Validation of a real-time polymerase chain reaction for the detection and quantification of the nucleic acid of Histoplasma from equine clinical samples

Histoplasma capsulatum var. farciminosum (HCF) is a dimorphic fungus that causes epizootic lymphangitis in equids. Current diagnostic approaches, including culture, microscopy, and clinical presentation, lack speed, sensitivity, and specificity when diagnosing clinical cases. In this study, equine blood and pus samples on Whatman FTA cards from Senegal (n = 3), The Gambia (n = 19), Ethiopia (n = 16), and Mali (n = 13) were tested using a real-time PCR (qPCR) protocol. The assay was optimized and tested for its suitability to detect and quantify HCF in blood and pus loaded onto Whatman FTA cards at sampling. Whatman FTA cards were tested for their suitability for use with qPCR and were found to recover DNA more efficiently than from direct extraction. Using TaqMan fluorescent probes and specific primers, the assay demonstrated 100% analytical specificity when detecting multiple strains of Histoplasma and no false positives with off-target organisms. The assay's diagnostic performance was measured against an existing nested internal transcribed spacer PCR protocol using a receiver operating characteristic curve. The test was found to have a diagnostic specificity and sensitivity of 100% and 71.4%, respectively, when analyzing pus samples using a cycle threshold (Ct) cutoff determined by Youden's index (27.75). Blood sample cutoff Ct value was proposed at 34.55. Further optimization is required to improve the performance of the protocol when applied to blood samples. This study has, for the first time, demonstrated the ability to detect and quantify the DNA of Histoplasma spp. in equine blood and pus samples with a high degree of accuracy, providing a platform to further investigate the pathogenesis and epidemiology of this disease.

IMPORTANCE

Histoplasmosis is a neglected yet major cause of morbidity and mortality in both equids and people in resource-scarce settings. One of the major hindrances to the control of histoplasmosis is a lack of readily available diagnostic tests. Tests are needed to support clinical decision-making and to be applied in population-based research to further understand this disease in situ. This paper reports, for the first time, the validation and application of a qPCR to detect Histoplasma directly from equine clinical samples, bypassing the need to culture this notoriously difficult organism. We report and comment on the performance of the qPCR in comparison with our previously developed nested PCR.

[Management Of Blader Exstrophy In Children At The CHU Gabriel Touré]

AIMS

To describe the clinical and evolutionary aspects of the primary closure of exstrophy at the CHU Gabriel Touré.

MATERIALS AND METHODS

This was a retrospective and prospective study carried out from January 2014 to December 2019 in all the children admitted and operated on for bladder exstrophy at the CHU Gabriel Touré.

RESULTS

We collected 35 cases of exstrophy, ie25 boys and 10 girls. The mean age at diagnosis was 4.8 months. The bladder plate was both normal and budded, ie 28.6% of cases. Plaque infection was found in 45.7%. A malformation was associated in 34.3% of cases. Primary plaque closure was achieved in all of our patients. Postoperative morbidity was 28.6% of cases and mortality 11.4% of cases.

CONCLUSION

Bladder exstrophy is a rare malformation of the urogenital sphere, its management is complex and its mortality is not null.

Electrolyte-Gated Organic Field-Effect Transistors for Quantitative Monitoring of the Molecular Dynamics of Crystallization at the Solid-Liquid Interface

Quantitative measurements of molecular dynamics at the solid-liquid interface are of crucial importance in a wide range of fields, such as heterogeneous catalysis, energy storage, nanofluidics, biosensing, and crystallization. In particular, the molecular dynamics associated with nucleation and crystal growth is very challenging to study because of the poor sensitivity or limited spatial/temporal resolution of the most widely used analytical techniques. We demonstrate that electrolyte-gated organic field-effect transistors (EGOFETs) are able to monitor in real-time the crystallization process in an evaporating droplet. The high sensitivity of these devices at the solid-liquid interface, through the electrical double layer and signal amplification, enables the quantification of changes in solute concentration over time and the transport rate of molecules at the solid-liquid interface during crystallization. Our results show that EGOFETs offer a highly sensitive and powerful, yet simple approach to investigate the molecular dynamics of compounds crystallizing from water.

Why are people still dying of drug-susceptible TB in Paris in the 21st century?

