[Relative frequency of malignant and benign tumors in Arlit, Niger. Analysis of data from anatomopathological examinations over a 15-year period]. / Fréquence relative des tumeurs malignes et bénignes à Arlit (Niger): bilan de 15 ans d'examens anatomo-pathologiques.

The purpose of this study was to determine the frequency and distribution of cancer in the uranium-mining region of Arlit, Niger, based on extensive data from all the anatomopathological examinations performed at local hospitals over a 15-year period. The overall annual incidence, i.e., 26 per 100000, was similar to incidences reported elsewhere in Africa. The rate of examinations leading to diagnosis of malignancy decreased between 1991 and 1997 and, for unexplained reasons, varied from one practitioner to another. There was no evidence of a higher rate of any cancer that might result from possible exposure to radiation during mining operations. The distribution of cancer by organ was unremarkable, i.e., in order of frequency, womb and ovaries in women; skin and prostate in men; thyroid and lymphatic tissue in both genders.

[Survey of diarrhoea survey in Kosovo Mitrovica. August 2001]. / Etude sur les diarrhées à Mitrovicè (Kosovo) en août 2001.

The upsurge of diarrhoea observed in children in Kosovo Mitrovica in the spring of 2001 led to a survey, jointly organized by the city health department, the GISPE association and the medical laboratory at the Val de Grâce Hospital (France). The available retrospective data showed an increase in cases of diarrhoea in which Giardia duodenalis was isolated. During the third week of August 2001, all children with diarrhoea consulting in the hospital south of city (n = 45) had a complete stool analysis. The analyses showed the presence of Giardia cysts and trophozoites in 40% of the cases, and no cases with helminthes or cryptosporidia. Moreover 3 strains of S. sonnei, a microorganism never previously identified, and different pathovars of E. coli in 11 patients were isolated. This "epidemic" appeared to be linked to the poor hygiene conditions that still prevailed 2 years after the events but not directly to the water supply, which was rehabilitated at the end of 1999. It is also necessary to strengthen the capacity of the public laboratories and health-care facilities of the province.

[Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic]. / Intérêt de la Spiruline chez les personnes vivant avec le VIH a Bangui (RCA).

Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems.

Nutritional approach to management of Buruli ulcer in Côte d'Ivoire.

Children in developing tropical countries are frequently undernourished. In rural areas, they are also often affected by Buruli ulcers. The treatment of this mutilating disease is sometime long and difficult for malnourished patients. Moreover, the eating behavior of patients with Buruli ulcers does not promote its quick healing, with numerous foods prohibited. They eat fewer fruits and legumes, which are rich in vitamins and minerals. Our survey in two health centers showed that only 8% ate fruits and legumes, and 29% leafy greens. This food deprivation increases their nutritional deficiencies. We conducted a nutritional intervention among Buruli ulcer patients (30 patients) in one center, and compared their healing with that of Buruli patients without nutritional care (n = 21). Those patients who received the intervention spent less time at the hospital (less than six months). Our study shows the association between the healing of Buruli ulcers in Côte d'Ivoire and good nutritional status: those with the intervention healed faster and presented fewer disabilities than the control patients.

[Ventricular tachycardia revealed by a left ventricular non-compaction]. / Tachycardie ventriculaire révélant un ventricule gauche non compacté.

We report a case of a 55-year-old woman who has a non-compaction of the left ventricular myocardium diagnosed after a cardiac arrest due to a polymorphic ventricular tachycardia. The patient was implanted with a cardioverter-defibrillator. A review of literature of this recently described cardiopathy is done.

Mycophenolic Acid reaches therapeutic levels whereas mycophenolate mofetil does not.

BACKGROUND: In kidney transplanted children, it is difficult to obtain blood levels of mycophenolic acid between 2 and 4 microg/mL, when mycophenolate mofetil doses up to 30 mg/kg/d are given two or three times a day. We proposed that using mycophenolic acid, instead of the salt mycophenolate mofetil, may help us to reach target levels. AIM: We sought to describe the pharmacokinetics of mycophenolic acid in eight kidney transplanted children over a period of 1.2 +/- 0.8 years. PATIENTS AND METHODS: Eight patients (5 boys and 3 girls) aged 7.0 +/- 1.8 years received cadaveric kidney transplantations. Induction with basiliximab was followed by cyclosporine (n = 4) or tacrolimus (n = 4), tapered steroids (withdrawal at 12 months in six cases and maintained at 0.15 mg/kg/d in two cases), and mycophenolate mofetil (25 to 30 mg/kg/d two or three times a day). For 1.0 +/- 0.3 years mycophenolic acid levels were between 0.8 +/- 0.3 microg/mL. When mycophenolic acid sodium tablets were available, all patients were switched to this drug. RESULTS: After the conversion, blood levels obtained at 8 +/- 3 days were 1.5 to 5.0 microg/mL (median, 3.2), which were far closer to the target 2 to 4 microg/mL. No gastrointestinal disorders were observed with the follow-up of 72 +/- 18 days. CONCLUSION: Mycophenolic acid sodium reaches therapeutic levels whereas mycophenolate mofetil does not. If mycophenolic acid were available in syrup form, it could be used in patients under 5 years of age. It is necessary to follow these patients to rule out enzymatic induction.

