[Covid-19 And Surgical Pathologies In General Surgery Of CHU Gabriel Toure Of Bamako]

INTRODUCTION

The pure digestive form of COVID-19 is possible and initially considered rare. Our objectives were to determine the frequency of COVID-19 in patients treated in general surgery, identify the circumstances of COVID-19 discoveries in surgery, describe the post-operative complications in patients operated on COVID-1919 and describe the reorganization of post-operative COVID-19 diagnosis management.

MATERIALS AND METHODS

We conducted a prospective descriptive study from March 2020 to August 2021 (18 months). All patients who have been operated on, hospitalized or consulted in the department, the Emergency Department (ERS) or other CHU-GT departments for surgical pathology with COVID-19 or infected with COVID-19 while hospitalized were included in the study.

RESULTS

23 cases collected, representing 8.91% (23/258) of COVID-19 cases identified, a frequency of 1.27/month. The age group 66-75 was the most affected, the average age was 49.13 18.75 years, the predominance was male (sex ratio of 1.3). More than 34.78% were recruited at the SAU, 16 patients (69.56%) consulted in emergency, and digestive signs of COVID-19 were: Abdominal pain 20 cases (89.96%), anorexia 19 cases (82.61%), vomiting 8 cases (34.78%) and diarrhea 3 cases (13.04%). The pulmonary signs of COVID-19 were: Cough 18 cases (78.26%), chest pain 15 cases (65.22%), and dyspnea 9 cases (39.13%). Manifestations of COVID-19 were: pulmonary 9 cases, digestive 9 cases, associated 3 cases, incidental discovery 2 cases. The diagnostic mean was Thoracic CT (100%), Test-PCR 14 cases (60.86%) with a positive PCR test in 50% of cases. Surgical pathologies were surgical emergencies in 7 cases (30.43%), cancers in 6 cases (26.09%), COVID-19 digestive event (30.43%) and other 3 cases (13.04%). More than half of patients were operated on 12 cases (52.17%). The overall mortality was 60.87% and the mortality of surgical patients was 41.67%.

CONCLUSION

The infectious risk of COVID-19 during hospitalization, during or after digestive surgery is a real and potentially serious risk for the patient and caregivers.

[Infection with the Hepatitis B virus in pregnant women in the Gynecology and Obstetrics Department of the Gabriel Touré University Hospital Center]

PURPOSE

The purpose of this study was to study hepatitis B virus infection in pregnant women.

METHOD

This was a one-year descriptive cross-sectional study carried out in the Gynecology-Obstetrics Department of the Gabriel Touré University Hospital.

RESULT

During this period, 796 pregnant people were seen in antenatal consultations. Ween rolled 500 pregnant women in whom the search for HBs Ag was carried out, a rate of 62.81%. Of these pregnant 85 had HBs Ag a prevalence of 17%. The average age of these women was 26.9±5.6 years. Our patients were paucipare sin 52.9%. Of these, 17.7% had a family history of chronic liver disease and 37.6% had once given birth in a referral health centre. Blood transfusion, polygamous focus and tattooing/scarification were the risk factors associated with HBs Ag carriage. Alarming clinical signs were absent in 95.2% of cases. Hepatic cytolysis and anaemia were foundin 28.8% and 76.3% of cases respectively; viral replication was observed in 13.6% of pregnant women with a high viral loadin 37.2%. Abdominal ultra sound was normal in 90.8% of cases and esophageal varices were present in 6% of women who performed eso-gastroduduedenal fibroscopy. Fibrosis was significant according to an APRI score in 3.4%.

CONCLUSION

The prevalence of HBs A in pregnant women followed remains high.

Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study

OBJECTIVE

The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs.

PATIENTS AND METHODS

We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors.

RESULTS

During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73).

CONCLUSION

Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

[Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]

Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.

P3344Research network in Africa (RNA): observatory of hospitalizations in cardiology departments in 14 African countries (FEBRUARY Study: 2016, 2017 and 2018)

Background

Epidemiological transition in the developing world has resulted in a shift from infectious to non-communicable diseases as leading causes of morbidity and mortality, cardiovascular (CV) disease (CVD) is the first cause of death in Africa. However, data regarding the characteristic of patients with CVD are scarce, especially in Sub-Saharan Africa.

Purpose

We built an observatory recording the characteristics of all patients admitted to hospital in CV departments and hospital care components in Sub-Saharan Africa (FEBRUARY Study).

Methods

We conducted a transversal and longitudinal study in CV departments of 29 hospitals from 14 African countries. FEBRUARY study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all patients admitted in hospitalization during the month of February every year since 2016 and will continue every year. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians.

Results

Overall 2680 patients were admitted to hospital in February 2016 (n=736), 2017 (n=967), and 2018 (n=987) in CV departments from 14 countries: Benin, Burkina Faso, Burundi, Cameroon, Congo, Côte d'Ivoire, Gabon, Guinea, Mali, Niger, Dem. Rep of The Congo, Senegal, Togo and Sudan (figure). Men represented 58,8%. Mean age of age was 54 years and Women 52 years. The mean length of stay was 9 days, and death rate 10,1%. The main cause of admission was cardiac failure (40,3%) followed by acute coronary syndrome (10.1%) and stroke (9,3%). Among CV risk factors, high blood pressure, sedentary behavior, diabetes, active tobacco consumption and dyslipidemia were present in 46%, 19%, 13%, 11% and 6% of patients, respectively.

