The purpose of this study of patients with pancytopenia in Republic of Djibouti was to identify etiologic factors and attempt to define diagnostic and therapeutic strategies adapted to local conditions. Clinical, biological and radiological assessment was performed in 81 patients hospitalized for pancytopenia. There were 56 men and 25 women. Mean hemoglobin, leukocyte and platelet rates were 56,5 +/- 22,7 g/l, 2,1 +/- 0,7.g/l and 56,2 +/- 24,7 g/l respectively. Vitamin deficiency was the most common cause of pancytopenia (49%), followed by hypersplenism (9%), HIV infection (6%) and leishmaniasis (6%). Vitamin-deficient patients had significantly more severe anemia and thrombopenia and significantly higher mean corpuscular volume than patients with pancytopenia related to other causes. Hemoglobin rate lower than 40 g/L and platelet rate lower than 35 G/L showed a positive predictive values of 90% and 100% respectively for a vitamin deficient pancytopenia. Vitamin deficiency is the most frequent etiology of pancytopenia and causes the most severe cytopenia in Djibouti. Rapid vitamin supplementation after minimal etiologic assessment including a myelogram is an effective treatment strategy for this public health problem.

Background/Aims: One hundred and eleven patients with acute hepatitis and 61 controls were investigated for hepatitis serological markers in order to determine the viral etiology of cases involved in a waterborne epidemic of hepatitis observed in 1993 in Djibouti, Republic of Djibouti (East Africa). These cases occurred both in indigenous Djiboutians, and in French soldiers and their families in Djibouti, A retrospective study of the viral etiology of acute hepatitis cases observed in French soldiers and relatives living in Djibouti during the 3-year period preceding the epidemic was also undertaken.Methods: HAV, HBV and HCV infections were investigated using commercial ELISA tests. HEV infections were investigated by testing IgG and IgM-specific antibodies by means of three different ELISA tests using recombinant proteins or synthetic peptides,Results: Hepatitis A was observed in 37 (33%) and hepatitis E in 43 (39%) of the 111 cases of acute hepatitis recorded during this epidemic. Hepatitis B represented only 6% of the indigenous cases and hepatitis C was not observed among the cases investigated. Anti-HEV IgG antibodies were also detected in 19% of the indigenous control group.Conclusion: These results suggest that both HAV and HEV were responsible for this waterborne epidemic of acute hepatitis. However, HAV and HEV infections were not equally distributed between French expatriates and Djibouti residents. Whereas HAV infections were mainly observed in French patients, HEV was almost exclusively found in indigenous patients. This study reports for the first time a waterborne outbreak of acute hepatitis simultaneously due to HAV and HEV.

A ce jour en Polynesie Francaise et en Nouvelle-Caledonie, les patients presentant une infection ciguaterique recoivent un traitement standard: calcium+polyvitaminotherapie B 6 +C par voie intraveineuse (IV), auquel le medecin ajoute suivant le tableau clinique diverses medications a visee symptomatique. En 1988, une etude menee a Majuro, aux Iles Marshall, a conclu a l'efficacite du mannitol par voie intraveineuse, dans le traitement d'intoxications graves avec suspicion d'oedeme cerebral. Depuis, ce traitement a ete employe avec succes dans plusieurs regions d'endemie

Brucellosis is an ubiquitous anthropozoonoses in the Republic of Djibouti, but it has only been studied in the City of Djibouti. This retrospective study of 42 cases of human brucellosis diagnosed between April 1993 and April 1995 was carried out at the Peltier Hospital in Djibouti to obtain epidemiological data concerning brucellosis in the Republic of Djibouti. Diagnosis was based on clinical symptoms and positive immunologic tests (Rose Bengal test > 100 UI and Wright serology > 1/80). The following information was obtained for each patient: nationality, ethnic origin, place of residence, age, sex, and risk factors for exposure to infected animals or products. There were 30 men and 12 women including 38 Djiboutis, 3 Somalis, and 1 Ethiopian. Ethnic origin was Afar in 32 cases, Somali in 6 cases, and undetermined in 4 cases. Mean age was 31.6 years. Of the 38 Djiboutis, 15 lived in the district of Djibouti, 17 in the district of Tadjourah, 3 in the district of Obock, and none in districts located in the Southern part of the country. In 18 cases brucellosis involved cattle raisers from the Northern part of the country. In five cases no risk factor could be identified. The incidence of brucellosis in the Republic of Djibouti appears to be comparable to that observed in other highly endemic countries. Further study is needed to determine the exact incidence in man and animals and ascertain the need and feasibility of preventive measures.

