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Abstract Background Mitral valve prolapse (MVP) is a common heart disorder characterized by an excessive production of proteoglycans and extracellular matrix in mitral valve leaflets. Large-scale genome-wide association study (GWAS) underlined that MVP is heritable. The molecular underpinnings of the disease remain largely unknown. Methods We interrogated cross-modality data totaling more than 500,000 subjects including GWAS, 4809 molecules of the blood proteome, and genome-wide expression of mitral valves to identify candidate drivers of MVP. Data were investigated through Mendelian randomization, network analysis, ligand-receptor inference and digital cell quantification. Results In this study, Mendelian randomization identify that 33 blood proteins, enriched in networks for immunity, are associated with the risk of MVP. MVP- associated blood proteins are enriched in ligands for which their cognate receptors are differentially expressed in mitral valve leaflets during MVP and enriched in cardiac endothelial cells and macrophages. MVP-associated blood proteins are involved in the renewal-polarization of macrophages and regulation of adaptive immune response. Cytokine activity profiling and digital cell quantification show in MVP a shift toward cytokine signature promoting M2 macrophage polarization. Assessment of druggability identify CSF1R, CX3CR1, CCR6, IL33, MMP8, ENPEP and angiotensin receptors as actionable targets in MVP. Conclusions Hence, integrative analysis identifies networks of candidate molecules and cells involved in immune control and remodeling of the extracellular matrix, which drive the risk of MVP.

Abstract Access to Hepatis C treatment in Sub-Saharan Africa is a clinical, public health and ethical concern. The multi-country open-label trial TAC ANRS 12311 allowed assessing the feasibility, safety, efficacy of a specific care model of HCV treatment and retreatment in patients with hepatitis C in Sub Saharan Africa. Between November 2015 and March 2017, with follow-up until mid 2019, treatment-naïve patients with HCV without decompensated cirrhosis or liver cancer were recruited to receive 12 week-treatment with either sofosbuvir + ribavirin (HCV genotype 2) or sofosbuvir + ledipasvir (genotype 1 or 4) and retreatment with sofosbuvir + velpatasvir + voxilaprevir in case of virological failure. The primary outcome was sustained virological response at 12 weeks after end of treatment (SVR12). Secondary outcomes included treatment adherence, safety and SVR12 in patients who were retreated due to non-response to first-line treatment. The model of care relied on both viral load assessment and educational sessions to increase patient awareness, adherence and health literacy. The study recruited 120 participants, 36 HIV-co-infected, and 14 cirrhotic. Only one patient discontinued treatment because of return to home country. Neither death nor severe adverse event occurred. SVR12 was reached in 107 patients (89%): (90%) in genotype 1 or 2, and 88% in GT-4. All retreated patients (n = 13) reached SVR12. HCV treatment is highly acceptable, safe and effective under this model of care. Implementation research is now needed to scale up point-of-care HCV testing and SVR assessment, along with community involvement in patient education, to achieve HCV elimination in Sub-Saharan Africa.

We conducted a cross-sectional serosurvey for chikungunya virus (CHIKV) exposure in fruit bats in Senegal during 2020–2023. We found that 13.3% (89/671) of bats had CHIKV IgG; highest prevalence was in Eidolon helvum (18.3%, 15/82) and Epomophorus gambianus (13.7%, 63/461) bats. Our results suggest these bats are naturally exposed to CHIKV.

Abstract Alterations in thyroid hormones (TH) and thyroid-stimulating hormone levels are frequently found following exposure to chemicals of concern. Dysregulation of TH levels can severely perturb physiological growth, metabolism, differentiation, homeostasis in the adult and developmental processes in utero. A frequently identified mode of action for this interaction is the induction of hepatic detoxification mechanisms (e.g. SULTs and UGTs), which lead to TH conjugation and elimination and therefore interfere with hormonal homeostasis, fulfilling the endocrine disruptors (EDs) definition. A short-term study in rats with dietary exposure to cyproconazole, epoxiconazole and prochloraz was conducted and hepatocyte hypertrophy, hepatic UGT activity and Phase 1/2 gene expression inductions were observed together with changes in TH levels and thyroid follicular hypertrophy and hyperplasia. To test for specific interaction with the thyroid hormone system, in vitro assays were conducted covering thyroidal I-uptake (NIS), TH transmembranal transport via MCT8 and thyroid peroxidase (TPO) function. Assays for iodothyronine deiodinases (DIO1–DIO3) and iodotyrosine deiodinase (DEHAL1) were included, and from the animal experiment, Dio1 and Dehal1 activities were measured in kidney and liver as relevant local indicators and endpoints. The fungicides did not affect any TH-specific KEs, in vitro and in vivo, thereby suggesting hepatic conjugation as the dominant MoA.

Introduction One of the most challenging outcomes after surgery is site infection, the consequences of which include the cost burden on hospitals, contributions to patient morbidity and readmissions. A shift to shorter hospital stays requires closer monitoring of surgical site infections (SSI) after discharge. This paper reviews post-discharge surveillance (PDS) methods on SSI identification, a comparison of some of these methods, SSI rates during and after hospitalization, and associated risk factors for SSI.

Introduction Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA.Methods SSA countries Demographic and Health Surveys data that had collected information on the CS’ timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries’ level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality.Results The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4–4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3–3.6). Private health facilities’ elective CS prevalence was estimated at 10.2% (95% CI 9.3–11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0–8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8–4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6–2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64–3.41), while no association was found with elective CS.Conclusions Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.

Abstract Heterogeneity of COVID-19 manifestations in human population is vast, for reasons unknown. Cotton rats are a clinically relevant small animal model of human respiratory viral infections. Here, we demonstrate for the first time that SARS-CoV-2 infection in cotton rats affects multiple organs and systems, targeting species- and age-specific biological processes. Infection of S. fulviventer, which developed a neutralizing antibody response and were more susceptible to SARS-CoV-2 replication in the upper respiratory tract, was accompanied by hyperplasia of lacrimal drainage-associated lymphoid tissue (LDALT), a first known report of mucosa-associated lymphoid tissue activation at the portal of SARS-CoV-2 entry. Although less permissive to viral replication, S. hispidus showed hyperplasia of bone marrow in the facial bones and increased pulmonary thrombosis in aged males. Augmentation of these features by SARS-CoV-2 infection suggests a virus-induced breach in regulatory mechanisms which could be devastating for people of all ages with underlying conditions and in particular for elderly with a multitude of ongoing disorders.

