Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income countries. World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries; however, outbreaks among select populations need to be adequately addressed. Continued vigilance and investment are needed to address syphilis worldwide. The epidemiology of syphilis differs in high-, and low- and middle-income countries.

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An Update on the Global Epidemiology of Syphilis

HIV infection has a significant impact on the natural history of chronic hepatitis B virus (HBV) infection, with increased levels of HBV DNA, accelerated progression of liver disease and increased liver-associated mortality compared with HBV monoinfection. Widespread uptake and early initiation of HBV-active antiretroviral therapy has substantially improved the natural history of HIV-HBV coinfection but the prevalence of liver disease remains elevated in this population. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV-HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease. We also review novel therapeutics for the management of HBV with a particular emphasis on clinical strategies being developed for an HBV cure and an HIV cure and their impact on HIV-HBV coinfected individuals.

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HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment.

Although much is known today about the prevalence of food allergy in the developed world, there are serious knowledge gaps about the prevalence rates of food allergy in developing countries. Food allergy affects up to 6% of children and 4% of adults. Symptoms include urticaria, gastrointestinal distress, failure to thrive, anaphylaxis and even death. There are over 170 foods known to provoke allergic reactions. Of these, the most common foods responsible for inducing 90% of reported allergic reactions are peanuts, milk, eggs, wheat, nuts (e.g., hazelnuts, walnuts, almonds, cashews, pecans, etc.), soybeans, fish, crustaceans and shellfish. Current assumptions are that prevalence rates are lower in developing countries and emerging economies such as China, Brazil and India which raises questions about potential health impacts should the assumptions not be supported by evidence. As the health and social burden of food allergy can be significant, national and international efforts focusing on food security, food safety, food quality and dietary diversity need to pay special attention to the role of food allergy in order to avoid marginalization of sub-populations in the community. More importantly, as the major food sources used in international food aid programs are frequently priority allergens (e.g., peanut, milk, eggs, soybean, fish, wheat), and due to the similarities between food allergy and some malnutrition symptoms, it will be increasingly important to understand and assess the interplay between food allergy and nutrition in order to protect and identify appropriate sources of foods for sensitized sub-populations especially in economically disadvantaged countries and communities.

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Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates

BackgroundThe increasing availability of antiretroviral therapy (ART) has improved survival and quality of life for many infected with HIV, but can also engender drug resistance. This review summar...

Rates of emergence of HIV drug resistance in resource-limited settings: a systematic review.

Background The use of skin lightening creams is common in the female population of some African countries. The long-term use of certain products for several months to years may cause cutaneous adverse effects.



Methods From 1992 to 1993, we conducted an epidemiologic and clinical study in Dakar, Senegal. Women were questioned about the use of skin lightening creams and examined for potential adverse skin reactions. Six hundred and eighty-five Senegalese women participated in the study.



Results Twenty-six per cent of women were using skin lightening creams at the time and 36% had used them at some time. The most common products used were hydroquinone and corticosteroids, but 25% of women had used products of unknown composition. Seventy-five per cent of women using such creams showed cutaneous adverse effects. Facial acne was the most common adverse effect.



Conclusions A major part of the female adult population of Senegal used skin lightening creams. The long-term use of these creams is responsible for a high rate of cutaneous adverse effects. This practice has also been reported in other countries from sub-Saharan Africa and suggests a widespread use in the African population.

The widespread use of skin lightening creams in Senegal: a persistent public health problem in West Africa

Aim To define the epidemiologic and clinical profile and course of the disease in African Kaposi's sarcoma (KS) and acquired immunodeficiency syndrome (AIDS)-associated KS in Togo. Methods This was a retrospective study performed on the medical records of patients seen at the Department of Dermatology, University Hospital of Lome, Togo from January 1994 to December 2004. The medical records of all patients with KS, who had undergone human immunodeficiency virus (HIV) serology, were included in the study. Results Ninety-three files on 98 patients with KS, who had undergone HIV serology, were included in the study. The annual incidence during the study period was 8.5. HIV serology was positive in 73 patients (78.5%) and negative in 20 patients (21.5%). The mean age of the patients with AIDS-associated KS was 33.8 ± 8.2 years, and 49.5 ± 15.8 years for African KS. The male to female ratio for AIDS-associated KS was 1.4, and 9 for African KS. The mortality rate at 2 years for African KS was 5%, and 45% for AIDS-associated KS. Conclusion The low level of access to antiretroviral drugs in HIV-infected patients explains the morbidity and mortality from AIDS-associated KS in Togo.

Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases.

Objective. The aim of the study is to investigate the possible associations between the blood groups ABO and Rhesus systems and the presence of keloids in patients with black skin. Method. This case-control study was conducted between September 2007 and August 2011 comparing dermatologic outpatients with keloids to matched controls recruited in preanesthetic consultation at Tokoin Teaching Hospital of Lome (Togo). Results. The distribution of different ABO blood groups and Rhesus blood groups in both groups (cases versus controls) was not significantly different. This distribution of different blood groups was superimposed on the general population of blood donors at the National Blood Transfusion Center of Lome. Univariate analysis between each blood group and the presence of keloid does not yield any statistically significant association between blood groups and presence of keloids in the subjects. Conclusion. The study shows no significant association between blood groups and the presence of keloids in our patients. Further investigation needs to be conducted to elucidate this hypothesis further by conducting multicenter studies of several ethnic groups.

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Is There an Association between Keloids and Blood Groups

BACKGROUND: In 2008 the proportion of truck drivers who were not systematically protected during sex was 63% with casual partners and 60% with sex workers. Despite the high level of knowledge on HIV/AIDS and the growing awareness of the existence of the risk of HIV infection condom use always encounters resistance among truck drivers in Togo. We sought to document the factors associated with condom use during casual sex among trucks drivers in Togo. METHODS: This was an analytical cross-sectional study conducted in 2010 and targeted truckers at truck station on the two main roads of Togo Lome-Cinkasse and Kodjoviakope-Sanvee Condji. RESULTS: In this study 1782 trucks drivers and their helpers were interviewed. All were men and their mean age was 28.8 +/- 8.8 years. Trucks drivers were doing an average of 3 stops on their journeys and 1229 (69%) of them had at least two years of experience in the work. Of the 1782 trucks drivers only 620 (34.8%) had consistently used condoms during casual sex in the last three months. In multivariate analysis predictors were: education level (primary schooling: OR = 1.54; p = 0.002; Secondary schooling and higher OR = 1.38; p = 0.036) good knowledge of ways of HIV transmission (OR = 1.53; p = 0.000) tested for HIV (OR = 1.67 p = 0.000) duration in the profession (2-5 years: OR = 1.43 p = 0.008; more than 5 years: OR = 1.38 p = 0.027) and HIV risks perception (OR = 1.44 p = 0.000). CONCLUSION: These results highlight factors associated with consistent condom use during casual sex by truck drivers in Togo. This is a key population group at high risk of HIV transmission toward which the national HIV/AIDS control program should strengthen the HIV prevention strategies.

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Consistent Condom Use during Casual Sex among Long-Truck Drivers in Togo.

Objective This study aims at describing the clinical characteristics of patients with acne using skin bleaching (SB) products.



Patients and methods  This is a prospective study conducted over 8 months in three dermatology departments and one private clinic. All patients examined for acne were included in the study.



Results  The study included 119 patients examined for acne from March to October 2010. Among them 48 (40.7%) did SB. Hydroquinone was the first product used for SB (26 of 48), followed by topical corticosteroids (17 of 48). The elementary lesions were papules (99.2%), comedos (36.1%), pustules (63.9%), pigmentation (26.1%), scars (21%), and nodules (20.2%). The extent of acne on the face was observed in all patients (100%). The lesions were extensive among 43.7% of the patients. The extent of acne lesions was not statistically associated with SB. Other body areas concerned were the chest (20.2%), back, and shoulders (41.2%). The relative risk of having lesions on the back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.08–6.84), which is significant.



Conclusion  The study suggests that the back and shoulders can be the main areas for acne lesions associated with the practice of SB. The influence of different types of product is unclear.

Acne and skin bleaching in Lomé, Togo

Aim. The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. Patients and Method. Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. Results. Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lome (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. Conclusion. Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

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Palokinam Pitché

Papers

Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases.

Is There an Association between Keloids and Blood Groups

Consistent Condom Use during Casual Sex among Long-Truck Drivers in Togo.

Acne and skin bleaching in Lomé, Togo

Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo