Epidemiological, Diagnostic, Therapeutic, and Prognostic Profile of Non-Tuberculous Community-Acquired Purulent Pleurisy in Children at the Bouaké University Hospital Center, 2017-2021

Introduction: In Côte d’Ivoire, there is a scarcity of data on children’s purulent pleurisies. Objective: This study aims to elucidate the epidemiological, diagnostic, therapeutic, and evolutionary facets of non-tuberculous purulent pleurisies in pediatric patients. Methods: A retrospective analysis was conducted using the medical records of children aged one month to fifteen years with purulent pleurisies at Bouaké University Hospital Center from January 2017 to December 2021. Results: The study identified 124 cases of purulent pleurisies, constituting 18% of lower respiratory tract infections and 0.8% of all hospitalizations. The majority of these cases (69%) were in children between 1 and 24 months of age. Prominent symptoms included dyspnea (85.5%), O2 saturation below 95% in room air (76.6%), respiratory distress (68.5%), cutaneous-mucosal pallor (63.7%), and fever (43.5%). Radiological findings predominantly showed right-sided pleurisy (62.1%). The pleurisy was often extensive (78.2%), accompanied by pneumothorax (37.1%), alveolo-interstitial opacities (8.1% of cases), and abscess formations (1.6%). Pleural fluid cultures were positive in 46.9% of cases, with Staphylococcus aureus (75%, methi-S) identified among 32 bacteria. Initial antibiotic treatment was empirical, favoring oxacillin (53.2%) or amoxicillin-clavulanic acid (53.2%) in dual (42%) or triple therapy (33%) with gentamicin (64.1%) and/or metronidazole (21.8%). Treatments also included pleural drainage (68.5%) or repeated evacuation punctures (33.1%), and blood transfusion (39%). The mortality rate was 18.8%. Conclusion: Non-tuberculous purulent pleurisy remains a significant concern in pediatric hospitalizations at the CHU of Bouaké, marked by high mortality rates.

Honey Dressing of Cutaneous Wounds on Limbs in the Traumatology Orthopaedics Department of Bouaké University Hospital

The study evaluated the effectiveness of honey dressings in healing recent skin wounds with soft tissue loss on limbs. Conducted over a year with 60 patients, results showed a significant reduction in wound size and early healing, with complete recovery on average within 29 days. The study supports honey as a viable wound treatment.

Diabetes Mellitus and COVID-19 at the Bouake University Hospital Center (Côte d’Ivoire)

Context: COVID-19 is a global public health problem and diabetes mellitus is a poor prognostic factor for the disease. The aim of this study was to investigate the epidemiological, clinical and evolutionary characteristics of COVID-19 in diabetic patients in Bouaké. Patients and Methods: This was a retrospective study carried out from January 2021 to December 2022. We included patients with diabetes known before COVID-19 infection and having a positive COVID-19 RT-PCR. Data were analyzed with Epi info7 software. Results: Among 1122 infected patients, 71 patients (6.3%) were diabetic, the sex ratio was 1.3 and the mean age was 58.7 years. Type 2 diabetes (97.2%) was predominant and the average seniority was 3.1 years. Arterial hypertension (46.5%) was the main comorbidity. The main clinical signs were cough (69%), dyspnea (43.7%) and fever (23.9%). Oxygen saturation was Conclusion: Diabetes mellitus remains one of the most important comorbidities of severe Covid-19. The death rate of diabetics was high. Hence the need to vaccinate people living with diabetes.

Craniofacial Horn Injuries: Rares Lesional Entities at the University Hospital of Bouaké(Côte d’Ivoire)

Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in the surgical emergency departments of Bouaké (Côte d’Ivoire) University Hospital from January 2013 to December 2017, for a period of 5 years. It focused on patients of 0 to 5 years old admitted for craniofacial trauma involving the horn of a bovine. Results: Of the 26 cases of traumatic encornment, 11 were craniofacial location (42%). There were 9 male and 2 female victims. The average age was 10.54 years with extremes of 6 months and 24 years. Patients came from rural areas of Côte d’Ivoire. Bovids were responsible for all causal encornements. The lesions involved the scalp (3 cases) and the face (8 cases). The lesions were cutaneous-musculo skeletal in 7 cases. The surgical treatment included debridement associated to a suture in all cases and associated with maxillo mandibular blockage in 3 cases and duro-cranioplasty in one case. Conclusion: In the local context, facial cranio traumatism by encornement is rare and seems to be essentially infantile, masculine and rural problem.

