[Sexual and reproductive health of adolescents living with HIV in pediatric care programs in Abidjan : Structured provision of care and perceptions of health care workers in 2019]. / Santé sexuelle et reproductive des adolescent(e)s vivant avec le VIH dans les programmes de prise en charge pédiatrique à Abidjan : offre de services des structures et perceptions des professionnels de santé en 2019.

INTRODUCTION: The majority of adolescents living with HIV (ALHIV) reside in sub-Saharan Africa, with sexual and reproductive health (SRH) needs to be met. The health care facilities and professionals involved have a major role to assume in the quality of SRH services offered to these teenagers. OBJECTIVE: To investigate the SRH services offered to ALHIV subjects in pediatric facilities in Abidjan, Ivory-Coast. METHODS: In 2019 we conducted an exploratory cross-sectional study using qualitative and quantitative methods in three pediatric facilities caring for ALHIV subjects (CIRBA, CTAP and CePReF) and participating in the IeDEA (International epidemiologic databases to Evaluate AIDS project) in Abidjan, Ivory Coast. This study included: (1) an inventory of SRH services, using a questionnaire and direct observation, describing their adaptation to the teenagers' needs and their inclusion in provision of care; (2 an assessment by means of semi-structured interviews of 14 health professionals' perceptions of the SRH needs of the ALHIV subjects with whom they worked. Quantitative data were expressed in percentages and qualitative data from the interviews were analyzed through inductive thematic analysis. RESULTS: The care provided in the three facilities was poorly adapted to the teenagers' needs. Few SRH services were effectively provided to the ALHIV subjects in the different centers. The services essentially consisted in condom distribution and organization of SRH-based focus groups. Exceptionally, hormonal contraception was offered to teenage girls. Barriers to the services were largely due to poorly equipped facilities, particularly in terms of SRH offer, health professionals' experience, and support provided for ALHIV subjects and their parents. The health professionals were desirous of SRH skill-building programs enabling them to deliver optimal, adequately contextualized SRH services to the teenagers. CONCLUSIONS: In pediatric programs addressed to ALHIV subjects in three Abidjan facilities, the teenagers' SRH needs remain unmet. It is urgently necessary to strengthen the health facilities by means of improved equipment, enhanced awareness of teenagers' needs, and training programs enabling the health professionals to provide more adapted sexual and reproductive health services.

[Management of breast cancer in Abidjan: A single center experience]. / Expérience africaine monocentrique de la prise en charge personnalisée des cancers du sein à Abidjan : défis et perspectives.

AIM: To present the results of the personalized care of Ivorian women suffering from breast cancer since the advent of immunohistochemistry in Côte d'Ivoire. METHODS: We carried out a single-center retrospective study at the Yopougon university hospital from January 2014 to December 2018. All women's breast cancer with complementary immunohistochemistry and treated at the Yopougon hospital center were selected. Standard descriptive statistical tests were used to describe patient and tumor characteristics, and univariate and multivariate analyzes were performed with a statistical significance set at a P-value of 0.05 using SPSS version 20.0. RESULTS: The mean age of women is 48.27 years, SD (11.92). 50.88 % of the tumors were hormone-dependent. The triple negative subgroup was the most represented (43.28 %) followed by luminal A (35.42 %). Conservative treatment represented 18.51 % of cases. In the univariate analysis, the risk of developing a hormone-dependent cancer is statistically significant respectively in women with an education level removed OR=1.98 (P˂0.015) and with a wealthy salary OR=1.85 (P˂0.009). On the other hand, the high level of education (OR=0.44; P˂0.005), and the well-off salary condition (OR=0.59; P˂0.024) would be protective factors for the development of triple negative breast cancer. All these factors are not significant in multivariate analysis, whether for hormone-dependent or triple negative tumors. CONCLUSION: The personalized care of breast cancer in our African context remains difficult and must take into account several medical and extra-medical parameters.

[Recurrences of precancerous lesions after conservative treatment: Operational results after a decade in Abidjan]. / Récidives des lésions précancéreuses après traitement conservateur : résultats opérationnels après une décennie à Abidjan.

OBJECTIVES: There remains a significant risk of recurrence of intraepithelial neoplasia regardless of the type of conservative treatment. The aim's work is to assess this rate. METHODS: All women's consenting who had received conservative treatment at the sites identified since for more than 12 months were included in this multicenter cross-sectional study. The outcome measure was a recurrence of precancerous lesions of the cervix during visual inspection with acetic acid performed by a single practitioner to limit interobserver variability. Data collection and analysis were done on the Stata 13 software. We performed an univariate then multivariate analysis with logistic regression. RESULTS: Two hundred and seventy-nine participated in this study with an average age of 37.44 (σ=7.31 years). A total of 52.33% were HIV positive. Moreover, 63.44% were treated by cryotherapy versus 36.66% by loop electrosurgical excision procedure. The overall prevalence of recurrences was 8.96%. Multivariate analysis with logistic regression concluded that the risk of recurrence was 5.72 times (OR=1.69-19.29; P=0.005) higher with cryotherapy and 2.85 times higher (OR=1.04-7.82; P=0.042) in women with HIV. CONCLUSION: The risk of recurrence is proportionally high with cryotherapy and HIV status. This suggests that an adaptation of the strict monitoring protocols to our African context due to the lack of cytocolposcopic logistical resources.

Prévention de la maladie thrombo-embolique et veineuse. Connaissances et attitudes pratiques du personnel soignant des services de gynécologie-obstétrique des centres hospitaliers universitaires de Côte d'Ivoire

Introduction : L'étude épidémiologique transversale ENDORSE montrait une forte prévalence 52% des patients hospitalisés présentant un risque de MTEV dans le monde dont 64% de patients en chirurgie. Ce risque est encore plus élevé pendant la période obstétricale. Objectif : Evaluer les connaissances et attitudes pratiques sur la prévention de la maladie thrombo-embolique du personnel des services de gynécologie-obstétriques de Côte d'Ivoire. Méthodes : Etude multicentrique, mixte, transversale descriptive avec 198 questionnaires anonymes correctement remplis retenus soit 61,9% et un taux de non-réponses élevé de 19% dans les CHU de Côte d'Ivoire destinés au Personnel soignant des structures concernées ayant donné leur consentement libre et éclairé sur une période de 4 mois allant du 1er avril au 31 juillet 2016. La collecte et le traitement des données a été réalisée grâce aux logiciels Epidata et Epi Info 7.Résultats : L'âge moyen était de 39,3 ans avec des extrêmes de 27 et 60 ans et 58,6% du personnel avait moins de 5 années d'activités dans le service. Il s'agissait en majorité des sages-femmes (60,1%) suivi du personnel médical (39,9%). Soixante et onze virgule quatre pour cent (71,4%) jugeaient leur niveau de connaissances suffisant. Les facteurs de risques les plus cités par le personnel médical et paramédical étaient l'immobilisation prolongée (92,4% et 82,4%) suivie de la chirurgie pelvienne (89,9% et 64,7%) et de la contraception orale (86,1% et 51,3%). Trente-huit pour cent des médecins instauraient une héparinothérapie après un accouchement par voie basse contre 95% pour un accouchement par césarienne. Quatre-vingt-six virgule sept pour cent (86,7%) des médecins débutaient l'héparinothérapie préventive entre 12 et 24 heures du post-partum quel que soit le mode d'accouchement, pendant au moins 3 semaines pour 78% d'entre eux.Conclusion : Cette étude montre une connaissance et des attitudes pratiques approximatives d'où la nécessité d'une formation continue du personnel et l'éducation des patients afin d'assurer l'amélioration continue de la qualité des soins

Intégration de la colposcopie comme méthode de dépistage des lésions précancéreuses et cancéreuses dans le paquet minimum d'activités dans une maternité niveau 3 sur une série de 569 cas. Exemple du CHU de Yopougon - Abidjan

Contexte : Les techniques de dépistage des lésions précancéreuses les plus efficaces et rentables dans les pays africains comprennent les inspections visuelles à l'aide de tests d'acide acétique et lugol tels que recommandés par l'OMS car peu coûteuses, indolores, simples à réaliser, reproductibles, socialement et culturellement acceptables, sans effets secondaires avec des résultats immédiats.Objectifs : Déterminer le taux de participation des femmes et ses déterminants, la prévalence des lésions précancéreuses et leur prise en charge. Patientes et méthodes : De janvier 2011 à décembre 2013, 569 femmes volontaires âgées de 18 à 65 ans, ayant eu une activité sexuelle ou non, porteuse ou non d'une grossesse de moins de 15 semaines d'aménorrhée, après un passage en consultation ou aux urgences pendant lesquelles, un dépistage par la méthode visuelle a été proposé ont été incluses. La colposcopie a eu lieu au service de Gynécologie-Obstétrique du Centre Hospitalier Universitaire de Yopougon Abidjan. Les prélèvements biopsiques étaient acheminés au laboratoire d'anatomie pathologie du Centre Hospitalier Universitaire de Treichville Abidjan. Les données ont été recueillies et analysées en utilisant le logiciel Epi info version 3.4.5.Résultats : Le taux de participation des femmes était en général de 6,03%. L'âge moyen de la population était de 40,3 ans IC1-α [36,2-44,4]. La moitié de la population (52,4%) n'avait pas de revenus fixes, et 36,9% d'entre elles étaient non-instruites. 74,2% des femmes habitaient la commune et étaient situées dans un rayon de 10 km. 20,2% des patientes étaient ménopausées. Les lésions acidophiles et iodo-négatives étaient respectivement de 8 et 10%. La prévalence des lésions précancéreuses et cancéreuses à la colposcopie était de 9,3% des cas. Les néoplasies intra épithéliales (CIN) CIN 1 représentaient près de la moitié des cas prélevés (44,8%) quand les CIN 2 et + totalisaient 20,7%. Soixante-huit virgule neuf pour cent (68,9%) des transformations atypiques (TAG) avaient des néoplasies intra-épithéliales de tout grade confirmées histologiquement. L'hystérectomie simple et l'électro-conisation ont été effectué respectivement chez 5,7 et 11,3% des femmes toutes CIN 2 et +. La cryothérapie avait été faite chez les femmes jeunes avec une CIN 1 soit 24,5%. Conclusion : Intégrée dans le paquet minimum des activités des centres hospitaliers, la colposcopie pourrait contribuer à la réduction de l'incidence et la mortalité liée au cancer du col de l'utérus dans nos pays

[Acquired caustic vagina stenosis: Surgical outcomes of 21 cases]. / Rétrécissements du vagin d'origine caustique. À propos de 21 plasties.

OBJECTIVE: To document epidemiology, causes, anatomical varieties and surgical management outcomes of caustic acquired vagina stenosis. METHODOLOGY: Retrospective study of 21 patients involved from 1996 to 2012 at the department of obstetrics and gynecology of Yopougon's teaching hospital in Abidjan, Côte d'Ivoire. Vaginal stenosis due to genital malformation, vaginal irradiation of pelvic tumours, repair of bladder and vaginal fistulae or intersexual disorders were excluded. RESULTS: The prevalence was 0.14/1000 admissions, mean age was 32.1 years, mean gravidity was 1.76 and mean parity was 1.1. Vaginal stenosis seat and extent were variable and 100 % had a caustic origin by use of traditional medicine vaginal pessaire. Of the patients, 95.2 % underwent surgical treatment followed by several dilations sessions with glass dilators. Successful surgical outcome allowing coitus was achieved in 47.6 % of cases with 52.4 % failure. CONCLUSION: Acquired caustic vagina stenosis are frequently occurring and are a public health problem related to ignorance. Health education and establishment of expert centers with exchange of experiences in West Africa should be able to improve surgical outcomes.

[Interest of multidetector CT virtual hysterosalpingography in the diagnosis of utero-peritoneal fistulas about 4 cases]. / Intérêt de l'hystéroscanner dans le diagnostic de la fistule utéro-péritonéale à propos de 4 cas.

We report four cases of uterine fistula found with the multidetector CT virtual hysterosalpingography. Patients were received for suspicious of a utero-peritoneal fistula at hysterosalpingography. They were young people at childbearing age (average age of 33 years), multigravidae, two of whom were nulliparous, one primiparous and one multiparous. We noted a history of voluntary interruption of pregnancy by curettage and a cesarean section. For the opacification, we used the classic hysterography standard equipment by means of 1/5 diluted iodine with saline solution as contrast. The multidetector CT virtual hysterosalpingography revealed small uterine perforations including three which were located in uterine posterior face at cervico-isthmic area and corporeal area, bringing about a utero-peritoneal fistula. The multidetector CT virtual hysterosalpingography is a simple and powerful technique for the diagnosis of utero-peritoneal fistula. It is convenient and then deserves an important place in the evaluation of uterine fistula.

Profil genomique tumoral d'une patiente atteinte d'un cancer du sein triple negatif : interet therapeutique

La biologie moleculaire est aujourd'hui un atout majeur pour la prise en charge adequate de cancer. Le profil genomique tumoral ou sequencage genomique des tumeurs est un test qui permet de dresser l'inventaire des genes d'une tumeur dont l'analyse conduit a identifier les cibles therapeutiques. Leur association avec les donnees cliniques; permet d'etablir un traitement personnalise. Ce procede constitue un recours precieux devant une tumeur multi-resistante aux traitements conventionnels. C'est cette derniere situation que les auteurs ont decidee de presenter; devant un cancer du sein triple negatif; resistant a plusieurs de lignes de chimiotherapie conventionnelle. L'evolution a change apres la realisation du profil genomique et l'ajustement du traitement

Cervical human papillomavirus and HIV infection in women of child-bearing age in Abidjan, Côte d'Ivoire, 2010.

BACKGROUND: We sought to document the association of Human immunodeficiency Virus (HIV) infection and immunodeficiency with oncogenic Human Papillomavirus (HPV) infection in women with no cervical neoplastic lesions identified through a cervical cancer screening programme in Côte d'Ivoire. METHODS: A consecutive sample of women stratified on their HIV status and attending the national blood donor clinic or the closest HIV clinic was recruited during a cervical cancer screening programme based on the visual inspection. Diagnosis of HPV infection and genotype identification were based on the Linear Array; HPV test. RESULTS: A total of 445 (254 HIV-positive and 191 HIV-negative) women were included. The prevalence of oncogenic HPV infection was 53.9% (95% confidence interval (CI) 47.9-59.9) in HIV-positive women and 33.7% (95% CI 27.1-40.3) in HIV-negative women (odds ratio (OR)=2.3 (95% CI 1.5-3.3)). In multivariate analysis, HIV-positive women with a CD4 count <200 cells mm(3) or between 200 and 499 cells mm(3) were more likely to harbour an oncogenic HPV compared with women with a CD4 count ≥500 cells mm(3) with OR of 2.8 (95% CI 1.1-8.1) and 1.7 (95% CI 1.0-2.9), respectively. CONCLUSION: A high prevalence of oncogenic HPV was found in women with no cervical neoplastic lesions, especially in HIV-positive women. Despite antiretroviral use, immunodeficiency was a main determinant of the presence of oncogenic HPV.

[Contralateral breast outcome after breast reconstruction for carcinoma]. / Devenir du sein controlatéral après reconstruction mammaire pour carcinome.

UNLABELLED: OBJECTIF: Since the treatment of breast cancer must be followed by a rigorous surveillance of the contralateral breast, especially in breast reconstruction context, we sought to determine contralateral breast cancer frequency after breast reconstruction during the ulterior surveillance. PATIENTS AND METHODS: Retrospective cohort survey of 273 breast reconstructions led at Tours regional and university hospital. Cumulative incidence of sequential contralateral breast cancer has been evaluated. RESULTS: For 6.6 follow-up, the prevalence was 1.8% and cumulated incidence at 4.6 ‰ person/years. DISCUSSION AND CONCLUSION: The probability of localization to contralateral breast after a primitive tumor of the breast is raised. The diagnosis of a sequential cancer must not be delayed by mammaplasty scars overhauls.

[Septo-optic dysplasia (De Morsier's syndrome). About one case discovered during the pregnancy]. / Découverte anténatale d'une dysplasie septo-optique (syndrome de De Morsier).

The authors report a case of septo-optic dysplasia discovered during the pregnancy without another abnormality. It's a rare cerebral abnormality that is characterized by an absence of septum pellucidum associated to a hypoplasia of ways and optic chiasm to variable degrees. Discovery is often made for adulthood. Future is extremely wide. It is determined with the arisen to different degrees of incapacity of Pituitary gland, psychomotor delay of variable intensity with mental deficiency, a visual confusion, and a confusion of the regulation of the temperature.

[Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa]. / Ligature des artères iliaques internes face aux hémorragies obstétricales graves en milieu africain.

