Introduction: Strokes are becoming more common in Africa, they are often accompanied by depressive symptoms, hence the need to investigate the factors associated with it for better management and prevention. Methodolo...Introduction: Strokes are becoming more common in Africa, they are often accompanied by depressive symptoms, hence the need to investigate the factors associated with it for better management and prevention. Methodology: We conducted a prospective cross-sectional study amongst patients hospitalized with stroke at the Neurology/Neuroscience Clinic of the FANN UNHC (Dakar) in 2016. After a clinical diagnosis, patients are subjected to socio-demographic questionnaire and were administered with modified Rankin and MADRS scores. Results: Among the patients, 33.7% had Post-Stroke Depression, most were aged 50 to 70 years, male and married. History of stroke and depression was strongly associated with Post-Stroke Depression, while functional or cognitive impairment caused by stroke contributed to the development of Post Stroke depression. The type of ischemic or haemorrhagic stroke did not appear to affect the occurrence of the Post-Stroke Depression, but Post-Stroke Depression was more frequent in subjects with a left hemispheric lesion 47.8% (p Discussion: The occurrence of a Post-Stroke Depression is a factor of poor prognosis, early diagnosis and holistic care lead to improved quality of life.展开更多
Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in ...Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.展开更多
<strong>Introduction: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">Acute Respiratory Infections (ARI) is a global public healt...<strong>Introduction: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">Acute Respiratory Infections (ARI) is a global public health priority. It is the leading cause of childhood morbidity and mortality, especially in developing countries. The main objective of this work was to look mainly at the bacteriological aspects of ARI in children in Senegalese hospitals. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">We have been conducted a prospective descriptive mono-centric study over a period of one year (from July 1, 2017 to June 30, 2018) at the Albert Royer National child hospital in Dakar. A multiplex PCR (protein chain reaction) has been performed on nasopharyngeal swabs taken from all patients. This technique (viral RNA transcribed into DNA, then the DNA of the different pathogens is simultaneously amplified in the same tube by PCR Fast-tract<span style="white-space:nowrap;"><sup>®</sup></span>, multiplex). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During the study period, 109 patients were included. The hospital prevalence of acute respiratory infections was 3.7%. </span><span style="font-family:Verdana;">The mean age was 23.7 months with extremes between 1 month and 144</span><span style="font-family:Verdana;"> months. Peaks of consultations were found in the months of August, March and April with 22%, 15.6% and 12.8% respectively. Fever, respiratory distress and pulmonary condensation syndrome were the main signs found in our patients. Bacteriology was positive in 82.6% of samples and the most frequently found bacteria were </span><i><span style="font-family:Verdana;">Streptococcus pneumoniae</span></i><span style="font-family:Verdana;"> in 38.5%, </span><i><span style="font-family:Verdana;">Haemophilus influenza</span></i><span style="font-family:Verdana;"> b in 32.1% and </span><i><span style="font-family:Verdana;">Moraxella catarrhalis</span></i><span style="font-family:Verdana;"> in 25.7%. Pneumonia was the main diagnosis, found in 61 cases, a prevalence of 59.9%. The average length </span><span><span style="font-family:Verdana;">of hospitalization was 10 days. Lethality was 1.8% or 2 cases. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> Acute Respiratory Infections in children still remains a public health problem in developing countries;children under 5 years of age are the most affected </span><span style="font-family:Verdana;">hence the need to strengthen ARI control programs. The identification of</span><span style="font-family:Verdana;"> germs is indispensable in treatment and epidemiological surveillance in our regions.</span></span>展开更多
<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Many health problems...<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Many health problems in pregnant women result in part from inadequate nutrition. Much progress has been made in improving the nutritional situation in Dakar, but it remains a concern to this day. Promoting dietary diversity is an effective way to combat any kind of nutrient deficiency. This study aims to investigate the determinants of dietary diversity in pregnant women in the Dakar region. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">It was a cross-sectional, descriptive, analytical study with a three-stage survey. The calculated sample was 292 pregnant women. Socio-demographic, economic, pregnancy-related data, related to practices and knowledge on nutrition were collected using a questionnaire and an observation grid. The collection was conducted from November 01 to December 15, </span><span style="font-family:Verdana;">2017</span><span style="font-family:Verdana;"> among pregnant women in the Dakar region. Data were entered using epi info software and analyses were done with R. Simple linear regression was used to find the explanatory factors of dietary diversification. The fit of the regression model was done by the Hosmer Lemeshow test. The odds ratios were measured with a 5% alpha risk. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 300 pregnant women were surveyed in two different health districts. The mean dietary diversification score was 5.47, the median was 5 and the standard deviation was 1.24. Factors associated with dietary diversity were age </span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.14 [</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.8;</span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">0.48], place of follow-up 0.39 [0.12;0.67], number of children 0.56 [0.25;1.1], mineral water consumption 0.27 [0.001;0.5] and husband’s income 0.79 [0.24;1.35]. </span><b><span style="font-family:Verdana;">Discussion-Conclusion: </span></b><span style="font-family:Verdana;">The Dietary Diversity Score was average, although it is important to note a real lack of dietary variety among women, which needs to be corrected through quality communication at prenatal consultations, but also the training of midwives in the field of nutrition remains essential.展开更多
