Prise en charge des hémopathies malignes au centre national d'oncologie médicale et de radiothérapie Alassane Ouattara d'Abidjan / Managem ent of hem atologic neoplasm sat the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara ofAbidjan

Introduction. Les hémopathies malignes sont des proliférations anormales et anarchiques de cellules hématopoïétiques à point de départ médullaire ou périphérique. Notre étude qui avait pour objectif de faire le bilan de la prise en charge des hémopathies malignes au Centre national d'oncologie médical et de radiothérapie Alassane Ouattara. Méthodes. Il s'agissait d'une étude rétrospective descriptive d'une durée de 2 ans 3 mois allant du 1er janvier 2018 au 31 Mars 2020 portant sur 80 dossiers de malades porteurs d'hémopathies malignes et prise en charge dans le centre. Résultats. Notre étude a permis de recenser 2,2% d'hémopathies malignes sur les 3650 cas de pathologies cancéreuses recensées au CNRAO, soit une incidence 26,66 cas/an avec un sex-ratio 1,2. Les syndromes lymphoprolifératifs (SLP) sont les plus fréquents (96,25 %), sous trois principales formes: lymphomes malins non hodgkiniens (LMNH) non Burkitt (51,25%), leucémie myéloïde chronique (20%) et le myélome multiple (16,25%). Les LMNH représentent 51,25% des HM recensées avec 41,46 % de lymphomes de haut grade de malignité. La chimiothérapie était de mise chez tous nos patients. Ainsi sur 41 cas de LMNH, seulement 12 (29,27%) ont bénéficié du protocole R-CHOP. On notait 46,34% de réponse complète. Dans notre étude, le LH représentait 8,75% il était traité à 71,43% avec le protocole ABVD avec une réponse complète chez 6 patients. 37,5% des patients porteurs de leucémie myéloïde chronique ont reçu le Rituximab; ils ont été traités par les protocoles COP (31,25%), CHOP (31,25%), RCVP (12,5%) et R-CHOP (25%). La réponse thérapeutique était complète à 68,75%. Le protocole utilisé dans le traitement du myélome multiple a été le VMCD-REV à 76,92% avec pour réponse thérapeutique complète chez 6 patients, 3 réponses partielles et 4 en cours de traitement. Conclusion. Les SLP qui sont les plus fréquents des HM avec trois principales formes: LMNH non Burkitt, leucémie myéloïde chronique et myélome multiple. Nous avons cependant des difficultés quant à la mise en route de la chimiothérapie.

Introduction. Hematologic neoplasms are abnormal and anarchic proliferations of hematopoietic cells with a medullary or peripheral starting point. Our study aimed to report the management of hematological malignancies at the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara (CNRAO). Methods. This was a descriptive retrospective study lasting 2 years 3 months from January 1st, 2018 to March 31st, 2020 concerning 80 patients with hematologic neoplasms who were managed in the CNRAO. Results. Hematologic neoplasms represented 2.2% of cancers (80/3650) at CNRAO, giving an annual incidence of 26.66 cases. The sex ratio was 1.2. Lymphoproliferative syndromes were the most common subgroups (96.25%). These were mainly non-Burkitt non Hodgkin lymphoma (51.25%), high grade lymphomas (41.46%), chronic lymphocytic lymphoma (20%) and multiple myeloma (16.25%). Chemotherapy was administered to all patients. Among 41 cases of non-Hodgkin lymphoma, 12 (29.27%) benefited from the R-CHOP protocol and full response was observed in 46.34% of them. We found 7 patients with Hodgkin lymphoma (8.75%) and the ABVD protocol was used for 6 cases (71.43%). Six out of these seven patients were in complete response. Among the 16 patients with chronic lymphocytic leukemia, 6 (37.5%) received Rituximab. The distribution of the patients with chronic lymphocytic leukemia was as follows: COP 31.25%, CHOP 31.25%, RCVP 12.5% and R-CHOP 25% and 68.75% had full response. The most common treatment protocol for multiple myeloma was VMCD-REV (76.92%). Six patients had complete response, 3 had partial response and 4 were in the course of treatment. Conclusion. In our practice, hematologic neoplasms are mainly lymphoproliferative syndromes and the most common varieties are non-Burkitt non Hodgkin lymphoma, high grade lymphomas, chronic lymphocytic lymphoma and multiple myeloma. We have difficulties in getting chemotherapy started.

