A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives.

Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.

[Squamous cell carcinoma associated with use of skin-lightening cream]. / Carcinome épidermoïde associé à une dépigmentation volontaire.

BACKGROUND: Women widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali. PATIENTS AND METHODS: A 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later. DISCUSSION: The high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.

[Management of chronic osteomyilitis of limbs at kati teaching hospital]. / Prise en charge des osteomyelites chroniques des membres au chu de kati.

OBJECTIVES: the purpose of this work was to describe the epidemiological, clinical, paraclinical and therapeutic aspect of surgical treatment of chronic osteomyilitis of limbs. PATIENTS METHODS: it was a retrospective study over a period of 12 years, from January 2003 to December 2014. It covered all cases of chronic osteomyelitis osteonecrosis treated our service. RESULTS: The authors report the results of the surgical treatment of a series 56 patients operated on for chronic limb osteomyelitis. The mean age was 20.7 years with extremes of 6 months and 56 years. The tibia and femur were the most affected segments. Staphylococcus aureus was the most frequently found germ, 80% of the cases. We obtained complete healing with total cure in 68% of cases and recurrence of suppuration in 32% of cases. CONCLUSION: Chronic osteomyelitis of limbs is a frequent pathology in Africa. Staphylococcus aureus was the most frequently found germ. Surgery in a time seems a good alternative. The rate of recurrence of the suppuration remains high.

OBJECTIF: Le but de ce travail était de présenter les aspects épidémiologiques, cliniques, bactériologiques, radiologiques et thérapeutiques des ostéomyélites chroniques des membres. MÉTHODES: Nous avons réalisé une étude rétrospective sur une période de 12 ans allant de Janvier 2003 à décembre 2014. Elle a porté sur tous les cas d'ostéomyélites chroniques pris en charge chirurgicalement dans notre service. RÉSULTATS: Nous avons recensé 56 cas d'ostéomyélite chronique des membres. L'âge moyen était de 20 ans avec des extrêmes de 6 mois et 56 ans. Le sex-ratio était de 1,9. Le tibia et le fémur ont été les os les plus atteints. Staphylococcus aureus a été le germe le plus fréquent soit 80% des cas. Nous avons obtenu la cicatrisation parfaite de la plaie dans 68% des cas et la récidive de la suppuration dans 32% des cas. CONCLUSION: L'ostéomyélite chronique des membres est une pathologie fréquente en Afrique. Staphyloccocus aureus demeure le germe le plus fréquent. La chirurgie en un temps nous paraît une bonne alternative. Le taux de récidive de la suppuration reste élevé.

[Anesthesic practice for gynecological and obstetric emergency in the Cocody CHU]. / Pratique anesthesique pour urgences gynecologiques et obstetricales au CHU de Cocody.

OBJECTIVE: To evaluate the anesthetic practice in the operating theater of gynecological and obstetric emergencies. MATERIAL AND METHOD: Prospective, descriptive and analytical study on patients admitted to the operating room for a gynecological and or obstetric emergency over a period of six months. RESULTS: We collected 3,486 patients out of 7,574 admissions, or 46.02%. The average age was 27.3 years with extremes of 15 and 45. SFA was the first operative indication for obstetric emergencies while gynecological emergencies were dominated by first trimester bleeding. 99.39% of the patients benefited from a CPA and 45.40% of them, were classified ASA I u. LAR by spinal anesthesia was the most commonly performed anesthetic regimen. Maternal lethality was 0.005. For the mother, the age group [30-45 years], the provenance, the hemorrhagic syndromes, the ASA III and IV classes, the long delays in transfusion and block management were factors of poor prognosis. (P≤0.05) For the fetus, hemorrhagic syndromes and general anesthesia were factors of poor prognosis. (P ≤ 0.05). CONCLUSION: Spinal anesthesia was the most widely used anesthetic regimen.

