[Pediatric orbital Rosai-Dorfman disease: An unusual case]. / Maladie de Rosai-Dorfman à localisation orbito-palpébrale de l'enfant : à propos d'une observation exceptionnelle.

INTRODUCTION: Rosai-Dorfman disease (RDD) is a sinus histiocytosis with massive lymphadenopathy. This rare condition is a benign disease of unknown etiology. Bilateral orbital localization of RDD is rare. OBSERVATION: The authors report the case of a 6-year-old child who presented with bilateral orbital-palpebral masses associated with chronic cervical lymphadenopathy. There were no laboratory signs of inflammation. Serological and tuberculosis screening tests were negative. Histopathological examination of a lymph node biopsy established a diagnosis of Rosai-Dorfman disease. The patient underwent surgical excision of the orbital lesions followed by long-term corticosteroid therapy. A favorable course was observed, with no sign of recurrence after one year of follow-up. CONCLUSION: Rosai-Dorfman disease is very rare in its bilateral orbital presentation. Histopathological diagnosis remains challenging. In Africa, the presence of chronic oculo-palpebral tumor associated with or without cervical lymphadenopathy must raise the suspicion of Rosai-Dorfman disease after ruling out tuberculosis and lymphoma.

Recreational Cannabis Legislation: substance use and impaired driving among Canadian rural and urban postsecondary students.

BACKGROUND: Investigation of cannabis use trends among emerging adults (EA, aged between 18 and 24 years) following 2018 Canadian Recreational Cannabis Legislation (RCL) is critical. EAs report the heaviest cannabis use in Canada and are particularly vulnerable to the onset of problematic substance use. OBJECTIVES: To describe and compare post-RCL use of cannabis and other state-altering substances, as well as the prevalence of impaired driving, among EA postsecondary students in both rural and urban settings, studying on one of five campuses in either Manitoba, Ontario, or Quebec. METHODS: For this quantitative cross-sectional study, a self-report survey was administered to 1496 EA postsecondary students in the months following RCL (2018-2019). Multiple logistic regression analyses were conducted to explore the influence of provincial and urban/rural living contexts on recreational cannabis use, other state-altering substance use and impaired driving behaviours, adjusting for sociodemographic variables. RESULTS: Statistically significant differences were observed between cohorts in almost all measures. Quebec students were more likely to have consumed cannabis during their lifetime (AOR = 1.41, 95% CI [1.05, 1.90]) than all other cohorts. Rural cohorts all had greater odds of reporting consumption of cannabis during the previous year compared to urban cohorts (AOR = 1.32, 95% CI [1.04, 1.67]). However, the relation between cannabis use in the last month and operating a motor vehicle after using cannabis (lifetime and past month) and living context differed between subjects in Quebec and those in the two other provinces. Quebec's students having lived mostly in urban contexts had greater odds of using cannabis in the past month and operating a motor vehicle after using cannabis (lifetime and past month) than those in rural contexts; the opposite was observed in Manitoba and Ontario. Differing interprovincial prohibitive/permissive legislation and licit cannabis infrastructure appeared to have little impact on post-RCL substance use. CONCLUSIONS: In Manitoba and in Ontario, rural/urban living context seems to better predict substance use and related road-safety practices, suggesting these trends supersede permissive/prohibitive provincial legislation and licit cannabis-related infrastructures. Further investigation into sociodemographic factors influencing state-altering substance use and impaired driving, and maintaining tailored cannabis misuse prevention campaigns, is warranted on Canadian campuses.

Three-dimensional ultrasound diagnosis of adenomyosis is not associated with adverse pregnancy outcome following single thawed euploid blastocyst transfer: prospective cohort study.

