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Rift Valley Fever (RVF) is a zoonotic arbovirosis. Among animals, it mainly affects ruminants, causing abortions in gravid females and deaths among young animals. In humans, RVF virus infection is usually asymptomatic or characterized by a moderate fever. However, in 1-3% of cases, the disease progresses to a severe form with 50% mortality.Search for risk factors and to propose appropriate measures to prevent the potential for extension of the epidemic, and to make recommendations for disease monitoring and control.This investigation involved human RVF cases reported between October 12 and November 20, 2012 in the area of Tagant in Mauritania. Arbovirosis diagnosis was established by the laboratory of the National Institute of Public Health Research in Nouakchott (Mauritania) in collaboration with the Pasteur Institute of Dakar (Senegal).Of 212 subjects, RVF serology was positive in 26 (12%). Among those seropositive for RVF, 11 (42%) had severe hemorrhagic forms. The case fatality rate was 91%. A series of animal abortions (cattle, sheep and goats) was observed in the area where all but two subjects resided. Exposure to potential risk factors for RVF virus infection was found in all patients.Mortality is very high in the hemorrhagic forms of RVF. Disease prevention is necessary by strengthening the fight against vectors, avoiding contact and consumption of organic products from diseased animals and vaccination of animals in areas where the disease is endemic. Furthermore, it is essential to establish management procedures for patients infected with the RVF virus. An appropriately equipped referral hospital is necessary, together with strengthened epidemiological surveillance by notifying all suspected cases of hemorrhagic fevers.

Rheumatic fever and acute rheumatic carditis (ARC), though now rare in developed countries, are the main cause of acquired heart disease in children and young adults and remain endemic in developing countries. This study aims to establish the current prevalence of ARC in Ivory Coast.A cross-sectional retrospective study was performed between January 2000 and December 2009 in the pediatric wards of the three university hospitals in Abidjan and in the Institute of Cardiology of Abidjan. It included all patients whose final diagnosis was ARC.There were 126 patients of which 57.1% were female. The mean age was 15 ± 6.7 years (range: 4 to 28 years). The average annual prevalence was 12.6 cases, with two peaks observed during the years 2004 (27 cases) and 2005 (20 cases). The hospital prevalence of ARC in the 10-year period was 1.1‰ which is less than in previous decades. The principal presentation leading to discovery of the ARC was heart failure (68.9%). This symptom was due to significant valvular regurgitation with dilatation of the cardiac chambers observed in 65.9%. Mitral regurgitation was the main lesion observed (87.3%). Apart from the cases of isolated pericarditis and three cases of mild mitral regurgitation, all other patients were suffering from valvular lesions as a result of previous rheumatic fever.A decrease in the hospital prevalence of ARC was observed. However the cases that were seen were diagnosed late and had a tendency to be severe.

The objective of this study were to recruit and present epidemiological, clinical, histological and therapeutic aspects of primary lymphomas of the urogenital tract in Cameroon.This was a retrospective study over a 10-year period (1999-2008) done on clinical records of the Urological Unit of the Yaounde Central Hospital. From these records, we noted the age and the sex of the patients, their clinical presentation and histological aspect. The patients were treated by surgical resection and chemotherapy.Twenty cases were recruited between this period of the study. The age of the patients varied from 6 to 60 years with a mean age of 35 years. There were 19 men and one woman. Eighteen cases involved the testis, one case the kidney and one penile involvement. On histology, there were 19 cases of Burkitt's lymphoma and one case of large B cell lymphoma involving the penis. Three patients had positive syphilis serology and two other were HIV positive. All the patients in this series had a complete remission after treatment but the tumour recurs after 6 to 9 months.Burkitt's lymphoma is the first malignant tumour of the testis in Cameroonian. Unfortunately, patients consult late, there are no supports for the treatment and this will lead to a poor prognosis.

