Cancer incidence in Eastern Libya: preliminary result of the year 2003.
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Algeria↗
Biomedical subjects
A Attia
Publications and source records attributed to A Attia.
HIV-1-related morbidity in adults, Abidjan, Côte d'Ivoire: a nidus for bacterial diseases.
We studied mortality and morbidity in 270 HIV-1-infected adults (60% women, median age 31 years, mean baseline CD4 count 331/mm(3) ) observed in a follow-up that lasted a median 10 months in Côte d'Ivoire. Survival and probability of remaining free from any episode of morbidity at 12 months were 0.80 and 0.50, respectively. Baseline CD4 count <200/mm(3) was the only variable associated with global morbidity and mortality, with hazard ratios of 2.50 and 7.57, respectively. The most frequent causes of morbidity were severe bacterial infections (incidence rate: 26.1 per 100 person-years [py]), followed by oral candidiasis (22.3% py), unexplained weight loss over 10% of baseline body weight (13.3% py), tuberculosis (10.1% py), unexplained chronic diarrhea (9.7% py), and isosporiasis (5.1% py). Nontyphoid Salmonella accounted for 37% of isolated strains during severe bacterial infections, followed by Streptococcus pneumoniae (34%), Escherichia coli (15%), and Shigella species (7%). A significant part of bacterial morbidity occurred in patients with baseline CD4 count > or = 200/mm(3), in whom the incidence rate of bacterial diseases was 21.3% py and the probability of remaining free from any bacterial infection at 12 months was 0.80 (vs. 36.4% py and 0.71 in patients with baseline CD4 count <200/mm(3); p =.07).
Adult↗
Prognostic value of cross-sectional anthropometric indices on short-term risk of mortality in human immunodeficiency virus-infected adults in Abidjan, Côte d'Ivoire.
In sub-Saharan Africa where weight loss is very difficult to estimate, cross-sectional anthropometric indicators could be useful to predict human immunodeficiency virus (HIV)-associated mortality. The study objective was to look for threshold values of baseline body mass index, arm muscle circumference, and fat mass to predict the risk of death in HIV-infected adults included in a 1996-1998 trial of early cotrimoxazole chemoprophylaxis in Abidjan, Côte d'Ivoire (COTRIMO-CI-ANRS 059 trial). The authors graphically determined if consecutive anthropometric categories with the closest hazards ratios of the risk of death could be clustered to obtain a unique threshold that distinctly separated two categories. When the threshold values were determined, the authors estimated the hazards ratio of mortality of this two-category model. A significant increase of mortality was observed for a body mass index of < or =20.3 in men (hazards ratio = 2.6; 95% confidence interval (CI): 1.4, 5.0) and of < or =18.5 in women (hazards ratio = 2.2; 95% CI: 1.05, 4.5) and for a fat mass of < or =6% in men (hazards ratio = 4.6; 95% CI: 2.3, 9.4) and of < or =18% in women (hazards ratio = 2.4; 95% CI: 1.2, 4.9). No simple threshold could be identified for arm muscle circumference. In Côte d'Ivoire where chemoprophylaxis of opportunistic infections has recently been recommended to be widely initiated on clinical criteria, such thresholds may help to screen patients with higher risks of mortality.
AIDS-Related Opportunistic Infections↗
Effect of early chemoprophylaxis with co-trimoxazole on nutritional status evolution in HIV-1-infected adults in Abidjan, Côte d'Ivoire.
