Mortality in Cardiology in Sub-Saharan Africa: Case of the Cardiology Department of the Teaching Hospital Sylvanus Olympio of Lome

Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.

Endoscopic Internal Urethrotomy in the Treatment of Male Urethral Stenosis in the Urology-Andrology Department of KARA Teaching Hospital (Togo)

Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.

Orbital Floor Fractures: Epidemiological, Clinical and Therapeutical Study at Sylvanus Olympio University Teaching Hospital in Loméabout 51 Cases

Introduction: Orbital floor fractures are a significant pathology among maxillofacial injuries. They can cause oculomotor, sensory, and sometimes esthetic disorders. The goal of this study was to determine the epidemiological profile of orbital floor fractures and show their clinical and therapeutic approach in Lomé. Patients and method: This was a descriptive retrospective study of orbital floor fractures collected in the ENT and maxillofacial surgery department of Sylvanus Olympio University Hospital in Lomé over 8 years (January 1, 2011 to December 31, 2018). Results: We reviewed 63 cases of orbital floor fractures out of 552 cases of facial trauma. According to the inclusion and non-inclusion criteria, we retained 51 cases. The hospital frequency of orbital floor fractures was 9.24% of facial fractures. The average age of the patients was 35 ± 10.34 years. Males were predominant (ratio = 7.5). The main etiology was road accidents (92.16%). Ophthalmological signs were dominated by vertical diplopia (31.37%), limited eye movement (25.49%), and enophthalmia (29.41%). The sensory sign was dominated by suborbital hypoesthesia (13.73%). Surgical treatment was performed in 86.27% of patients. The average intervention time was 17.84 ± 12.69 days after the trauma. The main approach was the subciliary route (65.91%). The surgical procedures consisted of muscle and fat removal (20.45%) and orbital floor repair by mesh plate (50%). The average length of hospitalization was 9.63 ± 5.23 days. Surgical site infection was the main postoperative complication observed in 3.92% of patients. The main sequelae were diplopia (4.55%), suborbital hypoesthesia (4.55%), and enophthalmos (4.55%). Conclusion: Orbital floor fractures are mainly due to road accidents. Management must be multidisciplinary and adequate in order to avoid irreversible functional and/or morphological sequelae. Their prevention consists of effective combat of road accidents.

Acute Stent Thrombosis: A Case at the Montlucon Hospital Center

Background and objective: Coronary angioplasty is one of the techniques introduced in 1976 by Andreas Grüntzig in Zurich. It is a revolutionary procedure that allows coronary circulation to be restored by inserting a stent. This new technique has considerably evolved over time, but sometimes has limitations, such as the development of neo-pathologies like stent thrombosis. The aim of our case report is to highlight one of the limitations of coronary angioplasty, although rare, and to encourage greater clinical and electrical monitoring after each procedure. Case report: We report the case of a patient who presented with early stent thrombosis barely an hour after placement of a pharmacoactive stent. Chest pain reported by the patient after the procedure and electrical changes prompted an urgent repeat procedure. Aetiologies of stent thrombosis are multifactorial, including patient-, procedure- and stent-dependent factors. Conclusion: Although rare, there is a risk of stent thrombosis after coronary angioplasty. Careful monitoring and rigorous follow-up of patients after coronary angioplasty are therefore required, as the prognosis for stent thrombosis is fairly poor.

Assessment of Haemostasis in Anaesthesia for Surgery at the Sylvanus Olympio University Hospital Center in Lomé

Title: Assessment of haemostasis in anaesthesia for surgery at the Sylvanus Olympio University Hospital Center in Lomé. Objectives: Evaluate the prescription of the preoperative haemostasis assessment. Methodology: This was a prospective descriptive and observational study which had taken place in the central operating room and in the operating room of the ENT department at UHC SO of Lomé from January 1 to June 31, 2016. It had concerned all patients who had anaesthesia for scheduled surgery after pre-anesthetic consultation and the haemostasis assessment carried out according to the anaesthesia technique and the type of surgery. Results: Two hundred and sixty (260) patients underwent anaesthesia during the study period. The male sex predominated (60%), the age group 18 - 40 years predominated (50.4%). GA was more practiced (62.7%) followed by spinal anaesthesia (30.3%). Minor ENT surgery was more performed (28%). ASA1 patients predominated (48.5%). The pre-anesthetic haemostasis assessment including platelet count, prothrombin rate, activated partial thromboplastin time and bleeding time was almost always done. The platelet count was achieved in all patients followed by the activated partial thromboplastin time (94%). No haemorrhagic complication related to a haemostasis disorder was observed in the perioperative period in anaesthesia than in surgery. Conclusion: The prescription of the pre-anesthetic haemostasis assessment should not be systematic. It must take into account the clinical history, the patient’s bleeding history during the anaesthesia consultation, the type of anaesthesia, the surgery planned and the age.

