Clinical characteristics of non-tuberculous mycobacterial pulmonary infections in Bamako, Mali.

The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02-0.13) and OR 0.32 (CI 0.11-0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.

Biology of two larval morphological phenotypes of Aedes aegypti in Abidjan, Côte d'Ivoire.

Since 2008, several outbreaks of yellow fever and dengue occurred in Abidjan, the economic capital of Côte d'Ivoire. A better knowledge of the biology of Aedes aegypti populations, the main vector of yellow fever and dengue viruses, is necessary to tailor vector control strategies implemented in the city. This study was designed to determine some biological parameters, occurring during the life cycle of two morphological phenotypes of Ae. aegypti larvae. Mosquitoes were sampled in a suburb of Abidjan (Treichville) using the WHO layer-traps technique. Biological parameters were studied in laboratory under standard conditions of temperature (27°C ± 2°C) and relative humidity (80% ± 10%). Our results indicated that the mean eggs laid by females from 'brown larvae' (BL) (85.95, 95% confidence interval (CI 95%) 78.87-93.02) was higher than those from 'white larvae' (WL) (64.40%, CI 95% 55.27-73.54). The gonotrophic cycle was 3 and 4 days in females from BL and WL, respectively. The overall yield of breeding mosquitoes from BL (63.88%, CI 95% 62.61-65.14) was higher compared with those of mosquitoes from WL (59.73%, CI 95% 58.35-61.12). The sex ratio (male/female) was 0.95 and 1.68 in Ae. aegypti populations from BL and WL, respectively. Females from BL lived slightly longer than those from WL (t = -2.332; P = 0.021). This study shows that Ae. Aegypti populations from BL and WL present different biological parameters during their life cycle. This could have an implication on their ability to transmit human disease viruses such as dengue and yellow fever. Further molecular studies are needed to determine genetic divergence between these Ae. aegypti populations.

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.

BACKGROUND: Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the "blank" countries without systematic data. METHODS: Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance. RESULTS: A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs. CONCLUSION: The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.

[Evaluation of periodontal health of prosthetic abutments. Pilot study about 100 abutments of crowns and bridges]. / Evaluation de la santé parodontale des piliers de prothèse fixée. Etude pilote autour de 100 piliers de couronnes et de bridges.

BACKGROUND: The confection of a fixed prosthesis finds its indication in response to the patient's aesthetic and/or functional whose requirements are stronger in terms of satisfaction. This involves maintaining the stability of prosthetic reconstructions on a sufficiency long time. To achieve this, the preservation of periodontal health of the prosthetic abutments occupies a special choice. PURPOSE: The aim of this study was to evaluate the periodontal health of fixed prosthesis abutment. MATERIALS AND METHODS: Thirty-nine patients having fixed prosthesis in the mouth for more than one year participated in our study. Ultimately, 38 single crowns and 27 seven bridges based on 100 abutments have been recorded. After an interview, clinical and radiographic examination was performed. It was to assess the level of oral hygiene, the health of the superficial and deep periodontal abutment using OHIS index of Green and Vermilion, periodontal index of Russel and mobility index of Mühlemann. RESULTS: On the 100 abutments examined, gingivitis (14%), gingival recession (13%), bone osteolysis (29%) and mobility (5%) were recorded. In addition, about 60% of patients had inadequate oral hygiene and less than 30% of them had a regular prosthetic maintenance. CONCLUSION: From this study, it appears that complications affecting periodontal prosthetic abutments are essentially bone lysed (29%), gingivitis (14%) and gingival recessions (13%).

[Micronecta sp (Corixidae) and Diplonychus sp (Belostomatidae), two aquatic Hemiptera hosts and/or potential vectors of Mycobacterium ulcerans (pathogenic agent of Buruli ulcer) in Cote d'Ivoire]. / Micronecta sp (Corixidae) et Diplonychus sp (Belostomatidae), deux hémiptères aquatiques hôtes et/ou vecteurs potentiels de Mycobacterium ulcerans agent pathogène de l'ulcère de Buruli en Côte d'Lvoire.

