Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

BACKGROUND: Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. METHODS: We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. RESULTS: We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5 years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1 min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). CONCLUSION: These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Diagnostic accuracy of swine echinococcosis cytopathological tests and challenges for a differential diagnosis: slaughterhouse data.

Echinococcosis disease shows clinical signs similar to many diseases. Hence we report cases that need to be confirmed using appropriate tests. A confirmatory study has been conducted to assess the accuracy of two cytopathological tests, with the histopathology test as the reference standard. The first cytopathological test evaluates the Ziehl Neelsen staining with an epifluorescence microscope (cytopath 1). The second cytopathological test uses the same staining followed by a transmitted light microscope examination (cytopath 2). Of a total of 2524 inspected pigs, 101 suspected cases of echinococcosis were detected, of which 67 were found positive with the two cytopathological tests and the histopathological one. The specificity of cytopath 1 (100 % [95 % CI 100 - 100]) and cytopath 2 (100 % [95 % CI 100;100]) were similar, as well as their respective positive predictive values: 100 % [95 % CI 100 - 100] vs. 100 % [95 % CI 100 - 100]. The sensitivity of cytopath 1 is 79.66 % [95 % CI 69.39 - 89.93], while cytopath 2 equals 66.10 % [95 % CI 54.02 - 78.18]. The difference in sensitivity of both tests was not significant. Negative predictive values found for cytopath 1, and cytopath 2 were 40 [95 % CI 18.53 - 61.47] and 28.57 [95 % CI 11.84 - 45.3], leading to the Generalized Estimating Equations (GEE) Model estimate for an odds ratio of 1.4 [95 % CI 0.41 - 5.2], p = 0.06. Cytopath 1 and cytopath 2 are equivalent in terms of specificity (100 % [95 % CI 100 - 100] vs. 100 % [95 % CI 100;100]) and positive predictive value (100 % [95 % CI 100 - 100]. Cytopath 1 is more sensitive than cytopath 2 but not significant (79.66 % [ 95 % CI 69.39 - 89.93] vs. 66.10 % [95 % CI 54.02 - 78.18]). However, the negative predictive value of cytopath 1 is better than that of cytopath 2: 40 % [95 % CI 18.53 - 61.47] vs. 28.57 % [95 % CI 11.84 - 45.3].

GAYET WERNICKE'S ENCEPHALOPATHY AFTER COVID-19 IN ELDERLY SUBJECTS IN TROPICAL ENVIRONMENTS: STUDY OF SIX (6) OBSERVATIONS IN CONAKRY.

In sub-Saharan Africa, the COVID-19 pandemic has caused severe malnutrition in elderly populations with the appearance of vitamin deficiencies, in particular thiamine responsible for Gayet Wernicke's encephalopathy (EGW). We present a series of six (6) patients hospitalized in the Neurology Department of the CHU Ignace Deen for the management of a brain syndrome with vigilance disorders after recovery from COVID-19, including oculomotor disorders, motor incoordination on a course of severe weight loss. The six patients underwent an evaluation of malnutrition by determining the WHO body mass index, the Detsky index, the serum albumin assay, the thiamine assay and a neuroradiological assessment (MRI) and an electroencephalogram (EEG) examination although this does not seem necessary for diagnosis. Study of nutritional status: weight loss greater than 5%, patients in Desky group B and C, plasma albumin<30 g/l, lowered thiamine and MRI neuroradiological data: by the existence of hypersignals in certain regions of the neocortex, certain gray nuclei, the mammillary bodies the thalamic nuclei close to the wall of the 3rd ventricle and the regions bordering the 4th ventricle sign Gayet Wernicke's encephalopathy syndrome. This study shows a stereotyped clinical, biological, neuroradiological and evolutionary profile of Gayet Wernicke's encephalopathy in elderly subjects recovered from Covid-19 with proven malnutrition. These results are useful for the therapeutic and prognostic discussion.

[Our experience of the sural flap with distal pedicle in the repair of foot plantar and heel of foot lesions]. / Notre expérience du lambeau sural à pédicule distal dans la réparation des lésions du talon et de la plante du pied.

PURPOSE: The sural flap has often been used to cover the weight-bearing and non-weight-bearing areas of the foot and ankle. This study reports our experience in the coverage of these defects in the foot in weight-bearing areas. PATIENTS AND METHOD: This is a retrospective and descriptive study of 70 months. This study includes 16 patients presenting a loss of plantar substance and/or heel of the foot covered by a sural flap with a distal pedicle. The sampling technique described by Masquelet served as our reference. An increase in the length of the pedicle of at least two centimeters during the dissection made it possible to avoid any stretching or compression for the most distal lesions. RESULTS: The average age was 35 years with a sex ratio of three in favor of men. Traumatic lesions predominated (n=10) with an average area of lesions of 68.8cm2. The average partial and total support times were 1.8 and 3.6 months respectively. We noted one case of flap necrosis. The natural evolution of the flap took place in three progressive stages: regeneration, keratinization and squamous metaplasia. Normal bipodal support and stable gait without footwear anomaly were noted in 15 cases. CONCLUSION: The distal pedicle sural flap technique is accessible. Its reliability makes it an ideal choice for distal loss of substance to the leg and foot.

Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis.

PURPOSE: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

[Which Management of Burn Sequelae to the Limbs in a Peculiar Context?] / Quelle Prise En Charge Des SÉquelles De BrÛlures Des Membres Dans Un Contexte Particulier ?

Burns are frequent lesions, often leading to serious functional or even life-threatening sequelae. Their care poses a problem in the countries of the South due to the lack of specialized centres. Through this study, we would like to share our experience. This was a descriptive retrospective study carried out over 36 months on 24 patients treated and followed up in the department for burn sequelae involving a limb. Functional results were classified as excellent, good, fairly good, fair and poor. Aesthetically, they have been categorized into satisfactory, unsatisfactory and poor. We recorded 1480 patients who underwent surgery, 24 of whom were operated on after burns. We noted a female predominance (sex ratio of 1.6) with an average age of 24.2 years (range 16-40). Domestic accidents (n=19) were the main circumstance of occurrence and there was a preponderance of thermal burns by flame (n=21). Twenty people were treated in the first year after burn with excellent, good and fair results in 10, 9 and 4 cases respectively. Burns can cause significant functional sequelae, the management of which requires specialized nursing staff. Training of caregivers oriented towards burn care without forgetting the related means remains a key element to minimizing the occurrence of these sequelae.

Infected urachal cyst in an adult, report of two observations.

INTRODUCTION: Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it. CASE PRESENTATION: Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection. CLINICAL DISCUSSION: Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery. CONCLUSION: Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

[Knowledges And Practices Of Iron Prescription By The Pediatric Ward In CHU Gabriel Touré Of Bamako, Mali]. / Connaissances Et Pratiques De La Prescription Du Fer Par Le Personnel Du Service De Pediatrie Du Chu Gabriel Toure De Bamako.

GOAL: To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali. TOOLS AND METHODS: It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1rstto 30 July 2012. The prescriptators' consent were solicited and obtained at first of all. RESULTS: Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage. CONCLUSION: The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies.

