Medecine tropicale : revue du Corps de sante colonial最新文献

Objective: The purpose of this report is to describe the epidemiologic, prognostic and clinic features of scarification in children in Congo.

Material and method: A transversal study of scarification was conducted from January 1, 2006 to December 31, 2008 in children hospitalized in neonatology and pediatrics department of Loandjili General Hospital.

Results: During the study period, therapeutic scarifications were observed in 130 patients including 74 (56.9%) girls. Median age was 17 months (range, 1 month to 9 years). Multiple scarifications were observed in 31.5% of cases. The main site of scarification was the hypochondrias (82.4%) followed by the flanks (14.6%) and hemithorax (13.8%). Scarification was performed for curative purposes in 114 cases (88%; p 0.001) and prophylaxis in the remaining cases. The main indications for curative scarifications were big belly in 46 cases, ponderal stagnation in 23 and recurrent bronchitis in 22. The most frequently used scarification instrument was a razor blade in 102 cases (78.5%). Risk factors included being the oldest sibling child and low socioeconomic level. In all cases, the influence of the grandparents was clear. Complications were treated in 34 cases including local infection in 26 cases, distant infection (particularly severe sepsis) in 7 cases and pulmonary-pleurostaphylococci in one case.

Conclusion: These findings show that scarification is still common in the Congo. Because of potential complications and therapeutic inefficiency of scarification, an effort should be made to eliminate this practice.

A prospective, multicenter was conducted in all specialized centers in the city of Dakar. The objective was to describe the epidemiology to assess the management of lung cancer. 45 patients were included. The sex ratio M/F = 8. The average age of patients was 57.5 years. Smoking was found in 84.4% of cases. The average time for consultation after the onset of symptoms was 6 months. The average time to diagnosis was 2 months. Two out of three patients (66%) had seen beyond the stage III B. Improved diagnostic performance for early diagnosis of cancer is needed. Emphasis should be on prevention through tobacco control.

Cholera, that had been present in rural areas north of Port-au-Prince, Haiti since October 2010, reached the urban area in November. Due to the novelty of the disease in this region, to the lack of health care, clean water, and waste disposal facilities, and to the extensive damage caused by the earthquake on January 12, 2010, that left a large victim population living in camps, a large-scale health disaster was feared. However, after two months, the disease appeared to be relatively well-controlled and treated with a fatality rate of less than 1% in the urban area. Actions implemented by the Ministry of Health long with its efforts to coordinate the intervention of the many humanitarian partners played a role in this outcome.

Introduction: The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap.

Patients and methods: This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included.

Results: Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%).

Conclusion: The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

Right-sided infective endocarditis accounts for 5 to 10% of endocarditic involvement and usually affects the tricuspid valve. The purpose of this report is to describe epidemiological, clinical and echocardiographical aspects of 6 cases of right-sided infective endocarditis observed in the Cardiology Department of Aristide Le Dantec Hospital in Dakar, Senegal from December 2007 to February 2010. Diagnosis was based on Duke's modified criteria. There were 3 men and 3 women with a mean age of 28.2 years (range: 20 and 43). Five of the 6 patients presented tricuspid endocarditis including one case associated with pulmonary endocarditis. In another case, pulmonary endocarditis was associated with aortic endocarditis. Infective endocarditis was acute in three cases and primary in four. One case of infective endocarditis was observed in a tetralogy of Fallot. Fever was present in 4 cases with an mean temperature of 38.4 degrees C (range, 37.2 to 40 degrees C) and heart failure was present in 5 cases. In 2 patients, blood cultures were positive for Staphylococcus aureus. All patients had leucocytosis with a neutrophilic predominance. Doppler echocardiography depicted vegetations in all cases. Contributing factors included congenital heart disease in 1 case, insertion of a venous catheter in 2 and dental infection in 2. No patient was addicted to intravenous drugs or infected by HIV. Outcomes included one in-hospital death with signs of refractory heart failure. Right-sided endocarditis is often primary and is dominated by the tricuspid involvement. It affects both sexes. Contributing factors include venous catheterization during the postpartum period and dental infection. Prevention requires strict asepsis during venous catheter insertion, treatment of dental infections and improved management of congenital heart disease.

The purpose of this report is to describe a case of abdominal actinomycosis (Actinomyces israelii) with a pseudo-tumoral appearance in a 57-year-old Senegalese woman.

Introduction: Histoid leprosy is a special and rare anatomoclinical form of multibacillary leprosy. Most of the few large series describing this entity In literature have been reported from India. The purpose of this study was to analyze the epidemiological, clinical and therapeutic characteristics of patients with histoid leprosy in Morocco.

Material and methods: This retrospective study was conducted at the National Centre of Leprology (CNL) in Casablanca from January 1991 to December 2006. Only histologially confirmed cases of histoid leprosy were included. Epidemiological, clinical, histological and therapeutic characteristics were compiled from records and analyzed using EPI-Info version 6.

Results: Confirmed histoid leprosy accounted for 18 of the new cases of leprosy recorded at CNL recorded during the 16-year study period. There were 13 men and 5 women with a mean age of 35.2 years. Family exposure was noted in 9 patients (50%) including two who had more than two relatives with leprosy. Nodules/subcutaneous nodules were the most common morphological pattern (88.8%). Neurological involvement was found in 10 patients. Seven patients had grade 1 deformities. Slit skin smears from histoid lesions revealed abundant bacilli with a high bacteriological index ranging from 3 + to 5 + according to the Ridley index. All patients received antibiotic treatment according to the Moroccan protocol. Outcome was favorable in all patients. Six patients (33.3%) developed erythema nodosum leprosum during the course of disease. With a average follow-up of 9 years, no recurrence has been observed.

Discussion: Because of its multibacillary character and despite its rarity, histoid leprosy poses a challenge to the leprosy eradication in Morocco. Like other forms of multibacillary leprosy, histoid leprosy requires early detection and prompt multidrug therapy. These requirments should be made a priority in the national program against leprosy.

Purpose: To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal.

Patients and methods: This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes.

Results: A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization.

Conclusion: Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.