Low-pressure versus standard pressure laparoscopic colorectal surgery (PAROS trial): a phase III randomized controlled trial.

TRIAL DESIGN: This is a phase III, double-blind, randomized, controlled trial. METHODS: In this trial, patients with laparoscopic colectomy were assigned to either low pressure (LP: 7 mmHg) or standard pressure (SP: 12 mmHg) at a ratio of 1 : 1. The aim of this trial was to assess the impact of low-pressure pneumoperitoneum during laparoscopic colectomy on postoperative recovery. The primary endpoint was the duration of hospital stay. The main secondary endpoints were postoperative pain, consumption of analgesics and postoperative morbidity. RESULTS: Some 138 patients were enrolled, of whom 11 were excluded and 127 were analysed: 62 with LP and 65 with SP. Duration of hospital stay (3 versus 4 days; P = 0.010), visual analog scale (0.5 versus 2.0; P = 0.008) and analgesic consumption (level II: 73 versus 88 per cent; P = 0.032; level III: 10 versus 23 per cent; P = 0.042) were lower with LP. Morbidity was not significantly different between the two groups (10 versus 17 per cent; P = 0.231). CONCLUSION: Using low-pressure pneumoperitoneum in laparoscopic colonic resection improves postoperative recovery, shortening the duration of hospitalization and decreasing postoperative pain and analgesic consumption. This suggests that low pressure should become the standard of care for laparoscopic colectomy. TRIAL REGISTRATION: NCT03813797.

The aim of this trial was to assess the impact of low-pressure pneumoperitoneum during laparoscopic colectomy. The study proved that using low pressure in laparoscopic colonic resection improves postoperative recovery, decreasing length of hospitalization, postoperative pain and analgesic consumption.

Metabolomics, lipidomics and proteomics profiling of myoblasts infected with Trypanosoma cruzi after treatment with different drugs against Chagas disease.

INTRODUCTION: Chagas disease, the most important parasitic infection in Latin America, is caused by the intracellular protozoan Trypanosoma cruzi. To treat this disease, only two nitroheterocyclic compounds with toxic side effects exist and frequent treatment failures are reported. Hence there is an urgent need to develop new drugs. Recently, metabolomics has become an efficient and cost-effective strategy for dissecting drug mode of action, which has been applied to bacteria as well as parasites, such as different Trypanosome species and forms. OBJECTIVES: We assessed if the metabolomics approach can be applied to study drug action of the intracellular amastigote form of T. cruzi in a parasite-host cell system. METHODS: We applied a metabolic fingerprinting approach (DI-MS and NMR) to evaluate metabolic changes induced by six different (candidate) drugs in a parasite-host cell system. In a second part of our study, we analyzed the impact of two drugs on polar metabolites, lipid and proteins to evaluate if affected pathways can be identified. RESULTS: Metabolic signatures, obtained by the fingerprinting approach, resulted in three different clusters. Two can be explained by already known of mode actions, whereas the three experimental drugs formed a separate cluster. Significant changes induced by drug action were observed in all the three metabolic fractions (polar metabolites, lipids and proteins). We identified a general impact on the TCA cycle, but no specific pathways could be attributed to drug action, which might be caused by a high percentage of common metabolome between a eukaryotic host cell and a eukaryotic parasite. Additionally, ion suppression effects due to differences in abundance between host cells and parasites may have occurred. CONCLUSION: We validated the metabolic fingerprinting approach to a complex host-cell parasite system. This technique can potentially be applied in the early stage of drug discovery and could help to prioritize early leads or reconfirmed hits for further development.

Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage.

BACKGROUND AND OBJECTIVES: Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT). METHODS: All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications. RESULTS: We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors. CONCLUSION: Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.

Acceptability of children's testing for HIV infection during routine care activities in the Pediatrics Department of Sourô Sanou Teaching Hospital in Bobo-Dioulasso (Burkina Faso).

