[Hepatitis B: cross-sectional study of knowledge and immunization among students at University of Cocody, Ivory Coast]. / Connaissance et couverture vaccinale contre l'hépatite virale B (HVB) : étude transversale parmi les étudiants de l'université de Cocody, Côte d'Ivoire.

BACKGROUND: To evaluate knowledge about hepatitis B and vaccination coverage among students at Cocody's University, Ivory Coast. MATERIALS AND METHODS: A cross-sectional study was conducted during the academic year 2005-2006 (2557 students). Parameters were collected by interview using a survey chart. Factors influencing knowledge and vaccination against hepatitis B were analyzed by logistic regression. RESULTS: The majority of students (n=1174, 69.4% [95% CI 68-71]) knew about hepatitis B. Only 17.5% and 26.1% of students respectively were aware of sexual and blood transmission. None of the students were aware of maternal-fetal transmission. Factors associated with knowledge of hepatitis B were enrollment in health sciences (Odds Ratio=24.19 [95% CI 8.65-76.63]) and having a scholarship (Odds Ratio=2.34 [95% CI 1.54-3.56]). Vaccination coverage against hepatitis B was low (Odds Ratio=3.7% [95% CI 3-4]). Factors associated with vaccination were: knowledge of hepatitis B (Odds Ratio=6.83 [95% CI 4.57-10.27]), enrollment in health sciences (Odds Ratio=3.59 [95% CI 2.60-4.96]), marriage (Odds Ratio=2.04 [95% CI 1.13-3.64]) and having a scholarship (Odds Ratio=1.60 [95% CI 1.09-2.35]). CONCLUSION: Knowledge and vaccination coverage against hepatitis B among students at Cocody's University is low. Students should be given information about hepatitis B and access to free vaccination. Students enrolled in health sciences should be vaccinated before admission because of specific risks of contamination, for themselves and for their patients.

[Tolerance and Acceptability of Gastroscopy in Adults in Ivory Coast: 300 Cases]. / Tolerance et Acceptabilite de la Gastroscopie Chez L'Adulte en Cote D'Ivoire a Propos de 300 cas.

The purpose of this study was to report the real-life experience of oesophagogastroduodenoscopy (OGD) patients in order to note apprehensions and postoperative feedback. This prospective study involving 300 patients of the Cocody Teaching Hospital, was carried out over a four month period. It included 158 men and 142 women with an average age of 40 years. OGD was performed on outpatients (78%) and hospitalized patients (22%). The feelings of patients before EGD were marked by anxiety (91%) or serenity (9%). 88% of the patients received premedication versus 12% who did not. This premedication was based on midazolam in 69.31% of cases and diazepam in 30.69%. No incident or accident related to the procedure or to the premedication was reported. The tolerance of the patients regarding OGD, as reported by the patients and doctors, was good (78% vs 78% respectively), acceptable (17% vs 16.67%) or bad (5% vs 5.33%). Patients found the examination to be unpleasant (43.34%), painful (30.33%) or painless (26.33%). Doctors reported that patients' attitudes were marked by anxiety (91%) and serenity (9%). Age, sex, previous information on the examination, psychological preparation, the feelings of the patients before the examination and premedication with hypnovel or valium did not influence the tolerance of patients since the differences were not statistically significant (p>0.05). 89.33% of our patients would accept a repeat of the digestive endoscopy versus 10.67% who would not. Almost all the patients (99.33%), would recommend an OGD to another person versus only 0.67% who would not. 83.33% of patients were satisfied with the OGD versus 16.67% who were not.The OGD remains bearable with 78% of patients presenting a good tolerance despite the important number of patients (91%) who felt anxious before the examination.

