Facteurs de Risque, Epidémiologie et Prise en Charge de la Grossesse Extra-utérine Rompue (GEUR) au Service de Gynécologie et d’Obstétrique de l’Hôpital National Ignace Deen du CHU de Conakry en 2022

Introduction : urgence gynécologique fréquente, découverte fortuite aux urgences médicales et ou chirurgicales dans un tableau d’anémie. L’objectif de ce travail était d’étudier les facteurs de risque, épidémiologie, et prise en charge de la grossesse extra-utérine rompue au service de gynécologie et d’obstétrique de l’hôpital national Ignace Deen du CHU de Conakry en 2022. Méthodes : il s’agissait d’une étude descriptive transversale à recrutement rétrospectif. Elle a été menée au service de gynécologie et d’obstétrique de l’hôpital national Ignace Deen du CHU de Conakry du 1er janvier  2019 au 31 Décembre 2022 soit une période de trois ans. Ont été étudiées les variables se rapportant aux facteurs de risque, épidémiologie, et la prise en charge de la GEUR dans notre contexte de travail. Nous avons utilisé le logiciel Excel pour l’analyse des données. Résultats : fréquence de la GEUR dans notre étude était 1,26 % sur l’ensemble des interventions gynécologiques, les tranches d’âge les plus représentées étaient celles de 20-24 ans et 30-34 ans dans 32,69%, plus de la moitié était célibataire 69,23%, sans profession, non scolarisé respectivement 64,23% et 42,31%, primipares dans 49,04%.  Parmi les facteurs de risque (FDR) retrouvés dans notre série, figuraient les antécédents de :  l’infection génitale 46,15%, les fausses couches spontanées 10,58%, la contraception par microprogestatif 16,34%. La prise en charge a été exclusivement chirurgicale (100%), associée à la transfusion sanguine comme moyen de réanimation dans 95,16%. Conclusion : la grossesse extra-utérine rompue est une urgence médicochirurgicale fréquente, le diagnostic précoce traine les pas dans les pays à faibles ressources.   Introduction : a frequent gynecological emergency, discovered incidentally in medical and/or surgical emergencies in the setting of anemia. The aim of this study was to investigate the risk factors and management of ectopic pregnancy in the gynecology and obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital in 2022. Methods : This was a descriptive study with retrospective recruitment. It was conducted at the gynecology and obstetrics department of the CHU Ignace Deen national hospital in Conakry from January 1, 2019 to December 31, 2022, a three-year period. Variables relating to risk factors, epidemiology and management of GEUR in our working context were studied. We used Excel software for data analysis. Results : The frequency of GEUR in our study was 1.26% of all gynaecological procedures, the most represented age groups were 20-24 and 30-34 years with 32.69%, more than half were single 69.23%, without profession, not in school respectively 64.23% and 42.31%, primiparous in 49.04%.  Among the risk factors found in our series were a history of : genital infection 46,15%, spontaneous miscarriage 10.58%, microprogestogen contraception 16.34%. Management was exclusively surgical (100%), associated with blood transfusion as a means of resuscitation in 95.16% Conclusion : Ruptured ectopic pregnancy is a frequent medico-surgical emergency, early diagnosis is lagging behind in low-resource countries

Caractérisation agropédologique des sols de mboltime dans la zone des niayes (Sénégal)

