Preliminary experience with tele-sonography and tele-mammography in Togo

Many medical centres are equipped with a sonograph. However, a sonographist is not always present or is not trained in all of the specialised domains of sonography. . A sonogram is not always possible due to a lack of physicians. This situation has given rise to the concept of remote-controlled sonography: tele-sonography, a medical procedure used in remote sonographic diagnosis in real time or deferred time. Tele-sonography can now be carried out in real time by the transmission of the expert's procedure (robotic system) or by the use of a 3D sonograph in real time. These modes of real time tele-sonography rely on expensive technologies requiring budgets and an infrastructure that is not always possible in developing countries where the needs in tele-medicine are increasing. This paper aimed to present a preliminary evaluation of a "low cost" system of sonographic tele-expertise in real time and the deferred sonographic telediagnosis accompanied by a tele-mammography between expert sites (university hospitals) and isolated sites (peripheral hospitals, dispensaries).     

échographie dans les abcès hépatiques à germes pyogènes chez les diabétiques

Ojectives

Evaluate different echographic aspects pyogenic liver abscess in diabetic patients, and compare them with those described in the literature in non-diabetic.

Materials and Methods

A retrospective study over a period of 10 years of the records of diabetic patients with pyogenic liver abscess who underwent an abdominal ultrasound study.

Results

The mean age of patients was 57±16.7 years old with a male predominance. All patients had type 2 diabetes. The clinical signs were mainly the right upper quadrant pain, hepatomegaly, impaired general condition and fever. The right liver was the most affected. The ultrasound appearances were polymorphic, mostly anechoic and heterogeneous. Rupture of abscesses into the abdominal cavity was noted in two patients, which requiring surgical treatement. Treatement consisted in insulinotherapy and antibiotherapy. The evolution was favorable in all cases.

Conclusion

The ultrasound appearances of hepatic abscesses in diabetics are polymorphic and depend on the evolutionary stage. They do not differ from those reported in the literature in non-diabetics.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.     

Hutchinson‐Gilford Progeria syndrome: Report of the first Togolese case

The aim of this article is to describe the first case of Hutchinson‐Gilford Progeria Syndrome (HGPS) in Togo and review all Africans cases. Our patient was a 12.8‐year‐old Togolese boy followed in our unit till he was 15‐year‐old for HGPS. He was the only child of non‐consanguineous parents. The phenotypic findings were craniofacial dysmorphy, dwarfism, lipodystrophy, diffusely scattered hyperpigmented foci, pyriform thorax, nail dystrophy, decreased joint mobility, and camptodactyly. He had characteristic facies with prominent forehead, prominent eyes, absent ear lobule, thin nasal skin, convex nasal profile, micrognathia, and crowded teeth. Radiologicals findings were bilateral coxa valga, pyriform thorax, and acro‐osteolysis. We sequenced the entire coding region of LMNA gene, and mutation analysis revealed a heterozygous mutation c.1824C>T (p.Gly608Gly). Our patient is therefore the fifth African and the fourth with classical mutation, first of Western Africa, and second of (sub‐Saharan) African black race. The recurrence of HGPS is low like the cause is neomutation or germinal mosaicism.     

Ability to predict six-month mortality and inter-tool agreement between four nutritional assessment instruments in the SAFES cohort

AimTo measure the ability to predict 6-month mortality of several different instruments for evaluating nutrition, and to compare agreement between results obtained with these different instruments.MethodsProspective, multi-centre cohort study, including subjects aged 75 years or older, admitted to hospital through the emergency room. The predictive capacity of the different nutrition instruments (namely: Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), body mass index (BMI) and albuminemia) were tested using a Cox model after adjustment for socio-demographic and clinical variables. Agreement between these four instruments was assessed by calculating Cohen's Kappa coefficient.ResultsIn total, 1306 subjects were included in the cohort, average age 85 ± 6 years. The crude death rate at 6 months was 24.4%. Prevalence of malnutrition varied from 24 to 59%. All the nutrition instruments evaluated were significantly related to survival; the strongest associations with mortality were observed with GNRI (hazard ratio [HR] = 1.65; 95% CI =  1.31–2.06) and MNA (HR = 1.64; 95% CI = 1.27–2.03). Agreement between indicators was moderate to poor.ConclusionThe GNRI and the MNA appear to be the most useful tools for detecting malnutrition in elderly patients admitted via the emergency room.     

Un cas d’invagination intestinale subaigu? sur diverticule de Meckel chez une adolescente au CHU Campus de Lomé en 2008

Adult intussusception is rare; the Meckel’s diverticulum is also a rare entity. Chronic abdominal pain, low digestive haemorrhages and the recurring obstructive symptoms can lead to an useless delay in the diagnosis. This case report describes a rare cause of adult intestinal intussusception due to Meckel’s diverticulum in order to point out the clinical, radiological aspects then therapeutic of this affection.