The frequency of ballistic spinal injuries is rising in developing nations around the globe. These injuries lead to a functional prognosis linked to disabling sequelae and vitals in patients, which often results in serious complications and death.This study describes the epidemiological, diagnostic, therapeutic, evolutionary characteristics of Ballistic Medullar-Vertebral trauma (BMVT). It presents the particularities of management in the sub-Saharan African country of Chad.This is a prospective descriptive study of 27 ballistic spinal injury patients conducted over an 18-month period.Ballistic Medullar-Vertebral injuries (BMVI) represented 12.9 % of spinal trauma. The average age of the patients was 31.8, and 40.7 % were between 31 and 40 years of age. Military personnel represented 78 % of the patients. 44.4 % of cases came from the Lake Chad region. 59.3 % of injuries were caused by Kalashnikov’s (AK 47) firearms. 74.1 % of cases were admitted to the emergency department within 12 to 24 h. The diameter of the wounds that corresponded to the entry orifice of the bullet was between 1 and 2 cm in 59.25 % of the cases. A Dural breach was found in 14.8 %. 48.1 % had ASIA C score and none of them met the criteria for spinal cord injury collection and immobilization. The lumbosacral location was reported in 55.6 %, and the type I Roy Camille fracture was found in 70.37 %. Surgical management was performed in 88.9 % cases. Multidisciplinary management of the associated lesions was performed in 25.9 %. 7.4 % of patients with cervical trauma died due to septic shock.Delayed emergency department admissions and limited access to medicalized transportation are main factors to BMVI in Chad. Lesion is predominantly located in the lumbosacral region. Lesions and spinal cord involvement were factors of poor vital and functional prognosis. Surgery plays an important role in management. Socio-professional reintegration remains problematic.

Introduction: Cirrhosis, is the consequence of a chronic attack of the liver, is histologically defined as a diffuse process associating mutilating fibrosis (concentric), and regenerative hepatocyte nodules, it has formidable complications (hemorrhagic, cancerous and encephalopathies) essentially. Method: this was a retrospective descriptive study from June 01, 2021 to May 30, 2023, i.e. 2 years. Results: we identified 205 cases of cirrhosis, 36 of which had at least one gastric or duodenal ulcer, i.e. a prevalence of 17.56%. There were 12 women and 24 men, i.e. a sex ratio (M/F) = 2. The mean age was 47.22 years ± 14.7 years with extremes ranging from 28 to 81 years. The etiologies of cirrhosis are (HBV 72.22%, HCV 15%, HBV+HCV 8.33% and chronic alcoholism 5.6%). Civil servants, pensioners, shopkeepers and housewives occupy the first places of complications respectively (25%, 16.7%, 13.9%, 11.1%). Signs of portal hypertension are represented by esophageal varices grade III with a proportion of 61.11% and grade II of 27.8% with or without red signs and at the gastric level, 63.9% of patients had gastropathy of portal hypertension. Ulcerative lesions were single in 80.55%, double in 19.44%, and in order of frequency according to bulbar (44.4%), antral (36.1%), antrobulbar (11.1%) and fundic (8.3%) location. The prognosis was, CHILD C (50%), CHILD B (30.55%) and CHILD A (19.45%). Conclusion: the complications of cirrhosis are formidable, prevention through awareness raising on the avoidance of risky behaviour and universal vaccination against hepatitis B remain the preferred option. Keywords: cirrhosis, Peptic ulcer, Portal hypertension, Cocody University Hospital