Abstract Surveillance of malaria vector species and the monitoring of insecticide resistance are essential to inform malaria control strategies and support the reduction of infections and disease. Genetic barcoding of mosquitoes is a useful tool to assist the high-throughput surveillance of insecticide resistance, discriminate between sibling species and to detect the presence of Plasmodium infections. In this study, we combined multiplex PCR, custom designed dual indexing, and Illumina next generation sequencing for high throughput single nucleotide polymorphism (SNP)-profiling of four species from the Anopheles (An.) gambiae complex (An. gambiae sensu stricto, An. coluzzii, An. arabiensis and An. melas). By amplifying and sequencing only 14 genetic fragments (500 bp each), we were able to simultaneously detect Plasmodium infection; insecticide resistance-conferring SNPs in ace1, gste2, vgsc and rdl genes; the partial sequences of nuclear ribosomal internal transcribed spacers (ITS1 and ITS2) and intergenic spacers (IGS), Short INterspersed Elements (SINE), as well as mitochondrial genes (cox1 and nd4) for species identification and genetic diversity. Using this amplicon sequencing approach with the four selected An. gambiae complex species, we identified a total of 15 non-synonymous mutations in the insecticide target genes, including previously described mutations associated with resistance and two new mutations (F1525L in vgsc and D148E in gste2). Overall, we present a reliable and cost-effective high-throughput panel for surveillance of An. gambiae complex mosquitoes in malaria endemic regions.

Background: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is a malaria prevention strategy recommended since 2012 by the World Health Organization (WHO) for children under 5 years. In Senegal, the scaling up of SMC started in 2013 in the south-eastern regions of the country with an extension of the target to 10 years old children. The scaling up of SMC requires regular evaluation of the strategy as recommended by the WHO. This study was conducted to evaluate the effectiveness of SMC. Methods: A case-control study was conducted in some villages of the health districts of Saraya and Kedougou in the Kedougou region from July to December 2016. A case was a sick child, aged 3 months to 10 years, seen in consultation and with a positive malaria rapid diagnostic test (RDT). The control was a child of the same age group with a negative RDT and living in the same compound as the case or in a neighbouring compound. Each case was matched with two controls. Exposure to SMC was assessed by interviewing the mothers/caretakers and by checking the SMC administration card. Results: Overall, 492 children, including 164 cases and 328 controls, were recruited in our study. Their mean ages were 5.32 (+/- 2.15) and 4.44 (+/-2.25) years for cases and controls, respectively. The number of boys was higher in both cases (55.49%; CI 95%=47.54-63.24%) and controls (51,22%; CI 95%=45.83-56.58%). Net ownership was 85.80% among cases and 90.85% among controls (p=0,053). The proportion of controls who received SMC was higher than that of cases (98.17% vs 85.98% and p=1.10-7). The protective effectiveness of SMC was 89% (OR= 0.12 (CI 95%=0.04-0.28)). Conclusions: SMC is an effective strategy in the control of malaria in children. Case-control studies are a good approach for monitoring the efficacy of drugs administered during SMC.

The globally invasive mosquito subspecies Aedes aegypti aegypti is an effective vector of human arboviruses, in part because it specializes in biting humans and breeding in human habitats. Recent work suggests that specialization first arose as an adaptation to long, hot dry seasons in the West African Sahel, where Ae. aegypti relies on human-stored water for breeding. Here, we use whole-genome cross-coalescent analysis to date the emergence of human-specialist populationsand thus further probe the climate hypothesis. Importantly, we take advantage of the known migration of specialists out of Africa during the Atlantic Slave Trade to calibrate the coalescent clock and thus obtain a more precise estimate of the older evolutionary event than would otherwise be possible. We find that human-specialist mosquitoes diverged rapidly from ecological generalists approximately 5000 years ago, at the end of the African Humid Period—a time when the Sahara dried and water stored by humans became a uniquely stable, aquatic niche in the Sahel. We also use population genomic analyses to date a previously observed influx of human-specialist alleles into major West African cities. The characteristic length of tracts of human-specialist ancestry present on a generalist genetic background in Kumasi and Ouagadougou suggests the change in behavior occurred during rapid urbanization over the last 20–40 years. Taken together, we show that the timing and ecological context of two previously observed shifts towards human biting in Ae. aegypti differ; climate was likely the original driver, but urbanization has become increasingly important in recent decades.

The aim of this study was to analyze the spatio-temporal distribution and determinants of the 2017 dengue epidemic in Burkina Faso. A principal component analysis of meteorological and environmental factors was performed to reduce dimensions and avoid collinearities. An initial generalized additive model assessed the impact of the components derived from this analysis on dengue incidence. Dengue incidence increased mainly with relative humidity, precipitation, normalized difference vegetation index and minimum temperature with an 8-week lag. A Kulldoff Satscan scan was used to identify high-risk dengue clusters, and a second generalized additive model assessed the risk of a health area being at high risk according to land-use factors. The spatio-temporal distribution of dengue fever was heterogeneous and strongly correlated with meteorological factors. The rural communes of Sabaa and Koubri were the areas most at risk. This study provides useful information for planning targeted dengue control strategies in Burkina Faso.

BackgroundThe number of malaria cases worldwide has increased, with over 241 million cases and 69,000 more deaths in 2020 compared to 2019. Burkina Faso recorded over 11 million malaria cases in 2020, resulting in nearly 4,000 deaths. The overall incidence of malaria in Burkina Faso has been steadily increasing since 2016. This study investigates the spatiotemporal pattern and environmental and meteorological determinants of malaria incidence in Burkina Faso.MethodsWe described the temporal dynamics of malaria cases by detecting the transmission periods and the evolution trend from 2013 to 2018. We detected hotspots using spatial scan statistics. We assessed different environmental zones through a hierarchical clustering and analyzed the environmental and climatic data to identify their association with malaria incidence at the national and at the district's levels through generalized additive models. We also assessed the time lag between malaria peaks onset and the rainfall at the district level. The environmental and climatic data were synthetized into indicators.ResultsThe study found that malaria incidence had a seasonal pattern, with high transmission occurring during the rainy seasons. We also found an increasing trend in the incidence. The highest-risk districts for malaria incidence were identified, with a significant expansion of high-risk areas from less than half of the districts in 2013-2014 to nearly 90% of the districts in 2017-2018. We identified three classes of health districts based on environmental and climatic data, with the northern, south-western, and western districts forming separate clusters. Additionally, we found that the time lag between malaria peaks onset and the rainfall at the district level varied from 7 weeks to 17 weeks with a median at 10 weeks. Environmental and climatic factors have been found to be associated with the number of cases both at global and districts levels.ConclusionThe study provides important insights into the environmental and spatiotemporal patterns of malaria in Burkina Faso by assessing the spatio temporal dynamics of Malaria cases but also linking those dynamics to the environmental and climatic factors. The findings highlight the importance of targeted control strategies to reduce the burden of malaria in high-risk areas as we found that Malaria epidemiology is complex and linked to many factors that make some regions more at risk than others.