Liver regeneration following repeated reversible portal vein embolization in an experimental model.

BACKGROUND: Portal vein embolization (PVE) is used routinely to prevent postoperative liver failure as a result of anticipated insufficient future liver remnant volume following resection. The authors have recently developed a technique for temporary PVE. The aim of this study was to assess the effect of repeated reversible PVE on hepatocyte proliferation and subsequent liver hypertrophy in rodents. METHODS: Four treatments were compared (n = 21 rats per group): single reversible PVE, two PVEs separated by 14 days, partial portal vein ligation or sham procedure. The feasibility and tolerance of the procedure were assessed. Volumetric imaging by CT was used to estimate the evolution of liver volumes. After death, the weight of liver lobes was measured and hepatocyte proliferation evaluated by immunostaining. RESULTS: Embolization of portal branches corresponding to 70 per cent of total portal flow was performed successfully in all animals. Repeated PVE induced additional hepatocyte proliferation. Repeated embolization resulted in superior hepatocyte proliferation in the non-occluded segments compared with portal vein ligation (31·1 versus 22·2 per cent; P = 0·003). The non-occluded to total liver volume ratio was higher in the repeated PVE group than in the single PVE and sham groups (P = 0·050 and P = 0·001 respectively). CONCLUSION: Repeated reversible PVE successfully induced additional hepatocyte proliferation and subsequent liver hypertrophy. Surgical relevance Portal vein embolization (PVE) is used routinely to prevent postoperative liver failure as a result of anticipated insufficient future liver remnant volume following resection. In the present study, a technique of repeated temporary PVE was developed in a rat model; this induced additional hepatocyte proliferation and an increase in liver volume compared with single embolization. This novel approach might help induce major hypertrophy of the future remnant liver, which could increase the rate of patients amenable to major liver resections.

Congruent phylogeographical patterns of eight tree species in Atlantic Central Africa provide insights into the past dynamics of forest cover.

Cycles of Quaternary climatic change are assumed to be major drivers of African rainforest dynamics and evolution. However, most hypotheses on past vegetation dynamics relied on palaeobotanical records, an approach lacking spatial resolution, and on current patterns of species diversity and endemism, an approach confounding history and environmental determinism. In this context, a comparative phylogeographical study of rainforest species represents a complementary approach because Pleistocene climatic fluctuations may have left interpretable signatures in the patterns of genetic diversity within species. Using 1274 plastid DNA sequences from eight tree species (Afrostyrax kamerunensis, A. lepidophyllus, Erythrophleum suaveolens, Greenwayodendron suaveolens, Milicia excelsa, Santiria trimera, Scorodophloeus zenkeri and Symphonia globulifera) sampled in 50 populations of Atlantic Central Africa (ACA), we averaged divergence across species to produce the first map of the region synthesizing genetic distinctiveness and standardized divergence within and among localities. Significant congruence in divergence was detected mostly among five of the eight species and was stronger in the northern ACA. This pattern is compatible with a scenario of past forest fragmentation and recolonization whereby forests from eastern Cameroon and northeastern Gabon would have been more affected by past climatic change than those of western Cameroon (where one or more refugia would have occurred). By contrast, southern ACA (Gabon) displayed low congruence among species that may reflect less drastic past forest fragmentation or a more complex history of vegetation changes. Finally, we also highlight the potential impact of current environmental barriers on spatial genetic structures.

[Managing pain in children with cancer in Africa: a survey from the French-African Pediatric Oncology group]. / Prise en charge de la douleur de l'enfant atteint de cancer en Afrique : état des lieux au sein du Groupe franco-africain d'oncologie pédiatrique.

