ABSTRACT
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
Subject(s)
Aged , Clinical Protocols , Disease Management , Vulnerable Populations , Diabetes Mellitus , SARS-CoV-2 , COVID-19 , Obesity , PandemicsABSTRACT
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.
Subject(s)
Nocardia Infections/diagnosis , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Adult , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Female , HIV Infections/complications , HIV Infections/drug therapy , HIV-1/physiology , Humans , Immunocompromised Host/physiology , Male , Middle Aged , Nocardia Infections/drug therapy , Nocardia Infections/etiology , Radiography, Thoracic , Senegal , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Tuberculosis, Pulmonary/diagnosisABSTRACT
The monitoring and evaluation is usually the weakest component of health programs in sub-Saharan Africa, what is undermining the sustainability of funding. The problems are complex and the weaknesses of the health systems are reflected on the monitoring and evaluation of specific programs. This paper gives an insight of the problems faced during field missions for monitoring and evaluation. The steps for building the M&E system have been reviewed and keys points for implementation have been provided.
Subject(s)
Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Outcome Assessment, Health Care , Public Health , Africa , Humans , Program EvaluationABSTRACT
Infection disease due to Listeria monocytogenes, which is a ubiquitous positive Gram bacillus to the essentially alimentary transmission, listeriosis happens on patients presenting an immunodeficiency. The authors report the two first cases of listeriosis diagnosed at Hopital Principal de Dakar. The first case was observed on a 73 years old man, hospitalised for a feverish coma scored at 9 using Glasgow scale, with neither meningitis syndrome, nor sign of neurological localisation. The analysis of the RLC reveals a hypercytosis at 126 GB/mm3, with prevailing neutrophile polynuclears, a hyperproteinorachia at 3.2 g/l. The culture of the RLC was sterile but the blood culture showed the presence of L. monocytogenes. The other paraclinical tests has revealed a glycaemia at 2.45 g/l, an imporant hepatic cytolisis with ASAT at 13 N and ALAT at 20 N. The patient was also presenting a cerebromeningitis and hepatic listeriosis on a diabetic field. The second case was observed on a 58 years old patient admitted for headaches, fever and an important degradation of the general state with an emaciation of 17 kg in 5 months. The physical screening revealed a bad general state, a fever at 38 degrees 2 and was without other particularity. The analysis of the RLC showed a hyperproteinorachia at 1.35 g/l with neither hypercytosis nor germ at the culture. Haemoculture isolated Listeria monocytogenes. HIV serology was positive. CD4 were counted to 61/mm3. and the viral charge was at 110.000 copies / mm3. The patient was presenting a Listeria monocytogenes at meningo-encephalitis on HIV-1 field. stade B of the CDC classification. This ubiquitous anthropozoonosis should be searched through early haemocultures before antibiotherapy. in case of long lasting fever, endocarditis, meningo-encephalitis, localised infections on children. pregnant women, diabetic persons, and people infected with HIV and some others presenting immunity troubles.
Subject(s)
Listeriosis/diagnosis , Aged , Hospitals , Humans , Male , Middle Aged , SenegalABSTRACT
The Senegalese army has acquired extensive experience in malaria prophylaxis in Sub-Saharan Africa. Until the early 90s, chloroquine-based drug prophylaxis was routinely administered during the transmission season. Currently this policy has been abandoned inside the country in favor of early treatment of infection. This change was made possible by the presence of qualified staff in all barracks. For extraterritorial interventions in Sub-Saharan Africa, drug prophylaxis is still used since most of the Senegalese population lives in the Sahelian zone without immunity to malaria and most host countries are in areas of high transmission. Treatment protocols have been defined in function of Plasmodium drug sensitivity in each country. For all West African nations except Nigeria, the protocol involves a combination of choroquine and proguanil at a dose of 300 mg per week and 200 mg per day respectively. For Central African nations in the south and east as well as for Nigeria, either mefloquine at a dose of 250 mg per week or doxycycline at a dose of 100 mg per day are used. Although acceptance has been slow, use of impregnated bednets is now an integral part of the prevention strategy. The insecticide used inside the country is deltametrin, but other products may be used during extraterritorial operations depending on vector sensitivity in the facilities host country. Vector control by spraying of insectides in and eliminating larval deposits is also an important part of the prevention strategy used by the Senegalese army which maintains a mobile unit for that purpose.
