Diagnosis Dilemma of Angioimmunoblastic T-Cell Lymphoma in Tuberculosis Endemic Region.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic malignancy recognized in the WHO 2016 classification as a clinical and histological entity. It is a very poorly described disease in Africa due to its rarity and diagnostic difficulties, particularly differential diagnosis with tuberculosis. Here, we report a 57-year-old man who presented with fever, weight loss, and lymphadenopathies. The diagnosis of tuberculosis was carried out based on lymph node fine needle aspiration showing the image of tuberculous adenitis and CT images in favor of necrotic lymphadenopathies. The presence of autoantibodies and the failure of tuberculosis treatment led us to perform a biopsy with immunostaining that confirmed pathological features of AITL. The patient was treated by CHOP-based chemotherapy, and complete remission was achieved. This case highlights the difficulty of recognizing AITL and the importance of considering other potential differential diagnoses of tuberculosis in the endemic region.

[Major Causes Of Limb Amputations At The Hospital In Sikasso]. / Les Causes Des Amputations Majeures Des Membres A L'Hopital De Sikasso.

INTRODUCTION: In this study, we aimed to determine the major causes of limb amputations to improve its treatment. PATIENTS AND METHODS: We conducted a-18 month prospective study from March 2015 to September 2016 at the Hospital of Sikasso, a hospital of second reference in Mali. RESULTS: We carried out 50 major limb amputations including 25 men and 25 women aged 38.9 years old on average with extremes of 3 and 80 years old. The amputed limb was the upperlimb in 38 cases (76%) and the lowerlimb in 12 cases (24%). Housewives were the most represented with 18 cases (36%), followed by farmers with 15 cases (30%). The amputation was done immediately or in delayed emergency in 32 cases (54%). Trauma was the most frequent etiology with 13 cases (26%). The post-operative complications have been met in 47 cases. They have been dominated by stump pain and delayed healing in 23 cases (49%) each, suppuration in 10 cases (21%) and the stump necrosis in 3 cases (7%). The mortality rate was 8% (4 cases). We have made prosthetic apparatus for18 patients (36%). CONCLUSION: The limb amputation is frequent and youths were the most involved. Due the lack of financial support, 64% of our patients could not afford prosthesis.

INTRODUCTION: Le but de ce travail était de déterminer les causes des amputations majeures des membres afin d'améliorer leur prise en charge. PATIENTS ET MÉTHODES: il s'agissait d'une étude prospective de 18 mois. Elle s'est déroulée de Mars 2015 à Septembre 2016à l'hôpital de Sikasso,un hôpital de deuxième référence du Mali. Elle a porté sur 50 patients (25 hommes et 25 femmes). RÉSULTATS: Nous avons réalisé 50 amputations majeures des membres chez 25 hommes et 25 femmes avec un âge moyen de 38,9 ans et des extrêmes de 3 ans et 80 ans. Dans 38 cas (76%) l'amputation avait concerné le membre inférieur et dans 12 cas (24%) le membre supérieur. Les ménagères étaient les plus représentées soit 18 cas (36%) suivies des agriculteurs dans15 cas (30%). L'amputation était réalisée en urgence ou urgence différée dans 32 cas (54%). L'étiologie traumatique était la plus fréquente soit13 cas (26%).Les complications post-opératoires ont été rencontrées dans 47 cas. Elles ont été dominées par la douleur du moignon dans 23 cas (49%), la suppuration dans 10 cas (21%), le retard de cicatrisation 11 cas (23%) et la nécrose du moignon dans 3 cas (7%). Le taux de mortalité était de 8% (4 cas). Nous avons confectionné des appareils prothétiques pour 18 patients soit 36%. CONCLUSION: L'amputation de membre a été fréquenteet a concerné le sujet jeune. Par manque de moyens financiers 64% de nos patients ne sont pas appareillés.

