Identification of hazards and critical control points during attiéké (a fermented cassava product) process in Côte d'Ivoire.

Attiéké is the major fermented plant food in Côte d'Ivoire. The aim of this study was to identify hazards and critical control points (CCP) in order to implement a HACCP system for the production of attiéké. Physico-chemical and microbiological analyses were carried out. pH of the cossettes used as raw material for attieke process was slightly acidic (6·5 ± 0·23). But attiéké produced had an acid pH (4·55 ± 0·67). The very high amount of hydrocyanic acid in cassava roots (116 ± 9·42 mg kg-1 ) was reduced to a lower value (3·4 ± 0·14 mg kg-1 ) in attiéké. It was less than the Codex Alimentarus recommended dose (10 mg kg-1 ). Microbiological analysis of the samples revealed the presence of coliforms, bacillus, Staphylococcus aureus and moulds in the intermediate products, the packaged attieke, the utensils, environment and ingredients. During the fermentation and pressing stage, the coliforms disappeared and the loads of Bacillus cereus, S. aureus and moulds were reduced. Cooking eliminated all micro-organisms except B. cereus (spores) whose load was reduced to a value of (1·1 ± 0·4)102  CFU per gram. All these micro-organisms reappeared in attiéké just after packaging. The load of micro-organisms in the packaged attiéké was lower than the Codinorm standard, CCP were cassava roots, the crushing, fermentation, and drying, cooking and packaging stage. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the great need to carry out microbiological tests frequently on attieke and even more the need to apply correct HACCP system during the production. This study will make it possible to minimize the problems encountered by women producers of attiéké, ensure consumer safety, face competition from imported starch products (wheat, rice, etc.), contribute to the opening of a small and medium-scale industrialization path for the production of attiéké and strengthen standardization on attiéké to facilitate its export.

[Epidemioclinical and Therapeutic Study of Condylomas (Genital Warts) in Dermato-Venereology Department (CHU Treichville, Abidjan, Côte d'Ivoire, 2013-2016)]. / Étude épidémioclinique et thérapeutique des condylomes vénériens dans un service de dermatovénéréologie (CHU Treichville, Abidjan, Côte d'Ivoire, 2013-2016).

We have conducted a retrospective study in the dermatology department of the CHU Treichville in Abidjan during 4 years. Three hundred and fifty cases of venereal warts were recorded with a hospital frequency of 1.5%, an average age of 29.37, a female predominance (51.3%), and a sex ratio (M/F) of 0.94. We have observed a giant condyloma in 0.9%, a main localization to the vulva (47.7%) and male genitalia (34.6%); HIV testing carried out in 60.8% of patients was positive in 80.7% of cases, all HIV1. Electrocoagulation was the mean treatment (93.1%), followed by cryotherapy (15 cases), chemotherapy (6 cases), and surgery (3 cases). Recurrences were reported in 9 cases (2.6%) of which more than half has occurred within a month.

Nous avons réalisé une étude rétrospective au sein du service de dermatologie du CHU de Treichville d'Abidjan pendant quatre ans. Trois cent cinquante cas de condylomes vénériens ont été recensés (1,5 % des hospitalisations en dermatologie) ; une moyenne d'âge de 29,37 ans ; une prédominance féminine (51,3 %) et un sexe-ratio (H/F) de 0,94. Nous avons observé un condylome géant dans 0,9 %, une localisation à la vulve (47,7 %) et aux organes génitaux externes masculins (34,6 %). Le dépistage du VIH-1, réalisé dans 60,8 % des cas, s'est avéré positif dans 80,7 % des cas, toujours avec VIH-1. L'électrocoagulation a été le traitement de choix (93,1 %), suivie de la cryothérapie (15 cas), la chimiothérapie (6 cas) et la chirurgie (3 cas). Des récidives ont été relevées dans neuf cas (2,6 %), dont plus de la moitié avant un mois.

Causes of death in the Taabo health and demographic surveillance system, Côte d'Ivoire, from 2009 to 2011.