OBJECTIF: Evaluer la pratique anesthésique au bloc opératoire des urgences gynécologiques et obstétriques. MATÉRIEL ET MÉTHODE: Etude prospective, descriptive et analytique portant sur les patientes admises au bloc opératoire pour une urgence gynécologique ou obstétrique sur une période de six mois. RÉSULTATS: Nous avons colligé 3486 patientes sur 7574 admissions soit 46,02%. La moyenne d'âge était de 27,3 ans avec des extrêmes de 15 et 45 ans. La SFA était la première indication opératoire pour les urgences obstétricales tandis que les urgences gynécologiques étaient dominées parles métrorragies du premier trimestre. La majorité de nos patientes ont eu une consultation pré-anesthésique. L'ALR par rachianesthésie était le schéma anesthésique le plus réalisé. La létalité maternelle était de 0,005. Pour la mère, la tranche d'âge [30-45 ans], la provenance, les syndromes hémorragiques, les classes ASA III et IV, les longs délais de transfusion et de prise en charge au bloc ont constitué des facteurs de mauvais pronostics. (P≤0,05)Pour le fœtus, les syndromes hémorragiques et l'anesthésie générale constituaient les facteurs de mauvais pronostics. (P≤0,05). CONCLUSION: La rachianesthésie était le schéma anesthésique le plus utilisé.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]. / Prevalence de la maladie renale au service des urgences de l'hopital Fousseyni Daou de Kayes.

INTRODUCTION: Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study. OBJECTIVES: to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes. METHODOLOGY: Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found. RESULTS: the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension. CONCLUSION: kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

INTRODUCTION: La maladie rénale (MR) définie comme l'ensemble des anomalies rénales fonctionnelle, morphologique et histologique. Elle est un véritable problème mondial de santé publique. Sa prévalence serait 50 fois celle de l'insuffisance rénale terminale (IRT). A Kayes, il n'existe pas de donnée sur la prévalence de la maladie rénale, d'où l'intérêt de cette étude. OBJECTIFS: déterminer la prévalence de la maladie rénale, ses principales causes et les principaux facteurs d'aggravation de cette pathologie dans le service des urgences de l'hôpital Fousseyni DAOU de Kayes. MÉTHODOLOGIE: Etude transversale rétrospective réalisée du 1er janvier 2014 au 1er février 2015. Etaient inclus, tous les patients hospitalisés chez qui au moins un marqueur d'atteinte rénale (élévation de la créatinine plasmatique, anomalie du sédiment urinaire, anomalie échographique ou histologique et une protéinurie significative) a été retrouvé. Les paramètres analysés étaient socio-épidémiologiques, cliniques et para-cliniques. Nous avons exclu tous les patients dont les dossiers médicaux étaient inexploitables. RÉSULTATS: la prévalence de la maladie rénale était de 9,9% (109/1099). Quatre-vingtneuf répondaient aux critères d'inclusion. La population d'étude était composée de 47 femmes (52,8%) et de 42 hommes (47,2%), avec un sex-ratio de 0,89 en faveur des femmes. La moyenne d'âge était de 40,09 ans avec une prédominance des patients de la tranche d'âge [40-59]. Les principaux motifs de consultation étaient hypercréatininémie (48,3%), syndrome œdémateux (16,9%), douleur lombaire (10,1%). L'hypertension artérielle (55,1%) et œdème des membres inférieurs (46,1%) étaient les antécédents pathologiques fréquemment retrouvées dans notre étude. La maladie rénale retrouvée était par ordre de croissance : insuffisance rénale chronique (51%) ; insuffisance rénale aigue (28%) ; protéinurie (16%), hématurie (3%), anomalie morphologique des reins (2%). La néphropathie tubulo-interstitielle représentait 64% des insuffisances rénales aiguës avec P= 0,000306. La néphropathie vasculaire constituait 46,7% des insuffisances rénales chroniques avec P= 0,000251. Aucun cas de néphropathie glomérulaire n'a été retrouvé chez les patients de plus de 60 ans.Les causes les plus fréquentes étaient représentées par les causes toxiques (médicaments néphrotoxiques) ; infectieuses ; l'hypertension artérielle et le diabète. Les facteurs d'aggravations les plus observés sont la phytothérapie, l'infection urinaire, l'hypoperfusion rénale et l'HTA non équilibrée. CONCLUSION: la maladie rénale n'est pas rare aux urgences de l'hôpital Fousseyni Daou de Kayes. Les causes les plus fréquemment rencontrées sont les médicaments néphrotoxiques, l'HTA et le diabète.

[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.

[Aseptic nonunion of patella at the Centre Hospitalier Universitaire Bocar Sidy Sall de Kati about 25 cases]. / Pseudarthrose aseptique de la patella au Centre Hospitalier et Universitaire Bocar Sidy Sall (CHU-BSS) de Kati a propos de 25 cas.

