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Introduction: Systemic inflammatory diseases (autoimmune and autoinflammatory) are quite infrequent and challenging to diagnose. The intent of this study is to determine the hospital frequency, clinical, and immunological aspects of these diseases in the internal medicine department of the CNHU-HKM of Cotonou. Methods: This was a cross-sectional, descriptive study that was conducted from March 30 to October 30, 2018, and involved patients followed in the Internal Medicine Department of the CNHU-HKM for systemic inflammatory diseases Results: During the study period (7 months), 699 patients had consulted the service. We counted 23 patients for our study, i.e. a frequency of 3.3%. The average age was 44 (±12) years with extremes of 24 to 64 years. The majority of our patients were women with a sex ratio (M/F) of 0.09. Prolonged fever was the primary reason for admission (34.8%), followed by polyarthralgia (25%). Systemic lupus was the most represented (52.2%), followed by scleroderma (13%), mixed connectivity (13%). As for the class of systemic inflammatory diseases, systemic autoimmune diseases were the most represented (87.0%). Anti-nuclear antibodies were the most frequent (56.5%). Conclusion: Systemic inflammatory diseases are little known in Benin Republic. In fact, their clinical and immunological presentations are quite polymorphic.

Introduction: In black Africa, connectivites have been for a long time a source of diagnostic erraticity because of their clinical polymorphism. This study aims to determine the therapeutic itinerary of patients followed for connectivitis in the Internal Medicine Department of the CNHU HKM of Cotonou. Methodology: This is a cross-sectional study that included patients followed for connectivitis in the HKM-Cotonou Internal Medicine Department from January 2010 to October 2018. Results: Out of 3600 patients hospitalized in the study period, 21 had connectivitis, i.e. a hospital frequency of 0.58%. Of the 21 patients collected, 18 met the inclusion criteria. The mean age was 40 (±11) years old and the youngest was of 21 and the oldest 58. The sex ratio was 17.9. The “Fon” ethnic group was the most represented (33.3%) and 15 (83.3%) subjects were Christians. Systemic lupus erythematosus was the most frequent connectivitis (55.6%). The average time of consultation was 38 months. Witchcraft was the most incriminating cause (78%). Ten (55.5%) patients had resorted to self-medication as their first choice of treatment, 5 (27.8%) to traditional medicine treatment and 3 (16.7%) to prayer for healing. The reasons for the first choice of treatment were satisfaction (44.4%), financial problems (27.8%), trivialization of the disease (16.7%), and advice from family and friends (11.1%). The consultation at the CNHU followed a referral from a first contact health structure (61%) or an initiative of the patient (27.8%). Conclusion: Connectivitis is a source of diagnostic error in our context. Awareness must be raised among patients for an early consultation at the first symptoms.

Introduction: Tuberculosis remains a major public health problem. The damage to the central nervous system is severe. We reported here two cases. Clinical Case 1: A 37-year-old female patient, naively Human Immunodeficiency Virus1 (HIV1)-positive with antiretroviral (ARV) treatment, hospitalized in the Internal Medicine department for altered consciousness in a febrile context. The clinical examination at admission noted a meningeal syndrome. Cytological analysis of the cerebrospinal fluid (CSF) revealed lymphocytic meningitis with 98% lymphocytes for 3634 leukocytes. CSF polymerase chain reaction (PCR) detected Mycobacterium tuberculosis DNA. She was put on anti-tuberculosis treatment. The immediate course was favourable, but a secondary worsening of the clinical picture was the cause of his death. Clinical Case 2: A 34-year-old male patient, naively HIV1-positive with ARV treatment. He is hospitalized in the Multi-Purpose Anaesthesia and Resuscitation Department of the CNHU HKM for altered consciousness in a feverish context. The clinical examination noted a meningeal syndrome. The cytological analysis of the CSF noted 184 leukocytes for 99% lymphocytes. The CSF PCR identified the DNA of Mycobacterium tuberculosis. He was put on anti-tuberculosis treatment. The evolution was marked by his death. Conclusion: The neuromeningeal localization of tuberculosis is a poor prognosis. Co-infection with HIV remains a potential deadly combination.

