[Epidemiological and clinical profile childhood cancers with pleural and pulmonary lesions in the pediatric oncology unit of Treichville University Hospital (Abidjan, Côte d'Ivoire)]. / Profil épidémiologique et clinique des cancers pédiatriques avec atteintes pleurales et pulmonaires au service de pédiatrie du CHU de Treichville (Abidjan, Côte d'Ivoire).

INTRODUCTION: Pediatric cancers are a major public health problem in sub-Saharan Africa. However, they are seldom studied, especially as regards in their extensive forms. METHODOLOGY: An eight-year retrospective and descriptive study was carried out so as to specify the epidemiological and clinical characteristics of cancers with pleural and pulmonary involvement in children of 0 to 14years of age in the pediatric oncology unit at the University Hospital of Treichville, Côte d'Ivoire (Ivory Coast). RESULTS: The frequency of pleural and pulmonary involvement in pediatric cancers was 13.8%. Children's average age was 7.2years, with sex ratio at 2.11. Solid tumors were predominant, with a predominance of Burkitt's lymphoma (39.3%) and nephroblastoma (35.7%). The most affected age groups were 10 to 15years (Burkitt's lymphoma) and 0 to 5years (nephroblastoma). Time to diagnosis ranged from 31 and 60days in 40.4% of cases, and time to treatment was at most 30 days, for the overwhelming majority (97.1%) of the children. Chemotherapy was initiated in 67.9% of patients. Hospital mortality was 73.2%. CONCLUSION: Through this study, the authors established the profile of childhood cancers with pleural and pulmonary involvement. Comparative studies of mortality in pediatric cancers with and without pleural and pulmonary involvement could further underline the importance of early management before dissemination.

[Catamenial hemothorax: Results of 11 operated cases]. / Hémothorax cataménial : résultats de 11 cas opérés.

OBJECTIVE: To report our therapeutic approach toward catamenial hemothorax. PATIENTS AND METHODS: This retrospective study from January 1994 to November 2018 concerned patients operated under general anesthesia for catamenial hemothorax. A posterolateral thoracotomy approach was implemented either directly or after primary videothoracoscopy. Six-month hormone therapy was systematically prescribed postoperatively. The result was assessed in terms of occurrence or non-occurrence of hemothorax upon resumption of menses after discontinuation of hormone therapy. RESULTS: Eleven patients were selected, with an average age was 32years (25-41). Catamenial hemothorax was associated with hemorrhagic ascites in 5 cases. Endometriotic plaques in the form of diaphragmatic fenestrations were found nine times and were resected (1 case) or covered by a synthetic non-absorbable patch (8 cases). Pleural symphysis completed the surgical procedures. The one hormone used was triptorelin. Mortality was zero. Mean postoperative hospital stay was 10.24days and mean follow-up was 3.5years. One patient was lost to follow-up at 3months. One hemothorax recurrence was observed after discontinuation of hormone therapy at 4months [1], and repeated pleural punctures were carried out while awaiting revision surgery. The five cases of ascites recurred and the patients were monitored in the gynecology unit. CONCLUSION: In patients suffering from catamenial hemothorax with diaphragmatic fenestrations, we recommend phrenoplasty using synthetic patches associated with pleural talcage and 6-month complementary concomitant hormone therapy.

[Cerebral toxoplasmosis in the infectious diseases department of the CHU du Point G in people living with HIV]. / La toxoplasmose cerebrale dans le service de maladies infectieuses du CHU du Point G chez les personnes vivant avec le VIH.

Toxoplasmosis is defined as a cosmopolitan protozoan disease caused by an obligate intracellular coccidia, Toxoplasma gondii. The advent of HIV infection has made cerebral toxoplasmosis one of the most widespread neurological opportunistic infections. METHOD: We conducted a descriptive cross-sectional study with retrospective review of files of cerebral toxoplasmosis on HIV infected patients who had been hospitalized in the infectious diseases department of Point G University Hospital between January 1st, 2014 and September 30th, 2019. RESULTS: During the study period, the frequency of cerebral toxoplasmosis was 10.1% and in 46.4% of the patients, the diagnosis led to the discovery of HIV co-infection. The clinical features were characterized by fever, headaches, and motor deficit at 86.6%, 84.5% and 69.1% respectively. Roundel image on computed tomography was most represented and was found in 24.4% of patients. Anti-toxoplasma treatment based on trimethoprim /sulfamethoxazole (TMP/SMX) associated with folinic acid was initiated in 78 patients out of 90, but 19 patients had a contraindication or adverse effects to this combination and were treated with clindamycin. HAART was initiated in 31 patients out of 45 (68.9%) newly diagnosed. The overall prognosis was limited with a mortality rate of 42%. CONCLUSION: The prevalence of cerebral toxoplasmosis was high in our study, 10.1%. To reduce this prevalence, chemoprophylaxis should be initiated in all HIV-infected patients with a CD4 count below 200 cells/mm3.

