[Gunshot wounds of low urinary tract in period of security crisis at the Sominé Dolo Hospital of Mopti (Mali): Epidemiological and diagnostic aspects]. / Blessures par arme à feu du bas appareil urinaire en période de crise sécuritaire à l'hôpital Sominé Dolo de Mopti (Mali) : aspects épidémiologiques et diagnostiques.

INTRODUCTION: Firearm injuries to the lower urinary tract are injuries resulting from an energy transfer from a projectile fired by a firearm or a blast from a firearm, to the bladder, prostate, urethra and terminal ureter. Our objective was to describe the epidemiological and diagnostic aspects in the context of a security crisis. PATIENTS AND METHOD: This was a descriptive cross-sectional study of lower urinary tract firearm injuries at Sominé Dolo Hospital in Mopti from January 2017 to December 2021. RESULTS: In five years, 29 traumas of the lower urinary tract have been collected, about 6 cases per year. The mean age of patients was 27.48 years, the sex ratio was 13.5/1. The main circumstances of occurrence were intercommunal violence 51.72 %, war wounds 31.03 %. Injuries were inflicted by rifles in 62.1 % and improvised explosive devices in 37.9 %. The main modes of discovery were acute urine retention, hematuria and penoscrotal wounds respectively in 31.03 %, 20.69 %, 17.24 %. The organs affected were the urethra in 58.62 %, the bladder, 37.93 %, the prostate 3.45 %. Associated non-urological lesions present in 68.96 % (n=20) were dominated by intestinal lesions and pelvic fractures. CONCLUSION: Firearm injuries to the lower urinary tract are rare despite the context of the security crisis. They affect young men, are mostly linked to intercommunal violence, and are dominated by urethral and bladder injuries.

Antibacterial activity of the stem bark of Tieghemella Heckelii Pierre ex. A Chev against methicillin-resistant Staphylococcus aureus.

BACKGROUND: Tieghemella heckelii (Sapotaceae) is a medicinal plant used in Africa, particularly in Côte d'Ivoire for treating various diseases including infections. Identification of prospective antibacterial compounds from stem bark of this plant as a result of its medicinal virtue, led to screening activity against methicillin resistant bacteria. METHODS: Six extracts (hexane, chloroform, ethyl acetate, ethanol, methanol and sterile distilled water) were prepared and tested on methicillin resistant Staphylococcus aureus (MRSA) using broth microdilution method for activity assessment. From this experiment, the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of the plant extracts were determined in sterile 96-well microplates in order to search for both bacteriostatic and bactericidal effects. Afterwards, data analysis was performed using GraphPad Prism5 software (One-way ANOVA and Turkey Multiple Comparison test). The results were then presented as Mean ± SD for experiment repeated three times. RESULTS: Four extracts (ethyl acetate, methanol, ethanol and sterile distilled water) showed credible potency, with strong, significant, and moderate growth inhibition of the MRSA tested. The MIC values which varied from 45 µg/mL to 97 µg/mL according to microbial phenotype, resolutely established the activity of the plant extracts. Additionally, the MBC values which varied, depending on the type of bacteria strain, revealed the bacteriostatic and bactericidal effects of the active extracts against Methicillin-resistant Staphylococcus aureus. CONCLUSION: The present study is a confirmation of the therapeutic potential of Tieghemella heckelii and its promising contribution to the discovery of a novel antibacterial drug pertaining to these resistant strains.

Review of cattle ticks (Acari, Ixodida) in Ivory Coast and geographic distribution of Rhipicephalus (Boophilus) microplus, an emerging tick in West Africa.

The exotic tick Rhipicephalus (Boophilus) microplus was discovered in Ivory Coast in 2007 and then gradually in other countries in West Africa. It is known to induce significant losses in farming and to replace other species of the same genus. In order to contribute to improve health and productivity of cattle in Ivory Coast regarding the emergence of this dreaded tick, a study was conducted to determine the current geographic distribution of the tick R. (B.) microplus and review cattle ticks in general. To this end, 23,460 ticks were collected from 180 farms located throughout the country. Ten species of ticks belonging to the genus Rhipicephalus (including those of the subgenus Boophilus), Hyalomma and Ambyomma were identified. It was found that the exotic tick R. (B.) microplus has invaded the entire Ivorian territory and is now the main cattle tick (63.6% of ticks collected), followed by Amblyomma variegatum that remains still dominant in the North. The population of indigenous species of Rhipicephalus (Boophilus) is in drastic decline.

