[Management of pre-term labor: use of nifedipine in Conakry, Guinea]

This purpose of this prospective and descriptive study was to evaluate the utility of a calcium-channel inhibitor, i.e. nifedipine, for management of preterm labor in our work setting in terms of safety and cost-effectiveness in comparison with betamimetics classically used for this indication. Study was carried out over a six-month period in the department of Gynecology-Obstetrics Department of Ignace Deen National Hospital in Conakry, Guinea. Pregnant women meeting the following criteria were included: 28 to 33 weeks of amenorrhea, six days of hospitalization either for preterm labor or for another diagnosis that was associated with the occurrence of preterm labor during hospitalization, and absence of contraindications for tocolysis using nifedipine. A total of 42 women were included. Pregnancy was extended for more than 48 hours after the first dose of nifedipine in 86.8% of cases. Administration of nifedipine failed in 5 cases including one case in which it was necessary to change the tocolytic and 4 cases in which delivery occurred less than 48 hours after the first dose of nifedipine. In 68% of cases, 90 mg of nifedipine were sufficient to stop uterine contractions within 48 hours. In 39.5% of cases, no side effects were observed. Adverse effects in the other cases were dizziness (39.5%) and headache (18.4%). The mean term of delivery was 36 weeks +/- 5 days of amenorrhea with a mean extension of 6.2 weeks. Apgar score was low in 30.5% of the newborns and normal in 69.5%. One newborn (2.8%) died. The results of this study indicate that nifedipine is an effective, economical and safe drug for tocolysis and that it can be used as an alternative to betamimetis in countries with limited resources. An information campaign is needed to promote use of nifedipine as a tocolytic in obstetrical facilities of our country.

[Stoma use in the general surgery service of CHU Gabriel Touré]

OBJECTIVES

Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma.

MATERIAL AND METHODS

It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P < 0.05.

RESULTS

We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%.

CONCLUSION

The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

[Clinical and medico - legal aspects of sexual aggressions at Gabriel Toure teaching hospital]

AIM

The sexual aggressions pose an important medico - legal problem. The implication of several services is often indispensable to determine the future of this aggression. Our survey objectives were to determine epidemiological and clinical characteristics of sexual aggressions and to specify the judicial continuations.

MATERIAL AND METHODS

We did historical cohort survey while recruiting all cases of consultation in the service for sexual aggressions. This survey spreads on a period of 60 months going from January 2004 to December 2008. A systematic health evaluation (HIV test, vaginal screeming, lever inflammatory deseases) is asked to every sexual abuse patients.Data have been recorded from patients' clinical files, cards of requisition and accounts returned of verbal suit of auditions and police custodies. khi 2 test has been used to appreciate relationship between variables, significativity doorstep P value < 5%.

RESULTS

The sexual aggression frequency in relation to admissions to emergencies is 3.12%. The age group <15 years were the more represented with 59.18%. The police authority referred the patients with a requisition in 65.17% of cases (p<0,005). Presumed aggressor was known by the patient in 63.67% of cases (p<5%) and in 72.28% of cases the aggression has been made by night (p=0,001) It was about one aggressor in 65.54% of cases; they were 2 and 3 numbers in 17.23%. (p=0,002). We noted a sexual penetration notion in 80.52% of cases against 19.48% of sexual attouchements. The threat has been noted in any case: 40.82% by weapon and 30.71% by stroke of point. More of the half of the patients (60.30%) had had sexual intercourse before the aggression. The clinic exam was normal in 76.40% of cases (P<5%). The main types of lesions were: hymeneal injuries (13.48%), vulva injuries (7.87%). The judicial continuations have been marked by 10.48% of condemnations, 46.06% of acquittal and 40.06% of friendly regulation (P<5%).

CONCLUSION

The number of sexual aggressions, although under valued, is raised in our country. The collaboration between the judicial, police and medical services should permit to reduce the frequency of these aggressions.

[Brain trauma at the Teaching Hospital Gabriel Touré]

AIMS

To evaluate mortality and morbidity related to brain trauma.

