COVID-19 New Cases and Environmental Factors During Wet and Dry Seasons in West and Southern Africa

Sub-Saharan Africa has been the last continent to experience a significant number of cases in the novel Coronavirus (COVID-19). Studies suggest that air pollution is related to COVID-19 mortality; poor air quality has been linked to cardiovascular, cerebrovascular, and respiratory diseases, which are considered co-morbidities linked to COVID-19 deaths. We examine potential connections between country-wide COVID-19 cases and environmental conditions in Senegal, Cabo Verde, Nigeria, Cote D'Ivorie, and Angola. We analyze PM2.5 concentrations, temperatures from cost-effective in situ measurements, aerosol optical depth (AOD), and fire count and NO2 column values from space-borne platforms from 1 January 2020 through 31 March 2021. Our results show that the first COVID-19 wave in West Africa began during the wet season of 2020, followed by a second during the dry season of 2020. In Angola, the first wave starts during the biomass burning season but does not peak until November of 2020. Overall PM2.5 concentrations are the highest in Ibadan, Nigeria, and coincided with the second wave of COVID-19 in late 2021 and early 2022. The COVID-19 waves in Cabo Verde are not in phase with those in Senegal, Nigeria, and Cote, lagging by several months in general. Overall, the highest correlations occurred between weekly new COVID-19 cases meteorological and air quality variables occurred in the dry season.

Effects of therapies for Ebola virus disease: a systematic review and network meta-analysis

BACKGROUND

Specific treatments targeting Ebola virus are crucial in managing Ebola virus disease. To support the development of clinical practice guidelines on medications for Ebola virus disease, we aimed to evaluate the efficacy and safety of therapies for patients with Ebola virus disease.

METHODS

In this systematic review and network meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, Global Health, African Index Medicus, World Health Organization Global Index Medicus, the Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, Epistemonikos, bioRxiv, medRxiv, and SSRN without language restrictions for randomised controlled trials (RCTs) published between database inception and Jan 1, 2022, comparing at least one therapeutic agent for Ebola virus disease against standard care or another therapeutic agent for Ebola virus disease. Two reviewers assessed study eligibility and extracted summary data independently using a standardised form. Our outcomes of interest were mortality, adverse maternal outcomes, risk of onward transmission, duration of admission to a health-care facility, functional status after Ebola virus disease, serious adverse events from medication, adverse perinatal outcomes, time to symptom resolution, and time to viral clearance. We did frequentist network meta-analyses to estimate the effect of all interventions and applied the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of the evidence. We registered the protocol with PROSPERO, CRD42022296539.

FINDINGS

We identified 7840 records through database searches, of which two RCTs with a total of 753 patients proved eligible. Only data on mortality, the duration of admission, serious adverse events, and time to viral clearance were available for meta-analysis. Compared with standard care, REGN-EB3 (relative risk [RR] 0·40, 95% CI 0·18 to 0·89; moderate certainty) and mAb114 (0·42, 0·19 to 0·93; moderate certainty) probably reduce mortality. Whether ZMapp (0·60, 0·28 to 1·26; very low certainty) and remdesivir (0·64, 0·29 to 1·39; very low certainty) reduce mortality compared with standard care is uncertain. With high certainty, REGN-EB3 reduces mortality compared with ZMapp (0·67, 0·52 to 0·88) and remdesivir (0·63, 0·49 to 0·82). With high certainty, mAb114 also reduces mortality compared with ZMapp (0·71, 0·55 to 0·91) and remdesivir (0·66, 0·52 to 0·84). Compared with standard care, REGN-EB3, mAb114, ZMapp, and remdesivir might have little or no effect on the time to viral clearance (mean difference ranged from -0·25 days to -1·14 days; low certainty). ZMapp might reduce the duration of admission compared with standard care (mean difference -2·02 days, 95% CI -4·05 to 0·01; low certainty). Findings for all comparisons suggested that there might be little or no difference in the prevalence of serious adverse events, but certainty was low or very low in all comparisons but one.

INTERPRETATION

REGN-EB3 and mAb114 separately reduce mortality compared with ZMapp, remdesivir, or standard care in patients with Ebola virus disease. These findings suggest that health-care workers should prioritise the use of REGN-EB3 and mAb114 for patients with Ebola virus disease during future outbreaks.

FUNDING

WHO.

[Epidemiological and clinical aspects of atrial fibrillation at the cardiology department of kati university hospital]

Atrial fibrillation is the most frequent permanent rhythm disorder.Theaim of this work was to determine the epidemiological and clinical aspects of atrial fibrillation cases hospitalized in the cardiology department of the University Hospital of Kati.

MATERIALS AND METHODS

We carried out a descriptive retrospective study, from January 2018 to December 2019.Patients of all ages and both sexes with clinical and EKG atrial fibrillation admitted to the department during the study period were included in the study.The variables studiedwere: socio-demographic characteristics, clinical signs, classification of atrial fibrillation, and comorbidities associated.

RESULTS

A total of 52 patients were included in the studyof 203 cases hospitalized in the department, with a hospital prevalence of 25.61%, the female sex was predominant 69.23%. The main reason for consultation was heart failure syndrome (46.15%).Arterial hypertension (55.76%) was the mostassociatedcomorbidity. Permanent atrial fibrillation accounted for 63.46% of cases .

