Deradelphous Cephalothoracoomphalopagus in kittens: case report / Cefalotoraconfalopago derafelfo em gatos: relato de caso

The present report describes a case of conjoined twins of the cephalo-thoraco-omphalopagus deradelphous type in cats. A feline female was transferred to our veterinary hospital as an emergency for dystocic labor. The stillborn was subjected to radiographic evaluation, and a single skull and two complete distinct vertebral columns were found. Anatomopathological examination revealed that the twins presented the head, chest, and umbilicus as the main points of union and were classified as the cephalo-thoraco-omphalopagus type. In addition, the twins had unique and well-developed faces, which allowed them to be classified as deradelphous. This malformation is rare in domestic animals, and to the best of our knowledge, this type has not been reported in felines. Further studies are warranted on this embryonic alteration, primarily because its etiology remains unknown.(AU)

O presente relato descreve um caso de gêmeos siameses do tipo cefalotoraconfalopago deradelfo em gatos. Uma fêmea felina foi atendida na emergência do hospital veterinário em trabalho de parto distócico. Os natimortos foram encaminhados para avaliação radiográfica e constatou-se que apresentavam um único crânio e duas colunas vertebrais completas e distintas. O exame anatomopatológico evidenciou que os gêmeos possuíam cabeça, tórax e umbigo como principais pontos de união, sendo classificados como cefalotoraconfalopago. Além disso, os gêmeos apresentaram face única e bem desenvolvida, o que permitiu classificá-los como deradelfos. Esse tipo de malformação é raro em animais domésticos, e não foi encontrado nenhum trabalho em felino com a mesma classificação do presente relato. Há necessidade de mais estudos sobre essa alteração embrionária, pois a etiologia do processo ainda não foi esclarecida.(AU)

[Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis]. / Portage génital bactérien au dernier trimestre de la grossesse et infection néonatale précoce.

UNLABELLED: Bacterial infections remain a major cause of morbidity and mortality in newborn infants. OBJECTIVE: To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection. RESULTS: Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked. CONCLUSION: Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

Oesophagostomiasis, a common infection of man in northern Togo and Ghana.

Infection with Oesophagostomum sp. is normally considered a rare zoonosis and up to this time its diagnosis has been based on the demonstration of larvae and young adult worms in the typical nodules formed in the intestinal wall. Only in Dapaong, in North Togo, and Bawku, North Ghana, have larger series of clinical cases been described. In the rural areas around these towns, a survey was made in which stool samples were collected and cultured. Third-stage larvae of Oesophagostomum sp. could be found after 5-7 days of incubation at room temperature, and the prevalence of infection with this parasite was often high but varied from one village to another. It was over 30% in seven villages out of the 15 villages surveyed. Anthelmintic treatment resulted in the evacuation of adult males and females of O. bifurcum. It is concluded that O. bifurcum is a locally common parasite of humans, not requiring an animal reservoir for completion of its lifecycle.

Geographic distribution and epidemiology of Oesophagostomum bifurcum and hookworm infections in humans in Togo.

In contrast to the rest of the world, infections with Oesophagostomum bifurcum are commonly found in humans in northern Togo and Ghana. In addition, infections with hookworm are endemic in this region. In the present study, a detailed map of the geographic distribution of O. bifurcum and hookworm infections in northern Togo was made. There were a number of foci with high prevalence of infection with O. bifurcum. All the villages examined were infected with hookworm, and the distribution was quite patchy. Women were infected with O. bifurcum more often than men, while infections with hookworm were more prevalent in men than in women. The prevalence and intensity of infection with both parasites were clearly age-dependent. We estimate that more than a 100,000 people in Togo are infected with O. bifurcum and more than 230,000 are infected with hookworm.

Treatment of mixed Oesophagostomum and hookworm infection: effect of albendazole, pyrantel pamoate, levamisole and thiabendazole.

Oesophagostomum bifurcum has recently been recognized as a common parasite of man in northern Togo and in Ghana. In a preliminary trial several anthelmintics were evaluated in the treatment of mixed Oesophagostomum and hookworm infections. Diagnosis was based on faecal culture, since the eggs of Oesophagostomum and hookworm cannot be distinguished morphologically. Of the anthelmintics tested, albendazole was most effective against both parasites. Pyrantel pamoate, 2 x 10 mg/kg, was effective against Oesophagostomum but not against hookworm. The cure rates for both parasites were moderate with thiabendazole and poor with levamisole.

Serological diagnosis of Oesophagostomum infections.

A sensitive and specific enzyme-linked immunosorbent assay (ELISA) is described to diagnose human infection with Oesophagostomum bifurcum. In an ELISA using crude soluble antigen, prepared from adult O. bifurcum, many cross reactions occurred when measuring IgG titres in patients with other helminth infections. An ELISA based on the detection of specific IgG4, however, had a specificity of over 95%. The sensitivity of the IgG4 ELISA was difficult to assess because a reliable parasitological diagnosis is not available. The IgG4-ELISA described seems to be a powerful new tool to study the distribution of this little known but locally very common nematode parasite.

