[Depression and associated factors: case of Cotonou civil prison]. / Depression et facteurs associes : cas de la prison civile de Cotonou.

INTRODUCTION: Living conditions in detention are particularly hard in sub-Saharan African countries. These conditions cause psychiatric illnesses, including depression. The purpose of this study was to determine the prevalence of major depressive disorders and to identify the associated factors in a sample of the prison population in the city of Cotonou. METHODS: A cross-sectional study in a penitentiary institution was conducted with 208 inmates. The data were collected during individual interviews conducted using a structured questionnaire. Depression was assessed using the Hamilton scale. RESULTS: The detainees interviewed were mostly men (86.5%) and in pre-trial detention (64.4%). The prevalence of depression was 32.2%. Depression was more prevalent among males, those with low education, those who had previously been convicted, and inmates who reported experiencing abuse within the prison. CONCLUSION: More attention should be given to the screening and management of inmate mental health issues.

INTRODUCTION: Les conditions de vie en détention sont particulièrement difficiles dans les pays d'Afrique subsaharienne. Ces condi-tions favorisent les maladies psychiatriques, dont la dépression. Cette étude avait pour objectif de déterminer la prévalence des troubles dépressifs majeurs et d'identifier les facteurs associés dans un échantillon de la population carcérale dans la ville de Cotonou. MÉTHODES: Une étude transversale en établissement a été conduite auprès de 208 détenus. Les données ont été collectées au cours d'entretiens individuels conduits à l'aide d'un questionnaire structuré. La dépression a été évaluée à l'aide de l'échelle de Hamilton. RÉSULTATS: Les détenus interrogés étaient majoritairement des hommes (86,5%) et en situation de détention préventive (64,4%). La prévalence de la dépression était de 32,2%. La dépression était plus fréquente chez les sujets de sexe masculin, chez les personnes peu instruites, chez celles qui avaient déjà été condamnées et chez les détenus qui affirmaient avoir subi des violences au sein de l'établissement carcéral. CONCLUSION: Une attention plus soutenue devrait être accordée au dépistage et à la prise en charge des problèmes de santé mentale des détenus.

[Rare location of tuberculosis: endometrial tuberculosis]. / Une localisation rare de la tuberculose: la tuberculose endométriale.

Tuberculosis is a public health problem, especially in the developing countries. Bacillary pulmonary tuberculosis is the most common form of tuberculosis while genital tuberculosis is rare and underdiagnosed. We here report a case of endometrial tuberculosis. The study involved a 72-year old female patient with SC hemoglobinopathy consulting her gynecologist because of chronic leukorrhea. Cytobacteriologic assessment of vaginal swabs showed Streptococcus agalactatiae. Despite suitable antibiotic therapy, the evolution was marked by the persistence of leukorrhea. Pelvic ultrasonography objectified thickened endometrium, appearing as hyperechoic at the base of the uterus. This was suggestive of endometrial cancer. Anatomo-pathological examination of endometrial curettage samples showed granulomatous endometritis suggesting follicular tuberculosis. Outcome was favorable under antituberculosis treatment. In TB endemic areas, genital tuberculosis is not exceptional and should be suspected in patients with chronic leukorrhea despite suitable treatment.

Caractéristiques cliniques, biologiques et évolution des cas de paludisme de l'adulte hospitalisés en médécine interne à l'hôpital de zone de Come

Objectif: Décrire les signes et l'évolution du paludisme en médecine interne.Patients et méthodes : Etude transversale, descriptive sur 2 ans (1er janvier 2012 au 31 décembre 2013) en médecine interne de l'hôpital de Zone de Comè (Bénin). Etaient inclus, les patients chez qui le paludisme a été diagnostiqué en cours d'hospitalisation. Les données ont été analysées avec SPSS 18.0.Résultats : 45 cas de paludisme ont été diagnostiqués parmi les 317 cas de fièvre enregistrés pen-dant la période d'étude, soit 14,2%. La sex-ratio était de 0,88 et l'âge moyen de 36,69±13,76 ans. Les autres symptômes les plus fréquents étaient l'asthénie (55,6%), les vomissements (22,2%) et les cé-phalées (20,0%). 25 patients (55,6%) avaient au moins un critère de gravité ; 4,4% étaient décédés et 6,6% ont été transféré vers un niveau supérieur. Conclusion : Le paludisme est fréquent en Médecine. Promptement pris en charge, l'évolution est souvent favorable

