Cocody University Hospital Research Articles

Impact of Latex Sensitization on Asthma and Rhinitis Progression: A Study at Abidjan-Cocody University Hospital - Côte d’Ivoire (Progression of Asthma and Rhinitis related to Latex Sensitization)

Background: The frequency of latex allergy is increasing, posing a major health problem. This increase is related to the widespread use of latex materials and cross-reactions between latex proteins and certain foods. This cross-reactivity makes latex avoidance difficult, and latex sensitization is likely to worsen atopic conditions. Objective: The authors evaluated the role of latex sensitization in the poor control of asthma and rhinitis. Methodology: An analytical cross-sectional study was conducted on 1860 patients of all ages and genders, followed up for allergic asthma and rhinitis since March 2012 in the Immuno-Allergology Unit of the Cocody University Hospital in Abidjan. Prick tests with native extracts and the European standard battery were performed to identify allergenic sensitization. The impact of latex sensitization on asthma and rhinitis control was assessed by calculating odds ratios. Results: A high frequency of latex sensitization was associated with asthma and rhinitis. The risks of poor control were related to monosensitization to latex and were even higher in the context of polysensitization. Conclusion: The impact of latex sensitization on the progression of asthma and rhinitis has been well demonstrated. It is recommended to integrate the latex sensitization status into the therapeutic management strategy of these two pathologies.

Epidemiological Trends Related to Stroke and Neuroinfectious Diseases in Patients Admitted to the Neurology Unit at Cocody Teaching Hospital in Abidjan

Background: In Ivory Coast, as in many tropical regions, there is a significant coexistence of infectious diseases and non-communicable diseases (NCDs), particularly within the field of neurology. The dual burden of neuroinfectious diseases, including meningitis and strokes, plays a crucial role in shaping public health strategies implemented by the World Health Organization (WHO) and national health programs. Unfortunately, the epidemiological trends are not regularly updated. This study aims to provide insights into hospital admissions and mortality related to strokes and brain infections to inform health policies and improve disease management. Method: It was a retrospective study that examined the medical records of patients admitted to the neurology department of the Cocody University Hospital in Abidjan from January 1, 2020, to December 31, 2023, and included individuals across all age groups who were diagnosed with stroke, brain abscess, meningitis, or encephalitis. Results: The study involved 1,518 patients, strokes were more common among older adults, with an average age of 57.3 ± 13.7 years. Strokes represented the primary reason for hospitalization, making up 69% of cases, with an annual growth rate of approximately 2%, while neuroinfectious diseases accounted for 13% of total admissions. In-hospital mortality rates were 15% for stroke patients and 28% for those with neuroinfectious diseases, the latter showing a significantly higher mortality risk (odds ratio = 2.50; p < 0.001). Conclusion: Strokes are the leading cause of hospital admissions in our department, with increasing rates; however, neuroinfectious diseases have higher and stable mortality rates, indicating a more severe prognosis. Therefore, health policies must be reassessed to improve prevention and management for both diseases.

Prevalence of peptic ulcers in cirrhotics at the Cocody and Angré University Hospitals in Côte d'Ivoire

Introduction: Cirrhosis, is the consequence of a chronic attack of the liver, is histologically defined as a diffuse process associating mutilating fibrosis (concentric), and regenerative hepatocyte nodules, it has formidable complications (hemorrhagic, cancerous and encephalopathies) essentially. Method: this was a retrospective descriptive study from June 01, 2021 to May 30, 2023, i.e. 2 years. Results: we identified 205 cases of cirrhosis, 36 of which had at least one gastric or duodenal ulcer, i.e. a prevalence of 17.56%. There were 12 women and 24 men, i.e. a sex ratio (M/F) = 2. The mean age was 47.22 years ± 14.7 years with extremes ranging from 28 to 81 years. The etiologies of cirrhosis are (HBV 72.22%, HCV 15%, HBV+HCV 8.33% and chronic alcoholism 5.6%). Civil servants, pensioners, shopkeepers and housewives occupy the first places of complications respectively (25%, 16.7%, 13.9%, 11.1%). Signs of portal hypertension are represented by esophageal varices grade III with a proportion of 61.11% and grade II of 27.8% with or without red signs and at the gastric level, 63.9% of patients had gastropathy of portal hypertension. Ulcerative lesions were single in 80.55%, double in 19.44%, and in order of frequency according to bulbar (44.4%), antral (36.1%), antrobulbar (11.1%) and fundic (8.3%) location. The prognosis was, CHILD C (50%), CHILD B (30.55%) and CHILD A (19.45%). Conclusion: the complications of cirrhosis are formidable, prevention through awareness raising on the avoidance of risky behaviour and universal vaccination against hepatitis B remain the preferred option. Keywords: cirrhosis, Peptic ulcer, Portal hypertension, Cocody University Hospital

