Medecine tropicale et sante internationale最新文献

Introduction: Antigen rapid diagnostic tests (RDTs) have been developed to facilitate malaria diagnosis in endemic areas. The blood samples collected for these tests can also be used to diagnose other infections.

Methods: We performed nucleic acid extraction followed by PCR identification of dengue virus (DENV), Borrelia spp., Bartonella spp., and Coxiella burnetti on RDTs collected from different health facilities in Touba during the Grand Magal of Touba (GMT), a mass gathering known for its infectious disease risks.

Results: A total of 2,381 RDTs were collected from eight healthcare facilities in the Mbacke department in 2022 and 2023 during the GMT. Thirteen cases (0.5%) of tick-borne relapsing fever borreliosis were identified by quantitative PCR (qPCR), including two cases of malaria-borreliosis co-infection. None of the samples tested positive for DENV, Bartonella spp., or C. burnetti.

Conclusion: Our results confirm that RDT antigens can diagnose non-malaria fevers, such as borreliosis, in some GMT participants with fever. Malaria RDTs used in the field are an easily accessible source of clinical samples for studying the epidemiology of fevers of unknown origin in GMT contexts.

Objective: Congenital absence of the tibia (congenital tibial aplasia) causes significant disability when walking. The usual treatment, which involves lengthening the lower leg or early amputation followed by prosthetic fitting, requires technical resources that are often lacking in developing countries. The proposed alternative consists of tibialization of the fibula with limb lengthening and by preservation of the foot equinismus.

Patients and method: The records of 25 children with congenital tibial aplasia were reviewed. Ten of these children underwent tibialization of the fibula (operated between one and three years of age) and amputation (at six and eight years of age) in two cases.

Results: With a mean follow-up period of two years and seven months, correct alignment of the lower leg and foot below the knee was achieved in all cases of tibialization of the fibula. Two children achieved independent walking. Three children were lost for follow-up.

Discussion: The management of congenital tibial aplasia must consider the local socioeconomic context. Although the follow-up period in this study is short, the protocol is simple and well-accepted by families.

Conclusion: Conservative treatment of tibial aplasia through tibialization of the fibula with equinus preservation to compensate the shortening is simple and takes local socioeconomic constraints into account, while avoiding the limitations and costs of modern protocols. Furthermore, it is always well accepted by families.

The 1998 French law on combating exclusion established PASS units (Permanences d'Accès aux Soins de Santé, or Healthcare Access Points) to guarantee access to healthcare for all, including people in precarious situations. PASS centers aim to address the social, economic, administrative, and linguistic barriers that prevent vulnerable populations from accessing the healthcare system.This article provides an overview of how PASS operate in France and describes the PASS at Hôtel-Dieu in Paris (Public Hospitals of Paris). This PASS offers patients a holistic approach that includes medical care, psychiatric follow-up, social support, interpretation services, and specialized consultations.As of 2023, there were 451 PASS centers in France. The Hôtel-Dieu PASS, with its multidisciplinary team, carried out over 10,500 medical consultations for 4,144 patients. Most users are young male migrants without health insurance (69%) or stable housing (nearly 90%). The most common conditions are chronic diseases (e.g., hypertension and diabetes), infectious diseases (e.g., hepatitis B/C, HIV, and tuberculosis), and mental health issues (e.g., post-traumatic stress disorder and anxiety).The Hôtel-Dieu example illustrates the specific features of PASS centers: accessibility without appointments, single locations and time slots, and adaptability to precarious schedules. These services enable vulnerable populations to reconnect with the healthcare system. However, their effectiveness depends on long-term funding, enhanced medical and social coordination, and institutional recognition of their role.PASS units respond to an ethical and public health imperative: caring for those furthest from the healthcare system. Their sustainability requires adequate human and financial resources. They must remain places of innovation, welcome, and inclusion that constantly adapt to social, political, and migratory changes.

Introduction: Post-stroke epilepsy is defined as unprovoked seizures occurring in a person with a history of stroke after all other causes have been excluded.

Objective: This study aimed to determine the epidemiological, clinical, radiological, and evolutionary characteristics of post-stroke epilepsy in the neurology department of the general referral hospital in Niamey, Niger. The study was retrospective, descriptive, and analytical, and it was conducted over a period of 29 months. Results. A total of 4,765 patients were included in the study, 21 of whom were diagnosed with post-stroke epilepsy. This represents a hospital prevalence of 4.4%o. The sex ratio was 0.75. The average age was 64. Ischemic stroke (IS) was the most common type, accounting for 81% of cases, with lesions most often occurring in the superficial territory of the middle cerebral artery. Seizures were focal in 52.4% of cases and occurred late, within one to two years. Most patients were treated with monotherapy, primarily with carbamazepine.

