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Togo - Top 30 Publications

Cervical Cancer Induction Enhancement Potential of Chlamydia Trachomatis: A Systematic Review.

Human papillomavirus (HPV) persistent infection is the necessary but not sufficient cause of cervical cancer. Other co-factors are required to induce cell transformation that will evolve to malignant cervical cancer. These co-factors include physical elements, other sexually transmitted infections, and immune response. Chlamydia trachomatis the most common bacterial sexually transmitted infection is often asymptomatic but causes various syndromes such as cervicitis, endometritis, pelvic inflammatory disease, and infertility. It is established that this bacterium is involved in cell proliferation process and inhibit apoptosis. Furthermore, C. trachomatis may induce chronic inflammation, interfere with immune response by decreasing the number of antigen presenting cells, and reduce the cell-mediated immunity allowing the persistence of HPV. However, it is unclear whether this bacterium plays a particular role in cervical cancer induction. We therefore aimed at enlightening the actual knowledge about the relationship between C. trachomatis and cervical cancer or precursor lesions through a systematic literature review. We summarized and analyzed the epidemiological data on C. trachomatis and its co-infection with HPV and their association to cervical cancer.

Risk factors for Mycobacterium ulcerans infection (Buruli Ulcer) in Togo ─ a case-control study in Zio and Yoto districts of the maritime region.

Buruli ulcer (BU) is a neglected mycobacterial skin infection caused by Mycobacterium ulcerans. This disease mostly affects poor rural populations, especially in areas with low hygiene standards and sanitation coverage. The objective of this study was to identify these risk factors in the districts of Zio and Yoto of the Maritime Region in Togo.

Novel Streptococcus suis Sequence Type 834 among Humans, Madagascar.

Two cases of meningitis caused by Streptococcus suis occurred in Madagascar, 1 in 2015 and 1 in 2016. We report the characterization of the novel sequence type, 834, which carried the mrp+/sly+/epf+ virulence marker and a mutation G→T at position 174, leading to a substitution mutS1 to mutS284.

Characterization of highly virulent multidrug resistant Vibrio cholerae isolated from a large cholera outbreak in Ghana.

The purpose of this study was to investigate the virulent factors of Vibrio cholerae which caused an unprecedented large cholera outbreak in Ghana in 2014 and progressed into 2015, affected 28,975 people with 243 deaths.

Shea (Vitellaria paradoxa Gaertn C. F.) fruit yield assessment and management by farm households in the Atacora district of Benin.

Vitellaria paradoxa (Gaertn C. F.), or shea tree, remains one of the most valuable trees for farmers in the Atacora district of northern Benin, where rural communities depend on shea products for both food and income. To optimize productivity and management of shea agroforestry systems, or "parklands," accurate and up-to-date data are needed. For this purpose, we monitored120 fruiting shea trees for two years under three land-use scenarios and different soil groups in Atacora, coupled with a farm household survey to elicit information on decision making and management practices. To examine the local pattern of shea tree productivity and relationships between morphological factors and yields, we used a randomized branch sampling method and applied a regression analysis to build a shea yield model based on dendrometric, soil and land-use variables. We also compared potential shea yields based on farm household socio-economic characteristics and management practices derived from the survey data. Soil and land-use variables were the most important determinants of shea fruit yield. In terms of land use, shea trees growing on farmland plots exhibited the highest yields (i.e., fruit quantity and mass) while trees growing on Lixisols performed better than those of the other soil group. Contrary to our expectations, dendrometric parameters had weak relationships with fruit yield regardless of land-use and soil group. There is an inter-annual variability in fruit yield in both soil groups and land-use type. In addition to observed inter-annual yield variability, there was a high degree of variability in production among individual shea trees. Furthermore, household socioeconomic characteristics such as road accessibility, landholding size, and gross annual income influence shea fruit yield. The use of fallow areas is an important land management practice in the study area that influences both conservation and shea yield.