BUT: Evaluer les connaissances et les pratiques relatives à la prescription du fer dans le service de pédiatrie du Centre Hospitalier Universitaire Gabriel Touré (CHU-GT) de Bamako, Mali. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale réalisée du 1 er au 30 Juillet 2012 à la pédiatrie. Nous avons soumis un questionnaire aux prestataires et analysé les dossiers des enfants âgés de 1 à 60 mois hospitalisés ayant reçu du fer. Le consentement des prescripteurs à été demandé et obtenu au préalable. RÉSULTATS: nous avons enquêté cinquante prestataires dont 10 pédiatres (20%), 31 médecins CES de pédiatrie (62 %), 2 médecins généralistes (4%), 7 étudiants en fin de cycle médical (14%) et analysé 100 dossiers. Trente pour cent des prestataires ont correctement défini le fer. Plus de la moitié des prestataires connaissaient les besoins en fer chez l'enfant. Les réserves en fer étaient connues de 42% des prestataires. Huit pour cent des prestataires savaient que les fers apportés par l'alimentation étaient le fer héminique ou le fer non héminique. Trente pourcent des malades ont reçu le fer à la dose de 8 à 10mg/kg. La durée du traitement n'a pas été précisée chez 92% des malades. CONCLUSION: Dans notre contexte la bonne connaissance théorique des indications et des règles de prescription du fer chez l'enfant n'excluait pas les mauvaises pratiques de sa prescription. D'autres travaux devraient analyser les raisons de cette discordance.

[Portal cavernoma at child about two observations]. / Cavernome portal chez l'enfant a propos de deux observations.

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Nous rapportons deux observations de cavernome portal diagnostiqué successivement à Bamako et à Dakar. Le premier est un enfant de 6 ans de sexe masculin admis dans le service pour ascite et douleurs abdominales. L'examen clinique notait une pâleur cutanéo-muqueuse modérée, une asthénie. Le bilan biologique retrouvait une anémie modérée normochrome normocytaire avec une fonction pancréatique perturbée tandis que les fonctions rénales et hépatiques étaient conservées. Le scanner abdominal réalisé après deux échographies abdominales peu contributives, objectivait des signes en faveur d'un cavernome portal avec varice péri-splénique et gastrique. Le second est un enfant de 8 ans de sexe masculin né d'un mariage non consanguin et issu d'une grossesse suivie avec accouchement prématuré. Il est le 3e enfant de sa fratrie et scolarisé. On retrouve dans ses antécédents pathologiques une notion de prématurité ayant nécessitée un séjour en néonatologie avec cathétérisme ombilical et des douleurs abdominales à répétition. L'enfant a commencé à se plaindre de douleurs abdominales récurrentes vers l'âge de 6 ans. Douleurs de siège péri ombilical sans réveil nocturne dans un contexte de constipation chronique d'allure fonctionnelle. Il a fait un épisode abdominal aigu justifiant une hospitalisation en chirurgie pour suspicion d'appendicite. A l'admission les paramètres cliniques (poids, taille, température, périmètre crânien et température) étaient dans les normes pour l'âge. L'échographie abdominale prescrite à cet effet était évocatrice de cavernome porte, confirmé par la suite par la tomodensitométrie abdominale.

[Knee dislocation at chu Gabriel TOURE : therapeutic and evolutionary aspects]. / Luxations du genou au chu Gabriel TOURE : aspects therapeutiques et evolutifs.

INTRODUCTION: Dislocations of the knee are serious, involving the functional prognosis and sometimes the vital prognosis of the limb concerned. The aim of our work was to assess the functional results of our care. MATERIALS AND METHODS: This were a prospective study concerning patients with dislocation of the knee, treated and followed in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE from January 2015 to October 2018. RESULTS: We collected 30 patients with knee dislocation. The male sex predominated (60%) with a sex ratio of 1.5. The average age was 32.56 years. AVP was the main etiology with 83.3%. The mechanism was direct in 86.7%. Standard knee X-ray with front and side views was performed in all patients. Posterolateral dislocation was the most common type of pathology (20%). Associated lesions were observed in 56.6%. The response time was less than 6 hours in 100%. The treatment was orthopedic in 93.3%. Complications were dominated by knee laxity with 43%. At the average follow-up of 18.9 months, the functional results were good in 20%. CONCLUSION: Knee dislocations are the prerogative of the young subject. Accidents due to motorcycles are the main circumstances. Associated lesions are frequent. Orthopedic treatment is still relevant but the evolution is still unpredictable despite the early treatment.

