Hémopathies malignes de l'adulte à Kinshasa: analyse documentaire d'une série des cas de 2011 à 2021 / Hematological malignancies in adults in Kinshasa: retrospective serial cases from 2011 to 2021

Contexte et objectif. Les hémopathies malignes (HM) constituent un problème majeur de santé publique en Afrique sub-saharienne où les moyens de prise en charge sont limités. L'objectif de l'étude était de décrire les aspects diagnostiques, thérapeutiques et évolutifs observées dans la prise en charge des HM en milieu hospitalier de Kinshasa. Méthodes. Etude observationnelle historique de type suivi des cas d'HM hospitalisés, dans formations sanitaires de Kinshasa entre les 1er janvier 2011 et 31 décembre 2021. Seuls les patients âgés de plus de 18 ans ont été inclus. Les paramètres d'intérêt étaient englobés les données sociodémographiques, cliniques, biologiques, d'imagerie, du myélogramme, de l'analyse histopathologique des pièces biopsiques ganglionnaires ou extra ganglionnaires, le type de chimiothérapie et de la survie à 6 mois. Les tests de chi-carré et de Student ont comparé respectivement les proportions et les moyennes. L'analyse de Kaplan Meier et la régression de Cox ont respectivement décrit la survie et recherché les facteurs associés à la mortalité à 6 mois. Résultats.Sur 2678 patients suspects d'HM, seuls de 250 patients (9,3%, âge moyen 47,6 ± 15,8 ans, 62,4% d'hommes) ont eu un bilan de confirmation. Les adénopathies périphériques (54 %), la fièvre au long cours (48 %) et la poly transfusion (29 %) étaient les principaux motifs de consultation. Les perturbations hématologiques rencontrées étaient l'anémie (72 %), la thrombopénie (50 %), l'hyperleucocytose ( 0 %) et la leucopénie ( 0 %). Les syndromes lymphoproliferatif (68 %) étaient plus fréquents et répartis en lymphomes non hodgkiniens (50 %), Lymphome hodgkinien (27%) et myélome multiple (15 %). Les leucémies aigues venaient en deuxième position (12 %) suivi des syndromes myélodysplasiques (11 %) et des syndromes myéloprolifératifs (8 %). 61 % des patients ont bénéficié de la chimiothérapie. Durant les 6 premiers mois de prise en charge, la létalité globale était de 58,4 %. Conclusion. En milieu hospitalier de Kinshasa, très peu de patients suspects d'HM bénéficient d'une mise au point complète et de la chimiothérapie. Les adultes jeunes, surtout les hommes, sont très affectés et plus de la moitié d'entre eux décèdent endéans 6 mois. L'amélioration de l'accessibilité à la chimiothérapie et du plateau technique permettra une réduction de la létalité.

Management and outcome of colorectal cancer in a resource-limited setting: Ahmadu Bello university teaching hospital, Zaria, Nigeria

Background: Colorectal cancer (CRC) is one of the most common malignancies seen in the Western World. It is increasing in developing countries due to adaptation of the western lifestyle with an incidence of 6% in Nigeria. Treatment options are dependent on the stage of disease at presentation, the performance status of the patient, and increasingly the molecular makeup of the tumor. There is a dearth of data on the treatment options obtainable for the management and outcome of CRC cases in Northwestern, Nigeria. Aim: The study assessed the treatment options and outcome of colorectal cancer patients in a tertiary institution, in Northwestern, Nigeria over a 10-year period. Patients and Methods: Between January 2006 and December 2015, data of one-hundred and twenty-two histologically confirmed colorectal cancer cases seen at the Surgery, Radiotherapy and Oncology Departments, ABUTH Zaria, were retrieved retrospectively from the case files and treatment cards of the patients at the health information unit of the hospital. The stage at disease presentation, treatment received, and outcome were analyzed. Results: Nearly a quarter of the patients fell within the age bracket 31­40 years with the median age being 41 years. While only 41% of the patients had their disease staged, 30.4% of the patients presented with advanced disease (Dukes'C + D). Only 95 cases received a form of surgery or the other. Colostomy however accounted for 28.4%. Eighty-nine of the patients received chemotherapy either as neoadjuvant, adjuvant or with palliative intent. External beam radiotherapy either with radical or palliative intent was received by 60 patients (49.2%). At 1-year follow-up sixty cases had been lost to follow up, and thirty-six cases had defaulted on one form of treatment. Conclusion: The study showed that stage at presentation and the available treatment options in the hospital informed treatment offered to the patients. However, surgery was readily performed due to the pattern of presentation and most patients benefited from just a diverting colostomy. Majority of the patients presented with rectal tumor which required radiotherapy as part of its treatment modality, although this is still a luxury in this part of the world. Chemotherapy is also readily available and often prescribed. Cost and limited facility for biomarker (K-ras) testing restrict the use of targeted therapy. Outcome at 1-year follow-up was poor with whereabouts of nearly half of the patients unknown.