BACKGROUND: In order to contribute to the fight against the pediatric HIV infection, we have assessed, through a study in which we have systematically proposed to carry out children's testing, the rate of acceptability and the feasibility of children's HIV testing during the routine activities of the department. We have also analyzed the reasons for the acceptability or the refusal of the child's HIV testing by the accompanying person. METHODS: The study took place from May to September 2015 including all the parents/legal guardians of any child aged 0 to 14 years coming for a consultation or who was hospitalized in the Pediatric Department of Souro Sanou Teaching Hospital. Counseling sessions conducted by community health workers focused on informing and proposing the principle of child testing. After obtaining the verbal and informed consent of the accompanying person, the first test was performed with Determine® by a hospital health worker. A second SD Bioline®/ImmunoCombII® test was performed if the first test was positive. With children aged less than 18 months, after a positive antibody test, we resorted to PCR for confirmation. RESULTS: A total of 848 accompanying persons, 568 of whom were female, underwent a pre-test interview during which the HIV test was offered to them. The mean age of accompanying persons was 30 (25.5 to 38) years; 747 accompanying persons (88.1%) accepted the testing of their child. We have found an influence of the accompanying person's religion (P=0.02) and the type of accompanying person on the acceptability of children's testing. Mothers were more willing to accept the test compared to other accompanying persons (P=0.002). The main reason for refusing the child's testing was the absence of one of the child's parents, mainly the father whose opinion was needed. The test was positive for HIV1 in 10 children. CONCLUSION: In health centers, getting the informed consent from parents to test their children is a big challenge. However, our study shows that this is possible, through the high rate of acceptability obtained.

Prospective observational study of the effect of dual antiplatelet therapy with tranexamic acid treatment on platelet function and bleeding after cardiac surgery.

BACKGROUND: The bleeding impact of dual antiplatelet therapy (DAPT), aspirin and clopidogrel, maintained until coronary artery bypass graft surgery (CABG), is still a matter of debate. The lack of preoperative antiplatelet activity measurement and heterogeneity of antifibrinolytic protocols in prior studies make the conclusions questionable. The aim of this prospective study was to determine, after preoperative antiplatelet activity measurement, if the maintenance of DAPT until CABG increases bleeding in patients treated with tranexamic acid (TA). METHODS: This observational study included 150 consecutive patients, 89 treated with aspirin and 61 treated with DAPT, undergoing a first-time planned on-pump CABG with TA treatment. Antiplatelet activity was measured with platelet aggregation tests and quantification of VASP phosphorylation. Postoperative bleeding at 24 h was recorded and propensity score analysis was performed. RESULTS: Based on VASP assay, 54% of patients showed high on-clopidogrel platelet activity inhibition. Postoperative bleeding at 24 h increased by 22% in the DAPT group, compared with the aspirin group (680 [95% CI: 360-1670] vs 558 [95%CI: 267-1270] ml, P < 0.01), consistent with increased blood transfusion (21% vs 7%, P = 0.01); a higher incidence of mediastinitis did not reach statistical significance (15% vs 4%, P = 0.05). Bleeding correlated with the extent of clopidogrel antiplatelet effect, with the best correlation for the VASP assay. CONCLUSIONS: Maintenance of DAPT until the day of CABG in patients treated with TA, increased postoperative bleeding at 24 h in parallel with preoperative antiplatelet activity induced by clopidogrel.

Brain lesions in eclampsia: A series of 39 cases admitted in an Intensive Care Unit.

The aim of this study was to identify the encephalic lesions in the eclampsia occurrences. Within a period of 18 months, computed tomography (CT) of the brain was performed in all patients admitted in intensive care for eclampsia. These CTs were analyzed and intracerebral lesions were identified. Thirty-nine patients were included. We noted 10 cases of ischemic stroke, 9 cases of cerebral edema, and 3 cases of hemorrhagic stroke and subarachnoid hemorrhage. The CT scan came back to normal in 20 eclamptic patients. Overall, delays in obstetric and intensive care and time of completion of the CT were long. CT has allowed highlighting in patients with eclampsia varied intracerebral lesions. The early performance of the CT is therefore essential for a better support of patients.

