Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa)

Aims. To determine the usefulness of platelet count (PC), spleen diameter (SD) and platelet count/spleen diameter ratio (PC/SD ratio) for the prediction of oesophageal varices (OV) and large OV in black African patients with cirrhosis in Côte d’Ivoire. Materials and Methods. Study was conducted in a training sample (111 patients) and in a validation sample (91 patients). Results. Factors predicting OV were sex: (OR=0.08, P=0.0003), PC (OR = 12.4, P=0.0003), SD (OR = 1.04, P=0.002) in the training sample. The AUROCs (±SE) of the model (cutoff ≥ 0.6), PC (cutoff 140) and PC/SD ratio (cutoff ≤ 868) were, respectively; 0.879 ± 0.04, 0.768 ± 0.06, 0.679 ± 0.06, 0.793 ± 0.06. For the prediction of large OV, the model’s AUROC (0.850 ± 0.05) was superior to that of PC (0.688 ± 0.06), SD (0.732 ± 0.05) and PC/SD ratio (0.752 ± 0.06). In the validation sample, with PC, PC/SD ratio and the model, upper digestive endoscopy could be obviated respectively in 45.1, 45.1, and 44% of cirrhotic patients. Prophylactic treatment with beta blockers could be started undoubtedly respectively in 36.3, 41.8 and 28.6% of them as having large OV. Conclusion. Non-invasive means could be used to monitor cirrhotic patients and consider treatment in African regions lacking endoscopic facilities

Local communities perception of parks and reserves in Cote dIvoire: Do the Wanne people consider the Monogaga Classified Forest as a natural patrimony

The Parks, Reserves and Classified Forests in Côte d’Ivoire are considered as to-be-conserved national natural patrimony. Their management seldominvolves the local communities who live around or inside them. Farming practices exert a continuously high pressure on forest cover. In the case of Monogaga, local people (the Wanne) were allowed to stay in the forest after ithad been declared classified. After a period of conflict between the Wanne and SODEFOR, the forest management authority, SODEFOR sought to understand why the Wanne people do not consider the entire forest as a patrimony to conserve and transfer to their children. The present study addresses this question. Local communities recognized several spatial units in the Monogaga Forest. The chiefs of lineage control and guarantee access to those units. In the subdivision of SODEFOR, each zone corresponds to aprecise designation: one for agriculture and another one for conservation. For SODEFOR, the forest ecosystems constitute a national patrimony to conserve while taking into accounts land rights and access to resources. For farmers,land that is inalienable and some of its resources (raphia swamp, kporo)constitute a patrimony of the lineage. In the latter case, the use of land and resources obey complexes access rules. Those traditional access rules to land and resources are still in use in Monogaga.Access rules, conservation, local people, natural heritage, SODEFOR, Cote dIvoire

Couverture Vaccinale contre le virus de l’hépatite B au sein du personnel d’un centre Hospitalier Universitaire à Abidjan

