Clinicopathological study of breast diseases presenting to the surgical oncology unit of Donka University Hospital in Conakry, Guinea.

AIM: The aim of this study was to describe the characteristics and trends in the number of patients presenting with breast diseases (BD), their evolution in time, and the referral route. METHODS: We reviewed all patients with breast disease who consulted at the Unit of Surgical Oncology of Donka from May 2007 to December 2009, examining the distribution of breast diseases. The numbers of women diagnosed with breast cancers was analysed with respect to time and referral source. RESULTS: There was a progressive increase in the number of patients presenting with breast diseases from year to year: 66 cases in 2007, 134 in 2008 and 227 in 2009. Of 423 patients with breast disease, 184 (43.5%) were diagnosed with breast cancer: 178 women and 6 men. Moreover, the percentage with breast cancer varied significantly according to referral route (p<10-3); 56.0% among patients referred by health professionals and 22.3% in women who self-referred. Mean age at diagnosis of breast cancer was 48 years (n=178), 52.2% were post-menopausal. Women with breast cancer had on average 4.7 full term pregnancies. The tumor was considered aggressive in 62.9% of women because of the rapidity of its evolution. Early stage at diagnosis was made only for 4.3% of the cases. The hormone receptor were positive in 4 of 13 cases (30.7%), and the Cerb2 oncogene was over expressed in 8 of 11 cases (72.7%). CONCLUSION: A better organisation of the consultation services in a unit of oncology in a developing country can allow a better sorting and a good orientation of the patients and thus allow the early detection of the breast cancer. This requires adequate awareness of the population, a better involvement and adequate training of the health professionals dedicated to the tasks. The study of the Cerb2's expression and the hormone receptor are to be considered for better understanding the aggressiveness of the breast cancer found in our practice.

[Co-morbidities, covid-19 infection and surgical pathologies. Case of the department of visceral and general surgery of Souro Sanou hospital in Bobo-Dioulasso (Burkina Faso)]. / Co-morbidites, infection a covid-19 et pathologies chirurgicales. Cas du service de chirurgie viscerale et generale de l'hopital Souro Sanou de Bobo-Dioulasso (Burkina Faso).

Burkina Faso recorded its first case of Covid-19 on March 09, 2020 but it was on April 1, 2020 that the general and visceral surgery department of the Center Hospitalier Universitaire Sourô SANOU (CHUSS) in Bobo-Dioulasso recorded its first case of COVID-19 and surgical pathology. From April to September 2020, our service recorded four cases, all male patients and tested positive for Covid-19 disease after an oropharyngeal sample performed using the RT- kit. PCR Detection kit for 2019-n COV RNA (Da An Gene Co) and the AriaMx (Real-Time PCR System) platform. The four patients were aged 63, 70, 60 and 66, respectively, and were being treated for blunt chest trauma, leg gangrene, bladder tumor and gastric adenocarcinoma. Two patients died in the ward. The other two had been transferred to the regional center specializing in the management of the COVID-19 with a favorable outcome. The impact of Covid-19 in 2020, observed in the general and visceral surgery department of the CHUSS, was a 82% decrease in surgical activities.

Le Burkina Faso a enregistré son premier cas de Covid-19 le 09 mars 2020 mais c'est au premier avril 2020 que le service de chirurgie générale et viscérale du Centre Hospitalier Universitaire Sourô SANOU (CHUSS) de Bobo-Dioulasso a enregistré son premier cas de COVID-19 et pathologie chirurgicale. En six mois, soit entre avril et septembre 2020, notre service a enregistré quatre cas, tous des malades de sexe masculin et testés positifs à la maladie de la Covid-19 après un prélèvement oropharyngé techniqué à l'aide de la trousse de RT-PCR Detection kit for 2019-n COV RNA (Da An Gene Co) et la Plate forme AriaMx (Real-Time PCR System).Les quatre malades étaient âgés respectivement de 63 ans, 70 ans, 60 ans et 66 ans et étaient pris en charge pour un traumatisme fermé du thorax, une gangrène de jambe, une tumeur vésicale et un adénocarcinome gastrique. Deux patients étaient décédés dans le service. Les deux autres avaient été transférés dans le centre régional spécialisé dans la prise en charge de la maladie COVID-19 avec une évolution favorable. L'impact de la Covid-19 en 2020 constaté dans le service de chirurgie générale et viscérale du CHUSS, a été une diminution de 82% des activités chirurgicales.

