Using evidence to inform response to the 2017 plague outbreak in Madagascar: a view from the WHO African Regional Office.

The 2017 plague outbreak in Madagascar was unprecedented in the African region, resulting in 2417 cases (498 confirmed, 793 probable and 1126 suspected) and 209 deaths by the end of the acute urban pneumonic phase of the outbreak. The Health Emergencies Programme of the WHO Regional Office for Africa together with the WHO Country Office and WHO Headquarters assisted the Ministry of Public Health of Madagascar in the rapid implementation of plague prevention and control measures while collecting and analysing quantitative and qualitative data to inform immediate interventions. We document the key findings of the evidence available to date and actions taken as a result. Based on the four goals of operational research - effective dissemination of results, peer-reviewed publication, changes to policy and practice and improvements in programme performance and health - we evaluate the use of evidence to inform response to the outbreak and describe lessons learned for future outbreak responses in the WHO African region. This article may not be reprinted or reused in any way in order to promote any commercial products or services.

[Eagle's syndrome: A case report ].

Introduction: Eagle syndrome, also termed stylohyoid syndrome is a radioclinical entity characterized by an elongated styloid process. Although frequent, it remains largely underdiagnosed by clinicians [1]. We report one case of Eagle syndrome studied at the ENT and radiology departments of the Heinrich Lübke hospital in Dioubrel. Radiologic, therapeutic and clinical data have been documented. The aim of our work is to report a case of Eagle syndrome in a 32 year old patient and to present the diversity of the presenting symptoms, the diagnostic challenges and the therapeutic options. Conclusion: Eagle syndrome represents an unusual and underappreciated entity and must be sought after in every underlying pharyngeal symptomatology with a normal clinical examination.

Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

[Darier's disease: three cases of psychosocial difficulties in an African setting]. / Difficultés d'intégration sociale au cours de la maladie de Darier en Afrique : trois cas.

BACKGROUND: Darier's disease is a rare disease. Multiple clinical forms have been observed, but the psychosocial aspects in Africa are rarely described. We report three cases involving difficulties regarding social integration. OBSERVATIONS: Case no. 1: a 19-year-old woman consulted for hyperchromic, greyish, keratotic papules, grouped in small plaques scattered all over the body. She had trouble finding a husband and was rejected by her peers. Case no. 2: a 20-year-old woman presented generalized keratotic, vegetative lesions. She was rejected by her husband because of the lesions. Like patient no. 1, she was unable to purchase her prescribed treatment. Case no. 3: a 33-year-old blacksmith presented Darier's disease with lesions on the interscapular region and chest. He was epileptic and depressive and was partly rejected by his family. DISCUSSION: Darier's disease, diagnosed on the basis of anatomoclinical factors, had a major impact on the social integration of all three patients. These generalised disfiguring forms of the disease adversely affect the quality of life and their association with neuropsychiatric disorders is another major handicap. CONCLUSION: Difficulties concerning social integration and therapeutic problems must be considered in the management of Darier's disease in Africa.

[COVID 19 in intensive care: epidemiological, clinical and prognostic aspects in Bamako]. / COVID 19 en reanimation : aspects epidemiologique, clinique et pronostique a Bamako.

OBJECTIVE: to report the epidemiological, clinical, paraclinical and therapeutic characteristics of the first COVID 19 patients in intensive care. PATIENTS AND METHOD: retrospective descriptive and analyticalstudy over 4 months, covering all adult patients tested positive for SARS-Cov-2 and admitted to intensive care. RESULTS: 49 patients, 35 men and 14 women (2% of cases) were admitted to intensive care. The median age was 64 years [26 - 92]. Hypertension (16; 32.6%), and diabetes (11; 22.4%) were the mostcommoncomorbidities. The most common symptoms on admission were cough (38; 80.9%), shortness of breath (35; 74.5%), and fever (33; 70.2%). The median time to onset of symptoms was 11 days. Non-invasive ventilation (NIV) was used in 21 patients (42.9%). Fourteen (28.6%) wereintubated and put onassisted ventilation. The mean hospital stay was 7.77 ± 7.30 days. We recorded 20 (40.8%) deaths. Factors associated with death were high blood pressure, onset of shock, and on mechanical ventilation. CONCLUSION: Covid-19 remains a public healthproblemwith high morbidity and mortality. The morbidity and mortalityfactorsare: comorbidities and the severity of the clinicalpicture.

