[EXTRAPULMONARY TUBERCULOSIS AT SYLVANUS OLYMPIO UNIVERSITY HOSPITAL]. / Tuberculose extra-pulmonaire au CHU Sylvanus Olympio.

Objectif: Décrire la tuberculose extrapulmonaire au CHU Sylvanus Olympio de Lomé. Méthodes: C'était une étude rétrospective et descriptive sur une période de 2 ans, de novembre 2020 à octobre 2022, des cas de tuberculose extrapulmonaire diagnostiqués et traités au CHU SO de Lomé. Résultats: Soixante-six cas ont été recensés. L'âge moyen était 42,39 ans avec des extrêmes de 4 et 85 ans. La sex-ratio était de 0,94. Un bas niveau socioéconomique était retrouvé (65,2 %). Un contage tuberculeux existait chez 4,6 % des patients. Sur les 66 patients 31 avaient fait la vaccination au BCG. Quarante-sept patients sur 66 avaient un amaigrissement et 30 une fièvre vespérale. La tuberculose ostéo-articulaire était prédominante (53,0 %). Le diagnostic était présomptif dans 78,8 % des cas. Le diagnostic de certitude était surtout histologique (12,1 %) et concernait surtout les atteintes ganglionnaires (100 %). Une infection à VIH était retrouvée chez 21,2 % des cas. Tous les patients ont bénéficié d'un traitement antituberculeux standard (RHZE). L'évolution hospitalière était favorable dans 97,0 % des cas. Nous avons noté 3 % de décès associé surtout à une infection à VIH. Conclusion: La tuberculose extra pulmonaire affecte toutes les tranches d'âge. L'immunodépression était le principal facteur favorisant. Les atteintes ostéoarticulaires sont prédominantes. Son diagnostic était très souvent présomptif. Mots clés: Tuberculose extra-pulmonaire, CHU-Sylvanus Olympio, Lomé (Togo).

[ELDERLY UNDERNUTRITION IN HOSPITALS IN LOMÉ: EPIDEMIOLOGICAL, CLINICAL AND BIOLOGICAL ASPECTS]. / Dénutrition du sujet âgé en milieu hospitalier à Lomé: Aspects épidémiologique, clinique et biologique.

Introduction: La dénutrition protéino-énergétique est un déséquilibre entre les apports et les besoins protéino-énergétiques. L'objectif était d'étudier les aspects épidémiologiques, cliniques et biologiques de la dénutrition chez les personnes âgées. Méthodes: Etude transversale sur 200 patients d'au-moins 60 ans en consultation gériatrique en médecine interne aux CHU Sylvanus Olympio et Campus effectuée de Novembre 2017 au 31 janvier 2020. Nous avons évalué l'IMC, MNA, et l'albuminémie. Résultats: On notait une prédominance féminine avec 122 femmes (sex-ratio H/F= 0,64). L'âge moyen était de 75 ans ± 08,6 ans avec des extrêmes de 60 à 99 ans. Les personnes âgées (PA) étaient regroupées en 03 tranches d'âge : 60-74ans, 75-84ans et plus de 85 ans. Les tranches d'âge les plus représentés étaient 60 -74ans (49,0%) suivi de 75-84ans (35,5%). 98(49,0%) étaient mariés et vivaient en couple, 82(41,0%) étaient veuf(ve)s, 11(05,5%) étaient célibataire, et 09(04,5%) étaient divorcés. Cinquante (25%) avaient IMC<21kg/m². 160 (80%) avaient un score de dépistage individuel inférieur à 12selon MNA-SF. La prévalence de la dénutrition et de risque de dénutrition selon MNA complet était de 87% (36% de dénutris et 51,0% de risque de dénutrition). Quatre-vingt-deux (41%) avaient une albuminémie inférieure à 35g/l. L'état nutritionnel selon MNA variait de manière significative avec le statut matrimonial, l'IMC la consommation de lait et les régimes restrictifs alors que celui selon l'albumine variait avec le sexe, les régimes restrictifs, les pathologies neuropsychologiques, la polypathologie et la polymédication. Conclusion: La dénutrition est fréquente en gériatrie d'où la nécessité d'un dépistage et une prise en charge précoce.

