[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]. / Infections du site operatoire en chirurgie generale du Centre Hospitalier Universitaire Bocar Sidy Sall de Kati.

INTRODUCTION: Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics. MATERIALS AND METHODS: This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018. RESULTS: During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days. CONCLUSION: Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

INTRODUCTION: Les infections du site opératoires (ISO) sont fréquentes et redoutables, au service de chirurgie. Elles représentent une hantise pour le chirurgien. Les objectifs étaient de déterminer la fréquence des ISO et les facteurs de risque, d'identifier les germes et étudier leur sensibilité aux différents antibiotiques. MATÉRIELS ET MÉTHODES: il s'agissait d'une étude transversale avec recueil prospectif des données, réalisée au service de chirurgie générale du Centre Hospitalier Universitaire Bocar Sidy Sall (CHU BSS) de Kati allant de janvier 2015 à décembre 2018. Elle a concerné tous les patients opérés dans le service pendant cette période d'étude. N'ont pas été inclus dans cette étude les cas de biopsie. RÉSULTATS: Au cours de cette période d'étude nous avons enregistré 55 cas d'ISO sur 650 malades opérés soit une fréquence de 8,46%. 450 malades ont été opérés au programme opératoire à froid (69,23%) et 200 malades en urgence (30,77%). L'âge moyen était de 39 ans, le sex-ratio à 2,66. Parmi les 55 cas d'ISO, 60% de ces malades ont été opérés en urgence et 40% au programme opératoire. Les différentes souches les plus retrouvées étaient l'Escherichia coli (E. coli) dans 38,3% des cas, le staphylococcus aureus dans 23,4%, klebsiella pneumonia dans 13,3%. Le taux d'hémoglobine était normal dans 70% des cas. 4 de nos patients soit 7,27% étaient diabétiques. Nous n'avions pas enregistré de cas d'obésité. Parmi les 55 cas des ISO, 66 % étaient de classe 3 et 4 d'Altemeier, 59% étaient de score ASA 2 et ASA 3, 55% étaient de score 2 de NNISS (National Nosocomial Infection Surveillance System), 5,45% étaient de score 3 de NNISS soit 3 cas et ces 3 cas ont développé des ISO. Les ISO étaient pariétales dans 49 cas soit 89%. Les germes retrouvés étaient sensibles à 100% à l'imipénème. Les interventions les plus pourvoyeuses des ISO étaient les péritonites 25 cas (45,45%), les occlusions intestinales 12 cas (21,82%), les abcès appendiculaires 8 cas (14,55%). Nous avions enregistré 2 cas de décès soit 3,64%, la durée moyenne d'hospitalisation a été de 13 jours. CONCLUSION: L'Escherichia coli était le germe fréquemment rencontré dans les ISO en chirurgie générale au CHU BSS de Kati. La résistance aux antibiotiques usuels doit susciter des actions préventives efficaces.

[The Ileal Neobladder With The Hautmann Technic At The Urology Depatment Of University Hospital Pr. Bocar S. SALL Of Kati]. / Le Remplacement De Vessie Selon La Technique De Hautmann Au Service D'Urologie Du Chu Pr. Bocar S. SALL De Kati.

Radical cystectomy is the standard treatment for bladder tumors infiltrating the bladder muscle, for patients who have tumors without invasion of neighboring organs and without metastasis. After radical cystectomy, the urinary diversion is a challenge for any urologist. Ileal neo bladder is a rare surgery in our country. The ileal neo bladder is recommended in these patients. We report a case of ileal neo bladder in a 42-year-old woman with a bladder tumor. We discuss the clinical, diagnostic and therapeutic aspects.

La cystectomie totale constitue le traitement de référence des tumeurs de vessie infiltrant le muscle vésical, pour les patients qui ont une tumeur sans envahissement des organes voisins et sans métastase. Après la cystectomie, la dérivation des urines est un challenge pour tout urologue. Le remplacement de vessie est un geste rarement réalisé dans notre pays. Un remplacement de vessie par l'intestin est recommandé chez ces patients. Nous rapportons un cas de remplacement de vessie chez une femme de 42 ans ayant une tumeur de vessie. Nous discutons les aspects cliniques, diagnostiques et thérapeutiques.