Mussel samples from the Dakar coast (Senegal) were analysed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Microwave acid digestion was also employed for metals (Mn, Pb, Cd, As) determination. Dakar coas...Mussel samples from the Dakar coast (Senegal) were analysed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Microwave acid digestion was also employed for metals (Mn, Pb, Cd, As) determination. Dakar coast usually receives numerous domestic and industrial discharges without prior treatment. The contents of Arsenic were, in all cases, higher than other metals. However, the bivalve molluscs present themselves as effective bio-monitors when assessing marine aquatic pollution by contaminants in the Dakar coast. The ANOVA analysis allows concluding that significant differences were found between mussels from different sampling points. In all cases, the February samples have in all cases a higher content than those collected in October.展开更多
Introduction: Pulmonary embolism is a relatively common life-threatening cardiovascular emergency. It remains a diagnostic problem because of its nonspecific clinical signs. Objective: The general objective was to stu...Introduction: Pulmonary embolism is a relatively common life-threatening cardiovascular emergency. It remains a diagnostic problem because of its nonspecific clinical signs. Objective: The general objective was to study pulmonary embolism in young patients admitted to the cardiology department of Dakar Principal Hospital in Senegal. Methodology: This was a retrospective, descriptive and analytical study in the cardiology department of the Dakar Principal Hospital over a period of two (02) years from January 1, 2015 to December 31, 2016 in young patients admitted for pulmonary embolism. Results: We collected 24 patients with a hospital prevalence of 2.18%. The average age was 42.29 years ± 8.41 years with a male predominance (sex ratio of 1.6). The Wells probability score was low in 54.16% of patients and medium in 45.83%. Functional signs were dominated by chest pain (83.33% of cases) followed by dyspnea (79.16% of cases). The thromboembolic risk factors found were gynecological-obstetrical in 16.6% of cases followed by prolonged bed rest. One case of thrombophilia was present with a deficiency of protein C and antithrombin III. The electrocardiogram recorded sinus tachycardia in 29.16% of patients;the Mac Ginn White sign (S1Q3T3) was found in 25% of cases. Echocardiography showed pulmonary arterial hypertension in 12.48% of cases, dilation of the right ventricle and a paradoxical septal motion in 14.28% of cases. CT pulmonary angiography showed 63.63% of cases with bilateral pulmonary embolism;it was unilateral in 22.72% of cases. Long-term anticoagulation was based on acenocoumarol 4 mg (66.7%) and Rivaroxaban (33.3%). 62.5% of the patients were seen at the 3rd month, when a checking was made to evaluate the tolerance of the treatment, and the evolution of the patient. Conclusion: Pulmonary embolism is not a rare condition in young subjects but is often underdiagnosed. Gyneco-obstetrical factors are predominant in this age group. Direct oral anticoagulants are more and more prescribed in our countries.展开更多
<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascula...<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. <b>Methods:</b> We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 201</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. <b>Results: </b>Overall, one</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> with a sex</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ratio of 1.28. Patients’mean age was 66.33 ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""></span><span style="white-space:normal;font-size:10pt;font-family:;" "="">13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">.</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes rang</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ing</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">for </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five (35) accounting for 39% were female patients and fifty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">as </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dys</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">lipidemia, physical inactivity, obesity and recurrent ischemic stroke. <b>Conclusion:</b> Long</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">term prognosis of ischemic stroke remains unclear in Senegal. </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">Therefore</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> a strategy for primary prevention is highly crucial and </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">it </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">requires the control of risk factors in general and that of high blood pressure in particular.</span>展开更多
Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk f...Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk factors for COVID-19 related death during the first three waves of the disease at the Epidemic Treatment Center (ETC) of Dakar Principal Hospital (DPH). Method: We conducted a descriptive and analytical perspective survival study from April 4, 2020 to September 25, 2021, including adult patients with COVID-19, hospitalized at the ETC of DPH. Log Rank test and multivariate Cox model were performed to identify risk factors for death. Results: We included 556 COVID-19 patients with mean age of 57 ± 17 years and a male-to-female ratio of 1.26. The number of deaths during one month of follow-up was 41, representing a cumulative risk of 7.4%. The log Rank test showed that being from the third wave (p = 0.0056), advanced age (p = 0.00098), presence of at least one comorbidity (p = 0.034), High blood pressure (p = 0.024), d-dimer level ≥ 1000 IU/L (p Conclusion: Our study showed that elderly and third-wave of COVID-19 patients were more at risk to die. Knowledge of risk factors for COVID-19 related death could improve the prognosis of these patients.展开更多