BACKGROUND: Although the burden of TB is lower in France than in low-income countries, patients continue to die from TB in Paris. Our goal was to describe TB-related deaths and to identify associated risk factors.METHODS: We conducted a retrospective cohort study in two hospitals in Paris between 2013 and 2018. All patients with drug-susceptible TB were included and followed until end of treatment. The primary outcome was death. We performed univariate and multivariate analysis using Cox proportional hazard model.RESULTS: Of the 523 patients included, 362 were men (median age 37 years), of whom 24 patients died (4.5%). The final survival model concluded that age (HR 1.1 for each additional year), not living in one´s own accommodation (HR 5.9), being born in France (HR 8.0), being alcoholic (HR 4.2), having a history of cancer (HR 7.1) or meningeal or miliary TB (HR 8.2) were associated with a higher risk of death.CONCLUSION: The rate of TB-associated death is unacceptably high for a curable disease. To note, patients born in France were much more at risk of death than immigrants. We believe raising awareness among healthcare professionals is a potentially easy and efficient lever for improving care.

[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.

[Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré]

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages.

OBJECTIVES

Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects.

MATERIALS AND METHOD

This was a retrospective descriptive study from January 1, 2010 to December 31, 2015 on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré.

RESULTS

In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main aetiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases.

CONCLUSION

Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality.

Real-time monitoring of crystallization from solution by using an interdigitated array electrode sensor

Monitoring crystallization events in real-time is challenging but crucial for understanding the molecular dynamics associated with nucleation and crystal growth, some of nature's most ubiquitous phenomena. Recent observations have suggested that the traditional nucleation model, which describes the nucleus having already the final crystal structure, may not be valid. It appears that the molecular assembly can range during nucleation from crystalline to partially ordered to totally amorphous phases, and can change its structure during the crystallization process. Therefore, it is of critical importance to develop methods that are able to provide real-time monitoring of the molecular interactions with high temporal resolution. Here, we demonstrate that a simple and scalable approach based on interdigitated electrode array sensors (IESs) is able to provide insights on the dynamics of the crystallization process with a temporal resolution of 15 ms.

First report of cryptococcosis due to Cryptococcus gattii sensu stricto VGI in an Ivorian HIV negative patient

INTRODUCTION

Cryptococcus gattii species complex is endemic to tropical and subtropical regions and is described as a causative agent of cryptococcosis in immunocompetent individuals.

CASE PRESENTATION

We describe the first case of cryptococcosis in a HIV-negative patient from Ivory Coast infected by Cryptococcus gattii sensu stricto VGI. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment up to 42 days after detection of the presence of yeasts in the CSF. Eighteen isolates were recovered, genetic diversity and antifungal susceptibility analyses were performed. All the isolates belonged to the Cryptococcus gattii sensu stricto (B;VGI) and were identified as a new sequence type (ST) 553 by Multilocus Sequence Typing (MLST) analyses. Susceptibility testing showed that all the strains had a wild-type phenotype for fluconazole, amphotericin B and flucytosine. Treatment with fluconazole (1200mg/day) was initiated with success.

CONCLUSION

This is the first case report of the presence of C. gattii sensu stricto VGI in a HIV-negative ivorian patient and the second report of the presence of species from the C. gattii complex species in this country.

[Socio-demographic, clinical, and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center]

HIV infection is a chronic infectious disease requiring long-term management and regular follow-up of patients.

OBJECTIVES

The aims of this study was to describe the socio-demographic, clinical, biological and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center.

PATIENTS AND METHODS

From 01/01/2001 to 31/12/2017, the medical records of children followed for HIV infection until adolescence were analyzed. It was a descriptive and analytical retrospective study.

RESULTS

One thousand five hundred and fourteen patients received antiretroviral treatment and 587 were still in follow-up on 31 December 2017, including 393 adolescents (sex-ratio = 1.2). The median age was 14.25 years and 55.1% of children had lost at least one parent. HIV serology was positive among mothers in 61.7% of cases (n=342), and 63% of them were on ARVs. Sixty-eight per cent of children were WHO Stage III or IV at the time of ART initiation. The median age at onset of ART was 53 months (26-96 months). The combination of 2 nucleotide reverse transcriptase inhibitors (NRTIs) with a non-nucleotide reverse transcriptase inhibitor (NNRTI) was used in 89% of patients. The median CD4 count before ARV treatment was 438/mm3. The average duration of follow-up under treatment was 9.8 ± 3.4 years. Fifty-one percent of adolescents had undetectable viral load. There was a correlation between the initiation of a second line of treatment and treatment failure (p<0.001).

