[Contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis]. / Apport du test Xpert MTB/Rif dans le diagnostic de la tuberculose toute forme a Saint-Louis.

INTRODUCTION: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. MATERIALS AND METHOD: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. CONCLUSION: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.

INTRODUCTION: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. MATÉRIELS ET MÉTHODE: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. RÉSULTATS: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. CONCLUSION: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

Sequelae of thoracic tuberculosis: manifestations and patients'quality of life.

For many patients, a history of tuberculosis is synonymous with disabling sequelae, impaired quality of life, and high morbidity and mortality. This retrospective study reviewed the files of patients hospitalized for sequelae of thoracic tuberculosis during 2017, to assess its various manifestations and their impact on quality of life. Of the 176 patients included, 75 % were aged from 35 to 65 years. They were predominantly male, with a sex ratio of 3.76. The socioeconomic level was mostly low (70 %). Only one episode of tuberculosis sufficed to cause sequelae in 89.8 % of cases. Smoking was often noted (52.3 %). Functional signs were dominated by coughs (90.3 %) and dyspnea (72.7 %). Pulmonary sequelae with fibrous scarring were observed in 52.2 % of the patients. Bacterial and/or viral superinfection was the leading cause of hospitalization (50 %). The death rate during hospitalization was 19 %. An improvement followed by discharge was observed for 81 %, 14.2 % of them with chronic respiratory insufficiency. In all, 13.28 % of the discharged patients died within the 6 months that followed. The sequelae of thoracic tuberculosis should be considered as long-term chronic conditions and deserve the same treatment.

[Epidemiological, Clinical And Radiological Profile Of Positive Microscopy Pulmonary Tuberculosis (PMPT) At The Regional University Hospital Of Saint-Louis]. / Profil Epidemiologique, Clinique Et Radiologique De La Tuberculose Pulmonaire A Microscopiepositive (TPM+) Au Centre Hospitalier Regional Universitaire De Saint-Louis (CHRU SL).

Pulmonary tuberculosis is still a global scourge, especially in developing countries, despite the control measures that have been in place for decades. The aim of this work was to describe the epidemiological, clinical radiological and evolutionary aspects of PMPT at the Saint-Louis Regional Hospital Center. This was a retrospective descriptive study on 191 PMPT files, hospitalized in the medical department from January 1, 2016 to December 31, 2017. PATIENTS AND METHOD: Were included in the study, all cases of pulmonary tuberculosis proved by the presence of bacillus Koch on direct examination of sputum. Were excluded from the study, cases of pulmonary tuberculosis with negative microscopy and cases of pulmonary tuberculosis in patients younger than 14 years. RESULTS: Of 1417 hospitalizations, 191 patients had a PTPM. The average age was 36.5 years with extremes of 14 to 81 years. The sex ratio was 2.2 in favor the male. Fishermen were the most affected with 34% of cases. A family tuberculosis was noted in 61 patients. One hundred and forty-six new PMPT cases were noted. CONCLUSION: Positive microscopy pulmonary tuberculosis remains a public health problem in Senegal. Much work remains to be done in Saint-Louis, which a region with a high burden of tuberculosis.

INTRODUCTION: la tuberculose pulmonaire demeure encore un fléau mondial en progression surtout dans les pays en voie de développement, malgré les actions de lutte mises en place depuis des décennies. Le but de ce travail était de décrire les aspects épidémiologiques, cliniques radiologiques et évolutifs de la TPM (+) au centre hospitalier régional de Saint-Louis. Il s'agissait d'étude descriptive rétrospective portant sur 191 dossiers de TPM+, hospitalisés au service de médecine du 1er Janvier 2016 au 31 Décembre 2017. Étaient inclus dans l'étude, tous les cas de TPM+ prouvée par la présence de BAAR à l'examen direct des crachats. Étaient exclus de l'étude les patients de moins de 14 ans, les cas de TPM(-) Résultats : Sur 1417 hospitalisations, 191 patients avaient une TPM+. L'âge moyen était de 36,5 ans avec des extrêmes de 14 à 81 ans. Sex-ratio de 2,2. Les pêcheurs étaient les plus touchés avec 34 % des cas. Un contage tuberculeux familial était noté chez 61 malades. Cent quarante six nouveaux cas de TPM(+) ont été notés. Conclusion : la TPM(+) demeure un problème de Santé Publique au Sénégal. Beaucoup d'efforts restent à faire dans la région de Saint-Louis à forte charge de tuberculose.