BACKGROUND: In sub-Saharan Africa, malnutrition is a major complication of HIV disease. Measuring accurately the nutritional benefits of a therapeutic intervention could be an easy-to-monitor secondary outcome. METHODS: Anthropometric data were analysed from patients participating in a placebo-controlled trial of co-trimoxazole prophylaxis in adults recruited at early stages of HIV-1 infection in Côte d'Ivoire (COTRIMO-CI ANRS 059 trial). Body mass index (BMI), arm muscle circumference (AMC) and percentage of fat mass (FM) were measured at baseline and quarterly during the follow up. Percentage of variation from the baseline value was compared between treatment groups and within the groups using Student t-test. RESULTS: An improvement of all anthropometric indicators was observed in the first 3 months of follow up in both treatment groups, significant in the co-trimoxazole group (P < or = 0.0006) but not in the placebo group (P > or = 0.06). In the co-trimoxazole group, this improvement was maintained for up to 24 months for BMI (P = 0.007), 21 months for AMC (P = 0.02) and only up to 12 months for FM (P = 0.04). The placebo group had a stable anthropometric status up to the end of the trial. Differences between treatment groups were significant for up to 15 months for BMI and AMC and 12 months for FM. CONCLUSION: As co-trimoxazole prophylaxis is now recommended in Africa as part of a minimum package of care for HIV-infected symptomatic subjects, the short-term improvement of these anthropometric indicators in adults who start co-trimoxazole prophylaxis should be considered as an effective clinical outcome.
Adult↗
Dietary problems in African HIV-1-infected adults, Abidjan, Côte d'Ivoire. COTRIMO-CI Study Group.
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AIDS-Related Opportunistic Infections↗
[Premalignant lesions and hepatocellular carcinoma on non cirrhotic liver overloaded with iron].
A 68-year old mildly obese Caucasian man underwent hepatic resection for multinodular hepatocellular carcinoma which had developed in the left lobe of a non-cirrhotic liver. The only risk factors found were heavy drinking, smoking, and serum markers of hepatitis B virus without virus genome in hepatocytes. The non tumoral liver was mildly fibrotic and iron overloaded (hepatic iron index: 1.6) with three types of iron-free lesions: (i) periportal clear hepatocyte foci, (ii) hyperplastic nodules and (iii) dysplastic or neoplastic nodules with well to moderately-differentiated hepatocellular carcinoma. The genetic investigation was negative for the C282Y and the H63D mutations of the HFE gene. This observation illustrates the multistep process of carcinogenesis in the non-cirrhotic liver and raises the question of i) the origin of this iron overload possibly linked to insulin resistance syndrome and ii) the role of iron as a co-carcinogen.
Aged↗
Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d'Ivoire: a randomised trial. Cotrimo-CI Study Group.
BACKGROUND: In sub-Saharan Africa, various bacterial diseases occur before pneumocystosis or toxoplasmosis in the course of HIV-1 infection, and are major causes of morbidity and mortality. We did a randomised, double blind, placebo-controlled clinical trial at community-health centres in Abidjan, Côte d'Ivoire, to assess the efficacy of trimethoprim-sulphamethoxazole (co-trimoxazole) chemoprophylaxis at early stages of HIV-1 infection. METHOD: 843 HIV-infected patients were screened and 545 enrolled in the study. Eligible adults (with HIV-1 or HIV-1 and HIV-2 dual seropositivity at stages 2 or 3 of the WHO staging system) received co-trimoxazole chemoprophylaxis (trimethoprim 160 mg, sulphamethoxazole 800 mg) daily or a matching placebo. The primary outcome was the occurrence of severe clinical events, defined as death or hospital admission irrespective of the cause. Analyses were by intention to treat. FINDINGS: Four of the randomised patients were excluded (positive for HIV-2 only). 120 severe events occurred among 271 patients in the co-trimoxazole group and 198 among 270 in the placebo group. Significantly fewer patients in the co-trimoxazole group than in the placebo group had at least one severe event (84 vs 124); the probability of remaining free of severe events was 63.7% versus 45.8% (hazard ratio 0.57 [95% CI 0.43-0.75], p=0.0001) and the benefit was apparent in all subgroups of initial CD4-cell count. Survival did not differ between the groups (41 vs 46 deaths, p=0.51). Co-trimoxazole was generally well tolerated though moderate neutropenia occurred in 62 patients (vs 26 in the placebo group). INTERPRETATION: Patients who might benefit from co-trimoxazole could be recruited on clinical criteria in community clinics without knowing the patients CD4-cell count. This affordable measure will enable quick public-health intervention, while monitoring bacterial susceptibility and haematological tolerance.
AIDS-Related Opportunistic Infections↗
Clinical and immunological stages of HIV-infected outpatients attending community clinics, Abidjan, Côte d'Ivoire.
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Adult↗
[Hepatocellular carcinoma (HCC) observed in Abidjan: aspects and role of ultrasonography].
In this retrospective study, we define the localization and ultrasound appearances of hepatocellular carcinomas observed in Abidjan. The study included 31 inpatients (23 males and 8 females), aged from 24 to 76 years (mean, 47.4). All patients had serum alphafetoprotein dosage and 21 patients had cytologic examination. Diagnosis was based on a high level of serum alpha-fetoprotein (> 500 ng/ml), with or without cytological proof. Tumor characteristics (size, number, echogenicity, nodular or diffuse form) and associated extratumoral signs were noted. Ultrasound identified 19 cases of small tumors (size < 5 cm), and 12 large tumors (size > or = 5 cm). The tumor forms were mostly nodular and multiple (24 cases), solitary nodule (3 cases), diffuse or infiltrative (4 cases). The liver was heterogeneous with hyperechoic tumoral nodules (16 cases), hypoechoic tumoral nodules (5 cases), hyperechoic and diffuse form (4 cases), and 2 cases of mixed form. We have noted a particular form in 4 cases represented by a heterogeneous liquid-like mass simulating tropical abscesses. Ascites (12 patient) was the most common extratumoral sign. Portal vein invasion or thrombus was rare (3 patients). Of the 31 patients, ultrasound was abnormal in all cases, alpha-fetoprotein test was positive in 12 cases (57.14%) and negative in 9 cases (42.8%). Cytological test was positive in 17 cases (80.95%), and negative in 4 cases (19.04%). Alphafetoprotein and cytologic tests were both positive in 8 cases and, nonconcordant in 13 cases; in 4 cases alphafetoprotein was positive while cytological tests were negative and, in 9 cases alphafetoprotein was negative while cytological tests were positive. Two negative tests were never observed. In Abidjan, hepatocellular carcinomas are commonly small or large, multinodular and hyperechoic tumors contrasting with the small nodular and hypoechoic tumors usually reported in western series. Ultrasound associated with cytologic examination, appears to us to be more usefulness than alphafetoprotein dosage in the diagnosis of hepatocellular carcinoma.
Adult↗
[Ultrasonically guided fine needle biopsy in the diagnosis of malignant liver tumors].
Ultrasonography can be used to guide fine needle biopsy of suspected malignant liver lesions. In Abidjan this method allowed cytologic identification of 63 liver lesions disclosed by ultrasonography. In 53 cases (84%) including 41 hepatocarcinomas, 4 Burkitt's lymphomas, and 8 metastases, cytology confirmed malignancy. In 10 cases, initially supposed to be hepatocarcinomas (6 cases) or metastases (4 cases), cytologic findings led to a different diagnosis of either cirrhosis, abscess, or necrotic tissue (4 cases). No complications were observed in this series of 63 ultrasonically guided biopsies. This safe, easy, sensitive, and cost-effective technique should be used to identify the solid tumors. This indication is common in Black Africa where these tumors are common.
Biopsy, Needle↗
The influence of anaesthetic drugs on the lower oesophageal sphincter in propofol/nitrous oxide anaesthetized dogs. Pressure profilometry in an animal model.
The lower oesophageal sphincter (LES) is the main barrier against gastro-oesophageal reflux. Various anaesthetic drugs have been reported to affect the LES pressure. In this study, the effects of cisapride, atropine, suxamethonium, vecuronium and pancuronium on the LES pressure of six mongrel dogs anaesthetized with propofol and nitrous oxide were investigated. By means of eight-channel pressure profilometry the LES pressure was measured in consecutive sessions before and after administration of each drug. Compared to basal values, atropine and suxamethonium significantly decreased LES pressure, pressure vector volume and sphincter length. Cisapride significantly increased all sphincter parameters, vecuronium significantly increased LES pressure and pressure vector volume while pancuronium had no significant effects. A significant decrease of the LES pressure and pressure vector volume was observed when nitrous oxide was omitted from the ventilation mixture. Three-dimensional imaging showed an asymmetric shape of the LES pressure which resulted from radial differences of the LES pressure. The results from this study show that both the anaesthetic animal model and the eight-channel pressure profilometry are useful procedures in studying the effects on sphincter function of different drugs during anaesthesia.
