Department Of Tropical Diseases Research Articles

The clinical, subclinical characteristics and treatment result of meningitis patients at Thai Nguyen National Hospital

Introduction: Meningitis is a devastating disease with a high case fatality rate, which can lead to serious long-term sequelae if not timely diagnosed, and treated.Objectives: Describing on the clinical, subclinical characteristics and analysing some factors related to the treatment results in meningitis patients at Thai Nguyen National Hospital.Methods: A cross-sectional descriptive study was conducted on 48 meningitis patients were treated at the Department of Neurology and Department of Tropical Diseases at Thai Nguyen National Hospital.Results: The average age of patients in the study was 43.27±15,31 (year); The percentage of male patients was 75,0%. The most common clinical symptom was headache (89.6%), fever (75%); The average white blood cell count in the CSF on admission was 509.92±681.27 (cells/ml) and at discharge was 94.42±102.60 (cells/ml); Protein in CSF on admission was 1.70±1.45 (g/L) and at discharge was 0.72±0.55 (g/L). The everage day of treatment was 12.57.Conclusion: The popularr symptoms of patients with bacterial meningitis are headache, fever, vomiting, nausea, constipation, and stiff neck. There was no relationship between age, gender, white blood cell count and white blood cell count in the CSF at admission to the number of treatment days in meningitis patients.

Study the factors associated with mortality in sepsis adult patients at Hue Central Hospital 2021 - 2022

Background: Sepsis has a high risk of death. Diagnosing and prognosing sepsis in the early stage play an important role, helping to reduce mortality and shorten the time of hospital stay of patients. Aims: Study the factors associated with mortality in sepsis adult patients. Materials and method: 110 patients over 15 years old were diagnosed with sepsis, at the Department of Tropical Diseases and Intensive Care Unit, Hue Central Hospital from 1/2021 to 12/2022. Tracked cross-sectional descriptive study. Results: The median age of sepsis patients was 66.4 ± 17.5. Male/female: 62/48. The duration of onset of the disease was about 4 days. The average length of hospital stay was 2 weeks. The rates of septic shock and multi-organ failure were 32.0% and 35.5%, respectively. The mortality rate was 20.0%. The heart, liver, respiratory, and kidney are the organs with the highest rates of dysfunction. There was a statistically significant difference in the time of hospital stay and the number of dysfunction organ, serum urea and creatinine between the two groups of death and survivors (p < 0.01). The SOFA score of patients who died gradually increased compared to the SOFA score at the admission, the survivors had a decrease in SOFA scores over time. Conclusion: The majority of sepsis patients > 60 years old (66.4%), the proportion of males was higher than females. The rates of septic shock and multiple organ failure were 31.8% and 35.5%, respectively. The mortality rate was 20.0%. The heart, liver, respiratory, and kidney are the organs with the highest rates of organ failure. Factors that were independently associated with mortality in sepsis patients were time of hospital stay, serum creatinine, and SOFA_T24. Key words: Sepsis, prognostic factor, mortality.

Severe Malaria and Risk Factors for Death in the Infectious Diseases Department of the University Hospital of Fann in Dakar, Senegal

Aim: The aim of this study was to describe the epidemiological, clinical, paraclinical and outcome aspects of severe malaria and to determine the risk factors for death.
 Methodology: This was a retrospective descriptive and analytical study of patients treated for severe malaria at the infectious and tropical diseases department of the University Hospital center of Fann between January 1, 2019 and December 31, 2021. Multivariate logistic regression was used to identify risk factors for death 
 Results: During our study, 138 patients were hospitalized for severe malaria over a period of 3 years, with a peak in the months of october and november. They were mostly from urban areas (68.11%). The average consultation time was 6.7 days ± 7.1 days. There was a clear male predominance, with a sex ratio of 3.18. The average age of patients was 33.96 ± 17 years. The main signs of clinical severity were coma (44.2%), prostration (36.95%) and jaundice (61.5%). Biological signs included anaemia (14.49%) and renal failure (9.42%). Severe malaria was associated with SARS Cov 2 infection in 4 patients. All patients were treated with injectable artesunate. The average length of hospitalization was 6 ± 6 days. Case fatality was 10.7. In multivariate analysis, coma (ORa =12.29 IC95%: 2.0 - 73.22 P=0.006) and severe anaemia (ORa=27.16 IC95%: 3.4 - 217.18 P=0.006) were risk factors associated with death.
 Conclusion: Early recognition of the signs of seriousness and their early management thanks to improved technical facilities in intensive care units can improve the prognosis of patients.

