[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.

[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.

Prevalence of SARS-CoV-2 among high-risk populations in Lomé (Togo) in 2020.

BACKGROUND: In December 2019, the COVID-19 outbreak began in China and quickly spread throughout the world and was reclassified as a pandemic in March 2020. The first case of COVID-19 was declared in Togo on March 5. Two months later, few data were available to describe the circulation of the new coronavirus in the country. OBJECTIVE: This survey aimed to estimate the prevalence of SARS-CoV-2 in high-risk populations in Lomé. MATERIALS AND METHODS: From April 23, 2020, to May 8, 2020, we recruited a sample of participants from five sectors: health care, air transport, police, road transport and informal. We collected oropharyngeal swabs for direct detection through real-time reverse transcription polymerase chain reaction (rRT-PCR) and blood for antibody detection by serological tests. The overall prevalence (current and past) of infection was defined by positivity for both tests. RESULTS: A total of 955 participants with a median age of 36 (IQR 32-43) were included, and 71.6% (n = 684) were men. Approximately 22.1% (n = 212) were from the air transport sector, 20.5% (n = 196) were from the police sector, and 38.7% (n = 370) were from the health sector. Seven participants (0.7%, 95% CI: 0.3-1.6%) had a positive rRT-PCR test result at the time of recruitment, and nine (0.9%, 95% CI: 0.4-1.8%) were seropositive for IgM or IgG against SARS-CoV-2. We found an overall prevalence of 1.6% (n = 15), 95% CI: 0.9-2.6%. CONCLUSION: The prevalence of SARS-CoV-2 infection among high-risk populations in Lomé was relatively low and could be explained by the various measures taken by the Togolese government. Therefore, we recommend targeted screening.

Predictors of three-month mortality among hospitalized older adults in Togo.

BACKGROUND: Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo. METHODS: We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality. RESULTS: The median age of the 650 older adults included in the study period was 61 years, IQR: [55-70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4-20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5 and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases. CONCLUSION: Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

[Diagnostic, therapeutic, and prognostic features of gestational diabetes at the Sylvanus Olympio University Hospital Center]. / Aspects diagnostiques, thérapeutiques et pronostiques du diabète gestationnel au Centre Hospitalier Universitaire Sylvanus Olympio.

INTRODUCTION: The purpose of this study was to describe the diagnostic, prognostic and therapeutic features of gestational diabetes at the Sylvanus Olympio University Hospital Center. METHODS: We conducted a retrospective descriptive study over a period of 5 years from 1st January 2013 to 31st December 2017. It involved 125 pregnant women who had given birth in the Department of Internal Medicine and in the Gyneco-Obstetric Department. RESULTS: The average age of patients was 30.84±4.17 years. The most common risk factors were overweight and obesity (57.7%), a family history of diabetes (33.3%), a history of spontaneous miscarriage (26.6%), a history of fetal death in utero (15.5%) and a history of gestational diabetes (8.8%). Gestational diabetes screening was performed using fasting blood glucose test and 75g oral glucose-tolerance test. Diagnosis was made in the first quarter in 55.6% of cases, in the second quarter in 33.3% and in the third quarter in 11.1%. Insulin therapy was necessary in 24.4% of cases and a healthy meal-plan alone in 66.6%. Sixty-six point seven percent (66.7%) of women had given birth by cesarean section and 33.3% vaginally. Maternal complications at birth included: arterial hypertension (22.2%), preeclampsia (17.7%) and premature ruptured membranes (2.2%). Newborn complications included macrosomia (48.9%), prematurity (11.1%), hypoglycaemia (11.1%), malformations (4.4%) and stillborn child (4.4%). Eighty-eight point nine percent (88.9%) of newborns had Apgar score greater than 7 and more than 48% were macrosomes. CONCLUSION: Gestational diabetes leads to maternofetal complications. Systematic screening is essential even in the absence of risk factors for optimal patient management.

[Knowledge, attitudes and practices of the populations of the city of Lomé relating to prevention of schistosomiasis: a case study conducted in the Canton of Légbassito]. / Connaissances, attitudes et pratiques des populations de la ville de Lomé en matière de prévention de la bilharziose: cas du canton de Légbassito.