The prevalence of latex allergy is high (to 17%) among groups at risk such healthcare workers. Our aim was to determine the prevalence and severity of allergy to latex gloves among health workers in Dakar.The study was conducted in three of the five hospitals in Dakar (Senegal). A randomized sample was constituted. All healthcare workers required to use latex gloves in their work were included. A questionnaire was administered. The analysis was performed using the Epi-info software package (6.0).One hundred and forty cases were included. The median age was 39 years and the sex-ratio was 0.57. Sixty-six (47%) cases had familial atopic dermatitis, 13 (9.6%) had atopic dermatitis, and 4 (2.9%) indicated food allergy (banana, avocado). Irritant dermatitis was found in 40.7% of cases, 112 healthcare workers (81.2%) used bleach and water to clean their hands. Antiseptics were used frequently: 75.5% of those interviewed used them more than three times a day. None of the healthcare workers indicated any allergy to latex condoms. Otherwise surgical procedures and bladder/rectal catheters were noted respectively in 24% and 18% cases. Fifteen healthcare workers (10.7%), of whom 12 were women, indicated appearance of clinical signs when using latex gloves. The clinical manifestations were: contact urticaria or immediate pruritus (8 cases), combined contact dermatitis and contact urticaria (2 cases), allergic conjunctivitis (1 case), allergic rhinitis (2 cases) and asthma (2 cases). We also noted 6 cases of contact dermatitis. Rechallenge tests were performed in 7 cases and were positive, 2/3 prick-tests and 1/4 patch-tests (standard European battery). The statistical analysis shows that allergy to latex gloves was significantly associated with atopy and irritant dermatitis (p0.03).We found a prevalence of allergy to latex gloves of 11% among healthcare workers in Dakar, reflecting reports in the literature. The classical risk factors such atopic dermatitis and irritant dermatitis were found. The correlation between irritant dermatitis and frequent use of bleach and water mean that these practices should be eradicated since they play an important role in the development of contact urticaria and anaphylactic reactions.

This retrospective study of 10 patients with hyperthyroidisma and diabetes mellitus concerned 8 women and 2 men, aged from 15 to 77 years. The two disease developed at the same time in 8 cases. Diabetes mellitus occurred first in 2 cases. Common signs were loss of weight. Hyperthyroidism led to tachycardia at more than 100 bpm. Diarrhea was observed simultaneously in 2 cases and muscular weakness in 5. Goiter was found in 10 cases with a diffuse aspect. Graves' disease was diagnosed with exophthalmia in 9 cases and affected both eyes in 8. Elevated levels of thyroid hormones confirmed diagnosis in 8 cases. Diabetes was insulin-dependent in 3 cases and non-insulin dependent in the 7 others. IDDM patients (2 female and 1 male) were aged 15, 17 and 38. Keto acidosis was the first symptom in all cases. NIDDM patients (6 female and 1 male) were aged between 37 and 77.

In insulin-dependent diabetes mellitus, HLA-DR markers are involved, namely DR3, DR4 and DR9 alleles, among black senegalese populations. Studying the different associations of these alleles showed a strong predisposition to insulin-dependent diabetes mellitus with DR3/4 (p10(-2); OR = 13.6); DR4/9 (p10(-2); OR = 8.32) and DR9/9 (p0.05; OR = 7.78). And then it was observed a tendency to an inverse relationship of DR3/4 frequency with age of onset in male patients.

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

Chronic thyreotoxic neuromyopathy was observed in four patients. The first two cases were observed in a 43-year-old woman and a 60-year-old man. In the man, muscle disorders were the first manifestation and in the woman they were preceded by Graves' hyperthyroidism. Muscle signs were seen as functional impotency with amyotrophy of the girdle which was major in the man and minor in the woman. In a third case, a pyramidal syndrome was associated with polyneuropathy in a 28-year old man. Laboratory tests showed hyperthyroidism, neurological signs regressed with antithyroid drug therapy. A fourth case presented as thyrotoxic hypokaliemic periodic palsy in a 37-year-old man who had loss 12 kg over a two month period after a psychological stress. This man then experienced two acute episodes of hypokaliemia and hypotonic tetraplegia. These signs were linked to Graves' hyperthyroidism. Clinical course was good under carbimazole and then radioactive iodine. These four cases illustrate the reality of thyrotoxic neuromyopathies in black Africans.

Primary hypothyroidism, other than cases of endemic goiter, has rarely been described in Africa. We conducted a retrospective study of the patients admitted to our hospital unit between 1985 and 1996. The inclusion criteria were clinical signs of hypothyroidism and low levels of thyroid-stimulating hormone. We investigated socio-demographic, clinical (hypometabolic syndrome, cutaneomucal syndrome, muscular syndrome) and etiological (spontaneous thyroid atrophy, thyroidectomy, multinodular goiter) factors. Overall, our study population contained 37 cases, 8 men and 29 women. The mean age of the men was 40.8 +/- 19.2 years and that of the women was 41.5 +/- 14.5 years. Eighteen patients (about 50%) lived in the suburbs, 25% of patients were from urban areas and 25% from rural areas. The associated clinical signs were: 1) hypometabolism: constipation (51% of cases), bradycardia (45%), physical asthenia (40%), sleeping during the day (32%), frilosity (35%); 2) cutaneomucal syndrome: hoarseness (48%), alopecia (32%), facial puffiness (27%), macroglossia (24%), hypoacousia (21%), weight gain (18%), dry skin (16%), pallor (2%); 3) muscular syndrome was rare: myalgia (4 cases), muscle weakness (2 cases). Mean total cholesterol concentration was 2.54 +/- 0.75 g/l; mean total T3 was 1.027 +/- 0.84 nmol/l; mean total T4 was 16.70 +/- 16.89 nmol/l; mean TSH concentration, measured by radiometry, was 63.74 +/- 51.01 mIU/l. The etiology was goiter in 13 cases, thyroidectomy (11 cases) and spontaneous thyroid atrophy (13 cases). Thus, primary hypothyroidism does occur in African hospitals, particularly in Senegal. This disease, which has traditionally been reported in public health studies of endemic goiter, also occurs in cosmopolitan African environments.