From the day they are born: a qualitative study exploring violence against children with disabilities in West Africa.

Despite the building evidence on violence against children globally, almost nothing is known about the violence children with disabilities in low and middle-income countries (LMICs) experience. The prevalence of violence against children with disabilities can be expected to be higher in LMICs where there are greater stigmas associated with having a child with a disability, less resources for families who have children with disabilities, and wider acceptance of the use of corporal punishment to discipline children. This study explores violence experienced by children with disabilities based on data collected from four countries in West Africa- Guinea, Niger, Sierra Leone, and Togo.

Clinical characteristics of non-tuberculous mycobacterial pulmonary infections in Bamako, Mali.

The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02-0.13) and OR 0.32 (CI 0.11-0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.

Child mortality infected with HIV1 followed in 40 pediatric care sites in Togo.

The infection in pediatric HIV is the reason a lot of problems in Africa The objective of our study were to identify factors associated with mortality during follow-up of children receiving antiretroviral therapy in Togo.

'Lactomassilus timonensis,' a new anaerobic bacterial species isolated from the milk of a healthy African mother.

We here report the main characteristics of a new anaerobic bacterial genus and species 'Lactomassilus timonensis,' strain Marseille-P4641T (CSUR = P4641), isolated by microbial culturomics from the milk of a 35-year-old healthy lactating mother from Mali.

Scleroderma in hospital settings in Lomé: 50 cases.

The aim of this study was to document the epidemiological and clinical profile, treatment used, and outcome of patients with scleroderma in hospital settings in Lomé. This descriptive study examined the records of all patients seen as outpatients or admitted for scleroderma in hospital dermatology and rheumatology departments in Lomé during the 20-year period of 1993-2012. During the study period, 50 (0.04%) of the 121,021 patients seen in these departments had scleroderma. There were 29 cases of localized scleroderma and 21 systemic cases, predominantly women (sex-ratio=0.2). The patients' mean age was 36 years. All patients with systemic scleroderma had speckled achromia (100%), and most (90.48%) had cutaneous sclerosis. After a mean follow-up period of 43.5 days, 71.43% of the patients had been lost to follow-up. All of the patients with localized scleroderma had cutaneous sclerosis, and the rate of loss to follow-up (after a mean of 17 days) was 96.55%. The results of this study confirm the extreme rarity of scleroderma in the teaching hospitals in Lomé and a clear female predominance. It points out the difficulty of management, which both influences and is aggravated by the high rate of loss to follow-up.

Upper gastrointestinal tract endoscopic lesions in a rural African hospitalo: 252 endoscopies at the Kara University Hospital, Togo.

To analyze the indications for upper gastrointestinal endoscopy (UGIE) and determine the frequency of the pathological findings observed in rural areas of Africa. This retrospective study includes 9 series of 5-day visits to perform these examinations. Patients were informed of the presence of the endoscopy team by a bulletin on a rural radio station and by general practitioners at the Kara University Hospital. Patients were recruited from the hospital clinics and from the general population of the Kara region. The study includes all UGIE reports from August, 2007, through September, 2014; these contain the indications for the procedure, the patients' sex and age, and the examination report. The study included 252 reports for 133 women and 119 men with a mean age of 42.44 years (range: 20 to 102 years). The most frequent indications were dyspeptic syndrome (79.76%) and diffuse abdominal pain (11.11%). In all, we observed 139 gastroduodenal lesions among the patients with dyspepsia, principally bile reflux (23.02%), gastroduodenal inflammatory lesions (18.71%) and gastroduodenal ulcers (17.99%). The most commonly observed lesions for diffuse abdominal pain were again, bile reflux (30.77%), followed by gastritis, esophageal mycoses, and tumors. This work made it possible to identify the various pathological lesions of the UGI tract seen on endoscopies in a rural hospital in Togo.

Digital Health in Francophone Sub-Saharan Africa: Catching Up!