Panorama des connectivités en medecine interne au Centre National Hospitalier et Universitaire-Hubert Koutoukou Maga de Cotonou

Introduction : Les connectivites sont peu diagnostiquées en Afrique au sud du Sahara probablement en raison d'une insuffisance de couverture du continent en service spécialisés. Il est nécessaire d'établir des politiques de dépistages Objectif : Etablir le panorama des connectivites dans un service de médecine interne après la réorga-nisation de sa prise en charge Méthode : Il s'agit d'une étude transversale descriptive qui a eu pour cadre le service de médecine interne du CNHU-HKM de Cotonou. L'étude a couvert une période 91 mois allant du 1er janvier 2010 au 31 août 2017. Les variables étudiées étaient les caractéristiques sociodémographiques, cliniques et biologiques au moment du diagnostic de connectivite. Résultats : 18 patients ont été inclus sur les 2219 patients suivis pendant la période d'étude soit une fréquence hospitalière de 0,8%. Le sex ratio était de 0,26 et l'âge moyen de 35,3±11,5 ans. Les connectivites identifiées au cours de la période d'étude étaient principalement le Lupus érythéma-teux systémique (77,8%), les connectivites indifférenciées (11,1%) et la sclérodermie (5,6%). Les manifestations cliniques étaient dominées par les manifestations ostéo-articulaires (77,8%), cutanéo-muqueuses (61,1%) et hématologiques (55,6%). Le profil immunologique des patients était dominé par les antiRNP, les antiSm, anti-SSA et antinucléosome. Conclusion : les connectivites sont peu fréquentes en Médecine interne au Bénin et sont majoritaire-ment représentées par le lupus. Des études multicentriques sont nécessaires afin de déterminer un panorama plus représentatif

Diversity of high risk human papilloma viruses in women treated with antiretroviral and in healthy controls and discordance with cervical dysplasia in the South of Benin.

BACKGROUND: High risk oncologic Human Papilloma Virus (HPV) is one of the leading causes of cervical cancer worldwide. We investigated HPV genotypes among women living or not with Human Immuno-deficiency Virus (HIV) in two major hospitals in the south of the republic of BENIN in the city of Cotonou. Our objective is to investigate the association of high risk-HPV to cervical dysplasia among women under stringent anti-retroviral (ARV) treatment and in controls without HIV. METHODS: The investigation was carried out within 1 year period in two groups of adult women: one group with HIV1 infection and under ARV therapy in the National University Hospital (CNHU-HKM) designated as CH group (n = 86); and one control group without HIV infection and attending the hospital Mènontin for routine gynecologic checkup and designated as ME group (n = 86). Cells derived from cervical uterine smears (CUS) were used for this investigation. The samples in ME group were selected to have similar lamin A/C profile with CH group. HPV genotypes were assessed by polymerase chain reaction (PCR) while lamin A/C expression profile was assessed by western blotting to corroborate the risk of cervical dysplasia. RESULTS: HPV56 is dominant in CH group while HPV66 is dominant in ME group. 31 % of women in CH group are infected with HPV compared to 23 % in ME group. Quadruple and quintuple HPV infections are more observed among CH group but not in ME group making HPV counts of 43 in CH group and 27 in ME group. Cervical dysplasia are present in 5 % (4/86) of women in CH group and in 1 % (1/86) of women in ME group at the time of CUS collection. The adjustment of the risk to develop cervical cancer in the future related to HPV infection and the total loss of lamin A/C is not significantly different in both groups. CONCLUSION: Women living with HIV are more sensitive to multiple HPV infection but not all HPV infections generated cervical dysplasia. The effectiveness of antiretroviral therapy in CH group may reduce significantly the frequency of cervical dysplasia.

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

BACKGROUND: HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA). METHODS: We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region. RESULTS: Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3). CONCLUSIONS: This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.

The spectrum of cancers in West Africa: associations with human immunodeficiency virus.

