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For many patients, a history of tuberculosis is synonymous with disabling sequelae, impaired quality of life, and high morbidity and mortality. This retrospective study reviewed the files of patients hospitalized for sequelae of thoracic tuberculosis during 2017, to assess its various manifestations and their impact on quality of life. Of the 176 patients included, 75 % were aged from 35 to 65 years. They were predominantly male, with a sex ratio of 3.76. The socioeconomic level was mostly low (70 %). Only one episode of tuberculosis sufficed to cause sequelae in 89.8 % of cases. Smoking was often noted (52.3 %). Functional signs were dominated by coughs (90.3 %) and dyspnea (72.7 %). Pulmonary sequelae with fibrous scarring were observed in 52.2 % of the patients. Bacterial and/or viral superinfection was the leading cause of hospitalization (50 %). The death rate during hospitalization was 19 %. An improvement followed by discharge was observed for 81 %, 14.2 % of them with chronic respiratory insufficiency. In all, 13.28 % of the discharged patients died within the 6 months that followed. The sequelae of thoracic tuberculosis should be considered as long-term chronic conditions and deserve the same treatment.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

Tobacco smoke alters lung defense mechanisms against infections and so increases the risk of mycobacterium tuberculosis infection.To determine the particular clinical features of tuberculosis in smokers and identify risk factors.We conducted a prospective, cross-sectional study over a period of nine months in Dakar, Senegal. The Chi-square test and multiple logistic regression were used to identify differences between smokers and non-smokers and to identify factors associated with clinical outcomes.We included 165 patients with active pulmonary tuberculosis (59 smokers versus 106 never-smokers). The average age of smokers was 43.8±12.7 versus 32.1±13.1 years (P0.0001). Smokers were overwhelmingly male (98.3% versus 1.8%, P0.0001). The average delay to consultation was longer among smokers (90 days [30-120] versus 60 days [30-90] ; P0.0001). In multivariate analysis, alcohol abuse, increasing age, male sex, and an unknown retroviral status were independent risk factors for pulmonary tuberculosis. Haemoptysis was observed more frequently in smokers (49.1% versus 31.1%, P=0.017). With regards to chest X-ray features, smokers presented with more advanced, bilateral and cavitating lung lesions.Diagnostic delay and haemoptysis are important characteristics of the pulmonary tuberculosis in tobacco smokers.

According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal.A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoThe rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects.The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe drug-induced reaction.We report the case of a 35-year-old man treated by RHEZ for a first episode of a smear positive pulmonary tuberculosis and who developed a DRESS syndrome due to pyrazinamide after twenty days of treatment, associated with a viral reactivation to Human Herpes Virus 6 (HHV6). He had a skin eruption, liver involvement and hypereosinophilia. He fully recovered after drug withdrawal, associated with local and general corticosteroids. He died two weeks after discharge.Discovery of DRESS syndrome during tuberculosis treatment is an uncommon complication and requires a searching for the responsible drug. That should be difficult because tuberculosis drugs are often given as fixed-dose combination. Physicians have to bear in mind the potential role of pyrazinamide.

Bronchoscopy is recommended into the exploration of chronic lung diseases. This one is expensive and invasive. We conducted this study in order to assess the benefit of the bronchoscopy in the etiologic diagnosis of chronic lung diseases.This study was retrospective, descriptive and analytical, using medical records of outpatients and in patients who has done the bronchoscopy in Pneumology Clinic, Fann hospital, Dakar from January 2010 to December 2014.We have reported 159 cases. The sex ratio was 2.2. Middle age was 44 years. Fever was found in 32.7%. Alveolar syndrome was found in 64.8%. The white blood cells (WBC) were normal in 80.7%. Bronchoscopy was contributive in 74.1%. Specimen analysis isolated banals germs in 69.2%, mainly bacteria in 51.6%. Parasitology of the fluid of broncho-alveolar lavage was positive in 28.6%.Bronchoscopy stills a use full exploration while diagnosing chronic lung diseases. It should be systematic in chronic lung diseases with or not fever, this, when sputum microscopy a sputum PCR are negative.