BACKGROUND: Current vital statistics from governmental institutions in Côte d'Ivoire are incomplete. This problem is particularly notable for remote rural areas that have limited access to the health system. OBJECTIVE: To record all deaths from 2009 to 2011 and to identify the leading causes of death in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire. DESIGN: Deaths recorded in the first 3 years of operation of the Taabo HDSS were investigated by verbal autopsy (VA), using the InterVA-4 model. InterVA-4 is based on the World Health Organization 2012 VA tool in terms of input indicators and categories of causes of death. RESULTS: Overall, 948 deaths were recorded, of which 236 (24.9%) had incomplete VA data. Among the 712 deaths analyzed, communicable diseases represented the leading causes (58.9%), with most deaths attributed to malaria (n=129), acute respiratory tract infections (n=110), HIV/AIDS (n=80), and pulmonary tuberculosis (n=46). Non-communicable diseases accounted for 18.9% of the deaths and included mainly acute abdomen (n=38), unspecified cardiac diseases (n=15), and digestive neoplasms (n=13). Maternal and neonatal conditions accounted for 8.3% of deaths, primarily pneumonia (n=19) and birth asphyxia (n=16) in newborns. Among the 3.8% of deaths linked to trauma and injury, the main causes were assault (n=6), accidental drowning (n=4), contact with venomous plants/animals (n=4), and traffic-related accidents (n=4). No clear causes were determined in 10.0% of the analyzed deaths. CONCLUSIONS: Communicable diseases remain the predominant cause of death in rural Côte d'Ivoire. Based on these findings, measures are now being implemented in the Taabo HDSS. It will be interesting to monitor patterns of mortality and causes of death in the face of rapid demographic and epidemiological transitions in this part of West Africa.

[Gingival displacement techniques in daily practice. Survey among dental surgeons in Abidjan, Ivory Coast]. / Réalisation des techniques d'ouverture sulculaire en pratique quotidienne. Enquête faite auprès des chirurgiens-dentistes d'Abidjan, Côte d'Ivoire.

INTRODUCTION: Access to cervical margins allows the practitioner to record the entire cervical margin in order to provide a true copy to the technician. This requires a gingival displacement obtainable by different techniques. This study aimed to assess the implementation of gingival displacement methods prior to impression taking in fixed prosthodontics. MATERIALS AND METHODS: This is a descriptive and cross-sectional survey of sample of 71 dentists practising in Abidjan, Ivory Coast; which ran from October 2nd, 2010 to November 14th, 2010. A survey form was administered to dentists. The questionnaire was organised around the following headings: identification of dentists and practice of gingival displacement methods. The data processing done using software Epi Info 6 and Excel XP on Window XP, allowed calculation of frequencies, means and proportions and the establishment of connection between variables with the chi2 test. The significance level was set at p < 0.05. RESULTS: The results of the survey indicate that non-surgical methods of gingival displacement, including retraction cords and temporary crowns are those they use most frequently (76.4%) because the vast majority of practitioners (87.22%) believe the most traumatic to the periodontium are surgical methods. CONCLUSION: Our study showed that the gingival displacement methods are frequently carried out in daily practice, regardless of the topography of the abutment teeth and their number, but with a preference for non-surgical methods, particularly those using retraction cords and temporary crowns. The use of injectable gingival displacement paste is not harmful to the periodontal tissues, easy to use and have a very efficient haemostatic action. It should also be known and practiced.

Non-puerperal uterine inversion in a young woman: a case report.

BACKGROUND: Uterine inversion is an uncommon complication in the non-puerperal period. Submucosal myoma is more frequently involved usually among women above 45 years old. CASE PRESENTATION: A 28 year-old patient was admitted to the gynaecology emergency room in Cocody Teaching Hospital, Abidjan, Cote D'Ivoire with a large lobulated fleshy mass in the vulval area. She had been having pelvic pain, heaviness in the pelvis and bleeding per vaginam intermittently for 6 months for which she had been treated conservatively without improvement. The clinical examination was consistent with uterine inversion secondary to a mass in the fundus of the uterus. The uterus with the mass in the fundus was excised by a combined vaginal and abdominal (abdominal hysterectomy) approach. Histopathology confirmed the mass to be a sub-mucosal uterine leiomyoma. She has been followed up for 12 months without complaints. CONCLUSION: We have presented a young woman with an unusual non-puerperal, total and chronic uterine inversion as a result of uterine leiomyoma managed successfully by a combined abdominal and vaginal approach.

