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Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room; of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases; and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%; fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Secondary hypertrophic osteoarthropathy, or Pierre-Marie Bamberger syndrome, is characterized by the association of digital clubbing, polyarthritis and periostitis affecting the long bones. Most commonly it is a paraneoplastic syndrome associated with lung cancer in 80% of cases. We report the case of a 49-year-old female patient who is actively smoking, one pack per day for 20 years. Seen in consultation for pain and swelling of the hands, elbows, knees, ankles, and feet evolving for about 5 months, associated with a poorly differentiated pulmonary adenocarcinoma. On history, she told us about a weight loss of about 8 kg, no fever, no cough, no family history of inflammatory rheumatism or cancer. Bilateral digital clubbing was noted. The diagnosis was based on imaging and histology. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and chemo-radiotherapy was started.

Objective: Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of the spondyloarthritis family. In black Africa, the prevalence of SpA associated with IBD is not clearly established. Thus the objective of our study was to describe the clinical and radiological characteristics of spondyloarthritis associated with IBD. Patients and Method: We carried out a prospective study in the rheumatology department of CHU Ignace Deen between January and December 2019. The diagnosis of SpA was based on clinical and biological arguments in accordance with the criteria of Amor and ASAS. Results: Fifteen observations of spondyloarthritis associated with IBD were collected in patients mean age 52 years with extremes of 32 and 65 years. 9 (53.33%) were female. Ten patients had Crohn’s disease (CD) and 5 had ulcerative colitis (UC). The mean number of pushes was 2.5 ± 1.2. The average diagnostic time was 46 months. Sacroiliitis was present in 73.3% of cases and the mean mSASSS score at diagnosis was 32.11/72. In total, corticosteroids were used in 9 (60%) of patients, NSAIDs in 26.6% while DMARDs salazopyrine and methotrexate in 33.3% and 20% of patients, respectively. Conclusion: The MICI and SpA association is undoubtedly underestimated in our regions. Better collaboration between rheumatologists and gastroenterologists could facilitate diagnosis and improve care.

Background: Mainly for economic reasons, histopathologic analysis is not a systematic practice in medical structures in Senegal, and the utility of this exam is being questioned by many authors. The purpose of this paper is to report the results of this exam, in our medical practice and try to determine if this exam should be systematic of kept only for individualized cases. Material and Methods: It was a retrospective study from January 2010 to December 2018, carried out in the Laboratory of Pathology of the Teaching Hospital of Grand Yoff in Dakar. The data were collected from the register of pathologic examinations of the laboratory. Results: We registered 543 results of histopathologic examination of products of conception from the first trimester abortion. The women mean age was 22.4 years ± 6.2 with extremes of 17 and 46 years. The routine histopathologic assessment of products of first- trimester miscarriages highlighted in our study three pathologies: hydatidiform mole (24.7%), infection (4.6%) and ectopic pregnancy (0.09%). Only 11.7% of cases of Hydatidiform mole (HM) were suspected before the histopathologic assessment. In our sample, molar pregnancy seems to be higher in anembryonic conception with a prevalence of 45%. The prevalence of Complete Hydatidiform Mole (CHM) was higher than the one of Partial Hydatidiform Mole (PHM) (14.8% vs. 9.9% of miscarriages). Indeed, both require follow up to prevent or manage at time the occurrence of choriocarcinoma. Conclusion: The results of the histologic analysis after abortion in the first trimester of pregnancy show that this exam should be practiced systematically in routine in our context because of high prevalence of hydatidiform mole.

Introduction: the roots of Leptadenia hastata, (L hastata) are remedies from the Senegalese pharmacopoeia and are as widely used as the leaves. However, few researchers have devoted themselves to their toxicity, unlike the leaves. However, in the traditional pharmacopoeia, the indications for use are very different. The aim of our study was to study the effect of the administration of methanolic extracts of roots of L hastata on renal tissue, using an animal model. Materials and Methods: a cohort of 18 rats was studied with a random distribution of the animals in 3 groups (n = 6). The first group was the control group. The treated groups (Group II and III) received the methanolic extract of L. hastata with an administration of 500 mg / kg / day and 1000 mg / kg / day respectively, for 28 days. Results: The dose of 1000 mg / kg / day was lethal in group III, from the first week in females. Serum creatinine was significantly higher in rats given the root extract. There was kidney damage with vacuolar degeneration starting at 500 mg / kg / day. The lesions were more severe in group III with glomerular involvement characterized by retraction in the renal corpuscles. Conclusion: If the leaves of L hastata seem to be safe for consumption according to the majority of authors in the literature, the roots of this same plant could be harmful. In addition to the lethality observed at the doses tested, the lesions in the renal parenchyma would be dose-dependent.

