[Influence of the knowledge of patients consulting at the Treichville antirabies Center on adherence to post-exposure prophylaxis]. / Influence des connaissances des patients consultant au centre antirabique de Treichville, Côte d'Ivoire, sur l'observance de la prophylaxie post-exposition.

AIM: Human rabies is a major public health problem in many African countries, including Ivory Coast. The objective of this study was to evaluate the influence of human rabies knowledge on compliance with post-exposure prophylaxis. MATERIALS AND METHODS: We conducted a descriptive and analytical cross-sectional study from September 2014 to May 2015 at the Abidjan Rabid Center, Treichville. After having given their consent, were interviewed, patients who came for a first consultation and who gave a mobile phone number available for the appointment reminder after abandoning or not starting the post-exposure prophylaxis. Data were processed with Epi Info version 3.5.3. Pearson's chi-square test and Fisher's exact test were used for statistical analysis with a significance level of 5%. RESULTS: A total of 744 patients were interviewed. Men accounted for the majority (58.2%) of those surveyed, with a sex ratio (M/F) of 1.7. The average age of patients was 24.55 (±17.3) years. The analysis showed that 42.6% (317/744) of the interviewees had heard of human rabies. However, having heard of human rabies did not influence adherence to post-exposure prophylaxis (P>0.05). Nevertheless, the post-exposure prophylaxis regimen was completed more often by subjects who knew that agitation is a sign of rabies than those who did not (ORa=0.4343, 95%CI=[0.204-0.925]). Subjects knowledgeable about disease transmission (animal bites) were less likely to continue their post-exposure prophylaxis than those unaware of this relationship (ORa=8.544, 95%CI=[1.002-72.869]). CONCLUSION: The main factors identified in this study that influenced the observance of post-exposure prophylaxis were knowledge of the manifestation of human rabies (signs of agitation) and of the mode of transmission of this disease (animal bites). With a view for better prevention against human rabies, rural and urban populations should be informed, educated and sensitized about this 100% life-threatening but vaccination-preventable disease.

Intent to receive flu vaccine and influenza vaccination coverage among health professionals during 2019, 2020 and 2021 campaigns in Côte d'Ivoire.

Vaccination of healthcare workers against influenza is a crucial strategy to reduce transmission amongst vulnerable populations, facilitate patient uptake of vaccination, and bolster pandemic preparedness. Globally, vaccination coverage of health workers varied from 10 % to 88 %. Understanding health workers' knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the fine-tuning and continued success of influenza vaccination campaigns. We conducted a cross-sectional survey of 472 health workers in Abidjan, Côte d'Ivoire, to inform subsequent subnational and national introductions of influenza vaccine and subsequent campaigns targeting health workers in 2019 (14302), 2020 (14872), and 2021 (24473). Using a purposive sample of university hospitals, general hospitals, rural, and urban health facilities, we interviewed a convenience sample of health workers aged 18 years and older. Physicians had the lowest intention to receive the influenza vaccine (58 %), while nurses (78 %) and midwives (76 %) were the most willing. Across all occupations, intention to receive vaccination increased if the vaccine was offered for free or if recommended by the Ministry of Health. 76 % of respondents believed that the influenza vaccine could prevent illness in health workers. Communication strategies, including about the benefits of influenza vaccination, could raise awareness and acceptance among health workers prior to vaccination campaigns. Influenza vaccination coverage rates between 2019 and 2021 were on par with rates of intention to receive vaccination in the 2018 survey; in 2019, 2020, and 2021, coverage among physicians was 73 %, 73 %, and 52 % and coverage among nurses and midwives was 86 %, 86 %, and 74 % respectively. Improving health workers' knowledge and acceptance of the influenza vaccine, particularly among physicians, is crucial for the continued success of influenza vaccination campaigns.

Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d'Ivoire.

