Search

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.Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique.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.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.

Prurigo is one of the most common dermatological conditions during HIV infection and AIDS. It appears as an immunosuppression marker associated with HIV infection. The study objective was to determine the prevalence of prurigo in people living with the human immunodeficiency virus (PLHIV) in Fousseyni N'Daou Hospital of Kayes, and to describe the socio-demographic aspects of patients and lesions associated with prurigo among PLHIV.It was a descriptive cross-sectional study included all cases of HIV infected patients with prurigo in the Dermatology-Venomology Department of Fousseyni N'DAOU Hospital from January 1, 2015 to August 31, 2015.We collected 121 cases of prurigo. The hospital prevalence was 14.5% among PLHIV with 65% Female and the average age was 34.8 years old (SD: 15-81 years). The elementary lesions associated with prurigo were seropapules (40.2%), vesiculo-crusts (13%), excoriated papules (33.3%), lichenified papules (10.8%), and cicatricial lesions (2.7%). The prurigo was generalized in 68.5% of cases and localized in 31.24%. More than half of our patients had weight loss, fever, diarrhea and oral candidiasis in their medical history. Patients were infected with HIV1 in 60.03% and HIV1+ 2 in 24.3%. More than the half of our patients had a CD4 count inferior to 250 cells/mm3 at the time of prurigo diagnosis.In our study, prurigo remains a common condition in PLHIV, particularly in patients with low CD4 counts. Early detection and rapid antietroviral therapy can reduce the frequency of prurigo in PLHIV.Le prurigo est l'une des affections dermatologiques les plus fréquentes au cours de l'infection à VIH et du sida. Il apparait comme un marqueur de l'immunodépression associée à l'infection VIH. L'objectif était de déterminer la prévalence du prurigo chez les personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à l'hôpital Fousseyni N'Daou de Kayes (HFDK) et décrire le profil sociodémographique des patients et les lésions associées au prurigo chez les PVVIH à HFDK.Il s'agissait d'une étude transversale descriptive de tous les cas de prurigo chez les PVVIH dans le service de Dermatologie-Vénéréologie de l'hôpital Fousseyni N'DAOU durant la période du 1Nous avons colligé 121 cas de prurigo. La prévalence hospitalière a été de 14,5% chez les PVVIH. Le sexe féminin a représenté 65% des cas. L'âge moyen a été de 34,8 ans (extrêmes :15 – 81 ans). Les lésions élémentaires associées au prurigo ont été les séropapules (40,2%), vésiculo-croutes (13%), papules excoriés (33,3%), papules lichenifiés (10,8%), lésions cicatricielles (2,7%). La forme généralisée a représenté 68,5% et la forme localisée 31,24%. Plus de la moitié de nos patients avait la notion d'amaigrissement, de fièvre, de diarrhée et des candidoses buccales dans leurs antécédents. Le VIH1 a représenté 60,03% et l'association VIH1 et VIH2 a représenté 24,3% des cas. Plus de la moitié de nos patients avait un taux de CD4 inférieure à 250 cellules/mmDans notre étude, le prurigo reste une affection fréquente chez les PVVIH, particulièrement lorsque le taux de CD4 est bas. Un dépistage précoce et le traitement antirétroviral rapide permet de réduire la fréquence du prurigo chez les PVVIH.

This study was conducted during the rainy season of 2017 in the agricultural areas at Mouila, with the aim to assess the determination of susceptibility ofCette étude a été menée en 2017 pendant la saison des pluies dans les zones d’exploitations agricoles à Mouila, afin de déterminer le statut de sensibilité des membres du complexe

The long-lasting insecticidal nets (LLINs) have been promulgated to compensate the low re-impregnation rate of conventional mosquito nets. Today, the cornerstone of the fight against malaria vectors is based on a large distribution of these LLINs for universal coverage. Despite this promotion, the question of their effective life in operational conditions remains unresolved. Between September and October 2013, a survey was conducted in 11 districts of Senegal where LLINs were sampled and routed to the laboratory for assessing their physical integrity and biological effectiveness. A total of 207 LLINs that were sampled in the 11 districts have been monitored during this study. Our results showed that Olyset® Net and PermaNet® 2.0 are the most represented brands in the districts. These two major brands have a good biological efficiency providing a high rate of knockdown despite their failing physical integrity.Les moustiquaires imprégnées à longue durée d'action (MILDA) ont été promues pour pallier le faible taux de réimprégnation des moustiquaires conventionnelles. Aujourd'hui, la pierre angulaire de la lutte antivectorielle repose sur une forte distribution de ces MILDA pour une couverture universelle. En dépit de cette promotion, la question de leur durée de vie effective en conditions opérationnelles reste toujours posée. Entre septembre et octobre 2013, une enquête a été menée dans 11 districts du Sénégal. Des MILDA y ont été échantillonnées et acheminées au laboratoire pour évaluer leur intégrité physique et leur efficacité biologique. Au total, 207 MILDA ont été collectées dans les 11 districts suivis au cours de cette étude. Nos résultats ont montré que les deux marques majoritairement distribuées présentaient une bonne efficacité biologique, car induisant un taux élevé de

Women widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali.A 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later.The high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.

