatment in our hospital considering the risk of relapse of the primary disease due to steroid reduction. His training regimen focused on minimum activities of daily living was performed, and its effectiveness was determined during approximately 60 days after the initiation of rehabilitation.
Two months after admission, he was independently eating, transferring, and toileting under supervision. He was discharged home 3 months after admission.
Intensive rehabilitation can be one of the effective comprehensive treatment strategy for patients with neurosarcoidosis. On the other hand, since there is no consensus treatment method, the duration of rehabilitation and goal setting should be adjusted based on an understanding of the characteristics of the disease and the overall treatment plan.
As the aged population increases, increasing numbers of people require walking support as the strength of their leg muscles deteriorates. We have developed a flexible power walking assistant system ...based on pneumatic artificial muscle. To date, the walking assistance effect of this approach has been validated in experiments, but few subjects were recruited. In the present study, we have incorporated pneumatic rubber artificial muscle into a new mechanism, enabling smaller and lighter weight devices for walking assistance. Unlike conventional mechanisms of this type, which require separate artificial muscles for each foot, our proposed mechanism assists both feet by a single artificial muscle. A prototype model of our proposed new mechanism was applied to artificial muscles, and its practicality was evaluated in operational experiments.
Loiasis is a major obstacle to ivermectin treatment for onchocerciasis control and lymphatic filariasis elimination in central Africa. In communities with a high level of loiasis endemicity, there is ...a significant risk of severe adverse reactions to ivermectin treatment. Information on the geographic distribution of loiasis in Africa is urgently needed but available information is limited. The African Programme for Onchocerciasis Control (APOC) undertook large scale mapping of loiasis in 11 potentially endemic countries using a rapid assessment procedure for loiasis (RAPLOA) that uses a simple questionnaire on the history of eye worm.
RAPLOA surveys were done in a spatial sample of 4798 villages covering an area of 2500×3000 km centred on the heartland of loiasis in Africa. The surveys showed high risk levels of loiasis in 10 countries where an estimated 14.4 million people live in high risk areas. There was a strong spatial correlation among RAPLOA data, and kriging was used to produce spatially smoothed contour maps of the interpolated prevalence of eye worm and the predictive probability that the prevalence exceeds 40%.
The contour map of eye worm prevalence provides the first global map of loiasis based on actual survey data. It shows a clear distribution with two zones of hyper endemicity, large areas that are free of loiasis and several borderline or intermediate zones. The surveys detected several previously unknown hyperendemic foci, clarified the distribution of loiasis in the Central African Republic and large parts of the Republic of Congo and the Democratic Republic of Congo for which hardly any information was available, and confirmed known loiasis foci. The new maps of the prevalence of eye worm and the probability that the prevalence exceeds the risk threshold of 40% provide critical information for ivermectin treatment programs among millions of people in Africa.
Plasmodium falciparum malaria remains a major public health concern in sub-Sahara Africa. Seasonal malaria chemoprevention (SMC) with amodiaquine + sulfadoxine-pyrimethamine is one of the most ...important preventive interventions. Despite its implementation, the burden of malaria is still very high in children under five years old in Burkina Faso, suggesting that the expected impact of this promising strategy might not be attained. Development of innovative strategies to improve the efficacy of these existing malaria control measures is essential. In such context, we postulate that screening and treatment of malaria in household members of children receiving SMC could greatly improve the impact of SMC intervention and reduce malaria transmission in endemic settings.
This randomized superiority trial will be carried out in the Nanoro health district, Burkina Faso. The unit of randomisation will be the household and all eligible children from a household will be allocated to the same study group. Households with 3-59 months old children will be assigned to either (i) control group (SMC alone) or (ii) intervention (SMC+ screening of household members with standard Histidin Rich Protein Rapid Diagnostic Test (HRP2-RDT) and treatment if positive). The sample size will be 526 isolated households per arm, i.e., around 1052 children under SMC coverage and an expected 1315 household members. Included children will be followed-up for 24 months to fully cover two consecutive malaria transmission seasons and two SMC cycles. Children will be actively followed-up during the malaria transmission seasons while in the dry seasons the follow-up will be passive.
The study will respond to a major public health concern by providing evidence of the efficacy of an innovative strategy to boost the impact of SMC intervention.
Aims: Impact of the real estate companies’ boom on the environment in the central region of Burkina Faso (Ouagadougou) and solutions to resorb the negative effects of the activity.
