How to Diagnose Early 5-Azacytidine-Induced Pneumonitis: A Case Report.

Interstitial pneumonitis is a classical complication of many drugs. Pulmonary toxicity due to 5-azacytidine, a deoxyribonucleic acid methyltransferase inhibitor and cytotoxic drug, has rarely been reported. We report a 67-year-old female myelodysplastic syndrome patient treated with 5-azacytidine at the conventional dosage of 75 mg/m2 for 7 days. One week after starting she developed moderate fever along with dry cough and subsequently her temperature rose to 39.5 °C. She was placed under broad-spectrum antibiotics based on the protocol for febrile neutropenia, including ciprofloxacin 750 mg twice daily, ceftazidime 1 g three times daily (tid), and sulfamethoxazole/trimethoprim 400 mg/80 mg tid. High-resolution computed tomography of the chest disclosed diffuse bilateral opacities with ground-glass shadowing and pleural effusion bilaterally. Mediastinal and hilar lymph nodes were moderately enlarged. polymerase chain reaction for Mycobacterium tuberculosis, Pneumocystis jiroveci, and cytomegalovirus were negative. Cultures including viral and fungal were all negative. A diagnosis of drug-induced pneumonitis was considered and, given the negative bronchoalveolar lavage in terms of an infection, corticosteroid therapy was given at a dose of 1 mg/kg body weight. Within 4 weeks, the patient became afebrile and was discharged from hospital. Development of symptoms with respect to drug administration, unexplained fever, negative workup for an infection, and marked response to corticosteroid therapy were found in our case. An explanation could be a delayed type of hypersensitivity (type IV) with activation of CD8 T cell which could possibly explain most of the symptoms. We have developed a decision algorithm in order to anticipate timely diagnosis of 5-azacitidine-induced pneumonitis, and with the aim to limit antibiotics abuse and to set up emergency treatment.

Implementation of a national external quality assessment program for medical laboratories in Burkina Faso: challenges, lessons learned, and perspectives.

OBJECTIVES: The National External Quality Assessment (NEQA) program of Burkina Faso is a proficiency testing program mandatory for all laboratories in the country since 2006. The program runs two cycles per year and covers all areas of laboratories. METHODS: All panels were validated by the expert committee before dispatch under optimal storage and transport conditions to participating laboratories along with report forms. RESULTS: Performance in the last 5 years varied by panel, with average annual performance of bacteriology panels for all laboratories rising from 75% in 2006 to 81% in 2010 and with a best average performance of 87% in 2007 and 2008. During the same period, malaria microscopy performance varied from 85% to 94%, with a best average performance of 94% in 2010; chemistry performance increased from 87% to 94%, with a best average annual performance of 97% in 2009. Hematology showed more variation in performance, ranging from 61% to 86%, with a best annual average performance of 90% in 2008. Average annual performance for immunology varied less between 2006 and 2010, recording 97%, 90%, and 95%. Except for malaria microscopy, annual performances for enrolled panels varied substantially from year to year, indicating some difficulty in maintaining consistency in quality. CONCLUSIONS: The main challenges of the NEQA program observed between 2006 to 2010 were funding, sourcing, and safe transportation of quality panels to all laboratories countrywide.

[National External Quality Assessment for medical biology laboratories in Burkina Faso: an overview of three years of activity]. / Contrôle national de qualité des laboratoires d'analyses de biologie médicale du Burkina Faso: bilan de trois années d'activités.

We report results of the National External Quality Assessment for (NEQA) laboratories in Burkina Faso, a country with limited resources located in West Africa whose epidemiology is dominated by infectious diseases. The national laboratory network consists of 160 laboratories including 40 private. The Government of Burkina Faso has adopted a national laboratory policy. One of the objectives of this policy is to improve the quality of laboratory results. One of the strategies to achieve this objective is the establishment of a NEQA. The NEQA is a panel testing also called proficiency testing. It is mandatory for all laboratories to participate to the NEQA. The NEQA is organized twice a year and covers all areas of laboratories (bacteriology-virology, biochemistry, hematology, parasitology and immunology). The review of three years of activity (2006-2008) shows the following results: (1) for microscopic examination of bacteria after Gram staining, the error rate decreased from 24.7% in 2006 to 13.1% in 2007 and 13% in 2008; (2) errors rate in reading slides for the microscopic diagnosis of malaria were 23.4%, 14.6% and 10.2% respectively in 2006, 2007 and 2008; (3) for biochemistry, the percentages of unsatisfactory results were respectively 12.5%, 14.8% and 13.8% in 2006, 2007 and 2008 for the overall parameters assessed. The analysis of the results generated by the laboratories during these three years shows a quality improvement. However, the NEQA should be strengthened through ongoing training and quality control of reagents and equipment.

[Causes of iron-deficiency anaemia in the internal medecine department of the national teaching hospital of Ouagadougou]. / Les étiologies des anémies ferriprives dans le service de médecine interne du centre hospitalier universitaire Yalgado-Ouédraogo de Ouagadougou.

