An Exceptional Adenocarcinoma in a Girl

Anal adenocarcinoma is very rare and usually occurs in the elderly. We present a case of a 12-year-old girl with an anal margin painful tumor infiltrating the lower rectum, with perineal and vulvar permeation nodules and bilateral fixed inguinal and iliac lymph nodes. Histology showed anal adenocarcinoma with mucosecreting component and independent cells. She had no extra pelvic metastasis on CT scan. She underwent a colostomy and palliative care. This exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. The precarious social context and the age of onset make it difficult to manage this rare cancer

GENERAL PARALYSIS IN A TROPICAL COUNTRY. STUDY OF 43 OBSERVATIONS

PARALYSIE GÉNÉRALE EN MILIEU TROPICAL. ÉTUDE DE 43 OBSERVATIONS RESUME Description :Les auteurs rapportent une étude de 43 cas de paralysie générale, révélés par un syndrome démentiel et des formes atypiques notamment les troubles confusionnels répétitifs et des crises épileptiformes. Objectif : L'objectif de cette étude est de réévaluer cette pathologie du point de vue clinique et paraclinique en milieu tropical. Méthode : Il s'agit d'une étude prospective. Le diagnostic a reposé sur la positivité des réactions sérologiques ( VDRL-TPHA) dans le sang et le liquide céphalo-rachidien, la présence d'une hypercellularité à prédominance lymphocytaire et d'une hyperprotéinorachie. Resultats : Les troubles cognitifs et moteurs, les états confusionnels répétitifs et les crises épileptiques constituent les formes cliniques dominantes de début. Chez tous les patients, le scanner a mis en évidence une discrète dilatation ventriculaire diffuse et un élargissement des sillons de la convexité. Le tracé électroencéphalographique était anormal dans près de 67% des cas. SUMMARY Description : The authors report a study of 43 cases of general paralysis revealed by some mental disorders and atypical forms notably repeater confessional disorders and some seizure-like attacks. Objective : The goal of this study is to revalue this pathology from the clinical and paraclinic point of view in tropical medium. Method : In this prospective study, the diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid (CSF); CSF cell count with lymphocyte predominance ; protein level in the fluid. Result : The diagnosis was based on the serologic tests (VDRL-TPHA) in the blood and the cerebrospinal fluid(CSF); high CSF cell count with lymphocyte predominance; high protein level in the fluid. The cogniture and motor troubles, the repeated confusion status and the epileptic seizures constitute the dominant clinical forms of the onset. In all the patients, the CT-scan revealed discrete diffuse ventricular dilation and widening of the grooves of the convexity. The electroencephalographic traces were abnormal in 67% of the cases. Key Words: Afrique, Guinée, paralysie générale, syphilis nerveuse, Africa, Guinea, general paralysis, neurosyphilis African Journal of Neurological Sciences Vol.23(2) 200

The Prevalence of HIV in Cancer Patients at the Surgical Oncology Unit of Donka University Hospital of Conakry (Guinea)

Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3 Kg/m2. They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317 cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis

Tuberculose multifocale associée à une toxoplasmose cérébrale sur terrain immunodéprimé à VIH chez un patient immigré africain au Centre Hospitalier de Soissons, France

Dans les pays industrialisés et notamment en France, vu les moyens de prévention, dépistage précoce et prise en charge immédiate de l'infection à VIH, la survenue d'infections opportunistes ne se voit presque chez les immigrés et certaines couches socio-professionnelles défavorisées. Nous rapportons donc le cas d'un homme de 42 ans, immigré africain, hospitalisé pour syndrome infectieux dans un contexte d'altération de l'état général, VIH1 positif sous antirétroviraux depuis deux ans, arrêtés depuis quatre mois, une tuberculose pulmonaire traitée et déclarée guérie en février 2017 avec, à l'examen une lenteur à l'idéation, une fièvre à 39,6°C et un amaigrissement. Le nadir CD4 à 12/mm3, une charge virale VIH1 à 5,80log. Le scanner thoraco-abdominal et l'IRM cérébrale ont permis de visualiser des lésions intra-abdomino-thoraciques et cérébrales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trithérapie antirétrovirale à quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une évolution favorable

Poor outcomes among critically ill HIV-positive patients at hospital discharge and post-discharge in Guinea, Conakry: A retrospective cohort study.

IntroductionOptimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.MethodsWe carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.Results401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.ConclusionOutcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care

Severe cutaneous drug reactions in Guinean children: a monocentric retrospective study of 35 cases

Background: Data on Severe cutaneous drug reactions (CADRs) are not common among in sub-Saharan Africa children. The purpose of this study was to document the clinical, etiological and evolutionary aspects of Severe CDRs in children hospitalized at the dermatology department of university hospitals of Conakry. Material and Methods: Retrospective study, conducted from 1 January 2000 to 31 December 2014. Were included all children aged 0-17 years hospitalized for severe CARDs. The data collected were Socio-demographic, clinical, para-clinical and evolution variables. The data was entered and analyzed using the Excel 8.0 software. Results: During a study period, 4437 patients of all ages was hospitalized in dermatology department. 35 patients were included with an average age of 11.3 years and a sex ratio of 1.5. The main clinical patterns were: Stevens Johnson syndrome 37.14% (13/35) Lyell syndrome 25.71 % and generalized bullous fixed eruption 22.85%. The drug was identified as 32 patients (91.42%): Sulfadoxine–Pyriméthamine 40.62%, cotrimoxazole 21.85%, nevirapin 12.5%, ampicillin 6.25%, traditional Pharmacopoeia 6.25% and griseofulin 3.12%. It was taken following self-medication in 14 patients, including a parental initiative in 9 patients. 7 patients had a history of drug allergy and 4 were HIV positive. We recorded 5 deaths. Conclusion: Our study confirms the rarity of severe CADRs in children. The importance of the sulfadoxine-pyrimethamine in the occurrence of severe CADRs in children is the particularity of our series