Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

EPILEPTIC SEIZURES REVEALING STURGE WEBER'S DISEASE IN A TROPICAL ENVIRONMENT: STUDY OF EIGHT CASES.

In sub-Saharan Africa (SSA), the etiological factors of epilepsy are multiple and phacomatoses, in particular Sturge weber's disease, are rarely reported due to under-medicalization and insufficient multidisciplinary care. We carried out a retrospective study of 216 patients hospitalized for recurrent epileptic seizures between 2015 and 2022 in the neurology and pediatrics department of the University Hospital Center of Conakry, among whom eight (8) patients were identified for Sturge Weber's disease in order to reassess this pathology from a clinical and paraclinical point of view in a tropical environment. Sturge Weber's disease was retained in eight (8) on the presence of symptomatic partial epileptic seizures (age 6 months to 14 years) with frequency of status epilepticus, homonymous lateral hemiparesis linked to occipital involvement, piriform calcifications on imaging and ocular disorders. The delay in consultation and medical care revealed severe mental deterioration in our patients. This study shows a stereotyped clinical picture in a context of aggravation of signs related to a delay in multidisciplinary management. These results are important for the diagnostic, therapeutic and prognostic discussion.

GAYET WERNICKE'S ENCEPHALOPATHY AFTER COVID-19 IN ELDERLY SUBJECTS IN TROPICAL ENVIRONMENTS: STUDY OF SIX (6) OBSERVATIONS IN CONAKRY.

In sub-Saharan Africa, the COVID-19 pandemic has caused severe malnutrition in elderly populations with the appearance of vitamin deficiencies, in particular thiamine responsible for Gayet Wernicke's encephalopathy (EGW). We present a series of six (6) patients hospitalized in the Neurology Department of the CHU Ignace Deen for the management of a brain syndrome with vigilance disorders after recovery from COVID-19, including oculomotor disorders, motor incoordination on a course of severe weight loss. The six patients underwent an evaluation of malnutrition by determining the WHO body mass index, the Detsky index, the serum albumin assay, the thiamine assay and a neuroradiological assessment (MRI) and an electroencephalogram (EEG) examination although this does not seem necessary for diagnosis. Study of nutritional status: weight loss greater than 5%, patients in Desky group B and C, plasma albumin<30 g/l, lowered thiamine and MRI neuroradiological data: by the existence of hypersignals in certain regions of the neocortex, certain gray nuclei, the mammillary bodies the thalamic nuclei close to the wall of the 3rd ventricle and the regions bordering the 4th ventricle sign Gayet Wernicke's encephalopathy syndrome. This study shows a stereotyped clinical, biological, neuroradiological and evolutionary profile of Gayet Wernicke's encephalopathy in elderly subjects recovered from Covid-19 with proven malnutrition. These results are useful for the therapeutic and prognostic discussion.

Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study.

OBJECTIVE: Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. METHODS: Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. RESULTS: Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. CONCLUSIONS: Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

