Hémorragie digestive haute de l’adulte au Burundi : aspects épidémiologiques, étiologiques, thérapeutiques et évolutifs

Aim

To describe by a prospective study the epidemiological, etiological, therapeutic and evolutive aspects of the upper gastrointestinal bleedind in Burundi.

Methodology

Prospective study that included from January 2010 to February 2011 all patients hospitalized in three main public hospitals of Bujumbura for an upper gastrointestinal bleeding.

Results

During this period, we included 61 patients, 37 males (60.7%) and 24 females (39.3%). The middle age was: 49.2±8years. 52.5% of the upper gastrointestinal bleeding (32 patients) concerned patients aged between 30 and 60 years. Hematemesis associated to the melena was the main manifestation of bleeding in 50.8%. The use of gastro-toxic medicines was noted among 8 patients (13.1%). At the admission, the blood pressure was abnormal in 51patients (86,9%) among which 27 patients (44.3%) were in a state of cardiovascular shock. The upper endoscopy was performed in 39 patients (63.9%). The mains etiologies were the gastroduodenal ulcers (46.1%) and the esophageal varices (28.2%). The treatment was essentially medical. 39 patients (63.9%) were transfused. The evolution was favorable with the bleeding arrest in 47 patients (77.1%). Mortality rate was 22.9% (14 patients). Recurrent bleeding was recorded in 7 patients (14.7%).

Conclusion

The upper gastrointestinal bleeding are severe with an elevated mortality in public hospitals in Burundi. The improvement of the technical equipment and the accessibility to medical cares remain major challenges to improve their prognosis in those public hospitals.     

Ingestion de corps étrangers chez l’adulte : approche épidémiologique, clinique et thérapeutique dans la région de Marrakech

Ingestion of foreign bodies is uncommon in adults, but it can be responsible for serious lesions. We retrospectively reviewed 63 cases of patients admitted for foreign bodies ingestion from January 2005 to October 2010, at the visceral surgery department of the CHU Mohamed VI. The purpose of this study was to gather the epidemiologic and diagnostic data and evaluate the therapeutic methods and the outcome of foreign bodies ingestion in our context. There were 34 men and 25 women with a mean age of 24.4 years. 32.5% of the patients were jail inmates at the time of ingestion, and 17.5% had a history of chronic psychosis. Ingestion was accidental in 57.5% of cases, in which 50% were observed in women with veil. Pins were the most frequent foreign body (29%). 57.5% of our patients were asymptomatic during their admission, and 6% developed clinical signs of peritonitis. A close observation was performed in 50% of the patients. The foreign bodies were spontaneously eliminated by natural means without any complication in 95% of cases. Therapeutic endoscopy was performed in 10% of the patients. Surgery was performed in 40% of cases. We deplore one death. We conclude that all the epidemiologic characters of our study agreed with the literature except the type of foreign bodies, which is dominated by pins in our context. Regarding therapeutic methods, our practitioners must improve the techniques of removal of foreign bodies, especially the endoscopic techniques, so as to reduce the mortality and morbidity rates. Sensitizing the general public, especially veiled women, to the risks of foreign bodies ingestion will help in prevention.     

Hépatite B chronique: aspects épidémiologique, diagnostique, thérapeutique et évolutif au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou

Abstract

The aim of this study was to describe epidemiological, diagnosis, therapeutic, and evolutionary aspects of chronic hepatitis B.

Patients and methods

It is a clinical practice study carried out from May 2005 to June 2009 in the Hepatogastroenterology Department of Yalgado-Ouédraogo Teaching Hospital in Ouagadougou. Patients with chronic hepatitis B have been followed regularly during this period. We included all patients aged over 15 with HbsAg-positive over 6 months.

