A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms.

BACKGROUND AND PURPOSE: Surgical clipping and endovascular treatment are commonly used in patients with unruptured intracranial aneurysms. We compared the safety and efficacy of the 2 treatments in a randomized trial. MATERIALS AND METHODS: Clipping or endovascular treatments were randomly allocated to patients with one or more 3- to 25-mm unruptured intracranial aneurysms judged treatable both ways by participating physicians. The study hypothesized that clipping would decrease the incidence of treatment failure from 13% to 4%, a composite primary outcome defined as failure of aneurysm occlusion, intracranial hemorrhage during follow-up, or residual aneurysms at 1 year, as adjudicated by a core lab. Safety outcomes included new neurologic deficits following treatment, hospitalization of >5 days, and overall morbidity and mortality (mRS > 2) at 1 year. There was no blinding. RESULTS: Two hundred ninety-one patients were enrolled from 2010 to 2020 in 7 centers. The 1-year primary outcome, ascertainable in 290/291 (99%) patients, was reached in 13/142 (9%; 95% CI, 5%-15%) patients allocated to surgery and in 28/148 (19%; 95% CI, 13%-26%) patients allocated to endovascular treatments (relative risk: 2.07; 95% CI, 1.12-3.83; P = .021). Morbidity and mortality (mRS >2) at 1 year occurred in 3/143 and 3/148 (2%; 95% CI, 1%-6%) patients allocated to surgery and endovascular treatments, respectively. Neurologic deficits (32/143, 22%; 95% CI, 16%-30% versus 19/148, 12%; 95% CI, 8%-19%; relative risk: 1.74; 95% CI, 1.04-2.92; P = .04) and hospitalizations beyond 5 days (69/143, 48%; 95% CI, 40%-56% versus 12/148, 8%; 95% CI, 5%-14%; relative risk: 0.18; 95% CI, 0.11-0.31; P < .001) were more frequent after surgery. CONCLUSIONS: Surgical clipping is more effective than endovascular treatment of unruptured intracranial aneurysms in terms of the frequency of the primary outcome of treatment failure. Results were mainly driven by angiographic results at 1 year.

African coastal camera network efforts at monitoring ocean, climate, and human impacts.

Regular and long-term monitoring of coastal areas is a prerequisite to avoiding or mitigating the impacts of climate and human-driven hazards. In Africa, where populations and infrastructures are particularly exposed to risk, there is an urgent need to establish coastal monitoring, as observations are generally scarce. Measurement campaigns and very high-resolution satellite imagery are costly, while freely available satellite observations have temporal and spatial resolutions that are not suited to capture the event scale. To address the gap, a network of low-cost, multi-variable, shore-based video camera systems has been installed along the African coasts. Here, we present this network and its principle of sharing data, methods, and results obtained, building toward the implementation of a common integrated coastal management policy between countries. Further, we list new contributions to the understanding of still poorly documented African beaches' evolution, waves, and sea level impacts. This network is a solid platform for the development of inter-disciplinary observations for resources and ecology (such as fisheries, and sargassum landing), erosion and flooding, early warning systems during extreme events, and science-based coastal infrastructure management for sustainable future coasts.

Reliability assessment and validation of the post-acne hyperpigmentation index (PAHPI) in a population from Sub-Saharan Africa in Senegal.

BACKGROUND: A post-acne hyperpigmentation index (PAHPI) has been developed in the United States to better compare therapeutic modalities. Our aim in this study was to validate the PAHPI score in patients with skin type VI from sub-Saharan Africa. PATIENTS AND METHODS: The study was conducted in Dakar, Senegal. Twenty-one patients with Fitzpatrick skin type VI, aged 17 to 55 years, presenting hyperpigmentation secondary to acne were included. Ongoing use of skin bleaching products or acne treatments was allowed. Four trained dermatologists rated the patients using the PAHPI. A narrow-band reflectance spectrophotometer (Mexameter MX-18, Cologne, Germany) was used to measure the degree of pigmentation of involved and adjacent skin on 6 representative facial lesions. RESULTS: The average inter-rater reliability (weighted Kappa) showed substantial agreement for intensity (0.67), moderate agreement for number (0.53) and fair agreement for lesion size (0.28). Inter-rater reliability for the total PAHPI was excellent for both day 1 and day 2 (interclass correlation coefficient of 0.87 and 0.85, respectively; P<0.0001). Intra-rater reliability for total PAHPI ranged from 0.83 to 0.93 (P<0.0001). PAHPI scoring thus demonstrated excellent reliability both between and within raters. The association was moderate to substantial for all raters on both days (range for rho on day 1: 0.531 to 0.815; range for rho on day 2: 0.448 0.762). The correlations between the Mexameter (Courage and Khazaka) measurements and PAHPI scores showed moderate to substantial agreement. CONCLUSION: Although tested primarily in African American women to date, PAHPI is also valid for patients from sub-Saharan Africa.

Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel.

OBJECTIVE: To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition. DESIGN: The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal. SETTING: Senegal, West Africa. PARTICIPANTS: A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study. RESULTS: Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children). CONCLUSIONS: Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study.

BACKGROUND AND PURPOSE: Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm. MATERIALS AND METHODS: In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study. RESULTS: In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (κ ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (κ > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (κ ≤ 0.6). CONCLUSIONS: The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.

Unusual extra-podal fungal mycetoma with black grains in a Senegalese child.

Mycetoma remains endemic in the tropical and subtropical regions of the "mycetoma belt" including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

[Pulmonary Metastase of a Knee Mycetoma in Senegal]. / Métastase pulmonaire d'un mycétome du genou au Sénégal.

Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.

Le mycétome se transmet principalement par piqures d'épines d'arbustes infectés. Les localisations primitives au niveau du pied sont les plus fréquentes. Les localisations pulmonaires sont exceptionnelles et secondaires à des localisations périphériques primitives. Nous rapportons un cas de localisation pulmonaire d'un mycétome fongique secondaire à une localisation au niveau du genou, puis nous faisons une revue de la littérature et nous discutons de la voie de dissémination.

[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]. / Étude des facteurs associés au retard de consultation sanitaire des victimes de viols au Sénégal.

INTRODUCTION: Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal. METHODOLOGY: A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively. RESULTS: At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]). CONCLUSION: Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

Individual exposure level following indoor and outdoor air pollution exposure in Dakar (Senegal).

The consequences of indoor and outdoor air pollution on human health are of great concern nowadays. In this study, we firstly evaluated indoor and outdoor air pollution levels (CO, CO2, NO, NO2, PM10) at an urban site in Dakar city center and at a rural site. Then, the individual exposure levels to selected pollutants and the variations in the levels of biomarkers of exposure were investigated in different groups of persons (bus drivers, traders working along the main roads and housemaids). Benzene exposure levels were higher for housemaids than for bus drivers and traders. High indoor exposure to benzene is probably due to cooking habits (cooking with charcoal), local practices (burning of incense), the use of cleaning products or solvent products which are important emitters of this compound. These results are confirmed by the values of S-PMA, which were higher in housemaids group compared to the others. Urinary 1-HOP levels were significantly higher for urban site housemaids compared to semirural district ones. Moreover, urinary levels of DNA oxidative stress damage (8-OHdG) and inflammatory (interleukin-6 and -8) biomarkers were higher in urban subjects in comparison to rural ones. The air quality measurement campaign showed that the bus interior was more polluted with PM10, CO, CO2 and NO than the market and urban or rural households. However, the interior of households showed higher concentration of VOCs than outdoor sites confirming previous observations of higher indoor individual exposure level to specific classes of pollutants.

[Recidives of Mycetoma after Amputation in Dakar (Senegal)]. / Récidives de mycétome après amputation à Dakar (Sénégal).

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

La chirurgie constitue le temps essentiel du traitement des mycétomes fongiques. Elle consiste en une amputation en cas d'atteinte osseuse. Nous avons observé 5 cas de récidives après amputation pour mycétome. Il s'agit dans tous les cas de patients présentant des mycétomes à grain noir avec atteintes osseuses. Les récidives sont survenues à moins de 18 mois de l'amputation faisant parler de reprise évolutive et posant le problème du niveau de l'amputation.