Tobacco smoke is a global health problem, and the largest avoidable cause of death in the world. The objective of our study was to determine the prevalence of tobacco smoking in schools in Dakar area (Senegal).This descriptive and analytical cross-sectional study was performed from September 2011 to June 2012 in 27 schools of the Dakar area.We questioned 1654 students over a 9-month school period. The mean age was 15±2.5years (range 11-22). The sample included 848 boys (51.3 %), therefore a sex ratio of 1.05. There were 68 smokers (4.1 %) and 60 ex-smokers (3.6 %). The mean age of the smokers was 16.9±2.2years (range 11-22) with a male preponderance of 70.6 % (n=48). Smoking in family members was the initiating factor most frequently reported by smokers (25 %). The average age of ex-smokers was 16.4±2years. Fear of parents' reactions was the most frequently invoked reason for stopping smoking (41.7 %).This study confirms the reality of smoking among school children in Senegal and highlights the urgency of the installation of a prevention policy near the young people.

Pneumothorax is defined as the presence of air in the pleural space. There is a paucity of data on pneumothorax in Senegal. The purpose of this prospective study conducted over a 18-month period was to determine the etiological and clinical characteristics of spontaneous pneumothorax in Senegal. This study was conducted in the respiratory disease unit of Dakar University Hospital between June 2005 and November 2006. All patients over the age of 15 years admitted with a diagnosis of spontaneous pneumothorax were included. Sociodemographic, clinical, radiological and biological data were recorded for all patients. Of the 1,053 patients admitted to the unit during the study period, 73 (6.93%) presented spontaneous pneumothorax that was classified as primary in 8 cases and secondary in 65. Median patient age was 32 years (range, 16 to 86). The male-to-female ratio was 3.6/1. The most common cause of secondary spontaneous pneumothorax was pulmonary tuberculosis followed by emphysema. The findings of this study indicate that secondary spontaneous pneumothorax is predominant in Senegal. Pulmonary tuberculosis that is endemic in the country is the main cause of secondary spontaneous pneumothorax and accounts for almost 3/4 of cases.

The addiction to tobacco remains a significant problem in the context of medical practice in African in general and in Senegal in particular. It is an important cause of morbidity and mortality. The main purposes of this study were to establish the smoking habits of hospital staff as a step towards elaborating a strategy for an anti-smoking campaign within the hospital environment.The study was a cross-sectional, prospective, descriptive going study conducted between 1st March 2007 and May 15th, 2008. We recovered 662 out of 750 questionnaires collected representing a 75% participation rate.Eighty-five respondents reported that they were smokers (12.8%). The sex-ratio was 7.5 times more common in men. The paramedical staff were more likely to smoke than doctors (14% versus 12.2%). The average age of the smokers was of 37.4 years. Women had begun to smoke at an earlier age (17.4 years against 20.5 years). According to the Fagerström test, 87% were averagely or strongly dependent on nicotine. It was mainly the pleasure (41.2%) and the influence of their circle of acquaintances (36.5%) that prompted the staff to smoke. Smoking cessation was most commonly achieved through the use of willpower alone (44.4%).The mortality and morbidity arising from the addiction to smoking is entirely avoidable in contrast to other pandemics. Consequently, engagement in the fight against smoking must constitute a major priority for health workers who must set an example for their patients.

Miliary tuberculosis is a severe, acute form of tuberculosis due to lymphohaematogenous dissemination of tubercle bacilli from a focal lesion.A prospective study of was undertaken at the Pneumology Clinic of the National University Hospital Centre (CHUN) of Fann, over a period of 30 months (January 2007-June 2009), in order to assess the epidemiological, clinical, paraclinical and evolutionary aspects of miliary tuberculosis.Miliary tuberculosis accounted for 3.8% (n=49) of all diagnosed cases of tuberculosis. The sex-ratio was 1.7. The average age of patients was 37.5 years with a range of 15 to 70 years. The typical radiological appearances were present in 88% of cases whereas only 10% were positive on direct smear. HIV serology was positive in 29%. In the hospital environment, the mortality was 12.2%.Miliary tuberculosis is a severe form of the disease. The prognosis depends on early diagnosis and treatment.

