[Cost of hospitalization by the Activity Based Costing method in the neonatal department of Principal Hospital of Dakar]. / Coût de l'hospitalisation par la méthode de comptabilité par activité dans le service de néonatalogie de l'hôpital Principal de Dakar.

OBJECTIVES: To determine the cost of hospitalization per day in the neonatal department of Principal Hospital of Dakar. METHODOLOGY: This prospective study took place during the month of July 2011 in the newborn unit. The activity-based costing method was used to analyze costs. RESULTS: During the study period, 52 newborns were hospitalized for a total of 590 days. The cost of the human resources during that month was 9,907,832 FCFA (US $ 19,815.66), the cost of depreciation of fixed assets was estimated at 571,952 FCFA (US $ 1143.90), and supplies at 112,084 FCFA (US $ 224.17). External services cost 386,753 FCFA (US $ 773.51) and support services 6,917,380.65 FCFA (US $ 13,834.7613). The monthly expenses incurred for the hospitalization of newborns totaled 17,896,002 FCFA (US $ 35,792), for a cost per patient per day of 30,332.20 FCFA (US $ 60.66) and an average cost of hospitalization 334,153.88 FCFA (US $ 668,31). CONCLUSION: This study is the first of its kind in Senegal and neighboring countries. By applying the ABC approach, we can obtain a more detailed and precise estimate of the cost of activities and services. Process improvements and corrective actions should make it possible to identify cost drivers, such as time.

[Mortality in hemodialysis unit in Togo]. / Mortalite dans l'unite d'hemodialyse au Togo.

PURPOSE: To determine the epidemiological and etiologic aspects associated with the death of haemodialysis patients. METHODOLOGY: A cross-sectional retrospective study was conducted in the department of hemodialysis of the Sylvanus Olympio Teaching Hospital from July 2010 to December 2011 (18 months). The files of all the haemodialysis patients for chronic renal insufficiency of both sexes and all ages who died were included in our study. RESULTS: 153 patients were dialysed during our period of study, 48 died (mortality rate: 31,4%). On these 48 deaths, 36 files were retained. The average age of the patients was 48.3 years with extremes of 16 and 73 years. The age bracket from 35 to 65 years was the most affected with 77% of deaths. The patients of less than 35 years and those of more than 65 years represented respectively 16% and 5% of deaths. The sex-ratio was 3.5 (M:W). Regarding chronic pathologies, 36% had hypertension, 25% were diabetics and 31% were HIV-positive. Regarding anaemia, only 16.6% benefited from an occasional and irregular treatment by erythropoietin and the remaining 83.4% by blood transfusion. For the hemodialysis, 75% of patients had benefited from a central venous catheter (CVC) and 25% of an artério-venous fistula (FAV). On 27 patients having used a central venous catheter as vascular access, 20 died in the first year of dialysis (74%). Thirteen (13) of our patients had interrupted their sessions of hemodialysis. The causes of death were dominated by infections (16 cases) followed by cardiovascular diseases (11 cases) and acute anaemia (5 cases). Sixty one percent of the patients died less than one year after the beginning of the hemodialysis sessions; 11.1% after 2 years. The rate of survival of our patients was 50% after 6 months of dialysis, 33.3% after 1 year and only 8.3% after 2 years. CONCLUSION: The mortality rate of haemodialysis is high in Togo with a very low survival a year following treatment. Infections played an important part in the death of haemodialysis patients partially due to the administration method, but more importantly cardiovascular and anemia.

BUT: Etudier les aspects épidémiologiques et les facteurs associés au décès chez les patients hémodialysés. MÉTHODOLOGIE: Il s'est agi d'une étude transversale rétrospective à visée descriptive ayant pour cadre l'unité d'hémodialyse du CHU Sylvanus Olympio. Les données ont été collectées sur une période de 18 mois de juillet 2010 à décembre 2011. Ont été inclus dans notre étude, les dossiers de tous les patients hémodialysés pour insuffisance rénale chronique décédés, sans discrimination de sexe et de tout âge. RÉSULTATS: Au total 153 patients ont été dialysés pendant notre période d'étude parmi lesquels 48 sont décédés soit un taux de mortalité de 31,4%. Sur ces 48 décès, 36 dossiers étaient éligibles. L'âge moyen des patients était de 48,3 ans avec des extrêmes de 16 et 73 ans. La tranche d'âge de 35 à 65 ans était la plus représentée avec un taux 77%. Les patients de moins de 35 ans et ceux de plus de 65 ans représentaient respectivement 16% et 5%. On notait une sex-ratio H/F de 3.5 :1. Au plan des pathologies chroniques, 36% étaient hypertendus, 25% diabétiques. Chez 31% de nos patients, la sérologie rétrovirale était positive au VIH. Pour ce qui concerne l'anémie, seul 16,6% ont bénéficié d'un traitement intermittent et irrégulier par érythropoïétine et 83,4% ont été transfusés. Pour l'hémodialyse, 75% des patients avaient bénéficié d'un cathéter veineux central (CVC) comme voie d'abord et 25% d'une fistule artério-veineuse (FAV). Sur les 27 patients chez qui un cathéter veineux central a été utilisé comme voie d' abord vasculaire, 20 soit 74% sont décédés dans la première année de dialyse. Treize(13) de nos patients avaient interrompu leurs séances d'hémodialyse. Les facteurs associés au décès étaient dominées par les infections (16 cas) suivies des maladies cardiovasculaires (11 cas) et l'anémie grave* (5 cas).Soixante un pourcent des patients sont décédés à moins d'un an après le début des séances d'hémodialyse et 11,1% après 2 ans. Le taux de survie de nos patients était de 50% à 6 mois de dialyse, 33, 3% à 1 an et seulement 8,3% à 2 ans. CONCLUSION: Le taux de mortalité des hémodialysés est élevé au Togo avec une survie à un an très faible. Les infections occupent une place importante dans les décès des hémodialysés dont la voie d'abord utilisée serait en partie responsable, mais les autres facteurs associés au décès étaient dominés par les atteintes cardiovasculaires et l'anémie.

