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Introduction: The general objective was to determine the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of connectivitis in the dermatology department of the CHU Aristide Le Dantec. Patients and methods: This was a retrospective and descriptive study conducted in the Dermatology Department of the University Hospital Center (UHC) Aristide Le Dantec (HALD) of Dakar between January 2009 and December 2019. Their diagnoses were retained according to the international criteria validated in the course of connectivites Results: We identified 290 cases of connectivitis. Systemic scleroderma was the most frequent in 34.42% (n=94), followed by systemic lupus in 25.86% (n=75), mixed connectivities in 22,06% (n=64) and dermatomyositis in 19,32% (n=56). Cancer was associated with dermatomyositis in 11 cases and with systemic scleroderma in 3 cases. The mean age of our patients was 38.23 years. The sex ratio was 4.2 and the mean duration of evolution was 25 months. Dermatological manifestations were constant, found in all patients. In systemic lupus, they were dominated by discoid lupus lesions found in 40% and hypochromic spots (86%) in systemic scleroderma. In dermatomyositis, skin lesions were dominated by periorbital erythroedema (66.07%). Joint manifestations were found in 56.89% of cases (n= 165), muscular manifestations in 41.37% of cases (n= 120) and pleuropulmonary manifestations in 31.3% of cases (n=91). Neuropsychiatric manifestations were noted in 5.17% of cases (n=15). All our patients were treated with corticosteroid therapy and 12.06% of them had received immunosuppressive treatment, the most commonly used molecules being methotrexate (3.44%) and cyclophosphamide (8.27%). Hydroxychloroquine was prescribed in 59.31% of patients, while D-penicillamine was prescribed in 42.06% of patients, 100% of whom were treated for systemic scleroderma. The main complications encountered were infectious complications in 83 cases (28.6%). Visceral complications, a type of visceral insufficiency, were noted in 4.13% of cases. Conclusion: Our study demonstrates the frequency of connectivitis in the dermatology department. Its particularity was the predominance of systemic scleroderma over lupus which was classically the first connectivite in dermatology services. The delay in diagnosis noted is correlated with visceral attacks; hence the importance of a better knowledge of these affections for an early management.

Objective: Describe the epidemiological, diagnostic, therapeutic and evolutionary profile of triple negative breast cancer at the Dakar Cancer Institute in Senegal. Patients and Methods: This was a retrospective study between January 1, 2011 and December 31, 2014. All patients with a triple negative molecular profile were included. The data were collected from the medical records of the patients. The data were entered and analyzed with SPSS edition 16 software under Windows 7. Results: Two hundred and twenty-five patients were selected. The mean age was 47.9 ± 12.5 years with extremes of 25 and 90 years. The main reason for consultation was dominated by the finding of a breast lump. The mean clinical tumor size was 8, 54 cm with a large majority of T3-T4 tumors 26% and 63% respectively, lymph node involvement in one hundred and seventy-two cases (76.4%); twenty eight patients (12.4%) were metastatic from the outset. Non-specific invasive carcinoma was the most common histologic type (78.2%), and more than half of the patients (53.3%) had an aggressive tumor (Scarff-Bloom-Richardson grading III). Neoadjuvant chemotherapy was performed in 65.78% of cases. We noted 27.7% total response and 41.7% partial response in patients who have received this neoadjuvant chemotherapy. The surgery was radical in 77% of cases, conservative in 14% and cleanliness surgery for palliative purposes in 9% of cases. Adjuvant radiotherapy is performed in 58.6% of operated patients. The mean time to follow-up was 20.63 months with extremes of 1 and 53 months. Overall survival was 69.8% at one year, 41.6% at two years and 25.6% at three years. Conclusion: The descriptive analysis of these results confirms the high frequency of triple-negative breast cancer in Senegal and its poor prognosis.