[Trans-vocal cord prostheses - preliminary experience treating benign laryngotracheal stenosis in adults]. / Sténoses laryngotrachéales bénignes de l'adulte : place des prothèses transcordales. Expérience préliminaire.

INTRODUCTION: Benign laryngotracheal stenosis is a rare pathology with multiple etiologies, the management of which is complex. This is because of the configuration and proximity of the larynx and the difficulty with surgical approaches, which are potentially mutilating, especially for the management of a benign disease. When surgery is challenging, iterative dilatations of the stricture or the fashioning of a definitive tracheotomy are therapeutic alternatives. Advances in rigid bronchoscopy and the evolution of prosthetic silicone material allow a new approach in the management of benign laryngotracheal stenosis, by placing flexible silicone prostheses which cover all the stenosis from the arytenoids to the trachea. This preliminary work aims to evaluate the feasibility, effectiveness, tolerance and complications of the implementation of this type of prosthesis. PATIENTS AND METHODS: This is a retrospective single-centre study which analyzed the records of patients with symptomatic benign laryngotracheal stenosis who underwent placement of a transcordial prosthesis over a period of three years. The prosthesis used, inserted under general anesthesia during a rigid tube interventional bronchoscopy, was either a straight silicone prosthesis or a Montgomery T-tube for those with a pre-existing tracheotomy. RESULTS: Six patients were included. Five are still alive, one patient died from a cause unrelated to the placement of the prosthesis. Four have no tracheostomy and two now have no transcordal prosthesis. The data collected on tolerance found, for three patients, two cases of minor aspiration and one case of transient cough. All patients had whispered voice dysphonia. We did not observe prosthesis migration or obstruction. CONCLUSION: These preliminary results are encouraging. Transcordal prostheses in benign laryngotracheal stenosis have a complementary or alternative role compared to surgery with a palliative or even curative objective.

[Management of a tracheal adenoid cystic medico-surgical carcinoma]. / Prise en charge médico-chirurgicale d'un carcinome adénoïde kystique trachéal : l'union fait la force.

Adenoid cystic carcinoma or cylindroma is a rare tumor of the trachea which arises from mucous secreting cells. Its evolution and growth are slow but it is often fatal in the absence of radical treatment. The latter relies on a surgical sleeve resection of the pathological area, with a tracheo-tracheal anastomosis. Therapeutic bronchoscopy plays a crucial role in the clinical improvement of patients before surgery which will be performed under better conditions. For inoperable patients, radiotherapy has proved its efficacy, unlike conventional chemotherapy. The finding of biomarkers expressed by tumor cells could lead to target therapies. This case report illustrates the efficient combination of therapeutic bronchoscopy and surgery for the treatment of adenoid cystic carcinoma affecting central airways.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

Profil épidémiologique, clinique et radiologique de la tuberculose pulmonaire A microscopie positive (TPM+) au centre hospitalier régional universitaire de Saint-Louis (CHRU SL)

Introduction : la tuberculose pulmonaire demeure encore un fléau mondial en progression surtout dans les pays en voie de développement, malgré les actions de lutte mises en place depuis des décennies. Le but de ce travail était de décrire les aspects épidémiologiques, cliniques radiologiques et évolutifs de la TPM (+) au centre hospitalier régional de Saint-Louis. Il s'agissait d'étude descriptive rétrospective portant sur 191 dossiers deTPM+,hospitalisés au service de médecine du 1er Janvier 2016 au 31 Décembre 2017. Étaient inclus dans l'étude, tous les cas de TPM+ prouvée par la présence de BAAR à l'examen direct des crachats. Étaient exclus de l'étude les patients de moins de 14 ans, les cas de TPM(-) Résultats : Sur 1417 hospitalisations, 191 patients avaient une TPM+. L'âge moyen était de 36,5 ans avec des extrêmes de 14 à 81 ans. Sex-ratio de 2,2. Les pêcheurs étaient les plus touchés avec 34 % des cas. Un contage tuberculeux familial était noté chez 61 malades. Cent quarante six nouveaux cas de TPM(+) ont été notés. Conclusion : la TPM(+) demeure un problème de Santé Publique au Sénégal. Beaucoup d'efforts restent à faire dans la région de Saint-Louis à forte charge de tuberculose

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

[Contribution of the Xpert MTB/RIF to the etiological diagnosis of tuberculous pleurisy]. / Apport de l'Xpert MTB/RIF dans le diagnostic étiologique des pleurésies tuberculeuses.