Study Design: The ...present study was run via the Problem-In-Context framework along with the Hydro-Quebec environmental assessment design.
Place and Duration of Study: The study was conducted in Burkina Faso, for the Environment department of Fada N’Gourma University for twelve months.
Methodology: The environmental impact of the project was assessed according to Hydro-Quebec group method by prioritizing the inventory items regarding to their sensitivity.
Results: Burkina Faso revised Law No. 034 on agrarian and land reorganization (RAF) on July 2, 2012. This revision allowed the population to be landowners, generating a boom in Real Estate development with the sale of big surfaces of lands by landowners. This boom is not without impacts on the environment. It leads to the destruction of forests, loss of biodiversity, loss of agricultural production areas, threats to green spaces conservation areas, anarchic occupation of lands, etc. by real estate companies and the non-ecological urbanization of the city of Ouagadougou. The anthropogenic and climatic constraints with which Burkina Faso is confronted generate strong pressure on the existing natural resources: soil, fauna, flora, water, etc.
Conclusion: The Burkinabe capital is about to engulf all the surrounding municipalities of Komki Ipala, Komsilga, Koubri, Loumbila, Pabré, Saaba and Tanghin-Dassouri. The main ways to reduce the environmental impacts of this real estate boom are the registration of agricultural production and conservation areas and the revision of the RAF in order to remove the right of land owning to the population.
Whether parenteral nutrition benefits growth of very low birth weight (VLBW) preterm infants in the setting of rapid enteral feeding advancement is unclear. Our aim was to examine this issue using ...data from Japan, where enteral feeding typically advances at a rapid rate.
We studied 4005 hospitalized VLBW, very preterm (23-32 weeks' gestation) infants who reached full enteral feeding (100 ml/kg/day) by day 14, from 75 institutions in the Neonatal Research Network Japan (2003-2007). Main outcomes were weight gain, head growth, and extra-uterine growth restriction (EUGR, measurement <10(th) percentile for postmenstrual age) at discharge.
40% of infants received parenteral nutrition. Adjusting for maternal, infant, and institutional characteristics, infants who received parenteral nutrition had greater weight gain 0.09 standard deviation (SD), 95% CI: 0.02, 0.16 and head growth (0.16 SD, 95% CI: 0.05, 0.28); lower odds of EUGR by head circumference (OR 0.66, 95% CI: 0.49, 0.88). No statistically significant difference was seen in the proportion of infants with EUGR at discharge. SGA infants and infants who took more than a week until full feeding had larger estimates.
Even in infants who are able to establish enteral nutrition within 2 weeks, deprivation of parenteral nutrition in the first weeks of life could lead to under nutrition, but infants who reached full feeding within one week benefit least. It is important to predict which infants are likely or not likely to advance on enteral feedings within a week and balance enteral and parenteral nutrition for these infants.
As a Semi-arid country, Burkina Faso is highly vulnerable to climate-related disasters such as drought and flood. Analyzing drought signature is therefore a key factor in advocating climate change ...adaptation at the local scale. In this study, Spatiotemporal trends of drought were conducted for the period 1960–2021 within Massili Basin using the standardized precipitation and evapotranspiration index (SPEI) package in R. The non-parametric method (Mann–Kendall) was then used to test for a monotonic trend, whereas the magnitude was estimated using Sen's method. Accordingly, the result revealed that during the period 1960-1979, the mean value of SPEI varies from 0.06 to 0.71; over 1980 to 2009, the mean value of the SPEI varies from -0.08 to -0.88 and for the last decades (2010 to 2021), the mean value of the SPEI ranges from 0.05 to 0.75. Normal to middle wet conditions is thus observed over the periods 1960-1979 and 2010-2021 while the period (1980-2009) depicts a middle drought condition. The Mann-Kendall test results show a decreasing trend of SPEI-3 and SPEI-24 with a Z value of - 0.784 and -0.530 respectively. A slightly increasing trend is observed for SPEI-6 and SPEI-12 with Z ranging from 0.598 to 1.917 respectively. The magnitude of the decrease is indicated by the sens’ slope value, which is -0.0014 for SPEI-3 and -0.00010 for SPEI-24 while the magnitude of the increase ranges from 0.00011 for SPEI-6 to 0.00037 for SPEI-12. This study highlights the importance of examining past drought features to obtain essential information to assist in designing and implementing efficient water resources management strategies over the Massili Basin.
