Profil Des Infections Ostéoarticulaires En Consultation Rhumatologique Au CHU- Kara (Togo)

Introduction: Osteoarticular infections remain public health problems in Africa. We aim at determining the clinical forms, topographic and etiological osteoarticular infections in a rheumatology unit of northern Togo. Methods: We conducted a cross-sectional study from April 2012 to March 2015 on inpatient records having suffered from musculoskeletal infection. Results: Of the 1813 patients admitted to the department in three years, 86 (4.74%) suffered from musculoskeletal infection. Of them, 36 (41.86%) were men and 50 (58.1% 4) were women, with a sex ratio (M/F) of 0.72. The mean age of the patients was 45 years. The mean duration of disease progression was 3.5 months. The different clinical forms observed were: spondylitis (47 patients, 54.65%), infectious arthritis (31 cases, 36.05%) and osteomyelitis (eight cases; 9.30%). The infection was likely tuberculous in 53 patients (61.63%), including 44 cases of Pott's disease. A banal germ was mentioned in the 33 others patients (38.37%). In four cases, the germ was isolated: Staphylococcus aureus (three cases) and Staphylococcus epidermidis (one case). The joints most affected by the infection were the hip (nine patients) and the knee (eight patients). Infection was multifocal in 14 cases (16.27%). The main risk factors for the infection identified were: promiscuity and poor hygiene (59.30%), alcoholism (26.74%) and retroviral infection (12.79%). Conclusion: This study and joint infections are a common reason for rheumatology consultation in northern Togo with a significant share of multifocal forms

Prise En Charge Infirmière De La Douleur Chez L’adulte Au CHU-Kara (Togo)

Introduction: Pain is a frequent reason for consultation in health facilities. Thus, nurses are in the forefront in the fight against pain. The aim of this study was to determine the role of the nurse in the management of the painful adult patient. Methodology: It was a cross-sectional study conducted in 11 departments of Kara teaching hospital during two weeks. Nurses who had managed a painful adult in the past seven days were included in the study. Results: Thirty nurses participated in the study. They were made of 24 men (76.67%) and six women (23.33%). The average age of nurses was 35 years (extremes: 23 years old and 50 years old) and 43.33% of them had less than five years of work experience. The main etiologies of pain managed were: trauma (22%), headache (18%) and abdominal pain (14%). Pain assessment tools were almost non-existent. Fifty percent of nurses did not know pain assessment tools. The evaluation of pain was performed with conventional tools by 16% of nurses. The analogical visual scale was the most used (three out of five nurses). Nursing intervention was dominated by counseling (43%) and thermal stimulation (22%). The use of analgesics was carried out in 83.33% of cases. Conclusion: This study shows that few nurses evaluated the pain during its management in adults. Therefore, it is necessary to initiate medical training for Togolese nurses on the management of the painful patient in order to make them more effective

Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis

Background: Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods: Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality.Discussion: The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations

Rhabdomyosarcome de I'iliopsoas : Localisation Exceptionnelle Chez une Femme de 65 Ans

Le rhabdomyosarcome est une tumeur maligne mésenchymateuse de l'enfant et de l'adolescent. Il représente 5% de l'ensemble des tumeurs solides à ces âges. Cette tumeur est rare chez l'adulte et exceptionnelle chez le sujet âgé. Les localisations les plus fréquentes sont la tête, le cou et l'appareil urinaire. Peu d'études rapportent des localisations rétropéritonéales et l'atteinte primitive du muscle iliopsoas a été exceptionnellement décrite dans la littérature. Les auteurs rapportent une nouvelle observation d'une patiente de 65 ans présentant un rhabomyosarcome alvéolaire de l'iliopsoas gauche.   Rhabdomyosarcoma is a malignant mesenchymal tumor in children and adolescents. It represents 5% of all solid tumors at these ages. This tumor is rare in adults and exceptional in the elderly. The most frequent localizations are the head, the neck, and the urinary tract. Few studies reported retroperitoneal emplacements, and primary involvement of the iliopsoas muscle has been described exceptionally. This paper focuses on reporting a new observation of a 65-year-old patient with alveolar rhabomyosarcoma of the left iliopsoas