Buruli ulcer is currently a major public health problem in Côte d'Ivoire. It is a neglected tropical disease closely associated with aquatic environments. Aquatic insects of the Hemiptera order have been implicated in human transmission of Mycobacterium ulcerans, the pathogenic agent of Buruli ulcer. The purpose of this preliminary study using the polymerase chain reaction (PCR) method was to evaluate aquatic insects in Sokrogbo, a village in the Tiassalé sanitary district where Buruli ulcer is endemic. Findings identified two water bugs hosting Mycobacterium ulcerans, i.e., one of the Micronecta genus in the Corixidae family and another of the Diplonychus genus in the Belostomatidae family. The PCR technique used revealed the molecular signatures of M. ulcerans in tissue from these two insects. Based on these findings, these two water bugs can be considered as potential hosts and/or vectors of M. ulcerans in the study zone. Unlike Diplonychus sp., this is the first report to describe Micronecta sp as a host of M. ulcerans. Further investigation will be needed to assess the role of these two water bugs in human transmission of M. ulcerans in Côte d'Ivoire.

[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

Investigation of Phages Infecting Escherichia coli Strains B and C, and Enterobacter cloacae in Sewage and Ebrié Lagoon, Côte d'Ivoire.

Background: Bacteriophages are a promising biotechnological against bacterial pathogens. Currently, phage research is garnering interest in sub-Saharan countries as bacterial resistance to antibiotics becomes widespread. They are sought in all environments as they offer the possibility of a sustainable alternative to antibiotics. Materials and Methods: Altogether 30 water samples from urban sewage and environmental water were screened for the presence of bacteriophages able to infect Escherichia coli and Enterobacter cloacae. Their genomic diversity was determined by random amplification of polymorphic DNA (RAPD)-PCR fingerprinting. Results: We isolated 35 phages including 9 polyvalent phages that infect simultaneously E. coli and E. cloacae. This study allowed first isolation of E. cloacae-specific phages in Côte d'Ivoire. All phages were distinct based on their RAPD band patterns. Conclusions: Sewage systems of Yopougon and the environmental water of Ebrié lagoon were a rich source of phages. The phage collection could be useful for phage application in Côte d'Ivoire.

[Implementation of in vitro culture of Mycobacterium ulcerans from clinical samples versus detection of acid-fast bachilli and bacterial genome in Abidjan, Côte d'Ivoire]. / Mise en place de la culture in vitro de Mycobacterium ulcerans à partir d'éhantillons cliniques versus recherche de BAARet détection du génome bactérien à Abidjan, Côte d'Ivoire

Mycobacterium ulcerans infections are a public health problem in Céte d'Ivoire. The etiological diagnosis of this disease made by culture remains a big concern due to the slowness and difficulties encountered. This detection by culture of M. ulcerans represents a big interest as it allows obtaining the circulating strains for research. The purpose of this study was to determine on a routine basis in a poorly equipped laboratory, in vitro culture of M. ulcerans from exudates of skin ulcerations and from biopsy of patients with suspected Buruli ulcer. A particular attention was paid to the conditioning of the sample forwarded to the laboratory and inoculation in Lowenstein-Jensen medium supplemented with glycerol. The results of the three methods for the analysis showed 26.7, 57.4 and 17.8% positive rate respectively in the microscopy examination by nested PCR and by culture. In all the analysis, the positive rate from biopsy is higher than that obtained from exudates. The overall contamination rate by invasion of the three tubes of culture by fungi is 15.8 with 14.3 and 19.4% respectively,from exudates and biopsies. All positive samples in Ziehl-Neelsen staining and in culture were also positive by nested PCR. The nested PCR confirmed the positive strains found in culture, which were responsible for skin ulcerations. After culture, only one strain was nPCR negative. This strain was identified as Mycobacterium Gordonae. Our culture conditions showed that M. ulcerans was not the only strain identified and that other strains were present in the culture. We can conclude that the culture of M. ulcerans, in spite of the growth difficulties of the bacterium can be performed in laboratory in developing countries despite the lack of reagent and consumables. The implementation of this culture is the only way to determine sensitivity tests in vitro and in vivo in order to treat patients with Buruli ulcer.

[Determinants of acute malnutrition among children aged 6-59 months in Menaka health district]. / Facteurs determinants de la malnutrition aigue chez les enfants de 6-59 mois dans le district sanitaire de Menaka.

BACKGROUND: Acute malnutrition continues to be a real public health problem due to morbidity and mortality. The aim of this study was to determine the risk factors related to acute malnutrition among children aged 6-59 months in the health district of Menaka. METHODS: This is a case-control study that was conducted in the health district of Menaka over a period of six (6) months from January to June 2019. Data collection was done for patients in recovery and nutrition education units and for controls, in health centers and in the general population. Subjects were matched on age and sex. Data analysis was done using SPSS software version 20.0. RESULTS: Children with no immunization or incorrect immunization (OR = 18.17 [3.49-94.56]), children not fed exclusively with breast milk before 6 months (OR = 16.44 [3 , 93-68.8]) and lack of compliance with the principle of spacing births (OR = 9.93 [1.65-59.8]) were strongly implicated in the occurrence of acute malnutrition. CONCLUSION: Efforts should be made by the authorities to improve population's living conditions, which would improve the nutritional status of children under five and also reduce acute malnutrition prevalence.