CONCLUSION

Atrial fibrillation is the most frequent arrhythmia in our environment, preventive measures must be put in place for early detection and better management of comorbiditiesassociatedwith atrial fibrillation.

Rapidly rising cases with omicron In Senegal

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Omicron variant continues to progress in Senegal with the appearance of new contaminations.

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IRESSEF detected the first positive case of the Omicron variant on Friday, December 3, 2021.

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Since this date, the number of Omicron variant infections has increased over the weeks.

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Molecular surveillance of the Omicron variant is carried out in real time to inform the medical authorities.

[Ct scan diagnosis of polyostotic fibrous dysplasia with maxillofacial dysmorphia: a case report]

We report a rare case of polyostotic fibrous dysplasia with maxillofacial dysmorphia diagnosed in the radiology department at Hopital Sominé Dolo of Mopti. The aim was to describe the role of medical imaging including the CT scan in its diagnosis. He was a 42-year-old man of rural origin with poor socio-economic conditions. He was sent to us for a craniofacial CT scan for assessment of a maxillofacial mass. This CT scan showed a thickening of the diploid of the vault and the cranial base with osteocondensation and osteolytic lesions at the maxillofacial level. An extension assessment showed polyostotic involvement. His diagnosis is based on medical imaging and in particular CT scan. Three types of radiological aspects are evocative: a homogeneous or heterogeneous clarity, a smoke-like appearance and a slightly condensed appearance. Complications observed were deformities, fracture of the femoral neck and aesthetic damage.

[Surgery wound infection at surgery "A" department of the University Hospital Point G]

AIM

To determine the frequency of the surgery wound infection, its favoring factors, causative germs and its antibiotic treatment of choice in the surgery "A" department of the University Hospital Point G.

METHOD

In a retrospective descriptive study over a 6-month period in the surgery "A" department of the University Hospital Point G, we enrolled all patients who underwent surgery necessitating at least 48 hours of hospital admission during our study period and in conformity with the Atlanta CDC criteria. Surgery patients with less than 48 hours postoperative hospital stay and those admitted to the hospital without surgery were not included.After the surgery, the nature and location of the infection have been clarified. In this work, ethical considerations have been respected and there is no conflict of interest.

RESULTS

Two hundred and sixty-five (n=265) patient files were collected including 24 cases of surgery wound infection (a hospital frequency of 9%. The average age was 41.41 years (y.o) old with extremes of 7 y.o and 102 y.o. The sex ratio was 0.9 in favor of women. The commonly studied pathologies were digestive surgery in 52.8%, gynecological surgery in 24.5%, etc… Patients were seen in regular outpatient surgery visits in 75.8% and surgical emergencies in 24.2%. Of the patients urgently admitted, 26.5% presented an ISO; for those received in ordinary consultation it was 3.48%. Fifteen (15) cases were classified ASA III and two (2) ASA II. Based on the Altemeier classification, surgery was clean in 66.8% of our patients, contaminated clean in 12.4%, contaminated in 12.1%, and dirty in 8.7% (including half resulting in surgery wound infection). In total, 79% of patients whose surgeries lasted more than two (2) hours presented a surgery wound infection. Postoperative infection of patients was superficial in 58.3% and deep in 33.3%. In 8.3% of cases, it was a space infection. At the cytobacteriological examination of the pus from the operative site, Escherichia coli (E. coli) was the most common germ with 58.3%. E. coli was sensitive to amoxicillin-clavulanic acid in 57.14%. Surgically, a re-intervention was performed in 20.8% of cases, a secondary suture in 12.5%, and a single dressing in 66.7%. The average postoperative stay was 6.5 days with extremes of 2 days and 69 days. In 3 months postoperatively we recorded 4 cases of death.

CONCLUSION

The surgery wound infection constitutes a major complication in a surgical environment starting with surgical act itself.Particular emphasis should be placed on prevention, which will reduce the risks of ISO occurrence.

A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics

BACKGROUND

Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.

METHODS

We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase-polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.

RESULTS

A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P = 0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P = 0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.

CONCLUSIONS

Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM ClinicalTrials.gov number, NCT03719586.).

Hot topic: Selecting cattle for low residual feed intake did not affect daily methane production but increased methane yield