Mobile Phone-based intervention to promote un-interrupted HIV treatment during the COVID-19 pandemic

Introduction: Keeping HIV-infected adults away from the health care system during the COVID-19 travel restrictions, presents a challenge to HIV treatment adherence. Methods: This study focused on the initial two phases where Phase 1 designed a Makerere College of Health Sciences (MakCHS) Unstructured Supplementary Service Data (USSD)-based application; and Phase 2 piloted patient enrolment onto the application and determined the feasibility of remote follow-up of patients receiving long-term antiretroviral therapy (ART). Results: A off/online user application, MakCHS Health app, was developed. Overall, 112 patients [(66(59%) female] receiving ART at Mulago ISS clinic, Kampala, were enrolled onto the MakCHS Health app. Up to 89 (80%) utilized the app to access medical help. Patients' medical queries included needs for drug refills, missed taking HIV medication, medical illnesses, access to COVID-19 vaccination and other personal needs that required clinicians' attention. Conclusion: Piloting a MakCHS Health application for patient follow-up was feasible and well-received by HIV treatment providers and patients receiving ART. We recommend scale up of the application to enroll all patients receiving long-term treatment for HIV/AIDS, and subsequently expand to. other HIV treatment programs in similar settings

Factors influencing adherence to asthma control measures among patients in Mama Lucy Kibaki Hospital, Nairobi Kenya

BACKGROUND :Asthma is an obstructive respiratory disease characterized by wheezing, chest tightness, cough and shortness of breath that is evidenced by expiratory airflow limitation. Patient awareness of asthma control measures is key in ensuring compliance with asthmatic drugs. The main aim of the study was to assess determinants of adherence to asthma control measures among adult asthmatic clients attending chest clinics in Mama Lucy Kibaki Hospital. MATERIALS AND METHOD We employed a descriptive cross-sectional study design involving asthmatic patients interviewed at Mama Lucy Kibaki Hospital in Nairobi, Kenya. The study participants had to have been diagnosed with asthma for at least three months preceding the study, attend the chest clinic and consent to participate in the study. We pretested the study tools at Mbagathi county hospital on 11 asthmatic patients. A systematic random sampling method was used to select 110 study participants and data was collected using a modified questionnaire and lung function test between March to June 2018. Quantitative data was analyzed using SPSS 22.0. The Chi-square test was used to establish the association between independent variables and asthma adherence control measures at a 95% confidence interval. RESULTS Our findings report a response rate of 89% (98). The majority (58.2%) of participants were females. On average 57.1% had good adherence to asthma control measures. Control of asthma was poor, with well-controlled being 27.5%, moderately controlled at 53.1% and poorly controlled at 19.4%, respectively P (0.003). Respondents with adequate knowledge were 56.1% and positive attitude with 71.2%. There was a significant association between adherence to asthma control measures and participants' attitude (P-value=0.000), knowledge (P-value=0.000), level of education (P-value=0.000), level of asthma control (P-value=0.003). Environmental factors were cleaning carpets/curtains (P-value=0.001), type of fuel (P-value=0.003), and use of carpet (Pvalue=0.014). CONCLUSION Adherence to asthma control measures was suboptimal resulting in a generally poor asthma control. Adequate knowledge was associated with a positive attitude. Adherence was strongly associated with attitude, knowledge, education and asthma control.