Connaissances et attitudes face à la prise en charge des maladies parodontales nécrotiques : enquête auprès des chirurgiens-dentistes de Dakar (Sénégal)

Les maladies parodontales nécrotiques nécessitent une prise en charge rapide et efficace pour ne pas compromettre le potentiel de cicatrisation du parodonte. L'objectif de ce travail était d'évaluer les connaissances et attitudes des chirurgiens dentistes de Dakar face aux maladies parodontales nécrotiques. Matériels et méthodes. Il s'agissait d'une enquête transversale descriptive concernant les chirurgiens dentistes de la région de Dakar. L'étude a inclus les chirurgiens dentistes de la région de Dakar inscrits aux tableaux de l'ONCDS de 2015 et ceux du Service de Santé des Armées. Résultats. L'échantillon était constitué de 122 dentistes sur un total de 238 soit un taux de participation de 51,26%. La majorité des praticiens (39,34%) avait une durée d'exercice comprise entre 1 à 5 ans. La formation continue était suivie par 52,45 % des dentistes. La majeure partie (73,77 %) des chirurgiens dentistes ignoraient que les maladies parodontales nécrotiques font partie de la nouvelle classification des maladies parodontales. Concernant le traitement d'urgence de ces pathologies, 91,80 % des praticiens prescrivaient systématiquement des antibiotiques, 67,21 % faisaient une détersion des lésions avec des compresses et 55,74 % pratiquaient un débridement mécanique et irrigation à la polyvidone iodée pendant la phase aigue de la maladie. Conclusion. La prise en charge des maladies parodontales nécrotiques n'est pas toujours conforme aux recommandations scientifiques actuelles. Il convient de faire de la formation continue des chirurgiens dentistes du Sénégal, un impératif éthique et légal

Épidémiologie des accidents domestiques chez l'enfant à Dakar (Sénégal)

Introduction. Ce travail avait pour but de rapporter les aspects épidémiologiques des accidents domestiques (AD) au niveau du service de chirurgie pédiatrique de l'Hôpital d'Enfants Albert Royer (HEAR) de Dakar. Matériels et méthodes. Les dossiers d'enfants victimes de traumatismes non intentionnels survenus à domicile ou dans ses abords immédiats étaient inclus. Nous avons noté l'âge et le sexe de l'enfant, le jour et l'heure de l'accident, le mécanisme de l'accident et le lieu de survenue. Nous avons aussi étudié les types de lésions occasionnées et leur siège. Résultats. On notait une prédominance masculine avec un sexe ratio de 2,21. L'âge moyen était de de 4,2 ans et les enfants âgés de moins de 5 ans étaient les plus touchés (63,4 %). Les familles avec plus de deux enfants étaient les plus concernées (67 %). L'AD survenait le plus souvent les jours ouvrables avec un pic les mercredis (18,4 %). Près de la moitié des AD (42,2 %) étaient survenues le soir entre 17 heures et 20 heures. Les alentours de la maison étaient l'endroit le plus accidentogène (18,2 %). Les types d'accidents rencontrés ont été les suivants: les traumatismes (77,6 %), les intoxications (20,4 %) et les ingestions de corps étrangers (2 %). Les lésions les plus rencontrées étaient les fractures (46 %), suivies des traumatismes cranio-encéphaliques (22,9 %), des contusions (21,3 %) et des plaies (9,8 %). Les membres pelviens étaient la partie du corps la plus touchée (51,5 %) suivis de la tête (10,6 %). Aucun cas de décès n'avait été enregistré. Conclusion. Les AD chez l'enfant sont fréquents dans notre service et surviennent essentiellement dans les abords immédiats de la maison. Les victimes sont essentiellement les garçons de moins de 5 ans. Les fractures prédominent et siègent aux membres

Does smallpox vaccination modify HIV disease progression among ART-naive people living with HIV in Africa?

