Anesthesie au cours des ventriculocisternostomies au Mali : Une serie de 31 cas

Introduction La ventriculocisternostomie est une technique moderne du traitement des hydrocéphalies. Elle est peu fréquente en Afrique. Objectif:  Décrire la prise en charge anesthésique et l’évolution des patients opérés par ventriculocisternostomie. Patients et Méthode: Etude de cohorte prospective de 15 mois de janvier 2014 au 31 mars 2015. La saisie et l’analyse des données ont été effectuées par Microsoft word 2010 Epi info 3.5.3.fr. Résultats:  Les nourrissons prédominaient avec un sexe ratio de 1,81 en faveur du sexe masculin. Un antécédent de méningite ou d’infection respiratoire à répétition a été retrouvé chez 10 patients (32,2%). L’indication de la ventriculocisternostomie était une hydrocéphalie chez 30 patients (96, 8%). La classe ASA était II chez 19 patients (61,3%). L’intubation était prévue difficile chez 28 patients (90,3%).Tous les patients ont été opérés sous anesthésie générale. Une antibioprophylaxie a été faite chez tous les patients. La tachycardie isolée a été le seul évènement indésirable per opératoire observé chez 13 patients (41,9%). La durée de la chirurgie était de 62, 25 ± 20,9 minutes celle de l’anesthésie était de 93,5 ± 25,4 minutes. En postopératoire, une complication a été observée chez 7 patients (22,6%). Il s’agissait d’une méningite chez 3 patients (42,9%), d’une souffrance cérébrale, d’une obstruction de la stomie, d’un abcès cérébral et une paralysie du nerf III dans 14,3% chacune (1 patient). L’évolution était favorable chez 29 patients (93,5%). La durée médiane d’hospitalisation était de 3 jours. Conclusion:  Au Mali, la prise en charge anesthésique au cours de la ventriculocisternostomie s’adresse à une population pédiatrique avec un terrain précaire.   English title: Anesthesia during endoscopic third ventriculostomy in Mali: A series of 31 cases Introduction: Endoscopic Third Ventriculostomy (ETV) is a modern technique for the treatment of hydrocephalus. It is uncommon in Africa. Objective To describe ananesthesic management and the outcome of patients operated on by ETV. Patients and Methods Prospective cohort study over 15 months to January 2014 at 31 march 2015. The data entry and analysis were done by word office, Epi info 3.5.3.fr. Results: Infants predominated with a sex ratio of 1.81 in favor of men. A history of meningitis or recurrent respiratory infection was found in 10 patients (32.2%). The indication of ETV was hydrocephalus in 30 patients (96.8%). The ASA class was II in 19 patients (61.3%).  Intubation was expected to be difficult in 28 patients (90.3%). All patients were operated on under general anesthesia. Antibiotic  prophylaxis was done in all patients. Isolated tachycardia was the only peroperative adverse event observed in 13 patients (41.9%). The duration of the surgery was 62.25 ± 20.9 minutes that of the anesthesia was 93.5 ± 25.4 minutes. Postoperatively, a complication was observed in 7 patients (22.6%). It was meningitis in 3 patients (42.9%), brain pain, obstruction of the stoma, brain abscess and nerve III paralysis in 14.3% each (1 patient). The outcome was favorable in 29 patients (93.5%). The median hospital stay was 3 days. Conclusion:  In Mali, anesthetic management during ETV is aimed at a pediatric population with precarious terrain

Epilepsie et permis de conduire au Mali : connaissances, attitudes et pratiques des moniteurs d’auto-école et des candidats au permis de conduire

Introduction: L’un des sujets les plus controversés dans le domaine de l’épilepsie est la problématique de la conduite chez l’épileptique.Objectif: Nous avons initié une étude, en collaboration avec l’Agence Nationale de la Sécurité Routière au Mali (ANASER), ayant pour but de faire l’état des lieux sur les connaissances, attitudes et pratiques des conducteurs, moniteurs et inspecteurs d’auto-écoles en matière d’épilepsie.Methode: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. Elle a porté sur 31 auto-écoles du district de Bamako. 568 personnes ont été interrogées (488 candidats au permis de conduire, 70 moniteurs d’auto-école et 10 inspecteurs).Resultats: Près de 60 % des personnes interrogées accordaient une origine surnaturelle à l’épilepsie ; plus de 85 % indiquaient que l’épilepsie était incompatible avec la conduite automobile. Plus de la moitié ignorait l’existence d’une réglementation. Près de 70 % pensaient que l’épilepsie était pourvoyeuse d’accident de la voie publique.Conclusion: A l’instar de nos précédentes études communautaires au Mali, ce travail a permis de mettre l’accent, d’une part, sur l’importance des connaissances erronées sur l’épilepsie et, d’autre part, sur la nécessité d’actualiser la réglementation en matière de conduite de véhicules motorisés pour ces patients.Mots clés: Attitudes, Épilepsie, Mali, Permis de conduire, Conduite automobileEnglish Title: Epilepsy and driving licence in Mali : knowledge, attitudes and practices of driving schools monitors and the candidates for the licenceEnglish AbstractBackground: One of the most controversial topics in the field of epilepsy remains the issue of driving license for epileptic patients.Purpose: We initiated a study in collaboration with ANASER (National Agency for Road Safety in Mali) with the goal, on one hand, of assessing the knowledge, attitudes and practices of drivers and driving school authorities on epilepsy and, on the other hand, to analyze the current regulations on issuance of license to epileptic patients.Methods: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. We interviewed 568 sujects, including 488 candidates for driver’s license, 70 driving school monitors and 10 inspectors.Results: About 60% gave a supernatural origin of the disease, and more than 85% believed that epilepsy was incompatible with driving. More than half were unaware of regulations. Approximately, 70% of respondents believed that epilepsy was a contributory factor to road accident.Conclusion: As in our previous community studies in Mali, this study emphasizes the importance of misconceptions about epilepsy, and has shown the need to update the regulations regarding the driving of motorized vehicles for these patients.Keywords: Epilepsy, Attitudes, Driving , Driving License, Mal

Annual population dynamics of mango fruit flies (Diptera: Tephritidae) in West Africa: Socio-economic aspects, host phenology and implications for management

Losses in West African commercial mango orchards due to fruit fly infestations have exceeded 50% by the middle of the crop season since 2005, resulting in considerable income loss for the growers. Materials and methods. In 2009, weekly monitoring of adult fruit fly species of economic significance was carried out in eight West African countries at 12 sites across five agro-ecological zones: (i) Humid Forest, (ii) Guinean savanna, (iii) Southern Sudan, (iv) Northern Sudan, and (v) Sahelian. Trapping was performed using methyl eugenol and terpinyl acetate in 288 Tephritraps, targeting Bactrocera invadens and Ceratitis cosyra. Results. The data showed that B. Invadens was present throughout the year in the Forest zone, abundant for 7 months, with a peak in May at the end of the mango season, C. cosyra being totally absent. In the Guinean savanna zone, B. invadens was abundant for 6-7 months, with a peak at the beginning of June coinciding with the season, with a few C. cosyra. In the Southern Sudan zone, B. invadens was abundant for 6 months, with a peak in mid-June during the season, C. cosyra peaking in April. In the Northern Sudan zone, B. invadens was abundant for 5 months, with a peak at the end of June at the end of the season, C. cosyra peaking in May. In the Sahelian zone, B. invadens was abundant for 4 months, peaking in August during the sea-son, C. cosyra peaking just before. These preliminary results showed that the exotic species, B. invadens, was present at high levels [mean peak of 378 flies per trap per day (FTD)] in all agro-eco-logical zones, while the native species, C. cosyra, preferred the drier zones of West Africa, with lower population levels (mean peak of 77 FTD).Conclusion. Detection trapping of male flies with parapheromones is a useful indicator of field population levels and could be used to deploy control measures (IPM package) in a timely manner when the Economic Injury Level is reached. Control strategies for these quarantine mango fruit fly species are discussed with respect to agro-ecological zones and the phenological stages of the mango tree. (Résumé d'auteur

Protocol for a parallel group, two-arm, superiority cluster randomised trial to evaluate a community-level complementary-food safety and hygiene and nutrition intervention in Mali:the MaaCiwara study (version 1.3; 10 November 2022)

BACKGROUND: Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We describe a protocol for a cluster randomised trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition. METHODS: We describe a mixed-methods, parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures. One hundred twenty clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. The community intervention will be focussed around an ideal mother concept involving all community members during campaign days with dramatic arts and pledging, and follow-up home visits. Participants will be mother–child dyads (27 per cluster period) with children aged 6 to 36 months. Data collection will comprise a day of observation and interviews with each participating mother–child pair and will take place at baseline and 4 and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary-food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. A additional structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Qualitative and health economic analyses including process evaluation will be done. CONCLUSIONS: The trial will provide evidence on the effectiveness of community-based behavioural change interventions designed to reduce the burden of diarrhoeal disease in the under-fives and how effectiveness varies across different contexts. TRIAL REGISTRATION: ISRCTN14390796. Registration date December 13, 2021 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06984-5

Case Report: COVID-19 and Lassa Fever Coinfection in an Ebola Suspected Patient in Guinea

ABSTRACT. In this case report, we describe a clinical presentation and therapeutic history of a unique case diagnosed with Lassa fever and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 23-year-old man from Yomou prefecture in southeast Guinea identified with suspected Ebola Virus Disease (EVD) in the midst of an ongoing outbreak of that disease in the same region. On May 3, 2021, he was admitted to the Nzérékoré Epidemic disease treatment center where his clinical condition deteriorated significantly. Laboratory testing performed on the same day reveals a negative EVD polymerase chain reaction (PCR). Three days later, the patient was tested positive for SARS-CoV-2 and Lassa fever by reverse transcriptase PCR (RT-PCR) assays. Laboratory examination also indicated severe hematological and biochemical deteriorations in the patient. This case substantiates the need for systematic differential diagnosis during epidemic-prone disease outbreaks to better manage severely unwell patients.</jats:p

Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks

These authors contributed equally: Alpha K. Keita, Fara R. Koundouno, Martin Faye, Ariane Düx, Julia Hinzmann.International audienc

ULTRASOUND IN THE ETIOLOGICAL ASSESSMENT OF HEMORRHAGES DURING THE 3RD TRIMESTER OF PREGNANCY AT THE FERTILIA MEDICAL CLINIC IN BAMAKO

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Haemorrhage in the third trimester of pregnancy is a major public health problem because it can jeopardize the vital prognosis of the mother and the fetus. The objective of our study was to study the sonographic etiologies of hemorrhages in the 3rd trimester of pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subjects and Methods: &lt;/strong&gt;This was a 5-year cross-sectional and prospective study, between JUNE 2017 and MAY 2022, which involved 82 pregnant women who were between 28 and 40 weeks of amenorrhea (SA) and who presented with hemorrhage regardless of its volume. The data collected was obtained on the ultrasound reports and a series of questions asked either of the patient or her companions. Data were entered and analyzed on SPSS version 26.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our study, we performed 12,900 obstetrical ultrasounds, of which 82 women had hemorrhage, i.e. a frequency of 0.63%. The average age was 29 years with extremes ranging from 17 to 43 years. 39 patients or 47.5% were between 20 and 30 years old. 42 patients or 51% were multi gestures. 51 patients or 62% were multiparous. The clinical information prompting an ultrasound was abdominal pain + metrorrhagia in 58.5% of cases. 70.7% were between 37 SA and 42 SA. The sonographic etiologies were retroplacental hematoma (HRP) with 56% placenta previa (33%), placenta previa+HRP (2.2%) and uterine rupture (1.8%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion : &lt;/strong&gt;Faced with the occurrence of metrorrhagia in the 3rd trimester of pregnancy, it is always necessary to think of the most serious etiologies, which are ultimately not so rare and can jeopardize the vital prognosis of the mother and the child. A targeted questioning and a concise clinical examination make it possible to quickly orient towards an etiology. Ultrasound is an invaluable diagnostic and prognostic aid. The speed of emergency care can sometimes save the child, most often the mother.&lt;/p&gt;&lt;p&gt;&nbsp;&lt;/p&gt

Combining viral genetic and animal mobility network data to unravel peste des petits ruminants transmission dynamics in West Africa

International audiencePeste des petits ruminants (PPR) is a deadly viral disease that mainly affects small domestic ruminants. This disease threaten global food security and rural economy but its control is complicated notably because of extensive, poorly monitored animal movements in infected regions. Here we combined the largest PPR virus genetic and animal mobility network data ever collected in a single region to improve our understanding of PPR endemic transmission dynamics in West African countries. Phylogenetic analyses identified the presence of multiple PPRV genetic clades that may be considered as part of different transmission networks evolving in parallel in West Africa. A strong correlation was found between virus genetic distance and network-related distances. Viruses sampled within the same mobility communities are significantly more likely to belong to the same genetic clade. These results provide evidence for the importance of animal mobility in PPR transmission in the region. Some nodes of the network were associated with PPRV sequences belonging to different clades, representing potential "hotspots" for PPR circulation. Our results suggest that combining genetic and mobility network data could help identifying sites that are key for virus entrance and spread in specific areas. Such information could enhance our capacity to develop locally adapted control and surveillance strategies, using among other risk factors, information on animal mobility. As animals move so do viruses. The viral disease peste des petits ruminants (PPR) has a major impact on the livelihood of sheep and goat farmers across Africa, Middle-East and Asia. A global PPR eradication campaign is underway, but extensive movements of infected animals impede control efforts in many regions, such as West Africa. Here we show for the first time that PPR virus genetic data can be combined with information on animal mobility to identify routes of PPR circulation in Senegal and neighbouring countries. Such information can be used to design more efficient disease surveillance and control strategies adapted to local livestock farming practices

Comparative evolutionary analyses of peste des petits ruminants virus genetic lineages

International audiencePeste des petits ruminants virus (PPRV) causes a highly infectious disease affecting mainly goats and sheep in large parts of Africa, Asia, and the Middle East and has an important impact on the global economy and food security. Full genome sequencing of PPRV strains has proved to be critical to increasing our understanding of PPR epidemiology and to inform the ongoing global efforts for its eradication. However, the number of full PPRV genomes published is still limited and with a heavy bias towards recent samples and genetic Lineage IV (LIV), which is only one of the four existing PPRV lineages. Here, we generated genome sequences for twenty-five recent (2010–6) and seven historical (1972–99) PPRV samples, focusing mainly on Lineage II (LII) in West Africa. This provided the first opportunity to compare the evolutionary pressures and history between the globally dominant PPRV genetic LIV and LII, which is endemic in West Africa. Phylogenomic analysis showed that the relationship between PPRV LII strains was complex and supported the extensive transboundary circulation of the virus within West Africa. In contrast, LIV sequences were clearly separated per region, with strains from West and Central Africa branched as a sister clade to all other LIV sequences, suggesting that this lineage also has an African origin. Estimates of the time to the most recent common ancestor place the divergence of modern LII and LIV strains in the 1960s–80s, suggesting that this period was particularly important for the diversification and spread of PPRV globally. Phylogenetic relationships among historical samples from LI, LII, and LIII and with more recent samples point towards a high genetic diversity for all these lineages in Africa until the 1970s–80s and possible bottleneck events shaping PPRV’s evolution during this period. Molecular evolution analyses show that strains belonging to LII and LIV have evolved under different selection pressures. Differences in codon usage and adaptative selection pressures were observed in all viral genes between the two lineages. Our results confirm that comparative genomic analyses can provide new insights into PPRV’s evolutionary history and molecular epidemiology. However, PPRV genome sequencing efforts must be ramped up to increase the resolution of such studies for their use in the development of efficient PPR control and surveillance strategies

Red List of Marine Bony Fishes of the Eastern Central Atlantic.

International audienceThe Red List of Marine Bony Fishes of the Eastern Central Atlantic (ECA) is a review of the conservation status of all native marine bony fishes in ECA according to the global Categories and Criteria of the IUCN Red List of Threatened Species. It identifies those species that are threatened with extinction at the global level and occur within the ECA region. This comprehensive assessment, which is the first of its kind in the ECA, aims to provide improved knowledge of species presence and extinction risk status for the purposes of guiding conservation actions and improved policies for these species both globally and regionally