[Xerodermapigmentosum: Challenge of diagnosis in West Africa]. / Xerodermapigmentosum : Difficulte diagnostique en Afrique Occidentale.

Xeroderma pigmentosum is related to a defect of the enzymes involved in repairing the oncogenic effects of ultraviolet exposure. The condition is found all over the world, in all ethnicities and races. This rare genodermatosis is often unknown in countries lacking specialist in dermatology. This scarcity and insufficiency of qualified personnel give rise to difficulties in diagnosing this pathology, especially in West Africa where XP is wrongly diagnosed for other pathologies. Objective: To share with colleagues the problem of diagnosis of Xeroderma pigmentosum in countries with insufficient number of dermatologist and poor technical platform. Observation: 21-year-old man, with no pathological history of dermatosis was seeking for medical consultation because of cutaneous dryness and photophobia. Previous visits at several health centers failed to diagnose the condition and no noticeable improvement was seen from given treatment. Verbal questioning found the notion of consanguinity (his father and his mother are cousins, and belong to the same Dogon group). Cutaneous pigmentary disorders were absent at birth but appeared at the age of 12 years. Physical examination highlighted photophobia in addition to specific clinical and paraclinical signs allowed to diagnose Xeroderma pigmentosum varying type. Conclusion: in West Africa, the challenge of diagnosis of Xeroderma pigmentosum is undoubtedly related to a lack of qualified personnel and technical means of diagnosis, which makes its frequency underestimated.

Le Xéroderma pigmentosum (XP) est lié à un défaut des enzymes impliquées dans la réparation des effets oncogènes de l'exposition aux ultraviolets. L'affection se rencontre dans le monde entier, dans toutes les ethnies et races. Cette génodermatose rare est souvent méconnue dans les pays en manque de spécialiste en dermatologie. Cette rareté de Xeroderma pigmentosum et l'insuffisance de personnel qualifié engendrent des difficultés diagnostiques de cette pathologie surtout en Afrique Occidentale où le XP est diagnostiqué à tort pour d'autres pathologies. OBJECTIF: Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique. OBSERVATION: il s'agissait d'un patient de 21 ans, sexe masculin, sans antécédents pathologique de dermatoses, issu d'un mariage consanguin qui a consulté pour sècheresse cutanée et photophobie après un long parcours dans beaucoup des centres de santé de la place sans diagnostic et sans amélioration notable, chez qui l'interrogatoire a retrouvé la notion de consanguinité (son père et sa mère sont des cousins, et provenaient du même clan Dogon),l'absence de troubles pigmentaires cutanées à la naissance et l'apparition des troubles pigmentaires cutanées à l'âge de 16ans. L'examen physique a objectivé la photophobie en plus des signes cliniques et paracliniques specifiques ce qui a permis de retenir le diagnostic de Xéroderma pigmentosum, forme variante. CONCLUSION: en Afrique Occidentale, la difficulté diagnostique de Xéroderma pigmentosum est sans doute en rapport avec un manque de personnel qualifié et des moyens techniques de diagnostic, ce qui rend sa fréquence sous-estimée.

