Yopougon University Hospital Research Articles

Special Features of Ketoacidosis Episodes of Diabetics Aged at least 65 Years in an Internal Medicine Department

Objective: The objective of this study was to contribute to a better knowledge of episodes of diabetic ketoacidosis of patients aged 65 years and older. Materials and method: This is a descriptive cross-sectional study that involved 62 cases of patients aged 65 years and older hospitalized for ketoacidosis in the internal medicine department of Treichville University Hospital and Diabetes Endocrinology Department of Yopougon University Hospital from June 2015 to June 2016. Results: Obtained are as follows: Epidemiology: Men are the most affected by the disease with a sex ratio of 1.38 and an average age of 68 years. Clinic and biology: it is putative type 2 diabetes with 39% of cases of inaugural ketoacidosis diabetes. Triggers were dominated by infections (52%) with malaria at the top of the list. Evolution: regimens on admission were SOS protocol (56.4%), ICO protocol (44.1%). The average length of hospital stay was 6 days during which four deaths were recorded. Standardized geriatric assessment: In 82% of cases patients had a risk of malnutrition, in 84% of cases patients had a high probability of depression, 85.5% of our patients were not dependent, they were able to live without aid, and 85.4% of patients had a strong suspicion of cognitive impairment. Conclusion: Ketoacidosis of patients aged 65 years and older is a particular complication of diabetes in senior patients hence the need to push for a geriatric approach for better management.

The Practice of Cerebral CT at Abidjan: Advocacy for the Implementation of Guidelines

Objectives: The aim of this study was to assess scanning activities at Yopougon University Hospital through its most common application that is the cranio-encephalic CT in order to make proposals for the improvement of its use. Patients and Methods: This was a three-year-cross-sectional study based on cranio-encephalic CT scans performed at Yopougon University Hospital from January 2011 to December 2013. All CT scans were performed on a TOSHIBA 64-bar scanner with or without injection of iodinated contrast agent. The variables studied were the epidemiological-clinical elements (age, gender and indications), the exploration technique, the overall results and the various pathologies discovered. Results: The mean age of our patients was 35.4 years with a predominance of children (age group of 0 and 14 years). The sex ratio was 1.38. Motor deficits (19.3%) and head trauma (17.5%) was the main indication of cranio-encephalic scanners. We performed 221 examinations without injection of iodinated contrast agent (36.8%) and 379 examinations with injection of iodinated contrast agent (63.2%). We recorded 298 normal findings and 302 pathological findings that are 49.7% and 50.3% respectively. Strokes were the predominant pathology found on the cranio-encephalic scanners (43.7%) followed by traumatic pathology (20.9%). Conclusion: The rate of normal findings for cranio-encephalic scanners was very high (49.7%). Pathological findings were dominated by strokes (43.7%) and traumatic pathology (20.9%). Infectious pathology was paradoxically rare (3%). A more rigorous prescription of cranio-encephalic scanners based on a well-conducted clinical examination and the guides of good use of imaging examinations (guidelines) could help to reduce the rate of normal scanner at Yopougon University Hospital.

Infectious Pathology of the Scrotum in Abidjan: Ultrasound Features of 80 Cases

Objectives: The aim of this study was to determine the epidemiological-clinical profile of patients with scrotal infectious pathology in Abidjan and describe the ultrasound features of this scrotal infectious pathology. Methods: This was a prospective study of 80 cases of scrotal infectious pathology objectified by ultrasound at Yopougon University Hospital from 1 January 2015 to 31 December 2015. Ultrasounds were performed using a high-frequency linear probe in B and Color Doppler modes by senior radiologists. The epidemiological-clinical data were recorded from the ultrasound request form and the interrogation of the patient. Results: The average age was 23 years with extreme ranging from 16 to 40 years. Soldiers were the most concerned (40%) followed by students (30%). The painful large bursa was the quasi constant presenting feature (95% of cases) and fever was associated in less than half of the cases (45% of cases). The scrotal involvement was most often unilateral (85% of cases) and the left side was involved in 70% of the cases. Epididymitis was the most frequent pathology (60%) followed by orchiepididymitis (30%) and orchitis (10%). The most commonly encountered accompanying ultrasound findings were envelope thickening (100%), intravaginal fluid effusion (60%), and Doppler Hypervascularization (30%). Conclusion: In Abidjan Scrotal infectious pathology is most often encountered among young soldiers or students most often with a ± febrile large bursa. The most common pathology is left unilateral epididymitis.

Acute Peritoneal Dialysis in African Pediatric Area Experience of Pediatric Nephrology Unit of Yopougon University Hospital (Abidjan, Côte d'Ivoire)

Introduction: Acute kidney injury (AKI) is a diagnostic emergency threatening patients in a major way. Pediatric renal extra purification methods are limited in African countries due to the nonavailability of resources. Peritoneal dialysis (PD) seems to be the modality that is the most practiced for children with acute renal failure (ARF). Methodology: We conducted a retrospective study on 5 years of records of children from 1 month to 15 years who have suffered an ARF and benefited from PD while being treated at the pediatric nephrology unit of the Chu of Yopougon. ARF is defined as the condition that exists when the serum creatinine level is high or equal to 200 µmol/l outside any underlying uropathies. Results: Out of the hospitalized 88 children for AKI, 33 were on PD. Twenty-two children have been on dialysis while 9 children had to discontinue treatment due to financial problems. The sex ratio was 0.46 and the average age was 8.1. The etiologies of the AKI were predominantly glomerular diseases (45%), malaria (31.8%), and secondary interstitial nephritis of toxic origin. The indications of the PD are anuria (31%), hyperkalemia (18%), acute edema of lung (13%), and hyperuremia (13%). Eight children had automated peritoneal dialysis, 02 children underwent manual PD, and 9 children had both methods of treatment. We recorded 31 mechanical complications and 10 infections. While 8 children died, 10 recovered from AKI. Conclusion: Trained surgical medical personnel and favorable economic statuses of patients are the factors that will determine the success of PD in our country.

L’échographie doppler dans la prévention des amputations des membres inférieurs du diabétique en Côte d’Ivoire

ObjectiveThe 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 methodIt 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. ResultsPatients’ 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. ConclusionColor 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.

Bacteriological aspects of purulent meningitis in the Yopougon university hospital, 1995–1998

Objective – The authors had for aim to determine the frequency and the distribution of germs responsible for purulent meningitis in the Yopougon University Hospital (Abidjan). Material and methods – Three hundred and sixty two purulent CSF collected over four years, were analyzed by bacteriological methods commonly used to detect meningitis. In 85.4% of the cases, the CSF was collected in children between 0 and 15 years of age among whom 40% from one month to two years of age. 28.2% of the CSF samples were lymphocytic and 71.8% were compatible with a purulent meningitis. Results – Two hundred and eighteen strains were isolated; including S. pneumoniae (46%), H. influenzae b (29.2%), N. meningitidis (14.1%), Streptococcus group B (6.8%), and a low percentage of enterobacteria (3.2%). Their distribution according to age range correlated to literature data, S. pneumoniae being found in all age ranges even though it was more frequently found between one month and five years, the monthly distribution did not show any specificity except for H. influenzae b. The strains presented variable levels of susceptibility to common antibiotic drugs such as penicillin, ampicillin, amoxicillin, chloramphenicol, erythromycin, tetracycline. Conclusion – Surveillance for the main bacteria responsible for community meningitis, especially S. pneumoniae, is imperative to identify the various serotypes circulating and assess their susceptibility to efficient and available antibiotic drugs.