The presentation of pulmonary aspergilloma is dominated by haemoptysis, the results of medical treatment are disappointing and there is significant morbidity and mortality following surgery; the only really curative treatment. These facts emphasise the gravity of this condition. We undertook a study to estimate the current profile of the disease and its management in Senegal.A retrospective study took place between January 2004 and September 2008 including all the cases of pulmonary aspergilloma diagnosed in private practice and\or the thoracic and cardiovascular surgery service of the Fann Hospital, Dakar.Thirty-five patient records were collected. The sex ratio was four males to one female. The average age of the patients was 43.7 years. All the patients had a history of pulmonary tuberculosis. Serology was positive for Aspergillus fumigatus at 22 patients out of 29 (75.86%). Histological examination of surgical biopsies confirmed the diagnosis in 88.46%. The treatment was essentially surgical with no recorded mortality. Nine cases of haemorrhage and eight of suppuration were reported.Surgery remains the reference treatment for pulmonary aspergilloma. In view of the morbidity of this condition we emphasize the importance of early screening and correct treatment of tuberculosis, particularly in endemic countries, to achieve clinical cure and prevent serious after effects.

The purpose of this study was to compare the epidemiology, clinical features and clinical course of primary presentations with pulmonary tuberculosis occurring in older and younger patients.We undertook a prospective, comparative study in the Pneumology clinic of the National University Hospital of Fann in Dakar, from April 1, 2005 to March 31, 2006, collecting data on all patients presenting with a first episode of bacterially confirmed pulmonary tuberculosis.We studied 187 first presentations with confirmed pulmonary tuberculosis including 12.8% (n=24) elderly (55 years) subjects (20 men and four women) and 87.2% (n=163) younger subjects (105 men and 58 women). In the older subjects, patients were more commonly men (sex-ratio: 5), without formal education, and working in the primary or informal sector. Comorbidities were more frequent in the older group, including smoking (P=0.002), alcohol consumption (P=0.01), diabetes (37.5%) (P0.005) and obesity with BMI superior than 20 in 25%. Pulmonary shadowing was common (41.7% of the cases), P=0.008 and generally bilateral P=0.0001 with cavitation, but this observation was not statistically significant.Complications were more frequent in the older patient (20.8%), as was mortality (29.3%, P=0.000) and rate of clinical improvement in response to treatment was less satisfactory (50%) there.

We have undertaken a transverse study of smoking among students at the National School of Health and Social Development (ENDSS) and the Health Service Institute (ISS) in Senegal. 683 out of 1142 students were questioned. 609 (89%) replied, of whom 313 (52%) were at the ENDSS and 293 (48%) at the ISS. Senior technical students were most strongly represented at 37.8%, followed by student nurses (27.4%) and midwifery students (23.3%). There were more women (n=378) than men with a sex ratio of 0.61. The average age of the population was 27.5 +/- 6.8 years (range 15 to 58). The average age was 26.2 +/- 5.6 years in the women and 29.6 +/- 8 in the men. The group aged 25-34 was significantly the most affected in both men and women (p=0.0000). The population comprised 502 non-smokers (82.4%), 62 ex-smokers (10.2%) and 45 smokers (7.4%).We found variable alcohol consumption in 119 subjects (19.2%) and 5 students admitted using cannabis. The 62 ex-smokers made up 10.2% of the population. The average age was 31.4 years. 25 ex-smokers (40.3%) drank alcohol, with a sex ratio of 1.95. The reasons for stopping smoking were illness and guilt in 27.4% of cases respectively, economic in 24.2%, medical statements on the effects of smoking on health in 17.7% and personal wishes in only 11.3%. The smokers, numbering 45 (7.4%), had an average age of 27.6 +/- 6.6 years with a sex ratio of 2 (p=0.00000). The age of starting smoking was 20.7 +/- 4.2 years for the women and 19.9 +/- 2.9 years for the men. The latter had smoked for an average of 9.2 years. Cigarettes were used by the great majority of smokers. It was associated with alcohol consumption in 35.6% and cannabis in 11.1% of cases. In the men the motives for starting smoking were stress (60%), pleasure (55.2%) and social influence (53.3%). By contrast, among the women, the two main reasons were stress and fashion in 60% (p=0.04). Our students smoked mostly in public places and in their homes. 34 smokers (75.6%) wished to stop (p=0.02) but only 27 of them expressed the need for medical or psychological support to do this. Dependence, quantified by the Fagerström Score, was medium (score 5-6) in 60% (n=27) and strong (score 7-10) in 31.1% (n=14).The estimated monthly cost of smoking increased with the degree of dependence. It was, on average, 12,143 F CFA (18.5euro) in cases of high dependence, representing 37% of the minimum wage in Senegal which is 33000F CFA (50euro). The students understood well the diseases caused by smoking (whether they were smokers, ex-smokers or non-smokers). These comprise mainly pulmonary diseases (96.2%) and cardio-vascular diseases (78.3%) All the recommended methods of the fight against smoking presented in the media, the publicity, national anti-smoking campaigns, personal contact and consultation, received more than 60% of favourable opinions among the total population studied.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.

