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P Pitche

Publications and source records attributed to P Pitche.

At least 19 recordsLinked to original sources
PubMed2005

[Cutaneous drug-reactions to nevirapine: study of risk factors in 101 HIV-infected patients].

BACKGROUND: Several studies have shown a high prevalence of rash induced by nevirapine. However, there is little knowledge about the risk factors associated with nevirapine-induced rash. The aim of this study was to identify risk factors associated with the occurrence of rash during the treatment with nevirapine of HIV-infected patients. METHODS: A retrospective study was conducted in the dermatology department of Besançon university teaching hospital between November 1998 and September 2001. The study included all HIV-infected patients receiving HAART regimens that included nevirapine. The following data were collected: age, sex, CDC classification of HIV, CD4 and CD8 lymphocyte counts, plasma HIV RNA load, hepatitis B, C and cytomegalovirus serostatus, history of drug allergy, concomitant medication (other antiretroviral drugs, corticosteroids, antihistamines). Univariate analysis was performed using a Chi2 test or Fischer's test and Student's t test. Fischer's test and the Cox proportional hazards model were used in the multivariate analysis. RESULTS: During the study period, 101 HIV-infected patients (74 men and 27 women; mean age: 41.6 +/- 10.3 years) were treated with HAART regimens including nevirapine. Fourteen developed cutaneous drug-reactions attributable to nevirapine (13.86%). We observed 13 cases of maculopapular exanthema and 1 case of DRESS. In the univariate analysis, female gender (p=0.002), plasma HIV RNA load > 10,000 copies/ml (p=0.05), heterosexual transmission (p=0.002) and abacavir treatment (p=0.05) constituted risk factors associated with rash. In the multivariate analysis, only female gender (p<0.0001) and plasma HIV RNA load > 10,000 copies/ml (p=0.0007) were associated with rash. DISCUSSION: The results of this study confirm the high frequency of toxidermy associated with nevirapine therapy. The risk factors associated with occurrence of rash due to nevirapine therapy were female gender and plasma RNA > 10,000 copies/ml. Several studies showed absence of any protective effect of antihistamines and corticosteroids in preventing the cutaneous adverse reactions associated with nevirapine. The identification of risk factors closely associated with nevirapine-induced rash could help physicians determine new strategies for safer use of nevirapine in the HAART regimen.

Adult↗
PubMed2005

[Stevens-Johnson syndrome and toxic epidermal necrolysis after intake of rifampicin-isoniazid: report of 8 cases in HIV-infected patients in Togo].

Dermatological reactions are frequent drug-related complications in patients with HIV infection. The most serious disorders are Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), a.k.a. Lyell's syndrome, that are potentially fatal. The purpose of this report is to describe 8 cases of SJS/TEN observed in Lomé teaching hospital (Togo) after intake of a combination of rifampicin-isoniazid by HIV-infected patients. There were 5 men and 3 women with a mean age of 28 years. All patients presented AIDS. The disorder was SJS in 3 cases and TEN in 5. In 6 cases, manifestations occurred during initiation of treatment (mean delay for onset, 16 days). In the remaining two cases, manifestations occurred 6 days and 8 days respectively after beginning treatment for recurrent tuberculosis. Mean skin detachment was 8% in patients with SJS and 55.7% in patients with TEN. Five patients including 4 with TEN and 1 with SJS died. This study documents incrimination of combined rifampin-isoniazid treatment in the occurrence of SJS/TEN in patients with HIV infection and confirms the severity and poor prognosis of these disorders. The presence of opportunistic infections such as pulmonary tuberculosis may be an unfavourable prognostic factor in immunocompromised patients with these severe dermatological disorders.

Adult↗
PubMed2005

[Child sexual abuse and sexually transmitted infections in sub-saharan Africa].

