Repair of Complex Post-Traumatic Facial Dislocations: Indications, Therapeutic Difficulties and Results at Treichville University Hospital, Abidjan, Cote d’Ivoire

Introduction: Complex post-traumatic facial disfigurements are caused by civilian or ballistic trauma. Their repercussions are functional, aesthetic and psychological. The initial emergency or secondary management of facial damage is difficult. The objective is to report, through the clinical observation of three patients, the results of the management of complex facial dislocations in a context of limited technical resources. Patients and methods: Three complex post-traumatic facial dislocations were managed between May 2006 and June 2017. Results: Primary treatment and secondary repair were established on a case-by-case basis. Local autoplasty was the indication of choice. Multidisciplinary management resulted in satisfactory functional and cosmetic outcomes. Two of the patients were lost to follow-up before the end of treatment. Discussion: The complete management of facial dislocations remains difficult and complex, in an extreme exercise situation. In an emergency, the priority is to save the life of the injured person. Several factors are involved in the therapeutic decision: the choice of the maxillofacial reconstruction technique, the availability of the technical platform, the financial capacity and the psychological state of the patient and his entourage. Sequential and multidisciplinary treatment gives satisfactory results in terms of morphology, function and aesthetics, despite the limited technical resources available. Psychological support is an essential complement for successful socio-professional and family reintegration.

Treatment and Sequelae of Panfacial Fractures in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan (Cote d’Ivoire)

Introduction: The treatment of panfacial fractures is complex and constitutes a challenge for the maxillofacial surgeon, who, despite therapeutic progress, frequently suffers functional and aesthetic sequelae. This study aimed to describe the treatment and evaluate the functional and aesthetic sequelae of panfacial fractures in the stomatology and maxillofacial surgery department of the Treichville University Hospital. Materials and Methods: We conducted a retrospective study over a 6 years in the stomatology and maxillofacial surgery department of Treichville University Hospital. Forty-two patients with panfacial fractures were included in the study. Results: Forty-two patients were registered. The average time to osteosynthesis was 12.4 days. Nasotracheal intubation was used most often (88%), and in the majority of cases, mixed osteosynthesis combining a screwed plate and steel wire was performed (64.29%). The “Bottom-up and Outside-in” surgical sequence was the most commonly used (64.29%). All patients had at least one functional and/or cosmetic sequela after treatment. Functional sequelae were dominated by occlusal problems and aesthetic sequelae by nasal deformities. Discussion: Panfacial fractures are characterised by their complexity, presenting maxillo-facial surgeons with a therapeutic and evolutionary challenge. The quality of the initial, often multidisciplinary, management of panfacial fractures is an essential factor in both functional and aesthetic prognosis. Conclusion: The treatment of panfacial fractures, even if well managed, is sometimes a source of sequelae, requiring often complex secondary management.

Assessment of Two Years of Free Surgical Treatment of Cleft Lip, Palate and Alveolar (CLPA) in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan

Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the upper lip, the alveolar bone and the palate. The incidence in Africa ranges from 1/2000 to 1/500 births. Their multidisciplinary management is long and costly. Thus, the help provided by humanitarian organisations during free care campaigns is welcome. Materials and Methods: This is a retrospective descriptive study conducted from August 2014 to July 2016 in the Maxillofacial Surgery and Stomatology Department of the Treichville University Hospital in Abidjan, Côte d’Ivoire. The objective was to describe the epidemiological, clinical and therapeutic aspects of CLPA during a humanitarian campaign for free care. Results: 51 cases of CLPA were operated on. Males were involved in 54.9% of the cases, i.e. a sex ratio of 1.2. The average age of the patients at the time of the operation was 3.44 years with extremes of 3 months and 52 years. Patients with low socioeconomic status represented 84.3% of the cases. Cleft lips (31.4%) and cleft palates (33.33%) predominated. For cleft lips, unilateral forms were the most frequent (73.5%) and the left side was most often affected (59.2%). The most common surgical techniques used were MILLARD cheiloplasty for cleft lips (79.36%) and Dorrance pushback for cleft palates (78.05%). The postoperative course was simple in the majority of cases (80.47%). Patients and/or parents were satisfied with the postoperative results in over 90% of cases. Discussion: Cleft lip and palate are common. Their management by humanitarian missions through mass campaigns allows us to receive a large number of patients affected by this pathology who are treated with a high satisfaction rate. Conclusion: The characteristics of cleft lip and palate in this study are in many respects identical to those described in the literature, but with some differences specific to Africa, notably the absence of antenatal diagnosis and the advanced age at the time of treatment.

