Profil hématologique des patients VIH/SIDA à l'hôpital régional de Nzérékoré / Hematological profi le of HIV/AIDS patients at the Nzérékoré Regional Hospital

Introduction. Le VIH/SIDA est à l'origine d'un grand nombre de manifestations biologiques à titre de troubles hématologiques graves pouvant atteindre toutes les lignées sanguines. L'objectif de cette étude était de mettre en évidence les anomalies de l'hémogramme chez les PVVIH à Nzérékoré afi n de contribuer à une meilleure prise en charge. Méthodes. Il s'agissait d'une étude prospective de type descriptif à visée analytique d'une durée de 6 mois allant du 25 février au 25 août 2021 sur les PVVIH dans le service de médecine générale de l'Hôpital régional de Nzérékoré. Résultats. Durant notre étude, la prévalence hospitalière du VIH au service de médecine générale de l'hôpital régional de Nzérékoré était de 20,34%. L'âge moyen était de 36,98 ans, le sexe féminin prédominait avec un sex-ratio de 0,74 ; majoritairement mariés (53,33%) et ménagères (41,66%). Les anomalies hématologiques les plus représentées étaient l'anémie (95%) et la lymphopénie (77,5) dont la majorité était au stade III et IV. Conclusion. Le VIH/SIDA reste un problème de santé publique. Son évolution est liée à des anomalies aussi cliniques que biologique imposant un suivi régulier et adéquat

Introduction. HIV/AIDS is the cause of a large number of biological manifestations as serious hematological disorders that can affect all blood lines. The objective of this study was to highlight blood count abnormalities in PLWHA in Nzérékoré in order to contribute to better management. Methods. This was a prospective descriptive study with an analytical aim, lasting 6 months from February 25 to August 25, 2021, on PLHIV in the general medicine department of the Nzérékoré regional hospital.. Results. During our study, the hospital prevalence of HIV in the general medicine department of the regional hospital of Nzérékoré was 20.34%. The average age was 36.98 years, the female sex predominated with a sex ratio of 0.74; the majority were married (53.33%) and housewives (41.66%). The most common hematological abnormalities were anemia (95%) and lymphopenia (77.5), the majority of which were stage III and IV. Conclusion. HIV/AIDS remains a public health problem. Its evolution is linked to both clinical and biological abnormalities requiring regular and adequate follow-up.

High rates of antiretroviral coverage and virological suppression in HIV-1-infected children and adolescents.

OBJECTIVES: To assess the outcome of HIV-infected individuals attending one of the largest French pediatric HIV centers in 2016-2017 and to compare the rates of antiretroviral coverage and virological suppression with the UNAIDS targets. PATIENTS AND METHODS: The clinical and immuno-virological status of 163 HIV-1-infected children and adolescents attending Necker Hospital in Paris, France, were investigated. Virological suppression was defined as an HIV-1 viral load<50 copies/mL for at least six months. All genotypic resistance tests performed since birth were analyzed. RESULTS: Most patients were born in Sub-Saharan African countries (41.7%) or in France (38.0%). Their median age was 14 years [IQR 7.3-17.0]. Although 33.7% of individuals had a history of AIDS-defining clinical event(s), 86.5% of children/adolescents were free from HIV-related symptoms at their most recent evaluation. Antiretroviral coverage was high (98.2%; mainly including one integrase inhibitor [42.3%] or one protease inhibitor [23.9%]). At the last visit, most patients (82.8%) had normal CD4T lymphocytes counts (≥25%). Although 61.7% of antiretroviral-experienced children had resistance to≥1 drug class and 9.2% had triple-class resistance, 80.3% of patients receiving antiretrovirals for≥6 months (126/157) were virologically suppressed. International adoptees were more frequently virologically suppressed than other patients (96.0% versus 74.6%, P=0.02). CONCLUSIONS: Antiretroviral coverage exceeded the second UNAIDS 90 target aimed at ending the AIDS epidemic. The rate of virological suppression, one of the highest reported in children in high-income countries, is approaching the third UNAIDS 90 target and the rate observed in French HIV-infected adults on antiretrovirals.