Reducing enteric methane (CH₄) production and improving feed conversion efficiency of dairy cows is of high importance. Residual feed intake (RFI) is one measure of feed efficiency, with low RFI animals being more efficient in feed conversion. Enteric CH₄ is an important source of digestible energy loss in ruminants and, because research in beef cattle has reported a positive relationship between RFI and daily CH₄ production, we hypothesized that low RFI dairy heifers, which are more feed efficient, would produce less CH₄/d. We measured the daily methane production (g of CH₄/d), methane yield [g of CH₄/kg of dry matter intake (DMI)], and CH₄ per kilogram of body weight (BW) gain for 56 heifers (20-22 mo old) in a 2 × 2 factorial arrangement: factors included 2 breeds (Holstein-Friesian and Jersey; n = 28/breed), with equal numbers of animals previously determined as being either high [+2.0 kg of dry matter (DM)/d] or low RFI (-2.1 kg of DM/d; n = 28/RFI category). All heifers were commingled and offered unrestricted access to the same diet of dried alfalfa cubes. Between RFI categories, heifers did not differ in BW or BW gain but low RFI heifers had 9.3 and 10.6% lower DMI and DMI/kg of BW, respectively, than high RFI heifers. Similarly, RFI category did not affect CH₄/d or CH₄/kg of BWg, but CH₄/kg of DMI was higher in low RFI heifers because of their lower DMI. These results might reflect more complete digestion of ingested feed in the more efficient, low RFI heifers, consistent with previous reports of greater apparent digestibility of organic matter. Holstein-Friesian heifers were heavier and consumed more total DM than Jersey heifers, but breed did not affect DMI/kg of BW or BWg. Jersey heifers produced less CH₄/d, but not CH₄/kg of DMI or CH₄/kg of BWg. We detected no interaction between breed and RFI category in any of the variables measured. In conclusion, differences in RFI in dairy heifers did not affect daily CH₄ production (g/d); however, low RFI heifers had a greater CH₄ yield (g/kg of DMI) on a high forage diet.

[Impact of migraine on life quality in school environment in Bamako, Mali]

INTRODUCTION

Migraine is a disabiliting disease accounting for 3%. Its prevalence and impact on the schoolar population deserves to be known.

METHODOLOGY

This is a five-month cross-sectional and descriptive study of students under 23 years of age at the high school in Bamako, Mali. The sampling was exhaustive and the population was stratified into school classes. Data related to the impact and disability of migraine were collected from a survey sheet integrating internationally validated items (GRIM, MIDAS, Headache Impact Test).

RESULTS

The prevalence of migraine was 21.0%. The sex ratio was 0.58. The average age was 17 years. Headache was pulsatile in 88.3% of cases, exacerbated by physical activities in 5.4%, unilateral topography in 73.2% of students. Phonophobia, photophobia were the most described signs of accompaniment. The intensity of pain was between 9 -10 in 69.5%. School absenteeism was ranged from 1 to 14 days in 91.2% of cases.

CONCLUSION

Migraine is a real public health concern in schools in Bamako because of its prevalence and its impact on academic performance.

[Prescription And Delivery's Survey Of Benzodiazepines In The Occurrence Of Addictions At Mbour's District]

Impact of the prescription and delivery of benzodiazepines in the occurrence of addictions in the district of Mbour.

INTRODUCTION

Benzodiazepines (BZD) are widely used nowadays and are at the origin of an addiction.

OBJECTIVES

The objective was to evaluate the quality of benzodiazepine prescribing and delivery in the Mbour department of Senegal and subsequently to implement an addictovigilance strategy. Thus, we studied the prescribing habits, the quality of delivery and identified the consumption habits of these drugs.

MATERIALS AND METHODS

It was a cross-sectional, prospective study with two questionnaires: addressed to patients and prescribers, conducted in pharmacies, hospitals, districts and Mbour health posts.

RESULTS

44% of BZD prescriptions were prescribed by doctors and especially general practitioner. 31.1% did not comply with the rules of prescription (marketing authorization). As for the dispensing rules, (85.3%) were dispensed without a prescription. The level of consumption was high in the 30-40 age group (43.95%) predominantly female (59%). Insomnia predominated as a reason for prescription (16.4%) on anxiety (11.94%) with (65.5%) dependence.

CONCLUSION

The abuses observed in the prescription, the delivery and consumption of BZD, constitutes a real health problem. Half of the consumers become addicted, hence the need for a national addictovigilance program.

[Diagnosis and therapeutic aspects of the amoebic liver abscesses in the surgery at point "G" Hospital]

AIM

Our aim was to evaluate the diagnosis and therapeutic aspects of the amoebic liver abscesses in the surgery «A» department of the University hospital Point "G".

PATIENTS AND METHODS

Were included in this study, patients admitted to the surgery «A» department for amoebic liver abscess confirmed by a positive amoebic serology and the chocolate appearance of bacteria-free pus. Bacterial liver abscesses were not included into this study.

RESULTS

Over a 10-year period, 52 cases of patients diagnosed with amoebic liver abscess were collected in the department. There were 41 men and 11 women, with a sex ratio of 3.7. The mean age was 37.8 years old with extremes of 15 and 66 years. The most represented professions were farmers (36.5%) followed by salesmen (26.7%) and students (11.5%). The average outpatient visit delay time was 18.5 days with the extremes of 5 and 34 days. The most frequent clinical signs were pain in the right hypochondrium (86.5%), fever (78.8%) and hepatomegaly (61.5%). Abdominal ultrasound showed a single located abscess in 44 patients (84.6%) and these abscesses were localized in the right hepatic lobe in 34 patients(65.4%). The average volume of the abscess was 366.5 cm³ with the extremes of 36 cm³ and 1580 cm³. Amoebic serology was positive in 38 patients (80.9%). Cytobacteriological analysis of pus in 37 patients (71%) was negative. Patients underwent an ultrasound assisted needle aspiration of pus in 65.4% he. Laparotomy and a laparoscopic approach were performed in 7.7% and in 5.8%, respectively. The clinical course was uneventfulin 94.2%. The mean hospital stay duration was 16.5 days with the extremes of 4 and 29 days. No death was recorded during hospitalization.