PATIENTS AND METHODS

It was about a descriptive study done on brain trauma patients admitted to the emergency of the teaching hospital Gabriel Touré from January to august 2004. Every patient admitted for brain trauma with ornote associated lesions was included. A p < 0.05 was considered significant. RESULTS During 8 months time 324 patients have been admitted for brain trauma. The male to female ratio was 3.1. School age and academic populations have represented 79 patients (24.4%). Brain trauma has happened in 268 cases (82.8%) in a context of public way accident. These accidents have concerned pedestrian in 42% of cases (auto-pedestrian or motorcycle-pedestrian). The morbidity rate was 11 %. Conclusion Intracerebral lesion are mostly seen in brain trauma. Being a pedestrian in an accident context may expose to brain trauma.

[Adverse events of anesthesia in pediatric surgery scheduled at Gabriel Toure hospital]

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia.

PURPOSE

To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled.

STUDY TYPE

Descriptive non-randomized study.

PATIENTS AND METHODS

Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period.

RESULTS

Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P < 0.05. All adverse events have received support except tachycardia, late revival but all developed positively.

CONCLUSION

This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

[Assessment of a rapid diagnostic test for malaria in rural health care facilities in Senegal]

PURPOSE

The aim of the study was to determine the accuracy of a rapid diagnostic test in confirming presumptive malaria diagnosis in a rural zone of Senegal. Thick blood smear was used as the reference technique for comparison. METHOHDOLOGY: Testing was conducted on children between the ages of 1 and 14 years at three health care facilities located in the Niakhar are from August 2006 to June 2007. If malaria was suspected by the nurse based on clinical findings, two thick smears and one rapid diagnostic test (Core Malaria Pf) were performed. Blood slides were stained in Niakhar and read in Dakar.

RESULTS

A total of 474 patients were examined. Three-fourths (75%) of these patients were seen during the rainy season. Malaria was suspected in 335 patients (71%). Rapid tests and thick smears were obtained in 330 of these patients with positive results in 194 (59%) and 180 (55%) respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the rapid test were 96%, 87%, 90% and 95% respectively.

CONCLUSION

Our data show that the rapid diagnostic test used in this study exhibits good sensitivity and positive predictive value. Despite its cost this test could be helpful in confirming malaria diagnosis in outlying health care facilities without the necessary resources to perform blood smears. Confirmation is necessary to avoid unwarranted prescription of malaria treatment due to inaccurate clinical diagnosis

The elimination of the onchocerciasis vector from the island of Bioko as a result of larviciding by the WHO African Programme for Onchocerciasis Control

The island of Bioko is part of the Republic of Equatorial Guinea and is the only island in the World to have endemic onchocerciasis. The disease is hyperendemic and shows a forest-type epidemiology with low levels of blindness and high levels of skin disease, and the whole population of 68,000 is estimated to be at risk. Control of onchocerciasis began in 1990 using ivermectin and this yielded significant clinical benefits but transmission was not interrupted. Feasibility and preparatory studies carried out between 1995 and 2002 confirmed the probable isolation of the vector on the island, the high vectorial efficiency of the Bioko form of Simulium yahense, the seasonality of river flow, blackfly breeding and biting densities, and the distribution of the vector breeding sites. It was proposed that larviciding should be carried out from January to April, when most of the island's rivers were dry or too low to support Simulium damnosum s.l., and that most rivers would not need to be treated above 500 m altitude because they were too small to support the breeding of S. damnosum s.l. Larviciding (with temephos) would need to be carried out by helicopter (because of problems of access by land), supplemented by ground-based delivery. Insecticide susceptibility trials showed that the Bioko form was highly susceptible to temephos, and insecticide carry was tested in the rivers by assessing the length of river in which S. damnosum s.l. larvae were killed below a temephos dosing point. Regular fly catching points were established in 1999 to provide pre-control biting densities, and to act as monitoring points for control efforts. An environmental impact assessment concluded that the proposed control programme could be expected to do little damage, and a large-scale larviciding trial using ground-based applications of temephos (Abate 20EC) throughout the northern (accessible) part of the island was carried out for five weeks from 12 February 2001. Following this, a first attempt to eliminate the vectors was conducted using helicopter and ground-based applications of temephos from February to May 2003, but this was not successful because some vector populations persisted and subsequently spread throughout the island. A second attempt from January to May 2005 aimed to treat all flowing watercourses and greatly increased the number of treatment points. This led to the successful elimination of the vector. The last biting S. damnosum s.l. was caught in March 2005 and none have been found since then for more than 3 years.

