Normal values of sudomotor function assessed by electrochemical skin conductance in African population.

BACKGROUND: Dysfunction of small nerve fibers remains a major public health concern. Subjects suspected of having small nerve fiber damage need to undergo reliable tests to confirm the diagnosis. Sudomotor function test is a reliable noninvasive exploration for detecting peripheral neuropathies. Nevertheless, the normal reference values derived from the sudomotor function test are not known in the African population. The objective of this study was therefore to describe the normal values of Electrochemical Skin Conductance (ESC) measured by the sudomotor function test in healthy African subjects. MATERIALS AND METHODS: Between December 1st, 2021 and May 31st, 2022, ESC was measured in 475 healthy subjects (median age: 42 [31-53] years, 46% men) using a sudomotor function test, in the hands and feet. Investigators proposed the examination and received participants' consent; demographic, anthropometric, biological, and clinical data were obtained before the test. Data on 475 healthy study participants who underwent sudomotor function testing was collected and analyzed. The sociodemographic (age, sex), anthropometric (weight, height, waist circumference, body mass index), diastolic blood pressure, systolic blood pressure, heart rate, and electrochemical skin conductances of the hands and feet were assessed. RESULTS: ESC values were statistically higher in men compared to women (right hand ESC: 70 [60-78] versus 63 [53-72], left hand ESC: 72 [61-80] versus 68 [57-75], right foot ESC: 77 [82-99] versus 72 [64-79], ESC left foot: 76 [68-82] versus 72 [62-78] respectively). ESC values were significantly inversely correlated with age (right hand ESC: r=-0.12, P=0.006; left hand ESC: r=-0.11, P=0.01; right foot ESC: r=-0.37, P<0.0001; ESC left foot: r=-0.38, P<0.0001). ESC values measured in feet were significantly inversely correlated with body mass index (right foot r=-0.22, P<0.0001; left foot r=-0.21, P<0.0001). CONCLUSION: This study reports normal reference values for ESCs according to age and gender in the healthy African population. Progressive decrease in ESC with aging is confirmed by our data. The value of ESC seems lower in the African population than in other reported ethnicities. This finding needs to be further explored in additional studies.

[Guillain-Barré syndrome in hospitals in Togo]. / Syndrome de Guillain-Barré en milieu hospitalier au Togo.

Introduction: In sub-Saharan Africa characterized by limited resources especially in health facilities and a relatively higher frequency of infectious diseases, studies on Guillain-Barré syndrome (GBS) are rare. Objectives: The objectives of this work are to describe the characteristics of GBS in Togo through a cohort of patients followed in the neurology unit of the Campus University Hospital of Lomé. Methodology: The study took place from May 2015 to July 2019. Patients with GBS of levels 1 to 3 of the Brighton criteria for diagnostic certainty were included consecutively and assessed at admission, at 6 months and at 1 year with the GBS disability score and the MRC sum score. Qualitative and quantitative variables were expressed, respectively, in frequency and median (interquartile range). Results: Out of 7012 hospitalized patients, 28 (0.39%) including 20 women (71%) with a median age of 40 (27-53) years, presented GBS. The clinical presentation mainly consisted of bilateral sensory-motor disorders predominantly in the lower limbs associated with facial diplegia and preceded by an infectious event. On admission, 39% of patients (n=11) were able to walk (GBS score 0 to 3) and the median MRC sum score was 28 (12-38). Cytoalbuminologic dissociation was present in 654% of patients (13 of 20 patients who underwent lumbar puncture). The demyelinating and axonal subtypes each accounted for 47% (9 of 19 patients who underwent an electroneuromyography examination). Immunoglobulins and intravenous corticosteroid therapy were administered in 18% (n=5) and 50% (n=14) of patients, respectively. Lethality rate during hospitalization was 11% (n=3). The median MRC sum score at 6 and 12 month-outcome were 40 (38-49) and 51 (46-58), respectively. After one year of evolution, case fatality rate was 18% (n=5), and 78% of survivors (n=14) could walk without assistance, of which 17% (n=3) were asymptomatic. Conclusion: In Togo, GBS, with a low hospital prevalence, remains a serious condition due to its high morbidity and lethality related to non-optimal treatment and delayed management.

[Disseminated cysticercosis: report of three cases in Togo]. / Cysticercose disséminée: trois cas au Togo.

We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.

Prevalence of cardiovascular risk factors in an urban area of Togo: a WHO STEPS-wise approach in Lome, Togo.

OBJECTIVE: To determine the prevalence of hypertension and other cardiovascular risk factors in the general adult population of Lome. METHODS: A cross-sectional household survey was conducted in Lome from October 2009 to January 2010, which focused on hypertension and other cardiovascular risk factors in 2 000 subjects 18 years and older. The World Health Organisation's STEPS-wise approach on non-communicable diseases was used. During the first session, blood pressure (BP) was measured on three successive occasions, one minute apart, and the mean was recorded. A second measurement session was done three weeks later in patients with BP ≥ 140/90 mmHg during the first session. Hypertension was defined as BP > 140/90 mmHg after the second session, or on antihypertensive treatment. The other risk factors were studied by clinical and blood analysis. RESULTS: We found 532 hypertensive patients out of a total of 2 000 subjects. The prevalence of hypertension was 26.6%. The mean age of hypertensive patients was 45 ± 10 years, ranging from 18 to 98 years. The prevalence of other cardiovascular risk factors was: stress (43%), sedentary lifestyle (41%), hypercholesterolaemia (26%), obesity (25.2%), hypertriglyceridaemia (21%), smoking (9.3%), alcohol use (11%) and diabetes (7.3%). CONCLUSIONS: The prevalence of hypertension and other cardiovascular risk factors in the population of Lome is high. These findings should draw the attention of authorities to define a national policy to combat hypertension and other cardiovascular risk factors.

Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study.

In order to determine the rate and the different causes of mortality associated with HIV/AIDS in health-care facilities we conducted a prospective study between 1 April and 30 September 2010 in the six health regions of Togo. We rationalized the choice of the healthcare facilities in order to cover the entire national territory. During the study period, 24,054 patients were hospitalized. HIV serology was positive in 1065 (18.2%) of the 5865 tested patients. Of the 24,054 patients, we recorded 2551 deaths (10.6%), including 309 HIV-infected patients (5.2%). The mortality rate associated with HIV/AIDS was 1.3% of the total number of inpatients and 5.3% of the number of patients tested for HIV. The mortality rate among HIV-infected patients was 29%. The causes of death in patients infected with HIV/AIDS were mainly anaemia and cerebral toxoplasmosis. This study shows that mortality associated with HIV/AIDS in health-care facilities in Togo remains relatively high.

[Opportunistic infections of the HIV/AIDS in adults in hospital settings in Togo]. / Infections opportunistes du VIH/sida chez les adultes en milieu hospitalier au Togo.

The objective of this study is to determine the main opportunistic infections (OI) and those strongly linked to high death rate in hospital settings in Togo. It is a descriptive study conducted from June to November 2008 in 22 public and private settings of all medical specialties throughout the entire Togolese territory. Hospitalized patients with OI and HIV positive data were collected. The study was started after getting patient approval. Of 7,361 hospitalized patients, 1,764 were tested, giving a screening rate of 23.7%. We registered 714 HIV-infected patients (HIVIP), 40.5% of the patients tested. The most common OI encountered were buccal candidiasis (49.7% of HIVIP), genital candidiasis (9.1%), meningeal cryptococcosis (2.9%), bacterial infections (48.2%), cerebral toxoplasmosis (11.2%) and pulmonary tuberculosis (11.3%). OI strongly linked to a high death rate were meningeal cryptococcosis (61.9%) and cerebral toxoplasmosis (46.3%). OI constitute a major reason of hospitalization for HIVIP in Togo. This study allows a better orientation of strategies for screening and taking care of HIVIP in Togo.

[Cerebral vascular accidents and embolic cardiovascular diseases]. / Accidents vasculaires cerebraux (AVC) et affections cardio-vasculaires emboligenes.

