[Upperurinary Tract Diversion With JJ Stent By Endoscopy : Indications, Results And Morbidity]. / Derivation Du Haut Appareil Urinaire Par Une Sonde Double J Par Voie Endoscopique : Indications, Resultats Et Morbidite.

OBJECTIVE: to report the indications and the results of the upper urinary tract by endoscopic route by a double J probe in our Center. PATIENTS AND METHODS: This was a retrospective mono-centric descriptive study from January 1st 2018 to June 30th 2019 including all patients that had a JJ stent as a type of upperurinary tract diversion. RESULTS: seventy four patients were included. The average age of patients was 43.6 ± 17.5 years. The sex-ratio was 0.6. The obstructive renal colic was the most common operative indication in 62.1% (46) of patients. The etiologies were dominated by urolithiasis with 39.1% (29) of patients. Anesthesia was general in 67.5% (50) and locoregional in 32.5% of patients (24). The procedure was performed without fluoroscopic control (blind) in 66.2% of cases(49), therewere 89.7% case of success (44 patients). The success rate was 86.5% (64) patients and the failure rate 13.5% (10) of patients. Five (6.7%) patients had a postoperative acute pyelonephritis complication requiringremoval of the JJ stent. CONCLUSION: The rise of the double J probe made possible to prepare the ureter, thus facilitating the endoscopic treatment of urinary lithiasis. The complication rate observed in our patients was low. The compliance with the rules of asepsis could reduce these complications.

OBJECTIF: rapporter les indications et les résultats de la dérivation du haut appareil urinaire par voie endoscopique par une sonde double J dans notre centre. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective mono-centrique de type descriptif incluant tous les patients ayant eu une montée de sonde double J par voie endoscopique en première intention comme type de dérivation du haut appareil urinaire durant la période du 1 janvier 2018 au 30 juin 2019 dans notre centre. RÉSULTATS: Soixante-quatorze patients étaient inclus. L'âge moyen des patients était de 43,6 ± 17,5 ans avec un sex-ratio de 0,6. La colique néphrétique obstructive était l'indication opératoire la plus fréquente, objectivée chez 62,1 % (46) des patients. Une insuffisance rénale aiguë était notée chez 4 % (3) des patients. Les étiologies étaient dominées par la lithiase urinaire, objectivée chez 39,1 % (29) des patients. L'anesthésie était générale chez 67,5 % (50) et locorégionale chez 32,5 % des patients (24).En peropératoire, l'amplificateur de brillance était utilisé chez 33,7 % (25) et 66,3 % (49) des patients n'avaient pas de guidage fluoroscopique. Parmi ces derniers, le taux de succès opératoire était de 89,7 % (44 patients). Le taux de succès était de 86,5 % (64) des patients et le taux d'échec á 13,5 % (10) des patients. Cinq (6,7 %) patients avaient eu une complication postopératoire à type de pyélonéphrite aigue à risque de complication ayant nécessité le retrait de la sonde double J. CONCLUSION: La montée de sonde double J a permis de préparer l'uretère facilitant ainsi le traitement endoscopique des lithiases urinaires. Le taux de complication observée chez nos patients était faible. Le respect des règles d'asepsie contribuerait à diminuer ces complications.

[Results of anastomotic urethroplasty for male urethral stricture disease]. / Résultats de l'urétroplastie anastomotique pour rétrécissement de l'urètre masculin.

OBJECTIVE: To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. PATIENTS AND METHODS: We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. RESULTS: Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. CONCLUSION: The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. LEVEL OF EVIDENCE: 4.

[NK/T-cell Lymphoma of nasal-type: A rare affection with a poor prognosis]. / Lymphome T/NK de type nasal : une pathologie rare de mauvais pronostic.