[Evolution of Uterine Ruptures at the Maternity of Ignace Deen National Hospital (Chu of Conakry)]. / Évolution des Ruptures Utérines à la Maternité de L'hôpital National Ignace Deen (Chu de Conakry).

Uterine rupture is a common obstetrical drama in our delivery rooms that has become exceptional in developed countries. In developing countries including Guinea, this tragedy is one of the major concerns of the obstetrician. The objectives of this work were: to evaluate the frequency of uterine rupture in the department, to describe the socio-demographic and clinical characteristics of the patients, to identify the factors favoring the occurrence of uterine rupture, to evaluate the maternal-fetal prognosis and propose a prevention strategy to reduce maternal and fetal morbidity and mortality by uterine rupture. This was a descriptive study with data collection in two phases, one retrospective lasting 18 months from July 1, 2017 to December 31, 2018 and the other prospective, lasting 18 months also from January 1, 2019 to June 30, 2020 both carried out at the maternity ward of the Ignace Deen National Hospital. We collected 84 cases of uterine rupture out of 18,790 deliveries, i.e. a frequency of 0.44%. During the same time 10,067 cesarean sections were realized, i.e. one laparotomy for uterine rupture for 120 cesarean sections. The average age of the patients was 28.14 years with a standard deviation of 2 years and the average profile is that of a housewife (51.8%), multiparous (44.6%), evacuated from peripheral maternity (85.5%) and having an insufficient number of antenatal consultations (82.6%). In 93.1% of cases, the uterine rupture had occurred in delivery centers, peripheral maternity hospitals and on the way, the uterine ruptures were mostly spontaneous (65.1%), and occurred in a healthy uterus (59.0%). Uterine rupture was more frequently complete (83.33%). Surgical treatment was more frequently conservative with hysterorrhaphy (88.1%). We recorded 12 maternal deaths, i.e. a case fatality rate of 14.6%. On admission, almost all of the women showed no signs of fetal life. To reduce the frequency of uterine ruptures, better organization of emergency obstetric and neonatal care and better screening for risk factors for obstructed labor during prenatal consultations should be encouraged.

HPV infection in women with and without cervical cancer in Conakry, Guinea.

BACKGROUND: Cervical cancer incidence in western Africa is among the highest in the world. METHODS: To investigate human papillomavirus (HPV) infection in Guinea, we obtained cervical specimens from 831 women aged 18-64 years from the general population of the capital Conakry and from 77 locally diagnosed invasive cervical cancers (ICC). Human papillomavirus was detected using a GP5+/6+ PCR-based assay. RESULTS: Among the general population, the prevalence of cervical abnormalities was 2.6% by visual inspection and 9.5% by liquid-based cytology. Fourteen of 15 high-grade squamous intraepithelial lesions were visual inspection-negative. Human papillomavirus prevalence was 50.8% (32.1% for high-risk types) and relatively constant across all age groups. Being single or reporting > or =3 sexual partners was significantly associated with HPV positivity. HPV16 was the most common type, both among the general population (7.3%) and, notably in ICC (48.6%). HPV45 (18.6%) and HPV18 (14.3%), the next most common types in ICC, were also more common in ICC than in HPV-positive women with normal cytology from the general population. CONCLUSION: The heavy burden of HPV infection and severe cervical lesions in Guinean women calls for new effective interventions. Sixty-three per cent of cervical cancers are theoretically preventable by HPV16/18 vaccines in Guinea; perhaps more if some cross-protection exists with HPV45.

Performance of colposcopy in five sub-Saharan African countries.

