Tableau d’encephalite revelant un anevrisme de l’artere communicante posterieure a parakou (Benin)

L‘anévrisme intra crânien est une dilatation localisée et persistante d‘une artère cérébrale. Nous rapportons le cas d‘une patiente de 30 ans présentant des céphalées à répétition depuis 3 mois et admise en Soins Intensifs pour un syndrome infectieux et des troubles neurologiques. Les résultats de la tomodensitométrie et de l‘examen du liquide cérébro-spinal ont permis d‘évoquer le diagnostic de méningo-encéphalite; l‘évolution sous traitement adapté a été marquée par la disparition des troubles de la vigilance et l‘amélioration de la force musculaire. Sa sortie de l‘hôpital a alors été faite. Un mois après, il a été noté la persistance du ptosis droit, du syndrome pyramidal hémicorporel gauche et l‘apparition d‘un trouble du comportement et d‘une agitation : un angioscanner cérébral réalisé révéla alors un anévrisme partiellement thrombosé de la communicante postérieure droite. Le traitement neurochirurgical indiqué n‘a pu être fait pour des raisons financières ; elle est donc suivie en consultation neurologique.   English title: A case of aneurysm of the posterior communicating artery mimicking an encephalitis in Parakou (Benin) The intracranial aneurism is a permanent enlargement of a cerebral aretery. We are reporting the case of a female patient who had a headache since 3 months and was admitted to Intensive Care Unit because of neurological deficiencies and fever. The CT scan and the cerebrospinal liquid‘s exams realized leaded to a meningoencephalitis diagnosis. Under the adapted treatment, the consciousness disorder disappeared and the muscular strength become better. Therefore, she went to home. After one month, she presented a persistence of the right ptosis, of a pyramidal syndrome. Moreover, she developped a behavioural trouble and become agitate: then an angioscanner were done and had shown an aneurism of the posterior communicating artery. The neurosurgical care recommended did not apply due to the patient‘s economic problems. She is currently following by the neurologist

Enquete sur la prevalence de la migraine chez l’adulte a titirou au Nord du Benin en 2017

Introduction: La migraine est une maladie neurologique fréquente en population, source de handicap et classée 13ème des affections les plus handicapantes par l’OMS. L’objectif de cette étude était d’étudier la prévalence de la migraine à Titirou en 2017. Méthodes: Il s’est agi d’une étude transversale de type porte-à-porte menée sur 2065 sujets âgés de 18 à 65 ans. L’enquête a été effectuée sur une période de 4 mois allant du 10 avril au 05 août 2017. Les critères diagnostiques de l’International Headache Society (IHS) de 2013 ont servi de base pour le diagnostic de la migraine. Les informations sociodémographiques, le poids et taille et les données relatives à la fréquence et l’intensité des céphalées furent collectés. Les données ont été saisies, traitées et analysées grâce au logiciel Epi Info version 2.2.0.165. Résultats: Il y avait une prédominance masculine avec un sex-ratio de 1,41. Les sujets étaient âgés de 18 à 65 ans avec une moyenne d’âge de 31,87±8,37ans. La prévalence des céphalées était de 63,49%. La  prévalence de la migraine à Titirou était de 3,82% [IC95% : (3,06%-4,72%)] (79 sur les 2065). Les facteurs associés à la migraine étaient l’âge (p=0,0026), le sexe (p=0,0001), le niveau d’instruction (p=0,0039), la profession (p<10-4 ) et l’indice de masse corporelle (p<10-4 ). L’intensité des céphalées était modérée dans 44,30%, forte dans 51,90%,  extrêmement forte chez 3,80% des sujets. La plupart des migraineux  (78,48%), avait moins de 5 crises par mois. La migraine avec aura  représentait 49,4%. Les auras les plus observées étaient les phosphènes (34,18%), les scotomes (13,92%) et l’aura sensitive (13,92%). Les  facteurs déclenchant les accès étaient le manque de sommeil (84,81%), la contrariété (68,35%) et le souci (62,03%). Conclusion : La migraine est assez fréquente et sa prévalence est comparable à celle rapportée dans la plupart des études en communauté en Afrique.Mots clés: Migraine -Prévalence-Adulte-Benin Introduction: The migraine is a common neurological disorder with a serious handicap and classified as the 13th disabling disease worldwide. The most consistently data on epidemiology of migraine are available in general population in Africa but not in northern Benin. We aimed to study the prevalence of migraine at Titirou in Parakou in 2017. Methods: This was a cross-sectional with door-to-door survey which included 2065 subjects aged 18 to 65 years. The survey was conducted over a period of 4 months from 10 April to 05 August 2017. The IHS diagnostic criteria of 2013 were used to define migraine. Socio-demographics information was collected. The data were analyzed using Epi Info 2.2.0.165.fr software. Results: There was a male predominance with 58.45% of men with sex ratio of 1.41. The mean age was 31.87 ± 8.37 years. The prevalence of headache was 63.49%. The prevalence of migraine in Titirou was 3.82% [95%CI: 3.06%-4.72%]. The associated factors were the age (p=0.00), the sex (p=0.00), level of education (p=0.00), occupation (p<10-4 ) and the body mass index (p<10-4 ). The migraine with aura represented 49.4%. The most type were visual aura (34.18%), sensitive aura (13.92%) and scotoma (13.92%).The intensity of headache was moderate in 44.30%, strong in 51.90%, extremely strong in 3.80% of subjects. The main triggering factors were lack of sleep (84.81%), annoyance (68.35%) and worry (62.03%). Conclusion: Migraine was more frequent in Parakou and this data are comparable to those reported elsewhere in sub-Saharan Africa.Key words: Headache, Migraine- Prevalence, epidemiology, Adult; Benin

