Coût financier de la prise en charge des hépatites virales chroniques B et C au CHU de Brazzaville (Congo)

Introduction. Les dépenses de santé ont considérablement augmenté dans le monde lors de la dernière décennie. Les hépatites virales chroniques B et C sont des affections chroniques nécessitant un traitement prolongé et qui est encore coûteux, le Congo ne disposant pas encore d'assistance maladie universelle. Le but de cette étude était d'évaluer le coût de la prise en charge des hépatites virales B et C au Congo. Matériels et Méthodes. Il s'agit d'une étude transversale rétrospective et descriptive, réalisée du 1er juin au 31 Décembre 2016 dans le service de Gastro-entérologie et médecine interne du CHU de Brazzaville. Nous avons colligé les dossiers des patients suivis pour hépatite B et C. Les variables d'étude ont été les coûts des examens paracliniques et les coûts des traitements. Résultats. les coûts des examens paracliniques étaient de 296 000 FCFA (451€) pour le coût maximum de l'hépatite B, celui de l'hépatite C était de 596 500 FCFA (910,6 €). Les coûts du traitement de l'hépatite virale C étaient de 1 050 000 FCFA (1603,05 €) pour trois mois. Pour l'hépatite B, ils étaient de 389 987 (595,4€) par semestre. Le coût global de la prise de l'hépatite virale C était de 1 345 313 FCFA (2053,9€) et de 535 569 (817,662 €) pour l'hépatite B. Conclusion. Les coûts de la prise en charge des hépatites B et C sont encore trop élevés au Congo. Une prise en charge globale s'avère nécessaire, similaire à celle de l'infection à VIH

Etude de la prise en charge de l'infection à Helicobacter Pylori dans les villes de Pointe-Noire et de Brazzaville en 2015

Introduction : L'infection à Helicobacter Pylori affecte environ 50% de la population mondiale. Sa prévalence est plus élevée dans les pays en développement. Elle est à l'origine de pathologies gastroduodénales et son éradication est de ce fait recommandée.Nous avons réalisé une étude dont l'objectif a été d'évaluer les possibilités diagnostiques, thérapeutiques et la séroprévalence de l'infection à Helicobacter pylori dans les villes de Pointe-Noire et Brazzaville.Méthodes: Etude transversale descriptive et analytique menée de mars à septembre 2015.Résultats : Sur (7) sept tests existants et validés dans le monde; seuls (4) quatre tests étaient disponibles. La non disponibilité du test respiratoire à l'urée marquée au carbone 13 était à l'origine du non contrôle de l'éradication après traitement. Les protocoles d'éradication étaient la quadrithérapie séquentielle ou continue sur 10 jours sans sel de bismuth, non disponible au Congo-Brazzaville.Au total 130 patients ont été inclus; 54(41,5%) hommes et 76 (58,5%) femmes dont 121 (93,1%) patients étaient testés positifs à l'helicobacter pylori, avec une prédominance féminine. Le reflux gastro-oesophagien était la pathologie la plus représentée chez les patients testés positifs mais sans différence significative (P=0,287).Conclusion: L'insuffisance des tests diagnostiques de l'infection à Helicobacter pylori notamment du test respiratoire à l'urée marquée au carbone 13 au Congo-Brazzaville ne permettait pas aux praticiens de contrôler l'éradication. La quadrithérapie bismuthée n'était non plus disponible alors que la séroprévalence hospitalière reste élevée. Ainsi nous faisons le plaidoyer pour l'acquisition du test respiratoire à l'urée marquée au carbone 13 et la mise sur le marché des sels de Bismuth au Congo-Brazzaville

Evaluation de la prise en charge de l'hépatite C chronique à Pointe-Noire en 2015

