[Efficacy of sodium hydroxide at 2.5 %, chlorhexidine gluconate at 0.5 % and calcium hydroxide against Candida albicans]

INTRODUCTION

Endodontic flora is dominated in the apical part of the channels by strict anaerobic and some facultative anaerobic bacteria but also by Candida yeasts, especially Candida albicans species that are involved in the maintenance and persistence of endodontic infections. Their elimination of the canal system in practice by chemo-mechanical methods of disinfection is not always guaranteed. Thus, this in vitro study was performed to determine the sensitivity of C. albicans with sodium hypochlorite (NaOCl) dosed at 2.5 %, the chlorhexidine digluconate 0.5 % and calcium hydroxide used in inter-session medication.

METHODS

The diffusion method was used initially to test the sensitivity of C. albicans strains with the above products. Then a dilution technique has allowed us to determine the minimum inhibitory concentration of these active products on C. albicans.

RESULTS

Strains from infected pulp teeth of patients showed a sensitivity of C. albicans to sodium hypochlorite to a minimum inhibitory concentration less than 70μg/mL and 30μg/mL for chlorhexidine.

CONCLUSION

This study demonstrated a sensitivity of C. albicans to sodium hypochlorite and chlorhexidine.

[Etiology of vaginal infections in Ouagadougou (Burkina Faso)]

OBJECTIVE

to determine the specific antimicrobial activity of the drugs proposed in the national algorithm for treatment of vaginal infections.

METHOD

Over a three-month period, the bacteriological laboratory of the Yalgado-Ouédraogo University Hospital in Ouagadougou analyzed vaginal swabs from women seen at 5 health-care facilities in that city.

RESULT

The study included 404 women with a mean age of 29 years. The microbes with the highest incidence rates were various species of Candida (20%), Gardnerella and/or Mobiluncus (18.8%), and Ureaplasma/Mycoplasma (10.9%). The agents isolated were highly susceptible to ciprofloxacin, erythromycin, fluconazole, miconazole, and nystatin.

CONCLUSION

This study demonstrated the continuing efficacy of the drugs in the national algorithm for treatment of vaginal infections, which is associated with compliance with the recommended diagnostic procedure and therapeutic protocol.

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases]

PURPOSE OF THE STUDY

To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health.

PATIENTS AND METHOD

We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study.

RESULTS

The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it.

CONCLUSION

Regardless of the anatomical and functional results, all women were satisfied with respect to body found.

[Prevalence of fixed prosthesis-related periodontitis in Senegal]

The purpose of this study was to determine radiographically the prevalence of periapical periodontitis in teeth restored with crown in a Senegalese population. Full mouth periapical radiographs were obtained from 208 consecutive adult patients (6234 teeth) presenting as new patients to the Dental Service of the University. The presence of crown restorations, the periapical status and technical quality of root fillings associated were evaluated. 7.69% (n = 16) of patients had at least one tooth that was crowned. The total number of crowns assessed was 0.95% (n = 59). The molars were the teeth most crowned 40.67% (n = 24) followed by anterior teeth 30.50% (n = 18) and premolars 28.81% (n = 17). All the crowned teeth had previous root canal treatment of which only 16.94% (n = 10) were acceptable. 53 % (n = 32) of the teeth had apical periodontitis (PAI > 2). Unacceptable root fillings were associated with a higher prevalence of periapical disease (p < 0.05). Crown with a post extending more than 4 millimetres from the apex were associated with more periapical lesions 64.28% (p < 0.05). The results indicate a low prevalence of crowned teeth, an absence of vital preparation, a high prevalence of radiographic periapical disease and unacceptable root fillings associated.

[Evaluation of the canal shaping duration with Pro Taper: 50 cases--clinical experience]

INTRODUCTION

Shaping canal is one of the most important steps in endodontic treatment. It allows the cleaning solutions to reach the totality of the canal and to control any infection of the canal system. To achieve this goal is not without difficulty with the steel instruments, because of their rigidity. Recently, the Nickel Titanium instruments were introduced in Endodontics, to allow a setting form technically simplified and faster The aim of this study was to evaluate the duration of the canal shaping with the Pro Taper system.

MATERIALS AND METHODS

This exploratory study was carried out in Conservative Odontology and Endodontics service (OCE) of the department of Odontology of Faculty of Medicine, Pharmacy and Odonto-Stomatology of the University CheikhAnta Diop of Dakar in 2006. Sixty nine root canals (50 teeth) were shaped with ProTaper.