INTRODUCTION: The French-African Pediatric Oncology group (GFAOP) has contributed to a significant improvement in the prognosis of pediatric cancers in Africa through the development of therapeutic protocols adapted to local conditions. In parallel, the development of supportive care such as pain management, is now a major priority of our group. OBJECTIVE: The main objective of this study was to evaluate the management of pain in children with cancer in sub-Saharan Africa. METHODOLOGY: A questionnaire was sent to both the doctor and nurse responsible for each of the 8 pilot units (PUs). RESULTS: All physicians and 2 nurses answered the questionnaire. Human resources (3 doctors and 4 nurses per PU) were modest compared to the size of the pediatric population (71 million) and the mean number of 102 cases of cancer/year per PU. Only six physicians had received specific training in pediatric oncology. Morphine was available in only 5 of the 8 PUs; major limitations for its prescription were mainly inconsistent availability (62.5%), fear of side effects (50%), and regulations (37.5%). During the curative phase, more than half of the parents had to buy analgesics when leaving the PU. Pain assessment relied mainly on clinical evaluation (8/8), but was generally concordant with parents' assessment. The majority of patients experienced pain at diagnosis and at a higher degree at relapse, cancer being the predominant etiology. Pain related to other causes such as medical procedures, mucositis, and neuropathic pain was detected; however, its management remained inadequate. Only 2 of 8 PUs had a written protocol for pain management. These deficiencies can be explained by limited resources, both human and financial, but also by cultural factors such as endurance against pain still advocated by many African traditions. CONCLUSION: In recent years, pain prevention and relief, whatever its origin, have become a priority for all medical teams, especially for children with cancer. With its profound sociocultural changes, Africa is no exception. All teams in our group are aware of the situation and hope for major improvement in pain management in the near future through increased resources and training.

[Prevalence of ketotic hypoglycaemia among schoolchildren in the village of Ahoué in Côte-d'Ivoire]. / Prévalence de l'hypoglycémie cétosique chez les enfants d'âge scolaire dans le village d'Ahoué en Côte-d'Ivoire.

To determine the prevalence of ketotic hypoglycemia among schoolchildren, a descriptive cross-sectional study was conducted in preschools and schools in rural areas that involved 102 schoolchildren, from 4 to 7 years old, comprised 51 girls and 51 boys. Index WHZ was used to evaluate the children's nutritional status. The sampling was obtained by a drop of capillary blood in the pulp of the finger. The determination of glucose was realized by glucose oxidase method using an ultra sensitive and fast (One Touch Ultra) glucometer, and ketonuria was detected by dipstick "Ketodiastix." The clinical results revealed that most of children had a normal birth weight with an average of 2.885 g, a good Apgar's score superior to 7, and then the nutritional index WHZ revealed 3% of severe malnutrition and 34% of moderate malnutrition. Ten children (9.8%) had a hypoglycemia with a median of 0.51 g/l and extreme values going from 0.42 to 0.59 g/l. Seven children had a hypoglycemia associated with ketonuria. The prevalence of ketotic hypoglycemia was 7% in this study, and more frequent in the children between 4 and 5 years with 57% of cases in this age group. Thus, this condition, found in Western countries is a reality in Côte d'Ivoire, where the diathesis of malnutrition (37% of the population of the study) is a favorable factor. Therefore, it is useful to prevent protein-energy malnutrition by a balanced food by avoiding fasting before school by diet management.

[Gallstone biochemical characteristics using Fourier transform infrared spectroscopy method]. / Caractéristiques biochimiques des lithiases vésiculaires par spectrométrie infrarouge à Abidjan.

This study reports biochemical composition and morphological aspect of gallstones as investigated by spectroscopy IR method. Participants were 24 patients composed of 12 males and 12 females who underwent cholecystectomy with age mean of 44.8 years. The gallstones were classified either as pigments stones (n = 12), cholesterol stones (n = 8) or as mixed stones (n = 4) according to analysis by Fourier transform infrared spectroscopy. The infrared spectroscopy quantification reported eight stones contained 100% of cholesterol, eight of 100% of calcium bilirubinate, four stones were composed of 65% calcium bilirubinate phosphate and 35% calcium carbonate, and four stones contained 65% cholesterol, 30% neutral calcium bilirubinate, 5% protein and traces of calcium bilirubinate acid. Our findings showed that most gallstones were composed of pigment stones with relative large proportion of cholesterol stones, whereas previous study in Caucasian reported predominance of cholesterol stones. These findings indicate the influence of diet and chronic haemolysis in the stones formation in regard to biochemical composition differences between those found in European area and our results. Therefore, Fourier transform infrared spectroscopy method allowed to determine quality and quantity of biochemical components of gallstones. Therefore, a careful survey must allow knowing the nutritional and environmental factors in the occurrence of gallstones to Côte d'Ivoire, in order to prevent this disease.

[Evaluation of the protocol CMA reinforced in the treatment of endemic Burkitt lymphoma at CHU of Yopougon in Abidjan]. / Evaluation du protocole CMA renforcé dans le traitement du lymphome de Burkitt endémique au CHU de Yopougon à Abidjan.

