[Evaluation of the risk of obstructive sleep apnea in patients awaiting general anesthesia in Burkina Faso]

INTRODUCTION

General anaesthesia and surgery increase morbidity and mortality in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who are not known to have OSAHS and therefore not treated before surgery. The objective of this study is to evaluate the risk of OSAHS using the STOP-BANG questionnaire (SBQ) in patients undergoing general anaesthesia in Burkina Faso.

MATERIAL AND METHOD

This is a cross-sectional study concerning patients having received pre-anaesthetic consultation from 1st July 2020 to 30th June 2021. Risk of OSAHS is considered "medium to high" when the risk of obstructive sleep apnea is medium or high on SBQ.

RESULTS

Our population consisted in 599 persons. A medium to high risk of OSAHS was found in 11.18%. The ASA score and the Mallampati scale were independently associated with moderate to high risk of OSAHS (P<0.001; P<0.001). ASA score of I and Mallampati class of I decreased the risk of OSAHS by 17 and 45% respectively (P=0.012; P=0.031).

CONCLUSION

The risk of OSAHS in this population is comparable to that of the general population. Confirmation of OSAHS by ventilatory polygraphy or polysomnography would help to achieve further precision.

[Factors associated with the occurrence of acute respiratory distress and death in patients with COVID-19 in Burkina Faso]

INTRODUCTION

The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso.

METHODS

This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19.

RESULTS

Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days.

CONCLUSIONS

Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.

Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population-based cross-sectional survey

Objective

Although distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self‐reported care seeking behaviours, neonatal and post‐neonatal under‐five child mortality in rural areas of Burkina Faso.

Methods

We performed a cross‐sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed‐effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey.

Results

Thirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care (P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care (P = 0.028), but not for late neonatal mortality (P = 0.479) and post‐neonatal under‐five child mortality (P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association.

Conclusion

While better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services.

[A case of malformation of aortic arches simulating asthma]

INTRODUCTION

Abnomalies of the aortic arches are rare and account for 1% of congenital cardiovascular malformations. They constitute one of the causes of compression of the airways with attacks of dyspnea sometimes simulating an asthma. We report the case of an infant with an anomaly development of aortic arches with impact breathing.

CASE REPORT

It was a 22-month-old infant who consulted for a dyspnea with a type of stridor associated with a fat cough. This clinical table started 45 days after its birth and led to many hospitalizations in the pediatric emergency. Clinical exam found polypnea, with a wheezing, bronchial groan and diffuse sibilants on the auscultation. The chest X-ray revealed a slightly retractile right lung. The angioscanner of the thoracic and abdominal aorta showed a double aortic arch with retro-oesophageal left ventricular artery. A thoracotomy was performed and the operative sequences were simple.

CONCLUSION

The congenital anomalies of the aortic arch are rare and varied, sometimes asymptomatic. This case reminds us that, in front of any recurrent or digestive respiratory signs in the infant, malformation of the aortic arches should be considered.

Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries

SETTING

Nine countries in West and Central Africa.

OBJECTIVE

To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs.

DESIGN

Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months.

RESULTS

Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months).

CONCLUSIONS

The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.

From the vasodilator and hypotensive effects of an extract fraction from Agelanthus dodoneifolius (DC) Danser (Loranthaceae) to the active compound dodoneine

AIM OF THE STUDY

Effects of the different fractions obtained by partition of ethanolic extract (EE) of Agelanthus dodoneifolius through column chromatography were investigated on rat blood pressure and aortic relaxation and compared to those observed in the presence of crude EE.

MATERIALS AND METHODS

The acute hypotensive activity of EE, fractions and dodoneine, administrated intravenously, was evaluated in anaesthetized rats using the invasive method of blood pressure recording. Bioassay-guided fractionation using rat aorta pre-contracted by norepinephrine to monitor the relaxant activity led to the isolation of dodoneine.

RESULTS

In normotensive rats, injection of EE (0.01-10 mg/kg) produced a dose-dependent decrease in both systolic and diastolic blood pressure without any significant change in heart rate. In a similar way, the EE (0.001-3 mg/mL) caused relaxation of rat pre-contracted aorta in a concentration-dependent manner. Fractionation of the EE afforded 14 fractions, F1-F14, that were tested on rat precontracted aortic rings. At the concentration level of 1 mg/mL, a maximum relaxation effect was observed for fractions F2-F5. F4 was the most effective to elicit a concentration-dependent relaxation effect with an ED(50)=160±1.1 μg/mL (n=5) and to decreased systolic and diastolic control pressure by 56.9% and 81.6% respectively. F4 contains most of the dihydropyranone dodoneine, with 93% of the sample mass. Dodoneine separated from this fraction was also able to decrease both systolic and diastolic arterial pressure by 32.5% and 38.7% at 100 μg/kg, respectively.

CONCLUSION

For the first time, this study demonstrates the hypotensive property of the dodoneine present in Agelanthus dodoneifolius.