Knowledge and Attitudes towards HIV and HCV among the Population Attending the Fast-Track Cities Mobile Unit in Brescia, Italy.

The Infectious and Tropical Diseases Department of the University of Brescia organized free rapid screening tests for HIV and HCV as part of the Fast-Track City commitment. A cross-sectional study was conducted, consisting of an anonymous multiple-choice questionnaire that was administered to individuals who underwent the screening or consultation. The study aimed to compare knowledge and attitudes towards HIV and HCV between age groups (18-40 vs. >40) and sexual orientations (heterosexual vs. LGBTQ+). Overall, 333 questionnaires were completed. Overall, only 107 (32%) of respondents knew how HIV is transmitted. Major differences were shown between different age groups, where people under the age of 40 had a significantly higher correct response rate than people over 40 (n = 101; 39% versus n = 6; 7.8%, p < 0.00001). Similarly, almost half of LGBTQI+ people (n = 28; 44.4%) gave the correct answer, versus 30% (n = 79) of heterosexuals (p = 0.0359). Only 9.6% of the population demonstrated high levels of knowledge for both HIV and HCV. Our study highlights that misconceptions about HIV and HCV should be addressed in prevention and education programs, whose target should also be specific populations.

Targeted Pharmaceutical Analysis of Antibiotic Use by Risk Criteria in Patients Hospitalized in the Infectious and Tropical Diseases Department at Treichville Teaching Hospital (Abidjan, Côte d'Ivoire)

Introduction: Most pharmacotherapeutic problems in hospitals are caused by anti-infectives. Audit of prescriptions by a clinical pharmacist is a control and prevention element for iatrogenic risks. Objective: The main aim of our study was to assess the use of antibiotics according to risk criteria in patients hospitalized in the infectious diseases Unit of the Treichville Teaching Hospital (Abidjan, Ivory Coast). Methods: This cross-sectional descriptive study conducted from August to December 2022 in the Infectious and Tropical Diseases department of the Treichville University Hospital aimed to analyze the use of antibiotics in patients with risk criteria. The tools for detecting pharmacotherapeutic problems allowed us to evaluate the frequency and nature of pharmaceutical interventions, highlighting the role of the pharmacist in patient management. Data were analyzed using SPSS version 20.0 software (IBM, USA). Results: A total of 88 patients were included in the study, with a majority of singles (54.5%) and a predominance of subjects under 45 years of age (87.6%) and HIV-positive (93.2%). Antibiotics were the most frequent treatment (75.1%), followed by beta-lactams (36.7%). The main drug interactions were precautions for use (53.6%) and contraindicated associations (45.6%), especially the combination of Ofloxacin with bivalent cations or didanosine. The main pharmaceutical interventions proposed were monitoring of biological parameters in at-risk patients (68.8%) and drug substitution (14.8%). All proposed pharmaceutical interventions were accepted by prescribers. Risk criteria associated with the use of antibiotics were significantly associated with the nature of proposed pharmaceutical interventions. Conclusion: In conclusion, the use of antibiotics in patients with risk criteria is common in the Infectious and Tropical Diseases department of the Treichville University Hospital. The results emphasize the importance of prescription audit by a clinical pharmacist in detecting pharmacotherapeutic problems and preventing iatrogenic risks. The proposed pharmaceutical interventions were accepted by prescribers and were tailored to the risk criteria associated with the use of antibiotics.

Tetanus, an infectious disease still topical in Lome (Togo)

Tetanus still remains a public health problem in Togo despite the existence of the Expanded Program on Immunization. A retrospective and descriptive cohort study was performed from January 1, 2008 to December 31, 2018 in the infectious and tropical diseases department of Sylvanus Olympio teaching hospital of Lome (Togo) on tetanus cases. We included 208 tetanus cases accounting for 6.5% of the whole hospitalizations in the infectious and tropical diseases department at this hospital. The median age of the patients was 23 [13-38 years] with male predominance (81.2%). The patients were workers (63.5%) and came mainly from urban areas (65.9%). Tetanus vaccination was only up to date in 9.3% of patients. Gateways were dominated by skin wounds (66.8%). Antitetanus serum was administered in 191 patients (91.8%) mainly through intrathecal route (189 patients (91.1%)). Complications were marked by superinfection of the wound (n=8), septic shock (n=3), acute respiratory failure and skin necrosis in 1 case respectively. The lethality was 27.4%. The morbidity of tetanus, in particular juvenile morbidity, remains high with significant lethality. It is therefore important to place particular emphasis on the vaccine booster component.

