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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

Extensive Bi-Atrial Remodeling on Hypertensive Patient with Permanent Atrial Fibrillation delayed Diagnosis of Fatal Cardiac Lambda Amyloidosis

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World Journal of Cardiovascular Diseases 2024年第6期14卷 409-420页

作者： Houzéiph Abdou Lassissi Ngardjibem Djita Ibrahima Sory Sylla Thome Masset Abdelrhani Moumen Sedjolo Emmanuelle Bibiane Kpomalegni centre hospitalier Nord Mayenne Mayenne France centre hospitalier Le Mans Le Mans France centre hospitalier Vierzon Vierzon France centre hospitalier universitaire de Grenoble Grenoble France

Background: Amyloidosis is a disease characterized by the deposition of fibrillar proteins in tissues. The nature of the protein defines the type of amyloidosis. Cardiac involvement is most often secondary to deposits of transthyretin and immunoglobulin light chains. Treatment depends on the type of amyloidosis. Cardiac light chain amyloidosis is a medical emergency. Aim: To highlight the importance of an early diagnosis of cardiac light chain amyloidosis. Case Presentation: We report the case of an 88-year-old hypertensive female patient with sustained atrial fibrillation and recurrent heart failure, in whom echocardiography showed concentric left ventricle hypertrophy with mildly reduced left ventricle ejection fraction (LVEF) to 45%. Bone scintigraphy was normal. Serum analysis showed increased lambda free light chains. Accessory salivary gland biopsy revealed weak Kappa light chain staining and clear overexpression of lambda light chain deposits. The diagnosis of stage 3B cardiac amyloidosis secondary to lambda light chain myeloma was made. After a multidisciplinary meeting, it was decided to start treatment with DARATUMUMAB + LENALIDOMIde. Patient’s general condition deteriorated with the occurrence of febrile pancytopenia. Chemotherapy was stopped and management was limited to comfort care until the patient’s death. Conclusion: Cardiac light-chain amyloidosis must be diagnosed early as it can be rapidly fatal.

关键词： Myeloma Cardiac Lambda Light Chain Amyloidosis Monoclonal Gammopathy Heart Failure

Prevalence and Associated Factors of Postpartum depression: A Study Conducted in Health centres in Dakar (Senegal)

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Open Journal of Psychiatry 2024年第1期14卷 45-66页

作者： Sokhna Seck Momar Camara Racky Wade Kane Djeynaba Bassine Baldé El Hadj Makhtar Bâ Adama Koundoul Idrissa Bâ Ibrahima Ndiaye Papa Lamine Faye Aida Sylla Service de psychiatrie Centre Hospitalier National Universitaire de Fann Dakar Sénégal

Introduction: Postpartum depression is the most common psychiatric disorder affecting women in the perinatal period. According to the WHO, it affects 10% - 15% of women who have just given birth. In Africa, and particularly in Senegal, epidemiological studies focusing exclusively on postpartum depression are rare or non-existent. For this reason, we conducted this screening study on postpartum depression to assess the socio-demographic characteristics and associated factors. Methods: This was a prospective cross- sectional study with descriptive and analytical aims. It was carried out in the twelve Dakar referral health centres during the period August 2021 to June 2022. Results: At the end of our survey we had recruited one hundred and twenty-two (122) participants with a PPD prevalence rate of 25.41%. The most common age group was 24 - 29 years. 40% of the participants were of Fulani ethnicity, followed by Wolof. Married women made up 93% of the sample. The school enrolment rate was 89%. Most participants were not in paid employment. Domestic violence was present in 14% of couples. 28% of mothers reported experiencing a stressful life event during their pregnancy. 22% of the women had a chronic medical condition, of which 55% had high blood pressure. 1% of the women reported a personal psychiatric history and 5% a family psychiatric history. Most women had between two and four healthy living children. The pregnancy was unwanted in 17% of cases and 12% of participants had a complication. 6% were dissatisfied with the quality of their antenatal care. The caesarean section rate was 18%. In terms of associated factors, eight factors were identified in a bivariate analysis: single marital status, lack of support from partner, domestic violence, conflict with in-laws, and the occurrence of a stressful life event during pregnancy, the presence of a personal medical history, lack of satisfaction with pregnancy follow-up, and mode of delivery by caesarean section. Conclusi

关键词： Postpartum depression Prevalence Associated Factors Senegal

Epdemiology and Treatment of Pseudarthrosis of Long Bones in the Servce D Orthopedics-Traumatology of the University Hospital of Donka

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Open Journal of Orthopedics 2024年第3期14卷 133-138页

作者： Camara Nouhou Mangué Diallo Mamadou Moustapha Moustapha Alhassane Diallo Alpha Mamadou Fela Sidimé Sory Camara Abdoulaye Kolié Germain Lamah Léopold Service d’Orthopédie-Traumatologie Centre Hospitalier Universitaire de Donka Conakry Republic of Guinea

Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.