[Assessing the reliability of clinical malaria diagnosis in children consulting in three peripheral health care facilities, in Niakhar rural area, Senegal]

A demographic survey site has been implemented in Niakhar rural zone in Senegal since the 1960s and many epidemiological and demographic studies have been conducted in this context. In this Sahelo-Sudanese area, malaria transmission is mesoendemic and mainly seasonal. In health care facilities, malaria real burden is poorly known as malaria diagnosis only relies on patients' clinical signs. The aim of our study was to measure the reliability of malaria diagnosis in these health centres by performing a parasitological confirmation of presumptive malaria cases and by assessing the validity of diagnosis according to child's age. A cross-sectional study was conducted in August-December 2006 (rainy season) and in February-June 2007 (dry season) in three health care facilities of the area (2 public centres and one private dispensary). Children aged 1 to 14 years old and accompanied by an adult were included. Two thick blood smears were carried out for each patient. A total of 474 children were included; among them 208 (43.9%) had a positive blood smear. Among the 335 (70.7%) presumptive malaria cases, 182 (54.3%) were confirmed by thick smear. Sensitivity specificity positive and negative predictive values were respectively 87.5%, 42.6%, 55.3% and 80.7%. Clinical signs which were predictive of confirmed malaria were vomiting and body temperature > or =38 degrees C. Clinical diagnosis performances decreased significantly during the dry season and in children under the age of two. The proportion of true malaria cases (54.3%) confirms the results of previous studies described in literature and shows a consistency for the last twenty years. Malaria is the main diagnosis attributed to patients by health care agents, regardless of the child's age or the season, whereas thick smear results are predominantly negative among children aged less than 2 and during dry season. A better knowledge of malaria morbidity in these health care facilities is an asset for setting up further epidemiological studies in this area and implementing interventions aiming at improving patients' care.

[Morbillivirus infections of ruminants: the nearly eradicated rinderpest and the "peste des petits ruminants", an expanding disease in the South and a threat for Europe]

Rinderpest (RP) and peste des petits ruminants (PPR) are contagious viral diseases of domestic and wild ruminants producing high mortality. They are caused by viruses belonging to the Morbillivirus genus, Paramyxoviridae family. Control tools (vaccines and specific diagnostic tests) exist for these two diseases. They have been successfully used during the global rinderpest eradication programme (GREP) and the disease is expected to be eradicated by 2010. In contrast, a similar programme does not exist for PPR, which is still spreading in Africa and Asia. The persistence of PPR in Turkey and its recent introduction in Morocco, make the disease a real threat for Europe. Improvement of control measures against PPR would benefit from the development of a marker vaccine and its companion serological test, thus allowing the differentiation between infected and vaccinated animals (DIVA vaccines and tests). The recent development of reverse genetics for morbilliviruses offers this new possibility.

[Medical care of post-operative pain in pediatric surgery: comparison of three protocols]

The gains of the struggle against the pain of the child are still fragile and poorly insured despite advances in both information and evaluate the degree of pain in the range of means at our disposal. The absence of systematic management of pain especially post-operative pain in pediatric surgery and the difficulty of obtaining a vein justify this study.

PURPOSE

The purpose was to compare analgesic effect of three protocols.

TYPE OF STUDY

prospective and comparative study.

