A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea.

OBJECTIVES: Papua New Guinea has among the highest prevalences of sexually transmissible infections (STIs) globally with no services able to accurately test for anorectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Here we prospectively evaluated the diagnostic performance of a molecular CT/NG assay used at the point-of-care (POC) with the aim of enhancing anorectal STI screening and same-day treatment. METHODS: Men who have sex with men, transgender women and female sex workers taking part in Papua New Guinea's first large-scale biobehavioural study were enrolled and asked to provide a self-collected anorectal swab for POC GeneXpert CT/NG testing. Same-day treatment was offered if positive. A convenience sample of 396 unique and randomly selected samples were transported to Australia for comparison using the Cobas 4800 CT/NG test (Roche Molecular Diagnostics, Pleasanton, CA, USA). RESULTS: A total of 326 samples provided valid results by Cobas whereas 70 samples provided invalid results suggesting inhibition. The positive, negative and overall percentage agreements of GeneXpert CT/NG for the detection of C. trachomatis were 96.7% (95% CI 92.3%-98.9%), 95.5% (95% CI 91.3%-98.0%) and 96.0% (95% CI 93.3%-97.8%), and for N. gonorrhoeae were 93.0% (95% CI 86.1%-97.1%), 100.0% (95% CI 98.3%-100.0%) and 97.8% (95% CI 95.6%-99.1%), respectively. CONCLUSIONS: The overall rate of agreement between the GeneXpert and Cobas CT/NG assays was high with 96.0% for C. trachomatis and 97.8% for N. gonorrhoeae. Results from this study data suggest that the GeneXpert CT/NG assay is suitable for testing self-collected anorectal specimens at the POC and that same-day treatment was feasible.

[Noma and Burkitt disease; a particular association about three observations seen in the Teaching Hospital Center Yalgado Ouedraogo (Burkina Faso)]. / Noma et maladie de Burkitt, une association exceptionnelle à propos de trois observations vues au centre hospitalier universitaire Yalgado Ouedraogo (Burkina Faso).

Cancrum oris is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, Gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles [3]. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma first described by Burkitt in 1958 in African children from areas holoendemic for malaria. It is the first cancer of African child [6]. The association between Burkitt lymphoma and cancrum oris is non common. We report in the present study three cases of this association at the Academic Hospital Yalgado Ouedraogo of Ouagadougou. This association poses a problem of late diagnosis with difficulties in therapeutic management.

[Epidemiology and clinic of dental extractions in University Teaching Hospital Yalgado Ouedraogo, (Burkina Faso)]. / Aspects épiémiologiques et cliniques des extractions dentaires au Centre Hospitalier Universitaire Yalgado Ouedraogo (Burkina Faso).

INTRODUCTION: The consequences of tooth loss are often severe for the patient: aesthetic deficit, decreased masticatory coefficient, malnutrition... The objective of this study was to describe the epidemiological and clinical aspects of dental extractions of patients attending the University Teaching Hospital Yalgado Ouedraogo (UTHYO). PATIENTS AND METHODS: It was a descriptive cross-sectional retrospective study on a sample of 65 patients who received a dental extraction at least in dental surgery of the UTHYO. RESULTS: The sample consisted of 33 (50.8%) patients female to 32 (49.2%) cases of male, or a sex ratio of 0.96. The average age was 36,55 year-old with extremes of 5 and 84 years. Employees and pupils were the most affected by extractions (33 cases; 47,8% and 22 cases; 33,8%). Dental extractions were more frequent in patients aged between 25 and 60 years. A total of 84 tooth extraction was performed in 65 patients, an average of 1.3 tooth extracted per patient. The most often extracted tooth was the third lower molar (17 cases, 22,95%). The canine was the less often extracted tooth (1 case, 1,35%). Dental decay and its complications (57 cases, 67,87%) and periodontal diseases (10 cases, 11,90%) were the commonest reasons for dental extractions. CONCLUSION: Dental decay and periodontal diseases are the most important causes of dental extractions. Particular emphasis should be placed on prevention and early care of teeth.

[Mandibular fractures in children. Apropos of 20 cases]. / Les fractures mandibulaires de l'enfant. A propos de 20 cas.

