Epidemiology of Non-Traumatic Lower Extremities Amputations in West Africa: Nationwide Data from Togo.

OBJECTIVE: Non-traumatic lower limb amputation (NT-LLA) has consequences at individual and public health levels. Population based studies in sub-Saharan Africa are scarce and often related to single centre series. This study aimed to estimate the incidence of NT-LLA (minor and major) and to describe epidemiological, clinical, and prognostic aspects in Togo. METHODS: This was a population based observational study conducted among all patients who underwent NT-LLA. Traumatic amputations were excluded. Sociodemographic, clinical, and work up data were collected from clinical files in any Togolese health centre from 1 January 2016 to 31 December 2021. Incidence rates were adjusted for age. RESULTS: Over the six year period, 352 patients (59% males) underwent NT-LLA (mean ± standard deviation age 60 ± 15.7 years). The average age adjusted incidence rate of NT-LLA was 8.5 per million/year (95% confidence interval [CI] 7.6 - 9.4). Men were 1.7 times more likely to undergo a NT-LLA than women. The relative risk of NT-LLA was 48 times higher in patients with diabetes than in patients without diabetes. Around 61.0% of the NT-LLAs occurred within the 50 - 74 age group and 54.3% had diabetes mellitus. Among amputees, 54.5% had a diagnosis of peripheral artery disease (PAD) and 52.8% had diabetic ulcers, with co-existence of several factors. Less than 5% of participants had a history of smoking tobacco. Average length of hospital stay was 12 days. The in hospital mortality rate was 8.8% (9.0% for major, 6.7% for minor amputations). Only 18.2% had duplex ultrasound performed and 1.7% angiography prior to amputation. No patient underwent vascular intervention prior to amputation. CONCLUSION: This is the first study to report nationwide and contemporary epidemiological data on NT-LLAs in West Africa, highlighting several specificities. Large scale interventions are needed to ameliorate the care of diabetes and PAD and improve facilities for optimal management of patients at risk of amputation in Africa.

Intrafat Sequestration of Artemisinin Disguised as a Purulent Collection during a Posterolateral Hip Approach.

The posterolateral hip approach is the oldest and most used way to implant total hip arthroplasty. The anterior part of the oblique portion of this posterolateral approach corresponds more or less to the superolateral quadrant of the buttock in which the intramuscular injection of various drugs, including the compounds derived from artemisinin, is carried out. Thus, in a malarial endemic area where gluteal injections of the compounds derived from artemisinin are not rare, poor performance of an injection by the deposition of the product in the fat and not deeply in the muscle can be at the origin of the sequestration of the drug in adipose tissue and give the macroscopic appearance of a pus. The authors present a case of intrafat sequestration of artemisinin taken for purulent collection during a posterolateral hip approach for total hip arthroplasty.

Sexuality, sexually transmitted infections and contraception among health sciences students in university of Lomé, Togo.

OBJECTIVES: Evaluate the practice of sexuality, contraception and the risk of sexually transmitted infections among students in the Faculty of Health Sciences, University of Lomé, Togo. RESULTS: Three hundred and sixteen (316) students were interviewed, with a response rate of 43.3%. The average age of students completing the form was 21.4 ± 2.7 years and their sex ratio was 2.2. Of this number of students who completed the form, 51.8% have already had sex. The mean age of first intercourse was 17.9 ± 3.2 years; 70.3% were heterosexual. Regarding the number of sexual partners, 48.5% of students had more than one partner, of whom 15.9% had at least 5 sexual partners. 21.5% of these students had only one sexual intercourse per month. Regarding contraception among students with the card, 67.5% of students used a method of contraception. Among those using contraceptives, it was a 55.3% condom, followed by the Ogino method at 14.1%. Some of our respondents used more than one method of contraception and 28.5% of respondents indicated that their partners used a method of contraception. For STIs, 10.8% of students completing the form were already infected. Gonorrhea was reported in 30.4% of cases, candidiasis in 26.1% of cases.

Mycetoma in the Togolese: An Update from a Single-Center Experience.

BACKGROUND: Mycetoma is a chronic inflammatory process caused either by fungi (eumycetoma) or bacteria (actinomycetoma). In this retrospective study, we report epidemiologic and histopathological data of mycetoma observed in the Lome Hospital, Togo in a 25-year period (1992-2016). METHODOLOGY: This is a retrospective study, over a period of 25 years, to analyze epidemiological and etiological findings of mycetomas seen in the single laboratory of pathological anatomy of the Lomé, Togo. RESULTS: A total of 61 cases were retrieved from which only 33 cases were included which where clinically and microbiologically confirmed. The mean age of the patients was 29.7 ± 1.34 and a sex ratio (M/F) of 1.5. The majority of patients were farmers (n = 23 cases; 69.7%). Diagnosed etiologic agents were fungal in 24 cases (72.7%) and actinomycotic cases in 9 cases (27.3%). The fungal mycetomas consisted of Madurella mycetomatis (black grains) and Falcifomispora senegaliensis (black grains). The actinomycotic agents were represented by Actinomadura madurae (white grains), Actinomadurae pelletieri (red grains) and Nocardia sp. (yellow grains). CONCLUSION: This report represents a single-center study which provides epidemiologic and histopathological data of mycetoma cases in Togo.