INTRODUCTION: Performance of the Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in pleural liquid is poorly described. The aim of this study was to determine its usefulness for the etiological diagnosis of a tuberculous pleurisy. PATIENTS AND METHOD: We performed a descriptive cross-sectional study, with analytical design, including all the patients having a unilateral serofibrinous pleurisy, exudative, lymphocytic, and sterile. The diagnosis of pleural tuberculosis was considered based on epidemiological, clinical, paraclinical and therapeutic arguments. The Xpert MTB/RIF of the pleural fluid was carried out among all patients. RESULTS: Pleural tuberculosis was confirmed in 301 patients. The median age was 32years. Our study has included 217 men (72.1%) with a final sex ratio of 2.6. The cost of the pleural biopsy coupled with histology made it practicable in only 90 patients (29.9%) with a yield of 80%. The Xpert MTB/RIF of the pleural liquid was positive in only 10 patients (3.3% of the cases). CONCLUSION: Gene amplification by Xpert MTB/RIF of the pleural liquid is much less effective in establishing the diagnosis of tuberculous pleurisy than pleural biopsy, which remains the gold standard.

[Contribution of fiberoptic bronchoscopy in the diagnosis of pulmonary dragging]. / Apport de la fibroscopie bronchique dans le diagnostic des pneumopathies traînantes.

INTRODUCTION: Bronchoscopy is recommended into the exploration of chronic lung diseases. This one is expensive and invasive. We conducted this study in order to assess the benefit of the bronchoscopy in the etiologic diagnosis of chronic lung diseases. PATIENTS AND METHODS: This study was retrospective, descriptive and analytical, using medical records of outpatients and in patients who has done the bronchoscopy in Pneumology Clinic, Fann hospital, Dakar from January 2010 to December 2014. RESULTS: We have reported 159 cases. The sex ratio was 2.2. Middle age was 44 years. Fever was found in 32.7%. Alveolar syndrome was found in 64.8%. The white blood cells (WBC) were normal in 80.7%. Bronchoscopy was contributive in 74.1%. Specimen analysis isolated banals germs in 69.2%, mainly bacteria in 51.6%. Parasitology of the fluid of broncho-alveolar lavage was positive in 28.6%. CONCLUSION: Bronchoscopy stills a use full exploration while diagnosing chronic lung diseases. It should be systematic in chronic lung diseases with or not fever, this, when sputum microscopy a sputum PCR are negative.

[Prevalence of tobacco smoking in primary and secondary schools in the Department of Dakar, Senegal]. / Prévalence du tabagisme dans l'enseignement moyen et secondaire dans le Département de Dakar, Sénégal.

INTRODUCTION: Tobacco smoke is a global health problem, and the largest avoidable cause of death in the world. The objective of our study was to determine the prevalence of tobacco smoking in schools in Dakar area (Senegal). MATERIEL AND METHODS: This descriptive and analytical cross-sectional study was performed from September 2011 to June 2012 in 27 schools of the Dakar area. RESULTS: We questioned 1654 students over a 9-month school period. The mean age was 15±2.5years (range 11-22). The sample included 848 boys (51.3 %), therefore a sex ratio of 1.05. There were 68 smokers (4.1 %) and 60 ex-smokers (3.6 %). The mean age of the smokers was 16.9±2.2years (range 11-22) with a male preponderance of 70.6 % (n=48). Smoking in family members was the initiating factor most frequently reported by smokers (25 %). The average age of ex-smokers was 16.4±2years. Fear of parents' reactions was the most frequently invoked reason for stopping smoking (41.7 %). CONCLUSION: This study confirms the reality of smoking among school children in Senegal and highlights the urgency of the installation of a prevention policy near the young people.

[Smoking among health workers at four large hospitals in Dakar (Senegal)]. / Le tabagisme chez le personnel médical et paramédical dans quatre grands hôpitaux de Dakar.