关键词： Pseudarthrosis Aseptic-Septic-Diaphysis Long Bones Screwed Plate Intramedullary Nailing Bone Graft Osteo-Muscular decortication

Prognostic Factors for Diabetic Foot at CNHU-HKM

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Journal of Diabetes Mellitus 2024年第1期14卷 20-27页

作者： Annelie Kerekou Hode Alihonou Hubert dedjan Déo-Gratias Gnaho centre National hospitalier universitaire Hubert Koutoukou Maga Cotonou Benin centre hospitalier universitaire Départemental-Ouémé/Plateau Porto-Novo Porto-Novo Benin

Introduction: Predictions on the prevalence of diabetes mellitus, according to the International Diabetes Federation, indicated 9.3% in 2019 and nearly 10.9% of the general population in 2045. In Benin, the increase in this prevalence, according to the World Health Organization (WHO), is constantly increasing. Diabetic foot is one of its most common complications. The aim of this work was to study the prognostic factors of diabetic foot in the department of Endocrinology, Metabolism and Nutrition of the CNHU-HKM of Cotonou. Patients and method: This is a descriptive and analytical retrospective study of the prognostic factors of diabetic foot over a period of 3 years from January 2019 to december 2021 in patients who have been hospitalized or followed on an outpatient basis for diabetic foot in the Endocrinology, Metabolism and Nutrition department of the CNHU-HKM of Cotonou. Results: A total of 112 patients were included in this study. The average age of the patients was 59.70 ± 2.10 years. A male predominance was noted with a sex ratio (M/F) of 1.7. Mixed gangrene and phlegmons were the most common lesions. According to the classification of diabetic feet according to the University of Texas, 59.1% of patients had a 100% risk of amputation. Ten patients died from sepsis (8.9%). The average blood glucose on admission was 2.74 ± 0.23 g/l, reflecting the glycemic imbalance in these patients. There is a statistically significant association between the duration of progression of diabetes, the type of lesion and amputation. Patients whose diabetes has lasted more than 30 years and patients who are not monitored have a greater risk of death. Conclusion: Diabetic patients most often consulted at a late stage, compromising conservative treatment. The duration of diabetes and the type of lesion on admission were the main factors leading to amputation, thus compromising the functional prognosis. As for death, it was mainly linked to irregular monitoring of diabetes and the

关键词： Diabetes Diabetic Foot Prognosis Blood Sugar Imbalence Benin

Results of an Eight Year Long Practice of Saline Bipolar Transurethral Resection of Prostate

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Open Journal of Urology 2024年第4期14卷 189-196页

作者： Sossa Jean Mangoue Moube Ariane Landry Yevi Dodji Inès Magloire Hodonou Fred Avakoudjo Déjinnin Josué Georges centre National hospitalier universitaire Hubert Koutoucou Maga Cotonou Benin

Background: Open prostatectomy has long been the only prostatic bladder outlet obstruction’s surgery available in Benin. It is prone to postoperative bleeding and infections and is not suitable for prostate cancer-induced bladder outlet obstruction. Objective: To evaluate the first results of endoscopic surgery of prostatic bladder outlet obstruction in our environment. Patients and Method: We conducted an observational study of saline bipolar transurethral resection of prostate (B-TURP) at the former Military Teaching Hospital of Cotonou. We retrospectively collected the data from patients’ medical records from November 17, 2014, to September 7, 2022. We used Excel 2019 to make a descriptive analysis of the data. Results: Saline B-TURP was performed in 60 consecutive patients. Their mean age was 69.1 years (range: 48-85). The procedure was indicated in 22 (36.7%), 32 (53.3%), 3 (5%), and 3 (5%) patients, respectively for acute urinary retention, chronic urinary retention, obstructive renal failure, and unresponsiveness to alpha-blockers. 35 patients (58.3%) had prostate cancer (PCa). 25 patients (41.7) had benign prostate hyperplasia (BPH). No patient got a blood transfusion. The duration of postoperative hospitalization was 3 days (88.3%) to 5 days (11.7%). 5 patients (8.3%), i.e., 3 BPH and 2 prostate cancer patients got preoperative urinary tract infection. The causative bacteria were Escherichia coli in 3 patients (60%), Klebsiella pneumoniae in 2 patients (40%), and multi-resistant Acinetobacter as a metachronous infection to Escherichia coli in 1 patient (20%). All the infections were associated with indwelling Foley catheter. 7 patients (11.7%), i.e., 3 BPH and 4 prostate cancer patients, got a second resection to recover full spontaneous micturition. Prostate size was available in the medical record of 21 BPH patients and 15 prostate cancer patients. Prostate size ranged from 22 to 123 g with a mean value of 61.1 g in BPH patients, and from 34 to 180 g with

关键词： Saline B-TURP BPH Prostate Cancer

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

Survival Rate and Factors Influencing It in Triptorelin-Castrated Metastatic Prostate Cancer Patients

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Open Journal of Urology 2024年第3期14卷 160-172页