Pharmaceutical situation of the pharmacological treatment of hospitalized patients with COVID-19 in Libya

By January 2020, severe acute respiratory syndrome coronavirus-2 has spread internationally to a pandemic that mainly targets the respiratory system. The relevant infectious disease has been identified as coronavirus disease-2019 (COVID-19) by World Health Organization and declared as a global pandemic. In Libya, National Center for Disease Control reported the first case of coronavirus disease-2019 on 24th March, 2020. The authorities decided to close borders and activate designated treatment centers to deal with COVID19 cases and contain the outbreak of SARS-COV-2. This study aimed to assess and evaluate the pharmaceutical situation of medications used in pharmacological management of hospitalized COVID-19 patients in Tripoli, Libya. Three WHO availability indicators were selected to be studied and reported. A comprehensive list of medicines used in the management of hospitalized COVID-19 patients was constructed after reviewing and comparing seven national and international pharmacological management protocols and guidelines for hospitalized COVID-19 patients. This comparison revealed that nearly 50 medications are intended for use in COVID-19 inpatient pharmacological management. They all agreed about the use of three medications, representing one from each main class. This list was used to cross check their availability at the chosen designated COVID-19 treatment center. This study proved that local treatment center's protocol is more in line with international guidelines than the national treatment guideline. The later was issued on March 2020. The Libyan National Essential Medicines' List contained 25 out of 50 medications of the comprehensive list based on the last update in April 2019. This study recommends that national treatment guidelines and National Essential Medicines' list require updating. Not all medications used in COVID-19 inpatient management were available in local treatment centers, although, the Emergency Management Department of Ministry of Health in Libya is responsible for the supply of the required medical supplies and medications to the COVID-19 treatment centers.

Hematological consequences of antiepileptic drug therapy among children with epilepsy

Epilepsy is a chronic neurologic disease that comes third after cerebrovascular and Alzheimer's disease. Anti-epileptic drugs may affect certain hematological parameters of epileptic patients. Few researches investigated hematological adverse effects of antiepileptic drugs in Libya. Thus, the aim was to evaluate hematological parameters in epileptic children who are on antiepileptic drugs. This retrospective study included 83 pediatric patients with epilepsy recruited from Benghazi Children Hospital, Department of Neurology, from December 2017 to April 2018. Data collected included demographic characteristics, types of epilepsy, anti-epileptic drugs and serum hematological parameters. Hematological parameters recorded included: hemoglobin, hematocrit, platelet, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration and white blood cell count. In all treated patients, regardless of the number of antiepileptic drugs therapy used, the average levels of hematological parameters were significantly lower in treated group compared to control group (11.64 gm per dl, 34.53%, 27.74 pg and 33.13 gm per dl, respectively). A significant increase (12.12109 per l) in white blood cell counts in treated group was found. Average hemoglobin, hematocrit and mean cell hemoglobin concentration levels were significantly lower in patients on poly-therapy compared to mono-therapy and control groups. Average white blood cell counts were significantly increased in patients on anti-epileptic drugs. In sodium valproate users, levels of hematological parameters were significantly decreased but significantly increased in white blood cell counts. In diazepam users, significant increases in white blood cells and platelet but no difference in other parameters observed. There were no differences in all hematological parameters among patients using carbamazepine except for platelet counts (significantly decreased). In conclusion, there is substantial effect of the anti-epileptic drugs, especially sodium valproate, on hematological parameters of children despite the effects were not critical as the changes were still in the normal range.

