Determinants and Risks Factors of Renal Failure in Patients with Heart Failure in Cardiology Department of CHU Sylvanus Olympio of Lomé(Togo)

Introduction: The morbidity and mortality of patients with heart failure are known to increase rapidly in the presence of renal insufficiency, which is usually the cause but may be a consequence. To organize better prevention of renal failure, we undertook this study to identify the determinants of renal failure in the population of patients with heart failure. Methodology: This was a retrospective descriptive and analytical study of heart failure (HF) cases hospitalized from January 1st to December 31st, 2016, over a period for twelve (12) months at CHU Sylvanus Olympio. Patients who performed cardiac Doppler ultrasound were included in our study. Renal failure was defined as eGFR (estimated glomerular filtration rate) less than 60 ml/min/1.73m2. Multivariate logistic regression was performed to investigate associated factors. The dependent variable was DFG status: coded 1 if the GFR is less than 60 ml/min and 0 if not. Results: A total of 216 patients were included. The majority were female (54.17%). The median age of patients was 53 years [IQI = 32 - 61 years] with extremes of 15 and 96 years. 16.49% of patients had a GFR of less than 60 ml/min. In multivariate analysis the average standard of living (OR = 2.40, p = 0.0456), diabetes (OR = 2.67, p = 0.0300), hypertension (OR = 5.66, p = 0.0399), alcoholism (OR = 4.00, p = 0.0063) were the main factors in the development of an RF/HF. Conclusion: The average standard of living, diabetes, hypertension, and chronic alcoholism are the determinants of renal failure in HF.

Epidemiological, Clinical and Biological Aspects of Kidney Disease in People Living with HIV Naive Antiretroviral Therapy at CHU Sylvanus Olympio of Lome (TOGO)

Introduction: Human immunodeficiency virus (HIV) infection is a common cause of kidney disease worldwide. HIV-related renal diseases are associated with high morbidity and mortality in Sub-Saharan African countries. The aim is to describe the epidemiological, clinical and biological aspects of kidney disease in people living with HIV naive antiretroviral therapy in Lomé in Togo. Methods: This was a cross-sectional study done in the department of Infectious and Tropical Diseases in Lomé from ESOPE database. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. Kidney disease was defined as GFR less than 90 mL/min/1.73 m2. Results: In total, 3118 HIV-infected ART-naive patients were included in this study. Among them, the prevalence of renal disease at the beginning of their care, was 41.8% or 1303 patients [95% CI: 40.0% - 43.5%]. The median estimated GFR was 94.7 ml/min/1.73 m2: 2.9% had eGFR 2. The median age was 40 years [IQR = 34 - 48 years] with a sex ratio at 0.45. BMI median was 20.6 Kg/m2. Most of patients (30.8%) were at clinic OMS stage 1. Median CD4 was 165/uL [IQR = 72 - 274/uL];median hemoglobin was 10.4 g/dl [IQR = 8.8 - 11.9 g/dl];median glycemia was 0.84 g/l [IQR = 0.75 - 0.95 g/l]. Most of patients (99.9%) had HIV-1. 8.5% had hyperleukocytosis, and all patients had thrombopenia. Conclusion: The incidence of kidney disease is high in Togolese HIV-infected ART naive patients.

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

Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of Obstetrics Gynaecology and the Radiology and Medical imaging Department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). Conclusion: Contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.

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

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the state of hemodynamic shock before the operation;lack of blood transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric hysterectomy is a very mutilating and complicated surgical procedure and is still common practice in Africa. The maternal prognosis is still reserved with a very high mortality rate in Togo.

Management and Evolution of Multiple Myeloma with Renal Failure in Developing Countries: The Case of the Sylvanus Olympio University Hospital in Lome, Togo