Characteristics, Management, and Outcomes of Bacterial Dermohypodermatitis at the Infectious and Tropical Diseases Department of Fann University Hospital, 2016-2020

Recent trends show a clear increase in cases of bacterial dermohypodermatitis (BDH) worldwide. According to some authors, this upsurge is linked to an increase in risk factors, particularly depigmentation. In Senegal, all data relating to BDH come from dermatology departments. The objective of this study was to describe the characteristics, management, and outcomes of dermohypodermatitis at the Infectious and Tropical Diseases Department (SMIT) of Fann hospital. This was a retrospective study conducted at the SMIT. The study population consisted of all patients hospitalized in the department for BDH from 2016 to 2020. We recorded 54 cases of BDH, representing a hospital frequency of 1.29%. The sex ratio (M/F) was 0.42. The median age was 46.5 years [17-85 years]. The most factor of BDH, was depigmentation (31.48%). BDH was localized to the lower limbs in 81.48%. Pain (96.30%), inflammatory swelling (92.59%), and erythematous placard (85.19%) were the main physical symptoms. Blood cultures were positive for Staphylococcus aureus, and Staphylococcus saprophyticus. Cytobacteriological examinations of fluid from ruptured phlyctens isolated Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter spp, Escherichia Coli, and Acinetobacter Spp. Deep vein thrombosis (DVT) was found in 4 patients (13.79%). Complications were present in 18 patients (33.33%). We recorded 5 deaths, representing a lethality rate of 9.26%. Depigmentation has become a major risk factor. Women need to be educated about the harmful effects associated with this practice.

Retrospective analysis of a cohort of HIV-infected patients on antiretroviral therapy in Abidjan (2003 to 2017)

Background: Antiretroviral therapy (ART) has been successful in improving clinical outcomes for HIV-positive patients, but efforts are needed to improve life expectancy and quality of life. This study aimed to analyze a long-term ART cohort and assess patients' life expectancy. Methods: A retrospective cohort study was conducted at the infectious and tropical diseases department of the University Teaching Hospital of Treichville from 2003 to 2017. Data analysis was done using VBA access and XLSTAT 2018 excel software. Patients on post-exposure chemoprophylaxis and prevention of mother-to-child transmission were excluded. Results: Out of 19,567 patient records, 49.60% were included, 72.43% were in 1st line, and 50.10% were over 50 years old, mostly female 58.49%, 98.4% HIV1. 74.31% had a CD4/mm3 (Nadir) count &lt;350. The patients were essentially on the 2IN+INN regimen (72.31%), TDF + XTC + EFV (20.57%). The average duration under treatment 6.15 [0-13.67] ±3.94 years, the average duration under a line of treatment 4.33 [0-14.04] ±2.96 years. Life expectancy was 10.37 years. It is higher in patients on 2IN+IPr (12.21 years) versus 10.12 years in patients on 2IN+INN. The comparison of duration on a line according to the CD4 counts and the line of treatment did not show a significant difference p&gt;0.05. Conclusions: The study concluded that ART significantly improved the life expectancy of patients, adherence could be improved to further enhance the benefits of ART. The use of new combinations of ART may reduce events related to non-compliance.

EVALUATION OF QUICK SOFA IN DIAGNOSIS AND PROGNOSIS OF SEPSIS PATIENTS TREATED AT HUE CENTRAL HOSPITAL (4/2018 - 3/2020)

Background: Sepsis is a life - threatening organ dysfunction. Previous consensuses defined sepsis as infection with systemic inflammation response syndrome (SIRS). The new 2016 consensus selected SOFA and Quick SOFA instead of SIRS in diagnosing sepsis. &#x0D; Objectives: 1. Describe clinical and subclinical characteristics of patients with sepsis. 2. Compare qSOFA and SIRS in the diagnosis and prognosis of the outcome of patients with sepsis. Subjects and method: Patients were diagnosed with sepsis based on the definition Sepsis - 2 (2001) or Sepsis - 3 (2016), treated at the Intensive Care Unit and the Department of Tropical Diseases, Hue Central Hospital. A prospective study.&#x0D; Results: There were 59 selected patients. The mean age was 60.22 ± 18.19 (28 - 90). Coagulation and cardiovascular dysfunction in patients with sepsis were the most common (61%), followed by kidneys (54%) and CNS (51%). Results of treatment: 44.1 % of patients had a septic shock; 28.8% died. In all patients, qSOFA ≥ 2 achieved rate was lower than SIRS ≥ 2 (72.9% compared to 98.3%). qSOFA0 had a high value in predicting ICU admission and had statistically significantly higher when compared to SIRS0. qSOFA0 had mean value in predicting in septic shock and had significantly higher when compared to SIRS0. qSOFA had a high value in predicting hospital mortality and had significantly higher when compared to SIR 0. &#x0D; Conclusion: SIRS is more noted than qSOFA in patients with sepsis. qSOFA0 has higher value than SIRS 0 in predicting ICU admission and hospital mortality in patients with sepsis.

Neuromeningeal cryptococcosis in an HIV-negative patient with pulmonary tuberculosis in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako, Mali

Neuromeningeal cryptococcosis and pulmonary tuberculosis are respectively serious mycotic and bacterial infections occurring in a subject regardless of its HIV serological status. We report here a case of neuromeningeal cryptococcosis associated with pulmonary tuberculosis and malnutrition in an HIV-seronegative patient with a CD4 count of 750/mm3, to highlight some particularities opposed to certain literatures. This is an 18-year-old patient, housewife, from Bamako, admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako on March 13, 2022 for fever and impaired consciousness. Her symptomatology appears to have gradually set in over a month, preceded by headache resistant to paracetamol, jet vomiting and irregular dry cough, initially treated with ceftriaxone, artesunate and paracetamol for confirmed malaria and suspicion of bacterial meningitis before admission. In whom no known medical-surgical history, no use of topical corticosteroids, no immunosuppressive therapy, no alcohol or tobacco, and no immunosuppressive pathology was found. The diagnoses of neuromeningeal cryptococcosis, pulmonary tuberculosis and undernutrition were retained in view of clinical and microbiological arguments. Diabetes, sickle cell disease, viral hepatitis B and C, kidney failure and cancer, which are immunosuppressive pathologies, were not found. She was successfully treated with first-line oral antituberculous drugs and fluconazole infusion. Three interests are drawn from this clinical case: neuromeningeal cryptococcosis is not only the prerogative of HIV-positive subjects, a high CD4 count does not always mean immunocompetence and fluconazole is an effective therapeutic alternative for neuromeningeal cryptococcosis.

STUDY ON THE EFFECT OF NAC IV IN ACUTE EPISODE OF LIVER DYSFUNCTIONS

Objectives: Evaluate the effectives and safety of IV NAC in acute episode of liver dysfunctions patient treated in Huunghi Viet Tiep Hospital.Material and methods: 31 patients treated in Tropical Diseases Department of Huunghi Viet Tiep Hospital who had acute episode of liver dysfunctions from April 15th to July 15th. &#x0D; Before-after study, compare the results before and after treatment. Beside the original treatment followed the hospital’s guideline, selected patients were received N-acetylcystein IV 100 mg/kg/24h in glucose 5% for 7 days. Patients had health check every day and liver function test was performed before treatment (D0) and on the 3rd and 7th day of treatment or the discharged date (D3 and D7).Results: After 7 days of treatment, the average value of ALT, AST, and GGT reduced from 626.1 ± 234.8 to 322.5 ± 121.1 (about 50%), from 495.4 ± 178.1 to 127.2 ± 76.5 (about 70%), and from 292.1 ± 88.5 to 227.9 ± 57.4, prospectively. There were 22 patients having high bilirubin value, and after 7 days of treatment, the average reduced 22%. 80.6% patients improved, the average hospital length of stay is 8.68 ± 2.97 days, no patient need for transplant. There was no severe adverse reaction or anaphylactic shock occurred.Conclusion: NAC IV was safe and effective in preventing the further progression of liver failure.