Recently there has been increasing public concern regarding escalating child sexual abuse (CSA) in the sub-Saharan Africa. Medical consequences of child sexual abuse (CSA) include sexually transmitted infection (STI) and human immune virus (HIV) infection. The purpose of the study was to review literature on CSA and associated STI/HIV in the sub-Saharan Africa. The study covered the 23-year period from 1980 to 2003. The mean age of the child victims was 8 years. The incidence of penetrative sex in the studies ranged from 70 to 97%. Physical signs of CSA included genital or anal injuries, perineal trauma, and vesico-vaginal or recto-vaginal fistula. The incidence of STD varied according to whether the study was retrospective or prospective. Ten percent to 67% of children with STD had been sexually abused while 15 to 30% of sexual abuse incidents were associated with STD. The prevalence of HIV ranged from 3% in Togo to 37.5% in Cameroon. Most alleged child abusers were adult males known by the child, i.e., family members (30-60%), instructors or teachers, household personnel or neighbours. Some acts were motivated by traditional practices such as early, forced marriage and beliefs such as presumed benefits of sex with virgin children (cure for STI/HIV/STD, magic powers or wealth). This study shows that CSA is widespread throughout sub-Saharan Africa. Most problem involving CSA in sub-Saharan Afica have not been documented. Knowledge about the extent and special aspects of CSA in Africa can be useful for implementation of suitable management measures.

Africa South of the Sahara↗
PubMed2003

[Successful treatment of haemodialysis-related porphyria cutanea tarda with deferoxamine].

BACKGROUND: End-stage renal failure and long-term hemodialysis treatment promote porphyria cutanea tarda. Iron overload is often associated with this disease and is thought to play a role in its pathogenesis. We report a case of hemodialysis related-porphyria cutanea tarda improved by deferoxamine. CASE REPORT: A 45-year-old man, with end-stage renal failure and who had received hemodialysis treatment since 1993, presented a several months-history of blisters of the face and the dorsum of the hands. Laboratory analysis showed: hemoglobin 10 g/dl; a moderate hepatic cytolysis; ferritin 195 ng/l. HIV, HBV, HCV serologies were negative. Porphyries analyses showed a porphyria cutanea tarda pattern. The cutaneous histology was non specific; direct immunofluorescence was negative. The patient received deferoxamine (40 mg/kg intravenously every week for 6 weeks) which led to dramatic improvement of the symptoms. DISCUSSION: Several treatments are proposed in the management of dialysis-related porphyria cutanea tarda. This case confirms that deferoxamine can induce rapid and prolonged remission.

Deferoxamine↗
PubMed2002

[Profuse scabies: kinetic curves of parasitologic cure with an association of benzyl benzoate and sulfiram].

BACKGROUND: In vitro exposure to benzyl benzoate (25 p. 100) kills Sarcoptes scabiei within three hours. The aim of our study was to determine in vivo elimination of Sarcopte scabiei with a benzyl benzoate-sulfiram association. METHODS: Medical charts of patients hospitalized for disseminated scabies from 1993 to 1999 were reviewed retrospectively. The diagnosis of scabies was confirmed by microscopic determination. Parasitological examinations were conducted every day or every two days until negative results. Patients were treated by successive applications of benzyl benzoate until parasitological cure. RESULTS: Twenty patients were included in the study. The median delay of parasitological cure was seven days. After 15 days, 95 p. 100 of patients were cured. Two cutaneous side-effects were reported. DISCUSSION: Despite immediate in vitro efficacy, benzyl benzoate action is delayed in vivo. The time of parasitological negativation after one application of benzyl benzoate is unknown. Therefore, it is not currently possible to determine whether our therapeutic regimen was excessive or not.

Aged↗
PubMed2001

[Anogenital warts in young children in hospital consultation in Lome (Togo). Role of transmission by sexual abuse].

The purpose of this 20-month prospective study conducted in the dermatology department of Lomé Teaching Hospital was to determine the prevalence of sexual abuse in pre-adolescent children with anogenital warts. From May 1997 to December 1998, a total of 16 cases of anogenital warts were diagnosed in children under the age of 12 years. Sexual abuse was discovered in 8 cases. All 8 cases involved girls (mean age, 6.1 +/- 1.9 years). The mode of acquisition involved self-infection from non anogenital warts in three cases and contamination by the mother in three cases. In two cases the mode of acquisition could not be identified. The alleged abuser was a member of child's family in 3 cases, a household employee working at the child's home in three cases, a teacher in 1, and a neighbor in 1. Syphilitic tests were negative in all children. However HIV infection was detected and the contaminator was identified in one 10-year-old girl. The results of this study document the correlation between anogenital warts and sexual abuse. In Black Africa, the consequences of child sexual abuse, which is not uncommon especially in major cities, are aggravated by the high prevalence of HIV infection.