Rubeoparvulum massiliense gen. nov., sp. nov., a new bacterial genus isolated from the human gut of a Senegalese infant with severe acute malnutrition.

Rubeoparvulum massiliense strain mt6T was isolated from the gut microbiota of a severely malnourished boy from Senegal and consisted of facultative anaerobic, spore-forming, nonmotile and Gram-negative rods. R. massiliense showed a 92% similarity with the 16S rRNA of Bacillus mannanilyticus. The genome of strain mt6T is 2 843 796 bp long with a 43.75% G+C content. It contains 2735 protein-coding genes and 76 RNA genes, among which are nine rRNA genes.

[Obstetrical vesico-vaginal fistula in Guinea: Data analysis of three sites of treatment at Engender Health ONG]. / Fistules vésico-vaginales obstétricales en Guinée : analyse des données de 3 sites de prise en charge de l'ONG Engender Health.

OBJECTIVE: To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea. PATIENTS AND METHODS: It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months. RESULTS: The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases. CONCLUSION: Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication. LEVEL OF EVIDENCE: 5.

La mortalité maternelle à l'hôpital régional de Kindia : facteurs épidémiologiques et axes stratégiques d'intervention

Objectifs. Calculer le ratio de la mortalité maternelle, identifier les caractéristiques épidémiologiques et proposer des axes stratégiques d'intervention. Méthodes. Il s'agit d'une étude descriptive et analytique à recrutement rétrospectif, réalisée du 1erJanvier 1998 au 31 Décembre 2001 à l'Hôpital Régional de Kindia (HRK). Elle a concerné tous les cas de décès maternels survenus au service de gynécologie obstétrique de l'Hôpital Régional de Kindia. Les caractéristiques épidémiologiques, la provenance, la période du décès et le caractère évitable ou non du décès ont été analysés. Le calcul statistique a été fait à l'aide du test de chi² avec une signifi cativité p < 0,05. Résultats. Il y a eu 128 cas de décès matériels pour 6586 naissances vivantes soit 1944 décès pour 100.000 nouveaux-nés. L'âge moyen de patientes était 28,2 ans avec un écart type de 10 ans et des extrêmes de 15 et 44 ans. Les patientes de la tranche d'âge 15-19 ans (31,3%) analphabètes (62,5%), primipares (42,9%), évacuées (76,6%) et celles n'ayant effectuées aucune CPN (56,3%) étaient les plus touchées. Conclusion. La réduction de la mortalité passerait par l'identification des causes de décès, l'offre des soins obstétricaux et néonataux d'urgences complets

The Usefulness of International Cooperation in the Repair of Inguinal Hernias in Sub-Saharan Africa.

INTRODUCTION: The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs). MATERIALS AND METHODS: As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh. The type of hernia and surgical technique were studied. Indicators of scientific and technical quality, indicators of efficiency and of effectiveness were analyzed. The results on the usefulness of interventions were calculated as avoided DALYs. RESULTS: Surgery was performed on 926 patients with a total of 1033 hernia repairs. 87.2 % of the repairs were made with mesh. There was no mortality in the series, complications were minor, and 85.7 % of patients remained less than 24 h in the center. There was a 2.8 % of recurrence, with a follow-up 58.7 % of the patients in the first year. 5014 DALYs were avoided, and the average of the avoided DALYs per patient was of 5.41. CONCLUSIONS: Hernia repair with mesh in low development countries is a procedure with low morbidity and high effectiveness that can prevent a large number of DALYs.

A molecular model for neurodevelopmental disorders.