OBJECTIVE: The objective of Our study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of Nonunion of patella fractures. PATIENTS METHODS: It was a retrospective study done concerning 25 patients treated fromJanuary 2005 to December 2015 in the orthopedic trauma service CHU Bocar Sidy SALL Kati. RESULTS: We gather together 25 cases of Nonunion of patella fractures disease among 28 caseswhich was about 89.28%. Our patients were divided into 20 men and 5 women, mean age was 36 years, ranging from ages 22 to 75 years. Posttraumatic period was 6-18 months. The initial fracture was neglected in 21 cases and treated in 4 cases. Physical examination revealed lameness in 92% of cases, atrophy of the quadriceps in 56% of cases, joint stiffness, 56% and an inter-fragmentary gap in 92% of patients. The radiographic data were consistent with pseudoarthrosis in all cases. The inter-fragmentary gap was 36 mm on average. The care of our patients was based on plugging and guy-wiring in 64 % of cases and strapping pre- and peri patella in 12% of cases. A partial patellectomy was practiced in 2 cases. A VY plasty of the quadriceps was recommended in 4 cases.The patients were reviewed after a mean of 10 months (8 months- 24 months). Functional outcomes analyzed using Bostman scores were excellent in 4 cases (16%), good in 18 cases (72%) and poor in 3 cases (12%). CONCLUSION: Nonunion of the patella is mostly due to the lack of treatment or wrong treatment leads. Treatment with plugging and guy-wiring seems the most appropriate method.

OBJECTIF: l'objectif de notre étude était décrireles aspects épidémiologiques, cliniques, thérapeutiques et pronostiques de la pseudarthrose de la patella. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective concernant 25 patients colligés entre janvier 2005 et décembre 2015 dans le service d'orthopédie et de traumatologie du CHU Bocar Sidy SALL de Kati. RÉSULTATS: Nous avons colligé 25 cas de pseudarthrose aseptique de la patella sur 28 cas, soit 89,28%. Nos patients se répartissaient en 20 hommes et 5 femmes. L'âge moyen était de 36 ansavec des extrêmes de 22 et 75 ans. Ledélai post traumatique était de 6-18 mois. La fracture initiale était négligée dans 21 cas et traitée dans 4 cas. L'examen clinique retrouvait une boiterie dans 92%, une amyotrophie du quadriceps dans 56%, une raideur du genou dans 56%, et un vide inter-fragmentaire dans 92%. Les données radiographiques étaient compatibles avec la pseudarthrose de la patella dans tous les cas. L'écart inter-fragmentaire était de 36 mm en moyenne. La prise en charge de nos patients reposait sur l'embrochage-haubanage dans 64%, le cerclage péri-rotulien dans 12%, une patellectomie partielle dans 2 cas (8%) et une plastie du quadriceps en VY était préconisée dans 4 cas (16%). Les patients étaient revus après un recul moyen de 10 mois (8mois-24mois). Les issues fonctionnelles analysées selon le score de Bostman étaient excellentes dans 4 cas (16%), bonnes dans 18 cas (72%) et mauvaises dans 3 cas (12%). CONCLUSION: la pseudarthrose de la patella est surtout le fait de l'absence du traitement ou d'un traitement mal conduit. Le traitement par l'embrochage-haubanage semble la méthode la plus indiquée.

Short-term follow up of cervical squamous intraepithelial lesions associated with HIV and human papillomavirus infections in Africa.

A prospective study in gynaecology clinics was conducted in Abidjan, Côte d'Ivoire, to assess the short-term evolution of squamous intraepithelial lesions (SILs). Of 94 women with a cytological diagnosis of SIL, 38 were infected with HIV. The average follow-up period after the initial smear was 5 months. Detection of human papillomavirus (HPV) by polymerase chain reaction (PCR) was performed at both the time of enrolment and final follow-up smear. There were 39 cases of persistent SILs. HIV-positive women had a higher percentage of persistent SIL (76%) than HIV-negative women (18%, relative risk (RR)=4.3, 95% confidence interval (CI) = 2.4, 7.7). SILs were more frequent among women infected with HPV at the time of enrolment or with persistent HPV infection, but these associations disappeared after adjusting for HIV serostatus. Spontaneous regression of SILs commonly occurs in HIV-negative African women. HIV-infected women with cervical dyskaryosis require gynaecology follow-up.

PIP: A prospective study was conducted in a gynecology clinic in Abidjan, Cote d'Ivoire, to assess the short-term evolution of cervical squamous intraepithelial lesions (SIL) associated with HIV and human papillomavirus (HPV) infections. Final analysis included 94 women with cytological diagnosis of SIL, who were seen for initial and follow-up smear control. All women underwent HIV antibody testing after pre-test counseling upon recruitment, and polymerase chain reaction was performed to detect HPV. Out of the 94 women, 38 were infected with HIV and 39 had persistent cases of SIL. HIV-positive women had a higher percentage of persistent SIL (76%) than those who were HIV-negative. SIL incidence was more frequent among women infected with HPV at the time of enrollment or with persistent HPV infection. This study concludes that if HPV infection plays a major role in cervical SIL, other factors contribute to the progression or regression of the lesion, particularly HIV-induced immunosuppression. Therefore, HIV screening should be offered to women with SIL, and specific gynecology follow-up should be conducted on HIV-infected women with cervical SIL in Africa.

