AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study.

BACKGROUND: Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. METHODS: This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. RESULTS: We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. CONCLUSION: Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

Interet du dosage de l'homocysteine; de la vitamine B12 et de l'acide folique au cours des maladies cardiovasculaires en Cote d'Ivoire

Objectif : cette etude avait pour objectif d'apprecier les variations des concentrations seriques de l'homocysteine; de la vitamine B12 et de l'acide folique au cours des maladies cardiovasculaires en Cote d'Ivoire. Methodes : il s'agissait d'une etude transversale realisee chez 122 sujets des deux sexes; ages de plus de 18 ans; repartis en deux groupes. Un groupe de 30 sujets apparemment sains et un groupe de 92 patients atteints de maladies cardiovasculaires. Ce dernier groupe se composait comme suit : 30 patients atteints d'hypertension arterielle (HTA); 30 patients atteints d'accident vasculaire cerebral (AVC); 19 patients atteints d'infarctus du myocarde (IDM) et 13 patients atteints de thrombose veineuse peripherique (TVP). Des echantillons de sang ont ete preleves chez les sujets a jeun depuis la veille au soir (12 heures). Les plasmas obtenus apres traitement ont ete separes en aliquotes qui ont servi au dosage de l'homocysteine; de la vitamine B12 et de l'acide folique. Resultats : Au terme de notre etude; nous avons constate que : - la difference entre la proportion de patients atteints d'AVC ayant une hyperhomocysteinemie et celle des sujets sains ayant une hyperhomocysteinemie etait statistiquement significativement avec p=0;0409; - la difference entre la proportion de patients atteints d'IDM ayant une hyperhomocysteinemie et celle des sujets sains ayant une hyperhomocysteinemie etait statistiquement significativement avec p=0;0205; - 52;63 des sujets de l'etude ayant une hyperhomocysteinemie presentaient une carence en acide folique ;- le risque relatif des MCV etait superieur a 2. Conclusion : Cette etude montre que l'hyperhomocysteinemie observee chez les patients atteints de MCV en Cote d'Ivoire est due dans 52;63 des cas a une carence nutritionnelle; notamment en acide folique. Le dosage plasmatique de l'acide folique et de l'homocysteine chez les patients atteints de MCV en particulier et chez l'Ivoirienne en general pourrait aider a la prevention des MCV et reduire les recidives

Resultat therapeutique et survie des lymphomes malins B diffus a grandes cellules dans le service d'hematologie clinique du CHU de Yopougon

"Objectif : Etudier la survie des patients atteints de lymphomes malins B diffus a grandes cellules. Population et methodes : Il s'agissait d'une etude retrospective; descriptive; analytique et non comparative portant sur 65 dossiers de patients atteints de lymphome B diffus a grandes cellules suivis dans le service d'hematologie clinique du CHU de Yopougon sur une periode de 20 ans. La survie a ete etudie selon la methode de Kaplan-Meir et la comparaison des courbes de survies selon le test de"" Log Rank"" Resultats : la moyenne d'age etait de 42 ans. Le sexe masculin predominait avec un sex-ratio de 1;9. La prise en charge d'un lymphome malin non Hodgkinien etait le motif de consultation le plus frequent dans 85%. 44 patients avaient un PS egal a 2 et la localisation ganglionnaire primitive etait majoritaire dans 69;2%. 86% presentaient des signes d'evolutivites cliniques; le type histologique centroblastique predominait (65%). 4 malades presentaient une serologie VIH positive sur 14 serologies demandees. Le stade d'ANN ARBOR III et IV etaient majoritaires (63% ). 83% des patients presentaient des signes d'evolutivites biologiques. Les taux de la lacticodeshydrogenase et de la ?2 microglobuline etaient eleves dans respectivement 83% et 86%. Le taux d'hemoglobine etait comprit entre 7g /dl et 12g/dl dans 77%. Le protocole CHOP etait le plus utilise dans 56%; la reponse therapeutique a ete evaluee chez 26 patients avec un taux de remission complete(RC) de 65%; la duree de la RC etait superieure a un an dans 47.06%. 91% de nos malades sont decedes. La survie globale a 1 an etait de 40% et a 5 ans de 5% avec une survie moyenne de 11 mois. Aucun des parametres sociodemographiques; cliniques; biologiques et therapeutiques analyses n'avait influence significativement la survie. "

The Effect of Imatinib Mesylate for Newly Diagnosed Philadelphia Chromosome-Positive, Chronic-Phase Myeloid Leukemia in Sub-Saharan African Patients: The Experience of Côte d'Ivoire.

