Epidemiological and Clinical Aspects of Hospitalized Patients with Chronic Rheumatic Disease at Cocody University Hospital in Abidjan

Objective: To study the epidemiological and diagnostic features of chronic rheumatic disease (CRD) in a black population in sub-Saharan Africa. Patients and Methods: Retrospective descriptive study over eight years (January 2005 to December 2012) of patients seen for CRD in rheumatology hospitalization at the CHU de Cocody in Abidjan, Côte d’Ivoire. Results: Of 3147 hospitalized patients, 92 had CRD, a frequency of 2.9%. The mean age of patients was 43.50 ± 15.6 years (extremes: 10 to 79 years). The sex ratio was 0.08 (7 men and 85 women). The socio-economic level was low in 44 patients (47.8%), medium in 44 patients (47.8%), and high in 4 patients (4.4%). The reasons for consultation were polyarthritis (64.1%), polyarthralgia (30.4%), and oligoarthritis (5.4%). The mean duration of symptomatology was 19 months (range: 3 to 20 years). The mean length of hospital stay was 14.2 ± 7.7 days (range: 2 to 36 days). The CRD observed were: rheumatoid arthritis (59.8%), systemic lupus erythematosus (23.9%), mixed connective tissue disease (6.5%), undifferentiated connective tissue disease (3.3%), polymyositis (3.3%), systemic scleroderma (2.2%), and systemic vasculitis (1%). Conclusion: CRD is not uncommon in rheumatology hospitals in Abidjan. Diagnostic delays are long, and rheumatoid arthritis and systemic lupus erythematosus are the most frequently encountered conditions.

Emergency Neonatal Obstetric Cares at Cocody University Hospital: Overview of Instrumental Extraction

Objectives: The aim of this study was to show an overview of situation of instrumental extraction at the maternity of Cocody University Hospital by determining availability and assessing the maternal and fetal prognosis. Patients and method: it was a retrospective study with a descriptive purpose on 6 months from January 1 to June 31, 2015. It concerned all patients admitted in the expulsive phase of labor delivery room and with an indication of fetal instrumental extraction and the state of their newborns at birth. Results: We saved 2288 vaginal deliveries;including 28 instrumental deliveries on 104 indications of instrumental extraction is an implementation rate of 26.9% (16 by vacuum extractor and 12 forceps). Among patients with indication but without instrumental extraction (n = 76), there is 42.3% vaginal delivery (n = 44) and 30.8% of cesarean section (n = 32). 44 have given birth vaginally (42.3%) and 32 by caesarean section (30.8%). It’s young patient (28 years), nulliparous (42.3%). Average time between instrumental extraction indication and the delivery of the baby was 58 min in the case of instrumental extraction and 1 hour 41 minutes in the case of spontaneous delivery in anticipation of the c-section. Motherhood had 3 instrumental extractors (2 vacuum extractors and 1 forceps) recycled after each use. The Apgar score was good in 85.7% in children born by instrumental extraction and bad in 54.5% in children born vaginally without instrumental extraction. We found 20 stillborn in intra partum occurred only in children born vaginally without instrumental extraction. Twelve (12) cases of bleeding of the issue by uterine atony (27.3%) were recorded in patients pregnant without instrumental extraction. No maternal deaths were observed. Conclusion: The realization of instrumental extraction rate remains low at the maternity of the UH-C. In the event, the fetal prognosis was better.

Urogenital Trauma by Pelvic Impalement: A Case Reported at Bouake University Hospital

Urogenital impalement trauma is a particular form of penetrating trauma to the pelvis. They are rare, spectacular or dramatic because they can be responsible for serious vascular and/or visceral lesions. This study reports a case of hypogastric impalement in a 19-year-old young man that caused musculoaponeurotic and urogenital lesions. Emergency surgical exploration was carried out urgently by a multidisciplinary team.