Conclusion: The outcome was favorable in 71.5% of cases with appropriate treatment.

Tahiti or the "myth of Paradise", Bora Bora, "the Pearl of the Pacific". Who has never wanted to take a plane and come and land on the heavenly beaches of Polynesia, a French territory at the antipodes of mainland France lost in the middle of the Pacific? However, we do not imagine that 60% of Polynesians live below the metropolitan low-income threshold or that life expectancy is lower than that of the mainland due to the high prevalence of cardiovascular diseases with three quarters overweight population.In addition to non-transmissible metabolic diseases, various pathologies common to temperate countries present specificities in Polynesia, leading to sometimes different management and medical reasoning. Indeed, in Polynesia where the islands extend over an area of the size of Europe, delays in treatment are frequent and it can sometimes seem difficult to send sick patients back to their isolated island. Certain pathologies that were once common in France, such as acute rheumatic fever, are still prevalent there, while others, such as gout, are rarely seen elsewhere in terms of prevalence or severity. Even if the geographical distance has protected Polynesia from a number of tropical diseases including malaria or dangerous animals, this territory presents a range of varied infectious diseases including arboviruses, leptospirosis, tuberculosis and leprosy or angiostrongylosis. Skin infections are very common with their corollary of complications including endocarditis and osteoarticular infections. The sea, which is omnipresent, also poses certain dangers such as ciguatera poisoning and exposure to certain marine organisms.Care is provided according to current medical standards thanks to European-level resources allowing diagnostic and therapeutic possibilities that do not exist in other Pacific island states.The objective of this overview is to guide health care providers coming to or practicing in French Polynesia in their daily practice, but also practitioners taking care of people returning from Polynesia.

Introduction: The World Health Organization's (WHO) "test and treat" strategy has significantly increased the number of people living with HIV (PLHIV) who receive antiretroviral therapy (ART). This study aimed to evaluate the status of ART in Burkina Faso during this period.

Methods: A retrospective descriptive study was conducted in Plateau-Central, one of the country's 13 regions. We extracted annual data from 2018 to 2023 from the pharmaceutical dispensing database, which is used to monitor individuals receiving ART. We analyzed a trend in treatment initiation. Quantitative variables were described using the median and interquartile range, and qualitative variables were described using proportions.

Results: From 2018 to 2023, the proportion of people who started treatment each year compared to the number of people who tested positive increased from 25% to 100%. Among adults during this period, more than 70% were women. The median age at the start of treatment ranged from 35 years (28-44) to 32 years (25-44). The median treatment duration ranged from five years [2-8] to six years [3-12]. The proportion of adults with at least 95% ART dispensing coverage fluctuated, ranging from a maximum of 70% in 2020 to a minimum of 47% in 2023. The main treatment combination used in adults was TDF/FTC/EFV, accounting for 42% in 2018, 50% in 2019, and 38% in 2020. The TDF/3TC/EFV combination was dominant in 2021, accounting for 46%. In 2022 and 2023, the TDF/3TC/DTG combination was the most common, at 76% in 2022 and 91% in 2023. Among children, males were predominant (around 55%) from 2019 to 2022. The median age at treatmentinitiation ranged from two years [0-9] to four years [2-9], and the median treatment duration ranged from five years [2-8] to six years [3-12]. AZT/3TC/NVP was predominant from 2018 to 2021 (57%, 59%, 40%, and 40%), and ABC/3TC/DTG was predominant from 2022 (52% and 84%). From 2018 to 2023, the proportion of children with at least 95% ART dispensing coverage fluctuated, ranging from a maximum of 76% in 2019 to a minimum of 24% in 2023.

Conclusion: The proportion of people on ART has gradually increased since the WHO's "test and treat" recommendations. These results bring Burkina Faso closer to achieving the UNAIDS targets.

Introduction: Antisynthetases syndrome (AS) is a subgroup of inflammatory myopathy where myositis is associated to polyarthritis, interstitial pneumopathy, Raynaud's phenomenon, "mechanic's hands" skin lesions, and positive anti-aminoacyl-transfer RNA (tRNA) synthetase antibodies. Here, we present seven cases from Gabon.

