Influence of the Granular Class of Crushed Granites on the Litho-Stabilization of Samo Laterites (South-East of Côte d’Ivoire)

Most of the laterites found in Ivory Coast do not meet the technical conditions to be used in their natural state for the design of road foundations. Also, to meet the growing needs for road materials, various amendments are made to them, including litho-stabilization. Thus, this study proposes to understand the influence of the granular class of natural aggregates on the performance of laterites. To achieve this objective, different proportions of crushed granites of class 0/5, 0/15 and 5/15 have been incorporated into the soils of southern Côte d’Ivoire, especially in Samo. This modified soil has been subjected to mechanical tests such as the modified Proctor and CBR test. The results obtained show that the dry densities of the incorporated laterites containing crushed granites increase with the content of natural aggregates and decrease with the increase in the water content. Likewise, the CBR bearing indices at 95% of the Modified Optimum Proctor of the different compositions (laterites + crushed granites) increase with the proportion of aggregates. The addition of coarse aggregates to the laterites therefore promotes the establishment of a framework which improves its bearing capacity. From 20% to 30% crushed granites respectively of class 0/15;0/5 and 5/15, the values of the CBR obtained are greater than those of 30% therefore these modified soils can be used as a foundation layer for traffic of T1, T2 and T3 type. Likewise, the laterites’ mixtures with at least 40% crushed granites of class 0/15 and 0/5 can also be used for the foundation and base layers.

Unusual Scalp Process Revealing a Thyroid Cancer: “Illustrative Case”

Background: Thyroid cancers commonly display slow evolution with local and or regional extension. The classic presentation is a painless nodule of the thyroid region in a euthyroid patient. Sometimes, the nodule is discovered only on ultrasonography. Cervical lymph node is often seen in papillary thyroid cancer due to their propensity to invade lymph node. This means that follicular thyroid cancers are more insidious. Observation: We report a painless slow-growing lesion of the scalp revealing a skull metastasis of thyroid cancer. Despite catastrophic intraoperative bleeding, a total removal was achieved. Lessons: Thus, in addition to local and regional control in the management of thyroid cancers, distant metastasis should be surgically removed to provide the best chance to prolong the patient’s survival. Moreover, neurosurgeon must be prepared to deal with massive bleeding in skull metastasis of thyroid cancer.

A Case of Cerebral Aspergillosis in a Patient with Chronic Lymphoid Leukemia

Cerebral aspergillosis commonly affects immunocompromised hosts, primarily patients on immunosuppressive therapy and those with acquired or immunodeficient states such as AIDS. We report a case of cerebral aspergillosis in a 39-year-old woman with a history of treated chronic lymphocytic leukemia (CLL). Multiple fragments of fixed tissues with formalin were freshly sent to the laboratory. An extemporaneous examination was performed by spreading. The rest of the sample was embedded in paraffin and studied according to the standard histological method with special stains and an immunohistochemical study. A microscopic observation showed abundant clusters of tangled mycelial filaments, Grocott+. At the edge, a nervous tissue was observed remodeled by an abundant inflammatory infiltrate consisting essentially of small lymphocytes and plasma cells. Additional immunohistochemistry was performed using anti-CD20, anti-CD3, anti-CD5, anti-CD23, anti-Bcl2, anti-Ki67, anti-IgD and anti-Kappa and Lamda antibodies. All taken together there were no further founding in support of a secondary localization of CLL. Cerebral aspergillosis is quite rare and often occurs in a context of immunosuppression. This case indicates the importance of a close collaboration between clinicians and pathologists for optimal patient care.

Pneumatosis Cystoides Intestinalis Revealed by an Occlusive Syndrome: A Case Report

Introduction: Pneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas cysts in the intestinal wall. It can affect different segments of the digestive tract. Male patients over 50 years old seem to be more affected. Classically, one opposes the primary or idiopathic forms and the secondary forms. Case Report: We report the case of a 62-year-old female patient with a history of treated peptic ulcers, who presented with episodes of intermittent atypical abdominal pain that worsened abruptly. The physical examination revealed a surgical abdomen with tenderness to palpation. The patient underwent a jejunal resection. The pathological examination showed macroscopically an intestinal fragment with confluent subserosal and intestinal intraparietal bullae. On opening, the portion containing the bullae was thickened, infarcted, congestive, hemorrhagic, and brittle with narrowing of the intestinal lumen. The bullae are tense and leave serosities. On histological examination, the intestinal wall was very congestive with hemorrhagic patches of suffusion. There were optically empty cystic formations that do not communicate with the digestive lumen. The adjacent mucosa is the site of a moderate subacute inflammatory reaction. Conclusion: Pneumatosis cystoides intestinalis is a rare and usually benign pathology. The symptoms, when they exist, are not specific. Its physiopathology is still very much debated. The prognosis is generally good. The knowledge of this pathology is necessary to avoid invasive explorations and heavy treatment without interest for the patient.

