BackgroundMalaria vectors have acquired widespread resistance throughout sub-Saharan Africa to many of the currently used insecticides. Hence, there is an urgent need to develop alternative strategies including the development of new insecticides for effective management of insecticide resistance. To maintain progress against malaria, it is necessary to identify other residual insecticides for mosquito nets. In the present WHOPES phase II analogue study, the utility of chlorfenapyr, a pyrrole class insecticide mixed with alpha-cypermethrin on a long-lasting mosquito bed net was evaluated against Anopheles gambiae s.l.MethodsBed nets treated with chlorfenapyr and alpha-cypermethrin and mixture of both compounds were tested for their efficacy on mosquitoes. Washed (20 times) and unwashed of each type of treated nets and were tested according to WHOPES guidelines. Efficacy of nets were expressed in terms of blood-feeding inhibition rate, deterrence, induced exophily and mortality rate. The evaluation was conducted in experimental huts of Vallée du Kou seven (VK7) in Burkina Faso (West Africa) following WHOPES phase II guidelines. In addition, a WHOPES phase I evaluation was also performed.ResultsMixture treated nets killed significantly (P < 0.05) more mosquitoes than solo alpha-cypermethrin nets, unwashed and washed. Proportionally, this equated to mortalities of 78 and 76% (for mixture nets) compared to only 17 and 10% (for solo alpha-cypermethrin) to An. gambiae, respectively. In contrast mixture net proportions were not significantly (P > 0.05) different from nets treated with chlorfenapyr 200 mg/m2 unwashed (86%). The washed and unwashed nets treated with the mixtures resulted in personal protection against An. gambiae s.l. biting 34 and 44%. In contrast the personal protection observed for washed and unwashed alpha-cypermethrin treated nets generated (14 and 24%), and chlorfenapyr solo treated net was rather low (22%).ConclusionAmong all nets trialled, the combination of chlorfenapyr and alpha-cypermethrin on bed nets provided better mortality in phase II after 20 washes. Results suggest that this combination could be a potential insecticide resistance management tool for preventing malaria transmission in areas compromised by the spread of pyrethroid resistance.

Adult females An. gambiae were exposed in 3 min cone test to treated nets with PPF before or after they were blood fed. The effects of PPF on ovaries development, females oviposition and eggs hatching were assessed. Both unfed and fed mosquitoes exposed to PPF exhibited nearly complete inhibition of fecundity (70-100%) and fertility (90-100%). After females have been exposed once to PPF, the sterilizing effect on their fecundity was observed over 3 consecutive blood meals suggesting that PPF might have an irreversible sterilizing effect. Observation of the ovaries of exposed females to PPF under microscope revealed that the ovaries failed to develop even after several blood meals. The combination of PPF to pyrethroids on bednets could provide better malaria control tool and prevent the further development and spread of pyrethroid resistance in malaria vectors.

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Intrauterine device represents the most reversible method of contraceptive worldwide. Its insertion is a medical procedure not free from complication. We report a rare case of intravesical migration of a copper intrauterine device inserted 18 months earlier in a 28-year-old multiparous woman. The patient presented with irritative lower urinary tract symptoms, and she was managed endoscopically. This case underscores the role of cystoscopy in irritative lower urinary tract symptoms post IUD insertion.

Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte d'Ivoire. This study (i) established a quality-assured gonococcal antimicrobial surveillance program, according to World Health Organization quality criteria, (ii) investigated the AMR to 8 therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and (iii) provided evidence for updating the National Sexually Transmitted Disease Syndromic Management Guidelines in Côte d'Ivoire. Methods During 2014 to 2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte d'Ivoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation, and symptoms. Minimum inhibitory concentrations of 8 antimicrobials were determined by Etest and interpreted using European Committee on Antimicrobial Susceptibility Testing breakpoints. β-lactamase production was detected using cefinase disks. Results The level of resistance, examining 212 gonococcal isolates, was as follows: 84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin. Conclusions We provide the first gonococcal AMR data, quality assured according to World Health Organization standards, from Côte d'Ivoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved gonococcal antimicrobial surveillance program and increased awareness when prescribing treatment in Côte d'Ivoire.

