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Introduction: Biermer’s disease is an autoimmune cause of anemia characterized by malabsorption of vitamin B12. It is often accompanied by other autoimmune pathologies. The objective was to study its profile in patients followed in the internal medicine department of the Abass Ndao hospital center. Methods: This was a retrospective and descriptive study of patients followed for Biermer’s disease from January 1, 2014 to December 31, 2019 (5 years). Results: 57 cases were collected, an incidence of 5.4 in the internal medicine department. The sex ratio was 0.58, an average age of 56.4 years. The circumstances of discovery were dominated by anemic syndrome (87.7%), dermatological (33.3%), digestive (29.8%), neurological (20%) pathologies. The specific signs to Biermer’s disease were digestive manifestations in 70.2% (including 30% Hunter’s glossitis), neurological manifestations in 36.8% (including 17.5% paresthesias), palmoplantar melanoderma in 68.4%. The mean hemoglobin level was 6.8 g/dL with a mean corpuscular volume of 110.7 fl. The myelogram reported megaloblastosis in 100% of the cases. The mean serum vitamin B12 level was 100 pg/ml. The anti-intrinsic factor antibody assay performed in 50 patients was positive in all cases. Upper digestive endoscopy showed an aspect of fundic atrophy in 69%. Histology showed intestinal metaplasia in 2 patients. An autoimmune disease was associated in 21% of cases. All patients had received treatment with vitamin B12 (51 patients took intramuscularly and 6 oral treatment). The course was favorable in all cases with a complete correction of the anemia. Conclusion: Biermer’s disease is a reality in Senegal. Its clinical and biological characteristics can be superimposed on the data in the literature. His prognosis under treatment is good whatever the route of administration of vitamin B12.

Introduction: Diabetic microangiopathies are common, but their time to onset in a diabetic patient varies from subject to subject. The aim of our study was to study the correlation between renal and ophthalmic disorders in patients with type 2 diabetes. Patients and methods: This longitudinal, analytical study took place from March 1, 2018 to March 31, 2019 at the Abass Ndao University Hospital Center. It was studying retinal involvement in diabetic patients with glomerulopathy. Results: Of the 100 cases of diabetic glomerulopathy, they are divided into 70 women and 30 men with an average age of 58.2 years. The average duration of diabetes was 6.1 years and their average glycated hemoglobin (HbA1c) was 8.1%. Only 37% of patients had an HbA1c level below 7%. The other cardiovascular risk factors were high blood pressure (HBP) (39%), dyslipidemia (36%), and obesity (15%). Among these patients, diabetic retinopathy was present in 21% of the cases. Retinopathies were more frequent in the group of patients diagnosed with diabetes for less than 6 years (69%) and in patients with chronic renal disease with slightly reduced glomerular filtration rate (GFR) (34%). Conclusion: Our study allowed us to conclude that during the course of type 2 diabetes, the onset of chronic kidney disease does not systematically imply the presence of diabetic retinopathy. It is thus important to make screenings and assessments of systematic complications.

Introduction: Cirrhosis is a public health problem and the causes are dominated by viral hepatitis and alcoholism. Deaths due to cirrhosis represented 2.4% of deaths worldwide in 2017. The aim of this work was to study the diagnostic and prognosis of cirrhosis at the department of internal medicine of the Abass Ndao hospital center. Patients and Methods: This is a retrospective, descriptive study, carried out on the basis of patient files followed from May 1, 1999 to February 28, 2018 (19 years) and included all patients for whom the diagnosis of cirrhosis was accepted. The diagnosis of cirrhosis was made on the basis of clinical, biological and ultrasound (portal hypertension, signs of hepatocellular insufficiency, a diffuse heterogeneous aspect, and irregularity of the liver contours). Results: 60 patient files were listed with an average age of 46.9 years, a sex ratio of 2.2 and alcoholism in 11.7% of the cases. The reasons for consultation were dominated by an increase in the size of the abdomen (55%), lose weight (50%). On physical examination, it was a hepatomegaly (43.3%) and jaundices (33.3%). Exploration of liver function showed a cholestasis (48%), a cytolysis (58%) and a hepatocellular insufficiency (46.2%). Anemia was found in (24%). The abdominal ultrasound found in all cases a dysmorphic, heterogeneous liver with irregular contours. Hepatic atrophy was found in 20%. Among the 34 patients who underwent upper gastrointestinal endoscopy, they were grade 2 to 3 esophageal varicose vein in 67.6%, an erosive gastropathy in 29.4%. The etiology was viral hepatitis B in 45%, alcoholism in 11.7% and undetermined in 43.3%. A hematemesis complicated the evolution in 16.7%. Carcinomatous degeneration was found in 5% and 16.7% of the patients had died. Conclusion: our experience with cirrhosis was marked by advanced forms at the stage of complications. The viral etiology B remains dominant. Prevention will involve early detection and vaccination.

Introduction: The diabetic foot is a real public health problem due to its economic and functional impact with a high risk of amputations. The objective was to determine the podiatric risk of type 2 diabetics according to the classification of the International Working Group on the Diabetic Foot (IWGDF) in order to put in place suitable prevention measures. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted over 12 months from May 01, 2018 to May 01, 2019 and concerning subjects with type 2 diabetes regularly followed up at the Marc Sankale Center at Abass Ndao Hospital in Dakar. Results: Two hundred (200) patients were collected with an average age of 58.9 ± 10 years, a sex ratio of 0.43. The majority of our patients had diabetes less than 5 years of age (52%) and were on non-insulin medication (63%). The average HbA1c level was 8.1%. Besides diabetes, high blood pressure and dyslipidemia were the most common cardiovascular risk factors in 65% and 25%, respectively. The main podiatric risk factors were: neuropathy (75.5%), arteriopathy (31.5%), deformities (19.5%), history of ulceration (24%) and amputation (2%). Factors associated with the risk of ulceration were: walking barefoot (42%), wearing tight shoes (26.5%), wearing unsuitable socks (46%), gait disturbance (39%), traumatic pedicure (3.5%). The podiatric risk assessment according to the IWGDF grading had identified a podiatric risk foot in 80% of the cases. Depending on the grade of injury, it was a grade 0 (20%), grade 1 (32%), grade 2 (34%) and grade 3 (14%) risky foot. A significant correlation was established between the onset of diabetic foot and age (p p p < 0.01). Conclusion: Podiatric assessment remains an essential point in the fight against complications of diabetes. This study demonstrates the high risk of developing diabetic foot, hence the importance of good grade planning to reduce the impact.

In 2006, Senegal adopted artemisinin-based combination therapy (ACT) as first-line treatment in the management of uncomplicated malaria. This study aimed to update the status of antimalarial efficacy more than ten years after their first introduction. This was a randomized, three-arm, open-label study to evaluate the efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DP) in Senegal. Malaria suspected patients were screened, enrolled, treated, and followed for 28 days for AL and ASAQ arms or 42 days for DP arm. Clinical and parasitological responses were assessed following antimalarial treatment. Genotyping (msp1, msp2 and 24 SNP-based barcode) were done to differentiate recrudescence from re-infection; in case of PCR-confirmed treatment failure, Pfk13 propeller and Pfcoronin genes were sequenced. Data was entered and analyzed using the WHO Excel-based application. A total of 496 patients were enrolled. In Diourbel, PCR non-corrected/corrected adequate clinical and parasitological responses (ACPR) was 100.0% in both the AL and ASAQ arms. In Kedougou, PCR corrected ACPR values were 98.8%, 100% and 97.6% in AL, ASAQ and DP arms respectively. No Pfk13 or Pfcoronin mutations associated with artemisinin resistance were found. This study showed that AL, ASAQ and DP remain efficacious and well-tolerated in the treatment of uncomplicated P. falciparum malaria in Senegal.

Introduction: Diabetes is a public health problem and is exposed to some complications, particularly infectious. The work on this entity remains segmentary in Africa. The objective was to describe the morbi infectious mortality of the diabetics at the Medical Clinic II of Abass Ndao Health Center of Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from 01 January 2016 to 31 December 2016. It covered patients with diabetes hospitalized during the study period. Epidemiological data and infectious diseases were evaluated. Results: During the study period, 346 diabetics have respected the inclusion criteria. These were 165 men (47.68%), a sex ratio of 0.91. The mean age was 56.17 years. The age group of [60 - 69 years] accounted for 31.5% and 95.6% of the patients came from the Dakar region. The average age of diabetes was 10.31. Diabetes had been evolving for less than 5 years in 25.15% of patients and inaugural in 11.46%. About 82.36% of our patients had type 2 diabetes. The acute complications of diabetes were ketoacidosis (51.89%), hyperosmolar hyperglycemia (0.58%), and hypoglycemia (1.45%). The mean infections were the skin and soft tissues (54.91%), urogenital infections (16.18%), respiratory infections (14.45%), malaria (3.46), infections of the skin and soft tissues were dominated by the diabetic foot (41.90%). The 125 non-diabetic patients developed 38 infectious pathologies, the main ones being respiratory infections (24.32%), infections of the skin and soft parts (24.32%). HIV infection was observed in 0.28% of diabetics and 8.10% of non-diabetic patients. 93 patients died (15.70%). Fifty-one of them died of infectious diseases (54.8%), 42 non-infectious diseases (45.16%), and subjects aged over 60 years, representing 72.54%. The means of consultation was 30 days. The highest rates of lethality were diabetes (37.41%), acute gastroenteritis (17.64%), and acute pyelonephritis (12.5%). The lethality rates of indeterminate infections and malaria were 10% and 8.33%, respectively. Conclusion: Infection is a significant complication in diabetics not neglectable to diabetes. These discovery patterns call for more early diagnosis and appropriate management to reduce the mortality of diabetics.

Introduction: The objective of our study was to describe the socio-demographic characteristics and cardiovascular risk factors (RVFs) of diabetic patients admitted for stroke in a department other than neurology. Methods: Retrospective cross-sectional study over a period of six (6) years (January 2010 and December 2016), performed at the Internal Medicine Department of the Abass Ndao Hospital Center in Dakar. Results: 79 adults with a mean age of 64.67 years, a female predominance (51.89%). The major risk factors found were arterial hypertension in 74.68% of cases, dyslipidemia in 32.35% of cases, smoking in 6.32% of cases. The reasons for consultation were a disorder of consciousness in 27.4% of cases, hemiplegia in 43.3% of cases, headache in 18.98% of cases, vertigo in 8.86% and dysarthria in 10.12% of the cases. Mean systolic blood pressure was 150 mmHg, mean diastolic blood pressure was 86 mmHg. The average blood glucose was 3 g/l. Strokes were associated with left ventricular hypertrophy in 30.55% of cases. Ischemic stroke accounted for 74.68%. The evolution was marked by a death in 20.25% (16) cases. Conclusion: Stroke is a major public health problem. Despite its predominance of women, they (stroke) affected 48.10% of men in our study when we know that in Africa the social activity is based on men. They remain a serious pathology in the diabetic by the high lethality.

Introduction: High blood pressure (hypertension) and diabetes mellitus are two major risk factors for cardiovascular disease, which is increasing rapidly in Africa and worldwide. Africa has the highest prevalence rate of hypertension in the world, with 46% of adults over the age of 25 with. Hypertension is common in type 2 diabetes and increases cardiovascular risk. The association of these two pathologies has many particularities in the sub-Saharan subject. The work related to this entity in Africa shows a frequency between 30% and 60%. The objective was to describe the epidemiological, clinical and therapeutic characteristics at the Medical Clinic II of the Abass Ndao Hospital Center in Dakar. Patients Methods: This was a cross-sectional, descriptive and analytical study conducted from 01 December 2016 to 31 January 2017. It focused on patients with cardiothyrosis. Epidemiological data, cardiovascular risk factors, and cardiothoracic characteristics were evaluated. Results: 303 cases were recorded with a prevalence of 42%, an average age of 61.63 years, a sex ratio of 0.22. The age group of [60 - 70] years was the most representative at 36.30%. The BMI (Body Mass Index) average was 27.06 kg/m2. Obesity was 25% and 35% were overweight. Dyslipidemia consisting of an increase in LDL cholesterol > 1 g/l in 79%, a hypercholesterolemia in 57%, a decrease in HDL cholesterol in 13.23% and a hypertriglyceridemia in 28%. Patients with three cardiovascular risk factors accounted for 93.72%. The average fasting glucose level was 2.85 g/l. Hyperglycemia was noted in 65%. The glycosylated hemoglobin is greater than 7% in 47%. The duration of diabetes was less than 5 years in 133 patients or 44%. 70% of patients were treated with oral antidiabetic drugs. Insulin was used in 21.1%. Hypertension was mild in 24.1%, moderate in 23.8% and severe in 14.8%. Hypertension treated with monotherapy was 49%, combination therapy was 43%. Converting enzyme inhibitors (CEI) were used in 44%; 20% were Calcium inhibitors and 7 were treated by Angiotensin II Receptor Antagonists (ARA). The inhibitor association of the conversion enzyme/calcium inhibitors (CEI/CI) is in 22%. Statins are used in 23%. The degenerative complications concerned four cases of acute edemas of the lower limbs (AELL), four cases of stroke (AVC). 37% had a balance of the blood pressure and among them 19.5% had followed a monotherapy and 33% a combination therapy. Conclusion: The combination of hypertension and diabetes is common in Africa and increases cardiovascular mortality. Training in the management of diabetes and other cardiovascular risk factors is needed.

Introduction: In Senegal, the frequency of diabetes mellitus is estimated at 3.2% and its management by the general patrician (gp) is dissatisfied. The objective was to evaluate the decentralized monitoring of diabetes mellitus and other cardiovascular risk factors by a trained general practician. Patients and methods: It was a retrospective, descriptive study conducted from June 1, 2013 to 31 May, 2015 in Dakar, where included the files of subjects with diabetes mellitus regularly followed. The data collected were epidemiological, diagnostic and therapeutic. Results: It was of 125 diabetics patients with a mean age of 56.4 years old. At the inclusion, their diabetes had a mean duration of 6.3 years and a mean average HbA1c of 10.4%. The complications were a neuropathy in 58 cases (46.4%), an arteritis in 46 cases (36.8%), a nephropathy in 16 cases (12.8%) and a retinopathy in 28 cases (22.4%). Other cardiovascular risk factors were an arterial hypertension in 74 cases (59.2%), smoking in 11 cases (8.8%), kidney disease in 16 cases (12.8%), and LDL-cholesterol > 1.6 g/l in 39 cases (31.2%). In total, 87 patients (69.6%) were at high cardiovascular risk and among them, 81.6% had LDL-cholesterol > 1g/l. At inclusion, anti-diabetic treatment was oral mono-therapy in 53 cases (42.4%), an insulin therapy in 49 cases (39.2%). After 12 month of follow-up, the dual therapy anti-diabetic was increased from 13.6% to 34.4%. The others associated drugs were anti-hypertensives in 72 cases (57.6%), statins in 29 cases (23.2%) and anti-platelet agent in 46 cases (36.8%). Only 31.2% of the patients with nephropathy were under the renin angiotensin system blockers. Statins and the anti-platelet agents were prescribed respectively at 25.2% and 47.1% of the 87 patients at high cardiovascular risk. During follow-up, the target HbA1c Conclusion: our study shows the importance and the interest of a trained general practician for the management of non-communicable diseases. However, it would be necessary to strengthen training in the care of other cardiovascular risk factors.