INTRODUCTION: NK/T cell lymphoma of nasal-type was described in 1933 as a malignant midfacial granuloma. The diagnosis of this rare affection is clinical and immunohistopathological. We report a case of NK/T cell lymphoma diagnosed at an advanced stage. OBSERVATION: A 60-year-old man with no particular medical history presented since seven months with a left nasal obstruction associated with a purulent and fetid rhinorrhea followed by a centrifugal midfacial necrosis. Blood tests showed an inflammatory syndrome. The CT-scan of the face showed a filling of the nose and sinus by a tissular process and a lysis of the bone walls. Three series of biopsies (le last being performed under general anesthesia) were necessary to get the diagnosis of NK/T cell lymphoma. The standard histology showed a malignant proliferation made of round and spindle-shaped lymphoid-like cells and angiocentric arrangement. The cells were CD 2+, CD 3+, CD 5+ and CD 56+. The spontaneous evolution was fatal one month after diagnosis in a context of septic shock. CONCLUSION: NK/T cell lymphoma of nasal-type is a rare disease but should be evocated in patient with midfacial necrosis of centrifugal evolution. The diagnosis certainty is made on immunohistopathological analysis. Multiple biopsies, made at distance from necrotic areas and under general anesthesia may be necessary.

On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings.

Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider perceptions of VL monitoring and indicate the importance of policies responsive to individual and environmental challenges of VL monitoring program implementation. Findings may inform scale-up by helping policy-makers identify strategies to improve feasibility and sustainability of VL monitoring.

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]. / Pseudo-tumeur inflammatoire vésicale expulsée par le méat urétral chez une fillette.

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

[Urological emergencies in paediatric surgery: a survey of 40 cases]. / Les urgences urologiques en chirurgie pediatrique: a propos de 40 cas.

AIMS: The objective of this study is to report our experience on the epidemiology of urological emergencies in pediatric surgery, and to analyze the diagnosis and therapeutic process. MATERIALS AND METHODS: It was a prospective survey which was carried out between January 2010 and June 2011 in the pediatric service of Aristide Le Dantec Hospital (HALD). All the children who came for a urological emergency consultation were included in the study. THE RESULTS: the urological emergencies accounted for forty cases which represented 2.57% of pediatric surgery emergencies. The average age of our patients was 4.5 years with extremes of 10 days and 15 years of age. 29 cases of severe big bursae were observed and among them there were strangulated hernia and ten cases of suspicious spermatic cord torsion. The other admission motives consisted of three cases of urine retention, two pyelonephritis cases, two cases of post circumcision glans sections, two paraphimosis cases, one tight phimosis case, one case of penis traumatism provoked by a game incident. The scrotum ultrasound performed on six patients helped find out a specificity of 66.6%. 60% of strangulated hernia have been reduced through under sedation taxis. In case of confirmed torsion, a detorsion followed by an orchidopexy were performed. Two orchidectomy were performed for a testicular necrosis. CONCLUSION: the painful big bursa is the number one cause for a urology pediatric consultation. It implies a fast and adequate diagnosis and treatment so as not to miss a digestive or testicular pain.

BUTS: Rapporter notre expérience sur l'épidémiologie des urgences urologiques en chirurgie pédiatrique, d'analyser la prise en charge diagnostique et thérapeutique. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude prospective réalisée dans le service de chirurgie pédiatrique de l'hôpital Aristide Le Dantec de Dakar (HALD), de janvier 2010 à juin 2011. Tous les enfants reçus pour une urgence urologique ont été inclus. RÉSULTATS: Les urgences urologiques représentaient 2,57% des urgences chirurgicales pédiatriques. L'âge moyen des patients était de 4,5 ans avec des extrêmes de 10 jours et de 15 ans. Nous avons noté 29 cas de grosses bourses aigues dont 15 hernies étranglées et 10 suspicions de torsion du cordon spermatique. Les autres motifs d'admission étaient représentés par 3 cas de rétentions aigues d'urine, 2 cas de pyélonéphrites, 2 cas de sections de gland post circoncision, 2 cas de paraphimosis, 1 cas de phimosis serré, 1 cas de traumatisme pénien. L'échographie scrotale réalisée chez 6 patients avait une spécificité de 66,6%. Soixante pour cent des hernies compliquées ont été réduites par taxis sous sédation. Deux orchidectomies ont été effectuées pour nécrose testiculaire. CONCLUSION: la grosse bourse aigue est le 1er motif de consultation en urologie pédiatrique. Elle implique une prise en charge rapide et adéquate pour ne pas passer à coté d'une souffrance testiculaire ou digestive.

[Pathology of the processus vaginalis in urological practice]. / La pathologie du canal péritonéo-vaginal en pratique urologique.

PURPOSE: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE: 5.

[Scrotal calcinosis: clinical and therapeutic aspects in 5 cases]. / La calcinose scrotale : aspects cliniques et thérapeutiques à propos de 5 cas.

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases.

[Testicular bilharzioma by Schistosomia haematobium: about two cases]. / Bilharziome testiculaire à Schistosomia haematobium: à propos de deux observations.

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.

[Post-hysterectomy vesicovaginal fistula]. / Fistules vésicovaginales posthystérectomie.

OBJECTIVE: Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF). PATIENTS AND METHODS: We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure. RESULTS: Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure. CONCLUSION: In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

Polymorphism pattern at a miniature inverted-repeat transposable element locus downstream of the domestication gene Teosinte-branched1 in wild and domesticated pearl millet.

Unravelling the mechanisms involved in adaptation to understand plant morphological evolution is a challenging goal. For crop species, identification of molecular causal polymorphisms involved in domestication traits is central to this issue. Pearl millet, a domesticated grass mostly found in semi-arid areas of Africa and India, is an interesting model to address this topic: the domesticated form shares common derived phenotypes with some other cereals such as a decreased ability to develop basal and axillary branches in comparison with the wild phenotype. Two recent studies have shown that the orthologue of the maize gene Teosinte-Branched1 in pearl millet (PgTb1) was probably involved in branching evolution during domestication and that a miniature inverted-repeat transposable element (MITE) of the Tuareg family was inserted in the 3' untranslated region of PgTb1. For a set of 35 wild and domesticated populations, we compared the polymorphism patterns at this MITE and at microsatellite loci. The Tuareg insertion was nearly absent in the wild populations, whereas a strong longitudinal frequency cline was observed in the domesticated populations. The geographical pattern revealed by neutral microsatellite loci clearly demonstrated that isolation by distance does not account for the existence of this cline. However, comparison of population differentiation at the microsatellite and the MITE loci and analyses of the nucleotide polymorphism pattern in the downstream region of PgTb1 did not show evidence that the cline at the MITE locus has been shaped by selection, suggesting the implication of a neutral process. Alternative hypotheses are discussed.

Genome-specific introgression between wheat and its wild relative Aegilops triuncialis.

Introgression of sequences from crop species in wild relatives is of fundamental and practical concern. Here, we address gene flow between cultivated wheat and its widespread polyploid relative, Aegilops triuncialis, using 12 EST-SSR markers mapped on wheat chromosomes. The presence of wheat diagnostic alleles in natural populations of the barbed goatgrass growing in proximity to cultivated fields highlights that substantial gene flow occurred when both species coexisted. Furthermore, loci from the A subgenome of wheat were significantly less introgressed than sequences from other subgenomes, indicating differential introgression into Ae. triuncialis. Gene flow between such species sharing nonhomeologous chromosomes addresses the evolutionary outcomes of hybridization and may be important for efficient gene containment.

[Venous thrombosis and bilateral arterial occlusion of lower limb revealing HIV infection]. / Thrombose veineuse et occlusion artérielle bilatérale des membres inférieurs révélant une infection par le VIH.

Human immunodeficiency virus (HIV) infection can cause vascular complications. This is most often of lower limb venous thrombosis. Rare cases of limb ischemia indicative of HIV infection have been described.We report a case of venous thrombosis of the left lower limb and bilateral lower arterial ischemia revealing an HIV infection in a patient of 44 years. The CD4 count was 195/mm(3). Investigations on coagulation were not realized. The patient was amputated both his legs.

[Anderson-Hynes open pyeloplasty: which indications in the area of laparoscopic surgery?]. / La pyéloplastie à ciel ouvert selon Anderson-Hynes : quelles indications devant le développement de la laparoscopie ?

OBJECTIVES: To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure. PATIENTS AND METHODS: It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature. RESULTS: The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27). CONCLUSION: Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery.