Epidemiological, Clinical and Paraclinical Profile of Osteoarthritis of the Lower Limbs in Obese Patients at the Cocody University Teaching Hospital

Objective: To describe the epidemiological, clinical and paraclinical characteristics of osteoarthritis of the lower limbs in obese patients at the Cocody University Teaching Hospital. Methodology: This was an analytical cross-sectional study carried out in the rheumatology department of the Cocody UTH in Abidjan (Ivory Coast) from March 1 to April 30 2023. Patients who came for rheumatology consultation presenting with mechanical arthralgia of the lower limbs, who were obese, had radiographic images were included. All patients without radiographic images were excluded. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m. The Chi2 test was used to compare proportions and determine the existence of associations between osteoarthristis and obesity, obesity severity and radiographic stage of osteoarthritis as well as the functional impact. A p-value below a predefined threshold (p = 0,05) indicates a significant relationship between the variables. Result: Out of 185 patients received for osteoarthritis of the lower limbs during the study period, 136 were obese (74%). There were 115 women (84.6%) with an average age of 56.03 with a standard deviation of 12.72 years (extremes: 22 and 84 years). The main socio-professional category was the informal sector (30%). The majority of patients had a low socio-economic level (80.2%) and lived in urban areas (92.6%). The most common past medical history was hypertension (33.08%) followed by peptic ulcer disease (16.91%). Patients had a body mass index class 1 (81.6%), class 2 (15.40%) and class 3 (2.90%). The average duration of symptom progression until diagnosis was 11 months. Genu varum was the main static disorder (56.10%) and the knee joint was the dominant topography (90.4%) with a bilateral localization (80%). The average Lequesne index was greater than 8 (59.5%). The Kellgren and Lawrence radiographic stages were stage 1 (9.20%), stage 2 (46.90%), stage 3 (29.20%) and stage 4 (6.90%). The Obesity severity was significantly associated with osteoarthritis of the knee (p = 0.042). There was no statistically significant association between obesity severity and radiographic stage of osteoarthritis (p = 0.163) or functional impact (p = 0.180). Conclusion: Osteoarthritis of the lower limbs affected obese women and was dominated by stage 2 osteoarthritis of the knee (Kellgren and Lawrence). There is an association between the severity of obesity and osteoarthritis of the knee.

Assessment of the Efficacy of Rifaximin in the Management of Irritable Bowel Syndrome (IBS)

The aim of our study was to assess in our context, the efficacy of Rifaxim in improving the symptoms of irritable bowel syndrome particularly in its diarrheal (IBS-D) or mixed (IBS-DC) component and therefore assess its impact on patients’ quality of life. Patients and methods: This was an uncontrolled, non-comparative prospective cohort study of a single group of patients. Patients recruitment was done in two University Hospitals for 6 months (September 2015-February 2016). Were included ambulatory patients, male or female, aged 18 - 75 years, with diarrheic IBS (IBS-D) or mixed IBS (IBS-DC) diagnosed according to Rome III criteria and who agreed to participate in the study. Each patient received 400mg Rifaximin × 2/d for 15 days. The overall assessment of the efficacy of treatment at D15 (end of treatment) and D30 (2 weeks post-treatment) was the primary criterion of judgment. The statistical tests used were the Chi-square test and Fisher’s exact test for the qualitative variables and Student’s test for the quantitative variables. Results: A total number of 30 patients (16 women) with an average age of 44.5 ± 13.9 years were included. The overall assessment of symptoms by the patient with the Likert scale found 28 (93.3%) patients, 12 (40%) patients and 10 patients (33.3%) for a scale ≥2 at D0, D15 and D30 respectively. The assessment of the intensity of pain or abdominal discomfort found at D0, D15 and D30 respectively: 27(90%), 13(43.4%) and 6(20.1%) patients who had an EVA score > 2. The mean score for Francis to assess the improved quality of life was 247.1 ± 97.4 at D0, 99.8 ± 63.1 at D15 and 128.8 ± 70.6 at D30. Conclusion: There is a good overall improvement of symptoms in our patients suffering from IBS-D or mixed (IBS-DC) on Rifaximin with improvement of the quality of life.

