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Multiplex Rapid Test with Acceptable Diagnosis Performance as a Solution to Increase Diagnosis of Hepatitis B and C Viruses in Pregnant Women in an Area of High Prevalence of Both Hepatitis Viruses Associated with HIV

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Open Journal of Medical Microbiology 2024年第1期14卷 50-65页

作者： Catherine Boni-Cisse Nina Esther Onstira Ngoyi Hermione Dahlia mossoro-kpinde Noella Packo Rabi Senekian Hermann Ndoidet Koutou Coretha Bokia-Baguida Christelle Luce Bobossi-Gadia Arthur Simplice Sombot-Ndicky Daniel Yvon Gonessa Freddy Samuel Ngbonga Konzapa Voulou christian diamant mossoro-kpinde Alassane OUATTARA National Center of Medical Oncology and Radiotherapy Abidjan Ivory Cost Department of Microbiology UFR of Medical Sciences University of Cocody Abidjan Ivory Cost Laboratory of Bacteriology-Virology of Teaching Hospital Center of Brazzaville Brazzaville Republic of Congo Faculty of Health Sciences Marien NGOUABI University Brazzaville Republic of Congo Department of Labor Medicine Service of HIV and STDs Control in the Workplace Bangui Central African Republic (CAR) Faculty of Health Sciences University of Bangui Bangui Central African Republic National Reference Center of Sexually Transmitted Diseases and Antiretroviral Therapy Bangui Central African Republic National Laboratory of Clinical Biology and Public Health Bangui Central African Republic Medicine Department District Hospital of Alindao Alindao Ouaka Prefecture Central African Republic Doctoral School of Sciences and Technology University of Bangui Bangui Central African Republic Coordination of Specialized Study of Clinical Biology University of Bangui Bangui Central African Republic Doctors without Borders Hospital Sica BanguiCRA Laboratory of Medical Analysis of Teaching Hospital Center Mother Elisabeth DOMITIEN of Bimbo Bimbo Central African Republic

Background and Objective: HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are very widespread in the world, however, less than 20% of the people affected are diagnosed and treated. This study aimed to determine the prevalence of HIV, HCV and HBV co-infections in pregnant women at Bangui Community University Hospital and the cost of screening. Methods: A cross-sectional study involving consenting pregnant women who came for antenatal care was performed. HIV, HCV antibodies and HBV antigens were detected using Exacto Triplex? HIV/HCV/HBsAg rapid test, cross-validated by ELISA tests. Sociodemographic and professional data, the modes of transmission and prevention of HIV and both hepatitis viruses were collected in a standard sheet and analyzed using the Epi-Info software version 7. Results: Pregnant women aged 15 to 24 were the most affected (45.3%);high school girls (46.0%), and pregnant women living in cohabitation (65.3%) were the most represented. Twenty-five (16.7%) worked in the formal sector, 12.7% were unemployed housewives and the remainder in the informal sector. The prevalence of HIV, HBV, and HCV viruses was 11.8%, 21.9% and 22.2%, respectively. The prevalence of co-infections was 8.6% for HIV-HBV, 10.2% for HIV-HCV, 14.7% for HBV-HCV and 6.5% for HIV-HBV-HCV. All positive results and 10% of negative results by the rapid test were confirmed by ELISA tests. The serology of the three viruses costs 39,000 FCFA (60 Euros) by ELISA compared to 10,000 FCFA (15.00 Euros) with Exacto Triplex? HIV/HCV/AgHBs (BioSynex, Strasbourg, France). Conclusion: The low level of education and awareness of hepatitis are barriers to development and indicate the importance of improving the literacy rate of women in the Central African Republic (CAR). Likewise, the high prevalence of the three viruses shows the need for the urgent establishment of a national program to combat viral hepatitis in the CAR.

