Molecular characterization of high-risk human papillomavirus (HR-HPV) in women in Lomé, Togo.

BACKGROUND: The causative agent of cervical cancer referred to as Human papillomavirus (HPV) remains a real public health problem. Many countries in West Africa, such as Togo have no data on the high-risk HPV (HR-HPV) infection and genotypes distribution. In order to fill the knowledge gap in the field in Togo, the main objective of this study was to determine the prevalence of pre-cancerous lesions of the cervix and HR-HPV genotypes among Togolese women. METHODS: Samples were collected from 240 women by introducing a swab in the cervix. Then, the screening of precancerous cervical lesions using the visual inspection with acetic acid and lugol (VIA / VIL) was conducted. The HR-HPV genotypes were characterised by real-time multiplex PCR. RESULTS: Out of 240 women recruited, 128 (53.3%) were infected by HR-HPV. The most common genotypes were HPV 56 (22.7%), followed by HPV 51 (20.3%), HPV 31 (19.5%), HPV 52 (18.8%) and HPV 35 (17.2%). The least common genotypes were HPV 33 (2.3%) and HPV 16 (2.3%). Among the women, 1.3% (3/240) were positive to VIA/VIL. CONCLUSION: This study allowed HR-HPV genotypes to be characterised for the first time in Lomé, Togo. This will help in mapping the HR-HPV genotypes in West Africa.

[Primary ileostomy for typhoid-related ileal perforation: a 62-case series in Ouagadougou, Burkina Faso]. / Iléostomie première des perforations iléales d'origine typhique: 62 cas à Ouagadougou (Burkina Faso).

OBJECTIVES: The purpose of this report is to evaluate the efficacy of primary ileostomy for treatment of typhoid-related ileal perforation based on our experience. METHODS: This retrospective study included all cases of typhoid-related ileal perforation treated by primary ileostomy in the Visceral Surgery Department of the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso from January 2006 to June 2008. Diagnosis was based mainly on peroperative findings revealing specific anatomical lesions. There were 45 men (72.6%) and 17 women (27.4%) with a mean age of 26 years (range, 14 to 68). Asthenic forms were observed in 41 cases (66.1%) and sthenic forms in 21 (33.9%). The mean delay for seeking treatment was 6 days (range, 1 to 30 days). RESULTS: Primary ileostomy was used for treatment of typhoid-related ileal perforation in 78.5% of cases. Most cases (80.6%) involved single perforations. A temporary ileostomy was performed in 55 cases (88.7%) and terminal ileostomy was performed in 7 (11.3%). Complications were observed in 18 patients (29.03%) including suppuration of wall in 8 cases. The mean duration for re-establishing continuity and of hospital stay was 34 and 41 days respectively. Four deaths occurred due to hypovolemic shock. CONCLUSION: In our department, primary ileostomy for typhoid-related ileal perforation reduced mortality despite high morbidity.

[Risk factors associated with osteoarthritis of the knee in a rheumatology outpatient clinic in Ouagadougou, Burkina Faso]. / Facteurs de risque associés à la gonarthrose en consultation de rhumatologie à Ouagadougou (Burkina Faso).

The purpose of this transverse prospective study was to assess risk factors associated with osteoarthritis (OA) of the knee observed in a rheumatology outpatient clinic in Ouagadougou, Burkina Faso. All patients presenting osteoarthritis of the knee diagnosed according to the clinical and radiological criteria of the American College of Rheumatology (ACR) were recruited over a 9-month period from November 2006 to July 2007. A total of 118 patients including 108 women were studied. Mean patient age was 55.7 +/- 10.8 years. Pain and disability scores assessed using theLequesne index were greater than 8 in 87.3% of patients. Hydarthrosis was observed in 56.5% of patients. The most common associated risk factors for development of osteoarthritis of the knee were obesity (42.4%), menopause in women (66.7%), history of OA (43.2%), and previous knee injury (19.5%). The most common associated risk factors for progression of osteoarthritis of the knee were Heberden nodes (19.5%) and genu varum (52.5%). The risk factors for development and progression of osteoarthritis of the knee in the subsahalian population of Ouagadougou are the same as in the Caucasian population of industrialized countries. An unexpected finding in this black African population was the high prevalence of Heberden nodes.

