Les maladies digestives dans un service de médecine à Madagascar: étude rétrospective

Aim

To list digestive diseases encountered at the Department of Gastroenterology, University Hospital of Antananarivo in aim to assess morbidity and mortality rate.

Materials and methods

A retrospective study of patient??s files including digestive diseases was conducted between the 1^st January 2007 and 30^th June 2009.

Results

Digestive diseases have represented 16,03% of all admissions. Three hundred twenty eight cases of digestive diseases were recorded corresponding to 276 patients. Men were more frequent between 30 and 70 years old (n = 139; 42,37%). Cirrhosis was the main pathology (n = 110; 33,54%) followed by duodenal ulcers (n = 9; 9,76 %). Cirrhosis was responsible of the highest mortality rate (n = 25; 22,73%).

Conclusion

Digestive diseases are frequent in a department of medicine in Madagascar. Amongst digestive diseases, cirrhosis is the most frequent and is responsible of high mortality rate.     

Les conséquences du confinement sur les maladies cardiovasculaires

BackgroundThe Sars COV-2 infection causing the covid-19 disease has started in December 2019 inWuhan, China, then spread quickly to more than 100 countries in less than 3 months. On March, 11th the WHO declared officially the pandemic of Covid 19. In the absence of an effective treatment of the SARS-Cov2 the measures of social distancing and lockdown remain the most effectives ways against the pandemic. However, these measures can have repercussions in particular on patients followed for chronic diseases, the goal of our study will be to evaluate the impact of the lockdown on non-Covid cardiac patients.MethodsWe have chosen a random sample of patients followed in the cardiology department of the CHU Tangier Tetouan Alhouceima, and we collected their demographic data as well as the symptoms, vital constants, lifestyle before and 60 days after the lockdown.ResultsA total of 100 patients were included in the study. The average age of our population is 55.34 years ± 15.86. The average BMI (body mass index) is 26.40 Kg/m² ± 5.84. The coronary artery disease was present in 27% of the patients, valvular disease in 40% and heart failure in 37%. Finally, arrhythmias appear in 22% and more than the half of our sample has high blood pressure. We noted a significant weight gain of 1.71 Kg (P < 0.000) after 60 days of lockdown, with an increase of BMI of 0,58 kg/m² (P < 0,005). The percentage of patients with SBP (systolic blood pressure) ≥ 140 mmHg has evolved from 38 to 44%, thus an increase of 6 % (P < 0,0001), while the percentage of the patients with DBP (diastolic blood pressure) ≥ 90 mmHg has passed from 21 to 15 % (thus a decrease of 6 %, P < 0,0001). Twenty patients stop smoking, thus a decrease of 7% (P < 0,0001). The sedentary lifestyle rate presented an elevation of 22% (P < 0,0001). The daily calorie intake has increased of 35,4 % and 46,8 % of the patients increased their salt intake by more than 4 g per day. The increase of the daily calorie intake concerned more the men than the women (41,9 % of men vs 31,3 % of the women). In the population with high blood pressure, we have not observed a statistically significant difference of the SBP, the DBP and the heart rate between the beginning and two months after the lockdown. Concerning patients with heart Failure, we have noted an worsen of the symptoms of HF. Thus, 8,1% of the patients presenting a stage two dyspnea has passed to a stage three of the NYHA (32,4 vs 40,5%), while the percentage of patients with lower limbs edema has increased of 13,5% but in a non-statistically significant way (P = 0,267). We have noticed a diet gap with an increase of salt intakes (more than 4 g per day) in more than the half of this subpopulation (55,6 %) during the period of the lockdown. In the subpopulation of patients with valvular pathology, we have identified a worsening of the dyspnea in 7,5% of the patients; this one has passed from stage two to stage three of the NHYA with an increase of the percentage of patients with lower limbs edema from 7,5% to 25% (P = 0,065). Furthermore, we have noticed an incidence of 10% of cardiovascular events (2 cases of myocardial infarction [among which one has deceased], one death because of end stage heart failure, three hospitalizations for congestive heart failure, two cases of aortic dissections and 2 cases of rapid atrial fibrillation).Our observationDepending on the results of this study, the sanitary lockdown induced important repercussions on the patients followed for cardiac diseases, hence the necessity of an awareness of these patients, and mostly a restructuring of our care system strongly disturbed by the Covid 19.     

Les bisalbuminémies : à propos d’un cas

Introduction

Bisalbuminemias consist in rare qualitative modifications of several aspects in the albumin pattern. Bisalbuminemias, most of which are not pathological, can be observed using capillary electrophoresis.

Les œsophagites disséquantes: à propos de trois observations

Introduction

Oesophagitis dissecans is a rare disease. It has an unknown etiopathogeny. Diagnosis is reliably obtained by endoscopy, however, its treatment is not codified.

Patients and methods

Retrospective study (2001–2008) registered three cases of oesophagitis dissecans in the hepatogastroenterology department, Hassan-II University Hospital in Fez.

