Overall survival and current management of breast cancer in elderly Ivoirian's women / Supervivencia general y tratamiento actual del cáncer de mama en mujeres ancianas de Costa de Marfil

Objective: To present the epidemioclinical features, the immunohistochemical profile and the overall survival rate of women over 65 with breast cancer.Materials and methods: In a retrospective study, we recruited women over 65 years old with breast cancer who were treated in the district of Abidjan. Our study took place in a period of 60 months, from 2014 until 2018. The patients were selected from several sources; namely the consultation's registers, the hospitalization's units, the operating theater and the archive files of all the above. The data were collected using a survey sheet, processed then analyzed from the Epi info7 software. The Kaplan–Méier test helped us appreciate the survival.Results: From a total of 2233 breast cancers, we got 52 patients over the age of 65, i.e. a proportion of 9.53%. These patients’ age range was between 65 and 86 years old with an average age of 72 years old. The non-specific invasive carcinoma represented the most frequent histological type with 94.23% of the cases. 1 out of 2 women (56.41%) received a neoadjuvant chemotherapy. The overall survival rate for 5 years were 9.62%. The median survival of the patients was 15.50 months. The immunohistochemical profile was determined for 21 patients and among them there was no Luminal B Her 2- and the Luminal A (43%) was the dominant profile.Conclusion: The management of elderly Ivoirian breast cancer was essentially non-surgical with a low survival. (AU)

Objetivo: Presentar las características epidemiológicas, el perfil inmunohistoquímico y la tasa de supervivencia global de mujeres mayores de 65 años con cáncer de mama.Materiales y métodosEn un estudio retrospectivo, reclutamos mujeres mayores de 65 años con cáncer de mama que fueron tratadas en el distrito de Abiyán, Costa de Marfil. Nuestro estudio se llevó a cabo en un periodo de 60 meses, desde 2014 hasta 2018. Las pacientes fueron seleccionadas de varias fuentes; a saber, los registros de consulta, las unidades de hospitalización, el quirófano y los archivos de todos los anteriores. Los datos se recopilaron mediante una hoja de encuesta, se procesaron y luego se analizaron desde el software Epi Info 7 (version 7.2.1.0). La prueba de Kaplan-Meier nos ayudó a apreciar la supervivencia.ResultadosDe un total de 2.233 cánceres de mama, obtuvimos 52 pacientes mayores de 65 años, es decir, una proporción del 9,53%. El rango de edad de estas pacientes estaba entre los 65 y los 86 años, con una edad promedio de 72 años. El carcinoma invasivo inespecífico representó el tipo histológico más frecuente, con el 94,23% de los casos. Una de cada dos mujeres (56,41%) recibió quimioterapia neoadyuvante. La tasa de supervivencia global durante cinco años fue del 9,62%. La mediana de supervivencia de las pacientes fue de 15,50 meses. Se determinó el perfil inmunohistoquímico para 21 pacientes, y entre ellas no hubo Luminal B Her2− y el Luminal A (43%) fue el perfil dominante.ConclusiónEl tratamiento del cáncer de mama de Costa de Marfil de edad avanzada fue esencialmente no quirúrgico, con una baja supervivencia. (AU)

[Opinion survey on postpartum pelvic floor rehabilitation among Ivorian practitioners]. / Enquête d'opinion des praticiens ivoiriens sur la pratique de la rééducation périnéale dans le post-partum.

INTRODUCTION: the purpose of this study was to report health care providers' experience of perineal rehabilitation in the Maternity Hospital of Abidjan by assessing their level of knowledge and their practical attitudes. METHODS: we performed a survey among obstetricians and midwives working in a Maternity Hospital in Abidjan over a period of at least two years. The information were collected using a questionnaire including direct, open and semi-open questions. RESULTS: the study included 120 practitioners, 66 midwives and 54 obstetricians. Seventy-nine point six percent of obstetricians and 37.9% of midwives worked in a university hospital. Midwifery knowledge was good or average in 25% of cases (interquartile range [IIQ] 16.8-48.3); 65% of obstetricians had a good or medium level of knowledge (IIQ 41.1 -48.3). The majority of providers summoned women in the postpartum period, but only 7 out of 10 caregivers performed perineal assessment and 2 out of 10 obstetricians suggested the need for rehabilitation. CONCLUSION: the low level of knowledge of Ivorian midwives and obstetricians regarding postpartum pelvic floor rehabilitation and the lack of practice suggest the need for ongoing training.

A rare case of important and recurrent abnormal uterine bleeding in a post partum woman caused by cavernous hemangioma: a case report and review of literature.