BACKGROUND: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries, cancer will contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancers among patients hospitalized for diagnosis or treatment of cancer in West Africa. METHODS: A case-referent study was conducted in referral hospitals in Côte d'Ivoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancer and clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancers and a subset of selected non-AIDS defining cancers to a referent group of non-AIDS defining cancers not reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancers sites compared to a referent group of other cancers. RESULTS: The HIV overall prevalence was 12.3% (CI 10.3-14.4) among the 1,017 cancer cases included. A total of 442 patients constituted the referent group with an HIV prevalence of 4.7% (CI 2.8-6.7). In multivariate analysis, Kaposi sarcoma (OR 62.2 [CI 22.1-175.5]), non-Hodgkin lymphoma (4.0 [CI 2.0-8.0]), cervical cancer (OR 7.9 [CI 3.8-16.7]), anogenital cancer (OR 11.6 [CI 2.9-46.3]) and liver cancer (OR 2.7 [CI 1.1-7.7]) were all associated with HIV infection. CONCLUSIONS: In a time of expanding access to ART, AIDS-defining cancers remain highly associated with HIV infection. This is to our knowledge, the first study reporting a significant association between HIV infection and liver cancer in sub-Saharan Africa.

Incidence of lipodystrophy and metabolic disorders in patients starting non-nucleoside reverse transcriptase inhibitors in Benin.

BACKGROUND: The incidence and risk factors for lipodystrophy and metabolic disorders among patients in Africa on first-line combined antiretroviral treatment (cART) mostly containing non-nucleoside reverse transcriptase inhibitors is poorly documented. METHODS: This prospective cohort study recruited 88 HIV-infected patients initiating cART between October 2004 and June 2005 in Cotonou, Benin. Patients were followed for 24 months. The main outcomes were incidence of lipodystrophy and metabolic disorders. Multivariate Cox proportional hazards regression models were used to describe factors associated with progression to lipodystrophy. RESULTS: After a median follow-up of 23.2 months (interquartile range 22.3-23.7), 24 (30%) patients developed lipodystrophy (lipoatrophy 9%, lipohypertrophy 24% and mixed pattern 2.5%). The incidence rate for lipodystrophy was estimated to 1.72 per person-month (95% confidence interval [CI] 1.15-2.56) occurring after a median time of 11 months on cART. Metabolic syndrome (International Diabetes Federation definition) appeared in 10 (13%) patients after a median of 15 months with an estimated incidence rate of 0.62 per person-month (95% CI 0.33-1.16). It was more common in women (19.2% versus 3.1% in men; P=0.043). Diabetes (8%) and hypercholesterolaemia (35%) were also observed. After adjustment, gender, young age (hazard ratio [HR] 0.45 [95% CI 0.22-0.90]; P=0.025), high BMI at inclusion (HR 1.53 [95% CI 1.28-1.83]; P<0.0001) and smoking (HR 28.0 [95% CI 2.5-307.4]; P=0.006) were significantly associated with lipohypertrophy. CONCLUSIONS: Lipodystrophy and metabolic syndrome were commonly and rapidly observed in this cohort of sub-Saharan patients initiating cART.

Prevention of venous thromboembolism among inpatients at Cotonou teaching hospital, Benin.

AIM: The aim of this retrospective study was to evaluate the use and appropriateness of preventive measures for venous thrombosis among adult inpatients in a Benin teaching hospital. PATIENTS AND METHODS: All patients were systematically enrolled. The risk of venous thrombosis was estimated according to international guidelines. Thromboembolic events were diagnosed using the Wells score and, when possible, by paraclinical investigations. The following variables were studied: the risk of venous thrombosis, the use and appropriateness of preventive measures, and the frequency of thromboembolic events. The data were analyzed with Epiinfo 6.04.fr and SPSS software, and significance was assumed at p=0.05. RESULTS: The study population consisted of 487 patients recruited in four surgical wards, four general wards and one obstetric-gynecology ward. Mean age was 38.7+/-11.3 years and the sex ratio 0.51. The risk of thrombosis was considered low in 15% of patients, moderate in 60.8%, high in 21.1% and very high in 3.1%. Prophylactic measures were prescribed to 33.9% of the patients overall, 53.6% in the obstetric gynecology ward, 28.5% in the surgical wards and 12.9% in the general wards. The frequency of preventive measures rose with the level of risk (p<0.0001). Preventive measures consisted of passive mobilization, aspirin, enoxaparin and acenocoumarol. The prescriptions were appropriate in only 6% of cases. Among 198 patients who were monitored for two months after hospital discharge, 8% had a venous thromboembolic event. Such events were more frequent in the absence of prophylaxis (12% vs 3.3%, p=0.02). CONCLUSION: The risk of venous thromboembolic is recognized but poorly managed in this Bénin teaching hospital.