Giant Epulis of the Gum and Palate Area: A Case Report in Stomatology Department at LoméUniversity Teaching Hospital

Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.

Epidemiological, Clinical and Therapeutic Issues of Epulis at Campus University Teaching Hospital of Lomé: About 33 Cases

Introduction: The epulis is a hyperplastic tumor-like of the gingival or cheek mucosa that would be due to inflammatory reactions. Its pathogenesis remains incompletely understood. It appears to be common in Africa, but no study has been conducted in Togo. Our purpose was to describe epidemiological, clinical and therapeutic aspects of the epulis at the Campus University Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study on 33 cases at the Odontostomatology Department, from January 1st, 2014 to December 31st, 2016. Results: The prevalence of epulis was 0.88%. The average age of the patients was 36.92 years old. The most affected age group was 20 - 29 years old (30.30%). The sex ratio was 0.57. Low education and poor socio-economic conditions were found to be predisposing factors. Mucous swelling was the main reason for consultation. A local irritative factor was found in more than half of the cases. The preferred seat was gum (63.63%). Inflammatory epulis was found in 36.36% of cases. Biopsy-excision was performed in 96.96% of patients, with a cure without sequelae in 100%. Conclusion: The epulis is a rare benign affection of the gum. Its favoring factors are mechanical or infectious local irritation, or hormonal factors. His diagnosis is essentially clinical, but requires histological confirmation to distinguish it from other serious tumors. Biopsy-excision is the main treatment. No sequelae are observed in all patients of our series.

Prevalence of Metabolic Syndrome and Associated Factors among Hemodialysis Patients Monitored at the National Teaching Hospital, Hubert Koutoucou Maga in 2015

Introduction: Metabolic syndrome is one of the main risk factors of cardiovascular disease among hemodialysis patients. Objective: The main objective of this study was to determine the prevalence and factors associated with metabolic syndrome among hemodialysis patients in Cotonou in 2015. Patients and methods: It was a cross-sectional, descriptive and analytical study conducted from 05th October to 02nd November 2015 at the National Teaching Hospital, Hubert Koutoucou Maga of Cotonou. All patients aged 18 years and above, regularly under hemodialysis for the past 3 months and who gave their informed consent were included in the study. Those excluded were: currently hospitalized hemodialysis patients, hemodialysis patients hospitalized in the last three months, hemodialysis patients whose general condition deteriorated or unable to answer the questionnaire. Metabolic syndrome was defined according to the International Diabetes Federation’s criteria. Factors associated with metabolic syndrome were sought using logistic regression in univariate analysis. Confidence intervals were calculated at 95% and alpha significance threshold at 5%. Outcomes: In total 165 patients were included in the study. Male predominance was observed, with 1.27 sex-ratios. Average age was 49.3 ± 12.9 years with extremes ranging from 18 to 78 years. Metabolic syndrome is observed among 46 patients undergoing hemodialysis or 27.9% prevalence rate. Factors associated with the metabolic syndrome in univariate analysis were: gender (p 0.001), age (p = 0.007), body mass index (p = 0.029) and prior diabetes history (p = 0.011). Conclusion: Metabolic syndrome is common among hemodialysis patients. Early screening and fighting against associated risk factors are very important.

Marjolin’s Ulcer at the Kara Teaching Hospital (Togo)

Marjolin’s ulcer is an aggressive tumor that occurs on a chronic non-healing wounds or burn scars. It’s a rare disease. Histologically, it is most often a squamous cell carcinoma. The real frequency is not known. Its incidence would be higher in developing countries where ancestral beliefs and financial difficulties cause consultation delays. Thus the diagnosis is delayed, due in part to the lack or insufficiency of diagnostic means. Our study aimed to describe the epidemiological, diagnostic and therapeutic particularities through three cases treated in our center. The delay in consultation resulted in the death of one patient, while for the other two, amputation prevented the extension of the tumor. Limb amputation is increasingly rare in the management of Marjolin’s ulcer, but in our difficult conditions it is still widely practiced when the tumor is localized at the extremity of the limb, without signs of remote invasion.

