Les tumeurs malignes anorectales en milieu hospitalier à Ouagadougou: aspects épidémiologiques et diagnostiques

Le but de notre étude était de décrire les caractéristiques épidémiologiques et diagnostiques des tumeurs malignes anorectales en milieu hospitalier à Ouagadougou. Il s'est agi d'une étude rétrospective et  transversale qui a concerné les patients vus en endoscopie digestive basse au cours de la période allant  du 29/09/1999 au 04/10/2008. À l'aide d'une fiche de collecte, nous avons recueilli, dans 4 structures  sanitaires et 3 laboratoires d'anatomie et de cytologie pathologiques de la ville de Ouagadougou, les  données à partir des comptes-rendus d'endoscopie digestive basse et des registres d'anatomie et de  cytologie pathologiques. Durant la période de notre étude, 645 patients ont été examinés en anorectoscopie et 882 cas d'affections anorectales colligés. Les tumeurs malignes anorectales avec 61 cas (6,9%) occupaient la quatrième place après la maladie hémorroïdaire (45,6%), les anites (21,1%) et les fissures (13,9%). Elles regroupaient les cancers du rectum (4,2%) et les cancers de l'anus (2,7%). Vingt cancers anorectaux ont été histologiquement confirmés parmi lesquels l'adénocarcinome était le  type histologique le plus retrouvé avec 17 cas. Les tumeurs malignes, quatrième affection anorectale la plus fréquente au cours de notre étude, constituent une préoccupation du fait de leur fréquence  croissante, leur diagnostic souvent tardif et les difficultés liées à leur prise en charge surtout dans nos pays avec une population à faible revenu. La sensibilisation de la population et la prescription plus large de l'endoscopie digestive basse devraient permettre une meilleure prise en charge des patients.Key words: Tumeurs malignes, pathologie anorectale, épidémiologie, diagnostic, Burkina Faso

Non-invasive diagnosis of variceal bleeding: choose the right target population and identify the right culprit

International audienc

Cirrhose du foie : aspects épidémiologiques et diagnostiques au centre hospitalier universitaire Yalgado Ouédraogo

Introduction Liver cirrhosis represent 27.63% of the hepatobiliary diseases in Burkina. We aimed at studying the epidemiological characteristics and diagnostic features of the cirrhosis. Patients and methods We implemented a cross-sectional and descriptive study, collecting retrospectively the data from 1st January 2012 to 31st March 2014. The diagnostic of cirrhosis was based on i) clinical criteria (an edema-ascitic syndrome with a heterogeneous hepatomegaly with a sharp inferior border or atrophic liver and a portal hypertension); ii) biological criteria (a hepatocellular insufficiency syndrome); and iii) ultrasound imaging suggesting cirrhosis. Qualitative variables were presented as frequencies and percentages while qualitative ones were presented as means. Results The data of 273 patients representing 33,9% of all hospitalizations were analyzed. The hepato-biliary diseases represented 74.7% of all diagnostics. The participants’ mean age was 46.9 years and the sex ratio, 2.7. The complaints at entry were dominated by abdominal pains (69.2% of the cases), weight loss (42.8%), asthenia (32.2%) and anorexia (28.2%). Hepatomegaly (68.03%), oesophageal varices (54.21%), conjunctival jaundice (54.2%), edema of the lower limbs (53.8%), poor general condition (32, 2%), gastrointestinal hemorrhage (8.4%) hepatic encephalopathy (8%) were the clinical manifestations at entry. The mean alpha-foeto-protein, HBV-DNA and HCV-RNA levels were 2843.6 IU / ml, 23295569.7IU / ml and 2749IU / ml, respectively, while the antigen HBs and anti-HCV antibody were positive in 76.5% and 14.6% of cases, respectively. Conclusion Cirrhosis of the liver still mostly affects the young and active male population. The main etiological factors are hepatitis B and C viruses. Prevention through vaccination (anti-hepatitis B) and early systematic screening are very efficient weapons at our disposal.  La cirrhose domine les pathologies hépatobiliaires avec 27,63% des cas au Burkina. Le but de notre travail était d’étudier les aspects épidémiologiques et diagnostiques de la cirrhose. Il s’est agi d’une étude transversale descriptive avec collecte rétrospective des données, du 1er janvier 2012 au 31 mars 2014. Le diagnostic de cirrhose a été retenu sur la base des i) arguments cliniques (un syndrome œdémato-ascitique, une hépatomégalie hétérogène à bord inférieur tranchant ou un foie atrophique, une hypertension portale) ; ii) biologiques (un syndrome d’insuffisance hépatocellulaire); et iii) d’imagerie évoquant une cirrhose. Les variables qualitatives ont été présentées sous forme de fréquences et de pourcentage tandis que les variables quantitatives on fait l’objet de calcul de moyennes. L’analyse a concerné 273 patients soit 33,9% des hospitalisations. La pathologie hépatobiliaire a représenté 74,7% des affections rencontrées. La moyenne d’âge était de 46,9, et le sex-ratio, de 2,7. La cirrhose du foie touche encore en majorité la population masculine, jeune et active. Les plaintes à l’entrée étaient dominées par la douleur abdominale (69,2% des cas), l’amaigrissement (42,8%), l’asthénie (32,2%) et l’anorexie (28,2%). L’hépatomégalie (68,03%), les varices œsophagiennes (54,21%), l’ictère conjonctival (54,2%), les œdèmes des membres inférieurs (53,8%), le mauvais état général (32,2%), l’hémorragie digestive (8,4%) l’encéphalopathie hépatique (8%) constituaient les manifestations cliniques à l’entrée. Les taux moyen d’alpha foeto-protéine, de l’ADN-VHB et de l’ARN-VHC étaient de 2843,6 UI/ml, 23295569,7UI/ml et de 2749UI/ml, respectivement, alors que l’antigène HBs et l’anticorps anti-VHC étaient positifs dans 76,5% et de 14,6% des cas, respectivement. Les virus de l’hépatite B et C sont donc les principales étiologies de la cirrhose au Burkina Faso. La prévention par la vaccination (anti-hépatite B) et le dépistage systématique précoce sont des armes très efficientes à notre disposition

