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Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

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Open Journal of Gastroenterology 2024年第1期14卷 18-30页

作者： antonin Wilson ndjitoyap Ndam Sonia Charlsia Ewuo Shu Mahamat Maimouna Winnie Bekolo Nga Isabelle Dang Babagna Paul Talla Mathurin Kowo Firmin Ankouane Andoulo Gloria Enow Ashuntantang Hepato Gastroenterologist Service Yaoundé General Hospital Yaoundé Cameroon Internal Medicine Department Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Clinical Sciences Faculty of Health Sciences University of Bamenda Bamenda Cameroon Nephrologist Service Yaoundé General Hospital Yaoundé Cameroon Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Hepato Gastroenterologist Service Centre Medical la Cathedrale Yaoundé Cameroon

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

关键词： Chronic Hepatitis B Tenofovir Factors Associated Renal Impairment Cameroon

Prevalence of Hepatitis B and Associated Factors in the Garoua Central Prison, Cameroon: A Cross-Sectional Study

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Open Journal of Gastroenterology 2024年第5期14卷 174-183页

作者： Mohamadou Abdou Galdima Adamou Dodo Balkissou Guy Roger Nsenga Djapa Winnie Tatiana Bekolo Nga Gilles Aghoagni antonin Wilson ndjitoyap Ndam Ali Abas Mathurin Pierre Kowo Firmin Ankouane Andoulo Dominique Noah Noah Oudou Njoya Servais Albert Fiacre Eloumou Bagnaka Faculty of Medicine and Biomedical Sciences University of Garoua Garoua Cameroon Garoua Regional Hospital Garoua Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Faculty de Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaound&#233 1 Yaound&#233 Cameroon

Introduction: Hepatitis B virus (HBV) infection is a major public health problem in Cameroon. Garoua city is the headquarters of the North Region of Cameroon, where the HBV prevalence is among the highest of the country. The aim of this study was to determine the prevalence of HBsAg carriage and associated factors among persons incarcerated in the Garoua Central Prison. Methods: It was a cross-sectional study conducted from July 1 to July 31, 2023 at the Garoua Central prison. We included all prisoners willing to participate in the study and who gave their verbal consent. We collected data using a pre-established data entry form and we used rapid test for blood screening for HBV surface antigen (HBs Ag) with ELISA confirmation. Data were analyzed using the R® software for Windows. After the univariate analysis, we selected associated variables to HBV infection with p-value p-value was set at 5%. Results: We included 1389 prisoners out of which 97.6% were male. The median age (IQR) of the study population was 28 (23 - 35) years. The median (IQR) duration of incarceration was 12 (6 - 26) months and the mean (±sd) number of incarcerations was 1.24 (±0.6). HBV prevalence was estimated at 14.8% (95% CI: 13.0 - 16.7). Upon uni- and multivariate analysis, no risk factor was significantly associated with viral hepatitis B infection in our study population. Conclusion: The prevalence of Hepatitis B was high in the Garoua Central Prison, but there were no additional risk factors for HBV infection. There is a need to include the Garoua Central Prison and by the way other prisons in the country in the chronic viral hepatitis care program.

关键词： Hepatitis B Prison Associated factors Cameroon

Acute Syphilitic Hepatitis in the Early Secondary Phase: A Case Report and Literature Review

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Open Journal of Gastroenterology 2022年第3期12卷 37-43页

作者： Paul Ngock Jacques Mauillon Larry Tangie antonin ndjitoyap Célestin Danwang Firmin Ankouane Department of Gastroenterology and Hepatology Jacques Monod Hospital Montivilliers France Internal Medicine Department Faculty of Medicine and Biomedical Sciences Yaounde Cameroon Epidemiology and Biostatistics Unit Institut de Recherche Expérimentale et Clinique Université catholique de Louvain Brussels Belgium

