Evaluation de la prise en charge des etats de mal convulsifs

Introduction: L’état de mal convulsif constitue une urgence médicale, accompagnée d’un risque élevé de morbidité et de mortalité dans les pays en développement.Objectif: L’objectif de cette étude était de faire une évaluation de la prise en charge des états de mal épileptiques dans le contexte Guinéen par rapport aux recommandations internationales.Méthodes: Il s’agissait d’une étude prospective de 3 ans allant de 2012 à 2015. Ont été inclus tous les patients admis au service de Neurologie pour des crises épileptiques sur une période d’au moins 5 minutes. Les données cliniques, paracliniques, thérapeutiques et évolutives ont été répertoriées. Les données ont été analysées à l’aide du logiciel épi info 7.2. Toute p-value ≤ 0,05 était considérée comme statistiquement significative.Résultats: Nous avons enregistré 90 cas d’état de mal convulsif sur 828 malades hospitalisés soit une fréquence de 10,86%. L’âge moyen des patients était de 47 +/- 15 ans. Le délai moyen de consultation était de 17,18 h. Les crises focales représentaient 47,78% des cas. Le délai moyen de prise en charge intra hospitalière était de 33,63 minutes. La prise en charge des patients était assurée par la famille dans 71,11% des cas. Le positionnement des malades était correct dans 66 cas (73,33%). Le taux de décès était de 43,33%.Conclusion: On note une grande disparité entre les recommandations internationales et la prise en charge de ces patients dans notre service. Cette étude met en évidence les limites de la prise en charge des états de mal épileptique.Mots clés: évaluation, état de mal épileptique, traitementEnglish Title: Evaluation of convulsive status epilepticus managementEnglish AbstractIntroduction: Status epilepticus is a medical emergency associated with high mortality and morbidity in developing countries.Objective: The aim of this study is to evaluate the management of status epilepticus in the Guinen context, in comparison to international guidelines.Methods: We report a prospective study of 3 years from 2012 to 2015. All patients admitted to Neurological department for seizures lasting at least 5 minutes were included. The clinical, paraclinic, therapeutic and evolutive data were recorded. Data were analyzed using Epi Info 7.2. Any p-value ≤ 0.05 was considered statistically significative.Results: We recorded 90 cases of convulsive status epilepticus among 828 patients with a frequency of 10.86%. The average age was 47 +/- 15 years. The average consultation delay was 17.18 h. Focal seizures represent 47.78%. The mean in hospital management delay was 33.63 minutes. The care support of patients was provided by family in 71.11% of cases. Positioning was adequate in 66 patients (73.33%). Death rate was 43.33%.Conclusion: There is a great disparity between the international guidelines and the management of these patients in our ward. This gap explains the high mortality. This study highlights the limitations of all management steps of status epilepticus.Keywords: evaluation, status epilepticus, managemen

Cryptococcal meningitis associated HIV infection in the Donka national hospital in Conakry (Guinea)

Background Cryptococcal meningitis (CM) is an infection of the brain parenchyma and subarachnoid space by the encapsulated saprophyte yeast organisms such as Cryptococcus neoformans. Over the last twenty years, HIV has created a large and severely immune compromisized population in whom C. neoformans is a dangerous opportunistic infection. In Guinea, the prevalence of CM is unknown. We hypothesized that the occurrence of CM correlates with AIDS/ HIV prevalence.Method This retrospective observational study was carried out at the national Hospital of Conakry (Guinea) between 2001 and 2002. We describe here the epidemiological and clinical and biological characteristics of CM disease in our national hospital.Results Our data show that, 28.6 % of HIV patients with neurological symptoms had Cryptococcus neoformans in their CSF by using Indian ink staining. The median age was 36±3 years and sex ratio (M/F) was 1.8. The major complaints were fever and cephalgia, giddiness while the major complications were altered consciousness and hemiplegia. CSF was clear with low level of glucose and higher level of albumin. The means of lymphocytes in CSF was 8±2/mm3.Conclusion This data therefore becomes relevant in not only focusing of neurological symptoms associated with HIV to be toxoplasmosis but the possibility of C neoformans in these patients; particularly when they present symptoms such as headaches, giddiness and sniff neck etc. This can easily be carried out with Indian ink staining technique

Collaborative Exploration of African rice (Oryza glaberrima Steud.) in Sénégal and Guinea in 2006