Introduction: Measuring the quality of life (QOL) in recent years has become an indispensable tool in monitoring patients suffering from chronic diseases. We conducted this study to assess QOL of patients undergoing p...Introduction: Measuring the quality of life (QOL) in recent years has become an indispensable tool in monitoring patients suffering from chronic diseases. We conducted this study to assess QOL of patients undergoing peritoneal dialysis in Dakar, and to identify associated factors. Patients and Methods: This is a cross-sectional study which was carried out from 10 to 30 June, 2011 in the peritoneal dialysis unit at university hospital in Dakar. We included all patients with end-stage renal disease (ESRD) of any age, who were on PD since at least six months and who gave their consent. The QOL was assessed using the Kidney Disease Quality of Life Short-Form 1.2 (KDQoL-SF). Results: Sixteen patients were included with a mean age of 50.25 ± 13.48 years and a sex-ratio of 1.27. Considering SF-36, the overall mean score (SMG) was 60.11 ± 15.96 with a Mean Physical Component Summary Scale of 53.66 ± 16.98 and a Mental Component Summary Scale of 70.85 ± 6.14. Concerning the KDQoL-SF, the global mean score was 61.83 ± 19.35 with a mean physical score of 50.55 ± 16.52 and a mean mental score of 62.52 ± 21.53. The mean dialysis specific dimension score was 62.52 ± 21.53 and the mean mental health score was 85.93 ± 12.06. Age, weight, level of instruction and social support were correlated with a worse QOL. Conclusion: This study showed an alteration of our PD patients’ QOL, particularly in their physical health. However, the number of patients included in the study is not enough to permit a formal conclusion.展开更多
In Dakar, there has been a considerable deficit in the drinking water supply for more than a decade. The distribution is poorly controlled in this region. And yet, there is no lack of supply sources or solutions. With...In Dakar, there has been a considerable deficit in the drinking water supply for more than a decade. The distribution is poorly controlled in this region. And yet, there is no lack of supply sources or solutions. With a drinking water deficit of 300,000 m3/d to fill, the State of Senegal proposed two (02) options: firstly, the construction of a second Plan at Keur Momar Sarr on the Guiers Lake with a capacity of 75,000 m3/d coupled with a third pipeline between Keur Momar Sarr and Thiès (KMS3);secondly, the construction of a seawater desalination Plant with a capacity of 75,000 m3/d. In this article, we studied the evolution of the drinking water consumption and the statistical data relating to population growth, which is the key element in the drinking water consumption evolution in Dakar. We were able to extract the equations from the trend curves that made it possible to predict a population growth. The results obtained with the equations and the curves show that the real needs for drinking water in Dakar are proportional to population growth.展开更多
Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment ...Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm<sup>3</sup> and high viral load at treatment initiation.展开更多
Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average ag...Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.展开更多
Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in...Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.展开更多
Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the us...Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were a shorter diabetes duration (P = 0.0008), high blood pressure (P = 0.0015) and absence of DR (P = 0.005). Conclusion: Our data show that kidney injury in a diabetic is not always diabetic nephropathy. The Kidney biopsy (KB) is often needed in order to adopt an effective management.展开更多
Introduction: Entero bacteria are mainly found in the gut of man and animals. The frequent acquisition of antibiotic resistance mechanisms explains why they are the bacteria most often implicated in human infectious p...Introduction: Entero bacteria are mainly found in the gut of man and animals. The frequent acquisition of antibiotic resistance mechanisms explains why they are the bacteria most often implicated in human infectious pathology. It is estimated to be involved in 50% of sepsis, 60% of enteritis, 70% of urinary tract infection case. Objective: To determine the prevalence of enterobacterial infections diagnosed at Fann Infectious Diseases Clinic, and describe their epidemiological, clinical, therapeutic and evolutionary aspects. Patients and Methods: This is a retrospective and descriptive study, on patients hospitalized from January 2013 to December 2014, at Fann Infectious Diseases Clinic, with bacteriological confirmation of an enterobacteria infection. Results: A total of 129 cases were collected during the study period. The average age was 41 years, and female were predominant (60%) with a sex ratio of 0.67. Comorbidity was found in 88.4% of the cases, most of which were HIV infection. The most common clinical signs were infectious syndrome (53.49%) and general impairment (40.31%). The main gateway was urinary (55.8%). Samples were monomicrobial in 76.7% of cases. Klebsiella and Escherichia were the most common and 68.7% of the subjects had probabilistic treatment. Most enterobacterial strains were resistant to third generation cephalosporins (C3G), aminoglycosides to ciprofloxacin and cotrimoxazole. Aside from 4% of them, all were sensitive to imipenem. Conclusion: The advent of antibiotics has brought hope in the treatment of enterobacterial infections. However, an increase in their resistance to the usual antibiotics has been noted in recent years. As a result, the fight against antibiotic resistance must be a priority.展开更多
