[Profile of HIV infected patients among blood donors in Abidjan, Côte d'Ivoire (1992-1999)]. / Profil des patients infectés par le VIH, dépistés au Centre national de transfusion sanguine d'Abidjan, Côte d'Ivoire, 1992-1999.

The FonSIDA is a private clinic created in 1992 within the premises of the National Blood Transfusion Center of Abidjan (CNTS), the largest city in Côte d'Ivoire. It provides medical and psychological follow-up for blood donors which are diagnosed as HIV-infected. This Centre provides blood for transfusions in Abidjan and the surrounding area, which from 1992 to 1999 collected 263,398 blood units. In this period, 5574 subjects were detected HIV-positive. Among those, 1766 (32%) HIV infected blood donors came back to be tested for confirmation of HIV diagnosis. Since then, only 9% of the 5574 donors have been seen at least twice a year for medical and psychological follow-up. Women were more compliant than men in the FonSIDA Clinic: they constituted 62% of the 409 patients who were followed-up (p < 0.001). 53% of men had sex with prostitutes the year before HIV diagnosis. 67% of women stated voluntary abortion at least once. In the same period the systematic use of condoms was reported by only 7% of women and 5% of men. 22% of women and 28% of men reported having two or more sexual partners in the year before HIV diagnosis. The main aim of every blood center is to improve blood safety, particularly in developing countries. The appropriate counseling towards blood donors and especially those detected HIV positive can contribute to reduce new HIV infections in high HIV prevalence cities. Rate of compliance of HIV-infected patients to follow-up has risen to 11% in 1992-1994 to 60% in 1997-1999 and will contribute to reach this aim.

[Bacillary angiomatosis in an adult infected with HIV-1 at an early stage of immunodepression in Abidjan, Côte d'Ivoire]. / Angiomatose bacillaire chez un adulte infecté par le VIH-1 à un stade d'immunodépression peu avancé à Abidjan, Côte d'Ivoire.

Human immunodeficiency virus (HIV)-associated bacillary angiomatosis has rarely been described in Africa. We report here the first case in Côte d'Ivoire. Although in industrialised countries bacillary angiomatosis has been described in patients with low CD4 count, this episode occurred in the first year following HIV-seroconversion in an adult patient with more than 500 CD4 cells per cubic millimetre. Symptoms rapidly and totally disappeared under erythromycin treatment, although with a relapse two years after the end of the first episode. In Africa where people living with HIV often present chronic cutaneous lesions, bacillary angiomatosis may be under-diagnosed. Bacillary angiomatosis must be systematically considered in face of lesions similar to Kaposi's sarcoma. Improving knowledge on symptoms of bacillary angiomatosis in Africa should lead to better treatment and a better estimation of its true frequency which may be underestimated.

Nutritional status and dietary intakes in human immunodeficiency virus (HIV)-infected outpatients in Abidjan, Côte D'Ivoire, 1995.

OBJECTIVE: To evaluate nutritional status and dietary intakes in HIV-outpatients in Abidjan, Côte d'Ivoire. DESIGN: Cross-sectional study. SETTING: In the Outpatients and Counselling Unit in the University Hospital in Treichville, and in the follow-up Unit of Blood Donors. SUBJECTS: 100 HIV-infected patients at different stages of the infection recruited consecutively in the two consultation services. MAIN OUTCOME MEASURES: Clinical, biological and anthropometric data were collected: weight, baseline weight, height, triceps skinfold (TS), arm circumference (AC), body mass index (BMI), muscular circumference (MC) and weight loss (WL). Dietary intake was estimated by the 24 h recall method. RESULTS: The M:F sex ratio was 1.1:1. Mean age was 32.5 y (30.7-34.4); 64% of the patients were symptomatic (S+). Mean weight was 58.7 kg (56.8-60.6) and mean BMI, 20.9 k/m2 (20.7-21.1); 67% of the patients had a BMI < 21.5 kg/m2. S+ patients had mean weight, BMI, AC and MC significantly lower than asymptomatic patients (P < 0.0001 = 0.001, 0.0003 and 0.004 respectively) and had suffered a more important WL (P < 0.0001). Immunodepressed patients had mean weight, AC and MC significantly lower than patients with a CD4 count > or = 200/mm3 (P = 0.04, 0.005 and 0.04 respectively). WL was independent of CD4 count. Protein, carbohydrate and fat intakes were respectively 59 g/24 h (52-66), 266 g/24 h (240-292) and 59 g/24 h (51-66). Energy mean intake was 7.6 MJ/24 h (6.9-8.4) and lower than WHO recommended intakes. CONCLUSIONS: In Abidjan, anthropometric parameters and dietary intakes of HIV-infected patients are worsened by clinical events. Nutritional intakes are generally lower than recommendations. Further studies are needed to determine if, in the African context, a causal relationship could exist between dietary intakes and nutritional status in HIV-infected patients.

