Localisation atypique de myomes en peropératoire: à propos de deux cas dont un dans un contexte d’urgence

Les fibromyomes sont des tumeurs bénignes de localisation utérine courante. Elles sont fréquentes chez la  femme noire, le diagnostique est échographique et  anatomo-histologique. La localisation extra utérine est rare et de physio-pathogénie mal connue. Cette localisation pose des problèmes de diagnostique. Nous  rapportons deux cas cliniques de fibromes localisés sur le segment sigmoïdien de l'intestin et sur la paroi interne du muscle transverse de l'abdomen d'une part chez une patiente âgée de 41 ans et d'autre part en région  épigastrique, chez une patiente de 47 ans. Toutes les patientes ont été opérées respectivement l'une de  myomes utérins pour infertilité et l'autre de laparotomie en urgence pour syndrome sub-occlusif au cinquante huitième jour post hystérectomie. Ces observations   doivent inciter les cliniciens ou les radiologistes à réaliser un bilan étendu à la recherche de localisation extra-utérine avant une myomectomie ou hystérectomie  car un myome peut en cacher un autre en dehors de l'utérus.Key words: Myomes, intestin, paroi abdominale, utéru

Substantial Contribution of Submicroscopical Plasmodium falciparum Gametocyte Carriage to the Infectious Reservoir in an Area of Seasonal Transmission

BACKGROUND: Man to mosquito transmission of malaria depends on the presence of the sexual stage parasites, gametocytes, that often circulate at low densities. Gametocyte densities below the microscopical threshold of detection may be sufficient to infect mosquitoes but the importance of submicroscopical gametocyte carriage in different transmission settings is unknown. METHODOLOGY/PRINCIPAL FINDINGS: Membrane feeding experiments were carried out on 80 children below 14 years of age at the end of the wet season in an area of seasonal malaria transmission in Burkina Faso. Gametocytes were quantified by microscopy and by Pfs25-based quantitative nucleic acid sequence-based amplification assay (QT-NASBA). The children's infectiousness was determined by membrane feeding experiments in which a venous blood sample was offered to locally reared Anopheles mosquitoes. Gametocytes were detected in 30.0% (24/80) of the children by microscopy compared to 91.6% (65/71) by QT-NASBA (p<0.001). We observed a strong association between QT-NASBA gametocyte density and infection rates (p = 0.007). Children with microscopically detectable gametocytes were more likely to be infectious (68.2% compared to 31.7% of carriers of submicroscopical gametocytes, p = 0.001), and on average infected more mosquitoes (13.2% compared to 2.3%, p<0.001). However, because of the high prevalence of submicroscopical gametocyte carriage in the study population, carriers of sub-microscopical gametocytes were responsible for 24.2% of the malaria transmission in this population. CONCLUSIONS/SIGNIFICANCE: Submicroscopical gametocyte carriage is common in an area of seasonal transmission in Burkina Faso and contributes substantially to the human infectious reservoir. Submicroscopical gametocyte carriage should therefore be considered when implementing interventions that aim to reduce malaria transmission

The plasticity of Plasmodium falciparum gametocytaemia in relation to age in Burkina Faso

BACKGROUND: Malaria transmission depends on the presence of gametocytes in the peripheral blood. In this study, the age-dependency of gametocytaemia was examined by microscopy and molecular tools. METHODS: A total of 5,383 blood samples from individuals of all ages were collected over six cross sectional surveys in Burkina Faso. One cross-sectional study used quantitative nucleic acid sequence based amplification (QT-NASBA) for parasite quantification (n = 412). The proportion of infections with concurrent gametocytaemia and median proportion of gametocytes among all parasites were calculated. RESULTS: Asexual parasite prevalence and gametocyte prevalence decreased with age. Gametocytes made up 1.8% of the total parasite population detected by microscopy in the youngest age group. This proportion gradually increased to 18.2% in adults (p < 0.001). Similarly, gametocytes made up 0.2% of the total parasite population detected by QT-NASBA in the youngest age group, increasing to 5.7% in adults (p < 0.001). This age pattern in gametocytaemia was also evident in the proportion of gametocyte positive slides without concomitant asexual parasites which increased from 13.4% (17/127) in children to 45.6% (52/114) in adults (OR 1.55, 95% CI 1.38-1.74, p < 0.001). CONCLUSIONS: The findings of this study suggest that although gametocytes are most commonly detected in children, the proportion of asexual parasites that is committed to develop into gametocytes may increase with age. These findings underscore the importance of adults for the human infectious reservoir for malaria

