Dynamique de la prise en charge thérapeutique et préventive de la Covid-19 chez les patients adultes vulnérables / Dynamics of therapeutic and preventive management of Covid-19 in vulnerable adult patients

La pandémie à Covid-19 continue sa progression et interpelle aujourd'hui toute l'humanité particulièrement le corps médical. A la date du 30 Juin 2020, le monde entier compte 10185374 cas confirmés avec 563862 décès [1]. La recherche scientifique intense a pu rapidement séquencer ce virus à ARN, partager sur sa clinique et son évolution. Mais six mois après il persiste encore beaucoup d'inconnues concernant son pouvoir pathogène, sa physiopathologie mais surtout sa prise en charge thérapeutique particulièrement chez les sujets âgés ou ayant des facteurs de risqué qui ont une mortalité significativement plus élevée [1, 2, 3]. La Covid-19 pose ainsi un problème de prise en charge thérapeutique chez les sujets vulnérables. Cette situation préoccupante pour tous, justifie la poursuite de la réflexion, de la recherche et surtout le partage d'expériences pour une meilleure prise en chargechez ces patients à risque

[The primary pulmonary MALT lymphoma: a rare lung tumor]. / Le lymphome pulmonaire primitif de type MALT: une tumeur pulmonaire rare.

The primary pulmonary lymphoma is a rare disease, representing 0.5 to 1% of the malignant lung tumors. In our countries, in spite of the increasing prevalence of the pulmonary tumors, aggravated by smoking and environmental factors, any case report of the primary pulmonary lymphoma is notified. We report a confirmed case of MALT lung lymphoma that is managed in our hospital. Mr. S.B., 68-year-old man, not smoking, without particular professional exhibition, is admitted for a chronic cough with blood-streaked sputum, dyspnea, chest pain and loss of weight. His symptomatology is evolving for 4months. In the examination, the general health was passable and he presented a pulmonary condensation syndrome at right. The physical examination of others systems was normal. There was a biological inflammatory syndrome. The bacteriological examinations of the bronchial expectorations were negative. The chest CT showed bilateral alveolar opacities at the upper, with attraction of the fissures, without nodes. The bronchoscopy showed anomalies of the bronchial mucous membrane in 2 superior lobes. The perendoscopiques biopsies confirmed a MALT lung lymphoma. We did not find other localizations. Chemotherapy was proposed to our patient with favorable evolution. The MALT primary lung lymphoma must not be underestimated. Clinical manifestations and radiological characteristics are no specific and it's necessary to eliminate a lung cancer or tuberculosis in our countries. The difficulties of their diagnostic are intensified by the not availability of an adequate technical tray.

[Adult-onset Still's disease: case report in Dakar, Senegal]. / Maladie de Still de l'adulte: une observation à Dakar (Sénégal).

Adult-onset Still's disease is a uncommon form of inflammatory rheumatism. It has rarely been reported in black Africa. The purpose of this report is to describe a case in a 49-year-old woman from Dakar, Senegal.

[Nocardiosis: 4 cases in Senegal]. / Nocardiose: 4 observations au Sénégal.

The purpose of this report is to describe four cases of nocardiosis observed over an eight-year period in medical units of Principal Hospital in Dakar, Senegal. It is a rare infection occurring mainly in people with weakened immune systems. Pulmonary forms are predominate and clinical and laboratory presentation can mimic pulmonary tuberculosis. Diagnosis should be suspected in patients presenting pulmonary infections and negative sputum bacilloscopy. Nocardia bacteria should be identified before starting antibiotic treatment. Patients require long-term antibiotic treatment with third generation cephalosporins or sulfamethoxazole-trimethoprim.

[Permanent deafness following typhoid fever: case report from Dakar, Senegal]. / Surdité définitive au décours d'une fièvre typhoïde une observation a Dakar (Sénégal).

Severe infections due to Salmonella typhi and Salmonella paratyphi are still common in sub-Saharan Africa where many patients are empirically treated for malaria. In addition to the usual clinical signs and complications of typhoid fever, clinicians practicing in high incidence areas must be aware of less common manifestations. The purpose of this report is to describe a case involving an 18-year-old boy who presented with quinine-resistant febrile coma. The final diagnosis was typhoid fever. After recovery the patient presented complete deafness. Discussion raises the question of whether deafness was secondary to typhoid fever or to drug therapy.

[Shoulder pain revealing tuberculosis of the humerus]. / Une épaule douloureuse révélant une tuberculose osseuse inhabituelle.

Tuberculous spondylitis is the most common form of musculoskeletal tuberculosis. However, extraspinal manifestations have been described with tuberculosis of the wrist, femur, foot or shoulder, as in the patient presented. Because of an often-indolent clinical presentation, the diagnosis is delayed and antituberculous treatment is not able to prevent serious bone destruction.

Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study).

The aim of this study was to determine hepatitis co-infection in a cohort of HIV infected patients at their inclusion in the Senegalese Initiative of ART Access. B, C, and D Hepatitis viruses serological markers were checked retrospectively on 363 stored plasma. For HBV, the Abbott laboratories equipment IMx was used to detect HBs Ag and anti Core Ab on negative HBs Ag samples. For HDV, anti Delta Ab was performed using the Abbott Murex Kit on all HBs Ag positive samples. For HCV, anti HCV Ab was detected by IMx as double screening test and confirmed by INNO-LIA(TM) HCV Core of Innogenetics laboratories. The statistical analysis was done with STATA V8. The study population was composed of 164 men and 199 women aged between 16 and 66 years. The immune and virological markers averages at their enrollment were 154 cell/mm(3) for TLCD4+ (n = 355 patients) and 4.9 log for viral load (n = 277 patients). HBs Ag was found in 61 patients or 16.8% and the prevalence of anti-HBc Ab was 83.2% (252/295). 2 patients or 3% on HBs Ag positive sample presents HBV/HDV co-infection Ab anti HCV was detects in 6 patients or 1.6% after confirmation and 2 patients had triple infection with HBV. These results showed that the prevalence of HBV and HCV in the population of persons living with HIV/AIDS in Senegal is similar to that found in the general population. Our data indicated that hepatitis pathology in the PLwHIV was essentially due to HBV. Further studies are needed to diagnose occult hepatitis in order to set up therapeutic strategies taking into account co-infections by hepatitis viruses in the ART programmes.

[Poster presentations]. / La communication affichée.

Posters have become an essential tool for dissemination of study findings at medical meetings. By presenting a quick snapshot, posters can be an effective means of communicating the main findings of the research quickly and of stimulating rewarding exchanges with the people in attendance. Success depends on catching and holding the attention of passing attendees long enough to establish contact and share knowledge and experience. The purpose of this article is to provide a few guidelines and techniques for preparing and presenting effective and clear research posters at scientific meetings.

[Empiric antituberculous therapy in patients with unexplained exsudative pleural effusion. Is it valid in Senegal?]. / Le traitement antituberculeux présomptif est-il licite dans la pleurésie lymphocytaire exsudative inexpliquée au Sénégal?

AIM: Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). METHODS: In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. RESULTS: During 1 year, 38 patients were enrolled (23 males, mean age=36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (<1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (12-24 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. CONCLUSION: In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE.

[Using PubMed subject headings to enhance reference searches]. / Utiliser les descripteurs dans PubMed pour améliorer une recherche bibliographique.

The PubMed search engine is an essential tool to stay abreast of the latest medical literature on specific topics. While the basic search techniques are common knowledge, the ability to use medical subject headings properly is an essential in obtaining valuable references. The purpose of this article is to explain what medical subject headings are and how they can be used to improve the results of reference searches in PubMed.