INTRODUCTION: La malnutrition aigue continue d'être un véritable problème de santé publique de par la morbidité et la mortalité. L'objectif de cette étude était de déterminer les facteurs de risques liés à la malnutrition aigue chez les enfants de 6-59 mois dans le district sanitaire de Ménaka. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude cas-témoins qui a été réalisée dans le district sanitaire de Ménaka sur une période de six(6) mois allant de Janvier à Juin 2019. Le recueil des données a été fait pour les malades dans les unités de récupération et d'éducation nutritionnelle et pour les témoins dans les centres de santé et dans la population générale. Les sujets ont été appariés sur l'âge et le sexe. L'analyse des données a été faite à l'aide du logiciel SPSS version 20.0. RÉSULTATS: La non vaccination ou la vaccination incorrecte des enfants (OR=18,17[3,49-94,56]), le non allaitement des enfants exclusivement au lait maternel avant l'âge de 6 mois (OR=16,44 [3,93-68,8]) et le non respect du principe de l'espacement des naissances (OR=9,93 [1,65-59,8]) étaient fortement impliqués dans la survenue de la malnutrition aigue. CONCLUSION: Des efforts devraient être entrepris par les autorités pour améliorer le cadre de vie des populations, ce qui permettrait d'améliorer l'état nutritionnel des enfants de moins de cinq ans et aussi réduire la prévalence de la malnutrition aigue.

Dupuytren's disease: A reality in Black Africa.

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.

[Epidemiological, clinical profile and outcomes of chronic hemodialysis patients in the Nephrology and Hemodialysis Department of the CHU du Point "G"]. / Profil epidemiologique, clinique et evolutif des patients en Hemodialyse chronique dans le service de Nephrologie et d'Hemodialyse du CHU du Point G.

AIM: Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis. PATIENTS AND METHODS: In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value. RESULTS: The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality. CONCLUSION: The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

OBJECTIF: L'hémodialyse est la seule méthode de suppléance rénale au Mali. But du travail : étudier l'évolution des hémodialysés chroniques. PATIENTS ET MÉTHODES: Etude rétrospective transversale de 3 ans chez 150 patients. Les paramètres étudiés : le profil épidémioclinique, les facteurs de risques, la qualité et l'impact des prestations sur la survie. Les données ont été analysées sur SPSS 12.0 pour Windows avec p<0,05 comme valeur de significativité. RÉSULTATS: L'âge moyen des patients était de 40,45 ans. Le revenu était faible chez 60%. Le taux d'hémoglobine était inférieur à 9g/dl chez 63,3%. La néphropathie vasculaire était la principale cause 42%. L'hyperphosphorémie isolée était retrouvée chez 38,6%. Le bilan lipidique était perturbé chez 73,9%. L'abord vasculaire était le cathéter central chez 78,7%. La mortalité était de 37,3%. Le décès était dû à la cardiomyopathie hypertrophique chez 35,5% (p = 0,002). Le taux d'hémoglobine bas (p=0,0002), le KT central (p=0,008), les complications cardiovasculaires (p=0,007) et la durée en hémodialyse (p=0,00001) sont des facteurs de risques de mortalité élevée. CONCLUSION: La durée de vie en hémodialyse reste liée aux complications de l'atteinte rénale et à la prise en charge précoce.

Performance of Mali's biosafety level 3 laboratory in the external quality assessment in preparedness of laboratory accreditation and support to clinical trials.

Background: The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC's) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys. Methods: We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017. Results: Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%. Conclusion: So far, UCRC's BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials.

[Entrapment of the median nerve after neglected dislocation of the elbow: a case report]. / Incarcération du nerf médian après luxation négligée du coude : à propos d'un cas.

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.

Pruritus in chronic hemodialysis patients in the nephrology department of the Point G University Hospital (Bamako-MALI).

