Constipation de l'enfant dans un service de pédiatrie générale à Bamako / Childhood constipation in a general pediatrics Unit in Bamako

Introduction : La constipation est un symptôme qui correspond à une anomalie des selles ou de leur élimination : elles sont trop volumineuses ou trop dures, trop rares, ou leur élimination est douloureuse, voire incomplète. Objectif : le but de cette étude était de déterminer la fréquence, les facteurs favorisants, les signes et les modalités thérapeutiques de la constipation de l'enfant dans le département de pédiatrie du CHU Gabriel Touré. Patients et Méthode : Il s'agissait d'une étude transversale descriptive à collecte prospective allant du 1 avril 2019 au 31 Janvier 2020. Ont été inclus tous les patients de 0 à 15 ans ayant consulté dans le département de pédiatrie pour constipation et répondant aux critères de Rome IV. Résultat : Nous avions enregistré 75 patients.Lafréquence hospitalière était de 0,23 %. La tranche d'âge d'un mois à deux ans représentait 61,3% des patients, l'âge moyen était de 27,7 +/- 43 mois. Le sexe masculin prédominait avec 58,7%. La constipation était le motif de consultation le plus fréquent avec 62,6%. Une selle par semaine a été retrouvée chez 77,3 % des patients. La douleur à la défécation a été retrouvée chez 65,3 % des patients. La constipation était fonctionnelle chez 69,3% des patients. La maladie de Hirschsprung était la cause de la constipation organique chez 65,2% des patients. Les laxatifs ont été prescrits chez 64 % des patients à la consultation. Conclusion: La constipation est une pathologie fréquente qui touche les enfants à tout âge. Elle est d'origine fonctionnelle dans la majeure partie des cas.

Introduction: Constipation is a symptom that corresponds to an anomaly of the stools or their elimination: they are too bulky or too hard, too rare, or their elimination is painful, even incomplete. Objective: was to determine the frequency, the contributing factors, the signs and the therapeutic methods of constipation in children in the pediatric department of the CHU Gabriel Touré. Patients and Method: This was a descriptive cross-sectional study with prospective collection from April 1, 2019 to January 31, 2020. All patients aged 0 to 15 who consulted in the pediatric department for constipation and responding to the Rome IV criteria. Result: We registered 75 patients. The hospital frequency of 0.23%. The age group from one month to two years represented 61.3% of the patients, the average age was 27.7 +/- 43 months. The male gender predominated with 58.7%. Constipation alone was the most common reason for consultation with 62.6%. One stool per week was found in 77.3% of patients. Pain on defecation was found in 65.3% of patients. Constipation was functional in 69.3% of patients. Hirschsprung disease was the cause of organic constipation in 65.2% of patients. Laxatives were prescribed in 64% of patients at the consultation. Conclusion: Constipation is a frequent pathology that affects children at all ages. It is of functional origin in most case

Santé bucco-dentaire des enfants diabétiques: aspects épidémiologiques et cliniques au centre hospitalier universitaire Donka / Oral health of children with diabetes: epidemiological and clinical aspects at Donka University hospital

Le diabète sucré est l'une des pathologies chroniques les plus rependues chez l'enfant à cause de son apparition dans la tranche d'âge pédiatrique. Les lésions gingivales liées à la micro-angiopathie et la présence du tartre sont exceptionnelles chez l'enfant. La parodontopathie peut rendre plus difficile le contrôle de la glycémie. Les données actuelles de la littérature ont révélé qu'un enfant diabétique est plus susceptible de développer une pathologie bucco-dentaire qu'un enfant non diabétique. L'objectif de cette étude était d'évaluer l'état de santé bucco-dentaire des enfants diabétiques suivis dans le service d'Endocrinologie à l'hôpital National Donka. Il s'agissait d'une étude transversale de type descriptif et analytique, portant sur les affections orales et métaboliques des enfants diabétiques suivis ou hospitalisés dans le service d'Endocrinologie par un recrutement exhaustif sur une période de 6 mois. La population cible était composée de 72 enfants âgés de 6 à 18 ans au moment de l'étude. Un questionnaire a été utilisé pour obtenir des données sur le niveau socio-économique, le niveau sociodémographique, le niveau comportemental, les habitudes d'hygiène bucco-dentaire et les antécédents familiaux associés à un examen oral. Les paramètres diabétiques sont contenus dans le dossier médical. L'impact du diabète sur l'état oral des jeunes patients a été étudié par des variables qualitative et quantitative. Une corrélation entre l'ancienneté du diabète et l'indice d'hygiène orale simplifiée (p<0,05) a été observée avec p=0,03. IC95% [0,00 ; 0,06]. Mais aucun lien statistique n'a été enregistré entre la tranche d'âge et l'IHOS, d'autre part entre et aussi l'IHOS et la présence de variable clinique (p>0,05). La plupart des bouches présentaient des lésions carieuses avec un taux de 91,98% et un indice C.A.O moyen de 2,94 ± 2,82. Une gencive inflammatoire était présente chez 84,73% des patients et presque tous (95,83%) avaient une affection buccale au moins. La maladie bucco-dentaire est un marqueur social, les enfants diabétiques issus de milieux défavorisés doivent donc être ciblés plus particulièrement par les programmes de prévention

