[PREVALENCE AND ASSOCIATED FACTORS OF HUMAN SCABIES IN PRISONS IN DOSSO, NIGER]. / PRÉVALENCE ET FACTEURS ASSOCIÉS À LA GALE EN MILIEU CARCÉRAL À DOSSO, NIGER.

Background: Scabies is a contagious, pruritic, cosmopolitan dermatosis, widespread especially in human communities, due to parasitism by a mite Sarcoptes scabiei var hominis A lack of hygiene and overcrowding inside the houses are favourable factors. The aim of our study was to determine the prevalence and factors associated with the occurrence of human scabies in the prison environment in Dosso (Niger). Materials and methods: Prospective descriptive cross-sectional study conducted in November 2022 in the civil prison of Dosso on authorization of the prison administration. The collected data were sociodemographic characteristics, personal history of pruritus and its characteristics, risk factors related to hygiene and conditions of incarceration, examination performed by a dermatologist to look for clinical signs of scabies. The diagnosis was retained in any inmate presenting one or more elements at the interrogation and at the physical examination. Results: Out of a total of 352 inmates, 43 (38 males and 5 females) had scabies, a prevalence of 12%. The average age was 33 with extremes of 18 and 62 years. Of the scabies patients, 9% reported a history of intense, sleepless pruritus prior to incarceration. Most of the inmates, 86%, were in cells with more than 20 inmates. Among those with scabies, 42% showered twice a day, 81% changed clothes after showering and 74% used soap regularly for washing. The topography of the lesions was external genitalia (37%), buttocks (21%), inner thighs (16%), interdigital spaces (9%), elbows (9%) and wrists (7%). The inmates were informed about the disease, treatment information was explained to them, and they attended a session on hygiene promotion. All cases of scabies detected were prescribed a local treatment based on benzyl benzoate lotion 25%. Discussion/conclusion: Human scabies is common in the prison environment in Dosso. Too often, scabies goes undetected and is confused with other pruritic dermatoses, such as eczema or atopic dermatitis. Prison medical staff should be trained in scabies in order to prevent scabies outbreaks. The authorities in the region should make the improvement of hygiene and detention conditions in prisons their priority.

[Drug-resistant pulmonary tuberculosis at Maradi Regional Hospital Center, Niger (2014-2018)]. / Tuberculose pulmonaire résistante à la rifampicine au Centre Hospitalier régional de Maradi, Niger (2014-2018).

Aim of study: To describe the clinical, therapeutic and evolutionary profile of patients followed for rifampicin-resistant pulmonary tuberculosis (RR-TB) at the Regional Hospital Centre (RHC) of Maradi (Niger) from 2014 to 2018. Methods: We conducted a retrospective and descriptive study based on the records of patients followed for Multidrug-resistant tuberculosis (MDR-TB) between January 1, 2014 and June 30, 2018 at the resistant tuberculosis management unit in Maradi (Niger). This unit is located within the RHC of Maradi and has a capacity of 20 beds in 4 wards. It receives patients with tuberculosis resistant to first-line anti-tuberculosis drugs. In this study, patients diagnosed with RR-TB by genotypic (GeneXpert MTB/RIF) or phenotypic (culture) testing were included. We excluded from this study: patients previously treated for more than 1 month with second-line anti-TB drugs; patients with resistance to second-line injectables (SLI) and/or fluoroquinolones (FQ); patients with an electrocardiogram QTc greater than 500 ms (the corrected QT (QTc) estimates the QT interval at a rate of 60 beats per second); cases of atypical mycobacteriosis detected by phenotypic testing.Patients were previously on 2RHZE/4RH prior to the discovery of resistance. The treatment protocol for resistant TB was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE (The second-line injectable was replaced by Lzd in case of initial or treatment-emergent deafness). HIV co-infected patients received, in addition to anti-tuberculosis drugs, antiretrovirals and cotrimoxazole in preventive doses. Results: A total of 80 patients were included in the present study (70 males and 10 females, mean age 34.4 years with extremes ranging from 18 to 71 years). Patients aged 18-35 years accounted for more than half. Patients with primary treatment failure were the most frequent type (36%) followed by patients with retreatment failure (24%) and patients with retreatment relapse (17%). It should be noted that 77 patients (96%) were previously treated for TB and only 3 patients (4%) were new cases. The majority of patients (70%) had a Body mass index of less than 18 kg/m2. 7.5% of patients were HIV positive, one was diabetic, 52% of the patients had grade 2 radiological lesions. Grade 1 deafness was noted at the beginning of treatment in 3%. A third of patients (36%) were primary treatment failures. The treatment protocol was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE. Only 1 patient had a positive culture at the end of the 4th month of treatment. Most of the patients had experienced adverse events, mainly digestive, with vomiting being the most common. The therapeutic success rate was 88%. We noted 10% of deaths, 1% of therapeutic failure and 1% of lost to follow-up.Six months after treatment, 48 patients (60%) were smear negative and 43 (54%) were culture negative. In 32 patients (40%), the smear was not performed and culture was not performed in 37. Conclusion: The short treatment regime gives satisfactory results in the absence of resistance to fluoroquinolones, with rare adverse effects. In Niger, further efforts should be made to minimize the delay in diagnosis which is responsible for most deaths during treatment. A centre could usefully be designated to organize "TB consiliums" allowing any practitioner to submit difficult cases of MDR-TB.

Unusual neurologic manifestations of Vogt-Koyanagi-Harada disease: a systematic literature review.