[Stillbirths at the regional center hospital of Sokodé, Togo]. / La mortinatalité au Centre hospitalier régional de Sokodé, Togo.

129 stillbirth cases out of 1,231 deliveries corresponding to a frequency of 104.79 out of 1,000 births have been gathered in ten months of obstetrical activity in the regional hospital of Sokodé. It is a growing frequency. The main risk factors are: The poor process even the carelessness of the prenatal consultations and the per-partum survey. Almost half the pregnancies have been followed up. The foetal per-partum death rate is 65.12%. The delivery at home: 19.38%. The reduction of the still-birth frequency depends on a popular action involving both the decision-makers of the population's health and the collectivity.

[Neonatal mortality in the Tantigou pediatric hospital, Dapaong (north Togo) in 1984-1985 and 1994-1995]. / Mortalité néonatale à l'hôpital d'enfants de Tantigou, Dapaong (nord-Togo) en 1984-1985 & 1994-1995.

370 deaths out of 1141 hospitalized cases of newborns aged 0-28 days were retrospectively analyzed in the Tantigou pediatric hospital of Dapaong, situated 645 km from Lome in northern Togo, in 1984-1985 and 1994-1995. A decreasing trend in neonatal mortality was noted: 42.5% and 27.6% respectively. Major causes of death were prematurity or low birth weight, sepsis, hypoxia conditions. The attendance of pregnant women at health information centres seems to be improving, but the neonatal mortality rate remaining high, the implementation of primary health care/Bamako Initiative resulting especially aiming at better prenatal care for pregnant women must be sustained.

[Risk factors associated with prematurity at the University Hospital of Lome, Togo]. / Facteurs de risque associés à la prématurité au CHU de Lomé, Togo.

OBJECTIVE: To determine the premature birth rate and the risk factors of preterm delivery linked to local conditions of life. METHOD: It is a prospective study including all births before 37 amenorrhoea weeks. All social, medical and behavioural factors linked to preterm deliveries have been analysed for and compared with those of the medical literature. RESULTS: Out of 1672 alive births, we identified 186 (11.1%) cases of prematurity and 30.1% of lethality. The main risk factors of preterm delivery were history of adverse pregnancy outcome (17.2%), history of induced abortion (11.3%), maternal age under 20 (26.3%), under 20 year old primipara (38.7%), inadequate antenatal care (66.6%), low level of education (38.7%) and mother suffering of overwork (29%). Other associated factors such as premature membrane rupture, malaria, urinary infections, gravidic toxaemia, genital infections and above all "unmarried-under 20 year old-primipara with low level of education and low socio-economical status", were significantly linked to preterm delivery. CONCLUSION: The risk factors thus identified correspond with the well-known factors. But many factors significantly linked to preterm delivery were local features whose importance could be reduced through better means of perinatal care and prevention.

[Bacterial flora in the genital tract the last trimester of pregnancy]. / Flores bactériennes génitales au dernier trimestre de la grossesse.

UNLABELLED: Very widespread in our clinical setting, early-onset sepsis is due to organisms that commonly colonize or infect the maternal genital tract; identifying such organisms would help improve prevention and treatment. OBJECTIVE: To determine the bacterial ecology and the pathological status of the genital organs during the last trimester of pregnancy, in order to evaluate the risk of materno-fetal infections and to improve the present prophylactic measures based on monitoring bacterial carriage during the first trimester. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy, in patients with no signs of sepsis and not taking antibiotics. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, Clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. RESULTS: Genital samples were collected from 306 pregnant women. Among them 118 were at 29-32 weeks of gestation, 104 at 33-36 and 84 at 37-40. The most frequent germs were C. albicans (33.3%), Enterobacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) or polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or cervicitis (10.4%) and asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. CONCLUSION: This is the first report of genital bacterial carriage in African women during the last trimester of pregnancy. Larger studies are required to evaluate the risk of maternofetal infections and to improve current prophylaxis measures.

[Maternal deaths and anesthetics in the Lomé (Togo) University Hospital]. / Mortalité maternelle: implication anesthésique au CHU de Lomée (Togo).

AIM: To assess the results of anesthesia practices in a department particularly inadequately staffed with physicians specializing in anesthesiology. SETTING AND METHODS: This six-month prospective study (from January through June 2002) took place in the anesthesiology/intensive care unit of the obstetrics and gynecology department of Lomé University Hospital Center. A case report file was completed for each patient, and all anesthetics administered in the obstetrical department (labor and delivery room) were recorded and considered. We examined the perinatal deaths among women who underwent surgery. RESULTS: Anesthetics were administered to 318 women during cesarean delivery (306) and uterine scar repair (12). Nearly all patients (98%) were classified in categories 1 or 2 of the ASA physical status classification system (healthy or mild systemic disease). General anesthesia was induced in 95.9% of the women and spinal bloc used for 4.1%. Thiopental was used most often, and certain drugs, including succinylcholine and ephedrine, were not available as needed. Intraoperative monitoring was essentially nonexistent. Emergency situations accounted for 89.6% of these surgical procedures. Of the 16 cases requiring transfusions, an inadequate supply of blood products or the patient's inability to obtain blood was reported in 14 of the cases. Twelve deaths occurred, for a mortality rate among surgical patients of 3.8%. The principal causes of death were respiratory complications of anesthesia and of pregnancy-related toxemia and the unavailability of hypertonic solutions and blood products. CONCLUSION: The results of this survey show that anesthetics play a role in maternal mortality in Togo. Good practice guidelines adapted to this setting must therefore be developed.