Diabetes mellitus is one of the most common chronic pathologies in children because of its appearance in the pediatric age group. Gingival lesions linked to microangiopathy and the presence of tartar are exceptional in children. Periodontal disease can make it more difficult to control blood sugar. Current data from the literature has revealed that a diabetic child is more likely to develop an oral pathology than a non-diabetic child. The objective of this study was to assess the oral health status of diabetic children followed in the endocrinology department at the national donka hospital. This was a descriptive and analytical cross-sectional study on the oral and metabolic disorders of diabetic children followed or hospitalized in the endocrinology department by exhaustive recruitment over a period of 6 months. The target population consisted of 72 children aged 6 to 18 at the time of the study. A questionnaire was used to obtain data on socioeconomic level, sociodemographic level, behavioral level, oral hygiene habits and family history associated with an oral examination. The diabetic parameters are contained in the medical file. The impact of diabetes on the oral status of young patients was studied by qualitative and quantitative variables. A correlation between the duration of diabetes and the simplified oral hygiene index (p0.05). Most of the mouths presented carious lesions with a rate of 91.98% and an average c.a.o index of 2.94 ± 2.82. Inflammatory gingiva was present in 84.73% of patients and almost all (95.83%) had at least one oral condition. Oral disease is a social marker, diabetic children from disadvantaged backgrounds must therefore be targeted more specifically by prevention programs.

Etat parodontal chez l'enfant et l'adolescent drépanocytaire au service de pédiatrie à l'hôpital national d'Ignace Deen / Periodontal condition in children and adolescents with sickle cell disease in the pediatric department at the Ignace Deen national hospital

La drépanocytose est une maladie génétique due à une anomalie de l'hémoglobine. Elle est la pathologie génétique la plus répandue dans le monde, elle touche plus de cinq millions de personnes. Les Parodontopathies sont l'ensemble des lésions inflammatoires ou dégénératives qui affectent le parodonte. Cette étude avait pour objectifs de déterminer la fréquence de l'atteinte parodontale et d'identifier ses lésions afin de recenser le traitement antérieur reçu chez les enfants atteints d'une maladie sanguine d'origine génétique. C'est une étude transversale descriptive qui s'est étalée sur une période de 06 mois allant du 01mars au 31 août 2016. L'enquête a été réalisée dans le service de pédiatrie à l'hôpital national d'Ignace Deen. La population cible était constituée de tous les enfants et adolescents ayant consulté au service de pédiatrie pendant la période d'étude. Au terme de cette enquête une fréquence de 73% des patients drépanocytaires associés aux Parodontopathies a été enregistrée dont 33,63% de l'échantillon présentaient des lésions profondes avec des poches infra osseuses. Le sexe masculin a été le plus dominant dont une fréquence de 66% contre 34% du sexe féminin avec une sex-ratio égale à 1,97. Les résultats de cette étude révèlent que la formation de base des pédiatres en dentisterie est nécessaire est que la collaboration interdisciplinaire est indispensable pour la prise en charge parodontale des enfants drépanocytaires

Sickle cell disease is a genetic disease caused by an abnormality in hemoglobin. It is the most widespread genetic pathology in the world, it affects more than five million people. Periodontal diseases are all inflammatory or degenerative lesions that affect the periodontium. The objectives of this study were to determine the frequency of periodontal disease and to identify its lesions in order to identify the previous treatment received in children with a blood disease of genetic origin. This is a descriptive cross-sectional study that spanned a period of 6 months from march 1 to august 31, 2016. The survey was carried out in the pediatric department at Ignace Deen national hospital. The target population was made up of all children and adolescents who consulted the pediatric department during the study period. At the end of this survey, a frequency of 73% of sickle cell patients associated with periodontal disease was recorded, of which 33.63% of the sample presented deep lesions with infra-bony pockets. The male sex was the most dominant with a frequency of 66% against 34% of the female sex with a sex ratio equal to 1.97. The results of this study reveal that the basic training of pediatricians in dentistry is necessary, and that interdisciplinary collaboration is essential for the periodontal management of children with sickle cell disease.

Astigmatisme induit après phaco-alternative: à propos de 100 yeux opérés au CHU Donka, Conakry / Induced astigmatism after phaco-alternative: An Analysis of100 eyes operated at Donka University Hospital, Conakry

ntroduction.Après une opération par phaco-alternative chez les patients souffrantde cataracte,on peut observerune acuité visuelle non souhaitée. Une réfraction met en évidence souvent un astigmatisme important appelé astigmatisme induit. La qualité du résultat fonctionnel dépend en partie de ce dernier qu'il faut réduire à son minimum.Le but de notre étude était d'étudier l'astigmatisme induit après phacoalternative à Conakry et suggérer des recommandations pour l'amélioration de la qualité de la chirurgie.Méthodologie. Il s'agissait d'une étude transversale, descriptive et analytique d'une cohorte de patients opérés de la cataracte par phaco alternative de Juillet 2016 à Janvier 2017 (six mois)au CHU de Donka. Résultats.Nous avons inclusdans notre étude 100 yeux opérés par phaco-alternative avec un âge moyen de 62±12,18ans pour un sex ratio de 1. La tranche d'âge la plus représentée était cellede 61 -70 ans(38%). La femme ménagère était la plus touchée (39%).L'hypertension artérielleétait l'antécédent le plus retrouvée dans 23% des cas.L'œil gauche était le plus opéré (59%). L'acuité visuelle était réduite à la perception lumineuse dans 58% des cas en préopératoire, 95% des astigmatismes préopératoiresétaient inférieurs à 2D et 57% selon la règle. La puissance moyenne de l'implant après biométrie était de 19±2,38 dioptries et 50% des patientsont reçu l'implant calculé.L'œdème cornéen était la complication précoce la plus fréquenteConclusion.la phacoalternativeavec incision supérieure linéaire induit un astigmatisme contre la règle de 3,15 dioptries en moyenne