OBJECTIF: L'hémorragie intracérébrale (HIC) semble plus répandue en Afrique subsaharienne (ASS) que dans les pays à revenu élevé (PRE), avec des résultats cliniques moins bons. Un impact plus élevé de l'hypertension et/ou de l'angiopathie amyloïde pourrait expliquer cette disproportion. Ici, nous avons cherché à (i) comparer rétrospectivement les schémas cliniques et d'imagerie de l'HIC en Belgique et en Guinée et dans une cohorte subséquente (ii) comparer de manière prospective les caractéristiques de l'IRM cérébrale pour rechercher des preuves d'une proportion différente des profils d'angiopathie amyloïde. MÉTHODES: 91 patients consécutifs admis pour HIC spontanée à l'hôpital Erasme-ULB de Bruxelles et à Ignace Deen-UGANC de Conakry ont été rétrospectivement comparés en termes de volume d'HIC estimé avec la méthode ABC/2, les caractéristiques cliniques et le score de classement modifié (mRS) à 30 jours. Le mRS a été dichotomisé en bons résultats (≤3) et mauvais résultats (>3). Une cohorte prospective de 30 patients consécutifs atteints d'HIC admis au CHU Ignace Deen-UGANC de Conakry a été incluse de manière prospective pour subir une IRM cérébrale. Les résultats de l'IRM guinéenne ont été comparés à ceux de 30 patients sélectionnés aléatoirement dans la cohorte initiale de Bruxelles. Le test t de Student apparié et le test u de Mann-Whitney ont été utilisés pour les comparaisons de groupe. RÉSULTATS: L'âge d'apparition de l'HIC était plus élevé en Belgique (68 ± 17 ans vs 56 ± 14 ans, P < 0,01) tandis que le volume de l'HIC et le taux de mortalité à 30 jours étaient plus élevés en Guinée (20 ml vs 11 ml, P < 0,01 et mortalité 33% vs 10%, P <0,01). La charge de l'HIC chez les survivants à Conakry et à Bruxelles a montré respectivement de bons résultats dans 56,7% et 60,4% (P = 0,09) et de mauvais résultats dans 10,3% vs 29,6% (P < 0,001). L'analyse IRM de la cohorte prospective n'a pas permis de révéler de différences significatives concernant les caractéristiques de l'IRM cérébrale. CONCLUSIONS: L'HIC a touché des patients 15 ans plus jeunes en Guinée avec des volumes d'hématomes plus importants et une mortalité plus élevée qu'en Belgique. Les résultats de l'IRM n'ont pas montré de pathologie angiopathique amyloïde plus répandue, ce qui suggère qu'une meilleure prévention primaire de l'hypertension pourrait avoir un impact positif sur l'épidémiologie de l'HIC en Guinée.

Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry.

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.

Minimal Setting Stroke Unit in a Sub-Saharan African Public Hospital.

Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE (n = 318) and POST (n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.

Acute parasitic and other infectious myelopathies in the tropics: 26 cases at the University Hospital in Conakry.

In tropical countries, laboratory-confirmed diagnostic certainty of parasitic and other infectious causes of acute myelopathy is difficult because of a shortage of medical professionals and consulting delays. We performed a retrospective study of 168 patients hospitalized for spinal disorders between 2007 and 2013 and identified 26 diagnosed with acute non-compressive myelopathy of presumed sudden onset. An parasitic or other infectious cause was established for all. A preliminary clinical infection preceding the development of neurologic signs was reported for 22 patients (84.6 %). Neurological signs were limited to the existence of a progressive sensorimotor symptomatology with sphincter disorders.

[Complications of digestive ostomies in pediatric surgery]. / Complications des stomies digestives en chirurgie pediatrique.

AIMS: To determine the frequency and factors of complications of intestinal stomas. METHODS: This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete. RESULTS: We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment. CONCLUSION: The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma.

OBJECTIFS: Déterminer la fréquence et les facteurs de complications des stomies digestives. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective de 7 ans allant de Janvier 2004 à Décembre 2010, portant sur tous les enfants âgés de 0­15ans, ayant bénéficié d'une stomie et hospitalisés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les stomies d'alimentations et urologiques, ainsi que les enfants dont le dossier médical était incomplet. RÉSULTATS: Nous avons colligé 192 cas de stomies soit 27 cas/an. Nous avons noté une complication chez 91 patients (48%) de nos patients. L'âge moyen a été de 3,64±5,03 ans avec des extrêmes de 6 heures et 15ans. Les facteurs de complications ont été: l'indication opératoire, le type de stomie, la variété de la stomie, la technique chirurgicale et l'appareillage. CONCLUSION: La réalisation d'une bonne technique et un appareil adéquat seraient nécessaires pour réduire certaines complications des stomies.

La cryptorchidie : aspects epidemio-clinique et therapeutique au service de chirurgie pediatrique du CHU Gabriel Toure

