Showing papers in "Open Journal of Gastroenterology in 2019"
TL;DR: The sustained virological response 12 weeks after oral treatment without interferon in HCV infected patients with genotypes 1 and 2 was above 90%, and direct-acting antivirals were effective in these patients.
Abstract: Background: Viral hepatitis C is the second leading cause of hepatocellular carcinoma after hepatitis B in Africa and Togo in particular. The advent of direct acting antivirals has revolutionized the care and prognosis of patients infected with hepatitis C virus (HCV). Objective: To evaluate the sustained virological response (SVR) 12 weeks after oral treatment without interferon in HCV infected patients with genotypes 1 and 2. Patients and Method: Descriptive and analytical study based on the retrospective collection of data in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from July 11, 2016 to April 22, 2018. All patients who had a chronic viral hepatitis C with viral replication, naive, regardless of the genotype, regardless of the degree of liver fibrosis, and who had completed their treatment with direct-acting antivirals were included. Results: We recruited 84 patients, 60 of whom were infected with HCV genotype 2 (71.43%) and 24 with HCV genotype 1 (28.57%). There were 58 men and 26 women (sex ratio: 0.45). In HCV genotype 1 patients, the median age was 54.29 years and Sofosbuvir/Ledipasvir was the most used combination (62.50%). In HCV genotype 2 patients, the median age was 54.5 years and Sofosbuvir associated with Ribavirin was the most used treatment (81.66%). The virological response at the end of treatment was 100% (genotype 1) and 93.30% (genotype 2). The SVR 12 was 100% (genotype 1) and 91.70% (genotype 2). Five patients were in treatment failure (genotype 2). Conclusion: Direct-acting antivirals were effective in our patients. The rate of sustained virological response was above 90%.
4 citations
TL;DR: Positive endoscopic findings were associated with betel quid addiction and with Hepatitis C infection, and both genders were almost equally included where most patients presented between the 3rd and 5th decades of life.
Abstract: Background: Endoscopic procedures are frequently performed to rule out any disease process which eventuates with either a positive or negative outcome. Association of patient demographics, clinical features with endoscopic outcomes are of paramount importance for better understanding and practice of endoscopy. Objectives: This study aimed to determine the frequency of positive endoscopic findings in patients with gastrointestinal symptoms compared to those with negative findings. As a secondary objective, the association between relevant demographics, symptoms, laboratory investigations and procedural outcomes of the participants and positive endoscopic findings were also assessed. Methods: A retrospective analysis of all the patients who underwent esophagogastroduodenoscopy from January 2017 to December 2017 was conducted. A total of 1066 endoscopy records were retrieved and using a convenience sampling technique, relevant data were manually entered to the questionnaires. Records with incomplete or inconsistent data were disregarded as per the exclusion criteria, resulting in 1011 patient records ultimately utilized for the study. All data were entered and analyzed using IBM SPSS 23.0. Results: The study comprised a total of 1011 patients where 52.2% were females and 47.8% males while the mean age of patients was 42.16 ± 15.45. Positive endoscopic findings were observed in 88.1%, where the most common finding was gastritis (49.1%). Approximately 14.5% had positive investigation findings for HBsAg and 23.1% were seropositive for anti-HCV antibody. P-values statistically significant were for age (p = 0.044), hematemesis (p = 0.002), betel quid addiction (p = 0.044), anti-HCV antibody (p = 0.043), HCV-RNA (p = 0.041) and “H. pylori” antigen (p = 0.032). Conclusion: Both genders were almost equally included where most patients presented between the 3rd and 5th decades of life. A high incidence of gastritis was noted. Positive endoscopic findings were associated with betel quid addiction and with Hepatitis C infection.
4 citations
TL;DR: Typhidot test is reliable, simple highly sensitive and specific test in diagnosing typhoid fever when compared with Widal test.
Abstract: Background and Study Aim: Typhoid (Enteric) fever is a systemic infection caused by Salmonella Typhi and Salmonella Paratyphi. It is endemic in the developing countries including Egypt. Different diagnostic tools can achieve diagnosis and include cultures from the blood, stool, bone marrow, rarely urine for isolation of the organism. Antibody detection by Widal test and relatively recent typhoid are also used. The current study aimed at comparing the most commonly used antibody detection Widal test with the rapid antibody detection typhidot for diagnosis of typhoid fever among Egyptian adults. Patients and Methods: The study included 140 patients who are presented with picture suggestive of typhoid fever. Confirmed cases after the blood culture were included in the final analysis. Widal and typhidot tests were performed in all patients and were compared for sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Results: 45 patients out of 140 were diagnosed as typhoid fever by blood culture. Out of them, Widal test was positive in 39 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 86.7%, 89.5%, 79.5%, 93.4% and 88.5% respectively. Typhidot test was positive in 42 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 93.3%, 90.6%, 82.3%, 96.6%, and 91.4% respectively (P = 0.00). Conclusions: Typhidot test is reliable, simple highly sensitive and specific test in diagnosing typhoid fever when compared with Widal test.