Inaugural Seizures Revealing COVID-19 in an Immunocompetent Infant at the University Teaching Hospital (UTH) of Bouaké

Introduction: Children are likely to present with atypical and non-specific clinical manifestations of COVID-19, unlike adults. The aim of this observation is to identify the difficulties related to the diagnosis and the curative and preventive management of SARS-CoV-2 infection in children. Observation: This is a 15-month-old infant admitted for febrile seizures. The interrogation revealed signs evolving 48 hours before his admission marked by post-prandial vomiting, wet cough, hypotonia, food refusal, incessant crying, fever, and seizures. His antecedents can be summed up as an uneventful pre- and per-natal period, good eating habits, good psychomotor and staturo-ponderal development, and outdated vaccination. The physical and paraclinical examination made it possible to retain the diagnosis of severe pneumonia. The initial management consisted of oxygenation, hydroelectrolyte intake, antibiotic therapy, and neurosedation. The evolution 3 days later was marked by a worsening of the clinical features, and the hypothesis of infection with SARS-CoV-2 was raised. The nasopharyngeal swab for COVID-19 RT-PCR performed was positive. The infant was isolated in the intensive care unit, where he received oxygen therapy with a mask, enteral nutrition, antibiotic therapy, corticosteroid therapy, and adequate nursing. The evolution was favorable 48 hours later. In addition, his asymptomatic mother and 14-year-old brother were placed in isolation after a positive RT-PCR COVID-19 test. Her father who was very often away from home for professional reasons was negative for COVID-19 RT-PCR. They all four live in the same 3-room house. Conclusion: Childhood COVID-19 has many facets. Clinicians should think about it in the face of any infectious manifestation, in order to avoid delays in treatment and improve the prognosis.

Knowledge, Attitudes and Practices of the Health Personnel of the Pediatric and Gynecology-Obstetrics Departments of the BouakéUniversity Hospital Center (CHU) regarding the Intestinal Microbiota and the First 1000 Days of Life

Introduction: The harmonious development of the intestinal microbiota during the first 1000 days of life promotes the child’s immediate and future good health. The objective of the study was to evaluate the knowledge and practices of health personnel on the intestinal microbiota and the first 1000 days of life for the improvement of child health. Methods: Knowledge, attitudes and practices (KAP) type survey conducted among health personnel of the pediatric and gynecology-obstetrics departments of the Bouaké University Hospital from July 1 to 31, 2017. All consenting agents working in the said services and present at the time of the study were included. The parameters studied concerned socio-professional characteristics, knowledge of the intestinal microbiota, and knowledge and practice of the first 1000 days. The data analysis was descriptive and analytical with a significance threshold p ≤ 0.05. Results: Out of 224 active agents, 76 (30 men, 46 women) participated in the survey, i.e. 33.9%. The respondent came from the gynecology-obstetrics (54%) and pediatrics (46%) departments and had professional experience >5 years in 38%. Thirty-eight percent of the respondents had a good knowledge of the intestinal microbiota. Concerning the first 1000 days of life, 64.5% of the respondents had a good knowledge of the first 1000 days overall. They advised exclusive breastfeeding for up to 6 months in 95% of cases. When breastfeeding was not feasible, the main criterion for choosing the infant formula was the composition (57.1%). They proposed a standard infant formula (43%), enriched with prebiotic (29.4%), enriched with probiotic (21.6%), a symbiotic (6%). Good knowledge of the intestinal microbiota was associated with belonging to the paediatric service (p = 0.013), socio-professional category (p = 0.031), year of experience >5 years (p = 0.032) and the first 1000 days of life to year of experience >5 years (p < 0.01). Conclusion: The health personnel interviewed did not have a good knowledge of the intestinal microbiota and the first 1000 days. Capacity building is needed.

