Complications of sinusitis: An 80-case series from the ENT and neurosurgery departments of the Fann university hospital center of Dakar, Senegal

INTRODUCTION

Locoregional complications of sinusitis are dominated by oculo-orbital and/or cranioencephalic manifestations that may be life-threatening or jeopardize functional prognosis. The aim of this study was to report epidemiological, diagnostic and therapeutic aspects.

MATERIALS AND METHODS

A retrospective study included inpatients managed for sinusitis complications in the ENT and neurosurgery departments of the Fann university hospital center in Dakar, Senegal between January 1, 2005 and December 31, 2016.

RESULTS

In all, 80 files were collected. Mean age was 18.5 years, with male predominance. Mean time to treatment was 18.2 days. Cranio-encephalic complications were the most frequent (54 cases; 67.5%): mainly subdural empyema (30 cases) and brain abscess (10 cases). Seventeen patients (21.25%) had oculo-orbital complications: mainly orbital cellulitis (52.9%) and preseptal cellulitis (29.4%). Nine patients (11.25%) had both cranioencephalic and oculo-orbital complications. Acute sinusitis (82.5%) was the main cause of complications. 52.5% of patients showed pansinus involvement. Medical treatment consisted in broad-spectrum antibiotic therapy combining third-generation cephalosporins, metronidazole and gentamycin in cranio-encephalic complications and clavulanic acid and metronidazole in oculo-orbital complications. Thirty-four patients (42.5%) underwent surgical sinus drainage. Neurosurgical drainage was performed in 35 cases (43.75%). Post-treatment course was marked by 6.25% mortality (5 cases) and 16.25% sequelae.

CONCLUSION

With 6.25% mortality and a high rate of functional sequelae, complications of sinusitis are a serious concern in our region. Improving prognosis requires earlier management and better coordination between health professionals.

Low rate of reinfection among a cohort of people who use drugs successfully treated for hepatitis C virus infection in Vancouver, Canada

INTRODUCTION

Concerns about reinfection may be limiting HCV treatment uptake among people who use drugs (PWUD), with rates of 17.1/100 person-years in some cohorts. The aim of this study was to evaluate reinfection following successful treatment for hepatitis C virus infection in a cohort of people who inject drugs in Vancouver, Canada.

METHODS

We identified a cohort of HCV-infected PWUD treated at our centre. Following cure, patients were maintained in long-term follow-up in a multidisciplinary program to address their medical, psychological, social, and addiction-related needs. HCV RNA measurements were repeated every 6 months, and ongoing drug use was documented. The primary outcome of this analysis was the occurrence of reinfection.

RESULTS

243 recent PWUD (use within 6 months of treatment initiation) have achieved SVR and maintained in long-term follow-up. Ongoing drug use post-treatment was documented in 195 individuals. Key characteristics: mean age 53 years, 25% female, 78% treatment naïve, 17% cirrhotic. Reinfection occurred in 4 cases, all in patients with ongoing drug use. This incidence was 1.05/100 [95% 0.8-5.2] person years based on 379 person-years of follow-up in individuals currently using drugs.

CONCLUSION

Approaches including long-term maintenance in multidisciplinary care may optimize long-term outcomes of HCV treatment in PWUD.

Daclatasvir, asunaprevir and beclabuvir fixed-dose combination for patients with genotype 1 chronic hepatitis C

Hepatitis C is killing 350,000 persons per year worldwide, 60% of the cases being patients with genotype 1 (GT-1). The fixed-dose tablet combination of daclatasvir (30 mg)/asunaprevir (200 mg)/beclabuvir (75 mg), DCV-TRIO, is one of the latest drugs in the pipeline of interferon-free direct-acting antiviral hepatitis C virus (HCV) therapies. DCV-TRIO increases the genetic barrier to resistance by acting at the same time against three hepatitis C key viral proteins. Results from the UNITY 1, 2, 3 and 4 phase III clinical trials showed that DCV-TRIO exhibited high sustained virologic responses at 12 weeks (between 92% and 100% for HCV GT-1 treatment-naive patients). Furthermore, DCV-TRIO was well tolerated in all studies with reported adverse events (AEs) with an incidence of at least 10% mostly being headache, diarrhea, fatigue and nausea and few AE-related discontinuations. Further research should focus on more real-life data on DCV-TRIO and on developing a pill regimen that works on other HCV genotypes with high genetic barriers and that is available at a reduced cost.