Effect of flumazenil on diaphragm electrical activation during weaning from mechanical ventilation after acute respiratory distress syndrome.

BACKGROUND: Diaphragm electrical activation (EAdi) and the ratio of tidal volume to EAdi (VT/EAdi) may provide clinical information on neuroventilatory efficiency (NVE) in patients being weaned from mechanical ventilation. We tested the hypothesis that residual sedation could interfere with respiratory recovery, by assessing the effects of flumazenil on EAdi and VT/EAdi ratio. METHODS: This observational study included 13 patients breathing with pressure-support ventilation (PSV) after a long period of controlled mechanical ventilation (i.e. >4 days) plus midazolam-based sedation for acute respiratory distress syndrome. EAdi and respiratory patterns were compared before and after a bolus of flumazenil, which was given because neurological status needed to be evaluated. RESULTS: Flumazenil induced a significant increase in EAdi [+71 (41-123)%, P=0.0002] and VT [+17 (8-32)%, P=0.0005], resulting in significantly decreased NVE [-34 (15-43)%]. The increased VT was significantly correlated with the increased EAdi (ρ=0.70, P=0.009). CONCLUSIONS: During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression. The increased EAdi with reversal of residual sedation was associated with a proportional increase in VT. These findings should be considered by the attending physician when interpreting daily EAdi and VT changes during weaning from mechanical ventilation.

[Epidemiology, etiology and psychosocial impact of urogenital fistulas in a cohort of 170 consecutive patients managed in three treatment centers in Burkina Faso from 2010 to 2012]. / Aspects épidémiologiques, étiologiques et impact psychosocial des fistules urogénitales dans une cohorte de 170 patientes consécutives, prises en charge dans trois centres du Burkina Faso de 2010 à 2012.

OBJECTIVE: To describe the socio-demographical aspects, etiologies and psychosocial consequences of urogenital fistula patients (UGF) in Burkina Faso (BF). PATIENTS AND METHODS: Descriptive study of a cohort of consecutive patients during a period of 18 months (December 1st 2010 to August 31st 2012) in three centers of treatment in BF. Each patient has had a standardized complete medical observation focused on sociodemographics, clinical finding, past medical history and etiologies of UGF. Some patients had an interview with a psychologist. RESULTS: One hundred and seventy patients with mean age 35 years (minimum: 16, maximum: 70) were enrolled during the study period. The majority of patients were housewives (90.5%, n=152) and illiterates (92.9%, n=158). Among the patients, 62.4% (n=106) lived in rural zones. Obstetrical fistula was the most common cause of UGF (87.6%, n=149) in our study and prolonged labor occurred in 93.3% (n=139) of cases with 17.5% (n=26) who delivered at home. The majority of our cases were vesico-vaginal fistula (70.6%, n=120). Fifty-five patients (32.4%) were divorced after the fistula. The sensation of humiliation and sadness were noted at all the patients who had a psychological evaluation and 87.5% (n=14) of them have had suicidal ideas. CONCLUSION: The UGF are frequent in Burkina Faso and obstetrical etiology is dominant. The physical and psychosocial repercussions are important for the women victims of this pathology. LEVEL OF EVIDENCE: 4.

Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist.

