Extended red blood cell antigens and phenotypes in Burkina Faso: potential issues to design local population-sourced red blood cell reagent panels.

To date, 43 blood group systems with 349 red blood cell (RBC) antigens have been recognized. The study of their distribution is useful for blood services to improve their supply strategies for providing blood of rare phenotypes, but also to design indigenous RBC panels for alloantibody screening and identification. In Burkina Faso, the distribution of extended blood group antigens is not known. This study aimed to investigate the extended profiles of blood group antigens and phenotypes of this population and to raise limitations and potential strategies for the design of local RBC panels. We conducted a cross-sectional study that included group O blood donors. Extended phenotyping for antigens in the Rh, Kell, Kidd, Duffy, Lewis, MNS, and P1PK systems was performed using the conventional serologic tube technique. The prevalence of each antigen and phenotype combination was determined. A total of 763 blood donors were included. The majority were positive for D, c, e, and k and negative for Fya and Fyb. The prevalence of K, Fya, Fyb, and Cw was less than 5 percent. The most frequent Rh phenotype was Dce, and the most common probable haplotype was R0R0 (69.5%). For the other blood group systems, the K-k+ (99.4%), M+N+S+s- (43.4%), and Fy(a-b-) (98.8%) phenotypes were the most frequent. Antigenic polymorphism of blood group systems by ethnicity and geography argues for the design and evaluation of population-sourced RBC panels to meet specific antibody profiles. However, some of the specificities identified in our study, such as the rarity of double-dose antigen profiles for certain antigens and the cost of antigen phenotyping tests, are major challenges to overcome.

Feasibility and performance of in-house red blood cell reagents to detect unexpected antibodies in immunized patients in Burkina Faso.

In sub-Saharan Africa, antibody detection tests remain inaccessible because of the high cost and limited shelf life of red blood cell (RBC) reagents. This study aimed at investigating the feasibility and performance of locally prepared RBC reagents for antibody detection in Burkina Faso. We conducted an experimental study comparing commercial RBC panels and a local panel prepared from phenotyped blood donors in Ouagadougou, Burkina Faso. Antibody detection testing was performed by the indirect antiglobulin test using a gel card filtration column in a low-ionic-strength solution. Judgment criteria were the concordance rate and the kappa agreement coefficient of results generated by the two panels. A total of 302 blood donors were phenotyped for the major antigens of the RH, KEL, MNS, FY, JK, LE, and P1PK blood group systems. From this pool of donors, we designed an RBC detection panel that was used to screen for unexpected antibodies in 1096 plasma samples from 832 patients with a history of transfusion and 264 recently delivered or pregnant women with no history of blood transfusion. A positive antibody detection test was observed in 8.1 percent of the samples using the local panel versus 6.4 percent with the commercial panels. A total of 23 samples were negative with the commercial panels and positive with the local panel, while the findings were reversed for four samples. The concordance rate was 97.5 percent, and the kappa agreement coefficient was 0.815. Our results suggest that the development of local RBC panels can be an alternative to commercial panels in countries with limited resources. It could also be a cost-effective intervention, mainly for children under 5 years of age, women of childbearing age, and pregnant women, all of whom are most at risk for malaria and sickle cell disease complications. Blood services could develop and implement appropriate strategies to make phenotyped donor pools available for the design of suitable RBC panels.

[Protection of caregivers in a university hospital at the time of Covid-19: Between overprotection and underprotection or between abandonment and weakening of the vital forces?] / Protection des soignants dans un CHU au temps du Covid-19 : entre surprotection et sous-protection ou entre abandon et affaiblissement des forces vives ?

During the first months of the Sars-Cov-2 pandemic, French caregivers faced difficult situations, organizational changes, and rapidly changing recommendations. The occupational physicians of the hospital staff had to accompany the caregivers, both to answer their questions, both to better prevent the risks to their health in connection with the pandemic. Recommendations were quickly issued by the Société française de médecine du travail (French Society of Occupational Medicine). In our CHU, an evaluation of exposures was made by department. Occupational physicians advised agents and the institution to limit the risks to the health of agents. However, faced with the uncertainties linked to ignorance of the virus, how can we play both the role of protection of each agent, and that of a doctor registered in a health war? This article revisits from a distance the ethical tensions of the hospital occupational physician and the qualities necessary for the accomplishment of these missions.

[Recurrence of dengue epidemics in Burkina Faso: Community preference for an intervention to prevent the disease]. / Épidémies récurrentes de la dengue au Burkina Faso : préférences communautaires pour une intervention de prévention de la maladie.

