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The cancrum oris is still an up to date disease in our environment. The death rate and the after effects of this disease make all together the main interest of this survey. In a retrospective survey carried out from January 2003 to December 2012, we colligated 55 cases of progressive cancrum oris followed at the stomatological and maxillofacial surgery at the Academic Hospital Yalgado OUEDRAOGO. On the epidemiological level, we noticed an impact of 5.5 cases per year. The average age of our patients was about 7.64 with a sex ratio of 1.03. Most of the patients were from an underprivileged family (96.4%). On the clinical level, we noticed that most of the patients consulted only after the gangrene had fallen (89.1%) and were seriously affected (67.3%) with a bad oral and dental hygiene (38.1%). The attacks were mainly jugal (25%) and labial (24.1%). The cancrum oris was in most of the cases associated to broncho pneumonitis, malaria and to HIV infection (31.37%). For the medical treatment, we focused on resuscitation, re nutrition, hydro electrolytic rebalancing and antibiotherapy. The surgical treatment was essentially made on the affected areas, controlled skinning and most often followed by sequestrectomy. 81.8% of the patients recovered completely from the infection, 60% had after effect injuries. We recorded a death rate of 14.5%. In order to overcome this disease we need both national and international support.

Staphylococcus aureus accounts for 2-5% of the etiologies of community-acquired pneumonia. These infections occur mainly in elderly patients with comorbidity, after a respiratory viral infection. S. aureus could also be responsible for necrotizing pneumonia, which occurs in young subjects, also after flu. Necrotizing pneumonia are associated with the production of a particular staphylococcal toxin called Panton-Valentine leukocidin, responsible for pulmonary focal necrosis, occurrence haemoptysis, leucopenia, and death. In Europe, these strains are still predominantly sensitive to anti-staphylococcal penicillin, which must be used at high dosage intravenously in combination with an antibiotic that reduces toxin production such as clindamycin, and intravenous immunoglobulin in severe cases. The mortality rate is estimated at 50%. In addition, S. aureus is one of the pathogens involved in early respiratory infections in cystic fibrosis patients, in whom methicillin resistance plays an important prognostic role. However, the involvement of S. aureus in COPD exacerbations is rare. Finally, S. aureus represents 20 to 30% of cases of hospital-acquired pneumonia, including ventilator-associated pneumonia. In these cases, methicillin-resistance is common and requires the use of glycopeptides or linezolid. The place of new anti-staphylococcal antibiotics such as new generation cephalosporins or tigecyclin remains to be defined., (Copyright © 2013. Published by Elsevier Masson SAS.)

Umbilical hernias occur frequently in children but complications are rarely reported. This study assesses the incidence of complicated umbilical hernias in our patients, evaluates data for risk factors, and shows dissimilarities with those encountered in developed countries. This study reports all children operated for complications due to strangulated umbilical hernia over a period of 3 years. On the whole, 162 children had umbilical hernias treated during this period. Thirty (18.5%) of these had complicated hernias. The average age of the complicated group was 3(1/2) years. Twenty-nine cases had a painful irreducible umbilical mass. Twenty-four children had bowel obstruction, while stercoral fistula occurred in one child. The average diameter of the hernia ranged between 1 and 1.5 cm. Five patients had ischemic intestine that required resection. One patient died. When active observation and follow-up after 1 year is difficult or not feasible when the wall defect diameter is 1.5 cm or less, and in suspicion of incarceration (unexplained abdominal pain, and irreducibility), umbilical hernia should be operated.

EMPIRICAL STRATEGY: Antibiotic therapy of upper and lower respiratory tract infections is based on an empirical strategy. However, arguments favoring the probability of a given bacteria may be lacking and, since resistance of Streptococcus pneumoniae and Haemophilus influenzae against conventional antibiotics is becoming increasingly frequent, therapeutic strategies must be revisited. SINUSITIS: H. influenzae and S. pneumoniae are the most frequent causal agents in acute maxillary sinusitis. For chronic sinusitis, beta-lactamase producing anaerobic bacteria, S. aureus and peni-resistant pneumococci and H. influenzae must also be considered. ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS: The main causal agents are H. influenzae and S. pneumoniae, followed by M. catarrhalis, S. aureus, enterobacteriaceae, and beta-hemolytic streptococci. COMMUNITY ACQUIRED PNEUMONIA: There are a wide range of pathogens, half of which are identified in different studies. RESISTANCES: For pneumococci, penicillin resistance is currently evidenced in 48% of the strains. For H. influenzae, 30% of the strains are ampicillin resistant.

The authors analyzed in published studies providing histologic data the value of diagnostic means of nosocomial bronchopneumonia (NBP) in critically ill patients. At least 10% of patients whose trachea is intubated and the lungs mechanically ventilated suffer an histologically-confirmed NBP. Histology of NBP consists of non systematized foci of infection, localised in 90% of cases in the posterior segments of the lower pulmonary lobes. In fact, small foci are disseminated in both lungs, usually within large areas of non infectious pulmonary lesions and are often multimicrobial. This may explain why the clinical and radiological diagnosis is inaccurate in more than 40% of cases. On chest X-ray, aeric bronchogram and alveolar infiltrates are suggestive but non-specific for NBP, as are also fever, leukocytosis and purulent sputum. Therefore, to confirm the diagnosis of infection and to isolate the microorganisms responsible for NBP, additional investigations are required whose interpretation is uneasy. In a simplified manner, bacteriological inoculum takes a course parallel to the histological bronchopulmonary lesions: no bacteria in the absence of infection, high bacterial inoculum in case of confluent NBP, intermediary in case of bronchitis, however with exceptions when antibiotherapy has recently been modified. In fact, neither bronchial protected brushing nor broncho-alveolar lavage techniques have a perfect sensitivity and specificity. As an example, a diagnostic procedure in assessed in calculating the probability of an accurate diagnosis of NBP. It is concluded that diagnosis of ventilator-associated pneumonia remains still unreliable with the means available today.

Background: Infants suffering from respiratory syncytial virus (RSV) infection can have severe responses that require intensive care. This study compares the epidemiologic patterns and the severity of respiratory diseases produced by RSV strain subtypes A and B., Population and Methods: The prevalence of RSV subgroups was studied over 8 consecutive outbreaks from 1982 to 1990. The files of 73 infants aged from 1 to 24 months admitted because of RSV infection between October 1987 and March 1990 were studied. The criteria of severity were tachypnea and/or the use of the accessory muscles for respiration, apnea and/or cyanosis, hospitalization for > 8 days, hypercapnia and/or acidosis, oxygen therapy, use of corticosteroids and/or bronchodilators, nutritional difficulties., Results: A total of 374 RSV strains were isolated: 142 were group A and were 232 group B. Subtype A predominated during the winter 1987-1988 and subtype B during 1983-1984, 1984-1985 and 1989-1990. Some indicators of severity, such as degree of respiratory distress, duration of hospitalization and levels of oxygen saturation, were correlated with A subgroup infections, but the difference in the severity index for the two subtypes was not statistically significant., Conclusions: The results are not consistent with other previous reports, perhaps because different indicators of severity were used in this study and infants less than one month old or having other underlying diseases were excluded.