Determinants of Postoperative Outcomes of Female Genital Fistula Repair Surgery

OBJECTIVE:: To determine predictors of fistula repair outcomes 3 months postsurgery. METHODS:: We conducted a multicountry prospective cohort study between 2007 and 2010. Outcomes, measured 3 months postsurgery, included fistula closure and residual incontinence in women with a closed fistula. Potential predictors included patient and fistula characteristics and context of repair. Multivariable generalized estimating equation models were used to generate adjusted risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS:: Women who returned for follow-up 3-month postsurgery were included in predictors of closure analyses (n=1,274). Small bladder size (adjusted RR 1.57, 95% CI 1.39-1.79), prior repair (adjusted RR 1.40, 95% CI 1.11-1.76), severe vaginal scarring (adjusted RR 1.56, 95% CI 1.20-2.04), partial urethral involvement (adjusted RR 1.36, 95% CI 1.11-1.66), and complete urethral destruction or circumferential defect (adjusted RR 1.72, 95% CI 1.33-2.23) predicted failed fistula closure. Women with a closed fistula at 3-month follow-up were included in predictors of residual incontinence analyses (n=1,041). Prior repair (adjusted RR 1.37, 95% CI 1.13-1.65), severe vaginal scarring (adjusted RR 1.35, 95% CI 1.10-1.67), partial urethral involvement (adjusted RR 1.78, 95% CI 1.27-2.48), and complete urethral destruction or circumferential defect (adjusted RR 2.06, 95% CI 1.51-2.81) were significantly associated with residual incontinence. CONCLUSION:: The prognosis for genital fistula closure is related to preoperative bladder size, previous repair, vaginal scarring, and urethral involvement. LEVEL OF EVIDENCE:: II.     

Hereditary Spastic Paraplegia Type 43 (SPG43) is Caused by Mutation in C19orf12

We report here the genetic basis for a form of progressive hereditary spastic paraplegia (SPG43) previously described in two Malian sisters. Exome sequencing revealed a homozygous missense variant (c.187G>C; p.Ala63Pro) in C19orf12, a gene recently implicated in neurodegeneration with brain iron accumulation (NBIA). The same mutation was subsequently also found in a Brazilian family with features of NBIA, and we identified another NBIA patient with a three‐nucleotide deletion (c.197_199del; p.Gly66del). Haplotype analysis revealed that the p.Ala63Pro mutations have a common origin, but MRI scans showed no brain iron deposition in the Malian SPG43 subjects. Heterologous expression of these SPG43 and NBIA variants resulted in similar alterations in the subcellular distribution of C19orf12. The SPG43 and NBIA variants reported here as well as the most common C19orf12 missense mutation reported in NBIA patients are found within a highly conserved, extended hydrophobic domain in C19orf12, underscoring the functional importance of this domain.     

First detection of Theileria parva in cattle from Cameroon in the absence of the main tick vector Rhipicephalus appendiculatus

A major risk factor for the spread of livestock diseases and their vectors is the uncontrolled transboundary movement of live animals for trade and grazing. Such movements constrain effective control of tick‐transmitted pathogens, including Theileria parva. Only limited studies have been undertaken to identify ticks and tick‐borne diseases (TTBDs) affecting cattle in central African countries, including Cameroon. We hereby report the collection of baseline data on the prevalence of T. parva in Cameroon through a countrywide cross‐sectional survey, conducted in 2016, involving collection of blood samples from cattle from 63 sites across the five agro‐ecological zones (AEZs) of the country. ELISA‐based surveillance of infected cattle was performed on 479 randomly selected samples and revealed specific antibodies to T. parva in 22.7% and T. mutans in 41.1% of cattle. Screening of 1,340 representative DNA samples for the presence of T. parva identified 25 (1.86%) positives using a p104 antigen gene‐based nested PCR assay. The positives were distributed across agro‐ecological zones I, II, III and V. None of the p104 positive cattle exhibited clinical symptoms of East Coast fever (ECF). Using reverse line blot (RLB), 58 (4.3%) and 1,139 (85%) of the samples reacted with the T. parva and T. mutans oligonucleotide probes, respectively. This represents the first report of T. parva from Cameroon. Surprisingly, no Rhipicephalus appendiculatus ticks, the main vector of T. parva, were identified in a parallel study involving comprehensive morphological and molecular survey of tick species present in the country. Only two of the 25 p104 positive cattle were PCR‐positive for the CD8+ T‐cell target schizont‐expressed antigen gene Tp1. Cloning and sequencing of Tp1 amplicons revealed sequence identity with the reference T. parva Muguga. This new finding raises serious concerns of a potential spread of ECF into the central African region.     

