ABSTRACT
OBJECTIVES: To assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. PATIENTS AND METHODS: This phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. RESULTS: Among 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4-13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41-0.89]; p = 0.012). No adverse event of medications was reported. CONCLUSION: A single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.
Subject(s)
Ciprofloxacin , Diarrhea , Humans , Ciprofloxacin/therapeutic use , Diarrhea/drug therapy , Anti-Bacterial Agents/therapeutic use , Africa , Fever/drug therapySubject(s)
Endoscopy, Gastrointestinal , Hookworm Infections/diagnosis , Adult , Capsule Endoscopy , Humans , Male , Video RecordingSubject(s)
Acidosis/etiology , Celiac Disease/diagnosis , Diarrhea/etiology , Multiple Trauma , Acidosis/diet therapy , Adult , Celiac Disease/complications , Celiac Disease/diet therapy , Diarrhea/diet therapy , Diet, Gluten-Free , Humans , Hypokalemia/diet therapy , Hypokalemia/etiology , Male , Shock/diet therapy , Shock/etiologySubject(s)
Colonic Diseases/chemically induced , Enema , Phosphates/adverse effects , Colonic Diseases/pathology , Humans , Male , Middle AgedABSTRACT
The purpose of this report is to describe a rare case of benign acute pericarditis associated with recurrent Plasmodium ovale malaria. It was observed in a 33-year-old soldier who was stationed in Djibouti after serving several previous stints in West Africa. A favorable clinical outcome was achieved using chloroquin (30 mg/kg on 6 days) in association with NSAID followed by salicylates for one month. Re-examination at one year showed no recurrence. This case shows that Plasmodium ovale malaria must be considered as a potential etiology for acute benign pericarditis in patients with a history of travel to endemic countries.
Subject(s)
Malaria , Pericarditis/parasitology , Plasmodium ovale , Acute Disease , Adult , Humans , MaleABSTRACT
Glandular heterotopia of the upper esophagus is a congenital abnormality that is frequently discovered during upper digestive tract endoscopy (in 0.26-4.9% of cases), but usually with no malignant potential. Indeed, adenocarcinoma of the upper esophagus related to such lesions is a rare entity. We report here the 27th observation of this rare type of tumor in an 87-year-old man complaining of cervical dysphagia. This adenocarcinoma had developed from an area of gastric heterotopia 3 cm below the upper sphincter of the esophagus. The treatment regimen was based on exclusive radiochemotherapy, which led to a complete endoscopic response at the end of treatment. The patient's symptom-free survival was six months and overall survival was 17 months from diagnosis. This case of a rare tumor of the upper esophagus raises the question of whether the detection and surveillance of this type of heterotopia would be useful and, thus, to be recommended.
Subject(s)
Adenocarcinoma , Esophageal Neoplasms , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Aged, 80 and over , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/therapy , Humans , MaleABSTRACT
Exertional heat stroke (EHS) is a medical emergency defined as tissue injury secondary to a prolonged period of extreme hyperthemia during strenuous physical activity. In the vast majority of cases, EHS is associated with minimal liver involvement with no clinical manifestations. However acute hepatic insufficiency has been reported including a few cases treated by liver transplantation but with poor results suggesting that conservative management is preferable. The purpose of this report is to describe a patient who developed EHS with acute liver insufficiency and multiple organ failure in Djibouti. Despite the remote location and limited medical resources available, full recovery was achieved with conservative therapy and intensive care.
Subject(s)
Heat Stroke/diagnosis , Liver Failure, Acute/diagnosis , Physical Exertion , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , Djibouti , Heat Stroke/complications , Heat Stroke/therapy , Humans , Liver Failure, Acute/etiology , Liver Failure, Acute/therapy , Male , Obesity, Morbid/complications , Renal Dialysis , Treatment OutcomeABSTRACT
Prospective data on management and outcome of stroke in Africa is scarce. The purpose of this prospective descriptive study is to present epidemiologic, clinical and outcome data for a series of patients with hemorrhagic stroke in Djibouti. All patients admitted to the intensive care unit of the Bouffard Medical-Surgical Center in Djibouti for cerebral hemorrhage documented by CT-scan of the brain were recruited in this study. A total of 18 patients including 16 men were enrolled. The median patient age in this series was 51.5 years [range, 20-72]. The median duration of intensive care was 3 days [range, 1-38]. Mean Glasgow score at time of admission was 9 [range, 3-14]. Five patients were brought in by emergency medical airlift. The main risk factors for stroke were arterial hypertension, smoking, and regular khat use. Mechanical ventilation was performed in 10 patients with a survival rate of 40%. Six patients (33%) died in the intensive care unit. Hospital mortality within one month was 39% and mortality at 6 months was 44.4%. One-year survival for patients with a Glasgow score < or = 7 at the time of admission was 33%. Arterial hypertension, khat use, and smoking appeared to be major risk factors for male Djiboutians. Neurologic intensive care techniques provided hospital mortality rates similar to those reported in hospitals located in Western countries. Functional outcome in local survivors appeared to be good despite the absence of functional intensive care. These data argue against the passive, fatalistic approach to management of hemorrhagic stroke and for primary prevention of cardiovascular risk factors.