Le sarcome alvéolaire de la cuisse chez un jeune adulte: à propos d'un cas à l'hôpital Skyborne de Bukavu et revue de la littérature / NA

Les auteurs rapportent l'un des types rares des cancers, le sarcome alvéolaire; survenu chez un sujet masculin âgé de 32 ans, qui consulte pour une importante tuméfaction de la face antérieure de la racine de la cuisse gauche et dont les bilans biologiques et radiologiques n'avaient rien montré des particuliers. L'étude histologique avait posé le diagnostic d'un sarcome alvéolaire. Une exérèse radicale avait été pratiquée et le patient avait été mis sous chimiothérapie avec bonne tolérance. Le patient a été revu tous le trois mois pendant trois ans, puis une fois tous les six mois pendant la 4eme année sans qu'aucune récidive ni localisation métastasique n'ait été objectivée, avant que nous constations une récidive avec métastase pulmonaire à la 5eme année, ce qui emporta notre patient.

The authors report one of the rare types of cancers, alveolar sarcoma; occurred in a male subject aged 32 years, who consults for a large swelling of the anterior face of the root of the left thigh and whose biological and radiological assessments had shown nothing particular. The histological study diagnosed alveolar sarcoma. Radical excision was performed and the patient was put on chemotherapy with good tolerance. The patient was reviewed every three months for three years, then once every six months during the fourth year without any recurrence or metastatic localization was objectified, before we found a recurrence with pulmonary metastasis in the 5th year, which took away our patient.

Evaluation de la prise en charge des cas graves de COVID-19 aux soins intensifs dans un environnement à ressources limitées: expérience du centre de traitement des épidemies (CTE) d'Allada / NA

Introduction : Dans sa politique de riposte contre la pandémie liée à l'infection au SARS-COV2, le Bénin a opté pour la construction d'Hôpitaux dédiés exclusivement à la prise en charge des COVID19. Pendant la première vague de la pandémie en Afrique, les systèmes de santé n'étaient pas encore bien outillés pour faire face à cette pandémie. Nous vous rapportons l'expérience des soins intensifs du Centre de traitement des épidémies (CTE) d'ALLADA. Objectifs : évaluer la prise en charges des cas graves de COVID19 à l'USI du CTE ALLADA. Matériels et méthode : Il s'est agi d'une étude prospective, descriptive et analytique, réalisée aux soins intensifs du centre de traitement des épidémies d'ALLADA, du 1er juin au 31 Août 2020. Résultats : Quatre-vingt-quatorze malades étaient éligibles pour notre étude. L'âge moyen des malades était de 58,41 ans, le sex-ratio 1,61. Les comorbidités les plus représentatives étaient l'hypertension artérielle (70,21%), le diabète (31,91%), l'obésité morbide (21,28%) et l'asthme (15,96%). Selon le score de gravité adopté au Bénin, trente-six malades (38,30%) étaient classés cas graves grade3 et ont bénéficié d'une ventilation mécanique. La VNI était la technique de ventilation la plus utilisée (75% des cas). Le plateau technique était limité et les ressources humaines qualifiées insuffisantes. Les associations chloroquine/azithromycine ou lopinavir/ritonavir/ribavirine étaient les traitements spécifiques utilisés. La mortalité était de 27,66%. Conclusion : Malgré les conditions de travail difficiles, notamment le plateau technique limité et les ressources humaines qualifiées insuffisantes, les résultats obtenus après traitement des cas graves de COVID19 à l'USI du CTE ALLADA étaient encourageants

Introduction: To respond to the pandemic linked to the SARS-COV-2 infection, Benin has opted for the construction of hospitals dedicated exclusively to the treatment of COVID-19. During the first wave of the pandemic in Africa, health systems were not yet well equipped to deal with this pandemic. We here report the Intensive CareUnit (ICU) experience of the Epidemic Treatment Center of ALLADA (ETCA). Purpose: To assess the management of serious cases of COVID-19 in the ICU of ETCA. Materials and method: This was a prospective, descriptive and analytical study, carried out in the ICU of ETCA, from June 1 to August 31, 2020. Results: Ninety-four patients were eligible for our study. The average age of the patients was 58.41 years with a sex ratio of 1.61. The most representative comorbidities were arterial hypertension (70.21%), diabetes (31.91%), morbid obesity (21.28%) and asthma (15.96%). According to the severity score adopted in Benin, thirty-six patients (38.30%) were classified as severe grade III cases and received mechanical ventilation. Non-Invasive Ventilation (NIV) was the most used ventilation technique (75% of cases). The technical platform was limited and the qualified human resources were insufficient. Chloroquine/azithromycin or lopinavir / ritonavir/ribavirine were the specific treatments used. Mortality was 27.66%. Conclusion: Despite the difficult working conditions, especially the limited technical platform and insufficient qualified human resources, the results obtained after treatment of serious cases of COVID-19 at the ICU of ETCA were encouraging