Introduction : La prise ne charge de l'hépatite virale C a connu un tournant décisif depuis la découverte des antiviraux directs. Sa prévalence au Congo-Brazzaville est estimée à 10% avec prédominance du génotype 4 et son traitement se heurte à plusieurs écueils notamment l'accessibilité au traitement. Nous avons réalisé une étude dont l'objectif a été d'évaluer les possibilités de diagnostic et de prise en charge thérapeutique des malades infectés par le virus de l'hépatite C à Pointe-Noire.Méthodes: Il s'est agi d'une étude expérimentale, prospective, descriptive et analytique réalisée dans le service de Gastroentérologie de l'hôpital général de Loandjili de Pointe-Noire.Résultats: Au total notre file active comptaient 81 dossiers des cas d'hépatite C et 34 (41,9%) cas traités ont été inclus. Il s'agissait de 21(61,76%) hommes et de 13(38,24%) femmes d'âge médian 50ans. Il y avait 15 (44,1%) patients alcooliques; 4 (11,8%) patients fumeurs; 15 (44,1%) patients sans intoxication. L'hépatite C était découverte lors d'un dépistage chez 19(55,8%) patients et suite aux symptômes chez 15 (44,1%) patients. Parmi ces 34 malades; 6 (17,6%) étaient du génotype 1 et 23 (67,6%) étaient du génotype 4; chez 5 (14,7%) patients le génotype était inconnue. Le financement du traitement était assuré par l'assurance maladie pour 5 (14,7%) patients; l'employeur pour 13 (38,2%); l'argent personnel pour 12 (35,3%); l'aide des parents pour 3 (8,8%) patients; non identifié chez 1 (2,9%) patient. Sur 34 patients traités par bithérapie pégylée 13(38,2%) étaient guéris et 21(61,7%) n'étaient pas guéris. Il restait 21 patients non guéris dont 2 patients traités par sofosbuvir + ribavirine (24 semaines) et 2 malades traités par sofosbuvir +daclastavir (12 semaines); tous ces 4 malades étaient guéris. Il restait 17 patients non guéris et non traités par les antiviraux directs faute de financement. En analyse uni et multivariée la charge virale était un facteur influençant l'efficacité du traitement.Conclusion : La prise en charge optimale de l'hépatite C chronique est possible au Congo-Brazzaville. Cependant la non disponibilité des médicaments, le prix exorbitants des antiviraux et le manque de couverture sociale, constituent des freins exposant les malades aux complications mortelles. Ainsi la création du programme national de lutte contre les hépatites virales au Congo Brazzaville pourrait lever ces obstacles inadmissibles en 2016

Evolution fatale à moyen terme d'une cirrhose virale C traitée par bithérapie pégylée

La prévalence de l'hépatite C au Congo-Brazzaville est élevée avec prédominance du génotype 4. Nous rapportons un premier cas clinique traité dont la réponse virologique en fin de traitement a été négative du fait que la patiente présentait tous les facteurs prédictifs de mauvaise réponse. L'évolution s'est faite vers les complications classiques mortelles. Les limites d'accès aux explorations et au traitement ont influencé négativement l'évolution. Nous venons de présenter un premier cas d'hépatite C traité à Pointe-Noire avec échec thérapeutique. Ce premier cas de notre expérience nous a permis de vivre la réalité de l'histoire naturelle et des difficultés de la prise en charge de l'hépatite C à Pointe-Noire

Cancer gastrique et infection à Helicobacter pylori en RD Congo. Aspects épidémiologiques

Objectif: Décrire le profil épidémiologique des lésions pré-cancéreuses et cancéreuses gastriques et la fréquence de leur association à l'infection à Helicobacter pylori.Matériel et méthodes: Enquête documentaire couvrant la période de 2001 à 2011,issue des registres reprenant les protocoles anatomopathologiques des analyses des biopsies gastriques effectuées dans les laboratoires d'anatomie pathologique des Cliniques Universitaires de Kinshasa, du centre Lomo Médical, de l'Institut National de Recherche Biologique (INRB), et de l'Hôpital Général de référence de Bukavu. La fréquence de lésions et l'association à l'infection à H. pyloriont été déterminées. Résultats: Cent dossiersdes patients avec lésions pré-cancéreuses ou cancéreuses gastriques ont été analysés. Leur âge moyen était de 54,8 ±13,3 ans. La fréquence du cancer a paru plus élevé dans les provinces de l'Est du pays (p = 0,005); avec l'adénocarcinome gastrique comme la forme la plus fréquente (83%). L'infection à Helicobacter pylori n'a été observée que chez 20% des patients. Conclusion: Le cancer gastrique, surtout l'adéno-carcinome est un cancer fréquent, prédominant surtout dans les régions orientales de la R D Congo. Ce cancer touche des sujets relativement jeunes. Des mesures préventives ciblées s'imposent

[Orphans in Brazzaville orphanages]. / Situation des enfants orphelins dans les orphelinats de Brazzaville.

UNLABELLED: Children are orphaned everywhere, but their situation is particularly acute in developing countries. OBJECTIVES: To assess the epidemiologic situation of orphans in Brazzaville and to identify the social and medical determinants of their placement in institutions. MATERIAL AND METHODS: This exploratory cross-sectional study was conducted from March 3, 2003, through January 30, 2004 (11 months). Direct interviews based on a standardized questionnaire collected information from the orphans old enough to answer questions, their parental substitutes or guardians, and the orphanage directors. The evaluation of the conditions in the orphanages was based on observable, quantifiable indicators. ON THE WHOLE: We identified 12 orphanages and 162 children: 92 boys (56.8%) and 70 girls (43.2%). Their average age was 10.5 years +/- 3.5 (range: 3 months to 15 years). Overall, 38 (23.5%) had lost only their mother, 22 (13.6%) their father, and 102 (63%) both parents. The child was placed at the orphanage by the family in 97 cases (60%), the social services department in 50 cases (30.9%), and by the police or the Red Cross in 15 cases (9.3%). The reasons for placement were: lack of financial support (137 cases, 84.5%), other social reasons (8 cases, 4.9%), abandonment (3 cases, 2%) and unspecified causes (14 case, 8.6%). The principal causes of parents' deaths were: pregnancy and childbirth 73 cases (45%), war, 45 cases (28%), HIV infection, 26 cases (16%), malaria, 6 cases (4%), accidents, 8 cases (5%) and unknown, 4 cases (2.5%). CONCLUSION: Orphanages are one alternative for the survival of children without parents able to care for them. Attention to them, support of their activities, and improvement of the living conditions there are all important.

[A case of isolated tuberculosis of the appendix at the University Hospital Center in Brazzaville, Congo]. / Une observation de tuberculose isolée de l'appendice au Centre Hospitalier et Universitaire de Brazzaville.

Since the outbreak of human immunodeficiency virus (HIV) infection, extrapulmonary tuberculosis has become increasingly frequent in developing countries. The purpose of this report is to describe a case of isolated tuberculosis of the appendix diagnosed following generalized peritonitis in a 53-year-old man. The appendix is the least frequent gastrointestinal location of isolated tuberculosis. Diagnosis was achieved by histopathological examination of the appendix immersed in formalin 10% after appendectomy. Paraffin-embedded histological sections stained with hematoxylin-eosin (HE) displayed caseofollicular lesions characteristic of infection by Koch bacillus. Outcome was favourable with a 9-month regimen of antituberculosis treatment according to the protocol of the World Health Organization (WHO).

Une observation de tuberculose isolee de l'appendice au centre hospitalier et universitaire de Brazzaville

La tuberculose extrapulmonaire est; dans les pays en voie de developpement; de plus en plus frequente avec l'avenement de l'infection au virus de l'immunodeficience humaine (VIH). Les auteurs rapportent l'observation d'un homme de 53 ans immunocompetent ayant presente une tuberculose isolee de l'appendice revelee par une peritonite generalisee. Cette atteinte isolee de l'appendice est la moins frequente parmi les localisations viscerales digestives. Le diagnostic anatomo-pathologique etait fait sur la piece d'appendicectomie immergee dans du formol a 10

[Simian smallpox (or monkey smallpox): study of 8 cases observed at Impfondo Hospital in Republic of Congo]. / Orthopoxvirose simienne (ou variole du singe): étude de 8 cas observés à l'hôpital d'lmpfondo de la République du Congo.

Monkeypox or simian smallpox is a viral disease whose clinical manifestations are similar to the human smallpox. In this study authors describe the care management and follow up of eight patients hospitalized at the Impfondo hospital in Congo. It was a transversal study conducted from the 23rd of May till the 7th of July 2003 at the District Hospital of Impfondo (Likouala province, Republic of Congo). We have analyzed 81 patient files hospitalized during that period. Using the Atlanta CDC criteria of case definition modified in 2003, monkeypox has been diagnosed in 8 patients. Our series has 4 male and 4 female patients. The mean age is 9.05 +/- 5.86 with extremes ranging from 5 months to 18 years old. The clinical manifestations included fever (n = 7), rash (n=8), articulations and muscles pains (n=2), mumps (n=4) and pruritus (n=6). 7 patients recovered among them 5 without complications and 2 with persistent hypochromic lesions for more than 6 weeks. The monkeypox strain responsible for these infections appeared not to be lethal to humans. However this study shows that monkeypox is an endemic public health risk in the sanitary district of Impfondo, within the Congo River basin. The endemic presence of monkeypox in the Congo basin could trigger a new outbreak if the viral strains involved here became lethal.

[Clinical management of patients and deceased during the Ebola outbreak from October to December 2003 in Republic of Congo]. / Prise en charge des malades et des défunts lors de l'epidémie de fièvre hémorragique due au virus Ebola d'octobre a décembre 2003 au Congo.

Outbreaks of Ebola virus hemorrhagic fever (EVHF) have been reported since 2001 in the Cuvette Ouest department, a forested area located in the Western North of Congo. At the end of October 2003 a new alarm came from this department which was quickly confirmed as being an epidemic of EVHF. The outbreak response was organized by the ministry of health with the assistance of an international team under the aegis of WHO. The case management of suspect cases was done in an isolation ward set up at the hospital; when patients refused to go to the ward for care they were isolated in their house according to a protocol "transmission risks reduction at home". Safe burials were performed by specialized teams which respected the major aspects of the funeral to allow the process of mourning of the families. An active surveillance system was set up in order to organize the detection of new cases and the follow-up of their contacts. A case definition was adopted. From October 11 to December 2, 2003, 35 cases including 29 deaths were reported, 16 cases were laboratory confirmed. The first four cases had been exposed to monkey meat (Cercopithecus nictitans). The epidemic spread was due to family transmission. The population interpretation of the disease, in particular questions around wizards and evil-minded persons, is a factor which must be taken into account by the medical teams during communication meetings for behavioral change of the populations. The case management of patient in isolation wards to prevent the transmission of the virus in the community remains the most effective means to dam up Ebola virus hemorrhagic fever outbreaks. The good perception by the community of the safe funerary procedures is an important aspect in the establishment of confidence relations with the local population.

[Reasons for consulting related to skin-bleaching products used by 104 women in Brazzaville]. / Motifs de consultation liés a l'usage des dépigmentants chez 104 utilisatrices a Brazzaville, Congo.

A prospective survey has been carried out in the Brazzaville (Congo) dermatology service in order to specify dermatosis linked to the use of bleaching agents in 104 Congolese women consulting for this problem. The used bleaching agents were topical corticoids based products for 40 cases, hydroquinone for 32 cases, and hydroquinone associated with topical dermocorticoids for 32 cases. Acne was the most frequent motive for consulting (24%), followed by the paradoxical peri-orbital hyperpigmentation (21.1%), profuse mycosis (16.3%) and vibices(8.6%). The results of this survey were not superimposable to those of Dakar where infectious dermatosis were the first reason for consulting.

[Histoepidemiologic profile of 375 primary bowel cancers at the University Hospital Center in Brazzaville, Congo]. / Profil histo-epidemiologique de 375 cancers digestifs primitifs au CHU de Brazzaville.

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville, Congo from January 1992 to December 2001. Incidence was 14.6%. The sex ratio was 1:5. Age ranged from 39 to 49 years. The liver (40.2%) was the most frequent location followed by the colon/rectum (30.2%), stomach (26.2%), and esophagus 2.1%. Predisposing factors included low-fiber diet, heavy consumption of smoked foods, and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57% of cases was adenocarcinoma that was observed in the esophagus, stomach, colon, rectum, and pancreas. Systematic screening and treatment of precancerous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer.

[Cost of of hospital management of cirrhoses and its complications at the University Hospital of Brazzaville]. / Le coût financier de la prise en charge hospitalière de la cirrhose et de ses complications au CHU de Brazzaville.

This retrospective pilot study was conducted in a series of 166 patients hospitalized for the first time for management of cirrhosis with or without complications over a two-year period at the University Hospital Center in Brazzaville, Congo. Complications included ascitics, hepatic encephalopathy, gastrointestinal bleeding, and hepatocellular carcinoma. Total care cost was determined by adding up expenditures for the initial examination, each day of hospitalization, adjuvant investigations, and administered medication. The mean per-patient cost was 272345 F CFA (415.79 [symbol: see text]) in cases involving ascites, 195675 F CFA (298.74 [symbol: see text]) in cases involving encephalopathy, 207935 F CFA (317.45 [symbol: see text]) in cases involving hepatocellular carcinoma, 245680 F CFA (375.08 [symbol: see text]) in cases involving gastrointestinal bleeding and 205615 F CFA (313.90 [symbol: see text]) in uncomplicated cases. These data document the high cost of hospital care for cirrhosis and related complications in Congo.

[Cervico-facial and ENT symptoms due to HIV infection in tropical area. About 253 Congolese cases]. / Les manifestations ORL et cervico-faciales de l'infection par le VIH en zone tropicale. A propos de 253 cas congolais.

In human immunodeficiency virus infection as well as in related syndromes, cervico-facial and otorhino-laryngologic manifestations are current. A retrospective study in Oto-Rhino-Laryngology service of Brazzaville University Hospital from December 1995 to November 2001 has been reported. 253 patients were selected from a total of 1352 consultations. The study population is young (average age: 34 +/- 4.8 years), and most of the patients are 30 to 49 years old (75.9%). Men represent 51% and women 49%. Although sexual multipartnership (59.7%) is the main risk factor, traditional practices (22.8%) are not neglictible in Africa. Among all cases, human immunodeficiency virus type 1 is found in 72.3% of cases. The affections are located in the neck (40.5%), ear (24.9%), pharynx (17.3%), rhinosinus (13.3%), oral cavity and vestibule (2.7%) and larynx (1.3%). These main affections are represented by: parotidosis (20.1%), peripheric facial paralysis (15.4%), pharyngeal candidiasis (14.6%), sinusitis (14.2%) and ganglial tuberculosis (11.5%). Lymphoma (7 cases), kaposi's sarcoma (7 cases) and epidermoid carcinoma (1 case) are the malignant affections identified in 15 cases (6%). The diagnosis of some affections like cystic parotiditis (11%), noma (1.6%), African histoplasmosis (0.4%) and rhinoscleroma (0.4%) constitutes this study particularity The Oto-rhino-laryngologist's role is important in early diagnosis of HIV infection as well as in the followed-up of patients.

[Digestive bleeding and anti-inflammatory drugs at the teaching hospital of Brazzaville]. / Les hémorragies digestives et les médicaments anti-inflammatoires au CHU de Brazzaville.

Authors relate a retrospective survey of 140 cases of digestive haemorrhage after intake of anti-inflammatory drugs from January 1988 to December 2000. The digestive haemorrhage frequency after intake of anti-inflammatory drugs reaches 16%. This survey included 94 men and 46 women whose average age is 42.3 years, with extremes of 15 and 79 years. Among these patients, 75 took salicylic acetyl acid (SAA), 56 non-steroidal anti-inflammatory drug (NSAID) and 9 the SAA and NSAID association. More than half of patients relied on self-medication (91 cases ie. 65%). The haematemesis followed by melaena induced the most frequent bleeding (42.8% of cases), while the isolated haematemesis, the isolated melaena and the isolated rectal haemorrhage were found respectively in 35%, 15% and 7.2%. Haemorrhages occur early under SAA and seem less severe than those occurring under NSAID. Lesions responsible for the bleeding are: the duodenal ulcer (68.7%), the haemorrhagic gastritis (6.4%), the gastric ulcer (5%), the oesophagitis (4.2%), the gastric and duodenal ulcer association (3.5%), anorectal exsudative pains and haemorrhagic anal ulcerations. The duodenal ulcer predominance could be attributed to previous lesions.

Profil histo-epidemiologique de 375 cancers digestifs primitifs au CHU de Brazzaville

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville; Congo from January 1992 to December 2001. Incidence was 14.6. The sex ratio was 1:5. Age ranged from 39 to 49 ye a rs. The liver (40.2) was the most frequent location followed by the colon/rectum (30.2); s t o m a ch (26.2); and esophagus 2.1. Predisposing factors included low-fiber diet; heavy consumption of smoked foods; and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57of cases was adenocarcinoma that was observed in the esophag u s ; stomach; colon; rectum; and pancreas. Systematic screening and tre atment of pre c a n c e rous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer

Liver cysts in Congolese patients with autosomal dominant polycystic kidney disease follow a family pattern.

BACKGROUND: It is now well established that at least two genes are associated with autosomal dominant polycystic kidney disease (ADPKD). OBJECTIVE: To analyse the clinical expression of ADPKD in Congolese patients and to compare ADPKD expression between families. METHODS: Following informed consent, ADPKD patients admitted to Brazzaville University Hospital (Congo) were reviewed and their relatives aged 20 years and older were screened by means of a clinical examination, abdominal ultrasound, urinalysis and determination of serum creatinine. RESULTS: We found 7 patients with ADPKD, belonging to 7 distinct families, and identified 100 relatives of whom 50, aged from 20 to 68 years, were diagnosed as having ADPKD. Polycystic kidney disease was associated with polycystic liver in 4 families. In the remaining 3 families no liver cysts were found. No family had a mixture of members with kidney cysts only and members with kidney and liver cysts. This finding was age-independent. CONCLUSION: Liver cysts follow a family pattern in our ADPKD patients. We suggest that our patients may carry at least two different genes for ADPKD, one of which may be associated with renal cysts alone and other with both renal and liver cysts.

[Gigantic keloïds after chicken-pox. A case report]. / Chéloïdes géantes post-varicelle. A propos d'un cas.

Keloïds are tumors which appear after a lesion or spontaneously. They are frequent on black skin. We report a gigantic keloïd case appeared after chicken-pox on a 29 year-old black girl who had viral infection when she was 6 years old. The tumors increased after chirurgical treatment and became very unaesthetic. This observation specific by its clinical presentation relates the treatment difficulties of these tumors in our area.