Bourbotte-Salmon F, Bertani A, Alvernhe A
… +2 more, Rongieras F, Mathieu L
Med Sante Trop
· 2019 Aug · PMID 31573519
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The authors report three pediatric cases presenting with tibial osteomyelitis complicated by fracture for which flap coverage was performed in a low-resource setting. Pedicled flap transfers are rarely used for the treat...The authors report three pediatric cases presenting with tibial osteomyelitis complicated by fracture for which flap coverage was performed in a low-resource setting. Pedicled flap transfers are rarely used for the treatment of chronic osteomyelitis in developing countries. However, these procedures are accessible to any orthopedic surgeon and enable satisfactory treatment of bone infection, reduce the duration of care, and enhance the reliability of bone grafts.
Elien Gagnan Yanza-Outou RR, Bakayoko S, Diallo S
… +7 more, Sylla A, Coulibaly T, Toure N, Tembely M, Diabaté CNR, Dicko MA, Sylla F
Med Sante Trop
· 2019 Aug · PMID 31573518
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A newborn 3 hours old newborn presented bilateral eyelid edema with erythema and inflammatory hypertrophy of the palpebral conjunctiva. PCR of the conjunctival swabbing showed the presence of Chlamydia trachomatis DNA. T...A newborn 3 hours old newborn presented bilateral eyelid edema with erythema and inflammatory hypertrophy of the palpebral conjunctiva. PCR of the conjunctival swabbing showed the presence of Chlamydia trachomatis DNA. Treatment with erythromycin suspension 125 mg/5 ml was initiated, supplemented by topical application of oxytetracycline ointment 1% and Azyter eye drops.
Picquendar V, Valois A, Garcia M
… +3 more, Pecoul T, Janvier F, Morand JJ
Med Sante Trop
· 2019 Aug · PMID 31573517
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Diphtheria is an infectious disease transmitted by air or by contact. There are three main species of corynebacterium: diphtheriae, ulcerans, and pseudotuberculosis. They may or may not secrete a toxin responsible for se...Diphtheria is an infectious disease transmitted by air or by contact. There are three main species of corynebacterium: diphtheriae, ulcerans, and pseudotuberculosis. They may or may not secrete a toxin responsible for serious cardiac or neurological complications. The frequent clinical presentations are diphtheria angina and cutaneous diphtheria. When it is suspected, it is urgent to send cutaneous or pharyngeal samples to the National Reference Center. If toxin is present, serotherapy should be instituted and the case should be reported. Antibiotic therapy with amoxicillin or azithromycin is the standard treatment. Vaccine prevention begun in the middle of the 20th century has helped to slow epidemics.
Med Sante Trop
· 2019 Aug · PMID 31573516
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We report the case of a 32-year-old man with septic arthritis and Neisseria gonorrhoeae tenosynovitis, diagnosed after joint fluid culture treated with ceftriaxone. It is one of the most frequent causes of purulent septi...We report the case of a 32-year-old man with septic arthritis and Neisseria gonorrhoeae tenosynovitis, diagnosed after joint fluid culture treated with ceftriaxone. It is one of the most frequent causes of purulent septic arthritis in young people in undeveloped countries. Early diagnosis is important to avoid complications.
Cardinale M, Scheiwe C, Boubotte-Salmon F
… +1 more, Laitselart P
Med Sante Trop
· 2019 May · PMID 31379353
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We report an unusual case of a foreign body removed from the urinary bladder of an 11-year-old boy, which had mimicked a recurrent bladder stone. The diagnosis was suspected by ultrasound. As the clinical presentation ap...We report an unusual case of a foreign body removed from the urinary bladder of an 11-year-old boy, which had mimicked a recurrent bladder stone. The diagnosis was suspected by ultrasound. As the clinical presentation appeared typical, no other examination was performed. Open surgery revealed that this foreign body was a surgical dressing forgotten during the first surgery eight years earlier. The absence of clinical evidence or infectious complications related to this foreign body over such a long period was surprising.
