[A rare association of Takayasu's disease and inflammatory bowel disease in Gabon]. / Association rare d'une maladie de Takayasu et d'une maladie inflammatoire chronique intestinale au Gabon.

Takayasu's disease is a vasculitis affecting large vessels, particularly the aorta and its main branches, for which the role of Mycobacterium tuberculosis has been suggested as a trigger by a hypersensitivity reaction. Inflammatory bowel diseases, which in sub-Saharan Africa can be confused with parasitic diseases, can rarely be found in association with Takayasu's disease. We report an association between both diseases in the Gabonese population.

[Conidiobolomycosis (rhinofacial entomophthoromycosis) in Gabon. About of one case]. / Conidiobolomycose (entomophthoromycose rhinofaciale) au Gabon, à propos d'une observation.

Background: Entomophthoromycosis constitutes a nosological group of subcutaneous mycoses including conidiobolomycosis (rhinofacial form) and basidiobomomycosis (subcutaneous form involving the trunk and the limbs). Conidiobolomycosis is characterized by a progressive nasal and facial deformity giving, in the evolved forms, a "hippopotamus snout". The literature review finds a hundred cases, with a tropism for the humid tropical regions. Methods. We report the observation of a 25-year-old patient, living in the equatorial zone, in the south of Gabon in a humid forest area, presenting a swollen aspect of the face mainly involving the eyelids, the nose and the upper lips. Results: The diagnosis of entomophthoromycosis was compatible with the histopathological and clinical aspects. The evolution was favorable in terms of facial aesthetics under itraconazole 300 mg/day for 2 months and corticosteroid therapy (bolus of methylprednisone 240 mg/day for 3 days relayed per os at a dose of 0.5 mg/kg/day, i.e. 30 mg/day) of prednisone), maintained for 3 months. The average nasal improvement could not be completed by surgery and the patient was lost to follow-up. Conclusion: This second observation of conidiobolomycosis in Gabon in the same province makes Ngounié a privileged ecosystem for this affection.

[Takayasu's disease: an underdiagnosed entity in Sub-Saharan Africa. Report of five Gabonese cases]. / Maladie de Takayasu : une entité sous-diagnostiquée en Afrique Subsaharienne. À propos de cinq observations gabonaises.

Background: Takayasu's disease (TM) is a vasculitis of the aorta and its main branches, Infectious diseases, especially Mycobacterium tuberculosis, can be a trigger for the development of TM by a hypersensitivity reaction, but paradoxically very few cases of the disease are reported in the literature review. Materials and methods: Through a retrospective study carried out in the departments of internal medicine and cardiology of the Centre hospitalier universitaire de Libreville (CHUL) in Gabon, we identified all the observations of TM diagnosed in the said departments from 03/2014 to 05/2022, and rediscussed them on the basis of the criteria of Sharma et al. of 1996. Results: Five patients (3 men, 2 women), with an average age of 38.4 years were found. 2/5 patients reported a history of pulmonary tuberculosis. There was a change in general condition (n=4), fever (n=2), arterial hypertension (n=4), a decrease in the radial pulse (n=2), rheumatological manifestations (n=3), involvement of the serous membranes (n=3). CRP was positive (n=4), and HIV1,2 serology negative (n=5). Echocardiography found pulmonary arterial hypertension (n=1), constrictive pericarditis (n=1) and valvular involvement (minimal aortic insufficiency) (n=1), and typing of aortic involvement by computed tomography or CT angiography staged Takayasu's disease as type IIa (n=2), IIb (n=2) and IV (n=1). The patients were treated with oral corticosteroid therapy (n=5) combined with methotrexate (n=4) and azathioprine (n=1). Discussion: The criteria of Sharma et al. from 1996, suggest a high probability of TM with a sensitivity of 92.5% and a specificity of 95%. In sub-Saharan Africa, TM requires the elimination of certain differential diagnoses, particularly syphillis, tuberculosis, salmonellosis, and atherosclerosis. Corticosteroid therapy (coupled with immunosuppressive treatment) remains effective, allowing significant remission of the disease, but comes up against the risk of opportunistic infections. Conclusion: There is a contrast between the involvement of Mycobacterium tuberculosis in the etiopathogenesis of TM on the one hand and the endemic nature of tuberculosis on the African continent on the other hand; which contrasts with the few cases reported in sub-Saharan Africa.

[An abdominal mass of unexpected etiology]. / Une masse abdominale d'étiologie inattendue.

