[Cardio-Renal Syndrome In Patients Hospitalized In The Cardiology Department Of The University Hospital Center Yalgado OUEDRAOGO (CHUYO): Epidemiology, Clinic, Paraclinic And Course's Aspects]. / Le Syndrome Cardio-Renal Dans Le Service De Cardiologie Du Centre Hospitalier Universitaire Yalgado OUEDRAOGO (CHU-YO) : Aspects Epidemiologiques, Cliniques, Para-Cliniques Et Evolutifs.

OBJECTIVE: The objective of this work was to study cardio-renal syndrome in patients hospitalized in the cardiology department of the University Hospital Center Yalgado OUEDRAOGO (CHUYO). PATIENTS AND METHODS: This was a retrospective, descriptive study for a period of three years, from 1st January 2010 to 31st December 2012. The study incorporated patients with associated signs of Heart Failure (HF) and Renal Insufficiency (RI). Sociodemographic, clinical and paraclinical parameters were considered in the study. We evaluated the value of creatinine clearance at admission and its progress during the hospitalization until patients were discharged. RESULTS: Sample group of 119 patients over the period; the prevalence of the syndrome cardio-renal (CRF) was 10.93%. The mean age of our patients was 52.6 ± 16.6 years. (extremes: 15-85 years). The sex ratio was 1.33. Our patients' medical histories were dominated by high blood pressure (58.8%) and hypertensive heart disease (33.6%). Dyspnea was the major functional sign in our study (84.9%). Left heart failure syndrome (LHFS) was the most frequently encountered clinical picture (91.3%). The mean value of the creatinine clearance at baseline was 41.5 ± 24.3 mL/min/1.73m2. The signs ECGs and Doppler echocardiograms were those of underlying heart disease: the hypertensive heart disease. An abdominal-pelvic ultrasound found a bilateral kidney failure in 65.7% cases. The average length of hospitalization was 17.7 ± 17.5 days. Death occurred in 19.5% cases. CONCLUSION: The prevalence of CRS was high in the CHU-YO. The prognosis was largely influenced by whether it was an acute or chronic kidney failure. Emphasis should be placed on primary prevention of CRS, early diagnosis and etiology of renal failure.

OBJECTIF: L'objectif de ce travail était d'étudier du syndrome cardio-rénal chez des malades hospitalisés dans le service de cardiologie du CHUYO. PATIENTS ET MÉTHODES: Il s'est agi d'une étude rétrospective à visée descriptive sur une période de trois ans allant du 1er janvier 2010 au 31 décembre 2012. Ont été inclus les dossiers de malades ayant des signes d'Insuffisance Cardiaque (IC) associés une Insuffisance Rénale (IR). Les paramètres sociodémographiques, cliniques et para-cliniques ont été étudiés. Nous avons évalué la valeur de la clairance de la créatinine à l'entrée et son évolution au cours de l'hospitalisation jusqu'à la sortie des patients. RÉSULTATS: Ainsi, nous avons retenu 119 sur la période; la prévalence du syndrome cardio-rénal (SCR) était de 10,93%. L'âge moyen de nos patients était de 52,6 ± 16,6 ans (extrêmes : 15-85 ans). Le sex-ratio était de 1,33. Les antécédents de nos patients étaient dominés par l'hypertension artérielle (58,8%) et les cardiopathies hypertensives (33,6%). La dyspnée constituait le signe fonctionnel majeur dans notre étude (84,9%). Le syndrome d'insuffisance cardiaque gauche (ICG) constituait le tableau clinique le plus fréquemment rencontré (91,3%). La valeur moyenne de la clairance de la créatininémie à l'entrée était de 41,5 ± 24,3 ml/min/1,73m2. Les signes ECG et échocardiographies Doppler étaient ceux de la cardiopathie sous jacente : la cardiopathie hypertensive. Une échographie abdomino-pelvienne retrouvait une souffrance rénale bilatérale dans 65,7% des cas. La durée d'hospitalisation moyenne était de 17,7 ± 17,5 jours. Le décès est survenu dans 19,5% des cas. CONCLUSION: La prévalence du SCR était élevée dans le service de cardiologie du CHU-YO. Son pronostic était largement influencé par le caractère aigu ou chronique de l'insuffisance rénale. L'accent doit être mis sur la prévention primaire du SCR, le diagnostic précoce et étiologique de l'insuffisance rénale.

