Medecine tropicale et sante internationale最新文献

Tahiti or the "myth of Paradise", Bora Bora, "the Pearl of the Pacific". Who has never wanted to take a plane and come and land on the heavenly beaches of Polynesia, a French territory at the antipodes of mainland France lost in the middle of the Pacific? However, we do not imagine that 60% of Polynesians live below the metropolitan low-income threshold or that life expectancy is lower than that of the mainland due to the high prevalence of cardiovascular diseases with three quarters overweight population.In addition to non-transmissible metabolic diseases, various pathologies common to temperate countries present specificities in Polynesia, leading to sometimes different management and medical reasoning. Indeed, in Polynesia where the islands extend over an area of the size of Europe, delays in treatment are frequent and it can sometimes seem difficult to send sick patients back to their isolated island. Certain pathologies that were once common in France, such as acute rheumatic fever, are still prevalent there, while others, such as gout, are rarely seen elsewhere in terms of prevalence or severity. Even if the geographical distance has protected Polynesia from a number of tropical diseases including malaria or dangerous animals, this territory presents a range of varied infectious diseases including arboviruses, leptospirosis, tuberculosis and leprosy or angiostrongylosis. Skin infections are very common with their corollary of complications including endocarditis and osteoarticular infections. The sea, which is omnipresent, also poses certain dangers such as ciguatera poisoning and exposure to certain marine organisms.Care is provided according to current medical standards thanks to European-level resources allowing diagnostic and therapeutic possibilities that do not exist in other Pacific island states.The objective of this overview is to guide health care providers coming to or practicing in French Polynesia in their daily practice, but also practitioners taking care of people returning from Polynesia.

Introduction: The World Health Organization's (WHO) "test and treat" strategy has significantly increased the number of people living with HIV (PLHIV) who receive antiretroviral therapy (ART). This study aimed to evaluate the status of ART in Burkina Faso during this period.

Methods: A retrospective descriptive study was conducted in Plateau-Central, one of the country's 13 regions. We extracted annual data from 2018 to 2023 from the pharmaceutical dispensing database, which is used to monitor individuals receiving ART. We analyzed a trend in treatment initiation. Quantitative variables were described using the median and interquartile range, and qualitative variables were described using proportions.

Results: From 2018 to 2023, the proportion of people who started treatment each year compared to the number of people who tested positive increased from 25% to 100%. Among adults during this period, more than 70% were women. The median age at the start of treatment ranged from 35 years (28-44) to 32 years (25-44). The median treatment duration ranged from five years [2-8] to six years [3-12]. The proportion of adults with at least 95% ART dispensing coverage fluctuated, ranging from a maximum of 70% in 2020 to a minimum of 47% in 2023. The main treatment combination used in adults was TDF/FTC/EFV, accounting for 42% in 2018, 50% in 2019, and 38% in 2020. The TDF/3TC/EFV combination was dominant in 2021, accounting for 46%. In 2022 and 2023, the TDF/3TC/DTG combination was the most common, at 76% in 2022 and 91% in 2023. Among children, males were predominant (around 55%) from 2019 to 2022. The median age at treatmentinitiation ranged from two years [0-9] to four years [2-9], and the median treatment duration ranged from five years [2-8] to six years [3-12]. AZT/3TC/NVP was predominant from 2018 to 2021 (57%, 59%, 40%, and 40%), and ABC/3TC/DTG was predominant from 2022 (52% and 84%). From 2018 to 2023, the proportion of children with at least 95% ART dispensing coverage fluctuated, ranging from a maximum of 76% in 2019 to a minimum of 24% in 2023.

Conclusion: The proportion of people on ART has gradually increased since the WHO's "test and treat" recommendations. These results bring Burkina Faso closer to achieving the UNAIDS targets.

Introduction: Antisynthetases syndrome (AS) is a subgroup of inflammatory myopathy where myositis is associated to polyarthritis, interstitial pneumopathy, Raynaud's phenomenon, "mechanic's hands" skin lesions, and positive anti-aminoacyl-transfer RNA (tRNA) synthetase antibodies. Here, we present seven cases from Gabon.

Materials and methods: This retrospective descriptive study was conducted in the Internal Medicine Department at Libreville University Hospital from January 1, 1984, to December 31, 2023. The study aimed to identify all patients with documented AS and clarify its characteristics.

Results: Seven female patients with a mean age of 42.5 years were identified. The cardinal signs of AS were predominantly muscular (n = 7) and pulmonary (n = 5) with diffuse interstitial pneumopathy (n = 5). The patients experienced stage 2 (n = 3) to stage 3 (n = 2) dyspnea and cutaneous manifestations, including "mechanic's hands" (n = 4). Two patients were positive for Jo-1 antibodies, one for PL7 antibodies, and four for PL12 antibodies.

