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Toussaint Rouamba,1,* Houreratou Barry,2,* Esperance Ouédraogo,1 Marc Christian Tahita,1 Nobila Valentin Yaméogo,3 Armel Poda,4 Arnaud Eric Diendéré,5 Abdoul-Salam Ouedraogo,4 Innocent Valea,1 Amariane M Koné,2 Cherileila Thiombiano,2 Isidore Traoré,2 Zekiba Tarnagda,1 Serge A Sawadogo,6 Zakaria Gansané,7 Yibar Kambiré,8 Idrissa Sanou,8 Fatou Barro-Traoré,8 Maxime K Drabo,1 Halidou Tinto1 On behalf of the CHLORAZ Study Group1Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso; 2Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso; 3Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso; 4Centre Hospitalier Universitaire Sourou Sanon, Bobo-Dioulasso, Burkina Faso; 5Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso; 6Centre PrïmO Nelson Mandela (Promotion de la Recherche et de l’Innovation en Immunologie Médicale de Ouagadougou), Ouagadougou, Burkina Faso; 7Clinical Monitoring in Africa-Clinical Research Organization, Ouagadougou, Burkina Faso; 8Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso*These authors contributed equally to this workCorrespondence: Toussaint RouambaInstitut de Recherche en Sciences de la Santé (CNRST-IRSS), 528, Avenue Kumda-Yoore, BP 218 Ouagadougou CMS 11, Ouagadougou, Nanoro, Burkina FasoTel +226 666 532 04Email rouambatoussaint@gmail.comIntroduction: Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce.Methods: We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance.Results: A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0– 10.0) days.Conclusion: Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.Keywords: SARS-CoV-2, chloroquine, hydroxychloroquine, azithromycin, safety, virus shedding

INTRODUCTION: Giant uterine leimyofibromas delivered through the uterine cervix are rare. MATERIALS AND METHODS: We report 3 observations in order to describe our diagnostic and therapeutic approach. RESULTS: Three patients aged 40, 49 and 41 years were seen for intense pelvic pain associated with metrorrhagia and a feeling of pelvic heaviness. The average delay of consultation was three years. They were all multiparous. The gynecological examination revealed a firm tissue mass with a smooth and regular surface of eight cm on average, occupying the vaginal cavity while respecting the vaginal walls. Speculum examination was not possible because of the size of the mass which was flush with the lower third of the vagina. Magnetic resonance imaging concluded to a myoma delivered through the cervix in all patients. A total hysterectomy was performed. Histology of the total hysterectomy specimen concluded a uterine leiomyoma of the uterus. CONCLUSION: These giant uterine leiomyomas are rare. Magnetic resonance imaging describes them well. The treatment is most often a total hysterectomy in women who do not wish to have pregnant.

Background: The epidemiology of hypothyroidism has been characterized by an increase in its frequency, especially in females and the elderly. Our aim was to study hypothyroidism in hospitals in Ouagadougou. Material and Method: This was a cross-sectional descriptive study with retrospective data collection covering a period of four (04) years between January 1, 2015 and December 31, 2018. It included patients followed in the internal medicine departments of three (03) teaching hospitals in the city of Ouagadougou. Yalgado OUEDRAOGO, Bogodogo and Tengandogo Teaching Hospitals, were the study setting. Results: 120 cases of hypothyroidism were enrolled. The mean age of the patients was 45.7 years with a sex ratio of 0.26. The signs frequently reported were weight gain (28.3%), asthenia (15.8%), and myalgia (15%). TSHus was elevated in 99.2% of patients in our series. The T3L assay level was lowered in 40.9%, with an average of 2.2 ± 1.5 pg/ml. T4L was lowered in 68.2% with an average of 6.6 ± 4 pg/ml. Primary hypothyroidism accounted for 99.2% of the cases, of which iatrogenic hypothyroidism was the most frequent with 77.5% followed by Hashimoto’s thyroiditis with 9.2% of the cases. Hormonal balance was achieved in the majority of patients (59.2%) who received hormonal supplementation with levothyroxine at an average dose of 84.5 μg/day. Conclusion: Hypothyroidism is common in women in their forties. Iatrogenic hypothyroidism was the predominant etiology reported in Ouagadougou.

Summary Background In the first 2 years after a nationwide mass vaccination campaign of 1–29-year-olds with a meningococcal serogroup A conjugate vaccine (MenAfriVac) in Burkina Faso, carriage and disease due to serogroup A Neisseria meningitidis were nearly eliminated. We aimed to assess the long-term effect of MenAfriVac vaccination on meningococcal carriage and herd immunity. Methods We did four cross-sectional studies of meningococcal carriage in people aged 9 months to 36 years in two districts of Burkina Faso between May 2, 2016, and Nov 6, 2017. Demographic information and oropharyngeal swabs were collected. Meningococcal isolates were characterised using whole-genome sequencing. Findings Of 14 295 eligible people, 13 758 consented and had specimens collected and laboratory results available, 1035 of whom were meningococcal carriers. Accounting for the complex survey design, prevalence of meningococcal carriage was 7·60% (95% CI 5·67–9·52), including 6·98% (4·86–9·11) non-groupable, 0·48% (0·01–0·95) serogroup W, 0·10% (0·01–0·18) serogroup C, 0·03% (0·00–0·80) serogroup E, and 0% serogroup A. Prevalence ranged from 5·44% (95% CI 4·18–6·69) to 9·14% (6·01–12·27) by district, from 4·67% (2·71–6·64) to 11·17% (6·75–15·59) by round, and from 3·39% (0·00–8·30) to 10·43% (8·08–12·79) by age group. By clonal complex, 822 (88%) of 934 non-groupable isolates were CC192, all 83 (100%) serogroup W isolates were CC11, and nine (69%) of 13 serogroup C isolates were CC10217. Interpretation Our results show the continued effect of MenAfriVac on serogroup A meningococcal carriage, for at least 7 years, among vaccinated and unvaccinated cohorts. Carriage prevalence of epidemic-prone serogroup C CC10217 and serogroup W CC11 was low. Continued monitoring of N meningitidis carriage will be crucial to further assess the effect of MenAfriVac and inform the vaccination strategy for future multivalent meningococcal vaccines. Funding Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Highlights • From 2011 to 2017, Burkina Faso had 20 pneumococcal meningitis clusters of ≥ 5 cases per district/week. • Clusters had a maximum weekly incidence of 7 cases and a maximum duration of 4 weeks. • Most clusters occurred prior to 13-valent pneumococcal conjugate vaccine introduction. • Clusters were caused by a mixture of serotypes, with serotype 1 being most common. • Due to the limited cluster size and duration, there were no clear indications for reactive vaccination., Background To better understand how to prevent and respond to pneumococcal meningitis outbreaks in the meningitis belt, we retrospectively examined Burkina Faso’s case-based meningitis surveillance data for pneumococcal meningitis clusters and assessed potential usefulness of response strategies. Methods Demographic and clinical information, and cerebrospinal fluid laboratory results for meningitis cases were collected through nationwide surveillance. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination; strains were serotyped using PCR. We reviewed data from 2011 to 2017 to identify and describe clusters of ≥ 5 confirmed pneumococcal meningitis cases per week in a single district. We assessed whether identified clusters met the 2016 WHO provisional pneumococcal meningitis outbreak definition: a district with a weekly incidence of >5 suspected meningitis cases/100,000 persons, >60% of confirmed meningitis cases caused by Streptococcus pneumoniae, and >10 confirmed pneumococcal meningitis cases. Results Twenty pneumococcal meningitis clusters were identified, with a maximum weekly incidence of 7 cases and a maximum duration of 4 weeks. Most identified clusters (15/20; 75%) occurred before nationwide introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2013. Most cases were due to serotype 1 (74%), 10% were due to PCV13 serotypes besides serotype 1, and 8 clusters had >1 serotype. While 6 identified clusters had a weekly incidence of >5 suspected cases/100,000 and all 20 clusters had >60% of confirmed meningitis cases due to S. pneumoniae, no cluster had >10 confirmed pneumococcal meningitis cases in a single week. Conclusions Following PCV13 introduction, pneumococcal meningitis clusters were rarely detected, and none met the WHO provisional pneumococcal outbreak definition. Due to the limited cluster size and duration, there were no clear instances where reactive vaccination could have been useful. More data are needed to inform potential response strategies.