OBJECTIF: rapporter les caractéristiques épidémiologiques, cliniques, paracliniques et thérapeutiques des premiers patients COVID 19 en réanimation. PATIENTS ET MÉTHODE: étude rétrospective descriptive et analytique sur 4 mois, portant sur l'ensemble des patients adultes testés positif au SARS-Cov-2 et admis en réanimation. RÉSULTATS: 49 patients, 35 hommes et 14 femmes (2% des cas) étaient admis en réanimation. L'âge médian était de 64 ans [26 ­ 92]. L'HTA (16 ; 32,6%), et le diabète (11 ; 22,4%) étaient les comorbidités les plus fréquentes. Les symptômes les plus fréquents à l'admission étaient la toux (38 ; 80,9%), l'essoufflement (35 ; 74,5%), et la fièvre (33 ; 70,2%). Le délai médian d'apparition des symptômes était de 11 jours. La ventilation non invasive (VNI) a été utilisée chez 21 patients (42,9%). Quatorze (28,6%) ont été intubés et mise sous ventilation assistée. La durée moyenne d'hospitalisation était de 7,77 ± 7,30 jours. Nous avons enregistré 20 (40,8%) décès. Les facteurs associés au décès étaient l'hypertension artérielle, la survenue d'un état de choc, la mise sous ventilation assistée. CONCLUSION: la Covid-19 reste un problème de santé publique avec une morbi mortalité élevée. Les facteurs de morbi-mortalité sont : les comorbidités et la sévérité du tableau clinique.

[The HIV epidemic among industrial male miners in Guinea: prevalence, associated factors and trends from 2001 to 2007]. / Épidémie du VIH chez les hommes travaillant dans les mines industrielles de Guinée : séroprévalence, facteurs de risque associés et tendance 2001-2007.

BACKGROUND: To estimate HIV prevalence, associated factors and trends from 2001 to 2007 among male miners in Guinea. METHODS: Two hundred and eighty-six male miners in 2001 and 579 in 2007 were tested for HIV and interviewed about their lifestyles and sexual practices. Investigations were conducted in the five mining companies operating in the country. A standard questionnaire was used for collecting data and SAS Windows 9.2 version (SAS Institute, Cary, North Carolina, USA) for statistical analysis. RESULTS: Median age was 45 years in 2001 and 39 years in 2007 (P=0.001). HIV prevalence was 4.5% (95% Confidence Interval [95% CI]: 2.1-7.0) in 2001 and 6.4% (95% CI: 4.4-8.4) in 2007. In multivariate analysis, HIV prevalence was associated with history of sexually transmitted infections (STIs) (Prevalence Ratio [PR]=2.21; P=0.03), and with paying for sex (PR=6.01; P=0.04), whereas it was significantly higher in divorced, separated or widowed men. HIV prevalence increased but not significantly between 2001 and 2007, whereas casual sex (P=0.03) and counseling activities against HIV (P<0.0007) decreased. CONCLUSION: HIV prevalence is high in this population and, although not statistically significant, the increase observed between 2001 and 2007 is worrying in a context where the population of miners became younger over time. Prevention of HIV/AIDS has to be reinforced among miners in Guinea.

[HIV prevalence, associated risk factors and evolution among truck drivers from 2001 to 2007 in Guinea]. / Prévalence du VIH, facteurs associés et tendances chez les camionneurs entre 2001 et 2007 en Guinée.

