[Contribution of mode B ultrasound in the diagnostic and therapeutic management of ocular pathologies in Abidjan]. / Apport de l'echographie mode B dans la prise en charge diagnostique des pathologies oculaires a Abidjan.

BACKGROUND: Ocular pathology is common throughout the world. The aim of our work was to study the contribution of mode B ultrasound in the diagnostic and therapeutic management of ocular pathologies in Abidjan. MATERIALS AND METHODS: Prospective, descriptive study, carried out at the Abidjan Military Hospital during a period of 3 months. Eye examinations were performed exclusively with a mode B ultrasound scanner by senior radiologists. All patients who performed an ocular ultrasound were included in the study. The epidemioclinical data, the examination request and the ultrasound results were analysed. RESULTS: We identified 114 cases of ocular ultrasound, i.e. 17% of the ultrasounds performed. The median age was 39.2 years with a male/female sex ratio of 1.15. Decreased visual acuity was the main indication Preoperative assessment for cataract (32.5%) was the most frequent indication. Ultrasound was pathological in almost all cases (98.2%). The most frequent pathology was cataract (77.2%) with predominance of total lens opacifications (45.6%). Other pathologies found were retinal detachment (21.1%) and intraocular hemorrhage (17%). CONCLUSION: The ocular pathology was varied in our context. It predominated in subjects of variable age and more often in males. Ocular ultrasonography in B mode was indicated for diagnostic purposes to explore trauma and visual acuity impairment, but especially for therapeutic purposes to establish. the preoperative assessment of the lesions observed. Its diagnostic sensitivity was 98.1%.

CONTEXTE: La pathologie oculaire est fréquente dans le monde. Le but de notre travail était d'étudier l'apport de l'échographie mode B dans la prise en charge diagnostique et thérapeutique des pathologies oculaires à Abidjan. MATÉRIELS ET MÉTHODES: Étude prospective, descriptive, réalisée à l'Hôpital Militaire d'Abidjan durant une période de3 mois. Les examens oculaires ont été réalisés exclusivement avec un échographe mode B par des radiologues séniors. Tous les patients ayant réalisé une échographie oculaire ont été inclus dans l'étude. Les données épidémio-cliniques, la demande d'examen et les résultats de l'échographie ont été analysés. RÉSULTATS: Nous avons récencé 114 cas d'échographie oculaire soit 17% des échographies réalisées. L'âge médian était de 39,2 ans avec un sex ratio homme/femme de 1,15. La baisse de l'acuité visuelle constituait la principale indication. Le bilan préopératoire pour la cataracte (32,5%) représentait l'indication la plus fréquente. L'échographie était pathologique dans la quasi-totalité des cas (98,2%). La pathologie la plus fréquente était la cataracte (77.2 %) avec prédominance des opacifications totales du cristallin (45,6%). Les autres pathologies retrouvées étaient le décollement de rétine (21,1%) et l'hémorragie intra oculaire (17%). CONCLUSION: La pathologie oculaire a été variée dans notre contexte. Elle prédominait chez les sujets d'âge variable et plus souvent de sexe masculin. L'échographie oculaire en mode B, a été indiquée dans un but diagnostique pour l'exploration des traumatismes et des baisses de l'acuité visuelle, mais surtout dans un but thérapeutique pour l'établissement du bilan préopératoire des lésions observées. Sa sensibilité diagnostique a été de 98,1%.

Nutritional approach to management of Buruli ulcer in Côte d'Ivoire.

Children in developing tropical countries are frequently undernourished. In rural areas, they are also often affected by Buruli ulcers. The treatment of this mutilating disease is sometime long and difficult for malnourished patients. Moreover, the eating behavior of patients with Buruli ulcers does not promote its quick healing, with numerous foods prohibited. They eat fewer fruits and legumes, which are rich in vitamins and minerals. Our survey in two health centers showed that only 8% ate fruits and legumes, and 29% leafy greens. This food deprivation increases their nutritional deficiencies. We conducted a nutritional intervention among Buruli ulcer patients (30 patients) in one center, and compared their healing with that of Buruli patients without nutritional care (n = 21). Those patients who received the intervention spent less time at the hospital (less than six months). Our study shows the association between the healing of Buruli ulcers in Côte d'Ivoire and good nutritional status: those with the intervention healed faster and presented fewer disabilities than the control patients.

[Contribution of break up time in the diagnosis and the treatment of dry eye syndrome in tropic area: about 234 patients in Abidjan]. / Contribution du break up time au diagnostic et à la prise en charge du syndrome sec oculaire en milieu tropical : à propos de 234 yeux à Abidjan.

