Mycobacterium canettii Tuberculosis Lymphadenopathy in a 3-Year-old Child.

A 3-year-old male originating from Djibouti presented with a cervical mass evolving for 2 months. Tuberculous lymphadenopathy was suspected based on biopsy results, and he improved quickly on standard antituberculous quadritherapy. Subsequently some features of the mycobacterium that grew in culture were unusual. The isolate was eventually identified as Mycobacterium canettii , a peculiar species of the Mycobacterium tuberculosis complex.

Oesophageal carcinoma in the horn of Africa Ten year cumulative experience in two hospitals in Djibouti.

INTRODUCTION: In this paper we report on our experience of diagnosis, treatment and follow up of cases of cancer of the oesophagus treated in Balbala Cheiko Hospital and in the Djibouty Military Hospital. Oesophageal cancer, mainly squamous cellular type, is the prevalent cancer of the gastrointestinal tract (GIT) observed in our two Hospitals. Djibouti is a small pacific country located in the Horn of Africa in the tropics, bordered by Somaliland in the south, Ethiopia in the southwest, Eritrea in the north and the Red Sea and the Gulf of Aden in the east. Yemen lies across the Gulf of Aden. Djibouti is the principal maritime port for Ethiopia. The country was formerly French Somaliland and it became independent from France in June 1977. It is a multi-ethnic nation with a population of just over 900,000. MATERIAL AND METHODS: From January 2011 to April 2021, we observed 159 patients diagnosed with cancer of the oesophagus: 89 females representing 56 % and 70 males representing 44 %. An Oesophageal Cancer Card (see Annex 1) was completed for each patient. 107 patients (67.30%) reported regularly (twice a week) chewing of khat (see Annex 2) and 68 patients (42,76%) regularly smoked more than 20 cigarettes and drank more than three very hot cups of coffee or tea per day. All patients underwent an oesophagoscopy with biopsy. Squamous Cell Carcinoma (OSCC) was confirmed by histology in all cases, 89 of them being females (64%) which is surprisingly different from data reported in the literature which reports a general prevalence of males. 60 patients (37.7 % of the total) underwent surgery. The Ivor-Lewis operation was the most frequent type of surgery and was done in 44 patients (66.6%). RESULTS: Our ten years experience involved two hospitals serving a large area. Cancer of the oesophagus (OC) was the prevalent gastrointestinal cancer we observed, second only to female breast cancer. There are no facilities in the country for radiotherapy. It is very difficult to report on long term survival because most of patients live in rural areas which are very difficult to reach and they rarely return for medical check-ups. The best survival recorded was a 48 year old Afar male who was still alive 6 years after an Ivor-Lewis operation was performed for squamous carcinoma on 3 April 2014 and checked on September 2020. A further 6 patients (2 males and 4 females, 3 with adenocarcinoma and 3 with squamous cell carcinoma) recently checked are still alive and come in regularly for check-up. CONCLUSIONS: Oesophageal cancer is one of the most frequent cancers found in the Horn of Africa and our experience in Djibouti confirms the data of the literature 16,28,29. A peculiarity in our study is the high prevalence in the female population. Our recommendation is to set-up an oesophageal cancer unit (OCU) with a team of specialists: gastroenterologist, surgical oncologist, anaesthesiologists, pathologists, nutritionalists and trained nurses who could ensure, not only hospital support, but also the active post operative follow up of patients. The implementation of a National Cancer Register would be mandatory. KEY WORDS: Oesophageal Cancer, Ivor Lewis Operation, Follow up, Djibouti.

Hg and 210Po in consumed fish of the Tadjoura Gulf (Djibouti): Levels and human health risk assessment.

Hg and 210Po were measured in the muscle tissue of commercially important fish species collected in the main coastal cities of the Djiboutian coast (Tadjoura Gulf) to evaluate the potential risk associated with their consumption. The levels of Hg among the different species ranged from 0.02 to 1.69 mg/kg w.w and exceeded tolerable limits as reported by the national regulation (2000-0727/PR/MAEM) and the Codex Alimentarius. The probabilistic distributions of health hazard were evaluated through Monte-Carlo simulation, which confirmed the carcinogenic risk from Hg. The levels of 210Po ranged from 4.1 to 134.5 Bq/kg w.w among muscle tissues of the eight commercially important species. The carcinogenic risk was in an unacceptable range and simulation revealed that children were the most vulnerable population. The results obtained confirms that the health impact is reduced when consuming two servings per week.

