Otomastoïdites aiguës dans le Service d’ORL du CHU Yalgadode Ouagadougou: à propos de 44 cas

Analyser les aspects diagnostiques et thérapeutiques des otomastoïdites dans le Service d’ORL du CHU-YO de Ouagadougou. Méthode : Il s’est agit d’une étude rétrospective de 10 ans, qui a porté sur 44 cas. Résultats: l’incidence annuelle était de 4,4 cas et l’âge moyen de 13,41 ans. Les mastoïdites étaient majoritairement fistulisées (59,09%) et les principaux germes incriminés étaient Staphylococcus aureus (35,29%), Proteus mirabilis (23,53%) et Pseudomonas aeruginosa (23,53%). Ils étaient surtout sensibles à la ciprofloxacine (82,35%) et la ceftriaxone (58,82%). Le traitement a été médico-chirurgical dans 86,36% des cas et l’évolution favorable dans 72,73%. Douze cas (27,27%) de décès par complication systémique et endocrânienne ont été enregistrés. Conclusion : Il convient de prioriser les mesures préventives et la prise en charge précoce des otites infectieuses.Mots clés: Otomastoïdite, épidémiologie, diagnostic, thérapeutique

Revisiting the circulation time of Plasmodium falciparum gametocytes: molecular detection methods to estimate the duration of gametocyte carriage and the effect of gametocytocidal drugs

BACKGROUND: There is renewed acknowledgement that targeting gametocytes is essential for malaria control and elimination efforts. Simple mathematical models were fitted to data from clinical trials in order to determine the mean gametocyte circulation time and duration of gametocyte carriage in treated malaria patients. METHODS: Data were used from clinical trials from East Africa. The first trial compared non-artemisinin combination therapy (non-ACT: sulphadoxine-pyrimethamine (SP) plus amodiaquine) and artemisinin-based combination therapy (ACT: SP plus artesunate (AS) or artemether-lumefantrine). The second trial compared ACT (SP+AS) with ACT in combination with a single dose of primaquine (ACT-PQ: SP+AS+PQ). Mature gametocytes were quantified in peripheral blood samples by nucleic acid sequence based amplification. A simple deterministic compartmental model was fitted to gametocyte densities to estimate the circulation time per gametocyte; a similar model was fitted to gametocyte prevalences to estimate the duration of gametocyte carriage after efficacious treatment. RESULTS: The mean circulation time of gametocytes was 4.6-6.5 days. After non-ACT treatment, patients were estimated to carry gametocytes for an average of 55 days (95% CI 28.7 - 107.7). ACT reduced the duration of gametocyte carriage fourfold to 13.4 days (95% CI 10.2-17.5). Addition of PQ to ACT resulted in a further fourfold reduction of the duration of gametocyte carriage. CONCLUSIONS: These findings confirm previous estimates of the circulation time of gametocytes, but indicate a much longer duration of (low density) gametocyte carriage after apparently successful clearance of asexual parasites. ACT shortened the period of gametocyte carriage considerably, and had the most pronounced effect on mature gametocytes when combined with PQ

Correlates of HIV-1 Genital Shedding in Tanzanian Women

BACKGROUND: Understanding the correlates of HIV shedding is important to inform strategies to reduce HIV infectiousness. We examined correlates of genital HIV-1 RNA in women who were seropositive for both herpes simplex virus (HSV)-2 and HIV-1 and who were enrolled in a randomised controlled trial of HSV suppressive therapy (aciclovir 400 mg b.i.d vs. placebo) in Tanzania. METHODOLOGY: Samples, including a cervico-vaginal lavage, were collected and tested for genital HIV-1 and HSV and reproductive tract infections (RTIs) at randomisation and 6, 12 and 24 months follow-up. Data from all women at randomisation and women in the placebo arm during follow-up were analysed using generalised estimating equations to determine the correlates of cervico-vaginal HIV-1 RNA detection and load. PRINCIPAL FINDINGS: Cervico-vaginal HIV-1 RNA was detected at 52.0% of 971 visits among 482 women, and was independently associated with plasma viral load, presence of genital ulcers, pregnancy, bloody cervical or vaginal discharge, abnormal vaginal discharge, cervical ectopy, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, an intermediate bacterial vaginosis score and HSV DNA detection. Similar factors were associated with genital HIV-1 RNA load. CONCLUSIONS: RTIs were associated with increased presence and quantity of genital HIV-1 RNA in this population. These results highlight the importance of integrating effective RTI treatment into HIV care services

Conjugation to the Cell-Penetrating Peptide TAT Potentiates the Photodynamic Effect of Carboxytetramethylrhodamine

Cell-penetrating peptides (CPPs) can transport macromolecular cargos into live cells. However, the cellular delivery efficiency of these reagents is often suboptimal because CPP-cargo conjugates typically remain trapped inside endosomes. Interestingly, irradiation of fluorescently labeled CPPs with light increases the release of the peptide and its cargos into the cytosol. However, the mechanism of this phenomenon is not clear. Here we investigate the molecular basis of the photo-induced endosomolytic activity of the prototypical CPPs TAT labeled to the fluorophore 5(6)-carboxytetramethylrhodamine (TMR).We report that TMR-TAT acts as a photosensitizer that can destroy membranes. TMR-TAT escapes from endosomes after exposure to moderate light doses. However, this is also accompanied by loss of plasma membrane integrity, membrane blebbing, and cell-death. In addition, the peptide causes the destruction of cells when applied extracellularly and also triggers the photohemolysis of red blood cells. These photolytic and photocytotoxic effects were inhibited by hydrophobic singlet oxygen quenchers but not by hydrophilic quenchers.Together, these results suggest that TAT can convert an innocuous fluorophore such as TMR into a potent photolytic agent. This effect involves the targeting of the fluorophore to cellular membranes and the production of singlet oxygen within the hydrophobic environment of the membranes. Our findings may be relevant for the design of reagents with photo-induced endosomolytic activity. The photocytotoxicity exhibited by TMR-TAT also suggests that CPP-chromophore conjugates could aid the development of novel Photodynamic Therapy agents

Les pertes de substances oro-faciales dans les séquelles de Noma à Ouagadougou (Burkina-Faso)

Le noma présente des séquelles à la fois fonctionnelles, esthétiques et psychologiques plus ou moins importants, dont la prise en charge peutêtre très lourde. Il s’agissait ici d’une étude de cohorte menée dans le service de stomatologie et de chirurgie maxillo-faciale du Centre Hospitalier Universitaire Yalgado OUEDRAOGO en collaboration avec  l’Organisation Non Gouvernementale «SENTINELLES». 50 cas de pertesde substance oro-faciale ont été colligés pendant la période de l’étude. L’âge moyen des patients était de 15,62 ± 12,42 ans, avec des extrêmes de 2 et 51 ans. Le sexe féminin était prédominant avec 48% des cas, soit un sex ratio de 0,72. Selon la classification de Diop, 42% des patients étaient classés type IV. La prise en charge à consisté en une chirurgie réparatrice, le plus souvent en plusieurs temps opératoires lors des  missions humanitaires et de coopération ou lors des évacuations à  l’étranger. Les résultats sont en majorité satisfaisants. Les pertes de substance causées par le noma peuvent être très étendues et très complexes, rendant difficile leur prise en charge dans les conditions  précaires.Mots clés : Pertes de substances oro-faciales, Noma, traitement The cancrum oris presents functional, esthetic and psychological important after-effects which cure is sometimes very heavy. Patients and Method: It is about a retrospective study realized in the service of Sotomatology and Maxillo-facial surgery of the academic Hospital Yalgado OUEDRAOGO with the collaboration of the non governmental organization “SENTINELLE”. 50 cases of oro-maxillo-facial loss substance  has been collected during the period of the study. The average age of the patients was 15,62 ±12,42 years old, with extremes of 2 and 51 years. The femal sex was the more represented with 48% of the cases (sex ratio: 0,72). According Diop’s classification, 42 % patients were listed type IV. The management consisted to a repairing surgery, usually several  operation time, during humanitarian missions and co-operations, or evacuations to Europe. The results were mainly satisfactory. Substances loss caused by cancrum oris can be extended and very complexious, making then the take of care difficult in precarious conditions.Key words : oro-facial loss substance, cancrum oris,treatment

Aspects épidémiologiques, diagnostiques et thérapeutiques des plaies faciales graves d’origine traumatique au CHU Yalgado Ouedraogo

