Use of contraceptive methods in rural areas in Cote d'Ivoire: a cross-sectional study

Patients and methods: This cross-sectional survey took place in May, 2018 in Kodjokro, a village in the south-east of Côte d'Ivoire. The study population consisted of women of reproductive age, from 15 to 49 years old. A questionnaire was used to collect data on socio-demographic, gyneco-obstetrical characteristics, knowledge and attitudes and he use of contraceptive methods. The chi-square test was used to measure the associations between the use of contraceptive methods and each of the characteristics studied

Redistribution of free tropospheric chemical species over West Africa: radicals (OH and HO2), peroxide (H2O2) and acids (HNO3 and H2SO4).

The purpose of this paper is to study the redistribution of chemical species (OH, HO(2), H(2)O(2), HNO(3) and H(2)SO(4)) over West Africa, where the cloud cover is ubiquitously present, and where deep convection often develops. In this area, because of these cloud systems, chemical species are redistributed by the ascending and descending flow, or leached if they are soluble. So, we carry out a mesoscale study using the Regional Atmospheric Modelling System (RAMS) coupled to a code of gas and aqueous chemistry (RAMS_Chemistry). It takes into account all processes under mesh. We examine several cases following the period (November and July), with inputs emissions (anthropogenic, biogenic and biomass burning). The radicals OH and HO(2) are an indicator of possibilities for chemical activity. They characterize the oxidizing power of the atmosphere and are very strong oxidants. The acids HNO(3) and H(2)SO(4) are interesting in their transformation into nitrates and sulfates in precipitation. In November, when photochemistry is active during an event of biomass burning, concentrations of chemical species are higher than those of November in the absence of biomass burning. The concentrations of nitric acid double and sulfuric acid increases 70times. In addition, the concentrations are even lower in July if there is a deep convection. Compared to measures of the African Monsoon Multidisciplinary Analysis (AMMA), the results and observations of radicals OH and HO(2) are the same order of magnitude. Emissions from biomass burning increase the concentrations of acid and peroxide, and a deep convection cloud allows the solubility and the washing out of species, reducing their concentration. Rainfalls play a major role in solubility and washing out acids, peroxides and radicals in this region.

[Surgical management of lungs destroyed by tuberculosis]. / Résultats chirurgicaux des poumons détruits post-tuberculeux.

OBJECTIVE: The purpose of this work was to report our experience with surgical management of lungs destroyed by tuberculosis and to analyze our results. MATERIAL AND METHODS: We reviewed the cases of 45 patients who underwent surgery between January 1978 and December 2004 after medical treatment for pulmonary tuberculosis considered successful. The series included 31 men and 14 women, mean age 31 years (range: 7-55 yr). Indications for surgery were chronic bronchorrhea (91.1%) and hemoptoic sputum associated with bronchorrhea (8.9%). Lung function tests were preformed in 42 patients and noted a restrictive syndrome with shunt in all: mean FEV1 was 1 890 ml. All patients were given a preoperative medical regimen for at least four weeks. Pneumectomy (17 right and 28 left) was performed; all bronchial sutures were made manually and protected. Operative bleeding was a constant feature and blood transfusion was needed (mean 1,500 cc). RESULTS: Operative mortality was 4.4% from hemorrhagic and infectious causes. Complications were non-fatal (16.3%) and marked by bleeding (0.9%) empyema with bronchopleural fistulae (8.9%). Mean postoperative hospital stay was 13 days without empyema and 150 days with empyema. Long-term outcome was satisfactory after a mean 7.5 years follow-up (range: 4 months - 20 years). CONCLUSION: Indications are patient comfort and necessity. Morbidity and mortality are acceptable with adequate preoperative preparation.

Typhoid ileal perforation: surgical experience of 64 cases.

OBJECTIVE: Intestinal complications of typhoid fever are quite common in developing countries. In order to contribute to the improvement of the prognosis of typhoid ileal perforation, the authors report their own surgical experience PATIENTS AND METHODS: between May 95 and July 98, 64 patients, (31 men and 33 women), with an average age of 34 years (ranging from 5 to 63 years) underwent surgery for typhoid ileal perforation. The surgical techniques used were excision-suture (n = 31) and resection-ileostomy (n = 33). All the patients were operated under similar pre-, per- and postoperative care facilities. RESULTS: Postoperative complications were observed in 59 patients (88.1%). The mean hospital stay was 30 days (ranging from 8 to 52 days). The overall postoperative mortality was 34% (22/64), mainly due to digestive fistula in 11 cases (8 cases of anastomotic leak after excision-suture, 3 cases of bowel fistula after conservative resection-ileostomy) and to chronic peristomal ulceration in 9 cases, which led to progressive malnutrition, cachexy and death. CONCLUSION: The mortality and morbidity after surgical treatment of typhoid ileal perforation remains very high in developing countries. However some recommendations could improve the outcome: aggressive resuscitation by intravenous hydratation of 4 to 6 hours, associated with adequate antibiotherapy, the resection of the last 60 centimetres of the ileum, in cases of serious abdominal suppuration, and a large abdominal washout.