OBJECTIVE: The purpose of this study was to estimate correlation between HIV prevalence and behavior at risk for infection among truck drivers in Guinea and to report the trends of these indicators from 2001 to 2007. METHODS: A total of 313 truck drivers in 2001 and 600 in 2007 were selected, interviewed and then tested for HIV infection. Data were analyzed with SAS Windows 9.2. RESULTS: The prevalence HIV was 7.0% in 2001 and 5.3% in 2007 (p=0.30). Seroprevalence was positively correlated with monogamous marital status [prevalence ratio (PR)=10.00; p=0.02] in 2001, absence from home for longer than a month (PR=2.06; p=0.03), international hauls (PR=2.39; p=0.01), and alcohol consumption (RP=2.00; p=0.04) and negatively correlated with the ability to abstain in risk situations (PR=0.35; p=0.01) in 2007. Comparison of responses obtained in 2001 and 2007 showed a decrease in the number of casual sex partners (p<0.0001) and an increase in condom use (p<0.0001). Comparison also showed a decrease in the number of drivers who reported receiving counseling about HIV/AIDS from NGOs, state health care services and schools (p<0.0001). CONCLUSION: These two surveys showed high HIV prevalence among Guinean truck drivers in both 2001 and 2007. Condom use increased between 2001 and 2007 but remained inadequate. The correlation between monogamous marriage observed in 2001 was not found in 2007 but other risk factors such as alcohol consumption, prolonged absence from home, and international hauls were observed. The ability to abstain from sex in risk situations was associated with lower seroprevalence. During the study period, a decrease was observed in the number of truck drivers who reported receiving HIV/AIDS counseling from NGOs, state health care services, or schools. Prevention activities against HIV/AIDS must be reinforced in this high-risk population.

[Contribution of the musculocutaneous flap of pectoralis major in head and neck oncology: 26 observations in Senegal]. / Apport du lambeau musculo-cutané du pectoralis major en carcinologie cervico-faciale: 26 observations au Sénégal.

INTRODUCTION: The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap. PATIENTS AND METHODS: This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included. RESULTS: Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%). CONCLUSION: The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

[Diabetes mellitus and early failures in oral implantology]. / Diabète et échecs précoces en implantologie orale.

It has become increasingly common for diabetic patients to be considered as candidates for dental implants. However even though success rates of implant therapy in diabetic are high, this does not preclude failures. Failure to osseointegrate in the initial healing phase results in a fibrous tissue encapsulation of the implant and clinical mobility, leading ultimately to the failure of the implant. This review presents the current knowledge regarding the effect of diabetes mellitus on the osseointegration of implants including pathophysiologic aspects as well as their potential implications on bone metabolism and osseointegration, implant success rate at the second-phase surgery and guidelines for pre and post-operative management. In experimental models of diabetes mellitus, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur at the second-phase surgery, seemingly pointing to the microvascular complications of this condition as a possible causal factor. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.

[HIV epidemic among female sex workers in Guinea: prevalence, associated risk factors, vulnerability and trend from 2001 to 2007]. / Epidémie du VIH chez les travailleuses du sexe en Guinée: prévalence, facteurs associés, vulnérabilité et tendances 2001-2007.

BACKGROUND: Estimate the associations between potential risk factors and HIV prevalence, as well as the trends from 2001 through 2007 of these indicators. Describe the vulnerability of female sex workers to in Guinea. METHODS: Female sex workers in Guinea were interviewed in 2001 (n = 339) and 2007 (n = 598) and then screened for HIV. This was a nationwide survey using a unique protocol. Associations between potential risk factors and HIV prevalence were tested, and their trends from 2001 through 2007 estimated, after adjustment using Generalized Estimating Equations. RESULTS: In 2001, HIV was associated with illiteracy (PR = 1.41; p = 0.2), and with genital ulcer symptom (PR = 1.89; p = 0.001). In 2007, it was associated with illiteracy (RP = 1, p = 0.03), and with older age (PR for 10 years = 1.29; p = 0.004). The profile of illiterate female sex workers included low price per sexual encounter in both 2001 and 2007, greater number of clients, and lesser exposure to HIV/Aids counselling in 2001. From 2001 to 2007, increases were noted for the number of clients by female sex workers (p < 0.0001), price per sexual encounter (p < 0.0001), condom use (p < 0.0001) and exposure to HIV/Aids counselling (p < 0.0001); decreases were noted for symptoms of sexually transmitted diseases (p < 0.0001) and HIV prevalence among female sex workers aged less than 20 years (p = 0.005). CONCLUSION: From 2001 through 2007, condom use and exposure to HIV/Aids counselling increased in Guinea while symptoms of sexually transmitted diseases and HIV prevalence declined. Nevertheless, illiterate female sex workers remained highly vulnerable.

[Solitary neurofibroma of the maxillary sinus]. / Neurofibrome isolé du sinus maxillaire.