A situational analysis of the care of road traffic victims in Burkina Faso: a challenge to achieve sustainable development objectives

Introduction The aim of this study was to assess the capacity of Burkina Faso’s health services to care for road accident victims, from the crash site up to their recovery and rehabilitation. Methods We performed a situation analysis rooted in the literature findings, overview of administrative documents, followed by the analysis of pre-hospital, hospital and post-hospital care. We also performed monitoring visits and interviewed a number of stakeholders, aiming to additionally understand the current situation and identify the most important knowledge gaps, required for the development of policy and implementation of the holistic intervention plan. Results The study identified numerous and strong deficiencies across the total care of road accident victims management spectrum. The results suggest that a broad-scope intervention is needed, although even smaller-scale effects on elements of total care may yield improvements in specific areas. We also detected a substantial need for more primary studies that can provide relevant data for policy. Conclusion This study identified numerous problems, which need to be further explored and quantified, before a more systematic intervention can be applied across the country, aiming to reduce the negative health consequences of road accidents

Managing insecticide resistance in malaria vectors by combining carbamate-treated plastic wall sheeting and pyrethroid-treated bed nets

<p>Abstract</p> <p>Background</p> <p>Pyrethroid resistance is now widespread in <it>Anopheles gambiae</it>, the major vector for malaria in sub-Saharan Africa. This resistance may compromise malaria vector control strategies that are currently in use in endemic areas. In this context, a new tool for management of resistant mosquitoes based on the combination of a pyrethroid-treated bed net and carbamate-treated plastic sheeting was developed.</p> <p>Methods</p> <p>In the laboratory, the insecticidal activity and wash resistance of four carbamate-treated materials: a cotton/polyester blend, a polyvinyl chloride tarpaulin, a cotton/polyester blend covered on one side with polyurethane, and a mesh of polypropylene fibres was tested. These materials were treated with bendiocarb at 100 mg/m²and 200 mg/m²with and without a binding resin to find the best combination for field studies. Secondly, experimental hut trials were performed in southern Benin to test the efficacy of the combined use of a pyrethroid-treated bed net and the carbamate-treated material that was the most wash-resistant against wild populations of pyrethroid-resistant <it>An. gambiae </it>and <it>Culex quinquefasciatus</it>.</p> <p>Results</p> <p>Material made of polypropylene mesh (PPW) provided the best wash resistance (up to 10 washes), regardless of the insecticide dose, the type of washing, or the presence or absence of the binding resin. The experimental hut trial showed that the combination of carbamate-treated PPW and a pyrethroid-treated bed net was extremely effective in terms of mortality and inhibition of blood feeding of pyrethroid-resistant <it>An. gambiae</it>. This efficacy was found to be proportional to the total surface of the walls. This combination showed a moderate effect against wild populations of <it>Cx. quinquefasciatus</it>, which were strongly resistant to pyrethroid.</p> <p>Conclusion</p> <p>These preliminary results should be confirmed, including evaluation of entomological, parasitological, and clinical parameters. Selective pressure on resistance mechanisms within the vector population, effects on other pest insects, and the acceptability of this management strategy in the community also need to be evaluated.</p