The intracellular human malaria parasite, Plasmodium falciparum, uses the PfATP4 cation pump to maintain Na+ and H+ homeostasis in parasite cytosol. PfATP4 is the target of advanced antimalarial leads, which produce many poorly understood metabolic disturbances within infected erythrocytes. Here, we expressed the mammalian ligand-gated TRPV1 ion channel at the parasite plasma membrane to study ion regulation and examine the effects of cation leak. TRPV1 expression was well-tolerated, consistent with negligible ion flux through the nonactivated channel. TRPV1 ligands produced rapid parasite death in the transfectant line at their activating concentrations, but were harmless to the wild-type parent. Activation triggered cholesterol redistribution at the parasite plasma membrane, reproducing effects of PfATP4 inhibitors and directly implicating cation dysregulation in this process. In contrast to predictions, TRPV1 activation in low Na+ media accentuated parasite killing but a PfATP4 inhibitor had unchanged efficacy. Selection of a ligand-resistant mutant revealed a previously uncharacterized G683V mutation in TRPV1 that occludes the lower channel gate, implicating reduced permeability as a mechanism for parasite resistance to antimalarials targeting ion homeostasis. Our findings provide key insights into malaria parasite ion regulation and will guide mechanism-of-action studies for advanced antimalarial leads that act at the host-pathogen interface.

Background: Seasonal malaria chemoprevention (SMC) has been adopted and implemented in the southern regions of Senegal in children aged between three and 120 months since 2013. Scaling up this strategy requires its evaluation to assess the impact. This study was carried out to determine the dynamics of Plasmodium falciparum carriage before and after two years of SMC implementation. Methods: Four household surveys were conducted in villages in the health district of Saraya, which is a SMC implementation area in Senegal. These villages were selected using probability proportional to size sampling. Each selected village was divided into segments containing at least 50 children. In each segment, a household questionnaire was administered to the parents or legal representatives of children aged three to 120 months. Blood smears were collected to determine P. falciparum prevalence by microscopy one month before the first round of SMC, one month after the last round of the first SMC campaign and two years after the start of the implementation. Results: A total of 2008 children were included with a mean average age of 4.81 (+/-2.73) years. Of the study population, 50.33% were more than five years old and 50.3% were male. In 2013, mosquito net ownership was 99.4 % before the SMC campaign and 97.4% after. In 2015, it was 36.6% before and 45.8% after the campaign. In 2013, the prevalence of plasmodium carriage was 11.8% before and 6.1% after the SMC campaign. In 2015, the prevalence was 4.9% before the administration of SMC and this increased up to 15.3% after. Malaria prevalence was high among children over five years old and in boys. Conclusions: The decrease in Plasmodium falciparum parasite prevalence, which subsequently increased after two years of SMC implementation in this study, suggests adding an extra cycle of the SMC or adjusting the administration period.

Summary: Background: Long-term care facilities (LTCFs) have reported high SARS-CoV-2 infection rates and related mortality, but the proportion of infected people among those who have survived, and duration of the antibody response to natural infection, is unknown. We determined the prevalence and stability of nucleocapsid antibodies (the standard assay for detection of previous infection) in staff and residents in LTCFs in England. Methods: This was a prospective cohort study of residents 65 years or older and of staff 65 years or younger in 201 LTCFs in England between March 1, 2020, and May 7, 2021. Participants were linked to a unique pseudo-identifier based on their UK National Health Service identification number. Serial blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid protein using the Abbott ARCHITECT i-system (Abbott, Maidenhead, UK) immunoassay. Primary endpoints were prevalence and cumulative incidence of antibody positivity, which were weighted to the LTCF population. Incidence rate of loss of antibodies (seroreversion) was estimated from Kaplan-Meier curves. Findings: 9488 samples were included, 8636 (91·0%) of which could be individually linked to 1434 residents and 3288 staff members. The cumulative incidence of nucleocapsid seropositivity was 34·6% (29·6–40·0) in residents and 26·1% (23·0–29·5) in staff over 11 months. 239 (38·6%) residents and 503 women (81·3%) were included in the antibody-waning analysis, and median follow-up was 149 days (IQR 107–169). The incidence rate of seroreversion was 2·1 per 1000 person-days at risk, and median time to reversion was 242·5 days. Interpretation: At least a quarter of staff and a third of surviving residents were infected with SAR-CoV-2 during the first two waves of the pandemic in England. Nucleocapsid-specific antibodies often become undetectable within the first year following infection, which is likely to lead to marked underestimation of the true proportion of people with previous infection. Given that natural infection might act to boost vaccine responses, better assays to identify natural infection should be developed. Funding: UK Government Department of Health and Social Care.

Introducción: más del 40 % de la población corre un riesgo variable de contraer paludismo en los países en donde persiste su transmisión, lo que constituye un importante problema de salud mundial. Objetivo: identificar las características clínicas, evolución y tratamiento de niños con alteraciones neurológicas provocadas por Plasmodium falciparum como formas de presentación del paludismo. Método: se hizo un estudio observacional, descriptivo, de serie de casos en una muestra aleatoria de 30 pacientes, que ingresaron en el Policlínico “Dr. Loeri Comba”, Guinea Ecuatorial, con diagnóstico de paludismo por este protozoo y alteraciones neurológicas asociadas, durante el período comprendido desde junio de 2017 hasta septiembre de 2019. Resultados: la convulsión (33,3 %) y el estado de coma (30 %) fueron las formas clínicas más frecuentes, sobre todo en los menores de cuatro años de edad. La alta parasitemia no estuvo presente en todos ellos, aunque fue la que predominó (63,3 %). La respuesta al tratamiento con artesunato intravenoso como medicamento de elección fue favorable (90 %), incorporándose además vitaminas a altas dosis en forma de complejo, sulfato de zinc, anticonvulsivantes, dexametasona y manitol, creando un protocolo de tratamiento propio en el servicio de Pediatría. Hubo tres fallecidos por infección respiratoria del tipo de neumonía asociado al paludismo. Conclusiones: los niños con alteraciones neurológicas provocadas por el Plasmodium falciparum en el paludismo, como formas de presentación del mismo, no solo se evidencia en el estado de coma que provoca la enfermedad, sino también en otras formas de presentación con afectación de la conciencia y presencia de convulsiones.