INTRODUCTION: Dry eye disease (DED) can be evaluated clinically by the tear film break up time (BUT). There is a discrepancy between symptoms in relationship with dry eye disease and objectives measures of BUT. So we tried to evaluate the reliability of BUT in the diagnosis and treatment of this disease in black African people. METHODS: We carried out a prospective study of 6 months where melanoderms adults presenting subjective symptoms of dry eye disease according a questionnaire of 7 items were included. Then the measure of BUT is performed after ocular instillation of fluorescein eyedrop. This measured is done by recording the time elapsed from the last complete palpebral blink to the appearance of the first dry spot. Patients with subjective symptoms and time of BUT lower than 10seconds were called concordants (suffering really of DED). The discrepant group was represented by a BUT upper than 10seconds despite the fact that these patients answered positively to the questionnaire. RESULTS: This survey included 234 patients and the average age was 49.1 years. Sex-ratio was 0.68 and we noticed predominance of BUT between 5 and 10seconds in 42.3% of cases. Subjective symptoms were strengthened clinically by a BUT lower to 10seconds in 149 patients. Therefore, the reliability of BUT as clinic tool for the diagnosis after symptoms in relationship with DED was 63.7%. In the group of concordants, women were more likely than men to experience symptoms of DED (P=0.0005). Age upper than 50 years and computer usage were risk factors of DED (P<0.01). DISCUSSION: Dry eye disease is a multifactorial affection of tear and ocular surface frequently seen in female and people using computer and older than 50. The reliability of BUT near to 65% is a reason to perform this test in our daily practice. CONCLUSION: Tear BUT is a reliable clinical test which must be performed systematically to assess the diagnosis of DED in black African people.

[Selective laser trabeculoplasty in African blacks]. / Trabéculoplastie sélective chez le mélanoderme africain.

INTRODUCTION: The treatment of primary open angle glaucoma (POAG) is preferably medical. However, when medical therapy fails, alternative or complementary treatments may be considered. In this regard, selective laser trabeculoplasty is a widely popular procedural treatment whose accepted benefits have been very little studied in African blacks. The objective of this study was to assess the efficacy of selective laser trabeculoplasty on the reduction of intraocular pressure (IOP) in African blacks with POAG. METHODS: We conducted a retrospective study of black patients treated with selective laser trabeculoplasty between March 2010 and March 2011. All patients had POAG with trabecular meshwork accessible over 360°. The treatment protocol consisted of a 360°treatment in two sessions (180°/session) 15 days apart. Success was defined as decrease from the initial IOP≥3mm Hg without additional medications. RESULTS: We included 44 patients, corresponding to 82 eyes. The mean age of the patients was 55.94±11.66 years with extremes of 19 years and 76 years. The mean intraocular pressure before laser treatment (initial IOP) was 18.43±4.81mm Hg. After laser treatment, the mean pressure reduction was (i) 3.81mm Hg (20.67%) at 15 days ; (ii) 4.08mm Hg (22.14%) at 1 month; (iii) 4.45mm Hg (24.14%) at 3 months; and (iv) 4.95mm Hg (26.86%) at 6 months. The success rate after laser treatment was 67.60% at 15 days, 83.78% at 1 month, 72.09% at 3 months and 80.43% at 6 months. CONCLUSION: Selective laser trabeculoplasty is effective in African blacks. Its efficacy is comparable to that of a carbonic anhydrase inhibitor or even a prostaglandin. It could be a complementary or substitutive alternative to POAG medications in African blacks.

Spontaneously closed gastrocutaneous fistula becomes symptomatic after 30 years with pregnancy.

Percutaneous endoscopic gastrostomy (PEG) is the standard procedure of choice for the provision of enteral nutrition in children who require long-term nutritional support. Removal of gastric tubes has a risk of causing gastrocutaneous fistula and this complication is dealt within childhood. The authors report a 34-year old woman who had a PEG procedure at the age of four years due to caustic esophageal injury and recovered without incident. Thirty years later she becomes pregnant and as her pregnancy progresses, her former fistula opening becomes more obvious and at the 34'h week of the pregnancy she' presents to the hospital with fistula. After a successful delivery, the fistula was evaluated and repaired surgically.

Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation?