Le pyoderma gangrenosum (PG) est une dermatose neutrophilique non infectieuse rare souvent méconnue. Il se présente généralement par des ulcérations cutanées inflammatoires, très douloureuses et d'évolution rapide. Il est fréquemment retrouvé dans un contexte de néoplasie, de pathologies inflammatoires digestives, rhumatologiques et/ou hématologiques. Son diagnostic est très souvent tardif après de multiples échecs thérapeutiques. Nous rapportons un cas de pyoderma gangrenosum dont le diagnostic n'a pas été criant. Un patient a été admis dans notre service pour une lésion dermatologique persistante et d'évolution défavorable malgré les débridements et l'administration d'antibiotiques. Il était suivi pour un cancer de la prostate, une hypertension artérielle et un asthme. Du fait des anomalies biologiques observées telles qu'une hyperleucocytose à polynucléaires neutrophiles avec myélémie à myélocytes et métamyélocytes, sans blastose sanguine et une anémie normochrome normocytaire, une leucémie myéloïde chronique a été évoquée chez ce patient. Elle a par la suite été infirmée devant les différents examens complémentaires non concluants. C'est ainsi que le diagnostic de PG a été évoqué et confirmé à l'examen anatomopathologique montrant un aspect histopathologique d'un tissu de granulation concordant avec un pyoderma gangrenosum et une absence de signe histologique de malignité. L'institution d'un traitement à base de corticothérapie a abouti à la guérison.

OBJECTIVE The prevalence of type 2 diabetes (T2D) is rapidly increasing in sub-Saharan Africa, where sickle cell trait (SCT) is also frequent. Although SCT is generally considered a benign condition, evidence suggests that SCT could exaggerate vascular dysfunction in T2D. However, it remains unclear whether SCT could increase the risk of the development of T2D complications. Therefore, this study was conducted to determine whether T2D complications were more prevalent among Senegalese individuals with SCT and T2D than among those with T2D only. RESEARCH DESIGN AND METHODS Rates of hypertension, retinopathy, peripheral neuropathy, peripheral artery disease, and impaired renal function as well as arterial stiffness, blood rheology, and concentrations of plasma advanced glycation end products (AGEs) and cytokines were compared between groups of Senegalese individuals with combined SCT and T2D (T2D-SCT) (n = 60), T2D (n = 52), SCT (n = 53), and neither T2D nor SCT (control) (n = 56). Human aortic endothelial cell (HAEC) expression of inflammatory and adhesion factors was measured after treatment with tumor necrosis factor-α and subjects’ plasma. Effects of AGE inhibition or tiron on HAEC expression of E-selectin were measured. RESULTS Retinopathy, hypertension, and reduced renal function were more prevalent, and arterial stiffness, blood viscosity at high shear rates, and thixotropic index were higher, in the T2D-SCT group compared with the other groups. Multivariable analysis showed that plasma AGE concentration was significantly associated with arterial stiffness. E-selectin expression was elevated in HAECs treated with T2D-SCT plasma compared with the other groups, but AGE inhibition reversed this. CONCLUSIONS SCT could potentially augment the risk of the development of T2D-related complications, including retinopathy, nephropathy, and hypertension.

In the article cited above, the first sentence in the Results section of the abstract had the name of the group …

Diabetic neuropathy occurs in more than 60% of diabetic’s populations. The aim of our study wasto describe clinical and electromyography characteristics of diabetic neuropathy in a Senegalese black diabetic population (Senegal). This was a cross-sectional study of 68 neuropathic type 2 diabetic patients with 56.8years mean age. Clinical examination, Visual Analog Scale, Neuropathy Symptom Score, Disability Neuropathy Score and electro neuromyography were used to characterize neuropathy. Mean duration of diabetes was 8.7 years and mean glycosylated hemoglobin9%. Motor neuron deficit was found in one patient. The main sensory disorders were paresthesia (97%), neuropathic pain (94%), and hyperesthesia (44%). Cramps were found in 45.5% and tendon reflex abnormalities in 63.2% of cases. Tachycardia (52.9%), intestinal transit disorders (42.6%) were the most common symptom of autonomic nervous system neuropathy. High blood pressure (p=0.05) and sex (p 0.05). Diabetic neuropathy in our series is a multi variate symptom with usually mixed type. Its risks’ factors were still poorly known. Studies on larger series would better characterize it.

Children's headaches are frequently primary. Their diagnosis is difficult because of anamnesis discomfort. Aetiologies are numerous, above all functional ones as migraine. As in adults, symptomatic headache has to be taken into account among these.