Subject(s)
Critical Care , Intracranial Hemorrhages/epidemiology , Stroke/epidemiology , Adult , Aged , Djibouti/epidemiology , Female , Hospital Mortality , Humans , Intensive Care Units , Intracranial Hemorrhages/etiology , Male , Middle Aged , Prospective Studies , Risk Factors , Stroke/complications , Stroke/therapyABSTRACT
Les donnees prospectives sur la prise en charge et l'evolution des accidents vasculaires cerebraux (AVC) en Afrique sont pauvres. Le but de ce travail etait de decrire les aspects epidemiologiques; cliniques et e volutifs d'une serie d'AVC hemorragiques a Djibouti. Une etude prospective descriptive a ete realisee pendant 18 mois de tous les patients admis dans le service de reanimation du Groupement Medico-Chirurgical Bouffard pour hemorragie cerebrale diagnostiquee par scanner cerebral. Dix-huit patients dont seize hommes ont ete inclus. L'agemedian etait de 51;5 ans [20-72]. La duree mediane de sejour en reanimation etait de 3 jours [1-38]. Le score de Glasgow moyen a l'entree etait de 9 [3-14]. Cinq patients ont beeeficie d'unee evacuation sanitaire aerienne. Les principaux facteurs de risque retrouvse etaient l'hypertension arterielle (HTA); le tabagisme et la consommation reguliere de Khat. Dix patients (55;5) ont beneficie de ventilation artificielle avec une survie de 40. La mortalite en reanimation etait de 33; la mortalite hospitaliere a 1mois de 39et la mortalite a 6 mois et 1 an de 44;4. La survie a un an des patients ayant un Glasgow . 7 a l'entree etait de 33. L'hypertension arterielle; le khat; et le tabagisme apparaissent comme des facteurs de risque importants pour les hommes djiboutiens. Les mesures medicales de neuroreanimation permettent d'obtenir des taux de mortalite hospitaliere proches de ceux des pays occidentaux. Le pronostic fonctionnel apparait bon pour les survivants autochtones malgre l'absence de reeducation fonctionnelle. Ces donnees plaident contre la passivite et le fatalisme dans la prise en charge en reanimation des hemorragies cerebrales; et pour la prevention primaire en luttant contre les facteurs de risque cardio-vasculaires
Subject(s)
Morbidity , Stroke/epidemiology , Stroke/mortalityABSTRACT
Celiac disease is poorly documented in intertropical Africa. The purpose of this retrospective report was to describe 8 cases observed at the Groupement Medico-Chirurgical of Bouffard Hospital in Djibouti (Horn of Africa) between January 2003 and January 2006. There were 5 females and 3 males ranging in age from 9 months to 17 years old (mean age: 48 months). Six patients were of Somali ethnic origin and two of Yemenite ethnic origin. Six were classified as middle class and 2 as lower class. All forms were symptomatic associating constant loss of weight with digestive manifestations (diarrhoea and vomiting). Diagnosis of celiac disease was based on the presence of anti-gliadin antibodies IgA and IgG associated with anti-endomysium or anti-transglutaminase antibodies that were measured in six and two cases respectively. Gastroduodenal endoscopy performed in three cases including two with duodenal biopsy demonstrated villous atrophy associated with gross of intra-epithelial lymphocytosis. A gluten-free diet initiated in five patients led to clinical improvement in four cases with a follow-up of 8.25 months. The findings of this study in Djibouti show that celiac disease exists in intertropical Africa. Its presentation is quite similar to elsewhere but diagnosis is more difficult due to poor knowledge about the disease and limited diagnostic facilities. Favourable response to presumptive treatment by a gluten-free diet is an alternative for diagnosis especially in Djibouti where eating habits differ from those in industrialized countries and this type of diet is easier to follow.