CONCLUSION

Amoebic liver abscess is an uncommon pathology in a surgical setting. Abdominal ultrasound andechography guided liver puncture allowed the diagnosis. Laparoscopic approach minimizes the burden of the laparotomy.

Tibial tubercle torsion, a new factor of patellar instability

INTRODUCTION

External torsion of the anterior tibial tubercle (TT), defined as external rotation around a craniocaudal axis with respect to the posterior femoral condylar plane, may induce patellar instability. To our knowledge no studies have focused on this parameter. The present study aimed to perform an MRI analysis of TT torsion. The study hypothesis was that TT torsion correlates with patellar instability and with 3 of its components: tibial tubercle-trochlear groove (TT-TG) distance, axial engagement index of the patella (AEI), and patellar tilt.

MATERIAL AND METHODS

Four observers performed MRI measurements for 2 groups: 37 patellar instability patients (PI group) with history of at least 2 patellar dislocations, and 50 control patients with meniscal lesion but free from patellofemoral pathology. All measurements were taken from 2 axial slices with the posterior condylar plane as reference.

RESULTS

The intra-class correlation coefficient (ICC) was 0.88. TT torsion correlated with patellar instability, with a mean 5.8̊ in controls and 17.9̊ in the PI group (P<0.001). There were also excellent correlations between TT torsion and TT-TG distance, patellar tilt and patellar lateralization (measured by AEI), with correlation coefficients greater than 0.85.

DISCUSSION

TT torsion is a reproducible measurement, with excellent ICC. It is significantly correlated with patellar instability, with a discrimination threshold of 11.5̊, and correlations with all 3 components of instability. These statistical correlations enable TT torsion to be added to the list of patellar instability factors. Further studies should determine its biomechanical role and assess the contribution of associating TT derotation to medialization or distalization procedures.

LEVEL OF EVIDENCE

III; case-control study.

Chryseobacterium gleum in a man with prostatectomy in Senegal: a case report and review of the literature

BACKGROUND

Here we report a rare case of a urinary tract infection due to Chryseobacterium gleum. This widely distributed Gram-negative bacillus is an uncommon human pathogen and is typically associated with health care settings.

CASE PRESENTATION

We describe a case of urinary tract infection caused by Chryseobacterium gleum in a 68-year-old man of Wolof ethnicity (an ethnic group in Senegal, West Africa) who presented to our Department of Urology in a university teaching hospital (Hôpital Aristide Le Dantec) in Dakar, Senegal, 1 month after prostatectomy. The strain isolated from a urine sample was identified as Chryseobacterium gleum by mass spectrometry (Vitek matrix-assisted laser desorption/ionization, time-of-flight, bioMérieux) and confirmed by 16S ribosomal ribonucleic acid sequencing. The organism was resistant to a wide range of antibiotics, including carbapenem, due to a resident metallo-β-lactamase gene that shared 99% of amino-acid identity with Chryseobacterium gleum class B enzym.

CONCLUSIONS

Infection by Chryseobacterium gleum is infrequent, and no such case has been previously reported in Africa. Despite its low virulence, Chryseobacterium gleum should be considered a potential opportunistic and emerging pathogen. Further studies on the epidemiology, pathogenicity, and resistance mechanisms of Chryseobacterium gleum are needed for better diagnosis and management.

[Input of a laboratory in the management of patients with Ebola virus disease and in the training of health personnel: experience of the Forecariah Ebola treatment centre (Guinea) in 2015]

Ebola virus disease (EVD) is associated with a high lethality rate even when the afflicted are provided with good support in an Ebola treatment center (ETC). Basic laboratory tests can help to better understand the pathophysiology of the disease, to guide treatment and to establish simple protocols and procedures tailored to the practice of medicine in the context of such precarious environment for caregivers. Based on a few clinical cases of patients treated in the ETC of Forecariah, Guinea, run by the French Red Cross, this article describes the difficult conditions associated with the provision of medical practice in this challenging environment, aiming to minimize the casualties in the EVD patient and to train the health staff.

[Ecology of Glossina palpalis VANDERPLANK, 1949 (Diptera: Glossinidae) in mangrove area of Guinea: influence of tides on tsetse densities]

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.

Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic

ETHNOPHARMACOLOGICAL RELEVANCE

The recent outbreak of Ebola virus infections has mostly remained confined to the West African countries Guinea-Conakry, Sierra-Leone and Liberia. Due to intense national and international mobilizations, a significant reduction in Ebola virus transmission has been recorded. While international efforts focus on new vaccines, medicines and diagnostics, no coherent national or international approach exists to integrate the potential of the traditional health practitioners (THPs) in the management of infectious diseases epidemics. Nevertheless, the first contact of most of the Ebola infected patients is with the THPs since the symptoms are similar to those of common traditionally treated diseases or symptoms such as malaria, hemorrhagic syndrome, typhoid or other gastrointestinal diseases, fever and vomiting.