[The register of activity at the Ebola treatment center in Forecariah (Guinea) from april 23 to june 5, 2015: analysis and thoughts]. / Bilan d'activité du centre de traitement Ebola de Forécariah (Guinée) du 23 avril au 5 juin 2015 : analyse et réflexions.

The register of activity at the Ebola Treatment Center (ETC) in Forecariah (Guinea), from April 23 to June 5, 2015 is presented for analysis. The viral load of each patient is evaluated by the cycle threshold (Ct). One hundred and thirty patients were seen in Triage at the ETC, of which 24 (18.5%) patients who failed to meet theWHO case criteria for viral hemorrhagic fever were excluded from admission to the ETC. Of the 106 patients admitted in the ETC, 72 (67.9%) were declared non-cases after the results of their two PCR (drawn 48 hours apart) tests were negative. Thirty-four patients were tested positive for Ebola virus disease (EVD): 19 women and 15 men (sex ratio: male/female = 0.78), mean age of 33.51 ± 20.1 years (extremes of 42 days to 70 years), of which six children were aged below 8 years. The median initial Ct value was 21.6 ± 6.3 cycles in this group. Enquiry into patient contacts was only able to identify actual contacts in 20 of these patients (58.8%). Thirteen patients were ultimately cured of EVD (six men and seven women) - with a median age of 31.8 years (extremes of 4 to 54 years). These patients presented on admission with a median Ct value of 21.88 ± 6.2 cycles (extremes of 17.6 to 31.7). Of the six children aged below 8 years, only one survived. Twenty-one patients (61.76%) with EVD died (9 men and 12 women) - median age, 34 ± 21 years (extremes of 42 days to 70 years). They presented on admission with a median Ct value of 18 ± 7 cycles (extremes of 12 to 24). The single most important factor associated with lethality was the Ct value at the time of admission to the ETC (P = 0.0004), i.e., the lower the Ct value, the higher the lethality rate or simply stated, the higher the viral load, the greater the lethality. Age, sex, identification of contact, and delay between the onset of symptoms and admission did not prove to be predictive of death outcome in our series.

[Input of a laboratory in the management of patients with Ebola virus disease and in the training of health personnel: experience of the Forecariah Ebola treatment centre (Guinea) in 2015]. / Apport d'un laboratoire dans la prise en charge des patients atteints de la maladie à virus Ebola et dans la formation des personnels soignants : expérience du Centre de traitement d'Ebola de Forécariah (Guinée) en 2015.

Ebola virus disease (EVD) is associated with a high lethality rate even when the afflicted are provided with good support in an Ebola treatment center (ETC). Basic laboratory tests can help to better understand the pathophysiology of the disease, to guide treatment and to establish simple protocols and procedures tailored to the practice of medicine in the context of such precarious environment for caregivers. Based on a few clinical cases of patients treated in the ETC of Forecariah, Guinea, run by the French Red Cross, this article describes the difficult conditions associated with the provision of medical practice in this challenging environment, aiming to minimize the casualties in the EVD patient and to train the health staff.

[Histologic kidney lesions during pure nephrotic syndrome in adults in Conakry]. / Lesions histologiques renales au cours du syndrome nephrotique pur de l'adulte a Conakry.

