Factors associated with the death of patients infected with the human immunodeficiency virus hospitalized in the gastroenterology department of the Campus Teaching Hospital of Lomé, Togo.

AIM: To determine the factors associated with the death of patients infected with human immunodeficiency virus (HIV) while hospitalized in the hepato-gastroenterology department of the Lomé University Hospital, Togo. PATIENTS AND METHOD: A retrospective cross-sectional study reviewed records covering a 10-year period from this department. It included all patients aged 15 years and older who were positive for HIV infection. RESULTS: The study included 432 HIV+ patients, including 201 men and 231 women (sex ratio: 0.87). Their median age was 41 years (interquartile range: 35 to 48.2 years). The death rate was 15.3 %, and differed significantly between men (19.4%) and women (11.7%) (P = 0.0262). The probability of death increased significantly with age assessed in quartiles (P = 0.0472). Impaired general status, jaundice, and abdominal distension were associated with a high risk of death (P = 0.0017). Conditions unrelated to HIV that were associated with a high risk of death were hepatocellular carcinoma, cirrhosis, and toxic hepatitis (P < 0.0001). Anemia and CD4 count were not associated with death. CONCLUSION: Death was associated with social and demographic (male sex and age) and clinical (altered general status, jaundice, cirrhosis, hepatocellular carcinoma and toxic hepatitis) factors.

Hepatobiliary diseases in people with HIV infection at the Lome, Togo, University Hospital: epidemiologic and diagnostic aspects.

PURPOSE: To determine the epidemiological and diagnostic aspects of hepatobiliary diseases in people with HIV infection at the Lomé University Hospital. METHODS AND PATIENTS: This 5-year retrospective descriptive and analytic study included all people with HIV infection aged 15 years and older of either sex admitted with a hepatobiliary disease. RESULTS: Among all patients admitted for hepatobiliary diseases, people with HIV infection accounted for 2%. They were predominantly women. Our patients' mean age was 43.03±10.3 years. The principal reasons for consultation were asthenia (95.2%), jaundice (93.7%), and abdominal pain (80.9%). The main clinical symptoms were by deterioration of general status (84.1%) and pain of the right hypochondrium (66.7%); 63.5%were classified at WHO disease stage III or IV for HIV infection and disease. All our patients were positive for HIV1; and 86.5% had a CD4 count < 350 cells/mm3. We noted HVB/HIV coinfection in 39.6% and HVC/HIV coinfection in 19%. Cirrhosis had been diagnosed in 44.4%, hepatocellular carcinoma in 12.6%, and toxic or drug-induced hepatitis in 46%, while 8% had acute acalculous cholecystitis. No case of alcoholic steatohepatitis or AIDS cholangiopathy was noted. CONCLUSION: Hepatobiliary diseases are infrequent and varied among people with HIV infection; the most common are toxic hepatitis, cirrhosis, and hepatocellular carcinoma, and they do not differ according to CD4 counts.

Upper gastrointestinal tract endoscopic lesions in a rural African hospitalo: 252 endoscopies at the Kara University Hospital, Togo.

To analyze the indications for upper gastrointestinal endoscopy (UGIE) and determine the frequency of the pathological findings observed in rural areas of Africa. This retrospective study includes 9 series of 5-day visits to perform these examinations. Patients were informed of the presence of the endoscopy team by a bulletin on a rural radio station and by general practitioners at the Kara University Hospital. Patients were recruited from the hospital clinics and from the general population of the Kara region. The study includes all UGIE reports from August, 2007, through September, 2014; these contain the indications for the procedure, the patients' sex and age, and the examination report. The study included 252 reports for 133 women and 119 men with a mean age of 42.44 years (range: 20 to 102 years). The most frequent indications were dyspeptic syndrome (79.76%) and diffuse abdominal pain (11.11%). In all, we observed 139 gastroduodenal lesions among the patients with dyspepsia, principally bile reflux (23.02%), gastroduodenal inflammatory lesions (18.71%) and gastroduodenal ulcers (17.99%). The most commonly observed lesions for diffuse abdominal pain were again, bile reflux (30.77%), followed by gastritis, esophageal mycoses, and tumors. This work made it possible to identify the various pathological lesions of the UGI tract seen on endoscopies in a rural hospital in Togo.

[Knowledge of hepatitis B virus among outpatients consulting in the hepatogastroenterology department at the Lome Campus University Hospital]. / Connaissances sur l'hépatite virale B en consultation d'hépato-gastro-entérologie au centre hospitalier et universitaire (CHU) Campus de Lomé.

