[Moving from prevention to elimination of mother-to-child transmission of HIV before 2015, an unrealistic objective? Social stakes in Senegal]. / Passer de la prévention de la transmission mère-enfant du VIH à son élimination avant 2015 : un objectif irréaliste ? Enjeux sociaux au Sénégal.

In 2010, international agencies began to promote the elimination of mother-to-child HIV transmission (EMTCT) in 2015 by proposing a new preventive strategy based on the extensive use of antiretrovirals. For a country like Senegal where the epidemic is considered to be concentrated, since prevalence is beyond 1%, and where the prevention program was fully applied to only 7 to 15% of children exposed to HIV, the objective is ambitious. The pharmacological efficacy of antiretrovirals will not be sufficient if the experience of actors in the field about the social aspects and the acceptability of the program to women are not considered. The aim of this article is to describe the social issues on the basis of two studies conducted in the region of Dakar (an exploratory study of the effects of the new prevention strategies and a study of the experience of patients receiving antiretroviral treatment for 10 years). The results reveal the main issues: community prevention showed its limits at the stage of access to the program and test, which suggests the importance of strategies to promote awareness and prevention that are focused on women; retention depends highly on the attitudes of health workers and on the role of peer counselors, but the integration of HIV testing and treatment in reproductive health services is not fully established; ambivalent perceptions of antiretrovirals complicate adherence; and finally, the organization of health services hinders a family approach of prevention. These results are innovative, since most publications on this topic concern southern and east Africa.

[Ketoacidosis in type 1 diabetes mellitus: 73 cases in Dakar]. / Acidocetose Chez Le Sujet Diabetique De Type 1 : A Propos De 73 Cas Colliges A Dakar.

INTRODUCTION: The follow-up of diabetes mellitus in children and teenagers remains a challenge. Ketoacidosis is the most frequent acute metabolic complication and is of bad prognosis. The objective of this study was to evaluate etiologicals factors of decompensation and evolutions in type 1 diabetes. PATIENTS AND METHODS: We conducted a transversal and prospective study from January 2009 to October 2010. All type 1 diabetic patients hospitalized for ketoacidosis had been included. For every patient, we have studied the epidemiologicals, etiologicals and clinicals factors as well as the outcomes. RESULTS: The prevalence was to 55.3 % among all ketoacidosis. Sex-ratio (Men/Women) was 0.78, mean age to 25.73 years and mean duration of diabetes was 3.9 years. Ketoacidosis was inaugural in 26 % of cases. Except Kussmaul dyspnea, prevailed digestives symptoms (87.6 %). Coma was noted in 82.1 % among whom 54.7 % had no previous diabetic follow-up. A decompensation factor was found in 93.1 % of which an infection (78 %) or stop insulin (53.42 %). Prevailing infectious sites were urogenitals (24.6 %), respiratories (20.5 %). The outcome was fatal in 6.8 % of the cases. It was about 24.3 years middle-aged, 1,6 year diabetes mellitus mean duration, without regular follow-up in 80 % of the cases. Other associated factors were coma stage 2 or 3 (80%), infection (60 %), hypokalemia (40 %). CONCLUSION: Ketoacidosis is frequent in type 1 diabetic patients and has a bad prognosis. Infection and stop insulin are major factors of decompensation. Its prévention requires an adapted therapeutic education associated to a regular follow-up of patients.

[Seroprevalence of HBsAgs in patients with rheumatoid arthiritis in a hospital setting in Senegal]. / Séroprévalence de l'antigène HBs au cours de la polyarthrite rhumatoïde en milieu hospitalier Sénégalais.

