Aspects épidémio-clinique et évolutif de la Cirrhose du foie à Kinshasa : Etude Multicentrique: Multicentric study on epidemiological, clinical and progressive aspects of liver cirrhosis in Kinshasa

Context and objectives. Liver cirrhosis is relatively common and leads to multiple complications in developing countries where management is often late. However, data on this disease are paradoxically scarce in DR Congo. The present study was designed to describe epidemiological, clinical, therapeutic aspects as well as outcome of cirrhosis in the city of Kinshasa. Methods. In a retrospective study, 1,056 records of patients having liver cirrhosis and attending 8 hospitals over 11 years (2001-2011) in the city of Kinshasa were analyzed. The parameters of interest included sociodemographic, clinical and disease progression data. Results. Their mean age was 51 ± 16 years with a male predominance (68.8%). The etiologies of cirrhosis were dominated by alcoholism (49.6%) and viral hepatitis (22.4%). Among patients with viral hepatitis, 11.3 % were seropositive for HBsAg, 34.0% for anti-HCV and 54.7% for HBV-HCV. Almost half of the patients presented with abdominal pain (45%), physical asthenia (43%) and abdominal bloating (42%). The most common clinical signs found were ascites, hepatomegaly and lower limb edema. The outcome was marked by ascites in 64.7%, jaundice in 42.3%, malignant degeneration in 33% and digestive hemorrhage in 32%. Beside the symptomatic treatment, an etiological treatment was rarely tempted. No patient benefited from hepatic transplantation and 44.2% of patients died. Conclusion. Almost half of cirrhotic patients studied were alcoholic and the treatment still symptomatic. This study argues for a national policy for the management of liver cirrhosis and especially prevention through the fight against chronic alcoholism and vaccination campaigns against viral hepatitis B and C. Contexte et objectifs. La cirrhose est relativement fréquente et occasionne des multiples complications dans les pays en voie de développement où la prise en charge est souvent tardive. Cependant, les données y relatives sont fragmentaires en RD Congo. Les objectifs de la présente étude étaient de décrire les aspects épidémiologiques, cliniques, et évolutifs de la cirrhose hépatique dans la ville de Kinshasa. Méthodes. Il s’agissait d’une étude documentaire ayant colligé les dossiers médicaux de 1056 patients ayant présenté une cirrhose du foie dans 8 centres hospitaliers de la ville de Kinshasa entre 2001 et 2011. Les paramètres d’intérêt comprenaient les données sociodémographiques, cliniques, ainsi que l’évolution des patients sous l’attitude thérapeutique. Résultats. Leur âge moyen était de 51ans (ET=16) avec une prédominance masculine (68,8%). Les étiologies de la cirrhose étaient dominées par l’alcoolisme (49,6%) et l’hépatite virale (22,4%). Parmi les patients avec hépatite virale (22,4%), 11,3% de l’Ag HBs, 34% de l’Ac anti VHC et 54,7% de co-infection VHB-VHC étaient rencontrés. Près de la moitié des patients ont présenté à l’admission des douleurs abdominales (45%), de l’asthénie physique (43%) et un ballonnement abdominal (42%). L’ascite, l’hépatomégalie et les œdèmes des membres inférieurs étaient les signes physiques fréquemment rencontrés. L’évolution était marquée par une ascite chez 64,7%, un ictère chez 42,3%, une dégénérescence maligne chez 33% et une HD chez 32%. En dehors du traitement symptomatique, le traitement étiologique était rarement tenté. Aucun patient n’a bénéficié d’une transplantation hépatique et 44,2% des patients étaient  décédés. Conclusion. Près de la moitié des patients étudiés avait une cirrhose alcoolique dont la prise en charge reste très délicate expliquant la surmortalité. Cette étude plaide pour une politique nationale de prise en charge de la cirrhose du foie et surtout de prévention par la lutte contre l’alcoolisme chronique et les campagnes de vaccination contre l’hépatite virale B et C

Evaluation du niveau de connaissance et des facteurs prédisposant aux hépatites B et C chez les patients suivis en consultations externes des trois hôpitaux de Kinshasa : étude transversale multicentrique: Assessment of level of knowledge and factors predisposing on hepatitis B and C in patients followed by external consultations of the three hospitals of Kinshasa: a multicenter cross-sectional study

