Drastic sex-dependent etiological distribution in severe liver diseases from Gabon.

Chronic liver diseases still represent a worrying public health issue in Sub-Saharan Africa. In this region, emphasis is generally made on hepatocellular carcinoma (HCC) albeit liver cirrhosis (LC) is also responsible for an important death toll. Very few studies have compared the presentation and etiologies of cancer and cirrhosis of the liver in Middle Africa. We conducted a comparative retrospective analysis of 74 and 134 cases of patients with HCC and LC treated in Libreville, Gabon. Viral or lifestyle risk factors, clinical symptoms, and biological features were compared. We observed that ages of diagnosis were 53.2 ± 15.7 years and 48.6 ± 18.6 years for HCC and LC with remarkably low M:F sex ratios (1.3-1.8). Ethanol consumption was highly prevalent in both disease types (65.0%-70.0%). Chronic viral infections with hepatitis B (HBV) or C (HCV) virus were also widespread with slight domination of the former in both diseases (43.4% vs. 34.3%, and 35.9% vs. 28.5%). Patients with HCC were presenting very late with a mean diameter of the main nodule of 84 ± 50 mm and a multifocal pattern in 72.7% of cases. HCC developed on a cirrhotic liver in 91.7% of cases. Serum AFP was frankly elevated (>400 ng/ml) in only 35.8% of HCC cases. The most striking feature of the HCC series was the contrasted contribution of distinct pathogenic etiologies involving sex, viral, metabolic, and toxic factors. A frequently dysmetabolic condition synergizing with hepatitis C (anti-HCV, 73.8% vs 22.7%, p < 0.0001) in females and a male cancer promoted by recreational toxicants and chronic hepatitis B (HBsAg, 83.5% vs 35.9%, p < 0.0001) were observed. Men with HCC were considerably younger than women (46.8 ± 14.5 years vs. 62.2 ± 12.2 years, p < 0.0001). Further studies are now warranted to identify routes of HCV transmission and if they are still fueling reservoirs of future patients. Public policies to prevent alcohol-related harm have also to be urgently implemented in Gabon.

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.

[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.

[HBs Ag and antibodies to hepatitis C virus in complicated chronic liver disease in Gabon. A case control study]. / Antigène HBs et anticorps anti-VHC dans les hépatopathies chroniques compliquées au Gabon.

BACKGROUND AND OBJECTIVE: The prevalence of HBs Ag and anti-HCV antibodies are high in the general population in Gabon. The aim of this study was to perform a case control study to determine the role of hepatitis B and C viruses in decompensated cirrhosis and hepatocellular carcinoma. METHODS: Between October 1990 and June 1998, HBs Ag and anti-HCV antibodies were investigated in 1 204 newly hospitalized patients. Sixty-seven had decompensated cirrhosis, 38 had hepatocellular carcinoma and six an association of both diseases. Prevalences were compared with those in a group of 527 sex and age matched controls from the same cohort. RESULTS: HBs Ag prevalence among cases was 35.1% (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 40.5%) and 12.5% among controls. Anti-HCV were detected in 32.4% of cases (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 28.6%) and in 20.1% of controls. Complicated chronic liver disease was linked to HBs Ag (OR=11.3; IC: 4.8-26.7; cirrhosis: OR=18; IC: 5.3-61.5; hepatocellular carcinoma: OR=8.3; IC: 2.5-27.8) in patients from 15 to 34 years old. Above 45 years, complicated chronic liver disease was linked to anti-HCV antibodies (OR=2.9; IC: 1.6-5.3; cirrhosis: OR=2.8; IC: 1.4-5.8; hepatocellular carcinoma: OR=3.2; IC: 1.1-9.5). CONCLUSION: Both Hepatitis B and C viruses are linked to complicated chronic liver disease in Gabon in an age-dependent manner.