Results

A total of 433 patients cohort were enrolled among 290men (66.9%). Themean age was 32 years. Circumstances of finding out chronic hepatitis B were: blood donation (53.6%), medical checkup (34.1%), asthenia, jaundice, and increased transaminases (12.5%). Duration of HBsAg carrier state varied from 1 to 23 years, with a mean age of 3.3 ± 3.6 years. In HBeAg2 384 patients (88.6%) were positive. Forty patients (23.2%) had an inactive HBsAg carrier status. In HBeAg-negative chronic hepatitis B, 70.3% of patients had persistent or intermittent elevation in transaminase levels. HBV-DNA was positive in 74.3% tested patients with a mean viral load of 1,300,646 UI/ml (6.1 log). In HBe-positive chronic hepatitis B, 71.4% of patients had persistent or intermittent elevation in transaminase levels. HBV-DNA was positive in 89.4% patients with a mean viral load of 15,000,000 UI/ml (7.1 log). We treated 62 patients: 77.7% HBeAg-negative. Sixty patients (96.7%) have been treated with lamivudine, one patient with adefovir, and another one with entecavir. In treated patients, 71.8% achieved normalization of transaminase levels. Virologic response was complete in 25 patients (40.3%) and partial in 32 patients (51.6%). In 4 of 60 lamivudine-treated patients, lamivudine resistance occurred in four cases (6.6%). A 34-year-old man presented a small hepatocellular carcinoma. Partial hepatectomy was performed. In treated patients, HBeAg loss occurred in 2 of 13 HBeAg positive patients (15.4%) and none in HBsAg. In nontreated patients, HBeAg loss occurred in 4 of 36 patients (11.1%). We observed HBsAg loss in 6 of 371 patients (1.6%) and the appearance of HBs antibody in four patients.     

Hépatite C chronique: épidémiologie, diagnostic et traitement au CHU Yalgado-Ouédraogo de Ouagadougou

Abstract

The aim of this study was to describe epidemiological, diagnosis and therapeutic aspects of chronic hepatitis C.

Patients and methods

It is a clinical prospective study carried out from October 2005 to November 2009 in the Hepatogastroenterology Department of Yalgado-Ouédraogo Teaching Hospital in Ouagadougou. We included patients with HCV antibodies and HCV-RNA positive. The quantification of HCV-RNA was done in real-time PCR. Treatment regimen was a combined therapy using peginterferon alfa-2a plus ribavirin.

Results

A total of 46 patients were enrolled, among whom 30 were men (65.2%). The mean age was 47 years. Circumstances of finding out chronic hepatitis C were: medical check-up (37%), increased transaminases (34.8%) and blood donation (15.2%). Five patients (10.9%) had a history of blood transfusion. Physical examination was normal in 42 cases (91.3%), and we found out cirrhosis in 4 patients (8.7%). The mean viral load was 960,978 IU/ml (5.9 log). The genotypes of HCV were 1, 2 and 5, with a predominant genotype 2 (71.1%). Eighteen patients who had not previously been treated underwent combination therapy. The overall sustained virological response occurred in 81.2% of patients, with 92.3% in genotype 2. Three patients relapsed, and we discontinued treatment for two of them due to severe adverse events. The mean fall of haemoglobin has been 3 ± 1.7 g/dl. We observed neutropenia (a neutrophil count < 750/mm³) in six cases (33.3%) and thrombocytopenia (a platelet count ≤ 100 000/mm³) in other two. Eight patients (44.4%) had peginterferon-dose reduction and 4 patients (22.2%) had ribavirin. Depression was diagnosed in three patients (6.5%).     

Aspects épidémiologiques et sémiologiques des troubles fonctionnels intestinaux dans les centres de santé de référence de Bamako

The main goal of this study was to evaluate epidemiological and clinical aspects of irritable bowel syndrome (IBS) in health districts of Bamako. It was a cross-sectional study conducted from June 2006 to November 2006. During the period of study, 104 of 487 patients, 21.35% of the examined population, met the inclusion criteria. The average age was of 30.5 ± 11.5 years, the age group of 16–26 years predominated with 45.2%. The sex-ratio was 0.5 in favor of women. The signs most frequently found were abdominal pain (97.1%), abdominal distension (51.9%), and constipation (45.2%). A frequent absenteeism was reported by 65.8% of the patients. The IBS can be regarded as a public health problem. Treatment and exploration costs and frequent absences with work constitute true socioeconomic problems.