[Sacroiliac joint disorders in Abidjan: epidemiological, clinical, radiological and etiological characteristics]. / Atteintes sacroiliaques à Abidjan: aspects épidémiologiques, cliniques, radiologiques et étiologiques.

BACKGROUND: The sacroiliac joint remains unknown in sub-Saharan Africa. Studies about the sacroiliac diseases are rare Aim : Describe the epidemiological, clinical, radiological and etiological characteristics of sacroiliac joint diseases in Abidjan Methods : Retrospective and descriptive study concerning 17 patients hospitalized from February 2003 to April 2010 in the department of rheumatology of university hospital center of Cocody (Abidjan) for buttock pain or others functional signs evoking sacroiliac joint which were attested by radiographic lesions. We were interested on the epidemiological, clinical and radiological characteristics and the etiologies in the sacroiliac disease. RESULTS: The hospital prevalence of sacroiliac diseases was 0.55% corresponding in 17 of 3067 rheumatological diseases. The female sex predominated (82.35%) and the mean age of 25.58 years. Gyneco-obstetric events were the predominant risk factors (47.05%). Sacroiliac damage was manifested by inflammatory pain (64.7%) localized at the buttock or lumbar spine, radiating to the thigh (52.9%) and was accompanied by functional disability (82.2%) and fever was not present every time (64.7%). The physical findings were the tripod sign positive (58.8%), the monopodal backing positive (41.2%) and palpation painful of sacroiliac joint. The standard radiograph revealed a blurring aspect and widening of joint space associated with demineralization (68.4%), a joint space narrowing and erosion of articular banks (23.5%). The etiologies found were bacterial arthritis (82.3%) mainly pyogenic (70.58%), osteoarthritis (11.7%) and ankylosing spondylitis (5.9%). CONCLUSION: Sacroiliac joint diseases are rare in rheumatology practice in Abidjan, concern younger subjects and are dominated by pyogenic sacroiliitis.

[Invasive squamous cell carcinoma: about 2 cases]. / Carcinome épidermoïde conjonctival invasif : à propos de 2 cas.

Conjunctival tumors are common in tropical areas, where exposure to ultraviolet radiation is high and almost permanent. Malignant tumors are quite rare and the most represented is conjunctival squamous cell carcinoma. We report two cases of invasive squamous cell carcinoma of the conjunctiva received in the ophthalmology department of the Sominé Dolo hospital in Mopti, Mali. The patients were 25 and 51 years old, living in a rural desert area exposed to sunlight and dust. They presented with a mass developed in the area of the palpebral fissure, invading the cornea and preventing palpebral occlusion. The mass was raised, multi-lobulated, well circumscribed, pearly white in color and papillomatous in appearance with dilation of the feeder vessels. A wide surgical excision at 4 - 5 mm from the healthy tissue edges was performed with anatomopathological examination of the specimen, which confirmed a mature and invasive differentiated squamous cell carcinoma of the conjunctiva. The extension workup and HIV serology were negative. The evolution was favorable in the medium term without recurrence.

Les tumeurs conjonctivales sont fréquentes dans les zones tropicales,où l'exposition aux rayons ultraviolets est forte et quasi permanente. Les tumeurs malignes sont assez rares et la plus représentée est le carcinome épidermoïde de la conjonctive.Nous rapportons deux cas de carcinome épidermoïde invasif de la conjonctive reçus dans le service d'ophtalmologie de l'hôpital Sominé Dolo de Mopti au Mali. Il s'agissait de deux patientes de 25 et 51 ans, vivant en zone rurale et désertique exposées aux rayons solaires et à la poussière. Elles présentaient une masse développée dans l'aire de la fente palpébrale, envahissant la cornée et empêchant l'occlusion palpébrale. La masse était en relief, multi lobulée, bien circonscrite, de couleur blanc nacré et d'aspect papillomateux avec une dilatation des vaisseaux nourriciers. Une exérèse chirurgicale large à 4 - 5 mm des berges de tissu sain a été réalisée avec examen anatomopathologique de la pièce qui a confirmé un carcinome épidermoïde différencié mature et invasif de la conjonctive. Le bilan d'extension et la sérologie HIV étaient négatifs. L'évolution était favorable à moyen terme sans récidive.