L´incidence de Reflux gastro-œsophagien (RGO) augmente en occident. Il reste sous-évalué en Guinée. Notre objectif était de déterminer le profil épidémiologique des patients souffrant de RGO, de décrire la symptomatologie et les modalités thérapeutiques. C´est une étude prospective, dynamique, descriptive d´une durée de 6 mois portant sur 114 patients. Le RGO a représenté 59,68% des patients adressés pour endoscopie. L´âge moyen était de 39 ans. La tranche d´âge 27-36 ans était la plus touchée 27,19% avec une prédominance féminine 60,53% (H/F 0,65). Les ménagères étaient les plus touchées 29,82%. La multiparité était le principal facteur de risque 22,81%. L´épigastralgie était le principal motif de consultation 54,55%. Les manifestations extradigestives étaient présentes chez 12,5%. L´endoscopie avait révélé une œsophagite chez 94,74% des patients parmi lesquels 80% présentaient une gastrite et/ou une duodénite. Ces œsophagites étaient des œsophagites peptiques stade I de Savary-Miller chez 84,11%. Un seul cas d´œsophagite candidosique. Le traitement de la majorité de nos patients (80%) était à base d´une trithérapie (IPP+beta-lactamine ou macrolide+ imidazolé) puis IPP. Aucun de nos malades n´a bénéficié d´un traitement endoscopique ou chirurgical. Durant le suivi, 16,67% de nos patients avaient un bon pronostic contre 7,89% stationnaire, 75,44% étaient perdus de vue. Le RGO est fréquent en Guinée. Il touche principalement les sujets jeunes avec une prédominance chez les ménagères multipares. En plus des manifestations digestives, il existe celles extradigestives qu´il faut connaitre pour la démarche diagnostique. L´endoscopie reste l´examen de choix pour le diagnostic et le suivi.

L´objectif de ce travail était de faire un état des lieux de l´hémodialyse chronique pédiatrique au Sénégal. Il s´agissait d´une enquête transversale descriptive et analytique concernant tous les centres publics ayant admis des enfants en hémodialyse chronique du 1er janvier 2016 au 31 décembre 2017; sur les 08 centres fonctionnels à cette période, 06 ont été retenus. Au total, nous avions recensés 311 patients hémodialysés dont 08% (n=25) étaient des enfants. L´âge moyen des enfants dialysés était de 13,92 ans ± 3,67 ans. Le sex-ratio était de 0,66. Les glomérulonéphrites chroniques identifiées représentaient 24% (n=6) dont 50% (n=3) de HSF primitive. La fistule artério-veineuse (FAV) était utilisée dans 36% (n=9) des cas. Le consommable de dialyse utilisé était gratuit pour tous les enfants et leur famille (100%). La presque totalité des enfants dialysés 96% (n=24) étaient régulièrement hémodialysés à raison de trois séances par semaine. Le décès était observé chez 44% (n=11) au cours des 16 premiers mois après l´initiation à la dialyse. Parmi les patients vivants, 86% (n=12) étaient toujours en hémodialyse. Un patient avait été transféré en dialyse péritonéale continue ambulatoire (DPCA) et un autre transplanté en France grâce à un don intrafamilial; les débuts de l´hémodialyse pédiatrique au Sénégal étaient confrontés à de nombreuses difficultés liées au faible accès des enfants malgré la gratuité de la dialyse et le vote de la loi autorisant la transplantation rénale depuis décembre 2015. Nous recommandons l´élaboration d´un projet thérapeutique pour la prévention et la prise en charge des enfants atteints de maladie rénale chronique.

INTRODUCTION: Children pay a heavy price for infection with the hepatitis B virus (HBV). The objective of this work was to determine the prevalence of Hepatitis B and describe the associated factors in children at the Pediatric Department of Donka Hospital. Methods: this was a cross-sectional study of a cohort of children in the Pediatric Department of Donka Hospital. HBsAg was performed by using an immunochromatographic method. The analysis of the data was done with software R. The proportions were compared using the Chi-square test or the Fisher test at the significance level of 5%. A logistic regression model was used to explain the prevalence of hepatitis B. Results: one hundred and forty-nine children were recruited between February and July 2017. HBsAg was present in 12 children, ie 8.16% (95% CI: 4.29-13.82). The average age was 93.32 months (IQR: 6-180). Male children were the most affected (n = 11, P =0.05), with a sex ratio of 1.01. The majority (51.35%) were on AZT + 3TC + NVP pediatric form and 25% were on AZT + 3TC + NVP adult form and 23.65% on TDF + FTC + EFV. In univariate analysis, ALT, HBsAg positivity, and maternal HBV vaccination status were associated with the prevalence of HBsAg (P =0.05). Conclusion: the prevalence of co-infection in children and adults is almost identical in our context. Hence the importance of strengthening preventive measures at all levels, especially the vaccination of children and mothers.

Introduction : L’abcès de la cornée ou kératite infectieuse ou kératite suppurative se définit comme une infection de la cornée par un germe (bactérie, champignon, parasite) associée à des signes d’inflammation. Il s’agit d’une infiltration purulente du stroma cornéen. Il survient très rarementsur une cornée saine maisapparait plus fréquemmentsur un épithélium cornéen défectueux. L’abcès de la cornée est une urgence diagnostique et thérapeutique pouvant entrainer la perte anatomique et/ou fonctionnelle du globe oculaire ; d’où la réalisation de cette étude dont le but est de contribuer à l’amélioration de la prise en charge de l’abcès de cornée à Bamako. Méthode : il s’agissait d’une étude transversale, analytique et descriptive d’une durée de 16 mois allant de décembre 2019 à avril 2020. Résultats : Durant notre étude, 286 prélèvements bactériologiques étaient revenus positifs sur le total de 472 prélèvements bactériologiques réalisés. Les germes majoritairement isolés étaient Staphylococcus aureus(48,11%) suivi de Pseudomonas aeruginosa (15,19%).l’abcès de cornée constitue l’une des principales causes de la morbidité oculaire et de cécité dans le monde et surtout dans les pays en voie de développement où l’hygiène est insuffisante. Conclusion : Notre étude souligne l’importance de la prise en charge adaptée au cas par cas des abcès de cornée.

Les cellulites orbitaires sont définies par une infection aigue du contenu orbitaire qui touche plus fréquemment l’enfant. Nous rapportons deux cas cliniques de cellulite orbitaire chez deux enfants âgés respectivement de 8 et 11 ans qui avaient présenté une cellulite orbitaire secondaire à une conjonctivite bactérienne non traitée. Dans les deux cas : La tomodensitométrie orbitaire avait mise en évidence une cellulite orbitaire diffuse et l’analyse bactériologique du prélèvement avaient mise en évidence le staphylococcus aureus. Le traitement comportait une antibiothérapie par voie locale et orale. L’évolution était favorable au bout de 7 jours de traitement avec résorption complète de la cellulite. La cellulite orbitaire est une affection peu fréquente. Son évolution est toujours grave en l'absence d'un traitement.

Lassa fever has not been reported in Côte d’Ivoire. We performed a retrospective analysis of human serum samples collected in Côte d’Ivoire in the dry seasons (January–April) during 2015–2018. We identified a fatal human case of Lassa fever in the Bangolo District of western Côte d’Ivoire during 2015.

