Epidemiological, clinical, therapeutic and evolutionary specificities of the association between venous thromboembolic event and cancer in sub-Saharan Africa: Case of Togo.

BACKGROUND: Our study aimed to describe the clinical, paraclinical, therapeutic and outcomes of patients with venous thromboembolic event (VTE) associated with cancer in the context of limited resources. MATERIALS AND METHODS: This was a descriptive cross-sectional study over a period of six years from March 1, 2016 to March 31, 2022, in the cardiology department and the oncology unit of the Sylvanus Olympio Teaching Hospital of Lome. Our study examined medical records of patients who were at least 18 years old and had venous thromboembolic disease and cancer that was histologically confirmed. This study did not include records that were incomplete or records from patients with coronavirus disease. RESULTS: Our study included 87 patients with average age of 56.36±15.26 years. The discovery of VTE occurred incidentally in 28.74%. Venous thrombosis was isolated in 68.96% and proximal in 95%. Pulmonary embolism was bilateral in 77.77%. Gynaecological and urological cancers were found in 33.33% and 32.19% respectively. Adenocarcinoma was the histological type of cancer found in 47.13%. Cancers were at a very advanced stage in 74.71%. Treatment with antivitamin K was prescribed in 12.65%. In our study, there were 58 patients who passed away with a mortality rate of 66.66%. The cause of death was a complication of VTE in 22.42% and related to the course of cancer in 63.79% of cases. CONCLUSION: VTE during cancer is particular with a fatal evolution due to the severity of VTE and the very advanced stage of cancer.

Tropical Laboratory Initiative: An innovative model for laboratory medicine in rural areas.

BACKGROUND: Communities in rural, low-resource settings often lack access to reliable diagnostics. This leads to missed and misdiagnosed cases of disease and contributes to morbidity and mortality. OBJECTIVE: This paper describes a model for providing local laboratory services to rural areas of Ghana, and provides suggestions on how it could be adapted and expanded to serve populations in a range of rural communities. METHODS: The Tropical Laboratory Initiative (TLI) system in Ghana comprises one central laboratory where samples delivered from clinics by motorbike riders are analysed. Test requests and results are communicated on a mHealth application, and the patient does not have to visit the laboratory or travel beyond the clinic to receive a test. The TLI also serves as a research base. The laboratory is accredited by the National Health Insurance Authority, and accepts the national health insurance. The TLI serves several communities in Amansie West, Ashanti region, and currently works with 10 clinics. The nearest hospital is a one-hour drive away and is the only other nearby facility for diagnostics beyond basic rapid tests. RESULTS: Demand for services has increased yearly since the launch in 2010, and the TLI currently provides over 1000 tests to approximately 350 patients monthly. The majority of patients are female, and the most common tests are for antenatal care. Our experience demonstrates that laboratory services can be affordable and most components already exist, even in rural areas. CONCLUSION: Ministries of health in low-resource settings should consider this model to complement the rapid tests available in clinics. Integrating with an insurance system promotes financial sustainability.

[Prevalence and determinants of the increased carotid intima-media thickness in a population of 1203 black African hypertensive]. / Prévalence et facteurs déterminants de l'épaisseur intima-media carotidienne élevée dans une population de 1203 hypertendus noirs africains.

OBJECTIVES: To evaluate the prevalence and determinants of increased carotid intima-media thickness (IMT) in a population of black hypertensive patients and it influence of on the assessment of their overall cardiovascular risk. PATIENTS AND METHODS: This was a 16-month, cross-sectional study conducted in the outpatient unit of the cardiology department of the Campus teaching hospital of Lome, and included 1203 hypertensive patients, both sexes, aged 35 years and more. Each patient benefited from a carotid IMT measure. Carotid IMT was increased if it was>0.9mm and the plaque was defined as a carotid IMT>1.2mm. RESULTS: The mean age of our patients was 53.3±10.4 years with a sex ratio of 1.6 in favor of women. The duration of hypertension was less than 5 years in 56.7% and hypertension was grade 1 in 47.7% of cases. The mean carotid IMT was 0.89mm±0.20. The prevalence of the increased carotid IMT was 45.8% and that of an atheroma plaque was 15.8%. Carotid IMT was correlated with age (P˂0.0001), duration of arterial hypertension (P=0.01), history of stroke (P˂0.0001), and presence of left ventricular hypertrophy to cardiac ultrasound (P=0.01). The overall cardiovascular risk was modified after taking into account the carotid IMT. An increase in cardiovascular risk was observed in 30.5% of hypertensive patients. CONCLUSION: Increased carotid intima-media thickness is frequent in Togolese hypertension. The determining factors are age, duration of arterial hypertension, left ventricular hypertrophy and stroke. The systematic measurement of the carotid intima-media thickness would better evaluate the overall cardiovascular risk for our patients.

Acute coronary syndromes: epidemiological, clinical, paraclinical and therapeutic characteristics at the Campus teaching hospital of Lome, Togo.