CONCLUSION

The adherence of adolescents to ARV treatment requires the implementation of innovative strategies to improve the therapeutic success rate.

[Health-care related infections in pediatric surgery of the teaching hospital Gabriel Toure, Bamako, Mali]

OBJECTIVES

to identify the main causative agents of infection associated with care and their susceptibility to antibiotics used and to identify risk factors for care-associated infection.

MATERIAL AND METHODS

This was a cross-sectional study with prospective data collection, conducted from 1 November 2016 to 1 April 2017 among all children admitted to the pediatric surgery department. Non-consenting parents and cases of necrosectomy were included in this study.

RESULTS

Our study involved 200 patients, 30 of whom presented a care-associated infection (15% infection rate). The average age of patients with infection was 56.33 ± 48.66 months (1 and 180 months). The main pathogens responsible for infection of the operative site were: Escherischia coli (4 cases), Acinetobacterbaumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). In the burned patients, the organisms found were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherischia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted in urinary tract infection. Antibiotics tested were amoxicillin, amoxicillin-clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. The mode of recruitment and the duration of hospitalization were the risk factors noted.

CONCLUSION

The infection associated with care is a frequent occurrence in our practice. These infections mainly occur at the operating sites. The germs found were: Acinetobacter, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus. They are all sensitive to imipenem and resistant to amoxicillin. The infection remains formidable in health care. It is essential to give special attention to the prevention of infectious risk, especially in the surgical setting.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]

INTRODUCTION

Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics.

MATERIALS AND METHODS

This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018.

RESULTS

During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days.

CONCLUSION

Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

[Management of Acute Malnutrition in Children in a Sahelian Secondary Hospital]

Malnutrition among children under five is a major public health problem in low-income countries, and contributes significantly to mortality in this age group. The purpose of this work was to evaluate the epidemiological and clinical profile of malnourished children at the Nara hospital in north of Mali.

METHOD

It was a retrospective and descriptive study, from 01/01/2016 to 31/12/2016. Children aged 6 months to 59 months admitted for acute malnutrition were included.

RESULTS

Four hundred and sixty-one children had malnutrition, representing 15% of consultations and 50% of hospitalizations. The median age was 26 months (2 months-93 months). The sex ratio was 0.92 (M = 222, F = 239). Nineteen percent of the patients had progressive weaning (n = 90), and it was brutal in 371 patients (80%). The distribution of patients according to the Z-score was as follows: Z-score <-1 (n = 15, 3%), Z-score <-2 (n = 46, 10%), Z-score <-3 (n = 400, 87%). Mean MUAC was 105 mm (99mm-124mm). Hypoglycemia was noted in 45% (n = 204). The marasmus cases accounted for 80% (n = 367) kwashiorkor 10% (n = 48). The mixed form of malnutrition accounted for 10% (n = 46). The disease associated with malnutrition were pneumonia (n = 219, 47%), malaria (n = 115, 25%) and gastroenteritis (n = 68, 15%). The F75 milk was administered predominantly for 3 months in 93% of cases. For phase 2 of treatment, Plumpy Nut and F100 milk were respectively administered in 88% and 12%. The nutritional recovery rate was 95% (n = 435). Five percent of the patients died (n = 26). Pneumonia was the cause of death in 85% of cases. The cure rate for marasmus and kwashiorkor cases was respectively 94% and 93%.

CONCLUSION

Acute malnutrition remains frequent in the Sahelian environment. Better knowledge of mothers about weaning and dietary diversification will improve the nutritional status of children.

[Kartagener's syndrome found incidentally during assessment of infertile couple: a case study]

Le syndrome de Kartagener est une entité particulière parmi les dyskinésies ciliaires primitives (DCP) caractérisée par une triade clinique: sinusite, bronchectasie et situs inversus complet ou incomplet. C'est une maladie congénitale rare à transmission autosomique récessive. Nous rapportons un cas de syndrome de Kartagener dans un contexte d'infertilité avec une akinospermie au spermogramme.

