[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

[Brachial Plexus: Dissection At The Laboratory Of Anatomy Of Bamako]

INTRODUCTION

The brachial plexus consists of the ventral twigs of the last four cervical nerves and the first thoracic nerve. It ensures the motor and sensitive innervations of the thoracic limb.

AIM

Our goal was to describe the brachial plexus of the cervical region to the middle third of the arm.

METHODOLOGY

We conducted a prospective study at the anatomy Laboratory of the Faculty of Medicine and Dentistry in Bamako from September 2016 to October 2017. We dissected the brachial plexus (PB) of 13 fresh adult corpses on both sides. The inclusion criteria were: Fresh adult corpses with cervical regions and brachial without scarring. The injected or scar-carrying corpses were not included in the cervical and brachial regions.

RESULTS

Twenty-six brachial plexus of which 18 bp in men and 8 bp in women were dissected. The average age of the subjects was 42 years (extreme: 18 and 70 years). We noted nerve block variations in 3.8%, fascicular in 3.8% and late terminal in 73.1%. The involvement of the anterior branch of the fourth spinal nerve (C4) was found in 46.2%.

CONCLUSION

The brachial plexus is the seat of many anatomical variations whose knowledge is indispensable to treat its lesions.

Mechanical clearance of red blood cells by the human spleen: Potential therapeutic applications of a biomimetic RBC filtration method

During their lifespan, circulating RBC are frequently checked for their deformability. This mechanical quality control operates essentially in the human spleen. RBC unable to squeeze though narrow splenic slits are retained and cleared from the blood circulation. Under physiological conditions this prevents microvessels from being clogged by senescent, rigid RBC. Retention of poorly deformable RBC is an important determinant of pathogenesis in malaria and may also impact the clinical benefit of transfusion. Modulating the splenic retention of RBC has already been proposed to support therapeutic approaches in these research fields. To this aim, the development of microplates for high throughput filtration of RBC through microsphere layers (microplate-based microsphiltration) has been undertaken. This review focuses on potential therapeutic applications provided by this technology in malaria chemotherapy and transfusion.

[Risk factors and clinical aspects of myocardial infarction in patients younger than 40 years in the Point G Teaching Hospital]

A retrospective and analytical study was conducted, over 9 years, from January 2004 to December 2012. It included 10 inpatients and took place at the cardiology service of the Point G teaching hospital. Its goals were to assess cardiovascular risk factors, the delay between the clinical onset and admission and to describe ECG changes and echocardiographic changes of myocardial infarction in patients under 40 year-old. Young patients accounted for 6.8% of MI admissions with a male predominance of 90%. The disease frequency has increased with age, 40% were within 38-40 year-old range, the risk factors were predominantly smoking 80%, Stress 50%, High Blood Pressure 40% and dyslipidemia 20%. Typical chest pain was the most common recorded symptom. Anterior necrosis was the most common of electrical pattern, 8 out 10 times the ejection fraction was down and segmental kinetic was impaired in 60% of patients on echocardiography. Over 3 quarters of patients were admitted 12 hours after the onset of symptoms and the evolution during hospitalization was good with no fatality.

The complex vaginal flora of West African women with bacterial vaginosis

Background

The spectrum of bacteria associated with bacterial vaginosis (BV) has recently expanded through taxonomic changes and the use of molecular methods. These methods have yet to be used in large-scale epidemiological studies in Africa where BV is highly prevalent.

Methods

An analysis of samples obtained during a clinical trial of the management of vaginal discharge in four West African countries. Samples were available from 1555 participants; 843 (54%) had BV. Nucleic acids of 13 bacterial genera or species potentially associated with BV were detected through the polymerase chain reaction.

Results

The associations between various components of the vaginal flora were complex. Excluding Lactobacillus, the other 12 micro-organisms were all associated with each other at the p≤0.001 level. The prevalence of various bacterial genera or species varied according to age, sexual activity and HIV status. In multivariate analysis, the presence of Gardnerella vaginalis, Bifidobacterium, Megasphaera elsdenii, Dialister, Mycoplasma hominis, Leptotrichia, and Prevotella were independently associated with BV as was the absence of Lactobacillus and Peptoniphilus. However, Mobiluncus, Atopobium vaginae, Anaerococcus, and Eggerthella were not independently associated with BV. Unexpectedly, after treatment with a regimen that included either metronidazole or tinidazole, the proportion of patients with a complete resolution of symptoms by day 14 increased with the number of bacterial genera or species present at enrolment.

Conclusions

Numerous bacterial genera or species were strongly associated with each other in a pattern that suggested a symbiotic relationship. BV cases with a simpler flora were less likely to respond to treatment. Overall, the vaginal flora of West African women with BV was reminiscent of that of their counterparts in industrialized countries.