Objectifs : Decrire les aspects epidemio-cliniques et analyser les resultats de la prise en charge des cryptorchidies. Materiels et methode : Il s'agissait d'une etude retro et prospective qui s'est deroulee du 1er Janvier 2005 a 31 Decembre 2009 et qui a porte sur tous les enfants de 1 a 15 ans traites pour cryptorchidie dans le service de chirurgie pediatrique du CHU Gabriel Toure. Resultats : En 5 ans nous avons collige 42 cas de cryptorchidie (8;4 cas/an). L'age moyen de nos patients a ete 6;48 ans. Trente et huit (90;5) patients ont ete recus pour vacuite scrotale et 4 patients (9;5) pour tumefaction inguinale. La cryptorchidie etait droite chez 24 malades (57;2); gauche chez 15 malades (35;7) et bilaterale chez 3 malades (7;1). L'orchidopexie conventionnelle a ete realisee chez 36 patients et la technique de Fowler- Stephens chez 6 autres. Apres 6 mois une retraction testiculaire a ete notee chez 2 malades (4;7). Apres 1 an elle a ete notee chez 6 malades (14;3) et une atrophie testiculaire chez 2 malades (4;7). La decouverte de la cryptorchidie est tardive dans nos pays. Un diagnostic et un traitement precoces assureraient un avenir fonctionnel et esthetique du testicule

[Ocular biometric values of the black African patient and theoretical consideration of the role of these values in various pathologies: analysis of 325 eyes]. / Valeurs biométriques de l'oeil du sujet africain de race noire et hypothèse du rôle dans certaines pathologies: à propos de 325 yeux.

INTRODUCTION: The international literature seldom refers to eye measurements of the black African patient. Therefore, the various patterns where biometry elements are used as constituents deserve reconsideration as they may not correspond to the eye of the black patient of our region. This study provides true measurements for the black African patient in Ivory Coast. It also establishes hypotheses by extrapolating the role of measurements in pathologies such as glaucoma. MATERIAL: and method: The study included 325 eyes of 217 male and female patients. All the patients underwent ocular keratometrics and echo biometrics to measure the depth of the anterior chamber, the width of the lens, and the total axial length with the ultrascan biometer using the contact method in A echometrics. RESULTS: The mean keratometry in women was significantly higher than in men (43.99 +/- 1.62 diopters vs 43.46 +/- 1.45 diopters). The anterior chamber was deeper in men (2.69 mm +/- 0.54 vs 2.53 mm +/- 0.48). The men's eyes were significantly longer, with an axial length of 23.26 mm +/- 1.07 vs 22.56 mm +/- 0.90. CONCLUSION: Significant biometric differences between men's and women's eyes, on the one hand, and between black African and white patients' eyes, on the other hand, can be observed. The reasons for these differences are several: they are natural, socioeconomic, and technical. If standard implant of a different power for black and white patients can be imagined, can we also infer that the biometrics of a black African patient predisposes him to a disorder such as glaucoma more than a white patient? Further in-depth studies could provide an answer to this question.

[Anatomopathologic, clinical and radiologic aspects of benign tumors of the prostate in Mali, 759 cases]. / Aspects anatomopathologiques, cliniques et radiologiques des tumeurs benignes de la prostate au Mali, a propos de 759 cas.

The benign prostate tumours are dominated by prostatic adenomyoma. They are the first uro-genital pathology worldwide. The objective of this work is to describe the anatomo-pathological, clinical and radiological aspects of benign prostate tumours in Mali. It is a retrospective study which was conducted in Bamako (Mali) form January 1998 to December 2003. It has involved 759 patients who had histological confirmed prostate adenoma in the Department of Urology in Point G University Hospital. The patients were classified according to age, the clinical exam, the rate of prostate specific antigen (PSA), the sonogram, the macro and microscopic exam. The average age of the patients is 75.5 years. The apical part of the prostate is the area mostly involved. The adenomyoma is the most frequent histological type (98% of the cases). A very clear radiological and macroscopic disparity was noticed. "The night pollakiuria" was the primarily clinical sign in all patients; the prostate specific antigen (PSA) is high among more than 80%.

