[Diabetes mellitus and high blood pressure over risk in HIV-infected people followed at Souro Sanou University Hospital Day Hospital, Bobo-Dioulasso 2018]. / Sur-risque de diabète sucré et d'hypertension artérielle chez les personnes infectées par le VIH suivies à l'hôpital de jour du CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, 2018.

BACKGROUND: Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS: A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS: A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION: Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.

Management of necrotizing and non-necrotic bacterial erysipelas of the face in tropical areas: a series of four cases and a review of the literature.

The necrotizing and not necrotizing acute bacterial dermohypodermitis (DHD) are acute bacterial infections of tissues situated between the skin and the muscles. The localizations of the face are infrequent, and sometimes put diagnostic difficulties with other current facial dermatosis. We report in this article 4 cases of DHD of the face with skin source, hospitalized in the service of the Infectious and Tropical Diseases of the Teaching Hospital Yalgado Ouédraogo of Ouagadougou (Burkina Faso). The objective is to make a current situation of their etiologies and complications, and to look for the difficulties to take care of them in a country with limited resources. The patient's care journey for this disease is long while it constitutes a medical or medical-surgical emergency. Imaging, which is essential for the diagnosis of heart valve disease and the daunting complications of necrotizing fasciitis and mediastinitis, is generally available only in tertiary hospitals. Antibiotic therapy is most often inadequate or insufficient. Anti-inflammatories, widely used, according to several authors contribute to serious forms and excess mortality. Health workers in resource-limited settings need to be better educated and guidelines issued to recognize the signs of this condition in order to enable early referral of patients in specialized settings. In addition, education of the population and hygiene awareness of skin lesions should be a priority to reduce complications.

[Characteristics of Low-Level Persistent viraemias in HIV-1 Patients Treated with Second-Line ARVs at the Sourô Sanou Teaching Hospital of Bobo-Dioulasso (Burkina Faso)]. / Caractéristiques des virémies persistantes de bas niveau des patients VIH-1 sous traitement antirétroviral de deuxième ligne au CHU Sourô Sanou de Bobo-Dioulasso (Burkina Faso).

We describe the characteristics of patients infected with HIV-1 as second-line antiretroviral therapy, with persisting low-level viremia. This was a descriptive retrospective study, conducted from January 1, 2010 to December 31, 2016, from the Cohort of the Infectious Diseases Department of Bobo-Dioulasso University Hospital. Patients infected with HIV-1, a second line of stable ARV treatment, with ≥95% compliance for at least 12 months, asymptomatic with CVp between 50 and 1000 copies/ml in two consecutive samplings at least 3 months apart. Out of 244 patients in second-line therapy, 79 met our inclusion criteria. The mean age of the patients was 42±10.2 years. Women (35.8 years) were younger than men (43.8 years) (p=0.001). Most were married (48.1%), 23.5% of whom were polygamous. The majority of patients (38/79) in the study had a CD4 count of <200 cells/ mm3. The median duration of ARV therapy since the beginning of the therapeutic history has been 4.8 (2.5-11 years). CVp greater than 10,000 copies/ml at the start of second-line therapy (p=0.003) and TDF+FTC + DRV + RTV combination (p=0.001) were associated with persistent low viremia. A genotypic resistance test is needed for these patients in order to better adapt the ARV treatment.

