[Assessment of pertinence and cost of preoperative examinations prescriptions by surgeons for programmed surgery]. / Evaluation de la pertinence et du cout de la prescription des examens preoperatoires par les chirurgiens pour une chirurgie programmee.

OBJECTIVE: To assess the pertinence and the cost of preoperative examinations prescriptions by surgeons at CHU-YO for programmed surgery. PATIENTS AND METHODS: This was a prospective and observational study of 145 patients received in preanesthetic consultations between February 4 and April 4, 2016 in the department of anesthesiology, intensive care unit and emergency of CHU-YO. It consisted of an evaluation of 1106 preoperative examinations prescribed by the surgeons of this hospital compared to the formalized recommendations of French experts. RESULTS: Out of a total of 1,106 prescribed preoperative examinations, 1069 (96.6%) have been achieved. The six most commonly prescribed tests were hemogram (95.9%), blood grouping (90.3%), prothrombin (PT) (91.7%), active cephalin time (ACT) (86.9%), blood sugar (92.4%) and creatininemia (89%). Ninety-two results (8.6%) examinations were abnormal. Prescriptions for preoperative examinations were relevant in 30.2% of cases. The average cost of performing preoperative examinations per patient was 19832±14023 FCFA. CONCLUSION: Prescriptions for preoperative examinations by surgeons are mostly non-rational, the application of a repository is essential to improve this practice.

OBJECTIF: évaluer la pertinence et le coût de la prescription des examens préopératoires par les chirurgiens au centre hospitalier universitaire Yalgado Ouédraogo (CHU-YO) en chirurgie réglée. PATIENTS ET MÉTHODES: Il s'est agi d'une étude prospective observationnelle portant sur 145 patients reçus en consultation préanesthésique entre le 4 février et le 4 avril 2016 dans le service d'anesthésie-réanimation et d'urgences du CHU-YO. Elle a consisté en une évaluation de 1106 examens préopératoires prescrits par les chirurgiens de cet hôpital, par comparaison aux recommandations formalisées d'experts français. RÉSULTATS: Sur un total de 1106 examens préopératoires prescrits, 1069 (96,6%) ont été réalisés. Les six examens les plus fréquemment prescrits étaient l'hémogramme (95,9%), le groupage sanguin (90,3%), la détermination du taux de prothrombine (TP) (91,7%), le temps de céphaline activée (TCA) (86,9%), la glycémie (92,4%) et la créatininémie (89%). Quatre-vingt-douze résultats (8,6%) d'examens étaient anormaux. Les prescriptions d'examens préopératoires étaient pertinentes dans 30,2% des cas. Le coût moyen de réalisation des examens préopératoires par patient était de 19832 ± 14023 FCFA. CONCLUSION: Les prescriptions d'examens préopératoires par les chirurgiens sont majoritairement non rationnelles, l'application d'un référentiel y relatif est indispensable pour améliorer cette pratique.

Clinical experience of AIDS in relation to HIV-1 and HIV-2 infection in a rural hospital in Ivory Coast, West Africa.

A dramatic rise in AIDS cases in a rural hospital 60 km west of Abidjan is described. Out of 212 adult cases diagnosed between January and November 1987 as having AIDS, using the World Health Organization (WHO) criteria defined in Bangui, 128 (60%) had antibodies to HIV-1 only, 61 (29%) had antibodies to both HIV-1 and HIV-2, 15 (7%) had antibodies to HIV-2 only and eight (4%) had no detectable antibodies to HIVs. These results, taken together with those of Ouattara et al. showing that both retroviruses have a similar seroprevalence in the general rural and urban populations, suggest that HIV-2 may have a lower physiopathological potential than HIV-1. This suggestion is supported by a 6-month follow-up of 60 AIDS cases, but only longer follow-up of cohorts of patients and healthy subjects with antibodies to one of the two viruses will allow definitive conclusions.