[Recurrences of precancerous lesions after conservative treatment: Operational results after a decade in Abidjan]. / Récidives des lésions précancéreuses après traitement conservateur : résultats opérationnels après une décennie à Abidjan.

OBJECTIVES: There remains a significant risk of recurrence of intraepithelial neoplasia regardless of the type of conservative treatment. The aim's work is to assess this rate. METHODS: All women's consenting who had received conservative treatment at the sites identified since for more than 12 months were included in this multicenter cross-sectional study. The outcome measure was a recurrence of precancerous lesions of the cervix during visual inspection with acetic acid performed by a single practitioner to limit interobserver variability. Data collection and analysis were done on the Stata 13 software. We performed an univariate then multivariate analysis with logistic regression. RESULTS: Two hundred and seventy-nine participated in this study with an average age of 37.44 (σ=7.31 years). A total of 52.33% were HIV positive. Moreover, 63.44% were treated by cryotherapy versus 36.66% by loop electrosurgical excision procedure. The overall prevalence of recurrences was 8.96%. Multivariate analysis with logistic regression concluded that the risk of recurrence was 5.72 times (OR=1.69-19.29; P=0.005) higher with cryotherapy and 2.85 times higher (OR=1.04-7.82; P=0.042) in women with HIV. CONCLUSION: The risk of recurrence is proportionally high with cryotherapy and HIV status. This suggests that an adaptation of the strict monitoring protocols to our African context due to the lack of cytocolposcopic logistical resources.

[Management of breast cancer in Abidjan: A single center experience]. / Expérience africaine monocentrique de la prise en charge personnalisée des cancers du sein à Abidjan : défis et perspectives.

AIM: To present the results of the personalized care of Ivorian women suffering from breast cancer since the advent of immunohistochemistry in Côte d'Ivoire. METHODS: We carried out a single-center retrospective study at the Yopougon university hospital from January 2014 to December 2018. All women's breast cancer with complementary immunohistochemistry and treated at the Yopougon hospital center were selected. Standard descriptive statistical tests were used to describe patient and tumor characteristics, and univariate and multivariate analyzes were performed with a statistical significance set at a P-value of 0.05 using SPSS version 20.0. RESULTS: The mean age of women is 48.27 years, SD (11.92). 50.88 % of the tumors were hormone-dependent. The triple negative subgroup was the most represented (43.28 %) followed by luminal A (35.42 %). Conservative treatment represented 18.51 % of cases. In the univariate analysis, the risk of developing a hormone-dependent cancer is statistically significant respectively in women with an education level removed OR=1.98 (P˂0.015) and with a wealthy salary OR=1.85 (P˂0.009). On the other hand, the high level of education (OR=0.44; P˂0.005), and the well-off salary condition (OR=0.59; P˂0.024) would be protective factors for the development of triple negative breast cancer. All these factors are not significant in multivariate analysis, whether for hormone-dependent or triple negative tumors. CONCLUSION: The personalized care of breast cancer in our African context remains difficult and must take into account several medical and extra-medical parameters.

[Descriptive study of COVID-19 cases in the third Municipality of Bamako, from March 26 to August 27, 2020]. / Etude descriptive des cas de COVID-19 en Commune III de Bamako du 26 Mars au 27 Aout 2020.

INTRODUCTION: A public health emergency of international concern, COVID-19 is an acute respiratory disease responsible in eight months of approximately 843,158 deaths worldwide, including 29,425 deaths in Africa. The objective was to describe the COVID-19 cases in the health district of Commune III of Bamako. METHODS: This was a descriptive cross-sectional study of COVID-19 surveillance data from March 26 to August 27, 2020. Our variables were extracted from the surveillance database and analyzed on Epi-Info 7.2. Frequencies, rates and proportions were calculated. RESULTS: A positivity rate of 14.86% identified 126 confirmed cases out of an 848 notified suspect. The median age of confirmed cases was 34 years with a minimum of 8 months and a maximum of 93 years. The sex ratio was 2.7 males to females. Civil servants accounted for 32.54% of the positive cases. All the health subdistricts have recorded positive cases. The lethality was 7.94% affecting those over 65 years old. Among asymptomatic people 10.75% were confirmed positive for COVID-19. CONCLUSION: Our study suggests that young males were more likely to be infected with COVID-19. We recommend systematic screening of all contacts and involvement of the community in surveillance.