Lumbar Paraspinal Hemangiopericytoma, An Unusual Location: Surgery with Preoperative Embolization

Background: Lumbar paraspinal hemangiopericytoma is rare. The hemorrhagic nature of the tumor causes problems of hemostasis and makes the resection delicate. We report a rare case of lumbar paraspinal hemangiopericytoma managed with preoperative embolization. Clinical Case: It is about a woman of 31 years, admitted for a large left lumbar paraspinal mass that evolved for 6 years. The clinical exam showed an asymmetry of the left paraspinal muscle. The mass painless was extended from the lumbar region. The neurological exam was normal. MRI showed the left large paraspinal mass tissue. It was extended from lumbar vertebrae, L1 to L4, and measured 100 × 50 × 50 mm. It was an iso-intense signal on T1-weighted with strong enhancement after gadolinium. It was hypervascular and supplied by left intercostal T12, L1, and L2 pedicles. The complete exclusion of the hyper-vascular left paraspinal tumor was obtained after selective embolization of the artery left L1 of the pedicle of the intercostal left L1 and trunks intercostal T12 and L2 left. The total resection of a mass encapsulated was performed. The operative outcome was good. The histology concluded to a hemangiopericytoma. No chemotherapy or radiotherapy was prescribed. After 5 years, the patient was asymptomatic. MRI control confirmed tumor resection with a residue at the level of the left intervertebral foramen L1 - L2. Conclusion: Lumbar paraspinal hemangiopericytoma is an extremely rare tumor. Selective preoperative embolization is recommended before the resection of large tumors to reduce vascular supply. A follow-up extended for these patients is necessary, given the frequency of recurrences.

Distribution of High-Risk Human Papillomavirus Genotypes in Precancerous Cervical Lesions in Ouagadougou, Burkina Faso

Aims: We aimed at identifying the high-risk HPV genotypes associated with high-grade dysplastic cervical lesions in Burkina Faso. The available vaccines to Burkina Faso only protect against two high risk HPV genotypes: HPV 16 and 18. Are the genotypes identified in the high-grade precan-cerous lesions in this survey covered by the available vaccines? Methods: The detection and genotyping of high-risk HPV have been conducted based on 118 formalin-fixed and paraffin-embedded archived tissues using the “HPV Genotypes 14 Real-TM Quant” (Sacace biotechnologies®, Italy) kit allowing for the detection of fourteen high-risk HPV genotypes: HPV 16, 31, 18, 39, 45, 59, 33, 35, 56, 68, 51, 52, 58 and 66. Results: The prevalence of high-risk HPV infections was 48.8% based on the appropriate PCR results (21/43). The most common HPV genotypes were HPV 39 (21.7%), HPV 35 (13.0%) and HPV 45 (13.0%). Two cases of multiple infections between HPV 39 - 45 and HPV 39 - 59 have been observed. HPV 16 was not detected in this study. Conclusions: We noted a high prevalence rate for HPV 39, HPV 35 and HPV 45, which are not covered by the commercial vaccines. We also found that the prevalence of HPV 18 was very low in this study and HPV 16 was not detected.

Anatomo-Clinical Case: Coexistence of Tuberculosis with Axillary Lymph Node Metastasis in Breast Carcinoma

Introduction: The coexistence of tuberculosis with axillary lymph node metastasis in breast carcinoma is uncommon. Observation: We report a case of a patient aged 59 years presenting a painless nodule in the right breast for one year. The scan and mammography revealed a long-axis node of 3 × 2 × 1 cm in the upper outer quadrant of the right breast ranked stage IV by the American College of Radiology (ACR), associated with a set of axillary lymph nodes and the largest one measuring 15 × 15 × 20 millimeters (mm). The breast biopsy helped diagnose a Scarff Bloom Richardson (SBR) grade II non-specific invasive carcinoma, modified by Ellis and Elston. A right mastectomy associated with a lymph node dissection was performed. We noticed a not well defined and whitish 5 mm tumor mass associated with 16 lymph nodes removed. The histological examination confirmed the diagnosis of SBR grade II non-specific invasive carcinoma with invasion of 7 lymph nodes (N+ = 7/16). In 3 metastatic lymph nodes, there were epithelioid and gigantocellular granulomas with full central necrosis. The Ziehl Neelsen staining had highlighted acid-fast bacilli. The tumor was oestrogen and progesteron receptor, without an overexpression of the oncoprotein human epidermal growth factor receptor 2 (HER2), which corresponds to a 0 score and the Ki 67 proliferation index assessed at 10%. The patient was given an anti-tuberculosis treatment combining Rifampicin (H), Isoniazid (I), Pyrazinamid (Z), Ethambutol (E) over 2 months and secondly a combination of Rifampicin and Isoniazid over 4 months (2RHZE/4 RH). The anti-tumor chemotherapy used a protocol combining 3 FAC60+ 3 Docetaxel (F = Fluorouracil®A = Adriblastin®, C = Cyclophosphamid). Conclusion: This coexistence is uncommon, of incidental discovery and necessitates a multidisciplinary care.