Le but de cette étude était de rapporter le vécu de la FOGD par les patients afin de vérifier la véracité des appréhensions. Cette étude prospective portant sur 300 patients recensés au CHU Cocody d'Abidjan, a été réalisée sur une période de quatre mois. Elle regroupait 158 hommes et 142 femmes, d'âge moyen de 40 ans. La FOGD était réalisée chez des patients vus en ambulatoire (78%) ou hospitalisés (22%). Les sentiments des patients avant la FOGD étaient marqués par l'anxiété (91%) ou la sérénité (9%). 88% de nos patients ont reçu une prémédication versus 12% sans prémédication. Cette prémédication était à base de midazolam (69,31%) ou de diazépam (30,69%). Aucun incident ou accident lié au geste ou à la prémédication n'a été rapporté. La tolérance de la FOGD selon les patients était superposable à celle selon les médecins : bonne (78% vs 78%), acceptable (17% vs 16,67%) ou mauvaise (5% vs 5,33%). Les patients avaient trouvé l'examen désagréable (43,34%), douloureux (30,33%) ou indolore (26,33%). Les attitudes des patients selon les médecins ont été marquées par l'anxiété (91%) ou la sérénité (9%). L'âge, le sexe, les informations antérieures sur l'examen, la préparation psychologique, les sentiments des patients avant l'examen et la prémédication à l'hypnovel ou au valium n'influenceraient pas la tolérance des patients puisque les différences observées n'étaient pas statistiquement significatives (p > 0,05). 89,33% de nos patients accepteraient de refaire une endoscopie digestive versus 10,67% d'avis défavorable. La quasi-totalité de nos patients soit 99,33% recommanderaient une FOGD à une autre personne contre seulement 0,67%. 83,33% des patients étaient satisfaits de la FOGD contre 16,67% qui ne l'étaient pas.La FOGD reste tout de même supportable avec 78% des patients présentant une bonne tolérance malgré le grand nombre qui étaient anxieux avant l'examen 91%.

[Pediatric colonoscopy at the University Hospital of Cocody (Ivory Coast)]. / Coloscopie pédiatrique: expérience du centre hospitalier universitaire de Cocody (Côte d'Ivoire).

No published data are available on pediatric colonoscopy in Ivory Coast (and only one report on pediatric gastroscopy). We conducted a retrospective study of all colonoscopy reports of procedures performed from 1 September, 1991, to December 31, 2010, at the University Hospital of Cocody in Abidjan (Ivory Coast) and examined the epidemiological aspects, conditions of performance, indications, and results of colonoscopy in patients younger than 18 years. Eleven of the total of 1 159 colonoscopies were performed in in this age group (0.94%). The mean age of these 8 girls and 3 boys was 15 years (range: 10 to 17 years). All patients had been referred by a gastroenterologist. Bowel preparation was performed in all with a water enema. Premedication was performed exclusively with midazolam. A pediatric colonoscope was used. The colonoscopy was incomplete in 36% of cases (n=4). Rectal bleeding was the main indication. Results were abnormal in 72% of cases (n=8) and the lesions found were juvenile polyps, ulcerative colitis, sigmoid varices, rectocolitis due to a caustic product, and adenomatous polyps. The results of the examination were normal in 3 children. No complications were reported. In conclusion, although the pediatric colonoscopy practice at the University Hospital of Cocody in Abidjan is extremely small, its therapeutic and diagnostic yields are high, particularly in cases of rectal bleeding. Physicians (general practitioners and pediatricians) managing children should not hesitate to ask for a colonoscopy when appropriate.

[Diagnosis of hematochezia in Abidjan Cocody University Hospital (Ivory Coast)]. / Diagnostic des rectorragies au centre hospitalier universitaire de Cocody à Abidjan (Côte d'Ivoire)