Aim: To evaluate the attitude practice and knowledge of pharmacists in the management of diabetes in the department of Dakar. Methodology: Cross-sectional study, conducted from 01 March to 30 September 2017 including ...Aim: To evaluate the attitude practice and knowledge of pharmacists in the management of diabetes in the department of Dakar. Methodology: Cross-sectional study, conducted from 01 March to 30 September 2017 including all pharmacists in the Dakar region who agreed to participate in the survey. Data was collected through a pre-established questionnaire. Results: A total of 144 pharmacists were included in the study, representing a participation rate of 87.58%. The average age was 33.90 years, with a sex ratio of 1.69. Pharmacists were single in 50.88% of cases, and a minimum experience of 5 years was found in 64.03% of cases. Pharmacist assistants accounted for 57.9% of our study population. The assessment of knowledge based on 16 items shows an average score of 9.02. The level of knowledge was low to insufficient in 37.21% of cases, average in (50%) half of cases and good for (13.16%). Less than half (34.21%) of pharmacists had received training and the average date of last training was 33.76 ± 24.6 months. Training was provided by medical representatives and academics in 66.66% and 26.67% respectively. The most felt positive feelings were respectively the need for help, the compassion in respectively 98.42%, 42.11%. Feelings felt and simultaneously cited were: need for help and compassion in more than 40% of respondents. Only 29% of pharmacists did not have a lot of difficulty with patient questions and the only reason was the lack of awareness (84.68%) of patients about their disease. Screening for diabetes by capillary blood glucose was performed by 57% of pharmacists. Dietary advice (76.15%) and referral to the hospital (94.41%) were the most common practices in case of blood sugar disruption. The dialogue with patients was impossible in 22.81% of pharmacists and the main reasons given were lack of time (53.85%) and lack of knowledge (34.62%). The method of delivery of insulin was done on: medical prescription (98.25%), presentation of the box (69.30%), on request of the patient (54.39%). Only one pharmacist recognized advising insulin (0.88%). The delivery of oral antidiabetic agents was: on medical prescription (96.49%), presentation of the box (67.54%), at the request of the patient (52.63%). The good level of knowledge was more found in the subjects after 40 years (p = 0.69), the female sex (p = 0.84), the assistants and holders (p = 0.24), after 5 years of professional experience (p = 0.13). Conclusion: Despite the lack of knowledge of pharmacists, attitudes and practices are considered satisfactory in the management of diabetics. Continuing medical education sessions could strengthen knowledge and consolidate the attitudes and practices of community pharmacists.展开更多
<strong>Introduction-Objective: </strong>Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The predictors of mortality due to TB are rarely evaluated in Senegal. The...<strong>Introduction-Objective: </strong>Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The predictors of mortality due to TB are rarely evaluated in Senegal. The aim of our study was to identify factors associated with related TB death in two treatment centers in Dakar, Senegal.<strong> Method: </strong>We conducted a prospective descriptive-analytical study dealing with TB patients followed in the Department of Infectious and Tropical Diseases at FANN Teaching Hospital and Dakar Principal Hospital and in the Department of Pulmonology at Dakar Principal Hospital from March 1<sup>st</sup>, 2019 to February 29<sup>th</sup>, 2020. Univariate and multivariate logistic regressions were performed to identify the associated factors of death. <strong>Results:</strong> Two hundred eighty-two patients in the Department of Infectious and Tropical Diseases at FANN teaching hospital (57%), in the Department of Infectious and Tropical Diseases at Dakar Principal Hospital (31%), and in the Department of Pulmonology at Dakar Principal Hospital (12%) were included in the study. The mean age was 39 ± 16 years and the male to female ratio was 2.2. Isolated pulmonary TB, isolated extrapulmonary TB, and both pulmonary and extrapulmonary TB were present in 33.3%, 30.5% and 36.2% of cases, respectively. Twenty-two patients died, corresponding to a mortality rate of 7.8%. Factors independently associated with death were age ≥ 60 years (26.2 [3.6 - 191.2]) compared to 16 - 40 years’ age group, HIV infection (7.2 [1.4 - 36.9]), neurological localization of TB (13.19 [3.2 - 54.3]), and hemoglobin level < 10 g/dl (5.5 [1.3 - 23.9]). <strong>Conclusion:</strong> Tuberculosis remains a fatal disease despite therapeutic advances. Better knowledge of associated factors of death from TB may help to reduce its mortality.展开更多
Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic featur...Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.展开更多
Due to the status of the Dakar region as the former capital of AOF (French West Africa) and current capital of the Republic of Senegal, it is home to a very large part of the population and most of the socio-economic,...Due to the status of the Dakar region as the former capital of AOF (French West Africa) and current capital of the Republic of Senegal, it is home to a very large part of the population and most of the socio-economic, administrative and cultural activities on a very small area of the country (0.28%). This situation makes it a very attractive region and subject to strong land pressure. The objective of this article is to study past and current urban dynamics as well as changes in natural spaces, in order to identify new urban centers. The methodological approach consists in analyzing satellite images to understand the evolution of different forms of spatial occupation in the Dakar region, and to study population movement flows and urban forms in order to reveal new urban centers. The results of the study show that the Dakar urban space is characterized by diverse forms which express a heterogeneous set of spaces. They also revealed the emergence of new clusters between 1986 and 2016, notably Ngor, Grand Yoff, Parcelles Assainies in the North-West, and Keur Massar and the North of the communes of Rufisque in the eastern part of the Dakar region.展开更多
Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors lin...Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.展开更多
文摘Introduction: Strokes are becoming more common in Africa, they are often accompanied by depressive symptoms, hence the need to investigate the factors associated with it for better management and prevention. Methodology: We conducted a prospective cross-sectional study amongst patients hospitalized with stroke at the Neurology/Neuroscience Clinic of the FANN UNHC (Dakar) in 2016. After a clinical diagnosis, patients are subjected to socio-demographic questionnaire and were administered with modified Rankin and MADRS scores. Results: Among the patients, 33.7% had Post-Stroke Depression, most were aged 50 to 70 years, male and married. History of stroke and depression was strongly associated with Post-Stroke Depression, while functional or cognitive impairment caused by stroke contributed to the development of Post Stroke depression. The type of ischemic or haemorrhagic stroke did not appear to affect the occurrence of the Post-Stroke Depression, but Post-Stroke Depression was more frequent in subjects with a left hemispheric lesion 47.8% (p Discussion: The occurrence of a Post-Stroke Depression is a factor of poor prognosis, early diagnosis and holistic care lead to improved quality of life.
文摘Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.
文摘<strong>Introduction: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">Acute Respiratory Infections (ARI) is a global public health priority. It is the leading cause of childhood morbidity and mortality, especially in developing countries. The main objective of this work was to look mainly at the bacteriological aspects of ARI in children in Senegalese hospitals. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">We have been conducted a prospective descriptive mono-centric study over a period of one year (from July 1, 2017 to June 30, 2018) at the Albert Royer National child hospital in Dakar. A multiplex PCR (protein chain reaction) has been performed on nasopharyngeal swabs taken from all patients. This technique (viral RNA transcribed into DNA, then the DNA of the different pathogens is simultaneously amplified in the same tube by PCR Fast-tract<span style="white-space:nowrap;"><sup>®</sup></span>, multiplex). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During the study period, 109 patients were included. The hospital prevalence of acute respiratory infections was 3.7%. </span><span style="font-family:Verdana;">The mean age was 23.7 months with extremes between 1 month and 144</span><span style="font-family:Verdana;"> months. Peaks of consultations were found in the months of August, March and April with 22%, 15.6% and 12.8% respectively. Fever, respiratory distress and pulmonary condensation syndrome were the main signs found in our patients. Bacteriology was positive in 82.6% of samples and the most frequently found bacteria were </span><i><span style="font-family:Verdana;">Streptococcus pneumoniae</span></i><span style="font-family:Verdana;"> in 38.5%, </span><i><span style="font-family:Verdana;">Haemophilus influenza</span></i><span style="font-family:Verdana;"> b in 32.1% and </span><i><span style="font-family:Verdana;">Moraxella catarrhalis</span></i><span style="font-family:Verdana;"> in 25.7%. Pneumonia was the main diagnosis, found in 61 cases, a prevalence of 59.9%. The average length </span><span><span style="font-family:Verdana;">of hospitalization was 10 days. Lethality was 1.8% or 2 cases. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> Acute Respiratory Infections in children still remains a public health problem in developing countries;children under 5 years of age are the most affected </span><span style="font-family:Verdana;">hence the need to strengthen ARI control programs. The identification of</span><span style="font-family:Verdana;"> germs is indispensable in treatment and epidemiological surveillance in our regions.</span></span>
文摘<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Many health problems in pregnant women result in part from inadequate nutrition. Much progress has been made in improving the nutritional situation in Dakar, but it remains a concern to this day. Promoting dietary diversity is an effective way to combat any kind of nutrient deficiency. This study aims to investigate the determinants of dietary diversity in pregnant women in the Dakar region. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">It was a cross-sectional, descriptive, analytical study with a three-stage survey. The calculated sample was 292 pregnant women. Socio-demographic, economic, pregnancy-related data, related to practices and knowledge on nutrition were collected using a questionnaire and an observation grid. The collection was conducted from November 01 to December 15, </span><span style="font-family:Verdana;">2017</span><span style="font-family:Verdana;"> among pregnant women in the Dakar region. Data were entered using epi info software and analyses were done with R. Simple linear regression was used to find the explanatory factors of dietary diversification. The fit of the regression model was done by the Hosmer Lemeshow test. The odds ratios were measured with a 5% alpha risk. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 300 pregnant women were surveyed in two different health districts. The mean dietary diversification score was 5.47, the median was 5 and the standard deviation was 1.24. Factors associated with dietary diversity were age </span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.14 [</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">1.8;</span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">0.48], place of follow-up 0.39 [0.12;0.67], number of children 0.56 [0.25;1.1], mineral water consumption 0.27 [0.001;0.5] and husband’s income 0.79 [0.24;1.35]. </span><b><span style="font-family:Verdana;">Discussion-Conclusion: </span></b><span style="font-family:Verdana;">The Dietary Diversity Score was average, although it is important to note a real lack of dietary variety among women, which needs to be corrected through quality communication at prenatal consultations, but also the training of midwives in the field of nutrition remains essential.
