Mathieu L, Potier L, Niang CD
… +3 more, Rongiéras F, Duhamel P, Bey E
Med Sante Trop
· 2018 Aug · PMID 30270825
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After limb salvage based on debridement and external fixation, Gustilo IIIB open tibia fractures must undergo soft-tissue repair within 7 days. In low-resource setting, the coverage is performed with pedicled flaps only,...After limb salvage based on debridement and external fixation, Gustilo IIIB open tibia fractures must undergo soft-tissue repair within 7 days. In low-resource setting, the coverage is performed with pedicled flaps only, which can be used by any orthopedic surgeon after minimal training. The authors describe here the simplified use of 7 basic flap transfers that can deal with almost all soft tissue defects. The diffusion of these techniques in developing countries is crucial for limiting functional and trophic effects related to prolonged exposure of the fracture site.
Teclessou JN, Akakpo AS, Saka B
… +3 more, Mouhari-Toure A, Kombate K, Pitche P
Med Sante Trop
· 2018 Aug · PMID 30105987
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The aim of this study was to describe the epidemiologic, clinical, and therapeutic profiles of cases of lichenoid dermatosis in Lomé, together with their outcomes. This retrospective descriptive study reviewed records of...The aim of this study was to describe the epidemiologic, clinical, and therapeutic profiles of cases of lichenoid dermatosis in Lomé, together with their outcomes. This retrospective descriptive study reviewed records of patients receiving care for lichenoid dermatosis from January 1997 to December 2016 in the dermatology departments of Lomé. In total, 959 (2.2%) cases of lichenoid dermatoses including 813 (84.8%) of lichen planus and 123 (12.8%) of lichen striatus were recorded. The mean age of the patients was 29.60 +/- 14 years and the sex ratio (M/F) was 0.7. Lichen planus was papular and found most often on the lower limbs (56.0%). Lichen striatus was banded along the lines of Blaschko, mainly on the lower limbs (55.3%). There were 23 patients with lichen nitidus lesions, most often on the trunk (47.8%). The treatment was based on corticosteroid therapy. Recurrences were noted in 40 (11.6%) cases of lichen planus and 4 (3.2%) of lichen striatus. This study shows that the principal lichenoid dermatoses in Lomé are lichen planus, and their management is based on corticosteroid treatment.
Med Sante Trop
· 2018 Nov · PMID 30095076
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A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leave...A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leaves) on lesions of a severe thermal burn. A temperature of 38̊C, a heart rate of 114 beats/min, and a blood pressure of 90/60 mm Hg were recorded. The tetanus vaccination was not up to date. The diagnosis of tetanus was immediately suggested. Antitetanus serum (immunoglobulin), an antibiotic (amoxicillin and clavulanic acid), and a myorelaxant (benzodiazepine) were administered. Local treatments were also performed. The child died within 24 hours.
Saka B, Abilogoun-Chokki AE, Akakpo S
… +8 more, Teclessou J, Soga GW, Mahamadou G, Gnassingbe W, Mouhari-Toure A, Kombate K, Dosseh ED, Pitche VP
Med Sante Trop
· 2018 Aug · PMID 30095074
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The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Ol...The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125 cases of CLU were identified during the study period. The patients' mean age was 56.6 years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9 weeks (range : 7 weeks to 4 years). They were mainly associated with a history of diabetes (32 cases), arterial hypertension (16 cases), varicose veins (14 cases), and malnutrition (14 cases). The main causes were : ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21 cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122 patients (67 on the right and 55 on the left) and bilateral in 3 patients. The locations were the foot in 56 cases, the leg in 37 cases, and leg and foot in 32 cases. In addition to dressings, surgical debridement was performed in 23 patients, followed by skin autografts for 16. Amputation was performed for 31 patients. Sixteen (12.8%) of the 125 patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.
Ndiaye Diop MT, Ly F, Diop A
… +3 more, Seck B, Diadie S, Kane A
Med Sante Trop
· 2018 Aug · PMID 30095073
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to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place...to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place in the two reference departments for the treatment of dermatological diseases in Dakar. We have included all patients with a dermatological emergency, regardless of age and gender, as determined by the doctor receiving the patient. The data were entered in Excel and analyzed with R software, version 3.1.2. the study included 189 patients, 40 % of all dermatology department admissions. The sex ratio was 0.89 (M/F) and the average age 49 years. The mean time from arrival to treatment was 30 minutes. Absolute emergencies accounted for 45.4 % of these emergencies, and relative emergencies 54.6 %. Absolute emergencies were dominated by severe drug eruptions (17 %) and relative emergencies by infectious dermatoses (38 %). Emergency measures were carried out in all cases, associated with etiological treatment. The mortality rate was 7 % (n=14), and 5 (36 %) of these deaths were due to severe drug eruptions. Infectious dermatoses and severe drug eruptions are the most frequent emergencies. The high mortality rate, related mostly to drug eruptions, indicates the need for early management and an adequate technical platform.