Comparative Evaluation of Extra Capsular Extraction (ECE) with Suture and Small Incision Cataract Surgery (SICS) Manual without Suture in the University Hospital of Bouake (Ivory Coast)

Objective: Cataract is a partial or total opacification of the lens responsible for blindness. The treatment is surgical. The purpose of our study was to evaluate the results of the newly introduced manual small incision cataract surgery (SICS) and compare them with those of the conventional extra-capsular extraction method. Patients and Method: Analytical cross-sectional study was carried out at the ophthalmology department of the University Hospital of Bouaké for a period of 1 year. Results: The two surgical techniques were compared at equal proportions. The average duration of interventions was longer during the sutured Extra Capsular Extraction (ECE) compared to the SICS. Rupture of the posterior capsule with vitreous exit, which was the most observed intraoperative complication, was predominant with ECE with suture (16%) against 8% for SICS. Corneal edema observed in the early postoperative period, was predominant with sutured ECE (30%), against 20% for SICS. Corneal edema, which was more observed with EEC compared to SICS, dominated secondary and late postoperative complications. Post-operative astigmatism induced by ECE with suture was between ?2 and ?4 dioptre in 51.5% of patients and between ?0.5 and ?2 dioptre in 73.91% of SICS. Visual acuity without correction in the early days was better with SICS. Conclusion: In this comparative study of cataract surgery, we noted superimposable results for both techniques. However, the prevalence of pre- and post-operative complications was more frequent with sutured ECE. The technique without suture allows visual recovery and a quick return to normal life.

Monkeypox in an Immunocompetent Vaccined Adult: A Case Report at the University Teaching Hospital of Bouake

Introduction: With the eradication of smallpox in 1980, vaccination against smallpox ceased and there was an upsurge in cases of monkeypox. The objective of this observation is to describe the characteristics of monkeypox in the vaccinated subject. Case Report: A 45-year-old, heterosexual, rural resident was referred for a rash. The history of the disease revealed signs of acute course marked by headache, asthenia, diffuse myalgia, chest pain, fever and pruritic rash. His background is marked by vaccination against smallpox in 1977, cohabitation with game hunters and domestic animals as well as a notion of contact with a person who presented similar but more generalized signs. The physical examination revealed a conscious patient with good general state, feverish, tachycardic, eupneic presenting skin lesions in the type of striated vesicles more or less umbilical, on the scalp, face, neck, trunk and the upper limbs associated with cervical lymphadenopathy. RT-PCR was performed on a dry swab by rubbing several vesicles and a throat swab proved positive for Monkeypox Virus (MPXV). Management consisted of isolation and symptomatic treatment. The evolution has been favorable. Conclusion: The symptomatology of monkeypox is similar to that of smallpox. Without widely available treatment or prophylaxis, rapid identification of cases is essential. Vaccination of people at risk is an alternative to curb the epidemic. However, the main prevention strategy is to raise awareness of the risk factors.

Occurrence Delays of Metastatic Relapses of Breast Cancers Treated at University Hospital of Treichville (Abidjan-Cote d’Ivoire)

Objective: Describe the occurrence delays of metastatic relapses of breast cancer based on the characteristics of the original tumor. Methodology: This is a retrospective and cohort study conducted from January 2000 to December 2015 on patients with metastatic relapse of breast cancer. Results: Out of 178 patients collected, the metastatic relapses were estimated at 49%, occurring in patients with an average age of 53.4 years. The majority of the patients was educated (91.6%) and did not have a high socioeconomic level (88.2%). The initial tumors were mainly at a clinical stage III (47.8%), SBR grade III (47.2%), high index Ki 67 (46.5%), negative RH (79.3%) and HER2 negative (58%). Metastases were unique in general (62.9%), dominated by bone locations (36.6%), with an average age of occurrence of 2.4 years. After the occurrence of these metastases, the cumulative survival rate was 5% at 3 years, and zero to 5 years. Conclusion: Metastatic relapses were common with poor prognosis.

Triceps Brachii Tendon Reconstruction with V-Y Plasty: Indication and Functional Results of a Case at BouakéTeaching Hospital

Repair of an old lesion of the triceps brachii tendon is infrequent. A V-Y plasty was performed 4 years after the injury in an adult. Post traumatic osteoarthritis limits functional outcomes. The patient is satisfied.