Epidemiological Features of Diabetic Retinopathy in Abidjan(Cote d’Ivoire):A Study about 448 Patients

Introduction: Diabetic retinopathy is the retinal location of diabetic microangiopathy. It is a public health problem and one of the target diseases of the global Vision 2020 initiative. The aim of our study was to determine the epidemiological features and risk factors of diabetic retinopathy in the melanoderma African in Abidjan. Materials and Methods: We carried out a prospective observational study which took place from April to September 2016 and which focused on the diabetic subjects received in consultation in the Ophthalmology Department of Cocody University Hospital. All Patients had had bio-microscopic examination of the fundus with Goldman three-mirror contact lens and optic coherence tomography of the macula and, in some cases, retinal fluorescein angiography. Results: Out of a population of 448 patients, 200 had diabetic retinopathy. That is a prevalence of 45%. The prevalence of macular edema was 6%. The subpopulation of subjects with retinopathy consisted of 61.5% (123) of male patients versus 38.5% (77) of female patients. The mean age of female patients with retinopathy was 42 ± 14.08 years and that of male patients 58 ± 15.07 years. The majority of patients with retinopathy lived in urban areas (73%), and had type II diabetes. The duration of evolution of diabetes was 5 to 10 years in 65% of cases. Obesity, smoking, dyslipidemia and high blood pressure were the main factors of co-morbidity associated with poor glycemic control. Discussion: Diabetic retinopathy had a high prevalence and predominated in males. Maculopathy was represented by macular edema, which is the leading cause of diabetes-related blindness. Conclusion: The prevention of blindness related to diabetes requires regular multidisciplinary follow-up in order to treat retinal damage early.

Ophthalmological Manifestations in Chronic Hemodialyzed Patients:A 132 Cases Study in Abidjan

Purpose: The aim of this study was to describe the eye signs seen in patients on chronic hemodialysis at Cocody University Hospital and the factors influencing their occurrence. Material and Methods: We carried out in the Ophthalmology Department of Cocody University Hospital a cross-sectional study over 15 months. It focused on 132 patients on chronic hemodialysis followed in the hemodialysis department of Cocody University Hospital. Results: Hypertensive nephropathy was the leading cause of chronic renal failure (58%). The most common ocular functional sign was loss of visual acuity (LVA) (38%), followed by ocular pruritus (22%). Twenty-one percent (21%) of our patients were visually impaired (MAVLC Discussion: Eye manifestations in people with chronic renal failure and on hemodialysis are variable. Several factors are involved, mainly hypertension;first and foremost is hypertension. Correction of these factors is necessary to prevent blindness.

Effect of daily supplementation of soy isoflavones on hot flashes and night sweats in African menopausal women

The aim of this study was to evaluate the effectiveness of a pharmaceutical grade isoflavone supplement (Inoclim?) 40 mg per capsule of soy extract rich in daidzin and genistin) on the number of hot flashes and night sweats in menopausal African women. This open, prospective, multicenter study involved 140 menopausal women with climacteric symptoms (i.e., a minimum of five hot flashes and/or moderate to severe night sweats per day). These patients received a daily 40-mg supplement of soy isoflavone contained in an Inoclim? capsule (Laboratoire Innotech International, France). The dose was increased to two capsules per day when there were more than five hot flashes or when the women could not sleep because of night sweats. The patients were followed up over a 4-month period and data were analyzed using EPI-InfoTM version 3.5.1. The outcome measure was fewer hot flashes and night sweats. The mean daily number of episodes of hot flashes was 5.7 at baseline and 1.8 at week 16, corresponding to a decrease of 68.4% (n = 93 patients at baseline and n = 66 at 16 weeks). The mean number of daily episodes of night sweats was 3.7 at baseline and 0.8 at week 16, corresponding to a decrease of 78.4% (n = 127 patients in the first week and n = 73 at 16 weeks). Over 80% of patients took a single one 40 mg capsule per day. The percentage of patients who adhered to the prescription was more than 95% during the 4-month follow-up period. These results confirm the effectiveness of a pharmaceutical grade isoflavone supplement (40 mg, rich in genistin and daidzin) on vasomotor symptoms in menopausal women.