Nous décrivons les caractéristiques des patients infectés par le VIH-1 en deuxième ligne de traitement antirétroviral, avec une virémie persistante de bas niveau. Il s'agissait d'une étude rétrospective à visée descriptive, menée du 1er janvier 2010 au 31 décembre 2016, à partir de la cohorte du service des maladies infectieuses du CHU de Bobo-Dioulasso. Ont été inclus les patients infectés par le VIH-1, en deuxième ligne de traitement ARV stable, ayant une observance ≥ 95 % depuis au moins 12 mois, asymptomatiques, avec une charge virale plasmatique comprise entre 50 et 1 000 copies/ml sur deux prélèvements consécutifs à au moins 3 mois d'intervalle. Sur 244 patients en deuxième ligne de traitement antirétroviral, 79 répondaient à nos critères d'inclusion. L'âge moyen des patients était de 42 ± 10,2 ans. Les femmes (35,8 ans) étaient moins âgées que les hommes (43,8 ans) (p = 0,001). La plupart des patients étaient mariés (48,1 %), parmis lesquels certains vivaient dans des régimes polygames (23,5 %). La majorité des patients (38/79) de l'étude avaient un taux de CD4 ≤ 200 cellules/mm3. La durée médiane du traitement ARV depuis le début de l'histoire thérapeutique était de 4,8 ans (2,5- 11 ans). La charge virale plasmatique supérieure à 10 000 copies/ml au début du traitement (p = 0,003), et la combinaison TDF+FTC+DRV+RTV (p = 0,001) étaient associées à la virémie persistante de bas niveau. La réalisation d'un test génotypique de résistance s'impose pour ces patients afin de mieux adapter le traitement antirétroviral.

[About 98 cases of dengue hospitalized in a private clinic of Ouagadougou: epidemiology, diagnostic and evolution]. / À propos de 98 cas de dengue hospitalisés dans une clinique privée de Ouagadougou : aspects épidémiologiques, diagnostiques et évolutifs.

Extremely widespread, the dengue is a reemerging infectious disease. In Burkina Faso, dengue is a reality that was little known. The aim of this study was to study epidemiology, diagnostic and outcomes of dengue patients in Ouagadougou. A retrospective study covered a period of two years, from 1 January 2013 to 31 December 2014 in a private clinic in Ouagadougou. Patients included in the study were hospitalized for fever and painful syndrome with a positive test to the dengue non-structural antigen 1 (NS1 Ag). Ninety-eight cases of dengue on 343 suspected cases were registered. The average age of patients was 35.9 years. The sex-ratio (M/F) was 1.18. According to the professional activity, there was a predominance of civil servants (35.7%). The pain syndrome was found in 93.9% of patients. Leukopenia (73.5%), neutropenia (56.1%) and severe thrombocytopenia (57.1%) were the predominant hematological disturbances. Of the patients, 18.4% had hemorrhagic dengue and 11.2%, a dengue shock syndrome. Four patients died. The use of non-steroidal antiinflammatory drugs was associated with the severity of the infection (p=0.04). Dengue fever occurs in our context and constitutes a risk of mortality. The diagnosis of dengue should be performed systematically in front of a painful and febrile syndrome. The vector control is the best way of prevention against dengue pending the development of a vaccine.

Depression and HIV: Epidemiological and clinical aspects at the Bamako University Hospital (Mali).

Depression plays an important role in clinical worsening, morbidity and mortality related to HIV/AIDS. To describe the epidemiological and clinical aspects of depressive disorders in people with HIV in Mali. This prospective study took place in the department of psychiatry and infectious diseases at the Bamako University Hospital from July 2004 through October, 2005 and included all HIV-positive antiretroviral-naive patients with depression, diagnosed according to ICD-10 criteria. The study included 84 HIV-positive patients with a depressive disorder; our total population of HIV-positive patients was 316 during the study period, for a prevalence rate of 26.7 % in this population. The mean age of these depressed patients was 36.7 ± 8.5 years (range: 20-57); 63.1% were women, 47.7% had not attended or at least not completed primary school; 66.6% were married, and 92.9% lived in urban areas. Sad mood, anxiety, and refusal to eat were reported by 27.7%, 10.9%, and 9.1%, respectively, as a reason for consultation. Depression was associated with an anxiety disorder in 33 (39.3%) and a delusional disorder in 14 (16.7%). Severe depression was associated with low BMI and at a CD4 count <200 cells/mm3. Depression was found at a high frequency in our study. Its detection, operational research about it, and improved management are recommended to improve the health of people living with HIV.

[Knowledge, attitudes and practices of healthcare professionals at the Souro Sanou university hospital of Bobo Dioulasso regarding Mellitus diabetes]. / Connaissances, attitudes et pratiques des professionnels de Sante du centre hospitalier universitaire Souro Sanou de Bobo Dioulasso en Matiere de diabete sucre.

