AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study.

BACKGROUND: Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. METHODS: This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. RESULTS: We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. CONCLUSION: Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

[Why and how to perform an ultrasound-guided transversus abdominis plane block: A step-by-step approach]. / Le TAP block échoguidé pas à pas : pourquoi et comment le réaliser ?

Used in clinical practice as part of a multimodal analgesic regimen, the transversus abdominis plane block (TAP block) is a relative novel procedure in which local anaesthetic agents are injected into the anatomic neurofascial space between the internal oblique and the transversus abdominis muscle. It allows a significantly prolonged duration of analgesia during the early postoperative stage in abdominal surgery. This regional anesthesia technique provides analgesia to the skin, muscles of the anterior abdominal wall and parietal peritoneum in order to decrease the incision-related pain. Thus, it reduces postoperative opiate requirements and opioids-related side effects (nausea, vomiting, delayed resumption of intestinal transit, drowsiness, respiratory depression, urine retention). Additionally, the TAP block appears particularly interesting when neuraxial techniques or opioids are contraindicated. Moreover, the ultrasound-guided procedure provides a significant success rate of this block and additionally avoids major complications. We describe our technique of ultrasound-guided TAP block and discuss its indications, contraindication and potential complications.

Surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at Yopougon Teaching Hospital.

INTRODUCTION: Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate our results at the middle term. HYPOTHESIS: The open reduction and ESIN technique provides satisfactory results with few major complications. PATIENTS AND METHODS: This was a retrospective study that focused on femoral diaphyseal fractures treated in the pediatric surgery unit at Yopougon Teaching Hospital (Abidjan, Côte d'Ivoire) between January 2007 and December 2013. Twenty children older than 6 years of age who underwent open reduction and ESIN without image intensifier assistance were included. Functional outcomes were assessed using Flynn's criteria. Postoperative complications and sequelae were recorded. RESULTS: At the 16-month follow-up, the results were excellent in 11 (55%) cases, good in eight (40%), and poor in one (5%) case. The mean duration of surgery was 71min (range, 57-103 min). The mean time for bone healing was 11.6 weeks (range, 7-15 weeks) and the average time to nail removal was 6 months. Complications included wood infection (n=3), skin irritation (n=3), knee stiffness (n=2), malunion (n=3), scar (n=5), and leg length discrepancy (n=3). DISCUSSION: Open reduction and ESIN yielded satisfactory results with few major complications. This method could be an alternative in low-income countries where the image intensifier is often unavailable. LEVEL OF EVIDENCE: Level IV retrospective study.

[Palmar and plantar keloid in a black African male]. / Chéloïdes palmaire et plantaire chez un Noir africain.

The keloid scar is a fibrous skin tumor, intradermal, and exuberant. It is commonly found on the glabrous skin. The keloid of the palms and soles are rare. Small series are reported in English literature. The authors report a case of large keloids located on both palms and soles, within a context of keloid disease, in a man of 37 years. On the left hand, the keloid scar caused a partial syndactyly IV-V. Large keloid tumors occupied the inner edge and, weight-bearing areas of both feet. These tumors rendered wearing of shoes impossible and interfered with walking. The treatment consisted of total excision of palmar and plantar keloid tumors. The residual defects were covered by a total skin graft taken from the suprapubic region. The results were satisfactory aesthetically, functionally and psychosocially.

Characterization of new microsatellite loci isolated from Santiria trimera (Burseraceae).

PREMISE OF THE STUDY: To study the genetic structure among three morphotypes of an African rainforest tree species, Santiria trimera, nuclear microsatellite markers were isolated and characterized. METHODS AND RESULTS: Seven polymorphic loci were isolated using a pyrosequencing-based protocol and successfully amplified on three different morphotypes of S. trimera. For six of the seven loci, there is at least one private allele for one of the three morphotypes. The mean effective number of alleles is about four for each of the three morphotypes. CONCLUSIONS: These microsatellite markers are promising to explore the genetic delimitation among sympatric morphotypes found in Gabonese forests and to study the spatial genetic structure within each gene pool.