La brucellose est une anthropozoonose ubiquitaire qui a ete etudiee, en Republique de Djibouti, uniquement sur Djibouti-ville. Cette etude retrospective concerne 42 cas de brucellose humaine diagnostiques entre avril 1993 et avril 1995 dans les services medicaux de l'Hopital Peltier a Djibouti. Elle a pour objet d'individualiser les caracteristiques epidemiologiques de la brucellose en Republique de Djibouti. Le diagnostic de brucellose a ete porte devant l'association de signes cliniques compatibles et de tests immunologiques positifs (Rose Bengale superieur a 100 UI et serologie de Wright superieure au 1/80 e ); pour chaque patient, les caracteristiques suivantes ont ete repertoriees: nationalite, origine ethnique, district et localite d'origine, âge, sexe et facteurs de risque d'exposition a l'agent pathogene. Il a ete denombre 30 hommes et 12 femmes, 38 djiboutiens, 3 somaliens et 1 ethiopien. Trente deux etaient d'ethnie Afar, 6 d'ethnie Somalie, 4 d'ethnie inconnue. L'âge moyen etait de 31,6 ans. Parmi les 38 djiboutiens, 15 vivaient dans le district de Djibouti, 17 dans les districts de Tadjourah, 3 dans le district d'Obock, aucun dans les districts situes au sud du pays. Il a ete releve 18 eleveurs, tous originaires des districts du nord tandis que 5 etaient sans facteur de risque evident. L'incidence de la brucellose humaine en Republique de Djibouti est probablement, pour le nord du pays, comparable a celle des pays a forte endemie. Il apparait necessaire d'evaluer l'incidence exacte de la maladie humaine et animale afin de juger de l'opportunite d'une strategie de prevention.

Authors report the results of a clinical study of 120 patients with a confirmed leptospirosis in french polynesia between 1984 and 1990. They show the clinical variety, the illness's complications, the difficulties of the diagnosis's confirmation and the evolution treated by penicillin. Three deaths were mourned.

Authors report the results of a clinical study of 120 patients with a confirmed leptospirosis in french polynesia between 1984 and 1990. They show the clinical variety, the illness's complications, the difficulties of the diagnosis's confirmation and the evolution treated by penicillin. Three deaths were mourned.

This prospective study of a duration of 7 months was made on 52 patients admitted in a International Medicine Service and watched over psychological aspect. The sample was composed mainly of Polynesians, two third of them being females. On the somatic aspect, the complaint more frequently recorded is a painful condition. Diagnosis of depressive status is made about almost half of the patients. The most obvious point is that Polynesian depressive patients are young and they expressed their profound discomfort not only by a suicidal attitude but also by a symptomatology in which body, body surface are the privileged significants.

Frequency of gout in French Polynesia has induced us to define a type of "hyperuricemia Polynesian" from a population of patients admitted in a general Medicine Ward. Each admitted patient gets immediately a blood check-up. A figure higher than 70 mg/l in male and 60 mg/l in female is considered as pathological. In such a case, uricemia and uraturia are tested every 24 h for three days and we consider the mean value of these three tests. On the other side, some admitted patients non-hyperuricemic, are examined according to the same protocol. So, we have two groups: 31 hyperuricemics and 20 non-hyperuricemics, secondarily grouped according to age, sex, ethnic. We did not consider some secondary causes of hyperuricemia (chronic renal insufficiency diuretic treatment, psoriasis etc.). 1. Within the hyperuricemic population, mean uricemia is 85.35 mg/l versus 52.65 mg/l in the second sample. In the hyperuricemic group (21 males and 10 females) 48% are gouty and 13% of them are females. Articular manifestations are acute arthritis, affecting mainly inferior limbs, ankles, knees). We did not notice any significant divergence between uricemia and uraturia of gouty and non gouty people. Within the group of gouty people, percentage of individual hyper excretion is 53% (uraturia greater than 600 mg/24 h) with no significant divergence with the non-gouty group: Nephrolithiasis is rare (3%). There is no significant divergence between urinary pH of gouty and non-gouty people. Associated metabolic troubles are: diabetes (26%) high triglyceridemia (43%) three syndromes associated together (hyperuricemia + diabetes + hypertriglyceridemia) in 19.5%, total cholesterol is normal (2.07 g/l) but a low cholesterol (0.30 g/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Seven Polynesians suffered from Hodgkin's disease were admitted in the territorial Hospital Center in 6 years. They came from different Polynesian archipelagos. Three of them are 30 years old and 3 are 40 years old. Diagnosis is based on an histological test, but has to be confirmed by a center specialized in lymphomae investigations since a scanner has been installed at the Territorial Hospital Center of Papeete (March 1987) results are satisfactory: echography and abdominal scanner lymphography and thoracic scanner osteoma medullare biopsy and liver biopsy puncture. Six patients presented a diffuse lesion (III B or IV) and one an intermediary phase (II B2). Treatment started by chemotherapy MOPP and ABVD alternatively. Four patients out of seven did not continue their treatment up to the end; one patient aged 34, after six treatments by MOPP and a recovering treatment by MIME got an autograft of bone marrow in Paris in October 1989, and he is actually in a good shape. Most of the patients are out of control. Application of complex therapeutic protocols during several months and inducing side effects, demands a large agreement of both patients and relatives. That is very rarely got nowadays.