Urban malaria is a major public health problem in Africa. In Senegal, the environmental changes seem to favor the persistence of malaria transmission in Dakar suburbs by creating, throughout the year, potential breeding sites of malaria vectors. In such a situation and in a context of a growing threat of insecticide resistance in anopheline vectors, the larval control making use of products from biological origin or growth regulators could represent an additional tool to the current strategies developed against anophelines. In this study conducted in 2012, the efficiency and residual effect of three biological larvicides (VectoBac

Malaria incidence has markedly declined in the Mbour, Fatick, Niakhar and Bambey districts (central and western Senegal) thanks to a scaling up of effective control measures namely LLINs (Long Lasting Insecticide Treated Net), ACTs (Artesunate Combination Therapy) and promoting care seeking. However malaria cases are now maintained by foci of transmission called hotspots. We evaluate the role of anopheles breeding sites in the identification of malaria hotspots in the health districts of Mbour, Fatick, Niakhar and Bambey. Surveys of breeding sites were made in 6 hotspot villages and 4 non-hotspot villages. A sample was taken in each water point with mosquito larvae by dipping method and the collected specimens were identified to the genus level. Additional parameters as name of the village and breeding sites, type of collection, original water turbidity, presence of vegetation, proximity to dwellings, geographic coordinates, sizes were also collected. Sixty-two water collections were surveyed and monitored between 2013 and 2014. Temporary natural breeding sites were predominant regardless of the epidemiological status of the village. Among the 31 breeding sites located within 500 meters of dwellings in hotspots villages, 70% carried Anopheles larvae during the rainy season while 43% of the 21 breeding sites located at similar distances in non-hotspot villages carried Anopheles larvae during the same period (P = 0.042). At the end of the rainy season, the trend is the same with 27% of positive breeding sites in hotspots and 14% in non-hotspots villages. The breeding sites encountered in hotspots villages are mostly small to medium size and are more productive by Anopheles larvae than those found in non-hotspot area. This study showed that the high frequency of smallest and productive breeding sites around and inside the villages can create conditions of residual transmission.

Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context.We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors.During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5).The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

The recent decline of malaria transmission in central-western of Senegal after a scaling up of control measures gives an open window for interventions toward malaria elimination. As a consequence, malaria transmission is now occurring as hotspots. The aim of the project is to evaluate whether target control measures combining indoor residual spraying (IRS) with chemoprophylaxis can virtually eliminate malaria in hotspots. Targeted villages located in four (4) health districts (Mbour, Fatick, Niakhar and Bambey) were sprayed in august 2013 with Actellic® 300 CS (Pirimiphosmethyl). Our objective in this study is to evaluate the acceptability of IRS in the population. IRS is a very complex intervention that requires strong adhesion of populations. After its implementation, 370 households have been interviewed. The results of this survey showed good acceptability of IRS using Actellic® 300 CS, with 97.8% of beneficiaries who declared that IRS is good and even excellent for the community. Despite inconveniences that may arise during intervention, including the preparation of structures to be treated, 98% of respondents were not disturbed in their daily activities. 98.6% of responders declared that sprayers were working with professionalism and almost all households (99.7%) are willing to accept IRS next year. The survey revealed a good acceptability of indoor residual spraying in hot spots located in central-western of Senegal; spraying with Actellic® 300 CS did not cause a problem to the targeted populations. Finally, there is great satisfaction in the population due a huge reduction of mosquito nuisances.

Specify epidemioclinical and legal aspects of sexual abuse among minors and evaluate the cost of care in Dakar.This is a retrospective multicenter cross-sectional study on sexual abuse among minors over a period of four years from 1st January 2006 to 31st December 2009. Four maternities were targeted: the Social Hygiene Institute of Medina, health center Roi-Baudouin Guédiawaye, the Pikine hospital and health center Youssou-Mbargane-Diop of Rufisque.During the study period, 252 child victims of sexual abuse were supported at four health facilities on a total of 272 sexual abuses of all ages, a frequency of 92.64%. The epidemiological profile of our patients was a child of 11 years old on average, female (100%) and living in the suburbs of Dakar (68.1%). Children were often abused during working hours (31.7%), outside the family environment and often by someone known to the victim (72.6%). Genito-genital contact was the most common mode of sexual contact (80.9%) with vaginal penetration in 61% of cases. Almost all of the victims (92.1%) came to consult, accompanied by their parents, between the 1st and 4th day after the sexual abuse (70%). The examination usually revealed a hymenal trauma (59.9%) of which nearly half (49%) consisted of old lesions. 56.9% of victims had a post-traumatic stress disorder and 31.1%, mutism. We recorded six (6) pregnancies, 2% of our sample. A case of HIV infection was recorded on a sample taken 72hours after sexual abuse. Control of three months HIV serology was requested in 7.1% of cases and only 20% of children had received antiretroviral prophylaxis. Antibiotic prophylaxis had been performed in 13.7% of cases using doxycycline as drug of choice (75%). Only 29% of our patients had received emergency contraception progestin and psychological care concerned only 22% of children. On the legal aspects, 46% of our patients had filed a complaint. Prosecutions were 38%, 45% of which were convicted and 21% were acquitted. The rate of out-of-court settlement was 35% and the time limit for settlement by the justice was on average 6 months with extremes of one month and 24 months. The average cost of care was estimated at 17,010 CFA francs (26 euros) taking into account the consumables used for clinical examination (sterile gloves, catheter, syringe), analysis and prescription drugs.The sexual abuse of minors is a disturbing reality that raises rightly universal reprobation. In Senegal, this mainly affects children and its magnitude is increasing over the years. Improved support for victims necessarily involves raising public awareness through the media and the development of specialized structures in the management of sexual abuse.

Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis.A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining.One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining.Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients.

Conjugal infertility in Senegal is surrounded with accusatory believes most oftenly unfavourable to woman who is generally incriminated and, in somes cases, repudied. This study is an account of a research work carried out on conjugal infertility causes analysis, using post coital and cytospermiologic tests. It aims to help our populations to better appreciate the conjugal infertility by giving them elements for an objective appraisal of this flail, particulary about the mutual responsabilities of the two partners. In a first stage, we run post coital tests with 4636 Negro-African infertile couples living in Senegal, at the Clinical Cytology, Cytogenetics, and Reproductive Biology Laboratory of Aristide Le Dantec Hospital in a period dated from 1983 to 1996. Post coital tests were abnormal for 3838 couples and 3150 of them had anomalies incriminating the husbands. In a second stage, post coital tests were suggested to these 3150 husbands, but only 2842 accepted the post coital test suggestion. The others refused it for sociocultural reasons. It stooks out of this study that: the responsability in the conjugal sterility is mixed and shared by both partners in 43.78% cases, the masculine responsability (38.30%) ruled the feminine one (17.92%) contrary to local believes, almost one husband out of four (23.89%) presented azoospermy, the feminine responsability is ruled by infection factors that represented half of the glair abnormalities (50%). These results contradict the present local mentalities and believes which accuse principally the woman.

From February 25th to June 28th of 1999, the authors carried out a prospective and descriptive study of the use of the preventive male condom in schools and universities through an anonymous inquiry questionary dealing with 1065 persons involving 650 boy students, 181 girl students, 128 college boys and 106 college girls. The questionnary involved 5 headings: the socio-demographic characteristics, the use of condoms, the sources of information and supply, the number of partners, and information about the prices. The inquiry essentially let out that: 56.4% of target population used the male condom. Boys used condoms more often than girls. Most of the boys who used condoms were unmarried. Young people used condoms for preventive purpose against STD/AIDS and for contraception in 82.5 cases. The reason more oftenly given by those who didn't like condoms was the reduction of the sexual delight. The mature age and highest level of instruction were factors predicting the use of condoms. About 2/3 of the information sources on condoms were from media. The drugstore was the main source of supply. More than half of the users wished an extension of the Condom commercialization. The problems of acceptability and access to condoms related more of religions and socio-cultural order than geographical and financial.

The purpose of this study was to compare the clinical characteristics of acne in adult women in France and in sub-Saharan Africa.Women aged 25 years and over consulting for acne in hospital dermatology departments in Créteil, Dakar and Bamako were included. The data collected concerned a health questionnaire, previous history of acne, clinical examination and use of skin lighteners. Patient characteristics were expressed as absolute numbers and percentages for qualitative variables and as means and standard deviations or medians, and first and third quartiles, for quantitative variables based on distribution.There was no significant difference between the groups in terms of body mass index, tobacco smoking, age at first period and use of contraceptives. The presence of a lozenge-shaped area of abdominal hyperpilosity was more common in women of dark phototype, with no other signs of hyperandrogenism being seen. Acne was more severe in Dakar and in Bamako than in Créteil. Post-inflammatory pigmentation and involvement of the cheeks and forehead occurred significantly more frequently in patients of dark phototype. Involvement of the chin was more common in light-skinned subjects. While none of the women not of African origin performed voluntary skin lightening, this practice was recorded in half of women of African origin in Créteil and in Africa.This study shows clinical differences in acne in adult women according to phototype and geographical zone.

This study evaluated the attitudes and practices of the personnel with respect to the prevention of nosocomial infections in a hospital environment. We carried out a qualitative survey of all categories of personnel between July 1998 and March 1999, at the five regional hospitals in Senegal (Thiés, Kaolack, Saint-Louis, Diourbel, and Louga). Data were collected in two ways: using a questionnaire to evaluate knowledge and by observing the attitudes and practices of the personnel. Hands were rarely washed before and after each procedure and surgical washing was often performed in poor conditions. The decontamination of soiled equipment was ineffective. Reusable instruments were washed directly with bare hands or by individuals wearing used surgical gloves. The equipment used for sterilization was dilapidated and unsuitable and the norms for sterilization were seldom respected. Circulation in the region of the operating theatre was disorganized, if not anarchic. The personnel had a high risk of contamination from blood. Biomedical waste was not decontaminated: it was collected poorly and disposed of directly into the environment. None of the sites visited had a program of waste incineration. In conclusion, at the sites visited, there is a high risk of nosocomial contamination during care and the reuse of equipment, for both the staff and the patients treated.