Prognostic factors for severity and mortality of sepsis patients in Hue Central Hospital 2018 - 2019

Background: Sepsis has a high risk of death from septic shock and dysfunction of many organs. Diagnosis and prognosis of patients in the early stage play a very important role, helping to reduce mortality and shorten the hospital stay of patients. Aims: Study some factors for severity and mortality of sepsis adult patients. Subjects and methods: 84 patients over 15 years old were diagnosed with sepsis, treated at the Department of Tropical Diseases and Intensive Care Unit, Hue Central Hospital during the period from April 2018 to June 2019. A cross-sectional study. Results: Lactate concentrations within 24 hours of admission had a good severe prognosis value with an AUC of 0.866 (p &lt; 0.001). PCT concentrations within 24 hours of admission had a good prognosis value with an AUC of 0.866 (p &lt; 0.001). Comorbidities, hospital infections, creatinine, PCT, blood lactate, and SOFA and APACHE II scores were factors associated with a severe prognosis in patients sepsis with an OR of 3.33 respectively; 5.39; 1.01; 1.05; 2.52; 4.16, and 1.36. SOFA and APACHE II scores at 24 hours post-admission had AUC of 0.982 and 0.876, respectively. The factors related to mortality are comorbidities, nosocomial infections and SOFA score at 24 hours after admission with OR 99.07, respectively; 7.66 and 2.02. Conclusion: Comorbidities, nosocomial infections, an increase in serum creatinine levels, an increase in PCT, blood lactate as well as increased SOFA and APACHE II scores are risk factors associated with severe prognosis in sepsis patients. The factors related to mortality are comorbidities, nosocomial infections and SOFA score at 24 hours after admission with OR 99.07, respectively; 7.66 and 2.02. Key words: Sepsis, prognostic factor.

Infectious Diseases with Epidemic Potential: A Retrospective Study from 2005 to 2014 in The Infectious and Tropical Diseases Department of The Point G University Hospital in Bamako, Mali

Infectious Diseases with Epidemic Potential: A Retrospective Study from 2005 to 2014 in The Infectious and Tropical Diseases Department of The Point G University Hospital in Bamako, Mali

The Reality of Medicine Use in the Department of Tropical Diseases at E hospital from 10/2019 to 3/2020

This paper analyzes the use of medicines in the Department of Tropical Diseases at E Hospital. The analysis shows that 100% of the medical records were completely and clearly filled out with the patient’s name, age, gender, address and clear information about the medicines, their concentrations and routes of administration. However, there were some deficiencies in administrative procedures, such as 7.75% of the medical records abbreviated the main diagnosis, 94.75% of them did not prescribe medicines according to their routes of administration. The average number of medicines per person per day was 5.04 and the average treatment time was 5.85 days. Notably, the percentage of the medical records with prescription of injectable medicines was remarkably high (98.75%).&#x0D; Keywords&#x0D; Medicine use, Department of Tropical Diseases, E hospital.&#x0D; References&#x0D; [1] N.T.T. Thuy, Analysis of the situation of medicines prescription for inpatient treatment at Military Medical Hospital 105 - General Logistics Department 2015, Specialized thesis I, 2015 (in Vietnamese).[2] N.T.P. Thuy, Analysis of of the situation of medicines prescriptions at the National Maternity Hospital in 2014, Master's thesis in pharmacy, 2015 (in Vietnamese).[3] M.A. Ghaleb, N. Barber, B. Dean Franklin &amp; I.C. Wong, What constitutes a prescribing error in paediatrics?, Qual Saf Health Care 14 (5) (2005) pp 352-357.[4] L.T. Duc, Analysis of medicines situation at Quang Nam Central General Hospital in 2013, Specialized thesis II, 2015 (in Vietnamese).[5] V.T. Sy, Analysis of the situation of medicines prescription at Ha Tinh General Hospital in 2016, Specialized thesis II, 2018 (in Vietnamese).[6] H.T.K. Dung, Analysis of medicines situation at Thai Nguyen Hospital C in 2014, Master's thesis in pharmacy, 2015 (in Vietnamese).[7] L.T.M. Hanh, Analysis of medicines indications for inpatient treatment at Nghe An General Hospital in 2015, Specialized thesis I, 2016 (in Vietnamese).[8] L.A. Tinh , Analysis of medicines situation for inpatient treatment at Huu Nghi - Nghe An General Hosptal in 2015, Specialized thesis I, 2015 (in Vietnamese).[9] P.L. Son, Analysis of the situation of the health insurance drug payment status , Pharmacy journal, vol 428 (2012) pp 12-16. (in Vietnamese).