文摘Mussel samples from the Dakar coast (Senegal) were analysed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Microwave acid digestion was also employed for metals (Mn, Pb, Cd, As) determination. Dakar coast usually receives numerous domestic and industrial discharges without prior treatment. The contents of Arsenic were, in all cases, higher than other metals. However, the bivalve molluscs present themselves as effective bio-monitors when assessing marine aquatic pollution by contaminants in the Dakar coast. The ANOVA analysis allows concluding that significant differences were found between mussels from different sampling points. In all cases, the February samples have in all cases a higher content than those collected in October.
文摘Introduction: Pulmonary embolism is a relatively common life-threatening cardiovascular emergency. It remains a diagnostic problem because of its nonspecific clinical signs. Objective: The general objective was to study pulmonary embolism in young patients admitted to the cardiology department of Dakar Principal Hospital in Senegal. Methodology: This was a retrospective, descriptive and analytical study in the cardiology department of the Dakar Principal Hospital over a period of two (02) years from January 1, 2015 to December 31, 2016 in young patients admitted for pulmonary embolism. Results: We collected 24 patients with a hospital prevalence of 2.18%. The average age was 42.29 years ± 8.41 years with a male predominance (sex ratio of 1.6). The Wells probability score was low in 54.16% of patients and medium in 45.83%. Functional signs were dominated by chest pain (83.33% of cases) followed by dyspnea (79.16% of cases). The thromboembolic risk factors found were gynecological-obstetrical in 16.6% of cases followed by prolonged bed rest. One case of thrombophilia was present with a deficiency of protein C and antithrombin III. The electrocardiogram recorded sinus tachycardia in 29.16% of patients;the Mac Ginn White sign (S1Q3T3) was found in 25% of cases. Echocardiography showed pulmonary arterial hypertension in 12.48% of cases, dilation of the right ventricle and a paradoxical septal motion in 14.28% of cases. CT pulmonary angiography showed 63.63% of cases with bilateral pulmonary embolism;it was unilateral in 22.72% of cases. Long-term anticoagulation was based on acenocoumarol 4 mg (66.7%) and Rivaroxaban (33.3%). 62.5% of the patients were seen at the 3rd month, when a checking was made to evaluate the tolerance of the treatment, and the evolution of the patient. Conclusion: Pulmonary embolism is not a rare condition in young subjects but is often underdiagnosed. Gyneco-obstetrical factors are predominant in this age group. Direct oral anticoagulants are more and more prescribed in our countries.
文摘<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. <b>Methods:</b> We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 201</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. <b>Results: </b>Overall, one</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> with a sex</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ratio of 1.28. Patients’mean age was 66.33 ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""></span><span style="white-space:normal;font-size:10pt;font-family:;" "="">13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">.</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes rang</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ing</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">for </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five (35) accounting for 39% were female patients and fifty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">as </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dys</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">lipidemia, physical inactivity, obesity and recurrent ischemic stroke. <b>Conclusion:</b> Long</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">term prognosis of ischemic stroke remains unclear in Senegal. </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">Therefore</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> a strategy for primary prevention is highly crucial and </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">it </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">requires the control of risk factors in general and that of high blood pressure in particular.</span>
文摘Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk factors for COVID-19 related death during the first three waves of the disease at the Epidemic Treatment Center (ETC) of Dakar Principal Hospital (DPH). Method: We conducted a descriptive and analytical perspective survival study from April 4, 2020 to September 25, 2021, including adult patients with COVID-19, hospitalized at the ETC of DPH. Log Rank test and multivariate Cox model were performed to identify risk factors for death. Results: We included 556 COVID-19 patients with mean age of 57 ± 17 years and a male-to-female ratio of 1.26. The number of deaths during one month of follow-up was 41, representing a cumulative risk of 7.4%. The log Rank test showed that being from the third wave (p = 0.0056), advanced age (p = 0.00098), presence of at least one comorbidity (p = 0.034), High blood pressure (p = 0.024), d-dimer level ≥ 1000 IU/L (p Conclusion: Our study showed that elderly and third-wave of COVID-19 patients were more at risk to die. Knowledge of risk factors for COVID-19 related death could improve the prognosis of these patients.