The cavernous hemangioma is a rare benign vascular tumor. About 50 cases of this disease were found in the literature over the last century and only 9 cases of cavernous hemangioma on the pregnant uterus were published it comes into cavernous or capillary form. The symptomatology is not unequivocal and when it occurs during pregnancy or postpartum, it causes life-threatening cataclysmic hemorrhage. Antenatal diagnosis is difficult and requires a multidisciplinary approach with pathologists, radiologists and gynecologists to avoid these complications or unnecessary hysterectomies. The diagnosis is histological. Hysterectomy is possible after failure of conservative treatment means. We report a rare case, a novel mixed cavernous hemangioma of the body associated with a capillary hemangioma of the cervix in a patient of 28 years 5th visors with recurrent genital bleeding in the postpartum period leading to a hysterectomy.

Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies.

Objective. To assess willingness to participate and diagnostic accuracy of visual inspection for early detection of cervical neoplasia among women in a health insurance company. Patients and Method. Cervical cancer screening was systematically proposed to 800 women after consecutive information and awareness sessions. The screening method was visual inspection with acetic acid (VIA) or Lugol's iodine (VILI). Results. Among the 800 identified women, 640 (82%) have accepted the screening, their mean age was 39 years, and 12.0% of them were involved in a polygamist couple. 28.2% of women had prior cervical screening. VIA has been detected positive in 5.9% of women versus 8.6% for VILI. The sensitivity was 72.9% and specificity was 95.2% for VIA versus 71.2% and 97.3% for VILI respectively. The histological examination highlighted a nonspecific chronic cervicitis in 4.6%, CIN1 lesions in 5.91%, and CIN2/3 in 1.2% of the cases. Conclusion. Cervical cancer screening by visual inspection showed appropriate diagnostic accuracy when used to detect early cervical lesions. It is a simple and easy to perform method that could be introduced progressively in the health insurance policy while waiting for a national screening program.

Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status.

BACKGROUND: Cervical cancer screening is not yet standard of care of women attending HIV care clinics in Africa and presents operational challenges that need to be addressed. METHODS: A cervical cancer screening program based on visual inspection methods was conducted in clinics providing antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire. An itinerant team of midwives was in charge of proposing cervical cancer screening to all HIV-positive women enrolled in ART clinics as well as to HIV-negative women who were attending the Abidjan national blood donor clinic. Positively screened women were systematically referred to a colposcopic examination. A phone-based tracking procedure was implemented to reach positively screened women who did not attend the medical consultation. The association between HIV status and cervical cancer screening outcomes was estimated using a multivariate logistic model. RESULTS: The frequency of positive visual inspection was 9.0% (95% CI 8.0-10.0) in the 2,998 HIV-positive women and 3.9% (95% CI 2.7-5.1) in the 1,047 HIV-negative ones (p < 10-4). In multivariate analysis, HIV infection was associated with a higher risk of positive visual inspection [OR = 2.28 (95% CI 1.61-3.23)] as well as more extensive lesions involving the endocervical canal [OR = 2.42 (95% CI 1.15-5.08)]. The use of a phone-based tracking procedure enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5% to 19.8% (p < 10-4). CONCLUSION: The higher frequency of positive visual inspection among HIV-positive women supports the need to extend cervical cancer screening program to all HIV clinics in West Africa. Women loss to follow-up after being positively screened is a major concern in cervical screening programs but yet, partly amenable to a phone tracking procedure.

Very high concentrations of active intracellular phosphorylated emtricitabine in neonates (ANRS 12109 trial, step 2).

Our objective was to investigate neonatal emtricitabine (FTC) plasma and intracellular pharmacokinetics. The study was designed as a phase I/II prospective trial in two sequential steps evaluating the combination of tenofovir disoproxil fumarate (TDF) and FTC for the prevention of mother-to-child-transmission (PMTCT) of HIV. HIV-1-infected pregnant women received two tablets of TDF (300 mg) and FTC (200 mg) at onset of labor and then one tablet daily for 7 days postpartum. Based on the data obtained in the first part of the Tenofovir/Emtricitabine in Africa and Asia (TEmAA) Study, single doses of 2 mg/kg of FTC and 13 mg/kg of TDF were given to the neonates within 12 h after birth. A total of 540 FTC plasma concentrations and 44 active intracellular phosphorylated metabolite FTC-TP concentrations were taken from the 36 enrolled women and their neonates. Concentrations were measured by the liquid chromatography-tandem mass spectrometry (LC-MS/MS) method and analyzed by a population approach. The proposed dose obtained by simulations based on plasma drug concentrations was confirmed. However, median FTC-TP exposures were, respectively, 5.9 and 6.8 times higher in the fetus and the neonate than in the adult. High FTC-TP concentrations were observed in the four children who had serious adverse events (SAEs), but the link between FTC-TP concentrations and SAEs in children was not formally identified. The exposure to the active form of FTC was high in neonates despite plasma drug concentrations equivalent to those in adults. Our results are similar to those obtained with zidovudine or lamivudine.