Cytomegalovirus (CMV) infection is an infection that most often affects immunocompromised individuals with a seroprevalence of more than 80%. CMV co-infection is associated with increased mortality in HIV-infected individuals despite antiretroviral treatment. It has the potential for hematogenous dissemination to all the organs, but only becomes symptomatic when the viral load is high. This is especially possible when the human immune system is well controlled so that the individual infected with CMV generally remains asymptomatic, and possibly for a long period. Once the immune system fails, CMV infection becomes symptomatic. Diagnosis is not easy and is often done postmortem in developing countries with limited technical facilities. We report here two cases diagnosed at the Internal Medicine Service of the CNHU-HKM in Cotonou. The patients were infected with HIV and had a long term fever. The diagnoses were made on the basis of CMV serology. The first diagnosis was post-mortem, and the second patient died 48 hours after the start of the treatment.

Introduction: Patients with Systemic Lupus Erythematosus (SLE) are seen late in specialized medical consultation in Benin. The objective of this work was to assess general practitioners’ knowledge in Cotonou about SLE. Materials and Methods: This work was a cross-sectional study that was led in the city of Cotonou from July 1 to September 30, 2017. In the study population, we have general practitioners who practice in the city. Data collection was set in response to a self-questionnaire. Result: The survey involved 209 general practitioners. The average age was 27.5 years with a minimum of 22 and a maximum of 34. Most of them practiced in private clinics. Besides, 17 doctors (8.1%) reported that they never heard of lupus. Among the 192 remaining, only one had an average knowledge of lupus, while the others had insufficient knowledge. Conclusion: From this study, we got that SLE is still little known by the general practitioner. Increasing the knowledge of general practitioners’ knowledge of lupus is compulsory to improve the screening rate.

Introduction: The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview about the reasons why the elderly come for consultation in the internal medicine department of the HKM-NHUC in Cotonou. Methodology: This was a retrospective, descriptive, and analytical study, which included all patients aged 65 years and over, who came for the first time for consultation in the Internal Medicine Department of the CNHU-HKM between January 1st and December 31st, 2017. Results: Among the 680 new patients received in internal Medicine consultations during the study period, 118 people were aged 65 and over, representing a hospital frequency of 17.35%. The sex ratio was 0.9 with a mean age of 73 ± 7 years. Hypertension was the main comorbidity of the patients (69%). Cough (11.3%) and low back pain (8.2%) dominated the reasons for consultation. The three main nosological groups of pathologies were, in descending order, diseases of the osteo-articular system (17.5%), diseases of the respiratory system (16.5%) and diseases of the circulatory system (12.4%). Pneumonia (11.3%) and lumbosacral spondylarthrosis (10.3%) were the most frequent pathologies in patients whose health needs remain quite varied. Conclusion: The elderly become gradually an important part of the population in southern Sahara. A better understanding of the health needs of this category of the population is necessary to deal effectively with the health challenges that will accompany this phenomenon.

Introduction: Approximately 5 to 25% of the 34 million people living with HIV (PLHIV) worldwide are co-infected with HBV or HCV. The objective of this work is to determine the prevalence of HBsAg in PLHIV followed at the University Hospital of Porto-Novo and to identify the factors associated with this co-infection. Methods: This was a descriptive and analytical cross-sectional study covering the period from 01/02/2016 to 01/05/2016. We included PLHIV on antiretroviral therapy (ARV) or not, who were older than 15 years and who gave their consent. HBsAg was investigated by the DiaSpot One-Step Test Strip Rapid Test. Results: 301 PLHIV participated in the study. The average age was 42 ± 10.3 years old. The age groups 35-45 (39.2%) and 25-35 (23.9%) were the most represented. Women (73.1%) were predominant. The main common risk factors were unprotected sex (98%), multiple sexual partnership (57.5%), circumcision outside hospital (66.7% of men), scarification (78.1%) and transfusion (17.6%). The prevalence of HBs Antigenemia was 14.3%. Factors associated with co-infection were history of liver disease and alanine aminotransferase levels greater than twice normal. Conclusion: The prevalence of HBsAg is high among our PLHIV. The search for this Ag should be systematic during the initial assessment of these patients in order to adapt the ARV treatment.