[Management of a case of unilateral exophthalmos due to an intraorbital lipofibroma at Kara teaching hospital in Togo]. / Prise en charge d'un cas d'exophtalmie unilatérale due à un lipofibrome intra-orbitaire au CHU de Kara au Togo.

In childhood, benign tumors are uncommon causes of exophtalmos. We report a case of intraorbital lipofibroma in an 11-year-old girl who presented with painless, progressive proptosis of the right eye over the preceding 6 months. Ultrasound had shown an extraconal intraorbital mass. Complete excision and pathologic examination were performed, revealing a lipofibroma with no signs of malignancy This case report is notable due to the rarity of the condition.

Diversity gradients and phylogeographic patterns in Santiria trimera (Burseraceae), a widespread African tree typical of mature rainforests.

PREMISE OF THE STUDY: New insights into the history of the African rainforest can be gathered from the phylogeographic structures of their constituent species, but few studies have been performed in this ecosystem. We studied the phylogeographic structure of Santiria trimera, a primate- and bird-dispersed, dioecious tree typical of mature African rainforests. METHODS: We sequenced three chloroplast DNA (cpDNA) regions (trnL-F, rbcL, and rpl36-infA-rps8) in 377 individuals from 42 populations. RESULTS: Sequence chromatograms regularly displayed double peaks of unequal heights. Cloning of PCR products and sequencing of outgroup taxa led to assigning the taller peak in ambiguous sequence positions to cpDNA. A total of 14 polymorphic cpDNA sites and 12 haplotypes were detected. Populations from three distinct biogeographic regions, namely, Upper Guinea, Lower Guinea, and the volcanic island of São Tomé, did not share any haplotype, indicating allopatric divergence. In Lower Guinea, Gabonese forests had high diversity mainly from the sympatry of two genetically divergent morphotypes, whereas forests of eastern Cameroon were less diversified. The two haplotypes of the morphotype without stilt roots were distributed north and south of the Ogooué River, suggesting refuges on both sides of the river bed. CONCLUSIONS: The divergence between Upper and Lower Guinean rainforests is explained by the discontinuity of forest between those regions throughout most of the Quaternary. The distribution of rare endemic haplotypes concurred with proposed Pleistocene rainforest refuges in west and southwest Cameroon. Overall, phylogeographic structure is consistent with the biogeographic hypotheses largely based on patterns of species diversity.

[Knowledge, attitudes and practices of healthcare providers in Togo regarding prevention of mother-to-child transmission of HIV in 2010]. / Connaissances, attitudes et pratiques des prestataires de soins en matière de prévention de la transmission du VIH de la mère à son enfant en 2010 au Togo.

OBJECTIVE: To evaluate the knowledge, attitudes and practices of health care providers (HCP) in Togo regarding prevention of mother-to-child transmission of HIV (PMTCT). METHOD: A cross-sectional study was conducted in 22 antenatal clinics with PMTCT programs from January 18 to February 6, 2010. Clinic selection was based on attendance and local factors. Data were collected through interviews conducted by 23 trained investigators. RESULTS: A total of 97 HCP were interviewed at the 27 selected clinics. Most, i.e., 76%, had received PMTCT training. In terms of knowledge, interview data revealed the following strengths: 83% of HCP identified transmission from mother to child as the main route of HIV transmission in children < 15 years; 87% asserted that HIV-infected pregnant women do not always transmit HIV to their children; 77% knew that the ELISA test was performed after 18 months: and 96% had a clear notion about feeding infants born to HIV-infected mothers. Knowledge assessment revealed the following weaknesses: 30% of HCP had never heard of polymerase chain reaction; 27% said that confidentiality about HIV status was not always necessary; and 22% were unaware that decontamination of equipment using a chlorine solution kills HIV. In addition, interview data revealed the following positive attitudes and practices: 83% of HCP were willing to continue working in a center with a PMTCT program and 87% referred women pregnant for the HIV serology. On the negative side, however, only 27% of HCP summonsed husbands whose wives tested positive for HIV. CONCLUSION: This investigation shows that the knowledge, attitudes and practices of HCP in Togo regarding PMTCT is fairly good. However, it also revealed several weaknesses that should be addressed by further training.

