No abstract

The objective of this study is to describe the clinical, biological, therapeutic and evolving current profile of hospitalized patients with HIV infection in the cohort of the Infectious and Tropical Diseases Unit (ITDU) in the aim to improve their care management. This is a retrospective study, conducted on medical data of hospitalized cases of patients with HIV infection in the ITDU at the teaching hospital of Treichville (Abidjan) from 2006 to 2007. During the two years, 447 patients were included in the study. Their average age was 39 years [18 years-86 years] and sex ratio was 0.69. Of the 447 patients, 35% were unemployed and 67% were new patients who had never undergone antiretroviral therapy (ART). The duration of drug exposure was less than 6 months in 59% of treated patients. The average time to initiate ART was seven weeks. Among naive patients 41.9% were lost to follow up, 35.9% were waiting for treatment and 22.1% waiting for baseline biological test to initiate ART. At the initiation of ART, 79.6% of patients had a CD4 count less than 200/mm(3). The reasons of hospitalization defining AIDS were dominated by tuberculosis (34.2%), cerebral toxoplasmosis (17.9%) and neuromeningeal cryptococcosis (8%). The main reasons of hospitalization in classifying non-AIDS were pyelonephritis (6.5%), bacterial pneumonia (5.4%) and undetermined infectious encephalitis (4.9%). Hospital mortality was 24.4%. The leading causes of death were tuberculosis (22.9%), cerebral toxoplasmosis (20.2%), undetermined infectious encephalitis (18.3%) and cryptococcal meningitis (13.7%). The profile of PLHIV in hospital is characterized by profound immunosuppression due to late diagnosis and high mortality associated with severe opportunistic infections and late initiation of ART.

The aetiologies are dominated by infections. The fatality rate is high and its risk factors are advanced age, low haemoglobin level, severe AKI, infection and drug intake. Prevention is essential.

IntroductionAcute kidney injury (AKI) is characterized by a sudden drop in glomerular filtration rate. It is commonly seen in our medical practice. Its incidence varies from 1.9% to 24.4% depending on the series (1-4). In intensive care units, this incidence is in the order of 20% to 50% (5). The etiologies of AKI vary from one region to the other of the world. In the West countries, septic shock, hyopovolemia, cardiogenic shock and post-operative AKI are the most common in adults (4). In Africa, the Implication for health policy/practice/research/medical education:In our study, we found that regardless of age, infection is the leading cause of acute kidney injury (AKI). Drug-induced AKI is more common in young adults. On the other hand, benign tumor of the urinary tract and malignant hypertension are more found in the elderly. In addition, mortality and non-recovery of renal function are higher in the elderly. The causes of death and the factors associated with mortality and non recovery of renal function differ in both groups. Please cite this paper as: Introduction:Numerous studies have shown that the recovery of renal function was slower and less complete in the elderly patients than in adults. Objectives: To compare the profile of acute kidney injury (AKI) of the young patients with that of the elderly patients. Patients and Methods: This is a prospective study carried out during the period from January 2010 to December 2015 in the department of Nephrology-Internal Medicine of the University hospital of Treichville. The diagnosis of AKI was retained according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: The mean age of patients was 26.8 ± 6 years in the young and 69.4 ± 7 years in the elderly. The proportion of males was 51.9% (55/106) in the young patients against 77.8% (84/108) in the elderly patients (P = 0.0001). The proportion of hypertension and diabetes in the elderly patients, respectively 30.6% and 36.1% was statistically higher than in the young patients (P = 0.001). However, human immunodeficiency virus (HIV) infection was more prevalent in the young patients (P = 0.0001). Anemia was observed in 84.9% in the young patients against 58.3% in the elderly patients (P = 0.001). It was severe in 34% among the young patients against 15.7% among the elderly patients (P = 0.002). The proportion of drug AKI was 17% in the young patients against 2.8% in the elderly patients (P = 0.0001). Malignant hypertension (P = 0.002) and urinary tract tumors (P = 0.001) were more observed in the elderly patients. Mortality was 31.1% in the young patients against 47.2% in the elderly patients (P = 0.011). Conclusion:The etiologies are the same with different proportions, except malignant hypertension observed only in the elderly patients. Mortality is higher in the elderly patients.

Background: Renal failure (RF) is a risk factor for morbidity and mortality in cancer patients. Objectives: To describe the profile of cancer patients with RF. Patients and Methods: This is a retrospective descriptive study of RF in patients enrolled in the national cancer registry of Abidjan, during the period from January 2012 to December 2015. The diagnosis of RF was confirmed based on a measured glomerular filtration rate (GFR) < 60 mL/min obtained using the Modification in Diet of Renal Disease (MDRD) formula. A comparison of patients with (n = 131) or without (n = 136) RF, followed by a logistic regression analysis, made it possible to identify the risk factors for RF. Results: The mean age was 54 ± 13.9 years in the group with RF versus 49 ± 14.8 years in the group without RF (P = 0.003). The etiologies of RF were urinary tract obstruction (41.2%), administration of platinum salts (19.8%) and water losses (12.2%). In multivariate analysis, age (P = 0.009), presence of hypertension (P = 0.02), uterine cancer (P = 0.0001) and prostate cancer (P = 0.014) were associated with the risk of RF in cancer patients. Factors such as male gender (P = 0.007), HIV infection (P = 0.021), GFR<15 mL/min (P = 0.002), and hemoglobin level <8 g/dL (P = 0.041) were associated with mortality in cancer patients with RF. Conclusions: Late diagnosis leads to renal complications with an increased risk of mortality.