Gas Blow Coating: A Deposition Technique To Control the Crystal Morphology in Thin Films of Organic Semiconductors

Rapid, large-scale, and low-cost coating methods that enable precise control of the crystal growth of organic semiconductors are essential to deliver high-performance devices that are robust and reproducible. In this work, a novel method is presented based on a gas blow coating technique, enabling the deposition of thin films of organic semiconductors, whose morphology can be optimized by adjusting the deposition parameters. We demonstrate the deposition of aligned single crystals of 6,13-bis(triisopropylsilylethynyl)pentacene (TIPS-pentacene) and 2,7-dioctyl[1]benzothieno[3,2-b][1]benzothiophene (C8-BTBT) by gas blow coating and their use as active layers in organic field-effect transistor (OFET) devices. The OFETs of TIPS-pentacene and C8-BTBT have charge mobilities of 0.15 and 1.4 cm² V^-1 s^-1, respectively, with low threshold voltages and on/off ratios exceeding 10⁵. This coating method can also be extended to polymeric semiconductors: films based on poly(3-hexylthiophene) and poly[2,5-(2-octyldodecyl)-3,6-diketopyrrolopyrrole-alt-5,5-(2,5-di(thien-2-yl)thieno[3,2-b]thiophene)] are realized, establishing gas blow coating as a novel and efficient technique for the deposition of thin films of organic semiconductors.

[Contribution of ultrasound in the diagnosis of rotator cuff rupture at the hospital of Béthune, France]

AIM

Describe the ultrasound aspects of rotator cuff tear by specifying the contribution of this technique in the shoulder scan.

PATIENTS AND METHOD

We conducted a prospective six-month analytical study from January 1, 2014 to May 31, 2014, on the rupture of the shoulder rotator cuff in the radiology department of the Béthune hospital center. Ultrasound examinations were performed using a Toshiba Aplion300 device using two linear probes of 13 and 15 Mhz. Data processing is done with SPSS 17.0 software. The Chi-square test was used to compare data with a significant threshold for p <0.05.

RESULTS

Our work focused on 28 patients who had a cuff tear during the ultrasound examination. The age group between 50 and 59 years was the most represented, 32.1%. Ultrasound showed calcification tendinopathy of the rotator cuff in 46.4% of cases. The rotator cuff tears were present in the supraspinatus, infra-spinal and subscapular tendons in 96.4% (27 cases), 32% (9 cases) and 21.4% (6 cases), respectively. In 58.3% there was a transfixing rupture of the supraspinatus with 72.3% non-transfixing ruptures. Seven patients had supraspinous tendon retraction including 6 cases of retraction stage 1 and 5 cases of stage 2 retraction. The infraspinatus was the second tendon of the cuff affected with 9 cases (32%) followed by the subscapularis 6 cases (21, 4%). We did not record lesions (rupture or calcification) of Teres minor. Radiography was normal in 7 patients, ie 32%.

CONCLUSION

Ultrasonography, coupled with standard radiography, is the firstline examination in the imaging assessment of the symptomatic shoulder. It allows, as in our work, a better morphological analysis of tendon rotator cuff.

[Caracteristics Of Severe Malaria In Child From 0 To 5 Years At The Hospital Of Sikasso In Mali]

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months.

OBJECTIVE

To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary.

PATIENTS AND METHODS

This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital.

RESULTS

The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P<10^-6).

CONCLUSION

Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.

[Urethral Prolapse Of The Girl In The Service Of Pediatric Surgery Of The Teaching Hospital Gabriel Touré]

OBJECTIVES

To describe the diagnostic and therapeutic aspects of urethral prolapse in girls in pediatric surgery.

PATIENTS AND METHOD

This was a 9-year retrospective study (January 2007 to December 2015) of girls aged 0-15 years with urethral prolapse and management in the department during the study period.

RESULTS

In 9 years, 18 cases of prolapsewerediagnosed, or 2 cases / year. The averageagewas 8.9 ± 3.4 yearswithextremes of 6 years and 15 years. Of the 18 cases identified, 10 werereferred. Femalegenital mutilation wasfoundin 15 (83.3%) patients, rectal prolapsewasassociatedin 2 cases (11.1%) and a cough concept in 5 (27.8%) patients. The average consultation time was 11.6 ± 7.9 dayswithextremes of 1 and 21 days. Eleven (61.1%) patients werereceivedurgently, including 2 cases (11.1%) of strangulation. Prolapsewas in the form of a roundedswelling, centered by the urethralmeatus. The mass wasblackishin 2 cases (11.1%). Shewasbleeding and painfulin 11 (61.1%) cases. Thesesignswere absent in 5 cases (27.8%). Swellingwasassociatedwithsigns of urinarydysuria and / or urinaryblightin 10 (55.5%) girls. The diagnosiswasclinical in all patients. Treatmentconsisted of excision and suturing of the prolapsedmucosa in all patients with placement of an indwellingurinarycatheter. Immediatefollow-up was simple in 16 (88.9%) patients and 2 cases (11.1%) of surgical site infection.

