Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years;sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p < 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p < 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients;furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

Quality of Life of the Patients Suffering from Chronic Liver Diseases at the University Health Center Campus of Lome

Objective: Assess the quality of life (QOL) of the patients suffering from chronic liver diseases in our service. Patients and Method: A transversal prospective study conducted at the service of hepatology and gastroenterology at the University health center Campus of Lomé from August 1, 2013 to August 31, 2014. We have used the short form 36 health survey questionnaire (SF-36). Patients of cirrhosis and hepatocellular carcinoma admitted during the said period were selected. Patients suffering from any other chronic diseases such as psychiatric or emotional troubles;linguistic or cognitive deficiencies that could hamper the dependability of the questionnaire were excluded. Results: The average age of the patients was 46 ± 12 years old with a male predominance (sex-ratio: 2.9). Our patients were distributed into 47.4% of cirrhosis and 52.6% of CHC. Those chronic liver diseases etiologies were alcoholic (57%), B viral (66%) and C viral (12.3%). The assessment of QOL showed an overall average score of 76.34 ± 21.1;a mean score of 30.4 ± 86.8 for the physical dimension and 36.5 ± 10.3 for the mental dimension. Patients with viral liver disease had poorer physical summary score (p = 0.000) and poorer mental summary score (p = 0.014) compared to alcoholic patients. Alcohol influenced the physical dimension of the patients (p = 0.000) while the mental dimension was more affected by the age of patients (p = 0.0035). Conclusion: The quality of life is altered by the patients suffering from chronic liver diseases (p = 0035) with regard to our context. This is so in particular with those identified to be viral infected.

Effectiveness of Treatment of Chronic Viral Hepatitis C by Direct-Acting Antivirals in Togo

Background: Viral hepatitis C is the second leading cause of hepatocellular carcinoma after hepatitis B in Africa and Togo in particular. The advent of direct acting antivirals has revolutionized the care and prognosis of patients infected with hepatitis C virus (HCV). Objective: To evaluate the sustained virological response (SVR) 12 weeks after oral treatment without interferon in HCV infected patients with genotypes 1 and 2. Patients and Method: Descriptive and analytical study based on the retrospective collection of data in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from July 11, 2016 to April 22, 2018. All patients who had a chronic viral hepatitis C with viral replication, naive, regardless of the genotype, regardless of the degree of liver fibrosis, and who had completed their treatment with direct-acting antivirals were included. Results: We recruited 84 patients, 60 of whom were infected with HCV genotype 2 (71.43%) and 24 with HCV genotype 1 (28.57%). There were 58 men and 26 women (sex ratio: 0.45). In HCV genotype 1 patients, the median age was 54.29 years and Sofosbuvir/Ledipasvir was the most used combination (62.50%). In HCV genotype 2 patients, the median age was 54.5 years and Sofosbuvir associated with Ribavirin was the most used treatment (81.66%). The virological response at the end of treatment was 100% (genotype 1) and 93.30% (genotype 2). The SVR 12 was 100% (genotype 1) and 91.70% (genotype 2). Five patients were in treatment failure (genotype 2). Conclusion: Direct-acting antivirals were effective in our patients. The rate of sustained virological response was above 90%.

Interest of Serum-Ascites Albumin Concentration Gradient in the Diagnosis of Portal Hypertension in Cirrhotic Patients

Objective: To find a more accessible and less restrictive mean such as serum-ascites albumin gradient (SAAG) to predict esophageal varices (EV) in cirrhotics with ascit. Patients and methods: Descriptive and analytical studies based on the retrospective collection of data on 125 patients’ records in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from January 1, 2008 to March 31, 2018 were included. Cirrhotic patients aged 15 years and older had performed cytochemical analysis of ascites fluid and upper gastrointestinal fibroscopy and had a protidogram. Statistical analysis was done by R Studio Software 3.4.2. Results: The mean age was 48.70 years;there was a male predominance (70.40%) with a sex ratio of 2.38. Protein levels in ascitic fluid was Conclusion: Our study noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV.

Characteristics and Prognosis of Patients with Hepatocellular Carcinoma at Campus Teaching Hospital of Lome

Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, as well as in Togo, where it is a major public health problem. HCC is the third most common cause of death from cancer. Chronic infection with HBV and HCV is the most important cause of HCC. Objective: To determine the epidemiological, diagnostic and evolutionary aspects of HCC in the hepatology and gastroenterology department of Campus Teaching Hospital of Lomé. Patients and method: Descriptive and analytical study, conducted from January 1, 2013 to December 31, 2017, on all patients admitted in the hepatology and gastroenterology department of Campus Teaching Hospital of Lome for hepatocellular carcinoma. The statistical analysis was done using Stata 13 software. The significance threshold was used for p Findings: A total of 250 patients were retained. Hospital prevalence was 6.1%. There was a male predominance with a sex ratio of 2.84. The average age was 47.15 ± 13.85 (extreme: 20 - 85 years). The average duration of symptoms was 67.08 ± 82.59 days. Pain in the right hypochondrium was the most common reason for consultation (64.6%). The average AFP value was 24,062 ± 33,318 ng/ml. Ultrasound found more than two nodules in 74.75% of cases and a portal thrombosis in 64.97% of cases. The main etiologies found were chronic hepatitis B (55%) and C (8%) virus infections. The majority (89.20%) of patients were in the BCLC D stage. Survival at 6 months was 45%. Factors associated with death were: chronic ethylism (OR = 16.87, p = 0.002), jaundice (OR = 341.57, p = 0.004), rupture of esophageal varices (OR = 42.45, p = 0.008) and a BCLC D score (OR = 9.82, p = 0.041). Conclusion: Young adults were the most affected by HCC, whose etiologies are dominated in our context by hepatitis B and C viruses. The majority of our patients consulted late and was found at the terminal stage of the disease, limiting any therapeutic possibility. In this situation, the best attitude remains prevention.

Prevalence of Hepatitis B among Students from the University of Lomé, Togo in 2015

Objective: Hepatitis B virus (HBV) is endemic in sub-Saharan Africa where more than 80 million subjects are chronic carriers. However, screening is not systematic in the population and prevalence data are scarce, especially among the youth population. The objective of this study was to estimate the prevalence of HBV and its correlates among first-year University students at the University of Lomé. Study design: A cross-sectional survey was conducted between November 2015 and January 2016 at the University of Lomé during the annual checkup offered to newly enrolled students. Method: A self-administered questionnaire was used to collect data on demographics and sexual behaviors, and rapid tests were used for the detection of Antigen HBS (HBsAg) and HIV in each participant. A logistic regression model was performed to identify factors associated with HBsAg positivity. Results: A total of 800 students (56.2% were men) were screened among 1505 students who participated in the study. The median age was 20 years (IQR: [18 - 21]). The overall prevalence of HBsAg was 4.6% (95% CI: [3.2 - 6.3]): 5.8% among men and 3.1% among women (p = 0.04). The prevalence of HIV was 0.8;95%CI [0.3% - 1.6%] and one case (0.1%) of coinfection HIV and HBV was identified. Factors associated with HBsAg positivity were male gender [adjusted Odds Ratio (aOR) = 2.08, 95% CI: 1.02 - 5.00, p = 0.0447] and ever having a sexual relationship [aOR = 2.44;95% CI = 1.11 - 5.78, p= 0.0264]. Conclusion: This study among university students demonstrates that the prevalence of HBV is high among this population and that there is a need for prevention programs to target this vulnerable population. This is an additional argument toward HBV screening and treatment among students during annual health check.

Patients’ Lived Experience and Injuries Observed during Upper Digestive Endoscopy at KARA Teaching Hospital (Togo)

Background: Endoscopy remains the most performant medical exam exploring the upper digestive tract;but depending on patients, its tolerance is variable. Objective: This study aimed at describing the experience and evaluating the tolerance, acceptability and injuries observed during upper gastrointestinal endoscopy. Methods: This is a prospective and descriptive study carried out from April to July 2017 in the digestive endoscopy unit of the Kara teaching hospital (Togo). The gastroscopy was performed by the same operator (Hepatogastroenteroloogist). The premedication was done with direct intravenous injection of 10 mg of Metoclopramide hydrochloride and viscous Lidocaine oral gel. Previously, essential information about the examination course was given to patients after obtaining their verbal consent. Patients’ impressions of the experience, tolerance and acceptability were collected on a survey sheet, before and after the examination. Results: One hundred and eleven patients were included, 62 women and 49 men. The average age was 45.9 years (15 - 88 years), and the sex ratio (F/M) was 1.2. Most of the patients (89.2%) were experiencing the gastroscopy for the first time, and the main reason was epigastralgia in 55%. The examination duration was good at 88.3% and tolerance was good at 72.1%. Tingling, irritation, pain or sore throat feelings were noted in 13.5%. Patients agreeing to make an ulterior UDE if necessary were up to 92.8%. Observed injuries were dominated by antral erythematous gastropathy (28.8%). Conclusion: UDE is well tolerated among our patients and its acceptability is high. Injuries are dominated by inflammatory pathologies of the stomach in our population.

Factors Associated to the Acute Metabolic Decompensation of Diabetes in Lome

The purpose of the study was to define basic factors of the acute metabolic decompensations of diabetes mellitus at the medical emergency units at the CHU-SO of Lomé. The question is about a prospective study carried on along 12 months from 1st January, to December 31, 2013. It implicated 83 diabetes patients known or unknown admitted at the casualty department for an acute metabolic complication. In total the frequency of acute metabolic complications of diabetes mellitus that have been essentially done through the ketoacidosis model (73.49%) and hypoglycaemic (26.5%) is of 23.38%. Majority of diabetes patients were of type 2 (68.66%) and aged 50 and over with a sex-ratio of 0.76. The ketoacidosis revealed the disease in 43.37% cases. The main factors of ketoacidosis decompensations were infections, treatment termination and myocarditis ischaemia. Hypoglycemia decompensation factors were due to the absence or deficiency of food, the overdosage. Metabolic complications of diabetes then remain frequent. Infection and treatment termination are the major factors of ketoacidosis decompensation whereas those of the absence or deficiency of food are that of hypoglycemia. The prevention is compulsory through early screening of the disease and high treatment awareness of diabetes patients.