In a longitudinal analysis, hospital admission due coronary syndrome increased from 7% in 2016 to 10.5% in 2018 (p for trend = 0.03). Length of hospital stay and rate of hospital death remain stable.

Hospitalizations by country (FEBRUARY)

Conclusion

The FEBRUARY observatory is an important tool to describe cardiovascular characteristics of patients in transversal analysis, but also the longitudinal evolution over the coming years in Sub-Saharan Africa.

A52 MERS coronaviruses from camels in Africa exhibit region-dependent genetic diversity

Middle East respiratory syndrome coronavirus (MERS-CoV) causes a zoonotic respiratory disease of global public health concern, and dromedary camels are the only proven source of this zoonotic infection. Although MERS-CoV infection is ubiquitous in dromedaries across Africa and the Arabian Peninsula, the continuous appearance of zoonotic MERS cases in humans is confined to the Arabian Peninsula. MERS-CoV from Africa has hitherto been poorly studied. Here, we report the genetic and phenotypic characterization of MERS-CoV from dromedaries in African countries. Phylogenetically, viruses from dromedaries in Africa formed a monophyletic clade, which we have provisionally designated as virus clade C. Molecular dating analyses of MERS-CoV, including clade C viruses, suggests that the ancestral MERS-CoV in dromedaries could have spread to the two continents within a short timeframe. Camel MERS-CoVs from west and north African countries form a subclade (C1) that shares genetic signatures of a major deletion in the accessory gene ORF4b. Compared with human and camel MERS-CoV from Saudi Arabia, virus isolates from Burkina Faso (BF785) and Nigeria (Nig1657) had lower virus replication competence in Calu-3 cells and in ex vivo cultures of human bronchus and lung, and BF785 replicated to lower titer in lungs of human DPP4-transduced mice. However, it is still inconclusive whether ORF4b deletions may lead to the reduced replication competence of BF785 and Nig1657. Genetic and phenotypic differences in West African viruses may be relevant to the zoonotic potential of MERS-CoV.

Kinetics of maternally-derived serogroup A, C, Y and W-specific meningococcal immunoglobulin G in Malian women and infants

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Immunisation with MCV during pregnancy resulted in an antibody response.

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Maternal immunization with MCV conveyed protective levels of MenA IgG at birth.

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Infant antibody levels declined over the first 3 months of life.

A prospective, randomised, controlled observer-blind trial measuring the efficacy and immunogenicity of trivalent influenza vaccine (TIV) and the immunogenicity of quadrivalent meningococcal conjugate vaccine (MCV) in pregnant women and their infants up to 6 months of age was conducted in Mali. Here we reported the immunogenicity of MCV, which was used as a comparator vaccine to TIV, in this population. Third-trimester pregnant Malian women were randomized to receive TIV or MCV. Blood samples were collected from women prior to vaccination, 28 days post-vaccination, at delivery and 3 and 6 months post-delivery and from infants at birth and 3 and 6 months of age. Meningococcal-specific serogroup (Men) A, C, Y and W-specific antibodies were measured by enzyme linked immunosorbent assay in a randomly selected subset of 50 mother-infant pairs where the mother had received MCV. At birth, 94.0% (47/50) of infants had MenA specific IgG levels ≥ 2 µg/mL decreasing to 72.9% and 30.4% at 3 and 6 months of age. For MenC, 81.3% (39/48) of infants had MenC specific IgG levels ≥ 2 µg/mL at birth decreasing to 29.4% and 17.8% at 3 and 6 months of age. For MenY, 89.6% (43/48) of infants had MenY specific IgG levels ≥ 2 µg/mL at birth decreasing to 64.6% and 62.5% at 3 and 6 months of age. For MenW, 89.6% (43/48) of infants had MenW specific IgG levels ≥ 2 μg/ml at birth decreasing to 62.5% and 41.7% at 3 and 6 months of age.

Maternal immunization with MCV conveyed protective levels of IgG at birth through to 3 months of age in the majority of infants.

Do bednets including piperonyl butoxide offer additional protection against populations of Anopheles gambiae s.l. that are highly resistant to pyrethroids? An experimental hut evaluation in Burkina Fasov

Malaria control is dependent on the use of longlasting insecticidal nets (LLINs) containing pyrethroids. A new generation of LLINs containing both pyrethroids and the synergist piperonyl butoxide (PBO) has been developed in response to increasing pyrethroid resistance in African malaria vectors, but questions remain about the performance of these nets in areas where levels of pyrethroid resistance are very high. This study was conducted in two settings in southwest Burkina Faso, Vallée du Kou 5 and Tengrela, where Anopheles gambiae s.l. (Diptera: Culicidae) mortality rates in World Health Organization (WHO) discriminating dose assays were < 14% for permethrin and < 33% for deltamethrin. When mosquitoes were pre-exposed to PBO in WHO tube assays, mortality rates increased substantially but full susceptibility was not restored. Molecular characterization revealed high levels of kdr alleles and elevated levels of P450s previously implicated in pyrethroid resistance. In cone bioassays and experimental huts, PBO LLINs outperformed the pyrethroid-only equivalents from the same manufacturers. Blood feeding rates were 1.6-2.2-fold lower and mortality rates were 1.69-1.78-fold greater in huts with PBO LLINs vs. non-PBO LLINs. This study indicates that PBO LLINs provide greater personal and community-level protection than standard LLINs against highly pyrethroid-resistant mosquito populations.

Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres

OBJECTIVE

Retrospective audit of IVIG Request Forms in four Ontario tertiary care centres: to determine the case mix of new IVIG requests, to authenticate information provided, and to determine documentation of clinical efficacy.

AIMS

To understand contributors to increases in IVIG utilisation and to determine whether IVIG is being used and monitored appropriately.

INTRODUCTION

Intravenous immunoglobulin (IVIG) use in Canada is high compared with other developed countries. We performed a retrospective audit of new IVIG Request Forms across four tertiary care centres in Ontario, one with an active surveillance programme, to determine the case mix, authenticate information provided and assess documentation of efficacy.

METHODS

Consecutive adult patients with a first-time IVIG request in 2014 were included. The ordering physician specialty, form completeness, documentation of diagnostic criteria for the medical condition and indication for IVIG use and documentation of efficacy were assessed by form and chart review.

RESULTS

Of 178 patients, the most common indications for IVIG were immune thrombocytopenia (24.2%) and secondary immune deficiency (20.2%). The most frequent prescribers were haematologists (37.6%) and neurologists (10.7%). Other conditions not listed on the form represented 24.2% of cases, with most not indicated in current guidelines. A total of 32.6% of cases overall lacked verification of diagnostic criteria and 51.7% lacked verification for IVIG utilisation criteria, with the number of cases meeting criteria based on documentation being higher at the active surveillance site (P = 0.005). A total of 19.1% of cases had a discrepancy between the indication written on the form and the documented clinical diagnosis. A total of 18.7% of clinic notes following IVIG had no mention of efficacy.

CONCLUSION

Our audit demonstrates a lack of compliance with IVIG Request Form requirements, a lack of documentation of diagnostic criteria and efficacy, and suggests inappropriate use of IVIG. Current implementation of the form may not be sufficient as a strategy for improving appropriate IVIG use.

High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes

AIM

This study compared the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for 16 weeks on whole-body and abdominal fat mass (FM) in postmenopausal women with type 2 diabetes (T2D).

METHODS

Seventeen women (69±1 years; BMI: 31±1kg.m^-2) were randomly assigned to either a HIIT [60×(8s at 77-85% HR_max, 12s of active recovery)] or MICT (40min at 55-60% of their individual HRR) cycling program for 16 weeks, 2 days/week. Dual-energy X-ray absorptiometry was used to measure whole-body and regional FM content, including abdominal adiposity and visceral adipose tissue. Plasma cholesterol, HDL, LDL, triglycerides, glucose and HbA_1c levels were measured. Levels of nutritional intake and physical activity were evaluated by 7-day self-reports.

RESULTS

Dietary energy (caloric) intake, physical activity level and total body mass did not vary in either group from the beginning to the end of the training intervention. Overall, total FM decreased and total fat-free mass significantly increased over time (by around 2-3%). Total FM reduction at the end of the intervention was not significantly different between groups. However, significant loss of total abdominal (-8.3±2.2%) and visceral (-24.2±7.7%) FM was observed only with HIIT. Time effects were noted for HbA_1c and total cholesterol/HDL ratio.

CONCLUSION

With no concomitant caloric restriction, an HIIT program in postmenopausal women with T2D (twice a week for 16 weeks) appeared to be more effective for reducing central obesity than MICT, and could be proposed as an alternative exercise training program for this population.

Virology. Mutation rate and genotype variation of Ebola virus from Mali case sequences

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.

Post-harvest management of aflatoxin contamination in groundnut

Aflatoxin contamination in groundnut by Aspergillus section Flavi is a major pre- and post-harvest problem causing kernel-quality loss. Post-harvest aflatoxin contamination is caused initially by infestation of aflatoxigenic strains at the pre-harvest stage, resulting in reduced kernel quality after harvest. Improper handling of pods and storage methods after harvest lead to high moisture and ambient temperatures, directly causing aflatoxin contamination. In this review, we report the extent of post-harvest contamination along the groundnut value chain in the Kolokani, Kayes, and Kita districts of Mali in West Africa. Groundnut kernels and paste samples were collected from retailers in selected markets from December 2010 to June 2011, and aflatoxin B1 (AFB1) content was estimated. Aflatoxin was significantly higher in groundnut paste than in kernels. Kolokani recorded the highest toxin levels in both kernels and groundnut paste compared with the other districts. Overall, AFB1 levels in kernels and paste increased during storage at the market level in the three districts and were above permissible levels (≯20 μg/kg). The effect of weather factors on post-harvest contamination and the reasons for aflatoxin build-up in Mali are discussed. This paper also highlights different management tools for reducing post-harvest aflatoxin contamination, such as post-harvest grain handling, post-harvest machinery, physical separation, storage methods and conditions, disinfestation, detoxification, inactivation, filtration, binding agents, and antifungal compounds. Post-harvest management options and enhanced use of good agricultural practices for mitigating this problem in Mali are also presented.