We examined the association between a history of smallpox vaccination and immune activation (IA) in a population of antiretroviral therapy-naïve people living with HIV (PLHIV). A cross-sectional study was conducted in Senegal from July 2015 to March 2017. Smallpox vaccination was ascertained by the presence of smallpox vaccine scar and IA by the plasma level of ß-2-microglobulin (ß2m). The association was analysed using logistic regression and linear regression models. The study population comprised 101 PLHIV born before 1980 with a median age of 47 years (interquartile range (IQR) = 42-55); 57·4% were women. Smallpox vaccine scar was present in 65·3% and the median ß2m level was 2·59 mg/l (IQR = 2·06-3·86). After adjustment, the presence of smallpox vaccine scar was not associated with a ß2m level ⩾2·59 mg/l (adjusted odds ratio 0·94; 95% confidence interval 0·32-2·77). This result was confirmed by the linear regression model. Our study does not find any association between the presence of smallpox vaccine scar and the ß2m level and does not support any association between a previous smallpox vaccination and HIV disease progression. In this study, IA is not a significant determinant of the reported non-targeted effect of smallpox vaccination in PLHIV.

Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

[Non-antiretroviral drugs uses among HIV-infected persons receiving antiretroviral therapy in Senegal: Costs and factors associated with prescription]. / Médicaments non antirétroviraux chez les personnes vivant avec le VIH sous traitement antirétroviral au Sénégal : coûts et facteurs associés à la prescription.

BACKGROUND: In addition to antiretroviral therapy, non-antiretroviral drugs are necessary for the appropriate care of people living with HIV. The costs of such drugs are totally or partially supported by the people living with HIV. We aimed to evaluate the overall costs, the costs supported by the people living with HIV and factors associated with the prescription of non-antiretroviral drugs in people living with HIV on antiretroviral therapy in Senegal. METHODS: We conducted a retrospective cohort study on 331 people living with HIV who initiated antiretroviral therapy between 2009 and 2011 and followed until March 2012. The costs of non-antiretroviral drugs were those of the national pharmacy for essential drugs; otherwise they were the lowest costs in the private pharmacies. Associated factors were identified through a logistic regression model. RESULTS: The study population was 61 % female. At baseline, 39 % of patients were classified at WHO clinical stage 3 and 40 % at WHO clinical stage 4. Median age, body mass index and CD4 cells count were 41 years, 18kg/m2 and 93 cells/µL, respectively. After a mean duration of 11.4 months of antiretroviral therapy, 85 % of patients received at least one prescription for a non-antiretroviral drug. Over the entire study period, the most frequently prescribed non-antiretroviral drugs were cotrimoxazole (78.9 % of patients), iron (33.2 %), vitamins (21.1 %) and antibiotics (19.6 %). The mean cost per patient was 34 Euros and the mean cost supported per patient was 14 Euros. The most expensive drugs per treated patient were antihypertensives (168 Euros), anti-ulcer agents (12 Euros), vitamins (8.5 Euros) and antihistamines (7 Euros). The prescription for a non-antiretroviral drug was associated with advanced clinical stage (WHO clinical stage 3/4 versus stage 1/2): OR=2.25; 95 % CI=1.11-4.57 and viral type (HIV-2 versus HIV-1/HIV-1+HIV-2): OR=0.36; 95 % CI=0.14-0.89. CONCLUSION: Non-antiretroviral drugs are frequently prescribed to people living with HIV in developing countries; mainly those infected with HIV-1 and those at an advanced clinical stage. Their costs can be a barrier to appropriate care and necessary efforts must made to make them available. However, early initiation of antiretroviral therapy and the registration of some non-antiretroviral drugs on the list of essential drugs, as well as social protection systems, should reduce their use and costs.

Rare cutaneous tuberculosis in Sub-Saharan Africa developed on discoid lupus erythematous lesion.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

Syndrome d'activation macrophagique secondaire chez l'enfant. Rapport de 5 cas sénégalais

