Genetic diversity and genotype multiplicity of Plasmodium falciparum infections in symptomatic individuals in the maritime region of Togo.

OBJECTIVE: To assess the genotype prevalence and the multiplicity of Plasmodium falciparum infections in the maritime region of Togo. METHODS: We enrolled 309 symptomatic individuals aged from 6 months to 15 years from Bè/Lomé and Tsévié, two malaria endemic zones. The number and the proportions of merozoite surface proteins 1, 2 and 3 genotypes in patients were determined using capillary electrophoresis genotyping. We further investigated the possible association between transaminases and homocysteine, and the severity of the disease. RESULTS: Of the 309 samples genotyped, 210 tested positive to msp-1, 227 to msp-2 and 193 to msp-3. The nested PCR revealed 22 different alleles for the allelic family msp-1, 33 for msp-2 and 13 for msp-3. At each locus, the family distribution was 54.58% of K1, 25% of MAD20 and 20.42% of RO33 for msp-1, and 51.71% and 48.29% of FC27 and 3D7, respectively, for msp-2. For all these allelic variants, the distribution was associated with neither the severity of malaria nor the zone of habitation. Pearson correlation coefficients between either the levels of homocysteine or the transaminase and the severity of the disease were very low. CONCLUSION: The severity of malaria was not associated with higher multiplicity of infections and did not appear restricted to particular genotypes. More comprehensive explorations including immunity, genetic factors, nutritional and sociologic status of the population could clarify the situation.

Evidence of the impact of monovalent rotavirus vaccine on childhood acute gastroenteritis hospitalization in Togo.

BACKGROUND: Monovalent rotavirus vaccine (RV1) was introduced in the immunization schedule of Togo in June 2014. We evaluated the impact of rotavirus vaccines on acute gastroenteritis (AGE) and rotavirus-associated hospitalizations in Togolese children. METHODS: Sentinel surveillance for AGE (defined as ≥3 liquid or semi-liquid stools/24 h lasting <7 days) hospitalizations among children <5 years of age was conducted in two sites in the capital city, Lome. ELISA was used for diagnosis of rotavirus infection in children with AGE. Additionally, review of hospitalization registers was performed at five hospitals to assess trends in AGE hospitalizations among children aged <5 years. For the vaccine impact assessment, pre-rotavirus vaccine introduction (July 2010-June 2014) and post-rotavirus vaccine introduction (July 2014-June 2016) periods were compared for annual changes in proportions of hospitalizations associated with AGE and rotavirus. RESULTS: During the pre-vaccine period, sentinel surveillance showed that 1017 patients were enrolled and 57% (range, 53-62%) tested positive for rotavirus, declining to 42% (23% reduction) in the first post-vaccine year and to 26% (53% reduction) in the second post-vaccine year; declines were most marked among infants. The patient register review showed that, compared with pre-vaccine rotavirus seasons, declines in hospitalizations due to all-cause AGE during post-vaccine rotavirus seasons were 48% among <1 year age-group in both first and second years following vaccine introduction. Among 1-4 year olds no reduction was noted in the first year and a 19% decline occurred in the second year. CONCLUSIONS: We report rapid and marked reduction in the number of AGE hospitalizations and the proportion of AGE hospitalizations attributable to rotavirus in the first two years post- RV1 implementation in Togo. It is necessary to monitor long-term vaccine impact on rotavirus disease burden through continued surveillance.

[Psoas abscess in Cote d'Ivoire: a report of eighteen cases]. / Les abces du psoas en Cote d'Ivoire: a propos de 18 cas.

BACKGROUND: Psoas abscess is a rarely encountered entity with a non specific clinical presentation resulting in delayed diagnosis and treatment. No published data exist on this disease in our country. OBJECTIVE: To describe the diagnostic and therapeutic features of psoas abscesses in Côte d'Ivoire. Methodes: A retrospective study of 18 psoas abscesses seen over seven years in two teaching hospitals. RESULTS: There were 10 women and eight men with a mean age of 35.7 years (range:16-62 years). The abscess was primary in 15 cases, secondary in three, right sided in 15 and left sided in three cases. Fever, abdominal pain, difficulties in walk, abdominal mass and psoitis were the main clinical signs. Ultrasonography allowed the diagnosis of psoas abscess in 14 cases and in the remaining 4 cases the diagnosis was done peroperatively. The germs were identified in 12 patients and were: Escherichia coli in 3 cases, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Klebsiella pneumoniae in two cases each and Mycobacterium tuberculosis in one case. Patients were given antibiotics together with surgical drainage of the abscess (n=16) or percutaneous needle aspiration (n=2). Postoperative complications included parietal suppurations (n=5) and intraperitoneal abscesses (n=2). No death occurred. CONCLUSION: For psoas abscess in our practice, ultrasonography is a useful diagnostic tool and surgical drainage remains an effective therapeutic method.

[Acute intestinal intussusceptions in adults: analysis of 20 cases]. / Invaginations intestinales aiguës de l'adulte: analyse d'une série de 20 cas.