We report the results of the protocol CMA (cyclophosphamide, methotrexate, Aracytine) reinforced of 26 patients affected by Burkitt lymphoma in facial-maxillary localisation, in a retrospective study from January 2000 till December 2007 and prospective from January till September 2008. Their average age was 7.89 years, with a sex ratio of 2.71. The global response to the treatment was 92.3% with 57.7% of complete remission and 34.6% of incomplete remission. The morbidity related to treatment was essentially a haematological complication (84.6%) and hydroelectrolytic complication (84.6%). Evolution was made towards death in 30.8 and 15.4% were lost of view. The median monitoring was 18.2 months. Treatment response was linked to the therapeutic compliance (P < 0.001), and the delay of consultation (P = 0.01).

[Interest of antioxidants in the care of the patients infected by the HIV: the experience of long term administration of Alternanthera pungens herb tea]. / Intérêt des antioxydants dans la prise en charge des patients infectés par le VIH : apport de la consommation régulière de tisane d'Alternanthera pungens.

UNLABELLED: The objective of this study was to evaluate the interest of regular consumption of an antioxidant-containing herb tea in the care of HIV-patients. We conducted a 24 month prospective study in 30 patients clinically asymptomatic, infected by the VIH1, with a rate of CD4 above 200/mm3, and naive of any antiretroviral treatment. Every patient received a supplementation in antioxidants by drinking every two days during twelve monthsherb tea issued from Alternanthera pungens. Venous sampling of blood was used to measure biomarkers of oxidative (malondialdehyde - MDA - and advanced oxidation protein end products - AOPP), T lymphocytes, amimotransferases and creatinine. RESULTS: We observed: (1) a significant decree (p < 0,001) in plama levels of studied biomarkers of oxidative stress (AOPP and MDA); (2) a significant increase (p < 0,001) of T CD4 and CD8 lymphocytes and (3) the lack of biological hepatic and renal toxicity by the regular consumption of the herb tea. In conclusion, we showed that consumption taking of natural antioxidants through Alternanthera pungens herb tea may lead to significant increase T lymphocytes and decrease in biomarkers of oxidative stress, and might help in the prevention of the opportunist diseases by maintaining blood lymphocytes CD4/CD8 rate.

[Prognosis of post-operative digestive fistulas in Chu de Yopougon: Abidjan/Cote d'Ivoire]. / Pronostic des fistules digestives post-operatoires au Chu de Yopougon : Abidjan/Cote d'Ivoire.

OBJECTIVE: Because of the difficulties to manage the post-operative digestive fistulas (FDPO) and their disappointing results, the authors led this survey. It's objective is to identify the prognosis factors in order to optimize their management and improve their prognosis. PATIENTS AND METHOD: It is a retrospective survey during 12 years, from January 1992 to December 2004 in the general and digestive surgery adult service of CHU Yopougon. It included 86 files of patients aged of 15 years at least presenting a FDPO. RESULTS: The middle age was of 36.8 years. The death rate was 29.06%. It rose with age. The risk of death was multiplied by 5.54 over age of 55 years (OR = 5.54 and p = 0.012). The number of death rose meaningfully with the length of the diagnostic delay (p = 0.016 for OR1 = 1.64 and OR2 = 8.94. The death rate was raised more in the exposed fistulas that in the controlled fistulas (87% against 45%). In 50% of the cases the death occurred when the debit was superior or equal to 500 cc daily. Among the patients submitted to the medical treatment 69.70% had a spontaneous closing of their fistula in a middle delay of 27.18 days for extremes varying between 13 and 47 days. CONCLUSION: The affection is very serious considering it's death rate. A precocious diagnosis and a fast and adapted management should permit to reduce this higher mortality.

Leaf extract of Caesalpinia bonduc Roxb. (Caesalpiniaceae) induces an increase of contractile force in rat skeletal muscle in situ.

