Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral au centre hospitalier régional de Sokodé (Togo), une décennie après la gratuité de la trithérapie

Introduction : L'initiation tardive du Traitement Anti-Rétroviral (TAR) est fréquente dans les pays à ressources limitées, où la plupart des individus ne connaissent pas leur statut sérologique jusqu'à ce qu'ils soient symptomatiques.Matériel et méthodes : Il s'est agi d'une étude transversale et analytique, qui s'est déroulée du 1er janvier 2016 au 31 décembre 2016 dans le service de médecine générale du Centre Hospitalier Régional (CHR) de Sokodé, le service de référence dans la prise en charge de l'infection à VIH dans la région centrale du Togo.Résultats : Cent-neuf patients dont 15 enfants (13,8%) ont été inclus dans la file active du service de médecine générale du CHR de Sokodé par l'initiation du TAR. La moyenne d'âge des patients était de 32,38 ans [1-59 ans] avec une prédominance féminine (67,9%). La majorité des patients était classée aux stades III (60 cas ; 55%) et au stade IV (11 cas ; 10,1%). Les manifestations cliniques ou affections opportunistes étaient dominées par la diarrhée chronique (15 cas), la fièvre prolongée inexpliquée (12 cas) et la candidose oropharyngée (12 cas). Le taux moyen des CD4 des patients était de 328,54 cellules/mm3 [0-2216 cellules/mm3] et la co-infection VIH-VHB a été retrouvée dans 13,8% (n = 15). L'association Ténofovir (TDF) - Lamivudine (3TC) - Efavirenz (EFV) (87,2% ; n = 95) a été la plus prescrite pour l'initiation du TAR.Conclusion : Le profil des patients infectés par le VIH à l'initiation du TAR à Sokodé est caractérisé par un stade avancé de l'infection à VIH

[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.

Biométrie échographique de la prostate normale chez le togolais de 15 a 50 ans à Lomé

But : Etudier la biometrie echographique de la prostate normale chez le Togolais age de 15 a 50 ans. Methodologie : Il s'est agit d'une etude prospective transversale effectuee sur une periode de douze (12) mois (avril 2010 - mars 2011) au service de radiologie du CHU SYLVANUS OLYMPIO de Lome portant sur une population d'etude de 512 sujets choisis pour une echographie sus pubienne de la prostate.Resultats : La valeur minimale de la hauteur etait de 27 mm et la valeur maximale etait de 41mm avec une valeur moyenne de 34mm. La valeur moyenne de la largeur etait de 33;7mm avec des extremes de 44 mm et 27 mm. La valeur minimale de l'epaisseur etait de 12 mm et la valeur maximale etait de 36mm avec une valeur moyenne de 22;4mm. Le volume moyen de la prostate etait de 12;83cm3. Conclusion : La biometrie de la prostate croit avec l'age. Les valeurs de cette etude ont des similitudes avec la litterature

[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.

[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.

[Vaginal infections in pregnant women at the Regional Hospital of Sokode (Togo) in 2010 and 2011]. / Infections vaginales chez les femmes enceintes au centre hospitalier régional de Sokodé (Togo) entre 2010 et 2011.

OBJECTIVE: The aim of this study was to evaluate the prevalence of the major microorganisms causing vaginal infections in pregnant women consulting at the Regional Hospital of Sokodé and to assess their sensitivity to antibiotics. MATERIALS AND METHODS: This prospective study took place from June 2010 through August 2011 and included 302 pregnant women from whom a sample was taken by a vaginal swab. Samples were processed for parasitic, bacterial, and fungal agents, by microscopic examination and culture. RESULTS: We isolated 273 germs, alone or in association in 221 women. These germs were distributed as follows: Gardnerella vaginalis (55.31%), Candida spp (30.77%), Staphylococcus aureus (5.49%), Enterobacteriaceae (4.40%), Trichomonas vaginalis (3.66%) and Mobiluncus spp (0.37%). No Streptococcus strain was isolated during the study. Over 40% of women had bacterial vaginosis and 23.08% of them were coinfected. The occurrence of coinfection was statistically influenced by the stage of pregnancy (P = 0.05). The susceptibility tests revealed that S. aureus developed a strong resistance to aminopenicillins (66.67%) and cephalosporins (>44.44%), while Enterobacteriaceae was resistant to cephalosporins and quinolones. (16.67%). CONCLUSION: This study showed that pregnant women in Sokode are still exposed to vaginal infection, caused mostly by G. vaginalis and Candida species. These results underline the need for at least one vaginal swab culture for each woman during pregnancy.