[Trachoma rapid assessment in the infantile population of Togo]. / Evaluation rapide du trachome infantile au Togo.

AIM: The aim of this study was to determine the prevalence and types of trachoma in children of central Togo. MATERIALS AND METHODS: This descriptive cross-sectional investigation was conducted in central Togo in November 2009. At every peripheral health unit (PHU) in 2 villages of the sanitary district, 15 schoolchildren between 6 and 9 years old and 35 children from the community between 1 and 5 years old were examined to detect signs of trachoma using a lamp wipes coupled with binocular magnifying loupes (2.5X). Data were analysed with Excel 2007. RESULTS: A total of 8200 children were examined at 82 PHU in 164 villages in the sanitary districts. In the 1-5 year age group including 5,740 children, follicular trachomatous inflammation (TF) was observed in 326 cases and intense trachomatous inflammation (TI) in 9 for a prevalence rate of 5.83%. In the 6-9 year age group including 2,460 schoolchildren, TF was observed in 144 and TI in 8 for a prevalence rate of 6.18%. The overall prevalence rate of active trachoma was 5.94 % (n = 487). CONCLUSION: This study confirms the persistence of active trachoma in children in central Togo. Trachoma may be public health problem in 2 districts: Blitta and Sotouboua. A population-based survey will be carried our to evaluate trachoma prevalence prior to implementation of the SAFE strategy in this region.

[Immunological aspects of a case of extragenital endometriosis localized in the mouth]. / Aspects immunologiques d'un cas d'endométriose extra-génitale à localisation buccale à Abidjan.

To appreciate the role of the immune system in transportation and development of endometer cells in mouth, authors reported the results of immunological parameters analysis in one patient suffering to a mouth localisation healed endometriosis out of hormonal therapy in experimental and analytic study. Immunoglobulin A, G, M and C3, C4 complement fractions were measured by Mancini radial immunodiffusion. The count of CD4+, CD8+and B Cell was performed by BD FASCalibur flow cytometer. Autoimmune diseases were searched after by measuring autoantibodies using agglutination and immunofluoresence methods. The results showed any antibodies detected and the count of CD4, CD8 and B cells was normal. However, IgG and IgA increased. But C3, C4 factions and IgM decreased. This seems an immunological disorder which could be more explored in NK cells and cytokines study.

The Effect of Imatinib Mesylate for Newly Diagnosed Philadelphia Chromosome-Positive, Chronic-Phase Myeloid Leukemia in Sub-Saharan African Patients: The Experience of Côte d'Ivoire.

Imatinib mesylate, showed encouraging activity in chronic myelogenous leukemia. However, there are few data regarding his efficacy and response monitoring in Sub-Saharan African patients. Our objective was to assess response to imatinib mesylate (Glivec) in Côte d'Ivoire patients with newly diagnosed Chronic Myeloid Leukemia (CML). From May 2005 to September 2009, we treated 42 patients (40 years; range 16-69) with Philadelphia chromosome (Ph+) positive in chronic phase CML with oral imatinib mesylate at daily doses of 400 mg. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. At a median follow up of 32 (range 7.6-113) months, the CHR rate in our study group was 76%. A major CR was found in 19 patients (45%) with 17% and 29% complete and partial CR respectively. There were no significant differences in the incidence of major cytogenetic response by known prognostics factors. Median time to CHR was 8 months (range 0.4-25), and 16 months (range: 0.1-36) for CR. Projected 5-year OS rate was 72% (95%CI 42-88). We conclude that imatinib therapy sub-Saharan African CML patients is very promising and has favorably changed the prognosis for black African patients with CML.

Aplasia cutis congenita associated with Goltz syndrome in a male neonate.

Here we report the association of giant aplasia cutis congenita in a newborn black male with Goltz syndrome. The cutis aplasia defect is extensive and circonscript at the vertex. The cerebral structures are visible through the lesions. In addition, the patient has a low birth weight, syndactyly, adactyly, cutaneous atrophy, and areas of hyperpigmentation on the legs and hypoplastic maxillary. We think that these signs are probably due to mosaic mutations in PORCN. We reviewed 18 cases of Goltz syndrome in 18 male neonates but none has aplasia cutis congenita. Such a combination of severe aplasia cutis congenita was not reported previously in Goltz syndrome.

