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The objective was to study the epidemiological, clinical and radiological aspects of patients with mandibular fractures in the odontostomatology department at the General hospital Idrissa Pouye in Senegal. This was a retrospective study of the records of patients who came for a mandibular fracture during the period from February 2007 to June 2019 to the odontostomatology department of the General hospital Idrissa Pouye in Dakar. The inclusion criterion was any patient file containing complete information and presenting a mandibular fracture received in the odontostomatology department. We used sociodemographic, clinical and radiographic variables. Of 128 patients who came for consultation with a mandibular fracture, 115 were male and 13 were female. The age group most affected was between 21 and 30 years. Workers (25.2%), pupils and students (25.2%) were the most represented. The most frequent cause of mandibular fractures was road traffic accidents (36.71%). In 41% of the road accidents, Jakarta mopeds were involved. The diagnosis was confirmed by radiological examination, which consisted of an orthopantomogram in 83.5% of cases. The mandibular symphysis was the most frequent location with 40.3% of fracture sites. Total continuity of the lines was observed in 21.9% of cases.

Aims Limited data are available on clinical characteristics and prognosis of heart failure (HF) in black African populations especially with respect to current classifications and HF management guidelines. Methods and results In this post hoc analysis, African patients admitted with acute HF and enrolled in the THESUS‐HF registry in one of 12 hospitals in 9 countries were classified as having preserved left ventricular ejection fraction (LVEF) (HFpEF), mid‐range LVEF (HFmrEF), and reduced LVEF (HFrEF) based on echocardiography performed close to the time of admission. Sociodemographic and clinical characteristics, management, and 60 and 180 day outcomes were compared between the groups. Of 888 patients with LVEF available, there were 472 (53.2%) with HFrEF, 174 (19.6%) with HFmrEF, and 243 (27.3%) with HFpEF. History of atrial fibrillation was higher in patients with HFmrEF (28.5%) than in patients with HFrEF (14.5%). Patients with HFrEF had a larger mean LV systolic diameter (54.1 ± 9.67 mm) than patients with HFmrEF (42.9 ± 8.47 mm), who had a larger mean LV diameter than patients with HFpEF (32.6 ± 8.64 mm); a similar pattern with LV diastolic diameter was observed. The mean posterior diastolic wall thickness (10.2 ± 2.94 mm) was lower in patients with HFrEF than in those with HFmrEF (11.1 ± 2.59 mm) and HFpEF (11.2 ± 2.90 mm). Patients with HFpEF were less likely to use angiotensin‐converting enzyme inhibitor/angiotensin receptor blockers, and aldosterone inhibitors, and more likely to use beta‐blockers than those with HFrEF at either admission or discharge/Day 7. Death or readmission rates through Day 60 and 180 day death rates did not differ significantly among the groups; unadjusted hazard ratios relative to patients with HFrEF were 1.32 [95% confidence interval (CI) 0.84–2.08] and 1.24 (95% CI 0.82–1.89) for 60 day death or readmission and 0.92 (95% CI 0.59–1.43) and 0.78 (95% CI 0.51–1.20) for 180 day death in patients with HFmrEF and HFpEF, respectively. Conclusions Classification by LVEF according to European Society of Cardiology guidelines revealed some differences in clinical presentation but similar mortality and rehospitalization rates across all EF groups in Africans admitted for HF.

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

Pleomorphic adenoma of the accessory salivary glands represents 60% of oral salivary tumors. Clinically it presents as a slow growing, painless swelling covered by a healthy mucosa. Its preferential location in the accessory salivary glands is the palate region. We report the case of a 61-year-old female patient who was referred for a swelling of the palate. The swelling measured approximately 40 mm in long axis, was firm to elastic, painless, did not bleed on contact and was covered by a healthy mucosa. The radiographic examination revealed an isodense, homogeneous, well-limited tissue process in the palatal vault and concluded that it was a palatal tumor measuring 47x35x24mm with benign characteristics. The removal of the encapsulated tumor was performed under general anesthesia. The postoperative course was simple. A prosthetic rehabilitation was performed two months later. No recurrence was observed after six months.