Hematological Malignancies in Sickle Cell Disease Patients: Report of Four Cases in Togo and Literature Review

Background: Hemopathies were rarely observed in major sickle cell disease patients some thirty years ago, probably due to the high mortality rate among the latter as a result of progressive complications. Thanks to advances in the management of sickle cell disease, patients' life expectancy has increased considerably, exposing them more frequently to neoplasia, including hematological malignancies. The increased risk of leukemogenesis is multifactorial and linked to the pathophysiological mechanisms of the clinical manifestations of sickle cell disease. Study Setting: The clinical haematology department of campus teaching hospital and the paediatric onco-haematology unit of Sylvanus Olympio teaching hospital in Lomé were used as study settings. Observations: Four hematologic malignancies were collected in a cohort of 5847 major sickle cell syndromes. The median age of the patients was 31.25 years (extremes: 14 and 58 years) and they were predominantly female (sex ratio M/F = 0.25). Two were on background therapy with hydroxyurea. Among the four patients, there were two cases of acute lymphocytic leukemia, including ALL3 in a 58-year-old SS woman and T-ALL2 in a 12-year-old SC. Then, a case of lymphocytic lymphoma in a 20-year-old SS man was reported and finally a case of chronic myelocytic leukemia in a 33-year-old woman of Sβ+ thalassaemia phenotype. Conclusion: To further report this coexistence, it is therefore essential to systematically consider hematological malignancies during major sickle cell syndromes even if there are similarities in the symptomatology of these two serious pathological situations.

Indications for Renal Needle Biopsy and Histological Spectrum of Kidney Disease in Togo

Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

Chest Computed Tomography of Elderly Subjects at University Hospital Campus Lomé

Background: Radiology in elderly as pediatric radiology poses a number of problems. The normal radiological appearance of the elderly patient’s chest is very varied and the changes are ubiquitous. Purpose: To describe the computed tomography profile of the elderly subject’s chest. Materials and Methods: Descriptive prospective study from January 1st to June 30th, 2018 carried out at the University Campus Hospital of Lomé. Results: We recorded 64 chest CT scans. The average age of the patients was 71.3. Internists (n = 21, 32.8%) and general practitioner (n = 16, 25%) were the major applicants for these tests. In most cases, thoracic CT examinations were requested as part of an extension assessment (n = 21, 32.8%), dyspnea and pneumonitis in 18.8% of cases each. All thoracic CT examinations were performed with contrast injection. CT with the TAP protocol was the most observed, accounted for more than half of the exams (56%). The main pathological lesions observed were diffuse parenchymal lesions (39.5%), pleurisy (11.1%) and PAH (11.1%). Conclusion: Computed tomography occupies an important place in the care of the elderly but the actors involved in their care must be trained to take optimal care.

Male Urethral Stricture: Epidemiological, Clinical, and Therapeutic Aspects in Kara

Background: Urethral stricture is a pathology frequently encountered in urological practice. Management is often surgical, with possible recurrences. What about this pathology in Kara, a semi-urban city? Objective: Assess the management of male urethral stricture in Kara. Patients and Methods: This was a descriptive study with retrospective data collection. The study took place in the urology department of the teaching hospital of Kara, from December 2020 to December 2022. All cases of male urethral stricture, surgically treated at the teaching hospital of Kara, were listed. The inclusion criteria were as follows: any patient who had been treated surgically for male urethral stricture in the urology department of the teaching Hospital of Kara. The operating theater register and hospital records were used to collect the data. The diagnosis of urethral stricture had been made with retrograde urethrogram. A total of 24 patients were treated for male urethral stricture during the study period. The following variables were studied: age, reason for consultation, location, length, and etiology of the stricture;the type of treatment received: optical internal urethrotomy, or anastomotic urethroplasty, and the results. The result was considered good if, after removal of the urethral catheter, the patient regained his micturition without the need for dilatation;the result was considered average if, after removal of the urethral catheter, the patient needed one or more dilatation sessions to regain urination;the result was considered poor if, after removal of the catheter, the patient did not regain good micturition despite the urethral dilatation sessions. Microsoft excel and epi info 7 software were used for data processing. Results: The average age of our patients was 43.7 years ± 10.18 with extremes ranging from 27 to 70 years. The most represented age groups were that of 40 to 50 years, with 37.5% of cases;and that of 30 to 40 years with 33.3% of cases. The patients had consulted for urine retention in 66.6% of cases;the location of urethral stricture was bulbar in 45.8% of cases. The most found etiology was infectious in 58.3% of cases. Among our patients, 58.3% had received optical internal urethrotomy as treatment, while 41.6% of our patients had received anastomotic urethroplasty as treatment. Postoperatively, after removal of the urinary catheter, 87.5% of patients had benefited from one or repeated dilatation. In terms of results, we had a good result in 20.8% of patients;the result was average in 45.8% of patients, and poor in 33.3% of patients. The average duration of follow-up was 14.3 +/- 7.2 months (3-27). Conclusion: Male urethral stricture mainly affects young adults in Kara. Surgical management is done by optical internal urethrotomy and/or anastomotic urethroplasty.