Digital health has the potential to strengthen health systems and empower patients to prevent ill health and manage their own care. To confirm this potential, however, it is urgent to shift from pilot studies to the implementation of programs at a sufficient scale, with interoperable solutions and integrated into the national health system, while respecting human rights. It is also important to plan for studies to demonstrate the impact and produce the necessary evidence. Francophone sub-Saharan Africa can catch up in this area.

Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa.

Association of habitual dietary intake with morningness-eveningness and rotating shift work in Japanese female nurses.

Rotating shift workers are associated with imbalanced dietary intakes. Rotating shift workers and dietary intakes in adults who do not engage in night work have also been shown to be associated with chronotype. However, no studies have examined associations between morningness-eveningness (i.e., the degree to which people prefer to be active in the morning or the evening), rotating shift work and dietary intakes. Therefore, our first purpose was to elucidate the association between morningness-eveningness and habitual food group intakes in rotating shift workers. The second purpose was to elucidate the association of morningness-eveningness and rotating shift work with food group intakes, considering habitual sleep durations. Japanese nurses (1095 day workers and 1464 rotating shift workers) were studied using a self-administered questionnaire. The questionnaire covered habitual dietary intakes, morningness-eveningness and demographic characteristics of the participants. A Japanese version of the Morningness-Eveningness Questionnaire (MEQ) was used to measure self-rated morningness-eveningness. Dietary intakes over the previous 1 month were evaluated using a semi-quantitative food frequency questionnaire. Intakes of pulses, green/yellow vegetables, white vegetables, fruits, algae, eggs, confectioneries/savory snacks and sugar-sweetened beverages were significantly (p < 0.05) associated with the MEQ score in rotating shift workers. Among these food groups, intakes of green/yellow vegetables, white vegetables, fruits and algae were significantly (p < 0.05) lower in rotating shift workers than in day workers, and intakes of confectioneries/savory snacks and sugar-sweetened beverages were significantly (p < 0.05) higher in rotating shift workers than in day workers. Intakes of these food groups were also significantly (p < 0.05) associated with the MEQ score in day workers. In addition, the MEQ score was significantly (p < 0.05) lower in rotating shift workers than in day workers, indicating greater eveningness among rotating shift workers. Multivariate linear regression revealed that the MEQ scores were significantly (p < 0.05) associated with intakes of these food groups, while rotating shift work was associated only with confectioneries/savory snacks. These results suggest that morningness-eveningness is associated with unbalanced dietary intakes in rotating shift workers as well as day workers, which may partially explain associations between rotating shift work and unfavorable dietary intakes. These findings have important implications for the development of novel strategies for preventing poor health caused by imbalanced dietary intakes in rotating shift workers.

An economic evaluation of the controlled temperature chain approach for vaccine logistics: evidence from a study conducted during a meningitis A vaccine campaign in Togo.

A recent innovation in support of the final segment of the immunization supply chain is licensing certain vaccines for use in a controlled temperature chain (CTC), which allows excursions into ambient temperatures up to 40°C for a specific number of days immediately prior to administration. However, limited evidence exists on CTC economics to inform investments for labeling other eligible vaccines for CTC use. Using data collected during a MenAfriVac™ campaign in Togo, we estimated economic costs for vaccine logistics when using the CTC approach compared to full cold chain logistics (CCL) approach.

Characterization of Pasteurella multocida involved in rabbit infections.