Materials and methods: This retrospective descriptive study was conducted in the Internal Medicine Department at Libreville University Hospital from January 1, 1984, to December 31, 2023. The study aimed to identify all patients with documented AS and clarify its characteristics.

Results: Seven female patients with a mean age of 42.5 years were identified. The cardinal signs of AS were predominantly muscular (n = 7) and pulmonary (n = 5) with diffuse interstitial pneumopathy (n = 5). The patients experienced stage 2 (n = 3) to stage 3 (n = 2) dyspnea and cutaneous manifestations, including "mechanic's hands" (n = 4). Two patients were positive for Jo-1 antibodies, one for PL7 antibodies, and four for PL12 antibodies.

Discussion: AS poses a significant challenge to clinicians in sub-Saharan Africa due to the diffuse interstitial pneumonitis that accompanies pulmonary involvement.

Conclusion: Our study confirms the predominance of anti-PL12 antibodies and the late diagnosis of this condition.

Introduction: According to the WHO, 278 million confirmed cases of COVID-19 had been recorded worldwide by the end of 2021, resulting in approximately 5.4 million deaths. In Burkina Faso, 17,632 cases and 318 deaths were recorded. Vaccination is one of the strategies implemented to control the pandemic. This study aimed to evaluate the status of the COVID-19 vaccination program among staff at a referral hospital in Burkina Faso.

Methods: From June 2 to December 31, 2021, we conducted a descriptive study at Tengandogo University Hospital (CHU-T). The study involved all staff members. Information was obtained through face-to-face and telephone interviews and self-administered questionnaires. Quantitative variables were described using the mean and standard deviation, while qualitative variables were described using proportions. All vaccinated individuals responded to the questionnaire. Unvaccinated individuals were volunteers.

Results: A total of 31% (174 out of 559) of healthcare workers were vaccinated, with a mean age of 41 ± 8 years. Men accounted for 55% (94/174) of the vaccinated workers. The main worker profiles were 62 doctors (35.6%), 62 nurses (35.6%), and nine ward boys and girls (5.2%). The main reason for accepting the vaccine was protection against the disease, reported by 132 workers (76%). There were 134 unvaccinated subjects who agreed to participate in the study. Their average age was 32.8 ± 7.3 years. The proportion of women was 60%. Uncertainty about vaccine effectiveness was the main reason for not getting vaccinated, cited by 106 workers (79%). Minor adverse events were reported by 136 of the vaccinated workers (78%). No serious adverse events were reported. Four vaccinated workers developed symptomatic SARS-CoV-2 infection during the study period.

Conclusion: The proportion of vaccinated subjects was low. Interventions to improve healthcare workers' adherence to vaccination should be developed.

Introduction: Since the introduction of antiretroviral therapy for HIV in Burkina Faso, several treatment adherence support mechanisms have been implemented to improve outcomes and prevent resistance. Our study aimed to evaluate the knowledge and perceptions of people living with HIV (PLHIV) regarding these mechanisms in the Plateau-Central region.

Methods: We conducted a descriptive study in the Plateau-Central region, which is one of the 13 regions of Burkina Faso. PLHIV were selected as they arrived for their follow-up visits. Information was collected through interviews using a standardized questionnaire. Adherence was calculated based on the participants' reports. Those who took all their medications in the month prior to the survey were considered adherent. Quantitative variables were calculated using the averages, and qualitative variables were calculated using proportions.

Results: A total of 347 PLHIV were included in the study. Of these, 69% were women, with a mean age of 45.6 ± 12.2 years. The mean treatment follow-up duration was 8.6 ± 5 years. Eighty percent of individuals adhered to treatment (95% CI [75-84]). Nearly all PLHIV (99.7%) were aware of adherence support mechanisms. The most well-known mechanisms were six-month antiretroviral drug supplies (RAVI6M) (71%), discussion groups (69.9%), individual discussion (69.9%), and counseling (64.2%).The recently introduced community-based antiretroviral drug refilling program outside of health facilities was less well known (42.2%). The most commonly used measures were face-to-face discussion (64%), counseling (62%), and RAVI6M (61.7%). The most appreciated measures were the six-month supply of antiretroviral drugs (44.6%), drug counting (10.7%), and patient interview (10.1%).

Conclusion: PLHIV are familiar with and appreciate adherence support measures. The most appreciated measure is six-monthly refills of ARV drugs. Community-based ARV supply policies should be encouraged.