4 citations
TL;DR: Serum L-FABP could be used as a new diagnostic biomarker for detecting NAFLD and a strong correlation was found between L- FABP and ALT, AST, BMI and glucose levels.
Abstract: Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disease worldwide, it causes chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. We aimed to assess the value of liver fatty acid binding protein (L-FABP) in the diagnosis of non-alcoholic fatty liver disease in comparison to ultrasonography. Patients and Methods: Ninty subjects were enrolled in this study who attended the Hepatology, Gastroenterology and Internal medicine clinics in Benha University Hospitals between January 2017 and January 2018 and divided into group I included 70 consecutive patients with non-alcoholic fatty liver disease who were diagnosed by ultrasound with or without elevated liver enzymes and group II included 20 healthy control subjects without NAFLD (by ultrasound) with normal liver enzymes. Serum levels of L-FABP were determined by enzyme-linked immunosorbent assay. Results: NAFLD patients were slightly older than healthy subjects as mean age in group I was (37.74 ± 11.7) while in group II was (36.5 ± 11.31). There was a slight increase in NAFLD in males, there was a high prevalence of NAFLD in the urban population. L-FABP levels in NAFLD patients were higher than in the control group (levels were 188.6 ± 34.94 and 137.7 ± 13.05 ng/l respectively). A strong correlation was found between L-FABP and ALT, AST, BMI and glucose levels. Analysis of ROC curve revealed that at a level 151.1 ng/sensitivity, specificity, PPV, NPV and accuracy were 83.3%, 71.8%, 31.3%, 96.6% and 73.3% respectively with AUC 0.839 and at a level 189.5 ng/sensitivity, specificity, PPV, NPV and accuracy were 90%, 90%, 95.4%, 95.4%, 88.9% with AUC was 0.950. Conclusion: Serum L-FABP could be used as a new diagnostic biomarker for detecting NAFLD.
4 citations
TL;DR: The low immunization coverage and the high prevalence of seronegative students reflect the need for a vaccine catch-up policy for adolescents born before the introduction of vaccination against the viral hepatitis B virus in the Expanded Program on Immunization.
Abstract: Aim: To determine the prevalence of HBs antigen in secondary schools, to appreciate the vaccination coverage of viral hepatitis B and to propose a vaccine catch-up strategy. Materials and Methods: This was a prospective cross-sectional study conducted over a two-month period from April 24 to June 24, 2006 among students aged 10 - 15, in two schools (one public and the other private) of the city of Abidjan selected at random. The assay of serum markers of viral hepatitis B of the samples collected after 5 ml peripheral venous sampling was carried out in the viral serology and bacteriology unit of the Pasteur institute of Ivory Coast using the ELISA technique (Enzyme-Linked-Immunosorbant-Assay). The ELISA technique is an enzyme immunoassay technique that can detect an antigen or an antibody by highlighting the antigen-antibody reaction. Results: Of the 282 students who participated in our study, 5.3% of students (n = 15) were infected with the hepatitis B virus. The majority of students (79.1%, n = 223) did not have no contact with the hepatitis B virus. Only 7.8% (n = 22) of the students were vaccinated against viral hepatitis B. Conclusion: The low immunization coverage and the high prevalence of seronegative students reflect the need for a vaccine catch-up policy for adolescents born before the introduction of vaccination against the viral hepatitis B virus in the Expanded Program on Immunization.
3 citations
TL;DR: The presence of weight loss, abdominal or rectal mass should motivate the realization of a complete colonoscopy in search of a colorectal tumor.
