[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]. / Les infections associees aux soins dans le departement de gynecologie ­ obstetrique du Centre Hospitalier Universitaire Gabriel Toure de bamako, mali.

OBJECTIF: the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré). PATIENTS AND METHODS: This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day. RESULTS: We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs. CONCLUSION: the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

LE BUT: de ce travail était d'étudier les infections associées aux soins dans le département de gynécologie ­obstétrique du Centre Hospitalier Universitaire Gabriel Touré (CHU G. Touré). PATIENTES ET MÉTHODES: Il s'agissait d'une étude épidémiologique, descriptive, analytique réalisée dans le département de gynécologie ­obstétrique du CHU G. Touré, allant du 11 Avril 2016 au 29 Août 2016 (4 mois et 18 jours) à collecte prospective des données qui a porté sur les caractéristiques cliniques et biologiques des infections associées aux soins chez les patientes au cours de leur hospitalisation. Etaient incluses dans l'étude toutes les patientes hospitalisées (opérées ou non) dans le service de gynécologie obstétrique, et qui ont accepté de participer à l'étude.Les critères utilisés pour le diagnostic de l'infection associée aux soins étaient ceux du CDC d'Atlanta et la réalisation d'une goutte épaisse dans notre contexte. Une surveillance des plaies opératoires a été faite jusqu'au 30ème jour post-opératoire. RÉSULTATS: Nous avons enregistrés 200 patientes dont 138 opérées et 62 non opérées parmi lesquelles 30 patientes ont développé une infection associée aux soins soit un taux de 15%. L'âge moyen des patientes ayant présenté une infection a été 32,52 ans ±13,36 ans contre 29.36 ans ±10,28 ans pour les patientes n'ayant pas présenté l'infection. Sept virgule cinq pourcent des patientes évacuées ont présenté une infection associée aux soins. Les types d'infections les plus retrouvés étaient l'infection du site opératoire avec 56,60% suivie du paludisme avec 23,30% et l'infection urinaire avec 20,00%. L'Escherichia coli et l'Acinetobacterbaumanii ont été les germes les plus retrouvés. Les germes isolés étaient dans 100% des cas résistants à l'Amoxicilline, dans 88,88% des cas résistants à la Ciprofloxacine et dans 77.77% des cas résistants à l'Amoxicilline +Acide clavulanique. La durée moyenne d'hospitalisation des patientes ayant développé l'infection a été 14,70 jours avec des extrêmes de 5 et 46 jours.Le taux de mortalité a été de 1,50%. Le coût moyen de prise en charge des patientes ayant développé l'infection a été 119837 FCFA ; les extrêmes ont été 17750 et 825750 FCFA et l'écart type de 174998 francs CFA. CONCLUSION: les infections associées aux soins restent fréquentes dans notre service et dominées par les infections du site opératoire. Les germes isolés étaient tous résistants dans 100% cas à l'Amoxicilline dans 88,88% cas à la Ciprofloxacine.

[Rhegmatogenous retinal detachment: Topography of breaks and agreement with lincoff's rules]. / Décollement de rétine rhegmatogène : topographie des déhiscences et conformité aux lois de Lincoff.

PURPOSE: To study the topography of retinal breaks and their agreement with Lincoff's rules. MATERIALS AND METHODS: We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included. RESULTS: Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed. DISCUSSION: Lincoff's rules are still relevant for localization of the breaks in retinal detachments. CONCLUSION: Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments.

[Ametropia among senegalese children in a hospital setting]. / Amétropie de l'enfant sénégalais en milieu hospitalier.

INTRODUCTION: Ametropia is common in children and cause strabismus and amblyopia. The goal was to establish its prevalence in a hospital setting among Senegalese children. PATIENTS AND METHODS: This was a retrospective study of patients under 15 years of age with clear ocular media. The marital status, circumstances of discovery, and results of cycloplegic refraction were recorded. RESULTS: Of 1506 children, 175 demonstrated ametropia. The mean age was 8 years, and the male : female ratio was 0.68. Family history of ametropia was present in 8.5 %. Decreased VA was present in 39.66 %, headache 10.06 %, and strabismus 4.47 %. Automated refraction in 109 patients and skiascopy in one patient showed 58.18 % cases of myopia, 18.18 % of hyperopia and 36.57 % of astigmatism. DISCUSSION: The most common ametropia was myopia. Patients were referred for symptomatic ametropia. CONCLUSION: Screening for ametropia might occur earlier if it is associated with pediatric monitoring in our regions.