INTRODUCTION: Les luxations du genou sont graves mettant en jeu le pronostic fonctionnel et parfois le pronostic vital du membre concerné. Le but de ce travail était de déterminer les aspects épidémiologiques, cliniques et d'évaluer les résultats du traitement. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude retro prospective concernant les patients présentant une luxation du genou , traités et suivis dans le service d'Orthopédie-Traumatologie au CHU Gabriel TOURE de janvier 2015 à octobre 2018. RÉSULTATS: Nous avons colligé 30 patients présentant une luxation du genou. Le sexe masculin a prédominé (60%) avec un sex-ratio de 1,5. L'âge moyen était de 32,56 ans. Les AVP ont été la principale étiologie avec 83,3%. Le mécanisme était direct dans 86,7%. Les radiographies standards du genou de face et profil ont été réalisées dans 100%. La luxation postéro-latérale a été le type anatomopathologique le plus fréquent (20%). Les lésions associées étaient observées dans 56,6%. Le délai de prise en charge a été de moins de 6 heures dans 100%. Le traitement a été orthopédique dans 93,3%. Les complications étaient dominées par la laxité du genou avec 43%. Au recul moyen de 18,9 mois, les résultats fonctionnels ont été bons dans 20%. CONCLUSION: Les lésions associées sont fréquentes. Le traitement orthopédique reste toujours d'actualité, mais l'évolution est toujours imprévisible malgré la précocité de la prise en charge.

[Acetabular Fractures at CHU Gabriel Toure : epidemiology, therapeutic and evolutinaryaspects]. / Les Fractures Acetabulaires au CHU Gabriel Toure : aspects epidemiologiques therapeutiques et evolutifs.

INTRODUCTION: Acetabularfractures involving the functionalprognosis of the hip. The aim of thisworkwas to determine the epidemiological, clinical, and outcome aspects of treatment. MATERIALS AND METHODS: This wasa retro-prospective study of patients withacetabulum fracture treated and followedfromJanuary 2015 to June 2018. RESULTS: Wecollected 49 patients with an acetabulum fracture. Acetabulum fractures made up 8.3% of all pelvic injuries during the studyperiod. The male sexprevailed (87.8%) with a sex ratio of 7.16. The averageagewas 36.14 years (range: 17 years and 77 years). The circumstances of the trauma were accidents on the public highway (69.4%), accidents atwork (14.3%), accidents in the home (10.2%), accidents in sports (4.1%), assaults (2%). The mechanismwas indirect in 87.8%.Pain with total functional impotence wasobservedin 83.7% and with a vicious attitude of the traumatized limbin 89, 8%. The standard radiographywith the incidences of the pelvis face as well as the ¾ wing and ¾ obturatorwasperformed in all patients. The transverse fracture of the acetabulumwas the mostcommonanatomo-radiological type (61.2%). Shock (34.6%) and hip dislocation (24.4%) were the mostcommonearly complications. Treatment was orthopedicin 95.9%. After an averagefollow-up of 23.24 months, the anatomicalresultsweresatisfactoryin 32.7% and the functionalresults good in 51%. Lameness (91.8%), mechanical pain (30.6%) and osteoarthritis (16.3%) were the main complications in the medium term. CONCLUSION: Fractures of the acetabulum are the preserve of the adult, especially of the male. The complications are dominated by mechanical pain, lameness and early hip osteoarthritis. The anatomicalresultsthat condition the functionalresults are less good with the orthopedictreatment.

