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

Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa.

BACKGROUND & AIMS: To eliminate hepatitis B virus (HBV) infection, it is essential to scale up antiviral treatment through decentralized services. However, access to the conventional tools to assess treatment eligibility (liver biopsy/Fibroscan®/HBV DNA) is limited and not affordable in resource-limited countries. We developed and validated a simple score to easily identify patients in need of HBV treatment in Africa. METHODS: As a reference, we used treatment eligibility determined by the European Association for the Study of the Liver based on alanine aminotransferase (ALT), liver histology and/or Fibroscan and HBV DNA. We derived a score indicating treatment eligibility by a stepwise logistic regression using a cohort of chronic HBV infection in The Gambia (n = 804). We subsequently validated the score in an external cohort of HBV-infected Africans from Senegal, Burkina Faso, and Europe (n = 327). RESULTS: Out of several parameters, two remained in the final model, namely HBV e antigen (HBeAg) and ALT level, constituting a simple score (treatment eligibility in Africa for the hepatitis B virus: TREAT-B). The score demonstrated a high area under the receiver operating characteristic curve (0.85, 95% CI 0.79-0.91) in the validation set. The score of 2 and above (HBeAg-positive and ALT ≥20 U/L or HBeAg-negative and ALT ≥40 U/L) had a sensitivity and specificity for treatment eligibility of 85% and 77%, respectively. The sensitivity and specificity of the World Health Organization criteria based on the aspartate aminotransferase-to-platelet ratio index (APRI) and ALT were 90% and 40%, respectively. CONCLUSIONS: A simple score based on HBeAg and ALT had a high diagnostic accuracy for the selection of patients for HBV treatment. This score could be useful in African settings. LAY SUMMARY: Limited access to the diagnostic tools used to assess treatment eligibility (liver biopsy/Fibroscan/hepatitis B virus DNA) has been an obstacle to the scale up of hepatitis B treatment programs in low- and middle-income countries. Using the data from African patients with chronic HBV infection, we developed and validated a new simple diagnostic score for treatment eligibility, which only consists of hepatitis B virus e antigen and alanine aminotransferase level. The diagnostic accuracy of the score for selecting patients for HBV treatment was high and could be useful in African settings

A new approach to prevent, diagnose, and treat hepatitis B in Africa

There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB

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

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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. &nbsp;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

Performance of two simplified HBV treatment criteria (TREAT-B score and WHO guidelines) in Burkina Faso, West Africa

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Knowledge, Attitude, and Practice of Health Care Workers in the Management of Peptic Ulcer at the Paul VI and the Bogodogo District Hospitals, in Burkina Faso

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD. Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives. Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Kno

Maladie de Biermer : étude de quatre cas au Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou

L’objectif de cette étude est de décrire des formes cliniques particulières de la maladie de Biermer reçues au Centre hospitalier Universitaire Yalgado Ouédraogo (CHUYO). Quatre cas ont été recensés dans les services de neurologie et de gastro entérologie du CHUYO. Le diagnostic était basé sur une baisse de la vitamine B12 sanguine associée à une gastrite atrophique histologique et la présence des anticorps anti-facteurs intrinsèques. L’âge moyen des patients était de 60,5 ans, le sex ratio de 0,33. L’anémie macro-cytaire était présente dans tous les cas avec le taux le plus bas à 4.5 gr. Les signes digestifs et neurologiques étaient présents dans (03 cas). Les troubles neurologiques constituaient un tableau de sclérose combinée de la moelle (SCM) dans tous les trois cas, avec un déficit moteur observé chez deux patients, une atteinte des nerfs crâniens chez un patient, et des troubles de la mémoire chez deux patients. Tous les patients avaient reçu une supplémentation en vitamine B12. Deux patients avaient suivi une rééducation motrice. La réponse au traitement était favorable chez tous les patients. Cette affection est rare dans notre contexte. Les cas rapportés quoique sévères connaissaient une évolution favorable avec un traitement approprié.Mots-clés : anémie, Biermer, Burkina Faso, mégaloblastique, vitamine B1

Improving communication about viral hepatitis in Africa.

International audienceAs a result of the high disease burden and advent of effective preventive and therapeutic measures for viral hepatitis, the UN has included its control in its Sustainable Development Goals, and the WHO has developed a viral hepatitis elimination strategy. Only with a genuine understanding of viral hepatitis can people living with these infections fully commit to a treatment program. New WHO guidelines on HBV/HCV testing published in Februay 2017, however, make little mention of communicating with populations about chronic viral hepatitis. Our recent anthropological research investigating local understandings of hepatitis B in five sub-Saharan African countries (The Gambia, Burkina Faso, Côte d’Ivoire, Central African Republic and Madagascar) underscore the communication challenges that treatment programmes must tackle: a lack of knowledge about hepatitis B; complex local terms describing visible symptoms of liver disease; and the inappropriate use of other pathologies to explain hepatitis B

Identifying gaps across the cascade of care for the prevention of HBV mother‐to‐child transmission in Burkina Faso: Findings from the real world

International audienceBackground: Prevention of mother-to-child transmission (PMTCT) is a challenge for controlling the hepatitis B epidemic. In Sub-Saharan countries, pilot interventions including the screening of pregnant women for HBsAg, implementation of anti-HBV therapy and infant immunization within 24 hours of life are initiated and need t