PIP: 212 adults with symptomatology indicative of acquired immunodeficiency syndrome (AIDS) presented to the Ivory Coast's Dabou Hospital between January-November 1987. 163 were males and 49 were females; the majority (151) were from rural areas. In terms of the clinical profile, 99% had experienced severe weight loss (greater than 10% of body weight), 43% had generalized pruritus, 66% reported fever exceeding 1 month's duration, 75% reported diarrhea exceeding 1 month's duration, 55% had experienced coughing for longer than 1 month, and 56% demonstrated generalized adenopathies. 128 (60%) of these 212 individuals were positive for antibodies to human immunodeficiency virus (HIV)-1, 15 (7%) were HIV-2 positive, 61 (29%) were seropositive for both HIV-1 and HIV-2, and 8 (4%) were negative for both viruses. Clinical follow-up was possible in 173 of these cases. After 6 months, those infected with HIV-1 manifested 16 unfavorable outcomes (deterioration or death) and 11 favorable outcomes (stable or improved condition). Among those infected with HIV-2, there were no unfavorable and 4 favorable cases. The group positive for HIV-1 and HIV-2 exhibited a clinical course at 6 months similar to that found among the HIV-1 seropositives: 11 unfavorable and 9 favorable outcomes. The data from the Dabou hospital attest to a steady rise in AIDS detection, from 0.21% of all adult outpatient cases in the 1st quarter of 1987 to 1.03% of cases in the last quarter. Although data from this series suggest a milder evolution for HIV-2 associated cases, a clinical follow-up of individuals seropositive for HIV-1 or HIV-2, over a 2-year period, is underway to confirm whether there is indeed a distinct symptomatology and disease pattern for each viral infection.

Replicative capacity of HIV-2, like HIV-1, correlates with severity of immunodeficiency.

We have obtained 15 HIV-2 isolates from the peripheral blood mononuclear cells (PBMCs) of 24 HIV-2-infected west African people. The frequency of virus isolation correlated with the severity of HIV-2 infection; only three isolates were obtained from 11 asymptomatic individuals, whereas virus was isolated from nearly all (12 of 13) individuals with symptoms. The HIV-2 isolates showed distinct replicative and cytopathic characteristics and, similarly to HIV-1 isolates, could be divided into two major groups: rapid/high and slow/low. Rapid/high isolates, i.e. isolates with the ability to replicate in tumour cell lines, were obtained from individuals with symptomatic HIV-2 infection and CD4+ lymphocyte counts less than 360/microliters blood; these isolates induced syncytia in PBMC cultures. HIV-2 isolates unable to replicate continuously in tumour cell lines (slow/low isolates) induced small syncytia, cell death, or no cytopathic effect at all. All HIV-2 isolates obtained from asymptomatic individuals showed a slow/low replication pattern.

Prevalence of HTLV-I compared to HIV-1 and HIV-2 antibodies in different groups in the Ivory Coast (West Africa)

Different Ivorian population groups were comparatively tested for antibodies to HTLV-1, HIV-1, and HIV-2. They included 1,334 healthy individuals, 176 unselected medical patients in regional hospitals, 149 female prostitutes, and 65 males with a sexually transmitted disease (STD) collected in 1987 from four regions (east, north, west, and central). The HTLV-1 prevalence averaged 1 to 2.7% in the different regions, without significant increase in sexually overexposed groups. Furthermore, in Dabou Protestant Hospital, 60 km west of Abidjan, 414 blood donors, 109 asymptomatic HIV-positive individuals, and 181 AIDS clinical cases were also tested. While a significant increase in the prevalence of HTLV-1 antibodies was observed only in AIDS patients. HIV-1 and HIV-2 prevalence increased, as expected, from a low rate (2.4%) in the general population to an intermediate rate (13-15%) in blood donors and unselected hospitalized patients and to a high rate (35%) in prostitutes and STD male patients.

Compared prevalence of infections by HIV-1 and HIV-2 during a 2-year period in suburban and rural areas of Ivory Coast.