Indications and Results of Hip Arthroplasty and Hemiarthroplasty at Treichville University Teaching Hospital

Objective: Hip arthroplasty has variable and codified indications. The interest of this study results from the need to adapt our practices to the socio-economic status of our patients. The aim of this study was to describe the epidemiological profile of patients, the indications and results of hip arthroplasties performed in our hospital. Methodology: A descriptive monocentric study was conducted from January 2010 to December 2019 at Treichville University Teaching Hospital. All patients, who underwent total hip arthroplasty or hemiarthroplasty with intermediate or cervico-cephalic prosthesis, were included in the study. Epidemiological, clinical, therapeutic and follow-up data were analysed. Results: We collected 95 patients with 97 hips operated. The mean age was 67 years. 56% of patients were male. Arthroplasty was performed after femoral neck fractures in 78% of cases, followed by osteonecrosis of the femoral head (15%). The left side was affected in 51% of cases. The Moore’s posterior approach was used in 79% of cases, followed by the Hardinge’s lateral approach (21%). Hemiarthroplasties were implanted in 78% of patients. We observed 4 dislocations and 3 post-operative infections at 48 months of follow-up. The mean Harris score was 75.2. Conclusion: Arthroplasty has improved the function of our patients. Most of young males undergo the arthroplasty. Intermediate prostheses are commonly used implants.

Management of an Unusual Complication of Uterine Fibroids in the Gynecological Department of the University and Hospital Center of Treichville (Cote D’ivoire): About 2 Cases of Non-Puerperal Uterine Inversion

Uterine inversion is rare. It is classically described as a complication of the delivery period. Non-puerperal uterine inversion is exceptional and usually results from a tumor implanted on fundus of the uterus. We report two cases of non-puerperal uterine inversion caused by fundal submucosal myoma. Its diagnosis can be difficult and a high index of clinical suspicion is required to make a prompt diagnosis. The delayed diagnosis observed in our cases, caused uterine necrosis, which was managed by hysterectomy. The patients’ post-operative course was uneventful.

Childhood Tuberculosis: A Descriptive Study in the Pediatric Ward of a University Hospital in Abidjan

Introduction:?Tuberculosis is one of the top ten causes of death in the world. Purpose:?The purpose of this study was to describe the different locations of tuberculosis and the diagnostic means used in our department. Methods:?This was a descriptive retrospective study of children under 15 years of age admitted in 2018 for tuberculosis. The variables under study were socio-demographic, clinical, paraclinical and evolutionary data Results:?Forty-eight children were enrolled. The median age was 8.2 years (± 4.5) and the M/F ratio was 1.4. TB contamination was found?in 20.8% of cases and the index was often a family member (80%). The median diagnostic time was 49 (± 33) days. Six patients had positive HIV serology, 82% had acute malnutrition and lung examination was abnormal in the majority of cases (70.8%). Thorax-ray abnormalities were common (81%) and tuberculin skin testing was positive in 70.6% of cases. The diagnosis was confirmed in 29.2% of the children and the confirmatory examinations were direct examination (9 cases), lymph node biopsy (4?cases) and rapid test (Expert MTB/RIF) (one case). In 70.8% of cases, this was a diagnostic presumption. Pulmonary tuberculosis accounted for 72.9% of which 39.6% multifocal forms and extra-thoracic form 27.1%. Thirty-nine patients had received standard TB treatment and death occurred in 22.9% of cases. Conclusion:?Children are a high-risk population for TB, especially in cases of family infection. Contacts screening through a systematic approach to diagnosis will reduce deaths. Diagnostic difficulties can be partly overcome by improving the accessibility of rapid testing.