MATERIAL AND METHOD

Our study was prospective and comparative. It took place in the services of anesthesia and intensive care and pediatric surgery of Gabriel Toure Hospital in Bamako during October 2003 to July 2004.Patients were randomized to three protocols: protocol A patients who received paracetamol suppository at a dose of 15 mg/kg,protocol B patients who received niflumique acid suppository at a dose of 13 mg/kg and protocol C patients who receiving combination paracetamol at a dose of 15 mg/kg with acid niflumique at a dose of 13 mg/kg per rectally. The first dose for each protocol was administered after anesthetic induction. In Protocol C paracetamol was administered immediately after induction and niflumique acid on awakening.

RESULTS

During the period, 202 patients were randomized to three protocols: protocol A (n = 65), protocol B (n = 69),protocol C (n = 68). Poignant pain has been observed with EVS ladder against none with the grid OPS.Patients of protocol C surgery for hernia had moderate pain with 4.40% of cases against 9.60% of patients in the protocol B with P = 0.0024 and 12% of patients in Protocol A, with P = 0.0018 in OPS. Patient's protocol C surgery for hernia showed no intensive pain against 14.20% of the patients in protocol B and 11.4% of patients in group A with EVS scale. No side effects related molecules have been observed in the three protocols.

CONCLUSION

Association of paracetamol and niflumique acid provides a quality analgesia by postoperative rectally in pediatric surgery.

[Coverage rate and satisfaction of populations after mass treatment with praziquantel and albendazole in Mali]

In Mali, schistosomiasis always remains a major public health problem. In 2005, mass treatment campaigns with praziquantel and albendazole have been organized in all endemic regions. The present study aimed to assess the impact of these mass treatment campaigns and the recipient's satisfaction in two endemic areas (Mopti and Ségou). It was a cross-sectional study with one passage from February to March 2006. The study carried out on political authorities (n=142), teachers and school administers (n=70), health workers (n=46), community distributors (n=33), community members (n=2170) and pupils (n=2480). We used Lot Quality Assurance Sample (LQAS) to determine treatment coverage and recipient's satisfaction. Two types of lots were considered, villages and schools. Questionnaires were used for investigation. In Ségou, the treatment rates varied from 100% at school level and in community in Bla district to 97.2% in the community of Ségou town. In Mopti, a treatment rate of 100% was observed in Bankass and Douentza both at school and in the community. The proportion of happiest individuals (to feel well) after the mass treatment campaign was 72.3% among pupils and 76.6% in the community. The results of this study suggest that the high treatment coverage rates observed during these campaigns should be sustained by a yearly chemotherapy strategy preceded by a community's health education programmes.

[Trauma and pregnancy: clinical and prognosis about 152 cases recorded into Gabriel Toure Teaching Hospital]

AIM

The objectives of our survey were to determine the frequency of trauma associated to pregnancy in our service, to describe types of lesions and the maternal and fetal complications.

MATERIAL AND METHODS

It is about a descriptive retrospective survey that spreads on a period of 63 months going from March 2002 to Jun 2007. We recorded all cases of trauma associated to pregnancy whatever the term of pregnancy. The parameters studied have been: admission mode, circumstances of intervening, gravida, parity, pregnancy age, delivery route and materno-fetal prognosis. We have used χ² test to appreciate relationship between variables studied, the significant doorstep has been P value < 5%.

RESULTS

During the period of the survey we recorded 152 cases of trauma associated to pregnancy and 8016 emergency consultations is a frequency of 1.90%. In 3 cases on 4 (115 cases, 75.66%), the age of pregnancy was at least equal to 12 weeks. We noted 13.16% of unevolutive pregnancy; 13.83% of case of abortion and 15.13% of childbirth witch 5 by cesarean section. The main lesions more associated were: bruises (41.28%), the fractures of the pelvic (25.64%), the rachis fractures (10.26%) and the cranial trauma (12.82%), 6.58% (10 cases) of patients are died.

CONCLUSION

Trauma in pregnant women often generate polymorphic lesions. Their complications can be serious dragging sometimes maternal and or fetal death. Their management is always multidisciplinary.