The purpose of this work is to describe pruritus in chronic hemodialysis patients at the G-University Hospital Center. METHOD AND PATIENTS: This a descriptive cross-sectional study included 30 patients receiving chronic hemodialysis. RESULTS: Among 90 chronic hemodialysis patients, the study selected 30, including 22 men (73.3%) and 8 women (26.7%), with an average age of 46.60 years (range: 24-82 years). All had pruritus: it was localized in 23.3 % (n=7) and diffuse in 76.7% (n=23). It occurred during dialysis sessions for half of them. It could be nocturnal (50%), diurnal (30%) intermittent (10%), or constant (10%). The dermatological signs associated with pruritus were cutaneous hyperpigmentation in 13.3% of cases, contact eczema in 3.3%, and cutaneous xerosis in 53.3%. CONCLUSION: Pruritus is still the most common sign of dermatological conditions in chronic hemodialysis. Treatment remains symptomatic.

[Pregnancy In Chronic Hemodialysis, Case Study]. / Grossesse Au Cours De L'Hemodialyse Chronique : A Propos D'Un Cas.

For a long time, pregnancy in chronic hemodialysis was considered medically contraindicated, because of the many maternal complications that it could cause. Its management is as heavy for the medical teams (nephrologist, obstetrician and neonatologist) as for the patient herself. We report here a case of pregnancy in a dialysis patient observed at the Madeleine clinic in Dakar, Senegal. This pregnancy is the first described with a birth of a living child having a normal birth weight without abnormal malformative thanks to the multidisciplinary follow-up nephrologist, obstetrician and neonatologist), the intensification of dialysis care, the correction of anemia, control of blood pressure and improvement of the mother status nutritional.

Pendant très longtemps la grossesse chez l'hémodialysée chronique était considérée comme médicalement contre indiquée, à cause des nombreuses complications materno fœtales qu'elles pouvaient engendrer. Sa prise en charge est aussi lourde pour les équipes médicales (néphrologue, obstétricien et neonatologiste) que pour la patiente elle-même. Nous rapportons ici un cas de grossesse chez une dialysée observé à la clinique madeleine de Dakar au Sénégal. Cette grossesse est la première décrite avec une naissance d'un enfant vivant ayant un poids de naissance normal sans anomalie malformative grâce au suivi pluridisciplinaire (néphrologue, obstétricien et néonatologiste), l'intensification des soins de dialyse, la correction de l'anémie, la maitrise de la pression artérielle et l'amélioration de l'état nutritionnel de la mère.

[Pulmonary Metastase of a Knee Mycetoma in Senegal]. / Métastase pulmonaire d'un mycétome du genou au Sénégal.

Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.

Le mycétome se transmet principalement par piqures d'épines d'arbustes infectés. Les localisations primitives au niveau du pied sont les plus fréquentes. Les localisations pulmonaires sont exceptionnelles et secondaires à des localisations périphériques primitives. Nous rapportons un cas de localisation pulmonaire d'un mycétome fongique secondaire à une localisation au niveau du genou, puis nous faisons une revue de la littérature et nous discutons de la voie de dissémination.

[Recidives of Mycetoma after Amputation in Dakar (Senegal)]. / Récidives de mycétome après amputation à Dakar (Sénégal).

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

La chirurgie constitue le temps essentiel du traitement des mycétomes fongiques. Elle consiste en une amputation en cas d'atteinte osseuse. Nous avons observé 5 cas de récidives après amputation pour mycétome. Il s'agit dans tous les cas de patients présentant des mycétomes à grain noir avec atteintes osseuses. Les récidives sont survenues à moins de 18 mois de l'amputation faisant parler de reprise évolutive et posant le problème du niveau de l'amputation.

Expansion of Aedes africanus (Diptera: Culicidae), a sylvatic vector of arboviruses, into an urban environment of Abidjan, Côte d'Ivoire.

In 2008, an outbreak of yellow fever occurred in Abidjan. The entomological investigations confirm that Abidjan is at risk of yellow fever with a suspicion of the National Park of Banco (NPB) forest as a likely area of re-emergence. This study aims to assess the dispersion of sylvatic vectors of arboviruses from the NPB forest to the surrounding areas (Andokoi and Sagbé). The sampling was done in the rainy season using the WHO layer-traps technique. Among the six species of Aedes sampled, Aedes aegypti and Aedes africanus were the potential vectors of arboviruses. Both species were collected in Sagbé but only Ae. aegypti in Andokoi. Only Ae. aegypti were present 400 and 800 m from NPB forest, but at 200 m, it showed respective proportions of 75.5% and 87.5% in Sagbé and Andokoi. In the NPB forest, however, Ae. africanus has been the predominant species. The study showed the presence of Ae. aegypti in Andokoi and Sagbé. However, Ae. africanus was found in the NPB forest and in the 200 m radius in Sagbé. The establishment of an entomological surveillance program in all areas would therefore be essential for the prevention of arboviruses outbreaks in Abidjan.

