Mortalite des accidents vasculaires cerebraux a la phase aigüe au centre Hospitalier Universitaire Souro Sanou Bobo-Dioulasso; Burkina Faso

Introduction: Les accidents vasculaires cérébraux (AVC) sont des urgences médicales fréquentes dans le monde, en particulier en Afrique, où ils sont grevés d‘une lourde mortalité.Objectif : Notre objectif était d‘analyser la mortalité et les facteurs liés au pronostic vital des patients  hospitalisés pour AVC au centre hospitalier Sourô SANOU de Bobo-Dioulasso.Méthodologie: Il s‘agit d‘une étude rétrospective portant sur les dossiers de 331 malades hospitalisés pour AVC du 1er janvier 2009 au 31 décembre 2013.Résultats: L‘âge moyen était de 61,01 ±13 ans avec un sex-ratio de 1,58 en faveur des hommes. Les principaux facteurs de risque cérébro-vasculaires retrouvés étaient l‘HTA chronique (68,23 %), le tabagisme (18,85 %), l‘antécédent d‘AVC (17,69 %), le diabète (7,35 %). Le délai moyen de consultation des cas d‘AVC était de 24 heures (42,54%). Les troubles de la conscience étaient notés chez 38,20% des AVC. La mortalité intra hospitalière était de 28,21% avec des décès survenant principalement dans les 24 premières heures (86,67%). Les facteurs associés à la mortalité étaient l‘âge (p=0,001; OR 2,4 ; IC95%1,4-4,1), le coma (p<0,001; OR= 3,8 ; IC95% :1,8-8,1), le type d‘AVC (p=0,007; OR= 2,0 ; IC95%:1,2-3,3), la prescription de mesures de réanimation (p <0,001; OR= 3,5 ; IC95%:1,6-7,8) ainsi que l‘hospitalisation en unité de réanimation (p <0,001; OR= 9,9 ; IC95%: 4,8-20,6).Conclusion: La mortalité intra hospitalière des AVC à Bobo Dioulasso reste élevée et survient surtout à la phase aigüe.   English title: Mortality among patients admitted for acute stroke in Sourô Sanou Teaching Hospital of Bobo-Dioulasso; Burkina Faso Introduction: Strokes are frequent medical emergencies in the world, especially in Africa, where they are burdened by a heavy mortality.Objective: Our objective was to analyze mortality and factors linked to the prognosis for survival of the patients hospitalized for stroke in Sourô SANOU teaching hospital of Bobo-Dioulasso.Methodology: It was a retrospective study concerning the cases of 331 patients admitted to hospital for stroke from January 1st, 2009 to December 31st, 2013.Results: The mean age was 61.01 (±13 years). The sex-ratio was 1.58. Chronic high blood pressure (68.23 %), smoking (18.85 %), history of stroke (17.69 %), diabetes (7.35 %) were the most frequent cerebro-vascular risk factors in past medical history. The average time for consultation was 24 hours (42.54 %). Loss of consciousness was noted in 38.20 % of the stroke patients. The fatality rate was 28.21 % occurring mostly during the first 24 hours. The factors associated with mortality were age (p=0.001; OR 2.4 ; IC95% :1.4-4.1), coma (p<0.001; OR= 3.8 ; IC95% :1.8-8.1), type of stroke (p=0.007; OR= 2.0 ; IC95%:1.2-3.3), prescription of resuscitation‘s measures (p <0.001; OR= 3.5 ; IC95%:1.6-7.8) and hospitalization in resuscitation unit (p <0,001; OR= 9.9 ; IC95%: 4.8-20.6).Conclusion: The in hospital m rtality remains high and occurs mainly in acute stage in stroke patients in Bobo Dioulasso

Les cardiopathies de l’enfant au CHU Souro Sanou de Bobo-Dioulasso: aspects échocardiographies et thérapeutiques