Fast visible imaging of turbulent plasma in TORPEX

Fast framing cameras constitute an important recent diagnostic development aimed at monitoring light emission from magnetically confined plasmas, and are now commonly used to study turbulence in plasmas. In the TORPEX toroidal device [A. Fasoli et al., Phys. Plasmas 13, 055902 (2006)], low frequency electrostatic fluctuations associated with drift-interchange waves are routinely measured by means of extensive sets of Langmuir probes. A Photron Ultima APX-RS fast framing camera has recently been acquired to complement Langmuir probe measurements, which allows comparing statistical and spectral properties of visible light and electrostatic fluctuations. A direct imaging system has been developed, which allows viewing the light, emitted from microwave-produced plasmas tangentially and perpendicularly to the toroidal direction. The comparison of the probability density function, power spectral density, and autoconditional average of the camera data to those obtained using a multiple head electrostatic probe covering the plasma cross section shows reasonable agreement in the case of perpendicular view and in the plasma region where interchange modes dominate.

Dynamics of plasma blobs in a shear flow

The global dynamic of plasma blobs in a shear flow is investigated in a simple magnetized torus using the spatial Fourier harmonics (k-space) framework. Direct experimental evidence of a linear drift in k space of the density fluctuation energy synchronized with blob events is presented. During this drift, an increase of the fluctuation energy and a production of the kinetic energy associated with blobs are observed. The energy source of the blob is analyzed using an advection-dissipation-type equation that includes blob-flow exchange energy, linear drift in k space, nonlinear processes, and viscous dissipations. We show that blobs tap their energy from the dominant ExB vertical background flow during the linear drift stage. The exchange of energy is unidirectional as there is no evidence that blobs return energy to the flow.

Cross-field transport by instabilities and blobs in a magnetized toroidal plasma

The mechanisms for anomalous transport across the magnetic field are investigated in a toroidal magnetized plasma. The role of plasma instabilities and macroscopic density structures (blobs) is discussed. Examples from a scenario with open magnetic field lines are shown. A transition from a main plasma region into a loss region is reproduced. In the main plasma, which includes particle and heat source locations, the transport is dominated by the fluctuation-induced particle and heat flux associated with a plasma instability. On the low-field side, the cross-field transport is ascribed to the intermittent ejection of macroscopic blobs propagating toward the outer wall. It is shown that instabilities and blobs represent fundamentally different mechanisms for cross-field transport.

[Epidemiological, clinical and prognostic aspects of cryptococcal meningitis in hospital area of Bamako, Mali]

The cryptococcosis is a major mycosis of forecast holds during the AIDS. The objective of this study was to determine the frequency of this affection during the AIDS with the service of the infectious diseases of the teaching hospital of the Point G. On the whole 55 patients reached of AIDS were included in this study. They presented all of the evocative signs of meningitis attack. The analysis of the cerebral spinal fluid (CSF) allowed us to detect among this population 17 cases of cryptococcal meningitis means a frequency of 30.9%. The average age was 34 years with the extreme ones going from 18 to 60 years old. The clinical signs were as follows: disorder of the conscious in 4/17 cases (23.6%), fever in 2/17 cases (11.8%), signs of meningitis in 11/17 cases (64.7%). The CSF was clear as water of rock with a lymphocyte at 100% to all the patients. The examination with the Indian ink noted yeasts in capsular identified like the Cryptococcus ones. The treatment was based on amphotericin B intravenous. Lethality rate was 58.8% in 10/17 cas. The crytococcus constitutes a frequent etiology of the meningo-encephalitis demonstrations during the AIDS in this service. We recommend the search for cryptococcus in front of any sign of meningitis occurring during AIDS in Mali.

Experimental observation of the blob-generation mechanism from interchange waves in a plasma

The mechanism for blob generation in a toroidal magnetized plasma is investigated using time-resolved measurements of two-dimensional structures of electron density, temperature, and plasma potential. The blobs are observed to form from a radially elongated structure that is sheared off by the E x B flow. The structure is generated by an interchange wave that increases in amplitude and extends radially in response to a decrease of the radial pressure scale length. The dependence of the blob amplitude upon the pressure radial scale length is discussed.