Virus de l'hepatite C et hepatopathies chroniques a Dakar : etude cas-temoins

En Afrique noire; la place de l'infection par le virus de l'hepatite C (VHC) dans la survenue des hepatopathies chroniques reste discutee; en particulier au Senegal ou la prevalence du VHC est moderee. C'est pourquoi une etude cas-temoins a ete menee a l'Hopital Principal de Dakar; en 1995; incluant 73 malades et 73 temoins. Les malades etaient repartis en 2 hepatites chroniques; 25 cirrhoses et 46 carcinomes hepatocellulaires. Les malades et les temoins ont fait l'objet d'etude serologique vis-a-vis du VHC (test ELISA de depistage; test ELISA de 3e generation en cas de positivite; puis confirmation par immunoblot) avec determination du serotype du VHC par methode immunoenzymatique; une recherche d'infection par le virus de l'hepatite B et une recherche d'anticorps anti-delta ont complete l'etude. Seulement 2 malades etaient porteurs d'anticorps anti-VHC (3 p. 100) et la serologie etait douteuse chez 2 autres ; le serotype 2 a ete mis en evidence chez l'un de ces malades ; aucun temoin n'etait positif vis-a-vis du VHC. Cinquante-quatre malades (74 p. 100) et 15 temoins (21 p. 100) etaient porteurs de l'antigene HBs parmi lesquels 13 malades (24 p. 100) et 1 temoin (7 p. 100) etaient porteurs d'anticorps anti-delta. Cette etude montre le role actuellement negligeable du VHC dans la survenue des hepatopathies chroniques en milieu hospitalier au Senegal et confirme le role predominant du virus de l'hepatite B et aggravant du virus de l'hepatite delta. Ces resultats sont confrontes aux donnees de la litterature concernant les pays d'Afrique noire. Au Senegal; l'impact du VHC parait inferieur a celui qui est oberve en Afrique centrale

[Internal quality control of the blood products in the Lomé National Blood Transfusion Centre]. / Contrôle de qualité interne des produits sanguins labiles préparés au Centre National de Transfusion Sanguine de Lomé.

AIM: Evaluate the conformity of blood red cells units prepared in the Lomé CNTS with European norms concerning volume, haemoglobin content and haematocrite. Measure the conservation of the haemostatic properties and the rate of haemostasis factors V and VIII in the fresh frozen plasma. Measure the rate of residual cells in the plasma. METHODS: In the year 2006, from March 1st to April 15th, we analysed the quality of 135 units of whole blood, red blood cells (RBC) and plasma from blood donors in the Lomé National Blood Transfusion Centre. The quality control had concerned: the volume of whole blood units; the volume, the haemoglobin content and the haematocrite of red blood cells units; the volume, the prothrombin rate, the cephalin with activator time (TCA), the rate of haemostasis factors V and VIII and the number of residual cells (red cells, leucocytes and platelets) in the plasma. RESULTS: Among the 135 units of whole blood which were controlled, 50.57% were in conformity with the norms concerning the volume. The red blood cells units were in conformity with norms concerning their volume, their haemoglobin content and their haematocrite respectively in 21.48%, 80.75% and 20% of the cases. The volume of 75.56% of the plasma units controlled were conform with the norm. All of the plasma units were conform with the norm concerning the number of residual platelets while the number of residual red blood cells and leucocytes were conform respectively in 80.74% and 60%. The percentage of conformity concerning the prothrombin rate, the TCA, the coagulation factor V and the factor VIII were respectively 66.67; 97.78; 48.89 and 47.4 before freezing, and 54.81; 88.14; 64.44; 84.44 a month after freezing. CONCLUSION: To improve the quality of the new blood products of the Lomé CNTS, some correctives actions must be applied concerning the adequate volume of blood which must be collected from the donors, the position of the blood bags in during the centrifugation and the volume of plasma which must be take out of the bag of red cells.

[Knowledge, attitudes and practices about blood donation. A sociological study among the population of Lomé in Togo]. / Etude des connaissances, attitudes et pratiques en matière de don de sang. Enquête sociologique dans la population de Lomé (Togo).

GOALS: 1) analyse the knowledge, attitudes and practices of Lome population about blood donation; 2) identify obstacles to blood donation among the population of Lome; 3) suggest some solutions to improve the performance of the National Blood Transfusion Centre (CNTS). METHODOLOGY: We have conducted a sample survey among the population of Lome from the 6th to 21st October 2003. Three hundred persons filled a questionnaire. RESULTS: In the sample, 183 (61%) were males. Their age ranged from 18 to 67 years with 2/3 of young peoples between 18 and 37 years. Pupils/students were 24,33%, wage-earners, 55% and the unemployed, 17,67%. More than the half of the investigated persons (54,67%) were unmarried and 96, 33% persons were literate. Nearly all the people (96,33%) knew about blood donation in Lome and they have received information mainly from friends, media and sensitization by the CNTS. Sixty-one percent of the investigated knew where blood is donated. All the investigated were unanimous about the vital role of blood. Whatever their religion, they recognized its sacred nature. The majority of the investigated (85%) were willing to donate blood. Only 95 people were donors. The reasons for non-donation were mainly related to the fear of catching diseases (31,71%) especially the HIV (9,76%), the lack of information (25,37%), the religious beliefs (19,51%) and the fear of knowing the result of one's HIV test. 277 people (92,33%) said that blood should be donated without remuneration. CONCLUSION: There is a growing interest in the blood donation among the population of Lome but new strategies must be elaborated to inform the population and motivate blood donors.

