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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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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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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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