Effets de la Nicardipine intraveineuse dans les crises hypertensives severes

32 patients d'age moyen 38;56+/- 12;44 ans presentant une poussee hypertensive d'en moyenne 221;31+/- 34;64 mm Hg/134;94 +/- 20;93mm Hg associee a des complications viscerales : accidents vasculaires cerebraux (39 pour cent); encephalopathie hypertensive (22 pour cent); oedeme aigu du poumon (22 pour cent); oligo-anurie (17 pour cent) ont beneficie d'un traitement anti-hypertenseur par la Nicardipine intraveineuse.

Induction of "tissue" transglutaminase in HIV pathogenesis: evidence for high rate of apoptosis of CD4+ T lymphocytes and accessory cells in lymphoid tissues.

Peripheral blood mononuclear cells and lymphoid tissues from HIV-infected individuals display high levels of "tissue" transglutaminase (tTG) with respect to seronegative persons. In asymptomatic individuals, > 80% of the circulating CD4+ T cells synthesize tTG protein and the number of these cells matches the level of apoptosis detected in the peripheral blood mononuclear cells from the same patients. In HIV-infected lymph nodes tTG protein is localized in large number of cells (macrophages, follicular dendritic cells, and endothelial cells), showing distinctive morphological and biochemical features of apoptosis as well as in lymphocytes and syncytia. These findings demonstrate that during the course of HIV infection, high levels of apoptosis also occur in the accessory cells of lymphoid organs. The increased concentration of epsilon(gamma-glutamyl)lysine isodipeptide, the degradation product of tTG cross-linked proteins, observed in the blood of HIV-infected individuals demonstrates that the enzyme accumulated in the dying cells actively cross-links intracellular proteins. The enhanced levels of epsilon(gamma-glutamyl)lysine in the blood parallels the progression of HIV disease, suggesting that the isodipeptide determination might be a useful method to monitor the in vivo rate of apoptosis.

Evidence for an in vivo superantigenic activity in human immunodeficiency virus-infected individuals.

In a previous study, we reported the existence of a specific anergy affecting selectively the V beta 8 subset in both CD4 and CD8 T cells from human immunodeficiency virus (HIV)-infected persons. Because this observation gives evidence for a previous in vivo activation of this subset by a superantigen, we further characterize, in the present study, this V beta 8-anergy associated with HIV infection. Molecular T cell receptor analysis indicates that the V beta 8-anergized T cells are polyclonal. Furthermore, we show the dependence of this anergy on the expression of allelic forms of HLA class II DRB1 molecules. These observations explain the frequency of anergic persons among HIV-infected donors (56%) and are consistent with a previous in vivo superantigenic activity. Comparative analyses of disease evolution between V beta 8 responder and anergic persons do not show any clear relation between the V beta 8 status and acquired immunodeficiency syndrome pathogenesis. However, the stability of the V beta 8 status, the absence of correlation with previous microbial infections, and the previously reported precocity of V beta 8 anergization are in favor of a strong association between the in vivo existence of a V beta 8-specific superantigen and HIV infection. Finally, the functional dichotomy we observe for all anergized donors between blood and lymph node T cells raises the question of the in vivo localization of the superantigenic activity.

[Value of selective prescription of preanesthetic laboratory tests]. / Intérêts de la prescription sélective des examens complémentaires préanesthésiques.