Xerodermapigmentosum : difficulté diagnostique en Afrique occidentale

Le Xéroderma pigmentosum (XP) est lié à un défaut des enzymes impliquées dans la réparation des effets oncogènes de l'exposition aux ultraviolets. L'affection se rencontre dans le monde entier, dans toutes les ethnies et races. Cette génodermatose rare est souvent méconnue dans les pays en manque de spécialiste en dermatologie. Cette rareté de Xeroderma pigmentosum et l'insuffisance de personnel qualifié engendrent des difficultés diagnostiques de cette pathologie surtout en Afrique Occidentale où le XP est diagnostiqué à tort pour d'autres pathologies. Objectif: Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique. Observation: il s'agissait d'un patient de 21 ans, sexe masculin, sans antécédents pathologique de dermatoses, issu d'un mariage consanguin qui a consulté pour sècheresse cutanée et photophobie après un long parcours dans beaucoup des centres de santé de la place sans diagnostic et sans amélioration notable, chez qui l'interrogatoire a retrouvé la notion de consanguinité (son père et sa mère sont des cousins, et provenaient du même clan Dogon),l'absence de troubles pigmentaires cutanées à la naissance et l'apparition des troubles pigmentaires cutanées à l'âge de 16ans. L'examen physique a objectivé la photophobie en plus des signes cliniques et paracliniques specifiques ce qui a permis de retenir le diagnostic de Xéroderma pigmentosum, forme variante. Conclusion: en Afrique Occidentale, la difficulté diagnostique de Xéroderma pigmentosum est sans doute en rapport avec un manque de personnel qualifié et des moyens techniques de diagnostic, ce qui rend sa fréquence sous-estimée

[Clinical and psychopathological postpartum depression: eleven Senegalese cases report]. / Aspects cliniques et psychopathologiques de la dépression du postpartum: rapport d'une série de onze cas sénégalais.

INTRODUCTION: The postpartum depression is a frequent puerperium psychiatric disorder. The authors study the clinical, therapeutic and evolutionary aspects of the postpartum depression among eleven Senegalese women. MATERIAL AND METHOD: They examined the medical reports and hospital registers of eleven patients belonging to a sample of 52 women presenting psychic disorders of the puerperality. The diagnosis was made by using the International Classification of the Diseases. RESULTS: The symptoms of depression were irritability, bad concentration, multiple somatic complaints, of insomnia of drowsiness, loss of the usual interests. All the patients profited from psychotherapy and have received chemotherapy with antidepressant treatment associated tranquillizing in six cases. They improved from 29 to 43 days after their admission. CONCLUSION: The pregnancy and the childbirth, the parity, personal history of the patient, their social environment and the cultural representations of maternity are factors of depression of the postpartum. The antidepressant is always essential in the treatment.

Aspects cliniques et psychopathologiques de la depression du postpartum : rapport d'une serie de onze cas senegalais

Introduction : La depression du post-partum occupe une place importante parmi les accidents psychiatriques de la puerperalite. Les auteurs rapportent les differents aspects cliniques; therapeutiques et evolutifs de la depression du post-partum dans une serie de onze cas senegalais. Materiel et methode : Il s'agit d'un travail mene a partir des observations medicales et des registres d'hospitalisation d'une serie de 11 patientes appartenant a un echantillon de 52 femmes presentant des troubles psychiques de la puerperalite. Le diagnostic a ete fait en utilisant la classification internationale des maladies. Resultats : Sur le plan clinique les symptomes de depression etaient constitues principalement d'irritabilite; de troubles de la concentration; de plaintes somatiques multiples; d'insomnie d'endormissement; de perte des interets habituels. Pour la prise en charge; toutes nos patientes ont beneficie d'une psychotherapie de soutien et d'un traitement antidepresseur; associes a un traitement tranquillisant dans six cas. L'evolution a ete favorable au bout de 29 a 43 jours d'hospitalisation. Conclusion : Le vecu de la grossesse et de l'accouchement; la parite; l'histoire personnelle de la patiente; son environnement et les representations culturelles de la maternite sont des facteurs de depression du postpartum. Le traitement antidepresseur est dans tous les cas indispensable

[Perceptions and behavior toward dentistry in students and non-students in Dakar (Senegal)]. / Perceptions et vécus de l'art dentaire chez des etudiants et des non-etudiants a Dakar (Sénégal).

The authors try to appreciate the perception by student and non student population of dental care throughout fear of dentist, pain and dentist-patient relationship, also the patient preventive attitude. Results show more fear of the dentist by students and expressed pain. Dental cares are expensive according both students and non students but seem to be comfortable. Dentist-patient relationship is more appreciated at the Odontologic Institute which form future dentists and 80 per cent of patients consult for prophylactics care against 29 at the medico-social centre of the university. Dental care accessibility in developing country is a real problem and rate of dental diseases cannot be taken down without support of information and communication waves.