Wilkie's syndrome.

A superior mesenteric artery syndrome (SMAS) was diagnosed in two young women with, respectively, a 2- and 1-year history of postprandial vomiting and epigastric pain. The patients underwent a laparoscopic duodenojejunal bypass, and resumed a normal diet on the fifth postoperative day. The patients are still symptom-free with patent anastomosis on gastrointestinal radiographic control at 24 and 6 months, respectively, following their operation. Herein we also describe the varying clinical presentation of this rare syndrome, as well as treatment options. We conclude that laparoscopic duodenojejunostomy offers a new therapeutic approach to SMAS. It is reliable and safe; the operating time is acceptable; and diet recovery and hospital stay are both short. However, these preliminary results still need to be confirmed by further observations.

Feline and canine coronaviruses are released from the basolateral side of polarized epithelial LLC-PK1 cells expressing the recombinant feline aminopeptidase-N cDNA.

In this study feline (FECV and FIPV) and canine (CCoV) coronavirus entry into and release from polarized porcine epithelial LLC-PK1 cells, stably expressing the recombinant feline aminopeptidase-N cDNA, were investigated. Virus entry appeared to occur preferentially through the apical membrane, similar to the entry of the related porcine coronavirus transmissible gastroenteritis virus (TGEV) into these cells. However, whereas TGEV is released apically, feline and canine coronaviruses were found to be released from the basolateral side of the epithelial cells. These observations indicate that local infections as caused by TGEV, FECV and CCoV do not strictly correlate with apical release, as suggested by earlier work.

[Highly selection portal decompression for ruptured esophageal varices: study of a series of 122 cases with long-term results]. / Décompression portale hypersélective pour rupture de varices oesophagiennes: étude d'une série de 122 cas avec résultats lointains.

STUDY AIM: The aim of this retrospective study was to report the results, with a minimum 10-year follow-up, of highly selective portal decompression (HSPD) realized in order to prevent bleeding recurrences from esophageal or gastric varices in a series of 122 cirrhotic patients. PATIENTS AND METHOD: From January 1980 to February 1997, 122 patients (85 men and 37 women, mean age: 50.4 years) with liver cirrhosis stage A (n = 6), B (n = 50), C (n = 6) according to Child classification, were operated on for bleeding varices after a delay in 106 patients, on emergency in 16 patients. The HSPD included a double vascular ligature (splenic artery ligature in case of hypersplenism [n = 42] and high perigastric veins ligature) and a double tissular stapling (low esophagus transection and valvuloplasty). Other associated procedures were performed including cholecystendesis in 21 patients. RESULTS: Perioperative mortality rate was 8% (n = 10). There was no anastomotic leakage but anastomotic stenosis in ten patients treated by dilatation. Three patients only out of 109 (2.5%) were lost for follow-up. Portocaval encephalopathy was not observed in any patient. Global survival rate was 60% at 5 years and 45% at 10 years. The mortality rate related to recurrent esophageal varice bleeding was 11% and related to hepatocellular failure 18.5% during the entire follow-up. CONCLUSION: HSPD appears to be the best procedure in cirrhotic patients for the prevention of recurrent esophageal varice bleeding. Preservation of portal pressure within the cirrhotic liver (whereas it is reduced in varices) contributes to the preservation of hepatocellular function, avoiding portocaval encephalopathy.

Characterization of adherence of nontypeable Haemophilus influenzae to human epithelial cells.