Ocular burns: epidemiological, clinical, therapeutic and evolutionary aspects at the Cocody University Hospital, Côte d'Ivoire

This study describes the socio-demographic characteristics, clinical, therapeutic, and evolutionary aspects of ocular burns to contribute to the improvement of their management. A retrospective study was conducted in the Ophthalmology Department of the Cocody University Hospital (CHU) in Abidjan, Côte d'Ivoire, from January 1, 2020, to January 31, 2021. It focused on 49 patient records with ocular trauma, including 12 bilateral cases, totaling 61 eyes. For each patient, socio-demographic data, the nature of the traumatic agent, burn etiologies, ocular burn stage, initial and final uncorrected visual acuity of the affected eye, and treatment were collected. The proportion of ocular burns was 11% out of 436 cases of ocular trauma that consulted in the department. The average age of patients was 27.9 years ± 14.2, ranging from 3 to 60 years, with a male predominance (70%). Students were the most frequent socio-professional category (39%). Work-related accidents were the predominant circumstances, in a third of cases. Chemical agents were the main traumatic agents, in 54% of cases. The average consultation time was 3.5 days ± 7.9, ranging from 1 to 60 days. Stage 1 of the Roper-Hall classification was the most observed stage (51% of cases). Initial visual acuity of the affected eye was less than 1/20 in 28% of cases. Treatment was mainly medical, and a third of treated eyes had a final acuity less than 1/20. Visual prognosis is influenced by burn stages, etiologies, and consultation time, varying according to social and geographical origins.

CAO Recovered in the General Intensive Care Unit: Epidemioclinical Characteristics and Mortality Factors in a Sub-Saharan African Country

Background: Cardiac arrest in the operating room (CAO) is a serious accident of often rare epidemiology.
 Methods: Retrospective, descriptive and analytical study from 2012 to 2021 in the multipurpose intensive care unit of the Cocody University Hospital in Abidjan, including all patients who presented a recovered CAO.
 Results: The prevalence was 1.5% (89 out of 5730 admissions). The mean age was 33.5 ± 26 years (13-81). The sex ratio was 0.1. The medical history was mostly hypertension (22.5%). Patients were classified ASA ≥ III (52.8%) for urgent surgery (52.8%) under spinal anesthesia (56.6%). CAO occurred mostly at anesthetic induction (44.3%). The causes were mainly persistent arterial hypotension (54.7%) and hemorrhagic shock (30.2%). Medical CPR was performed in 94.8% of cases in the operating room before transfer to the intensive care unit. The mean duration of LowFlow was 4.5±1.8 minutes (3-12). On admission, the mean Glasgow score was 6.3±4.4 (3-11). Treatment consisted of continued CPR. The mean stay was 3.1±2.9 minutes (1-12). The death rate was 60.4%. ASA class >3, urgent procedure, general anesthesia, presence of NA alone, Gl score ≤ 7, and Low Flow duration> 5 minutes were predictive of mortality (p < 0.05).
 Conclusion: strengthening of material resources and continuous training in extreme emergency situations for anesthesia personnel could optimize the prognosis of CAO.

Children mandibular fractures: Epidemiological and anatomo-clinical aspects

IntroductionMaxillofacial trauma in children is uncommon, accounting for between 1 % and 14 % of all facial trauma in the general population. ObjectiveTo describe the epidemiological and anatomical-clinical aspects of mandibular fractures in children. Material and methodThis was a retrospective descriptive cross-sectional study with non-probabilistic accidental sampling. It took place in the maxillofacial surgery and stomatology department of Cocody University Hospital in the Republic of Côte d'Ivoire, over a 20-year period (2000–2019). The study population consisted of patients aged 0–16 years admitted to our department for a mandibular fracture. At the end of this study, we identified 58 patients. Data was entered using Excel 2016. Tables and graphs were processed using Excel version 2016. Resultswe have identified 58 patients. The mean age of patients was 9.35 ± 2.1 years, with extremes of 1 and 16 years, and a sex ratio of 2,22 in favouring men. The 6–12 age group was the most affected (n: 34 cases or 60.35 %). Soft tissue wounds were present in all our patients, followed by peri-mandibular swelling (n: 37 cases or 63.79 %) and disorders of the dental articulation (n: 28 cases or 48.2 %). Condylar fractures were the most frequent (46.87 %).Mandibular fracture lines were uni-focal in 75 % of cases. These fractures were associated with other facial lesions in 48.28 % of cases and with extra-facial lesions in 34.48 % of cases. ConclusionMandibular fractures are common in maxillofacial trauma in children. Condylar fractures are the most common, almost always associated with chin injuries. Hence the importance of a systematic examination of the mandibular condyles.

Evaluation of Epileptic States at the Cocody University Hospital (Côte d'Ivoire): Clinical, Etiological, and Therapeutic Aspects

Evaluation of Epileptic States at the Cocody University Hospital (Côte d'Ivoire): Clinical, Etiological, and Therapeutic Aspects

Cross-sectional and descriptive study of centrofacial fractures at the Cocody University Hospital Center from 2016 to 2020

Background/Aim: Centrofacial fractures resulting from high-impact violence can be considered mild traumatic brain injuries. Given the complexities and associated risks, a comprehensive examination of these fractures is warranted. These fractures are increasingly prevalent among young adult patients and are commonly associated with road traffic accidents. In the literature, only a few studies have focused on this particular type of facial bone lesion. In Ivory Coast, no studies have been conducted on these fractures, which highlights the importance of our research aimed at describing the epidemiological and anatomical-clinical characteristics of centrofacial fractures in the stomatology and maxillofacial surgery department of the Cocody Teaching Hospital. Methods: This descriptive cross-sectional study was conducted in the Stomatology and Maxillofacial Surgery Department of the Cocody University Hospital Center from January 2016 to December 2020. Results: The prevalence of these fractures was 24.20%, with a predominance of male subjects. The age group most affected was 20 to 40 years old, accounting for 70.96% of cases, and most patients resided in Abidjan (59%). All socio-economic categories were represented, with a higher proportion of individuals in liberal professions (91.4%). Road traffic accidents involving two-wheeled vehicles were the primary cause of these fractures (76.8%), with the most common injury site being the naso-ethmoido-maxillo-fronto-orbital complex (NEMFOC) (32.5%). Conclusion: The epidemiological characteristics of centrofacial fractures associated with two-wheeled vehicles in the Abidjan metropolis of Côte d'Ivoire suggest the need for increased accountability among motor vehicle drivers and stricter enforcement of traffic laws.

Surgical Management of Postpartum Hemorrhage at Cocody University Hospital in the De Facto Capital City of Ivory Coast

Surgical Management of Postpartum Hemorrhage at Cocody University Hospital in the De Facto Capital City of Ivory Coast

Prevalence and severity of periodontitis among adults in Côte d'Ivoire according to the new EFP/AAP periodontal disease classification.

Background To describe the prevalence and severity of periodontitis in patients attending the Periodontics Service of the Cocody University Hospital at Abidjan.Methods This retrospective observational study reviewed records of patients aged 20-80 years who attended the Periodontics Service between January 2014 and December 2018. Periodontitis was diagnosed, according to the 2018 EFP/AAP new classification of Periodontal and Peri-Implant Diseases and Conditions. Chi-square test, 1-factor Anova test, and logistic regression were performed for analysis.Results A total number of 596 patients were included. The mean age was 44.94 ± 14.34 years and 59.20% of were males. 2 (0.40%) patients were classified as Stage I, 221 (37.08%) as Stage II, and 373 (62.58%) as Stage III/V; the extent of periodontitis was generalized in 39.77% of patients. PD ≥ 6 mm, missing teeth ≥ 5 and mobile teeth were present in 47.15%, 26.35% and 25.50% of the sample, respectively.Severity of periodontitis were associated with age (p < 0.001), socio-economic status (p=0.001), diabetes (p < 0.001), missing teeth (p < 0.001) and smoking (p=0.009). Age (OR= 1.59, 95% CI: 1.11-2.26) and missing teeth (OR= 2.31, 95% CI: 1.08-4.89) were identified as independent risks indicators.Conclusion The prevalence and severity of periodontitis were high. Risks indicators identified may allow early detection and management of groups at high risk in Côte d’Ivoire.