A study was performed to appreciate the importance of malaria in the low valley of the Senegal River North Bank in Mauritania. The malaria incidence was assessed among patients visiting the regional hospital of Rosso (Trarza region) for a "presumptive malaria", a diagnosis assigned by the clinicians based on fever and other suggestive symptoms of malaria. The malaria prevalence rate was also measured in schoolchildren. A total of 1431 febrile outpatients were sampled for thick and thin blood films, between December 2004 and March 2005, August and November 2005, and April and July 2006. The average malaria prevalence rate was 2.5% (36/1431). It varied from 0.7% (4/576) for the period from December 2004 to March 2005 to 3.8% (18/475) from August to November 2005 and 2.1% (8/380) from April to July 2006. Of the 1040 school children of 6 to 14 years of age, the average malaria parasite prevalence rate was 0.9% (9/1040). It was 0.4% (1/224), 1.7% (7/413) and 0.2% (1/402), Respectively, in February 2004 (cold and dry season), October 2005 (rainy season) and June 2006 (hot and dry season). These very low levels of malaria endemicity and incidence are comparable with those recorded in the same area on the (South) bank of the river in Senegal. In this context of unstable malaria, characterized by the absence or a low level of natural immunity of the population, an effective monitoring is essential for an early detection and a damming up of the malaria epidemic blazes that likely occur.

The impact of intermittent presumptive treatment (IPT) on the immunity of pregnant women in Senegal is still not very well known. We conducted a prospective study at the Roi-Baudouin maternity of Guediawaye in Senegal to assess IgG antibodies production against MSP1, GLURP and DBL5 in pregnant women under IPT. Blood samples were collected from the participating women at inclusion and delivery. Samples were analyzed after centrifugation for the detection of IgG antibodies in sera by Elisa. Informed consent was given by each study participant prior to their inclusion. A total of 101 eligible women aged from 18 to 44 were included in this study. Multigravidae women represented 70.3% of the study population, whereas primigravidae accounted for 29.7%. The IgG level decreased slightly from inclusion to delivery for the women with regard to anti-MSP1 (83.1at inclusion versus 79.5 at delivery, p = 0.52) as well as anti-GLURP-R2 (84.1 at inclusion versus 75.9 at delivery, p = 0.16). After adjustment for number of pregnancies, there was a significant decrease in the production of anti-VAR2CSA between inclusion and delivery (p0.05). By reducing the incidence of malaria during pregnancy, IPT reduced the acquisition of placental parasites antibodies suppressors which could delay the development of protective immunity against malaria. The application of IPT in pregnant women would thus be more appropriate in hypoendemic areas where malaria exposure is lower.

Merkel cell carcinoma (MCC) is a rare tumour with a poor prognosis. Rare cases of paraneoplastic neurological syndrome have been associated with this type of tumour, namely myasthenic syndrome of Lambert-Eaton and encephalomyelitis. We report the first case of severe necrotizing myopathy with anti-Hu antibodies complicating MCC.We describe the case of a 58-year-old woman with Merkel cell carcinoma (MCC) of the forearm complicated by severe necrotizing myopathy associated with the presence of anti-Hu antibodies. This myopathy occurred 3 months after complete remission of MCC. The patient was treated with high-dose corticosteroids combined with two intravenous infusions of immunoglobulins. Her neurological status deteriorated despite this treatment. Pararaneoplastic syndrome (anti-Hu antibodies, necrotizing myopathy) complicating MCC was suspected. There was no visible tumour relapse. After multidisciplinary discussion, it was decided to supplement treatment with chemotherapy (carboplatin and VP-16). The patient died 20 days after the first course of chemotherapy.Severe necrotizing myopathy with anti-Hu antibodies may be added to the list of possible paraneoplastic syndromes associated with Merkel cell carcinoma.

Two cases of Crimean-Congo haemorrhagic fever (CCHF) occurred in two French tourists during their visit in Senegal in November 2004. Febrile and hemorrhagic syndrome with ulorrhagia, petechiae, haematemesis, haematomas associated with biological signs of disseminated intramuscular coagulation were observed. For the first case who had a medical evacuation to France before diagnosis, Crimean-Congo virus infection was revealed by laboratory tests performed by the National Reference Center for Hemorrhagic Fevers (NRCHF, Institut Pasteur, Lyon) and secondly by the Centre de Référence OMS sur la Recherche des Arbovirus et des virus des Fièvres Hémorragiques (CRORA) in the Dakar Pasteur Institute (DPI). The second case diagnosed by the CRORA died after clinical deterioration with liver failure and severe haemorrhages. Healthcare workers and family members who had contact with tissue or blood from patients were followed up after the putative exposure either in France or in Senegal.

Establish specificity, sensibility of clinical pelvimetry using X-ray pelvimetry as the reference exam; Assess reproducibility of clinical pelvimetry comparing two physicians' findings.During a longitudinal study of 29 months, we compared clinical clinical pelvimetry findings of 114 patients with results of X-ray pelvimetry. Reproducibility was assessed comparing pelvic measures performed by two physicians for 40 patients. Based on caesarean ratio of 7% due to cephalopelvic disproportion in our department, the required size of sample was estimated between 114 and 200 patients. Statistics tests used were the independent test of Chi-2, the Kappa coefficient, the T-test and discriminant analyze. A p-value of 0.05 was considered as significant.The sensibility of clinical pelvimetry was found at 83.7%, specificity at 88.9%. Positive predictive value was 97.6% and negative predictive value founded at 50%. Best concordances were obtained for the measures of vertical diameter of Michaelis, Trillat diameter and assessment of sciatic spines and inominated lines. Clinical pelvimetry was reproducible with a kappa value of 0.62.Clinical pelvimetry, due to his good specificity and satisfactory reproducibility is still relevant in case of unavailability of X-ray pelvimetry as it happens in Africans ressourceless countries.