[Peritoneal tuberculosis and HIV infection in adults: 32 cases in Lome (Togo)]. / Tuberculose péritonéale et infection par le VIH de l'adulte: 32 observations à Lomé (Togo).

The purpose of this prospective study is to describe a series of adult HIV-infected patients treated for peritoneal tuberculosis over a 36-month period in Lome, Togo. A total of 32 cases were included. Mean patient age was 38 years (range, 20 to 69). The M/F sex ratio was 0.52. Ascites with fever was observed in all cases. Ascitic fluid was exsudative in 10.6% of cases and lymphocytic in 93.7%. Peritoneal tuberculosis was isolated in 27 patients, associated with pleural involvement in 15.6 % of cases, hematological in 75% and hepatic in 21.9%. Patients responded poorly to therapy and prognosis was unfavorable with a mortality rate of 12.5%. HIV infection substantially alters the epidemiological, clinical and therapeutic profile of peritoneal tuberculosis.

[Hematemesis in Togo: findings of a 12-month study in an intensive care unit]. / Hématémèses au Togo: expérience d'un an en réanimation.

This prospective study was conducted over a 12-month period on patients who underwent upper digestive endoscopy for hematemesis in the medical intensive care unit (ICU) of the Tokoin University Hospital Center in Lomé, Togo. A total of 44 patients with a mean age of 44 years were included. The sex-ratio was 2.61. Risk factors included use of non-steroid anti-inflammatory (NSAI) in 16 patients (36.4%) and alcohol abuse in 13 (29.6%). At the time of admission to the ICU, 21 patients (47.7%) were in hemodynamic shock and 11 (25%) presented signs of portal hypertension. The underlying etiology was peptic ulcer in 18 cases (40.9%) including 13 cases of duodenal ulcer and 5 cases of stomach ulcer, rupture of esophageal varicosities in 8 (18.2%), gastric tumor in 6 (13.6%), Mallory Weiss syndrome in 5 (11.4%), gastritis in 4 (9,1%), and esophagitis in 3 (6.8%) due to peptic inflammation in 2 and mycotic infection in 1. The mortality rate was 45.5%. The main causes of hematemesis were peptic ulcer and rupture of esophageal varicosities. The death rate was high due to inadequate care facilities.

[Upper digestive tract endoscopy in rural Africa: Togo]. / Endoscopie digestive haute en milieu rural africain au Togo.

The purpose of this report was to describe the profile of esogastroduodenal disease diagnosed by upper digestive tract endoscopy (UDTE) in a rural area of Togo. This prospective study combines data collected during two two-week screening campaigns carried out in the Kara region. Patients were informed of the presence of the endoscopy team by means of a bulletin on a rural radio station. All male and female patients 15 years or older were included. A total of 220 UDTE procedure reports were recorded and analyzed including 107 men and 113 women with a mean age of 37.7 years (range: 15-84 years). Disease was detected in 72 procedures mainly in the 21 to 41 year age group (47.2 %) with a higher proportion of men than women: 38% versus 27% respectively. The most frequent indications for UDTE were epigastralgia (47.7 %) including 39% of procedures leading to the discovery of disease and diffuse abdominal pain (21.8 %). The procedure was carried out for follow-up purposes in 19.1% of cases. The most common lesions were peptic ulcer (34.2%), inflammatory disease including esophagitis, gastritis, and bulboduodenitis (32.4%), gastroduodenal bile reflux (9.3%), pylorobulbar stenosis (5.5%), tumoral disease (3.7%), and esophageal varicosities (3.7%). This study based on UDTE diagnostic procedures provided insight into the profile of esogastroduodenal disease in rural Africa. These screening campaigns required special organization using appropriate equipment and personnel.

[Is endoscopic diagnosis of Candida albicans esophagitis reliable? Correlations with pathology and mycology]. / Le diagnostic endoscopique d'oesophagite à Candida albicans est-il fiable?