Background: The incidence of syphilis is clearly increasing. It is a source of visceral damage, particularly in the secondary phase. Acute syphilitic hepatitis is a rare clinical entity classically described but under-diagnosed because of its non-specific presentation. Case Presentation: We report the case of a 25-year-old French woman, without comorbidity, sexually active, having unprotected sex with only one partner. She was admitted to our unit for jaundice and a disturbed liver function test preceded 3 weeks earlier by a rash. The patient did not consume alcohol and did not report the introduction of a new medication. A skin rash compatible with syphilitic roseola and generalized adenopathy were found. The liver workup showed alanine aminotransferase (ALT) at 1984 U/L, aspartate aminotransferase (AST) at 1377 U/L, total bilirubin at 221 μmol/L, alkaline phosphatase activity (APL) at 419 U/L, gamma glutamyl transferase activity (GGT) at 229 U/L and a prothrombin concentration at 73%. The search for the most common etiologies of acute hepatitis was negative. Syphilitic serology was positive with a Treponema Pallidum Hemagglutinations Assay (TPHA) titration of 5120 IU and Veneral Disease Research Laboratory (VDRL) of 64 IU. Abdominal ultrasound revealed only homogeneous hepatomegaly and splenomegaly with no focal lesions. Other sexually transmitted infections (STI) were negative and her partner had positive syphilis serology. After a single dose of Benzathine benzylpenicillin, the clinical signs regressed after one week and the hepatic balance tended to normalize 20 days later. Conclusion: This highlights the need for a high index of suspicion for syphilitic hepatitis in sexually active patients presenting with acute hepatitis associated with a cutaneous rash.

关键词： Acute Hepatitis Rash Syphilis

Factors Associated with Antibody Levels among Children Aged 15 to 59 Months Vaccinated against Hepatitis B during the Expanded Program on Immunization in Cameroon

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Open Journal of Gastroenterology 2023年第2期13卷 91-98页

作者： antonin Wilson ndjitoyap Ndam Alpha Hamed Béchir Ndam Mefire Winnie Bekolo Guy Roger Nsenga Djapa Suzanne Ngo Um Sap Paul Koki Ndombo Elie Claude ndjitoyap Ndam Department of Internal Medicine and Specialities Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine and Specialities Faculty of Medicine and Biomedical Sciences University of Dschang Dschang Cameroun Department of Paediatrics Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Background: the hepatitis B virus infection remains a major public health problem worldwide. It can lead to a liver cirrhosis and/or hepatocellular carcinoma. The World Health Organisation (WHO) has recommended the implementation of generalised vaccination programs against hepatitis B. In Cameroon, this vaccine was introduced in the expanded program on immunization (EPI) in 2005, but few studies have assessed the immune response. Objective: the general objective of this study was to identify factors associated with antibody levels among children aged from 15 to 59 months vaccinated against hepatitis B during the EPI in Cameroon. Method: this was a cross-sectional study carried out from December 2021 to June 2022 in a paediatric centre of Yaoundé (Cameroon). We analysed the antibody level in children vaccinated against hepatitis B within the framework of the EPI. We enrolled children who had received a series of 3 intramuscular doses of hepatitis B vaccine at 6, 10 and 14 weeks after birth. Some children could receive a 4th booster dose between 12 months. The antibody level was assessed by measuring the anti-HBs in such children, aged 15 - 59 months. A good immunization was defined as a serum level of anti-HBs antibody level above 100 IU/mL;a poor immunization, for an anti-HBs antibody level between 10 and 100 IU/mL;and a non-immunization, for an anti-HBs antibody level < 10 IU/mL. Association between explored factors and poor or non-immunization was evaluated through the Chi square test. The significance threshold was defined at p < 0.05. Results: sixty subjects were included in the study with a slight female majority: 31 cases (52%). The average age was 38.5 ± 15.7 months (range 15 - 59 months). We found 32 (53%) cases of good immunization;21 (35%) of poor immunization;and 7 children (12%) with a non-immunization. The only factor associated with poor or non-immunization was the age between 37 - 59 months (p = 0.016). Conclusion: Anti HBs Antibody levels