[Is the mother a risk factor for transmission of Helicobacter pylori infection in children between the ages of 6 months and 5 years in Côte d'Ivoire?]. / La mère est-elle un facteur de risque de transmission de l'infection a Helicobacter pylori a l'enfant de 6 mois a 5 ans en Côte d'Ivoire?

OBJECTIVES: The goals of this study were to determine the prevalence of H. pylori antibodies in children, to establish the relationship between child and mother serostatus, and to identify potential risk factors for contamination. MATERIAL AND METHODS: A cross-sectional study was conducted over a 3-month period. All children between 6 months and 5 years of age examined in the Pediatrics Department of the University Hospital Center in Yopougon, Côte d'Ivoire were included after obtaining informed consent from their mothers. Testing for H. pylori antibodies using Pylorix (Acon) was performed in both children and mothers. Based on test results, children were divided into two groups, i.e. case group with H. pylori antibodies and control group without H. pylori antibodies. Case and control groups were compared according to the H. pylori status of their mother and several potential lifestyle and environmental factors. RESULTS: A total of 101 children and 101 mothers were included. The prevalence of H. pylori antibodies was 40.6% in mothers and 24.8% in children. The mean age of children (53% male) was 22.8 +/- 15.6 months (median, 18 months). The mean age of the mothers was 29.6 +/- 5.5 years (range, 19 to 46 years; median, 29 years). Most mothers, i.e., 78.2%, lived in two-parent households but 19% lived in single-parent settings (community or shacks). The number of persons living in the same house ranged from 2 to 20 people (mean, 7.2 +/- 3.8; median, 6 people). Mean monthly household income was 226,188 +/- 161,425 FCFA (range: 30,000 - 750,000 FCFA). In the case group, 80% of children had mothers infected with H. pylori. In the control group, 73.7% of children had non-infected mothers (OR = 11.2, p < 0.001). Median income was less than 150 000 FCA in 76% of families with seropositive children in comparison to 46.1% of families with seronegative children (p = 0.009). CONCLUSION: This study confirms the early occurrence of H. pylori infection in children. Findings also showed that poor socio-economic condition was a risk factor for infection but the greatest risk factor was living with a mother infected with H. pylori.

[Therapeutic impact of alpha interferon in chronic myelogenous leukaemia]. / Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique.

CONTEXT: Ten years after the use of alpha interferon in chronic myelogenous (CML) leukaemia treatment, we review this treatment. OBJECTIVE: We propose through this study to evaluate the therapeutic answer of the patients reached of CML in chronic phase and to study its impact on survival. MATERIAL AND METHODS: To be done we carried out a descriptive and analytical retrospective study concerning 40 patients carrying Chronic Myelogenous Leukaemia. RESULTS: The average age was 39.05 years and ratio sex was 0.9. 60% of the patients profited from the arm Hydroxyurea + Interferon alpha + Cytosine Arabinoside and 40% from Hydroxyurea + Interferon. The complete haematological answer was observed in 85.5%. The cytogenetic answer was documented only for two cases, and it acted of complete answer. On the evolutionary level, it was noted 27.5% of deaths related to a blastic transformation. The side effects were marked by occurred of alopecia, herpes and the gripal syndrome. The median of survival observed was 68.233 months or 5.68 years. The age, socioeconomic level, delay of treatment started, therapeutic protocol, length and regularity of treatment influenced the therapeutic response. CONCLUSION: Many factors influence the treatment response.

[Chronic lymphocytic leukemia in Subsaharian Africa: clinical outcome experience of Côte d'Ivoire]. / La leucémie lymphoïde chronique du Noir en Afrique subsaharienne : caractéristiques cliniques thérapeutiques et pronostiques (cas de la Côte d'Ivoire).

