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Evaluation of the Strategy and Efficacy of Treatment of Chronic Viral Hepatitis C with the Sofosbuvir/Daclatasvir Combination in a Resource-Limited Country

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Open Journal of Gastroenterology 2024年第7期14卷 233-240页

作者： Mayanna Habkreo ali mahamat moussa Adama Ahmed Ngare Abdraman Kossou Tahir mahamat Saleh Maire Dehainsala mahamat ali Hachim mahamat ali Bolti Oumaima Djarma Joseph Madtoingue Service de Gastroentrologie/Mdecine Interne du Centre Hospitalier Universitaire la Rfrence Nationale NDjamena Chad Service de Gastroentrologie du Centre Hospitalier Universitaire la Renaissance NDjamena Chad Service de Maladies Infectieuses du Centre Hospitalier Universitaire la Renaissance NDjamena Chad Service de Maladies Infectieuses du Centre Hospitalier Universitaire la Rfrence Nationale NDjamena Chad

Introduction: The treatment of viral hepatitis C (HCV), a major public health problem, has evolved considerably since the introduction of direct-acting anti-virals (DAAs). The aim of this study was to evaluate the strategy for initiating treatment with Sofosbuvir/Daclatasvir, and also to assess its efficacy. Patients and Methods: Included were patients aged at least 15 years, with detectable hepatitis C viremia and treated with a pan-genotypic Sofosbuvir/Daclatasvir regimen at the Centre “Hospitalier Universitaire la Référence Nationale de N’Djamena” between October 2019 and October 2023. The APRI score was used to assess fibrosis. Cure was defined by an undetectable viral load 12 weeks after the end of treatment. Results: A total of 835 patients were included (sex ratio 1.55, mean age 50.5 ± 13.73, extremes 20 and 84 years). The 60 - 69 age group was the most represented. The mean APRI score was 0.42 ± 0.29, with extremes of 0.019 and 1.84. The mean viral load was 2,316,193.086 IU/mL. All subjects had good renal function. Cytolysis was absent in 70% of cases. Without genotyping, a pan-genotypic regimen was used in all patients: Sofosbuvir (400 mg)/Daclatasvir (60 mg). The cure rate was 99.4%, with good tolerability. However, four cases of failure were recorded out of the 668 patients who underwent follow-up HCV-PCR testing after 12 weeks of treatment. Conclusion: The Sofosbuvir/Daclatasvir regimen is highly effective, with an excellent safety profile. However, the still high cost of these molecules limits their accessibility to a large proportion of patients.

关键词： Efficacy Tolerance Sofosbuvir/Daclatasvir HCV Chad

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Visceral Leishmaniasis at the National Reference University Hospital Center of N’Djamena (Chad): Epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

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Advances in Infectious Diseases 2024年第2期14卷 478-486页

作者： Joseph Mad-Toïngué mahamat ali Ahmat Oumaïma mahamat Djarma alifa Adjibera Philippe ali mahamat moussa Ngakoutou Rangar Choua Ouchemi mahamat ali Bolti Djiddi ali Sougoudi Mamissou Didi mahamat Doungous Atim Service des Maladies Infectieuses CHU de Référence Nationale N’Djamena Chad Service de Gastroentérologie et Médecine Interne CHU de Référence Nationale N’Djamena Chad Service de Pneumologie et Phtisiologie CHU de Référence Nationale N’Djamena Chad Service de Chirurgie viscérale CHU de Référence Nationale N’Djamena Chad Service de Médecine CHU de la Renaissance N’Djamena Chad

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases Department of the Centre Hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. Epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

关键词： Visceral Leishmaniasis Gold Mining Sites Chad

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Eradication Treatment of Helicobacter pylori Infection: Evaluation of Therapeutic Strategies in N’Djamena

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Open Journal of Gastroenterology 2024年第2期14卷 59-67页

作者： Mayanna Habkréo ali mahamat moussa Tahir mahamat Saleh Djerabet Franckly Fany Haby Mairé Dehainssala Adama Ngaré mahamat ali Hachim Service de Medecine Interne et Gastroenterologie Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad Service de Medecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad Service de Médecine Hopital de l’Amitié Tchad-Chine N’Djamena Tchad

Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion: H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.

