Incidence, prevalence, and mortality of type 1 diabetes in children and youth in Burkina Faso 2013-2022.

AIM: There are no data on type 1 diabetes (T1D) incidence and prevalence in Burkina Faso. We aimed to determine these in persons aged <25 years (y) since the implementation of Life for a Child (LFAC) program in 2013. PATIENTS AND METHODS: Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, abrupt onset of symptomatic hyperglycemia, need for insulin replacement therapy from diagnosis, and no suggestion of other diabetes types. RESULTS: We diagnosed 312 cases of T1D <25y in 2013-2022. Male-to-female ratio was 1:1. T1D incidence <25y per 100,000 population/year increased from 0.08 (CI 95% 0.07-0.60) in 2013 to 0.34 (CI 95% 0.26-0.45) in 2022 (p=0.002). Incidence <15y/y rose from 0.04 (CI 95% 0.01-0.10) to 0.27 (CI 95% 0.18-0.38) per 100,000/year in 2013 and 2022, respectively (p < 0.002). Prevalence per 100,000 population <25y was 0.27 (CI 95% 0.19-0.37) in 2013 and rose to 1.76 (CI 95% 1.546-1.99) in 2022 (p<0.0001). Mortality rate was 20 (CI 95% 13-29.6) per 1,000-person y. CONCLUSIONS: There is a low but sharply rising T1D incidence and prevalence rates in children and youth in Burkina Faso since LFAC program implementation. It is very likely this is partly due to improved case detection. Mortality remains substantial.

Skin oncoplasties: O-to-Z technique a technique of choice in situation of limited resources? Case of Burkina Faso.

BACKGROUND: In developing countries, the long delays in consultation lead to a delay in diagnosis and management of the skin tumors. The lesions are often large and bring the problem of skin coverage after their resections. Several reconstruction techniques allow skin coverage. The objective of this study is to describe the place of O-to-Z technique in the surgical treatment of skin cancers in Ouagadougou. We hypothesized that O-to-Z technique reduces healing times and the number of dressings compared with directed wound healing. PATIENTS AND METHODS: It was a two-center, retrospective, descriptive study on O-to-Z technique in skin cancers. It included patients who underwent surgery between January 1st, 2013 and March 30th, 2021 in Ouagadougou. Scar quality and healing time in Z-plasty were compared with those of secondary healing. We used the Student's t test. RESULTS: In 8 years and 3 months, 171 skin cancers were identified. The mean time to consultation was 13.6 months. The average size of the tumors was 9 cm. An O-to-Z technique was performed in 42 cases, being 58.3% of the patients operated on. The average healing time was 15 days. It was four and a half times shorter in O-to-Z technique than in secondary healing. Ischemic necrosis of the Z-corner was noted in 7 cases. The recurrence rate in O-to-Z technique and secondary healing was 7.1% and 9.1% respectively. Hypertrophic or keloidal scars were noticed in 7 cases and hypochromia in 2 cases. CONCLUSION: O-to-Z technique is a technique of choice for skin coverage after large resections in surgical oncology. It reduces the healing time and the cost of postoperative care without increasing the risk of tumor recurrence.

Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso.

Several studies report norovirus as the new leading cause of severe gastroenteritis in children after the global introduction of rotavirus vaccines. Burkina Faso introduced general rotavirus vaccination with the oral pentavalent vaccine RotaTeq in November 2013 and quickly reached a vaccine coverage of >90%. This study describes detection rates, clinical profiles and the molecular epidemiology of norovirus and rotavirus infections in 146 children aged <5 years with severe acute gastroenteritis in Ouagadougou, consecutively enrolled from a hospital between January 2015 and December 2015. Virus detection was performed with an antigen test or real-time polymerase chain reaction (PCR) and genotyping was performed by nucleotide sequencing or multiplex PCR. Rotavirus was found in 14% and norovirus in 20% of faecal samples. Norovirus infection was significantly more associated with severe dehydration compared to rotavirus (P < 0.001). Among genotyped norovirus samples 48% (12/25) belonged to GII.4 which caused significantly more diarrhoeal episodes than non-GII.4 genotypes (P = 0.01). The most common rotavirus genotypes were G2P[4] (30%), G12P[6] (25%) and G12P[8] (20%). Fifty percent of the rotavirus positive children were infected with fully or partly heterotypic strains. In conclusion, this study found a higher proportion of norovirus causing more severe symptoms in children with diarrhoea in Burkina Faso after the introduction of rotavirus vaccination.