Knowledge and Practices of Dentists, Oral and Maxillofacial Surgeons of Cone Beam Computed Tomography (CBCT) and the Dentascanner in a Low Income Country: Case of Togo

Background: In dental-maxillofacial imaging, 3D sectional imaging progressively replaces conventional 2D imaging in developed countries. They are based specially on Computed tomography (CT-Scan), with the Dentascan application and cone beam computed tomography (CBCT). In developing countries those technics are newly introduced. Aim: This study aimed at studying the knowledge and practices of dentist and oral and maxillofacial surgeons on sectional imaging such as Dentascan and Cone Beam Computed Tomography (CBCT). Materials and Methods: We conducted an anonymous survey among dentists and oral maxillofacial surgeons in Togo over one month. Results: The response rate was 78.79% (27/33). They were mainly male sex (sex ratio of 2.25 men for one woman). They were aged between 27 and 71 years old with an average of 49.69 years old. The majority (61.54%) had a professional experience over 20 years. The majority of respondents (65.38%) believed their level of knowledge about dental x-Ray was poor. Half of them (50%) confirmed that they had never asked for a Dentascan, and 15.38% asked from time to time for it and only two (7.69%) asked often for this test. 96.15% confirm they have no knowledge of the Dentascan. Regarding the CBCT, 84.62% didn’t ask for it because this technique did not exist in Togo before. 69.20% of respondents confessed to be interested in continuing training on sectional imaging. Conclusion: This study shows that sectional imaging is very little used by oral and dental practitioners in Togo because of the ignorance of the new techniques and the absence of the CBCT. It is therefore necessary to promote the teaching of the new technique of sectional imaging in the training syllabus of oral and dental specialists and to initiate continuing medical training.

Women’s Preferential Contraceptive Methods in Publics’ Family Planning Centers in Lomé(Togo, West Africa): A Prospective Study of 734 Cases

Justification and Objectives: The reasons for the choice of contraceptive methods in Lomé were insufficiently documented. The current study aimed to identify preferential contraceptive methods in women in Lomé and the reasons for the choices. Materials and Methods: Prospective study conducted on 734 clients recruited in five family planning centers in the municipality of Lomé over a period of 3 months (30th September to 30th December 2005). Data were collected by direct interview and processed by Excel and Epi info 7 software. Results: Contraceptive methods preferred in descending order were: Medroxyprogesterone acetate injection (51.6%), Norethisterone enantate injection (17.3%), inert Intra Uterine Device (12.0%), Progestogen implants (11.0%), combined oral pills (8.03%) and spermicide jelly (0.1%). The main reasons for choices were the method’s reversibility (32.56%) and its long acting property;especially in illiterate women (p 10-10). Friends and medical staff counted for the choice in 9.26%. In 76.87% of cases, the husbands were reported to agree with the chosen methods. Conclusion: The choice of contraceptive methods in Lomé was mainly guided by the notion of reversibility and its long acting property. The focus should be put more on the quality of counselling towards women with low education level.

Maxillofacial Trauma at LOMÉ(TOGO): About 501 Cases

Objective: We conducted a retrospective study to determine the epidemiological profile and describe the diagnostic aspects of maxillofacial trauma. Methods: It was a retrospective descriptive study over 20 years (January 1995-December 2014) in Oral and Maxillofacial Surgery Department of the Sylvanus Olympio Teaching Hospital in Lomé. All the hospitalized patients for facial trauma were included. Results: 501 cases of facial trauma were retained with an annual incidence of 25 cases. The average age was 33 years and the most represented age groups are those of 20 to 29 years (35.53%) and 30 to 39 years (30.14%);and the sex ratio was 9. Traffic roads accidents represented the main circumstance (89.81%) and the motorcycle was the most involved (80.34%). Patients were admitted in the first week (75.65%) with 35.93% on the first day. The maxillofacial CT-Scan was the most requested radiological examination (33.75%). Bone lesions were: mandible (31%), zygomatic (23.26%) and maxillary (18.99%). Dental lesions were found in 68 cases. Extra-facial lesions were found in 44 cases. The patients were treated in the first week (62.48%) and in the first day after admission (20.76%). Conclusions: Maxillofacial trauma is increasing, mainly in young adults due to road traffic accidents.