Descriptive Epidemiology of Cancers in Togo from 2009 to 2016

Background: Cancer is a global public health problem. According to World Report on Cancer in 2000, developing countries are becoming increasingly affected. Methods: This retrospective and descriptive 8-year study of all histological confirmed cancers was conducted using data from the anatomical pathology laboratory registry of Togo's only laboratory. The parameters were frequency, site and histological type as well as age and gender. Results: We found 1,738 cancers in patients aged from 4 months to 109 years (mean, 50.4 ± 4. The sex ratio (M/F) was 1.3. The most frequent localizations of the cancers were the prostate (10.3%) followed by the breast (9.9%), the stomach (8.4%) and the cervix (7.2%). In women, the median age was 47.4 ± 2.9 years, and the most common cancers were breast cancer (21.2%), followed by cervical cancer (16.3%). In men, the median age was 53.2 ± 7.3 years and the most frequent cancers were prostate cancer (18.5%), non-Hodgkin's lymphoma (13.2%) and stomach cancer (10.7%). In children, Burkitt's lymphoma (41.8%), retinoblastoma (11.6%) and nephroblastoma (9.6%) were the most important cancers. Conclusion: Cancers are frequent in Togo, those of the prostate, breast and cervix being most important with a worse prognosis. Emphasis should be placed on early detection and diagnosis.

Bilateral Divergent Shoulder's Fracture Dislocation Case in an Ischemic Stroke Patient.

INTRODUCTION: The literature review revealed that nowadays only about 15 cases of bilateral shoulder dislocation associated with the fracture of the upper end of the humerus have been published. The triad of lesional mechanism designated by the triple syndrome E composed of epilepsy, electrocution, and external trauma was the circumstances noted in which these fractures dislocations occur with migration of the two humeral heads either forward or backward. CASE REPORT: An architect of 36-year-old, right-handed, was admitted in emergency department for loss of knowledge of progressive installation. At admission the blood pressure, pulse, and temperature were normal. There was a right hemiparesis predominantly in brachiofacial side and an aphasia. After intensive resuscitation measures, the cerebral computed tomography scan revealed a left temporoparietal hypodensity area affecting the middle cerebral artery superficial territory with a mass effect compatible with acute ischemic stroke. During the hospitalization, episodes of generalized tonic-clonic convulsions appeared with a fever at 39°C and a leukocytosis at 35 thousand on the 5th day. These convulsions caused on the right shoulder an anterior dislocation under coracoid, associated with a fracture of the greater tubercle and on the left shoulder, posterior dislocation with much displaced comminuted articular proximal humeral fracture. We did reduction by external maneuvers for the right shoulder and open reduction with internal fixation by anatomical plate of left shoulder lesions. In the immediate aftermath of surgery, he presented episodes of agitation which led to the dismantling of the left shoulder fixation. He was evacuated to the North Country where an ablation of the left shoulder material and stabilization by locked plate were carried out. The sequelae were marked by the occurrence of an osteomyelitis with osteolysis of the entire upper right humerus extremity. It will require an inverted prosthesis. CONCLUSION: The surgical treatment must be done by a solid assembly and consultation with neurologists and anesthetists is essential. This multidisciplinary management could prevent any convulsive postoperative seizures that would risk sacrificing all therapeutic efforts.

Reconstruction of traumatic bone loss using the induced membrane technique: preliminary results about 11 cases.

INTRODUCTION: The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results. PATIENTS AND METHODS: It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions. AO plates or Orthofix external fixators were used for osteosynthesis. Bone healing was radiologically assessed and any complications were listed. RESULTS: During the study period, 11 patients were treated using the induced membrane technique. There were 8 males and 3 females. Their mean age was 40.45 years (21-59). The skeletal segments concerned were 2 humerus, 6 femurs and 3 tibias with a mean bone defect length of 4,45 cm (2.5-8). The delay between reconstruction and trauma was 8 months (20 days - 3 years). After a mean follow-up of 6.54 months (3-11) six patients presented a good radiological healing (4 femurs, 2 humerus) whereas in four patients, autograft osteointegration was still ongoing (2 femurs, 2 tibias). A tibia secondary infection was observed in a patient with the graft partial resorption. In another patient, an initial gangrene lead to a leg amputation. CONCLUSION: The induced membrane technique is an excellent option for bone defect reconstruction compared to other usual bone graft techniques. It helped us to manage large bone loss in various skeletal segments.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Extremity injuries in soldiers during the conflict in Mali: experience of Togo Level two Hospital.

