Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

EPILEPTIC SEIZURES REVEALING STURGE WEBER'S DISEASE IN A TROPICAL ENVIRONMENT: STUDY OF EIGHT CASES.

In sub-Saharan Africa (SSA), the etiological factors of epilepsy are multiple and phacomatoses, in particular Sturge weber's disease, are rarely reported due to under-medicalization and insufficient multidisciplinary care. We carried out a retrospective study of 216 patients hospitalized for recurrent epileptic seizures between 2015 and 2022 in the neurology and pediatrics department of the University Hospital Center of Conakry, among whom eight (8) patients were identified for Sturge Weber's disease in order to reassess this pathology from a clinical and paraclinical point of view in a tropical environment. Sturge Weber's disease was retained in eight (8) on the presence of symptomatic partial epileptic seizures (age 6 months to 14 years) with frequency of status epilepticus, homonymous lateral hemiparesis linked to occipital involvement, piriform calcifications on imaging and ocular disorders. The delay in consultation and medical care revealed severe mental deterioration in our patients. This study shows a stereotyped clinical picture in a context of aggravation of signs related to a delay in multidisciplinary management. These results are important for the diagnostic, therapeutic and prognostic discussion.

GAYET WERNICKE'S ENCEPHALOPATHY AFTER COVID-19 IN ELDERLY SUBJECTS IN TROPICAL ENVIRONMENTS: STUDY OF SIX (6) OBSERVATIONS IN CONAKRY.

In sub-Saharan Africa, the COVID-19 pandemic has caused severe malnutrition in elderly populations with the appearance of vitamin deficiencies, in particular thiamine responsible for Gayet Wernicke's encephalopathy (EGW). We present a series of six (6) patients hospitalized in the Neurology Department of the CHU Ignace Deen for the management of a brain syndrome with vigilance disorders after recovery from COVID-19, including oculomotor disorders, motor incoordination on a course of severe weight loss. The six patients underwent an evaluation of malnutrition by determining the WHO body mass index, the Detsky index, the serum albumin assay, the thiamine assay and a neuroradiological assessment (MRI) and an electroencephalogram (EEG) examination although this does not seem necessary for diagnosis. Study of nutritional status: weight loss greater than 5%, patients in Desky group B and C, plasma albumin<30 g/l, lowered thiamine and MRI neuroradiological data: by the existence of hypersignals in certain regions of the neocortex, certain gray nuclei, the mammillary bodies the thalamic nuclei close to the wall of the 3rd ventricle and the regions bordering the 4th ventricle sign Gayet Wernicke's encephalopathy syndrome. This study shows a stereotyped clinical, biological, neuroradiological and evolutionary profile of Gayet Wernicke's encephalopathy in elderly subjects recovered from Covid-19 with proven malnutrition. These results are useful for the therapeutic and prognostic discussion.

Prevalence of COVID-19 at the Wahgnion-Gold mining site in Burkina Faso and use of RT-PCR initial cycle threshold to monitor the dynamics of SARS-CoV-2 load

Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.18.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.

Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.

[Clinical and laboratory features of recessive Limb Girdle Muscular dystrophies in the Department Neurology of University Hospital of Point G]. / Aspects Cliniques et Paracliniques des Myopathies des Ceintures Récessives au Service de Neurologie du CHU Point G.

INTRODUCTION: Limb-Girdle Muscular dystrophies (LGMD) is a group of inherited diseases characterized by predominantly proximal and limb muscle weakness. These are rare diseases that have not been well studied in sub-saharan Africa. The aim of our was the clinical and paraclinical characterization of patients with recessive LGMD at the Department of Neurology of the Teaching Hospital of Point G. PATIENTS AND METHODS: We conducted a longitudinal prospective study which took place from March 2014 to May 2019. Patients with recessive LGMD phenotype were enrolled. Sociodemographic, clinical and laboratory data were analyzed. RESULTS: We enrolled 46 families (67 patients), i.e. a frequency of 16.7% among the neurodegenerative diseases seen in the service. Among them, 45.6% came from the Sikasso region. Autosomal recessive inheritance pattern was suspected in 67.4% of the families. Symptoms appeared mainly in the first decade of life. Proximal muscle weakness was found in almost all patients. Cardiac examination showed dilated cardiomyopathy in 4.5% of cases. CONCLUSION: Limb-Girdle muscular dystrophy is a disabling disease that is found in Mali. Further study of these cases could elucidate the underlying genetic defects.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali.

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

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.