Genes implicated in neurodevelopmental disorders (NDDs) important in cognition and behavior may have convergent function and several cellular pathways have been implicated, including protein translational control, chromatin modification, and synapse assembly and maintenance. Here, we test the convergent effects of methyl-CpG binding domain 5 (MBD5) and special AT-rich binding protein 2 (SATB2) reduced dosage in human neural stem cells (NSCs), two genes implicated in 2q23.1 and 2q33.1 deletion syndromes, respectively, to develop a generalized model for NDDs. We used short hairpin RNA stably incorporated into healthy neural stem cells to supress MBD5 and SATB2 expression, and massively parallel RNA sequencing, DNA methylation sequencing and microRNA arrays to test the hypothesis that a primary etiology of NDDs is the disruption of the balance of NSC proliferation and differentiation. We show that reduced dosage of either gene leads to significant overlap of gene-expression patterns, microRNA patterns and DNA methylation states with control NSCs in a differentiating state, suggesting that a unifying feature of 2q23.1 and 2q33.1 deletion syndrome may be a lack of regulation between proliferation and differentiation in NSCs, as we observed previously for TCF4 and EHMT1 suppression following a similar experimental paradigm. We propose a model of NDDs whereby the balance of NSC proliferation and differentiation is affected, but where the molecules that drive this effect are largely specific to disease-causing genetic variation. NDDs are diverse, complex and unique, but the optimal balance of factors that determine when and where neural stem cells differentiate may be a major feature underlying the diverse phenotypic spectrum of NDDs.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.

BACKGROUND: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. METHODS: Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. RESULTS: Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. CONCLUSIONS: Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.

[Clinical aspects and management of the torsion of the spermatic cord: study of 27 cases]. / Aspects cliniques et thérapeutiques de la torsion du cordon spermatique : étude de 27 cas.

OBJECTIVE: To analyze in a retrospective way the clinical and therapeutical aspects of the testicular torsion in our service. PATIENTS AND METHODS: It is a retrospective survey of 15 years, from June 1st, 1993 to May 31 2008 to the urology - Andrology service of Conakry. We have 27 files of patients with torsion of the spermatic cord confirmed to the intervention. A percentage of 70.30% patients were less than 25 years old. RESULTS: The scrotal pain was the most frequent functional sign (96.3%). Only 11 patients (40.7%) have been received before the sixth hour. The swelling of the scrotum, ascended testis and the sign of Prehn were the dominant physical signs. All patients have been operated. The number of spire towers varied from 1 to 3. Twenty-two testes (81.5%) have been judged viable and fixed. With a median follow-up of 60 months, the testes volume of these patients was stable in 20 cases (90.9%). The postoperative course was simple in 96.3% of cases. Twenty-three patients (85.2%) were released within a week. CONCLUSION: Torsion of the spermatic cord remained a dangerous affection because putting in game the vital prognosis of the testis. The only justifiable attitude is the urgent surgical operation.

[Gastroduodenal ulcer in the rural setting in Mali]. / Les ulceres gastro duodenaux en milieu rural au Mali.

The goal of our study was to describe the epidemiologic , clinical and endoscopic aspects of gastroduodenal ulcers at the regional hospital of sikasso (HRS). This prospective study was held from january 2002 to december 2003.All of the patients underwent an upper digestive tract endoscopy. Gastroduodenal ulcers comprised 10.88% of all of the digestive tract endoscopies. The average age of patients was 42.51 + 14.60 years with a gender ratio of 1.88 in favor of men. The overwhelm patients were lower middle class income. The main clinical symptoms were epigastric pain and dyspepsia. The ulcers were most often found in the duodenum (DI).

Les ulceres gastro duodenaux en milieu rural au Mali

Le but de notre travail etait de preciser les aspects epidemiologiques; cliniques et endoscopiques des ulceres gastro duodenaux a l'Hopital Regional de Sikasso (HRS). Cette etude prospective s'etait deroulee de janvier 2002 a decembre 2003. Tous les patients ont subi une endoscopie digestive haute. Les ulceres gastro duodenaux ont represente 10;88de l'ensemble des endoscopies digestives. L'age moyen des patients etait de 42;51 + 14;60 ans avec un sex-ratio de 1;88 en faveur des hommes. Les couches socioprofessionnelles a revenu modeste etaient les plus representees. Les principaux signes cliniques etaient l'epigastralgie et la dyspepsie. L'ulcere siegeait tres souvent au bulbe