Tubal ligation is a surgical sterilization procedure that provides permanent and reliable contraception to women. Tubal obstruction is a method of permanent birth control that can be performed after mini-laparotomy under local anesthesia. Objective: To determine the outcome of tubal sterilizations by mini-laparotomy under local anesthesia performed in clients who underwent the surgical operation in the Maternity Ward of Ignace Deen National Hospital. Patients and Methods: The Gynecology and Obstetrics Department of Ignace Deen National Hospital was used as the place for the study. The study involved all the women seeking voluntary surgical contraception. This was a retrospective study of a descriptive type carried out from January 1, 2017 to December 31, 2018. A consent form was filled out and signed by spouses after an interview and a systematically carried out pre-operative clinical and para-clinical assessment. Results: During the study period, 56 tubal ligations were performed i.e. 4.72 percent of all family planning methods. The recruiting for the surgical contraception involved clients whose typical profile is that of women with an average age of 35, mostly housewives (35.71%), major multiparous (69.63%) with 6 living children on average. Married women made up the bulk of the recruiting i.e. 96.44%. Unmarried women made much more use of other methods. Indications of personal convenience were the most frequently encountered common reason. Among medical causes, high blood pressure concerned the majority of cases: 38% of the indications. Surgical contraception in between was more practiced than the post-partum one. The recorded complication was the parietal hematoma due to a lack of hemostasis and it accounted for 1.79% of cases. The progress was uncomplicated in 98.68% of cases. Forty couples (71.42%) expressed their feelings of satisfaction against only 6 cases of regret (10.71%). Conclusion: The surgical contraception has become a requirement for modern couples. Tubal ligation by mini-laparotomy is a simple operation and a harmless method of contraception that allows clients to use permanent contraception. Carried out on an outpatient basis, incidents and accidents are rare and may have psychological repercussions that are difficult to assess. The technical mastery of the gesture helps to minimize these incidents.

Malaria is one of the most dangerous and deadly tropical disease in Africa affecting millions of individuals yearly. It is a major global public health problem, with an alarming spread of parasite resistance to the ACTs drugs. This situation explain the urge to discover new antimalarial compounds. Indigenous species to Africa and traditionally used for years by traditional healers, Artemisia afra is a big source for new antimalarial drugs. Aerial parts of Artemisia afra plant collected from South Africa, Kenya, Tanzania, Burundi and Senegal were each extracted with solvents of different polarity (hexane, dichloromethane, ethanol, and water), and the different extracts were then screened and compared for their antimalarial activities against two Plasmodium falciparum strains W2 (CQ resistant) and D6 (CQ sensitive); and also compared for their total phenols, flavonoids content and antioxidant activities. Phytochemical screening of the extracts revealed the presence of terpenoids, alkaloids, tannins, saponins and cardiac glycosides. Ethanolic extract of Artemisia afra collected from Burundi was found to have the highest concentration of phenols (606.9449 mg GAE/g of extract) and flavonoids (242.4745 mg Rutin/g of extract) and also exhibited the highest antioxidant activity (IC50 = 3.12 μg/mL) compare to the others. Total phenols and total flavonoids were found to correlate with the antioxidant activity. Artemisia afra collected from Burundi also showed the highest antimalarial activity compare to the other extracts, the hexane extract of A. afra from Burundi have the highest (IC50 = 0.71μ g/ml for W2 and IC50 = 3.18 μg/ml for D6); following by the ethanolic extract (IC50 = 2.66 μg/ml for W2 and 7.84 μg/ml for D6; then the dichloromethane extract (IC50 = 3.04 μg/ml for W2 and IC50 = 7.92 μg/ml for D6). Comparison of the five A. afra plants collected from South Africa, Kenya, Tanzania, Burundi and Senegal showed that the extracts from Burundi had the highest total content of phenols and flavonoids and also the highest level of antimalarial activity compared to the other plant extracts.

Purpose: The objective of this work was to describe different presentations of peritoneal tuberculosis on ultrasound. Materials and methods: This was a retrospective study conducted between 2008 and 2016 at the Main Hospital in Dakar, and including 38 cases of peritoneal tuberculosis. The tests were performed on Philips Envisor and Hitachi Preirus with 10 and 12 MHz linear transducers. The mean age was 26 years and the sex ratio was 0.8. The diagnosis of peritoneal tuberculosis was based on histological evidence (17 cases), isolation of BK from sputum (5 cases), positive adenosine deaminase in ascites fluid (4 cases) or a favorable clinical course after trial antituberculosis treatment (4 cases). The structures studied were the parietal peritoneum, the mesentery, the large omentum, as well as the characteristics of ascites, and extra-peritoneal lesions. Results: Parietal peritoneal involvement was found in 89.4% of patients, including regular diffuse hypoechoic thickening in 70.5% and nodular thickening in 11.7%. Ascites was present in 84.2% of patients. The great omentum showed anomalies in 73.6% of cases in relation to 3 aspects: trilamellar thickening made up of a thick, hyperechoic central layer surrounded by 2 thin peripheral hypoechoic layers in 46.4% of cases; a single-layer hyperechoic thickening in 21.4% of cases; heterogeneous hyperechogenic thickening with hypoechoic nodules in 32.1% of cases. Mesentery abnormalities were noted in 63.1% of patients with hypoechoic thickening. Conclusion: Ultrasound with the advantage of safety and accessibility is a reliable technique for the diagnosis of peritoneal tuberculosis. In some cases, it allows for a guided percutaneous biopsy to avoid the use of laparoscopy. Purpose: The objective of this work was to describe different presentations of peritoneal tuberculosis on ultrasound. Materials and methods: This was a retrospective study conducted between 2008 and 2016 at the Main Hospital in Dakar, and including 38 cases of peritoneal tuberculosis. The tests were performed on Philips Envisor and Hitachi Preirus with 10 and 12 MHz linear transducers. The mean age was 26 years and the sex ratio was 0.8. The diagnosis of peritoneal tuberculosis was based on histological evidence (17 cases), isolation of BK from sputum (5 cases), positive adenosine deaminase in ascites fluid (4 cases) or a favorable clinical course after trial antituberculosis treatment (4 cases). The structures studied were the parietal peritoneum, the mesentery, the large omentum, as well as the characteristics of ascites, and extra-peritoneal lesions. Results: Parietal peritoneal involvement was found in 89.4% of patients, including regular diffuse hypoechoic thickening in 70.5% and nodular thickening in 11.7%. Ascites was present in 84.2% of patients. The great omentum showed anomalies in 73.6% of cases in relation to 3 aspects: trilamellar thickening made up of a thick, hyperechoic central layer surrounded by 2 thin peripheral hypoechoic layers in 46.4% of cases; a single-layer hyperechoic thickening in 21.4% of cases; heterogeneous hyperechogenic thickening with hypoechoic nodules in 32.1% of cases. Mesentery abnormalities were noted in 63.1% of patients with hypoechoic thickening. Conclusion: Ultrasound with the advantage of safety and accessibility is a reliable technique for the diagnosis of peritoneal tuberculosis. In some cases, it allows for a guided percutaneous biopsy to avoid the use of laparoscopy.