GOAL: To evaluate the knowledge abouthepatitis B virus (HBV) infection of patientsconsulting in the hepatogastroenterology department. MATERIALS/METHODS: This prospective, descriptive, and analytic study took place over a two-month period among outpatients in this department of the Lome Campus University Hospital. RESULTS: The study included 276 patients, predominantly male. Participants' mean age was 36.7 years (range: 17 to 75 years). In all, 190 patients (around 68.8%) confirmed that they had heard of this disease at least once, mainly via the media or the hospital. Twenty patients (10.5%) mentioned as the main means of infection sexual intercourse, body fluids (blood), and maternalfetal transmission. Overall, 28 participants reported having been vaccinated against HBV. Of those who had ever heard of this disease, only 58 (30.5%) knew that it exists in an acute form and 69 patients (36.3%) about its chronic form. Thirty (15.8%) patients knew that cirrhosis and liver cancer are its main complications, and 68 (35.8%) were unaware that HBV treatment is available in Togo. CONCLUSION: This study revealed that participants had a poor level of knowledge about HBV.

[Pancreatic cancer: Epidemiological, clinical, and management aspects in the department of hepatogastroenterology at the Lome Campus teaching hospital (Togo)]. / Cancer du pancréas: études épidémiologique et clinique, et prise en charge dans le service d'hépato-gastro-entérologie du CHU Campus de Lomé (Togo).

PURPOSES: To study the epidemiological, clinical, and laboratory aspects of pancreatic pancreatic cancer in Togo, as well as its management. PATIENTS AND METHOD: This retrospective, descriptive study includes patients diagnosed with such cancers over an 8-year period based on features observed on imaging (ultrasound and computed tomography). RESULTS: During the study period, 30 patients, accounting for 0.68% of all admissions, were diagnosed with pancreatic cancer. Their average age was 55.6 years. The M/F sex ratio was 1.72. Weight loss was the most frequent clinical sign, found in 93%. Epigastric pain was reported by 60%. Laboratory results included cholestasis in 97%, hyperglycemia in 47%, hyperlipasemia in 17%, hyperamylasuria in 13%, and hyperamylasemia in 10%. Assays showed elevated Ca19-9 in 23% of patients and elevated ACE in 7%. Abdominal ultrasound showed a poorly defined heterogeneous mass that deformed the contours of the pancreas, with the tumor in the head of the pancreas in 96% of patients. Abdominal CT showed a pancreatic tumor of variable size with hepatic metastases and dilatation of the pancreatic duct in 11 cases. Management involved mainly administration of step 2 or 3 analgesics. The average duration of hospitalization was 12.4 days and death occurred before discharge in 87% of the cases. CONCLUSION: The incidence of pancreatic cancer seems to be rising in Togo. Its prognosis is very poor. Early detection is essential to reduce mortality.

[Panorama of digestives violations related to HIV in CHU Campus in Lome (Togo)]. / Panorama des atteintes digestives liées au VIH au CHU Campus de Lomé (Togo).

OBJECTIVE: To describe the different gastrointestinal manifestations encountered in adult patients with HIV infection in a gastroenterology department in Togo. PATIENTS AND METHODS: This one-year (2011) prospective, descriptive study included all adult HIV-positive patients admitted to our department. Patients not known to be HIV-positive before admission were tested after informed consent. RESULTS: 82 (8.4% of departmental admissions) HIV-positive patients participated in the study. Their mean age was 38.78 years ± 9 years, and they were mainly women (sex-ratio = 0.82). The reasons for consultation were mainly asthenia (39%), weight loss (35.4%), and vomiting (34.1%). Their histories included tuberculosis (4%), jaundice (4%), and herpes zoster (2%). Nearly all (91%) had CD4 counts below 350 cells/L, and most (80%) were treated with antiretroviral agents (ARV) before admission. Most patients were also chronic alcoholics (72%) and took traditional herbal treatments (55%). General symptoms included deterioration of the general condition (77%) and conjunctival pallor (48%). Physical signs included ascites (32%) and hepatomegaly (29%). All patients were positive for HIV-1; 30% were co-infected with HBV and 1.2% with HCV. The main diagnoses were hepatobiliary diseases (46%), including cirrhosis (24.4%), acute toxic hepatitis (12%), and hepatocellular carcinoma (6.1%). Of the latter, one also had lung metastases. Esophageal diseases included candidal esophagitis (24%), and the gastric diseases, two gastric ulcers (2%) and one case of gastric cancer. The primary disease of the colon and small bowel was acute gastroenteritis (38%). Peritoneal conditions were all tuberculosis (7%), and pancreatic involvement was acute pancreatitis (2%).