MATERIALS AND METHODS

In an ethnomedical survey conducted in the 4 main Guinean regions contacts were established with a total of 113 THPs. The socio-demographic characteristics, the professional status and the traditional perception of Ebola Virus Disease (EVD) were recorded.

RESULTS

The traditional treatment of the main symptoms was based on 47 vegetal recipes which were focused on the treatment of diarrhea (22 recipes), fever (22 recipes), vomiting (2 recipes), external antiseptic (2 recipes), hemorrhagic syndrome (2 recipes), convulsion and dysentery (one recipe each). An ethnobotanical survey led to the collection of 54 plant species from which 44 identified belonging to 26 families. The most represented families were Euphorbiaceae, Caesalpiniaceae and Rubiaceae. Literature data on the twelve most cited plant species tends to corroborate their traditional use and to highlight their pharmacological potential.

CONCLUSIONS

It is worth to document all available knowledge on the traditional management of EVD-like symptoms in order to evaluate systematically the anti-Ebola potential of Guinean plant species.

[Management of goiters in the surgery «A» department of the Point G university hospital]

The aim of this study was to evaluate the surgical treatment of goiter in the «A» surgical department of the Point G University Hospital in Bamako.

PATIENTS AND METHODS

This was a retrospective and descriptive study in the «A» surgical department of the Point G University Hospital from January 2007 to August 2014. Included in the study were all the patients operated for goiter. The patients who underwent surgery for other thyroid diseases were not selected. Postoperatively patients were followed for one year. The sociodemographic, clinical, para-clinical, therapeutic aspects and the postoperative course were the study parameters. Data analysis was performed on SPSS 21. The Chi square test was used for statistical analysis. A p-value inferior to 0.05 was considered statistically significant.

RESULTS

A total of 378 patients' records were collected. Thyroidectomy represented 6.2% (378 cases) over 6027 operations. The mean age was 41.29 years with a standard deviation of 13.58. Extremes were 3 and 85 years. The sex ratio was 7.22 in favor of women. The frequent reason for consultation was due to antero-cervical tumor with 97.07% of cases (n = 367). We identified 118 cases (31.22%) of goiter in cooled hyperthyroidism patients, 211 cases (55.82%) of euthyroid goiter, 7 cases (1.85%) of the thyroid neoplasia and one case (0.3%) of hypothyroidism goiter. Pathological histology helped to highlight a micro-vesicular macro adenoma in 16.1% of cases (61 patients); adenocarcinoma in 0.7% of cases (3 patients) and papillary carcinoma in 1.1% of patients (4 patients). The patients classified as ASA I and ASA II represented the majority with respectively 248 cases (65.60%) and 120 cases (31.74%). The most performed surgical techniques were subtotal thyroidectomy (n=181; 49.7%), the isthmo-lobectomy (126; 33.3%), total thyroidectomy (n=11; 2.9%) and sternotomy in one case of endothoracic goiter. Intraoperative complications were marked by hemorrhage in 12.7% of cases (45 patients). The postoperative one month follow up was uneventful in 91.79% (n = 347) and transient recurrent nerve injury was found in 2% of cases (1 patient). In one year follow up the postoperative outcome was good in 94.17% (n = 356) of patients. The mean hospital stay was 4.18 days. Six deaths were recorded (1.7%).

CONCLUSION

Goiter surgery is relatively common in the surgery 'A' department of the Point G University hospital. Good patient preparation and a better postoperative monitoring could help to minimize postoperative complications.

Tsetse diversity and abundance in Southern Burkina Faso in relation with the vegetation

The increase of human population, combined with climatic changes, contributed to the modification of spatial distribution of tsetse flies, main vector of trypanosomiasis. In order to establish and compare tsetse presence and their relationship with vegetation, entomological survey was performed using biconical traps deployed in transects, simultaneously with phyto-sociological study, on the Comoe river at its source in the village of Moussodougou, and in the semi-protected area of Folonzo, both localities in Southern Burkina Faso. In Folonzo, the survey revealed a diversity of tsetse with 4 species occurring with apparent densities as follows: Glossina tachinoides (8.9 tsetse/trap/day); G. morsitans submorsitans (1.8 tsetse/trap/day); G. palpalis gambiensis (0.6/trap/day) and G. medicorum (0.15 tsetse/trap/day). In Moussodougou, a highly anthropized area, mainly G. p. gambiensis was caught (2.06 tsetse/trap/day), and rarely G. tachinoides. The phyto-sociological study allowed discrimination of 6 types of vegetation in both localities, with 3 concordances that are riparian forest, shrubby and woody savannah. In Moussodougou, all tsetse were caught in the riparian forest. That was also the case in Folonzo where a great proportion (95 to 99 % following the season) of G. p. gambiensis and G. tachinoides were caught in the gallery, while G. m. submorsitans was occurring as well in the gallery as in the savannah, and G. medicorum in the forest gallery. This study showed that although G. tachinoides and G.p. gambiensis are both riparian, they do not have the same preference in terms of biotope.