Missing maternal deaths: lessons from Souro Sanou University Hospital in Bobo-Dioulasso, Burkina Faso.

We investigated the location of maternal deaths in the Souro Sanou University Hospital of Bobo-Dioulasso, Burkina Faso. In all, the deaths of 585 women of reproductive age (12-49 years) were reviewed, and 132 (22.6%) were found to be maternal. Of these132, 43 (33.6%) occurred outside of the maternity unit. Some direct causes of death (eclampsia and sepsis) and indirect causes of death (cardiac illness and HIV/AIDS) would be omitted if only cases occurring on the maternity ward are investigated. Alarmingly, 93 (70%) of the 132 maternal deaths would have been missed in this hospital if we had used a narrow search process (excluding non-maternity wards) and narrow definition (excluding indirect causes). In conclusion, the results of this study demonstrate the potential for seriously underestimating the magnitude of maternal mortality within facilities and for neglecting pregnant or recently pregnant women dying in non-maternity wards and from indirect complications.

[Characteristics of the population under care from 1990 to 2000, Department of Psychiatry, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso]. / Caractéristiques de la population prise en charge au Service de Psychiatrie du CHU Yalgado Ouédraogo de Ouagadougou (Burkina Faso) de 1990 à 2000.

Mental disorders constitute an important portion of the world sickness ratio. In developing countries, in the absence of data on morbidity, hospital statistics are worthy of interest. Our study was carried out on a population of patients under care in the department of psychiatry of the Ouagadougou Hospital between January 1st 1990 and December 31st 2000, a period of 11 years. For each patient, we noted the sociodemographical features and the clinical diagnosis referring to the ICD-10 of the WHO. Within the scope of the study, 7 313 patients (60% men and 40% women) were analysed. The average age of the patients was 31.06 +/- 13.07 years. Among these patients, 80.60% had been exclusively under ambulatory care and 19.40% had been hospitalized at least once. The main categories of the available diagnoses were listed according to recurrence: acute psychotic disorders (20.68%), schizophrenia (17.25%) and depression (15.13%). In the men, the main diagnosis was acute psychotic disorders, whereas depression came top of the list for women. In the present state of socio-economic and cultural development in Burkina Faso, we note that only very serious mental disorders and/or those who cannot obtain favourable response with the traditional care system, come to medical centers. Therefore, there is a need to investigate the population as a whole, and to assess their need for medical care in this domain.

Molecular Epidemiology of High-Risk Human Papillomavirus in High-Grade Cervical Intraepithelial Neoplasia and in Cervical Cancer in Parakou, Republic of Benin.

Human papilloma virus (HPV) infection remains a worldwide concern, especially in Sub-Saharan Africa where cervical cancer is the leading cause of cancer death in women. The aim of the study was to determine the prevalence and genotypic distribution of High-Risk HPV (HR-HPV) involved in Cervical Intraepithelial Neoplasia (CIN) II and III and in cervical cancer in Parakou. Out of a total of 149 samples of cervical tissues archived, fixed and paraffin-embedded, 78 samples with histological diagnosis of CIN-II, CIN-III and cervical cancer went through deparaffinization with xylene, followed by an extraction of HPV DNA and the detection of HR-HPV by real-time multiplex PCR. The average age of the women was 40.05±13.99 years. The samples were positive to at least one HR-HPV genotype in 76.92% (50/65) of cases. The HR-HPV genotypes which are most common in the cervical cancer and in CIN-II and III were, respectively HPV-39 (38 and 37.50%), HPV-18 (35 and 31.30%), HPV-45 (35 and 31.30%), HPV-35 (9 and 25%) and HPV-52 (9 and 12.50%). The HPV-16 was absent. This study helped to detect (in samples archived, fixed and paraffin-embedded tissues) HR-HPV involved in high-grade precancerous lesions and in cervical cancer in Parakou, some of which are not covered by currently available vaccines.