Frequency of the C677T Polymorphism of MTHFR, G20210A of Prothrombin and R506Q of Factor V Leiden in Type 2 Diabetics in Abidjan

In Africa, the prevalence of diabetes is escalating and remains a concern due to the numerous complications it causes. Vascular damage associated with diabetes leads to a prothrombotic state observed in diabetic individuals. Diabetes is a complex and multifactorial disease involving genetic components. With the aim of preventing complications and contributing to an efficient management of diabetes, we investigated genes likely to lead to a risk of thrombosis, in particular the C677T of MTHFR, G20210A of prothrombin, and R506Q of factor V Leiden in type 2 diabetics in Abidjan receiving ambulatory care. A descriptive cross-sectional study was carried out on consenting type 2 diabetic patients. Mutation detection was carried out using the PCR-RFLP method employing restriction enzymes. Hemostasis tests (fibrinogen, D-dimers, fibrin monomers, and von Willebrand factor) were performed using citrate tubes on the Stage? Star Max automated system. Plasminogen activator inhibitor was assayed by ELISA method, and biochemical parameters were determined using the COBAS C311. The study population consisted of 45 diabetic patients, 51.1% of whom presented vascular complications, mainly neuropathy. Disturbances in hemostasis parameters were observed, with 15.5% of patients showing an increase in fibrin monomers. Mutation analysis revealed an absence of factor V mutation (factor V Leiden) and of G20210A mutation of the prothrombin gene. However, 15.6% of subjects had a heterozygous C677T mutation of MTHFR, with 57% of them being anemic. The exploration of biological and genetic factors associated with thrombotic risk is of significant interest in the optimal management of African type 2 diabetics.

Macrosomia at the Center Hospital of Montelimar (France): 141 Cases Report

Introduction: Macrosomia is usually defined by the delivery of a child over 4000 g at term. Because of the margins of error, the obstetrician must take into account, in addition to ultrasound, the constitutional and acquired factors of the mother in order to be able to prevent the complications expected during the delivery of a large fetus. Material and method: We carried out a cross-sectional, descriptive, 12-month study in a level 2 hospital in southern France (Montélimar). The aim of the study was to assess the prevalence of macrosomia, to identify the epidemiological characteristics of the patients, to specify the management of obstetrics and complications in this hospital. Results: We recorded 141 births with a weight greater than or equal to 4000 g. That is a rate of 7.95%. The average age of our patients is 30 years. Half of them had a BMI of less than 25 and were not diabetic. 75% of the patients gave birth by a low-dose route. The sex ratio of the children is male to female 2:1. The main maternal complications were the perineovaginal tears (39 cases) and the hemorrhages of the deliverance (6 cases). Conclusion: The delivery of macrosomia is not uncommon at the Hospital Center of Montélimar. It predominates among Caucasians. Usual risk factors have rarely been found. Overall management was without major complications for both the mother and the child.

Persistently High Glycated Hemoglobin in a Subgroup of Type 2 Diabetic Patients Who Failed Usual Oral Antihyperglycemics and Insulin in Côte d’Ivoire

Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m2, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.

Profile of Patients with Breast Cancer Brain Metastasis in Abidjan

Patients with breast cancer will develop brain metastases in 15% - 25% of cases. Objective: To identify the profile of patients with breast cancer brain metastasis. Method: Retrospective study over 4 years in the oncology department of Treichville Hospital. All patients with breast carcinoma who had a brain metastasis during their cancer management were included. Results: 41 cases of breast carcinoma brain metastasis were collected. Patients were older than 40 years in 78% of cases. Family history of breast cancer was found in 7% of patients. More than 80% of patients had consulted with T3 and T4 tumor masses, with 100% of cases of node involvement. The brain was the second site of metastasis. The tumors were Triple negative in 48%, Her2 positive in 36% and luminal in 16%. Brain metastases were of late onset in the majority of cases (68%). They were clinically characterized by headaches (100%), most often included in an intracranial hypertension syndrome (52%). They were multiple (60%). Therapeutically, no surgery was performed on the metastases. Three patients received whole brain radiation therapy. All patients received systemic therapy. In terms of response, 30 cases of progression were observed after treatment and 2 cases of complete response were obtained. Survival from onset of brain metastasis was of 75% at 3 months and 2% at 12 months. Patients with longer survival rates were over 40 years old with triple negative breast cancer. Conclusion: Brain metastasis from breast cancer most often occurs in a particular clinical and pathological context in our countries.