[Stomach cancer: Epidemiological, clinical and histological aspects at the Lome Campus teaching hospital (Togo)]. / Cancer de l'estomac: aspects épidémiologiques, cliniques et histologiques au CHU Campus de Lomé (Togo).

PURPOSE: To describe the epidemiological, clinical, and histological aspects of stomach cancer in the gastroenterology department of University Hospital Campus of Lome (Togo). METHODS: This retrospective descriptive and analytical study reviewed records of patients hospitalized for stomach cancer over an 8-year period. RESULTS: With 32 cases among the 250 gastrointestinal tract cancers over the study period, stomach cancer accounted for the largest proportion (12.8%) of these cases. The sex ratio was 2.5 and the mean age of patients was 58.82 years (range: 32 to 85 years). The clinical picture was dominated by epigastric pain (44%). Ulcerative budding lesions were most common, especially in the pyloric antrum (72%). Adenocarcinoma was the most common histological type (94%). Thirteen of our patients were transferred to the visceral surgery department for palliative care. Nine more were lost to follow-up after release against medical advice due to lack of financial support. Five patients died (16%) during hospitalization. CONCLUSION: Stomach cancer is common in Togo and ranks first among gastrointestinal cancers in our department. Training hepatogastroenterologists and providing adequate technical facilities, on the one hand, and early recognition of warning signs and a reduction in the cost of gastrointestinal endoscopies, on the other, could improve the survival of patients with gastric cancer in Togo.

[The transfusion practice in the hepatogastroenterology department of the Campus Teaching Hospital of Lomé (Togo)]. / La pratique transfusionnelle dans le service d'hépato-gastroenterologie du centre hospitalier universitaire campus de Lomé (Togo).

OBJECTIVE: To evaluate transfusion practice in the hepatogastroenterology department of the Campus Teaching Hospital of Lomé. METHODOLOGY: This is a respective, descriptive and analytical study conducted from January 1 to December 31, 2013 on cases of in-patients' observation in the department. The cases of in-patients of more than 15 years old, having benefited from a blood transfusion were included. FINDINGS: During the study period, 849 patients were admitted; 136 were transfused, or blood transfusion rate of 16.02%. The average age of patients was of 48.25 years with extremes of 15 and 90 years. The most transfused rhesus blood group was O positive (36.76%). Red blood cell was the most frequently used blood product (94.12%). The transfusion was performed in 58.82% of cases as a matter of emergency. Gastrointestinal bleeding were the main indications (55.88%). The average pre-transfusion hemoglobinemia was 6.51 g/dL±1.67. The average post-transfusion hemoglobinemia was 8.95 g/dL±1.75. Liver disease (cirrhosis and hepatocellular carcinoma) were the main diagnosis associated with blood transfusion (44.85%). The quantity of blood to be transfused was not calculated in 100% of cases. In 11.03% of cases, the compatibility test has not been done in the laboratory. Incidents during blood transfusion were noted in 5 cases. CONCLUSION: Blood transfusion is frequent in the department. There is a good observance of blood transfusion safety regulations. However, its practice remains to be improved.

[Endoscopic aspects of toxic ingestions during attempted suicides at Lome Campus teaching hospital (Togo)]. / Aspects endoscopiques des ingestions toxiques au cours des tentatives de suicide au centre hospitalier universitaire Campus de Lomé (Togo).

GOAL: To describe the epidemiological, clinical, and endoscopic aspects of attempted suicides treated in the gastroenterology department of Lome Campus Teaching Hospital. METHODS: This retrospective study examined data collected over a 5-year period for patients admitted for attempted suicide by consumption of toxic substances (for example, caustics, medications, and insecticides) and who had an upper gastrointestinal endoscopy. Caustic lesions are described according to Di Costanzo's classification. RESULTS: Of 3075 admissions in the department during the study period, 35 (1.14%) were admitted for attempted suicide. Only 21 of these cases (60%) met our inclusion criteria. The patients' mean age was 25.86 years old, and 71% were female. These attempted suicides were most frequent among high school and college students (52%). The ingested substances were mostly caustic in nature (13 cases). Twenty patients (95%) were admitted less than 12 hours after the suicide attempt. The dominant symptoms at the department were abdominal pain and throat inflammation. Ten patients had an upper gastrointestinal endoscopy within 24 hours after the attempt. In the case of caustic ingestion, severe lesions (IIb, III) represented 53% of the cases. An esophageal stricture was noticed on the patient admitted 45 days after a suicide attempt by ingestion of a caustic substance. CONCLUSION: The frequency of attempted suicides is underestimated here because most patients are admitted to the internal medicine or psychiatric departments. Caustic substances were the main substances used and caused severe lesions.