BACKGROUND: Rheumatic heart disease (RHD) was found in the THESUS-HF registry to be the third most common cause of acute heart failure (AHF) in Sub-Saharan Africa. METHODS: One thousand six patients with AHF from 9 Sub-Saharan African countries were recruited in THESUS-HF, of which 143 (14.3%) had RHD-AHF. Clinical characteristics and outcomes in patients with RHD-AHF and non-RHD-AHF were compared. Kaplan-Meier plots for time to all-cause death and/or HF readmission according to the presence of RHD-AHF and non-RHD-AHF were performed and survival distributions compared using the log-rank test. Cox regression was used to determine the hazard ratio of death to day 180 and death or readmission to day 60 after adjusting for confounders. RESULTS: Patients with RHD-AHF were younger, more often females, had higher rates of atrial fibrillation, had less hypertension, hyperlipidemia and diabetes, had lower BP, and higher pulse rate and better kidney function and echocardiographic higher ejection fraction larger left atria and more diastolic dysfunction. Patients with RHD-AHF had a numerically longer mean stay in the hospital (10.5 vs. 8.8 days) and significantly higher initial hospitalization mortality (9.1% vs. 3.4%). CONCLUSIONS: In conclusion, patients with HF related to RHD were younger, have higher rate of atrial fibrillation and have a worse short-term outcome compared to HF related to other etiologies in Sub-Saharan Africa.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

Hypertension is a common chronic disease representing a major public health problem. In 2000, it reached one out of four adults worldwide, ie a rate of 26.5%, with an evolution in prevalence

Aim The aim of this study was to assess of the risk of sudden death in a population of hypertrophic cardiomyopathy patients in Dakar. Methods This was a transverse study at the cardiology clinic of Aristide Le Dantec Hospital from January 2014 to June 2015. We used the European Society of Cardiology risk score to calculate this risk. Results The average age of patients was 53 years. Unexplained syncope was found in two patients and two others had a family history of sudden death. The septal hypertrophy average was 20.9 mm. Seven patients had left intraventricular obstruction. One patient had a high risk of sudden death, three had intermediate risk and 13 had low risk. Competitive sport was not allowed, 13 patients were under medical treatment, one had an implantable cardioverter defibrillator and two had no treatment. Conclusion Our study highlighted a low and intermediate risk of the occurrence of sudden death at five years. One patient had a high risk of sudden death.

Introduction: Precordial pain is a common reason for admission in cardiology, and has many causes. Acute myocarditis in its pseudo-infarctoid form is sometimes difficult to differentiate from myocardial infarction. Cardiac magnetic resonance imaging (MRI) helps to differentiate these two disease entities. We report the respective cases of two young patients, one presenting with myocarditis whilst the other with myocardial infarction. Case Report: We present the cases of two patients. The first who had a recent history of febrile syndrome is a 23-year-old who stopped smoking 3 months prior to presentation whilst the second is a 22-year-old professional footballer with a history of stress with no other cardiovascular risk factors. They were respectively admitted in our emergency department for a constrictive, intense chest pain. Physical examination was normal. The chest pain in both patients was associated with elevated cardiac markers, primary repolarisation abnormalities on ECG, wall motion abnormalities as well as left ventricular systolic dysfunction on transthoracic echocardiography. Coronary angiograms were normal in both patients. In the first patient, MRI concluded with an acute myocarditis with apical akinesia extending to the anterior wall, a T2 hypersignal indicative of myocardial edema, and uptake of a nodular heterogeneous contrast without affecting the sub-endocardial layers on the late enhancement sequences. In the second patient, MRI showed an appearance consistent with acute extensive infarction in the antero-apical region with severe hypokinesia and late quasi-transmural enhancement, impairment of the anterior papillary muscle of the mitral valve and a reduced left ventricular ejection fraction at 33%. In addition to analgesics, the first patient was treated with perindopril and bisoprolol, and the second patient received antithrombotic and anticoagulant treatment. There was clinical improvement in both patients. Conclusion: Cardiac MRI is a useful diagnostic tool for the precise diagnosis of precordial pain with elevated cardiac enzymes, especially in young patients.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Introduction: Osseous dysplasia is a benign tumor of the jaws predominantly occurring in melanoderm women. The pathogenesis remains unknown. Its often fortuitous discovery usually is in the fourth decade of life. Its treatment involves surgery. Our aim was to report a case of osseous dysplasia secondary infection in Senegal. Observation: The over sixty-year-old patient initially came for recurring old suppuration. A prior history of dental avulsions and self-medication was found out. The clinical features were predominant chronic osteitic manifestations. Its radiologic presentation suggested a florid form. The combination of spiramycin-metronidazole had to be given twice. The isolated sequestrum was enucleated and the anatomopathology confirmed the diagnostics. Discussion: The patient’s age conformed to late discovery due to silent progression and poor access to medical care. The prior iatrogenic avulsions can be explained by the absence of systematic radiological exploration and by the unawareness of the inconspicuous tumor. The clinical and radiological features at this stage of the osseous dysplasia secondary infection were typical. The treatment and the follow-up were dependent on the prevailing work conditions. Conclusion: The chronic osteitic manifestations are indicative of osseous dysplasia in elderly women in Senegal.

