Hélio Razafimahefa - Academia.edu (original) (raw)
Papers by Hélio Razafimahefa
ecancermedicalscience
The aim of this study was to describe the demographic, clinical and aetiological characteristics ... more The aim of this study was to describe the demographic, clinical and aetiological characteristics of hepatocellular carcinoma (HCC) in a Malagasy population sample in view to defining an appropriate control program. Methods: This was a retrospective, descriptive study conducted in the Gastroenterology Department, Joseph Raseta Befelatanana University Hospital, Antananarivo, over a period of 6 years (January 2012 to December 2017). Results: A total of 42 patients were selected, 29 of whom were men (69.05%) and 13 women (30.95%) (sex ratio: 2.2). The mean age was 56.6 years with extremes of 21 and 82 years. Subjects aged 60-69 years were most affected (35.71%). Abdominal pain was the main revealing symptom (38.10%). The main aetiological factors were: hepatitis B virus (HBV) (42.86%), hepatitis C virus (19.05%) and chronic alcoholism (23.81%). All patients were cirrhotic, of which 23 patients (54.76%) had Child-Pugh B class and 15 (35.71%) Child-Pugh C. Twenty-six patients (61.90%) had α-foetoprotein level plus 500 ng/mL. Six patients (14.29%) had portal thrombosis at diagnosis. Twenty patients (47.62%) had advanced HCC (Barcelona Clinic Liver Cancer C (BCLC C)) and 21 (50%) had end-stage HCC (BCLC D). Management was palliative in 41/42 patients. The in-hospital death rate was 23.81%. Conclusion: HCC are diagnosed at advanced stage in this study. The prognosis is poor for most patients. HBV infection is the main risk factor. An effort should be made for early diagnosis and prevention.
International Journal of Progressive Sciences and Technologies, Oct 29, 2019
Upper gastrointestinal bleeding is one of main digestive emergencies and remains a major cause of... more Upper gastrointestinal bleeding is one of main digestive emergencies and remains a major cause of morbidity and mortality. Eighty percent of acute HD are of high origin. By this work, we document the epidemiological, clinico-biological aspects of upper gastrointestinal bleeding. This is a descriptive study of patients who presented upper gastrointestinal bleeding at Hepato-gastroenterology unit of Joseph Raseta Befelatanana Antananarivo (Madagascar) University Hospital during 5 months. During this period, 31 patients had been admitted for high gastrointestinal bleeding. The average age of patients was 49.6 years. There were more men than women. Melena was the most common manifestation (n = 21, 67.7%). Ulcerative (32.3%, n = 10).and variceal bleeding (54.8%, n = 17) were predominant. Optimal initial management of co-morbidities and haemorrhage with early endoscopic examination may improve the prognosis of upper gastrointestinal bleeding.
Journal Africain d?Hépato-Gastroentérologie
Aim To list digestive diseases encountered at the Department of Gastroenterology, University Hosp... more Aim To list digestive diseases encountered at the Department of Gastroenterology, University Hospital of Antananarivo in aim to assess morbidity and mortality rate. Materials and methods A retrospective study of patient’s files including digestive diseases was conducted between the 1st January 2007 and 30th June 2009. Results Digestive diseases have represented 16,03% of all admissions. Three hundred twenty eight cases of digestive diseases were recorded corresponding to 276 patients. Men were more frequent between 30 and 70 years old (n = 139; 42,37%). Cirrhosis was the main pathology (n = 110; 33,54%) followed by duodenal ulcers (n = 9; 9,76 %). Cirrhosis was responsible of the highest mortality rate (n = 25; 22,73%). Conclusion Digestive diseases are frequent in a department of medicine in Madagascar. Amongst digestive diseases, cirrhosis is the most frequent and is responsible of high mortality rate.
Médecine d'Afrique noire
In Madagascar, the susceptibility of the bacteria responsible for infection of urinary tract in a... more In Madagascar, the susceptibility of the bacteria responsible for infection of urinary tract in adult patients at hospital is underrated. Our purpose was to determine the rate of resistance of bacteria to antibiotics in infection of urinary tract in aim to improve management. We conducted a retrospective descriptive study from October 2002 to august 2008 at 2 internal medicine services in Antananarivo. Amongst 2933 inpatients, 417 have got cyto-bacteriology examination of urine. One hundred and fourteen were diagnosed as infection of urinary tract. Mean age was 55,6 year-old and sex-ratio was 0,6. One hundred and twenty five strains were isolated. Enterobacteria were the most frequent agent (78,4%), particularly Escherichia coli (44,8%) and Klebsiella pneumonia (11,2%). Escherichia coli loss susceptibility to amoxicillin (15,4%) and the association trimethoprim-sulfamethoxazole (15,2%). However, they remained sensitive to 3rd generation cephalosporin (91,7%) and to fluoroquinolon (8...
Médecine tropicale : revue du Corps de santé colonial, 2010
Cirrhotic patients have poorer life expectancy than the general population. The purpose of this s... more Cirrhotic patients have poorer life expectancy than the general population. The purpose of this study was to identify causes of death in a sample of cirrhotic patients from Madagascar. A retrospective analytic and descriptive study was conducted on the files of cirrhotic inpatients admitted to the gastroenterology department of the Joseph Raseta Befelatanana University Hospital Center in Antananarivo, Madagascar from January 1, 2003 to June 30, 2007. The files of 117 patients were reviewed. Death occurred in 31 cases for a mortality rate of 26.5%. The main causes of death were disorders of consciousness (51.6%) and hypovolemic shock (25.8%). Jaundice, encephalopathy, and gastrointestinal bleeding were predictive factors for mortality. Cirrhotic patients in this study were hospitalized at a late stage of disease. Further prospective study in a larger sample will be needed to standardize the management protocol in Madagascar.
La Revue de Médecine Interne, 2009
Clinical and Experimental Gastroenterology
Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. ... more Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. It is responsible for surface and deep tissue destruction leading to perforations and hemorrhage. Its pathogenesis represented by an angio-invasion is at the origin of a local infarction and a vascular thrombosis. We report a case of gastrointestinal (GI) mucormycosis-induced multiple gastric ulcers, GI bleeding and rectal perforation. Case Presentation: A 75-year-old man, with type II diabetes mellitus, was admitted to the intensive care unit for an acute abdominal pain associated with massive hematochezia. Clinical examination was that of an acute peritonitis and a hemorrhagic shock state. Abdominal and pelvic CT scan with intravenous contrast concluded to a perforation of the anterior wall of the rectum. He underwent immediate laparotomy with temporary colostomy. Several upper GI endoscopies had shown multiple gastric ulcer lesions. Lower GI endoscopy showed a fistulous orifice of the rectum on its anterior surface. Histopathology of the gastric biopsy showed acute and subacute inflammatory changes with filamentous elements suggesting mucormycosis. Histopathology of the rectal biopsy showed a subacute non-specific inflammation. Culture of the secretions from the rectal fistula orifice showed the strain Rhizopus sp. Antifungal susceptibility testing reported sensitivity to liposomal amphotericin B. The diagnosis of GI mucormycosis-induced multiple gastric ulcers, rectal perforation and pulmonary embolism in the patient with type II diabetes mellitus was retained. The outcomes were favorable after 6 weeks of treatment with liposomal amphotericin B associated with temporary colostomy and appropriate diabetes management. Conclusion: GI mucormycosis remains a multidisciplinary diagnostic challenge, less frequent in clinical practice, with a long diagnostic pathway. This opportunistic systemic mycosis can lead to numerous GI complications including perforation, massive GI bleeding and even multiple extra-GI complications. GI mucormycosis has a good prognosis if it is treated early with medical and surgical treatment.
BioMed Research International
Background. Accessibility of full dose daily of tenofovir disoproxil fumarate (TDF) is limited in... more Background. Accessibility of full dose daily of tenofovir disoproxil fumarate (TDF) is limited in Madagascar with an estimated cost well above the purchasing power of Malagasy population. Objective. The study is aimed at evaluating the efficacy and safety of low-dose tenofovir for the treatment of chronic hepatitis B (CHB). Methods. This prospective cohort study from January 2018 to December 2020 was conducted in the Department of Hepato-Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. The patients enrolled in the study received low dose of TDF 900 mg/week (300 mg daily, three days per week). Results. A total of 45 patients (male/female: 31/14) were included. The mean age was 45.1 ± 11.5 years. Fifteen patients were nucleos(t)ide (NA)-naïve, and 30 patients had prior NA therapy (NA-experienced). Thirty patients were HBeAg positive. A complete virological response (CVR) was achieved in 36/45 patients (80%) at 3 months, 41/45 (91.1%) at 6 mon...
