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Biomedical subjects

D Nkoghe

Publications and source records attributed to D Nkoghe.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical treatment of spondylolisthesis in Gabon].

PURPOSE: Spondylolisthesis is a spinal disease revealed by lombalgia and/or lombosciatalgia, which may persist under medical treatment and physiotherapy. Indications for surgery are impairing symptoms and emergency conditions. We report outcome in 21 patients (14 women, 7 men, aged from 30 to 60 years old) who underwent surgery for isthmic (n = 10) and degenerative (n = 11) spondylolisthesis. Radiographic staging was: I in seven patients, II in ten, and III in four. METHOD: Many techniques were used: simple laminectomy (n = 4), Gill's operation (n = 4), Lapras' technique (n = 4), and Roy-Camille instrumentation (n = 9). RESULTS: Immediate and long-term postoperative follow-up of sixteen patients confirm good results: excellent outcome in eleven patients, good in four, and fair in one. CONCLUSION: Considering social and economic factors, we prefer Lapras' technique which provides very satisfactory results.

Adult↗
PubMed2006

[Epidemiology of childhood tuberculosis in Libreville, Gabon from 1997 to 2001].

The purpose of this retrospective study was to determine the epidemiological features of tuberculosis patients under the age of 15 years treated at the Tuberculosis Control Center in Libreville, Gabon from 1997 to 2001 as a basis for improving management. Study criteria included age, sex, BCG vaccination status, social level, type of tuberculosis, HIV status and outcome of treatment. Statistical analysis was performed using EPI INFO software. The childhood tuberculosis rate was 9% with a sex ratio of 1.02 and the most common age group was 0 to 4 years. Three fourths of children were from poor zones and 90% had received BCG vaccination. The incidence of tuberculosis did not increase from year to year. The location of tuberculosis was pulmonary in 77% of cases (n=433) and extrapulmonary in 23% (n=129). No case involving meningitis or miliary disease was observed. Sputum bacilloscopy was positive in 21% of cases involving pulmonary tuberculosis and HIV serology was positive in 4.4% of children tested. The success rate was 54%. Tuberculosis-related mortality was 0.7% but 37% of children were lost from follow-up. Efforts to control tuberculoses by screening children exposed to bacilliferous conditions and vaccinating newborns must be continued. Treatment for tuberculosis must be given free of charge and under medical supervision as recommended by the World Health Organization.

Adolescent↗
PubMed2005

[HIV seroprevalence among tuberculosis patients in Nkembo Hospital, Libreville, Gabon. Short note].

There are nearly 31,000 HIV infected patients in Gabon. In Libreville, the capital, the prevalence is estimated at 7.7%. About 2627 tuberculosis patients, all types included, have been notified in 2001 to the World Health Organization of which 43% of smear positive new cases. The co-infection HIV-TB worsens the overall prognosis of our patients. The objective of our study is to determine the HIV seroprevalence among our tuberculosis patients. It is a cross-sectional study conducted between June 25th and August 31th 2001. All patients are new or relapse tuberculosis cases. There is no difference between the types of tuberculosis. The diagnosis was clinical, radiological and based on smear AFB sputum (according to the Ziehl Neelsen method). The patients agreed orally for HIV testing. We made two tests: a rapid one followed by Elisa if positive. 358 patients were examined among them 141 women and 217 men. The M/F sex ratio was 1.53 and the average age 32 years. Proportion of new patients reached 61%. Ninety seven per cent of patients suffered from a pulmonary tuberculosis, 58% smear positive and 26% were HIV-1 positive. According to this status, no statistical difference was notified towards sex, types of disease or patients and the smear sputum results.

Adult↗
PubMed2005

[Multiple Ebola virus haemorrhagic fever outbreaks in Gabon, from October 2001 to April 2002].

Outbreaks of Ebola virus haemorrhagic fever have been reported from 1994 to 1996 in the province of Ogooué Ivindo, a forest zone situated in the Northeast of Gabon. Each time, the great primates had been identified as the initial source of human infection. End of November 2001 a new alert came from this province, rapidly confirmed as a EVHV outbreak. The response was given by the Ministry of Health with the help of an international team under the aegis of WHO. An active monitoring system was implemented in the three districts hit by the epidemic (Zadié, Ivindo and Mpassa) to organize the detection of cases and their follow-up. A case definition has been set up, the suspected cases were isolated at hospital, at home or in lazarets and serological tests were performed. These tests consisted of the detection of antigen or specific IgG and the RT-PCR. A classification of cases was made according to the results of biological tests, clinical and epidemiological data. The contact subjects were kept watch over for 21 days. 65 cases were recorded among which 53 deaths. The first human case, a hunter died on the 28th of October 2001. The epidemic spreads over through family transmission and nosocomial contamination. Four distinct primary foci have been identified together with an isolated case situated in the South East of Gabon, 580 km away from the epicenter. Deaths happened within a delay of 6 days. The last death has been recorded on the 22nd of March 2002 and the end of the outbreak was declared on the 6th of May 2002. The epidemic spreads over the Gabon just next. Unexplained deaths of animals had been mentionned in the nearby forests as soon as August 2001: great primates and cephalophus. Samples taken from their carcasses confirmed a concomitant animal epidemic.

