[Epidemiological and clinical profile childhood cancers with pleural and pulmonary lesions in the pediatric oncology unit of Treichville University Hospital (Abidjan, Côte d'Ivoire)]. / Profil épidémiologique et clinique des cancers pédiatriques avec atteintes pleurales et pulmonaires au service de pédiatrie du CHU de Treichville (Abidjan, Côte d'Ivoire).

INTRODUCTION: Pediatric cancers are a major public health problem in sub-Saharan Africa. However, they are seldom studied, especially as regards in their extensive forms. METHODOLOGY: An eight-year retrospective and descriptive study was carried out so as to specify the epidemiological and clinical characteristics of cancers with pleural and pulmonary involvement in children of 0 to 14years of age in the pediatric oncology unit at the University Hospital of Treichville, Côte d'Ivoire (Ivory Coast). RESULTS: The frequency of pleural and pulmonary involvement in pediatric cancers was 13.8%. Children's average age was 7.2years, with sex ratio at 2.11. Solid tumors were predominant, with a predominance of Burkitt's lymphoma (39.3%) and nephroblastoma (35.7%). The most affected age groups were 10 to 15years (Burkitt's lymphoma) and 0 to 5years (nephroblastoma). Time to diagnosis ranged from 31 and 60days in 40.4% of cases, and time to treatment was at most 30 days, for the overwhelming majority (97.1%) of the children. Chemotherapy was initiated in 67.9% of patients. Hospital mortality was 73.2%. CONCLUSION: Through this study, the authors established the profile of childhood cancers with pleural and pulmonary involvement. Comparative studies of mortality in pediatric cancers with and without pleural and pulmonary involvement could further underline the importance of early management before dissemination.

[Contribution Of The Cytology In The Diagnosis And Evaluation Of The Pronostic Of Metastatic Ascites]. / Contribution De La Cytologie Au Diagnostic Et A L'Evaluation Du Pronostic Des Ascites Metastatiques Au Mali.

INTRODUCTION: Metastatsic tumoral ascites are characterised by the presence of cancerous cells in peritoneal fluid. They are frequent at an advanced stage of cancer. The goal of our work was to study cytology's contribution in the diagnosis of metastatic ascites at the teaching hospital of Point G. MATERIAL AND METHODS: It was a 3 years retrospective and prospective study, from January 2013 to December 2015. The study included every ascitic samples containing malignant cells at the teaching hospital of Point G. We looked for clinical informations in the patient's fold to find the primary cancer site, the histological diagnosis and the folllowup. RESULTS: We collected data from 213 patients with ascite. Among them, 61 where malignant (28.6 %). Sixty-six percent (66%) of our patients were women. The most represented range age was from 46 to 60 years with a mean of 57.7 years. Housewives were the most frequent among our patients with a rate of 50.8%. Ovarian cancer was the first site with metastatic ascite (26%). It was followed by liver and stomach with respectively 20% and 18%. Ascite was the first clinical manifestation in 36% patients with cancer. It was isolated in 78%. After 6 months, the mortality rate was 76.6%. CONCLUSION: The cytology of ascite liquid is an imortant test for the diagnostic of metastatic ascites.

INTRODUCTION: Les ascites métastatiques cancéreuses sont caractérisées par la présence de cellules cancéreuses métastatiques dans le liquide péritonéal. Elles sont fréquentes à un stade avancé des cancers. Il s'agissait de déterminer la contribution de la cytologie au diagnostic et à l'évaluation du pronostic des ascites métastatiques dans le service d'Anatomie et Cytologie Pathologiques du CHU du Point G. MATÉRIEL ET MÉTHODE: Notre étude s'est étendue de Janvier 2013 à Décembre 2015; soit une période de 3 ans. Elle était rétrospective et prospective incluant tous les patients dont l'étude cytologique des liquides d'ascitea mis en évidence des cellules malignes. Le dossier médical des patients a été exploité pour la recherche du site primitif et du diagnostic histologique éventuel et le suivi. RÉSULTATS: Sur 213 examens cytologiques de liquide d'ascite; 61 étaient malins, soit un taux de 28,64%. La tranche d'âge la plus répresentée était de 46 à 60 ans avec un âge moyen de 53,7 ± 14,7 ans. Le sexe féminin était dominant avec un taux de 66%. La profession la plus fréquente était les ménagères soit un taux de 50,82%. Le siège primitif le plus fréquent était l'ovaire (26%). Il était suivi par le foie et l'estomac avec respectivement 20% et 18%. L'ascite a été le signe révélateur du cancer dans 36% des cas. Elle était isolée dans 78%. Après 6 mois de suivi, le taux de mortalité était 75,6%. CONCLUSION: L'examen cytologique constitue un examen paraclinique dans le diagnoticdes ascites metastatiques cancéreuses.

