Evaluation of the tele-expertise project in the management of common dermatoses in Togo / Évaluation du projet de téléexpertise dans la prise en charge des dermatoses courantes au Togo

Introduction: Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo. Method: A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform. Results: A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist's expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist's diagnosis was not included in the health worker's hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice. Conclusions: The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Introduction: La téléexpertise en dermatologie représente une piste pour modifier l'exercice médical en réponse aux besoins d'économies de la santé. Le but de cette étude était d'évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode: Il s'agit d'une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l'analyse des données postées sur la plateforme de téléexpertise. Résultats: Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l'expertise du dermatologue n'a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l'hypothèse clinique unique proposée par l'agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l'agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n'avait été formulée dans 113 cas (15,3 %). La concordance entre l'hypothèse clinique proposée par l'agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l'acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions: Les résultats montrent la faisabilité et l'acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo.

AIM: The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. PATIENTS AND METHOD: Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. RESULTS: Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. CONCLUSION: Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

Risk factors associated with abscess formation among patient with leg erysipelas (cellulitis) in sub-Saharan Africa: a multicenter study.

BACKGROUND: Abscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries. METHOD: This is a multicenter prospective study conducted in dermatology units in eight sub-Saharan African countries from October 2013 to September 2014. We performed univariate and multivariate analysis to compare characteristics among the group of patients with leg erysipelas complicated with abscess against those without this complication. RESULTS: In this study, 562 cases of leg erysipelas were recruited in the eight sub-Saharan African countries. The mean age of patients was 43.67 years (SD =16.8) (Range: 15 to 88 years) with a sex-ratio (M/F) of 5/1. Out of the 562 cases, 63 patients (11.2%) had abscess formation as a complication. In multivariate analysis showed that the main associated factors with this complication were: nicotine addiction (aOR = 3.7; 95 % CI = [1.3 - 10.7]) and delayed antibiotic treatment initiation (delay of 10 days or more) (aOR = 4.6; 95 % CI = [1.8 - 11.8]). CONCLUSION: Delayed antibiotics treatment and nicotine addiction are the main risk factors associated with abscess formation of leg erysipelas in these countries. However, chronic alcohol intake, which is currently found in Europe as a potential risk factor, was less frequent in our study.

Is There an Association between Keloids and Blood Groups?

Objective. The aim of the study is to investigate the possible associations between the blood groups ABO and Rhesus systems and the presence of keloids in patients with black skin. Method. This case-control study was conducted between September 2007 and August 2011 comparing dermatologic outpatients with keloids to matched controls recruited in preanesthetic consultation at Tokoin Teaching Hospital of Lomé (Togo). Results. The distribution of different ABO blood groups and Rhesus blood groups in both groups (cases versus controls) was not significantly different. This distribution of different blood groups was superimposed on the general population of blood donors at the National Blood Transfusion Center of Lomé. Univariate analysis between each blood group and the presence of keloid does not yield any statistically significant association between blood groups and presence of keloids in the subjects. Conclusion. The study shows no significant association between blood groups and the presence of keloids in our patients. Further investigation needs to be conducted to elucidate this hypothesis further by conducting multicenter studies of several ethnic groups.

Acne and skin bleaching in Lomé, Togo.

OBJECTIVE: This study aims at describing the clinical characteristics of patients with acne using skin bleaching (SB) products. PATIENTS AND METHODS: This is a prospective study conducted over 8 months in three dermatology departments and one private clinic. All patients examined for acne were included in the study. RESULTS: The study included 119 patients examined for acne from March to October 2010. Among them 48 (40.7%) did SB. Hydroquinone was the first product used for SB (26 of 48), followed by topical corticosteroids (17 of 48). The elementary lesions were papules (99.2%), comedos (36.1%), pustules (63.9%), pigmentation (26.1%), scars (21%), and nodules (20.2%). The extent of acne on the face was observed in all patients (100%). The lesions were extensive among 43.7% of the patients. The extent of acne lesions was not statistically associated with SB. Other body areas concerned were the chest (20.2%), back, and shoulders (41.2%). The relative risk of having lesions on the back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.08-6.84), which is significant. CONCLUSION: The study suggests that the back and shoulders can be the main areas for acne lesions associated with the practice of SB. The influence of different types of product is unclear.

[Scientific dissemination of medical dissertations at the University of Lomé (Togo)]. / Devenir scientifique des thèses de médecine soutenues à l'université de Lomé (Togo).

INTRODUCTION: The medicine dissertation is often the last step of a physician's medical studies. Long considered a rite of passage, it is now regarded as a scientific work deserving attention from the national and international scientific community. The objectives of this study were to document the means by which dissertations at the University of Lomé Medical School are diffused and to determine their impact on the scientific production of medical school faculty. METHODOLOGY: This cross-sectional study included all dissertations in medicine at the University of Lomé from 1993 through 2002. We interviewed dissertation supervisors and co-supervisors (questionnaire-structured interviews) and consulted the Medline and CNRS/PASCAL databases, scientific communication registers and local journals to collect information. RESULTS: During this period, 240 dissertations were defended at the University of Lomé medical school. More than half came from the departments of medicine (n=85, 35.4%), surgery (n=57, 23.7%) and paediatrics (n=51, 22.5%). The majority dealt with epidemiological (47 %) and clinical (35.8 %) themes, and only a small minority concerned topics in microbiology and biochemistry (7.5 %). Ninety-nine dissertations (41 %) were published: 54 (22.5%) in indexed journals and 45 (18.5 %) in non-indexed journals; 130 (54%) were delivered as papers or posters at scientific meetings. The distribution of published dissertations according to department showed that the departments of paediatrics (51.3 %), medicine (21.2 %) and surgery (21 %) had the best rates of publication in indexed journals, compared with obstetrics and gynaecology (4 %) and basic science (13.8 %) departments. During the study period, faculty at the University of Lomé medical school published 264 articles in indexed journals: dissertations accounted for only 20.4 %. Dissertations made up a higher proportion of publications in the paediatrics department (32.2 %) than in surgery (20.7 %), medicine (19.8 %), basis sciences (14 %) or obstetrics and gynaecology (3.6 %). CONCLUSION: Our study shows that the proportion of published dissertations remains small and is even smaller if we consider only those published in indexed journals (22.5 %). Dissertations also account for an insignificant proportion of the publications by medical school faculty. This raises the question of the scientific interest that the faculty accord to these dissertations.

Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases.

AIM: To define the epidemiologic and clinical profile and course of the disease in African Kaposi's sarcoma (KS) and acquired immunodeficiency syndrome (AIDS)-associated KS in Togo. METHODS: This was a retrospective study performed on the medical records of patients seen at the Department of Dermatology, University Hospital of Lomé, Togo from January 1994 to December 2004. The medical records of all patients with KS, who had undergone human immunodeficiency virus (HIV) serology, were included in the study. RESULTS: Ninety-three files on 98 patients with KS, who had undergone HIV serology, were included in the study. The annual incidence during the study period was 8.5. HIV serology was positive in 73 patients (78.5%) and negative in 20 patients (21.5%). The mean age of the patients with AIDS-associated KS was 33.8 +/- 8.2 years, and 49.5 +/- 15.8 years for African KS. The male to female ratio for AIDS-associated KS was 1.4, and 9 for African KS. The mortality rate at 2 years for African KS was 5%, and 45% for AIDS-associated KS. CONCLUSION: The low level of access to antiretroviral drugs in HIV-infected patients explains the morbidity and mortality from AIDS-associated KS in Togo.