Tripartite interactions between tsetse flies,Sodalis glossinidius and trypanosomes—An epidemiological approach in two historical human African trypanosomiasis foci in Cameroon

Epidemiological surveys were conducted in two historical human African trypanosomiasis foci in South Cameroon, Bipindi and Campo. In each focus, three sampling areas were defined. In Bipindi, only Glossina palpalis was identified, whereas four species were identified in Campo, G. palpalis being highly predominant (93%). For further analyses, 75 flies were randomly chosen among the flies trapped in each of the six villages. Large and statistically significant differences were recorded between both (1) the prevalence of Sodalis glossinidius (tsetse symbiont) and the prevalence of trypanosome infection of the major fly species G. p. palpalis and (2) the respective prevalence of symbiont and infection between the two foci. Despite these differences, the rate of infected flies harbouring the symbiont was very similar (75%) in both foci, suggesting that symbionts favour fly infection by trypanosomes. This hypothesis was statistically tested and assessed, showing that S. glossinidius is potentially an efficient target for controlling tsetse fly vectorial competence and consequently sleeping sickness.     

The epidemiology of Neisseria meningitidis meningitis in Togo during 2003-2005

Few reports documenting the epidemiology of Neisseria meningitidis (Nm) serogroup W135 exist, and none from Togo. During 2003-2005, we conducted acute bacterial meningitis surveillance at three major reference hospitals in Togo. Of 116 Nm identified, 83 (71%) were NmA, 23 (20%) were NmW135, and 10 (9%) did not have a serogroup identified. Nine percent of NmW135 cases and 35% of NmA cases occurred among those aged 15 years or older. The two hospitals in central Togo reported 23% of all Nm cases and 78% of NmW135 cases. Twelve of the 23 NmW135 cases occurred during February-March 2003, while the remaining 11 occurred sporadically over the remaining 18 months of the study. NmW135 meningitis showed pronounced temporal and geographic clustering and occurred almost exclusively among those younger than 15 years old. By the 2004-2005 epidemic season, NmW135 had largely disappeared from Togo for unknown reasons.     

Pattern of Lower Intestinal Ostomies in a Low-Income Country: Case of Southeast of Niger Republic

Background

Intestinal ostomies are common surgical procedures performed in visceral surgery as part of management for several gastrointestinal diseases. This study aims to report the socio-demographic characteristics, indications and prognosis of intestinal ostomies in low-income country.

Methods

This was a 4-year retrospective study (January 2013 to December 2016) at Zinder National Hospital (Niger). All patients with a digestive ostomy on an ileum or colic segment were included in the study.

Results

During the study period, 2437 patients underwent digestive surgery, including 328 gastrointestinal stomas (13.5%). Patients classified ASA3 were 60.7% (n = 199). The median age was 12 years (IQ: 7–25). Children represent 64% (n = 210) of patients with ostomy. The sex ratio was 2.60. The stoma was performed in emergency in 96.3% (n = 316) of cases. Acute peritonitis was the main indication of the stoma in 70.73% (n = 232). The ileostomies accounted for 75.61% (n = 248). Ostomy was intended as temporary in 97.3% of cases (n = 319). Complications were observed in 188 patients (57.3%). Mortality was 14.02% (n = 46). The indigent status (OR: 4.15 [2.20–7.83], P = 000), ASA score 4 (OR: 2.53 [1.54–4.15], P = 0.0003), Altemeier class IV (OR: 4.03 [2.10–7.73], P = 0.0000) and ileostomy (OR: 2.7853 [1.47–5.29], P = 0.0018) were statistically associated with the occurrence of major complications. The mean time for stoma closure was 59.3 ± 14.5 days.

Conclusion

Acute peritonitis was the main indication of digestive ostomy. The occurrence of major complications was associated with bad socioeconomic status, ASA4 score, Altemeier class IV and ileostomy.

     

Distribution of ABO and RHD blood group antigens in blood donors in Burkina Faso

Geographical distribution of ABO and RHD antigens is important for blood transfusion services and population genetics studies. There are few data on this topic in Burkina Faso, a multi‐ethnic country. Our study aims at reporting phenotypic and allelic frequencies of ABO and RHD blood groups among voluntary blood donors from various ethnical regions of Burkina Faso. We conducted a cross‐sectional study including 81,486 blood donors. ABO allelic frequencies were determined using the Bernstein method. Differences in phenotypic distribution of blood groups were assessed using the chi‐square test; a p value <0.05 being considered as statistically significant. We noticed that O+>B+>A+>AB+>O‐>B‐>A‐>AB‐ in our population. Phenotypic frequencies of blood groups A, B, O and AB were respectively 22.54%, 28.56%, 43.30% and 5.60%. RHD+was 92.24%. The allelic frequencies of A, B, O and D were respectively 0.1524; 0.1887; 0.6590 and 0.7214. We noticed statistical differences (p < 0.05) between these administrative regions which corresponded roughly to some natural ethnic areas. Indeed, the phenotype O was more frequent in the Central‐west, Central and East regions corresponding to “Mossi,” “Gourounsi,” “Gourmantché” areas while the phenotype A and AB were more reported in “Boucle du mouhoun” and “Hauts‐Bassins” regions where we have “Bwaba” and “Bobo.” The phenotype O negative was less frequent in “Bwaba.” Our study provides interesting information to blood services that will allow them to better refine their donor recruitment strategies.