Introduction: Viral hepatitis B is a public health problem in Niger which is classified as a high endemicity area with a prevalence ranging from 8 to 17% depending on the studies [1] and that of HBV-related cirrhosis ...Introduction: Viral hepatitis B is a public health problem in Niger which is classified as a high endemicity area with a prevalence ranging from 8 to 17% depending on the studies [1] and that of HBV-related cirrhosis is about 40.26% in 2024. The decision to treat is based on a combination of three parameters: viral load, ALT values and the degree of hepatic fibrosis [2]. The latter is assessed by hepatic elastography (Fibroscan), which is a decisive factor in treatment. In Niger, until 2024, the decision to treat or not to treat a patient with HBV was based on the determination of viral load B and transaminases, and no work evaluating the contribution of this third element, liver elasticity, has been done, hence the interest of our study. Objective: To study the contribution of Fibroscan in measuring hepatic elasticity in the management of patients with HBV. Methodology: This was a prospective descriptive study conducted from January 05 to November 30, i.e. a period of 11 months, on clinically asymptomatic HBsAg-positive patients who had undergone FibroScan liver elasticity measurement. The examination was carried out by a hepatogastroenterologist who had received training in the Fibroscan. The median of ten measures of liver elasticity at the same point with an IQR of less than 30% was considered the valid measure and no or minimal fibrosis was defined as a value ˂7 Kpa, moderate fibrosis as a value between 7 and 10 kpa, severe fibrosis as a value greater than 10 Kpa, and the existence of cirrhosis as a value greater than 14 Kpa were analyzed using SPSS version 20 software. Results: Out of 398 patients monitored for HBV, 60 cases met the inclusion criteria, i.e., a frequency of 15.07%. The mean age of the patients was 35.63 years, with extremes of 18 and 70 years. They were predominantly male, with a sex ratio of 3.2. Married patients accounted for 61.67% (n = 37). Jaundice was absent in 91.67% (n = 55). The circumstances of discovery of HBV were the routine health check-up, followed by blood donation with 50% and 46.67%, respectively. The viral load was >2000 UI/ml in 32.7% (n = 17). HBeAg was negative in 93.33% of cases (n = 56). ALT levels were normal in 47 patients (78.33%). Mean liver elasticity was 6.7 KPa. Fibrosis was classified as F0 - F1 in 75% (n = 45), F1 - F2 in 18.33% (n = 11) and F3 - F4 in 6.67% (n = 4) of patients. There was no significant relationship between viremia value, liver activity, degree of fibrosis and quantitative HBsAg. Conclusion: Measurement of hepatic elasticity has made it possible to diagnose cases of compensated cirrhosis and significant fibrosis in patients considered to be inactive carriers (viral load ˂2000 IU/ml and normal transaminases) in asymptomatic HBV+ patients. This made it possible to put these patients on Tenofovir in order to avoid decompensation for the first group and for the second the progression to cirrhosis. It is an excellent tool to aid in the decision to start treatment.展开更多
Objective: Improve the care of patients followed for acute leukemia in the Oncohematology department of the National Hospital of Niamey. Methods: This was a prospective study, over a period of 2 years from January 1, ...Objective: Improve the care of patients followed for acute leukemia in the Oncohematology department of the National Hospital of Niamey. Methods: This was a prospective study, over a period of 2 years from January 1, 2018 to December 31, 2019, in patients with acute leukemia in the Oncohematology department of the National Hospital of Niamey (HNN), whose diagnosis was made on a blood smear associated with a myelogram and immunophenotyping and who were consenting. Results: We collected 25 cases of acute leukemia confirmed by myelogram and immunophenotyping. The mean age of the patients was 31.32 years, with a predominance of women, a sex ratio of 0.92. Pupils and students were in the majority with 40% and most came from the Niamey region, i.e. 68%. Anemic syndrome was the most common clinical sign in 96%. ALL predominated in 64% of cases. On the blood count, the hyperleukocytosis was more marked in AML (mean white count: 197256.6 elts/mm3) than in ALL (137891.6 elts/mm3), it was the same for thrombocytopenia which is more marked in AML (75588.89/mm3) than in ALL (52156.25/mm3). Therapeutically, 52% of patients received chemotherapy. The mean overall survival was 16.223 ± 3.191 months, including a mean survival for AML of 6.853 ± 1200 months compared to 21.720 ± 5.920 months for ALL. Conclusion: Acute leukemia still remains a major problem in our context, due to the precariousness of limited financial, diagnostic and therapeutic resources. Thus reflecting in our results, the increasing number of cases, the diagnostic delay and the guarded prognosis. This is the reality in several other countries in the sub-region and even in certain developed countries.展开更多