OBJECTIVES: The objectives of this study were (1) to assess the prevalence of ultrasound (US) features of adenomyosis in an infertile population undergoing in-vitro fertilization (IVF), (2) to define the inter- and intrarater agreement of three-dimensional (3D) US assessment of adenomyosis, and (3) to evaluate sonographic features of adenomyosis with respect to pregnancy outcome following transfer of a single thawed euploid blastocyst. METHODS: This was a prospective cohort study. Subjects scheduled to undergo a single thawed euploid blastocyst transfer between April and December 2017 at a large IVF center were eligible for inclusion. Enrolled subjects underwent endometrial preparation for frozen embryo transfer. 3D-US was performed on the day prior to embryo transfer, with images stored for subsequent evaluation. Subjects then underwent transfer of a single thawed euploid blastocyst, and pregnancy outcomes were collected. All 3D-US volumes were de-identified and reviewed independently by five reproductive endocrinologists/infertility specialists with expertise in gynecological US for the presence of seven sonographic features of adenomyosis: global uterine enlargement, myometrial wall asymmetry, heterogeneous echogenicity, irregular junctional zone, myometrial cysts, fan-shaped shadowing and ill-defined myometrial lesions. Adenomyosis was considered to be present if the majority of the reviewers noted at least one of the seven sonographic features. Inter- and intrarater agreement was evaluated using Fleiss's kappa. Clinical and cycle characteristics of subjects with and those without adenomyosis were compared. The primary outcome of interest was live birth rate. Secondary outcomes included clinical pregnancy rate and miscarriage rate. Logistic regression analysis was performed to account for potential confounders. RESULTS: A total of 648 subjects were included. The prevalence of adenomyosis on US was 15.3% (99/648). On retrospective chart review, very few patients with adenomyosis had symptoms. The inter- and intrarater agreement amongst five independent specialists conducting the 3D-US assessments of adenomyosis were poor (κ = 0.23) and moderate (κ = 0.58), respectively. Subjects with adenomyosis were older (37.1 vs 35.9 years, P = 0.02) and more likely to undergo a gonadotropin-releasing hormone agonist downregulation protocol when compared with those without adenomyosis (12.1% vs 5.1%, P = 0.02). Clinical pregnancy (80.0% vs 75.0%) and live birth (69.5% vs 66.5%) rates were similar between the groups. When adjusting for potential confounders, there was no difference in the rate of clinical pregnancy (adjusted odds ratio (aOR), 1.47 (95% CI, 0.85-2.56)), miscarriage (aOR, 1.3 (95% CI, 0.62-2.72)) or live birth (aOR, 1.28 (95% CI, 0.78-2.08)) between subjects with and those without adenomyosis. No individual sonographic marker of adenomyosis was predictive of pregnancy outcome. CONCLUSIONS: The inter-rater agreement of 3D-US assessment of adenomyosis is poor. Furthermore, sonographic markers of adenomyosis in asymptomatic patients may not be associated with altered pregnancy outcome following transfer of a single thawed euploid blastocyst. These findings suggest that routine screening for asymptomatic adenomyosis in an unselected infertile patient population undergoing frozen embryo transfer may not be warranted. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa.

BACKGROUND: While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. METHODS: We used data collected over 2010-2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. RESULTS: In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410-$US721 and US$468-US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: - 0.138 to 0.023 and - 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. CONCLUSIONS: Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00928187.

Severe infectious keratitis in tropical environments: 118 cases collected over 10 years.

INTRODUCTION: The aim of our study was to evaluate the clinical, microbiological, and contributing factors of microbial keratitis in tropical environment. Materiel and methods: We performed a retrospective study of all patients admitted to the ophthalmology department of Principal Hospital in Dakar for infectious keratitis, over ten years from January 2006 to December 2015. Clinical, microbiological, and contributing factors as well as visual effects were studied. RESULTS: We collected data of 118 patients hospitalized for unilateral infectious keratitis in 10 years, for an average of 12 cases per year. The patients' mean age was 50 years. At least one local risk factor was found in 58.5% of cases. These were mainly ocular trauma (39%), followed by local treatment of glaucoma (16%), and recent eye surgery (14.5%). In 9 cases (8%), the only risk factor for abscess was an isolated general factor. This was diabetes in 7 cases. The clinical aspects described can be grouped according to topography, depth, and severity in pre-perforation state or perforation (45%), anterior chamber Tyndall effect greater than 1 cross, reaching a hypopyon stage (24%), stromal infiltrate larger than 2 mm (18%) and the abscess located within 3 mm of the corneal center (13%). The microbiological examination isolated a germ in 17% of cases, principally Pseudomonas aeruginosa (40%), followed by Staphylococcus aureus (20%). Prognosis was severe with visual acuity of less than 1/10 in 90% of cases and evisceration in 16% of cases. DISCUSSION: The most common risk factor was local ocular trauma by foreign bodies in the cornea. The poor prognostic factors were possible delay in consultation, low initial visual acuity, and low rate of positive microbiological examinations. CONCLUSION: Infectious keratitis is a potentially serious condition that can lead to blindness and eventually to loss of the ocular globe in tropical environments. Local risk factors are largely dominated by ocular trauma. Only early management based on the microbiological results improves the prognosis.