Introduction:les complications cardiovasculaires sont devenues la 3ecause de décès et le 4emotif d´hospitalisation des patients infectés par le VIH. L´objectif de ce travail était de déterminer la fréquence de l´ischémie myocardique asymptomatique chez les patients infectés par le VIH sous traitement antirétroviral. Méthodes:étude transversale descriptive qui s´est déroulée en novembre 2015. Ont été inclus les patients infectés par le VIH1, sous traitement ARV, asymptomatiques suivis dans l´unité d´Hôpital de Jour du service des Maladies Infectieuses du CHU Souro Sanou de Bobo-Dioulasso. Les patients inclus ont bénéficié d´un recueil des facteurs de risque cardiovasculaire, de deux mesures en consultation de la pression artérielle en position assise après 10 minutes de repos et d´un électrocardiogramme 12 dérivations de repos. Résultats:au total, 123 patients infectés par le VIH1 avec un âge médian de 42 ans (IIQ: 36-50) et composés à 79% de sujets de sexe féminin ont été inclus. Les facteurs de risque cardiovasculaire retrouvés se répartissaient comme suit: HTA (31,7%), obésité (33%), dyslipidémies (10,57%), tabagisme actif (0,8%), diabète (0,8%). Tous les hypertendus connus (5,7%) étaient insuffisamment traités. La durée médiane d´exposition aux ARV était de 5,3 années (IIQ: 3-7,7). Les troubles de la repolarisation étaient observés dans 26 cas (21,13%). Ils se répartissaient en ischémie sous épicardique dans 20 cas (16,26%), lésion sous endocardique dans 2 cas (1,63%) et en séquelle de nécrose dans 4 cas (3,25%). L´hypertrophie ventriculaire gauche (HVG) était observée dans 12 cas (9,76%) et était observée chez les patients hypertendus. Le QTc était allongé chez 7 patients (5,69%) indépendamment de la classe d´ARV administré. Conclusion:dans cette étude sur les patients infectés par le VIH1, il ressort que l´ischémie myocardique asymptomatique est fréquente. Il conviendrait de renforcer son dépistage par des tests d´ischémie plus performants afin de mieux préciser sa gravité dans cette sous population au risque cardiovasculaire accru.

Le sport de haut niveau d´entrainement entraine des modifications électrocardiographiques. Certaines sont bénignes, d´autres sont péjoratifs à l´origine de mort subite. Les auteurs se proposent de décrire les caractéristiques électrocardiographiques de repos chez les sportifs de haut niveau d´entraînement de la ville de Bobo-Dioulasso. Il s´est agi d´une étude transversale descriptive allant d´août 2015 à février 2016 dans le service de cardiologie du CHU Sanou Sourô de Bobo-Dioulasso. Elle a inclus des sportifs de haut niveau d´entrainement âgés de 17 à 35 ans ayant au moins huit heures d´entrainement par semaine depuis plus de six mois quel que soit le type de sport. Deux cents sportifs de haut niveau d´entrainement de 4 disciplines sportives ont été inclus. L´âge médian des athlètes était de 24 ans (IIQ: 21-27). L´ancienneté médiane de la pratique du sport à haut niveau d´entrainement était de 6 ans (IIQ: 4-8) et la durée médiane des séances d´entraînement hebdomadaire de 10 heures (IIQ: 10-10). Seulement 4% des athlètes avaient déjà réalisé un électrocardiogramme (ECG). L´ECG présentait des anomalies dans 90,5% et la bradycardie sinusale était l´anomalie la plus fréquente rapportée dans 72,5% des cas. L´hypertrophie ventriculaire gauche et celle atriale gauche étaient rapportées respectivement dans 44% et 34,5%. Le syndrome de repolarisation précoce était retrouvé dans 47% des cas. La pratique du sport de haut niveau d´entraînement peut occasionner des modifications électriques chez l´athlète. Celles-ci nécessitent d´être connus par les praticiens afin de les différencier de la pathologie cardiaque.

Elite sport results in electrocardiogram changes. Some are minor, others are likely to cause sudden death. The authors intended to describe the electrocardiogram features of top athletes at rest in Bobo-Dioulasso. This descriptive transversal study was carried out from August 2015 to February 2016 in the cardiology department of CHU Sanou Souro in Bobo-Dioulasso. The study sampled top athletes aged 17 to 35 with at least eight hours’ training per week for more than six months regardless of the type of discipline. Two hundred top-level athletes from 4 sport disciplines were included. The median age of athletes was 24 years (IIQ: 21 -27). The median duration in high level sport was 6 years (IIQ: 4 - 8) and the median length of weekly training sessions was 10 hours (IIQ: 10 - 10). Only 4% of the athletes had already conducted an Electrocardiogram (ECG). ECG abnormalities were reported in 90.5% of cases and sinus bradycardia was the most common abnormality reported in 72.5% of cases. Left ventricular and left atrial hypertrophy were reported in 44% and 34.5% of cases respectively. Early repolarization syndrome was registered in 47% of cases. Practicing top-level sport activity can result in electrical changes with athletes. These changes need to be identified by practitioners so that the can differentiate them from heart diseases.

BACKGROUND: The prevalence of cardiovascular diseases is increasing in low-income countries. Various questionnaires to estimate walking capacity in patients are available in multiple languages but they are not suitable for illiterate patients. OBJECTIVE: The walking estimated limitation stated by history (WELSH) tool aims at rating individual walking disability using only drawings and four items. METHODS: A six-month prospective study was performed on new patients referred to the Department of Cardiology at the Centre Hospitalier Universitaire Souro Sanou in Bobo- Dioulasso, Burkina Faso. We administered the WELSH tool after a short oral presentation in the patient’s language or dialect. Thereafter, patients performed a six-minute walking test in the hospital corridor under the supervision of a nurse who was blinded to the results of the WELSH score. We performed a step-by-step multilinear regression analysis to determine the factors predicting maximal walking distance (MWD). RESULTS: There were 40 female and 10 male patients in this study. Their ages ranged from 54.8 ± 10.7 years. Only 32% of the patients had attended primary school. Most patients were classified as stage I to III of the New York Heart Association (NYHA) classification. The objective measurement of MWD during a six-minute walking test showed no association with the subjects’ educational level, body mass index, NYHA stage or gender, but a significant correlation with the WELSH scores. The Spearman r-value for the WELSH score-to- MWD relationship was 0.605 (p < 0.001). CONCLUSIONS: The WELSH tool is feasible and correlated with measured MWD in a population of predominantly illiterate patients.

Background In 2013, Burkina Faso introduced 13-valent pneumococcal conjugate vaccine (PCV13) into the routine childhood immunization program, to be administered to children at 8, 12, and 16 weeks of age. We evaluated the impact of PCV13 on pneumococcal meningitis. Methods Using nationwide surveillance, we gathered demographic/clinical information and cerebrospinal fluid (CSF) results for meningitis cases. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination; strains were serotyped using PCR. We compared annual incidence (cases per 100 000) 4 years after PCV13’s introduction (2017) to average pre-PCV13 incidence (2011–2013). We adjusted incidence for age and proportion of cases with CSF tested at national laboratories. Results In 2017, pneumococcal meningitis incidence was 2.7 overall and 10.5 ( Conclusions In Burkina Faso, meningitis caused by PCV13 serotypes continues to decrease, especially among young children. However, the concurrent decline in non-PCV13 serotypes and short pre-PCV13 observation period complicate evaluation of PCV13’s impact. Efforts to improve control of serotype 1, such as switching from a 3 + 0 schedule to a 2 + 1 schedule, may improve overall control of pneumococcal meningitis in this setting.

