Pancreatic Cancer: Epidemiological, Clinical and Therapeutic Aspects in Abidjan (Ivory Coast)

Aim: The aim was to study the epidemiological, clinical and therapeutic aspects of pancreatic cancers in Ivory Coast. Materials and methods: A retrospective multi-center and multidisciplinary study aimed at describing sixteen years and four months from January 1, 2000 to April 30, 2016 in several hospitals in the city of Abidjan taking charge of pancreatic cancers (hepato-gas troenterology services of the universities hospitals of Cocody and Yopougon), internal medicine departments of University Hospital of Treichville and Abidjan Military Hospital, the department of oncology of the university hospital center of Treichville, private clinics (DANGA, PISAM and GMP), the COBA center in Treichville. The diagnosis of cancer was based on either histological criteria or a set of clinical and paraclinical arguments. Patients whose files did not include imaging were excluded from this study. The following parameters were collected: age, sex, reason for consultation, physical signs, personal and family antecedents, tumor characteristics, delay in diagnosis and the nature of the treatment administered. Results: We have observed 150 cases of pancreatic cancer. The mean age of patients was 59.09 years with extremes ranging from 24 years to 88 years. Our study population consisted of 98 men and 52 women (sex ratio 1.88). Risk factors were dominated by diabetes 20.7%. Epigastralgia is the main reason for consultation (48%). The tumor was localized at the cephalic level in 84.67%. In 13 cases the diagnosis was histological and was dominated by adenocarcinoma (100%). The majority of our patients was seen at an advanced stage of the disease: stage IV (74.56%). The average time to diagnosis was 2.76 months. Fourteen of our patients (9.33%) had benefited surgery. This was curative surgery in 35.71% (n = 5) and palliative in 64.29% (n = 9). Among those who benefited from this curative surgery, three died two months after surgery and two lost to follow-up. The majority (90.67%) of our patients had received symptomatic treatment. Conclusion: Pancreatic cancer is an appalling cancer with a very bad and late diagnosis because of its insidious symptomatology. Most of the time, tumors had already metastasized before diagnosis, so the treatment is often symptomatic.

Seroprevalence of Viral Hepatitis Markers B in Secondary School in Abidjan: Advocacy for a Catch-Up Vaccination

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.

Prevalence of Heartburn in Abidjan, a Black African Country, and Associated Factors

Aims: To determine the prevalence and risk factors of heartburn in Abidjan, a black African city. Patients and Methods: cross-sectional study from June 15 to September 30, 2003. One thousand nine hundred forty (1940) persons from five health zones of the city Abidjan were included after their informed consent. Socio demographic and clinical parameters were collected using a questionnaire in an interview format. Heartburn was defined as a discomfort or burning sensation extending from the sternal manubrium to the base of the neck. Factors related to the complaint were asked such as predisposing factors, habits (tobacco, alcohol and coffee intake) and body mass index. Stepwise multiple logistic regression analyses were used to examine associations between these factors and heartburn. Results: Among 1940 respondents (mean age 28 ± 9 years;sex ratio (M:F) 0.86), heartburn occurred in 433 persons (once a week in 9.2% of case (178 persons)). Five factors were statistically associated with heartburn: male sex (p = 0.025, OR = 0.555 [CI95% 0.331 - 0.930]), heartburn in a family member (p = 0.010, OR = 1.765 [95%CI 1.143 - 2.725]), constipation (p = 0.011, OR = 2.182 [95%CI 11,953,983]), right lateral decubitus (p = 0.001, OR = 6.247 [95%CI 2.079 - 18.775]) and after a meal (p = 0.000, OR = 2.643 [95%CI 1.594 4.383]). Conclusion: Heartburn is common in this black African population. Male sex appears to be less associated. Constipation, right lateral decubitus and after a meal are trigger factors for heartburn. Heartburn in a family member is a risk factor.

Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)

Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%;27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years;p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.

Prevalence of HBs Ag among blood donors in Transfusion Center, Abidjan (Ivory Coast)

Aim: To study the prevalence of HBsAg among persons without risk factors for hepatitis B. Patients and Methods: Cross-sectional study (28 January to 31 December 2010) about 4310 new volunteers blood donors consecutively recruited. Among all, a risk factor for hepatitis B was investigated (standardized questionnaire and clinical examination). Blood of all blood donors without risk factors of hepatitis B (n = 3823) were systematically collected for HBsAg, hepatitis C antibody, syphilis serology and human immunodeficiency virus serology. The blood was analyzed with a third generation ELISA (Abbott Murex). Results: HBsAg was positive in 179 persons (4.68% [95% CI 4% - 5%]). It was associated with hepatitis C antibodies (0.28% (n = 11)), syphilis antibodies (0.68% (n = 26)) or anti-human immunodeficiency virus antibodies (0.2% (n = 8)). In multivariate analysis, age 30 to 39 years (1.545 [95% CI 1.074 to 2.222]), male sex (2.426 [95% CI 1.550 to 3.799]) and positive syphilis serology (14.344 [95% CI 5.161 to 39.865]) were associated with presence of HBsAg. Conclusion: The prevalence of HBsAg among adult without risk factors for hepatitis B was not negligible. Also, it is essential to maintain routine screening before any vaccination against hepatitis B in adult. Our study is not for an immunization against hepatitis B only targeting risk populations in adult.

Screening for Hepatitis B and C in Occupational Settings: Cross-Sectional Study about 4268 Corporates Agents in Cote d’Ivoire

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.