[Hygienic quality of meat used in institutional food services: university cafeterias in Ouagadougou (Burkina Faso)]

This present study was conducted to assess the hygienic quality of meals served in three cafeterias at the national university in Ouagadougou and the compliance of kitchen staff with good hygiene practices. Microbiological analyses assessed the hygienic quality of the raw meat and of meat-based meals. The results showed poor hygiene practices by food handlers along the food chain. These observations were confirmed by the identification of salmonella, coliform and staphylococcal bacteria in raw meat and cooked meals. Overall, 60% of the raw meat samples were unsatisfactory for aerobic mesophilic flora and 6.6% for salmonella. For the cooked meat meals, on the other hand, 45% of the samples were satisfactory for aerobic mesophilic flora, 100% for salmonella, 93.3% for fecal thermotolerant coliforms and 96.6% for staphylococci. These results showed poor hygiene in the handling of raw meat, but a clear improvement in hygienic quality after cooking. Raising the awareness of cafeteria staff about compliance with hygiene rules appears primordial. Moreover improvement of the food environment, the kitchen equipment, and organization as well as the introduction of a cleaning-disinfection programme would make it possible to provide more hygienic meals in these institutional facilities.

[Side infection during HIV/AIDS at Trechville university health center (CHU)]

To highlight the main sides infections and their progress with HIV sick people selected in the inner health department of the CHU of Treichville, Abidjan, a retrospective survey was carried out from the files of sick people over 30 months of period; from January 1, 1999 through July 15, 2001. 279 patients (143 males and 136 females) where involved; 382 side infections where found out and the most frequent were: tuberculosis (28.3%), fungous infection (26.7%), gastro-enteritis.7%) and brain toxoplasmosis (15%). The lethal rates were respectively 16.6% for tuberculosis, 51.6 for gastroenteritis, 66.7% for neuro-meningeal Cryptococcus and 68.1% for brain toxoplasmosis. The impact of side infections on the progress of HIV/AIDS requires a preventive type of rallying as therapeutic progress is still unreachable for developing countries, which are the most affected by the HIV epidemics.

[Pulmonary tuberculosis in an endemic area with high HIV prevalence]

The aim of this study was to study clinical and radiological aspects of caseous pneumonia in Burkina Faso where we have higher prevalence of tuberculosis/HIV. 3 years of retrospective study, from 1st January to December 31-1999, had been carried out in the "Centre Hospitalier National Yalgado Ouédraogo de Ouagadougou". Among 106 of patients studied, 26 caseous pneumonia were observed (24.5%) of whom 9 patients were holders of HIV. Often observe on late because of the non specificity of signs, 9 cases of pneumonia upon 26 were excaved (2 holders of HIV and 7 non holders of HIV). The lesion have predominated on upper right lob (19 cases upon 26). The antituberculosis treatment was effective in the major cases but with the sequella (excavations, fibrosis) in patients with excaved lesions or treated in late. Considering the gravity of the disease and its sequella which can be avoid, the presence of fever, slimming even at absence of bacteriologic prouf in debilited patient must evoke caseous pneumonia diagnosis and allowed to begin specific treatment.

[Radiographic and ultrasonographic diagnosis of a left thoracic mass]

A chest roentgenogram of a 69-year-old man undergoing a check-up before prostate surgery showed a mass in the antero-inferior zone of the lung, just above the diaphragm. At ultrasonography, it was considered to be a thoracic ectopic kidney. This radiological case illustrates the place of this anomaly in the differential diagnosis of lung solitary mass, which can be explored with ultrasonography when retroperitoneal herniation is suspected.

[Bronchopulmonary Kaposi's disease in 2 AIDS patients living in a zone of high tuberculosis/HIV prevalence]

The epidemic form of Kaposi's disease, called Kaposi-AIDS, was first described in 1981 by Hymmes in two young AIDS patients. Lung lesions are observed in 10 to 45% of patients with cutaneous Kaposi and are the second leading localization of visceral involvement after the digestive tract. Diagnosis and management of these visceral forms remains difficult. We report two cases of broncho-pulmonary Kaposi-AIDS in two patients treated for cutaneous Kaposi's disease. The diagnosis was made on the basis of epidemiological, clinical, biological, radiological, endoscopic, and histological evidence. The diagnosis was achieved by elimination after ruling out all other opportunistic diseases with pulmonary tropism. The fear of miliary tuberculosis remains strong in zones with a high prevalence of tuberculosis. Despite considerable improvement with antiretroviral drugs, especially antiproteases, outcome remains unpredictable with or without specific treatment.

[Primary pulmonary myxoid liposarcoma discovered fortuitously]

We report a fortuitous discovery of primary pulmonary myxoid liposarcoma in an HIV-positive patient. Primary pulmonary localizations are uncommon. Generally, pulmonary localizations are metastatic. There is a male predominance and diagnosis is generally made around 40 years of age. The two main features of liposarcoma are the large tumor size and the complex histology that evolves over time. Pathology findings are rarely reproducible and vary from one pathologist to another. Macroscopically, liposarcomas can mimic benign tumors. The risk of recurrence is high after simple enucleation due to microscopic extracapsular extensions. Surgery remains the predominant treatment. Wide complete excision, if possible, provides long-term survival.