Condé K, Niasse M, Garba MS
… +2 more, Diouf C, Diallo S
Med Sante Trop
· 2019 May · PMID 31379352
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Publisher ↗
Reports of late-onset spondyloarthritis in sub-Saharan Africa are sparse. This series allows us to describe the characteristics of this disease in Senegal. This is a retrospective study conducted in the Rheumatology Depa...Reports of late-onset spondyloarthritis in sub-Saharan Africa are sparse. This series allows us to describe the characteristics of this disease in Senegal. This is a retrospective study conducted in the Rheumatology Department of the Dantec University Hospital (Dakar) where we reviewed records of spondyloarthritis cases. Its diagnosis met the modified ASAS and New York criteria. Late-onset was defined as after the age of 55 years. During the study period, the department managed 133 late-onset patients, or 38% of all spondyloarthritis cases (350). Age ranged from 65 to 74 years, with a mean of 66. HLA B 27 phenotyping was performed in 89 patients; 39 patients were HLA B27 positive (29%). The treatments were based on DMARDs (salazopyrin and methotrexate).
Gueye M, Ndiaye MD, Diallo M
… +3 more, Mbodji A, Kane Gueye SM, Moreau JC
Med Sante Trop
· 2019 May · PMID 31379351
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To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is...To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.
Iba Ba J, Nseng Nseng Obiang I, Ntsame Ngoua S
… +7 more, Igala M, Kombila UD, Malekou Mwenpindi D, Nziengui Madjinou MI, Cabrera NO, Ledaga Letombo L, Boguikouma JB
Med Sante Trop
· 2019 May · PMID 31379350
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Publisher ↗
Autoimmune diseases are a group of heterogeneous conditions responsible for polymorphic clinical and biological manifestations. Because pregnancy activates them and promotes gestational complications, it is difficult for...Autoimmune diseases are a group of heterogeneous conditions responsible for polymorphic clinical and biological manifestations. Because pregnancy activates them and promotes gestational complications, it is difficult for women with these diseases. Pregnancy and autoimmune diseases have rarely been studied in sub-Saharan Africa. We report the experience of the Internal Medicine Department of the University Hospital of Libreville. Conducted retrospectively for 2008 through 2011, and prospectively from 2012 through August 31, 2018, this descriptive and analytical study examined the records at the Department of Internal Medicine of the University Hospital Center of Libreville of women with a known autoimmune disease, receiving regular care there, and who became pregnant after the diagnosis. During pregnancy, women were monitored and manÂged simultaneously in the departments of obstetrics and internal medicine. Data considered for this study were demographic data (Âge, sex, social status), type of autoimmune disease, including the diagnosis, the therapies used, extent of disease control, and time from diagnosis to each pregnancy. Obstetric data include the number of fetuses, obstetric complications, gestational Âge at and route of delivery, fetal sex, and Apgar score to 5 minutes (normal ≥ 7). Women had the following autoimmune diseases : systemic lupus erythematosus (SLE) (n = 16), Sjögren's disease (n = 3), inflammatory myopathy (n = 2), rheumatoid arthritis (n = 1), primary antiphospholipid syndrome (APS) (n = 1), and Still disease (n = 1).The overall averÂge Âge at diagnosis was 26.6 years (range : 13-40). The 24 women had 32 pregnancies. The mean interval from diagnosis to first pregnancy was 3.3 years, to the second pregnancy also 3.3 years (n = 6), and to the third (n = 2), 5 years. Disease was controlled for at least 2 years (n = 23) except for one woman with primary APS. Therapeutically, corticosteroids were used alone (n = 2) or combined with other immunomodulatory therapies (n = 32). Gestational complications included spontaneous abortions in the first trimester (n =2), in utero deaths (n = 2), perinatal death on day 12 (n = 1), and eclampsia (n = 2), one of which was complicated by a pulmonary embolism in the first pregnancy. The mean gestational Âge at delivery was 37 weeks. Intrauterine growth restriction affected 11 fetuses, and preterm delivery 18. There were 11 cesarean deliveries and 16 vaginal. Mean birth weight was 2353.3 grams, Apgar was ≥ 7 for all neonates except in one case of dermatomyositis complicating a neonatal death. The sex ratio was 13 male infants per 17 females. Women with optimal disease control can become pregnant and have positive pregnancy outcomes. This possibility has been little explored in sub-Saharan Africa; mystical-religious notions of conceptions persist and can prevent women from attempting to become prégnant . This experience with a short series of viable fetuses of women with autoimmune diseases is therefore encouraging and deserves to be continued.