关键词： Helicobacter pylori Therapeutic Strategies Eradication Dyspepsia Chad

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Tuberculosis in the Carcinal Environment in Chad Due to the Mycobacterium Tuberculosis Circulante Complex

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Journal of Biosciences and Medicines 2024年第2期12卷 214-224页

作者： Ahmat Idriss Ahmat mahamat Tahir Ngaré Hassan Ngandolo Bongo Nare Richard mahamat Adanao Adoudou Mbah Ntepe Leonel Javeres Hamidou Yacoubou ali mahamat moussa Laboratory for Diagnostic Research and Scientific Expertise University of N’Djamena N’Djamena Chad Veterinary and Zootechnical Research Laboratory of Farcha N’Djamena Livestock and Development Research Institute N’Djamena Chad Institute of Medical Research and Medicinal Plant Studies (IMPM) Ministry of Scientific Research and Innovation Yaoundé Cameroon Cameroon Ministry of Public Health Yaoundé Cameroon Faculty of Human Health Sciences University of N’Djamena N’Djamena Chad

Tuberculosis (TB) is a serious infectious disease and its control is considered a challenge, particularly among vulnerable populations such as prisoners. The prevalence of TB in prisons is an alarming public health problem in many countries. The aim of this study is to describe the epidemiology of tuberculosis and the strategies for controlling this disease in the Chadian prison population. During the course of our study, the prevalence of tuberculosis in prisons was 9.64%. The age group between 55 years and over (43.33%) was the most represented in this study, and all patients were men with a frequency of 62.66%. The cross-tabulation of Culture_7H9G and Culture_7H9P showed that out of our total positive sample, we found a total of 87 positive strains and 63 negative strains. Our study shows that it is essential to know the prevalence of tuberculosis in all the country’s prisons. Indeed, this can serve as an indication of the need for action in prisons to reduce TB rates, in particular by improving the structure of prison environments, diagnosing new cases quickly and accurately, identifying drug-resistant strains and implementing effective, direct treatment observed in people with tuberculosis.

关键词： Mycobacterium Prison Tuberculosis and Chad

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Hepatocellular Carcinoma in Chad: A Retrospective Study of 219 Cases

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Open Journal of Gastroenterology 2023年第11期13卷 382-392页

作者： ali mahamat moussa Pascal Pineau Mayanna Habkreo Gumbo Nedjim Tahir mahamat Saleh Adoum Abderrazak Fouda mahamat ali Hachim Adawaye Chatté Bessimbaye Nadlaou moussa Kalli Choua Ouchemi Service de Médecine Interne et Gastroentérologie Centre Hospitalier Universitaire La Référence Nationale N’Djamena Tchad Unité “Organisation Nucléaire et Oncogenèse” Institut National de la Santé et de la Recherche Médicale U993 Paris France Service de Médecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad Programme de Lutte contre le VIH et SIDA Hépatites et Infectins Sexuellement Transmissibles Ministère de la Santé Publique N’Djamena Tchad Service du Laboratoire Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad Service de Chirurgie Générale Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad

Background: Although hepatocellular carcinoma was historically considered an important scourge in Middle Africa, there is no publication describing this disease in Chad. Methods: We conducted a retrospective analysis of 219 patients with hepatocellular carcinoma (HCC) attending care at the University Reference Hospital of Ndjamena between 2007 and 2016. Results: This series of HCC was characterized by a male predominance (M:F = 2.4) with a mean tumor onset at the end of the fifth decade of life (49.9 ± 14.7 years). Tumors appear on a cirrhotic liver in 70% of cases and were already multifocal at diagnosis in two thirds of the patients. Alpha-fetoprotein was above the physiological threshold (10 ng/mL) in 73.4% of cases measured and above the so-called diagnostic level (400 ng/mL) in 53.4% of patients. The principal risk factor was chronic infection with hepatitis B virus, detected in 52.6% of cases. Patients seropositive for hepatitis C virus were infrequent (8.6%) and heavy alcohol intake was even less prevalent (5.9%). Remarkably, a very large subset of patients did not present any infectious or lifestyle risk factor (43.4%). Mean AFP values or fibrosis assessment scores are usually lower in these patients than in HBV-infected ones. Conclusions: The etiological spectrum of HCC is far from being fully established in Chad. Further epidemiological research is warranted to identify risk factors involved in a large proportion of cases. Exposure to aflatoxin B1 and dysmetabolic conditions affecting the liver have to be investigated as priority.