Hydranencephalie a Cotonou (Benin) a propos de 3 cas cliniques

L’hydranencéphalie est une malformation rare du système cérébral. Elle est caractérisée par une disparition des hémisphères cérébraux bilatéraux qui sont remplacés par le liquide céphalorachidien. Nous rapportons 3 cas cliniques. Le diagnostic repose sur le scanner cérébral et l’IRM et pose un problème thérapeutique et éthique car aucun traitement n’améliore le développement neurologique.Mots-clés: hydranencéphalie, hydrocéphalie, malformation, système nerveux central, BéninEnglish Title: Hydranencephaly at Cotonou (Benin): 3 cases reportsEnglish AbstractHydranencephaly is a rare malformation of the brain system. It is characterized by the absence of bilateral cerebral hemispheres which are replaced by cerebrospinal fluid. We present three clinical cases. Brain CTscan was performes for diagnosis. Therapeutic and ethic problems are discussed.Keywords: hydranencephaly, hydrocephalus, malformation, central nervous system, Beni

L’infection a virus de l’Immunodeficience Humaine (VIH), facteur predictif de gravite et de mortalite des accidents vasculaires cerebraux au Centre National Hospitalier et Universitaire-Hubert Koutoukou Maga (CNHU-HKM) de Cotonou, Benin

Introduction: L’atteinte du système nerveux central est fréquente et précoce au cours de l’infection à VIH. Cependant, la survenue de l’accident vasculaire cérébral (AVC) au cours de l’évolution naturelle du VIH est peu documentée.Objectif: Déterminer la prévalence hospitalière du VIH chez les patients AVC et comparer les caractéristiques cliniques des AVC entre les sujets infectés et non infectés par le VIH.Méthode: Etude transversale qui s’est déroulée au CNHU-HKM de janvier 2008 à décembre 2011. Elle a porté sur 432 sujets tous hétérosexuels, atteints d’AVC confirmé par un scanner cérébral et ayant bénéficié d’une sérologie VIH. Deux groupes ont été constitués. Le groupe des sujets AVC infectés par le VIH (AVCVIH+) et le groupe des sujets AVC non infectés par le VIH (AVCVIH-). La gravité de l’AVC sur la base du score NIHSS à l’admission et la mortalité à J30 ont été étudiées. Le logiciel Epi info a servi à l’analyse des données.Résultats: La prévalence hospitalière du VIH chez les patients atteints d’AVC était de 26,1% (113/432). L’âge moyen des PVVIH était de 43 ± 7 ans. Aucun d’eux ne se connaissait VIH+ avant l’admission. La médiane des CD4  était basse : 119±36/mm3. Il n’y a pas de différence significative entre les deux groupes pour ce qui concerne l’âge (p=0,08), le sexe (p=0,24), l’antécédent d’HTA (p=0,2), l’antécédent de diabète (p=0,231). En revanche, l’AVC ischémique (67,3% vs 62,4% ; p=0,02) et la mortalité à J30 (23% vs 10,5% ; p=0,007) étaient significativement plus élevés chez les sujets VIH+ que les VIH-. De même, l’AVC à l’admission (NIHSS&gt;13 ; p=0,002) était plus grave dans le groupe AVCVIH+ que dans le groupe AVCVIH-. Le risque de faire un AVC est multiplié par au moins 2 lorsque le sujet était séropositif que séronégatif pour le VIH, tous autres facteurs étant égaux par ailleurs (RR=2,3).Conclusion: Ces résultats suggèrent que l’AVC est fréquent au cours de l’infection à VIH et peut être son mode de révélation. De même, l’infection à VIH apparait comme un facteur de risque de mauvais pronostic au cours de l’AVC.Mots clés: AVC, VIH, gravité, mortalité, BéninEnglish Title: Human Immunodeficiency Virus infection (HIV), stroke severity and mortality predictive indicator in centre national Hospitalier et Universitaire-Hubert Koutoukou Maga (CNHU-HKM) Cotonou, BeninEnglish AbstractIntroduction: During HIV infection, the central nervous system is frequently affected. However, the occurrence of stroke during the natural course of HIV is poorly documented.Objectives: To determine the prevalence rate of HIV among stroke patients and to compare the clinical characteristics of stroke in people with HIV and those HIV free.Method: A Cross-sectional study was conducted in the Neurology department of CNHU-HKM in Cotonou from January 2008 to December 2011. It involved 432 subjects all heterosexual, with stroke confirmed by brain CT scan and who underwent HIV test. Two groups were formed. The group of stroke subjects with HIV infection (AVCVIH +) and that of stroke subjects not infected by HIV (AVCVIH-). Stroke severity based on NIHSS score at admission and mortality at day 30 was studied. Epi Info was used for data analyses.Outcome: The prevalence rate of HIV among patients with stroke was 26.1% (113/432). The average age of HIV’s subjects was 43 ± 7 years. None of them knew prior to admission that their status was HIV +. The median CD4 count was low: 119 ± 36/mm3. There is no significant difference between the two groups regarding age (p = 0.08), sex (p = 0.24), hypertension history (p = 0.2), diabetes history (p = 0.231). However, ischemic stroke (67.3% vs. 62.4%, p = 0.02) and mortality at day 30 (23% vs. 10.5%, p = 0.007) were significantly higher among HIV + than HIV-. Similarly, stroke on admission (NIHSS&gt; 13, p = 0.002) was more severe in the group AVCVIH + than in group-AVCVIH. The risk of stroke is multiplied by at least 2 when the subject was HIV+ compare to HIV-, all other factors being equal (RR = 2.3).Conclusion: These results prove that stroke is common during HIV infection and may be one of its revealing factor. Similarly, HIV infection is a risk factor of poor outcome during stroke.Keywords: Stroke, HIV, AVC, severity, mortality, Beni

