[Ulcerative colitis: a case in Togo]. / La rectocolite hémorragique : une observation au Togo.

Ulcerative colitis seems to be rare in sub-Saharan Africa. Because its clinical and radiological signs are non-specific, anatomopathologic studies are necessary for definitive diagnosis after exclusion of parasitic, bacterial, and viral causes. The purpose of this report is to describe a fatal case of ulcerative colitis in a 68-year-old woman in Togo.

[Hematemesis in Togo: findings of a 12-month study in an intensive care unit]. / Hématémèses au Togo: expérience d'un an en réanimation.

This prospective study was conducted over a 12-month period on patients who underwent upper digestive endoscopy for hematemesis in the medical intensive care unit (ICU) of the Tokoin University Hospital Center in Lomé, Togo. A total of 44 patients with a mean age of 44 years were included. The sex-ratio was 2.61. Risk factors included use of non-steroid anti-inflammatory (NSAI) in 16 patients (36.4%) and alcohol abuse in 13 (29.6%). At the time of admission to the ICU, 21 patients (47.7%) were in hemodynamic shock and 11 (25%) presented signs of portal hypertension. The underlying etiology was peptic ulcer in 18 cases (40.9%) including 13 cases of duodenal ulcer and 5 cases of stomach ulcer, rupture of esophageal varicosities in 8 (18.2%), gastric tumor in 6 (13.6%), Mallory Weiss syndrome in 5 (11.4%), gastritis in 4 (9,1%), and esophagitis in 3 (6.8%) due to peptic inflammation in 2 and mycotic infection in 1. The mortality rate was 45.5%. The main causes of hematemesis were peptic ulcer and rupture of esophageal varicosities. The death rate was high due to inadequate care facilities.

[Aetiologics aspects of proctorrhagia at the black adult African: about 85 cases collect in 12 years in CHU-Campus of Lome]. / Aspects etiologiques des rectorragies chez l'adulte en milieu Africain: a propos de 85 cas colliges en 12 ans au CHU-Campus de Lome.

PURPOSE: To count the aetiology of proctorrhagia in Lomé. METHODS: It is a retrospective study, over 12 years (1st January 1995-31 December 2006), realised from the reports of the coloscopy . It included the patients of the two sexes, old of more than 15 years, having presented a proctorrhagia explored by ano-rectoscopy and coloscopy. RESULTS: The proctorrhagia represent 38.72% of the indications of the coloscopy. The patients from 24 to 45 years were reached (52.94%). A male prevalence was found (sex-ratio: 2.4). Among the aetiology found, the haemorrhoids more frequent (23.53%), were followed by the non specific colitis (16.47%), the ulcero- haemorrhage rectocolitis (15.29%), the colon diverticulosis (10.58%), the amoebic colitis (9.4%) and colorectal cancer (5.88%). The hemorroid were associated with a non specific colitis (1 case), a ulcero-hemorrhagic rectocolitis (1 case), an amoebic colitis (1 case) and diverticulose colic (1 case). In 12 cases (14.12%), no aetiology was found. CONCLUSION: The haemorrhoids represent the most frequent aetiology of the proctorrhagia in Lomé; however their discovery in ano-rectoscopy should not exempt realisation of a complete coloscopy in the search of other causes.

Evidence for a human leucocyte antigen-DM-induced structural change in human leucocyte antigen-DObeta.

Human leucocyte antigen (HLA)-DO is a non-classical major histocompatibility complex class II molecule which modulates the function of HLA-DM and the loading of antigenic peptides on molecules such as HLA-DR. The bulk of HLA-DO associates with HLA-DM and this interaction is critical for HLA-DO egress from the endoplasmic reticulum. HLA-DM assists the early steps of HLA-DO maturation presumably through the stabilization of the interactions between the N-terminal regions of the alpha and beta chains. To evaluate a possible role for HLA-DM in influencing the conformation of HLA-DO, we made use of a monoclonal antibody, Mags.DO5, that was raised against HLA-DO/DM complexes. Using transfected cells expressing mismatched heterodimers between HLA-DR and -DO chains, we found that the epitope for Mags.DO5 is located on the DObeta chain and that Mags.DO5 reactivity was increased upon cotransfection with HLA-DM. Our results suggest that HLA-DM influences the folding of HLA-DO in the endoplasmic reticulum. A mutant HLA-DO showing reduced capacity for endoplasmic reticulum egress was better recognized by Mags.DO5 in the presence of HLA-DM. On the other hand, an HLA-DO mutant capable of endoplasmic reticulum egress on its own was efficiently recognized by Mags.DO5, irrespective of the presence of HLA-DM. Taken together, our results suggest that HLA-DM acts as a private chaperone, directly assisting the folding of HLA-DO to promote egress from the endoplasmic reticulum.

Aspects etiologiques des rectorragies chez l'adulte en milieu africain : a propos de 85 cas colliges en 12 ans au CHU - campus de Lome

But : recenser les etiologies des rectorragies au CHU-Campus de Lome. Methodologie : Il s'agit d'une etude retrospective sur 12 ans (1er janvier 1995 - 31 decembre 2006); realisee a partir des comptes-rendus de coloscopie. Elle a inclus les dossiers des malades des deux sexes; ages de plus de 15 ans; ayant presente une rectorragie exploree par une ano-rectoscopie et une coloscopie totale. Resultats : les rectorragies representent 38;72des indications de la coloscopie. Les malades ages de 24 a 45 ans ont ete les plus atteints (52;94). Une predominance masculine a ete retrouvee (sex-ratio : 2;4). Parmi les etiologies retrouvees; les hemorroides ont ete plus frequentes (23;53) suivies par les colites non specifiques (16;47); la recto-colite ulcero-hemorragique (15;29); la diverticulose colique (10;58); les colites amibiennes (9;4) et le cancer colorectal (5;88). Les hemorroides etaient associees a une colite non specifique (1 cas); a une recto-colite ulcerohemorragique (1 cas); a une colite amibienne (1 cas) et a une diverticulose colique (1 cas). Dans 12 cas (14;12); aucune etiologie n'a ete retrouvee. Conclusion : Les hemorroides representent l'etiologie la plus frequente des rectorragies a Lome; cependant leur decouverte a l'ano-rectoscopie ne doit pas dispenser de la realisation d'une coloscopie complete a la recherche de lesions associees

[Knowledge and acceptance of obstetric peridural analgesia: survey of pregnant women in Togo]. / Niveau de connaissance et acceptabilité e l'analgésie péridurale: enquête auprès des femmes enceintes au Togo.

The purpose of this study was to evaluate knowledge and acceptance of obstetric peridural analgesia among pregnant women in Togo. A prospective, descriptive survey was carried out over a period of one month. A standardized survey form was used to collect data. A total of 303 pregnant women with a mean age of 27 +/- 6 years were interviewed. A proportion of primiparous and multiparous was the same, i.e., 50%. Among multiparous women, 83.5% described labor pain during previous deliveries as severe. Twelve percent of the pregnant women interviewed claimed knowledge of techniques to control labor pain. Three pregnant women reported a detailed understanding of peridural analgesia obtained from the Internet. A total of 253 women (83.5%) replied affirmatively when asked if they would opt for peridural analgesia if it was offered free of charge for delivery at the end of the current pregnancy. Acceptance was motivated by better delivery conditions for the newborn (112 women) and comfort achieved by pain relief (130 women). Refusal was motivated by a religious belief that painful delivery was in the natural order (31 women). Among the six Moslem women that refused painless delivery, two from the Djerma ethnic group stated that pain was the best expression of their femininity. The acceptance rate fell from 83.5% to 70% if peridural analgesia was offered at extra charge. Most pregnant women in Togo expressed interest in trying peridural analgesia. It is compulsory in medical indications.

A point mutation in the groove of HLA-DO allows egress from the endoplasmic reticulum independent of HLA-DM.

B lymphocytes express the nonclassical class II molecule HLA-DO, which modulates the peptide loading activity of HLA-DM in the endocytic pathway. Binding to HLA-DM is required for HLA-DO to egress from the endoplasmic reticulum (ER). To gain insights into the mode of action of DO and on the role of DM in ER release, we sought to identify DM-binding residues on DO. Our results show that DOalpha encompasses the binding site for HLA-DM. More specifically, mutation of residue DOalpha41 on an exposed lateral loop of the alpha1 domain affects the binding to DM, ER egress, and activity of DO. Using a series of chimeric DR/DO molecules, we confirmed the role of the alpha chain and established that a second DM-binding region is located C-terminal to the DOalpha80 residue, most probably in the alpha2 domain. Interestingly, after mutation of a buried proline (alpha11) on the floor of the putative peptide-binding groove, HLA-DO remained functional but became independent of HLA-DM for ER egress and intracellular trafficking. Collectively, these results suggest that the binding of HLA-DM to DOalpha allows the complex to egress from the ER by stabilizing intramolecular contacts between the N-terminal antiparallel beta-strands of the DOalphabeta heterodimer.