Abstract Background and Objectives: Adenomas and certain serrated polyps have the potential to develop into colorectal cancer (CRC). Despite barriers limiting routine screening for CRCs in Côte d’Ivoire, it is important to focus on the risk factors for colorectal (CR) polyps. To facilitate the identification of individuals to prioritize for CRC screening, this study aimed to determine the risk factors of CR polyps in a hospital setting in Abidjan. Materials and Methods: From January 1st, 2023, to July 31st, 2023, a prospective analytical multicenter case–control study was conducted in four hospitals in Abidjan. Patients diagnosed with CR polyps (cases) were compared to those without polyps (controls), matched for age and gender at a 1:1 ratio. Logistic regression was employed to determine factors associated with the discovery of CR polyps. Results: Thirty-three cases were matched to 33 controls [age ( P = 0.97), gender ( P = 0.80), recruitment site ( P = 1.00), indication for colonoscopy ( P = 0.93)]. Adenomatous polyps represented 68.3% ( n = 28) of cases. In univariate analysis, factors associated with CR polyps were body mass index ( P = 0.004), personal or family history of CRC ( P = 0.004) and/or CR polyps ( P = 0.007), and consumption of red meat ( P < 0.001). After multivariate analysis, only red meat consumption was statistically associated with CR polyps ( P = 0.02) [odds ratio (OR) = 17.0 (1.5–189.3)]. Alcohol and tobacco were not statistically associated with the presence of CR polyps either in univariate analysis [alcohol (OR= 0.14) and tobacco (OR= 1.00)] or in multivariate analysis [alcohol (OR= 0.99) and tobacco (OR= 0.99)]. Conclusion: Our study found that increased consumption of red meat is associated with the presence of CR polyps. However, tobacco and alcohol did not show an association with CR polyps in our study. Larger studies are necessary to validate or challenge our findings.

The characteristics of viral hepatitis B and D co-infection are poorly documented in Chad. The aim of our study was to determine the prevalence of HBV/HDV co-infection and the characteristics of this co-infection. Materials and Methods: This was a retrospective study including all patients with chronic HBsAg carriers referred in our department from January 2014 to December 2018. Non-inclusion criteria were: absence of anti-HDV testing, presence of anti-viral hepatitis C or Human Immunodeficiency Virus antibodies or excessive alcohol consumption. The variables studied were age, sex, blood transaminase level, HBV DNA level, HDV RNA level, and liver fibrosis and activity score (Actitest Fibrotest). The prevalence of HDV and the characteristics of HDV/HBV co-infection were determined. Results: During the study period, 403 patients were seen in these two hospitals for chronic HBsAg carriage. Of these, 378 (75%) had performed the anti HDV assay. Anti-HDV antibodies were positive in 53 patients (14%). In multivariate analysis, HBV/HDV co-infected patients were less frequently HBeAg positive (5.4% vs. 28.1%; p = 0.0001), older (35 years vs. 32 years; p = 0.001), and more frequently had significant necrotic-inflammatory activity (3.9% vs. 3.2%; p = 0.031) compared with mono infected patients. Neither gender (76.9% male vs. 77.4% male; p = ns), nor viral load (median 530 IU/ml vs. 195 IU/ml; p = ns), nor significant liver fibrosis (35.1% vs. 47.1%; p = ns), nor transaminases (median 26 vs. 32 IU/ml) were different with mono infected patients. Conclusion: VHD is common in Chad. It is associated with increased hepatic necrotic-inflammatory activity.

Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type; multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.