The prevalence of odontogenic maxillary osteitis at the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), Abidjan (Ivory Coast): clinical and therapeutic aspects

Maxillary osteitis is a bone tissue disease or condition with a dentoalveolar origin. This condition remains a public health concern in most developing countries, particularly in the Ivory Coast. Without appropriate management, it can alter the patient's overall health owing to aesthetic, functional, and psychological complications. This study aimed to provide a better understanding of odontogenic maxillary osteitis to consequently improve its diagnosis and medical care. Three major etiologies of maxillary osteitis have been reported: infectious, traumatic, and physicochemical causes. According to the literature, osteitis is grouped into two clinical forms, namely circumscribed osteitis and diffuse osteitis. Their diagnosis is based on a rigorous clinical examination as well as radiographic, histological, and bacteriological examinations. At the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), patients with the late stages of the condition present with significant, disabling, and unsightly osteocutaneous-mucous lesions. Treatment of this osteitis is preventive, curative, and restorative. Odontogenic maxillary osteitis is encountered frequently and typically at a late stage at the Cocody University Hospital's CCTOS. To limit aesthetic and functional damage, raising awareness among African people about oral hygiene and the need for regular consultations should be encouraged.

Evaluation of Antibiotic Prescription in Medical Emergencies of the University Hospital Centre of Cocody-Abidjan

Objective: To evaluate the prescription of antibiotics in patients admitted, in December 2017, to the medical emergencies of the University Hospital Center (UHC) of Cocody. Methodology: A retrospective descriptive and analytical study of 187 patient files registered from December 1, 2017 to December 31, 2017 at the Cocody UHC’s medical emergencies. All patients aged 16 and over, regardless of sex, nationality and place of residence, having consulted at the Cocody UHC Medical Emergencies and having received antibiotics locally or generally during the study period were included. Patients on antibiotics before admission to medical emergencies or admitted to medical emergencies but not treated with antibiotics or died in medical emergencies before receiving antibiotic therapy were not included in our study. Results: In one month, 265 antibiotic prescription lines were recorded in 187 patients divided into 113 men (60.42%) and 74 women (39.57%) with a sex ratio of 1.52 and an average age of 47.5 years. 58.62% (187/319) of patients had received antibiotic therapy for lung (32.23%), neurological (21.49%) and parasitological (13.22%) affections. Beta-alactamines were the most prescribed molecules (70.57%), mainly in monotherapy and intravenously. Antibiotic therapy was unjustified (66.41%) with a non-compliant dosage (29.43%). The evolution of patients on antibiotics was favourable (50.80%) with however a death in 15.51% of cases. Conclusion: Antibiotic therapy in medical emergency at Cocody University Hospital was based on probabilistic reasoning. This implies that the emergency physician must have a good knowledge of the rules of antibiotics use and that he applies them.

Ophthalmological Manifestations in Chronic Hemodialyzed Patients: A 132 Cases Study in Abidjan

Purpose: The aim of this study was to describe the eye signs seen in patients on chronic hemodialysis at Cocody University Hospital and the factors influencing their occurrence. Material and Methods: We carried out in the Ophthalmology Department of Cocody University Hospital a cross-sectional study over 15 months. It focused on 132 patients on chronic hemodialysis followed in the hemodialysis department of Cocody University Hospital. Results: Hypertensive nephropathy was the leading cause of chronic renal failure (58%). The most common ocular functional sign was loss of visual acuity (LVA) (38%), followed by ocular pruritus (22%). Twenty-one percent (21%) of our patients were visually impaired (MAVLC < 3/10). The adnexal lesions were polymorphic. The most commonly encountered were dry eye (14%) and eyelid edema (8%). The anterior segment involvement was dominated by cataract (28%). Hypertensive retinopathy was noted in 42% of patients. The frequency of ophthalmological manifestations decreased as the duration of dialysis increased. Discussion: Eye manifestations in people with chronic renal failure and on hemodialysis are variable. Several factors are involved, mainly hypertension; first and foremost is hypertension. Correction of these factors is necessary to prevent blindness.