Results

The patients are 31, 20 and 37 years old, respectively. Two of them are male. The endoscopy exam was preceded by a history of dysphagia in two, and a history of anaemia in the other. In the three patients, endoscopy feature was characterized by the presence of areas mucosa forming a transverse streaks. The mucosal detachment was induced by the contact with biopsy pince witch allows to diagnosis.

Conclusion

It is a benign affection, therefore it is rare and considered as an exceptional aetiology of chronic dysphagia. Diagnosis is easy but its treatment remains to be codified.     

Les maladies auto-inflammatoires associées aux mutations de NLRC4 : revue systématique de la littérature

The auto-inflammatory diseases linked to NLRC4 mutations are recently described entities. Transmission is autosomal dominant in 80 % of cases; cases of somatic mutation have already been reported. The disease may display two very different clinical phenotypes: the phenotype 1 (30 %), severe, is dominated by a multisystemic inflammation starting in the first year of life with symptoms of chronic inflammatory bowel disease (IBD), macrophagic actication syndrome (MAS), or even a presentation suggesting a cryopyrinopathy in its CINCA form; the mortality of this phenotype is high (25 %). The phenotype 2 (70 %), mild, usually starts after the age of 3 and is characterized by cold urticaria, arthralgia, ocular features and fever in 50 % of cases without visceral failure. Anti-interleukin-1 inhibitors are effective in most cases (83 %). Interleukin-18 (IL-18) levels are very high in both clinical forms. Interleukin-18 inhibitors and anti-interferon-gamma inhibitors were remarkably effective in two very severe phenotype 1 patients. Thus, NLRC4 mutations can induce various clinical manifestations with two distinct phenotypes. Although still rare, because very recently described, this group of diseases could be evoked by an internist in front of cold familial urticarial; probably more and more cases will be diagnosed thanks to the major progresses of genetic diagnostic tools such as next generation sequencing.     

Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period.MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25 ± 13 years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest.ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n = 2). Morbidity was marked by conduction abnormalities (n = 2), bleeding and hematoma of the residual cavity that required surgical treatment (n = 3). Eleven patients were followed with a mean period of 40.5 ± 19.4 months. At follow-up, neither late deaths nor recurrence have occurred.ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.     

Hépatopathies et maladies vasculaires pulmonaires

About 70% patients waiting for liver transplantation have a dyspnea. Two pulmonary vascular disorders can be associated with portal hypertension or chronic liver diseases: portopulmonary hypertension (PoPH) related to pulmonary small arteries remodeling and obstruction and hepatopulmonary syndrome (HPS) characterized by pulmonary capillaries dilatations and proliferations. PoPH is defined by the combination of pulmonary arterial hypertension (PAH) (mean pulmonary artery pressure [PAP] ≥ 25 mmHg, with normal pulmonary artery wedge pressure ≤ 15 mmHg and pulmonary vascular resistance [PVR] > 3 Wood units [WU]) and portal hypertension. HPS is a triad of intrapulmonary vascular dilatations, hypoxemia (increased alveolar-arterial oxygen gradient) and liver disease or isolated portal hypertension. The pathophysiology of both syndromes is complex and poorly understood. PoPH and HPS have a negative impact on functional and vital prognosis in patients with portal hypertension. Liver transplantation is the established treatment standard in HPS. PoPH treatment is improved over the years with the use of specific PAH treatment despite the lack of randomized assay in this indication. Liver transplantation could be considered in PoPH leading to stabilization, improvement or recovery in selected patients (mean PAP < 35 mmHg without severe right ventricular dysfunction and PVR < 4 WU).     

Les tests cutanés dans l’exploration de l’allergie à la pénicilline

Allergy to penicillin is reported to occur in up to 8% of the patients who receive this class of drugs. 80 to 85% of the patients with a positive clinical history to penicillin will nevertheless tolerate penicillin with no adverse effect. Of the remaining 15 to 20%, only a few will develop a severe adverse reaction, and these patients can be identified by skin tests with derivatives of penicillin used at optimal concentrations according to a protocol that is effective and safe. Skin tests to penicillin are positive in 25% of patients with a history of an immediate reaction to penicillin; they are more frequently positive in those who have had a severe reaction. In addition to being able to identify patients who are at risk for a severe reaction when they take penicillin, skin tests can also provide immunological evidence of the origin of delayed clinical reactions such as maculopapular rashes. Such rashes, a frequent and benign manifestation of penicillin allergy, are usually caused by the widely used aminopenicillins. Intradermal skin tests (IDR) and late phase (patch) tests can demonstrate allergy to betalactamines in 5 to 45% of patients with negative skin tests to major and minor determinants of penicillin. When skin tests are positive, provocation tests are not recommended. On the other hand, when the skin tests are negative, an oral provocation test should be done, but such tests can result in an immediate clinical reaction, which may be severe in 3 to 10% of cases.