The 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates. The country continues to record cholera cases and ...related deaths to date. However, there is a dearth of evidence on context-specific drivers and their operational mechanisms in mediating recurrent cholera transmission in Nigeria. This study therefore aimed to fill this important research gap, with a view to informing the design and implementation of appropriate preventive and control measures.
Four bibliographic literature sources (CINAHL (Plus with full text), Web of Science, Google Scholar and PubMed), and one journal (African Journals Online) were searched to retrieve documents relating to cholera transmission in Nigeria. Titles and abstracts of the identified documents were screened according to a predefined study protocol. Data extraction and bibliometric analysis of all eligible documents were conducted, which was followed by thematic and systematic analyses.
Forty-five documents met the inclusion criteria and were included in the final analysis. The majority of the documents were peer-reviewed journal articles (89%) and conducted predominantly in the context of cholera epidemics (64%). The narrative analysis indicates that social, biological, environmental and climatic, health systems, and a combination of two or more factors appear to drive cholera transmission in Nigeria. Regarding operational dynamics, a substantial number of the identified drivers appear to be functionally interdependent of each other.
The drivers of recurring cholera transmission in Nigeria are diverse but functionally interdependent; thus, underlining the importance of adopting a multi-sectoral approach for cholera prevention and control.
Tuberculosis dactylis is exceptional. We report one case in an 11 years old girl.
N.D., 11 years old, was admitted for a right hand second finger tumour evolving since six months and linked to a ...trauma. Clinical examination founded a painful fusiform of the right second finger with limited movements of the finger. The hand radiography showed a second phalange osteitis of the finger without periosteitis reaction. The sedimentation rate was accelerated to 130 mm at the first hour. The intracutaneous reaction with tuberculin was positive to 19 mm. In her preceding, her mother would have suffered from pulmonary tuberculosis two years before incompletely treated during eight months. Histological examination showed a caseous necrosis and an epithelial giant cellular follicle. A twelve months antituberculosis polychimiotherapy permitted a healing without sequelae.
Tuberculosis dactylis has to be evoked with epidemiological, clinical, radiological and immunological arguments. The antituberculosis treatment permitted to do the retrospective diagnosis and to get a healing.
Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge ...by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults.
This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately.
In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 95% confidence interval (CI) 1.28-1.85, antidepressants 1.57 (95% Cl 1.43-1.74), tricyclic antidepressants 1.41 (95% CI 1.07-1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85-2.20), benzodiazepines 1.42 (95%, CI 1.22-1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05-3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04-1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting.
Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies.
Community screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, ...and health-related quality of life are unknown.
In a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.
We randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval CI, 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.
Advice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.).
The occurrence of Ebola virus (EBOV) in West Africa during 2013-2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which ...indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10(-4) substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns.
Objectives
To determine characteristics and effectiveness of prevention programs on fall‐related outcomes in a defined setting.
Design
Systematic review and meta‐analysis.
Setting
A clearly described ...subgroup of nursing homes defined as residential facilities that provide 24‐hour‐a‐day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm.
Participants
Nursing home residents (N = 22,915).
Measurements
The primary outcomes were number of falls, fallers, and recurrent fallers.
Results
Thirteen studies met the inclusion criteria. Six fall prevention programs were single (one intervention component provided to the residents), one was multiple (two or more intervention components not customized to individual fall risk), and six were multifactorial (two or more intervention components customized to each resident's fall risk). Meta‐analysis found significantly fewer recurrent fallers in the intervention groups (4 studies, relative risk (RR) = 0.79, 95% confidence interval (CI) = 0.65–0.97) but no significant effect of the intervention on fallers (6 studies, RR = 0.97, 95% CI = 0.84–1.11) or falls (10 studies, RR = 0.93, 95% CI = 0.76–1.13). Multifactorial interventions significantly reduced falls (4 studies, RR = 0.67, 95% CI = 0.55–0.82) and the number of recurrent fallers (4 studies, RR = 0.79, CI = 0.65–0.97), whereas single or multiple interventions did not. Training and education showed a significant harmful effect in the intervention groups on the number of falls (2 studies, RR = 1.29, 95% CI = 1.23–1.36).
Conclusion
This meta‐analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers but, for the first time, showed that fall prevention interventions significantly reduced the number of recurrent fallers by 21%.
L’abcès du foie (AF) est une infection grave par ses complications qui peuvent mettre en jeu le pronostic vital.
Le but de ce travail était de décrire les aspects épidémiologique, diagnostique et ...évolutif des AF au Centre hospitalier national d’enfants Albert-Royer de Dakar et de proposer un protocole thérapeutique des AF de l’enfant.
Il s’est agi d’une étude rétrospective descriptive, menée du 1er janvier 2010 au 31 décembre 2014. Tous les enfants âgés de 0 à 15ans, hospitalisés pour un AF avec confirmation échographique, ont été inclus. Les données sociodémographiques, cliniques, paracliniques, thérapeutiques et évolutives ont été recueillies.
Vingt-six cas ont été colligés, soit une prévalence hospitalière de 100 cas pour 100 000 admissions. Le sex-ratio était de 1,36. L’âge moyen était de 7,2ans. Le faible niveau socio-économique, l’hygiène de vie précaire et l’existence de terrains tels que l’anémie dans 69 % des cas, la malnutrition dans 42 % des cas, et le traumatisme abdominal dans 15 % des cas en étaient les facteurs favorisants. La triade de Fontan était présente dans 58 % des cas. À l’échographie abdominale l’AF était unique dans 24 cas. Il s’agissait d’un abcès à pyogène dans 17 cas et d’un abcès amibien dans 9 cas. Les principaux pyogènes étaient Klebsiella pneumoniae dans 2 cas, Pseudomonas aeruginosa dans 1 cas, Steptococcus pneumoniae dans 1 cas et Staphylococus aureus dans 1 cas. Un drainage a été réalisé dans 92 % des cas et l’évolution a été favorable chez tous les enfants.
La prévalence de l’AF dans notre institution était relativement élevée comparée aux données de la littérature. L’antibiothérapie combinée au drainage percutané reste le traitement de choix permettant un pronostic favorable.
Liver abscess is a serious infection that can cause life-threatening complications.
To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital.
A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0–15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P<0.05 was considered significant).
We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children.
The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.
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