Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

In-plane InGaAs/Ga(As)Sb nanowire based tunnel junctions grown by selective area molecular beam epitaxy.

In-plane InGaAs/Ga(As)Sb heterojunction tunnel diodes are fabricated by selective area molecular beam epitaxy with two different architectures: either radial InGaAs core/Ga(As)Sb shell nanowires or axial InGaAs/GaSb heterojunctions. In the former case, we unveil the impact of strain relaxation and alloy composition fluctuations at the nanoscale on the tunneling properties of the diodes, whereas in the latter case we demonstrate that template assisted molecular beam epitaxy can be used to achieve a very precise control of tunnel diodes dimensions at the nanoscale with a scalable process. In both cases, negative differential resistances with large peak current densities are achieved.

[Evolution of Uterine Ruptures at the Maternity of Ignace Deen National Hospital (Chu of Conakry)]. / Évolution des Ruptures Utérines à la Maternité de L'hôpital National Ignace Deen (Chu de Conakry).

Uterine rupture is a common obstetrical drama in our delivery rooms that has become exceptional in developed countries. In developing countries including Guinea, this tragedy is one of the major concerns of the obstetrician. The objectives of this work were: to evaluate the frequency of uterine rupture in the department, to describe the socio-demographic and clinical characteristics of the patients, to identify the factors favoring the occurrence of uterine rupture, to evaluate the maternal-fetal prognosis and propose a prevention strategy to reduce maternal and fetal morbidity and mortality by uterine rupture. This was a descriptive study with data collection in two phases, one retrospective lasting 18 months from July 1, 2017 to December 31, 2018 and the other prospective, lasting 18 months also from January 1, 2019 to June 30, 2020 both carried out at the maternity ward of the Ignace Deen National Hospital. We collected 84 cases of uterine rupture out of 18,790 deliveries, i.e. a frequency of 0.44%. During the same time 10,067 cesarean sections were realized, i.e. one laparotomy for uterine rupture for 120 cesarean sections. The average age of the patients was 28.14 years with a standard deviation of 2 years and the average profile is that of a housewife (51.8%), multiparous (44.6%), evacuated from peripheral maternity (85.5%) and having an insufficient number of antenatal consultations (82.6%). In 93.1% of cases, the uterine rupture had occurred in delivery centers, peripheral maternity hospitals and on the way, the uterine ruptures were mostly spontaneous (65.1%), and occurred in a healthy uterus (59.0%). Uterine rupture was more frequently complete (83.33%). Surgical treatment was more frequently conservative with hysterorrhaphy (88.1%). We recorded 12 maternal deaths, i.e. a case fatality rate of 14.6%. On admission, almost all of the women showed no signs of fetal life. To reduce the frequency of uterine ruptures, better organization of emergency obstetric and neonatal care and better screening for risk factors for obstructed labor during prenatal consultations should be encouraged.

Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital.

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.

Uterine rupture: socio-demographic aspects, etiology and therapy at the University Clinic of Gynecology and Obstetrics of the National Donka Hospital in Conakry University Hospital, Guinea.

Uterine rupture is an obstetric catastrophe that has become rare in developed countries. In developing countries, including Guinea, however, it remains a major concern of obstetricians. The objectives of this work were to calculate the frequency of uterine rupture in our département, describe the women's social and demographic characteristics, identify factors predisposing them to uterine rupture, describe its treatment, and assess maternal and fetal prognosis. Data for this descriptive study were collected in 2 phases, with a retrospective review of files covering the 3-year period from April 1, 2011, to March 31, 2014, followed by prospective data collection for the 6-month period from April 1 to September 30, 2014. This study of uterine rupture took place at the maternity unit of Donka National Hospital (CHU Conakry). We identified 98 cases of uterine rupture among 26 827 births, for a frequency of 0.36%. The women's mean age was 28.4 years (range: 16-43 years). The socio-demographic profile of the women admitted for uterine rupture was that of a housewife (50%), with two or three previous deliveries (41.84%), and who had no prenatal care (58.17%). Most of the ruptures took place in birthing centers, outlying maternity units, or during the journey to reach our reference department (87.16%). Most uterine ruptures were iatrogenic (69.38%) and occurred on an non cicatriciel uterus (62.24%). The rupture was most often complete. Most surgical treatment was conservative, by hysterorrhaphy (80.61%). Four women died, for a lethality rate of 4.80%. Almost all women were admitted without signs of fetal life. The role of uterine rupture in the obstetric activity in this service requires joint and urgent action by all stakeholders in the health system to combat this catastrophic complication that is evidence of a poor quality of obstetric care.