The Current State of Neurosurgery in Somaliland.

BACKGROUND: Surgical conditions account for as much as one third of the global burden of disease, yet 5 billion people worldwide do not have access to timely, affordable surgical care. These disparities in access to timely surgical care are most pronounced in low- and middle-income countries, where the availability of specialty surgical services such as neurosurgery are severely limited or completely absent. The African autonomous region of Somaliland, in the Horn of Africa, is one such region. METHODS: Discussions were conducted with key individuals in Somaliland to ascertain the current state of neurosurgery in Somaliland. RESULTS: The current state of neurosurgery in Somaliland was characterized. First, a background on the recent history of the republic and the surrounding region was furnished, which provides context for the challenging socioeconomic conditions in Somaliland. Brief biographical sketches were presented of local leaders and general surgeons who are actively working to improve economic and health conditions and who welcome opportunities to improve all health services, including neurosurgery. In addition, an overview was presented of new initiatives in capacity building in neurosurgery and sources of directed training and care in neurosurgery. CONCLUSIONS: This article provides the first-ever assessment of current neurosurgery-related activity in Somaliland. The article provides recommendations to guide the international neurosurgery community in future contributions.

Aloe djiboutiensis: Antioxidant Activity, Molecular Networking-Based Approach and In Vivo Toxicity of This Endemic Species in Djibouti.

For the first time, the study of the antioxidant activity, the characterization of the phytoconstituants, and the evaluation of in vitro and in vivo toxicity of A. djiboutiensis leave and latex are performed. The antioxidant activity of both latex (ADL) and the methanolic extract of leaves (ADM) is determined using 1-diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azino-bis 3-ethylbenzothiazoline-6-sulphonic acid (ABTS) scavenging radical methods and ferric reducing/antioxidant power (FRAP) assay. The phytochemical study of latex is done using Liquid Chromatography-Mass Spectrometry (LC-MS/MS) and a molecular networking-based approach. The evaluation of in vivo toxicity is performed on mice by oral gavage with a suspension of ADL. Our results show that weak antioxidant activity of ADL and ADM in opposition to their high polyphenol, 83.01 mg and 46.4 mg expressed in gallic acid equivalent (GAE)/g of dry weight (DW), respectively, and flavonoid contents 13.12 mg and 4.25 mg expressed in quercetin equivalent (QE)/g dry weight (DW), respectively. Using the Global Natural Products Social Molecular Networking (GNPS) website, nine (9) anthraquinones derivatives, ten (10) chromones derivatives, two (2) flavonols/ chromones isomers are annotated in the molecular network. The treated mice do not display abnormalities in their general physical appearance and biochemistry parameters, compared to the controls. Only glucose and calcium levels are slightly higher in male treated mice compared to the vehicles.

Chronic abdominal pain and diarrhea.

Pigmented macules on the patient's oral mucosa provided an important clue to the diagnosis.

Adenovirus Infections in African Humans and Wild Non-Human Primates: Great Diversity and Cross-Species Transmission.

Non-human primates (NHPs) are known hosts for adenoviruses (AdVs), so there is the possibility of the zoonotic or cross-species transmission of AdVs. As with humans, AdV infections in animals can cause diseases that range from asymptomatic to fatal. The aim of this study was to investigate the occurrence and diversity of AdVs in: (i) fecal samples of apes and monkeys from different African countries (Republic of Congo, Senegal, Djibouti and Algeria), (ii) stool of humans living near gorillas in the Republic of Congo, in order to explore the potential zoonotic risks. Samples were screened by real-time and standard PCRs, followed by the sequencing of the partial DNA polymerase gene in order to identify the AdV species. The prevalence was 3.3 folds higher in NHPs than in humans. More than 1/3 (35.8%) of the NHPs and 1/10 (10.5%) of the humans excreted AdVs in their feces. The positive rate was high in great apes (46%), with a maximum of 54.2% in chimpanzees (Pan troglodytes) and 35.9% in gorillas (Gorilla gorilla), followed by monkeys (25.6%), with 27.5% in Barbary macaques (Macaca sylvanus) and 23.1% in baboons (seven Papio papio and six Papio hamadryas). No green monkeys (Chlorocebus sabaeus) were found to be positive for AdVs. The AdVs detected in NHPs were members of Human mastadenovirus E (HAdV-E), HAdV-C or HAdV-B, and those in the humans belonged to HAdV-C or HAdV-D. HAdV-C members were detected in both gorillas and humans, with evidence of zoonotic transmission since phylogenetic analysis revealed that gorilla AdVs belonging to HAdV-C were genetically identical to strains detected in humans who had been living around gorillas, and, inversely, a HAdV-C member HAdV type was detected in gorillas. This confirms the gorilla-to-human transmission of adenovirus. which has been reported previously. In addition, HAdV-E members, the most often detected here, are widely distributed among NHP species regardless of their origin, i.e., HAdV-E members seem to lack host specificity. Virus isolation was successful from a human sample and the strain of the Mbo024 genome, of 35 kb, that was identified as belonging to HAdV-D, exhibited close identity to HAdV-D members for all genes. This study provides information on the AdVs that infect African NHPs and the human populations living nearby, with an evident zoonotic transmission. It is likely that AdVs crossed the species barrier between different NHP species (especially HAdV-E members), between NHPs and humans (especially HAdV-C), but also between humans, NHPs and other animal species.

