AIM:To assess the predictive factors for in-hospital death after acute coronary syndromes (ACS) in Abidjan Heart Institute. PATIENTS AND METHODS:Observational prospective study from January, 2019 to December, 2023 using data from REgistre des syndromes coronAriens aigus de CôTe d'IVoire (REACTIV). Patients aged 18 years old and over admitted to the Intensive Care Unit (ICU) of the Abidjan Heart Institute for ACS were included. We collected socio-demographic, clinical, paraclinical and outcomes data. Predictive factors for in-hospital death were identified by multivariate analysis. RESULTS:Six hundred and sixty one (661) patients presented with ACS among the 3302 admitted to the ICU of the Abidjan Heart Institute, giving an overall prevalence of 20.0%. ACS occurred in relatively young patients, with a median age of 57 years [48-65] and a male predominance (sex ratio=2.86). Hypertension (55.6%), active smoking (33.4%) and diabetes (25.7%) were the most common cardiovascular risk factors. Median admission time was 24 [8-72]h. Overall in-hospital mortality was 9.5%, decreasing from 11.2% in 2019 to 5.0% in 2023. In multivariate analysis, age (RR 1.08; CI95% 1.05-1.12), diabetes (RR 1.9; CI95% 1.1-3.3), Killip class≥2 on admission (RR 3.5; CI95% 2.1-5.8) and severe ventricular rhythm disorder (RR 8.3; CI95% 3.3-20.4), were risk factors for in-hospital death. Percutaneous coronary intervention (PCI), performed in 56% of patients, was a protective factor (RR 0.4; CI95% 0.2-0.7). CONCLUSION:ACS, which is increasing our practice, is responsible for high mortality, with well-identified in-hospital death risk factors. PCI appeared to be a protective factor. The implementation of ACS management networks and improved technical facilities should help improve long-term outcomes.
Introduction:Sickle cell disease leads to numerous complications that require frequent medical care. This study aimed to analyze the care pathway of children with severe sickle cell syndrome who were admitted to the pediatric emergency department at Cocody University Hospital. The goal was to identify factors associated with delayed consultation and promote the early and appropriate management of complications. Methodology:This retrospective descriptive study was conducted in the pediatrics department at Cocody University Hospital from January 1 to December 31, 2024. Children with major sickle cell syndrome and a known electrophoretic profile who were hospitalized for an acute complication of the disease were included in the study. The care pathway was analyzed. Data were entered and analyzed using Excel software. Fisher's exact test was used to compare proportions, setting the significance threshold at 5% (p < 0.05). Results:Of the 800 admissions, 60 children with major sickle cell disease were included, representing a hospital prevalence of 7.5%. The mean age was 5.38 years, ranging from six months to 14 years. The sex ratio was 1.07. Fifty percent of the patients were diagnosed before the age of two, often due to clinical manifestations such as anemia (35%), vaso-occlusive crises (18.3%), and hand-foot syndrome (16.7%). The mean age at diagnosis was 1.8 years ± 8.9, ranging from three months to 12 years. Follow-up was inadequate in 61.7% of cases. In 68.3% of cases, vaccination status was incomplete or undocumented. Patients were referred from a health center in 50% of cases. Of those who received treatment prior to referral, 73.3% were included in the study. The most commonly prescribed drug classes in the outpatient setting were analgesics/antipyretics, antimalarials, and antibiotics, accounting for 63.3%, 23.3%, and 60% of cases, respectively. Delayed consultation was observed in 71.7% of cases and was associated with unfavorable socioeconomic status (p = 0.036), self-medication (p = 0.023), use of traditional medicine (p = 0.02), poor follow-up quality (p < 10-3), and taking analgesics at home (p < 10-3). Conclusion:This study highlights several shortcomings in the care pathway for children with sickle cell disease, particularly delays in seeking medical consultation linked to socioeconomic and cultural factors. A more structured, educational approach to care is essential to improving their prognosis.