Tuberculosis is a scourge in our region; it is particularly dangerous in young children, above all those of tuberculous mothers. The object of this study is to evaluate the prevalence of tuberculosis in the children of tuberculous mothers and to determine how to increase their chances of survival and healthy development.Between 1 January and 31 July 2002, 45 women were admitted to hospital with a child of less than 5 years. They received (mothers and children) an intradermal tuberculin test (IDTT) of 10 i.u., chest x-ray, and sputum examination for the mothers.45 women (aged from 18 to 45 years) were hospitalised for sputum positive tuberculosis, an average IDTT of 13 mm and a high bacterial load (1 to10 bacilli/hpf). Almost all (96%) presented with cavitating parenchymatous disease. We found no cases positive for HIV. Progress was satisfactory in 43 mothers treated with SRHZ. There were 2 deaths. In the children who were systematically examined, 82% (37) were less than 20 months old, there were 23 boys (51%), and 26 children (58%) were symptomatic at the first consultation. All the children were breast fed, explaining their admission with their mother. Evidence of tuberculous contact was found, 6 times with the father and 4 times with the grandparents. The most common physical signs were fever (92%) cough and weight loss (77%), malnutrition (69%). The IDTT was positive in 38/45 (84.5%) and pustular in 16/38 (42%). The chest x-ray was normal in 16/45 (35.6%), revealed mediastinal adenopathy in 19/29 (65.5%), accompanied by ipsilateral ventilatory problems in 11/29 (38%) and by parenchymal involvement in 3/29 (10.3%). Progress was satisfactory in 44 children on antituberculous treatment (RHE). There was one death on account over severe malnutrition.Treatment of tuberculosis in the mother and child is a guarantee of recovery for the mother and healthy development for the child. S: streptomycin, R: rifampicin, H: isoniazid, E: ethambutol, Z: pyrazinamide.

to compare the epidemiological, clinical and paraclinical features of smear-negative pulmonary tuberculosis (PT-) and the smear-positive pulmonary tuberculosis (PT+), to determine the risk factors of smear-negative pulmonary tuberculosis.It was a prospective study, conducted from November 1995 to November 1996. Data were analysed by EPI-INFO 6.04 (OMS/CDC).The study included 426 patients with pulmonary tuberculosis. Among them, 348 (81.7%) were PT+ and 78 (18.3%) were PT-. The sex-ratio was 2.4. Age group of 26 to 45 years was more affected (58.4% for the PT+ and 52.6% for the PT-). The prevalence of HIV infection was statistically higher in PT- (p = 0.01). Cough, sputum and lung condensation syndrom were more observed in PT+ group (p = 0.01). PT- patients had best nutritional status (p = 0.01). The chest X-ray showed more cavitations in the PT+ group (p = 0.000). While, in the PT- group, extra pulmonary lesions as pleural fluid were more frequent (p = 0.02). The full blood count found an anaemia (Hb=9 g/dl) associated to a neutrophilic h yperleucocytosis and an increased e rythrocyte sedimentation at the first hour in the both groups, without significant differance. The rates of CD4, CD8 lymphocytes and the ratio CD4/CD8 were in the normal range. Negative skin tuberculin test was more found in PT- (p = 0.04). The culture of sputum for PT- patients was positive in 15 patients out of 23 (65.2%).The risk factors of PT- identified are: Age45 years, HIV infected patients, no expectoration, no or inefficient cough, no cavitations at the Chest X-ray.