[Role of CT in diagnosis and monitoring of retinoblastoma in Senegal]. / Apport de la TDM dans le diagnostic et le suivi du retinoblastome au Sénégal.

INTRODUCTION: Retinoblastoma is a malignant tumor of neuroepithelial origin, developed from young retinal cells, occurring in infants and young children. The goal of the study was to assess the role of CT in the diagnosis of retinoblastoma at the Aristide le Dantec Hospital in Dakar. PATIENTS AND METHODS: This is an 11-year retrospective study of 160 patient records in the ophthalmology department and pediatric oncology unit of the same hospital. RESULTS: One hundred and sixty (160) patients were recruited. The male:female ratio was 1.05. The mean age was 32.19 months. Leukocoria was the most common clinical sign, occurring in 105 cases (65.62 %). The retinoblastoma was intraocular in 97 cases (60.62 %). We saw 122 (76.25 %) unilateral and 3 (1.87 %) trilateral presentations. CT was performed in 150 children with 110 cases (73.33 %) of calcifications ; 62 cases (41.33 %) of optic nerve invasion ; 24 cases (16 %) of extraocular muscle invasion and 18 cases (12 %) endocranial extension. Associated tumors were found on CT: 2 cases of suprasellar mass and 1 case of pineoblastoma. In patients whose specimens were analyzed, histology showed 48.15 % optic nerve invasion, consistent with the CT findings. DISCUSSION: CT has an important role in the diagnosis of retinoblastoma, despite its recent contraindication in bilateral and unilateral multinodular forms. CONCLUSION: CT is a good alternative to MRI in the diagnosis of retinoblastoma in developing countries with limited technological resources.

[Evaluation of mean macular thickness by optical coherence tomography (SD OCT) in black Senegalese subjects]. / Évaluation de l'épaisseur maculaire moyenne par la tomographie en cohérence optique (SD OCT) chez le sujet mélanoderme sénégalais.

INTRODUCTION: Our goal was to evaluate the normal macular thickness in Blacks by OCT and to determine socio-demographic and clinical parameters which may influence it. MATERIALS AND METHODS: This was a multicenter, prospective, descriptive study over 6 months. It included Black adults followed in the ophthalmology departments of Abass Ndao and Aristide-Le-Dantec hospitals in Dakar. Included subjects had corrected visual acuity of 10/10 (0 logMAR) and P2 (+0.1 logMAR), clear ocular media, and no retinal abnormalities. We used the Topcon 3D 2000 OCT to measure the central thicknesses of the cornea (CT) and of the macula (MT), and cup to disc ratio (C/D) in each eye. Socio-demographic, clinical and tomographic data were collected on a survey form and correlated to the MT. The analysis was carried out by the Epi info 7 software. We used the Chi2 comparison test with a P value˂0.05. RESULTS: One hundred and nine patients were included. The mean age was 27.39 years with a male/female ratio of 0.65. The subjects were emmetropic in 54.13% of cases. The mean CT was 519.97µm, the mean C/D was 0.23, and the mean MT was 264.35µm. The P-value (P) was greater than or equal to 0.1 for all the factors studied. CONCLUSION: MT in our study was lower than that of Whites, and the various parameters studied did not demonstrate a statistically significant influence on MT.

[Giant retinal tears: Senegalese experience]. / Aspect thérapeutique des déchirures géantes de la rétine : expérience sénégalaise.