We reported in this retrospective study the clinical outcome of 56 chronic lymphoïd leukemia of black African in Ivory Coast and the predicting prognosis factors. The mean age was 62 years old with average of 38 to 84 years. According to Binet staging, 29 patients with stage A, and respectively 11 and 16 patient for stage B and C. All patient received chemotherapy protocol regimens (CVP, chlorambucil, CHOP). The global response was 51.78%. The death occurred in 29 patients. The mean survival was 8.22 years. The disease free survival was 58.8% at 5 years. In univariate analysis, factors with high-risk of death are patients age above 60 years, the presence of node, liver involvement, Spleen large IV and V of Hackett classification, WBC superior to 100,000/microL, lymphocytosis superior to 63,000/microL, Anaemia inferior to 10 g/dL, thrombopenia inferior to 100,000/microL, medullar lymphocytosis superior to 73% and Binet Stage B and C. In multivariate analysis, only age, adenopathy, hepatomegaly and lymhocytosis were an independent prognostic factor for predicting survival.

Tuberculosis of the cervix and infertility: report of a rare case.

Tubercolosis is a frequent bacterial infection in less developed countries. Lung and lymph node localisations are common, while the genital apparatus is less involved. In this work a rare case of cervical tuberculosis followed by some lesions causing infertility in a 20-year-old woman is reported. The diagnosis was confirmed by a histological examination from a biopsy of the cervix. The patient was offered six-month antituberculosis therapy which eliminated the cervical lesions. A few years later she came under our care for infertility due to uterine adhesions diagnosed by hysterosalpingography. Now the patient is being treated for infertility complicated by amenorrhoea.

[Is hepatomegaly a prognosis factor of chronic myeloid leukaemia among African blacks?]. / L'hepatomegalie est-elle un facteur pronostic de la LMC du Noir Africain?

It acts of a retrospective study relating to 74 patients reached of chronic Leukaemia myeloid (LMC) over one 5 year period followed in the clinical service of hematology of the University Hospital of Yopougon (Abidjan, Ivory Coast). The splenomegaly is quasi-constant in chronic phase of the disease often associated hepatomegaly in 20.27% of the cases which constitutes a pejorative factor of the LMC. Indeed, the hyperleukocytosis of more than 300,000 white globules is correlated with the presence of hepatomegaly (p=0.0005) with risks of portal hypertension. 80% of the patients carrying the LMC with a clinical hepatomegaly in chronic phase of the disease have against an incomplete hematologic remission 20% of complete remission (P = 0.002) among patients without hepatomegaly. The strong rate of death (73.33%) recorded occurred among patients carrying a hepatomegaly against 15.25% of death without hepatomegaly (P = 0.0001). The overall rates Total survival is on average 17 months against 20 months 28 days in the event of absence of the hepatomegaly (P = 0.0001).

[Anemic complications of sickle cell disease: frequency and evolution of 338 cases reported at Yopougon Teaching Hospital]. / Les complications anémiques de la drépanocytose homozygote: fréquence et évolution. A propos de 338 cas au CHU de Yopougon.

INTRODUCTION: Anemic complications of sickle cell disease are defined as all acute or chronical complications due to anemia. In order to describe complications of sickle cell disease, authors reported frequency and course of anemic manifestations. METHOD: This is a descriptive study based on retrospective analysis of data about 338 patients with sickle cell disease collected in the Service d'hematologie Clinique of Yopougon Teaching Hospital over a period of 11 years (March 1994 to September 2005). RESULTS: Mean age of our patients was 21.34 years, ranging from 7 months and 62 years.Majority of patients (68.93%) are aged 15 years or more. Male patients are predominant, with a sex-ratio of 1.36 and most of our patients (98.82%) are from low social condition. Anemic complications were the most occurring complications in our patients with a frequency of 18.78%. Acute anemic complications are the most frequently noticed (87.87%), among which acute crises of deglobulization are mainly present (94.27%). Chronical anemic complications are noticed in 23.67%of our patients and consist mainly of gall bladder lithiasis (20.12%). Death occurred in 10.35% of our patients and was due to anemic complications in 42.86% of cases. COMMENTS: The predominance of acute anemic complications may be due to the comorbidity observed in most of our major sickle cell disease patients. It may turn a chronical haemolytic anemia in acute hemolysis which is a major complication. CONCLUSION: Sickle cell disease has become nowadays a disease of little letality. Its anemic complications are the most important ones in our working conditions.