[Stage at diagnosis of retinoblastoma in Niger: Current situation and perspectives]. / Stade au diagnostic du rétinoblastome au Niger : état des lieux et perspectives.

The objective of this work is to assess the current situation in the ophthalmology department of the tertiary care center for the conservative treatment of retinoblastoma in Niger. This was a retrospective study from January 2016 to October 2022 (6years and 10months). Retinoblastoma represents 43.27% of pediatric cancers, of which 10.92% of cases are bilateral. The mean age of our patients is 36months, with the range between 2-3years, with extremes ranging from 1month to 132months. The male sex represents 65.55% (n=78), with a sex ratio of 1.9. The distance traveled varies from 1355 kilometers in the furthest region (Diffa) from the capital to 113 kilometers in the nearest region (Tillabéry). Neighboring countries such as Mali and Benin represent 5.88% (n=5). It should be noted that 58% saw traditional healers before coming to the medical center. The most common clinical signs are leukocoria 39.5% (n=47), proptosis 34.45% (n=41) and exorbitism in 15.97% (n=19). An orbital/brain CT was ordered in 54.62% (n=65) of cases. We used the TNM classification; extraocular extension occurred in 47.90% (n=57) and intraocular cases 27.73% (n=33). Neoadjuvant chemotherapy was used in (63.03% n=74). Histology was carried out in (26.89% n=32), with the result obtained in 14days on average. The visit to traditional practitioners as well as the remoteness of certain regions contribute to the delay in diagnosis in our context. The continued implementation of the early diagnosis campaign program could reverse the trend.

SURGERY OUTCOMES IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM AND IMPACT OF INTRA-OPERATIVE PTH MEASUREMENT.

CONTEXT: The current therapeutical management of secondary hyperparathyroidism (S-HPTH) is difficult to obtain due to the lack of kidney donors. Surgical intervention on the pathologic parathyroid tissue has been suggested as a method to alleviate symptoms in patients with chronic kidney disease (CKD). OBJECTIVE: The aim of our study was to evaluate the outcomes of parathyroid surgery in patients with S-HPTH and the advantages of intraoperative quick PTH (iqPTH) to improve surgical results. MATERIAL AND METHODS: In a real-life study, we compared one group of S-HPTH with iqPTH performed after removing all suspected glands and before wound suture (Group 1) and one group in that iqPTH was not assessed (Group 2). When iqPTH dropped less than 50%, additional exploration followed. RESULTS: Eight out of the 34 patients from Group 1, who underwent subtotal parathyroidectomy, showed elevated levels of serum PTH and calcium, which remained elevated during follow-up, thus, suggesting disease persistence. From the 21 patients in Group 2, none showed early postoperative disease persistence. Serum calcium, but not PTH was increased in one patient from the iqPTH group but normalized after one month. Overall, iqPTH allowed detection of a supplementary parathyroid gland in one case, thereby increasing early post-surgery remission to 100% in Group 2 compared to 76.47% in Group 1. Late postoperative remission of hyperparathyroidism with no further increase in the rate of hypoparathyroidism was obtained in Group 2. CONCLUSIONS: Assessment of intra-operative PTH levels proved to be a useful tool in augmenting the outcome of S-HPTH surgery. In patients which are eligible for renal transplantation who undergo a subtotal resection, iqPTH can enhance the post-operative quality of life by lowering disease recurrence rates until the kidney transplant procedure.

Nationwide integrated mapping of three neglected tropical diseases in Togo: countrywide implementation of a novel approach.

