Le Syndrome des Anticorps Anti Phospholipides: Une Etiologie des Fausses Couches Laquelle on Ne Pense pas Souvent en Afrique Noire

Contexte : Le syndrome des anticorps antiphospholipides est l’une des étiologies des fausses couches rarement évoquée en première intention, sous diagnostiquée en Afrique Noire. Presentation de Cas : Les auteurs rapportent l’observation d’une femme de 36 ans, aux antécédents d’ulcère de la jambe gauche, suivie au service de gynéco-obstétrique pour des fausses couches à répétition totalisant cinq (5) épisodes. Le diagnostic initial était orienté vers les causes gynéco-obstétricales, lesquelles trois cerclages du col ont été réalisés avec échec. La survenue d’une pancytopénie qui était le motif majeur de consultation de la patiente a permis de porter le diagnostic de syndrome des anticorps antiphospholipides lupiques par un titrage significatif des anticorpsantiphospholipides et des anticorps antinucléaires de spécifié anti DNA. Le traitement avec les corticoïdes, immunosuppresseurs, l’aspirine et l’héparine a permis une évolution favorable conduisait une 6è grossesse avec succès. Conclusion : Ce travail interpelle les praticiens à rechercher systématiquement le syndrome des anticorps antiphospholipides devant toutes fausses couches spontanées en vue d’un diagnostic et prise en charge précoce. Background: The antiphospholipid antibody syndrome (APL) was rarely evoked as abortion etiology in black Africa. Case Report: The authors reported a case of a 36-year-old female with a medical history of leg ulcer who presented five episodes of recurrent abortion. The diagnosis was oriented to obstetrical etiologies, and three uterine cervix cerclages were realized with failure. As a result of pancytopenia which was the main reason of consultation, the diagnosis was made with immunology test showing a high titer of antiphospholipid antibody and lupus anticoagulant. The patient was treated with corticosteroids, immunosuppressive agents, aspirin, and heparin. The 6th pregnancy was free from complications and led to the birth of a living child. Conclusion: This case calls on practitioners to systematically search for the antiphospholipid antibody syndrome during the investigation of spontaneous miscarriages for diagnosis and early management

Characteristics and Results of the Treatment of Multiple Myeloma in the Subject under the Age of 65 at the University Hospital of Yopougon in Abidjan, Côte d’Ivoire

We retrospectively studied 30 cases of multiple myeloma in patients under the age of 65, diagnosed from 1991 to 2005 in the clinical hematology department of the University Hospital of Yopougon that is a hospital incidence of 2.9 cases/year. The age of patients ranged from 34 to 64 years, with a mean age of 49 years and a sex ratio of 1.73. The professional activity was variable with 3% of radiographers and 10% of farmers. Clinically, the dominant sign was bone pain in 83% of cases. Myeloma was secretory in 93% of cases. It was Ig G-type in 86%, kappa-type in 66% of cases. 86% of patients were anemic, 20% had creatinine >20 mg/L, and 10% had serum calcium >120 mg/L. Geodes were found in 80% of cases. 53% were at stage III of DURIE and SALMON. Complications were infectious (33%), renal (20%), and hemorrhagic (7%). Chemotherapy regimens were VAD (10%), VMCP (30%), and VMCP/VBAP (60%) with 47% of partial responses, 33% of stable disease, and 7% of very good quality partial responses. The outcome developed towards death in 37% and causes of death were renal in 46% of cases. The median survival was only 5.1 months

Results of chemotherapy in the treatment of chronic lymphoid leukemia in Black Africa: Experience of Côte d’Ivoire

Background: The treatment of chronic lymphoid leukemia currently uses news drugs which are more expensive in our countries. Its why, the results of chemotherapy remains a challenge in our sector. Aims: To evaluate the place of polychemotherapy in the treatment of chronic lymphoid leukemia in black Africa. Methods: It was a prospective, descriptive, analytic and non-comparative study, concerning the records of patients with chronic lymphoid leukemia treated and followed at the department of clinical hematology in Abidjan. Results: We included 56 patients. The average age was 62 years with extremes of 38 and 84 years. The sex ratio was 0.8 in favor of female. The clinical signs noted a tumor syndrome among which splenomegaly, classified stage III (46, 43%) and adenopathy (64, 29%). Biologically, we observed a blood lymphocytosis (50%), an anemia (39.29%) and a thrombocytopenia (62.50%). The majority of patients were classified stage A of BINET (51.79%). The COP protocol (44.64%) and the monochemotherapy with chlorambucil (39.29%) were the most used. The therapeutic response of polychemotherapy was low (12.5%) compared to 35, 71% for monochemotherapy (p = 0.0001) with overall survival significantly better in monochemotherapy. The outcome of patients used polychemotherapy were more adverse that of patients used chlorambucil alone (p = 0,003). The overall probability of survival at 12 months was 90, 9% for patients who used monochemotherapy and 63, 4% for polychemotherapy. Conclusion: Polychemotherapy in chronic lymphoid leukemia of black African has an adverse therapeutic response hence the interest of using new therapeutic possibilities

Nonreplacement therapy for hemophilia in low-income countries: experience from a prospective study in Ivory Coast.