Objective To study the contribution of teledentistry, via the WhatsApp application of the “Dentists of Senegal”, on the management of oral and maxillofacial pathology. Material and Methods: This was a descriptive cross-sectional study. The study took place over a period of 3 months, from 1 October to December 30, 2020. This study was conducted on the WhatsApp group platform of the Senegalese Dentists. A total of 150 communications were included. Results Public sector dentists sent more communications, 88% of the communications. By specialty, general practitioners had sent more communications, 82.7% of communications. For the oral surgery receiver site, 71% of communications were received. 65% of referring dentists had given a diagnosis. Patients with tumours and cysts represented more than half of the sample (53.3%) followed by trauma patients (18.6%). The most common infections were cellulitis (46.66%) and osteitis (33.33%). Oral and maxillofacial surgeons managed 69.33% of the pathology. Conclusion WhatsApp is a fundamental contribution to the remote diagnosis and management of oral and maxillofacial pathologies, especially during the current covid-19 pandemic.

Objective Describe the sociodemographic, clinical and therapeutic aspects of the patients received for an emergency, during this period of pandemic, in a service of reference the service of odontostomatology General Hospital Grand Yoff of Dakar. Patients and methods This was a descriptive cross-sectional study over a threemonth period from March 3 to June 3, 2020. Referred and non-referred patients received for odontostomatological emergencies were included in the study. The data collected were entered in Excel and analyzed using SPSS20.0 software with Chi2 tests performed between certain variables with a significance level set at 0.05. Results Non-referred patients represented 64.9% (n = 131) of the study population and referred patients 35.1% (n = 71). Emergencies were infectious in 74.7% (n = 151) of cases and traumatic in 14.3% (n = 29). Acute apical periodontitis was encountered in 44.6% (n = 90), cellulitis in 16.4% (n = 33) and pulpitis in 9.4% (n = 19) of cases. Therapeutic attitudes were dominated by dental avulsion in 56.4% (n = 114) of cases, pulp sedation in 9.4% (n = 19) of cases and mono-maxillary restraint in 8.4% (n = 17) of cases. Conclusion Despite the risk of contamination and possible dissemination of the covid19 virus, the continuity of oral care must be ensured because of the emergencies that can jeopardize the functional or even vital prognosis of patients. Certain recautions must therefore be taken at the level of the structures of care of these affections.