OBJECTIVE: To illustrate the rarity and difficulty diagnosing maxillary sinus neurofibroma through a case report. PATIENTS AND METHODS: A 35-year-old female consulted our department for left cheek swelling evolving over 6 months, upper gum swelling, and a dental occlusion disorder. RESULTS: A computed tomography scan showed a tumor of the left maxillary sinus with bone destruction. Histological examination of a biopsy fragment found an in situ carcinoma. A maxillary resection was performed to excise the tumor. Histological examination of the specimen showed a neurofibroma. No sign of recurrence was noted after 8 months of follow-up. CONCLUSION: The difficulty diagnosing maxillary sinus neurofibroma is related to its nonspecific clinical and radiological signs. Consequently, the otorhinolaryngologist must keep this rare histological variety in mind within the range of tumors of the paranasal sinuses.

[Clinical and therapeutic aspects of trigeminal neuralgia. Apropos of 27 cases treated at the General Hospital of Grand-Yoffin Dakar]. / Aspects cliniques et thérapeutiques de la névralgie faciale essentielle du trijumeau. A propos de 27 cas colligés a l'Hôpital Général de Grand-Yoff de Dakar.

The trigeminal neuralgia or "painful tic" of the face is an invalidating affection, which affects the quality of life of the patient. The odontologist must be able to diagnose it and take part in his good therapeutic assumption of responsibility. The diagnosis is sometimes difficult, being able to involve unsuited therapeutic methods prejudicial for the patient. The objective of our study was to analyse the clinical and therapeutic aspects of the trigeminal neuralgia. It was a transverse and descriptive study which 27 files of patients suffering of trigeminal neuralgia and treated in the odontology service of the General hospital of Grand-Yoff in Dakar between July 2002 and July 2008. We exploited the following parameters: the age, the sex, the oral state, duration of the symptoms, characteristics of the pain, the type of treatment. 22 patients of the 27 cases were female. The time of consultation was often late, the patients generally preferring begin with the traditional treatments. The neuralgia of V2 dominated the clinical picture, followed that neuralgia of V3. The pain was strictly unilateral, it was started by movement, speaking, eating or touching the trigger zone. The prescription of carbamazepine (Tegretol) was systematic, and constituted a true test diagnosis, it made possible to obtain an immediate sedation of the pains. In front of the medicamentous treatment failure, the alcoholization of the trigeminal branch has given good performances, indeed it made possible to obtain, a clear lull of more than 12 months for 9 patients out of the 10 who profited from it. The alcoholization of the trigeminal nerve remains an effective cure and constitutes an accessible alternative under our work conditions in Africa.

Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital.

Sexual violence is widespread in the world and has a negative impact on women's mental, social, and physical well-being. The purpose of this study was to describe the epidemiological and clinical aspects of the occurrence of sexual violence among patients seen in the Gynecology-Obstetrics department at Ignace Deen National Hospital. This is a cross-sectional, descriptive, observational study of victims of sexual violence seen in the department, directly or on court orders, during the two-year period from May 1, 2016, to April 30, 2018. The data were analyzed with SPSS 16.0 software. Sexual violence accounted for 3.5% of all consultations in the department during the study period. They concerned adolescents (64.0%), females (97.1%), students (78.6%), and single individuals (95.7%). More than half of the sexual assaults were committed in the abuser's home (57.1%), by an assailant known to the victim (87.0%), at night (71.4%), by one person (85.7%), and during the weekend (60.0%). The lesions observed included vulvovaginitis (45.8%), vaginal tears (8.7%), facial bruises (8.7%), anal tears (4.4%), and ocular contusions (4.4%). The gynecological examination was normal in 21.4% of cases. Vaginal penetration was the sexual act practiced most often (88.4%) by aggressors, compared with acts of sodomy (4.3%). We noted 7.2% of fondling. Overall, 58.6% had previously had their hymen broken, and 34.3 very recently, while the hymen was intact in 7.1% of cases. The frequency of sexual violence is underestimated in our society. Its prevention involves its punishment, adequate medical care of victims, and improvement of the status of women.

Status epilepticus in black African patients with hypertensive encephalopathy: a rare entity that must not be underrated.