[Effects of war on control of tuberculosis in Côte d'Ivoire from 2002 to 2007]. / Effets de la guerre sur le contrôle de la tuberculose en Côte d'Ivoire de 2002 à 2007.

OBJECTIVES: To specify consequences of armed conflict in Côte d'Ivoire from 2002 to 2007 on treatment outcomes of new cases of smear-positive pulmonary tuberculosis (PTB+) and retreatment cases. METHODOLOGY: Retrospective analysis of treatment outcomes and reprocessing notified to the National Program against Tuberculosis from 2001 to 2008. RESULTS: Totally, 7,4232 cases of TPM+ and 5094 cases of reprocessing had been declared during the war period in Côte d'Ivoire. The global average rate of therapeutic success was 72% with a lower average rate of success in retreatment in Center, Northern et Western (CNO) zone (54%) than in Southern zone (73%). The average rate of lost sight was higher in CNO zone than in the South with respectively 27% and 11%. The average rate of success in retreatment was 60% on the national level with a lower rate in CNO zone (48%) than in the South zone (62%) and the average rate of lost sight in retreatment was higher in CNO zone than in the South zone (28% versus 16%). CONCLUSION: Our results show that there was no early epidemic of tuberculosis during the armed conflict in Côte d'Ivoire which has although severely disrupted activities of tuberculosis management in ex-nongovernmental zone.

Severe skin forms of psoriasis in black africans: epidemiological, clinical, and histological aspects related to 56 cases.

Bacground. Psoriasis is an erythematosquamous dermatosis of chronic development. In sub-Saharan Africa, few studies have been focused on complicated forms of psoriasis. Objective. The aim is to describe epidemiological, clinical, and histological features of severe skin forms of psoriasis in Cote d'Ivoire. Material and Methods. The study was both cross-sectional and descriptive, that focused on patient admitted to the dermatology unit for complicated psoriasis, from January 1st, 1986, to December 31th, 2007. Results. Fifty-six patients admitted to hospital for severe skin forms of psoriasis were recorded and included in our study over 7.503 patients hospitalized during the study period. They represented 0.75% of cases. The average age was 39.6 ± 3.3 years. There were 49 male (87.5%) and 7 female patients (12.5%) with a sex ratio of 7. At socioprofessional level, 48 patients (87.5%) were from category 1. Patients' history was dominated by the psoriasis vulgaris. Physical and general signs were dominated by itching (58.9%). The three severe skin forms were observed with predominant erythrodermic psoriasis (60.7%). Fifteen patients (34.9%) were HIV positive. Conclusion. Severe skin forms of psoriasis are rare in our setting. But in the quarter of HIV-positive patients, they are dominated by the erythrodermic psoriasis.

Postprocessing microflora of commercial attieke (a fermented cassava product) produced in the south of Côte d'Ivoire.