Angiomas at the university hospital of Yalgado Ouedraogo in Ouagadougou, Burkina Faso: Epidemiological and clinical profile.

Angiomas are vascular abnormalities that affect less than 1% of the world's population. Data on these disorders in Africa are limited. The purpose of our work was to study the epidemiological and clinical aspects of angiomas in the Dermatology-Venerology Department of the University Hospital of Yalgado Ouedraogo in Ouagadougou (Burkina Faso) to contribute to improving knowledge of this group of pathologies in our region. This cross-sectional descriptive, retrospective, and prospective study covers cases from 1998 through 2014. We identified 61 patients with angioma, 67.2% of them younger than 30 months. The sex ratio was 0.56. Vascular tumors (hemangiomas) accounted for 43 cases (70.5%) and vascular malformations 18 (29.5%). Lesions appeared between 0 and 15 days of life in 57.4% of cases. Their size ranged from 1 to 3 cm in 49.2% of cases. They were most frequently located on the head (49.2%). The most frequent clinical forms were cutaneous hemangiomas (tuberous) (36 cases), followed by the nevus flammeus (8 cases), and mixed hemangiomas (7 cases). Only one complex forms was observed: one case of Klippel-Trenaunay syndrome. Superficial vascular abnormalities are rare in our dark skin type context including infantile hemangiomas. The clinical peculiarities of the angiomas observed in this African series in Ouagadougou seem quite similar to the characteristics described in European and American series.

[Ekbom syndrome or delusional parasitosis: Three cases in Ouagadougou (Burkina Faso)]. / Syndrome d'Ekbom ou parasitose délirante : trois cas à Ouagadougou, Burkina Faso.

INTRODUCTION: Ekbom syndrome is a rare disease characterized by a delusional conviction on the part of the patient of infestation with cutaneous parasites. It is rarely described in an African setting. Herein we report three cases observed in Ouagadougou. PATIENTS AND METHODS: Case 1: a 40-year-old housewife, living alone since her spouse left her, consulted for a feeling of insects under the skin and exulceration progressing over the previous year. A diagnosis was made of Ekbom syndrome in a depressed patient. Case 2: a 45-year-old bachelor, unemployed and with no children, consulted in dermatology for a sensation of continuous movement of insects under his skin, experienced over the previous six years. This sensation, which was worse in hair-covered areas, led to regular hair removal and untimely cleansing in a bid to dislodge them. Case 3: an 80-year-old patient, widowed for 3 years, consulted for a sensation of insects under her skin over the previous 2 years. This sensation was accompanied by intermittent pruritus and she removed the "insects" from her skin, which she brought to us in a sachet, but which in reality corresponded to debris of dead skin. We concluded on Ekbom syndrome in a depressive patient. CONCLUSION: These three cases of delusional parasitism observed in Ouagadougou, Burkina Faso, confirm the main clinical characteristics of Ekbom syndrome and underline the role of emotional and financial isolation, as well as pre-existing psychological difficulties, as potential triggers for this syndrome.

Intra-test and test-retest reliability of exercise oximetry in arterial claudication.