Subject(s)
Celiac Disease/diagnosis , Adolescent , Autoantibodies/blood , Celiac Disease/diet therapy , Child , Child, Preschool , Diet, Protein-Restricted , Djibouti , Female , Glutens/administration & dosage , Humans , Immunoglobulin A/immunology , Immunoglobulin G/immunology , Infant , Male , Retrospective Studies , Transglutaminases/immunologyABSTRACT
La maladie coeliaque est meconnue en Afrique intertropicale. Nous en rapportons 8 observations colligees de facon retrospective entre janvier 2003 et janvier 2006; au Groupement Medico-Chirurgical Bouffard a Djibouti. Elles ont concerne 5 filles et 3 garcons dont l'age varie de 9 mois a 17 ans (age moyen : 48 mois); d'ethnie Somali 6 fois et Yemenite 2 fois; issus des classes moyennes de la population 6 fois et des classes les plus defavorisees 2 fois. Il s'agissait toujours de formes symptomatiques : alteration de l'etat general constante associee a des troubles digestifs (diarrhee ou vomissements). Le diagnostic a ete retenu dans ce contexte sur la presence d'anticorps anti-gliadine de type IgA et IgG; associes a des anticorps anti-endomysium ou anti-transglutaminase respectivement realises dans 75et 25des cas. Une endoscopie gastroduodenale realisee 3 fois avec biopsies duodenales a montre deux fois une atrophie villositaire totale associee a une augmentation de la lymphocytose intra epitheliale. Un regime sans gluten; instaure chez 5 malades; a entraine une reponse clinique favorable dans 4 cas avec un recul de 8;25 mois. La maladie coeliaque existe en Afrique intertropicale dans la region de la Corne de l'Afrique ou elle ne presente pas de particularite; en dehors de difficultes diagnostiques liees a une meconnaissance de l'affection et des moyens diagnostiques souvent insuffisants. La reponse favorable au regime sans gluten d'epreuve peut constituer une alternative diagnostique d'autant que ce regime parait moins astreignant a suivre a Djibouti qu'en occident en raison d'habitudes alimentaires differentes
Subject(s)
Celiac Disease , Diet , Glutens , Signs and SymptomsABSTRACT
Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and re-dissolve when rewarmed. So their collection and processing are critical. We describe the methodology used in the biochemical laboratory of Military hospital Laveran (Marseille) for detection determination of type and quantitation of cryoglobulins. In this study, we have found cryoglobulins in 53% of healthy subjects and in 77% of patients with chronic hepatitis C.
Subject(s)
Cryoglobulins/analysis , Hepatitis C, Chronic/blood , Cryoglobulins/classification , Humans , Immunoglobulin G/blood , Reference Values , Serum Albumin/analysisABSTRACT
Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and redissolve when rewarmed. Cryoglobulins can be asymptomatic. When not, clinical features are in most cases cutaneous, renal or neurological. Cryoglobulinemia are associated with malignant haematological disorder, connective tissue disease or infection process especially infection with hepatitis C virus. In some case, no aetiology can be found, in theses cases cryoglobulinemia are called primary or essential cryoglobulinemia. For the last ten years it has been widely demonstrated that virus C infection causes the most part of essential cryoglobulinemia.
Subject(s)
Cryoglobulinemia , Cryoglobulinemia/complications , Cryoglobulinemia/diagnosis , Cryoglobulinemia/etiology , HumansSubject(s)
Diarrhea/etiology , Diarrhea/prevention & control , Practice Guidelines as Topic , Travel , Anti-Bacterial Agents , Humans , Hygiene , Risk Factors , Water SupplyABSTRACT
The purpose of this report is to describe a case of tropical calcific pancreatitis (TCP). This disease is specific to tropical regions and constitutes the main cause of chronic pancreatitis in children worldwide. It can also be observed in young adults (2nd and 3rd decade). Shortage of dietary lipids during childhood has been implicated in the development of TCP and mutation of the SPINK1 gene has been cited as a predisposing genetic factor. The underlying pathophysiology of TCP is the same as chronic calcific pancreatitis (CCP) due to alcohol abuse. The main features are a sex ratio of 1, absence of alcohol consumption, occurrence of childhood diabetes in one third of cases, low incidence of acidoketosis, and presence of macro-calcifications especially in ducts. In 10% of cases TCP is complicated by pancreatic carcinoma occurring at an early age, located mainly in the body and tail of the pancreas, and having a less favorable prognosis than primary cancer. Treatment of patients with TCP is the same as for patients with CCP due to alcohol abuse. Prevention depends on improvement of nutritional status of the population.