Otalgia is a frequent reason for medical consultation. In Africa, few studies have been devoted to the epidemiology and aetiology of otalgia. To our knowledge, no study has been carried out in Chad. The objective of this study is to describe the epidemiological, clinical and aetiological aspects of otalgia in Chadian hospitals. This was a prospective, descriptive and analytical study conducted at the Renaissance University Hospital from January to August 2020. All the patients that were consulting in the ENT department for otalgia were included. Data was analysed using SPSS version 26. The chi-square test was used to compare the results. 88 (22.3%) of the 395 patients suffered from otalgia. Their sex ratio was 1:1 (M:F). Their average age was 30.4 ± 19.5 years. The median age was 31.5 years with extremes from 1 to 70 years. Children (1–18 years) represented 30.7% of the cases. The average time of consultation was 27.8 ± 35.0 days. Otalgia was associated with deafness in 33% of the cases and 29.5% of the patients have used cotton swabs. Otogenic otalgia in 73.9% of the cases was significantly more frequent in children (92.6% versus 65.6%, P =0.008). Otogenic otalgia was related to otitis externa, chronic otitis media and Eustachian tube dysfunction in 44.6%, 21.5%, and 13.9% of cases respectively. The aetiologies of the referred otalgias were angina and rhinopharyngitis (30.4%), trigeminal neuralgia (21.7%) and oral cavity, pharyngeal and laryngeal cancer (21.7%). Otalgia is a frequent reason for medical consultation at any age regardless of sex. However, ear infections are more frequent in children. Referred otalgias predominate in adults, dominated by pharyngeal infections, trigeminal neuralgia and oral cavity, pharyngeal and laryngeal cancers.

Introduction: The aim of this study was to describe the clinical characteristics of patients admitted for Covid-19 in the department of Covid-19 of the University Hospital Center of Renaissance (UHCR) of N’Djamena in Chad. The pandemic of the sickness of Covid-19 constitutes a real public health problem in the world since its appearance in December 2019. Materials and Methods: This was an observational, transversal and descriptive study carried out from 19 March 2020 to 19 November 2021. All patients diagnosed with Covid-19, confirmed at least either by RT-PCR or chest computed tomography (CT) were included. The healing was defined through the disappearance of clinical signs and two negative RT-PCRs at 72 hours intervals. Results: Our study included 825 patients of which 613 (74.34%) men (sex ratio 2.9). Age Medium for patients was 50 ± 4 years with extreme ranging from 19 to 84 years old. Six hundred and thirty-three (76.70%) patients came directly from their residences. Respectively 82 and 71 were transferred from the provincial hospital of Farcha (9.9%) and from a private health structure (8.7%). Three hundred and thirteen patients had at least a comorbidity especially arterial hypertension (n = 173; 21%); the diabetes (n = 156; 19.7%); chronic renal failure (n = 28; 3.5%); heart disease (n =27; 3.3%) and obesity (n= 14; 1.6%), HIV infection (n = 9; 1.09%). five hundred and seventy-two (61.12%) patients performed the CT and all the RT-PCR. Four hundred and ninety-two patients (59.60%) presented severe forms of the disease, 160 (19.40%) were critical and 124 (15.10%) were moderates. The hospital lethality was 16.24% (n = 134). The treatment consisted in the administration of Hydroxychloroquine-Azythromycin in 99.4% of cases (n = 813) and by covid-organics in 0.6% of cases (n = 5). Conclusion: The infected patients with Covid-19 were admitted with the advance stage of the disease. Lethality was associate with the presence of comorbidities. The sensitization of the population on the importance of vaccination, barrier measures and recourse to care are necessary.

Background Noise pollution, unwanted or excessive sound, is one of the most common nuisances in industrial sectors. In the city of N’Djamena, Chad, workers in power plants are exposed to very high levels of noise, which could have deleterious effects on human health. The purpose of the study is to determine the level of noise pollution and its repercussions in a population of power plant workers. Results Ninety-two (11.5%) of the 800 workers were included. Their sex ratio was 88 men: 4 women with an outcome of 22. The age range was from 23 to 64 years with an average of 38.7 ± 9.0 years. Forty-seven (51.1%) of the employees had received occupational safety training. The average noise level in the machine rooms was 113.5 ± 4 dB(A). The average duration of exposure to noise was 10.8 ± 8.5 years. Personal protective equipment was worn regularly in 85.9% ( n = 79). The consequences of noise pollution were auditory fatigue (38%; n = 35), tinnitus (32.6%; n = 30), hearing loss (15.2%; n = 14), nervousness (45.7%; n = 42), headache (33.7%; n = 31), raised voice (27.1%; n = 25), and insomnia (14.1%; n = 13). Conclusions The level of noise pollution is relatively high in power plants in N’Djamena, Chad. Hearing effects and an altered quality of life are observed among industrial workers. The acquisition of machines with regulated noise levels is desirable. The audiometric test should be integrated into the follow-up assessment of all employees.