Resume Objectif Decrire notre experience d’oncoplastie selon Thorek en situation de gigantomastie et ptose majeure. Methode Treize dossiers de carcinomes mammaires sur gigantomastie operes selon la technique de Thorek entre 2014 et 2019 au Burkina Faso ont ete retrospectivement analyses. Ont ete pris en compte les indications operatoires, la technique et les resultats. Le Breast Q a ete utilise pour evaluer la satisfaction des patientes. Resultats L’indication d’oncoplastie selon Thorek a ete un carcinome des quadrants inferieurs du sein, associe a une ptose importante et une gigantomastie. Il y avait une repercussion vertebrale dans 9 cas sur 13. Les seins etaient durs, peu plastiques rendant les autres techniques de reduction mammaires difficiles. Cette technique a permis d’emporter le carcinome, de reduire le volume du sein et de corriger la ptose. Les patientes etaient satisfaites du volume des seins restants et de leur aspect esthetique. Les marges de resection etaient saines. Deux dyschromies areolaires ont ete notees. Conclusion La technique de Thorek reste une alternative devant des tumeurs sur gigantomastie, avec des seins dures, peu plastiques et une ptose importante. Le resultat allie les exigences carcinologiques et esthetiques.

Resume Objectif Decrire la prise en charge et l’evolution des embolies pulmonaires a haut risque de deces associees a des thrombi intracavitaires droites. Materiel et methodes Il s’est agi d’une cohorte prospective qui s’est deroulee sur 54 mois du 1 er mars 2012 au 30 septembre 2015. Ont ete inclus les patients chez qui une embolie pulmonaire a risque de deces haut et intermediaire-haut a ete diagnostiquee. Les patients ont ete subdivises en deux groupes selon que l’echographie cardiaque retrouvait ou non un thrombus intracavitaire droite (TIC+ vs TIC−). Le suivi a dure 30 jours. Nous avons suppose que les donnees suivaient une loi normale et le test de Khi 2 a ete utilise avec un seuil de significatif fixe a p Resultats La prevalence des embolies associees a des thrombi intracavitaires etait de 4 %. Le groupe TIC+ etait caracterise par une proportion significativement plus elevee dans le groupe TIC−. Dans le groupe TIC+, la thrombolyse reduisait significativement la mortalite donnant une survie a 30 jours de 80 % contre 20 % chez les patients qui recevaient uniquement de l’heparine. Conclusion Les embolies pulmonaires associees a des thrombi du cœur droit notamment de l’oreillette ne sont pas exceptionnelles. Ces patients courent un grand risque de deces precoce. La thrombolyse ameliore la survie.

Resume Objectifs L’objectif de cette etude a ete d’etudier le profil evolutif des syndromes coronaires aigus (SCA) en fonction des scores de risque GRACE, TIMI et SRI chez les patients hospitalises dans le service de cardiologie du centre hospitalier universitaire Yalgado Ouedraogo (CHU YO). Patients et methodes Il s’agit d’une etude prospective monocentrique de 111 patients consecutifs admis pour SCA (âge moyen de 57,61 ans, 77,5 % de sexe masculin) entre le 1er janvier 2010 et le 31 mai 2015. Resultats La prevalence des SCA etait de 4,2 %. Les patients etaient admis pour SCA ST+ et SCA non ST+ dans respectivement 88,3 % et 11,7 %. Dix-neuf patients (17,1 %) etaient admis avant la 12e heure. La mortalite hospitaliere etait de 8,1 % et passait a 16,2 % en un mois. Apres stratification du risque, la survie a un mois des patients a risque eleve, etait plus courte que celle des patients a risque faible quel que soit le score GRACE (log-rank = 9,93 ; p = 0,007), TIMI (log-rank = 14,91 ; p = 0,001) et SRI (log-rank = 10,01 ; p = 0,006). Les scores GRACE (HR = 1,01 ; p = 0,002), TIMI (HR = 1,33 ; p = 0,01) et SRI (HR = 1,02 ; p = 0,01) etaient des facteurs pronostiques majeurs de survie globale. Conclusion Les SCA demeurent une pathologie grave avec une morbi-mortalite elevee dans les jours qui suivent l’accident initial. Ces scores de risque sont des outils applicables au Burkina Faso comme en atteste la statistique C (GRACE = 0,75, TIMI = 0,78 et SRI = 0,74).

Although dengue is the most common arbovirus infection worldwide, studies of severe dengue in Africa are lacking, and risk factors for severe dengue have been insufficiently described. This study was conducted in the context of the 2016 dengue epidemic in Burkina Faso to determine the prevalence of severe dengue, identify factors associated with severe dengue, and perform mapping of dengue cases in the country's capital, Ouagadougou.This cross-sectional study was conducted from November 2015 to January 2017. Data were collected in 15 public and private health centres, and included sociodemographic, clinical and patient outcome variables. Dengue was diagnosed using SD Bioline Dengue Duo rapid diagnostic tests. Data were analysed using Epi-Info Version 7. Logistic regression was used to identify predictors of severe dengue.Of the 811 patients who tested positive for dengue, 609 (75%) had early dengue (AgNS1 positive) and 272 (33.5%) had severe dengue. Patient age ranged from 1 to 83 years (median 30.5 years) and 393 (48.3%) were female. Renal failure (13.1%) and severe bleeding (10.6%) were the most common signs of severe dengue. Risk factors for severe dengue included age, male sex, haemoglobin S, diabetes, hypertension, and primary dengue. Dengue cases were more concentrated in sectors located in the centre of the city and close to the health centres.Dengue is increasingly common in Africa and factors associated with severity should be sought systematically as soon as a patient tests positive. Additional studies are needed to determine if the factors found to be associated with severity can be used to identify patients at risk for dengue-related complications, and to provide early and specialized management to reduce morbidity and mortality related to dengue in Africa.

Background: We sought the value of the six-minute walk test distance in predicting re-admission in patients with chronic heart failure (CHF) in the department of cardiology, Yalgado Ouedraogo University Hospital, Ouaga-dougou, Burkina Faso. Methods: We did a prospective observational study in patients hospitalized with acute decompensated heart failure and who underwent a 6-minute walk test (6-MWT) at their discharge from hospital. The primary end-point was hospital re-admission for heart failure de-compensation. Results: Sixty-one patients (52% females, mean age 46.9 ± 14.1 years, mean left ventricular ejection fraction 32.4 ± 8.2%, mean 6-MWT distance 336.3 ± 65 meters) were followed-up for a 277.6 ± 129.8 days’ period. Twenty-one patients (45.3 percent person-years) were re-admitted. Re-admitted patients had shorter 6-MWT distance (p = 0.007) and were more likely to die than those who were not re-admitted (RR = 1.72, 95% CI = 1.13 - 2.62, p = 0.003). Multivariate Cox regression analysis showed that re-admission was independently predicted by shorter 6-MWT distance (p

Background Few studies have addressed the pattern of atrial fibrillation (AF) in rural Africa. The purpose of the study was to assess the epidemiology and long-term prognosis of AF in rural African patients in the Regional Hospital Center (RHC) of Tenkodogo, Burkina Faso. Results Overall, 107 of 1805 cardiac cases presented with AF (prevalence of 5.9%). Six patients were excluded. Mean age was 66.56 ± 14.92 years, and 53.47% were female. Hypertension was the most prevalent cardiovascular risk factor (59.41%). Congestive heart failure (HF) was reported in 85.15% of the study patients at presentation. Most of the study population presented with severe underlying heart disease (93.1%), and hypertensive heart disease was the most prevalent with 45.54% of the cases. The mean CHA2DS2VASc score in patients with non-valvular heart disease (n = 91) was 3.33 ± 1.25 (extremes 1–6) while the risk of bleeding was low (HAS-BLED score ≤ 1) in 82 patients (81.2%). Oral anticoagulation was prescribed in few cases (5.26%). During a follow-up period of 74.43 ± 23.94 weeks, acute HF and stroke occurred in respectively 43 and 6 patients. Forty-one patients (40.59%) died. The overall survival rate was 69% at 6-month and 59.4% at 1-year follow-up. Patients with idiopathic dilated cardiomyopathy were at higher risk of death than other patients (log-rank test = 11.88, p