Incidence, caractéristiques et facteurs de risque des douleurs chroniques postcésariennes à l’hôpital Yalgado Ouédraogo au Burkina Faso

OBJECTIF : Étudier l’incidence, les caractéristiques et facteurs de risque des douleurs chroniques postcésariennes (DCPC) à l’hôpital Yalgado. PATIENTES ET MÉTHODES : Un questionnaire était administré par appel téléphonique à 204 patientes aux sixième, neuvième et douzième mois après une césarienne. Les questions portaient sur la présence de douleurs cicatricielles, leurs caractéristiques et leurs répercussions sur la vie des patientes. L’enrôlement s’est fait durant la consultation du 45e jour postopératoire, a duré deux mois, et les données cliniques, chirurgicales et anesthésiques étaient recueillies rétrospectivement. Le questionnaire de suivi de la douleur leur a été expliqué pendant l’enrôlement, puis ultérieurement administré par le même enquêteur. Après une analyse descriptive de la population étudiée avec Epi Info version 3.3.1, une comparaison des patientes avec et sans DCPC était effectuée afin de mettre en évidence les facteurs de risque. RÉSULTATS : Sur 204 patientes incluses, 113 (55,4 %) ont terminé l’étude et 91 patientes ont été perdues de vue. Au total, 72 femmes (63,7 %) ont rapporté des DCPC à un moment ou l’autre de leur suivi. Les perdues de vue étaient comparables aux patientes suivies. La fréquence des DCPC diminuait au fil du temps, passant de 63,7 % à six mois (15,2 % de douleur modérée à sévère) à 52,21 % au neuvième mois et 38,9 % au 12e mois (4,5 % de douleur modérée à sévère). Le jeune âge (OR: 1,48, p = 0,002), l’antécédent de césarienne (OR: 2,94; p = 0,01), les chirurgiens en formation (OR: 4,15, p = 0,05), l’incision Pfannenstiel (OR: 5,96, p = 0,001), l’anesthésie générale (OR: 3,21, p = 0,03) sont les facteurs de risque associés à des DCPC, alors que la rachianesthésie (OR: 0,4, p = 0,009) protégeait contre la DCPC. L’intensité médiane était de 1,7 au sixième mois, de 1,03 au neuvième mois et de 0,85 au 12e mois. La douleur était modérée dans 51,38 % des cas au sixième mois contre 18,18 % au 12e mois. La douleur était intermittente (59,7 %) ou permanente (16,6 %) au sixième mois versus respectivement 86,3 et 4,5 % au 12e mois. L’intensité de la douleur diminuait dans le temps. La majorité des femmes (89,2 %) s’automédiquaient, et 3,2 % ont présenté des troubles du sommeil. CONCLUSION : Les DCPC sont fréquentes dans notre série et souffrent d’un manque de prise en charge médicale.[The Incidence, Characteristics and Risk Factors of Chronic Post-Caesarean Pain at Yalgado Ouédraogo Hospital in Burkina Faso] AIM: To study the incidence, characteristics and risk factors of chronic post-Caesarean pain (CPCP) at Yalgado Hospital. PATIENTS AND METHODS: A survey was conducted via telephone of 204 patients at 6, 9 and 12 months after a Caesarean section. The questions focused on the presence of scar pain, its characteristics and the subsequent repercussions on patients’ lives. Enrolment was carried out during the postoperative day 45 consultation; it lasted for two months and clinical, surgical and anaesthetic data was collected retrospectively. The pain follow-up questionnaire was explained during enrolment, then subsequently delivered by the same person. After a descriptive analysis of the population studied was conducted with ÉpiInfo™ version 3.3.1, a comparison of patients with and without CPCP was made in order to highlight any risk factors. RESULTS: Of the 204 patients included, 113 (55.4%) completed the study and 91 patients were lost to follow-up. A total of 72 women (63.7%) reported CPCP at one point or another during their follow-up. The patients lost to follow-up were comparable to those who received follow-up. The frequency of CPCP decreased over time, falling from 63.7% at 6 months (15.2% had moderate to severe pain) to 52.21% at month 9 and 38.9% at month 12 (4.5% with moderate to severe pain). Young age (OR: 1.48, P = 0.002), previous Caesarean (OR: 2.94, P = 0.01), trainee surgeons (OR: 4.15, P = 0.05), a Pfannenstiel incision (OR: 5.96, P = 0.001), and general anaesthesia (OR: 3.21, P = 0.03) are risk factors associated with CPCP, whereas spinal anaesthesia (OR: 0.4, P = 0.009) protected against CPCP. The median pain intensity was 1.7 at month 6, 1.03 at month 9 and 0.85 at month 12. The pain was moderate for 51.38% at month 6, compared with 18.18% at month 12. Pain was intermittent (59.7%) or permanent (16.6%) at month 6, versus 86.3% and 4.5% respectively at month 12. The intensity of the pain decreased over time. The majority of the women (89.2%) self-medicated, and 3.2% had sleep-related difficulties. CONCLUSION: CPCP is a common experience in our series, and suffers from a lack of medical car