Background Cardiovascular complications in Marfan syndrome (MFS) make all its seriousness. Taking as a basis the Ghent criteria, we conducted a family screening from an index case. The objective was to describe the clinical characteristics of MFS anomalies and to detect cardiovascular complications in our patients. Case presentation Six subjects were evaluated. Patients had to be in the same uterine siblings of the index case or be a descendant. The objective was to search for MFS based on the diagnostic criteria of Ghent and, subsequently, detecting cardiovascular damage. The average age was 24 years. The examination revealed three cases of sudden death in a context of chest pain. Five subjects had systemic involvement with a score ≥ 7 that allowed to the diagnosis of MFS. Two patients had simultaneously ectopia lentis and myopia. In terms of cardiovascular damage, there were three cases of dilatation of the aortic root, two cases of aortic dissection of Stanford’s type A with severe aortic regurgitation in one case and moderate in the other. There were three patients with moderate mitral regurgitation with a case by valve prolapse. Conclusion The family screening is crucial in Marfan syndrome. It revealed serious cardiovascular complications including sudden death and aortic dissection.

Introduction: Ameloblastic fibro-odontoma (AFO) is a benign odontogenic tumor of mixed origin. It is often asymptomatic and can be diagnosed by a delayed eruption of a permanent tooth. AFO is often associated with one or more impacted teeth. Observation: The patient in the reported case was a 20-year-old girl, who consulted us because of pain associated with functional impairment in the left mandibular region for approximately 4 years. Intraoral examination demonstrated bud-like lesion at the location of the missing left lower molars. The computed tomography scan showed intralesional calcifications and dental densities. Enucleation was performed under general anesthesia. Excised tissues included two teeth, with their pericoronal bags, and hundreds of microelements isolated or embedded in membranes. Macroscopic examination showed >400 odontomas, and 28 membranous portions containing other odontomas, apart from permanent teeth. Postoperative recovery was satisfactory. Conclusion: It is an extensive odontogenic tumor often associated with an impacted tooth.

Patient: Female, 32 Final Diagnosis: Obstructive primary cardiac T-cell lymphoma Symptoms: Right heart failure Medication: — Clinical Procedure: None Specialty: Cardiology Objective: Rare disease Background: Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. Case Report: Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. Conclusions: The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

Hydatidosis, an anthropozoonosis caused by the development of theLa localisation péricardique d’

Resume Introduction Les facteurs de risque cardio-vasculaire sont en nette augmentation dans les pays en voie de developpement. Parmi ces facteurs, la dyslipidemie est souvent retrouvee, cela liee aux changements des habitudes comportementales et alimentaires (OMS, 2006). La dyslipidemie est une « modification pathologique primitive ou secondaire des lipides seriques », c’est une anomalie metabolique et chronique caracterisee par une elevation persistante des TG, du LDL-c et une diminution du HDL (Attias et al., 2013–2014). L’objectif de cette etude etait de determiner la prevalence de la dyslipidemie et de donner le profil lipidique de la population de Gueoul. Patients et methode Nous avons effectue une etude observationnelle, transversale, descriptive exhaustive sur les Senegalais ayant 35 ans ou plus, residant a Gueoul depuis au moins 6 mois. Le bilan lipidique (cholesterolemie totale, triglyceridemie, HDL-cholesterol, LDL-cholesterol) etait systematique. Le prelevement etait fait apres 12 heures de jeune. Resultats La dyslipidemie etait retrouvee dans 61,3 % des cas avec 50 % d’hypercholesterolemie pure ( n = 705). Seuls 20 sujets (2,3 % = 20/864) savaient qu’ils avaient une dyslipidemie. Le taux de depistage etait de 59,8 % ( n = 844). Le type le plus represente etait l’hypoHDLemie (45,6 %) suivie de l’hyperLDLemie (28,8 %). Les triglycerides etaient augmentes dans seulement 2,8 % des cas. Conclusion La prevalence de la dyslipidemie est tres elevee dans nos regions. Elle est souvent associee au genre feminin, a l’HTA, au diabete et a l’obesite. Ses principales causes sont la sedentarite, le changement des habitudes de vie et de comportement alimentaire. Elle est souvent meconnue et sa prise en charge est limitee dans la majorite des cas au regime hypocalorique.