Anesthesia↗
Synthesis of 3,5-disubstituted pyridines as antimicrobial agents.
3,5-Diacetylpyridine (1) reacted with hydroxylamine hydrochloride, thiourea or phenylhydrazine affording the corresponding carbaldoximo- (2) aminothiazolyl-(3) and phenylhydrazono- (4) derivatives, respectively. Cyclization of 4 by the action of PPA or thionyl chloride afforded the corresponding indolyl- (5) and thiadiazolyl-(6) derivatives. Condensation of 1 with aldehydes yielded bis-(beta-acryloyl) derivatives 7, which on further treatment with malononitrile or ethyl cyanoacetate afforded cyanopyridines of the types 8 and 9. The latter was successfully utilized in the synthesis of thieno[2,3-b]pyridines 13. Some of the obtained compounds showed remarkable antimicrobial activity comparable to oxytetracycline.
Anti-Bacterial Agents↗
Correlation between human sperm hypo-osmotic swelling test and other semen parameters.
Ninety semen samples from male patients were studied. They were classified into 4 different groups; normospermic fertile, oligospermia, asthenospermia, and oligoasthenospermia. In addition to routine semen analysis, the hypo-osmotic swelling test was done for all these samples, measuring total protein and specific gravity. A significant positive correlation was observed between percent sperm swelling and its motility, its total protein, and specific gravity. Also a significant negative correlation was noticed between percent sperm swelling and its count. Although there were overlapping ranges, different groups showed significant relations of percent sperm swelling among themselves. It is postulated that the sperm quality and not its quantity is the cornerstone of the hypo-osmotic test and that the physico-chemical properties of the sperm influences its swelling.
Adult↗
Tuberculosis of the rectum in a patient with acquired immune deficiency syndrome. Report of a case.
Tuberculosis of the rectum is a rare disease. A patient with a miliary pattern of pulmonary tuberculosis had a rectal lesion which proved to be tuberculosis. The patient subsequently developed several opportunistic infections characteristic of acquired immune deficiency syndrome. The clinical, endoscopic, radiologic, and histologic findings of this treatable lesion are presented.
Acquired Immunodeficiency Syndrome↗
An unusual case of dysphagia: esophageal intramural pseudodiverticulosis.
A 30-yr-old man presented with chronic dysphagia and a questionable upper gastrointestinal hemorrhage. On endoscopic evaluation, numerous openings were seen throughout the esophagus. Barium esophagram confirmed the diagnosis of esophageal intramural pseudodiverticulosis. The clinical presentation and the endoscopic, radiographic, histopathological, and manometric data are presented. Our findings illustrate common esophageal conditions associated with this rare entity.
Adult↗
Primary lymphoma of the liver treated with extended left hepatic lobectomy.
Primary lymphoma of the liver is an extremely rare entity; only five cases have been reported in the English language literature. Presented is a case report of a patient with primary hepatic lymphoma successfully treated by major liver resection. The current management trends are reviewed.
Female↗
Testicular biopsy in azoospermia and severe oligozoospermia.
The continued experience of testicular biopsy application in 861 cases of azoospermia and 152 cases of severe oligospermia is reported adding to the previously published cases of 1075 patients with azoospermia. The most common finding in the whole series was that of normal testis denoting obstruction (48%), while among cases of functional azoospermia, Sertoli cell only and spermatogenic arrest were the most frequent (66%).
Adult↗
Lymphangioma of the mesentery of the jejunum: report of a case and a brief review of the literature.
Lymphangiomas are benign tumors of lymphatic vessels, that are more commonly found in the pediatric age group, and thought to be congenital in nature. They most commonly occur in the region of the neck, but they frequently may be found in the abdominal cavity. In the abdominal cavity, the tumors usually involve the mesentery of the small or large intestines. They are usually asymptomatic but may present with signs and symptoms of intestinal obstruction. The tumors are rare enough to arouse interest whenever a case is encountered. We present a case of lymphangioma of the mesentery of the jejunum in a young adult which clinically mimicked acute appendicitis.
Acute Disease↗