INTRODUCTION: In Burkina Faso, the insufficiency of doctoral interns, of endocrinologists, and medical services specialized in the coverage of the diabetes, means that these cases are relegated to general practitioners and the paramedical staff. OBJECTIVES: To study the level of knowledge, attitudes and practices of the medical and paramedical staff on the coverage of sugar diabetes in the Souro Sanou University Hospital of Bobo Dioulasso. METHOD: A cross-sectional study of descriptive type was conducted over a 3 month period, from March 1st to May 31st, 2013. The investigated population was constituted of healthcare professionals represented by general practitioners, female nurses, State-certified male nurses, and patented male nurses of the Souro Sanou University Hospital of Bobo Dioulasso. A questionnaire, adapted for each professional category, was administered to the participants. A notation grid enabled us to record the level of knowledge, attitude and practice of the staff regarding sugar induced diabetes. RESULTS: Three hundred four (304) healthcare professionals, 187 men and 117 women (sex ratio of 1.59) were investigated. The average age was of 40.84 years with extremes of 26 and 60 years. Their level of knowledge, attitude and practice on sugar induced diabetes varied from one professional category to another. Clinical signs of the disease, as well as its physiopathology were well known by healthcare providers. However, the definition of the disease, its diagnostic criteria, its classification by cause, were little known general practitioners. The general practitioners, had a good attitude and practice in front of a case of diabetes compared to other professional categories. CONCLUSION: Adapted staff recycling is essential across the professional categories for healthcare providers of the university hospital.

INTRODUCTION: Au Burkina Faso, l'insuffisance de médecins internistes, d'endocrinologues, et des services médicaux spécialisés dans la prise en charge du diabète sucré, font que les médecins généralistes et le personnel paramédical sont relégués au premier. OBJECTIFS: Etudier le niveau de connaissances, attitudes et pratiques du personnel médical et paramédical sur la prise en charge du diabète sucré au CHU SS de Bobo Dioulasso. MÉTHODE: Il s'est agi d'une étude transversale de type descriptif, déroulée sur trois (03) mois, du 1er mars au 31 mai 2013. La population enquêtée était constituée de professionnels de santé représentés par les médecins généralistes, les attachés de santé, les infirmiers diplômés d'état, les sages-femmes/maïeuticiens d'état, les infirmiers brevetés du CHU SS de Bobo Dioulasso. Un questionnaire a été administré au personnel consentant adaptée à la catégorie professionnelle. Une grille de notation a permis d'apprécier le niveau de connaissance, d'attitude et de pratique du personnel en matière de diabète sucré. RÉSULTATS: Trois cent quatre (304) agents de santé dont 187 hommes (sex ratio = 1,59) ont été enquêtés. Leur moyenne d'âge était de 40,84 ans avec des extrêmes de 26 et 60 ans. Leur niveau de connaissance, d'attitude et de pratique sur le diabète sucré était variable d'une catégorie professionnelle à une autre. Ainsi, les signes cliniques de la maladie, ainsi que sa physiopathologie étaient bien connus par les agents de santé. Cependant, la définition de la maladie, ses critères diagnostiques, sa classification étiologique, étaient peu connus des médecins généralistes. Les médecins généralistes, avaient une bonne attitude et pratique devant un cas de diabète sucré par rapport aux autres catégories professionnelles. CONCLUSION: Des besoins de recyclage du personnel adapté aux catégories professionneles s'avèrent indispensables pour les agents de santé du CHU SS.

[Inventory of fixtures on the tolerance of the treatment) of the resistant multi-tuberculosis (Burkina Faso)]. / Etat des lieux sur la tolerance du traitement de la tuberculose multi resistante (Burkina Faso).

