[Clinical, paraclinic and evolutive profile of HIV infected subject compared with that of non-HIV infected subject in pneumology hospitalization at Abidjan]

INTRODUCTION

The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology.

METHODOLOGY

Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital.

RESULTS

On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]).

CONCLUSION

HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate.

[Comparative diagnosis of bacterial pneumonia and pulmonary tuberculosis in HIV positive patients]

INTRODUCTION

Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic.

METHODS

This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia.

RESULTS

Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4.

CONCLUSION

The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.

Bayesian QTL analyses using pedigreed families of an outcrossing species, with application to fruit firmness in apple

Proof of concept of Bayesian integrated QTL analyses across pedigree-related families from breeding programs of an outbreeding species. Results include QTL confidence intervals, individuals' genotype probabilities and genomic breeding values. Bayesian QTL linkage mapping approaches offer the flexibility to study multiple full sib families with known pedigrees simultaneously. Such a joint analysis increases the probability of detecting these quantitative trait loci (QTL) and provide insight of the magnitude of QTL across different genetic backgrounds. Here, we present an improved Bayesian multi-QTL pedigree-based approach on an outcrossing species using progenies with different (complex) genetic relationships. Different modeling assumptions were studied in the QTL analyses, i.e., the a priori expected number of QTL varied and polygenic effects were considered. The inferences include number of QTL, additive QTL effect sizes and supporting credible intervals, posterior probabilities of QTL genotypes for all individuals in the dataset, and QTL-based as well as genome-wide breeding values. All these features have been implemented in the FlexQTL(™) software. We analyzed fruit firmness in a large apple dataset that comprised 1,347 individuals forming 27 full sib families and their known ancestral pedigrees, with genotypes for 87 SSR markers on 17 chromosomes. We report strong or positive evidence for 14 QTL for fruit firmness on eight chromosomes, validating our approach as several of these QTL were reported previously, though dispersed over a series of studies based on single mapping populations. Interpretation of linked QTL was possible via individuals' QTL genotypes. The correlation between the genomic breeding values and phenotypes was on average 90 %, but varied with the number of detected QTL in a family. The detailed posterior knowledge on QTL of potential parents is critical for the efficiency of marker-assisted breeding.

[Evaluation of multidrug-resistant tuberculosis treatment in Ivory Coast from 2008 to 2010]

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.

[Etiologies of non tuberculous empyema in adult patients infected with HIV in a service of pneumology, Abidjan (Ivory Coast)]

OBJECTIVES

To identify the main bacteria that cause thoracic empyema of HIV-infected patients.

METHODS

Retrospective study analyzing the etiology of thoracic empyema in patients admitted to the pneumology clinic of the university hospital center in Abidjan from January 1998 to December 2010. We included all patients with bacteriologically confirmed thoracic empyema and had serological test for HIV. We compared the different pathogens based on HIV status.

RESULTS

There were 42 patients of thoracic empyema composed of 24 (63.3%) HIV-infected patients [15 (62.5%) males and nine (37.5%) women] and 18 (36.7%) HIV-negative patients [13 (72.22%) men and five (27.78%) women]. The average age of HIV-infected patients was 41.2 years and 44.8 years for HIV-negative patients. HIV status was known only for 4.76% patients at admission, and most of them had a severe stage of immune suppression, (the average T CD4 cell count was 96/mm(3)). Pleurisy was monomicrobial in 83.33% HIV-infected patients and 94.4% HIV-negative patients. It was polymicrobial in 16.67% immunocompromised patients and 5.56% HIV-negative patient. Gram-negative bacteria were isolated from 58.33% HIV-infected patients. Streptococcus Pneumoniae was observed in 61.11% HIV-negative patients.

CONCLUSIONS

Gram-negative bacteria are the main causes of thoracic empyema in patients HIV-infected.

[Contribution of the surgical treatment of drug-resistant tuberculosis during medical follow-up (experience of the pneumology department of the CHU of Cocody, in connection with five observations)]

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.

[Characteristics of supposedly bacterial community acute pneumonia among HIV-positive patients: prospective preliminary study]

INTRODUCTION

Community-acquired pneumonia (CAP) is the second leading cause of hospitalization in the respirology department in Abidjan after tuberculosis. Frequently associated with HIV infection, it has a high mortality rate of about 20% to 30%. The aim of this study is to identify the specificities and severity factors associated with bacterial CAP (BCAP) outcome in HIV-positive patients.

METHODS

The authors conducted a prospective and comparative preliminary study on two groups of patients: 29 HIV-positive patients with BCAP and 21 HIV-negative patients with BCAP. All of the patients were hospitalized for BCAP with symptoms of severity according to the usual score of severity.

RESULTS

The sociodemographic, clinical and paraclinical characteristics were similar in both groups. Failures and deaths were more frequent in the group with HIV infection. In particular, HIV infected patients with a body mass index under 18.5 and a rate of T CD4 lymphocytes lower than 200/mm(3) presented the least favourable evolution.

CONCLUSIONS

A more extensive study should help define the appropriate severity criteria for BCAP associated with HIV infection.

[Removal of an intratracheobronchial foreign body opaque to X-rays in a child within a context of inadequate medical technical equipment]

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.