Background: Renal failure (RF) is a frequent complication during multiple myeloma (MM) and sometimes reveals the disease. The median survival of MM patients with RF is shorter than that of patients with myeloma without renal involvement. Although patient survival has been prolonged with the new therapies, the median survival does not exceed five to seven years. Few data on this subject are available in sub-Saharan Africa. Objectives: To describe the therapeutic management and evolution of MM with RF in a developing country like Togo. Method: This was a retrospective descriptive and analytical study which took place over a period of ten years (2010-2019) and included the records of patients with MM according to the 2009 and/or 2014 IMWG criteria, hospitalized or followed up in the nephrology and rheumatology departments of the CHU-SO with a GFR Results: During the study period, 78 patients with MM had renal failure (55.7%). Therapeutically, hygienic and dietary measures were dictated in 84.6% of cases (68 patients). Rehydration was performed in 38 cases (48.7%);alkalinization of urine in 10 cases (12.8%);use of antibiotics in 36 cases (46.2%), NSAIDs in 51 cases (65.4%);use of biphosphonates in 36 cases (46.6%). Surgical immobilization by screw-plate osteosynthesis was performed in 02 patients. Nephrologically, 8 patients underwent ESRD. The different chemotherapy protocols used were Melphalan-Prednisone in 70% of cases, Melphalan-Cyclophosphamide-Prednisone in 26.7% of cases and Cyclophosphamide-Prednisone in 3.3%. The median overall survival was 8 months. The median survival was 13 months in patients who recovered from renal failure versus 2 months in those who did not recover from renal failure (p = 0.0030). Of the 78 patients in our series, 22 patients had died (28.2%). Conclusion: Despite renal failure, the Alexanian protocol and biphosphonates are still widely used in combination with symptomatic treatment with significant results.

Intracranial Meningiomas among Intracranial Tumors in the Neurosurgical Unit of Sylvanus Olympio Teaching Hospital

Objective: To describe the pattern of intracranial tumors in Sylvanus Olympio teaching hospital of Lomé (Togo). Method: We conducted a retrospective and descriptive study between November 2017 and December 2019. Data were obtained from the clinical records of patients with intracranial tumors treated in our neurosurgery unit, and histology obtained. Patients without a definitive histological diagnosis were excluded. Results: 53 patients were operated and had a histological diagnosis in the period of the study. The mean age at diagnosis was 32 ± 27.1 years. The majority of tumors were seen in adults at 88.7% with age range between 23 - 75 years and a mean age of 40 ± 10.5 years. Meningioma was the commonest intracranial tumor in adults (47.2%) and more seen in females. The histological type of meningioma is meningotheliomatous in our study. In children, principal tumors were medulloblastoma and ependymoma (11.3%). Conclusion: Meningioma is the most common intracranial tumor in adults, while embryonal tumors (medulloblastoma and ependymoma) are the most frequent in children in our environment.

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%) S? 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.

Predictive Factors of Renal Failure in COVID-19 Patients at the Anti-COVID Center in Lome, Togo

Background: Angiotensin-converting enzyme 2 has been identified as the receptor that allows the entry of SarsCov2 into the human cell. Its expression in the kidney is 100 times higher than in the lung;thus, making the kidney an excellent target for SarsCov2 infection manifesting as renal failure (RF). The objective of this study was to determine the predictive factors of RF during COVID-19 in the Togolese context. Patients and Methods: This was a retrospective descriptive and analytical study conducted at the Lomé Anti-COVID Center including the records of patients hospitalized for COVID-19, of age ≥ 18 years and having performed a creatinemia. RF was defined by a GFR 2 calculated according to the MDRD formula. Patients were randomized into 2 groups according to GFRResults: 482 patients were selected for this study with a mean age of 58.02 years. Sixty-five percent of the patients were men, i.e., a sex ratio of 1.88. Fifty-two patients had RF, i.e., a frequency of 10.8%.There were 65% men (315 cases), for a sex ratio (M/F) of 1.88. Risk factors for renal failure in COVID-19 were age ≥ 65 years (ORa 2.42;CIa95% [1.17 - 4.95];p = 0.016), anemia (ORa 2.49;CIa95% [1.21 - 5.26];p = 0.015), moderate (ORa 13;CIa95% [2.30 - 2.44];p = 0.017), severe (ORa 26.2;CIa95% [4.85 - 4.93];p = 0.002) and critical (ORa 108;CIa95% [16.5 - 21.76];p Conclusion: Renal failure would therefore be related to the severity of COVID-19 and is the most formidable factor, conditioning the course of the disease and the patient’s vital prognosis.