Imatinib mesylate, showed encouraging activity in chronic myelogenous leukemia. However, there are few data regarding his efficacy and response monitoring in Sub-Saharan African patients. Our objective was to assess response to imatinib mesylate (Glivec) in Côte d'Ivoire patients with newly diagnosed Chronic Myeloid Leukemia (CML). From May 2005 to September 2009, we treated 42 patients (40 years; range 16-69) with Philadelphia chromosome (Ph+) positive in chronic phase CML with oral imatinib mesylate at daily doses of 400 mg. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. At a median follow up of 32 (range 7.6-113) months, the CHR rate in our study group was 76%. A major CR was found in 19 patients (45%) with 17% and 29% complete and partial CR respectively. There were no significant differences in the incidence of major cytogenetic response by known prognostics factors. Median time to CHR was 8 months (range 0.4-25), and 16 months (range: 0.1-36) for CR. Projected 5-year OS rate was 72% (95%CI 42-88). We conclude that imatinib therapy sub-Saharan African CML patients is very promising and has favorably changed the prognosis for black African patients with CML.

[Therapeutic impact of alpha interferon in chronic myelogenous leukaemia]. / Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique.

CONTEXT: Ten years after the use of alpha interferon in chronic myelogenous (CML) leukaemia treatment, we review this treatment. OBJECTIVE: We propose through this study to evaluate the therapeutic answer of the patients reached of CML in chronic phase and to study its impact on survival. MATERIAL AND METHODS: To be done we carried out a descriptive and analytical retrospective study concerning 40 patients carrying Chronic Myelogenous Leukaemia. RESULTS: The average age was 39.05 years and ratio sex was 0.9. 60% of the patients profited from the arm Hydroxyurea + Interferon alpha + Cytosine Arabinoside and 40% from Hydroxyurea + Interferon. The complete haematological answer was observed in 85.5%. The cytogenetic answer was documented only for two cases, and it acted of complete answer. On the evolutionary level, it was noted 27.5% of deaths related to a blastic transformation. The side effects were marked by occurred of alopecia, herpes and the gripal syndrome. The median of survival observed was 68.233 months or 5.68 years. The age, socioeconomic level, delay of treatment started, therapeutic protocol, length and regularity of treatment influenced the therapeutic response. CONCLUSION: Many factors influence the treatment response.

La maladie de Hodgkin classique au CHU de Yopougon

L'un des facteurs pronostiques de la maladie de Hodgkin classique est l'aspect histologique decrit dans la classification de l'Organisation Mondiale de la Sante (OMS). Selon celle-ci; il y aurait une predominance du type 2 en Occident et du type 3 en Afrique. Sur la base de ces donnees; nous avons entrepris une etude retrospective; descriptive et comparative de 1991 a 2004; qui a porte sur 66 cas de maladie de Hodgkin classique de type 2 et 3. Nous avons observe 44 hommes (66;7) et 22 femmes (33;4) soit un sex ratio de 2 et un age moyen de 22;5 ans. La localisation ganglionnaire a ete le motif le plus frequent de consultation (85) et surtout au stade III d'Ann Arbor (45;5). Histologiquement le type 3 a predomine avec 59. La chimiotherapie selon les protocoles MOPP et/ou ABVD a donne les resultats suivants : 66; 7de remission complete; une probabilite de survie de 80a un an dans le type 2 et 43dans le type

Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique

Contexte : Dix annees apres l'utilisation de l'interferon alpha dans le traitement de la leucemie chronique; dans le service d'hematologie clinique du CHU de yopougon; nous faisons le point de cette therapeutique. Objectif : nous nous proposons a travers cette etude d'evaluer la reponse therapeutique des patients atteints de leucemie myeloide chronique en phase chronique et d'etudier l'impact de ce traitement sur la survie. Materiel et methodes : nous avons effectue une etude retrospective descriptive et analytique concernant 40 patients porteurs de leucemie myeloide chronique. Resultats : l'age moyen etait de 39.05 ans et le sex ratio de 0.9. Les patients ont beneficie dans 60du bras Hydroxyuree + Interferon alpha + Cytosine Arabinoside et dans 40de l'association Hydroxyuree + Interferon alpha. La reponse hematologique complete a ete observee dans 85.5des cas. La reponse cytogenetique a ete documentee seulement dans deux cas; et il s'agissait de reponses completes. Sur le plan evolutif; il a ete note 27.5de deces lies a une transformation blastique. Les effets secondaires ont ete marques par la survenue d'alopecie; d'herpes et de syndrome grippal. La mediane de survie observee etait de 68.233 mois soit 5.68 ans. L'age; le niveau socioeconomique; le delai de prise en charge; le protocole therapeutique; la duree du traitement; la compliance influencaient la reponse therapeutique. Conclusion : de nombreux facteurs influencent la reponse au traitement

