Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa)

Aims. To determine the usefulness of platelet count (PC), spleen diameter (SD) and platelet count/spleen diameter ratio (PC/SD ratio) for the prediction of oesophageal varices (OV) and large OV in black African patients with cirrhosis in Côte d’Ivoire. Materials and Methods. Study was conducted in a training sample (111 patients) and in a validation sample (91 patients). Results. Factors predicting OV were sex: (OR=0.08, P=0.0003), PC (OR = 12.4, P=0.0003), SD (OR = 1.04, P=0.002) in the training sample. The AUROCs (±SE) of the model (cutoff ≥ 0.6), PC (cutoff 140) and PC/SD ratio (cutoff ≤ 868) were, respectively; 0.879 ± 0.04, 0.768 ± 0.06, 0.679 ± 0.06, 0.793 ± 0.06. For the prediction of large OV, the model’s AUROC (0.850 ± 0.05) was superior to that of PC (0.688 ± 0.06), SD (0.732 ± 0.05) and PC/SD ratio (0.752 ± 0.06). In the validation sample, with PC, PC/SD ratio and the model, upper digestive endoscopy could be obviated respectively in 45.1, 45.1, and 44% of cirrhotic patients. Prophylactic treatment with beta blockers could be started undoubtedly respectively in 36.3, 41.8 and 28.6% of them as having large OV. Conclusion. Non-invasive means could be used to monitor cirrhotic patients and consider treatment in African regions lacking endoscopic facilities

Enquête sur l’utilisation et l’effet des médicaments à base de plantes chez les patients hépatiques hospitalisés au Service de médecine et d’hépatogastroentérologie du Centre Hospitalier Universitaire (CHU) de Cocody en Côte d’Ivoire

Objectif: Cette étude a été menée afin d’identifier les plantes et leurs produits dérivés utilisés par les patients avant leur admission au service de Médecine et d’Hépato-gastroentérologie du Centre Hospitalier et Universitaire (CHU) de Cocody en Côte d’Ivoire.Méthodologie et résultats: Un questionnaire a été administré à ces patients au cours d’entretien semistructuré lors des enquêtes menées entre février et mai 2016. Un total de 125 patients a été enquêté dont 88 % ont eu recours à la médecine traditionnelle les 12 derniers mois précédent l’enquête. Les plantes médicinales sont le plus souvent consommées par les patients pour traiter des maladies telles que le paludisme et l’asthénie avec des fréquences de citation (fc) de 45,5 % et 11 % respectivement. Vingt (20) plantes médicinales appartenant à 13 familles et 19 genres ont été citées. Vernonia amygdalina (Asteraceae) « feuille amère", avec une fc de 16,32 %, Alchornea cordifolia (Euphorbiaceae) "Arbre de djeman" et Senna occidentalis (Fabaceae) "faux kinkéliba" (fc = 12,24 %), étaient les espèces les plus utilisées.Conclusions et application des résultats: Les patients hépatiques ont eu recours aux produits de la médecine traditionnelle. Ces résultats sont importants pour la sécurité sanitaire des consommateurs de plantes médicinales. Ils pourront contribuer à améliorer le diagnostic des maladies du foie.Mots-clés: Centre hospitalier, Côte d’Ivoire, Hépatotoxicité, Maladies du foie, Plantes médicinales, PatientsEnglish Title: Survey on the use and effect of herbal medicines on hospitalized liver patients in the Department of Medicine and Hepatogastroenterology at the University Hospital Center (UHC) of Cocody in Côte d’IvoireEnglish AbstractObjective: This descriptive study was conducted to identify the plants and their derivatives used by patients prior to their admission to the Medicine and Hepato-gastroenterology department of the University Hospital Center (UHC) of Cocody in Côte d'Ivoire.Methods and Results: A semi-structured interview questionnaire was applied to these patients from February to May 2016. A total of 125 patients were interrogated, 88% of whom used traditional medicine in the last 12 months prior to the survey. The medicinal plants were mostly consumed by patients to treat diseases such as malaria and asthenia with citation frequencies (cf) of 45.5% and 11%, respectively. Twenty (20) plants species belonging to 13 families and 19 genders were cited. Vernonia amygdalina (Asteraceae) "bitter leaves" with cf of 16.32%, Alchornea cordifolia (Euphorbiaceae) "christmas bush" and Senna occidentalis (Fabaceae) "negro coffee" (cf = 12.24%) were the most used species.Conclusion and application of results: The liver patients have used products of traditional medicine. The results are important for the safety of consumers of medicinal plants. These results may contribute to improving the diagnosis of liver diseases.Keywords: Hospital center, Côte d’Ivoire, Hepatotoxicity, Liver diseases, Medicinal plants, Patient

Couverture Vaccinale contre le virus de l’hépatite B au sein du personnel d’un centre Hospitalier Universitaire à Abidjan

Introduction: Le personnel des hôpitaux est une population à risque viral B. la prévention primaire par la vaccination contre le virus de l’hépatite B est efficace. Peu de données existent sur cette prévention en milieu hospitalier ivoirien. Le but de notre étude était d’évaluer la couverture vaccinale contre le VHB et les facteurs associés à cette vaccination au sein du personnel du CHU de Cocody Méthode: Nous avons réalisé une étude transversale analytique allant du 1er Juillet au 31 Décembre 2016 incluant tout le personnel du CHU de Cocody. Tous ceux absent pendant toute la durée de l’étude ou ayant refusé d’y participer ou chez qui une difficulté technique était notée au cours de l’analyse au laboratoire était exclu de l’étude. Des variables sociodémographiques, anamnestiques et biologiques étaient colligés sur une fiche d’enquête pré établie. La vaccination anti virale B était complète lorsque le sujet avait reçu les trois doses du vaccin. Résultats: Sur les 1479 agents du CHU de Cocody, 867 avaient été inclus soit un taux de participation de 58,6%. L’âge moyen était de 41,2 ±9,4 ans, la médiane de 40 ans (18 à 66 ans). Le sex ratio était de 0,82. Un accident d’exposition au sang était déclaré par 18,5% de sujet. L’AgHBs était positif chez 7,2% de cas. Dans 33,4% des cas les sujets affirmaient avoir reçus au moins une dose de vaccin contre le VHB. Un dépistage pré vaccinal était réalisé dans 17,6% des cas. Les sujets incomplètement vaccinés avaient reçu leur dernière dose avant un an, de 1 à 5 ans et plus de 5 ans dans respectivement 23,8%, 32,0% et 44,3% des cas. Les facteurs associés de façon indépendante à une vaccination complète étaient le statut matrimonial marié (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) et la profession médicale (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: La vaccination est un acte peu réalisé par le personnel du CHU de Cocody. Celle-ci était meilleure chez le personnel marié et médical. Mots clés: personnel hospitalier ; vaccination ; hépatite virale B ; Abidjan- côte d’ivoire English Title: Vaccination coverage against viral hepatitis B Abidjan teatching hospital English Abstract Introduction: Hospital staff is a risk population for viral hepatitis B. The primary prevention by anti-viral B vaccination is effective. There is few data about that prevention in Ivorian hospital environment. Method: We made a prospective cross-sectional study from the 1st of July to the 31st of December 2016, including all CHU de Cocody regularly assigned agent. All those who were absent throughout the duration of the study or refused to participate or in whom a technical difficulty was noted during laboratory analysis were excluded. Sociodemographic, anamnestic and biologic data were collected on a pre-established survey sheet. The anti-viral B vaccination was complete when the person had received three doses of the vaccine. Results: Among the 1479 agents of the CHU de Cocody, 867 was included, giving a participation rate of 58.6%. The middle age was 41.2± 9.4 years, the median was 40 years (18 to 66 years). The sex ratio was 0.82. Average professional seniority was 11.2 ± 9.7 years. Married agents (45.8%) and paramedics (45.9%) was relatively the most numerous. 91.5% of the hospital workers had already heard about viral hepatitis B. 70% of them were directly exposed to human organics fluids. A blood exposure accident was reported by 18.5% of hospital agents. Paramedical staff represented the majority. Positive HBs antigen was found in 7.2% of our study population. The agents claiming to have received at least one dose of anti-viral B vaccine numbered 290 (33.4%). A pre-vaccination screening had been achieved in 17.6 % of them. Respectively 29 (23.8%), 39 (32%) and 54 (44.3%) among the incompletely vaccinated agents have had their last dose before one year old, between 1 and 5 years old and after 5 years old. Independently associated factors with a complete vaccination was married marital status (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) and the medical profession (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: Vaccination coverage is poor in CHU de Cocody regularly assigned agents.It was better among married agents and medical staff. Keywords: Hospital staff; vaccination; viral hepatitis B, Abidjan-ivory- cos

Evaluation of Four Rapid Tests for Detection of Hepatitis B Surface Antigen in Ivory Coast

Background. Hepatitis B virus (HBV) infection is a leading cause of liver disease worldwide. Hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs) could be an ideal tool for a large-scale HBV screening in settings with high endemicity but limited infrastructure. The aim of this study was to evaluate the diagnosis performance of such RDTs for screening HBV infection in Ivory Coast. Methods. From September 2018 to January 2019, a cross-sectional phase I evaluation study of RDTs was conducted in three laboratories of Abidjan (CeDReS, CNTS and IPCI), on a panel of 405 whole blood samples and 699 plasmas. Four HBsAg RDTs (Determine™ HBsAg, SD Bioline HBsAg WB®, Standard Q HBsAg® and Vikia HBsAg®) were evaluated. The diagnostic performance (sensitivity and specificity) was calculated in comparison to the reference sequential algorithms of two EIA tests (Dia.Pro HBsAg® one version ULTRA and Monolisa™ HBsAg ULTRA). Results. The Determine™ HBsAg and Vikia HBsAg® tests performed well, with 100% of sensitivity, specificity both on plasma and on whole blood. For SD Bioline HBsAg WB® and Standard Q HBsAg®, the specificities were 99.8% and the sensitivities 99.3% and 97.1% respectively. Finally, there were a total of 19 false negative results: 3 with SD Bioline HBsAg WB® and 16 with Standard Q HBsAg®. Conclusion. Determine HBsAg® from Alere and Vikia HBsAg® from Biomérieux are the most suitable RDTs for screening for HBV in Ivory Coast. A phase II evaluation must be initiated

Evolution of hepatocellular carcinoma epidemiology in Côte d’Ivoire

International audienceIntroduction: Hepatocellular carcinoma is a major concern for Public health in West Africa. In Côte d'Ivoire, the bulk of our knowledge stems from studies conducted decades ago. Our aim was, thus, to assess whether the epidemiological features of this tumor changed recently.Methods: Records from 863 patients diagnosed between 2007 and 2014 were analyzed.Results: We observed major drifts concerning hepatocellular carcinoma with regards to the 1970-1980 period. Age at presentation is substantially delayed (49.4±14.1 years) whereas sex ratio decreased substantially (M:F=2.6). Patients seropositive for hepatitis B surface antigen and anti-hepatitis C virus represented 65% and 25% of cases whereas alcohol intake was reported in 36%. AFP level was above 400ng/mL in 36% of cases and tumors were already multinodular and/or metastatic at diagnosis in 77% and 26% of patients. Geographical and anthropological variations were observed with excesses of female cases affecting regions (Lagunes) or linguisitic groups (Kru). North-Mande speakers were more often identified as nonBnonC than others.Discussion: Ivorian epidemiology of hepatocellular carcinoma was reshaped during the last decades. These changes, most likely due to the spread of hepatitis C virus, resulted in an older and feminized population of patients. We fear that the current and future prevalence of anti-HCV cases might thwart the expected benefits of anti-hepatitis B immunization. Appropriate measures should be taken to prevent further transmission of hepatitis C in the country

Efficacy of 4 quadruple therapy to eradicate Helicobacter pylori in the real life

Background: The effectiveness of rate of eradication Helicobacter pylori is unknown in Côte d'Ivoire in daily practice. Objectives : The aim ofour study was to assess the effectiveness of 4 quadruple therapies Materials and Methods : This was a retrospective multi center study carriedout in Abidjan. The medical records of naive patients over 18 years old treated with quadruple therapy [sequential (Q s), concomitant 10 (Qc10) or14 days (Qc14) or bismuth based therapy (Qb)]confirmed histologically on gastric biopsies were included. All had a histologic al check for theeradication of H pylori at least 4 weeks after the en d of treatment. The quadruple th erapy eradication rate has been determined. Results : Onehundred and seventy files were included. The overall eradication rate was 60.6% [53.3% 67.9% 95% CI]. It was 55.6% for Qs (30/54, [42.3%68.9% 95% CI]), 80% for Qc10 (8/10, [55.2% 100% 95% CI ]]), 58.3% for Qc14 (49/84, [47,756%, 68,844% 95% CI]) and 72.7% for Qb (16/22,[54,084%, 91,316% 95% CI]). The patients of the 4 protocols were comparable for age (p = 0.054); gender (p = 0.157); reason p = 0.173) andendoscopy result (p = 0.244); intensit y of antral (p = 0.542) and fundic (p = 0.744) H pylori infection in histology; frequency of side effects (p =0.131) and adherence to therapy (p = 0.564). Conclusion s : T he eradication rate of H pylori in daily practice was not optimal regardless of thequa druple therapy regimen used. A study of the resistance of H pylori to different antibiotics is necessary