[FACTORS ASSOCIATED WITH HIGH CARDIOVASCULAR RISK IN DIABETIC PATIENTS WITH DIABETIC NEPHROPATHY AT THE SYLVANUS UNIVERSITY HOSPITAL IN LOMÉ (TOGO)]. / Facteurs associés au haut risque cardiovasculaire chez des patients diabétiques présentant une néphropathie diabétique au CHU Sylvanus de Lomé (Togo).

Objectif: Le but de cette étude était de rechercher les facteurs associés au haut risque cardiovasculaire chez le patient diabétique présentant une néphropathie diabétique. Méthodes: Il s'agit d'une étude rétrospective transversale descriptive et analytique menée au Centre Hospitalier Universitaire Sylvanus Olympio sur une période de 5 ans (01 janvier 2016 au 31 Décembre 2020). Résultats: Au total 610 patients étaient inclus. Le sex-ratio (H/F) était de 1,2 et l'âge moyen de 57,9 ±13,9ans.L'hypertension artérielle (HTA) était la comorbidité la plus retrouvée (74,8%). Le très haut risque cardiovasculaire était prédominant (72,1%). En analyse multivariée, les facteurs associés au risque cardiovasculaire chez les patients présentant une néphropathie diabétique étaient l'âge supérieure à 58 ans (aOR : 1,75; IC à 95%:[1,12-2,81]), le sexe masculin (aOR : 1,23; IC à 95%: [1,1-1,69]), l'HTA (aOR : 1,55; IC à 95%: [1,21-2,17]), l'ancienneté du diabète (aOR : 2,05; IC à 95%: [1,55-6,62]), la dyslipidémie (aOR : 1,97; IC à 95%: [1,22-5,84]), les complications microangiopathiques (aOR : 1,99 ; IC à 95%: [1,25-2,47]) et l'albuminurie des 24h (aOR : 2,01 ; IC à 95%: [1,24-2,65]). Conclusion: Cette étude montre une forte prédominance du très haut risque cardiovasculaire au cours de la néphropathie diabétique avec de nombreux facteurs associés. Il demeure important de maitriser ces facteurs pour ralentir la progression de la maladie rénale.

COVID-19 vaccination coverage among travellers at Lomé international airport (Togo), in 2022.

COVID-19 pandemic management leads to new health policies including the requirement of a vaccination pass or a negative Polymerase Chain Reaction (PCR) test for cross-border flights. The objective of this study was to estimate COVID-19 vaccination coverage among travellers, as well as factors associated with a full vaccination. A cross sectional study was conducted in July 2022 at the Gnassingbé Eyadema International Airport (LFW) in Lomé. Travellers met at LFW, aged 12 years or above, and who agreed to participate in the study have been submitted a questionnaire. Logistic regression analysis was performed to identify factors associated with full vaccination defined as having received at least two doses of COVID-19 vaccine according to a validated vaccine schedule. A total of 847 travellers were included. 67% were men The median age was 40 years, Interquartile Range [31-48]. The main health document presented by travellers was the vaccination pass (69.1%). The majority (84.4%) of travellers had received at least one dose of COVID-19 vaccine and 63.9% had received at least two doses. Being 40 years of age or above (aOR=1.42; P=0.046), and travelling from a country outside Africa (aOR=2.18, P=0.003), were positively associated with full vaccination. Vaccination coverage among travellers at the LFW was relatively high. Travellers from a region outside Africa and aged 40 years or above were more likely to be full vaccinated. Better communication and strengthening of the vaccination strategies in Africa could help reduce these gaps.

[Rapid decline of kidney function in diabetic patients in Lomé (Togo)]. / Déclin rapide de la fonction rénale chez les patients diabétiques à Lomé (Togo).