Epidemiological andEtiological Characteristics ofMyelopathies intheNeurology Department oftheUniversity Hospital Center ofCocody, Abidjan (Ivory Coast)

The term myelopathy defines a suffering of the spinal cord whatever the etiologies. They often represent real therapeutic emergencies and are burdened by serious functional sequelae. The aim of this work was to describe the epidemiological, clinical, and etiological aspects of all myelopathies. We have conducted a prospective and descriptive study from January1, 2015 to December31, 2016 at the Neurology department of the Cocody University Hospital in Abidjan. Seventy-one patients out of 1,006 were included, that is, a prevalence of 7.06%. The sex ratio was 1.7. The average age was 49years old. HIV was associated with myelopathy in 24.7% of cases. Medullary compression syndrome was predominant. Pott's disease was the etiology of compressive myelopathies (43.9%) followed by bone metastases (26.8%). Tuberculous myelitis was the most common etiology of non-compressive myelopathies (30%). Myelites of undetermined causes account for 50% of non-compressive myelopathies.

Impact of the Perception of Work and Professional Aspirations on the Involvement of Medical Staff at Cocody University Hospital (Abidjan)

Based on the theories of social representations and expectations, this study analyzes the factors influencing the involvement in the work of the medical personnel and more particularly the midwives of the Cocody Hospital. Following a survey of 80 midwives using a questionnaire, those with a favorable perception of work are more involved in work than their counterparts who have an unfavorable perception. Similarly, midwives who nurture a strong occupational aspiration are also more involved in performing their function compared to their pairs who develop rather a low occupational aspiration.

Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis

Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan® (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to societe francaise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan® at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880; P = 0.272]; 0.588 [0.436 - 0.739; P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.

External evaluation of the quality of CD4 T cells enumeration in the laboratory of immunology and hematology at the Cocody University Hospital Center

IntroductionLe taux de lymphocytes T-CD4 (LT4) est un paramètre crucial de suivi et de décision thérapeutique au cours de l'infection au Virus de l'Immunodéficience Humaine (VIH). Sa détermination doit être fiable et précise. Pour fournir des résultats de qualité, le laboratoire d'immunologie et hématologie du Centre Hospitalier et Universitaire (CHU) de Cocody participe à l'Evaluation Externe de la Qualité (EEQ) de la numération des LT4 du QASI (Quality Assessment and Standardization for Immunological Measures relevant to HIV/AIDS). L'objectif de notre travail était d'évaluer la performance du laboratoire dans la numération des LT4.MéthodesUne étude rétrospective a été menée sur les rapports de performance d'EEQ du laboratoire. Les indicateurs de performances SDI (indice de déviation standard), CV (coefficient de variation) ont été évalués.RésultatsLe taux de participation au programme était de 83,33%. Les indicateurs de performance étaient satisfaisants. Les SDI étaient en majorité inclus dans l'intervalle de confiance [-2; +2]. Les CV des échantillons de valeurs normales de CD4 étaient dans les normes. Les taux de conformité des résultats CD4 rendus étaient respectivement de 89,58% et 91,87% pour le compte absolu et le compte relatif. Seuls les CV des échantillons de faible taux de CD4 étaient au-delà des normes (> 15%).ConclusionL'EEQ était un outil indispensable qui permettait au laboratoire de surveiller la qualité de ses analyses. Toutefois des mesures correctives devraient être renforcées dans le suivi-évaluation pour pérenniser et améliorer la qualité des analyses.

Epidemiological Features of Diabetic Retinopathy in Abidjan (C&amp;#244;te d’Ivoire): A Study about 448 Patients

