RESUMEN
Introduction: The life of a couple is a place of emotional support. It can allow the management of patients infected with HIV on antiretroviral therapy to be optimized.The objective of our study was to analyze the impact of married life on the therapeutic follow-up of patients living with HIV. Methodology: We carried out a mono-centric, prospective, descriptive and analytical study in the care unit of patients living with HIV of the pneumology service of the Cocody Teaching Hospital in Abidjan. The investigation took place from September 1, 2015 to March 31, 2016. Results: We included 411 patients. The sex ratio was 0.51. The average age was 43.2 years with extremes of 19 and 69 years. The patients lived as a couple in 59.1% of cases. Couple life was associated with severe immunosuppression at 12 months in 23.3% (42/180) of cases [p = 0.043 OR = 1.735 (0.964 - 3.121)], the appearance of new opportunistic conditions between the 6th and the 12th month of treatment in 5.6% (13/232) of cases [p = 0.006; OR = 9.438 (1.222 - 72.890)], information sharing with the partner before the start of treatment in 92.4% (208/225) of cases [p = 0.035; OR = 1.976 (1.005-3886)] and the existence of sexual intercourse since the discovery of the disease in 92.6% (225/243) of cases [p < 0.001; OR = 14.423 (8.174 - 25.448)]. Sexual relationships were less protected among people living in a couple 65.9% (149/226) versus 78% (64/82) among others [p = 0.027; OR = 0.544 (0.301 - 0.923)]. The loss of the sexual partner at the onset of the disease was observed regardless of marital status (p = 0.203). Conclusion: The life of a couple negatively influences the management of HIV infection. It appears necessary to set up counseling and testing programs for couples.
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Infecciones por VIH , Neumología , Adulto , Côte d'Ivoire/epidemiología , Infecciones por VIH/tratamiento farmacológico , Hospitales de Enseñanza , Humanos , Estudios ProspectivosRESUMEN
BACKGROUND: Developed initially for the diagnosis of multidrug-resistant tuberculosis, the Xpert® MTB/RIF test has shown to be useful for the diagnosis of tuberculosis, especially among HIV-infected subjects. The objective of the study was to determine the contribution of the Xpert® MTB/RIF test for routine pulmonary tuberculosis diagnosis in an endemic area. METHODOLOGY: We undertook a prospective study among patients presenting with cough and sputum. The sputum was submitted to microscopic examination, to the Xpert® MTB/RIF test and cultured by the Mycobacteria growth indicator tube (MGIT) technique. The study compared cases of pulmonary tuberculosis confirmed by a positive sputum culture and cases with cough but negative sputum culture. RESULTS: In multivariate analysis, the factors associated with positive cultures were the following: male gender, cough for more than 2 weeks, loss of weight and fever. The estimated clinical suspicion score consisted of 4 signs each having a coefficient of 1. The sensitivity of each clinical sign varied between 79 and 94%. In 348 cases of negative microscopic examination (composed of 295 cases with score<4 and 53 cases with score=4), the predictive positive value of the Xpert® MTB/RIF was 80% for a score equal to 4 and 40.9% for a score<4. In cases of negative microscopic examination of the sputum, the Xpert® MRT/RIF test should be undertaken if the score=4. CONCLUSION: The diagnosis of tuberculosis in endemic zones could be improved by using the Xpert® MTB/RIF.