OBJECTIVE: To determine the hospital frequency of diabetic patients with a rapid decline in their renal function, to look for the associated factors. METHOD: Descriptive and analytical cross-sectional study carried out over 12 months (May 1, 2019 to April 31, 2020). Were included all patients aged 18 and over, having achieved at least 3 creatinine during the previous 2 years but spaced at least 6 months apart and having an eGFR calculated from their last creatinine greater than 30 mL/min by the formula of CDK-EPI. We evaluated the eGFR by the CDK-EPI formula using the calculator developed by the Poitiers University Hospital and the Inserm unit of the Francophone Diabetes Society. RESULTS: A total of 80 patients medical files were retained. The rapid decline in renal function was found in 28 patients, either a frequency of 35%. The sex ratio M/F was 1.5. The mean age was 62.93 years (range 18-85 years). Hypertension was the most common comorbidity (92.5%). The very high cardiovascular risk was predominant in 82.5% of cases. The very high renal risk was found in 20 patients, either 25%. Univariate and multivariate analysis showed that the rapid decline in renal function was associated with very high cardiovascular risk (P=0.037) and glomerular filtration rate (P˂0.001). CONCLUSION: this study showed a high hospital frequency of the rapid decline in renal function in Togo (35%). Our results have identified the very high cardiovascular risk and glomerular filtration rate as risk factors. The originality of our study was the demonstration of the high proportion of very high cardiovascular risk (82.5%) and very high renal risk (25%) in the evaluation of renal and cardiovascular risk.

Assessment of self-medication practices in the context of the COVID-19 outbreak in Togo.

BACKGROUND: To date, there is no effective treatment for COVID-19, which is a pandemic disease, caused by a novel coronavirus called SARS-CoV-2. In Togo, where four in five people practice self-medication, the absence of a cure for COVID-19 and the constant progression of the disease requires an assessment of self-medication patterns in the context of the pandemic. This study aimed to estimate the prevalence of self-medication to prevent COVID-19 and its associated factors in Lomé, Togo. METHODS: A cross-sectional study was conducted in Lomé, the capital city of Togo, from April 23rd to May 8th, 2020, with a sample of participants from five sectors: the healthcare, air transport, police, road transport and informal sectors. The participants were invited to provide information about their self-medication practices to prevent COVID-19 in the 2 weeks preceding the survey. RESULTS: A total of 955 participants (71.6% men) with a median age of 36 (IQR 32-43) were included. Approximately 22.1% were in the air transport sector, 20.5% were in the police sector, and 38.7% were in the health sector. The overall prevalence of self-medication to prevent COVID-19 was 34.2% (95% CI: 31.2-37.3%). The most commonly used products were vitamin C (27.6%) and traditional medicine (10.2%). Only 2.0% of participants reported using chloroquine/hydroxychloroquine. Female sex (aOR=1.90; p< 0.001), work in the health sector (aOR=1.89; p= 0.001), secondary education level (aOR= 2.28; p= 0.043) and university education level (aOR= 5.11; p< 0.001) were associated with self-medication. CONCLUSION: One-third of the individuals in high-risk populations in Lomé practiced self-medication. Intensifying awareness campaigns is crucial to fight misinformation about alleged COVID-19 prevention products on social media.

[External Quality Assessment of Thick and Thin Blood Smear Slides for the Diagnosis of Malaria in the Lomé and Gulf Health Districts of Togo]. / Évaluation Externe de la Qualité de la Goutte Épaisse/Frottis Sanguin pour le Diagnostic du Paludisme dans les Districts Sanitaires de Lomé et du Golfe au Togo.

