Facteurs associés à la qualité de vie de patients souffrant du diabète de type 2 au Burkina Faso

Le diabète est une maladie responsable de complications qui aggravent le risque de mortalité chez les malades. au Burkina Faso, très peu de données existent sur la qualité de vie des patients souffrant du diabète de type 2. l'objectif de l'étude est de decrire la qualité de vie des patients diabétiques de type 2 dans les deux principales villes du pays. il s'agit d'une étude transversale descriptive qui a inclus des patients de Ouagadougou et Bobo-dioulasso souffrant de diabète de type 2 et suivis par un spécialiste dans les hôpitaux publiques et les cliniques privées. au total cent 100 (patients) ont été inclus dans l'étude. les informations sociodémographiques et cliniques ont été collectées à partir de questionnaires adminitrés en vis-à-vis par des enquêteurs formés. la perception de la qualité de vie a été mesurée sur une échelle de 10 (10/10 = vit parfaitement avec sa maladie ; 0/10 = ne vit pas du tout parfaitement avec sa maladie). le patient était considéré comme mécontent de sa qualité de vie si le score était < 5. une analyse descriptive pour explorer l'échantillon a été réalisée. ensuite, une analyse factorielle des correspondances multiples a été effectuée pour analyser la relation entre les caractéristiques des patients et la qualité de vie perçue. dans l'échantillon, il y avait 52 % (52) d'hommes et 61 % (61) des patients avaient plus de 50 ans. la plupart des patients étaient mariés, chefs de ménage, et avaient un travail. au total, 39 % (39) des patients ne vivaient pas du tout parfaitement avec leur maladie. les facteurs qui contribuent à la première dimension (65,2 % de l'inertie) appelée « répercussions de la maladie » étaient celle décrivant l'impact du diabète sur la vie professionnelle (12,2 %), économique (11,2 %), sociale (9,4 %) et familiale (3,8 %) du patient. les facteurs qui contribuent à la deuxième dimension (27,37 % de l'inertie) appelée « complications de la maladie » étaient les complications cardiovasculaires (16,6 %), nerveuses (12,5 %, rénales (11,2 %), et oculaires (9,2 %), et le fait d'avoir une durée de la maladie d'au moins 5 ans (7,5 %). l'étude a montré que le diabète de type 2, a non seulement des répercussions sur la vie professionnelle, économique, sociale et familiale, mais aussi des repercussions en termes de complications cliniques qui impactent négativement sur la qualité de vie des malades. une stratégie de promotion de santé centrée sur la sensibilisation de l'entourage des malades et l'accessibilité aux soins permettraient d'améliorer la santé des patients souffrant de diabète de type 2

[Connective tissue diseases in hospital practice in Ouagadougou (Burkina Faso)]. / Les connectivites en pratique hospitalière à Ouagadougou (Burkina Faso).

To describe the semiological and immunological features of connective tissue diseases seen at the Yalgado Ouédraogo University Hospital in Ouagadougou. A retrospective study reviewed the records of patients seen in the hospital dermatology and internal medicine departments from January 1, 2004, through December 31, 2009 and diagnosed with systemic lupus erythematosus (SLE), systemic sclerosis (ScS), dermatopolymyositis (DPM), primary Gougerot-Sjögren disease (GS), polymyositis (PM) or indeterminate connective tissue disease (ICTD) meeting the criteria of the American College of Rheumatology. The study included 42 patients, 36 women and 6 men. Their mean age was 41.2 years ±11.97 (range: 15-75). SLE was the diagnosis for 10 patients, ScS for 14, DPM for 7, primary GS for 1, PM for 1, and ICTD for 9. Hematologic (93%), cutaneous (88%), and rheumatologic (81%) abnormalities were the most frequent manifestations. The specific auto-antibodies associated with SLE patients were: anti-native DNA (3/6), anti-Sm (3/6), anti-RNP (3/6), and anti-SSA (4/6); anti-Scl 70 antibodies were present in 5 patients with ScS. Connective tissue diseases seem to be rare in Africa, south of the Sahara. However, the very fragmentary studies and the weak healthcare coverage do not allow any definitive conclusions.

[Sexuality and risk for sexual transmission of HIV among serodiscordant couples in Ouagadougou, Burkina Faso]. / Sexualité et risque de transmission du VIH chez les couples sérodiscordants suivis à l'hôpital de jour du CHU de Ouagadougou (Burkina Faso).

This article is a contribution to improve the management of serodiscordant couples in Ouagadougou. The aim of the study was to explore sexuality and the risk for sexual transmission of HIV among serodiscordant couples followed-up in CHU-YO. The study consisted of a descriptive cross-sectional study conducted over 6 months, from 1 January 2010 to 30 June 2010. A total of 80 heterosexual serodiscordant couples participated. Women were infected with HIV in most cases (75%). The mean age was 37.5 years for HIV partners and 40 years for seronegatives. Men were significantly older than women (p = 0.01). The couples weremarried (83.7%) or cohabiting (16.3%). The average of serodiscordance duration was 4 years. Seventy-four couples (92.5%) engaged in sexual intercourses, mostly vaginal intercourses. Both partners were satisfied only in 9 couples (12.2%). Although most couples (97.5%) knew the use of condoms for HIV prevention, 59.5% did not use it consistently, particularly when women were the seropositive partners (p = 0.01). The lack of privacy (37.5%) and desire of childbearing (26.25%) were the main reasons for not consistently using condoms among couples. Sexual dysfunction was a concern with 97.5% of the couples. The decrease in libido was most common (37.2%). Sexual intercourses with an outside partner were reported in 20 couples (25%), mostly regarding men (p = 0.03). Specific management could improve the quality of sexual life for couples in the light of the difficulties they face and reduce the risk for HIV transmission to negative partners.

Characterization of HIV-1 genotypes and antiretroviral drug-resistance mutations among patients in Burkina Faso.

The purposes of this study were: (1) to describe the genetic variability of HIV strains found in Burkina Faso, (2) to characterize non-B HIV strains mutation profiles selected by ARVs and (3) to detect possible resistances induced by ARV drugs. From 30 October 2002 to 20 November 2003, 132 HIV 1-positive patients taking Highly Active Antiretroviral Therapy (HAART) for more than one year in Bobo-Dioulasso and Ouagadougou were included. T-CD4+ lymphocytes count was done using Dynabeads technique while genotypic test and ARV-resistance tests were conducted using Pol sequencing that codes for reverse transcriptase reverse, integrase and protease. Due to undetectable viremia, 86 samples out of 132 could not be characterized. Whereas in the 46 others that had a viral load exceeding 1000 copies mL(-1), the following HIV-1 subtypes were identified: CRF06 (54,55%); CRF02(38,63%); CRF01 (4,55%) and subtype A (2,27%). In addition, several mutations related to PI, NRTI and NNRTI resistance were isolated in 27 samples. This study found a huge genetic HIV-1 polymorphism in Burkina Faso. The level of acquired resistance to ARV after one year of treatment amounted 20.4%. These results clearly show that there is imperative need to set up an ARV resistance surveillance network in Burkina Faso to guide treatment strategies and follow the extension of the phenomenon in the country.

[Prevalence and risk factors associated with infection by human immunodeficiency virus, hepatitis B virus, syphilis and bacillary pulmonary tuberculosis in prisons in Burkina Faso]. / Prévalences et facteurs associés aux infections a Virus de l'Immunodéficience Humaine et virus de l'épatite B, a la syphilis et a la tuberculose pulmonaire bacillifère en milieu carcéral au Burkina Faso.

This purpose of this study was to determine prevalences and risk factors associated with infection by human immunodeficiency virus, hepatitis B Virus, syphilis and bacillary pulmonary tuberculosis in prisons in Burkina Faso. From February 20 to March 20, 2009, 300 prisoners over 18 years of age held in Ouagadougou were selected to take part in this descriptive and analytical cross-sectional study. Sociodemographic data, confinement information (number, motive and prison time), medical history, substance addiction (alcohol, tobacco, drug), and the other risk behaviors (sexual relations, type of partners, sharing of toiletries or razor) were compiled for each prisoner. Serological tests were performed to detect anti-HIV antibodies, Hbs antigen, and anti-treponema antibody. In prisoners presenting signs of tuberculosis, BAAR detection was performed by direct examination of sputum. Men represented 95% of the study population. Median age was of 30.1 +/- 8.9 years (range, 18 and 63). The prevalences of HIV infection, Hbs antigen and positive syphilitic serology were 5%, 27.3% and 5.7% respectively. Four prisoners (1.3%) had bacillary pulmonary tuberculosis. Two prisoners reported homosexual intercourse and 44 reported drug abuse. Sharing of toiletries and razor blades was reported by 18.7% and 20% of the prisoners respectively. Immediate measures are needed reduce the spread of these infections in prisons in Africa.

[Prevalence and factors associated with low back pain among hospital staff in Ouagadougou (Burkina Faso)]. / Prévalence et facteurs de risque associés à la lombalgie chez le personnel hospitalier à Ouagadougou (Burkina Faso).

OBJECTIVE: The aim of our study was to determine the prevalence, risk factors, associated with low back pain among hospital staff in a developing country. PATIENTS AND METHODS: This transversal study was conducted from March 2007 to February 2008 at Yalgado Ouédraogo Teaching Hospital in Ouagadougou (CHU-YO), Burkina Faso. RESULTS: There were 256 men and 180 women with an average age of 38 +/- 8.25 years (range, 22 to 58). Mean BMI was 25.11 +/- 4.03 Kg/m2. The prevalence of chronic low back pain was 56.4% overall, 47.3% in men and 69.4% in women. Individual risk factors included female sex (p=0.000004), age (p=0.026), and high BMI (p=0.0002). Sports activity appeared to be a protective factor (p=0,035). Professional risk factors were the number of working hours per week (p=0,005) and numbers of guards per month (p=0.014) and posture during work (p=0.01). Analysis of socioprofessional consequences revealed significant impact in 43 (17,5%) patients. The loss work hours in 2007 were estimated to 1020. Three patients had to change working stations due to disability and 82 (19%) reported restricted working capacity. CONCLUSION: The prevalence of low back pain is high among hospital staff of CHU-YO. Preventive measures are needed to reduce socioprofessional consequences.

[Rheumatologic diseases and haemoglobinopathies in Ouagadougou (Burkina Faso)]. / Pathologies rhumatologiques et hémoglobinopathies à Ouagadougou (Burkina Faso).

The purpose of this study is the prevalence of the rheumatologic complications in the sickle cell disease and the associations between haemoglobinopathies and rheumatologic affections. It is a retrospective study from 29 February 2006 to 28 March 2008 conducted in the Internal Department of the University Hospital Yalgado-Ouédraogo. All patients received in the period of study and having an electrophoresis of haemoglobin realized in alkaline pH were included. These patients came from hematologic consultation. Two hundred and seventy-seven patients out of 1451 were included: 142 patients (51.30%) had haemoglobinopathies, including 21 (7.60%) with composite sickle cell disease SC and 17 patients (6.13%) had aseptic necrosis of the femoral head including 7 with haemoglobin SC. The other rheumatologic affections did not have a semiological particularity related to the type of haemoglobin. The prevalence of patients who have haemoglobinopathies is important in rheumatologic practice. The sickle cell disease is strongly associated to osteonecrosis.

[Rheumatic disorders observed in HIV infected patients undergoing highly active antiretroviral therapy (HAART): a 366 case prospective study in Burkina Faso]. / Manifestations rhumatologiques des personnes vivant avec le virus de l'immunodéficience humaine, traitées par antirétroviraux: etude prospective de 366 malades au Burkina Faso.

OBJECTIVE: The purpose of this report is to describe epidemiological aspects of rheumatic disorders observed in HIV-infected patients undergoing highly active antiretroviral therapy (HAART). Patients and methods. This cross-sectional study was conducted from January 1 to June 30, 2008 in the HIV unit of an internal medicine department in Burkina Faso. All patients who had been undergoing HAART for at least one year were included. Interviewing and thorough physical examination were performed in all cases. Radiography of the pelvis and hip was performed in some patients. Bone densitometry was never performed. RESULTS: A total of 366 patients including 265 women and 101 men (sex ratio of 0.38) were included. Mean patient age was 39.61 +/- 8.54 years. Three hundred and thirty-five patients (91.53%) were positive for HIV1, 17 (4.64%) for HIV2 and 14 (3.83%) for both HIV1 and HIV2. Mean duration of infection was 3.58 +/- 1.88 years. Mean CD4 cell count was 394.20 cell/microL. A recent HIV viral load determination was available for 285 patients including 262 who had no detectable virus. Mean duration of HAART was 35.80 +/- 15.17 months. Only 61 patients (16.66%) were treated with protease inhibitor (PI). The prevalence of rheumatic disorders was 5.73% (21 cases). A variety of disorders were observed, i.e., lower back pain in 8 patients (38.1%), arthralgia in 4 patients including 2 treated with PI, osteoarthritis of the knee in 2 patients, Pott disease in 2 patients, De Quervain disease in 2 patients including one treated with PI, tendinitis of the shoulder in one patient treated with PI, gout in one patient treated with PI and unclassifiable inflammatory rheumatism in one patient. No case of symptomatic osteonecrosis or osteoporosis was observed. CONCLUSION: Rheumatic disorders are uncommon in the HIV-infected patients undergoing HAART in Burkina Faso. The most likely explanation is that PI is not widely used.

[Arthropathic and degenerative pathology in rheumatology patients in Burkina Faso]. / Pathologie mécanique et dégénérative en consultation de rhumatologie au Burkina Faso.

OBJECTIVE: The purpose of this report is to describe epidemiologic features of arthrosic and degenerative disorders observed during the first two years of rheumatologic practice in Ouagadougou, Burkina Faso. PATIENTS AND METHODS: The files of all patients examined between March 2006 to February 2008 were reviewed. All patients presenting arthrosic or degenerative disorders were included. RESULTS: Out of 1,439 patients examined during the study period, 1,078 (74.91%) were included. Spine pain accounted for 33.7% of cases, i.e., 485 patients including 306 with lumbago. The mean age in this group was 47.8 +/- 15.19 years and the M/F sex ratio was 0,75. Osteoarthritis represented 20.43% of cases including osteoarthritis of the knee in 18%. The mean age in this group was 54.66 +/- 12.29 years and the M/F sex ratio was 0.23. Aseptic osteonecrosis (AON) of the femoral head was observed in 1.11% of cases, i.e. 16 patients including 8 with sickle cell disease (SC) The mean age in this group was 40.75 years. Abarticular rheumatism accounted for 15.98% of cases, i.e. 230 patients including 118 cases with tendinitis of the shoulder. The mean age in this group was 48.48 years. CONCLUSION: Arthrosic and degenerative disorders observed in this series from Ouagadougou presented the same semiological features as in other African series. Primary osteoarthritis of the hip was uncommon.

Impact of a modified directly administered antiretroviral treatment intervention on virological outcome in HIV-infected patients treated in Burkina Faso and Mali.

OBJECTIVE: This study explores whether viral load measurements can be used in resource-limited settings to target those in need of adherence assistance. It was hypothesized that high plasma viral loads (pVLs) (>/=500 HIV-1 RNA copies/mL) were the result of poor antiretroviral therapy adherence and amenable to improvement with adherence assistance. DESIGN: A single-arm, multicentre pilot study was conducted from November 2003 to March 2004 on 606 treatment-experienced patients who had initiated an antiretroviral regimen in Mali and Burkina Faso >/=6 months before study enrolment. In these patients, those whose pVL was >/=500 copies/mL were offered 1 month of modified directly administered antiretroviral treatment (mDAART) with weekly follow-up visits from pharmacists or adherence counsellors. METHODS: An adherence questionnaire was given to all cohort patients and viral load was used to screen for patients with >/=500 copies/mL. mDAART participants included cohort patients with >/=500 copies/mL, who completed the adherence questionnaire. Genotypic analyses were conducted on samples taken prior to and after the intervention. The intervention was considered effective when there was a decrease of >/=1 log(10) in pVL. RESULTS: mDAART was effective in over one-third of the intervention participants, while in two-thirds no decrease in pVL was observed. The majority of mDAART participants had major resistance mutations. CONCLUSIONS: pVL measurement was useful to identify patients who needed adherence assistance. However, because it was performed >/=6 months after starting treatment, mDAART came too late for most participants, as they had already developed important resistance mutations that might have been avoided with better laboratory monitoring.

Les leucémies lymphoides chroniques au CHU Yalgado Ouedraogo de Ouagadougou

20 cas de leucemie lymphoide chronique (LLC) ont ete diagnostiquees entre janvier 1995 et juin 2003 au Centre Hospitalier et Universitaire (CHU) Yalgado Ouedraogo de Ouagadougou au Burkina Faso. On y a compte 14 femmes et 6 hommes (doit deux femmes pour un homme) dont l'age moyen a ete de 53; 8 ans. Les patients ont chaque fois mis un long delai entre la survenue du premier symptome et la presentation a la consultation. Le motif de consultation le plus frequent a ete une masse abdominale en rapport a une splenomegalie associes ou non a des adenopathies. La lymphocytose sanguine en moyenne de 53.250/mm3 (extremes : 12;910-387.000/mm3) et l'anemie ont ete les perturbations biologiques essentielles. Sur les 20 observations; 16 etaient de mauvais pronostic car classees aux stades III et IV de Rai

[Chronic osteomyelitis at the Ouagadougou teaching hospital (Burkina Faso). A retrospective study of 102 cases (1996-2000)]. / Ostéomyélites chroniques au CHU de Ouagadou- gou (Burkina Faso). Etude rétrospective de 102 cas (1996-2000).

This is a retrospective study carried out in the orthopaedic and trauma department of the Yalgado-Ouédraogo teaching hospital. All the patients hospitalized in the service with a chronic osteomyelitis (COM) from March 1, 1996 to March 28, 2000 were included. The frequency of COM was 5.3%. The patients' average age was 17.7 with extremes of 2 and 60 years old. 63.9% were male; 80.7% had fistulized COM. A pathological fracture was observed in 16.9% of the patients. Lower limbs were affected most frequently (65%). Thirty patients (36.1%) had haemoglobin S, among them 22 had a major sickle cell disease. Staphylococcus aureus was present in the majority of the cases (more than 50%). Salmonella were observed among patients carrying haemoglobin S. One case of ceftriaxone-resistance salmonella osteomyelitis was reported. The medico-surgical and orthopaedic treatment was statistically more favourable than a medical or medico-surgical treatment without immobilization.

[Haematological parameters evolution during the antiretroviral therapy of HIV infected patients in Burkina-Faso]. / Evolution des paramètres hématologiques au cours du traitement antirétroviral chez les patients infectés par le VIH au Burkina Faso.

Haematological anomalies are frequent during HIV infection, and can be the fact of virus and or bone marrow toxicity of antiretroviral drugs. In order to analyze the evolution of the haematological parameters during HAART this work was carried out in the internal medicine department of the national teaching hospital Yalgado-Ouédraogo in Ouagadougou. So 107 patients receiving for the first time HAART and followed regularly were retained. The immunological efficacy at the end of the first six months was 60, 75% with an average gain of 119 CD4/mm3. The haematological changes at the end of these first six months showed: --an anaemia in 51.4% of the cases at month 6 versus 80.3% at baseline (p=0.0001). The average rate of haemoglobin was 11.8 versus 11.2 g/dl at baseline in the AZT containing HAART regimen (p=0.014) and 12.2 versus 10.7 g/dl at baseline in the group without AZT (p=0.00006). --a neutropenia in 35.5% of the cases at month 6 versus 31.7% at baseline (p=0.6). The average rate of neutrophil was 1908/mm3 versus 2267.1/mm3 at baseline in the AZT containing HAART regimen and 2150.7/mm3 versus 2001.9/mm3 at baseline in the group without AZT These results show that the therapeutic efficacy measured on the immunological answer is accompanied by a reduction of haematological anomalies. They also suggest the necessity to evaluate the cotrimoxazole impact before deciding the interruption of AZT.