Resume Introduction La recherche de l’atteinte cardiaque chez les patients atteints de polyarthrite rhumatoide permet de prevenir les complications et les place dans une logique de prevention secondaire. L’objectif de cette etude etait d’etudier les parametres electrocardiographiques et echocardiographiques dans une population de patients senegalais atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Patients et methode Nous avons realise une etude transversale descriptive, ayant inclus de facon prospective des patients suivis en ambulatoire dans le service de medecine interne du centre hospitalo-universitaire Aristide Le Dantec de Dakar au Senegal, avec un diagnostic de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Elle a porte sur un echantillon de 73 patients des deux sexes âges d’au moins 18 ans. Apres l’examen clinique, nous avons realise un bilan biologique (CRP, fibrinogene, la VS, les facteurs rhumatoides : Latex et Waaler-Rose, les anti-CCP, les facteurs antinucleaires et les anticorps anti-ENA), un ECG, une echocardiographie standard. Les donnees ont ete analysees selon une etude descriptive des differentes variables avec le calcul des proportions pour les variables categorielles et les parametres de position et de dispersion pour les variables quantitatives. Resultats Au total, 73 patients atteints de polyarthrite rhumatoide sans manifestations cardiaques evidentes remplissant les criteres de definition de l’ACR 1987 ont ete inclus dans l’etude. L’âge moyen etait de 44,17 ± 14,43 ans avec des extremes de 18 et 75 ans. La duree moyenne d’evolution de la PR etait de 5,93 ± 4,78 ans. La notion de rhumatisme inflammatoire familial etait rapportee dans 35,60 % des cas et quasiment un patient sur six presentait au moins un facteur de risque cardiovasculaire (16,96 %). Les anomalies retrouvees a l’echo-doppler cardiaque etaient dominees par une dysfonction diastolique du VG (42,46 %), une augmentation de la masse ventriculaire gauche dans 35,61 %. Des fuites valvulaires de grades variables ont ete mises en evidence touchant tous les orifices mais rarement significatives. Conclusion La realisation de l’echocardiographie chez des patients atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire permet de mettre en evidence des anomalies cardiovasculaires liees a l’evolution naturelle de la maladie.

The central giant cell granuloma (CGCG) of the jaws is a rare benign tumour of the mandible (lower jaw) and the maxilla (upper jaw) characterized by destruction of the bone, loss of symmetry of the face and displacement of teeth and tooth germs, especially in younger patients. It is asymptomatic and present with slow growth often accompanied by dental mobility. The removal of this tumour is mutilating and is followed prosthetic rehabilitation. The aim of this study was to report a case of central giant cell granuloma localizated to the symphyseal region in a young patient. The case reported is that of a 14-year-old girl who received a consultation for a tumor in the symphysical region causing an aesthetic impact. The tumor was firm, painless and had been developing for about a year. The cortical were broken in places, in transverse, sagittal and coronal sections. The treatment consisted of her excision under general anesthesia causing a significant loss of substance. The tumor mass, very hemorrhagic, was extended to the buccal floor. At the end of the intervention, a significant loss of substance was observed. Two months later, a partial adjunct prosthesis was performed. The anatomo-pathological examination showed of several multinucleated giant cells, a few histiocytes, lymphocytes and fibroblasts. The removal of this aggressive tumour remains mutilating, with significant psychological repercussions. More recently, antiangiogenic therapy with interferon alpha has been successfully applied.

Pulmonary embolism and acute aortic dissection are two formidable cardio-vascular emergencies. Their association, although exceptional, is burdened with a heavy mortality in the absence of an early and adapted surgery. We report a case of Standford acute type A aortic dissection associated with fatal pulmonary embolism. This is a 66-years old man with a notion of a long trip received for prolonged chest pain since 3 days, of sudden onset, maximal intensity, tearing, transfixing, migratory, radiating towards the back and the loins, exacerbated by breathing. The examination noted 120 bpm tachycardia, 70% SaO2 desaturation, asymetric blood pressure and asymetric pulse, aortic insufficiency murmur and bilateral crackling rettles at lungs. The chest X-ray showed an enlargement of the upper mediastinum with double-contoured image. The electrocardiogram recorded a regular sinus tachycardia at 132 cycles/min, a lateral sub epicardial ischemia in lateral leads. CT scan revealed total thrombosis of the right branch of the pulmonary artery extending to part of the trunk and an intimal flap from the aortic arch to the abdominal aorta. The evolution was brutally lethal two days after hospitalization. The dissection of the aorta and the pulmonary embolism are medical emergencies whose association poses more difficulties as well on the diagnosis plan but especially therapeutic.

