Effectiveness of the Treatment of Chronic Hepatitis C Virus Infection Genotype 2 by the Combination Sofosbuvir/Ledipasvir in a Black African Kidney Transplant.

The advent of direct-acting anti-virals revolutionized the treatment and prognosis of patients infected with hepatitis C. The interest of this presentation is to draw attention to the issue of therapeutic management posed by the hepatitis C virus in a kidney graft in Côte d'Ivoire, a resource-limited country where all the direct-acting anti-virals are not yet available. We report the case of a kidney transplant of 52 years old, chronic carrier of viral hepatitis C who presented after his kidney transplant in decompensated active cirrhosis. A treatment based on Sofosbuvir 400 mg/Ledipasvir 90 mg in this patient with genotype 2 for 12 weeks was initiated. Sustained virologic response 12 weeks and 24 weeks off therapy was observed. This is the first documented case of successful treatment of a genotype 2 viral C infection based on Sofosbuvir/Ledipasvir in a black African cirrhotic kidney transplant patient undergoing immunosuppressive therapy.

Effect of age, pubertal stage and season on testosterone concentration in male dromedary camel.

The present study was conducted in the Laboratory of Animal Physiology and Biotechnology, Department of Animal Production, Faculty of Agriculture, Mansoura University, Egypt. The present investigation aimed at studying effects of ages, pubertal stages and seasons of the year on testosterone concentrations in blood plasma and tissue homogenate of the testes. The testes used in the current study were collected from a total of 104 one-humped male camels (Camelus dromedarius). Samples were taken from pre (1-3.5 years) and post (3.5-13 years) pubertal camels. Testes were studied for a two consecutive seasons. The freshly prepared homogenate of the testicular tissue and blood plasma were used for determining the concentrations of testosterone in plasma and testicular extract. The concentrations of testosterone in blood plasma and testicular tissue were significantly increased during the breeding season compared with that of non-breeding season; the concentration of testosterone was higher in testicular tissue than in blood plasma. Testosterone concentrations in plasma and testicular tissue were increased in breeding than in non-breeding season. In addition, the testosterone concentrations were closely related with seasonal changes, stage of puberty and advancing age.

[Is the mother a risk factor for transmission of Helicobacter pylori infection in children between the ages of 6 months and 5 years in Côte d'Ivoire?]. / La mère est-elle un facteur de risque de transmission de l'infection a Helicobacter pylori a l'enfant de 6 mois a 5 ans en Côte d'Ivoire?

OBJECTIVES: The goals of this study were to determine the prevalence of H. pylori antibodies in children, to establish the relationship between child and mother serostatus, and to identify potential risk factors for contamination. MATERIAL AND METHODS: A cross-sectional study was conducted over a 3-month period. All children between 6 months and 5 years of age examined in the Pediatrics Department of the University Hospital Center in Yopougon, Côte d'Ivoire were included after obtaining informed consent from their mothers. Testing for H. pylori antibodies using Pylorix (Acon) was performed in both children and mothers. Based on test results, children were divided into two groups, i.e. case group with H. pylori antibodies and control group without H. pylori antibodies. Case and control groups were compared according to the H. pylori status of their mother and several potential lifestyle and environmental factors. RESULTS: A total of 101 children and 101 mothers were included. The prevalence of H. pylori antibodies was 40.6% in mothers and 24.8% in children. The mean age of children (53% male) was 22.8 +/- 15.6 months (median, 18 months). The mean age of the mothers was 29.6 +/- 5.5 years (range, 19 to 46 years; median, 29 years). Most mothers, i.e., 78.2%, lived in two-parent households but 19% lived in single-parent settings (community or shacks). The number of persons living in the same house ranged from 2 to 20 people (mean, 7.2 +/- 3.8; median, 6 people). Mean monthly household income was 226,188 +/- 161,425 FCFA (range: 30,000 - 750,000 FCFA). In the case group, 80% of children had mothers infected with H. pylori. In the control group, 73.7% of children had non-infected mothers (OR = 11.2, p < 0.001). Median income was less than 150 000 FCA in 76% of families with seropositive children in comparison to 46.1% of families with seronegative children (p = 0.009). CONCLUSION: This study confirms the early occurrence of H. pylori infection in children. Findings also showed that poor socio-economic condition was a risk factor for infection but the greatest risk factor was living with a mother infected with H. pylori.