Authors report their experiences about the caring for child mandible fractures at Yalgado Ouedraogo University Hospital Centre, CHUYO. These fractures constitute day-to-day relative immediate emergencies. The techniques of retention used after bone setting are various. Ligatures with steel thread are frequently used. The retention is shortened because of the quick strengthening noticed in child. The satisfying results reveal the necessity of classical retention and ligatures with steel thread in jawbone fractures.

[Oro-facial manifestations during AIDS/HIV infection. Apropos of 60 cases seen at the Ambulatory Treatment Center in Ouagadougou and at the Yalgado University Hospital Center]. / Les manifestations bucco-faciales au cours de l'infection VIH/SIDA. A propos de 60 cas vus au Centre de Traitement Ambulatoire de Ouagadougou et au Centre Hospitalier Universitaire Yalgado (CHU-YO).

The opportinistics complaints of the AIDS occur all along the episode of the infection and depend on the individual's body immunity and on the existence or no of an anti-retroviral treatment. The buccal appearences on the face are relatively frequent. They are dominated by the buccal mycosis, the lymphatic ganglion's complaints, the inflammation of gums and buccal mucous, and the tooth decay in our context. Some authors suggest a classification that can make easy their study and treatment. Complaints like the herpes simplex infection, the herpes zoster infection, are usually found during the symptomatic stage non AIDS, whereas others like KAPOSI's disease are typical to AIDS disease. The availlability of an anti-retroviral treatment and a specialized one strenghten the efficiency of the reimbursement and improve the prognosis.

Should we still perform angioplasty and stenting of an unprotected left main coronary artery stenosis in heart transplant patients? Two new cases and a review of the literature.

Coronary balloon angioplasty with stent implantation has emerged as a possible alternative to bypass grafting or repeat transplantation in left main coronary stenosis in heart transplant patients. We report 2 new cases of stent implantation for unprotected and isolated left main stenosis in heart transplant patients. Despite an initially successful procedure, restenosis prompted the performance of bypass surgery in both patients. The relative advantages and disadvantages of available techniques of revascularization are discussed in the context of the literature.

Infective endocarditis due to Streptococcus bovis. A report of 53 cases.

Fifty-three patients (42 men; 11 women) with Streptococcus bovis infective endocarditis attended a tertiary cardiology hospital between 1980 and 1991, and constituted 11% of the total number of infective endocarditis cases hospitalized there during that period. The mean age was 59 +/- 15 years; 15 had previously suffered valvular disease (12) or had a valvular prosthesis (3); one patient had had a previous infective endocarditis. The infective episode involved the aortic valve in 26 patients, both the aortic and mitral valves in 18 patients, the mitral valve only in six and other valves in three. Echocardiographic examination showed one or more vegetations in 44 patients. Cardiac failure was diagnosed in 35 patients and embolic episodes in 22, of whom 11 were cerebrovascular accidents. The patients became afebrile 19 +/- 39 days after starting antibiotic treatment. Valve replacement was performed in 37 patients during their initial hospitalization, and in four during follow-up. After a mean follow-up of 4.6 +/- 3.1 years with a 100% follow-up, 15 patients died: 1 preoperatively, one in the first 30 days after operation, 13 later (8141 operated patients and 5/12 non-operated patients). Actuarial survival was 73% at 5 years. Gastrointestinal signs were present in 12 patients; 43 patients (81%) had a full colonic examination which showed polyps in 20 patients and adenocarcinomas in seven. Of 11 late deaths four were related to a malignant colonic tumour. This study confirms that Streptococcus bövis infective endocarditis is 'relatively benign', but it stresses the frequency and potential severity of the associated colonic lesions, requiring colonoscopy and making the treatment of high risk lesions mandatory.

[Has life expectancy of patients after surgery for aortic valve endocarditis improved over the last twelve years?]. / L'espérance de vie des malades opérés pour endocardite infectieuse aortique a-t-elle augmentée dans les douze dernières années?