[Prevalent Of Echocardiography Anomaly In Chronic Hemodialysis Patients At The Point G Hospital]. / Prevalence Des Anomalies Echocardiographiques Chez Les Hemodialyses Au Chu Point G.

INTRODUCTION: Cardiovascular abnormalities are frequent and often early, severe and masked in patients with renal impairment. These cardiovascular complications are the main causes of death in hemodialysis patients. The diagnosis of these cardiovascular anomalies by cardiac ultrasound allows the individualization of patients at high cardiovascular risk. We conducted this study to evaluate the echo-cardiographic aspects of chronic hemodialysis in the nephrology and hemodialysis department of the G-Point CHU. METHODS: This is a retrospective study of chronic renal failure patients who have undergone extra-renal treatment for 6 months or more from January 1, 2011 to December 31, 2012. Results: During this study, 83 files were retained The sex ratio was 1.51 in favor of men. The average age of patients was 48 years old. HTA (59%) and tobacco (43.3%) remain the dominant risk factors. Vascular nephropathy was the leading cause of CKD, 44.6%. Echo-cardiac abnormalities are dominated by cavitary dilatation (78.3%), LVH (41%), cardiac dysfunction (83.2%), valvular lesion (30.1%), and pericarditis (22,9%). The cardiovascular complications were LVH (41%), hypertension (25.3%) and dilated cardiomyopathy (9.7%). The evolution was favorable for 73.5% of the patients, the mortality represented 8.4% with various complication (18.1%).

INTRODUCTION: les anomalies cardiovasculairessont fréquentes et souvent précoces, sévères et masquées chez les patients insuffisants rénaux. Ces complications cardiovasculaires sont les principales causes de mortalités et de morbidité chez les hémodialysés. Le diagnostic de ces anomalies cardiovasculaires par l'échographie cardiaque permet l'individualisationdes patients à haut risque cardio vasculaire. L'objectif de cette étude était d'évaluer les aspects échocardiographiques chez les hémodialyses chroniques dans le service de néphrologie et d'hémodialyse du CHU du point G. MÉTHODES: Il s'agit d'une étude rétrospective du 1er janvier 2011 au 31 décembre 2012 et a concerné les insuffisances rénales chroniques ayant bénéficié d'une épuration extra-rénale depuis6mois. RÉSULTATS: Au cours de cette étude 83 dossiers étaient retenus. Le sex ratio était de 1,5 en faveur des hommes. L'âge moyen des patients était de 48 ans. L'HTA (59%), le tabac (43,3%) restent les facteurs de risque dominant. La néphropathie vasculaire a été la principale cause d'IRC soit 44,6%.Les anomalies échocardiographiques sont dominées par la dysfonction cardiaque (83,2%), ladilatation cavitaire (78,3%), l'HVG (41%), la lésion valvulaire (30,1%), et l'épanchement péricardique (22,9%). Les complications cardiovasculaires étaient l'HTA (67.%), lacardiomyopathie dilatée (49,7%) et l'HVG (41%). L'évolution était favorable chez 73,5% des patients, la mortalité représentait 8,4% avec complication diverse (18,1%).

Private pharmacy staff in five main towns in Benin, Burkina Faso, and Mali: knowledge and practices concerning malaria care in 2014.

The Global Fund's involvement in the fight against malaria has led to significant improvements, but mostly through programs supporting public-sector health facilities and personnel. The authors report the results of the preliminary survey preceding their intervention with private pharmacies. A simple random sampling technique was used to select the sample of pharmacies in urban areas in Burkina Faso, Benin, and Mali. A pretested questionnaire was administered to the supervisor present in each pharmacy at the time of the survey. Data were collected by local students in the first quarter of 2014. In all, 94 pharmacies were surveyed, representing 17.6% of all the pharmacies in these 5 cities. Among the participants, 84% knew about the national malaria control program, and 77.7% about artemisinin-based combination therapy (ACT), while 38.8% knew the national protocols. Licensed pharmacists had a better knowledge of ACT than their assistants, and training improved knowledge of treatment for uncomplicated malaria episodes. These pharmacists and assistants would like to be more involved in the fight against malaria. They are ready to advise ACT when appropriate after rapid detection tests. It is necessary to find resources for subsidized inputs in the private sector to make these drugs and tests more accessible for all patients.