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.

Resume Le faux anevrisme du ventricule gauche est une complication tardive peu frequente de l’infarctus du myocarde. Des formes dites non coronaires ont ete decrites chez le sujet jeune. Dans ce cadre, nous rapportons trois observations. Monsieur M.B., 20 ans, a consulte pour des precordialgies associees a des palpitations. L’examen cardiovasculaire retrouvait une voussure precordiale battante expansive et un souffle systolo-diastolique mesocardiaque. On notait un rythme sinusal avec des extrasystoles ventriculaires a l’ECG. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale de l’arc inferieur gauche. L’echocardiographie-Doppler montrait un volumineux faux anevrisme apical ventriculaire gauche. Mme O.B., 23 ans, a ete admise pour une insuffisance cardiaque globale chez qui l’examen retrouvait un souffle systolique apexien. L’ECG inscrivait une tachycardie sinusale reguliere, une hypertrophie auriculaire gauche et ventriculaire gauche. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale des arcs moyen et inferieur gauches. L’echocardiographie-Doppler revelait un volumineux faux anevrisme apical du ventricule gauche. Monsieur I.S., âge de 24 ans, admis pour la prise en charge d’une insuffisance cardiaque globale. Le patient avait un syndrome inflammatoire non specifique a la biologie, une tachycardie sinusale et des extrasystoles a l’ECG. La radiographie du thorax de face montrait une solution de continuite au niveau de l’arc posterieur de la sixieme cote, une cardiomegalie et une dilatation anevrismale de l’arc inferieur gauche. A l’echocardiographie-Doppler, on notait un volumineux faux anevrisme du ventricule gauche de siege apical.

Objectif : L’objectif de cette etude etait de mettre en exergue le role de l’orthopantomographie dans la prediction des difficultes rencontrees lors de l’avulsion des troisiemes molaires incluses en utilisant l’echelle de Pederson. Materiel et methode : Il s’agissait d’une etude descriptive transversale effectuee au service de chirurgie buccale du departement d’odontologie de l’universite de Dakar. L’etude a dure cinq mois (octobre 2012-fevrier 2013) et a concerne 62 dossiers de patients. Resultats : La tranche d’âge 15-25 ans etait la plus representee (57 %). L’âge moyen des patients etait de 26 ± 9 ans avec des extremes a 15 et 73 ans. Les troisiemes molaires mandibulaires a deux racines representaient 92 %. Les angulations horizontale (44 %) et mesioangulaire (35 %) etaient les plus representees. La moitie de notre echantillon presentait une profondeur d’inclusion de position A (54 %). La position I representait 40 % des cas. Dans 33 % des cas, il n’y avait pas de contact entre les racines et le canal mandibulaire. Conclusion : L’ortopantomogramme permet de grader le niveau de difficulte de l’extraction selon l’echelle de difficultes de Pederson. Dans notre echantillon, l’extraction etait jugee difficile dans 69 % des cas, moderee dans 21 % et facile dans 33 %.

Pheochromocytoma may be responsible for various cardiac events including cardiac arrhythmias Authors report the case of a young child in whom pheochromocytoma was revealed by a junctional tachycardia The determination of urinary free catecholamines found a very high level of Noradrenaline and the abdominal CT showed a left hilar renal mass

Introduction : Le syndrome cardio-renal (SCR) est un trouble physiopathologique du coeur et des reins dans lequel une dysfonction chronique ou aigue de l’un peut induire une dysfonction chronique ou aigue de l’autre. En Afrique et au Senegal en particulier l’incidence du syndrome cardiorenal est mal connue. L’objectif de cette etude etait d’apprecier la prevalence du SCR en milieu cardiologique. Methodes : Nous avons mene une etude retrospective incluant tous les insuffisants cardiaques ayant une alteration de leur fonction renale et hospitalises entre avril 2010 et avril 2011 au service de cardiologie. Les donnees etaient analysees avec le logiciel statistique Epi-info 3.5.3. Resultats : Nous avons inclus 36 patients. La prevalence etait de 3,7% avec une predominance masculine (sex-ratio a 1,77) et un âge moyen a 56,9 ans [30-92]. Les antecedents etaient domines par l’hypertension arterielle (52,77%) et le diabete (19,4%). Les principales etiologies etaient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie etait dominee par la dyspnee (69,4%) et les oedemes (50%). On notait une anemie (17 patients). La clairance moyenne (MDRD) a 46 ml/min. L’echocardiographie Doppler retrouvait majoritairement des troubles de la cinetique (89,3%), une dysfonction systolique VG (71%). Les 3 echographies renales etaient normales. Six deces (16,7 %) etaient notes. Conclusio n: Le syndrome cardio-renal est une realite et marque un tournant dans l’evolution de toute cardiopathie et nephropathie. Sa prevalence en milieu cardiologique senegalais est faible. Des etudes prospectives et multicentriques sont necessaires pour une meilleure evaluation au Senegal.

Summary Background: The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure. Methods: Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models. Results: Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates. Conclusions: Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.

Objectives: The objectives of this study were to evaluate the prevalence of the right ventricular infarction and its diagnostic, therapeutic and prognostic characteristics. Patients and methods: A single center retrospective study was carried out between January 2011 and December 2014. Patients who were diagnosed with right ventricular infarction at electrocardiogram and echocardiography were recruited. Outcomes: Among the 159 patients hospitalized for myocardial infarction, 10 had myocardial infarction extended to the right ventricle (6.3%). It occurred on an inferior infarction in 7 cases out of 35 and anterior infarction in 3 cases out of 124. The mean age was 53 years and sex ratio M/F of 2.33. All patients had at least 3 cardiovascular risk factors. Right-sided heart failure was found in 4 patients. Right ventricular infaction was associated with inferior STEMI in 7 patients, and anterior STEMI in 3 patients. Echocardiography showed right ventricular dilatation and impaired right ventricular systolic function in respectively 6 cases. Thrombolysis was performed in 7 patients and rescue angioplasty in 1 case. A regressive cardiogenic collapse was noted in 6 cases and one death in 1 case. Conclusion: Right ventricular infarction is relatively rare and usually related to an extension of an inferior myocardial infarction. Hemodynamic instability is of worse prognosis.

Vasospastic angina is considered rare but its prevalence is probably underestimated, especially in the case of atheromatous coronary lesions. Its diagnosis remains important because of its poor prognosis and its therapeutic features. We report a clinical case illustrating the issue of vasospastic angina’s diagnosis. Diagnostic ways such as coronary spasm challenge tests must be adapted to the evolution of the techniques and the use of coronary angiography nowadays, in particular the preferential use of the radial pathway especially in women with a smaller radial caliber compared to men.

Aims Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes. We sought to describe factors prognostic of re-admission and death in this developing population. Methods and results Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in a model excluding the geographic region were a history of malignancy and severe lung disease, admission systolic blood pressure, heart rate and signs of congestion (rales), kidney function (BUN), and echocardiographic ejection fraction. In a model including region, the Southern region had a higher risk. Age and admission sodium levels were not prognostic. Predictors of 180-day mortality included malignancy, severe lung disease, smoking history, systolic blood pressure, heart rate, and symptoms and signs of congestion (orthopnoea, peripheral oedema and rales) at admission, kidney dysfunction (BUN), anaemia, and HIV positivity. Discrimination was low for all models, similar to models for European and North American patients, suggesting that the main factors contributing to adverse outcomes are still unknown. Conclusion Despite the differences in age and disease characteristics, the main predictors for 6 months mortality and combined 60 days re-admission and death are largely similar in sub-Saharan Africa as in the rest of the world, with some exceptions such as the association of the HIV status with mortality.