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Técnicas Bacteriológicas/métodos , Pruebas Diagnósticas de Rutina/métodos , Esputo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Enfermedades Endémicas/estadística & datos numéricos , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
UNLABELLED: Multidrug resistance tuberculosis (MDR-TB) of health workers raises the question of hospital-borne transmission of infection. OBSERVATIONS: We report 4 cases of MDR-TB confirmed at the health workers over a period of 8 years (January, 2005 to December 2012), in the 2 services of pulmonology from Abidjan to Côte d'Ivoire). It was about young grown-up patients (aged between 28 and 39 years), all HIV negatives, in a no-win situation of antituberculosis treatment (3 patients/4). The most concerned staffs were the male nurses (2/4). Two agents worked in general hospital and the only one in a pulmonology department at the time of the diagnosis. The tuberculosis was of lung seat with bilateral radiographic hurt (3/4) and multiples excavations (4/4). The case index, when it was identified (2/2), was a family case. Among 3 agents who benefited from a second line treatment, 1 died further to an extensive drug resistance and 2 are declared to be cured. The fourth died before the beginning of the treatment. These cases of cure were in touch with a premature care. CONCLUSION: Multidrug resistant tuberculosis at the health workers could have a negative impact on the antituberculosis fight imposing rigorous measures of infection control and better implication of the occupational medicine.
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Personal de Salud , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Côte d'Ivoire , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/tratamiento farmacológico , Resultado Fatal , Femenino , Humanos , Masculino , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/transmisiónRESUMEN
INTRODUCTION: The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. CONCLUSION: XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.
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Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Antituberculosos/uso terapéutico , Côte d'Ivoire , Quimioterapia Combinada , Tuberculosis Extensivamente Resistente a Drogas/diagnóstico , Resultado Fatal , Femenino , Humanos , Radiografía , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.
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Accidentes de Trabajo , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades del Sistema Nervioso/inducido químicamente , Contaminación por Petróleo/efectos adversos , Trastornos Respiratorios/inducido químicamente , Adolescente , Adulto , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Côte d'Ivoire/epidemiología , Estudios Transversales , Exposición a Riesgos Ambientales , Oftalmopatías/inducido químicamente , Oftalmopatías/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades de los Genitales Femeninos/inducido químicamente , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Trastornos Respiratorios/epidemiología , Estudios Retrospectivos , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/epidemiología , Evaluación de Síntomas , Adulto JovenRESUMEN
This is a retrospective study conducted from January 2008 to December 2010 on sectional descriptive analysis of records of patients treated for MDR-TB and whose follow-up was in the thoracic department of Centre Hospitalier Universitaire (CHU) of Cocody in Abidjan Côte d'Ivoire. We selected eight patients who met the inclusion criteria of 21 MDR-TB patients registered during the study period. The average age was 29.25years ranging from 21 to 39. Males accounted for 75% of the patients (6 males and 2 females). The students represented the professional social layer most affected with 37.5% of the patients. All patients had a history of tuberculosis and only one patient was HIV positive under anti-retroviral (zidovudin, lamivudin and efavirenz). All cultures found Mycobacterium tuberculosis. The resistance profile in addition to isoniazid and rifampicin, found two cases of resistance to ethambutol and streptomycin. The chest radiograph at the time of initiation of second-line treatment showed essentially excavations in 75% of cases and infiltrates in 25%. The lesions were bilateral in 7 of 8 patients (87.5%). The main side effects observed during treatment were limited to cochleovestibular disorders (2 patients) and neuropsychiatric disorders (2 patients) and digestive disorders in half of the patients with removal of the offending molecule kanamycin. After 24months of treatment, it was numbered five cures (62.5%), two failures and one death.