[Diffculties in medico-social management of tuberculosis in Pneumology Departement of Fann University Teaching Hospital]. / Difficultés dans la prise en charge médico-sociale de la tuberculose a la clinique de Pneumologie du CHU de Fann.

This prospective study included all the patients who, during the month of September 1995, were admitted for pulmonary baclliferous tuberculosis to the Pneumology Clinic of the Fann University Hospital, Dakar. The patient's escorts and the health personnel were also included in this study. The aim of the study was to find the different socio-economic and health factors impeding the hospitalization of tuberculosis patients in the Pneumology Clinic of Fann University Hospital. 22 members of the health team, 209 patients aged between 15 and 65 years and 209 escorts were interviewed. Out of the 10% of tuberculosis patients with HIV seropositivity, 80% admitted not to have informed their spouses of their infection. The decision to be admitted was made by the patient himself in 54.4% of cases and by his family in 45.5% of cases. Late admittance with regards to the beginning of symptoms was due to the recourse to traditional medicine in 43.7% of cases, wrong diagnosis in 24%, ignorance in 19.3% and, in 13% of cases, due to inappropiate anti tuberculosis treatment. Despite the fact that anti tuberculosis medicine was free of charge, each patient or his family spent an average sum of 87,500 CFA F (US dollar 175) for a month's admission (the minimal salary (SMIG) in Senegal is 32,000 CFA F (US dollar 64), and 40% of the patients and escorts had difficulties making this payment. 9 patients were judged to be poor by 25.7% of the patients and 8.7% found relations with the health personnel difficult. The escorts deplored the lack of toilets (only 1 out of 4 was functional), the time worn facilities, the overcrowding as well as the irregularity and poor quality of the hospital meals. The entire health team deplored the lack of adequate personnel and 30% of them deplored the lack of hygiene of some patients and escorts. Taking financial charge of tuberculosis patients at the Pneumology Clinic of the Fann University Hospital requires an increased financial effort from the State (rehabilitation of the facilities, recruitment of medical and paramedical personnel, improved meals) harmonisation on a national scale of anti tuberculosis therapeutic protocoles and an Information-Education-Communication (IEC) programme on tuberculosis and hygiene.

[Self-destructive behavior in African adolescents]. / Conduites auto-agressives de l'adolescent Africain.

The purpose of this study was to analyze self-destructive behavior in adolescents in Senegal. Based on four case reports the authors stress the central importance of family breakdown in the process leading to this behavior as opposed to the first descriptions implicating an offense against the honor of the group. The vulnerability of teenagers in the absence of structural initiation is also advanced. Systematic intervention may be recommended in such cases.

[Prevalence and clinical aspects of puerperal mental disorders at the University Hospital Center of Dakar]. / Prévalence et formes cliniques des troubles psychiques de la puerpéralité au CHU de Dakar.

This is a contribution to the survey on psychiatric disorders of puerperality. We are particularly interested in the clinical signs and the ethiopathogenical facts of psychiatric disorders of the post-partum which appear-in our point of view-to be the main point on which we could probably act to reduce the effect of the disease. It is a retrospective survey going from January, 1st 1992 to December, 31st 1996. Here are included all the female patients whose age is more than 15, hospitalised during survey period and who presented a mental pathology linked with puerperality in accordance with diagnosis criterions of World Health Organization. In 1 627 hospitalisations, there were 658 women among whom 52 presented puerperality psychical disorders, that's meaning 7.9% of the female patients hospitalised in psychiatry, with an average age of 24.5 years. Concerning the classification of the diseases, the acute delirious psychosis and the depressive disorders are more important with respectively 56% and 19% of the sample. 92% of the women gave birth by the vaginal normal way and 61.5% presented disorders in the first week following their delivery. The married women are 94%. Concerning their occupations, 98% are house keepers. 52% are primiparas and 48% are multiparas. Psychical disorders of puerperality are frequent in Dakar. Acute psychosis and mood disorders are the main clinical aspects. The management of the future mother to her new roles by health education and prenatal check-ups in health centers by skilled and appropriate personnal is necessary.