The testing for human immune deficiency virus type 2 (HIV-2) antibodies of 794 sera collected in July-August 1985 in the four regions of Korhogo, Bondoukou, Man, and Bouaké in Ivory Coast and the collection and testing for HIV-1 and HIV-2 antibodies of 1,126 sera collected in July-August 1987 in the same regions and age groups showed a remarkable stability in the prevalence of infection by these two retroviruses (0.7 and 0.4% in 1985 vs. 0.9 and 0.2% in 1987, respectively, for HIV-1 and HIV-2) in rural areas. In contrast, the increase in prevalence of both HIV-1 (from 1 to 1.9%) and HIV-2 (from 0.8 to 1.3%) from 1985 to 1987 in the urban population was accompanied by a sharp increase during these 2 years of the number of acquired immune deficiency syndromes in regional hospitals.

PIP: The testing for human immune deficiency virus type 2 (HIV-2) antibodies of 794 sera collected in July-August 1985 in the 4 regions of Korhogo, Bondoukou, Man, and Bouake in Ivory Coast and the collection and testing for HIV-1 and HIV-2 antibodies of 1126 sera collected in July-August 1987 in the same regions and age groups showed a remarkable stability in the prevalence of infection by these 2 retroviruses (0.7 and 0.4% in 1985 vs 0.9 and 0.2% in 1987, respectively for HIV-1 and HIV-2) in rural areas. In contrast, the increase in prevalence of both HIV-1 (from 1-1.9%) and HIV-2 (from 0.8-1.3%) from 1985-87 in the urban population was accompanied by a sharp increase during these 2 years in the number of AIDS cases in regional hospitals. (author's modified).

Increase of the prevalence of hepatitis B virus surface antigen related to immunodeficiency inherent in acquired immune deficiency syndrome (AIDS).

During the period from January to December 1987, 2,191 serum samples were collected from different groups of the population in the Ivory Coast (1,126 healthy people selected from the general population, 416 blood donors, 112 healthy anti-HIV carriers, 173 AIDS patients, and 364 patients suffering from icterigenic hepatitis) and tested for anti-HIV (HIV-1 and HIV-2) antibodies, HBsAg, HBeAg, delta antigen (HDAg), and anti-delta (anti-HD) antibody. Anti-HIV antibodies were found in 30 (2.6%) of the general population. 55 (13.2%) blood donors, and 93 (25.5%) patients suffering from icterigenic hepatitis. HBsAg was observed in 103 (9.1%) of the general population, 45 (10.8%) blood donors, 15 (13.4%) healthy anti-HIV carriers, 59 (34.1%) AIDS patients, and 45 (40%) icterigenous hepatitis patients. The simultaneous presence of anti-HIV and HBsAg was noted in 4 (0.4%) of the general population, 8 (2%) blood donors, 15 (13.4%) healthy anti-HIV carriers, 59 (34.1%) AIDS cases, and 36 (10%) patients suffering from icterigenic hepatitis. A high prevalence of HBeAg and serological markers of infection by the delta agent were noted in the different groups. HDAg was noted only among AIDS patients or those suffering from icterigenic hepatitis, with a higher frequency among anti-HIV carriers. Our conclusion from this study is that healthy anti-HIV carriers are no more likely to be HBsAg carriers than the HIV-seronegative subjects. However, immunodeficiency induced previously by HIV infection is likely to be responsible for the high prevalence of HBsAg among AIDS patients.

[Vaccination of adults against hepatitis B virus in a tropical African environment (Ivory Coast). Study of results according to the serologic status toward the virus]. / Vaccination des adultes contre le virus de l'hépatite B en milieu tropical africain (Côte-d'Ivoire). Etude des resultats selon le statut sérologique vis-à-vis du virus.

A total of 103 volunteers, from 18 to 55 years of age have received subcutaneous injection of the hevac B Pasteur 5 micrograms vaccine: one injection a month during three months and one booster injection after one year. The study of the anti-HBs reaction of the subjects, with regard to the serologicale status to the hepatitis B virus before inoculation, has shown that only 78.8% of the subjects, who are only positive towards the anti-HBc antibody, will develop an anti-HBs response of primary type with a relatively low value. On the contrary, all anti-HBc and/or anti-HBs subjects, who were positive before inoculation, react with relatively high anti-HBs value immediately after the first injection. 93.3% of the seronegative subjects before inoculation will develop an anti-HBs seroconversion after the complete inoculation procedure.