Introduction: Diabetic retinopathy is the retinal location of diabetic microangiopathy. It is a public health problem and one of the target diseases of the global Vision 2020 initiative. The aim of our study was to determine the epidemiological features and risk factors of diabetic retinopathy in the melanoderma African in Abidjan. Materials and Methods: We carried out a prospective observational study which took place from April to September 2016 and which focused on the diabetic subjects received in consultation in the Ophthalmology Department of Cocody University Hospital. All Patients had had bio-microscopic examination of the fundus with Goldman three-mirror contact lens and optic coherence tomography of the macula and, in some cases, retinal fluorescein angiography. Results: Out of a population of 448 patients, 200 had diabetic retinopathy. That is a prevalence of 45%. The prevalence of macular edema was 6%. The subpopulation of subjects with retinopathy consisted of 61.5% (123) of male patients versus 38.5% (77) of female patients. The mean age of female patients with retinopathy was 42 ± 14.08 years and that of male patients 58 ± 15.07 years. The majority of patients with retinopathy lived in urban areas (73%), and had type II diabetes. The duration of evolution of diabetes was 5 to 10 years in 65% of cases. Obesity, smoking, dyslipidemia and high blood pressure were the main factors of co-morbidity associated with poor glycemic control. Discussion: Diabetic retinopathy had a high prevalence and predominated in males. Maculopathy was represented by macular edema, which is the leading cause of diabetes-related blindness. Conclusion: The prevention of blindness related to diabetes requires regular multidisciplinary follow-up in order to treat retinal damage early.

Emergency Neonatal Obstetric Cares at Cocody University Hospital: Overview of Instrumental Extraction

Objectives: The aim of this study was to show an overview of situation of instrumental extraction at the maternity of Cocody University Hospital by determining availability and assessing the maternal and fetal prognosis. Patients and method: it was a retrospective study with a descriptive purpose on 6 months from January 1 to June 31, 2015. It concerned all patients admitted in the expulsive phase of labor delivery room and with an indication of fetal instrumental extraction and the state of their newborns at birth. Results: We saved 2288 vaginal deliveries; including 28 instrumental deliveries on 104 indications of instrumental extraction is an implementation rate of 26.9% (16 by vacuum extractor and 12 forceps). Among patients with indication but without instrumental extraction (n = 76), there is 42.3% vaginal delivery (n = 44) and 30.8% of cesarean section (n = 32). 44 have given birth vaginally (42.3%) and 32 by caesarean section (30.8%). It’s young patient (28 years), nulliparous (42.3%). Average time between instrumental extraction indication and the delivery of the baby was 58 min in the case of instrumental extraction and 1 hour 41 minutes in the case of spontaneous delivery in anticipation of the c-section. Motherhood had 3 instrumental extractors (2 vacuum extractors and 1 forceps) recycled after each use. The Apgar score was good in 85.7% in children born by instrumental extraction and bad in 54.5% in children born vaginally without instrumental extraction. We found 20 stillborn in intra partum occurred only in children born vaginally without instrumental extraction. Twelve (12) cases of bleeding of the issue by uterine atony (27.3%) were recorded in patients pregnant without instrumental extraction. No maternal deaths were observed. Conclusion: The realization of instrumental extraction rate remains low at the maternity of the UH-C. In the event, the fetal prognosis was better.

Therapeutic Itinerary of Women with Uterine Fibroids in Abidjan: About 170 Cases at the Cocody University Hospital (UH-C)

Summary Introduction: The uterine fibroid is responsible for serious complications in African black women and represents the leading cause for hysterectomy. Material and method: We did a prospective descriptive casecontrol study over 3 years, from October 1, 2012 to September 30, 2015. The study was carried out with the help of 170 patients with uterine fibroid operable whom 129 had an itinerary of alternative care, called case group; and 41 who only visited the hospital which constituted the control group. We performed surgery for 82 patients in the case group and 41 patients in the control group and then compared the two groups including management and prognosis. Results: In the case group, patients had an age between 30 and 40 years in 45.2% and were zero gravidity in 39.2%; against 63.4% and 19.5% respectively in the control group; with a statistically significant difference (alpha=5%). The reasons for consultation of the patients in the case group were genital hemorrhage in 75.6%; pelvic pain in 29.3% or pelvic mass in 49.9%. While in the control group, these same reasons of consultation were accounted respectively for 70.7%; 7.3% and 21.2% with a statistically significant difference. Most of the patients consulted in first intention a traditional healer (43.9%) and saw their worst condition (RR=4,5). A hysterectomy was performed in 22% among cases compared to 7.3% in the controls. Discussion: The trend of the first consultations made to the traditional healers. The condition worsens with the appearance of a larger number of pelvic mass and pelvic pains. There is more realized hysterectomy among cases than controls. Conclusion: Patients have unconventional therapeutic itinerary which expose them to a hysterectomy.