Investigating the n- and p-Type Electrolytic Charging of Colloidal Nanoplatelets

We investigate the ion gel gating of 2D colloidal nanoplatelets. We propose a simple, versatile, and air-operable strategy to build electrolyte-gated transistors. We provide evidence that the charges are injected in the quantum states of the nanocrystals. The gating is made possible by the presence of large voids into the NPL films and is sensitive to the availability of the nanocrystals surface

Investigating the n- and p-Type Electrolytic Charging of Colloidal Nanoplatelets

We investigate the ion gel gating of 2D colloidal nanoplatelets. We propose a simple, versatile, and air-operable strategy to build electrolyte-gated transistors. We provide evidence that the charges are injected in the quantum states of the nanocrystals. The gating is made possible by the presence of large voids into the NPL films and is sensitive to the availability of the nanocrystals surface

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course

Ten-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries

INTRODUCTION: Sex differences have already been reported in sub-Saharan Africa for attrition and immunological response after antiretroviral therapy (ART) initiation, but follow-up was usually limited to the first two to three years after ART initiation. We evaluated sex differences on the same outcomes in the 10 years following ART initiation in West African adults. METHODS: We used cohort data of patients included in the IeDEA West Africa collaboration, who initiated ART between 2002 and 2014. We modelled no-follow-up and 10-year attrition risks, and immunological response by sex using logistic regression analysis, survival analysis with random effect and linear mixed models respectively. RESULTS: A total of 71,283 patients (65.8% women) contributed to 310,007 person-years of follow-up in 16 clinics in eight West African countries. The cumulative attrition incidence at 10-year after ART initiation reached 75% and 68% for men and women respectively. Being male was associated with an increased risk of no follow-up after starting ART (5.1% vs. 4.0%, adjusted Odds Ratio: 1.25 [95% CI: 1.15 to 1.35]) and of 10-year attrition throughout the 10-year period following ART initiation: adjusted Hazard Ratios were 1.22 [95% CI: 1.17 to 1.27], 1.08 [95% CI: 1.04 to 1.12] and 1.04 [95% CI: 1.01 to 1.08] during year 1, years 2 to 4 and 5 to 10 respectively. A better immunological response was achieved by women than men: monthly CD4 gain was 30.2 and 28.3 cells/mL in the first four months and 2.6 and 1.9 cells/μL thereafter. Ultimately, women reached the average threshold of 500 CD4 cells/μL in their sixth year of follow-up, whereas men failed to reach it even at the end of the 10-year follow-up period. The proportion of patients reaching the threshold was much higher in women than in men after 10 years since ART initiation (65% vs. 44%). CONCLUSIONS: In West Africa, attrition is unacceptably high in both sexes. Men are more vulnerable than women on both attrition and immunological response to ART in the 10 years following ART initiation. Innovative tracing strategies that are sex-adapted are needed for patients in care to monitor attrition, detect early high-risk groups so that they can stay in care with a durably controlled infection