Assessing Communities of Practice in health policy : A conceptual framework as a first step towards empirical research

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Titre des hemolysines alpha et beta chez les donneurs de sang de groupe sanguin o et leur impact potentiel sur la securite des receveurs de produits sanguins au Burkina Faso

English Title: Titer of alpha and beta hemolysins in o group blood donors and their potential impact on blood recipients’ safety in Burkina Faso English Abstract Introduction: Some subjects, due to immunization episodes can develop anti-A and antiB allo-antibodies named hemolysins. These hemolysins can cause serious hemolytic accidents and newborn hemolytic disease. Objectives: Our study aims to assess the prevalence and titer of anti-A and anti-B hemolysins in O blood group donors and to estimate the risk of post-transfusion hemolytic reactions. Methodology: We conducted a cross-sectional study between June 27 and August 4, 2017 that included O blood group donors from the Ouagadougou Regional blood transfusion center. The hemolysins screening was carried out according to a standardized tube technique with saline solution. Results: The prevalence of anti-A and anti-B hemolysins was 37.6%. Hemolysins anti-A was present in 9.7% of cases, hemolysins anti-B in 13.8% and anti-A + anti-B in 14%. Female gender (p = 0.04) and young donors (p = 0.03) were more likely to have high prevalence of hemolysins in univariate analysis. But in multivariate analysis, only female gender (OR=1.8, CI 95% [1.1-2.9]; p=0.02) was significantly associated to the presence of hemolysins. The prevalence of hemolysins of high titer (1:64) was 0.27%. The risk of post-transfusion hemolytic reactions was 2.2 x 10-6. Keywords: Hemolysin, Universal donors, Hemolytic reactions, Anti-A and anti-B antibodies

Evaluation de la douleur chez les enfants avec syndrome drepanocytaire majeur : Experience d’un hopital en Afrique subsaharienne

Objectifs. La drépanocytose constitue un véritable problème de santé publique en Afrique subsaharienne. Au Burkina Faso, 5 à 10 % de la population en serait atteinte. L'expression clinique des syndromes drépanocytaires majeurs dominée par la triade anémie, crises douloureuses vaso-occlusives et infections. La première cause d’admission des drépanocytaires à l’hôpital est essentiellement la crise douloureuse. Le but de cette étude était de faire un état des lieux de l’évaluation de la douleur chez des enfants syndromes drépanocytaires majeurs. Patients et méthodes. Il s’agissait d’une étude prospective à visée descriptive et analytique de 15 mois. Ont été inclus les patients âgés de 6 mois à 15 ans et ayant été hospitalisés dans le service de pédiatrie du Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso) pendant la période pour une crise vaso-occlusive douloureuse de drépanocytose majeure. Résultats. Trente-trois patients ont été inclus dans l'étude. Chez 66 % des patients, la douleur était intense à l’admission. Le  paracétamol et l’acide niflumique étaient coprescrits chez 42 % des patients. Les résultats de l’analgésie étaient bons dans 33 % descas ; passables dans 9 % des cas et mauvais chez 58 % des cas. La douleur intense avait les délais de sédation les plus longs. Les antalgiques de palier I étaient prescrits dans 91 % des cas. Conclusion. Cette étude a permis de mettre en évidence la nécessitéd’évaluer systématiquement la douleur chez les enfants ayant un  syndrome drépanocytaire majeur pour une prescription antalgique optimale. Mots-clés : Drépanocytose, douleur, antalgiques, enfants. English title: Assessment of pain in children presenting with a major sickle syndrome: experience of a hospital in Sub-Saharan Africa Assessment of pain in children presenting with major sickle syndromes: experience of a hospital in sub-Saharan Africa. Objectives. In Burkina Faso, the prevalence of sickle cell disease vary from 5 to 10 percent in the population. The clinical expression of the major sickle syndromes is dominated by the triad anaemia-infections-vaso-occlusive crisis pain. The purpose of this study was to assess pain in children with major sickle syndromes. Patients and methods. This prospective study was undertaken in the Department of Paediatrics  of the   Charles de Gaulle Paediatric University Teaching Hospital of Ouagadougou (Burkina Faso) from 15 October 2012 to January 15, 2014. Were included patients aged 6 months to 15 years hospitalized during the period for a vaso-occlusive crisis pain of a major sickle cell disease. Results. Thirty-three patients were included in the study. In 66% of patients, the pain was intense at the admission. Paracetamol and niflumic acid were coused in 42% of the patients. The results of analgesia were good in 33% of cases; passable in 9% of cases and bad in 58% of cases. The pain of intense severity had the longest delays of sedation. Scale # 1 analgesic medicines were prescribed in 91% ofcases. Conclusion: This study highlight the need to systematically assess pain in patients with major syndrome of sickle cell for an optimal analgesic prescription. Keywords: Sickle cell disease, pain, analgesic, children

The main BCR-ABL mRNA transcript types and hematological features of newly diagnosed chronic myeloid leukemia in Burkina Faso

Objective: Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome with an abnormally shortened chromosome 22, which is the result of a reciprocal translocation of chromosomes 9 and 22 that creates BCR-ABL fusion transcripts. CML accounts for approximately 15% of all leukemia cases and 24.3% of hematological disorders in Burkina Faso. The present study identified the main BCR-ABL fusion transcript variants using multiplex PCR in CML patients and investigated the hematological features at the time of diagnosis. Patients and Methods: Total cellular RNA was extracted from 107 blood leukocytes using methods adapted from Chomczynsky and Sacchi (1987). A reverse transcription reaction was performed using a high capacity cDNA reverse transcription kit from Applied Biosystem (Ref 4368814) following the manufacturer’s instructions. BCR-ABL transcript types were investigated using a homemade PCR method that was adapted and optimized from published protocols. A single reaction with multiple primers was used in multiplex PCR to detect and investigate the type and frequency of CML in 41 enrolled patients. Results: The average age of patients was 39 years and ranged between 12 and 65 years. Two main transcript types were identified in 38 of the 41 patients included in the study. The most common transcripts were b2a2 (47.4%) and b3a2 (34.2%). Eight samples (18.4%) presented both types of transcripts. During the diagnosis, the average hemoglobin level, average white blood cell number and platelets in newly diagnosed CML patients were 8.3 g/dL; 270.1 G/L and 350.2 G/L, respectively. Conclusions: Multiplex-PCR allowed for the rapid, specific and simultaneous detection of the most frequent BCR-ABL variant transcripts. The present study showed a higher frequency of b2a2 than b3a2 transcripts in Burkina Faso CML patients. These findings will guide us in the choice of specific BCR-ABL variant primers for the monitoring of patients undergoing Imatinib treatment

Le syndrome drépanocytaire de type hémoglobine SC :expérience du CHU Yalgado Ouédraogo de Ouagadougou (Burkina Faso).

To evaluate the clinical features of children with hemoglobin sickle cell disease (HbSC) and compare them to children with sickle cell anemia (HbSS).English AbstractJournal Articleinfo:eu-repo/semantics/publishe

Preparation of red cell concentrates in low-income countries: Efficacy of whole blood settling method by simple gravity in Burkina Faso

Aim: This study aims to describe the characteristics of the red cell concentrâtes RCCs) produced by whole blood settling in Burkina Faso. Methods: We conducted a cross-sectional study in the blood centers of Ouagadougou and Koudougou between 12th February and 15th March 2015. 427 blood units selected at Koudougou and divided into three groups were processed by settling method over three durations (methods I = 36–48 h, II = 48–72 h and III = 72–96 h). Other 139 units selected at Ouagadougou were processed by centrifugation (method IV). The RCCs units’ characteristics were described by the mean of their hematocrit, volume, hemoglobin level and content. The residual plasma level, the hematocrit yield and the hematocrit concentration ability (ability of method to raise hematocrit in comparison with whole blood) have been used to assess methods efficacy. Results: The volume and hemoglobin content of overall units met standard requirements. 2.1%, 14.2% and 27.7% of units respectively issued from methods I, II, III had hematocrit over 50%. The average volume (mL) was 372.88, 357.91, 350.30 and 332.26 respectively for method I to IV (p<0.05). The mean hematocrit (%) was respectively 45.42,47.41, 48.24 and 62.28 (non-significant difference between methods II and III). The hematocrit concentration ability was respectively 1.14, 1.22, 1.24 and 1.51 and the proportion of residual plasma 0.39, 0.33, 0.30 and 0.09. Conclusion: The RCCs obtained by settling method did not meet all standards. But we can hypothesize that they would be more effective and safe for patients. However, it is necessary to undertake further studies to verify it