AIM: To determine the prevalence of endoscopic lesions, according to age and location, in patients with rectal bleeding who underwent total colonoscopy. METHODS: Retrospective observational study examining records from the hepatogastroenterology department at the Cocody University Hospital (Abidjan) of colonoscopies for rectal examination from September 1, 1991, through August 15, 2007. The data collected and analyzed from the records included age, sex and colonoscopy results. A p value less than 0.05 was considered statistically significant. RESULTS: Of 1,158 colonoscopies, 270 (23.3%) were performed for hematochezia: 105 women (mean age: 48.8 years ± 19.9 years, range: 10-96 years) and 165 men (mean age: 46 ± 14.2, range: 21-83 years) with a sex-ratio (M/F) of 1.57. Because colorectal cancer seems to occur at a younger age in Africa, patients were divided into two groups (aged 45 years: 139 [51.5%] and above 45 years: 131 [48.5%]). The abnormalities found were consistent with anal pathologies (16.3%), polyps (10.4%), diverticular disease (11.1%), colorectal inflammatory lesions (21.5%) and carcinoma (7%). Diverticula were significantly more common in those older than 45 years and inflammatory lesions in the younger group (p < 10(-3)). More than two thirds of the significant lesions were found in the distal colon (p < 10(-3)). CONCLUSION: The predominance of distal colon lesions suggests that exploration by flexible sigmoidoscopy can be performed in patients with low to moderate risk of colorectal cancer, with total colonoscopy reserved for the population at high risk.

[Pediatric upper gastrointestinal endoscopy: experience in a hospital setting in Côte d'Ivoire]. / Endoscopie digestive haute pédiatrique: une expérience hospitalière en Côte d'Ivoire.

AIMS: The purpose of this report was to describe epidemiological aspects of endoscopic upper gastrointestinal endoscopy at a pediatric teaching hospital in Cocody, Côte d'Ivoire. MATERIALS AND METHODS: The records of all patients under 15 years of age who underwent upper gastrointestinal endoscopy in the gastrointestinal endoscopy unit of a teaching hospital of Cocody between January 1, 2000 and April 30, 2006 were reviewed. The following parameters were compiled: age, sex, indications, name of endoscopist, type of sedation, gastric biopsy to detect Helicobacter pylori, and endoscopic findings. RESULTS: Pediatric gastroscopy accounted for 1% of procedures performed in the upper gastrointestinal endoscopy unit. Patient ages ranged from 6 months to 15 years and M/F sex ratio was 0.88. The procedures were ordered by general practitioners in 55% of cases, gastroenterologists in 14%, and pediatricians in 10%. Sedation with intravenous midazolam 0.25 was used in 74% of patients (n = 38). No incident or complication was observed. Tolerance of the examination by the child was considered as poor by the operator in 96% of cases. The main indications for endoscopy were epigastralgia in 54% of cases, vomiting in 13.7%, and gastrointestinal bleeding in 13.7%. The procedure was performed or supervised by an operator with over ten years of experience in gastrointestinal endoscopy in 55.1% and 54.0% of cases respectively. The main endoscopic finding was duodenogastric bile reflux in 23.5% of cases. Gastroscopy was normal in 43% of patients. Gastric biopsy to detect Helicobacter pylori was performed in 23% of patients. CONCLUSION: Pediatric gastroscopy performed under mild sedation by experienced endoscopists is a safe procedure for detecting lesions and obtaining biopsies for histological examination.

[Chronic abdominal pain and fever in an Ivoirian woman: Mycobacterium avium-intracellulare duodenitis in an AIDS patient in Abidjan, Cote d'Ivoire]. / Douleurs abdominales chroniques et fièvre chez une ivoirienne.