UNLABELLED: The distribution and presence of hygiene indicator and pathogenic micro-organisms in 375 samples of attieke marketed in Côte d'Ivoire, and their roles in the food poisoning were evaluated. Microbiological analyses were carried out, which included the total viable bacteria, coliforms, Escherichia coli, Staphylococcus aureus, Salmonella, Bacillus spores, fungi and Clostridium perfringens. The results revealed that the viable bacteria counts ranged from 2·2 ± 1·2 × 10(5) to 3·4 ± 1·4 × 10(6) CFU g(-1), while the yeasts and the moulds counts ranged, respectively, from 2·4 ± 0·12 × 10(4) to 9·8 ± 0·4 × 10(5) CFU g(-1) and 1·3 ± 0·7 × 10(1) to 1·7 ± 0·7 × 10(2) CFU g(-1). Bacillus subtilis, Bacillus cereus, Staphylococcus aureus, Citrobacter freundi, Enterobacter amnigenus, Citrobacter youngae, Enterobacter aerogenes, Klebsiella pneumoniae, Serratia marcescens, Enterobacter agglomerans and Klebsiella oxytoca were the bacteria isolated, and Rhizopus spp., Mucor spp., Thamnidium spp., Fusarium spp., Moniliella spp. the fungi. Escherichia coli, Clostridium perfringens and Salmonella spp. were not found. The occurrence of some bacteria and fungi illustrate that attieke collected in Côte d'Ivoire markets may act as a reservoir of pathogenic micro-organisms for human. SIGNIFICANCE AND IMPACT OF STUDY: This study demonstrates the great need to carry out microbiological tests frequently on attieke and even more the need to apply correct HACCP system during the production. Attieke is especially a well-known product in West Africa; hence, it is extremely important to ensure an adequate microbiological quality to guarantee consumers health. Overall, the study highlighted the need for effective communication on microbiological food risks, proper instruction and supervision in food-handling procedures, greater education on food safety risks.

Leiomyomatosis peritonealis disseminata and pregnancy: a case report.

Leimyomatosis peritonealis disseminata (LPD) is a benign tumor of smooth muscle tissue. It is rare and is characterized by the development of multiple peritoneal nodules mimicking peritoneal carcinomatosis. We report a case of LPD diagnosed in a 35-year-old patient, G4/P1, without any major gynecological history. The patient underwent an elective cesarean section at 42 weeks, during which numerous peritoneal nodules ranging in size from 0.1 to 0.5 cm were found. Microscopic examination showed a proliferation of smooth-muscle cells without mitosis or atypia or necrosis.

Endometrial osseous metaplasia and infertility: a case report.

Endometrial osseous metaplasia is a rare clinical entity. It causes infertility and occurs in more than 80% of cases after an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce bone. This disease may be misdiagnosed. However once diagnosed, the complete removal of bone spicules by hysteroscopy allows, in most cases, fertility to be restored. We present the case of a 36-year-old patient nulliparous with a history of abortion for eight years who consulted May 5, 2008 to become pregnant. Detailed examination showed chronic endometritis with bone metaplasia as a possible cause of her infertility. Seven months after complete removal of bone fragments by hysteroscopy, the patient had a spontaneous pregnancy with normal development. She gave birth to a male infant weighing 3,000 g with an Apgar score of 9 at 1 and 5 min. Delivery and postpartum were normal.

[Spontaneous splenic rupture in the first trimester of pregnancy: report of a case and review of the literature]. / Rupture spontanee de la rate au 1er trimestre de la grossesse: a propos d'un cas et revue de la litterature.

The authors return a case of spontaneous rupture of the spleen occured at the first quater of pregnancy. It is a rare accident during pregnancy that often entails the maternal death. Its exact reasons are difficult to determine. Among the reasons of the hemoperitoines at the firt quarter it is necessary to know how to think about the rupture of the spleen. Its diagnosis is unsuspected. The hold in charge surgical fast in our case permitted the pursuit of pregnancy.

[Appendicitis and pregnancy: 21 cases]. / Appendicite aiguë et grossesse. A propos de 21 cas.

OBJECTIVE: Describe the epidemiological, diagnostic and therapeutic features of acute appendicitis in pregnant women. MATERIAL AND METHODS: Retrospective analysis of a series of 21 cases of appendicitis in pregnant women who underwent surgery between January 1997 and June 2001. RESULTS: The association of acute appendicitis with pregnancy was noted in 0.2% of the pregnant women. Ten patients were in the first trimester of pregnancy, ten in the second and one in the third. Abdominal pain was noted in all patients. The localization varied with gestational age. Abdominal ultrasound contributed to the diagnosis in twenty patients who underwent the examination. Diagnoses retained were: acute uncomplicated appendicitis (n=18), acute appendicitis with focal induration (n=1) and acute diffuse peritonitis (n=2). Appendectomy was performed in all cases. Intensive care, peritoneal cleaning and drainage were associated in cases with appendicitis. In cases with focal induration, medical treatment was followed by appendectomy performed after delivery. Tocolysis was instituted in all cases. Twelve pregnancies continued to delivery: one fetal death, one premature delivery and ten term deliveries of live infants. CONCLUSION: Pregnancy makes it difficult to confirm the diagnosis of appendicitis. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.

