Genital prolapse at university hospital of Cocody: clinical aspects and therapeutic management

Background: To determine the epidemiological aspects of genital prolapse; to describe the different clinical aspects of genital prolapse observed and to evaluate the therapeutic management of genital prolapse at the University hospital of Cocody (UH-C).Methods: We did an observational and transversal study with a descriptive purpose over 5 years from 2012 to 2016 in the Gynecology and obstetrics department of UH-C. The studied population was all cases of genital prolapse diagnosed and treated in the service during the period of the study. A follow-up over one year after surgery has been observed to evaluate surgical outcomes and recurrences. Genital prolapse was generally a uterine prolapse at stage 3 or 4. It was associated to cystocele in 31.4%. We did not find stress urinary incontinence associated with prolapse in our study. The surgical intervention performed was, in the majority case, the triple perineal intervention with success of 95.6%. A case of recurrence in the form of cystocele has been observed to a year of decline.Results: Genital prolapse was relatively common. It accounted for 0.5% of all gynecological visits. Women were young with an average age of 39.5 years. 62.9% were multiparous. 62.5% had given birth at least once at home without medical assistance. The reason for consultation the most watched was the projection of body at the vulva.Conclusions: Genital prolapse is a condition under estimated in Côte d'Ivoire. It represented 0.5% of the gynecological visits. Obstetric traumas were frequently found in our young patients with genital prolapse. The sociocultural considerations have contributed to delay consultations, to observe very advanced stages. The surgery performed was mainly the perineal triple surgery

Efficacity of ternidazole-neomycin sulfate-nystatin and prednisolone association in syndromic management of vaginitis in low and middle incomes countries

Background: Vaginitis is a frequent and treated based on clinical evaluation in our countries in absence of microbiological laboratories. Evaluate the effectiveness of the management of vaginitis by ternidazole, neomycin sulfate, nystatin, prednisolone association.Methods: A five-month prospective study was carried out in three health facilities in Abidjan. Two-hundred and thirty-three patients with clinical signs of vaginitis were included after signed consent. Pregnant and breast-feeding patients, hypersensitivity or idiosyncrasy to ternidazole, neomycin sulfate, nystatin, prednisolone association were not included. Patients were divided into reference group (n=200) for which a microbiological analysis of vaginal secretions was carried out 2-4 days before treatment and control group (n=33) for which treatment was initiated straightaway. Evaluation criteria were clinical symptoms, microbiological balance carried out 10 to 14 days after treatment and occurrence of side effects. Statistical tests used were Khi2 and exact Fisher test (p<0.05).Results: Pathological leucorrhoea was differently observed in both group (p=0.001). During the follow-up visit, the persistence of symptoms was not different (p=0.99). This combination has demonstrated its efficacy in cases of Candida albicans vaginitis, bacterial vaginosis, trichomonas vaginalis vaginitis, and mixed vaginitis. A significantly improvement of symptoms (p=0.001) and low rate of biologically proven recurrence was observed in both groups. No allergic reactions linked was reported.Conclusions: In our countries this therapeutic combination appears to be an option for treated mixed vaginitis in first intention without preliminary samples of vaginal secretions

Breast location of tuberculosis: a case report and literature review

Breast tuberculosis (TB) is a rare localization of extra-pulmonary TB. We report the first case observed in our daily activities to show the difficulties in the diagnosis and the good evolution in the treatment. In spite of the fact that it is rare, breast TB should not be ignored, especially in a country with high TB endemicity

Int J Cancer

As human papillomavirus (HPV) immunisation and HPV-based cervical cancer (CC) screening programmes expand across sub-Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high-risk (HR)-HPV distribution among women with CC in Cote d'Ivoire. From July 2018 to June 2020, paraffin-embedded CC specimens diagnosed in Abidjan, Cote d'Ivoire were systematically collected and tested for HR-HPV DNA. Type-specific HR-HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0-60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373-833] cells/mm(3) and 86% were on antiretroviral therapy (ART). The overall HR-HPV prevalence was 89.4% [95% CI: 84.7-94.1]. All were single HR-HPV infections with no differences according to HIV status (P = .8). Among HR-HPV-positive CC specimens, the most prevalent HR-HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9-86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3-86.5] in women without HIV (P = .3). The study confirms the major role of HPV16/18 in CC in Cote d'Ivoire and should support a regional scale-up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR-HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Cote d'Ivoire, both for WLHIV and women without HIV

Genital prolapse at university hospital of Cocody: clinical aspects and therapeutic management