Resume Introduction Les soins palliatifs constituent un nouveau concept dans la pratique des soignants au Benin. Les objectifs de notre travail etaient d’evaluer la connaissance et de repertorier les pratiques infirmieres en matiere d’accompagnement des patients en fin de vie. Materiels et methodes Il s’agit d’une etude transversale descriptive qui s’est deroulee du15/08 au 30/09/2014. Elle a concerne tous les infirmiers exercant dans les services de medecine du centre national hospitalier universitaire Hubert-K.-Maga a Cotonou. Resultats Un total de 28 infirmiers a ete enquete. Seulement huit connaissaient la notion de fin de vie (soit 28,6 %), parmi lesquels sept avaient declare que les besoins principaux etaient de calmer la douleur (soit 87,5 %). Vingt-et-un infirmiers ont declare n’avoir jamais participe a un accompagnement en fin de vie (soit 75 %). Conclusion L’accompagnement des patients en fin de vie est meconnu par le personnel infirmier. Les besoins de formation du personnel dans ce domaine s’averent donc necessaires.

Introduction: Healthcare-associated infections are involved in hospital long-stay and in the increase in inherent costs to patients care. Objectives: Objective was to describe the characteristics of healthcare-associated bacteremia and urinary tract infections in medical wards of CNHU-HKM of Cotonou, describe the distribution of germs identified according to admission wards and identify factors associated with onset of healthcare-associated infections. Materials and Methods: It was a cohort study conducted from 4th April to 16th September 2016. The study population included patients admitted in wards A and B of CNHU-HKM Medicine department for at least the past 48 hours, or readmitted in one of the medical wards less than 14 days after their discharge from hospital. Results: The study included 825 patients in total. Prevalence of healthcare-associated infections was 9.8%. Bacteremia was the most represented group (65.4%). The most often identified germs regardless of the site were respectively: K. pneumonia (38.5%), S. aureus (23.1%) and E. coli (20.0%). HIV+ status, internal medicine department, nephrology and endocrinology, duration of admission and the use of urinary catheter represent factors statistically associated with the onset of healthcare-associated infections. Conclusion: Healthcare-associated infections are a real public health issue in CNHU-HKM Medicine Department. There is pressing need to conduct a study on clinical hygiene so as to assess healthcare staff in practice.

Objective: To study the epidemiological, clinical and paraclinical aspects of cirrhosis at Borgou Departmental University hospital Center. Methods: This is a retrospective study for descriptive purpose conducted in the Internal Medicine Department. The study population consists of patients hospitalized in the Internal Medicine Department during the period from 1st January 2009 to 31st December 2016. Results: The frequency of cirrhosis was 1.35%. The sex ratio was 3.76. The average age of patients was 45.22 ± 15.23 years old, with a range from 15 to 82 years. There is a post hepatitis Bcirrhosis predominance in 87.5% of cases, followed by alcoholic cirrhosis in 21.59% of cases. The complications of cirrhosis are dominated by ascites (78.4%) and jaundice (52%). Conclusion: Cirrhosis is a condition that is wide spread. The hepatitis B virusis the main cause of liver cirrhosis followed by alcoholism. Ascites is the most encountered complication. It’s very important now to educate the populations for a behaviour change and to promote vaccination against viral hepatitis.

Resume Introduction Les travaux consacres a l’evaluation et a la prise en charge de la douleur au cours du VIH sont inexistants au Benin. Les objectifs de notre travail etaient d’evaluer les connaissances du personnel en charge des personnes vivant avec le VIH (PVVIH) sur la douleur et de determiner les freins lies a l’analgesie. Materiels et methodes Il s’agit d’une etude descriptive conduite en mars 2017 aupres du personnel des services de medecine interne et du centre de traitement ambulatoire (CTA) des PVVIH. Resultats Au total, 22 personnels de sante ont ete enquetes dont 15 medecins, 4 infirmiers et 3 etudiants en these de doctorat de medecine. Dans la pratique, ils n’evaluaient pas systematiquement la douleur chez tous les patients (36,4 %). Si evaluation, l’EN, l’EVA et l’EVS etaient les principales echelles utilisees. L’utilisation d’analgesie etait freinee par l’accessibilite difficile de la morphine (59,1 %). Conclusion La douleur chez le PVVIH est sous-estimee et sa prise en charge reste a ameliorer. Il est necessaire de recycler le personnel de sante sur l’evaluation de la douleur et la prescription correcte d’antalgique.

Aim: To determine the frequency, the clinical and etiological aspects of ascites in the Internal Medicine Division of the University Hospital of Porto-Novo. Methods: It was a cross-sectional study with a descriptive focus covering the period from January 16 to August 31, 2015. It covered patients hospitalized for ascites in Internal Medicine Department at the Departmental University Hospital of Porto-Novo during the study period. Data were collected on a survey sheet and entered by Excel and analyzed with SPSS. The Chisquare test was used for statistical analysis and a significance threshold of 5% was retained. Results: Of the 511 hospitalized patients during the study period, 61 (11.9%) had ascites. The mean age was 49.6 ± 13.6 years with extremes of 19 years and 80 years. There was a male predominance with a sex ratio of 2.05. Ascites were often type III (34 patients, 55.7%), or type II (22 patients, 36.1%). The frequent signs were hepatomegaly (65.6%), splenomegaly (45.9%), pelvic limb edema (44.3%), and abdominal collateral venous circulation (39.3%). The macroscopic appearance of the ascites fluid was dominated by citrin yellow (82%), followed by hazy (11.5%). The hematic appearance was found in 6.5% of the cases. Hepatic cirrhosis was the most frequent etiology (34.4%) followed by overall heart failure (21.0%). Hepatocellular carcinoma was found in 16% of cases and nephrotic syndrome in 10% of cases. Conclusion: The etiological diversity of ascites, found in our study, imposes a careful clinical and paraclinical approach.

Background: Late presentation to care is associated with increased morbidity, mortality and healthcare cost. Objectives: To determine the prevalence of late presentation to care in Benin, describe its trends and identify risk factors associated. Methods: We conducted a retrospective analysis from 2003 to 2014 at the National HIV Referral Centre in Benin. The definition of the European Late Presentation Consensus Group (ELPCG) for late presentation to care was used. Late Presenters (LP) were defined as patients presenting to care with CD4 count below 350 cells/mm3 or with an AIDS defining event, and patients with advanced HIV disease (AHD) were defined as persons with a CD4 count below 200 cells/mm3. Results: 5018 patients were included. Women accounted for 62.9%. Patients ranged in age from 18 to 62 years. 4233 patients (84.4%) were late presenters (LP) and 3126 (62.3%) were in Advanced HIV Disease (AHD). Late presentation decreased from 97.7% in 2003 to 78.7% in 2009. Between 2009 and 2014, there was no substantial decrease. Older age [Odds Ratio (OR) = 3.17; 95% Confidence Interval (CI) = [2.52 - 4.00], p < 0.001], male gender (OR = 1.85; 95% CI = [1.56 - 2.22], p < 0.001) and non-schooling (OR = 2.13; 95% CI [1.77 - 2.56], p < 0.001), were associated with late presentation to care. Being diagnosed through the Prevention of Mother To Child Transmission (PMTCT) of HIV, appeared as a protective factor (OR = 0.20; 95% CI [0.15 - 0.27], p < 0.001). Conclusions: The prevalence of late presentation to care in Cotonou is alarming. This prevalence has been on a declining trend, but it remains extremely high. In order to reach the first 90 of the 90-90-90 targets, policymakers should promote the Provider-initiated HIV Testing and Counselling in all health facilities, modeled on the existing PMTCT of HIV screening during pregnancy.