In rabbit, P. multocida is considered a predominant pathogenic agent; despite this, few data on the molecular epidemiology are available so far. The aim of this work was to characterize P. multocida isolates from rabbit affected by various diseases in Italy. Comparison was made to reference strains from other countries. Thirty-nine isolates were tested using PCRs to detect the genes coding capsular antigens, virulence factors and lipopolysaccharide structures (LPS). Multilocus sequence typing (MLST) was performed and 19 STs registered that belonged to 9 clonal complexes. Italian isolates were all related to P. multocida subsp. P. multocida. Three sequence types dominated (ST9, ST50 and ST74). The isolates were assigned to capsular types A (20/39), D (9/39) and F (10/39), to virulence genes pfhA (13/39), hgbB (21/39) and pfhA+hgbB (4/39) (one without virulence factors) and the isolates either belonged to the LPS genotypes 3 (22/39) or 6 (17/39). The clonal relationships of the Italian strains from rabbit had similarity to previously reported rabbit isolates that belonged to ST9, ST74, ST204 and ST206, however, they differed from other rabbit references strains that belonged to six other STs. In particular, ST9 with capsular type F has been previously reported from diseased rabbit in Czech Republic and ST74 has been observed for older rabbit isolates. ST50 has probably been reported from Spain. ST9 and ST50 have previously also been reported from birds and pig, respectively, whereas ST74 has exclusively been reported from pig. It remains to be investigated if the isolates obtained from diseased rabbit in Italy represent introductions from other host or they are primarily of rabbit origin.

Descriptive Epidemiology of Cancers in Togo from 2009 to 2016

Background: Cancer is a global public health problem. According to World Report on Cancer in 2000, developing countries are becoming increasingly affected. Methods: This retrospective and descriptive 8-year study of all histological confirmed cancers was conducted using data from the anatomical pathology laboratory registry of Togo’s only laboratory. The parameters were frequency, site and histological type as well as age and gender. Results: We found 1,738 cancers in patients aged from 4 months to 109 years (mean, 50.4 ± 4. The sex ratio (M/F) was 1.3. The most frequent localizations of the cancers were the prostate (10.3%) followed by the breast (9.9%), the stomach (8.4%) and the cervix (7.2%). In women, the median age was 47.4 ± 2.9 years, and the most common cancers were breast cancer (21.2%), followed by cervical cancer (16.3%). In men, the median age was 53.2 ± 7.3 years and the most frequent cancers were prostate cancer (18.5%), non-Hodgkin’s lymphoma (13.2%) and stomach cancer (10.7%). In children, Burkitt’s lymphoma (41.8%), retinoblastoma (11.6%) and nephroblastoma (9.6%) were the most important cancers. Conclusion: Cancers are frequent in Togo, those of the prostate, breast and cervix being most important with a worse prognosis. Emphasis should be placed on early detection and diagnosis.

Breast cancer cases of female patients under 35 years of age in Togo: A series of 158 cases.

Breast cancer in young female patients represents a public health problem in developing countries. The objectives of the study were to study the epidemiological and histological characteristics of breast cancer in female patients under 35 years of age. This was a retrospective analytical study of a series of 158 cases of breast cancer in female patients under 35 years of age, conducted at the University Teaching Hospital of Lomé between 2000 and 2015. A total of 158 cases were collected, representing 36.2% (436) of all breast cancer cases. The average age of the patients was 30.9 years (range, 16-35 years). A family history of breast cancer at the 1st or 2nd degree was identified in 13.9% of cases. Genetic mutation studies were carried out for 7 patients, 5 of which revealed mutations (4 BRCA1 and 1 BRCA2). According to the locus, the cancer was located preferentially in the left breast in 88 cases (55.7%). Malignant mammary lesions were epithelial tumors (n=144 cases, 91.1%), infiltrating (n=125 cases, 79.1%) and non-infiltrating (n=19 cases, 12.0%). The other histological groups consisted of 8 cases of sarcomas (5 cases of angiosarcoma, 2 cases of fibrosarcoma and 1 case of Kaposi's sarcoma), 5 cases of lymphomas and one case of melanoma. Not otherwise specified infiltrating ductal carcinomas were SBR II and III in 43.2 and 35.2% of cases, respectively. The tumors classified as T4 were the most frequent (30.4%). Regarding the lymph node status, lymph node metastasis was noted in 22.8% of cases. Studies of hormone receptors were carried out in 23 patients and were positive for 11 patients: Estrogen receptor (ER)+plus progesterone receptor (PR)+(7 patients), ER+PR-(4 patients). Of the aforementioned 8 cases of sarcoma, 5 were angiosarcoma. The lymphomas were predominantly Burkitt's type for 4 cases. Mammary ultrasonography was performed in 45.6% of the patients and 54.4% underwent the combined ultrasonography and mammography. Ultrasound identified one or more sign of malignancy in 67 patients (42.4%), and combined ultrasonography and mammography classified 51.9% of lesions in BIRADS 4 and 5. The incidence of breast cancer in young Togolese patients is high. It is a disease distinguished by a delay in diagnosis, which contributes to the high number of cases that initially diagnosed at an advanced stage, particularly the high histo-prognosis grades of infiltrating ductal carcinoma. These results indicate a genetic origin; therefore, a thorough investigation into genetic mutations should be carried. In addition, further collaborative studies are required to verify these results.