作者： Sossa Jean Vissoh Gilvias Yevi Dodji Magloire Inès Hodonou Fred Avakoudjo Déjinnin Josué Georges centre National hospitalier universitaire Hubert Koutoucou Maga Cotonou Bénin

Background: Most newly diagnosed prostate cancers in Benin are metastatic diseases and patients are reluctant to undergo orchiectomy. Still, chemical androgen deprivation therapy is not always available and not every patient can afford it. Thus, it will be interesting to evaluate the results of that therapy in the country. Objective: To analyze the survival rate and factors influencing it in metastatic prostate cancer patients who underwent triptorelin-based androgen deprivation therapy at the former Military Teaching Hospital of Cotonou from January 1, 2012, to december 31, 2022. Patients and Method: Metastatic prostate cancer patients received intragluteal injections of triptorelin 11.25 mg every 3 months. We retrospectively collected follow-up data from the patients’ medical records. By means of the software StataTM version 15, we performed a descriptive analysis of qualitative data. We used Kaplan-Meir method to estimate the overall survival rate in the whole cohort and in specific subgroups of patients. We compared survival rates by using the log-rank test. Results: 68 metastatic prostate cancer patients aged 47-86 years (mean = 69.9) with initial PSA ranging from 24.25 to 6334 ng/mL (mean = 666.1) started triptorelin-based castration. The tumor grade in 21 (33.3%), 14 (22.2%), 15 (23.8), 8 (12.7%), and 5 (7.9%) patients was respectively ISUP grade groups 5, 4, 3, 2, and 1. 15 (22.1%), 4 (5.9%), 2 (2.9%), 1 (1.5%), 11 (16.2%), and 7 (10.3%) patients respectively had hypertension, diabetes mellitus, peptic ulcer, asthma, unilateral or bilateral hydronephrosis, and paralysis. The mean nadir PSA level was 22.5 ng/mL (range: 0.01-220.25). The mean time to nadir PSA level was 8.9 months (range: 3-57). The overall survival rate was 42.6%. There was no significant survival difference between age groups (p = 0.475), relating to the presence of diabetes or hypertension (p = 0.757) or to the presence of paralysis or hydronephrosis (p = 0.090). The initial PSA level exert

关键词： Metastatic Prostate Cancer Androgen deprivation Therapy Overall Survival PSA Nadir

Molecular Diagnosis of Sexual Differentiation Disorders in Burkina Faso

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Journal of Biosciences and Medicines 2024年第3期12卷 1-15页

作者： Bazie Bapio Valérie Elvira Jean Télesphore Sawadogo Soumaïla Zohoncon Théodora Mahoukèdè Tall Ahmadou Bado Prosper Soubeiga Serge Théophile Ouattara Moussa Sorgho Abel Kiendrebeogo Touwendpoulimdé Isabelle Yonli Albert Theophane Djigma Florencia Millogo/Traore Timongo Françoise Danielle Simpore Jacques centre National de la Recherche Scientifique et Technologique (CNRST) Institut de Recherche en Sciences de la Santé (IRSS) Ouagadougou Burkina Faso Université Joseph KI-ZERBO Unité de Formation en Sciences de la Vie et de la Terre Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE) Ouagadougou Burkina Faso centre de Recherche Biomoléculaire Pietro Annigonie (CERBA) Ouagadougou Burkina Faso centre hospitalier universitaire Régional de ouahigouya Ouagadougou Burkina Faso centre hospitalier universitaire Yalgado Ouedraogo Université Joseph Ki-Zerbo Ouagadougou Burkina Faso

Sex development anomalies represent a group of congenital pathologies in which chromosomal, gonadal and anatomical sex differentiation is atypical. The aim of our study was to use molecular biology techniques to elucidate sex in cases of anomalies of sexual differentiation in Burkina Faso. This cross-sectional study took place from March 2023 to June 2023. Oral and blood samples were collected respectively using sterile swabs and stored on Swab Kits and NUCLEIcardTM (https://***/product-ranges/nucleic-card/) were used to determine gonosome profiles. Extraction was carried out using the DNA Swap solution Kit and the DNA IQ System Kit, and a PowerPlex? 21 kit (Promega) for amplification. The Applied Biosystems 9700 thermal cycler was used for PCR followed by 36 cm capillary electrophoresis in the Applied Biosystems 3130 prism sequencer. Sequence files were analyzed using GeneMapper IDX v. 3.2 software. Seven (07) patients were registered during the study period. There were 4 cases of XX DSD or 46, XX DSD and 3 cases of XY DSD or 46, XY DSD. The median age of our patients was 16 years. Civilian sex was male in 4 cases and female in 3. The most frequent reason for consultation was micropenis in 3 cases, followed by primary amenorrhea and sex ambiguity. There were 03 cases of discrepancy between genetic sex and civil sex. The accessibility of molecular diagnosis is little known to clinicians. XX DSDs or 46, XX DSDs were the most frequent (4/7) in our study. The problem facing this situation is early diagnosis to help prevent complications in Burkina Faso.

关键词： Gonosome DSD Abnormal Sexual development Burkina Faso