Polyarthrite rhumatoïde et hemoglobinopathie ss chez une femme de 61 ans

La survenue de la polyarthrite rhumatoïde (réputée moins fréquente en Afrique subsaharienne qu’en Occident) chez un malade atteint de drépanocytose (maladie génétique spécifique de la race noire) comporte des conséquences diagnostique thérapeutique et pronostique. Nous en rapportons un cas observé chez une femme de 61 ans dont la polyarthrite n’a été reconnu qu’au stade de carpite fusionnante bilatérale. La double coxopathie dont souffrait cette patiente relevait d’une nécrose d’allure aseptique des têtes fémorales. Le terrain et les différentes répercussions des deux affections ont rendu complexe la prise en charge de la patiente.   English title: Rheumatoïd arthritis and sickle cell disease in a 61-year – old woman The occurrence of rheumatoid arthritis (known to be less frequent in sub-Saharan Africa than in the West) in a patient with sickle cell disease (a specific genetic disease of the black race) has diagnostic, therapeutic and prognostic consequences. We report a case observed in a 61-year-old woman whose rheumatoid arthritis was only recognized at the stage of bilateral fusing carpitis. The bilateral hip involvement from which this patient was suffering was due to aseptic necrosis of the femoral heads. The terrain and the different repercussions of the two conditions made the patient management complex

Prise en charge des rhumatismes inflammatoires chroniques en guinee

Objectif: Etudier la prise en charge des patients atteint de rhumatisme inflammatoire chronique en Guinée.Patients et méthodes: Etude transversale descriptive de 18 mois ( du 1er Octobre 2016 au 30 Avril 2018) au service de rhumatologie de l'hôpital national Ignace Deen. Tous les malades répondant aux critères diagnostiques des rhumatismes inflammatoires chroniques ont été inclus.Résultats: Nous avons colligé 339 cas de rhumatisme inflammatoire chronique sur 1502 patients (22,56 %) dont 56,63 % de femmes. L’âge moyen des patients était de 43,05 ±18,04 ans (extrêmes de 8 mois et 90 ans). L’âge moyen de début des symptômes était de 39,20± 18,04 ans. Le délai diagnostique moyen était de 3,88 ± 5,36 ans. La polyarthrite rhumatoïde était le rhumatisme inflammatoire chronique le plus fréquent (108 cas, soit 31,86%) et le méthotrexate était le traitement de fond le plus utilisé (36,09%). Aucun patient n’avait bénéficié de biothérapie. Le méthotrexate était le traitement qui avait le plus d’effets secondaires (12 ; 3,53%). L’évolution était favorable à 3 mois dans 57,52% des cas, marquée par une rémission. Le coût mensuel de la prise en charge était en moyenne équivalent à 1,5 fois le salaire minimum garanti en Guinée.Conclusion: Les rhumatismes inflammatoires chroniques sont fréquents en Guinée. La prise en charge est empreinte de difficultés liées à la faiblesse du plateau technique et au bas niveau socio-économique des patients. Mots clés : polyarthrite rhumatoïde, spondyloarthrites, méthotrexate, Guinée.   English title: Management of chronic inflammatory rhumatism in guinea Objective: To study the management of patients with chronic inflammatory rheumatism in Guinea. Patients and methods: descriptive cross-sectional study of 18 months (1st October 2016 to 30th April 2018) at the rheumatology department of Ignace Deen National Hospital. All patients meeting the diagnostic criteria were included. Results: We collected 339 cases (22.56%) of chronic inflammatory rheumatism in 1502 patients (22.56%), 56,63% of whom were women. The mean age of the patients was 43.05 ± 18.04 years (range: 8 months to 90 years). The mean age of onset of symptoms was 39.20 ± 18.04 years. The mean diagnostic delay was 3,88 ± 5.36 years. Rheumatoid arthritis was the most common condition (108 cases, or 31.86%), Methotrexate were the most commonly used DMARDs (36.09%). No patient had receive biotherapy. Methotrexate was the treatment with the most side effect (12 cases, 3.53%). The evolution was favourable at 3 months in 57.52% of the cases, marked by a remission. The monthly cost of care was on average equivalent to 1.5 times the guaranteed minimum wage in Guinea. Conclusion: Chronic inflammatory rheumatism is common in Guinea. The management is fraught with difficulties related to the weakness of the technical platform and the low socio-economic level of the patients. Keywords: Rheumatoid arthritis, spondyloarthritis, methotrexate, Guinea

