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.

Antiretroviral Therapeutic Profile in Patients Living with HIV with Chronic Kidney Disease

Chronic Kidney disease (CKD) is one of the important complications during HIV infection. The advent of Highly Active Antiretroviral Therapy (HAART) has significantly improved the prognosis of these patients. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) of the Department of Infectious Diseases of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months from January 1, 2018 to June 30, 2018. A total of 234 patients were enrolled during the study period. The mean age of patients at initiation of treatment was 42.07 ± 9.49 years with an average duration of follow-up under antiretroviral treatment of 5.61 ± 3.22 years. The female sex was predominant (70.09%) and a sex ratio (M/F) of 0.43. Most people living with HIV were mostly classified at clinical stage 2 (30.77) and 3 (31.62%) of WHO at initiation of HAART. The mean CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of study. The frequency of CKD was 11.11%. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% of cases. In univariate analysis shows that age greater than 45 years (p = 0.017). Pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only age (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD.

Chronic Kidney Disease (CKD) in Patients Living with HIV under Antiretroviral Treatment: Prevalence and Risk Factors

CKD is one of the major complications when infected by HIV. The surveillance of CKD indicators and control of its determinants in the HIV-infected population in our African communities is essential. This was a descriptive and analytical cross-sectional study of people living with HIV received at the Ambulatory Treatment Center (ATC) at Infectious Diseases department of Sylvanus Olympio University Hospital (CHU-SO). The study period was 6 months—from January 1, 2018 to June 30, 2018—CKD was defined by a clearance below 60 ml/min/1.73 m2 for at least 3 months. A total of 117 patients were enrolled during the study period. The average age of patients for trial treatment was between 9.49 and 42.0 7 years. The duration of follow-up for antiretroviral treatment was ±3.22 to ±5.64 years. The female gender was predominant (70.09%) with a sex ratio (M/F) of 0.43. Most of people living with HIV were mostly classified at clinical stage 2 (31.03%) and 3 (31.90%) of WHO at initiation of HAART. The main CD4 rate was 223.30 ± 143.764 at initiation of HAART and 462.58 ± 202.723 at the time of the study. The majority of patients were placed in a fixed combination of Tenofovir/Lamivudine/Efavirenz in a proportion of 81.20% cases. CKD was found in 13 patients—that is 11.11% of patients. Univariate analysis shows that age greater than 45 years plus (p = 0.017) and pathological proteinuria (p = 0.021) were associated with CKD. In multivariate analysis, only ages (p = 0.045) and pathological proteinuria (p = 0.035) were significantly associated with CKD. The prevalence of CKD in HIV-infected patients is significant in Togo. The occurrence of proteinuria is linked to the delay in taking antiretroviral therapy.

Dyslipidemia in People Living with HIV on Anti-Retroviral Treatment: Case of the Ambulatory Treatment Center (ATC) of the Sylvanus Olympio University Hospital of Lome

Introduction: Dyslipidemia is a significant cardiovascular risk factor in patients living with HIV (PLWHIV). Few data are available in Togo. Objective: The purpose of this study is to assess the prevalence of dyslipidemia and associated factors in PLWHIV on Highly Active Antiretroviral Therapy (HAART). Methods: This is a descriptive and analytical cross-sectional study of patients followed at the Sylvanus Olympio University Hospital’s infectious diseases department for six months. The study population consisted of any PLWHIV patient on HAART over 18 years of age who had been regularly monitored and had a serum lipid fraction assay. Results: Two hundred and eighty-four patients were included. 75.4% were women. The median age was 46 years (IQR: 39 - 52) and the median CD4 count was 461 cel/U1 (IQR: 330 - 607). Eighty-three percent of the patients had suppressed viral load. The median duration of follow-up under antiretroviral treatment antiretroviral treatment was 4.18 years (IQR: 2 - 7). The prevalence of dyslipidemia was 72.5%. HDL hypocholesterolemia (HDL-c Conclusion: Our study revealed a high prevalence of dyslipidemia in patients on HAART as well as associated factors. To this end, it is necessary to insist on screening for dyslipidemia before and after initiation of HAART in order to prevent the occurrence of cardiovascular events in PLWHIV.