Abstract: Background and Aims: Diagnostic colonoscopy allows exploration of the colonic mucosa. Indications are multiple. The purpose of this work was to describe the indications and to report the lesions observed during colonoscopy at the General Hospital of Douala. Methods: This was a cross-sectional study with retrospective data collection over a period of 7 years (January 1, 2010 to January 31, 2017). The data collected from the reports were socio-demographic characteristics, indications and lesions observed at colonoscopy. Binary logistic regression allowed us to identify the independent risk factors associated with the presence of tumors and polyps. Results: We included 719 exams. The main indications were rectorrhagia (29.5%), abdominal pain (25.9%) and constipation (17.8%). A colonic lesion was found in 60.1% of cases. A colorectal tumor accounted for 10.3% of cases. Factors independently associated with colonic tumor were complete colonoscopy (aOR: 0.167 95% CI [0.096 - 0.289], p < 0.001), presence of abdominal or rectal mass (aOR: 13.390 95% CI) [5.684 - 31.544], p < 0.001) and weight loss (aOR: 5.143, 95% CI [2.450 - 10.797], p < 0.001). Conclusion: The presence of weight loss, abdominal or rectal mass should motivate the realization of a complete colonoscopy in search of a colorectal tumor. The most observed lesions remain hemorrhoids, polyps and diverticulosis of the colon.
3 citations
TL;DR: The impairment of the QoL was moderated to severe (RQS® < 16) for 2/3 of the patients (n = 62) and was associated with elderly, female sex, frequency and in case of GERD requiring continuous administration of PPIs.
Abstract: The gastroesophageal reflux disease (GERD) represents a major problem for public health because of its high prevalence. The chronic character of the symptoms can have a very important impact on the quality of life (QoL). The purpose of this study is to assess the impact of the GERD on the quality of life of our patients and to determine the main aggravating factors. Patients and Methods: This is a cross-sectional, observational study of 100 patients presenting signs of GERD in the gastroenterology department of the university medical center Hassan II-Fez, for a period of 3 months (October to December 2014). We used the Reflux-Qual short form (RQS®) to evaluate the QoL of our patients. Results: Over the study period, 100 patients were included. The average age of our patients was 47 years [20 - 75 years] with a sex-ratio F/M in 2.12. Among our patients, 20% (n = 20) were chronic cigarette smokers. The diagnosis of GERD was clinical in 75% of the cases (n = 75) and based on 24-hour pH monitoring in the remaining 25% (n = 25). Approximately 2/3 of the patients were receiving proton pump inhibitors (PPIs) treatment at the time of the questionnaire. The impairment of QoL was moderated to severe (RQS® < 16) for 62% of the patients (n = 62). This impairment was associated with elderly (p = 0.01), female sex (p = 0.03) and the frequency of symptoms (p = 0.001). Moreover, patients having a GERD that requiring a daily and continuous administration of PPIs had a lower index of RQS® (p = 0.001). The quality of life impairment was not associated with chronic cigarette smoking (p = 0.3). Conclusion: The impairment of the QoL was moderated to severe (RQS® < 16) for 2/3 of the patients (n = 62). This impairment was associated with elderly, female sex, frequency and in case of GERD requiring continuous administration of PPIs.
3 citations
TL;DR: It was noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV, and there was no correlation among SAAGs and the grade of EV), red signs, gastric varices and portal hypertension gastropathy.
Abstract: Objective: To find a more accessible and less restrictive mean such as serum-ascites albumin gradient (SAAG) to predict esophageal varices (EV) in cirrhotics with ascit. Patients and methods: Descriptive and analytical studies based on the retrospective collection of data on 125 patients’ records in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from January 1, 2008 to March 31, 2018 were included. Cirrhotic patients aged 15 years and older had performed cytochemical analysis of ascites fluid and upper gastrointestinal fibroscopy and had a protidogram. Statistical analysis was done by R Studio Software 3.4.2. Results: The mean age was 48.70 years; there was a male predominance (70.40%) with a sex ratio of 2.38. Protein levels in ascitic fluid was <30 g/l in 88.80% of patients. EV were found in 64.80% of cases. The median SAAG was 1.40 g/dl. EV were significantly more frequent in case of high SAAG ≥ 1.10 g/dl, p = 0.0208. There was no correlation among SAAG and the grade of EV, red signs, gastric varices and portal hypertension gastropathy. Patients with SAAG ≥ 1.10 g/l had 1.63 times the risk of having EV (95% CI 0.63 - 4.15, p = 0.3020). At the threshold of 0.91 g/dl, the sensitivity was 83.95% and the specificity 40.90%; the area under the ROC curve was 0.61. Conclusion: Our study noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV.