The aim was to undertake a pilot study of integrated surveillance of yellow fever (YF) in Senegal, based on i) a human surveillance involving healthcare centers in the 11 administrative regions of the country ii) an entomological surveillance including domestic and sylvatic environment and iii) screening mosquitoes for YF virus using RT-PCR method. The integrated approach of human and entomological surveillance was conducted for 2 years (2003-2004). Surveillance in human population was based on screening samples of YF suspected cases (i.e. patients with acute (or = 15 days) febrile illness with jaundice) for YF specific IgM antibodies. The entomological surveillance was carried out by collecting mosquitoes using human landing catch method and attempt to detect YF virus on them by RT-PCR. Forty five percent of the healthcare centres notified at least one suspected YF case during 2003-2004 periods. Among the 342 sera collected over 2 years, 2 revealed anti-YF IgM antibodies leading to investigations which allowed identification of the source and place of infection and implementation of a reactive focused YF immunization campaign. In addition, YFV was detected by RT-PCR from 49 out of 1762 mosquitoes tested and distributed as follows: in the sylvatic environment, 29 from Aedes furcifer and 1 from Aedes aegypti while in the domestic area, 15 Aedes aegypti and 4 Aedes furcifer. RT-PCR was found more sensitive and rapid than viral isolation for YF virus detection in mosquitoes. The pilot study in Senegal for YF surveillance integrating human and entomological parameters in domestic and sylvatic areas showed that this approach is very efficient in detecting yellow fever virus circulation due to the complementarity of the two systems. Therefore, in the light of the encouraging results presented herein, similar studies in different context and areas are needed to further validate and allow the extension of its application to other endemic regions of Africa.

We report three patients (respectively 36, 52 and 52 years old) with a long history of hidradenitis suppurativa associated with pubic lymph oedema.Dramatic pubic oedema was noted, with "rugby-ball and bag-like" tumefaction associated with nodules and fistula. There was no evidence of lymph node involvement or abdominal lymphatic blockade. One patient underwent surgical excision combined with split-thickness graft and complete healing ensued. Pathological examination of the excised tissue showed telangiectasia and fibrosis.Chronic lymphedema affects patients with severe and long-lasting disease. The complication is caused by chronic and recurrent inflammation due to HS with subsequent blockade or destruction of local lymph drainage routes. Once this complication appears, no medical treatment is effective.

The seroprevalence against heartwater for maure zebus coming from Mali and Mauritania is analysed by indirect ELISA using the major antigenic protein number 1-B (MAP1-B). Sero-epidemiological results realized on maure zebu cattle give a good adequation between the abundance or absence of the vector tick in the two countries for 98% of prevalence in Mali (infected area) and 0% of prevalence in Mauritania (non infected area).

We present a retrospective study of eight cases of vulvar bilharziasis who attended our institution for dermatological visit from 1998 to 2001. The mean age was 11 years old (range: 7 to 13). The clinical examination found wart like or ulcerated nodules, papules and/or diffuse infiltration. All the lesions were located on the left side of the vulvae (labium) and/or the groin. S. haematobium was the only causative agent identified in all specimens. The exclusive left side location of the lesions reported here has never been mentioned in the previous studies. The physiopathology of this finding is possibly linked to factors similar to those explaining the Cockett syndrome. Further examinations, including ultrasonography of the pelvis in larger series, are needed to learn more about the mechanism of this clinical entity.

Caesarean section is our first activity in obstetrical surgery. Due to his high frequency and the maternal and foetal prognostic, we have undertaken to do a prospective, longitudinal, exhaustive study concerning all women whose delivery necessitated a caesarean section, between 01 January and 31 December 2001 in Gynaecological and Obstetrical Clinic of University Hospital Center Le Dantec. Our objectives were: describe the epidemiological aspects, evaluate the maternal and foetal prognosis of caesarean sections performed in University Hospital Center. The study revealed that 25.1% of births necessitated a caesarean section. The average age was of 26; the mean parity of 2; the medium height of 161cm. 26.4% of patients were evacuated and coming from the health centers in majority (41.9%) with unmedicalised evacuation in 44.9% of cases. 78.7% of patients have realised at least 3 antenatal consultations. The mains indications were cephalopelvic disproportions (34.9%) and foetal distress (18.9%). The classification per indications group revealed that 37.2% were "prudence caesarean section", 40.1% were "obligator's caesarean section" and 22.7% "necessity's caesarean section". The mean Apgar's score at the birth was 6,5 at first minute. 12 maternal deaths were noted, means 0.8% of global lethality; the morbidity was at 10.5% of cases, represented mainly by postoperative infection (64.3%). The per natal mortality was estimated to 5.9% and neonatal morbidity to 32%. About the quality of caesarean sections, the temporal (24h/24) and financial(kit of caesarean section) accessibilities are more satisfying; otherwise the quality of surgical act and the postoperative follow-up was not optimal. An inflationist advancement is actually noted about the rate of caesarean section, and due to the widening of the indications to the foetal interest. Nevertheless, despite agreed efforts, the quality is still insufficient because the maternal and per natal morbidity and mortality are still high.