BACKGROUND: Transcutaneous oxygen pressure (tcpO2) reliability is blunted by an unpredictable transcutaneous gradient through the skin. We hypothesized that the "Decrease from Rest of Oxygen pressure (DROP: subtraction of limb-changes from chest-changes from the respective starting values) would show a good to excellent reliability during Exercise -tcpO2 investigations. METHODS: In three different experiments we tested: The intra-test variability at the peripheral level (Experiment A: 32 patients, 16 at each location), at the chest level (Experiment B: 45 patients) and the test-retest reproducibility within 3 months (Experiment C: 67 patients). We calculated the intra-class coefficient of correlation (ICC) with 95% confidence interval [Lower/upper limit]. ICC between 0.60 and 0.749 indicate a good agreement. ICC above 0.750 indicates an excellent agreement. RESULTS: ICC values for DROP-min were 0.848 [0.723/0.935] at the buttock and 0.920 [0.846/0.967] at the calf levels, in experiment A; ICC were 0.873 [0.799/0.923] at the buttock and 0.898 [0.790/0.953] at the calf levels, in experiment B; 0.806 [0.716/0.871] at then buttock level (n = 67) and 0.807 [0.722/0.868] at the calf in experiment C. CONCLUSIONS: Intra-test and test-retest reliability is excellent using the DROP calculation for exercise-tcpO2 investigations.

Contrôle qualité et étude de comprimabilité des poudres de feuille de Moringa oleifera (lam) et de pulpe du fruit de Adansonia digitata

Moringa oleifera (LAM), arbre tropical à usages multiples, constitue de nos jours une nouvelle ressource alimentaire et économique pour les pays du Sud. Ces feuilles sont faciles d'accès et très riches en protéines, en vitamines et en minéraux. Elles sont de plus en plus utilisées dans des projets luttant contre la malnutrition. Cependant, le goût, la présentation et la qualité de ces produits demeurent une préoccupation majeure nécessitant des adaptations innovantes. L'objectif de cette étude était d'étudier la comprimabilité des poudres de feuilles de Moringa oleifera en améliorant le goût avec des matières premières locales et facilement accessibles comme la poudre de pulpe de Andansonia digitata. Les propriétés physico-chimiques et les tests pharmacotechniques ont permis de contrôler la qualité des poudres, des comprimés et orienter le choix du procédé de fabrication. Cinq (5) types de formulations (F1 à F5) ont été réalisés et les comprimés ont été fabriqués par compression après granulation par la voie sèche. Les comprimés des formulations F4 et F5 ont donné de meilleures propriétés pharmacotechniques selon les recommandations de la pharmacopée Européenne 6.0. L'association des deux poudres offre une alternative pour la fabrication de comprimés à croquer avec un goût acceptable

Crosse aortique droite et lobe de la veine d'Azygos : une association extrêmement rare

Le lobe de la veine d'Azygos et la crosse aortique droite, représentent chacun une variante anatomique extrêmement rare dont le diagnostic pris isolément est simple à la radiographie thoracique. En revanche le diagnostic radiographique de leur association peut être un challenge. Nous rapportons un cas de lobe de la veine d'Azygos méconnu à la radiographie pulmonaire en incidence de face, en présence d'une crosse aortique droite

Breast and pleuropulmonary metastasis of multirecurrent scalp dermatofibrosarcoma protuberans: a case report.

BACKGROUND: Dermatofibrosarcoma protuberans is a rare tumor, representing about 0.1% of skin malignant tumors. It is characterized by local aggressiveness with significant potential for recurrence. Although metastasis is rare, it does occur. We report a case of a Burkinabe woman with dermatofibrosarcoma protuberans. CASE PRESENTATION: A 27-year-old Burkinabe woman consulted our institution for a recurrent scalp nodule that had been evolving for 13 years. At clinical examination, she was in good condition with a dry cough. An atrophic scarring alopecic plaque of 15-cm diameter in the right parietal region of the scalp, topped by an erythematous firm nodule measuring 3 × 2 × 2 cm, was noted, as well as a mobile nodule located in the axillary tail of the right breast. Cerebral computed tomodensitometry had not objectified the reach of the vault or the brain. A thoracic scan revealed four intrathoracic tissue masses straight to pleural touch. There were no evolutionary lesions in the abdominopelvic region. Histopathologic examination of the biopsy of the scalp nodule showed a proliferation of fibrous background, with fusiform cells carrying a storiform appearance. These cells had dark, elongated nuclei and showed some mitosis without atypia. The cells expressed CD34 intensely and diffusely. The test results were negative for PS100 and smooth muscle actin. The breast nodule showed the same profile as the scalp nodule. CONCLUSIONS: We concluded on the diagnosis of scalp dermatofibrosarcoma protuberans with breast metastasis and probable pleuropulmonary metastasis.