Many studies have underlined the theorical and practical role of Skin Tuberculin Test (STT) as an important tool for the diagnosis and for the screening of tuberculosis in the population.This prospective study evaluated STT in 51 smear positive tuberculosis patients and 108 contacts tuberculosis patients apparently in a good health condition. Twenty seven patients have disappeared before the end of the study and 7 patients were excluded for non suitable results. So we analysed only 73 cases.The mean age was 34 years, with extreme of 1 and 77 years. There were 33 male and 40 female patients for a sex-ratio of 0,8. BCG vaccination scar was found in 64% of patients. We calculated the Body-Mass-Index and we found a proteinocaloric malnutrition (BMI18,5) in 30%. The mean diameter of STT induration was 12,3mm with extremes of 7 and 20mm. Considering a STT7 mm as negative, 4 patients (5%) had a negative STT and 69 (95%) a positive STT. 13 of these 69 patients had a STT15mm. The age group of the 10 to 50 years had more positive STT. Meanwhile, according to the sexe and to the nutritional status, there was no statistical difference. All patients with a negative STT received BCG vaccination after 2 months of follow-up. Those with STT15mm were examinated and had a chest X-ray the day of their enrolment, at the second month and at the sixth month and we didn't find any evolutive tuberculosis.According to these results, we can conclude that STT is not an important test for the screening of pulmonary tuberculosis in contact patients. Clinical examination, chest X-ray and sputum smear remain very important for the diagnosis. Despite these results, STT remain the only validated technic between the different tuberculin tests. Its interest was twofold: the research of an acquired immunity against tuberculosis after BCG immunisation and it is clinical test for the diagnosis of tuberculosis in children.

This is a prospective study of 30 cases of smear positive pulmonary tuberculosis, with at least two sputum positive members of the family, seen in the respiratory clinic between January 2003 and June 2004.They constitute the index cases who represent 3.5% of the cases of tuberculosis (n=850) and 2.9% of hospital admissions (n=1034) during the same period. Four patients were HIV positive. In the family circle, all contacts received an intradermal tuberculin test (IDTT) of 10 IU and/or a chest x-ray and/or sputum examination for AFB.Of the 601 contacts 359 (60%) had a positive IDTT with a mean diameter of 13 mm. Active pulmonary tuberculosis was found in 16 contacts giving a prevalence of 2.7% and an incidence of 4.5% (16/359). 67% of the contacts were adults aged 16-87 with a mean age of 35 years. The IDTT was positive with a mean diameter of 12.3 mm. The chest x-ray was abnormal in 40 adults (16.7%) and sputum examination confirmed pulmonary tuberculosis in 14 cases. 33% of the contacts were children (n=119) aged from 3 months to 15 years with the majority (85%) aged under 10. The IDTT was positive with a mean diameter of 12 mm and the chest x-ray was abnormal in 22 cases (18.5%). Two children of 15 years had active tuberculosis.The contacts identified were treated according to the tuberculosis protocol of Senegal (2RHEZ/6EH) with the intensive phase dispensed in hospital. It is of major importance therefore to develop effective strategies of information, education, diagnosis and management for cases of infectious pulmonary tuberculosis.

Tobacco smoking is truly a modern plague. The WHO estimates that there are 1.3 billion smokers worldwide, about a third of the world's population. In various studies in Senegal the prevalence of smoking has varied between 16 and 36%. The risks associated with smoking are well established. However it is also well established that 'knowledge of risks alone is not sufficient to modify behaviour.' We undertook a study to assess knowledge of the risks of smoking among patients admitted to The Pulmonology Clinic of the Centre Hospitalier National de Fann de Dakar.All patients admitted to the clinic between 1st December 2003 and 31st May 2004 were enrolled into this prospective, cross-sectional study. A questionnaire in French was administered together with the Fagerstrom test of clinical addiction.Of 343 patients admitted 75 (22%) were smokers. Only 2 (2.6%) of the smokers were female. As in previous studies, smoking was associated with social disadvantage. 34.7% of smokers had attended school to primary level only and 33.3% had had no schooling at all. Mean age of starting smoking was 16 (range 9 to 38 years). The monthly cost of smoking to individuals was estimated at between 2 and 45% of the Guaranteed Minimum Wage (SMIG). 44% of smokers also consumed alcohol and 2.6% smoked cannabis. More than two thirds of patients (68%) thought that smoking caused ill health. The majority of subjects (93.3%) had stopped smoking, at least since admission, though 6.7% continued to smoke. Previous consumption was estimated as a mean of 20 pack-years. Nicotine dependence was defined as medium in 37 patients (49.3%).Certain diseases such as malaria, tuberculosis and AIDS exist at endemic levels producing considerable morbidity and mortality. We should not allow the epidemic of smoking to continue. Collective action, particularly by pneumologists is required.

