Chapitre 4. Subventions discriminatoires de soins medicaux à l'épreuve du principe éthique de la justice : cas d'un service d'orl au burkina faso.

INTRODUCTION: A legal exception to the principle of equal health rights, discriminatory subsidies often pose an ethical dilemma in the field of application. AIM: To analyze discriminatory subsidies for healthcare in the light of the ethical principle of justice and to propose alternatives to any inherent legal and ethical conflicts. METHOD: This was a qualitative, descriptive and analytical study based on semi-structured interviews with caregivers. RESULTS: Participants felt that the application of discriminatory subsidies has a negative impact on substantial distributive justice. The infringements of the award conditions were exclusively for the benefit of the patients concerned. Their impact was considered positive on distributive justice and negative on formal justice. DISCUSSION: Discriminatory care subsidies generally stem from a legal requirement whose application should not be ambiguous. It is apparent that the infringements of the conditions for attribution were in favour of substantial distributive justice. This opposition is a potential source of decision-making difficulties for caregivers who often choose to violate conditions for the benefit of their indigent patients. There are therefore violations of ethically understandable standards, which must be admitted. This could be done through the provision of exceptions for the application of standards for ”noble causes” and conscientious objection clauses in health policy texts. CONCLUSION: The legitimacy of health policy norms is essential for their effective application, hence the interest of taking distributive justice into account in the genesis of formal norms.

How alcohol and/or tobacco use and raised glycemia are associated with oral hygiene practices among Burkinabè adults: Evidence from the first national non-communicable disease risk factors survey.

Socio-demographic correlates with oral hygiene practices are commonly investigated. The present study aimed to determine whether alcohol and/or tobacco use and hyperglycemia were associated with oral hygiene practices among Burkinabè adults. This descriptive, cross-sectional study included 4550 adults selected through multistage cluster sampling performed during the first WHO STEPS survey conducted in 2013 in Burkina Faso. The practices we considered were the frequencies of tooth cleaning, the fluoridated toothpaste use and the dentist visit within the past-six months. We collected data on self-reported alcohol and tobacco use and measured fasting blood glucose (FBG). About 82.8% of respondent reported they cleaned their teeth at least once a day, 31.5% cleaned them at least twice a day, 25.4% used fluoridated toothpaste, 2.2% had visited a dentist in the past six months, 38.8% used either alcohol or tobacco and 8.4% had raised FBG. After adjusting for socio-demographic factors, alcohol and/or tobacco use was an unfavorable factor for tooth cleaning at least once a day [aOR = 0.7 (0.6-0.8) p < 0.001], or at least twice a day [aOR = 0.6 (0.5-0.7) p < 0.001]. Moreover, raised FBG was negatively associated with cleaning tooth at least twice a day [aOR = 0.7 (0.5-0.9) p < 0.01] or the use of fluoridated toothpaste [aOR = 0.7 (0.6-0.9) p < 0.05]. Oral health education in addition to cardiovascular risk factor reduction should be efficiently integrated in the behavioral lifestyle interventions' strategies for the non-communicable diseases' prevention.

Locoregional anesthesia for removal osteosynthesis hardware from healed corpus mandibularis fractures: A descriptive study of a series of 40 cases.

INTRODUCTION: Locoregional anesthesia represents a very interesting modality for the removal of osteosynthesis hardware of the corpus mandibularis. Several procedures have been described, but each is dedicated to a single mandibular segment. MATERIAL AND METHODS: The surgical records of 40 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site and number of plates, time of plate removal, reasons for plate removal, and postoperative. RESULTS: Our study enrolled 40 patients, 45% of whom had single-focal plate placement and 55% of whom had bifocal plate placement. 66% of the patients with bifocal plate placement had the plates removed during the same operation. The average operative time was 45 min for bifocal and 28 min for single-focal approaches. Postoperative complications were observed only for the truncal analgesia procedure of the inferior alveolar nerve at the mandibular foramen. Anesthesia failure was reported in 2 patients. DISCUSSION: Various locoregional anesthetic procedures are used to remove mandibular body plates but each has its indication depending on the mandibular segment being treated. Factors that can lead to failure of locoregional anesthesia are dominated by the state of inflammation at the site and patient anxiety which can be minimized by premedication with anxiolytics. CONCLUSION: Locoregional anesthesia for removal of osteosynthesis hardware of the corpus mandibularis remains a good anesthetic method that is performed in good conditions when it is done in compliance with standards. Its use avoids the usual risks and complications that can occur under general anesthesia.

Parotid swelling revealing an unusual pathological state: HIV and ewing sarcoma.

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors. These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies. We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma.

Bone choristoma of the gingiva: A case report.

INTRODUCTION: Bone choristoma is a benign tumor with normal histology and ectopic location. This paper aims to report a rare case of bone choristoma in the maxillary gingival location. OBSERVATION: The authors report a case of a 39-year-old woman, with a history of maxillary full edentulousness, who consulted for a slight pain evolved for about six months, triggered by movements on the lesion. Clinical examination found growth at the level of the right maxillary gingival alveolar ridge. Surgical biopsy was indicated and performed under local anesthesia. The histological examination of the excisional specimen concluded at a bone choristoma. The patient had a good evolution after the surgical removal. CONCLUSION: Choristoma is a rare and benign condition. The management is surgical.

Characterization and Antimicrobial Susceptibility of Lactococcus lactis Isolated from Endodontic Infections in Ouagadougou, Burkina Faso.

BACKGROUND: This study aimed to characterize and test the antimicrobial susceptibility of Lactococcus lactis isolated in endodontic infections in Burkina Faso. MATERIAL AND METHODS: This was a prospective study conducted at the Municipal Oral Health Center of Ouagadougou, Burkina Faso, from June to October 2014. Clinical data were collected using a questionnaire form. The method of streaking on selective medium was used to isolate bacteria. Identification was made using the API 20 Strep gallery. Antibiotic susceptibility was performed by the diffusion method on solid medium. RESULTS: One hundred and twenty-five (125) patients were received with a significant proportion from the age group of 19 to 40 years (55.2%). Apical periodontitis accounted for 50.4% and cellulitis for 49.6% of cases. Lactococcus lactis ssp. lactis was identified in five exudate samples. Isolates were 100% resistant to cefixime and metronidazole, 80% to ceftriaxone, cefuroxime, cefotaxime, chloramphenicol and 60% to penicillin G, amoxicillin, amoxicillin clavulanic acid. A multidrug resistance of more than three families of antibiotics was noticed. No strains produced extended spectrum ß-lactamases. CONCLUSION: Lactococcus lactis is part of endodontic biofilm. The reported strong antibiotic resistance involving endodontic therapy will focus on the effect of the disinfectant solution and the mechanical action of the canal instruments.

Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures.

In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the effectiveness and complications of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses some of its other benefits and disadvantages. Notes of 227 patients with facial fractures treated by wire internal fixation at department of stomatology and maxillofacial surgery of CHU Souro Sanou, Burkina Faso between 2006 and 2010 are reviewed retrospectively. A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site. Wire internal fixation may be a reasonable alternative for the surgical treatment of non-comminuted facial fractures and those without bone substance loss, in the setting of limited resources.