Real-world Efficacy of Direct-Acting Antiviral Therapy for HCV Infection Affecting People Who Inject Drugs Delivered in a Multidisciplinary Setting

Background

Many clinicians and insurance providers are reluctant to embrace recent guidelines identifying people who inject drugs (PWID) as a priority population to receive hepatitis C virus (HCV) treatment. The aim of this study was to evaluate the efficacy of direct-acting antiviral (DAA) HCV therapy in a real-world population comprised predominantly of PWID.

Methods

A retrospective analysis was performed on all HCV-infected patients who were treated at the Vancouver Infectious Diseases Centre between March 2014 and December 2017. All subjects were enrolled in a multidisciplinary model of care, addressing medical, psychological, social, and addiction-related needs. The primary outcome was achievement of sustained virologic response (undetectable HCV RNA) 12 or more weeks after completion of HCV therapy (SVR-12).

Results

Overall, 291 individuals were enrolled and received interferon-free DAA HCV therapy. The mean age was 54 years, 88% were PWID, and 20% were HCV treatment experienced. At data lock, 62 individuals were still on treatment and 229 were eligible for evaluation of SVR by intent-to-treat (ITT) analysis. Overall, 207 individuals achieved SVR (90%), with 13 losses to follow-up, 7 relapses, and 2 premature treatment discontinuations. ITT SVR analysis show that active PWID and treatment-naïve patients were less likely to achieve SVR (P = .0185 and .0317, respectively). Modified ITT analysis of active PWID showed no difference in achieving SVR (P = .1157) compared with non-PWID.

Conclusion

Within a multidisciplinary model of care, the treatment of HCV-infected PWID with all-oral DAA regimens is safe and highly effective. These data justify targeted efforts to enhance access to HCV treatment in this vulnerable and marginalized population.

[Results of anastomotic urethroplasty for male urethral stricture disease]

OBJECTIVE

To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results.

PATIENTS AND METHODS

We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure.

RESULTS

Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up.

CONCLUSION

The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique.

LEVEL OF EVIDENCE

4.

[Profiles of IgG responses against CSP, GLURP and LSA-3NR2 in urban malaria (Dakar): relations with haemoglobin levels and parasite densities]

Malaria remains a major health problem in sub- Saharan African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Vaccines candidates were mainly tested in rural endemic setting; however increasing proportion of the population is living in urban area. Evaluation of the qualitative or quantitative immune responses to key targets of anti-Plasmodium immunity requires further investigation in urban area. In a cohort of 144 patients with mild malaria living in Dakar, we analyzed IgG responses against target antigens of P. falciparum: CSP, LSA-3NR2 and GLURP by ELISA. A mean age of 15 yrs (4-65 yrs) was found and patients were separated in 59 adults (<15yrs) and 85 children (≤15 yrs). Parasites densities (0,01-15%) did not differ between the two age groups. In contrast, haemoglobin levels appeared lower in children (4.5-16.6 g/dl) (p<0.01). For the immune results, the most recognized antigens were GLURP and CSP compared to LSA-3NR2. Levels of IgG against these antigens were significantly different between the two age groups and they were positively correlated (rho = 0.32; p<0.001). In addition, levels of IgG anti-GLURP were associated with low parasitemia (≤1%) and absence of anemia (≥11g/dl), particularly in adults (p<0.001). In a multiple regression analysis, no significant relationship was found between parasite densities and IgG responses against all the tested antigens. Our study shows the implication of IgG anti-GLURP in humoral immune response against the parasite. The present work contributes to determine IgG levels that can be used as relevant immunologic biomarkers in urban clinical malaria.

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal

OBJECTIVE

We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL).

METHODS

Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT.

RESULTS

One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/μL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74).

CONCLUSION

SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.