Performance of microscopic observation drug susceptibility for the rapid diagnosis of tuberculosis and detection of drug resistance in Bamako, Mali.

OBJECTIVES: In Mali early detection and treatment of multidrug-resistant tuberculosis (MDR-TB) are still challenging due to the cost, time and/or complexity associated with regular tests. Microscopic Observation Drug Susceptibility (MODS) is a low-cost assay validated by WHO in 2010. It is a liquid-culture-based assay to detect the 'cording' characteristic of Mycobacterium tuberculosis complex and to assess susceptibility to both isoniazid and rifampicin defining multidrug-resistant tuberculosis (MDR-TB). In this study we aimed to evaluate the performance of MODS as diagnostic tool compared with a validated method-Mycobacteria Growth Indicator Tube/Antimicrobial Susceptibility Testing/Streptomycin, Isoniazid, Rifampicin and Ethambutol (MGIT/AST/SIRE). METHODS AND RESULTS: Between January 2010 and October 2015 we included 98 patients with suspected TB in an observational cohort study. The sensitivity and specificity of MODS assay for detecting TB were respectively 94.12% and 85.71% compared with the reference MGIT/7H11 culture, with a Cohen κ coefficient of 0.78 (95% CI 0.517-1.043). The median time to culture positivity for MODS assay and MGIT (plus interquartile range, IQR) was respectively 8 days (IQR 5-11) and 6 days (IQR 5-6). In detecting patients with MDR-TB, the sensitivity and specificity of MODS assay were respectively 100% and 95.92%. The positive predictive value and negative predictive value were, respectively, 66.7% and 100%. The median turnaround times for obtaining MDR-TB results using MODS assay and MGIT/AST/SIRE was respectively 9 days and 35 days. Hence, the MODS assay rapidly identifies MDR-TB in Mali compared with the MGIT/AST/SIRE. CONCLUSION: As an easy, simple, fast and affordable method, the MODS assay could significantly improve the management of TB.

[Ectopic pregnancy at the Ignace Deen University Hospital in Conakry: epidemiologic, social, demographic, therapeutic, and prognostic aspects]. / Grossesse extra-utérine dans la clinique de gynécologie-obstétrique Ignace-Deen du CHU de Conakry Aspects épidémiologique, sociodémographique, thérapeutique et pronostique.

The objectives of this study were to calculate the frequency of ectopic pregnancy in the department, define its epidemiological, diagnostic, therapeutic, and prognostic aspects, and determine a clear therapeutic approach appropriate to our setting. In this prospective study, we compiled all cases of ectopic pregnancy seen in 2011 and 2012 in the obstetrics-gynecology department at Ignace Deen University Hospital in Conakry. Ectopic pregnancies represented 1.3% of all deliveries over this period. In the 111 cases in this population, women aged 30-34 years accounted for 31.5%, those pregnant for the first time 40.5%, nulliparous women 35.1%, married women 72.1%, those without schooling 43.2%), and those with a history of sexually transmitted infection 57.6% (these categories are not exclusive, and the same women may be included in several). Secondary amenorrhea with abdominopelvic pain and metrorrhagia was the reason for admission in 56.5% of cases. Ultrasound in early pregnancy is infrequent in Conakry. Almost all of our patients underwent emergency surgery (80.2%) More than half of the ectopic pregnancies were located in the ampulla of the uterine tubes (73.0%). There were three abdominal pregnancies and 2 ovarian. In all cases the treatment was surgical, most often salpingectomy. Postoperative complications occurred in 35.1% of cases, most often anemia (27.9% of all cases) requiring blood transfusion in 11.7% of all cases before, during, or after surgery. The maternal death rate was 1.8%. Ectopic pregnancy remains a major concern at Ignace Deen CHU. Reduction of its frequency requires increased population awareness of sexually transmitted infections and illegal abortions. Management should be prompt and appropriate.

[Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis]. / Les hystérectomies au CHU de Conakry : caractéristiques sociodémographiques et cliniques, types, indications, voies d'abord et pronostic.

The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its indications.

[Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea]. / Evacuations obstétricales intrapartum: aspects sociodémographique, clinique et pronostique à Conakry, Guinée.

The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

Class 2 integron-associated antibiotic resistance in Shigella sonnei isolates in Dakar, Senegal.

Forty-three Shigella sonnei isolates from adult patients with diarrhoea in Dakar were analysed for the presence of integrons. Isolates were resistant to sulphamethoxazole, trimethoprim, tetracycline, streptomycin and spectinomycin. A high prevalence of class 2 integrons (93%) was found. These integrons showed three distinct structures: a class 2 integron, part of the Tn7 family and its derivatives, carrying four cassettes in the order dfrA1-sat-aadA1-orfX; a truncated class 2 integron, without orfX; and a third type ca. 4 kb in size. These class 2 integrons probably play a role in the spread of multiresistance in S. sonnei isolates. To our knowledge, this is the first description of class 2 integrons in S. sonnei isolated in sub-Saharan Africa.

Distribution of lung density and mass in patients with emphysema as assessed by quantitative analysis of CT.

STUDY OBJECTIVE: To assess the effects of emphysema on the apex-to-base gradient of lung density (D) and lung mass (M) and to explore the relationship between M and lung function. METHODS: CT scans of whole lungs were performed in 12 healthy subjects and 29 patients who were breathing at functional residual capacity, after which lung function tests were performed. Whole D and M and regional D (RLD) and M (RLM) were calculated. The degree of emphysema was scored. RESULTS: The RLM for each height did not differ significantly between patients with disease and healthy subjects, while RLD was significantly lower in the patients with disease. A less marked nonlinear, increasing, craniocaudal gradient of D was observed in the group with disease, suggesting that the distension increases progressively from the apex to the base. RLD and RLM in the 40 to 90% lung height differed significantly among patients in the emphysema group with normal, high, and low M compared to the healthy subjects. M did not differ significantly between patients with centrilobular and panlobular emphysema, which was thought to stem from the marked variations in the results. Vital capacity was lower in the patients with low M. CONCLUSIONS: The lower RLD in the group with low M was due to both lung overinflation and to tissue loss, while in the groups with high or normal M, it was due only to lung overinflation.

Lung density and lung mass in emphysema.

Mean lung density (dm) and radiologic (VLx) lung volume can be calculated using CT scan data. As many emphysematous patients are overdistended, the analysis of dm alone could be meaningless. However, lung mass (m) can be calculated as the product of dm and VLx. Twenty-four patients suspected of mild or severe emphysema as judged by roentgenographic and physiologic examinations as well as 16 healthy subjects were included in the protocol. They all underwent both a CT scan of the whole lung and functional tests from which the following were derived: airway resistance, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), total lung capacity (TLC), CO transfer capacity, quasi-static compliance at functional residual capacity (FRC), and blood gases. All CT scans were performed at the FRC of each patient. The dm was lower in emphysema patients than in healthy subjects, as m was greater in patients than in healthy subjects; 1,303 +/- 398 g and 997 +/- 133 g, respectively. Although dm values were significantly correlated to FEV1, FEV1/FVC, and TLC, m values were not correlated to any of these functional indices. Unexpectedly, these results show that most patients (22/24) with emphysema have a normal or increased lung mass. Normal or above normal m values might be due to oversecretion in some patients. Nevertheless, the synthesis of new tissue due to chronic inflammation is the most likely explanation that could account for this finding.