关键词： Chad Middle Africa Hepatocellular Carcinoma Hepatitis Viruses Alcohol Idiopathic

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Risk Factors of Liver Cirrhosis in Chad: Large Proportion of Cases without Clear Etiology

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Open Journal of Gastroenterology 2023年第11期13卷 339-350页

作者： ali mahamat moussa Pascal Pineau Mayanna Habkreo moussa Hassan Elefi Tahir mahamat Saleh Maire Dehainsala mahamat ali Hachim Adama Ahmed N’Gare Adoum Abderrazak Fouda Bessimbaye Nadlaou Adawaye Chatté Service de Médecine Interne et Gastroentérologie Centre Hospitalier Universitaire La Référence Nationale Ndjamena Tchad Unité “Organisation Nucléaire et Oncogenèse” Institut National de la Santé et de la Recherche Médicale U993 Paris France Service de Medecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad Programme de Lutte contre le VIH et SIDA Hépatites et Infectins Sexuellement Transmissibles Ministère de la Santé Publique N’Djamena Tchad Service de Laboratoire Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad

Background: In comparison to other forms of chronic liver diseases, cirrhosis is generally poorly studied in sub Saharan Africa. In Chad, more particularly, no data are available despite the burden of liver diseases considered as the first cause of hospitalizations in the country. Methods: We conducted a retrospective analysis of 268 patients with liver cirrhosis attending care at the University Reference Hospital between 2007 and 2016. Results: This series of liver cirrhoses was characterized by a weak mal predominance (M:F = 1.7). The age of onset occurs significantly earlier in women than in men (40.6 ± 12.0 vs. 44.4 ± 13.4, p = 0.0171). The principal risk factor was persistent infection with hepatitis B virus (49% of cases) followed distantly by infection with hepatitis C virus (13%) and excessive alcohol consumption (10%). Men were more frequently carrying HBV surface antigen than women (65.6% vs 35.9% p = 0.0019). HBV-associated liver cirrhosis was overall more severe than diseases from other causes. A large proportion of cirrhosis (30%), observed primarily in women (48.1% vs 24.1%, p = 0.0036), was considered are cryptogenic. Conclusions: The etiological spectrum of liver cirrhosis remains to be properly defined in Chad. This lack of knowledge prevents the implementation of an efficient policy of prevention. A significant effort should be secured to characterize hitherto neglected infectious, lifestyle or genetic risk factors responsible of this form of terminal disease and improve subsequently liver health of local populations.

关键词： Chad Liver Cirrhosis Hepatitis Viruses Alcohol Cryptogenic

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HIV and Seroconversion among Pregnant Women at the University Hospital of Mother and Child in Chad

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Journal of Biosciences and Medicines 2023年第1期11卷 106-115页

作者： Fissou Henry Yandai ali mahamat moussa mahamat ali Bolti Djidda Abakar Oumar Hissene Adanaou Khadidja Attimer Hamit mahamat alio Kuan Abdoulaye Traore Nicolas Barro Institut de Recherche en Elevage pour le Développement (IRED) N’Djamena Tchad Centre Hospitalier Universitaire la Renaissance (CHU-R) N’Djamena Tchad Laboratoire de Biologie Moléculaire d’Epidémiologie et de Surveillance des Bactéries et Virus Transmissibles par les Aliments (LaBESTA) Université Joseph KI-ZERBO Ouagadougou Burkina Faso Faculté des Sciences de la Santé Humaine (FSSH) N’Djamena Tchad Laboratoire de Sciences de la Vie et de la Terre (LaSVT) Université Norbert ZONGO Koudougou Burkina Faso