3 citations
TL;DR: A case of 68-year-old man with perianal soft tissue lesion biopsied and histopathology revealed an adenocarcinoma, which was a distant metastasis from rectal cancer.
Abstract: Implantation metastasis from colorectal cancer into haemorroidectomy wound is very rare. The management of this condition remains controversial. We report a case of 68-year-old man with perianal soft tissue lesion biopsied and histopathology revealed an adenocarcinoma. Further investigation by colonoscopy and computed tomography scan revealed rectal adenocarcinoma. Pathological examination confirmed that this lesion was a distant metastasis from rectal cancer. The case was discussed at the multidisplinary meeting and the patient was advised to undergo long course neoadjuvant chemoradiotherapy followed by anterior resection and local excision of perianal metastasis. This case will be treated with long course neoadjuvannt chemoradiotherapy and after six weeks from treatment completion the plan is to perform sphincter sparing anterior resection and local excision of perianal implanted tumor.
3 citations
TL;DR: It can be said, that DM caused a destructive alteration pancreatic histo-architecture with improved functional capabilities in wistar rats at administration of Silymarin and vitamin C, which posed antioxidant potentials, with ameliorated pancreatic dysfunctions.
Abstract: Diabetes mellitus (DM) is reportedly the commonest metabolic disorder with multi organ involvement. By inducing DM (with Alloxan) in Wistar rats, current study investigated the changes in antioxidant activities of selected gastrointestinal (GI) tissues [stomach, duodenum, pancreas and liver], upon treatment with Silymarin and/or Vitamin C. One hundred and twenty five (125) adult male wistar rats of between 130 to 180 grams were procured for the study. Five units of one control and four experimental units were designated with twenty five (25) rats per group (n = 25); Unit 1: Control rats, Unit 2 were DM induced, Silymarin untreated rats, and Units 3, 4 and 5 were DM induced, vitamin C, Silymarin and Vitamin C + Silymarin treated respectively. Following four (4) weeks of administration of test substance(s), rats were euthanized and blood samples obtained for biochemical and antioxidant assay on aforementioned GI tissues. One way analysis of variance (ANOVA) and Students t-test at p < 0.05 were set to be statistically significant on analysis of obtained data. First, study found DM to have caused a statistically significant decrease in body weight prior to sacrifice. Catalase (CAT), superoxide dismutase (SOD) and malonaldehyde (MDA) levels were also seen to significant increase (p < 0.05) at comparison of extract treated unit to control. Study also observed a significant change in pancreatic, liver, and duodenal anti-oxidant marker levels with Vitamin C, Silymarin and Vitamin C + Silymarin co-administrations to diabetic rats. It can therefore be said, that DM caused a destructive alteration pancreatic histo-architecture with improved functional capabilities in wistar rats at administration of Silymarin and vitamin C. Thus, Silymarin posed antioxidant potentials, with ameliorated pancreatic dysfunctions.
2 citations
TL;DR: Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group, particularly among patients treated at Ocean Road Cancer Institute from 2010-2015.
Abstract: Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of westernized diets, obesity, cigarette smoking, and alcohol and reduced physical activity. Clinical Presentations are blood per rectum, abdominal pain, Anemia, change in bowel habits and bowel obstructive symptoms. The treatment of colorectal cancer is a dependent stage which includes chemotherapy, radiotherapy, surgery or both. Objective: This study aims at describing the clinical pathological characteristics of colorectal carcinoma and factors influencing survival among patients treated at Ocean Road Cancer Institute. Methods: This was a cross sectional study that involved histological confirmed colorectal carcinoma treated at Ocean Road Cancer Institute from 2010-2015. Results: Among 100 files extracted, 63% were males and 37% females. 21% were below 40 years of age. Left-sided tumor accounted for 46%. Abdominal pain, rectal bleeding and constipation were 72%, 68% and 55% respectively. Moderately differentiated adenocarcinoma accounted for 80%. Patients presented at stage III and IV were 37% and 56% respectively. Colostomy was the most surgical procedures performed. Folinic acid, Fluorouracil and Oxaliplatin were the most common chemotherapies used. Median overall survival was estimated to be 9.4 months. Conclusion: A significant proportion of patients in this study population are young. Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group.
TL;DR: A case of PVS in a 62-year-old patient admitted to the department of gastroenterology and internal medicine for high dysphagia, where a circular ring immediately above Killian’s mouth ruptured during the examination.