First concurrent assessment of elemental- and organic-contaminant loads in skin biopsies of whale sharks from Djibouti.

The Gulf of Tadjoura (Djibouti) is an important site where the whale shark (Rhincodon typus Smith, 1828) aggregates seasonally. Because of the proximity to the port of Djibouti that is located along one of the busiest shipping areas in the world, whale sharks are potentially exposed to relatively high levels of trace elements and organochlorines. To assess their contamination status, concentrations of 15 trace elements, DDTs and PCBs were concurrently assessed for the first time in skin biopsies of 20 whale sharks. Additionally, 12 zooplankton samples were collected and analyzed for trace elements content. Concentration of As, Cu, Zn and Se were higher than in previous studies on this species. Whale shark samples exceeded the maximum allowable limits for foodstuffs for Cr, Pb Se, Cd and Zn. Results from this study suggests that Cr, Ni and Mo may biomagnify in this species. With regard to PCBs, the predominant congener were Tetra-CB, accounting for 41% of total PCBs and Penta-CB for 23%, while for DDTs, the predominant metabolite was DDE contributing for 51% of total compounds. The maximum residue limit for DDTs and for the ind-PCBs in fish set by U.S. EPA and by the EU regulation, respectively, was exceeded in 62% of whale sharks. Moreover, the p,p'DDE/ΣDDT ratios were higher than the critical value of 0.6, indicating possible recent inputs of technical DDTs in the area. This study suggests some concerns for the contamination status of whale sharks in Djibouti and, since major threats for this species include bycatch and illegal fisheries, highlights some level of risk from the exposure to elemental- and organic-contaminant via shark consumption.

Current practice in diagnosis and treatment of breast cancer in Cheicko Balbala Hospital Djibouti.

INTRODUCTION: This report details the results of the first breast cancer (BC) prevalence study done in Djibouti, a small country in the Horn of Africa. The study was done in the Surgical Department of Balbala Hospital (also known as the Italian Hospital). PATIENTS AND METHODS: 102 female patients with clinical BC were evaluated between 2012 and 2017. All patients came directly to the hospital without a prior referral. Fine Needle Aspiration (FNA) was carried out on all suspected lesions representing 40.6 % of patients. A biopsy was carried out on all clinically evident lesions. RESULTS: Following histopathological confirmation for all patients, 86 women (84,31%) accepted surgical procedure and clinico-histopathological staging was possible. 16 (15.69%) women refused surgery. There are no radiotherapy and chemotherapy facilities in Djibouti however hormonal therapy, Tamoxifen, is available. CONCLUSIONS: The Italian Government built the Hospital in 1985 in Balbala, a District of Djibouti Ville ,with a population of over 250.000. It is an example of a successful cooperation between Italy and Djibouti in the health sector. Following a long period of assistance and support from the Italian Ministry of Foreign Affairs, the Hospital is now taken completely managed by the Ministry of Health of Djibouti . The hospital is one of the main referral hospitals in the country. Better provision of information to the local population and medical general practitioner about breast cancer would improve diagnosis, the treatment and the overall prognosis of this disease. KEY WORDS: Breast Cancer, Epidemiology, Surgery, Italian Balbala Hospital Djibouti.

The contribution of pediatric surgery to poverty trajectories in Somaliland.

BACKGROUND: The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. METHODS: This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. RESULTS: We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. CONCLUSION: Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment.

Trace elements and POPs in two commercial shark species from Djibouti: Implications for human exposure.