Multilevel Cervicothoracic and Lumbar Pott’s Disease: About Three New and Unusual Cases in the Rheumatology Department of the Teaching Hospital of Cocody in Abidjan (Côte d’Ivoire)

Pott’s disease usually affects two contiguous vertebrae or two spinal levels. The involvement of the three cervicothoracic and lumbar levels is rarely described. Only three cases have been described in the literature to our knowledge. The authors report three new cases of tuberculous spondylodiscitis of cervicothoracic and lumbar site. Our three cases were characterized by symptoms similar to the other topographical forms of Pott’s disease. A predisposing factor is often identified like the infection with human immunodeficiency virus. The definitive diagnosis was made in two cases by identifying acid and alcohol-fast bacilli for one case and by histology for the other case. For the third case, there was a diagnostic presumption reinforced by the satisfactory outcome on tuberculosis chemotherapy for a period of 12 months. The multilevel nature of diseases does not influence the effectiveness of treatment of this form of spinal tuberculosis.

Primary Cutaneous Leiomyosarcoma of the Face: A Rare Tumor that Is Difficult to Diagnose

Leiomyosarcoma is a rare malignant tumour of the lower limbs. Its differential histological diagnosis is difficult and is made in the presence of young scar tissue, leimyoma, dermatofibroma, melanoma, rabdomyosarcoma, sarcomatoid carcinoma, fibroxantoma, Darrier Ferrand dermatofibrosarcoma and myofibroblastic tumours. Treatment is essentially surgical, with margins of 3 to 5 centimetres. We report two observations of tumours localised to the face, including one case of a known leiomyosarcoma and another case initially diagnosed as a leiomyosarcoma which turned out to be a cellular myofibroma with no sign of malignancy after several readings. The aim of this work is to review the literature on this pathology while highlighting the diagnostic and therapeutic difficulties. Conclusion: A rare smooth muscle tumour with a high risk of local recurrence in the event of incomplete treatment, leiomyosarcoma in its dermal component is preferentially located in the head and neck. Its treatment is exclusively surgical and highly mutilating.

Recent Traumatic Dislocations of the Shoulder in Adults: Epidemiological, Therapeutic and Evolutionary Aspects

Introduction: Shoulder dislocations represent about 50% of all joint dislocations. The objective was to describe the epidemiological, therapeutic and evolutionary aspects of traumatic shoulder dislocations in Bouaké. Methods: This retrospective and descriptive study was conducted between January 2017 and December 2019. It concerned patients over 15 years of age with a recent traumatic shoulder dislocation treated and followed in the department. The variables studied were epidemiological, therapeutic and evolutionary. The severity of the trauma was assessed according to the Injury Severity Score (ISS). Functional outcome was assessed according to the Constant score. Results: There were 49 patients (49 dislocations) out of 22,569 patients. The prevalence was 0.2%. The mean age was 32 years (17 - 62). There were 38 men (77.5%). The sex ratio was 3.4. Students predominated (n = 10;20.4%). The etiology was dominated by road traffic accidents (n = 19;38.8%). Anterior dislocation was the most common (n = 45;92%). The ISS score was minor (n = 46;93.8%). The mean time to reduction was 7 hours (4 - 16). Orthopaedic reduction using the Kocher technique predominated (n = 44;89.8%). The mean duration of external rotation immobilisation of the shoulder was 23 days (16 - 45). Recurrence occurred in 8 patients (21.6%). The functional outcome at a mean Constant follow-up of 15 months (8 - 20) was satisfactory (n = 44;89.8%). Conclusion: Traumatic dislocation of the shoulder represented 0.2%. Treatment was mainly orthopaedic. Recurrence was rare.

Unusual Cause of Acute Appendicitis: Bone Fragment

Foreign bodies are a rare cause of appendicitis, because in most cases these ingested foreign bodies cross the digestive tract asymptomatically [1] [2] [3]. However, some penetrate the lumen of the appendix causing its inflammation. We report an unusual observation of acute appendicitis induced by a foreign body namely a bone fragment in the visceral surgery department of the Centre Hospitalier Intercommunal de Villeneuve Saint-Georges.

