Current Issue : October - December Volume : 2018 Issue Number : 4 Articles : 7 Articles
Current antiretroviral therapy has reduced morbidity and mortality of HIV\npatients. However, their induced hepatotoxicity constitutes a risk. In this issue,\nwe report a clinical case of fulminant hepatitis, observed in the HIV unit\nof the hepatogastroenterology department of the General hospital of Loandjili\nin Pointe-Noire. The patient is a 36-year-old female HIV treated with triple-\ndug combination antiretroviral therapies (ART) including one antiprotease\n(ritonavir) and two non-nucleoside reverse transcriptase inhibitors (nevirapine\nand efavirenz). He developed fulminant hepatitis five years after treatment\ninitiation. He succumbed to the side effects. Although antiretroviral\ncombination therapies are the standard of care for HIV infection, increased\nvigilance is warranted to early identify this side effect and adjust treatment in\norder to prevent fatal consequences....
Gut microbiota is established during birth and evolves with age, mostly maintaining the commensal relationship with the host.\nA growing body of clinical evidence suggests an intricate relationship between the gut microbiota and the immune system. With\nageing, the gut microbiota develops significant imbalances in themajor phyla such as the anaerobic Firmicutes and Bacteroidetes as\nwell as a diverse range of facultative organisms, resulting in impaired immune responses. Antimicrobial therapy is commonly used\nfor the treatment of infections; however, this may also result in the loss of normal gut flora. Advanced age, antibiotic use, underlying\ndiseases, infections, hormonal differences, circadian rhythm, and malnutrition, either alone or in combination, contribute to the\nproblem. This nonbeneficial gastrointestinal modulation may be reversed by judicious and controlled use of antibiotics and the\nappropriate use of prebiotics and probiotics. In certain persistent, recurrent settings, the option of faecal microbiota transplantation\ncan be explored. The aim of the current review is to focus on the establishment and alteration of gut microbiota, with ageing. The\nreview also discusses the potential role of gut microbiota in regulating the immune system, together with its function in healthy\nand diseased state....
Hepatitis E virus (HEV) is a common etiology of acute viral hepatitis worldwide. Recombinant HEV vaccines have been developed,\nbut only one is commercially available and licensed in China since 2011. Epidemiological studies have identified genotype 3 as the\nmajor cause of chronic infection in immunocompromised individuals. Ribavirin has been shown to be effective as a monotherapy\nto induce HEV clearance in chronic patients who have undergone solid organ transplant (SOT) under immunosuppressive therapy.\nEfforts and improvements in prevention and control have been made to reduce the instances of acute and chronic hepatitis E in\nendemic and nonendemic countries. However, this review shows that further studies are required to demonstrate the importance\nof preventive vaccination and treatment worldwide, with emphasis on hepatitis E infection in the public health system....
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is\nassociated with high morbidity and mortality in the absence of clinical management,\nmaking identification of these cases crucial. Screening for hepatitis\nviral-HIV coinfection before initiation of treatment for viral hepatitis or HIV\nis recommended. In this context, we report a case of possible cross-reaction\nbetween the serology of viral hepatitis C and HIV infection by rapid diagnostic\norientation tests. Although these rapid tests are the main diagnostic tools\nin developing countries, their scientific validation must be required before\nthey are made available to practitioners. The knowledge and the rigorous application\nof diagnostic algorithms of viral infections will make it possible to\nsave money and to better organize the prevention and management strategies\nfor patients as part of an integrated Hepatitis/HIV program....
Due to the increase in the incidence of upper gastrointestinal bleeding, the\ntreatment methods are more and more diversified. With the popularization of\nendoscopic techniques and the wide range of endoscopic hemostasis methods,\nendoscopy has become an important method for the treatment of upper gastrointestinal\nbleeding, and greatly updated the treatment concept of upper\ngastrointestinal bleeding. In this paper, we reviewed the literature reports of\nendoscopic treatment of upper gastrointestinal bleeding in recent years....
Background: Autoimmune hepatitis (AIH) is a hepatocyte injury characterized\nby a dis-regulated immune system, inflammation of the liver with interface\nhepatitis, serum antibodies and elevated gamma-globulins. Currently, it\nexists 2 mainly types on autoimmune hepatitis, based on the presentation of\ntheir autoantibodies: type 1 and 2. Type 1 is the one of interest in this review.\nAutoimmune hepatitis type 1 is an indolent inflammatory disease mediated by\nabnormal autoimmune reaction, commonly seeing in women (4:1), with no\npreference of age, however typically present in 4th and 6th decade�s individuals,\nand a good response to immunosuppressive therapy. Autoimmune hepatitis\nis known to present not specific symptoms which can go from inexistent to\nfulminant or exacerbate presentation. The incidence of autoimmune hepatitis\nin western country is 1/5000 - 1/10,000. Although the detection rate of AIH\nincreasing, especially in China, autoimmune hepatitis diagnosis and treatment\nremain challenging. Most AIH case do not present pathognomonic biomarkers,\nhowever the diagnostic has to considerate other features, which had been\ncodified into validated diagnosis scoring systems. Regarding the treatment,\nbased on prior literature autoimmune hepatitis is mostly sensitive to prednisone\nor azathioprine, however the use of other immunosuppressive agent or\nevent their combination had offer distinct advantages. Autoimmune hepatitis\npresents a great life threatening disorder especially because of the delay in the\nearly stage on the disease, the not specific presentations, and the large overlap\nsyndrome associate with it. A deep knowledge in its identification, specific\ndiagnostic criteria, and its therapeutic strategy is much needed. Conclusion:\nAutoimmune hepatitis is a systemic disease that is difficult to recognize because\nof its variable clinical presentation and histological features that are not\nstrictly specific. Several new autoantibodies as well as recently simplified diagnostic\ncriteria may allow the primary care physician to progress in the diagnostic\nprocess. This is all the more important as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis and immunosuppressive\ntreatment leads to remission in a large majority of cases....
Diffuse varioliform gastritis is a rare attack of the gastric mucosa occurring\nmostly on atopic ground. This report is based on the observation of a\n16-year-old girl with diffuse varioliform gastritis discovered after an internal\nmedical examination via endoscope after attempting a suicidal act by overdosing\nherself with Ibuprofen. After the medical examination of the patient.\nDespite the quantity of ingested ibuprofen and presence of Helicobacter pylori\non the biopsie, the particularity of this study is that there is no exudative lesion\nof the gastric mucosa. With h�©licobacter pylori eradication evolution was\nfavorable....
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