INTRODUCTION: La toxoplasmose est une protozoose cosmopolite due à Toxoplasmagondii. Avec l'avènement du VIH, la toxoplasmose cérébrale est une des infections opportunistes neurologiques les plus répandues. MÉTHODE: Nous avons mené une étude transversaledescriptive à collecte rétrospective portant sur des cas de toxoplasmoses cérébrales sur terrain d'immunodépression aux VIH ayant séjourné en hospitalisation dans le service des maladies infectieuses du CHU de Point G du 1er janvier 2014 au 30 septembre 2019. RÉSULTATS: La prévalence de la toxoplasmose cérébrale était de 10,1%. Chez 46,4% des patients, le diagnostic de toxoplasmose cérébrale avait permis la découverte d'une coïnfection à VIH. Le tableau clinique était dominé par la fièvre, les céphalées et le déficit moteur soit respectivement 86,6%, 84,5% et 69,1%. L'image en cocarde à la tomodensitométrie a été retrouvée chez 24,4% des patients. Le traitement anti-toxoplasmique à base de triméthoprime/sulfaméthoxazole (TMP/ SMX) associée à l'acide folinique a été conduit chez 78 patients sur 90. Dix-neuf patients avaient une contre-indication ou des effets indésirables à l'association TMP/ SMX et ont été traités par la clindamycine. Le traitement ARV a été initié chez trente-un patients sur 45 nouvellement dépistés soit 68,9%. Le pronostic chez nos patients était réservé et marqué par une mortalité de 42%. CONCLUSION: La prévalence de la toxoplasmose cérébrale était élevée dans notre étude soit 10,1%. Pour diminuer cette prévalence, la chimio-prophylaxie doit être instaurée chez tous les patients infectés par le VIH et ayant un taux de CD4 inférieur à 200 cellules/mm3.

Reason for immigration and immigrants' health.

OBJECTIVES: The existing literature on the health trajectories of the UK immigrants has mainly focussed on the relationship between ethnicity and health. There is little information on the role of immigration status and no previous information on the role of reason for immigration to the country. This study fills this gap in the literature by analysing the heterogeneity of immigrant-native differences in health by reason for immigration. STUDY DESIGN: Analysis of cross-sectional quarterly data from the UK Labour Force Survey covering the period of 2010 (quarter 1) to 2017 (quarter 2). The sample includes 345,086 observations. The dependent variables of interest include suffering from a long-lasting condition, the link between long-lasting conditions and labour market performance and the prevalence of 12 specific health conditions. METHODS: Data were analysed using linear probability models to adjust for differences in age, education, gender, ethnicity, local authority of residence and year of survey. The analysis also explores the role of length of stay in the UK and the percentage of current lifetime spent in the UK (duration in the UK/age). RESULTS: Results indicate that, in general, immigrants are less likely than natives to report suffering from a long-lasting (1 year or more) health problem. This pattern generally remains the same when we consider the specificity of the long-lasting health problem. However, there are key differences across the immigrant groups by reason for immigration. Those who migrated for employment, family and study reasons report better health outcomes than natives, while those who migrated to seek asylum report worse health outcomes than natives. There is convergence to natives' health outcomes over time for those who migrated for non-asylum reasons, but not for those who migrated to seek asylum. CONCLUSIONS: The findings show that the prevalence of health problems differs not only between natives and immigrants but also across groups of immigrants who moved to the UK for different reasons.

[Current situation of primary prophylaxis with isoniazid (INH) in children who are contacts of patients with bacillary pulmonary tuberculosis in Abidjan (Cote d'Ivoire)]. / Situation actuelle de la chimioprophylaxie primaire à l'isoniazide (INH) chez les enfants contacts des patients atteints de tuberculose pulmonaire bacillifère à Abidjan (Côte d'Ivoire).

INTRODUCTION: The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital. MATERIAL AND METHOD: We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment. RESULTS: Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339). CONCLUSION: High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children.

[Multidrug resistant tuberculosis among health personnel in Côte d'Ivoire]. / Tuberculose multirésistante chez le personnel de santé en Côte d'Ivoire.

UNLABELLED: Multidrug resistance tuberculosis (MDR-TB) of health workers raises the question of hospital-borne transmission of infection. OBSERVATIONS: We report 4 cases of MDR-TB confirmed at the health workers over a period of 8 years (January, 2005 to December 2012), in the 2 services of pulmonology from Abidjan to Côte d'Ivoire). It was about young grown-up patients (aged between 28 and 39 years), all HIV negatives, in a no-win situation of antituberculosis treatment (3 patients/4). The most concerned staffs were the male nurses (2/4). Two agents worked in general hospital and the only one in a pulmonology department at the time of the diagnosis. The tuberculosis was of lung seat with bilateral radiographic hurt (3/4) and multiples excavations (4/4). The case index, when it was identified (2/2), was a family case. Among 3 agents who benefited from a second line treatment, 1 died further to an extensive drug resistance and 2 are declared to be cured. The fourth died before the beginning of the treatment. These cases of cure were in touch with a premature care. CONCLUSION: Multidrug resistant tuberculosis at the health workers could have a negative impact on the antituberculosis fight imposing rigorous measures of infection control and better implication of the occupational medicine.