Influence of Haptoglobin and Hemoglobin Phenotypic Polymorphisms on Sickle Cell Disease Morbidity

Objectives: Sickle cell disease (SCD) has a varied clinical and biological expression depending on the hemoglobin phenotype: SSFA2, SFA2, SAFA2 and SC. Considering the antioxidant properties of the different haptoglobin phenotypes (Hp 1-1, Hp 2-1, Hp 2-2), it seemed relevant to know their influence on the morbidity of the different hemoglobin phenotype of SCD. Thus, the objective of this study was to identify associations between haptoglobin phenotype and morbidity of different SCD phenotypes. Methods: In a retrospective cross-sectional descriptive and analytical study, with a cohort of 170 black African carriers of hemoglobin S, in Ivory Coast, West Africa, hemoglobin and haptoglobin phenotypes were determined by electrophoretic methods. Results: The three major phenotypes of haptoglobin polymorphism were found in the SCD cohort: Hp 1-1 (24.1%), Hp 2-1 (56.5%), Hp 2-2 (19.4%). Vaso-occlusions were associated with haptoglobin phenotype Hp 1-1, (OR = 2.03;CI95% = [1.06 - 3.9];p Conclusions: Haptoglobin phenotype was associated to morbidity-adjusted hemoglobin phenotype. The study revealed a greater probability of a worse morbidity when the hemoglobin phenotype is homozygous. Unexpectedly, the worse morbidity is associated to Hp 1-1 haptoglobin phenotype, the most powerful antioxidant within the different haptoglobin phenotypes. Associations found were not systematic and need further studies to enlighten the determinism of SCD morbidity.

Systemic Form of Juvenile Idiopathic Arthritis: Epidemiological, Clinical, Paraclinical and Therapeutic Aspects of 13 Cases in Abidjan

Objective: To describe the epidemiological, clinical, paraclinical and therapeutic aspects of systemic juvenile idiopathic arthritis observed in Abidjan. Materials and Method: This retrospective and descriptive study covered 13 children suffering from systemic juvenile idiopathic arthritis selected in the Rheumatology Department of University Hospital Center of Cocody in Abidjan (Cote d’Ivoire) from January 2005 to December 2015. We were interested to the sociodemographical, clinical, paraclinical and therapeutic aspects. Results: The systemic form of the juvenile idiopathic arthritis represented 0.2% of the 4608 rheumatologic diseases and 70.58% of the JIA. We selected 6 boys and 7 girls, with an average age of 10.8 years and mostly going to school (84.61%). The diagnostic delay was 18 months. The main clinical signs were fever and joint damage observed each in 100% of cases, impaired general condition (92.30%) and tumor syndrome (83.33%). Biological signs were characterized by hyperleukocytosis (69.20%) and the presence of a biologic inflammatory syndrome (on average, erythrocyte sedimentation rate 59.6 mm and C Reactive Protein 56.4 mg/l). The cervical damage was the essential functional complication (38.46%). The major treatment has been a therapeutic combination based on corticotherapy and methotrexate (100%) with 1 death case by macrophage activation syndrome. Conclusion: Systemic juvenile idiopathic arthritis is rarely diagnosed in the rheumatologic practice in Abidjan. It concerns children relatively big, and is characterized by a febrile polyarthritis with impaired general condition and tumor syndrome. This systemic form is treated by corticotherapy and methotrexate.

Acute Volvulus of a Wandering Spleen on Pregnancy: A Case Report

Wandering or ectopic spleen is a rare congenital or acquired abnormality due to a defect in the anatomical fixity of the spleen with the surrounding organs. Pedicle twisting is its most common complication. It is an anatomo-clinical entity most often described in children, but rare in adults. It is a serious condition, especially when it occurs on a pregnancy putting at stake maternal and fetal prognosis. Authors report a case of acute volvulus of wandering spleen in a 26-year-old patient admitted for abdominal pain on an active pregnancy of 15 weeks of amenorrhea. Abdominal ultrasound scan helped to set the diagnosis. At laparotomy, the enlarged spleen was in an ectopic position, in the iliac fossa with a pedicle abnormally twisted in several spiral turns. Splenectomy was performed. The post-operative period was simple and the pregnancy progressed well to term.