Micro-Raman imaging on 4H-SiC in contact with the electrode at room temperature.

Raman images (30μm×30μm×180μm) of a bulk 4H-SiC wafer in contact with a Ni/Au electrode film in 100nm/200nm thick were measured with Micro-Raman spectroscopy at room temperature. As the imaging area approached the interface between the SiC and electrode, the center frequency of the E2(TO) mode (778cm-1) immediately declined; in the Raman imaging, relative distribution of compressive residual stress around residual tensile stress, and linewidth were broadened due to crystal distortion. For LOPC (LO-phonon-plasmon-coupled) mode (970cm-1), center frequency showed variation right next to the interface, while linewidth decreased slowly as the imaging area approached the interface. We evaluated the temperature dependence of the line broadening and the center frequency of the LOPC mode in 4H-SiC in a high-temperature region. Free carrier concentration increased with temperature, and remained almost constant in the center frequency after impurities were ionized completely.

Two Distinct Fluorescence States of the Ligand-Induced Green Fluorescent Protein UnaG.

UnaG is a recently discovered ligand-induced fluorescent protein that utilizes bound bilirubin (BR) as its fluorophore. The fluorescence of the UnaG-BR complex (holoUnaG) compares in quantum efficiency to that of enhanced green fluorescent protein, but it is superior in that the fluorophore formation is instantaneous and not dependent on oxygen; hence, much attention has been paid to UnaG as a new fluorescent probe. However, many important molecular properties of fluorescent probes remain unknown, such as the association/dissociation rates of BR, which determine the stability thereof, and the dispersibility of UnaG in aqueous solutions, which influence the functions of labeled proteins. In this study, we found, in the process of investigating the association rate, that the holoUnaG takes two distinct fluorescence states, which we named holoUnaG1 and holoUnaG2. The holoUnaG1 initially forms after binding BR and then changes to the brighter holoUnaG2 by a reversible intra-molecular reaction, thereby finally reaching an equilibrium between the two states. Spectroscopic analysis indicated that the intra-molecular reaction was associated not with a chemical change of BR but with a change in the environmental conditions surrounding BR. We also revealed that the molecular brightness ratio and equilibrium population ratio of the two states (holoUnaG1/holoUnaG2) were 1:3.9 and 6:4, respectively, using photon number counting analysis. From these results, we have suggested a novel schema, to our knowledge, for the formation of the UnaG and BR complex system and have determined the various rate constants associated therein. Additionally, using analytical ultracentrifugation, we established that UnaG in the apo-state (apoUnaG) and the holoUnaG are monomeric in aqueous solution. These findings provide not only key information for the practical use of UnaG as a fluorescent probe, but also the possibility for development of a brighter UnaG mutant by genetic engineering to constitutive holoUnaG2.

Prevalence and Factors Associated with Self-Medication in Dermatology in Togo.

This study aimed to determine the prevalence of and factors associated with self-medication in dermatology in Lomé, Togo.

Cell softening in malignant progression of human lung cancer cells by activation of receptor tyrosine kinase AXL.