关键词： HIV-HCV-HBV Co-Infection Multiplex Immunochromatographic Rapid Test Central Africa Serology Test Cost Diagnostic Accessibility

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Mass Screening Using Antigenic and Molecular Diagnostic Tests of COVID-19 in Bangui at the Beginning of the Second Wave in July 2021

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Journal of Tuberculosis Research 2024年第1期12卷 1-12页

作者： Clotaire Donatien Rafaï Marie-Roseline Darnycka Belizaire Pierre Somse Wilfrid Sylvain Nambei Ernest Lango-Yaya Oscar Senzongo Luc Salva Hereidebona Ulrich Jeffrey Kotemossoua Rabbi Mermoz Senekian Simon Pounguinza christian-diamant mossoro-kpinde Alain Le Faou Jean De Dieu Longo François-Xavier Mbopi-Keou Gérard Grésenguet Boniface Koffi National Laboratory of Clinical Biology and Public Health Bangui Central African Republic Faculty of Health Sciences University of Bangui Bangui Central African Republic World Health Organization Bangui Central African Republic Ministry of Health and Population Bangui Central African Republic Faculty of Medicine Maieutic and Health Sciences University of Lorraine Pole Brabois Santé Nancy France Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroun

Objective: COVID-19 surveillance was established as early as March 2020 in the Central African Republic (CAR), after the WHO statement relating to the identification of several cases outside China. However, given the non-performing molecular biology technical platform in many developing countries in sub-Saharan Africa, the second wave promised to be surprising and formidable. In this context, a mass survey was launched in Bangui to determine the prevalence of COVID-19. Patients and Methods: From March 18 to April 2, 2021, a mass screening campaign took place in tourist places, companies and the main hospital infrastructures. Nasopharyngeal swab samples were collected from participants with and without symptoms of Influenza-like illness (ILI) and stored in VTM tubes. The Ag (COVID-19) and RT-PCR tests were carried out in Bangui at the LNBCSP. The sequencing of RT-PCR SARS-CoV-2 positives was carried out at the INRB. Results: We included 1480 participants of whom 33 (2.23%) were SARS-COV-2 positive, of whom 24 were male and 9 female. This sex difference was statistically significant (p = 0.012) as the sex ratio M/F was 1.09. Sampling sites located in the 1st arrondissement were the most prolific (p = 0.006) and were sequenced. In addition to the analysis of the 33 samples from the predefined sites under study, 17 control sequences from the provinces generated during the same period are added. We detected 2 Variants Of Concern (VOC) including the predominant B.1.620 (43.86%) followed by B.1.1.7 or Alpha (5.10%). Conclusion: The study showed the importance of surveillance and the availability of means of diagnosis of COVID-19. The identified risk factors were sex and sampling site. This study has shown the importance of setting up sentinel sites for COVID-19 surveillance in all regions of the country and the appropriate use of the anti-COVID-19 vaccine.

关键词： COVID-19 Variants Central African Republic

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Significant Improvement in Tuberculosis Diagnosis by Detection of the Wall Lipoarabinomannan from Mycobacterium tuberculosis in Central African Republic (CAR)

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Open Journal of Medical Microbiology 2022年第3期12卷 71-82页

作者： christian diamant mossoro-kpinde Honorat Nouzoukem Marcel Mbeko Simaleko Nina Esther Ngoyi Ontsira Hermione Dahlia mossoro-kpinde Irenee Galendji Henri Diemer Gérard Grésenguet University Hospital Center Mother Elisabeth Domitien Bimbo Central African Republic National Laboratory of Clinical Biology and Public Health Bangui Central African Republic Department of Biomedical Sciences Health Sciences Faculty Bangui Central African Republic Public Health Department Health Sciences Faculty Bangui Central African Republic Bacteriology and Virology Laboratory University Hospital Center of Brazzaville Brazzaville Republic of the Congo Faculty of Sciences Marien Ngouabi University Brazzaville Republic of the Congo Regional University Hospital of Bria Bria Central African Republic