[How do Ivorien rural populations perceive family planning?]. / Comment les populations rurales Ivoiriennes perçoivent-elles la planification familiale?

The government of Côte d'Ivoire has recently adopted its population policy. One of the objectives of this policy is to reduce the high rate of population growth through family planning. The success of the family planning program will depend not only on the strength of effort to be deployed, but also on the acceptability of the idea of family planning to the population, given the pronatalist nature of the society, especially in rural areas. The aim of this study is to assess the acceptability of family planning to the rural population. The study is based on a survey conducted in rural areas of the country on various issues including the social representation of family planning. Analyses rely on simple methods such as frequency tables and cross tabulation. The results show that rural populations, somehow, have an open mind towards family planning. They are interested in using family planning services if they are provided with them. However, implementation of family planning programs in rural areas requires some precautions--birth limitation should not be included among the objectives, at least at the beginning of the program; a preliminary advocacy program at the level of rural community leaders is required; there is need to adapt program strategies to the level of infrastructural development of the villages; etc.

[Population aging in the Sahel: a process of contrasts]. / Vieillissement de la population au Sahel: un processus contraste.

PIP: Demographic aging has been occurring in developing countries over many years. The size of the elderly population in Africa is steadily rising, yet its proportion relative to the entire population remains low. Demographic aging in Africa is occurring without a corresponding decrease in the proportion of the youth. Africa maintains high fertility, while mortality has decreased considerably and the quality of life has improved. Thus, demographic aging is a corollary of development. It can have negative consequences for society as well as for the elderly themselves if aging is not addressed. In the case of Africa, some demographers think that fertility will remain the most immediate determining cause of demographic aging due to its impact on population structure. Thus, aging will remain insignificant for a long time. Other demographers think that mortality is the leading determining factor of demographic aging because life expectancy in the advanced ages in developing countries matches that in developed countries. This view reinforces the insignificance of demographic aging in Africa. Gains in life expectancy in Africa could be attributed to a reduction in infant mortality. Stagnant fertility combined with reduced infant mortality contributes to a very pronounced rejuvenation of African populations. Demographic aging is not yet an important phenomenon in Mali. Mali is very open to emigration, which changes the population structure because the economically active age group leaves. 6.2% of the population of Mali were elderly in 1987, and 6.3% were in 1976. Demographic aging results in an increase in widows. It will lead to a variety of family structures, which could mean a different status for the elderly. Population research and policies should address the changes in the quality of life of the elderly.^ieng

[Etiological factors of deep vein thromboses in the limbs of Black African subjects]. / Facteurs étiologiques des thromboses veineuses profondes des membres chez le sujet Noir Africain.

Deep thrombosis of limbs are unknown in Africa South of the Sahara. Looking for their etiological factors, the authors reviewed 82 cases admitted with an undisputable diagnosis of thrombosis. They underline the coming in of the disease which appears to strike two targets populations female in strong genital activity and males between 40 and 60 years of age. The authors are of opinion that etiological factors are similar to those described in the literature but they underline some peculiarities. Anemia, mainly because of iron deficiency (30.5 p.c.) gyneco-obstetrical context with oral contraception (26.8 p.c.) dysmetabolism (19.5 p.c.) heredity (15 p.c.) and infections (14.5 p.c.) are on the top of etiological factors. Then we have congestive cardiopathies (9.7 p.c.) digestive lesions (6.1 p.c.) and neoplasiae, hemoglobinopathies, quite frequent in the region as well as surgical context without preventive anticoagulants (7.3 p.c.) do not seen to play a significant role: they start again the discussion about the natural protection of Black African against thrombo-embolic diseases. Finally, they point out the interest of antithrombine III and proteins C and S tests in any known causal factor.