Hepatic Medicine: Evidence and Research
Background: Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypert... more Background: Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypertension in developing countries. Variceal bleeding is the most common cause of mortality during HSS. The objective of this study was to evaluate the efficacy of splenectomy associated with endoscopic variceal ligation (EVL) compared with EVL alone in preventing variceal bleeding in patients with HSS. Methods: This was a single-center, retrospective, case-control study. Between January 2015 and December 2019, a total of 59 patients with HSS who had at least one variceal bleeding episode and received EVL with or without splenectomy were identified and stratified. In this case-control design, 22 patients had splenectomy + EVL (case group) and 37 patients had EVL alone (control group). The main endpoints were the rate of variceal rebleeding and the mortality rate between the two groups. Results: The mean age of our patients was 39.92 ± 13.4 (19-75) years with a sex ratio of 1.8. The recurrence rate of variceal bleeding was significantly lower in the case group (splenectomy + EVL) than in the control group (EVL alone) (4.45% vs 27.2%, p = 0.041). There was no significant difference between the two groups in terms of mortality (4.54 vs 2.7%, p = 1.00). Conclusion: Splenectomy combined with EVL was effective than EVL alone in preventing variceal rebleeding in patients with HSS.
International Medical Case Reports Journal, 2022
Background: SARS-CoV-2 has been described as a respiratory tropic virus since its emergence in De... more Background: SARS-CoV-2 has been described as a respiratory tropic virus since its emergence in December 2019. During the course of the disease, other extra-pulmonary manifestations have been reported in the literature including pancreatic involvement such as acute pancreatitis. This phenomenon linking COVID-19 and acute pancreatitis has been reported by several case reports and cohort studies. No cases had been reported in sub-Saharan Africa and Madagascar. We report one more case Of COVID-19 induced acute pancreatitis in a Malagasy woman patient without risk factors, further consolidating the existing evidence. Case Presentation: A 44-year-old woman was diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and had a favorable course under home isolation and drug treatments. One week later, the patient was admitted to hospital with severe acute abdominal pain. Acute pancreatitis was considered according to the revised Atlanta criteria with the presence of the three criteria. Other etiologies of acute pancreatitis (lithiasis, alcohol, hypercalcemia, hypertriglyceridemia, tumor, trauma, surgery) were excluded. Ultimately, a COVID-19 induced acute pancreatitis was retained. The outcome was favorable under symptomatic medical treatment (fluid resuscitation, bowel rest, management of pain and vomiting, and early oral feeding). The patient was discharged after one week of hospitalization. Conclusion: COVID-19 is a possible etiology of acute pancreatitis. Acute pancreatitis should be routinely ruled out in a patient with COVID-19 infection with acute abdominal pain.
African journal of nephrology, Dec 2, 2021
Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated ci... more Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at the Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. results: The hospital prevalence of decompensated cirrhosis with HRS was 7.9% (41/519). The mean age of the patients was 49.8 ± 11.33 years (range 25-70 years). Male gender predominated at 83% (n = 34). History of alcohol (46.3%) and viral hepatitis B (34.1%) were the main aetiologies of cirrhotic disease. Most of our patients (88%) had a Child-Pugh C score. HRS occurred during the first decompensation (63.4%) and the first years of cirrhosis (81%). Spontaneous bacterial peritonitis (46%) and gastrointestinal bleeding (32%) were the main risk factors. HRS type-1 predominated at 66% (n = 27). The prognosis was poor with a mortality rate of 81% (100% in HRS type 1 and 42.9% in type 2). Most patients (n = 22; 67%) died within 14 days. conclusion: The prevalence of HRS was 7.9%. It affects young people with advanced cirrhosis. The prognosis is grim with a mortality rate of 81%.
The Egyptian Journal of Internal Medicine, 2022
Choledochal cysts (CDCs) are characterized by congenital cystic dilations of the intrahepatic or ... more Choledochal cysts (CDCs) are characterized by congenital cystic dilations of the intrahepatic or extrahepatic bile ducts or both. CDCs are very rarely reported in sub-Saharan Africa. This congenital anomaly of the bile ducts is rarely discovered at the stage of advanced chronic liver disease with portal hypertension. We report the first Malagasy case of a type IVA choledochal cyst discovered during an etiological work-up of cirrhosis. A 23-year-old woman was hospitalized for jaundice and ascites. Biological and radiological investigations have led to the diagnosis of secondary biliary cirrhosis due to type IVA choledochal cyst. In view of the severity of the liver damage (Child-Pugh C score), a collegial decision (hepato-gastroenterologists and visceral surgeons) had rejected surgical intervention and opted only for the management of cirrhotic decompensation. A type IVA choledochal cyst is a possible etiology of advanced chronic liver disease.