Within Djibouti (Gulf of Aden), the scalloped hammerhead shark (Sphyrna lewini) and milk shark (Rhizoprionodon acutus) are important components of the artisanal fishery and they are caught to be exported or sold for local consumption. However, little scientific information exists on the contamination load of these species in this area of the world. With global populations of elasmobranchs in decline, understanding the extent of contaminant exposure is critical to future conservation as well as to assess the health risks for consumers of these species. The contaminants analyzed in this study comprised PCB, DDT and trace elements in livers, muscles and fins of both hammerhead sharks and milk sharks. The overall organochlorine compounds (OCs) and trace elements concentrations were similar among the two sharks' species and the pattern of PCB and DDT tissue distribution showed the highest burdens in livers compared with muscles and fins. However, the different accumulation profiles of OCs among shark species suggest species-specific accumulation of these contaminants. The p,p'DDE/∑DDT ratios were equal or slightly higher than the critic value of 0.6, suggesting possible recent inputs of technical DDT in the area. Concentration of trace elements from this study were generally comparable to those found in sharks from other areas of the world and, highlight the wide variation in metal concentrations between species, individuals and tissues. As far as Hg is concerned, scalloped hammerhead sharks showed higher accumulation in muscles compared with milk sharks. Both species showed elevated concentration of Se, which might be related to high Hg levels since Se inhibits Hg toxicity. The potential cancer risk for PCB, Cd, Ni, Cr and As fell within the range of 10-6-10-4, suggesting some concerns for the overall contamination levels in both species. Indeed, consuming of fish involves a mixture of all analyzed elements, and therefore, some potential risk might arise from regularly consuming these species.

Khat chewing and cirrhosis in Somaliland: Case series.

BACKGROUND: Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. AIM: To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. SETTINGS: A university-affiliated teaching hospital in Somaliland. METHODS: Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. RESULTS: Eight Somali men aged 27-70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15-128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. CONCLUSION: Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis.

Prevalence of Primary HPV in Djibouti: Feasibility of Screening for Early Diagnosis of Squamous Intraepithelial Lesions.

OBJECTIVE: In many African Sub-Saharan countries, human papilloma virus (HPV) prevalence data are not available. The current study estimated the prevalence of HPV virus in the female population of Djibouti. METHODS: Approximately 1000 asymptomatic women 16 to 64 years old were enrolled from 3 of the main health structures of Djibouti in 2014 and 2015; 998 cervical samples were tested for HPV-DNA of high risk types, 499 during the first year, and 499 during the second. Positive samples were typed with an HPV genotyping kit. RESULTS: The women were an average age of 38.8 years (SD, 10.2); 54 women tested positive for HPV (prevalence rate, 5.4% [95% confidence interval, 4.0-6.8]). The highest prevalence was observed among the women younger than 35 years. HPV66 was the most prevalent (15.4% of the infections), followed by HPV31 and HPV52 (10.8% both) and HPV16 (9.2%). All 54 women who tested HPV-positive underwent a Pap test, which was positive in 8 cases (14.8%): 2 high-grade squamous intraepithelial lesion (HSIL) and 6 low-grade (LSIL). CONCLUSIONS: The HPV prevalence shows a curve by age similar to that of other African countries. The proportion of HPV16 is among the lowest ever seen in similar studies. The findings suggest to Djibouti the choice of a strategy of screening that includes forms of cytological triage, thus limiting recourse to colposcopy.

Diagnostic Accuracy of Emergency Physician-Performed Ultrasound for Acute Appendicitis in a Remote Location.

BACKGROUND: Preoperative imaging for suspected acute appendicitis (AA), such as ultrasonography (US), was shown to improve diagnostic accuracy and patient outcomes. Criteria for diagnosis of AA by US are well established and reliable. In previous studies, US assessments were always performed by skilled radiologist physicians. However, a radiologist and computed tomography scanning equipment are not always available in the community hospitals or remote sites of developing countries. OBJECTIVE: Our aim was to assess a diagnostic pathway using clinical evaluation, routine US performed by an emergency physician, and clinical re-evaluation for patients suspected of having AA. METHODS: Patients suspected of having AA admitted to the emergency department in a developing country were prospectively enrolled between November 2010 and January 2011. Clinical and US data were studied. A noncompressible appendix with a diameter ≥6 mm was the main US diagnosis criterion. RESULTS: Among the 104 included patients, surgery was performed on 28. Of the 25 patients with positive US, 22 actually had AA, matching the surgical report. The remaining 76 patients without US appendicitis criteria underwent clinical follow-up and had medical conditions. Sensitivity of US was 88%, specificity was 96%, positive predictive value was 88%, and negative predictive value was 96%. The likelihood ratios for our US assessment highlight the need for a test with enhanced diagnostic accuracy. CONCLUSIONS: A diagnostic strategy using clinical evaluations, routine US performed by emergency physicians, and clinical re-evaluation of patients with acute abdominal pain is appropriate to provide positive results for the diagnosis and treatment of appendicitis in remote locations.