Medical Ultrasound Practice in Developing Countries: Example of Togo

Background: Ultrasound has become the most widely practiced medical imaging examination even in developing countries because of its non-irradiating, non-invasive nature and its relatively affordable cost. Objective: The objective of this study was to review the practice of medical ultrasound in Lomé city. We carried out a descriptive cross-sectional study using the pre-established fact sheets. It took place from 16 August to 30 November 2013 in the healthcare facilities of the city of Lomé. Results: A total of 47 centers were surveyed, including 14 public centers and 33 private centers. The ultrasound scanners were mostly acquired in the new state (59.6%) with only 34.1% of these ultrasound scanners equipped with the Doppler mode. There were 3 ultrasound scanners (6.4%) that had a 3D probe. Radiologists were the ones who carried out most of the ultrasound examinations in public centers, while in private they accounted for half of the performers (45.5%). Physicians enrolled in a specialty in radiology played a significant role in these private structures, accounting for 24.2% of performers. Cardiac ultrasound was performed only in 2 centers (4.2%). The ultrasound report was available in all public centers using the pre-established and standardized forms. The qualification of sonographers and the status of ultrasound scanners are relatively acceptable. Conclusion: Ultrasound scanners were mostly acquired in new condition. Radiologists remained the ones who carried out the largest number of ultrasound examination in Lomé.

Mandibular Sequela Noma: Metal Plate Repair Associated with a Submental Flap, about One Case

Introduction: Noma is a severe and mutilating gangrenous stomatitis of the orofacial sphere, starting on periodontal side. It is rare and occurs mainly in children that land is weakened by malnutrition. We report a case of mandibular sequela noma requiring plastic surgery. Clinical case: This was a 7-year-old patient with moderate acute malnutrition. She was referred from a peripheral care facility for gangrene of the left cheek, communicating the oral cavity with the outside, through an orostoma. This lesion had been evolving for two months, with a tendency towards progressive destruction of the soft tissues of the cheek and the mandibular bone. The neck and facial CT-Scan demonstrated destruction of the mandibular bone exposed on the left side, without signs of tumor invasion. After correction of nutritional status and local infection, the patient was treated with a metal plate recovered by sub-mental flap. Conclusion: Noma is a severe gangrenous stomatitis that transforms patients’ faces into ghosts by destroying soft tissues and underlying bone planes. The management of his sequelae is surgical, sometimes using complex techniques of plastic surgery.

Umbilical Artery Resistance Index in the Surveillance of Pregnancies at Risk of Fetal-Maternal Hemodynamic Disorders in Lomé(Togo)

Objective: Evaluate the role of umbilical artery Doppler ultrasound in the surveillance of pregnancies at risk of vascular disorders in Lomé. Study Method: The study was a cross-sectional analytical study carried out in the department of radiology of Campus teaching hospital over a period of 6 months. This study was based on the measurement of the resistance index of the umbilical artery in pregnant women presenting vascular risk and other pregnant women without vascular risk. The correlation between the pathological index and the at-risk pregnancies was assessed by the Odds Ratio as well as the correlation between the resistance index and the Apgar score at birth. Results: The resistance index was measured in 209 at-risk pregnant women and in 425 pregnant women without vascular risk. The average age of pregnant women was 26.31 years for “the at-risk pregnant” versus 25.38 years for the “pregnant-witnesses”. The association between the pathological resistance index (RI) and the gestational pathologies studied, had been positive and significant with an odds ratio of 1.57 for a 95% confidence interval of [1.07 - 2.20]. A pathological RI is a risk factor for the occurrence of a pathological Apgar score at birth because this association was positive and significant for “pregnant-cases” as for “pregnant-witnesses”. Conclusion: Measuring the index of resistance is not a common practice in our communities. However, it could be an important tool in the surveillance of at-risk pregnancies for diseases such as malaria, pre-eclampsia, and maternal anemia.