Introduction.After a phaco-alternative operation in patients suffering from cataracts, unwanted visual acuity may be observed. Refraction often reveals significant astigmatism called induced astigmatism. The quality of the functional result partly depends on the amount of induced astigmatism, which needs to be minimized. The aim of our study was to investigate induced astigmatism after phaco-alternative in Conakry and suggest recommendations for improving the quality of surgery. Methodology.This was a cross-sectional, descriptive, and analytical study of a cohort of cataract patients operated by phaco-alternative from July 2016 to January 2017 (six months) at Donka University Hospital. Results.We included 100 eyes operated by phaco-alternative with an average age of 62±12.18 years and a sex ratio of 1. The most represented age group was 61-70 years (38%). Homemakers were the most affected group (39%). Hypertension was the most commonly found history in 23% of cases. The left eye was the most operated on (59%). Visual acuity was reduced to light perception in 58% of cases preoperatively, 95% of preoperative astigmatism was less than 2D, and 57% were with-the-rule. The average power of the implant after biometry was 19±2.38 diopters, and 50% of patients received a calculated implant. Corneal edema was the most common early complication. Conclusion.Phaco-alternative with a linear superior incision nduces an astigmatism against-the-rule of 3.15 diopters on average.

Prevention and treatment for COVID-19 associated severe pneumonia in the Gambia (PaTS-COVID-19), a single-blinded randomized clinical trial: study protocol

Background: The coronavirus disease (COVID-19) pandemic resulted in an unprecedent global response for the development of COVID-19 vaccines. However, as viral mutations continue to occur, potentially decreasing the efficacy of currently available vaccines, and inequity of vaccine access continues, identifying safe and effective drugs to minimise severity of COVID-19 disease remains a priority. Methods: We designed an adaptive individually randomized single blinded non identical placebo-controlled trial to evaluate the safety and efficacy of repurposing licenced treatments for COVID-19 patients in an African setting. The trial has two cohorts: Cohort 1 recruits mild and moderate COVID-19 cases and their household contacts. Cases are actively followed up for 14 days, with a final visit at day 28. There are two co-primary endpoints: clinical progression to severe-pneumonia and persistence of the virus at day 14. The primary endpoint for household contacts is infection during a 14-day follow-up period. Cohort 2 recruits hospitalized patients with severe COVID-19 associated pneumonia followed up actively until discharge or death, and passively until day 90, with a final visit. The primary endpoint is clinical progression or death. Conclusions: This randomized trial will contribute African-specific data to the global response to COVID-19. Besides the efficacy of drugs on clinical progression, the trial will provide information on the dynamics of intra-household transmission. Trial registration: This study is registered with Clinical Trials.gov with registration number NCT04703608 and with Pan African clinical trials registry with registration number PACTR202101544570971.

Cellulite cervico-faciale à l'hôpital national Ignace Deen de Conakry: résultats d'une étude de 5 ans / Cervico-facial cellulitis at the Ignace Deen hospital in Conakry: results of a 5-year study

Introduction : La cellulite cervico-faciale est une diffusion cellulaire d'un foyer infectieux vers les tissus cellulo-adipeux du cou et de la face, avec une prédominance des anaérobies et des germes commensaux de la flore orale. L'objectif de ce travail était de contribuer à l'amélioration de la prise en charge de cellulites cervico-faciales à l'Hôpital National Ignace Deen. Méthodes : Il s'est agi d'une étude rétro-prospective de type descriptif sur une période de cinq (5) ans (01 janvier 2017 au 31 décembre 2021) réalisée aux services d'ORLCCF et d'Odontostomatologie/CMF de l'Hôpital National Ignace Deen de Conakry. Résultats : 97 patients qui présentaient une cellulite cervico-faciale, soit une fréquence de 4,36% ont été inclus. La tranche d'âge de 21 à 30 ans était la plus représentée soit 40,21%. L'âge moyen était de 33 ,15 ± 13,97 ans avec des extrêmes de 1 et 65 ans. Le sex-ratio était de 1,30. La tuméfaction douloureuse était le principal motif de consultation soit 98,97%. Les Anti-Inflammatoires Non Stéroïdiens étaient le facteur le plus présent chez 85 patients soit 78,35%. L'état général était peu satisfaisant chez 94 patients soit 96,91%. Une cellulite suppurée a été retrouvée chez 82,47% patients. Le traitement était médico-chirurgical chez 85 patients soit 87,63%. L'évolution était bonne chez 90 patients soit 92,78%. Conclusion : La cellulite cervico-faciale est une urgence médicochirurgicale qu'il faut savoir diagnostiquer et prendre en charge dans les meilleurs délais. Non traitée, elle peut engager le pronostic vital.