Introduction: Le personnel des hôpitaux est une population à risque viral B. la prévention primaire par la vaccination contre le virus de l’hépatite B est efficace. Peu de données existent sur cette prévention en milieu hospitalier ivoirien. Le but de notre étude était d’évaluer la couverture vaccinale contre le VHB et les facteurs associés à cette vaccination au sein du personnel du CHU de Cocody Méthode: Nous avons réalisé une étude transversale analytique allant du 1er Juillet au 31 Décembre 2016 incluant tout le personnel du CHU de Cocody. Tous ceux absent pendant toute la durée de l’étude ou ayant refusé d’y participer ou chez qui une difficulté technique était notée au cours de l’analyse au laboratoire était exclu de l’étude. Des variables sociodémographiques, anamnestiques et biologiques étaient colligés sur une fiche d’enquête pré établie. La vaccination anti virale B était complète lorsque le sujet avait reçu les trois doses du vaccin. Résultats: Sur les 1479 agents du CHU de Cocody, 867 avaient été inclus soit un taux de participation de 58,6%. L’âge moyen était de 41,2 ±9,4 ans, la médiane de 40 ans (18 à 66 ans). Le sex ratio était de 0,82. Un accident d’exposition au sang était déclaré par 18,5% de sujet. L’AgHBs était positif chez 7,2% de cas. Dans 33,4% des cas les sujets affirmaient avoir reçus au moins une dose de vaccin contre le VHB. Un dépistage pré vaccinal était réalisé dans 17,6% des cas. Les sujets incomplètement vaccinés avaient reçu leur dernière dose avant un an, de 1 à 5 ans et plus de 5 ans dans respectivement 23,8%, 32,0% et 44,3% des cas. Les facteurs associés de façon indépendante à une vaccination complète étaient le statut matrimonial marié (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) et la profession médicale (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: La vaccination est un acte peu réalisé par le personnel du CHU de Cocody. Celle-ci était meilleure chez le personnel marié et médical. Mots clés: personnel hospitalier ; vaccination ; hépatite virale B ; Abidjan- côte d’ivoire English Title: Vaccination coverage against viral hepatitis B Abidjan teatching hospital English Abstract Introduction: Hospital staff is a risk population for viral hepatitis B. The primary prevention by anti-viral B vaccination is effective. There is few data about that prevention in Ivorian hospital environment. Method: We made a prospective cross-sectional study from the 1st of July to the 31st of December 2016, including all CHU de Cocody regularly assigned agent. All those who were absent throughout the duration of the study or refused to participate or in whom a technical difficulty was noted during laboratory analysis were excluded. Sociodemographic, anamnestic and biologic data were collected on a pre-established survey sheet. The anti-viral B vaccination was complete when the person had received three doses of the vaccine. Results: Among the 1479 agents of the CHU de Cocody, 867 was included, giving a participation rate of 58.6%. The middle age was 41.2± 9.4 years, the median was 40 years (18 to 66 years). The sex ratio was 0.82. Average professional seniority was 11.2 ± 9.7 years. Married agents (45.8%) and paramedics (45.9%) was relatively the most numerous. 91.5% of the hospital workers had already heard about viral hepatitis B. 70% of them were directly exposed to human organics fluids. A blood exposure accident was reported by 18.5% of hospital agents. Paramedical staff represented the majority. Positive HBs antigen was found in 7.2% of our study population. The agents claiming to have received at least one dose of anti-viral B vaccine numbered 290 (33.4%). A pre-vaccination screening had been achieved in 17.6 % of them. Respectively 29 (23.8%), 39 (32%) and 54 (44.3%) among the incompletely vaccinated agents have had their last dose before one year old, between 1 and 5 years old and after 5 years old. Independently associated factors with a complete vaccination was married marital status (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) and the medical profession (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: Vaccination coverage is poor in CHU de Cocody regularly assigned agents.It was better among married agents and medical staff. Keywords: Hospital staff; vaccination; viral hepatitis B, Abidjan-ivory- cos

Valeur prédictive négative du ratio taux de plaquettes sur diamètre de la rate pour exclure la présence de varices œsophagiennes chez le cirrhotique d’origine virale B

Objectif : Evaluer la valeur prédictive négative du ratio taux de plaquette/ diamètre de la rate pour exclure la présence de varices œsophagiennes chez des cirrhotiques d’origine uniquement virale B compensée. Patients et méthodes : Il s’agissait d’une étude prospective, bi centrique qui s’était déroulée sur 9 mois.  Durant cette période, tous les patients porteurs chroniques du virus de l’hépatite B dont le score d’élasticité du foie était supérieur à 11 kPa ont été considérés cirrhotiques et inclus. Chez chaque patient, les paramètres suivants ont été notés : cliniques (âge, sexe, IMC), biologiques (transaminases, taux de prothrombine, taux de plaquettes, bilirubine totale, albuminémie), échographiques (taille de la rate) et endoscopiques (varice œsophagienne). L’ensemble des données était compilé et analysé par le logiciel d’analyses statistiques SPSS version 20.0. Pour chaque patient un rapport taux de plaquettes (nombre d’éléments/mm3) sur le diamètre bipolaire de la rate (mm) était calculé. Le seuil de significativité était fixé à une valeur p inférieure à 0,05. Résultats : Au total 60 patients étaient inclus. L’âge moyen était de 48,5 ± 12,8 ans avec une prédominance masculine (sex ratio 3). Le rapport taux de plaquette / diamètre splénique à 892 (N / mm3) / mm présentait une sensibilité de 77%, une spécificité de 81%, une VPP à 74%, une VPN à 84%, un R+ à 4,05 et un R- à 0,28 pour prédire la présence de VO. Quant à prédire la présence de grosses VO sa sensibilité, sa spécificité, sa VPP, sa VPN, son R+ et R- étaient respectivement : 79%, 77%, 65%, 87%, 2,7 et 0,27. Conclusion : Bien que relativement élevée, VPN du ratio taux de plaquette/ diamètre de la rate ne permet pas d’exclure la présence de varice œsophagienne chez tous les patients cirrhotiques compensés.   English title: Negative predictive value of the ratio of platelets to spleen diameter to exclude the presence of esophageal varices in cirrhotic patients of viral B origin  Objective: To assess the negative predictive value of the platelet count / spleen diameter ratio to exclude the presence of esophageal varices in cirrhotics of only viral B compensated. Patients and methods: This was a prospective, bi-centric study that took place over 9 months. During this period, all patients with chronic hepatitis B virus carriers with a liver elasticity score greater than 11 kPa on FibroScan® were considered cirrhotic and included. In each patient, the following parameters were noted: clinical (age, sex, BMI), biological (transaminases, prothrombin level, platelet count, total bilirubin, albuminemia), ultrasound (size of the spleen) and endoscopic (esophageal varices). All data was compiled and analyzed using SPSS statistical analysis software version 20.0. For each patient a ratio of platelet count (number of elements / mm3) to the bipolar diameter of the spleen (mm) was calculated. The significance level was set at a p-value less than 0.05. Results: A total of 60 patients were included.The mean age was 48.5 ± 12.8 years with a predominance of men (sex ratio 3). The platelet count / splenic diameter ratio at 892 (N / mm3) / mm had a sensitivity of 77%, a specificity of 81%, a PPV of 74%, a NPV of 84%, an R + of 4.05 and a R- at 0.28 to predict the presence of VO. As for predicting the presence of large VO, its sensitivity, specificity, PPV, NPV, R + and R- were respectively: 79%, 77%, 65%, 87%, 2.7 and 0.27. Conclusion: Although relatively high, NPV of the platelet count / spleen diameter ratio does not exclude the presence of varicose veins in all compensated cirrhotic patients