Animals↗
PubMed2005

[Isolated case of haemorrhagic fever observed in Gabon during the 2002 outbreak of Ebola but distant from epidemic zones].

During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches Médicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks.

Data Collection↗
PubMed2004

[Identification of factors influencing the response of antiretroviral treatment].

OBJECTIVE: The authors had an aim to define the ideal patient profile by determining the factors responsible for an initial variation of CD4 lymphocytes and viral load, and the effect of these factors on the therapeutic response after 12 months of treatment in HIV infected patients. PATIENTS AND METHOD: A retrospective study was made on data concerning the clinical stage, the HIV phenotype strain, the therapeutic status, and the type of treatment. This data was compared to the CD4 count and the viral load before and after 12 months of treatment. RESULTS: Initially, CD4 lymphocytes values were low in case of: phenotype SI (p = 0.012), patient in clinical stage C (p < 0.0001), or treated with protease inhibitor (p < 0.0002). The viral loads were high for patients in stage C (p < 0.0002) and treated with protease inhibitor (p < 0.0001). After 12 months of treatment, the increase of CD4 count was lower in patients with phenotype SI (p = 0.05). Furthermore, the viral load was statistically more important in naive patient (p < 0.0001). CONCLUSION: According to our study, the ideal patient is naive and presents with phenotype NSI.

Adult↗
PubMed2002

[Morphological and metabolic abnormalities related to antiretroviral therapy].

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are involved in the origin of these abnormalities. So, NRTIs inhibit mitochondrial gamma polymerase and induce body fat distribution disorders. PIs interfere with lipid metabolism, leading to hyperlipidaemia and insulin resistance symptomatology. The diagnosis is made by clinical (far wasting or accumulation, or mixed syndrome) and biological signs (hyperlipidaemia, hyperglycaemia, hyperlactacidaemia). Radiological exams can quantify morphological abnormalities. The management consists in drug substitution, diet and exercise, and corrective drugs. Plastic surgery can be useful.

Adipose Tissue↗
PubMed2002

[Still's disease in the adult].

The Adult Onset Still's Disease (AOSD) is an entity of unknown origin characterised by fever, polyarthralgias or polyarthritis, a pharyngitis, a cutaneous eruption and elevation of leucocytes. We present observations of 17 patients diagnosed during the last thirteen years. Files of hospitalized patients with suspected AOSD have been examined in a retrospective study and Yamaguchi and Kahn's criterias applied in order to confirm the diagnosis. Treatments undertaken and the evolution have been noted. The sex ratio is 1.83; the middle age of intervening from 42 to 45 years. The middle delay for the diagnosis is 3 to 8 weeks. Fever, eruption and polyarthralgias are the most frequent clinical signs. Elevation of leucocytes, hepatic cytolysis and hyperferritinemia are usual. Constantly, inflammatory tests are increased and the rheumatoid factor and the antinuclear antibodies are negative. Yamaguchi's criterias have been met by all patients. The non steroïd anti-inflammatory drugs and corticoïds constituted the main treatment. In the evolutionary shield, 6 cases of remission have been noted. The other patients evolved toward the chronicity with either a systemic or an articular shape. In the two situations, a state of corticodependance got settled with necessity of association to immunosuppressive drugs. The diagnosis of AOSD is easily done on basis of Yamaguchi's criterias. Corticoïds can permit to control the bouts. There are 3 types of evolution: remission, chronic systemic or chronic articular shape.

Adolescent↗
PubMed2002

[Management of HIV infected patients. Experience of the Liege University Hospital Center].

We present data from 112 patients followed in the Infectious Diseases Unit of the Liege University Hospital (CHU Sart-Tilman). The primary goal of this study was to evaluate the efficiency of highly active antiretroviral therapy (HAART) on surrogate immunological and virological parameters. The study also aimed at determining the prevalence of opportunistic infections and iatrogenic metabolical abnormalities in the era of HAART. Data from HIV infected patients under combined treatment were collected from March 1996 till July 1999. The follow-up focused on the variation of the CD4 cell counts and viral load, and the occurrence of opportunistic infections. The average age was 39 +/- 10 years and the sex ratio (M/F) was 2.3. At baseline, the CD4 count was 352 +/- 244/mm3 and the viral load was 4.1 +/- 1.2 log. After 12 months, the CD4 cells were at 540 +/- 374 and the viral load at 2.5 +/- 1.5 log. This favourable outcome was observed in 70% of patients (naive and experienced). Clinically, patients in therapeutic success presented few opportunistic infections, but many drugs related toxicity. Our data demonstrate the efficiency of combined treatment in the management of HIV infected patients. However, the apparition of toxicity problems could limit the benefit brought by these drugs.

Academic Medical Centers↗
PubMed2001

HIV-associated hematologic disorders are correlated with plasma viral load and improve under highly active antiretroviral therapy.

