[Changes in malaria prevalence and management of fevers from 2000 to 2012 in Casamance, Senegal]. / Évolution de la prévalence du paludisme et de la prise en charge des fièvres de 2000 et 2012 en Casamance, Sénégal.

Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.

Localized fluidization in a granular medium.

We present here experimental results on the progressive development of a fluidized zone in a bed of grains, immersed in a liquid, under the effect of a localized upward flow injected through a small orifice at the bottom of the bed. Visualization inside the model granular medium consisting of glass beads is made possible by the combined use of two optical techniques: refractive index matching between the liquid and the beads and planar laser-induced fluorescence. Gradually increasing the injection rate, three regimes are successively observed: static bed, fluidized cavity that does not open to the upper surface of the granular bed, and finally fluidization over the entire height of the granular bed inside a fluidized chimney. The phase diagram is plotted and partially interpreted using a model previously developed by Zoueshtiagh and Merlen [F. Zoueshtiagh and A. Merlen, Phys. Rev. E 75, 053613 (2007)]. A typical sequence, where the flow rate is first increased and then decreased back to zero, reveals a strong hysteretic behavior since the stability of the fluidized cavity is considerably strengthened during the defluidization phase. This effect can be explained by the formation of force arches within the granular packing when the chimney closes up at the top of the bed. A study of the expansion rate of the fluidized cavity was also conducted as well as the analysis of the interaction between two injection orifices with respect to their spacing.

[Tuberculosis in elderly persons]. / Tuberculose du sujet âgé

OBJECTIVES: The purpose of this study was to compare the epidemiology, clinical features and clinical course of primary presentations with pulmonary tuberculosis occurring in older and younger patients. PATIENTS AND METHODS: We undertook a prospective, comparative study in the Pneumology clinic of the National University Hospital of Fann in Dakar, from April 1, 2005 to March 31, 2006, collecting data on all patients presenting with a first episode of bacterially confirmed pulmonary tuberculosis. RESULTS: We studied 187 first presentations with confirmed pulmonary tuberculosis including 12.8% (n=24) elderly (>55 years) subjects (20 men and four women) and 87.2% (n=163) younger subjects (105 men and 58 women). In the older subjects, patients were more commonly men (sex-ratio: 5), without formal education, and working in the primary or informal sector. Comorbidities were more frequent in the older group, including smoking (P=0.002), alcohol consumption (P=0.01), diabetes (37.5%) (P<0.005) and obesity with BMI superior than 20 in 25%. Pulmonary shadowing was common (41.7% of the cases), P=0.008 and generally bilateral P=0.0001 with cavitation, but this observation was not statistically significant. COMPLICATIONS: Complications were more frequent in the older patient (20.8%), as was mortality (29.3%, P=0.000) and rate of clinical improvement in response to treatment was less satisfactory (50%) there.

Dosing accuracy of artesunate and amodiaquine as treatment for falciparum malaria in Casamance, Senegal.

OBJECTIVES: Several products of artesunate plus amodiaquine (AS + AQ) are being deployed in malaria-endemic countries for treating uncomplicated falciparum malaria but dosing accuracy and consequential effects on efficacy and tolerability have not been examined. METHODS: Patients with parasitologically confirmed, uncomplicated falciparum malaria were treated and followed by research teams or local health centre staff in Casamance, Senegal. AS + AQ was given as: (i) loose combination (AS 50 mg, AQ 200 mg), dosed on body weight, or (ii) co-blistered product (AS 50 mg, AQ 153 mg) dosed by weight or age. Target doses were: (i) AS 4 (2-10) mg/kg/day and (ii) AQ 10 (7.5-15) mg/kg/day. Patients receiving therapeutic doses defined dosing accuracy. Treatment-emergent signs and symptoms (TESS) were recorded. RESULTS: A total of 3277 patients were treated with loose (n = 1972, weight-dosed) or co-blistered (n = 1305, 962 age-dosed, 343 weight-dosed) AS + AQ by the research team (n = 966) or clinic staff (n = 2311). AS was dosed correctly in >99% with all regimens. Loose AQ by weight was 98% correct. The co-blister AQ overdosed 18% of patients when dosed by age and underdosed 13% by weight. Low weight was an independent risk factor for overdosing. The co-blister had significantly more TESS than the loose product [117/1305 (9%) vs. 41/1972 (2%), relative risk = 4.3 (95% CI: 3.0-6.1, P < 0.0001)]. Age-based dosing accounted for the difference. TESS occurred mostly within one day (72%) and were mild or moderate (75%). CONCLUSION: Artesunate is easier to dose than AQ. Currently available age-dosed, co-blistered AS + AQ tends to overdose AQ and is less well tolerated than loose tablets. It is not the optimal presentation of AS + AQ.

[Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. / Apport de l'échographie dans la prise en charge de la ténosynovite de de Quervain: à propos de 22 cas.

PURPOSE: To assess the role of US in the management of de Quervain's tenosynovitis. MATERIALS AND METHODS: Using a high-frequency transducer (12 MHz), sagittal and axial images were obtained of the first extensor compartment. The US features of 22 symptomatic patients were reviewed (positive Finkelstein's maneuver). RESULTS: US findings included tendon thickening and synovial sheath thickening with peritendinous edematous changes resulting in a peritendinous hypoecoic halo in all patients. An intertendinous septum was identified in two patients. CONCLUSION: US can confirm the suspected diagnosis and provide follow-up of lesions. It can confirm the presence of an intertendinous septum and provide guidance at the time of steroid injection. It can increase the rate of conservative management by demonstrating the absence of septum.

[Congenital absence of the patella: two cases reported]. / Absence congenitale de rotules: à propos de deux cas.

OBJECTIVES: To remind a rare disease, To emphasize the importance of patellar agenesis because it's a calling sign, To insist on the necessity to know child bony growth. MATERIALS AND METHODS: We reported observations of two negro-african children's, one female and one male, who were both 7-years-old. They were referred for troubles of the walk, knee pains for the male, and for the female frequent falls and hypotonia. We have noted previous history of second degree familial consanguinity and paternal grandfather's ungueal anomalies for the female. RESULTS: For the female, examination showed ligamentary hyperlaxity, anterior flattening and lateral dimple of the knee, so varied skeletal defects. Skeletal radiographies displayed absence of the patella, "console like" aspect of the superior tibial metaphysis. At the male, examination is normal. Standard radiographies showed semilunar opacities and tomodensitometry showed presence of a tissular formation who looks like the patella. Aplasia of the patellar apparatus is evocated for the female, even though for the male, the diagnosis of hypoplasia seems more probable. CONCLUSION: Absence of patella is rare. It can be transient and patellar nucleus appears lately. It can be permanent and in this case, it is isolated whether associated with other osseous malformations. Interest of such observations is in its rarity and its functional impact related to the biomechanical importance of the patella.

[Tuberculosis and diabetes]. / Tuberculose et diabète.

INTRODUCTION: We performed a retrospective case control study for the period between 1st January 1999 and 31st August 2004, comparing the radiological appearances of tuberculosis in 100 diabetics to those in patients matched for age and sex, with pulmonary TB alone presenting to The Chest clinic of the National Hospital of Fann. METHODS AND RESULTS: Diabetes was present in 4.7% of the 2116 patients hospitalized for pulmonary tuberculosis during the period of study and occurred more commonly in men (60%) with an average age of 51 years (73%). 82% had type II, non-insulin dependent diabetes. The various types of radiological lesions classically described in tuberculosis were found in nearly identical proportions in the two groups of patients, with parenchymal shadowing the most frequent appearance in both diabetics (N=86) and controls (N=88). Cavitation occurred significantly less frequently in diabetics (72%) than controls (88%) (p=0.04). Where radiological abnormalities were bilateral, they were worse on the left in the diabetics (27% versus 15% in controls). There was a trend for basal lesions to occur more frequently in diabetics (15%) than controls (3%) (p=0.06). CONCLUSION: Mortality was higher in diabetics (18%) than controls (6%), with death generally occurring within the first 24 hours of hospitalization.

[Infantile cortical hyperostosis: case report]. / Hyperostose Corticale Infantile : a propos d'un cas.