INTRODUCTION: The addiction to tobacco remains a significant problem in the context of medical practice in African in general and in Senegal in particular. It is an important cause of morbidity and mortality. The main purposes of this study were to establish the smoking habits of hospital staff as a step towards elaborating a strategy for an anti-smoking campaign within the hospital environment. PATIENTS AND METHOD: The study was a cross-sectional, prospective, descriptive going study conducted between 1st March 2007 and May 15th, 2008. We recovered 662 out of 750 questionnaires collected representing a 75% participation rate. RESULTS: Eighty-five respondents reported that they were smokers (12.8%). The sex-ratio was 7.5 times more common in men. The paramedical staff were more likely to smoke than doctors (14% versus 12.2%). The average age of the smokers was of 37.4 years. Women had begun to smoke at an earlier age (17.4 years against 20.5 years). According to the Fagerström test, 87% were averagely or strongly dependent on nicotine. It was mainly the pleasure (41.2%) and the influence of their circle of acquaintances (36.5%) that prompted the staff to smoke. Smoking cessation was most commonly achieved through the use of willpower alone (44.4%). CONCLUSION: The mortality and morbidity arising from the addiction to smoking is entirely avoidable in contrast to other pandemics. Consequently, engagement in the fight against smoking must constitute a major priority for health workers who must set an example for their patients.

[Miliary tuberculosis: a report of 49 cases]. / Miliaire tuberculeuse: à propos de 49 cas.

INTRODUCTION: Miliary tuberculosis is a severe, acute form of tuberculosis due to lymphohaematogenous dissemination of tubercle bacilli from a focal lesion. PATIENTS AND METHODS: A prospective study of was undertaken at the Pneumology Clinic of the National University Hospital Centre (CHUN) of Fann, over a period of 30 months (January 2007-June 2009), in order to assess the epidemiological, clinical, paraclinical and evolutionary aspects of miliary tuberculosis. RESULTS: Miliary tuberculosis accounted for 3.8% (n=49) of all diagnosed cases of tuberculosis. The sex-ratio was 1.7. The average age of patients was 37.5 years with a range of 15 to 70 years. The typical radiological appearances were present in 88% of cases whereas only 10% were positive on direct smear. HIV serology was positive in 29%. In the hospital environment, the mortality was 12.2%. CONCLUSION: Miliary tuberculosis is a severe form of the disease. The prognosis depends on early diagnosis and treatment.

[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.

[Smoking among students at the School of Health and Social Development and the Health Service Institute in Senegal]. / Le tabagisme chez les élèves de l'Ecole de Développement Sanitaire et Social et de l'Institut Santé Service.

We have undertaken a transverse study of smoking among students at the National School of Health and Social Development (ENDSS) and the Health Service Institute (ISS) in Senegal. 683 out of 1142 students were questioned. 609 (89%) replied, of whom 313 (52%) were at the ENDSS and 293 (48%) at the ISS. Senior technical students were most strongly represented at 37.8%, followed by student nurses (27.4%) and midwifery students (23.3%). There were more women (n=378) than men with a sex ratio of 0.61. The average age of the population was 27.5 +/- 6.8 years (range 15 to 58). The average age was 26.2 +/- 5.6 years in the women and 29.6 +/- 8 in the men. The group aged 25-34 was significantly the most affected in both men and women (p=0.0000). The population comprised 502 non-smokers (82.4%), 62 ex-smokers (10.2%) and 45 smokers (7.4%).We found variable alcohol consumption in 119 subjects (19.2%) and 5 students admitted using cannabis. The 62 ex-smokers made up 10.2% of the population. The average age was 31.4 years. 25 ex-smokers (40.3%) drank alcohol, with a sex ratio of 1.95. The reasons for stopping smoking were illness and guilt in 27.4% of cases respectively, economic in 24.2%, medical statements on the effects of smoking on health in 17.7% and personal wishes in only 11.3%. The smokers, numbering 45 (7.4%), had an average age of 27.6 +/- 6.6 years with a sex ratio of 2 (p=0.00000). The age of starting smoking was 20.7 +/- 4.2 years for the women and 19.9 +/- 2.9 years for the men. The latter had smoked for an average of 9.2 years. Cigarettes were used by the great majority of smokers. It was associated with alcohol consumption in 35.6% and cannabis in 11.1% of cases. In the men the motives for starting smoking were stress (60%), pleasure (55.2%) and social influence (53.3%). By contrast, among the women, the two main reasons were stress and fashion in 60% (p=0.04). Our students smoked mostly in public places and in their homes. 34 smokers (75.6%) wished to stop (p=0.02) but only 27 of them expressed the need for medical or psychological support to do this. Dependence, quantified by the Fagerström Score, was medium (score 5-6) in 60% (n=27) and strong (score 7-10) in 31.1% (n=14).The estimated monthly cost of smoking increased with the degree of dependence. It was, on average, 12,143 F CFA (18.5euro) in cases of high dependence, representing 37% of the minimum wage in Senegal which is 33000F CFA (50euro). The students understood well the diseases caused by smoking (whether they were smokers, ex-smokers or non-smokers). These comprise mainly pulmonary diseases (96.2%) and cardio-vascular diseases (78.3%) All the recommended methods of the fight against smoking presented in the media, the publicity, national anti-smoking campaigns, personal contact and consultation, received more than 60% of favourable opinions among the total population studied.