The relationship between HIV-1 replication and hematologic parameters was examined in two separate studies. The first study was a cross-sectional evaluation of 207 untreated patients. In this study, the proportion of patients with hematologic disorders increased with disease progression. There was a significant inverse correlation between HIV-1 plasma viral load and all hematologic values (r = -0.266 to -0.331). The second study was a longitudinal evaluation of patients on combination antiretroviral therapy (HAART) with hematologic alterations before treatment ( N = 27 with platelets <150,000/microl, 24 with hemoglobin <12 g/dl, 36 with neutrophils <2000/microl and 29 with leukocytes <3000/microl). Samples were analyzed every 3 months for 2 years. At 2 years, >50% of patients experienced a sustained virologic response, with viral loads <500 RNA copies/ml. Hematologic reconstitution occurred progressively for all blood cell lineages and became statistically significant after the sixth month of therapy ( p <.001). Mean values increased from 110 to 180 x 10(3)/microl for platelets, from 10.7 to 12.3 g/dl for hemoglobin (stabilizing finally at 11.4 g/dl), from 1,260 to 2,240/microl for neutrophils, and from 2,260 to 3,600/microl for leukocytes. In conclusion, hematologic disorders are corrected by combination antiretroviral therapy. This suggests a causative role of HIV-1 in hematologic disorders.

Adult↗
PubMed2001

[Shoshin beriberi: myth or reality?].

Shoshin is a fulminating form of cardiac beriberi developing in a few hours in a young alcoholic. Without specific treatment it evulers, toward death by cardiogenic shock and metabolic acidosis. Treatment by thiamine and alkalinisation permits a spectacular and fast recovery.

Acidosis↗
PubMed2001

[Pharma-clinics how I treat ... an HIV infection. IV. Protease inhibitors].

Protease inhibitors constitute the last class of antiretroviral drugs appeared on the market. They raised an enormous enthusiasm, reinforced by recent studies results. These molecules prevent the formation of infectious viral particles, while inhibiting a viral enzyme that plays a key role in the cycle of replication of the HIV. Their efficiency, especially in association, is recognized for all stages of the infection and the intervening of a resistance often requires many mutations. However, the unexpected adverse events such as lipodystrophy and some interactions can limit their utilization in first intention.

Cell Cycle↗
PubMed2000

[Clinical case of the month. A new case of nephropathia epidemica due to Puumala virus].

Nephropathia epidemica due to Puumala virus has already been described in Belgium. Its evolution is usually favourable. The main symptoms are fever, a decrease platelet count, proteinuria and acute renal insufficiency, which, in an epidemiological context, quickly point the correct diagnosis. Acute and transitory myopia is typical. Nevertheless, the clinical presentation, including multisystemic symptoms may lead to the false diagnosis of an acute bacterial or immune disease.

Acute Kidney Injury↗
PubMed2000

[Influenza: from vaccine prevention to antiviral therapy].

Influenza is a highly infectious disease responsible for dangerous epidemics, especially in patients at high risk. The vaccine exerts a valuable protective effect estimated up to 70% and is still considered as the key-approach against influenza. Antiviral agents of the first generation (amantadine, rimantadine, ribavirine) have limited use because of poor tolerance and occurrence of resistance. Zanamivir or Relenza, marketed by Glaxo Wellcome, is a new virostatic drug acting as a neuraminidase inhibitor. It prevents the release of new viruses and so stop the propagation of the infection. It must be taken orally by inhalation within 48 hours after the onset of symptoms. The treatment lasts 5 days (10 mg twice daily). Its efficacy has been demonstrated in controlled clinical trials, and its tolerance is generally excellent. However, caution is recommended in patients with asthma and chronic bronchitis because of the potential risk of bronchoconstriction. No resistance has been detected until now. Zanamivir is active on all strains of influenza A and B viruses.

Administration, Inhalation↗
PubMed2000

[Guidelines for the management of patients with HIV infection. I. Adolescents and adults. Liege Working Group on HIV Infection].

The management of HIV infected patient requires an approach that must put in balance profits expected from a tritherapy (suppression of viral replication, immune reconstitution) and problems related to treatment (difficulty of adherence, side effects, long-term toxicity, resistance). Controversies appear currently on the institution of a precocious treatment, on the use of protease inhibitors at initiation, in order to preserve choices when a modification is necessary. Many concepts, in investigation, are described in the management of a therapeutic failure. Resistance testings progressively find their place in the follow-up. Modes of prophylaxis-interruption of opportunistic infections are established, as well as is the management of professional postexposure. The question remains on how best to advise seropositive couples, about conception, and to elaborate recommendations after non-professional postexposure.

Adolescent↗
PubMed2000

[Guidelines for the management of patients with HIV infection. II. Pregnant women and children. Liege Working Group on HIV Infection].

The management of the HIV infected child is nearly identical to the adult. Nevertheless, there are many clinical, immunological and virological details. Difficulties evoked for the adult have an even bigger importance, in view of the foreseeable longevity of these children under treatment. The reduction of the mother to child transmission, thanks to the AZT-caesarean association, must be continued. The use of anti-retroviral drugs during pregnancy requires a sustained attention because of the potential risks and benefits for the foetus and mother. The long-term impact of these drugs, in children exposed during pregnancy, remains unknown. The follow-up of these children therefore remains important.

Adult↗