Introduction: Cervico-facial cellulitis is a cellular diffusion of an infection to the cellulo-adipose tissues of the neck and face, with a predominance of anaerobic and commensal germs of oral flora. The objective of this work was to contribute improving the management of cervicofacial cellulitis at Ignace Deen National Hospital. Methods: This was a five (5) year (01 January 2017 to 31 December 2021) descriptive retro-prospective study conducted at the ENT-RTC and Odontostomatology / FJA departments of the Ignace Deen National Hospital in Conakry. Results: 97 patients who presented cervico-facial cellulitis, i.e. a frequency of 4.36%, were included. The 21- 30 age group was the most represented, either 40.21%. The average age was 33.15 ± 13.97 years with extremes of 1 and 65 years. The sex ratio was 1.30. Painful swelling was the main reason for consultation, 98.97%. Non- Steroidal Anti-inflammatory Drugs were the most common factor in 85 of our patients, either 78.35%. The overall condition was unsatisfactory in 94 of our patients, either 96.91%. Suppurated cellulitis was found in 82.47% of our patients. Treatment was medico-surgical in 85 patients, either 87.63%. The evolution was good in 90 patients, either 92.78%. Conclusion: Cervico-facial cellulitis is a medical and surgical emergency that must be diagnosed and managed as soon as possible. If left untreated, it can trigger a vital prognosis.

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

COVID-19 et pathologies chirurgicales en chirurgie générale du CHU-Gabriel Touré de Bamako / Covid-19 and surgical pathologies in general surgery of CHU Gabriel Toure of Bamako

Introduction : La forme digestive pure de la COVID-19 est possible et initialement considérée comme rare. L'objectif était d'étudier la COVID-19 en milieu chirurgical. Matériels et méthodes: L'étude était descriptive prospective de Mars 2020 à Aout 2021 (18 mois). Tous les patients qui ont été opérés, hospitalisés ou consultés dans le service, au service d'accueil des urgences (SAU) ou dans d'autres services du CHU. GT pour pathologie chirurgicale avec COVID-19 ou infecté au COVID-19 en cours d'hospitalisation étaient inclus dans l'étude. Résultats : 23 cas colligés ; représentant 8,91 % (23/258) des cas de COVID-19 recensés, une fréquence de 1,27/mois. La tranche d'âge 66-75 ans était la plus atteinte, la moyenne d'âge était de 49,13 ± 18,75ans, la prédominance était masculine (sex-ratio de 1,3). Plus de 34,78% ont été recrutés au SAU, 16 malades (69,56%) ont consultés en urgence, les signes digestifs du COVID-19 étaient : Douleur abdominale 20 cas (89,96%), anorexie 19 cas (82,61%), Vomissements 8 cas (34,78%), diarrhée 3 cas (13,04%). Les signes pulmonaires du COVID-19 étaient : Toux 18 cas (78,26%), douleur thoracique 15 cas (65,22%), dyspnée 9 cas (39,13%). Les manifestations du COVID-19 étaient : pulmonaire 9 cas, digestives 9 cas, associées 3 cas, découverte fortuite 2 cas. Le moyen diagnostic a été la TDM Thoracique (100%), le Test-PCR 14 cas (60,86%) avec un test-PCR positif dans 50% des cas. Les pathologies chirurgicales étaient des urgences chirurgicales dans 7 cas (30,43%), des cancers dans 6 cas (26,09%), manifestation digestive COVID-19(30,43%), autres 3 cas (13,04%).Plus de la moitié des malades étaient opérés 12 cas (52,17%). La mortalité globale était de 60,87% et la mortalité des malades opérés était de 41,67%. Conclusion : Les pathologies chirurgicales et COVID-19 n'étaient pas fréquentes. La plupart des malades avaient plus de 50 ans avec une présence moyenne de comorbidité. Les signes pulmonaires étaient les plus marquants, cependant les signes digestifs étaient inaugurales dans la moitié des cas de notre étude. La TDM Thoracique associée ou non au Test-PCR oro-pharyngé permet de faire le diagnostic. Le traitement peut-être médico-chirurgical ou médical. Le risque infectieux de la COVID-19 au cours de l'hospitalisation, pendant ou après la chirurgie est réel et potentiellement grave pour le malade ainsi que les soignants.

Introduction: The pure digestive form of COVID-19 is possible and initially considered rare. Our objectives were to determine the frequency of COVID-19 in patients treated in general surgery, identify the circumstances of COVID-19 discoveries in surgery, describe the post-operative complications in patients operated on COVID-1919 and describe the reorganization of post-operative COVID-19 diagnosis management.Materials and methods: We conducted a prospective descriptive study from March 2020 to August 2021 (18 months). All patients who have been operated on, hospitalized or consulted in the department, the Emergency Department (ERS) or other CHU-GT departments for surgical pathology with COVID-19 or infected with COVID-19 while hospitalized were included in the study.Results: 23 cases collected, representing 8.91% (23/258) of COVID-19 cases identified, a frequency of 1.27/month. The age group 66-75 was the most affected, the average age was 49.13 18.75 years, the predominance was male (sex ratio of 1.3). More than 34.78% were recruited at the SAU, 16 patients (69.56%) consulted in emergency, and digestive signs of COVID-19 were: Abdominal pain 20 cases (89.96%), anorexia 19 cases (82.61%), vomiting 8 cases (34.78%) and diarrhea 3 cases (13.04%). The pulmonary signs of COVID-19 were: Cough 18 cases (78.26%), chest pain 15 cases (65.22%), and dyspnea 9 cases (39.13%). Manifestations of COVID-19 were: pulmonary 9 cases, digestive 9 cases, associated 3 cases, incidental discovery 2 cases. The diagnostic mean was Thoracic CT (100%), Test-PCR 14 cases (60.86%) with a positive PCR test in 50% of cases. Surgical pathologies were surgical emergencies in 7 cases (30.43%), cancers in 6 cases (26.09%), COVID-19 digestive event (30.43%) and other 3 cases (13.04%). More than half of patients were operated on 12 cases (52.17%). The overall mortality was 60.87% and the mortality of surgical patients was 41.67%.Conclusion: The infectious risk of COVID-19 during hospitalization, during or after digestive surgery is a real and potentially serious risk for the patient and caregiver

