Rupture Uterine Par Accident De La Voie Publique: A propos d’un cas.

Un cas de rupture utérine par accident de la voie publique associée à une fracture de l’humérus droit et du bassin est décrit. Les pronostics maternels et foetal sont discutés à la lumière de la revue de la littérature

An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial)

Background: Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed – the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies. Objective: To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks. Design: The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) trial was a pragmatic, prospective, international, multicentre, non-inferiority, non-blinded, randomised (1 : 1 ratio) clinical trial. Originally, randomisation occurred before initial lumpectomy (prepathology) and, if allocated TARGIT, the patient received it during the lumpectomy. Subsequently, the postpathology stratum was added in which randomisation occurred after initial lumpectomy, allowing potentially easier logistics and a more stringent case selection, but which needed a reoperation to reopen the wound to give TARGIT as a delayed procedure. The risk-adapted approach meant that, in the experimental arm, if pre-specified unsuspected adverse factors were found postoperatively after receiving TARGIT, EBRT was recommended. Pragmatically, this reflected how TARGIT would be practised in the real world. Setting: Thirty-three centres in 11 countries. Participants: Women who were aged ≥ 45 years with unifocal invasive ductal carcinoma preferably ≤ 3.5 cm in size. Interventions: TARGIT within a risk-adapted approach and whole-breast EBRT. Main outcome measures: The primary outcome measure was absolute difference in local recurrence, with a non-inferiority margin of 2.5%. Secondary outcome measures included toxicity and breast cancer-specific and non-breast-cancer mortality. Results: In total, 3451 patients were recruited between March 2000 and June 2012. The following values are 5-year Kaplan–Meier rates for TARGIT compared with EBRT. There was no statistically significant difference in local recurrence between TARGIT and EBRT. TARGIT was non-inferior to EBRT overall [TARGIT 3.3%, 95% confidence interval (CI) 2.1% to 5.1% vs. EBRT 1.3%, 95% CI 0.7% to 2.5%; p = 0.04; Pnon-inferiority = 0.00000012] and in the prepathology stratum (n = 2298) when TARGIT was given concurrently with lumpectomy (TARGIT 2.1%, 95% CI 1.1% to 4.2% vs. EBRT 1.1%, 95% CI 0.5% to 2.5%; p = 0.31; Pnon-inferiority = 0.0000000013). With delayed TARGIT postpathology (n = 1153), the between-group difference was larger than 2.5% and non-inferiority was not established for this stratum (TARGIT 5.4%, 95% CI 3.0% to 9.7% vs. EBRT 1.7%, 95% CI 0.6% to 4.9%; p = 0.069; Pnon-inferiority = 0.06640]. The local recurrence-free survival was 93.9% (95% CI 90.9% to 95.9%) when TARGIT was given with lumpectomy compared with 92.5% (95% CI 89.7% to 94.6%) for EBRT (p = 0.35). In a planned subgroup analysis, progesterone receptor (PgR) status was found to be the only predictor of outcome: hormone-responsive patients (PgR positive) had similar 5-year local recurrence with TARGIT during lumpectomy (1.4%, 95% CI 0.5% to 3.9%) as with EBRT (1.2%, 95% CI 0.5% to 2.9%; p = 0.77). Grade 3 or 4 radiotherapy toxicity was significantly reduced with TARGIT. Overall, breast cancer mortality was much the same between groups (TARGIT 2.6%, 95% CI 1.5% to 4.3% vs. EBRT 1.9%, 95% CI 1.1% to 3.2%; p = 0.56) but there were significantly fewer non-breast-cancer deaths with TARGIT (1.4%, 95% CI 0.8% to 2.5% vs. 3.5%, 95% CI 2.3% to 5.2%; p = 0.0086), attributable to fewer deaths from cardiovascular causes and other cancers, leading to a trend in reduced overall mortality in the TARGIT arm (3.9%, 95% CI 2.7% to 5.8% vs. 5.3%, 95% CI 3.9% to 7.3%; p = 0.099]. Health economic analyses suggest that TARGIT was statistically significantly less costly than EBRT, produced similar quality-adjusted life-years, had a positive incremental net monetary benefit that was borderline statistically significantly different from zero and had a probability of \u3e 90% of being cost-effective. There appears to be little uncertainty in the point estimates, based on deterministic and probabilistic sensitivity analyses. If TARGIT were given instead of EBRT in suitable patients, it might potentially reduce costs to the health-care providers in the UK by £8–9.1 million each year. This does not include environmental, patient and societal costs. Limitations: The number of local recurrences is small but the number of events for local recurrence-free survival is not as small (TARGIT 57 vs. EBRT 59); occurrence of so few events (\u3c 3.5%) also implies that both treatments are effective and any difference is unlikely to be large. Not all 3451 patients were followed up for 5 years; however, more than the number of patients required to answer the main trial question (n = 585) were followed up for \u3e 5 years. Conclusions: For patients with breast cancer (women who are aged ≥ 45 years with hormone sensitive invasive ductal carcinoma that is up to 3.5 cm in size), TARGIT concurrent with lumpectomy within a risk-adapted approach is as effective as, safer than and less expensive than postoperative EBRT. Future work: The analyses will be repeated with longer follow-up. Although this may not change the primary result, the larger number of events may confirm the effect on overall mortality and allow more detailed subgroup analyses. The TARGeted Intraoperative radioTherapy Boost (TARGIT-B) trial is testing whether or not a tumour bed boost given intraoperatively (TARGIT) boost is superior to a tumour bed boost given as part of postoperative EBRT. Trial registration: Current Controlled Trials ISRCTN34086741 and ClinicalTrials.gov NCT00983684. Funding: University College London Hospitals (UCLH)/University College London (UCL) Comprehensive Biomedical Research Centre, UCLH Charities, Ninewells Cancer Campaign, National Health and Medical Research Council and German Federal Ministry of Education and Research (BMBF). From September 2009 this project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 73. See the NIHR Journals Library website for further project information