INTRODUCTION: Urgence de santé publique de portée internationale, la COVID-19 est une maladie respiratoire aiguë responsable en huit mois d'environ 843 158 décès dans le monde dont 29 425 décès en Afrique. L'objectif était de décrire les cas de la COVID-19 en Commune III de Bamako. MÉTHODES: Il s'agissait d'une étude transversale descriptive des données de surveillance de la COVID-19 du 26 Mars au 27 Août 2020. Nos variables ont été extraites de la base de données de surveillance et analysées sur Epi-Info 7.2. Les fréquences, taux et proportions ont été calculés. RÉSULTATS: Un taux de positivité de 14,86% a permis d'identifier 126 cas confirmés sur un 848 suspect notifié. L'âge médian des cas confirmés était de 34 ans avec un minimum de 8 mois et un maximum de 93 ans. Le sex-ratio était de 2,7 en faveur des hommes. Les fonctionnaires représentaient 32,54% des positifs. Toutes les aires de santé ont enregistré des cas confirmés. La létalité était de 7,94% affectant les plus de 65 ans. Parmi les personnes asymptomatiques 10,75% ont été confirmés positives à la COVID-19. CONCLUSION: Notre étude suggère que les jeunes de sexe masculin étaient plus susceptibles d'être infectés par la COVID-19. Nous recommandons le dépistage systématique de tous les contacts et une implication de la communauté dans la surveillance.

[Contribution of the University Clinical Research Center's laboratoryin the diagnosis of SARS-CoV-2 in Mali]. / Contribution du laboratoire du Centre Universitaire de Recherche Clinique (UCRC) au diagnostic de SRAS-CoV-2 au Mali.

INTRODUCTION: The rapid diagnostic capacities of laboratories in Mali have been an essential element in the response to COVID-19. The University Clinical Research center (UCRC) diagnosed the first cases of Mali COVID-19. OBJECTIVE: The objective was to describe the contribution of the UCRC in the diagnosis of Covid-19 and to clinically and epidemiologically characterize the patients tested in the UCRC laboratory. MATERIALS AND METHODS: A cross-sectional study was conducted during eight months of intense activity. The samples were sent from the National Institute of Public Health (INSP) to the UCRC. RESULTS: The UCRC tested 12,406 contacts and suspected samples and confirmed the diagnosis in 1091 patients, or 9%. The most common symptoms were cough (48.78%), headache (34.14%), fatigue / weakness (34.14%), while (33.33%) of the patients were asymptomatic. The sample positivity rate among new cases decreased from May to September 2020, despite almost 230% of the number of samples tested. CONCLUSION: The laboratory played a major role in the response and there may be a low transmission of the virus in the Malian community.

INTRODUCTION: Les capacités de diagnostic rapide des laboratoires au Mali ont été un élément essentiel dans la riposte contre la COVID-19. Le Centre Universitaire de Recherche Clinique (UCRC)a diagnostiqué les premiers cas du Mali. OBJECTIF: Etait de décrire l'apport de l'UCRC dans le diagnostic de la Covid-19 et de caractériser cliniquement et épidémiologiquement les patients testés au laboratoire de l'UCRC. MATÉRIELS ET MÉTHODES: Une étude transversale a été conduite pendant huit mois d'activité intense. Les échantillons ont été envoyés de l'Institut National de Santé Publique (INSP) à l'UCRC. RÉSULTATS: L'UCRC a testé 12 406 échantillons contacts et suspects et a confirmé le diagnostic chez 1091 patients soit 9%. Les symptômes les plus rencontrés ont été la toux (48,78%), les maux de tête (34,14%), la fatigue/faiblesse (34,14%), tandis que (33,33%) des patients étaient asymptomatiques. Le taux de positivité des échantillons a diminué entre mai et août et avec une légère diminution en septembre 2020,avec près de 230% du nombre d'échantillons testés. CONCLUSION: Le laboratoire a joué un grand rôle dans la riposte et il y'aurait une faible transmission du virus dans la communauté Malienne.