Background: The effect of eradicating Helicobacter pylori on the course of chronic gastritis (CG) is controversial. The aim of this study was to assess the impact of H. pylori eradication treatment on CG. Materials and Methods: This was a retrospective (January 2016 to December 2018) multicenter study. All medical records of patients treated with a quadruple therapy to eradicate H. pylori who were confirmed with histology at least 4 weeks after the end of treatment were included. The evolution of the CG ratings after treatment was analyzed. Results: The records of 170 patients (male/female ratio 0.95, average age 49.3 ± 12.2 years) were included. Respectively, inflammation and H. pylori levels decreased (P < 0.001) in antrum (2.09 to 1.45; 1.95 to 0.63) and fundus (1.82 to 1.27; 1.76 to 0.55). Gastric atrophy levels regressed in antrum (0.28 to 0.18; P = 0.0655) and fundus (0.19 to 0.09; P = 0.0096) on sequential quadruple therapy (0.42 to 0.26; P = 0.2384), with bismuth (0.27 to 0.1l8; P = 0.6232) or with concomitant therapy for 14 days (0.20 to 0.13; P = 0.1288). Gastric intestinal metaplasia progressed in the antrum (0.05 to 0.06; P = 0.5930) and the fundus (0.02 to 0.03; P = 0.2568); in sequential quadruple therapy (0.04 to 0.07; P = 0.3173) and in bismuth therapy groups (0.04 to 0.09; P = 0.5637) even after eradication of H. pylori (0.03 to 0.09; P = 0.0455). Conclusions: The eradication treatment for H. pylori improved elements of the Sydney CG system except for intestinal metaplasia.

Tumors of the peripheral nerves are not well described. Plexiform neurofibromas are common NF1 benign tumors that carry a low malignant risk of transformation. In some area where the conventional therapies (clinical trial) are not available, surgery remains the gold standard although this one is not radical. There is not a lot of publications related to this subject in Africa. The aim of study is to share our experience and show the difficulties of managing this pathology in children. We report a case of a 4 year old boy without any family history of neurofibromatosis. He presented to our department of neurosurgery at renaissance hospital of Ndjamena (Chad) with primary skin concern about a right lumbar swelling which was progressive increase in size over the last few years. Physical examination revealed the presence of several cafe-au-lait macules (CALM) more than forty, freckling, hypertrichosis, hyperpigmentation, and thoraco-lumbar scoliosis without other associated lesions. Ultrasonography, CT scan and Magnetic resonance imaging (MRI) of the swelling was done, and gave features description of this lesion. The patient underwent surgery and the diagnosis of plexiform neurofibromatosis was made at the histological examination. After a follow-up of 16 months there is no tumor recurrence. A regular follow-up is necessary for this young patient. The surgery has an aesthetic purpose and it delays the progression of the disease.

To our knowledge, no case of a hook inhalation in a child has been reported. However, we report the first case diagnosed in a 12-year-old child located at the laryngeal level and extracted endoscopically without any complications using Magill's forceps.