[Difficulties of the patients to undergo their ARV treatment at the Libreville outpatient health center, Gabon]. / Les difficultés rencontrées par les malades pour suivre leur traitement antirétroviral au Centre de traitement ambulatoire de Libreville, Gabon.

The therapeutic observance is a real issue of chronic diseases. This issue is twice as much important in the case of aids treatment by antiretrovirals as a good observance is essential to avoid emergence of resistances and to improve patients' health. A research was conducted in Libreville, the capital of Gabon, at the ambulatory treatment center of HIV patients. The interviews of one hundred patients of the center, under treatment for more than two months, concerned their problems related to specific drugs intake and have helped to point out some reasons of non observance. The first reason refers to side effects inducing many difficulties in regular drugs intakes, a complete information is requested by the patients. Another main reason of non observance or bad observance is linked to material and financial problems or to treatment's reduced accessibility The research points out the importance of supplementary treatment costs (transportation, sick leave, food). At last, major observations were made on schedule management, drugs intake management, needs for more information and help for prevention, everyday life and diet.

[Use of antiretroviral drugs invoices for the follow-up of a treatment programme. Example in Abidjan, Côte d'Ivoire]. / Utilisation des factures des médicaments antirétroviraux pour le suivi d'un programme de traitement. Exemple a Abidjan, Côte-d'Ivoire.

A retrospective analysis of the prescriptions of the ARV treatment programme in Abidjan, Côte-d'Ivoire enabled the authors to assess the collected anonymous information in order to evaluate the efficacy of the programme. This collection of information helps to supervise each center at a lower cost, to alert on some working problems and to follow the quality of the observance. This supervision is possible regardless of the health care places, it can be carried out systematically from the administrative or financial services. In this study this follow-up reveals some problems.

[Poor access to antiretroviral treatment in French-speaking Africa: situation in 2004]. / Difficultés d'acces aux antirétroviraux dans les pays d'Afrique francophone: tat des lieux en 2004.

A survey by questionnaire and interview was carried out with persons in charge of purchasing central structures and AIDS control programs in 18 French-speaking African countries between June and October 2004. Survey data showed that a total of 3300 patients received antiretroviral (ARV) treatment during the study period. This corresponds to a treatment rate of 0.1 to 9.6% of the number of patients requiring ARV treatment. All countries reported interruptions of the ARV supply for a variety of reasons. The main causes were budgetary issues and procedural complexity involving financial aid. The prices charged to the patients varied greatly in function of national policies. Cost price also varied in function of the negotiating leverage of the purchasing central. Improve general access to ARV treatment and reducing the number of supply shortages will require more training in management and distribution of medicines. It would also be useful to improve communications between the persons in charge of national purchasing structures.

[Assessment of a programme of prevention of mother-to-child transmission of HIV in Abidjan, Ivory Coast (1999-20002)]. / Evaluation d'un programme de prévention de la transmission mère- enfant ou VIH à Abidjan (Côte d'Ivoire/1999-2002).

The purpose of this article is to report the results of a programme for prevention of mother-to-child transmission (PMCT) of HIV conducted from 1999 to 2002 by the PNLS in Abidjan, Ivory Coast. This programme was supported by grants from the Fonds de solidarité international (FSTI) and the Glaxo Smith Kline (GSK) Foundation. After pre- and posttest counselling, pregnant women from 4 PMI centres underwent screening for HIV. Seropositive women were offered short course AZT and the possibility of financial assistance for breast-feeding. All programme activities were carried out in close cooperation with association members. A total of 22466 tests were given and 18116 women returned for results. Among the 1829 seropositive women to whom PMCT intervention was proposed, 667 received short course AZT. The rate of transmission at 18 months was 162%. In addition 69 mothers and 28 children eligible for ARV therapy benefited from tritherapy. Limiting factors, at each phase, and efficacy of intervention were analyzed.

[Measuring treatment compliance in patients with HIV in Bangui, Central African Republic]. / Mesure de l'observance thérapeutique des patients vivant avec le VIH à Bangui.