Profile of cervicobrachial neuralgia among rheumatology patients in Lomé, Togo

Objectives: To determine the frequency and the different clinical forms of cervicobrachial neuralgia in a rheumatological setting in Lomé, Togo.Design: This was a cross-sectional multicenter study conducted from January 2012 to December 2018 on the records of patients seen in the three rheumatology units in Lomé, Togo.Methods: Patients who reported for consultation purposely because of cervicobrachial neuralgia were included. Diagnosis of the various clinical forms of degenerative cervical spine disease was essentially clinical, whereas radiological imaging findings contributed to the diagnosis of spondylodiscitis and neoplastic disease.Results: Cervicobrachial neuralgia was the reason for the clinic visit in 143 (0.69%) out of the 14,346 patients examined over the eight year study period. These 143 patients comprising 84 women (58.74%) and 59 men (41.26%) had a mean age of 53.36±13.33 years. The average time to consultation was two years. Degenerative disease (138 cases,96.5%) was the most commonly observed pathology. It included the following clinical forms: cervical osteoarthritis (n=120; 83.91%), cervical myelopathy (n=13; 9.10%) and herniated disc (n=5; 3.49%). Disc degeneration in isolation (60.83%) was the main radiographic finding in patients with degenerative disease. Spondylodiscitis was probably due to tuberculosis in the four patients who had it and two of them were HIV- positive. Bone metastasis from prostate cancer was found in one case.Conclusion: Cervicobrachial neuralgia appears to be significant among rheumatology patients in Lomé. It predominantly affects adult women in professional activity. Althoughmainly dominated by degenerative pathology, its aetiologies can also be infectious as well as neoplastic, hence the relevance of modern imaging modalities. Key words: Cervicobrachial neuralgia, Osteoarthritis, Spondylodiscitis, Tumours, Sub-Saharan Afric

Medication prior to rheumatology consultation in a Togolese Teaching Hospital

Objective: To determine the frequency and nature of the medication prior to specialized consultation in rheumatic patients. Design: This was a cross- sectional study of patients admitted for the first time for rheumatology consultation at CHU-SO in Lomé, Togo.Methods: The data relating to the medication prior to the consultation were collected by questioning. The diagnosis of the conditions covered by the consultation was based on clinical and para-clinical examinations. Results: Two hundred and eleven patients (151 women and 60 men) with a mean age of 49 years were included in the study. Forty-five patients (21%) were covered by health insurance because of their status as state employees, unlike the other 166 (79%) working in the informal sector. Spinal degenerative pathology (76%), knee osteoarthritis (20%) and tendinitis (10%) were the main diseases observed. One hundred and ninety- five patients(92%) were on medication prior to the rheumatology consultation. Non-steroidal anti- inflammatory drugs (118 cases, 75%) and analgesics (93 cases, 59%) were the most common therapeutic classes that were used. Self-medication was observed in 141 patients (67%) at all levels of education combined. Eighty- four of the 141patients(60%) have used street drugs, and 98 of them (70%) were oriented by word of mouth. General medical practitioners (25%) and medical assistants (19%) were the main prescribers before the rheumatology consultation. Epigastric pain (16 cases) was the main side effect observed. One hundred and forty- four patients (66%) had no idea of the risks of self-medication, added to lack of money by 122 (87%) patients and lack of knowledge of rheumatology by 67 (48%) patients. Conclusion: Self-medication, the frequency of which is known all over the world, is more notable in Africa and in rheumatic diseases where pain is the main symptom and its relief is one of the criteria for evaluating the effect of any therapy. Key words: Self-medication, Rheumatology, Togo, Afric