INTRODUCTION: Les fractures de l'acétabulum mettent en jeu le pronostic fonctionnel de la hanche et leur traitement est difficile. Le but de ce travail était de déterminer les aspects épidémiologiques, cliniques, et d'évaluer les résultats du traitement. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude retro prospective concernant les patients présentant une fracture de l'acétabulum, traités et suivis de janvier 2015 à juin 2018. RÉSULTATS: Nous avons colligé 49 patients présentant une fracture de l'acétabulum. Les fractures de l'acétabulum ont constitué 8, 3% des traumatismes du bassin pendant la période d'étude. Le sexe masculin a prédominé (87,8%) avec un sex-ratio de 7,16. L'âge moyen était de 36,14 ans (extrêmes : 17 ans et 77 ans). Les circonstances du traumatisme ont été les accidents de la voie publique (69,4%), les accidents de travail (14,3%), les accidents de vie domestique (10,2%), les accidents de sport (4,1%), les agressions (2%). Le mécanisme était indirect dans 87,8%. La douleur avec impotence fonctionnelle totale a été observée dans 83,7%, et avec une attitude vicieuse du membre traumatisé dans 89, 8%. La radiographie standard avec les incidences du bassin de face ainsi que les ¾ alaire et ¾ obturateur était réalisée chez tous patients. La fracture transversale de l'acétabulum a été le type anatomoradiologique le plus fréquent (61, 2%). L'état de choc (34,6%) et la luxation coxo-fémorale (24,4%) ont été les complications précoces les plus observées. Le traitement a été orthopédique dans 95,9%. Après un recul moyen de 23,24 mois, les résultats anatomiques ont été satisfaisants dans 32,7% et les résultats fonctionnelsbons dans 51%. La boiterie (91,8%), la douleur mécanique (30, 6%) et l'arthrose (16, 3%) ont été les principales complications à moyen terme. CONCLUSION: les fractures de l'acétabulum touchent fréquemment l'adulte, surtout de sexe masculin. Les complications sont dominées par les douleurs mécaniques, la boiterie et la coxarthrose précoce. Les résultats anatomiques qui conditionnent les résultats fonctionnels sont moins bons avec le traitement orthopédique.

Incidental discovery of duplicated inferior vena cava in a septuagenarian: the radiologist's viewpoint.

Duplication of the inferior vena cava is a rare malformation, normally without clinical impact, explained by abnormal development and regression of certain segments of the venous system during embryonic life. However, its presence and type should be systematically reported in the radiological report because of its potential implications for diagnostic and interventional procedures. This observation describes the case of a 77-year-old man with a complete asymmetric duplication of the inferior vena cava (type III IVC according to Natsis) that was incidentally discovered on CT-scan.

Case report: a rare case of NOMA (cancrum oris) in a Malian woman.

Noma or cancrum oris is a multi-bacterial and opportunistic infection that destroys soft tissue, as well as muscle and bone, and can be fatal. We present a rare case of Noma in a 32-year-old Malian woman, from whom we isolated an Escherichia coli extended-spectrum beta-lactamase.

Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

Estimates of serious fungal infection burden in Côte d'Ivoire and country health profile.

Due to limited access to more powerful diagnostic tools, there are few data on the burden of fungal infections in Côte d'Ivoire, despite a high HIV and TB burden and many cutaneous diseases. Here we estimate the burden of serious fungal infections in this sub-Saharan country with a health profiling description. National demographics were used and PubMed searches to retrieve all published articles on fungal infections in Côte d'Ivoire and other bordering countries in West Africa. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE (www.LIFE-Worldwide.org). The population of Côte d'Ivoire is around 25 million; 37% are children (≤14 years), and 9% are>65 years. Tinea capitis in children is common, measured at 13.9% in 2013. Considering the prevalence of HIV infection (2.6% of the population, a total of ∼500,000) and a hospital incidence of 12.7% of cryptococcosis, it is estimated that 4590 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 2640 new cases occur each year with the prevalence of 11% of newly diagnosed HIV adults, and 33% of children with HIV/AIDS. Disseminated histoplasmosis is estimated a 1.4% of advanced HIV disease - 513 cases. An estimated 6568 news cases of chronic pulmonary aspergillosis (CPA) occur after pulmonary tuberculosis (a 5-year prevalence of 6568 cases [26/100,000]). Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) were estimated in 104/100,000 and 151/100,000 respectively, in 1,152,178 adult asthmatics. Vulvovaginal candidiasis (VVC) is common and recurrent VVC affects ∼6% of women in their fertile years - 421,936 women. An unknown number develop candidaemia and invasive aspergillosis. The annual incidence of fungal keratitis is estimated at 3350. No cases of sporotrichosis, mucormycosis and chromoblastomycosis are described, although some cases of mycetoma and Conidiobolus infection have been reported. This study indicates that around to 7.25% (1.8 million) of the population is affected by a serious fungal infection, predominently tinea capitis in children and rVVC in women. These data should be used to inform epidemiological studies, diagnostic needs and therapeutic strategies in Côte d'Ivoire.

