RESULTATS DU TRAITEMENT DU VOLVULUS DU SIGMOÏDE A N’DJAMENA, TCHAD

The sigmoid colon volvulus is a common cause of intestinal obstruction in Africa. This work aimed to describe the treatment of sigmoid volvulus in N'djamena, Chad. Materials and Methods: This was a retrospective descriptive study realized in the General Surgery Ward of the Hopital General de Référence Nationale of N'Djamena, Chad during the period from 1/1/2010 to 31/12/2014. The records of patients operated during that period were the source of the studied data collection. The study parameters were: age, gender, physical findings and functional signs, para clinical examinations, the presence or not of colonic necrosis, the type of treatment, length of hospital stay, morbidity and mortality. Results: Sixty six cases were retained. The sigmoid volvulus constituted 9% of the operated intestinal obstruction during the study period. They were 64 men (96.7%) and 2 women (3.03%) or a sex ratio of 32/1. The clinical signs were: abdominal pain (91.2%), abdominal distension ( 88.6), and a cessation of stools and gas. (73.6%) Moreover, vomiting was found in 58 % and fever in 29,% of cases. The mean time to diagnosis was 37.7 hours (range 6 hours and 101h). The necrosis rate was 16.6% or 11 cases. The operative techniques were: resection - colostomy according Hartmann in 33 cases (50%); resection followed by immediate colo-colonic anastomosis in 23 cases (34.85%), and a simple untwisting in 10 cases (15.15%). Morbidity was 13.6% represented by two anastomotic leaks in the group of resection anastomosis, 4 parietal wall suppurations, and two medical complications. The average hospital stay was 11.2 days (range 5 days and 58 days). Mortality was 5.4%, and all concerned three patients over 60 years and with comorbidities. Conclusion: In the management of sigmoid volvulus, the Hartmann procedure is the safest method in our context. Ideal colectomy may be propsed in selected cases. The simple untwisting of the colon by laparotomy is not recommended, because of frequent relapses

Biochemical profile and resistance phenotype of isolates responsible for bacteremia in 111 HIV-infected patients hospitalized at the National Reference University Hospital of N'Djamena from 2020 to 2023

Introduction: Surveillance of antibiotic resistant bacteria provides important information to optimize care for people living with HIV (PLHIV). The objective of this work was to determine the prevalence of bacteremia in PLHIV and to describe the biochemical profile and resistance of bacteria to antibiotics commonly prescribed for the care of patients and followed in the cohort in the infectious disease departments (SMI) of the National Reference University Hospital (CHU-RN) of N'Djamena. Material and methods: This was a descriptive, analytical and etiological diagnostic study carried out on isolates responsible for bacteremia in PLHIV, from 01/01/2020 to 03/31/2023. The isolation, the identification of the bacteria and the antibiogram were carried out by standard methods of clinical microbiology. Results: The study included 111 PLHIV, 51 of who were positive on blood culture (54%). The average age of PLHIV was 45.5 years with the extremes ranging from 15 and 76 years. The age group most affected by bacteremia was that of 55 years and over. A significant difference was observed in terms of the predominance of women over men (P = 0.02). The most identified bacteria were Staphylococcus aureus (56.86%) and Escherichia coli (16.68%). The most determined resistance phenotypes were multi-resistant bacteria (BMR) and extended-spectrum beta-lactamases (ESBL) with the proportions of 29.41% and 23.52% respectively. Conclusion: The results of this study raise the need for continuous monitoring of antibacterial resistance and to apply the recommendations for the proper use of antibiotics among PLHIV in Chad

