Emergence de souches d'entérobactéries résistantes aux fluoroquinones dans les cultures des plaies diabétiques compliquées d'ostéites à Abidjan (Côte d'Ivoire)

Objectif. Décrire les caractéristiques épidémiologiques et microbiologiques des pieds diabétiques compliqués d'ostéite à Abidjan. Méthodes. Il s'agit d'une étude transversale, rétrospective ayant concerné 71 prélèvements bactériologiques (écouvillonnage) suivis d'une culture en présence d'un pied diabétique avec ostéite, colligés dans le service d'endocrinologie ­ Diabétologie du CHU de Yopougon (Abidjan) de 2002 à 2012. Résultats. La population d'étude était constituée de 71 patients dont 92,2% diabétiques de type 2, d'âge moyen 56,6± 12,6 ans, de durée moyenne d'évolution du diabète 10,4±8 avec une moyenne glycémique à 3,33±1,54 g/l et au stade de multiples complications du diabète. Le facteur déclenchant de la plaie était souvent un traumatisme (21,1%), une phlyctène spontanée (21,1%) ou un pied d'athlète (12,2%). Parmi les 71 patients avec pieds diabétiques compliqués d'ostéite ayant bénéficié d'un prélèvement, 51 cultures ont été positives soit 71,83 % des cas. Elles ont été le plus souvent monomicrobiennes 42 soit 82,3% des cas. A l'issue des examens microbiologiques 61 germes ont été isolés repartis selon les familles, les espèces et sous espèces. Parmi ces germes 60,65% étaient des bacilles Gram négatif, dont 86,5 % d'Entérobactéries, et 39,35% des Cocci Gram positif. La recherche de germes anaérobies n'a pas êté réalisée. En fonction des espèces, Escherichia coli a été isolé dans 35,13% des cas et les staphylocoques aureus ont été isolés dans 18% des cas. Au total 52,7% dessouches d'entérobactéries étaient résistantes aux quinolones et 22,7 des souches de Staphylocoque étaient méticillino-résistants. Conclusion. L'écologie bactérienne des pieds diabétiques compliqués d'ostéite est dominée par des souches d'entérobactéries résistantes aux antibiotiques usuels

Leucémie lymphoïde chronique au Niger: une étude de 99 cas au service d'onco-hématologie de l'hôpital national de Niamey

Introduction. Le but de l'étude est de décrire les caractéristiques épidémiologiques et cliniques de la leucémie lymphoïde chronique (LLC) au Niger. C'est la première étude nigérienne spécifiquement consacrée à cette maladie. Méthodologie. Nous avons mené une étude rétrospective couvrant la période de janvier 2000 à décembre 2011 (12 ans) dans le service d'Onco-Hématologie de l'HNN. Le diagnostic de LLC était retenu sur la base d'une hyper lymphocytose sanguine > 15 000/mmᶾ associée à une infiltration médullaire de plus de 40% de lymphocytes mâtures. Les données ont été recueillies dans les dossiers de malades. Nos variables d'étude étaient les aspects épidémiologiques, cliniques et évolutifs de la maladie. Résultats. Au cours de la période d'étude, 99 patients ont été colligés soit une fréquence d'environ huit cas par an. Le sex ratio était de 0,47 et la moyenne d'âge des patients de 53,25 ans (extrêmes: 30 à 82 ans). L'échantillon était constitué de 89 % de paysans (cultivateurs, éleveurs femmes au foyer). La durée moyenne des troubles avant la première consultation était de 24 mois. Les principaux motifs de consultation étaient: la splénomégalie (81,8%), les adénopathies (38,4%) et l'anémie (21,2%). Les principaux signes physiques étaient: les adénopathies (84,8%); la splénomégalie (80,8%); la pâleur cutanéo-muqueuse (31,3%); la fièvre (29,3%) et l'hépatomégalie (25,3%). Selon la classification anatomo-clinique de Binet, 39 patients (39,4%) étaient au stade A, 16 cas (16,2%) au stade B et 44(44,4%) au stade C. Conclusion. À Niamey, la LLC est une maladie de l'adulte jeune diagnostiquée souvent à un stade avancé du fait du retard de la première consultation

Frantz’ Tumour: A Rare Pancreatic Neoplasm

Frantz’ tumour of the pancreas is also known as solid pseudopapillary tumour (SPT) of the pancreas. It is a rare pancreatic neoplasm and represents about 3% of all the pancreatic cystic neoplasm. It occurs predominantly in young woman in 2nd to 3rd decade of life. These tumours exhibit indolent behaviour and very often reach considerable size before the first symptoms appear. Despite this presentation these tumours have low malignant potential and complete surgical resection render excellent prognosis. We reported a case of a 16-year-old girl who presented with upper abdominal mass with symptoms of gastric outlet obstruction for 7 months duration. Clinical examination revealed a huge epigastric mass measuring 10 x 12 cm in size. CT scan showed presence of mass arising from the body of the pancreas which was hypervascular, well-encapsulated with mixed cystic and solid components. She then underwent successful distal pancreatectomy and splenectomy and recovered uneventfully.

The Enhancement Of Driver Seat Comfort For Small Size Car: A Preliminary Study

Seating comfort is one of the important indicators while driving especially for a long hour drive. The objective of this study was to execute a preliminary study of survey and identify the discomfort of body while driving and after driving session by conductinga survey. The questionnaire developed was tested for its reliability. By using Cronbach’s Alpha, this paper’s contribution was found to be significant in which it provides a survey with acceptable test reliability in which the alpha (α) was 0.887. The survey was conducted on 30 students of University Malaysia Pahang (20 male and 10 female) with driving experience and valid driving license. The subjects should have experiences in driving small size car or mini car as well. The results showed that the body area that the drivers felt discomfort while driving and after driving should be known. The findings showed that the discomfort was intense at the neck, upper back, and lumbar while and after driving.

Prolong Placement of Tracheostomy Tube Causing Unusual Complication

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.

Assessing the readiness to integrate tobacco control in medical curriculum: Experiences from five medical colleges in southern India.

Background. Making tobacco cessation a normative part of all clinical practice is the only way to substantially reduce tobacco-related deaths and the burden of tobacco-related morbidity in the short term. This study was undertaken because information on receptivity to integrate tobacco control education in the medical curriculum is extremely limited in low- and middle-income countries. Methods. From five medical colleges (two government) in southern India, 713 (men 59%) faculty and 2585 (men 48%) students participated in our cross-sectional survey. Information on self-reported tobacco use and readiness to integrate tobacco control education in the medical curriculum was collected from both the faculty and students using a pretested structured questionnaire. Multiple logistic regression analysis was done to find the associated factors. Results. Current smoking was reported by 9.0% (95% CI 6.6–12.1) of men faculty and 13.7% (CI 11.8–15.9) by men students. Faculty who were teaching tobacco-related topics [odds ratio (OR) 2.29; 95% CI 1.65–3.20] compared to those who were not, faculty in government colleges (OR 1.69; CI 1.22–2.35) compared to those in private colleges and medical specialists (OR 1.79; CI 1.23–2.59) compared to surgical and non-clinical specialists were more likely to be ready to integrate tobacco control education in the medical curriculum. Non-smoking students (OR 2.58; CI 2.01–3.33) compared to smokers, and women students (OR 1.80; CI 1.50–2.17) compared to men were more likely to be ready to integrate a tobacco control education in the curriculum. Conclusion. Faculty and students are receptive to introduce tobacco control in the medical curriculum. Government faculty, medical specialists and faculty who already teach tobacco-related topics are likely to be early introducers of this new curriculum.

Pattern of Presentation and Survival of Breast Cancer in a Teaching Hospital in North Western Nigeria

Developing countries are experiencing demographic and epidemiologic transition and the prevalence of non-communicable diseases especially cancers which is on the increase. Breast cancer is the most common and lethal malignancy in developing countries with varying presentation. This study aims to determine the pattern of presentation and survival of breast cancer patients in North Western Nigeria. A five-year retrospective review of breast cancer records from 2001-2005 was conducted. Relevant information was retrieved and analyzed using statistical package for social science software. Manchester stage III and IV were classified as advance disease. Survival analysis was carried out with survival defined as the time between the date of commencement of treatment and the date of last follow-up or death. Most of the patients were in the 4th and 5th decades 58 [57.4%] with a mean age of 44.5 +/- 13 years. Majority of the patients were females 99 [96.1%]. One of the four males had invasive lobular carcinoma while the others presented with invasive ductal carcinoma 3 [75.0%]. Most of the patients were premenopausal 62 [62.6%] and were presented late with advanced breast cancer disease 64 [62.1%]. The left breast was more affected 64 [62.1%], and the upper outer quadrant was mostly involved 48 [60.7%], followed by the areola, 43[41.7%] either singly or in combination. Invasive ductal carcinoma was detected in 85 [82.5%] cases and was the predominant histological finding. Survival rate beyond 30 months was observed in 24.5% of cases and 100% for advanced and early breast cancer respectively, [p=0.0001]. The overall survival rate beyond 36 months was 70.4% and postmenopausal patients [70.6%] had better survival beyond 36 months than premenopausal [68.5%] patients [p=0.05]. The overall survival rate was low and patients with early breast cancer had better survival than those with advanced disease. Majority of the patients were young premenopausal women with advanced breast cancer

Use of Chloroquine in Uncomplicated Falciparum Malaria Chemotherapy: The Past; the Present and the Future