Background: No study in black Africa has investigated the profile of chronic hepatitis B according to the new European association for the study of the liver (EASL) classification. The aim of the study was to determine the biological profile of chronic HBsAg carriers according to the EASL classification of chronic hepatitis B. Method: This is a prospective cross-sectional study carried out in the gastroenterology outpatient department at the Renaissance Hospital in N’Djamena from January, 2018 to July, 2019. All patients with chronic HBsAg were included and documented for at least one year. Patients with hepatitis C, hepatitis D or HIV or alcoholic were excluded. The biological profile was determined according the EASL classification: HBeAg-positive chronic infection, HBeAg-positive chronic hepatitis, HBeAg-negative chronic infection, HBeAg-negative chronic hepatitis and HBsAg-negative phase. Factors associated with presence of significant liver fibrosis were founded by logistical regression. Results: 106 patients were included. The average age were 42.4 years old. The sex ratio was 1.43. The median of the transaminase were 24 IU/ml (AST) and 21 IU/ml (ALT). 61 patients had HBeAg-negative chronic infection (59.8%) and 37 patients had HBeAg-negative chronic hepatitis (36.2%). HBeAg-positive chronic infection and HBeAg-positive chronic hepatitis were both seen in 2% of the cases. Significant liver fibrosis was independently associated with the ALT levels (Odds ratio=1.038 [1.009-1.068]; p=0.009). Conclusion: Chronic HBeAg-negative B infection is the main form in chronic HBsAg-positive carriers. Transaminases are a predictive factor for the presence of hepatic fibrosis.

But: L’etude avait pour but d’evaluer et de comparer l'efficacite de trois modeles de tritherapie de premiere ligne bases sur la combinaison d'un inhibiteur de la pompe a protons (IPP) et de 3 types d'antibiotiques: l'omeprazole (O), l'amoxicilline (A) la clarythromycine (C) et metronidazole (M). Patients et methodes: Il s’est agi d’un essai clinique randomise ouvert sur 3 bras paralleles: OAM (groupe 1 ou G1), OAC (groupe 2 ou G2) ou OCM (groupe 3 ou G3). Le critere d'evaluation principal etait le taux d'eradication de H. pylori apres sept jours de tritherapie. Le diagnostic de l’infection a H. pylori etait base sur l’histologie des biopsies gastriques. Un controle histologique a ete effectue 4 semaines apres la fin du traitement pour evaluer le taux d'eradication de H. pylori. Resultats: L’âge moyen etait de 44,33 ± 11,72 ans. Le principal motif de l'endoscopie etait le syndrome dyspepsie 75,16%). Nous avons trouve une gastroscopie normale dans 28,76% des cas, un ulcere gastroduodenal ou gastrique dans 17% des cas et une gastropathie dans 45,75%. Tousles patients etaient comparables pour l'âge, le sexe, les indications d'endoscopie, les antecedents de consommation d'alcool ou de tabagisme et la prise de medicaments anti-inflammatoires. Environ 23% des patients ont presente des effetsindesirables. Le taux d'eradication global de H. pylori etait de 22,3%. Il n'y avait pas de difference significative du taux d'eradication de H. pylori selon le traitement utilise (28,1%, 21,4% et 15,1% pour G1, G2 et G3, p = 0,34). Conclusion: Le taux d'eradication de H. pylori etait mediocre quelle que soit la tritherapie utilisee. Mots cles : Helicobacter pylori, Tritherapie, Eradication, Afrique de l’ouest.

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.