This retrospective study in the internal medicine department of the national teaching hospital of Ouagadougou was conducted to identify the main causes of iron-deficiency anaemia. Among the 65 subjects meeting the inclusion and exclusion criteria, mean haemoglobin was 7.5 g/dl, with mean serum ferritin 8.9 microg/l among women and 15.5 microg/l among men. The most common cause was chronic blood loss, and hookworm was a major cause in 19.6% of cases. These results suggest the need for preventive measures against iron deficiency and for reinforcement of the fight against diseases producing fecal blood loss.

[Types of anaemia in patients with cirrhosis at the Yalgado Ouedraogo hospital centre of Ouagadougou (Burkina Faso)]. / Les différents types d'anémie au cours des cirrhoses au Centre hospitalier universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso).

During chronic diseases, patients may develop a specific form of anaemia called "inflammatory anaemia" or anaemia of chronic disease. The objective of this study was to study the forms of anaemia during cirrhosis. The leading cause of cirrhosis in these 161 patients was chronic active (viral) hepatitis, accounting for 58.3% of cases. The overall prevalence of anaemia was 74.5%. All types of anaemia were observed. Normochromic normocytic anaemia was observed in 43.3%, combined with blood loss in 48%. These results show that the hypochromic microcytic anaemia observed in 20% of cases is not exclusively linked to blood loss or iron deficiency. They also emphasise the importance of the haemogram interpretation to avoid routine iron prescription.

[Vaccination status of children with sickle cell disease in Ouagadougou (Burkina Faso)]. / Evaluation du statut vaccinal de l'enfant drépanocytaire de la ville de Ouagadougou (Burkina Faso).

Because of the importance of preventive activities in fighting sickle cell disease, we sought to assess the vaccination status of children with this disease in Burkina-Faso. This cross-sectional study used a questionnaire to collect information from outpatients of the pediatric department of the Yalgado Ouédraogo hospital center and of Saint Camille medical center, also in Ouagadougou, from October 2005 through March 2006. The study included 122 children, 52.5% of whom had an SC phenotype. Coverage for vaccinations included in the WHO expanded vaccination programme was 97.5%. For other specific vaccines, coverage varied from 5.7% for the anti-Haemophilus influenzae vaccine to 65.8% for the 23 pneumococci included in pneumo23. The major reasons for non-vaccination were ignorance and the prohibitive cost of these vaccines for the families who knew about them. These results suggest the need for a national program against sickle cell disease, which should enable treatment centers to include in their preventive activities a specific vaccination program. Only in this way can we reduce the mortality rates among those younger than 5 years by 40% by 2015, the goal of the International Organization against sickle cell disease, to which Burkina-Faso belongs.

[What is your diagnosis? Hypochromic microcytic anemia with Evans syndrome or autoimmune thrombocytopenic purpura?]. / Quel est votre diagnostic? Anémie microcytaire hypochrome révélatrice d'un syndrome d'Evans ou purpura thrombopénique auto-immun?

We report a case of Evans syndrome associated with scleroderma in a 50-year-old woman admitted to the department of internal medicine of Yalgado Ouedraogo National Teaching Hospital in Burkina Faso. The interest of this case lies in on its mode of revelation: chronic bleeding that led to hypochromic microcytic anemia. The indirect antiglobulin test was positive. Corticosteroid treatment has been successful. Nonetheless, because autoimmune cytopenia may indicate underlying disorders, particularly lymphoid tissue malignancies, rigorous monitoring of this patient is essential.

[Maternal and neonatal iron status in Ivory Coast]. / Métabolisme du fer et valeurs érythrocytaires du nouveau-né ivoirien: relation avec le statut en fer de la mère.

Despite the high prevalence of neonatal anemia in Côte d'Ivoire, complete blood counts and iron studies have not been adequately explored. The authors studied complete blood counts (from peripheral blood mononuclear cells), hemoglobin electrophoresis results, and serum iron, ferritin and transferrin levels in 40 newborns and their mothers. The neonatal results (mean +/- SD) were: hemoglobin: 14.96 +/- 2.24 g/dl; serum iron: 16.88 +/- 7.29 micromol/l; total iron-binding capacity (TIBC): 39.88 +/- 14.85 micromol/l; transferrin: 2 +/- 0.65 g/l; ferritin: 116.20 +/- 105.25 microg/l; and hemoglobin electrophoresis: 22.5% of infants showed some hemoglobinopathy (FAC, FAS, FSA(2)). Maternal serum iron levels were positively correlated with the newborns' TIBC (r = 0.362, p<0.05), maternal ferritin with neonatal transferrin (r = 0.374, p<0.05), maternal transferrin coefficient of saturation (CS) with neonatal TIBC (r = 0.554, p<0.01). These results suggest a high prevalence of iron deficiency in mothers and a consequent potential risk of iron deficiency in their newborns in the absence of iron supplementation.