Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d'Ivoire.

Introduction: The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d'Ivoire. Method: A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. Results: A total of 5649 patients were included. The prevalence of STEMI was 0.7% (n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% (n = 8) of cases. All patients received double anti-platelet aggregation and 50% (n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% (n = 29) were referred to the Bouaké Cardiology Department and 34.1% (n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% (n = 3) of patients in Abidjan. Conclusion: Tele-ECG was an effective means of STEMI screening in Côte d'Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.

Factors associated with the abandonment of postexposure prophylaxis at the antirabies center in Abidjan, Côte d'Ivoire.

The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional study took place at the ARC of Abidjan from September 2014 through May 2015. Data were collected in two stages: first, all patients were interviewed at their first consultation. Exposed patients who failed to return were interviewed by telephone three days later. We recorded 441 subjects (59.3%) who had dropped out of their PEP. After multivariate analysis of social and demographic factors, the dropout rate was low in the groups aged 40-49 years (aOR = 0.40, 95% CI = 0.2, 0.8), 50-59 years (aOR = 0.40, 95% CI = 0.21; 0.82), and 60 years and older (aOR = 0.26, 95% CI = 0.09; 0.76), while it was elevated in retired persons (aOR = 10.07, 95% CI = [1.11, 91 , 7]). Moreover, the choice of protocol influenced PEP adherence, with subjects who chose the 5-dose protocol dropping out more frequently (P≤0.001). The main reason given by the subjects exposed to a suspect animal to explain dropping out of PEP was the lack of financial resources (41.5%). To alleviate this dropout problem, the ARC should strengthen public awareness of human rabies and the Ivorian government must implement universal health coverage to help the poor or make the vaccine available for free to all.

Urgences ORL de l'enfant au CHU de Yopougon (Côte d'Ivoire)

Objectif : Décrire les caractéristiques épidémiologiques, cliniques et thérapeutiques des urgences ORL de l'enfant dans le service d'ORL-CCF du CHU de Yopougon.Patients et méthodes : Il s'agissait d'une étude prospective transversale portant sur les patients âgés de moins de quinze ans reçus en urgence sur une période de dix mois. Résultats : Cent-vingt-six (126) enfants sur 239 patients ont été reçus en urgence (52,72%). Le sexe masculin représentait 57,94% d'enfants avec un sex-ratio de 1,37. L'âge moyen était de 4,26 ans ± 3,59 (extrêmes 1 jour et 15 ans). Dans cet échantillon, 73,81% des patients ont été reçus pendant la garde en dehors des heures de consultation dont 30,95% les week-ends. Les urgences absolues représentaient 14,30% des cas. Les corps étrangers, les traumatismes externes et les tuméfactions cervicales fébriles ont été observés dans respectivement 50%, 15,08% et 7,14% des cas. La prise en charge était multi-disciplinaire dans 11,12% des cas. Elle concernait en plus de l'ORL, la pédiatrie, la neurochirurgie et la réanimation. Le traitement était médical dans 50% des cas parfois associé aux méthodes physiques (9,52%) ou médico-chirurgicales dans 26,98% des cas. Les méthodes physiques seules ont été suffisantes dans 18 cas (14,29%). Cinq abstentions thérapeutiques (3,97%) ont été répertoriées. L'évolution était favorable dans 90 cas (71,43%). Il a été noté 1 cas de décès. Conclusion : La prévention des accidents de la voie publique et la surveillance des enfants sont des mesures à prendre pour réduire la prévalence des urgences ORL dans notre pratique quotidienne

Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation?

PURPOSE: To propose polyhydramnios seen during prenatal diagnosis as a warning sign of foetal malformation. PATIENTS AND METHODS: A retrospective multicentre study over a three-year period carried out in Ivory Coast and Burkina Faso. We reviewed 3903 obstetric ultrasound reports. All cases of foetal malformation and polyhydramnios were counted. The instances of foetal malformation associated with polyhydramnios were compared to those of foetal malformation without polyhydramnios and to polyhydramnios only. RESULTS: A list of 72 cases of polyhydramnios was made (equating to 1.8%). In 55 cases (76.4%), polyhydramnios was combined with foetal malformation. These were lethal abnormalities in 33 cases and non-lethal in 22 cases. In 17 cases, polyhydramnios was not associated with any foetal malformations and in eight cases, foetal malformation was discovered in the absence of polyhydramnios. Polyhydramnios had a positive predictive value of 76.4% for the presence of foetal malformation. The negative predictive value was 99.8%. Sensitivity was 87.3% and specificity was 99.5%. CONCLUSION: Polyhydramnios is a highly sensitive and specific sign for prenatal diagnosis of foetal malformation. If it is identified, then this should lead to a very careful search for foetal malformation.