Introduction: Le personnel des hopitaux est une population a risque viral B. la prevention primaire par la vaccination contre le virus de l’hepatite B est efficace. Peu de donnees existent sur cette prevention en milieu hospitalier ivoirien. Le but de notre etude etait d’evaluer la couverture vaccinale contre le VHB et les facteurs associes a cette vaccination au sein du personnel du CHU de Cocody Methode: Nous avons realise une etude transversale analytique allant du 1er Juillet au 31 Decembre 2016 incluant tout le personnel du CHU de Cocody. Tous ceux absent pendant toute la duree de l’etude ou ayant refuse d’y participer ou chez qui une difficulte technique etait notee au cours de l’analyse au laboratoire etait exclu de l’etude. Des variables sociodemographiques, anamnestiques et biologiques etaient colliges sur une fiche d’enquete pre etablie. La vaccination anti virale B etait complete lorsque le sujet avait recu les trois doses du vaccin. Resultats: Sur les 1479 agents du CHU de Cocody, 867 avaient ete inclus soit un taux de participation de 58,6%. L’âge moyen etait de 41,2 ±9,4 ans, la mediane de 40 ans (18 a 66 ans). Le sex ratio etait de 0,82. Un accident d’exposition au sang etait declare par 18,5% de sujet. L’AgHBs etait positif chez 7,2% de cas. Dans 33,4% des cas les sujets affirmaient avoir recus au moins une dose de vaccin contre le VHB. Un depistage pre vaccinal etait realise dans 17,6% des cas. Les sujets incompletement vaccines avaient recu leur derniere dose avant un an, de 1 a 5 ans et plus de 5 ans dans respectivement 23,8%, 32,0% et 44,3% des cas. Les facteurs associes de facon independante a une vaccination complete etaient le statut matrimonial marie (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) et la profession medicale (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: La vaccination est un acte peu realise par le personnel du CHU de Cocody. Celle-ci etait meilleure chez le personnel marie et medical. Mots cles: personnel hospitalier ; vaccination ; hepatite virale B ; Abidjan- cote d’ivoire English Title: Vaccination coverage against viral hepatitis B Abidjan teatching hospital English Abstract Introduction: Hospital staff is a risk population for viral hepatitis B. The primary prevention by anti-viral B vaccination is effective. There is few data about that prevention in Ivorian hospital environment. Method: We made a prospective cross-sectional study from the 1st of July to the 31st of December 2016, including all CHU de Cocody regularly assigned agent. All those who were absent throughout the duration of the study or refused to participate or in whom a technical difficulty was noted during laboratory analysis were excluded. Sociodemographic, anamnestic and biologic data were collected on a pre-established survey sheet. The anti-viral B vaccination was complete when the person had received three doses of the vaccine. Results: Among the 1479 agents of the CHU de Cocody, 867 was included, giving a participation rate of 58.6%. The middle age was 41.2± 9.4 years, the median was 40 years (18 to 66 years). The sex ratio was 0.82. Average professional seniority was 11.2 ± 9.7 years. Married agents (45.8%) and paramedics (45.9%) was relatively the most numerous. 91.5% of the hospital workers had already heard about viral hepatitis B. 70% of them were directly exposed to human organics fluids. A blood exposure accident was reported by 18.5% of hospital agents. Paramedical staff represented the majority. Positive HBs antigen was found in 7.2% of our study population. The agents claiming to have received at least one dose of anti-viral B vaccine numbered 290 (33.4%). A pre-vaccination screening had been achieved in 17.6 % of them. Respectively 29 (23.8%), 39 (32%) and 54 (44.3%) among the incompletely vaccinated agents have had their last dose before one year old, between 1 and 5 years old and after 5 years old. Independently associated factors with a complete vaccination was married marital status (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) and the medical profession (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: Vaccination coverage is poor in CHU de Cocody regularly assigned agents.It was better among married agents and medical staff. Keywords: Hospital staff; vaccination; viral hepatitis B, Abidjan-ivory- cost