Les péritonites aigues au CHU Bss de Kati : aspects étiologiques et thérapeutiques

Introduction : D'après Monteiro [1], la péritonite aigue est une réponse inflammatoire de tout ou une partie du péritoine à une agression dont l'origine est le plus souvent infectieuse. En Afrique, c'est la première cause des abdomens aigus chirurgicaux. Le but était de décrire les aspects étiologiques et thérapeutiques de la péritonite aigue. Méthodologie : Il s'agissait d'une étude rétrospective réalisée au CHU BSS de Kati de janvier 2007 à décembre 2012. Tous les patients opérés pour péritonites aigues dans le service ont été inclus. Résultats : Les péritonites aiguës ont ainsi représenté : 34,9% (202/579) des abdomens aigus chirurgicaux ; 16,5% (202/1223) des interventions chirurgicales ; 13,1% (202/1545) des hospitalisations et 3,2% (202/6250) des consultations. L'âge moyen était 25,8 ans avec un sexe ratio 2,1 en faveur des hommes. L'étiologie était dominée par la perforation appendiculaire 44,5% suivie par les perforations iléales d'origine typhique 38,6%. Nous avons procédé à 47% d'appendicectomie, 25,5%d'excision suture, 12,9%de résection anastomoses et 3,5% de stomie. La morbidité était de 24,7% avec une mortalité de 8,91%. Conclusion : La prévalence de la péritonite aigue reste toujours élevée, et sa prise en charge demeure toujours une hantise pour le chirurgien

Obesity and response to neoadjuvant chemotherapy in breast cancer

The prevalence of obesity is rising worldwide including Sub-Saharan Africa just as the incidence of breast cancer is rising in same region with increasing morbidity and mortality. Obesity or overweight has been identified as a risk factor for breast cancer and both have been associated with poor outcome of breast cancer treatment. The objective of this study was to assess the effect of obesity /overweight on clinical response to Adriamycin Cyclophosphamide-Paclitaxel (AC-P) regimen neoadjuvant chemotherapy in patients with breast cancer. A prospective observational of 39 female patients with breast cancer. A prospective observational study of newly diagnosed breast cancer patients with palpable breast lumps on neoadjuvant chemotherapy of AC-P regime. Age of the patients, tumour size, stage, estrogen, progestogen and HER2 receptor status were noted. Height measured in metres and weight measured in Kilograms were recorded and Body Mass Index (BMI) calculated .Tumour size measured at presentation, then after first, third, sixth and eighth doses to determine response as defined by the UICC method such as complete clinical response, partial clinical response, stable disease and progressive disease. BMI was then categorized into Normal weight 25kg/m2 and Overweight 25-30kg/m2 and Obese 30kg/m2. 43.6% were obese, 33.3% were overweight and 23.1% were normal weight. Thirty percent of overweight /obese patients had complete clinical response 2 compared with 77% of low/normal weight patients and this was statistically significant (X2 =6.53, p 0.015). 76.7% of the overweight/obese were premenopausal compared with 23.3% who were post menopausal, and this is statistically significant.(X2 =5.84, p 0.024). Obesity/ overweight is associated with poorer clinical response to neoadjuvant chemotherapy in the cohort of patients studied

Cervicofacial necrotizing fasciitis of odontogenic origin following chemotherapy: A case report and implications for Oral Care in cancer treatment