[Chronic kidney failure at subclinical stage in hypertensive patients in the cardiology department of the Gabriel TOURE university hospital]

OBJECTIVE

This work aimed to describe the epidemiological, clinical, biological and ultrasound aspects of the subclinical renal failure in hypertensive patients in the department of cardiology of the Gabriel TOURÉ University Hospital of Bamako.

PATIENTS AND METHODS

The study was cross-sectional and prospective from 1 January 2007 to 31 December 2007 in the cardiology department of the Gabriel Touré University Hospital. These were all patients who achieved at least the basic test for renal impairment such as serum creatinine, 24h proteinuria, renal ultrasound.

RESULTS

Total of 114 patients with kidney failure without evocative clinical symptoms have been included, among them 60 men and 54 women, average age of 57 years. In the hypertensive population, the beginner to moderate chronic renal failure had a frequency of 12.9% (114/880), the sex ratio was 1.11 in favor of men. Patients aged less than 60 years were more numerous with a frequency of 61.5%. Dyspnea (38.6%), and headache (36.8%) were the main manifestations of the high blood pressure (HBP). Renal disease characterized by microalbuminuria was predominant compared to the macro-albuminuria: 25.5% versus 7%. Renal ultrasound was abnormal in 14.1% with a predominance of stage 0 (86%), stages 1 and 2 were each 7%, we have not found any stage 3.

CONCLUSION

Chronic renal failure is a frequent complication of the hypertension. Some biological tests are necessary for the diagnosis. Renal ultrasound remains a useful test for its assessment. The optimal treatment of high blood pressure is essential, as it not only reduces the overall cardiovascular risk of patients, but also slows or even stabilizes the worsening of renal function.

[Bessef Hogen's disease, or exostosis disease, with spinal cord compression: a case in the service of the Paediatric CHU Ouedraogo, Ouagadougou, BF]

CA, 14 old years, female, born last uterine siblings of 9 children, 4 died of various causes, was admitted in the pediatric service of CHU-YO for functional impairment of the lower limbs. Physical examination revealed swelling and deformation harsh, uneven surfaces, the circumferential upper and lower limbs and lumbar spine associated with spastic paraplegia. Sphincter disturbances accompany this clinical picture. The radiographic bone marrow hypertrophy individually with images of exostosis at the epiphyses. Multiple exostosis or BESSEF Hogen's disease is rare and has a reserve functional prognosis because of outcome of low spinal cord compression and vascular compression. We felt it appropriate to bring this case discovered during our clinical practice because of its rarity and the risk of malignant degeneration.

[Aorto-pulmonary fistula found in a 9 year old girl at the Yalgado Ouedraogo University Hospital, Ouagadougou Burkina Faso]

The CS child, aged 9, is evacuated from a health center located 200km away from Ouagadougou (capital of BF) for decompensated heart failure. Clinically we noted a syndrome of congestive heart failure. No obvious cause has been found outside of the advancing age of parents (50 years) and the potential risks of rubella infection. A Doppler echocardiography revealed a fistula aorto-pulmonary 17mm wide associated with a pericardial effusion of average circumferential abundance and a dilation of the left ventricular. Pulmonary radiography showed a large cardiomegaly and left pleurisy. The discovery of congenital heart disease between 2 and 4 years is very rare but the prognosis is good with surgical treatment.

Forearm reconstruction with bone allograft following tumor excision: a series of 10 patients with a mean follow-up of 10 years

BACKGROUND

After a tumor resection, the reestablishment of the bone continuity at the forearm remains a challenge for restoring the biomechanics of hand and elbow. Bone allograft might be one option to consider amongst other suitable alternatives but there are insufficient data available to substantiate its value.

PATIENTS AND METHODS

We retrospectively investigated a series of 10 consecutive patients that had presented a bone tumor at the forearm. After bone excision, the segmental loss was replaced either by a bone allograft or an osteochondral allograft. Patients were reviewed clinically and with radiographs.

RESULTS

The mean follow-up was 110 ± 99 months. Fracture of the allograft was the most prevalent complication occurring in four patients, mainly in the osteoarticular group. Four patients were surgically revised: two of them had a fracture of the allograft that required a new one, another one had a painful stiff wrist requiring removal of the allograft and arthrodesis with autograft and the fourth one had a non-union of an intercalary allograft that was treated by a distal ulnar joint resection. Intercalary allograft had fewer complications than osteoarticular allografts and they had a better functional MSTS score with an average of 79% of a normal function compared to osteoarticular allografts with an average score of 62%. There was no infection. At the latest follow-up, one reconstruction of the forearm with an allograft failed and concerned the distal radius joint.