BACKGROUND: Community-based interventions have proven effective in several Latin American countries in controlling dengue vector Aedes aegypti and reducing the burden of the disease. However, we did not find any study reporting the assessment or implementation of such interventions in Sub-Saharan Africa. This article presents local communities' preferences for activities as part of the implementation of a community-based intervention for dengue prevention in Ouagadougou (Burkina Faso) where dengue epidemics are recurrent during the rainy season. METHODS: A mixed-method study combining qualitative and quantitative data collection was conducted. Information from 983 households and their preferences for community-based activities for dengue prevention were collected in five neighborhoods of the city using a quantitative questionnaire. Then, 15 qualitative focus groups were organized in one of the neighborhoods that was randomly selected to receive a community-based intervention for dengue prevention. These groups were made up of 216 people representing the different socio-cultural categories: community leaders, men, women, young girls and boys. RESULTS: More than 95% of household respondents to the quantitative questionnaire found community-based interventions acceptable and/or useful: to raise awareness of mosquito-borne disease transmission, to identify and remove the mosquito breeding sites and areas favorable to the development of the adult vectors. Most participants in the focus groups, preferred outreach activities such as video/debate sessions, school and home education sessions, focus groups. They also preferred the implementation of community working groups, responsible for identifying and eliminating mosquito breeding sites in the neighborhood. However, many participants had reservations about sending preventive text messages to residents. They found it feasible but not useful since most people cannot read. CONCLUSION: This study shows that it is important to get the local communities involved in the formulation of health prevention activities in sub-Saharan Africa where some interventions are often implemented using strategies from other continents.

Natural Infection of Cashew (Anacardium occidentale) by Xanthomonas citri pv. mangiferaeindicae in Burkina Faso.

Xanthomonas citri pv. mangiferaeindicae is the causal agent of bacterial canker of mango (Mangifera indica, Anacardiaceae), a disease of international importance. Since the original description of the bacterium in the 1940s, the status of cashew (Anacardium occidentale, Anacardiaceae) as a host species has been unclear. Here, we report the first outbreak of a cashew bacterial disease in Burkina Faso (Western Africa) where X. citri pv. mangiferaeindicae recently emerged on mango. A comprehensive molecular characterization, based on multilocus sequence analysis, supplemented with pathogenicity assays of isolates obtained during the outbreak, indicated that the causal agent on cashew in Burkina Faso is X. citri pv. mangiferaeindicae and not X. citri pv. anacardii, which was previously reported as the causal agent of a cashew bacterial leaf spot in Brazil. Pathogenicity data supported by population biology in Burkina Faso suggest a lack of host specialization. Therefore, the inoculum from each crop is potentially harmful to both host species. Symptoms induced on cashew leaves and fruit by X. citri pv. mangiferaeindicae and nonpigmented strains of X. citri pv. anacardii are similar, although the causative bacteria are genetically different. Thus, xanthomonads pathogenic on cashew may represent a new example of pathological convergence in this bacterial genus.

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases]. / Pratique de la chirurgie plastique reconstructrice du clitoris après mutilations génitales au Burkina Faso. À propos de 94cas.

PURPOSE OF THE STUDY: To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health. PATIENTS AND METHOD: We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study. RESULTS: The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it. CONCLUSION: Regardless of the anatomical and functional results, all women were satisfied with respect to body found.

A 2020 baseline assessment for the monitoring of the End TB indicator of catastrophic costs in Burkina Faso.

BACKGROUND Prior assessment of the economic burden of TB showed high risk of catastrophic costs in Burkina Faso. A decade later, the National TB Programme conducted the first national patient cost survey, establishing a baseline for future policymaking.METHODS A national TB patient cost survey was conducted early 2020. Following WHO methods, a structured questionnaire was administered to 465 patients (20 clusters) to report on the direct and indirect costs of TB, household income and coping strategies adopted by the TB-affected families. The share of households facing catastrophic costs was assessed. Multiple logistic regression was performed to identify factors associated with catastrophic costs due to TB.RESULTS One in two (54.4%) TB-affected households in Burkina Faso faced catastrophic costs, resulting in major improvements over the past decade. On average, households incurred in US$962.64 per episode of care (respectively US$741.7, US$122.3 and US$98.6 for indirect, direct medical and non-medical costs), leaving substantial costs requiring mitigation strategies (39.8%). Major risk factors were associated with hospitalisation and wealth-related variables. Job loss, food insecurity and other social consequences were also experienced.CONCLUSION Despite progress, reducing the End TB indicator of catastrophic costs remains central to policymaking to ensure effective financial protection in Burkina Faso.