Between 1983 and 1991, 104 patients (average age: 52 +/- 13 years) with aortic endocarditis (94 on native and 10 on prosthetic valves), were operated, 81 before the end of antibiotic therapy. Blood cultures were negative in 17 patients, identified a streptococcus in 49 patients, a staphylococcus in 16 patients, and a Gram negative or other organism in 22 patients. The following complications were observed before surgery: severe cardiac failure in 67 patients, renal failure in 24 patients, conduction defects in 13 patients, neurological complications in 13 patients, systemic or coronary embolism in 12 patients. Aortic valve replacement was performed in all patients, associated with mitral valve replacement in 25 patients and tricuspid valve replacement in 1 patient. Twelve patients died after surgery (11/81 of early operations, 1/23 operated later; NS). During a follow up of 3.5 +/- 2.8 years, there were 24 late deaths, 12 of non cardiovascular causes. Of the 20 variables tested, 3 were related to perioperative and late mortality (age, cardiac and renal failure). The 5 year survival (58.1 +/- 5.7%) is identical to that of the period 1970-1982 despite a very significant drop in perioperative mortality. Some of the causes of late mortality (older age of patients, changes in the infecting organisms) provide little hope of improving the prognosis in the near future. Others suggest that earlier surgery could improve the long term prognosis.

[Radionuclide ejection fraction at rest and in exercise in chronic aortic insufficiency. Pre- and postoperative study in asymptomatic or paucisymptomatic patients]. / Fraction d'éjection isotopique du ventricle gauche au repos et à l'effort dans l'insuffisance aortique chronique. Etude pré- et postopératoire chez les patients a- ou paucisymptomatiques.

Twenty patients (17 men and 3 women: average age 50 +/- 14 years) with asymptomatic or paucisymptomatic aortic regurgitation were studied to compare the values of radionuclide left ventricular ejection fraction (EF) at rest and on exercise before (1) and 6 +/- 1 months (2) and 5.7 +/- 1.1 years (3) after surgery. The resting EF was similar at all three examinations: 53 +/- 8 (1); 57 +/- 8 (2); 55 +/- 16 (3). However, it increased significantly on exercise from 40 +/- 10 (1) to 54 +/- 12 (2) (p < 0.001) and to 52 +/- 20 (3) (p = 0.036 versus 1). In the 7 patients with resting EF greater than 55 before surgery, there was no postoperative improvement: 61 +/- 6 (1); 61 +/- 5 (2); 65 +/- 9 (3). However, the exercise EF increased from 44 +/- 13 (1) to 55 +/- 17 (2) and 69 +/- 11 (3) (p = 0.004 vs 1). In 13 patients with resting EF < 55%, the value increased in the early postoperative phase but not later: resting: 49 +/- 5 (1); 55 +/- 8 (2) (p = 0.04); 49 +/- 17 (3) (NS vs 1); effort: 38 +/- 7 (1); 54 +/- 10 (2) (p < 0.001); 40 +/- 16 (3) (NS vs 1). Left ventricular systolic function only returns to normal and exercise after surgery in patients with resting preoperative EF > or = 55%, but nothing indicates that this normalisation is an absolute condition for a successful surgical result in aortic insufficiency in terms of survival and quality of life.

[Value of coronary angiography in the diagnosis of coronary artery disease of the transplanted heart. Coronary angiography and arteriosclerosis of the graft]. / Valeur de la coronarographie dans le diagnostic de la maladie des artères coronaires du greffon après transplantation cardiaque. Coronarographie et athérosclérose du greffon.

The diagnostic value of coronary angiography, a widespread method of detection of transplant coronary artery disease, was studied in 17 cardiac transplant patients with reference to histological examination. In the 6 coronary segments studied, the only significant but weak correlation that was found was for the distal left anterior descending artery: the correlations were not statistically significant in the other 5 segments. Coronary angiography underestimated lesions and false negative results were frequently reported (66 and 27% respectively). The limitations of coronary angiography may be explained by the technical artefacts related to both methods of evaluation and the anatomically diffuse and distal nature of transplant coronary artery atherosclerosis. A more reliable diagnostic method would seem to be required in view of the clinical importance of this pathology.

[Prognosis of non-revascularized triple coronary vessel disease. Apropos of 87 cases]. / Pronostic des coronariens tritronculaires non revascularisés. A propos de 87 observations.