[Interest of laparoscopic surgery in the management of chronic abdominal pains in the surgery "A" department of the of the Point G University Hospital]

AIM

to evaluate the contribution of laparoscopic surgery in the management of chronic abdominal pains of unspecified etiology.

METHODS

A retrospective descriptive study was conducted over a period of 49 months (March 2008 to March 2012), in the surgery A service of the Point G university hospital.

RESULTS

52 patients suffering from chronic abdominal pain for 3 months have been listed. There were 36 women and 16 men, with a sex-ratio of 2.25. The pathologies found in laparoscopy were: 16 cases of adherences, 16 cases of gynaecological diseases, 6 cases of chronic appendicitis, 5 cases of chronic cholecystitis, 6 cases of abdominal tumors and 3 cases of intrauterine contraceptives in abdomen. Conversion to laparotomy was not made and mortality was null. No lesion was found in 11.54% of cases. The mean duration of hospitalization was 2 days. The duration of follow-up of the patients was 18 months with a minimum of 6 months and a maximum of 24 months. No painful symptomatology was found in 6 months in 88.46% of the cases. Persistent stomach pains were found in 3% of the cases. 8.54% of the patients had an improvement of symptomatology.

CONCLUSION

Chronic abdominal pains put a diagnosis problem in surgery. Laparoscopy is a reference technique to diagnose this pain and to discuss them.

[Neurological complications of chronic alcoholism: study of 42 observations in Guinea]

Neurologic disorders related to chronic alcoholism in traditional areas of Guinea are frequent, but reports about them are rare. We conducted the first study in Guinea on this subject and retrospectively collected 42 cases of neurologic manifestations related to alcoholism over a 7-year period. The standard findings of the literature were confirmed in our population: peak frequency after the age of 40 years (82.8%) and clear male overrepresentation (M/F sex ratio: 13/1). All the standard signs and symptoms are reported, with a clear predominance of alcoholic polyneuropathy and hepatic encephalopathy. The study of nutritional status by both body mass index (BMI) and the Detsky criteria showed that these patients were severely malnourished. The brain MRI was a crucial contribution for diagnosing the standard central nervous system complications of alcoholism: Gayet Wernicke encephalopathy, Marchiafava-Bignami disease, Korsakoff syndrome, central pontine myelinolysis, and cerebellar degeneration.

[Treatment of malignant gastric tumors in the surgery "a" department of the Point G teaching hospital: 84 cases]

OBJECTIVE

To evaluate the short-term results of the treatment of malignant gastric tumors.

PATIENTS AND METHODS

A 3-year retrospective study from january 2007 to december 2010 was conducted in the Surgery "A" department of the Point G Teaching Hospital. The clinical records of 84 patients with gastric cancers were collected. Included in this study were patients who underwent surgery for malignant gastric tumors confirmed by histology. Patients who did not undergo surgery and those who presented tumors of the cardia were not included in this study.

RESULTS

The treatment consisted of a subtotal gastrectomy with ganglionic curettage taking out the first and the second relays in 33 patients (39.28%), total gastrostomy in 3 patients (3.57%), and the remaining 48 patients (57.14%) underwent gastro-entero anastomosis. Morbidity was 10.7%, represented by 7 cases of parietal suppuration and 2 cases of evisceration. Mortality rate was 11.11%, due to poor general condition of the patients. The global 1-year survival rate was 36.9%. The one and two-year survival rates after subtotal gastrostomy were 93.9% and 75.75%, respectively. No survival case was noticed one year after total gastrectomy and gastric enteric anastomosis.

CONCLUSION

Partial gastrectomy with ganglionic curettage when possible associated with an early diagnosis could allow a sharp improvement of the gastric tumors' survival rate.

Molecular analysis of changes in Pseudomonas aeruginosa load during treatment of a pulmonary exacerbation in cystic fibrosis

BACKGROUND

Intravenous antibiotics for pulmonary exacerbations (PEs) of cystic fibrosis (CF) usually target Pseudomonas aeruginosa. Insights into the CF lung microbiome have questioned this approach. We used RT-qPCR to determine whether intravenous antibiotics reduced P. aeruginosa numbers and whether this correlated with improved lung function. We also investigated antibiotic effects on other common respiratory pathogens in CF.

METHODS

Sputa were collected from patients when stable and again during a PE. Sputa were expectorated into a RNA preservation buffer for RNA extraction and preparation of cDNA. qPCR was used to enumerate viable P. aeruginosa as well as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Burkholderia cepacia complex and Aspergillus fumigatus.

RESULTS

Fifteen CF patients were followed through 21 PEs. A complete set of serial sputum samples was unavailable for two patients (three separate PEs). P. aeruginosa numbers did not increase immediately prior to a PE, but numbers during intravenous antibiotic treatment were reduced ≥4-log in 6/18 and ≥1-log in 4/18 PEs. In 7/18 PEs, P. aeruginosa numbers changed very little with intravenous antibiotics and one patient demonstrated a ≥2-log increase in P. aeruginosa load. H. influenzae and S. pneumoniae were detected in ten and five PEs respectively, but with antibiotic treatment these bacteria rapidly became undetectable in 6/10 and 4/5 PEs, respectively. There was a negative correlation between P. aeruginosa numbers and FEV1 during stable phase (r(s)=0.75, p<0.05), and reductions in P. aeruginosa load with intravenous antibiotic treatment correlated with improved FEV1 (r(s)=0.52, p<0.05).

