Peripheral neuropathies revealing HIV infection at the Hospital Center of Bobo-Dioulasso (Burkina Faso)

Several peripheral neuropathies are associated with human immuno-deficiency virus (HIV) infection. In Africa, certain diseases are of particular importance. In the present work, we report peripheral neurological involvement as revealing signs of HIV infection within the internal medicine unit of a large city over a 2-year period. All adult subjects with a positive HIV serology revealed by a peripheral neuropathy observed in the National Hospital Centre of Bobo-Dioulasso over a two-year period (1 January 1999 and 31 December 2000) were included in the study. 46 cases of peripheral neuropathies revealing HIV infection were screened. Peripheral facial paralysis concerned 25 patients, 15 women and 10 men, in the early stages of HIV infection. The average age was 34 years. For 80% of the patients, he CD4 count was over 200. 5/10 cases of polyneuropathy occurred at the early stage of the HIV infection. Herpes zoster occurred in the early stages in 5/7 cases. 3/4 cases of polyradiculopathy occurred at a later stage with CD4 count under 200. Our study indicates clearly that isolated peripheral facial paralysis, sensitive polyneuropathy, herpes zoster and polyradiculopathy in young adults should lead to HIV testing.     

Sur-risque de diabète sucré et d’hypertension artérielle chez les personnes infectées par le VIH suivies à l’hôpital de jour du CHU Souro Sanou,Bobo-Dioulasso,Burkina Faso, 2018

BackgroundNon-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension.MethodsA cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7 mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90 mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender.ResultsA total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6 kg/m² (IQR: 15.4 – 22.7) and 48.3% of patients had a BMI ≥ 25 kg/m². The median CD4 count was 590 cells/mm³ (IQR: 417–785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI + 1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P < 10^?3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population.ConclusionPrevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.     

Arythmie ventriculaire et activité sportive : tachycardie ventriculaire d’effort de Gallavardin sur cœur sain, à propos d’un cas et revue de la littérature

Regular physical exercice has undeniable cardiovascular benefits and improves life expectancy. This benefice seems limited to moderate intensity exercises. Intense and chronic physical exercice would lead to heart structural changes. For a long time, knowledge of these cardiac effects seemed limited to the left ventricle. Since more authors have shown that right ventricle is vulnerability to the effects of intense chronic training. We report a Gallavardin-type ventricular stress tachycardia in a young with healthy hearted; in whom a right infundibular arrhythmogenic focus has been found in the absence of structural alteration of the right ventricle. Intense athletic activity may reveal a latent arrhythmogenic focus through sympathetic activation. Ablation was the preferred therapeutic strategy, preferred to drug therapy and derived from an analysis of risk-benefit ratios.     

Therapeutic uses of honey and honeybee larvae in central Burkina Faso

The therapeutic uses of hive-derived products by local people in four zones from the central part of Burkina Faso are described. Of 13 apitherapeutic applications recorded, only honey (12) and honeybee larvae (1) were used. The uses described included treatment of various gastrointestinal disorders, respiratory ailments, fatigue, vertigo, ophthalmic disorders, toothache, measles, wounds, burns, chest pains, period pains and postnatal disorders, male impotence as well as its application as a skin cleansing agent. The effectiveness against some of these conditions, e.g. measles, period pains and postnatal disorders, requires further investigation and confirmation.     

Prise en charge et pronostic des embolies pulmonaires associées à des thrombi intracavitaires droits : à propos d’une série prospective au centre Hospitalier Universitaire Yalgado Ouédraogo

Objective

To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi.

Audit of cesarean delivery in Burkina Faso

Objective

To assess the level and determinants of unnecessary cesarean delivery.

Methods

In a retrospective study, the medical charts were reviewed for 300 low-risk women who underwent intrapartum cesarean delivery at 10 referral hospitals in Burkina Faso between May 2009 and April 2010. In this context, cesarean deliveries were delegated to clinical officers who have less training than doctors.

Results

Among the 300 study patients, 223 women (74.3%) were referred from primary healthcare facilities. The reason for referral was not medically justified for 35 women. Cesarean was performed by a gynecologist–obstetrician (46.0%), a trained doctor (35.0%), or a clinical officer (19.0%). Acute fetal distress and fetopelvic disproportion were the main indications recorded for intrapartum cesarean delivery. These diagnoses were not confirmed by an obstetrician–gynecologist in 12.0% of cases. Clinical officers were associated with a higher risk of unnecessary cesarean delivery compared with gynecologist–obstetricians by multivariate analysis (odds ratio, 4.46; 95% confidence interval, 1.44–13.77; P = 0.009).

Conclusion

Verification of cesarean indications by highly qualified personnel (i.e. second opinion), in-service training, and supervision of health workers in primary healthcare facilities might improve the performance of the referral system and help to reduce unnecessary cesarean deliveries in Burkina Faso.     

Polyneuropathies in patients treated with HAART in Bobo-Dioulasso hospital, Burkina Faso

Peripheral neuropathies (PN) represent the most common neurological manifestation in patients with HIV infection. Introduction of highly active antiretroviral therapy (HAART) had a significant impact on the epidemiology of HIV-associated neuropathies even in poor-resources countries. HIV-infected patients were followed up over a 2-years period from January 2002 to December 2003. PN was clinically diagnosed based on abnormalities of ankle reflexes or vibratory perception and if patients described pain, paresthesia or numbness. Electromyography was not performed in this study Among the 133 HIV-infected patients treated with HAART 31 patients (23 females and 8 males) with 38.8 of mean age were followed up for PN. 95.5% among them were HIV1-infected. According to the availability of the antiretroviral therapy, 9 patients were treated with protocol A including lamivudine + stavudine + nevirapine, 12 patients with protocol B including combination of stavudine + lamivudine + efavirenz, and 10 patients with protocol C with other combinations of antiretroviral therapies. Average CD4 cell count was 229.3/microl and 60% of the sample had < 200 CD4 cell counts at the time of diagnosis. PN occurred within 5.6 months from the institution of the HAART and 80% less than 3 months after the beginning of the treatment. Burning feet syndrome was found in 16.1% of the sample. 45.2% of polyneuropathies occurred in late stage of HIV infection (< 200 CD4/microl). The presence of PN was related to decreased CD4 cells counts and neurotoxic antiretroviral therapy Introduction of HAART has modified the course and the prognosis of HIV infection even in poor resources setting. The incidence of toxic neuropathies is increasing with longer patients' life expectancy and represents a major factor in treatment limitation and the neurological side effects of HAART should be well identified by physicians.     

Cervix cancer screening in a health district (Burkina Faso) by voluntary biopsies after the application of acetic acid and lugol

A voluntary screening of uterus cervix cancer took place in Kossodo health district from February 1st 2001 to April 30th 2002. It involved the age-group women of 25 to 59 years. This study included 239 women given a participation rate of 6.8%. We had sampled young women in three categories with average age of 38 years: a) doing a remunerated job (64.9%); b) mostly educated (85.3%); and c) married (86.2%). The visual inspection was the method used after the application of 4% acetic acid followed by that of lugol. In all 74 biopsies have been undertaken. Furthermore, we have noticed a 4.2% prevalence of pre-cancerous injuries. The cancerous lesions represented 2.5% of the sampling and the inflammatory lesions 13.4%. VPH infection was found on 2.5% samples and condylomatous injuries in 5% cases. This experience would deserve to be carried out always and a cervix cancer screening campaign held at national level.     

Birth spacing and informed family planning choices after childbirth in Burkina Faso and the Democratic Republic of Congo: Participatory action research to design and evaluate a decision-making tool for providers and their clients

Objectives

Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women.