OBJECTIVE: The performance of colposcopy provided in a screening study in five African countries was evaluated. DESIGN: Cross-sectional study. SETTING: Burkina Faso, Congo Brazzaville, Guinea Conakry, Mali and Niger. POPULATION: Women aged 25-59 years. METHODS: A total of 29 294 women participated in a cervical screening study in the five study sites, and newly trained local doctors performed colposcopy and directed biopsies as indicated. Using meta-analytical tools, four measures of colposcopy performance at different thresholds of colposcopic abnormalities were assessed. Sources of heterogeneity were also assessed. MAIN OUTCOME MEASURES: Proportions of women receiving biopsies, adequate biopsies and women diagnosed with cervical intraepithelial neoplasia (CIN). RESULTS: Among 28 553 women with satisfactory colposcopy, 3101 had a colposcopic diagnosis of probable low-grade or worse lesions and 1128 probable high-grade or worse lesions. Overall, the measures that reached the set standards were proportion of biopsy taken at colposcopy threshold of probable high-grade or worse lesions (95%, 95% CI 90-100%) and proportion of adequate biopsy samples. The set standards were not met for the proportions of women diagnosed with CIN at different colposcopic abnormality thresholds. Detection of CIN2 or worse lesions increased with increasing colposcopic abnormality. CONCLUSIONS: The performance of colposcopy in some of the African sites studied was comparable to that previously observed in other studies. With appropriate training, monitoring, continuing practice and quality assurance, adequate standards of colposcopy can be attained in sub-Saharan Africa.

Integration of Family Planning Counselling to Mass Screening Campaign for Cervical Cancer: Experience from Guinea.

AIM: To assess feasibility of integrating family planning counselling into mass screening for cervical cancer in Guinea. METHODOLOGY: This was a descriptive cross-sectional study conducted over a month in Guinea regional capital cities. The targeted population comprised women aged 15 to 49 years. Nearly 4000 women were expected for the screening campaigns that utilized VIA and VIL methods with confirmation of positive tests through biopsy. A local treatment was immediately performed when the patient was eligible. RESULTS: Overall 5673 women aged 15 to 60 years were received, a surplus of 42% of the expected population. 92.3% of women were aged 15-49 years and 90.1% were 25-49 years. Long-acting methods were the most utilized (89.2% of family planning users). 154 precancerous and cancerous lesions were screened, a global positivity rate of 2.7%. CONCLUSION: Integration of counselling and family planning services provision during cervical cancer mass screening is a feasible strategy. A cost-effective analysis of this approach would help a better planning of future campaigns and its replication in other contexts.

Uterine rupture: socio-demographic aspects, etiology and therapy at the University Clinic of Gynecology and Obstetrics of the National Donka Hospital in Conakry University Hospital, Guinea.

Uterine rupture is an obstetric catastrophe that has become rare in developed countries. In developing countries, including Guinea, however, it remains a major concern of obstetricians. The objectives of this work were to calculate the frequency of uterine rupture in our département, describe the women's social and demographic characteristics, identify factors predisposing them to uterine rupture, describe its treatment, and assess maternal and fetal prognosis. Data for this descriptive study were collected in 2 phases, with a retrospective review of files covering the 3-year period from April 1, 2011, to March 31, 2014, followed by prospective data collection for the 6-month period from April 1 to September 30, 2014. This study of uterine rupture took place at the maternity unit of Donka National Hospital (CHU Conakry). We identified 98 cases of uterine rupture among 26 827 births, for a frequency of 0.36%. The women's mean age was 28.4 years (range: 16-43 years). The socio-demographic profile of the women admitted for uterine rupture was that of a housewife (50%), with two or three previous deliveries (41.84%), and who had no prenatal care (58.17%). Most of the ruptures took place in birthing centers, outlying maternity units, or during the journey to reach our reference department (87.16%). Most uterine ruptures were iatrogenic (69.38%) and occurred on an non cicatriciel uterus (62.24%). The rupture was most often complete. Most surgical treatment was conservative, by hysterorrhaphy (80.61%). Four women died, for a lethality rate of 4.80%. Almost all women were admitted without signs of fetal life. The role of uterine rupture in the obstetric activity in this service requires joint and urgent action by all stakeholders in the health system to combat this catastrophic complication that is evidence of a poor quality of obstetric care.

Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic.