Introduction: The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d'Ivoire. Method: A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. Results: A total of 5649 patients were included. The prevalence of STEMI was 0.7% (n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% (n = 8) of cases. All patients received double anti-platelet aggregation and 50% (n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% (n = 29) were referred to the Bouaké Cardiology Department and 34.1% (n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% (n = 3) of patients in Abidjan. Conclusion: Tele-ECG was an effective means of STEMI screening in Côte d'Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.

Decompensated cirrhosis and pregnancy: a case report.

The association of decompensated cirrhosis and pregnancy is rare. Portal hypertension exposure to gastrointestinal bleeding from a ruptured esophageal varix may at any time complicate the course of the disease. We report the case of a 24-year-old patient who delivered at 35 weeks/four days of gestation with decompensated cirrhosis secondary to viral hepatitis B; icterus, oedema, and ascites were present. The postpartum course was uneventful despite the biological disorder of coagulation.

Leiomyomatosis peritonealis disseminata and pregnancy: a case report.

Leimyomatosis peritonealis disseminata (LPD) is a benign tumor of smooth muscle tissue. It is rare and is characterized by the development of multiple peritoneal nodules mimicking peritoneal carcinomatosis. We report a case of LPD diagnosed in a 35-year-old patient, G4/P1, without any major gynecological history. The patient underwent an elective cesarean section at 42 weeks, during which numerous peritoneal nodules ranging in size from 0.1 to 0.5 cm were found. Microscopic examination showed a proliferation of smooth-muscle cells without mitosis or atypia or necrosis.

[Effects of Covid-19 Pandemic on the Vaccine Activities on a Reference Immunization Center in Treichville, Côte D'ivoire]. / Effets de la Pandémie à Covid-19 sur les Activités Vaccinales D'un Centre de Vaccination de Référence de Treichville en Côte D'ivoire.

Introduction: Since March 11, 2020, Côte d'Ivoire has been affected by the coronavirus epidemic, declared that same day as pandemic by WHO. March 11, 2021, one year after the pandemic, Côte d'Ivoire has notified 36,824 cases of Covid-19 patients and among them 211 have died. As of May 31, 2020, Côte d'Ivoire had already notified 2,833 cases and 33 deaths. At that time, false rumors were circulating in Africa about the setting up of clinical trials on candidate vaccines. The impact of these rumors on the overall use of health services had to be measured and in particular on vaccination centers. Objectives: The objective of this study was to determine the effects of the pandemic on the activities of the immunization services of the National Institute of Public Hygiene in Abidjan, which comprises four departments: International Vaccination Center, Community Vaccination Service, Rabies Center, and Vaccination Unit of the Expanded Program on Immunization. The study was based on activity reports of the immunization services. Results: At the International Vaccination Center, activities fell by about 50% in March, 86% in April and 82% in May in comparison with 2018 and 2019. Activities of Community Vaccination Service decreased by about 26% in March and 99% in April and May. At the Rabies Control Center, this reduction was estimated at 38% in April and 45% in May. The highest losses were for yellow fever and meningitis vaccines. Conclusion: The drop in attendance at vaccination services could increase the risk of epidemics, especially yellow fever, which are recurrent in Abidjan. Intensive awareness and catch-up actions should be carried out and further studies performed to assess the impact of the pandemic on immunization activities.

[Implementation of in vitro culture of Mycobacterium ulcerans from clinical samples versus detection of acid-fast bachilli and bacterial genome in Abidjan, Côte d'Ivoire]. / Mise en place de la culture in vitro de Mycobacterium ulcerans à partir d'éhantillons cliniques versus recherche de BAARet détection du génome bactérien à Abidjan, Côte d'Ivoire