Chloroquine is a 4-aminoquinoline discovered over five decades ago for treatment of uncomplicated malaria. It was widely used as first line treatment and prophylaxis for individuals going into malaria endemic regions. It was initially highly effective against the four Plasmodium species (P. falciparum; P. malaria; P. ovale and P. vivax) infecting human. It is also effective against gametocytes except those of P. falciparum. Resistance of P. falciparum to chloroquine is widespread and led to discontinuation of chloroquine in malaria treatment by most countries. In recent times; evidences are emerging for chloroquine to probably secure its original place in treatment of acute uncomplicated falciparum malaria. This would be a welcome idea since chloroquine is readily available; relatively safer and cheaper than most currently use antimalarial drugs. Thus; researchers should intensify efforts on periodic in vitro monitoring of chloroquine efficacy; clinicians should further discourage use of chloroquine until efficacy is remarkably restored and pharmaceutical industries should look into potential chloroquine and chloroquine-resistance reversal fixed and non-fixed doses combinations

Electrocardiographic Abnormalities in Patients with Heart Failure : Cardiovascular Topics

Background : The morbidity and mortality from heart failure (HF) differ between patients with reduced ( 50) and with preserved ( 50) left ventricular ejection fraction (LVEF) on account of many factors; including abnormalities detected in the electrocardiogram (ECG). The aim of this study was to determine and compare the ECG abnormalities between HF patients with reduced and with preserved LVEF. Methods : The study was cross-sectional in design and carried out in Aminu Kano teaching hospital and Murtala Mohammed specialist hospital; Kano; Nigeria; from April 2005 to June 2006. We studied the resting electrocardiograms of all HF patients aged 15 years and older who were referred to the two centres for echocardiography. Results: A total of 113 patients were studied and 98.2of them had abnormal ECGs. Forty-two patients (37.2) had preserved LVEF while the remaining 71 (62.8) had reduced LVEF. Left ventricular hypertrophy ( LVH) was the commonest ECG abnormality; found among 55 patients (77.5) with reduced LVEF; and 21 patients (50) with preserved LVEF (p = 0.0026). The commonest arrhythmia was atrial fibrillation; found among 10 patients (14.1) with reduced LVEF and eight patients (19.1) with preserved LVEF (p = 0.486). Prolonged corrected QT interval was found among 30 (71.4) and 56 patients (78.9) with preserved and reduced LVEF; respectively (p = 0.370). Conclusion: Most of the patients with heart failure studied in Kano; Nigeria had abnormal electrocardiograms; and the most common abnormality was LVH

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria

Evaluation of the different technique for repair of distal hypospadias

Hypospadias is one of the most common congenital anomalies occurring in approximately 1:520 to 1:300 live births [Baskin, 2000]. Hypospadias in boys, may be defined classically as an association of the penis: 1. An abnormal ventral opening of the urethral meatus, 2. An abnormal ventral curvature of the penis [chordee]; 3. An abnormal distribution of the foreskin, with a hood present dorsally and deficient foreskin ventrally [Mouriquand et al, 1950]. The aim of this work was to adequately describe the abnormal anatomy met with distal hypospadias cases and to evaluate the results of repair of distal hypospadias comparing the results of the different techniques of repair to be aware about the most suitable technique. This study was done on 40 patients with distal hypospadias in the age range 6 months to 12 years in the period from October 2004 to October 2005 in Plastic Surgery Department, Sohag university Hospital. Full history, clinical examination and routine investigations was done for every patients. We used three operative procedures: a-Tubularized incised plate urethroplasty [Snodgrass] [TIP], be-Meatal based flap [Mathieu] repair, and c-Meatal advancement and glanuloplsty incorporated technique [MAGPI]. Pin hole meatus was the commonest finding to be present in association with hypospadias in this study [12.5%]. Edema is the most common complication in the early postoperative period; represent, 83% in Mathieu, 80% in TIP75% in MGAPL. As regard the chronic complication, fistula is the most important complication of hyospadius repair, it was recorded in 4 out of 20 cases with TIP repair, 3 out of 12 cases with Mathieu repair and one case out of 8 cases with MAGPI repair

Effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome

To study the effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. Garlic powder in a capsule form was given to 15 children with hepatopulmonary syndrome [confirmed by contrast echocardiography] at the dosage of 1 g/1.73 m[2] per day. Patients were evaluated clinically and by arterial blood gas every four weeks. The garlic capsule was administered to 15 patients with hepatopulmonary syndrome. There were 10 boys and 5 girls with a mean age of 9.4 +/- 3.9 years. The underlying problems were biliary tract atresia [4 patients], autoimmune hepatitis [4 patients], cryptogenic cirrhosis [4 patients] and presinusoidal portal hypertension [3 patients]. Eight patients [53.3%] showed an increase of 10 mmHg in their mean arterial oxygen pressure. The baseline PaO2 was 65.6 +/- 12.1 mmHg in the responder group and 47.1 +/- 11.2 mmHg in non-responder group. At the end of treatment the mean PaO[2] in responders and non-responders was 92.2 +/- 7.75 mmHg and 47.5 +/- 11.87 mmHg, respectively [P < 0.01]. Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome