Medecine et sante tropicales最新文献

Access to drugs is a key element in the treatment of diabetes. Access remains an issue because of their price, availability, and especially affordability. Two elements included in the sustainable development goals - universal health coverage and partnerships - offer an opportunity to improve access.

The results of the fight against tuberculosis in Cameroon remain far from the WHO goals for the eradication of tuberculosis on a global scale, which aim to achieve a global incidence rate of fewer than 100 cases per million inhabitants by 2035. The objective of this study was to describe the social, demographic, and clinical profiles of all patients (n=59) with tuberculosis at the Saint Vincent de Paul Hospital in Dschang, Cameroon, over a one-year period, with an emphasis on their healthcare paths to identify potential factors that may explain delays in their diagnosis and follow-up. Epi Info Version 3.5.3 and Microsoft Excel 2013 software were used to analyze the data. The results of the study showed men accounted for 57.6% of the patients (sex ratio: 1.36). The participants' mean age was 41.87 ± 12 years. The mean duration from onset of first symptoms to the clinical and laboratory diagnosis of TB was 3.26 months. Initially 38.98%, sought care from illicit drug sellers (street sellers), 23.73% from hospital facilities, and 22.03% from traditional medicine practitioners. The influence of illicit drug sellers and traditional practitioners in delaying the diagnosis of these TB infections should be taken into account in national TB control policies in Cameroon.

Study the epidemiological, diagnostic, and treatment features and outcomes of necrotic breast cancer in women. This observational, longitudinal, and descriptive study covered the period from January, 2011, to the end of May, 2016 at the Surgery and Gynecology Departments of Yalgado Ouedraogo University Hospital and Schiphra Medical Center. The study included all women with necrotic breast cancers. Survival was calculated by the Kaplan Meier method and survival comparison was possible with the log-rank method. À risk of error of 0.05 was allowed. Necrotic cancer accounted for 9.1% of all breast cancers. The median age of the patients was 46 years old. The median interval before consultation was 12.4 months. The histological type was invasive ductal carcinoma in 90.8% of cases. Surgery was performed in 51 patients (52%). It was a palliative (cleaning) procedure in 92.2% of cases. Chemotherapy was performed in 28 patients. Overall survival was 61.8% at 6 months, 39.5% at 1 year, and 9.2% at 3 years. Median survival was 10 months: 13 months for women with surgery and 6 months for those without it (p<0.001). Necrotic breast cancer is still common in Ouagadougou. Surgery is the mainstay of the treatment. Survival is mediocre. It therefore seems urgent to focus on raising population awareness and organizing screening campaigns.

Antiretroviral agents (ARVs) are the leading therapeutic weapon against HIV/AIDS infection. When first-line treatment fails, a second-line ARV is needed.

Objective: To determine the prevalence of HIV-infected children treated with second-line ARVs, to assess their adherence and therapeutic response, and to identify factors of good adherence.

Material and methods: A retrospective multicenter study covering the period from January 2015 to July 2016 in all centers providing care to children with HIV included all children treated with a second-line ARV.

Results: A total of 71 children were identified, with a male to female ratio of 1.1 and a mean age of 14.2±3.2 years (range: 5 to 19). Mother-to-child transmission was observed for 97.2 %. In all, 64.8 % of the children had lost at least one parent, 29.6 % both of them. Family socioeconomic status was low for 15.5 % and middle for 74.6 %. Nearly half (46.5 %) were aware of their HIV status, and all received psychological support. The therapeutic regimen used for 54.9 % included ABC + DDI + LPV/r, and the treatment lasted for less than 2 years in 22.5 % and between 2 and 4 years in 38 %. Therapeutic adherence was good in 54.9 %, better in boys (p < 0.01) and in those aged 15 years and younger (p < 0.001). The therapeutic response was good in 89 % at 12 months and 86 % at 4 years, better in those aged 15 years and younger (p < 0.001).

Conclusion: Despite the small proportion of good therapeutic adherence to second-line ARVs, the rate of good clinical and therapeutic response of 86 % in children and adolescents 4 years after being switched to them is an argument that should encourage prescribers to shift patients to second-line treatment as soon as there is an indication. However, challenges remain in improving the management of children and adolescents treated with a second-line ART.

Introduction: Children and adolescents are more vulnerable than adults to virologic failure and the emergence of resistance. The objective of our study was to determine the resistance patterns in adolescents on antiretroviral therapy at Sylvanus Olympio University Hospital in Lome, Togo.

Methods: From June 1 to September 30, 2014, we included patients who had been on HAART for more than 12 months in the pediatric ward of Sylvanus Olympio University Hospital. Patients with an HIV viral load ≥ 1000 copies underwent resistance genotyping.

Results: Virologic failure was found in 36 of the 198 children and adolescents in the study (18.2%). Half were in WHO stage 3,72.2% were treated with a combination of two NRTIs (nucleoside reverse transcriptase inhibitors) and one NNRTI (non-nucleoside reverse transcriptase inhibitor). The mutations were mostly found in the NNRTI class with 100% mutations for EFV and NVP. The mutations associated with the most frequent NRTIs were M184V, Y181C, and T215Y.

Conclusion: Our study shows the need to use PIs (boosted protease inhibitors) in most children treated with NNRTI. It is necessary to strengthen the virological monitoring of children on HAART.

Chronic noncommunicable diseases are increasingly frequent in low- and medium-income countries, but problems of malnutrition, such as growth restriction in children or micronutrient deficiencies in both children and adults, persist in these same countries. This double burden of malnutrition and the emergence of chronic diseases such as type 2 diabetes strain healthcare systems and constitute a sometimes unbearable load for the countries concerned, for the government, but also for the individuals affected and their families. This double burden is often associated with the nutrition transition or the progression away from the local traditional diet towards a Westernized diet frequently high in fat, salt, and sugar, with low nutritional density. This transition is attributed to worldwide changes in dietary systems expressed by an increased availability of foodstuffs marketed across the planet, such as vegetable oils, sugars, and refined flours, but also the multiplication of points of sale of food that has been processed, even ultraprocessed. The efforts to battle this scourge must take into account the complexity of the phenomenon and the many factors associated with it. A systemic approach that considers the global forces governing the food systems must be promoted. Actions concerning nutrition must therefore emphasize simultaneously the problems of undernutrition and of overnutrition. WHO labels these interventions "double duty actions."