Le remplacement de vessie selon la technique de hautmann au service D'urologie du CHU pr. Bocar s. Sall de kati

La cystectomie totale constitue le traitement de référence des tumeurs de vessie infiltrant le muscle vésical, pour les patients qui ont une tumeur sans envahissement des organes voisins et sans métastase. Après la cystectomie, la dérivation des urines est un challenge pour tout urologue. Le remplacement de vessie est un geste rarement réalisé dans notre pays. Un remplacement de vessie par l'intestin est recommandé chez ces patients. Nous rapportons un cas de remplacement de vessie chez une femme de 42 ans ayant une tumeur de vessie. Nous discutons les aspects cliniques, diagnostiques et thérapeutiques

The Clinical Relevance of Antifibrillarin (anti-U3-RNP) Autoantibodies in Systemic Sclerosis.

Systemic sclerosis (SSc) is a heterogeneous autoimmune disease associated with several antinuclear autoantibodies useful to diagnosis and prognosis. The aim of the present multicentric study was to determine the clinical relevance of antifibrillarin autoantibodies (AFA) in patients with SSc. The clinical features of 37 patients with SSc positive for AFA (AFA+) and 139 SSc patients without AFA (AFA-) were collected retrospectively from medical records to enable a comparison between AFA- and AFA+ patients. Antifibrillarin autoantibodies were screened by an indirect immunofluorescence technique using HEp2 cells and identified by an in-house Western blot technique and/or an EliA test. Comparing AFA+ and AFA- patients, AFA+ patients were significantly younger at disease onset (36.9 versus 42.9; P = 0.02), more frequently male (P = 0.02) and of Afro-Caribbean descent (65% versus 7.7%; P < 0.001). At diagnosis, the Rodnan skin score evaluating the cutaneous manifestations was higher (13.3 versus 8.7; P = 0.01) and myositis was also more common in the AFA+ group (31.4% versus 12.2%; P < 0.01). Patients with AFA+ were not associated with diffuse cutaneous SSc or with lung involvement and no difference in survival was observed. Antifibrillarin autoantibodies are associated with patients of Afro-Caribbean origin and can identify patients with SSc who are younger at disease onset and display a higher prevalence of myositis.

[Case study of renal oncocytoma at the Kati hospital]. / Oncocytome renal a propos d'un cas a l'hopital De Kati.

Renal oncocytoma is a rare benign tumor of the kidney. This benign tumor of epithelial origin represents 5% of renal tumors. Preoperative diagnosis is difficult. The final diagnosis can only be made on the anatomical part; even imaging result can often be evocative. We report the case of a 41 year old patient with renal oncocytoma confirmed after radical nephrectomy for renal tumor.

L'oncocytome rénal est une tumeur bénigne rare du rein d'origine épithéliale représentant 5% des tumeurs rénales. Le diagnostic préopératoire est difficile. L'imagerie est souvent évocatrice. Le diagnostic final ne peut être fait que sur la pièce anatomique. L'exploration chirurgicale demeure la règle en absence d'une biopsie rénale pour obtenir un diagnostic histologique précis. Nous rapportons l'observation d'un patient âgé de 41 ans ayant l'oncocytome rénal confirmé après néphrectomie élargie pour tumeur rénale.

[Epidemiological and clinical profile of traffic accident victims at the emergency department of the University Hospital of Gabriel Touré]. / Aspects epidemiocliniques des accidents de voie publique au service d'accueil des urgences CHU Gabriel Toure Bamako.

OBJECT: Studying the Epidemiological and clinical profile of accidents on public ways at the welcome service of emergencies, CHU Gabriel Touré within the scope of accident reduction on public ways and an improvement of their taking in charge. METHODOLOGY: Retro prospective study over a three-year- period including all the files of any patient emitted for accident happening on public ways without regard to race and sex. RESULT: Over a three-year-period (from January 2007 to December 2009). Our team has analized 2450 hospitalization files with a follow-up going from 0 to 45 days. The most concerned ages range from 15 to 29 years (43 per cent) with a male predominance (81 per cent). The mechanism motorcycles-pedestrians (30.9 per cent) was the most represented. The mains lesions observed were cranial traumatisms (58.9 per cent), followed with fractures of limbs (13.5 per cent). Death-rate has been risen at the level of young men above all (from 15 to 29 years) and it was mainly due to cranial traumatisms. CONCLUSION: Accidents on public ways represent a keen problem in matter of public health. The taking in charge of the curse should be very urgent. Information, communication and education of all the professional and social stratums seem necessary.

Genetic characterization and antibiotic resistance of Campylobacter spp. isolated from poultry and humans in Senegal.