AIM OF THE STUDY: To report our experience in the management of acute intestinal intussusceptions in adults. PATIENTS AND METHODS: Retrospective study of data of patients older than 15 years who were operated on for acute intestinal intussusceptions from January 1997 to December 2001. RESULTS: Twelve of the patients were males and eight females with an average age of 41 years (range: 16-71). The clinical and radiological findings were suggestive of bowel obstruction (N = 14), peritonitis (N = 5) and appendicular abscess (N = 1). Correct preoperative diagnosis of acute intestinal intussusceptions was established in 6 cases. Type of intussusception was jejunojejunal (N = 1), ileo-ileal (N = 8), ileocolic (N = 1), ileocecocolic (N = 7) and colocolic (N = 3). Necrosis was found in the intussusceptum in 10 cases and a tumor on the lead point in 14 cases (5 benign lesions and 9 malignant ones). For intussusception involving the colon, all patients underwent en bloc resection with immediate anastomosis, while intussusception located on the small bowel were treated by surgical reduction (N = 1), en bloc resection (N = 8) with immediate (N = 7) or delayed (N = 1) anastomosis. The mortality rate was 15%. CONCLUSION: In our experience, intussusceptions in adults is not an uncommon clinical entity but correct diagnosis is often established peroperatively. En bloc resection is recommended because of the frequency of neoplasms and bowel ischemia.

[Appendicitis and pregnancy: 21 cases]. / Appendicite aiguë et grossesse. A propos de 21 cas.

OBJECTIVE: Describe the epidemiological, diagnostic and therapeutic features of acute appendicitis in pregnant women. MATERIAL AND METHODS: Retrospective analysis of a series of 21 cases of appendicitis in pregnant women who underwent surgery between January 1997 and June 2001. RESULTS: The association of acute appendicitis with pregnancy was noted in 0.2% of the pregnant women. Ten patients were in the first trimester of pregnancy, ten in the second and one in the third. Abdominal pain was noted in all patients. The localization varied with gestational age. Abdominal ultrasound contributed to the diagnosis in twenty patients who underwent the examination. Diagnoses retained were: acute uncomplicated appendicitis (n=18), acute appendicitis with focal induration (n=1) and acute diffuse peritonitis (n=2). Appendectomy was performed in all cases. Intensive care, peritoneal cleaning and drainage were associated in cases with appendicitis. In cases with focal induration, medical treatment was followed by appendectomy performed after delivery. Tocolysis was instituted in all cases. Twelve pregnancies continued to delivery: one fetal death, one premature delivery and ten term deliveries of live infants. CONCLUSION: Pregnancy makes it difficult to confirm the diagnosis of appendicitis. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.

[Appendicular peritonitis]. / Péritonites appendiculaires.

Peritonitis (i.e. acute inflammation of the peritoneum) from appendicular origin, can be due to acute appendicitis or be observed after appendicectomy. Diagnosis is based on physical examination. Imaging procedures (ultrasound and computed tomography) are particularly useful in localized and postoperative peritonitis. Management includes surgery, antibiotics and intensive care. Early surgical treatment by appendicectomy represents the best way to improve the prognosis of the disease. Mortality is mainly observed in case of delayed diagnosis and in aged patients.

Constraining predictions of the carbon cycle using data.

We use a carbon-cycle data assimilation system to estimate the terrestrial biospheric CO(2) flux until 2090. The terrestrial sink increases rapidly and the increase is stronger in the presence of climate change. Using a linearized model, we calculate the uncertainty in the flux owing to uncertainty in model parameters. The uncertainty is large and is dominated by the impact of soil moisture on heterotrophic respiration. We show that this uncertainty can be greatly reduced by constraining the model parameters with two decades of atmospheric measurements.

[Implementation of palliative care in Ivory Coast]. / Mise en place de la politique nationale des soins palliatifs en Côte d'Ivoire.

Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place.

[Post-operative morbidity and mortality in non traumatic colon emergencies]. / Morbidite et mortalite post-operatoire des urgences coliques non traumatiques a propos de 85 interventions.

UNLABELLED: This study aimed to evaluate emergency non traumatic colonic surgery mortality and morbidity in our practice MATERIAL AND METHODS: Data of all 85 patients who underwent an emergency non traumatic colonic surgery during the period from August the 1st 1998 to June the 30th 2006, were retrospectively reviewed. Surgical procedures included either colonic resections with (n = 33) or without (n = 47) immediate anastomosis or, ileostomies (n = 3) or colostomies (n = 2) without colonic resection. RESULTS: A 16.5% (n = 14) mortality rate was recorded due to septic shock (n = 6), postoperative peritonitis (n = 2), stroke (n = 2) and cachexia, malnutrition, acute anemia, acute heart failure (n = 1 each). Morbidity rate was 38.8% (n = 33). Surgical complications (n = 29 34.1%) were related to wound infection (21.1% n = 18), stoma related (n = 6), post-operative peritonitis due to an anastomotic dehiscence and prolonged ileus (n = 2 each), rectorragy (n = 1). Medical complication reached a 4.7% rate and included malaria (n = 2), acute pulmonary edema, diabete acido cetosis (n = 1 each). Seven patients (8.2%) needed a reoperation for post operative complication. Hospital stay was 19.4 days. CONCLUSION: Post-operative morbidity and mortality in non traumatic colon emergencies still remain high owing to anastomotic leak, patients comorbidities and infectious complications.

Wound recurrence after resection of hepatocellular carcinoma.

Cutaneous metastases arising along the exit site of an abdominal drain in one patient and within the operative wound in two others after resection of a hepatocellular carcinoma (HCC) are reported. All patients underwent curative hepatic resection, and cutaneous metastases occurred 9, 12, and 22 months after surgery respectively. Cutaneous metastases were not associated with intrahepatic recurrence and were treated by local excision. Two patients are alive and disease-free 48 and 49 months after hepatic resection, respectively; the third patient died from recurrence 39 months later. These observations suggest that cutaneous malignant seeding may occur, and the authors recommend the observance of special care during liver surgery to prevent occurrence of this complication, including the use of wound protection and avoiding the opening of the specimen by the surgeon. The follow-up of patients who have undergone liver resection for an HCC should include the examination of all operative wounds including the exit site of abdominal drains. These subcutaneous nodules should be resected as an appreciable survival can be expected.