文摘Introduction: Measuring the quality of life (QOL) in recent years has become an indispensable tool in monitoring patients suffering from chronic diseases. We conducted this study to assess QOL of patients undergoing peritoneal dialysis in Dakar, and to identify associated factors. Patients and Methods: This is a cross-sectional study which was carried out from 10 to 30 June, 2011 in the peritoneal dialysis unit at university hospital in Dakar. We included all patients with end-stage renal disease (ESRD) of any age, who were on PD since at least six months and who gave their consent. The QOL was assessed using the Kidney Disease Quality of Life Short-Form 1.2 (KDQoL-SF). Results: Sixteen patients were included with a mean age of 50.25 ± 13.48 years and a sex-ratio of 1.27. Considering SF-36, the overall mean score (SMG) was 60.11 ± 15.96 with a Mean Physical Component Summary Scale of 53.66 ± 16.98 and a Mental Component Summary Scale of 70.85 ± 6.14. Concerning the KDQoL-SF, the global mean score was 61.83 ± 19.35 with a mean physical score of 50.55 ± 16.52 and a mean mental score of 62.52 ± 21.53. The mean dialysis specific dimension score was 62.52 ± 21.53 and the mean mental health score was 85.93 ± 12.06. Age, weight, level of instruction and social support were correlated with a worse QOL. Conclusion: This study showed an alteration of our PD patients’ QOL, particularly in their physical health. However, the number of patients included in the study is not enough to permit a formal conclusion.
文摘In Dakar, there has been a considerable deficit in the drinking water supply for more than a decade. The distribution is poorly controlled in this region. And yet, there is no lack of supply sources or solutions. With a drinking water deficit of 300,000 m3/d to fill, the State of Senegal proposed two (02) options: firstly, the construction of a second Plan at Keur Momar Sarr on the Guiers Lake with a capacity of 75,000 m3/d coupled with a third pipeline between Keur Momar Sarr and Thiès (KMS3);secondly, the construction of a seawater desalination Plant with a capacity of 75,000 m3/d. In this article, we studied the evolution of the drinking water consumption and the statistical data relating to population growth, which is the key element in the drinking water consumption evolution in Dakar. We were able to extract the equations from the trend curves that made it possible to predict a population growth. The results obtained with the equations and the curves show that the real needs for drinking water in Dakar are proportional to population growth.
文摘Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm<sup>3</sup> and high viral load at treatment initiation.
文摘Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.
文摘Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.
文摘Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were a shorter diabetes duration (P = 0.0008), high blood pressure (P = 0.0015) and absence of DR (P = 0.005). Conclusion: Our data show that kidney injury in a diabetic is not always diabetic nephropathy. The Kidney biopsy (KB) is often needed in order to adopt an effective management.
文摘Introduction: Entero bacteria are mainly found in the gut of man and animals. The frequent acquisition of antibiotic resistance mechanisms explains why they are the bacteria most often implicated in human infectious pathology. It is estimated to be involved in 50% of sepsis, 60% of enteritis, 70% of urinary tract infection case. Objective: To determine the prevalence of enterobacterial infections diagnosed at Fann Infectious Diseases Clinic, and describe their epidemiological, clinical, therapeutic and evolutionary aspects. Patients and Methods: This is a retrospective and descriptive study, on patients hospitalized from January 2013 to December 2014, at Fann Infectious Diseases Clinic, with bacteriological confirmation of an enterobacteria infection. Results: A total of 129 cases were collected during the study period. The average age was 41 years, and female were predominant (60%) with a sex ratio of 0.67. Comorbidity was found in 88.4% of the cases, most of which were HIV infection. The most common clinical signs were infectious syndrome (53.49%) and general impairment (40.31%). The main gateway was urinary (55.8%). Samples were monomicrobial in 76.7% of cases. Klebsiella and Escherichia were the most common and 68.7% of the subjects had probabilistic treatment. Most enterobacterial strains were resistant to third generation cephalosporins (C3G), aminoglycosides to ciprofloxacin and cotrimoxazole. Aside from 4% of them, all were sensitive to imipenem. Conclusion: The advent of antibiotics has brought hope in the treatment of enterobacterial infections. However, an increase in their resistance to the usual antibiotics has been noted in recent years. As a result, the fight against antibiotic resistance must be a priority.