Background and Objective: Tuberculosis is one of the leading causes of morbi-mortality, especially in developing countries, due to delayed diagnosis and management. The goal of this study is to assess the contribution of lipoarabinomannan (LAM) in improving tuberculosis (TB) diagnosis in the Central African Republic (C.A.R.). Methods: We conducted a retrospective study at the Regional University Hospital of Bria. The records of patients hospitalized, tested by Determine® TB LAM Ag (Alere, Medical Co, LTD, Chiba, Japan) immunochromatographic test for the detection of LAM in urine, associated or not with acid-fast bacilli (AFB) research by Ziehl-Neelsen stain, were selected from August to October 2020. Results: During this study, 152 files were selected. Among them, there were 50.0% of children aged 14 or less (≤14 years: 33.6% + 16.4%) and 50.0% of adults represented. Patients living in the displaced person camp represented a larger group (65.1%) than those in the other 2 sites. There were seventy-four patients (i.e. 48.7%) who did not benefit from screening for AFB. For the other seventy-eight (i.e. 51.3%), there were 17.1% positive results for the search of AFB. However, among the 152 patients, there was a positive HIV serology in 30.9% of cases (i.e. 47 out of 152) and a positive Determine® TB LAM Ag in 38.2% of cases (i.e. 58 out of 152). It appears that Determine® TB LAM Ag was significantly more able to diagnose tuberculosis than AFB (p 0.003). The 58 patients diagnosed with TB LAM included 20 children who could not provide sputum and HIV-infected patients (p 0.03). Conclusion: The results of this study showed that the microscopy for AFB made it possible to make the diagnosis of tuberculosis in 17.1% of patients against 38.2% for the Alere Determine® TB LAM Ag test. This result highlights the need for routine use of LAM detection to improve the diagnosis of tuberculosis. The conduct of a subsequent stu

关键词： Tuberculosis Diagnosis TB-LAM Acid-Fast Bacilli Microscopy HIV/AIDS Central African Republic

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Contribution of Automated Antigen Tests, the LumiraDx Ag Test in the Response during the Second Wave of the COVID-19 Pandemic in Bangui

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Journal of Tuberculosis Research 2023年第4期11卷 173-183页

作者： Clotaire Donatien Rafaï Pierre Somse Wilfrid Sylvain Nambei Ernest Lango-Yaya Marie-Roseline Darnycka Belizaire Ulrich Vickos Narcisse Patrice Komas Oscar Senzongo Luc Salva Heredeibona Ulrich Jeffrey Kotemossoua Rabbi Mermoz Senekian Simon Pounguinza Jephté Estimé Kaleb Kandou christian-diamant mossoro-kpinde Laurent Bélec Jean De Dieu Longo Norbert Richard Ngbale Abdoulaye Sepou François-Xavier Mbopi-Keou Gérard Grésenguet Boniface Koffi National Laboratory of Clinical Biology and Public Health Bangui Central African Republic Faculty of Health Sciences University of Bangui Bangui Central African Republic Ministry of Health and Population Bangui Central African Republic World Health Organization Bangui Central African Republic Institut Pasteur de Bangui Bangui Central African Republic Virology Laboratory Georges Pompidou European Hospital Université Paris Cité Paris France Hôpital Communautaire of Bangui Bangui Central African Republic Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis. The Central African Republic is not spared. The emergence of variants and their impact require health monitoring despite the obligation of vaccination. The purpose of this campaign was to determine the circulation of pending second-wave variants. Patients and Methods: A second mass screening campaign took place from 02 to 22 July 2021 in the main land and river entry points of Bangui (Exit North-PK12, Exit South-PK9, Port Beach) and at the LNBCSP. Antigenic and RT-PCR tests carried out on nasopharyngeal samples made it possible to select strains which were finally sequenced. Results: Of 2687 participants included in the study, 53 (1.97%) were positive for SARS-CoV-2. Thirteen (1.53%) were male and 40 (2.18%) female. The analyses carried out on the LumiraDx analyzer were positive for 109 samples against 53 on the RT-PCR. The prevalence was higher in the most tested age groups (30 to 50 years) with two clusters identified. B.1.617.2 (Delta) variants were predominant (57%). Conclusion: SARS-CoV-2 continues to circulate. The acquisition of automated antigenic tests (LumiraDx®) with sensitivity and specificity close to those of the reference test (RT-PCR) will allow better mass diagnosis for an optimization of the surveillance of COVID-19 in our countries with limited resources. The predominance of the B.1.617.2 (Delta) variant would suggest a third wave in the Central African Republic.