Objective: Cervicofacial necrotizing fasciitis (CNF) is a rapidly spreading and often fatal infection of the soft tissues of head and neck characterized by tissue necrosis and profuse purulent discharge. This report describes a cancer patient, who had undergone chemotherapy and developed CNF of odontogenic origin to highlight the need for oral examination before commencement of chemotherapy.Case description: A 68 years old retired gardener who developed CNF from infected right permanent mandibular first and second molars. He had undergone surgery and had 3 cycles of Cisplastin, 5-Fluorouracil and Adriamycin on account of carcinoma of the head of pancreas. No oral assessment was carried out prior to commencement of chemotherapy to detect a potential source of infection. Management included removal of the causative teeth, incision and drainage, repeated debridement, daily dressing of wound with Povidone-iodine solution and intravenous antibiotic based on pus microscopy, culture and sensitivity report. He however succumbed to the disease 23 days later. Conclusion: CNF of odontogenic origin is an extremely fatal condition. Early detection and prompt aggressive treatment is a key to successful outcome. Clinicians involved with management of cancer patients should routinely seek the expertise of a dentist for a pre-chemotherapy oral assessment and all potential sources of infections are removed before chemotherapy begins

Prise en charge de l'infection à Helicobacter pylori dans le contexte de la Ville Province de Kinshasa

Contexte et objectifs. L?infection bactérienne à Helicobacter Pylori constitue un des problèmes majeurs de santé publique en Afrique où elle atteindrait plus de 90% des adultes dans certaines régions. En République Démocratique du Congo comme dans la plupart de pays de la région des Grands lacs, la prise en charge de l?infection à HP n?est pas encore codifiée. L?objectif de la présente étude était de proposer un schéma accessible financièrement et adapté des recommandations des sociétés savantes.Méthodes. Partant de la revue fournie de la littérature sur la question notamment sur les méthodes diagnostiques et contrôle d?éradication et les protocoles de traitement de l?infection à HP, nous avons retenu les recommandations diagnostiques et thérapeutiques les plus pertinentes afin de les adapter à notre environnement de travail sous forme d?un protocole à proposer au consensus des participants.Résultats. L?infection à HP est une entité nosologique qui a des manifestations cliniques liées au stade auquel on débute sa prise en charge. L?infection est fréquente et jouerait un rôle important dans les survenues des lésions précancéreuse et cancéreuse d?où l?intérêt de promouvoir un management codifié aussi bien diagnostique que thérapeutique Les méthodes diagnostiques les plus pertinentes et les mieux adaptées à notre milieu sont celles invasives obtenues lors de l?examen endoscopique par biopsie (le test rapide à l?uréase) et celle non invasive (la détection immunologique des antigènes bactériens dans les selles). Le traitement adapté est celui accessible financièrement : la quadrithérapie sans bismuth : séquentielle, concomitante ou hybride à savoir l?association d?un Inhibiteur de la pompe à protons (IPP), de l?Amoxycilline, la Clarythromycine et le Métronidazole pendant 10 à 14 jours.Conclusion. Le traitement standard a été remplacé par quadrithérapie sans bismuth. Le défi majeur est celui d?adapter et d?adopter le meilleur schéma de traitement disponible et de continuer à optimiser les thérapies pour surmonter avec succès la résistance croissante de l?HP. Une étude prospective et analytique sur la sensibilité de le HP aux antibiotiques usuels pour la mise au point d?un traitement efficace et simple adapté à notre environnement est à envisager. La recherche d?un vaccin avec un succès partiel déjà atteint ne devrait pas être abandonnée

Evaluation morphologique du pied bot après traitement initial selon la technique de Ponseti

Objectif - La méthode de Ponseti est le traitement de choix du pied bot. Le but de cette étude prospective était d'évaluer les résultats du traitement avec le score de Pirani.Patients et méthodes - Deux cent quatre pieds bots idiopathiques (122 enfants) ont été traités par la méthode de Ponseti du 1er juin 2012 au 1er juin 2015. L'âge moyen des enfants à la première consultation était de 3 mois18 jours (2 jours - 1 an 11 mois). Le score de Pirani moyen était de 4,5/6. Le nombre moyen de plâtre était de 6,8. Une ténotomie a été faite pour 147 (72,1%) sous anesthésie locale à l'aide d'une aiguille. La dernière phase du traitement était le port de l'attelle d'abduction de Steenbeck.Résultats - Le score moyen de Pirani à la fin du traitement était de 0,3/6 ( 0 à 3/6). La correction était complète (n=173 ; 84,4%), modérée (n= 17 ; 8,3%), et incomplète (14 ;7,3%). Conclusion - Notre étude suggère que cette méthode lorsqu'elle est réalisée le plus tôtpar une équipe entrainée donne un excellent résultat morphologique et fonctionnel du pied permettant un chaussage normal