PURPOSE: To appreciate the epidemiological characteristics and to show the therapeutic aspects of the giant retinal tears. PATIENTS AND METHODS: We conducted a retrospective study from January 2014 to June 2017 on subjects with giant retinal tears. Patients with media opacities limiting examination were excluded. RESULTS: We identified 17 cases of giant retinal tears. The frequency of detachments related to a giant retinal tear was 17% compared to all retinal tears. The mean age was 50.75 years with a sex ratio (M/F) of 6.5. We found three cases of high myopia, one case of hyperopia and four trauma cases. All patients had a decrease in visual acuity. The average time to consultation was four weeks. The mean intraocular pressure was 8mmHg. The tear was found in the left eye in eight cases and in the right eye in five cases; two cases were bilateral. We performed intraocular surgery in five eyes and laser in four eyes. We achieved anatomical reattachment and functional improvement in all operated patients. COMMENTS AND CONCLUSION: The prognosis of a giant retinal tear remains guarded, especially if patients are seen and treated late. Laser photocoagulation of giant tears remains effective, especially in cases of early diagnosis.

[Perception of ocular blinding manifestations of sickle cell disease by practitioners in Dakar university hospital]. / Perception des lésions oculaires cécitantes de la drépanocytose par les praticiens hospitalo-universitaire de Dakar.

INTRODUCTION: In Senegal, 10% of the population are said to be carriers of hemoglobin S, the most widespread hemoglobinopathy in the world. It is responsible for potentially blinding ophthalmological manifestations. Few practitioners refer patients for ophthalmologic screening. The goal of our study was to assess the level of knowledge of practitioners of the blinding ocular lesions of sickle cell disease. MATERIALS AND METHODS: A cross-sectional prospective study was carried out over five months. It included Dakar university hospital practitioners aside from ophthalmologists. On the survey form, each practitioner specified his or her specialty and responded to eight questions regarding sickle cell patients seen in consultation, knowledge of the blinding lesions related to the disease, and ocular monitoring for blinding systemic diseases. The practitioners were divided into three groups: department of medicine and medical specialties (group I), surgery and surgical specialties (group II), and biology and functional testing (group III). The descriptive analysis was done with the EPI-INFO software version 6.04. RESULTS: The participation rate was 45.88%. Group I represented 45.29% of the sample, Group II 35.85% and Group III 18.86%. In all, 87.73% of practitioners saw sickle cell patients in consultation, 75.47% were aware of ocular involvement related to sickle cell disease, and 58.49% were aware of blinding lesions. 94.62% of practitioners saw sickle cell disease patients without systematically recommending ophthalmological consultation. CONCLUSION: Practitioners' level of knowledge of the blinding ocular lesions of sickle cell disease is considered to be low.

[A systemic approach to the diagnosis and treatment of allergic conjunctivitis]. / Démarche diagnostique et thérapeutique des conjonctivites allergiques.

The diagnosis of allergic conjunctivis begins by a meticulous questioning emphasizing the existence of ocular itching, the way of evolution of the signs and allergic preceeding. The examination searchs after follicles and papillae of the conjunctiva who usually go with serous discharges, blepharitis and keratitis. So four clinical forms may be described the chronic conjunctivitis, the vernal kerato-conjunctivitis, the atopic conjunctivitis and the giganto-papillar conjunctivitis. For the treatment, all non specific signs of allergy must be eliminated, the focal infections also and allergic substance isolated. If evolution is worse, an antiallergic eye drop is given until the disappearance of all the physical signs. In the same time, steroids and anti H1 drugs must be avoided. In case of failure, the specialist in allergy will be helpful to exam the patient.

[Patients' quality of life after cataract surgery]. / Qualité de vie des patients après chirurgie de la cataracte.

INTRODUCTION: Our goal is to assess the Quality of Life (QL) of our patients after cataract surgery. MATERIALS AND METHODS: We performed a multicenter prospective study from July 2012 to December 2013 including patients undergoing cataract surgery, aged 18 and older. A survey sheet with sociodemographic data, clinical data and QL survey (VF-14) was given to each patient after surgery at day 7 (D7), one month (M1) and two months (M2) postoperatively. The final score was obtained by the following formula: QL=V (%)=(F __/__ C)×25. The data analysis was performed using SPSS software. RESULTS: A total of 100 patients were included, 56 men, and 61 years was the mean age. The mean QL score was 29.86% at D7, 73.97% at M1 and 81.21% at M2. Subjects between 18 and 30 years of age had a score of 90.15% vs. 82.52% at M2 for older patients. After optical correction, the quality of life scores increased from 83.22% at D7 to 93.18% at M2. Patients who did not have functional signs had a QL score of 83.94%. Anxious patients had a QL score of 44% at D7, 61.23% at M1 and 52.67% at M2. CONCLUSION: Good surgical outcomes require, in addition to clinical success, good quality of life. Several factors may influence this quality of life.