[Chronic lymphocytic leukemia in Subsaharian Africa: clinical outcome experience of Côte d'Ivoire]. / La leucémie lymphoïde chronique du Noir en Afrique subsaharienne : caractéristiques cliniques thérapeutiques et pronostiques (cas de la Côte d'Ivoire).

We reported in this retrospective study the clinical outcome of 56 chronic lymphoïd leukemia of black African in Ivory Coast and the predicting prognosis factors. The mean age was 62 years old with average of 38 to 84 years. According to Binet staging, 29 patients with stage A, and respectively 11 and 16 patient for stage B and C. All patient received chemotherapy protocol regimens (CVP, chlorambucil, CHOP). The global response was 51.78%. The death occurred in 29 patients. The mean survival was 8.22 years. The disease free survival was 58.8% at 5 years. In univariate analysis, factors with high-risk of death are patients age above 60 years, the presence of node, liver involvement, Spleen large IV and V of Hackett classification, WBC superior to 100,000/microL, lymphocytosis superior to 63,000/microL, Anaemia inferior to 10 g/dL, thrombopenia inferior to 100,000/microL, medullar lymphocytosis superior to 73% and Binet Stage B and C. In multivariate analysis, only age, adenopathy, hepatomegaly and lymhocytosis were an independent prognostic factor for predicting survival.

[Anemic complications of sickle cell disease: frequency and evolution of 338 cases reported at Yopougon Teaching Hospital]. / Les complications anémiques de la drépanocytose homozygote: fréquence et évolution. A propos de 338 cas au CHU de Yopougon.

INTRODUCTION: Anemic complications of sickle cell disease are defined as all acute or chronical complications due to anemia. In order to describe complications of sickle cell disease, authors reported frequency and course of anemic manifestations. METHOD: This is a descriptive study based on retrospective analysis of data about 338 patients with sickle cell disease collected in the Service d'hematologie Clinique of Yopougon Teaching Hospital over a period of 11 years (March 1994 to September 2005). RESULTS: Mean age of our patients was 21.34 years, ranging from 7 months and 62 years.Majority of patients (68.93%) are aged 15 years or more. Male patients are predominant, with a sex-ratio of 1.36 and most of our patients (98.82%) are from low social condition. Anemic complications were the most occurring complications in our patients with a frequency of 18.78%. Acute anemic complications are the most frequently noticed (87.87%), among which acute crises of deglobulization are mainly present (94.27%). Chronical anemic complications are noticed in 23.67%of our patients and consist mainly of gall bladder lithiasis (20.12%). Death occurred in 10.35% of our patients and was due to anemic complications in 42.86% of cases. COMMENTS: The predominance of acute anemic complications may be due to the comorbidity observed in most of our major sickle cell disease patients. It may turn a chronical haemolytic anemia in acute hemolysis which is a major complication. CONCLUSION: Sickle cell disease has become nowadays a disease of little letality. Its anemic complications are the most important ones in our working conditions.

[Is hepatomegaly a prognosis factor of chronic myeloid leukaemia among African blacks?]. / L'hepatomegalie est-elle un facteur pronostic de la LMC du Noir Africain?

It acts of a retrospective study relating to 74 patients reached of chronic Leukaemia myeloid (LMC) over one 5 year period followed in the clinical service of hematology of the University Hospital of Yopougon (Abidjan, Ivory Coast). The splenomegaly is quasi-constant in chronic phase of the disease often associated hepatomegaly in 20.27% of the cases which constitutes a pejorative factor of the LMC. Indeed, the hyperleukocytosis of more than 300,000 white globules is correlated with the presence of hepatomegaly (p=0.0005) with risks of portal hypertension. 80% of the patients carrying the LMC with a clinical hepatomegaly in chronic phase of the disease have against an incomplete hematologic remission 20% of complete remission (P = 0.002) among patients without hepatomegaly. The strong rate of death (73.33%) recorded occurred among patients carrying a hepatomegaly against 15.25% of death without hepatomegaly (P = 0.0001). The overall rates Total survival is on average 17 months against 20 months 28 days in the event of absence of the hepatomegaly (P = 0.0001).