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital

Comparison of reported symptoms to those produced by treadmill testing in patients with claudication suspected of arterial origin.

AIM: We aimed at comparing lower limb symptoms reported by history to those observed during a standard treadmill test. METHODS: We retrospectively studied symptomatic patients referred over a three years period for suspected arterial claudication and used the Edinburgh claudication questionnaire before exercise and symptoms observed on a treadmill. We confronted, right and left, proximal (lower-back thigh or buttocks) and distal (leg or foot) lower-limb symptoms before and during treadmill exercise. Results are reported as mean ± standard deviation for percentage and 95% confidence interval and Kappa statistics are performed. RESULTS: Of 795 patients with claudication, aged 63 ± 12 years, treadmill test resulted in 715 reporting lower-limb symptoms on treadmill. Cohen's Kappa for the site-specific analysis of symptoms by history vs. symptoms on treadmill was 0.509 ± 0.21 (P < 0.01), showing a moderate agreement. Nevertheless, symptoms on treadmill reproduced, at least partly, symptoms by history in 675 (84.9% 95CI: 82.3-87.2) of patients, although symptoms on treadmill were strictly of the same localizations as symptoms by history in only 378 (47.6% 95CI: 44.1-51.0) of all studied patients. Last, 279 patients (35.1% of all patients) reported non limb symptoms on treadmill. CONCLUSION: Although on a site by site basis the concordance of symptoms by history to symptoms by treadmill is moderate, most patients reproduced their usual symptoms on treadmill. Age does not seem to impair the concordance. Last, beyond the sole measurement of maximal walking capacity, treadmill frequently unmasks non-limb limiting symptoms that may require clinical attention.

External validation of the "walking estimated limitation calculated by history" (WELCH) questionnaire in patients with claudication.

OBJECTIVE: To externally validate the recently proposed "Walking Estimated Limitation Calculated by History" (WELCH) questionnaire. METHODS: A prospective study was performed on 450 new patients referred to our laboratory for treadmill testing (constant load 3.2 km/h and 10% slope for 15 minutes and then incremental increases). Results are presented as mean ± SD or median [25th-75th percentiles] or number (percentage). An ankle brachial index <0.90 defined the presence of peripheral artery disease (PAD). Typical "vascular-type claudication" is a lower-limb pain or discomfort that is absent at rest, appears at exercise, forces stopping, and disappears within 10 minutes of exercise stopping. The Spearman r coefficient of correlation between maximal walking time (MWT) on treadmill and WELCH scores was calculated for patients with (PAD+) or without (PAD-) PAD, and reporting typical vascular-type claudication (VTC+) or not (VTC-). RESULTS: The WELCH score was obtained in all included patients. The number (%) of patients with a WELCH score <25 was 37 (54%), 198 (65%), 14 (44%), and 18 (38%), and the Spearman correlation coefficient between WELCH score and treadmill MWT was 0.588, 0.609, 0.581, and 0.591 in the VTC-/PAD+, VTC+/PAD+, VTC-/PAD-, and VTC+/PAD- groups respectively (all p < .001). In PAD+/VTC+ patients, the WELCH positive predictive value for the inability to walk for 5 minutes on the treadmill was 79%. CONCLUSION: The WELCH score correlates moderately with treadmill-walking capacity in patients with or without PAD, and with or without typical VTC. It appears to be a simple to complete and easily scored instrument to help clinicians standardise the subjective estimation of walking capacity in their patients.

[Assessment of knowledge and pain management by traumatological emergencies staff of the teaching hospital of Ouagadougou]. / Evaluation des connaissances et pratiques du personnel des urgences traumatologiques de Ouagadougou sur la prise en charge de la douleur.