Discussion: AS poses a significant challenge to clinicians in sub-Saharan Africa due to the diffuse interstitial pneumonitis that accompanies pulmonary involvement.

Conclusion: Our study confirms the predominance of anti-PL12 antibodies and the late diagnosis of this condition.

Introduction: According to the WHO, 278 million confirmed cases of COVID-19 had been recorded worldwide by the end of 2021, resulting in approximately 5.4 million deaths. In Burkina Faso, 17,632 cases and 318 deaths were recorded. Vaccination is one of the strategies implemented to control the pandemic. This study aimed to evaluate the status of the COVID-19 vaccination program among staff at a referral hospital in Burkina Faso.

Methods: From June 2 to December 31, 2021, we conducted a descriptive study at Tengandogo University Hospital (CHU-T). The study involved all staff members. Information was obtained through face-to-face and telephone interviews and self-administered questionnaires. Quantitative variables were described using the mean and standard deviation, while qualitative variables were described using proportions. All vaccinated individuals responded to the questionnaire. Unvaccinated individuals were volunteers.

Results: A total of 31% (174 out of 559) of healthcare workers were vaccinated, with a mean age of 41 ± 8 years. Men accounted for 55% (94/174) of the vaccinated workers. The main worker profiles were 62 doctors (35.6%), 62 nurses (35.6%), and nine ward boys and girls (5.2%). The main reason for accepting the vaccine was protection against the disease, reported by 132 workers (76%). There were 134 unvaccinated subjects who agreed to participate in the study. Their average age was 32.8 ± 7.3 years. The proportion of women was 60%. Uncertainty about vaccine effectiveness was the main reason for not getting vaccinated, cited by 106 workers (79%). Minor adverse events were reported by 136 of the vaccinated workers (78%). No serious adverse events were reported. Four vaccinated workers developed symptomatic SARS-CoV-2 infection during the study period.

Conclusion: The proportion of vaccinated subjects was low. Interventions to improve healthcare workers' adherence to vaccination should be developed.

Introduction: Since the introduction of antiretroviral therapy for HIV in Burkina Faso, several treatment adherence support mechanisms have been implemented to improve outcomes and prevent resistance. Our study aimed to evaluate the knowledge and perceptions of people living with HIV (PLHIV) regarding these mechanisms in the Plateau-Central region.

Methods: We conducted a descriptive study in the Plateau-Central region, which is one of the 13 regions of Burkina Faso. PLHIV were selected as they arrived for their follow-up visits. Information was collected through interviews using a standardized questionnaire. Adherence was calculated based on the participants' reports. Those who took all their medications in the month prior to the survey were considered adherent. Quantitative variables were calculated using the averages, and qualitative variables were calculated using proportions.

Results: A total of 347 PLHIV were included in the study. Of these, 69% were women, with a mean age of 45.6 ± 12.2 years. The mean treatment follow-up duration was 8.6 ± 5 years. Eighty percent of individuals adhered to treatment (95% CI [75-84]). Nearly all PLHIV (99.7%) were aware of adherence support mechanisms. The most well-known mechanisms were six-month antiretroviral drug supplies (RAVI6M) (71%), discussion groups (69.9%), individual discussion (69.9%), and counseling (64.2%).The recently introduced community-based antiretroviral drug refilling program outside of health facilities was less well known (42.2%). The most commonly used measures were face-to-face discussion (64%), counseling (62%), and RAVI6M (61.7%). The most appreciated measures were the six-month supply of antiretroviral drugs (44.6%), drug counting (10.7%), and patient interview (10.1%).

Conclusion: PLHIV are familiar with and appreciate adherence support measures. The most appreciated measure is six-monthly refills of ARV drugs. Community-based ARV supply policies should be encouraged.

Introduction: The Kokolo military health zone in the city of Kinshasa (DRC) is one of the areas affected by mpox, with the presence of two subclades Ia and Ib of the monkeypox virus. This study presents the results of mpox-related surveillance activities in this area.

Methods: Descriptive study of data reported by the surveillance system on the mpox epidemic in the Kokolo health zone between August and November 2024.