Under the cooperation of the Institut Sénégalais de Recherche Agronomique(ISRA), Africa Rice Center(WARDA), and Institut de Recherche Agronomique de Guinée(IRAG), we explored African rice, Oryza glaberrima Steud. in Sénégal and Guinea. The total 67 cultivated and wild rice including 42 O. glaberrima were collected through the survey. Most of O. glaberrima were grown in the wetlands and flood-prone area. Through the fact-finding on the spot in farmer\u27s fields, the collected O. glaberrima had elongation ability in wetland as well as tolerance of deepwater. O. glaberrima seems to adapt better in wetlands than in upland. In the area on tributary of Niger river in Guinea, farmers like to cultivate the O. glaberrima because of its shoot elongation ability and other biological resistance to disease and pest even if its lower productivity. On the other hand, a farmer knew cultivation selectively in most of O. glaberrima in Sénégal. However, most of farmers abandon the O. glaberrima because of their unfavorable taste, and new improved rice, O. sativa, has been introduced into the farmer\u27s fields enthusiastically. Moreover, collected genetic resources were analyzed morphologically. Among cultivars, a variation of grains shape, color, paddy hair was small in O. glaberrima compared with collected O. sativa . In conclusion, O. glaberrima adapts itself in severe water stresses condition under lower input rice cultivation system in the regions

GENERAL PARALYSIS IN A TROPICAL COUNTRY. STUDY OF 43 OBSERVATIONS

PARALYSIE GÉNÉRALE EN MILIEU TROPICAL. ÉTUDE DE 43 OBSERVATIONS RESUME Description :Les auteurs rapportent une étude de 43 cas de paralysie générale, révélés par un syndrome démentiel et des formes atypiques notamment les troubles confusionnels répétitifs et des crises épileptiformes. Objectif : L'objectif de cette étude est de réévaluer cette pathologie du point de vue clinique et paraclinique en milieu tropical. Méthode : Il s'agit d'une étude prospective. Le diagnostic a reposé sur la positivité des réactions sérologiques ( VDRL-TPHA) dans le sang et le liquide céphalo-rachidien, la présence d'une hypercellularité à prédominance lymphocytaire et d'une hyperprotéinorachie. Resultats : Les troubles cognitifs et moteurs, les états confusionnels répétitifs et les crises épileptiques constituent les formes cliniques dominantes de début. Chez tous les patients, le scanner a mis en évidence une discrète dilatation ventriculaire diffuse et un élargissement des sillons de la convexité. Le tracé électroencéphalographique était anormal dans près de 67% des cas. SUMMARY Description : The authors report a study of 43 cases of general paralysis revealed by some mental disorders and atypical forms notably repeater confessional disorders and some seizure-like attacks. Objective : The goal of this study is to revalue this pathology from the clinical and paraclinic point of view in tropical medium. Method : In this prospective study, the diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid (CSF); CSF cell count with lymphocyte predominance ; protein level in the fluid. Result : The diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid(CSF); high CSF cell count with lymphocyte predominance; high protein level in the fluid. The cogniture and motor troubles, the repeated confusion status and the epileptic seizures constitute the dominant clinical forms of the onset. In all the patients, the CT-scan revealed discrete diffuse ventricular dilation and widening of the grooves of the convexity. The electroencephalographic traces were abnormal in 67% of the cases. Key Words: Afrique, Guinée, paralysie générale, syphilis nerveuse, Africa, Guinea, general paralysis, neurosyphilis African Journal of Neurological Sciences Vol.23(2) 200

The Prevalence of HIV in Cancer Patients at the Surgical Oncology Unit of Donka University Hospital of Conakry (Guinea)

Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3 Kg/m2. They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317 cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis

Evaluation of maternal and child care continuum in Guinea: a secondary analysis of two demographic and health surveys using the composite coverage index (CCI)

