ABSTRACT
Objective: Our work aimed to assess the efficacy and safety of direct-acting antiviral drugs in the treatment of hepatitis C in Madagascar. Methods: This retrospective clinical study was carried out from March 2018 to February 2020 in the hepato-gastro-enterology department of the University Hospital Center Joseph Raseta de Befelatanana. Results: A total of 35 patients were included, out of which 24 received sofosbuvir/ledipasvir ± ribavirin, 10 sofosbuvir/ribavirin and one sofosbuvir/velpatasvir. Thirty-three patients were naïve to the treatment and 2 patients were initially treated with the sofosbuvir/ledipasvir combination. The sustained virologic response was 94% (33/35) in the general population, 23/25 in cirrhotic patients and 10/10 in non-cirrhotic patients. The sustained virologic response was 22/24 for sofosbuvir/ledipasvir ± ribavirin, 10/10 for sofosbuvir/ribavirin and 1/1 for sofosbuvir/velpatasvir. Adverse effects were observed in 13 patients, mainly asthenia and insomnia. Discussion: The small number of patients with hepatitis C treatments and their limited financial resources are the main limits of this survey. Conclusion: Direct-acting antivirals are effective and characterized by good tolerance in these Malagasy hepatitis C patients.
Subject(s)
Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/adverse effects , Drug Therapy, Combination , Genotype , Hepacivirus , Hepatitis C/drug therapy , Hepatitis C, Chronic/drug therapy , Hospitals, Teaching , Humans , Madagascar/epidemiology , Retrospective Studies , Ribavirin/therapeutic use , Sofosbuvir/adverse effectsABSTRACT
Acute cholangitis secondary to ascariasis is rare and occurs mainly in areas of high endemicity. The clinical presentation is non-specific, sometimes complicated by liver abscess. Abdominal ultrasound plays an important role in diagnosis and therapeutic surveillance. We report the case of a 35-year-old Malagasy woman with an acute cholangitis secondary to ascariasis and complicated by liver abscesses and its course to full recovery under medical treatment.
Subject(s)
Ascariasis/complications , Cholangitis/parasitology , Liver Abscess/complications , Acute Disease , Adult , Female , HumansABSTRACT
Helicobacter pylori (H. pylori) resistance against antibiotics is a major challenge, particularly in developing countries. We report a case of H. pylori infection where eradication by two lines of treatment, one including metronidazole and the other clarithromycin, failed, and discuss the management of such a case in a tropical area. This 55-year-old man complained of epigastric pain dating back for three years. A stool antigen test for H. pylori was positive. First-line eradication therapy, which combined a proton pump inhibitor, amoxicillin and metronidazole, was unsuccessful, as was the second-line therapy, which replaced metronidazole by clarithromycin. Third-line treatment, which still included a proton pump inhibitor and amoxicillin but added levofloxacin was successful. A stool antigen test to verify eradication was finally negative. In developing countries, H. pylori eradication must be managed rationally. In particular, fluoroquinolones must be reserved for treatment failure. The stool antigen test appears to be a useful and economical alternative to the urea breath test for verifying eradication.
Subject(s)
Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori , Levofloxacin/therapeutic use , Proton Pump Inhibitors/therapeutic use , Anti-Infective Agents/therapeutic use , Clarithromycin/therapeutic use , Drug Therapy, Combination , Humans , Male , Metronidazole/therapeutic use , Middle Aged , Treatment Failure , Tropical MedicineABSTRACT
Pernicious anemia is uncommon in Africa. The purpose of this report is to describe a case of pernicious anemia observed in Madagascar. The revealing manifestation was encephalomyelitis with combined medullar sclerosis that responded favorably to vitamin B12 replacement therapy. Clinical symptoms included paresthesia associated with allodynia of all four extremities and with tetrapyramidal syndrome, medullar ataxia and minor cognitive disturbances ongoing for 5 months. Hemogram testing revealed macrocytic anemia. Serum cobalamin level was low. Anti-intrinsic factor antibody was detected. Spinal cord magnetic resonance imaging showed diffuse high-signal intensity along the posterior spinal cord extending from C1 to C4. Vitamin B12 replacement therapy led to full regression of clinical signs after six weeks. Association of central nervous system involvement with macrocytic anemia suggests vitamin B12 deficiency and pernicious anemia should be suspected. This disease can be considered as a curable form of myelitis in Africa and Madagascar.
Subject(s)
Anemia, Pernicious/diagnosis , Encephalomyelitis/etiology , Anemia, Pernicious/drug therapy , Encephalomyelitis/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tropical Climate , Vitamin B 12/therapeutic use , Vitamins/therapeutic useABSTRACT
L'hepatite fulminante est definie par l'association de signes d'encephalopathie hepatique a une chute du taux de prothrombine inferieur a 50survenant moins de deux semaines apres l'apparition d'un ictere. Elle est grave et mortelle en absence de transplantation hepatique. Cependant; nous rapportons un cas d'hepatite fulminante d'evolution favorable sous traitement medical seul. Il s'agissait d'un cas secondaire a un traitement antituberculeux qui a ete arrete tout de suite et remplace par un lavement au lactulose des l'apparition des signes d'encephalopathie hepatique. L'evolution etait marque par un retour progressif de l'etat de conscience a la normale et une amelioration nette du bilan hepatique
Subject(s)
Antitubercular Agents , Case Reports , Hepatic Encephalopathy , HepatitisABSTRACT
Le virus d'Epstein-Barr est responsable de la mononucleose infectieuse. Il peut induire la formation d'anticoagulants circulants sans qu'apparaissent obligatoirement des manifestations thrombotiques. Nous rapportons le cas d'un jeune patient hospitalise pour une thrombose portale revelee par des manifestations douloureuses abdominales. La recherche d'anticoagulant circulant de type lupique dans le sang etait positive. Le bilan de thrombophilie s'averait negative. Nous n'avons pas retrouve de cas similaire dans la litterature. Le role des anticoagulants circulants semble etre primordial dans la constitution de cette obstruction de la veine porte. Une infection virale peut etre a l'origine de manifestations thrombotiques intra-abdominales par le biais de l'action thrombogene des anticoagulants circulants in vivo
Subject(s)
Anticoagulants , Case Reports , Epstein-Barr Virus Infections , Venous ThrombosisABSTRACT
OBJECTIVE: Cirrhotic patients have poorer life expectancy than the general population. The purpose of this study was to identify causes of death in a sample of cirrhotic patients from Madagascar. METHODS: A retrospective analytic and descriptive study was conducted on the files of cirrhotic inpatients admitted to the gastroenterology department of the Joseph Raseta Befelatanana University Hospital Center in Antananarivo, Madagascar from January 1, 2003 to June 30, 2007. RESULTS: The files of 117 patients were reviewed. Death occurred in 31 cases for a mortality rate of 26.5%. The main causes of death were disorders of consciousness (51.6%) and hypovolemic shock (25.8%). Jaundice, encephalopathy, and gastrointestinal bleeding were predictive factors for mortality. CONCLUSION: Cirrhotic patients in this study were hospitalized at a late stage of disease. Further prospective study in a larger sample will be needed to standardize the management protocol in Madagascar.
Subject(s)
Cause of Death , Liver Cirrhosis/mortality , Female , Fever , Gastrointestinal Hemorrhage/mortality , Hepatic Encephalopathy/mortality , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/epidemiology , Madagascar/epidemiology , Male , Middle AgedABSTRACT
L'hemoperitoine spontane est defini par la presence de sang dans la cavite peritoneale en l'absence de tout traumatisme. Il s'agit d'un accident rare mais grave. Nous rapportons le cas d'une jeune femme de 28 ans; sous traitement anticoagulant oral; qui presentait une douleur abdominale aigue; une instabilite hemodynamique et une deglobulisation sans notion de traumatisme. Le traitement medical doit etre propose en premiere intention en cas d'hemoperitoine. La prevention reste la meilleure strategie dans la prise en charge des accidents des anticoagulants