[Evaluation of the benefit of different complementary exams in the search for a TB diagnosis algorithm for HIV patients put on ART in Niamey, Niger]. / Évaluation du bénéfice apporté par des examens complémentaires pour le diagnostic de la tuberculose chez des patients infectés par le VIH mis sous ARV à Niamey, Niger.

In Niger, the tuberculosis (TB) screening among people living with human immunodeficiency virus (HIV) (PLHIV) is nonsystematic and the use of additional tests is very often limited. The objective of this research is to evaluate the performance and the cost-effectiveness of various paraclinical testing strategies of TB among adult patients with HIV, using available tests in routine for patients cared in Niamey. This is a multicentric prospective intervention study performed in Niamey between 2010 and 2013. TB screening has been sought in newly diagnosed PLHIV, before ART treatment, performing consistently: a sputum examination by MZN (Ziehl-Nielsen staining) and microscopy fluorescence (MIF), chest radiography (CR), and abdominal ultrasound. The performance of these different tests was calculated using sputum culture as a gold standard. The various examinations were then combined in different algorithms. The cost-effectiveness of different algorithms was assessed by calculating the money needed to prevent a patient, put on ART, dying of TB. Between November 2010 and November 2012, 509 PLHIV were included. TB was diagnosed in 78 patients (15.3%), including 35 pulmonary forms, 24 ganglion, and 19 multifocal. The sensitivity of the evaluated algorithms varied between 0.35 and 0.85. The specificity ranged from 0.85 to 0.97. The most costeffective algorithm was the one involving MIF and CR. We recommend implementing a systematic and free direct examination of sputum by MIF and a CR for the detection of TB among newly diagnosed PLHIV in Niger.

How to perform the skull vibration-induced nystagmus test (SVINT).

The skull vibration-induced nystagmus test is a robust, nonintrusive and easy to perform test. This test acts as a vestibular Weber test and is performed as a bedside examination. It usually instantaneously reveals vibration-induced nystagmus (VIN) even in long standing or chronic compensated unilateral vestibular lesions. The test requires stimulation at 30, 60 or more efficiently at 100Hz. The vibrator is applied perpendicularly to the skin on a subject sitting up straight on the right and then the left mastoid (level with external acoustic meatus) and vertex. The VIN can be observed under videonystagmoscopy or Frenzel goggles. Either the direct tracing or the VIN slow phase velocity can be recorded on a 2D or 3D videonystagmograph. The patients should be relaxed and not treated by strong sedative medications. This rapid first-line test is not influenced by vestibular compensation and usefully complements other tests in the multifrequency evaluation of the vestibule. It acts as a global vestibular test by stimulating both canal and otolithic structures at 100Hz. It is useful in case of external acoustic meatus or middle ear disease as a substitute for the water caloric test and is preferable in elderly patients with vascular disease or arthritis of the neck to the head-shaking-test or head-impulse-test.

[Epidemio-clinical aspects of bacterial acute infant Pneumopathies at Yalgado Ouédraogo University Health Center]. / Aspects Epidemio-Cliniques des Pneumopathies Aiguës Bacteriennes de L'Enfant Au Chu Yalgado Ouedraogo.

INTRODUCTION: Infections of low respiratory tracks represent a public health issue and are a frequent reason for antibiotic prescription . For children in Africa, they are the main morbidity factor (50% of visits) and mortality (about 20% of infant mortality). Actually, the antibiotherapy, mainly probabilistic, rests on the awareness of the epidemiology of the germs which are responsible in a given region, at a given period. The purpose of this study was to evaluate the Epidemio-clinical aspects of bacterial acute infant Pneumopathies at Yalgado Ouédraogo Univercity Health Center. PATIENTS AND METHOD: This a descriptive retrospective study, base on the files of hospitalized patients in the Paediatric Unit of CHU YO from January 1, 2005 through December 31, 2006. RESULTS: All in all, 5803 patients with 658 cases of acute bacterial pneumopathy (11.3%) were hospitalized in the paediatric unit. Besides, acute bacterial Pneumopathies, 254 patients had another associated affection. Proteino-calorific malnutrition were frequent (59.7%), coupled with anaemia (36%). The reported most frequent germs are respectively: Streptococcus pneumoniae (29.3%), Klebsiella pneumoniae (29.3%) et Staphylococcus aureus (25%). The streptococcus was sensitive to association amoxicilline + clavulanic in 66.7% of the cases, to ceftriaxone in 57.1 % of cases. It was 100% resistant to ampicilline and to amoxicilline. The clinical evolution of our patients was favorable in 90% of the cases with 5.5% deaths. CONCLUSION: Pneumopathies affect mostly children who are less than 2 years old favored by malnutrition and anaemia. The high morbid-morbidity related to this pathology could be improved through a better awareness and regular updating of local bacterial ecology.