Environmental neurodevelopment toxicity from the perspective of Bronfenbrenner's bioecological model: a case study of toxic metals / Toxicidade neurodesenvolvimental ambiental sob a perspectiva do modelo bioecológico de Bronfenbrenner: um estudo de caso de metais tóxicos / Toxicidad en el neurodesarrollo ambiental desde la perspectiva del modelo bioecológico de Bronfenbrenner: un estudio de caso de metales tóxicos

A growing body of literature reports the need for an integrated approach to study the effects of the physical environment on the neurodevelopment of children. Assessment of the true neurotoxicity of pollutants cannot be performed separately from the ecological and multidimensional contexts in which they act. In this study, from the perspective of the Bronfenbrenner's bioecological model, a conceptual model was developed that encompasses the social and biological characteristics of children from the gestational period to childhood, considering exposure to toxic metals. First, we present the toxicity of the main metals and some concept notions that we used in our framework, such as social and structural determinants of health, allostatic load, embodiment, and epigenetic concepts. Then, the main aspects of the Bronfenbrenner's bioecological model, which allow integration of the gene-social relationship in addition to the physical environment, where these metals act, are explained. Finally, we present and discuss the conceptual framework showing how, in real life, biological and social factors may together influence the neurodevelopment of children. Although this model is based on a group of contaminants, it opens new horizons on how environmental sciences, such as neurotoxicology and environmental epidemiology, can articulate with the theoretical models from human sciences to provide a broader approach to study the effects on human neurodevelopment.

Uma crescente literatura relata a necessidade de uma abordagem integrada para estudar os efeitos do ambiente físico no neurodesenvolvimento de crianças. A avaliação da verdadeira neurotoxicidade dos poluentes não pode ser realizada separadamente dos contextos ecológicos e multidimensionais em que atuam. Neste estudo, sob a perspectiva do modelo bioecológico de Bronfenbrenner, um modelo conceitual foi desenvolvido para abranger as características sociais e biológicas das crianças desde o período gestacional até a infância, considerando a exposição a metais tóxicos. Primeiro, apresentamos a toxicidade dos principais metais e algumas noções conceituais que utilizamos em nossa abordagem, tais como determinantes sociais e estruturais da saúde, carga alostática, incorporação e conceitos epigenéticos. Em seguida, explicamos os principais aspectos do modelo bioecológico de Bronfenbrenner, que permitem a integração da relação gene-social, além do ambiente físico, onde esses metais atuam. Por fim, apresentamos e discutimos o quadro conceitual mostrando como, na realidade, fatores biológicos e sociais podem, em conjunto, influenciar o neurodesenvolvimento das crianças. Embora esse modelo seja baseado em um grupo de contaminantes, ele abre novos horizontes sobre como as ciências ambientais, como a neurotoxicologia e a epidemiologia ambiental, podem dialogar com os modelos teóricos das ciências humanas para ter uma abordagem mais ampla ao estudar os efeitos no neurodesenvolvimento humano.

Una creciente literatura informa la necesidad de un enfoque integrado para estudiar los efectos del entorno físico en el neurodesarrollo de los niños. La evaluación de la verdadera neurotoxicidad de los contaminantes no puede llevarse a cabo por separado de los contextos ecológicos y multidimensionales en los que actúan. En este estudio, desde la perspectiva del modelo bioecológico de Bronfenbrenner, se desarrolló un modelo conceptual para abarcar las características sociales y biológicas de los niños desde el período gestacional hasta la infancia, considerando la exposición a metales tóxicos. Primero, presentamos la toxicidad de los principales metales y algunas nociones conceptuales que utilizamos en nuestro enfoque, como los determinantes sociales y estructurales de la salud, la carga alostática, la incorporación y los conceptos epigenéticos. A continuación, explicamos los principales aspectos del modelo bioecológico de Bronfenbrenner, que permiten la integración de la relación gen-social, además del entorno físico, donde actúan estos metales. Finalmente, presentamos y discutimos el marco conceptual que muestra cómo, en realidad, los factores biológicos y sociales pueden, en conjunto, influir en el neurodesarrollo de los niños. Aunque este modelo se basa en un grupo de contaminantes, abre nuevos horizontes sobre cómo las ciencias ambientales, como la neurotoxicología y la epidemiología ambiental, pueden dialogar con los modelos teóricos de las ciencias humanas para adoptar un enfoque más amplio al estudiar los efectos sobre el neurodesarrollo humano.