Spatial dispersion and characterisation of mosquito breeding habitats in urban vegetable-production areas of Abidjan, Côte d'Ivoire.

Although urban agriculture (UA) in the developing world may enhance nutrition and local economies, it may also lead to higher densities of mosquito breeding sites and, consequently, to increased transmission of malarial parasites. If targeted interventions against malaria vectors are to be successful in urban areas, the habitats that support Anopheles breeding need to be identified and detected. Mosquito breeding sites have recently been characterised, and the factors associated with productive Anopheles habitats identified, in market gardens of Abidjan, Côte d'Ivoire. Two surveys were conducted in seven vegetable-production areas, one towards the end of the rainy season and one during the dry season. A standardized methodology was used for habitat characterisation and the detection of Anopheles larvae and mosquito pupae. Overall, 454 and 559 potential mosquito-breeding sites were recorded in the rainy-season and dry-season surveys, respectively. In the rainy season, Anopheles larvae and mosquito pupae were found in 29.7% and 5.5% of the potential breeding sites, respectively, whereas the corresponding percentages in the dry season were 24.3% and 8.6%. The potential breeding sites in an agricultural zone on the periphery of Abidjan were those least likely to be positive for Anopheles larvae and mosquito pupae whereas 'agricultural trenches' between seedbeds were the sites most likely to be positive. In a spatially-explicit Bayesian multivariate logistic-regression model, although one out of every five such wells was also found to harbour Anopheles larvae, irrigation wells were found to be the least productive habitats, of those sampled, for pupae. In the study area, simple and cost-effective strategies of larval control should be targeted at agricultural trenches, ideally with the active involvement of local stakeholders (i.e. urban farmers and urban agricultural extension services).

[Sensory ataxic neuromyelopathy in acquired copper deficiency]. / Ataxie proprioceptive et carence en cuivre masquée.

INTRODUCTION: Neurological involvement associated with copper deficiency has been reported recently in humans and may be under-recognized. CASE REPORT: A 65-year-old patient, with past history of gastrectomy 40 years earlier, developed a myelodysplastic syndrome and then subacute onset of progressive gait ataxia and paresthesias in the lower extremities. Serum vitamin B12 level was low but neurological deterioration persisted, despite vitamin replacement therapy and normal cobalamin level. Further diagnostic investigations revealed severe copper deficiency. Copper supplementation led to hematologic improvement and neurological stabilization. CONCLUSION: Copper and vitamin B12 deficiency, due to malabsorption as a cause of progressive neuromyelopathy and hematologic manifestations, may coexist.

[Spitting cobras: description of 2 cases in Djibouti]. / Cobras cracheurs: 2 observations à Djibouti.

The purpose of this report is to describe two cases involving ophthalmic exposure to venom from spitting cobras. Based on these cases, readers are reminded that eye injury can be prevented by low-cost treatment consisting of prompt, prolonged saline irrigation. This treatment also reduces pain.

[Watery diarrhea with fever: consider the possibility of pneumococcal meningitis]. / Diarrhée fébrile "jus de melon": penser à la méningite à pneumocoques!

The purpose of this report is to describe two rare cases of pneumococcal meningitis observed in Africa. Both cases were revealed by gastrointestinal symptoms characterized by abdominal pain and watery diarrhea. Due to the potential severity of bacterial meningitis, early diagnosis is required. Since diarrhea with fever is a common occurrence in Africa, differential diagnosis is necessary. Isolated diarrhea can be caused by meningeal syndrome and calls for testing to detect invasive pneumococcal infection.

[Epidemiology of anguillulosis among public school children in Abidjan, Cote d'Ivoire]. / Epidémiologie de l'anguillulose chez les enfants scolarisés à l'école publique à Abidjan (Côte d'Ivoire).