[Use of the Xpert® MTB/RIF test in routine screening of new cases of pulmonary tuberculosis in an endemic area]. / Test Xpert® MTB/RIF et dépistage des nouveaux cas de tuberculose pulmonaire en routine dans une zone de haute endémicité tuberculeuse.

BACKGROUND: Developed initially for the diagnosis of multidrug-resistant tuberculosis, the Xpert® MTB/RIF test has shown to be useful for the diagnosis of tuberculosis, especially among HIV-infected subjects. The objective of the study was to determine the contribution of the Xpert® MTB/RIF test for routine pulmonary tuberculosis diagnosis in an endemic area. METHODOLOGY: We undertook a prospective study among patients presenting with cough and sputum. The sputum was submitted to microscopic examination, to the Xpert® MTB/RIF test and cultured by the Mycobacteria growth indicator tube (MGIT) technique. The study compared cases of pulmonary tuberculosis confirmed by a positive sputum culture and cases with cough but negative sputum culture. RESULTS: In multivariate analysis, the factors associated with positive cultures were the following: male gender, cough for more than 2 weeks, loss of weight and fever. The estimated clinical suspicion score consisted of 4 signs each having a coefficient of 1. The sensitivity of each clinical sign varied between 79 and 94%. In 348 cases of negative microscopic examination (composed of 295 cases with score<4 and 53 cases with score=4), the predictive positive value of the Xpert® MTB/RIF was 80% for a score equal to 4 and 40.9% for a score<4. In cases of negative microscopic examination of the sputum, the Xpert® MRT/RIF test should be undertaken if the score=4. CONCLUSION: The diagnosis of tuberculosis in endemic zones could be improved by using the Xpert® MTB/RIF.

[Current situation of primary prophylaxis with isoniazid (INH) in children who are contacts of patients with bacillary pulmonary tuberculosis in Abidjan (Cote d'Ivoire)]. / Situation actuelle de la chimioprophylaxie primaire à l'isoniazide (INH) chez les enfants contacts des patients atteints de tuberculose pulmonaire bacillifère à Abidjan (Côte d'Ivoire).

INTRODUCTION: The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital. MATERIAL AND METHOD: We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment. RESULTS: Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339). CONCLUSION: High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children.

[Ivory Coast physician's knowledge and attitudes about smoking in patients with tuberculosis]. / Connaissances et attitudes des médecins ivoiriens vis-à-vis du tabagisme chez les patients atteints de tuberculose.

INTRODUCTION: Smoking promotes, among other health problems, the development of tuberculosis and the discovery of a case of tuberculosis can therefore be an opportunity for tobacco control interventions. METHODS: We conducted a prospective study evaluating the knowledge of 37 Ivorian physicians (32 men and 5 women with 5 active smokers) on the relationship between smoking and tuberculosis and their attitudes to smoking tuberculous patients between February and August 2012 using an anonymous self-administered questionnaire. RESULTS: The response rate to the questionnaire was 88.1%. Among them, 70.3% of Ivorian physicians knew that smoking increased the incidence of tuberculosis, 75.7% said that forms of tuberculosis were more severe in smokers and about 27% thought that the cure rate of tuberculosis was lower in smokers. No significant difference was observed according to respondents' smoking status, or gender. Patients' smoking status was always assessed by 64.9% of physicians and by 78.4% in patients with tuberculosis, again not differing by physicians' smoking status or gender. The risks of smoking were always explained to patients with active pulmonary tuberculosis by 43.2% and benefits of stopping smoking ware always described in 35.1%. An intervention for smoking cessation was systematically offered to smokers having tuberculosis by 59.4% of physicians and 8.1% offered medication for smoking cessation. CONCLUSION: These results strongly support the need to reinforce physician behaviors to address smoking in patients with tuberculosis in Ivory Coast.

[Extensively drug resistant tuberculosis in Ivory Coast]. / Tuberculose ultrarésistante en Côte d'Ivoire.

INTRODUCTION: The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. CONCLUSION: XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.