DISCUSSION

A bone allograft when available can be considered as one amongst other suitable options for the reconstruction of the forearm skeleton.

[Multiple facial squamous cell carcinomas in a child, revealing a xeroderma pigmentosum]

BACKGROUND

Squamous cell carcinoma of the skin is very rare in children. One of its most common risk factors is xeroderma pigmentosum (XP), an autosomal recessive disease characterized by defective cellular DNA repair, and hypersensitivity to ultraviolet radiation.

CASE REPORT

We report a case of XP in a 7-year-old black African boy, revealed by squamous cell carcinomas of the inferior lip and upper left eyelid.

DISCUSSION

In sub-Saharan regions, the early diagnosis of XP is difficult because of its uncommon occurrence on black skin and black skin specificities. The strong sun radiation in the tropics and a late diagnosis make XP treatment challenging. Thus, prevention in patients' families is mandatory.

[Lymphocytic meningitis in Bamako, Mali]

We conducted a prospective survey from January 2001 to March 2002. Our objective was to study etiologic, clinic, and prognostic aspect of lymphocytic meningitis in hospital of Point G to Bamako. We included 35 patients with 25 male (71. 4%) and 10 female (28. 6%), sex - ratio (M / F) equal 2. 5. The median age was of 35 ± 25.4 years (range, 16 - 66 years). HIV serology was positive 26 cases (83. 9%). Clinical presentations were different. We observed 15 cases of encephalitis, 12 cases of meningoencephalitis, 2 cases of meningitis and 6 cases of febrile syndrome. Mean duration of hospitalization was 32. 6 ± 68 days. Mean of lymphocyte was 85.3 ± 25.9% among leukocytes in cerebrospinal fluid of 31 patients. Analysis of cerebrospinal fluid (CSF) identified in 9 cases Cryptococcocus neoformans. In 16 cases etiology was determination based on indirect arguments. In 9 cases viral meningoencephalitis diagnosis was made by exodiagnosis. It concerned 2 cases of TB meningitis, 1 case of cerebral toxoplasmosis, 1 case of decapitate bacterial meningitis and 1 case of cerebral tumor. Malaria thick smear permits to diagnosticate 1 case of cerebral malaria and 1 case of uncomplicated malaria. There are still 10 cases in which the cause remained unknown during study. HIV infection provides principally lymphocytic meningitis. Co morbidity with HIV is associated to lethality at 75%. But no statistical difference with patients without HIV (p = 0.52). Our work puts in exergue all problematic and hold correct of lymphocytic meningitis in 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 .

The JAK2(V617F) tyrosine kinase mutation identifies clinically latent myeloproliferative disorders in patients presenting with hepatic or portal vein thrombosis

Clinically latent myeloproliferative disorders (MPDs) are important causes of what would otherwise be considered idiopathic hepatic (HVT) or portal vein thrombosis (PVT). They may be difficult to diagnose initially because the peripheral blood count may be normal at the time of thrombosis. A strong association between an activating mutation of the gene encoding one of the Janus kinase family of tyrosine kinases (JAK2(V617F)) and the Philadelphia chromosome-negative MPDs has been identified. We have studied 19 patients with unexplained HVT or PVT and tested for JAK2(V617F). Fourteen (74%) of the 19 patients were heterozygous for JAK2(V617F) but did not meet diagnostic criteria for a MPD at the time of presentation with thrombosis. Prolonged follow-up established the presence of an overt MPD in 13 of the 14 patients after a median duration of 38 months. We recommend testing for JAK2(V617F) in all patients with unexplained HVT or PVT, to identify latent MPDs and prevent potential complications.

Fumonisin exposure and the sphinganine/sphingosine ratio in urine, serum and buccal cells in adults from Burkina Faso, West Africa

Fumonisins are mycotoxins that frequently contaminate maize, a dietary staple in Burkina Faso. Fumonisins have been linked with both the incidence of oesophageal cancer, and to neural tube defects. However, epidemiological studies of these associations are hampered by lack of validated exposure biomarkers. One candidate biomarker is the sphinganine/sphingosine (Sa/So) ratio in biological samples. Twenty husband-wife pairs aged 20-40 were recruited from Dingasso-1, western Burkina Faso. Plate ready food was sampled over three consecutive days (day one to three) for fumonisin B1 and B2, to provide a measure of total fumonisin intake. The Sa/So ratio was determined in (1) first morning urines taken on days two to four, (2) buccal cells and (3) serum on days one and four only. Fumonisin intake was moderate (mean 0.81 µg/kg bw/day (range 0.01-2.40 µg/kg bw/day) compared to exposures reported in China and South Africa. For each person the mean fumonisin intake over three days was compared to the mean Sa, So and Sa/So ratio in urine, buccal cells and serum. A modest positive trend between mean fumonisin intake and mean serum Sa/So was observed (P=0.067). When individuals were dichotomised based on the median fumonisin intake (<0.75 µg/kg bw/day), the serum Sa/So ratio was moderately higher (P=0.044) in the high intake group (geometric mean 0.64; 95% CI: 0.54, 0.75) compared to the low intake group (0.49; 95% CI: 0.41, 0.59). Neither urinary nor buccal cell Sa/So ratio was associated with mean fumonisin intake. Neither mean individual Sa nor So level for urine, buccal cells or urine was associated with mean individual fumonisin intake. The study population was exposed to moderate levels of fumonisin with limited evidence of altered Sa/So ratio. Further work on serum Sa/So ratio is merited in comparison with other biomarker approaches such as urinary fumonisin B1 or sphingolipid 1-phosphate metabolites.

