Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects.

BACKGROUND: We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. METHODS: Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. RESULTS: We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15-90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050-4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. CONCLUSIONS: Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and  relative complications.

[Skin disease and HIV infection among inmates in Lomé, Togo: a study of 194 prisoners]. / Pathologie cutanée et infection à VIH chez les détenus à Lomé, Togo: étude de 194 cas.

OBJECTIVE: The aim of this work was to study the prevalence of skin diseases among inmates in Lomé (Togo) and its relation to their HIV status. PATIENTS AND METHODS: This cross-sectional descriptive study took place from November 14 to December 5, 2011, in the civil prison of Lomé and included prisoners who agreed to have an HIV screening test. RESULTS: In all, 194 prisoners, all men (median age: 29 years), were examined during the study period. The group aged younger than 30 years accounted for 51% of the population. Overall, 166 (85.6%) of the 194 prisoners examined had cutaneous lesions; 153 reported that these had developed after their imprisonment. HIV serology was positive in 21 (10.8%) of the 194 prisoners tested. The most common cutaneous diseases were pruritus (n = 62), fungal infections (n = 45), boils (n = 26), eczema (n = 21), and scabies (n = 20). The frequency of skin disorders did not differ significantly between HIV-infected prisoners and those who were not infected (p>0.05). CONCLUSION: This study shows a potential for high prevalence of HIV infection and an existing high prevalence of infectious dermatosis among these prisoners. It is essential to reduce the overpopulation and crowding in prisons to decrease the prevalence of these skin disorders.

[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.