[Teenage knowledge about sex]. / Information des jeunes en matière de sexualité.

The aim of this study was to investigate the quality and sources of teenagers' information about sex. Between October 26th and December 16th 1997, 277 pupils from lower and upper schools agreed to participate in this study. Two hundred and seventy (97.5%) of the pupils in this population declared that they had received information about sex. This information was provided principally by the media, followed by friends, boyfriends and girlfriends, the school and their parents. The information received concerned sexually transmitted diseases (STDs and AIDS), the consequences of sexual relationships, sexual hygiene and the signs of puberty. We found that 95.5% of the pupils knew about AIDS and gonorrhea and that 91.7% knew how to protect themselves against AIDS and STDs. Thus, most pupils had received information, from various sources, on sexuality. Parents played little role in the sexual education of their children, and the State was involved in various ways.

[Actual experiences of menopause in 342 women]. / Etude du vécu de la ménopause auprès de 342 femmes.

The objective of this study is to assess the actual experiences of menopause in menopaused women without hormone replacement therapy. A cross-sectional study was conducted among 342 women who had natural menopause. The target population was recruited from subjects attending the Departement of Gynécologie-Obstétrique du CHU TOKOIN from November 1996 to October 1997. All women investigated presented clinical signs related to menopause. 51.5% found its symptoms embarrassing. 53.8% of the women enjoyed their menopause. The difference between the two groups of women having accepted their menopausal status or not, where the menstrual period were embarrassing or not (p = 0.0001) and were the climateric symptoms were embarrassing or not (p = 0.0001) were significant. Agreement to undertake a hormone replacement therapy were given by 29.8% of women. In spite of the climateric symptoms, menopaused women hardly accept their status and few were available for a hormone replacement therapy.

Cultura y modelo biomédico: reflexiones en el proceso de salud enfermedad / Culture and biomedical model: reflections in the health-disease process

El presente ensayo tiene como propósito abordar el tema de la cultura y el modelo biomédico en el proceso de salud enfermedad a través de una serie de reflexiones. El hombre ha logrado construir diferentes conceptos sobre salud, enfermedad, formas de aliviarla, acciones para su prevención y fomento de la salud, de acuerdo con la cultura de cada sociedad y su forma de organización. El Modelo Biomédico tiene sus bases en el pensamiento racionalista cartesiano y de la física newtoniana, divide la naturaleza humana en cuerpo y mente y, el cuerpo es considerado como una estructura biológica cuyos elementos funcionan de acuerdo a leyes de la física clásica, en términos de movimientos y ajustes de sus partes. Es fundamental que en el proceso de salud enfermedad los sistemas médicos no sean vistos de manera aislada e imponente sino apreciados dentro de todo el ámbito de la cultura y la sociedad en la que funcionan. Se debe lograr un engranaje entre la cultura y el modelo biomédico en el proceso de salud-enfermedad, ya que ambos pueden lograr la complementariedad y así mejorar el bienestar social y colectivo.

This paper aims to address the issue of culture and the biomedical model in the health-disease process through a series of reflections. The man has built different concepts of health, disease, ways to relieve it, measures for prevention and health promotion, according to the culture of each society and its form of organization. Model Biomedical is rooted in the Cartesian rationalist thought and Newtonian physics, divided human nature, body and mind and the body is considered as a biological structure whose elements operate according to laws of classical physics, in terms of movement and settings of its parts. It is essential that in the process of health illness medical systems are not seen in isolation and imposing but appreciated in the entire field of culture and society in which they operate. It must achieve a gear between culture and the biomedical model in the health-disease process, as both can achieve complementarity and improve the social and collective welfare.

Human Oesophagostomum infection in northern Togo and Ghana: epidemiological aspects.

Recently, it has been established that human infection with Oesophagostomum bifurcum is common in northern Togo and northeastern Ghana. Two surveys were conducted in this area. In a regional survey, O. bifurcum infection appeared to occur in 38 of 43 villages. The highest prevalences (up to 59%) occurred mostly in small isolated villages and were usually associated with high hookworm infection rates. The infection was relatively rare in children under five years of age (7% infected). In older individuals, females showed higher prevalences than males (30% vs. 24%). In a second survey, the entire population of two high-prevalence villages was examined. Infection rates were low in children under three years of age, but rose quickly thereafter, suggesting intense transmission. A stable level of infection was reached by 10 years of age. Oesophagostomum larvae were found more frequently in hookworm-positive than in hookworm-negative coprocultures, and possible explanations for the association between infection with Oesophagostomum and hookworm are discussed.