INTRODUCTION: Nephrotic syndrome represents a significant part of chronic kidney disease in Black Africa. Our work aimed to determine the frequency and type of kidney lesions in an adult carrying pure nephrotic syndrome. PATIENTS AND METHODS: We conducted a prospective and descriptive study (2003-2004), 40 patients were recruited on the basis of the presence of a pure nephrotic syndrome. Proteinuria was plentiful, selective to albumin greater than 3 g/24h, not accompanied by hematuria, or high blood pressure, or kidney failure. Cases of bacterial, parasitic and viral infections (hepatitis B, C, HIV) were excluded. By following contra-indications of renal biopsy, samples were taken under local anesthesia by means of percutaneous lumbar and fixed in two tubes, one containing "Michel's medium" and the other 12% Formalin. These techniques and readings were carried out in the pathological anatomy Laboratories of Nantes (France) and Conakry (Guinea). RESULTS: There were 24 men and 16 women with an average age of 26.2 ± 8 years [range: 20-51]. Clinical symptoms were dominated by weight gain characterized by edema. Proteinuria was between 3-3.5 g/24h in 16 (40%); between 3.6-5 g in 2 cases (5%) and greater than 5 g/24h in 22 cases (55%). The number of glomeruli was on average 11 ± 9 [range: 3-36]; glomerular permeability was on average 10.4 ± 10. Renal impairment was glomerular in 22 cases, tubulointerstitial in 12 cases and vascular in 6 cases. Immunofixation was positive in 30/40 cases for IgA IgG IgM; in 26 cases for C1q C3; in 4 cases for C1q C3 C4; and finally for fibrin in 28 cases. Histological renal lesions were FSGS (40%), MDC (35%), MGN (5%), MPGN (5%) and undetermined (15%). CONCLUSION: A regular practice of renal anatomopathological examination "on the spot" will lead us to carefully assess the causes of kidney failure associated with nephrotic syndrome.

INTRODUCTION: Le syndrome néphrotique représente une part importante d'insuffisance rénale chronique en Afrique noire. Notre travail avait pour but de déterminer la fréquence et le type de lésions histologiques rénales chez un adulte porteur d'un syndrome néphrotique pur. PATIENTS ET MÉTHODES: Au cours d'une étude prospective et descriptive (2003­2004), 40 patients ont été sélectionnés sur la base de la présence d'un syndrome néphrotique pur. La protéinurie était abondante, sélective à l'albumine, supérieure à 3 g/24h, non accompagnée d'hématurie, ni d'hypertension artérielle, ni d'insuffisance rénale. Les cas d'infections bactériennes, parasitaires et virales (hépatites B, C, HIV) ont été volontiers exclus. En respectant les contre indications de la biopsie rénale, les prélèvements ont été effectués sous anesthésie locale, par voie lombaire percutanée, puis fixés dans deux tubes dont un contenait du « liquide de Michel ¼ et l'autre du Formol à 12%. Les techniques et lectures ont été effectuées aux Laboratoires d'anatomie pathologique de Conakry (Guinée) et de Nantes (France). RESULTATS: Il s'agissait de 24 hommes et de 16 femmes âgés en moyenne de 26,2 ± 8 ans [20­51]. La symptomatologie clinique était dominée par une prise de poids marquée par les œdèmes. La protéinurie était comprise entre 3­3,5 g/24h dans 16 cas (40%); entre 3,6­5 g dans 2 cas (5%) et supérieure à 5 g/24h dans 22 cas (55%). Le nombre de glomérules était en moyenne de 11 ± 9 [3­36]; la perméabilité des glomérules était en moyenne de 10,4 ± 10. L'atteinte rénale était glomérulaire dans 22 cas, tubulo-interstitielle dans 12 cas et vasculaire dans 6 cas. L' immunofixation a été positive dans 30 cas /40 pour les IgA IgG IgM; dans 26 cas pour C1q C3; dans 4 cas pour C1q C3 C4; et en fin pour la fibrine dans 28 cas. Les lésions histologiques rénales étaient une HSF (40%), une LGM (35%), une GEM (5%), une GNMP (5%) et indéterminée (15%). CONCLUSION: Une pratique régulière de l'examen anatomo-pathologique rénal «sur place" nous amènerait à apprécier judicieusement les causes d'insuffisance rénale en rapport avec un syndrome néphrotique.

[Breech presentation: mode of delivery and maternal and fetal outcomes at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital]. / Presentation de siege: mode d'accouchement et pronostic maternal-foetal a la Clinique de Gynecologie Obstetrique Ignace Deen du CHU de Conakry.