BACKGROUND: Neuro-ventilatory efficiency (NVE), defined as the tidal volume to electrical diaphragm-activity ratio (VT/EAdi) at the beginning and end of the weaning process after acute hypoxaemic respiratory failure, may provide valuable information about patient recovery. METHODS: This observational study included 12 patients breathing with neurally adjusted ventilatory assist (NAVA). When a spontaneous breathing trial (SBT) with pressure support of 7 cm H2O and PEEP was unsuccessful, NAVA was used and the level was adjusted to obtain an EAdi of ∼60% of maximal EAdi during SBT. VT and EAdi were recorded continuously. We compared changes in NVE between NAVA and SBT at the first failed and first successful SBT. RESULTS: When patients were switched from NAVA to SBT, NVE was significantly reduced during both unsuccessful and successful SBT (-56 and -38%, respectively); however, this reduction was significantly lower when SBT was successful (P=0.01). Between the first and last day of weaning, we observed that NVE decreased with NAVA [40.6 (27.7-89.5) vs 28.8 (18.6-46.7); P=0.002] with a significant decrease in NAVA level, whereas it remained unchanged during SBT [15.4 (10.7-39.1) vs 19.5 (11.6-29.6); P=0.50] with significant increases in both EAdi and VT and no difference in respiratory rhythm. CONCLUSIONS: These results suggest that in patients after respiratory failure and prolonged mechanical ventilation, changes in VT and NVE, between SBTs are indicative of patient recovery. Larger clinical trials are needed to clarify whether changes in NVE reliably predict weaning in patients ventilated with NAVA.

[Hepatitis B: cross-sectional study of knowledge and immunization among students at University of Cocody, Ivory Coast]. / Connaissance et couverture vaccinale contre l'hépatite virale B (HVB) : étude transversale parmi les étudiants de l'université de Cocody, Côte d'Ivoire.

BACKGROUND: To evaluate knowledge about hepatitis B and vaccination coverage among students at Cocody's University, Ivory Coast. MATERIALS AND METHODS: A cross-sectional study was conducted during the academic year 2005-2006 (2557 students). Parameters were collected by interview using a survey chart. Factors influencing knowledge and vaccination against hepatitis B were analyzed by logistic regression. RESULTS: The majority of students (n=1174, 69.4% [95% CI 68-71]) knew about hepatitis B. Only 17.5% and 26.1% of students respectively were aware of sexual and blood transmission. None of the students were aware of maternal-fetal transmission. Factors associated with knowledge of hepatitis B were enrollment in health sciences (Odds Ratio=24.19 [95% CI 8.65-76.63]) and having a scholarship (Odds Ratio=2.34 [95% CI 1.54-3.56]). Vaccination coverage against hepatitis B was low (Odds Ratio=3.7% [95% CI 3-4]). Factors associated with vaccination were: knowledge of hepatitis B (Odds Ratio=6.83 [95% CI 4.57-10.27]), enrollment in health sciences (Odds Ratio=3.59 [95% CI 2.60-4.96]), marriage (Odds Ratio=2.04 [95% CI 1.13-3.64]) and having a scholarship (Odds Ratio=1.60 [95% CI 1.09-2.35]). CONCLUSION: Knowledge and vaccination coverage against hepatitis B among students at Cocody's University is low. Students should be given information about hepatitis B and access to free vaccination. Students enrolled in health sciences should be vaccinated before admission because of specific risks of contamination, for themselves and for their patients.

[Management of prostate cancer in Senegal: what is being done?]. / Cancer de la prostate : quelle prise en charge au Sénégal ?

OBJECTIVE: To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS: We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS: We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION: The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

[Epidemiology of a cohort of 450 urolithiasis at the Yalgado Ouédraogo university hospital of Ouagadougou (Burkina Faso)]. / Épidémiologie d'une cohorte de 450 lithiasesurinaires au CHU Yalgado Ouédraogo deOuagadougou (Burkina Faso).

OBJECTIVE: To report the epidemiological and diagnosis characteristics of urolithiasis in the city of Ouagadougou (Burkina Faso). PATIENTS AND METHODS: We performed a retrospective and descriptive study of a cohort of urolithiasis patients from January 2009 to December 2011 at the department of urology of the Yalgado Ouédraogo University hospital of Ouagadougou. The minimum required data were: age, gender, occupation, residence, complete medical observation and medical imaging results. RESULTS: Four hundred and fifty patients with a median age of 35 years were included in this study. Urinary stones prevalence was 12.5%. There was a male predominance with a sex ratio of 1.91. Renal colic found in 32% of patients was the main pattern of consultation. Urinary schistosomiasis was the main etiological factor correlated with the occurrence of urolithiasis (P < 0.05). The majority of urinary stones in this study were located in the upper urinary tract (86.5%). Complications were dominated by urinary tract infections (45.2%) and obstructive renal failure (8.9%). CONCLUSION: The characteristics of urolithiasis in our center were similar to those reported in the developing world but seem to evolve toward those of industrialized countries.

FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso.

FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.

Reducing tidal volume and increasing positive end-expiratory pressure with constant plateau pressure during one-lung ventilation: effect on oxygenation.

BACKGROUND: It is no longer safe to use large tidal volumes (V(T)) (>8 ml kg(-1)) for one-lung ventilation (OLV), and limiting plateau pressure should be a major objective. Due to the specificity of OLV, the use of positive end-expiratory pressure (PEEP) remains controversial. This study determined whether at the same low plateau pressure, reducing V(T) and increasing PEEP were not inferior to larger V(T) and lower PEEP ventilation in terms of oxygenation. METHODS: This prospective, randomized, non-inferiority, cross-over trial included 88 patients undergoing open thoracotomy who received two successive ventilatory strategies in random order: V(T) (8 ml kg(-1) of ideal body weight) with low PEEP (5 cm H(2)O), or low V(T) (5 ml kg(-1)) with a high PEEP. Respiratory rate and PEEP were, respectively, adjusted to maintain constant ventilation and plateau pressure. The primary endpoint was the ratio under each ventilatory strategy. RESULTS: The non-inferiority of low-V(T) ventilation could not be established. The mean adjusted ratio was lower overall during low-V(T) ventilation, and differences between the two ventilatory modes varied significantly according to baseline (T0). Decreased oxygenation during low V(T) was smaller when baseline values were low. Systolic arterial pressure was not lower during low-V(T) ventilation. CONCLUSION: During OLV, lowering V(T) and increasing PEEP, with the same low plateau pressure, reduced oxygenation compared with larger V(T) and lower PEEP. This strategy may reduce the risk of lung injury, but needs to be investigated further.

[Epidemiology of urologic cancers at the university teaching hospital of Cotonou, Benin. Review of about 158 cases of urologic cancers]. / Épidémiologie des cancers urologiques au Centre national hospitalier universitaire Hubert Koutoukou Maga Cotonou, Bénin. Analyse d'une série hospitalière de 158 cas.

OBJECTIVE: To study the epidemiological profile of urologic cancers in the department of urology at the teaching hospital of Cotonou. METHODOLOGY: We analysed the course of all urological cancer data over a 42-month period, from January the 1st 2008 to 30th June 2011. RESULTS: Urologic cancers were frequent in our hospital practice with a frequency of 17.38%. They are dominated by prostatic cancer (69%), the cancer of bladder (28.5%), the cancer of the kidney (8.5%) and cancers of the external genitals (testis and scrotum) which are marginal in our review. We did not report any case of penis cancer and urethral cancer. They occured at an advanced age with an average age 62.89±15.51 years. Urologic cancers were the prerogative of the subjects of male sex with a sex ratio of 9/10. Specific mortality rate which is attached to them was high. CONCLUSION: The epidemiologic profile of urologic cancers in our practice had some essential characteristic for the primary prevention. The improvement of the quality of data, the installation of a cancer register and the improvement of the technical skills will allowed a better approach of urologic cancer in our urology unit.

Dengue Immunological Markers Evolution at Saint Camille Hospital in Ouagadougou (HOSCO) Burkina Faso.