Background: HIV in pregnant women presented a risk of transmission to newborns. This study was to determine HIV prevalence among pregnant women in the birthing rooms and give antiretrovirals to women infected and their newborns. Methods: A preliminary study was conducted from 2013 to 2015 at the Mother and Child Hospital. Pregnant women were counseled and tested for HIV-antibody according to the national algorithm using Determine HIV 1 & 2 and Immunocomb II Bispot HIV1 & 2. The women screened HIV-negative during the prenatal consultation and who accepted a second test were screened in the birth room. The data collected were processed using the Access Microsoft office 16 and SPSS software version 18. Results: A total of 6080 pregnant women were tested before and in the birth room. Of these, 5943 (97.4%) were detected as HIV-negative and 159 (2.6%) were HIV-positive. Of the 5943 with HIV-negative status, 1333 accepted the second test in the birth room, 10 of which have become HIV-positive. The rate of seroconversions was 0.75%. Conclusion: This study determined the prevalence of HIV in pregnant women. The result reveals the importance and necessity of repeating the screening test in the birth room because of the possibility of seroconversion or new infection during pregnancy.

关键词： HIV Prevalence Seroconversion Pregnancy Chad

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Different Species of Salmonella spp and Shigella spp and Their Risk of Infection in N’Djamena Chad

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Journal of Biosciences and Medicines 2023年第11期11卷 1-12页

作者： mahamat Tahir N’garé Hassan Ahmat Idriss Ahmat Yacoub mahamat Allamine Abakar Lawane Idriss Allagueryane Djimadinan Abderrazzack Adoum Foudda ali mahamat moussa Laboratoire de Recherche Diagnostics et d’Expertises Scientifiques Ministère de la Santé Publique et de la Prevention N’Djamena Tchad Laboratoire de Recherche en Sciences des aliments et Nutrition Faculté des Sciences de la Santé Humaine (FSSH) Université de N’Djamena N’Djamena Tchad Programme Sectoriel de Lutte Contre le Sida Université Touma&iuml N’Djamena Tchad Services Gastro-Entero-Hépatique Centre Hospitalier Universitaire de la Référence Nationale N’Djaména Tchad Faculté des Sciences de la Santé Humaine N’Djaména Tchad

Introduction: Salmonella and Shigella are gram-negative bacilli that are resistant to most antibiotics and play an important role in an etiology of diarrhea disease. The aim of the study was to determine the prevalence of Salmonella spp and Shigella spp isolated from stool and blood samples in the city of N’Djamena. Materials and Method: This was a prospective study conducted in the four district hospitals of N’Djamena from 14 July 2022 to 31 December 2022. A questionnaire form was drawn up to collect the information sent to the study patients. The samples were analyzed at the CHU de la Mère et de l’Enfant, Labo-Redes laboratory according to their protocols and the standard of the antibiogram committee of the French microbiology society. Results: Of the 803 biological samples analyzed, 39 were positive for Salmonella spp and Shigella spp, including 15 for Salmonella and 24 for Shigella, giving an overall prevalence rate of 4.85%. Borehole water, uncooked food and lack of access to a latrine constitute a risk of being infected by Salmonella spp and Shigella spp species. Of the 8 antibiotics tested, Salmonella spp and Shigella spp strains showed good sensitivity to nalidixic acid (100% for Salmonella and 90 for Shigella) and to ciprofloxacin (90.9% for Salmonella and 75% for Shigella). Resistance to ampicillin was found in 81.81% of Salmonella species and 78.57% of Shigella species, as was resistance to chloramphenicol (81.81% of Salmonella species and 67.85% of Shigella species). Similarly, cleanliness of the service and equipment is an essential factor in preventing Salmonella and Shigella infections.