[Profile of neovascular glaucoma in Senegalese patients]. / Profil du glaucome néovasculaire chez les patients sénégalais.

OBJECTIVE: To describe the etiologies, clinical presentation and therapeutic management of neovascular glaucoma (NVG) in Senegalese patients. PATIENTS AND METHODS: We retrospectively studied the records of patients followed for NVG between 1993 and 2016. We included eyes with Iridis rubeosis with or without ocular hypertension. We recorded age, sex, medical and ophthalmologic history, results of the eye examination, treatment modalities broken up into hospitalisation, procedural interventions and number of antiglaucoma medications prescribed. The data analysis was performed by epi-info 7. RESULTS: Forty-eight eyes of 44 patients were included. The mean age was 59.7 years and sex ratio 2.1. Etiologies were type 2 diabetes in 31.8 % cases and central retinal vein occlusion in 16.6 % cases. All eyes were blind. Eye pain was present in 75 % of eyes, a limbal flush in 29.1 % of eyes and mydriasis in 31.25 % of eyes. Mean intraocular pressure was 49.7mmHg. Corneal edema occured in 54.1 % of eyes. Fundus examination showed proliferative retinopathy in 14.5 %. Treatment required hospitalisation for 43.75 % of patients. Therapeutic procedures were cyclocryoapplication for 31.25 % of eyes, retrobulbar xylo-alcohol injection for 14.5 % of eyes and panretinal laser photocoagulation (PRP) for 12.5 % eyes. Antiglaucoma preparations were used in dual therapy for 29 % of eyes, in triple therapy and quadruple therapy for 25 % of eyes each. DISCUSSION: The etiologies are comparable to those described in the literature. The diagnosis was late and treatment limited by adverse economic conditions. CONCLUSION: NVG in Senegalese patients is an affection of men in their sixties. It is responsible for irreversible painful blindness for which treatment is difficult - thus the interest in prevention by strict monitoring and prompt treatment of any retinal ischemia.

Does smallpox vaccination modify HIV disease progression among ART-naive people living with HIV in Africa?

We examined the association between a history of smallpox vaccination and immune activation (IA) in a population of antiretroviral therapy-naïve people living with HIV (PLHIV). A cross-sectional study was conducted in Senegal from July 2015 to March 2017. Smallpox vaccination was ascertained by the presence of smallpox vaccine scar and IA by the plasma level of ß-2-microglobulin (ß2m). The association was analysed using logistic regression and linear regression models. The study population comprised 101 PLHIV born before 1980 with a median age of 47 years (interquartile range (IQR) = 42-55); 57·4% were women. Smallpox vaccine scar was present in 65·3% and the median ß2m level was 2·59 mg/l (IQR = 2·06-3·86). After adjustment, the presence of smallpox vaccine scar was not associated with a ß2m level ⩾2·59 mg/l (adjusted odds ratio 0·94; 95% confidence interval 0·32-2·77). This result was confirmed by the linear regression model. Our study does not find any association between the presence of smallpox vaccine scar and the ß2m level and does not support any association between a previous smallpox vaccination and HIV disease progression. In this study, IA is not a significant determinant of the reported non-targeted effect of smallpox vaccination in PLHIV.