[AIDS related Kaposi sarcoma: 103 cases in dermatology in Lomé (Togo)]. / Maladie de Kaposi associée au VIH : 103 observations en dermatologie à Lomé (Togo).

OBJECTIVE: The purpose of this study was to describe the epidemiological and clinical profile and the treatment and natural history of AIDS-related Kaposi sarcoma in 3 major dermatology departments in Lomé (Togo). PATIENTS AND METHOD: This retrospective, descriptive study was based on the records of patients with AIDS-related Kaposi sarcoma from January 2005 through October 2011. RESULTS: During the study period, 157 patients were treated in the dermatology departments for Kaposi sarcoma. HIV serology was positive for 103 (89.6%) of the 115 patients tested. Seventy-nine patients were known to be HIV-positive before the consultation, while Kaposi sarcoma was the circumstance of discovery of the HIV infection for 24. The average age of the 103 patients was 36.7±14.9 years and the sex-ratio (M/F) was 1.1. The main locations of the lesions were the lower limbs (n = 76), mucosa (n = 53), trunk (n = 38) and upper limbs (n = 17). The average CD4-cell count was 226±168 cells/mm(3). The main antiretroviral protocol used was stavudine/lamivudine/nevirapine (70 cases). Besides the antiretroviral treatment, chemotherapy was prescribed, with vinblastine for 17 patients, bleomycin for 5, and doxorubicin for one. For financial reasons, 80 other patients did not receive chemotherapy and were lost to follow-up after an average duration of 3 months. At 5 months, the rate of complete remission was 21.1%, partial remission 21.1%, and failure 57.8%. Side effects were dominated by hematologic and nervous complications. CONCLUSION: Our study highlighted a high prevalence of AIDS-related Kaposi sarcoma in dermatology departments in Lomé, with a tendency to gender equality. It also shows the difficulties of access to chemotherapy for most patients and the poor efficacy of chemotherapy.

[Profile of Buruli ulcer treated at the National Reference Centre of Togo: a study of 119 cases]. / Profil de l'ulcère de Buruli pris en charge au Centre national de référence du Togo: étude de 119 cas.

The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.

[Ulcerative colitis: a case in Togo]. / La rectocolite hémorragique : une observation au Togo.

Ulcerative colitis seems to be rare in sub-Saharan Africa. Because its clinical and radiological signs are non-specific, anatomopathologic studies are necessary for definitive diagnosis after exclusion of parasitic, bacterial, and viral causes. The purpose of this report is to describe a fatal case of ulcerative colitis in a 68-year-old woman in Togo.

[Evaluation of the treatment of Kaposi's sarcoma with vinblastine in Togo: a study of 23 cases]. / Évaluation du traitement de la maladie de Kaposi par la vinblastine au Togo: étude de 23 cas.

The aim of this study was to evaluate the efficacy of treatment of AIDS-related and non AIDS-related Kaposi's sarcoma (KS) using vinblastine (Velbé®). A retrospective study was conducted between January 1990 and December 2009 in the Department of Dermatology at the Lomé teaching hospital. The therapeutic protocol is the administration of 10 injections of vinblastine every 15 days. Evaluation was done at 10 weeks, 5 months, 11 months and 17 months. Twenty-three patients including 11 cases of non AIDS-related KS and 12 cases of AIDS-related KS were included in our study. The average age of patients was 39.3 ± 11.2 years. The sex-ratio (M/F) was 6:7. At ten weeks, partial remission was 26% and failure rate was 74%. Side effects as a result of the first five injections were dominated by anemia. At 5 months, complete remission was 17% including 3 cases of non AIDS-related KS, partial remission was 26% including 4 cases of non AIDS-related KS. Side effects of the last five injections were dominated by anemia and nervous toxicity. At 11 months, one patient was lost to follow-up and complete remission persisted in 13% of the patients. At 17 months, complete remission persisted in 9% of the patients against 4% of relapses. No long-term side effects were identified. Our study shows a poor efficacy of vinblastine in the treatment of AIDS-related and non AIDS-related KS and confirms the hematologic and nervous toxicity of this drug. The efficacy is better in the non AIDS-related KS than in the AIDS-related KS.