Objective. Our work aimed to assess the efficacy and safety of direct-acting antiviral drugs in t... more Objective. Our work aimed to assess the efficacy and safety of direct-acting antiviral drugs in the treatment of hepatitis C in Madagascar. Methods. This retrospective clinical study was carried out from March 2018 to February 2020 in the hepato-gastro-enterology department of the University Hospital Center Joseph Raseta de Befelatanana. Results. A total of 35 patients were included, out of which 24 received sofosbuvir/ledipasvir ± ribavirin, 10 sofosbuvir/ribavirin and one sofosbuvir/velpatasvir. Thirty-three patients were naïve to the treatment and 2 patients were initially treated with the sofosbuvir/ledipasvir combination. The sustained virologic response was 94 % (33/35) in the general population, 23/25 in cirrhotic patients and 10/10 in non-cirrhotic patients. The sustained virologic response was 22/24 for sofosbuvir/ledipasvir ± ribavirin, 10/10 for sofosbuvir/ribavirin and 1/1 for sofosbuvir/velpatasvir. Adverse effects were observed in 13 patients, mainly asthenia and insom...
Clinical Case Reports, 2021
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
L’avenement des anti-TNF a revolutionne la prise en charge des maladies inflammatoires chroniques... more L’avenement des anti-TNF a revolutionne la prise en charge des maladies inflammatoires chroniques, notamment intestinales (MICI). Parallelement a une utilisation de plus en plus frequente, de nombreux effets secondaires, notamment cutanes, sont rapportes et leur prise en charge mieux apprehendee par les cliniciens. Les effets secondaires cutanes les plus frequemment decrits sont les reactions au point d’injection (RPI), les reactions a la perfusion, les infections cutanees et les eruptions psoriasiformes. Les RPI resultent d’une hypersensibilite retardee mediee par les lymphocytes T. Les reactions aux perfusions sont preferentiellement des reactions anaphylactoides, plus rarement de vraies hypersensibilites. Les eruptions psoriasiformes correspondent, soit a une exacerbation d’un psoriasis preexistant, soit a l’apparition d’un psoriasis de novo, soit a des reactions psoriasiformes drogues induites. Ces differentes reactions cutanees de gravite variee ne necessitent pas obligatoireme...
International Journal of Infectious Diseases, 2021
The aim of this study was to evaluate the efficacy and safety of sofosbuvir/ledipasvir AE ribavir... more The aim of this study was to evaluate the efficacy and safety of sofosbuvir/ledipasvir AE ribavirin in Malagasy patients with hepatitis C virus genotypes 1 and 2, in real conditions. Patients and methods: This was a retrospective monocentric clinical study, carried out over a period of 3 years from March 1, 2017 to February 28, 2020, in a hospital hepato-gastroenterology department. Results: In total, 26 patients (M/F: 11/15) with hepatitis C virus genotype 1 (n = 13) or genotype 2 (n = 13), were treated with sofosbuvir/ledipasvir without (n = 21) or with (n = 5) ribavirin for 12 weeks. The mean age was 61.38 AE 7.09 years. Seventeen patients (65.4%) had cirrhosis. The overall sustained virological response was 96.2% (95% CI = 80.4-99.9%). There was no significant difference between the sustained virological responses of genotypes 1 and 2 (92.3% vs 100%; p = 0.31) or those of cirrhotic or non-cirrhotic patients (94.1% vs 100%; p = 0.46). A relapse was observed in one patient (5.9%)cirrhotic and genotype 1bunder sofosbuvir/ledipasvir with ribavirin. Seven patients (26.9%) experienced mild adverse reactions, including asthenia (57.1%) and insomnia (42.9%). Conclusion: Treatment with sofosbuvir/ledipasvir AE ribavirin for infection with hepatitis C virus genotype 1 has been shown to be safe and effective, even in the presence of cirrhosis. The sofosbuvir/ledipasvir combination is a good option for genotype 2 non-cirrhotic patients.
JGH Open, 2021
Salmonella typhi remains an endemic disease in Madagascar. Acute pancreatitis remains a rare comp... more Salmonella typhi remains an endemic disease in Madagascar. Acute pancreatitis remains a rare complication of S. typhi colitis. We presented the case of a 27‐year‐old male, admitted to febrile diarrhea, vomiting, and severe abdominal pain. Blood work‐up revealed elevated plasma lipase level. Abdominal CT scan showed acute pancreatitis without necrosis. Blood and stool culture positivity for S. typhi. Patient was diagnosed as acute pancreatitis caused by S. typhi. The outcome was favorable under symptomatic medical treatment (rehydration and analgesic) combined with adapted antibiotic therapy. Acute pancreatitis is a possible complication of Salmonella infections. The presence of severe abdominal pain and febrile diarrhea should draw clinicians' attention to possible Salmonella acute pancreatitis.
Arteria lusoria is a rare cause of dysphagia in which dysphagia due to esophageal compression. Th... more Arteria lusoria is a rare cause of dysphagia in which dysphagia due to esophageal compression. The upper GI endoscopy does not bring significant element that can orient the diagnosis. The injected thoracic CT scan remains the key examination for the diagnosis of dysphagia lusoria and to characterize the defective artery.
