RESUMEN
The purpose of this report is to describe 4 cases of Biermer's anemia observed in West Africa over a 7-year period. Severe asthenia was the main clinical manifestation. Laboratory tests consistently demonstrated macrocytic anemia usually with a deep drop in hemoglobin levels ranging from 40 to 84 g/l associated with various degrees of thrombocytopenia or leukopenia. Other consistent findings were bone marrow megaloblastosis, serum vitamin B12 deficiency, and intrinsic factor antibodies. In most cases diagnosis was established on the basis of therapeutic tests with subsequent confirmation. Treatment using vitamin B12 therapy was successful in all cases. The authors recommend iron deficiency testing during the course of the disease and gastric biopsy during fibroscopy of upper digestive tract even if no macroscopic lesions are found.
Asunto(s)
Anemia Megaloblástica/diagnóstico , Anemia Megaloblástica/patología , África Occidental , Anciano , Diagnóstico Diferencial , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Deficiencia de Vitamina B 12/diagnósticoRESUMEN
OBJECTIVE: To compare in a randomized study the efficacy and the toxicity of the new WHO intravenous quinine treatment of cerebral malaria including a loading dose regimen to a regimen without loading dose. PATIENTS AND METHODS: Seventy-two children eight months to 15 years of age with cerebral malaria were included. Quinine formiate was administered to a group of 35 patients in an initial loading dose of 20 mg salt/kg (equivalent to 17.5 mg/kg of the base) in 10 mL/kg of 5% glucose over four hours, followed eight hours later by a maintenance dose quinine of 10 mg salt/kg (equivalent to 8.7 mg/kg of the base) dissolved in 15 mL/kg of 5% glucose over and every 12 hours. The second group of 37 patients received intravenous quinine 15 mg salt/kg (13.1 mg of base) dissolved in 15 mL/kg of 5% glucose infused over 6 to 8 hours, every 12 hours. In both groups this treatment was continued until the patient could swallow, then quinine tablets were given to complete seven days treatment. The assessment of cardiovascular side effects was made by an ECG at admission, the 4th hour, the 24th hour and at the end of treatment for each patient. RESULTS: Coma mean durations were similar in the two groups: 35.5 +/- 17.8 hours and 28.6 +/- 14.4 hours respectively for the loading dose group and the group without loading dose. The two groups were comparable also for the decrease evolution of parasitemia. Case-fatality rates were also similar: 95% of healing at the 72nd hour and a lethality rate between 5 and 6% in the two groups. But a significant increase of the body temperature was noted between the 51st and the 63rd hour in the group without loading dose. No significant cardiovascular toxicity was noticed in the two groups. The mean cost of the loading dose regimen was less than that of the second regimen. CONCLUSION: The loading dose regimen of quinine is well tolerated and it seemed slightly more effective than the regimen without loading dose. In cases of contra-indications (patients who recently received quinine, mefloquine or halofantrine), regimens without loading dose, which remains effective, should be used.
Asunto(s)
Antimaláricos/administración & dosificación , Malaria Cerebral/tratamiento farmacológico , Quinina/administración & dosificación , Administración Oral , Adolescente , África , Antimaláricos/farmacología , Temperatura Corporal , Niño , Preescolar , Esquema de Medicación , Costos de los Medicamentos , Femenino , Humanos , Lactante , Infusiones Intravenosas , Malaria Cerebral/patología , Masculino , Quinina/farmacología , Resultado del TratamientoRESUMEN
BACKGROUND: This study is an evaluation of the first year ambulatory follow up of patients from the sickle-cell care centre of the paediatric ward of the teaching hospital in Lomé-Tokoin. PATIENTS AND METHODS: Togo is situated in the epicentre of the Benin haplotype. A total of 132 patients (109 SS, 22 SC and 1 S beta zero thal) followed up during one year from their admission date (period of 1st January 1996 to 31st December 1997). 132 patients were included in the study. RESULTS: The patients' age varied, for the majority, between 2 months and 15 years, but a few adults (15%) were included in the study. Information was collected from the hospital files and health cards, which unfortunately did not have specific entrees for sickle cell disease. Clinical features revealed that the frequency of tooth decay and chronic persistent splenomegaly was low when compared to the rates in central Africa (Bantu haplotype). Laboratory findings lead to the conclusion that some analysis are relevant such as the dosage of the G6PD activity (24.1% of patients were deficient), parasitologic analysis of faeces (positive in 22.5%), retinal fluoro-angiography (32.2% of ocular lesions), and cardiologic check-up. On the other hand, scanning of biliary tracts and systematic X-rays of the hips seems to be secondary. Some positive results were noticed by the scanning of biliary tracts without any therapeutic decisions in non-symptomatic patients; no case of osteonecrosis was detected by the X-rays. The mean haemoglobin level was 7.4 +/- 1.4 g/dl for the SS and 10.7 +/- 2.4 g/dl for the SC. The mean MCV were 91.3 +/- 10.1 fl and 82.1 +/- 7.7 fl, respectively. Specific vaccinations were not well performed because of their high cost. CONCLUSION: In order to carry on and improve the ambulatory management of patients with sickle cell disease, it is important in low income countries, such as Togo, to target the necessary laboratory tests for an initial and annual check-up. Solidarity networks for patients should be promoted and effective involvement of the health authorities ensured.
Asunto(s)
Atención Ambulatoria , Anemia de Células Falciformes/terapia , Pediatría , Adolescente , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/diagnóstico , Niño , Preescolar , Femenino , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Hemoglobinas/análisis , Hospitales de Enseñanza , Humanos , Lactante , Recién Nacido , Masculino , Togo , VacunaciónRESUMEN
Prevalence of priapism and knowledge on this disease was assessed by interviewing a group of 114 sickle cell anemia patients, 5 years and older, considered to be genotypically homogenous (Benin or #19 haplotype). Prevalence of priapism in homozygous sickle cell patients was 26.3% (30/114) and that of the control group of subjects with Hb AA was 2% (2/102) (the difference was very significant: p = 5.10-7). Actuarial probability of having priapism by 20 years of age was 69 +/- 8.5%. Few homozygous patients without a history of priapism (15.8%) have heard about priapism. This lack of knowledge, added to low accessibility of a health care system, may explain the high rate of impotence (31.6%). The results of this study led us to plan a large program of infonnation about priapism and sickle cell disease in the Togolese population.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Priapismo/epidemiología , Priapismo/etiología , Análisis Actuarial , Adolescente , Adulto , Distribución por Edad , Edad de Inicio , Estudios de Casos y Controles , Niño , Recolección de Datos , Conocimientos, Actitudes y Práctica en Salud , Homocigoto , Humanos , Masculino , Prevalencia , Togo/epidemiologíaRESUMEN
AIM: This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country. PATIENTS AND METHODS: This study was non comparative, including twelve children (eight SS, three SC and one SEzerothalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons: financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient). RESULTS: The mean age of patients was 9.5 +/- 2.6 years. The long bones were the predominantly site. Salmonella species were present in 75% of cases, followed by other enterobacteriaceae (16.7%), and Staphylococcus aureus (8.3%). Successful outcome occurred in all cases after three to four-weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient. CONCLUSION: In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.