When diabetes has been diagnosed, its classification into different types is traditionally carried out according to clinical criteria. But with arising of new parameters, one of which is C-peptide, and various subtypes of diabetes, it became more difficult. So, in order to improve the accuracy of the classification, 270 diabetic patients and 269 controls, all black senegalese subjects, were submitted to a two-step oral glucose tolerance test (0 and 120 min.) with determination of plasma glucose and C-peptide concentrations. The majority of NIDDM were confirmed at the opposite of IDDM; furthermore, it has been pointed out a group corresponding with impaired glucose tolerance (IGT) among the initial controls. When comparing the two classification modes, before and after plasma C-peptide determination, it appeared statistically significant differences with p values of 10(-4) for both IDDM and NIDDM.

At the opposite of HLA-DR, HLA-DQ was not well documented in homogeneous negroïd populations. So, 93 IDDM and 115 control patients, all black senegalese people, were studied. The results showed three HLA-DQ IDDM-related susceptibility genotypes and also a high risk conferred by HLA-DR4/DR9 usually described in Mongoloïd people. Furthermore, DR:DQ associations allowed the identification of three IDDM predisposition genotypes, each of them with a characteristic mean age for disease diagnosis.

From mars 1989 to mars 1992, 26 fractures of the patella were treated surgically in the "Orthopaedic and Traumatological center in Dakar". We have evaluated the functional and the anatomical results. The mean age of the patients was 45 years. The most common mechanism was direct trauma (24 cases). We have registered 12 opened fractures, 24 displaced fractures and 13 comminutive fractures. Surgical methods were modified tension band internal fixation (18 cases), tension band wiring for fixation (5 cases) and circumferential wire loop fixation (3 cases). The mean follow-up was ten months. Only eight patients have adequate post-operative kinesitherapy. So functional results was poor in 50% of cases. The anatomical reconstruction of the patella were achieved in 18 cases. We have observed a relation between: anatomical results and inadequate indications; excellent functional results and adequate kinesitherapy. So the authors recommend modified tension band internal fixation in transversal fractures and fracture with central communication. Tension band wiring for fixation is used in others comminutive fractures. Post operative kinesitherapy must be realized in a adequate center and criteria of functional evaluation be wider theses.

The authors report 3 cases of Turner's syndrome. These rare observations in Africans are the opportunity to give clinical and cytogenetic characteristics of Turner's syndrome. The importance of molecular biology in this disease is emphasized. All this because consensus about diagnostic and therapeutic recommendations are projected.

Forty one patients with 51 pregnancies form the basis of this study of etiological factors and reciprocal effects of pregnancy and thyrotoxicosis. Pregnancy influences the course of thyrotoxicosis and may modify its diagnostic aspects, clinical course, variations in laboratory parameters and treatment. The effect of thyrotoxicosis on pregnancy may lead to abortions, premature labour and/or toxemia. It may sometimes influence the products of conception. The essential point appears to be to seek the minimal dose of antithyroid drug capable of controlling thyroid disease without impairing fetal thyroid function.

123 renal tumours, among which 4 benign, were observed in 13 years. Renal tumours have a low incidence in Africa and are mostly seen in young patients. Nephroblastoma is the most frequent of these tumours. The clinical and paraclinical aspects of these tumours have nothing particular but the diagnosis is usually late.