Zamina BYG, Tiembré I, Attoh-Touré H
… +3 more, N'Guessan KE, Tetchi SM, Benié BVJ
Med Sante Trop
· 2018 May · PMID 29997083
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The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional stud...The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional study took place at the ARC of Abidjan from September 2014 through May 2015. Data were collected in two stages: first, all patients were interviewed at their first consultation. Exposed patients who failed to return were interviewed by telephone three days later. We recorded 441 subjects (59.3%) who had dropped out of their PEP. After multivariate analysis of social and demographic factors, the dropout rate was low in the groups aged 40-49 years (aOR = 0.40, 95% CI = 0.2, 0.8), 50-59 years (aOR = 0.40, 95% CI = 0.21; 0.82), and 60 years and older (aOR = 0.26, 95% CI = 0.09; 0.76), while it was elevated in retired persons (aOR = 10.07, 95% CI = [1.11, 91 , 7]). Moreover, the choice of protocol influenced PEP adherence, with subjects who chose the 5-dose protocol dropping out more frequently (P≤0.001). The main reason given by the subjects exposed to a suspect animal to explain dropping out of PEP was the lack of financial resources (41.5%). To alleviate this dropout problem, the ARC should strengthen public awareness of human rabies and the Ivorian government must implement universal health coverage to help the poor or make the vaccine available for free to all.
Girard P, Hassan-Farah I, Bich CS
… +3 more, Charpail C, Rigal S, Mathieu L
Med Sante Trop
· 2018 May · PMID 29997082
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Management of acute compartment syndrome is well known and based on emergent and generous fasciotomies. In absence of such fasciotomies, or if they are performed too late, the compartment syndrome leads to a Volkmann's s...Management of acute compartment syndrome is well known and based on emergent and generous fasciotomies. In absence of such fasciotomies, or if they are performed too late, the compartment syndrome leads to a Volkmann's syndrome or to a dramatic septic myonecrosis raising the question of an amputation. However, salvage treatment of these extreme clinical presentations may be preferable at the upper extremity, particularly in developing countries where access to sophisticated prosthetic devices is limited. The authors report four typical observations about management of upper extremity delayed compartment syndromes with severe infectious complications. To clarify treatment principles and pitfalls, two situations are distinguished: subacute septic myonecrosis and chronic osteomyelitis. Management specificities of both situations are discussed according to literature data and available resources in austere environments. Despite challenging in low-resources setting, upper extremity salvage is possible at the cost of simple but iterative surgical procedures. Limitations are represented by the need of repeated blood transfusions in the subacute phase, and difficulties in providing medical treatment of bone infection in the chronic phase.
Chadli S, Taqarort N, El Houate B
… +1 more, Oulkheir S
Med Sante Trop
· 2018 May · PMID 29997081
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Morocco is undergoing the third phase of its epidemiological transition. Mortality indicators have declined significantly. Life expectancy at birth has increased by 23 years over this 55-year study period. The total fert...Morocco is undergoing the third phase of its epidemiological transition. Mortality indicators have declined significantly. Life expectancy at birth has increased by 23 years over this 55-year study period. The total fertility rate has dropped from 7.06 in 1960 to 2.89 in 2015. The country is going through the epidemiological transition characterized by a shift in the overall burden of morbidity and mortality from infectious diseases to noncommunicable diseases and injuries. Chronic diseases now account for 75 % of all deaths. Cardiovascular diseases, diabetes, and cancer are among the leading causes of death (57 %). Accidents and injuries account for 7 % of deaths. The emerging diseases are largely related to changes in lifestyles, high blood pressure, obesity, smoking, and the harmful use of alcohol. This epidemiological transition, with its enormous health and economic consequences, presents many new challenges for the national health system, including in the organization of care pathways for diabetes and hypertension, the fight against overweight and obesity, and the therapeutic education of patients, health education in schools, and public awareness programs.
