Impact of infection prevention and control training on health facilities during the Ebola virus disease outbreak in Guinea.

BACKGROUND: In 2014-2016, West Africa faced the most deadly Ebola Virus Disease (EVD) outbreak in history. A key strategy to overcome this outbreak was continual staff training in Infection Prevention and Control (IPC), with a focus on Ebola. This research aimed to evaluate the impact of IPC training and the quality of IPC performance in health care facilities of one municipality of Conakry, Guinea. METHODS: This study was conducted in February 2016. All health facilities within Ratoma municipality, Conakry, Guinea, were evaluated based on IPC performance standards developed by the Guinean Ministry of Health. The IPC performance of healthcare facilities was categorised into high or low IPC scores based on the median IPC score of the sample. The Mantel-Haenzsel method and logistic regression were used for statistical analysis. RESULTS: Twenty-five percent of health centres had one IPC-trained worker, 53% had at least two IPC-trained workers, and 22% of health centres had no IPC-trained workers. An IPC score above median was positively associated with the number of trained staff; health centres with two or more IPC-trained workers were eight times as likely to have an IPC score above median, while those with one IPC-trained worker were four times as likely, compared to centres with no trained workers. Health centres that implemented IPC cascade training to untrained medical staff were five times as likely to have an IPC score above median. CONCLUSIONS: This research highlights the importance of training healthcare staff in IPC and organising regular cascade trainings. IPC strategies implemented during the outbreak should continue to be reinforced for the better health of patients and medical staff, and be considered a key factor in any outbreak response.

Cerebral paradoxical embolism associated with patent foramen ovale and idiopathic venous thromboembolism in a 31-year-old patient.

Paradoxical embolism is the passage of venous thrombi into the arterial circulation through a pulmonary or intracardiac shunt. We report the management of a 31-year-old patient who initially presented with chest pain and right brachiofacial paresis. A diagnosis of paradoxical cerebral embolism associated with a spontaneous venous thromboembolism and a patent foramen ovale was made. The patient benefited from thrombolytic therapy and lifelong anticoagulation with good recovery. This case showed that percutaneous closure of a patent foramen ovale needs to be discussed individually.

[Analysis of uterus cervical cancer screening campaign results in Conakry, Guinea]. / Analyse des résultats des campagnes de dépistage du cancer du col de l'utérus à Conakry, Guinée.

OBJECTIVE: Reduce morbidity and death rates of women with cervical cancer in Guinea. METHODOLOGY: This was a five-day cross-sectional study carried out in two successive years (2012 and 2013) at the CERFFO-PCG in Conakry. The target population was women aged 25-49. Approximately 500 women for 2012 and 900 women were expected in these cervical screening campaigns by visual methods (IVA and IVL) with immediate treatment of precancerous lesions. After histologic confirmation of the cancer lesions, the management was carried out according to the protocols in force in the country. We performed a simple descriptive analysis and the results expressed as a percentage and on average. RESULTS: The target population represented 60.4% in 2012 and 76.2% in 2013, of the total number of women received. The incidence rate of high-grade intraepithelial lesions and cancers increased from 2.6% in 2012 to 0.9% in 2013. In 2012, the 57 precancerous lesions were treated with immediate treatment and 10 cases of cancers out of the 16 had a surgical treatment. Also in 2013, all precancerous lesions were treated immediately and 2 cancers out of the 4 benefited from surgery. CONCLUSION: Our research shows that, with creativity, flexibility, good organization and efficient use of resources, morbidity and death rates of women with cervical cancer in a very resources can be significantly reduced.

[Ischemic stroke despite normal brain MRI: about a case]. / Un AVC ischémique a IRM cérébrale normale: à propos d'un cas.

MRI remains the current gold standard imaging modality to diagnose ischemic stroke. MRI sensitivity for acute ischemic stroke detection does not always reach 100%. We report the case of a patient with ischemic stroke despite normal initial brain MRI. Normal brain MRI during the early phase of ischemic stroke raises doubt about the indication for thrombolysis which is the treatment of choice for cerebral embolism. The repetition of fine cut examination by B2000 diffusion weighted imaging (DWI) enables the early detection of small volume infarction not visualized by conventional brain MRI.

Unusual sensory disturbances revealing posterior spinal artery infarct.

Spinal cord infarctions are rare, especially at the cervical level and in the posterior spinal artery territory. Moreover, this diagnosis is difficult to establish as the clinical picture varies. Even if sensory patterns appear as cardinal signs, their distribution can be very variable. We report a rare case of posterior cervical cord infarction revealed by an unusual pure sensory clinical picture.