Autism and COVID-19: A Case Series in a Neurodevelopmental Unit.

Background: COVID-19 has become pandemic and can impact individuals with autism as well. Here, we report a case series admitted to a neurobehavioral unit dedicated to challenging behaviors in patients with autism. Methods: We describe 16 patients (mean age 20.8 years; range 12–43 years; 76% male) with autism hospitalized between March 2020 and mid-April 2020 for challenging behaviors, for which COVID-19 disease has been suspected and who needed both psychiatric and medical care. A close cooperation with the Infectious and Tropical Diseases Department was organized to limit viral spread and training sessions (e.g., hygiene, clinical COVID-19 monitoring, virus testing) were given to staff members. Results: Most patients had severe autism and severe/moderate intellectual disability. Eleven patients were already in the unit when it was hit by the pandemic, and five were admitted from the community. Based on a virus search via reverse transcriptase polymerase chain reaction (RT-PCR) or serology at the 2-month follow-up, we had 11 confirmed COVID-19 cases. The main COVID-19 symptoms included benign upper respiratory infection signs (N = 9, 81.8%), diarrhea (N = 7, 63.6%), fatigue (N = 7, 63.6%), and respiratory signs (N = 5, 45.5%), including one patient who needed oxygen therapy. Three patients remained asymptomatic and COVID-19-free (including two under immunosuppressive treatments). Among the symptomatic patients, five showed atypical behaviors that we understood as idiosyncratic manifestations (e.g., irrepressible licking behavior). On day 14, only one patient with respiratory dysfunction still had a positive RT-PCR SARS-CoV-2 test. Conclusions: Organizing a COVID+ unit for patients with autism is realistic and requires close collaboration with infectologists. We believe that this initiative should be promoted to limit both the spread of the virus and the ostracism of patients with autism and challenging behaviors.

Evaluation of CD44 and CD133 as markers of liver cancer stem cells in Egyptian patients with HCV-induced chronic liver diseases versus hepatocellular carcinoma.

BackgroundCancer stem cells (CSCs) play a critical role in tumor development, progression, metastasis and recurrence.AimTo evaluate hepatic expression of CD44 and CD133 in Egyptian patients with HCV-induced chronic liver diseases and hepatocellular carcinomas (HCCs), and to assess its correlation with inflammatory activity scores, stages of fibrosis (in chronic hepatitis with or without cirrhosis) and grades of HCC.MethodsThis prospective case-control study was conducted on eighty subjects who attended the Tropical Diseases Department, Al-Azhar University Hospital, and in collaboration with Theodor Bilharz Research Institute (2014–2016). They were divided as follows: A) Control healthy group: Ten individuals with serologically negative HCV-Ab and HBsAg, and histopathologically normal liver, B) Seventy patients subdivided into 3 groups; Twenty subjects each, as: HCV-Ab+ non-cirrhotic, HCV-Ab+ cirrhotic and HCC. Necroinflammatory activity and fibrosis in non-neoplastic liver biopsies were scored according to the METAVIR scoring system. CD44 and CD133 immunostaining was evaluated in all groups semi-quantitatively using H score. Statistical analysis was performed by SPSS version 22, using independent-samples t-test.ResultsOur study showed a significant increase of mean CD44 & CD133 expression values with disease progression among the groups (p<0.05). Their expressions increased significantly with the inflammatory activity scores and stages of fibrosis, reaching the highest values in A3F4 score compared to A1F1 (p<0.05). Moreover, there was a significant increase of their expressions across HCC grades (p<0.05), however with no significant correlation with focal lesions size.ConclusionCSCs clusters exhibiting CD133+ and/or CD44+ profiles were identified in chronic hepatitis, liver cirrhosis and HCC. CD133 and CD44 expressions significantly corresponded to the increased inflammatory activity, fibrosis stages and higher tumor grades. Therefore, evaluation of CD44 and CD133 expression profiles as CSCs markers in non-neoplastic liver and HCCs can help in development of novel therapeutic agents for HCC targeting and prevention.