Cardiovascular risk factors and physical activity among university students in Somaliland.

Physical inactivity is a well-known risk factor for the development of cardiovascular diseases and counts as fourth leading cause of death worldwide. The study aimed to elucidate to what extent cardiovascular risk factors exist in university students in Somaliland. In a cross-sectional survey, self-administered questionnaires were used to elucidate existence of cardiovascular risk factors in 173 university students (117 male, 56 female) in Hargeisa, Somaliland. Information elucidated included socio-economic and demographic data in addition to questions on coffee intake, on physical activity behavior, type of sport/activity and intensity and duration. Height and weight were taken, as was blood pressure (BP). Median age was 23 years in male and 20 years in female students. Mean BMI was 19.7 in male and 21.8 in female students. The prevalence rates of elevated BP and overweight (BMI ≥ 25) in female and male students were, 0 versus 9 and 14 versus 7 %, respectively. Coffee consumption was reported by 39 % of students. None of the female students reported smoking cigarettes, while 5.1 % of the male students did. Physical inactivity was reported by 52 % of the female students and 27 % of the male students (p = 0.01). Overall, male students reported a higher degree and intensity of physical activity. The prevalence of cardiovascular risk factors is low in female and male university students in Somaliland. However, the results demonstrate a high degree of physical inactivity and overweight might become a problem in the future. This issue should be addressed by increasing the motivation and opportunities for physical activity in students.

Are the new IADPSG criteria for gestational diabetes useful in a country with a very high prevalence?

The International Association of Diabetes and Pregnancy Study Groups released new recommendations on screening methods and diagnostic criteria for gestational diabetes. The main objectives of the present study were to analyze characteristics of mothers who underwent the new screening test, and to assess the prevalence of gestational diabetes and related pregnancy complications such as the 5-minute Apgar score <7, in a urban maternity clinic in Djibouti. The effect of treating gestational diabetes was also evaluated. Totally, 231 mothers underwent the new screening test, and 106 were diagnosed as having gestational diabetes (45.9%). Mothers with gestational diabetes had an excess risk of low Apgar scores, even after adjustment for socio-economic and medical covariates, with an odds ratio of 6.34 (1.77-22.66), p value <0.005. Only 46.2% of mothers with gestational diabetes followed the recommendations regarding treatment. Among these patients, 18.6% of infants from untreated mothers had a 5-minute Apgar score <7, compared to 3.9% infants from treated mothers (p value = 0.017). After adjustment, untreated mothers still had a high excess risk of low Apgar scores, although non-significant, with an odds ratio of 4.67 (0.78-27.87), p value = 0.09. In conclusion, gestational diabetes is highly prevalent in Djibouti and is related to low Apgar scores.

[Heart failure patterns in Djibouti: epidemiologic transition]. / Insuffisance cardiaque chez l'adulte à Djibouti : la perspective d'une transition épidémiologique.

BACKGROUND: The features of heart failure (HF) in Djibouti have not been well described. We sought to document the current patterns of HF here. METHODS: We prospectively included Djiboutian adults hospitalized for HF in the French Military Hospital (Djibouti) from August 2008 through December 2010. RESULTS: Of 1688 adults hospitalized in the medical department, 45 (2.7%) had symptomatic HF: 38 (84%) men, mean age 55.8 years (range 27-75). Twenty-five (56%) patients were initially hospitalized for acute pulmonary edema. The underlying diseases included coronary artery disease (CAD) (62%), hypertensive heart disease (18%), rheumatic valvular disease (13%), and primary dilated cardiomyopathy (7%). Their cardiovascular risk factors included tobacco use (53%), hypertension (69%), diabetes (47%), and hypercholesterolemia (51%). Patients in the CAD group were older, and had diabetes more often (p<0.01). All khat chewers (53%) were males and smokers. Mean left ventricular ejection fraction (LVEF) was 39 ± 14%. During follow-up (14.4 ± 9 months), 8 (18%) patients died, 9 (20%) were again hospitalized for HF, and 3 (7%) had ischemic strokes. One month after discharge, the New York Heart Association (NYHA) class was II for 40%, III for 44%, and IV for 16%. Higher NYHA classes and dilated cardiomyopathy were both associated with poorer outcomes (p<0.03). CONCLUSION: In hospitalized Djiboutians, most HF patterns are similar to those in industrialized countries. CAD is more prevalent than previously reported in African patients with HF.