In order to assess the parasitic risks related to M'Boune's valley water launching, a study has been carried out from September 16 to November 24, 1998 in 12 villages: four villages surrounding the Guiers lake, four villages surrounding Ferlo already water launched 10 years ago, and four villages within M'Boune not water launched. The prevalence rate of urinary bilharziosis is 0.002% in the frist area, 1.3% in the second one and 13.7% in the third area. In these areas, intestinal parasitosis are prevaling respectively at rates of 38.2%, 36.4% and 21.3%. Although, there is no reason to fear immediately a worsening of the epidemiological situation due to M'Boune's valley revitalisation project, nevertheless, appropriate steps should be taken right now aiming at tackling the extension of conditions related to hydric medium.

The aims is to evaluate fertility and medical cost about post ectopic pregnancy follow up. It is about a retrospective and descriptive study about 337 patients who have the opportunity to get a salpingectomy for an ectopic pregnancy between 1989 and 1997 at Le Dantec Gynecological and Obstetrical Clinic. After the ectopic pregnancy cure, women are followed with contraception, just time before trying to obtain another pregnancy. The studied parameters are: age, parity, socio-economical status, level of instruction, obstetrical and gynecological antecedents, Chlamydia serology, hysterosaipingography data, fertility after ectopic pregnancy, fees related to the cost of follow up after ectopic pregnancy. Data exploitation is done through an epidemiologic programme named Epi Info version 5 The average age of the patients was 27 years and that of the parity was 2.70. 87.83% of women were married. More than the half of those patients came from the suburb of Dakar. 171 patients (50.74%) were followed regularly, the other 166 (49.26%) disappeared. A Chlamydia trachomatis infection was found among 23.4% of cases. A tubal obstruction was noted in the level of the horns at 12.5 % of women. No case of maternal death was observed. Among 59 patients who wished a pregnancy, 34 ectopic pregnancy had been obtained (57.62%) in 4 month after stopping contraception and 26 cases of a new ectopic pregnancy. The expenses of medical cure after ectopic pregnancy are about 17.814 to 71,574.65 F CFA with an average of 38,689 F CFA (389.89 FF). Medical care after ectopic pregnancy raises a lot of problems: --some patients disappeared probably because of the inaccessibility of financial cost, --the high rate of Chlamydial trachomatis infection, an hypofertility after ectopic pregnancy. To combat this, we have to insist in the prevention of sexually transmitted diseases in general and of the chlamydial infection in particular. We have also to insist in the early diagnosis of the ectopic pregnancy. At last, we must set up a registre of ectopic pregnancy at the national level.

Candidiasis are very usual infections of HIV infected patients. By medicine pressure, susceptibility to antifungal drugs decrease in some Candida strains. This study carded out in 1997 at hospital, aimed to identify the yeast species isolated from HIV infected patients with oropharyngeal candidiasis, test their susceptibility to antifungal drugs and a previous antifungal treatment impact. Thus, 60 patients yielded to questionnary were recruited. Isolated yeast colonies from buccal tract after culture on Sabouraud medium with chloramphenicol were identified with the API 20 C AUX (BioMérieux) system by assimilation of different sugars. Susceptibility was evaluated by ATB FUNGUS (BioMérieux) system. 55 from the 60 isolated yeasts were identified and among them C. albicans and C. tropicalis were the main species with 75% and 11,7% respectively rates. In HIV1 infected patients, all specieswere isolated and C. albicans predominated (80,4%) on the other hand, C. albicans and C. tropicalis were the only isolated yeasts from the HIV2 infected patients with 83,3% and 16,6% respectively rates. Susceptibility of C. albicans was 72,2% to nystatine, 58,3% to amphotericin B, 83,3% to flucytosin, 12,8% to miconazole, 8,5% to econazole and 10,6% to ketoconazole. Susceptibility of C. albicans to polyenes was modified by a previous antifungal treatment. This study indicated emergence of saprophytic yeasts of the buccal mucosa and seemed to be more fostered by HIV1 serotype than HIV2. So, C. albicans's susceptibility to polyenes decreased by untimely use of antifungal drugs and by controlling it one could improve the clinic conditions of HIV infected patients.

The authors had for aim to assess the epidemiology of leprosy in Senegal after 7 years of efficient prevention.A retrospective study was made on epidemiologic data in Senegal collected between January 1 and December 31, 2002. The indicators of eradication (total number of new cases diagnosed in that year compared to the country's population, expressed in cases per 100,00 inhabitants), the coverage rate (number of cases treated compared to the number of patients recorded for treatment), as well as the cure rate (percentage of patients having complied to the duration of treatment) were all noted.The mean detection rate was 0.5 case per 100,000 inhabitants with 434 new cases reported. The prevalence rate was 0.99 per 10,000 with 981 cases recorded for total management. The coverage rate for total management was 100%. The observed cure rate was 89% and 8% of the patients were lost to follow-up.