OBJECTIVES: Estimate the tolerance of antituberculous drugs prescribed in the treatment of multi resistant tuberculosis on patients followed in the service of Pneumology of the University hospital of Yalgado Ouedraogo. PATIENTS AND METHODS: It was a retrospective and prospective longitudinal investigation. The files of patients allowed to inform the questionnaire for the retrospective phase (2010-2011), the follow-up of patients during the prospective phase (2011-2013) allowed for data collection. All the patients under antituberculous treatment of 2nd line between January 1st, 2010 and the August 31st, 2013 were included. RESULTS: 71 cases of multi resistant tuberculosis (MRT) were included. The sex-ratio was 3.4. The age bracket from 30 to 39 was the most represented (39.4 %). A notion of tubercular contage was found in 18 (25.3%) patients. All MRT patient had histories of treatment including aminoside lasting more than 2 months. Intolerance of the treatment was reported in 57 patients. Intolerance predominated in 30 to 39 years olds and in Tuberculosis/HIV co-infected patients. The neurological (47.9%) and psychiatric (47.9%) infringements were the most represented. Vestibulocochlear impact was seen in 42.3% of cases with 18.3% reporting of total deafness. CONCLUSION: The intolerance of the antituberculous treatment of the second line is real focus for clinicians. Shorter timeframes would avoid certain therapeutic modifications thought to be at the origin of failures.

OBJECTIFS: Apprécier la tolérance des antituberculeux prescrits dans le traitement de la tuberculose multi résistante chez les patients suivis dans le service de Pneumologie du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU YO). PATIENTS ET MÉTHODES: Il s'est agi d'une enquête longitudinale rétrospective et prospective. Les dossiers des patients ont permis de renseigner le questionnaire pour la phase rétrospective (2010­2011), le suivi des patients durant la phase prospective (2011­2013) a permis la collecte des données. Etaient inclus tous les patients sous traitement antituberculeux de 2ème ligne entre le 1er Janvier 2010 et le 31 Aout 2013. RÉSULTATS: Au total 71 cas de tuberculose multi résistante (TB-MDR) ont été recrutés. Le sex- ratio était 3,4. La tranche d'âge de 30 à 39 était la plus représentée (39,4%). Une notion de contage tuberculeux a été retrouvée chez 18 (25,3%) des patients. Tous les patients TB-MR avaient des antécédents de traitement incluant des aminosides de durée supérieure à 2 mois. L'intolérance au traitement a été rapportée chez 57 patients. Elle prédominait chez les 30 à 39 ans et chez les sujets co-infectés Tuberculose/VIH. Les atteintes neurologiques (47,9%) et psychiatriques (47,9%) étaient les plus représentées. L'atteinte vestibulo-cochléaire était de 42,3% avec 18,3% de surdité totale. CONCLUSION: L'intolérance du traitement antituberculeux de deuxième ligne est un véritable hantise pour le clinicien. Des régimes plus courts éviteraient certainement des modifications thérapeutiques à l'origine de survenue d'échecs.

[Study of factors associated to therapeutic failure of children infected by HIV1 under antiretroviral treatment in the Sanou Sourô University Hospital of Bobo-Dioulasso (2007-2013)]. / Etude des facteurs associes a l'echec therapeutique au cours du suivi des enfants infecte par le VIH1 sous traitement antiretroviral au CHU-Sanou Souro de Bobo-Dioulasso (2007­2013).

OBJECTIVE: To determine the prevalence of therapeutic failure and the associated factors in children aged 6 months to 15 years old with HIV 1 and regularly visiting the Sanou Sourô University Hospital (SSUH) of Bobo-Dioulasso. METHODS: A retrospective study was conducted concerning the children followed in the SSUH between February, 2007 and February 2013 infected by HIV 1 under ARV for at least six months. The diagnosis of therapeutic failure was defined according to the WHO criteria. RESULTS: the population of study was 311 infected patients, 53.8 % were male. The average age was of 108 months ± 67, and 62.0 % had a rate CD4 higher than 200 cells/ µ L; 43.5 % of the patients were at class III / IV of the WHO classification. Prevalence of the failure was at 19.6 %. The female genital organ (RR: 0.49 IC95 %: [0.24-0.99] p = 0.03), respect for the treatment ≤ 95 % (RR 0.37 IC95 % [0.15-0.92] p=0.04), the death of the mother (RR: 0.33 IC95 % [0.09-1.21] p=0.04) and the class WHO advanced (III / IV) (RR 0.26 IC95 % [0.09-0.77] p=0.02) was associated to the therapeutic failure. CONCLUSION: prevalence of therapeutic failure was high for the children being followed at the Sanou-Sourô University Hospital of Bobo-Dioulasso. The female genital organ, respect for the treatment ≤ 95 %, death of the mother, and the advanced WHO classification stages (III / IV) were associated with therapeutic failure.