Les ruptures traumatiques de l'uretre posterieur : analyse de 87 cas au CHU de Conakry

Objectif : Rapporter notre experience dans la prise en charge des ruptures traumatiques de l'uretre posterieur. Patients et methodes : Quatre-vingt-sept patients presentant une rupture traumatique de l'uretre posterieur ont ete traites dans le service d'Urologie-Andrologie du CHU de Conakry de janvier 1988 a decembre 2004. Le contexte traumatique a ete un accident de la voie publique dans 68 (78;2) cas et un accident de travail dans 19 (21;8) cas. Seuls 32 (36;8) des patients ont ete recus dans les 72 heures qui ont suivi le traumatisme; les autres ont ete recus au stade de stenose uretrale constituee. Une fracture du bassin a ete notee chez 56 (64;4) patients. La symptomatologie clinique etait dominee par la retention d'urine dans 62 (71;3); l'uretrorragie dans 59 (67;8) et l'hematome perineal dans 23 (26;4) cas. Resultats : Le traitement a consiste en un realignement sur sonde uretrale en urgence; une reparation uretrale en urgence differee entre le 8e et le 10e jour et une uretroplastie tardive selon qu'il s'agissait d'une rupture recente ou ancienne de l'uretre. Les resultats therapeutiques ont ete bons dans 32 (36;8) et moyens dans 39 (44;8) cas. Une dysfonction erectile a ete notee chez 19 (21;8) patientsConclusion : Le traitement des ruptures de l'uretre posterieur demeure controverse; cependant pour nous; l'uretrorraphie termino-terminale en urgence differee reste la methode therapeutique de choix dans notre contexte devant l'impossibilite de pouvoir realiser un realignement endoscopique et en l'absence de lesions associees severes. Devant des lesions associees graves la refection uretrale passe au second plan cedant la priorite aux lesions engageant le pronostic vital

[Erectile dysfunction and diabetes in Conakry (Guinea): frequency and clinical characteristics from 187 diabetic patients]. / Dysfonction érectile et diabète à Conakry (Guinée): fréquence et profil clinique à partir de 187 observations.

Sexual dysfunction is frequent in the diabetic population. In Africa, medical care for erectile dysfunction is underprovided, profoundly altering the quality of life of the patients. We report the prevalence of erectile dysfunction in 187 diabetic patients followed in the department of Endocrinology of the Conakry teaching hospital. Prevalence was estimated from the French version of the International Index of Erectile Function (IIEF). Erectile dysfunction concerned 90 patients (48%) of whom a severe form was observed in 54%, a moderate form in 35% and a mild form in 12%. The patients who presented erectile dysfunction were significantly older, displayed longer duration of diabetes with more complications (sensorial neuropathy and macroangiopathy) and often took drugs for associated cardiovascular diseases. In 28% of the cases, erectile dysfunction was associated with a decline in libido and in 26% with ejaculation disorders. In conclusion, erectile dysfunction is frequent and severe among diabetic patients in Guinea. The medical staff plays an essential role to initiate early diagnosis, promote psychological support and provide medication, if possible.

Conditions d'utilisation et contrôle de qualité des lecteurs de glycémie capillaire au chu de conakry avec l'hemocue b glucose