Multivariate analyses on morphological traits of goats in Burkina Faso

Abstract. A total of 10,147 female goats from Burkina Faso were scored for 7 body measures and 12 qualitative traits. Sampling included the three main environmental areas and goat breeds of Burkina Faso: the Sahel area (Sahelian goat), the Sudan-Sahel area (Mossi goat) and the Sudan area (Djallonké goat). Overall, the Sahelian goat had the highest values for the all the analysed body measures. Differences between the Sudan and the Sudan-Sahel goat were little. The Burkina Faso goat is mainly spotted (61.92 %) with horns type “Spanish Ibex” (84.05 %), frequent absence of beard (75.33 %) and wattles (70.92 %) and poorly developed udder (73.72 %). The Sahelian population included most individuals with dropping (95.60 %) and curled (73.62 %) ears, whilst most Sudan-Sahel individuals had horizontal ears (73.14 %) and most Sudan individuals had vertical ears (97.88 %). The largest Mahalanobis distance was found between the Sahelian and Sudan areas (7.50) whilst the Sudan and the Sudan-Sahel populations were poorly differentiated (1.15). Discriminant analysis showed that most Sahel and Sudan-Sahel individuals were classified into their source population (79.29 % and 82.69 %) whilst the Sudan individuals (93.40 %) were classified as Sudan-Sahel individuals. Both the canonical and the correspondence analyses showed that the Sahelian and Sudan individuals tended to cluster separately whilst the Sudan-Sahel individuals showed an intermediate distribution but clearly biased toward the Sudan individuals. The Sudan-Sahel (Mossi) population can be considered a result from the genetic contact between Sahelians and Sudan goats.

Longitudinal evaluation of three azithromycin distribution strategies for treatment of trachoma in a sub-Saharan African country, Mali

OBJECTIVES

Trachoma, caused by repeated ocular infections with Chlamydia trachomatis is an important cause of blindness. Mass azithromycin distribution is part of current recommended strategies for controlling trachoma. In order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in Mali between May 2000 and February 2002.

METHODS

Three azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy I), treatment of all children under 11 years of age and of women between 15 and 50 (strategy II), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy III). In a particular Malian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. According to the strategy allocation, adults were eventually given a single dose of 1g azithromycin, and children a unique dose of 20 mg/kg. Moreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. Ophthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. The outcome variable was clinically active trachoma frequency 12 months after intervention among children under 11 years of age. A descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies.

RESULTS

Among children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy I, from 20.8% to 6.8% in strategy II, and from 20.2% to 8.5% in strategy III. After adjustment on age (adjusted odds ratio [AOR] = 0.81; 95% confidence interval [95% CI]: 0.75-0.87) and on active trachoma occurrence at baseline (AOR = 3.81; [95% CI]: 2.70-5.39), the multiple logistic regression model showed that both strategies I and II gave similar results, while strategy III appeared significantly less effective (AOR = 1.56; [95% CI]: 1.00-2.43).

CONCLUSION

In mesoendemic trachoma areas, targeted treatment to all children under 11 years of age and women between 15 and 50 (strategy II) was as effective as indiscriminate mass distribution (strategy I) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy III). Strategy II could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy I).

Caractéristiques de la population prise en charge au Service de Psychiatrie du CHU Yalgado Ouédraogo de Ouagadougou (Burkina Faso) de 1990 à 2000

Mental disorders constitute an important portion of the world sickness ratio. In developing countries, in the absence of data on morbidity, hospital statistics are worthy of interest. Our study was carried out on a population of patients under care in the department of psychiatry of the Ouagadougou Hospital between January 1st 1990 and December 31st 2000, a period of 11 years. For each patient, we noted the sociodemographical features and the clinical diagnosis referring to the ICD-10 of the WHO. Within the scope of the study, 7 313 patients (60% men and 40% women) were analysed. The average age of the patients was 31.06 +/- 13.07 years. Among these patients, 80.60% had been exclusively under ambulatory care and 19.40% had been hospitalized at least once. The main categories of the available diagnoses were listed according to recurrence: acute psychotic disorders (20.68%), schizophrenia (17.25%) and depression (15.13%). In the men, the main diagnosis was acute psychotic disorders, whereas depression came top of the list for women. In the present state of socio-economic and cultural development in Burkina Faso, we note that only very serious mental disorders and/or those who cannot obtain favourable response with the traditional care system, come to medical centers. Therefore, there is a need to investigate the population as a whole, and to assess their need for medical care in this domain.

