Treatment of Fractures in Black Africa: The Current State of Play

Editorial Comment by Dr. Packo Dieu-le-veut Saint-Cyr Sylvestre, Member, International Editorial Board, IHRJ and Dr. Feigoudozoui Hermann Victoir

Primary Gastric Localization of Diffuse Large Cell Lymphoma and Viral Hepatitis C. A Case Report at the Department of Clinical Hematology of University Hospital of Yopougon, Abidjan (Côte d’Ivoire)

Non-Hodgkin's lymphomas are characterized by its clinical and pathological polymorphism. In the stomach, MALT lymphomas are common and mostly associated with Helicobacter Pylori infection. We report a case of 76-year old women with a medical history of chronic stomach pain, addressed for the investigation of normochromic normocytic anemia. The clinical picture included signs of digestive hemorrhage and stomach pain. Gastrointestinal endoscopy and histology noted an unspecified ulcer-budding tumor without signs of Helibacter pylori infection. Immunohistochemistry concluded to diffuse large B cell lymphoma with CD79b +, BCL10 +/-, BCL2+, BCL6 +, MUM1+. The Ann Arbor classification was  stage IE. The serology of Helicobacter pylori was negative. Pre-treatment investigation noted a comorbity with Hepatitis C infection. This study has two interests. Firstly the rarity of the localization of this lymphoma, and secondly, the etiopathological interest because of association with hepatitis C virus

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

Evolutionary profile of patients with hemoglobin SC disease regularly followed in Côte d'Ivoire

Background: West Africa is recognized as the elective focus of hemoglobin C. The S and C combination in the same patient gives a major sickle cell syndrome. In our country, very few series dealing with the evolutionary features of this SC form have been published contrary to the homozygous SS form. The aim of this study was to describe the evolutionary profile of double heterozygous SC sickle cell patients.Methods: This was a retrospective and prospective study with descriptive and analytical purpose of 174 SC sickle cell patients.Results: The median age was 26 years with extremes of 6 years and 57 years. 96% of patients had less than 4 vaso-occlusive seizures per year. The evolutionary complications were mainly ischemic (56.30%) and infectious (39.10%). Among ischemic complications, sickle cell retinopathies and aseptic osteonecrosis are the most common with 59.20% and 31.63% respectively. Infectious complications were dominated by ENT (36.76%) and osteoarticular (35.29%) infections. Only age had an influence on the occurrence of ischemic complications (p = 0.0001). The probability of survival at 5 years was 99.38% and that at 20 years was 91.57%. The overall survival was not influenced by evolutionary complications.Conclusions: Infectious and ischemic evolutionary complications show the importance of vaccination and an early screening program

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

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

Caractéristiques cliniques, biologiques, thérapeutiques et évolutives des leucémies aigues en République Centrafricaine