CPC-064 How is It Best to Report Pharmaceutical Interventions to a Medical Team? A Clinical Relevance Assessment

BackgroundThe clinical pharmacy department has recently started working with the medical team of the infectious and tropical diseases department. A pharmacy student, supervised by a clinical pharmacist, cheques 28 patient...

Tuberculosis en pacientes con diabetes mellitus: Un estudio epidemiológico y clínico en el Hospital Nacional Cayetano Heredia.

Objetivo: Describir las características epidemiológicas y clínicas de pacientes diabéticos con tuberculosis atendidos en el Hospital Nacional Cayetano Heredia (HNCH). Material y Métodos: Estudio retrospectivo, observacional, descriptivo. Se identificaron los “casos” (pacientes diabéticos con TBC) revisando los registros del Servicio de Endocrinología, Servicios de hospitalización de Medicina y del Departamento de Enfermedades Infecciosas y Tropicales del HNCH atendidos durante el periodo de 1997 al 2003. Resultados: Se encontraron 85 episodios de TBC en 74 historias clínicas revisadas. El promedio de edad fue de 49,4 +12,8 años; 48/74 (65%) fueron hombres y 26/74 (35%) mujeres. 72/74 (97,3%) pacientes presentaron diabetes mellitus tipo 2. El tiempo promedio de enfermedad diabética previo al desarrollo de TBC fue de 4.2 +4 años. 75/85 (88,2%) episodios presentaron TBC pulmonar, habiendo confirmación bacteriológica en el 51,3% de estos casos. 59/85 (69%) casos no cumplían regularmente con el tratamiento indicado para la diabetes y 60/85 (71%) tenían mal control metabólico al desarrollar TBC. 31/74 (42%) pacientes fueron hospitalizados por TBC, asociándose cetoacidosis diabética (CAD) en el 51,4% de las hospitalizaciones por esta causa. La TBC puede ser causa importante desencadenante de CAD en nuestro medio. La tasa de fracasos al tratamiento fue de 15/85 (17,6%); hubo sospecha de TB-MDR en 13/74 pacientes (17,6%). La tasa de recaídas fue de 15/74 (20,3%). Fallecieron 3/74 pacientes (4%) durante el período de estudio. Conclusiones: Pacientes diabéticos mal controlados desarrollan TBC con una elevada tasa de recaídas, fracasos y TB-MDR, con alta sospecha de contagio intrahospitalario.

Cryptoccocal meningitis and HIV in the era of HAART in Côte d’Ivoire

ObjectiveThe authors had for aim to describe the management of cryptococcal meningitis in HIV infected adults, in Ivory Coast. Patients and methodsA retrospective study was made from January 1, 2005 to December 31, 2008 on the files of consecutive hospitalized patients presenting with cryptococcal meningitis, at the Treichville University Hospital, Infectious and tropical diseases department (Abidjan). The socio-demographic, clinical, and biological aspects as well as the outcome were analyzed. ResultsEighty patients presenting with cryptococcal meningitis, (2.6% of hospitalized patients) were included: 41 men (51.25%) and 39 women (48.75%); mean age: 40 years (range 26 to 58 years). The delay before consultation was 5.4 days, range 2–12 days). The mains symptoms were headache (83.7%), fever (63.7%), and consciousness disorders (60%). Meningo-encephalitis accounted for 75% of the clinical presentations; 54 patients (67.5%) were naive of antiretroviral treatment (mean CD4: 45/mm3 (range 5–103/mm3), while 26 (32.5%) had received antiretrovirals before presenting with cryptococcal meningitis (Nadir CD4=81/mm3). Amphotericin B relayed by fluconazole was prescribed to 86.2% of the patients, associated with a therapeutic lumbar puncture for 30 patients. The death rate was 41.2%. ConclusionIn spite of antiretroviral treatment availability in Ivory Coast, cryptococcal meningitis remains frequent with a high death rate. This study stresses the importance of early management to improve the prognosis.

Patient education for HIV-infected patients: a tool for success

BackgroundPatient education (PE) is a discipline supported by the current legislation in France. A PE programme has been set up at Tenon Hospital (Paris, France) by pharmacists and nurses for...