Antibacterial properties studies of trunk barks of Terminalia ivorensis, a commercial and medicinal species on some methicillin-resistant Staphylococci species strains.

BACKGROUND: Methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus infections are a worldwide concern. Terminalia ivorensis, of Combretaceae family plant, is widely used traditional medicinal in Côte d'Ivoire to treat dermal diseases (affection in which Staphylococci are implied) including local inflammation and also to treat voice-loss. OBJECTIVES: This study focused to investigate the effect in vitro of the extracts of trunk barks of Terminalia ivorensis on some methicillin/oxacillin-resistant strains of Staphylococcus aureus, S. epidermidis, coagulase-negative S. and reference strain of S. aureus ATCC 25923. METHODS: Antibacterial activity of aqueous, 70% ethanolic 70% and aqueous residue extracts was assessed using agar disc-diffusion method and liquid medium microdilution method in 96 multi-well micro-titer plates. This method led us to determine minimum inhibition concentration (M.I.C.) and minimum bactericidal concentration (M.B.C.). The presence of chemical groups major was detected qualitatively. RESULTS: Aqueous and 70% ethanolic 70% extracts showed significant activity against all the bacteria except aqueous residue when compared with the standard antibiotic oxacillin (5 µg/ml). M.I.C. for aqueous and 70% ethanolic 70% extracts ranged from 0,83-16,67 mg/ml and 0,156-13,33 mg/ml respectively. Viable cell determination revealed the bactericidal nature of the two barks extracts. The 70% ethanolic 70% extract exhibited the highest activity according to the M.B.C. values. The phytochemical analysis indicates the presence of tannins, saponins, flavonoids, terpen/sterols, coumarins, polyphenols and traces of alkaloid. CONCLUSION: The in-vitro antibacterial efficacy shown by the barks of this plant and his lushness in chimical compounds, would justify use of this one in the traditional treatment of some diseases of microbial origin. These compounds could be suggested to provide alternative solution to the development of new therapeutic agents.

[Investigation of urinary schistosomiasis outbreak in the primary school of the village Guébo 2, Abidjan, Côte d'Ivoire]. / Investigation d'un foyer épidémique de bilharziose urinaire dans l'école primaire du village de Guébo 2, Abidjan, Côte d'Ivoire.

We report the results of an outbreak investigation of urinary schistosomiasis in 2012 among school children at Guébo 2. Among the 250 school children, 107 (42.8%) had confirmed urinary schistosomiasis. Age ≥ 10y (OR = 2.6 [1.1 to 6.2]) and self-reported bathing in the river (OR = 14.0 [4.7 to 42.5]) were associated with the presence of S.h. in the adjusted analyses. A massive deworming of the population of Guébo-1&2 was conducted as epidemic-response.

[Surgical options in the treatment of noma]. / Options chirurgicales dans la prise en charge du noma.

In the acute phase of noma, the role of surgery is minor and the treatment consists in the realisation of local or regional flaps and sometimes the management of haemorragia. For reasons social and economic reconstruction of the loss of substance should be conducted on site. The treatment consists of surgical excision of fibrous tissue, the removal of the ankylosis and the closure of the PDS by local flaps, or free pediculated. Because of the extreme variety of loss of substance (PDS) and the multiple surgical options, a systematic and eventually, the standardization of the surgical approach in the treatment of sequelae of noma is essential.

A la phase aigue du noma, le rôle de la chirurgie est mineur et consiste en des soins locaux et occasionnellement au traitement de l'hémorragie.Pour des raisons socioculturelles et économiques, la reconstruction des pertes de substance doit se dérouler sur place. Le traitement chirurgical consiste en l'excision des tissus fibreux, la levée de l'ankylose et la fermeture des PDS par des lambeaux locaux, pédiculés ou libres.A cause de l'extrême variété des pertes de substance (PDS) et des multiples options chirurgicales, une systématisation et éventuellement, une standardisation de l'approche chirurgicale dans le traitement des séquelles de noma est indispensable.

[Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center]. / La procidence du cordon: facteurs etiologiques et pronostic foetal a propos de 47 cas colliges dans un centre de sante de reference.