Cardiovascular disease in children in Djibouti: a single-centre study.

INTRODUCTION: Few data are available about pediatric cardiovascular disease (CVD) in the Horn of Africa. The objective of this study was to describe the spectrum of CVD in children in Djibouti. METHODS: Clinical features and management of Djiboutian children between 1 month-old and 15 year-old with CVD were prospectively recorded over a two-year period in Bouffard Military Hospital in Djibouti (January 2009- December 2010). RESULTS: Clinical examination and echocardiography were performed on 156 patients: 32 of them (20%) had CVD. Three (10%) of them had Down's syndrome. The median age was 5 years (male 53%). Congenital heart disease was observed in 27 (84%) patients and dilated cardiomyopathy (DCM) in 5 (16%) patients including 2 patients with rheumatic valvular disease. Ventricular septal defect was frequent (28%). Other abnormalities were atrial septal defect (13%), Tetralogy of Fallot (9%), pulmonary stenosis (6%) and 3 other patients had multiple congenital anomalies condition. Surgical management was required in 22 (69%) patients and was performed on 15 (47%) cases. During follow up (mean 11.3 ± 6.8 months), 5 (16%) patients died. Absence of surgery was associated with significant mortality (p > 0.05) but age, sex and mean follow up were not. CONCLUSION: Pediatric CVD is at least as common in this Djiboutian community as in other African cohorts. The absence of surgery was a major mortality risk factor. DCM was frequent in this study. Much work remains to be done to discover the size and nature of genetic and environmental contributions to these various forms of heart diseases in the Horn of Africa.

[Invasive aspergillosis of sphenoidal sinus in a patient in Djibouti, revealed by palsy of cranial nerves: a case report]. / Aspergillose invasive du sinus sphénoïdal révélée par une paralysie de paires crâniennes : à propos d'un cas pris en charge à Djibouti.

The authors report a case of invasive aspergillosis of a sphenoid sinus mucocele revealed in a patient with diabetes in Djibouti by homolateral palsy of the 3rd, 4th, 5th and 6th nerves. This rare condition occurs preferentially in immunodeficient subjects. Because of its clinical polymorphism, its diagnosis is difficult and is often not made until complications develop. Endonasal surgery with anatomopathological and mycological examination is both a diagnostic and therapeutic procedure. It must be performed early, to avoid functional or even life-threatening complications.

[Acute myocardial infarction in Djibouti: 2-year prospective study]. / Infarctus du myocarde en phase aiguë à Djibouti : étude prospective sur deux ans.

OBJECTIVES: Acute myocardial infarction (AMI) is a life-threatening emergency. In Africa, the increasing prevalence of cardiovascular risk factors is leading to an epidemiological transition. No data have yet been reported about AMI in Djibouti. PATIENTS AND METHODS: This study prospectively included all patients with acute coronary syndrome and persistent ST segment elevation admitted to the emergency department of Bouffard Military Hospital in Djibouti from January 2009 through December 2010. It analyzed their clinical data and management. RESULTS: The study included 35 patients. Their mean age was 52 ± 11 years [range: 29-76]. The sex ratio was 7.7 (men/women). Cardiovascular risk factors were: hypercholesterolemia (83%), tobacco use (60%), khat chewing (57%), diabetes (49%), hypertension (46%), and heredity (20%). AMI was anterior in 40% of cases. Fifteen patients (43%) arrived within 12 hours after the onset of symptoms (average 5 hours); thrombolysis was successful for 11 of them (73%). Seven patients (20%) died over the entire follow-up (11.3 ± 9 months), 5 within the first month. Mortality was significantly associated with diabetes (p<0.01), initial severe clinical complications (p<0.01) and initial low left ventricular ejection fraction (p<10(-6)). CONCLUSION: Patients with AMI in Djibouti are 10 to 15 years younger than in Western countries. Their high level of cardiovascular risk is remarkable. Khat use did not significantly affect prognosis. The high mortality rate was similar to rates reported before the percutaneous coronary angioplasty era.