PURPOSE: Strongyloides stercoralis is a neglected soil-transmitted helminth species. In Cote d'Ivoire, as elsewhere, there is a lack of parasitologic and epidemiologic data pertaining to this parasite. The purpose of this study was to evaluate the prevalence and impact of sociodemographic factors on anguillulosis among public school children in Abidjan, Cote d'Ivoire. METHODS: Testing for Strongyloides stercoralis was performed in a random sample of 411 children from 10 public primary schools in Abidjan. Detection methods included direct examination of stool smears, the Baermann test and helminth coproculture study. RESULTS: The overall prevalence of anguillulosis was 2.7% (N=411) (IC95% = 1.34-4.73). The M/F sex-ratio was 1. No correlation was found between prevalence and sex (p = 0.12). Prevalence was higher among children who reported contact with swamps and rivers (respectively 80% and 7.9%) than those who did not report such contact (respectively 1.7% and 1.5%) (p <0.01). CONCLUSION: Contact with swamps and rivers is correlated with an increase in anguillulosis prevalence. Avoiding these areas and proper sanitation could help to reduce the prevalence of anguillulosis in Abidjan.

[Practices and Factors Associated with Recent HIV Testing in the General Population, Côte d'Ivoire: Results of the ANRS Study 12323 DOD-CI]. / Pratiques et facteurs associés au dépistage récent du VIH en population générale, Côte d'Ivoire. Résultats de l'étude ANRS 12323 DOD-CI.

With 2.9% of HIV prevalence in the general population, Côte d'Ivoire is one of the countries most affected by the HIV epidemic in West Africa. In this country, only 63% of people infected with HIV are aware of their status. A cross-sectional phone survey was conducted with a representative sample of 3,867 individuals to describe the practices and factors associated with a recent HIV testing (≤ 1 year) in Côte d'Ivoire. Data relative to the last done HIV test as well as the socio-demographic characteristics, sexual behavior, access to information, perceptions, capacities and autonomy as well as social and geographical environment of the participants were collected. Logistical regression models were used to identify the associated factors with a recent HIV test (≤ 1 year). Lack of information is one of the main barriers to HIV testing (only 60% of individuals know a place to get tested). For men, despite the fact that HIV testing is free of charge, poor economic conditions seem to be a barrier to testing. The social environment, including peer influence, also appears to have an effect on testing among men. For women, testing is associated with their perceptions of HIV exposure. There is a need to rethink the current HIV testing communication in Côte d'Ivoire and to identify economic or social incentives to remove access barriers to HIV testing.

Avec 2,9 % de sa population infectée par le VIH, la Côte d'Ivoire fait partie des pays d'Afrique de l'Ouest les plus touchés par l'épidémie à VIH. On estime que seules 63 % des personnes infectées par le VIH connaissent leur statut. Une enquête transversale, par téléphone, a été réalisée auprès d'un échantillon représentatif de 3 867 personnes afin de décrire les pratiques et les facteurs associés à la réalisation récente (≤ 1 an) d'un dépistage du VIH en Côte d'Ivoire. Les données collectées concernaient le dernier test réalisé ainsi que les caractéristiques sociodémographiques, comportements sexuels, accès à l'information, perceptions, capacités, autonomies ainsi que l'environnement social et géographique des participants. Des modèles de régression logistique ont été réalisés afin d'identifier les facteurs associés à la réalisation récente d'un test du VIH (≤ 1 an). Le manque d'information est l'un des principaux freins au dépistage (seuls 60 % des individus connaissent un lieu où réaliser un test). Chez les hommes, malgré la gratuité du dépistage, une faible condition économique semble être un frein à la réalisation d'un test. L'environnement social, notamment l'influence des pairs, semble aussi avoir un effet sur le recours au dépistage chez les hommes. Chez les femmes, le dépistage est associé à leurs perceptions d'exposition au VIH. L'offre de dépistage actuelle en Côte d'Ivoire nécessite de repenser la communication autour du test ainsi que d'identifier des incitatifs économiques ou sociaux permettant de lever les freins au dépistage.

Performance of Mali's biosafety level 3 laboratory in the external quality assessment in preparedness of laboratory accreditation and support to clinical trials.

Background: The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC's) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys. Methods: We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017. Results: Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%. Conclusion: So far, UCRC's BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali.

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

Implementing family-focused HIV care and treatment: the first 2 years' experience of the mother-to-child transmission-plus program in Abidjan, Côte d'Ivoire.