Abstract: Plummer-Vinson syndrome (PVS) is a rare condition characterized by classical triad; high dysphagia, iron-deficiency anemia and oesophageal ring formation. We report a case of PVS in a 62-year-old patient admitted to the department of gastroenterology and internal medicine for high dysphagia. The clinical examination showed anemic syndrome, general impairment and polyarthritis. Biological examinations concluded to iron deficiency anemia. The endoscopy had observed a circular ring immediately above Killian’s mouth ruptured during the examination. The patient was treated with iron and proton pump inhibitors. The oesophageal symptomatology regressed completely from the second day of treatment.
TL;DR: The rapid urease test proved more reliable in the diagnosis of Helicobacter pylori infection than the stool antigen test, and was also used in gastric biopsies.
Abstract: Objective: To determine the place of two identification tests
for Helicobacter pylori infection available in Congo. Materials and Methods: This was a comparative study carried out in two digestive endoscopy centers in
Brazzaville from 1 January to 31 May 2018. Symptomatic patients referred for
upper gastrointestinal endoscopy were included systematically. The frequency of
infection was determined from two identification tests, namely the rapid urease
test in gastric biopsies and the detection of antigen (Ag) for the germ in the
stool. The criterion for judging the presence of the germ in each patient was
the positivity of at least one of the two tests. The McNEMAR X2 test (p Results: During the study period,
137 consenting patients were included, including 62 men and 75 women. The
overall incidence of Helicobacter pylori (Hp) infection was 79.6% (109/28). Of
the 137 patients, 18 were urease positive only; 6 were
looking for Hp Ag in the stool, and 85 were in the two tests. The frequency of
infection was 75.2% (103/137) with the rapid urease test and 66.4% (91/137)
with the Hp Ag test in stool. The rapid urease test proved more reliable in the
diagnosis of Helicobacter pylori infection than the stool antigen test.
TL;DR: It is thought that G/P can be given to the HD patients’ safety, but the authors will accumulate a case in future, and it is thought to be necessary to examine utility and safety.
Abstract: Background: Glecaprevir (nonstructural protein 3/4A protease inhibitor) and Pibrentasvir (nonstructural protein 5A inhibitor) (G/P), a coformulated once-daily, all oral, ribavirin (RBV)-free, direct-antiviral regimen, was evaluated for safety and efficacy in chronic hemodialysis patients with genotype 2 hepatitis C virus infection. Methods: In this prospective, observational, single-center study at Masuko Memorial Hospital, between November 2017 and December 2018, a total of 8 HD patients with an HCV infection genotype 2 received G/P combination therapy. Age was an average of 67.1 (61 - 75) years and there were four men and two women. It was FIB4 INDX an average of 2.67 (1.5 - 3.34) before the start of therapy. It was quantity of HCV RNA an average of 4.43 (2.1 - 6.5). HCV RNA levels were measured by real-time RCR-based method (COBAS AmpiPrep/COBAS TaqMan HCV Test. 4 cases 12 weeks were 2 cases eight weeks for dosing period. Patients were excluded if they had evidence of hepatocellular carcinoma. This study was approved by the ethics committee of our hospital, while we obtained written consent from the participants after providing a thorough explanation of the contents and methods of this study. Results: 6 patients were available for total dose internal use. As for the HCV RNA of the fourth week, (100%) HCV RNA became negative after administration start of therapy. Rapid virologic response (RVR) achieved all cases. 5 patients achieved 12-week sustained virologic response (SVR12) and were following up the 1 patient. The itching appeared in two cases (33%), but there was symptom improvement in nalfurafine hydrochloride use treatment, and treatment continuation was possible. Conclusion: It is thought that G/P can be given to the HD patients’ safety, but we will accumulate a case in future, and it is thought to be necessary to examine utility and safety.
TL;DR: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.
Abstract: The objective of our study was to evaluate hepatitis B virus (HBV) infection in an urban population. This longitudinal study was conducted in Bamako District and Kati Commune. After a preparatory phase, the persons who accepted the protocol were assessed for HBsAg. HBsAg carriers had blood collection for HBeAg assay, viral load assessment, genotyping, DNA mutation testing, and severity of hepatic fibrosis and necrosis. At the end of this study, 1475 persons were included, of which 195 had HBsAg positive confirmed, that is to say 13.97%. The mean age of HBsAg positive patients was 35.11 ± 11.12 years with a sex ratio of 2.68. HBeAg was found in 8.9% of the patients tested for this antigen. The viral load was undetectable in 10.52% of patients and greater than 2000 IU/mL in 32.24% of cases. Fibrosis ≥ F2 and necrosis ≥ A2 were found in respectively 19.72% and 6.80% of cases. Genotype E was found in 91.6 patients and an R249S mutation observed in 39.04% of cases. Conclusion: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.