Obstetric References in Disadvantaged Environments: Case of References to the University Hospital Center of Kara, in Northern Togo

Introduction: References are frequent and most often carried out in emergency situations. The objective of this study was to describe the epidemiological and clinical profile of obstetric referrals to the CHU-Kara. Methodology: This was a retrospective cross-sectional descriptive study conducted from September 1, 2022, to February 28, 2023, at CHU-Kara, focusing on obstetric referrals to the Gynecology-Obstetrics department. Result: 828 patients were referred for obstetric reasons out of 1295 admissions, representing a frequency of 63.9%. The average age was 25.04 years. They were primigravida (38.3%), unemployed (62.7%). Motorcycles were the main means of transportation, accounting for 53.1% of cases. The average distance to reach the referral center was 31.6 km, covered in an average of 71 minutes. In 40.7% of cases, patients had less than 4 prenatal consultations and were referred in peripartum (56.6%) for pre-eclampsia (14%), post-term pregnancy (11.8%), dystocia (10.5%). Eighty-six point nine percent (86.9%) of the referred patients were able to deliver during their stay in the department, of which 61.7% had vaginal deliveries. The maternal and perinatal mortality rates were 0.7% and 14.9%, respectively. Conclusion: Obstetric referrals to Kara University Hospital are frequent during the perpartum period and are often carried out by motorbike.

Obstetric Emergencies at the Kara University Hospital Maternity Ward: Sociodemographic, Etiological and Prognostic Aspects

Introduction: Obstetric emergencies are common throughout the world and more particularly in developing countries where they are responsible for high maternal-fetal mortality and morbidity. Objective: Study obstetric emergencies in the maternity ward of Kara University Hospital. Method: Retrospective and descriptive study from April 1, 2022 to March 30, 2023, carried out in the Obstetrics and Gynecology Department of Kara University Hospital. Results: Eight hundred and thirty-five (835) obstetric emergencies were recorded out of 2215 admissions, i.e. a frequency of 37.7%. The average age of the patients was 26.7 with a range of 14 and 45 years. They were primigravidas (36.7%) and nulliparous (38.7%), referred (84.7%) and came from rural areas (72%). Emergencies occurred in the 3rd trimester in 74.1% and in parturients (54.1%). Preeclampsia (27%), cessation of progression of labor due to feto-pelvic disproportion (12.4%), postpartum hemorrhage (7.5%) constituted the main obstetric emergencies. In 44.8%, the delivery was carried out vaginally. Magnesium sulfate was the most used drug, i.e. 30.1%;followed by antihypertensive medications in 28.1%. Blood transfusion was performed in 24.3%. The evolution was simple in 90.9%. The maternal fatality rate was 1.6%. The perinatal case fatality rate was 12.3%. Conclusion: Obstetric emergencies are common, dominated by preeclampsia, stopping progress of labor and postpartum hemorrhages. They are responsible for high morbidity and mortality.

Epidemiological and Diagnostic Aspects of Childhood Proptosis in Lome (Togo) from 2010 to 2020

Background: Although proptosis is rare, it is nevertheless the main sign of orbital disease. Its discovery usually indicates a serious eye disease especially in children. Objective: To determine epidemiological and diagnostic aspects of childhood proptosis in Lome (Togo). Methods: Retrospective cross-sectional study conducted from June 2010 to May 2020, which is 10 years, in the ophthalmology department of CHU-campus of Lome. Files of patients between the age of 0 and 15 who presented a proptosis during the study period were taken into account in the study. Patients with a false proptosis or incomplete records during the study period were not taken into account in the study. Results: The study considered 42 children with an age average of 7.63 years ± 4.96 [4 days;15 years] and a sex-ratio of 1.33. The frequency of proptosis was 0.5% with an average progression of 383.7 days before the first consultation. The proptosis was unilateral in 80.95% of cases. The orbito-cerebral CT scan was done in 47.62% of cases. The proptosis in these patients was predominantly of grade 3 in 45% of cases. The tumor pathologies were at the forefront in 35.71%, dominated by retinoblastoma, and followed by infectious and inflammatory diseases in 14.29%. Conclusion: Childhood proptosis is rare and often indicative of infectious and tumor pathologies in our context. Its diagnosis is delayed, which shows the importance of an early and effective diagnosis. .

Determinants of the Ophthalmological Follow-Up of Sickle Cell Patients at the National Center of Research and Care for Sickle Cell Patients in Lome-Togo

Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .

Factors Associated with Homicides in Psychiatric Expertise in Togo

Background: In most societies, homicide or murder is a crime that often leads to imprisonment. Studies around the world have sometimes found cases of mental illness (schizophrenia spectrum disorders) as an explanation for some homicides. The aim of this study was to determine the factors associated with homicide in the Togolese context. Methods: This was a descriptive and analytical cross-sectional study of pre-trial psychiatric expertise reports from January 31st, 2019 to January 30th, 2022. Results: Out of 704 defendants appraised, 206 (29.3%) had committed homicide. Males accounted for 91.7% of Homicide defendants (HD). Their average age was 31.6 ± 12.2 years, with extremes of 16 and 74 years. Factors associated with homicide were female gender, age between 30 and 45 years, married or cohabiting status and occupation as a farmer/fisherman/breeder. Psychoactive substance use (PAS), mental illness and psychiatric history were not associated with homicide. Conclusion: Preventing delinquency and interpersonal conflict, and promoting social cohesion, could significantly reduce homicides in Togo.

Games of Chance and Money of the Togolese National Lottery in Lomé

Introduction: The addiction to games of chance and money is frequently encountered among some players. The general objective of this study was to describe the level of the gambling addiction among the players of the Togolese National Lottery (LONATO) in the city of Lomé. Method: This was a descriptive cross-sectional study through non-random sampling by convenience surveys, conducted on October 09, 2019 in 20 LONATO plying sites which affected 611 players. The screening was done using the South Oaks Gambling Screen (SOGS) questionnaire. Results: Of the 611 players surveyed, 55% were aged 18 to 35 years with an average age of 36 years and the extremes ranging from 14 to 78 years. The male gender was in the majority (84.26%). The prevalence of pathological gambling was 62.52%. Among the pathological gamblers, 16.89% had a family history of pathological gambling, 19.00% had a mood disorder, 28.50% had excessive alcoholism, and 17.15% consumed another psychoactive substance. Cannabis was the most consumed substance (6.87%) followed by tobacco (6.07%) and soporific (6.07%). More than half of players (62.03%) thought that pathological gambling is not a disease. Conclusion: The pathological gambling is a global phenomenon and a reality in Togo. Raising everyone’s awareness will reduce its negative impact on the players.

Pre-Hospital Management of Craniocerebral Trauma in South Saharan Africa: Cotonou Experience

The management of craniocerebral trauma begins at the site of the accident. This is one of the diseases for which pre-hospital care is well codified. The objective of this study is to report the experience of the Emergency Aid Medical Service (EMAS) of BENIN in the pre-hospital management of craniocerebral trauma. 146 head injuries were cared for. 116 were male. The mean age was 32 years with extremes ranging from 2 to 77 years. Etiology in 68% of patients was a public road accident. And the request for the use of the EMAS was made by highway users for 41% of the injuries. About 5.5% were severe cranio-brain injuries, more than 75% of which had died in intensive care. In 77% of the EMAS interventions, there was an intensive care physician in the team. 34 wounded had been transported in a vacuum mattress. The rigid cervical collar was used in 8 major traumas. All the wounded were transported by ambulance. The duration of hospitalization varied from a few hours in the emergency department to 90 days in the hospital ward. 9 patients died. One of them, who died in an ambulance, was a woman. The prehospital medical care of head trauma in BENIN is still progressing.

Pseudotumoral Chronic Subdural Hematomas on Two Cases

Introduction: Calcified forms with pseudo-tumor symptomatology of chronic subdural hematomas are rare. They are the result of slow bleeding over several years. The main etiology is related to the complications of the ventriculo-peritoneal shunt (VP). The purpose of this study was to recall the peculiarities and physiopathology of its pseudotumoral hematomas through 2 observations. Observation: Case 1: 8-year-old patient with a history of ventriculoperitoneal shunt at 3 months of age for congenital hydrocephalus, was admitted for functional impotence of the left-side of the body of insidious onset spreading over 9 months in a chronic headache, blurred vision and generalized seizure. CT scan showed a heterogeneous subdural hematoma of the right frontoparietal with calcifications. The patient underwent an excision by morcellation of a yellowish, friable partly calcific mass. The postoperative history was marked by a total recovery of the neurological deficit. There was no recurrence at 6 months postoperatively. Case 2: 11-year-old adolescent, treated with VP shunt at 6 months of age for post-meningitic hydrocephalus, was admitted for helmet headache, dizziness, lightheadedness and apathy progressing for 3 years. CT scan showed hypodensity of right peri-hemisphere with calcified linings, exerting a mass effect on the medial structures. The patient was given a block excision of a calcific mass with blood content. The evolution was marked by the complete resolution of seizures and hemiparesis. There was no recurrence at 6 months postoperatively. Conclusion: Calcified subdural hematomas are rare and consecutive to the complications of VPS. The clinical signs are those of a benign brain tumor. Treatment is dominated by the difficulties of cerebral reexpression.

Massive Envenomation by Bees Sting in a Child in Togo

Attacks by swarm of bees realize arrays of mass poisoning. We report the case of a 9 years old boy whoes severity was related to the large number of bees which was about 400 and their locations spread throughout the skin surface with a preponderance to the cephalic end. Complications were hemolytic anemia, kidney failure and convulsions. The outcome was favorable with symptomatic care and hemodialysis.

Treatment of Precancerous Lesions of the Cervix of the Uterus by Leep: Experience of the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

Objectives: Describe the socio-demographic characteristics, describe the main indications for LEEP and present the main complications. Methodology: This was a cross-sectional and descriptive study with consecutive recruitment of the study population through cervical cancer screening campaigns throughout the country during the period July 1, 2017 to April 30, 2019. Included were all patients eligible for LEEP and having benefited from this therapeutic method during our study period. Data were collected from a registry and recorded on a questionnaire developed for this study. These data were analyzed using Epi info 3.5.1 software. The following parameters were studied: patient age, indication for LEEP, intraoperative and postoperative complications, histological examination of the specimens, and postoperative surveillance and screening follow-up one year after LEEP. Results: During the study period, 12,595 women were screened for precancerous cervical lesions. A total of 474 women had precancerous lesions. Of these women, 227 had undergone loop resection, a rate of 47.9%. The main indications for LEEP were extensive lesions (68.7%), lesions penetrating the internal cervical os (12.8%). Incidents occurred in 7.5% of patients during the procedure. Post-operative complications occurred in 14.7% of cases. Conclusion: LEEP is a better way to treat precancerous lesions but is not well known by medical staff. The equipment of health facilities and the training of medical staff will make it possible to popularize the practice throughout the country. This extension will contribute to the fight against cervical cancer.

Viral Characteristic of HIV Infected Patients Naïf of Anti-Retroviral Therapy with CD4+ T Lymphocytes Rate Greater than 350 per Microliter of Blood in LoméTogo

Objective: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All HIV-1 infected patients whose CD4+ T lymphocytes rate was ≥350/μl of blood were retained. The count of CD4+ T lymphocytes was made by cytometer FACSCalibur? flow of BD biosciences and the determination of viral load was achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and 58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28 (27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4 rate below 500/μl of blood.

Resistance to Beta Lactam Antibiotics of <i>Pseudomonas aeruginosa</i>Isolated in Community Infections within HIV Infected Persons in Lomé-Togo

Objective: Describe resistance to beta lactam antibiotics of Pseudomonas aeruginosa in community infection within HIV-1 infected persons. Methods: We have studied prospectively from June 15th to December 31st 2013 inthe Clinic Hotel-Dieu and NGO VISA of Lomé, adult HIV-1 infected patients under anti retroviral therapy combining tenofovir, lamivudine and efavirenz for at least one year. The technique of agar diffusion susceptibility using discs of Ticarcillin + clavulanic acid is used to study the β-lactamase production. The diagnosis of species was performed by the chloroform test and the test for sensitivity to kanamycin and colistin. Results: Thirty five strains of Pseudomonas aeruginosa were obtained. The T-lymphocytes CD4 mediane was 575 cells/mm3 of blood. Urine represented 15 cases, skin abscesses 11 cases, externa suppurate otitis 7 cases and vaginal swab for 2 cases. The phenotypes were: wild phenotypes 23 cases (65.7%), resistant phenotypes 12 cases. Among resistant phenotypes, 4 were complex phenotype;5 were ESBL phenotypes;2 were hyper productive cephalosporinases phenotypes and 1 was a specific phenotype with impermeability to imipenem. Conclusion: The acquisition of resistance of Pseudomonas aeruginosa to beta lactam antibiotics in community infections among HIV-1 infected person incentives controls and promotes the rational use of antibiotics.