Resume Objectif Determiner la prevalence de l’antigenemie cryptococique chez les patients infectes par le VIH a Cotonou en vue de la mise en place d’un depistage systematique. Patients et methodes Il s’agit d’une etude transversale, descriptive et analytique menee de juin a septembre 2015 dans quatre centres de traitement ambulatoire aupres des patients adultes vivant avec le VIH, beneficiant ou non d’un traitement antiretroviral avec un nombre de CD4 ≤ 200 cell/μL. Pour chaque patient enrole, apres la signature du formulaire de consentement, il a ete realise un examen clinique, puis l’administration d’un questionnaire permettant de collecter les renseignements generaux, biologiques et therapeutiques. Ensuite un prelevement sanguin pour le comptage des lymphocytes CD4 et la recherche de l’antigenemie cryptococique ont ete faits. Resultats Au total, 355 patients sont inclus dans l’etude avec une moyenne d’âge de 40 ± 10,2 ans. La prevalence globale de l’antigenemie cryptococcique est de 1,7 %. Tous les patients ayant une antigenemie positive ont un taux de CD4 inferieur a 100 cell/μL avec une majorite ayant un taux 2 , un etat general altere avec un taux de lymphocyte CD4 Conclusion Cette etude pilote a montre une faible prevalence de l’antigenemie cryptococcique dans la population d’etude, mais plus elevee chez les patients tres immunodeprimes avec un taux de CD4

La tuberculose demeure un problème de santé publique, surtout dans les pays en voie de développement. Si la forme pulmonaire bacillaire est la plus fréquente, la forme génitale est rare et sous-diagnostiquée. Nous rapportons un cas de tuberculose de l’endomètre. Il s’agit d’une patiente de 72 ans ayant une hémoglobinopathie SC qui a consulté son gynécologue pour des leucorrhées trainantes. L’examen cytobactériologique des prélèvements vaginaux a mis en évidence un Stréptococcus agalactatiae. Malgré une antibiothérapie adaptée, l’évolution a été marquée par une persistance des leucorrhées. L’échographie pelvienne a objectivé un endomètre épaissi avec une image hyperéchogène du fond de l’utérus, évocatrice de tumeur de l’endomètre. L’examen anatomopathologique des pièces de curetage biopsique de l’endomètre a conclu à une endométrite granulomateuse en faveur d’une tuberculose folliculaire. L’évolution a été favorable sous traitement antituberculeux. La tuberculose génitale n’est pas exceptionnelle et doit être évoquée devant une leucorrhée persistante malgré un traitement adapté en milieu d’endémie tuberculeuse.

Corticosteroid therapy has revolutionized the treatment of many diseases in medicine. The most concerned diseases are chronic inflammatory diseases. Its use may be either short-term or long-term, thus generating several side effects, some of which are conventional and known, but others are rare, such as Kaposi’s sarcoma. We report here a particular clinical observation. Observation: This is a patient of 37 years, who consults in Internal Medicine for the treatment of mucocutaneous lesions, papular nodular, hyper pigmented, budding and disseminated appeared after six months of corticosteroid therapy. This treatment was introduced for the treatment of acoustic neurinoma. The patient is not diabetic or alcoholic and has a negative HIV status. The diagnosis of Kaposi’s sarcoma was made by histology of biopsied skin lesions which concluded for a regular proliferation without atypia spindle cell or mitosis. The lesions persisted over a month despite discontinuation of corticosteroid therapy. Treatment with Bleomycin was necessary. The outcome was favorable under treatment with progressive and complete disappearance of lesions after 15 treatments. Conclusion: The classical side effects of long-term corticosteroid are known, but Kaposi sarcoma complicating long-term corticosteroid is rare in the literature. It is vital that any long-term corticosteroid should be the subject of careful and regular monitoring.

