[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.

[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.

[Non-traumatic splenic rupture revealed by acute renal failure]. / Rupture non traumatique de la rate révélée par une insuffisance rénale aiguë.

We report a case of rupture of spontaneous subcapsular splenic hematoma caused by toxic product and revealed by acute renal failure with intravascular hemolysis.

[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.

[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.