Duodenal infection by Mycobacterium avium-intracellulare is a common opportunistic disease in HIV-infected patients. Individuals with CD4 counts <50 cells/mm3 are at highest risk. The main symptoms are diarrhea, abdominal pain, weight loss, and fever. Endoscopic examination shows various abnormalities including disseminated nodules that may be yellowish, whitish, or pinkish in color. Other mucosal lesions may be found such as erosion, erythema, or friable edematous aspect. Since these findings are non-specific, it is important to obtain biopsy specimens for histological and microbiological examination. The most common histologic features are atrophic mucosa resembling Whipple's disease with strongly positive PAS staining. The presence of BARR in macrophages is typical of MAI. Diagnosis is based on identification of the bacteria using either conventional culture techniques or polymerase chain reaction (PCR). Differential diagnosis includes other gastrointestinal infections associated with AIDS, i.e., microsporidiosis, cryptosporidiosis, giardiosis, anguillulosis, CMV, and isoporosis. The course of the disease is usually unfavorable even with antibiotic treatment. The purpose of this report is to describe a case of duodenitis due to atypical mycobacterial infection in a 30-year-old woman who was seropositive for human immunodeficiency virus. She was hospitalized due to fever with deterioration of her general condition (more than 10% of body weight loss) and chronic abdominal pain with inflammation. Diagnosis of MAI was confirmed by biopsy and Ziehl-Neelsen coloration. The patient was treated with rifampicine, isoniazide, ethambutol, and pyrazinamide in association with stavudine, lamuvidine and efavirenz. Despite improvement of general condition, fever persisted and the patient died after 40 days of treatment.

[Materno-fetal transmission of hepatitis B virus in Ivory Coast. Plea for mass vaccination]. / Transmission materno-foetale du virus B de l'hépatite en Côte d'Ivoire. Plaidoyer pour la vaccination de masse.

BACKGROUND: Hepatitis B is a major public health problem in the developing countries of Africa and Asia because the prevalence of HBs antigen carriers is high. In Ivory Coast, the prevalence of HBs antigen carriers is more than 8% (6 to 29%). In these countries, in which hepatitis B is highly endemic, most infections with hepatitis B virus (HBV) occur during early childhood. The chronic carriage of HBV was found to be common in children, who played a key role in maintaining the high level of endemicity in these areas. Vaccines against HBV are effective and their introduction as part of the Expanded Program of Immunization (EPI), as recommended by the WHO, is feasible. OBJECTIVE: The aim of this study was to evaluate the prevalence of HBs antigen in pregnant women and to determine the rate of maternal transmission of HBV to the fetus, to demonstrate the importance of HBs antigen screening during pregnancy and the immunization of babies in the Ivory Coast. PATIENTS AND METHODS: Between August 1995 and February 1996, 395 women in the last three months of pregnancy (age 25 +/- 6.9 years) were screened for HBs antigen. Those testing positive were also screened for HBe antigen. Transmission of HBV in utero was studied with 322 mothers and their offspring. HBs antigen was assayed in the cord blood of the offspring of HBs antigen-positive mothers. If the test for HBs antigen was positive, HBe antigen was also assayed. Second-generation ELISA tests (MONOLISA HBs Ag and MONOLISA HBe Ag from Sanofi Pasteur) were used. Babies from HBs antigen-positive mothers were vaccinated at birth with three doses of GenHevac B.

[Chronic calcifying pancreatitis in hospitals in the Ivory Coast]. / Pancréatite chronique calcifiante en milieu hospitalier en Côte d'Ivoire.

The authors report on 34 cases of chronic calcifying pancreatitis in Ivory Coast. Chronic calcifying pancreatitis is rare (0.24 P.C. of admitted patients) and appears mainly in man 40 years old, revealed by diabetes (73.5 P.C.). Principal aetiology was alcoholism, 50 P.C. Genuine tropical chronic calcifying pancreatitis exists in small number. It seems its physiopathological mechanism is not only nutritional.

[Distomatosis of the bile ducts, value of ultrasonics (apropos of a new case)]. / Distomatoses des voies biliaires, intérêt de l'échotomographie. (A propos d'un nouveau cas).

The authors report on a new case of distomatosis localized in the main biliary duct. It has been revealed by a repeated angiocholitis, diagnosed only by endoscopic retrograde cholangiopancreatography. They draw attention on the difficulties to diagnose this clinical form of distomatosis, and underline the interest of ultrasonography in the diagnosis and the selection of therapeutic means.