The authors in a prospective, analytical study of 8 months from January 1st to August 31st performed at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital; assessed the impact of the mode of delivery in breech presentation on maternal and fetal outcome in the African context of Guinea. Breech presentation in mono fetal pregnancy of at least 28 weeks of amenorrhea was the inclusion criterion in this study. Among 1490 deliveries, 144 breech presentations were reviewed, representing a frequency of 9.66%. Half of breech deliveries (49.99%) were premature against only 11.85% in cephalic presentations. The breech was incomplete in 57.64% cases and complete in 42.35%. Caesarean section was performed in 40.97% of cases against 39.54% in cephalic presentation. The indications were often primiparity (30.50%), acute fetal distress (28.81%) and macrosomia (23.72%). Deliveries through the lower route frequently used the maneuver of Bracht (52.50%). 54.16% of the new-born babies had a fetal weight lower than 2500 g at born. Morbid Apgar score at the 1st minute after delivery through the lower route was found in 69.40% of the breech presentation born babies; however, this rate was 32.70% in cephalic presentation (p=0.000). The maternal morbidity concerned essentially perineal lesions (26.53%). The outcome is largely better in case of delivery through the upper route. The caesarean section is an alternative for the improvement of fetal outcome in countries with low resources.

Presentation de siege : mode d'accouchement et pronostic materno-feotal a la clinique de gynecologie obstetrique Ignace Deen du CHU de Conakry

Les auteurs dans une etude prospective de type analytique de 8 mois; allant du 1er janvier au 31 aout 2006; realisee a la clinique de gynecologie obstetrique de l'hopital Ignace Deen du CHU de Conakry; ont evalue l'impact du mode d'accouchement dans la presentation du siege sur le pronostic materno-foetal dans le contexte africain guineen. La grossesse mono foetale en siege d'au moins 28 semaines d'amenorrhee a ete le critere d'inclusion.Sur 1490 accouchements; 144 presentations de siege ont ete colliges; soit une frequence de 9;66. La moitie des accouchements en siege (49;99) etait prematuree contre seulement 11;85en sommet. Le siege etait decomplete dans 57;64des cas et complet dans 42;35. La cesarienne a ete realisee dans 40;97des cas; contre 39;54dans la presentation du sommet. Les indications etaient le plus souvent la primiparite (30;50); la souffrance foetale aigue (28;81) et la macrosomie (23;72).Les accouchements par voie basse avaient recours plus frequemment a la manoeuvre de Bracht (52;50). 54;16des nouveaux nes avaient un poids foetal inferieur a 2500 g a la naissance. L'Apgar morbide a la 1ere minute; apres accouchement par voie basse; a ete retrouve chez 69;40des nouveaux nes en siege ; alors que ce taux en sommet etait de 32;70(p=0;000). La morbidite maternelle concernait essentiellement les lesions perineales (26;53).Le pronostic est largement meilleur lors de l'accouchement par voie haute. La cesarienne est une alternative pour l'amelioration du pronostic foetal dans les pays a ressources limitees

[Dyslipidemia in uremic patients at the National Hospital of Donka-Conakry]. / Profil lipidique des urémiques a l'Hôptal National de Donka à Conakry.