[Rare causes of childhood leukocoria]. / Les causes rares de leucocorie chez l'enfant.

PURPOSE: The purpose was to record the causes of leukocoria among children under 10years of age and to determine the proportion of rare causes of leukocoria. PATIENTS AND METHODS: This retrospective study was conducted over a period of ten years, from January 1, 2004 to December 31, 2013, in patients under 10years of age who were referred for leukocoria. RESULTS: Leukocoria represented one of the ten reasons for consultation among children under 10years of age. The mean age of our patients was 42.5months. In 76 % of cases, the leukocoria patients were children under 6years of age. Male patients were affected more commonly, with a sex-ratio of 1.5. Patients coming from Dakar and its suburbs represented two thirds of the total. Bilateral involvement represented 53.7 % of the total. Cataracts were responsible for 74.3 % of cases, retinoblastoma 20.58 %, retinal detachment 0.96 %, retinopathy of prematurity 0.96 %, pupillary membrane persistence 0.96 %, persistent hyperplastic primary vitreous 0.64 %, endophthalmitis 0.64 %, optic nerve coloboma 0.32 %, iris heterochromia 0.32 % and ametropia 0.32 %. DISCUSSION: The total percentage of rare causes was 5.12 % in our study, including one case of hyperopia. These etiologies, although rare, do exist. CONCLUSION: Rare causes of leukocoria require special attention. The discovery of leukocoria necessitates rigorous etiological work-up. Ametropia must be a diagnosis of exclusion.

[Isolated microspherophakia in a Senegalese family]. / Microsphérophakie isolée dans une famille sénégalaise.

PURPOSE: To report the clinical investigation of isolated microspherophakia involving a Senegalese family in order to appreciate its functional impact. OBSERVATIONS: This is a rural family comprised of 7 members. The sibship included three girls and two boys. One of the girls, who lived in a distant zone, was unable to be examined. Of all the examined members of the family, only the father was unaffected by the illness. There was no consanguinity. The general medical examination was normal. The best-corrected visual acuity (VA) for the girls was 2/10. For one of the boys, BCVA was 8/10 for both eyes, and for the other, BCVA was 10/10 for the right eye and 8/10 for the left eye. The mother's VA was 10/10 and P2 without correction. Myopia and astigmatism were present in the 4 children of the sibship. During the examination, we noted the presence of small crystalline lenses, which were very round and presented an abnormal visibility of the lens equator and zonular fibers. The diagnosis of microspherophakia was confirmed by measurement of the lens diameters by ultrasound biomicroscopy. Complications were present in the girls, including pupillary block glaucoma and amblyopia for the elder, and retinal degeneration and amblyopia for the younger daughter. The elder daughter was managed medically with glaucoma drops. The younger daughter received optical correction and a prophylactic Argon LASER treatment. The two boys received optical correction. No treatment was recommended for the mother. CONCLUSION: Microspherophakia is a rare condition. Some serious complications can lead to amblyopia. A better multidisciplinary evaluation would allow for early detection and a better prognosis.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]. / Empyème sous-dural compliquant une sinusite frontale aiguë. A propos de 4 cas.

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[Ocular lesions of artificial depigmentation]. / Lésions oculaires de la dépigmentation artificielle.