[Adult renal cancer in Senegal: Current epidemiological, clinical features, profile's evolution over the two past decades]. / Le cancer du rein de l'adulte au Sénégal : aspects épidémiologiques et cliniques actuels et évolution du profil sur les deux dernières décennies.

OBJECTIVE: To study current epidemiological and clinical features of adult renal cancer in Senegal and the evolution of these features over the two past decades. PATIENTS AND METHODS: We conducted a retrospective ten years study (2000-2009) that analyzed all the renal cell cancer in adult admitted in the urology department and the pathology department of the university teaching hospital Aristide-Le-Dantec (Dakar). The results of this study were compared with those of the previous decade. RESULTS: We included 74 cases of renal cell cancer. The median age of patients was 49 years (18-72 years). There was a slight female predominance (51.3%). Twenty-eight (37.8%) patients presented at least with one renal cell cancer risk factor. The median duration of symptoms was 10 months (1-96 months). The localization of the renal cancer was right in 42 patients (56.7%) and left in 32 cases (43.8%). Almost all the tumors were symptomatic. Symptoms were dominated by loin pain (87.8%) and abdominal mass (77%). There were only two cases (2.7%) of incidental renal cell cancer. The median tumor size was 12 cm (2.4-26 cm). The more frequent tumor stages according to the TNM 2002 staging system were T2 (39.2%) and T3 (33.7%). Metastases were found in 23 (31%) patients. Forty-four patients underwent nephrectomy (43 radical and one partial). No adjuvant treatment or metastasectomy were done. The main histological subtype of tumors was renal cell carcinoma (47 cases). The mean duration of the follow up was 30.5 ± 33.6 months. Among the 44 patients who underwent nephrectomy, no tumor recurrence was found on 35 cases. Tumor recurrence occurred on nine patients. The specific mortality rate was 47.3%. Epidemiological and clinical features of the adult renal cell cancer in Senegal haven't significantly changed over the 20 past years. CONCLUSION: The adult renal cell cancer incidence was low in Senegal. Its clinical profile was characterized by a predominance of locally advanced and metastatic forms.

[Renal cell carcinoma in children: Report of a case with lymph node involvement]. / Carcinome à cellules rénales chez l'enfant : à propos d'un cas avec envahissement ganglionnaire.

Renal cell carcinoma (RCC) in children is rare. This entity has different clinical and biological presentation characteristics from adult RCC. In contrast to Wilms tumor, the efficacy of chemotherapy and radiation therapy in pediatric RCC remains uncertain. Debate continues on the importance of lymph node dissection. The authors present a case of RCC with lymph node involvement in a 12-year-old boy. The treatment was radical nephrectomy and a limited lymphadenectomy. No adjuvant therapy was given. After 13 months of follow-up, there is no evidence of recurrence. This case shows that lymph node involvement (in the absence of distant metastases) is not associated with a poor prognosis in pediatric RCC and that lymphadenectomy in lymph node-positive cases is important.

Inter-laboratory evaluation of the ISO standard 11063 "Soil quality - Method to directly extract DNA from soil samples".

Extracting DNA directly from micro-organisms living in soil is a crucial step for the molecular analysis of soil microbial communities. However, the use of a plethora of different soil DNA extraction protocols, each with its own bias, makes accurate data comparison difficult. To overcome this problem, a method for soil DNA extraction was proposed to the International Organization for Standardization (ISO) in 2006. This method was evaluated by 13 independent European laboratories actively participating in national and international ring tests. The reproducibility of the standardized method for molecular analyses was evaluated by comparing the amount of DNA extracted, as well as the abundance and genetic structure of the total bacterial community in the DNA extracted from 12 different soils by the 13 laboratories. High quality DNA was successfully extracted from all 12 soils, despite different physical and chemical characteristics and a range of origins from arable soils, through forests to industrial sites. Quantification of the 16S rRNA gene abundances by real time PCR and analysis of the total bacterial community structure by automated ribosomal intergenic spacer analysis (A-RISA) showed acceptable to good levels of reproducibility. Based on the results of both ring-tests, the method was unanimously approved by the ISO as an international standard method and the normative protocol will now be disseminated within the scientific community. Standardization of a soil DNA extraction method will improve data comparison, facilitating our understanding of soil microbial diversity and soil quality monitoring.