[Hospital mortality associated with upper gastrointestinal hemorrhage due to ruptured esophageal varices at the Lomé Campus Hospital in Togo]. / Mortalité hospitalière liée à une hémorragie digestive haute par rupture de varice œsophagienne au CHU Campus de Lomé (Togo).

AIM: To study hospital mortality associated with upper gastrointestinal hemorrhages due to variceal bleeding in the department of hepatology and gastroenterology at the Lome Campus University Hospital. PATIENTS AND METHOD: This retrospective cross-sectional and analytic study examined the 55 patients admitted for variceal bleeding on upper endoscopies during the 3-year period from January 1, 2008, through December 31, 2010. RESULTS: These patients accounted for 4.1% of all hospitalizations during the study period in the department. Their average age was 35 years, and their sex-ratio 4. A history of chronic liver disease was found in 65.5%. Liver cirrhosis was the principal cause of the esophageal varices, complicated by hepatocellular carcinoma in 30.9% of them. The mortality rate was 25.5% and was not related to the cause of portal hypertension. All the patients with a recurrence of bleeding died. Mortality was associated with jaundice. Blood transfusion did not significantly improve the prognosis. CONCLUSION: the mortality rate among patients with upper gastrointestinal hemorrhage linked to variceal bleeding is high in our unit. The prevention of hepatitis virus B is important because it is the main cause of chronic liver disease causing portal hypertension in our department.

[Knowledge, attitudes, and practices relative to the risk of transmission of hepatitis B and C viruses in a hospital in Togo]. / Connaissances, attitudes et pratiques du personnel soignant sur le risque de transmission des hépatites virales B et C en milieu hospitalier au Togo.

OBJECTIVE: To assess the knowledge, the attitudes, and the practices of hospital nursing staff in relation to the infectious risks of the hepatitis B and C viruses. METHODS: Cross-sectional descriptive survey conducted at the Lome Campus Teaching Hospital among the nursing staff present during at least one of the 2 consecutive workdays of the survey. RESULTS: The total nursing staff included 190 people, 115 (60.5%) of whom participated in the investigation. Slightly more than three-fifths were men (61.7%). Their mean age was 37.9 ± 10.7 years. The contaminated materials encountered most often were blood (94.8%), needle-drawn fluids (77.4%), and biopsy samples (53.9%). Staff most often did not comply with protective measures: 75.5% did not use gloves regularly and 46.0% did not use bibs. More than one third of the nursing staff (34.8%) had had such a needle-stick or related accident, but only 8.8% had reported them: 74.2% because of the potential administrative difficulties and 25.8% because of ignorance (25.8%). Staff knowledge about the means of transmission of these viruses was good (98.3%). The vaccination coverage rate of the nurses questioned was 51.3%. CONCLUSION: Training and awareness campaigns about the occupational risks of HBV and HCV remain necessary.

[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.

[Aetiologics aspects of proctorrhagia at the black adult African: about 85 cases collect in 12 years in CHU-Campus of Lome]. / Aspects etiologiques des rectorragies chez l'adulte en milieu Africain: a propos de 85 cas colliges en 12 ans au CHU-Campus de Lome.

PURPOSE: To count the aetiology of proctorrhagia in Lomé. METHODS: It is a retrospective study, over 12 years (1st January 1995-31 December 2006), realised from the reports of the coloscopy . It included the patients of the two sexes, old of more than 15 years, having presented a proctorrhagia explored by ano-rectoscopy and coloscopy. RESULTS: The proctorrhagia represent 38.72% of the indications of the coloscopy. The patients from 24 to 45 years were reached (52.94%). A male prevalence was found (sex-ratio: 2.4). Among the aetiology found, the haemorrhoids more frequent (23.53%), were followed by the non specific colitis (16.47%), the ulcero- haemorrhage rectocolitis (15.29%), the colon diverticulosis (10.58%), the amoebic colitis (9.4%) and colorectal cancer (5.88%). The hemorroid were associated with a non specific colitis (1 case), a ulcero-hemorrhagic rectocolitis (1 case), an amoebic colitis (1 case) and diverticulose colic (1 case). In 12 cases (14.12%), no aetiology was found. CONCLUSION: The haemorrhoids represent the most frequent aetiology of the proctorrhagia in Lomé; however their discovery in ano-rectoscopy should not exempt realisation of a complete coloscopy in the search of other causes.