[Susceptibility of Culex quinquefasciatus to insecticides in Bobo Dioulasso, Burkina Faso]. / Sensibilité de Culex quinquefasciatus aux insecticides a Bobo Dioulasso, Burkina Faso.

This study conducted from 1999 to 2000 in the suburbs of Bobo Dioulasso a town in the South of Burkina, aimed at investigating the susceptibility of the local population of Culex quinquefasciatus to various insecticides and proposing alternative strategies allowing a better management of insecticide resistance in the field. Eggs of C. quinquefasciatus were first collected in stagnant waste water places. The larvae were reared to early 4rth instar and tested by larval bioassays to determine the LC50/95 and the resistance ratios (RR50 and RR95) as well as their confidence intervals. A susceptible reference Strain "Slab" was used as control. Resistance was found to DDT and pyrethroids, but reduced susceptibility was found for carbamates, organophosphorates, phenyl pyrazole and in a less extend to Bacillus sphaericus. Resistance to pyrethroides is quite alarming since these insecticides are mainly used for bed net impregnation for the Roll Back malaria programme implemented in Africa. The high levels of insecticide resistance in C. quinquefasciatus suggest that alternative strategies have to be implemented to minimize the pressure of selection on resistant genes. The use of bio-larvicides (Bacillus sphaericus) alone or in rotation with different compounds may be a promising strategy for controlling C. quinquefasciatus in Bobo Dioulasso.

[People living with HIV: daily life and management of the risk of transmission in the infected person's entourage: study in Ouagadougou]. / Les personnes vivant avec le VIH, vécu quotidien et gestion du risque de transmission à l'entourage: étude à Ouagadougou.

HIV infection has modified social relationships not only within various population subgroups but also at the family level. Patient management has been seriously affected. In 2001 we undertook a descriptive study among a population of PLHIV treated in an ambulatory center in order to 1(o)) describe the socio-demographical characteristics of PLHIV admitted to the center and 2(o)) identify the strategies adopted by PLHIV and their families to control the risk of HIV transmission in the entourage. Patients were systematically included over a period of two weeks. Each patient was asked to indicate the name of a family member that could be interviewed by the research team. A total of 188 PLHIV (122 women) ranging in age from 19 to 55 years were questioned. Interviews were conducted in 66 families. Most PLHIV had received some formal education ranging from primary school to university. Over one third (36.4%) had known that they were seropositive for at least one year. Almost three-fourths (73.4%) were aware that HIV was transmissible to other people. The most frequently mentioned transmission hazards were handling contaminated articles (51.5%), unprotected sexual intercourse (46.4%), contact with blood (34.8%), and sharing personal toilet articles (11.6%). The most commonly mentioned preventive measures were abstinence from sex (27.1%), use condoms (28.7%), and protection from pointed or cutting objects (19.1%). According to responding family members, the most common protective measures against HIV transmission were observing hygiene measures (36.5%), discarding any fluids from the ill person in the toilet (26.5%), wearing gloves (25%), and protecting against handling contaminated objects (5.8%). These data suggest that programs aimed at educating PLHIV and their families on the risk of HIV transmission and preventive measure has had a positive impact on the quality of life.

[HIV infection and modification of social relationships: study of 188 HIV-infected persons in Ouagadougou (Burkina Faso)]. / Infection à VIH et modifications des relations sociales: étude auprès de 188 personnes infectées par le VIH à Ouagadougou (Burkina Faso).