Risk communication and community engagement in COVID-19: Fighting infodemics among non-governmental/community-based organizations in Africa

As the world battles the latest strain of the coronavirus known as COVID-19 characterized as a pandemic by the World Health Organization (WHO), "infodemics" ­ an excessive amount of (mostly untrue) information about the pandemic that makes it difficult to discern essential information ­ has been identified by the health body as one of the major obstacles to be tackled to win the war against the raging pandemic. In a bid to control spread of the virus, the WHO published a guideline on Risk Communication and Community Engagement (RCCE) to COVID-19, noting these responses are vital for containment. The COVID-19 pandemic is testing and stretching health systems and their ability to effectively communicate with their populations. Failure to communicate accurate public health facts could lead to losses of trust, reputation, economy, and lives. This paper turns its searchlight on nongovernmental and community-based organizations (NGOs and CBOs) in Africa, and how they handle infodemics in an information environment battling not just a health pandemic, but a hoax pandemic too. Methods: The study employed mixed method, with data drawn from Africanbased NGOs and CBOs via online questionnaire and interviews against the backdrop of the Situational Theory of Publics. Findings reveal, based on what NGO/CBO survey respondents report their local clients think, that many at the grassroots still do not believe COVID-19 is real, while others view it as government's scheme to embezzle funds. NGO/CBOs therefore look to WHO and Health Ministries for accurate information. It concludes that RCCE with the public and atrisk populations help reduce confusion and builds trust in the public health guidance community members can take thereby restricting the disease spread as an outcome of the RCCE approach

Mortalité maternelle chez les adolescentes au service de Gynécologie-Obstétrique de l'Hôpital National Ignace Deen / Maternal mortality among adolescents in the Gynecology-Obstetrics department of Ignace Deen National Hospital

Introduction. L'objectif de cette étude était de contribuer à l'étude de la mortalité maternelle chez les adolescentes. Méthodes. Il s'agissait d'une étude retro-prospective descriptive et analytique cas témoin, d'une durée de trois ans. La collecte rétrospective avait porté sur deux (2) ans allant du 1er Janvier 2018 au 31 Décembre 2019 et celle prospective sur un (1) an allant du 1er Janvier 2020 au 31 Décembre 2020. Résultats. Durant la période d'étude nous avons enregistré 38 cas de décès maternels sur 16175 naissances vivantes soit un ratio de 235 décès pour 100000 naissances vivantes. Le décès concerne l'adolescente de 18-19 ans (65,8%), mariée (63,2%), non scolarisé (42,1%), et nullipare (65,8%). La majorité des adolescentes avait effectué 1-3 CPN (44,7%), et provenait d'une maternité périphérique (84,2%) et avait accouché par voie basse (78,4%). Le moyen de transport le plus utilisé était le transport en commun (63,2%). La cause de décès était dominée par l'hémorragie (44,7%). Le post-partum a été la période la plus pourvoyeuse de décès (52,6%). Conclusion. La mortalité maternelle constitue un problème de santé majeure dans notre pays, sa réduction nécessite la mobilisation de tous les acteurs de la société et implique une bonne éducation pour la santé, l'amélioration de la qualité du suivi prénatal et celle des soins obstétricaux d'urgence.

Introduction. The objective of this study was to contribute to the study of adolescent maternal mortality. Methods. This was a retrospective descriptive and analytical case-control study, lasting three years. The retrospective data collection covered two (2) years from January 1, 2018 to December 31, 2019 and the prospective one over one (1) year from January 1, 2020 to December 31, 2020. Results. During the study period we recorded 38 cases of maternal deaths out of 16,175 live births, ie a ratio of 235 deaths per 100,000 live births. The death concerns an adolescent girl aged 18-19 (65.8%), married (63.2%), out of school (42.1%), and nulliparous (65.8%). The majority of adolescent girls had performed 1-3 ANC (44.7%), and had come from a peripheral maternity hospital (84.2%) and had given birth vaginally (78.4%). The most used mode of transportation was public transit (63.2%) The cause of death was dominated by hemorrhage (44.7%). The postpartum period was the most significant period of death (52.6%). Conclusion: Maternal mortality is a major health problem in our country, its reduction requires the mobilization of all actors in society and involves good health education, improving the quality of prenatal care and that of obstetric care emergency

Pyélolithotomie par chirurgie ouverte (PLCO) par lombotomie: indications et résultats au service d'urologie du CHU de Conakry / Pyelolithotomy: Indications and Results at the Urology Department of the Conakry University Hospital

Objectif. Le but de cette étude était d'évaluer les résultats de la pyélolithotomie par chirurgie ouverte au service d'Urologie de l'hôpital national Ignace Deen, CHU de Conakry. Méthodes. Il s'agissait d'une étude prospective et descriptive portant sur les patients opérés de lithiase pyélique du 1er janvier 2018 au 31 décembre 2020. Les variables étudiées étaient sociodémographique, clinique, paraclinique et thérapeutique. Résultats. Dans notre étude la lithiase pyélique a occupé la première place parmi les lithiases du haut appareil urinaire n=50 (56%) et le deuxième rang par rapport à l'ensemble des calculs urinaires n=28 (29,9%). La tranche d'âge la plus touchée était celle de 31 à 40 ans avec 32,1%. Le sexe ratio était de 18 hommes pour 10 femmes. La douleur lombaire était le principal motif de consultation. L'examen cytobactériologique des urines a mis en évidence une infection chez 24 patients soit 85,7%. L'UIV avait permis de poser le diagnostic dans 85,7% des cas. La taille moyenne des calculs était de 24,1 ± 6,7 mm de diamètre. La durée moyenne d'intervention était de 103±38mn. En peropératoirenous avons enregistré deux cas d'ouverture accidente du péritoine, un cas d'avulsion de l'uretère, et un cas de lésion du pelvis rénal. La principale complication post-opératoire, était l'infection du site opératoire dans 28,6% des cas Conclusion. La pyélolithotomie par chirurgie ouverte garde encore ses indications dans certains pays du tiers monde comme le nôtre. De nos jours elle est de plus en plus rare au profi t des techniques mini- invasives (LEC ; Endo- urologie)