Thymic epithelial tumors (TET) are rare lesions. The brain metastases of these tumors are even rarer. We report a case of brain metastases in a known patient with a thymic carcinoma diagnosed in October 2016. She was a 73-year-old woman who presented with headache, nausea, and right hemiplegia. Brain MRI revealed five lesions (1 insular, 1 frontal and 2 left temporal, 1 right parafalcine). These lesions were initially treated using two stereotactic radiosurgery gamma knives. A macroscopically complete excision of the left frontal lesion was subsequently performed without any complications with a good evolution of the neurological symptoms postoperatively. Immunohistochemical examination was compatible with metastatic thymic carcinoma. The patient died 14 months after the initial diagnosis. A review of the literature in English has reported another 45 TET cases with brain metastases.

OBJECTIVE To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

Objective: To evaluate the clinical and therapeutic aspects of male subfertility in the Region of Thies. Patients and methods: This is a retrospective and analytical study involving patients followed for subfertility over a period of 4 years from January 2013 to November 2017 at the level of 3 health structures in the region of Thies. Results: During the period, we collected 201 patients. The average age was 38 ± 8.4 years with a greater distribution in the age group 30-39 years. Primary subfertility was predominant with 81.1% of cases. The average duration was 5 years. We found a history of urethritis (4%) and orchiepididymitis (2.5%). Thirty-three percent of patients presented a varicocele (67 cases). Cryptorchidism was recorded in 2% of cases, testicular hypotrophy in 18.4% and testicular atrophy in 1.5%. The spermogram identified oligospermia-like abnormalities in 40.8% of cases, azoospermia 22.4%, and hypospermia 4%. For the qualitative abnormalities, we recorded cases of asthenospermia in 60.2% of the cases or 121 patients, a necrospermia 58.2% and a teratospermia 20.4%. A combination of these abnormalities was also reported as astheno-necrospermia in 19.4% of cases, oligo-astheno-necrospermia 14.4%, oligo-asthenotera-necrospermia 10% and oligo astero-teratospermia in 2.5%. An assessment of FSH, LH and testosterone was performed in 5.9% of the cases, or 12 patients. Varicocelectomy was performed in 68.4% of cases 19 patients, and (medically) assisted procreation in 2 patients. We recorded 13 cases of pregnancy. Conclusion: Male hypofertility is a real problem of management, and requires a particular approach.

Introduction: Ventriculomegaly is one of the most common abnormalities detected by prenatal ultrasound. This entity can be associated with brain abnormalities and other malformations. In order to perform a good prenatal counseling, the diagnosis is essential. Objective: Our purpose was to report the management of 3 cases of ventriculomegaly in our practice and underline the benefits of the neuropathologic exam. Methods: We analyzed retrospectively 3 medical files concerning fetus that were diagnosed as having one or two ventricles of >10 mm and a follow up for prenatal diagnosis. Results: All cases were diagnosed between 22 and 27 weeks of gestation by an ultrasound. In a case, the ventriculomegaly evolved rapidly to a hydrocephalus. In two cases, the pregnancy was terminated with medical interruption by the parent’s request. Amniocentesis confirmed the diagnosis of congenital toxoplasmosis in case 2 there were no chromosomal abnormalities after karyotyping. Causes included holoprosencephaly, congenital toxoplasmosis and mesencephalosynapsis. Conclusion: Ultrasonography may detect ventriculomegaly nerverthless in the cases presented, pathology exam was essential to assess the diagnostic. Causes are numerous and prognosis variable. We recommand MRI that is more and more accessible in our regions in the follow up of this entity and neuropathology exam in case of termination of the pregnancy. The establishment of main causes of ventriculomegaly in our regions (infectious causes for example) could help to prevent this outcome in our practice.