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Tuberculosis Resistente a Múltiples Medicamentos/terapia , Adulto , Antituberculosos/uso terapéutico , Côte d'Ivoire/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Etambutol/uso terapéutico , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Isoniazida/uso terapéutico , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Estudios Retrospectivos , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Privación de Tratamiento/estadística & datos numéricos , Adulto JovenRESUMEN
CONTEXT: Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. BACKGROUND: The advent of HIV has contributed to the increase in the number of people with tuberculosis. The clinical and paraclinical of TB/HIV co-infected are polymorphic and function of immune status. OBJECTIVES: To determines the clinical and paraclinical characteristics of TB related to different levels of CD4 lymphocytes. METHODOLOGY: A retrospective case series based on analysis of 450 patients with both TB/HIV co-infections. It focused on the records of patients with pulmonary smear-positive (TPM +) with a positive HIV status. The effect of immunosuppression was analyzed in groups based on the CD4 count (<200/mm(3), of 200-350/mm(3) and>350/mm(3)), in a chronological fashion from April to September 2010 until there were 150 patients in each CD4 group. RESULTS: Among the 450 patients, 71.1% were between 25 and 45years old. The clinical signs were more significant as the level of CD4 fell. The clinical signs were predominantly fever (93%) and weight loss (62.7%). Pulmonary cavitation (59.3%), infiltrates (38.7%) and the location of the lesions at the lung apex (72%) were more common in the third group patients. By contrast, extra pulmonary lesions (mediastinal lymphadenopathy, pleurisy) and normal x-ray (9.3%) were more frequent in patients of the first group. The scarcity of cavitations (22.3% compared to 59.3% CD4>350) and the increase in associated lesions became more marked if patients were immunocompromised. Hematologic, hepatic, renal disorders were more frequent and severe in the most immunocompromised patient group. CONCLUSION: HIV-associated tuberculosis has an atypical clinical, radiological, biological presentation and is more severe when there is significant immunosuppression.
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Infecciones Oportunistas Relacionadas con el SIDA , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , VIH-1 , Tolerancia Inmunológica , Tuberculosis Pulmonar , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Coinfección/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/patología , Adulto JovenRESUMEN
OBJECTIVE: To analyze the epidemiology, clinical features and outcome of patients with hematologic abnormalities in miliary tuberculosis. METHODS: This was a retrospective study in the pneumology department of the University hospital in Abidjan (RCI), between January 2000 and December 2009. We analyzed the medical records of patients with pancytopenia occurring in the context of miliary tuberculosis. We compared the clinical characteristics and the outcome in patients with pancytopenia versus patients without pancytopenia. RESULTS: Pancytopenia occurred in 12% of patients with miliary tuberculosis; 11 men (61%) and seven women (39%). The average age of patients was 33 years, [17-67 years]. Pancytopenia with miliary tuberculosis was frequently associated with HIV: 92.8% (P=0.0009). The clinical characteristics were: fever (88.9%), severe weight loss: 100% vs. 78.8% MT without pancytopenia (P=0.025), respiratory distress: 100% vs. 52.3% MT without pancytopenia (P=0.00032), splenomegaly: 77.8% vs. 5.30% MT without pancytopenia (P=0.0000), multiple lymph nodes: 66.7% vs. 29.5% MT without pancytopenia (P=0.0043). The occurrence of pancytopenia in military TB is associated with a bad prognosis and the outcome was unfavorable in 8.33% (P=0.00001). CONCLUSION: Patients with pancytopenia in miliary tuberculosis have a high mortality despite tuberculosis treatment.
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Pancitopenia/epidemiología , Pancitopenia/etiología , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/epidemiología , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/diagnóstico , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tuberculosis Miliar/diagnóstico , Adulto JovenRESUMEN
Ficus exasperata is widely used in african pharmacopoeia against hypertension and edema. The hypotensive effects of aqueous extract of F. exasperata leaves are reduced in the presence of atropine and methylene blue. The treatment of hypertension often requires the combination of antihypertensive drugs and diuretics substances. The aim of this study was to evaluate the effects of aqueous extract of F. exasperata leaves on urinary excretion in rat. Single doses of this extract (50 mg kg(-1) b.wt.) and furosemide (10 mg kg(-1) b.wt.) were administered to two groups of rats. A control group receives NaCl 9 per thousand. Urine excretion is collected, measured and sampled for 24 hours. At the end of the experiment, blood is sample. Urinary excretion volume induced by this plant extract was relatively high and greater than that induced by furosemide. Aqueous extract of F. exasperata leaves increased urinary excretion of electrolytes, creatinine and urea. However, creatinine and blood urea obtained are similar to those induced by furosemide. At the end of this work, it appears that aqueous extract of F. exasperata leaves induced a significant diuretic effect and electrolyte output which does not alter significantly the rate of electrolytes, creatinine and urea plasma.