Recently some common skin diseases (SD) (i.e. pyoderma, scabies, and superficial mycosis) received special interest in terms of public health assessing their significance in developing countries (DC). The importance of this problem has been established through several kinds of studies: studies from specialized dermatology centres, where the main reasons for consulting were common infectious skin diseases; prevalence studies in the general population pointing out very high prevalence rates for common infectious SD; and studies conducted in non-specialized health centres, where those SD represented about 10% of the total number of consultations. Classical complications of common infectious SD, such as post-streptococcic nephritis, appear rather unusual. However, the costs related to SD have been established as significant; this is partly due to the low efficiency of the health agents when trying to manage SD, and to their usual lack of training. So far, SD have been considered as having a very low priority level, due to their low lethality rate, and therefore have been ignored by health authorities. However, it seems unwise to ignore a health problem for which such a demand of the populations is expressed. Health policies aiming at the improvement of this situation have to be aware of the economic and health system context in DC, and should take into account every step of the health system. The following actions have been proposed: definition of SD priorities; training of non-specialized health agents to a basic management of SD priorities; promotion of use and availability of low-cost "essential dermatologic drugs"; education of the populations regarding measures to prevent certain SD. The feasibility and the impact of such a "public health dermatology" program remain to be evaluated.

The purpose of this prospective longitudinal study was to analyze data concerning patients treated for uterine rupture at surgical maternity hospitals in Senegal between January 1 to December 31, 1996. A total of 50 cases of uterine ruptures were recorded during the study period, i.e., 1 rupture for every 45 cesarian sections. Typical epidemiological features were rural residence (68%), age over 30 years (66%), multiparity (64%), and presence of obstetrical risks factors (76%). In 96% of cases, rupture usually occurred after failure or natural delivery assisted by personnel with limited skills in non-surgical facilities. Treatment consisted of uterine suture in 22% of cases and obstetrical hysterectomy in 78%. As a result of poor facilities for emergency transportation (68% of cases), mean delay between the indication for operative treatment and intervention was 11 hours. Maternal mortality and morbidity were 16% and 14% respectively. Neonatal mortality was 95%. The incidence of uterine rupture could be lowered by improving emergency obstetrical care and identifying risk factors for dystocia during prenatal examinations.

The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar?This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%.Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis.Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

Noma is a necrotic stomatitis, frequent in undernourished children in tropical countries. Its occurrence in adults is extremely rare and has recently been described during AIDS. We report two new cases.The first patient, a 37 year-old farmer, consulted for a mutilating ulcer of the commissure of the right lip. The second patient, a 25 year-old woman, consulted for an ulcerating and necrotic tumefaction of the left cheek. Anamnesis reconstructed the chronology of the lesions and a cutaneous biopsy revealed non-specific ulcers. The status of health of both patients was poor and they both exhibited positive HIV serology.The diagnosis of noma is easy and based on clinical manifestations. The characteristic aspect is that of a mutilating ulcer of the face with conventional progression: tumefaction, followed by ulceration and finally elimination necrosis. This disease predominates in children. Its discovery in adults is a sign of poor prognosis because it may reveal an HIV infection at the AIDS stage.It is important to draw the attention of practitioners on the interest of performing HIV serology when confronted with an adult exhibiting a noma, and to evoke a noma when confronted with a tumefaction of the face rapidly progressing towards necrosis.

The difficulties related to the bacilloscopic diagnosis of leprosy, providing a more reliable classification of cases, in 1995 led the WHO to recommend the use of a new classification, in endemic countries, based on clinical criteria alone, in order to simplify the poly-chemotherapeutic regimens. According to our experience in the Marchoux Institute, this classification may lead to errors in diagnosis through overzealous or mis-interpretation of the two forms of leprosy. The aim of our study was to evaluate the concordance between this clinical classification and that based on a bacilloscopic examination.We conducted a descriptive study of new cases of leprosy seen at the Marchoux Institute, without distinction in gender or age, from January to December 2000. All the patients included underwent clinical examination and a bacilloscopic exploration to provide a double classification. The concordance between the two classifications was assessed using the Kappa test.Two hundred new cases of leprosy were included. Out of 126 clinically multi-bacillary cases, 61 were confirmed bacteriologically, and 65 were false positives. Out of 74 clinical cases with few bacilli, 2 were bacteriologically multi-bacilli. The concordance between the two classifications was average (Kappa=0.40). There was a significant difference between the percentages of multi-bacilli observed in both classifications (p10(-8)).The clinical classification may well overestimate the multi-bacillary form. In the absence of a reliable bacilloscopic apparatus, a more detailed clinical classification of leprosy forms must be developed.