Missounga L, Iba Ba J, Nseng Nseng Ondo IR
… +4 more, Nziengui Madjinou MIC, Mwenpindi Malekou D, Mouendou Mouloungui EG, Boguikouma JB
Med Sante Trop
· 2018 May · PMID 29997080
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OBJECTIVE: to clarify the eligibility criteria for biotherapies in patients with chronic inflammatory rheumatism (CIR) in sub-Saharan Africa and to describe the characteristics of the first 8 patients treated with biothe...OBJECTIVE: to clarify the eligibility criteria for biotherapies in patients with chronic inflammatory rheumatism (CIR) in sub-Saharan Africa and to describe the characteristics of the first 8 patients treated with biotherapy in Gabon. MATERIALS AND METHODS: Patients who responded inadequately to treatments by cDMARDs (EULAR criteria) had a face-to-face interview to inform them about and obtain their consent to biotherapy for at least 3 months, with details of the cost and side effects of each available biotherapy and a certificate of "necessity of biotherapy". The inclusion and follow-up of patients took place in the outpatient rheumatology consultations at the University Hospital of Libreville (Gabon) between January 2010 and December 2016. RESULTS: Of the 30 patients who failed cDMARDs and required biologic treatment, 8 (26.6%) were able to start a biotherapy: 4 men and 4 women with rheumatoid arthritis (n = 4.50%), spondyloarthritis or psoriatic rheumatism (n = 2.25% each). The biotherapy was etanercept (n = 4, 50%), adalimumab, golimumab, infliximab and rituximab (n = 1, 12.5% each). The average duration of the biotherapy was 27.4 months (9-54). Biotherapy was stopped in 4 cases (50%), one each (12.5%) for multifocal tuberculosis, pregnancy, financial reasons, and remission. CONCLUSION: Our study shows that biotherapies, which are currently very expensive, can be prescribed in Africa provided that the usual recommendations are followed strictly. Here, access to biotherapies is only possible through private insurance and the rheumatologist must play the role of facilitator for needy and consenting patients.
Bouglouga O, Bagny A, Lawson-Ananissoh LM
… +4 more, Yakoubou RE, Kaaga L, Djibril MA, Redah D
Med Sante Trop
· 2018 May · PMID 29997079
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PURPOSE: To determine the epidemiological and diagnostic aspects of hepatobiliary diseases in people with HIV infection at the Lomé University Hospital. METHODS AND PATIENTS: This 5-year retrospective descriptive and ana...PURPOSE: To determine the epidemiological and diagnostic aspects of hepatobiliary diseases in people with HIV infection at the Lomé University Hospital. METHODS AND PATIENTS: This 5-year retrospective descriptive and analytic study included all people with HIV infection aged 15 years and older of either sex admitted with a hepatobiliary disease. RESULTS: Among all patients admitted for hepatobiliary diseases, people with HIV infection accounted for 2%. They were predominantly women. Our patients' mean age was 43.03±10.3 years. The principal reasons for consultation were asthenia (95.2%), jaundice (93.7%), and abdominal pain (80.9%). The main clinical symptoms were by deterioration of general status (84.1%) and pain of the right hypochondrium (66.7%); 63.5%were classified at WHO disease stage III or IV for HIV infection and disease. All our patients were positive for HIV1; and 86.5% had a CD4 count < 350 cells/mm3. We noted HVB/HIV coinfection in 39.6% and HVC/HIV coinfection in 19%. Cirrhosis had been diagnosed in 44.4%, hepatocellular carcinoma in 12.6%, and toxic or drug-induced hepatitis in 46%, while 8% had acute acalculous cholecystitis. No case of alcoholic steatohepatitis or AIDS cholangiopathy was noted. CONCLUSION: Hepatobiliary diseases are infrequent and varied among people with HIV infection; the most common are toxic hepatitis, cirrhosis, and hepatocellular carcinoma, and they do not differ according to CD4 counts.
Cissé CAT, Inzale MA, Wade NF
… +3 more, Niang MM, Diallo D, Ndiaye Seye N
Med Sante Trop
· 2018 May · PMID 29997078
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OBJECTIVES: To assess the feasibility and results of the implementation of systematic HIV screening of pregnant women and antiretroviral (ARV) treatment for those found to be HIV-positive and their newborns at the IHS Gy...OBJECTIVES: To assess the feasibility and results of the implementation of systematic HIV screening of pregnant women and antiretroviral (ARV) treatment for those found to be HIV-positive and their newborns at the IHS Gynecology-Obstetrics Department in Dakar, Senegal. PATIENTS AND METHODS: This cross-sectional prospective study took place in 2014-1016 and examined the results of screening pregnant women for HIV during their prenatal consultations and treating those found to be HIV-positive and their infants with ARV. RESULTS: HIV screening was routinely proposed to the 1616 pregnant women attending antenatal clinics, and 93.9 % accepted. The test was positive for 5 of these women, for an HIV prevalence of 0.3 % of pregnant women. In addition, another 23 HIV-positive pregnant women were referred to the IHS for their prenatal care and delivery, for a total of 28 women with HIV. Their mean age was 30 years, their mean parity 1.6, and all had HIV-1. Triple therapy was initiated for all HIV-positive pregnant women, in line with the WHO guidelines' "B + option", currently adopted by Senegal. During follow-up, only 35.7 % of the women had access to a viral load assay. The outcome of pregnancy was favorable in 91.6 % of cases; 72.2% of the women had vaginal deliveries. All live-born infants were given antiretroviral prophylaxis at birth. The mode of breastfeeding used was mainly exclusive protected breastfeeding (72.2 %). During postnatal follow-up, 2 of the 17 live-born infants were lost to follow-up, and 15 had PCR testing for HIV, which was positive in only 1 case, for a transmission rate of 6.6 %. CONCLUSION: The systematic offer and performance of HIV testing in all pregnant women is feasible and acceptable. Good organization of care can provide ARV treatment for all HIV-positive pregnant women and their newborns. The accessibility of viral load testing and of PCR screening for neonates still requires improvement.