文摘Introduction: Viral hepatitis B is a public health problem in Niger which is classified as a high endemicity area with a prevalence ranging from 8 to 17% depending on the studies [1] and that of HBV-related cirrhosis is about 40.26% in 2024. The decision to treat is based on a combination of three parameters: viral load, ALT values and the degree of hepatic fibrosis [2]. The latter is assessed by hepatic elastography (Fibroscan), which is a decisive factor in treatment. In Niger, until 2024, the decision to treat or not to treat a patient with HBV was based on the determination of viral load B and transaminases, and no work evaluating the contribution of this third element, liver elasticity, has been done, hence the interest of our study. Objective: To study the contribution of Fibroscan in measuring hepatic elasticity in the management of patients with HBV. Methodology: This was a prospective descriptive study conducted from January 05 to November 30, i.e. a period of 11 months, on clinically asymptomatic HBsAg-positive patients who had undergone FibroScan liver elasticity measurement. The examination was carried out by a hepatogastroenterologist who had received training in the Fibroscan. The median of ten measures of liver elasticity at the same point with an IQR of less than 30% was considered the valid measure and no or minimal fibrosis was defined as a value ˂7 Kpa, moderate fibrosis as a value between 7 and 10 kpa, severe fibrosis as a value greater than 10 Kpa, and the existence of cirrhosis as a value greater than 14 Kpa were analyzed using SPSS version 20 software. Results: Out of 398 patients monitored for HBV, 60 cases met the inclusion criteria, i.e., a frequency of 15.07%. The mean age of the patients was 35.63 years, with extremes of 18 and 70 years. They were predominantly male, with a sex ratio of 3.2. Married patients accounted for 61.67% (n = 37). Jaundice was absent in 91.67% (n = 55). The circumstances of discovery of HBV were the routine health check-up, followed by blood donation with 50% and 46.67%, respectively. The viral load was >2000 UI/ml in 32.7% (n = 17). HBeAg was negative in 93.33% of cases (n = 56). ALT levels were normal in 47 patients (78.33%). Mean liver elasticity was 6.7 KPa. Fibrosis was classified as F0 - F1 in 75% (n = 45), F1 - F2 in 18.33% (n = 11) and F3 - F4 in 6.67% (n = 4) of patients. There was no significant relationship between viremia value, liver activity, degree of fibrosis and quantitative HBsAg. Conclusion: Measurement of hepatic elasticity has made it possible to diagnose cases of compensated cirrhosis and significant fibrosis in patients considered to be inactive carriers (viral load ˂2000 IU/ml and normal transaminases) in asymptomatic HBV+ patients. This made it possible to put these patients on Tenofovir in order to avoid decompensation for the first group and for the second the progression to cirrhosis. It is an excellent tool to aid in the decision to start treatment.
文摘Objective: Improve the care of patients followed for acute leukemia in the Oncohematology department of the National Hospital of Niamey. Methods: This was a prospective study, over a period of 2 years from January 1, 2018 to December 31, 2019, in patients with acute leukemia in the Oncohematology department of the National Hospital of Niamey (HNN), whose diagnosis was made on a blood smear associated with a myelogram and immunophenotyping and who were consenting. Results: We collected 25 cases of acute leukemia confirmed by myelogram and immunophenotyping. The mean age of the patients was 31.32 years, with a predominance of women, a sex ratio of 0.92. Pupils and students were in the majority with 40% and most came from the Niamey region, i.e. 68%. Anemic syndrome was the most common clinical sign in 96%. ALL predominated in 64% of cases. On the blood count, the hyperleukocytosis was more marked in AML (mean white count: 197256.6 elts/mm3) than in ALL (137891.6 elts/mm3), it was the same for thrombocytopenia which is more marked in AML (75588.89/mm3) than in ALL (52156.25/mm3). Therapeutically, 52% of patients received chemotherapy. The mean overall survival was 16.223 ± 3.191 months, including a mean survival for AML of 6.853 ± 1200 months compared to 21.720 ± 5.920 months for ALL. Conclusion: Acute leukemia still remains a major problem in our context, due to the precariousness of limited financial, diagnostic and therapeutic resources. Thus reflecting in our results, the increasing number of cases, the diagnostic delay and the guarded prognosis. This is the reality in several other countries in the sub-region and even in certain developed countries.