The aim of this study was to determine the comparative value of routine or selective ordering of preoperative tests. 400 ASA I, II, III patients were enrolled in the study. Two periods were considered: a retrospective period where the patients (n = 200) underwent routine preoperative tests and a prospective period where the patients (n = 200) had only preoperative tests according to the results of questioning and clinical examination. During the retrospective period 1.408 tests were effected with 44 abnormal results. During the prospective period, the abnormal results among 855 prescribed tests were: 0.8% in ASA I patients, 7.5% in ASA II and 5.9% in ASA III patients. The ASA I patients had an average of 3.47 +/- 1.28 tests each, ASA II patients 4.50 +/- 1.21 and ASA III 7.50 +/- 1.50. No complication inducing sequelae or death could be linked to lacking tests. The mean cost of tests was reduced by 50 percent.

Burns in Abidjan, Cote d'Ivoire.

Burns are frequent in Côte d'Ivoire with about 700 cases yearly registered in the three Teaching Hospitals of Abidjan (Yopougon, Treichville and Cocody). Unfortunately, no specialized substructure is equipped for treating these patients in the country. The aim of the retrospective study carried out during 1993 in the Burns Care Unit of the Teaching Hospital of Cocody is to illustrate the epidemiology of burns in a poorly developed country in West Africa. Faced with many problems and especially a lack of space, the burns care unit is fighting to become a burns centre, which may become functional in 1995. Regarding studies from other countries, the results from our service are comparable to those obtained in poorly developed countries, they are different from those notified in countries with a higher socioeconomic level where substructures and financial means allow more appropriate care. The Abidjan Burns Centre aims to improve the current preventive activities and to provide burned people with the best possible care.

A propos d'un cas de barytome iatrogene chez un nourrisson de 5 mois. [Lettre]

Les auteurs rapportent une observation de peritonite aigue consecutive a une perforation colique lors d'un lavement baryte. L'accident est survenu chez un nourrisson de 5 mois presentant une invagination intestinale aigue. La precocite du diagnostic et du traitement encadre par une reanimation efficace; ont permis l'evolution favorable. Des complications (infection; desordre hydroelectrolytique; trouble hemodynamique) ont emaille cette evolution. Les auteurs font une revue de la litterature sur la question et attirent l'attention des praticiens (chirurgiens; radiologistes et reanimateurs) sur la gravite de l'accident; la necessite de son diagnostic et des difficultes de sa prise en charge tout au long de son evolution. Ils preconisent le suivi a long terme des malades vivants a la recherche de sequelles et de complications ulterieures et enoncent des mesures prophylactiques

Seroprevalence de l'infection a VIH dans le service de reanimation du CHR de Bouake

"Dans cette etude prospective; sur 100 patients hospitalises dans le service de reanimation du CHR de Bouake; menee sur une periode de 45 jours (1er juillet 1994 au 15 aout 1994); 18 patients ont une serologie a VIH positive soit un taux de seroprevalence hospitaliere de 18 pour cent. La prevalence par serotype est de 83;3 pour cent de patients a VIH 1 positifs; 5;6 pour cent de patients a VIH positifs et 11;1 pour cent de patients doublement positifs a VIH 1 et VIH 2. Les maries sont les plus touches et representent 61;1 pour cent de seropositifs; tandis que le taux des celibataires est de 27;8 pour cent. Les ""sans profession"" representent 33;36 pour cent. Les patients qui n'ont aucun niveau d'etude ont un taux de 56 pour cent. La notion de transfusion se retrouve chez 11 pour cent de patients seropositifs. On note 3 deces (VIH 1 positifs) parmi les patients seropositifs soit un taux de 17 pour cent et on observe egalement 17 pour cent de deces dans l'echantillon global. On ne note pas une difference significative entre le taux de deces dans l'echantillon global et celui du groupe des patients seropositifs. Ces resultats interpellent les auteurs sur la necessite d'observer des mesures preventives visant a lutter contre ce fleau"

Approche de la dose utile de Diprivan au cours de l'intervention cesarienne

Le but de ce travail est de determiner la dose de Diprivan necessaire a utiliser lors de l'operation cesarienne chez 28 femmes en considerant le poids en fin de grossesse. Le Diprivan a ete utilise a l'induction a la dose de 2;5 mg/kg (poids en fin de grossesse) suivie de l'injection de la celocurine pour l'intubation tracheale. Apres la delivrance artificielle; l'anesthesie a ete approfondie par l'injection de Pavulon ou de Norcuron (0;1 mg/kg) du Fantanyl 50 mcg toutes les 20 mn; du N20/02 (50 pour cent) et des reinjections de 50 mg de Diprivan au moindre signe de reveil. 190;44 6;80 mg de Diprivan a l'induction et 127;02+-1;67 mg lors des reinjections; ont ete utilisees soit au total 317;46+-29;92 mg. La dose moyenne par kg est egale a 4;3 mg/kg soit celle retrouvee dans l'etude de CORTAMBERT et coll

[Blood transfusions in Africa during the AIDS epidemic. Condition of localities and perspectives in the Ivory Coast]. / Réflexions sur la transfusion sanguine en Afrique au temps de l'epidemie de SIDA. Etat des lieux et perspectives en Côte-d'lvoire.

HIV is transmitted essentially by the heterosexual route in Africa. As part of an international mobilization against the Aids epidemic, information, education and communication strategies should continue to reduce the frequency of the infection. In this paper, we underline the high risk of HIV infection from blood transfusion in Africa. Although few epidemiological data are available, we feel that this problem should be made a priority, and that blood transfusion in Africa can be made reasonably safe by rational use of limited resources. We first report how the Ivory Coast health ministry, with funding from the European Community, has organized blood transfusion services in the main urban areas. Despite routine screening tests, the risk of HIV transmission through blood products remains high because of the large number of infected donors who are antibody-negative. The accent must thus be placed on alternatives to blood transfusions, while the use of transfusions must be minimized, especially in pediatric and general medical wards. As malaria, undernutrition and obstetric surgery are leading causes of anemia, health programs should be aimed at controlling these factors with the ultimate goal of limiting the spread of HIV.

Excluding blood donors at high risk of HIV infection in a west African city.

OBJECTIVE: To examine the potential impact of deferral of blood donors at high risk of HIV infection in a west African city where blood is screened for HIV antibodies but no other special measures are taken to protect the blood supply. DESIGN: Cross sectional study. SETTING: National Blood Transfusion Centre and Project RETRO-CI, an international collaborative AIDS research project, Abidjan, Côte d'Ivoire. SUBJECTS: 1257 male first time blood donors. INTERVENTIONS: Blood donors were interviewed about demographic and behavioural characteristics and tested for HIV antibodies by enzyme immunoassay and, if positive, synthetic peptide based tests. MAIN OUTCOME MEASURES: HIV antibody status in relation to presence of behavioural risk factors; calculation of sensitivity, specificity, and predictive values of specific criteria for excluding HIV infected donors. RESULTS: The overall prevalence of HIV infection was 11.4%. The most important risk factors for HIV positivity were prostitute contact and being aged 30-39 years. For identifying seropositive donors individual criteria had sensitivity, specificity, and positive predictive values ranging from 15% to 98%, 38% to 91%, and 17% to 30% respectively. Prostitute contact in the past five years would have excluded 31% of all donors and 73% of HIV infected donors. 27% of those excluded would have been HIV positive. CONCLUSIONS: The widespread assumption that donor deferral is not feasible in sub-Saharan Africa needs reassessment. In Abidjan this approach was well accepted and potentially effective. Donor deferral requires evaluation as a strategy for improving blood safety in resource poor areas with high rates of HIV infection.

PIP: During February-November 1991 in Abidjan, the Ivory Coast, interviews with 1257 male first-time blood donors and screening of their blood for antibodies to HIV-1 and HIV-2 were conducted at the National Blood Transfusion Center to determine whether it is feasible to exclude or defer donors at high risk of HIV infection. 143 (11.4%) men had antibodies to HIV. The multivariate analysis showed that the strongest risk factor for HIV infection was sex with prostitutes in the last 5 years without regular condom use (odds ratio [OR] = 10, confidence interval [CI] = 6.6-15) followed by prostitute contact in the last 5 years regardless of condom use (OR = 8.4, CI = 5.6-12.6), and an age of 30-39 years (OR = 6.9, CI = 18). 27% of all donors with prostitute contact in the last 5 years were infected (positive predictive value). If the center had used prostitute contact in the last 5 years as a criterion, it would have discarded 31% of all units of blood. Thus, more than 75% of all potentially excluded units would have been from donors infected with HIV. The sensitivity, specificity, and positive predictive values ranged from 15% to 98%, 38% to 91%, and 17% to 30%, respectively. These findings suggest that it is feasible in Abidjan to exclude donors based on behavioral characteristics of those most at risk of HIV infection. Donor deferral should be evaluated as a strategy to improve blood safety in resource-poor areas with high rates of HIV infection.

Morsures de serpents : aspects epidemiologiques et protocole therapeutique

En 12 mois; 53 cas de morsures de serpents ont ete colliges. Le sexe masculin est le plus touche. Le tableau clinique est celui d'un syndrome inflammatoire localise au niveau des membres inferieurs; il est plus sensible a l'heparinate de sodium intraveineux qu'aux anti-flammatoires non steroidiens. La duree moyenne d'hospitalisation a ete de 2;87 jours. Le traitement a ete uniquement symptomatique et l'evolution favorable dans 100 pour cent des cas

Bloc crural associe a la rachianesthesie pour chirurgie de la hanche chez des sujets ages A.S.A. III

Le bloc crural avec 6 ml Bupivacaine a 0;5 et 6 ml de Lidocaine a 2 pour cent a precede la rachianesthesie realisee avec 2 ml de Bupivacaine a 0;5 pour cent; 1ml de G 10 pour cent et 2 ml de Fentanyl. L'indication de cette rachianesthesie etait posee devant une chirurgie de la hanche chez des sujets du grand age (64 a 85 ans) et tares (ASA III). L'analgesie obtenue grace a cette association a ete precoce (6 min.); suffisante pour la chirurgie; et d'une duree prolongee jusque dans le post-operatoire (6h30). Ces auteurs conseillent donc un large usage de ce protocole simple; pas cher et interferant sur les tares preexistantes; surtout dans cette indication particuliere

Risk of HIV infection from transfusion with blood negative for HIV antibody in a west African city.

OBJECTIVE: To estimate the risk of infection with HIV (HIV 1 or HIV 2, or both) from transfusion of a screened unit of blood in a high prevalence area in west Africa. DESIGN: Retrospective cohort study for January-July 1991. SETTING: National Blood Transfusion Centre, Abidjan, Côte d'Ivoire. SUBJECTS: Repeat donors (5831 units of blood) and first time donors (5076 units) in the first five months of 1991. MAIN OUTCOME MEASURES: Prevalence and estimated incidence of HIV infection in repeat and first time donors; estimated rate of potentially infected, HIV antibody negative units; and rate of (false negative) potentially infected units assuming a laboratory test sensitivity of 99%. RESULTS: Overall HIV prevalence was 11.0% in first time donors and 2.1% in repeat donors. In the first seven months of 1991, 29 HIV antibody positive (27 HIV 1, 1 HIV 2, 1 dually reactive) donors with a seronegative unit of blood earlier in the year were identified; 26 had donated blood eight weeks or less before their estimated dates of seroconversion and may have been infectious (minimum rate 26/5831 (4.5/1000 potentially infected units)). Estimated incidence of infection in repeat donors was 1.2-2.5%. Laboratory test insensitivity would result in an estimated 1.1/1000 false negative units from first time donors and 0.2/1000 units from regular donors. The overall rate of potentially infected units (all donors, seroconversions, and errors) was estimated at 5.4-10.6/1000. CONCLUSIONS: The risk of HIV infection from a single unit of blood remains substantial (5.4-10.6/1000 units). To prevent infection from blood transfusion in areas of high incidence and prevalence of HIV all but absolutely essential transfusions should be avoided, and donors with low incidence of HIV infection should be selected.

[The effect of the local anesthetic temperature on spinal anesthesia using 0.5% bupivacaine]. / Influence de la température de l'anesthésique local sur la rachianesthésie à la bupivacaïne à 0.5%.

The aim of this study was to compare spinal anaesthesia with 0.5% bupivacaine at 20 degrees C and 5 degrees C. One hundred two patients ASA I-II were randomized into two groups. After atropine and IV fluid administration, patients of group I received intrathecally at L3-L4 level 0.02 ml.cm-1 of plain 0.5% bupivacaine at 20 degrees C, while patients of group II received the same solution and the same doses but at 5 degrees C. No significant difference was found between the times for installation of sensory and motor blocks nor between the durations of motor block in the two groups. On the other hand significant differences were found between the durations of sensory block in group I (283.33 min +/- 9.40 min) and group II (314.35 +/- 8.80 min) (P < 0.001) and all the more (P < 10(-9)) between the cephalad block extensions in group I (D 7.45 +/- 0.14) and group II (D 4.82 +/- 0.20). Therefore plain bupivacaine 0.5%, isobaric at 20 degrees C, seems to get the properties of an hyperbaric solution when cooled at 5 degrees C.

[Factors changing the length of analgesia in spinal anesthesia]. / Facteurs modifiant la durée de l'analgésie au cours de la rachianesthésie.

So as to determine the effects of some factors on the duration of bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 152 ASA I or II patients. They were randomly allocated to six groups. The patients of group I were given 4 ml of 0.5% bupivacaine at 27 degrees C. The patients of group II were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 1 ml fentanyl in 1 ml of 10% dextrose solution. The group III was given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.20 mg adrenaline. The group IV was given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.15 mg clonidine. The patients of group V were given 4 ml of 0.5% bupivacaine at 20 degrees C and those of group VI were given 4 ml of 0.5% bupivacaine at 5 degrees C. There is significant difference between regression times of sensory analgesia of group II and group I, group IV and group III, group VI and group V. The choice of product to lengthen analgesia in spinal anaesthesia depends on the use of each anaesthesist, the characteristic of patients and the duration of surgery.

Utilisation du glycerol buvable dans le traitement preventif de l'hypertension intracranienne

Se proposant de tester l'effet osmotique anti-oedemateux cerebral du glycerol oral; les auteurs de cette communication ont selectionne 53 patients; 25 de sexe masculin et 28 de sexe feminin : 14 accidents vasculaires cerebraux; 30 traumatismes craniens et 9 craniectomies. Tous ces malades avaient a l'admission un score de Glasgow compris entre 13 et 8 et un oedeme papillaire au fond de l'oeil. Les cas d'H.E.D. et d'H.S.D. sont exclus de ce travail. Le glycerol buvable a ete utilise comme element principal de traitement anti-oedemateux cerebral. La resorption de l'oedeme papillaire a ete effective chez 32 pour cent des sujets au bout de 4 jours et chez 47 pour cent des sujets au bout de 7 jours de prise du glycerol et l'evolution finale a ete favorable dans 71;7 pour cent des cas au prix de complications mineures

[Comparison of adrenaline and clonidine to extend the analgesic effect of bupivacaine without glucose in spinal anesthesia]. / Comparaison de l'adrénaline et de la clonidine pour prolonger l'effet analgésique de la bupivacaïne sans glucose au cours de la rachianesthésie.

So as to determine the effects of adrenaline and clonidine on the duration of isobaric bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 20 ASA I or II patients. They were randomly allocated to two groups. The patients of group I were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.2 mg adrenaline. The patients of group II were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.15 mg clonidine. The segmental level of sensory loss was tested using forceps. The time course required for maximal spread on the sensory blockade did not differ in the two groups: 4.00 +/- 1.01 min. for group I and 3.60 +/- 0.90 min. for group II. No difference was observed between median highest levels of sensory analgesia. Regression times were 520.70 +/- 79.52 min for group II and 360.40 +/- 51.47 min. for group I. Significant prolongation of motor block was also associated with the addition of vasoconstrictors. It is concluded that addition of 0.15 mg clonidine may be useful to increase duration of isobaric bupivacaine spinal anaesthesia.