INTRODUCTION: The purpose of this study was to determine the knowledge, attitudes and practices of the populations relating to schistosomal infestation. METHODS: We conducted a cross-sectional descriptive and analytical study of knowledges, attitudes and practices of the population of the township of Légbassito relating to schistosomiasis. The sampling calculated on the basis of the population of the township by the software DosBox 0.74 of Epi Info 3.5.4 allowed to investigate 380 subjects. RESULTS: The study highlighted that out of 380 people investigated, 57,30% were not aware of the symptoms of the disease, 40,10% did not know the mode of transmission of the disease, 26.40% knew that avoiding any contact with contaminated surface water could prevent the disease, 18,20% came into contact with fresh waters of the area in which 46,40% of them went to bathe. Regarding sewage disposal, 90,80% used latrines, 1.30% urinated sometimes in the streams, 85,80% used wells water for domestic needs, 48.40% didn't think they could live with an individual whose urine or stool contains blood, 24.5% were not often involved in mass treatment. CONCLUSION: The township of Légbassito is an endemic area for schistosomiasis infestation. Population attitudes and practices are unfavorable to the elimination of the disease, such as bathing during the hot hours, urinating in fresh waters and coming into contact with other water courses. These practices could lead to new cases of infestation.

[Patients living with human immunodeficiency virus on antiretroviral therapy diagnosed with lipid and carbohydrate disorders who are at risk of cardio-vascular disease: study conducted at the Medical Centre of the ONG Espoir Vie in Lomé]. / Troubles lipidiques et glucidiques à risque cardio-vasculaires chez les personnes vivant avec le virus d'immunodéficience humaine sous traitement antirétroviral: cas du centre de prise en charge médicale de l'ONG Espoir-Vie-Togo à Lomé.

Antiretroviral drugs are responsible for side effects or undesirable effects. These may include redistribution of adipose tissue and disorders of the lipid or carbohydrate metabolism. Given the growing number of people living with HIV (PLHIV) on antiretroviral therapy, it is necessary to assess the frequency of disorders of carbohydrate and lipid metabolism in patients who are on antiretroviral therapy (ARV). Our analysis focused on 493 patients with HIV/AIDS and on ARV treated in the Medical Centre of the ONG Espoir Vie Togo, Lomé. Paraclinical data such as blood glucose, serum total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were studied. The study showed the following anomalies: hypercholesterolemia, LDL hypercholesterolemia, HDL-hypocholesterolemia were found in 41.4%, 23.5% and 17.4% of patients respectively. The incidence of hyperglycemia was 12.4%. It is important to note that the incidence of lipido carbohydrate disorders was higher in patients receiving treatment schedule including protease inhibitors. The study also highlighted that 31.2% of patients with disorders of carbohydrate and lipid metabolism were overweight or obese. The incidence of these disorders differs depending on whether patients were under triple therapy including protease inhibitors or not.

[Knowledge, attitudes and practices of healthcare professionals at the Souro Sanou university hospital of Bobo Dioulasso regarding Mellitus diabetes]. / Connaissances, attitudes et pratiques des professionnels de Sante du centre hospitalier universitaire Souro Sanou de Bobo Dioulasso en Matiere de diabete sucre.

INTRODUCTION: In Burkina Faso, the insufficiency of doctoral interns, of endocrinologists, and medical services specialized in the coverage of the diabetes, means that these cases are relegated to general practitioners and the paramedical staff. OBJECTIVES: To study the level of knowledge, attitudes and practices of the medical and paramedical staff on the coverage of sugar diabetes in the Souro Sanou University Hospital of Bobo Dioulasso. METHOD: A cross-sectional study of descriptive type was conducted over a 3 month period, from March 1st to May 31st, 2013. The investigated population was constituted of healthcare professionals represented by general practitioners, female nurses, State-certified male nurses, and patented male nurses of the Souro Sanou University Hospital of Bobo Dioulasso. A questionnaire, adapted for each professional category, was administered to the participants. A notation grid enabled us to record the level of knowledge, attitude and practice of the staff regarding sugar induced diabetes. RESULTS: Three hundred four (304) healthcare professionals, 187 men and 117 women (sex ratio of 1.59) were investigated. The average age was of 40.84 years with extremes of 26 and 60 years. Their level of knowledge, attitude and practice on sugar induced diabetes varied from one professional category to another. Clinical signs of the disease, as well as its physiopathology were well known by healthcare providers. However, the definition of the disease, its diagnostic criteria, its classification by cause, were little known general practitioners. The general practitioners, had a good attitude and practice in front of a case of diabetes compared to other professional categories. CONCLUSION: Adapted staff recycling is essential across the professional categories for healthcare providers of the university hospital.