Impact of HIV type 1 subtype on drug resistance mutations in Nigerian patients failing first-line therapy.

A diverse array of non-subtype B HIV-1 viruses circulates in Africa and dominates the global pandemic. It is important to understand how drug resistance mutations in non-B subtypes may develop differently from the patterns described in subtype B. HIV-1 reverse transcriptase and protease sequences from 338 patients with treatment failure to first-line ART regimens were evaluated. Multivariate logistic regression was used to examine the effect of subtype on each mutation controlling for regimen, time on therapy, and total mutations. The distribution of HIV-1 subtypes included CRF02_AG (45.0%), G (37.9%), CRF06_cpx (4.4%), A (3.6%), and other subtypes or recombinant sequences (9.2%). The most common NRTI mutations were M184V (89.1%) and thymidine analog mutations (TAMs). The most common NNRTI mutations were Y181C (49.7%), K103N (36.4%), G190A (26.3%), and A98G (19.5%). Multivariate analysis showed that CRF02_AG was less likely to have the M41L mutation compared to other subtypes [adjusted odds ratio (AOR) = 0.35; p = 0.022]. Subtype A patients showed a 42.5-fold increased risk (AOR = 42.5, p = 0.001) for the L210W mutation. Among NNRTI mutations, subtype G patients had an increased risk for A98G (AOR = 2.40, p = 0.036) and V106I (AOR = 6.15, p = 0.010), whereas subtype CRF02_AG patients had an increased risk for V90I (AOR = 3.16; p = 0.003) and a decreased risk for A98G (AOR = 0.48, p = 0.019). Five RT mutations were found to vary significantly between different non-B West African subtypes. Further study to understand the clinical impact of subtype-specific diversity on drug resistance will be critically important to the continued success of ART scale-up in resource-limited settings.

[Ketoacidosis in type 1 diabetes mellitus: 73 cases in Dakar]. / Acidocetose Chez Le Sujet Diabetique De Type 1 : A Propos De 73 Cas Colliges A Dakar.

INTRODUCTION: The follow-up of diabetes mellitus in children and teenagers remains a challenge. Ketoacidosis is the most frequent acute metabolic complication and is of bad prognosis. The objective of this study was to evaluate etiologicals factors of decompensation and evolutions in type 1 diabetes. PATIENTS AND METHODS: We conducted a transversal and prospective study from January 2009 to October 2010. All type 1 diabetic patients hospitalized for ketoacidosis had been included. For every patient, we have studied the epidemiologicals, etiologicals and clinicals factors as well as the outcomes. RESULTS: The prevalence was to 55.3 % among all ketoacidosis. Sex-ratio (Men/Women) was 0.78, mean age to 25.73 years and mean duration of diabetes was 3.9 years. Ketoacidosis was inaugural in 26 % of cases. Except Kussmaul dyspnea, prevailed digestives symptoms (87.6 %). Coma was noted in 82.1 % among whom 54.7 % had no previous diabetic follow-up. A decompensation factor was found in 93.1 % of which an infection (78 %) or stop insulin (53.42 %). Prevailing infectious sites were urogenitals (24.6 %), respiratories (20.5 %). The outcome was fatal in 6.8 % of the cases. It was about 24.3 years middle-aged, 1,6 year diabetes mellitus mean duration, without regular follow-up in 80 % of the cases. Other associated factors were coma stage 2 or 3 (80%), infection (60 %), hypokalemia (40 %). CONCLUSION: Ketoacidosis is frequent in type 1 diabetic patients and has a bad prognosis. Infection and stop insulin are major factors of decompensation. Its prévention requires an adapted therapeutic education associated to a regular follow-up of patients.

[Pyonephrosis: 44 cases in Senegal]. / Pyonéphrose: 44 observations au Sénégal.

PURPOSE: To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal. PATIENTS AND METHODS: This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes. RESULTS: A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization. CONCLUSION: Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.