HIV infection creates diverse representations among sick people, their families, the community and healthcare workers, representations that modify social relationships. To analyze the interpersonal relationships in families of people living with HIV, we began a cross-sectional descriptive study in 2001 of a population of HIV patients treated at an outpatient center in Ouagadougou. Our objectives were to: 1 degree) describe the changes in the social relationships between the subjects and members of their families; 2 degrees) itemize the difficulties they met within their families and identify the different types of discrimination they may suffer there. The systematic inclusion of HIV patients at the treatment center made it possible to question 188 subjects, including 122 women and 66 men aged 19 to 55 years. With the subjects' consent, 66 family members were also interviewed. According to these patients, the principal significant events experienced after disclosing their HIV status were absence of sexual intercourse with the partner (16.0%), rejection by their family (9.6%), taunting, criticism and contempt (6.4%). This conduct came from siblings (25%), other family members (20.8%), neighbours (20.8%), in-laws (16.7%), and the spouse (4.2%). Among our subjects, 74.5% informed their families that they were HIV-positive. Of the family members questioned, 82.1% considered the subject to be a victim and 17.9% considered him or her guilty. After receiving this information 21.5% of the families modified their relationships with the subjects. Despite information and awareness campaigns, HIV infection is laden with emotion and prejudice and subjects its victims to discriminatory behavior. Further public education is necessary to improve acceptance of people with this disease by their family and friends.

[Radiographic and ultrasonographic diagnosis of a left thoracic mass]. / Diagnostic radiologique et échographique d'une masse thoracique gauche.

A chest roentgenogram of a 69-year-old man undergoing a check-up before prostate surgery showed a mass in the antero-inferior zone of the lung, just above the diaphragm. At ultrasonography, it was considered to be a thoracic ectopic kidney. This radiological case illustrates the place of this anomaly in the differential diagnosis of lung solitary mass, which can be explored with ultrasonography when retroperitoneal herniation is suspected.

[Semiological features and risk factors associated with osteoarthritis of the hip in Ouagadougou (Burkina Faso)]. / Caractéristiques sémiologiques et facteurs de risque associés à la coxarthrose à Ouagadougou (Burkina Faso).

OBJECTIVE: To study the epidemiological and clinical aspects of osteoarthritis (OA) of the hip in Ouagadougou, as well as its risk factors. PATIENTS AND METHODS: This retrospective study covered cases treated over a 3-year period (February 2006 through January 2009) in the internal medicine department of the Yalgado Ouedraogo Teaching Hospital of Ouagadougou (Burkina Faso) and the surgery department of the private hospital Notre-Dame-de la Paix of Ouagadougou. All patients included had OA of the hip that met the Kellgren and Lawrence criteria. RESULTS: There were 46 patients who met the study criteria, but only 40 files could be used. The patients' mean age was 46.4 years ± 15.2 years (range 25-80 years; 10 patients were older than 56 years). Men accounted for more than half (n=23, 57.5%). The mean duration of disease was 6.2 years ± 4.5 years (range: 1-19 years). The right hip alone was concerned in 20 patients (50%), the left hip in 16 (40%), and the OA was bilateral in four (10%). Seventeen patients had sickle cell disease (42.5%), 11 SC and 6 SS. The risk factors included necrosis of the femoral head in 19 cases (59.37%), hip dysplasia in 6 (18.74%), hip trauma in 3 (9.37%), inflammatory arthropathy in 3 more (9.37%), and epiphysitis in one (3.13%). The OA of the hip was primary in 8 cases (20%). Three patients were at stage 1, 9 at stage 2, 15 at stage 3, and 13 at stage 4 according to the Arlet-Ficat classification. CONCLUSION: OA of the hip arises in a young population and is dominated by secondary OA. The dominant risk factor was aseptic necrosis of the femoral head associated with sickle cell disease. In view of the small number of patients with primary OA, no definitive conclusions can be drawn about it.

[Anatomic pitfalls of vagotomies]. / Les pièges anatomiques des vagotomies.

In order to minimise relapses and functional problems after vagotomies, an anatomic study of the vagus nerve at the base of the esophagus and stomach was carried out. Fifty stomachs of adult black African corpses were collected, placed in a formaldehyde solution and then dissected. At the level of the esophageal hiatus, the trunks of the vagus nerve were found in 46% of the cases for the anterior vagus and 24% for the posterior. At the level of the abdominal esophagus there was a single anterior vagus in 68% of cases and single posterior vagus in 64% of cases. At the level of the greater curvature, a recurrent anterior branch was found. At the level of the lesser curvature, the main nerves had a plexiform appearance in 8% of cases for the anterior nerve and 6% of cases for the posterior nerve. The classical arrangement was found in 60% of cases for the main anterior nerve and 64% of the cases for the posterior nerve. At the level of the angulus, the classical crowsfeet was found in 20% of cases for the anterior vagus and in 32% of cases for the posterior vagus. The anterior vagus was plexiform in 54% of cases and 46% of cases for the posterior. This study confirms the extreme variability of the vagus in the stomach. A better knowledge of the variations should lead to more successful vagotomy regardless of its forms.