INTRODUCTION: Au Burkina Faso, l'insuffisance de médecins internistes, d'endocrinologues, et des services médicaux spécialisés dans la prise en charge du diabète sucré, font que les médecins généralistes et le personnel paramédical sont relégués au premier. OBJECTIFS: Etudier le niveau de connaissances, attitudes et pratiques du personnel médical et paramédical sur la prise en charge du diabète sucré au CHU SS de Bobo Dioulasso. MÉTHODE: Il s'est agi d'une étude transversale de type descriptif, déroulée sur trois (03) mois, du 1er mars au 31 mai 2013. La population enquêtée était constituée de professionnels de santé représentés par les médecins généralistes, les attachés de santé, les infirmiers diplômés d'état, les sages-femmes/maïeuticiens d'état, les infirmiers brevetés du CHU SS de Bobo Dioulasso. Un questionnaire a été administré au personnel consentant adaptée à la catégorie professionnelle. Une grille de notation a permis d'apprécier le niveau de connaissance, d'attitude et de pratique du personnel en matière de diabète sucré. RÉSULTATS: Trois cent quatre (304) agents de santé dont 187 hommes (sex ratio = 1,59) ont été enquêtés. Leur moyenne d'âge était de 40,84 ans avec des extrêmes de 26 et 60 ans. Leur niveau de connaissance, d'attitude et de pratique sur le diabète sucré était variable d'une catégorie professionnelle à une autre. Ainsi, les signes cliniques de la maladie, ainsi que sa physiopathologie étaient bien connus par les agents de santé. Cependant, la définition de la maladie, ses critères diagnostiques, sa classification étiologique, étaient peu connus des médecins généralistes. Les médecins généralistes, avaient une bonne attitude et pratique devant un cas de diabète sucré par rapport aux autres catégories professionnelles. CONCLUSION: Des besoins de recyclage du personnel adapté aux catégories professionneles s'avèrent indispensables pour les agents de santé du CHU SS.

Radiographie standard du thorax dans le diagnostic de la toux de l'adulte

Objectifs : Cette etude etait menee dans le but de determiner la frequence des demandes de radiographie standard du thorax dans le diagnostic de la toux; de decrire les differentes lesions radiographiques elementaires observees et de repertorier les differentes etiologies mises en evidence. Patients et methode : Il s'est agi d'une etude prospective de dix (10) mois portant sur 981 patients adultes recus pour radiographie du thorax dans le cadre de la toux. Les cas pathologiques diagnostiques nous ont permis d'etablir le diagnostic etiologique et la correlation entre les lesions radiographiques et les etiologies retenues. Resultats : La frequence de prescription de la radiographie du thorax dans le cadre de la toux etait de 17;02%. L'age de nos patients a varie de 18 a 87 ans avec 40 ans comme age moyen. Une predominance feminine s'etait degagee de notre etude 504 femmes contre 477 hommes. Les resultats etaient pathologiques dans 63;10% des cas (n=619). Les lesions pulmonaires de siege apical (45;88%; n=284) etaient dominantes. Les lesions elementaires se sont presentees en majorite sous forme d'opacites (73;83%; n=457). Les syndromes mixte (34;89%); alveolaire (21;97%) et interstitiel (18;09%) etaient les plus dominants. La tuberculose (50;46%; n=218) et la pneumonie communautaire (23;38%; n=101) etaient les principales etiologies repertoriees alors que le pneumothorax (01;39%; n=06) et le cancer broncho-pulmonaire (0;46%; n=02) etaient les moins representes. Toutes les lesions elementaires ont ete retrouvees dans la tuberculose avec une predominance des opacites micronodulaires (22;02%; n= 48) suivies des opacites alveolo-interstitielles (13;76%; n= 30). Les opacites systematisees avec bronchogramme aerien ont ete caracteristiques de la pneumonie dans 51;49% des cas (n= 52). Conclusion : La radiographie pulmonaire est d'un grand apport dans le diagnostic de la toux chez l'adulte

Post-operative pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Togo.

BACKGROUND: The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. PATIENTS AND METHODS: A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 January to 30 June 2012. Data collected include: demography, type of surgery, American Society of Anaesthesiologists (ASA) classification, anaesthetic protocol, analgesia technique, post-operative complications and cost of analgesia. RESULTS: The study includes 106 post-operative children. Abdominal surgery was performed in 41.5% and orthopaedic surgery in 31.1%. A total of 75% of patients were classified ASA 1. General anaesthesia (GA) was performed in 88%. Anaesthetists supervised post-operative care in 21.7% cases. Multimodal analgesia was used in every case and 12% of patients received a regional block. The most frequently unwanted effects of analgesics used were nausea and/or vomiting in 12.3%. At H24, child under 7 years have more pain assessment than those from 7 to 15 years (46% vs 24%) and this difference was statistically significant (chi-square = 4.7598; P = 0.0291 < 0.05). The average cost of peri-operative analgesia under loco regional analgesia (LRA) versus GA during the first 48 h post-operative was US $23 versus $46. CONCLUSION: Our study showed that post-operative pain management in paediatric surgery is often not well controlled and paediatric loco regional analgesia technique is under practiced in sub Saharan Africa.