Facteurs de risque, épidémiologie 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 cette étude 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 de 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 antécédent de :  l’infection génitale 46,15%, 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

Facteurs de risque, épidémiologie 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 cette étude 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 de 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 antécédent de :  l’infection génitale 46,15%, 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

Aspects Epidemiologiques, Cliniques, et Prise en Charge Chiryrgivale des Fibromyomes Uterins au Service de Gynecologie -Obstetrique de l’Hopital National Ignace Deenchu de Conakry 2022

Introduction : L’objectif était d’étudier les aspects épidémiologiques, cliniques, et la prise en charge chirurgicale des fibromyomes utérins au service de gynécologie-obstétrique de l’hôpital national Ignace Deen du CHU de Conakry en 2022. Méthodologie: Il s’agissait d’une étude descriptive transversale, allant du 1er Mai au 30 octobre 2022 soit une période de six (6) mois. Ont été étudié les variables épidémiologiques, cliniques et la prise en charge. Les données ont été collectées à l’aide de la fiche d’enquête préétablie et prétestée. Le logiciel SPSS version 21 a été utilisé pour l’analyse des données. Résultats : les interventions chirurgicales pour fibromyome utérin ont occupé 55,47% (76/137) des activités chirurgicales pour pathologie gynécologique. L’âge moyen de nos patientes était de 38,38 ±9 ans avec les extrêmes 22 et 70 ans, la tranche d’âge la plus représenté était celle de 31-39 ans avec la proportion de 43,40%. Les nullipares étaient les plus représentées 48,68% (37/76). Il s’agissait des femmes non scolarisées 42,10% (32/76), en foyer 73,30% (56/76), exerçant une profession libérale 40,80% (31/76). Cliniquement, le volume utérin simulant une grossesse de 12- 20 SA était le motif de consultation le plus représenté 72,40% (55/76), puis la ménorragie 28,53% (55/76), la classification de FIGO à l’échographie a été réalisée dans 9,21% (7/76). Utérus polymyomateux était l’indication opératoire la plus rependue 65,79% (50/76), le traitement conservateur (myomectomie) a été dans 64,47% (49/76) des cas, par contre le taux d’hystérectomie n’était pas négligeable 35,52% (27/76) et les complications per opératoires ont été marquées par l’hémorragie (23,15%). Le nombre moyen de noyaux myomateux énucléés était de 7.  Il y a une effraction accidentelle de la cavité utérine chez 15 patientes (15,78%). L’anémie était la complication post opératoire immédiate la plus fréquente dans 5,26% (4/76) des cas et la transfusion sanguine a été réalisée chez 43,40% de nos malades. Aucun décès n’a été enregistré.  Conclusion : Le traitement conservateur pour la prise en charge du fibromyome utérin constitue une option salutaire pour les femmes en âge de procréer.   Introduction: This paper focuses on studying the epidemiological, clinical aspects, and surgical management of uterine fibromyomas in the Gynecology-Obstetrics Department of the Ignace Deen National Hospital of the Conakry University in 2022. Methodology: This was a cross-sectional descriptive study, running from May 1 to October 30, 2022, within a period of six (6) months. Epidemiological, clinical, and management variables were studied. The data was collected using the pre-established and pre-tested survey form. SPSS version 21 software was used for data analysis. Results: Surgical interventions for uterine fibromyoma occupied 55.47% (76/137) of surgical activities for gynecological pathology. The average age of our patients was 38.38 ±9 years with the extremes of 22 and 70 years. The most represented age group was that of 31-39 years with the proportion of 43.40%. Nulliparous women were the most represented (48.68% (37/76)). These women were not in school (42.10% (32/76)), in households (73.30% (56/76)), and exercising a liberal profession (40.80% (31/76)). Clinically, the uterine volume simulating a pregnancy of 12-20 weeks was the most represented reason for consultation (72.40% (55/76)), which is followed by menorrhagia (28.53% (55/76)). The FIGO classification at Ultrasound was performed in 9.21% (7/76). Polymyomatous uterus was the most common operative indication (65.79% (50/76)), while conservative treatment (myomectomy) was in 64.47% (49/76) of cases. On the other hand, the rate of hysterectomy was not negligible (35.52% (27/76)) and intraoperative complications were marked by hemorrhage (23.15%). The average number of enucleated myomatous nuclei was 7. There was an accidental break-in of the uterine cavity in 15 patients (15.78%). Anemia was the most frequent immediate postoperative complication in 5.26% (4/76) of cases, and blood transfusion was performed in 43.40% of our patients. No deaths were recorded. Conclusion: Conservative treatment for the management of uterine fibromyoma constitutes a beneficial option for women of childbearing age

