24 research outputs found

    Risk factors for surgical site infections after caesarean section at Yaounde, Cameroon

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    Background: Surgical site infection is the invasion by microorganisms of the tissue layers affected by the surgical procedure. Maternal morbidity from infections has been shown to be higher after caesarean section compared to the vaginal delivery. Objective of the research was to analyze the risk factors associated with surgical site infections after caesarean section.Methods: This was a cross sectional (affected/non affected) study approved by the institutional committee for ethics and research of the faculty of medicine and biomedical sciences. A total of 310 medical files were assessed, 62 files from patients with surgical site infections and 248 files from patients without any complications. The data was collected using a pretested questionnaire and analyzed using the statistical package for the social sciences (SPSS) software version 22.0. The Chi squared and the Fisher exact tests were used to assess homogeneity between the 2 groups. Odd ratio 95% confidence interval was used to assess the association between the variables.Results: The proportion of surgical site infections during the study was 1.81%. Factors associated with surgical site infections were premature rupture of membranes (OR: 2.065; 95% CI 1.051-4.05; p=0.035); the vertical midline incision (OR=5.26; 95% CI; 1.41-19.57; p=0.013) and a operation by a resident physician doctor (OR=1.98; 95% CI 1.09-3.59; p=0.02).Conclusions: A factors associated with surgical site infections after caesarean section are a premature rupture of membranes, vertical midline incision and the qualification of the practitioner

    Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa.

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    OBJECTIVE: To report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV) and anogenital warts (AGW) among women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA), and to explore HIV-related factors associated with these outcomes. METHODS: We enrolled 1238 WLHIV (BF = 615; SA = 623) aged 25-50 years and followed them at three time points (6, 12 and 16 months) after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW. RESULTS: Women in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p500 cells/μL). Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes. CONCLUSION: LR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population

    Human Papillomavirus Serology Among Women Living With HIV: Type-Specific Seroprevalence, Seroconversion, and Risk of Cervical Reinfection.

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    Background: Human papillomavirus (HPV) serodynamics following infection has never been evaluated prospectively among women living with HIV (WLHIV). We determined HPV seroprevalence, seroconversion, and cervical HPV-DNA acquisition among WLHIV. Methods: Prospective study of 604 WLHIV in Johannesburg, South Africa aged 25-50 years. At baseline and 16 months (endline), HPV type-specific antibodies (HPV6/11/16/18/31/33/35/39/45/52/56/58/59/68/73) were measured using HPV-pseudovirions and cervical HPV-DNA genotypes using INNO-LiPA. Results: Seroprevalence of any-HPV was 93.2% and simultaneous seropositivity for HPV types of the bivalent (HPV16/18), quadrivalent (HPV6/11/16/18), and nonavalent (HPV6/11/16/18/31/33/45/52/58) vaccines were 21.4%, 10.9%, and 2.8%. Among 219 women with cervical HPV-DNA, same-type seronegative and without high-grade cervical intraepithelial neoplasia at baseline, 51 (23.3%) had type-specific seroconversion at endline. Risk of type-specific seroconversion was higher among recent antiretroviral therapy users (ART ≤2 years vs ART naive: adjusted OR [aOR] = 2.39; 95% CI, 1.02-5.62), and lower among women with low CD4+ at endline (≤350 vs >350 cells/mm3: aOR = 0.51; 95% CI, 0.24-1.07). Risk of cervical HPV-DNA acquisition was lower in women seropositive for HPV18, 35, and 58 at baseline. Conclusion: WLHIV have evidence of seroconversion in response to baseline HPV-DNA, dependent on CD4+ count and ART. Baseline HPV seropositivity confers limited protection against some HPV types

    Diagnostic value of human papillomavirus (HPV) 16 and HPV18 viral loads for the detection of high-grade cervical intraepithelial neoplasia (CIN2+) in a cohort of African women living with HIV.

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    BACKGROUND: African women living with HIV (WLHIV) are at high risk of cervical cancer but rarely adequately screened. Better strategies enabling identification of WLHIV with high-grade cervical intraepithelial lesions (CIN2+) are required. OBJECTIVES: To investigate the diagnostic value of HPV16 and HPV18 viral loads in a cohort of African WLHIV. DESIGN: HPV16 and HPV18 viral loads were determined by quantitation of the E6 gene DNA by real-time PCR in cervical specimens collected at baseline and endline (16 months) from 245 African WLHIV positive for HPV16 or/and HPV18. Cervical biopsies were graded using the histopathological CIN classification. RESULTS: Women with CIN2+ had higher viral load for HPV16 (p < 0.0001) or HPV18 (p = 0.03) than those without CIN2+. HPV16 viral load ≥3.59 log copies/1000 cells detected CIN2+ with sensitivity and specificity of 93.5% (95%CI: 81.7-98.3%) and 74.1% (95%CI: 66.3-80.6%), respectively, whereas HPV18 viral load ≥1.63 log copies/1000 cells detected CIN2+ with sensitivity and specificity of 59.1% (95%CI: 38.7-76.7%) and 66.9% (95%CI: 58.8-74.1%), respectively. A high baseline HPV16 viral load was significantly associated with persistence of, or progression to CIN2+ at endline; these findings were not observed for HPV18. CONCLUSIONS: HPV16 viral load is a powerful marker of CIN2+ in African WLHIV. HPV18 viral load is of lower diagnostic value in this population

    Associations of Human Papillomavirus (HPV) genotypes with high-grade cervical neoplasia (CIN2+) in a cohort of women living with HIV in Burkina Faso and South Africa.