PURPOSE: To propose polyhydramnios seen during prenatal diagnosis as a warning sign of foetal malformation. PATIENTS AND METHODS: A retrospective multicentre study over a three-year period carried out in Ivory Coast and Burkina Faso. We reviewed 3903 obstetric ultrasound reports. All cases of foetal malformation and polyhydramnios were counted. The instances of foetal malformation associated with polyhydramnios were compared to those of foetal malformation without polyhydramnios and to polyhydramnios only. RESULTS: A list of 72 cases of polyhydramnios was made (equating to 1.8%). In 55 cases (76.4%), polyhydramnios was combined with foetal malformation. These were lethal abnormalities in 33 cases and non-lethal in 22 cases. In 17 cases, polyhydramnios was not associated with any foetal malformations and in eight cases, foetal malformation was discovered in the absence of polyhydramnios. Polyhydramnios had a positive predictive value of 76.4% for the presence of foetal malformation. The negative predictive value was 99.8%. Sensitivity was 87.3% and specificity was 99.5%. CONCLUSION: Polyhydramnios is a highly sensitive and specific sign for prenatal diagnosis of foetal malformation. If it is identified, then this should lead to a very careful search for foetal malformation.

Diuretic effects of aqueous extract of Ficus exasperata Vahl. leaves in rat.

Ficus exasperata is widely used in african pharmacopoeia against hypertension and edema. The hypotensive effects of aqueous extract of F. exasperata leaves are reduced in the presence of atropine and methylene blue. The treatment of hypertension often requires the combination of antihypertensive drugs and diuretics substances. The aim of this study was to evaluate the effects of aqueous extract of F. exasperata leaves on urinary excretion in rat. Single doses of this extract (50 mg kg(-1) b.wt.) and furosemide (10 mg kg(-1) b.wt.) were administered to two groups of rats. A control group receives NaCl 9 per thousand. Urine excretion is collected, measured and sampled for 24 hours. At the end of the experiment, blood is sample. Urinary excretion volume induced by this plant extract was relatively high and greater than that induced by furosemide. Aqueous extract of F. exasperata leaves increased urinary excretion of electrolytes, creatinine and urea. However, creatinine and blood urea obtained are similar to those induced by furosemide. At the end of this work, it appears that aqueous extract of F. exasperata leaves induced a significant diuretic effect and electrolyte output which does not alter significantly the rate of electrolytes, creatinine and urea plasma.

The diagnostic value of indirect ultrasound signs during acute adult appendicitis.

PURPOSE: To evaluate the diagnostic value of indirect ultrasound signs during acute appendicitis. PATIENTS AND METHODS: Our retrospective study lasted 5 years, from May 2005 to April 2010. It concerned 620 cases of appendectomy performed following prior ultrasound examination of the right iliac fossa (RIF). In 448 cases, ultrasonography clearly showed the appendix, which was inflamed. The presence of indirect signs of appendix inflammation without visualisation of the appendix was confirmed by ultrasound examination in 160 cases. In 12 cases, the appendix was not visualised nor were there any indirect signs on the ultrasound image. The indirect signs involved were hypertrophy of the peritoneal fat (HPF), pain caused by compression on exploration of the right iliac fossa, and localised hypokinesia in the digestive loops (LHL). We compared the results found by ultrasonography with the operative and anatomical pathology reports. RESULTS: The positive predictive value of the indirect signs of appendicitis on the ultrasound scan was 95.8% if the three indirect signs were associated, 87.5% for the association of pain and HPF, 45.8% for the association of pain and LHL, and 25% if there was just pain. The negative predictive value of the indirect signs of appendicitis on the ultrasound scan was 57.2% if the three signs were associated, 65.9% for the association of pain and HPF and 60.7% for the association of pain and LHL, with 83.3% for pain alone. The sensitivity of the indirect signs was 83.9% if the three signs were associated, 31.8% for the association of pain and HPF, 50% for the association of pain and LHL, and 50% if there was just pain. The specificity of the indirect signs was 85.7% if the three signs were associated, 96.7% for the association of pain and HPF, 56.7% for the association of pain and LHL, and 62.5% if there was just pain. CONCLUSION: When tomodensitometry cannot be performed and the appendix is not visible on ultrasound examination, indirect ultrasound signs must be systematically sought, particularly in populations in which appendicitis are highly prevalent.

[Spondylodiscitis in Côte d'Ivoire: findings of computed tomography scan in 18 cases]. / Spondylodiscites en Côte d'Ivoire: aspects tomodensitométriques de 18 observations.

The aim of this study was to document computed tomography (CT) scan findings and nosological characteristics in patients managed for spondylodiscitis in Abidjan, Côte d'Ivoire. This retrospective study was carried out over a two-year period (January 2006 to December 2007). A total of 18 cases of spondylodiscitis assessed in the radiology department of Yopougon Teaching Hospital in Abidjan were included. Mean patient age was 39.4 years. Seven patients (38.9%) had positive HIV serology. Mycobacterium tuberculosis was the main causative agent of spondylodiscitis accounting for 94.4% of cases. Only one case (5.6%) of pyogenic spondylodiscitis (staphylococcus aureus) was observed. The upper back was the preferential location (55.6%) of spondylodiscitis. Both discs and vertebral bodies were involved in all cases. Associated manifestations included balance impairment (dorsal kyphosis) (11.2%), soft tissue abscess (44.4%), vertebral compression (11.2%), epiduritis (16.7%), and medullar compression (16.7%). This study shows that CT scan not only plays a decisive role in early positive diagnosis of spondylodiscitis but also contributes to therapy by guiding biopsy to obtain samples necessary to identify the causal germ and assess disco-vertebral involvement. Findings also show that most cases of spondylodiscitis in Abidjan are related to tuberculosis and located in the upper back.

