A study of 87 mycetoma patients seen at three health facilities in Nouakchott, Mauritania.

BACKGROUND: Mycetoma is a chronic, progressive and destructive inflammatory disease that affects the skin, subcutaneous and other tissues. The objective of this study was to identify all cases of mycetoma diagnosed in three health facilities in Nouakchott, Mauritania during 2016-2018. METHODS: This retrospective hospital-based study was conducted at the Dermatology, Orthopedics, Mycology and Pathology departments of the National Hospital Center of Nouakchott, the Military Hospital of Nouakchott and the National Institute for Research in Public Health of Nouakchott. RESULTS: Eighty-seven patients were included in this study. They comprised 65 male patients (74.71%) and 22 females (25.28%) with a gender ratio of 4:1. The mean age was 41.87 y and ages ranged from 14 to 70 y. The most common age group was 40-45 y (11%). The foot was the most frequently affected site seen in 60 patients (69%), followed by ankle and hand with 6 patients each (7%). In the study, 56 patients (64%) had regional lymphadenopathy. Forty-nine patients (56%) had bone involvement. Thirty-two patients (37%) had medical treatment. Twenty-seven patients (87%) received fluconazole and four patients (13%) had co-trimoxazole treatment. CONCLUSION: The mycetoma patients seen in these three centres were mainly male farmers from rural areas. The lesions were seen mainly in the lower limbs and the majority had bone involvement radiologically.

Epidemiology of scalp ringworms and superficial fungal infections in schools in Mauritania.

INTRODUCTION: Scalp Tinea is the most common mycosis in children and adolescents. The objective of this work was to determine the epidemiological and etiological profile of Scalp Tinea in schoolchildren in Mauritania, during the year 2019. METHODS: This is a descriptive cross-sectional study lasting four months, from May to September 2019, in a sample of schoolchildren from Nouakchott, included following a random survey at three levels, having benefited from a clinical examination, mycological and culture samples. RESULTS: A total of 228 children out of the 434 included (52,5%) were detected as carriers of Scalp Tinea, after fungal culture, i.e. rates of 54% in boys and 46% in girls. The most affected age group was 9-12 years (49%). Public schools were the most affected (37,7%), followed by private schools (32%) and traditional schools (30,3%), (p<0,05). Trichophyton sudanense represented 23,5% (n=102) followed by Trichophyton rubrum (15,4%, n=67) and Microsporum langeronii 8,1% (n=35). The type of habitat, the humidity of the environment and walking with bare feet did not significantly influence the presence of ringworms, unlike overcrowding (sleeping with more than two people). The prevalence of scalp ringworms increased from 1,3% for children sleeping on single beds to 22,8% in children sharing their beds and to 75,9% in students sleeping together on the same bed (p˂0,05). CONCLUSION: The results of this survey, conducted in 2019, confirmed the changes in the epidemiological and ecological trend of the mycological profile of Scalp Tinea, in Mauritania. It is necessary to strengthen these results with the molecular characterization of fungal strains circulating in our country.

Tinea capitis in school children from Mauritania: A comparative study between urban and rural areas.

INTRODUCTION: In Mauritania, only an investigation carried out 26 years ago allows to report epidemiological findings about tinea capitis in Nouakchott. The objective of this study was to reactualize the tinea capitis epidemiological, clinical and mycological profile in school children and to compare this profile in urban and rural area. PATIENTS AND METHODS: All subscribed students in targeted schools and present during the investigation were examined clinically before samples collection. Mycological diagnosis was made by direct examination and culture in Sabouraud Dextrose Agar with chloramphenicol and supplemented with cycloheximide. The results were considered positive when culture with the presence of dermatophytes was obtained. RESULTS: Prevalence of tinea capitis among school children was 10.50% and it was more important in rural area (12.21%) than in urban area (9.52%). The age group ranged between 6 and 8 years was the most affected (13.58%). According to the gender, male (11.46%) were more affected than female (9.62%). Trichophytic tinea were predominant and Trichophyton soudanense was more isolated followed by Trichophyton rubrum, Trichophyton schoenleinii and Microsporum audouinii.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

[Vulvovaginal candidiasis in pregnant women in the Mère et Enfant Hospital center in Nouakchott, Mauritania]. / Candidoses vulvo-vaginales chez les femmes enceintes au centre hospitalier Mère et Enfant de Nouakchott (Mauritanie).