Asphyxie périnatale au Centre Hospitalier Universitaire pour enfants de Diamniadio, Dakar, Sénégal

Introduction : L'asphyxie périnatale représente la deuxième cause de mortalité néonatale après la prématurité. Elle est souvent liée dans notre contexte aux circonstances de l'accouchement.Objectifs : Décrire les aspects épidémiologiques, cliniques et pronostiques de l'asphyxie périnatale chez des nouveau-nés à terme à l'unité de néonatologie de l'Hôpital pour Enfants de Diamniadio (Dakar).Patients et méthode : Etude rétrospective, descriptive et analytique menée d'octobre 2014 à novembre 2015. Etaient inclus tous les nouveau-nés à terme hospitalisés dans un contexte d'asphyxie.Résultats : Nous avons colligé 50 cas d'asphyxie, soit une fréquence de 19,5% des nouveau-nés à terme. Le sex-ratio était de 1,5. La majorité des mères soit 80% avait un âge compris entre 18-35 ans. Les pathologies obstétricales rencontrées étaient dominées par la rupture prématurée des membranes 28%, l'infection maternelle 18%, l'HTA 16% et les accidents funiculaires 12%. La naissance par césarienne concernait 1 enfant sur 5. La présentation de siège était la plus fréquente. Le liquide amniotique avait un aspect pathologique (teinté, méconial, purée de pois, hématique) dans 54% des cas. Cinquante-quatre pour cent (54%) des patients avaient un score d'Apgar à 7 à la cinquième minute. L'encéphalopathie anoxo-ischémique, la détresse respiratoire et le choc ont été les complications les plus retrouvées avec 88%, 28% et 22% des cas. Le retentissement biologique était surtout rénal et hépatique dans 24% et 38%. Le phénobarbital était l'anticonvulsivant le plus administré (52%) lors du traitement initial. La mortalité était de 32% (16 patients) ; l'âge moyen de décès était de 36 jours. Le liquide amniotique (p = 0,022), les convulsions (p = 0,041), les troubles de la conscience (p = 0,022), l'EAI au stade 2 et 3 (p = 0,036) et la rupture prématurée des membranes (p = 0,019) étaient significativement associés au risque de décès. Des séquelles étaient observées chez 34,2% des patients : une IMC (11), un trouble du langage (7) et une épilepsie (2).Conclusion : L'asphyxie périnatale reste une pathologie grave. La mortalité élevée et la gravité des séquelles rappellent qu'il est impératif de renforcer la prévention par un bon suivi des grossesses et de l'accouchement

Hématome sous-galéal révélant une hémophilie A sévère en période néonatale. A propos d'un cas

Introduction : L'hématome sous-galéal est une urgence diagnostique et thérapeutique souvent d'origine traumatique. Cependant, il peut révéler des troubles constitutionnels de l'hémostase.Observation : M.N, de sexe masculin est né par voie basse à terme, avec une notion d'expressions abdominales. Il pesait 3200 g pour un Périmètre Crânien (PC) de 33 cm et une taille de 52 cm. Il est reçu à H24 de vie pour augmentation du PC à 39 cm avec à l'examen un hématome diffus du cuir chevelu décollant les oreilles, une anémie clinique, une détresse respiratoire et neurologique. Le bilan retrouvait une anémie à 2.8g/dl et une thrombopénie. Le diagnostic d'hématome sous-galéal était retenu et il bénéficiait d'une transfusion sanguine, de vitaminothérapie K et d'une hospitalisation de 10 jours. Une semaine après l'exéat, il est revu pour des hématomes en regard des points de prélèvement avec anémie à 9.5g/dl, un taux de plaquettes normal, un TP normal et un TCA allongé. Le dosage des facteurs VIII et IX ramène un taux de facteur VIII bas à 0.9%. Le diagnostic d'hémophilie A est posé et le patient reçoit une injection intraveineuse de facteur anti hémophilique A.Conclusion : La recherche d'une anomalie de l'hémostase doit être systématique devant toute hémorragie chez le nouveau-né

Ethics of health research partnerships in Global South : PhD students in learning.

In view of the worldwide epidemic processes that require and result in simultaneous research in several countries and in an increasingly more structured scientific community, especially in countries of Global South, it is essential to establish partnerships between researchers, policy-makers, local supervisors, and communities in both the North and the South. The objectives of this essay are to: 1) present the context and issues linked to research in the framework of a North-South partnership; 2) describe the development of appropriate responses to improve consideration of ethical aspects; and 3) discuss the current role of young researchers in this era of multiple partnerships and share the observations and thoughts of PhD students in one research unit.

[Etiology and prognosis of the eye traumas by war weapons in the Senegalese army]. / Étiologies et pronostic des traumatismes oculaires par armes de guerre dans l'armée sénégalaise.

INTRODUCTION: The aim of this work is to identify the main weapons causing eye injuries during the campaigns of the Senegalese army in the south of the country, as well as the prognosis of these traumas. PATIENTS AND METHODS: This study is retrospective and concerns soldiers wounded by the weapons of war during the exercise of their mission within the Senegalese armed forces of 1991 in 2005. They are mainly soldiers affected in the south of the country during a war, clashes with the rebels or in Guinea-Bissau during operation Gabou in 1998. And they were evacuated to the ophthalmology department of the Principal Hospital in Dakar, which is a level 3. RESULTS: Thirty-seven military all male, with an average age of 30.5 years. Forty-six eyes including 9 bilateral cases. The trauma agent is a burst of RPG7 shells in 62% of cases, mine explosion in 13.5%, offensive grenade 10.8%, assault rifle 5.7% and flame lance-roquette anti-char (LRAC) accounts for 8%. We noted a phthisis of the globe for 14 eyes (30.43%) and for 15 eyes (32.60%) a functional loss of the affected globe. Inability to fight was decided by 29 wounded soldiers (78.37% of the cases), sedentary employment in 27 cases (72.97%) and 10 cases (27.03%) of reformed soldiers. DISCUSSION: In the conflict in southern Senegal, the RPG7 shell burst causes 62% of eye injuries. This RPG7 shell called "rebel weapon" is frequently used in conflicts in Africa. The prognosis of trauma with these types of weapons is severe. CONCLUSIONS: The combat goggles systematically integrated in the equipment of the Senegalese combatant, would be an invaluable contribution on the prevention of the traumatisms of the eye.

Prevalence of TB/HIV coinfection in antiretroviral-naïve patients at the Fann Ambulatory Treatment Center in Dakar.

To determine the prevalence of tuberculosis and describe its epidemiological, clinical, paraclinical, and therapeutic characteristics and its outcome in patients with HIV. This retrospective, descriptive, and analytical study examined the records of patients with HIV at our outpatient treatment center and selected those who were antiretroviral-naive and presented tuberculosis between January 2008 and December 2012. Among a total of 757 HIV-positive patients, 76 had tuberculosis, for a prevalence of 10 %. The sex ratio of 1.23 favored men. The average age was 42.5 years (range: 25 to 69 years. Nearly all these patients (71 cases) had HIV-1. A history of tuberculosis was reported by 39.5 %. Seventeen patients were malnourished. Management included chemoprophylaxis with cotrimoxazole for 64 patients. The pulmonary form predominated (72.4 %). Among these forms, there were 34 cases of negative microscopy tuberculosis and 21 cases of positive microscopy tuberculosis. The extrapulmonary forms (21 cases) were dominated by tuberculosis in the lymph nodes (11 cases), the pleura (7), pericardium (2), and peritoneum (1). Anemia was found in 44 patients. Severe immunosuppression was noted in 90 %, with CD4+ cell counts <350/mm3. Lethality was 7.9 %. TB/HIV coinfection is a major public health problem in Africa. Better coordination of activities in support of programs for tuberculosis and HIV/AIDS are needed.

Ascite urinaire néonatale révélant des valves de l'urètre postérieur. A propos d'un cas

Le diagnostic étiologique d'une ascite récidivante en période néonatale est parfois difficile. Une cause rare à laquelle il faut penser est l'ascite urinaire qui résulte d'une extravasation transpéritonéale de l'urine dans la cavité péritonéale. Elle est généralement secondaire à une uropathie obstructive. Nous rapportons l'observation de l'enfant A.T. qui est un nouveau-né de sexe masculin reçu à 21 jours de vie pour une ascite de grande abondance évoluant depuis le 3ème jour de vie. L'examen clinique notait : une ascite, une détresse respiratoire, une perte de poids, une hypothermie et une anurie. A la biologie on notait un syndrome inflammatoire, une hyponatrémie, une hyperkaliémie, une altération de la fonction rénale avec une natriurèse et une kaliurèse abaissées. L'échographie abdominale confirmait l'ascite de grande abondance associée à une souffrance rénale bilatérale avec hydronéphrose. La ponction d'ascite ramenait un liquide jaune citrin transsudatif avec un taux de protide à 15g/L et un rapport, créatinine de l'ascite sur la créatinémie, supérieur à 1. L'urétro-cystographie rétrograde objectivait des valves de l'urètre postérieur très sténosants avec vessie de lutte. L'évolution était favorable avec disparition de l'ascite et normalisation de la fonction rénale après sondage urinaire transurétrale. Il faut penser à l'ascite urineuse chez le nouveau-né porteur d'une malformation obstructive des voies urinaires surtout si elle est récidivante

Indifférence congénitale à la douleur chez un garçon de 27 mois

Introduction : Nous rapportons le cas d'une indifférence congénitale à la douleur encore appelée analgésie congénitale ou algo-ataraxie, découverte chez un garçon de 27 mois. Observation : Le patient était né à terme, complètement vacciné avec un développement psychomoteur correct, en phase sensori-motrice et prospective. La mère avait rapporté une absence de pleurs ou de changement de comportement lors des vaccinations. Elle avait aussi rapporté des morsures répétées de la langue et des faces muqueuses des lèvres. Il n'y avait pas d'antécédents familiaux particuliers déclarés. Le diagnostic a été évoqué devant les brûlures répétées des mains associées à des lésions d'automutilation. Il y avait de multiples stigmates d'anciens traumatismes à la tête, au tronc et aux quatre membres. L'examen clinique avait objectivé une indifférence à la douleur et à la chaleur. L'électromyogramme avait mis en évidence une polyneuropathie sensitive des quatre membres.Conclusion : L'indifférence congénitale à la douleur chez un garçon issu d'un milieu défavorisé, en pleine phase sensori-motrice et prospective du développement psychomoteur, pose le problème de sa mise en danger permanente. La prise en charge pluri-disciplinaire et l'éducation parentale doivent préserver l'intégrité physique et assurer un développement psychomoteur correct

[Kangaroo mother care for low birth weight infants at Albert-Royer National Children Hospital Center of Dakar]. / Les soins kangourou pour nouveau-nés de faible poids de naissance au centre hospitalier national d'enfants Albert-Royer de Dakar.

INTRODUCTION: Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal. MATERIAL AND METHODS: This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0. RESULTS: We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology. CONCLUSION: Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

La détresse respiratoire du nouveau-né à terme au service de néonatologie du Centre hospitalier d'enfants Albert Royer de Dakar, Sénégal

