RESUMO
INTRODUCTION: Viral hepatitis remains a major public health problem in the sub-Saharan region. Diagnosis is often made at an advanced stage after a long period with few or no symptoms. Late diagnosis impedes optimal management. MATERIALS AND METHODS: All patients treated for documented chronic hepatitis B or C from January 2001 to December 2009 were identified and the cost of their treatment was estimated. Data examined included socioeconomic information, circumstances surrounding diagnosis, cost of work-up, cost of curative treatment (pegylated interferon + ribavirin for hepatitis C and lamivudine for hepatitis B), and overall cost of support. RESULTS: The study included 146 patients (65 women, 81 men) with a mean age of 34 years. Hepatitis was type B in 89 patients, type C in 51, and type B/C coinfection in 6 patients. The estimated cost of work-up was 483 USD for type B and 507 USD for type C. The cost of curative treatment was 1569 USD for type B and 7842 USD for type C. The estimated cost of support was 407 USD. The total cost of management was 2459 USD for type B and 8757 USD for type C. Only 9 patients received optimal treatment, and it resulted in curing 3 of the 4 with hepatitis B and 4 of the 5 with hepatitis C. During treatment, progression to cirrhosis occurred in two patients, one with hepatitis B and one with hepatitis C. CONCLUSION: Financial constraints frequently prevent patients in Gabon with hepatitis B and C from receiving optimal care. The creation of a national healthcare system in 2008 may lead to cost reductions and improve management of this disease in a predominantly young population.
Assuntos
Hepatite B Crônica , Hepatite C Crônica , Adolescente , Adulto , Idoso , Criança , Feminino , Gabão , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/economia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto JovemRESUMO
Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.
Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , População Negra , Síndrome do Artelho Azul/etiologia , Isquemia/etiologia , Dedos do Pé/irrigação sanguínea , Adulto , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Biomarcadores/sangue , Síndrome do Artelho Azul/induzido quimicamente , Síndrome do Artelho Azul/diagnóstico , Síndrome do Artelho Azul/imunologia , Anticoncepcionais Femininos/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Isquemia/diagnóstico , Levanogestrel/efeitos adversos , Fatores de RiscoRESUMO
Castleman's disease is an atypical lymphoproliferative disorder characterized by hyperplasia of lymphoid structures with vascular proliferation. It has rarely been diagnosed in black African populations. The purpose of this report is to describe the first case in Gabon. The patient was a 47-year-old black African man. Outcome was fatal.
Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico , Alcoolismo/complicações , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/terapia , Evolução Fatal , Gabão , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tuberculose Pulmonar/complicaçõesRESUMO
Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.
Assuntos
Carcinoma Hepatocelular/complicações , Neoplasias Hepáticas/complicações , Polimiosite/etiologia , Adulto , Carcinoma Hepatocelular/diagnóstico , Evolução Fatal , Humanos , Neoplasias Hepáticas/diagnóstico , MasculinoRESUMO
Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Adolescente , Corticosteroides/uso terapêutico , Feminino , Gabão , Linfadenite Histiocítica Necrosante/tratamento farmacológico , Linfadenite Histiocítica Necrosante/patologia , Humanos , Linfonodos/patologia , Resultado do Tratamento , Adulto JovemRESUMO
Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/complicações , Adulto , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , RNA Viral/sangue , Recidiva , Carga ViralRESUMO
The purpose of this retrospective study was to evaluate the cost of managing systemic lupus erythematosus in Gabon. Study was carried out from 01/2004 to 12/2007. All patients presenting at least 4 of the 11 diagnostic criteria of the American College of Rheumatology were included. The total cost was calculated for the first year and from the second year. A total of 25 patients (24 women, 1 man) with a mean age of 29.6 years (range: 18 and 45) were included in the study. Care was provided by the patient her/himself (n = 8), parents (n = 11), or jointly by other relatives (n = 6). The average cost of accommodation was euro 769.6. Diagnostic review and impact cost were euro 53.3 and euro 58.6 respectively. Overall the average cost of hospitalization was euro 972.7. The total cost for the first year following diagnosis was 1398.6 for patients with the cutaneous-articular form of systemic lupus erythematousus and euro 1500.7 for patients with visceral forms. From the second year on, the annual cost was euro 261 for patients with the cutaneous-articular form and euro 534.7 for patients with visceral forms. Sixteen of the 25 patients were regularly re-examined as outpatients. Nine patients were lost to follow-up including 5 during the first year, 3 during the second year, and 1 during the third year. Two deaths occurred due to chronic renal failure and septic shock. This study shows that long-term follow-up for systemic lupus erythematosus in Gabon is difficult due to patient dropout.