[Pathologies of peritoneo-vaginal canal in pediatric surgery at the teaching hospital Gabriel Touré]

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology.

OBJECTIVE

To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal.

MATERIALS AND METHOD

This was a prospective study from January 1^st to December 31^st, 2015 carried out in the pediatric surgery department of University Hospital Gabriel Touré. It covered all children aged 0-15 years old with a pathology of the peritoneal-vaginal canal operating in the department during the study period. This study did not include cases that were not operated on or not seen during the study period.

RESULTS

During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months.

CONCLUSION

Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.

[Undesirable Events During Anesthesia For Programmed Digestive Surgery]

OBJECTIVES

to study the morbidity operative peri in digestive surgery.

PATIENT AND METHOD

It was about a prospective and descriptive survey in the services of digestive surgery and anesthesia resuscitation from February to August 2014. The population of survey was constituted of the whole patients having benefitted an anesthesia for programmed digestive surgery. The statistical test used for the comparison of the qualitative variables was CHI2 with p <0,05 considered meaningful.

RESULTS

during the period 125 files have been collected. The patients having presented at least an undesirable event were of 86 either 68,8%. These events had occurred in 77.9% of cases during the interview. The middle age was of 47.46±15, 68years with extremes of 18years. and 85 years. Sex ratio was of 1, 55. Patients were classified ASA I in 83.2%. The predominant operative indication was the gastric tumor in 26.4 % of the cases. General anesthesia was practiced in 82.4% of the cases. Anesthesia were achieved in 55.2% of the cases by male nurses' anesthetists and 44,8% by the students in diploma of studies specials(DES).Main recovered undesirable events were of cardiovascular, respiratory and digestive nature (nausea and vomiting). Intervening of the undesirable events was bound to the technique of anesthesia, Anesthetic time length of intervention, used narcotic and to the antecedents of the patients with p <0, 05.

CONCLUSION

Factors of avoidable operative morbidity peri are nearly present in all our acts for digestive surgery. The formation of the staff and the setting to disposition of products better tolerated will permit to reduce these factors.

Changes in viral hepatitis B screening practices over time in West African HIV clinics

BACKGROUND

We aimed to describe changes in hepatitis B screening practices over a 3-year period among HIV-infected patients in West Africa.

METHODS

A medical chart review was conducted in urban HIV treatment centers in Ivory Coast (3 sites), Benin, Burkina Faso, Senegal, and Togo (1 site each). Among patients who started antiretroviral treatment between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical, and laboratory data was collected using a standardized questionnaire. We assessed changes in the proportion of patients screened over time and identified predictors of screening in a multivariable logistic regression.

RESULTS

A total of 2097 patients were included (median age: 37 years, 65.4% of women). Overall, 313 (14.9%) patients had been screened for hepatitis B, with an increase from 10.6% in 2010 to 18.9% in 2012 (P<0.001) and substantial differences across countries. In multivariable analysis, being aged over 45 years (adjusted odds ratio: 1.34 [1.01-1.77]) and having an income-generating activity (adjusted odds ratio: 1.82 [1.09-3.03]) were associated with screening for hepatitis B infection. Overall, 62 HIV-infected patients (19.8%, 95% confidence interval: 15.5-24.7) were HBsAg-positive and 82.3% of them received a tenofovir-containing drug regimen.

CONCLUSION

Hepatitis B screening among HIV-infected patients was low between 2010 and 2012. The increasing availability of HBsAg rapid tests and tenofovir in first-line antiretroviral regimen should improve the rates of hepatitis B screening.

[Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]

OBJECTIVE

Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast.

PATIENTS AND METHODS

A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed.

RESULTS

Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture.

CONCLUSION

Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

Antiretroviral chemoprophylaxis in children and adolescents victims of rape in Abidjan

OBJECTIVE

We described the use of antiretroviral drugs to prevent HIV transmission among children and adolescents victims of rape in Abidjan (Ivory Coast).

MATERIALS AND METHOD

We conducted a retrospective and descriptive study on children (0-9 years) and adolescents (10-19 years) victims of rape between 2000 and 2013. We analyzed the patients' socio-demographic characteristics and the modality of the chemoprophylaxis.