RESUME Introduction. Les professions sanitaires sont exposees au risque d’infection virale B et C des accidents resultant du contact professionnel avec les milieux biologiques. Les donnees sur les accidents exposant au sang (AES) sont rares en Afrique noire. Le but de notre etude etait d’evaluer la prevalence des AES au sein du personnel soignant en milieu hospitalier a Ndjamena. Methodes. Il s’agissait d’une etude transversale realisee du 8 Aout au 8 Novembre 2015 dans cinq hopitaux de la ville de Ndjamena a l’aide d’un questionnaire standardise administre par des enqueteurs a des agents de sante. Resultats. le taux de participation a l’enquete etait faible (34,2%). Parmi les personnes interrogees, 60,2% affirmaient avoir eu un AES, surtout des infirmiers (57%). Seuls 38% declaraient administrativement leur accident. L’attitude apres un AES etait insuffisante et consistait essentiellement en une desinfection et une serologie de la personne source (51,9%). Une formation sur les hepatites virales avait ete recue par 44 des agents interroges (12%). La couverture vaccinale VHB, le portage des anticorps anti VHC et de l’AgHBs etaient respectivement de 38,7%, 1,6% et de 13%. Conclusion. La prevalence des AES est elevee chez les agents de sante de Ndjamena. Leurs connaissances sur les hepatites B et C sont insuffisantes. De ce fait, la mise en œuvre d’un programme de sensibilisation sur les hepatites et la vaccination du personnel s’avere indispensable. ABSTRACT Introduction- aim. Health professions are exposed to the risk of viral infection B and C from accidents resulting from professional contact with biological materia. Data on blood-related accidents are rare in more African countries. The aim of our study was to evaluate the prevalence of blood-related accidents among hospital staff in Ndjamena. Methods. This was a cross-sectional study conducted from 8 August to 8 November 2015 in five hospitals of Ndjamena using a standardized questionnaire administered by investigators to health workers. Results. The survey participation rate was low (34.2%). Among the respondents, 60.2% said they had a blood-related accident, mostly nurses (57%). Only 38% reported their accident. The attitude after blood-related accidents was insufficient and consisted essentially of disinfection and getting information about the serology data of the patient (51.9%). Training on viral hepatitis was received by 44 agents (12%). HBV vaccination coverage, anti-HCV antibodies and HBsAg carriers were 38.7%, 1.6% and 13%, respectively. Conclusion. The prevalence of BRA is high among hospital staff of Ndjamena. Their knowledge about hepatitis B and C is insufficient. The implementation of an awareness program on hepatitis and vaccination is mandatory.

Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan® (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to societe francaise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan® at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880; P = 0.272]; 0.588 [0.436 - 0.739; P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.

ABSTRACT Objectif. Decrire le profil et l’evolution clinique des patients traites pour hemorragie digestive haute a l’Hopital General de Reference Nationale de N’Djamena. Patients et Methodes. Etude transversale descriptive realisee sur une periode de quatre ans, incluant tous les patients hospitalises pour une hemorragie digestive haute. Une fiche comportant differentes variables et rubriques s’inspirant de l’etude de l’Observatoire des Hemorragies Digestives Hautes en Afrique Francophone a ete utilisee. Les variables etudiees incluaient les parametres demographiques, les caracteristiques cliniques, le taux d’hemoglobine, les donnees endoscopiques, ainsi que l’evolution des hemorragies. Resultats. cent quinze (115) fiches ont ete analysees. L’âge moyen des patients etait de 47 ans dont 78% d’hommes. L’hematemese etait la forme du saignement la plus frequente (70,43%) et l’hemoglobinemie etait inferieure a 7 g/dl dans 30% des cas a l’hospitalisation. Les ulceres gastroduodenaux etaient les causes les plus retrouvees (43%) et la prise d’anti-inflammatoires non steroidiens (AINS) etait notee chez 7% des cas. La mortalite globale etait de 18% et n’etait liee a aucun facteur precis. Conclusion. A Ndjamena, les hemorragies digestives hautes se presentent avant tout comme des hematemeses. Les ulceres gastroduodenaux sont la principale cause. Le taux de mortalite est eleve. RESUME Aim. To describe the clinical pattern, the causes and the outcome of patients with acute upper gastrointestinal bleeding in the National Reference General Hospital of N’Djamena. Patients and Methods. This was a cross sectional descriptive study carried out over a period of four years, including all patients recovered for an upper gastrointestinal bleeding. Data were collected using a sheet inspired from the “Upper gastrointestinal bleeding Observatory in Africa French-speaking Area”. Study variables included demographic data, clinical presentation, hemoglobin rate, endoscopic findings, and the issue of patient. Results. The files of one hundred fifteen patients were analyzed. 78% of them were male. Their mean age was 47 years. Hematemesis was the most frequent form of bleeding (70, 43%). Hemoglobin rate was less than 7 g/dl in 30% of cases. Gastroduodenal ulcer disease was the most common cause of bleeding. The use non-steroidal anti-inflammatory drugs (NSAIDs) was identified in 7% of cases. Overall mortality rate was 18%. Conclusion. In Ndjamena, upper gastrointestinal bleeding usually presents as hematemesis. gastro duodenal ulcer disease is the most common cause. The overall mortality rate is high.

