Neuromyelitis optica in Sub-Saharan Africa: the first case report from Togo.

Neuromyelitis optica (NMO) appears to affect blacks disproportionately in mixed populations. We report the first case of documented NMO in Togo (West Africa). A 26-year-old Togolese woman was admitted for progressive tetraplegia, acute urine retention, and dyspnea. Magnetic resonance imaging of the cervical spinal cord demonstrated an extensive longitudinal lesion, and an ophthalmologic examination found bilateral optic neuritis. Antibody testing for AQP4-IgG was positive. The patient died of severe respiratory distress despite high doses of intravenous corticosteroids. Epidemiological data about NMO in sub-Saharan Africa would improve our understanding of the role of genetic and environmental risk factors in this disease.

[Management of spinal cord compression in Togo]. / Prise en charge des compressions médullaires lentes au Togo.

PURPOSE: The aim of this study was to describe the epidemiologic, clinical, diagnostic and therapeutic aspects of spinal cord compression at the Lomé-Campus teaching hospital. MATERIAL AND METHOD: We retrospectively analyzed the files of all patients hospitalized for spinal cord compression at Lome-Campus teaching hospital from January 1, 1998, through December 31, 2007. RESULTS: 39 files were selected, mostly of men (77%). The mean age was 53 years (range: 22 to 79). Median time from the start of symptoms to hospital admission was 14.9 ± 24.5 weeks. The spinal cord compression was confirmed by myeloscan in 35 cases (90%), myelography in 2 (5%) and magnetic resonance imaging in 2 cases (5%). The thoracic spine was the most common site of involvement. The principal cause was malignant neoplasm (17 cases: 44%), followed by cervical spondylotic myelopathy (9 cases: 23%) and Pott's disease (7 cases: 18%). Only one patient underwent surgery. CONCLUSION: Spinal cord compression appears to be a rare condition in Togo. It is a true medical emergency and immediate intervention is required. Its management remains precarious and its prognosis poor.

[Evaluation of asthma care in Africa]. / Evaluation de la prise en charge de l'asthme en Afrique.

BACKGROUND: Despite international recommendations, asthma is still considered as a condition that is not perfectly managed. This was the first study performed in Togo to access asthma management among physicians. OBJECTIVE: To evaluate the attitude of physicians and internes in the management of asthma in Togo. Methods Descriptive survey through auto-questionnaire conducted among physicians and internes on 1st through 31st march 2005. The studied population was 159 physicians who at least managed once an asthma patient. Computerized data were the initial complementary check up in asthma patients, the prescription habit during and between acute periods, the knowledge of the technical procedure of metered-dose inhaled devices, the using of peak-flow meter and prescription of sport. Data analysis was performed with Epi 2002 software. RESULTS: Participation rate was 78%. The peak-flow meter wasn't known by the investigated physicians and was prescribed by only 14.5% of them. Chest X-ray (97.5%) and hemogram (91.2%) were the most prescribed analysis. For the management of acute periods of asthma, beta 2 agonists were prescribed especially for inhaled route or for drips often combined with corticosteroïds. Between acute periods, aerosol of beta 2 agonists were prescribed with corticosteroïds (metered-dose aerosol and tablets). Dry powders were not known. Physicians in Togo forbade sport in 44%. CONCLUSION: Asthma management is not correctly done in Togo.

[Smoking among journalists in the private and public media in Togo]. / Tabagisme dans les médias publics et privés du Togo.

BACKGROUND: Collaboration with journalists should help to reduce the tobacco epidemic. All over the world, no study assessed the extent of tobacco smoking in the bosom of reporters. OBJECTIVE: To determine the prevalence of tobacco smoking among reporters and to evaluate their attitudes towards tobacco. MATERIALS AND METHODS: A cross-sectional survey using an anonymised questionnaire was conducted among reporters working for both the public and private media in Togo between the 1st May and the 31st June 2005 using the "from door to door" method. Data analysis was performed with Epi-Info 3.3.2. RESULTS: The participation rate was 82.44%. The prevalence of tobacco smoking was 25%. Smoking was more common in men (26.1% versus 19.6%, p=0.03). The average age that subjects had started to smoke was 17.1 years (Range: 6 and 30 years) with all smokers reporting that they smoked tobacco only in the form of cigarettes. 79.3% of smokers thought that they would quit within the next five years. Only 6.2% reporters often talked about smoking while on the microphone. A majority of the reporters approved of anti-smoking initiatives. CONCLUSION: Because of their importance in the diffusion of news, the media must be enrolled in the fight against tobacco.

Attitudes of private pharmacists in the management of asthma patients in Lomé.

BACKGROUND: Optimal asthma management requires interventions by a number of health professionals, including pharmacists. OBJECTIVE: To assess the attitudes of pharmacists towards asthma patients and to evaluate their knowledge about how to use the metered dose inhaler. METHODS: A descriptive survey through self-administered questionnaire was conducted among pharmacists in private pharmacies in Lomé, Togo. Pharmacists who did not respond before the sixth round of the investigator were excluded from the study. RESULTS: The participation rate was 76.4%. All pharmacists stated that asthma patients visited their pharmacies during and/or between acute episodes. Some asthma patients visited the pharmacies without prior medical prescription. Asthma drugs were delivered without medical prescription, particularly during acute episodes. In case of acute episodes, care was provided by 51.2% of pharmacists. Aerosol devices were the most widely used treatment, although the technical procedures required for correct inhalation were found to be poorly understood by 27.4% of the pharmacists. Pharmacists provided recommendations to patients on long-term treatment, regular medical follow-up and avoidance of allergens and tobacco smoking. CONCLUSION: Rather than limiting their action to dispensing drugs, pharmacists can also become involved in educating asthma patients.