[Mental confusion and multifocal lymphatic and pulmonary tuberculosis. A case report]. / Confusion mentale et tuberculose multifocale ganglionnaire et pulmonaire. A propos d'un cas.

This report describes a case of mental confusion associated with ongoing adenitis and pulmonary tuberculosis in a 20-year-old man with no history of psychiatric disorders. Diagnosis was based on clinical and laboratory findings. Tranquillizers improved mental status and antituberculosis treatment was administered before referring the patient to an internal medicine department. The authors emphasize the rarity of these cases in the Senegalese medical literature and discuss possible diagnostic pitfalls.

[Apropos of 1 attempted suicide with a fire arm in an adolescent]. / A propos d'une tentative de suicide par arme à feu chez un adolescent.

This is the presentation of an adolescent's clinical case who tried to commit suicide with a fire arm during a depressive crisis. An emphasis is placed on the family interaction model and on a more global approach of the patient's personality. The authors underlined some of the problems raised by the diagnostic approach linked to the delirious syndrome, full of psychotic elements: themes of persecution, mystico-religious themes associated with impulsive escapade, all of them going with a depressive state. They gave also an important place to a pluridisciplanary treatment in those particular stages of crisis.

Cultural response to mental illness in Senegal: Reflections through patient companions--Part I. Methods and descriptive data.

Patient records from the Thiaroye mental hospital in Senegal were analyzed to see if the patterns of persons accompanying patients to the hospital could help portray the community's response to mental illness. A systematic sample of 935 records of initial our-patient visits were examined. Patterns of patient companionship were found to strongly correlate with specific patient sociodemographic and clinical characteristics. Interpretation of these findings helped to clarify both prevailing attitudes toward the mentally ill and the social response and management of mental illness. This article presents the study setting, methods, patient sociodemographic and clinical characteristics, and characteristics of patient companions. The second article in this series examines the statistical associations of companion number, gender and kinship relationship with patient sociodemographic and clinical characteristics.

Cultural response to mental illness in Senegal: reflections through patient companions--Part II. Statistical correlates.

Patient records from the Thiaroye Psychiatric Hospital in Senegal were studied to see if analysis of patterns of persons accompanying patients to the hospital could help to portray the community's response to mental illness. A systematic sample of 935 records of initial out-patients visits were examined. Patterns of patient companionship were found to strongly correlate with specific patient sociodemographic and clinical characteristics. Interpretation of these findings helped to clarify both prevailing attitudes toward the mentally ill and the social response and management of mental illness. The first article in this series presented the study setting, methods, sociodemographic and clinical characteristics of the patients, and characteristics of patient companions. The current article examines the statistical associations of companion number, gender and kinship relationship with patient sociodemographic and clinical characteristics.

[Marital conflict in Senegal: an anguished plea from the women]. / La conjugopathie au Sénégal: une plainte angoissée de la féminité.

Conjugopathy partner relational problem in its systemic definition is a Western concept that is only partially applicable to situations encountered in Africa. A series of 10 women were carefully studied at the Psychiatric Clinic of the Fann University Hospital Center in Dakar. In the following article the authors give a detailed description of 3 of these cases and discuss several situations characteristic of African conjugopathy: preferential, forbidden and early marriage, endogamy, non-cohabitational conjugal life, polygyny, and individual psychic vulnerability. The fact that males do not acknowledge conjugal problems accounts for the exclusively female population in this study and explains the greater suffering of women in these situations. After having exhausted traditional avenues of recourse, African women turn to the hospital. Their symptoms reveal a rebellion against a society that stifles female expression. This repression favors clinical syndromes involving depression and/or psychosomatic manifestations.