[Epidemio-clinical aspects of adult acute bacterial pneumonia at Yalgado Ouédraogo University Health Center]. / Aspects Epidemio-cliniques des Pneumopathies Aiguës Bacteriennes de L'Adulte au Chu Yalgado Ouedraogo.

INTRODUCTION: Bacterial Pneumopathies are low respiratory infections due to parenchyma pulmonary attack, which etiologic agent is a bacteria different from tubercular bacillus. Factually, the treatment is based on a probalistic antibiotherapy. This requires awareness of the epidemiology of the germs which are responsible in a given region, at a given period. PATIENTS AND METHOD: In order to better grasp mainly the bacteriological and therapeutic aspects of adult bacterial Pneumopathies in Burkina Faso, we have come up with a two year journal/documentary. RESULTS: The reported most frequent germs are respectively: Streptococcus pneumoniae (32,6%), Klebsiella pneumoniae (21%) et Staphylococcus aureus (13,9%). Negative Gram bacteries represented 53.5% of isolated germ and Acinetobacter was found only with HIV positive patients. The streptococcus was sensitive to association amoxicilline + clavulanic in 91.7% of the cases, to ceftriaxone in 83.3% of cases, to ampicilline and to amoxicilline in 66.7% of cases The clinical evolution of our patients was favorable in 74.5% of the cases with 21.8% deaths. The evolution was more significant within alcoholic patients (p = 0.001) as well as tobacco addicted patients (p = 0.02). CONCLUSION: The high morbi-morbidity due to acute pneumopathy could be improved through a better awareness and regular updating of local bacterial ecology.

Factors associated with the adoption of a smoking ban in Quebec households.

The home represents an important source of exposure to environmental tobacco smoke for non-smokers, including children, who live with smokers. Our goal is to identify the sociodemographic factors associated with the adoption of smoking bans in "smoker households" in Quebec. Selected associations are compared with three other Canadian provinces (Ontario, British Columbia and Nova Scotia). This is a cross-sectional study involving 2648 respondents. Logistic regression analysis is employed. Few smoker households in Quebec (21%) have a ban on smoking; the presence of a non-smoker is strongly linked to the existence of such a ban; the presence of a child under the age of 6 is less strongly associated with the adoption of a ban in Quebec than in the other provinces, and the presence of an adolescent shows no association whatsoever. In addition to the child health benefits of household smoking bans, greater emphasis should be placed on the impact that such bans can have on children's future smoking behaviour. One option from a health promotion standpoint might be to organize a campaign aimed at non-smokers who live with smokers, in order to urge them to be less tolerant of environmental tobacco smoke.

Contrast and velocity ultrasonic tomography of long bones.

Our objective is to derive quantitative sound speed images of cortical bone using ultrasonic transmission tomography. Cortical bone is a highly refracting medium, i.e., the sound velocity changes abruptly across the interface between soft tissue and bone. It results in a loss of data compared to classical tomography in soft tissues. In order to correct for degradation by refraction effects, the classical acquisition procedure of projection data is modified: the transducers are oriented according to Snell's law of refraction with the aim of optimizing the sound propagation as parallel longitudinal rays inside the bone. This strategy allows the subsequent application of straight-ray reconstruction by the backprojection technique, which is a classical procedure in x-ray tomography. The method is validated with Plexiglas solid cylinders and tubes immersed in water. Improved sound velocity images are then derived using conventional Radon transform of the experimental time-of-flight data. The method is then extended to in vitro human femur immersed in water. The geometry of the bone cross-section is reconstructed from measurements using ultrasonic reflection tomography. The result is then introduced in the calculation of the position and orientation of the transducers, which are associated with the parallel acoustical paths in bone in the transmission measurements. The procedure leads to significant restoration enhancement over the non corrected image. The mean value of the velocity of 3,200 ms(-1) in the cortical shell is consistent with the values known from literature. These preliminary quantitative images using combined reflected and transmission ultrasound show promise for bone imaging.

[Clinical, radiographic and ultrasonographic aspects of mediastinal nodular tuberculosis in the era of HIV infection]. / Aspects cliniques, radiologiques et endoscopiques de la tuberculose ganglionnaire médiastinale.