AIM: To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania. PATIENTS AND METHOD: The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media. RESULTS: Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy. CONCLUSION: This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.

Protein covalent immobilization via its scarce thiol versus abundant amine groups: Effect on orientation, cell binding domain exposure and conformational lability.

Quantity, orientation, conformation and covalent linkage of naturally cell adhesive proteins adsorbed or covalently linked to a surface, are known to influence the preservation of their subsequent long term cell adhesion properties and bioactivity. In the present work, we explore two different strategies for the covalent linking of plasma fibronectin (pFN) - used as a cell adhesive model protein, onto a polystyrene (PS) surface. One is aimed at tethering the protein to the surface in a semi-oriented fashion (via one of the 4 free thiol reactive groups on the protein) with a heterofunctional coupling agent (SSMPB method). The other aims to immobilize the protein in a more random fashion by reaction between the abundant pendant primary amine bearing amino acids of the pFN and activated carboxylic surface functions obtained after glutaric anhydride surface treatment (GA method). The overall goal will be to verify the hypothesis of a correlation between covalent immobilization of a model cell adhesive protein to a PS surface in a semi-oriented configuration (versus randomly oriented) with promotion of enhanced exposure of the protein's cell binding domain. This in turn would lead to enhanced cell adhesion. Ideally the goal is to elaborate substrates exhibiting a long term stable protein monolayer with preserved cell adhesive properties and bioactivity for biomaterial and/or cell adhesion commercial plate applications. However, the initial restrictive objective of this paper is to first quantitatively and qualitatively investigate the reversibly (merely adsorbed) versus covalently irreversibly bound protein to the surface after the immobilization procedure. Although immobilized surface amounts were similar (close to the monolayer range) for all immobilization approaches, covalent grafting showed improved retention and stronger "tethering" of the pFN protein to the surface (roughly 40%) after SDS rinsing compared to that for mere adsorption (0%) suggesting an added value to the covalent grafting immobilization methods. However no differences in exposure of the cell binding domains were observed (ELISA results) before SDS rinsing, suggesting that pFN protein grafting to the surface is initially kinetically driven be a stochastic random adsorption phenomenon. Covalent grafting acts in the final stage as a process that simply tethers and stabilizes (or freezes) the initial conformation/orientation of the adsorbed protein on the surface. In addition covalent linkage via the SSMPB approach is likely favored by surface-induce exposure of one of the normally hidden free thiol group pair, thus optimizing covalent linkage to the surface. However after SDS rinsing, this "tethering"/"freezing" effect was significantly more prominent for the GA grafting approach (due to greater number of potential covalent links between the protein and the surface) compared to that for the SSMPB approach. This hypothesis was buttressed by the improved resistance to denaturation (smaller conformational lability) for the GA compared to the SMPB approach and improved exposure of the cell binding domain for the former (>50%) even after SDS rinsing. These results are promising in that they suggest covalent tethering of fibronectin to PS substrate in a monolayer range, with significantly improved irreversible protein surface bonding via both approaches (compared to that for mere adsorption). The latter are likely applicable to a wide range of proteins.

[Severe acute colitis: two fatal cases in Dakar]. / La colite aiguë grave : deux observations mortelles à Dakar.

OBJECTIVE: Severe acute colitis (SAC) is one of the major complications of inflammatory bowel disease (IBD), especially ulcerative colitis, and it is life-threatening. Although IBD is considered rare in sub-Saharan Africa, we report 2 fatal cases of SAC in Senegalese patients with ulcerative colitis in Dakar. CASES: One patient was a 73-year-old man and the other a 35-year-old woman. In both cases, the diagnosis was preceded by a chronic dysenteric syndrome (febrile in the woman). Despite antibiotic treatment for potential infectious colitis, both patients' condition worsened. Second-line treatment of parenteral corticosteroids did not prevent the occurrence of intestinal perforation for the man, who developed multiorgan failure. The woman developed toxic megacolon during antibiotic treatment, and it was fatal despite bolus corticosteroids: cardiovascular collapse with shock (case 2) occurred before emergency surgery could begin. Conclusion: in subtropical zones where infectious colitis predominates, it is important to consider the diagnosis of SAC in patients with ulcerative colitis and to begin appropriate treatment despite the fear of infection and the difficulty of accessibility to endoscopic exploration.