International Journal of Infectious Diseases, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
ecancermedicalscience
The aim of this study was to describe the demographic, clinical and aetiological characteristics ... more The aim of this study was to describe the demographic, clinical and aetiological characteristics of hepatocellular carcinoma (HCC) in a Malagasy population sample in view to defining an appropriate control program. Methods: This was a retrospective, descriptive study conducted in the Gastroenterology Department, Joseph Raseta Befelatanana University Hospital, Antananarivo, over a period of 6 years (January 2012 to December 2017). Results: A total of 42 patients were selected, 29 of whom were men (69.05%) and 13 women (30.95%) (sex ratio: 2.2). The mean age was 56.6 years with extremes of 21 and 82 years. Subjects aged 60-69 years were most affected (35.71%). Abdominal pain was the main revealing symptom (38.10%). The main aetiological factors were: hepatitis B virus (HBV) (42.86%), hepatitis C virus (19.05%) and chronic alcoholism (23.81%). All patients were cirrhotic, of which 23 patients (54.76%) had Child-Pugh B class and 15 (35.71%) Child-Pugh C. Twenty-six patients (61.90%) had α-foetoprotein level plus 500 ng/mL. Six patients (14.29%) had portal thrombosis at diagnosis. Twenty patients (47.62%) had advanced HCC (Barcelona Clinic Liver Cancer C (BCLC C)) and 21 (50%) had end-stage HCC (BCLC D). Management was palliative in 41/42 patients. The in-hospital death rate was 23.81%. Conclusion: HCC are diagnosed at advanced stage in this study. The prognosis is poor for most patients. HBV infection is the main risk factor. An effort should be made for early diagnosis and prevention.
International Journal of Progressive Sciences and Technologies, Oct 29, 2019
Upper gastrointestinal bleeding is one of main digestive emergencies and remains a major cause of... more Upper gastrointestinal bleeding is one of main digestive emergencies and remains a major cause of morbidity and mortality. Eighty percent of acute HD are of high origin. By this work, we document the epidemiological, clinico-biological aspects of upper gastrointestinal bleeding. This is a descriptive study of patients who presented upper gastrointestinal bleeding at Hepato-gastroenterology unit of Joseph Raseta Befelatanana Antananarivo (Madagascar) University Hospital during 5 months. During this period, 31 patients had been admitted for high gastrointestinal bleeding. The average age of patients was 49.6 years. There were more men than women. Melena was the most common manifestation (n = 21, 67.7%). Ulcerative (32.3%, n = 10).and variceal bleeding (54.8%, n = 17) were predominant. Optimal initial management of co-morbidities and haemorrhage with early endoscopic examination may improve the prognosis of upper gastrointestinal bleeding.
Journal Africain d?Hépato-Gastroentérologie
Aim To list digestive diseases encountered at the Department of Gastroenterology, University Hosp... more Aim To list digestive diseases encountered at the Department of Gastroenterology, University Hospital of Antananarivo in aim to assess morbidity and mortality rate. Materials and methods A retrospective study of patient’s files including digestive diseases was conducted between the 1st January 2007 and 30th June 2009. Results Digestive diseases have represented 16,03% of all admissions. Three hundred twenty eight cases of digestive diseases were recorded corresponding to 276 patients. Men were more frequent between 30 and 70 years old (n = 139; 42,37%). Cirrhosis was the main pathology (n = 110; 33,54%) followed by duodenal ulcers (n = 9; 9,76 %). Cirrhosis was responsible of the highest mortality rate (n = 25; 22,73%). Conclusion Digestive diseases are frequent in a department of medicine in Madagascar. Amongst digestive diseases, cirrhosis is the most frequent and is responsible of high mortality rate.
Médecine d'Afrique noire
In Madagascar, the susceptibility of the bacteria responsible for infection of urinary tract in a... more In Madagascar, the susceptibility of the bacteria responsible for infection of urinary tract in adult patients at hospital is underrated. Our purpose was to determine the rate of resistance of bacteria to antibiotics in infection of urinary tract in aim to improve management. We conducted a retrospective descriptive study from October 2002 to august 2008 at 2 internal medicine services in Antananarivo. Amongst 2933 inpatients, 417 have got cyto-bacteriology examination of urine. One hundred and fourteen were diagnosed as infection of urinary tract. Mean age was 55,6 year-old and sex-ratio was 0,6. One hundred and twenty five strains were isolated. Enterobacteria were the most frequent agent (78,4%), particularly Escherichia coli (44,8%) and Klebsiella pneumonia (11,2%). Escherichia coli loss susceptibility to amoxicillin (15,4%) and the association trimethoprim-sulfamethoxazole (15,2%). However, they remained sensitive to 3rd generation cephalosporin (91,7%) and to fluoroquinolon (8...