RESULTATS DU TRAITEMENT DU VOLVULUS DU SIGMOÏDE A N’DJAMENA, TCHAD

The sigmoid colon volvulus is a common cause of intestinal obstruction in Africa. This work aimed to describe the treatment of sigmoid volvulus in N'djamena, Chad. Materials and Methods: This was a retrospective descriptive study realized in the General Surgery Ward of the Hopital General de Référence Nationale of N'Djamena, Chad during the period from 1/1/2010 to 31/12/2014. The records of patients operated during that period were the source of the studied data collection. The study parameters were: age, gender, physical findings and functional signs, para clinical examinations, the presence or not of colonic necrosis, the type of treatment, length of hospital stay, morbidity and mortality. Results: Sixty six cases were retained. The sigmoid volvulus constituted 9% of the operated intestinal obstruction during the study period. They were 64 men (96.7%) and 2 women (3.03%) or a sex ratio of 32/1. The clinical signs were: abdominal pain (91.2%), abdominal distension ( 88.6), and a cessation of stools and gas. (73.6%) Moreover, vomiting was found in 58 % and fever in 29,% of cases. The mean time to diagnosis was 37.7 hours (range 6 hours and 101h). The necrosis rate was 16.6% or 11 cases. The operative techniques were: resection - colostomy according Hartmann in 33 cases (50%); resection followed by immediate colo-colonic anastomosis in 23 cases (34.85%), and a simple untwisting in 10 cases (15.15%). Morbidity was 13.6% represented by two anastomotic leaks in the group of resection anastomosis, 4 parietal wall suppurations, and two medical complications. The average hospital stay was 11.2 days (range 5 days and 58 days). Mortality was 5.4%, and all concerned three patients over 60 years and with comorbidities. Conclusion: In the management of sigmoid volvulus, the Hartmann procedure is the safest method in our context. Ideal colectomy may be propsed in selected cases. The simple untwisting of the colon by laparotomy is not recommended, because of frequent relapses

Prevalence and Diversity of Hepatitis Virus Markers among Patients with Acute Febrile Jaundice in Chad

peer reviewedOnly a minority of the patients with acute febrile jaundice evaluated through the Yellow Fever surveillance program were found positive for antibodies against Yellow Fever Virus (YFV). In order to characterize patients with acute febrile jaundice negative for YFV, we collected 255 sera between January to December 2019. We screened for HBV antigens, and antibodies against HCV and HEV. The seroprevalences observed were 10.6% (27/255) for HBV, 2% (5/255) for HCV, 17.3% (44/255) for HEV IgG, 4.3% (11/255) for HEV IgM, and 12.5% (32/255) for both IgG and IgM HEV. Prevalence of HEV was significantly higher in females than males (p < 0.01). HEV IgG prevalence was highest in those 20–29 years old, but the highest incidence rate (IgM positive) was in children 0–9 years old. Exposure to HEV was higher in the Sahelian zone (55.8%, 95%CI: 40.97–70.66) than in the Sudanese zone (30.2%, 95% CI: 24.01–36.37, p = 0.003). The high prevalence rates and hepatitis virus diversity underline the challenge of routine clinical diagnosis in Chad’s Yellow Fever surveillance program

Launch of the Laboratory for Major Tropical Epidemics (LAGET) in Chad: Strengthening the capacity for epidemiological surveillance, monitoring and diagnosis of endemic or emerging infectious diseases in Central Africa

In an increasingly interconnected world, with the devastating effects of climate changes and humanitarian crises, pandemics and emerging infectious diseases are more likely to become our daily reality. When it comes to health care, sub-Saharan Africa faces more challenges than most other regions of the world, including lack of funds, precarity and poor infrastructures. Yet, these areas are most often on the front lines of infectious threats

Diagnosis, Treatment and Prognosis of Fournier's Gangrene in Africa: a scoping review protocol

collect, analyze and compare the various data (clinical, therapeutic and prognostic) from African studies of Fournier gangrene with the available non-African literature

Compliance of hypertensive patients with antihypertensive drug therapy at the Renaissance Hospital of N’Djamena, Chad

Introduction: High blood pressure is a major cardiovascular risk factor. In hypertension, non-compliance is frequent. The objective of this work is to evaluate the therapeutic observances and to identify the predictive factors of poor compliances in Chadian hypertensive patients. Patients and Methods: It was a prospective cross-sectional study over a six-month period from January 15 to July 15, 2019. This was performed in the outpatient Cardiology and Nephrology units at the Renaissance Hospital of N’Djamena. We included all follow-up patients who had hypertension who consulted during the study period. However, dialysis patients and children were excluded from this study. The parameters studied were demographic characteristics, economic and therapeutic data and the rate of therapeutic compliance. Results: Eighty-seven patients were included. The average age was 50 years old. The sex ratio was 2.5. Sixty-seven percent (n = 58) of the patients were from urban areas. The predominant cardiovascular risk factors were smoking in 25% (n = 22) and diabetes in 23% (n = 20). Hypertension was uncontrolled in 76% (n = 66) patients. Adherence was poor in 66% (n = 57) of patients. The monthly cost of treatment was respectively 10,000 and 20,000 FCFA in 52% (n = 45) of cases. Combination therapy was observed in 70% of cases (n = 61) and 56% (n = 49) of patients had more than one drug intake. The adherence rate was 93% (n = 28) in the urban population (p < 0.001). All patients (n = 30) who were observing their treatment were educated (p < 0.001). The adherence rate was 20% (n = 6) in patients who had a monthly income less than 100,000 FCFA (p = 0.004). The adherence rate was 60% (n = 18) when the monthly cost was less than FCFA 10,000 (p = 0.003). The adherence rate was 77% (n = 23) in patients receiving monotherapy (p < 0.001). Conclusion: This study showed a low level of adherence in Chadian hypertensive patients. The complexity and cost of antihypertensive therapy, poor knowledge of hypertension, and ignorance of its severity have been the main factors of poor compliance