[IgG responses to candidate malaria vaccine antigens in the urban area of Dakar (Senegal): evolution according to age and parasitemia in patients with mild symptoms]

Malaria remains a major problem in African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Studies for the evaluation of qualitative or quantitative Ab responses to key targets of anti-plasmodium immunity were mostly done in rural endemic setting compared to urban area. In a cohort of 200 patients with mild malaria and living in Dakar, we analyze total and subclasses IgG responses to a panel of P. falciparum blood stage antigens: MSP1p19, MSP3, EB200, GST-5 and R23. A mean age of 15 yrs (4 to 56 yrs) and parasitemia between 0.1 to 17% were found. Levels of IgG anti-MSP3 were higher in patients with low parasitemia (≤1%) and appear negatively correlated to parasite densities (Rho =. 0.54; p= 0.021). This correlation is more significant in children (≤ 15 yrs). In addition, an increase of IgG responses against MSP1p19 is highly observed in adults having a parasitemia less than 1%. In those patients, we find that IgG1 subclasses were predominant (p <0.01). Our study shows an association between Ab responses and parasitemia. This association is dependant to IgG anti-MSP3 in children and IgG anti-MSP1p19 in adults living in urban area.

Profile of parotid gland tumours: experience of 93 cases over a period of 16 years

OBJECTIVE

The pathology of the salivary glands focuses on that of the parotid gland. The purpose of this study is to clarify and explain the epidemiological features of parotid tumors in a Senegalese context, to highlight the importance of clinical examination when access to complementary investigations is limited, to discuss respective indications and finally to describe certain aspects of treatment in our context.

MATERIALS AND METHODS

This retrospective study of 114 cases of parotidectomy spans 16 years, from 1992 to 2007. It was performed in the ENT department of University Hospital of Fann, Senegal. All patients operated on for chronic mass of the parotid region for whom histological results were available when initially included. Benign swellings were subsequently excluded. The study parameters were epidemiological, clinical, paraclinical and surgical.

RESULTS

The 114 parotidectomies showed a predominance of benign tumours: 63 procedures (55.26%) essentially concerned pleomorphic adenoma; 30 cases (26.31%) concerned malignant tumours, mainly parotid adenocarcinoma. There were 21 cases of benign swelling (18.4%). The study focused on the series of 93 cases of benign and malignant tumours of the parotid gland. Both sexes were affected similarly. All age groups were concerned, from 5 to 89 years. A total of 97% of patients underwent surgery: conservative total parotidectomy in 75.51% of cases.

CONCLUSION

Although there are features specific to the local context, the epidemiological profile of parotid tumours is well-known. Indications for complementary investigations are discussed, as availability in Senegal is restricted, highlighting the important role of clinical examination in the management of parotid tumours.

[Pathology of the processus vaginalis in urological practice]

PURPOSE

To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams.

PATIENTS AND METHODS

We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment.

RESULTS

A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences.

CONCLUSION

Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams.

LEVEL OF EVIDENCE

5.

[Primitive neuroectodermal tumor of the vagus nerve]

Primitive neuroectodermal tumors are a rare type of malignant neuroectodermal tumor that is very aggressive. Cervicofacial location is rare, even exceptional. We report a case of a 4-month-old male infant, referred from the pediatric clinic for severe supralaryngeal dyspnea, a firm mass under the left mandibular angle, mobile and extended to the parotid area, painful, with a curve of the left side wall of the oropharynx. Cervical computed tomodensitometry showed a well-limited mass in the carotid area, enhanced by the contrast product. A vascularized mass, which had developed at the expense of the vagus nerve, was removed surgically. Histology found a primitive neuroectodermal tumor.

[Post-hysterectomy vesicovaginal fistula]

OBJECTIVE

Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF).

PATIENTS AND METHODS

We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure.

RESULTS

Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure.

CONCLUSION

In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

[Prevalence and factors related to therapeutic adherence among black African outpatients with stable coronary artery disease in a cardiology department of Dakar in Senegal]

INTRODUCTION

The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease.

METHODOLOGY

We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence.

RESULTS

We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014).

CONCLUSION

Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

[Anderson-Hynes open pyeloplasty: which indications in the area of laparoscopic surgery?]

OBJECTIVES

To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure.

PATIENTS AND METHODS

It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature.

RESULTS

The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27).

CONCLUSION

Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery.

Cancer du pénis au Sénégal : aspects cliniques et thérapeutiques

Buts

décrire les aspects cliniques et thérapeutiques des cancers de la verge au Sénégal.

Patients et méthodes

nous avons effectué une étude rétrospective qui s’est intéressée aux dossiers des patients suivis pour cancer de la verge au service d’urologie du CHU Aristide Le Dantec entre janvier 2000 et décembre 2011.

