[Drug-resistant pulmonary tuberculosis at Maradi Regional Hospital Center, Niger (2014-2018)]. / Tuberculose pulmonaire résistante à la rifampicine au Centre Hospitalier régional de Maradi, Niger (2014-2018).

Aim of study: To describe the clinical, therapeutic and evolutionary profile of patients followed for rifampicin-resistant pulmonary tuberculosis (RR-TB) at the Regional Hospital Centre (RHC) of Maradi (Niger) from 2014 to 2018. Methods: We conducted a retrospective and descriptive study based on the records of patients followed for Multidrug-resistant tuberculosis (MDR-TB) between January 1, 2014 and June 30, 2018 at the resistant tuberculosis management unit in Maradi (Niger). This unit is located within the RHC of Maradi and has a capacity of 20 beds in 4 wards. It receives patients with tuberculosis resistant to first-line anti-tuberculosis drugs. In this study, patients diagnosed with RR-TB by genotypic (GeneXpert MTB/RIF) or phenotypic (culture) testing were included. We excluded from this study: patients previously treated for more than 1 month with second-line anti-TB drugs; patients with resistance to second-line injectables (SLI) and/or fluoroquinolones (FQ); patients with an electrocardiogram QTc greater than 500 ms (the corrected QT (QTc) estimates the QT interval at a rate of 60 beats per second); cases of atypical mycobacteriosis detected by phenotypic testing.Patients were previously on 2RHZE/4RH prior to the discovery of resistance. The treatment protocol for resistant TB was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE (The second-line injectable was replaced by Lzd in case of initial or treatment-emergent deafness). HIV co-infected patients received, in addition to anti-tuberculosis drugs, antiretrovirals and cotrimoxazole in preventive doses. Results: A total of 80 patients were included in the present study (70 males and 10 females, mean age 34.4 years with extremes ranging from 18 to 71 years). Patients aged 18-35 years accounted for more than half. Patients with primary treatment failure were the most frequent type (36%) followed by patients with retreatment failure (24%) and patients with retreatment relapse (17%). It should be noted that 77 patients (96%) were previously treated for TB and only 3 patients (4%) were new cases. The majority of patients (70%) had a Body mass index of less than 18 kg/m2. 7.5% of patients were HIV positive, one was diabetic, 52% of the patients had grade 2 radiological lesions. Grade 1 deafness was noted at the beginning of treatment in 3%. A third of patients (36%) were primary treatment failures. The treatment protocol was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE. Only 1 patient had a positive culture at the end of the 4th month of treatment. Most of the patients had experienced adverse events, mainly digestive, with vomiting being the most common. The therapeutic success rate was 88%. We noted 10% of deaths, 1% of therapeutic failure and 1% of lost to follow-up.Six months after treatment, 48 patients (60%) were smear negative and 43 (54%) were culture negative. In 32 patients (40%), the smear was not performed and culture was not performed in 37. Conclusion: The short treatment regime gives satisfactory results in the absence of resistance to fluoroquinolones, with rare adverse effects. In Niger, further efforts should be made to minimize the delay in diagnosis which is responsible for most deaths during treatment. A centre could usefully be designated to organize "TB consiliums" allowing any practitioner to submit difficult cases of MDR-TB.

[Survey of patients admitted to the Regional Hospital Center (RHC) of Maradi following self-medication]. / Enquete chez les patients admis au Centre Hospitalier Regional (CHR) de Maradi a la suite d'une automedication.

OBJECTIVE: The objective of this study was to evaluate the impact and complications related to self-medication among patients admitted to the Maradi RHC. METHODOLOGY: We conducted a cross-sectional, descriptive and analytical study at the Maradi RHC, in the referral department from June 30 to September 30, 2021, by means of an interview. RESULTS: A total of 254 patients were interviewed. The frequency of self-medication at the Maradi CHR was 3.63%. The majority of the patients surveyed were women (53.94%). The average age was 42 years. Among them, 63.39% were attending Koranic school and 38.19% were housewives. Street vendors and traditional practitioners were the main suppliers of self-medication drugs, respectively 45.28% and 30.31%. The most commonly used products were traditional medicines, analgesics, antibiotics and anti-malarial (47.63%, 26.37%, 22.44% and 16.92% respectively). The lack of financial means and accessibility of treatment were the main reasons for this practice. Digestive diseases were the most frequent pathology group. Jaundice was the first complication related to self-medication, followed by urticaria and Lyell's syndrome. Following management, 8% (n=20) patients were discharged cured and 6% (n=15) had died. CONCLUSION: Self-medication is a rapidly growing practice, favored by many factors despite the many risks that can arise from it. In order to prevent these risks, an awareness program is necessary to make the population adhere to a change of behavior.