Abstract Insecticide resistance across sub-Saharan Africa may impact the continued effectiveness of malaria vector control. We investigated the association between carbamate and pyrethroid resistance with Anopheles gambiae s.l. parity, Plasmodium falciparum infection, and molecular insecticide resistance mechanisms in Guinea. Pyrethroid resistance was intense, with field populations surviving ten times the insecticidal concentration required to kill susceptible individuals. The L1014F kdr-N1575Y haplotype and I1527T mutation were significantly associated with mosquito survival following permethrin exposure (Prevalence Ratio; PR = 1.92, CI = 1.09–3.37 and PR = 2.80, CI = 1.03–7.64, respectively). Partial restoration of pyrethroid susceptibility following synergist pre-exposure suggests a role for mixed-function oxidases. Carbamate resistance was lower and significantly associated with the G119S Ace-1 mutation. Oocyst rates were 6.8% and 4.2% among resistant and susceptible mosquitoes, respectively; survivors of bendiocarb exposure were significantly more likely to be infected. Pyrethroid resistant mosquitoes had significantly lower parity rates than their susceptible counterparts (PR = 1.15, CI = 1.10–1.21). Our findings emphasize the need for additional studies directly assessing the influence of insecticide resistance on mosquito fitness.

We report detection of Lassa virus and Crimean-Congo hemorrhagic fever virus infections in the area of Bamako, the capital of Mali. Our investigation found 2 cases of infection with each of these viruses. These results show the potential for both of these viruses to be endemic to Mali.

Objectif: Décrire les caractéristiques épidémiologiques et les modalités de prise en charge préventive des patients. Résultats : Cent cinquante-deux (152) patients ont consulté suite à une exposition au risque d’infection rabique principalement à la suite d’une morsure par un chien (133cas/152). Aucun animal mordeur n’a été mis en observation. La majorité (90%) provenait de Dakar. L’âge médian était de 22 ans [1 - 90 ans] et les hommes étaient les plus touchés avec un sex ratio (H/F) de 1,8. Les blessures de catégorie II étaient les plus fréquentes (100 cas). Près de deux tiers des personnes exposées ont été prises en charge dans les 48 heures. La quasi-totalité des patients avaient bénéficié du protocole Zagreb mais environ 41% d’entre eux avaient abandonné leur prophylaxie post exposition (PPE) en cours de suivi, soit un taux de complétude de 59%. Conclusion : Composante essentielle de la lutte contre la rage, la prophylaxie post exposition doit être améliorée par la sensibilisation et la collaboration avec les services vétérinaires. Tout ceci dans l’esprit du one health ou santé unique ainsi que l’amélioration de l’accessibilité financière des vaccins et des immunoglobulines antirabiques

Guinea, like many other African countries, has been facing an unprecedented COVID-19 outbreak, since March 2020. In April 2020, Guinean National agency for health security recorded 1351 confirmed cases of COVID-19, including 313 recoveries and 07 deaths. To address this health crisis, some drastic measures were implemented to prevent the spread of COVID-19. Those measures might potentially cause some psychological problems among Guineans. Thus, we conducted this study to assess the psychosocial impacts of COVID-19 in the Guinean population. We carried out an online cross-sectional survey among internet users in Guinea. A free e-survey platform was used, and questionnaires were sent to internet users. The study ran from May 1 through May 10 2020. Participation in the study was voluntary. Data collection was based on sociodemographic information and self-reported questionnaires: Impact of Event Scale-Revised (IES-R) for stress evaluation, Penn state worry questionnaire (PSWQ), and an adapted Social Psychological Measurements of COVID-19. A total of 280 participants took part in the study; responses from 5 participants were deleted because of incompleteness. The average age of participants was 28.9 [95% CI: 28.1;29.6]. Most of participants were male 65.5% [95% CI: 59.5%;71.1%]. Unemployed participants stood for 48.7% [95% CI: 42.7%;54.8%]. IES-R scale for stress evaluation yielded the following findings: 19.6% (mild), 5.23% (moderate) and 9.15% (severe); 82.8% and 17.2% of participants had respectively reported low and moderate worry. No significant statistical association was found between sociodemographic variables and traumatic events (IES-R and PSWQ). However, 82% of our participants had to cope with the negative impacts of COVID-19. Although there were few cases of traumatic events, negative impacts of COVID-19 on study participants deserve to be underlined. So, further investigations are necessary to identify and disentangle specific psychosocial problems in different Guinean socio-cultural contexts.

L´éviscération transanale de l´intestin grêle par empâlement est exceptionnelle chez l´enfant. Nous rapportons l´observation d´un adolescent de 11 ans reçu à 2 heures d´une issue des anses grêles à travers l´anus suite à une chute avec réception sur un morceau de bois pointu. L´examen clinique avait objectivé un bon état général, une issue, par l´anus, d´environ 25 cm d´intestin grêle viable et un abdomen sensible dans son ensemble. Le bilan biologique préopératoire était normal et aucune imagerie n´était réalisée. Après une réanimation, l´exploration chirurgicale avait mis en évidence un liquide séro-hématique (300 ml) et une issue d´environ 60 cm d´anse grêle inflammatoire à travers une brèche d´environ 5 cm de la paroi antérieure du rectum. Une réduction des anses grêles éviscérées par traction douce, une réparation de la paroi rectale par des points séparés, une toilette et un drainage ont été réalisés. Le patient était sous antibiotique à large spectre. Les suites opératoires étaient simples avec une reprise du transit à J2 post-opératoire. La sortie a été autorisée à J7 post opératoire. Après un recul d´un mois, la patiente a été revue en consultation et l´examen clinique était normal.

La varicelle est une affection considérée bénigne. Nous rapportons l´observation d´un garçon âgé de 2 ans et 2 mois qui se présente avec une fièvre chiffrée à 38oc et des éruptions érythématho-vesiculeuses d´âges différents évoluant depuis 7 jours débutant au niveau du périnée et du tronc qui se sont généralisées à tout le corps. L´évolution s´est marquée par l´apparition d´un placard inflammatoire au niveau de l´hypochondre droit, chaud et douloureux à la palpation. La porte d´entrée a été les lésions de la varicelle. Le bilan a montré une hyperleucocytose 21290/mm3 et une CRP 207,95 mg/l. Une échographie abdominale a mis en évidence une infiltration inflammatoire diffuse de la graisse de la région de l´hypochondre droit. Il a été mis sous amoxicilline-acide clavulanique, la tuméfaction a régressé après 3 jours. La cellulite abdominale est une complication très rare de la varicelle chez les enfants qui doit être reconnue et traitée précocement.