INTRODUCTION: The aim of this work was to describe the epidemiological, clinical, and therapeutic characteristics of acute coronary syndromes (ACS) in the cardiology department of Lome Campus University Hospital in Togo. METHODOLOGY: We conducted a prospective study that consistently included patients hospitalized from 2014 to 2017 for ACS, based on clinical, electrocardiographic, and laboratory findings. RESULTS: Of 1914 patients admitted to the department during the study period, 67 were admitted for ACS, for a 3.5% prevalence. The (M/F) sex ratio was 1.91. Patients' mean age was 60 ± 12 years. The clinical presentation was an ST elevation myocardial infarction (STEMI) in 71.6% of cases, and non-STEMI in 28.4% of cases, including 18.1% non-Q-wave infarction and 10.3% unstable angina. The mean time to admission after the onset of symptoms was 81.9 ± 124.6 hours. Patients were transported to the hospital by a private vehicle in 82.1% of cases. Thrombolysis was performed for 14.6% of patients (7/48 patients with ACS STEMI), with a success rate of 85.7% (n=6). In-hospital mortality was 10.5% (7/67). This mortality was significantly associated with the interval from onset of symptoms to admission and with the Killip stage. CONCLUSION: Acute coronary syndromes are increasingly common in Togo. They are characterized by a relatively young age and a long delay until admission. Improving the management of these conditions in our countries requires effective primary prevention.

[Effusive pericarditis: clinical and etiological aspects in Lomé]. / Les péricardites liquidiennes : aspects cliniques et étiologiques à Lomé.

OBJECTIVE: to describe the course and the etiologic, prognostic, and therapeutic aspects of effusive pericarditis (EP) in Togo. MATERIAL ANDMETHODS: Prospective and longitudinal study conducted at the cardiology department of Sylvanus Olympio Teaching Hospital of Lome from February 1, 2011, to January 31, 2014, of patients hospitalized for EP, confirmed by Doppler echocardiography. RESULTS: The study included 38 patients. The hospital incidence rate of EP was 2.0%. The mean age was 42.5 ± 14.9 years (range: 16 to 73 years) with a sex ratio of 0.7. Exertional dyspnea, poor general condition, chest pain, and fever were the main symptoms. Pericardial effusion was abundant in 24 patients (63%). The Koch bacillus was identified on direct examination in five patients (13%) and only from sputum. HIV serology was positive in 18 patients (47%). Pericardial fluid was collected from 24 patients (63%). Pathology examinations of pericardial tissue found nonspecific inflammation in 5 patients and pericardial tuberculosis in 7. The causes of EP were: tuberculous (55%), idiopathic (16%), bacterial (8%), HIV-related (5%), uremic (5%), neoplastic (5%), lupus (3%), and rheumatic (3%). CONCLUSION: EFP is a frequent, serious, even deadly disease in Africa because of the HIV-AIDS pandemic. Treatment depends on the cause, most often tuberculosis.

[Hypertension and pregnancy in Lome (sub-Saharan Africa): epidemiology, diagnosis and risk factors]. / Hypertension artérielle et grossesse à Lomé (Afrique sub-saharienne) : aspects épidémiologiques, diagnostiques et facteurs de risque.

AIM: Describe the epidemiology, diagnosis and risk factors of hypertension in pregnant women in Lome. METHODS: It was a prospective, descriptive and comparative study during 12 months (October 1st, 2011 to September 31st, 2012) on 200 cases of hypertension among 1620 pregnant women, in the department of gynecology and obstetrics at the Tokoin teaching hospital of Lome. RESULTS: We had 200 cases of hypertension on 1620 pregnant women. The prevalence of hypertension in pregnant women in Lome was 12.3%. The average age of pregnant women was 30±7 years, with extremes of 15 and 44 years. Hypertension was more common (50%) in ages of 30-39 years. The society the most represented were housewives (33.33%), civil servants (16.67%) and traders (16.66%). Hypertension was found incidentally or during a complication especially during the third trimester of pregnancy. Preeclampsia (44%) and pregnancy-induced hypertension (33%) were the most represented. The main risk factors where primiparity (especially older primipars >30ans), nulliparity, familial history of hypertension, low economic level, history of pregnancy-induced hypertension, age >30 years, twinning, obesity and stress. CONCLUSION: Hypertension in pregnancy is frequent in Lome. A regular follow-up before and after delivery is important according to fetal and maternal complications, and the risk of heart and kidney disease at mild and long outcome.

