Aspects cliniques et thérapeutiques des anomalies de la jonction pyélo-urétérale au CHU du point G

Cette étude a été faite pour analyser les aspects cliniques et thérapeutiques des anomalies de la jonction pyélo-urétérale. Etude transversale et descriptive portant sur 35 cas d'anomalies de la jonction pyélo-urétérale (AJPU) colligés au service d'Urologie du CHU du Point G durant une période de 4 ans (Janvier 2010 au Décembre 2014). Les données ont été recueillies sur les fiches d'enquête, les dossiers médicaux et les registres du bloc. Les données sociodémographique, clinique et thérapeutique ont été saisies sur Microsoft Word 2007 et analysées sur Excel 2007 et SPSS 18.0. 35 cas d'AJPU ont été colligés en 4 ans. La moyenne d'âge était de 29,3 ans. La douleur lombaire était le motif de consultation le plus fréquent soit 40 %. 20 % des patients ont été en consultation pour la première fois 10 ans d'évolution symptomatique. Une destruction rénale avait été observée dans 28,6 %. Le couple Echographie + UIV a permis d'établir le diagnostic chez 37,1 %. La complication lithiasique était présente chez 17,1 % des patients. 51,4 % des patients ont reçu une pyéloplastie à ciel ouvert selon Anderson KUSS. L'anomalie de la jonction pyélo-urétérale dans notre étude a été caractérisée par un retard de consultation avec des complications redoutables. La chirurgie à ciel ouvert a été le gold standard avec des résultats satisfaisants. L'endopyéloplastie, la cure de la jonction coelioscopique sont des chirurgies mini invasives non disponible chez nous mais à encourager et à intégrer dans l'arsenal thérapeutique.Pan African Medical Journal 2016; 2

Etude épidémiologique, clinique et thérapeutique des hydrocèles dans trois districts sanitaires de la région de Sikasso/Mali: Epidemiological, Clinical and Therapeutic Study of Hydroceles in Three Health Districts in the Sikasso Region / Mali

Context and objective. Hydrocele is one of the most common urogenital manifestations of lymphatic filariasis. It is a common cause of enlarged scrotum in the tropics. This study aims to describe the epidemiological, clinical and therapeutic aspects of hydroceles. Methods. This cross-sectional descriptive study of hydroceles in three endemic filarial Sikasso areas in Mali was conducted from November 2017 to December 2018. The variables studied were: frequency of hydrocele, age of patients, duration of evolution, type of anesthesia, surgical technique, volume, operative time and postoperative results. Results. Three hundred fifty-eight patients were operated on in fourteen months. The frequency of hydrocele‘s surgery was 31%. Their average age was 47.1 years old (extremes 4 months and 94 years). The duration of evolution was 10.7 years (extremes 6 months and 21 years). The right side was the most affected with 44.1% followed by the left side with 31.3%. Hydrocele was bilateral in 19%. Local anesthesia (with xylocaine 2%) was used in 88%. All patients underwent a successful vaginal resection. Conclusion. The hydrocele remains a common urological pathology in these endemic areas. The diagnosis is made after a long period of evolution of the disease. Treatment in outpatient surgery is undertaken using local anesthesia. These hydrocele management campaigns should be encouraged to treat the maximum number of patients. Contexte et objectif. L’hydrocèle constitue l’une des manifestations urogénitales les plus fréquentes de la filariose lymphatique. Elle est une cause fréquente de grosse bourse dans les régions tropicales. L’objectif de cette étude est de décrire les aspects épidémiologiques, cliniques et thérapeutiques des hydrocèles. Méthodes. Il s’agissait d’une étude transversale et descriptive sur les hydrocèles, réalisée entre novembre 2017 et décembre 2018 ; dans trois zones endémiques filariennes dans la région de SIKASSO au Mali. Les variables étudiées étaient : la fréquence de l’hydrocèle, l’âge des patients, la durée d’évolution, le type d’anesthésie, la technique chirurgicale, le volume, le temps opératoire et les résultats postopératoires. Résultats. Trois cent cinquante-huit patients ont été opérés en quatorze mois. L’intervention de l’hydrocèle rendait compte de 31% des activités chirurgicales. Leur âge moyen était de 47,1 ans (extrêmes 4 mois et 94 ans). La durée d’évolution était de 10,7 ans (extrêmes de 6 mois et 21 ans). Le testicule droit était le plus touché (44,1 %) suivi du côté gauche (31,3%). L’hydrocèle était bilatérale dans 19 %. L’anesthésie locale à la xylocaïne 2 % a été réalisée dans 88%. La résection vaginale a été réalisée chez tous les patients avec succès. Conclusion. L’hydrocèle reste une pathologie urologique fréquente en zone d’endémie filarienne. Le diagnostic se fait après une longue durée d’évolution de la maladie. Le traitement en chirurgie ambulatoire réalisée sous anesthésie locale a montré des résultats satisfaisants. Ces campagnes de prise en charge de l’hydrocèle sont à encourager pour pouvoir traiter le maximum de patients

Status, Needs, and Perspectives on the Practice of Endourology in Africa: a Continental Survey of 21 Reference Centers

Endourology occupies an important place in modern urological practice. Compared with conventional surgery, it offers improved safety and patients experience less severe postoperative effects. Its use requires a certain level of equipment and technical skills. In many developed countries, it has been established for years and its practice has become routine. In Africa, it is still not very practical or even non-existent in certain reference centers. This survey conducted among the heads of urology departments or training coordinators in African referral centers defines the current practice of endourology. According to the needs and perspectives identified, it is important, if not essential, to create services or reference centers specializing in endourology. The role of these centers will be to take care of patients and train urologists in technical skills. The creation of a sub-regional and international network could contribute to the development of this practice. Multi-stakeholder cooperation (inter-state, with non-governmental organizations, companies or corporations) is also necessary

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control. © The Author(s) 2020

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries

Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal.

Abstract Background—The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)–defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. Methods—We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of anti-retroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together to form a “rare ADEs” category. Results—During a median follow-up period of 43 months (interquartile range, 19–70 months), 2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non- Hodgkin’s lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84–22.35) and progressive multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70–14.92). Three groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped confidence intervals: severe (non-Hodgkin’s lymphoma and progressive multifocal leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55–9.48]), moderate (cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76–3.13]), and mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08–2.00]). Conclusions—In the combination antiretroviral therapy era, mortality rates subsequent to an ADE depend on the specific diagnosis. The proposed classification of ADEs may be useful in clinical end point trials, prognostic studies, and patient management

Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal

Abstract Background—The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)–defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. Methods—We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of anti-retroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together to form a “rare ADEs” category. Results—During a median follow-up period of 43 months (interquartile range, 19–70 months), 2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non- Hodgkin’s lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84–22.35) and progressive multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70–14.92). Three groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped confidence intervals: severe (non-Hodgkin’s lymphoma and progressive multifocal leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55–9.48]), moderate (cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76–3.13]), and mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08–2.00]). Conclusions—In the combination antiretroviral therapy era, mortality rates subsequent to an ADE depend on the specific diagnosis. The proposed classification of ADEs may be useful in clinical end point trials, prognostic studies, and patient management