[Consequences of coelioscopic sacrocolopoxy on the sexuality of the couple]. / Impact des cures de prolapsus pelviens par promontofixation laparoscopique sur la sexualité du couple.

AIM: To assess the impact on the sexuality of the couple of pelvic organ prolapse repair with coelioscopic sacrocolopoxy. MATERIAL: Pilot, prospective, monocentre study conducted in Nîmes university hospital. Consecutive patients undergoing coelioscopic sacrocolpopexy and their partner were invited to participate. Women attended a pre-surgical visit and a 6-month post-surgery visit where pelvic organ prolapse status was clinically assessed. In the same time, they and their partner filled general quality of life and specific sexual quality of life questionnaires (questionnaires PISQ12, PFDI-20 in women, medical history, IIEF, modified PISQ12 questionnaires in men). RESULTS: From May to December 2010, 25 couples were assessed. Anatomical success rates (POPQ<2) in the middle, anterior and posterior compartments were respectively of 100%, 95.4% and 66.7%. After surgery, 65.2% of pairs (n=15) reported an at least hebdomadal frequency of sexual intercourse, as compared with 54.2% (n=13) of pairs before surgery (P<0.001). Two cases of decrease of sexual intercourses frequency were reported and appeared partner-related. There was an overall non-significant improvement in sexual quality of life in men and women. General pelvic organ distress, urinary incontinence and specific pelvic organ prolapse distresses were significantly improved after surgery. CONCLUSION: Coelioscopic sacrocolpopexy does not impair couple's sexuality, assessed as sexual intercourses frequency and could even improve it. Partner's assessment can bring important information with respect to the interpretation of functional sexual results of surgery.

Lead powder use for skin care and elevated blood lead level among children in a Chinese rural area.

To investigate the association between lead powder use, as folk skin care, and blood lead level (BLL) in children, we studied 222 children up to 14-years old living in a Chinese rural area and administered a face to face interview with their parents to collect information on lead powder use and other potential exposure. We measured children's BLL at baseline and 2 years later after an intervention. The children were divided into three categories according to their use of lead powder: regular use, irregular use and never use. We applied multivariate linear regression to determine the association between lead powder use and elevated BLL. The average BLL of all children was 18 µg/dl; 56% of them had BLL of 10 µg/dl or higher. Lead powder use was significantly associated with elevated BLL. After adjusting for potential confounders the BLL of regular and irregular users was higher than non-users by 3.11 µg/dl and 1.47 µg/dl, respectively. Duration of lead powder use was positively associated with BLL, but the time since last use was inversely associated. A significant BLL reduction was observed 2 years later, and the greatest reduction (21 µg/dl) was seen in the youngest group of regular users. This study showed that traditional use of lead powder for a skin care purpose was a major contributor to elevated BLL in these children.

Dimerization of defect fullerenes and the orientational phase transition in oxidized C60 fullerite.

Oxidized fullerite was obtained by heating a fullerite sample intercalated with oxygen, (O2)0.44C60, up to 300 degrees C. Orientational phase transitions in the oxidized fullerite are studied using differential scanning calorimetry (DSC) and have been found to possess a specific enthalpy whose value is lower by 25% than in the initial (O2)0.44C60 sample. In order to find possible reasons for hindrance to the buckyball rotations, we performed optimizations of defect buckyball fullerenes C60-n with different distributions of vacancies along with the dimers C60-n-C60-n and C60-C60-n for n = 1-4 using density functional theory with generalized gradient approximation. We found that the dimerization energy ranges from 1.07 eV (C58-C58) to 6.56 eV (C56-C56) and from 1.81 eV (C60-C58) to 4.29 eV (C60-C56), respectively. The formation of such dimers, which could in addition interact with defect buckyball cages and form larger aggregates, is to be related to the lowering of the orientational transition enthalpy.

[Lung cancer in Dakar, Senegal]. / La cancer bronchique a Dakar, Sénégal.

A prospective, multicenter was conducted in all specialized centers in the city of Dakar. The objective was to describe the epidemiology to assess the management of lung cancer. 45 patients were included. The sex ratio M/F = 8. The average age of patients was 57.5 years. Smoking was found in 84.4% of cases. The average time for consultation after the onset of symptoms was 6 months. The average time to diagnosis was 2 months. Two out of three patients (66%) had seen beyond the stage III B. Improved diagnostic performance for early diagnosis of cancer is needed. Emphasis should be on prevention through tobacco control.