Concomitant existence of spondylodiscitis and a psoas abscess in a patient with a history of plasmacytoma should be the subject of extensive etiological research.

Profil clinique, biologique et traitement des drépanocytaires régulièrement suivis au Centre Hospitalier Universitaire de Libreville / Clinical, biological and treatment profile of sickle cell patients regularly followed at Libreville University Hospital Center

Introduction: La mise en place depuis Septembre 2016 au Centre Hospitalier Universitaire (CHUL) d'une consultation d'hématologie dédiée aux adultes drépanocytaires a été l'occasion de mener cette étude dont le but principal était d'établir les profils clinique et paraclinique de l'adulte drépanocytaire régulièrement suivi.Patients et méthodes : Il s'agissait d'une étude rétrospective. La population d'étude était constituée de patients drépanocytaires homozygotes de 18 ans et plus, qui avaient effectués au moins trois consultations d'hématologie sur une année. Les informations recueillies, après étude du dossier médical et entretien téléphonique avec le patient, concernaient les données socio-démographiques, l'histoire de la drépanocytose, les antécédents, les complications de la maladie, les examens biologiques et radiologiques et le traitement.Résultats : Au total 88 patients répondaient aux critères d'inclusion sur les 233 drépanocytaires vus durant la période de l'étude. L'âge moyen était de 30,4 ± 7,8 ans. L'interrogatoire révélait que la crise vaso-occlusive (CVO) était la principale complication aiguë et la lithiase vésiculaire (36,3%) la première complication chronique. L'hémoglobine moyenne était de 7,8 g/dl et pour 49,3% des patients elle se situait entre 7 et 9 g/dl. Les leucocytes étaient augmentés dans 65,7%. L'échographie cardiaque réalisée chez 35 patients retrouvait 11,1% d'hypertension artérielle pulmonaire et 22,8% d'hypertrophie ventriculaire gauche. L'intensité de la crise douloureuse motivait une consultation au service des urgences du CHU dans 81,6% des cas dont plus de 62% déploraient un retard dans l'exécution de cette prise en charge bien qu'ils en aient été satisfaits dans 54,9% des cas.Conclusion : Les drépanocytaires adultes régulièrement suivis au CHUL sont peu nombreux. La transition entre le suivi pédiatrique et adulte doit se faire avec une transmission des informations du dossier médical sur l'histoire de la drépanocytose.

Introduction: The establishment since September 2016 at the University Hospital Center (CHUL) of a hematology consultation dedicated to adults with sickle cell disease was an opportunity to conduct this study, the main purpose of which was to establish the clinical and paraclinical profiles of the adults with sickle cell disease regularly monitored. Patients and methods: This was a retrospective study. The study population consisted of homozygous sickle cell patients aged 18 and over, who had performed at least three hematology consultations over a year. The information collected, after studying the medical file and telephone interview with the patient, concerned socio-demographic data, history of sickle cell disease, history, complications of the disease, biological and radiological examinations and treatment. Results: A total of 88 patients met the inclusion criteria out of the 233 sickle cell patients seen during the study period. The mean age was 30.4 ± 7.8 years. The questioning revealed that vaso-occlusive crisis (VOC) was the main acute complication and cholelithiasis (36.3%) the first chronic complication. The average hemoglobin was 7.8 g/dl and for 49.3% of the patients it was between 7 and 9 g/dl. Leukocytes were increased in 65.7%. Cardiac ultrasound performed in 35 patients found 11.1% pulmonary arterial hypertension and 22.8% left ventricular hypertrophy. The intensity of the painful crisis motivated a consultation in the emergency department of the CHU in 81.6% of cases, of which more than 62% complained of a delay in the execution of this care although they were satisfied with it in 54 .9% of cases.Conclusion: Few adult sickle cell sufferers are regularly monitored at the CHUL. The transition between pediatric and adult follow-up must be made with a transmission of information from the medical file on the history of sickle cell disease

Burnout level and associated factors in a sub-Saharan African medical setting: prospective cross-sectional survey.

BACKGROUND: Burnout in the hospital environment is a problem that affects care and training. Often explored in the high-income medical context, burnout is poorly studied in low and middle-income countries characterized by a precarious hospital situation and a high stake linked to the Millennium Development Goals. The aim of our study was to determine in medical practitioners, in a sub-Saharan African country's medical context, the burnout level and associated factors. METHODS: A prospective cross-sectional study by using a self-administered Likert-scale questionnaire addressed to doctors and doctoral medical students in Gabon. Maslach Burnout Inventory scale has been used. Burnout symptoms were defined by high level in at least one of the 3 dimensions. Severe burnout defined by high level in all dimensions. Explored factors: socio-demographic and psychometric. Multiple logistic regression has been performed. RESULTS: Among 104 participants, severe burnout prevailed at 1.9% (95% CI: 0.2-6.8%) and burnout symptoms at 34.6% (95% CI: 25, 6-44.6%). The associated factors with burnout symptoms: age (OR = 0.86, p = 0.004), clinical activity in a university hospital center (OR = 5.19, p = 0.006), the easy access to the hospital (OR = 0.59, p = 0.012), number of elderly dependents living with the practitioner (OR = 0.54, p = 0.012), place of residence (same borough where the hospital is located: OR = 4.09, p = 0.039) and to be favorable to traditional medicine (OR = 1.82, p = 0.087). Nagelkerke's R-squared:53.1%. CONCLUSION: In Gabon, middle-income country, almost one practitioner in two has burnout symptoms. The young age, the university hospital center, the difficulty to access to hospital and to live in the borough where the hospital is located increase the probability of burnout symptoms. These results must put question to relevant authorities regarding health and medical education, to set up: a public transport for practitioners, an optimal primary health care system, a regulation of medical tasks in hospitals, a training in clinical supervision.

Intravenous infusion of glucose 5% despite sodium mixed, is main contributor of acquired hyponatremia in adult polyvalent medicine service: Case control study.

BACKGROUND: Acquired hyponatremia is a life threatening event. Intravenous infusion of a mixture of 5% glucose and sodium solute is mainly used, but its contribution in the occurrence of acquired hyponatremia in adult, is under-investigated outside intensive care unit. OBJECTIVE: To evaluate the place of intravenous infusion of a mixture of 5% glucose and sodium in predicting acquired hyponatremia in adult polyvalent medicine service. PATIENTS AND METHODS: A case-control study have been conducted. The main exposure was intravenous infusion of a mixture of 5% glucose and sodium solute (4 grams NaCl/liter of 5% glucose). OUTCOME: Acquired hyponatremia during hospitalization. By logistic regression, the global multifactorial model predicting acquired hyponatremia, and its sub-models were established; as well as following parameters: area under the Receiving Operator Characteristic curve (AUC), maximal Youden's index with its couple of coordinates (sensibility-specificity), Nagelkerke's R-squared adjusted. RESULTS: Adjusted odds ratio (cases/controls; main exposure; outcome) ORa=2.73 (95% CI 1.40-5.32; P=0.003). Prediction of acquired hyponatremia: global multifactorial model: AUC=0.78 (95% CI 0.72-0.85; P<0.0001), Youden's index=0.34 (95% CI 0.24-0.41); sub-model (global multifactorial model without main exposure): AUC=0.72 (95% CI 0.66-0.78; P<0.0001), Youden's index=0.18 (95% CI 0.07-0.22). CONCLUSION: Intravenous infusion of a mixture of 5% glucose and sodium mainly used, highly contribute to predict acquired hyponatremia in adult polyvalent medicine service, and should be the first cause to consider for managing this acquired hyponatremia.

[Still disease in subSaharan Africa: report of four cases in Gabon]. / Maladie de Still en Afrique subsaharienne : à propos de quatre observations gabonaises.

Still disease is an inflammatory rheumatism occurring predominantly in children and adolescents, but which is sometimes diagnosed in adults. A combination of fever, arthralgia, transient dermatological lesions, hyperleucocytosis predominantly neutrophilic, and ferritinaemia greater than 1,000 µg/L is suggestive of this disease, but infectious, haematological, immunological, and tumor diseases must first be ruled out. Accordingly, patients' financial limitations keep this disease from being diagnosed often in sub-Saharan Africa. We report four cases of Still disease with favourable outcome after corticosteroid therapy.

[Bilateral papillary necrosis during indinavir treatment]. / Nécrose papillaire bilatérale lors d'un traitement par indinavir.

INTRODUCTION: Papillary necrosis results from ischemia of the renal medulla and papillae, induced by a variety of mechanisms. Papillary necrosis is a rare adverse effect of continuous protease-inhibitor therapy with indinavir. CASE: We describe the case of a patient who developed bilateral papillary necrosis. It was reversible after treatment interruption and increased hydration. CONCLUSION: This case shows the need to monitor kidney markers in patients under continuous treatment with indinavir.