Decentralising DOT for drug-susceptible TB from the health facilities to the community level in Togo.

In Togo, the COVID-19 pandemic paved the way for decentralising directly observed treatment (DOT) to the community level through the evaluation of two innovative community-based DOT approaches-a community health worker-based (CHW-DOT) and family-based (FB-DOT). METHODS We conducted an observational prospective study from April 2021 to January 2022. Sputum conversion at Month 2 and favourable treatment outcomes at Month 6 were assessed and compared between the two groups. Sociodemographic and clinical factors related to these outcomes were identified. RESULTS A total of 182 TB patients were enrolled. The CHW-DOT group had significantly increased odds of sputum conversion (aOR 2.95, 95% CI 1.09-7.98) and lower odds of unsuccessful treatment outcomes (aOR 0.37, 95% CI 0.13-1.1). Non-smokers had 4.85 higher odds of converting than smokers (aOR 4.85, 95% CI 1.76-13.42) and lower odds of an unsuccessful treatment than smokers (aOR 0.11, 95% CI 0.04-0.32). CONCLUSION CHW-DOT is associated with higher sputum smear conversion rates and a more favourable treatment outcome. The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable adjunct to a CHW-DOT approach during TB treatment..

[The optic disk in Togolese patients with glaucoma]. / La papille chez le glaucomateux togolais.

BACKGROUND: We conducted this retrospective study to analyze the main characteristics of the disc cuppings in patients diagnosed with chronic open angle glaucoma. METHODS: Data of 489 patients seen in our department and presenting chronic open angle glaucoma were collected. All these patients entered our glaucoma criteria and had disc cupping examination by color stereophotography during the follow up period of 36 months. RESULTS: The sample for the whole comprised 489 patients, of whom 327 where men (67%) and 162 female (33%). Most of the patients are young, 68.97% less than 45 years old. The disc cuppings had various distributions: 28% at 0.4; 25.8% at 0.5; 19.3% at 0.6; 13.2% at 0.7; 10.7% at 0.8; and 4.3% at 0.9. The mean cupping in the left eye (0.6) was greater than that of the right eye (0.52); p = 0.001. There were also differences in the values of the mean cupping with the age (p = 0.0001). However, there was a correlation between the cuppings and the result of the automatic perimetry. CONCLUSION: This study demonstrated the importance of disc cup examination for the diagnosis, follow-up, and treatment of chronic open angle glaucoma in our populations.

[Characteristics of corneal topography in candidates for surgery for myopia]. / Caractéristiques de la topographie cornéenne des candidats à la chirurgie de la myopie.

INTRODUCTION: Videokeratography analyses the corneal anterior topography. It is necessary in refractive surgery to estimate the anatomical effect of the surgery and to eliminate early Keratoconus. METHODOLOGY: Corneal anterior topography was studied on 70 consecutive patients (140 eyes) candidates for low myopia surgery (-1 to -6); 87 eyes were wearing regularly contact lenses. With the topographic analysis machine of EYESYS compagny, keratometry (Km) at 3 mm, astigmatism (delta K) at 3 mm, I-S value at 3 mm and 5 mm according to Rabinowitz method were measured in each eye. RESULTS: The average keratometry was 43.50 +/- 1.87 D. The average astigmatism was 0.909 +/- 0.75 D. 51 eyes presented an asymmetric corneal and among them 32 ware contact lenses regularly; 8 eyes out of 140 (6%) presented the association of an high central Keratometry value (> or = 47 D) and corneal asymmetry (I-S > 0.5 value). COMMENTS: The incidence of Keratoconus is higher in a candidate population for refractive surgery by self-selection. Its frequency is difficult to evaluate accurately because of the present limits for the diagnostic measures. In this population, it seems to represent about 6%. CONCLUSION: The videokeratography before refractive surgery is necessary to reveal corneal anterior topography abnormalities and to eliminate early Keratoconus.

Les chorioretinites toxoplasmiques au CHU de Lome

La toxoplasmose oculaire represente l'effet pathogene de toxoplasma gondii; elle determine chez les sujets immunocompetents une chorioretinite d'allure necrosante volontiers temporel avec des aspects en rosace; une atteinte du segment anterieur parfois. Sa frequence chez un immunodeprime comme dans l'infection par le VIH serait de 30 fois plus elevee que chez le sujet immunocompetent. Ce present travail est consacre aux differents aspects anatomocliniques observes chez 24 malades presentant une toxplasmose oculaire d'age moyen de 32;09 ans avec des extremes a 14 ans et 57 ans; atteignant les deux sexes dans les proportions de 41;66 pour cent de femmes contre 58;33 pour cent d'hommes. Les lesions etaient dans 91;66 pour cent (22 malades) exclusivement des chorioretinites; deux cas de participation du segment anterieur etaient observes; 66;66 pour cent de localisations temporales sont notees (16 malades); 29;16 pour cent d'atteintes nasales (7 malades) et une seule localisation justapaillaire; 14 localisations droites sont notees contre 10 du cote gauche; 8 lesions eatient evolutives (33;33 pour cent) contre 16 lesions cicatricielles (66;66 pour cent); le dye test de Sabin Feldman etait positif chez tous les malades par contre les lgM etaient variables. La toxoplasmose doit etre recherchee devant toute chorioretinite dans nos milieux car le diagnostic ophtalmoscopique est de haute predictivite