Background: The use of artemisinin derivative-based combination therapy (ACT) such as artesunate plus amodiaquine is currently recommended for the treatment of uncomplicated Plasmodium falciparum malaria. Fixed-dose combinations are more adapted to patients than regimens involving multiple tablets and improve treatment compliance. A fixed-dose combination of artesunate + amodiaquine (ASAQ) was recently developed. To assess the efficacy and safety of this new combination and to define its optimum dosage regimen (once or twice daily) in the treatment of uncomplicated P. falciparum malaria, a multicentre clinical study was conducted.

Taenia solium was declared potentially eradicable by the International Task Force for Disease Eradication in 1992. Yet, very few well-designed community-based randomized controlled trials have been conducted to measure the effectiveness of alternative control strategies. Most strategies have been tested in pre-post intervention designs in very few communities, often without a control group. The only two community-based randomized controlled trials suggest that an educational program alone or a combination of human and porcine mass treatment reduce porcine cysticercosis in the short term. A transmission dynamics model suggests that improved sanitation and pig management are more effective and sustainable than pig vaccination, human or porcine mass treatment. Current evidence does not support the eradication of Taenia solium in the foreseeable future. Investigators should follow international recommendations on the conduct of community-based randomized control trials to provide more valid estimates of the effect and cost-effectiveness of alternative control strategies for cysticercosis.

OBJECTIVE: To examine whether the industry-run television (TV) Parental Guidelines discriminate on violence, sexual behavior, alcohol use, and smoking in TV shows, to assess their usefulness for parents.METHODS: Seventeen TV shows (323 episodes and 9214 episode minutes) across several TV show rating categories (TVY7, TVPG, TV14, and TVMA) were evaluated. We contentcoded the episodes, recording seconds of each risk behavior, and we rated the salience of violence in each one. Multilevel models were used to test for associations between TV rating categories and prevalence of risk behaviors across and within episodes or salience of violence. RESULTS:Every show had at least 1 risk behavior. Violence was pervasive, occurring in 70% of episodes overall and for 2.3 seconds per episode minute. Alcohol was also common (58% of shows, 2.3 seconds per minute), followed by sex (53% of episodes, 0.26 seconds per minute), and smoking (31% of shows, 0.54 seconds per minute). TV Parental Guidelines did not discriminate prevalence estimates of TV episode violence. Although TV-Y7 shows had significantly less substance use, other categories were poor at discriminating substance use, which was as common in TV-14 as TV-MA shows. Sex and gory violence were the only behaviors demonstrating a graded increase in prevalence and salience for older-child rating categories.CONCLUSIONS: TV Parental Guidelines ratings were ineffective in discriminating shows for 3 out of 4 behaviors studied. Even in shows rated for children as young as 7 years, violence was prevalent, prominent, and salient. TV ratings were most effective for identification of sexual behavior and gory violence.

No abstract

Introduction: Delayed cerebral ischemia (DCI) is a determinant of short-term and long-term morbidity after subarachnoid hemorrhage (SAH). DCI is likely due to neurohumoral activation and inflammation-thrombosis cross-talk during the acute phase. Coated-platelets (CP), a subset of procoagulant platelets, contribute to systemic thrombogenicity and are associated with recurrent ischemic stroke. Hypothesis: We hypothesized that high CP levels during first 3 weeks of SAH (acute hospitalization) would be associated with worse short-term clinical outcome. Methods: A prospective cohort of 28 patients with post-discharge clinical follow-up (average 12 weeks) was studied. Outcomes were assessed using modified Rankin Scale (mRS) and Montreal Cognitive Outcome Assessment (MOCA). Blood samples to measure CP levels were performed - 1) during acute hospitalization and 2) at follow-up visit (defined as patient’s baseline). Trend of CP during acute hospitalization was analyzed against weighted mean baseline CP level to test hypothesis. Results: Average age of cohort was 52.6±12.2 years with 71.5% women. During acute phase 9 (32.1%) patients developed symptomatic vasospasm and 14 (50%) had DCI on imaging. Baseline CP levels did not differ (p=0.118) between patients with MOCA ≥26 (41.3%, n=13) and MOCA <26 (29.5%, n=15). However, patients with MOCA <26 had significantly higher CP levels during first 5 days than baseline (50.4% vs 29.5%, p=0.0004). These levels decreased by 1.77%/day from 6-21 days as compared to 1.55%/day for patients with MOCA ≥26 (p=0.723). In contrast, 20 (71.4%) patients with mRS 0-2 had average baseline CP levels of 37.3% vs 8 (28.6%) with mRS 3-6 having CP levels of 31.7%. For patients with mRS 0-2 and mRS 3-6, CP levels increased from baseline during first 5 days after SAH by 10.3% and 16.5% respectively (not statistically significant). Rate of CP decrease during 6-21 days was 1.43%/day and 2.02%/day (p=0.259) for mRS 0-2 and mRS 3-6 respectively. Conclusion: Elevated CP levels during the acute phase of SAH are strongly associated with lower MOCA scores at 12 weeks but not with higher mRS assessment. These results suggest that increased thrombogenicity after SAH leads to cognitive impairment despite good physical outcomes.