Kiemtoré S, Yaméogo SA, Touré B
… +4 more, Ouédraogo I, Kaboré WC, Ouédraogo A, Bonané-Thiéba B
Med Sante Trop
· 2019 May · PMID 31379349
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Knowledge of the factors of non-use of modern contraceptive methods should help to reduce the number of infants born after short interpregnancy intervals, which are associated with adverse effects for mothers, children,...Knowledge of the factors of non-use of modern contraceptive methods should help to reduce the number of infants born after short interpregnancy intervals, which are associated with adverse effects for mothers, children, and families. For this reason, this study aimed to determine the factors associated with this non-use among mothers of infants aged 12 to 23 months. This case-control study included a sample of mothers of children aged 12 to 23 months. The case mothers were users of modern contraceptive methods and the control mothers were non-users. Data were collected from January 1 through March 31, 2018. Six factors were significantly associated with the use of modern contraceptive methods: age younger than 25 years, lack of gainful activity, desire for a family size ≥ 4 children, BMI greater than 25, opposition by husband, and failure to attend the 45-day postnatal consultation. Modifiable socio-economic factors were significantly associated with the non-use of modern contraceptive methods by mothers of children aged 12 to 23 months.
Baldé IS, Diallo A, Diallo MH
… +4 more, Baldé O, Sylla I, Diallo BS, Sy T
Med Sante Trop
· 2019 May · PMID 31379348
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Publisher ↗
Sexual violence is widespread in the world and has a negative impact on women's mental, social, and physical well-being. The purpose of this study was to describe the epidemiological and clinical aspects of the occurrenc...Sexual violence is widespread in the world and has a negative impact on women's mental, social, and physical well-being. The purpose of this study was to describe the epidemiological and clinical aspects of the occurrence of sexual violence among patients seen in the Gynecology-Obstetrics department at Ignace Deen National Hospital. This is a cross-sectional, descriptive, observational study of victims of sexual violence seen in the department, directly or on court orders, during the two-year period from May 1, 2016, to April 30, 2018. The data were analyzed with SPSS 16.0 software. Sexual violence accounted for 3.5% of all consultations in the department during the study period. They concerned adolescents (64.0%), females (97.1%), students (78.6%), and single individuals (95.7%). More than half of the sexual assaults were committed in the abuser's home (57.1%), by an assailant known to the victim (87.0%), at night (71.4%), by one person (85.7%), and during the weekend (60.0%). The lesions observed included vulvovaginitis (45.8%), vaginal tears (8.7%), facial bruises (8.7%), anal tears (4.4%), and ocular contusions (4.4%). The gynecological examination was normal in 21.4% of cases. Vaginal penetration was the sexual act practiced most often (88.4%) by aggressors, compared with acts of sodomy (4.3%). We noted 7.2% of fondling. Overall, 58.6% had previously had their hymen broken, and 34.3 very recently, while the hymen was intact in 7.1% of cases. The frequency of sexual violence is underestimated in our society. Its prevention involves its punishment, adequate medical care of victims, and improvement of the status of women.