OBJECTIVE: To conduct a nationwide integrated neglected tropical disease (NTD) prevalence survey to define the need for public health interventions using an innovative mapping protocol. METHODS: Two villages were selected in every peripheral health unit in endemic districts: 29 districts for schistosomiasis and STH, 15 of them for trachoma. In each village, 15 children aged 6-9 years at a randomly selected school were tested. An additional convenience sample of 35 children aged 1-5 years underwent an eye examination for trachoma. This integrated mapping was followed by a 20-cluster trachoma survey in each district that surpassed the WHO-defined threshold of 10% prevalence of trachomatous inflammation-follicular (TF). RESULTS: A total of 1096 villages were surveyed in <6 weeks. The district prevalence of schistosomiasis ranged from 2 to 49% and of STH from 5 to 70%, with prevalence at the village level ranging from 0 to 100% for both diseases. Two districts passed the threshold of 10% for active trachoma, but the cluster survey indicated this was because of misclassification bias and that the real prevalence was <1%. CONCLUSION: Results of this mapping were used by the MoH and partners to plan integrated mass drug administration (MDA). Mass drug administration for trachoma was not implemented as no district passed the threshold requiring public health intervention.

[Trachoma rapid assessment in the infantile population of Togo]. / Evaluation rapide du trachome infantile au Togo.

AIM: The aim of this study was to determine the prevalence and types of trachoma in children of central Togo. MATERIALS AND METHODS: This descriptive cross-sectional investigation was conducted in central Togo in November 2009. At every peripheral health unit (PHU) in 2 villages of the sanitary district, 15 schoolchildren between 6 and 9 years old and 35 children from the community between 1 and 5 years old were examined to detect signs of trachoma using a lamp wipes coupled with binocular magnifying loupes (2.5X). Data were analysed with Excel 2007. RESULTS: A total of 8200 children were examined at 82 PHU in 164 villages in the sanitary districts. In the 1-5 year age group including 5,740 children, follicular trachomatous inflammation (TF) was observed in 326 cases and intense trachomatous inflammation (TI) in 9 for a prevalence rate of 5.83%. In the 6-9 year age group including 2,460 schoolchildren, TF was observed in 144 and TI in 8 for a prevalence rate of 6.18%. The overall prevalence rate of active trachoma was 5.94 % (n = 487). CONCLUSION: This study confirms the persistence of active trachoma in children in central Togo. Trachoma may be public health problem in 2 districts: Blitta and Sotouboua. A population-based survey will be carried our to evaluate trachoma prevalence prior to implementation of the SAFE strategy in this region.

[What do we know about trachoma in the economically weakest infantile population of Kara in Togo?]. / Que savons-nous de la prévalence du trachome dans la population infantile économiquement défavorisée de la region de Kara au Togo?

PURPOSE: To describe the distribution of the trachoma in the infantile population of Kara region. MATERIALS AND METHODS: A descriptive cross sectional investigation has been achieved in 6 sanitary districts of Kara's region in November 2009. In each of the 2 villages of the sanitary area of every peripheral health unit (PHU), 15 schoolchildren aged of 6 to 9 years then 35 children of the community aged of 1 to 5 years have been examined to search signs of trachoma with the help of a lamp wipes coupled of a binocular loupe (2.5X magnification). RESULTS: To the total 10,100 children have been examined in 202 villages of the sanitary areas of 101 PHU. Among the 7070 children aged of 1-5 years, 289 presented trachomatous inflammation follicular (TF) and 131 trachomatous inflammation intense (TI), corresponding to a prevalence rate of 5.94%. Among the 3030 schoolchildren, 68 presented TF and 62 TI corresponding to 4.29% prevalence rate. The prevalence rate of the active trachoma was of 5.44% in the infantile population of this region. CONCLUSION: This investigation could confirm that active trachoma still exists in this region. Another investigation will be carried out to determine the prevalence of trachoma among the adult subjects in order to have a more complete data base in view of further action for trachoma elimination in this region.

[Traditional treatment of cataract in Niger. Apropos of 22 cases]. / Traitement traditionnel de la cataracte au Niger. A propos de 22 cas.

Empiric treatment of cataracts by couching is still commonly performed by traditional healers in West Africa. In the ophthalmology department in the regional hospital of Zinder, in Niger, 22 cases have been identified and their complications treated medically and surgically. The semiotic analysis demonstrated the diversity of methods used, sometimes successfully by the traditional healers. Apart from the classical technics of luxation in the vitreous, we have observed a number of cases with integrity of the posterior capsule and disappearance of the nucleus. These last observations have lead us to believe that certain traditional healers may use local plants with phakolytic effects in their pharmacopia.