[Ivory Coast physician's knowledge and attitudes about smoking in patients with tuberculosis]. / Connaissances et attitudes des médecins ivoiriens vis-à-vis du tabagisme chez les patients atteints de tuberculose.

INTRODUCTION: Smoking promotes, among other health problems, the development of tuberculosis and the discovery of a case of tuberculosis can therefore be an opportunity for tobacco control interventions. METHODS: We conducted a prospective study evaluating the knowledge of 37 Ivorian physicians (32 men and 5 women with 5 active smokers) on the relationship between smoking and tuberculosis and their attitudes to smoking tuberculous patients between February and August 2012 using an anonymous self-administered questionnaire. RESULTS: The response rate to the questionnaire was 88.1%. Among them, 70.3% of Ivorian physicians knew that smoking increased the incidence of tuberculosis, 75.7% said that forms of tuberculosis were more severe in smokers and about 27% thought that the cure rate of tuberculosis was lower in smokers. No significant difference was observed according to respondents' smoking status, or gender. Patients' smoking status was always assessed by 64.9% of physicians and by 78.4% in patients with tuberculosis, again not differing by physicians' smoking status or gender. The risks of smoking were always explained to patients with active pulmonary tuberculosis by 43.2% and benefits of stopping smoking ware always described in 35.1%. An intervention for smoking cessation was systematically offered to smokers having tuberculosis by 59.4% of physicians and 8.1% offered medication for smoking cessation. CONCLUSION: These results strongly support the need to reinforce physician behaviors to address smoking in patients with tuberculosis in Ivory Coast.

[Extensively drug resistant tuberculosis in Ivory Coast]. / Tuberculose ultrarésistante en Côte d'Ivoire.

INTRODUCTION: The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. CONCLUSION: XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.

[Fixed drug eruption after taking ethambutol]. / Érythème pigmenté fixe secondaire à la prise d'éthambutol.

INTRODUCTION: Fixed drug eruption (FDE) is a specific skin reaction and the only exclusively medicinal dermatosis. Among the drugs usually responsible are the antituberculous antibiotics including rifampicin and, less often, isoniazid and pyrazinamide. FDE after taking ethambutol is rarely described. CASE REPORT: A 32-year old HIV negative patient presented a FDE localized to the internal surface of the lips and the interdigital folds during the 4th month of antituberculous treatment comprising rifampicin, isoniazid and ethambutol. The diagnosis was supported by the characteristic appearances of the lesions of FDE and their early reappearance in the same areas after accidental reintroduction of antituberculous triple therapy including ethambutol. Double-agent therapy with rifamicin and isoniazid was tolerated well. CONCLUSION: Discovery of FDE requires a rigorous search for the responsible medicine. During antituberculous treatment, the practitioner has to bear in mind the potential role of ethambutol, which is possibly potentiated by rifampicin.

[Effects of war on control of tuberculosis in Côte d'Ivoire from 2002 to 2007]. / Effets de la guerre sur le contrôle de la tuberculose en Côte d'Ivoire de 2002 à 2007.

OBJECTIVES: To specify consequences of armed conflict in Côte d'Ivoire from 2002 to 2007 on treatment outcomes of new cases of smear-positive pulmonary tuberculosis (PTB+) and retreatment cases. METHODOLOGY: Retrospective analysis of treatment outcomes and reprocessing notified to the National Program against Tuberculosis from 2001 to 2008. RESULTS: Totally, 7,4232 cases of TPM+ and 5094 cases of reprocessing had been declared during the war period in Côte d'Ivoire. The global average rate of therapeutic success was 72% with a lower average rate of success in retreatment in Center, Northern et Western (CNO) zone (54%) than in Southern zone (73%). The average rate of lost sight was higher in CNO zone than in the South with respectively 27% and 11%. The average rate of success in retreatment was 60% on the national level with a lower rate in CNO zone (48%) than in the South zone (62%) and the average rate of lost sight in retreatment was higher in CNO zone than in the South zone (28% versus 16%). CONCLUSION: Our results show that there was no early epidemic of tuberculosis during the armed conflict in Côte d'Ivoire which has although severely disrupted activities of tuberculosis management in ex-nongovernmental zone.

[Simvastatin indused chylothorax]. / Chylothorax induit par la simvastatine.

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin.

[Persistent, cavitating, non-tuberculous pneumopathy in a patient with HIV: the role of Candida?]. / Pneumopathie persistante et excavee non tuberculeuse chez un patient infecte par le VIH: rôle de candida?

Fungal agents are not common cause of pneumonia. In favorables conditions mycosis can cause atypical clinical and radiographic figures. Authors report the observation of a 45 years and VIH-positive patient presenting a persistant and excavating pneumonia probably caused by Candida albicans.

Pneumopathie persistante et excavee non tuberculeuse chez un patient infecte par le VIH : role de candida ?

Les mycoses sont une cause peu commune de pneumopathie. Dans certaines circonstances favorables; elles peuvent etre a l'origine de tableaux cliniques et radiologiques trompeurs; pouvant faire errer le diagnostic