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.

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.

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.

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.

[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.

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.

[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.

[Epidemiologic study on patrons of traditional drink establishments (Bandjidromes) in Abidjan, Ivory Coast and surrounding areas]. / Enquête epidémiologique a propos des usagers des débits de boissons traditionnelles (Bandjidromes d'Abidjan et de sa banlieue).

This transverse descriptive study was conducted over a three-month period from January 10 to April 10, 2003. Findings demonstrated a clear profile of 120 patrons of traditional drinking establishments called n the city of Abidjan and surrounding areas in the Ivory Coast. All subjects interrogated were male. Mean age was 31.1 years. Almost all subjects interrogated (99.2%) were of Ivory Coast nationality. The main ethnic group was Akan (86.7%) from Baoulé (60%). More than a third (35.9%) of subjects interviewed were unemployed. Most (62.5%) were single. All subjects interrogated stated that they attended "bandjidromes" to drink palm wine although other alcoholic beverages were served. However only 9.2% of subjects drank only palm wine. The euphoric effect of alcohol and friendly atmosphere of the drinking establishment were the main reasons for attendance (53.3%). Most persons interrogated (63.3%) had been consuming alcohol for more than 10 years. More than half (55%) spent less than three hours a day drinking alcoholic beverages. Daily consumption of palm wine ranged from two to four liters for most atrons (76.7%). Only 2.5% (3/120) presented neuropsychiatric disturbances. These results could be useful in the fight against alcoholism.

[Direct sputa examination limits in tuberculosis active detection in 200 immigrant candidates in United States of America]. / Limites de l'examen direct des expectorations dans le dépistage actif de la tuberculose chez 200 candidats à l'émigration aux Etats-Unis.

The Côte-d'Ivoire Pasteur Institute unit of Tuberculous and Nontuberculous Mycobacteria carried out 600 smears stained by Ziehl-Neelsen in 200 immigrant candidates for the U.S.A. The sputa of 44 of them were put in culture on Lowenstein-Jensen medium. Eight (4%) candidates had active pulmonary tuberculosis among whom 5 had smear negative sputum. The pulmonary tuberculosis active detection performed on target population with accessible and sensitive tool can contribute to strengthen the fight against tuberculosis in endemic areas.

[Systematic serologic detection of treponema at the antivenereal centre of the National Institute of Public Health in Abidjan (Côte-d'Ivoire), from 1994 to 1999]. / Dépistage systématique sérologique des tréponé- matoses au dispensaire antivénérien (DAV) de l'Ins- titut national d'hygiène publique (INHP) d'Abidjan (Côte-d'Ivoire) de 1994 a 1999.

We conducted a medical records review on 11,662 patients consulting the antivenereal clinic of Treichville from 1994 to 1999. The main objective of the study was to analyse the data from systematic screening of syphilis in this specialized centre for sexual transmitted infection. The results of this study were: 162 (1.39%) patients had active syphilis; we noticed a decreasing incidence of syphilis during the last six years, 98.77% of the patients had symptoms of sexual transmitted diseases that did not directly evoke syphilis. In summary we can say that syphilis remains an important problem in the sexually transmitted infections consultation. The screening of syphilis must continue and needs to be extended to other services, because of the high frequency of asymptomatic forms and the existence of severe complications.

[Study of tooth shade in Black Africans]. / Etude de la teinte des dents des noirs africains.

The 243 sample prospective study shows specifities about black African teeth shade particularly the colour. The results after the use of a study mixed shader composed from three standard shaders are; first: the sequence from the clearest tooth to the less is: central incisor, lateral incisor. Second: the maxillary teeth shade is clearer than the mandibulars. Third, 16% teeth shade not be conducted to determine the objective parameters for black African dentogenics. Therefore: esthetic restorative treatment will be more efficient.

[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.

[Awareness, attitudes, and practices of secondary school students in relation to HIV/AIDS in Abidjan, Ivory Coast]. / Connaissances, attitudes et pratiques des collégiens et lycéens d'Abidjan face au VIH/sida.

In May 2001, we conducted a descriptive transversal survey with a single data collection phase in 13 schools in Abidjan, Ivory Coast. The purpose of the study was to evaluate the awareness, attitudes, and practices of teenagers with regard to HIV/AIDS. Most respondents (66.5%) were female. Mean age was 16.32 years (range, 13 to 19 years). Most respondents stated that they had heard about AIDS and demonstrated good factual knowledge. The most frequently mentioned method of prevention was condom use (89.2%). A total of 338 (56.1%) had already experienced sexual intercourse. However most sexually active respondents stated that they did no always use condoms.

[Why should we use plaster for the prime impression in complete removable prosthodontics]. / Pourquoi une empreinte primaire mucostatique au platre en prothese amovible totale.

This thirty years literature review about removable complete denture prime impressions show that the plaster static impression is better. This product doesn't induce abnormal pressure on the biologic and anatomic support structures of the prosthesis. The plaster for impression physical properties is adapted to reproduce the details needed by the laboratory to manufacture the individual impression tray for the definitive functional impression. The only precaution is to follow the method. Our clinical experiences advise us to propose RIGNON-BRET (10, 11) simple plaster impression techniques. The one case where it is forbidden is when the patient has recently been treated by radiotherapy. All the other materials induce irritated pressure on the alveolar bone and consequently the second functional pressure added the stability of the denture may be defected.

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.

The neuropathology of HIV-infected African children in Abidjan, Côte d'Ivoire.

In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.

Seroprevalence of HIV infection in the general population of the Côte d'Ivoire, West Africa.

A seroepidemiological survey to determine the prevalence of human immunodeficiency virus (HIV) infection in the general population of the Ivory Coast was carried out in February 1989. Sera were collected from subjects between 15 and 65 years old in urban areas (not including Abidjan) and rural areas using the cluster sample technique. A total of 1,700 people were tested in urban areas, and 125 (7.3%) were HIV positive. This rate varied significantly with age and sex; a maximum rate of 16.3% was observed among men between 35 and 44 years old. In rural areas, a total of 3,199 people were tested, and 159 (4.9%) were positive for HIV; the highest rate (10.7%) was noted in the men aged 25-34 years. The high seroprevalence recorded in the general population in urban and rural areas is compatible with the incidences of acquired immune deficiency syndrome (AIDS) cases reported in hospitals all over the country.