Background Lipid-based nutrient supplements (LNS) and corn–soy blends (CSBs) with varying soy and milk content are used in treatment of moderate acute malnutrition (MAM). We assessed the impact of these supplements on child development. Methods and findings We conducted a randomised 2 × 2 × 3 factorial trial to assess the effectiveness of 12 weeks’ supplementation with LNS or CSB, with either soy isolate or dehulled soy, and either 0%, 20%, or 50% of protein from milk, on child development among 6–23-month-old children with MAM. Recruitment took place at 5 health centres in Province du Passoré, Burkina Faso between September 2013 and August 2014. The study was fully blinded with respect to soy quality and milk content, while study participants were not blinded with respect to matrix. This analysis presents secondary trial outcomes: Gross motor, fine motor, and language development were assessed using the Malawi Development Assessment Tool (MDAT). Of 1,609 children enrolled, 54.7% were girls, and median age was 11.3 months (interquartile range [IQR] 8.2–16.0). Twelve weeks follow-up was completed by 1,548 (96.2%), and 24 weeks follow-up was completed by 1,503 (93.4%); follow-up was similar between randomised groups. During the study, 4 children died, and 102 children developed severe acute malnutrition (SAM). There was no difference in adverse events between randomised groups. At 12 weeks, the mean MDAT z-scores in the whole cohort had increased by 0.33 (95% CI: 0.28, 0.37), p < 0.001 for gross motor; 0.26 (0.20, 0.31), p < 0.001 for fine motor; and 0.14 (0.09, 0.20), p < 0.001 for language development. Children had larger improvement in language z-scores if receiving supplements with milk (20%: 0.09 [−0.01, 0.19], p = 0.08 and 50%: 0.11 [0.01, 0.21], p = 0.02), although the difference only reached statistical significance for 50% milk. Post hoc analyses suggested that this effect was specific to boys (interaction p = 0.02). The fine motor z-scores were also improved in children receiving milk, but only when 20% milk was added to CSB (0.18 [0.03, 0.33], p = 0.02). Soy isolate over dehulled soy increased language z-scores by 0.07 (−0.01, 0.15), p = 0.10, although not statistically significant. Post hoc analyses suggested that LNS benefited gross motor development among boys more than did CSB (interaction p = 0.04). Differences between supplement groups did not persist at 24 weeks, but MDAT z-scores continued to increase post-supplementation. The lack of an unsupplemented control group limits us from determining the overall effects of nutritional supplementation for children with MAM. Conclusions In this study, we found that child development improved during and after supplementation for treatment of MAM. Milk protein was beneficial for language and fine motor development, while suggested benefits related to soy quality and supplement matrix merit further investigation. Supplement-specific effects were not found post-intervention, but z-scores continued to improve, suggesting a sustained overall effect of supplementation. Trial registration ISRCTN42569496, In this analysis of secondary trial outcomes, Mette F. Olsen and colleagues show the effects of different supplements on child language and motor skill development., Author summary Why was this study done? Moderate acute malnutrition (MAM) affects more than 33 million children globally with long-term consequences for their development. There has been a call for research on the effects of MAM treatment on functional outcomes, but previous trials have not assessed effects of the treatments on child development. What did the researchers do and find? We conducted a randomised trial of 1,609 children with MAM in Burkina Faso to investigate the effectiveness of supplemental foods, including a comparison of matrix (lipid-based nutrient supplements [LNS] or corn–soy blend [CSB]), soy quality (soy isolate or dehulled soy), and content of milk protein (0%, 20%, or 50% of protein). We assessed child development as gross motor, fine motor, language, and cognitive skills using the Malawi Development Assessment Tool (MDAT). We found that child development improved across intervention groups during the supplementation and continued to improve after the supplementation had ended. Supplements containing milk protein were beneficial for fine motor and language development. Our findings also indicated a benefit of soy isolate over dehulled soy and a benefit of LNS over CSB among boys. What do these findings mean? Previously reported findings from this trial showed that children mainly put on fat-free mass during supplementation. With the data presented here, we show that motor, language, and cognitive development of children also improve during supplementation and that this improvement is sustained post-supplementation. Our results support the use of milk protein in food products, while suggested benefits of soy isolate and LNS merit further investigation. These findings contribute to the needed evidence of supplementation effects on functional outcomes, including child development, and allow better understanding of children’s ability to thrive following MAM treatment.

Objective Glutathione S-transferases have been associated with experimental resistance to some drugs. The present study investigated the factors associated with blood pressure control in patients with essential hypertension, especially the role of GSTT1 and GSTM1 genes polymorphisms. This cross-sectional study in Burkina Faso consisted of 200 patients with essential hypertension and under treatment. Results In the present study, 57.5% (115/200) of patients had their hypertension under control. No statistically significant difference was found between controlled and uncontrolled groups for anthropometric and biochemical parameters as well as for GSTT1 or GSTM1 gene polymorphisms (all p > 0.05). Current alcohol consumption (OR = 3.04; CI 1.88–6.13; p p p p

Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6–23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI.Trial registration: ISRCTN42569496.

Resume But de l’etude Decrire les caracteristiques cliniques, electrocardiographiques et echocardio-graphiques du cœur d’athlete. Patients et methodes Il s’est agi d’une etude transversale realisee d’aout 2015 a fevrier 2016 dans la ville de Bobo-Dioulasso au Burkina Faso. Des sportifs de haut niveau d’entrainement (au moins 8 heures d’entrainement hebdomadaire, depuis plus de six mois quel que soit le type de sport) ont beneficie : d’un examen clinique, d’une electrocardiographie et d’une echographie cardiaque de repos pour rechercher des modifications cardiaques electriques, morphologiques et fonctionnelles. Resultats Les 192 sportifs ayant un cœur d’athlete inclus avaient un âge median de 24 ans (IIQ : 21–27). La mediane de l’anciennete de la pratique du sport de haut niveau etait de 6 ans (IIQ : 4–8) et celle des seances d’entrainement hebdomadaire de 10 heures (IIQ : 10–10). La consommation de tabac, alcool, the/cafe, medicaments et/ou boissons energisantes etaient rapportee respectivement chez 4,2 %, 7,3 %, 99 %, 53,4 %. Un antecedent de malaises d’effort etait rapporte par 4,7 des athletes. Les modifications electriques etaient presentes chez 92,1 %. La bradycardie sinusale etait l’anomalie la plus frequente (75,0 % des cas). La prevalence de la dilatation de l’oreillette gauche et celle du ventricule gauche etaient respectivement de 72,4 et 22,4 %. Celle de l’hypertrophie du ventricule gauche etait de 9,0 %. Conclusion Chez l’athlete de haut niveau d’entrainement les prevalences des modifications electriques, morphologiques et fonctionnelles etaient elevees. Celles-ci necessitent d’etre connus par les praticiens afin de les differencier de la pathologie cardiaque.

Multiple pregnancies are increasing with the progress in Assisted Reproductive Technology. The authors report a case of quintuplet pregnancy after Clomiphene Citrate stimulation. This is a 28-year-old woman, G2, P1 with a 4-year-old child alive, who consulted for maternity desire. She was treated with Clomiphene Citrate at 100 mg daily for five days. The presence of a quintuplet pregnancy at 8 weeks + 5 days was found by ultrasound on 29/12/2018. During the follow up of the pregnancy, she presented pre-eclampsia from 24th week (TA 140/100 mmHg, significant proteinuria, edema of lower limbs). Methyl Dopa treatment was instituted. Tocolytic treatment with Salbumol was prescribed facing uterine contractions at 30 weeks. The patient had premature rupture of membranes at 34 weeks + 4 days, followed by uterine contractions. She had a cesarean section at the same day with the birth of five newborns alive. This is the first reported case in Burkina Faso.

