Aspects Thérapeutiques du Décollement de la Rétine chez les Évacués Sanitaires de Horns, Bénin, de 2015 à 2020

L’objectif de cette étude est de décrire les aspects thérapeutiques du décollement de la rétine chez les évacués sanitaires hors Bénin de 2015 à 2020. Nous avons réalisé une étude observationnelle transversale descriptive à visée analytique avec collecte rétrospective des données. Elle s’est déroulée à la Direction Générale de la Médecine Hospitalière et des Explorations Diagnostiques et dans des centres d’Ophtalmologie publics et privés. La durée moyenne entre le diagnostic et la chirurgie était de 81,67 ±23,05 jours avec des extrêmes de 2 et 400 jours.  Une chirurgie de DR par voie endoculaire était réalisée sur 28 yeux (60,87%). Notons que des 28 yeux ayant subi une chirurgie endoculaire, 19 ont eu un tamponnement par huile de silicone et les 9 restants, un tamponnement par gaz. Sur les 46 yeux, 25 (54,35%) présentaient des complications postopératoires dont 15 cataractes et 9 récidives du DR. En préopératoire, 28 yeux sur 46 (60,87%) avaient une AV<1/20 et 5 yeux (10,87%) avaient une AV>3/10. En postopératoire, 34 yeux (73,91%) avaient une AV≥1/20 dont 32 (69,57%) une AV >1/20 et 17 (36,96%) une AV>3/10. L’AV était réduite pour 7 yeux (15,22%), stationnaire pour 10 yeux (21,74%) et 29 yeux (63,04%) ont eu un gain d’AV. En préopératoire, 6 yeux (13,04%) avaient une AV<1/20 et 2 yeux (4,35%) avaient une AV>3/10. En postopératoire, 4 yeux (8,70%) avaient une AV<1/20 et 4 yeux (8,70%) avaient une AV>3/10. Chez les 2 sujets opérés dans un délai ≤ 7 jrs (4,35%), l'AV était améliorée et le gain supérieur à 6 lignes. Le décollement de la rétine est une pathologie oculaire grave pouvant causer la cécité. Toutefois, de bonnes pratiques thérapeutiques donnent généralement un bon gain visuel.   The objective of this study is to describe the therapeutic aspects of retinal detachment in medical evacuees outside Benin from 2015 to 2020. We conducted an observational cross-sectional descriptive study with an analytical purpose and retrospective data collection. The study took place at the General Directorate of Hospital Medicine and Diagnostic Explorations and in public and private Ophthalmology centers. The average duration between diagnosis and surgery was 81.67 ± 23.05 days, ranging from 2 to 400 days. Endocular surgery for retinal detachment was performed on 28 eyes (60.87%). Of these 28 eyes undergoing endocular surgery, 19 had tamponade with silicone oil, and the remaining 9 had tamponade with gas. Among the 46 eyes, 25 (54.35%) had postoperative complications, including 15 cataracts and 9 retinal detachment recurrences. Preoperatively, 28 eyes out of 46 (60.87%) had visual acuity (VA) <1/20, and 5 eyes (10.87%) had VA >3/10. Postoperatively, 34 eyes (73.91%) had VA ≥1/20, with 32 (69.57%) having VA >1/20 and 17 (36.96%) having VA >3/10. VA was reduced for 7 eyes (15.22%), remained stationary for 10 eyes (21.74%), and 29 eyes (63.04%) showed a gain in VA. Preoperatively, 6 eyes (13.04%) had VA <1/20, and 2 eyes (4.35%) had VA >3/10. Postoperatively, 4 eyes (8.70%) had VA <1/20, and 4 eyes (8.70%) had VA >3/10. Among the 2 subjects operated within ≤ 7 days (4.35%), VA improved, and the gain was greater than 6 lines. Retinal detachment is a serious ocular condition that can lead to blindness. However, proper therapeutic practices generally result in significant visual improvement