Prevalence of common gastrointestinal nematode parasites in scavenging pigs of different ages and sexes in eastern centre province, Burkina Faso

The range and infestation intensities of gastrointestinal parasitic nematode species depend on the type of swine production system. The present study focused mainly on nematodes of veterinary importance in scavenging pigs in Burkina Faso, and aimed at determining the prevalence of gastro-intestinal nematode parasites by means of faecal egg per gram (EPG) counts. Between November 2001 and October 2002, faecal samples from 383 pigs of different sexes and ages (< 5 months, 5-12 months and > 12 months) were collected from the rectum and examined for gastrointestinal nematodes parasites using the Mc Master method. Of the 383 pigs examined, 91% were infected by one or more parasites. Ascaris suum (40%; 100-1 400 EPG) was the most prevalent parasite followed by Strongyloides ransomi (21%; 100-4200 EPG), Oesophagostomum spp. (18%; 100-1000 EPG), Hyostrongylus rubidus (11%; 100-1 800 EPG), Globocephalus spp. (10%; 100-400 EPG) and Trichuris suis (1 %; 100-200 EPG). The prevalence was significantly higher in female pigs (n = 239) than in males. In addition, females excreted significantly (P < 0.05) more eggs in their faeces than males, except in the case of Globocephalus spp. The age of the animal had no effect on the prevalence of A. suum whereas there were significant differences in age categories concerning S. ransomi, H. rubidus, Oesophagostumum spp. and Globocephalus spp. Unexpectedly, the high prevalence of these common parasites was not accompanied by elevated EPG values, which suggests the existence of moderate infestations. The present work indicates that the common nematode infestations in pigs do not necessarily need a systematic herd anthelmintic treatment, as only a small number of worms is required to induce immunity. A further study is needed to formulate appropriate and cost-effective strategies for the control of gastro-intestinal nematode parasites in pigs in Burkina Faso.

Model-based evaluation of an on-line control strategy for SBRs based on OUR and ORP measurements

Application of control strategies for existing wastewater treatment technologies becomes necessary to meet ever-stricter effluent legislations and reduce the associated treatment costs. In the case of SBR technology, controlling the phase scheduling is one of the key aspects of SBR operation. In this study a calibrated mechanistic model based on the ASM1 was used to evaluate an on-line control strategy for the SBR phase-scheduling and compare it with the SBR's performance using no control strategy. To evaluate the performance, reference indices relating to the effluent quality, the required energy for aeration and the treated wastewater volume were used. The results showed that it is possible to maintain optimal SBR performance in the studied system at minimal costs by on-line control of the length of the aerobic and anoxic phases.

An on-line optimisation of a SBR cycle for carbon and nitrogen removal based on on-line pH and Our: the role of dissolved oxygen control

A pilot plant sequencing batch reactor (SBR) was applied in a wastewater treatment plant treating urban wastewater focused on carbon and nitrogen removal. From an initial predefined step-feed cycle definition, the evolution of the on-line monitored pH and calculated oxygen uptake rate (OUR) were analysed in terms of knowledge extraction. First, the aerobic phases of the SBR cycle were operated using an On/Off dissolved oxygen (DO) control strategy that concluded with a sinusoidal pH profile that made detecting the "ammonia valley" difficult. After changing to fuzzy logic control of the dissolved oxygen and by adding an air flow meter to the pilot plant, the pH evolution and on-line calculated OUR showed a clearer trend during the aerobic phases. Finally, a proposed algorithm for adjusting the aerobic phases of the SBR for carbon and ammonia removal is presented and discussed.

[Myocardial localization of a disseminated cysticercosis. Echocardiographic diagnosis of a case]

Cysticercosis (cysticercus cellulosoe) is a parasitic infestation of human by a larval form of Taenia solium. The localisations are mostly the central nervous system, skeletal muscles and subcutaneous tissue, but other organs can be concerned. Myocardial cysticercosis is an extremely rare infection. We report a case of myocardial cysticercosis in a 37 year old patient who presented a disseminated form. The myocardium involvement is diagnosed by echocardiography. The clinical and echographic evolution was favourable after a treatment with albendazole. The other cardiovascular manifestations described in the literature are discussed.

[Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso]

BACKGROUND

The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order

METHODS

A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained.

RESULTS

Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002).

CONCLUSIONS

These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.

[Pityriasis rosea in secondary schools in Ouagadougou, Burkina Faso]

BACKGROUND

Pityriasis rosea is a spontaneously regressive benign erythematous squamous dermatosis. A better understanding of this condition in developing countries would be useful.

PATIENTS AND METHODS

We conducted a cross section study based on one-day surveys in Ouagadougou, Burkina Faso, secondary schools. The stratified cluster sampling method described by Henderson was used. Six thousand pupils were examined to collect epidemiology and clinical data and to determine the presence of complications and results of complementary explorations performed.