关键词： COVID-19 Automated Antigen Testing

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Antibiotic Resistance Profile of Serotypes of Streptococcus pneumoniae Strains in Bangui, from 2017 to 2022: Case of Serotype 1

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Open Journal of Medical Microbiology 2024年第2期14卷 131-145页

作者： Zéphirin Dalengat Vogbia Ernest Lango Yaya Marceline Djeintote Stéphanie Judith N’Yetobouko Jean de Dieu Longo Clotaire Donatien Rafaï christian diamant mossoro-kpindet Gérard Gresenguet Epidemiology and Research Service National Reference Center for Sexually Transmitted Infections and Anti-Retroviral Therapy Ministry of Health Bangui Central African Republic Faculty of Health Sciences Doctoral School of Human and Veterinary Health Sciences University of Bangui Bangui Central African Republic National Laboratory of Clinical Biology and Public Health Bangui Central African Republic National Blood Transfusion Center Bangui Central African Republic Public Department Ministry of Health Bangui Central African Republic

Goals: The aim of this study was to determine the antibiotic resistance profile of serotypes of Streptococcus pneumoniae strains circulating in Bangui. Methodology: A prospective and analytical analysis was carried out at the National Laboratory of Clinical Biology and Public Health from 2017 to 2022. The strains came from our study on the contribution to the study of antibiotic sensitivity of Streptococcus pneumoniae strains. The multiplex PCR test was used for its cost-effectiveness in terms of amplifiers which can be purified in order to be sequenced. It also makes it possible to detect several germs as well as their serotypes. For a PCR reaction, several elements are involved in the reaction medium or Master Mix. These are the desoxyribonucleotides (dNTPs), the magnesium ions (MgCl2) and the primers. A set of 14 primers divided into 3 classes were used. Class 1 primers served as an internal control by targeting the cpsA gene. It is a highly conserved gene found in capsular loci characterized to date. The primers of the second class were used to target specific serotypes by specific reactions (out of six possibilities). The group reaction was carried out using the primers of the third class in order to carry out an initial screening of the samples and to classify the pneumococcal isolates. Related serotypes were grouped based on the amplification of common genes. Using the technique of electrophoresis on agarose gel and an ultraviolet radiation device, the migration bands are then visualized and analyzed. The data collected had been entered into Excel 2010 and analyzed with Epi info 7. The exact Fischer chi2 test at the 5% threshold, the relative risk and its 95% confidence interval were used to compare the proportions and determine the associations. Results: 187 antibiotic-resistant strains of Streptococcus pneumoniae were collected. The average frequency of serotypes 1, 9A, 4 and untypeable identified were 43.59%, 18.18%, 18.27% and 39.57% respectively. The fre

关键词： Streptococcus pneumonia Serotype Antibiotic Resistance Bangui

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Contribution to the Study of the Incidence of Post-Streptococcal Complications in Republic Central African Republic from 2015 to 2018

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Open Journal of Epidemiology 2024年第1期14卷 110-121页

作者： Zéphirin Dalengat Vogbia Ernest Lango Yaya Jean De Dieu Longo Augustin Balekouzou Gaspard Tekpa christian Maucler Pamaticka Stéphanie Judith N’Yetobouko Maurel Anicet Adonis Ouoko Fatigbia christian diamant mossoro kpindet Gérard Gresenguet Epidemiology and Research Service National Reference Center for Sexually Transmitted Infections and Anti-Retroviral Therapy Ministry of Health Bangui Central African Republic Direction of National Laboratory of Clinical Biology and Public Health Ministry of Health Bangui Central African Republic Training Project Manager and Heald of Public Departement Ministry of Health Bangui Central African Republic Faculty of Health Sciences Doctoral School of Human and Veterinary Health Sciences University of Bangui Bangui Central African Republic National Committee for the Fight against AIDS Primature Bangui Central African Republic Infectious Disease Department The Sino Central African Friendship University Hospital Center Bangui Central African Republic Epidemiology Department Bangui National University Hospital Center Bangui Central African Republic