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    OBJECTIVE: To describe associations of high-risk human papillomavirus (HR-HPV) with high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA). METHODS: Prospective cohort of WLHIV attending HIV outpatient clinics and treatment centres. Recruitment was stratified by ART status. Cervical HPV genotyping using INNO-LiPA and histological assessment of 4-quadrant cervical biopsies at enrolment and 16 months later. RESULTS: Among women with CIN2+ at baseline, the prevalence of any HR-HPV genotypes included in the bi/quadrivalent (HPV16/18) or nonavalent (HPV16/18/31/35/45/52/58) HPV vaccines ranged from 37% to 90%. HPV58 was most strongly associated with CIN2+ (aOR = 5.40, 95%CI: 2.77-10.53). At 16-months follow-up, persistence of any HR-HPV was strongly associated with incident CIN2+ (aOR = 7.90, 95%CI: 3.11-20.07), as was persistence of HPV16/18 (aOR = 5.25, 95%CI: 2.14-12.91) and the additional HR types in the nonavalent vaccine (aOR = 3.23, 95%CI: 1.23-8.54). CONCLUSION: HR-HPV persistence is very common among African WLHIV and is linked to incident CIN2+. HPV vaccines could prevent between 37-90% of CIN2+ among African WLHIV

    Les avortements clandestins au Centre Hospitalier Universitaire de Libreville de 2014 Ă  2018 : Ă  propos de 212 cas

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    Objectif : Cette étude avait pour but d’étudier les aspects épidémiologiques cliniques et thérapeutiques des avortements clandestins dans le service de gynécologie interne du Centre Hospitalier Universitaire de Libreville de 2014 en 2018. Patients et méthodes : Il s’est agi d’une étude rétrospective, descriptive qui s’est déroulée du 1er janvier au 31 décembre 2018. Elle a porté sur toutes les patientes ayant pratiquées un avortement clandestin avec un âge gestationnel inférieur ou supérieur à 12 semaines aménorrhée, mariées ou célibataires, admises et/ou prise en charge dans le service de gynécologique interne du CHUL, dans la période de l’étude quelle que soit leur provenance. L’approche de collecte était une enquête par dépouillement de dossiers médicaux assortie à une étude des registres de compte rendu d’hospitalisation. Résultats : La fréquence moyenne annuelle des avortements provoqués était de 50±3,1 avortements pour 1000 accouchements. Cette fréquence a été multipliée par 5 en 2014 et 2018. L’âge moyen était de 27,3± 6,6 ans avec des extrêmes de 14 et 50ans. La majorité, soit 62,3% était du niveau secondaire, 79,9% était célibataires. L’âge gestationnel était connu pour 60,4% et inférieur à 12 semaines d’aménorrhée dans 46,7% des cas. Deux ethnies étaient majoritairement représentées : les fangs 32,1% et les punus 25,5%. Le lieu de l’avortement était principalement le domicile familial pour 72,6% des patientes. La méthode abortive utilisée était principalement le comprimé de misoprostol à 58,0%. Le motif de l’avortement était à 52,8% une grossesse non désirée plus ou moins associée à 22,6% à un manque de moyens financiers. Sur le plan clinique, le diagnostic retenu était principalement l’avortement compliqué d’une hémorragie (55,6%). La prise en charge comprenait : le&nbsp; remplissage vasculaire (59,0%), l’AMIU (50,9%), l’antibiothérapie (88,6%) dominé par le métronidazole à 53,3%, la transfusion (60,8%), le fer et les acides foliques (35,4%), utérotonique (34,0%). La complication majeure était l’anémie (71,7%). L’évolution était favorable pour 92,5% dont 75% (soit 16/212) sont décédés en cours d’hospitalisation. Conclusion : L’avortement clandestin demeure un problème de santé publique dans notre pays, de par sa fréquence croissante, et ses omplications à type d’hémorragie pouvant engager le pronostic vital. La technique d’Aspiration Manuelle Intra utérine (AMIU) a encore montré son efficacité dans la prise en charge des complications de cette pratique avant l’âge gestationnel de 12 semaines d’aménorrhée. Sensibiliser davantage les populations sur les méthodes contraceptives et élargir sur le plan juridique l’accès à l’avortement médicalisé au premier trimestre de grossesse, pourraient amoindrir l’incidence et les complications de ces avortements dans notre region. Mots clés : Epidémiologie, clinique, thérapeutique, avortement clandestin, Libreville English Abstarct: Clandestine abortions at the Libreville University Hospital Center from 2014 to 2018: About 212 cases Objective: The aim of this study was to investigate the clinical and therapeutic epidemiological aspects of clandestine abortions in the internal gynecology department of the University Hospital of Libreville from 2014 to 2018. Patients and methods: This was a retrospective, descriptive study that took place from January 1 to December 31, 2018. It focused on all patients who had performed a clandestine abortion with a gestational age of less than or greater than 12 weeks of amenorrhea, married or single, admitted and/or managed in the internal gynecological service of the CHUL, in the period of the study regardless of their origin. The collection approach was a medical record survey combined with a study of hospitalization records. Results: The average annual frequency of induced abortions was 50±3.1 abortions per 1000 deliveries. This frequency increased 5-fold in 2014 and 2018. The average age was 27.3± 6.6 years extreme 14 and 50 years. The majority, 62.3% were of secondary school level, 79.9% were single. Gestational age was known for 60.4% and less than 12 weeks of amenorrhea in 46.7% of cases. Two ethnic groups were predominantly represented: the Fangs (32.1%) and the Punus (25.5%). The place of abortion was mainly the family home for 72.6% of patients. The abortion method used was mainly misoprostol tablets (58.0%). The reason for the abortion was an unwanted pregnancy in 52.8% of cases, more or less associated with a lack of financial means in 22.6%. Clinically, the diagnosis was mainly abortion complicated by hemorrhage (55.6%). Management included: vascular filling (59.0%), MVA (50.9%), antibiotic therapy (88.6%) dominated by metronidazole (53.3%), transfusion (60.8%), iron and folic acids (35.4%), uterotonic (34.0%). The major complication was anemia (71.7%). The evolution was favorable for 92.5% of which 75% (16/212) died during hospitalization. Conclusion: Clandestine abortion remains a public health problem in our country, due to its increasing frequency, and its complications such as hemorrhage that can be life threatening. The IMIU technique has again shown its effectiveness in the management of complications of this practice before the gestational age of 12 weeks of amenorrhea. Increased awareness of contraceptive methods and legal access to medical abortion in the first trimester of pregnancy could reduce the incidence and complications of these abortions in our religion. Keywords: Epidemiology, clinical, therapeutic, clandestine abortion, Libreville