[Case management and diagnosis of severe malaria in adults and the application of national guidelines in Burkina Faso]. / Diagnostic et prise en charge du paludisme grave chez l'adulte : observance des directives nationales au Burkina Faso.

UNLABELLED: The purpose of this study was to assess the application of national guidelines on the diagnosis and treatment of severe malaria in adults in Burkina Faso. We conducted a retrospective study of medical records of the patients admitted for severe malaria in the emergency service of the regional hospital of Fada N'Gourma in the east of Burkina Faso in the year 2008; 165 records were chosen by simple random sampling. We reported all the severe clinical and biological signs of malaria and its treatment. We compared them with the criteria of severe malaria diagnosis and its treatment according to the national guidelines. The mean age of patients was 38 ± 16.2 and male to female ratio was 0.96. The most frequent period of admissions was between July and October. Fever or recent past of fever was reported in 142 cases (86.1%). According to the two criteria for severe malaria (means existing of at least one of the severe signs associated and positive parasitemia with Falciparum plasmodium), we noted that only 74 cases had at least one of the severe signs (44.8%) which were: anemia (51.3%), cardiovascular collapse (7.9%), jaundice (7.3%), dyspnea (6.7%), impairment of consciousness (5.5%), prostration (5.5%), renal failure (4.8%), hypoglycemia (2.4%), hemorrhage (1.8%) and seizures (1.2%). The biological signs were not systematically searched. Parasitological exam was conducted in 91 cases (55.1%). Only 18 were positive (19.8%). In total, only 18 cases (10.9%) met the guidelines' criteria of severe malaria. The other cases were over-diagnosed; note that the investigation was not complete for 74 of these cases (50.3%). Among the 165 cases, the treatment was appropriate in 146 (88.5%) and 19 cases (11.5%) didn't receive treatment for malaria. CONCLUSION: So much we observed an over diagnosis of severe malaria in adults that we can suggest an under diagnosis of the disease due to the lack of biological investigations.

[Failure of first-line antiretroviral therapy in HIV-infected children in Ouagadougou, Burkina Faso]. / Echecs du traitement antirétroviral de première ligne chez les enfants infectés par le VIH à Ouagadougou (Burkina Faso).

Approximately one-fourth of the estimated 10,000 HIV-infected children in Burkina Faso are undergoing antiretroviral (ARV) therapy. At the Charles de Gaulle Pediatric Hospital Center in Ouagadougou, Burkina Faso, Support for ARV therapy began in July 2003 and a total of 250 children were undergoing treatment in late 2007. The purpose of this retrospective case-control study conducted over a period of 54 months from July 2003 to December 2007 was to investigate cases involving failure of first-line ARV therapy in particular with regard to cause. All patients (n = 32) showing poor virological, immunological, and/or clinical response to ARV therapy were considered as failures and thus included in the case group. The control group (n = 160) consisted of patients with good responses to treatment. Cases and controls were compared using the Chi-square test and odds ratio (OR) technique with a confidence interval at 95%. The failure rate was 12.8%. Failure was significantly correlated with low socioeconomic level (OR = 3), orphan status (OR = 4), age over 10 years (OR = 5), male gender (OR = 3), baseline viral load > or = 1,000,000 copies/mL (OR = 9), and poor compliance (OR = 37). Mortality in children who failed to respond to first-line ARV therapy was 25% due to the unavailability of a national second-line ARV therapy program. This study underlines the need for patient education to promote compliance and for creation of reference centers to prescribe ARV therapy to HIV-infected children including second-line ARV and genotyping.

Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance.

Background: Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood. Methods: We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex. Results: About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently. Conclusions: Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.

Mucosal lactoferrin response to genital tract infections is associated with iron and nutritional biomarkers in young Burkinabé women.