Introduction: Acute rheumatic fever (AAR) is a non-suppurative complication of late infection by group A. Infections due to streptococci remain a public health problem in the Central African Republic. The present study aims to determine the incidence rate of AAR cases and its complications. Methodology: This was a retrospective and analytical study over a period of 4 years (from January 2015 to December 2018) at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. It focused on samples concerning the diagnosis of AAR and patient files seen in consultation in the capital’s reference health establishments. Laboratory registers and patient consultation files were used to collect data. They were entered into Excel 2010 to be analyzed with Epi Info 7. A univariate analysis by logistic regression, Ficher’s exact test, and chi2 at the 5% threshold (p Results: We analyzed 94 cases meeting Jones’s criteria. The ages of the patients ranged from 18 to 85 years (mean age 52 years and mode 45 years). The incidence rate of AAR for the female sex was higher than that of the male sex during the study period (p > 0.05). It went from 166.6 in 2015 to 200 in 2016 and 2018 cases of AAR per 1000 people per year. The average incidence rate was 296.18 cases of AAR per 1000 people per year. The average incidence rate was 223.5 cases of AAR per 1000 people per year for joint damage. Joint damage represented 80.85% (RR = 0.62;Chi2 = 4.88;95% CI [0.39-0.97];p Conclusion: The study allowed data on the impact rate and complications of the AAR in Bangui. Special attention to data management will help produce a complete result on the problem. Joint complications predominated. Sustaining an effective surveillance system and preventing infection would help reduce the risk of AAR occurrence.

关键词： Incidence Acute Joint Rheumatism Central African Republic

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Evaluation of HIV Viral Load Activity at the Bacteriology-Virology Laboratory in the University Hospital Center of Brazzaville

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Open Journal of Medical Microbiology 2019年第4期9卷 178-185页

作者： Esther Nina Ontsira Ngoyi Tanguy Mieret Roland Bienvenu Ossibi Ibara Axel Aloumba Géril Obili Sekangue Armel Claude Itoua Irène Laure Opfou christian diamant mossoro-kpinde Hervé Léon Iloki Bertrand Dupont Christine Rouzioux Bacteriology-Virology Laboratory of the Teaching Hospital Center (CHU) Brazzaville Congo Health Sciences Faculty of MarienNgouabi University Brazzaville Congo National Laboratory of Clinical Biology and Public Health Ministry of Public Health Central African Republic and University of Bangui Faculty of Health sciences Central African Republic Bangui Central African Republic Infectious Diseases Department of the Teaching Hospital Center (CHU) Brazzaville Congo Gynecology and Obstetrical Department of the Teaching Hospital Center (CHU) Brazzaville Congo Infectious Diseases and Tropical Department Neckerteaching Hospital Center Paris France Virology Laboratory of the Necker Teaching Hospital Center Paris Descartes University Paris France

Introduction: The bacteriology-virology laboratory of the teaching university hospital of Brazzaville, was equipped with a real-time PCR device like Miniopticon (Biorad? , France). The aim of this work was to do an evaluation of the HIV viral load activity, with a view to proposing some recommendations. Material and methods: Retrospective study, January 2013 to March 2015, in patients on first line ARV three-therapy, pre-inclusion therapy checkup in HIV positive patients, but again screening after sexual abuse in women or accident of exposure (AES). A blood sample on EDTA tube was made and RNA extraction with Qiagen kit. Ultrasensitive HIV-RNA quantification was performed using the Generic HIV real-time PCR assay (Biocentric?, Bandol, France). Results: 126 patients were included. The mean age was 37.63 years +/- 10.43 years, sex ratio F/H = 2.3. The HIV viral load was detectable in 94 cases (74.6%). Concerning patients with detectable viral load (copies/ml): 403 to 996 in 35 cases (37.23%), 1411 to 1812 in 41 cases (43.62%) and >1814 in 5 cases (5.32%) (therapeutic failure). Conclusion: This work reports success in the setting up of the molecular biology unit. Procedures that implement information and education actions on the risks associated with AES must be disclosed.