Mycobacterium ulcerans infections are a public health problem in Céte d'Ivoire. The etiological diagnosis of this disease made by culture remains a big concern due to the slowness and difficulties encountered. This detection by culture of M. ulcerans represents a big interest as it allows obtaining the circulating strains for research. The purpose of this study was to determine on a routine basis in a poorly equipped laboratory, in vitro culture of M. ulcerans from exudates of skin ulcerations and from biopsy of patients with suspected Buruli ulcer. A particular attention was paid to the conditioning of the sample forwarded to the laboratory and inoculation in Lowenstein-Jensen medium supplemented with glycerol. The results of the three methods for the analysis showed 26.7, 57.4 and 17.8% positive rate respectively in the microscopy examination by nested PCR and by culture. In all the analysis, the positive rate from biopsy is higher than that obtained from exudates. The overall contamination rate by invasion of the three tubes of culture by fungi is 15.8 with 14.3 and 19.4% respectively,from exudates and biopsies. All positive samples in Ziehl-Neelsen staining and in culture were also positive by nested PCR. The nested PCR confirmed the positive strains found in culture, which were responsible for skin ulcerations. After culture, only one strain was nPCR negative. This strain was identified as Mycobacterium Gordonae. Our culture conditions showed that M. ulcerans was not the only strain identified and that other strains were present in the culture. We can conclude that the culture of M. ulcerans, in spite of the growth difficulties of the bacterium can be performed in laboratory in developing countries despite the lack of reagent and consumables. The implementation of this culture is the only way to determine sensitivity tests in vitro and in vivo in order to treat patients with Buruli ulcer.

Primitive breast localisation of Buruli ulcer in an endemic zone: a rare case.

A case of Buruli ulcer with primitive breast localisation with evident epidemiological and clinical aspects is reported. This localisation is exceptional; the differential diagnosis with breast cancer is essential. If diagnosed early, it can be cured with surgery, broad-spectrum antibiotherapy and thermotherapy.

Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients.

AIM: To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis. METHODS: Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo. RESULTS: The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 +/- 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score. CONCLUSION: The CPT score displays the same prognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.

Tuberculosis of the cervix and infertility: report of a rare case.

Tubercolosis is a frequent bacterial infection in less developed countries. Lung and lymph node localisations are common, while the genital apparatus is less involved. In this work a rare case of cervical tuberculosis followed by some lesions causing infertility in a 20-year-old woman is reported. The diagnosis was confirmed by a histological examination from a biopsy of the cervix. The patient was offered six-month antituberculosis therapy which eliminated the cervical lesions. A few years later she came under our care for infertility due to uterine adhesions diagnosed by hysterosalpingography. Now the patient is being treated for infertility complicated by amenorrhoea.

Factors associated with the abandonment of postexposure prophylaxis at the antirabies center in Abidjan, Côte d'Ivoire.

The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional study took place at the ARC of Abidjan from September 2014 through May 2015. Data were collected in two stages: first, all patients were interviewed at their first consultation. Exposed patients who failed to return were interviewed by telephone three days later. We recorded 441 subjects (59.3%) who had dropped out of their PEP. After multivariate analysis of social and demographic factors, the dropout rate was low in the groups aged 40-49 years (aOR = 0.40, 95% CI = 0.2, 0.8), 50-59 years (aOR = 0.40, 95% CI = 0.21; 0.82), and 60 years and older (aOR = 0.26, 95% CI = 0.09; 0.76), while it was elevated in retired persons (aOR = 10.07, 95% CI = [1.11, 91 , 7]). Moreover, the choice of protocol influenced PEP adherence, with subjects who chose the 5-dose protocol dropping out more frequently (P≤0.001). The main reason given by the subjects exposed to a suspect animal to explain dropping out of PEP was the lack of financial resources (41.5%). To alleviate this dropout problem, the ARC should strengthen public awareness of human rabies and the Ivorian government must implement universal health coverage to help the poor or make the vaccine available for free to all.

[Direct sputa examination limits in tuberculosis active detection in 200 immigrant candidates in United States of America]. / Limites de l'examen direct des expectorations dans le dépistage actif de la tuberculose chez 200 candidats à l'émigration aux Etats-Unis.