BACKGROUND: Hemophilia management has fundamentally evolved over the last decades with the development of ground-breaking therapies. Because of their mode of action and biochemical properties, these innovative therapies that are available in developed countries could be readily implemented among people from low-income countries who are either not or inadequately treated with clotting factor concentrates (CFCs). OBJECTIVES: We aimed at evaluating the impact of prophylaxis with emicizumab, a bispecific monoclonal antibody mimicking the FVIII activity administered subcutaneously, among boys with severe hemophilia A (HA) from the Ivory Coast, where access to CFCs is limited to humanitarian aid. METHODS: We prospectively collected data on the implementation and outcomes of prophylaxis with emicizumab, in 33 Ivorian boys aged 2 to 13 years with severe HA (with and without inhibitors). Bleeds, CFC consumption, quality of life and satisfaction of the patients and their parents were assessed. RESULTS: Overall, 12 months after initiating emicizumab, a 99% reduction in bleeding rates was observed, with a raise from 18% to 100% of boys having zero spontaneous joint bleeds. Three boys required a single FVIII infusion following a traumatic bleed. Health-related quality of life measures significantly improved, and perception of treatment efficacy was positively rated in children and parents. Acceptance, tolerance, and adherence were excellent. Emicizumab was instrumental in successfully implementing uninterrupted, highly efficacious, and well-tolerated prophylaxis in 72% of the Ivorian children aged ≤ 13 years identified with severe hemophilia A. CONCLUSION: These data illustrate how innovative and disruptive nonreplacement therapies that are already accessible in developed countries could potentially provide equity in care by profoundly and rapidly modifying hemophilia burden with a magnified impact in low-income countries

Fatal agranulocytosis associated with Metamizole treatment in a 16-year-old girl

Agranulocytosis is one of the common reasons of consultation in hematology. It’s life-threatening because of an infection risk. The metamizole is a drug, known for its potential rare danger of inducing a severe agranulocytosis. However, it remains widely used because of its beneficial effect analgesic and antipyretic. We report in this study, a case of a girl who was 16 years old, referred for severe agranulocytosis, and appeared two weeks after treatment with Novalgin. The clinico-biological symptoms were dominated by Streptococcal septicemia with an infectious pulmonary and digestive focus. The blood cell count confirmed a severe agranulocytosis with total disappearance of neutrophils. Despite broad-spectrum antibiotic therapy and stimulation with hematopoietic growth factor, the clinical evolution was fatal in the short term. What motivates us to add this case to those of the literature in order to remind practitioners about the danger of this drug, and to promote has doubled of vigilance during use

Efficacy and Tolerance of Vascular Electrical Stimulation Therapy in the Management of Vaso-Occlusive Crises in Patients with Sickle Cell Disease: A Phase II Single-Centre Randomized Study in Ivory Coast

Background. Vaso-occlusive crisis (VOC) is the primary cause of hospitalization in patients with sickle cell disease. Treatment mainly consists of intravenous morphine or nonsteroidal anti-inflammatory drugs (NSAIDs), which have many dose-related side effects. The question arises as to whether vascular electrical stimulation therapy (VEST) could be effective or not on VOCs. Objective. To measure the effectiveness and safety of VEST in reducing the median time spent in severe VOC. Methods. We conducted a phase II, single blinded, randomized, controlled, triple-arm, comparative trial. We included thirty (30) adult patients with severe vaso-occlusive crisis. The study arms were divided as follows: our control group (group 0) constituted of 10 patients followed with conventional therapy (Analgesics + Hydration + NSAIDs), while 20 patients were divided equally into two interventional arms—10 patients followed with VEST + Analgesics + Hydration (group 1) and the other 10 patients followed with VEST + Analgesics + Hydration + NSAIDs (group 2). The primary efficacy endpoint was median time to severe crisis elimination. The secondary end points were median time to end-of-crisis, median tramadol consumption, progress of the haemoglobin level over 3 days, side effects, and treatment failure. Results. The age ranged from 14 to 37 years, including 23 women. We noted a beneficial influence of the VEST on the median time to severe crisis (VAS greater than 2) elimination; 17 hours (group 1) against 3.5 hours (group 2) p=0.0166 and 4 hours (group 3) with p value = 0.0448. Similar significant results were obtained on the diminution of total duration of the crisis (VAS over 0) and median tramadol consumption in patients in the interventional arms. Conclusion. These statistically significant results in the interventional arms suggest that VEST could be an alternative treatment of VOC in sickle cell patients