Traumatismes Balistiques Au Chu De Bobo-Dioulasso (Burkina Faso) : A Propos De 39 Cas

Introduction : Cette étude a été menée dans le but de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des traumatismes balistiques au Centre hospitalier universitaire Sourô Sanou (CHUSS) de Bobo-Dioulasso.Matériel et Méthodes : Il s’agissait d’une étude rétrospective sur 18mois (du 1er janvier 2008 au 30 juin 2009). Elle a concerné tous les patients admis aux urgences chirurgicales du CHUSS pour un traumatisme balistique récent. Les caractéristiques démographiques, diagnostiques ainsi que le traitement et l’évolution à cours terme des patients ont été notés.Résultats : Trente neuf patients répondaient aux critères d’inclusion. Le sexe masculin était le plus touché (87,2%). L’âge moyen a été de 28 ans. Les cultivateurs et les commerçants étaient les principales victimes (71,8%). Le traumatisme était d’origine accidentelle dans 58,9%. Le siège le plus fréquent des lésions a été l’appareil locomoteur avec une prédominance au membre thoracique. Tous les patients ont bénéficié d’un parage des plaies, d’une prophylaxie antitétanique et antibiotique. Les fractures et luxations ont été traitées orthopédiquement dans 10 cas et chirurgicalement dans 5 cas. Sept patients ont été amputés secondairement. Le taux de mortalité intra-hospitalière était de 10,3% (n=4).Conclusion : Les traumatismes balistiques sont peu fréquents dans notre centre mais responsables d’une morbi-mortalité élevée. Une politique rigoureuse de contrôle des armes à feu et une meilleure éducation des populations pourraient réduire l’incidence de ces traumatismes en pratique civile.Mots clés : Traumatisme, Arme à feu, Chirurgie, Bobo-Dioulasso.ABSTRACTBackground: This study was conducted to describe the epidemiology, diagnosis and treatment of gunshot injuries at Sourô Sanou University Hospital in Bobo-Dioulasso.Patients and Methods: This was a retrospective study over 18 months (January 2008 to June 2009). It concerned all patients admitted with a recent gunshot injury. The demographic characteristics, diagnosis and treatment and short-term course of patients were noted.Results: Thirty nine patients were admitted for gunshot injury during the study period. The male was the most affected gender (87.2%). The average age was 28 years. Farmers and traders were the most affected (71.8% of cases). The aetiology of trauma was mostly accidental (58.9%). The most common injury was musculoskeletal (n = 34) with a predominance of upper extremity. We noted 15 cases of fractures and 6cases of dislocation of member, 2 cases of neurotrauma (brain and spinal cord) and 2 cases of digestive visceral lesions. All patients received debridement of wounds, a tetanus and antibiotic prophylaxis.Fractures and dislocations have benefited from a non surgical treatment in 10 cases and surgery and in 5 cases. Seven patients were amputated secondarily. The mortality rate was 10.3% (n=4).Conclusion: Gunshot injury are uncommon but serious in our center. A policy of strict control of firearms and better educated populations could reduce the incidence of such injuries in civilian practice.Keywords: Bobo-Dioulasso, Burkina Faso, Gunshot, Injury, Surgery

URBAN CITIES AND WASTE GENERATION IN DEVELOPING COUNTRIES: A GIS EVALUATION OF TWO CITIES IN BURKINA FASO

Cities in developing countries are faced waste management challenges in terms of quantity and quality. Most of the time, solid and liquid wastes are dumped on street and open spaces. Uncontrolled waste dumped has led to diverse kind of health problems. The purpose of this article is to characterize urban cities and evaluate their waste generation using the Geographical Info rmation System (GIS). The focus is on two cities in Burkina Faso. Specific variabl es which were considered during the survey include urban fabric, grey water outlets a nd household garbage dumps sites/techniques. The study shows that in the two cities, the most dominant urban fabric is low standard of living (about 64% of housing in Fada and 62% of housing in Pouytenga). The urban fabric is also characterized by the exis tence of empty spaces. Overall, the average density of grey water discharge points is 0.85 points and 5.7 points per ha of street in Fada N’Gourma and Pouytenga respectivel y. The average density of solid waste dumps is 1.45 waste dumps per ha street a nd 7 waste dumps per ha street in Fada N'Gourma and Pouytenga respectively. In case of urgent waste management intervention, the priority areas for speedy intervention are area 10 in Fada N’Gourma, areas 2 and 5 in Pouytenga. GIS applied to w aste management can be a decision making tool for urban planne rs in developing country

Etude de la qualité de l’eau chlorée et des conditions d’utilisation au Centre Hospitalier Universitaire Sourou Sanou (CHUSS) de Bobo-Dioulasso

L’eau chlorée est un désinfectant efficace et facile à préparer. Le département de la pharmacie du Centre Hospitalier Universitaire Sourou Sanou (CHUSS) est chargé de la préparation de l’eau chlorée qui est utilisée dans les services de l’hôpital depuis 2003. La qualité chimique, les conditions de production et d’utilisation de cette eau chlorée demeurent inconnues alors que les normes de bonnes pratiques exigent un contrôle de qualité de la production et de l’utilisation. Le but de cette étude était de contribuer à évaluer la qualité de l'eau chlorée et les conditions d’utilisation au CHUSS.Il s’agissait d’une enquête sur les conditions de production, d’utilisation et une analyse chimique de la qualité de l’eau chlorée. L’étude s’est déroulée du 1er Juillet au 30 Septembre 2014 au CHUSS.Elle a révélé que la production de l’eau chlorée ne respectait pas les recommandations du fabricant de l’appareil de production. La concentration moyenne en chlore actif mesurée à la production (2,74 ± 0,25 g/L) était inférieure à celle attendue (5 g/L). Le pH de l’eau chlorée à la production était de 8,42 ± 0,03. Les conditions d'utilisation étaient parfois non conformes. Des travaux ultérieurs sur l’efficacité microbiologique de cette eau chlorée doivent être envisagés. Mots-clés: désinfectants, eau chlorée, productions, utilisation, CHUSS. English Title: Study of the quality of chlorinated water and the conditions of use at the Sourou Sanou University Hospital Center (CHUSS) in Bobo-Dioulasso. English Abstract Chlorinated water is an effective disinfectant and easy to prepare. The pharmacy department of the University Hospital Center of Sourou Sanou (CHUSS) is responsible for the preparation of chlorinated water which has been used in hospital departments since 2003. The chemical quality, the conditions of production and use of this chlorinated water remains unknown. However, good practice standards require quality control of production and use. The aim of this study was to help assess the quality of chlorinated water and the conditions of use at CHUSS. It was a survey on the conditions of production, use and a chemical analysis of the quality of chlorinated water. The study took place from July 1 to September 30, 2014 at CHUSS. The investigation revealed that the production of chlorinated water did not meet the recommendations of the manufacturer of the production device. The average concentration of active chlorine measured at production (2.74 ± 0.25 g / L) was lower than that expected (5 g / L). The production pH of chlorinated water was 8.42 ± 0.03. The conditions of use were sometimes non-compliant. Further work on the microbiological effectiveness of this chlorinated water should be considered. Keywords: disinfectants, chlorinated water, production, utilisation, CHUS

Repeat Ivermectin Mass Drug Administrations for Malaria Control II: Protocol for a Double-blind, Cluster-Randomized, Placebo-Controlled Trial for the Integrated Control of Malaria.

BACKGROUND: The gains made against malaria have stagnated since 2015, threatened further by increasing resistance to insecticides and antimalarials. Improvement in malaria control necessitates a multipronged strategy, which includes the development of novel tools. One such tool is mass drug administration (MDA) with endectocides, primarily ivermectin, which has shown promise in reducing malaria transmission through lethal and sublethal impacts on the mosquito vector. OBJECTIVE: The primary objective of the study is to assess the impact of repeated ivermectin MDA on malaria incidence in children aged ≤10 years. METHODS: Repeat Ivermectin MDA for Malaria Control II is a double-blind, placebo-controlled, cluster-randomized, and parallel-group trial conducted in a setting with intense seasonal malaria transmission in Southwest Burkina Faso. The study included 14 discrete villages: 7 (50%) randomized to receive standard measures (seasonal malaria chemoprevention [SMC] and bed net use for children aged 3 to 59 months) and placebo, and 7 (50%) randomized to receive standard measures and monthly ivermectin MDA at 300 μg/kg for 3 consecutive days, provided under supervision to all eligible village inhabitants, over 2 successive rainy seasons. Nonpregnant individuals >90 cm in height were eligible for ivermectin MDA, and cotreatment with ivermectin and SMC was not permitted. The primary outcome is malaria incidence in children aged ≤10 years, as assessed by active case surveillance. The secondary safety outcome of repeated ivermectin MDA was assessed through active and passive adverse event monitoring. RESULTS: The trial intervention was conducted from July to November in 2019 and 2020, with additional sampling of humans and mosquitoes occurring through February 2022 to assess postintervention changes in transmission patterns. Additional human and entomological assessments were performed over the 2 years in a subset of households from 6 cross-sectional villages. A subset of individuals underwent additional sampling in 2020 to characterize ivermectin pharmacokinetics and pharmacodynamics. Analysis and unblinding will commence once the database has been completed, cleaned, and locked. CONCLUSIONS: Our trial represents the first study to directly assess the impact of a novel approach for malaria control, ivermectin MDA as a mosquitocidal agent, layered into existing standard-of-care interventions. The study was designed to leverage the current SMC deployment infrastructure and will provide evidence regarding the additional benefit of ivermectin MDA in reducing malaria incidence in children. TRIAL REGISTRATIONS: ClinicalTrials.gov NCT03967054; https://clinicaltrials.gov/ct2/show/NCT03967054 and Pan African Clinical Trials Registry PACT201907479787308; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=8219. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41197

Prévalence de la Maladie Rénale Chronique chez les personnes retraitées dans la ville de Bobo-Dioulasso (Burkina Faso)

La maladie rénale chronique (MRC) est une pathologie silencieuse, fréquente au sein de la population des personnes âgées. Les données émanant de l’Afrique sub-saharienne sont rares. Notre objectif était de déterminer la prévalence de la maladie rénale chronique chez les sujets retraités à  Bobo-Dioulasso. Nous avons conduit une étude prospective durant la période allant de juin à septembre 2014 chez dessujetsretraités dans la ville de Bobo-Dioulasso. Des constantes physiques ainsi que des données sociodémographiques et cliniques ont été collectées chez tous les participants. Les variables biologiques dosées sur des prélèvements sanguins et urinaires étaient : l’albuminurie, la leucocyturies, le nitrite, l’hématurie, la  créatininurie, la créatinémie et la cystatine C plasmatique. Les débits de filtrations glomérulaires (DFG) ont été estimés selon les équations MDRD et CKD-EPI Cystatine C. La prévalence de l’insuffisance rénale chez lessujetsretraités était de 15,3 % (25/163) (IC95 % = 9,8-20,9 %) de la population en considérant le débit de filtration glomérulaire utilisant la formule MDRD et 39,9 % (65/163) (IC95 % = 32,4-47,4 %) avec la cystatine C (p 0,01). Le rapport albuminurie/créatininurie supérieur à 3 mg/mmol a noté une albuminurie chez 14,7 % (24/163) (IC95 % = 9,3-20,3 %) des sujets retraités avec une moyenne de 26,8 ± 44,7 mg/mmol. L’hématurie a été retrouvée chez 6,1 % des sujets. Cette étude a fourni une prévalence de la maladie rénale chronique relativement forte chez les sujets retraités dans la ville de Bobo-Dioulasso. La cystatine C serait un bon marqueur avec unebonne sensibilité dans le dépistage de la MRC. Mots-clés : Maladie rénale chronique, âgé, retraités, Afrique sub-saharienne.   Chronic kidney disease (CKD) is a silent disease, common in the elderly population. It is rarely reported in sub-saharan Africa. Our aim wasto  determine the prevalence of chronic kidney disease among retired seniors. We conducted a prospective study during June to September 2014 among elderly retired people in BoboDioulasso’s city of Burkina Faso. Physical constants as well as socio-demographic and clinical data werecollected from all participants. The biological variables measured on blood and urine samples were: albuminuria, leucocyturia, nitrite, hematuria, creatinuria, serum creatinemia and plasma cystatin C. Glomerular filtration rate (GFR) were estimated using MDRD and CKD-EPI Cystatin C  equations. The prevalence kidney failure among retired peoples was 15.3 % (25/163) (CI95 % = 9.8-20.9 %) of our population for glomerular filtrationrate using MDRD equation versus 39.9 % (65/163) (CI95 % = 32.4-47.4 %) with CK-EPI cystatin C equation (p ˂ 0.01). Albuminuria defined by albuminuria/creatininuria ratio greater than 3 mg/mmol was found in 14.7 % (24/163) (CI95% = 9.3-20.3 %) of the retired people with an average of 26.8 ± 44.7 mg/mmol. Hematuria was found in 6.1 % of the subjects. This study thus provided a relatively high prevalence of chronic kidney disease among retired people in Bobo-Dioulasso’s city. Cystatin C would be a better marker with better sensitivity in screening the CKD among elderly people. Keywords: Chronic kidney disease, elderly, retired people, sub-saharan Africa