Vertebral hemangiomas are benign tumour and are rarely symptomatic. Aggressive forms represent less than 1% of all cases. Medical imaging allows both diagnosis and evaluation of their aggressivity. To assess the role of radiology, embolisation, percutaneous vertebroplasty and surgery in the diagnosis and treatment of vertebral hemangiomas, we report our experience of one patient who had an age of 13 years. She presented with progressive medullary compression and is investigated with CT and MRI. The vertebral hemangioma is located in the lumbar spine at L3. Lumbar CT scan and MRI were done. In the CT scan we noticed L3 vertebral body and posterior arc destruction associated with hind sliding of L2 on L3. These lesions are associated with a significant infiltration of peri-vertebral soft tissues and dural sheath with heterogenous enhancement. The patient has embolised before surgery.

Tenofovir reduces viral load during viral cirrhosis B and improves prognosis. The aim of this study was to evaluate the effectiveness and safety of Tenofovir during the treatment of viral B cirrhosis. The study was retrospective and prospective on patients with viral B cirrhosis treated with Tenofovir in the Hepato-Gastroenterology Department of University Hospital Gabriel Toure in Bamako (Mali) and evaluated between three and six months after the start of treatment. We included 89 patients. The mean age was 44.5 ± 16 years with extremes of 18 and 90 years. The sex ratio was 1.2. At inclusion all patients had a detectable viral load with an average of 2651.96 ± 1495.85 IU/ml. Follow-up viral load was undetectable in 84.3% with patients between 3 and 6 months of treatment. The average detectable viral load was only 27.04 ± 21.05 IU/ml. There was also an improvement in hepatocellular function and few side effects. Conclusion: This study shows the interest of Tenofovir in the treatment of viral cirrhosis B with very few adverse effects.

Background To determine how clinicians with a DATA waiver to prescribe buprenorphine for opioid use disorder (OUD) adapted during the COVID-19 pandemic to emergency authorities, including use of telehealth to prescribe buprenorphine, the challenges faced by clinicians, and strategies employed by them to manage patients with OUD. Methods From June 23, 2020 to August 19, 2020, we conducted an electronic survey of U.S. DATA-waivered clinicians. Descriptive statistics and multivariable logistic regression were used for analysis. Results Among 10,238 respondents, 68 % were physicians, 25 % nursing-related providers, and 6% physician assistants; 28 % reported never prescribing or not prescribing in the 12 months prior to the survey. Among the 72 % of clinicians who reported past 12-month buprenorphine prescribing (i.e. active practitioners during the pandemic) 30 % reported their practice setting closed to in-person visits during COVID-19; 33 % reported remote prescribing to new patients without an in-person examination. The strongest predictors of remote buprenorphine prescribing to new patients were prescribing buprenorphine to larger numbers of patients in an average month in the past year and closure of the practice setting during the pandemic; previous experience with remote prescribing to established patients prior to COVID-19 also was a significant predictor. Among clinicians prescribing to new patients without an in-person examination, 5.5 % reported difficulties with buprenorphine induction, most commonly withdrawal symptoms. Conclusions Telehealth practices and prescribing to new patients without an in-person examination were adopted by DATA-waivered clinicians during the first six months of COVID-19. Permanent adoption of these authorities may enable expanded access to buprenorphine treatment.

Summary Pathological conditions of the falciform ligament are rare, one of which is the twisting of a fatty fringe that can lead to fatty infarction of the peritoneal fat. To our knowledge, only 21 cases with radiological documentation have been published in the literature. Ultrasound and computed tomography facilitated prompt diagnosis of this rare finding. The condition is best managed conservatively, but sometimes, a surgical intervention is necessary. We report herein a case of torsion of fatty falciform ligament appendage in a 73-year old female.

Introduction Coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea. Methods All patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained. Results The RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea. Conclusion This work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary.

Resume Objectif Une prise en charge therapeutique tardive ou inadaptee augmente le risque de mortalite associe au VIH/sida. L’objectif de cette etude etait d’analyser la proportion et les facteurs associes aux perdus de vue chez des personnes sous traitement antiretroviral a Conakry. Methode Il s’agissait d’une cohorte retrospective des patients âges de plus de 15 ans, infectes par le VIH et qui ont recu un traitement antiretroviral du 1er aout 2008 au 31 juillet 2015, au centre de traitement ambulatoire (CTA) de l’Association des femmes de Guinee pour la lutte contre les IST et le sida (ASFEGMASSI). Un patient etait considere comme perdu de vue lorsqu’il ne s’etait pas presente au CTA depuis plus de trois mois apres le dernier rendez-vous. La methode de Kaplan–Meier, le modele de Cox univarie et multivarie ont ete utilises pour analyser les facteurs associes a la perte de vue. Les analyses ont ete effectuees avec le logiciel STATA 13. Resultats Au total, les donnees de 614 patients seropositifs majoritairement des femmes (68,4 %), residant a Conakry (80,5 %) et âges en moyenne de 36,3 ± 11,2 ans ont ete analysees. Parmi eux, 104 etaient perdus de vue, correspondant a 16,9 % (IC 95 % : 14,2–19,7 %) ou 5,79/100 personnes-annee. Les resultats de l’analyse multivariee ont montre que les facteurs independamment associes a la perte de vue des patients etaient la denutrition (RRajuste = 7,05 ; IC 95 % : 2,05–24,27 ; p = 0,002) et le taux de CD4 a l’initiation pour lequel le RR varie de 2,35 (IC 95 % : 1,61–6,39 ; p = 0,016) pour 201–350 CD4/μL a 5,83 (IC 95 % : 2,85–11,90 ; p Conclusion Une proportion importante de personnes est perdue de vue apres le debut du traitement malgre la gratuite des antiretroviraux et l’effort des agents de sante. La denutrition et le taux de CD4 a l’initiation sont independamment associes aux perdus de vue.

