[Prevalence and Management of Snake Bite Envenomation at the Regional Hospital Center of Sokodé (Togo)]. / Prévalence et prise en charge des envenimations par morsure de serpent au centre hospitalier régional de Sokodé (Togo).

Snakebite envenomation (SBE) is a public health issue in Africa, unfortunately neglected and underestimated. SBE is a medical emergency that can be devastating and lifethreatening. A retrospective study was performed from January 1, 2016 to December 31, 2016 in the general medicine department of the Regional Hospital Center (CHR), Sokodé. We included 91 SBE accounting for 5.7% of the whole hospitalizations in the general medicine department at the CHR of Sokodé. The median age of the patients was 34 [23.5-42] with male predominance (59%). Farming activities (75%) and walking (24%) were the most frequent activities when SBE happened, and they occurred mostly in rural areas (80%) during the dry season (56%). Echis genus (37%) belonging to the Viperidae family was the king of snake most often identified. Hospital admission time after a bite often exceeded 24 hours (44%). Clinical manifestations resulted in 76 cases of viper syndrome (83%) and 7 cases of dry bites (8%). Antivenom was administered in 84 cases (92%) within 12 hours (54%) after the bite with a minimum dose of 20 mL (43%). Observed complications were severe anemia (19 cases) and diffuse hemorrhage (32 cases). Case fatality rate was 9%. Antivenom is critical in cases of obvious SBE. High cost and poor access of antivenom, in addition to delayed care due to traditional treatment seeking behavior, are factors of poor prognosis.

Il s'agit d'une étude rétrospective des envenimations par morsure de serpent qui s'est déroulée du 1er janvier 2016 au 31 décembre 2016 dans le service de médecine générale du CHR de Sokodé. En un an, 91 envenimations par morsure de serpent ont été incluses. Leur fréquence dans le service de médecine générale du CHR de Sokodé était de 5,7 %. L'âge médian des patients était de 34 ans [23,5-42] avec une prédominance masculine (59 %). Les travaux agricoles (75 %) et les déplacements pédestres (24 %) représentaient les circonstances de morsure survenant surtout en milieu rural (80 %) et pendant la saison sèche (56 %). Le genre Echis (37 %) appartenant à la famille des Viperidae était le serpent le plus souvent identifié. Le délai d'admission à l'hôpital après une morsure dépassait souvent les 24 heures chez 44 % des patients. Nous avons observé 76 syndromes vipérins (83 %) ; sept morsures blanches (8 %). L'immunothérapie antivenimeuse a été administrée dans 84 cas (92 %) dans un délai d'administration de 12 heures ou plus après la morsure (54 %) et une dose minimale de 20 ml (43 %). Les complications étaient marquées par une anémie sévère (19 cas) et des hémorragies diffuses (32 cas). Huit patients (9 %) sont décédés. L'immunothérapie antivenimeuse est indispensable en cas de signes évidents d'envenimation. Son coût élevé et son accessibilité parfois difficile associés au retard de prise en charge en raison du recours aux soins traditionnels en première intention sont des facteurs de mauvais pronostic.

Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral au centre hospitalier régional de Sokodé (Togo), une décennie après la gratuité de la trithérapie

Introduction : L'initiation tardive du Traitement Anti-Rétroviral (TAR) est fréquente dans les pays à ressources limitées, où la plupart des individus ne connaissent pas leur statut sérologique jusqu'à ce qu'ils soient symptomatiques.Matériel et méthodes : Il s'est agi d'une étude transversale et analytique, qui s'est déroulée du 1er janvier 2016 au 31 décembre 2016 dans le service de médecine générale du Centre Hospitalier Régional (CHR) de Sokodé, le service de référence dans la prise en charge de l'infection à VIH dans la région centrale du Togo.Résultats : Cent-neuf patients dont 15 enfants (13,8%) ont été inclus dans la file active du service de médecine générale du CHR de Sokodé par l'initiation du TAR. La moyenne d'âge des patients était de 32,38 ans [1-59 ans] avec une prédominance féminine (67,9%). La majorité des patients était classée aux stades III (60 cas ; 55%) et au stade IV (11 cas ; 10,1%). Les manifestations cliniques ou affections opportunistes étaient dominées par la diarrhée chronique (15 cas), la fièvre prolongée inexpliquée (12 cas) et la candidose oropharyngée (12 cas). Le taux moyen des CD4 des patients était de 328,54 cellules/mm3 [0-2216 cellules/mm3] et la co-infection VIH-VHB a été retrouvée dans 13,8% (n = 15). L'association Ténofovir (TDF) - Lamivudine (3TC) - Efavirenz (EFV) (87,2% ; n = 95) a été la plus prescrite pour l'initiation du TAR.Conclusion : Le profil des patients infectés par le VIH à l'initiation du TAR à Sokodé est caractérisé par un stade avancé de l'infection à VIH

Tuberculosis of the Breast in Togo: A Series of 28 Presumed Cases.

Our study aimed to describe the epidemiological, clinical and histological aspects of mammary tuberculosis in Togo. This is a descriptive cross-sectional study of breast tuberculosis for which the diagnosis was presumed on histological grounds in the pathology department (LAP) of the Lomé Tokoin university hospital from January 1995 to December 2016 (20 years). A total of 28 presumed cases of mammary tuberculosis were identified. There were 26 women and 2 men, with an average age of 34.2 ± 0.3 years. The clinical signs were nodule (84.1%), tumefaction (75%), abscess (63.6%) and tumefaction with cutaneous fistulization (59.1%). Breast involvement was isolated in 31.8% of cases and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was found in 63.9 % of cases. Histology showed inflammatory granulomas made of Langhans giant cells, epithelioid cells and lymphocytes around the foci of caseous necrosis. Thoracic radiography was abnormal in 16 patients (57.1%).Mammary tuberculosis is not rare in our country. Clinical presentation is often misleading and is a diagnostic challenge, more particularly with breast abscess or cancer.

[Analysis of a series of 44 cases of peritoneal tuberculosis diagnosed in the pathology laboratory of the Tokoin teaching hospital of Lomé (1993-2014)]. / Analyse d'une série de 44 cas de tuberculose péritonéale diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé (1993-2014).

It is a descriptive and cross-sectional study on all issues relating to peritoneal tuberculosis histological diagnosed in the pathology department (LAP) of the Lomé Tokoin CHU from January 1993 to December 2014 (20 years). A total of 44 cases of peritoneal tuberculosis were included. They were 18 women and 26 men, with a mean age of 37.6±0.2 years. The circumstances of discovery were dominated by ascites (84.1%), fever (75%), weight loss (63.6%) and abdominal pain (59.1%). The peritoneal involvement was isolated in 31.8% of cases, and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was present in 63.9% of cases. Twenty-five patients (69.4%) with information about their social conditions had low socioeconomic level: unemployed (10 cases; 40%), workers (10 cases; 40%) and retired (5 cases; 20%). An increase in cell count was observed in 94.6% of cases. Histology revealed the epithelial giant cell granuloma associated with caseous necrosis in 38 cases (86.4%) and cheesy isolated in 6 patients. Peritoneal tuberculosis is not exceptional in our country. The diagnosis should be considered in febrile ascites, and will be confirmed by laparoscopy with histological samples for a histological diagnosis.

[Prevalence of HIV-TB co-infection and impact of HIV infection on pulmonary tuberculosis outcome in Togo]. / Prévalence de la co-infection VIH-tuberculose et impact de l'infection VIH sur l'évolution de la tuberculose pulmonaire au Togo.