UNLABELLED: Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis. MATERIAL AND METHODS: Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000. RESULTS: We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life. CONCLUSION: Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.

Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in Africa. Dyscer-CI Group.

BACKGROUND: Squamous intraepithelial lesions (SILs) of the cervix are associated with human immunodeficiency virus (HIV) infection, but multiple risk factors must be considered in this context. The authors performed a cross-sectional study to assess the prevalence of and the factors associated with SILs and invasive cervical carcinoma (ICC). METHODS: In Abidjan, Côte d'Ivoire, women were recruited from three outpatient gynecology clinics and screened for both cervical disease and HIV infection. A CD4 cell count was performed for HIV-infected women. RESULTS: A total of 2198 women were included in the study. The prevalence of HIV infection was 21.7%. Of the 2170 women who underwent a cervical screening, 254 (11.7%) presented with a dysplasia or neoplasia: 7.6% had low grade SILs (LSILs), 3.3% had high grade SILs (HSILs), and 0.8% had ICCs. In multivariate analyses, factors associated with these lesions were as follows: for LSILs, HIV-1 seropositivity, age <24 years, parity >1, consultation for genital infection, and no use of oral contraception in the past; for HSILs, HIV-1 seropositivity, chewing tobacco use, low educational level, and parity >1; and for ICCs, age >33 years, parity >3, and illiteracy. In women infected with HIV-1, the prevalence of LSILs increased with a decrease in CD4 cell count, whereas this relation was not found among patients with HSILs. ICCs were linked to HIV-2 infection, but not to HIV-1 infection, in univariate analysis. CONCLUSIONS: In Africa, the prevalence of SILs is high. The factors associated with precancerous and cancerous lesions are different. Cancers in women infected with HIV-1 often may not reach the invasive stage. These findings could have implications for cervical screening programs in the future.

Human papillomavirus and human immunodeficiency virus infections: relation with cervical dysplasia-neoplasia in African women.

Our study assessed the factors associated with cervical squamous intra-epithelial lesions (SILs) and invasive cervical cancer, with special attention to human immunodeficiency virus (HIV) and human papillomavirus (HPV) infections. Women from 3 outpatient gynecology clinics of Abidjan, Côte d'Ivoire, were screened for cervical abnormalities: 151 women with low-grade SILs and 151 controls, 60 with high-grade SILs and 240 controls, and 13 with invasive cancer and 65 controls were enrolled in 3 case-control studies. Controls were chosen at random among the women without lesions, with a frequency matching for age and center. We used the PCR method for the detection of cervical HPV DNA and the restriction fragment length polymorphism analysis for HPV typing. HIV antibody testing and CD4 cell count were performed. In multivariate analyses, factors associated with cervical lesions were: for low-grade SILs, HPV positivity, HIV-1 seropositivity and parity >3; for high-grade SILs, HPV positivity, chewing tobacco, HIV-1 seropositivity and illiteracy, and for invasive cancer, HPV positivity only. We found a diversity of HPV types associated with SILs. In HIV-1-infected women, SILs occurred at an early stage of HIV disease. Women infected with both HIV-1 and HPV were at much higher risk of SILs than women infected with each of these 2 viruses separately. Invasive cancer was linked to HIV-2 infection in univariate analysis only. Our results suggest that the relation of SILs with HIV-1 infection is mainly explained by HPV infection and that HIV-1-infected African women may not often reach the invasive stage of cervical cancer.

PIP: The factors associated with cervical squamous intraepithelial lesions (SILs) and invasive cervical cancer were assessed in case-control studies of women from 3 outpatient gynecology clinics in Abidjan, Ivory Coast. Enrolled were 151 women with low-grade SILs and 151 controls, 60 women with high-grade SILs and 240 controls, and 13 women with invasive cervical cancer and 65 controls. Human papillomavirus (HPV) was detected in 75% of the high-grade SILs and cancers compared to 20% in the age-matched control groups. In the multivariate analysis, low-grade SILs were associated with HPV positivity, HIV-1 seropositivity, and parity above 3; for high-grade SIL, these risk factors were HPV positivity, chewing tobacco, HIV-1 seropositivity, and illiteracy. Cervical cancer was associated only with HPV positivity. Women infected with both HPV and HIV-1 were at a significantly higher risk of SILs than women infected with only one of these two viruses. These findings suggest that the association of SILs with HIV-1 infection is primarily explained by HPV infection and that HIV-infected African women may not live to reach the invasive stage of cervical cancer. The feasibility of cervical screening directed preferentially to African women with a low educational level or multipara merits assessment.