[Identification of barriers to routine HIV testing prescription by midwifes and doctors in Guadeloupe]. / Identification des freins à la prescription du test de dépistage de l'infection au VIH par les sages-femmes et médecins en Guadeloupe.

OBJECTIVES: Guadeloupe is the second highest French area for diagnosis and prevalence of HIV infection and AIDS. In October 2009, the French High Health Authority has published guidelines for a more systematic HIV screening. The goal of this study is to identify the limitations in HIV testing prescription by the Guadeloupian prescribers according to these new recommendations. MATERIALS AND METHODS: Data were collected with a questionnaire submitted to physicians and midwives after random selection. RESULTS: Among 285 randomly selected prescribers, 67 midwives and 40 physicians participated from August to December 2010. The main limitations to HIV testing prescription were: a consultation for another purpose, patient or his life style were known, and lack of HIV infection symptoms. Some characteristics of more easily screened patient did not match with those who had been newly diagnosed in Guadeloupe. Finally, both quantitative and qualitative knowledge of these new recommendations was insufficient. CONCLUSION: Implementation of these new testing recommendations should give emphasis to the systematic and annual nature of HIV testing for whole population. It should also insist on distinction between HIV testing and diagnosis of a symptomatic patient.

[Cerebrovascular accidents and AIDS]. / Accidents vasculaires cérébraux et SIDA.

A number of pathological and clinical data suggest that AIDS could be an underestimated cause of cerebro-vascular disease, especially in young individuals. Eight retrospective cases of stroke in AIDS patients are reported. Mean age was 39 years, mean CD4 cells count 57/mm3. Pathogenic mechanism, particularly the role of opportunistic infections remains unclear. Prognosis does not seem constantly pejorative: only one patient died from stroke, six are still alive with a 6 months follow-up, without relapse and with minor or no sequellae. Alcohol or cocaine (crack) abuse was present in half the cases. The role of specific risk factors and consequently adapted prophylaxis is questionned.

[Polycystic kidney. Clinical and familial aspects. Apropos of 29 cases]. / La polykystose rénale. Aspects cliniques et familiaux. A propos de 29 cas.

The polycystic kidney disease is a hereditary malformation seldom described in Africa. Nineteen cases among 6 men and 13 women were seen in the internal Medicine Service in seven years. The range of age was 28 to 77 years. Ten other patients (of whom four were less than 15 years old were discovered via systematic family investigations and confirmed by ultra sound. The diagnosis was based essentially on consistent clinical signs and the presence of at least 5 cysts in each kidney. Infectious manifestations were the most frequent, presented in 37% of the cases. These acute infections can affect either the urinary ducts or a hepatic or renal cyst. The family investigations established that a third of the subjects examined were asymptomatic or had lumbar pain and hematuria never associated with their underlying cause.

[Apropos of hepatorenal polycystic disease associated with cirrhosis]. / A propos d'une maladie polykystique hépatorénale associée à une cirrhose.

The authors report a case of association of cirrhosis with (autosomal dominant) polycystic kidney and liver disease, which is hereditary malformation. The occurrence of hepatic cysts during the disease is relatively common, and the development in general is benign. In this case, the large hepatic cysts are responsible of biliary ducts compression, with clinical and biological cholestasis. Portal hypertension like impaired hepatocellular function develop because of cirrhosis.

[Contribution of echography in the diagnosis ruptured liver abscess (Apropos of 4 cases)]. / Apport de l'échographie au diagnostic de rupture d'abcès du foie (a propos de 4 observations).

The authors report 4 cases of ruptured hepatic abscesses in peritoneum (2 cas) and in pleural (2 cases). The cases occurred in 3 men (two of them were alcoholic) and one woman who was in the postpartum period. The cases confirm the classic pictures according to which, ruptures of hepatic abscesses have unclear clinical presentation whether they are amoebic or bacterial in origin! In these cases, ultrasound is very useful in the rapid detection of peritoneal or pleural abscesses which can be confirmed by ultrasonically guided fine needle punction When the channel from the intra hepatic abscess can be visualised, or when they are a coexisting hepatic and peritoneal pleural abscesses, the diagnosis is clear. However when the abscess has been completely emptied of its contents the diagnosis may the difficult.

[Chronic calcifying pancreatitis in a young patient in a tropical environment. Report of a case]. / La pancréatite chronique calcifiante du sujet jeune en milieu tropical. A propos d'une observation.

The authors report one case of calcifying, chronic pancreatitis in an 18-year-old patient, discovered during a diabetic coma. The patient had been suffering from steatorrhoea for several years, and his father had died from acute pancreatitis. Hereditary pancreatitis and nutritionally provoked, juvenile, tropical pancreatitis are discussed. The patient's brothers and sisters have not been examined yet.

Persistence of circulating complexes between HBsAg and immunoglobulin M in sera of hepatitis B surface antigen positive patients suffering from liver cirrhosis or primary liver cancer.

Complexes between hepatitis B surface antigen (HBsAg) and immunoglobulin M (IgM) have been detected in acute type B hepatitis. Sequential serum testing for the presence of these complexes has been shown to be the best method for predicting disease chronicity. The presence of HBsAg/IgM complexes was investigated using an enzyme-linked immunosorbent assay with selected sera from Senegal. The three population groups studied were composed of 405 Senegalese soldiers as well as 84 liver cirrhosis and 169 primary liver cancer patients. Only one of the 122 HBsAg negative sera tested was found to be positive for HBsAg/IgM complexes. Complexes were detected 13.9% of the HBsAg positive soldiers, in 40% of the HBsAg positive liver cirrhosis patients, and in 50% of the HBsAg positive primary liver cancer patients. HBsAg/IgM complexes were also detected in 53.6% of the hepatitis B e antigen (HBe) positive soldiers, compared to 75 and 76% for the HBeAg positive liver cirrhosis and primary liver cancer patients, respectively. In anti-HBe positive sera, an increased proportion of HBsAg/IgM complexes was observed during the sequence chronic hepatitis (5%)-cirrhosis (29%)-primary liver cancer (42%). On the other hand, it has been reported that in the sequence of events leading from chronic hepatitis to primary liver cancer, there is an increase in anti-HBeAg prevalence and in alpha-fetoprotein levels. In this study, only alpha-fetoprotein levels were found to increase. Values higher than 15 IU/ml were observed in 4.3, 27.3, and 86.4% of the HBsAg positive individuals from the three groups. No significant variation was observed in the anti-HBe prevalence between the population group (64-75%).