关键词： Hepatitis B Vaccination Children Antibody Levels Immunization Cameroon

Diagnosis of Helicobacter pylori Infection in Low Out-Outcome Country: Rapid Urease Test, Serological Test, versus Direct Microbiological Examination with Gram Stain

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Open Journal of Gastroenterology 2023年第6期13卷 199-208页

作者： Winnie Tatiana Bekolo Nga Guy Roger Nsenga Djapa Kelly Ilinga Meme Mamende antonin Wilson ndjitoyap Ndam David Sepo Sepo Agnès Malongue Firmin Ankouane Andoulo Oudou Njoya Henry Luma Namme Elie Claude ndjitoyap Ndam Carole Else Eboumbou Servais Albert Fiacre Eloumou Bagnaka Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Medecine Douala General Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of Internal Medecine Douala Military Hospital Douala Cameroon

Introduction: Helicobacter pylori is a gram-negative bacillus responsible for numerous gastroduodenal pathologies, and this infection is a public health problem. The prevalence of infection with this bacterium remains high in countries with limited resources. Diagnosis relies mainly on numerous invasive and noninvasive methods. The aim of this work was to evaluate the different indirect diagnostic methods using bacterial cultures. Methods: We conducted a cross-sectional and analytical study from January to May 2022 in the gastroenterology departments of Douala General Hospital and Douala Military Hospital. All patients aged 18 years and older who were in the gastroenterology consultation and agreed to participate were included in our study. Sociodemographic, clinical, and paraclinical data were collected. Urease, liquid urea, and culture tests were performed from the specimens obtained by fibroscopy. Serological tests were performed on the blood sample. Results: 101 patients were included, 58 were female and 43 were male, for a sex ratio of 1.3. The mean age was 44.2 ± 16 years. The prevalence of infection was 90.5%, 44.1%, 40.6% and 21.8% for serology, direct microbiological examination, RUT (rapid urea test) and culture, respectively. Comparison of the different tests showed sensitivity and specificity of 67.1% and 64%, respectively, for RUT, 100% and 73.7%, respectively, for direct microbiological examination, and 100% and 14.8%, respectively, for serology. The positive and negative predictive values were 39.5% and 100% for serology, 39% and 85% for RUT, and 55.6% and 100% for direct microbiological examination, respectively. Conclusion: The prevalence of Helicobacter pylori infection depends on the type of test used. Direct examination is more reliable than RUT and serology.

关键词： Helicobacter pylori Diagnostic Tests Sensitivity Specificity Positive and Negative Predictive Value

Management of Endoscopic Portal Hypertension Lesions in Cirrhotic Patients in a Country with Limited Resources: About 603 Cases in the City of Douala in Cameroon

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Open Journal of Gastroenterology 2023年第12期13卷 429-438页

作者： Winnie Tatiana Bekolo Nga Aghoani Gilles Machékam-Matanga Olga antonin ndjitoyap Agnès Malongue Mathurin Kowo Dominique Noah Noah Oudou Njoya Firmin Ankouane Andoulo Luma Henry Namme Servais Albert Fiacre Eloumou Bagnaka Department of Internal Medicine the Douala General Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Medicine University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon

Introduction: Portal hypertension (HTP) is a morbi-mortality factor in cirrhotic patients. It is responsible for endoscopic lesions and has digestive hemorrhage as the main complication. The objective of the study was to study the management of endoscopic lesions of portal hypertension in a country with limited resources. Methodology: This was a cross-sectional and analytical study conducted in 04 hospitals in the city of Douala, Cameroon, over a period of 08 years from 1 January 2014 to 31 December 2022. Included were cirrhotic patients with viral hepatitis with endoscopic lesions of PH. The data collected were sociodemographic, clinical, paraclinical, therapeutic and evolutionary. Data analysis was done using SPSS software version 25.0. Logistic regression allowed the search for prognostic factors with a significance threshold of p Results: We included 603 patient records. They were mainly male patients (56.1%) with an average age of 47.6 ± 6.3 years. The Child Pugh score was ranked B in 53.7% of cases. Digestive hemorrhage was the main complication in 66.8% of cases. We had grade 2 esophageal varices in 61.5% of cases. The main treatments were prescription of propanolol (63.3%) and ligation of esophageal varices (53.3%). The average number of ligation sessions was 2.1 ± 1.8 with an interval between sessions of 28 ± 2.8 days. Prevention of rupture of esophageal varices was secondary in 66.5% of cases (n = 452). The rate of hemorrhagic recurrence was 9.3%. Hospital mortality was 15.1%. Recurrence of hemorrhage was associated with PT Conclusion: The management of HTP lesions was based on the prescription of beta-blockers and the ligation of esophageal varices. Factors associated with mortality were hemorrhagic recurrence, low PT and Child Pugh C score.

关键词： Portal Hypertension Cirrhosis Endoscopic Lesions PEC Cameroon

Evaluation of Non-Invasive Markers of Liver Fibrosis in Chronic Hepatitis B Patients in a Sub-Saharan African Setting: Transient Elastography versus APRI, FIB4, GTT/Platelet Scores

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Open Journal of Gastroenterology 2023年第6期13卷 209-224页

作者： Servais Albert Fiacre Bagnaka Eloumou Tatiana Winnie Bekolo Nga antonin ndjitoyap Ndam Gael Gilles Aghoagni Gouajio Guy Roger Nsenga Djapa Cynthia Kila Shang Agnes Malongue Dominique Noah Noah Firmin Ankouane Andoulo Christian Tzeuton Henry Namme Luma Faculty of Medecine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine Gynecologic and Pediatric Hospital of Douala Douala Cameroon Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon

Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub-Saharan Africa. We aimed at evaluating liver fibrosis, using the Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis Index Based on 4 factors (FIB4), and Gamma-glutamyl transpeptidase to Platelet Ratio (GPR) in chronic hepatitis B patients with transient elastography as the reference so as to choose an alternative to transient elastography. Method: We carried out a cross-sectional study using the records of patients who attended the Douala General Hospital and Marie O Polyclinic Douala from 2012 to 2017. Non-invasive tests were compared with Transient Elastography. The Spearman coefficient was used to determine correlation. The sensitivity, specificity, positive predictive values and negative predictive values were used to get the optimal cut-off values. The diagnostic accuracy was estimated by calculating the area under the Receiver Operating Characteristic Curve (ROC). P Results: Of the 243 patient records studied, the median age or interquartile range (IQR) was 35 (29 - 42) years with a male predominance of 73.7%. More than 60% of the study population had normal transaminases. Significant fibrosis was found in 88 (36.2%) patients and 32 (13.7%) patients had cirrhosis. APRI had the best cut-off values and highest area under the ROC Curve, for significant fibrosis and cirrhosis with 0.55 (0.823 95% CI [0.769 - 0.869], P Conclusion: APRI, had the best diagnostic properties to detect liver fibrosis and cirrhosis in patients with Chronic Hepatitis B in Douala. The cut-off values are 0.55 and 0.65 for significant fibrosis and cirrhosis respectively.

关键词： Chronic Hepatitis B Liver Fibrosis Non-Invasive Tests Cross Sectional Douala

Prevalence and Factors Associated with Hepatic Steatosis in Patients with Metabolic Syndrome in Cameroon: Cases of 4 Reference Hospitals

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Open Journal of Gastroenterology 2023年第3期13卷 99-110页

作者： Winnie Tatiana Bekolo Nga Martine Claude Etoa Bidjogo Gwet Marina Servais A. F. Eloumou Bagnaka antonin Wilson ndjitoyap Ndam Agnès Malongue Mathurin Kowo Christian Tzeuton Dominique Noah Noah Oudou Njoya Firmin Ankouane Andoulo Luma H. Namme Department of Internal Medicine General Hospital of Douala Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon National Obesity Centre Central Hospital of Yaoundé Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Department of Internal Medicine Gynecologic and Pediatric Hospital of Douala Douala Cameroon Department of Internal Medicine Teaching Hospital of Yaoundé Yaoundé Cameroon Clinic of Capucines Douala Cameroon

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide and its prevalence increases with that of metabolic syndrome and its components. NAFLD is associated with complications such as cirrhosis and hepatocellular carcinoma. Diagnosis is mainly based on liver biopsy, but there are validated non-invasive methods. The purpose of the study was to assess the impact of metabolic steatopathy in patients with metabolic syndrome in Cameroon. Methods: This was a cross-sectional and analytical study conducted over a 6-month period from January 1st, 2019, to August 31st, 2022. Included were patients with metabolic syndrome who had consulted in endocrinology or gastroenterology at Yaoundé Central Hospital, Douala General Hospital and Douala Gyneco-obstetric and Pediatric Hospital. The diagnosis of NAFLD was made on abdominal ultrasound in front of a homogeneous or heterogeneous hyperechogenic aspect of the hepatic parenchyma compared to that of the right renal cortex called “brilliant liver” and fibrosis evaluated through non-invasive scores (Fib4 and NALFD Fibrosis score). Logistic regression by a uni- and multivariate analysis made it possible to search for the associated factors. Results. We included 133 patients. The female sex represented 64.7%. The mean age was 55 ± 9 years. The prevalence of NAFLD was 48.9%. At the evaluation of fibrosis was significant according to FIB-4 and NAFLD fibrosis score respectively in 6.2% and 4.6% of cases. The independently associated factors were Triglyceridemia ≤ 1.5 g/l (OR = 0.33;95% CI [0.11 - 0.95];p = 0.04) and LDL hypercholesterolemia (OR = 2.94;95% CI [1.07 - 8.11];p = 0.036). Conclusion: NAFLD was present in almost half of patients with metabolic syndrome. We had very few patients with significant fibrosis, but it needs to be further evaluated. The associated factors are hypertriglyceridemia and LDL hypercholesterolemia.

关键词： Hepatic Steatosis Metabolic Syndrome Prevalence Cameroon

Seroprevalence of Hepatitis E Virus Infection and Factors Associated in HIV Infected Patients in Yaoundé(Cameroon)

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Open Journal of Gastroenterology 2020年第7期10卷 181-186页

作者： antonin Wilson ndjitoyap Ndam Ousmanou Nsangou Mbombo Njoya Richard Njouom Mathurin Kowo Serge Clotaire Billong Firmin Ankouane Oudou Njoya Elie Claude ndjitoyap Ndam Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Pasteur Center of Cameroon Yaoundé Cameroon

The Hepatitis E Virus (HEV) infection is one of the main causes of acute viral hepatitis. This affection is generally asymptomatic and benign. Its incidence is elevated in sub Saharan Africa. In Human Immunodeficiency Virus (HIV) infected patients, the HEV can cause chronic hepatitis with risks of cirrhosis and cancer. Assessing the prevalence and risk factors of an HEV infection in people living with HIV can help to prevent the transmission and the onset of their complications. The aim of this study was to evaluate the seroprevalence of HEV markers and associated factors among HIV infected patients in Yaoundé (Cameroon). Ninety HIV infected patients were included in this study, with 29 men (32.2%) and 61 women (67.8%). The mean age was 46 ± 11.4 years old (21 - 74). The prevalence of HEV serological markers was 6.7% and 12.2% for immunoglobulins (IgG) and IgM respectively. Both IgG and IgM were positive for 2 patients (2.2%), while 15 patients (16.7%) had at least one immunoglobin positive. The consumption of well water and porcine foods was found to be associated with the presence of IgM HEV antibodies. There was no association between CD4 count, viral load and the presence of HEV serological markers.

关键词： Seroprevalence Hepatitis E HIV Associated Factors Yaoundé