Results: Of 202 specimens (143 males, sex ratio 0.71) from individuals clinically suspected of having mpox or contacts of known cases, 25.2% were positive by PCR at the National Institute for Biomedical Research laboratory (median age 25 years, IQR 11-31). Subjects aged 18 years and older were most affected, i.e. 41/51 (80%). Of these 51 confirmed cases, 13 (26%) and 10 (20%) were from the Kokolo 2 health areas and the Kokolo camp logistics base, respectively. All confirmed cases presented with rash. Other reported symptoms were myalgia (50/51, 98%), genital rash (42/51, 82%), arthralgia (42/51, 82%), and headache (41/51, 80%). The median length of stay at the mpox treatment center was 10 days (IQR: 7-9).

Conclusions: This study showed that of 202 tests performed on persons suspected of having mpox or contacts of known cases, 25.2% were positive by PCR. All confirmed cases presented with rash, with other common symptoms including myalgia, genital rash, arthralgia, and headache. These results underscore the need to strengthen surveillance and control measures for the spread of mpox, particularly in the most affected health care settings.

Upon Christopher Columbus's return, an unknown disease was discovered in Barcelona, Spain, in 1493, before appearing in Naples, Italy, in 1494/1495 during a war with France. Initially described among the troops, it quickly spread throughout Europe as the armies withdrew. The question arises whether there is a cause-and-effect relationship with Columbus's return to Spain or if it is merely a coincidence, as syphilis seems to have been present in Europe before Europeans arrived in the Americas, though it may not have been identified as such. This would explain why it was not clearly recognized by the population or described in the available literature. Recently, archaeological and paleopathological research on human remains from the modern era, supported by genetic data, has clearly established the presence of syphilis in ancient Europe. These findings also suggest that syphilis may not have existed in the Americas during Columbus's time. However, it seems possible that Columbus's companions brought back to Europe a non-venereal strain of treponematosis, which could have mutated while adapting to new environmental conditions, increasing its pathogenicity and altering its mode of transmission when transferred to new individuals, possibly prostitutes. In turn, this venereal syphilis strain may have infected the American continent during the Spanish conquests and/or the transatlantic slave trade. This study provides some recent arguments to fuel the controversy.

French Guiana, the last malaria-endemic region of France, is facing an epidemic resurgence of malaria since the end of 2023. This epidemic, primarily caused by Plasmodium vivax, mainly affects populations that are far from the healthcare system. It has highlighted the difficulties of providing a full course of treatment. This includes both curative treatment with artemisinin derivatives (following the withdrawal of chloroquine from the market) and eradicative treatment with primaquine, with the challenge of excluding G6PD deficiency. The aim of this paper is to describe the problems of malaria diagnosis and management in this unique territory, to highlight the adaptations made and to propose diagnostic, therapeutic and follow-up schemes adapted to the possibilities of access to the health system, with a view to homogenizing practices. This article also highlights the innovative strategies implemented in French Guiana to deal with this new epidemic: health mediation, mobile malaria team, rapid diagnostic tests and immediate out-of-hospital treatment Test and Treat, development of self-diagnosis and self-treatment. These proposals are part of a campaign to eliminate malaria in France in the short term.

Introduction: The aim of our study was to analyze retention in care and survival at 12, 24, and 36 months among people living with HIV (PLWH) on antiretroviral therapy (ART).

Methods: This is a retrospective cross-sectional analysis of a cohort of PLWH aged 15 years and older who started ART. Purposive sampling was used, taking into account the activities of different health centers and budgetary constraints (quantitative approach). In-depth individual interviews and focus groups were also conducted (qualitative approach).

Results: During the study period, 2,100 HIV-infected patients were enrolled. The median age of patients was 44 years (interquartile range (IQR) [36-51]), with a statistically significant difference according to sex (p< 0.001), with women being younger than men (42 versus 46 years). The median duration of ART was 5 years (IQR [2-8]) with no statistical difference by gender (p=0.752). At baseline, 20.5% (n=431) and 25.1% (n=509) were lost to follow-up (LTF) 90 days and 28 days after scheduled visit, respectively. There were 146 adult deaths, for a crude mortality rate of 6.9% (95% CI [5.9-8.1]). Approximately 60% of the 158 PLWH randomly selected from our LTF patients could be reached by telephone. They reported that they were still in care. Retention in care was 72.5%, and the probability of retention was 91.6% at 12 months, 87.8% at 24 months, and 78.7% at 60 months. Retention in care was more pronounced among women and more significant among PLWH aged 35 years and older when treatment was initiated in health care facilities offering the full range of activities (care and treatment, active patient search, presence of social mediators).

Conclusion: Our study, conducted during the Covid-19 pandemic, shows acceptable retention rates in care for PLWH. These results make possible to propose solutions to improve the care program in the country: the harmonization of procedures for tracing PLWH with the implementation of their active search (with the help of community mediators) and the dispensing of ART to PLWH for three or six months.