[Fundamentals of the anatomy of oculomotor behavior]. / Les bases anatomiques de l'oculomotricité.

The oculomotricity rests on complex anatomo-physiological bases and allows the binocular vision, which is a sensory function very completed in the human. After a short embryologic recall, the binocular vision is defined. The anatomical structures, which take part in the binocularity, are reviewed within three functional stages: an effector peripheral stage (eye ball, extrinsic muscles and their nerves), a sub cortical central stage, generator of the movements (oculomotor nuclei, reticularis formation...), and a central, cortical and subcortical stage, incitator of the movements (cortical areas, vestibular nuclei, cerebellum...). These anatomical bases make it possible to understand the many disorders observed in pathology.

[Epidemiology of enuresis in children and adolescents aged 5-16 years in Ouagadougou (Burkina Faso)]. / Epidémiologie de l'énurésie chez les enfants et les adolescents de 5 à 16 ans à Ouagadougou (Burkina Faso).

BACKGROUND: Enuresis is a frequent manifestation with important psychological and social consequences in Africa. In order to help the public authorities to plan monitoring actions and better targeted health interventions, we carried out this prospective study in one district of Ouagadougou. The aim of this study was to describe and analyze enuretic children and teenagers' profile from 5- to 16-years old, and their parents' attitude toward the disorder. POPULATION AND METHODS: A cross-sectional study was conducted among 1,575 children and teenagers of this age group. Those children and teenagers were chosen from a random sample of 645 households. Sociodemographic and medical data were obtained from respondents by using a written questionnaire. RESULTS: The rate of young people affected was 12.95%. Among them, 78.9% had primary enuresis; 50.5% of them were not treated. Those with secondary enuresis were more easily treated than those with primary stage. 87.3% were traditionally treated and 3.4% of enuretic children were essentially submitted to fluid restrictions. In about 27% of the cases, children were punished by their parents. CONCLUSION: Sociodemographic characteristics of our sample were similar to those in the literature. However, the parents in our study rarely used modern treatment and had inappropriate attitudes toward the disorder. We recommend that the most important factors to be taken into account in the secondary prevention of enuresis are the parents' ignorance and/or their scepticism toward the modern therapeutic possibilities.

[The current situation with regard to nicotine addiction in Burkina Faso: tobacco supply and data from the KAB-P survey of young people in Ouagadougou]. / Situation actuelle du tabagisme au Burkina Faso: données global sur l'offre et enquête CAPC auprès des jeunes de la ville de Ouagadougou.

Smoking is a worldwide phenomenon and many studies have demonstrated that tobacco use is a risk factor for morbidity and mortality. We investigated aspects of the supply of, and demand for, tobacco in Burkina Faso, with a view to helping the public authorities design strategies to combat this phenomenon. We used data on the importation of tobacco and the making of cigarettes in Burkina Faso and carried out a survey of adolescents and young adults (n = 289) with a mean age of 20.9 years. In 1997, Burkina Faso imported 1,905, 214 metric tons of tobacco of all kinds, with a CAF value of 5,808, 905,269 CFA francs. In the survey, 30.7% of those interviewed said that they smoked. These individuals gave various reasons for their use of tobacco including imitating friends (38.6%) and personal liberty (14.1%). These young people were generally aware of the risks of tobacco use, but this did not deter them from smoking. In countries like Burkina Faso, which is faced with many challenges, controlling tobacco advertising and providing ways and means to help young people to stop smoking or to deter them from starting to smoke are of major importance for future public health.

[Abscesses of the spleen. Value of echoguided percutaneous drainage apropos of 4 new cases]. / Les abcès de la rate. Intérêt du drainage percutané échoguidé à propos de quatre nouveaux cas.

