Mortalité à long terme des survivants d'accidents vasculaires cérébraux ischémiques à Bobo Dioulasso, Burkina Faso / Long-term mortality of ischaemic stroke survivors in Bobo-Dioulasso, Burkina Faso

Contexte et objectif. La survie à long terme des accidents vasculaires cérébraux ischémiques (AVCI) reste un défi majeur. L'objectif de ce travail était d'analyser la mortalité à long terme des survivants d'AVCI. Méthodes. Il s'est agi d'une cohorte rétrospective portant sur les patients hospitalisés du 1er janvier 2017 au 31 décembre 2019, sortis vivants du service de neurologie au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso après un AVCI. Nous avons recouru aux méthodes de Kaplan Meier et la regression de Cox pour décrire respectivement la survie et les prédicteurs de la mortalité. Résultats. Au total, 87 patients dossiers ont été colligés. L'âge moyen était de 61,2 ans (±13,7). Le sex-ratio M/F était de 1,23/1. L'hypertension artérielle était le principal facteur de risque cardiovasculaire (65,5 %). Les antécédents de cardiopathies étaient présents chez 6 patients. La conscience était normale chez 82 patients et les complications de décubitus ont été observées chez 20 patients au cours de l'hospitalisation. La durée moyenne d'hospitalisation était de 15,8 jours. La mortalité cumulée en post hospitalisation était de 40,2 % à 4 ans. Les facteurs prédictifs de la mortalité étaient l'âge > 60 ans (p=0,008; HRa= 3,05 ; IC 95 % : 1,33-6,99), le score de Glasgow>9 (p<0,001; HRa = 0,09; IC 95 % : 0,02-0,31) et l'absence de complication de décubitus (p=0,009; HRa = 0,34; IC95 % : 0,15-0,76). Conclusion. Dans ce contexte, la mortalité à long terme des AVCI est élevée. Le renforcement du suivi vis-à-vis des groupes spécifiques pourrait contribuer à réduire considérablement cette mortalité à long terme.

Context and objective. Long-term survival from ischaemic stroke remains a major challenge. The aim of this study was to analyse the long-term mortality of stroke survivors at the Sourô Sanou University Hospital in Bobo-Dioulasso. Methods. This was a retrospective cohort of hospitalized patients from January 1, 2017 to December 31, 2019, discharged alive from the neurology service after ischaemic stroke. We used Kaplan Meier and Cox regression methods to describe survival and predictors of mortality, respectively. Results. A total of 87 patients were included in this study. The mean age was 61.2 years (±13.7). The sex ratio M/F was 1.23. Hypertension was the main cardiovascular risk factor (65.5%). A history of heart disease was present in 6 patients (6.9%). Consciousness was normal in 82 patients (94.2%) and decubitus complications were observed in 20 patients (23%) during hospitalisation. The average length of hospital stay was 15.8 days. Cumulative post-hospital mortality was 40.2% at 4 years. Factors predictive of mortality were age >60 years (p=0.008; aHR= 3.05; 95%CI: 1.33-6.99), Glasgow score>9 (p<0.001; aHR = 0.09; 95% CI: 0.02-0.31) and absence of decubitus complication (p=0.009; aHR = 0.34; 95%CI: 0.15-0.76). Conclusion. In this context, long-term mortality in ischaemic stroke is high. Closer monitoring of specific groups could help to reduce considerably this long-term mortality.

[Maxillo-facial loss of substances of traumatic origin at the Yalgado Ouedraogo University Hospital]. / Pertes de substances maxillo-faciales d'origine traumatique au centre hospitalier universitaire Yalgado Ouedraogo.

OBJECTIVE: This work aims to report the modalities of management of maxillofacial substance loss following trauma in our context. METHODS: This was a descriptive cross-sectional study with retrospective data collection of 55 cases of maxillofacial substance loss of traumatic origin over a period of 7 years from 2014 to 2020 in the department of stomatology and maxillofacial surgery of Yalgado Ouedraogo University Hospital. RESULTS: The annual prevalence was 7.86 cases. The etiology was dominated by road traffic accidents (80% of cases). Loss of labial substance was the most frequent (58.18%). The lesions were severe, Lakmann type IV in 76.36% of cases. Bone loss occurred in 9.10% of the cases and was mainly located in the mandible. The repair of substance losses by locoregional flaps was the main technique for soft tissue reconstruction. Bone defects were repaired with non-vascularized bone grafts. The evolution was satisfactory in the majority of cases (80.3%). Infections were the main complications (5 cases) and the sequelae were dominated by unaesthetic scars (45.45%). CONCLUSION: The management of maxillofacial substance loss of traumatic origin must be early and adequate for a better aesthetic and functional result.

