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Biomedical subjects

M Mijiyawa

Publications and source records attributed to M Mijiyawa.

At least 19 recordsLinked to original sources
PubMed2000

Low back pain in hospital outpatients in Lomé (Togo).

OBJECTIVE: To determine the patterns of low back pain and the conditions associated with this symptom in outpatients attending the rheumatology unit of the Lomé Teaching Hospital. METHODS: Medical records of patients seen over a ten-year period were studied retrospectively. RESULTS: Among the 9,065 patients seen during the study period, 3,204 (35.34%; 1,850 women and 1,354 men) had low back pain. Mean age at onset was 41 years, and mean duration of low back pain was three years. Diseases associated with low back pain were as follows: degenerative spinal disease, N = 3,054 (95.32%); spinal infections, N = 79 (2.47%); spondyloarthropathies, N = 44 (1.37%); and tumors, N = 27 (0.84%). The patterns of degenerative spinal disease included low back pain (N = 1,535, 47.91%), low back pain with nerve root pain suggestive of disk herniation (N = 1,108, 34.58%), and low back pain with nerve root pain and claudication suggestive of lumbar spinal stenosis (N = 411, 12.83%). Schöber's index was abnormal in 831 of the 1,408 patients (59%) with acute pain or disk herniation. Most patients with lumbar spinal stenosis were women (72.26%) and were aged 35 to 64 years. Findings suggestive of tuberculosis were present in 62 of the 79 patients with lumbar spinal infection. Among the 44 patients with spondyloarthropathies, 15 had ankylosing spondylitis and 11 had infection with the human immunodeficiency virus (HIV). Multiple myeloma was present in ten patients and metastatic tumors in eight. CONCLUSION: Low back pain seems to be as common in sub-Saharan Africa as in occidental countries, with a prevalence of one-third among rheumatology outpatients. Lumbar spinal stenosis seems more common than in the occident and is mainly observed in woman. Schöber's index is not useful for measuring forward bending of the lumbar spine in Africans. The epidemiology of spondyloarthropathies in sub-Saharan Africa has been changed by the expanding HIV epidemic, despite the low prevalence of the HLA B27 phenotype.

Adult↗
PubMed2000

Spondyloarthropathies in sub-Saharan Africa.

HLA-B27 is virtually absent in most of the sub-Saharan Africa populations, and ankylosing spondylitis is rare; only a few patients have been reported from central and southern Africa. HLA-B27 was present in only one of 17 patients (6%). The disease shows clinical features that are similar to those observed in white HLA-B27-negative patients with ankylosing spondylitis; ie, the disease onset is later compared with HLAB27-positive patients, the patients rarely get acute anterior uveitis as one of the extra-articular manifestations, and familial occurrence of ankylosing spondylitis is rarely observed. There is a virtual absence of ankylosing spondylitis even in the west African countries of Gambia and Senegal, where 3% to 6% of the general population has HLA-B27. The epidemic of HIV infection in sub-Saharan Africa in recent years, however, has been associated with a dramatic upsurge in the prevalence of spondyloarthropathies other than ankylosing spondylitis, primarily reactive arthritis and undifferentiated forms of the disease, and less often psoriatic arthritis. HLA-B27, because of its rarity and virtual lack of association with the observed cases of spondyloarthropathy in this population, cannot be used as an aid to diagnosis of spondyloarthropathy in black Africans. Conversely, HIV infection is increasingly showing such a strong association with reactive arthritis, psoriatic arthritis, and undifferentiated spondyloarthropathies in sub-Saharan African populations that any patient with acute or chronic inflammatory arthritis may need to be tested for possible HIV infection. More research is needed on the evaluation of risk and protective factors in sub-Saharan African populations to better delineate the relative importance of genetic and environmental factors in the pathogenesis of spondyloarthropathies.

AIDS-Related Opportunistic Infections↗
PubMed2000

Risk factors for gout in Togolese patients.