Infantile cortical hyperostosis (ICH) or Caffey-Silverman disease is affection that attained skeleton most frequently flat bones, contiguous fasciae and muscles. We reported the case of a 3 months old female infant of Mauritanian origin, referred for recurrent osteitis of the left clavicle. The present complaints are incessant snivelling and functional disability of the left upper limb. Examination showed clavicular and mandibular swelling, without fever. Biological check-up showed inflammatory signs. Radiographies showed cortical thickening of the left clavicle and mandible. Interest of such an observation is in the rarity of this affection, its originality as for the striking age limitation, in the disconcerting but suggestive symptomatology, at least in the classical sites and in the possibility of its antenatal diagnosis.

Access to medicines in Senegal: results of a sample survey.

The survey was conducted in Senegal in April 2001 on a representative sample of providers and clients. Results show that access to medicines in Senegal was limited for three main reasons: (1) the supply of drugs was inadequate, and even critical drugs were often missing in health centres, and were somewhat less in pharmacies; (2) the health infrastructures appeared insufficient to cover the needs of the whole population, creating high opportunity costs; (3) the cost of the drugs prescribed was higher than the minimum price, sometimes exceeding the capacity of poorer people, although high cost was seldom reported as the main reason for not acquiring prescribed drugs. Improving access to medicine is a priority to help reduce health inequalities in developing countries.

[Syndrome of "Coup de fouet". A case description and literature review]. / Syndrome du "Coup de Fouet" syndrome d'un cas et revue de la litterature.

The authors bring back the observation of a 48-year-old woman having induced a big painful left calf. The dread os a thrombophlebitis drew away the strarting of an anticoagulative treatment. This treatment was later supended in front of the putting in an a bvious place in echo-Doppler of a haematoma of the calf linked to a normal side of venous fluxes. This table made recall a syndrome of "coup de fouet". It is about a desease characterised by the unpromted rupture of a deep vein of the calf accomplishing a haematoma. It happens in repose or in step as at our patient. It posed a problem of differential diagnosis with a thrombophlebitis of lower limb. Evolution was favourable under treatment linking pause, an anti inflammatory and the haematoma paracentesis under echographique guidance .

[Sonographic evaluation of periportal fibrosis in children living in a Schistosoma mansoni endemic region]. / Fibrose périportale chez les enfants en zone d'endémie à Schistosoma mansoni: évaluation échographique.

PURPOSE: To assess with ultrasound periportal fibrosis due to chronic Schistosoma mansoni infection in children living in an endemic region. Materials and methods. A total of 441 children underwent two stool examinations and abdominal sonography. Liver echotexture was assessed by two observers and compared to pre-defined image patterns and a fibrosis score was assigned ranging from 0 to 8. Ultrasound features were correlated to age, sex, and parasitologic findings. RESULTS: Prevalence of Schistosoma mansoni infestation was 63%. Two cases of advanced fibrosis (E pattern or fibrosis score of 6) were observed. Fibrosis correlated with age. No correlation existed between fibrosis and intensity of egg-output. A correlation between the two examinors was noted in 84% of examinations with a kappa coefficient of 0.7. CONCLUSION: Although severe periportal fibrosis is a rare finding in this endemic region, follow-up sonography must be performed because it is the only non invasive and reliable tool for detection of periportal fibrosis.

[Spiral CT in aortic dissection]. / Place de l'angioscanner dans le diagnostic de la dissection aortique.

Patients with suspected dissection of the thoracic aorta require immediate diagnostic evaluation so that urgent therapeutic interventions can begin. Two women with suspected aortic dissection and one man with abdominal aortic aneurysm underwent color-flow Doppler echocardiography and CT angiography with multiplanar reconstructions. Spiral CT showed ascending aortic dissection (type A Stanford) in two cases and descending aortic dissection (type B Stanford) in one case. It also access the visualization of the intimal flap, the extent of dissection, the size of the aorta, and the presence of pericardial fluid. CT angiography is an accurate diagnostic procedure for patients with suspected aortic dissection and possesses several advantages over other modalities such as transthoracic echocardiography, transesophageal echocardiography and aortography.

