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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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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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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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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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Upper Tract Treatment of Urogenital Fistulas at the National Fistula Treatment Center (CNTF)

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Open Journal of Urology 2024年第1期14卷 11-19页

作者： mahamat ali mahamat Vadandi Valentin Aché Haroun Saleh Nedjim Abderassoul Abdraman Gadam Kimassoum Rimtebaye Faculty of Health Sciences University of N’Djamena N’Djamena Chad Faculty of Health Sciences University of Adam Barka Abeche Chad University Hospital of National Reference N’Djamena Chad

Introduction: Urogenital fistula is the existence of an abnormal pathway between a urinary organ and a genital organ. It is a public health problem because of its frequency and social aspect. The aim of this study was to analyse the management of urogenital fistulas by the upper route at the National Fistula Treatment Centre in N’Djamena. Material and Methods: This was a 10-year retrospective descriptive and analytical study from May 2011 to April 2021. The records of all patients who had received fistula treatment during this period were identified and analysed. Results: During the study period 2369 patients were managed for cure of urogenital fistula including 84 by the upper route, i.e. 3.5%. The mean age was 28.5 ± 8.13 years. Loss of urine was the most common reason for consultation (71.4%). Primigravida were represented in 50% (n = 42). The average gestational age was 3.2 ± 2.8 with extremes of 0 to 9 pregnancies. Obstetric aetiology was the most common (92.8%). Ureterovaginal fistulas were the most common anatomoclinical type (36.9%). Uretero-vesical reimplantation was the main surgical procedure (41.7%). Late postoperative follow-up was successful in 85.7% of cases. Conclusion: Urogenital fistulas are common in our practice. The only way to combat this scourge is through prevention through information, education and communication.

关键词： Urogenital Fistula Upper Tract CNTF N’Djamena Chad

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Gangrene of the External Genitalia at Chu-Abeche

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Open Journal of Urology 2024年第4期14卷 197-206页

作者： Vadandi Valentin mahamat ali mahamat Abdelmahamoud Chene Vounouzia Barthelemy Temga Ouang Michael Minguemadji Allah Siyangar Ndormadjita Allah Siyangar Rimtebaye Kimassoum Urology Department University Hospital Center Abeche Chad Urology Department University Hospital of National Reference N&#8217Djamena Chad Urology Department University Hospital of Renaissance N&#8217Djamena Chad

Introduction: Gangrene of the external genitalia organs (EGO) is a medico-surgical emergency that is still very common in Third World countries. The main etiologies are urogenital, dermocutaneous and proctological. Mortality remains very high despite therapeutic advances. Our aim was to report on the epidemiological, diagnostic and therapeutic aspects of gangrene of the external genitalia, and to identify prognostic factors. Patients and Method: This was a 5-year retrospective descriptive study, from February 2016 to February 2021, of cases of gangrene of the external genitalia admitted to and treated in the Urology Department of Abeche University Hospital. Results: We collected 49 cases of gangrene of the external genitalia. The mean age of patients was 42 ± 16.81, with extremes of 20 and 81 years. The age group most concerned was between 20 and 29. The most frequent reasons for consultation were suppuration of the external genitalia and scrotal swelling. The average consultation time was 19.05 ± 16.02 days. The most common comorbidity was diabetes (35.9%). The most frequent pathological antecedents were urinary tract infections and endourethral maneuvers, reported in 40.5% and 38.7% respectively. Urogenital aetiology was predominant in 54.7%, and idiopathic in 35.9%. Lesions involved the scrotum in 60.6%, the scrotum and penis in 16.5%, and the penis alone in 5.7% of cases. Lesions extended to the perineum in 13.6% of cases, and to the abdomen in 3.6%. Vascular filling via the central venous line was performed in 58.6% of cases, and via the peripheral venous line in 41.4%. 3rd-generation cephalosporins and associated imidazoles were the most commonly used antibiotics. Necrosectomy was performed in 37 patients (73.4%), debridement combined with bypass cystostomy in 26.6% of cases. Colostomy was performed in 4% of cases. 90.8% of patients were cured and 9.2% died. The average hospital stay was 30 ± 75 days. Conclusion: The gangrene of the external genitalia is a med

关键词： Gangrene External Genitalia Medical and Surgical Treatment

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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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Genomic Profile of SARS-COV-2 Associated with COVID-19 Outbreaks in N’Djamena, Chad

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Advances in Bioscience and Biotechnology 2024年第7期15卷 432-442页