Impact of renal failure on survival of African patients with cirrhosis.

To assess the effect of renal failure on the survival of black African patients with cirrhosis, we studied 132 (82 males, 50 females) cirrhotic black African patients with mean age of 47.5+/-14.4 years and mean follow-up period of 373+/-194 days. The edema and ascitis were the main reasons for admission to hospital. Renal failure was present in 30 (22.7%) patients, and it was positively correlated to the severity of the stage of the liver disease, and associated with severe hyponatremia. Survival at 1 year was 60.1% and 37.6% in the absence or presence of renal failure, respectively (p<0.001)). The stage of the liver disease was significantly inversely correlated with survival, which was further diminished in the presence of renal failure:23.7% versus 12.5% for Child-Pugh-Turcote (CPT) A-B in the absence or presence of renal failure, respectively (p=0.67), 30.2% versus 81.8% for CPT C in the absence or the presence of renal failure respectively (p<0.001). Hyponatremia has also appeared detrimental to survival, since mortality was 38.4% versus 81.8% in the absence or the presence of hyponatremia respectively (p<0.001). By multivariate analysis, renal failure, CPT stage C, and hyponatremia independently significantly correlated to mortality in patients with cirrhosis. We conclude that renal failure is frequently associated with decompensated cirrhosis. The presence of renal failure in this setting often results in high mortality. Renal failure that occurs in the setting of a severe liver disease and hyponatremia may be part of hepatorenal syndrome.

Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients.

AIM: To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis. METHODS: Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo. RESULTS: The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 +/- 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score. CONCLUSION: The CPT score displays the same prognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.

[Colonic transit time in healthy Ivorian subjects]. / Détermination du temps de transit colique de sujets ivoiriens sains.

Colonic transit time (CTT) values obtained from healthy Western populations cannot be applied to the population of the Cote d'Ivoire, whose diet is very different. We report the first study of CTT among healthy Ivorian volunteers. This study included 20 healthy Ivorian volunteers (16 men, 4 women, mean age: 25). None was constipated, and all had at least three stools a week. They took no medication and presented no diseases that might affect their digestion. Vegetable fiber was not added to their diet. CTT was assessed according to the method described by Chaussade and al. in 1986: Subjects ingested three types of radiopaque markers in soluble medication capsules at fixed hours for three successive days; plain abdominal radiography was performed on days four, seven, and, if markers remained in the colon on day seven, again on day ten. The plain abdominal radiographs were divided into three parts, representing the right, left and rectosigmoid colons, and radiopaque markers were counted in each segment. CTT was calculated according to Arhan's formula. Mean values (m+/-SD) for CTT were 8.94+/-5.76 hours in the right colon, 12.6+/-8.29 hours in the left, 14.4+/-5.45 hours in the rectosigmoid and 34.94+/-15.09 hours for the entire colon. The corresponding upper limits (M + 2DS) for each segment were 20, 29, 25, and 65 hours. These results suggest the specificity of CTT in healthy Ivorian subjects. CTT norms obtained from healthy Caucasian subjects must not be used to assess CTT in Ivorian patients with constipation.

[Clinical, endoscopic and histologic aspects of chronic Helicobacter pylori gastritis in Côte d'Ivoire: study of 102 patients]. / Aspects cliniques, endoscopiques et histologiques des gastrites chroniques à Helicobacter pylori en Côte d'Ivoire: étude de 102 patients.

BACKGROUND: Helicobacter pylori (H. pylori) is the most frequent aetiological factor of chronic gastritis (CG). The relationship between H. pylori gastritis, gastro-duodenal ulcer and some gastric cancers (adenocarcinoma, gastric MALT lymphoma) has now been proven. AIM: Describe clinical, endoscopical and histological aspects of H. pylori gastritis in Côte d'Ivoire. METHODS: Retrospective analysis of 1960 gastroscopy reports carry out between January 1994 and December 1995. Analysis of clinical and gastric histological results in 137 patients. FINDINGS: Among 137 patients with gastric biopsy, 102 had H. pylori gastritis (68 men, 38 women, mean age: 39.3 years) and 35 had chemical gastritis. Epigastric pain was the most frequent symptom. The mucosa was frequently erythematous or exsudative at endoscopy. Histological anomalies were located in the antrum, the fundus or generalised, respectively in 33.3%, 25.5% and 41.2% of cases. Mild atrophic CG was more frequent in various locations. Gastritis activity was present in 81.4%, intestinal metaplasia in 18.6% and follicular lymphoid hyperplasia in 36.3% of cases. CONCLUSION: Clinical and endoscopical aspects of H. pylori gastritis did not present any particularities. Fundic gastritis without antral localisation was not unusual. This situation could be the result of antibiotic and gastric acid secretion inhibitor treatments.