RESULTS

The results showed that an average time of 17.35 minutes was necessary for the shaping of the long canals against 15.38 minutes for the middle canals and 14.29 minutes for the short canals. The average duration of canal shaping of the one-root teeth is 13.76 minutes and 17.77 minutes for the plural root teeth.

CONCLUSION

Taking into account the necessity of maintaining the teeth on the arcade during long year; include that we have now to respect imperatively the biological principles during the canal shaping in a restricted duration to realize a dense and hermetic canal obturation of the canal system in the same meeting. The Pro Taper system is so a reliable means.

[Radiographic study of the canal anatomy of mandibular premolars in a Senegalese population]

AIM

The purpose of this study was to assess the canal anatomy of mandiblar premolars in Senegalese population.

MATERIALS AND METHODS

Retroalveolar radiographs of mandibular premolars of 208 patients in Senegal were obtained. Two experienced practitioners using a long cone tube and the parallel plane technique with angulators took the radiographs. The canal morphology of each tooth was determined in terms of the number of canals radiologically visible to the apex. Any anatomic structure emanating from the pulp chamber or the principal canal to the apex and measuring more than 3 millimetres was considered to be a supplementary canal.

RESULTS

For the 208 patients studied, 412 first premolars were present and 4 were absent.Among the 412 teeth, 335 (81.3%) had a single canal, 62 (15.1%) 2 canals, and 17 (3.6%) 3 canals. For the second premolars 408 were present. Of the 408 teeth, 352 (86%) had one canal, 49 (12%) 2 canals, and 8 (2%) 3 canals.

CONCLUSION

The prevalence of two or more canals in premolar mandibular from Senegalese patients was similar to that found in the others ethnic population.

Prevalence and technical quality of root fillings in Dakar, Senegal

AIM

To examine the prevalence and technical quality of root fillings and the periapical status of root-filled teeth in a subpopulation of Dakar, Senegal.

METHODOLOGY

Full-mouth periapical radiographs were obtained from 208 consecutive adults presenting as new patients to the Dental Service of the University. The occurrence and technical quality of root fillings were assessed for each root according to the apical extent of the root fillings and its density. The periapical status was evaluated using the Periapical Index Scoring System with a PAI > 2 indicating periapical disease. The presence of coronal restorations and posts was also noted. Statistical analysis was performed with the chi-square test with a significance level set at P < 0.05%.

RESULTS

Of the 6234 teeth examined, 2.6% were root filled. A PAI > 2 was associated with 56.1% of the filled roots. Only 17.7% of the root fillings were technically acceptable and 26.2% of these were associated with a PAI > 2. In roots with unacceptable root fillings, 62.5% had a PAI > 2. Unacceptable root fillings were associated with a higher prevalence of periapical disease (P < 0.001). A post was seen in 18.9% of the filled roots with 66.2% associated with a PAI > 2. A permanent coronal restoration was present in 78.5% of the filled roots, of which 50.7% had a PAI > 2 vs 75.7% for no permanent restoration. At least one periapical lesion was seen in 59.6% of the subjects.

CONCLUSION

The results indicate a low prevalence of teeth with radiographic periapical disease, a low prevalence of root-filled teeth and a high prevalence of unacceptable root fillings.

[Yaws in Côte d'lvoire: health problem forgotten and neglected]

Yaws is endemic in Côte d'Ivoire, with an hospital incidence estimated by the medical statistics at 0.58 per thousand in 2000; cases of yaws were notified in all medical districts. This study describes the yaws situation in Côte d'Ivoire based on available hospital statistics and a cross section investigation. The yaws diagnoses during the investigation were based on clinic lesions. The yaws prevalence found at the end of the investigation was 5 per thousand: the majority of the patients were children under 15 years old (82%) and male (91%). Only 27% of diagnosed patients had a medical treatment at the time of the study. Yaws is still endemic in Côte d'Ivoire which underlines the need for an implementation of a national control strategy.

[Acceptability of HIV screening in patients suffering from sexually transmitted infections at the antiveneral center of Abidjan, Côte-d'Ivoire]

The systematic screening in high risk groups can be an efficient way to struggle against HIV/AIDS. We have conducted a transversal descriptive study in patients suffering from STI and who had consulted the antiveneral dispensary of the Institut National de Santé Publique (Abidjan) from 1st September 2002 to 31st October 2002. The aim was to identify the acceptability of the HIV screening test. During this inquiry, 167 patients were recruited. This study permits to confirm the young age of the population with a male predominance in patients having sexual transmitted infections. So, 70.1% have accepted to do this test. However, 23.4% of patients recruited had really done the HIV test. Among those who have accepted to do the test, 28.2% were infected.