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

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

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

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

[Comparative metric study of the edentulous dental arch in black Africans and white Europeans]. / Etude métrique comparative de l'arcade mandibulaire de l'édente total noir Africain et du blanc Europeen.

The current 89 samples comparative study shows that the mandible arch is different statistically in Blacks and Whites populations. African Blacks mandible dimensions are superior considering both inter retromolar tubercles measurements and the arch length. Therefore, the impression trays manufacturing should be reconsidered for Blacks prosthetic rehabilitation.

[Prevalence of tuberculosis in sickle cell Africans]. / Prévalence de la tuberculose chez le drépanocytaire africain.

We performed a cross-sectional analysis of 68 files of patients with a major form of drepanocytosis and hospitalized for lower respiratory tract infection over a 6-year period. The frequency of respiratory infections was 32.69%. Non-tuberculosis infections dominated (64,68, 94%). Tuberculous infection was less frequent and occurred in 4/68 (6%). Extensive disease was frequent and diagnosis difficult.

[Results of treatment of 62 cases of Hodgkin's disease in Côte d'Ivoire]. / Résultats du traitement de 62 cas de maladie de Hodgkin en Côte d'Ivoire.

This study reports the follow-up after 22 years of 62 treated cases of Hodgkin's disease. Complete remission was obtained in 66% of cases versus 31% of incomplete remission and 3% of failures. Overall survival of patients ranged from 10 days to 48 months. Real event-free survival was difficult to estimate given that 40% were completely lost to follow-up. The most frequently encountered disorders were haematologic ones. The difficulties were directly linked to precarious socio-economic conditions for most patients.

Le protocole CMA dans le traitement du lymphome de Burkitt africain

Une etude prospective sur la place du protocole cyclophosphamide-methotrexate-Aracytine (CMA) a ete entreprise d'octobre 1994 a fevrier 1999; sur 50 patients. Les resultats enregistres peuvent etre resumes en : remission complete; 76d'une duree moyenne de 24 mois; 5 cas de guerison a 5 ans; des survies allaient de 6 mois a 5 ans. Le pourcentage de deces a ete de 35. Les criteres de bonnes reponses therapeutiques ou protocole CMA; ont aussi ete determine.s

Aspects epidemiologiques des leucemies aigues en Cote d'Ivoire

Les auteurs rapportent un etude epidemiologique des leucemies aigues allant d'octobre 1991 a fevrier 1999. La prevalence hospitaliere est de 23;86pour 1000 malades hospitalises. Il y avait 59;09de leucemies aigues lymphoblastique (LAL) et 40;91de leucemies aigues myeloide (LAM). L'age global etait de 29;13 ans et 60;60des patients etaient ages de 2 a 30 ans. Il a ete note une legere predominance masculine. Les hydrocarbures aromatiques (benzene et ses derives) sont fortement incrimines

L'hepatomegalie est-elle un facteur pronostic de la LMC du noir africain ?

Objectif : a l'instar des parametres pronostiques du score de Sokal; l'hepatomegalie dans la leucemie myeloide chronique est-elle un facteur pronostic ? Methode : Il s'agit d'une etude retrospective portant sur 74 patients atteints de Leucemie myeloide chronique (LMC) en phase chronique sur une periode de 5 ans suivis dans le service d' hemato-logie. A l'aide des dossiers medicaux des patients inclus dans notre etude; nous avons recueilli les donnees epidemiologiques; cliniques et biologiques et therapeutiques. Nous avons analyse l'influence de l'hepatomegalie sur la reponse therapeutique; et la survie globale des patients. . Le calcul de la survie s'est fait selon la methode de Kaplan-Meir en tenant compte du facteur pronostique l'hepatomegalie Resultats : La splenomegalie est quasi-constante en phase chronique de la maladie souvent associee a une l'hepatomegalie dans 20;27. L'hyperleucocytose de plus de 300.000 globules blancs est correlee a la presence d'une l'hepatomegalie (p=0.0005) avec des risques d'hypertension portale. Les patients porteurs d'une hepatomegalie ont 20de remission complete hematologique (P = 0;002); un fort taux de deces (73;33) (P = 0;0001) et une survie globale est en moyenne de 17 mois (P = 0;0001). Conclusion : L'hepatomegalie peut etre consideree comme un facteur pejoratif chez les patients porteurs d'une leucemie myeloide chronique en phase chronique du noir africain