Child↗
PubMed2000

[Sickle cell disease priapism: treatment with intracavernous injections of etilefrine].

Intracavernous injection (ICI) of adrenergic agonists has recently been proposed for treatment of priapism associated with sickle cell hemoglobinopathy and appears to be effective in cases less than 28 hours old. The purpose of this study was to confirm the usefulness of this technique in a large series of patients. From January 1996 through September 1998, 19 patients with sickle cell disease were treated by ICI of etilefrine for one or several episodes of low-flow priapism lasting between 2 hours and 15 days. A total of 72 consecutive ICI were performed alone in patients with priapism less than 6 hours old or in combination with prior drainage in patients with priapism more than 6 hours old. Results depended mainly on the delay to treatment. Detumescence was achieved in all 10 cases treated within 29 hours as opposed to only 2 of 9 cases treated beyond 29 hours. This finding is in agreement with experimental findings demonstrating histological evidence of necrosis of endothelial cells and cavernous smooth muscle fibers after 24 hours. However based on our experience showing that good results with preservation of erectile function can be achieved after delays longer than 40 hours (42 hours and 5 days in two of our patients), we recommend that treatment by ICI be tried before surgery in sickle cell anemia patients even with long-standing priapism. Untoward side effects including intense pain in the penis and retrosternal pain were observed in 4 patients. ICI of adrenergic agonists is one of the best treatment currently available for management of priapism in patients with sickle cell disease. Surgery should be used only after failure of ICI.

Adolescent↗
PubMed1999

[Prevalence of HIV infection in patients with pellagra and pellagra-like erythemas].

Pellagra is a systemic disorder caused by severe niacin deficiency. While uncommon in Europe and North America, pellagra and pellagra-like erythema are frequently encountered in undernourished adults in poor African countries. The purpose of this three-year prospective study was to determine the prevalence of HIV infection in patients with pellagra. Between 1996 and 1998, all documented cases of pellagra and pellagra-like erythema diagnosed in the Dermatology Department and Internal Medicine Department of the Teaching Hospital in Lome, Togo were included. Patients underwent screening tests for HIV infection. During the study period, pellagra or pellagra-like erythema was diagnosed in a total of 108 patients (59 women and 49 men) with a mean age of 41 +/- 3.5 years (range, 18 to 68 years). Serology tests for HIV were positive in 6 of these patients (5.5 p. 100; mean age 35 years). In four asymptomatic patients with no opportunistic infection, detection of HIV was an incidental discovery. The other two patients had AIDS symptoms. The principal causes of pellagra were malnutrition (n = 30), alcoholism (n = 15), and combined malnutrition and alcoholism (n = 60). The findings of this study suggest that the incidence of HIV infection in patients with pellagra and pellagra-like erythema is low, i.e., not higher than in the general population. This study also confirms previous etiologic and epidemiological data concerning pellagra in poor countries, i.e., the preponderant role of nutritional deficiency.

Adolescent↗
PubMed1998

[Scleroderma in a hospital setting in Togo].

The purpose of this retrospective study was to determine the epidemiological and semiological profile of scleroderma in Black Africa. Medical records of patients who consulted in the Dermatology Clinic and the Rheumatology Clinic of the Teaching Hospital in Lomé, Togo between 1980 and 1996 and between 1989 and 1996 respectively were reviewed. Scleroderma was diagnosed in 18 of the 34,169 patients seen during the study periods (0,05%). The disease was systemic in 13 cases (8 females, 5 males; mean age: 31 years) and localized in 5 cases (mean age: 20 years). There were no predisposing occupational or therapeutic factors. The clinical manifestations were Raynaud's phenomenon in six of the 13 patients with systemic scleroderma. Extensive cutaneous sclerosis in 10 cases, poikiloderma in seven cases, dysphagia in three cases, pulmonary fibrosis in four cases, and polyarthralgia in two cases. Myalgia and renal involvement were not observed. The findings of this study documents the low incidence of scleroderma in Togo. The high frequency of extensive cutaneous sclerosis, poikiloderma and low frequency of Raynaud's phenomenon which were often mild are the most remarkable features of the disease in Lomé. These features have been pointed out previously but epidemiologic data is still insufficient to confirm the existence of an African form of scleroderma.

Adolescent↗