TL;DR: The seroprevalence and molecular biodiversity of HCV is high in this study and these are important data for the improvement of the management of diabetics.
Abstract: Summary: There is no evidence for comorbidity diabetes and hepatitis C virus infection in the Congo. The aim of this work was to determine the seroprevalence and molecular biodiversity of HCV in order to contribute to improving the management of Congolese diabetics. Patients and methods: It was a cross-sectional study that took place from 1 February to 30 September 2018 at the Brazzaville University Hospital, the Diabcare Health Center and the Adolphe Cisse Hospital in Pointe-Noire. It concerned diabetic patients followed in Brazzaville and Pointe-Noire agreeing to the study, after obtaining the opinion of the ethics committee of the research in health science. All samples collected were screened for the presence of anti HCV Ab using a rapid ALERE HCV test and the Monolisa HCV Ag-Ab ultra test for confirmation in Congo. Detection of the viral RNA was done by PCR retrotranscription and genotyping was performed according to the reverse hybridization technique in France. Data analysis was done with EpiInfo 6.0 software (2016); the proportions were compared using the Chi-square test or the Fisher test at the significance level of 5%. Results: Of 447 patients with diabetes mellitus, 49 had HCV positive serology and the sex ratio was 0.63. Seroprevalence of AC anti HCV was 11% (49/447); HCV RNA was detectable in 71.4% (n = 35) patients. The average age of the population was 62 ± 10 years with extremes ranging from 26 to 82 years. The circulating genotypes were 4 (97.1%) and 1 (2.8%). Subtyping was defined in 17.64% (n = 6) of genotype 4 patients; undefined in 82.36% (n = 28) of Genotype 4 patients, and in one of genotype 1 patients. The subtypes identified were subtype 4e (60%), subtype 4e (8.8%), subtype 4a/4c/4d (5.8%), and subtype 4h (2.9%). Conclusion: The prevalence of HCV is high in our study. These are important data for the improvement of the management of diabetics.
TL;DR: The prevalence of hepatic events was high at the third month of treatment and the triple therapy of Zidovudine, Lamivudine and Nevirapine (AZT + 3TC + NVP) was the most incriminated.
Abstract: Introduction: Human immunodeficiency virus (HIV) infection is a public health problem of concern. Anti-retroviral therapy (ART) is associated with multiple side effects. This study aimed at identifying the different hepatic manifestations of antiretroviral therapy and the responsible molecules. Patients and Methods: This was an eight months period prospective descriptive study, from January 1st to August 31st, 2015, conducted in the Department of Gastroenterology and Internal Medicine at the Brazzaville University Teaching Hospital. Study participants were treatment-naive HIV patients who were initiated on ART treatment during the study period. Patients with liver disease, liver cytolysis prior to initiation of therapy, and those with alternative therapy that may cause hepatotoxicity were excluded. The sample size was 110 patients. Results: The age was ranging from 25 to 70 years with a mean age of 47.5 ± 7.5 years. During the six months of follow-up, the alarming hepatic signs were observed in 26.36% of cases (n = 29) in the 3rd month of treatment. There was no observed alarming sign in the 6th month of follow-up. The cytolytic pattern was observed in 54.55% of cases (n = 60) in the 3rd month. The cholestatic pattern was observed in 6.36% of cases (n = 7) in the 3rd month. Triple therapy combination of Zidovudine, Lamivudine and Nevirapine (AZT + 3TC + NVP) was the most used in 57.27% (n = 63) with a statistically significant p value to the occurrence of cytolytic pattern (p < 0.03) in the 3rd month of treatment. Conclusion: Drug induced liver toxicity occurs in a significant number of patients starting ART. The prevalence of hepatic events was high at the third month of treatment and the triple therapy of Zidovudine, Lamivudine and Nevirapine (AZT + 3TC + NVP) was the most incriminated.
TL;DR: Hepatic Encephalopathy is a common complication during cirrhosis with a poor prognosis and in the majority of cases, a precipitating factor could be determined.