La tumeur fibreuse solitaire est une tumeur fibroblastique benigne des tissus mous. Plusieurs localisations ont ete decrites ; celles de la cavite buccale ont une prevalence de 3 %. L’etiologie est encore inconnue mais plusieurs auteurs ont retrouve des antecedents de traumatismes. Dans cet article, on rapporte un cas de tumeur fibreuse solitaire evoluant dans la joue gauche, survenue chez une patiente âgee de 58 ans. L’exerese de la tumeur sous anesthesie locale a permis l’examen anatomo-pathologique qui a diagnostique une tumeur fibreuse solitaire.

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.

Introduction: Rheumatic heart disease (RHD) is the commonest cause of valvular heart disease and a common cause of heart failure in sub-Saharan Africa (SSA). Atrial fibrillation (AF) complicates RHD, precipitates and worsens heart failure and cause unfavourable outcomes. We set out to describe the prevalence, clinical characteristics and outcomes of valvular atrial fibrillation in a cohort of African patients with acute heart failure (AHF). Methods: The sub-Saharan Africa Survey of Heart Failure (THESUS-HF) was a prospective, observational survey of AHF in nine countries. We collected demographic data, medical history and signs and symptoms of HF. Electrocardiograms (ECGs) were done in a standard fashion. AF was defined as either a history of AF or AF on the admission ECG. Using Cox regression models, we examined the associations of AF with all-cause death over 180 days and a composite endpoint of all-cause death or readmission over 60 days. Results: There were 1 006 patients in the registry. The mean age was 52.3 years and 50.8% were women. AF was present in 209 (20.8%) cases. Those with AF were older (57.1 vs 51.1 years), more likely to be female (57.4 vs 49.1%), had significantly lower systolic (125 vs 132 mmHg) and diastolic (81 vs 85 mmHg) blood pressure (BP), and higher heart rates (109 vs 102 bpm). Ninety-two (44%) AF patients had valvular heart disease. The presence of AF was not associated with the primary endpoints, but having valvular AF predicted death within 180 days. Conclusion: AF was present in one-fifth of African patients with AHF. Almost half of the AF patients had valvular disease (RHD) and were significantly younger and at risk of dying within six months. It is important to identify these high-risk patients and prioritise their management, especially in SSA where resources are limited.

Introduction Le syndrome cardio-rénal (SCR) est un trouble physiopathologique du cœur et des reins dans lequel une dysfonction chronique ou aiguë de l’un peut induire une dysfonction chronique ou aiguë de l’autre. En Afrique et au Sénégal en particulier l’incidence du syndrome cardio-rénal est mal connue. L’objectif de cette étude était d’apprécier la prévalence du SCR en milieu cardiologique. Méthodes Nous avons mené une étude rétrospective incluant tous les insuffisants cardiaques ayant une altération de leur fonction rénale et hospitalisés entre avril 2010 et avril 2011 au service de cardiologie. Les données étaient analysées avec le logiciel statistique Epi-info 3.5.3. Résultats Nous avons inclus 36 patients. La prévalence était de 3,7% avec une prédominance masculine (sex-ratio à 1,77) et un âge moyen à 56,9 ans [30-92]. Les antécédents étaient dominés par l’hypertension artérielle (52,77%) et le diabète (19,4%). Les principales étiologies étaient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie était dominée par la dyspnée (69,4%) et les œdèmes (50%). On notait une anémie (17 patients). La clairance moyenne (MDRD) à 46 ml/min. L’échocardiographie Doppler retrouvait majoritairement des troubles de la cinétique (89,3%), une dysfonction systolique VG (71%). Les 3 échographies rénales étaient normales. Six décès (16,7 %) étaient notés. Conclusion Le syndrome cardio-rénal est une réalité et marque un tournant dans l’évolution de toute cardiopathie et néphropathie. Sa prévalence en milieu cardiologique sénégalais est faible. Des études prospectives et multicentriques sont nécessaires pour une meilleure évaluation au Sénégal.