La tuberculose multifocale est une forme rare et grave de tuberculose définie par l’atteinte simultanée de plusieurs sites, le plus souvent pulmonaires et extra pulmonaires. Elle représente un défi diagnostique majeur, notamment lorsqu’elle mime des pathologies hématologiques ou néoplasiques. Nous rapportons le cas d’une patiente de 53 ans, immunocompétente, admise pour une altération progressive de l’état général évoluant depuis plusieurs mois, associée à une asthénie importante, une anorexie et un amaigrissement. Les explorations cliniques, biologiques et radiologiques ont mis en évidence une atteinte pulmonaire associée à une infiltration médullaire, initialement évocatrice d’une hémopathie maligne. Les examens microbiologiques et histopathologiques ont finalement permis de retenir le diagnostic de tuberculose multifocale. Un traitement antituberculeux standard a été instauré, avec une évolution clinique favorable. Ce cas illustre la diversité des présentations cliniques de la tuberculose multifocale et souligne la nécessité de l’évoquer systématiquement devant un syndrome général prolongé, même chez les patients immunocompétents. Mots-clés : tuberculose, moelle osseuse, hémopathie.
Tuberculosis (TB) remains a leading cause of morbidity and mortality for children living with HIV (CLHIV), with gaps in TB screening, diagnostics, management, and TB preventive therapy (TPT). We investigated reported practices in these domains at sites caring for CLHIV in low- and middle-income countries (LMICs) within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We implemented a site survey from September 2020 to February 2021, querying pre-pandemic practices. This analysis included sites in LMICs providing care for CLHIV that diagnosed TB in 2019. We analyzed responses using descriptive statistics and assessed regional differences using Fisher's exact or chi-square tests. Of 238 IeDEA sites, 227 (95%) responded and 135 met the inclusion criteria. Most (90%) reported screening for TB at HIV care enrollment. Access to diagnostics varied significantly by region, including nucleic acid amplification testing (NAAT, range 67-100%), mycobacterial culture (range 43%-83%), and drug susceptibility testing (range 30%-82%) (P < .001). On-site TB treatment was high (90%). Reported stock-outs occurred for isoniazid (23/116, 20%) and other TB medications (11/114, 9.6%, range 0%-33%, P = .008). TPT provision ranged 50%-100% (P < .001). Six months of isoniazid was the most common TPT regimen for children (88%). Shorter TPT regimens were uncommon (0.9%-2.8%), as were regimens for multidrug-resistant TB exposure (4.6%). Overall reported availability of NAAT and integrated TB/HIV treatment for CLHIV cared for at these IeDEA sites in LMICs is encouraging but varies by context. Heterogeneous implementation gaps remain-particularly for drug susceptibility testing, TPT delivery, and TPT regimens-which may impede TB prevention, management, and successful outcomes for CLHIV, warranting continued close attention over time and as global TB care guidelines and services evolve.
RÉSUMÉ L’hypertension intracrânienne idiopathique (HTIC) est rare en pédiatrie. Nous illustrons, à travers le cas d’une adolescente de 10 ans, l’impérieuse nécessité d’un diagnostic et d’une prise en charge précoces pour prévenir les complications visuelles. La patiente, présentant une obésité, a été hospitalisée pour un syndrome méningé associé à une HTIC. Le fond d’œil a objectivé un œdème papillaire stade 2, tandis que l’IRM cérébrale et l’analyse du liquide céphalorachidien étaient normales, hormis une hyperpression à la ponction lombaire (36 cm H₂O). Le traitement combinant méthylprednisolone et acétazolamide a permis une régression complète des symptômes. Ce cas souligne l’importance d’une démarche diagnostique rapide et d’un traitement adapté pour éviter les séquelles irréversibles, notamment visuelles. ABSTRACT Idiopathic intracranial hypertension (IIH) is rare in children. We report the case of a 10-year-old adolescent girl with obesity, admitted for meningeal syndrome and IIH. Fundoscopy revealed stage 2 papilledema, while brain MRI and cerebrospinal fluid (CSF) analysis were normal except for elevated opening pressure (36 cm H₂O). Treatment with intravenous methylprednisolone and oral acetazolamide led to complete resolution of symptoms. This case underscores the need for prompt diagnosis and targeted therapy to prevent irreversible visual sequelae. Early recognition of IIH in pediatric patients with obesity and meningeal signs is critical for optimal outcomes.