INTRODUCTION: Pain is a frequent reason of consultation in traumatological emergencies. Its management is characterized by oligoanalgesia whose causes are multiple. The purpose of this study is to assess the knowledge and practices of pain management by traumatological emergencies staff of the teaching hospital Yalgado Ouedraogo of Ouagadougou. MATERIALS AND METHODS: A questionnaire survey of health workers performing in traumatological emergencies has been conducted. Two different questionnaires, one for medical staff and one for the paramedics were administered. RESULTS: A total of 67 health workers participated in the study with a participation rate of 98% and 100%, respectively, for the medical and paramedical staff. According to their report, 65.3% of medical and 77.7% of paramedical staff had never received training on pain and its management. For 85.7% of physicians, pain should be assessed before treatment, but 79.6% of them didn't know any conventional pain assessment method. All the nurses and 40.8% of physicians felt that pain in the emergency services should not be treated immediately to prevent misdiagnosis. Morphine and regional anesthesia were not used for pain treatment in the emergency room. 10.2% of medical staff and 27.8% of the paramedics said that they systematically search for the analgesicsside effects. CONCLUSION: The knowledge of health workers about pain and its management is insufficient. The lack of training of health workers on the management of pain is the cause and contributes to explain the oligoanalgesia in this service.

INTRODUCTION: La douleur est un motif fréquent de consultation aux urgences traumatologiques. Sa prise en charge est caractérisée par une oligoanalgésie dont les causes sont multiples. Le but de cette étude est d'évaluer les connaissances et pratiques du personnel des urgences traumatologiques du Centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou sur la prise en charge de la douleur. MATÉRIEL ET MÉTHODE: Une enquête par questionnaire auprès du personnel de santé exerçant aux urgences traumatologiques a été menée. Deux questionnaires différents, l'un pour le personnel médical et l'autre pour le personnel paramédical ont été administrés. RÉSULTATS: Au total, 67 agents de santé ont participé à l'étude avec un taux de participation de 98% et 100% respectivement pour le personnel médical et paramédical. Selon leur déclaration, 65,3% du personnel médical et 77,7% du personnel paramédicaux n'avaient jamais bénéficié de formation sur la douleur et sa prise en charge. Pour 85,7% des médecins, la douleur devrait être évaluée avant traitement mais 79,6% d'entre eux ne connaissaient aucune méthode conventionnelle d'évaluation de la douleur. L'ensemble des infirmiers et 40,8% des médecins estimaient que la douleur aux urgences ne devrait pas être traitée d'emblée afin d'éviter des erreurs diagnostiques. La morphine et l'anesthésie locorégionale n'étaient pas utilisées aux urgences pour traiter la douleur. 10,2% du personnel médical et 27,8% du personnel paramédical ont affirmé rechercher systématiquement les effets secondaires des antalgiques. CONCLUSION: Les connaissances des agents de santé sur la douleur et sa prise en charge sont insuffisantes. L'absence de formation du personnel de santé en algologie en est la cause et contribue à expliquer l'oligoanalgésie observée dans ce service.

Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso.

OBJECTIVE: To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. METHODS: This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. RESULTS: Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. CONCLUSIONS: Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.

[Surgical abdomen caused by traditional treatment. Five-case report in teaching hospital Yalgado Ouédraogo of Ouagadougou]. / Les abdomens chirurgicaux dus au traitement traditionnel. À propos de cinq cas au Centre hospitalier Yalgado Ouédraogo de Ouagadougou.

The traditional products used to treat some pains can cause serious complications of which surgical abdomen. We listed in two years five cases of surgical abdomen complicating a traditional treatment in the service of digestive and general surgery of the hospital complex Yalgado Ouédraogo. There were two men and three women with an average age of 34,4 years. These traditional products were used to treat constipation, sexual impotence, sterility and to "posses" her husband. Oral and rectal routes were used by one and three patients respectively, another patient used triple routes (oral, rectal and vaginal). The digestive lesions were in the upper tract in one case (gastric phytobezoar), two patients presented acute intestinal occlusion and two others acute generalized peritonitis. All the five patients underwent laparotomy. Two patients died in immediately post-operative course. The prevention of severe surgical complications of the digestive tract induced by traditional treatments has to be broadcasted through information, education and communication.