OBJECTIVE: The purpose of this study was to determine the clinical, radiographic, and ultrasonographic aspects of mediastinal nodal tuberculosis and ascertain its clinical course in the era of HIV infection. PATIENTS AND METHODS: We reviewed retrospectively 39 patients referred to the Ouédraogo Yalgado National Hospital Center and the National Anticancer Institute between February 1996 and December 1999 for mediastinal nodal tuberculosis. Endoscopic proof of tuberculosis was obtained in 30 cases (81.8%). HIV serology was positive in 26 of the 30 patients tested (86.6%). RESULTS: Nodal mediastinal tuberculosis accounted for 1.7% of the cases of tuberculosis recorded over the same period at the Anticancer Institute. Mean age of the patients was 32.8 years and the sex ratio was 1.05 in favor of men. Clinically, a past medical history was found in 18 cases (46%) including a herpes zoster in 6 (15.4%), cough in 38 (97.5%). Weight loss (95%), fever (100%) and peripheral node enlargement (20%) were found frequently, probably related to HIV infection more than tuberculosis. Radiographically, standard x-rays evidenced associated lesions in 22 cases, with 59% having predominant parenchymatous lesions. Other localizations of tuberculosis were very frequent (42.5%). DISCUSSION: Bronchial fibroscopy is most contributive to diagnosis of mediastinal nodal tuberculosis with an 81.8% yield in our series. HIV infection had a determining effect on the disease course since among the 16 patients who died, 14 were HIV-positive (52%).

[Semiologic value and optimum stimuli trial during the vibratory test: results of a 3D analysis of nystagmus]. / Intérêt sémiologique et essai d'optimisation du stimulus au cours du test vibratoire: résultats d'une analyse 3D du nystagmus.

Nystagmus signaling vestibular dysfunction was observed after vibratory stimulation with a 100 Hz ABC stimulator in a population of 36 patients with unilateral labyrinthine pathology (ULP) (pre and postoperative neuromas, vestibular neurectomies) and 10 patients with vestibular neuritis. The stimulus was applied on 3 bony points of the skull (vertex and 2 mastoids) and 2 muscular points of the neck (right and left posterior cervical region). These results were compared with those in 95 normal subjects and 19 cases of central disease and were correlated on the same day with results of the caloric test and head shaking test (HST). A consistent nystagmus was found in only 6 % of the normal subjects (specificity 94 %) and in 10 % of the central lesions, but in 94 % of the 36 peripheral ULP. The sensitivity of the test was equivalent to the HST. The signal was optimized in 30 patients: stimulus frequency, amplitude, stimulator mass, form of the contact, patient tolerance. The best results were obtained for a frequency of 100 Hz and an amplitude of 0.5 mm (there was no response under 0.1 mm vibration amplitude). Under videoscopy and 3D videonystagmography, the direction or side of the nystagmus was constant, but its axis (horizontal, oblique or rotational) changed according to the location of the stimulator: on the mastoid (elective location of stimulation with responses in 94 % of cases) the axis was most often horizontal or horizontal rotational. On the vertex location (where nystagmus was observed in 60 % of cases) the axis of nystagmus was most often rotational or oblique and sometimes horizontal-rotational. The nystagmus showed short latency (less than 200 ms). It started and stopped as stimulation was initiated and interrupted. Nystagmus persisted for the duration of patient tolerance. This nystagmus generally signifies unilateral vestibular weakness rather than vestibular predominance. It is a good indicator of unilateral vestibular dysfunction and could serve as a useful test in clinical practice. We discuss the origin of the nystagmus which may originate in muscle proprioception (by propagation of the vibration to neck muscles) or in the labyrinth (simultaneous excitation of 3 canals on each side).

[Hydatid cyst of the breast. 20 cases]. / Le kyste hydatique du sein. Etude de 20 observations.

Hydatid cysts of the breast are benign new growths due to Echinococcus Granulosus. This retrospective report concerns 20 cases observed at Salah Azaiez Institute of Tunis from 1969 to 1982. Hydatid cyst involves women of 30 to 50 years of age living in areas where hydatid is endemic. As they evolve slowly, clinical features do not make it easy to confuse the diagnosis with new growths but mainly with cysts in mammary dysplasia or benign tumours. Mammography is the key examination to make the diagnosis even though this is not obvious each time. Specific immunological patterns are rarely used because it is easier to diagnose hydatid by other methods. Surgical treatment is curative in all cases.