PURPOSE: To evaluate the type and frequency of the ocular lesions found in patients practicing artificial depigmentation. PATIENTS AND METHOD: We conducted a prospective study over 3 months involving 108 patients, of whom 72 underwent depigmentation, and 36 did not, representing the controls. RESULTS: Among patients undergoing depigmentation, 100% were female, of whom 34.72% developed ocular lesions. Exogenous ochronosis lesions of the eyelid predominated (34.72%), followed by ocular ochronosis (25.81%). Cataract (19.35%) and glaucoma (6.45%) were the least frequent. Among the untreated, only 19.44% had ocular lesions. These included cataract (57.14%) and glaucoma (42.86%). Ocular lesions were more frequent in patients using products containing hydroquinone. CONCLUSION: Artificial depigmentation is responsible for ocular lesions of variable severity. Our study highlights the importance of the raising awareness amongst the general population of the complications of artificial depigmentation, particularly the ocular lesions.

[Scleral mini-incision without ultrasound in the treatment of congenital cataract]. / Mini-incision sclérale sans ultrasons dans le traitement de la cataracte congénitale.

PURPOSE: Congenital cataract surgery can be performed by pars plana or limbal incision. We report our experience with scleral incision without ultrasounds in congenital cataract surgery. MATERIAL AND METHODS: Fifteen children with congenital cataract underwent surgery of both eyes (30 eyes). The zonular ciliaris and the lens anlage were normal in all cases. All procedures were performed by the same surgeon. A 3.2 mm scleral tunnel incision was made 2 mm from the limbus. Large capsulorhexis or capsulopuncture were performed after injection of a viscoelastic substance in the anterior chamber. After hydrodissection, the nucleus and cortex were aspirated. The wound was closed by apposition suture. RESULTS: The mean age was 70.13 months (range 5 months to 130 months). Mean induced astimatism calculated with the Cravy method was 0.70 dipoters. A posterior capsular tear was observed in 1 case. CONCLUSION: Small scleral incision without ultrasounds has advantages. No expensive instruments are required and astimatism is not induced. The anterior chamber lies deep during the operation, protecting the endothelial cells and facilitating aspiration. Postoperative inflammation is minimal. The small scleral incision technique is useful in selected cases of congenital cataract.

[Epidemiological and angiofluorographic aspects of diabetic retinopathy in Senegal]. / Aspects épidémiologiques et angiofluorographiques de la rétinopathie diabétique au Sénégal.

PURPOSE: Attempting to improve life expectancy among diabetics reveals degenerative complications, including diabetic retinopathy (DR) linked to microangiopathy. We assessed the incidence of diabetic retinopathy in its various forms amongst diabetics in Senegal. PATIENTS AND METHODS: We carried out a survey between March and October 1998. The 51 patients surveyed had been affected for more than 5 years. They were divided into two groups: insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD). Patients were aged 17-71 and included 27 IDD and 24 NIDD. Each patient was given both a biological checkup (blood sugar level, HBA1c, creatininemy, triglycerides, cholesterol, albuminaria and urinary glucose) and an ophthalmological checkup with angiography in fluorescence. RESULTS: Of the 51 patients studied, 26 presented a progression span of the disease of over 10 years. DR was detected in 62 eyes out of 102 (60.78%), with 37.25% of nonproliferating DR, 17.65% of preproliferating DR, and 5.88% of proliferating DR. Maculopathy was detected in 10 eyes (9.80%). Amongst the IDD patients, diabetic retinopathy accounted for 57.14% of diabetes, with a progression span of less than 10 years, compared to 84.62% for diabetes with a progression span of over 10 years. Amongst the NIDD patients, diabetic retinopathy accounted for 36.36% compared to 61.54%. DISCUSSION: Through these results, a connection can be made between diabetic retinopathy, the progression span of diabetes, the type of diabetes, and the other microangiopathies. We noted a rise in retinopathy that increased with the age of diabetes patients and their IDD group. CONCLUSION: A multidisciplinary support of diabetes ensures early detection of diabetic retinopathy; hence the need for closer collaboration between the endocrinologist and the ophthalmologist.

[Contribution of the Kansas technique for reducing complications of mature cataract surgery]. / Apport de la technique de Kansas dans la réduction des complications de la chirurgie des cataractes mûres.

PURPOSE: We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction. PATIENTS AND METHODS: This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital. RESULTS: Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort. DISCUSSION: Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions. CONCLUSION: Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

[Compliance of medical treatment in primitive glaucoma open angle]. / L'observance au traitement médical dans le glaucome primitif à angle ouvert. Résultats préliminaires.