Résultats

huit patients d’âge moyen de 51,5 ans avec des extrêmes de 27 à 77 ans ont été répertoriés. Ils étaient tous circoncis dans l’enfance. L’examen clinique avait mis en évidence une tumeur ulcérobourgeonnante intéressant le gland et une partie du corps de la verge dans cinq cas; dans deux cas, elle intéressait la totalité de la verge alors que seul un cas était limité au gland. Les patients étaient ainsi classés selon le système TNM 2002 de l’UICC en cT2 (quatre cas), cT3 (trois cas) et cT1 (un cas). Le type histologique de la tumeur était le carcinome épidermoïde chez tous les patients. Il n’y avait pas de localisation secondaire au scanner thoracoabdomino-pelvien. Sur le plan thérapeutique, une pénectomie partielle a été réalisée dans cinq cas, une pénectomie totale avec curage ganglionnaire dans un cas. Deux patients ont refusé le traitement chirurgical. Aucune récidive n’était notée chez les cinq patients ayant subi une amputation partielle du pénis. La survie globale était donc de 83,3 % pour les patients opérés.

Conclusion

le cancer de la verge est rare au Sénégal. La prise en charge est délicate du fait du diagnostic tardif avec des lésions évoluées, d’où l’importance d’une sensibilisation des populations.

[Pyonephrosis: 44 cases in Senegal]

PURPOSE

To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal.

PATIENTS AND METHODS

This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes.

RESULTS

A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization.

CONCLUSION

Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.

Aspects diagnostiques et thérapeutiques de la torsion du cordon spermatique au CHU Aristide-Le-Dantec de Dakar

Objectif

Étudier les aspects diagnostiques et thérapeutiques de la torsion du cordon spermatique (TCS) dans notre pratique quotidienne et faire une revue de la littérature.

Patients et méthodes

Étude rétrospective de janvier 2002 à décembre 2009 sur tous les cas de suspicion de TCS reçus en urgence.

Résultats

La TCS était confirmée chez 58 patients après scrototomie exploratrice. L’âge moyen des patients était de 21 ans (avec des extrêmes de 1 et de 44 ans) et 48 patients (83 %) étaient âgés de plus de 15 ans. Le délai moyen entre le début de la symptomatologie douloureuse et l’arrivée aux urgences était de 102 heures (avec des extrêmes de 2 et de 480 heures); 47 patients ont été reçus après la sixième heure et 19 patients ont été référés d’une structure périphérique. La torsion était supravaginale chez cinq sujets âgés de plus de 15 ans et était sanctionnée d’une orchidectomie chez 30 patients (52 %).

Conclusion

Notre série est caractérisée par un taux élevé de castration d’où l’intérêt de mettre l’accent sur la sensibilisation des populations qui doivent venir consulter en urgence devant une grosse bourse douloureuse aiguë.

[Three-point bending moment of two types of resin for temporary bridges after reinforcement with glass fibers]

One of the concerns of the dental surgeon in the realization of any operational act is the durability of this one. The mechanical resistance of the provisional prostheses contributes in a large part to the durability of those. The resins in general, have weak mechanical properties. The purpose of this study is to evaluate the resistance in inflection of temporary bridges reinforced with glass fibre. To remedy the weak mechanical properties of resins, we thought in this study, to reinforce them with glass fibres. For this purpose, we realized with two different resins, four groups of temporary bridges of 3 elements, including two groups reinforced fibreglass and the others not. Tests of inflection 3 points have been made on these bridges and resistance to fracture was analysed. The statistical tests showed a significant difference in four groups with better resistance for the reinforced bridges.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[A prospective longitudinal study of coma in the intensive care unit in an African setting: case of Dakar, Senegal]