Estimation of running capacity can likely be removed from questionnaires estimating walking impairment in patients with claudication.

OBJECTIVE: The Estimating Ambulation Capacity by History-Questionnaire (EACH-Q) and the Walking Impairment Questionnaire (WIQ) are used to estimate maximal walking distance (MWD). The EACH-Q and WIQ included 4 and 14 items respectively, among which one item dealing with running capacity. We hypothesised that this item was of little interest in patients with claudication. DESIGN: The WIQ and EACH-Q were self-completed and corrected before a constant load (3.2 km h(-1); 10% slope) treadmill tests, maximised to 15 min. PATIENTS: 371 patients (298 males/73 females, 62.9 ± 11.2 years). METHODS: The number of errors (duplicate, absent or paradoxical answers to one item) and correlation of questionnaire scores with MWD on treadmill were calculated, before and after skipping the answer to the running item. RESULTS: The proportion of questionnaires with errors was 27% with the EACH-Q and 48% with the WIQ. Two-hundred and twenty-one (59.6%) and 245 (66%) out of 371 patients reported to be unable to run, for the EACH-Q and WIQ, respectively. The rate of errors was reduced by 15% for the EACH-Q (p < 0.05) when skipping the running item for scoring. The correlation coefficients between the MWD and the questionnaire scores were 0.449 and 0.485 for the EACH-Q and were 0.571 and 0.572 for the WIQ, before and after skipping the running item, respectively. CONCLUSION: Most of our patients reported to be unable to run and skipping the running item reduce the rate of errors in self-completing the questionnaires without impairing the correlation of questionnaire scores with treadmill results. It is likely that the running item could be removed from the WIQ and EACH-Q questionnaires.

[Acute bacterial meningitis with soluble antigen detected by latex particle agglutination tests at the Sourô-Sanou University Hospital of Bobo-Dioulasso (Burkina Faso)]. / Méningites bactériennes aiguës à recherche d'antigène soluble positive au CHU de Sourô-Sanou de Bobo-Dioulasso (Burkina Faso)

INTRODUCTION: Acute bacterial meningitis constitutes a major public health problem in Burkina Faso, in part because of its high lethality rate, estimated in 2004 at 17.5%. Failure to confirm suspected cases of meningitis results in overestimating reported cases and incorrectly treating false positives. The latex particle agglutination test is a diagnostic alternative that overcomes these limitations. OBJECTIVE: Determine the bacteriological and therapeutic profile as well as the course of cases of acute meningitis confirmed by the latex agglutination test at Sourô-Sanou University Hospital. METHODS: This prospective longitudinal study took place over a one-year period (2008 to 2009). Data were collected from clinical and laboratory records. The diagnosis of meningitis was confirmed by testing for specific soluble antigens in the spinal fluid. We used the Pastorex(™) Meningitis Kit for that purpose. The threshold of significance selected for our study was 0.05. RESULTS: In all, 457 samples of spinal fluid from patients with suspected acute bacterial meningitis were analyzed and the latex test was performed in 438 of these samples: 154 (35.2%) were positive. The average age of our cases confirmed by the latex test was 13.2 ± 4.2 years old. This test confirmed more cases than any other method of identification. The therapeutic strategy used from one to four treatment agents. Streptococcus pneumoniae was the most virulent and the most lethal pathogen, with a 64.7% lethality rate. CONCLUSION: The earliness of the consultation and the treatment of the bacterial meningitis seem to have a positive effect on the course of disease.

Exercise treadmill testing in patients with claudication, with and without diabetes.