L'objectif de cette étude était de faire une évaluation de la fertilité physico-chimique de différents sols du village de Mboltime et de déterminer les similarités relatives. Les horizons de cinq fosses pédologiques (P1 , P2, P3, P4 et P5) ouvertes dans les zones dunaires et inter-dunaires ont servi à cet effet. Les résultats obtenus ont montré que les horizons de surface sont sableux à sablo-limoneux avec des pH et conductivité électrique variant selon les profils et les horizons. Seul le profil P4 a montré des sols acides et salés au niveau des horizons P4H1, P4H3 et P4H5. Les autres profils ont montré des sols neutres à légèrement alcalins et non salins. Les teneurs en matière organique et azote total ont été assez faibles dans les profils 1, 2, 3 et 5, et moyens dans le profil 4 avec un rapport C/N variant de 2,72 à 16,50. Les teneurs en Ca2+, Mg2+, Na+ et K+ varient suivant le C et N. Le cation le plus abondant dans les sols a été le Ca2+; suivi du Mg2+ et du Na+ alors que K+ a été le cation le moins abondant. L'analyse factorielle des correspondances (AFC) a permis de mettre en évidence deux groupes de sols en fonction de la salinité et de l'acidité. Un groupe I constitué de sols très salins et un groupe II constitué de sols non salins. Cette étude a mis en évidence deux contraintes majeures à la production végétale dans le village de Mboltime que sont la salinité et l'acidité des sols.Mots clés : Sol, Profil pédologique, Niayes, salinite ; Sénégal AGROPEDOLOGICAL CARACTERIZATION OF MBOLTIME SOILS IN NIAYES AREA (SENEGAL)The objective of this study was to evaluate physico - chemical properties of different soils from Mboltime village and relevant similarities. Horizons of five soil profiles (P1, P2, P3, P4 and P5) in the dune and inter-dune areaswere used for that purpose. The results showed variance in topsoil contents of sand with silt- loam, pH and electric conductivity according to the  profiles. Only the P4 profile presents acid and salty soil to the level asof horizons P4H1, P4H3 and P4H5. The other profiles presented neutral to slightly alkaline soil pH with limited salinity. The soil contents of organic matter, and total nitrogen were rather weak in the profiles 1, 2, 3 and 5, and moderate in profile 4. The C/N ratio values varied from 2.72 to 16.50 while soil contents of Ca2+, Mg2+, Na+ and K+ variations were according to C and N. The most abundant cations in land was Ca2+; followed by Mg2+, Na+ and K+ was the least abundant cationin soils. The factorial  correspondence analysis (FCA) showed two groups of soil according to  salinity and acidity mainly depending to high and low salinity respectively. This study showed two major constraints to land productivity in the village of Mboltime which are the salinity and the acidity of soils.Keywords : Soil, soil profile, salinity, Niayes, Senega

Etude longitudinale de la névralgie cervico-brachiale dans le service de neurologie du CHU Gabriel Touré, Bamako (Mali)

Introduction: La Névralgie Cervico-Brachiale (NCB) est une pathologie relativement fréquente dans la pratique courante. Elle est pourvoyeused'importants coûts médicaux et socio-économiques. Peu de données existent sur la NCB en Afrique.Méthodes: Il s'agit d'une étude longitudinale, descriptive et prospective qui s'est déroulée du 1er novembre 2009 au 30 Août 2010 au CHU Gabriel Touré de Bamako, Mali. Elle a pour objectif d'étudier les caractéristiques épidémiologiques et cliniques de la NCB. Le diagnostic à été strictement clinique, et la DN4 a permis de déterminer les caractéristiques de cette névralgie. L´intensité de la douleur a été évaluée par l'échelle verbale simple (EVS).L'échelle concis de la douleur et l'échelle HAD ont permis d'étudier l'impact de la douleur sur la qualité de vie des patients. Résultats: La fréquence de la NCB est de 10,9%.Les ménagères sont les plus touchées, 21(40,4%). L'âge moyen des patients est de 48 ±7 ans. La tranche d'âge de 50-59 ans représente la classe modale. La douleur est à prédominance nocturne chez 75,0% des patients. Les décharges  électriques sont la caractéristique principale soit 48,1% des patients et 57,7% malades présentent une douleur intense. Sur le plan  topographique, la racine C7, est la plus atteinte soit 50,0%. Sur la qualité de la vie, 44,2% des malades présentent des troubles du sommeil. Sur le plan thérapeutique l'évolution a été favorable chez 78,8% des patients sous AINS, Tramadol et Amitriptilline. Conclusion: otre travail à l'instar des études antérieures sur la NCB montre que cette pathologie reste une entité clinique relativement courante. Le pronostic généralement favorable est fonction d'un diagnostic précoce et d'une prise en charge adaptée

Evolution of Mycobacterium tuberculosis complex lineages and their role in an emerging threat of multidrug resistant tuberculosis in Bamako, Mali