OBJECTIVE: To determine the risk factors for gout in Togolese patients. METHODS: The medical records of patients admitted to the Lomé Teaching Hospital (Togo) rheumatology department over a ten-year period were reviewed retrospectively. RESULTS: Of the 8351 study patients, 160 (1.9%) fulfilled American Rheumatism Association criteria for gout; 159 were male. Mean age at disease onset was 44 years, and mean disease duration was six years. Tophi were recorded in 35 cases and a history of renal colic in one. Only five patients (3.1%) had no identifiable risk factors. The main risk factors in the remaining patients were alcohol abuse (133/160, 83.12%), overweight/obesity (64/160, 40%), and hypertension (42/160, 26.25%); 153 patients (95.6%) had at least one of these risk factors, 58 patients (36.32%) had two, and 14 (8.8%) had all three. Of the 42 hypertensive patients, 20 were on diuretic therapy. Seventeen patients (10.62%) had a family history of gout. There was no evidence that AS or AC hemoglobinopathy (32 and 13 cases, respectively) influenced the course or natural history of gout. CONCLUSION: Although population-based studies are needed for confirmation, our study suggests that risk factors for gout in Togolese patients are similar to those in other parts of Africa and in Western countries.

Adult↗
PubMed1999

[Connective tissue diseases in the hospital outpatient service in Lomé (Togo)].

PURPOSE: There have been few studies of connective tissue diseases in Africa. METHODS: A retrospective study was conducted in order to describe the various connective tissue diseases and their semiological profile in patients attending the dermatology and rheumatology units at Lomé hospital. RESULTS: Clinical examinations showed that eighty-four (0.2%) out of the 34,169 patients were suffering from connective tissue diseases. Diseases that were encountered were the following: scleroderma (18 cases), systemic lupus erythematosus (four cases), discoid lupus erythematosus (15 cases), rheumatoid arthritis (29 cases), polymyositis and dermatomyositis (16 cases), juvenile rheumatoid arthritis (one case), giant cell arteritis (one case). Raynaud's syndrome was present in six out of the 18 patients suffering from scleroderma. Nephrotic syndrome was observed in a patient suffering from systemic lupus erythematosus. A septicemia caused this patient's death. Two patients suffering from polymyositis had cancer. No etiology was found in the 14 other patients. Hip involvement was present in two patients suffering from rheumatoid arthritis. Patients with rheumatoid arthritis had no systemic involvement (nodulitis, vasculitis). CONCLUSION: Our results are in agreement with those of previous studies on connective tissue diseases in Africa. However, further studies are required to better understand the epidemiological and semiological profiles of connective tissue diseases in Africa.

Adolescent↗
PubMed1999

Musculoskeletal conditions in children attending two Togolese hospitals.

OBJECTIVE: A retrospective study was conducted in order to point out the different kinds of musculoskeletal conditions observed in children attending two Togolese hospitals. RESULTS: A total of 434 (242 females, 192 males) of the 29 620 children examined (1.5%) were suffering from these conditions. Probable joint and bone infections (187 patients, 43%), limb deformities (106 patients, 24%), osteochondrosis (60 patients, 14%) and vaso-occlusive crisis due to haemoglobinopathies (29 patients, 7%) were the main conditions observed. Osteomyelitis observed in 128 patients affected the humerus (25 patients), radius (10 patients), femur (68 patients), tibia (15 patients), fibula (five patients), and both tibia and fibula (five patients). Probably, infectious arthritis seen in 30 patients affected mainly the hip (11 patients) and the knee (13 patients). In the spine, infection affected the midthoracic and upper lumbar areas. Underdevelopment, sickle cell anaemia and sickle cell haemoglobin C disease were the main risk factors in determining susceptibility to infections. Vaso-occlusive crises were due to sickle cell anaemia (11 patients) and sickle cell haemoglobin C disease (18 patients). Osteochondrosis seen in 60 patients free from haemoglobinopathy involved the spine (Scheuermann's disease, 38 patients) and the hip (Legg-Calvé-Perthes disease, 22 patients). Limb deformities were observed in the knee (varus and valgus deformities in 64 patients) and the foot (talipes varus equin in 40 patients). CONCLUSION: This study's findings, which require further confirmation, suggest some conclusions. Scheuermann's disease can explain in part the degenerative disc conditions observed in African adults. Valgus and varus deformities play an important role in the development of knee osteoarthritis in Black Africa. An African child with joint or bone pain should be investigated for sickle cell anaemia. In the future, improved lifestyle and better health care will be essential to reduce bone and joint infections, and allow refined diagnosis of connective tissue diseases now probably underestimated in African children.