Médecine tropicale : revue du Corps de santé colonial, 2010
Cirrhotic patients have poorer life expectancy than the general population. The purpose of this s... more Cirrhotic patients have poorer life expectancy than the general population. The purpose of this study was to identify causes of death in a sample of cirrhotic patients from Madagascar. A retrospective analytic and descriptive study was conducted on the files of cirrhotic inpatients admitted to the gastroenterology department of the Joseph Raseta Befelatanana University Hospital Center in Antananarivo, Madagascar from January 1, 2003 to June 30, 2007. The files of 117 patients were reviewed. Death occurred in 31 cases for a mortality rate of 26.5%. The main causes of death were disorders of consciousness (51.6%) and hypovolemic shock (25.8%). Jaundice, encephalopathy, and gastrointestinal bleeding were predictive factors for mortality. Cirrhotic patients in this study were hospitalized at a late stage of disease. Further prospective study in a larger sample will be needed to standardize the management protocol in Madagascar.
La Revue de Médecine Interne, 2009
Clinical and Experimental Gastroenterology
Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. ... more Mucormycosis is a rare systemic fungal infection, mainly observed in immunocompromised patients. It is responsible for surface and deep tissue destruction leading to perforations and hemorrhage. Its pathogenesis represented by an angio-invasion is at the origin of a local infarction and a vascular thrombosis. We report a case of gastrointestinal (GI) mucormycosis-induced multiple gastric ulcers, GI bleeding and rectal perforation. Case Presentation: A 75-year-old man, with type II diabetes mellitus, was admitted to the intensive care unit for an acute abdominal pain associated with massive hematochezia. Clinical examination was that of an acute peritonitis and a hemorrhagic shock state. Abdominal and pelvic CT scan with intravenous contrast concluded to a perforation of the anterior wall of the rectum. He underwent immediate laparotomy with temporary colostomy. Several upper GI endoscopies had shown multiple gastric ulcer lesions. Lower GI endoscopy showed a fistulous orifice of the rectum on its anterior surface. Histopathology of the gastric biopsy showed acute and subacute inflammatory changes with filamentous elements suggesting mucormycosis. Histopathology of the rectal biopsy showed a subacute non-specific inflammation. Culture of the secretions from the rectal fistula orifice showed the strain Rhizopus sp. Antifungal susceptibility testing reported sensitivity to liposomal amphotericin B. The diagnosis of GI mucormycosis-induced multiple gastric ulcers, rectal perforation and pulmonary embolism in the patient with type II diabetes mellitus was retained. The outcomes were favorable after 6 weeks of treatment with liposomal amphotericin B associated with temporary colostomy and appropriate diabetes management. Conclusion: GI mucormycosis remains a multidisciplinary diagnostic challenge, less frequent in clinical practice, with a long diagnostic pathway. This opportunistic systemic mycosis can lead to numerous GI complications including perforation, massive GI bleeding and even multiple extra-GI complications. GI mucormycosis has a good prognosis if it is treated early with medical and surgical treatment.
BioMed Research International
Background. Accessibility of full dose daily of tenofovir disoproxil fumarate (TDF) is limited in... more Background. Accessibility of full dose daily of tenofovir disoproxil fumarate (TDF) is limited in Madagascar with an estimated cost well above the purchasing power of Malagasy population. Objective. The study is aimed at evaluating the efficacy and safety of low-dose tenofovir for the treatment of chronic hepatitis B (CHB). Methods. This prospective cohort study from January 2018 to December 2020 was conducted in the Department of Hepato-Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. The patients enrolled in the study received low dose of TDF 900 mg/week (300 mg daily, three days per week). Results. A total of 45 patients (male/female: 31/14) were included. The mean age was 45.1 ± 11.5 years. Fifteen patients were nucleos(t)ide (NA)-naïve, and 30 patients had prior NA therapy (NA-experienced). Thirty patients were HBeAg positive. A complete virological response (CVR) was achieved in 36/45 patients (80%) at 3 months, 41/45 (91.1%) at 6 mon...
Hepatic Medicine: Evidence and Research
Background: Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypert... more Background: Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypertension in developing countries. Variceal bleeding is the most common cause of mortality during HSS. The objective of this study was to evaluate the efficacy of splenectomy associated with endoscopic variceal ligation (EVL) compared with EVL alone in preventing variceal bleeding in patients with HSS. Methods: This was a single-center, retrospective, case-control study. Between January 2015 and December 2019, a total of 59 patients with HSS who had at least one variceal bleeding episode and received EVL with or without splenectomy were identified and stratified. In this case-control design, 22 patients had splenectomy + EVL (case group) and 37 patients had EVL alone (control group). The main endpoints were the rate of variceal rebleeding and the mortality rate between the two groups. Results: The mean age of our patients was 39.92 ± 13.4 (19-75) years with a sex ratio of 1.8. The recurrence rate of variceal bleeding was significantly lower in the case group (splenectomy + EVL) than in the control group (EVL alone) (4.45% vs 27.2%, p = 0.041). There was no significant difference between the two groups in terms of mortality (4.54 vs 2.7%, p = 1.00). Conclusion: Splenectomy combined with EVL was effective than EVL alone in preventing variceal rebleeding in patients with HSS.