The prevalence of the dyslipidemia is higher at the patients in chronic renal failure (CRF) than in the general population. The objective of this study was to determine the prevalence and the lipidic anomalies among uraemic patients and to evaluate the others associated factors of cardiovascular risk. The study was descriptive with prospective recruitment (November 2004-June 2005); concerned 60 patients having an advanced chronic renal failure whose calculated clearance of creatinin was lower than 30 ml/mn as well as the hemodialysed patients. The lipidic disturbances on the whole 9/16 dialysed (56%) and 31 uraermia /44 were not dialysed (70%). This majority triglyceride dyslipidemia comprised 8 cases of hypertriglyceridemia in the group of dialysed patients against 19 in the group of not dialysed; 1 case of mixed hyperlipidemia against 6 cases and 4 cases of hypercholesterolemia HDL in the non dialysed group with 1 case of HDL low cholesterol. The patients with dyslipidemia were 4 females (25%) and 5 males (31%) among dialysed group; and of 13 female (29%) and 18 male (41%) among not dialysed. The average age was of 54.3 +/- 0.7 years for dialysed against the 46.6 +/- 0.2 years for the dyslipidémia in the non dialysed. Among others factors of cardiovascular risk, the arterial high blood pressure was noted at 9 dialysed patient's dyslipidémia and 20 case / 31 to the not dialysed dyslipidémia; and the diabetes was observed in 1 and 3 cases respectively. The addiction to smoking was noted in both groups except at the dialysis patients not dyalipidémiques.

In-vitro processing of sperm with autoantibodies: analysis of sperm populations.

Ejaculates from 51 infertile men with significant levels of anti-sperm antibodies were submitted to processing in vitro in order to increase the number of antibody-free spermatozoa. Rapid removal and washing of spermatozoa from antibody-containing seminal fluid resulted in a variable decrease in IgG and/or IgA binding; only IgG binding was significantly reduced. Those spermatozoa were allowed to swim-up into an overlaying medium to select those with the best progression. Unexpectedly, in the post-migration samples (PM), the proportion of progressively motile spermatozoa coated with IgG and IgA antibodies increased significantly. An efficient selection of antibody-free spermatozoa was achieved prior to swim up migration by immuno-binding to polystyrene Petri plates coated with anti-human immunoglobulin antibodies. Non-adherent populations were depleted of 27-100% of IgG and IgA antibody-coated spermatozoa. After migration, the percentages of antibody-coated spermatozoa of those populations (PMP) remained low. The comparison between PM and PMP populations shows that immunobinding increases the number of motile antibody-free spermatozoa. The fertility potential of both sperm populations is currently under investigation.

Incidence of sperm-associated immunoglobulins in infertile men with suspected autoimmunity to sperm.

Semen samples from 120 infertile men with suspected autoimmunity to sperm were investigated by a direct immunobead test (IBT). Fifty-three (44%) of them had 10% or more motile sperm coated with anti-IgG and/or anti-IgA immunobeads. Both classes of immunoglobulins were found to be present in 88.7% of the antibody positive ejaculates. These sperm-bound Igs were associated with sperm autoagglutination in 80% of the ejaculates and with decreased sperm penetration into cervical mucus in 97.6% of the cases. The close correlation found between the IBT results and the occurrence of antisperm antibodies in serum and in seminal plasma suggests that sperm-bound Ig's are sperm-specific antibodies. It is concluded that the direct IBT is not only a reliable screening test for sperm antibodies but is also a relevant test to determine whether these antibodies exert an influence on male fertility.

Morphological factors influencing the penetration of human sperm into cervical mucus in vitro.

The efficiency of cervical mucus in filtering out single, multiple and associated abnormalities of human spermatozoa was determined. Twenty semen samples which gave a normal in vitro cervical mucus penetration test (CMPT) were analysed before and after migration using a detailed classification system (13 categories). The % of normal forms was significantly increased in cervical mucus (59.5 vs 33.2%), whereas the % of sperm with single, multiple or associated abnormalities of the midpiece or of the flagellum were found to decrease significantly in cervical mucus. Sperm with single or multiple abnormalities confined to the head migrated similarly to normal forms. The decrease in amorphous and elongated tapering sperm was explained by their more frequent association with other defects of the midpiece and/or of the flagellum.

Levels of seminal free L(-) carnitine in fertile and infertile men.