Screening for Hepatitis B in partners and children of women positive for surface antigen, Burkina Faso

International audienceObjective To evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus(HBV) attending antenatal care.Methods We identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso.At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to bescreened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivityamong family members.Findings Of 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%)partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, whoattended the woman’s first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity wasassociated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariableanalysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49–29.48) or having a mother with HBV DNA level≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61–29.00).Conclusion In low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected householdcontacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viralload or infectivity should be a priority for testing and linkage to car

Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study.

Hepatitis B virus (HBV) elimination requires expanding and decentralising HBV care services. However, peripheral health facilities lack access to diagnostic tools to assess eligibility for antiviral therapy. Through the Hepatitis B in Africa Collaborative Network (HEPSANET), we aimed to develop and evaluate a score using tests generally available at lower-level facilities, to simplify the evaluation of antiviral therapy eligibility in people living with HBV. We surveyed the availability of clinical and laboratory parameters across different health-care levels in sub-Saharan Africa. We used data from the HEPSANET dataset, the largest cross-sectional dataset of treatment-naive people living with HBV in sub-Saharan Africa, to derive and validate the score. Participants from this dataset were included in the analysis if they were aged 18 years or older and had liver fibrosis stages determined by a liver stiffness measurement or liver histopathology. Participants with co-infections or metabolic disorders were excluded. We allocated participants to the derivation and validation sets by geographical site. In the derivation set, we used stepwise logistic regression to identify the best performing parameters for identifying participants that met the 2017 European Association for the Study of the Liver (EASL) criteria. Regression coefficients were converted into integer points to construct simplified algorithms for different health-care levels. In the validation set, we estimated the area under the receiver operating characteristic, sensitivity, and specificity of the simplified algorithm for identifying antiviral therapy eligibility defined by the 2017 EASL criteria. At 11 sites from eight countries that returned surveys, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count were generally available at district hospital levels, and hepatitis B e antigen and point-of-care HBV DNA tests were available only at regional and provincial hospital levels or above. Among 2895 participants included from the HEPSANET database (1740 [60·1%] male, 1155 [39·9%] female), 409 (14·1%) met EASL antiviral therapy eligibility criteria. In the derivation set, the optimal district-level hospital score was: ALT (IU/L), less than 40 (0 points), 40-79 (+1), 80 or greater (+2); AST (IU/L), less than 40 (0), 40-79 (+1), 80 or greater (+2); and platelet counts (10 /L), less than 100 (+2), 100-149 (+1), 150 or greater (0). When combined with family history and clinical data for decompensated cirrhosis that do not require any biological tests, a cut-off of 2 points or more had a sensitivity and specificity of 82% (95% CI 76-86) and 95% (93-96) to identify treatment-eligible individuals in the derivation set, and 78% (71-85) and 87% (86-89) in the validation set, respectively. Using a score incorporating platelet counts, AST, and ALT, the majority of people living with HBV requiring antiviral therapy can be identified. Our findings suggest that clinical staging can be decentralised down to district hospital level in sub-Saharan Africa. European Association for the Study of the Liver Foundation, John C Martin Foundation. For the French translation of the abstract see Supplementary Materials section