Poly sensibilisation dans le cadre d'un eczéma de contact des mains chez une aide-ménagère dans le nord du Bénin / Poly sensitization in the context of hand contact eczema in a household helper in northern Benin

L'eczéma des mains est fréquent. Son étiologie est souvent multifactorielle comprenant les facteurs environnementaux et des facteurs individuels prédisposants. Il pose des problèmes de diagnostic étiologique en particulier dans un contexte de poly sensibilisation. Observation Il s'est agi d'une employée de maison âgée de 17 ans sans antécédents allergiques connus. Elle a développé un eczéma bilatéral des mains six mois après embauche. Le patch test avec la batterie standard européenne a montré une poly sensibilisation à plusieurs allergènes contenus dans les détergents et désinfectants. Le patch test aux gants est revenu négatif mais n'exclut pas son implication dans la survenue des lésions devant le caractère bilatéral et symétrique des lésions. Une réorientation professionnelle a été proposée devant le jeune âge de la travailleuse Conclusion La connaissance des allergènes en cause au cours d'un eczéma est un atout pour une meilleure prise en charge du patient mais leur identification n'est pas toujours aisée. La réorientation professionnelle lorsqu'elle est possible assure la guérison.

Introduction: Hand eczema is common. Its etiology is often multifactorial, including environmental factors and individual predisposing factors. It poses problems of etiological diagnosis, particularly in the context of poly sensitization. Observation: This case involved a 17-year-old domestic worker with no known allergic history. She developed bilateral hand eczema six months after hiring. The patch test with the standard European battery showed poly-sensitization to several allergens contained in detergents and disinfectants. The glove patch test came back negative, but did not rule out its involvement in the lesions, given the bilateral and symmetrical nature of the lesions. In view of the young age of the worker, a vocational reorientation was carried out. Conclusion: Knowledge of the allergens involved in eczema is an asset for better patient management, but identifying them is not always easy. When possible, professional reorientation ensures recovery

Evaluation of Ledipasvir plus Sofosbuvir for treatment of compensated and decompensated HCV cirrhotic patients

Background:unlike human immunodeficiency virus (HIV) and hepatitis B virus (HBV), hepatitis C virus (HCV) infection is a curable disease. Current direct acting antiviral agent (DAA) targets are focused on HCV NS3/4A protein (protease), NS5B protein (polymerase) and NS5A protein. The first generation of DAAs includes boceprevir and telaprevir, which are protease inhibitors and were approved for clinical use in 2011. The cure rate for genotype 1 patients increased from 45% to 70% when boceprevir or telaprevir was added to standard PEG-IFN/ribavirin. More effective and less toxic second generation DAAs supplanted these drugs by 2013. The second generation of DAAs includes sofosbuvir, simeprevir and fixed combination medicines containing ledipasvir plus sofosbuvir and Viekira Pak. These drugs increase cure rates to over 90% without the need for interferon and effectively treat all HCV genotypes. With these drugs the "cure HCV" goal has become a reality. The aim of this study was to assess of ledipasvir plus sofosbuvir as treatment of HCV infection in patients with advanced liver disease including cirrhotic patients with child B and C. Patients and methods:in this prospective study, seventy five HCV PCR positive patients were classified into three groups according to child score. Each group included twenty five patients. All patients received ledipasvir plus sofosbuvir for six months. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg, alpha fetoprotein as baseline screening. HCV PCR done for all patients at end of treatment and three months later to detect sustained virological response (SVR12). Patients with combined HCV and HBV infection, hepatic or extrahepatic malignancies and late child C were excluded. Results: showed that no statistical significant difference were detected in patients of group A as regard liver function tests before and after treatment and SVR12 achieved by 96%. Patients of group B showed significant statistical difference as regard liver function tests before and after treatment with SVR12 achieved by 88%. In patients of group C there were significant statistical difference in liver function tests with SVR12 achieved by 80%. Also there were clinical improvement in patients of group B and C after end of treatment. Conclusion:it could be concluded that there will be a dramatic improvement in HCV therapy followed the introduction of oral medicines that directly inhibiting the replication cycle of HCV. The combination pill contains a fixed-dose of ledipasvir 90 mg and sofosbuvir 400 mg, two direct-acting antiviral agents against HCV. Ledipasvir is an inhibitor of the NS5A protein, which is required for HCV replication. Sofosbuvir inhibits the HCV NS5B RNA-dependent RNA polymerase, which is also required for viral replication. Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form a pharmacologically active triphosphate that can incorporate into the HCV RNA. Ledipasvir plus sofosbuvir can be used safely in treatment of compensated and decompensated post hepatitis C liver cirrhosis. SVR12 can be achieved by 96% in patients with early cirrhosis (child A), 88% in patients with child B cirrhosis and 80% in patients with child C with subsequent improvement in liver functions

A Clinician's Guide to 2009 H1N1 Influenza

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Antiretroviraux et milieu associatif au Senegal: outils et methodes pour renforcer les capacites des associations et ameliorer le role des communautes dans l'Initiative senegalaise d'acces aux antiretroviraux (ISAAR)

Ce document resulte d'un atelier de sensibilisation sur les ARV et le role potentiel susceptible d'etre joue par les associations dans l'Initiative senegalaise d'acces aux antiretroviraux (ISAARV) tenu a Dakar en mars 2004. Les differents modules de formation utilises durant l'atelier y sont presentes; avec les elements relatifs aux objectifs de la session; la liste du materiel pedagogique utilise; le resume de la methodologie de la session; les informations donnees en reponse aux questions des participants; les posters presentes

Antenatal HIV Screening and Treatment in South Africa: Social Norms and Policy Options

South Africa has one of the highest prevalence of HIV and AIDS in the world; with mother-to-child transmission being an important route for spread of the infection. For years; AIDS scientists and activists locally and internationally have been working desperately for the people of South Africa to have access to treatment for HIV and AIDS. Policymakers in South Africa have consistently maintained that HIV infection is not responsible for AIDS; thus creating the biggest obstacle to implementation of appropriate prevention and therapeutic programmes; including antiretroviral therapy for HIV positive persons. Only recently; people within the government and ruling party; defying previous policy; have agreed that antiretroviral drugs should be given to pregnant women with HIV. The social fabric of South African society is markedly different from that of Western countries. In this paper; the author analyses the likely implications of antenatal testing and treatment of pregnant women in South Africa; in light of the socio-economic and cultural status of women in that society

Drug Resistance to AIDS; Tuberculosis and Malaria in the African Region

With just 10of the world population; sub-Saharan Africa has the highest burden of HIV/AIDS; tuberculosis and malaria in the world. Both access to and adequate utilization of eff ective treatment with quality-assured medicines are crucial for reducing the disease burden. However; eff orts to improve access to treatment are hampered by the development of HIV; TB and malaria drug resistance. This is a result of genetic mutations and is a major threat to control of HIV/AIDS; TB and malaria. HIV drug resistance can be minimized by good antiretroviral treatment (ART) programmes; removal of barriers to continuous access to ART and reduction of HIVtransmission. Recent surveys conducted at antenatal clinics in several countries in the African Region estimated that HIV resistance to all drug classes is less than 5. A global HIV drug resistance network established in 2001 supports countries in capacity building and guidance on standard procedures for monitoring HIV drug resistance. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are principally a result of inadequate or poorly administered treatment regimens. The new WHO Stop TB Strategy launched in 2006 identifies management of MDR-TB as a core component of TB control. The magnitude of MDR-TB in the African Region is still unknown. In 2007; 27 countries notifi ed MDR-TB cases; and six reported at least one case of XDR-TB. Following widespread resistance to chloroquine and sulphadoxine-pyrimethamine all malaria-endemic countries except two in the Region have changed the treatment policy to artemisinin-based combination therapy (ACT). The main method of monitoring antimalarial drug resistance is through therapeutic efficacy testing. Todate there has been no confi rmed resistance to ACTs in the African Region. Given the emergence and spread of resistance to HIV; TB and malaria drugs; the purpose of this paper is to describe the issues and challenges and propose a way forward with regard to the prevention and control of such resistance

Access to treatment for HIV/AIDS: report of a meeting of international experts; 12-13 June 2001; Washington; DC; USA

This publication is a report of an international experts meeting held in 12-13 June 2003 at Washington (USA); which aims to explore and prioritise operations research questions about access to treatment for HIV/AIDS. Even if the discussions focused on treatment with ARVs; many of the issues raised and the research questions identified also pertain to treatment of opportunistic infections and the provision of palliative and end-of-life care

Prise en charge medicale des patients vivant avec le VIH/sida au Senegal

Ce guide constitue un outil de formation des formateurs au niveau decentralise sur la prise en charge de l'infection par le VIH chez l'enfant et chez l'adulte.Il traite des aspects relatifs a l'organisation du systeme de sante et de soins au Senegal; aux paquets minimum d'activites VIH/sida selon le niveau de la pyramide sanitaire; au depistage de l'infection par le VIH; a la prise en charge medicale de l'enfant et de l'adulte vivant avec le VIH; a la prevention de la transmission mere-enfant du VIH; a la prise en charge des accidents avec exposition au sang; aux procedures standardisees par la prevention des accidents avec exposition au sang; aux soins palliatifs et de fin de vie au cours de l'infection par le VIH