The pharmacological properties of Caesalpinia bonduc Roxb. (Caesalpiniaceae) are not well known, but it is used traditionally to treat snake bite (Bellomaria and Kacou, 1995; Schaffner, 1997). In the present study, the mechanism through which Caesalpinia bonduc extract (Cebo) affects gallamine-induced relaxation in rat tibial muscle contractility were studied via measurement of isometric-tension-anesthetized, 10-12-week-old, male rats. Isometric twitch contractions of the indirectly-stimulated anterior tibia muscle of the right hindleg were recorded in situ. Cebo administered intravenously (i.v.) increased twitch contractions in a dose-dependent manner. The ED50 value is 2.75 x 10(-4) g/kg body wt. Similar results were obtained using the anticholinesterase neostigmine. In contrast, gallamine (a non-depolarizing muscle relaxant) or the venom of the puff adder Bitis arietans reduced the force of contraction. Treatment with Cebo or neostigmine, however, reversed the relaxation induced by either gallamine or puff adder venom. In conclusion, Cebo stimulates the muscle contractile activity, an effect which may be due to an activation of the cholinergic mechanism.

[Sub-cutaneous location of Burkitt's lymphoma. Apropos of 1 case at Yopougon Central University Hospital, Abidjan (Côte d'Ivoire)]. / Localisation sous-cutanée du lymphome de Burkitt. A propos d'un cas au CHU de Yopougon, à Abidjan (Côte d'Ivoire).

Burkitt Lymphoma is the most frequent lymphoma of childhood in West Africa. The main localisations are facial and abdominal. In this study, the authors describe the case of a sub-cutaneous localisation of a Burkitt to a seven years old boy. He was admitted at the hospital because of an abdominal tumefaction. Nowadays such a case has seldom been published. After using cyclophosphamide, methotrexate and aracytine, all the tumefactions disappeared. This case was interesting because of the exceptional localisation of the lymphoma, which may induce a wrong diagnosis.

[Prevalence of Herpes simplex virus infection in pregnant women in Yopougon (Côte d'Ivoire)]. / Prévalence de l'infection par Herpes simplex virus chez la femme enceinte à Yopougon (Côte d'Ivoire).

A transversal survey on 150 pregnant women was carried out at the P.M.I. center in Yopougon, in order to determine the prevalence of genital herpes and to estimate the frequency of asymptomatic excreting of Herpes simplex virus (HSV) in pregnant women. The viral isolation and the direct immuno-fluorescence (IF) assay of the genital secretions were found to have a prevalence of 12.7% Among the women who tested positive (the majority of whom were from modest socio-economic origin and young), 10% had antecedents of genital herpes, 2.7% showed an asymptomatic excretion and 36.8% had an acute episode during their pregnancy including a primary infection in the 20th week. In these women an unexpected recurrence will constitute the major risk for maternal transmission and an emergence of neonatal herpes.

[Infection profile in sickle cell anemia]. / Profil infectieux chez le drépanocytaire.

Our objectives were to determine aetiology and localisation of infection in sickle cell anaemia patients. The origin of fever was malaria in 47% of cases, 50% of bacterial infections and 3% of viral infections. Respiratory infections were concerned in 61% of cases, versus 24% of osteomyelitis. Salmonella were found in 37%, Haemophilus (16%), Staphylococcus (14%), Streptococcus (10%) and Pneumococcus (9%). We found more bacterial infection in anaemic forms (SS and SFA2) and more bacterial infection anemic forms (SC, SAFA2). In view of these findings, we preconize malaria prophylaxis and vaccination against Salmonella, Haemophilus and Pneumococcus in sickle cell anemia patients.

[Post-vaccination anti-poliomyelitis seroprevalence in an urban setting in Abidjan]. / Séroprévalence antipoliomyélitique post-vaccinale en milieu urbain à Abidjan.

In order to determine the antipoliomyelitis seroprevalence of children in Abidjan, we checked the presence of antipoliovirus antibodies in 48 children received in the South Abobo's vaccination center for vaccination against measles. According to the vaccination schedule and rules applied in Côte d'Ivoire: 12.5% of the children have received less than three doses or oral polio vaccine (OPV), 87.5% have received the three doses. Antibody titration results indicated that 78.6, 93 and 76.2% of the children have been immunized against Poliovirus type I, type II and type III, respectively; 71.4% of the children showed antibodies against the three poliovirus serotypes and 4.8% had no antipoliovirus antibodies at all. The children which showed an antibodies titer less than 1/8 were considered unprotected: the proportion of unprotected was 21.4, 7 and 23.8% against Poliovirus type I, type II and type III, respectively. Although these results showed that the level of protection against poliomyelitis in Abidjan is acceptable (> 75%), the efforts for vaccination program in Côte d'Ivoire need to be improved in order to eradicate poliomyelitis.