Aspects épidémiologique et clinique des uvéites au Niger: analyse rétrospective d'une série de 127 cas colligés sur 5 ans / Epidemiological and clinical aspects of uveitis in Niger: A retrospective analysis of a series of 127 cases collected during 5 years

Contexte & objectif L'uvéite est peu très peu documentée en Niamey. L'objectif de la présente étude était de décrire les aspects épidémiologique et clinique des uvéites. Méthodes. Il s'agissait d'une étude rétrospective et descriptive portant sur 127 dossiers des patients suivis pour uvéites à la clinique lumière de Niamey sur une période de 5 ans (2015 ­ 2020). Les paramètres sociodémographiques, cliniques et thérapeutiques ont été recueillis. Résultats. La fréquence hospitalière des uvéites était de 0,21 %. Le sex-ratio était de 1,01. L'âge moyen des patients était de 40,76 ans. La douleur oculaire représentait le motif de consultation le plus fréquent avec 51 ,97 %. La majorité des patients avait présenté 2 épisodes d'uvéites soit 57,48 %. L'atteinte était unilatérale dans 70,97 % et les uvéites antérieures étaient les plus fréquentes 66,93 %. Les étiologies étaient identifiées chez seulement 7,87 % des patients dont près de la moitié était la tuberculose. 33,07 % des patients avaient présenté des complications. Conclusion. Il ressort de cette étude que l'uvéite touche plus des jeunes adultes, ses étiologies sont indéterminées dans la majorité de cas. Les formes antérieures sont plus fréquentes.

Context and objective Little is known about Uveitis in Niamey. This study aimed to analyze the epidemiological and clinical aspects of uveitis. Methods. This was a retrospective, descriptive study of 127 records of patients followed up for uveitis at the Niamey Lumière Clinic over a 5-year period (2015 ­ 2020). Sociodemographic, clinical and therapeutic parameters were collected. Results. The hospital frequency of uveitis was 0.21%. The sex ratio was 1.01. The mean age of patients was 40.76 years. Ocular pain was the most frequent reason for consultation, accounting for 51.97 %. The majority of patients (57.48%) had presented with 2 episodes of uveitis. Involvement was unilateral in 70.97 %, and anterior uveitis was the most frequent, at 66.93 %. Etiologies were identified in only 7.87 % of patients, of which tuberculosis accounted for almost half. Complications occurred in 33.07 % of patients. Conclusion. This study shows that uveitis affects mainly young adults, and its etiologies are undetermined in most cases. Anterior forms are more frequent.

Potential Impacts of Climate Change on the Toxicity of Pesticides towards Earthworms.

This review examined one of the effects of climate change that has only recently received attention, i.e., climate change impacts on the distribution and toxicity of chemical contaminants in the environment. As ecosystem engineers, earthworms are potentially threatened by the increasing use of pesticides. Increases in temperature, precipitation regime changes, and related extreme climate events can potentially affect pesticide toxicity. This review of original research articles, reviews, and governmental and intergovernmental reports focused on the interactions between toxicants and environmental parameters. The latter included temperature, moisture, acidification, hypoxia, soil carbon cycle, and soil dynamics, as altered by climate change. Dynamic interactions between climate change and contaminants can be particularly problematic for organisms since organisms have an upper and lower physiological range, resulting in impacts on their acclimatization capacity. Climate change variables such as temperature and soil moisture also have an impact on acidification. An increase in temperature will impact precipitation which might impact soil pH. Also, an increase in precipitation can result in flooding which can reduce the population of earthworms by not giving juvenile earthworms enough time to develop into reproductive adults. As an independent stressor, hypoxia can affect soil organisms, alter bioavailability, and increase the toxicity of chemicals in some cases. Climate change variables, especially temperature and soil moisture, significantly affect the bioavailability of pesticides in the soil and the growth and reproduction of earthworm species.

Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up.