Comparison of the Efficacy of Colistin Monotherapy and Colistin Combination Therapies in the Treatment of Nosocomial Pneumonia and Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii

Objective. To investigate whether there was a difference in mortality; clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU).Methods. This retrospective; observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii; on median day 5 of admission; colistin monotherapy was used in 23 (21.6%) patients; a carbapenem combination was used in 80 (59.7%) patients; sulbactam-ampicillin combination was used in 42 (31.4%) patients; tigecycline combination was used in 26 (19.4%) patients; and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days; and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%; p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017; 95% confidence interval (CI) 1.330 - 3.061) and vasopressor use (OR 9.014; 95% CI 1.360 - 59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality

Assessment of pharmacist's knowledge on use of non-steroidal anti-inflammatory drugs in hypertensive patients with co-morbid arthritis and pharmaceutical services rendered in Ibadan, Nigeria

Background: hypertension and arthritis are two co-morbid diseases that require pharmaceutical care (PC) services. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for treatment of arthritis.Objectives: The study evaluated the knowledge of pharmacist on the use of NSAIDs in this set of patients and the PC services rendered to them. Methods: structured tested questionnaires were distributed to pharmacists working in public hospitals and community pharmacies in Ibadan metropolis. The questionnaire elicited information on the demographics of respondents, identification of drug related problems and ways of resolving them, knowledge on pharmacotherapy of arthritis and hypertension. Data was analysed with descriptive analysis using statistical package for the social sciences (SPSS) version 16 for windows.Results: a total of 165 questionnaires were distributed with 124 properly filled and returned giving a response rate of 75.2%. Majority (64.5%) were females, the mean year of graduation of the respondents was 9.12years and 50.8% practice as Community pharmacists. Common PC activities include; counseling (84.4%), monitoring of patients B.P (53.3%), blood glucose measurement (53.3%), monitoring patient's using available laboratory results (44.3%). Majority (85.5%) resolved side effects complaint from patients by reassuring the patients that side effect will subside as therapy continues while 77.4% took full medication history and 65.3% consulted physician for a change of medication. Majority (88.7%) agreed that they encountered prescriptions containing NSAIDs for arthritis in their practice. Good numbers of the respondents had no idea of what measure to take when a patient diagnosed of arthritis and hypertension was prescribed NSAIDs if the blood pressure was control or when it was uncontrolled. Few 16.9% and 8.9% indicated they monitored B.P of such patients with controlled or uncontrolled B.P, while more than half (55.6%) of the respondent indicated that COX2 inhibitor are safer in hypertension as compared to COX1 and that NSAIDs effects on hypertension is dose dependent. Most(77.4%) of them indicated that NASIDs can exacerbate hypertension while 55.6% indicated that NSAIDs can induce hypertension. Conclusion: Respondents' knowledge of the pharmacotherapy with antihypertensives and NSAIDs use in patients with hypertension co-morbid arthritis need to be improved. Good and well established pharmacist physician relationship, refresher courses and remuneration of pharmacist for the PC services will also improve services provided by the pharmacist

Comparative drug therapy problems and pharmacists' intervention in selected health facilities in Ogun State