The Côte-d'Ivoire Pasteur Institute unit of Tuberculous and Nontuberculous Mycobacteria carried out 600 smears stained by Ziehl-Neelsen in 200 immigrant candidates for the U.S.A. The sputa of 44 of them were put in culture on Lowenstein-Jensen medium. Eight (4%) candidates had active pulmonary tuberculosis among whom 5 had smear negative sputum. The pulmonary tuberculosis active detection performed on target population with accessible and sensitive tool can contribute to strengthen the fight against tuberculosis in endemic areas.

Rapid detection of Mycobacterium tuberculosis complex in sputum Samples using PURE TB-LAMP assay.

OBJECTIVE/BACKGROUND: Lack of rapid and accurate diagnostic testing is a critical obstacle to global tuberculosis (TB) control. Sensitivity of sputum smear microscopy (SSM) is not optimal; however, it remains the most prevalent tool for TB confirmation in poor countries. As a part of passive case finding of TB detection, this study was conducted to determine the clinical performance of PURE TB-LAMP assay using liquid culture medium as the gold standard. METHODS: Centre Antituberculeux de Yopougon is one of the 17 intermediate Tuberculosis centers in Côte d'Ivoire. A standardized questionnaire was submitted to patients with signs and symptoms consistent with tuberculosis by a trained caregiver. After obtaining signed consent forms, sputum samples were collected according to National TB Control Programme guidelines (spot-morning). SSM after Ziehl-Neelsen staining and TB-LAMP assay were blindly performed on the first sample. Samples transported to Institut Pasteur de Côte d'Ivoire were decontaminated according to the N-acetyl-L-Cystein method. In Mycobacteria Growth Indicator Tube (MGIT), 500mL of pellets were inoculated and incubated in the MGIT 960 system. MPT64 antigen was detected in positive cultures. RESULTS: Of the 500 patients enrolled, 469 (232men and 239 women) patients were included. The mean ages of men and women were 36.9 (15-86) and 37.3 (15-37.3) years, respectively. There were 56 (12.2%) HIV-infected patients, including 14 women. Clinical isolates of M. tuberculosis complex were detected for 157 (33.5%) patients. Compared with culturing, the overall sensitivity and specificity of SSM were 86% (95% confidence interval [CI]=81-91) and 96% (95% CI=94-98), respectively. The overall sensitivity and specificity for TB-LAMP was 92% (95% CI=0.88-0.96) and 94% (95% CI=0.91-0.97), respectively. Positive likelihood ratios for TB-LAMP and SSM were 15.3 and 21.5, respectively, and negative likelihood ratios for TB-LAMP and SSM were 0.09 and 0.15, respectively. Among the 469 patients, active tuberculosis was detected using TB-LAMP assay and SSM in 162 (34.5%) and 147 (31.3%) patients, respectively. CONCLUSION: For accurate diagnostic of pulmonary TB, TB-LAMP could be used as a tool of the first intention.

[Clinical, microbiological and evolutionary profile of patients experiencing failures and relapses of tuberculosis in Ivory Coast]. / Profil clinique, microbiologique et évolutif des patients en situation d'échecs et de rechutes de tuberculose en Côte d'Ivoire.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is a major obsession for TB control. The main risk factor for MDR-TB remains a history of TB treatment especially bad conduct. The objective of this study is to describe the profile of patients in situations of failure and relapse of tuberculosis. METHODS: We performed a retrospective survey of the analysis of records of patients starting TB retreatment for failure or relapse of tuberculosis. We used 193 cases with results of culture-sensitivity. RESULTS: The proportion of failure is 59/193 (30.6 %) and cases of relapse are 134/193 (69.4 %). The proportion of married life is 23.4 % (11/47) in chess against 41.5 % (51/123) in relapse of TB [P=0.021, OR=0.431 (0.201 to 0.927)]. Patients failing therapy have more chest pain [5.8 % (3/52) versus 0 % (0/126) with P=0.024]. The proportion of MDR-TB was 61.4 (38/59) in case of failure against 41 % (55/134) in case of relapse [P=0.002, OR=2.599 (1.378 to 4.902)]. The evolution is the same whatever the indication of reprocessing. CONCLUSION: The proportion of MDR-TB is very important in case of reprocessing failure and relapse of tuberculosis.

Evaluation of HIV serial and parallel serologic testing algorithms in Abidjan, Côte d'Ivoire.

OBJECTIVE: To evaluate HIV serologic testing algorithms based on a combination of three enzyme linked immunosorbent assays (ELISA) for the confirmation of HIV infection in Abidjan, Côte d'Ivoire, where HIV-2 and HIV-1 non-B subtypes are prevalent. METHODS: A total of 1069 human sera with known serologic status, in addition to a seroconversion and low titer antibody panel were initially tested by six ELISA to determine the sensitivity, specificity and delta values of the assays. On the basis of the performance of the assays, three ELISA (Enzygnost, ICE 1.0.2, and Vironostika) were selected for use in a parallel and serial testing algorithm in analyzing 8283 consecutively collected sera. In the parallel testing algorithm, sera concordantly reactive or non-reactive by Enzygnost and ICE 1.0.2 were considered as true positive or true negative, respectively. In the serial algorithm, sera reactive by Enzygnost were retested by ICE 1.0.2. Sera with discordant results were tested by Vironostika, and the results was considered definitive. All reactive sera, plus a random sample of negative sera were tested for confirmation by Peptilav. In addition, a random sample of reactive sera was tested by Western blot. RESULTS: All ELISA had 100% sensitivity; specificities ranged from 96.8 to 100%. Positive and negative delta values of the ELISA were high (range, 6.89 to 46.07 and -2.05 to -5.75, respectively). Of the 8283 sera, 2054 were considered true positives and were correctly classified by the parallel testing algorithm (sensitivity, 100%). Of the 6229 true negative sera, 6226 were negative by the parallel testing algorithm (specificity, 99.95%). The sensitivity of the serial algorithm was 99.96%, and specificity was 99.95%. None of the 250 concordant ELISA-negative sera in the algorithm that were randomly tested in Peptilav was positive; similarly, all of the 103 concordant ELISA-positive sera were confirmed by Western blot. The three-ELISA algorithm resulted in reagent cost-savings of at least 50% compared with the Peptilav-based algorithm. CONCLUSION: These results suggest that a combination of ELISA using different principles or antigens in a serial or parallel algorithm is an efficient and cost-effective alternative to the standard algorithm in areas where HIV-1 and HIV-2 are prevalent.

[Preliminary study on isoniazid-epiroprim combination in a tuberculosis murine model]. / Etude préliminaire de l'association isoniazide-épiroprim dans un modèle murin de tuberculose.

The purpose of this study regarding isoniazid-epiroprim's association applied to antituberculosis chemotherapy, carried through murine model, initiated into Institut Pasteur of Côte d'Ivoire and worked out at Institut Pasteur of Paris was to evaluate the epiroprim's effect alone and associated with isoniazid on Mycobacterium tuberculosis. Sixteen mouses (lineage C57Bl/6) were inoculated by venous way with 10(5) viable bacillus (strain H37Rv) suspended in 500 microliters sterile physiological aqueous solution and were shared out into 4 sets. Fifteen days later the sets have been submitted or not to a daily treatment by gavage during three weeks (epiroprim, isoniazid, isoniazid plus epiroprim). The mouses were euthanasied, spleen and lung were removed from each animal. The titres of determined bacillus into those organs prove that isoniazid and epiroprim associated seem more efficacious than the isoniazid monotherapy for mouses pulmonary tuberculosis. Bacillus obtained are sensitive to isoniazid.

[Contribution of gene amplification in Mycobacterium ulcerans detection in exudates and cutaneous biopsies in Côte d'Ivoire]. / Apport de l'amplification génique dans la détection de Mycobacterium ulcerans dans les exsudats et les biopsies cutanées en Côte d'Ivoire.

Mycobacterium ulcerans skin ulceration is a major issue of public health in Côte d'Ivoire. The diagnosis of M. ulcerans infection is hampered by the slow growth of the bacterium in culture, implying a delay of several weeks before a specific diagnosis can be obtained. In Côte d'Ivoire the diagnosis of Buruli ulcer is almost based on clinical features. During the last decade, many studies have demonstrated the extremely high capacity of PCR for rapidly and specifically detecting bacteria and genes of interest. That ability has revealed PCR as a powerful tool in clinical microbiology studies. In this study we evaluated the M. ulcerans detection in specimens of exudates and biopsies collected from patients clinically suspected of Buruli ulcer and treated in "Raoul Follereau" centre of Manikro in the North-central region of Côte d'Ivoire. The microscopic research of BAAR in 185 swabs loaded with skin lesions collected from these patients showed a positive rate of 14.6%. The PCR detection in 48 h or 72 h of the M. ulcerans IS2404 and IS2606 in the swabs and in the 26 biopsies, from these patients, showed positive rates of 15.7% and 84.6% respectively and in the same samples. These results obtained with PCR detection of M. ulcerans insertions sequences suggest that this technique performed with exudates and biopsy can be used to confirm a routine specific diagnosis of M. ulcerans and early screening of Buruli ulcer in Côte d'Ivoire.

[Value and limits of microscopy of exudates in Mycobacterium ulcerans cutaneous infection in Côte d'Ivoire]. / Intérêt et limites de la microscopie des exsudats au cours de l'infection cutanée à Mycobacterium ulcerans en Côte d'Ivoire.

The objective of this study was to estimate the interest and the limits of skin exudate microscopy for patients with chronic ulceration with clinically suspected Buruli's ulcer and living in an endemic area in Côte d'Ivoire. Two stained smears, one with Ziehl-Neelsen and the other Dugomier staining, were produced from 140 samples obtained after a swab of skin lesions. The positive smear rate for the acid fast bacilli (AFB) was respectively 16.4% and 12.9% for Dugomier and Ziehl-Neelsen staining. The ulceration with less than one year of evolution have high AFB rates of 15.8% for Ziehl-Neelsen staining and 21.1% for Dugomier's. Microscopic examination of skin exudate in face of ulceration, clinically suspected to be a Buruli's ulcer is not the best tool for biological diagnosis, due to poor technical sensibility. Nevertheless, it remains a good first means of investigation in an endemoepidemic area.

[Localization and registration of the hinge axis in black Africans]. / Le point sur la localisation et le transfert de l'axe charnière chez le sujet melanoderme africain.

The study of the cinematic method using "SAM" and "Quick Axis of FAG" added to mandibular condyle palpation for the hinge axis limited points, show that the Black Africans mandibular condyle rotation axis position is higher (3.5 mm) and backer (2 mm) than the Caucasians. The axial points are located to between 11 and 12 mm in front of the tragus and between 7 and 8 mm below on the perpendicular line to the furrow defining the tragus superior side to the Ectocanthus.

[Toward a more resistant resin, more economical and better suited to conditions in developing countries]. / Pour une resine plus resistante, plus economique et adaptee aux contextes des pays du sud.

The breakage of prosthesis constructed in polymethacrylate resin is a reality in daily practice. Several solutions have been proposed to overcome this problem. Thus, the reinforcement of resin with carbon fibre improved greatly the mechanical properties, notably the fatigue strength. The technique of elaboration of such prosthesis proposed in this study has little impact on aesthetic as well as on the final cost. This proposition could be a relevant solution for third world countries opposite to economical and technological problems generated by cast metallic framework.