PURPOSE: Rheumatoid arthritis is the most common chronic inflammatory joint disease in adults. In Senegal, where biotherapy is unavailable, treatment of RA relies on a combination of glucocorticoids and disease-modifying antirheumatic drugs (DMARD). Since DMARD, particularly methotrexate, induce hepatotoxicity pretreatment assays of serum transaminase and albumin levels, as well as serological tests for the hepatitis B and C viruses is recommended. Hepatitis B virus (HBV) infection is endemic in Africa, particularly in Senegal. The purpose of this study was to assess the seroprevalence of the HBV surface antigen (HBsAg) for HBV in 258 patients with RA in Senegal as a basis for defining the least hepatotoxic DMARD for these patients and ensuring the most suitable monitoring. METHOD: This retrospective study was based on a review of the medical records of patients examined between January 2005 and December 2009 at the rheumatology outpatient clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal. All patients met the American College of Rheumatology criteria for RA. RESULTS: A total of 258 patients were tested for HBsAg. Tests were positive in 6 for a seroprevalence of 2.3%. All 6 positive patients were women with a mean age of 48.7 years (range, 16-79 years). Transaminase levels were normal in 5 patients. In the remaining patient, ASAT level elevation were twice normal and ALAT was normal. No patients had clinical evidence of liver disease. CONCLUSION: HBsAg seroprevalence in our population of patients with RA was lower than in the general population of Senegal: 2.3% versus 15%-18%. No evidence indicated that HBVinfection produced specific features in patients with RA. Based on these findings, widespread use of methotrexate in optimal dosages appears safe in patients with RA in Senegal. Treatment should be accompanied by careful attention to HBV prevention.

[Descriptive study of diabetic foot at the Marc Sankale Diabetes Center. Report of 105 cases]. / Etude descriptive du pied diabetique au centre du diabete marc sankale. A propos de 105 cas.

INTRODUCTION: Diabetic foot is a major complication of diabetes due to its frequency and its high risk of evolution to amputation. We report 105 cases recruited at the diabetes centre Marc Sankale. METHOD: It's a prospective study including all diabetic patients who attended the diabetes centre for any foot lesion during a one year period. Besides clinical examination data, results of glycaemia, foot X-ray Doppler and bacteriological analysis of the pus were collected. RESULTS: foot lesion represented 2.8% of diabetologist causes of consultation. Mean age of occurrence was 55 +/- 14 years in 63% women and 37% men. Diabetes was type 2 in 90% cases, poorly controlled in 63.92 % cases. Foot lesion was dominated by infection (97%), isolated or associated to peripheral vascular disease (32.4%) or neuropathy (13.3%). 67 patients had medical treatment and healed their wounds in 3 months in 76% cases. 38 other cases needed surgery : major amputation (15%), minor amputation (13%) debridment (9%) and revascularization (1%). CONCLUSION: Diabetic foot is a frequent reason for consultation at the National diabetes centre. Despite all the improvements made after the implementation of the patient's educational program, treatment starts late because of economical and cultural reasons that increase morbidity.

[Frequency of microalbuminuria during diabetes in Dakar, Senegal]. / Fréquence de la microalbuminurie au cours du diabète a Dakar (Senegal).

Nephropathy is one of the complications occuring during diabetes and it is diagnosed via microalbuminuria. From 1992 to 1999, five hundred and eighty seven (587) diabetic patients were recruited and distributed into two groups, A (n = 270) and B (n = 317). Microalbuminuria was determined by immunonephelemetry for group A and immunoturbidimetry for group B. The results showed respectively 15.5% and 20.19% pathological cases in the two groups (NS). Considering the distribution of patients with microalbuminuria according to the type of diabetes, there were 16.12% type 1 and 15.07% type 2 in group A against 22.60% and 18.13% in group B; no statistically significant differences were observed either in the same group or from one group to another. These frequencies might reflect the situation in the nineties; they are lower than those encountered in other populations. Nevertheless monitoring is needed through a regular schedule to prevent nephropathy.

[Frequency of micoalbuminuria during diabetes in Dakar (Senegal)]. / Frequence de la microalbuminurie au cours du diabète à Dakar (Sénégal).