Rakotoniaina AI, Razafindrakoto R, Rasamindrakotroka A
Med Sante Trop
· 2019 May · PMID 31379347
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Publisher ↗
Screening for HIV is recommended for all TB patients but it has not yet been initiated in some regions of Madagascar. In this study, our main objective was to determine the seroprevalence of HIV infection in TB patients...Screening for HIV is recommended for all TB patients but it has not yet been initiated in some regions of Madagascar. In this study, our main objective was to determine the seroprevalence of HIV infection in TB patients and secondarily to determine the risk factors favoring TB infection in these patients. This prospective cross-sectional study took place in the pneumology department of the University Hospital of Tulear from January to April, 2017. We diagnosed 75 patients with tuberculosis, 96.05% of them new cases. The sex-ratio was 1.81. Patients' mean age was 35 years. Two patients (2.66%) were coinfected with HIV. Among the new cases diagnosed, 62.66% had pulmonary tuberculosis with positive microscopy (TPM +). Two patients reported a person with tuberculosis among their family or close friends. Living with someone in poor hygiene conditions was reported by 82.66% of the cases. Overall, 24% were unemployed. These patients had quite varied ethnic origins. The prevalence of HIV infection in TB patients was higher than in the general population. Low income and low educational levels were the main risk factors for TB infection in Madagascar.
Med Sante Trop
· 2019 May · PMID 31379346
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Publisher ↗
To determine the prevalence of HIV infection among stroke patients admitted to the Douala General Hospital (DGH) and to describe the clinical characteristics and outcome of the stroke patients with HIV infection. This pr...To determine the prevalence of HIV infection among stroke patients admitted to the Douala General Hospital (DGH) and to describe the clinical characteristics and outcome of the stroke patients with HIV infection. This prospective cohort study took place in 2010-2015 at the DGH. The study included patients older than 15 years with a CT-confirmed stroke. All patients underwent HIV tests with Western-Blot confirmation. The functional prognosis of the patients was assessed by the Rankin score at 6 months after stroke onset. The prevalence rate of HIV among stroke patients was 6.6% (40/608). Of the 40 HIV-positive patients, 58% were aware of their status at admission; 83% of these patients were receiving antiretroviral therapy. Males were predominant (65%), and the mean age was 51.3 ± 10.4 years. Hypertension was the main cerebrovascular risk factor (65%). At admission, 47.5% of HIV+ patients were febrile, and 7.5% presented with coma. Ischemic stroke accounted for 60% of cases. The mean CD4 cell count was 351 ± 236/mm with a median of 330/mm. The length of stay was 10 ± 8 days. At 6 months, the cumulative mortality of HIV+ patients was 37.5%, and 38.5% were dependent (Rankin>2). HIV prevalence is high among stroke patients in our setting. This suggests that an HIV test should be routinely proposed to stroke patients.
Diemer SCH, Konzelo Gassa Ngazo AD, Tekpa G
… +2 more, Longo JDD, Mbelosso P
Med Sante Trop
· 2019 May · PMID 31379345
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Publisher ↗
To determine the rate of attrition of patients in the antiretroviral treatment program in Bangui and factors associated with this loss to follow-up. This was a retrospective descriptive, analytical cohort study from Janu...To determine the rate of attrition of patients in the antiretroviral treatment program in Bangui and factors associated with this loss to follow-up. This was a retrospective descriptive, analytical cohort study from January 1, 2014 to March 31, 2017 in two large outpatient treatment centers in Bangui. Data were entered in and analyzed with Epi info version 3.5.4 software. Survival probability was calculated by a Kaplan Meier curve. The Cox model and logistic regression were used to determine the association between attrition and risk factors. A total of 292 patients were registered. Attrition rates at 6, 12, and 24 months were 14%, 20% and 31%, respectively. Factors associated with attrition were patients' age (young), living alone (compared to living with a partner), distance between place of residence and treatment center, presence of opportunistic infections, low hemoglobin levels, and lack of therapeutic education. This study identified the main risk factors for patients leaving the care system. Innovative strategies including differentiated approaches must be implemented to improve quality of screening, early start of treatment, and geographical access to care. Particular emphasis should be placed on therapeutic education to train and educate patients about their illness and how to manage it.
Igala M, Kouégnigan Rerambiah L, Ledaga Lentombo LE
… +5 more, Ifoudji Makao A, Nto'o Eyene S, Mbiye Cheme SW, Bouyou Akotet M, Boguikouma JB
Med Sante Trop
· 2019 May · PMID 31379344
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Publisher ↗
Pseudothrombocytopenia or artefactual thrombocytopenia is an abnormally low number of platelets due to their agglutination in a sample tube, with no ex vivo clinical translation. It occurs in ethylene diamine tetraacetic...Pseudothrombocytopenia or artefactual thrombocytopenia is an abnormally low number of platelets due to their agglutination in a sample tube, with no ex vivo clinical translation. It occurs in ethylene diamine tetraacetic (EDTA) test tubes. Non-EDTA anticoagulants, such as citrate, fluoride oxalate, and heparin lithium, may be responsible for it, alone or in combination. It can occur in patients with autoimmune diseases, neoplasia, atherosclerosis, liver disease, or infections. We report the case of a 5-year-old child, who after falciparum malaria showed persistent thrombocytopenia. Further exploration has led to the conclusion of pseudothrombocytopenia due to three anticoagulants: EDTA, citrate, and fluoride oxalate.
Coulibaly M, Toure MK, Koita SA
… +11 more, Coulibaly BB, Diop TM, Mangane MI, Al Meimoune AH, Nientao O, Dabo A, Diallo B, Dicko H, Konate M, Diango DM, Coulibaly Y
Med Sante Trop
· 2019 May · PMID 31379343
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Publisher ↗
The severity of a blood pressure spike is more closely associated with serious organ dysfunction, which can be life-threatening in the short term, than with the blood pressure level itself. A hypertensive emergency is de...The severity of a blood pressure spike is more closely associated with serious organ dysfunction, which can be life-threatening in the short term, than with the blood pressure level itself. A hypertensive emergency is defined as the presence of high blood pressure associated with acute organ dysfunction. The specific nature of high blood pressure in black patients may cause more frequent hypertensive emergencies. In this retrospective case study, we report our experience and highlight the specific prognosis for black African patients. We examined three patients, aged 27, 47, and 59 years, admitted to intensive care for a hypertensive emergency with neurological distress, and all in status epilepticus. Average blood pressure was 171 mm HG. Treatment included intubation, ventilation, and induction of a barbiturate coma, plus antihypertensive treatment. The outcome was favorable, with an average stay of 5 days. The frequency of hypertensive emergencies varies according to age, ethnic origin, and period studied. Black patients often suffer from more severe forms of high blood pressure, arising at an earlier age. Hypertensive encephalopathy can occur in patients with or without chronic hypertension. Without treatment, the encephalopathy induces a coma that can quickly become fatal. Its spontaneous course is catastrophic (10-20% survival at one year), but more favorable with adequate treatment (60-80% survival at five years).
de l'Escalopier N, Choufani C, Grosset A
… +4 more, de Lesquen H, Murison JC, Bertani A, Mathieu L
Med Sante Trop
· 2019 May · PMID 31379342
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Publisher ↗
Mycetoma is a disease that occurs in the mycetoma belt, between latitudes 15̊ south and 30̊ north. It affects disadvantaged regions with limited access to medical and health facilities. Its general principles of care hav...Mycetoma is a disease that occurs in the mycetoma belt, between latitudes 15̊ south and 30̊ north. It affects disadvantaged regions with limited access to medical and health facilities. Its general principles of care have changed little and are poorly known. We analyzed the management of mycetoma in Chad by French military surgeons deployed within the Epervier and Barkhane operations. This retrospective descriptive study was conducted among the cohort of Chadian patients managed by the N'Djamena forward surgical team from 2007 to 2018 as part of the medical support to the population. It includes 132 patients who had surgery for mycetoma. Surgical parameters of primary treatment and revisions procedures were analyzed. Postoperative follow-up was at least six months. Amputation was performed in 87/132 (66%) patients. Overall 11 (8.3%) required revision surgery, including 7 (5%) with eumycetoma recurrence. All recurrences occurred in the lower limb. The recurrence rate after excision was 10.2% (5/49) versus 2.3% after amputation (2/87). In the absence of effective and accessible medical treatment, surgery remains the basic treatment for mycetoma. Salvage surgery with local excision should always be considered. However, amputation is the only reliable treatment in cases with late presentation. It should not be proposed too early as limb function is preserved for a long time.