关键词： Salmonella Shigella Species Prevalence Antibiotics Resistance Chad

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Prevalence and Predictors of Viral Hepatitis D Co-Infection in Chronic HbsAg Carriers

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Open Journal of Gastroenterology 2022年第9期12卷 213-220页

作者： ali mahamat moussa Tahir mahamat Saleh Mayanna Habkreo Bessimbaye Nadlaou Adama Ahmed Ngare Doffou Adjeka Stanislas Assi Constant Service de Medecine Interne & Gastroentérologie CHU La Référence Nationale N’Djamena Tchad Service de Medecine Interne CHU La Renaissance N’Djamena Tchad Service de Laboratoire CHU La Référence Nationale N’Djamena Tchad

The characteristics of viral hepatitis B and D co-infection are poorly documented in Chad. The aim of our study was to determine the prevalence of HBV/HDV co-infection and the characteristics of this co-infection. Materials and Methods: This was a retrospective study including all patients with chronic HBsAg carriers referred in our department from January 2014 to December 2018. Non-inclusion criteria were: absence of anti-HDV testing, presence of anti-viral hepatitis C or Human Immunodeficiency Virus antibodies or excessive alcohol consumption. The variables studied were age, sex, blood transaminase level, HBV DNA level, HDV RNA level, and liver fibrosis and activity score (Actitest Fibrotest). The prevalence of HDV and the characteristics of HDV/HBV co-infection were determined. Results: During the study period, 403 patients were seen in these two hospitals for chronic HBsAg carriage. Of these, 378 (75%) had performed the anti HDV assay. Anti-HDV antibodies were positive in 53 patients (14%). In multivariate analysis, HBV/HDV co-infected patients were less frequently HBeAg positive (5.4% vs. 28.1%;p = 0.0001), older (35 years vs. 32 years;p = 0.001), and more frequently had significant necrotic-inflammatory activity (3.9% vs. 3.2%;p = 0.031) compared with mono infected patients. Neither gender (76.9% male vs. 77.4% male;p = ns), nor viral load (median 530 IU/ml vs. 195 IU/ml;p = ns), nor significant liver fibrosis (35.1% vs. 47.1%;p = ns), nor transaminases (median 26 vs. 32 IU/ml) were different with mono infected patients. Conclusion: VHD is common in Chad. It is associated with increased hepatic necrotic-inflammatory activity.

关键词： Viral Hepatitis D (Anti VHD Ac) Prevalence Favouring Factors Necrotic-Inflammatory Activity Chad

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Frequency of Viral Replication Markers in Chronic HBV Carriers in N’Djamena, Chad

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Open Journal of Gastroenterology 2022年第10期12卷 271-277页

作者： ali mahamat moussa Mayanna Habkreo Adawaye Chatté Borde Emmanuel Adoum Abdelrazack Fouda Bessimbaye Nadlaou Service de Médecine Interne et Gastroentérologie CHU La Référence Nationale de N’Djamena N’Djamena Tchad Département des Sciences Biomédicales et Pharmaceutiques Faculté des Sciences de la Santé Humaine Université de N’Djamena N’Djamena Tchad Programme National de Lutte Contre le VIH/IST/Hépatite Ministère de la Santé Publique N’Djamena Tchad

Introduction: According to the WHO, Chad is located in an area of high endemicity for hepatitis B virus (HBV). The aim of this study was to analyze the virological profiles of chronic HBV carriers. Materials and Method: This was a retrospective and analytical study including outpatients with chronic HBV of any age received in Department of Internal Medicine and Gastroenterology of National General Reference Hospital of N’Djamena from 2013 to 2017. Results: During the study period, 401 chronic hepatitis B virus carriers (mean age was 35 years ± 11 years with sex ratio of 3.26) were seen in outpatient clinic with a frequency of 3.34% (401/11,988). HBeAg (+) patients were 12.8% and HBeAg negative 87.2%. HBeAg-negative patients were significantly older (p = 0.000) than those with HBeAg (+). The mean HBV-DNA level was higher in HBeAg (+) patients. The HBV-DNA level in HBeAg-positive patients was higher than in HBeAg-negative patients with a significant difference (p = 0.043). The mean ALT level was 45 IU/L in HBeAg (−) patients. It was 49 in HBeAg (+) patients. Conclusion: HBeAg (−) chronic hepatitis B is the most predominant form in our study. This observation is important because it can help to adapt the management strategies.

关键词： Chronic Hepatitis B Epidemiology HBeAg Viral Replication Ndjamena Chad

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