Aspects anatomopathologiques, cliniques et radiologiques des tumeurs bénignes de la prostate au Mali à propos de 759 cas

Les tumeurs bénignes de la prostate sont dominées par l'adénomyome de la prostate, il constitue la première pathologie urologique dans le monde. Le but de ce travail est de décrire les aspects anatomopathologiques, cliniques et radiologiques des tumeurs bénignes de la prostate au Mali. Il s'agit d'une étude rétro et prospective qui s'est déroulée à Bamako (Mali) de janvier 1998 à décembre 2003, elle a concerné 759 patients porteurs d'un adénome de la prostate histologiquement prouvé et admis dans le service d'urologie du CHU du point G. Ces patients ont été appariés selon l'âge, l'examen clinique, le taux de l'antigène prostatique spécifique (PSA), l'examen échographique et l'examen macroscopique et microscopique. L'âge moyen de nos patients est de 71,5 ans, la partie crâniale de la prostate est la plus atteinte, l'adénomyome est le type histologique le plus fréquent(98% des cas). Une discordance radiologique et macroscopique très marquée a été notée. La pollakiurie nocturne est le signe clinique évocateur chez tous nos patients et l'antigène prostatique spécifique (PSA) est élevé chez plus de 80%

[Sickle cell beta-thalassemia leading to serious ischemic retinopathy: a study of 18 patients in Abidjan]. / Les bêtathalasso-drépanocytoses pourvoyeuses de rétinopathies ischémiques graves. A propos de 18 patients étudiés à Abidjan.

The authors in this study intended to demonstrate that S-beta thalassemia can lead to severe ocular hemorrhagic risks, as is true of the sickle cell form. Both forms are also comparable in terms of the risk of aseptic necrosis of the femoral head. Out of the 18 patients studied, 13 (72.2%) had sickle cell retinopathy. Three of 13 patients had already developed new vessels and risked intravitreous hemorrhage. The authors recommend that more vigilance be mounted for the detection of S-beta thalassemia so as to benefit from rigorous and systematic follow-up and early treatment. Retinal argon laser photocoagulation is only effective if a clear diagnosis is made early.

[Isolated palpebral tumor revealing Von Recklinghausen's neurofibromatosis: a case report]. / Tumeur palpébrale isolée révélatrice de la neurofibromatose de Von Recklinghausen.

INTRODUCTION: Von Recklinghausen's neurofibromatosis is the most frequent of phakomatoses. Its incidence is 1/2,500-3,000 births. It is inherited through a dominant autosomal mode with a strong prevalence and changing expression. Eye and skin signs are essential to diagnosis and this case provided a noteworthy example of a unilateral upper palpebral tumor revealing this disease. CLINICAL CASE: We report a case of a 6-year-old boy whose original clinical manifestation was a tumor on the upper eyelid of the right eye, present at birth. According to the anamnesis, this palpebral tumor gradually increased in size, causing a full ptosis. A biopsy exeresis of the tumor was carried out with an anatomicopathological study of the biopsy specimen, confirming the diagnosis. CONCLUSION: The anatomicopathological study of the biopsy specimen enabled diagnosis of a neurofibromatosis revealed by this isolated palpebral localization responsible for significant aesthetic and functional damage.

Method for correcting the wavelength misalignment in measured ultraviolet spectra.

A new method for correcting the wavelength misalignment in measured UV spectra is presented. It is based on a comparison between measured irradiances and irradiances computed from a radiative transfer code for a set of given atmospheric and solar conditions (250 < Dobson units < 450, 30 degrees < solar zenith angle < 75 degrees ). Results of tests run with spectra recorded on a clear-sky day by two spectroradiometers in a French UV spectral network station are analyzed. Applying the method once reduces shift to less than 0.05 nm. The smoothing included in the method enables detection of aberrant irradiance values and then completion of an initial quality control of measured spectra. A technique for assessing the instruments' slit function is also presented. The key algorithms needed to build a computer code based on this method are given.

Oeil et medecine tradipraticienne: a propos d'un cas de traitement intempestif

La medecine traditionnelle a survecu a l'epreuve du developpement de la medecine moderne dans nos pays et gagne meme de plus en plus de terrain. Malheureusement cette medecine mal dosee et surtout mal maitrisee peut provoquer des complications graves. Nous rapportons ici un cas qui illustre bien la gravite de la situation. Il s'agit du cas d'une exophtalmie maligne apparue chez un homme de 42 ans souffrant de maladie de Basedow. Il a ete traite par application des produits traditionnels. Les consequences sont effroyables

Glaucome a pression normale: probleme diagnostique

Les auteurs rapportent une serie de glaucomes a pression normale et soulignent les problemes diagnostiques qu'ils soulevent