关键词： Viral Load HIV Miniopticon CHU Brazzaville

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Contribution to the Study of Antibiotic Sensitivity of Streptococcus pneumoniae Strains in Spinal Cerebral Fluids in Bangui from 2017 to 2022

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Journal of Biomedical Science and Engineering 2023年第7期16卷 95-106页

作者： Zéphirin-Dalengat Vogbia Ernest Lango Yaya Marie Colette-Nganda Banguet Jean de Dieu Longo Clotaire -Rafaï Maurel Anicet Adonis Ouoko Fa-Tigbia christian diamant mossoro Gérard Gresenguet Ministry of Health Epidemiology and National Reference Center for Sexually Transmitted Infections and Anti-Retroviral Therapy Research Service Bangui Central African Republic Faculty of Health Sciences University of Bangui Bangui Central African Republic Ministry of Health National Laboratory of Clinical Biology and Public Health Bangui Central African Republic Emergency Department at the Pediatric University Complex Bangui Central African Republic Ministry of Health Training Project Manager and Head of Public Department Bangui Central African Republic

A prospective and analytical study was carried out from January 2017 to Decem-ber 2022, at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. 352 samples of cerebrospinal fluid (CSF) were confirmed out of 2065, coming from the four hospitals in Bangui. This study aimed to evalu-ate the evolution of antibiotic sensitivity to strains of Streptococcus pneumoniae. CSF had been collected from patients who presented with meningeal syndromes. Based on the leukocyte count (White blood cells ≥ 5 mm3), an aliquot was trans-ferred to trans-isolate medium and sent to the LNBCSP for confirmatory testing, culture and determination of antibiotic sensitivity. The antibiotic sensitivity of Streptococcus pneumoniae strains was tested according to the methods recom-mended by the Antibiogram Committee of the French Society of Microbiology. The data collected was entered into Excel 2010 to be analyzed with Epi Info 7.2. Ficher’s exact test, chi2 at the 5% threshold (p < 0.05) was used to compare pro-portions and analyze associations between variables. The average sensitivity rate to β-lactams was 74.43%. The sensitivity rate of Fluoroquinolones was 54.54%. That of levofloxacin was 87%. The average rate of sensitivity to β-lactams for the age group under 5 years old was 79.25%. That of fluoroquinolones was 52.59%. Levofloxacin had 90.37%. The average sensitivity rate to β-lactams for the age group over 5 years old was 76.03%. Fluoroquinolones had 45.16%. Levofloxacin had 69.58%. The average sensitivity rate to β-lactams for males was 76.68%. Fluoroquinolones had 54.26%. That of levofloxacin was 83.40%. The sensitivity rate to β-lactams for females was 74.41%. That of fluoroquinolones was 51.16%. Levofloxacin had 67.44%. Cyclins had 28.68%. The study noted an association between age and sensitivity (p < 0.05;CI [1.05-2.57]). Strains of Streptococcus pneumoniae were always detected in the CSF. The average rate of sensitivity to macrolides was 36.93%;aminoglyc

关键词： Streptococcus pneumoniae Sensitivity Antibiotics Central African Republic

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Evolution of the Etiologies of Purulent Meningitis in Children over a Period of 24 Months in Conflict-Affected Rural Areas of the Central African Republic after the Introduction of 2 New Vaccines in the Expanded Vaccination Program

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Open Journal of Medical Microbiology 2023年第3期13卷 183-194页

作者： Rostand Kombaya Marie Colette Nganda Bangue Irenee Galendji Honorat Nouzoukem Edgar Tchoumateu Brice Olivier Bogning Mejiozem Freddy Samuel Ngbonga Konzapa Voulou Henri Saint Clavaire Diemer christian diamant mossoro-Kpindé Pediatric University Hospital Complex Bangui Central African Republic (CAR) Régional University Hospital of Bria Bria Central African Republic (CAR) Régional University Hospital of Bossangoa Bossangoa Central African Republic (CAR) Faculty of Health Sciences The University of Bangui Bangui Central African Republic (CAR) National Laboratory of Clinical Biology and Public Health of Bangui Bangui Central African Republic (CAR)