Introduction : La Détresse Respiratoire (DR) est fréquente en néonatalogie, souvent liée à des difficultés d'adaptation ou à l'infection. Objectifs : Décrire les aspects épidémiologique, clinique, thérapeutique et pronostique de la détresse respiratoire du nouveau-né à terme au service de néonatologie Centre hospitalier National d'Enfants Albert Royer de Dakar (CHNEAR).Patients et méthode : Etude rétrospective, descriptive du 1er janvier au 31 décembre 2014, concernant les nouveau-nés à terme hospitalisés pour détresse respiratoire. Résultats : Nous avons colligé 214 cas de DR, soit une fréquence de 34,8% des nouveau-nés à terme. Le sex-ratio était de 1,06 et l'âge moyen de 8,5 jours. L'accouchement était fait par césarienne dans 39 cas (18,2%) et 132 nouveau-nés (61,5%) étaient eutrophiques. Une réanimation en salle de naissance avait été nécessaire pour 86 nouveau-nés (40,2%). La DR était précoce en salle de naissance dans 75 cas (35,0%) et 107 nouveau-nés (50%) étaient admis avant 48 heures de vie. Le transfert était fait par transport en commun dans 92 cas (42,8%). La DR était sévère chez 102 nouveau-nés (47,7%). La SpO2 moyenne était de 78% sous oxygène à l'admission. Les principales étiologies étaient l'infection néonatale (118 cas ; 55,1%), l'asphyxie périnatale (53 cas ; 24,8%), l'inhalation méconiale (30 cas ; 14,0%), les cardiopathies congénitales (29 cas ; 13,5%), la bronchiolite aiguë 20 cas ; (9,3%), l'atrésie des choanes (9 cas ; 4,2%). Une ventilation artificielle était réalisée pour 45 nouveau-nés (21,0%). La létalité était de 31,8% (68 décès). Cette létalité était significativement associée à l'existence d'une détresse respiratoire en salle de naissance (p = 0,007 ; OR 2,2), d'une hypertension artérielle pulmonaire (p <0,001 ; OR 5,1), d'un pneumothorax (p < 0,001 ; OR 3,3), d'une inhalation méconiale (p = 0,006 ; OR 4,0), et d'une cardiopathie congénitale (p = 0,004 ; OR 3,7). Conclusion : Les détresses respiratoires néonatales sont fréquentes et sont associées à une létalité élevée. La prise en charge en salle de naissance, pendant le transfert et en néonatologie doit être améliorée

Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal.

OBJECTIVE: We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/µL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL). METHODS: Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT. RESULTS: One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/µL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74). CONCLUSION: SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.

[Selective laser trabeculoplasty (SLT): our experience in African blacks]. / La trabéculoplastie au laser sélectif (TLS) : notre expérience chez le noir africain.

INTRODUCTION: The purpose of our study was to evaluate in the short and medium term, intraocular pressure results after selective laser trabeculoplasty in black patients with chronic open angle glaucoma or isolated ocular hypertension. MATERIALS AND METHODS: We conducted a retrospective study with a mean 12.5-month follow-up in black patients who underwent SLT. Inclusion criteria were: an open iridocorneal angle greater than or equal to Schaeffer grade 3, data recorded and available on trabecular pigmentation, data on SLT parameters available, and intraocular pressure by Goldmann applanation tonometry recorded.A positive result was defined as a post-laser IntraOcular Pressure (IOP) less than 21 mmHg after 1-month follow-up. The main motivation was the reduction of number of eye drops used. Performed first was a treatment of the inferior 180° (3:00-9:00), possibly supplemented by a second session at 15 days or 1 month if a pressure decrease was noted after the first session. IOP results were evaluated prior to SLT, immediately following SLT and then depending on the drop in pressure. Statistical analysis was performed using the EPI.info 7 software. RESULTS: A total of 69 eyes of 40 patients treated with SLT were identified. The mean IOP prior to SLT was 18.3 mmHg ± 4. Our results showed 90% of patients who positively responded to the treatment (10% failure) with a mean IOP decrease of 2.3 ± 1 mmHg, that is 13%, by the second week. The mean pressure decrease continued to 4.78 ± 1 mmHg for patients (30%) in the group treated for 360°, that is 27% in the same period of time. SLT permitted discontinuation of a prostaglandin in 60% (42 cases). Eyes on triple-drug therapy went from 23 before SLT to 5 following SLT (a 26% decline), eyes on two medications went from 32 to 16 (24% decline). In result association tests, only pigmentation of the angle and visual field stage had a statistically significant probability. DISCUSSION: In our experience, SLT is indicated in black patients to potentiate less effective treatments, to reduce the number of drops in order to limit side effects, but also to avoid or delay monotherapy treatment-naïve, hypertensive eyes. CONCLUSION: In the short and medium term, SLT brought about an IOP decrease in 90% of black patients, and discontinuation of a prostaglandin in 60% of our patients. In addition, the iridocorneal angle in blacks appears to be less pigmented than previously thought, and a protocol systematically treating 360° seems to provide better results.