[Contribution of bronchial fibroscopy in pneumonology services in developing countries]

Bronchial fibroscopy is a recent investigation method that requires equipment and facilities difficult to implement in respiratory diseases units in developing countries. In Burkina Faso, this technique was introduced for the first time in February 1997. The purpose of this study was to determine the contribution of bronchial fibroscopy for the diagnosis of respiratory disease in countries with limited resources. This study was conducted between February 1997 and October 1998 at the respiratory diseases unit of the Yalgado Ouedraogo National Hospital Center in Ouagadougou, Burkina Faso. Thirty-five cases of tuberculosis were diagnosed, including 29 cases with bronchial node involvement, where bronchial fibroscopy is an essential diagnostic examination, and 6 cases of bacteriologically proven pulmonary tuberculosis. Ten cases of lung cancer were diagnosed (40% squamous cell carcinoma). Malignant disease is a reality in developing countries despite low rates of diagnosis due to insufficient diagnostic facilities. For tuberculosis, the importance of specific treatment is certainly well established and should always be initiated, even if fibroscopy cannot be performed. This contrasts with the situation for malignant disease, where the high prevalence of lung cancer (9.9% of the bronchial fibroscopies performed) is associated with total lack of treatment due to the absence of a thoracic surgery unit or a radiotherapy unit, and the impossibility of providing satisfactory surveillance of anti-cancer chemotherapy.

[Simultaneous resistance to rifampicin and isoniazid in patients with pulmonary tuberculosis]

Percentages of primary and acquired resistance to anti-tuberculosis drugs provide an epidemiological indicator useful for assessing national anti-tuberculosis programs. Rifampicin and isoniazide are widely used in countries with a high prevalence of tuberculosis. In tropical Africa, these drugs are the mainstay treatment for tuberculosis, used both in the initial and long-term regimens. Simultaneous resistance to these two antibiotics would seriously jeopardize therapeutic efficacy. We studied simultaneous rifampicin and isoniazide resistance in patients hospitalized for tuberculosis in the respiratory disease unit of the Treichville University hospital in Abidjan, Ivory Coast. Mycobacterium tuberculosis was isolated in 8 patients. All the strains isolated were resistant to streptomycin. History taking revealed that resistance was observed at the initial prescription in 6 cases. A notion of contagion was present in 4 cases. Six patients were HIV-positive. Surveillance of resistance to anti-tuberculosis drugs is helpful in detecting early changes which could compromise the efficacy of the therapeutic scheme.

[Caseous pneumonia in a 14-month-old infant]

We report a case of caseous pneumonia in a 14-month-old HIV-negative infant. This clinical picture is usually observed in healthy young adults, rarely in infants. The clinical and radiological signs of caseous pneumonia often simulate acute non-tuberculous respiratory disease. Bacteriological confirmation is required, but the diagnosis can be suggested in case of a pulmonary syndrome with no bacterial isolate and unresponsive to well-conducted antibiotic therapy. The clinical course is rapid with caseous involution of the lung. Early diagnosis is required for specific curative treatment and to limit sequelae.

[Active tuberculosis in a patient with Hodgkin's disease. A case report]

We report a case of active tuberculosis in a patient with Hodgkin's disease. The two diagnoses were established simultaneously at the Respiratory Disease Unit of the Yalgado National Hospital, Burkina Faso. The clinical presentation was misleading as the signs and symptoms of the two disease are similar. Certain diagnosis was established after isolation of tuberculosis bacilli and histocytology findings for Hodgkin's disease. Both diseases are potentially curable. The clinical course depends on early diagnosis and treatment.

[Efficacy of a short 6 month therapeutic coursefor HIV infected tuberculosis patients in Abidjan, Côte d'Ivoire]

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.

[Traditional concept of madness and therapeutic difficulties in the Moose of Kadiogo.]

The practice of psychiatry in the south of the Sahara in Africa collides with many problems of acceptability of care for the ill and their families. The frequent rejection of the psychiatrist's therapeutic approach can often be explained by the inadaptation of the etiopathogenic approach. Indeed, in black Africa, responsibility of illness differs according to the fact that one has been schooled or not. The western world teaches minorities having the chance to live there or learn about it, that the human body can be assaulted by bacteria, viruses, mycoses or be self-assaulted by changes of its own physiology. Traditional education, for its part, regards the body as a mysterious entity susceptible of being penetrated or eaten by geniuses and anthrophagic sorcerers following a mystico-religious mechanism linked to beliefs and customs. In the majority of the Moose of the Moaga plateau in Burkina Faso, especially regarding madness, these assailants are ancestral geniuses or geniuses from the bush. Psychological suffering caused by a family, social or intrapsychic conflict independent of the invisible world is ultimately delirious for them thus provoking a resistance to give up complete charge of their mentally ill to psychiatric care. For us, an analysis of probable causes of this resistance appeared necessary. Interviews have shown that the psychiatric institution is experienced by the Moose of Kadiogo as a stage in the therapeutic itinerary of their mentally ill, a stage in the course of which their demand for care is reduced to the elimination of inconvenient symptoms. For them, the elimination of the cause derives from a knowledge that psychiatry does not possess, which renders the therapeutic relationship frustrating for both parties.