Les fistules anastomotiques (FA) post-colectomie au Service de Chirurgie Générale de l’Hôpital Aristide Le Dantec

La fistule anastomotique reste la complication la plus redoutée après chirurgie colorectale et continue à poser un problème diagnostique et thérapeutique. Le but de cette étude est de déterminer à la fois la prévalence et les éléments de prises en charge diagnostiques et  thérapeutiques de la fistule colique après colectomie. Nous avons mené une étude rétrospective descriptive des cas de fistule colique après  colectomie sur une période de 7 ans allant de janvier 2007 au décembre 2013. Il y avait 17 patients qui ont présenté une fistule colique parmi les 170 patients ayant bénéficié de colectomie dans notre service soit un taux de 10%. L'âge moyen au moment de l'intervention initiale était de 45,1 ans (extrêmes de 20 et 78 ans). Il y avait une prédominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) était les principales indications de colectomie L'intervention initiale a été réalisée en urgence chez 13 patients. Le délai moyen d'apparition de la fistule était de 10,8 jours. Il y avait 10 patients ayant présenté une fistule colo-cutanée et 7 cas de péritonites postopératoires stercorales. Onze de nos patients présentaient une anémie (taux moyen d'hémoglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100  leucocytes/mm3). Une échographie, réalisée chez 6 patients, était revenue normale chez 1 patient et avait mis en évidence un épanchement intra péritonéal chez 5 patients tandis que La tomodensitométrie (TDM) sans opacification digestive, réalisée chez 2 patients, n'était contributive au diagnostic que chez 1 seul patient. Neuf patients avaient bénéficié de traitement médical seul. Ce dernier consistait en une couverture  antibiotique, un régime hyperprotéique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est fermée spontanément, dans un délai moyen de 15 jours. La reprise chirurgicale a été réaliséechez 8 patients dans un délai moyen de 4,8 jours. Elle a été indiquée pour une péritonite par fistule anastomotique chez 7 patients et pour  persistance de la fistule colocutanée malgré traitement médical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont présenté au moins une complication liée à la fistule colique (2 récidives de la fistule, 3 suppurations et 2 éviscérations). La durée moyenne d'hospitalisation était de 55,2 jours (extrêmes de 15et 168 jours). Deux décès étaient enregistrés consécutif à un choc septique. Une accessibilité des moyens thérapeutiques telles que la nutrition parentérale et le drainage percutané nous permettrait de réduire une durée d'hospitalisation prolongée et également des coûts de prise en charge élevés.Mots clés: Colectomie, anastomose, fistule, péritonite, stomi

L’hésitation à la vaccination COVID-19 dans les communes de Bamako au Mali

Bien que le développement de vaccins soit un exploit considérable, ce n'est que récemment qu'une attention considérable a été accordée à l'hésitation face au vaccin COVID-19. L'hésitation à la vaccination pourrait être un obstacle à l'optimisation de l'adoption et de l'acceptation des vaccins COVID-19. Cette étude voudrait déterminer les facteurs associés à l’hésitation à la vaccination COVID-19 dans les communes de Bamako au Mali. C’est une étude quantitative, descriptive et transversale utilisant un questionnaire pour déterminer les facteurs associés à l’hésitation à la vaccination COVID-19. La population de cette étude a concerné les adultes vivants dans les communes de Bamako au Mali. Au total 532 personnes vivants dans les communes de Bamako ont accepté de participer dont plus de la moitié étaient des femmes.  Environ 18,6 % avaient déjà reçu au moins une dose de vaccin contre la COVID-19. La peur des réactions secondaires (77 ,1%), était la principale raison de la réticence ou de l’hésitation à la vaccination COVID-19. Cette étude a rapporté une relation significative entre le statut vaccinal et les caractérisques socio-démographiques à savoir le sexe (p=0,01), l’âge (p=0,02), situation matrimoniale (p=0,04), le niveau d’éducation (p=0,01) et la connaissance sur la vaccination COVID-19 (p=0,002). L'hésitation à l'égard des vaccins est une menace imminente dans la bataille contre le COVID-19, car l'obtention d'une immunité collective dépend de l'efficacité du vaccin lui-même et de la volonté de la population à l’accepter