Introduction : La tuberculose représente encore un problème majeur de santé publique dans le monde et particulièrement en Afrique subsaharien. Le but de ce travail était de déterminer le profil épidémiologique, diagnostic et évolutif des patients suivis pour tuberculose pharmaco-sensible au centre de diagnostic et de traitement du centre de santé communautaire et universitaire de Konobougou dans le district sanitaire de Barouéli au Mali. Méthode et matériels : Il s'agissait d'étude transversale et rétrospective des patients suivis pour tuberculose au centre de diagnostic et de traitement de Konobougou dans le district sanitaire de Barouéli allant du 1er janvier 2017 au 30 juin 2019. Résultats : Nous avons retenu dans cette étude 48 tuberculeux toutes formes confondues. Le sexe masculin a été le plus fréquent soit 79,2% avec un sexe ratio de 3,8. La tuberculose pulmonaire bactériologiquement confirmée représentait 89 ,6% (n=43) et 10,4% (n=5) était extra pulmonaire. La comorbidité tuberculose – VIH représentait 12,5% des patients. Le succès thérapeutique était à 87,9% (n=42). 8,3% de décès, avec 2,1% cas de perdu de vue et 2,1% cas d'échec thérapeutique. Conclusion : La prise en charge de la tuberculose en milieu communautaire par la stratégie du traitement directement observé serait un élément important dans le succès thérapeutique.

Le pronostic du cancer gastrique reste mauvais. Il représente la 3èmè cause de mortalité par cancer. L´objectif de notre travail est d´identifier et d´évaluer les facteurs histo-pronostiques pré, per et post opératoires en termes de survenu de récidive locale, de métastase et de survie avec ou sans récidive. Il s´agit d´une étude transversale descriptive, rétrospective étalée sur une période de 5 ans, concernant une série de 106 patients. Les facteurs histo-pronostiques retrouvés en analyse uni variée dans la population globale, indépendamment associés à la récidive tumorale étaient (age p0,045, Type d´exérèse p0,028, Ré opération p0,003), associés à l´apparition de métastase (biopsie per-endoscopique p0,005, curage ganglionnaire p0,020, effraction capsulaire p0,018, stade tumoral p0,047, délai apparition de métastase p0,000, survie globale p0,000) et ceux associés à la survie avec ou sans récidive (type histologique sur pièce opératoire p0,030). A l´analyse multi variée, il résulte qu´il y a plus d´apparition de métastase 1 an après la chirurgie (OR=27,36, p=0,000). La régression logistique nous a permis de conclure qu´être réopéré et le type d´exérèse R0(résection sans résidu tumoral) sont des facteurs protecteurs contre la survenue de récidive tumorale. La re-intervention augmente les chances de survie (p=0,007, OR=0,07). Le cancer de l´estomac reste un cancer de mauvais pronostic. Les facteurs histo-pronostiques identifiés par notre étude sont en partie modifiables et doivent être prise en compte dans la prise en charge de ces patients.

La tumeur pseudo-papillaire et solide du pancréas, aussi appelé tumeur de Frentz, est une tumeur kystique rare, souvent solide et hémorragique, parfois volumineuse. Elle survient chez les enfants et les femmes jeunes. Le diagnostic est généralement fortuit ou suite à une douleur abdominale. Il n´existe pas d´imagerie typique, ni de marqueurs tumoraux spécifiques. Le risque de dégénérescence est de 10 à 20%. Le traitement est chirurgical. Nous rapportons le cas d´une tumeur pseudo-papillaires et solides du pancréas chez une patiente de 28 ans sans antécédents notables.

l´urgence abdominale en situation oncologique avancée est une pathologie aiguë abdominale menaçant la vie et survenant dans un contexte oncologique presque incurable. Nous rapportons la prise en charge de 31 cas d´abdomen aigu en situation carcinologique avancée. Etude prospective de Janvier à Décembre 2017 au CHU de Fès. L´âge moyen était de 54,23 ans, avec un sexe ration H/F 1,15. 30% des cas avaient des antécédents de cancer. Les circonstances de découvertes étaient: le syndrome occlusif (83,87%), la contracture abdominale (12,9%) et la fistule (3,23%). Le scanner avait révélé des localisations tumorales au niveau des sites suivants: colorectale (non perforées 77,42% contre 6,45% perforée), gastriques perforées ou fistulisées (6,45%), pancréatique envahissant le transverse (3,23%), vésicale envahissant le sigmoïde avec hernie interne (3.23%) et cervicale utérine envahissant le rectum (3,23%). L´extension locale était présente chez 93,6 % des patients et métastatique dans 100% des cas. Le geste opératoire était une colostomie 51,61%, Hartmann 6,45%, suture gastrique 6,45%, réduction de hernie interne 3,23%. 7 patients (22,58%) ont bénéficié d´une corticothérapie, prothèse colique 6,45% et drainage radiologique 3,23%. L´évolution était favorable chez 90,30% contre 9,68% de décès. La chirurgie palliative garde sa place chez ces malades en urgence abdominale sur cancer avancé en les conférant un confort et une certaine survie. Cependant une collaboration multidisciplinaire serait importante pour la prise en charge adéquate de ces patients, mais l´urgence de la situation rend cette tâche difficile en pratique.

La maladie de Takayasu (MT) est une artériopathie inflammatoire chronique touchant l´aorte, ses principales branches et les artères pulmonaires. Son appellation tient de l´ophtalmologiste japonais MikitoTakayasu qui publia en 1908 la première description de la maladie. Il s´agissait d´un patient de 78ans admis pour douleur abdominale, douleur du membre inférieur droit à la marche, insomnie. Evoluant depuis 1an sans antécédent de maladie cardio vasculaire connu. A l´examen physique: le rythme cardiaque régulier à 87 battement par minute sans bruits pathologique surajoutés avec une absence de pouls pédieux droit, tension artérielle à 120/78 mmhg , poumons libres, abdomen souple avec une masse battante dans la fosse iliaque droite dont l´auscultation met en évidence un souffle continu. Le reste de l´examen est sans particularité. L´Angio scanner abdominal confirmait un aspect de dissection aortique étendue sur l´ensemble de l´aorte abdominale avec opacification synchrone des deux chenaux, un anévrisme thrombosé des artères iliaques primitives mesurant 48mm x100mm à droite et 38mm x 90mm à gauche, absence de fissuration visible. Nous rapportons le cas d´une dissection de l´aorte abdominale associée à un anévrisme thrombosé des artères iliaques primitives révélant une maladie de Takayashu au service de cardiologie de l´hôpital national Ignace Deen. La fréquence de la dissection de l´aorte abdominale au cours de la maladie de Takayasu est rare. Elle est plus souvent diagnostiquée dans sa phase occlusive. Le pronostic dépend des complications évolutives.

One of the complications of Etonogestrel implant (Implanon NXT®) is it usually migration 2 cm away from its insertion point. The case presented here is of a rarity. Indeed, the rod has migrated up to 17 cm from the insertion point and was localized in the left axillary region. After unsuccessful extraction of the Etonogestrel implant in the first attempt, its extraction was possible and completed without complications with the second attempt.