Le cancer du rectum a une incidence estimee a 30 000 cas par an dans les pays developpes, avec une survie globale de 55% a 5 ans. Les techniques d’imagerie moderne, desormais disponibles au Senegal pourraient permettre de mieux poser les indications therapeutiques de cette affection dans les pays en voie de developpement, en precisant notamment les criteres de resecabilite. Les auteurs ont collige sur 20 mois 32 dossiers d’IRM de patients atteints de cancer du rectum; les examens ont ete realises sur un aimant de 1,5 Tesla. La marge circonferentielle et la marge distale ont pu etre predites chez 16 patients parmi les 17 adresses pour bilan pre-therapeutique, confirmant l’IRM comme outil performant pour determiner les criteres de resecabilite.

Introduction: The increase of both the frequency and severity of the bacterial dermohypodermitis (BDH) in Senegal suggests the existence of other risk factors outside of those classically known to be involved. Our study aimed to clarify the epidemiological, clinical and risk factors of BDH in Senegal.

Aims: The aim of the present study was to determine the prevalence of diabetes, and to assess its awareness and related risk factors among adult Guineans.Methods: A population-based cross-sectional survey was conducted on 1 100 adults (46.6% women) aged 35–64 years from Lower Guinea, during September to December 2009, using the WHO STEPwise approach of surveillance of chronic disease risk factors. Data were collected in three steps: demographic and behavioural risk factors, blood pressure and anthropometric measurements, and fasting blood cholesterol and glucose testing. A multi-stage cluster sample design was applied to generate nationwide representative data.Results: The mean age of all participants was 47.3 years (SD 8.8), similarly in Conakry, rural Lower Guinea and urban Lower Guinea. The prevalence of diabetes was 5.7% (95% CI 4.0–8.1). Among participants with diabetes, only 44.0% were aware of their status. In multivariable logistic regression analysis, determinants of diabetes prevalence were urban residency, male sex, age group 45–64 years, increased waist circumference, hypertension and hypercholesterolemia. Male sex, rural residency, age group 45–54 years, no formal education, waist circumference, hypertension and hypercholesterolemia were independent predictors of screen-detected diabetes.Conclusion: The present study found a high prevalence and low awareness of diabetes, suggesting the need for appropriate actions to strengthen primary healthcare approaches towards non-communicable diseases in Guinea.Keywords: Diabetes, epidemiology, Guinea

Resume Introduction Les etiologies des intertrigos chez l’adulte sont multiples et variees. L’objectif de notre travail etait d’etudier les aspects epidemiologiques, cliniques, evolutifs et facteurs de risque des intertrigos chez les adultes. Methodologie Nous avons mene une etude prospective d’une duree de 7 mois dans deux services de dermatologie de Dakar. Ont ete inclus apres consentement tous les adultes presentant un intertrigo consultant durant cette periode. Resultats Nous avons recense 103 patients atteints d’intertrigo, soit une prevalence hospitaliere de 2,54 %. Le sex-ratio etait de 0, 63 et l’âge moyen de 41,9 ans. Les habitudes et modes de vie etaient une depigmentation artificielle dans 26 cas, une activite sportive pratiquee dans 22 cas, le port de vetements synthetiques et le tabagisme respectivement dans 20 cas et dans 22 cas. Des complications infectieuses etaient notees dans 9 cas (8,7 %). Elles etaient de type bacterienne (3,88 %) et virale (1,94 %). Une erythrodermie seche etait notee dans 3 cas (2,9 %). Les etiologies etaient dominees par les mycoses dans 48,5 %, les manifestations immuno-allergiques dans 34,9 %, la maladie de Verneuil et le psoriasis inverse dans chacun 2,9 %. Les femmes representaient 58 % des patients ayant une dermatophytie et 63 % des cas de candidoses. La depigmentation artificielle etait notee dans 35 % des cas de dermatophytie et 45 % des cas de candidoses. Conclusion Les intertrigos chez les adultes sont dominees par les etiologies infectieuses en particulier les mycoses et suivies des affections immuno-allergiques. Il existe des professions a risque et des terrains.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