Prise en charge de la malnutrition aigüe chez l'enfant dans un hôpital secondaire sahelien

La malnutrition chez les enfants de moins de cinq ans est un problème majeur de santé publique dans les pays à faibles revenus, et contribue de manière significative à la mortalité dans cette tranche d'âge.Le but de ce travail était d'évaluer le profil épidémioclinique et thérapeutique des enfants malnutris pris en charge au centre de santé de référence de Nara.Méthode:IL s'est agi d'une étude rétrospective et descriptive,allant du 01/01/2016 au 31/12/2016.Tous les enfants d'âge compris entre 6 mois et 59 mois, admis pour malnutrition aigüe ont été inclus.Résultats:La malnutrition a été diagnostiquée chez quatre cent soixante un enfant, soit 15% des consultations et 50% des hospitalisations.L'âge médian était de 26 mois (2 mois 93 mois). Le sex ratio était 0,92 (M=222;F=239).Dixneuf pour cent des patients ont eu un sevrage progressif (n=90), et il a été brutal chez 371patients, soit 80%. La répartition des patients selon le Z score était le suivant: Z-score <-1 (n=15;3%), Z-score <-2 (n=46; 10%), Z-score <-3 (n=400; 87%). Le périmètre brachial moyen était de 105mm (99mm-124mm). A l'admission, l'hypoglycémie a été notée chez 45% (n=204). Les cas de marasme représentaient 80% (n=367) kwashiorkor 10% (n=48). La forme mixte de la malnutrition a représentée10% (n=46). Les pathologies associées à la malnutrition étaient: les pneumopathies (n=219; 47%), lepaludisme (n=115;25%) et les gastroentérites (n=68; 15%).Le F75 a été administré majoritairement pendant 3 mois dans 93% des cas. Pour la phase 2 du traitement, le Plumpy Nut et le F100 ont été respectivement administré à 88% et 12%.Le taux de récupération nutritionnelleétait de 95% (n=435).Cinq pour cent des patients sont décédés (n=26). La pneumonie a été la cause du décès dans 85% des cas. Le taux de guérison pour les cas de marasme et de kwashiorkor était respectivement de 94% et 93%.Conclusion:la malnutrition aigüe demeure fréquente et préoccupante en milieu pédiatrique sahelien. Une meilleure connaissance des mères sur le sevrage et la diversification alimentaire permettront d'améliorer l'état nutritionnel des enfants

Diabetes Mellitus among new tuberculosis patients in Bamako, Mali.

INTRODUCTION: Diabetes Mellitus (DM) increases worldwide, mostly in low- and middle-income countries. In Mali, the prevalence in the adult population is estimated at 1.8%, but tuberculosis (TB) patients are not systematically screened. The goal of our study was to determine the prevalence of DM among newly diagnosed TB patients. METHODS: We conducted a cross sectional study and a pilot prospective cohort study in four health centers in Bamako. All patients underwent fasting capillary-blood glucose (FCBG) test at Day 0, and repeated after one-week of TB treatment. Venous FBG test was performed for discrepancies between the two FCBG results. Thereafter, FCBG was performed for pilot study at month-2 (M2) and M5 of TB treatment. RESULTS: Two hundred and one patients were enrolled in this study. Impaired fasting blood glucose was identified in 17 (8.5%), of whom 11 (5.5%) had DM (VFBG >7 mmol/L). Among patients with DM, seven (63.6%) had successful TB treatment outcome, versus 142 (74.7%) of those without DM (p = 0.64), and (OR: 1.69, 95%CI 0.47-6.02). CONCLUSION: The prevalence of DM among TB patients in Bamako exceeds that of the general population and screening at TB diagnosis suffices to identify those with DM. Systematic screening of both diseases will allow better treatment.

[Multidrug-resistant tuberculosis (MDR-TB) in a black African carceral area: Experience of Mali]. / Tuberculose multi-résistante (TB-MR) en milieu carcéral noir africain : expérience du Mali.

INTRODUCTION: Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center. MATERIAL AND METHODS: Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case. RESULT: Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment. CONCLUSION: It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.

Strengthening human genetics research in Africa: report of the 9th meeting of the African Society of Human Genetics in Dakar in May 2016.

The 9th meeting of the African Society of Human Genetics, in partnership with the Senegalese Cancer Research and Study Group and the Human Heredity and Health in Africa (H3Africa) Consortium, was held in Dakar, Senegal. The theme was Strengthening Human Genetics Research in Africa. The 210 delegates came from 21 African countries and from France, Switzerland, UK, UAE, Canada and the USA. The goal was to highlight genetic and genomic science across the African continent with the ultimate goal of improving the health of Africans and those across the globe, and to promote the careers of young African scientists in the field. A session on the sustainability of genomic research in Africa brought to light innovative and practical approaches to supporting research in resource-limited settings and the importance of promoting genetics in academic, research funding, governmental and private sectors. This meeting led to the formation of the Senegalese Society for Human Genetics.

Le 9ème congrès de la Société Africaine de Génétique Humaine, en partenariat avec le Groupe d'Etude et de Recherche sur le Cancer (GERC) et le Consortium H3Africa, s'est tenu à Dakar, au Sénégal. Le thème était «Renforcer la recherche en Génétique Humaine en Afrique¼. Les 210 participants sont venus de 21 pays africains et de six non africains. L'objectif était de valoriser la génétique et la génomique à travers l'Afrique avec comme but ultime d'améliorer la santé des populations, et de promouvoir les carrières des jeunes chercheurs Africains. Une session sur la pérennité de la recherche génomique a révélé des approches innovantes et pratiques supportant la recherche dans des contextes de ressources limitées et l'importance de promouvoir la formation universitaire en génétique, le financement de la recherche par les gouvernements et le privé. Ce congrès conduisit à la création de la Société Sénégalaise de Génétique Humaine.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]. / Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

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.