Cellulite diffuse cervico-thoracique d'origine dentaire compliquée de pyothorax: à propos d'un cas au centre hospitalier universitaire Tenganogo (Burkina Faso) / Cervico-thoracic cellulitis of dental orgin complicated with pyothorax: about a case at the teaching hospital of Tenganogo (Burkina Faso)

Introduction: Les cellulites diffuses cervico-faciales sont des infections à extension rapide des loges cellulo-graisseuses de la face, le plus souvent d'origine dentaire. Elles sont graves et potentiellement mortelles. Nous rapportons un cas de cellulite diffuse cervico-thoracique compliquée de pyothorax. L'objectif de cette observation est de montrer les difficultés thérapeutiques de ce cas rare dans un pays sous médicalisé. Observation: il s'est agi d'un patient de 30 ans sans antécédents pathologiques particuliers admis dans le mois de Mai 2022 aux urgences médico-chirurgicales du Centre Hospitalier Universitaire Tenganogo pour détresse respiratoire associée à une tuméfaction cervico-thoracique avec nécrose cutanée. Cette symptomatologie était consécutive à une odontalgie de la 36 qui évoluait depuis deux semaines avec notion d'automédication. Le diagnostic de cellulite diffuse cervico-thoracique d'origine dentaire a été posé. Devant la détresse respiratoire avec un syndrome d'épanchement pleural liquidien, la réalisation d'une radiographie thoracique de face a mis en évidence une pleurésie unilatérale gauche de grande abondance dont la ponction suivie du drainage a ramené 3500cc de liquide purulent nauséabond. Un prélèvement bactériologique a été effectué et le patient a bénéficié d'un traitement fait d'une bi-antibiothérapie probabiliste par voie injectable (amoxicilline 1g + acide clavulanique 125mg/8H et métronidazole 500mg/8H), d'une réanimation énergique associée à un drainage cervico-thoracique sous anesthésie générale. L'évolution a été favorable marquée par une bonne ré-expansion pulmonaire à la radiographie de contrôle au bout de deux semaines de traitement. Conclusion : les cellulites diffuses cervico-faciales sont des affections graves, redoutables et constituent de véritables urgences médicochirurgicales

Introduction: Cervico-facial diffuse cellulitis is a rapidly spreading infection of the cellulo-fatty loges of the face, most often of dental origin. They are serious and potentially fatal. We report a case of cervicothoracic diffuse cellulitis complicated by pyothorax. The objective of our study was to report our expérience in the management of this condition. Observation : this was a 30-years old patient with no particular pathological history admitted in May 2022 to the medical-surgical emergency room of the Tenganogo University for respiratory distress associated with a cervico-thoracic swelling with skin necrosis. This symptomatology was consecutive to an odontologia of tooth 36 which has been evolving for two weeks with the notion of self medication in whom the diagnosis of cervicothoracic diffuse cellulitis of dental origin was made. In front of the respiratory distress with syndrome of liquid pleural effusion, the realization of a thoracic radiolography of face showed a unilateral left pleurisy of great abondance whose drainage function brought back 3500 of nauseating purulent liquid. A bacteriological sampling was carried out and the patient benefited from a treatment made of a probabilistic biantibiotitherapy by injectable way (amoxicillin 1g + clavulanic acid 125mg/8h and metronidazol 500mg/8H), of an energetic resuscitation associated with an excision cervico-thoracic drainage under general anesthesia. The evolution was favorable. Conclusion: diffuse cervico-facial cellulitis are serious, dreadful affections and constitue real medical and surgical emergencies.

Traumatismes maxillo-faciaux par accidents de la circulation routière impliquant les engins à deux roues au Centre Hospitalier Universitaire Yalgado Ouedraogo (CHU-YO). Aspects épidémiologiques et anatomo-cliniques