[Effects of war on control of tuberculosis in Côte d'Ivoire from 2002 to 2007]. / Effets de la guerre sur le contrôle de la tuberculose en Côte d'Ivoire de 2002 à 2007.

OBJECTIVES: To specify consequences of armed conflict in Côte d'Ivoire from 2002 to 2007 on treatment outcomes of new cases of smear-positive pulmonary tuberculosis (PTB+) and retreatment cases. METHODOLOGY: Retrospective analysis of treatment outcomes and reprocessing notified to the National Program against Tuberculosis from 2001 to 2008. RESULTS: Totally, 7,4232 cases of TPM+ and 5094 cases of reprocessing had been declared during the war period in Côte d'Ivoire. The global average rate of therapeutic success was 72% with a lower average rate of success in retreatment in Center, Northern et Western (CNO) zone (54%) than in Southern zone (73%). The average rate of lost sight was higher in CNO zone than in the South with respectively 27% and 11%. The average rate of success in retreatment was 60% on the national level with a lower rate in CNO zone (48%) than in the South zone (62%) and the average rate of lost sight in retreatment was higher in CNO zone than in the South zone (28% versus 16%). CONCLUSION: Our results show that there was no early epidemic of tuberculosis during the armed conflict in Côte d'Ivoire which has although severely disrupted activities of tuberculosis management in ex-nongovernmental zone.

[Simvastatin indused chylothorax]. / Chylothorax induit par la simvastatine.

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin.

Avian influenza and Newcastle disease in three risk areas for H5N1 highly pathogenic avian influenza in Mali, 2007-2008.

Our survey aimed to investigate avian influenza (AI) and Newcastle disease (ND) prevalence and risk factors in three areas of Mali at risk for occurrence of H5N1 highly pathogenic avian influenza. Blood samples and cloacal and oropharyngeal swabs were collected from 1470 birds between February 2007 and May 2008 and were tested by commercial enzyme-linked immunosorbent assay to detect antibodies and real-time reverse-transcription (rRT)-PCR to detect virus. Risk factors associated with seropositivity or positive rRT-PCR were identified by random effect logistic regression. AI seroprevalence was significantly lower in birds from commercial farms (0%) than in village backyard birds (3.1%). For backyard birds, no individual risk factors (species, age, sex) were identified, but birds in the Mopti area in the Sahelian zone, where millions of wild birds migrate, were more seropositive than in the Sikasso area in the Sudano-Guinean zone (odds ratio [OR] = 2.0, P = 0.051). Among backyard birds nonvaccinated against ND, ND seroprevalence was 58.4%, and the odds of seropositivity was 2.0 higher in chickens than in ducks, 1.7 higher in females than in males, 3.1 higher in adults than in young birds, and 3.0 higher in poultry from the Sikasso area than from the Mopti area (P < 0.01 in all cases). Prevalence established by rRT-PCR was low for both AI virus (1.1%) and ND virus (2.6%) and was associated with no risk factors for AI but was higher in chickens than in ducks (OR = 5.3, P = 0.05) and in the Sikasso area than in the Mopti area (OR = 3.4, P = 0.027) for ND. For AI and ND, prevalence assessed by serology or rRT-PCR varied over time, although seasonal and interannual variation could not be clearly distinguished. The intracluster correlation coefficient for serologic data was low for AI (0.014) and higher for ND (0.222). These results are useful to optimize surveillance and control strategy for notifiable avian diseases in African countries with similar agroecological and resource-limited contexts.

[Epidemiology of rinderpest and cattle plague in Mali: serological surveys]. / Epidémiologie de la peste des petits ruminants (PPR) et de la peste bovine au Mali: enquêtes sérologiques.

Within the epidemiological surveillance of rinderpest in Mali a serological survey has been carried out on 58 herds of small ruminants. Out of 567 tested sera for the detection of antibodies against rinderpest 2 were positive. These sera were collected from two animals over 6 years old, probably infected during the last outbreak of rinderpest in Mali in 1986. Therefore, it can be assumed that the rinderpest virus has not circulated in Mali since that year. However, the infection rate among goats and sheep due to the PPR virus seemed to be high: 74% of herds had already been infected. The prevalence of individual infection is 32%. A similar serological survey was conducted on 450 cattleheads, without antibodies against the rinderpest virus and showed that 1.78% of these animals had been in contact with the PPR virus. With such a low infection rate in cattle, the PPR virus probably has no incidence in the epidemiology of rinderpest in Mali.