Amputation labiale par morsure humaine: à propos d'un cas à l'hopital national donka

Les morsures humaines représentent 3 % des morsures rencontrées au service d'urgence. Les preuves et le consensus sur les meilleures pratiques en matière de gestion des morsures humaines font défaut d'échec et de déterminer l'intérêt d'une réparation secondaire. Notre première tentative de reconstitution à partir de la pièce amputée étant échouée alors us avons entrepris cette étude dont les objectifs étaient d'identifier les facteurs OBSERVATION:Une patiente de sexe féminin âgée de 24 ans, ménagère A l'examen endo buccal, on notait une ouverture buccale d'amplitude normale. Les 32 et 31 sont exposées du fait de la perte de substance labiale. L'articulé dentaire conservée, l'hygiène bucco-dentaire défectueuse A l'admission, la patiente détenait dans un verre rempli d'eau minérale la pièce amputée de 2 cm x 1,8 cm dont la couleur laissait présager une vitalité compromise par défaut de vascularisation Les examens biologiques n'ont révélé aucune particularité. Le délai entre l'amputation et l'admission dans le Service était de 7h compromettant plus ou moins la vitalité de la pièce. Un délai nettement inférieur à celui trouvé par Roland et al. dans trois études différentes et qui ont trouvé moins de 14 % des patients ont été admis et plus de 80 % se sont présentés dans les 12 ou 24 heures suivant la morsure. CONCLUSION: Une tentative de replacement intentionnel d'une pièce amputée par morsure humaine sans chirurgie vasculaire est vouée à l'échec par une nécrose évolutive. Cependant la réparation chirurgicale de seconde intention donne un résultat esthétique et fonctionnel satisfaisant.

CRISPR-mediated base editing in mice using cytosine deaminase base editor 4

BACKGROUND: Many human genetic diseases arise from point mutations. These genetic diseases can theoretically be corrected through gene therapy. However, gene therapy in clinical application is still far from mature. Nearly half of the pathogenic single-nucleotide polymorphisms (SNPs) are caused by G:C>A:T or T:A>C:G base changes and the ideal approaches to correct these mutations are base editing. These CRISPR-Cas9-mediated base editing does not leave any footprint in genome and does not require donor DNA sequences for homologous recombination. These base editing methods have been successfully applied to cultured mammalian cells with high precision and efficiency, but BE4 has not been confirmed in mice. Animal models are important for dissecting pathogenic mechanism of human genetic diseases and testing of base correction efficacy in vivo. Cytidine base editor BE4 is a newly developed version of cytidine base editing system that converts cytidine (C) to uridine (U). RESULTS: In this study, BE4 system was tested in cells to inactivate GFP gene and in mice to introduce single-base substitution that would lead to a stop codon in tyrosinase gene. High percentage albino coat-colored mice were obtained from black coat-colored donor zygotes after pronuclei microinjection. Sequencing results showed that expected base changes were obtained with high precision and efficiency (56.25%). There are no off-targeting events identified in predicted potential off-target sites. CONCLUSIONS: Results confirm BE4 system can work in vivo with high precision and efficacy, and has great potentials in clinic to repair human genetic mutations.

Evaluation of Official Healthcare Informatics Applications in Saudi Arabia and their Role in Addressing COVID-19 Pandemic / 대한의료정보학회지

Objectives@#The purpose of this study was to examine official healthcare informatics applications in Saudi Arabia in the context of their role in addressing the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#This is a case study of official healthcare informatics programs and applications (apps) developed in Saudi Arabia before and during the COVID-19 pandemic. The qualitative content analysis (QCA) method was used. Data collection consisted of two components: a desktop review of documents and actual testing of the programs. According to the QCA method, we developed a matrix for abstracting information on different apps and programs in order to categorize the data. The compilation of information and discussion were based on information summarized in the matrix. @*Results@#Six apps in total were developed before the COVID-19 pandemic. With the advent of the COVID-19 pandemic, three of the apps, SEHA, Mawid, and Sehaty were modified to address different aspects of the pandemic. Both SEHA and Mawid included information about COVID-19 awareness. During the COVID-19 pandemic, three official apps were developed: Tawakkalna, Tetamman, and Tabaud. The Tawakkalna app is mandatory for all citizens and residents to activate when visiting stores and institutions. It has a wide range of COVID-19 and other health-related functions. The Tetamman app provides COVID-19 test results and allows one to check his or her daily symptoms. It also has an educational content library and provides alerts. The Tabaud app notifies individuals if they have been exposed to COVID-19. The features, advantages, and disadvantages of all of the apps were examined. @*Conclusions@#Overall, there were more strengths than shortcomings in the role played by healthcare informatics in the handling of the COVID-19 pandemic in Saudi Arabia.