Saoud MZ, Ezzariga N, Benaissa E
… +3 more, Moustachi A, Lyagoubi M, Aoufi S
Med Sante Trop
· 2019 May · PMID 31379341
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Publisher ↗
Morocco does not record any indigenous malaria case since 2004 and is certified by the World Health Organization as malaria-free since 2010. However, the country continues to record a significant number of imported malar...Morocco does not record any indigenous malaria case since 2004 and is certified by the World Health Organization as malaria-free since 2010. However, the country continues to record a significant number of imported malaria cases from endemic areas, especially from West Africa. The purpose of our work is to determine the epidemiological and diagnostic characteristics of malaria cases diagnosed at Ibn Sina Hospital Center in Rabat, Morocco. This work is a retrospective study of a series of malaria cases diagnosed between January 2012 and December 2016 at the Central Laboratory of Parasitology and Mycology of Ibn Sina Hospital Center. The methods used for the parasitological diagnosis are the search for the parasite at direct examination on thin blood film and thick drop and the search for parasite antigens by a rapid diagnostic immunochromatographic test (OptiMAL-IT® kit). Of 192 patients in whom malaria was sought, we recorded 54 positive cases (average of 10.8 cases per year). The prevalence was 28.12%. The age ranged from 4 to 76 years (average of 29.5 years). The sex ratio was 2.6. All cases had in their antecedents a notion of recent travel in an endemic area. The most common travel area was West Africa: Ivory Coast, with 31.43% of cases, followed by Guinea, with 14.29% of cases. The symptomatology was dominated by fever in 52 patients (96.3% of cases), followed by headache in 22 cases (40.74%). Anemia was present in 7 and thrombocytopenia in 12 patients. The most isolated species was Plasmodium falciparum (84.21% of cases), followed by P. vivax (10.53% of cases) and P. ovale (5.26% of cases). One case involved two species: P. falciparum and P. vivax. Parasitaemia was between less than 0.1 and 20%. Despite the local eradication of malaria, the persistence of imported cases, mainly due to the lack of chemoprophylaxis, should call for the strengthening of health education of travelers, especially in endemic areas.
Um Boock A, Ntozo'o JP, Boua B
… +1 more, Vander Plaetse B
Med Sante Trop
· 2019 May · PMID 31379340
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Publisher ↗
The incidence of neglected tropical diseases (NTD) can serve as an indicator for assessing the quality of healthcare systems because these diseases affect the poorest populations, living in areas where healthcare access...The incidence of neglected tropical diseases (NTD) can serve as an indicator for assessing the quality of healthcare systems because these diseases affect the poorest populations, living in areas where healthcare access is most difficult. The Central African Republic Ministry of Health, in collaboration with FAIRMED, decided to conduct the survey reported here in a village named/owned by the Central African Society of Agriculture and Wood Peeling (SCAD). The study took place from June 11-20, 2017. There were 137 clinical diagnoses of yaws, 102 of them positive on laboratory tests. Moreover, 79% were highly contagious forms. The prevalence of yaws in our study is higher than the 11% found in 2012 in the Lobaye region [4]. We also identified 57 cases of leprosy by screening; 68.42% (n= 39) were multibacillary. Among children younger than 15 years, 8 (16.66%) had grade 2 impairments. The screening rate for new cases is 13.333 per 10 000, quite substantially higher than the mean rate of 2.9 per 10 000 for the 121 countries and territories of this WHO region in 2016 [6]. Among the cases screened during the study, 51% (n=29/57) were already known to healthcare facilities. This study demonstrates the extent of the NTDs in Lobaye in the Central African Republic.