L’hésitation à la vaccination COVID-19 dans les communes de Bamako au Mali

Bien que le développement de vaccins soit un exploit considérable, ce n'est que récemment qu'une attention considérable a été accordée à l'hésitation face au vaccin COVID-19. L'hésitation à la vaccination pourrait être un obstacle à l'optimisation de l'adoption et de l'acceptation des vaccins COVID-19. Cette étude voudrait déterminer les facteurs associés à l’hésitation à la vaccination COVID-19 dans les communes de Bamako au Mali. C’est une étude quantitative, descriptive et transversale utilisant un questionnaire pour déterminer les facteurs associés à l’hésitation à la vaccination COVID-19. La population de cette étude a concerné les adultes vivants dans les communes de Bamako au Mali. Au total 532 personnes vivants dans les communes de Bamako ont accepté de participer dont plus de la moitié étaient des femmes.  Environ 18,6 % avaient déjà reçu au moins une dose de vaccin contre la COVID-19. La peur des réactions secondaires (77 ,1%), était la principale raison de la réticence ou de l’hésitation à la vaccination COVID-19. Cette étude a rapporté une relation significative entre le statut vaccinal et les caractérisques socio-démographiques à savoir le sexe (p=0,01), l’âge (p=0,02), situation matrimoniale (p=0,04), le niveau d’éducation (p=0,01) et la connaissance sur la vaccination COVID-19 (p=0,002). L'hésitation à l'égard des vaccins est une menace imminente dans la bataille contre le COVID-19, car l'obtention d'une immunité collective dépend de l'efficacité du vaccin lui-même et de la volonté de la population à l’accepter

OmpA family proteins and Pmp-like autotransporter: new adhesins of Waddlia chondrophila

Waddlia chondrophila is a obligate intracellular bacterium belonging to the Chlamydiales order, a clade that also includes the well-known classical Chlamydia responsible for a number of severe human and animal diseases. Waddlia is an emerging pathogen associated with adverse pregnancy outcomes in humans and abortion in ruminants. Adhesion to the host cell is an essential prerequisite for survival of every strict intracellular bacteria and, in classical Chlamydia, this step is partially mediated by polymorphic outer membrane proteins (Pmps), a family of highly diverse autotransporters that represent about 15% of the bacterial coding capacity. Waddlia chondrophila genome however only encodes one putative Pmp-like protein. Using a proteomic approach, we identified several bacterial proteins potentially implicated in the adhesion process and we characterized their expression during the replication cycle of the bacteria. In addition, we demonstrated that the Waddlia Pmp-like autotransporter as well as OmpA2 and OmpA3, two members of the extended Waddlia OmpA protein family, exhibit adhesive properties on epithelial cells. We hypothesize that the large diversity of the OmpA protein family is linked to the wide host range of these bacteria that are able to enter and multiply in various host cells ranging from protozoa to mammalian and fish cell

Application of geographically-weighted regression analysis to assess risk factors for malaria hotspots in Keur Soce health and demographic surveillance site.

BACKGROUND: In Senegal, considerable efforts have been made to reduce malaria morbidity and mortality during the last decade. This resulted in a marked decrease of malaria cases. With the decline of malaria cases, transmission has become sparse in most Senegalese health districts. This study investigated malaria hotspots in Keur Soce sites by using geographically-weighted regression. Because of the occurrence of hotspots, spatial modelling of malaria cases could have a considerable effect in disease surveillance. METHODS: This study explored and analysed the spatial relationships between malaria occurrence and socio-economic and environmental factors in small communities in Keur Soce, Senegal, using 6 months passive surveillance. Geographically-weighted regression was used to explore the spatial variability of relationships between malaria incidence or persistence and the selected socio-economic, and human predictors. A model comparison of between ordinary least square and geographically-weighted regression was also explored. Vector dataset (spatial) of the study area by village levels and statistical data (non-spatial) on malaria confirmed cases, socio-economic status (bed net use), population data (size of the household) and environmental factors (temperature, rain fall) were used in this exploratory analysis. ArcMap 10.2 and Stata 11 were used to perform malaria hotspots analysis. RESULTS: From Jun to December, a total of 408 confirmed malaria cases were notified. The explanatory variables-household size, housing materials, sleeping rooms, sheep and distance to breeding site returned significant t values of -0.25, 2.3, 4.39, 1.25 and 2.36, respectively. The OLS global model revealed that it explained about 70 % (adjusted R(2) = 0.70) of the variation in malaria occurrence with AIC = 756.23. The geographically-weighted regression of malaria hotspots resulted in coefficient intercept ranging from 1.89 to 6.22 with a median of 3.5. Large positive values are distributed mainly in the southeast of the district where hotspots are more accurate while low values are mainly found in the centre and in the north. CONCLUSION: Geographically-weighted regression and OLS showed important risks factors of malaria hotspots in Keur Soce. The outputs of such models can be a useful tool to understand occurrence of malaria hotspots in Senegal. An understanding of geographical variation and determination of the core areas of the disease may provide an explanation regarding possible proximal and distal contributors to malaria elimination in Senegal