Adolescent↗
PubMed1998

[Scleroderma in a hospital setting in Togo].

The purpose of this retrospective study was to determine the epidemiological and semiological profile of scleroderma in Black Africa. Medical records of patients who consulted in the Dermatology Clinic and the Rheumatology Clinic of the Teaching Hospital in Lomé, Togo between 1980 and 1996 and between 1989 and 1996 respectively were reviewed. Scleroderma was diagnosed in 18 of the 34,169 patients seen during the study periods (0,05%). The disease was systemic in 13 cases (8 females, 5 males; mean age: 31 years) and localized in 5 cases (mean age: 20 years). There were no predisposing occupational or therapeutic factors. The clinical manifestations were Raynaud's phenomenon in six of the 13 patients with systemic scleroderma. Extensive cutaneous sclerosis in 10 cases, poikiloderma in seven cases, dysphagia in three cases, pulmonary fibrosis in four cases, and polyarthralgia in two cases. Myalgia and renal involvement were not observed. The findings of this study documents the low incidence of scleroderma in Togo. The high frequency of extensive cutaneous sclerosis, poikiloderma and low frequency of Raynaud's phenomenon which were often mild are the most remarkable features of the disease in Lomé. These features have been pointed out previously but epidemiologic data is still insufficient to confirm the existence of an African form of scleroderma.

Adolescent↗
PubMed1996

[Spinal diseases in a rheumatology hospital unit in Lomé (Togo)].

A retrospective study was conducted to determine the different kinds of spinal diseases in patients attending the rheumatology unit of Lomé hospital, Togo. Among the 4927 patients seen over a 5-year period, 1966 (40%) had spinal involvement. The disease observed were as follows: degenerative spinal disorders: 1872 cases (95%); infectious discitis: 41 cas (2.1%); spondyloarthropathies: 33 cases (1.8%); tumors: 20 cases (1.1%). Degenerative spinal involvement affected mainly lumbar and cervical spine. The only unusual clinical feature was that Schober's index was often normal. Lumbar spinal stenosis was common (233 cases, 12.4%), especially in females, and occurred at an earlier age than in the Western world. Ankylosing spondylitis features included mildness of extra-articular manifestations and an often negative family history. Pott's disease was de leading cause of infectious discitis. The present study suggests that spinal disorders are as frequent in Africa as in Western countries.

Adult↗
PubMed1995

Gout in patients attending the rheumatology unit of Lomé Hospital.

A retrospective study was carried out to determine the semiological and aetiological profiles of gout in patients attending a hospital clinic in Lomé, Togo. Gout was diagnosed in 106 of the 3517 patients seen from October 1989 through October 1993. Clinical findings and hyperuricaemia were the basis for the diagnosis of gout in 88 patients. In the remaining 18 patients, monosodium urate crystals were demonstrated in synovial fluid in addition. One hundred and five patients were male. The mean age at disease onset was 45 yr and the mean duration of the disease was 8 yr. Twenty patients (19%) had tophi. None of the patients had a history of renal colic. The ankle, the knee and the first metatarsophalangeal joint were the joints most often affected. Sixty-three patients (59%) had a monoarticular involvement, whereas an oligo- or polyarticular involvement was observed in the remaining 43 patients. Twelve patients (11%) had a familial history of gout. Forty patients (38%) were obese and 78 (74%) were habitual drinkers. Forty-one patients (39%) had hypertension and 17 of them were under diuretic therapy. While more work is needed before drawing a definite conclusion, this study is in striking contradiction with the common belief that gout is exceedingly rare in Black Africa. The risk factors in Togo seem to be no different from those observed in Caucasians.

Adult↗
PubMed1995

[Sociocultural aspects of rheumatological practices in Sub-Saharan Africa].

Conceived by the patient as the result of a surnatural origin, rheumatism, as most diseases in Black Africa, justifies the consultation of a witch or a quack. This consultation occurring upstream or downstream that of the modern physician aims to determine the exact cause of the disease in order to prescribe a suitable treatment. The recourse to traditional medicine is far from being influenced by the level of instruction of the patient. It occurs frequently during rheumatic diseases of which the symptomatology is dominated by pain and the physiopathology often obscure. The patient while looking for a solution to his problem does not act alone. He must take notice of the advice and requirements of his family of which he constitutes an indissociable element. The theory of humours is still present in the minds and is expressed by the recourse to purgative and vomitive drugs and to bloodletting. Thus by some of its conceptual and practical features, traditional African medicine reminds that which had prevailed in the west before the scientific and technical discoveries or the 19th century.