Sexual Experience of Women after Gynecological Hysterectomy in the Department of Obstetrics and Gynecology of Yalgado Ouedraogo Teaching Hospital, 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.

Hemostasis Hysterectomies in a Low Resources Country: Epidemiological, Clinical, and Therapeutic Aspects

Background: The perilous path of the African woman’s pregnancy often ends in difficult situations putting her life in danger. One of the solutions to save her is often to “remove” her uterus, in a hemorrhage and emergency context. It is the hemostasis hysterectomy. It’s generally practiced in difficult conditions with complicated operative follow-ups. The tragedy is that finally the patient will die (almost 1 time out of 2 in our study). This is the sad reality of resource-limited countries. How many women will continue to die under these conditions? This study attempts to explore the different aspects of this reality. Objective: To study the epidemiological, clinical, and therapeutic aspects of hemostasis hysterectomies at the Teaching Hospital of Souro Sanou University Hospital in Burkina Faso. Methodology: This was a prospective cross-sectional descriptive study conducted over 12 months from January 1 to December 31, 2015. Included in our study were all patients received in our department and who required a total or subtotal hysterectomy in the management of a severe postpartum hemorrhage, during the study period. Results: The frequency of hemostasis hysterectomies was 0.4% compared to all deliveries. The average age was 29.65 years old. The average parity was 4.3. Multiparas and large multiparas accounted for 65%. The main indications were uterine rupture (40%) and uterine inertia (60%). Hysterectomy was subtotal in 95% of cases. Maternal morbidity was dominated in 90% of cases by hemorrhagic shock, hemostatic disorders, and obstetrical fistulas. The prognosis was poor, with 8 deaths or 40% of cases. Conclusion: Better management of pregnancy and childbirth would reduce cases of hemostasis hysterectomies. The availability of blood products would improve the maternal prognosis.

Prevalence of Group B Streptococcus among Pregnant Women in Bobo-Dioulasso (Burkina Faso)

Background: Group B Streptococcus (GBS) or Streptococcus agalactiae, which asymptomatically colonizes the female genital tract, is one of the leading causes of septicemia, meningitis and pneumonia in neonates. This study was conducted in Bobo Dioulasso, Burkina Faso to determine the prevalence of GBS colonization among pregnant women. Methods: Six hundred and eleven (611) pregnant women were screened for GBS colonization between July and December 2016. Vaginal swab samples were aseptically collected from the subjects after oral informed consent. Standard microbiological methods were used to isolate and identify GBS isolates. The antibiotic susceptibility profile of GBS isolates was assessed using the Kirby-Bauer disk diffusion method. Results: Colonization prevalence was 6.05%. No risk factors associated with the carriage rate was statistically identified. All isolates were susceptible to Amoxicillin, Ampicillin, Cefotaxime, Levofloxacin, Vancomycin and Nitrofurantoin. Resistance to antibiotics was found for erythromycin (35.14%), lincomycin (16.22%) and penicillin G (10.81%). Conclusion: Although a low carriage (6.05%) rate and isolates were susceptible to many antibiotics found in this study, a policy of systematic screening of pregnant women at least in the third trimester must be promoted.

Prevention and Control of Healthcare-Associated with Infections in Birth Rooms of Referral Hospitals in Ouagadougou: Availability of Equipment, Knowledge and Practices of Health Workers

Objective: The neonatal mortality rate remains a serious problem in most countries in sub-Saharan Africa such as Burkina Faso, where, in 2010 this mortality rate was 28 per 1000 live births [1] [2]. Its reduction is possible and passes first by the strict prevention of infections in birth rooms. The objective of this study was to describe the practices of infection prevention in the birth rooms of seven referral hospitals in Ouagadougou from April 1 to July 31, 2016. Materials and Methods: This was a cross-sectional study on the knowledge, attitudes and practices of the rules of prevention and control of healthcare associated infections (PCHAI) among 123 consenting health workers who provided birth room care in 7 hospitals in Ouagadougou. Data were collected through individual interviews and direct observations. The study was authorized by the Institutional Ethics Committee in 2015 under the number 32. The data analysis was done with the Epi Info software version 2000. Results: The “five clean in the birth room” were known by 26.83%. Regarding the equipment used for PCHAI, sterile gloves were mentioned by 75.61% of the agents, the source of clean water by 62.60% and soap by 57.11%;in practice, 17.07% of the respondents had not washed their hands and 42 providers (34%) had not performed with complete mastery the wearing of sterile gloves before giving birth, and 55.28% had not cleaned the perineum. Conclusion: Deficiencies in the prevention and control of healthcare-associated infections have been identified. Training on infection prevention in the neonatal period is needed for the benefit of hospital providers.