BACKGROUND AND PURPOSE: The usual neurologic manifestations of Vogt-Koyanagi-Harada (VKH) disease include aseptic meningitis and headaches. We performed the present study to review all unusual neurologic manifestations reported in VKH disease to summarize them. METHODS: A literature search was performed in the English language on Scopus and Medline via PubMed from 1946 to July 31, 2021, by using the following terms: "Vogt Koyanagi Harada disease" OR "VKH disease" AND "Brain" OR "Spinal cord" OR "CNS" OR "Central nervous system" OR "Neurologic" OR "Peripheral nervous system" OR "Polyneuropathies. Our inclusion criteria were unusual neurologic manifestations of VKH disease. RESULTS: Our literature search yielded 417 total articles (PubMed = 334, Scopus = 83) from which 32 studies comprising 43 patients (22 men and 21 women, of which 62.8% were younger than 50 years) were included in this systematic literature review. Regarding the study design, all studies were case reports and published between 1981 and 2021. CNS involvement was the most reported (93%) in VKH disease. Peripheral nervous system involvement represents 7% of cases. The cerebral lesions were parenchymal inflammatory lesions in the white matter or posterior fossa with or no contrast enhancement (16.3%), leptomeningitis (9.3%), pachymeningitis (7%), meningoencephalitis (2.3%), ischemic stroke (4.6%), hemorrhagic stroke (2.3%), transient ischemic attack (2.3%), and hydrocephalus (2.3%). The optic nerve lesions were anterior ischemic optic neuropathy (20.9%) and optic neuritis (9.3%). Concerning spinal cord lesion, it was mainly myelitis (14%). CONCLUSION: This systematic literature review provides a summary of the different unusual neurologic manifestations reported in VKH disease.

Clinical and etiological profile of epilepsy at the regional hospital center of Tahoua (Niger): A 4-year retrospective study.

OBJECTIVE: We aimed to evaluate epilepsy management at the regional hospital center (RHC) of Tahoua (Niger) to determine the intrahospital deficiencies to optimize to improve the management of people with epilepsy. METHODS: A descriptive retrospective study was carried out at the Psychiatric Unit of the RHC of Tahoua between January 1, 2016 and December 31, 2019. We collected from the registers of consultation all patients followed by nurse technicians in mental health for epilepsy whose diagnosis was made by nonspecialist physicians or internists. The study included patients with epilepsy who had a medical follow-up at least 6 months. RESULTS: Of the 2022 patients seen during the period of the study, 246 patients were consulted for epilepsy with a hospital frequency of 12.2%. The mean age was 22.38 years, with a slight predominance of men (57.7%). Only generalized tonic-clonic seizures (95.1%) and focal-aware seizures (4.9%) were reported. The main etiologies were cerebral malaria (18.7%), bacterial meningitis (8.1%), and head trauma (4.9%). In 60.2% of cases, the etiology was undetermined, but the etiological diagnosis investigation was incomplete (CT scan not done). Only the first-generation antiepileptic drugs were used. Only 2.8% of the patients had drug-resistant epilepsy, and 97.2% of the patients had controlled seizures. CONCLUSION: The study shows a predominance of infectious causes, particularly cerebral malaria. We found a high proportion of epilepsies with unknown etiologies with incomplete workup. The RHC of Tahoua should facilitate access to the CT scan for people with epilepsy to improve etiological diagnosis investigation.

Subhepatic appendix: an ectopic topography not to be disregarded: a case report.

INTRODUCTION: Subhepatic appendix is most often due to an anomaly of rotation of the primary intestine occurring during embryogenesis. This ectopic topography associated with advanced age can be a serious diagnosis problem at the stage of appendicitis or appendicular peritonitis. CASE PRESENTATION: We report the case of a 60-year-old melanoderm man, with a history of urinary pathology and peptic ulcer, referred from a health district for abdominal pain of the right hypochondrium evolving for about 5 days, secondarily generalized, in whom we suspected peritonitis, the etiology of which remains to be determined. During the surgical intervention, after preoperative resuscitations measures, a phlegmonous perforated appendix was found under the liver. No postoperative complication was noted, and he was discharged home 8 days after his operation. CONCLUSION: Subhepatic appendicular peritonitis occurring in an elderly patient poses enormous diagnostic problems. When faced with right upper quadrant pain, considering acute ectopic appendicitis would significantly reduce complications.

Teachers' Knowledge About Epilepsy and Their Attitudes Toward Students with Epilepsy: A Cross-Sectional Survey in the City of Tahoua (Niger).

PURPOSE: In this survey, first, we aimed to investigate the views held about epilepsy of primary and secondary school teachers in the city of Tahoua (Niger, a Sub-Saharan African country), and secondarily, how their experience and knowledge about epilepsy influence their attitudes towards school children with epilepsy. MATERIALS AND METHODS: A cross-sectional survey was carried out between November and December 2019. We used a self-administered questionnaire survey in French-language comprising sociodemographic part, and knowledge and attitudes about epilepsy part. Composite scores of knowledge and attitudes were calculated, and statistical analyses were performed to assess their association with sociodemographic characteristics. RESULTS: Two hundred eighty-four (284) school teachers had agreed to answer the questionnaire survey, among which 25% had already witnessed an epileptic seizure in the classroom or the schoolyard. Epilepsy is considered as a chronic brain disease and psychiatric illness in 31% and 32.4% of cases, respectively. In 41.9% of cases, epilepsy is considered as a contagious disease. Significantly, we found that the composite score of knowledge and attitudes was lower in younger school teachers (p = 0.007) and those with fewer years of teaching experience (p = 0.048). High school teachers had better score composite than those of primary school and college (p = 0.072). Regarding the composite score of attitudes, we did not find an association with sociodemographic characteristics. CONCLUSION: Teachers' attitudes were not associated with their level of school taught, years of teaching experience, and their religion. It is necessary to integrate educational training courses about epilepsy into the curriculum of teachers' training.