In recent years Bamako has been faced with an emerging threat from multidrug resistant TB (MDR-TB). Whole genome sequence analysis was performed on a subset of 76 isolates from a total of 208 isolates recovered from tuberculosis patients in Bamako, Mali between 2006 and 2012. Among the 76 patients, 61(80.3%) new cases and 15(19.7%) retreatment cases, 12 (16%) were infected by MDR-TB. The dominant lineage was the Euro-American lineage, Lineage 4. Within Lineage 4, the Cameroon genotype was the most prevalent genotype (n=20, 26%), followed by the Ghana genotype (n=16, 21%). A sub-clade of the Cameroon genotype, which emerged ~22 years ago was likely to be involved in community transmission. A sub-clade of the Ghana genotype that arose approximately 30 years ago was an important cause of MDR-TB in Bamako. The Ghana genotype isolates appeared more likely to be MDR than other genotypes after controlling for treatment history. We identifed a clade of four related Beijing isolates that included one MDR-TB isolate. It is a major concern to fnd the Cameroon and Ghana genotypes involved in community transmission and MDR-TB respectively. The presence of the Beijing genotype in Bamako remains worrying, given its high transmissibility and virulence

The contribution of qualitative research within the PRECISE study in sub-Saharan Africa.

The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as "placental disorders") in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE's objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally.We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health

A “reverse pharmacology” approach for developing an anti-malarial phytomedicine

A “reverse pharmacology” approach to developing an anti-malarial phytomedicine was designed and implemented in Mali, resulting in a new standardized herbal anti-malarial after six years of research. The first step was to select a remedy for development, through a retrospective treatment-outcome study. The second step was a dose-escalating clinical trial that showed a dose-response phenomenon and helped select the safest and most efficacious dose. The third step was a randomized controlled trial to compare the phytomedicine to the standard first-line treatment. The last step was to identify active compounds which can be used as markers for standardization and quality control. This example of “reverse pharmacology” shows that a standardized phytomedicine can be developed faster and more cheaply than conventional drugs. Even if both approaches are not fully comparable, their efficiency in terms of public health and their complementarity should be thoroughly considered

Sustainable development of a GCP-compliant clinical trials platform in Africa: the Malaria Clinical Trials Alliance perspective

BACKGROUND: The Malaria Clinical Trials Alliance (MCTA), a programme of INDEPTH network of demographic surveillance centres, was launched in 2006 with two broad objectives: to facilitate the timely development of a network of centres in Africa with the capacity to conduct clinical trials of malaria vaccines and drugs under conditions of good clinical practice (GCP); and to support, strengthen and mentor the centres in the network to facilitate their progression towards self-sustaining clinical research centres. CASE DESCRIPTION: Sixteen research centres in 10 African malaria-endemic countries were selected that were already working with the Malaria Vaccine Initiative (MVI) or the Medicines for Malaria Venture (MMV). All centres were visited to assess their requirements for research capacity development through infrastructure strengthening and training. Support provided by MCTA included: laboratory and facility refurbishment; workshops on GCP, malaria diagnosis, strategic management and media training; and training to support staff to undertake accreditation examinations of the Association of Clinical Research Professionals (ACRP). Short attachments to other network centres were also supported to facilitate sharing practices within the Alliance. MCTA also played a key role in the creation of the African Media & Malaria Research Network (AMMREN), which aims to promote interaction between researchers and the media for appropriate publicity and media reporting of research and developments on malaria, including drug and vaccine trials. CONCLUSION: In three years, MCTA strengthened 13 centres to perform GCP-compliant drug and vaccine trials, including 11 centres that form the backbone of a large phase III malaria vaccine trial. MCTA activities have demonstrated that centres can be brought up to GCP compliance on this time scale, but the costs are substantial and there is a need for further support of other centres to meet the growing demand for clinical trial capacity. The MCTA experience also indicates that capacity development in clinical trials is best carried out in the context of preparation for specific trials. In this regard MCTA centres involved in the phase III malaria vaccine trial were, on average, more successful at consolidating the training and infrastructure support than those centres focussing only on drug trials

Evolution of virulent genotypes and an emerging threat of multidrug resistant tuberculosis in Bamako, Mali