The aim of our study was to assess in our context, the efficacy of Rifaxim in improving the symptoms of irritable bowel syndrome particularly in its diarrheal (IBS-D) or mixed (IBS-DC) component and therefore assess its impact on patients’ quality of life. Patients and methods: This was an uncontrolled, non-comparative prospective cohort study of a single group of patients. Patients recruitment was done in two University Hospitals for 6 months (September 2015-February 2016). Were included ambulatory patients, male or female, aged 18 - 75 years, with diarrheic IBS (IBS-D) or mixed IBS (IBS-DC) diagnosed according to Rome III criteria and who agreed to participate in the study. Each patient received 400mg Rifaximin × 2/d for 15 days. The overall assessment of the efficacy of treatment at D15 (end of treatment) and D30 (2 weeks post-treatment) was the primary criterion of judgment. The statistical tests used were the Chi-square test and Fisher’s exact test for the qualitative variables and Student’s test for the quantitative variables. Results: A total number of 30 patients (16 women) with an average age of 44.5 ± 13.9 years were included. The overall assessment of symptoms by the patient with the Likert scale found 28 (93.3%) patients, 12 (40%) patients and 10 patients (33.3%) for a scale ≥2 at D0, D15 and D30 respectively. The assessment of the intensity of pain or abdominal discomfort found at D0, D15 and D30 respectively: 27(90%), 13(43.4%) and 6(20.1%) patients who had an EVA score > 2. The mean score for Francis to assess the improved quality of life was 247.1 ± 97.4 at D0, 99.8 ± 63.1 at D15 and 128.8 ± 70.6 at D30. Conclusion: There is a good overall improvement of symptoms in our patients suffering from IBS-D or mixed (IBS-DC) on Rifaximin with improvement of the quality of life.

Aim: To screen hepatitis B and C in occupational setting. Methods: Cross-sectional study multicenter in 16 enterprises (one occupational exposure; 5602 agents). Screening was preceded by information, sensibilisation and informed consenting physician labor, labor union and agents. Hepatitis B surface antigen (HBsAg) and antibodies anti-hepatitis C (Elisa, third generation) were tested in all. For those with HBsAg positive, this test was completed by IgM and IgG, anti HBc, HBeAg, antibodies anti HBe, transaminases and HBB DNA; for those with positive anti-VHC antibodies, test was completed by transaminases and VHC’s RNA. Results: Rate of participation was 76.2% (4268/5602 labors). HBsAg or hepatitis C antibodies were positives in 425 (9.9%) of cases (HBsAg positive: 8.48%; Hepatitis C Antibodies positives: 1.50%; both: 0.05%). In HBsAg positive, viral replication and cytolysis were seen respectively in 2.5 % and 18.2%. According with transaminases, serologic markers and viral load, immunotolerance, inactive and immuno active phase were suspected in 0.56%, 80.9% and 1.6% of cases. In hepatitis C antibodies positives persons, any had viral replication but cytolysis was observed in 33.3% (n = 21). HBsAg was significantively (p < 0.00001) higher in exposed occupational enterprise versus non-occupational setting (14.4% vs 7.8%). They were no differences (p = 0.71) about hepatitis C antibodies in the two setting (1.8% vs 1.7%). Conclusion: Prevalence of HBsAg and hepatitis C antibodies was high in occupational setting in hepatitis endemic country. It’s important to screen all of person in these setting with no consideration with blood exposed or not exposed enterprise.