We report three cases of tumors of the vulva following an excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

Still frequent in Africa, the idiopathic peripartum cardiomyopathy (PPC) is the subject of only few prospective studies. The aim of this prospective work was to assess the echocardiographic abnormalities of the PPC and to determine on 26 patients the evolution and the prognostic factors of this disease. Six women had mild to moderate pericardial effusion. The abnormalities of the wall motion, constantly found, were diffuse in 20 cases (77.1%) and localized or prevalent on the interventricular septum or the left ventricular posterior wall in the other cases. The cardiac chambers were dilated in 24 cases (92.3%). Left ventricular hypertrophy was noted among 16 patients (61.5%); it was eccentric in 15 cases. The left ventricular systolic dysfunction was constant. The other abnormalities were: the abnormal left ventricular relaxation (one case), low mitral and aortic flow (12 cases), the mitral (21 cases) and tricuspid regurgitation (five cases). One noted a septal hypertrophy and an isolated dilatation of the right ventricle. The mean follow-up was 7.3 +/- 1 month (1-18 months). Two patients died at the 4th and 8th month. Among the 24 survivors, 11 had normalized were: the gestity (p = 0.01), the parity (p = 0.01), the cardiothoracic ratio (p = 0.04), the left ventricular volumes (p = 0.02), and the parameters of left ventricular function. The echocardiography of patients with PPC usually shows a pattern of dilated and hypokinetic cardiomyopathy, but many variations are possible. Most of the patients keep echocardiographic abnormalities after mean term follow-up.

One of the weak points in the strategy for eliminating leprosy is the poor quality of screening. To overcome this, the World Health Organization (WHO) encourages endemic countries to run campaigns for the elimination of leprosy by circulating educational messages and mobilizing the medical community for early screening of cases. The aim of our study was to identify the motives for consultation with high predictive value for the diagnosis of leprosy and to determine the late diagnosis factors and hence assist the staff on site to improve the results of their leprosy elimination campaigns.The study consisted, during the second trimester of 1999, in interviewing all the patients consulting for the first time the Marchoux Institute or the units screening for leprosy in the Bamako area. The interview recorded the motives for consultation, the delay before consulting and the reasons for late consulting. To assess their positive predictive value, the motives for consultation were related to the diagnosis retained (leprosy or not).One thousand one hundred and seventy seven patients were interviewed. The motive for consulting, "suspected leprosy", scored the highest positive predictive value (PPV) (80 p. 100): 12 cases of leprosy were diagnosed by 15 consultants having suspected leprosy. Neurological problems were the second motive for consultation (PPV=61.9 p. 100). The most frequent motive for consultation was spots or "macules" (20 p. 100 of consultations), but only provided a positive predictive value of 19 p. 100. Prior consultations and non-specialized treatments were identified as factors of delay in diagnosing leprosy (P0.001).Diagnosis of leprosy cannot be based on the motives for dermatological consultation alone. The macules are the most apparent signs, but of low predictive value. Nevertheless, they are an early but non-specific sign of leprosy and are often neglected by the patient. Other than macules, attention must be paid to the neurological signs (dysesthesia, motor disorders) when screening for leprosy. These signs may appear early on, or be observed at a late stage in the progression of the disease.

The aim of the study was to compare two cesarean section techniques Methodology. A prospective study was conducted UB 400 cesareans performed at the Gynecological and Obstetric Clinic of the Dakar Teaching Hospital between March 2000 and August 2000. Two hundred patients underwent the classical procedure (CL group) and the other 200 the Misgav Ladach procedure (ML group). Per- and post-operative data were compared between the two groups with Student's test and the Chi(2) test. A p-value less than 0.05 was considered statistically significant.The two groups were similar for socio-demographic and clinical data. The delay between the skin incision and infant delivery was significantly shorter in the ML group (5 minutes 26 seconds versus 6 minutes 20 seconds). The same trend was found for the length of operation (36 minutes 36 seconds versus 54 minutes 38 seconds). Fewer sutures were used in the ML group (2.92 versus 4.14). There is no significant difference for dose of analgesia, post-operative complications and hospital discharge. Cost analysis demonstrated that the Misgav Ladach procedure was 10000 FCFA (15 euros) less costly.Misgav Ladach method is simple, rapid, cost-effective cesarean procedure which appears to be an attractive alternative to traditional cesarean section.

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

National prospective descriptive study on dystocia were conducted in Senegal in 1992 and 1996. We examined more closely the data on uterine rupture to determine trends between these two surveys.Data were collected for all patients undergoing an obstetrical intervention between January 1st and December 31st in 1992 and in 1996 in one of the referral maternity-obstetrical surgery units in each of the 10 regions in Senegal.The rate of uterine rupture was 1 per 51 interventions in 1992 (1.87%) versus 1 per 53 interventions in 1996 (1.94%). This dramatic event was recurrent in 7 of the 10 regions. The patients involved were aged 25-35 years (68% in 1992 versus 70% in 1996), multiparous or grand multiparous (52% in 1992 versus 70% in 1996), illiterate (90%), with poor follow-up (less than 3 prenatal consultations in 56% of the cases), and were generally evacuated to the unit (80% in 1992 versus 97% in 1996) without medical care (55%). Maternal mortality was high (28% in 1992 versus 12% in 1996). Infant mortality was also very high (98% in 1992 versus 86.6% in 1996). Conservative treatment of uterine rupture was used increasingly: the rate of conservative suture rose from 3.3% in 1992 to 22% in 1996.Prevention is a challenge for healthcare workers, public authorities and the population in general. Health policy should be directed towards forming general practitioners in obstetrical surgery. Emergency surgery kits should be made available to improve the quality of care in all maternity units throughout the country.