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La Côte-Saint-André, France

Desmonde S.,University of Bordeaux Segalen | Desmonde S.,French Institute of Health and Medical Research | Dicko F.,Hopital Gabriel Toure | Koueta F.,University of Ouagadougou | And 12 more authors.
AIDS | Year: 2014

Objective: We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4+ cell response in West African HIV-infected children. Methods: All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 + cell count measurements, including one at ART initiation (baseline) were included. CD4+ cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 + cell count, sex, first-line ARTregimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model compared immune recovery for age within 24 months post-ART. Results: Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4+ cell gains compared with children less than 2 years, the reference group (P<0.001). However, by 24 months, we observed higher CD4+ cell gain in children who initiated ART between 3 and 4 years compared with those less than 2 years (P<0.001). The 24-month CD4 + cell gain was also strongest in immunodeficient children at baseline. Among these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95% confidence interval: 0.56-0.86). Conclusion: These results suggest that both the initiation of ART at the earliest age less than 5 years and before any severe immunodeficiency is needed for improving 24-month immune recovery on ART. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Kouame-Koutouan A.,Center Hospitalo University Of Cocody | Sidibe S.,University of Rennes 2 - Upper Brittany | N'Goan-Domoua A.M.,Center Hospitalo University Of Yopougon | Treguier C.,University of Rennes 2 - Upper Brittany
Medecine Nucleaire | Year: 2013

Les duplications gastriques (DG) sont des malformations digestives congénitales rares de l'enfant. Leur diagnostic fait souvent appel à de multiples méthodes d'imagerie médicale allant de l'échographie à l'IRM. La tomoscintigraphie est une excellente méthode diagnostique rarement utilisée surtout lorsque le mode de découverte de la DG n'est pas en rapport avec une hémorragie digestive. Nous rapportons un cas de duplication digestive non communicante et non hémorragique découverte chez une fille de 6. ans dont l'exploration a bénéficié de multiples moyens d'imagerie, y compris la tomoscintigraphie après injection intraveineuse de pertechnetate de Tc-99. m. Notre objectif est de mettre l'accent sur le rÔle de la scintigraphie dans la prise en charge diagnostique des DG de l'enfant et de discuter l'opportunité des autres moyens d'imagerie dans l'exploration de cette pathologie. © 2013 .

Jesson J.,French Institute of Health and Medical Research | Koumakpai S.,University of Benin | Diagne N.R.,Hopital des Enfants Albert Royer | Amorissani-Folquet M.,Center Hospitalo University Of Cocody | And 10 more authors.
Pediatric Infectious Disease Journal | Year: 2015

Background: We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the International epidemiologic Databases to Evaluate Aids West African paediatric cohort. Methods: Malnutrition was defined at ART initiation (baseline) by a Z score <-2 standard deviations, according to 3 anthropometric indicators: weight-for-age (WAZ) for underweight, height-for-age (HAZ) for stunting and weight-for-height/BMI-for-age (WHZ/BAZ) for wasting. Kaplan-Meier estimates for catch-up growth (Z score ≥-2 standard deviations) on ART, adjusted for gender, immunodeficiency and malnutrition at ART initiation, ART regimen, time period and country, were compared by age at ART initiation. Cox proportional hazards regression models determined predictors of catch-up growth on ART over 24 months. Results: Between 2001 and 2012, 2004 HIV-infected children <10 years of age were included. At ART initiation, 51% were underweight, 48% were stunted and 33% were wasted. The 24-month adjusted estimates for catch-up growth were 69% [95% confidence interval (CI): 57-80], 61% (95% CI: 47-70) and 90% (95% CI: 76-95) for WAZ, HAZ and WHZ/BAZ, respectively. Adjusted catch-up growth was more likely for children <5 years of age at ART initiation compared with children ≥5 years for WAZ, HAZ (P < 0.001) and WHZ/BAZ (P = 0.026). Conclusions: Malnutrition among these children is an additional burden that has to be urgently managed. Despite a significant growth improvement after 24 months on ART, especially in children <5 years, a substantial proportion of children still never achieved catch-up growth. Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa. © 2015 Wolters Kluwer Health, Inc.

Ouedraogo P.A.,Center Hospitalier Of Chambery | Ouedraogo P.A.,Center Hospitalo University Of Yopougon | Kouame N.,Center Hospitalo University Of Yopougon | Ngoan-Domoua A.M.,Center Hospitalo University Of Yopougon | And 2 more authors.
Medecine Nucleaire | Year: 2013

Objective: To determine indications, technique and results of breast MRI performed at Chambery hospital (CH). Patients and methods: Analytical retrospective study of 12 months, conducted at CH. It involved the analyzing of 100 breast MRI examinations performed in 84 patients using a brand device Siemens Magneton Area®. Results: The mean age of patients was 56.2 years. The indications for breast MRI were the assessment of local and regional extension of breast cancer (28%), the results of monitoring of neoadjuvant chemotherapy (22%), the research of local recurrence after conservative treatment (14%) and cases of diagnostic discrepancies (13%). The most commonly used sequences were axial T1 ES (91%), axial T2 STIR (91%) and axial T1 with gadolinium injection (97%). The assessment of locoregional extension revealed multifocal invasion in 14 cases, pectoral in 3 cases, lymph node in 7 cases and skin in 4 cases. Concerning the monitoring of neoadjuvant chemotherapy, tumor involution was found in 10 patients and stability in 3 others. The distinction between tumor recurrence and postoperative scar showed 10 negative cases and 4 cases of tumor recurrence. Conclusion: Breast MRI is an excellent non-invasive method for studying fully and satisfactorily within. It is mainly practiced in the CH to the extension of cancer and monitoring neoadjuvant chemotherapy balance. © 2013 Elsevier Masson SAS.

Kouame N.,Center Hospitalo University Of Yopougon | Koffi D.,Center Hospitalo University Of Yopougon | N'goan-Domoua A.M.,Center Hospitalo University Of Yopougon | Setcheou A.,Center Hospitalo University Of Yopougon | And 6 more authors.
Medecine Nucleaire | Year: 2011

Objective: The aim of this study was to demonstrate the role of the Doppler ultrasound examination in the management of diabetic feet and particularly in the prevention of the diabetic's amputation. Patients and method: It is about a retrospective study carried out over a 4-year period at Yopougon University Hospital (Abidjan, Côte d'Ivoire). It consisted in the analysis of the records of 78 patients hospitalized for diabetic foot and in whom was performed a Doppler ultrasound examination of the lower limbs vessels. The analysis of patients' records helped to bring out the epidemiological, clinical, radiographic, biologic, therapeutic and evolutional elements. Results: Patients' mean age was 57.6 years. The sex ratio was 1.05. Adult diabetes accounted for 93.5% of cases and had been developing for 11.49 years on average. On the Doppler ultrasound scan of the lower limbs arterial anomalies of these limbs were found in 70 cases. They were associated with a venous anomaly in four cases. Arterial anomalies were represented by stenosis (34 cases), occlusions (10 cases), medialarterosclerosis (four cases), small arteries (six cases) and the associations of several elementary lesions (nine cases). In three cases, the arterial abnormality was not indicated. A medical treatment was instituted for all the patients. The outcome was favorable for 61 patients, 13 were amputated and four deaths were recorded. Conclusion: Color Doppler ultrasound examination of lower limbs vessels helped to bring out a vascular anomaly in 89.7% of patients with diabetic foot whose treatment helped to keep the lower limb in 78.2%. We recommend the systematic request of this examination in the African diabetic with adult diabetes which has been developing for more than 10 years before the onset of diabetic foot. © 2011 Elsevier Masson SAS.

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