Les cardiopathies de l'enfant déterminent en Afrique un problème de santé publique difficile à prendre en charge, de part la densité de la population jeune, le faible niveau socioéconomique et l'insuffisance de plateaux techniques adaptés. Les auteurs rapportent les aspects échocardiographiques et thérapeutiques des cardiopathies de l'enfant dans le département de pédiatrie du CHUSS de Bobo-Dioulasso. Il s'agissait d'une étude transversale descriptive concernant la période de janvier 2013 à décembre 2014 (24 mois). Elle a consisté en une revue documentaire des comptes rendus d'échocardiographies réalisées chez les enfants de moins de 15 ans dans le laboratoire d'échocardiographie du CHUSS et de leurs dossiers de suivi thérapeutique. Durant la période d'étude, 184 examens écho-cardiographiques avaient été réalisés et permis la mise en évidence de 93 cas de cardiopathies de l'enfant, soit 50,50% des cas. Parmi eux, on distinguait 71% (66/93) de cardiopathies congénitales et 29% (27/93) de cardiopathies acquises. Les cardiopathies congénitales les plus fréquentes étaient : la CIV (27,2%), CIA (10,6%), CAV (7,5%), T4F (9,1%), TAC (6%), formes associées (15%). Les cardiopathies acquises étaient dominées par les valvulopathies rhumatismales (48%), la cardiomyopathie dilatée hypokinétique (33,3%) et la tamponnade péricardite (18,5%). L'indication chirurgicale était posée dans 53,7% (50/93) des cas dont 86% (43/50) de cardiopathies congénitales et 14% (7/50) de cardiopathies acquises. 21% (9/43) des cardiopathies congénitales ont bénéficié d'une chirurgie cardiaque. Aucune cardiopathie acquise d'indication thérapeutique chirurgicale n'avait été opérée. Les cardiopathies de l'enfant sont fréquentes à Bobo-Dioulasso. La conception de stratégies multidisciplinaires associées à une optimisation des moyens devraient améliorer la prise en charge de ces cardiopathies.The Pan African Medical Journal 2016;2

Factors associated with change in Stiffness index during second-line antiretroviral treatment in multivariable analysis.

<p>Factors associated with change in Stiffness index during second-line antiretroviral treatment in multivariable analysis.</p

Evolution of bone quality by treatment received.

<p>Bone Quality was assessed by calcaneal quantitative ultrasound Stiffness index (Achilles, GE Healthcare, Little Chalfont, UK).</p

HIV infection related characteristics at baseline.

<p>HIV infection related characteristics at baseline.</p

TDF and quantitative ultrasound bone quality in African patients on second line ART, ANRS 12169 2LADY sub-study.

Bone demineralization, which leads to osteoporosis and increased fracture risk, is a common metabolic disorder in HIV-infected individuals. In this study, we aimed to assess the change in bone quality using quantitative ultrasound (QUS) over 96 weeks of follow-up after initiation of second-line treatment, and to identify factors associated with change in bone quality.In a randomized trial (ANRS 12169), TDF and PI-naïve participants failing standard first-line treatment, from Burkina Faso, Cameroon, and Senegal were randomized to receive either TDF/FTC/LPVr, ABC/ddI/LPVr or TDF/FTC/DRVr. Their bone quality was assessed using calcaneal QUS at baseline and every 24 weeks until week 96. Stiffness index (SI) was used to measure bone quality. Out of 228 participants, 168 (74%) were women. At baseline, median age was 37 years (IQR: 33-46 years) and median T-CD4 count was 199 cells/μl (IQR: 113-319 cells/μl). The median duration of first-line antiretroviral treatment (ART) was 52 months (IQR: 36-72 months) and the median baseline SI was 101 (IQR: 87-116). In multivariable analysis, factors associated with baseline SI were sex (β = -10.8 [-18.1,-3.5] for women), age (β = -8.7 [-12.4,-5.1] per 10 years), body mass index (BMI) (β = +0.8 [0.1,1.5] per unit of BMI), and study site (β = +12.8 [6.5,19.1] for Cameroon). After 96 weeks of second-line therapy, a reduction of 7.1% in mean SI was observed, as compared with baseline. Factors associated with SI during the follow-up were similar to those found at baseline. Exposure to TDF was not associated with a greater loss of bone quality over time.Bone quality decreased after second-line ART initiation in African patients independently of TDF exposure. Factors associated with bone quality include age, sex, baseline BMI, study site, and duration of follow-up

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population