ETHNOPHARMACOLOGICAL RELEVANCE: The recent outbreak of Ebola virus infections has mostly remained confined to the West African countries Guinea-Conakry, Sierra-Leone and Liberia. Due to intense national and international mobilizations, a significant reduction in Ebola virus transmission has been recorded. While international efforts focus on new vaccines, medicines and diagnostics, no coherent national or international approach exists to integrate the potential of the traditional health practitioners (THPs) in the management of infectious diseases epidemics. Nevertheless, the first contact of most of the Ebola infected patients is with the THPs since the symptoms are similar to those of common traditionally treated diseases or symptoms such as malaria, hemorrhagic syndrome, typhoid or other gastrointestinal diseases, fever and vomiting. MATERIALS AND METHODS: In an ethnomedical survey conducted in the 4 main Guinean regions contacts were established with a total of 113 THPs. The socio-demographic characteristics, the professional status and the traditional perception of Ebola Virus Disease (EVD) were recorded. RESULTS: The traditional treatment of the main symptoms was based on 47 vegetal recipes which were focused on the treatment of diarrhea (22 recipes), fever (22 recipes), vomiting (2 recipes), external antiseptic (2 recipes), hemorrhagic syndrome (2 recipes), convulsion and dysentery (one recipe each). An ethnobotanical survey led to the collection of 54 plant species from which 44 identified belonging to 26 families. The most represented families were Euphorbiaceae, Caesalpiniaceae and Rubiaceae. Literature data on the twelve most cited plant species tends to corroborate their traditional use and to highlight their pharmacological potential. CONCLUSIONS: It is worth to document all available knowledge on the traditional management of EVD-like symptoms in order to evaluate systematically the anti-Ebola potential of Guinean plant species.

[Malaria in the infant in a rural area of maritime Guinea (Guinea Conakry). I. Immune and parasitic status of the mother and the newborn]. / Impaludation du nourrisson dans une zone rurale de Guinée maritime (Guinée Conakry). I. Statuts immunitaire et parasitaire de la mère et du nouveau-né.

Among 216 women who had given birth in the rural health maternity centre of Maférinyah (Guinea), 32% had parasitemia with no clinical signs. Antimalarial antibodies could be measured only for 156 women and were present in all of them. Serological antimalarial tests were carried out on 133 newborns, all of whom had antibodies. The serological results of 122 mother infant pairs are given in this article. The absence of parasitemia in 122 newborns confirms the rarity of congenital malaria and would seem to favour the protective role of transmitted maternal antibodies.

[Malaria in infants in a rural area of maritime Guinea (Guinea Conakry). II. Development of antimalarial antibodies and malaria during the first year of life]. / Impaludation du nourrisson dans une zone rurale de Guinée maritime (Guinée Conakry). II-Evolution des anticorps antipaludéens et impaludation au cours de la première année de vie.

A transversal investigation carried out on 551 children and a longitudinal study of 55 infants showed the disappearance of maternal anti-plasmodium antibodies during the first year of life. Out of 212 new-borns surveyed for one year, 59 (28%) were infested by Plasmodium, but never during the first two months of life. This infestation was not related to the age of the infant nor to the season. For 46% of cases, infestation was completely asymptomatic, for 18% of cases respiratory signs were present and for 20% digestive signs not specific to malaria. Fever was present in 14 cases (24%) and isolated in 6 cases. Only 7 infants received a specific antimalarial treatment. Evolution under medical surveillance was favourable in all cases. These findings prove the difficulties inherent to the diagnosis of malaria, especially in the absence of laboratories for diagnosing other infections--such as typhoid--which do not appear in sanitary statistics. The findings also raise the question as to the efficiency of systematic antimalarial treatment in case of fever in the infant or child. Asymptomatic parasitemia can be explained by the existence of antitoxic immunity different from antiplasmodia immunity.

[Maternal mortality at the University Hospital Center of Donka (Conakry, Guinea)]. / Etude de la mortalité maternelle au CHU de Donka (Conakry, Guinée).

We report the first results of the analysis of maternal mortality at the university hospital of Donka, Conakry, Guinée. This paper details the mortality rate [12.47/1,000] in a consultant service which has very limited facilities. It outlines the causes of death, the dramatic circumstances in which the accidents occur and it discusses the notion of responsibility and above all the means to reduce these terrible mortality figures: an increase in primary health care, peripheral obstetrical services, training of health personnel and of traditional birth attendants, as well as education of the population.