[Clinical, biological and radiological spectrum of newly diagnosed pulmonary tuberculosis]. / Profil clinique, biologique et radiologique des nouveaux cas de tuberculose pulmonaire au Centre Hospitalier Universitaire de Fann-Dakar.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.

[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.

[Familial tuberculosis: tracing the contacts of an infectious case]. / Tuberculose familiale: dépistage parmi les sujets contacts autour d'un cas index contagieux.

INTRODUCTION: This is a prospective study of 30 cases of smear positive pulmonary tuberculosis, with at least two sputum positive members of the family, seen in the respiratory clinic between January 2003 and June 2004. METHODS: They constitute the index cases who represent 3.5% of the cases of tuberculosis (n=850) and 2.9% of hospital admissions (n=1034) during the same period. Four patients were HIV positive. In the family circle, all contacts received an intradermal tuberculin test (IDTT) of 10 IU and/or a chest x-ray and/or sputum examination for AFB. RESULTS: Of the 601 contacts 359 (60%) had a positive IDTT with a mean diameter of 13 mm. Active pulmonary tuberculosis was found in 16 contacts giving a prevalence of 2.7% and an incidence of 4.5% (16/359). 67% of the contacts were adults aged 16-87 with a mean age of 35 years. The IDTT was positive with a mean diameter of 12.3 mm. The chest x-ray was abnormal in 40 adults (16.7%) and sputum examination confirmed pulmonary tuberculosis in 14 cases. 33% of the contacts were children (n=119) aged from 3 months to 15 years with the majority (85%) aged under 10. The IDTT was positive with a mean diameter of 12 mm and the chest x-ray was abnormal in 22 cases (18.5%). Two children of 15 years had active tuberculosis. CONCLUSION: The contacts identified were treated according to the tuberculosis protocol of Senegal (2RHEZ/6EH) with the intensive phase dispensed in hospital. It is of major importance therefore to develop effective strategies of information, education, diagnosis and management for cases of infectious pulmonary tuberculosis.

[Knowledge of the risks of smoking in patients admitted to a respiratory clinic in Senegal]. / Connaissances des risques liés au tabagisme chez des patients hospitalisés à la Clinique de Pneumologie du CHN de Fann de Dakar.

INTRODUCTION: Tobacco smoking is truly a modern plague. The WHO estimates that there are 1.3 billion smokers worldwide, about a third of the world's population. In various studies in Senegal the prevalence of smoking has varied between 16 and 36%. The risks associated with smoking are well established. However it is also well established that 'knowledge of risks alone is not sufficient to modify behaviour.' We undertook a study to assess knowledge of the risks of smoking among patients admitted to The Pulmonology Clinic of the Centre Hospitalier National de Fann de Dakar. PATIENTS AND METHODS: All patients admitted to the clinic between 1st December 2003 and 31st May 2004 were enrolled into this prospective, cross-sectional study. A questionnaire in French was administered together with the Fagerstrom test of clinical addiction. RESULTS: Of 343 patients admitted 75 (22%) were smokers. Only 2 (2.6%) of the smokers were female. As in previous studies, smoking was associated with social disadvantage. 34.7% of smokers had attended school to primary level only and 33.3% had had no schooling at all. Mean age of starting smoking was 16 (range 9 to 38 years). The monthly cost of smoking to individuals was estimated at between 2 and 45% of the Guaranteed Minimum Wage (SMIG). 44% of smokers also consumed alcohol and 2.6% smoked cannabis. More than two thirds of patients (68%) thought that smoking caused ill health. The majority of subjects (93.3%) had stopped smoking, at least since admission, though 6.7% continued to smoke. Previous consumption was estimated as a mean of 20 pack-years. Nicotine dependence was defined as medium in 37 patients (49.3%). CONCLUSION: Certain diseases such as malaria, tuberculosis and AIDS exist at endemic levels producing considerable morbidity and mortality. We should not allow the epidemic of smoking to continue. Collective action, particularly by pneumologists is required.