AIMS: The main objectives of this study were to investigate the diversity of Campylobacter genotypes circulating in Senegal and to determine the frequency of antibiotic resistance. METHODS AND RESULTS: Strains of Campylobacter jejuni isolated from poultry (n = 99) and from patients (n = 10) and Campylobacter coli isolated from poultry (n = 72) were subtyped by pulsed-field gel electrophoresis (PFGE). The pulsotypes obtained after digestion by SmaI and KpnI revealed a significant genetic diversity in both species, but without any predominant pulsotypes. However, farm-specific clones were identified in the majority of poultry houses (76.5%). Human and poultry isolates of C. jejuni had common PFGE patterns. High quinolone-resistance rates were observed for C. jejuni (43.4%) and C. coli (48.6%) isolates obtained from poultry. CONCLUSIONS: The results showed a genetic diversity of Campylobacter between farms indicating multiple sources of infection; but specific clones had the ability to colonize the broiler farms. The antimicrobial resistance patterns were not related to any specific PFGE pattern suggesting that resistance was due to the selective pressure of antibiotic usage. Campylobacter with similar genotypes were circulating in both human and poultry. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is important for the understanding of the epidemiology of Campylobacter in broiler farms in Senegal. It also emphasizes the need for a more stringent policy in the use of antimicrobial agents in food animals.

Epidemiological analysis of Salmonella enterica ssp. enterica serovars Hadar, Brancaster and Enteritidis from humans and broiler chickens in Senegal using pulsed-field gel electrophoresis and antibiotic susceptibility.

AIMS: Salmonella Hadar, Salmonella Brancaster and Salmonella Enteritidis are the main Salmonella enterica ssp. enterica serovars isolated from poultry in Senegal. Our objective was to analyse the pulsed-field gel electrophoresis (PFGE) and antibioresistance patterns of strains belonging to these serovars and to assess the significance of broiler-chicken meat as a source of human infection. METHODS AND RESULTS: A total of 142 Salmonella isolates were analysed: 79 were isolated from Senegalese patients with sporadic diarrhoea (11 S. Hadar, nine S. Brancaster and 59 S. Enteritidis) and 63 from poultry (30 S. Hadar, 17 S. Brancaster and 16 S. Enteritidis). The PFGE of XbaI- and SpeI-digested chromosomal DNA gave 20 distinct profiles for S. Hadar, nine for S. Brancaster and 22 for S. Enteritidis. Each serovar was characterized by a major pulsotype which was X3S1 in 42% of S. Hadar, X8S1 in 53.8% of S. Brancaster and X1S2 in 43% of S. Enteritidis isolates. Human and poultry isolates of Salmonella had common PFGE patterns. Antibiosensitivity tests showed multiresistance (more than two drugs) was encountered in 14.5% of S. Hadar and in 5% of S. Enteritidis isolates. Resistance to quinolones was considered to be of particular importance and 14.5% of S. Hadar isolates were found to be resistant to nalidixic acid. CONLCUSIONS: The sharing of similar PFGE profiles among isolates from humans and poultry provided indirect evidence of Salmonella transmission from contaminated broiler meat. But most of the Salmonella isolates remained drug sensitive. SIGNIFICANCE AND IMPACT OF THE STUDY: Efforts are needed to eliminate Salmonella from poultry meat intended for human consumption. This study has also highlighted the importance of continuous surveillance to monitor antimicrobial resistance in bacteria associated with animals and humans.

Risk factors for contamination of ready-to-eat street-vended poultry dishes in Dakar, Senegal.

Our objective was to investigate the Salmonella and Campylobacter contamination of traditional ready-to-eat street-vended poultry dishes and to assess the association of some restaurant characteristics and cooking practices with the contamination of these meals. One hundred and forty-eight street-restaurants were studied from January 2003 to April 2004 in Dakar. A questionnaire was submitted to the managers, and samples of ready-to-eat poultry dishes were taken. Salmonella spp. was isolated in 20.1% of the 148 street-restaurants studied and in 10.1% samples of poultry dishes. The most prevalent serovars isolated were Salmonella hadar, Salmonella enteritidis and Salmonella brancaster. Campylobacter jejuni was detected in only 3 restaurants and 3 poultry dishes. Not peeling and not cleaning vegetables and other ingredients during meal preparation (OR=3.58), dirty clothing for restaurant employees (OR=4.65), reheating previously cooked foods (OR=5.2), and no kitchen and utensils disinfection (OR=3.47) were associated with an increasing risk of Salmonella contamination. Adequate cooking procedures decreased the risk of Salmonella contamination (OR=0.15).

Risk factors associated with Salmonella enterica subsp. enterica contamination of chicken carcases in Senegal.