The cardiopathies occupy a place of choice in CVA (cerebro vascular accident) but in Togo no work have been done in this sector to realize it. Our work had for an objective to determine the prevalence of the association of cardiopathy and CVA (cerebro vascular accident). To determine the prevalence of embologenic cardiopathies. It was about a retrospective study on 91 files on 1102 cases of CVA (cerebro vascular accident) admitted from 1st January 2001 to 31st December 2005 in cardiological and neurological units in CHU Campus Lomé. The prevalence was of 8,25%, the average age was 59,19 years +/- 11,45. The sex ratio was 1,06. The principal affections found were embologenic cardiopathies 89,01% among which we can note troubles of the rhythm (41,75%), Ischaemia cardiopathies (27,47%), The valvulopathies (23,07%), The endocarditis (8,87%). The principal cardiovascular risk factors was arterial hypertension (60,43%), dyslipidémia (51,65%) and alcool (31,87%). The mortality rate was 27,47% and the morbidity rate was (50,55%), The association of the cardiopathies and C.V.A (cerebro vascular accident) constitute a public health problem in Togo. The embologenic cardiopathies occupy in this sector a preponderant place. The early prevention of this association must have for a target surely rhumatismal cardiopathy than arterial hypertension and its risk factors.

Management of epilepsy patients in Batamariba district, Togo.

OBJECTIVE: To describe the feasibility of managing epilepsy in a rural setting in a developing country. METHODS: The project comprised four phases. After a study of the perception of epilepsy, we conducted a sensitization campaign in November 2001. The third phase was a survey, to detect epilepsy patients, in which 6249 persons were asked to complete a questionnaire. Persons with epilepsy were then examined, treated, mainly with phenobarbital, and followed up. RESULTS: The prevalence of epilepsy was estimated to be 15.7 per thousand. Ninety-two patients took antiepileptic drugs from 1 February 2002. By November 2005, 92.7% of all treated patients had achieved complete suppression of seizures, and 7.3% had reduced seizure frequency. CONCLUSIONS: Despite the stigma attached to epilepsy in many developing countries, it can be controlled by relatively simple measures. At present, 601 epilepsy patients are being followed up at the Nadoba health centre, where epilepsy is now the second commonest disease.

[Neurological disorders and endemic goiter: comparative analysis of 2 provinces in Togo]. / Affections neurologiques et endémie goitreuse: analyse comparative de deux provinces du Togo.

Neurological diseases are one of the main causes of high mortality and morbidity in developing countries. The prevention of these diseases is possible if they are well known. The purpose of this study was to evaluate the prevalence and the distribution of the main neurological affections in two rural districts. WHO research protocol for measuring the prevalence of neurological disorders in developing countries was used by the same staff. The first survey was conducted in Kloto from July to August 1989 on 19,241 inhabitants and the second in Akébou from January to February 1995 on 4182 subjects. Akébou was known as endemic goiter district. The prevalence of epilepsy was 12.3@1000 in Kloto and 13.1@1000 in Akébou. That of stroke was 2.4@1000 in Kloto versus 1.7@1000 in Akébou. The prevalence of Parkinson's disease was 0.2@1000 in Kloto and 0.2@1000 in Akébou. That of psychomotor retardation was 3.2@1000 in Kloto versus 8.1@1000 in Akébou. The prevalence of neurological cretinism was 97@1000 while that of myxoedematous cretinism was 31@1000 in Akébou. Apart from neurological disease, the prevalence of goitre was 43% in females and 26.1% in males in Akébou. Mental retardation and cretinism were frequent in Akébou, a district endemic for goitre. Besides stroke and febrile convulsions which predominated in Kloto, the main neurological disorders were most prevalent in Akébou. Community based care for epilepsy is provided in these districts as is the prevention of iodine deficiency in the Akébou district with the intention of reducing neurological affections.

[Prevalence of HTLV-1 virus infection in Togo (Kozah prefecture and the University Hospital Center of Lomé]. / Prévalence de l'infection par le virus HTLV-1 au Togo (préfecture de la Kozah et CHU de Lomé).

The aim of this study was to determine the prevalence of Human T cell Leukaemia Virus Type 1 (HTLV1) in a representative population sample, in neurological and non-neurological patients hospitalised in the Lomé teaching hospital in order to study the clinical manifestations of this retrovirus. There was no statistical difference among the three groups concerning the prevalence of HTLV1 respectively (1.2%: 21/1717, 1.8%: 15/828 and 1.6%: 4/244). Spastic paraparesis was the only disease significantly linked to HTLV1 (15.5%: 9/58).

[Cysticercosis and epilepsy in the city of Tone, north of Togo]. / Cysticercose et épilepsie au nord du Togo dans le Tone.

An epidemiology study was conducted in Tone, a city in the very north of Togo from November 1 to 25, 1995. The prevalence of epilepsy was studied in 9,155 subjects and seroprevalence of cysticercosis in 1,343. This was a representative sample of this region with 194,000 inhabitants. The prevalence of epilepsy was 18.6 per 1 000 inhabitants. A causal relationship was found betwen cysticercosis and epilepsy. The prevalenced of cysticercosis was 38 per 1 000 persons in the general population and 135.29 per 1 000 epileptic patients. The difference was highly statistically significant (X( 2)=74.17, p<10(-6)).

[Clinical and epidemiological aspects of traditional therapeutic scarification in epilepsy in Togo]. / Intérêts cliniques et épidémiologiques des scarifications thérapeutiques traditionnelles chez l'épileptique au Togo.

One of the major problems of epilepsy in Africa are its social implications. Prejudice against the disease is common and epileptics are marginalised. Epilepsy is concealed from all non-family members. The very pronunciation of the word "falling disease" (as epilepsy is called) is taboo, the disease being regarded as supernatural. This unfavourable context introduces considerable bias in hospital and population-based studies. Traditional doctors are consulted by patients especially when they have such a "supernatural" disease. Traditional scarifications are used for the treatment of epileptics in Togo. We examined the skin of 36,000 patients in the neurological department of Lomé's teaching hospital between 1985 and 1995 and conducted a similar, population-based study on about 20,000 inhabitants in the Kloto district of south-western Togo and on 10,000 inhabitants in the Tone district of northern Togo. Interviews with 40,000 traditional doctors revealed that forehead scarifications are characteristic of epilepsy treatment. More than 80% of epileptics have forehead scarifications. When the seizures are rare, scarifications are slim, short (1-3 mm), near the roots of hair on the forehead and concealed; but when they are frequent, known by many people, scarifications are large, long, visible on forehead, the patient showing the sign of his social sentence.. On the skin of epileptics in Togo, is written the diagnosis of his affection. It only needs to look at it.

[Traditional tattoos with neurological diseases in Togo]. / Les scarifications traditionnelles chez les malades neurologiques au Togo.

In Africa, there are two types of health systems: the modern system and the traditional one. Traditional medicine attracts more patients, because it is more financially accessible and corresponds to cultural representations of disease in society. Traditional therapeutic tattoos are not well known by the conventional health system in West Africa, although they are commonly used by traditional healers. We report here our experience of these tattoos. We examined the skin of 36,000 patients in the neurological department of the teaching hospital of Lome from 1985 to 1995. We found three types of tattoos amongst patients. The first are tribal or social tattoos: they are large, homogeneous, located on exposed parts of the body and can be seen easily by others (fig 1: g, h, i), whilst therapeutic tattoos are slight and hidden under clothes and can also be repeated (heterogeneous). The second type of tattoo is one that reveals the patient's pathological history. The third is linked to the motive of consultation. Seventy-five per cent (75%) of patients had traditional therapeutic tattoos. Epilepsy tattoos are slim, located on the forehead (fig 1a); peripheral facial paralysis tattoos are found on the facial nerve (fig 1 b). In cases of peripheral neuropathy, tattoos are symmetrically distributed on hands and legs (fig 1 f). As for medullar compression, the highest tattoos correspond to the level of compression. Studying the localisation, age, and aim of tattoos brings to light their diagnostic, prognostic, and epidemiological interests. Skin can thus reveal itself to medical staff as an open, though coded, medical file. They need only to learn how to read it.

[Sexual behavior, knowledge and attitudes to AIDS and sexually transmitted diseases of students at the University of Benin (Togo)]. / Comportements sexuels, connaissances et attitudes des étudiants de l'Université du Bénin (Togo) face au sida et aux maladies sexuellement transmissibles.

Many studies have shown that in Africa, particularly in Togo, the 20- to 29-year-old age group is the age group most frequently affected by AIDS. This age group accounts for 84% of the students of the University of Benin. We studied students, most of the age group thought to be most at risk, investigating sexual behavior, knowledge and attitudes to AIDS and sexually transmitted diseases (STDs). The level of knowledge about the problems of AIDS and STDs was similar for both sexes and for all ages and levels of education of the students. Students had a reasonable knowledge of AIDS, particularly concerning the transmission of HIV (88.6% of students aware), risk behavior (80.8%), AIDS treatment (57.0%) and more general information about HIV (49.4%). They were poorly informed about the transmission (42.9%) and complications (0.69%) of other STDs. Most students had positive attitudes towards HIV issues, particularly the use of preventive measures (3.41 in 5) and the acceptance of infected individuals (3.98 in 5). However, few had seriously considered that AIDS and STDs might impact on their own sex lives (1. 84 in 5) and some were even fatalistic concerning HIV infection. The students were highly sexually active, having intercourse a mean of 31 times per year. Their sexual behavior depended on age and sex. The 15- to 19-year-olds preferred occasional partners. They had sexual intercourse 1 to 3 times per month and used condoms 10 to 20% of the time. The 20- to 29-year-olds had multiple partners. They had sexual intercourse 3 to 5 times per month and used condoms more than 30% of the time. Students over the age of 30 had many partners in addition to their regular partner. They had sexual intercourse 5 to 10 times per month and used condoms 0 to 20% of the time. Significantly more women than men had high-risk sexual behavior (40. 5% of men claimed to regularly use condoms, versus only 22.7% of the women and 11.9% of the women accepted anal penetration versus only 8. 4% of men). The general assumption is that students, who have a high level of education, should be well informed concerning AIDS and STDs and should therefore have positive attitudes and responsible sexual behavior. This study demonstrates that the assumption bears no resemblance to reality. The students were aware of the way in which HIV is transmitted and of what construes risky behavior, but there was nonetheless a high frequency of high-risk behavior (e.g. multiple sexual partners, anal and oral sex, homosexuality, intravenous drug use). The behavior of the students was not significantly different from that of young people living on the streets of Lomé. There were significant relationships between knowledge and attitudes and between some types of sexual behavior and knowledge. However, there was no correlation between attitudes and behavior. The education of young people should focus on both the prevention of AIDS and STDs and on facing up to these diseases.

Peripheral facial paralysis (PFP) and HIV infection in Togo.

OBJECTIVES: The purpose of this study was to determine the seroprevalence of HIV in a group of 150 patients with PFP and to study the semiological and evolutive aspect of PFP in patients with or without HIV. MATERIAL AND METHODS: This semilongitudinal study was conducted during 6 years (1990-1995) at the Lomé teaching hospital. Patients consulting for PFP had the HIV test and regular controls. RESULTS: The HIV seroprevalence was 52%. The average age was 31.4+/-8.81 years There was no difference on clinical features between patients with or without HIV infection. Cerebrospinal fluid was normal in patients without HIV infection, but it showed pleiocytosis in patients with HIV infection (87.88%). Of the HIV carriers 14% presented a recurrence. A total of 26.32% of the patients screened in 1990 developed AIDS when followed up. CONCLUSION: Peripheral facial paralysis is frequently associated to HIV infection. An HIV test must be proposed to all patients with PFP in Africa.

[Huntington disease in a large family in southern Togo]. / La maladie de Huntington dans une vaste famille au sud du Togo.

We report the clinical manifestations and the family in a large family in Southern Togo in which Huntington's disease is known to exist for the past 6 generations. At present there are 8 patients in this family, 67 members descending from patients. This family study adds further information to our knowledge of Huntington's disease among black Africans.