Between 1982 and 1988, 87 patients (74 men, 13 women), with an average age of 59.6 +/- 10.1 years, had triple coronary artery disease and did not undergo any medical or surgical revascularisation, mainly because of the severity of the coronary disease or left ventricular dysfunction. Sixty-four patients had previous myocardial infarction, 33 unstable angina and 37 left ventricular failure. At coronary angiography, 31 patients had Class III or IV (NYHA) angina. The cardiothoracic ratio was 0.50 +/- 0.06; the left ventricular ejection fraction was 0.47 +/- 0.20. During follow-up of 3.9 +/- 2.6 years (2 patients lost to follow-up), 35 patients died (26 of cardiac and 9 of non-cardiac causes), giving a 5 year actuarial survival of 63%. In univariate analysis, the factors predictive of increased cardiac mortality were: absence of alcohol consumption (p = 0.013); class 3 or 4 angina (p = 0.017); resting angina (p = 0.030); cardiac failure (p = 0.0006); chest X ray showing interstitial or alveolar oedema (p = 0.002); increased cardiothoracic ratio (p = 0.003). A decreased left ventricular ejection fraction was only at the limit of statistical significance (p = 0.054). In multivariate analysis (Cox model), only 4 variables were correlated with increased cardiovascular mortality: resting angina (relative risk, RR = 2.56), cardiac failure (RR = 2.55), increased cardiothoracic ratio (RR = 2.14), absence of alcohol consumption (RR = 4.43). These results confirm the poor prognosis of patients with triple vessel disease not revascularised. They show the value of clinical appreciation to determine the prognosis of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pre- and postoperative ventricular arrhythmia in mitral valve insufficiency]. / Les arythmies ventriculaires pré- et postopératoires de l'insuffisance mitrale.

In order to assess the prevalence and prognosis of ventricular arrhythmias in patients with surgical mitral regurgitation, a prospective cooperative study was undertaken in 14 French cardiological centres. Seventy-nine patients (45 men, 34 women, average age 62.8 +/- 12.8 years), who underwent mitral valvuloplasty (44 cases) or valve replacement (35 cases), were included. Three 24 hour Holter recordings were performed before, 15 days and 6 months after surgery. Etiology of mitral disease was dystrophic in 49 patients, degenerative in 11, rheumatic in 10, post-endocarditis in 3 and undetermined in 6. Only 5 patients had a left ventricular ejection fraction < or = 45 %. Complex ventricular arrhythmias (Lown > or = 4) were recorded before surgery in 22 patients (28 %), more often in dystrophic disease (17/49 versus 5/30, p = 0.04). No significant correlation was observed between the ventricular arrhythmias and the other preoperative findings, except for a tendency to an inverse correlation between the left ventricular ejection fraction and the Lown grade. Two patients died in the immediate postoperative period (Lown 1); 1 died of a non-cardiac cause at the 2nd month (Lown 4A). The prevalence of complex arrhythmias was unchanged after surgery (34 % on early Holter and 22% on late Holter recordings) with no difference between valvuloplasty and valve replacement. In conclusion, these results indicate that ventricular arrhythmias do not influence the early and 6 month postoperative prognosis in mitral regurgitation with good left ventricular function.

[Obstructive hypertrophic cardiomyopathy: medical or surgical treatment?]. / Myocardiopathie hypertrophique obstructive: traitement médical ou chirurgical?