International Medical Case Reports Journal, 2022
Background: SARS-CoV-2 has been described as a respiratory tropic virus since its emergence in De... more Background: SARS-CoV-2 has been described as a respiratory tropic virus since its emergence in December 2019. During the course of the disease, other extra-pulmonary manifestations have been reported in the literature including pancreatic involvement such as acute pancreatitis. This phenomenon linking COVID-19 and acute pancreatitis has been reported by several case reports and cohort studies. No cases had been reported in sub-Saharan Africa and Madagascar. We report one more case Of COVID-19 induced acute pancreatitis in a Malagasy woman patient without risk factors, further consolidating the existing evidence. Case Presentation: A 44-year-old woman was diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and had a favorable course under home isolation and drug treatments. One week later, the patient was admitted to hospital with severe acute abdominal pain. Acute pancreatitis was considered according to the revised Atlanta criteria with the presence of the three criteria. Other etiologies of acute pancreatitis (lithiasis, alcohol, hypercalcemia, hypertriglyceridemia, tumor, trauma, surgery) were excluded. Ultimately, a COVID-19 induced acute pancreatitis was retained. The outcome was favorable under symptomatic medical treatment (fluid resuscitation, bowel rest, management of pain and vomiting, and early oral feeding). The patient was discharged after one week of hospitalization. Conclusion: COVID-19 is a possible etiology of acute pancreatitis. Acute pancreatitis should be routinely ruled out in a patient with COVID-19 infection with acute abdominal pain.
African journal of nephrology, Dec 2, 2021
Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated ci... more Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at the Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. results: The hospital prevalence of decompensated cirrhosis with HRS was 7.9% (41/519). The mean age of the patients was 49.8 ± 11.33 years (range 25-70 years). Male gender predominated at 83% (n = 34). History of alcohol (46.3%) and viral hepatitis B (34.1%) were the main aetiologies of cirrhotic disease. Most of our patients (88%) had a Child-Pugh C score. HRS occurred during the first decompensation (63.4%) and the first years of cirrhosis (81%). Spontaneous bacterial peritonitis (46%) and gastrointestinal bleeding (32%) were the main risk factors. HRS type-1 predominated at 66% (n = 27). The prognosis was poor with a mortality rate of 81% (100% in HRS type 1 and 42.9% in type 2). Most patients (n = 22; 67%) died within 14 days. conclusion: The prevalence of HRS was 7.9%. It affects young people with advanced cirrhosis. The prognosis is grim with a mortality rate of 81%.
The Egyptian Journal of Internal Medicine, 2022
Choledochal cysts (CDCs) are characterized by congenital cystic dilations of the intrahepatic or ... more Choledochal cysts (CDCs) are characterized by congenital cystic dilations of the intrahepatic or extrahepatic bile ducts or both. CDCs are very rarely reported in sub-Saharan Africa. This congenital anomaly of the bile ducts is rarely discovered at the stage of advanced chronic liver disease with portal hypertension. We report the first Malagasy case of a type IVA choledochal cyst discovered during an etiological work-up of cirrhosis. A 23-year-old woman was hospitalized for jaundice and ascites. Biological and radiological investigations have led to the diagnosis of secondary biliary cirrhosis due to type IVA choledochal cyst. In view of the severity of the liver damage (Child-Pugh C score), a collegial decision (hepato-gastroenterologists and visceral surgeons) had rejected surgical intervention and opted only for the management of cirrhotic decompensation. A type IVA choledochal cyst is a possible etiology of advanced chronic liver disease.
Objective. Our work aimed to assess the efficacy and safety of direct-acting antiviral drugs in t... more Objective. Our work aimed to assess the efficacy and safety of direct-acting antiviral drugs in the treatment of hepatitis C in Madagascar. Methods. This retrospective clinical study was carried out from March 2018 to February 2020 in the hepato-gastro-enterology department of the University Hospital Center Joseph Raseta de Befelatanana. Results. A total of 35 patients were included, out of which 24 received sofosbuvir/ledipasvir ± ribavirin, 10 sofosbuvir/ribavirin and one sofosbuvir/velpatasvir. Thirty-three patients were naïve to the treatment and 2 patients were initially treated with the sofosbuvir/ledipasvir combination. The sustained virologic response was 94 % (33/35) in the general population, 23/25 in cirrhotic patients and 10/10 in non-cirrhotic patients. The sustained virologic response was 22/24 for sofosbuvir/ledipasvir ± ribavirin, 10/10 for sofosbuvir/ribavirin and 1/1 for sofosbuvir/velpatasvir. Adverse effects were observed in 13 patients, mainly asthenia and insom...