[Uterine rupture. Apropos of 155 cases observed in Conakry (Republic of Guinea)]. / Ruptures utérines. A propos de 155 cas observés à Conakry (République de Guinée).

From 155 cases of uterus rupture observed during 5 years at the CHU of Donka (Conakry), the authors are reminding: a) the high frequency of this obstetrical emergency: 0.74% of child births and 12.76% of the extractions by caesarean section: b) the high rate of maternal mortality: 25.16%. They insist on: 1. The important role of some parameters: socio economic conditions, lack of an appropriate infrastructure and of a qualified staff leading to a lack of obstetrical observation, parity, age of pregnant women, way of recruiting.... 2. The necessity to apply a correct supervision of the pregnant women and of delivery by establishing a good system of prenatal examination. The therapeutic problems, including the future of the mother and of the child are discussed, insisting on the necessity of the chirurgical celerity in case of dystocia.

[Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis]. / Les hystérectomies au CHU de Conakry : caractéristiques sociodémographiques et cliniques, types, indications, voies d'abord et pronostic.

The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its indications.

[Maternal mortality. Apropos of 212 instances in 7 years (1980-1986) at the Ignace-Deen Maternity Hospital in Conakry (Guinea)]. / La mortalité maternelle. A propos de 212 observations en sept ans (1980-1986) à la Maternité Ignace-Deen de Conakry (Guinée).

In Conakry the maternal mortality rate in the University Hospital is not the real maternal mortality rate of the country but it gives an idea of the importance of this problem of public health. The authors try to explain the reasons for this high mortality and propose preventive measures: increase in primary health care, equipping of regional obstetric wards in referral hospitals, training of personnel, health education of the population.

[Aspects of genital tuberculosis in women]. / Aspects de la tuberculose génitale de la femme.

Thirteen cases of genital tuberculosis are reported to make emphasis onto the difficulties of diagnosis, management and prognosis of the disease. The average age of the patients is 31 years. Most of them were under 30. The circumstances of diagnosis were variable. The diagnosis was essentially made thanks to histology. The evolution was favorable under antibiotics. But clinical sequels as amenorrhea and infertility are frequent.

[Anemia and pregnancy. Epidemiologic, clinical and prognostic study at the university clinic of the Ignace Deen Hospital, Conakry (Guinee)]. / Anémie et grossesse. Etude épidémiologique, clinique et pronostique à la clinique universitaire de l'hôpital Ignace Deen, Conakry (Guinée).

Our intentions were to determine the incidence of the association of anemia and pregnancy, to evaluate maternal and fetal prognosis and to offer some recommendations regarding national health care policies. This prospective study lasting 30 months included all cases of anemia and pregnancy detected by clinical and laboratory examinations. Thus 13,191 women were enrolled in the study but only 1408 cases of anemia and pregnancy (10.67%). Primipara and grand multipara were particularly at risk. Severe forms of anemia and pregnancy were encountered often (51.71%). Maternal and fetal prognoses were very poor. Maternal mortality was 852/100,000, accounting for 65% of the maternal mortality of the department. The stillborn rate was 50 per thousand. This is a serious health problem which needs to be dealt with by a national health education programme.

Cancer incidence in Conakry, Guinea: first results from the Cancer Registry 1992-1995.

We have registered 2,064 cases of cancer among the inhabitants of Conakry, Guinea, during 1992-1994, corresponding to age-standardized incidence rates (ASRs) of 83.3 per 100,000 in men and 110.5 per 100,000 in women. As elsewhere in West Africa, the principal cancer of men was liver cancer (ASR 32.6), with modest rates of stomach (ASR 6.2) and prostate (ASR 8.1) cancers. In women, cervix cancer was the dominant malignancy (ASR 46.0), followed by liver cancer (ASR 12.5) and breast cancer (ASR 10.9). In contrast to contemporary East and Central Africa, Kaposi's sarcoma remained rare (only 4 cases). In the childhood age group, relatively high incidence rates were found for Hodgkin's disease, Burkitt's lymphoma and, especially, retinoblastoma.