OBJECTIVES: Assess the efficiency of internal iliac arteries ligation in intractable obstetrical hemorrhage and ascertain success or failure factors. PATIENTS AND METHODS: It was a retrospective study which concerned 159 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from March 1992 to February 2007. Arrest of hemorrhage after ligation with survival of the patient was considered as successful; was considered as failure, persistence of hemorrhage in spite of the ligation or patient death. RESULTS: Internal iliac arteries ligation allowed hemorrhage control in 84.3% of cases. Main etiology of hemorrhage were: uterine atony (42.8%), abruptio placentae (31.4%). Coagulation disorders and hypovolemic shock, consequences of long delay of management were identified as bad prognosis factors. Blood transfusion was also singled out as a factor likely to ameliorate prognosis, especially in hemodynamic precarious situations. Surgical complications incidence was 1.89%, represented by two internal iliac vein lesions and one ureteral section successfully repaired. DISCUSSION AND CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. The outcome is better when it is performed precociously (p=0.0000003) before the happening of disseminated intra vascular coagulation (p=0.006), hemodynamic troubles (p=0.0099) and acute severe anemia (p=0.02). It is a good alternative to arterial embolization in Africa.

[Systematic controlled placenta birth: analysis of 200 cases recruited at the general hospital of Abobo (Abidjan, Côte d'Ivoire)]. / La délivrance dirigée systématique: analyse d'une série de 200 cas recrutés a l'hôpital général d'Abobo (Abidjan, Côte d'Ivoire).

Haemorrhage of placenta birth is one of the main reasons of maternal mortality in developing countries. The control of this third stage of delivery remains one of the means to stem the scourge. This survey shows that controlled placenta birth is a safe mean to reach this objective: 200 women who had normal vaginal deliveries at the Abobo North hospital were included in the survey. Among them, one hundred women had a controlled placenta birth whereas 100 had a normal one. The analysis of the results showed that: the haemorrhage rates during placenta birth slightly decrease in the group with controlled placenta birth and are clearly lower in the group of patients with risks factors of haemorrhage in 10% of the cases; the delay of placenta birth is twice shorter in the group having a controlled placenta birth than in the group with normal placenta birth; blood loss in the group with controlled placenta birth is three times less important than in the other group. This study speaks in favour of a systematic controlled placenta birth during the third stage of labour as it is already performed elsewhere.

[Risk factors of post-operative complications in early hospital releases: case of the Yopougon and Treichville teaching hospitals]. / Facteurs de risque de complications post-opératoires dans les sorties précoces: cas des CHU de Yopougon et Treichville.

A multicentric and prospective survey has been carried out in simple blind from August 1998 to May 2000 at Yopougon and Treichville Teaching Hospitals on 185 patients having undergone an emergency or sheduled surgical intervention for a non septic gynaecological affection. Ninety five patients were discharged early just after bowel motion, and ninety others left seven days after the surgical intervention. The authors compared the complications observed in the two modes of discharge and showed that there is no meaningful difference between their respective frequencies. In a more general way it has not been identified particular risk factors of post-operative complications.

[Health behaviour of women attending child health clinics in health centers at Abidjan, Ivory Coast]. / Comportements de santé des femmes consultant en protection maternelle et infantile dans lese formations sanitaires d'Abidjan, Côte d'Ivoire.

OBJECTIVE: To describe the health behaviour of women attending child health clinics in four health centres (HC) in the Yopougon and Abobo districts of Abidjan, Côte d'Ivoire, in March 2000. PATIENTS AND METHODS: Cross-sectional survey among women who came for infant consultations in the HC. Anonymous questionnaires filled in through interviews by social workers about the last pregnancy, delivery, and family planning (FP). RESULTS: Two hundred and forty-six women were interviewed in 1 month. The age (median: 25 years) and parity (median: two liveborn children) were comparable in the four HCs. A median of four prenatal consultations had been performed during the last pregnancy. The search of albumin and sugar in urine had been performed in >90% of women, like tetanus toxoid immunisation, anti-malaria and anti-anaemia prophylaxis. Blood group was checked in half of the women, syphilis infection status and haemoglobin level in less than one third. According to the HC, 3-23% of the women delivered at home. If delivery occurred in a HC, median duration between admission and delivery was 116 min while median stay at the HC after delivery was 11 h. Only 14% of the women had attended at least one post-partum consultation and 8.5% a FP consultation. CONCLUSION: Our observations have shown a relatively good management of pregnancy in these HC of Abidjan and some failures regarding delivery, post-partum follow-up and infant feeding.