Objective: To study the sexual experience of women after gynecological hysterectomy in the obstetrics and gynecology department of Yalgado Ouedraogo University Teaching Hospital in Burkina Faso. Patient and Method: We conducted a cross-sectional study from October 1, 2016 to March 30, 2017. It included any patient who had a gynecological indication for a hysterectomy in the Department of Obstetrics and Gynecology of Yalgado Ouedraogo University Teaching Hospital (CHU-YO) during the study period. A total of 85 patients were included. We collected information from the consultation records, clinical records, and operating room registries and by surveying the patients themselves. Result: The frequency of hysterectomy in the gynecological period was 3.9%. The mean age of the patients was 51.71 (extremes: 35 and 66 years) and the mean parity was 4.8. Married women were the majority. Fibromyoma and genital prolapse accounted for 56.47% and 23.53% respectively of operative indications. Regarding postintervention sexuality, 29.41% of women declared no longer having sexual desire. Also, they complained of vaginal dryness (31.8%), decreased frequency of orgasm (42.3%), dyspareunia (37.65). Sexual dysfunction was present in 82.35% of women. There was a statistically significant difference between global sexual functioning and geographic origin, educational attainment, socio-economic level, surgical approach, preintervention sexual counseling, women’s psychological profile and their emotional relationship with their spouses. Conclusion: The psychosexual soundness of hysterectomy is important. A diagnosis of sexual disorders prior to the intervention and psychological follow-up throughout the therapeutic process of the pathology indicative of a hysterectomy is necessary for successful postoperative sexuality.

The dermoid ovarian is an organic mild tumor. It can be revealed by an adnexal torsion which constitutes a gynecological emergency that can bring into play in a short term after the functional prognosis. We are reporting an observed case in an 11-year-old teenager who is in times peri-pubertal. The patient was presenting a painful abdomino-pelvic syndrome and a pelvic mass at the physical examination. The ultrasound was showing a right cyst mass with a right moderated hydronephrosis. A right adnexectomy was realized. The histological test after excision of the adnexal was showing a mature cystic teratoma of the right ovary with a congestive and edematous tubal fragment.

Objective: To study the knowledge, attitudes and practices regarding contraception among young people in the Burkinabe’s family well-being association for youth listening center in Bobo-Dioulasso city. Methods: This was a survey of 635 clients in the youth listening’s center of Bobo-Dioulasso city, Burkina Faso. These clients were gradually included by random choice from January 15 to April 15, 2018. The data were collected by self-administered written questionnaire under the supervision of an investigator and after a free and informed verbal agreement of the participant. The analysis was done using the software Epi info version 7.1.1.0. Results: The average age of the respondents was 20.62 years. Female respondents were more numerous, 508 (80%). Contraceptive methods were known by 98.12% of respondents and 61.42% said they were always using them. Two-thirds of clients (67%) cited at least two benefits of contraceptive methods which were correct. Condoms were the best-known method (92.60%) and also the most used (92.56%). But emergency contraception was known by 30.71% of participants. Young people who were already sexually active accounted for 73.54% of the sample with a mean age at their first sexual intercourse of 18.42 years. Conclusion: The majority of respondents knew contraceptive methods. However, risky sexual behaviors and misconceptions about contraception remain. The setting up of family planning services within schools and the teaching of a reproductive health module in all secondary schools will contribute to improve their sexual and reproductive health.

We describe the characteristics of patients infected with HIV-1 as second-line antiretroviral therapy, with persisting low-level viremia. This was a descriptive retrospective study, conducted from January 1, 2010 to December 31, 2016, from the Cohort of the Infectious Diseases Department of Bobo-Dioulasso University Hospital. Patients infected with HIV-1, a second line of stable ARV treatment, with ≥95% compliance for at least 12 months, asymptomatic with CVp between 50 and 1000 copies/ml in two consecutive samplings at least 3 months apart. Out of 244 patients in second-line therapy, 79 met our inclusion criteria. The mean age of the patients was 42±10.2 years. Women (35.8 years) were younger than men (43.8 years) (p=0.001). Most were married (48.1%), 23.5% of whom were polygamous. The majority of patients (38/79) in the study had a CD4 count of

Introduction: Vascular complications of infective endocarditis are frequent and severe. The aim of this study was to clarify the epidemiological, clinical and prognostic characteristics of these vascular damages and determine their associated factors.

Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy. This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow. Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36–4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01–3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE. AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.

Introduction: This study aimed at describing the socio-economic, diagnostic, and progressive features of patients evacuated thanks to philanthropic sponsors. Patients and methods: all evacuated patients, contacted through the phone and interviewed, were included in the study. A questionnaire helped in collecting data which were analyzed through the software Epi-Info (version 7). Outcomes: A total of 63 patients out of 134 were included in the study among which there are 22 adults and 41 children. The sex-ratio was 1.30. Patients living in Ouagadougou accounted for 79% of cases. The children’s average age at evacuation was 3.58 ± 3.86 years against 27.52 ± 12.54 years for adults. Ventricular septal defects among children (58.53%) and mitral valve diseases among adults (72.72%) were the main diagnoses at the time of evacuation. The average fall was 47 months for children, and 54 months for adults in the post-operative period. 68% of adults had an income below 50,000 FCFA per month. The evacuation average cost was estimated at 21,083,000 FCFA per patient, corresponding to 2,825,122,000 FCA over 10 years. Each adult patient spent an average of 15,000 FCFA per month for the follow up, against 8725 FCFA for children. 16% of patients were lost of sight in the post-operative. Conclusion: Philanthropic sponsors significantly contribute to the management of cardiac patients, and their efforts should be supported by a better monitoring. Setting-up cardiac surgery and interventional cardiology in Burkina Faso are required to address these health shortcomings.

Background Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplements (LNSs) or corn-soy blends (CSBs) but little is known about the impact of these supplements on hemoglobin, iron status, and inflammation. Objective The objective of this study was to investigate the impact of supplementary foods for treatment of MAM on hemoglobin, iron status, inflammation, and malaria. Design A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6-23 mo with MAM received 500 kcal/d as LNS or CSB, containing either dehulled soy (DS) or soy isolate (SI) and different quantities of dry skimmed milk (0%, 20% or 50% of total protein) for 12 wk. The trial was double-blind with regard to quality of soy and quantity of milk, but not matrix (CSB compared to LNS). Hemoglobin, serum ferritin (SF), serum soluble transferrin receptor (sTfR), serum C-reactive protein (CRP), serum α1-acid glycoprotein (AGP), and malaria antigens were measured at inclusion and after supplementation. Results Between September 2013 and August 2014, 1609 children were enrolled. Among these, 61 (3.8%) were lost to follow-up. During the 12-wk supplementation period, prevalence of anemia, low SF adjusted for inflammation (SFAI), elevated sTfR, and iron-deficiency anemia decreased by 16.9, 8.7, 12.6 and 10.5 percentage points. Children who received LNS compared to CSB had higher hemoglobin (2 g/L; 95% CI: 1, 4 g/L), SFAI (4.2 µg/L; 95% CI: 2.9, 5.5 µg/L), and CRP (0.8 mg/L; 95% CI: 0.4, 1.2 mg/L) and lower sTfR (-0.9 mg/L, 95% CI: -1.3, -0.6 mg/L) after the intervention. Replacing DS with SI or increasing milk content did not affect hemoglobin, SFAI, sTfR, or CRP. Conclusion Supplementation with LNS compared to CSB led to better hemoglobin and iron status, but overall prevalence of anemia remained high. The higher concentrations of acute-phase proteins in children who received LNSs requires further investigation. This trial was registered at www.controlled-trials.com as ISRCTN42569496.