Etude comparative de trois tritherapies dans l'eradication d'Helicobacter pylori dans une zone de forte prevalence (Afrique de l'Ouest)

But: L’étude avait pour but d’évaluer et de comparer l'efficacité de trois modèles de trithérapie de première ligne basés sur la combinaison d'un inhibiteur de la pompe à protons (IPP) et de 3 types d'antibiotiques: l'oméprazole (O), l'amoxicilline (A) la clarythromycine (C) et métronidazole (M). Patients et méthodes: Il s’est agi d’un essai clinique randomisé ouvert sur 3 bras parallèles: OAM (groupe 1 ou G1), OAC (groupe 2 ou G2) ou OCM (groupe 3 ou G3). Le critère d'évaluation principal était le taux d'éradication de H. pylori après sept jours de trithérapie. Le diagnostic de l’infection à H. pylori était basé sur l’histologie des biopsies gastriques. Un contrôle histologique a été effectué 4 semaines après la fin du traitement pour évaluer le taux d'éradication de H. pylori. Résultats: L’âge moyen était de 44,33 ± 11,72 ans. Le principal motif de l'endoscopie était le syndrome dyspepsie 75,16%). Nous avons trouvé une gastroscopie normale dans 28,76% des cas, un ulcère gastroduodénal ou gastrique dans 17% des cas et une gastropathie dans 45,75%. Tousles patients étaient comparables pour l'âge, le sexe, les indications d'endoscopie, les antécédents de   consommation d'alcool ou de tabagisme et la prise de médicaments anti-inflammatoires. Environ 23% des patients ont présenté des    effetsindésirables. Le taux d'éradication global de H. pylori était de 22,3%. Il n'y avait pas de différence significative du taux d'éradication de H. pylori selon le traitement utilisé (28,1%, 21,4% et 15,1% pour G1, G2 et G3, p = 0,34). Conclusion: Le taux d'éradication de H. pylori était médiocre quelle que soit la trithérapie utilisée. Mots clés : Helicobacter pylori, Trithérapie, Eradication, Afrique de l’ouest

Efficacy of 4 quadruple therapy to eradicate Helicobacter pylori in the real life