[Hepatitis C virus and chronic hepatopathies in Dakar: case-control study]. / Virus de l'hépatite C et hépatopathies chroniques à Dakar: étude cas-témoins.

In Black Africa, the role of hepatitis C virus (HCV) in the onset of chronic hepatic disease is unclear. This is particularly true in Senegal where the prevalence of HCV is moderate. To gain insight into this question, a case-control study including 73 patients and 73 controls was carried out at Principal Hospital in Dakar in 1995. The patients included in this study presented chronic hepatitis in 2 cases cirrhosis in 25 and hepatocellular carcinoma in 46. Patients and controls underwent serologic testing for HCV (ELISA screening test followed by 3rd generation ELISA test in case of positive results and confirmation by immunoblot) with determination of HCV serotype using the immunoenzymatic method. Testing also included research for infection by hepatitis B virus and for anti-delta antibodies. Anti-HCV antibodies were detected in two patients (3 p. 100) and serology was suspicious in two others. Serotype 2 was detected in one of these patients. No positive results were recorded in controls. Fifty-four patients (74 p. 100) and 15 controls (21 p. 100) presented the HBs antigen including 13 patients (24 p. 100) and I control (7 p. 100) with anti-delta antibodies. This study shows that HCV currently plays a minor role in the onset of hepatic disease in hospitalized patients in Senegal. It also confirms the predominant role of hepatitis B and complicating effect of the delta hepatitis virus. These findings are compared with reported data for Black African countries. The impact of HCV appears to be lower in Senegal than in central Africa.

[Laboratory diagnosis of monoclonal gammopathies. Prospective study of 14 cases in Dakar, Senegal]. / Diagnostic au laboratoire des gammapathies monoclonales. Etude prospective de 14 cas à Dakar, Sénégal.

Monoclonal gammapathies are detected because of clinical symptoms and biological tests confirm their presence. Wishing to investigate these diseases, we carried out a series of biochemical tests on 14 patients from October 1995 to July 1996: protein, cryoglobulin, electrophoresis of proteins, proteinuria of BENCE JONES, C-reactive protein, weight measuring of immunoglobulins (Ig), immunofixation of Ig, creatinine and calcium. The results we obtained confirmed the presence of 14 cases of myeloma with: -9 IgG myelomas with 6 kappa light chains and 3 lambda light chains -4 IgA myelomas with 2 kappa light chains and 2 lambda light chains -1 IgG kappa, Ig lambda biclonal gammapathy united to a cryoglobulin of class I. We observed a predominance of the IgG over the others Ig and the kappa over the alpha light chains. The proteinuria of BENCE JONES was present among 3 patients, hypercalcemia among 4 patients and hypercreatininemia in 1 patient with chronic renal failure.

[Etiopathogenic, ultrasonographic and prognostic features of postpartum cardiomyopathy]. / Particularités étiopathogéniques, échographiques et évolutives de la myocardiopathie du post-partum.

Peripartum cardiomyopathy is a classic but uncommon entity in African women about which there is little etiologic understanding. From January 1990 to March 1996 a series of 30 cases of peripartum cardiomyopathy was collected at the Principal Hospital in Dakar, Senegal. Peripartum cardiomyopathy was defined as the occurrence of cardiac insufficiency in a woman with no previous history of heart disease, during the period between the second and twentieth weeks after delivery confirmed by ultrasound evidence of dilated cardiomyopathy. The overall incidence of peripartum cardiomyopathy during the study period was 30 out of 1200 deliveries. The mean age of the women in the study was 34 years and mean parity was 5.2. In 13.3% of cases births involved twins. There were no predisposing socio-economic or climatic factors. The clinical picture was severe cardiac failure in 80.3% of cases and left ventricular insufficiency in 16.6%. In all cases ultrasound findings were typical of dilated cardiomyopathy. Serum selenium and vitamin B1 levels were normal. Measurements of T CD4 and CD8 in eight patients were normal. Conversion enzyme inhibitors were administered to twenty patients. Complete remission was achieved in 14 patients, three patients died, and thirteen patients presented ultrasonic evidence of persistent dilated cardiomyopathy. One patient relapsed after a subsequent delivery. These findings are in agreement with previous reports concerning the clinical and prognostic features of peripartum cardiomyopathy in Africa.

[A case of a combination heterozygote with hemoglobin K Woolwich and hemoglobin C (Hb Kw/HbC) discovered in Bobo-Dioulasso (Burkina Faso)]. / Remarques à propos d'un hétérozygote composite présentant une hémoglobine K Woolwich et une hémoglobine C (Hb Kw/HbC) dépisté à Bobo-Dioulasso (Burkina Faso).

During a study on malaria in pregnant women in Burkina Faso, the authors gave a particular attention to the hemoglobin of a mother and her new-born child (blood of cord) and they noticed an hemoglobin migrating before the HbA which was identified by isoelectric focusing (IEF). The child is a composite HbK/HbC heterozygote. A survey was carried out to check the transmission of such a K Woolwich hemoglobin within the family of the mother. Out of 40 people, 17 got HbKw. A noticeable anemia was found in HbKw/HbC heterozygote. The authors tried to identified a possible thalassemia. There was little probability for an association of a minor alpha-thalassemia in the absence of Bart's hemoglobin in the blood of the cord (IEF test) and there was no associated beta-thalassemia.