Smoking represents a major threat to public health, being responsible for considerable morbidity and mortality. We undertook this study to establish the prevalence of smoking among personnel at the Centre Hospitalier National de Fann, their smoking habits and the attitude of staff to the problems caused by smoking as well as their understanding of their role in promoting smoking cessation.A prospective study was undertaken between February and April 2004 in which a standardised, anonymous, self-completion questionnaire in French was administered to 262 medical and paramedical staff at the CHN de Fann.The response rate was 95%. The biggest single group of respondents came from the infectious diseases service (24.5%). 63% of participants were paramedical and 54% of respondents were male. The mean age of respondents was 39.2 for men and 35.9 for women. 11.6% were smokers and 13.3% were ex-smokers. The mean age of ex-smokers was 43.8 years with a male/female ration of 7.25 to 1. Among the ex-smokers 51.7% had stopped smoking within the last 10 years with health problems the most commonly cited reason for quitting (24.2%), followed by guilt (21.2%). Smokers had a mean age of 38.6 with a male to female ratio of 8.6 to 1. Mean age at which they had started to smoke was 14.3 for women and 21 for men with a mean duration of smoking of 21 in women and 17 in men. 96.6% smoked cigarettes with 31% smoking20 cigarettes per day. 75.9% of our smokers had tried to quit at least three times. 86.2% wished to stop but only 48.3% considered getting medical and or psychological support to help them to quit. The Fagerström score showed a high level of dependency in 27.6% of smokers. More than half the total population studied (65.6%) thought that healthcare workers should help others to stop smoking and 75.5% thought that they had influence to do this.Healthcare workers in Senegal have an opportunity and a responsibility to promote smoking cessation. Legislative proposals and smoking cessation clinics should help to combat the tobacco epidemic.

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

The Acute Chest Syndrome (ACS) is defined by the association of chest pain with dyspnea, fever, a recent radiological abnormality and hyperleucocytosis. Acute pulmonary complications are the primary cause of mortality in sickle cell patients. We report a 19-year old male patient with homozygous sickle cell anemia who consults for respiratory symptomatology and bone algia. The diagnosis of ACS by left pneumopathy due to pneumococcal infection was based on the clinical tests, chest x-ray and blood culture. The appearance of pneumopathy in patients suffering from sickle cell anemia is explained by the functional asplenia and the inability of phagocyte cells to destruct bacteria. These incidents are triggered by alveolar hypoventilation, fat embolism from bone infarction, infections, pulmonary oedema and thrombosis. The evolution of these ACS by pneumopathy depends on their early diagnosis and treatment but also on the sensitivity of the germs to antibiotics.

From June 1668 to June 2002, we have studied at the Pneumology Clinic of Fann Hospital, pulmonary tuberculosis among 9 pregnant women. The average age was 26 years old and the consultation's delay was 5 months. All our patients had a productive cough and an evening fever coupled with a thoracic pain and a deterioration of the general condition in 7 patients (77.7%). The dyspnea and the heamoptisis were a consultation motive for 44.4% and 33.3% of the patients. The evolution of pregnancies was 29 weeks. They had all benefited from the intradermal reaction with tuberculin (IDRT) with an average diameter of 11.7 mm; it was negative in one patient. The bacilloscopy systematically done was negative in 2 patients. At the front thoracic radiography, we have found basal lesions unilateral in more than half of the cases and excavated in 44.4% of cases. They benefited from an antitubercular treatment (Rifampicine (R) + Isoniazide (H) + Pyrazinamide (Z) with a good clinical, biological, bacteriological and radiological progression. From the obstetrical point of view, there was an abortion after 5 months, 2 premature deliveries between the 7th and the 8th month and 6 normal deliveries at 9 months. Babies born from bacillary mothers systematically received an antitubercular treatment with breast feeding. In conclusion, pregnant women with pulmonary tuberculosis essentially pose a therapeutic problem, requiring a good collaboration between the lung specialist, the gyneco-obstetrician and the pediatrician. It could be more hazardous not to act early in treating a pregnant women with pulmonary tuberculosis.