Les auteurs rapportent une observation d´un hémangiome géant hépatique révélé par un traumatisme abdominal suite à un accident de la voie publique. L´originalité de ce cas tient à la découverte à la tomodensitométrie d´un angiome géant du foie chez un individu de sexe masculin reçu dans le cadre du bilan radiologique d´évaluation de son traumatisme. Cette présentation clinique ne permettait en aucun cas d´évoquer un hémangiome du foie.

INTRODUCTION: Sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs. METHODS: the purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis. RESULTS: little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence. CONCLUSION: there is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.

BackgroundWhereas 72% of hepatitis C virus (HCV)-infected people worldwide live in low- and middle-income countries (LMICs), only 6% of them have been diagnosed. Innovative technologies for HCV diagnosis provide opportunities for developing testing strategies more adapted to resource-constrained settings. However, studies about their economic feasibility in LMICs are lacking.MethodsAdopting a health sector perspective in Cameroon, Cote-d'Ivoire, and Senegal, a decision tree model was developed to compare 12 testing strategies with the following characteristics: a one-step or two-step testing sequence, HCV-RNA or HCV core antigen as confirmative biomarker, laboratory or point-of-care (POC) tests, and venous blood samples or dried blood spots (DBS). Outcomes measures were the number of true positives (TPs), cost per screened individual, incremental cost-effectiveness ratios, and nationwide budget. Corresponding time horizon was immediate, and outcomes were accordingly not discounted. Detailed sensitivity analyses were conducted.FindingsIn the base-case, a two-step POC-based strategy including anti-HCV antibody (HCV-Ab) and HCV-RNA testing had the lowest cost, €8.18 per screened individual. Assuming a lost-to-follow-up rate after screening > 1.9%, a DBS-based laboratory HCV-RNA after HCV-Ab POC testing was the single un-dominated strategy, requiring an additional cost of €3653.56 per additional TP detected. Both strategies would require 8-25% of the annual public health expenditure of the study countries for diagnosing 30% of HCV-infected individuals. Assuming a seroprevalence > 46.9% or a cost of POC HCV-RNA < €7.32, a one-step strategy based on POC HCV-RNA dominated the two-step POC-based strategy but resulted in many more false-positive cases.ConclusionsPOC HCV-Ab followed by either POC- or DBS-based HCV-RNA testing would be the most cost-effective strategies in the study countries. Without a substantial increase in funding for health or a dramatic decrease in assay prices, HCV testing would constitute an economic barrier to the implementation of HCV elimination programs in LMICs.

IntroductionDiabetic polyneuropathy (DPN) with or without neuropathic pain is a frequent complication of diabetes. This work aimed to determine the prevalence of diabetic polyneuropathy, to describe its epidemiological aspects, and to analyze the therapeutic itinerary of patients with DPN.MethodsThis was a cross-sectional, descriptive study performed synchronously over six months at two major follow-up sites for patients with diabetes in Mali. DPN was diagnosed based on the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic nature of the pain and the quality of life of patients were evaluated by the DN4 and the ED-5D scale, respectively. We used three (3) different questionnaires to collect data from patients (one at inclusion and another during the follow-up consultation) and from the caregivers of patients with DPN.ResultsWe included 252 patients with diabetes, and DPN was found to have a healthcare facility-based prevalence of 69.8% (176/252). The sex ratio was approximately three females for every male patient. The patients were mostly 31 to 60 years of age, 83% had type 2 diabetes, and 86.9% had neuropathic pain Approximately half of the patients (48.3%) had autonomic neuropathy and they reported moderate to intense pain, which was mainly described as a burning sensation. The patients exhibited impaired exteroceptive and proprioceptive sensations in 51.7% of cases. The patients smoked tobacco in 3.4% of cases, while 36.6% of the patients were obese and had dyslipidemia. The caregivers clearly indicated that appropriate medications were not readily accessible or available for their patients with DPN.ConclusionThe healthcare facility-based prevalence of DPN with or without neuropathic pain was high in our cohort. These inexpensive and easy-to-use tools (MNSI, DN4) can be used to adequately diagnose DPN in the African context. In Mali, screening and early treatment of patients at risk of DPN should allow for a reduction of the burden of the disease, while caregivers need to be adequately trained to manage DPN.

In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18-23 years were recruited in 2012-2015 as age-matched controls to the vaccinated women and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types. HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9-5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4-63%) lower among women with 2-

During the 2014–2015 outbreak of Ebola virus disease in Guinea, 13 type 2 circulating vaccine-derived polioviruses (cVDPVs) were isolated from 6 polio patients and 7 healthy contacts. To clarify the genetic properties of cVDPVs and their emergence, we combined epidemiologic and virologic data for polio cases in Guinea. Deviation of public health resources to the Ebola outbreak disrupted polio vaccination programs and surveillance activities, which fueled the spread of neurovirulent VDPVs in an area of low vaccination coverage and immunity. Genetic properties of cVDPVs were consistent with their capacity to cause paralytic disease in humans and capacity for sustained person-to-person transmission. Circulation ceased when coverage of oral polio vaccine increased. A polio outbreak in the context of the Ebola virus disease outbreak highlights the need to consider risks for polio emergence and spread during complex emergencies and urges awareness of the challenges in polio surveillance, vaccination, and diagnosis.

Le pityriasis rosé, décrit par Gibert en 1860, est une dermatose fréquente, bénigne, transitoire, et d’étiologie inconnue qui atteint surtout les adultes jeunes. On pense qu'il s'agit d'une affection virale, mais sans argument bien probant. Nous rapportons un cas de Pityriasis Rosé de Gibert (PRG) révélant une hépatite virale B. Observation : Il s’agissait d’un adulte de 47 ans originaire de Diago (Commune de Kati), sans antécédents médicaux et chirurgicaux connus, qui consulte pour des macules rosées disséminées sur tout le tronc associées à du prurit chez qui le diagnostic de PRG a été retenu. Il a bénéficié de la vaseline à l’urée 5% et de la Mequitazine 10mg comme traitement. Devant la persistance du prurit un bilan biologique à la recherche d’une étiologie fut demandé et cela a conduit au diagnostic d’une infection par le virus de l’hépatite B. Conclusion : Cette observation devrait conduire les dermatologues à proposer systématiquement la recherche d’une infection virale à l’hépatite B devant des PRG très prurigineux et résistants aux traitements habituels.

Dans les pays industrialisés et notamment en France, vu les moyens de prévention, dépistage précoce et prise en charge immédiate de l'infection à VIH, la survenue d'infections opportunistes ne se voit presque chez les immigrés et certaines couches socio-professionnelles défavorisées. Nous rapportons donc le cas d'un homme de 42 ans, immigré africain, hospitalisé pour syndrome infectieux dans un contexte d'altération de l'état général, VIH1 positif sous antirétroviraux depuis deux ans, arrêtés depuis quatre mois, une tuberculose pulmonaire traitée et déclarée guérie en novembre 2017 avec, à l'examen une lenteur a l'idéation, une fièvre à 39,6,C et un amaigrissement. Le nadir CD4 à 12/mm3, une charge virale VIH1 à 5,80log. Le scanner thoraco-abdominale et l'IRM cérébrale ont permis de visualiser des lésions intra-abdomino-thoraciques et cérébrales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trithérapie antirétrovirale à quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une évolution favorable.