To study the role of cell softening in malignant progression, Transwell assay and atomic force microscope were used to classify six human non-small cell lung cancer cell lines into two groups: a high motility-low stiffness (HMLS) group and a low motility-high stiffness (LMHS) group. We found a significant role of activity of the AXL receptor tyrosine kinase, which belongs to the TAM (Tyro3, AXL, Mer) family, in the stimulation of motility and cell softening. HMLS cells expressed higher AXL levels than LMHS cells and contained phosphorylated AXL. H1703 LMHS cells transfected with exogenous AXL exhibited increased motility and decreased stiffness, with low levels of actin stress fibre formation. Conversely, the AXL-specific inhibitor R428 and AXL-targeting siRNA reduced motility and increased stiffness in H1299 HMLS cells. Knockdown of AXL stimulated actin stress fibre formation, which inhibited tumour formation in a mouse xenograft model. The Ras/Rac inhibitor SCH 51344, which blocks disruption of actin stress fibres, exerted similar effects to AXL inactivation. We therefore propose that the Ras/Rac pathway operates downstream of AXL. Thus, AXL activation-induced cell softening promotes malignant progression in non-small cell lung cancer and represents a key biophysical property of cancer cells.

Risk factors for retinal detachment in Togo.

Retinal detachment poses management problems in developing countries due to the shortage of technical equipment. Prevention passes through knowledge and elimination of risk factors. This study aimed to identify the risk factors for retinal detachment in people living in Togo.

Effects of Field-Map Distortion Correction on Resting State Functional Connectivity MRI.

Magnetic field inhomogeneities cause geometric distortions of echo planar images used for functional magnetic resonance imaging (fMRI). To reduce this problem, distortion correction (DC) with field map is widely used for both task and resting-state fMRI (rs-fMRI). Although DC with field map has been reported to improve the quality of task fMRI, little is known about its effects on rs-fMRI. Here, we tested the influence of field-map DC on rs-fMRI results using two rs-fMRI datasets derived from 40 healthy subjects: one with DC (DC+) and the other without correction (DC-). Independent component analysis followed by the dual regression approach was used for evaluation of resting-state functional connectivity networks (RSN). We also obtained the ratio of low-frequency to high-frequency signal power (0.01-0.1 Hz and above 0.1 Hz, respectively; LFHF ratio) to assess the quality of rs-fMRI signals. For comparison of RSN between DC+ and DC- datasets, the default mode network showed more robust functional connectivity in the DC+ dataset than the DC- dataset. Basal ganglia RSN showed some decreases in functional connectivity primarily in white matter, indicating imperfect registration/normalization without DC. Supplementary seed-based and simulation analyses supported the utility of DC. Furthermore, we found a higher LFHF ratio after field map correction in the anterior cingulate cortex, posterior cingulate cortex, ventral striatum, and cerebellum. In conclusion, field map DC improved detection of functional connectivity derived from low-frequency rs-fMRI signals. We encourage researchers to include a DC step in the preprocessing pipeline of rs-fMRI analysis.

Successful endovascular therapy for multiple intracranial arterial stenosis associated with medically intractable giant cell arteritis.

On the distribution and natural history of a rarely encountered species: <i>Goliathus</i> (<i>Fornasinius</i>) <i>klingbeili</i> Zöller, Fiebig, &amp; Schulze, 1995 (Coleoptera: Scarabaeidae: Cetoniinae).

Mudge et al. (2012) surveyed the Cetoniinae (Coleoptera: Scarabaeidae) of Ghana and recorded Goliathus (Fornasinius) higginsi Westwood, 1874, but no other species from this subgenus. We add the rare species Goliathus (Fornasinius) klingbeili Zöller, Fiebig, & Schulze, 1995 as a new country record for Ghana from the dense forests of the Volta and Eastern Regions. The species was previously reported as very rare in Togo (Zöller et al. 1995) in the northern dry part of the Bafilo Region. We record that the larvae develop in hyrax (Dendrohyrax dorsalis (Fraser, 1855) (Mammalia: Procaviidae) middens and can be locally common in this microhabitat. The purpose of this note is to record the new distributional and natural history data, discuss the taxonomy and bionomy of the subgenus Goliathus (Fornasinius) Bertoloni, 1852, and provide a key to species.