Objective: In sub-Saharan Africa where 90% of malaria cases are concentrated, the control of this disease constitutes a major challenge whose diagnosis by thick and thin smear deserves to be exact and reproducible. The purpose of this study is to assess the performance of thick/thin blood smear in order to improve its implementation process. Material and methods: This was a descriptive and analytical study that took place from May to June 2017 and involved participating laboratories (PL) coming from public, liberal and confessional sectors in Lomé. A set of 13 blood smear slides of variable parasite densities (PD) with assigned values (AV) of parasite densities and the Plasmodium species assigned was used. The criterion for establishing the parasite densities compliance interval was assigned values ± 25% and the performance rates were compared to the 80% recommended by the WHO for Africa region. Results: 41.9% (13/31) of the PLs had a compliance rate greater than 80% including four with a performance of 100% for the ability to identify the Plasmodium species. For the parasitaemia < 100/µl, 51.6% of participating laboratories had a performance rate less than 80% and for parasitaemia > 2000/µl, 100% of these laboratories had a performance rate greater than 80%. Conclusion: The evaluated laboratories had insufficient ability for the identification of Plasmodium falciparum and the correct estimation of low parasitaemia. A need to strength the technical skills, adapted to the context of low parasitaemia are essential to improve the biological diagnosis of malaria in Togo.

Evaluation of the "license, master, doctorate" reform in medical school of University of Lomé (Togo): strengths and weaknesses.

INTRODUCTION: The License, Master and Doctorate (LMD) reform that structured high studies in three cycles, has been instituted since the Bologna declaration in 1999. To be conformed to international standards, the LMD system has been instituted in University of Lomé in 2009 to foster pathways between medical and paramedical training. The purpose of this study was to evaluate the strengths and weaknesses of the LMD reform since its introduction in medical school of Lomé. METHOD: It was an opinion survey conducted during four months in University of Lomé among the medical school's teachers about strengths and weaknesses of LMD reform since its application. The strengths were defined as all facilities brought by LMD reform in organization of courses and practices, evaluations, new Information and Communication Technologies (ICTs) (internet, video projector, courses on line). The LMD weaknesses were defined as any problem that it could generate. RESULTS: Of 113 resident teachers of the medical school of Lomé, seventy-six have completed the questionnaire (67.2%). The majority of teachers (74) thought that the introduction of LMD reform will make Lomé medical school fit into international standards. The availability of the video projectors was mentioned by 90.8% of the teachers and 82.9% of them used it for teaching. Online course was not available. The main strengths of LMD were: a better evaluation system (33.3%), the organization of training in units with credit (28.6%), the usage of new ICTs (23.8%). Respondents also reported many weaknesses of LMD reform: the plethoric number of students (36.2%), the absence of an intermediate diploma and pathways between studies (29.3%). The Insufficiency of human resources and material was also mentioned. CONCLUSION: This study highlights that LMD reform needs adaptation to local realities and improvement to ensure that students will get better training in conformity with international standards.

[Risk factors associated with acne keloidalis nuchae, in black subjects: A case-control study]. / Facteurs de risque associés aux folliculites fibrosantes de la nuque chez le sujet noir : étude cas-témoins.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with acne keloidalis nuchae (AKN), seen in a dermatology clinic in Lomé (Togo). PATIENTS AND METHODS: This was a case-control study conducted from January to December 2018. Patients were recruited at outpatients dermatological clinics and controls were recruited at outpatients dermatological clinics and then in other hospital departments. RESULTS: We recruited 303 consenting subjects, comprising 101 patients with AKN and 202 controls case-matched by age (±5 years). The mean patient age was 34.9±10.7 years vs. 35.6±11.2 years for controls. The most frequently observed AKN lesions were papules (73/101; 72.2%), fibrous scars (42/101; 41.5%) and folliculitis/pustules (41/101; 40.6%). In multivariate analysis, the following factors were associated with AKN: excess weight (adjusted odds ratio=4.8; 95% CI=[2.3-11.7]) or obesity (OR=9.2; 95% CI=[2.1-34.2]), bleeding during hairdressing either occasionally (aOR=13.9; 95% CI=[5.1-40.0]) or systematically (aOR=22.1; 95% CI=[6.2-40.7]), hairdressing procedures less than once per week (aOR=10.1; 95% CI=[3.2-50.8]), and extremely close cropping of hair (aOR=4.9; 95% CI=[2.8-15.5]). CONCLUSION: AKN is common in young adults. Excess weight or obesity, bleeding during hairdressing, and frequency and style of hairdressing are all associated factors. The results of this study stress the importance of limiting injury during hairdressing, and of refraining from shaving or cropping hair without a trimmer. Since management of AKN is extremely difficult, identification of associated risk factors allows suitable preventive approaches to be adopted.

Suicidal ideation and suicide attempts in subjects aged 15-19 in Lomé (Togo).

OBJECTIVES: The purpose of this study was to study the epidemiological and clinical profile of adolescents with suicidal thoughts, with or without suicide attempts, and to identify associated factors. RESULTS: A total of 155 (16.5%) of the 941 adolescents interviewed had suicidal thoughts. The average age of the respondents was 18 ± 2.1 years. The sex ratio (m/f) was 1.4. With regard to marital status, 70.2% were single and 29.8% were in a relationship with a cohabiting partner. Family history of suicide was reported in 40%. In their personal history, eight were infected with HIV, three were chronic ethylic and two were diabetics. Forty-six (29.7%) of the 155 adolescents who had suicidal ideation had ever had a suicide attempt. Teens affected by suicide lived in a boarding school in 25.8%, with one parent in 23.9% and 50.3% with both parents. Factors associated with suicide attempts were female sex (p = 0.0107), age over 18 years (p = 0.0177), living in a couple (p = 0.0316), underlying immunodepression (HIV infection, p = 0.0059, sickle cell disease, p = 0.0043) and having a family history of suicides (p = 0.0461).

[Circumstances of diagnosis of diabetes mellitus at the Sylvanus Olympio University Hospital in Lomé]. / Les modes de révélation du diabète sucré au CHU Sylvanus Olympio de Lomé.

The purpose of this study was to describe the different circumstances in which diabetes mellitus was detected in the Department of Internal Medicine at the Sylvanus Olympio University Hospital in Lomé. We conducted a retrospective and descriptive study in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé from January 2015 to December 2017. During the study period, 307 patients with diabetes mellitus were admitted to our Department, of whom 104 did not know to have diabetes. The average age of patients was 51.27 years (ranging from 20 to 90 years), the sex ratio (M/F) was 0,5. Type 2 diabetes was diagnosed in 75% of cases, type 1 in 23% of cases and secondary in 2% of cases. The discovery of diabetes was fortuitous in 11.53% of cases (n=12). Some patients had symptoms (26.92%, n=28) while others had complications (61.53%, n=64). Complications included: ketoacidosis (n=34), hyperosmolar hyperglycemic syndrome (n=3), high blood pressure (n=8), ischemic stroke (n=4), diabetic foot (n=2), diabetic nephropathy (n=2), polyneuropathy (n=1), infections (n=18, 8 with metabolic complications). This study shows that in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé, diabetes mellitus is most commonly diagnosed when patients have complications. It is essential to educate our populations about prevention and screening tests.

[Types of bcr-abl and their correlations with the blood count in chronic myeloid leukemia (CML) in Togo]. / Les transcrits bcr-abl et leurs corrélations avec l'hémogramme au cours de la leucémie myéloïde chronique (LMC) au Togo.