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1�4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980�2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age�sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95 uncertainty interval UI 5·7�6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7�53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3�43·6) to 2·6 million (2·6�2·7) neonatal deaths and 47·0% (35·1�57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6�3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Antimicrobial susceptibility profile of community-acquired urinary tract infection in adults: A seven months prospective cross-sectional study in Dakar Town, Senegal

Introduction: With the increasing trend of antibiotic resistance, the management of urinary tract infection (UTI) is likely to become complicated, and there is a need for continuous surveillance of antibiotic susceptibility of uropathogens.Objective: This study aimed to assess the current antimicrobial susceptibility pattern in the common uropathogens isolated from outpatients and hospitalized (<72 h).Subjects and methods: This was a prospective observational study examining urinary isolates from patients aged ≥18 years. Urine samples were collected from 494 consecutive outpatient adults, clinically-suspected cases of urinary tract infections. Bacterial identification and antimicrobial susceptibility testing were carried out using the VITEK® 2 Compact kit of bioMérieux.Results: The observed prevalence of UTI was (132/494) 26.7%, 95% CI [22.9%; 30.9%]. Among the 147 organisms isolated from 132 patients, more than 90% (133) were Gram-negative bacteria. Imipenem appeared as the most active drug, with less than 3% resistance of isolates. Amikacin and cefotaxim were in general active with susceptibility rate of 70% and 67% of isolates, respectively. However cefixim was the most active oral drug tested (61%). Trimethoprim /sulfamethoxazole, nalidixic acid and fluoroquinolons were the less active drug displaying a resistance rate of 73%, 69% and 60% respectively.Conclusion: Trimethoprim/sulfamethoxazole, nalidixic acid and fluoroquinolons should no longer be used as empirical treatments of UTI in Dakar. Alternatives must be recommended, such as cefixim the most active oral drugs available in this country.Keywords: Urinary tract infections; Antibiotic susceptibility; Community-acquired infections; Developing countr

Detection and differentiation of bovine herpesvirus 1 and 5 using a multiplex real-time polymerase chain reaction.

A multiplex real-time PCR was developed for the detection and differentiation of two closely related bovine herpesviruses 1 (BoHV-1) and 5 (BoHV-5). The multiplex real-time PCR combines a duplex real-time PCR that targets the DNA polymerase gene of BoHV-1 and BoHV-5 and a real-time PCR targeting mitochondrial DNA, as a house-keeping gene, described previously by Cawthraw et al. (2009). The assay correctly identified 22 BoHV-1 and six BoHV-5 isolates from the Biosecurity Sciences Laboratory virus collection. BoHV-1 and BoHV-5 were also correctly identified when incorporated in spiked semen and brain tissue samples. The detection limits of the duplex assay were 10 copies of BoHV-1 and 45 copies of BoHV-5. The multiplex real-time PCR had reaction efficiencies of 1.04 for BoHV-1 and 1.08 for BoHV-5. Standard curves relating Ct value to template copy number had correlation coefficients of 0.989 for BoHV-1 and 0.978 for BoHV-5. The assay specificity was demonstrated by testing bacterial and viral DNA from pathogens commonly isolated from bovine respiratory and reproductive tracts. The validated multiplex real-time PCR was used to detect and differentiate BoHV-1 and BoHV-5 in bovine clinical samples with known histories