Nephropathy is one of the complications occuring during diabetes diagnosed via microalbuminuria. From 1992 to 1999, five hundred and eighty seven (587) diabetic patients were recruited in groups A (n = 270) and B (n=317). Microalbuminuria was determined by immunonepheletry for A and immunoturbidimetry for B. The results pointed out respectively 15.5% and 20.19% pathological cases (NS). Considering the distribution of patients with microalbuminuria according to the type of diabetes there were 16.12% type 1 and 15.07% type 2 in group A against 22.60% and 18.13% in group B ; no stastically significant differences were observed either in the same group or from one group to another. These frequencies would reflect the situation in the nineties; they are lower than those encountered in other populations. Nevertheless monitoring is needed through a regular schedule to prevent nephropathy.

Oro-dental and craniofacial anomalies in LEOPARD syndrome.

'LEOPARD syndrome' is a syndrome affecting many systems or organs. The main anomalies are summarized in the acronym LEOPARD in which each letter corresponds to the damage of a given organ. In the presented case, there are oro-dental and craniofacial anomalies. The relationship between the LEOPARD syndrome and the given anomalies and the possibilities of the management and the follow-up of the diseased are studied. The clinical case presented is a 4-year-old boy with LEOPARD syndrome showing retardation of dental development, delayed development and possible agenesis of permanent teeth, and craniofacial anomalies (osseous hypodevelopment). The bibliographical study shows that LEOPARD syndrome is due to damage of the neural crest cells. Thus, the dental and craniofacial anomalies arise since neural crest cells participate in the formation of the teeth and some craniofacial bones. Therefore, dental and craniofacial anomalies might be expected in some cases of the disease. The therapeutic management of the lesions, and the follow-up of the patient would be done by a multidisciplinary team.

[Hypercholesterolemia in diabetes in Dakar. Sociodemographic and etiological factors and therapeutic bases]. / Hypercholestérolémie au cours du diabète à Dakar. Facteurs socio-démographiques et étiologiques et bases thérapeutiques.

This study took place between January and September 1996. The inclusion criteria was a blood cholesterol concentration of at least 2.5 g/l. Thirty-three patients were included. They were aged from 37 to 77 years, with a mean age of 59 (+/- 9.4) years. Twenty-six were women and seven were men. The mean age of the women was 58.9 (+/- 10) years and that of the men was 61 (+/- 6.1) years. Sixteen patients were from urban areas, 14 from semi-rural areas and 3 were of rural origin. The mean duration of diabetes was 9 (+/- 6.5) years. Mean post-prandial blood glucose concentration was 2.2 (+/- 1.0) g/l. Mean body mass index was 25.6 (+/- 5.6). Mean systolic blood pressure was 15.0 (+/- 2.5) cm Hg and mean diastolic blood pressure was 9.0 (+/- 1.3) mm Hg. Blood cholesterol concentration was between 2.5 g/l and 5.6 g/l, and mean HDL cholesterol concentration was 0.7 (+/- 0.4) g/l. Mean blood triglyceride concentration was 1.0 (+/- 0.4) g/l. Body mass index was negatively correlated with high cholesterol levels (r = -0.29). Hypercholesterolemia was primary, with no associated high triglyceride concentration. Cholesterol levels were also negatively correlated with post-prandial blood glucose concentration (r = -0.1). Thus, treatment should involve the prescription of drugs to reduce blood lipid concentration rather than just the restriction of lipid intake.

[Bacteriological study of purulent nasopharyngitis in children in Senegal]. / Etude bactériologique des rhinopharyngites purulentes de l'enfant au Sénégal.