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Diuréticos/farmacología , Ficus/química , Extractos Vegetales/química , Extractos Vegetales/farmacología , Animales , Creatinina/metabolismo , Diuréticos/química , Electrólitos/metabolismo , Furosemida/farmacología , Masculino , Hojas de la Planta/química , Ratas , Ratas Wistar , Urea/sangre , Urea/metabolismo , Agua/química , Equilibrio Hidroelectrolítico/efectos de los fármacosRESUMEN
BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.
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Países en Desarrollo/estadística & datos numéricos , Mycobacterium tuberculosis , Tuberculosis/epidemiología , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Côte d'Ivoire/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Estudios RetrospectivosRESUMEN
INTRODUCTION: The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE: The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY: Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS: The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION: Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.
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Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones por VIH/epidemiología , Hospitalización/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Tuberculosis/epidemiología , Adulto , África/epidemiología , Países en Desarrollo , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Neumología , Enfermedades Respiratorias/complicaciones , Estudios Retrospectivos , Tuberculosis/complicaciones , Adulto JovenRESUMEN
INTRODUCTION: In countries where tuberculosis is endemic, the main differential diagnosis for pleural infection by common bacteria is pleural tuberculosis. OBJECTIVE: The purpose of our study was to determine the differences between pleural infection by common bacteria and that caused by pleural tuberculosis. METHODOLOGY: Our study was a retrospective analysis and compared the characteristics of confirmed pleural infection by common bacteria (PIB) and that due to pleural tuberculosis (PT). RESULTS: For the PIB, the signs evolved for 2.4 ± 1.4 weeks versus 5.6 ± 2.2 weeks for the PT (P=0.01). In multivariate analysis, for PIB the onset of symptoms was more abrupt (OR=3.8 [1.5; 9.9]; P=0.01), asthenia was less frequent (OR=0.3 [0.1; 0.9]; P=0.03), pleural liquid was more purulent (OR=40.0 [15.0; 106.7]; P<0.01). The blood neutrophil count was more frequently raised in cases of PIB (OR=2.5 [1.2; 5.4]; P=0.02). Pneumothorax/hydropneumothorax was less frequent in PIB (OR=0.3 [0.1; 1.0]; P=0.04). CONCLUSION: Clinical differences exist between pleural effusions caused by tuberculosis (TB) and those due to other bacterial infections. However, they are not sufficiently sensitive and therefore the search for the tuberculous bacillus must be systematic while waiting for implementation of new diagnostic tests for the organism.
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Infecciones Bacterianas/diagnóstico , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/epidemiología , Tuberculosis Pleural/diagnóstico , Tuberculosis Pleural/epidemiología , Adolescente , Adulto , Algoritmos , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/etiología , Côte d'Ivoire/epidemiología , Diagnóstico Diferencial , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/epidemiología , Hidroneumotórax/etiología , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/fisiología , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/etiología , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/microbiología , Neumotórax/diagnóstico , Neumotórax/epidemiología , Neumotórax/etiología , Estudios Retrospectivos , Tuberculosis Pleural/complicaciones , Tuberculosis Pleural/etiología , Adulto JovenRESUMEN
CONTEXT: Fires of wood and charcoal play an essential part in the cooking of food in Africa. These fires emit thick smoke that has definite health consequences. OBJECTIVES: To determine the clinical manifestations related to kitchen smoke and to identify the type of fire most often incriminated. METHODS: It was a transverse study comparing the clinical features in women using three types of fire: wood, charcoal and gas. We questioned 200 women in each group who used one type of fire exclusively for five days a week for at least five years. RESULTS: Clinical manifestations associated with the smoke were reported in all the women using wood as opposed to 98.5% using charcoal and 45.5% using gas. More than 80% had physical signs. These comprised 89.1% upper respiratory and 77% pulmonary signs. Upper respiratory signs were the most common, mainly sneezing and nasal obstruction. At the pulmonary level, a predominance of signs was found in women using wood fires (47.3%) and charcoal (36.2%), the difference being statistically significant. The signs included chronic cough, chest pain and dyspnoea. Wheezes were found in 15% of the women. CONCLUSION: Cooking smoke exposes women to complications which are most frequently associated with the use of wood or charcoal.