Introduction : Les traumatismes maxillo-faciaux par Accident de la Circulation Routière (ACR) impliquant les engins à deux roues sont fréquents et peuvent occasionner des lésions graves.Matériels et méthodes : Il s'agit d'une étude prospective allant du 1er janvier 2017 au 31 avril 2017 dans le service de stomatologie et de chirurgie maxillo-faciale du CHUYO. Les dossiers médicaux des patients, les registres de consultation et les comptes-rendus opératoires ont été les sources de collecte des données.Résulats : Au total 230 cas ont été colligés dans le service de stomatologie et de chirurgie maxillo-faciale du CHUYO. Ces cas étaient relativement fréquents soit 84.24% des motifs de consultation de traumatologie. Les travailleurs du secteur informel (43,48%) et l'homme jeune de sexe masculin (84,35%) ont été les plus touchés. Les motocyclistes (80,70%) constituaient les principaux usagers. La consommation d'alcool (49,13%) et la méconnaissance du code de la route (77,29%) étaient les principaux facteurs favorisants. Les lésions des parties molles étaient les plus fréquentes (90,43%). Le zygoma était l'os le plus atteint (49,46%). Les fractures des membres (44,73%) ont constitué les principales lésions osseuses extra-faciales associées.Conclusion : La sensibilisation de nos populations sur la sécurité routière et la collaboration interdisciplinaire permettraient de renforcer l'efficacité de nos structures de soins

[Epidemiology of maxillo-facial traumatism s sequels at stomatology and maxillo-facial surgery service of Yalgado Ouedraogo University Hospital Center]. / Epidémiologie des séquelles de traumatismes maxillo-faciaux au service de stomatologie et chirurgie maxillo-faciale du Centre Hospitalier Universitaire Yalgado Ouedraogo (Burkina Faso).

Introduction: Our study brings back the epidemiological and anatomo-clinical characteristics of the maxillo-facial traumatisms sequels at Yalgado Ouedraogo University Hospital Center of Ouagadougou. Methodology: It was a transversal descriptive study going from May 2013 to April 2015. Results and Discussion: In all, 152 cases of post traumatisms sequels were collected. The masculine sex was more affected with a sex-ratio of 2,53. The mean age was 30,80 years. The public road accidents (73,68%) were the main etiology of initial lesions. The isolated functional and morphological sequels respectively represented 1/3 and 1/6 of cases. Half of patients had mixed sequels. The odontological sequels (41,45%), the disgracious scars (93,68%), the neurological sequels (15,79%), the ocular sequels (11,18%), and the temporo-mandibular ankylosis were the main sequels found in our study. These sequels could be explained by the nature of initial lesions and the lateness of consultations. Conclusion: Development of population's awareness and close interdisciplinary collaboration helped to reduce the frequency of these sequels.

[Tooth decay: epidemiological and therapeutic aspects in dental service of University Teaching Hospital Yalgado Ouedraogo and Municipal Centre of Oral Health]. / La carie dentaire: aspects épidémiologiques et thérapeutiques aux services de chirurgie dentaire du Centre Hospitalier Universitaire Yalgado Ouedraogo et du Centre Municipal de santé bucco-dentaire.

INTRODUCTION: In order to improve the prevention and treatment of dental caries in Burkina Faso, we conducted a study on the epidemiological and therapeutic aspects of dental caries in the dental services of University Teaching Hospital Yalgado Ouedraogo and in the Municipal Centre of Oral Health of Ouagadougou. MATERIAL AND METHODS: A prospective and descriptive study from October, 15th 2012 to January, 15th 2013 was conducted on a sample of 191 patients. The variables recorded were: patient's identity, age, sex, area of residence, food mode, socioeconomic level, reason for consultation, oral hygiene, DMFT index, degree of tissue damage, the topography of the carious lesions and the applied therapy. RESULTS: Caries prevalence was 93.19% more female consultations, with sex ratio at 0.77. The average age was 31 years for a sample often engaged in trade and the informal sector. Carious lesions were usually limited to less than 4 teeth. The main motivation for the consultation was pain at 82.20%. CONCLUSION: The use of preventive care is quite low in our population. Extractions still occupy an important part of treatment. We need to improve oral hygiene and show to patients the necessity of routine visits to the dentist every year for early treatment.

[Two cases of sinus histiocytosis with massive cervical lymphadenopathy (Destombes-Rosai-Dorfman disease)]. / Deux cas d'histiocytose sinusale ganglionnaire cervicale de Destombes-Rosai-Dorfman.