Little is known on coma in neurological intensive care unit (NICU) in the setting of developing country in Sub-Saharan Africa. The aim of this study was to determine the morbi-mortality and survival of coma in the NICU of Dakar, Senegal. We carried out a prospective longitudinal study in the NICU of the teaching hospital of Fann in Dakar during a period of 15 months (with 12 months of inclusion) on comatose patients. Were included all patients presenting with a Glasgow score inferior to 9. Standard biological analyses were prescribed for each patient while CT scan was performed if indicated. Daily evaluation was done and complications recorded. Each patient was followed for at least 3 months. Survival was determined by the Kaplan Meier method. 345 patients were admitted in the NICU and 169 were included (48,99 %). The mean age of the patients was 58.04 +/- 17.55 years with a sex ration of 0.92. The mean time from installation of disorders and initial consultation was 47.30 +/- 138.34 hours. Etiologies were vascular disease (71 %), status epilepticus (9.47 %), meningoencephalitis (8.88 %) and metabolic disorders (8.88 %). The mean duration of hospitalization was 8.89 +/- 9.53 days associated with a mortality rate of 82.25 % for the same period. Survival at day 90 was 10.65 %. Mortality was related to infectious condition (28.4 %), renal failure (14.78 %), cardiovascular failure (13.61 %), cerebral engagement (12.43 %), multivisceral failure (11.24 %), pulmonary embolism (1.18 %) and unknown cause (18.34 %). In conclusion, coma is associated with a high mortality rate in our context and suggests that early consultation, a good control of vascular risk factors and better management of infectious condition should reduce this impact.

[Prognosis of intracerebral hemorrhage with coma in a neurological critical care unit in the tropics]

Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

[Determination of the average value of the condylar slope of black Africans]

The objective of this work was to determinate the average value of the condylar slope of Black African subject and to set up its variation according to whether the localization of the hinge axis is real or arbitrary. With this intention, we made an axiographic study at 63 subjects presented complete natural teeth, with a normoclusion in class 1 of Angle. The results of this study reveal that the average value of the slope condylar is 44,28 degrees in arbitrary hinge axis and 45,7 degrees in hinge axis real; and this difference is not statistically significant. The graphic recording of condylar displacement by the "Quick-Axis" is thus possible without risk of error in the layout and the reproduction of the mandible movements which is of a great interest for the general practitioner taking into account the simplicity of handling of the FAG system.

[Survival of comatose stroke victims in a neurological department in Dakar]

BACKGROUND

In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal.

METHODS

This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded.

RESULTS

A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9).

CONCLUSION

Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.

[Epilepsy in a cohort of Senegalese children]

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Epidemiology of stroke at the Clinic of Neurology, Fann University Teaching Hospital, Dakar-Senegal]

OBJECTIVE

Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal.

METHODOLOGY

Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done.

RESULTS

The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%.

CONCLUSION

It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

[Vascular aphasias: clinical, epidemiologicaland evolutionary aspects]

INTRODUCTION

Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias.

MATERIALS AND METHODS

We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year.

RESULTS

55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis.

CONCLUSION

Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.

Prise en charge des accidents vasculaires cérébraux au Sénégal

OBJECTIVES

Because of its acuteness and rapid progress to irreversible injury, stroke is a dramatically high priority medical emergency. The purpose of this prospective study was to ascertain the average time limit for primary management of stroke victims referred to the Senegalese national medical center considered as the final link within the country's healthcare organisation.

PATIENTS AND METHODS

We reviewed the files of 170 patients aged 25-90 (average 61+/-13 years). The sex ratio was 0.68. Seventy percent of the patients resided in the nation's capital, Dakar.

RESULTS

Most of the patients were referred to a medical center late. Admission was before the 6th hour for only one patient and none of the patients were admitted before the 3rd hour. Late treatment was related to the remoteness of medical centers. Among patients residing in Dakar, the first visit occurred between 6 and 24 hours for 30p.cent versus 7.8 p.cent for patients residing in rural areas of the country. Educational level and socio-economic status had no effect on late treatment. None of the patients were given prehospital care. Treatment was essentially symptomatic in patients with hemorrhagic stroke. Anticoagulants or anti-platelet agents were prescribed for patients with ischemic stroke. Only 29.4 p.cent of patients were given rehabilitation care. Mortality was 50.6 p.cent and the rate of dependency 41.7 p.cent.

CONCLUSION

In Senegal, stroke victims receive care too late. This situation arises because of insufficiency of human and material resources and inaccessibility to care centers.