The purpose of this trial was to test a simple method of measuring and identifying non-compliance with antiretroviral (ARV) therapy and cotrimoxazole (CTX) prophylaxis in a resource-limited setting. A cross-sectional study was undertaken among HIV patients attending two outpatient clinics in Bangui, Central African Republic. Compliance with ARV and CTX treatment was assessed based on 5 measurement modalities, i.e., skipping medication during the 4 days prior to attendance, attendance assiduity, number of remaining tablets, patient visual analogue scale (VAS), and physician VAS. These measures were combined to obtain an overall medication compliance score. A total of 141 patients were interviewed including 89 using ARV and 52 using CTX. Compliance scores varied according to measurement modality from 66.3% to 96.6% for ARV and from 67.3% to 90.4% for CTX. The only significant difference between patients using ARV and CTX involved physician VAS that was significantly lower for CTX than ARV (p=0.04). Overall medication compliance scores classified 117 patients (83%) as compliant and 21 patients (17%) as non-compliant. According to this study the level of medication compliance was relatively good (83%). Findings also indicated that measurement of compliance was feasible using a combination of remaining tablet count and assessment of medication skipping in the last 4 or 7 days. Routine clinical use of these modalities allows assessment and improvement of medication compliance.

[Assessment of compliance with ARV treatment in Africa]. / Bilan de quelques études sur l'observance aux ARV en Afrique.

This study was conducted in health facilities in the capitals of five sub-Saharan African countries (Cotonou, Benin; Bangui, Central African Republic; Libreville, Gabon; Yaoundé, Cameroon; and Casablanca, Morocco). The purpose was to investigate factors promoting and impeding compliance with antiretroviral therapy (ART) and cotrimoxazole (CTX) prophylaxis in adult patients. Patients were interviewed immediately after follow-up examination to identify the problems that they encountered and the solutions that they proposed to improve compliance. Compliance was assessed based on three measurement modalities, i.e. skipping medication during the four days prior to attendance, counting the number of remaining tablets, and attendance assiduity. Compliance scores varied according to measurement modality from 65% to 90%. All patients underlined the impact of treatment on their daily life and the difficulty of following the prescribed regimen properly. Impeding factors for compliance were treatment-related hunger, lack of information, out-of-pocket expenses (including laboratory tests, transportation, and loss of income), side effects, long waiting time at the treatment centers, and fear stigma and discrimination. Efforts to increase access to treatment can only be successful if accompanied by measures to promote compliance.

[Syphilis test proposed within the context of a programme to reduce mother/child HIV transmission: example of the Wassakara Health Care Center in Abidjan]. / Dépistage de la syphilis dans le cadre d'un pro- gramme de réduction de la transmission mère-enfant du VIH : exemple du centre de santé de Wassakara a Abidjan.

During the program MTCT+ set up in Abidjan by the national authorities with the assistance of the FSTI and FGSK, free screening and treatment of the syphilis infection were proposed to pregnant women. One test of agglutination on blades VDRL (Carbon Antigen Biotec the U.K.) and one TPHA test on plates for the positive VDRL (TPHA Nosticon Biomérieux F) were performed. Over the period from June 1999 to December 2001, 4 320 samples were taken. The laboratory observed 84 positive tests VDRL and 59 confirmed by TPHA, that is to say a syphilis seroprevalence (TPHA) of 1.4%. In addition 391 results were not available for various reasons (errors of numbering, haemolysed blood, absence of reagents, etc.) ie. 9.0%. Among the 59 positive women (TPHA), 30 came back for their result and 23 women were correctly treated (3 or 4 penicillin delay injections). In addition 7 partners received a complete treatment and 8 incomplete treatment. The cost of each detected and treated case rose approximately to 150 Euros, which is relatively low except in time/ staff and indirect costs for women. This study confirmed that all the activities of SMI must be integrated to have an efficient PTME programme. The biological assessment must be accessible as a whole, to minimize the additional costs and transportations. A training of all the personnel in 2002 helped to improve in an important way the results of the intervention in the center.

[A study on antiretroviral treatment compliance in Casablanca (Morocco)]. / Etude sur l'observance du traitement antirétroviral à Casablanca (Maroc).

OBJECTIVE: Compliance in HIV infection treatment is a major stake to give worldwide access to antiretroviral (ARV) treatment and especially in Africa. In September 2003, we undertook a study on compliance among HIV positive patients under antiretroviral treatment. These patients were included in a therapeutic educational program in the infectious diseases department of the Casablanca University Hospital (Morocco). The main objective of the study was to assess obstacles to compliance and to find possible solutions. DESIGN: A transversal investigation was made, based on questionnaires for patients under ARV treatment, chosen consecutively. The physician's and the educator's opinion on patient compliance was collected. RESULTS: Patients were between 21 and 65 years of age. Ninety-two patients were questioned and 89 analyzed. Treatment duration lasted from 2 to 67 months. Compliance according to educators was good (>90%) for 78 patients. The main obstacles for a good compliance were difficulty to respect administration schedule and the long distance between home and hospital, or the presence of adverse effects and other diseases. CONCLUSIONS: The role of the therapeutic educational program in improving compliance was largely highlighted.

