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

Access to antiretroviral treatment (ART) in resource-limited countries has increased significantly but scaling-up ART into semi-rural and rural areas is more recent. Information on treatment outcome in such areas is still very limited notably due to additional difficulties to manage ART in these areas. 387 HIV-1 infected adults (≥18 years) were consecutively enrolled when attending healthcare services for their routine medical visit at 12 or 24 months on first-line ART in five HIV care centers (four semi-rural and one rural). Among them, 102 patients were on first-line ART for 12 ± 2 months (M12) and 285 for 24 ± 2 months (M24). Virological failure was observed in 70 (18.1 %) patients ranging from 13.9 to 31.6 % at M12 and from 8.1 to 22.4 % at M24 across the different sites. For 67/70 patients, sequencing was successful and drug resistance mutations were observed in 65 (97 %). The global prevalence of drug resistance in the study population was thus at least 16.8 % (65/387). Moreover, 32 (8.3 %) and 27 (6.9 %) patients were either on a completely ineffective ART regime or with only a single drug active. Several patients accumulated high numbers of mutations and developed also cross-resistance to abacavir, didanosine or the new NNRTI drugs like etravirine and rilpivirine. The observations on ART treatment outcome from ART clinics in semi-rural areas are close to previous observations in Lome, the capital city suggesting that national ART-programme management plays a role in treatment outcome.

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Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo.

Acne is a chronic inflammatory condition affecting the pilosebaceous follicle that mainly affects adolescents and young adults. The aim of this study was to assess the quality of life (QOL) of patients with acne, and to determine the correlation between the QOL and the severity of acne, in Lome (Togo). From July 2017 to February 2018, we conducted a study in three dermatology departments of Lome. The clinical evaluation of acne and assessment of the QOL were done using the ECLA (Echelle de Cotation des Lesions d’acne) and CADI (Cardiff Acne Disability Index) scores respectively. We enrolled 300 patients aged 12 to 52 years; 71.3% of whom were female. The face was affected by acne in 100% of cases and papulopustular acne was the most common clinical form (66.7%). Acne was mild to moderate in 162 patients (54%) and severe in 138 (46%). Impairment was observed in all patients’ QOL (scores ranged from 1 to 14 points). There was a positive correlation between severity of acne and QOL impairment in the patients (r = 0.21; p = 0.0002). We also found a positive correlation between overall CADI score and factors F1 and F3 of the ECLA scale: the severity of facial acne (r = 0.15; p = 0.0073) and the presence of scars (r = 0.21; p = 0.0002). In contrast, the global ECLA score was significantly correlated with items 2, 3, and 5 of the CADI questionnaire: the patient’s relationship (r = 0.13; p = 0.0241), avoidance behaviors (r = 0.21; p = 0.0002) and perception of acne (r = 0.16; p = 0.0067). Acne negatively impacts the QOL of patients. The severity of acne has an impact on the patient’s relationships, avoidance behaviors and perception of the acne.

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Acne in Lomé, Togo: clinical aspects and quality of life of patients

INTRODUCTION: We determined the sero-prevalence of HIV among female sex workers (FSWs) in Togo identified their sexual risk behaviors. METHODS: We conducted a cross-sectional study from 17 to 27 December, 2011 on 1106 FSWs in Togo. Venous sample were collected to estimate HIV prevalence as per national algorithms. Behavior data were collected by interviewer-administered questionnaires. RESULTS: Of the 1106 FSWs (mean age = 27.6 years) surveyed, 17% and 63% had their first sexual intercourse before the age of 15 and 18 years respectively. Overall, 43.4% of the FSWs had more than seven clients per week. Most FSWs (95%) said they had sex using a condom in their lifetime while 8.8% had used a condom during their last sexual intercourse. About 79% of FSWs used a condom during their sexual encounters the previous week and 11.6% had used a condom during each of their sexual encounters the previous day. Most FSWs (62.2%) reported to have been tested for HIV. Of these, 145 (13.1%) were HIV positive. HIV sero-prevalence decreased from 19.4% in the south to 7.5% in the north of the country. Behaviors associated with FSW being HIV positive included: FSW having more than 7 clients per week (p<0.001), not using condoms at every intercourse act (p=0.003) or during the last sexual encounter (p=0.006) and trading sex in brothels (p<0.001). CONCLUSION: We estimate HIV sero-prevalence among FSWs in 2011 to be 13.1% in Togo, significantly lower than a prevalence of 29.5% estimated previously in 2005. Inconsistent use of condoms was identified as associated with high risk factor for acquiring HIV.

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HIV prevalence and behavioral studies in female sex workers in Togo: a decline in the prevalence between 2005 and 2011

Mots cles Theses de medecine ; publications scientifiques. Abstract Goals: The objectives of this study were to document the diffusion means of medical thesis defended in Lome's University and to determine their impact on the teacher's scientifics productions. Methods: It was a transversal study, which included all the medicine thesis defended in Lome's University from 1993 to 2002. We interview the theses directors and co- directors and we consulted Medline and CNRS/PASCAL databases. Results: During this period, 240 medical thesis had been defended in this University. More than half of the thesis were started in medicine (85 thesis), surgery (57 thesis) and paediatrics (37 thesis) departments. 99 thesis (41 %) had been published: 54 (22,5 %) in indexed magazines and 45 (18,5 %) in non indexed magazines; 130 thesis (54 %) were the objects of announcements during scien- tific congresses. The paediatrics (51,3 %), medicine (21,2 %) and surgery (21 %) departments had the best rate of publi- cation. 56 thesis had been the objects of a protocol. During the period studied, the teachers of medical school had published 264 articles. Thesis constituted only 20,4 % of these publications. Conclusion: Our study shows that the proportion of published of medical thesis remains small in indexed magazines (22,5 %). Otherwise, thesis represent an insignificant pro- portion in teachers' publications.

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Devenir scientifique des thèses pour le diplôme d'état de doctorat en médecine soutenues à l'université de Lomé (Togo)

During the study period, we recorded 78 cases of keloids out of 5821 new consultations, i.e. a prevalence of 1.34%. The sex ratio (men/women) was 4. The mean age of the patients was 27 years (range 2–85 years). The mean duration of the course of disease before consultation was 2 years. The head and neck were the sites most frequently affected (28 cases, including 25 cases of acne keloidalis nuchae), followed by the trunk (26 cases, including 20 cases in the presternal area) and then the limbs and multiple locations (eight cases). The principle etiologies were as follows (Table 1): inflammatory skin diseases (11 cases of acne keloidalis nuchae and six cases of varicella) and post-traumatic and post-operative keloids (10 cases). Spontaneous keloid represented only 8.97% of cases. The mean course was 31 months. The main reasons for consultation were pain and pruritus. Fewer patients consulted because of embarrassment about the appearance of keloids, and these were mainly young women. Discussion

Palokinam Pitché

Papers

Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo.

Acne in Lomé, Togo: clinical aspects and quality of life of patients

HIV prevalence and behavioral studies in female sex workers in Togo: a decline in the prevalence between 2005 and 2011

Devenir scientifique des thèses pour le diplôme d'état de doctorat en médecine soutenues à l'université de Lomé (Togo)

Keloids in dermatology outpatients in Lomé, Togo.