Molecular studies on avian strains of Pasteurella multocida in Australia

A collection of 45 strains of Pasteurella multocida was assembled. The strains had been isolated from cases of fowl cholera in eastern Australia over 8 years, and included mainly type A strains. All the strains were examined for plasmids and resistance to 10 antimicrobial agents and most of the strains were examined for restriction fragment length polymorphism. Nine strains were assayed for pathogenicity for mice. Twenty strains yielded no plasmid. Seven contained a single plasmid of 1.3 kbp and 18 contained 2 plasmids, of 2.4 and 7.5 kbp. All the strains were resistant to streptomycin, trimethoprim and lincomycin while one strain was resistant to tetracycline. There was no correlation between plasmid content and resistance to antimicrobial agents. Three strains that lacked plasmids were highly virulent for mice, 6 strains containing plasmids were not. Restriction fragment length polymorphism generated by Hpall allowed the 39 strains that were tested to be divided into 10 groups

Detection of equine herpesvirus type 1 using a real-time polymerase chain reaction.

Equid herpesvirus 1 (EHV1) is a major disease of equids worldwide causing considerable losses to the horse industry. A variety of techniques, including PCR have been used to diagnose EHV1. Some of these PCRs were used in combination with other techniques such as restriction enzyme analysis (REA) or hybridisation, making them cumbersome for routine diagnostic testing and increasing the chances of cross-contamination. Furthermore, they involve the use of suspected carcinogens such as ethidium bromide and ultraviolet light. In this paper, we describe a real-time PCR, which uses minor groove-binding probe (MGB) technology for the diagnosis of EHV1. This technique does not require post-PCR manipulations thereby reducing the risk of cross-contamination. Most importantly, the technique is specific; it was able to differentiate EHV1 from the closely related member of the Alphaherpesvirinae, equid herpesvirus 4 (EHV4). It was not reactive with common opportunistic pathogens such as Escherichia coli, Klebsiella oxytoca, Pseudomonas aeruginosa and Enterobacter agglomerans often involved in abortion. Similarly, it did not react with equine pathogens such as Streptococcus equi, Streptococcus equisimilis, Streptococcus zooepidemicus, Taylorella equigenitalis and Rhodococcus equi, which also cause abortion. The results obtained with this technique agreed with results from published PCR methods. The assay was sensitive enough to detect EHV1 sequences in paraffin-embedded tissues and clinical samples. When compared to virus isolation, the test was more sensitive. This test will be useful for the routine diagnosis of EHV1 based on its specificity, sensitivity, ease of performance and rapidity

Multiplex real-time PCR for the detection and differentiation of equid herpesvirus 1 (EHV-1) and equid herpesvirus 4 (EHV-4).

A multiplex real-time PCR was designed to detect and differentiate equid herpesvirus 1 (EHV-1) and equid herpesvirus 4 (EHV-4). The PCR targets the glycoprotein B gene of EHV-1 and EHV-4. Primers and probes were specific to each equine herpesvirus type and can be used in monoplex or multiplex PCRs, allowing the differentiation of these two closely related members of the Alphaherpesvirinae. The two probes were minor-groove binding probes (MGB?) labelled with 6-carboxy-fluorescein (FAM?) and VIC® for detection of EHV-1 and EHV-4, respectively. Ten EHV-1 isolates, six EHV-1 positive clinical samples, one EHV-1 reference strain (EHV-1.438/77), three EHV-4 positive clinical samples, two EHV-4 isolates and one EHV-4 reference strain (EHV-4 405/76) were included in this study. EHV-1 isolates, clinical samples and the reference strain reacted in the EHV-1 real-time PCR but not in the EHV-4 real-time PCR and similarly EHV-4 clinical samples, isolates and the reference strain were positive in the EHV-4 real-time PCR but not in the EHV-1 real-time PCR. Other herpesviruses, such as EHV-2, EHV-3 and EHV-5 were all negative when tested using the multiplex real-time PCR. When bacterial pathogens and opportunistic pathogens were tested in the multiplex real-time PCR they did not react with either system. The multiplex PCR was shown to be sensitive and specific and is a useful tool for detection and differentiation of EHV-1 and EHV-4 in a single reaction. A comprehensive equine herpesvirus disease investigation procedure used in our laboratory is also outlined. This procedure describes the combination of alphaherpesvirus multiplex real-time PCR along with existing gel-based PCRs described by other authors