AIM OF STUDY: To assess the reliability of endoscopic diagnosis of Candida albicans esophagitis. PATIENTS AND METHODS: A case - control prospective study was carried out from November 1997 to July 1998 at the Campus Teaching Hospital of Lome, in patients with esophagitis macroscopically suggestive of Candida albicans origin at upper digestive endoscopy. Fifteen subjects with normal endoscopy served as controls. Esophageal biopsies for mycologic and pathological examination were performed, as well as HIV serology. RESULTS: During the study period, 26 of the 850 endoscopies performed in our Unit revealed an esophagitis suggestive of Candida albicans origin. Mycology confirmed the presence of filamentous form of Candida albicans in 23 patients and pathology showed non-specific lesions of esophagitis, 20 with intramucous hyphae. HIV serology was positive in 19/23 patients (82.6%) and in 1/15 controls (6.6%). Sensitivity and specificity of upper GI endoscopy for the diagnosis of Candida albicans were 100 and 83.3% respectively; positive and negative predictive values were 88.5 and 100%, respectively. CONCLUSION: Upper digestive endoscopy is a reliable method for the diagnosis of Candida albicans esophagitis. However, mycological confirmation is warranted.

[Gout in Togolese patients]. / La goutte chez des malades togolais.

A study was carried out to determine the frequency and semiological characteristics of gout in patients attending a hospital clinic in Lomé, Togo. Gout was diagnosed in 71 of the 1,821 patients seen from october 1989 through october 1991. Clinical findings and increased serum uric acid levels were the basis for the diagnosis of gout in 63 patients; in addition, in the eight other patients monosodium urate crystals were demonstrated in joint fluid. All gout patients were male and mean age at onset was 45 years. Mean duration of the disease was 8.5 years, Forty-seven patients had normal hemoglobin, whereas a hemoglobinopathy was present in the 24 other subjects (hemoglobin AS: 15 cases; hemoglobin AC: 7 cases; hemoglobin CC: 2 cases). Twenty-seven patients (38%) were obese and 24 (34%) had hypertension. Forty-six patients (65%) were habitual drinkers. Twenty patients (28%) had tophi. None of the patients had a history of renal colic. The other clinical features of the disease were similar to those seen in Western countries. Results of this study are in striking contradiction with the common belief that gout is exceedingly rare in black Africa.

[Rheumatic diseases in hospital outpatients in Lome (Togo)]. / Maladies rhumatismales observées en consultation hospitalière à Lomé (Togo).

The aim of this study was to point out the different kinds of diseases in patients attending the rheumatology unit of Lomé Hospital from October 1989 to October 1990. Eight hundred and forty three patients (456 females, 387 males) were examined. The main results of this study are as follows: degenerative spinal involvement: 39.6%; tendinitis: 13.8%; knee osteoarthritis: 12.7%; hip osteoarthritis: 0.7%; hip involvement associated with hemoglobinopathies: 1.3%; gout: 5%; spondylarthropathies/0.8%; asymmetrical oligoarthritis: 0.6%; rheumatoid arthritis/0.2%; chronic polyarthritis without joint destruction: 1.2%; osteoporosis: 0.1%; connective tissue diseases: 0.7%. The scarcity of hip osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus and osteoporosis is in accordance with previous studies. The same is true of the high frequency of degenerative spinal involvement and knee osteoarthritis. However, the high frequency of gout and the non exceptional character of spondylarthropathies are in contrast with previous studies effected in Black Africa.

[Spondylo-arthritis in Togolese patients]. / Spondylarthropathies chez des malades togolais.

A survey was conducted to determine the frequency and semiological characteristics of spondylarthropathies encountered in hospital consultation in Lomé, Togo. Spondylarthropathy was diagnosed in 13 out of 1498 consulting patients. All the patients were male, ranging in age from 18 to 44 years at the onset of the disease. Six patients suffering from ankylosing spondylitis had bilateral sacroiliitis: 5 were human immunodeficiency virus (HIV)-positive and had no signs of sacroiliitis on pelvic X-rays; the remaining 2 patients had no sacroiliitis and were HIV-negative. HLA typing was not carried out in any patient. The symptoms of ankylosing spondylitis in our patients were comparable to those of European patients. The symptoms of HIV-positive patients were reminiscent of those describing reactive arthritis in such patients. The results of this study contradict the reputed scarcity of ankylosing spondylitis and other spondylarthropathies in black Africa. HIV infection may increase the incidence of reactive arthritis and, as a consequence, that of spondylarthropathies in this region.

PIP: A survey was conducted to determine the frequency and semiological characteristics of spondylarthropathies seen during hospital consultation in Lome, Togo. Spondylarthropathy was diagnosed in 13 of 1498 consulting patients. All were male and ranged in age from 18 to 44 at the onset of the disease. 6 patients suffering from ankylosing spondylitis had bilateral sacroiliitis--5 were HIV positive and had no signs of sacroiliitis on pelvic x-rays and the remaining 2 were HIV negative and had no sacroiliitis. HLA typing was not carried out in any patient. The symptoms of ankylosing spondylitis in these patients were comparable to those of European patients. The symptoms of HIV-positive patients were reminiscent of those describing reactive arthritis in such patients. The results of this study contradict the reputed scarcity of ankylosing spondylitis and other spondylarthropathies in black Africa. HIV infection may increase the incidence of reactive arthritis and, as a consequence, that of spondylarthropathies in this region. (author's)