Use of Dried Blood Spot to Improve the Diagnosis and Management of HIV in Resource-Limited Settings

peer reviewedOver 75% of people infected with HIV live in countries where health resources are very limited for the diagnosis and biological monitoring of people infected by the virus. In resource-limited settings, the use of DBS is a valuable alterna- tive. It has provided technical and economical alternative to the collection of blood in the tubes for testing HIV infec- tion. The DBS can be kept for over a year, it is economical in storage space and facilitates storage conditions because it can be stored at room temperature. It is more discreet and easier to carry over liquid samples that require tubes and other appropriate materials. The amount is sufficient for certain analyses of DNA generally, but may be insufficient for the analysis of viral RNA if the viral load is low. Its disadvantage is often associated with small amounts of blood col- lected available for testing, and the difficulties encountered in laboratories to extract the maximum possibilities without material contamination. DBS can be stored at room temperature (25°C - 35°C), at 4°C, −20°C or even −70°C. With PCR, the DBS is a suitable medium for the diagnosis of patients infected with HIV, virological monitoring by the VL and even analyzing viral genotype. It is a handy stand for the collection, transport and analyses of biological monitoring of HIV infection. It is indeed very suitable for environments with limited accessibility where it is difficult for specialized laboratories to monitor these patients. The DBS is suitable for resource-limited settings.Nouvelles approches génotypiques pour le monitoring de résistance du VIH aux ARV dans les pays à ressources limitée

Biochemical and resistance profile of Helicobacter pylori isolated in N’Djamena in Chad

Helicobacter pylori infection and resistance to antibiotics is a public health problem. The objective of this study was to determine the prevalence and rates of resistance to antibiotics used in the protocol for the management of patients with Helicobacter pylori infection. Spanning a period from February 2020 to February 2021, it was an observational diagnostic study on gastric biopsies and stool including 97 patients admitted for endoscopy. It was carried out according to standard methods of medical microbiology. Of 97 patients whose mean age was 46.10 years with extremes of 16 and 85 years, an infection prevalence of 60.82% was observed. 44.07% of infected patients were between 16 and 39 years old, 33.90% between 40 and 63 years old, and 22.03% between 63 and 85 years old. Significant differences were observed between the proportions of positive (81.44%) and negative (18.56%) cultures, between infection with H. pylori (75%) and other microbial agents (25.35%) with probabilities of 0.01 and 0.02 respectively. The most resistant antibiotics were: Metronidazole, Clarithromycin, Levofloxacin, Tetracycline and Amoxicillin with resistance rates of 74.58%, 16.95%, 13.56%, 8.47%, and 5.08% respectively.&nbsp; The frequencies of antibiotic resistance revealed 74.58% for Metronidazole, 16.95% for Clarithromycin, 13.56% for Levofloxacin, 8.47% for Tetracycline, and 5.08% for Amoxicillin. This study made it possible to determine a significant proportion of H. pylori infection and to shed light on the resistance to the antibiotics used in the eradicating treatment of the bacteria. From this study, we retain that the prescription of Metronidazole is prohibited in Chad. Keywords: Helicobacter pylori, Resistance, Antibiotic, Chad

La diagnosi sierologica delle gastriti croniche atrofiche

The majority of atrophic chronic gastritis is related to the H. pylori infection. Opposite to a small group related with autoimmune diseases. Gastrointestinal endoscopy with biopsies is claimed to be the gold standard for the diagnosis of atrophic gastritis. The morphological abnormalities of gastric mucosa may be associated with changes of gastric secretion. A panel of four serological parameters: serum pepsinogens I and II gastrin-17 and anti-Helicobacter anti-body (GASTROPANEL) is described to be useful to single out gastric atrophic lesions. Additionally, GASTROPANEL can detect the topography of atrophic gastritis (in corpus, in antrum or in both) and the aetiology of atrophic damages. Considering unspecific symptoms on the one hand and the serious sequelae (gastric cancer, anemia, etc...) on the other one of atrophic gastritis, GASTROPANEL could represent a useful tool for the clinical management of patients with upper gastrointestinal symptoms and for selected people at high risk for gastric cancer