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.

Calcification of the Renal Vein and Inferior Vena Cava on a Renal Tumor: An Exceptional Case

Background: A thrombus of the inferior vena cava and renal vein makes the management of renal cancer more difficult. Aim: The aim is to highlight and discuss the management of a case of renal cancer with an unusual thrombus in our context. Case Presentation: We report the case of a 49-year-old female with left kidney cancer, complicated by a calcified thrombus of the renal vein and inferior vena cava. A calcification of renal vein and vena cava was discovered during surgery, even though the diagnosis prior to surgery was a renal tumor with partial thrombus of the IVC. We performed a thrombectomy and left nephrectomy. The post-operative course was marked by the death of the patient a month later. Conclusion: Renal vein and inferior vena cava (IVC) calcifications are uncommon. Preoperative diagnosis is difficult but guided by medical imaging. Renal cancer is one of the causes. A thrombus or calcification of the vena cava worsens the prognosis of cancer.

Metastatic(Advanced)Prostate Cancer Resistant to Castration:The Time before Resistance Development and Therapeutic Measures Undertaken in Cote d’Ivoire

Objective: Contribute to improving care for prostate cancer patients in Cote d’Ivoire by identifying the average time before the development of the hormone-resistance and inherent therapeutic strategies. Patients and Method: It was a retro and prospective study over three years performed at the University Teaching Hospital of Treichville in Abidjan. 84 patients with metastatic prostate adenocarcinoma and resistant to hormone therapy were involved in the study. The analysis of clinical records enabled us to integrate different parameters in our study. Results: Our patients were relatively young (an average age of 61 years) and most of them belonged to the middle socio-economic class (50%). The resistance occurred within an average period of 9 months. The mixing of Docetaxel and Prednisone chemotherapy was the most used method of treatment (70% of cases). However, few patients (9.5%) received Abiraterone Acetate. Digestive and hematologic toxicities were noticed but they could be controlled by inherent treatment or disappear spontaneously. After nine months of treatment, 54.24% of patients who received specific treatment were alive, but high rates of mortality were observed as for patients who were only treated symptomatically. Conclusion: The relatively short average time before the development of hormone-resistance shows the aggressiveness of prostate adenocarcinoma from black Africans. The main therapeutic standard in our context remains Taxane-based chemotherapy with a good and fair tolerance.

Non-Small Cell Lung Cancer:Therapeutic and Evolutionary Aspects in Cote d’Ivoire

Non-small cell lung cancer (NSCLC) is a heterogeneous group of malignancies including squamous cell carcinoma, adenocarcinoma, bronchioloalveolar carcinoma and large cell carcinoma. They are known to be of poor prognosis, despite a better understanding of bronchial oncogenesis. This descriptive retrospective study carried out over three years (January 2013 to December 31st, 2016) at the Oncology Department of the Treichville University Hospital in Abidjan was aimed to assess the efficacy of new treatments for NSCLC in Cote d’Ivoire and to specify their benefit in terms of quality of life, comfort and overall survival. This 77 patients study, found that NSCLC, the most frequent of which is squamous cell carcinoma, occurs in relatively young subjects, smokers (91%) diagnosed at a locally advanced or metastatic stage (89%). Cisplatin base multi-drug chemotherapy was mostly used (71%). Combined all treatments, there was a significant clinical gain. However, no complete response was observed. Hematological and digestive toxicities were seen in more than 30% of cases. Overall survival was of 9 months on average. This study is an advocate to optimize primary prevention policies for a cancer with poor prognosis despite the development of new treatments such as target therapies.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).