Introduction: leucémies aigues restent encore non documentées aux milieux hospitaliers République Centrafricaine. Objectif: Décrire les caractéristiques, cliniques, biologiques, thérapeutiques et évolutives des patients Centrafricains porteurs d’une leucémie aigüe. Matériels et méthodes: il s’agissait d’une étude descriptive menée sur une période de 5 ans dans les centres hospitaliers de Bangui. Le diagnostic des leucémies était retenu par le myélogramme en exigeant un nombre de blastose ≥ 20%. Notre échantillon était constitué de 27 patients. Les paramètres épidémiologiques, cliniques, biologiques, thérapeutiques étaient étudiés. Résultats: L’âge moyen des patients était de 29,1 ans avec les extrêmes de 3 et 75 ans. La prédominance de sexe était masculine, un sexe ratio de 1.7. 62,9% des patients résidaient en zone rurale et étaient agriculteurs (29,6%), commerçants (22,2%). Les facteurs de risques étaient l’exposition aux pesticides (22.2%) et benzènes (25.9%). Le tableau clinique était dominé par une altération de l’état général (85,2%), les signes d’insuffisance médullaire (100%), le syndrome tumoral (51.2%). Au plan biologique, l’anémie et la thrombopénie étaient constantes. Les types cytologiques selon FAB étaient les LAL1 (29,6%), LAL2 (14,8%), LAL3 (7,4%), LAM1 (18,5%), LAM2 (3,7%), LAM3 (7%). Les protocoles thérapeutiques associant Oncovin-Prednisone et Oncovin Prednisone-Cytarabine selon le type de leucémie étaient utilisés avec 18.5% de réponse partielle, aucune rémission complète, 59.2% de décès, 37% de perdu de vue. La probabilité de survie à 1 mois est de 59%, 43% à 2 mois et elle est nulle à 3 mois. Conclusion: Les leucémies aigues restent une affection grave et potentiellement mortelle en République Centrafricaine. La prise en charge reste un challenge et nécessite l’amélioration de nos plateaux technique. Mots clés: Leucémie aigüe, République Centrafricaine English Title: Clinical, biological, therapeutic and evolutionary characteristics of acute leukemia in the Central African Republic. English Abstract Introduction: acute leukaemias still remain undocumented in Central African Republic. Objective: To describe the clinical, biological, therapeutic and evolutionary characteristics of Central African patients with acute leukemia. Materials and methods: It was a descriptive study with duration of 5 years, conducted in Bangui. The diagnosis of leukemia was required a number of blastosis ≥ 20%. Our sample consisted of 27 patients. The epidemiological, clinical, biological and therapeutic parameters were studied. Results: The mean age of the patients was 29.1 years with the extremes of 3 and 75 years. The sex predominance was male, a sex ratio of 1.7. 62.9% of patients lived in rural areas and were farmers (29.6%), traders (22.2%). The risk factors were exposure to pesticides (22.2%) and benzenes (25.9%). The clinical picture was dominated by deterioration in general condition (85.2%), signs of bone marrow failure (100%), tumor syndrome (51.2%). Biologically, anemia and thrombocytopenia were constant. The cytologic types according to FAB were LAL1 (29.6%), LAL2 (14.8%), LAL3 (7.4%), LAM1 (18.5%), LAM2 (3.7%), LAM3 (7 %). The treatment protocols combining Oncovin-Prednisone and Oncovin Prednisone-Cytarabine according to the type of leukemia were used with 18.5% partial response, no complete remission, 59.2% death, 37% loss to follow-up. The probability of survival at 1 month is 59%, 43% at 2 months and it is zero at 3 months. Conclusion: Acute leukemia remains a serious and potentially fatal condition in the Central African Republic. Support remains a challenge and requires the improvement of our technical platforms. Key words: Acute leukemia, Central African Republi

Hypercalcémie importante révélant un myélome multiple chez une adolescente de 19 ans

Le myélome multiple est caractérisé par une prolifération des plasmocytes malins sécrétant une immunoglobuline monoclonale complète ou incomplète. C’est une affection de l’adulte mûr. L’âge moyen de survenue est au-delà de 50 ans, rare avant 40 ans et exceptionnel chez les enfants ce qui fait qu’il n’est pas toujours évoqué en première intention chez les sujets jeunes en Afrique Noire. Nous rapportons dans cette étude, l’observation d’une adolescente de 19 ans, sans antécédents pathologiques particuliers, adressée dans notre service pour l’investigation d’une anémie sévère. La symptomatologie était dominée par une hypercalcémie importante inexpliquée associée à une insuffisance rénale. Le myélogramme fait dans le compte d’une anémie normochrome normocytaire arégénérative notait une infiltration médullaire d’environ 12 % par les plasmocytes dysmorphiques. La présence d’une immunoglobuline monoclonale IgG exprimant la chaine légère de type kappa à l’immunofixation des protéines urinaires et les lésions osseuses multiples ont permis de porter le diagnostic de myélome multiple. La chimiothérapie par le protocole VRD a permis une rémission partielle avec correction de la calcémie. L’intérêt de cette étude réside dans le caractère exceptionnel de cette affection à cette tranche d’âge suscitant un intérêt étiopathogénique. Ceci devait motiver les praticiens à y penser devant les signes révélateurs chez les sujets jeunes.Mots-clés: Myélome multiple, adolescent, AbidjanEnglish Title: Significant hypercalcaemia revealing multiple myeloma in young girls of 19-year-oldEnglish AbstractMultiple myeloma is characterized by proliferation of malignant plasma cells secreting complete or incomplete monoclonal immunoglobulin. It is an affection of the elderly. The average age of onset is beyond 50 years old, rare before 40 years old and exceptional in children so that it is not always evoked in first intention in young people in Black Africa. We report, the case of the girl who was 19 years old, with no particular medical history, adressed for the investigation of severe anemia. The symptomatology was dominated by unexplained significant blood calcemia associated with renal failure. The bone marrow exam, done because of an aregenerative normocytic normochromic anemia noted an infiltration about 12% of dysmorphic plasma cells in the bone marrow. The monoclonal IgG immunoglobulin expressing the kappa light  chain found during the urinary proteins immunofixation and multiple bone lesions confronted to the diagnosis of multiple myeloma. The chemotherapy with the VRD protocol allowed a partiel remission with correction of the calcemia. The interest of this study resides in the exceptional character of the affection with this age group and which arouses an etiopathogenic interest. This should motivate practitioners to think about it during signs in young people.Keywords: Multiple myeloma, young people, Abidja