Intérêt du gradient de concentration sérum-ascite en albumine dans le diagnostic des varices oesophagiennes chez le cirrhotique africain, Abidjan (Côte d'Ivoire)Interest serum-ascites albumin concentration gradient in the diagnosis of esophageal varices in cirrhotic African, Abidjan (Côte d'Ivoire) Résumé Buts : Déterminer la corrélation entre le gradient de concentration sérum-ascite en albumine (GASA) et la prédic-tion des varices oesophagiennes (VO) et autres paramètres de l'hypertension portale (HTP) à savoir signes rouges, grades des varices, varices cardiotubérositaires et les gastropathies d'HTP chez le cirrhotique noir africain en Côte d'Ivoire. Patients et méthode : Etude transversale rétrospective portant sur 113 dossiers médicaux de patients présentant une ascite liée à l'HTP. La fibroscopie digestive haute pour la recherche de signes d'HTP. Le dosage des protéines dans le sérum et le liquide d'ascite a été réalisé par les méthodes chimiques courantes. La sensibilité et la spécificité obtenues par l'aire sous la courbe ROC (Receiver-Operating-Characteristic). Résultats : A 1,1 g/dl, le GASA prédisait les VO avec une sensibilité (53,3%), une spécificité (80%) pour une performance diagnostique faible (64%). A partir de 1,5 g/dl du SAAG, la spécificité était maximale (100%) mais on relevait 40% de faux-négatifs. Pour une valeur-seuil de -1,240 g/dl, la performance diagnostique du GASA était meilleure avec une sensibilité (96%), une spécificité (55%) pour une performance diagnostique à 84%. Conclusion : La valeur seuil du GASA efficace pour la détection des VO était inférieure chez les sujets africains en raison des facteurs nutritionnel et infectieux fréquents dans ces pays à faible revenu. Mots clés Varices oesophagiennes · Gradient · Albumine · Cirrhose · AfriqueAbstract Aims: To determine the correlation between the concentration Serum Ascites Albumin Gradient (SAAG) and the prediction of esophageal varices (VO) and other parameters of portal hypertension (PHT), namely red signs grades varicose veins, varicose veins and cardio tuberosity, the gastropathie portal hypertension among African blacks cirrhotic Ivory Coast. Patients and Methods: A retrospective cross-sectional study of 113 medical records of patients with ascites associated with PH. The gastroscopy to search for signs of HTP. The protein assay in serum and ascitic fluid produced by standard chemical methods. The sensitivity and specificity obtained by the area under the ROC curve (Receiver-Operating-Characteristic). Results: 1.1 g/dl, the SAAG predicted VO with a sensitivity (53.3%), specificity (80%) for low diagnostic accuracy (64%). From 1.5 g/dl of SAAG, specificity was highest (100%) but fell 40% false-negative. For a threshold value of -1.240 g/dl, the diagnostic performance of SAAG was better with a sensitivity (96%), specificity (55%) for a diagnostic accuracy of 84%. Conclusion: The threshold value of SAAG effective for the detection of VO was lower among African because of frequent nutritional and infectious factors in these low-in...

BackgroundIn view of widespread pyrethroid resistance in malaria vectors in Africa, two long-lasting insecticidal nets (LLINs) incorporated with a synergist, piperonyl butoxide (PBO), DawaPlus 3.0 (deltamethrin + PBO in the roof panel; deltamethrin alone in the side panels) and DawaPlus 4.0 (deltamethrin + PBO in all panels), were evaluated in an experimental hut trial in a rice growing irrigated area in Burkina Faso. Efficacy of nets was tested against free-flying malaria vector, Anopheles gambiae s.l., with high pyrethroid resistance involving L1014F kdr and CYP6P3P450 resistance mechanisms.MethodologyThe efficacy of unwashed and 20-times washed DawaPlus 3.0 (polyethylene roof panel with 120 mg/m2 deltamethrin and 440 mg/m2 PBO; polyester side panels with deltamethrin 100 mg/m2) and DawaPlus 4.0 (same composition as roof of DawaPlus 3.0) was evaluated against DawaPlus 2.0 (80 mg/m2 deltamethrin; positive control). Volunteer sleepers and treatments were rotated in huts using a Latin square design on 63 consecutive nights during August–October 2016. Mortality, human blood-feeding inhibition, deterrence and exit rates of An. gambiae s.l. were monitored.Principal findingsSignificantly higher rates of mortality and blood-feeding inhibition were observed with unwashed DawaPlus 4.0 (36%; 47.5%) than unwashed DawaPlus 3.0 (11.8%; 33.3%), DawaPlus 2.0 (4.3%; 6.4%) or untreated net (P < 0.05). Washing reduced personal protective efficacy yet PBO-LLINs were more protective and both met the WHO criteria.ConclusionsThe PBO-containing DawaPlus 4.0 significantly protected against An. gambiae s.l. in the study area. Unwashed DawaPlus 3.0 gave low to moderate protection against the positive control. PBO inhibits oxidase action; hence in areas with active malaria transmission having oxidase mechanisms, PBO nets could confer additional personal protection.

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