Compressions medullaires lentes en milieu Rhumatologique a Lome (Togo)

Patients et méthodes : Il s’est agi d’une étude multicentrique, transversale, menée du 1er janvier au 31 mars 2019 sur dossiers des patients admis en hospitalisation dans les trois services de rhumatologie à Lomé. Le diagnostic positif de syndrome de compression médullaire était clinique. Le diagnostic étiologique a reposé sur des arguments cliniques et paracliniques.Résultats : 165 des 3261 patients examinés (5%) souffraient d’un syndrome de compression médullaire lente. Les 165 patients (84 hommes ; 81 femmes) avaient un âge moyen de 54 ± 17 ans (extrêmes : 2 et 86 ans). La durée moyenne d’évolution était de 20 ± 35 mois (extrêmes : 2j et 18 ans). Les motifs d’hospitalisation étaient une impotence fonctionnelle (80,6%) associée ou non à une cervicalgie (12,9%), à une dorsalgie (15,3%), à une dorsolombalgie (28,8%) et à une lombalgie (46,6%). Les principaux signes cliniques étaient un syndrome rachidien (96,4%) et une parésie ou paralysie (95,2%). Le syndrome de compression médullaire était révélateur de la maladie dans 64,8% des cas. La radiographie standard a été réalisée chez tous les patients (100%), la TDM dans 43,6% des cas et l’IRM dans 16,4%. Les étiologies étaient les causes tumorales malignes (93 ; 56,4%) dominées par les métastases de cancers solides (59 ; 35,7%), les spondylodiscites bactériennes (46 ; 27,8%) dominées par le mal de Pott (40 ; 24,2%) et les affections rachidiennes dégénératives (26 ; 15,8%).Conclusion : Le syndrome de compression médullaire lente est rare en pratique rhumatologique à Lomé. Les étiologies sont dominées par les causes tumorales malignes principalement les métastases de cancers solides. Mots clés : Compression médullaire; Etiologie; Métastases de cancers solides ; Mal de Pott. English abstract: Spinal cord compressions in Rheumatology in Lome (Togo)  Objective: To determine the prevalence and etiologies of slow spinal cord compression syndrome in rheumatology in Lomé. Patients and methods: This was a multicenter, retrospective study, conducted from January 1 to March 31, 2019 on records of patients admitted to hospital in the three rheumatology departments in Lomé. The positive diagnosis of spinal cord syndrome was clinical. The etiological diagnosis was based on clinical and paraclinical arguments. Results: 165 of 3261 patients examined (5%) suffered from slow spinal cord compression syndrome. The 165 patients (84 men; 81 women) had a mean age of 54 ± 17 years (range: 2 and 86 years). The mean duration of evolution was 20 ± 35 months (range: 2 days and 18 years). The reasons for hospitalization were a limitation of the walking distance (85.5%) associated or not with back pain (98.8%), and radiculalgia (89.1%). The main clinical signs were spinal syndrome (96.4%) and paresis or paralysis (95.2%). Spinal cord compression syndrome was indicative of the disease in 64.8% of cases. Standard radiography was performed in all patients (100%), CT in 43.6% of cases and MRI in 16.4%. The aetiologies were malignant tumor causes (56.4%) dominated by metastases of solid cancers (63.4%), bacterial spondylodiscitis (27.8%) dominated by Pott's disease (24.2%) and degenerative spinal diseases (15.8%). Conclusion: Slow spinal cord compression syndrome is rare in rheumatology practice in Lomé. The aetiologies are dominated by malignant tumor causes, mainly metastases from solid cancers. Key words: Spinal cord compression; Etiology; Metastases of solid cancers; Pott's disease