[Ultrasound and epidemiological features of ectopic pregnancy in a suburb of Abidjan (Cote d'Ivoire)]. / Profil echographique et epidémiologique des grossesses extra-utérines dans une banlieue d'Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of our study was to describe current ultrasound and epidemiological features of ectopic pregnancy in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This prospective study was carried out over a 24-month period (February 2006 to January 2008) at Nanglé Medical Clinic, i.e., a private clinic located in Abidjan's Yopougon suburb. RESULTS: A total of 32 cases of ectopic pregnancy were discovered by suprapubic and/or endovaginal ultrasound scan. The estimated frequency of ectopic pregnancy was 1.7%. Mean patient age was 26.2 years. The main risk factors were prior history of abortion (32%) and adnexal infection (20%). Most patients (52.5%) were nulliparous. The most frequent indication for ultrasound scan was metrorrhagia. Diagnosis of ectopic pregnancy was made at the ruptured stage in 65.6% of cases and nonruptured stage in 34.4%. The presenting lesions was hematosalpinx in 40.6% of cases and embryonate ectopic gestational sac in 31.3%. Salpingectomy and salpingorrhaphy were successful in 65.6% and 34.4% of cases respectivlely. CONCLUSION: In Abidjan, ectopic pregnancy involves young nulliparous women with a prior history of abortion and adnexal infection. Ultrasound allowed early diagnosis and, consequently, tube preservation in 34.4% of cases.

[Generalized tetanus with otitic portal of entry after using intra-auricular traditional remedies in a 2 old child]. / Tetanos généralisé à porte d'entrée otitique, suite à l'utilisation de topiques traditionnels intra-auriculaires chez un enfant de 2 ans.

A case of tetanus with uncommon way of contamination was found in the paediatric department of the Yopougon teaching hospital in Côte d'Ivoire. A two-year-old child, without vaccination against tetanus and suffering from a chronic otitis presented a generalized tetanus, after the use of traditional local remedies in his ear. Through this observation, the authors want to make population aware of the detrimental effects of traditional local auricular remedies and want to advise all physicians to make a serotherapy and/or a vaccination against tetanus to all children with chronic otitis in our area.

[Results of the thoracic radiography profile of 247 candidates at the recruiting office of a land-transport society in Abidjan, Cote d'Ivoire]. / Resultats du bilan radiographique thoracique de 247 candidats a l'embauche dans une Societe de Transport Terrestre a Abidjan (Cote D'Ivoire).

The purpose of this prospective study done from May to July 2007 was to show the interest of systematic chest X-Ray of future bus conductors. The main abnormalities were big heart, parenchymal lesion and pleural effusion.

[Analysis of the diagnostic criteria used in childhood tuberculosis in a Cote d'Ivoire hospital]. / Analyse des critères diagnostiques de la tuberculose de l'enfant en milieu ivoirien hospitalier.

Based on a retrospective study the authors analyzed the diagnostic criteria used in pediatric department in Yopougon CHU (teaching hospital), from January 1996 to December 2002. Fifty children, aged of 1 month to 15 years, have been studied. The tuberculosis contact was found in 18%. The diagnosis of tuberculosis was accurate in 32% and it was based on presumptive arguments in 68%. The pulmonary examination and pulmonary radiographs seem to be good criteria for the tuberculosis diagnosis. The pulmonary examination found an abnormality in 96%, and the radiographs found a pathological picture in 85% of cases. The skin test was positive in 42%. The Ziehl-Neelsen coloration was used to look for the acid-fast bacilli and it was positive in 41%. But the two last examinations were not reliable in the case of HIV infection. The skin test which is very important for the diagnosis of tuberculosis is often negative among HIV infected children because of their anergy. On the other hand, the Ziehl-Neelsen coloration is based on the recognition of the acid-fast bacillus, which is not specific of the Mycobacterium tuberculosis. In our area the prevalence of HIV/AIDS is high, the atypical pneumonia with Mycobacterium were also frequent and may reveal a wrong positive diagnosis for the tuberculosis diagnosis, as they are also acid-fast bacillus.