Diabetic Pregnancy Prognosis in Seventies is it better in Eighties because of Patient Education?Retrospectively, since 1980 to 1989, in Women in status to breed, Diabetic Pregnancy was screened in our Department. W.H.O.'s (1980) Diabetes Mellitus Criterias, PEDERSEN's Criterias, White's Classification were used. Studied Parameters were etiologic factors (age, type, Diabetes oldness and control), former and present Evolution of Pregnancies (term and pregnancy's product).A--In Global Study, 15.07% Diabetic Pregnancies were observed: 22 (37%) Insulin Dependent and 38 (63%) Non Insulin Dependent. The global mean of age was 31 years; Diabetic Mellitus was less than 10 years old in 90% cases whatever the type. Their control was not good (Glycemic Control1.4 g/l in less than 50%). Diabetes complications were nephropathy (13.6% and 8%), retinopathy (13.6% and 18.5%), arterial hypertension (0% and 26.32%), cetoacidosis (31.42% and 0%), urinary tract infection (18% and 0%) respectively in Insulin Dependent and Non Insulin Dependent Pregnancies. Near a third (31.6%) of Insulin Dependent and a third (33.41%) for Non Insulin Dependent were of D, F, H White's Class. Multipares were often Non Insulin Dependent and inversely Insulin Dependent frequently paucipare. Former Pregnancies had near 25.5% interrupted term in Insulin Dependents. Present Pregnancies have given 28.5% and 32% of Normal Children: 14.25 and 12% of Abortions and 14.25% and 6% of Spontaneous Premature Parturitions respectively in Insulin Dependents and Non Insulin Dependents. B--In Analytic Study of Foetopathies, bad Prognosis Factors were high Maternal Age, Multiparity, bad Glycemic Control whatever Diabetes type. For Insulin Dependent, Negligency was added and for Non Insulin Dependent, Obesity, Arterial Hypertension and all PBSP.A relatively mild Diabetic Pregnancy Prognosis in our areas with limited means has been observed despite of Patients Education.

Study of Diabetic arteriopathies Arteriopathies in cervico encephalic arteries and lower limbs were detected both with Echography and Doppler flow velocity waveform analysis from 60 treated patients. They were shared into 34 women (57%) and 26 men (43%). Patients age varied between 39 and 77 years. 85% were non insulin dependent versus 15% insulin dependent patients. 36 patients (60%) presented arterial abnormalities, 14 of which (23.33%) were located in the lower limbs, 19 (31.66%) in the carotid arteries, and 3 (7%) in both carotid arteries and the lower limbs. Arteriopathies were found in medium aged patients (40-60 years). Arteriopathies are often noted in medium aged diabetics. The prevalence of lesions were relatively higher in supra-aortic trunks (36%) than in lower limbs arteries (28%). They are distal in lower limbs and constitute a factor of diabetes prognosis. The sensitivity and the less expensive cost of ultrasonor methods give a first choice to these technics in the patients following up and prevention of vascular complications of diabetes in Africa.

Most of road accident casualties are directed to the "Centre de Traumatologie et d'Orthopedie" between March 1989 and March 1991, the emergency Department received 8250 casualties treated by a team core comprising anesthetist-intensive care doctors and orthopaedic surgeons supplemented when necessary by other specialists. Out of those 8250 casualties aged 30 in average, 156 died at the hospital in varying time limits. The authors of present study intend to assess the efficiency of the medical and surgical care provided to identify the most frequent death causes and to suggest ways means of reducing the death toll. Forensic autopsies revealed the following lesions by order of prevalence: brain traumas 68, polytraumatisms 58, cervical vertebral traumas 13, abdomen traumas 7, polyfractures 3. In despite of the working conditions improvement at this specialized center (intensive care, technical facilities and staff) the mortality rate remains high, specially in polytraumatisms and brain traumas. The authors insist upon the need for a medically assisted transport unit which would take care of casualties before their arrival at hospital and for the acquisition of modern diagnosis means (tomodensitometry).

Up to 1989, conservative treatment was used for fractures of the acetabulum at the Dakar teaching hospital, with in previous study, of poor result. The same authors present here their first experience of surgical treatment of displaced fractures of acetabulum using LETOURNEL plate at the "Centre de Traumatologie" of Dakar for three years. Fourteen patients (12 men and 2 women) presented after traffic road accident: fracture of posterior wall: 7 cases transversal fracture: 1 case complex fractures: 6 cases. Those displaced fractures were associated with hip dislocation in 8 cases. The initial emergency treatment by reducing the dislocation, associated with transfemoral pin traction was realized. At the day 7 through a posterior surgical approach in 11 cases and through a combined anterior and posterior approach in three cases. The anatomical reconstruction of the acetabulum was achieved in 12 cases. It's still early to make a final clinical assessment, but the early functional results using MERLE D'AUBIGNE's criteria (pain, lamenliss, mobility) are very good in 10 cases and poor in 2 cases. The reliability of the procedure, and the adequate post operative kinesitherapy is according to the authors the main indication for displaced fractures of the acetabulum.

