Comas non traumatiques chez l'adulte à l'Unité de soins intensifs du Centre Hospitalier Universitaire Sylvanus Olympio: à propos de 484 cas / Non-traumatic comas with the adult in the intensise care unit of the Sylvanus Olympio Teaching Hospital: concerning 484 cases

Introduction : Le coma non traumatique est une urgence médicale, relativement fréquente dont les différents aspects restent encore obscurs dans les services de réanimation en Afrique. Objectif : Cette étude avait pour but de décrire les aspects épidémiologiques, étiologiques et pronostiques des comas non traumatiques (CNT). Méthodes : Il s'était agi d'une étude rétrospective descriptive menée au Centre Hospitalier Universitaire Sylvanus Olympio à l'Unité des Soins Intensifs (USI) de janvier 2018 à décembre 2019. Résultats : L'étude avait concerné 484 patients hospitalisés pour comas non traumatiques sur un total de 1835 patients. Les comas non traumatiques de l'adulte représentaient 26,4% des admissions à l'USI. L'âge moyen des patients était de 52,8 ans (extrêmes de 18 et 92 ans) avec une sex-ratio (H/F) de 0,94. Plus de la moitié des patients avait été référée de structures sanitaires périphériques (55,4%). L'hypertension artérielle (HTA) était l'antécédent le plus retrouvé dans 36,4% ; suivi du diabète et de l'infection au virus de l'immunodéficience acquise (VIH) dans 14,9% chacun. Le coma était de survenue brutale dans 77,7% des cas. Les étiologies des comas étaient dominées par les causes vasculaires dans 32,2% des cas, puis les causes infectieuses dans 27,3% des cas et les comas urémiques dans 14,1% des cas. Le pronostic était défavorable avec une mortalité de 68,6%. La première étiologie de décès concernait les causes vasculaires. Conclusion : L'amélioration du pronostic des comas non traumatiques passe nécessairement par une amélioration du plateau technique pour une meilleure prise en charge des patients

Introduction: The non-traumatic coma is a medical emergency relatively frequent which different aspects remain obscure in intensive care units in Africa. Goals: The aim of this study was therefore to describe the epidemiological, etiological and prognostic aspects of non-traumatic comas. Methodology: This was a retrospective descriptive study carried out at the Sylvanus Olympio Teaching Hospital in the Intensive Care Unit (USI) from January 2018 to December 2019. Results: The study involved 484 patients hospitalized for non-traumatic comas out of 1835 patients. Non-traumatic comas in adults were 26.4% of admissions in the Intensive Care Unit. The mean age of patients was 52.8 years of a sex ratio (M / F) of 0.94. More than half of patients (55.4%) were referred from peripheral care centers. Arterial hypertension was the most common antecedent found in 36.4%, followed by diabetes and the infection of human immunodeficiency virus (HIV) at 14.9% each. The coma was sudden aspect in 77.7% of the cases. Aetiologies of the comas were dominated by vascular causes in 32.2% of causes, then infectious in 27.3% of cases and uremic comas in 14.1% of cases. The prognosis was unfavorable with 68.6% mortality. The first etiology of death was related to vascular cases. Conclusion: The Improving of the prognosis of non-traumatic comas needs an improvement of modern medical technology for a better patient care.

[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.

[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.

[Circumstances of diagnosis of diabetes mellitus at the Sylvanus Olympio University Hospital in Lomé]. / Les modes de révélation du diabète sucré au CHU Sylvanus Olympio de Lomé.

The purpose of this study was to describe the different circumstances in which diabetes mellitus was detected in the Department of Internal Medicine at the Sylvanus Olympio University Hospital in Lomé. We conducted a retrospective and descriptive study in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé from January 2015 to December 2017. During the study period, 307 patients with diabetes mellitus were admitted to our Department, of whom 104 did not know to have diabetes. The average age of patients was 51.27 years (ranging from 20 to 90 years), the sex ratio (M/F) was 0,5. Type 2 diabetes was diagnosed in 75% of cases, type 1 in 23% of cases and secondary in 2% of cases. The discovery of diabetes was fortuitous in 11.53% of cases (n=12). Some patients had symptoms (26.92%, n=28) while others had complications (61.53%, n=64). Complications included: ketoacidosis (n=34), hyperosmolar hyperglycemic syndrome (n=3), high blood pressure (n=8), ischemic stroke (n=4), diabetic foot (n=2), diabetic nephropathy (n=2), polyneuropathy (n=1), infections (n=18, 8 with metabolic complications). This study shows that in the Department of Internal Medicine, at the Sylvanus Olympio University Hospital in Lomé, diabetes mellitus is most commonly diagnosed when patients have complications. It is essential to educate our populations about prevention and screening tests.

[Epidemiological, diagnostic, therapeutic and evolutionary features of diabetic foot: a study conducted at the Medico-surgical Clinic, University Hospital Sylvanus Olympio in Lomé]. / Pied diabétique: aspects épidémiologique, diagnostique, thérapeutique et évolutif à la Clinique Médico-chirurgicale du CHU Sylvanus Olympio de Lomé.

BACKGROUND: Diabetic foot is a common and severe complication of diabetes. This study aimed to determine the epidemiological, diagnostic, therapeutic and evolutionary features of diabetic foot at a Hospital in Lomé (Togo). METHODS: We conducted a retrospective, descriptive study from 1 January 2011 to 31 December 2015 (5 years) at the Medico-surgical Clinic, University Hospital Sylvanus Olympio in Lomé All patients hospitalized for diabetic foot during the study period were enrolled. RESULTS: Diabetic foot prevalence was 12.90%. The average age of patients was 60,74 years (ranging from 39 to 86 years). Diabetic foot was predominant in male patients, with a sex ratio of 1.38. Type 2 diabetes was found in 88.70% of patients. The mean duration of diabetes evolution was 11.67 years (ranging from 1 to 24 years). Foot lesions were caused by a trauma resulting in a superinfected sore in 70.97% of cases. Gangrene (61.29%) and ischemic necrosis (12.90%) were the most common lesions. Neuropathy was the main etiopathogenetic factor (61.29). The majority of lesions (61.29%) were classified as Wagner grade 4 and 5 and 51,62% of patients underwent lower limb amputation. CONCLUSION: Foot lesions are frequent in diabetic patients living in Lomé. The fight against this scourge depends on education of patients and their caregivers as well on multidisciplinary and concerted patient management.

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

Epidemiology and antibiotic resistance of bacterial meningitis in Dapaong, northern Togo.

OBJECTIVE: To assess the seasonality of the bacterial meningitis and the antibiotic resistance of incriminated bacteria over the last three years in the northern Togo. METHODS: From January 2007 to January 2010, 533 cerebrospinal fluids (CSF) samples were collected from patients suspected of meningitis in the Regional Hospital of Dapaong (northern Togo). After microscopic examination, samples were cultured for bacterial identification and antibiotic susceptibility. RESULTS: The study included 533 patients (306 male and 227 female) aged from 1 day to 55 years [average age (13.00±2.07) years]. Bacterial isolation and identification were attempted for 254/533 (47.65%) samples. The bacterial species identified were: Neisseria meningitidis A (N. meningitidis A) (58.27%), Neisseria meningitidis W135 (N. meningitidis W135) (7.09%), Streptococcus pneumoniae (S. pneumoniae) (26.77%), Haemophilus influenza B (H. influenza B) (6.30%) and Enterobacteriaceae (1.57%). The results indicated that bacterial meningitis occur from November to May with a peak in February for H. influenzae and S. pneumoniae and March for Neisseriaceae. The distribution of positive CSF with regards to the age showed that subjects between 6 and 12 years followed by subjects of 0 to 5 years were most affected with respective frequencies of 67.82% and 56.52% (P<0.001). Susceptibility tests revealed that bacteria have developed resistance to several antibiotics including aminosides (resistance rate >20% for both bacterial strains), macrolides (resistance rate > 30% for H. influenzae) quinolones (resistance rate >15% for H. influenzae and N. meningitidis W135). Over three years, the prevalence of S. pneumoniae significantly increased from 8.48% to 73.33% (P<0.001), while the changes in the prevalence of H. influenzae B were not statistically significant: 4.24%, vs. 8.89%, (P = 0.233). CONCLUSIONS: Our results indicate that data in African countries differ depending on geographical location in relation to the African meningitis belt. This underlines the importance of epidemiological surveillance of bacterial meningitis.