OBJECTIF: Cette étude avait pour objectif d'évaluer l'impact et les complications liées à l'automédication chez les patients admis au CHR de Maradi. MÉTHODOLOGIE: Nous avons mené une étude transversale, descriptive et analytique au CHR de Maradi, dans le service d'aiguillage du 30 Juin au 30 septembre 2021, par le biais d'une interview. RÉSULTATS: Au total 254 patients ont été interviewés. La fréquence de l'automédication au CHR de Maradi était de 3,63%. La majorité des patients enquêtés étaient des femmes 53,94%. La moyenne d'âge était de 42 ans. Parmi eux, 63,39% fréquentaient l'école coranique et 38,19% étaient des ménagères. Les vendeurs de la rue et les tradipraticiensétaient les principaux acteurs qui fournissaient les médicaments d'automédication soit respectivement 45,28% et 30,31%. Les produitsles plus utilisées étaient les médicaments traditionnels, les antalgiques, les antibiotiques et les antipaludiques soit respectivement 47,63%, 26,37%, 22,44% et 16,92%. Le manque de moyen financier et l'accessibilité du traitement étaient les principales causes motivant cette pratique. Les affections digestives représentent le groupe de pathologie les plus fréquentes. L'ictère était la première complication liée à l'automédication suivi de l'urticaire et le syndrome de Lyell. A la suite de la prise en charge,8%(n=20) patients de étaient sortis sont sortis guéris et 6% (n=15) étaient décédés. CONCLUSION: L'automédication est une pratique en forte croissance, favorisée par bien de facteurs malgré les nombreux risques qui peuvent découler de celle-ci. En vue de prévenir ces risques un programme de sensibilisation s'avère nécessaire afin de faire adhérer la population à un changement de comportement.

Subhepatic appendix: an ectopic topography not to be disregarded: a case report.

INTRODUCTION: Subhepatic appendix is most often due to an anomaly of rotation of the primary intestine occurring during embryogenesis. This ectopic topography associated with advanced age can be a serious diagnosis problem at the stage of appendicitis or appendicular peritonitis. CASE PRESENTATION: We report the case of a 60-year-old melanoderm man, with a history of urinary pathology and peptic ulcer, referred from a health district for abdominal pain of the right hypochondrium evolving for about 5 days, secondarily generalized, in whom we suspected peritonitis, the etiology of which remains to be determined. During the surgical intervention, after preoperative resuscitations measures, a phlegmonous perforated appendix was found under the liver. No postoperative complication was noted, and he was discharged home 8 days after his operation. CONCLUSION: Subhepatic appendicular peritonitis occurring in an elderly patient poses enormous diagnostic problems. When faced with right upper quadrant pain, considering acute ectopic appendicitis would significantly reduce complications.

[Frequency of tuberculosis and the impact of immunosuppression in people living with HIV (PLHIV) followed at the Regional Hospital Center of Maradi, Niger]. / Frequence de la tuberculose et l'impact de l'immunodepression chez les personnes vivant avec le VIH (PVVIH) suivies au Centre Hospitalier Regional de Maradi, Niger.

OBJECTIVE: Objective of this study was to determine the frequency of tuberculosis (TB) and the impact of immunosuppression in patients living with HIV (PvVIH) monitored at the Regional Hospital Center (CHR) of Maradi. METHODS: That was a retrospective study based on the medical records of PvVIH followed in the infectious diseases department of the CHR of Maradi. All HIV-positive adults were included in regular consultations between January 2013 and September 2018. RESULTS: A total of 872 patients were included. The average age of the cohort was 36.10 years ± 11,53. Of these patients, 15 had tuberculosis infection with a frequency of 1.72% (95% CI: 1.05 - 2.82) and 429 a CD4 T cell count of less than 200 / mm3. Of the 15 co-infected HIV / TB patients, 60% had a CD4 T cell count of less than 200 / mm3 (p = 0.78). HIV1 was tested in 98.73% of cases, HIV2 in 0.69% and both types of virus in 0.58% of cases. All patients who had a TB infection were HIV1 +. CONCLUSION: Knowledge about the prevalence and impact of TB in people living with HIV is needed to establish a mechanism for controlling this disease. It is more than necessary to prevent TB among PLWHIV when CD4 counts begin to decline.