Spinal Cord Compression, a Rare Neurofibromatosis Complication

Objective: The objective of this study is to report a case of spinal cord compression, which is a rare complication of neurofibromatosis type 1. Observation: We report the case of a 45-year-old man, which presented a syndrome of thoracic spinal cord compression at the stage of spastic paraparesis. Its installation was gradually over 6 months associated with the inaugural back pain. He had a clinical history of neurofibromatosis type 1 with “Café-au-lait” spots. There were multiple painless nodules under the skin of different size on the chest, forearms and legs. A large isolated nodule, purplish was observed on the chest. The neuro-imaging showed a para-spinal anterior mass expansion inside the spinal canal causing spinal compression at the level of the second and third thoracic vertebra. It extends into the intervertebral foramen of the third and fourth thoracic vertebra leading to a scalloping. A second large heterogeneous left intra-abdominal mass containing cyst areas and calcifications was discovered in imaging. After a spinal decompression with laminectomy of the second and third thoracic vertebra, the reduction of pain and motor recovery was gradual. The large nodule excision was performed. Histology found a plexiform neurofibroma. Excision of the left intra-abdominal mass could not be performed because the patient’s consent had not been obtained. Conclusion: The spinal cord compression is a rare complication of neurofibromatosis type 1. However, it is essential to think about it in front of any spinal cord symptoms or any atypical long term spinal pain.

Symptomatic Extra-Dural Arachnoid Cyst

Objective: The aim of this study is to report a case of arachnoid cyst due to mass effect on the thoracic marrow. Observation: A 15-year-old patient was admitted to our institution and complaining of high back pain. Three months before he developed progressive and occasional back pain with thoracic irradiation in hemi-belt, increased by the dorsal decubitus. Neurological examination revealed a spasmodic paraplegia. The muscular strength was quoted as 2 to the left and 3 to the right on a scale of 5. Magnetic resonance imaging (MRI) revealed and extradural cyst located to the dorsal spinal cord. The ablation of a voluminous translucent cyst was achieved after a vast decompressive laminectomy from the sixth to the eighth thoracic vertebra. The dural communication with the cyst was stitched. After surgery, the pain has disappeared and the neurological recovery was progressive over a period of 21 days. The diagnosis of arachnoid cyst was confirmed by histological examination. Conclusion: The extradural thoracic arachnoid cyst is a rare affection of good forecast. In the symptomatic form, the surgery as soon as possible remains the solution. The MRI keeps all its interest for the diagnostic orientation and the therapeutic strategy.

Molecular Epidemiology of High-Risk Human Papilloma Virus Infection in Sexually Active Women at Bobo-Dioulasso University Teaching Hospital

The objective of this study was to determine the prevalence of HPV-HR genotypes in the population of sexually active women in Bobo-Dioulasso, Burkina Faso. Methods: This study took place at Souro Sanou Teaching Hospital in Bobo-Dioulasso from September to June 2017. A total of 234 women in the gynecological period and also sexually active were enrolled after they gave an individual consent. Swabbing of the endocervical canal was done. From the sample stored at -20°C, the viral DNA was extracted using the “DNA-Sorb-A” kit from SACACE biotechnologies&reg. Amplification of the PCR of the extracted DNA was made, using the “HPV Genotypes 14 Real-TM Quant” V67-100 FRT kit. Data were analyzed with SPSS software version 17.0 and Epi Info 6. Chi-square and Fisher’s tests were used to compare proportions and averages;a link was significant when p 0.05. Results: The mean age was 30.7 ± 7.3 years (median: 30 years);84.5% of them were married, 43.5% had a socio-professional activity and 61% were schooled. A total of 20.6% of women were positive for at least one of the following HPV-HR genotypes: HPV 18, 31, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Genotypes the most frequently found were HPV 52 with 11 cases (17.2%) and 66 with 10 cases (15.6%). Conclusion: Our results show a predominance of HPV-HR genotypes not covered by available vaccines. Mapping genotypes are needed to fully understand viral ecology at the national level. But for instance, the nonavalent vaccine, which has a better coverage of the predominant genotypes, is to be promoted.