INTRODUCTION: Sinus histiocytosis with massive lymphadenopathy is a rare disease. Its location is ubiquitous, but the most frequent is cervical lymph nodes. OBSERVATION: We report 2 cases of sinus histiocytosis with massive lymphadenopathy. The patients were respectively 9 and 30 years of age. They both presented with bilateral cervical polylymphadenopathy with a cervical compression syndrome in the first patient. The diagnosis was made histologically by demonstrating histiocyte emperipolesis, in the first case, and by immuno-histochemistry in the second. The treatment was corticosteroids, resulting in an almost total involution. DISCUSSION: Sinus histiocytosis with massive lymphadenopathy is a clinical and a specific pathology, but its etiopathogenesis remains to be elucidated. The cervical localization is common. The definitive diagnosis is histological. There is currently no codified treatment. The outcome is usually favorable, apart from mechanical and systemic complications that are important prognostic factors.

[Noma and Burkitt disease; a particular association about three observations seen in the Teaching Hospital Center Yalgado Ouedraogo (Burkina Faso)]. / Noma et maladie de Burkitt, une association exceptionnelle à propos de trois observations vues au centre hospitalier universitaire Yalgado Ouedraogo (Burkina Faso).

Cancrum oris is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, Gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles [3]. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma first described by Burkitt in 1958 in African children from areas holoendemic for malaria. It is the first cancer of African child [6]. The association between Burkitt lymphoma and cancrum oris is non common. We report in the present study three cases of this association at the Academic Hospital Yalgado Ouedraogo of Ouagadougou. This association poses a problem of late diagnosis with difficulties in therapeutic management.

Tuberculosis of the temporomandibular joint.

INTRODUCTION: Extrapulmonary and extra-spinal tuberculosis (TB) is rare, even in countries where the disease is endemic. Ten percent of these localizations are cervico-facial. Involvement of the temporomandibular joint (TMJ) is very unusual. We present the features of such a case. REVIEW: We looked for patients managed for TMJ TB in 2 Maxillofacial Surgery departments and in 1 Pneumology & Phthisiology Department since 1992. The second part of the study was a literature review. One case was found in our departments and 15 other cases were found in published data. Most patients were women with mean age of 39.9 years (5 to 68). Pre-auricular swelling was the predominant functional sign, often without fever or change in the health status. The biological and radiological abnormalities were non-specific (osteolysis, joint pinching, etc.). No lung involvement was observed. The joint recovered its normal function after appropriate management. DISCUSSION: Tuberculosis of the TMJ is difficult to diagnose given its rarity and the non-specific nature of clinical and paraclinical signs. It must be considered in the differential diagnosis for common diseases of the TMJ whether TB is endemic or not.

[Evoluting form of cancrum oris, about 55 cases collected at the Academic Hospital Yalgado Ouedraogo of Ouagadougou]. / Le noma évolutif, à propos de 55 observations vues au centre hospitalier universitaire Yalgado Ouedraogo de Ouagadougou.

The cancrum oris is still an up to date disease in our environment. The death rate and the after effects of this disease make all together the main interest of this survey. In a retrospective survey carried out from January 2003 to December 2012, we colligated 55 cases of progressive cancrum oris followed at the stomatological and maxillofacial surgery at the Academic Hospital Yalgado OUEDRAOGO. On the epidemiological level, we noticed an impact of 5.5 cases per year. The average age of our patients was about 7.64 with a sex ratio of 1.03. Most of the patients were from an underprivileged family (96.4%). On the clinical level, we noticed that most of the patients consulted only after the gangrene had fallen (89.1%) and were seriously affected (67.3%) with a bad oral and dental hygiene (38.1%). The attacks were mainly jugal (25%) and labial (24.1%). The cancrum oris was in most of the cases associated to broncho pneumonitis, malaria and to HIV infection (31.37%). For the medical treatment, we focused on resuscitation, re nutrition, hydro electrolytic rebalancing and antibiotherapy. The surgical treatment was essentially made on the affected areas, controlled skinning and most often followed by sequestrectomy. 81.8% of the patients recovered completely from the infection, 60% had after effect injuries. We recorded a death rate of 14.5%. In order to overcome this disease we need both national and international support.

[Epidemiology and clinic of dental extractions in University Teaching Hospital Yalgado Ouedraogo, (Burkina Faso)]. / Aspects épiémiologiques et cliniques des extractions dentaires au Centre Hospitalier Universitaire Yalgado Ouedraogo (Burkina Faso).