In this study the authors report 5 cases of malignant lymphomas consisting in a Hodgkin's disease and 4 non Hodgkinian lymphomas. Patients aged from 16 to 55 years were 4 males and 1 female, consulting in Department of respiratory disorders of the University Hospital in Dakar, Senegal, West Africa, from 1986 thru 1992. Detoriation of the general status, cough, dyspnea and cervical adenopathy were remaked in all patients. Thoracic pain and syndrom of right pleurisy were diagnosed in one case of non Hodgkinian malignantlymphoma. X Ray exploration of the chest detected 4 cases of mediastinal adenopathies and 3 pleurisis in non Hodgkinian malignant lymphomas; and reticulonodular opacities of pulmonary basis in the Hodgkin's disease case. The diagnosis has been confirmed by pathologic anatomy studis of the biopsed ganglia. The endemic characteristic of tuberculosis in developing countries make necessary to evoke it in first of any adenopathy. When the clinical feature is atypical, a biopsy of ganglia must be performed to avoid diagnosis delay which could lead to agravate the prognosis of malignant lymphomas.

The Fernand Widal syndrome combines a nasal polyposis, an asthma and aspirin sensitivity. It remains a nosological entity often unrecognized because of the trivialization of aspirin in-take on the one hand the other its etiopathogenesis which has not yet been clarified because of the inhibition of the cyclo-oxygenase. In actual fact the aspirin molecule has yet to reveal all its secrets (advantages and disadvantages). We report 2 cases of Fernand Widal syndrome observed in 2 women in their thirties with a notion of atopy in one at the Pneumophtisiology clinic at the Fann University Hospital in Dakar. The confirmed diagnosis was based on oral provocative test in addition to suggestive clinical signs which emphasize the classical triad with a chronological appearance more or less typical. The best treatment could combine inhaled corticotherapy, nasalization of sinus cavities, antihistaminics, no aspirin in take and educating the patient.

We report two cases of localized benign pleural mesothelioma with different clinical features. Neuropsychiatric symptoms, including coma, hemiplegia, seizures and misbehavior predominated in the first case, associated with hypoglycemia. The symptoms in the second case were essentially respiratory (cough, dyspnea, and chest pain). Treatment consisted in thoracotomy and complete surgical resection. Histopathology revealed fusiform cells and collagen stroma. These two cases illustrate the diversity of clinical expression of benign localized pleural mesothelioma and confirm their complete resolution after surgical treatment.

A prospective cross-sectional study was conducted in March 1999 on the prevalence of smokers and smoking habits among physicians practicing in the Dakar region. The study population was composed of 163 physicians; 128 male (78.5%) and 35 female (21.5%). The prevalence of smokers was 27.6%. The average age of the smokers was 40.5 (+/- 6.2) years (extremes between 30 and 61 years) and an average duration of 18 (+/- 6.6) years in smoking. Men smoked more than women (93.9% versus 6.7%) with 56.4% of heavy smokers. Specialists represented 63.3% and generalists 36.4%. Initiating factors were stress (28.9%), circle of friends/acquaintances (24.4%), fashion (24.4%), pleasure (20%) and advertisements (2.2%). A little over 82% smoked in public places, 68.9% in their work places and 49.5% before children. The average time duration smoking was stopped followed by relapse was 15.7 (+/- 9.7) months. 97.7% of smokers manifested their intention to stop. Nicotine dependence according too the Fagerström questionnaire was average (37.9%), high (39.6%) and very high (12.6%). Smoking is a reality in the medical environment in Dakar. Specific campaigns aimed at physicians will be necessary to hope for a sustainable change in behavior and for a much more pronounced implication in the fight against tobacco addiction.

National immunization and control programs have not brought about a significant decline in tuberculosis, which remains a real public health concern in our regions. Prevention in the working environment should be part of an overall prevention program for the general population. Nevertheless, companies should play a leading role because they have the necessary structure and assets. We analyzed the epidemiology of tuberculosis in the working environment using demographic data on employees in Senegal, current medicolegal data on tuberculosis in Senegal and data on prevention of tuberculosis. Our analysis led to a proposed strategy for controlling tuberculosis spread and its prevention in the working environment in Senegal.