Clinical Case Reports, 2021
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
L’avenement des anti-TNF a revolutionne la prise en charge des maladies inflammatoires chroniques... more L’avenement des anti-TNF a revolutionne la prise en charge des maladies inflammatoires chroniques, notamment intestinales (MICI). Parallelement a une utilisation de plus en plus frequente, de nombreux effets secondaires, notamment cutanes, sont rapportes et leur prise en charge mieux apprehendee par les cliniciens. Les effets secondaires cutanes les plus frequemment decrits sont les reactions au point d’injection (RPI), les reactions a la perfusion, les infections cutanees et les eruptions psoriasiformes. Les RPI resultent d’une hypersensibilite retardee mediee par les lymphocytes T. Les reactions aux perfusions sont preferentiellement des reactions anaphylactoides, plus rarement de vraies hypersensibilites. Les eruptions psoriasiformes correspondent, soit a une exacerbation d’un psoriasis preexistant, soit a l’apparition d’un psoriasis de novo, soit a des reactions psoriasiformes drogues induites. Ces differentes reactions cutanees de gravite variee ne necessitent pas obligatoireme...
International Journal of Infectious Diseases, 2021
The aim of this study was to evaluate the efficacy and safety of sofosbuvir/ledipasvir AE ribavir... more The aim of this study was to evaluate the efficacy and safety of sofosbuvir/ledipasvir AE ribavirin in Malagasy patients with hepatitis C virus genotypes 1 and 2, in real conditions. Patients and methods: This was a retrospective monocentric clinical study, carried out over a period of 3 years from March 1, 2017 to February 28, 2020, in a hospital hepato-gastroenterology department. Results: In total, 26 patients (M/F: 11/15) with hepatitis C virus genotype 1 (n = 13) or genotype 2 (n = 13), were treated with sofosbuvir/ledipasvir without (n = 21) or with (n = 5) ribavirin for 12 weeks. The mean age was 61.38 AE 7.09 years. Seventeen patients (65.4%) had cirrhosis. The overall sustained virological response was 96.2% (95% CI = 80.4-99.9%). There was no significant difference between the sustained virological responses of genotypes 1 and 2 (92.3% vs 100%; p = 0.31) or those of cirrhotic or non-cirrhotic patients (94.1% vs 100%; p = 0.46). A relapse was observed in one patient (5.9%)cirrhotic and genotype 1bunder sofosbuvir/ledipasvir with ribavirin. Seven patients (26.9%) experienced mild adverse reactions, including asthenia (57.1%) and insomnia (42.9%). Conclusion: Treatment with sofosbuvir/ledipasvir AE ribavirin for infection with hepatitis C virus genotype 1 has been shown to be safe and effective, even in the presence of cirrhosis. The sofosbuvir/ledipasvir combination is a good option for genotype 2 non-cirrhotic patients.
JGH Open, 2021
Salmonella typhi remains an endemic disease in Madagascar. Acute pancreatitis remains a rare comp... more Salmonella typhi remains an endemic disease in Madagascar. Acute pancreatitis remains a rare complication of S. typhi colitis. We presented the case of a 27‐year‐old male, admitted to febrile diarrhea, vomiting, and severe abdominal pain. Blood work‐up revealed elevated plasma lipase level. Abdominal CT scan showed acute pancreatitis without necrosis. Blood and stool culture positivity for S. typhi. Patient was diagnosed as acute pancreatitis caused by S. typhi. The outcome was favorable under symptomatic medical treatment (rehydration and analgesic) combined with adapted antibiotic therapy. Acute pancreatitis is a possible complication of Salmonella infections. The presence of severe abdominal pain and febrile diarrhea should draw clinicians' attention to possible Salmonella acute pancreatitis.
Arteria lusoria is a rare cause of dysphagia in which dysphagia due to esophageal compression. Th... more Arteria lusoria is a rare cause of dysphagia in which dysphagia due to esophageal compression. The upper GI endoscopy does not bring significant element that can orient the diagnosis. The injected thoracic CT scan remains the key examination for the diagnosis of dysphagia lusoria and to characterize the defective artery.
International Journal of Infectious Diseases, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.