    Global prevalence and incidence of surgical site infections after appendectomy: a systematic review and meta-analysis protocol.

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    Acute appendicitis is a surgical emergency and the most frequent aetiology of acute surgical abdominal pain in developed countries. Universally, its widely approved treatment is appendectomy. Like all surgical procedures, appendectomy can be associated with many complications among which are surgical site infections (SSIs).Despite the increasing number of appendectomies done around the world and the associated morbidities related to SSI after appendectomy, there is still scarcity of data concerning the global epidemiology of SSI after appendectomy. The current review aims at providing a summary of the published data on epidemiology of SSI after appendectomy. We will include randomised controlled trials, cohort studies, case-control and cross-sectional studies. Electronic databases including Embase, MEDLINE and ISI Web of Science (Science Citation Index) will be searched for relevant abstracts of studies published between 1 January 2000 and 30 December 2017, without language restriction. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After screening of abstracts, study selection, data extraction and assessment of risk of bias, we shall assess the studies individually for clinical and statistical heterogeneity. Appropriate meta-analytic techniques will then be used to pool studies judged to be clinically homogenous. Visual inspection of funnel plots and Egger's test will be used to detect publication bias. Results will be presented by country and continent. Since primary data are not collected in this study, ethical approval is not required. This review is expected to provide relevant data to help in quantifying the global burden of SSI after appendectomy. The final report will be published in a peer-reviewed journal. CRD42017075257

    Relative faible taux de mortalité de la COVID-19 au Cameroun : et si l’âge était le principal facteur ?

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    Depuis le début de la pandémie à COVID-19, un scénario catastrophique en termes de mortalité avait été prédit en Afrique subsaharienne. Dans cette correspondance, à partir des données de mortalité belge selon l’âge, nous réalisons une extrapolation à la population du Cameroun. Cette extrapolation montre que même avec le scénario belge, on devrait s’attendre à environ 2.319 décès par COVID-19 au Cameroun, soit une mortalité par habitant 10,3 fois moindre. En conclusion, la jeunesse de la population camerounaise pourrait être un des principaux facteurs de faible mortalité liée à la COVID-19 dans ce pays. Cependant des études sont nécessaires pour éliminer d’autres facteurs, notamment génétiques et environnementaux.[Relatively low mortality rate of COVID-19 in Cameroon: what if age was the main factor?] Since the beginning of the COVID-19 pandemic, a catastrophic scenario in terms of mortality was predicted in Sub-Saharan Africa. In this correspondence, we have compared adjusted case fatality rate of Belgian to that of Cameroon. Our estimates showed that, even with the Belgian scenario, about 2319 COVID-19 deaths should be expected in Cameroon, i.e. 10.3 times lower per inhabitant mortality. In conclusion, the youthfulness of the Cameroonian population could be the main factor of low mortality rate related to COVID-19 in this country. However, studies are needed to eliminate other factors, notably genetic and environmental
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