The authors discuss the vesicovaginal fistulas seen at the Central Hospital in Yaounde. Rectomyoplasty was widely used for treatment. Fortunately, public health policies have succeeded in reducing the incidence of this condition.

The chronometric method was applied to 141 diabetics and 151 reference subjects from both sexes aged between 19 and 60 years, all of Black race and Senegalese nationality, to study the effects of Antithrombin III (AT III). A significant reduction in the physiological activity of antithrombin III (AT III) was observed for ages 36-45 and 56-60 and correlated with obesity and other complications. With our patients, insulin dependence does not seem provoke any reduction in antithrombin III's effectiveness.

The authors report on a series of 14 cases (10 men and 4 women) of epiphrenic diverticula treated surgically over a period of 14 years. Size was variable and the neck was narrow in 7 cases, wide in 5, and very wide in 2. Four patients presented with a double diverticulum. The diverticula are normally found on the right side (9 cases), and underlying dyskinesia is always present, often accompanied by major or minor cardiospasm (11 cases) or reflux from sliding hiatal hernia (3 cases). No manometric exploration was carried out in this series. Management was based on physiopathological considerations - 6 diverticulectomies with 5 myotomies, 6 myotomies with no diverticulectomy. The approach was left thoracic in 7 cases and abdominal in the others. The mortality rate was zero, and functional results are good. They are all the better in that the diverticulectomy, the myotomy and the repair of the gastroesophageal reflux have now been performed.

The incidence of leptospirosis in West Africa is still almost unknown. Doubtful or positive serological tests were found in approx. 35% of the patients admitted to the hospital, among which leptospirosis could clinically or biologically be suspected. This rather high proportion reflects the frequency of recent or past contacts with leptospira antigen. It is in agreement with the high infestation prevalence observed among several domestic or wild animals, besides small rodents. On the countrary, it should be noted that the leptospirosis-illness, at least in its pure form, with its characteristic hepatic, renal and neurological signs, is seldom seen. Seven typical cases only (among which five at the hosptical Le Dantec) have been diagnosed in Dakar during these last 6 years. Even taking into account that the proportion of atypical, fruste or undiagnosed forms is not negligible, leptospirosis does not appear to be a major medical problem in Senegal.

For a long time endocrine pathology was unrecognized or even denied to exist in Black Africans, but this is not true. It seems to be recognized more frequently since medicalization has increased. This pathology does not present any particularities. Hyperthyroidism appears frequently, at least in urban areas. A series of 87 personal cases has permitted a review of the principal clinical and biological aspects; myasthenia seems to be particularly important; radical treatment is preferred over prolonged medical treatment which is not within the financial possibilities of our patients. There have been 30 observations of cortico-adrenal anomalies of which 7 known personally. It must be noted that the Black living in his traditional rural environment presents a certain degree of physiological hypocorticism with respect to whites and especially Blacks of higher social standing. Pathological hypocorticism is essentially due to tuberculosis; the melanodermia is evident to an alert observer. Metabolic hypercorticism produces the usual manifestations. Only 9 cases of Sheehan syndrome have been reported (5 personal). In the Black African woman, it appears earlier than in Europe often due to premature nuptiulity and the higher incidence of tachyparity. One is surprised that this syndrome is detected so rarely; it is, without a doubt, often well tolerated during a long period of time therefore goes undetected.

The routine use of needle biopsy of the liver in 129 African patients, aged over 15 years and suffering from various varieties of tuberculosis, gave the following results : specific lesions, above all during miliary tuberculosis, 25,6%, non-specific lesions alone, 37,2% ; normal parenchyma : 37,2%. These result were comparable with those obtained in Europe, in two similar studies, carried only by Coury and al. on pulmonary tuberculosis patients only, an by Morère et al. concerning all forms of tubercuosis. Steatosis without any alcoholic explanation, was observed in 24% of cases. Bacteriological research, even on a culture of liver tissue, was usually disapponting; only one positive result for 34 cultures. This possible spread of tuberculous infection at all stages of its course is still difficult to explain. It leads one to distinguish secondary liver infestations which suggest another localisation of the disease, from liver tuberculosis observed in clinically primary forms.

Fifteen cases of rupture of the spleen were reported, in which a conservative form of treatment was applied with success. These consisted of 4 splenorrhaphies and 11 partial splenectomies. Collagen (PANGEN) was used in 6 of the cases to buttress the suture. In view of the relatively low incidence of post of complications, the authors are of the opinion that the above described treatment be widely applied in cases of rupture of the spleen, especially in the child where the spleen still plays a vital role.