Introduction: The aim of this work is to study the clinical aspects and the impact of cryptorchidism on male infertility in the region of Thies. Patients and methods: This is a retrospective study involving 28 patients followed up at the Saint Jean de Dieu, Barthimee and Tivaouane hospitals of the region of Thies between January 2007 and December 2016. Results: Among the 223 patients followed up for the undescended testicle, 13% (n = 28) were adults or at least 15 years old. 71% (n = 20) were married. Fourteen patients were followed up for primary infertility lasting for a period of time averaging 7 years. The mean age of the patients was 28 years (range: 17 years and 45 years). Cryptorchidism was unilateral in 82% (n = 23) and bilateral in 18% (n = 5). The mean delay of consultation varied from 1 to 13 years. The main reason for consultation was couple infertility (50%). The semen analysis was requested in all our patients. The levels of FSH, LH and testosterone were measured by immunoassay for the patients with azoospermia (n = 9). We noticed 2 cases of hypotestosteronemia and 3 cases of increased FSH serum level. Computed Tomography scans (CT) were performed in 28.5% of patients (n = 8) and ectopic testicles were found very high in the inguinal area in 5 cases. The open inguinal approach was used. In perioperative period, the testicle was found, high in the inguinal region in 5 patients (17.8% of the cases) and low in inguinal region in 19 patients (67.8%). In 4 cases the testicle was in abdominal position. The testicle was atrophied in 53.5% of the patients (n = 15) and 8 patients presented testicular hypotrophy. An orchidectomy was performed in 1 patient in whom it was impossible to lower the atrophied testicle. The postoperative period was uneventful and simple. The mean follow-up duration after the operation was 36 months (12 - 60 months).

Ciliated hepatic foregut cyst is a rare benign liver lesion with about a hundred cases described in the literature.

Omphalocele is one of the most common congenital defects in the anterior abdominal wall. The malformation is associated with various pathologies especially with chromosomal disorders. The developmental defect is observed in Congolese hospitals, but risk factors are not well precised on the published case reports, which are more often focused on management. We aim in this paper to make a review on the condition, insisting on the risk factors of omphaloceles mainly of those of genetic origins.

Mycetoma remains endemic in the tropical and subtropical regions of the “mycetoma belt” including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

This work was funded and supported by King Abdullah University of Science and Technology (KAUST). The authors thank Ali I. Al-Naimi Petroleum Engineering Research Center (ANPERC) at KAUST for the assistance with the CT scanner imaging. The authors thank Mr. Tariq Ali Alghamdi (KAIMRC) and Samer Yahya Zakari (KAIMRC) for their help in tissue sectioning and staining. The authors thank Dr. Shahida Shafi and Dr. Abdelhamid Saoudi for their support.

L’appendagite est une cause peu commune de douleur abdominale aigue. Elle resulte d’une torsion d’un appendice epiploique, avec ischemie ou thrombose veineuse spontanee. L’incidence de cette pathologie n’est pas reellement connue, et elle varierait de 2 a 7 % chez les patients hospitalises pour suspicion d’appendicite ou de sigmoidite. Les auteurs rapportent trois cas d’appendagite colliges au departement d’imagerie medicale de l’hopital Principal de Dakar. Les patients ont ete recus pour exploration d’un syndrome douloureux abdominal aigu localise persistant, associe ou non a un syndrome subocclusif, sans syndrome inflammatoire biologique. Ces patients ont beneficie d’une tomodensitometrie abdominopelvienne avec injection de contraste iode qui a permis le diagnostic d’appendagite devant la decouverte d’une masse ovalaire ou oblongue « en navette » adjacente au colon, de densite plus elevee que la graisse peritoneale normale et cernee d’un lisere hyperdense. Grâce a cette semiologie typique, un recours inutile a la chirurgie a pu etre evite.

The aim of this study was to determine the clinical features and outcomes of women younger than 35 years with breast cancer. This study was performed at Gynecologic and Obstetric Clinic of Dakar Teaching Hospital and retrospectively reviewed the records of all women younger than 35 years seen in our department for histologically proven breast cancer. Data were analyzed with SPSS software (Statistical Package for Social Science) Version 23. Between 2007 and 2015, 62 women with breast cancer met the inclusion criteria and were included. The incidence of women in this age group treated in our department was 22.6%. The median age at diagnosis was 29.7 years. The mean time to consultation was 12.5 months, and the disease was locally advanced at diagnosis in 79% of cases. Histological study found 85.5% of cancers were invasive ductal carcinoma. The immunohistochemical study found positive hormone receptors in 12 women (19.4%) and overexpression of HER-2 in 8 (12.9%). Chemotherapy was performed in 54 patients (87.1%), and surgery in 47 (62.9%). Recurrence occurred in 12. In all, 22 women died (35.5%) by the end of the study period. Mean survival was 36.7 months (CI 29.5 to 43.9) and median survival 39.7 months (CI 22.1 to 57.5). This high incidence rate in our study is consistent with that found in young African-American women and is worrisome. These results seem to point towards a genetic origin and call for a thorough search of the profile. They also call also for the involvement of pathologists and collaboration with other research teams.

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

The authors report the case of a 22-year-old man referred seven months after the onset of papulo-nodular skin lesions, lymphadenopathy, splenomegaly and hepatomegaly. Mycologic and histologic examination of skin lesions enabled the diagnosis of African histoplasmosis, by Histoplasma capsulatum var duboisii. The lymph nodes were caseous. The culture in Lowenstein-Jensen medium was negative.

Dermatophytic mycetoma of the scalp is a rarity, especially when not associated with tinea capitis. Here, we report a case of dermatophytic mycetoma of the scalp, that was not associated with tinea capitis, caused by an atypical Microsporum audouinii strain. To our knowledge, this is the second reported case, thirty-eight years after the first that was published in 1980.

