Objectif : Décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la tuberculose pulmonaire en milieu carcéral au Niger. Il s’agissait d’une étude transversale réalisée ...sur 3ans incluant tous les cas confirmés de tuberculose pulmonaire à microscopie positive (TPM+), les co-infections VIH/ tuberculose et les cas de tuberculose pulmonaire à microscopie négative (TPM-). Résultats : Au total 3322 étaient détenus avec une prévalence de la tuberculose de 0,84%. Tous les patients étaient des hommes. La moyenne d’âge était de 36 ans avec des extrêmes allant de 21 à 62 ans. 17,85% exerçaient dans le secteur informel.35, 71% provenaient des milieux urbains. Sur le plan juridique 71,48% des patients étaient des condamnés et 36% des patients avaient une durée de détention de plus de 3ans au moment du diagnostic. La triade faite de toux (100% de cas) –fièvre (92,85% de cas) -expectoration (67,85% de cas) dominait le tableau clinique. L’amaigrissement (46,42% de cas) et la cachexie (42,46% de cas) constituaient l’essentiel des signes généraux. Le taux de co-infection VIH/SIDA- tuberculose s’élevait à 21,42%. Sur le plan thérapeutique 82,14% des patients étaient de la catégorie 1. 53,56% des patients avaient fait l’objet d’une hospitalisation tandis que 46,44% avaient observé le traitement selon un mode ambulatoire. La guérison était de 46,42% de cas, le décès était 28,53 %. Conclusion : Des mesures préventives et thérapeutiques efficaces sont indispensables en milieu pénitencier.
Besides inclusion in 1st line regimens against tuberculosis (TB), pyrazinamide (PZA) is used in 2nd line anti-TB regimens, including in the short regimen for multidrug-resistant TB (MDR-TB) patients. ...Guidelines and expert opinions are contradictory about inclusion of PZA in case of resistance. Moreover, drug susceptibility testing (DST) for PZA is not often applied in routine testing, and the prevalence of resistance is unknown in several regions, including in most African countries.
Six hundred and twenty-three culture isolates from rifampicin-resistant (RR) patients were collected in twelve Sub-Saharan African countries. Among those isolates, 71% were from patients included in the study on the Union short-course regimen for MDR-TB in Benin, Burkina Faso, Burundi, Cameroon, Central Africa Republic, the Democratic Republic of the Congo, Ivory Coast, Niger, and Rwanda PZA resistance, and the rest (29%) were consecutive isolates systematically stored from 2014-2015 in Mali, Rwanda, Senegal, and Togo. Besides national guidelines, the isolates were tested for PZA resistance through pncA gene sequencing.
Over half of these RR-TB isolates (54%) showed a mutation in the pncA gene, with a significant heterogeneity between countries. Isolates with fluoroquinolone resistance (but not with injectable resistance or XDR) were more likely to have concurrent PZA resistance. The pattern of mutations in the pncA gene was quite diverse, although some isolates with an identical pattern of mutations in pncA and other drug-related genes were isolated from the same reference center, suggesting possible transmission of these strains.
Similar to findings in other regions, more than half of the patients having RR-TB in West and Central Africa present concomitant resistance to PZA. Further investigations are needed to understand the relation between resistance to PZA and resistance to fluoroquinolones, and whether continued use of PZA in the face of PZA resistance provides clinical benefit to the patients.
Abstract Background Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal cancer, but is not complication-free. Aims To evaluate the incidence of early and ...delayed polypectomy complications and factors associated with their occurrence in a community setting. Methods Web-database collection of patients’ and polyp's features in consecutive colonic polypectomies during a 3-month period in 18 endoscopy centres. Results Data on 5178 polypectomies in 2692 patients (54.3% males, mean age 59 years) were collected. The majority of the polyps were <10 mm (83.5%). Antithrombotic agents were taken by 22.7% of patients, 57.3% of which withheld them before the procedure. Overall, 5 patients experienced perforations (0.2%) and 114 had bleeding (4.2%); the overall complication rate was 4.4%. Early complications were observed in 87 (3.2%); delayed complications (all major bleedings) occurred in 32 (1.2%). At multivariate analysis polyp size (size >10 mm: OR 4.35, 95% CI 5.53–7.48) and, inversely, right-sided location (OR 0.58, 95% CI 0.36–0.94) were correlated with bleeding events. The use of antithrombotics was associated with 5-fold increased risk of delayed bleeding. Conclusions In the community setting, polypectomy was associated with a 1.4% risk of major complications. Polyp size and, inversely, right-sided location were associated with early bleeding; the use of antithrombotics increased the risk of delayed events.
The microscopic detection of free peritoneal tumour cells in peritoneal lavage fluid in gastric cancer patients is a useful predictor of peritoneal recurrence and poor prognosis. The aim of this ...study was to verify the prognostic significance of intraoperative peritoneal lavage cytology and its value as a predictor of peritoneal recurrence. We evaluated the presence of free peritoneal tumour cells with extemporary cytological examination in a series of 170 peritoneal washing samples from patients undergoing gastrectomy for gastric cancer over the period from January 1992 to June 2001. Twenty-eight patients (16%) had positive extemporary lavage cytology and there were no false-negatives as compared with the final examination. All patients with positive cytology presented serosal infiltration (T3/T4). Positive peritoneal lavage cytology was a predictor of poor prognosis and peritoneal recurrence: the 24 month survival rate was 17% for positive and 60% for negative cases (P = 0.003); in positive cases 71% of recurrences were located in the peritoneum. Intraoperative cytological examination of peritoneal washings can detect the presence of free malignant cells in the peritoneal cavity and can be used to select patients who may benefit from intraperitoneal chemotherapy.
PDF