OBJECTIVES: To describe a family-focused approach to HIV care and treatment and report on the first 2 years experience of implementing the mother-to-child transmission (MTCT)-plus program in Abidjan, Côte d'Ivoire. PROGRAM: The MTCT-plus initiative aims to enroll HIV-infected pregnant and postpartum women in comprehensive HIV care and treatment for themselves and their families. MAIN OUTCOMES: Between August 2003 and August 2005, 605 HIV-infected pregnant or postpartum women and 582 HIV-exposed infants enrolled. Of their 568 male partners reported alive, 52% were aware of their wife's HIV status and 30% were tested for HIV; 53% of these tested partners were found to be HIV-infected and 78% enrolled into the program. Overall only 10% of the women enrolled together with their infected partner. On the other hand, the program involved half of the seronegative men who came for voluntary counselling and testing (VCT) in the care of their families. Of 1624 children <15 years reported alive by their mothers (excluding the last newborn infants of the most recent pregnancy systematically screened for HIV), only 10.8% were brought in for HIV testing, of whom 12.3% were found to be HIV-infected. LESSONS LEARNED AND CHALLENGES: The family-focused model of HIV care pays attention to the needs of families and household members. The program was successful in enrolling HIV women, their partners and infants in continuous follow-up. However engaging partners and family members of newly enrolled women into care involves numerous challenges such as disclosure of HIV status by women to their partners and family members. Further efforts are required to understand barriers for families accessing HIV services as strategies to improve partner involvement and provide access to care for other children in the households are needed in this West African urban setting.

[Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa]. / Ligature des artères iliaques internes face aux hémorragies obstétricales graves en milieu africain.

OBJECTIVES: Assess the efficiency of internal iliac arteries ligation in intractable obstetrical hemorrhage and ascertain success or failure factors. PATIENTS AND METHODS: It was a retrospective study which concerned 159 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from March 1992 to February 2007. Arrest of hemorrhage after ligation with survival of the patient was considered as successful; was considered as failure, persistence of hemorrhage in spite of the ligation or patient death. RESULTS: Internal iliac arteries ligation allowed hemorrhage control in 84.3% of cases. Main etiology of hemorrhage were: uterine atony (42.8%), abruptio placentae (31.4%). Coagulation disorders and hypovolemic shock, consequences of long delay of management were identified as bad prognosis factors. Blood transfusion was also singled out as a factor likely to ameliorate prognosis, especially in hemodynamic precarious situations. Surgical complications incidence was 1.89%, represented by two internal iliac vein lesions and one ureteral section successfully repaired. DISCUSSION AND CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. The outcome is better when it is performed precociously (p=0.0000003) before the happening of disseminated intra vascular coagulation (p=0.006), hemodynamic troubles (p=0.0099) and acute severe anemia (p=0.02). It is a good alternative to arterial embolization in Africa.

[Value of hand disinfection by rubbing with alcohol prior to surgery in a tropical setting]. / Intérêt de la désinfection chirurgicale des mains par friction alcoolique en milieu tropical.

OBJECTIVE: The purpose of this study was to assess the value of hand disinfection by rubbing with alcohol in terms of prevention of surgical site infection (SSI) and cost in a tropical setting. MATERIAL AND METHOD: This prospective cohort study carried out in the Gynecology Obstetrics Department of the Yopougon University Teaching Hospital from May to September 2005 was designed to compare two different methods of hand disinfection, i.e., traditional 3-step hand scrubbing using an antiseptic preparation versus handwashing without an antiseptic preparation followed by two applications of an aqueous alcohol solution. RESULTS: The study population included 318 patients who underwent surgery during the study period. The SSI rate was 13.2% in patients operated on after traditional hand scrubbing and 11.5% after handwashing followed by rubbing with alcohol (not significantly different). Hand disinfection by rubbing with alcohol did not increase the risk of SSI and was considered as easier than traditional hand scrubbing by 90% of users. Skin tolerance was deemed good by 52% of users. Most users (69%) wished both hand disinfection methods to be available. Hand disinfection by rubbing with alcohol was much more cost-effective than traditional hand scrubbing both with regard to initial investment and to consumable costs (50% lower). CONCLUSION: This study shows that hand disinfection by rubbing with an alcoholic solution is not only as effective as traditional hand scrubbing for prevention of SSI but also more cost-effective. These findings indicate that rubbing with alcohol is a suitable alternative to traditional scrubbing for hand disinfection prior to surgery in our tropical setting.