Aspects Therapeutiques du Decolement de Retine chez les Evacues Sanitares Hors Benin de 2015 a 2020

L’objectif de cette étude est de décrire les aspects thérapeutiques du décollement de la rétine (DR) chez les évacués sanitaires hors Bénin de 2015 à 2020. Nous avons réalisé une étude observationnelle transversale descriptive à visée analytique avec collecte rétrospective des données. Elle s’est déroulée à la Direction Générale de la Médecine Hospitalière et des Explorations Diagnostiques et dans des centres d’Ophtalmologie publics et privés. La durée moyenne entre le diagnostic et la chirurgie était de 81,67 ±23,05 jours avec des extrêmes de 2 et 400 jours.  46 yeux de 42 patients ont été inclus dans l’étude. Une chirurgie de DR était réalisée par voie endoculaire sur 28 yeux (60,87%), par voie externe sur 4 yeux (8,70%) et technique chirurgicale non précisée sur 14 yeux (30,43%).  Notons que des 28 yeux ayant subi une chirurgie endoculaire, 19 ont eu un tamponnement par huile de silicone et les 9 restants, un t amponnement par gaz. Sur les 46 yeux, 25 (54,35%) présentaient des complications postopératoires dont 15 cataractes et 9 récidives du DR. En préopératoire, 28 yeux sur 46 (60,87%) avaient une AV<1/20 et 5 yeux (10,87%) avaient une AV>3/10. En postopératoire, 34 yeux (73,91%) avaient une AV≥1/20 et 17 (36,96%) une AV>3/10. L’AV était réduite pour 7 yeux (15,22%), stationnaire pour 10 yeux (21,74%) et 29 yeux (63,04%) ont eu un gain moyen d’AV de 3 lignes. Chez les 2 sujets opérés dans un délai ≤ 7 jours (4,35%), l'AV était améliorée et le gain supérieur à 6 lignes. Le décollement de la rétine est une pathologie oculaire grave pouvant causer la cécité. Toutefois, de bonnes pratiques thérapeutiques donnent généralement un bon gain visuel. The objective of this study is to describe the therapeutic aspects of retinal detachment in medical evacuees outside Benin from 2015 to 2020. We conducted an observational cross-sectional descriptive study with an analytical purpose and retrospective data collection. The study took place at the General Directorate of Hospital Medicine and Diagnostic Explorations and in public and private Ophthalmology centers. The average duration between diagnosis and surgery was 81.67 ± 23.05 days, ranging from 2 to 400 days. Endocular surgery for retinal detachment was performed on 28 eyes (60.87%), externally in 4 eyes (8,70%) and unspecified surgical technique in 14 eyes (30,43%). Of these 28 eyes undergoing endocular surgery, 19 had tamponade with silicone oil, and the remaining 9 had tamponade with gas. Among the 46 eyes, 25 (54.35%) had postoperative complications, including 15 cataracts and 9 retinal detachment recurrences. Preoperatively, 28 eyes out of 46 (60.87%) had visual acuity (VA) <1/20, and 5 eyes (10.87%) had VA >3/10. Postoperatively, 34 eyes (73.91%) had VA ≥1/20, with 17 (36.96%) having VA >3/10. VA was reduced for 7 eyes (15.22%), remained stationary for 10 eyes (21.74%), and 29 eyes (63.04%) showed a gain in VA. Among the 2 subjects operated within ≤ 7 days (4.35%), VA improved, and the gain was greater than 6 lines. Retinal detachment is a serious ocular condition that can lead to blindness. However, proper therapeutic practices generally result in significant visual improvement

Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

Background: Physicians depend on reliable information on the local epidemiology of infection and antibiotic resistance rates to guide empiric treatment in critically ill patients. As these data are scarce for Central Africa, we performed a retrospective analysis of microbiological findings from a secondary care hospital in Gabon. Methods: Microbiological reports from 2009 to 2012 were used to assess the non-susceptibility rates of the three most common isolates from six major types of infections (bloodstream, ear-eye-nose-throat, surgical site, skin and soft tissue, urinary tract and wound infection). Results: A high diversity of pathogens was found, but Staphylococcus aureus was predominant in the majority of infections. Overall, the three most prevalent pathogens in children were S. aureus (33.7%), Streptococcus pyogenes (8.1%) and Escherichia coli (4.5%) and in adults S. aureus (23.5%), E. coli (15.1%) and Klebsiella pneumoniae (7.4%). In total, 5.8% (n = 19) of all S. aureus isolates were methicillin resistant. The proportion of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae was 15.4% (n = 78), 49.4% of all K. pneumoniae were ESBL-producer (n = 42). Conclusion: The high diversity of potential pathogens and high resistance rates in Gram-negative bacteria challenge a rational empiric use of antibiotics. Countrywide continuous sentinel surveillance is therefore urgently needed.<br

Pre-hospital risk factors for inpatient death from severe febrile illness in Malian children.

BACKGROUND: Inpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality. METHODS: Prospective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period. FINDINGS: The case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome. INTERPRETATION: Aside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality

A Randomized Controlled Phase Ib Trial of the Malaria Vaccine Candidate GMZ2 in African Children

BACKGROUND: GMZ2 is a fusion protein of Plasmodium falciparum merozoite surface protein 3 (MSP3) and glutamate rich protein (GLURP) that mediates an immune response against the blood stage of the parasite. Two previous phase I clinical trials, one in naïve European adults and one in malaria-exposed Gabonese adults showed that GMZ2 was well tolerated and immunogenic. Here, we present data on safety and immunogenicity of GMZ2 in one to five year old Gabonese children, a target population for future malaria vaccine efficacy trials. METHODOLOGY/PRINCIPAL FINDINGS: Thirty children one to five years of age were randomized to receive three doses of either 30 µg or 100 µg of GMZ2, or rabies vaccine. GMZ2, adjuvanted in aluminum hydroxide, was administered on Days 0, 28 and 56. All participants received a full course of their respective vaccination and were followed up for one year. Both 30 µg and 100 µg GMZ2 vaccine doses were well tolerated and induced antibodies and memory B-cells against GMZ2 as well as its antigenic constituents MSP3 and GLURP. After three doses of vaccine, the geometric mean concentration of antibodies to GMZ2 was 19-fold (95%CI: 11,34) higher in the 30 µg GMZ2 group than in the rabies vaccine controls, and 16-fold (7,36) higher in the 100 µg GMZ2 group than the rabies group. Geometric mean concentration of antibodies to MSP3 was 2.7-fold (1.6,4.6) higher in the 30 µg group than in the rabies group and 3.8-fold (1.5,9.6) higher in the 100 µg group. Memory B-cells against GMZ2 developed in both GMZ2 vaccinated groups. CONCLUSIONS/SIGNIFICANCE: Both 30 µg as well as 100 µg intramuscular GMZ2 are immunogenic, well tolerated, and safe in young, malaria-exposed Gabonese children. This result confirms previous findings in naïve and malaria-exposed adults and supports further clinical development of GMZ2. TRIAL REGISTRATION: ClinicalTrials.gov NCT00703066

Migration outflows and optimal migration policy: rules versus discretion

We study the effects of more open borders on return migration and show that migrants are more likely to return to the origin country when migration rules are softened, because this implies that they could more easily re-migrate if return migration is unsuccessful. As a result, softening migration rules leads to lower net inflows than is generally acknowledged. We show that if government follows rules to shape the optimal migration policy, it will choose more open “borders” than were its behaviour to be discretionary. However, this requires an appropriate commitment technology. We show that electoral accountability may be a solution to the commitment problem. As a matter of fact, observed softer immigration rules in western countries suggest the effectiveness of such a mechanism.info:eu-repo/semantics/publishedVersio

Transmission of malaria and genotypic variability of Plasmodium falciparum on the Island of Annobon (Equatorial Guinea)

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