Med Sante Trop
· 2018 May · PMID 29997077
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AIM: To evaluate the professional practices of physicians in Antananarivo in managing acute diarrhea in infants. METHODS: This prospective study was conducted from March 19 to April 21, 2012, as an anonymous survey of ra...AIM: To evaluate the professional practices of physicians in Antananarivo in managing acute diarrhea in infants. METHODS: This prospective study was conducted from March 19 to April 21, 2012, as an anonymous survey of randomly selected general practitioners and pediatricians working in the public or private sector in the city of Antananarivo. RESULTS: The survey included 125 physicians: 105 general practitioners, 11 pediatricians, and 9 other specialist physicians (7.2%) with pediatric activity. Only 4.8% of the physicians questioned had not received training about diarrhea in the previous two years. One doctor in 4 (25.6%) did not prescribe oral rehydration solution. The reasons given were lack of signs of dehydration (50%) and recommendation of other beverages (15.5%). Zinc prescription was rare (9.6%). Early refeeding was recommended by 41.6% of physicians. Almost half (47.2%) routinely use antibiotics, and 86.4% prescribe antidiarrheal medications. CONCLUSION: The WHO recommendations for the treatment of acute diarrhea in children are not followed. Continuing and repeated medical education is necessary.
Mbusa Kambale R, Balibuno Y, Isia Francisca N
… +3 more, Bwija Kasengi J, Fatuma Mayele G, Mungo Masumbuko B
Med Sante Trop
· 2018 May · PMID 29997076
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Publisher ↗
BACKGROUND: Traditional uvulectomy in children, a very common and dangerous practice, remains poorly documented in the Democratic Republic of Congo (DRC). The aim of this study was to establish the epidemiological and cl...BACKGROUND: Traditional uvulectomy in children, a very common and dangerous practice, remains poorly documented in the Democratic Republic of Congo (DRC). The aim of this study was to establish the epidemiological and clinical profile of children after a traditional uvulectomy and to determine their outcome of the children after this practice in 2 pediatric emergency unities in South Kivu province, DRC. METHOD: This was a cross-sectional study took place conducted in 2 pediatric emergency unities in Bukavu town, in South Kivu province, throughout from January to December 2016. It included all children from 0 to 15 years of age. The usual statistical measures (frequenciesy, percentages, means, and medians) were used. Differences in group proportions and categorical variables were assessed withusing the chi-square test. These different tests were considered statistically significant at P < 0.05. FINDINGS: In all, A total of 1078 children were admitted to these pediatric emergency departments during the study period, including 202 cases of traditional uvulectomy, forgiving a prevalence of 18.7% among admissions. The median age of the children was 11 (1-168) months. Of the mothers who resorted to this practice, 153 One hundred fifty-three (75.7%) mothers who resorted to this practice had a low level of education. The main reasons for this practice were fever (50%), vomiting (15.8%), and refusal to suckle (12.4%). The mortality rate after uvulectomy was 11.9%. Risk factors associated with mortality following traditional uvulectomy were HIV infection ([OR (95 % CI) 3.16, 95% CI (1.28-7.79); P = 0.040] and acute malnutrition ([OR (95% CI) 2.87, 95% CI (1.28 - 6.43); P = 0.024)]. CONCLUSION: The prevalence of traditional uvulectomy and the mortality rate after traditional uvulectomy both remain high. Information, education, and communication campaigns on this practice must be developed in order to reduce this scourge.
Issoufou I, Harmouchi H, Belliraj L
… +5 more, Ammor F, Lakranbi M, Sani R, Ouadnouni Y, Smahi M
Med Sante Trop
· 2018 May · PMID 29997075
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Aspergillus is a mycelial fungus formed of filaments that penetrate the airways when its spores are inhaled. It is rarely located in the pleura. We report two cases of patients, one aged 67 years and the other 37 years,...Aspergillus is a mycelial fungus formed of filaments that penetrate the airways when its spores are inhaled. It is rarely located in the pleura. We report two cases of patients, one aged 67 years and the other 37 years, with pleural aspergillosis. The first underwent a thoracostomy, followed later by a myoplasty for closure. Pleuropulmonary decortication was performed in the second patient. The pathology examination confirmed an intrapleural aspergilloma in both patients. Antifungal treatment was not performed. The postoperative course was simple and no recurrence was noted. Based on these two cases over a 7-year period and a review of the literature, we detail the issues in this management and emphasize the interest of surgery.