Context and objective. Knowledge on prevention and risk factors for HBV and HCV in the community is essential in order to fight against efficiently the spread of HBV and HCV. The aim of this study was to assess the extent of the risk factors for hepatitis B and C virus infection in Congolese community settings through outpatients. Methods. A multicentric cross-sectional study was conducted from May to October 2016. It consisted directly in collecting information on hepatitis B and C from outpatients in 3 hospitals of Kinshasa: Clinique d’Or, CUK and CHEM. Data collection was done consecutively. Results. 133 patients were interviewed (male 66.9%, mean age 33.9 ± 7.8 years). Knowledge of hepatitis B or C was found in 58.6% patients. The predisposing factors of hepatitis B and C were on average 4 factors in the same person and 24.8% of the respondents had at least 4 predisposing factors. The high level of study was the major factor associated with best knowledge of hepatitis B and C (aOR: 15.81, 95% CI: 4.90-18.01, p <0.001). Conclusion. The frequency of predisposing factors for hepatitis B and C is high in our environment; sufficient information on the harmful effects of these viruses would reduce this frequency and increase knowledge about hepatitis B and C. Contexte et objectif. La connaissance par la population des moyens de prévention et des facteurs prédisposant est indispensable en vue de lutter efficacement contre la propagation des virus de l’hépatite B et C. L’objectif de cette étude était d’évaluer l’ampleur des facteurs prédisposant l’acquisition de l’infection par le virus de l’hépatite B et C en milieu communautaire congolais. Méthodes. Etude transversale multicentrique, ayant inclus des patients recrutés, par convenance en consultation externe des trois formations hospitalières de Kinshasa ; entre mai et octobre 2016. Elle avait consisté à recueillir directement par entretiens dirigés, des informations sur les connaissances des hépatites B et C. Résultats. Au total 133 sujets ont été interviewés (hommes 66,9%, âge moyen était de 33,9±7,8 ans). Près de 59% des patients avaient avoué avoir des connaissances sur les hépatites B et C. Les facteurs prédisposant aux hépatites B et C étaient en moyenne de 4 chez la même personne. Le niveau d’étude élevé a émergé comme seul facteur associé de manière indépendante, à la connaissance de l’hépatite B et C (ORa : 15,81 ; IC 95% : 4,90-18,01, p<0,001). Conclusion. La fréquence des facteurs prédisposant à l’hépatite B et C est élevée dans nos milieux, une information suffisante sur les méfaits de ces virus, permettrait de diminuer cette fréquence et d’augmenter la connaissance sur les hépatites B et C

Congrès AFMED 2017 : Prévalence et facteurs de risque de l’hépatite B et C dans la communauté : Etude transversale des croyants de l’Eglise La Compassion et l’Eglise Providence Divine: Prevalence and Risk Factors of Hepatitis B and C in the Community: Cross-sectional Study of the Church’s Beliefs Compassion and Providence Divine Church

Background. Hepatitis B and C are a real public health problem due to the increased prevalence of these two viruses around the world. The present study aimed to evaluate the prevalence of hepatitis B and C, the exposure factors of these hepatitis in ecclesiastical environment and to sensitize these populations on the factors of hepatitis B and C.Methods. We conducted a descriptive cross-sectional study of members of the two churches during the period of worship from 6 August to 30 September 2017. The interview allowed the collection of sociodemographic characteristics and risk factors, to determine the Ag HBs and the anti HCV Ac and analyzed on SPSS 21.Results. During this period, 159 subjects were studied (52% women sex ratio 1H: 1F of average age of 31.2 ±12.2 years with extremes of 16 and 68 years. Among these, 40.3% were students, 46.5% of the respondents had a notion of hepatitis B and C. the prevalence of hepatitis B was 1.9% ie 3 cases and that of hepatitis C is 0%. The most common hepatitis B and C exposure factors were hospitalization or surgery (64.2%), non condom use (66%), transfusion 22%, piercing (19.5%), drug use (5%) ; 6% of respondents had no exposure factor, 50.3% had no more than 3 exposure factors. Factors associated with non-condom use were single (ORa: 16.5 95% CI: 2.1-26.9), young age (<25 years) (ORa: 4, 95% CI: 2, 4-6.8), the status of the student (ORa: 3.6, 95% CI: 2.1-6.3). Conclusion. Almost 2 percent of study population exhibit hepatitis B. The most frequent exposure factor for hepatitis B and C among young students, the most common being non-condom use, the determinants of which were bachelor's status, young age, and student status. Contexte et objectif. Les hépatites B et C constituent un réel problème de santé publique suite à l‟augmentation de la prévalence de ces deux virus dans le monde. L‟objectif de la présente étude était d‟évaluer la prévalence des Hépatites B et C, les facteurs d‟exposition de ces hépatites en milieu Ecclésiastique et de sensibiliser ces populations sur les facteurs des hépatites B et C.Méthodes. Etude transversale descriptive réalisé auprès des membres des deux Eglises au cours de culte, durant la période du 6 aout au 30 septembre 2017. L‟interview a permis de collecter les caractéristiques socio-démographiques et les facteurs de risque, un prélèvement de sang a permis de déterminer les Ag HBs et les Ac anti VHC et analysées sur SPSS 21.Résultats. Pendant la période d‟étude, 159 sujets étaient enrôlés (52% de femmes sex ratio 1H : 1F, âge moyen de 31,2±12,2 ans avec extrêmes de 16 et 68 ans). Parmi eux, 40,3% étaient des étudiants. 46,5% des répondants avez une notion de l‟hépatite B et C. La prévalence de l‟hépatite B était de 1,9% soit 3 cas et celle de l‟hépatite C était de 0%. Les facteurs d‟exposition aux hépatites B et C les plus retrouvés étaient l‟hospitalisation ou les interventions chirurgicales (64,2%), la non utilisation de préservatif (66%), la transfusion 22%, le piercing (19,5%), l‟usage de drogue (5%). 6% des répondants n‟avaient aucun facteur d‟exposition, 50,3% avaient au plus 3 facteurs d‟exposition. Les facteurs associés à la non utilisation de préservatif de manière indépendante étaient le statut de célibataire (ORa : 16,5 IC 95% : 2,1-26,9), le jeune âge (<25 ans) (ORa : 4, IC 95% : 2,4-6,8), le statut de l‟étudiant (ORa : 3,6, IC 95% : 2,1-6,3).Conclusion. Près de deux pourcent de sujets enquêtés présentent une hépatite virale B. Le facteur d‟exposition aux hépatites B et C cités par les jeunes étudiants est le non usage du préservatif ayant comme déterminants le statut du célibataire, le jeune âge et le statut de l‟étudiant

