Economic and Psychosocial Impacts of Health Evacuations Abroad for Coronary Angioplasty in Togolese Patients

Introduction: Coronary artery disease is the leading cause of premature death worldwide. The management of its severe form requires angioplasty, not yet available a year ago in Togo, which motivated the evacuation of Togolese patients with this disease. Objectives: To evaluate the cost of angioplasty and the economic and psychosocial impacts in evacuated Togolese patients. Methodology: This was a three-year descriptive and prospective study (January 2015 to December 2018) that included all Togolese patients evacuated for coronary angiography from 4 health facilities in the city of Lomé. Results: The mean age was 56.8 ± 11 years. There was a male predominance with a sex ratio of 2.63. The main countries of evacuation were France (50%), Tunisia (25%) and Ivory Coast (20%). The main indications of coronary angiography were myocardial infarction in 47.5%, NSTEMI (22.5%) and ischemic heart disease (15%). Fifty-five percent of the patients had monotroncular involvement. Angioplasty was performed in 16 patients, 3 patients had bypass surgery and only one patient had medical treatment. Sixty percent of patients received an active stent and 20% a bare stent. The total cost of the 40 evacuations was four hundred and fifty one thousand four hundred and nineteen US dollars (US$451,419). The average cost per evacuation was eleven thousand two hundred and eighty-six US dollars (US$11,286), or 182 times the Togolese minimum wage. At the announcement of the disease and evacuation, 40% had been afraid and 35% had accepted their illness. Fifty-five percent perceived evacuation as a healthy outcome. In 25% of cases the coronary angiography was simple and 20% found it painful. After the coronary angiography 40% had regained hope of recovery, 37.5% had accepted their result and 37.5% were happy with the outcome. Conclusion: Coronary artery disease is a serious pathology in terms of cardiovascular morbidity and mortality, especially its severe form, which is myocardial infarction, the treatment of which requires angioplasty. This comes back during an evacuation that is too expensive for the average Togolese;only its implementation in our country remains the solution to fight against its often fatal complications as well as the flight of capital and the stress of patients and their families.

Predictive Factors of No Reflow during Primary Angioplasty

Introduction: No reflow during primary angioplasty is associated with a poor prognosis despite the reopening of the culprit coronary. The aim of our work was to determine the predictive factors of no reflow. Methodology: Single-center retrospective analytical study from June 2000 to December 2016 that included patients presenting with STEMI took care of by primary angioplasty. No reflow was defined according to angiographic criteria: a TIMI flow Results: The prevalence of no reflow was 24%. In univariate analysis mean age, diabetes,hypertension, tachycardia, hypotension, killip stage 4 left ventricular failure, hyperglycemia > 11, renal failure, left ventricular dysfunction, tritruncal status, common trunk involvement, initial TIMI flow at 0, significant thrombotic load, delay to angioplasty > 6 hours, and predilation were all correlated with no reflow with a p 75 years [OR = 6.02, 95% CI 1.4 - 27, p = 0.014], tachycardia [OR = 4.3, 95% CI 1.6 - 7.4, p = 0.037], delay to angioplasty > 6 hours [OR = 1.3, 95% CI 1.1 - 2.1, p = 0.003] and high thrombotic load [OR = 1.5, 95% CI 1.3 - 3.2, p = 0.02] were independent predictors of no reflow. Conclusion: No reflow is associated with a poor short-term prognosis. Its care requires knowledge of predictive factors, prevention and treatment.

Metabolic Syndrome in People Living with HIV in Lome (Togo): Epidemiological Aspects and Associated Factors

Introduction: People living with HIV (PLWHIV) are exposed to Metabolic Syndrome (MS), which increases their risk of having cardiovascular events and type 2 diabetes. No data on this subject is available in Togo. Objective: The objective of our study was to make an inventory of the metabolic syndrome among PLWHIV in Togo. Method: This was a prospective cross-sectional descriptive and analytical study on PLWHIV received at the day hospital of the Infectious Diseases Department of the Sylvanus Olympio University Hospital for a period of six months. Results: A total of 279 PLWHIV patients were enrolled, of which 237 (84.9%) were on Highly Active Antiretroviral Treatment (HAART) and 42 (15.1%) were naive. Metabolic syndrome has been demonstrated in 28.7% of the study population. Abdominal obesity was the most represented component of MS with a proportion of 57.7%. Risk factors associated with MS were female sex (OR = 3.01;CI: 1.52 - 5.93;p 2 (OR = 3.29;CI: 1.92 - 5.64;p 3 (OR = 1.85;CI: 1.06 - 3.20;p Conclusion: There is a need to screen MS for PLWHIV so that risk factors associated with it can be addressed early.