La maltraitance à enfants a longtemps été ignorée. Les récents plans ministériels prévoient de nombreuses mesures de protection dont le déploiement d’unités d’accueil pédiatriques des enfants en ...danger (UAPED). Malgré toutes ces avancées, le diagnostic reste sous-estimé dans le secteur de la santé avec une prévalence de l’ordre de 1 enfant sur 10 dans les pays à hauts revenus, toutes catégories de maltraitance confondues. La fréquence de décès serait de 1 enfant tous les 5jours en France. Les violences subies durant l’enfance représentent une lourde perte de chance en termes d’espérance de vie, de santé, de développement et d’insertion. Le rapport est limité aux maltraitances physiques chez l’enfant (MPE) et n’aborde donc pas les maltraitances sexuelles. Le maître-mot est la nécessité d’hospitaliser l’enfant pour une protection immédiate, une évaluation multidisciplinaire, les soins et l’alerte des autorités en temps utile. Les résultats de l’étude montrent une réelle prise de conscience de la MPE dans le secteur pédiatrique. Toutefois, le diagnostic peut être sous-estimé et banalisé chez l’enfant, ce qui signifie que l’étiologie « traumatisme infligé » doit être évoquée largement par le médecin quel que soit son lieu d’intervention. Il y a une amélioration nette de la formation dans ce domaine. Toutefois, le rapport met en évidence une insuffisance persistante des moyens humains dans les secteurs des UAPED, de médecine scolaire, de PMI et de pédopsychiatrie. Le psychotraumatisme doit être pris en charge à court, moyen et long terme. Le diagnostic différentiel permet d’éliminer toutes les étiologies confondantes telles que traumatisme accidentel, maladie rare ou autres. Tout médecin doit pouvoir être guidé, accompagné et protégé pour les situations de MPE. Les médecins référents « Violences » des conseils départementaux de l’Ordre des médecins (CDOM) doivent avoir une compétence dans le domaine de la MPE. L’Académie nationale de médecine propose 6 recommandations : une hospitalisation prioritaire de tout enfant victime ou suspect de MPE jusqu’à ce que tous les éléments du diagnostic soient établis ; un renforcement des moyens humains des UAPED en y intégrant un temps de pédopsychiatrie ; un renforcement du repérage des situations à risque dès la maternité ; un renforcement de la protection et de l’accompagnement des médecins afin que ceux-ci n’hésitent plus à signaler les situations de MPE ; l’extension du périmètre du numéro 119 aux médecins et personnels de santé ; la création d’un registre national pour suivre l’épidémiologie et juger de l’efficacité des mesures prises.
Child abuse has long been ignored. Recent ministerial plans provide numerous protection measures including the implementation of pediatric units for children in danger (UAPED). However, the diagnosis remains underestimated in the health sector with a prevalence of about 1 in 10 children in high-income countries, all categories of abuse combined. Death frequency could be up to 1 child every 5 days. Violence suffered during childhood represents a serious loss of opportunity in terms of life expectancy, development, and integration. This report is limited to child physical abuse (CPM) and does not address abuse of sexual origin. The key message is the need to hospitalize any suspected child for immediate protection, multidisciplinary assessment, decision on care and alert of the authorities in due time. The results show an awareness of CPM in the pediatric healthcare sector. However, the diagnosis can be overlooked in children, meaning that the etiology “inflicted trauma” must be considered by any physician regardless of the place of intervention. There is a clear improvement in training on this subject. However, the report highlights a persistent shortage of human resources in UAPEDs, school medicine, maternal and child protection (PMI) and child psychiatry sectors. Psycho-trauma must be managed in the short, medium and long term. Differential diagnosis makes it possible to eliminate all confusing etiologies such as accidental trauma, rare diseases or any others. Every physician should be guided, supported, and protected in CPM situations. CDOM violence referral physicians must have expertise in the CPM field. The National Academy of Medicine proposes 6 recommendations: mandatory hospitalization of any child victim or suspected of CPM until all elements of the diagnosis are established; improving the human resources of UAPEDs including child psychiatric monitoring; strengthening the identification of risk situations from pregnancy care period; protection and support of physicians so that they are not weary to report CPM situations; the extension of the scope of 119 phone number to physicians and health professionals; the creation of a national registry to monitor epidemiology and evaluate the effectiveness of the measures taken.
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