Pulmonary and Serum Antibody Responses Elicited in Zebu Cattle Experimentally Infected with Mycoplasma mycoides Subsp. mycoides SC by Contact Exposure

The purpose of the present study was to characterize the Mycoplasma mycoides subsp. mycoides small colony (MmmSC)-specific humoral immune response at both systemic and local levels in cattle experimentally infected with MmmSC, for a better understanding of the protective immune mechanisms against the disease. The disease was experimentally reproduced in zebu cattle by contact. Clinical signs, postmortem and microbiological findings were used to evaluate the degree of infection. Serum and bronchial lavage fluids (BAL) were collected sequentially, before contact and over a period of one year after contact. The kinetics of the different antibody isotypes to MmmSC was established. Based on the severity of the clinical signs, post mortem and microbiological findings, the animals were classified into three groups as acute form with deaths, sub-acute to chronic form and resistant animals. Seroconversion was never observed for the control animals throughout the duration of the experiment, nor for those classified as resistant. Instead, seroconversion was measured for all other cattle either with acute or sub-acute to chronic forms of the disease. For these animals, IgM, IgG1, IgG2 and IgA responses were detected in the serum and BAL samples. The kinetics of the IgM, IgG1 and IgG2 responses was nearly similar between both groups of animals. No evident correlation could thus be established between the levels of these isotypes and the severity of the disease. Levels of IgA were high in both BAL and serum samples of animals with sub-acute to chronic forms of the disease, and tended to persist throughout the entire experimental period. In contrast, animals with acute forms of the disease showed low levels of IgA in their BAL samples with none or very transient but low levels of IgA in the serum samples. Our results thus demonstrated that IgA is produced locally in MmmSC experimentally infected cattle by contact and may play a role in protection against contagious bovine pleuropneumonia

Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum

Cervical cancer screening in pregnancy at the maternity clinics of Nabil Choucair health center and the Institute of Social Hygiene of Dakar, Senegal: a study on 67 cases

Background: This study aims were to develop the epidemiological profile of patients who received Pap smears during pregnancy, to describe aspects of cytological smears performed in pregnant women and to describe the therapeutic management in case of anomalies in the cervical smear during pregnancy.Methods: This was a prospective, descriptive and analytical study conducted from January 15, 2015 to June 31, 2015 at maternity of Nabil Choucair Health Centre and the Institute of Social Hygiene in Dakar. The Pap smear was performed in all patients who had given their consent to the experience. The parameters studied concerned socio-demographic aspects, gynecological and obstetric background, gestational age at the time of collection, cervico-vaginal smear results, diagnostic and therapeutic management of cytological and histological abnormalities. The data collected on a survey sheet prepared for this purpose were entered and analyzed through the version 3.5.3 of Epi info software.Results: During the study period, 67 pregnant women had received a Pap smear. The epidemiological profile of our patient was a paucipare gestity with an average of 3 with extremes ranging from 1 to 7, an average parity of 2.4 with extremes ranging from 1 to 7. The mean age of pregnancy was 15.4 weeks of amenorrhea (range of 6 and 32 weeks). Only 5 patients (7.4%) had already received a cervical-vaginal swab before the study. The smear was normal in 88.7% of the cases but got abnormalities in 11.3% of the cases. The abnormalities were mainly found in squamous cells and were divided into low-grade lesions (57.1%) and skew-cell abnormalities whose meaning was undetermined (42.1%). Colposcopy was performed in 8 patients. Colposcopy was normal and satisfactory in 4 patients (50%) and identified as atypical grade 1 transformation in 2 patients (25%) and an atypical grade 2 transformation in 2 patients (25%). From a therapeutic point of view, diathermic loop conduction associated with strapping was performed in one patient (12.5%) for severe dysplasia. In postpartum, all dysplastic cervical lesions diagnosed during pregnancy had declined.Conclusions: In the context of our study, where there is no organized screening policy for cervical cancer, antenatal clinics are an excellent screening opportunity to seize