Clinical Study of Testicular Fasciotomy for Testicular Torsion.

Between November 2011 and November 2014, we performed a tunica albuginea incision with tunica vaginalis flap coverage (TAI+TVFC) on 5 out of 15 patients who underwent surgery for testicular torsion. Of those 15 patients, 7 underwent orchidopexy alone (Group A), 5 underwent TAI+TVFC (Group B), and 3 underwent an orchidectomy procedure (Group C). All were followed for 1 year and preservation of testicular volume >50% on the contralateral side in ultrasound measurements was considered as salvaged. During the follow-up examinations, no testicular atrophy was noted in Group A. In Group B, tension and testis color were immediately improved in all 5 patients after TAI+TVFC, while blood perfusion was also improved after the operation. Also 3 patients in Group B were considered to be salvaged, while testicular atrophy occurred in 2 after 8 or more hours from onset until surgery. Our results indicated that TAI+ TVFC is useful for restoring blood flow after surgery for testicular torsion, although the so-called'Golden time'for torsion surgery has a significant impact in such cases.

Juvenile myasthenia gravis in sub-Saharan Africa: a case study of two consanguine sisters born from consanguinity in Togo.

Myasthenia gravis is a rare acquired autoimmune pathology causing neuromuscular transmission impairment. Juvenile onset of myasthenia gravis is often characterized by ocular involvement. We report two cases of ocular juvenile myasthenia gravis (JMG) in two siblings. They were two young girls, XA and XB, aged 11 and 9 years, of Malian origin, residing in Togo, born from first-degree of consanguinity presenting to Ophthalmology due to progressive decrease in visual acuity. XA showed visual acuity 8/10 on both eyes while XB showed improvement in visual acuity from 3/10 to 7/10 using a pinhole occluder, suggesting ametropia. XA had a 2-year history of bilateral ptosis lifting the upper eyelid of 7 mm, while XB had a 3-year history of bilateral ptosis with no lifting of the upper eyelid. Ice pack test was strongly positive in both patients. They had Cogan's lid twitch with paresis of the oculomotor nerve without diplopia. The dosage of acetylcholine receptor autoantibodies was normal. The diagnosis of JMG associated with ametropia was suspected. Ametropia was corrected by glasses and a specific treatment with pyridostigmine was initiated, but both patients were lost to follow-up. Autoimmune myasthenia gravis with inaugural ophthalmologic manifestation is rare but it can occur among children living in sub-Saharan Africa. Studies should be conducted to establish the features of this disease.

Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo.

In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo.

Cancer mortality in the urological department of the Sylvanus Olympio Teaching Hospital in Lome, Togo.

To determine the proportion of cancer mortality seen in the urology department of a teaching hospital in sub-Saharan Africa and to identify the contributing factors. This 10-year retrospective study took place in the urology department of the Sylvanus Olympio Teaching Hospital of Lomé (Togo) and analyzed the records of patients who died of cancer from January 2006 through December 2015. During the study period, 94 deaths were recorded in the department, 84% of them due to a urological cancer. The mean age of patients was 62 years,- and there was a significant male predominance with a sex ratio of 4.3. Prostate cancer was the most common cause of death, accounting for 49 (62%) cases. The mean duration of symptoms was 2.4 months. At diagnosis, 75.9% of patients were metastatic and 66% had comorbidities, such as high blood pressure or diabetes. Palliative treatment was instituted for 87.3% of patients. Deterioration of their general condition was the immediate cause of death in 71% of cases. Urological cancers remain a challenge for specialists in Togo, especially because they are characterized by late presentation with diagnosis at the metastatic stage. Their prognosis is aggravated by the presence of comorbidities.