AIM: To compare symptoms and walking capacities of patients with and without diabetes reporting vascular-type claudication. METHODS: We recorded self-reported maximal walking distance, maximal walking distance on treadmill test (3.2 km h(-1) , 10% slope), exercise transcutaneous oxygen pressure DROP index [limb transcutaneous oxygen pressure (TcpO2) changes from rest minus chest TcpO2 changes from rest] and symptoms on treadmill in 230 patients with diabetes and 982 patients without diabetes. Exercise-induced proximal and distal symptoms were analysed in the perspective of underlying proximal and distal ischaemia (DROP value < negative 15 mmHg). RESULTS: Self-reported maximal walking distance did not differ between groups, whereas maximal walking distance on treadmill test was lower in patients with diabetes vs. patients without diabetes (261 ± 257 and 339 ± 326 m, respectively; P < 0.05 when adjusted for potential confounders). In patients with ischaemia, the number of ischaemic areas (proximal and/or distal on right and/or left) was comparable between the two groups. Patients with diabetes had more distal ischaemia than patients without diabetes (38 vs. 29%, respectively; P < 0.01), whereas proximal ischaemia was similar between groups. The prevalence of lower-limb exercise-related symptoms without ischaemia was comparable between groups. There were more symptoms other than lower-limb pain in patients with diabetes than patients without diabetes (29.6 vs. 18.3%, respectively; P < 0.01). CONCLUSIONS: Patients with diabetes show more severe limitation on the treadmill and more non-limb symptoms than patients without diabetes, although self-reported walking capacity is comparable between the two groups. Using TcpO2, we confirm that patients with diabetes reporting claudication show more distal ischaemia than patients without diabetes, with no difference at the buttock level. Treadmill testing is of interest in patients with peripheral artery disease and diabetes.

Chest tcpO2 changes during constant-load treadmill walking tests in patients with claudication.

Changes in chest transcutaneous-pO(2) at rest (ΔtcpO(2)) mimic absolute changes in arterial-pO(2) during moderate exercise, although the absolute starting values may dramatically differ. We retrospectively studied 485 patients (group 1), prospectively studied 292 new patients (group 2) and estimated the intra-test and the test-retest reproducibility of ΔtcpO(2) during constant-load treadmill tests: 3.2 km h(-1), 10% grade, using the cross correlation technique. Patients were classified into groups according to their best fit to nine pre-defined mathematic models. Respectively, 71% and 76% of patients of groups 1 and 2 fitted with a model showing a ΔtcpO(2) increase during and a decrease following exercise. Another 18% and 12% of the patients of groups 1 and 2 respectively fitted with a model that showed an abrupt decrease at exercise onset, a slow increase during walking and an overshoot in the recovery period, referred here as a walking-induced transcutaneous hack (WITH) profile. The mean r(max) value for the cross-correlation analysis was 0.919 ± 0.091 and 0.800 ± 0.129 for intra-test and test-retest reproducibility. Most profiles show the expected ΔtcpO(2) exercise-induced increase. Future studies are needed to confirm and explain the WITH profiles that we found, and screen for potential-associated diseases.

Limitations of self-reported estimates of functional capacity using the Walking Impairment Questionnaire.

OBJECTIVE: A potential issue with the Walking Impairment Questionnaire (WIQ) is that it is relatively complex. We estimated the number of errors made by patients when self-completing the WIQ, and assessed the benefit of correcting missing, duplicate or paradoxical (i.e., reported lower difficulty for a higher-intensity task) answers. DESIGN: Prospective non-interventional study. MATERIALS: All consecutive new patients with claudication over a 3-month period. METHODS: The WIQ was self-completed before patients performed a constant-load treadmill walking test (maximised to 750 m). MAIN OUTCOME MEASURE: We analysed the coefficient of determination of the linear relationship between overall WIQ score (mean of the available subscales when at least two subscales are available) and treadmill maximal walking distance (MWD), before and after correction of errors. RESULTS: We studied 73 patients. Thirty-seven questionnaires had to be corrected for one or more errors. The coefficient of determination between the overall WIQ score and MWD was R(2) = 0.391 (n = 56) and R(2) = 0.426 (n = 73) before and after correction, respectively. CONCLUSION: Supervision of self-completed WIQs detects errors in almost half of the questionnaires, resulting in a missing overall WIQ score in 23% of cases among uncorrected questionnaires. The overall WIQ score correlates only moderately with MWD, even after correction. CLINICAL TRIAL REGISTRATION: NIH database: NCT01114178.