Le Syndrome d'Activation Macrophagique (SAM) est défini comme la traduction clinico-biologique d'une prolifération et d'une activation non-spécifique des macrophages du système réticulo-histiocytaire avec phagocytose des éléments figurés du sang. Nous rapportons 5 cas de SAM secondaires chez des enfants hospitalisés dans le service de pédiatrie de l'hôpital Aristide le Dantec entre août 2015 et avril 2016. Il s'agissait de 3 filles et 2 garçons âgés de 7 ans à 14 ans. Cliniquement, la fièvre, l'altération de l'état général et la splénomégalie étaient constantes. Quatre patients ont présenté des adénopathies et chez 2 patients une hépatomégalie a été retrouvée. Au niveau de l'hémogramme, l'anémie était constante, la thrombopénie et la leuco-neutropénie étaient retrouvées chez 3 patients et le frottis sanguin révélait 36% de blastes chez un patient. L'hémophagocytose médullaire était retrouvée chez tous les patients, l'hyper ferritinémie était constante et chez trois patients une hypertriglycéridémie avec un taux élevé de lactate déshydrogénase (LDH) ont été notés. Le diagnostic était surtout guidé par le médullogramme et basé sur les critères de l'hemophagocytic histiocytosis et les étiologies étaient infectieuses et néoplasiques. Chez trois patients, le SAM était d'origine infectieuse et les germes retrouvés étaient le Streptococcus, l'Escherichia coli et le Mycobacterium tuberculosis alors que les deux autres cas étaient d'origines néoplasiques secondaires à une leucémie aiguë myéloïde et à un lymphome hodgkinien. Le traitement était basé sur l'antibiothérapie (cas 1 et 2), les antituberculeux (cas 3) et la chimiothérapie (cas 4 et 5). L'évolution était favorable chez tous nos patients

Paralysie récurrentielle bilatérale : l'aryténoïdopexie est-elle toujours compétitive ?

Introduction : La Paralysie Récurrentielle (PR) bilatérale en adduction est une situation clinique dramatique. Le traitement repose sur la chirurgie par voie endoscopique couplée au laser. Ce procédé thérapeutique est inaccessible dans beaucoup de pays en développement. La chirurgie par voie externe peut-elle constituer une alternative ? Matériel et méthodes : Nous avons mené une étude rétrospective portant sur 20 patients, porteurs d'une PR bilatérale en adduction post-thyroïdectomie, sur une période de 12 ans. Tous les malades ont été traités par abord chirurgical cervical externe. L'appréciation des résultats se faisait sur la possibilité de décanulation et la qualité de la voix.Résultats : Tous les malades étaient de sexe féminin avec un âge moyen de 43 ans. La PR était une complication de la thyroïdectomie totale dans 85% des cas et subtotale dans 15% des cas. L'abord latéral du larynx nous a permis de réaliser 16 aryténoïdopexies selon King et 2 aryténoïdectomies associées à une cordopexie selon Graaf Woodman. L'abord antérieur par thyrotomie, effectué dans 4 cas, a permis de réaliser une aryténoïdectomie dans 1 cas et une cordo-aryténoïdectomie dans 3 cas. La décanulation a été effective chez tous les malades après un délai moyen de 30 jours. Après analyse perceptuelle, chez 11 patients, la qualité de la voix était jugée bonne dans 4cas (36.63%), passable dans 2 (18.18%) et mauvaise dans 5 (45.46%).Conclusion : Nos résultats sont satisfaisants et comparables à ceux des séries des pays développés, usant des procédés endoscopiques au laser

Monitoring CO2 invasion processes at the pore scale using geological labs on chip.

In order to investigate at the pore scale the mechanisms involved during CO2 injection in a water saturated pore network, a series of displacement experiments is reported using high pressure micromodels (geological labs on chip - GLoCs) working under real geological conditions (25 < T (°C) < 75 and 4.5 < p (MPa) < 8). The experiments were focused on the influence of three experimental parameters: (i) the p, T conditions, (ii) the injection flow rates and (iii) the pore network characteristics. By using on-chip optical characterization and imaging approaches, the CO2 saturation curves as a function of either time or the number of pore volume injected were determined. Three main mechanisms were observed during CO2 injection, namely, invasion, percolation and drying, which are discussed in this paper. Interestingly, besides conventional mechanisms, two counterintuitive situations were observed during the invasion and drying processes.

[Surgery in black grain mycetoma: about 44 patients treated at aristide le dantec hospital (Dakar, Senegal) from December 2008 to March 2013]. / Chirurgie des mycétomes fongiques à grain noir. À propos de 44 patients pris en charge à l'Hôpital Aristide le Dantec de Dakar (Sénégal) de décembre 2008 à mars 2013.

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.