The objective of this study was to identify the risk factors for Salmonella spp. contamination of Senegalese chicken carcases during slaughtering. One hundred and twenty traditional slaughterhouses were studied from January 2000 to December 2002 in and around Dakar. A questionnaire was administered to the slaughterers and samples of breast skin were taken to assess the Salmonella spp. status of chicken carcases. Results showed that 43.3% of the chicken batches were contaminated with Salmonella spp., with Salmonella Hadar and Salmonella Brancaster as the two main serovars. Salmonella spp. contamination of the live birds before slaughtering was related to contamination of the carcases after slaughtering. Feed withdrawal before slaughtering and thorough cleaning and disinfection procedures decreased the risk of Salmonella contamination. One individual worker for each slaughtering stage was also associated with a decreased risk of Salmonella contamination. Using scalding water for plucking increased the risk of contamination. These results will help slaughterers to produce safer products for local consumers.

Risk factors associated with Salmonella enterica subsp. enterica contamination of chicken carcases in Senegal.

This study was to identify the risk factors for Salmonella spp. contamination of Senegalese chicken carcases during slaughtering. One hundred and twenty traditional slaughterhouses were studied from January 2000 to December 2002 in and around Dakar. A questionnaire was answered by the slaughterers, and samples of breast skin were taken to assess the Salmonella status of chicken carcases. Results showed that 43.3% of the batches were contaminated with Salmonella, indicating Salmonella Hadar and Salmonella Brancaster as the two main serovars. Salmonella contamination of the carcases after slaughtering was related to contamination of the live birds. Feed withdrawal before slaughtering and thorough cleaning and disinfection procedures decreased the risk of contamination. One individual worker for each slaughtering stage was also associated with a decreasing risk of contamination. Using scalding water for plucking the chicken carcases increased contamination risk. These results will help slaughters to produce safer products for local consumers.

Risk factors for Campylobacter spp. infection in Senegalese broiler-chicken flocks.

Our objective was to identify the risk factors for Campylobacter infection in Senegalese broiler flocks. Seventy broiler farms were studied around Dakar from January 2000 to December 2001 around Dakar. A questionnaire was administered to the farmers, and samples of fresh droppings were taken to assess the flocks' Campylobacter status. About 63% of the flocks were infected by Campylobacter spp.; Campylobacter jejuni was the most-prevalent species (P < 0.05). An elevated risk of Campylobacter infection was associated with other animals (mainly laying hens, cattle and sheep) being bred in the farm, the farm staff not wearing their work clothing exclusively in the poultry houses, uncemented poultry-house floors and the use of cartons that transport chicks from the hatchery to the farm as feed plates (rather than specifically designed feed plates). Alternatively, thorough cleaning and disinfection of poultry-house surroundings and manure disposal outside the farm were associated with decreased flock risk.

Risk factors for Salmonella enterica subsp. enterica infection in senegalese broiler-chicken flocks.

Our objective was to assess the association of managerial practices, general hygiene and Salmonella infection in Senegalese broiler flocks. Seventy broilers farms were studied from January 2000 to December 2001 around Dakar. A questionnaire was submitted to the farmers and samples of fresh broiler droppings were taken. A 28.6% of the flocks were infected by Salmonella (mainly Hadar and Brancaster serovars). Salmonella infection of the previous flock (OR = 6.82) and of day-old chicks (OR = 3.73), frequent poultry farmers' visits (OR = 5.38) and keeping sick birds inside the farm (OR = 5.32) increased the risk of Salmonella infection. But, using antibiotics on day-old chicks (OR = 0.17) and a detergent for cleaning (OR = 0.16) decreased the risk.

[Hysteria in children: Briquet's syndrome (a case report)]. / Hystérie de l'enfant: le syndrome de Briquet (à propos d'une observation).

In this case report, the authors studied the difficulties to set up the diagnosis of hysteria in the Briquet's Syndrome. The description presented here is about an eleven years old girl patient without any particular family background and who, after her tonsils have been out against her will, presented a hysteria in the form of Briquet's Syndrome. All the explorations showed no abnormalities. It is the questioning, and the analysis of facts from informations by the patient and her family which allowed to conclude the diagnosis of hysteria. She received a chemotherapy, associated with a psychotherapy and a family guidance. The course was favourable after two months. The authors compare these findings with some data of the literature and underline the diagnostic and therapeutic difficulties they faced. How physicians should approach such form of hysteria to set up the diagnosis is to proceed by elimination because the disease can simulate all sorts of medical or psychiatrical affections.

[Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects]. / Le noma de l'enfant en milieu hospitalier de Bobo-Dioulasso: aspects épidemiologiques, cliniques et prise en charge.

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

High immunoglobulin G2 (IgG2) and low IgG4 levels are associated with human resistance to Plasmodium falciparum malaria.

There is accumulating evidence for a role of immunoglobulin G (IgG) in protection against malarial infection and disease. Only IgG1 and IgG3 are considered cytophilic and protective against P. falciparum, whereas IgG2 and IgG4 were thought to be neither and even to block protective mechanisms. However, no clear pattern of association between isotypes and protection has so far emerged. We analyzed the isotypic distribution of the IgG response to conserved epitopes and P. falciparum blood-stage extract in 283 malaria-exposed individuals whose occurrence of infection and malaria attack had been monitored for about 1 year. Logistic regression analyses showed that, at the end of the season of transmission, high levels of IgG2 to RESA and to MSP2 epitopes were associated with low risk of infection. Indeed, IgG2 is able to bind FcgammaRIIA in individuals possessing the H131 allele, and we showed that 70% of the study subjects had this allele. Also, high specific IgG4 levels were associated with an enhanced risk of infection and with a high risk of malaria attack. Moreover, specific IgG2 and IgG3 levels, as well as the IgG2/IgG4 and IgG3/IgG4 ratios, increased with the age of subjects, in parallel with the protection against infection and disease. IgG4 likely competes with cytophilic antibodies for antigen recognition and may therefore block cytotoxicity mediated by antibody-activated effector cells. In conclusion, these results favor a protective role of IgG3 and IgG2, which may activate effector cells through FcgammaRIIA, and provide evidence for a blocking role of IgG4 in malarial infection and disease.

[Analysis of the genetic factors controlling malarial infection in man]. / Analyse des facteurs génétiques contrôlant l'infection palustre chez l'homme.

Genetic factors have clearly been shown to play a role in controlling malarial infection in animal models. There is now also increasing evidence for the genetic control of malaria in man. We carried out a segregation analysis based on blood parasite load phenotype for a population of the town of Bobo-Dioulasso (Burkina-Faso). This analysis demonstrated a strong genetic effect. Our results were not consistent with the segregation of a major gene and thus suggest that parasite load is under the control of minor genes. The genetic effect was stronger in children than in adults. We carried out a regression analysis in children and found that there was an association between the phenotype for blood parasite load and the q31-33 region of chromosome 5. We identified a gene in this region, Pfil1 (Plasmodium falciparum infection levels 1), which accounted for almost 50% of the variance in blood parasite load and which played a fundamental role in the control of infection. The 5q31-33 region contains several genes encoding cytokines that regulate T lymphocytes. The identification of genes controlling malarial infection opens up new possibilities for preventive and treatment strategies. It should be possible in the near future to identify individuals at risk of malaria, who would derive the greatest benefit from preventive and therapeutic measures. Finally, a deeper understanding of these genes controlling protective immune responses could be of value for the development of vaccines.

Epidemic of fatal encephalopathy in preschool children in Burkina Faso and consumption of unripe ackee (Blighia sapida) fruit.

BACKGROUND: On March 21, 1998, the Regional Health Authority of Bobo-Dioulasso, Burkina Faso, asked the Centre Muraz to investigate an unexplained outbreak of epidemic fatal encephalopathy (EFE). We aimed to identify the cause of this epidemic. METHODS: We identified cases retrospectively through review of health-service records and interviews of family members, village chiefs, and local healers. Active surveillance was started in administrative divisions within the study area in April, 1998, to identify further EFE cases. We did a case-control study of households to investigate the risk from various environmental and health factors. Blood and urine samples were collected if possible and urine dicarboxylic acid concentrations measured by gas chromatography. FINDINGS: 29 cases of EFE were identified from January to May, 1998. Estimated age-specific attack rates (2-6 years) ranged from 31 to 847 per 100,000 population (p<0.001). The most common symptoms were hypotonia, vomiting, convulsions, and coma. All children died in 2-48 h. The only factor associated with EFE was the presence of ackee trees (Blighia sapida) within 100 m of households (odds ratio 5.1 [95% CI 1.8-14.7] p=0.001). Poisoning with unripe ackee fruits was suggested by urine concentrations of dicarboxylic acids four to 200 times higher in cases (n=2) than in controls (n=3). CONCLUSION: Consumption of unripe ackee fruit probably caused this epidemic and may lead to a substantial number of unexplained deaths in preschool children in west Africa every year. Educational campaigns have the potential to prevent these deaths.