Autosomal-recessive forms of demyelinating Charcot-Marie-Tooth disease

Autosomal-recessive forms of Charcot-Marie-Tooth (ARCMT) account for less than 10% of the families in the European CMT population but are more frequent in the Mediterranean basin and the Middle East because of more widespread consanguinity. Until now, demyelinating ARCMT was more extensively studied at the genetic level than the axonal form. Since 1999, the number of localized or identified genes responsible for demyelinating ARCMT has greatly increased. Eight genes, EGR2, GDAP1, KIAA1985, MTMR2, MTMR13, NDRG1, PRX, and CTDP1, have been identified and two new loci mapped to chromosomes 10q23 and 12p11-q13. In this review, we will focus on the particular clinical and/or neuropathological features of the phenotype caused by mutations in each of these genes, which might guide molecular diagnosis.

Pronostic fonctionnel des accidents vasculaires cérébraux dans les pays en voie de développement : Sénégal

OBJECTIVE

To evaluate the functional outcome in patients followed in the department of neurology of Dakar for stroke.

MATERIALS AND METHOD

Prospective longitudinal observational study from August 2003 to May 2005 included inpatients or outpatients with stroke one month or less from entry confirmed by computed tomography scan. Patients were followed monthly for 12 months. At each visit, data on functional autonomy measured by the Barthel index and the treatments received were collected.

RESULTS

One hundred and seventy patients aged 25 to 90 years (mean 61+/-13 years) were evaluated. The sex ratio was 0.68. A total of 64.7% of strokes involved ischemic cerebral vascular accidents and 35.3% hemorrhagic vascular accidents. Right hemiplegia was present in 55.9%, left hemiplegia in 42.9% and bilateral paresis in 1.2% of patients. A total of 28.8% of patients died between d0 and d30, 50.6% within one year. At entry, the Barthel score was greater than 60 in only 4.7% of patients. After one-year follow-up, 58.3% of the patients had a Barthel score greater than 60, 19.1% had a score between 20 and 40 and 22.6% a score between 40 and 60. Only 53.5% received rehabilitation care. The parameters significantly associated with a functional recovery were age less than 55 years (P<0.05), hemorrhagic vascular accident as opposed to ischemic vascular accident (P<0.05), and earlier rehabilitation care under qualified personnel (P<0.01).

DISCUSSION

Our study shows an important rate of mortality during the first year following stroke and the rather young age of our population. The parameters associated with a better functional recovery are comparable to most of the data in the literature. The results of our study suggest that it is possible to improve functional prognosis after stroke by setting measures of prevention of the risk factors and rehabilitation in the early management of hemiplegia.

[Prognosis of stroke in department of neurology of Dakar]

INTRODUCTION

The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar.

MATERIALS AND METHODS

This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months.

RESULTS

The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects.

CONCLUSION

Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

[Evaluation of the cost of stroke management in Dakar, Senegal]

The purpose of this one-year cross-sectional study conducted in 1997 was to estimate the direct cost of stroke management in the Neurology Department of Fann University Hospital in Dakar, Senegal. Data were collected about the type of care services required and related spending. Cost analysis was made in CFA Francs (CFAF), the Senegalese currency (1 USD = 500 CFAF in 1997). A total of 1260 patients were hospitalized in the department including 383 for stroke (30.4%). Mean age was 60.8 +/- 14.2 years and men accounted for 49.2% of the population. The mortality rate was 46.2% among hospitalized patients. A total of 33,573 medical acts were carried out including 12,052 (35.9%) for stroke management. The direct cost of stroke management was 32,614,442 CFAF with a mean cost of 78,426 CFAF per patient. The cost was 18,839 CFAF in the patient care unit (57.8%) and 4,954,635 CFAF in the neuroradiology unit (15.2%). The cost of health care personnel was 19,373,172 CFAF (59.4%) and the cost for drugs and other medical products was 8,253,246 CFAF. Health education programs aimed at increasing awareness of risk factors are needed to reduce the cost of stroke management in this difficult economic period.

[Peripheral neuropathies and antiretroviral drugs. Preliminary results]

INTRODUCTION

In order to appreciate the antiretroviral drugs impact in the HIV positive patients with peripheral neuropathy, a clinical, electrophysiological and neurpathological study of nerve biopsies was performed.

PATIENTS AND METHODS

A group of 8 HIV seropositive patients with peripheral neuropathy was compared with an other group of 10 HIV seropositive patients treated with multiple antiretroviral drugs. Electrophysiological examination with motor nerve conduction velocity (MNCV) mesure of the median and the sciatic popliteal nerve was followed by nerve biopsy. Nerve fragments carried out the neuropathological technics for morphological examination.

RESULTS

Eighteen seropositive HIV patients (16 HIV-1 and 2 HIV-2) were included in this study. Six patients among them had motor and sensitive neuropathy of the four limbs and 2 patients had sensitive neuropathy associated with pyramidal signs. In fine, 1 patient had sensitive neuropathy with distal amyotrophy of the four limbs. Slow MNCV was observed in all the patients and more severe in the lower limbs. Nerve were unexciting in the lower limbs in 2 patients. Nerve biopsy showed severe axonal loss in all the patients treated but one. They associated axonal lesion in 5 cases and myelinated lesions in 2 cases. Two patients non treated had normal nerve biopsy. Axonal loss was mild in 2 cases and very severe in one case associated with non inflammatory demyelinated lesions.

CONCLUSION

we observed more severe and more frequent nerve lesions in treated patients than in no treated patients, as at the clinical, electrophysiological and neuropathological examination. Antiretroviral drugs cause more frequently pain motor and sensitive neuropathies at usual posologies. The occurence of recrudescence of pain peripheral neuropathy under antiretroviral treatment allows to reconsider drugs posologies.

[Diabetic neuropathies in Neurological Clinic of Dakar]

INTRODUCTION

Common diabetic mellitus complication, neuropathies present various clinical forms. OBJECTIVE to evaluate the hospital frequency and clinical features of diabetic neuropathies.

PATIENTS AND METHOD

It is a retrospective study concerning peripheral neuropathies observed in "clinique neurologique" of Dakar between January 1991 and December 2001 in diabetic patients treated for a long time. Inclusion criterion are distal and/or proximal sensitive and/or motor neuropathies with abolition or reduction of patellar reflex. Are excluded neuropathies of others aetiologies. Electrophysiological examination with motor conduction velocity measure is performed in about half of them . One neuro-muscular biopsy was performed using current neuropathological examination including teased fiber technic.

RESULTS

17 cases of peripheral neuropathy are observed on 10,000 documents (0.17%). They were 11 males and 6 females, aged from 27 to 77 years (means 56.41). Among them, 10 cases of distal motor sensitive neuropathy are identified; 2 cases of sensitive neuropathy, 3 cases of pure motor neuropathy and 2 cases of multiple mononeuritis neuropathy with dysautonomic disorders of sphincter and genital type in one of them. Glucose serum level was between 1.25 to 4.25 g/l . Diabetes was 18 months to 20 years of duration at the moment of admission . Normal serum level glucose was rapidly obtained with insulin treatment. The evolution was favourable in 82.9% of cases under anti-diabetic treatment, vitamin B and kinesitherapy.

CONCLUSION

diabetes mellitus neuropathies are rare in "Clinique n eurologique" of Dakar where diverse clinical forms are observed. Favourable outcome in most of cases occurred when serum glucose equilibration is rapidly obtained.

[Epidemiological and clinical aspects of amyotrophic lateral sclerosis in neurological clinic of Dakar]

In Africa, little data has been published in Amyotrophic lateral sclerosis (ALS). We conducted a retrospective survey among the in-patients from December 1993 to March 2000 in the Department of Neurology of the University Hospital. This study reported epidemiological and clinical data of ALS. ALS has been diagnosed by El Escorial criteria. 33 patients were 16 to 77 years old. Parental consanguinity was found in 15.2%. On the basis of diagnosis criteria, ALS in our patients were established in 57.6% of cases, probable in 30.3% of cases, possible in 9.12% and suspected in 3% of cases. Evolution after hospitalisation is unknown for the majority of patients. Only one patient died after 12 months of evolution.

[Composite-bonded bridges reinforced with Ribbond THM ribbon: an alternative of choice to other temporary prosthetic methods]

In the presence of anterior unitary tooth loss, the therapeutical arsenal of the practitioner remains the implant solution. But, at the young patients who have not completed their growth, it's necessary to pass by a transitional stage. The bonded bridges reinforced by a polyethylene fibbers splint such as Ribbond THM constitute an alternative of choice to solve the aesthetic damage in the short and medium term while waiting for the prosthesis with implant. It's a similar case that is reported through this article.