Introduction: Since the advent of antiretroviral therapy, the vital prognosis of people living with HIV (PLWHA) has improved significantly. However, the risk of metabolic complications is high, thus making the bed of cardiovascular disease. Our objective was to compare the prevalence of metabolic abnormalities among PLWHA receiving ARVs to that observed in those who are not treated. Methods: We conducted a cross-sectional study (January to April 2010) at the PLWHA ambulatory care center of national university hospital (CNHU-Hubert K. Maga) in Cotonou, Benin. We recruited 420 PLWHA (210 treated for at least 6 months and 210 untreated). We determined the prevalence of metabolic syndrome (MS) defined by the criteria of NCEP-ATP III, and the prevalence of abnormal glucose and lipid, and lipodystrophy. Association between metabolic syndrome and ARVs used was analyzed by binomial regression. Confidence intervals were calculated at 95% and 5% alpha level. Results: The prevalence of MS was 16% (18% of patients treated vs. 13% of non-treated, p = 0.18). That of hyperglycemia was 18% (30% of patients treated vs. 6% of untreated; p < 0.001) and of diabetes 7% (12% of patients treated vs 2% of untreated; p < 0.0001). The total cholesterol prevalence was 29% (44% of treated vs 13% of untreated; p

The haemorrhoidal disease is a very common disorder in proctology. It is favoured by many factors. Although benign, its treatment is difficult. Our aim is to study the epidemiological, clinical and anuscopic of haemorrhoidal disease. This was a cross sectional, descriptive and prospective study covering a three-month period from 06 January 2014 to 10 April 2014. It involved patients seen in gastroenterology consultation in internal medicine of the National Teaching Hospital of Cotonou and in the digestive diseases Unit of the Hospital of Menontin. We recorded 182 patients including 57 cases of haemorrhoidal disease, a prevalence of 31.3%. The sex ratio was 1.10. The average age was 43 years with extremes of 18 and 88 years. Anal events were dominated by rectal bleeding (54.4%) with a predominance of internal haemorrhoidal disease (87.7%). Stage 2 evolution of the disease was the most represented (65.4%). Haemorrhoidal disease is a common disorder seen mainly in actively producing people (young adult) with a male predominance.

The location of a primary duodenal adenocarcinoma is exceptional. Only few cases have been reported in the literature. We hereby report a case of primary adenocarcinoma of the duodenum with a 60 years old patient admitted because of chronic iron deficiency anemia. Endoscopic examination revealed a budding and ulcerated process in the second duodenum. The biopsy analysis showed primary adenocarcinoma. No other primary tumor was found. The staging directed showed cephalic pancreatic invasion. The patient died in the aftermath of a surgical management.

The fight against cardiovascular diseases requires the knowledge of their modifiable risk factors. This study aimed to assess the level of modifiable cardiovascular risk factors in a rural area in order to develop a prevention program. Methods: This is an analytical and cross-sectional study on data collected during a fairground medical consultation of adults from 20 to 25 May 2013, in both border districts of the municipality of Djidja (Agouna and Houto). The studied parameters were the capillary blood glucose profile, blood pressure profile, waist circumference (WC) and Body Mass Index (BMI). Diabetes is defined by a fasting blood glucose ≥ 1.26 g/L two times. Hypertension is defined according to the criteria of JNC VII and obesity by BMI ≥ 30 kg/m2; abdominal obesity is defined by a WC above 102 cm in men and 88 cm in women. Data were analyzed using SPSS software version 18.0. Results: A total of 926 people were included among whom 57.8% were women. The average age was 38.43 ± 15.84 years. The prevalence of diabetes mellitus was 2.9%. The prevalence of obesity (BMI ≥ 30 kg/m2) was 8.4%; 10.8% of studied population had abdominal obesity and 19.2% had hypertension. Age above 35 years and obesity were significantly associated with hypertension. Risk factors of obesity (IMC ≥ 30 kg/m2) were the place of residence (Agouna), the female gender, age between 35 and 64 and abdominal obesity. Conclusion: The frequency of cardiovascular risk factors, although small compared to the national level, remains a concern in the investigated rural communities. This must lead to undertake a survey on the lifestyle and dietary habits of the inhabitants of these areas.