Safety and immunogenicity of the Plasmodium falciparum merozoite surface protein-3 long synthetic peptide (MSP3-LSP) malaria vaccine in healthy, semi-immune adult males in Burkina Faso, West Africa.

UNLABELLED: The merozoite surface protein-3 long synthetic peptide (MSP3-LSP) comprises the amino acid sequence 186-276 of the Plasmodium falciparum protein MSP3. It is currently in development as an erythrocytic stage (blood stage) malaria vaccine candidate. We report here the first data on the safety, reactogenicity and immunogenicity of three doses of MSP3-LSP, adjuvanted with aluminium hydroxide, in healthy male adults living in a malaria endemic area. METHODS: A phase 1b single-blind controlled trial was performed in the village of Balonghin in Burkina Faso. Thirty male volunteers aged 18-40 years were randomised to receive either three doses of 30 microg MSP3-LSP or 0.5 ml of tetanus toxoid vaccine. The second and third vaccine doses were given 28 and 112 days after the first dose. We followed participants for 1 year. RESULTS: There were no serious adverse events in either vaccine group. In both groups participants reported local reactions at the site of injection when compared to an earlier trial in European volunteers. Only one systemic adverse event (tachycardia) was identified which occurred immediately after the first vaccination in one individual receiving MSP3-LSP. No clinically significant biological abnormalities following vaccination were observed. Humoral immune responses (IgG, IgG subclasses, IgM) to MSP3-LSP peptide were similar in the two groups following vaccination. Some cell-mediated immune responses appeared to differ between the two vaccine groups. After the second dose of MSP3-LSP, there appeared to be a marked increase in the lymphocyte proliferation index and IFN-gamma in response to stimulation with MSP3-LSP. CONCLUSION: These data suggest that three doses of 30 microg MSP3-LSP when administered subcutaneously on days 0, 28 and 112 are well-tolerated by adult males previously exposed to natural P. falciparum infection. They also suggest that MSP3-LSP is able to stimulate an enhanced cell-mediated immune response in individuals with some degree of preexisting immunity

2017- CSA Monitoring: Lawra-Jirapa Climate-Smart Village (Ghana)

his dataset contains the files produced in the pilot implementation of the “Integrated Monitoring Framework for Climate-Smart Agriculture” in the Lawra-Jirapa Climate Smart Village (Uganda) in October 2017. This dataset contains the files produced in the implementation of the “Integrated Monitoring Framework for Climate-Smart Agriculture” in the Hoima Climate Smart Village (Uganda) in October 2018. This monitoring framework developed by CCAFS is meant to be deployed annually across the global network of Climate-Smart Villages to gather field-based evidence by tracking the progress on:Adoption of CSA practices and technologies, as well as access to climate information services and Their related impacts at household level and farm levehis framework proposes standard Descriptive Indicators to track changes in: 5 enabling dimensions that might affect adoption patterns, a set of 5 CORE indicators at Household level to assess perceived effects of CSA practices on Food Security, Productivity, Income and Climate vulnerability and 4 CORE indicators on Gender aspects (Participation in decision making, Participation in implementation, Access/control over Resources and work time). At farm level, 7 CORE indicators are suggested to determine farms’ CSA performance, as well as synergies and trade-offs among the three pillars. This integrated framework is associated with a cost-effective data collection App (Geofarmer) that allowed capturing information in almost real time.The survey questionnaire is structured around different thematic modules (Demographic, Livelihoods, Food Security, Climate events, Climate Services, CSA practices, Financial Services) connected to standard CSA metrics and the specific indicators.The framework responds to three main research questions: Within each CSV community, who adopts which CSA technologies and practices and what are their motivations, enabling/constraining factors? What are the gender-disaggregated perceived effects of CSA options on farmers’ livelihood (agricultural production, income, food security, food diversity and adaptive capacity) and on key gender dimensions (participation in decision-making, participation in CSA implementation and dis-adoption, control and access over resources and labour)? How does CSA perform at farm level, and what synergies and trade-offs exist (whole farm model analysis)