Evaluation of Official Healthcare Informatics Applications in Saudi Arabia and their Role in Addressing COVID-19 Pandemic / 대한의료정보학회지

Objectives@#The purpose of this study was to examine official healthcare informatics applications in Saudi Arabia in the context of their role in addressing the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#This is a case study of official healthcare informatics programs and applications (apps) developed in Saudi Arabia before and during the COVID-19 pandemic. The qualitative content analysis (QCA) method was used. Data collection consisted of two components: a desktop review of documents and actual testing of the programs. According to the QCA method, we developed a matrix for abstracting information on different apps and programs in order to categorize the data. The compilation of information and discussion were based on information summarized in the matrix. @*Results@#Six apps in total were developed before the COVID-19 pandemic. With the advent of the COVID-19 pandemic, three of the apps, SEHA, Mawid, and Sehaty were modified to address different aspects of the pandemic. Both SEHA and Mawid included information about COVID-19 awareness. During the COVID-19 pandemic, three official apps were developed: Tawakkalna, Tetamman, and Tabaud. The Tawakkalna app is mandatory for all citizens and residents to activate when visiting stores and institutions. It has a wide range of COVID-19 and other health-related functions. The Tetamman app provides COVID-19 test results and allows one to check his or her daily symptoms. It also has an educational content library and provides alerts. The Tabaud app notifies individuals if they have been exposed to COVID-19. The features, advantages, and disadvantages of all of the apps were examined. @*Conclusions@#Overall, there were more strengths than shortcomings in the role played by healthcare informatics in the handling of the COVID-19 pandemic in Saudi Arabia.

Outcome of surgical management of genital prolapse in the obstetric gynecology department of the Ignace Deen Hospital in Conakry, Guinea

Background: Each year several patients are operated on for genital prolapse in our department, but no study has yet been done to analyse the results. The objective of this study was to highlight the operating techniques used and to analyse the anatomical and functional outcomes.Methods: It was an observational, longitudinal, prospective and descriptive study which took place over a period of 2 years in the department of obstetrics and gynecology of the Ignace Deen hospital de Conakry in Guinea. This study focused on patients operated on in the department for genital prolapse.Results: During the study period, 67 patients underwent genital prolapse surgery in the department. The operating techniques used are the triple perineal operation or, associated with colposuspension and/or Richter or Mc Call, Richardson's operation, Rouhier's operation and promonto-fixation. This study recorded in the follow up a case of recurrence of hysterocele one year after a Richardson operation, a correction of all digestive and sexual functional disorders and a correction of 81.25% of functional urinary disorders. The intraoperative complications were a rectal wound, two bladder wounds and three cases of hemorrhage requiring blood transfusion. The post-operative results were good in 98.5% of the cases.Conclusions: The lower approach is the main route used for surgical treatment of prolapse. The anatomical and functional results obtained are encouraging.

Management of pre-eclampsia and its complications in the department of gynecology and obstetrics at Donka national hospital Conakry, Guinea

Background: Vascular-renal syndrome, also known as pre-eclampsia, is a condition specific to pregnancy, usually occurring in the last trimester of pregnancy. Pregnant women are sometimes at risk of unpredictable obstetrical complications such as: hemorrhage, kidney failure, HELLP syndrome, sometimes even brain damage requiring prompt care and multidisciplinary collaboration. Vascular-renal syndromes are the third leading cause of maternal death and also the world's leading cause of perinatal death. Objectives of this study were to analyse the management of vascular-renal syndromes. Calculate their frequency, describe the sociodemographic characteristics of patients, describe the clinical and biological signs of patients, evaluate the maternal-fetal prognosis.Methods: The study was conducted in the department of obstetrics and gynecology of Donka National Hospital. It was a prospective, descriptive, cross-sectional, 6-month study from March 1st to August 31st, 2015, of pregnant women with pre-eclampsia.Results: The study included 217 cases of pre-eclampsia out of a total of 3054 patients, i.e. a proportion of 7.10%. The proportion of pre-eclampsia was high in patients aged between 15 and 19 years, housewife, married, primary. The predisposing factors were primigestitis, obesity and twinkling. The clinic was dominated by headaches and visual disturbances. Severe preeclampsia in 78.49%, eclampsia in 21.65% or simple hypertension in 1.75%. Maternal and fetal complications were dominated by eclampsia 26.26%, PPH (2.63%), eclamptic coma (0.46%), acute fetal distress 27.19%, and fetal death in utero (11.40%). In order to improve maternal and fetal prognosis it is necessary to provide multidisciplinary care, which unfortunately is not always available in our context.Conclusions: Obstetric emergency is a frequent situation for which a better management would improve the maternal-fetal prognosis.

Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections.

Diagnosis and management of benign ovarian tumors at the Ignace Deen Maternity Hospital of Conakry University Hospital in Guinea

Background: Benign ovarian tumors are a common reason for consultation and intervention in gynecology. The objective of this was to describe the clinical, ultrasonographic, histological and therapeutic aspects of benign ovarian tumors in the department.Methods: This is a retrospective and descriptive study of three years and six months from January 1, 2016, to June 30, 2019, which focused on the records of women-operated during this period of benign ovarian tumors.Results: The incidence of benign ovarian tumors was 12.58%. The circumstances of discovery were dominated by disorders of the menstrual cycle (35.05%) followed by infertility (20.78%), the sensation of a pelvic mass (19.48%), and pelvic pain. (15.58%). The ultrasound report was in favor of a serous cyst in 74% of cases, a mucoid cyst in 14% of cases, a dermoid cyst in 9% and an endometriotic cyst in 3%. Histology revealed a serous cystadenoma in 70.13% of the cases, a mucinous cystadenoma in 16.88% of the cases, a mature poly tissue teratoma in 9.09% of the cases and an endometrial cyst in 3.90 % of the cases. Cystectomy was the most performed surgical procedure (71%).Conclusions: Benign ovarian tumors are common in our practice. The most common histological forms were serous and mucinous cystadenomas. Conservative treatment has been practiced in the majority of cases.