Africa↗
PubMed1995

[Chronic myeloid leukemia manifesting as gout. Reflections on secondary gout in Black Africa].

This report describes the case of a 63-year-old obese and alcoholic butcher who suffered two episodes of distal oligoarthritis. These episodes were attributed to gout on the basis of response to colchicine and demonstration of hyperuricemia. Given the presence of hepatomegaly, splenomegaly and hyperleukocytosis, a sternal puncture and myelogram were performed and led to diagnosis of chronic myelogenous leukemia. In addition to the classic predisposing factors for gout, sickle cell anemia could be implicated in Black Africa. Longer life expectancy for patients with sickle cell anemia could increase the incidence of gout in Black Africa.

Africa↗
PubMed1995

Epidemiology and semiology of rheumatoid arthritis in Third World countries.

Studies conducted over the last three decades in Third World countries have confirmed that rheumatoid arthritis occurs throughout the world. When interpreting the results of these studies, however, the potential biases resulting from the socioeconomic, demographic and health care conditions in these countries should be kept in mind. These studies, of which most did not include representative samples, identified geographic variations in the semiology and genetic profile of the disease. In India, the prevalence of rheumatoid arthritis (0.75%) is similar to that in the West. In China, Indonesia, and the Philippines, in contrast, rheumatoid arthritis appears rare (prevalence below 0.4%), in both urban and rural settings. The rarity of rheumatoid arthritis in rural Africa contrasts with the high prevalence of the disease in Jamaica, where over 2% of the adult population are affected. In a study in Latin America, rheumatoid arthritis was the reason for seeking medical advice in 22% of rheumatology clinic patients. These differences probably reflect variations in the interactions between genetic and environmental factors. Rheumatoid arthritis may be less severe in Asia and West Africa than in western countries. No such difference has been found for Jamaica or southern and eastern Africa. In China and India, the genetic profile associated with rheumatoid arthritis is not uniform. Thus, associations with antigens other than HLA DR4 have been demonstrated. This genetic variability may reflect the heterogeneity of the Chinese and Indian populations. It may also support the theory of a shared epitope. In southern Africa, most rheumatoid arthritis patients carry the HLA DR4 antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1995

[Kaposi's sarcoma in dermatology consultations at Lome, Togo].

The purpose of this retrospective study conducted in a dermatologic out patient clinic in Lomé was to assess the epidemiologic, clinical, and prognostic profile of Kaposi's sarcoma in Togo during the 15 years period between 1980 and 1994. Only patients who had undergone serologic tests for human immunodeficiency virus (HIV) were included. There were 30 patients (27 men and 3 women) with a mean age of 35.2 years (range: 17 to 59 years). Thirteen patients were seropositive (epidemic Kaposi's sarcoma or EPK) and 17 were seronegative (endemic Kaposi's sarcoma or ENK). The mean age of patients with EPK was lower than that of patients with ENK (30.0 vs 42.3 years). Extensive (92.3%) and edematous (90%) forms and involvement of the upper extremities (66.7%), trunk (01.6%), and mucosa (92.3%) were characteristic clinical features of EPK while localized nodular forms (92.3%) were characteristic of ENK. A death was noted after 5 years of follow-up in the ENK group as compared to 12 deaths after a mean follow-up of 15.95 years in the EPK group. This study illustrates the current profile of Kaposi's sarcoma in Black Africa where HIV infection has greatly changed clinical findings and prognosis.

Adolescent↗
PubMed1995

[Multiple bone lesions of a type of disseminated African histoplasmosis in a Togolese immunocompetent child].

The authors report one case of disseminated African's histoplasmosis with numerous bones in Togolese immunocompetent child. The left tibia and fibula, the collarbones and the acromion were the bones mostly affected. The chronic fistulate lesion of the left leg associated with skin lesion allowed to evoke the diagnosis, this being confirmed by histological examination. The authors review the different diagnosis which will be discussed considering the radiographic appearance of african's histoplasmosis.

Acromion↗