Severe malaria in children in Togo

BACKGROUND: The definition of severe malaria is no longer limited to cerebral malaria, but is as well extended to other clinical forms of the disease. This work analyses epidemiological, clinical and evolutive aspects of severe malaria in Togo. PATIENTS AND METHODS: This study included 549 children, aged from 0 to 15 years, hospitalized in 1994-5 in the pediatric department of the Lome-Tokoin University Teaching Hospital for severe malaria as defined by World Health Organization (WHO) criteria. RESULTS: The hospitalization frequency was 7.44%; the maximum frequency was from 1 to 5 years of age, but 6.56% of patients were more than 10 years old. The most frequent clinical form was that of severe anemia, followed by cerebral complications, as seen in many African countries. The death rate was 18.94% and the proportional mortality was 8.21%; 2.73% of the patients had neurological sequelae (behaviour disturbances in five cases, aphasia in four, hemiplegia in three, mumbling in one, oculomotor paralysis in one, and cerebellar ataxia in one). Hypoglycemia was fairly frequent (11.6%) and was associated with a poor prognosis. CONCLUSION: It is possible to improve severe malaria prognosis in Africa by insisting not only on better equipment in intensive care wards, but also on improved and early management of hypoglycemia.     

Maternal and perinatal health in Mali, Togo and Nigeria

When healthcare executives speak of managed care, they often use the term generically to refer to any arrangement with a healthcare payer other than traditional fee-for-service reimbursement. All too often, the "management" aspect is missing from managed care, resulting in an arrangement that could more aptly be described as "discounted care." This lack of clinical representation is unfortunate, since there are numerous issues that have an impact on clinical care, including choice of referral providers, noncoverage of certain procedures or treatments, and similar issues that may influence the patient's plan of care. Organizations that approach managed care as a system that blends the resources of management, finance, and clinicians, will enjoy the greatest potential for success. With their practical experience and insight into the administrative and clinical issues that may be encountered, nurse case managers will ultimately be responsible for managing the care of the contracted population. As case managers are the vital link among payers, providers, patients, and families, it is essential that the case manager understand managed care concepts, be conversant in the terminology of managed care, function as a member of the team responsible for evaluating contracts, and periodically review existing arrangements. This article presents an overview of the managed care contract development process, and provides tools to enable the nurse case manager to participate in the contracting process.     

Melanoma in Togo. A retrospective study over 20 years

INTRODUCTION: The malignant melanoma is a rare malignant tumour in black patients, but it is common in white patients. MATERIAL AND METHODS: Medical records were reviewed retrospectively during 20 years (1973-1992) to determine the epidemiological features of malignant melanoma in Togo. RESULTS: During this period 63 cases (31 males and 32 females) of malignant melanoma were histologically diagnosed; an average of 3.15 cases each year. The tumor takes place preferably on the feet 40 cases (63.49%), hands 15 cases (19.04%), legs and thigh 10 cases (15.87%). CONCLUSION: The results of this study confirm the particularity of malignant melanoma in black subjects: its rarity and the feet localizations.     

Osteoarthritis of limbs in hospital practice in Lomé (Togo)

Medical records of patients seen at the Lomé Teaching Hospital rheumatology clinic (Togo) were studied retrospectively to determine the prevalence and topographic patterns of osteoarthritis. Among the 2626 patients seen over a three-year period, 232 had appendicular osteoarthritis. Distribution of affected joints was as follows: knee, 212 patients (83% female, 17% male); hip, 17 patients with primary osteoarthritis; scapulohumeral joint, 2 patients; and fingers, 1 patient. At the knee, the lesions involved the medial femorotibial compartment in 114 patients, the lateral femorotibial compartment in 54 patients and the patellofemoral compartment in 44 patients. Mean age at onset of femorotibial osteoarthritis was 50 years. Among females with femorotibial osteoarthritis, 70% were obese and 90% had varus or valgus deformities. This study confirms that in black Africa the high prevalence of femorotibial osteoarthritis contrasts with the low prevalence of primary osteoarthritis of the hip and of osteoarthritis of the fingers. Female sex, obesity, and varus or valgus deformities are the main risk factors for femorotibial osteoarthritis in black Africa.     

Cutaneous ulcerations in sarcoidosis

We report the case of a 23 year-old Caribbean woman with sarcoidosis who developed specific skin ulcerations. Ulcerative lesions in sarcoidosis are distinctly unusual, generally multiple, painless, with preponderant location on the lower limbs. The diagnosis is difficult. The pathogenesis is discussed. The most successful therapy is hydrochloroquine with corticosteroids.     

Cutaneous symptoms in vasculitides

Vasculitis has a very variable dermal manifestation. It includes purpura, pustules, bullae, ulcers, nodosits, pomphi etc. Dermal manifestation can represent the initial signs in systemic vasculitis and therefore its early clinical and histopathologic evaluation represents a presupposition for the determination of the subsequent examination route. The study gives information on general morphogenesis, principles of the correctly performed probatory excision, and clinical and histopathologic patterns of individual vasculitis types. (Tab. 2, Ref. 8.).     

Bullous toxidermatosis and HIV infection in hospital environment in Lome (Togo)

The therapeutic possibilities in tumour of the biliary pathways are rather limited and the survival of patients treated by palliative methods is usually short. The most frequent complication of tumours of the biliary tract is biliary obstruction. A palliative treatment involves surgical derivation of bile the endoscopic or percutaneous route. Irradiation as part of palliative therapy is limited by the relatively low sensitivity of the tumours to radiation and the close contact with various radiosensitive organs. One of the possibilities how to avoid damage of neighbouring organs is local actinotherapy. A suitable approach for introducing a radiation source is a percutaneous drain in the biliary tract. There are several patterns of irradiation programmes, most frequently Irridium 192 is used. The total dose of 30 Gy is divided into six fractions which are administered in the course of 2-3 weeks. Local irradiation is followed by implantation of a metallic self-expanding stent into the stenotic part. The effect of this treatment is diminution of the tumours mass, patency of the branches of the intrahepatic bile ducts obstructed by the tumour and prolongation of the patency of the implanted stents. Complications of local actinotherapy are minimal, the majority of complications is associated with percutaneous drainage. The most suitable indication for this treatment are non-resectable tumours of the upper part of the biliary tract, less suitable are tumours of the gallbladder and ampullomas of the papilla Vateri. In the above indication local actinotherapy is palliative treatment which prolongs survival and improves the patient's comfort.     

Cutaneous adenolipoma

INTRODUCTION: Adenolipoma of the skin is an unusual microscopic variant of the solitary lipoma, superposable to the adenolipoma of the breast, characterized by the presence of normal eccrine sweat glands inside the fat proliferation. OBSERVATIONS: Two new cases are reported. DISCUSSION: Adenolipoma of the skin is a benign lesion whose clinical features are similar to those of solitary lipoma. Probably, it is only a histological curiosity in which the eccrine glands are entrapped and carried by the adipose proliferation.     

Idiopathic thrombopenic purpura in a child in black Africa: a case report in Togo

The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure >95 and <114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years. There were no differences between the groups according to age, gender and other parameters. There were no anginal symptoms, and resting ECGs were in normal limits in all cases. The diagnosis of silent ischaemia was considered to be present if there was ST depression >2 mm/at least 120 sec in ambulatory ECG examination without angina or its equivalent cardiac symptoms. The incidence of silent ischaemia was 6.4%, 18.8%, and 26.2% in cases with normal blood pressure, WCH, and hypertension, respectively. The differences between groups were significant. It was concluded that WCH is not a benign condition, but shares some characteristics with essential hypertension.     

Cutaneous graft-versus-host disease

Graft-versus-host disease (GvHD) includes inflammatory and/or fibrosing manifestations that may arise at various times after transplantation of any organ containing lymphoid cells. For the dermatologist, the importance of GvHD is real and current. Indeed, because it has become easier to perform bone marrow transplantation (EMT), the indications of BMT have become broader, making follow-up of patients receiving grafts a widespread practice. Nonetheless, GvHD remains a frequent complication of BMT and its principal target organ is the skin. Furthermore, recent innovations, such as grafting of umbilical cord blood and the mobilization of peripheral blood progenitor cells, will be the source of new questions concerning the development of GvHD under these conditions. Finally, because of its analogies with other spontaneous idiopathic skin diseases, GvHD constitutes a model that may lead to a better understanding of the pathophysiological features of these diseases. In this review, the cutaneous aspects of GvHD are emphasized.