The authors make out a statement about HIV infection in French Polynesia at the date of 1991 December 31. 96 cases all together of seropositive and AIDS infected people were recorded. These patients are young generally (78 p.c. between 21 and 40 years old) sexually contaminated (72 out of 96) and live in Tahiti island (94 p.c.). Sex-ratio is 2.8 male/1 female. Among them, we noted 55 p.c. of Europeans, 38 p.c. of Polynesians and 7 p.c. of Asiatic people. Epidemiological monitoring of the infection was made easy because of a set of laws and possibilities of detection highly favourable. Progress of the infection is constant, with 20 new cases detected each year with a prevalence of 150 cases of AIDS per 1 million of inhabitants, French Polynesia could be classified as the 5th or 6th region of France as far as the importance of the disease. Clinical, biological and epidemiological taking of charge of patients is detailed as well as the prevention campaign.Serological surveillance of HIV infection in accordance with World Health Organization guidelines has taken place in French Polynesia since 1985. 20,000 tests are conducted annually in a population not exceeding 200,000. 30% of tests are among blood donors. An average of 20 new cases of HIV infection are diagnosed each year. A total of 96 cases of HIV infection or AIDS were reported to the public health authorities between 1985 and December 31, 1990. 78% of the 96 persons were aged 21-40 years. The sex ratio was 2.8 men per woman. 55% were in Europeans (53 cases among 24,000 European residents), and 7% were in Asians (7 cases among 10,000 Asians). 94% of the patients were inhabitants of Tahiti. 44 of the 96 patients were male homosexuals or bisexuals, 18 were heterosexuals with multiple partners, 13 received transfusions before 1985, 10 were sex partners of seropositive persons, 9 were former addicts, 1 was the infant of an infected mother, and 1 had no known risk factor. ELISA tests were conducted in 6 different laboratories in the island of Tahiti, with confirmation by Western blot at the laboratory of the Louis Mallarde Territorial Medical Research Institute. Contacts are traced and tested, and seropositive individuals are followed regularly, with consultations at 6 month intervals for seropositive persons. Of the 46 patients present in the territory as of December 1990, 36 were at stage 1, 2 at stage 2, 5 at stage 3, and 3 at stage 4 according to the World Health Organization guidelines. 20 of the other 50 had died and 30 left the territory.

The authors report on the results of a survey on cardiovascular accidents hospitalized between 01 April 1990 and 31 January 1991 carried out in the Services of Medicine and Cardiology in the Territorial Hospital Center of Papeete. This survey was: 56 cardiovascular accidents: 1/4 (hemorrhagic and 3/4 (42) ischemic. Mean age 59 (extremes 23-86). 36 males (64%); 20 females (36%). 50 Polynesians; 6 Chinese people. Among the risk factors recorded, 38 (68%) were hypertensed patients; 17 (30%) were due to tabagism and 15 (25%) to diabetes; 3 (5%) are known to be carriers of a hypercholesterolemia. 59% of the patients had no case history; 25% the cardiovascular accidents have been observed in patients with cardiopathy; 12.5% are recurrent cardiovascular accidents. Clinically, 5 transient ischemic accidents (12%) out of 42 cardiovascular ischemic accidents. High arterial tension was recognized in 12/14 (86%) of hemorrhagic cardiovascular accidents and in 26/42 (62%) of ischemic cardiovascular accidents. In 42 ischemic cardiovascular accidents, 31 patients suffered from cardiopathy (74%) of which 15 (36%) presented an embolic cardiopathy. Interest of echography and electrocardiogram are discussed. Ultrasonic exam of carotid vessels was found abnormal in almost half of the cases when utilized (12/26). Finally, etiological diagnosis was certain in 17 cases, of presumption in 16 cases, and in 9 cases, it was not possible to precise any cardiovascular etiology. Tomodensitometric tests are discussed. 86% of the ischemic cardiovascular accident were treated with anticoagulants/thrombocyte antiagglutination. 24% of the patients died, 50% recovered incompletely and 26% completely.

Les auteurs rapportent le suivi a la consultation de diabetologie du Centre Hospitalier Territorial de Papeete de 51 patients polynesiens, diabetiques non insulinodependants (DNID) pendant une duree de 12 a 30 mois (26,5 mois en moyenne) de juillet 1988 a decembre 1991. -31 hommes et 20 femmes (sex-ratio 1,5); l'âge moyen est de 55,9 ans; les extremes sont de 22 et 76 ans. -Facteurs de risque du diabetique non insulinodependant: heredite (43%), obesite (67%); enfants avec poids de naissance >4 kg (10%), -les modes de revelation du diabete les plus frequents: bilan systematique (37%), complications cliniques (36%), signes cardinaux (20%)

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers : rates of mistaken and doubtful results were similar with both investigations (10 %) ; specificity of both tests was comparable (90 %) but sensitivity was significantly greater for CT scan (91.2 %) than for conventional roentgenograms (71.6 %), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revelaed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers: rates of mistaken and doubtful results were similar with both investigations (10%); specificity of both tests was comparable (90%) but sensitivity was significantly greater for CT scan (91.2%) than for conventional roentgenograms (71.6%), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revealed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.