RESULTS

We included 10 children and 89 adolescents in the study. The median age was 16 years old (3-19 years). The median time to consultation was 23.5 hours (5-152 hours). The antiretroviral chemoprophylaxis was administered to 92 patients (93%). No HIV and HBV seroconversion was observed after a 3-month follow-up.

CONCLUSION

A better management of rape victims is required in Abidjan.

[Complications of digestive ostomies in pediatric surgery]

AIMS

To determine the frequency and factors of complications of intestinal stomas.

METHODS

This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete.

RESULTS

We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment.

CONCLUSION

The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma.

Innocuity and immune response to Brucella melitensis Rev.1 vaccine in camels (Camelus dromedarius)

A field trial was conducted in a camel brucellosis-free herd to evaluate antibody response to the Brucella melitensis Rev.1 vaccine in camels and assess shedding of the vaccine strain in milk. Twenty eight camels were divided into four groups according to their age and vaccination route. Groups A (n=3) and B (n=3) consisted of non-pregnant lactating female camels, vaccinated through subcutaneous and conjunctival routes, respectively. Groups C (n=10) consisted of 8-11 months old calves vaccinated through conjunctival route. The rest of the herd (n=12) composed of female and young camels were not vaccinated and were considered as the control group. Each animal from groups A, B and C was given the recommended dose of 2 × 10(9) colony forming units of Rev.1 vaccine irrespective of age or route of vaccination. Blood samples were collected from all the animals at the time of vaccination and at weekly, bi-weekly and monthly interval until 32 weeks post vaccination and from controls at weeks 8 and 24. The serological tests used were modified Rose Bengal Test, sero-agglutination test, and an indirect Enzyme Linked Immunosorbent Assay. Milk samples were collected from all vaccinated female camels and tested for the presence of Rev.1 vaccine strain. Most vaccinated animals started to show an antibody response at week 2 and remained positive until week 16. By week 20 post-vaccination all animals in the three groups were tested negative for Brucella antibodies. Bacteriological analysis of milk samples did not allow any isolation of Brucella melitensis. All samples were found Brucella negative in PCR analysis. The results of this study indicate that the Rev.1 vaccine induces seroconversion in camels. Rev.1 vaccine strain is not excreted in the milk of camels. These findings are promising as to the safe use of the Rev.1 vaccine in camels.

[Typhoid peritonitis in children: Evaluation of morbi-mortality at the Gabriel Touré teaching hospital in Bamako]

AIMS

To determine related factors of complications typhoid perforations in the small intestine in children.

MATERIAL AND METHOD

A retrospective study was conducted between June 1^st, 2005 to June 30^th, 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study.

RESULTS

In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications.

CONCLUSION

Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever.

[Peritoneal disease in AIDS at the hospital services in Bamako]

The objective of this work was to evaluate peritoneum attack in AIDS affected patients. IT was a cross sectional descriptive study from October 2000 to May 2003 in services of Internal Medicine of the Hospital of the Point G and Hepato-Gastro-enterology of the Hospital Gabriel Touré and that concerned patient hospitalization files, registers of laparoscopy and registers of anatomopathology results. Have been included in this study, patients HIV positive presenting an abdominal symptomatology as abdominal pain, ascite, hepatomegaly, splenomegaly and that benefitted a laparoscopy with oriented biopsies of lesions. Anatomopathology exam of biopsy fragments has been made in the National institute of Research in Public Health (INRSP) of Bamako, Mali and in Pharo, Marseille in France. In term of this study 20 patients have been included. The mean age of our patients was 40.1 +/- 11 years with a sex ratio equal 1. Married women were the socio-professional category the most affected (45%). The clinical symptomatology was dominated by ascite (70%), abdominal pain (45%), abdominal meteorism (40%), hepatomegaly (35%), splenomegaly (30%). Peritoneal localization was the most frequent (50%). Granulations were the laparoscopic aspect the most met (80%) and confirmed in 80% cases by histology. Hepato-peritoneal tuberculosis was the most frequent etiology (60%) come then the non specific inflammations (30%), the lipophagic granulome (5%), and non specific granulomatose inflammations (5%). This study is characterized by an increased frequency of hepato-peritoneal tuberculosis during the pathology of peritoneum in AIDS affected patients. It deserves to be searched and treated for patients' survival.