Data about the levels of free L-carnitine, an epididymal marker in human semen, are contradictory and unclear, particularly in their relationship to fertility. This can perhaps be explained by the absence of any studies of seminal L-carnitine in a large group of fertile men, and by the lack of consideration of factors influencing its secretion. In this study, free L-carnitine was determined using a spectrophotometric method in deproteinized semen samples from fertile (n = 162) and infertile men without azoospermia (n = 303). Our results can be summarized as follows: Infertile men were found to have significantly lower (P less than 0.001) seminal carnitine levels (755 +/- SD 499 nmoles) compared with fertile men (1010 +/- 570). Percentiles have been calculated for fertile men, and 'normal' values proposed (10th percentile = 390 and 90th percentile = 1830 nmoles). Distribution of the levels of L-carnitine were asymmetric in fertile as well as in infertile men (median: 922 nmoles vs 645). In both groups, a significant increase in carnitine levels was observed with increasing length of abstinence, and a decrease in the ratio of carnitine/days of abstinence. Methodological, physiological and pathological factors which may explain these results are discussed.

Reversible inhibition of sperm production and gonadotrophin secretion in men following combined oral medroxyprogesterone acetate and percutaneous testosterone treatment.

Six men requesting male contraception received a daily oral dose of 20 mg medroxyprogesterone acetate (MPA) in combination with 50 or 100 mg percutaneous testosterone for 1 year. From the third month the sperm concentration was less than 10(6)/ml for all the men at one time or another during treatment, and usually less than 5 X 10(6)/ml, with an average reduction of 95% with respect to pre-treatment values. The sperm count returned to previous values 3-6 months after cessation of the treatment. While FSH and LH secretion was inhibited throughout the treatment period, plasma testosterone levels were not reduced. Oestradiol levels were unaffected while dihydrotestosterone was elevated. The secretory activity of the prostate and seminal vesicles was not appreciably affected; seminal carnitine concentration was reduced during the treatment with a subsequent return to pretreatment values. No pregnancies occurred during treatment. There was no impairment of libido in the subjects, nor any incidence of gynaecomastia, or increase in average body weight. The only observed metabolic side-effect was a moderate increase in glycaemia. A synergistic action of MPA and testosterone is proposed to explain the inhibition of gonadotrophin secretion.

PIP: 6 men requesting male contraception received a daily oral dose of 20 mg medroxyprogesterone acetate (MPA) in combination with 50 or 100 mg percutaneous testosterone for 1 year. From the 3rd month, the sperm concentration was 1 million ml for all the men at 1 time or another during treatment, and usually 5x1 million/ml, with an average reduction of 95% with respect to pretreatment values. The sperm count returned to previous values 3-6 months after cessation of the treatment. While follicle stimulating hormone and luteinizing hormone secretion was inhibited throughout the treatment period, plasma testosterone levels were not reduced. Estradiol levels were unaffected while dihydrotestosterone was elevated. The secretory activity of the prostate and seminal vesicles was not appreciably affected; seminal carnitine concentration was reduced during the treatment with a subsequent return to pretreatment values. No pregnancies occurred during treatment. There was no impairment of libido in the subjects, nor any incidence of gynecomastia, or increase in average body weight. The only observed metabolic side effect was a moderate increase in glycemia. A synergistic action of MPA and testosterone is proposed to explain the inhibition of gonadotropin secretion.

[Semen characteristics and fertility (author's transl)]. / Paramètres du sperme et fertilité.

The semen characteristics of 215 fertile men (F = fathers requesting vasectomy) and of 409 infertile men (I) have been analysed under strictly identical conditions. The mean values for volume, sperm concentration, and the percentages of motile, vital and morphologically normal spermatozoa were greater in group F than in I. Seminal variations were much greater in cases of testicular lesions (cryptorchidism, hypotrophy) than in varicocele, although there remains a difference between F and I even after exclusion of all clinical lesions suggesting a role for other factors in the origin of much cases of infertility. Other than in cases of azoospermia, there is no difference in the function of the accessory glands detectable by the assay of seminal biochemical markers: fructose (seminal vesicles) acid phosphatase and citrate (prostate); only L-carnitine (epididymal marker) is elevated in the fertile men, however this difference is only a reflection of the observed difference in sperm concentration in combination with the close correlation between sperm concentration and L-carnitine values.