[The vermiformis appendix localization in the hernial sac].

Own experience was presented of surgical treatment of 22 patients, suffering abdominal wall hernia, in whom processus vermiformis (PV) was revealed in a hernial sac during herniotomy performance. In such cases PV was macroscopically not changed or had various grades of change--from hyperemia, cicatricial thickening and involvement into adhesive process to its pronounced inflammation and destruction. Hernioplasty in conjunction with appendectomy was performed in 11 patients, in 10 of them--allohernioplasty, in 1--plasty, using tissues of their own. According to histologic investigations data the expediency of appendectomy performance in a planned order in patients while pathologic changes in PV present was confirmed. Late results of surgical treatment were studied up in 19 (86%) patients. Hernial recurrence was not observed.

[Malaria knowledge, attitudes and practices among women living in the rural area of Poponguine, Senegal]. / Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal.

Malaria is a major public health and development problem in Senegal where it is the leading cause of morbidity and mortality. Children under five and pregnant women are the most vulnerable groups. The purpose of this transverse, descriptive, analytical study was to assess rural women's knowledge, attitudes and practices regarding malaria. It was conducted in the Poponguine district of Senegal from April 1 to 15, 2005. The estimated population size needed for this cluster survey was 800. Women between the ages of 15 and 45 years who had been living in the district for more than one year were recruited for study. The mean age of the population was 28 years (95% confidence interval, 27.7 - 28.8). Teenagers accounted for over one eighth of the population (13.75%) and three fourths (75.87%) were married. Almost half (49.6%) were attending school and nearly two thirds (65.5%) were classified at the low socioeconomic level. Most (82.25%) knew that mosquitoes transmitted malaria and that the main signs were fever or warm body (82.25% and 81% respectively). However knowledge about the clinical features of severe malaria was poor. Geographical and financial access to IB was good for most of the women interviewed. Over half had a good understanding of preventive strategies for children less than five years of age and pregnant women, i.e., use of insecticide-treated nets (ITN) (62.9%) and of intermittent preventive therapy (IPT) during pregnancy (52.4%). Most (92%) declared that they would go to the health center for care in case of malaria. The main sources of information were medical personal (60.4%) or community volunteers (62,9%). Coverage for ITN and IPT was 33% and 71.1% respectively. There was a good correlation between good knowledge and practices (p<0.05). The main predictors of good knowledge were age and level of education. Practices by mothers were correlated with age, source of income, and marital status. Based on the findings of the study our recommendations for the Poponguine district are in agreement with those of the national malaria control program, i.e., reinforcement of the behavior change program to improve public knowledge about malaria. Further study will be needed to gain more epidemiological insight.

Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal

Au Sénégal, le paludisme est un problème majeur de santé publique et de développement, car il représente la première cause de morbidité et de mortalité. Ce sont les enfants de 0-5 ans et les femmes enceintes qui sont les plus vulnérables. L'objectif est d'évaluer les connaissances, attitudes et pratiques des femmes en zone rurale sur le paludisme. Il s'agit d'une étude transversale, descriptive et analytique menée dans le district de Poponguine du 1er au 15 avril 2005. Il s'agissait d'une enquête en grappe. La taille de l'échantillon calculée était égale à 800. La population d'étude était constituée par des femmes vivant dans le district depuis plus de 1 an et âgées de 15 à 45 ans. L'âge moyen des femmes était de 28 ans, (intervalle de confiance à 95% = 27,7 ­ 28,8). Parmi ces femmes, 49,6% étaient scolarisées et 65,5% avaient un niveau socioéconomique faible. 82,25% savaient que le paludisme est dû à la piqûre d'un moustique. Le signe principal (la fièvre ou corps chaud) a été cité dans 81% des cas. Cependant les signes du paludisme grave n'étaient pas bien connus. Il existait une bonne connaissance des mesures préventives aussi bien chez l'enfant que chez la femme enceinte : la Moustiquaire Imprégnée (MI) (62,9%) et la pratique du Traitement Préventif Intermittent (TPI) lors de la grossesse (52,4%). Il existait une bonne accessibilité géographique et financière des femmes interrogées par rapport aux MI. Plus de la moitié des femmes interrogées (92%) disait avoir recours à la structure sanitaire en cas de grossesse et/ou pour un enfant suspect de paludisme. Le personnel de santé (60,4%) et les relais communautaires (62,9%) constituaient la principale source d'information. La couverture en MI était de 33% et le taux d'utilisation du TPI de 71,1%. Il existait une relation significative entre le niveau de connaissances et les pratiques (p < 0,05). Les facteurs déterminant les connaissances étaient l'âge et le niveau d'instruction. Les pratiques des mères étaient influencées par l'âge, la source de revenus et la situation matrimoniale. A l'issue de cette étude, nous recommandons, pour le district de Poponguine, en accord avec le programme national de lutte contre le paludisme de renforcer le programme de sensibilisation afin d'amener les populations à améliorer leur connaissance en matière de paludisme et à changer de comportement mais aussi de mener une enquête qualitative pour compléter cette étude épidémiologique