Prognostic value of (18)F-FDG PET/CT in liver transplantation for hepatocarcinoma.

AIM: To evaluate the prognostic value of pretreatment FDG positron emission tomography computed tomography (PET-CT) in patients with hepatocarcinoma treated by liver transplantation (LT). METHODS: The authors retrospectively analyzed the data of 27 patients (mean age 58 +/- 9 years) who underwent FDG PET-CT before LT for hepatocarcinoma. Mean follow-up was 26 +/- 18 mo. The FDG PET/CT was performed according to a standard clinical protocol: 4 MBqFDG/kg body weight, uptake 60 min, low-dose non-enhanced CT. The authors measured the SUVmax and SUVmean of the tumor and the normal liver. The tumor/liver activity ratios (RSUVmax and RSUVmean) were tested as prognostic factors and compared to the following conventional prognostic factors: MILAN, CLIP, OKUDA, TNM stage, alphafoetoprotein level, portal thrombosis, size of the largest nodule, tumor differentiation, microvascular invasion, underlying cirrhosis and liver function. RESULTS: Overall and recurrence free survivals were 80.7% and 67.4% at 3 years, and 70.6% and 67.4% at 5 years, respectively. According to a multivariate Cox model, only FDG PET/CT RSUVmax predicted recurrence free survival. Even though the MILAN criteria alone were not predictive, it is worth noting that none of the patients outside the MILAN criteria and with RSUVmax < 1.15 relapsed. CONCLUSION: FDG PET/CT with an RSUVmax cut-off value of 1.15 is a strong prognostic factor for recurrence and death in patients with HCC treated by LT in this retrospective series. Further prospective studies should test whether this metabolic index should be systematically included in the preoperative assessment

Prevalence and determinants of Hepatitis C Virus Infection and Genotypes in Chronic Hemodialysis Patients in Kinshasa: Prévalence et déterminants de l’infection par le virus de l’hépatite C et génotypes chez les hémodialysés chroniques, à Kinshasa

Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l’infection par le virus de l’hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60-5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d’infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d’où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte. Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09-10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo

Hepatitis C virus in sub-Saharan Africa: a long road to elimination

The development of direct-acting antivirals against hepatitis C virus (HCV) has transformed the treatment landscape and underpinned the WHO goal of HCV elimination by 2030. However, as of 2021, few countries remain on track to achieve this goal. Reliable data remain scarce, especially those on national plans for HCV elimination in many regions of the world and particularly in sub-Saharan Africa, which accounts for around 11 million of 71 million people estimated to be living with HCV

The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?

Background & aims: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas. Methods: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied. Results: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries. Conclusions: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels. Lay summary: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed

Advancing the global public health agenda for NAFLD: a consensus statement

© Springer Nature Limited 2021, corrected publication 2021Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.info:eu-repo/semantics/publishedVersio