[Epidemiology of infections caused by human immunodeficiency viruses HIV-1 and HIV-2 in the Ivory Coast]. / Epidemiologie des infections par les virus de l'immunodeficience humaine VIH1 et VIH2 en Côte d'Ivoire.

A study of antibodies to HIV1 and HIV2 has been performed among selected groups in Ivory Coast from January to December 1987. In total, 2,578 serum samples were examined. A seropositivity to HIV1 and/or HIV2 was observed in 32 (2.4%) of 1.334 healthy subjects of the general population from 5 different areas, 9 (3.6%) of 246 pregnant women, 58 (12.3%) of 471 blood donors, 72 (34.3%) of 210 female prostitutes, 23 (35.3%) of 65 patients with sexual transmitted diseases, 21 (35.6%) patients with chronic renal insufficiency and 98 (50.7%) patients with severe pulmonary tuberculosis. Among the 313 HIV antibodies carriers, the frequency of HIV1 infection (6.7%) was higher than HIV2 infection (2%). However, 3.4% had a double seropositivity HIV1 and HIV2.

[Vaccination against hepatitis B on the Ivory Coast: study of the anti-HBs response in healthy adult subjects carrying only anti-HBc antibodies before vaccination]. / Vaccination contre l'hépatite B en Côte-d'Ivoire: étude de la réponse anti-HBs chez des sujets adultes sains porteurs uniquement de l'anticorps anti-HBc avant la vaccination.

A total of 103 volunteers, from 18 to 55 years of age, have received the hevac B Pasteur 5 micrograms vaccine subcutane on sly; one injection a month during three months and one booster injection after one year. The study of the anti-HBs reaction of the subjects, with regard to the serological status to the hepatite B virus before inoculation, has shown that only 78.8% of the subjects, who are only positive towards the anti-HBc antibody, will develop an anti-HBs response of primary type with a relatively low value. In contrast, all anti-HBc and/or anti-HBs subjects, who are positive before inoculation, react with relatively high anti-HBs values right after the first injection, of the seronegative subjects before inoculation. 93.3% will develop an anti-HBs seroconversion after the complete inoculation procedure.

[Serodiagnosis of schistosomiasis mansoni using an egg extract semi-purified by precipitation with ammonium sulfate]. / Diagnostic sérologique de la bilharziose à S. mansoni à l'aide d'un extrait ovulaire semi-purifié par précipitation par le sulfate d'ammonium.

Fifty one sera from bilharziosis patients and thirty control sera were examined with a Schistosoma mansoni egg antigen purified by precipitation with ammonium sulphate at 50% saturation. Sensitivity and specificity were good and showed a good correlation with results obtained by MSA1 antigen, but antigen tested is far more easier to prepare than MSA1.

[Rubella in pregnant women in Abidjan (Ivory Coast)]. / L'infection rubéolique chez les femmes enceintes à Abidjan (Cote-d'Ivoire).

1,143 serums samples collected from pregnant females at first term were tested for the presence of rubella haemagglutination inhibition antibodies. Rubella antibodies were present in 679 (59.4%) of the pregnant females and 464 (40.6%) were seronegative. No statistically significant difference was found in the prevalence of rubella specific antibodies in three age categories considered. 155 positive serum samples for rubella antibodies (IHA) were tested afterward retrospectively for rubella-specific IgM by ELISA technic, and 14 (9.03%) were positive.

[HIV1 seropositivity and B and D viruses in West Africa]. / Séropositivité VIH1, virus B et D en Afrique de l'Ouest.