Les objectifs de l'étude étaient de préciser les conditions d'utilisation et la fiabilité des résultats des lecteurs de glycémie utilisés par le personnel soignant au Centre Hospitalier et Universitaire (CHU) de Conakry. Chaque lecteur en utilisation (n=21) a été testé sur les mêmes prélèvements capillaires, en normoglycémie et en hyperglycémie par rapport à la valeur cible de référence : l'analyseur HemoCue B glucose®. Des données complémentaires ont été recueillies au près de chaque utilisateur qui a été ensuite soumis à une observation directe pendant qu'il effectuait une glycémie. Les appareils recensés étaient de la marque Life scan® (n=17) et Roche® (n=4). Le modèle le plus utilisé était le One Touch Basic® (n=7). En moyenne, les résultats rendus par les différents lecteurs de glycémies s'écartaient de la référence de 0,09 g/L (soit 9,7% de la valeur de référence) en normoglycémie et de 1,40g/l (soit 26%) en hyperglycémie. Les valeurs obtenues par 81% des lecteurs de glycémie étaient à plus de 15% de la valeur cible de référence. Aucun utilisateur n'employait les bandelettes de contrôle. Deux lecteurs étaient souillés de sang et aucun port de gants lors de la réalisation des glycémies n'a été observé. La formation des utilisateurs et un contrôle de qualité régulier des lecteurs de glycémies pourraient prévenir le risque induit de traitement inadapté ou de transmission nosocomiale d'infection

Pied diabétique: facteurs de risque dans le service de diabétologie du C.H.U de Donka

L'objectif de ce travail était de décrire les principales lésions retrouvées et d'identifier les facteurs de risque associés aux lésions du pied diabétique parmi les patients suivis au CHU de Donka. Nous avons réalisé une étude de type cas-témoins dans laquelle 30 patients qui avaient un pied diabétique (cas) ont été comparés à 60 patients diabétiques indemnes de lésion du pied (témoins) selon les caractéristiques de personne, celles du diabète, les facteurs de risque cardiovasculaire et les complications liées au diabète. Les lésions observées étaient l'infection dans 22 cas (62 %), la gangrène sèche dans 9 cas (26 %), l'ostéite dans 3 cas (9%) et le mal perforant plantaire dans 1 cas (3%). Les facteurs de risque du pied diabétique identifiés étaient la neuropathie sensitive (p=0,006), l'artérite des membres inférieurs (p=0,001) et le mauvais équilibre glycémique (p=0,01). Un bon équilibre du diabète associé à une éducation de ces patients à risque podologique élevé, focalisée sur ces facteurs de risque, permettrait de prévenir les lésions du pied

[Control of tuberculosis as seen "in the field": popular perceptions of the disease and access to care in Conakry, Guinea]. / La lutte contre la tuberculose vue du "terrain" représentations populaires de la maladie et accès aux soins à Conakry (Guinée).

Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease "in the field". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry, Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population, which constitutes a major impediment for screening and treatment.

"La lutte contre la tuberculose vue du ""terrain"" representations populaires de la maladie et acces aux soins a Conakry (Guinee)"

"Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease ""in the field"". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry; Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population; which constitutes a major impediment for screening and treatment."

[Ureteroplasty by penile pedicular flap]. / Urétroplastie par lambeau pénien pédiculé selon Quartey.

The authors relate a retrospective study on 30 cases of urethral stenosis and four cases of urethral rupture with a mean follow up of 28 months (8 to 44 months). The mean age of the patients was 47.5 years (6 to 85 years). The main aetiology was inflammatory sclerosis (73.5%). The predilection was bulbar (52.94%). The main symptom was constituted by dysuria (n = 24). The peri-urethral sclerosis was found in 44, 12% of cases. The penile flap as tube or patch. Immediate complications were a loosen of sutures (n = 7), urinary fistula (n = 4). The later complications were essentially recidives (n = 6). The results were good in 73.5% of cases.

[Harpoon scrotal injury: unusual accident in submarine fishing]. / Plaie de la bourse par embrochage: un accident rare de pêche sous-marine.

The authors report a case of transfixing injury of the scrotum while diving. The patient was seen one hour after the accident. The harpoon traversed the right side of the scrotum from below upwards. Emergency surgical exploration only revealed effraction of the sinus of the epididymis and the abdominal muscles. The overall risk for fertility was suggested in view of a possible lesion of the epididymal canal.