OBJECTIF: Déterminer la prévalence et les facteurs associés à l'échec thérapeutique chez les enfants âgés de six mois à 15 ans dépistés positifs au VIH-1 et suivis régulièrement au CHU-Sanou Sourô de Bobo-Dioulasso. MÉTHODES: Il s'agissait d'une étude de cohorte rétrospective ayant concerné les enfants suivis au CHUSS entre février 2007 et février 2013 infectés par le VIH-1 sous ARV depuis au moins six mois. Le diagnostic de l'échec thérapeutique a été défini selon les critères de L'OMS. RÉSULTATS: La population d'étude était de 311 patients infectés, 53,8% étaient de sexe masculin. L'âge moyen était de 108 mois ± 67, et 62,0% avait un taux CD4 supérieur à 200 cellules/µL ; 43,5% des patients étaient au stade III/IV de l'OMS. La prévalence de l'échec était de 19,6%. Le sexe féminin (RR : 0,49 IC95% : [0,24­0,99] p= 0,03), l'observance < 95% (RR :0,37 IC95% [ 0,15­0,92] p=0,04), le décès de la mère (RR : 0,33 IC95% [ 0,09­ 1,21] p=0,04) et le stade OMS avancé (III/IV ) (RR :0,26 IC95% [0,09­0,77] p=0,02) étaient associés à l'échec thérapeutique. CONCLUSION: la prévalence de l'échec thérapeutique était élevée chez les enfants suivis au CHU-Sanou-Sourô de Bobo-Dioulasso. Le sexe féminin, l'observance ≤ 95%, le décès de la mère, et le stade OMS avancé (III/IV) étaient associés à l'échec thérapeutique.

[Immuno-virologic dissociation in patients infected by HIV-1 under antiretroviral treatment at the Day hospital of Bobo-Dioulasso from 2008 to 2012 (Burkina Faso)]. / Dissociation immuno-virologique chez les patients infectes par le VIH-1 sous traitement antiretroviral a l'hopital de Jour de Bobo-Dioulasso de 2008 a 2012 (Burkina Faso).

OBJECTIVE: describe the sociodemographic, clinical, therapeutic, biological profile and the observance of treatment in cases of immuno-virologic dissociation response (IVDR) in HIV-1 patients at te 12 months of antiretroviral treatment (ARVT). METHODS: This was a historical cohort study with a descriptive and analytical focus from January 2008 to December 2012; covering the IVDR cases at the day hospital of Bobo Dioulasso. We collected the data during medical consultations by means of the ESOPE software and from medical records of the patients. RESULTS: Of 2078 patients on ARVT, 84 or 4% presented one IVDR, among which 56 women (66.7%) and 28 men (33.3%). The average age was 45 years [range: 45-55 years]. At the initiation of ARVT, most patients were in clinical stage 3 or 4 of the WHO classification (57.1%). The body mass index (BMI) average was 20.5kg/m2 [IQR = 18.5 and 23]. The average number of +CD4 T lymphocyte was 42 cells/mm3 [IQR = 12- 63]. During follow-up, the median gain in BMI was 3.2 kg/m2 [IQR = 1.2 to 4.3 kg/m2], the median gain was 76 cells/µl [IQR = 60 - 88]. The viral plasmatic load of the HIV-1 was undetectable with a rate of TCD4+ < 100 cells /µl in 12 months. Factors associated with IVDR were the age between 35 and 45 years (p = 0.0009), the number of +CD4 T cells (+CD4T≤50) at initiation of ARVT (p = 0.00045 ) and the WHO classification clinical stage 3. CONCLUSION: This study demonstrates the problem of IVDR management in Bobo-Dioulasso and reminds of the interest of care follow-up of people living with HIV-1 by viral load and not only by the rate of CD4+ T especially in the decentralized structures of coverage of HIV, where changes of therapeutic mechanisms operate disjointedly.