This study was undertaken to investigate relationships between three widespread viruses in West Africa, i.e. HIV1 and viruses B and D, in Ivory Coast. Serologic tests for viruses B and D were carried out in a random sample of black adults of both sexes with asymptomatic HIV1 seropositivity. Coinfection by virus B or viruses B and D was a common finding. Coinfection with both viruses B and D, but not with virus B alone, was found to be significantly more frequent in these HIV1-infected adults than in a control group with acute viral hepatitis. Potential interactions between the HIV1 and viruses B and D as well as other viruses are discussed. These findings suggest that one or several cofactors acting alone or in combination play a major role in the clinical expression of HIV infection. The results of this study, together with the suggestion put forward by several investigators that B virus infection may increase the severity of AIDS, are evidence in support of the value of immunization against the B virus in the management of AIDS.

Blood transfusions and HIV infections (HIV1, HIV2/LAV2) in Ivory Coast.

Sera from 500 blood donors, 67 multiply-transfused children with sickle-cell anaemia and 320 healthy children who had not been transfused were tested for HIV1 and HIV2 antibodies. Amongst blood donors, 49 (9.8%) exhibited antibodies to retroviruses: 12 (2.4%) to HIV1, 17 (3.4%) to HIV2 and 20 (4%) to both HIV1 and HIV2. Fifteen (22.4%) of the 67 multiply-transfused children had retroviral antibodies: five (7.4%) to HIV1 four (6%) to HIV2 and six (9%) to both HIV1 and HIV2. In contrast, among 320 non-transfused children only two (0.62%) exhibited HIV1 infection. These results suggest that children with sickle-cell anaemia who have been repeatedly transfused, constitute a high risk group for HIV1 and HIV2 infections in Ivory Coast.

[Parasites of fish currently consumed in the Ivory Coast]. / Les parasites des poissons de consommation courante en Cote-d'Ivoire.

The authors study parasites of the six most commonly consumed species of fishes in Côte-d'Ivoire. Analysis of gills, alimentary canal and blood of 188 fishes reveal the presence of extremely diverse families of parasites.

[Detection of the hepatitis A virus in fish at a fish farm]. / Détection du virus de l'hépatite A au niveau des poissons d'aquaculture.

In this study, we have researched enteroviruses in digestive tract and gills of 106 fishes from farming station, belonging to the five most eaten species in Ivory Coast (Chrisychthys walkeri, Chrisychthys nigrodigitatus, Tilapia nilotica, Tilapia guineensis, Sarotherodon melanotheron). Hepatitis A virus was found in 12 fishes (11.3%), five times in gills, three times in digestive tract and four times in both. The two species apparently the more contaminated, were Chrisychthys nigrodigitatus, Sarotherodon melanotheron with a 4.7% contamination rate for the both.

[Seroepidemiology of rubella in the Ivory Coast. Geographic distribution]. / Séroépidémiologie de la rubéole en Cote-d'Ivoire. Distribution géographique.

A total of 3,473 serum samples were collected from healthy subjects in five geographical areas of Côte-d'Ivoire, between July 1985 and August 1986, and were analysed for the presence of rubella haemagglutination inhibition antibodies. Rubella antibodies were present in 1,994 of the samples giving a prevalence of 57.4%. The distribution of this prevalence appeared to be influenced by the climatic conditions and the density of population. The areas of Korhogo and Sinematiali in the north with a hot and dry climate had high prevalences, while the areas of Bouake and Bondoukou in the Centre and Centre-east respectively had low prevalences. The prevalence of rubella antibodies increases with age until it reaches a relatively low level from the age of 15 onward. The analysis of the data by the chi 2 test indicates that there was a statistically significant variation in the prevalence of rubella antibodies between urban and rural communities (p less than 0.001). In the areas of Korhogo and Sinematiali the rubella virus appeared to be best circulate in the rural communities, while the reverse was observed in the areas of Bouake and Bondoukou. In this study, there was not a sex influence in immunity to rubella, because no difference immunity to the virus was observed between males and females. In women of child-bearing age (15 to 44 years) the rubella immunity was relatively low (61.2%).