Abstract: Background: Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. Methods: This was a cross-sectional multicenter inpatient study in cirrhotic patients admitted for HE in four tertiary hospitals in Yaounde (Cameroon) from December 2016 to May 2017. The diagnosis of HE was based on West Haven clinical criteria. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs. Results: A total of 53 patients with HE (mean age: 49.9 ± 18.9 years, 35 Males) were included. The frequency of hospital admission for HE was 4.9%. HE grade III was the most common (37.7%), followed by grades I and II (26.4% and 26.4%, respectively). Grade IV was present in 9.4% of cases. According to the Child-Pugh score, 72.1% of the patients were at stage C and 27.9% at stage B. The main precipitating factors found were: constipation (38.5%), hyponatremia (35.9%), hepatocellular carcinoma (HCC) (31.7%), herbal medicine (28.3%), hypokalemia (25.6%), gastrointestinal bleeding (22.6%) and ascitic fluid infection (spontaneous bacterial peritonitis) (13.8%). In 5.7% of cases, no factor was identified. Mortality rate during hospitalization was 45.3% and was significantly associated with stage III (RR = 11.1; 95% CI: 1.9 - 64.5; p = 0.003) and IV (RR = 24; 95% CI: 1.6 - 40.9; p = 0.01) of HE; Child-Pugh C score (RR = 15.2; 95% CI: 1.7 - 30.1; p = 0.003) and hypokalemia (RR = 12.2; 95% CI: 1.3 - 19; p = 0.01). Conclusion: HE is a common complication during cirrhosis with a poor prognosis. In the majority of cases, a precipitating factor could be determined.
TL;DR: Tenofovir reduces viral load during viral cirrhosis B and improves prognosis and there was also an improvement in hepatocellular function and few side effects.
Abstract: Tenofovir reduces viral load during viral cirrhosis B and improves prognosis. The aim of this study was to evaluate the effectiveness and safety of Tenofovir during the treatment of viral B cirrhosis. The study was retrospective and prospective on patients with viral B cirrhosis treated with Tenofovir in the Hepato-Gastroenterology Department of University Hospital Gabriel Toure in Bamako (Mali) and evaluated between three and six months after the start of treatment. We included 89 patients. The mean age was 44.5 ± 16 years with extremes of 18 and 90 years. The sex ratio was 1.2. At inclusion all patients had a detectable viral load with an average of 2651.96 ± 1495.85 IU/ml. Follow-up viral load was undetectable in 84.3% with patients between 3 and 6 months of treatment. The average detectable viral load was only 27.04 ± 21.05 IU/ml. There was also an improvement in hepatocellular function and few side effects. Conclusion: This study shows the interest of Tenofovir in the treatment of viral cirrhosis B with very few adverse effects.
TL;DR: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.
Abstract: Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short- and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19 - 86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation; they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1 - 4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental treatment by ligature. The initial evolution was specified with a average follow-up of 3 months (1 - 13 months). The recurrence rate was 22.3% (N: 33 cases) after an average follow-up of 9.5 months (1 - 48 months). In the long term (over one year) and in the short term, the recidivism rate was 6% (n = 9 cases) and 16.2% (n = 24) respectively. Among recurrent patients, the sclerosis protocol was repeated in 20 patients (60.6%) with a success rate of 85%; for the remaining 13 patients, we opted for elastic ligation in 4 patients, and for surgery in 6 patients, while 3 patients were lost to follow-up. Conclusion: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.
TL;DR: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoid of Grade 2 to 3.
Abstract: Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.
TL;DR: In this small observational study, EV VP1 is consistently demonstrated in tissue samples of CD patients as compared to control subjects; and neutralizing antibody for E18 was found in all of the patients with available serum samples.
Abstract: Background: Enterovirus (EV) can cause gastroenteritis and are known to replicate in Peyer’s patches of terminal ileum. EV has been found in the intestinal specimens from immunocompromised patients with regional enteritis, and another study demonstrates the presence of enterovirus in the resected terminal ileum of immunocompetent pediatric patients with Crohn’s disease (CD). Cluster outbreaks of CD have also been reported in the literature but the cause of the disease remains elusive. Materials and Methods: A small cluster of pathologically proven CD occurred in our geographic area in 2004-2005, concurrently with an epidemic of Echovirus 18 (E18) meningitis. Serum samples of these and other CD patients and control subjects were tested for neutralizing antibodies of 11 common typeable enteroviruses and Echovirus 18; and tissue samples of CD patients, and terminal ileum and colon biopsies of normal controls were tested for the presence of viral capsid protein 1 (VP1) by immunoperoxidase staining. Results: Immunoperoxidase staining demonstrated VP1 in a rare epithelial granuloma, in diseased muscle of terminal ileum and also in colon biopsies of CD patients. Significantly elevated E18 neutralizing antibody was found in patients with pathologically-proven Crohn’s disease, as compared to control subjects. Conclusion: In this small observational study, EV VP1 is consistently demonstrated in tissue samples of CD patients as compared to control subjects; and neutralizing antibody for E18 was found in all of the patients with available serum samples. Larger cross-sectional studies will be needed to define the role of E18 in this chronic disease.