The aim of this study was to determine the prevalence of HIV infection in tuberculosis patients and its impact on the TB treatment. We enrolled 569 pulmonary TB patients in four diagnosis and treatment centres in Togo. All patients were new TB cases and received the first-line TB drugs: two months of rifampicin-pyrazinamide-isoniazid-ethambutol and six months of isoniazid-ethambutol. HIV testing was done according to the national guidelines, using rapid diagnosis tests. The CD4 lymphocyte counting was performed by Facscalibur (BD, Sciences) for all HIV-positive patients. Of the 569 TB patients enrolled, 135 (23.7%) were HIV positive (TB/HIV+). HIV prevalence was 22.4% (76 of 339) among men and 25.6% (59 of 230) among women without statistical difference. The global rate of treatment success was 82.2%. The rate of treatment success was lower (64.3%) in TB/HIV+ patients than in TB/HIV- patients (87.5%) (p <0.01). The mortality rates were 25.6% and 11.8% in TB/HIV+ patients and TB/HIV- patients, respectively, with a statistically significant difference (p <0.01). We did not found any statistical difference between the rates of treatment success among TB/HIV- (87.5%) patients and TB/HIV+ patients who had TCD4 lymphocyte counts above 200/µl (84.4%). TB program in Togo must take into account HIV infection to improve its performance.

[Kidney ultrasound scan performed on the adult patient with HIV serology positive in the University Hospital of Tokoin and campus of Lome]. / Echographie renale chez le sujet adulte porteur du VIH aux CHU Tokoin et campus de Lome.

PURPOSES: To describe the elementary lesions, to list the kidney pathologies, to determine the kidney reach frequency and to establish an interrelationship enters the gravity of the kidney reach and the kidney's structure at the ultrasound scan. PATIENT AND METHOD: It was about a prospective survey of ten (10) month, realized in the Departments of radiology of the Teaching Hospitals of Lomé (CHU Tokoin and Campus), concerning 281 patients aged of 18 to 71 years whose HIV serology is positive. RESULTS: The radiological frequency of the HIV/AIDS infection noted during our period of survey was of 3.27% (281/8583). The modal age group was of 30-40 years (32.38%). The female representativeness was 56.92% against 43.08% of men. The drivers (23.13%) follow-ups of the tradesmen were the more touched. The bachelors were more exposed (38.43%). The kidney increased size in 31.85% of the cases. The majority of the patients (88.19%) was at the echographic advanced stage of the renal suffering of which 70.08% were at the III stage. The length of the kidneys was generally normal (74.38%), their width was normal in 53.38% of the cases and increased in 44.42% of the cases. As for the thickness, it was increased in general (71.88%). The kidney suffering (49.03%) was the most dominant pathology. CONCLUSION: The wealth of the kidney pathology associated to the infection of the HIV/AIDS should bring the practitioners to integrate the ultrasound scan in the balance of this affection.

Echographie renale chez le sujet adulte porteur du VIH aux CHU Tokoin et Campus de Lomé

Objectifs : Par ce travail nous voulons decrire les lesions elementaires; repertorier les pathologies renales; determiner la frequence des atteintes renales et etablir une correlation entre la gravite de l'atteinte renale et la structure renale a l'echographie.Patients et methode : Il s'est agi d'une etude prospective de dix (10) mois; menee dans les services de radiologie des CHU Tokoin et Campus de Lome; concernant 281 patients ages de 18 a 71 ans dont la serologie VIH est positive. Resultats : La frequence radiologique de l'infection VIH/SIDA notee pendant notre periode d'etude etait de 3;27(281/8583). La tranche d'age modale etait de 30 a 40 ans (32;38). La representativite feminine etait 56;92contre 43;08d'hommes. Les chauffeurs (23;13) suivis des commercants etaient les plus touches. Les celibataires etaient les plus exposes (38;43) Le rein a augmente de taille dans 31;85des cas. La majorite des patients (88;19) etait a des stades echographiques avances de la souffrance renale dont 70;08au stade III. La longueur des reins etait generalement normale (74;38); leur largeur etait normale dans 53;38des cas et augmentee dans 44;42des cas. Quant a l'epaisseur; elle etait en general augmentee (71;88). La souffrance renale (49;03) etait la pathologie la plus dominante. Conclusion : La richesse de la pathologie renale associee a l'infection au VIH /SIDA devrait amener les praticiens a integrer l'echographie dans le bilan de cette affection