Several studies have shown the importance of therapeutic education in the management of diabetes. Its implementation requires a prior assessment of the level of patients’ knowledge. The objective of this study was to assess the level of diabetics’ knowledge about their disease. Methods: This was a cross-sectional study conducted between 2013 and 2015; consenting diabetics, followed for at least one year in medicine department of Souro Sanou Hospital, have been surveyed. The data were collected using a 51-item questionnaire, adapted from “Audit of Diabetes Knowledge” and administered by an interviewer. The level of knowledge was satisfactory/good if at least 80% of the set items or a topic were known. Results: A total of 268 diabetics were surveyed. Their mean age was 54.3 ± 1.4 years and the sex ratio 0.8. The majority (80.9%) lived in urban areas and half (50.4%) were uneducated. Type 2 diabetics accounted for 93.3% of the population; the average seniority was 6.0 ± 0.7 years. The level of knowledge was generally insufficient, with an average total score of 25.4 ± 1.0/51. The topics which were not well mastered related to diet (0.8%), glycated haemoglobin (4.5%), and signs of hypoglycemia (7.8%). The main relatively well-known topics related to the effect of physical exercise on glycemia = 37.7%, the effect of food on glycemia = 36.9% and glycemia target = 32.8%. Conclusion: This study revealed a lack of knowledge from diabetic patients who are followed in the medicine department of the Teaching Hospital Souro SANON (CHUSS). The implementation of a therapeutic education program for diabetics is necessary and urgent.

Resume Objectifs La stimulation cardiaque au Burkina Faso devient une realite. Le but de notre etude etait d’evaluer cette activite sur cinq ans et apprecier l’impact de la collaboration avec des hopitaux de la region d’Auvergne dans son developpement. Materiel et methodes Etude prospective dans laquelle les patients appareilles et suivis depuis juin 2011 ont ete inclus consecutivement. Les donnees collectees portaient sur les indications, le delai de prise en charge, le type de stimulation, les complications, le cout du traitement, l’education et la qualite de vie du patient opere. Resultats Soixante-neuf patients ont ete appareilles de juin 2011 a juin 2016 dont 45,5 % de femmes. L’âge moyen etait de 69 ans avec des extremes de 35 et de 89 ans. La quasi-totalite des patients (94 %) etait symptomatique (54 % de syncopes et 30 % de vertiges et lipothymies). L’indication principale de la stimulation cardiaque definitive etait le bloc auriculo-ventriculaire complet d’origine degenerative (83 %). Le delai moyen entre l’indication et l’appareillage etait de 8,2 jours et seulement 4 % des patients ont beneficie d’une stimulation temporaire. L’absence de prise en charge financiere constituait le principal motif du retard a la prise en charge. Durant la periode de l’etude, les deux structures de sante ont beneficie d’un appui en materiel de stimulation, d’un plateau technique, et de formations et stages pratiques reguliers. Cette collaboration a permis de pallier l’insuffisance en ressources materielles, humaines et financieres. Nous avons enregistre comme complications, un cas d’exteriorisation de boitier, deux cas d’hematome d’evolution benigne et deux cas de deplacement de sonde. La qualite de vie des patients s’est nettement amelioree, tous les patients operes n’etaient plus symptomatiques. Conclusion L’organisation de la stimulation cardiaque au Burkina Faso est une realite. Des efforts doivent toujours etre faits pour perenniser l’activite et renforcer la collaboration avec des hopitaux du Nord.

L’hypertension arterielle pulmonaire (HTAP) precapillaire peut etre decouverte fortuitement mais elle est souvent revelee par une dyspnee ou une insuffisance cardiaque droite. Nous rapportons un cas d’HTAP precapillaire revelee par des accidents vasculaires cerebraux ischemiques paradoxaux recidivants chez un patient de 43 ans. Le bilan a mis en evidence un foramen ovale permeable et un anevrisme du septum interauriculaire. Sous traitement conservateur, l’evolution a ete fatale en trois ans.

Childhood malnutrition is highly prevalent and associated with high mortality risk. In observational and interventional studies among malnourished children, body composition is increasingly recognised as a key outcome. The deuterium dilution technique has generated high-quality data on body composition in studies of infants and young children in several settings, but its feasibility and accuracy in children suffering from moderate acute malnutrition requires further study. Prior to a large nutritional intervention trial among children with moderate acute malnutrition, we conducted pilot work to develop and adapt the deuterium dilution technique. We refined procedures for administration of isotope doses and collection of saliva. Furthermore, we established that equilibration time in local context is 3 h. These findings and the resulting standard operating procedures are important to improve data quality when using the deuterium dilution technique in malnutrition studies in field conditions, and may encourage a wider use of isotope techniques.

La varicelle est une virose dont l'épidémiologie est mal connue au Burkina Faso. Cette étude s'est donnée pour objectif de décrire le profil hospitalier de la pathologie dans le service des maladies infectieuses du Centre Hospitalier Universitaire Yalgado Ouedraogo (CHU-YO). Il s'est agi d'une série de 19 patients hospitalisés entre le 1er janvier 2005 et le 31 décembre 2014. Ont été inclus, tous les patients avec un dossier complet et exploitable, dont le diagnostic positif de varicelle a été fait. La proportion périodique de varicelle était de 6,2% et a représenté 14,6% des éruptions fébriles. Elle était plus fréquente en 2011, de janvier à mars. L'âge médian était de 19 ans, et la moitié des patients avaient entre 6 et 30 ans. Les comorbidités étaient dominées par l'infection à VIH et l'herpès. Sur le plan clinique, la fièvre et le prurit étaient les symptômes communs et la vésicule la principale éruption. A l'admission, les principales complications étaient pulmonaires, hématologiques et cutanées. La durée médiane d'hospitalisation était de 5 jours, avec des extrêmes de 0 et 13 jours. Les principaux traitements étaient antiviral dans 9 cas, antipyrétique dans 19 cas, local dans 17 cas et antihistaminique dans 11 cas. Sur 19 cas de varicelle, 14 ont guéri et deux sont décédés, dont un adulte sur 10 et 1 enfant sur 9. Si la varicelle est une affection habituellement bénigne, elle peut être fatale chez l'adulte et l'enfant en cas de complications graves.

International audience; BACKGROUND:It has been reported that people living with HIV in West Africa exhibited the highest risks for chronic kidney disease (CKD) in the world. Here, we aimed at determining the CKD frequency and changes in kidney function during antiretroviral treatment (ART) in a large cohort of HIV-patients followed in Burkina Faso.METHODS:We included ART-naive adults who initiated ART at the Day Care Unit of the Souro Sanou University Hospital between 01/01/2007 and 12/31/2016. We assessed the estimated glomerular filtration rate (eGFR) by serum creatinine using the Modification of Diet in Renal Disease (MDRD) equation. Following the K/DOQI recommendations, CKD was defined as eGFR

New lateral flow tests for the diagnosis of Neisseria meningitidis (Nm) (serogroups A, C, W, X, and Y), MeningoSpeed, and Streptococcus pneumoniae (Sp), PneumoSpeed, developed to support rapid outbreak detection in Africa, have shown good performance under laboratory conditions. We conducted an independent evaluation of both tests under field conditions in Burkina Faso and Niger, in 2018–2019. The tests were performed in the cerebrospinal fluid of suspected meningitis cases from health centers in alert districts and compared to reverse transcription polymerase chain reaction tests performed at national reference laboratories (NRLs). Health staff were interviewed about feasibility. A total of 327 cases were tested at the NRLs, with 26% confirmed Nm (NmC 63% and NmX 37%) and 8% Sp. Sensitivity and specificity were, respectively, 95% (95% CI: 89–99) and 90% (95% CI: 86–94) for Nm and 92% (95% CI: 75–99) and 99% (95% CI: 97–100) for Sp. Positive and negative predictive values were, respectively, 77% (95% CI: 68–85) and 98% (95% CI: 95–100) for Nm and 86% (95% CI: 67–96) and 99% (95% CI: 98–100) for Sp. Concordance showed 82% agreement for Nm and 97% for Sp. Interviewed staff evaluated the tests as easy to use and to interpret and were confident in their readings. Results suggest overall good performance of both tests and potential usefulness in meningitis outbreak detection.

