[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

Dermatological emergencies in tropical zones: 189 dermatology cases in Dakar.

to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place in the two reference departments for the treatment of dermatological diseases in Dakar. We have included all patients with a dermatological emergency, regardless of age and gender, as determined by the doctor receiving the patient. The data were entered in Excel and analyzed with R software, version 3.1.2. the study included 189 patients, 40 % of all dermatology department admissions. The sex ratio was 0.89 (M/F) and the average age 49 years. The mean time from arrival to treatment was 30 minutes. Absolute emergencies accounted for 45.4 % of these emergencies, and relative emergencies 54.6 %. Absolute emergencies were dominated by severe drug eruptions (17 %) and relative emergencies by infectious dermatoses (38 %). Emergency measures were carried out in all cases, associated with etiological treatment. The mortality rate was 7 % (n=14), and 5 (36 %) of these deaths were due to severe drug eruptions. Infectious dermatoses and severe drug eruptions are the most frequent emergencies. The high mortality rate, related mostly to drug eruptions, indicates the need for early management and an adequate technical platform.

[Direct cost of traumatic brain management in Hospital of Ségou Mali: What funding for care management in Mali?] / Cout direct de la prise en charge du Traumatisme cranio-encephalique au Chr de Segou au Mali : Quel financement pour la pec au Mali?

Traumatic Brain Injury (TBI) is the second cause of admission in the emergency department at the Nianankoro Fomba hospital of Ségou. Young adults with low income are the most affected. The objective of this study is to evaluate the direct cost of the management of TBI at the emergency ward and to make a proposal for future financing of this management in Mali. We conducted a prospective study from September 2009 to December 2010 at the Nianankoro Fomba hospital of Ségou. All patients admitted in the emergency ward for TBI for more than 24 hours were included. The age range between 21-40 was the most affected. All socioprofessional categories were affected. The average cost of prescription was 55,392 CFA. Medical evacuation was necessary in 15 cases for an average fee of 60,700 CFA. Due to lack of money, 75% of deceased patients were not evacuated at the third level. The average cost of management was 99,385 CFA [range: 39,115-282,944]. The total cost of services was 7,269,320 CFA. The high cost of the management of TBI is a major determinant of morbidity and mortality of this disease.

Le traumatisme crânien encéphalique (TCE) est la deuxième cause d'admission aux urgences de l'hôpital Nianankoro Fomba de Ségou. Il touche l'adulte jeune avec un faible pouvoir d'achat. L'objectif de ce travail était d'évaluer le coût direct de la prise en charge (PEC) du TCE en réanimation et de proposer les modalités de financement pour sa PEC au Mali. Il s'agissait d'une étude prospective de Septembre 2009 à Décembre 2010 au centre hospitalier Nianankoro Fomba de Ségou. Tous les patients admis pour TCE en réanimation pour plus de 24 heures étaient inclus. La tranche d'âge 21­40 était prédominante. Toutes les couches socioprofessionnelles étaient exposées. Le coût moyen des ordonnances était de 55.392 CFA. L'évacuation sanitaire était effectuée dans 15 cas pour un frais de 60.700 francs. Pour manque de moyens, 75% des patients décédés n'étaient pas évacués en 3ème référence. Le coût moyen de la PEC était de 99.385 Francs (39.115-282.944). Le coût total des prestations s'élevait à 7.269.320 francs CFA. Le coût de la PEC des TCE est élevé et constitue un déterminant majeur de la morbimortalité liée à ce fléau.

Cout direct de la prise en charge du traumatisme cranio-encepahlique au CHR de Segou au Mali : quel financement pour la PEC au Mali ?

Le traumatisme cranien encephalique (TCE) est la deuxieme cause d'admission aux urgences de l'hopital Nianankoro Fomba de Segou. Il touche l'adulte jeune avec un faible pouvoir d'achat. L'objectif de ce travail etait d'evaluer le cout direct de la prise en charge (PEC) du TCE en reanimation et de proposer les modalites de financement pour sa PEC au Mali. Il s'agissait d'une etude prospective de Septembre 2009 a Decembre 2010 au centre hospitalier Nianankoro Fomba de Segou. Tous les patients admis pour TCE en reanimation pour plus de 24 heures etaient inclus. La tranche d'age 2140 etait predominante. Toutes les couches socioprofessionnelles etaient exposees. Le cout moyen des ordonnances etait de 55.392 CFA. L'evacuation sanitaire etait effectuee dans 15 cas pour un frais de 60.700 francs. Pour manque de moyens; 75% des patients decedes n'etaient pas evacues en 3eme reference. Le cout moyen de la PEC etait de 99.385 Francs (39.115-282.944). Le cout total des prestations s'elevait a 7.269.320 francs CFA. Le cout de la PEC des TCE est eleve et constitue un determinant majeur de la morbimortalite liee a ce fleau

[Cutaneous leishmaniasis in hospital area: epidemiological and clinical aspects, about 16 cases]. / Leishmaniose cutanée en milieu hospitalier: aspects epidémiologiques et cliniques a propos de 16 observations.

Cutaneous leishmaniasis, a chronic infectious ulcerative skin disease caused by a protozoan parasite of the genus Leishmania, is transmitted by the bite of sandflies. We report 16 cases of cutaneous leishmaniasis observed in Dakar from 1990 to 2000. The aim of this retrospective study was to determine the epidemiological and clinical features. Their age range was 10 to 78 years (mean 41.12 years). The sex ratio was 3. The most commun presentation was the ulcero-crusted lesions (bouton d'orient) observed in 56.25% of cases. The other clinical presentation are the sporotrichoid lesions (25%), the lupoid lesions observed in 12.5% and the cutaneous diffus leishmaniasis in 12.5%. In all these cases, there were many lesions. On treatment we observed 87.5% of total remission.

Detection of hepatitis B virus DNA by polymerase chain reaction in HBsAg negative Senegalese patients suffering from cirrhosis or primary liver cancer.

The polymerase chain reaction was used to search for hepatitis B virus (HBV)-DNA sequences in the sera of HBsAg-negative Senegalese patients suffering from liver cirrhosis or liver cancer. Amplified HBV-DNA sequences were detected by hybridization with a digoxigenin-labelled HBV-DNA probe. HBV-DNA was detected in 17% of HBsAg negative Senegalese subjects from the general population and in 44% and 58% of the patients suffering from cirrhosis or primary hepatocellular carcinoma (PHCC) respectively. In the control group, amplified HBV-DNA was detected in 25% of the subjects without HBsAg and anti-HBs antibodies, and in 6% of subjects positive for anti-HBs antibodies. This study confirmed the hypothesis that there is an etiologic link between HBV and PHCC in HBsAg-negative patients.

Antibody response to preS1 in hepatitis-B-virus-induced liver disease and after immunization.

Antibodies to the pre-S1-encoded sequence of hepatitis B virus (HBV) envelope were detected by ELISA using a synthetic peptide analogue of preS1 proteins, in different groups of HBV-infected subjects and also in hepatitis B vaccine recipients. Such antibodies were specifically found in only 1% of HBsAg chronic carriers including patients with cirrhosis and primary liver cancer. Anti-preS1 were detected in patients with acute hepatitis; in 13% of the HBsAg+ sera obtained before recovery and in 37% of the sera obtained after recovery. Anti-preS1 antibodies were detected in recipients of a plasma-derived vaccine, but not in those receiving a recombinant vaccine. The results indicate that anti-preS1 is an earlier serum marker of HBV clearance than anti-preS2 and anti-S antibodies.