This retrospective study assesses the results of medical and surgical treatment on survival and functional capacity of patients with hypertrophic obstructive cardiomyopathy (HOCM). Between 1981 and 1991, 73 patients were referred for treatment of HOCM: 24 were operated (Group 1) and 49 were treated medically (Group 2). Patients in Group 1 had more severe forms of HOCM than those in Group 2: 83% were in > or = NYHA Class III compared with only 20% in Group 2 (p = 0.003); 42% had previous cardiac failure compared with 16% in Group 2 (p = 0.02); 29% had atrial fibrillation compared with only 8% in Group 2 (p = 0.004); the average intraventricular pressure gradient was 78 mmHg compared with 42 mmHg in Group 2 (p = 0.001); mean pulmonary arterial pressures were 24 mmHg compared with 15 mmHg in Group 2 (p < 0.001); the cardiac index was 2.2 l/min/m2 compared with 2.7 l/min/m2 in Group 2 (p = 0.001); Sellers > or = grade 3 mitral regurgitation was present in 48% compared with 12% in Group 2 (p = 0.002). However, a family history of HOCM or of sudden death was commoner in Group 2 (28% vs 4% in Group 1: p = 0.03). Surgery consisted of myomectomy alone (5 patients) or associated with mitral valve replacement (MVR) (17 patients) or MVR alone (2 patients). Two patients in Group 1 died (1 perioperative death, 1 late death due to dissection of the aorta), giving over a 3.4 +/- 3.0 year follow-up period without any losses to follow-up, an abnormal mortality of 2.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of non invasive methods for the diagnosis of atherosclerosis of the graft after orthotopic cardiac transplantation]. / Evaluation des méthodes non invasives pour le diagnostic d'athérosclérose du greffon après transplantation cardiaque orthotopique.

The frequency and severity of atherosclerosis of the cardiac transplant make it an essential complication of cardiac transplantation. Coronary angiography is the usual diagnostic method but it has severe limitations. In order to evaluate other diagnostic methods coronary angiography and non-invasive techniques: echocardiography, exercise stress ECG, exercise radionuclide ejection fraction, stress Thallium scintigraphy, were performed practically simultaneously in 60 patients after cardiac transplantation. These non-invasive methods were said to be positive in the presence of, respectively, a segmental wall motion abnormality, ischaemic ST segment depression, absence of increased ejection fraction on exercise, reversible or irreversible myocardial hypofixation. Coronary angiography was considered as the reference procedure for distinction between "normal coronary circulation" (no angiographically detectable lesion) and "graft atherosclerosis" (at least one coronary stenosis irrespective of the severity and extension). None of the non-invasive methods had an adequate sensibility when compared with coronary angiography (echocardiography 0.27, exercise stress ECG 0.28, exercise radionuclide ejection fraction 0.64, myocardial scintigraphy 0.62) or negative predictive value (echocardiography 0.56, exercise stress ECG 0.58, exercise radionuclide ejection fraction 0.68, myocardial scintigraphy 0.66). This inadequacy of the non-invasive technique may be explained by the fact that they are more adapted to the diagnosis of myocardial ischaemia than that of coronary studies. In addition, the extent of the coronary lesions may have masked discordance between 2 segments by the global hypovascularisation. The results of this study indicate that the non-invasive methods studied cannot be recommended for diagnosis of atherosclerosis of cardiac transplants.

[Heart valve surgery and associated diseases in aged subjects]. / Chirurgie valvulaire et pathologies associées chez les sujets âgés.

The object of this study was to assess the additional risk related to associated pathology in patients aged 70 or over undergoing valvular heart surgery. Two hundred and thirty nine patients aged 70 to 87 years (average 74.6 +/- 3.2) underwent this form of surgery between October 1979 and June 1989. Sixty seven had coronary artery disease, 26 had atherosclerotic occlusive peripheral arterial disease, and 149 had one or more extracardiovascular pathology. Two hundred and thirteen patients underwent monovalvular and 26 bivalvular replacement. Coronary bypass was associated in 25 cases. Eighteen patients (7.5%) died in the 30 days following surgery. The perioperative mortality was not significantly greater in patients with extra-cardiac pathology (9.4% vs 4.4%; NS), in patients with coronary artery disease (11.9% vs 5.8%; NS), in patients with respiratory failure and FEV1 < 1 litre (1 death out of 20 cases) or in patients with renal failure and serum creatinine levels > or = 175 mumol/l (20% vs 6.3%, NS). Respiratory failure was the only extra-cardiac variable identified with increased perioperative morbidity. The perioperative mortality of elderly patients with valvular heart disease is greater than that of patients under 70 years of age (6.4% vs 2.1%) in our experience of the last 6 years p < 0.01). Associated arterial and extra-cardiac pathology does not significantly increase the mortality and strict selection of elderly inoperable patients together with improved surgical techniques and postoperative care has considerably reduced perioperative morbidity and mortality in this group of patients.