Background - Regular medication reviews will reduce the occurrence of Drug Therapy Problems (DTPs). This study set out to identify, document DTPs and evaluate the impact of pharmacists´ interventions in selected health facilities. Methods - The study was carried out simultaneously at two tertiary and two secondary hospitals in Ogun States. Pharmacists were trained to document all identified DTPs in prescriptions and impacts of pharmacists' interventions for six months using the documentation form, PCNE V5.01. Data was analyzed and presented as frequencies with test of significance of main parameters. Results ­ One hundred and four (104) DTPs were reported in all the health facilities but with no significant difference in occurrence at the two hospital levels. Commonly occurring DTPs were drug choice problems (35.6%), dosing problems (33.9%), adverse drug reaction (22.8%), drug use problems (4.23%) and drug interactions (1.69%). Most proposed interventions (77.0%) were approved by prescribers with (77.2%) resolution of DTPs in tertiary hospitals. Conclusion- There was no significant difference in occurrence of DTPs in the hospitals but there was higher incidence of non-allergic ADR, contraindication, duration of drug use and duplication of drugs at the secondary level. Acceptance rate of proposed interventions by physicians was high (77.2%) confirming that pharmacists' intervention in rational pharmacotherapy is valuable

Prise en charge medicamenteuse des troubles de l'humeur des adolescents au service d'hygiene mentale; Abidjan; Cote d'Ivoire

Introduction. Les troubles mentaux et neurologiques sont devenus une priorite de sante publique. En effet; la morbidite liee a la depression apparait desormais au premier rang des pathologies psychiatriques dans le monde et une place de choix pour les troubles bipolaires avec ses consequences individuelles et sociales majeures. En Cote d'Ivoire; ces troubles pourraient etre aggraves chez l'adolescent du fait de la longue crise militaro- politique. Notre etude avait pour but d'evaluer les elements indicatifs de la prise en charge medicamenteuses des troubles de l'humeur chez les adolescents dans un contexte de crise sociopolitique a Abidjan. Materiels et Methodes. Ce travail retrospectif a visee descriptive a concerne des patients ages de plus seize ans en Cote d'Ivoire. Le recueil actif des donnees s'est fait a partir d'un questionnaire valide; de consultation des dossiers medicaux des patients du service de l'hygiene Mentale et d'un entretien structure avec le personnel. Resultats. Adolescents ages de 18 ans a 20 ans (48;1%) predominant suivis de ceux de la tranche de 21 a 22 ans (38;9%). La repartition des adolescents selon le sexe a releve une predominance du sexe feminin (58%) contre 42%; soit une sex ratio de 1;24. Les eleves et etudiants (69;5%) etaient les plus atteintes des troubles de l'humeur; 63;4% des adolescents ont ete adresses par la famille; vivent dans une famille monoparentale. La majorite des adolescents (63;4%) ont ete adressees au SHM par leurs familles dont 25;9% des centres soins conventionnelles. Les bizarreries comportementales representaient le motif de consultation le plus frequent avec un taux (11;7%). Le mode de debut des troubles de l'humeur etait brutal dans la majorite des cas (63;4%). Les symptomes somatiques (37;7%) representent l'essentiel des symptomes de la consultation psychiatrique; Les etats depressifs (56;4%) representent essentiellement le diagnostic le plus rencontre devant les acces maniaques (40;54%). Les antidepresseurs (30;9%) ont ete les plus prescrits car les etats depressifs etaient les plus rencontres (56;4%); suivis des thymoregulateurs (25;1%). Conclusion. Notre etude a permis de montrer une bonne prise en charge medicamenteux des troubles de l'humeur chez l'adolescent. Il en ressort qu'une subvention de l'etat Ivoirien du cout des psychotropes; utilises au long court; serait un soulagement des patients et la famille car ils constituaient le facteur determinant du pronostic du malade

Universal Combination Antiretroviral Regimens to Prevent Mother-to-Child Transmission of HIV in Rural Zambia: a Two-Round Cross-Sectional Study

To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.Methods Combination antiretroviral regimens were offered to pregnant and breastfeeding; HIV-infected women; irrespective of immunological status; at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death. Findings In the first survey (2008-2009); 335 of 1778 women (18.8) tested positive for HIV. In the second (2011); 390 of 2386 (16.3) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95 confidence interval; CI: 0.63-0.76) in the first survey and 0.89 (95 CI: 0.83-0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33; 95 CI: 0.15-0.73). Maternal knowledge of HIV status; use of HIV tests and use of combination regimens during pregnancy increased between the surveys. Conclusion The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased