Validation of the Patient-Oriented SCORing for Atopic Dermatitis tool for black skin.

BACKGROUND: SCORing for Atopic Dermatitis (SCORAD) is a tool developed by the European Task Force on Atopic Dermatitis (AD) which is used by physicians to assess AD severity during consultations with their patients. Patient-Oriented SCORAD (PO-SCORAD) is a self-assessment tool for use by patients which has been validated in a study performed in European countries. However, there is currently no adapted tool for evaluating AD severity in black skin. OBJECTIVE: To evaluate the performance of the version of the PO-SCORAD specifically adapted for black skin patients (children and adults) with AD. METHODS: In this multicenter, cross-sectional and non-interventional study, children and adults with AD were recruited during regular consultations. This international study was performed in seven sub-Saharan countries (Benin, Burkina Faso, Cameroon, Ivory Coast, Gabon, Mali and Senegal). During the consultation, AD severity was assessed by the physician using SCORAD score and by the patients or parents using PO-SCORAD. RESULTS: One hundred and thirteen patients were included, 72 children and 41 adults, mainly females (61.6%). SCORAD assessed by physicians and PO-SCORAD assessed by patients/parents were well correlated (r = 0.66, P < 0.0001). Correlation coefficients for SCORAD and PO-SCORAD subscale scores were also good, except for symptom intensity criteria. CONCLUSION: Altogether, these data indicate that PO-SCORAD for black skin correlates well with SCORAD and is therefore a valuable tool, which requires no specific level of education, for use by black skin patients with AD.

Sickle-cell disease with an eruptive appearance? What is your diagnosis?

Lupus is an autoimmune disease of the connective tissues, relatively frequent in the black population, and with a marked female prevalence. Clinical polymorphisms explain the diverse and varied nature of the clinical forms that are sources of diagnostic aberrations. This disease can be associated with various diseases. Here we report an unusual association with AS hemoglobinopathy.

[Histoplasmosis: case report from Gabon]. / Histoplasmose : première observation au Gabon.

The purpose of this report is to describe the first case of infection with Histoplasma capsulatum variety duboisii in Gabon, in a patient with HIV infection.

[Socioeconomic aspects and management of chronic hepatitis B and C in Libreville, Gabon]. / Aspects socioéconomiques de la prise en charge des hépatites chroniques B et C à Libreville (Gabon).

INTRODUCTION: Viral hepatitis remains a major public health problem in the sub-Saharan region. Diagnosis is often made at an advanced stage after a long period with few or no symptoms. Late diagnosis impedes optimal management. MATERIALS AND METHODS: All patients treated for documented chronic hepatitis B or C from January 2001 to December 2009 were identified and the cost of their treatment was estimated. Data examined included socioeconomic information, circumstances surrounding diagnosis, cost of work-up, cost of curative treatment (pegylated interferon + ribavirin for hepatitis C and lamivudine for hepatitis B), and overall cost of support. RESULTS: The study included 146 patients (65 women, 81 men) with a mean age of 34 years. Hepatitis was type B in 89 patients, type C in 51, and type B/C coinfection in 6 patients. The estimated cost of work-up was 483 USD for type B and 507 USD for type C. The cost of curative treatment was 1569 USD for type B and 7842 USD for type C. The estimated cost of support was 407 USD. The total cost of management was 2459 USD for type B and 8757 USD for type C. Only 9 patients received optimal treatment, and it resulted in curing 3 of the 4 with hepatitis B and 4 of the 5 with hepatitis C. During treatment, progression to cirrhosis occurred in two patients, one with hepatitis B and one with hepatitis C. CONCLUSION: Financial constraints frequently prevent patients in Gabon with hepatitis B and C from receiving optimal care. The creation of a national healthcare system in 2008 may lead to cost reductions and improve management of this disease in a predominantly young population.

[Purple extremities in black-skinned patients: blue toe syndrome as presenting sign of antiphospholipid antibody syndrome]. / Extrémités violettes sur peau noire: orteils pourpres révélateurs d'un syndrome des antiphospholipides.

Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.

[Castleman's disease: first case in Gabon]. / Maladie de Castleman: première observation au Gabon.

Castleman's disease is an atypical lymphoproliferative disorder characterized by hyperplasia of lymphoid structures with vascular proliferation. It has rarely been diagnosed in black African populations. The purpose of this report is to describe the first case in Gabon. The patient was a 47-year-old black African man. Outcome was fatal.

[Association myositis and hepatocellular carcinoma: one case and review of literature]. / Association myopathie inflammatoire et hépatocarcinome : à propos d'une observation et revue de la littérature.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

[Lupus, corticosteroid treatment and opportunistic infection: 26 cases in Gabon]. / Corticothérapie et infections opportunistes dans une cohorte de 26 lupus au Gabon.

Opportunistic infection is frequent in lupus patients. Susceptibility is inherent in the lymphopeniant nature of the disease and enhanced by the use of immune-suppressing agents (alone or in combination) for optimal disease control. The purpose of this retrospective series of lupus patients diagnosed based on the criteria of the American College of Rheumatology (ACR) was to assess the frequency of opportunistic infection in a high-risk epidemiological area. A total of 26 patients (24 women, 2 men) with a mean age of 28.8 years were identified. Systematic review carried infectious before the steroid and in light of the local endemicity (HBs Ag, hepatitis C serology, HIV + Rx Thorax IDR) coupled with blood cultures was non-contributory, without waking the tank or during the introduction treatment. With a mean follow-up of 3.6 years (range, 0.83 to 9.91), only one case of tuberculosis was observed with fatal outcome. Our study indicates that the prevalence of opportunistic infections in the Lupus under treatment in a high-risk area for infectious diseases was low. This finding suggests that the risk of infectious complications secondary to corticosteroid therapy in sub-Saharan zone is acceptable provided that surveillance is performed on a regular basis.

[Elevated C reactive protein rate in 23 black African patients with systemic lupus erythematosus and without opportunistic infectious disease]. / Valeur prédictive de l'augmentation de la protéine C réactive dans le lupus systémique en l'absence d'infection intercurrente chez le patient noir africain à travers une série de 23 lupus systémiques.

INTRODUCTION: CRP rarely increases during systemic lupus exacerbations. MATERIALS AND METHODS: This retrospective study of patients with systemic lupus diagnosed according to ACR criteria examined all patients with no intercurrent infectious disease and responding to corticosteroid treatment and compared the patients with normal and with significantly elevated (> or = 30 mg/l) CRP. RESULTS: 23 black patients (22 women, 1 man) were selected and classified in two groups: group I with CRP > 30 mg/l (n = 12) and the controls, group II, with normal CRP (n =11). In group I, mean CRP was 279 mg/l. Four patients had isolated pericarditis, and one pericarditis associated with pleurisy. Nine patients had no cardiovascular risk factors or abnormal liver function enzymes. Antinuclear antibodies were specific for anti-DNA (n= 8), anti-Sm (n = 2), anti-RNP (n = 1), and anti-SSA (n = 1). In group II, seven patients had pericarditis, and nine had no cardiovascular risk factors or liver function results. Antinuclear antibodies were specific for anti-DNA (n = 9), anti-Sm (n = 1) and unknown (n = 1). DISCUSSION: The paucity of data about black Africans in the literature makes it difficult to interpret these results in terms of their specificity for this population or as a typical profile of elevated CRP without infectious disease. CONCLUSION: In absence of a specific profile for patients with elevated CRP without intercurrent infectious disease, we consider the possibility of a subgroup of the black population that may be particularly vulnerable and express CRP more easily.

[Dermatomyositis and pregnancy: a case in Gabon]. / Dermatomyosite et grossesse: une observation au Gabon.

The purpose of this report is to describe a case of successful pregnancy involving a 30-year-old Afican woman presenting dermatomyositis, without use of immunosuppressive treatment. The child was delivered prematurely by caesarean section at 32 weeks of gestation.

[Two cases of probable immune restoration syndrome under antiretroviral treatment in patients treated for tuberculosis in Gabon]. / Probables syndromes de restauration immunitaire lors de la mise sous traitement antirétroviral chez des patients traités pour tuberculose: à propos de deux observations au Gabon.

Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.

[Evaluation of the cost of managing systemic lupus erythematosus in Gabon]. / Evaluation du coût de la prise en charge du lupus érythémateux disséminé au Gabon.

The purpose of this retrospective study was to evaluate the cost of managing systemic lupus erythematosus in Gabon. Study was carried out from 01/2004 to 12/2007. All patients presenting at least 4 of the 11 diagnostic criteria of the American College of Rheumatology were included. The total cost was calculated for the first year and from the second year. A total of 25 patients (24 women, 1 man) with a mean age of 29.6 years (range: 18 and 45) were included in the study. Care was provided by the patient her/himself (n = 8), parents (n = 11), or jointly by other relatives (n = 6). The average cost of accommodation was euro 769.6. Diagnostic review and impact cost were euro 53.3 and euro 58.6 respectively. Overall the average cost of hospitalization was euro 972.7. The total cost for the first year following diagnosis was 1398.6 for patients with the cutaneous-articular form of systemic lupus erythematousus and euro 1500.7 for patients with visceral forms. From the second year on, the annual cost was euro 261 for patients with the cutaneous-articular form and euro 534.7 for patients with visceral forms. Sixteen of the 25 patients were regularly re-examined as outpatients. Nine patients were lost to follow-up including 5 during the first year, 3 during the second year, and 1 during the third year. Two deaths occurred due to chronic renal failure and septic shock. This study shows that long-term follow-up for systemic lupus erythematosus in Gabon is difficult due to patient dropout.

[Mycosis fungoides in a Gabonese patient infected with HTLV-I]. / Mycosis fongoïde chez une gabonaise infectée par le HTLV-I.

Association of human T-lymphotropic virus type-1 (HTLV-1) with T-cell malignancy is well-known but its relationship with mycosis fungoides is controversial. Typical mycosis fungoides was diagnosed at tumor stage in a 58-year-old Gabonese woman also infected with HTLV-1. Infection with lymphoma of the skin is uncommon in Africa but it is probably underestimated. Association of mycosis fungoides with retrovirus infection could be coincidental since there is a high prevalence of HTLV-1 in Gabon and the only currently recognized association is T-cell leukemia/lymphoma. However recent data indicate the presence of similar retrovirus particles and a common tax gene in the monocytes of most patients presenting mycosis fungoides.