The severity of a blood pressure spike is more closely associated with serious organ dysfunction, which can be life-threatening in the short term, than with the blood pressure level itself. A hypertensive emergency is defined as the presence of high blood pressure associated with acute organ dysfunction. The specific nature of high blood pressure in black patients may cause more frequent hypertensive emergencies. In this retrospective case study, we report our experience and highlight the specific prognosis for black African patients. We examined three patients, aged 27, 47, and 59 years, admitted to intensive care for a hypertensive emergency with neurological distress, and all in status epilepticus. Average blood pressure was 171 mm HG. Treatment included intubation, ventilation, and induction of a barbiturate coma, plus antihypertensive treatment. The outcome was favorable, with an average stay of 5 days. The frequency of hypertensive emergencies varies according to age, ethnic origin, and period studied. Black patients often suffer from more severe forms of high blood pressure, arising at an earlier age. Hypertensive encephalopathy can occur in patients with or without chronic hypertension. Without treatment, the encephalopathy induces a coma that can quickly become fatal. Its spontaneous course is catastrophic (10-20% survival at one year), but more favorable with adequate treatment (60-80% survival at five years).

[Acute Complications Of Snakebite Envenomation In Department Resuscitation Of CHU-Mother Child "Luxembourg" Of Bamako]. / Complications Aigues De L'Envenimation Par Morsures De Serpent Au Service De Reanimation Du Chu Mere Enfant "Le Luxembourg" De Bamako.

Envenomation by snakebite remains a public health problem in Africa. The purpose of our work was to study the acute complications of snakebite envenomation and the risk factors for its complications. METHOD: This was a retrospective and prospective study over a period of 07 years, which was performed in the department of anesthesia resuscitation and emergencies of CHU-Mother Child "Luxembourg" of Bamako. RESULTS: During this period, 76 cases of Ophidian envenomation were recorded. The average age of the patients was 34 ± 12 years old. . The family of vipers (Echis and Bitis) was the most incriminated 84,61% of the cases. Hemorrhagic complications were observed in 78.94% of patients, other complications (cardiovascular, neurological, dermatological, ophthalmological ...) were observed in 21.05% of patients. The main risk factor for complication observed was the delay in management (> 6 hours delay) in 100% of patients. The absence of serotherapy and or the initial resort to traditional treatment have been complicating risk factors. Almost all victims of Elapidae bites, 89.9% (5/6 cases) died. Serotherapy was performed urgently in 97.4% of cases. The morbidity in our study was 10.52% with a 7.8% mortality. CONCLUSION: in our context, the management of envenomations by snake bite remains dependent on a multitude of complications. The prognosis is conditioned by the early administration of symptomatic treatment and a specific antidote.

L'envenimation par morsure de serpent reste un problème de santé publique en Afrique. Notre travail avait pour objectif d'étudier les complications aigues de l'envenimation par morsure de serpent, ainsi que les facteurs de risque de ses complications. MÉTHODE: Il s'agissait d'une étude rétrospective et prospective sur une période de 07 ans, qui a été réalisée dans le département d'anesthésie réanimation et des urgences du CHU-Mère enfant le « Luxembourg ¼ de Bamako. RÉSULTATS: Durant cette période, 76 cas d'envenimations ophidiennes ont été enregistrés. L'âge moyen des patients était de 34±12 ans. . La famille des vipéridés (Echis et Bitis) était la plus incriminée 84,61% des cas. Les complications hémorragiques ont été observées chez 78,94% des patients, d'autres complications (cardiovasculaire, neurologique, dermatologique, ophtalmologique...) ont été observées chez 21,05% des patients. Le principal facteur de risque de survenu de complication observé, était le retard de prise en charge (délai> 6heures) Chez 100% des patients. L'absence de la sérothérapie et ou le recours initial à un traitement traditionnel ont été des facteurs de risques de complication. La presque totalité des victimes par morsures d'Elapidés soit 89,9% (5/6 cas) sont décédées. La sérothérapie a été effectuée en urgence chez 97,4% des cas. La morbidité dans notre étude a été de 10,52% avec une mortalité à 7,8%. CONCLUSION: dans notre contexte, la prise en charge des envenimations par morsure de serpent reste tributaire d'une multitude de complications. Le pronostic est conditionné par l'administration précoce d'un traitement symptomatique et d'un antidote spécifique.