Curative treatment in 4 patients with splenic abscesses was obtained after echoguided percutaneous drainage. An analysis of the literature from 1986 to 1992 revealed that both splenectomy (87 cases) and percutaneous drainage (47 cases) have had their indications. This could appear rather surprising since that in 1986 several reports had already indicated the safety and effectiveness of percutaneous drainage which leads to cure in 70% of the cases and reduces both the cost of the surgical procedure and he long-term risks of splenectomy. The analysis of the recent literature would suggest, with certain reservations related to the nature of this type of analysis, that percutaneous drainage is a superior technique compared with splenectomy. Mortality reported after splenectomy was high (14%) compared with mortality after percutaneous drainage (2%) (1 out of 47 cases). Percutaneous drainage was unsuccessful in 5 patients (11%) who then underwent successful splenectomy. Global cure rate for percutaneous drainage alone was 87%. Based on the results of this analysis of the data in the literature, and on our own personal experience, we conclude that splenectomy should be performed only exceptionally for splenic abscesses, usually in cases with multifocal abscesses or complicated with rupture.

[Secondary school teachers' smoking in Ouagadougou, Burkina Faso]. / Le tabagisme chez les enseignants du secondaire de la ville de Ouagadougou, Burkina Faso.

This study was carried out among teachers of 10 secondary schools in Ouagadougou, Burkina Faso, in order to contribute to the development and implementation of a tobacco control programme in the school setting. The study had the following objectives: 1) to determine the extent of teachers' smoking addiction in the secondary schools in the city of Ouagadougou, 2) to describe the perceptions, attitudes and behaviour of teachers in the secondary school setting when confronted with smoking in the city's schools, 3) to determine the teachers' level of knowledge with respect to the harmful effects of smoking. The study was carried out from May 25 to June 30, 2001, and it included 300 teachers, 218 of which were men and 82 women. The study demonstrated that it is important to inform and sensitise teachers based upon their attitudes and perceptions with respect to tobacco.

[Complications of Meckel's diverticulum in Dakar (apropos of 2 cases)]. / Complications du diverticule de Meckel à Dakar (a propos de 2 observations).

Meckel's diverticula is the most common lesion among the abnormalities resulting from the persistence of the vitelline canal and its vessels. Studying it is interesting, on the one hand, because of the difficulty of detecting it, and, on the other, because of the possibility of accidents dominated by intestinal occlusions and digestive haemorrhages. Two observations on complications in Meckel's diverticula discovered in young men in the casualty unit are covered, and literature on the rare pathology is reviewed.

[Anatomic study of the anterior interventricular artery (Ramus interventricularis anterior). Apropos of 200 anatomical samples]. / Etude anatomique de l'artère interventriculaire antérieure (ramus interventricularis anterior) a propos de 200 pièces anatomiques.

The coronary system has been studied on the basis of 200 hearts taken during necropsies and treated by injection of a synthetic resin followed by corrosion. Sixty samples were used for the study of the L.A.D. and one hundred and fifty were used for studying intercoronary anastomosis on L.A.D. The study highlighted the following particularities: the left coronary is the most common origin of L.A.D. (90 per cent cases); the L.A.D. irrigates: all the left ventricle ventral wall, the right apical part of both ventricles and the upper portion of the interventricular septum; out of 92 anastomoses, 49 were located on the L.A.D. which could protect against ischemia.

[Branches of the vertebral artery to the spinal cord]. / Les rameaux de l'artère vertébrale à destination médullaire.

On the cervical level, ramifications stemming directly from the vertebral artery are studied while nevertheless taking into account contributions from rising and deep cervical, and while sometimes even from the upper intercostal and/or the occipital, as well as anastomoses contracted from these various sources at the level of the neck. No bulging cervical artery exists, but the variations observed are frequent. Pedicles are rarely symmetrical and usually alternate between left and right sides. Two, differently coloured injections sometimes reveal a preponderance for one side rather than the other, but the injections must be able to be made at the same time and with an equal degree of precision if a formal conclusion is to be drawn from this.