Cette étude avait pour but de renforcer la prise en charge des plaies faciales graves d’origine traumatique au Centre Hospitalier Universitaire Yalgado Ouedraogo. Il s’est agi d’une étude prospective allant du 1er janvier au 31 décembre 2014 dans le service de chirurgie maxillo-faciale du Centre Hospitalier  Universitaire Yalgado Ouedraogo. Au total 107 cas ont été colligés, représentant 13,1% des motifs des consultations dans le service. Les accidents de la voie publique (85,01 %) étaient l’étiologie principale. Les lésions type IV de Lackmann (64,5 %) étaient les plus fréquentes. La prise en charge de 25% des patients avait nécessité l’intervention d’un autre spécialiste, à côté du chirurgien maxillo-facial. Cependant, un seul patient avait été pris en charge par plusieurs spécialistes dans le même temps opératoire. Le fonctionnement des services spécialisés n’avait pas permis une prise en charge optimale des patients. L’évolution avait été favorable chez la plupart de nos patients (97,2%), au prix cependant de séquelles chez 49,5% des patients.Mots clés : plaie, faciale, grave, traumatique.This study was designed to reinforce the management of severe facial injuries at the Teaching Hospital  Yalgado Ouedraogo. It was a prospective study from january 2014 to december 2014, in the Department of Maxillofacial Surgery of the Teaching Hospital Yalgado Ouedraogo. One hundred and seven cases were recorded, representing 13.1% of the out patient consultations in the service during the study period. Type IV lesions of Lackmann (64.5%) were the most frequent. The management of 25% of the patients required the intervention of another specialist in addition to the maxillofacial surgeon. However, only one patient was operated by many specialists at the same time. Indeed, the functioning of specialized  services did not allow providing an optimal care to patients. The outcome was good in most cases  (97.2%). However, 49.5% of the patients healed with sequelae.Key words: Injury, facial, severe, traumatic

Lymphangiome kystique dans le service d’ORL du CHU Yalgado de Ouagadougou : Aspects épidémiologique, diagnostique et thérapeutique

Le but de cette étude est d’analyser les aspects épidémiologiques et  diagnostiques et thérapeutiques des lymphangiomes kystiques cervico-faciaux. Il s’agit d’étude rétrospective de 10 ans (janvier 2003 à décembre 2012) avec 32 patients enregistrés dans le service d’ORL du CHUYO de Ouagadougou. L’incidence annuelle était de 3,2 cas et l’âge moyen de 08 ans. Les principaux motifs de consultation étaient la tuméfaction cervicale (56,25%), la compression aéro-digestive (31,25 %) et la surinfection locale(18,75%). Le diagnostic a été échographique (93,75%) et histologique (68,75%). Le traitement était médico-chirurgical (68,75%) ou médical isolé (31,25 %) avec une évolution favorable dans 75% des cas, nonobstant  31,25% de séquelles post-thérapeutiques. Quatre cas (12,5%) de décès imputables à des complications infectieuses ont été enregistrés dans notresérie. Relativement rare, le lymphangiome kystique reste hautement morbide dans notre contexteMots clés : Epidémiologie, diagnostic, lymphangiome, kystique,  thérapeutiqueThe aim of this study was to analyze epidemiological, diagnostic and therapeutic aspects of neck and facial cystic lymphangioma.Method: retrospective study of 10 years, from January 2003 to December 2012, with 32 patients unregistered in the ENT service of university hospitalcenter of Ouagadougou.Results: the annual incidence was 3,2 cases and the mean age was 08 years. The principal reasons of consultation were neck tumefaction (56,  25%), aero-digestive compression (31,25 %) and local infectious (18,75%). The diagnostic was echographic (93,75%) et histological  (68,75%). The treatment has been medico-surgical (68,75%) or medicalonly (31,25 %). The evolution was favorable (75%) with notwithstanding 31,25% of cases of sequelaes. Four cases (12,5%) of post-therapeutic relapse and 04 cases (12,5%) of dead attributable to the infectious complications were unregistered in our series.Conclusion: Cystic lymphangioma stays highly morbid in our context.Key word : epidémiological, cystic lymphangioma,diagnostic, therapeuti