Identification des dysfonctionnements dans la prise en charge de la morbidité maternelle grave à Abidjan (Côte d'Ivoire)

A study was carried out using a clinical audit aimed at identifying the dysfunctions in the care of female patients with serious morbidity. The study was done at the University Hospital of Cocody (CHU de Codody) and in the health training unit in the southern part of Abobo (Abidjan) from January to May 2000. The study allowed us to track and record the frequency of women who nearly died (40.4%) in both of the sites during the period of the study. Malfunctions were found at all stages of the female patients' care. The provision of medical care during the patients' hospitalisation and care provided in the emergency room were the cases and situations wherein the most frequency was noted, with 42.8% and 39.6% of dysfunctions found respectively. The delay for patients to wait to receive care was long, varying from 80 minutes to 5 days coupled with a lack of follow-up and surveillance of patients. This data demonstrates the inadequacy of the quality of obstetrical care.

[Prevalence of non carious dental lesions in the department of Dakar]

Non carious dental lesions are destructions of dental external surfaces originating from non bacterial cause in opposition to dental caries. We distinguish 5 types of non carious dental lesions: attrition, abrasion, abfraction, erosion and demastication. These lesions may be pathological or physiological. Data dealing with them are not very numerous in the literature. Their study shows a real interest in conservative dentistry because of problems both aesthetic and functional they set We carried out an epidemiological trial in the department of Dakar with as aim providing data on the prevalence of these lesions. Our results have disclosed the following rates of prevalence: 60% of attrition, 25,55% of abrasion, 7,22% of abfraction, 5,55% of demastication and 1,68% of erosion. The results indicate once more the importance of the need for clinical evaluation of those dental lesions.

Risk factors for maternal mortality: Results of a case-control study conducted in Conakry (Guinea)

OBJECTIVE

To assess the risk factors of maternal mortality in an urban area of West Africa (Conakry, capital of Guinea).

METHOD

A case-control study where 102 maternal deaths were compared with 338 control women who had given birth and survived, during 1 year (from July 1, 1989 to June 30, 1990).

RESULT

Of all the socio-demographic variables studied, only a low family income (R = 2.6; 1.1-6.5) was found to be a risk factor for maternal death In the obstetrical part of the survey, neither parity nor the number or location of pre-natal consultations constituted risk factors. However, the presence during pregnancy or delivery of signs of infection (R = 3.7; 1.4-9.8), anemia (R = 2.1; 1.1-4.1), hypertension (R = 19.8; 5.8-67.8) and dystocia (R = 9.0; 3.7-21.5) were found to be the main predictive risk factors of maternal death. The maternal mortality risk was multiplied by 12 if the women had had a cesarean section, and by 4 in the case of complications in the post-partum period.

CONCLUSION

To achieve substantial reductions in maternal mortality levels, work must be done on these specific risk factors, and future programs must urgently be concentrated on a higher standard of pre-natal monitoring, obstetrical emergency facilities and training of obstetrical staff.

[Assessing severe maternal anemia and its consequences: the value of a simple examination of the coloration of palpebral conjunctiva]

The aims of this study were: (1) to investigate the relationship between pre-delivery hemoglobin (Hb) concentration and the outcome of the pregnancy for the mother and child and (2) to assess the extent to which the pallor of the conjunctiva indicates severe anemia in pregnancy (Hb < 7 g/dl). We carried out a prospective study in 1995, in the maternity department of the National Sourô Sanou Hospital (Bobo-Dioulasso, Burkina Faso). Women arriving to give birth at the maternity unit gave verbal consent and underwent a physical examination including the assessment of conjunctiva coloration. Finger-prick blood samples were taken from all the women selected and Hb was determined with a portable hemoglobin meter (HemoCue AB, Sweden). For each woman, information about age, obstetric history, the condition of mother and child at admission and delivery and any post-delivery complications in the first 48 hours was collected before discharge from the maternity unit, 3 to 5 days after the delivery. Women with multiple pregnancies were excluded from the study and 247 women were included overall. Endometriosis was observed in only three cases. Three women died, two due to septic shock. The third woman died from hypovolemic shock. The Hb concentrations of these women were 8 g/dl, 10.2 g/dl and 2.6 g/dl respectively. The mean Hb concentration for our population was 10.1 g/dl (SD = 2.08), with 165 women (67%) having less than 11 g Hb/dl. Forty-one women (17%) had less than 9 g Hb/dl and 16 (6%) had less than 7 g Hb/dl. Severe maternal anemia and pallor of the conjunctiva were significantly associated with pre-term delivery and perinatal death, but not with low birth weight. The sensitivity of the pallor of the conjunctiva for detection of severe maternal anemia was 87%, and its specificity was 88%. We found no evidence that maternal Hb levels of 9 to 10.9 g/dl were associated with a high risk of poor pregnancy outcome for either the mother or the child, although women with such levels of Hb are classed as anemic by the World Health Organization criteria. These results show that poor pregnancy outcome is associated with severe maternal anemia. Examination of the coloration of the conjunctiva is a suitable and affordable screening method for the detection of severe anemia. Mothers with severe anemia present with signs and symptoms of anemia and could therefore be given iron treatment to improve their health. This demonstrates the importance of nutritional intervention during pregnancy.