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Contaminación del Aire Interior/efectos adversos , Población Negra , Culinaria , Lesión por Inhalación de Humo/epidemiología , Humo/efectos adversos , África/epidemiología , Contaminación del Aire Interior/estadística & datos numéricos , Biomasa , Población Negra/estadística & datos numéricos , Carbón Orgánico , Culinaria/normas , Femenino , Humanos , Estudios Longitudinales , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/etnología , Enfermedades Respiratorias/etiología , Lesión por Inhalación de Humo/etnología , Lesión por Inhalación de Humo/etiología , Factores Socioeconómicos , Mujeres , MaderaRESUMEN
Multidrug resistance is defined as a resistance to two major antituberculosis drugs, which are isoniazid and rifampicin. The aim of the study was to specify the place of the thoracic surgery during the medical follow-up of the TB-MDR. Five files were kept over six years during this retrospective study. On the clinical and radiological level, localised lesions and a negative HIV serology were noted in the five patients. The completion date of the surgery varied between the third month and the 22nd after the beginning of the medical treatment. This delay in carrying out the surgery was encouraged by the social conditions of the patients. Three series of expectoration culture post-surgery were all negative. After surgery, the medical treatment was drawn out over six and 12 months depending on the clinical condition of the patient. No recurrence was observed. Only one patient died one year after the surgery from hemoptysis in relation to pulmonary sequelae.
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Neumonectomía , Tuberculosis Resistente a Múltiples Medicamentos/cirugía , Adulto , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Isoniazida/farmacología , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Neumonectomía/métodos , Neumología , Estudios Retrospectivos , Rifampin/farmacología , Rifampin/uso terapéutico , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/mortalidadRESUMEN
INTRODUCTION: In Côte d'Ivoire, since April 2002, the antituberculous regime for category I patients (ARC-I) passed from 2RHZ/4RH to 2RHZE/4RH, without modification of the antituberculous regime for category II (ARC-II) for treatment of cases of the failures to respond to treatment with ARC-I (FARC-I) and patients with a relapse of tuberculosis (TR). The objective of this study was to determine the outcome of patients treated by ARC-II (2RHZES/1RHZE/5RHE). METHODOLOGY: This study was retrospective and compared outcomes during patient follow-up under ARC-II between 1999-2000 (period 1=267 cases) and 2004-2005 (period 2=434 cases). The ARC-II regime has been prescribed for 297 cases of FARC-I and 404 cases of TR. RESULTS: The failure rate of the ARC-II regime was estimated to be 11.98% during the first period compared to 5.53% during the second (P<0.001). Among FARC-I cases, therapeutic failure was estimated to 20.54% versus 5.92% in TR group (P<0,001). We noted a positive sputum smear among FARC-I : 16.16% at the second month, 13.13% to the third month and 20.54% at the fifth month versus 4.20% at the second month, 1.48% to the third month and 5.92% at the fifth month within TB cases (P<0.001). CONCLUSION: Management of failures to the ARC-I regime must be reviewed to prevent the development of multidrug resistant TB.
Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Protocolos Clínicos , Femenino , Humanos , Masculino , Retratamiento , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
INTRODUCTION: Tobacco smoking is a scourge that continues to increase in developing countries despite its known consequences. Is the population of the Ivory Coast sufficiently informed about the consequences of smoking? For this reason, we decided to evaluate the knowledge of the effects of smoking among the people of Abidjan. OBJECTIVE: To evaluate the knowledge of the effects of smoking in the population of Abidjan. To relate this knowledge to the educational level and smoking status. METHODS: We evaluated knowledge about smoking and its consequences as a function of educational level and smoking status in the population of Abidjan over the age of 15 years. This was undertaken in 3 months, from November 2005 to January 2006, in the two busiest communes in Abidjan. The minimum number of persons required was 1152 but, in fact, we interviewed 1409. RESULTS: The prevalence of smoking was 36.5% with a predominance of males (sex ratio = 3:11). They were mainly young with a mean age of 27.44 years. This population's main sources of information on the ill effects of smoking were the mass media. In general, the subjects did not have a good understanding of smoking and its consequences. With regard to the diseases related to smoking, bronchial carcinoma and cardiovascular disorders were the best known, in 53.1 and 18.1%, respectively. With regard to the components of tobacco, nicotine was the best known (92.6%). Knowledge was related to the level of education: the subjects of a higher educational level were the most knowledgeable about the consequences of smoking. As a result, these subjects were less attached to smoking than the less educated. CONCLUSION: The consequences of smoking are poorly understood by the general population. With regard to the level of education, the better educated had a better understanding of the effects of smoking and were also those who smoked the least.
Asunto(s)
Fumar/epidemiología , Adolescente , Adulto , Côte d'Ivoire/epidemiología , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
We describe three cases of Lyell syndrome - toxic epidermal necrolysis - occurring in patients under the respiratory service of CHU de Cocody in Abidjan in the Ivory Coast, who were undergoing anti-tuberculous (TB) chemotherapy. All three were adult males who were HIV-positive, but none of them were receiving anti-retroviral treatment. They were on standard anti-TB treatment; rifampicin, isoniazid, pyazinamide and ethambutol. The lesions appeared early during their treatment for TB (14, 20 and 45 days). The patients were on no other medication that might have caused Lyell's syndrome except one who had been on cotrimoxasole for 6 months without complications. Despite admission to the acute care facility and appropriate care two of the three patients died.
Asunto(s)
Antituberculosos/efectos adversos , Seropositividad para VIH/complicaciones , Síndrome de Stevens-Johnson/etiología , Adulto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Entamoeba histolytica, is a human pathogen which is endemic in tropical areas. The most common extra-intestinal locations for disease after the liver are pleural and pulmonary. Although the outcome of pleural and pulmonary amoebiasis is generally favourable, it is important to note that a significant proportion of patients do develop pleural and pulmonary after-effects. We report a case of pleural and pulmonary amoebiasis where the evolution of a massive pleural effusion and 3 associated liver abscesses was spectacular. The surgical management of pleural, pulmonary and liver amoebiasis is discussed.
Asunto(s)
Entamoeba histolytica , Entamebiasis/diagnóstico , Absceso Hepático Amebiano/diagnóstico , Enfermedades Pulmonares Parasitarias/diagnóstico , Derrame Pleural/parasitología , Adulto , Animales , Antibacterianos/uso terapéutico , Antiprotozoarios/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/tratamiento farmacológico , Entamebiasis/parasitología , Humanos , Absceso Hepático Amebiano/tratamiento farmacológico , Absceso Hepático Amebiano/parasitología , Enfermedades Pulmonares Parasitarias/tratamiento farmacológico , Enfermedades Pulmonares Parasitarias/parasitología , Masculino , Metronidazol/uso terapéutico , Derrame Pleural/diagnóstico , Resultado del TratamientoRESUMEN
Intratracheobronchial foreign bodies are common accidents in children. In developed countries, the removal of these intratracheobronchial foreign bodies is performed with flexible or rigid fiberoptic bronchoscopy. Resorting to surgery is rare. In the inadequate medical context described, suitable medical technical equipment doesn't exist. Removal alternatives are necessary in order to avoid sanitary evacuation which is not always within patients' means. In this study, the authors describe the removal of an intratracheobronchial foreign body opaque to X-rays with foreign body forceps. The forceps, passed through the orotracheal intubation probe, were guided by an image intensification system in a traumatology operating theatre.