INTRODUCTION: The consequences of tooth loss are often severe for the patient: aesthetic deficit, decreased masticatory coefficient, malnutrition... The objective of this study was to describe the epidemiological and clinical aspects of dental extractions of patients attending the University Teaching Hospital Yalgado Ouedraogo (UTHYO). PATIENTS AND METHODS: It was a descriptive cross-sectional retrospective study on a sample of 65 patients who received a dental extraction at least in dental surgery of the UTHYO. RESULTS: The sample consisted of 33 (50.8%) patients female to 32 (49.2%) cases of male, or a sex ratio of 0.96. The average age was 36,55 year-old with extremes of 5 and 84 years. Employees and pupils were the most affected by extractions (33 cases; 47,8% and 22 cases; 33,8%). Dental extractions were more frequent in patients aged between 25 and 60 years. A total of 84 tooth extraction was performed in 65 patients, an average of 1.3 tooth extracted per patient. The most often extracted tooth was the third lower molar (17 cases, 22,95%). The canine was the less often extracted tooth (1 case, 1,35%). Dental decay and its complications (57 cases, 67,87%) and periodontal diseases (10 cases, 11,90%) were the commonest reasons for dental extractions. CONCLUSION: Dental decay and periodontal diseases are the most important causes of dental extractions. Particular emphasis should be placed on prevention and early care of teeth.

[Temporomandibular Joint Ankylosis: Focus On 17 Cases And A Review Of The Literature]. / L'Ankylose Temporomandibulaire: A Propos De 17 Patients Et Revue De La Litterature.

PURPOSE: The purpose of this report was to describe the epidemiology, clinical and curative treatment of a simple interrupter resection of the temporomandibular ankylosis. MATERIALS AND METHODS: This is a retrospective descriptive study of patients who underwent surgical treatment for temporomandibular ankylosis at the university hospital of Bobo-Dioulasso. The treatment protocol comprised of a resection of the ankylosis followed by early functional rehabilitation. RESULTS: 17 patients were studied. The age of the patients at the beginning of the causal disease was between 3 and 50 years. 13 patients were younger than 15 years old. The sex ratio (men/women) was 1.4. The causes of ankylosis were dominated by noma and acute facial cellulite (76.5%), followed by facial trauma (23.5%). Transient facial paralysis, one anterior open bite and a recurrence of ankylosis were the main postoperative complications. CONCLUSION: The temporomandibular ankylosis is a serious complication in maxillofacial pathology. Actions for the prevention and for a better curative treatment are recommended.

BUT: Le but de ce rapport de série était de décrire l'épidémiologie, la clinique et les résultats du traitement curatif par une résection interruptrice simple, de l'ankylose temporo mandibulaire. MATÉRIEL ET MÉTHODE: Il s'est agit d'une étude rétrospective descriptive de patients ayant bénéficié d'un traitement chirurgical pour ankylose temporo mandibulaire au Centre Hospitalier Universitaire de Bobo-Dioulasso. Le protocole thérapeutique comprenait une résection du bloc d'ankylose suivie d'une rééducation fonctionnelle précoce. RÉSULTATS: 17 patients ont été inclus. L'âge des patients au début de la maladie causale était compris entre 3 et 50 ans. 13 patients étaient âgés au plus de 15 ans. Le sex-ratio Homme/femme était de 1,4. Les étiologies de l'ankylose étaient dominées par le noma et les cellulites aiguës de la face (76,5%), suivis des traumatismes faciaux (23,5%). Une paralysie faciale transitoire, une béance antérieure et une récidive de l'ankylose ont été les principales complications post-opératoires. CONCLUSION: L'ankylose temporo mandibulaire est une complication redoutable en pathologie maxillo-faciale. Des actions pour la prévention et pour un meilleur traitement curatif et fonctionnel sont recommandées.

[HIV and noma in Burkina Faso]. / VIH et noma au Burkina Faso.

INTRODUCTION: Noma is a "gangrenous" disease beginning in gums and spreading to other parts of the face. It usually occurs in undernourished children with bad orodental hygiene. Its incidence in adults is increasing. HIV infection is very common in African countries. We had for objective to compare noma characteristics in patients with, or without, HIV. MATERIAL AND METHODS: This retrospective and descriptive study included patients managed for noma in our unit from January 1988 to December 2007. The clinical, epidemiological, and outcome data of patients treated for noma were compared according to HIV infection status. RESULTS: Two hundred and twelve patients were included and 14 (6.6%) among them were HIV positive. In the HIV positive group, there were a male predominance and patients were older (mean age 15.3 vs. 4.7 years in the other group). HIV positive patients were less frequently operated (35.7% vs. 76.3%) and their death rate was higher (37.5% vs. 5.6%). DISCUSSION: HIV infection during the course of noma impacts the clinical and epidemiological features of this condition. It worsens the prognosis. Noma could be considered as an opportunistic infection in the WHO disease staging system.