[Naawtal or the psychopathological aspects of a particular migration]. / Le Naawtal ou les aspects psychopathologiques d'une migration particulière.

This study deals with some psycopathological features of naawtal. Naawtal is a Wolof word designating a social practice based on black magic that consists in ostracizing someone to prevent him from competing for a common goal or approaching a loved one. This traditional practice leads to involuntary migration from one place to another in the country. The survival of this practice in the socio-economic context of modern Senegal and indeed its extension to social classes not previously involved, reflects individual suffering, collective malaise, and ongoing social adjustments. Analysis of the practice of naawtal not only distinguishes motives, author, means of casting the spell (involving birds and wind), and the way to break the spell but also underlies the essential place of sexual identity with the notion of greater female vulnerability. To illustrate this article, the case of a woman persecuted by auditory hallucinations is analyzed in the light of the syndrome of mental and motor automatism characteristic of the diagnosis of chronic hallucinatory psychosis. The basic notion of internal exile and drifting contained in this traditional representation of mental illness is called on to explain the psychopathologic features. The authors emphasize the value of the reference to naawtal in the therapeutic relationship in helping to achieve acceptance of psychiatry in Africa.

Why discrepancies exist between structured diagnostic interviews and clinicians' diagnoses.

The authors employed empirical methods to study the causes of discrepancies between clinicians' and epidemiologists' diagnoses of "cases" from the general population within the homogeneous DSM-III/DIS system. Four interviewers conducted 139 interviews using the DIS, while psychiatrists completed a DSM-III checklist, after which they could then ask any questions they wanted. All kappas exceeded 0.58. Meetings were subsequently organized with all participating psychiatrists in order to point out reasons for discrepancies between DIS diagnoses and clinical judgement. The authors came to the following conclusions: (1) DSM-III ambiguities led to discrepancies, especially when reference periods were not specified. (2) Discrepancies arose when cases were difficult: symptoms pertaining to different diagnoses or multiple diagnoses and the fact that clinicians could use volunteered comments, while interviewers were obliged to keep strictly to the schedule, contributed to discrepancies. (3) Other approaches, such as CIDI for anxiety and DISSA for depression, could improve DIS performances.

Infections a VIH SIDA et problemes d'adaptation : l'exemple du Senegal

L'infection a VIH-SIDA; par ses effets nefastes dans l'organisme et son evolution ineluctable; provoque chez la femme des problemes dramatiques d'adaptation. Par sa signification d'entrave a ses projets dans la vie; elle lui cree un univers physique; affectif et social ou elle se remet en situation avec la prise en compte du poids des contraintes economiques; sociales et surtout culturelles propres au contexte senegalais

[The patient with Hansen's disease confronts his distress]. / Le hansénien face à son angoisse.

This article is about the effect of Hansen's disease on the personality of 29 patients of the Institute of Applied Leprology of Dakar, Foundation of the Order of Malta. This approach to the distress of these patients was done by an inquiry based on sociocultural and clinical variables and compared to a study composed of tubercular and psychiatric patients. This study reports four distress levels (loss of identity, loss of object, forlornness, culpability) which are distinguished by sex and age. The actual analysis of the experience of this distress shows the importance of support of the traditional representation of these leprous patients' psychology.

[Antimicrobial activity of some medicinal species from the Dakar markets]. / Activité antimicrobienne de quelques espèces médicinales des marchés Dakarois.

After drawing up an inventory of Dakar markets popular medicinals plants, antimicrobial activity of 43 species have been screened. With the agar diffusion method, crude extracts of 24 species show an activity against Sarcina lutea or Escherichia coli. The antimicrobial spectrum of these extracts against 11 germs has been evaluated with the agar dilution method. 13 species show M.I.C. lower than 10 mg/ml against some germs. This preliminary study select some plants of potential interest for development of new antibacterial.