Background MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF ® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. Methods We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. Results We found that age ≤40years (OR = 2.56. 95% CI: 1.44–4.55), two courses of prior TB treatment (OR = 3.25,95% CI: 1.44–7.30), TB treatment failure (OR = 3.82,95% CI 1.82–7.79), sputum microscopy with 3+ bacilli load (OR = 1.98, 95% CI: 1.13–3.48) and a history of contact with a TB patient (OR = 2.48, 95% CI: 1.11–5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR = 0.88, 95% CI: 0.34–1.94). Conclusion We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease.

Summary OBJECTIVETo study the quality of diagnostic practice in rural Burkina Faso. METHOD In 9 health centres of 3 districts, 313 outpatient consultations were observed, and 417 diagnoses by 15 nurses were analysed. Criteria for evaluation of patient history and clinical examination were based on the diagnostic guidelines distributed by the Ministry of Health. RESULTS In only 20% of the diagnoses the nurses took a sufficient history and in only 40% they conducted a sufficient clinical examination. In 21% patients underwent no clinical examination at all. Only 12% of all diagnoses were based on sufficient history-taking and adequate clinical examinations. The individual elements of clinical examination were performed correctly in 82% of cases. The variation between nurses was immense, but no correlation could be found with regard to their basic training. However, nurses who had received the diagnostic guidelines examined patients more carefully than those who had not. Larger numbers of patients per day are not associated with shorter nurse-patient contact, and neither is sufficiency of patient history associated with duration of the consultation. CONCLUSION The low diagnostic quality of the outpatient consultations in the studied area indicates that this issue has been neglected in national public health initiatives. But examination skills are good and diagnostic guidelines may have had a positive effect on the diagnostic quality.keywords diagnosis, history taking, Burkina Faso correspondence Dr Gérard Krause,

Fifteen cases of open-heart surgery in patients with sickle-cell haemoglobinopathies are reported; 13 had sickle-cell trait, one had SC haemoglobinopathy, and one had ,8-thalassaemia sickle-cell disease. All patients except one were operated on with moderate hypothermia, aortic cross-clamping, topical hypothermia, and cold cardioplegia. A bloodless priming solution was used in nine patients and five did not receive any blood throughout their hospital stay. Arterial and venous blood gas analysis and a search for sickle cells and haemolysis were carried out during and after cardiopulmonary bypass. The data were compared with the findings in a group of 29 patients without haemoglobinopathy operated on without blood transfusion. Two patients died from low cardiac output, unrelated to the haemoglobinopathy. All other patients recovered uneventfully. Sickling occurred during and after bypass in only one case, and the percentage of sickle cells was considerably lower during and after surgery than before. Haemolysis occurred only once during cardiopulmonary bypass and twice after surgery (the two deaths from low cardiac output). There was no acidosis or hypoxia. There was no difference in the loss of haemoglobin between the 13 survivors and the control group. Our data suggest that adequate oxygenation and avoidance of acidosis and dehydration during surgery are important. On the other hand, we do not believe that preoperative transfusion or exchange transfusion, a blood prime, normothermia, and the avoidance of aortic cross-clamping or topical hypothermia are essential precautions. We believe that transfusion should be used during cardiopulmonary bypass only for severely anaemic patients. The technique used in our cases adds to the safety of the procedure and improves the protection of the myocardium.The potential dangers to patients with sickle-cell haemoglobinopathies during operations requiring cardiopulmonary bypass have been emphasised by several authors.'-6 There have been only 11 reported cases; one of these patients died from sickle-cell thrombosis.7 Recommendations for precautions at cardiopulmonary bypass based on these patients include the use of exchange transfusions, preoperative transfusions, and blood in the priming solution and the avoidance of acidosis, hypoxia, hypothermia, aortic cross-clamping, and mechanical valvular prostheses. More recently, however, a case of successful cardiopulmonary bypass in a patient with sickle-cell trait was reported where aortic cross-clamping, cardioplegia, and topical hypothermia were used.8 We report our experience with 15Address for reprint requests: D M6tras, MD Institute of Cardiology, BP V 206 Abidjan, Ivory Coast.

After implementation of a nation-wide essential drug programme in Burkina Faso a prospective study was undertaken consisting of non-participant observation in the health centre and in the village pharmacy, and of household interviews with the patients. The study covered all general consultations in nine health centres in three districts over a two-week period as well as all client-vendor contacts in the corresponding village pharmacies; comprising 313 patients in consultations and 498 clients in eight village pharmacies with 12 vendors involved in dispensing 908 drugs. Additionally patients were interviewed in their households. Performance and utilization of the village pharmacy: 82.0% of the drugs prescribed in the health centres were actually dispensed at the village pharmacy, 5.9% of the drugs were not available at the village pharmacy. Wrong drugs were dispensed in 2.1% of cases. 41.3% of the drugs dispensed in the village pharmacy were bought without a prescription. Differences are seen between the district and are put in relation to different onset of the essential drug programme. Patient compliance: Patients could recall the correct dosage for 68.3% of the drugs. Drug taking compliance was 63.1%, derived from the pills remaining in the households. 11.5% of the drugs had obviously been taken incorrectly to such an extent that the occurrence of undesired drug effects was likely. The study demonstrates the success of the essential drug programme not only in performance but also in acceptability and utilization by the population.

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Background: The prevalence of non-tuberculous mycobacteria (NTM) has been increasing worldwide in both developed and developing countries. NTM infection is clinically indistinguishable from tuberculosis and therefore poses significant challenges in patient management, especially in patients chronically treated for pulmonary TB. In this study, we evaluated a new highly sensitive Multiplex MTB/NTM assay that can differentiate M. tuberculosis complex (MTBC) from all NTM, including the treatable and most common NTM, M. avium complex (MAC). Methods: We developed and optimized a new open-Multiplex MTB/NTM assay with two gene-targets for MTBC (IS6110/senX3-regX3) and two targets for MAC (IS1311/DT1) with samples spiked with stored strains and testing 20 replicates.

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