BACKGROUND/OBJECTIVES: The iron-binding affinity of vaginal lactoferrin (Lf) reduces iron available to genital pathogens. We describe host reproductive, nutritional, infection and iron biomarker profiles affecting vaginal Lf concentration in young nulliparous and primigravid women in Burkina Faso. SUBJECTS/METHODS: Vaginal eluates from women who had participated in a randomized, controlled periconceptional iron supplementation trial were used to measure Lf using a competitive double-sandwich ELISA. For this analysis samples from both trial arms were combined and pregnant and non-pregnant cohorts compared. Following randomization Lf was measured after 18 months (end assessment) for women remaining non-pregnant, and at two antenatal visits for those becoming pregnant. Associations between log Lf levels and demographic, anthropometric, infection and iron biomarker variables were assessed using linear mixed models. RESULTS: Lf samples were available for 712 non-pregnant women at end assessment and for 303 women seen at an antenatal visit. Lf concentrations of pregnant women were comparable to those of non-pregnant, sexually active women. Lf concentration increased with mid-upper-arm circumference, (P = 0.047), body mass index (P = 0.018), Trichomonas vaginalis (P < 0.001) infection, bacterial vaginosis (P < 0.001), serum C-reactive protein (P = 0.048) and microbiota community state types III/IV. Adjusted Lf concentration was positively associated with serum hepcidin (P = 0.047), serum ferritin (P = 0.018) and total body iron stores (P = 0.042). There was evidence that some women maintained persistently high or low Lf concentrations from before, and through, pregnancy. CONCLUSION: Lf concentrations increased with genital infection, higher BMI, MUAC, body iron stores and hepcidin, suggesting nutritional and iron status influence homeostatic mechanisms controlling vaginal Lf responses.

Reconstruction of a Traumatic Bone Defect from Distal Femur.

INTRODUCTION: Bone defect is a difficult problem in orthopedics. The treatment conventionally relies on techniques such as induced membrane, grafts, and elongations. The reintegration of an externalized osseous fragment involves significant infectious risks but is essential in certain situations. CASE REPORT: We report the case of a 10 cm traumatic bone loss of the right distal femur in a 35-year-old woman. Treatment consisted of paring, reintegration and stabilization by the external fixative. The 5-year follow-up was satisfactory with good consolidation and good function of the limb. CONCLUSION: The reintegration of a bone fragment of limb expelled onto the soil is rare. We tried it because the response time was very short, but also and especially because the fragment was expelled on very hot bitumen. These two elements limited the risk of infection and favored the osseointegration of the fragment. We have not found a similar case reported in the literature allowing comparisons and recommendations.

Pseudotumeur inflammatoire colique / Colic inflammatory pseudotumor

Introduction : Les pseudotumeurs inflammatoires coliques sont des lésions bénignes très rares, d'étiologie inconnue et dont le diagnostic différentiel est difficile avec les adénocarcinomes. Résultat : Nous rapportons le cas d'une patiente de 20 ans, admise en urgence dans un contexte d'occlusion intestinale aiguë chez qui en per opératoire, nous avons retrouvé une tumeur ulcéro -nécrotique du côlon droit suspecte de malignité. Mais l'examen histologique de la pièce d'hémi colectomie a affirmé sa bénignité. Conclusion : Les pseudo-tumeurs inflammatoires bien que rares, ne sont pas exceptionnelles. Elles sont de diagnostic difficile car peuvent simuler des tumeurs malignes et l'examen histologique est indispensable pour affirmer le diagnostic

Introduction: Colonic inflammatory pseudotumors are rare benign lesions, they are of unknown etiology and the differential diagnosis is difficult with adenocarcinomas. Result: We report the case of a 20-year-old patient admitted urgently in an acute intestinal occlusion in which laparotomy has objectified an ulcerative-necrotic tumor of the right colon suspected of malignancy; it is the histological examination of the piece of hemicolectomy which affirmed its benignity. Conclusion: Inflammatory pseudo-tumors, although rare, are not exceptional; they are difficult to diagnose because they can simulate malignant tumors and histological examination is essential to assert the diagnosis

Etiological, therapeutic and prognostic particularities of primary biliary peritonitis in tropical environments.

To describe the etiological, therapeutic, and prognostic aspects of primary biliary peritonitis in Burkina Faso. This retrospective study reviewed records of all patients admitted for primary biliary peritonitis at Tenkodogo Regional Hospital (Burkina Faso) from 2010 through 2016. Cases of secondary biliary peritonitis have been excluded. Thirty patients were identified. Their average age was 26.5 years. Fourteen patients were under 12 years of age. The reasons for consultation were dominated by abdominal pain (in all cases) and bile-induced vomiting (in 22 cases). Seven patients had a general condition classified in stage 2 of the World Health Organization classification, 18 in stage 3, and 5 in stage 4. The etiologies of peritonitis were acute typhoidal cholecystitis, which predominated (27 cases), and gallstones (3 cases). The surgical approach was a laparotomy in all cases. Intraoperative observation showed an inflamed and perforated gallbladder in 24 cases; gangrene was noted in 6 cases. Treatment consisted of cholecystectomy and peritoneal lavage, associated with antibiotic therapy. The post-operative period was complicated by septicemia in 12 cases. Fourteen patients died, for a mortality rate of 46.7 %. In rural Burkina Faso, primary biliary peritonitis occurs in young subjects. Its cause is most often acute cholecystitis due to Salmonella typhi. Mortality is very high.