CONCLUSIONS

Exacerbations are not due to increased P. aeruginosa numbers in CF adults. However, lung function improvements correlate with reduced P. aeruginosa burden suggesting that current antibiotic treatment strategies remain appropriate in most patients. Improved understanding of PE characterised by unchanged P. aeruginosa numbers and minimal lung function improvement following treatment may allow better targeted therapies.

Passive circulating cell sorting by deformability using a microfluidic gradual filter

The deformability of circulating leukocytes plays an important role in the physiopathology of several diseases like sepsis or acute respiratory distress syndrome (ARDS). We present here a microfluidic method for the passive testing, sorting and separating of non-adherent cell populations by deformability. It consists of microfluidic sieves in series with pore sizes decreasing from the upstream to the downstream. The method capabilities are demonstrated with monocytic cell lines (THP-1) treated by Jasplakinolide (a stabilizer of polymerized actin), LatrunculinA (an inhibitor of actin polymerization), and with the plasma of patients suffering from ARDS. Simple sample injection with standard syringes and pumps makes the method readily adapted for experimentation in hospitals.

[Ileal typhoid perforations: clinical and therapeutic aspects in tropical area]

AIMS

The aim of this study was to describe the clinical and therapeutic aspects of peritonitis by typhoid ileal perforation in a tropical typhoid fever endemic area.

PATIENTS AND METHODS

A descriptive retrospective study over an 8 year period (January 2000 to December 2007) was undertaken in a visceral service of the Point G teaching hospital in Bamako, Mali. Only patients diagnosed and operated for peritonitis presenting lesions or perforations of the final ileum were included in the study.

RESULTS

The data from 120 patients meeting the inclusion criteria was collected. The average age was 22.7 years old. Triad abdominal pains (120 cases; 100%), vomiting (41; 62.3%), lack of matter and gas (22; 32.3%) constituted the main part of the functional signs. The physical examination showed a localised abdominal defence (7 cases, 10.3%), generalized defence (98 cases; 81.6%), and 2 unspecified cases (2.9%). A "wood belly" abdomen was palpated among 105 patients (87.5%), as well as umbilical hernias (106 cases; 88.3%). The Felix and Widal agglutination test was positive for 75 patients (62.5%) and negative for 27 patients (22.5%). During the operation, the quantity of aspirated pus was higher than 1500 ml in 2 cases and lower or equal to 500 ml in 57.4% of cases. The site of the perforation was ante mesenteric in 64 cases (53.3%). Excision-suture and abdominal cleansing were the most common surgical procedures (68 cases; 57%). Postoperatively 19 patients (15.83%) died of septic shock. The average duration of hospitalization was 20.6 days.

CONCLUSION

The peritonitis by typhoid ileum perforation is still the cause of a high mortality rate in our country. The prevention by the vaccination in young populations could decrease the incidence of pathology and the serious complications which result from this.

Association between herpes simplex virus type 2 and HIV-1 in a population of married couples from Dakar, Senegal

Numerous studies suggest that herpes simplex virus type 2 (HSV-2) increases the risk of HIV-1 infection but recent clinical trials of HSV-2 suppressive therapy failed to show an effect. We assessed the putative association between HSV-2 and HIV-1 in a population of HIV-concordant-negative, HIV-1-discordant and HIV-1-concordant-positive married couples from Dakar, Senegal. In agreement with previous studies, we observed a strong overall association between HSV-2 and HIV-1 (odds ratio 4.61; P < 0.001). However, this association was mainly determined by a low HSV-2 prevalence in HIV-concordant-negative couples compared with HIV-1-discordant and HIV-1-concordant-positive couples (23% versus 59% and 66%, respectively; P < 0.001). We observed no further differences in HSV-2 prevalence between HIV-1-discordant and HIV-1-concordant-positive couples (59% and 66%, respectively; P = 0.483). Neither the index (59% versus 62%, P = 1.000) nor recipient partners (41% versus 63%, P = 0.131) in HIV-1-discordant and HIV-1-concordant-positive couples showed significant differences in HSV-2 prevalence. HSV-2 does not constitute a clear risk factor for HIV-1 infection in this population.

[Prise en charge chirurgicale des goitres hyperthyroïdiens a Bamako]

GOAL

To assess the surgical therapy in goiter with hyperthyroidism in a surgical unit of CHU du Point-G.

PATIENTS AND METHODS

A retrospective study was conducted, concerning 131 patients having undergone a thyroidectomy for goiter with hyperthyroidism from January 1st 1998 to December 31st 2007.