<b>Background and Objective:</b> Dengue is a remerging vector-borne viral disease in Burkina Faso since the outbreak of 2013 and requires special attention from health authorities. This study reports the prevalence of dengue fever serological markers (NS1Ag, IgM and IgG) and infection dynamic from January, 2018 to December, 2020 among patients tested for dengue infection at Saint Camille Hospital of Ouagadougou (HOSCO). <b>Materials and Methods:</b> The study population consisted of 6414 patients aged 0-97 years. Dengue virus infection was detected in serum or plasma using the SD bioline dengue duo rapid detection kit. <b>Results:</b> The prevalence of dengue NS1Ag was 2.25% (45/2003), 18.43% (501/2719) and 2.42% (38/1569) in the study population in 2018, 2019 and 2020, respectively. The age groups over 50 years and 15-20 years were significantly more infected compared to the group 21-30 years respectively in 2019 (p = 0.030) and 2020 (p = 0.035). Patients tested positive for at least one of these markers (NSlAg, IgG and IgM) represented 26.01% (521/2003) and 38.98% (1060/2719). The peak of infection during 2018 and 2019 was observed between October and November. The present study reports a high seroprevalence of acute dengue virus infection. The presence of NS1Ag, IgM and IgG in patients suggests an active circulation of the dengue virus in Ouagadougou. <b>Conclusion:</b> Data shows recurrent outbreaks of dengue infection in our country need strong surveillance and a suitable and affordable diagnostic system to clarify the burden, pinpoint the risk factors and for better case management.

Epidemiology of glaucoma in Burkina Faso: Determination of the prevalence and circulating glaucomatous phenotypes in Ouagadougou.

PURPOSE: Glaucoma encompasses a particular set of degenerative diseases of the optic nerve which may have predisposing genetic factors. The objective of this study was to determine the prevalence and phenotypes of primary glaucoma encountered in the population. METHODS: This was a cross-sectional study carried out on retrospective data from three healthcare centers in the city of Ouagadougou between 2012 and 2020. Data collection was carried out using patient records. RESULTS: The population receiving diagnostic glaucoma examinations in the 3 healthcare centers during the study period consisted of 13,378 patients, of which 50.55% were female. The general prevalence of patients with primary glaucoma was 4.04% (or 540 patients). Primary open-angle glaucoma (80.37%), congenital glaucoma (15.74%) and primary angle-closure glaucoma (3.89%) were identified in the study population. CONCLUSION: Glaucoma is a public health problem in Burkina Faso. It is often diagnosed in the late stages because of its insidious progression. In a developing country, effort must be also made to equip and increase the number of healthcare centers. In addition, efforts must be made to raise awareness, and to develop and popularize molecular biologic techniques for early detection in order to provide patients with appropriate care.

[Anesthesic practice for gynecological and obstetric emergency in the Cocody CHU]. / Pratique anesthesique pour urgences gynecologiques et obstetricales au CHU de Cocody.

OBJECTIVE: To evaluate the anesthetic practice in the operating theater of gynecological and obstetric emergencies. MATERIAL AND METHOD: Prospective, descriptive and analytical study on patients admitted to the operating room for a gynecological and or obstetric emergency over a period of six months. RESULTS: We collected 3,486 patients out of 7,574 admissions, or 46.02%. The average age was 27.3 years with extremes of 15 and 45. SFA was the first operative indication for obstetric emergencies while gynecological emergencies were dominated by first trimester bleeding. 99.39% of the patients benefited from a CPA and 45.40% of them, were classified ASA I u. LAR by spinal anesthesia was the most commonly performed anesthetic regimen. Maternal lethality was 0.005. For the mother, the age group [30-45 years], the provenance, the hemorrhagic syndromes, the ASA III and IV classes, the long delays in transfusion and block management were factors of poor prognosis. (P≤0.05) For the fetus, hemorrhagic syndromes and general anesthesia were factors of poor prognosis. (P ≤ 0.05). CONCLUSION: Spinal anesthesia was the most widely used anesthetic regimen.