[Eighty cases of uterine rupture at the maternity service of the National Hospital Center of Ouagadougou , Burkina Faso]

In this retrospective study, we recall the frequency of uterine ruptures within a national health center of West Africa and propose solutions in order to reduce the incidence. This very high frequency was 23/1000, i.e. one uterine rupture for 44 deliveries. The feto-maternal prognosis was poor with a high stillbirth rate and maternal mortality. Maternal mortality which was 35% of cases represented 22.7% of the causes of maternal mortality observed within the unit during the survey. The stillbirth rate was 95% representing 145/1000 of the hospital stillbirth rate recorded during the survey. Maternal morbidity was also high because 14% of those who survived presented a parietal suppuration with the release of suture during the immediate postsurgical period. The seriousness of the feto-maternal prognosis is linked to a lack of adequate patient management. The importance of uterine ruptures in the obstetrical activity of the unit needs a joint and urgent action of all intervening parties within the sanitary system in order to contend with this scourge, which is the sign of poor quality health care in Obstetrics.

[Female sterilization in Burkina Faso. Report of 142 cases]

Through a transversal study over a twelve month period, the authors report 142 cases of female sterilization (FS) in Burkina Faso. The aims of this study were to determine the profile of women undergoing FS and to precise the indications and the immediate outcome. The study took place in the two main gynecologic and obstetric units of the country. Various data about the socio-demographic characteristics of the women, their reproductive history, the indications for the FS and the short term follow up were recorded. The woman undergoing tubal ligation (TL) is 36 years old, gravida 7 para 7 with 5 children (3 boys for 2 girls). Her occupation is housewifery, she is married and is illiterate in 84.4% of the cases. This woman has no prior history of contraceptive use in 71% of the cases. FS was performed for medical reasons in 50% of the cases whereas economic reason was invoked by only 5% of the couples. Prior to the TL oral informed consent was obtained from both the woman and her husband. The TL was performed during caesarean section in 55.6%, in the postpartum period in 34.5% of the cases. Two wound abscesses occurred. With a follow up ranging from 2 to 14 months, no pregnancy has been reported. To give a chance to FS to be popular in Burkina Faso, the authors made some suggestions.

[Male breast cancer in Africa, Apropos of 5 cases at the Ouagadougou University Teaching Hospital (Burkina Faso)]

A retrospective study of male breast cancer was undertaken at Ouagadougou University Teaching Hospital over a 3 year period (1993-1996). Authors report 5 cases representing 4.16% of all breast cancers. The patients' mean age was 61 years. The average duration of signs and symptoms before the diagnosis was 13 months. Clinically all the 5 cases presented advanced cancers (4 T4N2M0, 1 T4N2M1 according to UICC TNM System) with size ranging from 5.5, to 11.5 cm. Histology found: 2 medullary infiltrating carcinoma, 1 canalar infiltrating carcinoma, 1 colloid mucous carcinoma and 1 lobular infiltrating carcinoma. All patients had mastectomy associated with axillary clearance in 4 cases. Radiotherapy, chemotherapy and hormonotherapy were not associated because unavailable in Burkina Faso. Three patients died: the first, 10 days after surgical treatment and the 2 others respectively after 14 and 17 months. We have lost sight 1 patients. The last one is still alive. Authors find that to get better prognosis, it is important to improve medical and technical means, to increase information and to promote early detection.

Voluntary female sterilisation via minilaparotomy: report from Burkina Faso

We present the first study of voluntary female sterilisation in Burkina Faso. The average woman undergoing tubal ligation was a 37 year old, married, house wife para 8 with five living children. The main reasons for TL were: achieved desired family size (45.9%) and medical reason (29.5%). The TL was usually performed (77.8%) in the postpartum, using the Pomeroy technique. With a follow up of three to fifteen months, no pregnancy has been reported and no request for reversal expressed. The authors make some suggestions to increase the prevalence of TL in Burkina Faso.