[Cerebrovascular accidents: risk factors, clinical course and prognosis in the Cardiology "B" Service of the du Point G University Hospital Center, Bamako]

Our study of series, futurology, descriptive and analytical proceeded in the service of Cardiology B of the CHU of the Point G of the 1(er) July at 31 Décember 2007 and related to 57 in-patients. It aimed to release the factors of risks, to evaluate under treatment the evolution and to determine the prognostic elements of the cerebral vascular accidents. All the patients hospitalized in the service of Cardiology G for the period of study for cerebral vascular accident documented by a cerebral TDM was included in the series. The cerebral vascular accidents represented more of the quarter (25,22 %) of the admissions. The sample counted 29 women (50,9 %) and 28 men (49,1 %) with a sex ratio of 1,03 in favour of the women. The average age was 61,17 years ± 13,71 there. Arterial hypertension (59,6 %) was the first factor of risk and in the series the ischaemic AVC constituted approximately three quarters (70,2 %) of the organic types. It was especially male and the rather female hemorrhagic lesion. The hemorrhagic AVC was noted before 30 years and the ischaemic AVC beyond. The complications were with female prevalence and identical lethality in the two sexes. The hospital death rate in the study was considerable (10,5 %). The found prognostic elements did not have statistical significance.

[The use of rhythmic Holter record in the diagnosis of unexplained syncope at the point hospital cardiology division]

Authors report the finding of the descriptive study of 36 syncope case following while 1 year (January-December 2006) in cardiology A service at the hospital of point G. The unexplained syncopes have represented 30% of the all syncopes. The female frequency sex was predominant with 58% of cases. The mean age of patients was 43 +/- SD years. The holter rhythmic during 24 hours has been productive for 58% in term of etiology research of syncope dominate essentially by the trouble of rythm at 19%.

The syndromic management of vaginal discharge using single-dose treatments: a randomized controlled trial in West Africa

OBJECTIVE

To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge.

METHODS

A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo. Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes. Effectiveness was assessed by symptomatic response on day 14. CLINICAL IDENTIFIER ClinicalTrials.gov NCT00313131.

FINDINGS

The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26). Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis. The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20). Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections. Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment.

CONCLUSION

Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection. Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome.

Improving second-generation surveillance: the biological measure of unprotected intercourse using prostate-specific antigen in vaginal secretions of West African women

BACKGROUND

Second-generation surveillance for HIV includes measures of high-risk behaviors among the general adult population and sex workers (SW). Questionnaires are prone to social desirability biases because individuals minimize the frequency of behaviors not expected from them.

OBJECTIVE

Determine whether the prostate-specific antigen (PSA) could be used as a biological marker of unprotected intercourse.

METHODS

We measured the presence of PSA in vaginal secretions of women who were (n = 508) or were not (n = 658) SW presenting with vaginal discharge in health facilities of Ghana, Togo, Guinea, and Mali. The cutoff for a positive assay was determined as > or =0.4 microg/L based on a subsample of 95 non-SW claiming abstinence for 3 months.

RESULTS

A positive PSA assay was correlated with infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. Among non-SW, a positive PSA was more common among those with HIV, but less frequent in those better educated. Among SW and non-SW, women from Ghana were less likely to have a positive PSA and had a lower prevalence of sexually transmitted infections than those from elsewhere.

CONCLUSIONS

PSA can be used as a biological marker of unprotected intercourse, allowing interventions to target efforts on those at highest risk.

Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management

OBJECTIVES

To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm.

METHODS

In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B).

RESULTS

Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01).

CONCLUSIONS

NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.

[Complications of illegal induced abortions at Bamako (Mali) between December 1997 and November 1998]

We carried out a descriptive retrospective study over a period of one year, in the Gynecology and Obstetrics Referrals Department of Gabriel-Touré Hospital at Bamako. We analyzed 1,081 files of patients presenting at the department with complications of spontaneous or induced abortion. We identified and studied 189 cases of illegal induced abortions. The patients were young (mean age 21.8 years), of a low socioeconomic level and most (71.4%) had no living child. The gestational age of the fetus was less than 12 weeks for 19.5% of the women and between 13 and 16 weeks for 47.6%. The abortions were carried out by traditional practitioners (3.7%), general practitioners (9%), trainee nurses (10.5%) and state nurses and midwives (57.1%). In more than half the cases (71.4%), the abortion took place at the home of the practitioner. Several methods of abortion were used (e.g. curettage, uterine probes). In 44.4% of the cases, the woman refused to comment on the reasons for the abortion. The other women cited mostly academic reasons (20.63% of cases) and fear of their parents (13.22%). The main reasons for consultation were bleeding (51.3%), hyperthermia (35.4%), pain (9. 52%) and neurological problems (3.1%). Three types of complication were identified: bleeding (47%), infectious complication (33.3%) and drug poisoning (4.2%). The rate of maternal mortality was 10% and the management of the patients required surgical (from curettage to hysterectomy) and medical treatment, with a mean stay in hospital of 10 days.

[Role of iron deficiency in anemia in pregnant women in Mali]

The epidemiological characteristics of iron deficiency anemia after radioimmunoassay of serum and erythrocyte ferritin were evaluated in 209 Malian women at the time of delivery in a maternity unit in Bamako, Mali. The incidence of iron deficiency anemia was high (36.8%). This incidence did not reflect socio-economic status, nor even any particular obstetric history, but was significantly higher in younger mothers (aged under 26). The severity of anemia was such that 2.4% of women would require a blood transfusion post-partum. It looks therefore desirable, in Mali, to screen routinely and to ensure the prevention of iron deficiency in adolescent girls and to include, in the prevention of anemia of pregnant women, routine iron supplements from the beginning of pregnancy.