OBJECTIF: décrire le profil sociodémographique, clinique, thérapeutique, biologique et l'observance du traitement des cas de réponse immuno-virologique dissociée (DIV) chez les patients VIH-1 à 12 mois de traitement antirétroviral (ARV). MÉTHODES: Il s'agissait d'une étude de cohorte historique à visée descriptive et analytique de janvier 2008 à décembre 2012, portant sur les DIV suivis à l'hôpital de jour (HDJ) de Bobo- Dioulasso. Nous avons recueilli les données au cours des consultations médicales à l'aide du logiciel ESOPE et à partir du dossier médical des patients. RÉSULTATS: Sur 2078 patients sous ARV, 84 soit 4% présentaient une dissociation immuno-virologique (DIV), dont 56 femmes (66,7%) et 28 hommes (33,3%). L'âge médian était de 45 ans [EIQ = 45­ 55 ans]. A l'initiation du traitement ARV, la plupart des patients étaient aux stades cliniques 3 ou 4 de l'OMS (57,1%). La médiane de l'IMC était à 20,5kg/m2 [EIQ=18,5 et 23 ans]. La médiane du nombre de lymphocyte TCD4+ était de 42 cellules/mm3 [EIQ= 12­ 63]. Au cours du suivi, le gain médian en indice de masse corporelle était de 3,2 kg/m2 [EIQ=1,2­4,3 kg/m2], le gain médian en TCD4+ était de 76 cellules/µl [EIQ=60 ­ 88]. La charge virale plasmatique du VIH-1 était indétectable chez tous avec un taux de TCD4+ < 100 cellules/µl à 12 mois. Les facteurs associés à la réponse immunovirologique dissociée étaient l'âge compris entre 35 à 45 ans (p = 0,0009), un nombre de lymphocytes T CD4 (CD4≤50) à l'initiation du traitement ARV (p=0,00045) et le stade clinique OMS 3. CONCLUSION: Cette étude prouve la problématique de la gestion de la réponse immuno-virologique dissociée à Bobo-Dioulasso, et rappel tout l'intérêt du suivi des PvVIH par la charge virale et non seulement par le taux de TCD4+ surtout dans les structures déconcentrées de prise en charge du VIH, où des changements de régime thérapeutique s'opèrent à tord.

[State of tolerance of multi resistant tuberculosis treatment (Burkina Faso)]. / Etat des lieux sur la tolerance du traitement de la tuberculose multi resistante (Burkina Faso).

OBJECTIVES: Estimate the tolerance of antituberculous drugs prescribed in the treatment of multi resistant tuberculosis on patients followed in the service of Pneumology of the University hospital of Yalgado Ouedraogo. PATIENTS AND METHODS: It was a retrospective and prospective longitudinal investigation. The files of patients allowed to inform the questionnaire for the retrospective phase (2010-2011), the follow-up of patients during the prospective phase (2011-2013) allowed for data collection. All the patients under antituberculous treatment of 2nd line between January 1st, 2010 and the August 31st, 2013 were included. RESULTS: 71 cases of multi resistant tuberculosis (MRT) were included. The sex-ratio was 3.4. The age bracket from 30 to 39 was the most represented (39.4 %). A notion of tubercular contage was found in 18 (25.3%) patients. All MRT patient had histories of treatment including aminoside lasting more than 2 months. Intolerance of the treatment was reported in 57 patients. Intolerance predominated in 30 to 39 years olds and in Tuberculosis/HIV co-infected patients. The neurological (47.9%) and psychiatric (47.9%) infringements were the most represented. Vestibulocochlear impact was seen in 42.3% of cases with 18.3% reporting of total deafness. CONCLUSION: The intolerance of the antituberculous treatment of the second line is real focus for clinicians. Shorter timeframes would avoid certain therapeutic modifications thought to be at the origin of failures.