RESULTS

Thirty-six cases of pityriasis rosea were observed (0.6 p. 100). Prevalence was higher in children from an unfavorable social and economic background. A typical eruption was often observed with classical localizations and morphology in 86.1 p. 100 of the cases. Pruritus was often observed with an inaugural lesion (61.1 p. 100) predominantly on the upper limbs (54.6 p. 100) and the trunk (31.8 p. 100) measuring 1 to 3 cm. A typical second eruption was found in most cases, situated on the trunk (75 p. 100), distal portions of the limbs (64.4 p. 100), proximal portions of the limbs (33.3 p. 100) and the neck (30.5 p. 100). The eruption evolved for 1 week to 1 month in most cases (61 p. 100). In 55.5 p. 100 of the cases, therapeutic abstention was the rule. Secondary treatment-related complications occurred in 38.9 p. 100 of the cases. Stool studies generally demonstrate ameba cysts. Syphilis serology was negative.

DISCUSSION

Our sampling technique in the secondary school setting provided a representative sample of the urban population of African cities. This work demonstrated the variability of prevalence by social and economic conditions and is in favor of an infections cause, demonstrating several similar features with other series reported in the literature. Generally, a stool study is not necessary and syphilis serology is negative in typical cases. Health care workers should be more aware of pityriasis rosea in order to avoid poorly adapted treatment.

1H-nmr study of water dynamics in hydrated collagen: transverse relaxation-time and diffusion analysis

Water proton transverse relaxation times (T2) and self-diffusion coefficients (D) were measured in randomly oriented hydrated collagen fibers. Three T2 relaxation times were discerned indicating the presence of at least three water fractions in the collagen sample. The D values associated with each water fraction were determined. The diffusion time dependence of D suggests water motion is restricted by macromolecular structure. The experimental results are discussed with reference to the structural properties of hydrated collagen fibers.

Oxygen reactive radicals production in cell culture by okadaic acid and their implication in protein synthesis inhibition

Okadaic acid (OA), a diarrhetic shellfish toxin is a potent promoter of tumours in mouse skin and a specific inhibitor of protein phosphatases 1 and 2A. Recently it has been shown that OA inhibited protein synthesis in a cell-free system, with 50% inhibitory concentration of 6.3x10(-12) M but the mechanism whereby this inhibition is mediated was still unclear. In the present study, the effect of OA on protein synthesis in Vero cell cultures was investigated. Protein synthesis was inhibited by OA alone in Vero cells in a concentration-dependent manner (IC50=27 ng/ml i.e. 3. 3x10(-8) M). Since OA also induced lipid peroxidation and likely oxygen reactive radicals, it was interesting to know whether these radicals impair the protein synthesis process. Therefore, SOD+catalase known as scavenger of active oxygen radicals were added in the culture medium in the presence of OA and labelled leucine. These enzymes partially prevented the inhibition of protein synthesis induced by OA, indicating that the formation of high reactive oxygen free radicals could be one of the pathways this marine toxin induces its toxicity. Since the prevention by SOD+catalase was only partial (the IC50 increased from 27 ng/ml to 48 ng/ml i.e. 3.3x10(-8) M to 5.9x10(-8) M) it was speculated that the production of oxygen reactive radical scavengered by SOD+catalase is not the main mechanism whereby OA induces its cytotoxicity. Vitamins E and C completely prevent the lipid peroxidation induced by OA in cells, but failed to reduce the inhibition of protein synthesis to the same level, indicating that a more specific mechanism might be responsible for protein synthesis inhibition. That is the hyperphosphorylation of elongation factor EF-2 in the protein synthesis machinery. However our results pointed to lipid peroxidation being a precocious phenomenon following the OA exposure, since a concentration with enhanced MDA production was lower than that inducing significant cellular protein synthesis inhibition.

Variations in the distribution of okadaic acid in organs and biological fluids of mice related to diarrhoeic syndrome

Okadaic acid (OA) is the main toxin produced by dinoflagellates which can accumulate in the hepatopancreas of mussels and cause diarrhetic shellfish poisoning in consumers. This toxin is also a tumour promoter and a specific potent inhibitor of protein phosphatases 1 and 2A. No specific target organ is known for this toxin. This study concerns the distribution of [3H]OA in organs and biological fluids of Swiss mice having received a single dose per os of AO (50 microg/kg). The determination of the toxin extracted from mouse organs 24 h after administration of [3H]OA and derivatised with 9-anthryldiazomethane (ADAM) before HPLC and fluorescent detection showed the highest concentration in intestinal tissue and stomach. This distribution was even more pronounced in intestinal tissue, when animal were given per os 90 microg/kg which induced diarrhoea. The high concentrations of [3H]OA in intestinal tissues and contents 24 h after administration demonstrates a slow elimination of OA. When the dose of OA was increased from 50-90 microg/kg, the concentrations of the toxin in the intestinal content and faeces increased proportionally. A good correlation was found between an increase of OA in the intestinal tissue and the diarrhoea in animals given 90 microg/kg orally. Moreover OA was present in liver and bile and in all organs including skin and also fluids. Altogether these results confirmed an enterohepatic circulation of OA as previously shown. These data also revealed that in acute OA intoxication the concentration of the toxin in the intestinal tissues reaches cytotoxic concentrations in accordance with the diarrhoea which is the main symptom of OA poisoning.