PURPOSE: The aim of this study was to analyse war-related and non-war-related extremity injuries in soldiers in the Mali conflict. MATERIALS AND METHODS: This prospective study was performed from 1 May 1 to 31 December 2014. It concerned extremity injuries in soldiers treated at Togo Level 2 Hospital. RESULTS: Seventy-nine patients with an average age of 31.19 years were assessed. Among them, 50 were admitted after war injury and 29 from nonwar injury. Most war-related injuries were due to improvised explosive devices (IEDs) (36 %); road traffic accidents (51.72 %) were the main mechanism of non-war injury. A total of 125 injuries were analysed. Limb fractures were identified in 37 patients (29.6 %), and 22 cases (59.46 %) were open fractures. Twenty-six (20.8 %) patients had soft tissue wounds. The other injuries were sprains (18.4 %), muscle contusions (15.2 %), dislocations (8.8 %), traumatic amputations (4 %) and burns (3.2 %). Surgical debridement and external fixator application were the most frequently performed surgical procedures. Thirty-nine per cent of patients were evacuated to a level 3 hospital for better care. CONCLUSION: The severity of injuries and their rapid treatment require orthopaedic surgeons to have high levels of surgical experience and knowledge pertaining to military or disaster surgical doctrine.

[Epiphyseal growth fractures: epidemiology and treatment. Retrospective report of 44 cases]. / Les traumatismes du cartilage de croissance chez l'enfant: aspects epidemiologiques, lesionnels et therapeutiques a propos de 44 cas.

OBJECTIVE: To value the frequency of epiphyseal growth fracture and to take out the therapeutic aspects of the epiphyseal growth fracture and to value the results for un good management. PATIENTS AND METHOD: It is about a retrospective study carrying on 44 children aged of less than 15 years hospitalized and treated in the pediatric surgery department or the Tokoin teaching hospital (Lome) from 1st January 2002 to 31st December 2006. RESULTS: The prevalence of epiphyseal growth fracture was of 3.6% with a masculine predominance(59.1%). The middle age was of 9.8 }3.2 years.The type 2 lesions of Salter and Harris classification represented 44%. The accidents of game were the main suppliers (41 %) with affluence in April and August. The orthopedic treatment was applied in 64.4% of case. With a middle receding of 2 years, 4 patients had presented some afterrnaths. CONCLUSION: Epiphyseal growth fracture has a relatively frequency. The diagnostic trap of the epiphyseal growth fracture is numerous and is sometimes the origin of the therapeutic mistake. Their treatment must be well codified to avoid some long-term afterrnaths.

Les traumatismes du cartilage de croissance chez l'enfant : aspects épidémiologiques, lésionnels et thérapeutiques à propos de 44 cas

Objectif : Evaluer la fréquence des traumatismes du cartilage de croissance, faire ressortir les aspects thérapeutiques des traumatismes du cartilage de croissance chez l'enfant et en évaluer les résultats afin d'améliorer leur prise en charge. Patients et méthode : Il s'agit dune étude rétrospective portant sur 44 dossiers d'enfants âgés de moins de 15 ans allant de la période du 1er janvier 2002 au 31 décembre 2006, hospitalisés et traités dans le service de chirurgie pédiatrique du CHU Tokoin de Lomé pour traumatisme du cartilage de croissance. Résultats : La prévalence des traumatismes du cartilage de croissance était de 3,6% avec une prédominance masculine (59,1 %). L'âge moyen était de 9.8± 3,2 ans. Les lésions de type 2 de Salter et Harris avaient représenté 44% des cas. Les accidents de jeu en étaient les principaux pourvoyeurs (41 %) avec une affluence dans les mois d'avril et d'août. L'atteinte de l'extrémité inférieure du fémur avait représenté 28,9% des cas. Le traitement orthopédique était appliqué dans 64 4% des cas. Avec un recul moyen de 2 ans, 4 patients avaient présenté des séquelles. Conclusion : Les traumatismes du cartilage de croissance ont une fréquence relativement faible. Les pièges diagnostiques des traumatismes du cartilage de croissance sont nombreux et sont parfois à l'origine d'erreurs thérapeutiques. Leur prise en charge doit être bien codifiée pour éviter des séquelles à long terme