[Spontaneous ascitic infection in cirrhotic Africans. Descriptive study apropos of 12 cases]. / L'infection spontanée du liquide d'ascite chez le cirrhotique africain. Etude descriptive à propos de 12 cas.

BACKGROUND: Spontaneous ascitic infection (SAI) is a frequent and serious complication of cirrhosis. OBJECTIVE: In a retrospective study, the authors report clinical and biological data associated with SAI for cirrhotic patients in an African medical centre. METHODS: Twenty-two cirrhotic patients with ascites were included in a one-year study (November 1996 to October 1997). Clinical and biological data were obtained through medical files. FINDINGS: The mean age of the 22 cirrhotic patients with ascites (12 men, 10 women) was 48.9 years. Twelve cases of SAI were found. In a univariate analysis, the more frequent data in patients with SAI when compared to patients without SAI were: fever or hypothermia (91.7% versus 10%, p = 0.002), abdominal pain (83.3% versus 40%, p = 0.046), cloudy ascitic fluid (66.7% versus 10%, p = 0.003), medium albuminemia (18.2 g/l versus 23 g/l, p = 0.02), medium prothrombin rate (42.8% versus 58.3%; p = 0.04) and ascitic fluid protein level < or = 10 g/l (91.7% versus 30%, p = 0.01). The protein level in ascitic fluid cirrhotic patients was significantly lower in SAI than in patients without SAI (7.6 g/l versus 11 g/l; p = 0.005). In a multivariate analysis, protein levels in ascitic fluid were the only factor associated with SAI (p = 0.024).

Anti-sperm antibodies and seminal characteristics after testicular biopsy or epididymal aspiration in dogs.

A study was performed to determine if performing testicular biopsies or epididymal aspirates in dogs would induce sperm-bound anti-sperm antibodies (ASA), affect long-term sperm production or semen quality. Semen was collected from 8 mature dogs 3 times a week before and after hemicastration and then 3 times a week after testicular biopsy (n=3 and 1 control) or epididymal aspiration (n=3 and 1 control). Detection of anti-sperm IgG (ASA) on sperm cells was performed by flow cytometry analysis using a flow cytometer. Two dogs with testicular biopsies became positive for ASA 16 d after testicular biopsy and remained positive for 7 and 9 d, respectively. One dog that had an epididymal aspirate became positive 13 d after epididymal aspiration and remained positive for 35 d. One dog became positive 21 d after hemicastration and remained positive for 28 d. Sperm output declined significantly in 7 of 8 dogs after hemicastration. A control epididymal aspirate treatment dog had decreased sperm output, and a testicular biopsy treatment dog had increased sperm output. None of the dogs with ASA had significant changes in sperm output after treatment. Sperm motility declined significantly in 3 dogs after hemicastration. An epididymal aspiration treatment dog had a decrease in sperm motility, a control epididymal aspirate treatment dog and a control testicular biopsy treatment dog each had increases in sperm motility. None of the dogs with ASA had significant changes in motility. The percentage of normal spermatozoa significantly decreased in 3 dogs and significantly increased in 1 dog after hemicastration. Two dogs that had testicular biopsies and 1 dog that had an epididymal aspiration had decreases in percent normal sperm. Two of 3 dogs with decreases in percent normal sperm after treatment had ASA, but 2 dogs with ASA had no change in motility. Hemicastration, epididymal aspiration, and testicular biopsy can induce ASA production within 2 wk of the procedure, but ASA are transient and do not have a predictably negative effect on total sperm output or motility. Testicular biopsy and epididymal aspiration are safe diagnostic procedures, but further work investigating post-treatment fertility must be done before final conclusions can be made.