La tuberculose vaginale est exceptionnelle et sous diagnostiquée sous nos cieux. Nous rapportons le cas d'une patiente de 53 ans, immunodéprimée par le VIH hospitalisée dans le service pour altération de l'état général dans un contexte de fièvre au long cours. L'interrogatoire, et l'examen physique avaient retrouvé les éléments suivants : tousseur chronique dans l'entourage, partenaire sexuel multiple, leucorrhées persistantes. Le Mycobactérium tuberculosis était retrouvé dans les leucorrhées à l'examen direct. La sérologie VIH était positive au VIH1, le taux des lymphocytes TCD4 était à 22 cells/μL. Le diagnostic de tuberculose vaginal sur terrain immunodéprimé sévère au VIH a été retenu. Un traitement antituberculeux fut institué. Le traitement Antirétroviral a démarré deux semaines plus tard. L'évolution a été rapidement favorable et après 6 mois de traitement la patiente était déclarée guérie de la tuberculose. Chez un patient immunodéprimé au VIH, tout écoulement purulent persistant même vaginal doit faire rechercher une tuberculose

Objectives: To determine the frequency of the chronic kidney failure (CKF) in people living with HIV (PLHIV) on antiretroviral treatment (ART) and to identify associated factors. Methods: This cross-sectional, descriptive and analytical study, conducted in the Outpatient Centre of PLHIV in the National Teaching Hospital of Cotonou from April to July of 2013. Were included, PLHIV aged over 16 years, taking ART for at least three months and having in their file, creatinine at ART initiation. Creatinine was performed at inclusion in the study. Proteinuria was sought on the strip. Chronic kidney failure was defined as creatinine clearance calculated according to Cockcroft-Gault less than 60mL/min for at least 3 months. Factors associated were searched by logistic regression univariate and multivariate analysis. Confidence intervals were calculated at 95% and alpha level was 5%. Results: A total of 480 patients participated in the study (73.3% women; mean age 41.4 ± 9.16 years, in school: 64.6%). The prevalence of chronic kidney failure was 18.7%. The main factors associated in univariate analysis were age (p

L’histoplasmose est une mycose systemique rare causee par deux champignons, Histoplasma capsulatum var capsulatum et Histoplasma capsulatum var duboisii qui sevit en Afrique. Nous rapportons deux cas d’histoplasmoses disseminees a Histoplasma capsulatum var. duboissii diagnostiques par examen mycologique microscopique des pus cutanes chez deux beninois de sexe masculin immunocompetents. Le premier cas est celui d’un sujet de 17 ans presentant une histoplasmose cutanee pris a tort pour une maladie de Recklinghausen. L’evolution a ete marquee par une poussee a localisations osteoarticulaire et pulmonaire un mois apres l’arret d’un traitement au ketoconazole qui avait dure huit mois. La guerison definitive a ete obtenue apres une nouvelle cure d’un an. Le second cas est celui d’un patient de 50 ans presentant une histoplasmose cutanee dont l’aspect clinique evoquait une cryptococcose cutanee. Mis sous ketoconazole, l’evolution a ete marquee par une tendance a la guerison des lesions cutanees et par la survenue d’une poussee a localisations osseuses et digestives. Ce patient est sorti contre avis medical apres deux mois de traitement. Ces observations mettent en exergue le polymorphisme et l’aspect souvent trompeur de cette affection rare, souvent consideree a tort, comme exclusivement opportuniste du sida. Elles permettent egalement de souligner, la difficulte d’une bonne observance therapeutique du fait de la duree et du cout eleve du traitement dans notre contexte de pays en developpement.

