The Impact of HIV Infection on the Surgical Disease Burden in Africa

"The Human Immunodeficiency Virus (HIV) infection stands among the greatest health challenges facing Africa today. However; the impact of the pandemic on the surgical diseases burden in the continent has received scant attention in the world literature. This study had as general objective to determine through literature the impact of the HIV infection on surgical diseases in Africa and in our regions in particular. To achieve this task searched Google website in the first half of July 2008 to reference lists of literature on HIV and surgical diseases burden to add to our own humble experience. We also contacted and discussed with local experts in the field.Data retrieved point out that HIV infection; throughout last two decades; has highly increased the number of African common surgical burdening diseases; mainly in Sub-African countries. The burden is on all categories of surgical diseases: injuries; congenital abnormalities; tumours; surgical inflammations and infections. However; while the management of the HIV and its opportunistic infections has met the attention of the international community and has continued attracting health care donors and partnerships; surgical practice has not been given any rank among disease control priorities of the United Nations Millennium Goals. It is suggested that that African surgeons; especially in sub-Saharan countries; should together join in efforts so that surgical diseases be considered as ""Other Neglected Tropical Diseases (NTD)"" listed among the UN health care problems and deserve the attention of the international committee."

Les manifestations psychiatriques chez les personnes vivant avec le VIH au Mali

Les troubles psychiatriques au cours de l'infection a VIH ont un impact negatif sur la prise en charge des autres co-morbidites et peuvent constituer en eux-memes une cause de mortalite. Le but de notre etude etait d'evaluer la prevalence des troubles psychiatriques au cours de l'infection par le VIH dans les services de maladies infectieuses et de psychiatrie du CHU du Point G. Nous avions realise une etude prospective et descriptive allant du 1er Juillet 2004 au 31 Octobre 2005 portant sur 166 patients. Les cas d'infection a VIH ont ete definis sur la base de la positivite de la serologie VIH par au moins 2 tests rapides associes ou non a des signes cliniques du SIDA selon la classification CDC. Toute perturbation des fonctions superieures etait consideree comme manifestations psychiatriques. Le sexe feminin etait majoritaire avec un sex- ratio de 0;9. La tranche d'age de 36 a 41 ans etait la plus touchee. Les menageres representaient 36;7de l'echantillon et les maries representaient 64;5. La prevalence des troubles psychiatriques etait de 58;9. Les troubles ont ete domines par la depression (45;8) suivis du syndrome confusionnel 31;9et de l'epilepsie 7;8. Les sujets etaient infectes par le VIH-1 dans 93;4des cas. La survenue des troubles psychiatriques etait inversement proportionnelle au taux de CD4. La letalite etait tres elevee soit 56

The Pattern of Medical Mortalities in a Specialist Hospital in North-Central Nigeria

Background: Review of causes of morbidity and mortality in health care facilities is an important exercise which gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. This exercise is a necessary component for planning of the health care needs of the community. Objective: To determine the mortality pattern on the medical wards of the Kogi State Specialist Hospital; a tertiary center located in Lokoja; North-Central Nigeria. Methods: A retrospective review of medical records of all patients admitted to the medical wards of the hospital over a period of 18 months (December 2008 - May 2010) was carried out. The information recorded from these sources included the age and gender; diagnosis/cause of death and the duration of admission. Results: A total of six hundred and eighty-four patients were admitted during the period being studied with a predominance of female patients (Female: Male Ratio = 1.07). There were seventy-six deaths (11.1) during the period in question with HIV and related complications accounting for most recorded mortality (32.9) closely followed by non-communicable cardiovascular conditions (hypertension; heart failure and CVD) - 28.9. Conclusion: This study clearly shows that HIV infection and its complications remains the leading cause of death despite the advent of HAART. Clearly there is a need to revisit the strategies of HIV prevention and control. Also there is an urgent need to focus on the prevention and treatment of non-communicable diseases like hypertension and diabetes

The Kidney : an Important Target for HIV Infection

HIV-infected patients may present with a variety of patterns of renal involvement. Acute renal failure is common and most often a result of sepsis; hypotension and nephrotoxic agents. It is potentially avoidable; and support through the period of renal failure may lead to resolution of the renal dysfunction. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy that ranges in prevalence form 1 to 10 per cent of the HIV infected population in different geographic locales. This complication of HIV infection will likely present a growing challenge to the medical community as HIV infection continues to spread worldwide. Deciphering the pathogenitic mechanisms of this most rapidly progressive form of focal segmental glomerulosclerosis is not only clinically relevant; but will hopefully provide valuable insights into the medication of the more common idiopathic form of the disease. The potential for improved renal survival of patients with HIV-associated nephropathy ahs become more realistic with the development and the use of antiretroviral agents; as well as studies on the role of immunosuppression and Angiotensin Converting Enzyme (ACE) inhibition in this population

Abces de foie et infection par le virus de l'immunodeficience humaine (VIH)

Cette etude compare les differents aspects des abces du foie chez des personnes infectes (groupes II) et non infectees (groupe I) par le virus de l'immunodeficience humaine (VIH) : ces groupes I et II comprenaient respectivement 52 et 37 patients. Sur le plan clinique; le tableau classique de l'hepatomegalie douloureuse et febrile a ete retrouve dans les deux groupes mais l'elevation thermique etait plus marquee chez les seronegatifs (34;6 pour cent contre 24;3 pour cent); de meme l'etude a revele une grande frequence d'abces microbiens dans ce groupe que dans le groupe II (21;02 pour cent contre 13;5 pour cent). Du point de vue biologique; les perturbations du bilan hepatique etaient moderees et similaires dans les deux groupes. Aucun germe atypique ou opportuniste n'a ete isole chez les seropositifs. Le drainage chirurgical et la ponction-aspiration echoguidee ont ete les methodes therapeutiques de choix dans les abces microbiens quelle que soit la serologie. La seropositivite a ete un facteur de mauvais pronostic puisqu'on y a note un pour centage plus eleve de deces (10;8 pour cent) que dans le groupe des seronegatifs (3;8 pour cent)

Aspects epidemiologiques; cliniques; biologiques; evolutifs et therapeutiques de la tuberculose associee a l'infection V.I.H. : etude prospective portant sur 457 malades tuberculeux du Centre Hospitalier Sanou Souro de Bobo-Dioulasso (Burkina Faso)

Il s'agit d'une etude prospective portant sur 457 tuberculeux de l'hopital de Bobo-Dioulasso au Burkina Faso. 119 (26 pour cent) malades sur les 457 etaient infectes par le V.I.H.; plus specifiquement 73 (15;9 pour cent) malades etaient infectes par le V.I.H.-1; 38 (8;3 pour cent) par le 2 virus et 8 (1;7 pour cent) par le V.I.H.-2. Au moment du diagnostic de la tuberculose; 20 (16;8 pour cent) des patients etaient asymptomatiques; 70 (58;8 pour cent) etaient symptomatiques et 29 (24;3 pour cent) etaient des sideens averes. Un taux de deces plus eleve a ete enregistre chez les tuberculeux (22;7 pour cent contre 6;7 pour cent) et dans 60 pour cent des cas; ces deces sont survenus dans le premier trimestre du traitement. La compliance au traitement qui est presque la meme dans les 2 groupes est jugee acceptable. Le traitement de courte duree (6 mois) chez tous les malades a ete efficace. Parmi; 39 tuberculeux seropositifs ayant suivi un traitement complet; 38 (97;4 pour cent) ont ete gueris et 1 seul etait en retard de negativation (>8 mois). Chez les tuberculeux seronegatifs; 123 (89;7 pour cent) ont ete gueris et 14 etaient en situation de retard a la negativation. 4 rechutes ont ete enregistrees dans les 6 mois suivant la guerison; dont 1 (6;25 pour cent) parmi 16 tuberculeux seropositifs suivis; et 3 (5;6 pour cent) parmi 53 seronegatifs. Lors de la surveillance du traitement; il y eut 2 reactions allergiques mortelles chez les tuberculeux seropositifs

"Etude epidemiologique et aspects cliniques de 316 cas de tuberculoses a ""lesions fermees"" a Bobo-Dioulasso; Burkina Faso."

"L'analyse epidemiologique n'a pas montre de particularite en ce qui concerne la repartition selon l'age; le sexe; l'origine geographique et la profession; par rapport aux donnees disponibles pour les tuberculoses pulmonaires communes dans le pays. Les formes cliniques dominantes sont la tuberculose des sereuses : 24;05 pour cent des tuberculoses a ""lesions fermees"" et 18;04 pour cent des tuberculoses osteo-articulaires. Cependant certaines formes rares et exceptionnelles ont ete identifiees : tuberculoses uro-genitales; multifocales; peritoneales. Les difficultes et erreurs diagnostiques illustrees avec notamment les localisations sereuses; osteo-articulaires; apparaissent imputables tant aux insuffisances des moyens d'investigation; qu'au peu d'interet porte en general a ces tuberculoses reputees non contagieuses. Il est suggere une attention particuliere pour ces formes; eu egard aux relations entre certaines localisations particulieres et l'infection a V.I.H."