[Young heart failure: epidemiological, clinical and etiological aspects in the teaching hospital Sylvanus Olympio of Lomé]. / Insuffisances cardiaques du sujet jeune : aspects épidémiologiques, cliniques et étiologiques au CHU Sylvanus Olympio de Lomé

AIMS: The aim of the study was to analyze the epidemiologic, clinical and etiologic aspects of heart failures of the young age to 18 to 45 years. PATIENTS AND METHOD: It consisted of a cross-sectional study realized in hospitalization in the service of cardiologic of Teaching Hospital Sylvanus Olympio of Lomé on 35 months (January 2009 to November 2012). The completion of a Doppler echocardiography was necessary to include the patients in the study. RESULTS: The prevalence heart failure in the 45 years old young people to more was of 28.6%. The median age of the patients was of 36.5±3 years with a sex ratio of 10.7. Heart failure was total among 268 patients (71.3%). The electrocardiogram found 88 patients (23.4%) in complete arrhythmia by auricular fibrillation. Cardiac echography found a dilation of the left ventricle among 271 patients (72.1%), a systolic dysfunction of left ventricle among 213 patients (56.6%) and an intracavitary thrombus among 37 patients (9.8%). The etiologies were: hypertension 161 cases (42.8%), heart valve diseases 68 cases (18.1%), the peripartum cardiomyopathy 58 cases (15.4%), dilated cardiomyopathy 22 cases (5.8%), the alcoholism 12 cases (3.1%), ischaemic heart diseases 10 cases (2.7%), congenital heart diseases 10 cases (2.7%), the chronic pulmonary heart 8 cases (2.1%), the cardiothyreosis 7 cases (1.8%), the pericardial tamponnade 4 cases (1.1%) and myocarditis with VIH 4 cases (1.1%). Hospital lethality was of 16.4% (62 patients). CONCLUSION: Heart failure is a serious and frequent pathology in Africa. It affects young and active subjects. The causes are dominated by hypertension.

Prevalence of cardiovascular risk factors in an urban area of Togo: a WHO STEPS-wise approach in Lome, Togo.

OBJECTIVE: To determine the prevalence of hypertension and other cardiovascular risk factors in the general adult population of Lome. METHODS: A cross-sectional household survey was conducted in Lome from October 2009 to January 2010, which focused on hypertension and other cardiovascular risk factors in 2 000 subjects 18 years and older. The World Health Organisation's STEPS-wise approach on non-communicable diseases was used. During the first session, blood pressure (BP) was measured on three successive occasions, one minute apart, and the mean was recorded. A second measurement session was done three weeks later in patients with BP ≥ 140/90 mmHg during the first session. Hypertension was defined as BP > 140/90 mmHg after the second session, or on antihypertensive treatment. The other risk factors were studied by clinical and blood analysis. RESULTS: We found 532 hypertensive patients out of a total of 2 000 subjects. The prevalence of hypertension was 26.6%. The mean age of hypertensive patients was 45 ± 10 years, ranging from 18 to 98 years. The prevalence of other cardiovascular risk factors was: stress (43%), sedentary lifestyle (41%), hypercholesterolaemia (26%), obesity (25.2%), hypertriglyceridaemia (21%), smoking (9.3%), alcohol use (11%) and diabetes (7.3%). CONCLUSIONS: The prevalence of hypertension and other cardiovascular risk factors in the population of Lome is high. These findings should draw the attention of authorities to define a national policy to combat hypertension and other cardiovascular risk factors.

An indigenous plant food used by lactating mothers in west Africa: the nutrient composition of the leaves of Kigelia africana in Ghana.

Although the leaves of Kigelia africana are used to make a palm-nut soup which is consumed mainly by lactating women in many parts of sub-Saharan Africa, little is known about the nutrient qualities of this underutilized and underappreciated plant food. Leaves of Kigelia africana, called "sausage tree" in English and "nufuten" in the Twi language of Ghana, were collected in Kumasi and analyzed for their content of nutritionally important fatty acids, amino acids, minerals, and trace elements. The dried leaves contained 1.62% fatty acids, of which α-linolenic acid and linolenic acid accounted for 44% and 20%, respectively, of the total. Protein accounted for 12.6% of the dry weight and, except for lysine, its overall essential amino acid profile compared favorably to a World Health Organization protein standard for school children. Kigelia leaf contained considerable amounts of many essential elements, including calcium (7,620 µg/g), iron (161 µg/g), magnesium (2,310 µg/g), manganese (14.6 µg/g), zinc (39.9 µg/g), and chromium (0.83 µg/g); selenium, however, was not detected. These data indicate that Kigelia africana leaf compares favorably with many other commonly-consumed green leafy vegetables such as spinach and provides a rational basis for promoting the conservation and propagation of the plant and encouraging its wider use in the diets of populations in sub-Saharan Africa.

Biochemical and toxicological studies on the effect of high and low erucic acid rapeseed oil on rats.

Rats were fed on diets containing rapeseed oil, either containing low or high erucic acid content as well as the hydrogenated ones for 6 weeks. Body weight gain, biochemical and pathological parameters were investigated. The data showed high body weight gain for rats fed diets containing low erucic rape oil (LERo) compared with those fed either the high erucic rape oil (HERo), the hydrogenated or the partially hydrogenated oil diets. All rats showed non significant changes for total lipids, total cholesterol, GPT and GOT, except the partially hydrogenated rape oil diet which showed significant decrease for total cholesterol. Alkaline phosphatase however showed a significant decrease, while plasma phospholipids showed significant increase in rats fed on the hydrogenated oil diet. Triglycerides indicated non significant increase except in the group that received low erucic rape oil diet. Histopathological study showed changes in all tissues examined (liver and kidney).