International audienceIntroduction: The composite coverage index (CCI) is the weighted average coverage of eight preventive and curative interventions received along the maternal and childcare continuum. This study aimed to analyse maternal and child health indicators using CCI.Methods: We performed a secondary analysis of demographic and health surveys (DHS) focused on women aged 15 to 49 and their children aged 1 to 4. This study took place in Guinea. The CCI (meeting the need for planning, childbirth assisted by qualified healthcare workers, antenatal care assisted by qualified healthcare workers, vaccination against diphtheria, pertussis, tetanus, measles and Bacillus Calmette-Guérin, taking oral rehydration salts during diarrhoea and seeking care for pneumonia) is optimal if the weighted proportion of interventions is > 50%; otherwise, it is partial. We identified the factors associated with CCI using the descriptive association tests, the spatial autocorrelation statistic and multivariate logistic regression.Results: The analyses involved two DHS surveys, with 3034 included in 2012 and 4212 in 2018. The optimal coverage of the CCI has increased from 43% in 2012 to 61% in 2018. In multivariate analysis, in 2012: the poor had a lower probability of having an optimal CCI than the richest; OR = 0.11 [95% CI; 0.07, 0.18]. Those who had done four antenatal care visits (ANC) were 2.78 times more likely to have an optimal CCI than those with less OR = 2.78 [95% CI;2.24, 3.45]. In 2018: the poor had a lower probability of having an optimal CCI than the richest OR = 0.27 [95% CI; 0.19, 0.38]. Women who planned their pregnancies were 28% more likely to have an optimal CCI than those who had not planned OR = 1.28 [95% CI;1.05, 1.56]. Finally, women with more than 4 ANC were 2.43 times more likely to have an optimal CCI than those with the least OR = 2.43 [95% CI; 2.03, 2.90]. The spatial analysis reveals significant disparities with an aggregation of high partial CCI in Labé between 2012 and 2018.Conclusion: This study showed an increase in CCI between 2012 and 2018. Policies should improve access to care and information for poor women. Besides, strengthening ANC visits and reducing regional inequalities increases optimal CCI

Tuberculose multifocale associée à une toxoplasmose cérébrale sur terrain immunodéprimé à VIH chez un patient immigré africain au Centre Hospitalier de Soissons, France

Dans les pays industrialisés et notamment en France, vu les moyens de prévention, dépistage précoce et prise en charge immédiate de l'infection à VIH, la survenue d'infections opportunistes ne se voit presque chez les immigrés et certaines couches socio-professionnelles défavorisées. Nous rapportons donc le cas d'un homme de 42 ans, immigré africain, hospitalisé pour syndrome infectieux dans un contexte d'altération de l'état général, VIH1 positif sous antirétroviraux depuis deux ans, arrêtés depuis quatre mois, une tuberculose pulmonaire traitée et déclarée guérie en février 2017 avec, à l'examen une lenteur à l'idéation, une fièvre à 39,6°C et un amaigrissement. Le nadir CD4 à 12/mm3, une charge virale VIH1 à 5,80log. Le scanner thoraco-abdominal et l'IRM cérébrale ont permis de visualiser des lésions intra-abdomino-thoraciques et cérébrales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trithérapie antirétrovirale à quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une évolution favorable

Severe cutaneous drug reactions in Guinean children: a monocentric retrospective study of 35 cases

Background: Data on Severe cutaneous drug reactions (CADRs) are not common among in sub-Saharan Africa children. The purpose of this study was to document the clinical, etiological and evolutionary aspects of Severe CDRs in children hospitalized at the dermatology department of university hospitals of Conakry. Material and Methods: Retrospective study, conducted from 1 January 2000 to 31 December 2014. Were included all children aged 0-17 years hospitalized for severe CARDs. The data collected were Socio-demographic, clinical, para-clinical and evolution variables. The data was entered and analyzed using the Excel 8.0 software. Results: During a study period, 4437 patients of all ages was hospitalized in dermatology department. 35 patients were included with an average age of 11.3 years and a sex ratio of 1.5. The main clinical patterns were: Stevens Johnson syndrome 37.14% (13/35) Lyell syndrome 25.71 % and generalized bullous fixed eruption 22.85%. The drug was identified as 32 patients (91.42%): Sulfadoxine–Pyriméthamine 40.62%, cotrimoxazole 21.85%, nevirapin 12.5%, ampicillin 6.25%, traditional Pharmacopoeia 6.25% and griseofulin 3.12%. It was taken following self-medication in 14 patients, including a parental initiative in 9 patients. 7 patients had a history of drug allergy and 4 were HIV positive. We recorded 5 deaths. Conclusion: Our study confirms the rarity of severe CADRs in children. The importance of the sulfadoxine-pyrimethamine in the occurrence of severe CADRs in children is the particularity of our series