2,5-diketopiperazines mitigate the amount of advanced glycation end products accumulated with age in human dermal fibroblasts.

OBJECTIVE: Glycation is a common non-enzymatic reaction between proteins and sugars, resulting in the formation of advanced glycation end products (AGEs) in the human body. As can be seen in diabetic patients, the accumulation of AGEs in the skin has aesthetic consequences (wrinkles, brown spots and yellowish complexion). Therefore, the objective of this work was to find compounds isolated from natural sources that could eliminate the final AGEs accumulated in the skin with ageing. METHODS AND RESULTS: A preliminary screening performed on a bank of microbial extracts and pure compounds showed that 2,5-Diketopiperazines (DKPs), as well as the extract of Sphingobacterium sp (SNB-CN13), reduced the presence of AGEs in fibroblasts by -28% and -23%, respectively. In this article, we present the dereplication approach used to reveal the presence of 26 different DKPs in the crude extract of Sphingobacterium sp. Bioguided fractionation has led to the isolation of 12 of them, whose identity has been confirmed by HRMS and NMR. A green synthesis approach has been developed to synthesize 3 symmetrical DKPs. The biological activity of all DKPs was evaluated by the development of an in vitro test using immunocytochemistry to reveal the presence of AGE carboxymethyl-lysine in human dermal fibroblasts. CONCLUSION: Our work shows for the first time that DKPs decrease the amount of carboxymethyl-lysine AGE in elderly human dermal fibroblasts grown in vitro. Therefore, diketopiperazines can be considered as compounds of interest for dermatological and cosmetic applications with an anti-ageing aim.

OBJECTIF: La glycation est une réaction non enzymatique courante entre les protéines et les sucres, qui entraîne la formation de produits finaux de glycation avancée (AGE) dans le corps humain. Comme on peut le voir chez les patients diabétiques, l'accumulation d'AGE dans la peau a des conséquences esthétiques (rides, taches brunes, teint jaunâtre). Par conséquent, l'objectif de ce travail était de trouver des composés isolés de sources naturelles qui pourraient éliminer les AGE finaux accumulés dans la peau avec le vieillissement. MÉTHODES & RÉSULTATS: Un examen préliminaire effectué sur une banque d'extraits microbiens et de composés purs a montré que les 2,5-dicétopipérazines (DKP), ainsi que l'extrait de Sphingobacterium sp. (SNB-CN13), réduisaient la présence d'AGE dans les fibroblastes de - 28% et - 23% respectivement. Dans cet article, nous présentons l'approche de déréplication utilisée pour révéler la présence de 26 DKP différentes dans l'extrait brut de Sphingobacterium sp. Le fractionnement bioguidé a conduit à l'isolement de 12 d'entre elles, dont l'identité a été confirmée par HRMS et RMN. Une approche de synthèse verte a été développée pour synthétiser 3 DKP symétriques. L'activité biologique de toutes les DKP a été évaluée par le développement d'un test in vitro utilisant l'immunocytochimie pour révéler la présence de carboxyméthyl-lysine AGE dans les fibroblastes dermiques humains. CONCLUSION: Nos travaux montrent pour la première fois que les DKP diminuent la quantité de carboxyméthyl-lysine AGE dans les fibroblastes dermiques humains âgés cultivés in vitro. Par conséquent, les dicétopipérazines peuvent être considérées comme des composés intéressants pour des applications dermatologiques et cosmétiques à visée anti-âge.