Le diabète est un puissant facteur de risque cardio-vasculaire indépendant. Les auteurs se proposent de décrire les anomalies électrocardiographiques et échocardiographiques observées chez les diabétiques de type 2 suivis dans le département de médecine du CHUSS. Une étude transversale descriptive a été réalisée d’avril à septembre 2014 incluant tous les diabétiques de type 2 consentants. Tous ont bénéficié d’un recueil de données cliniques, d’une électrocardiographie et d’une échocardiographie doppler. Un total de 155 diabétiques a été enquêté. L’âge médian de la population était de 55 ans (IIQ: 47-64) à prédominance féminine (Sex ratio 0,5). Les anomalies électrocardiographiques étaient représentées par les troubles de la repolarisation (31%) et les troubles du rythme auriculaire (16,12%). Sur le plan échocardiographique, l’hypertrophie du ventricule gauche (VG) était rapportée dans 20,64%. L’oreillette gauche était dilatée dans 14,19%, une dilatation VG dans 1,3% des cas. Une altération de la fraction d’éjection VG était notée dans 3,87% des cas. Les entités nosologiques étaient représentées par la cardiomyopathie hypertensive dans 27 cas (54%), la cardiopathie ischémique dans 19 cas (38%), la cardiomyopathie dilatée dans 2 cas (4%) et la cardiomyopathie diabétique dans 2 cas (4%). L’insuffisance cardiaque était notée dans 22 cas (44%) indépendamment de l’atteinte cardiaque présentée. Les anomalies électrocardiographiques et échocardiographiques sont fréquentes dans la population de diabétique de type 2 au CHUSS de Bobo-Dioulasso. Une meilleure collaboration entre cardiologues et diabétologues et la mise en place d’un plateau technique adéquat de dépistage serait un préalable pour une meilleure stratification du risque cardiaque dans cette population.

Objective: To investigate the intra-hospital delay in the treatment of gynecological and obstetric emergencies in the obstetrics and gynecology department at the UTH-YO. Patients and methods: It has been a prospective and descriptive study over a period of four months from 1 May to 31 August 2015 in the obstetrics and gynecology department at the UTH-YO. All patients and their escorts were included in our study, admitted to gynecological or obstetric emergencies who have accepted to participate in the survey. Data were entered and analyzed using a PC equipped with the SPSS 16.0 software English version. Results: During the study period, we recorded 2627 admissions. Delays in the management involved 216 patients or a frequency of 8.2%. The average age of patients was 26.6 ± 6.2 years, ranging from 16 and 46 years. Patients had no income in 165 cases (that is to say 76.4%). The referred patients accounted for 165 admissions (85.7%). The intake patterns were dominated by obstetric acute fetal distress in 44 cases (20.4%), pre-failure syndrome in 27 cases (that is to say 12.8%) and in gynecology by the ectopic pregnancy in 171 cases (79.3%). The average waiting period between the arrival of a patient and the beginning of first aid was 2 hours and 23 minutes with extremes of 16 min and 546 min. The main reason for the delay was the unavailability of the operating room in 61.1% of cases. The opinion of escorts was dominated by improving communication with the creation of a post of information in 47% of cases. Maternal prognosis was marked by a maternal death in 0.1% of cases and maternal morbidity in 13.4% of cases. The fetal prognosis was dominated by death at birth in 13.8% of newborns. Conclusion: Despite the subsidy of the government in obstetric and neonatal emergencies, there remain intra-hospital delays in the management of emergencies. The opening of discussions between the various stakeholders responsible for the implementation of this grant is urgent to contribute more effectively to the fight against maternal mortality.

Objective: To analyze the caesarean section prognosis aspects according to Misgav-Ladach versus classical technique in the regional hospital of Banfora. Materials and Methods: This is about a randomized clinical test of 2 groups carried in the regional hospital in Banfora on a two-month period from 1st October to 30 November 2015. In the first group, 66 patients had benefited from a caesarean section by the Misgav-Ladach technique. In the control group, 44 patients had benefited from a caesarean in the conventional technique. Were included in our sample all patients having benefited from a cesarean in the study site during the study period and who had consented to participate in the study. All patients were followed until the postpartum healing of the surgical wound. All prognostic elements have been compared. The results were analyzed with Epi Info 3.5.1 software and the significance level was set at 5%. Results: The indications for cesarean section were dominated by maternal causes in 70 cases (63.6%). The average duration of the surgical procedure was 27.98 mm for Misgav-Ladach technique versus 28.27 mm for the conventional technique (p = 0.49). The evaluation of blood loss by the change in hemoglobin pre- and post-operative did not find statistically significant differences between the two techniques (p = 0.6). The evaluation of the number of intraoperative suture used, was in favor of the technique of Misgav-Ladach (p = 0.007). The evolutionary trend in the intensity of postoperative pain was in favor of the technique of Misgav-Ladach. The average time of wound healing was 16.33 days for group 1 versus 21, 27 days for group 2 (p = 0.0001). Postoperative morbidity was greater with the conventional technique in comparison to Misgav-Ladach’s (p = 0.046). There was no statistically significant differences in length of hospital stay (p = 0.056). Conclusion: The Misgav-Ladach cesarean section reduces operative risk. The adoption and diffusion of this technique to the national level and its effective integration into training curriculas should contribute to reducing maternal morbidity and mortality of abdominal delivery.

Objective: To report our experience of the esophageal plasty for caustic stenosis of the esophagus. Methods: Retrospective study of caustic stenosis of the esophagus in patients aged over 15 years, operated in Ouagadougou from 2008 to 2016. Nine patients were operated. Patients ranged in age from 25 to 53 years. Caustic ingestion was voluntary in 6 cases. Psychiatric disorders were confirmed in one case. The type of surgery and the postoperative evolution were analyzed. Results: In 6 patients the plasty was preceded by a gastrostomy or a feeding jejunostomy. The transplant, always placed in retro sternal position, was colic in 8 cases and gastric in one case. The evolution was marked by the occurrence of a cervical fistula in 5 cases, postoperative peritonitis in 2 cases, parietal suppuration in 2 cases and pneumothorax in 3 cases. One case of death was noted. After a follow-up of 6 months to 9 years, we noted a case of dysphagia. Conclusion: Esophageal plasty is a saving gesture that restores normal nutrition to the patient. It deserves to be promoted.

Introduction: Vasopressive amines are frequently used in cardioology. The aim of our work was to evaluate the practical modalities of use of amines in the cardiology department of University Hospital Yalgado Ouedraogo. Patients and Methods: We conducted a prospective observational study for 6 months, from 01 June to 31 November 2013, including all patients treated with vasopressive amines. We were interested in the different clinical pictures, the indications, the choice of amines, and the practical application of the treatment. Results: Fifty patients were included in the study; the mean age was 58 ± 17.6. The sex ratio was 0.85. Hypertensive heart disease was the underlying cardiac disease in 34% of cases. A known chronic heart failure was observed in 62% of cases. Clinical admission tables were dominated by overall heart failure (74%). Vascular collapse (38%) and shock (36%) were the main indications of treatment. Severe alterations in left ventricular systolic function were found in 74% of cases. Dobutamine was the amine of choice (90%). The average time to start treatment was 96.32 minutes (range 15 - 660 minutes). The time to relay between syringes was more than ten minutes in 72% of the cases, and the nurses’ unavailability was the main cause. Monitoring was manual in almost all cases. The average duration of treatment was 6.64 days. Treatment-related incidents were observed in 26% of cases. The intra-hospital mortality of patients with amines was 48%. Conclusion: The indications of vasopressive amines in the cardiology department are close to the international recommendations. But this treatment suffers in its practical application. The duration of treatment remains excessive but is explained by the lack of therapeutic alternative.