OBJECTIVE: To report the long-term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow-up period of 10 years. PATIENTS AND METHODS: We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit. Outcomes were measured by comparing preoperative and follow-up videocystometrograms (VCMGs). Complications were identified from case notes and the surgery database. Subjective assessment was through a previously validated questionnaire. RESULTS: The mean (range) follow-up was 14.7 (10.5-20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12-52) years. The mean (range) period from injury to surgery was 4.5 (0.3-22) years. All had suprasacral injuries. The VCMGs showed a significant improvement in bladder capacity and a decrease in intravesical pressures (P < 0.001). Long-term complications included bladder stones (n= 4); urosepsis (n= 2); vesico-ureteric reflux ([VUR]n= 2), VUR requiring ureteric re-implantation (n= 1); neurogenic detrusor overactivity ([NDO]n= 1); and laparatomy for bowel obstruction (n= 1). Surveillance cystoscopies did not detect any bladder neoplasms. The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfied with the operation such that they would consider it again or recommend it to a friend. No patient reported any significant changes in either bowel habit or sexual function. CONCLUSIONS: We found that AIC has excellent long-term outcomes in the definitive management of refractory NDO in patients with SCI. The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients.

Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders.

OBJECTIVE: To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS: Twelve women (mean age 53.3 years, range 41-80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS: The mean (range) follow-up was 10 (8.5-12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS: In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes.

Patients' perspective of botulinum toxin-A as a long-term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury.

OBJECTIVE: To evaluate patients' perspective on whether they would consider botulinum toxin-A (BTX-A) injections as a long-term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI). PATIENTS AND METHODS: In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX-A were invited to participate in a 5-min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied). RESULTS: Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX-A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX-A injections as a long-term treatment option. Only seven (15%) of patients still having BTX-A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one-off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman's correlation coefficient, -0.52, 95% confidence interval -0.78 to -0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8). CONCLUSION: With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX-A. Most consider continuing BTX-A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX-A injection service for patients with NDO.

Infant weaning practises of some Idoma women in Makurdi, Nigeria.

The weaning practices in infants aged 4-9 months of two hundred Idoma women resident in Makurdi were examined. A pre-tested standard questionnaire was used to collect data from mothers who regularly visited the post-natal health clinics in Makurdi. The results showed that better educated mothers breast fed for a shorter time or planned to cease breast feeding after a shorter period than mothers who had little education or no formal training. Most mothers (97%) fed milk formula which they claimed was used to supplement breast milk and was good for their babies. The most influential factors were the hospital and the husband. The majority of the mothers fed pap; 73% using corn in its preparation, with 91% of them storing such paps in flask. More than half of the mothers used a bottle in feeding the paper or gruel to their infants while a similar proportion (65.5%) fed legumes to their infants in addition to fruits. The implications of these practices in comparison with other ethnic groups is discussed.

PIP: During May-September 1993, in Benue State, Nigeria, interviews were conducted with 200 healthy Idoma mothers aged 16-43 years attending the postnatal health clinic in the Kwararafa area of Makurdi--largely a Tiv tribe settlement--so researchers could learn about infant weaning practices of Idoma women. 67% of the mothers had no more than primary education, while about 60% of the husbands had at least secondary education. Most mothers breast fed on demand 6-8 times a day for 5-15 minutes. 90% planned to cease breast feeding at 12 months. The less educated mothers, who were either self-employed or unemployed, planned to cease breast feeding later than the more educated mothers who were in salaried employment. 97% gave their infant milk formula. Education was associated with milk formula use (93% of mothers with no formal education, 97% of mothers with primary education, and 100% of mothers with secondary or higher education). The major reasons for using milk formula were supplementation of breast milk (43%) and claiming it is good for infants (36.5%). The leading milk formula brands were Nan (46.3%), Cerelac (30%), and SMA (10.5%). The factors that most influenced introduction of milk formula included hospital advice (46.5%) and husband's advice (33%). 52.5% introduced supplementary feeding at 3-4 months. 88.5% of all mothers gave supplementary food alongside breast milk. The most important factors influencing type of supplementary food were suitability for infant (35.5%), high quality (21.5%), and price (19.5%). The leading type of weaning foods were pap (50.5%), Cerelac (26.5%), and pap mixed with other food (11%). 82% of mothers fed gruel to their infant with a feeding bottle. 65.5% also fed legumes, vegetables, and/or fruits to their infant. The decision to feed these foods to their infant were based on hospital advice (36%), availability in the family menu (24%), and easy availability (18.5%). Based on these findings, health workers should use nutrition education, advice, and demonstration to teach appropriate and timely introduction of supplementary foods, methods of food preparation, and use of local fruits and vegetables.