Seroprevalence of HIV in patients who present with features suggestive of acute appendicitis

A total of fifty patients; thirty one (62) HIV seronegatives and nineteen (38) seropositives who presented with features suggestive of appendicitis and had surgery are presented. Thirteen (68.4); three (15.8) and three (15.8) of the nineteen HIV positive patients were in clinical stages 1;2 and 3 of the WHO staging system for HIV infection and diseases respectively. Pre-operative diagnosis of appendicitis was clinical in all patients. None of the signs of an inflammed appendix on plain abdominal radiograph namely: Signs of localised paralytic ileus affecting the terminal ileum; caecum; or ascending colon; a radio-opaque appendicular faecolith; free intra-peritoneal or retro-peritoneal gas etc. was seen in four (8) patients who underwent this investigation. Three patients had a clinical diagnosis of appendicitis; and small bowel obstruction as the second differential. Two had essentially normal x-ray films but had histologically confirmed appendicitis. Both of them were HIV seronegative. The x-ray film of the third patient showed features of small bowel obstruction. At laparotomy; he was found to have ileo-caecl intussusception due to caseous mesenteric lymphadenopathy; which were proved to be tuberculosus at histology. he was HIV seronegative. The fourth patients had a clinical diagnosis of acute abdomen. His abdominal x-ray film looked normal. He had non specific mesenteric adenitis and a histologically normal appendix. She was HIV seropositive. High resolution (5-7.5 Megahertz) transabdominal ultrasonography using curved array transducer for the diagnosis of appendicitis has a sensitivity and a specificity of 50-60in experienced hands in Mulago Hospital (Personal communication). This investigation did not contribute to the diagnosis of appendicitis in two patients in whom it was done. In one patient; the ultrasonographic diagnosis was an appendicular mass. The mass did not improve on conservative treatment. Exploratory laparotomy revealed mesenteric lymphadenopathy which were found to be tuberculous at histology. He was HIV seropositive. In the reamining patient; the abdomen was essentially normal at ultrasonography but had bilateral Ovarian cysts and mildly inflammed fallopian tubes at laparotomy. There was no correlation between appendicitis and white blood cell counts in both HIV seronegative and seropositive patients (table 11 and 12). Common conditions which mimicked appendicitis in this study included : cholecystisis; carcinoma of the caecum; pelvic inflammatory disease; acute abdomen of no obvious cause etc. (table 14).These were found in nine (29.0) of thirty one HIV seronegative and one (5.3) of nineteen seropositive patients. Conditions that were considered to be HIV related which mimicked apendicitis namely:- terminal ileitis; tuberculous mesenteric adenitis and non-specific haemorrhoaegic mesenteric masseses were found in one (3.2) of thirty one HIV seronegative and nine (46.8) of nineteen HIV seropositive patients (Table 14). There were thirty histologically confirmed appendicitis. Twenty one (70) and nine (30 (Kakande et al; 1978) and 28.8 (Personal findings; 1995). the improved diagnosis of appendicitus in Mulago Hospital during this study period could have been due to improved clinical diagnostic skills that are being stressed on all the time in all clinical practice as the key to effective management of patients; but awareness of such a study being carried out in the hospital could have influenced the deisions to operate on patients who presented with features suggestive of appendicitis. However; the negative appendicectomy rates in the two groups were three (14.3) in twenty one and two (22.2) in nine HIV seronegative and seropositive patients respectively. The appendix specimens of two patients autolysed before a historical diagnosis was made. They were however perforated appendix at surgery. A disease appendix can macrospically look normal at operation and hencethe need for a historical diagnosis. In this study; an appendix that looked normal to the surgeon was categorised as a negative appendix although this is not a reliable way of dagnosing appendicitis. Appendicectomy was not done in thirteen patients. In twelve patients; the appendices looked normal at surgery and other conditions were found (table 14). In the remainingpatient; appendicectomy had been done in the yaer 1995! He was found to have perforated urinary bladder. From this study; it can be concluded that the HIV seropositive rate of 38among patients who presented with features suggestive of appendicitis was not very different from that of the general population which was given in 1992 (30) of Kampala. Secondly; that appendicitis was more common in HIV seronegative than seropositive patients with ratio of 2:1.Thirdly; that conditions which mimicked appendicitis in this study included those which are known all over the world; but some of the conditions that are said to be emerging and are considered to be HIV related were also encountered namely: terminal ileitis; tuberculous mesenteric adenitis and nonspecific haemorraegic mesenteric masses. fourthly that HIV has not lead to increased negative appendicectomy rate in Mulago but that there was a trend towards higher chances of falsely diagnosed appendicitis in HIV seropositive patients. This could have been most probably due to a bigger number of conditions that were considered to be HIV related in this group of patients as compared to their seronegative counterparts. Lastly; tuberculosis can present as appendicitis