RESULTS

The files of 131 patients were analysed. The average age of patients was 39.74 years, with 114 women and 17 men. The goiter in Basedow disease was the first indication for surgery in hyperthyroidism (48 cases; 36.6%) followed by toxic adenoma (39; 29.8% of the cases) and toxic multinodular goiter (38; 29% of cases). Ninety patients had a subtotal thyroidectomy (68.7% of cases). One total thyroidectomy (0.8%), 39 isthmolobectomies (29.7%) and one isthmectomy (0.8%) were carried out. Anatomohistology showed 67.1% of colloid benign tumours, and 8 cases of cancers (6.2% of the cases). Early postoperative follow ups were due to hemorrhage (2 cases; 1.5%) and 3 cases of dysphonia (2.5%). One patient died (0.8%). After six months, 3 cases of wound cheloide (2.5%), one case of dysphonia, and one case of hypothyroidism were noted. For 86 patients (71.1%) the postoperative follow up was simple.

CONCLUSION

Surgery remains a treatment of choice for hyperthyroidism goiter. Other options are too expensive or not available.

[Digestive tract perforations at Point G Teaching Hospital in Bamako, Mali]

AIMS

To determine the most frequent causes of the digestive perforations and to evaluate the surgical procedures, the morbidity and mortality.

PATIENTS AND METHODS

It was about a retrospective descriptive study, over 5 year's period in a visceral service of CHU du Point G, Bamako. Were included in the study all the patients operated for digestive perforation and hospitalized in the service of surgery "A". Were not included in the study patient operated not presenting a digestive perforation. Per operational etiologies of the perforations and their frequency were determined, as well as the morbidity and morbidity and mortality.

RESULTS

Files of 202 patients were collected. The average age of the patients was 28.3 ± 15.5 years with extremes of 6 and 71 years. The frequency of digestive perforations was higher in the age from 11 to 20 years (29.7%). The average time of consultation was of 7± 6 days. Abdominal pains, nauseas and vomiting, matter and gas stop (48.5%) were the most current functional signs. A "wood belly" abdomen was found in 72,3% of the cases. The radiography of abdomen without preparation found a diffuse greyness (64.7%), a pneumoperitoine (30.7%). A double antibiotic therapy was made in all the cases. A median laparotomy was practiced in 98,5%, and laparoscopy in 3 cases (1.5%). A single perforation was found among 172 patients (85,1%). Morbidity, all confused causes, was made of 30 cases of parietal suppurations (14.8%). Total mortality was 74%. According to aetiologies it was 10.3% in the typhic perforations, 4.6% in the appendicular perforations and 4.9% in the perforations of gastroduodenal ulcers.

CONCLUSION

The most frequent aetiologies of digestive perforation in our context were the typhoid fever, acute appendicitis and the gastroduodenal ulcer. The résection - joining and peritoneal toilet were the most practised procedure. The main factor of bad outcome remains the diagnostic delay burdening morbidity and mortality.

Trapping tsetse flies on water

Riverine tsetse flies such as Glossina palpalis gambiensis and G. tachinoides are the vectors of human and animal trypanosomoses in West Africa. Despite intimate links between tsetse and water, to our knowledge there has never been any attempt to design trapping devices that would catch tsetse on water. In mangrove (Guinea) one challenging issue is the tide, because height above the ground for a trap is a key factor affecting tsetse catches. The trap was mounted on the remains of an old wooden dugout, and attached with rope to nearby branches, thereby allowing it to rise and fall with the tide. Catches showed a very high density of 93.9 flies/"water-trap"/day, which was significantly higher (p < 0.05) than all the catches from other habitats where the classical trap had been used. In savannah, on the Comoe river of South Burkina Faso, the biconical trap was mounted on a small wooden raft anchored to a stone, and catches were compared with the classical biconical trap put on the shores. G. p. gambiensis and G. tachinoides densities were not significantly different from those from the classical biconical one. The adaptations described here have allowed to efficiently catch tsetse on the water, which to our knowledge is reported here for the first time. This represents a great progress and opens new opportunities to undertake studies on the vectors of trypanosomoses in mangrove areas of Guinea, which are currently the areas showing the highest prevalences of sleeping sickness in West Africa. It also has huge potential for tsetse control using insecticide impregnated traps in savannah areas where traps become less efficient in rainy season. The Guinean National control programme has already expressed its willingness to use such modified traps in its control campaigns in Guinea, as has the national PATTEC programme in Burkina Faso during rainy season.

[Results of a survey to evaluate the efficacy of a regional awareness campaign on counterfeit street medicines in Bamako, Mali and Nouakchott, Mauritania]

The purpose of the report is to describe the results of a survey conducted among schoolchildren in Mali and Mauritania to evaluate the efficacy of an awareness campaign (essentially poster-based) on illegal street medicines. Under teacher supervision, a total of 3,182 schoolchildren (n=) completed a written questionnaire. Analysis of responses demonstrated that campaign was effective since 61% of the pupils had seen the posters in pharmacies and 61% had spoken about them with their parents. More than 84% of the pupils had already heard about the dangers associated with illegal medicine. Despite a number of disparities especially with regard to the price and dangers of illegal street medicine, the schoolchildren were knowledgeable about rules of conservation and outlets for purchase of legal medicine. The responses obtained from schoolchildren from Nouakchott and those attending private schools were generally better than those obtained from schoolchildren from Bamako and those attending the public schools.