文摘Aim: To evaluate the attitude practice and knowledge of pharmacists in the management of diabetes in the department of Dakar. Methodology: Cross-sectional study, conducted from 01 March to 30 September 2017 including all pharmacists in the Dakar region who agreed to participate in the survey. Data was collected through a pre-established questionnaire. Results: A total of 144 pharmacists were included in the study, representing a participation rate of 87.58%. The average age was 33.90 years, with a sex ratio of 1.69. Pharmacists were single in 50.88% of cases, and a minimum experience of 5 years was found in 64.03% of cases. Pharmacist assistants accounted for 57.9% of our study population. The assessment of knowledge based on 16 items shows an average score of 9.02. The level of knowledge was low to insufficient in 37.21% of cases, average in (50%) half of cases and good for (13.16%). Less than half (34.21%) of pharmacists had received training and the average date of last training was 33.76 ± 24.6 months. Training was provided by medical representatives and academics in 66.66% and 26.67% respectively. The most felt positive feelings were respectively the need for help, the compassion in respectively 98.42%, 42.11%. Feelings felt and simultaneously cited were: need for help and compassion in more than 40% of respondents. Only 29% of pharmacists did not have a lot of difficulty with patient questions and the only reason was the lack of awareness (84.68%) of patients about their disease. Screening for diabetes by capillary blood glucose was performed by 57% of pharmacists. Dietary advice (76.15%) and referral to the hospital (94.41%) were the most common practices in case of blood sugar disruption. The dialogue with patients was impossible in 22.81% of pharmacists and the main reasons given were lack of time (53.85%) and lack of knowledge (34.62%). The method of delivery of insulin was done on: medical prescription (98.25%), presentation of the box (69.30%), on request of the patient (54.39%). Only one pharmacist recognized advising insulin (0.88%). The delivery of oral antidiabetic agents was: on medical prescription (96.49%), presentation of the box (67.54%), at the request of the patient (52.63%). The good level of knowledge was more found in the subjects after 40 years (p = 0.69), the female sex (p = 0.84), the assistants and holders (p = 0.24), after 5 years of professional experience (p = 0.13). Conclusion: Despite the lack of knowledge of pharmacists, attitudes and practices are considered satisfactory in the management of diabetics. Continuing medical education sessions could strengthen knowledge and consolidate the attitudes and practices of community pharmacists.
文摘<strong>Introduction-Objective: </strong>Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The predictors of mortality due to TB are rarely evaluated in Senegal. The aim of our study was to identify factors associated with related TB death in two treatment centers in Dakar, Senegal.<strong> Method: </strong>We conducted a prospective descriptive-analytical study dealing with TB patients followed in the Department of Infectious and Tropical Diseases at FANN Teaching Hospital and Dakar Principal Hospital and in the Department of Pulmonology at Dakar Principal Hospital from March 1<sup>st</sup>, 2019 to February 29<sup>th</sup>, 2020. Univariate and multivariate logistic regressions were performed to identify the associated factors of death. <strong>Results:</strong> Two hundred eighty-two patients in the Department of Infectious and Tropical Diseases at FANN teaching hospital (57%), in the Department of Infectious and Tropical Diseases at Dakar Principal Hospital (31%), and in the Department of Pulmonology at Dakar Principal Hospital (12%) were included in the study. The mean age was 39 ± 16 years and the male to female ratio was 2.2. Isolated pulmonary TB, isolated extrapulmonary TB, and both pulmonary and extrapulmonary TB were present in 33.3%, 30.5% and 36.2% of cases, respectively. Twenty-two patients died, corresponding to a mortality rate of 7.8%. Factors independently associated with death were age ≥ 60 years (26.2 [3.6 - 191.2]) compared to 16 - 40 years’ age group, HIV infection (7.2 [1.4 - 36.9]), neurological localization of TB (13.19 [3.2 - 54.3]), and hemoglobin level < 10 g/dl (5.5 [1.3 - 23.9]). <strong>Conclusion:</strong> Tuberculosis remains a fatal disease despite therapeutic advances. Better knowledge of associated factors of death from TB may help to reduce its mortality.
文摘Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.
文摘Due to the status of the Dakar region as the former capital of AOF (French West Africa) and current capital of the Republic of Senegal, it is home to a very large part of the population and most of the socio-economic, administrative and cultural activities on a very small area of the country (0.28%). This situation makes it a very attractive region and subject to strong land pressure. The objective of this article is to study past and current urban dynamics as well as changes in natural spaces, in order to identify new urban centers. The methodological approach consists in analyzing satellite images to understand the evolution of different forms of spatial occupation in the Dakar region, and to study population movement flows and urban forms in order to reveal new urban centers. The results of the study show that the Dakar urban space is characterized by diverse forms which express a heterogeneous set of spaces. They also revealed the emergence of new clusters between 1986 and 2016, notably Ngor, Grand Yoff, Parcelles Assainies in the North-West, and Keur Massar and the North of the communes of Rufisque in the eastern part of the Dakar region.
文摘Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.