Place de l'angioscanner dans le diagnostic de la dissection aortique

La dissection aigue de l'aorte thoracique est une urgence thérapeutique. L'imagerie doit rapidement poser le diagnostic et faire le bilan d'extension. Le but de ce travail est de montrer l'intérêt de l'angioscanner dans le diagnostic de DA à parti de 3 observations. Deux femmes de 40, 43 ans adressées pour dissection aortique thoracique et 1 homme de 60 ans pour anévrysme aorte abdominale ont bénéficié d'une échographie cardiaque et d'un angio-scanner de l'aorte thoraco-abdominale suivi de reconstructions multiplans. La TMD a permis de montrer une dissection de l'aorte ascendante dans 2 cas (stade A de Stanford) et de l'aorte abdominale dans 1 cas (stade B de Stanford) L'angioscanner a visualisé la membrane intimale décollée, précisé l'extension de la dissection, chiffré l'ectasie aortique dans les 3 cas et a monté des signes de gravité à type d'épanchement péricardique. L'angioscanner constitut une alternative fiable dans le diagnostic de DA. Elle est plus sensible que l'échographie transthoracique, moins opérateur dépendant que l'échographie transoesophagienne et plus facile à réaliser qu'une aortographie

[Antiparasitic effect of Senegalese Annonaceae used in traditional medicine]. / Activités antiparasitaires d'Annonaceae du Sénégal utilisées en médecine traditionnelle.

Annonaceae is a large family of plants widely used in alimentation and traditional medicine. The interest of their study is raised up by the presence of biologically active substances among that the acetogenins which are specific to them. In Senegal, three species are widely used in traditional medicine for various indications and particularly in parasitic diseases: Annona senegalensis, Uvaria chamae and Xylopia aethiopica. The study of antiparasitical extracts from various organs showed an interesting activity of the fruits and leaves of Xylopia aethiopica on Leishmania donovani, the stem barks and roots of Uvaria chamae on Trypanosomia brucei and the roots of Annona senegalensis on the chloroquino-resistant strain of Plasmodium falciparum. Bioguided fractionation of the active extracts led to isolate Annonaceous acetogenins. Therefore, thirteen acetogenins, from the roots of Uvaria chamae and Annona senegalensis, were identified. The presence of acetogenins, substances with antiparasitical activity, could partly explain the biological proprieties of these various drugs.

[Chronical renal failure in one Dakar Hospital Department]. / L'insuffisance rénale chronique dans un service hospitalier dakarois.

Chronic renal failure (CRF) is a polymorphic disease whose management need frequently multiple drugs administration and multidisciplinary approach. Thirteen years after the beginning of haemodialysis treatment in Senegal, we aimed to evaluate the management of chronic renal failure in Dakar University Hospital Internal Medicine Department. We analysed retrospectively 243 CRF in patients managed during the last three years in this department. Most of these patients (43.6%) were under 46 years old. The sex ratio (M/F) was 1.31. The clinical symptoms were distributed as follow: high blood pressure (85.6%), anorexia (61.73%), anaemia (83.9%) and pruritus (12.3%). More than one third (37.04%) of patients had a clearance of creatinine under 10 ml/mn, at the diagnosis, and therefore required chronic haemodialysis. Only 8.23% of cases had the opportunity to get a medical treatment. Five machines ware available at this unity). The deficience of dialysis and nephrology personal is obvious in our practice. The majority of CRF patients can not afford the treatment cost. Therefore, medical training, prevention and screening of renal diseases seem to be the best way to solve this public health problem in developing countries.

[Commissural agenesis associated with inter hemispheric cyst]. / Agénesie commisurale associée a un kyste inter hemisphérique.

The Objectives of this study were to Report a rare malformation and to try to understand the embryological origin of such lesion. We reported the case of an eight-month-old female infant, without any particular past medical history, who was refered for seizures and vomiting. The examination revealed normal anthropometric constants, a soft painless and renitent tumefaction of the vertex and a psychomotor delay. Skull x-ray showed a parietal lacuna opposite to an opacity. Ultrasound scan showed an encephalocystocele communicating with dilated ventricles. CT x-ray revealed a single ventricle with an important back and upper extension, which evokes a cystic formation of the centre line. The existence of this cystic formation suppose an agenesis of diencephalic and telencephalic structures notably commissural. Interest of such observation is in its rarity, its complexity, the possibility of its antenatal diagnosis and in the etiopathogenic discussions that she gives rise to.