OBJECTIF: Evaluer la pratique anesthésique au bloc opératoire des urgences gynécologiques et obstétriques. MATÉRIEL ET MÉTHODE: Etude prospective, descriptive et analytique portant sur les patientes admises au bloc opératoire pour une urgence gynécologique ou obstétrique sur une période de six mois. RÉSULTATS: Nous avons colligé 3486 patientes sur 7574 admissions soit 46,02%. La moyenne d'âge était de 27,3 ans avec des extrêmes de 15 et 45 ans. La SFA était la première indication opératoire pour les urgences obstétricales tandis que les urgences gynécologiques étaient dominées parles métrorragies du premier trimestre. La majorité de nos patientes ont eu une consultation pré-anesthésique. L'ALR par rachianesthésie était le schéma anesthésique le plus réalisé. La létalité maternelle était de 0,005. Pour la mère, la tranche d'âge [30-45 ans], la provenance, les syndromes hémorragiques, les classes ASA III et IV, les longs délais de transfusion et de prise en charge au bloc ont constitué des facteurs de mauvais pronostics. (P≤0,05)Pour le fœtus, les syndromes hémorragiques et l'anesthésie générale constituaient les facteurs de mauvais pronostics. (P≤0,05). CONCLUSION: La rachianesthésie était le schéma anesthésique le plus utilisé.

Pressure-controlled ventilation and intrabronchial pressure during one-lung ventilation.

BACKGROUND: Pressure-controlled ventilation (PCV) has been suggested to reduce peak airway pressure (P(peak)) and intrapulmonary shunt during one-lung ventilation (OLV) when compared with volume-controlled ventilation (VCV). At the same tidal volume (V(T)), the apparent difference in P(peak) is mainly related to the presence of a double-lumen tracheal tube. We tested the hypothesis that the decrease in P(peak) observed in the breathing circuit is not necessarily associated with a decrease in the bronchus of the dependent lung. METHODS: This observational study included 15 consecutive subjects who were ventilated with VCV followed by PCV at constant V(T). Airway pressure was measured simultaneously in the breathing circuit and main bronchus of the dependent lung after 20 min of ventilation. RESULTS: PCV induced a significant decrease in P(peak) [mean (sd)] measured in the breathing circuit [36 (4) to 26 (3) cm H(2)0, P<0.0001] and in the bronchus [23 (4) to 22 (3) cm H(2)O, P=0.01]. However, the interaction (ventilatory mode x site of measurement) revealed that the decrease in P(peak) was significantly higher in the circuit (P<0.0001). Although the mean percentage decrease in P(peak) was significant at both sites, the decrease was significantly lower in the bronchus [5 (6)% vs 29 (3)%, P<0.0001]. CONCLUSIONS: During PCV for OLV, the decrease in P(peak) is observed mainly in the respiratory circuit and is probably not clinically relevant in the bronchus of the dependent lung. This challenges the common clinical perception that PCV offers an advantage over VCV during OLV by reducing bronchial P(peak).

[Obstacles to laboratory diagnosis of malaria in Mali--perspectives]. / Problématique du diagnostic biologique du paludisme au Mali--perspectives.

Rapid accurate laboratory diagnosis is necessary for effective malaria management. In Mali, meeting this prerequisite is impeded by underuse of laboratory diagnosis by clinicians, absence of qualified laboratory facilities in some locations, and poor continuous professional education of laboratory technicians. The twofold aim of this investigation was to perform quality control of thick smear readings made by laboratory technicians in 1998 and 1999 and to study the feasibility and diagnostic value of two rapid diagnostic tests (RDT), i.e., ParaSight and OptiMAL, in comparison with the thick smear technique in the period from 1998 to 2003. Quality control of thick smear readings indicated a 56% false positive rate with 49.3% concordance between laboratory technician readings and the reference centre. Trials using RDT showed that the OptiMAL test was more efficient with 97.2% sensibility, 95.4% specificity and 93% concordance in comparison with thick smear. A program of training, refresher courses, and regular didactic supervision (quality control) for laboratory technicians has been set up in Mali under the sponsorship of the "Fondation Mérieux" (ACTION BIOMALI) and the President's Malaria Initiative (PMI). These institutions provide funding for training as well as equipment and consumables in all public medical laboratories in Mali. The thick smear method is still being used as the reference technique, but use of RDT is to be implemented at all levels of the health care pyramid.