La leucemie prolymphocytaire T est une hemopathie lymphoide tres rare, de phenotype post thymique et reputee de mauvais pronostic. Elle se caracterise par un syndrome tumoral, des lesions dermatologiques et une lymphocytose importante. Elle doit etre differenciee des autres syndromes lymphoproliferatifs matures a cellules T et meme de la leucemie prolymphocytaire B et ceci ne peut se faire qu’avec une approche multidisciplinaire.

The presence of DNA fragmentation in semen is associated with poor results in ART (Assisted Re-productive Technology). This has led to the introduction of sperm DNA integrity testing in the clinical assessment of male infertility. The TUNEL assay is one of the most commonly used tests to measure DNA fragmentation in research studies, but it is now being optimized for routine clinical use. So, the objectives of our study were to install the TUNEL assay in our laboratory and to use it to assess the degree of DNA fragmentation in our patients dealing with couple infertility. Forty seven (47) and 25 samples from patients followed up for infertility and known fertile men were analyzed between August 2013 and July 2015 respectively. The sperm samples were evaluated according to the World Health Organization Guidelines. Sperm DNA damage was assessed by the TUNEL assay, with a standardized protocol that we adapted for reading using fluorescence microscopy instead of flow cytometry. The Sperm DNA Fragmentation Index was significantly higher in patients with infertility compared to the controls (22.2% ± 5.6% vs. 16.7% ± 0.7%) with a p < 0.05. This Index was also high in patients with varicocele compared to the control group (22.8% ± 9.2 vs. 16.7% ± 0.7%) (p < 0.01). After establishing the ROC curve (Receiver Operating Characteristics curve), we found a 15% threshold of DNA fragmentation, separating the patients with infertility from the control group. In our study, a 15% threshold positivity of DNA fragmentation using the TUNEL assay was highly associated with infertility. The results indicate that high level DNA fragmentation is associated with infertility.

Introduction: Inter individual variation for semen on analysis is well known. Therefore, Semen profile is not the same in individuals from different geographic locations, environments, ways of life, and populations. It is important for a laboratory to have an idea of the semen profile of its population, especially for those who present with infertility. The aim of this study was to draw the pattern of semen abnormalities in male partner of infertile couple in Dakar, Senegal. Materials and Methods: A retrospective study of all the semen samples of male partners of infertile couples submitted for analysis in the laboratory of Cytogenetic and Reproductive Biology of Dakar at the University Teaching hospital from January 2013 to June 2014. Results: A total of 262 male semen analyses were reported. Analysis was performed according to WHO, 2010 manual for examination of human semen. Our study reveals that 80.9% of men in infertile couples present an abnormality in sperm pattern. The main one is oligo-astheno-terato-necrozoospermia (20.2%), followed by azoospermia, (14.1%), astheno-necrospermia (10.3%) and astheno-terato-necro-zoospermia (10.3%). Leucocytospermia was found in 57.8%. Teratozoospermia (80.9%) was the most associated abnormality, followed by necrozoospermia (76.2%). Low sperm count under 5 million per ml concerned 27.7% of the patients, and 11.2% patients had low ejaculate volume. Nearly 42.1% of the male partners are potential candidates for Assisted Reproductive Technology for male infertility. Conclusion: The high rate of semen abnormality in patients of infertile couples and consequently the high rate of potential candidates to Assisted Reproductive Technology for male infertility are important reasons for taking into account rigorously the male subject if we want to improve fertility rate in our context. The pattern of the specific abnormalities found is precious clues to guide management of these patients.

We report here a case of intraventricular schwannoma. This location is rare. Our patient was a 68-year-old female with a large intraventricular lesion of the body of the lateral ventricle on the right side. Brain magnetic resonance imaging (MRI) revealed this lesion. After a right parietotemporal craniotomy, microsurgical excision using neuronavigation was performed to completely remove the tumor. Histological and immunohistochemical examination confirmed the diagnosis of intraventricular schwannoma devoid of atypical features. Postoperative MRI showed macroscopically complete tumor removal with no recurrence after 12 months of follow-up. A review of the literature identified 32 such cases published to date.