Background: The effectiveness of rate of eradication Helicobacter pylori is unknown in Côte d'Ivoire in daily practice. Objectives : The aim ofour study was to assess the effectiveness of 4 quadruple therapies Materials and Methods : This was a retrospective multi center study carriedout in Abidjan. The medical records of naive patients over 18 years old treated with quadruple therapy [sequential (Q s), concomitant 10 (Qc10) or14 days (Qc14) or bismuth based therapy (Qb)]confirmed histologically on gastric biopsies were included. All had a histologic al check for theeradication of H pylori at least 4 weeks after the en d of treatment. The quadruple th erapy eradication rate has been determined. Results : Onehundred and seventy files were included. The overall eradication rate was 60.6% [53.3% 67.9% 95% CI]. It was 55.6% for Qs (30/54, [42.3%68.9% 95% CI]), 80% for Qc10 (8/10, [55.2% 100% 95% CI ]]), 58.3% for Qc14 (49/84, [47,756%, 68,844% 95% CI]) and 72.7% for Qb (16/22,[54,084%, 91,316% 95% CI]). The patients of the 4 protocols were comparable for age (p = 0.054); gender (p = 0.157); reason p = 0.173) andendoscopy result (p = 0.244); intensit y of antral (p = 0.542) and fundic (p = 0.744) H pylori infection in histology; frequency of side effects (p =0.131) and adherence to therapy (p = 0.564). Conclusion s : T he eradication rate of H pylori in daily practice was not optimal regardless of thequa druple therapy regimen used. A study of the resistance of H pylori to different antibiotics is necessary

Particularities of ballistic spinal injuries and management in an African context (Chad): Study of 27 cases

The frequency of ballistic spinal injuries is rising in developing nations around the globe. These injuries lead to a functional prognosis linked to disabling sequelae and vitals in patients, which often results in serious complications and death.This study describes the epidemiological, diagnostic, therapeutic, evolutionary characteristics of Ballistic Medullar-Vertebral trauma (BMVT). It presents the particularities of management in the sub-Saharan African country of Chad.This is a prospective descriptive study of 27 ballistic spinal injury patients conducted over an 18-month period.Ballistic Medullar-Vertebral injuries (BMVI) represented 12.9 % of spinal trauma. The average age of the patients was 31.8, and 40.7 % were between 31 and 40 years of age. Military personnel represented 78 % of the patients. 44.4 % of cases came from the Lake Chad region. 59.3 % of injuries were caused by Kalashnikov’s (AK 47) firearms. 74.1 % of cases were admitted to the emergency department within 12 to 24 h. The diameter of the wounds that corresponded to the entry orifice of the bullet was between 1 and 2 cm in 59.25 % of the cases. A Dural breach was found in 14.8 %. 48.1 % had ASIA C score and none of them met the criteria for spinal cord injury collection and immobilization. The lumbosacral location was reported in 55.6 %, and the type I Roy Camille fracture was found in 70.37 %. Surgical management was performed in 88.9 % cases. Multidisciplinary management of the associated lesions was performed in 25.9 %. 7.4 % of patients with cervical trauma died due to septic shock.Delayed emergency department admissions and limited access to medicalized transportation are main factors to BMVI in Chad. Lesion is predominantly located in the lumbosacral region. Lesions and spinal cord involvement were factors of poor vital and functional prognosis. Surgery plays an important role in management. Socio-professional reintegration remains problematic

B Cells Are Critical to T-cell-Mediated Antitumor Immunity Induced by a Combined Immune-Stimulatory/Conditionally Cytotoxic Therapy for Glioblastoma12

We have demonstrated that modifying the tumor microenvironment through intratumoral administration of adenoviral vectors (Ad) encoding the conditional cytotoxic molecule, i.e., HSV1-TK and the immune-stimulatory cytokine, i.e., fms-like tyrosine kinase 3 ligand (Flt3L) leads to T-cell-dependent tumor regression in rodent models of glioblastoma. We investigated the role of B cells during immune-mediated glioblastoma multiforme regression. Although treatment with Ad-TK+Ad-Flt3L induced tumor regression in 60% of wild-type (WT) mice, it completely failed in B-cell-deficient Igh6-/- mice. Tumor-specific T-cell precursors were detected in Ad-TK+Ad-Flt3L-treated WT mice but not in Igh6-/- mice. The treatment also failed in WT mice depleted of total B cells or marginal zone B cells. Because we could not detect circulating antibodies against tumor cells and the treatment was equally efficient in WT mice and in mice with B-cell-specific deletion of Prdm 1 (encoding Blimp-1), in which B cells are present but unable to fully differentiate into antibody-secreting plasma cells, tumor regression in this model is not dependent on B cells' production of tumor antigen-specific immunoglobulins. Instead, B cells seem to play a role as antigen-presenting cells (APCs). Treatment with Ad-TK+Ad-Flt3L led to an increase in the number of B cells in the cervical lymph nodes, which stimulated the proliferation of syngeneic T cells and induced clonal expansion of antitumor T cells. Our data show that B cells act as APCs, playing a critical role in clonal expansion of tumor antigen-specific T cells and brain tumor regression