Background: Bamako, Mali, has a well-structured hierarchyfor tuberculosis (TB) case management. However, in recent yearsBamako has been faced with an emerging threat from multidrugresistant TB (MDR-TB). Here we present insights into the genomicepidemiology of TB and the evolutionary mechanisms driving theemergence of MDR-TB in Bamako.Methods & Materials:Isolates recovered from tuberculosispatients from local reference centers and the University Teach-ing Hospital at Point G, in Bamako, Mali between 2006 and 2012(n = 208), were tested for antimicrobial susceptibility at the MRCUnit The Gambia. A subset of 76 isolates were analysed using wholegenome sequencing. A time dated phylogenetic tree was recon-structed using BEAST. Lineage and resistance conferring mutationswere inferred using PhyResSe.Results:Patients included 21 females and 55 males agedbetween 3 to 78 years, among whom 12(16%) were infectedby MDR-TB. Most patients 61(80%) were new cases and among15 retreatment cases 9(60%) were MDR-TB. The phylogeny wasreconstructed from 8508 variant core genome sites. The dom-inant lineage was the Euro-American super lineage, lineage 4.Within lineage 4, the Cameroon genotype was the most preva-lent genotype (n = 20, 26%) followed by the Ghana genotype (n = 16,21%). Cameroon genotype isolates diverged from a common recentancestor∼161 years ago to form three clusters, one of whichemerged∼22 years ago and is likely to be involved in on-goingtransmission. Seven Ghana genotype isolates were MDR-TB repre-senting over half all MDR-TB in this dataset (7/12). Ghana genotypeisolates were more likely to cause MDR-TB than other genotypesafter controlling for treatment status (OR = 5.6, p-value = 0.043).The MDR-TB Ghana genotype isolates formed a clade that divergedapproximately 30 years ago, in which thekatGSer315Thr mutationwas conserved. Other Euro-American genotypes included the sixLAM, two H37Rv-like and one Uganda. Four patients were infectedwith closely related Beijing strains and five patients were infectedwith non-MDRMycobacterium africanum2

Evaluation and optimization of membrane feeding compared to direct feeding as an assay for infectivity

<p>Abstract</p> <p>Background</p> <p>Malaria parasite infectivity to mosquitoes has been measured in a variety of ways and setting, includind direct feeds of and/or membrane feeding blood collected from randomly selected or gametocytemic volunteers. <it>Anopheles gambiae s.l </it>is the main vector responsible of <it>Plasmodium falciparum </it>transmission in Bancoumana and represents about 90% of the laboratory findings, whereas <it>Plasmodium malariae </it>and <it>Plasmodium ovale </it>together represent only 10%.</p> <p>Materials and methods</p> <p>Between August 1996 and December 1998, direct and membrane feeding methods were compared for the infectivity of children and adolescent gametocyte carriers to anopheline mosquitoes in the village of Bancoumana in Mali. Gametocyte carriers were recruited twice a month through a screening of members of 30 families using Giemsa-stained thick blood smears. F1 generation mosquitoes issued from individual female wild mosquitoes from Bancoumana were reared in a controlled insectary conditions and fed 5% sugar solution in the laboratory in Bamako, until the feeding day when they are starved 12 hours before the feeding experiment. These F1 generation mosquitoes were divided in two groups, one group fed directly on gametocyte carriers and the other fed using membrane feeding method.</p> <p>Results</p> <p>Results from 372 <it>Plasmodium falciparum </it>gametocyte carriers showed that children aged 4–9 years were more infectious than adolescents (p = 0.039), especially during the rainy season. Data from 35 carriers showed that mosquitoes which were used for direct feeding were about 1.5 times more likely to feed (p < 0.001) and two times more likely to become infected, if they fed (p < 0.001), than were those which were used for membrane feeding. Overall, infectivity was about three-times higher for direct feeding than for membrane feeding (p < 0.001).</p> <p>Conclusion</p> <p>Although intensity of infectivity was lower for membrane feeding, it could be a surrogate to direct feeding for evaluating transmission-blocking activity of candidate malaria vaccines. An optimization of the method for future trials would involve using about three-times more mosquitoes than would be used for direct feeding.</p