Les kystes arachnoïdiens intrasellaires sont des malformations bénignes. La localisation intrasellaire est extrêmement rare de l’ordre de 3%. Leur physiopathologie est encore mal élucidée. Nous rapportons un cas de kyste arachnoïdien intrasellaire à expansion suprasellaire dont la prise en charge avait consisté en une fenestration endoscopique par voie transsphénoïdale. Les aspects épidémiologiques, cliniques, physiopathologiques, radiologiques, thérapeutiques et évolutifs ont été analysés. Les procédures neuroendoscopiques sont de plus en plus utilisées pour la prise en charge chirurgicale. Leur pronostic est bon, et la récidive fréquente même après plusieurs années d’évolution.

L'objectif de cette étude était d'analyser les aspects épidémiocliniques, thérapeutiques et anatomopathologiques de la fistule urogénitale (FUG). L'étude rétrospective porte sur les cas de FUG admis dans le Service de Chirurgie Générale et Gynéco-obstétrique entre le 1er janvier 2014 et le 30 décembre 2015 y compris les 5 premières campagnes du projet fistule-Mali. La FUG occupe 19,53% de nos activités urologiques. L'âge moyen au 1er mariage: 16,57 ans. La majorité (96,70%) de nos patientes était analphabètes et non salariées provenant à 85,36% des communes rurales. La stagnation du travail était l'étiologie dominante avec 91,50% de mort-né. Les patientes étaient primipares à 43,33% et, parmi elles 53,60% n'ont effectué aucune consultation prénatale. Le taux de divorce lié à la maladie était estimé à 7,30%. La plupart des patientes ont bénéficié d'une fistulorraphie simple dont 121 par voie basse, 26 par voies hautes et 3 par la voie mixte. Les résultats ont été satisfaisants chez 65,33% et mauvais chez 34,66% des patientes. Les fistules type I et type V ont montré les plus forts taux de succès comparés aux fistules types IV. La fistule urogénitale demeure un réel problème de santé publique. Le traitement est surtout chirurgical et son pronostic est compromis par l'étroitesse du champ, la complexité des lésions et l'état du tissu environnant. L'accent doit être mis sur la promotion socioéconomique des filles et l'accessibilité aux soins obstétricaux d'urgence. La recherche et les échanges doivent continuer afin de faciliter la mise au point d'une classification standard.

Nous rapportons une observation d'un cas de tumeur stromale gastro-intestinale à localisation multiple au niveau du grêle découverte dans un contexte de péritonite. La particularité de ce cas tient à la découverte en per-opératoire de masses tumorales multifocales grêliques, évoquant à la tomodensitométrie en post opératoire des tumeurs stromales gastro-intestinales. Ce tableau clinique de péritonite ne permettait en aucun cas d'évoquer une origine tumorale.

Objectif: Décrire les caractéristiques épidémiologiques et les modalités de prise en charge préventive des patients. Résultats : Cent cinquante-deux (152) patients ont consulté suite à une exposition au risque d'infection rabique principalement à la suite d'une morsure par un chien (133cas/152). Aucun animal mordeur n'a été mis en observation. La majorité (90%) provenait de Dakar. L'âge médian était de 22 ans [1 - 90 ans] et les hommes étaient les plus touchés avec un sex ratio (H/F) de 1,8. Les blessures de catégorie II étaient les plus fréquentes (100 cas). Près de deux tiers des personnes exposées ont été prises en charge dans les 48 heures. La quasi-totalité des patients avaient bénéficié du protocole Zagreb mais environ 41% d'entre eux avaient abandonné leur prophylaxie post exposition (PPE) en cours de suivi, soit un taux de complétude de 59%. Conclusion : Composante essentielle de la lutte contre la rage, la prophylaxie post exposition doit être améliorée par la sensibilisation et la collaboration avec les services vétérinaires. Tout ceci dans l'esprit du one health ou santé unique ainsi que l'amélioration de l'accessibilité financière des vaccins et des immunoglobulines antirabiques

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.

INTRODUCTION: Hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal. METHODS: between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels 10 IU/l) were considered as seroprotected against HBV. RESULTS: during the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb e" 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb e" 100 IU/L. CONCLUSION: our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal.

In clinical outcome studies, analysis has traditionally been performed using patient-level factors, with minor attention given to provider-level features. However, the nature of care coordination and collaboration between caregivers (providers) may also be important in determining patient outcomes. Using data from patients admitted to intensive care units at a large tertiary care hospital, we modeled the caregivers that provided medical service to a specific patient as patient-centric subnetwork embedded within larger caregiver networks of the institute. The caregiver networks were composed of caregivers who treated either a cohort of patients with particular disease or any patient regardless of disease. Our model can generate patient-specific caregiver network features at multiple levels, and we demonstrate that these multilevel network features, in addition to patient-level features, are significant predictors of length of hospital stay and in-hospital mortality.

IntroductionLimited "real life" data on raltegravir (RAL) use during pregnancy are available. Thus, we aimed at describing effectiveness and safety of RAL-based combined antiretroviral therapy (cART) in this setting.MethodsHIV-1-infected women receiving RAL during pregnancy between 2008 and 2014 in ten French centers were retrospectively analysed for: (1) proportion of women receiving RAL anytime during pregnancy who achieved a plasma HIV-RNA (pVL) < 50 copies/mL at delivery, and (2) description of demographics, immuno-virological parameters and safety in women and new-borns.ResultsWe included 94 women (median age, 33 years) of which 85% originated from Sub-Saharan Africa and 16% did not have regular health insurance coverage. Sixteen women were cART-naïve (median HIV diagnosis at 30 weeks of gestation), whereas 78 were already on cART before pregnancy (40% with pVL < 50 copies/mL). RAL was initiated before pregnancy (n = 33), during the second trimester (n = 11) and the third trimester of pregnancy (n = 50). No RAL discontinuations due to adverse events were observed. Overall, at the time of delivery, pVL was < 50 copies/mL in 70% and < 400 copies/mL in 84% of women. Specifically, pVL at delivery was < 50 copies/mL in 82%, 55% and 56% of cases when RAL was started before pregnancy, during the second or third trimester of pregnancy, respectively. Median term was 38 weeks of gestation, no defect was reported and all new-borns were HIV non-infected at Month 6.ConclusionsRAL appears safe and effective in this "real-life" study. No defect and no HIV transmission was reported in new-borns.