Sylvanus Olympio University Hospital Research Articles

Management of Cardiac Wounds in Togo: About Two Cases at the Sylvanus Olympio University Hospital in Lome, Togo

Cardiac wounds are an extreme life-threatening emergency. Trauma caused by a knife (in the context of a brawl or assault) or a firearm (in the context of war) represent the main etiologies. Only 10% of patients arrive alive at the hospital where diagnosis and paraclinic should not delay the implementation of resuscitation and surgery in any way. Very few African series have been reported because of the delay in diagnosis and treatment, which means that few patients arrive at the hospital alive. We report two heart wounds that occurred in the context of a brawl whose rapid treatment made it possible to preserve the vital prognosis at the Sylvanus Olympio University Hospital in Lomé, Togo.

Pheochromocytoma Discovered Incidentally at the Sylvanus Olympio University Hospital in Lomé (Togo)

Pheochromocytoma Discovered Incidentally at the Sylvanus Olympio University Hospital in Lomé (Togo)

Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé

vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1st January 2009 to 31st December 2011. the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. severe sickle cell-related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

Female Contraception: Comparative Study of Biometrics and Vascularization of the Uterus at Sylvanus Olympio University Hospital (Togo)

Female Contraception: Comparative Study of Biometrics and Vascularization of the Uterus at Sylvanus Olympio University Hospital (Togo)

Maternal Death before Admission to the Sylvanus Olympio University Hospital Center (CHU SO): Epidemiological and Etiological Aspects

Maternal Death before Admission to the Sylvanus Olympio University Hospital Center (CHU SO): Epidemiological and Etiological Aspects

Oto-rhino-laryngological and cervico-maxillofacial pathologies among hospitalized older patients: epidemiological, diagnostical and therapeutical aspects in Lomé, Togo

In developing countries, 10% of the population is over 60 years old and this proportion is increasing rapidly. The general objective of this study was to describe the profile and management of the elderly subject aged 60 and over, hospitalized in the ENT (Ear, Nose and Throat) and Head/Neck surgery department of the Sylvanus Olympio University Hospital in Lomé, from 2012 to 2021. Retrospective descriptive study. After reviewing the files, selection of patients aged 60 and over, regardless of sex, and hospitalized for an ENT pathology from January 2012 to December 2021. Not included in our study were files of elderly subjects hospitalized but whose age was imprecise, or empty or very incomplete files. A total of 296 cases were included, representing 6.7% of the department's activities. The mean age of the patients was 72 ± 7.3 years with extremes of 60 and 95 years. The age group 6069 years represented 59.5%. The sex ratio M/F was 0.92. Infectious/inflammatory lesions were found in 138 patients (46.6%) including 38.9% of acute cellulitis of dental origin, and tumors were found in 135 patients (45.6%). Tumors were malignant in 59 patients (43.7%) and benign in 76 patients (56.3%). Thyroid was the site of 46 (60.5%) benign lesions and larynx of 29 (49.2%) malignant lesions. Poor oral hygiene, use of non-steroidal anti-inflammatory drugs, diabetes and the combination of smoking and alcohol were the factors favoring the occurrence of acute cellulitis of dental origin in 89.6%, 80.9%, 20.0% and 2.6% of cases respectively (p<0.001). The combination of smoking and alcohol was a factor favoring the occurrence of malignancy in 39% (p<0.001). Surgical treatment was performed in 234 patients (79.1%). With a case lethality rate of 21%, acute cellulitis of dental origin was the leading cause of death (p<0.001). The most frequent pathologies of the ENT sphere in the elderly in our tropical context were infectious and tumoral, largely dominated by acute cellulitis of dental origin, thyroid adenoma and squamous cell carcinoma of the larynx. Despite the tendency to balance infectious and tumoral pathologies, the proportion of acute cellulitis of dental origin remains twice as high as that of malignant tumors. It contrasts with data from other sub-Saharan series where tumoral pathology remains predominant in the elderly. It is important to provide dental care assistance to the elderly and to advocate for the development of geriatrics and access to universal health coverage for the elderly in Togo.

Radical Prostatectomy: Indication, Technique and Results at Sylvanus Olympio University Hospital Center of Lom&amp;#233;

Radical Prostatectomy: Indication, Technique and Results at Sylvanus Olympio University Hospital Center of Lom&amp;#233;

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Maternal Deaths after Obstetrical Referral and/or Evacuation to the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center, Togo

Introduction: Maternal death or maternal mortality is “the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1st, 2021 to April 30th, 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). Results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 0.05). Conclusion: Determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.

Direct Medical Cost of Breast Cancer Care in Lome: Case of Sylvanus Olympio University Hospital and International Cancer Centre

Direct Medical Cost of Breast Cancer Care in Lome: Case of Sylvanus Olympio University Hospital and International Cancer Centre

Epidemiological and Prognostic Aspects of Obesity and Pregnancy in the Gynecology-Obstetrics Department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lom&amp;#233;

Introduction: Obesity and pregnancy is a major public health problem worldwide, both maternal and fetal. Objective: This is to describe the epidemiological and prognostic aspects of obesity and pregnancy in the gynecology-obstetrics department at the Sylvanus Olympio University Hospital Center (CHU SO) in Lomé. Methodology: This was a descriptive cross-sectional study concerning obesed pregnant women. The survey was conducted from the 1st to the 30th of June 2022 at the CHU SO. Results: We enrolled 55 obese pregnant women. The frequency of obesity and pregnancy was 5.14%. Resellers were represented at 41.8%. The average age was 31 years old. As risk factors, 85.5% claimed to have a fatty diet and 76% did not practice sports. The gestational pathologies found during pregnancy were hypertension in 47.4% of cases, preeclampsia in 24.6% and gestational diabetes in 7%. Caesarean section was the way of delivery in 63.6% of cases and those who gave birth vaginally presented a tear of the soft tissues in 85% of cases. Birth weight was abnormal (low weight and excess weight) in 61.8% of cases. Conclusion: The association between obesity and pregnancy constitutes an important risk factor for the mother and the fetus.

Intracranial Suppurations in Togo: Etiologies and Treatment

Objective: Intracranial suppurations are a cosmopolitan pathology whose prevalence depend of the region of the world. They are mostly caused by otolaryngological infections. Despite the progress, they remain serious diseases in Africa. The objective of this study was to report the epidemiology, clinical and etiological aspects of intracranial suppurations in Togo. Method: This was a retrospective and descriptive study carried out from January 1, 2012 to December 31, 2020 including all cases of intracranial suppuration treated in the neurosurgery unit of Sylvanus Olympio university hospital in Lomé. The evolution was evaluated at discharge, at 3 and 6 months after. Results: We collected 185 cases of intracranial suppuration. The average age of the patients was 12.6 years with a male predominance (72.4%). The main clinical signs were the infectious syndrome (92.4%), intracranial high pressure (51.4%), focal deficit (38.4%) and seizures (20.5%). An otolaryngological infections history was noted within 3 months in 72.4%. The brain CT scan noted a predominance of empyema (63.8%) mostly subdural (64.4%). Radiological sinusitis was found in 57.3%. We identified etiology in 69.2% predominated by otolaryngological causes. Patients received medical and surgical treatment in 77.3%. The bacteriology was positive only in 7 cases. The mortality rate was 15.1%, mostly no operated cases (78.6%). At 6 months 84% recovered without sequelae. The predictive prognostic factors for mortality were: coma (p 0.001), absence of surgical treatment (p 0.02). Conclusion: Intracranial suppuration remains frequent in our country, mainly due to otolaryngological pathologies. The clinical presentation is not always specific and Bergman’s triad is rarely complete. The results of treatment are good if it is early.

Cardiovascular Profile And Risk of Patients During Non-Cardiovascular Surgery Scheduled at Sylvanus Olympio University Hospital in Lome

Objective: To describe the cardiovascular profile and the preoperative cardiovascular risk stratification prior to scheduled non-cardiac surgeries at CHU SO. Materials and methods: This is a retrospective and descriptive study on the records of patients received in consultation in the Cardiology and anesthesia departments of the CHU-SO of Lomé from March 2014 to October 2019. Results: A total of 220 patient records were selected. The mean age was 57.1±14.4. In 81% of cases, these are minor predictors; intermediate predictors are found in 9.1% of cases and in 1.4% they are major factors. Patients were classified as ASA1 (50.0%), ASA 2 (39.1%), ASA 3 (9.6%), and ASA4 (41.3%). As age increased, patients had a major predictor factor or were classified as ASA3 and ASA4. The predictors of minor operative risk were hypertension (70.3%) followed by age correlated with sex (48.2%) in men, metabolic syndrome (21.8%), and left ventricular hypertrophy (LVH) (21.0 %). Intermediate predictors were dominated by diabetes (9.1%), chronic myocardial ischemia (6.8%), and RI (4.5%). Patients with diabetes (9.1%) or morbid obesity (7.7%) were classified as ASA3 Heart failure (1.4%) and renal failure (4.5%) classified patients as ASA4. Conclusion: The predictors of cardiovascular risk for NCS are multiple and are observed in the same patients. The overall operative risk is moderate to medium.

Maternal and neonatal complications of childbirth among adolescents at the Sylvanus Olympio University Hospital Centre (CHU-SO), Lomé

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Epidemiology and management of Lefort fractures at the Sylvanus Olympio University Hospital of Lomé (Togo)

IntroductionLefort fractures are lesions of the facial mass following violent trauma. They can be life-threatening and functionally dangerous in the short or long term. This study aimed to report the management of this type of fracture in our context. MethodologyThis was a descriptive cross-sectional study with retrospective data collection from January 1, 2011, to December 31, 2020, in the Department of Otolaryngology and Cervico-Maxillofacial Surgery at the Sylvanus Olympio University Hospital of Lomé. ResultsThe annual frequency was 15.2 cases. The average age of the patients was 34.43 ± 11.98 years with extremes of 15 and 70 years and a sex ratio of 9.13. The majority of patients were workers in the informal sector (44.08%). The etiologies were dominated by road traffic accidents (91.45%) and 28.29% of the patients were emergency cases on admission. Imaging showed 51.06% Lefort II fractures. Treatment was surgical in 99.34%, with screw plates (89.40%). Functional sequelae were reported in 5.92% of patients. ConclusionLefort fractures are common in young adult males after road traffic accidents. Their treatment is delicate and often leaves serious after-effects. Active measures for the prevention of these road traffic accidents are therefore necessary.

Satisfaction of parents of children hospitalized in pediatrics in Togo

In order to evaluate the degree of satisfaction of parents of children treated in the pediatric service of the Sylvanus-Olympio University Hospital of Lomé (Togo), a cross-sectional and analytical study was conducted from August 1 to 31, 2020, among 300 parents. The sociodemographic aspects of the families and those related to their perception of the care provided in the service were evaluated. Overall, the families were satisfied with the reception and the care their child received.

Faecal carriage of multi-drug resistant Enterobacteriaceae in hospitalized children at University Teaching Hospital Sylvanus Olympio of Lomé, Togo

Background: High prevalence of infections and associated antibiotherapy may put children at increased risk for development of multidrug-resistance (MDR), mostly to bacterial infections. The objective of this study therefore was to determine the prevalence of gastrointestinal carriage of MDR Enterobacteriaceae among hospitalized children in the Paediatric department of Sylvanus Olympio University Hospital, Lomé, Togo.Methodology: A descriptive cross-sectional study was carried out on randomly selected hospitalized children in the Paediatric wards of the hospital from November 03 to November 10, 2020, after obtaining informed consent from their parents/guardians. Rectal swabs and stool samples were collected from each participant and cultured for isolation of members of the family Enterobacteriaceae on Hektoen enteric agar containing 4 µg/L cefotaxime, which was incubated aerobically at 37oC for 24 hours. The isolates were identified using in-house biochemical tests. Antibiotic susceptibility test (AST) of each isolate to a panel of antibiotics including ertapenem and imipenem was done by the disc diffusion method and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints version 2020 V.1.1. ESBL production was detected by the double-disc synergy test of amoxicillin and clavulanic acid, and resistance to carbapenem was inferred by resistance to ertapenem and imipenem discs in the AST. Multi-drug resistance (MDR) was defined as resistance to at least three families of antibiotics. Statistical analysis of data was carried out on Excel 2010 and EPI INFO 7.2 and p value &lt; 0.05 was considered to be statistical significance. Results: A total of 70 hospitalized children during the study period were randomly recruited with an average age of 4 years 3 days and a range of 1 day to 18 years. The male gender was predominant (54.3%) with a M: F ratio of 1.2. Samples were culture positive in 85.7% (60/70) and a total of 72 species of Enterobacteriaceae were isolated in 93.3% (56/60) of these cultures. Escherichia coli was the most frequently isolated species(56.9%, 41/72). More than 90% (65/72) of the isolates were resistant to ampicillin, 58.3% (42/72) to third generation cephalosporins, 59.7% (43/72) to fourth generation cephalosporins, 43% (31/72) to amino-glycosides, 55.6% (40/72) were multi-drug resistant, 48.6% (35/72) were ESBL-producing strains, and 6.9% (5/72) were carbapenem resistant. Eighty-three percent (29/35) of ESBL-producing and all the carbapenem resistant isolates (5/5) were recovered from children on antibiotic therapy. The prevalence of ESBL-producing phenotypes among culture-positive children on antibiotic treatment (72.5%, 29/40) was significantly higher than among culture-positive children not on antibiotic treatment (20.0%, 4/20), indicating that antibiotic therapy was significantly associated with carriage of MDR isolates (OR=10.545, 95% CI=2.882-38.590, p=0.0002). Conclusion: The high faecal carriage rate of MDR Enterobacteriaceae, which are all ESBL-producing strains, in this study is worrying. There is urgent need to develop measures to monitor and limit the spread of these MDR organisms in children and the community in Togo.

Manifestations cutanéo-muqueuses des traitements anticancéreux à Lomé (Togo): Une série de 35 ca

Objective: This study aimed to describe the mucocutaneous manifestations of anti-cancer treatments in cancer patients in Lomé (Togo). Patients and Method: This is a descriptive cross-sectional study conducted in the oncology department of the Sylvanus Olympio University Hospital and in a private medical clinic in Lomé over 6 months. Results: A total of 35 patients were included with 26 patients (74.3%) receiving either mono or multidrug therapy or 9 (25.7%) receiving radiotherapy. The mean age of the patients was 52±11.36 years with extremes ranging from 24 to 71 years and the sex ratio (M/F) was 0.35. The main drugs used during chemotherapy were platinum salts (n=18; 69.2%), antimetabolites (n=15; 61.5%), taxanes (n=9; 34.6), topoisomerase inhibitors (n=7; 26.9%), alkylating agents (n=6; 23.1%). The main mucocutaneous manifestations observed were localized hyperpigmentation (palms and soles, fingertips, tongue) noted in 11 patients (n=42.3%), followed by alopecia observed from the first treatment (n=8; 30.8%), skin xerosis (n=4; 15.4%), and oral involvement (aphthoid lesions, gingivitis), (n=4; 15.4%). Radiodermatitis grade 3, 2 and 1 was noted in 4 patients (44; 4%), 4 other patients (44.4%) and 1 patient (11.2%) respectively. Conclusion: Our study identifies localized hyperpigmentation, alopecia, grade 3 and 2 radiodermatitis as the respective mucocutaneous manifestations of multidrug therapy and radiotherapy in Lomé, Togo.

Outpatient Management of Sickle Cell Disease: Assessment of 13 Years Follow-Up of Pediatric Patients at the Sylvanus Olympio University Hospital

Objective: To evaluate thirteen years of ambulatory follow-up of patients with major forms of sickle cell disease. Methods: This was a study of 1055 records of sickle cell patients aged 6 months to 45 years followed between 2006 and 2018. Results: Six hundred and eighty-one (64.5%) homozygous SS, 283 (26.8%) SC, 86 (8.2%) SF, 4 (0.4%) Sß thalassemia and 1 (0.1%) SD sickle cell patients were followed. The majority of the patients (97.9%) were living in the capital city of Lomé and its surrounding suburbs. Most children (67.3%) were less than 5-year-old when they were diagnosed with sickle cell disease, and only 21.3% of cases were discovered before the first year birthday of the patients. Osteo-articular vaso occlusive crisis (VOC) was the principal symptom at the onset of the diagnosis, approximately 28.9% of the cases, followed by severe anemia (19%), then hand-foot syndrome in 15.6%. The systematic screening was performed in 5.4%. Twenty-six percent were G6PD deficient, 4 were HIV immunocompromised, and 29.7% were transfused. Among the degenerative complications, 2.4% had retinopathy, 1.9% osteonecrosis of the femoral head, 1.4% leg ulcers, and 0.8% cardiomyopathy. Salmonella typhi was the main cause of infection, 51.4% of the cases. The mean baseline hemoglobin level (n = 27) was 7.67 ± 1.64 g/dl. Four (0.4%) patients had a splenectomy. The mortality rate was 2.4%. The primary cause of death was anemia (28%), followed by sepsis in 20% of the cases. One case of suicide was documented as the cause of death. Conclusion: Outpatient medical follow-up of sickle cell patients is essential in sub-Saharan African countries where neonatal screening does not exist, and diagnosis is often late. The improvement in quality of life observed should be studied.

The COVID-19 Vaccine Acceptance in Hemodialysis Patients in Togo

Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination. Results: One hundred and twenty-three patients on regular hemodialysis were interviewed; their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.