Les complications post opératoires précoces des abdomens aigus chirurgicaux dans le service de chirurgie générale et digestive du chu Yalgado Ouédraogo au Burkina Faso : à propos de 98 cas

L’évolution post opératoire précoce des abdomens aigus chirurgicaux est marquée de complications liées à l’insuffisance de prise en charge. Le but de cette étude était de décrire les complications post opératoires précoces des abdomens aigus chirurgicaux dans le service de chirurgie générale et digestive du CHU-YO. Il s’est agi d’une étude transversale à caractère descriptif couvrant la période du 1er janvier au 31 décembre 2015 et réalisée à partir de patients de 15 ans et plus opérés dans le service de chirurgie générale et digestive du CHU-YO pour abdomens aigus chirurgicaux. Durant la période d’étude, nous avons colligé 98 patients soit 16,6% des abdomens aigus chirurgicaux qui ont présenté au total 159 des complications post opératoires précoces. L’âge moyen des patients était de 35,1 ans. Le sex-ratio était de 1,72. Les acteurs du secteur informel étaient plus concernés (31,6%). Les patients de bas niveau socioéconomique étaient retrouvés dans 49% des cas. Les patients provenant de zones urbaines représentaient 59,2%. La péritonite aigue généralisée était l’étiologie la plus fréquente (68,4%) et celle qui a enregistrée le plus de complications post opératoires (72,3%). Les complications post opératoires précoces étaient infectieuses dans 76,7% des cas. La suppuration pariétale (31%), la septicémie (13,2%), la péritonite post opératoire (6,3%), la fistule digestive (5,7%), l’éviscération (5,7%), l’infection pulmonaire (4,4%) et l’infection urinaire (3,7%) étaient les complications retrouvées. Le traitement a été chirurgical dans 18,4% des cas. La survenue des complications post opératoires est essentiellement liée à l’urgence, au malade, à l’intervention. La mortalité était de 13,3%. Pour conclure, la maîtrise de la prévention des infections contribuera à la réduction considérable des complications post opératoires des abdomens aigus chirurgicaux.Mots-clés: complications, post opératoires, abdomen aigu, Burkina FasoEnglish AbstractPostoperative evolution of acute surgical abdomen is marked by many complications. The aim of this study was to describe the early postoperative complications of acute surgical abdomen in the service of general and digestive surgery of the university hospital YO. Cross-sectional study in descriptive character for the period from 1 January to 31 December 2015 and made from patients 15 years and older admitted and operated in the service of General and Digestive Surgery of the university hospital -YO to acute surgical abdomen. During the study period, we collected 98 patients who have Early postoperative complications which represented 16.6% of acute surgical abdomen. They present 159 early postoperative complications. The average age of patients was 35.1 years. The sex ratio was 1.72. The informal sector workers were more concerned (31.6%). Patients of low socioeconomic were found 49% of cases. Patients from urban areas accounted for 59.2%. The generalized acute peritonitis was the most common etiology (68.4%) and that has recorded the most postoperative complications (72.3%). The complications were infectious in 76.7% of cases. Parietal suppuration (31%), sepsis (3.2%), the postoperative peritonitis (6.3%), digestive fistula (5.7%), evisceration (5.7%), pulmonary infection (4.4%) and urinary tract infection (3.7%) were the complications most found. The treatment was surgical in 18.4% of cases. The occurrence of postoperative complications is mainly due to the emergency, the patient, intervention. Mortality was 13.3%. To conclude, the control of infection contribute to the significant reduction of early surgical postoperative complications of acute abdomens.Keywords: Post operative, complications, Acute, surgical abdome