International audience; Objective: To investigate the factors associated with HIV 1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Design: Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. Methods: HIV-infected women were enrolled in the second trimester of pregnancy. Socioeconomic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Results: Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. Conclusions: This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

From September 2008 to December 2011, we enrolled and followed-up 247 HIV-negative, 88 untreated and 32 treated HIV-positive female sex workers (FSWs), as well as 238 untreated and 115 treated HIV-positive patients from the general population (GP) of Cotonou, Benin. We wanted to assess the effect of antiretroviral therapy (ART) on sexual risk-taking in FSWs and patients from the GP. We used multivariate log binomial regression models for repeated measures to compare risky behaviours reported during pre-ART and post-ART visits and we performed linear time-trend analyses to assess changes in condom use in all five groups. At 58.8% of pre-ART and 45.3% of post-ART visits (adjusted p-value=0.293), treated FSWs have reported ≥16 clients during the last week of work. Inconsistent condom use with clients over the same period decreased by more than 50% (from 20.7 to 10.0%, adjusted p-value=0.082). In treated patients from the GP, inconsistent condom use with regular partners during the last four months was reported at 52.8% of pre-ART and 53.5% of post-ART visits (p=0.778). Reported casual sex was stable (36.8% versus 38.7%, adjusted p-value=0.924). In linear time-trend analyses, there was a significant downward trend in inconsistent condom use at the early stage of the study and stability thereafter in all HIV-negative and HIV-positive FSWs. There was no negative alteration in sexual behaviour following ART initiation either inpatients from the GP or in FSWs. The results underscore the key role of concomitant sexual risk-reduction strategies.

The objective of this study was to determine the prevalence of obesity among employees CHUD in Parakou and risk factors in 2013. Methods: This was a cross sectional study, descriptive analytical referred to place from 05 August to 05 September 2013. The study population consists of employees of CHUD in Parakou. Data were collected using a questionnaire and by anthropometric measures. Results: The overall prevalence of overweight and obesity was 55.9%. The sex ratio was 0.8. The mean age of subjects was 37.2 ± 9.0 years. Factors associated with obesity were: female gender (p = 10-11), those aged 30-49 years (p = 0.04), subjects with a level of secondary education limited (p = 0.01), subjects with a daily consumption and accidental alcohol (p = 10-9), snacking (p = 0.00012). Conclusion: Obesity prevention should involve the establishment and maintenance during the lifetime of healthy eating habits and regular physical activity.

Objectif Determiner la frequence de l’IR chez les PVVIH sous traitement antiretroviral (TAR) et identifier les facteurs associes. Patients et methodes Il s’agit d’une etude transversale, descriptive et analytique, conduite au Centre de Traitement Ambulatoire des PVVIH du CNHU-HKM de Cotonou d’avril a juillet 2013. Etaient inclus, les patients âges de plus de 16 ans, prenant un TAR depuis au moins trois mois et ayant dans leur dossier medical la creatininemie a l’initiation du TAR. Une nouvelle creatininemie a ete realisee a l’inclusion dans l’etude. La proteinurie etait recherchee a la bandelette. L’insuffisance renale etait definie par une creatininemie superieure a 12 mg/L chez la femme et a 14 mg/L chez l’homme. Les facteurs associes a l’IR etaient recherches par regression logistique en analyse uni- et bivariee. Les intervalles de confiance etaient calcules a 95 % et le seuil alpha a 5 %. Resultats Quatre cent quatre-vingt patients etaient inclus (73,3 % de femmes ; âge moyen : 41,4 ± 9,16 ans, scolarises : 64,6 %). La prevalence de l’IR etait de 9,8 % (47 cas). Les principaux facteurs associes etaient l’hypertension arterielle (OR : 2,81 [1,37–5,80] ; p Discussion et conclusion La prevalence de l’IR chez les patients recevant un TAR est elevee. Le dosage de la creatininemie dans le suivi biologique au cours du TAR reste une necessite.