[Clinical appearance and scalable profile Thiamine deficiency in prison in Guinea: study of thirty-eight observations]. / Aspect clinique et profil évolutif de la carence en thiamine en milieu carcéral en Guinée : étude de trente-huit observations.

Cardiovascular and neurological manifestations associated with thiamine deficiency in Guinean prisons are common but not reported.We performed a prospective study of 38 cases related to vitamin B1 deficiency over a period of 4 years. In this population, the literature of traditional data gathered: frequency peak after thirty (92.6%) and clear representation male (sex ratio M/F: 18/1). The clinical symptomatology remains essentially dominated by sensorimotor polyneuropathy and pure sensory (52.2%), overall heart failure (31.5%) and to a lesser degree by Gayet Wernicke's encephalopathy (7.8%) and shoshin beriberi with severe evolution (5.2%). The study of nutritional status by body mass index (BMI) of the World Health Organization, by the criteria of Detsky and biological markers including albumin, shows that these patients are severely malnourished.

Acute parasitic and other infectious myelopathies in the tropics: 26 cases at the University Hospital in Conakry.

In tropical countries, laboratory-confirmed diagnostic certainty of parasitic and other infectious causes of acute myelopathy is difficult because of a shortage of medical professionals and consulting delays. We performed a retrospective study of 168 patients hospitalized for spinal disorders between 2007 and 2013 and identified 26 diagnosed with acute non-compressive myelopathy of presumed sudden onset. An parasitic or other infectious cause was established for all. A preliminary clinical infection preceding the development of neurologic signs was reported for 22 patients (84.6 %). Neurological signs were limited to the existence of a progressive sensorimotor symptomatology with sphincter disorders.

Epidemiology of community-onset bloodstream infections in Bouaké, central Côte d'Ivoire.

Bacterial bloodstream infections (BSI) account for considerable morbidity worldwide, but epidemiological data from resource-constrained tropical settings are scarce. We analysed 293 blood cultures from patients presenting to a regional referral hospital in Bouaké, central Côte d'Ivoire, to determine the aetiology of community-onset BSI. The prevalence of bacteraemia was 22.5%, with children being most commonly affected. Enterobacteriaceae (predominantly Klebsiella pneumoniae and Salmonella enterica) accounted for 94% of BSI. Staphylococcus aureus was the only relevant Gram-positive pathogen. Clinical signs and symptoms were not significantly associated with blood culture positivity after controlling for malaria.

[Neurological complications of chronic alcoholism: study of 42 observations in Guinea]. / Complications neurologiques de l'alcoolisme chronique : étude de quarante-deux observations en Guinée.

Neurologic disorders related to chronic alcoholism in traditional areas of Guinea are frequent, but reports about them are rare. We conducted the first study in Guinea on this subject and retrospectively collected 42 cases of neurologic manifestations related to alcoholism over a 7-year period. The standard findings of the literature were confirmed in our population: peak frequency after the age of 40 years (82.8%) and clear male overrepresentation (M/F sex ratio: 13/1). All the standard signs and symptoms are reported, with a clear predominance of alcoholic polyneuropathy and hepatic encephalopathy. The study of nutritional status by both body mass index (BMI) and the Detsky criteria showed that these patients were severely malnourished. The brain MRI was a crucial contribution for diagnosing the standard central nervous system complications of alcoholism: Gayet Wernicke encephalopathy, Marchiafava-Bignami disease, Korsakoff syndrome, central pontine myelinolysis, and cerebellar degeneration.

[Consequences of hysterectomy at the national- hospital of Pikine in Dakar]. / Conséquences de l'hystérectomie àu centre hospitalier national de Pikine a Dakar.

BACKGROUND: Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy. METHODS: That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery. RESULTS: Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases. CONCLUSION: Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.

[Neurological disorders related to vitamin B12 deficiency in prisons in Guinea: a 22-case study]. / Manifestations neurologiques associées à la carence en vitamine B12 en milieu carcéral en Guinée : étude de 22 observations.

Neurological disorders related to vitamin B12 deficiency are common in prisons of tropical Africa. We collected 22 cases (20 men and 2 women). They all showed vitamin B12 deficiency associated with neurological signs that were represented by sclerosis combined with bone marrow (n = 9), peripheral neuropathy (n = 6), cerebellar syndrome (n = 2), a pyramidal syndrome of the lower limbs (n = 4) and optic neuropathy (n = 1). Laboratory tests showed a mean hemoglobin concentration of 7.2 ± 1.5 g/dl, mean 104 ± 28 fl, macrocytic anemia in 10 patients. Biermer's disease was identified in 9 patients, 3 patients showed the syndrome of non dissociation of vitamin B12, a gastrectomy in 2 patients and no etiology was identified in 8 patients.