The objective of this study is to examine the factors associated with severe addiction in cannabis users who are undergoing treatment at the national center for the integrated care of addictions in Dakar. A retrospective, descriptive and analytical study was conducted at the national center for the integrated care of addictions in Dakar. The study period was from 2015 to 2018. Patients were being treated for cannabis addiction. Data entry was done using Epi info7 software while analysis was done using SPSS version 22. A total of 273 patients were enrolled in our study. Factors associated with severe cannabis addiction were: being over 20 years of age with an ORaj=6.1 [2.4-15.6], being of Senegalese nationality with an ORaj=4.3 [1.1-17.9], having more than one child with an ORaj=3.8 [1.1-14.1], consuming cannabis 2 to 3 times a week or more with an ORaj=32.1 [3.9-100] and starting age of consumption less than or equal to 15 years with an ORaj=4.5 [1.8-11.8]. Factors associated with psychiatric disorders were: having an address other than Dakar center with an ORaj=2.8 [1.2-6.6], having an addiction problem in the family with an ORaj=3.9 [1.5-10.7], lack of professional activity with an ORaj=3, 6 [1.5-8.7], being treated by a specialist in addictology with an OR aj=5.1 [1.5-17.8] and finally having a history of psychiatric hospitalization with an OR aj=55.9 [19.6-158]. The factors associated with the severe addiction and psychiatric disorders found in this study should push health authorities to reflect on a new strategy to fight this pandemic that is cannabis use. The use of the media for mass and parental awareness is essential.

Introduction: Coated-platelets (CP), a subpopulation of activated platelets, can be used as a surrogate marker for systemic thrombogenic propensity. Microthrombosis causes delayed cerebral ischemia (DCI) and is a major determinant of morbidity after subarachnoid hemorrhage (SAH). Association studies have reported increased morbidity and mortality after SAH depending on disease severity at admission. Hypothesis: We hypothesized that severe clinical and radiological grades of SAH would be associated with increased CP and contribute to DCI. Methods: Prospective cohort of 44 patients with non-traumatic, spontaneous SAH was enrolled. Clinical and radiological severity was recorded using Hunt and Hess (H&H), World Federation of Neurosurgeons Scale (WFNS), Simplified Applied Physiology Score (SAPS-II), Acute Physiology and Chronic Health Evaluation (APACHE-II) and modified Fisher scale (mFS). DCI and clinical vasospasm were used to assess in-hospital morbidity. CP levels were measured on predetermined days after SAH for each patient using flow cytometry. Mixed linear models were used to study test hypothesis. Results: Cohort average age was 51.4 (IQR 44-58.5) and women representing 70.5% patients. Fifteen (34.1%) developed symptomatic vasospasm, and imaging identified 21 (47.7%) with DCI. During the first 5 days after SAH, scales indicating severe disease were associated with a 5-10% increase in CP. But this was only significant for mFS, 10.4% higher CP in grades 3 and 4 (95%CI: 1.5%, 19.4%; p=0.0251) than in those with grades 1 and 2. Similarly, higher clinical and radiological severity were associated with subsequent downtrending levels of CP after an initial rise but was only statistically significant for SAPS-II (upper tertile 0.8%/day vs middle tertile 1.7% vs lower tertile 1.02%/day, p=0.0297). Conclusion: Higher initial CP levels among patients with severe clinico-radiologic findings, along with declining CP trends over 21 days, suggest that neurohumoral triggers may induce systemic thrombogenicity and contribute to DCI and clinical vasospasm after SAH.