INTRODUCTION: Compliance to medical treatment expresses the patient's perception of the disease and the treatment prescribed by the doctors. Lack of compliance endangers chronic glaucoma care, which explains the importance it has been given these last years. The objectives of this survey were to evaluate the compliance of adult patients suffering from primary open angle glaucoma to discover the influential factors. MATERIALS AND METHODS: We conducted a survey at the ophthalmology clinic of Le Dantec Hospital from January 1997 to May 1998 among 31 adults being treated for primary open angle glaucoma. An indirect evaluation of the patients' compliance was made on the basis of a questionnaire after examination of their medical files. It was deemed good, average, or bad depending on: regularity of the patient's visits to the doctors, regularity of the treatment, respect of the doctor's prescription and the prescribed times for taking the medicine. The Chi square independence test was used to study the influence of the following factors: age, sex, residence, socioeconomic status, duration of symptom progression, level of instruction, counseling, and treatment. RESULTS: The patients' mean age was 60.5 years. Compliance was deemed good for 29% of the total cases, average for 32.3%, and bad for 38.7%. Only factors such as the regular visits to the doctor, the regularity of the treatment, and respect of the doctor's prescription and the prescribed times for taking the medicine were found to be influential (p<0.05). CONCLUSION: The medical treatment of primary open angle glaucoma, whether temporary or permanent, with a maximum of efficacy and a minimum of side-effects requires good compliance on the part of the patient. This compliance in turn requires a good doctor-patient relationship based on effective repeated counseling to educate patients, help them understand the disease, and act on the influential factors.

[Intestinal parasitosis in the inhabitants of a suburban zone in which the groundwater is polluted by nitrates of fecal origin (Yeumbeul, Senegal)]. / Les parasitoses intestinales chez des habitants d'une zone péri-urbaine à nappe phréatique polluée par les nitrates d'origine fécale (Yeumbeul, Sénégal)

This study was carried out in 1997 to 1998, to determine the prevalence of intestinal parasite infestations due to groundwater pollution at Yeumbeul, Senegal, and to follow the progression of parasite infestations following anti-parasite treatment. The study included 705 people living in a suburban zone in which the water table was polluted with nitrates of fecal origin. These individuals consumed either well water or water from springs. The overall prevalence of parasite infestation was 42.26%, but varied significantly with age (p < 0.001). Individuals who consumed well water were more frequently infested than those who consumed spring water, but the difference was not significant (p > 0.3). Giardia and Entamoeba coli were the most frequently isolated parasites, with Giardia predominating in the 0 to 9 year age-group. There was no significant correlation between the prevalence of the various parasites and indicators of water pollution (R2 = 0.0566 for nitrates and 0.1086 for fecal coliform bacteria). Similarly, no correlation was found with water pollution factors such as the depth of the water table (R2 = 0.027) and the distance between the wells and the latrines (R2 = 0.00007). Following specific treatment, the prevalence of parasite infestation fell to 30.81%. This indicates the limitations of drug treatment, which is always used alone to combat intestinal parasites, in the face of possible reinfestation.

[Vitreo-retinal complications of hemoglobinopathy SC]. / Complications vitréo-rétiniennes de l'hémoglobinopathie SC.

Sickle hemoglobinopathies are frequent in black population. Double heterozygous SC gives less general symptoms but ocular complications are very common. Fluorescein angiography of 20 cases are reported. All the patients had hemoglobin electrophoresis showing double heterozygous SC. Clinical investigations included fundus examination and fluorescein angiography. Laser treatment or cryotherapy were realised regarding lesions features. Vascular retinal complications were found in 75% of cases, including vitreous hemorrhage (10% of cases). There was no correlation between fundus examination and fluorescein angiography. Fluorescein angiography is useful for early diagnosis and allows preventive laser treatment.

[Idiopathic serous retinal pigment epithelial detachment (a case report)]. / Le décollement séreux idiopathique de l'épithélium pigmentaire de la retine (a propos d'un cas).

Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.