Background: Hypertension is a major public health concern in Burkina Faso. Its management relies on in-office medical setting blood pressure monitoring which is known to be an imperfect diagnosis tool. Objective: This study aims to assess the contribution of ambulatory blood pressure monitoring in the management of hypertension at Blaise Compaore University Hospital. Methods: A monocentric descriptive retrospective study was conducted in the cardiology outpatient unit of Blaise Compaore University Hospital. Patients aged at least 18 years who underwent ambulatory blood pressure monitoring between March 2013 and June 2015 were enrolled. Hypertension was defined as follows: average blood pressure over 24 hours > 130/80 mmHg, or diurnal blood pressure > 135/85 mmHg, or nocturnal blood pressure >120/70 mmHg. Data were analyzed using the SPSS 20.0 software. The threshold for significance was set at 5% for a validity interval at 95%. Chi square test was used for the statistical analysis. Results: A total of 122 patients were enrolled. The main reasons for ambulatory monitoring were the evaluation of hypertensive therapy (51.6%) and the diagnosis confirmation (39.3%). The results of the ambulatory monitoring found 61.4% of the patients with hypertension and 37.7% with normal blood pressure. A treatment adjustment was made for 36.1% of the patients; an initiation of antihypertensive therapy was undertaken for 24.6%, an abstention from drug therapy was recommended for 23.8%, and the pursuit of previous treatment for 13.1% of the patients. Conclusion: Ambulatory blood pressure monitoring should be used more often in order to optimize the management of hypertension in our current practice.

Resume La super hypertension arterielle est definie comme une pression arterielle systolique ≥ 250 mmHg et/ou une pression arterielle diastolique ≥ 150 mmHg en presence ou non de complications. L’objectif de notre etude etait de decrire les aspects epidemiologiques et evolutifs de la super hypertension arterielle dans le service de cardiologie du CHU Yalgado Ouedraogo. Il s’agissait d’une cohorte observationnelle sur une periode de 2 mois (juillet 2011 a aout 2013). Nous avons recrute 34 patients soit une prevalence de 12,9 % des patients hypertendus. La duree moyenne de suivi des patients etait de 7,1 mois. L’âge moyen etait de 47 ans avec un sex-ratio de 1,3. L’hypertension arterielle etait connue chez 62 % (n = 21) des patients dont 24 % regulierement suivis, 57 % sous traitement et aucun n’avait un traitement regulier. La dyspnee etait le motif de consultation dans 38 % des cas. Nous avons note un fond œil stade III–IV dans 55,9 % des cas. Tous les patients avaient une hypertrophie ventriculaire gauche electrique et 90 % echographique. Une complication etait notee a l’admission dans 91 % des cas. L’evolution a ete marquee par une insuffisance renale chronique dans 14,7 % des cas, un taux brut de mortalite de 0,5 personnes-annee. La survie a un mois etait de 70 % pour l’ensemble des patients. L’âge moyen des patients decedes etait de 35 ans. La presence d’une insuffisance renale, la meconnaissance de l’hypertension arterielle et un âge

Resume Introduction Peu d’etudes en Afrique noire se sont interessees a l’HTA resistante. Les objectifs de ce travail etaient de determiner la frequence de l’HTA resistante dans une population d’hypertendus noirs africains et de decrire ses aspects clinique et therapeutique. Patients et methodes Du 1 er mai 2010 au 31 mai 2012, nous avons inclus de maniere consecutive les hypertendus suivis dans deux centres hospitaliers de la ville de Ouagadougou, sous traitement antihypertenseur a dose optimale et observants. Les patients dont la pression arterielle etait non controlee malgre une triple therapie antihypertensive a dose optimale comprenant un diuretique associee aux mesures hygienodietetiques ont beneficie d’une mesure ambulatoire de la tension arterielle. A l’issue de cet examen, les patients dont la tension arterielle etait ≥ 135/85 mmHg le jour et/ou ≥ 120/70 mmHg la nuit etaient consideres comme ayant une HTA resistante. Nous avons recherche les facteurs de risque cardiovasculaire de meme que les atteintes des organes cibles. Nous avons associe au traitement la spironolactone 50 mg en l’absence de contre-indication, et apprecie l’evolution des chiffres tensionnels sous ce traitement. La mesure de l’activite renine plasmatique n’a pas ete effectuee. L’analyse statistique a ete realisee a l’aide du programme SPSS version 17 pour Windows. Resultats Nous avons inclus 692 patients dont 14,6 % d’HTA resistante. L’âge moyen des patients etait de 54,8 ± 11,1 ans dans la population globale, 56,5 ± 11,8 ans dans le sous-groupe des hypertendus non resistants et 64,2 ± 5,4 ans dans le sous-groupe des hypertendus resistants. Les symptomes etaient representes par les cephalees (11,9 %), les vertiges (9,9 %) et les precordialgies (8,9 %). Les facteurs de risque cardiovasculaire modifiables outre l’hypertension arterielle etaient domines par les dyslipidemies, le diabete et l’obesite/surcharge ponderale. Ces facteurs de risque etaient significativement plus frequents dans le sous-groupe des hypertendus resistants. Le risque cardiovasculaire global etait eleve dans 24,9 % des cas dans la population globale, 22,5 % dans le sous-groupe des hypertendus non resistants et 38,6 % dans le sous-groupe des hypertendus resistants. Les atteintes des organes cibles etaient significativement plus frequentes dans le meme sous-groupe des hypertendus resistants. Apres adjonction de la spironolactone, 21,8 % des patients hypertendus resistants ont ete controles. Conclusion Cette etude montre que l’HTA resistante est frequente chez le sujet noir africain. Il s’agit majoritairement de sujets de la sixieme decade, aux revenus economiques limites et residant en milieu rural. En l’absence de contre-indication, la spironolactone permet de diminuer la morbidite de cette pathologie.

Metastatic tumor involvement of the heart is uncommon but may occur with all types of primary neoplasms. We report the case of a 51-year-old male who developed a massive mass involving the upper right pulmonary vein. The tumor was removed and the final pathology report disclosed metastatic hepatocellular carcinoma. Hepatocellular carcinoma affecting the pulmonary veins is a very rare condition.

ObjectiveTo assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d’Ivoire using validated process indicators.DesignHealth facility-based cross-sectional study with direct observation of healthcare workers’ practices while caring for mother–newborn pairs during intrapartum and immediate postpartum periods.SettingPrimary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d’Ivoire.ParticipantsHealthcare providers who care for mother–newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth.Main outcome measure(s)Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point.ResultsA total of 532 and 627 labouring women were included in Burkina Faso and Côte d’Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d’Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum.ConclusionsWomen delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.

Introduction : L'objectif principal etait d'etudier les facteurs associes a la survenue de l'insuffisance cardiaque aigue (ICA) chez les patients hospitalises pour un infarctus du myocarde (IDM) au Centre National Hospitalier Universitaire de Cotonou. Methodes : Au cours d'une etude retrospective descriptive menee de janvier 2011 a decembre 2013, ont ete etudies chez ces patients la frequence de l'ICA, les facteurs associes a sa survenue et la mortalite hospitaliere. Resultats : 70 patients ont ete inclus, d'âge moyen egal a 58,39 ans, dont 67,14% d'hommes. L'ICA a ete diagnostiquee dans 47,14% des cas. Les facteurs identifies associes a sa survenue etaient l'âge avance, l'atteinte electrocardiographique etendue et les comorbidites telles que les infections, l'anemie et l'insuffisance renale. 7,46% des patients etaient decedes durant l'hospitalisation soit 12,5% en cas d'ICA et 2,86% en l'absence d'ICA. Des resultats similaires ont ete rapportes par de nombreuses publications anterieures. Conclusion : L'ICA est un facteur de mauvais pronostic dans l'IDM. Une revascularisation myocardique rapide et le traitement adequat des comorbidites et des complications rythmiques permettront d'ameliorer le pronostic des patients.