OBJECTIFS: Apprécier la tolérance des antituberculeux prescrits dans le traitement de la tuberculose multi résistante chez les patients suivis dans le service de Pneumologie du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU YO). PATIENTS ET MÉTHODES: Il s'est agi d'une enquête longitudinale rétrospective et prospective. Les dossiers des patients ont permis de renseigner le questionnaire pour la phase rétrospective (2010­2011), le suivi des patients durant la phase prospective (2011­2013) a permis la collecte des données. Etaient inclus tous les patients sous traitement antituberculeux de 2ème ligne entre le 1er Janvier 2010 et le 31 Aout 2013. RÉSULTATS: Au total 71 cas de tuberculose multi résistante (TB-MDR) ont été recrutés. Le sex-ratio était 3,4. La tranche d'âge de 30 à 39 était la plus représentée (39,4%). Une notion de contage tuberculeux a été retrouvée chez 18 (25,3%) des patients. Tous les patients TB-MR avaient des antécédents de traitement incluant des aminosides de durée supérieure à 2 mois. L'intolérance au traitement a été rapportée chez 57 patients. Elle prédominait chez les 30 à 39 ans et chez les sujets co-infectés Tuberculose/VIH. Les atteintes neurologiques (47,9%) et psychiatriques (47,9%) étaient les plus représentées. L'atteinte vestibulo-cochléaire était de 42,3% avec 18,3% de surdité totale. CONCLUSION: l'intolérance du traitement antituberculeux de deuxième ligne est un véritable hantise pour le clinicien. Des régimes plus courts éviteraient certainement des modifications thérapeutiques à l'origine de survenue d'échecs.

[Blood exposure accidents: Knowledge, attitudes and practices of nursing and midwifery students at the Bobo-Dioulasso teaching hospital (Burkina Faso)]. / Connaissances, attitudes et pratiques des élèves des formations paramédicales face aux accidents d'exposition au sang au CHU Sanou-Sourô de Bobo-Dioulasso (Burkina Faso).

Blood exposure accidents are the source of major risks of contamination of healthcare personnel. The objective of this study was to describe the knowledge of standard precautions, and the attitudes and practices of nursing and midwifery students in relation to this accidental exposure. This cross-sectional survey, conducted in November 2011, was based on voluntary anonymous questionnaires completed by students working in the medical ward of the Bobo-Dioulasso teaching hospital. Of the 275 students asked to participate, 219 (92.8%) completed the questionnaire: 138 (63,0%) were student nurses and 81 (37.0%) student midwives. Their mean age was 27.9 ± 5 years. Among them, 64 (29.1%) acknowledged accidental exposure to blood during treatment performed as part of their hospital work. Only 30 of these 64 cases were reported at the time. The standard precautions for the prevention of these accidents were known to 131 students (59.8%); 58.4% always wore gloves for invasive procedures; 74.9% reported that the syringe container was "always" or "often" used. The needles used were "always" or "often" recapped before disposal in only 39.1% of cases. Only 11.0% were fully vaccinated against hepatitis B. Blood exposure accidents were not uncommon among these students and their knowledge of the standard precautions and actions to take in case of an accident is insufficient. These data show the need for further training and awareness campaigns to improve these hospital practices.

[Metabolic syndrome and cardiovascular risk patients under antiretrovirals in a day hospital at Bobo-Dioulasso (Burkina Faso)]. / Syndrome métabolique et risque cardiovasculaire chez des patients sous antirétroviraux à l'hôpital de jour de Bobo-Dioulasso (Burkina Faso).

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

[Efficacy and tolerability of antiretroviral therapy containing tenofovir disoproxil fumarate-emtricitabine-efavirenz in treatment-naive patients infected with HIV-1 in Bobo Dioulasso (Burkina Faso, 2009-2011)]. / Efficacité et tolérance d'une trithérapie antirétrovirale à base de ténofovir disoproxil-emtricitabine-éfavirenz chez les patients naïfs infectés par le VIH-1 à Bobo Dioulasso (Burkina Faso, 2009-2011).