[Abdominal pain during the course of lung cancer]. / Douleur abdominale au cours de l'évolution d'un cancer bronchique.

INTRODUCTION: Metastatic involvement of the peritoneum from a lung cancer is infrequently encountered. METHODS: We present the case report of a patient with bronchial adenocarcinoma whose course is complicated by the occurrence of a peritoneal carcinomatosis, as documented by FDG-PET. CONCLUSION: Unexplained abdominal pain in a lung cancer patient may be a peritoneal carcinomatosis. The diagnosis can be helped by PET-scan. However, the therapeutic opportunities are very limited.

[Tuberculosis in the mother and child]. / La Tuberculose dans le couple mère-enfant.

INTRODUCTION: Tuberculosis is a scourge in our region; it is particularly dangerous in young children, above all those of tuberculous mothers. The object of this study is to evaluate the prevalence of tuberculosis in the children of tuberculous mothers and to determine how to increase their chances of survival and healthy development. METHODS: Between 1 January and 31 July 2002, 45 women were admitted to hospital with a child of less than 5 years. They received (mothers and children) an intradermal tuberculin test (IDTT) of 10 i.u., chest x-ray, and sputum examination for the mothers. RESULTS: 45 women (aged from 18 to 45 years) were hospitalised for sputum positive tuberculosis, an average IDTT of 13 mm and a high bacterial load (1 to>10 bacilli/hpf). Almost all (96%) presented with cavitating parenchymatous disease. We found no cases positive for HIV. Progress was satisfactory in 43 mothers treated with SRHZ. There were 2 deaths. In the children who were systematically examined, 82% (37) were less than 20 months old, there were 23 boys (51%), and 26 children (58%) were symptomatic at the first consultation. All the children were breast fed, explaining their admission with their mother. Evidence of tuberculous contact was found, 6 times with the father and 4 times with the grandparents. The most common physical signs were fever (92%) cough and weight loss (77%), malnutrition (69%). The IDTT was positive in 38/45 (84.5%) and pustular in 16/38 (42%). The chest x-ray was normal in 16/45 (35.6%), revealed mediastinal adenopathy in 19/29 (65.5%), accompanied by ipsilateral ventilatory problems in 11/29 (38%) and by parenchymal involvement in 3/29 (10.3%). Progress was satisfactory in 44 children on antituberculous treatment (RHE). There was one death on account over severe malnutrition. CONCLUSION: Treatment of tuberculosis in the mother and child is a guarantee of recovery for the mother and healthy development for the child. S: streptomycin, R: rifampicin, H: isoniazid, E: ethambutol, Z: pyrazinamide.

[Differentiated approach to surgical treatment of inguinal hernia recurrence in accordance with morphologic characteristics of musculo-aponeurotic structures of inguinal channel].

In 44 patients, ageing 39-73 yrs and suffering inguinal hernia recurrence, the investigation of musculo-aponeurotic structures of inguinal region was conducted. In 21 patients, suffering primary inguinal hernia recurrence, in concurrence with the connective tissue complex degeneration the pronounced atrophy of tissues was revealed. In 23 patients, suffering multiple inguinal hernia recurrence, the tissues degeneration and atrophy were manifested significantly. The results of investigation trust the necessity of additional plastic material application while performing hernioplasty for inguinal hernia recurrence. To optimize the primary inguinal hernia recurrence, the combined hernioplasty, applying polypropylene mesh, was performed, and for secondary recurrence--preperitoneal allohernioplasty, using operative access through the inguinal channel.