This study aims to describe the different bcr-abl gene transcript variants in order to determine their frequency and to study their influence on CBC diagnostic test. We conducted a cross-sectional study of 34 patients with chronic myeloid leukemia in Togo. The search for fusion transcripts was performed in the laboratory of biological haematology at the Henri Mondor Hospital, Créteil (France). The average age of patients was 42,32±14,87 years ranging between 9 and 65 years. Most patients were male, with a sex- ratio of 1.61 (21 men and 13 women). Molecular examination showed b3-a2 transcript and b2-a2 transcript. Nineteen patients (55.88%) expressed b3-a2 transcript, 13 patients (38.24%) b2-a2 transcript (32.10%) and two patients expressed both b3-a2 and b2-a2 transcripts (5.88%). At diagnosis, mean hemoglobin level, the average number of white blood cells and the average number of platelets in patients expressing b3-a2 transcript were 99,2g/L; 207,63g/l and 451,28g/l respectively. In patients expressing b2-a2 transcript values were 104,6g/l, 114,32g/l and 486,11g/l. In patients with both transcripts, values were 67g/L, 867g/l and 780g/l respectively. CBC parameters are more significantly altered in patients with both transcripts b3-a2 and b2-a2.

Acne in Lomé, Togo: clinical aspects and quality of life of patients.

BACKGROUND: Acne is a chronic inflammatory condition affecting the pilosebaceous follicle that mainly affects adolescents and young adults. The aim of this study was to assess the quality of life (QOL) of patients with acne, and to determine the correlation between the QOL and the severity of acne, in Lomé (Togo). METHOD: From July 2017 to February 2018, we conducted a study in three dermatology departments of Lomé. The clinical evaluation of acne and assessment of the QOL were done using the ECLA (Echelle de Cotation des Lésions d'acné) and CADI (Cardiff Acne Disability Index) scores respectively. RESULTS: We enrolled 300 patients aged 12 to 52 years; 71.3% of whom were female. The face was affected by acne in 100% of cases and papulopustular acne was the most common clinical form (66.7%). Acne was mild to moderate in 162 patients (54%) and severe in 138 (46%). Impairment was observed in all patients' QOL (scores ranged from 1 to 14 points). There was a positive correlation between severity of acne and QOL impairment in the patients (r = 0.21; p = 0.0002). We also found a positive correlation between overall CADI score and factors F1 and F3 of the ECLA scale: the severity of facial acne (r = 0.15; p = 0.0073) and the presence of scars (r = 0.21; p = 0.0002). In contrast, the global ECLA score was significantly correlated with items 2, 3, and 5 of the CADI questionnaire: the patient's relationship (r = 0.13; p = 0.0241), avoidance behaviors (r = 0.21; p = 0.0002) and perception of acne (r = 0.16; p = 0.0067). CONCLUSION: Acne negatively impacts the QOL of patients. The severity of acne has an impact on the patient's relationships, avoidance behaviors and perception of the acne.

Cutaneous parasitosis in dermatology in Lomé: series of 1217 cases.

The aim of this study was to determine the epidemiological and clinical profile of cutaneous parasitosis in Lomé, Togo. Of the 71422 patients seen in 3 dermatology departments during the study period, 1217 (1.7%) had cutaneous parasitosis, 98% of them ectoparasitosis.

Scleroderma in hospital settings in Lomé: 50 cases.

The aim of this study was to document the epidemiological and clinical profile, treatment used, and outcome of patients with scleroderma in hospital settings in Lomé. This descriptive study examined the records of all patients seen as outpatients or admitted for scleroderma in hospital dermatology and rheumatology departments in Lomé during the 20-year period of 1993-2012. During the study period, 50 (0.04%) of the 121,021 patients seen in these departments had scleroderma. There were 29 cases of localized scleroderma and 21 systemic cases, predominantly women (sex-ratio=0.2). The patients' mean age was 36 years. All patients with systemic scleroderma had speckled achromia (100%), and most (90.48%) had cutaneous sclerosis. After a mean follow-up period of 43.5 days, 71.43% of the patients had been lost to follow-up. All of the patients with localized scleroderma had cutaneous sclerosis, and the rate of loss to follow-up (after a mean of 17 days) was 96.55%. The results of this study confirm the extreme rarity of scleroderma in the teaching hospitals in Lomé and a clear female predominance. It points out the difficulty of management, which both influences and is aggravated by the high rate of loss to follow-up.