The objective of this study was to evaluate the effectiveness and the clinical tolerance of a combination containing TDF/FTC/EFV in the treatment of HIV infection. This was a retrospective and descriptive study which included 196 adults infected by HIV-1 and treated by a combination containing TDF/FTC/EFV during 29 months in the daily hospital of Bobo Dioulasso. The median duration of follow-up was 7 months IQR [5-14 month]. The median age was 37 years IQR [31-45].With the initiation of treatment ARV, the median of the index of body mass was of 19 IQR [17-22]. The median of the lymphocytes TCD4 was 201/µl IQR [74-298/µl]. During the follow-up, we reported 25 deaths (12.8%). HIV-1 RNA plasma viral load was undetectable in 91.9% of the patients (124/135) at six months of treatment. The majority of the adverse effects of the treatment were of a neurosensory nature (40.5%). The TDF/FTC/EFV combination showed a good effectiveness in the treatment of the infection with HIV-1 in the first intention just as a good clinical tolerance.

[Antiretroviral therapy with three nucleoside reverse transcriptase inhibitors in treatment-naive HIV-infected patients in Abidjan (Cote d'Ivoire)]. / Le traitement antirétroviral à base de trois inhibiteurs nucléosidiques de la transcriptase inverse chez les patients naïfs infectés par le VIH à Abidjan (Côte d'Ivoire).

This study assesses the results of initial antiretroviral therapy with 3 nucleoside reverse transcriptase inhibitors over the first 12 months of treatment. Patients' general health improved significantly during the year, with a significant mean weight gain (from 59.3 kg to 65.12 kg) and a strong regression in the frequency of opportunistic infections over the study period, from 38% to 2% (P<0.0001). The mean CD4 T-cell count rose from 242.8 to 390.5 cell/mm(3), for a mean increase of 147.7 cells/mm(3). Accordingly, antiretroviral treatment with three nucleoside reverse transcriptase inhibitors is effective and is a useful alternative in a country with limited resources.

[The psychiatric manifestations of people living with HIV in Mali]. / Les manifestations psychiatriques chez les personnes vivant avec le VIH au Mali.

HIV/AIDS related disorders have a negative impact on the assumption of responsibility of other Comorbidities and could lead to a highest lethality rate. The goal was to evaluate the prevalence of the psychiatric disorders during HIV/AIDS at infectious diseases service of "hôpital du Point G". We carried out an exploratory study and descriptive energy of July 1, 2004 to bearing 31 October 2005 out of 166 patients. The cases of HIV were defined on the basis of positivity of serology HIV by at least 2 fast tests associated or not with clinical signs with the AIDS according to CDC. Any disturbance of the higher functions was regarded as psychiatric demonstrations. The female sex was in a majority with a sex- ratio of 0.9. The ages bracket the most touched lay between 36 and 41ans. The housewives were 36.7%. The grooms accounted for 64.5%. The prevalence of the psychiatric disorders was 58.9%. The disorders were dominated by the depression (45.8%) followed confusional syndrome 31.9% and epilepsy 7.8%. All the patients with psychiatric antecedents developed a confusional syndrome. The subjects having presented a psychiatric disorder were infected by the HIV-1 in 93.4% of the cases.Occurred of the psychiatric disorders was inversely proportional to the rate of CD4. Lethality was very high is 56%.

Snakebite in Bobo-Dioulasso, Burkina Faso: illustration of realities and challenges for care based on a clinical case

We report herein the case of 19-year-old female farmer who suffered a double snakebite on the right foot. After an unsuccessful traditional treatment, she consulted a health center, 48 hours after the bite. Upon arrival at the hospital, she showed signs of severe damage, including hemorrhagic syndrome, extensive gangrene of the bitten limb and severe acute renal failure. Due to financial constraints, neither antivenom nor the scheduled amputation was performed. After 35 days of hospitalization, she returned home, against the advice of medical personnel. Our case summarizes the daily challenges of patients and practitioners that suffer snakebite envenomation in Bobo-Dioulasso, western Burkina Faso.(AU)