Challenges of cold chain quality for routine EPI in south-west Burkina-Faso: An assessment using automated temperature recording devices.

BACKGROUND: Abnormal temperatures are a major issue for vaccines within the Expanded Program of Immunization in tropical climates. Prolonged exposure to temperatures outside the standard +2 °C/+8 °C range can impact vaccine potency. METHODS: The current study used automatic temperature recording devices (Testostore 171-1©) to monitor cold chain in remote areas of Western Burkina Faso. A series of 25 randomly selected health centers representing 33% of the existing 176 EPI facilities in Western Burkina Faso were prospectively assessed for eight months in 2015. Automatic measurements were compared to routine temperature loggers and vaccine vial monitors (VVM). RESULTS: The median age for all refrigerators was 9 years with 10/25 (42%) older than 10 years. Adverse temperatures were recorded in 20/24 (83%) refrigerators and ranged from -18.5 °C to +34.2 °C with 12,958/128,905 (10%) abnormal hourly records below +2 °C and 7357/128,905 (5.7%) above +8 °C. Time of day significantly affected the rate of temperature excursions, with higher rates from 00 am to 06 am (p < 0.001) for low temperatures and 10-12 am (p < 0.001) and 13-16 pm (p < 0.001) for high temperatures. Abnormal temperatures lasted from 1 h to 24 h below +2 °C and 13-24 h above +8 °C. Standard manual registers reported only 182/2761 (7%) inadequate temperatures and VVM color change detected only 133/2465 (5%) disruptions. Reliability of the refrigerators ranged from 48% to 98.7% with a median of 70%. Risk factors for excursions were old age of the refrigerators, the months of April and May, hours of high activity during the day, and health staff-associated factors such as inappropriate actions or insufficient knowledge. CONCLUSION: Important cold chain reliability issues reported in the current study in Western Burkina Faso raise concern about vaccine potency. In the absence of systematic renewal of the cold chain infrastructure or improved staff training and monitoring, antibody response assessment is recommended to study levels of effective immunization coverage.

Corps étrangers chroniques dans l'œsophage chez l'enfant / Chronic foreign bodies in the oesophagus in children

Les ingestions de corps étrangers sont des accidents fréquents en pédiatrie. La plupart sont sans grande conséquence sauf ceux qui sont enclavés dans l'œsophage. Nous rapportons 2 cas de pile bouton intraœsophagienne chez 2 enfants âgés de: 4ans de sexe masculin et 2 ans de sexe féminin. Le motif de consultation dans les deux cas était la dysphagie aux solides. La fibroscopie broncho-oesophagienne a été effectuée dans les 2 cas avec échec d'extraction conduisant à une extraction chirurgicale par voie de thoracotomie chez le garçon et de cervicotomie chez la fille. Une sténose œsophagienne est survenue à 2 mois dans les suites opératoires chez le garçon. L'évolution a été favorable après dilatation aux bougies de Rehbein modifiées. Chez la fille en postopératoire un œdème laryngé est survenu et a nécessité des séances de nébulisations. L'évolution a été favorable chez les 2 enfants avec un recul de 5 ans et de 2 mois. Conclusion: Les piles boutons sont des corps étrangers particuliers qu'il faut extraire en urgence. L'oesophagoscopie reste le moyen le plus fréquemment employé mais la chirurgie reste le dernier recourt avec des possibilités de complication.

Ingestion of foreign bodies is a common accident in paediatrics. Most of them are of little consequence except for those that are enclosed in the esophagus. We report 2 cases of intraesophageal button stacks in 2 children aged 4 years' male and 2 years female. The reason for consultation in both cases was solid dysphagia. Bronchoesophageal fibroscopy was performed in both cases with failed extraction leading to surgical extraction by thoracotomy in boys and cervicotomy in girls. Esophageal stenosis occurred at 2 months of age in the postoperative period in boys. The development was favourable after expansion at the modified Rehbein candles. In the postoperative girl, laryngeal edema occurred and required nebulization sessions. The evolution was favorable in the 2 children with a follow-up of 5 years and 2 months. Conclusion: Button batteries are special foreign bodies that need to be removed urgently. Esophagoscopy remains the most frequently used method, but surgery remains the last resort with the possibility of complications.

Management of necrotizing and non-necrotic bacterial erysipelas of the face in tropical areas: a series of four cases and a review of the literature.

The necrotizing and not necrotizing acute bacterial dermohypodermitis (DHD) are acute bacterial infections of tissues situated between the skin and the muscles. The localizations of the face are infrequent, and sometimes put diagnostic difficulties with other current facial dermatosis. We report in this article 4 cases of DHD of the face with skin source, hospitalized in the service of the Infectious and Tropical Diseases of the Teaching Hospital Yalgado Ouédraogo of Ouagadougou (Burkina Faso). The objective is to make a current situation of their etiologies and complications, and to look for the difficulties to take care of them in a country with limited resources. The patient's care journey for this disease is long while it constitutes a medical or medical-surgical emergency. Imaging, which is essential for the diagnosis of heart valve disease and the daunting complications of necrotizing fasciitis and mediastinitis, is generally available only in tertiary hospitals. Antibiotic therapy is most often inadequate or insufficient. Anti-inflammatories, widely used, according to several authors contribute to serious forms and excess mortality. Health workers in resource-limited settings need to be better educated and guidelines issued to recognize the signs of this condition in order to enable early referral of patients in specialized settings. In addition, education of the population and hygiene awareness of skin lesions should be a priority to reduce complications.

[Results after surgical management of ileal perforation due to typhoid fever, about 29 cases in Ouahigouya (Burkina Faso)]. / Résultats de la prise en charge des perforations iléales typhiques : à propos de 29 cas à Ouahigouya (Burkina Faso).

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Epidemiological, clinical, and therapeutic features of typhoid intestinal perforation in a rural environment of Burkina Faso.

The aim of this study was to describe the epidemiological, clinical, and therapeutic features of ileal perforation due to typhoid fever at the regional hospital of Tenkodogo (Burkina Faso). This cross-sectional study examined the records over a 5-year period of all patients treated for typhoid ileal perforation. Ileal perforation was diagnosed intraoperatively, and its typhoid origin determined according to the following criteria : background signs of typhoid fever, location of the perforation on the antimesenteric edge of the terminal ileum, and a positive Widal-Felix serology. The study included 216  patients. Their mean age was 13.8 years, and 63.4% were male. The average time to consultation was 11 days. Clinical signs were mainly abdominal pain, vomiting, and abdominal tenderness. Anemia was observed in 135 patients (62.5%). All patients underwent laparotomy. Three procedures for treating surgical perforation were used : excision and suture of the perforation in 86 patients (39.8%), ileal resection with anastomosis in 98 (45.4%), and ileostomy with subsequent recovery in 32 (14.8%). The average length of hospital stay was 16.1 days. Postoperative complications occurred in 156 patients (72.2%). Thirty-seven patients died, for a mortality rate of 17.1 %. Ileal perforations due to typhoid fever are the main cause of peritonitis in rural areas of Burkina Faso. Patients are relatively young, and most are anemic at admission. Morbidity and mortality are significant.

Epidemiological, bacteriological and therapeutic aspects of chronic osteomyelitis in a sub-Saharan environment.

The purpose of this study was to describe the epidemiological and bacterial aspects of chronic osteomyelitis at the regional hospital of Tenkodogo, in Burkina Faso. This prospective study took place at the regional hospital in Tenkodogo during the 3 year-period 2011-2013 and included all cases of chronic osteomyelitis diagnosed during those years. The diagnosis was based on clinical and radiological evidence. In all, 86 patients were identified, with a mean age of 18.5 years, and predominantly male (73 %). The mean time to consultation was 18 months. The most common sites of chronic osteomyelitis were the tibia and femur. Bacteriologically, the pathogen most frequently isolated was Staphylococcus (75.6 %). The pathogens isolated were mostly responsive to gentamicin (75 % of pathogens) and ciprofloxacin (56.2 % of pathogens). Resistance to the combination amoxicillin + clavulanic acid was observed frequently. The treatment included a sequestrectomy and additional long-term antibiotic therapy based on susceptibility testing. The recurrence rate was 5.8 % over a one-year follow-up. Encouraging results can be obtained in chronic osteomyelitis with proper treatment. In this perspective, the isolation of the causative organism and knowledge of its sensitivity to antibiotics are essential information.