作者： Mathieu Hota Henry Yandai Fissou Dezoumbe Koutaya Djallaye Djimtoïbaye mahamat Moussa ali cole Doctorale Sciences Techniques et Environnement Universit de NDjamena NDjamena Tchad Institut de Recherche en Elevage pour le Dveloppement NDjamena Tchad Laboratoire des Grandes pidmies Tropicales du CHU le Bon Samaritain NDjamena Tchad Facult des Sciences de la Sant Humaine (FSSH) Universit de NDjamena NDjamena Tchad

Background: SARS-CoV-2 has circulated worldwide with dramatic consequences. In Chad, we have no data reported of variants. The aim of this study was to identify the SARS-CoV-2 variants that circulated during the epidemic from 2020 to 2021. Methods: This is a cross-sectional, descriptive study carried out between 2020 and 2021. Samples from patients with suspected COVID-19 were tested in five laboratories in N’Djamena. One hundred quality samples of the positives were sequenced in Kinshasa using Oxford nanopore technologies minion and the Protocol Midnight SARS-CoV2. Data were processed using Excel version 16 software. Results: Of the 100 samples sequenced, 77 (77%) produced sequences, 23 (23%) did not. The genomic profiles were wild-type Wuhan and minor mutations (19A, 19B (A), 20A (B.1, B.2), 20B (AV.1), 20D (B.1.1.1 /C.36), 20C), variant of concern Alpha (20I), variant of concern Delta (21A/J), variant of interest Eta (21D), variant of concern Omicron (21K) and unclassified variant under surveillance (B.1.640). Of these variants, the maximums were detected in patients aged 26 - 35 with 30.26% and 25.26% in 36 - 45. However, 24.67% were in travelers and 75.32% in residents, 35.06% in those vaccinated against COVID-19 and 62.33% in non-vaccinates. The estimated case-fatality rate was 2.44% (107/4374). Conclusion: This work has provided preliminary data on COVID-19 and SARS-CoV-2 variants circulating during the 2020-2021 epidemics in Chad.

关键词： COVID-19 SARS-CoV-2 Genomic Profile Variant Chad

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Epidemio-Clinical Aspects of Ecrectile Dysfunction in Type 2 Diabetics at Abeche Chu

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Open Journal of Urology 2024年第2期14卷 50-60页

作者： Vadandi Valentin mahamat ali mahamat Minguemadji Allah Siyangar Temga Ouang Michael Vounouzia Barthelemy Ndormadjita Allah Siyangar Abdelmahamoud Chene Konan Paul Gerard Rimtebaye Kimassoum Urology Department University Hospital Center Abeche Chad Urology Department University Hospital of National Reference N’Djamena Chad Urology Department University Hospital of Renaissance N’Djamena Chad Urology Department University Hospital Center Abidjan Cote d’Ivoire

Introduction: Erectile dysfunction (ED) is a frequent complication of diabetes and more frequently affects type 2 diabetics. It is often unrecognised or its management is delayed because it is often overshadowed by other complications. The aim of our study was to describe the epidemiological and clinical aspects of ED. Patients and Method: This was a descriptive cross-sectional study over an 8-month period from April to December 2021, of type 2 diabetic subjects with erectile dysfunction (ED) seen at the University Hospital of Abeche. Erectile function was assessed using the International Index of Erectile Function (IIEFS5). Results: Out of a total of 112 patients with type 2 diabetes, 64 agreed to take part in the study. Only 40 patients correctly completed the survey form. Of these, 34 (85%) had erectile dysfunction. On average, our patients were over 49.4 years old, and 55.9% of them had had diabetes for more than 10 years. Erectile dysfunction had affected the social life of 21 patients (61.76% of cases) and 28 (82.35%) had not been informed by a healthcare professional. Most of them, 31 cases or 91.17%, had never told their GP about their erectile dysfunction. The patients who thought that diabetes had an influence on their erectile dysfunction represented 74%. Diabetes was poorly controlled in 22 patients (64.70%). According to the International Index of Erectile Function (IIEF5), 85% of diabetic patients suffer from erectile dysfunction, including 28.6% with severe erectile dysfunction, 35.7% with moderate erectile dysfunction and 14.3% with mild erectile dysfunction. Erectile dysfunction was significantly more frequent in diabetics with arterial hypertension and poor diabetic control. Conclusion: The hospital prevalence of erectile dysfunction in our patients is high. Early detection of this disorder therefore remains a challenge to be met in order to organise better psychological and drug treatment.

关键词： Diabetes Erectile Dysfunction Screening

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