OBJECTIF: L'objectif de cette étude était de déterminer la fréquence de la tuberculose (TB) et l'impact de l'immunodépression chez les personnes vivants avec le VIH (PvVIH) suivies au Centre Hospitalier Régional (CHR) de Maradi. MÉTHODES: Nous avons mené une étude rétrospective à partir des dossiers médicaux de PvVIH suivies dans le service des maladies infectieuses du CHR de Maradi. Ont été inclus tous les adultes séropositifs au VIH vus en consultation régulière entre Janvier 2013 et Septembre 2018. RÉSULTATS: Au total, 872 patients avaient été inclus dans notre étude. L'âge moyen de la cohorte était de 36,10 ans ± 11,53. Parmi ces patients, 15 avaient présenté une infection tuberculeuse soit une fréquence de 1,72% (IC 95% : 1,05 - 2,82) et 429 avaient un taux de Lymphocytes TCD4 inférieur à 200/mm3. Sur les 15 patients co-infectés VIH/TB, 60% avaient un taux de Lymphocytes T CD4 inférieur à 200/mm3 (P=0,78). Le VIH1 était impliqué dans 98,73% des cas, le VIH2 dans 0,69% et les deux types de virus à la fois dans 0,58% des cas. Tous les patients qui avaient présenté une infection tuberculeuse étaient VIH1+. CONCLUSION: Les connaissances sur les fréquences et l'impact sur l'immunodépression de la tuberculose chez les PvVIH sont nécessaires pour la mise en place d'un mécanisme de lutte efficace contre cette maladie. Il est plus que nécessaire de prévenir la tuberculose chez les PvVIH lorsque le taux de CD4 commence à régresser.

[Prevalence Of Hbs Antigen In Hiv-Infected Patients At The Regional Hospital Center In Maradi, Niger]. / Prevalence De L'Antigene Hbs Chez Les Patients Infectes Par Le Vih Au Centre Hospitalier Regional De Maradi, Niger.

OBJECTIVE: The present study aimed to determine the seroprevalence of HBs Ag in HIV-infected patients followed at the Maradi CHR. METHODS: This is a retrospective study based on the records of the infectious diseases department of the CHR of Maradi. Included were all HIV-positive adults seen in consultation who received HBs Ag research between 2006 and 2018. The data was collected from patients' medical records. RESULTS: In total, 2770 patients included in our study. The average age of the cohort was 38 years old. Of these patients, 159 had HBs Ag or a prevalence of 5.74% (95% CI: 4.93 - 6.67). HIV-HBV coinfections were higher in men (52.20%). HIV1 subtype was involved in 96.86% of cases. Two patients co-infected with HIV-HBV had HIV1 and HIV2 dual profile. Which represents 1.26% (95% CI: 0.15 - 4.47). CONCLUSION: This study confirms the high prevalence rate of HBV coinfection in HIV-infected patients. It is therefore necessary to screen all HIV-infected patients for better management.

OBJECTIF: La présente étude visait à déterminer la séroprévalence de l'Ag HBs chez les patients infectés par le VIH suivi au CHR de Maradi. MÉTHODES: Il s'agit d'une étude rétrospective réalisée à partir des registres du service des maladies infectieuses du CHR de Maradi. Ont été inclus tous les adultes séropositifs au VIH vus en consultation et ayant bénéficié d'une recherche de l'Ag HBs entre 2006 et 2018. Les données ont été collectées à partir des dossiers médicaux des patients. RÉSULTATS: Au total, 2770 patients inclus dans notre étude. L'âge moyen était de 38 ans. Parmi ces patients, 159 étaient porteuses de l'Ag HBs soit une prévalence de 5,74% (IC 95% : 4,93 - 6,67). Le taux des coinfectés VIH-VHB étaient plus élevé chez les hommes (52,20%). Le sous type VIH1 était impliqué dans 96,86% des cas. Deux patients co-infectés VIH-VHB avait présenté le double profile VIH1 et VIH2 soit 1,26% (IC 95% : 0,15 - 4,47). CONCLUSION: Cette étude confirme le taux de prévalence élevé de la coinfection par le VHB chez les patients infectés par le VIH. Il est donc nécessaire de dépister tous les patients infectés par le VIH en vue d'une meilleure prise en charge.