Background and Objective: Purulent meningitis is a therapeutic emergency and remains a real public health problem in the world, particularly in limited resources countries. The study aimed to describe the epidemiological clinical, etiological and scalable features of purulent meningitis in children in Bria. Methods: A cross-sectional descriptive study was conducted from January 1, 2018 to December 31, 2019 (24 months). It included all suspected cases of purulent meningitis in children aged 0 to 15 years, confirmed by agglutination with Pastorex meningitis. A standard sheet was used to collect the data which was entered and analyzed on Epi Info 7 software. Results: A total of 37 cases of purulent meningitis were confirmed among 90 suspected cases. The female gender predominated (59.5%), with a sex ratio of 0.7. The age group from 0 to 11 months was majority (48.6%). Nearly 2 thirds of children were not vaccinated (64.8%). The most frequent functional signs were fever (83.8%), and convulsion (51.4%). The etiologies were Streptococcus (51.4%), Neisseria meningitidis (35.1%) and Haemophilus influenzae (13.5%). Therapeutic success under 3rd generation cephalosporin treatment was obtained in 86.5% including 8.1% with sequelae;13.5% of death was observed. Streptococcus was the most lethal bacterium at 21.1%. Conclusion: The results of these studies show that pediatric purulent meningitis is still common despite the availability of free vaccination. They require early therapeutic management to limit the occurrence of sequelae and death. Hence, it is important to strengthen prevention strategies.

关键词： Purulent Meningitis Children Epidemiology Etiologies Bria Central African Republic

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Continuous Spinal Anesthesia in Precarious Patients: An Experience in Lubumbashi DR Congo

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Open Journal of Anesthesiology 2023年第11期13卷 226-233页

作者： Wasso Milinganyo Eddy Timothée Dontaine Sagboze Zalambo Sandra Kibonge Mukakala Augustin Zirhumana Namegabe Franck Somwa Muhemedi Lucien Mukalay Banza Yves Tshisuz Nawej christian Nguz A. Kutshid Nathan Kanyanda Nafatalewa Dimitri Ilunga Banza Mannix Mulewa Umba Deogracias Manika Muteya Michel Mbuyi Musanzayi Sébastien Arung Kalau Willy Iteke Fefe Karl-Rivain Department of Anesthesia and Critical Care University Clinics of Lubumbashi Lubumbashi DR Congo Department of Surgery Great Hospital of Charleroi Charleroi Belgium Department of Surgery University Clinics of Lubumbashi Lubumbashi DR Congo Department of Surgery Medicine School Official University of Bukavu Bukavu DR Congo Department of Anesthesia and Critical Care Diamant Medical Center Lubumbashi DR Congo

Background: Continuous spinal anesthesia (CSA) is an underused technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia (SSA) usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. It is indicated in elderly patients undergoing lower limbs and sub umbilical surgery. Aim: This work aims to highlight the advantages of CSA on hemodynamic stability and as an alternative to heavy anesthetic procedures in already fragile patients. Case presentation: Our cases were two elderly patients, both of them with past stories of cardiac diseases. Both of them were undergoing amputation indicated for wet gangrene on lower limbs. They had unstable hemodynamics states due to inflammatory state. They were all rated ASA 3. CSA was performed with low doses of local anesthetics and maintenance by reinjections of mixture with the same doses. The interventions took place without major incidents and all patients survived. Conclusion: CSA is an underused technique in modern anesthesia. However, there is renewed interest due to the quality of the blocs and the hemodynamics stability. We report a case series of 2 elderly patients with past stories of cardiac diseases undergoing amputation for dry gangrene that had been operated under CSA.

关键词： Continuous Spinal Anesthesia (CSA) Precarious Patient Dry Gangrene Elderly Subject DR Congo

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