Despite satisfactory efficacy of WHO-recommended second-line antiretroviral treatment for patients with HIV in low-income countries, the need for simplified, low-cost, and less-toxic maintenance strategies remains high. We compared boosted protease inhibitor monotherapy with dual therapy with boosted protease inhibitor plus lamivudine in patients on second-line antiretrovial therapy (ART).We did a multicentre, randomised, parallel, open-label, superiority, trial in the HIV services of five hospitals in sub-Saharan Africa (Yaoundé, Cameroon; Dakar, Senegal; and Bobo Dioulasso, Burkina Faso). We recruited patients from the long-term, post-trial cohort of the ANRS 12169/2LADY study that compared the efficacy of three second-line combinations based on boosted protease inhibitors. Participants for our study were HIV-1 infected with multiple mutations including M184V, at first-line failure, aged 18 years and older, on boosted protease inhibitor plus two nucleoside reverse transcriptase inhibitors (NRTI) for at least 48 weeks with at least 48 weeks follow-up in the 2LADY trial, with two viral load measurements of less than 200 copies per mL in the previous 6 months, CD4 counts of more than 100 cells per μL, adherence of at least 90%, and no change to ART in the past 3 months. We randomly assigned participants (1:1) to receive either monotherapy with their boosted protease inhibitor (once-daily darunavir 800 mg [two 400 mg tablets] boosted with ritonavir 100 mg [one tablet] or coformulation of lopinavir 200 mg with ritonavir 50 mg [two tablets taken twice per day]) or to boosted protease inhibitor plus once-daily lamivudine 300 mg (one 300 mg tablet or two 150 mg tablets). Computer-generated randomisation was stratified by study site and viral load at screening (50 copies per mL, and 50-200 copies per mL), and concealed from study personnel throughout the inclusion period. After randomisation, treatment allocation was not masked from clinicians or patients]. Patients had follow-up visits at weeks 4 and 12, and every 3 months until 96 weeks; if viral load exceeded 500 copies per mL at any visit, NRTI (tenofovir and lamivudine) were reintroduced into treatment. The primary outcome was the proportion of participants who had treatment failure at 96 weeks in the intention-to-treat analysis, where treatment failure was defined as one of the following: a confirmed viral load of more than 500 copies per mL, reintroduction of NRTI, or interruption of boosted protease inhibitor. We designed the study to detect a difference of 12% between groups in the primary outcome, with an expected 20% of patients having treatment failure in the monotherapy group. This study is registered with ClinicalTrials.gov, number NCT01905059.Between March 5, 2014, and Jan 26, 2015, 265 participants were assigned to receive monotherapy (133) or boosted protease inhibitor plus lamivudine (132). At week 48, an independent data safety monitoring board reviewed data, and advised discontinuation of the monotherapy group because the number of failures had exceeded the expected 20%; therefore results here are for week 48. At this point, treatment failure occurred in four (3·0%; 95% CI 0·8-7·6) of 132 participants on dual therapy and 33 (24·8%; 17·7-33·0) of 133 participants on monotherapy (relative risk 8·2, 95% CI 3·0-22·5; odds ratio 10·6, 95% CI 3·6-42·1). The difference between groups (21·8%, 95% CI 13·9-29·7; p0·0001) showed superiority of dual therapy compared with monotherapy. We recorded 46 severe adverse events of grade 3 or 4 (29 in the monotherapy group, 17 in the boosted protease inhibitor plus lamivudine group); one event in the montherapy group (intoxication resulting from co-administration of ritonavir-boosted lopinavir with an ergotamine derivate) was deemed related to study drug. Two participants in the monotherapy group and one in the dual therapy group died, all from causes not related to study drugs or procedures (one from complications from gastric cancer surgery, one in a work accident, and one from a lung disease of unknown cause).After viral suppression with boosted protease inhibitor plus NRTI in second-line ART, maintenance therapy with boosted protease inhibitor plus lamivudine was associated with a high rate of success, despite the presence of M184V mutations at first-line treatment failure. Results indicated that boosted protease inhibitor monotherapy cannot be recommended for these patients.Agence National de Recherche sur le Sida et les hépatites and Janssen Pharmaceutica.

We report a case of a 28-year-old man with xanthomas over the extensors of the limbs, cataract, chronic diarrhea and various neurological disabilities. There was also an ichthyosis, which predominate over the lower limbs. Chest CTscan showed bilateral apical opacities with cystic images in the culmen. Brain MRI revealed bilateral and symmetric T2 and FLAIR hyper-signals sequences in the region of dentate nucleus and adjacent cerebellar and periventricular white matter. We have reported the first case of CTX in Senegal, which is remarkable by an acquired ichthyosis and excavated lung lesions simulating a tuberculosis.

Only 1% to 5% of HIV patients who develop a direct complications following. HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. It is a rare association, here we report the case of a woman of 69 years immunocompromised who Stroke diagnosed without another etiology found despite an etiologic assessment of the most common causes in our context. The patient had received treatment with an overall favorable evolution. Before a stroke recurrent of unknown etiology should think of HIV as this will allow appropriate treatment. The mechanism can be related with syphilis (Vasculitis) or by direct action of the virus on the central nervous system.

The occurrence of Pyoderma gangrenosum (PG) during pregnancy or postpartum has rarely been reported. These forms can also occur on a recent scar facilitated by the pathergy phenomenon. A 25-year-old woman showed an abruptly worsening of a post-caesarean wound that evolved rapidly into a painful, purulent, extensive ulcer with breakdown of sutures, along with fever and leukocytosis despite antibiotic therapy. The diagnosis of postoperative PG was evoked on the unusual course of the surgical wound, the existence of old cribriform scars on the legs, the clinical appearance of the ulceration around the surgical incision and confirmed by histology, as well as the favourable outcome under systemic corticosteroid. This case raises once again the issue of the possible relationship between pregnancy and PG. In our case, pregnancy could have triggered the PG, and the Caesarean section facilitated its clinical expression by the pathergy phenomenon. Thus, pregnancy could be in the same way as chronic inflammatory diseases, such as arthritis, inflammatory bowel disease and haematological disorders, a triggering or exacerbating factor of PG.

Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P P P P P 3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.