Management of Inflammatory Breast Cancers in Subsaharian Africa Context

Objective: To report the experience of Gynecology Department of the University Hospital of Treichville in the management of the inflammatory breast cancers. Methodology: We conducted a retrospective and descriptive study on cases of the inflammatory breast cancers managed in the Gynecology Department of the University Hospital of Treichville, from January 2011 to December 2015. Results: We collected 44 cases of inflammatory breast cancer representing 17.9% of all breast cancers. The average age of patients was 46.5 years (32 - 70 years) and among them, the majority had inadequate socioeconomic level (90.9%). The risk factor for cancer found in the majority of patients was the age of first menstrual periods before the age of 12 years (52.3%). The average consultation time was long (10 months) and several patients had extensive inflammatory signs (38.6%), with lymph node involvement (84.1%) and metastases (36.4%). At the histological analysis, the most common type was invasive ductal carcinoma (81.8%), SBR grade III (54.5%). Regarding treatment, mastectomy according to Patey associated with a chemotherapy was performed in 22.7% cases. The evolution has been marked by an overall 5-year survival of 20%. Conclusion: The management of inflammatory breast cancers was late and incomplete in our service making poor prognosis.

Paraclinical, Therapeutic and Evolutionary Profile of Osteoarticular Tuberculosis: A Report about 550 Cases in Abidjan

Objective: To describe paraclinical, therapeutic and evolutionary aspects of osteoarticular tuberculosis in Abidjan. Materials and Method: We realized a descriptive retrospective study carried out in the Rheumatology Department of the University Hospital Center of Cocody in Abidjan about 550 patients over a period of 10 years from January 2004 to December 2013. The paraclinical, therapeutic and evolutionary data had interested us. Results: Osteoarticular tuberculosis represented 12.13% of 4531 rheumatic diseases identified during the study period. The tuberculin skin test was positive in 78.49% of cases. An inflammatory syndrome was present with erythrocyte sedimentation rate and C-reactive protein respectively into 69.45% and 76.54% of cases. The research of Mycobacterium tuberculosis was realized into 176 of cases which 50% was positive. Polymerase chain reaction and biopsy of tissue were performed respectively in 8 and 6 cases. Plain radiography (89.82%) and computed tomography (83.63%) were the most realized imaging. Computed tomography has contributed for the diagnostic in 99.78% of cases. The majority of our patients (82.91%) received anti-tuberculous treatment which consisted of two months of combination of rifampicin (R), isoniazid (H), pyrazinamide (Z) and Ethambutol (E) (2RHZE), followed by 10 months of rifampicin (R) and isoniazid (H) (10 RH). The outcome in patients on this treatment was favorable in 528 cases (96%). Conclusion: This study revealed that the research of Mycobacterium tuberculosis was often realized and positive. On the contrary, polymerase chain reaction and biopsy of tissue were rarely performed. The main imaging is computed tomography. Our protocol of treatment is effective.

Factors Associated with the Unsuppressed Viral Load of Children on Antiretroviral Therapy Followed Up in the GbêkêRegion (Côte d’Ivoire)

Introduction: Unsuppressed viral load (VL) in immunocompromised children on antiretroviral therapy (ART) increases the risk of child morbidity and death. The aim of the study was to identify factors associated with unsuppressed viral load in children on ART for the improvement of prognosis. Patients and Methods: this is a retrospective, descriptive and analytical study carried out from July 2015 to December 2019 in the 28 pediatric HIV/AIDS treatment centers supervised by the NGO IRAA in the region of Gbêkê. It Included children from 0 to 15 years who were HIV positive, on ART for at least 6 months with at least one viral load. The variables studied were socio-demographic, diagnostic and evolutionary. Data analysis was descriptive and analytical with a significance level of p < 0.05. Results: out of 329 children included, 118 (62 boys, 53 girls) had a non-suppressed VL, i.e. a prevalence of 36%. The mean age at diagnosis was 61 months. The mother was a small trader (36.4%), illiterate (45.8%). Unsuppressed viral load was significantly associated with poor nutritional status at the start of treatment (p < 0.001), non-compliance with treatment (p < 0.001), poor maternal education (p = 0.011) and the lack of follow-up of the mother in the context of PMTCT (p = 0.03). Conclusion: Unsuppressed viral load is common in children on ART in the Gbêkê region. It mainly concerns the child who did not comply with ART, and whose mother was not followed within the framework of PMTCT. Strengthening early detection, early initiation of ART, PMTCT and increased therapeutic education strategies would improve the prognosis of children infected with HIV.