[Results of alginate and hypertonic solution in wound healing of head and neck cancers]. / Résultats de l'association de deux produits issus de la mer dans les troubles de la cicatrisation en cancérologie cervico-faciale.

INTRODUCTION: In head and neck cancers, complications such as pharyngostoma, orostoma, or fistula can present following surgery or surgery after irradiation. OBJECTIVE: To report the results of the association of two sea-derived products (Sinomarin and Algosteril) compared to normal saline for the management of healing. MATERIAL AND METHODS: This is retrospective study (1998-2000). Thirty patients were included in group 1 (Sinomarin-Algosteril) and 17 patients in group 2 (normal saline). The average age was respectively 60 and 56.2. Patients in both groups presented with advanced head and neck carcinoma (T3-T4) and healing complications. RESULTS: The delay of healing was respectively of 33.53 and 72.94 days. Results were statistically significant (Student T-test P < 0.05). CONCLUSION: Our results show the efficiency (p < 0.05) of the Sinomarin Algosteril association in head and neck cancer healing complications.

[Should the administration of anticoagulants be altered for oral surgery: a study of 32 cases]. / Faut-il interrompre l'administration d'anticoagulants pour un Acte de Chirurgie Buccale: a propos d'une étude de 32 cas.

INTRODUCTION: The study is transversal and descriptive. It take place in the odontology department in a public hospital in Dakar (Senegal), during 09 month (January-September 2005). The objective of this work was to determine the TP-INR value making possible to carry out an act of oral surgery without haemorrhagic risk. (INR = International Normalized Ratio). MATERIAL AND METHOD: It concerned 32 patients referred to the Odontology service by the Cardiology They presented a cardiovascular pathology having required an anticoagulant therapy, and also need an act of oral surgery. We exploited the following parameters: identification of the patient, oral state, types of oral surgery, types of cardiopathy, AVK posology, value of TP-INR, haemostatics means. RESULTS: 81.25% of the patients were women (26), with a sex ratio of 0.23. The mean age was 53ans, with 21 and 84 years like the extremes. 56.25% of our patients had undergone a single extraction, 25% had beneficed multiple extractions, and 18.75% had profited from a scaling-curetting. The average value of the TP-INR was 2.22 with extremes between 2 and 2.84. CONCLUSION: In favour of the haemostat means, no haemorrhagic complication post operational was revealed. It is allowed that the risk of thromboembolic accident by stopping the treatment is much more prejudicial than the hemorrhagic risk for the patient.

[The pentoxifylline, a corticosteroid sparing in the treatment of sarcoidosis: A case report]. / La pentoxifylline, un épargneur de corticoïdes dans le traitement de la sarcoïdose : à propos d'une observation.

INTRODUCTION: The pentoxifylline seems to have some effects on immune cells by inhibiting tumor necrosis factor alpha (TNFα). Its role as a sparing corticosteroids in the treatment of sarcoidosis remains to be defined. CLINICAL CASE: We present the case of a patient with sarcoidosis corticodependent despite the use of azathioprine. It was finally improved clinically, functionally and by a thoracic computed tomography with addition of pentoxifylline. CONCLUSION: When the tolerance of the pentoxifylline is good and there is not a bleeding risk, the benefit-risk in the long term might be interesting in some patients with sarcoidosis corticodependent.

Laryngeal papillomatosis in Senegal: A ten-year experience.

OBJECTIVES: The objectives of this study were to describe the epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis in the Fann teaching hospital ENT department in Dakar, Senegal. PATIENTS AND METHODS: We retrospectively reviewed all cases of laryngeal papillomatosis managed in the Fann teaching hospital ENT department between 1st January 2006 and 31st December 2015. Epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis were studied. Statistical analysis was performed with SPSS 18 software. RESULTS: The median age at diagnosis was 11 years and the sex ratio was 1.88. The mean time to consultation was 4.5 years. The predominant symptom was dysphonia, present in all cases, followed by laryngeal dyspnoea in 64.6% of cases. The glottic area was involved in all patients. Tracheostomy was performed in 20.8% of cases. All patients in our study underwent endoscopic excision of the lesions. CONCLUSION: Laryngeal papillomatosis is the most common benign tumor in children, but it can also occur in adults. Treatment has been revolutionized by progress in endoscopy and antiviral therapy. However, tracheostomy still occupies an important place in our practice.