TL;DR: Young adults were the most affected by HCC, whose etiologies are dominated in the authors' context by hepatitis B and C viruses, limiting any therapeutic possibility.
Abstract: Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, as well as in Togo, where it is a major public health problem. HCC is the third most common cause of death from cancer. Chronic infection with HBV and HCV is the most important cause of HCC. Objective: To determine the epidemiological, diagnostic and evolutionary aspects of HCC in the hepatology and gastroenterology department of Campus Teaching Hospital of Lome. Patients and method: Descriptive and analytical study, conducted from January 1, 2013 to December 31, 2017, on all patients admitted in the hepatology and gastroenterology department of Campus Teaching Hospital of Lome for hepatocellular carcinoma. The statistical analysis was done using Stata 13 software. The significance threshold was used for p < 0.05. Findings: A total of 250 patients were retained. Hospital prevalence was 6.1%. There was a male predominance with a sex ratio of 2.84. The average age was 47.15 ± 13.85 (extreme: 20 - 85 years). The average duration of symptoms was 67.08 ± 82.59 days. Pain in the right hypochondrium was the most common reason for consultation (64.6%). The average AFP value was 24,062 ± 33,318 ng/ml. Ultrasound found more than two nodules in 74.75% of cases and a portal thrombosis in 64.97% of cases. The main etiologies found were chronic hepatitis B (55%) and C (8%) virus infections. The majority (89.20%) of patients were in the BCLC D stage. Survival at 6 months was 45%. Factors associated with death were: chronic ethylism (OR = 16.87, p = 0.002), jaundice (OR = 341.57, p = 0.004), rupture of esophageal varices (OR = 42.45, p = 0.008) and a BCLC D score (OR = 9.82, p = 0.041). Conclusion: Young adults were the most affected by HCC, whose etiologies are dominated in our context by hepatitis B and C viruses. The majority of our patients consulted late and was found at the terminal stage of the disease, limiting any therapeutic possibility. In this situation, the best attitude remains prevention.
TL;DR: Pneumatic dilation is a minimally morbid and effective procedure and odynophagia, and the number of dilation sessions, are two predictive factors of endoscopic treatment failure.
Abstract: The achalasia is a rare primary esophageal motor disorder characterized by relaxation disorders of the lower esophageal sphincter and absence of the esophageal body peristalsis. Several studies suggest that the response to the endoscopic treatment depends on several predictors. The aim of our study was to evaluate the endoscopic treatment of esophageal achalasia and identify the predictive factors of endoscopic treatment response. Patients and Methods: This is a retrospective analytical study of 78 patients with achalasia, managed in the gastroenterology department of the university medical center Hassan II-Fez, during a period of 5 years (January 2009 to December 2014). The diagnosis of achalasia was retained on a set of clinical, endoscopic, manometric and radiological arguments. A graded dilation protocol starting with a 35 mm balloon three times for 30 seconds in progressive pressure between 5 and 8 psi was performed. We used the Eckardt score to evaluate the clinical remission. Results: During the study period, 78 patients were included. The average age of our patients was 47 years old [18 - 81] with a sex-ratio M/F of 1.05. The average of Eckardt score before dilation was 5.9 [3 - 9]. An average of 1.41 dilation sessions was performed per patient with 85.9% of the initial success rate (n = 67). Initial success without further dilation sessions was achieved in 55.1% of our patients (n = 43). A clinical recurrence requiring further dilation sessions was observed in 30.8% of the cases (n = 24). The average relapse time after first dilation success was 2.7 years, 75% occurs within the first year. Dilation failure was retained in 14 patients (17.9%) requiring surgery. Only one post-dilation perforation was noted. In multivariate analysis, only odynophagia and the number of dilatation sessions were factors of failure of the endoscopic dilation. Conclusion: Pneumatic dilation is a minimally morbid and effective procedure. Our work showed that odynophagia, and the number of dilation sessions, are two predictive factors of endoscopic treatment failure.