Background: To determine the epidemiological aspects of genital prolapse; to describe the different clinical aspects of genital prolapse observed and to evaluate the therapeutic management of genital prolapse at the University hospital of Cocody (UH-C).Methods: We did an observational and transversal study with a descriptive purpose over 5 years from 2012 to 2016 in the Gynecology and obstetrics department of UH-C. The studied population was all cases of genital prolapse diagnosed and treated in the service during the period of the study. A follow-up over one year after surgery has been observed to evaluate surgical outcomes and recurrences. Genital prolapse was generally a uterine prolapse at stage 3 or 4. It was associated to cystocele in 31.4%. We did not find stress urinary incontinence associated with prolapse in our study. The surgical intervention performed was, in the majority case, the triple perineal intervention with success of 95.6%. A case of recurrence in the form of cystocele has been observed to a year of decline.Results: Genital prolapse was relatively common. It accounted for 0.5% of all gynecological visits. Women were young with an average age of 39.5 years. 62.9% were multiparous. 62.5% had given birth at least once at home without medical assistance. The reason for consultation the most watched was the projection of body at the vulva.Conclusions: Genital prolapse is a condition under estimated in Côte d'Ivoire. It represented 0.5% of the gynecological visits. Obstetric traumas were frequently found in our young patients with genital prolapse. The sociocultural considerations have contributed to delay consultations, to observe very advanced stages. The surgery performed was mainly the perineal triple surgery

Surgical Management of Postpartum Hemorrhage at Cocody University Hospital in the De Facto Capital City of Ivory Coast

Background: Postpartum hemorrhage (PPH) is the most common cause of maternal mortality in low-and middle-incomes countries (LMICs). It is treated surgically when first line treatments fail. The goal of the sutdy is to report the results of surgical management of PPH at a University Hospital in the Capital of Côte d’Ivoire from 2015–2017. Methods: This was a retrospective study of all cases of PPH surgically managed at the university hospital of Cocody over two years. We did not include cases of maternal soft tissue injuries such as cervical, vaginal, vulvar and perineal lacerations. We studied the sociodemographic characteristics, surgical method performed and outcome of 54 cases who were operated on for PPH. Surgical management was either Radical Uterine Surgery (RUS): postpartum hysterectomy or Conservatice Uterine Surgery (CUS): hysterography, tsirulnikov triple ligation and bilateral hypogastric artery ligation (BHAL). No embolization was performed because it is not available in our country. Data were analyzed using Stata 13.1 software 2013, StataCorp, College Station-Texas, USA. Results: Of 23,730 deliveries there were 971 cases of PPH (4.1%) 54 of which (5.6% of PPH cases) were managed surgically. Of these, 34 were after cesarean and 20 after vaginal delivery. The mean age was 30 years and the mean parity was 3. Referred patients after PPH comprised 75.9% of cases. The average time elapsed from delivery to postpartum surgery was 133 minutes ± 33.39. The average time from admission to surgery was 86 minutes ± 53. Thirty-four underwent postpartum hysterectomy (63%) and 20 CUS (37%). N = 10 women (18.5%) died, 2 status post cesarean and 8 after vaginal delivery. All died within 120 minutes of postpartum surgery. Maternal morbidity was common such as postoperative anemia (68.2%), surgical site-infection (15.9%) and endometritis (6.8%). Conclusions: Postpartum hysterectomy was generally performed in older multiparous women and CUS in younger pauciparous women. None of the surgical options showed superiority over the others, however the small sample size does not allow generalization of the results. The choice of method should be guided by the condition of the mother, the experience and skill of the surgeon, the availability of the operating room, and the possibilities of resuscitation

The context of child sexual abuse, and points of departure

This chapter sets out the context of child sexual abuse and marks out several points of departure from which the rest of the book proceeds. It first defines the concept of child sexual abuse. Then, it reviews the best literature on the prevalence of child sexual abuse both generally, and in specific contexts, around the world. It reviews other important epidemiological features, referring to evidence about gender, age of onset, the relationship between those who inflict abuse and the child, frequency of offending, factors influencing offending, and theories of offending. It notes the common health and behavioural consequences of child sexual abuse. Significantly, it then reviews literature on the common non-disclosure of child sexual abuse by both girls and boys: a critical feature of this context. The chapter than shows that the gravity of child sexual abuse should be and is recognised in international policy and in most social norms. An appropriately nuanced approach is then urged, in recognition of a spectrum of cases that demand appropriately differentiated responses. Finally, the chapter explains that the book also proceeds on the basis that in any civilised society, individuals, institutions and broader social systems and nation states have a deep ethically-based duty to prevent and identify child sexual abuse, and to respond appropriately to it after it occurs. These ethical duties are consistent with bodies of political and public health theory, the Capabilities Approach, and human dignity informing the book’s entire conceptual approach