The adherence of 58 nontypeable Haemophilus influenzae isolates obtained from patients with otitis media or chronic obstructive pulmonary disease (COPD) and obtained from the throats of healthy individuals to Chang and NCI-H292 epithelial cells was compared. Otitis media isolates, but not COPD isolates, adhered significantly more to both cell lines than did throat isolates. Since high-molecular-weight (HMW) proteins are major adhesins of nontypeable H. influenzae, the isolates were screened for HMW protein expression by Western blotting with two polyclonal sera and PCR with hmw-specific primers. Twenty-three of the 32 adhering isolates (72%) and only 1 of the 26 nonadherent strains were HMW protein or hmw gene positive. Among the 32 isolates adhering to either cell line, 5 different adherence patterns were distinguished based on the inhibiting effect of dextran sulfate. Using H. influenzae strain 12 expressing two well-defined HMW proteins (HMW1 and HMW2) and its isogenic mutants as a reference, we observed HMW1-like adherence to both cell lines for 16 of the 32 adherent isolates. Four others showed HMW2-like adherence to NCI-H292. Of the three other patterns of adherence, one probably also involved HMW protein. Screening of the isolates with six HMW-specific monoclonal antibodies in a whole-cell enzyme-linked immunosorbent assay showed that the HMW proteins of COPD isolates and carrier isolates were more distinct from the HMW proteins from H. influenzae strain 12 than those from otitis media isolates. Characterization of the HMW protein of a COPD isolate by adherence and DNA sequence analysis showed that despite large sequence diversity in the hmwA gene, probably resulting in the antigenic differences, the HMW protein mediated the HMW2-like adherence of this strain.

Splenic metastasis of a fallopian tube adenocarcinoma.

Clinical, diagnostic and therapeutic characteristics of a case of a fallopian tube adenocarcinoma splenic metastasis are reported. This case illustrates the diagnostic difficulties of this situation. These difficulties are both related to the poorly specific symptomatology and the low specificity of the current imagery. Percutaneous biopsy aspiration guided by ultrasonography or CT-scan could be helpful. The treatment is surgery, eventually combined with adjuvant radiotherapy: it can allow a long survival time. Splenic metastasis should be systematically checked up in every tumoral context.

[Evolution of the surgical treatment of chronic pancreatitis over the last 25 years]. / Evolution sur 25 ans du traitement chirurgical de la pancreatite chronique.

The author briefly reminds us of the physiopatholopy of chronic pancreatitis (CP) and of its two principal surgical therapies: the excision (mainly cephalic or caudal) and the derivations (essentially towards an excluded jejunal ring). In order to avoid such a mutilation, either pancreatic or jejunal for the treatment of obstructive "pancreatic lithiasis", the author proposes to classify the lesional repercussions in cavitary CP (in which the existence of a pseudocyst is dominant) and in parenchymatous CP (ensheating the ducts, that are more or less dilated). He infers from this the possibility of a treatment that is as physiological as possible, essentially by cystoduodenostomy (CD) with a tripod forceps, for CP with a dominant cavitary type (with pseudocysts showing a cephalic and/or a corporeocaudal localization) and by wirsungosphincteroclasia (W-SC) for the CP with a parenchymatous prevalence. This therapeutic evolution, aiming at abandoning the classical operations of excision or derivation is based upon the author's experience acquired since 1970. During these 25 years, the author operated on 549 patients showing a CP with several severe evolutive complications. Beside 75 exopancreatic operations, the author performed 474 operations selectively concerning the pancreas: 245 excision operations and 228 derivation operations. Since the introduction, in October 1986, of the W-SC operation, among the 169 recent pancreatic operations for severe CP, only 10 exeresis operations were performed: 66 CD (41.5%) and W-SC 92 (57.9%), coupled in two thirds of the cases with a biliodigestive cholecystoplasty. The very encouraging results of this more physiological and non-mutilating treatment of severe CP justify, according to the author, forsaking the classical techniques of parenchym-exeresis or of derivation to an excluded ring an favour of a direct drainage into the duodenum both for a cavitary CP by CD as for a parenchymatous CP by W-SC.

Effects of promethazine on ischemic and reperfusion arrhythmias in rat heart.

The effects of the H1-receptor antagonists promethazine, mepyramine, and chlorpheniramine on ischemic and reperfusion arrhythmias were studied in the isolated perfused rat heart. Promethazine reduced both ischemic and reperfusion arrhythmias (2 x 10(-6)M-7.5 x 10(-6)M). Mepyramine and chlorpheniramine decreased these arrhythmias but at concentrations about 10 times higher. The H2-blockers cimetidine and ranitidine had no antiarrhythmic effect. Promethazine also: (i) increased release of noradrenaline by the heart; and (ii) increased coronary flow in the reperfusion period and in some mildly ischemic zones. It is proposed that promethazine exerts most of its antiarrhythmic effects by a nonspecific mechanism, possibly membrane stabilization; in addition, enhanced coronary flow may play a role.

[1st case of eosinophilic meningitis in Ivory Coat with the presence of a Parastrongylus sp. in the cerebrospinal fluid]. / Premier cas de méningite a éosinophiles en Côte-d'Ivoire avec présence d'un Parastrongylus sp. dans le liquide céphalo-rachidien.

The authors report the first observation, in West Africa, of eosinophilic meningitis in an ivorian child who ingested raw Achatina sp. The presence of a Parastrongylus. sp. in the cerebrospinal fluid was detected.