[Study conducted at the Yaoundé University Hospital on anti-retroviral treatment compliance (Cameroon)]. / Etude sur l'observance des traitements antirétroviraux au Centre hospitalier universitaire de Yaoundé (Cameroun).

To build the knowledge base on anti-retroviral (ARV) treatment compliance in Africa, a study has been carried out at Yaoundé University Hospital. It documented and studied the follow up of 231 patients under tri-therapy at the time of the study (December 2003). Respecting the strict time schedules is a crucial issue, especially for taking the morning and evening doses of medication. This is true for all patients, regardless of their social or economic status. The majority of the patients request more thorough information about their treatment. Some patients face economic problems which are more often related to the indirect costs rather than to the cost of treatment. Finally, the difficulty in confronting the treatment's side effects or the galenic nature of ARV treatment itself is noted. Nevertheless, it seems that the patients could better manage these issues and deal with the ensuing challenges if better communication with more complete information was provided to them at the beginning of their treatment, accompanied by written fact sheets specific to each type of treatment.

Prevalence of HIV infection among patients with leprosy in African countries and Yemen.

Screening for human immunodeficiency viruses types 1 and 2 (HIV-1 and HIV-2) antibodies was carried out in the serum of 1,245 leprous patients and 5,731 controls selected in nine different centers from the Congo, Ivory Coast, Senegal, and Yemen Arab Republic. In Yemen, all sera were negative. In the Congo, the seropositivity among patients and controls was, respectively, 3.8 and 5.2%; in Senegal, it was 1.3 and 0.6%; and in the Ivory Coast 4.8 and 3.9%. Differences were not statistically significant, even considering lepromatous or tuberculoid forms (3.6% and 3.7%, respectively). HIV-2 antibodies were only detected in subjects from the Ivory Coast and Senegal. Using appropriate criteria for seropositivity (confirmation by Western blot, reactivity to HIV envelope glycoproteins) and a large selection of patients (several countries with several centers), it appears that leprosy (and specially the lepromatous form) is not a factor for HIV infection.

Fibrosing alveolitis and hepatitis B surface antigen-associated chronic active hepatitis in a patient with immunoglobulin A deficiency.

Fibrosing alveolitis is described in a 22 year old woman with immunoglobulin A (IgA) deficiency and hepatitis B surface antigen (HBsAg)-associated chronic active hepatitis. At lung biopsy HBsAg was detected by indirect immunofluorescence in the alveolar space but not in the septal fibrosis. We discuss the possible relationships between IgA deficiency on the one hand, and HBsAg-associated lung and liver diseases on the other hand.

Fibrinogen is an independent marker for thoracic aortic atherosclerosis.

The fibrinogen level is an independent risk factor for coronary events and stroke, but no detailed data are available concerning fibrinogen and atherosclerotic disease of the thoracic aorta. This prospective study using multiplane transesophageal echocardiography examined the relation between atherosclerotic thoracic aortic plaque and fibrinogen level. One-hundred forty-eight patients (65 +/- 11 years) with valvular heart disease underwent multiplane transesophageal echocardiography and coronary angiography. We measured plasma fibrinogen level for each patient and recorded the following cardiovascular risk factors: age, sex, systemic hypertension, history of smoking, hypercholesterolemia, diabetes mellitus, body mass index, and family history of coronary artery disease (CAD). Patients with thoracic aortic plaque had a higher level of plasma fibrinogen (p = 0.0001), were older (p = 0.0001), and had significantly more risk factors: history of smoking (p = 0.009), hypertension (p = 0.008), hypercholesterolemia (p = 0.0001), diabetes mellitus (p = 0.01), and family history of CAD (p = 0.003). Multivariate logistic regression analysis of fibrinogen level and risk factors revealed 4 independent predictors of thoracic aortic plaque: fibrinogen, age, hypercholesterolemia, and history of smoking. Fibrinogen was also an independent predictor of CAD. There was a relation between fibrinogen levels and the severity of aortic atherosclerosis (r = 0.46; p = 0.0001) and the severity of CAD (r = 0.30; p = 0.0001). This prospective study indicates that fibrinogen is an independent marker for thoracic aortic plaque related to the severity of thoracic aortic atherosclerosis and confirms that fibrinogen constitutes an independent marker for CAD related to the severity of angiographically evaluated coronary atherosclerosis.

Correlation of thoracic aortic atherosclerotic plaque detected by multiplane transesophageal echocardiography and cardiovascular risk factors.

This study of 416 patients identified age, male gender, smoking, diabetes, hypertension, and hypercholesterolemia as independent predictors of thoracic aortic atherosclerotic plaque. Age, smoking, hypercholesterolemia, hypertension, and diabetes were predictors of the severity and extent of thoracic aortic atherosclerosis.