BACKGROUND: S pneumoniae, H influenzae and M catarrhalis are the main bacteria isolated from rhinopharynx in Europe. The purpose of this work was to study the frequency of potential pathogenic bacteria isolated from acute purulent rhinopharyngitis among children in Senegal. POPULATION AND METHODS: Ninety-three children from one month to 7-years old suffering from purulent rhinopharyngitis were recruited from April 1 to July 1996. The withdrawal samples were taken from the cavum with a swab which was immediately immersed in an agar shipping medium. Bacteria's grouping and serotyping were made by immunoagglutination. A standard antibiogram was made for all isolates and furthermore the minimal inhibitory concentration (MIC) were determined for S pneumoniae. RESULTS: Two hundred bacterial strains were isolated: S pneumoniae 28% (60% of the children), C group streptococci: 19% (41% of the children), H influenzae: 15.5% (33% of the children), S pyogenes: 9.5% (20% of the children), S aureus: 8% (17% of the children) and M catarrhalis: 6% (13% of the children). The other isolates were: B and D groups streptococci, P aeruginosa and Klebsiella spp. S pnuemoniae strains belonged to serogroups 6, 19 and 23. Only three strains of H influenzae were capsulated (serotype b). Infants aged from 6 to 18 months were the most affected. No resistance to penicillin was observed for S pneumoniae and S pyogenes. Ampicillin (81%) and chloramphenicol (96%) both inhibited the majority of H influenzae strains. CONCLUSIONS: This descriptive bacterial epidemiology study of children's rhinopharynx's flora in Senegal allowed us to identify three major pathogenic germs: S pneumoniae, H influenzae and S pyogenes contributing to a better knowledge of these microorganisms' serotypes, biotypes and antibiotypes.

Le centre de recuperation et d'education nutritionnelles : une structure a vulgariser

Le probleme de la malnutrition s'accentue au fil des annees au Senegal malgre la mise sur pied de centres visant a promouvoir l'education sanitaire de base et a prendre en charge les enfants malnutris. En se fondant sur le bilan des cinq annees d'activites des CREN de Dakar et de Thies qui prennent en charge en moyenne 600 a 700 malnutirs par an avec des resultats satisfaisants (80 pour cent de succes); l'utilisation de tels centres s'est imposee. En consequence; leur implantation dans les differentes structures de sante publique aiderait a juguler ce fleau

Statut en vitamine C des enfants hospitalises a Dakar

Le dosage de l'ascorbemie chez cinquante enfants hospitalises pour des affections diverses montre un taux moyen bas par rapport a leurs congeneres sains recrutes dans les memes milieux. De meme les repas servis aux enfants hospitalises n'assurent pas la couverture en vitamine C. Il importe donc qu'un effort soit fait pour procurer davantage de vitamine C a chaque enfant hospitalise. Cet effort se fera par apport sous forme de fruits disponibles et bon marche (papaye; orange; citron; ditakh ou datarium senegalensis) voire sous forme de supplementation medicamenteuse

Risk factors for HIV-1 and HIV-2 infection in pregnant women in Dakar, Senegal.

This study examines the prevalence and risk factors for Human Immunodeficiency Virus type 1 (HIV-1) and type 2 (HIV-2) infection in pregnant women in Dakar, Senegal. From April 1991 to January 1993, 9,518 pregnant women were interviewed and serologically tested for antibodies to HIV-1 and HIV-2; 26 (0.3%) were HIV-1 seropositive, 44 (0.5%) were HIV-2 seropositive, two (0.02%) were dually seropositive, and 9,448 (99.3%) were seronegative. Guinea-Bissau nationality and age > 25 years were associated with HIV-2 infection, whereas parity < or = 2 was associated with HIV-1 infection. Among women who gave birth to live infants, shorter length of union with the partner and having been married more than once were associated with HIV-2 infection, whereas age < or = 25 years was associated with HIV-1 infection. Information gained by this study may help target intervention strategies for preventing maternal HIV infection and understanding biological differences between the two viruses.

Thymome malin de l'enfant : a propos d'un cas observe au CHU de Dakar. [Lettre]

Cette observation; qui est le premier cas de thymome malin diagnostique chez l'enfant senegalais; tire son interet de la rarete de l'affection; du jeune age du patient; du mode de revelation inhabituelle sous forme de tamponnade cardiaque; qui fait evoquer une etiologie beaucoup plus frequente dans nos regions: la pericardie tuberculeuse. Ce cas confirme la grande valeur pronostique du comportement loco-regional au detriment de l'histologie

Le paludisme chez l'enfant

Le paludisme est la premiere cause de mortalite infantile en Afrique; d'ou sa gravite. Il reste alors un defi; car les proges therapeutiques sont remis en cause par l'apparition de resistance aux medicaments antipaludeens