Background: Type 2 diabetes mellitus, beyond its well-known cardiovascular and neurological complications, is now increasingly recognized as having deleterious effects on bone tissue. It’s thus presented as an independent risk factor for bone fragility with a considerable fracture risk relating to many more or less intricate parameters. The general objective of our study is to assess bone mass during type 2 diabetes in Senegalese women. Methodology: We had carried out a cross-sectional and descriptive study. Socio-demographic characteristics were collected on the basis of a questionnaire. Then each of the subjects had undergone a complete clinical examination followed by a blood sample for a biological assessment of certain cardiovascular risk factors. Bone mass was measured using a bio-impedancemeter. Results: We recruited 88 women with type 2 diabetes and 83 healthy control women. The mean age of diabetic subjects was 52.7 years ± 6.8 (with extremes of 39 and 74 years). In control, the mean age was 51.0 ± 8.5 years (with extremes of 35 and 72 years). Among the diabetic subjects, 22 subjects or 25% practiced a regular walk against 27 (32.5%) in the control. Forty-three among the diabetic subjects (48.8%) were known hypertensive and followed. According to the body mass index, 71 patients (80.7%) were overweight compared to 59 (71.1%) controls. According to the waist size, 80 (90.9%) diabetic subjects had an elevated waist size compared to 69 control women (83.1%). Among diabetic subjects, 41 patients (46.5%) were hyperglycemic imbalance according to fasting blood glucose and 59 patients (67%) according to glycated hemoglobin level. Thirty-seven diabetics (42%), had both high fasting blood glucose and elevated glycated hemoglobin. The mean duration of diabetes was 8.68 ± 7.18 years. We found significantly higher bone mass in type 2 diabetic subjects (p = 0.03). Among diabetics, 27.3% had low bone mass compared to 36.1% of control. It’s noted that the subjects of the “low bone mass” group among the control subjects also have a significant drop in other anthropometric parameters (weight, body mass index, waist size, muscle mass). It should also be noted that the fat mass is significantly higher in diabetic subjects with normal or even high bone mass. In control subjects, bone mass was positively correlated with weight (r = 0.36; p = 0.001), muscle mass (r = 0.93; p < 0.0001) and fasting blood glucose (r = 0.26; p = 0.02); and negatively correlate with age (r = 0.22; p = 0.04). On the other hand, in type 2 diabetic subjects, bone mass is positively correlated with age (r = 0.22; p = 0.04), muscle mass (r = 0.89; p < 0.0001) and the diabetes duration (r = 0.44; p = 0.001). Conclusion: Bone mass is higher in type 2 diabetics compared to healthy controls. Chronic hyperglycemia and the diabetes duration are believed to be responsible for the increase in bone mass. In addition, an increase in muscle mass would lead to an increase in bone mass.

Background: High blood pressure (BP) (hypertension) is one of the leading causes of death and cardiovascular disease worldwide. In 2001, hypertension, considered both pathology in its own right and a risk factor for other diseases, was responsible for more than 7.6 million deaths. A 2014 study in Dakar showed that the prevalence of hypertension was 27.50%. Aim and Objective: The objective of this study is to assess the involvement of the community pharmacist in the management of high BP with regard to screening, counseling, and treatment and to assess the difficulties encountered in these stains. Materials and Methods: This is a descriptive and analytical cross-sectional study of all community pharmacists who meet our eligibility criteria. The survey took place from April 15, 2019, to June 10, 2019, and involved 100 pharmacies in the Dakar region. The questionnaire was designed on the basis of the following headings: Presentation of the pharmacy; BP screening and measurement; tips for primary and secondary prevention of high BP; tertiary prevention; and difficulties encountered by pharmacists. Results: The results showed that 46% of pharmacists gave a false definition of ATH. No pharmacist had the three types of armbands (adults, children, and obese). The rest time before measuring the BP, namely, 5–10 min, was respected by 94.12% of the pharmacists respected. The patient’s position at the measurement and the grip on both arms were not respected by most of the respondents who disagreed with the recommendations. Hygienic-dietary measures were not recommended enough. However, the sodium diet and smoking cessation have been recommended by all pharmacists. Concerning the drugs to avoid in hypertensive patients, only 35.29% of pharmacists advised against non-steroidal anti-inflammatory drugs and 47% for sympathomimetics. Most pharmacists referred patients to the doctor when the BP was abnormally high, whether he was on or without treatment with a compliance check for patients on treatment. Conclusion: At the end of this study, the results obtained certainly show a certain mastery of the management of average handle time but are not very satisfactory. Indeed, many gaps and shortcomings in terms of knowledge and practice have been highlighted.

L’hypothyroïdie de l’enfant é été peu étudiée au Sénégal. Le but de cette étude était d’évaluer les aspects épidémiologiques, diagnostiques et évolutifs de l’hypothyroïdie congénitale. Il s’agissait d’une étude rétrospective descriptive et analytique portant sur tous les enfants suivis pour hypothyroïdie congénitale au Centre Hospitalier National d’Enfants Albert Royer sur la période de 2001 à 2014 (14 ans). A partir des dossiers des malades, nous avons recueilli et analysé les données sociodémographiques, cliniques et évolutives. Au total, 28 patients ont été inclus, soit une moyenne de 2 cas par an. L’âge moyen de découverte de l’hypothyroïdie était de 54,25 ± 43 mois avec une prédominance féminine (Sex- ratio 0,47). Seuls 2 cas d’hypothyroïdie ont été diagnostiqués dans la période néonatale. La consanguinité était présente chez 68% des patients. Les signes cliniques étaient dominés par le retard des acquisitions psychomotrices (96%), l’hypothermie (46%), la dysmorphie cranio-faciale (43%) et le goitre (39%). Le retard statural était constant au-delà de 6 mois. Les étiologies étaient dominées par les troubles de l’hormonosynthèse (84,21%). Dans l’évolution, la taille moyenne des patients était passée de -3,5 DS à -2,25 DS pour une durée de traitement moyenne de 28 mois. La débilité mentale était présente dans 73% des cas. Le retard de croissance et la débilité mentale étaient d’autant plus sévères que le diagnostic était tardif. Nos résultats confirment l’insuffisance d’une prise en charge précoce des patients. Il urge de mettre en place un système de dépistage néonatale systématique, afin d’améliorer le pronostic mental de cette affection. The Pan African Medical Journal 2016;25

Le syndrome hémolytique et urémique (SHU) est une cause fréquente d’insuffisance rénale aiguë (IRA) organique chez l’enfant. C’est une complication évolutive des gastroentérites aiguës (GEA) en particulier à Escherichia coli de l’enfant. Notre objectif était de décrire les aspects cliniques, thérapeutiques et évolutifs de cette affection chez quatre enfants. Nous avions colligé quatre cas de SHU. L’âge moyen était de 10,5 mois (5-15mois) exclusivement des garçons. L’examen clinique retrouvait une anémie de type hémolytique (pâleur et ictére), un syndrome oedémateux avec oligo-anurie (2 cas), une hypertension artérielle (1 patient), une GEA avec déshydratation sévère et choc hypovolémique (2 patients), des troubles de conscience. L’IRA était notée chez tous les patients de même que la thrombopénie et les schizocytes au frottis. Le Coombs direct était négatif. Il y avait une hyperkaliémie (3patients) dont 1 patient supérieure à 9,2 mmol/l, une hyponatrémie à 129mmol/l(1 patient) et une hypernatrémie à 153mmol/l (1 patient). Le shu était secondaire à une pneumonie à pneumocoque (1 patient), une GEA à E. coli (1 patient). Le traitement était essentiellement symptomatique et comprenait la restriction hydrique, la transfusion de concentrés érythrocytaires, les diurétiques, la dialyse péritonéale et l’hémodialyse. L’évolution était marquée par la survenue d’une insuffisance rénale chronique (1 patient) après 6 mois de suivi et la guérison (1 cas). Nous avions noté 3décés.Le SHU est la cause la plus fréquente d’IRA organique du nourrisson. Le diagnostic est essentiellement biologique, le traitement est surtout symptomatique. The Pan African Medical Journal 2016;24

Background: Chronic obstructive pulmonary disease (COPD) is characterized by high mortality. The latter is strongly attributed to cardiovascular events whose onset is endothelial dysfunction and vascular remodeling. Aims and Objectives: The aims were to evaluate the endothelial function during COPD and the factors involved with possible endothelial dysfunction in Senegalese Black men aged at least 18 years. Materials and Methods: This was a prospective and cross-sectional study. After a complete clinical examination and evaluation of the body composition by a bioimpedancemeter, the endothelial function was evaluated by EndoPAT2000®. Results: the mean age was 61.50 years ± 6.62. Of the subjects, 70% were smokers and 50% had limited chest enlargement. According to the body mass index and the percentage of body fat, underweight was 30% and 40%, respectively. The 75.5% of the meager could not be evaluated by bio-impedancemeter due to extreme thinness. Endothelial dysfunction involved 70% of subjects. In addition, 86% of subjects with endothelial dysfunction were smokers. The reactive hyperemia index was positively correlated with body mass index (P = 0.017 and r = 0.73), body fat percentage (P = 0.016 and r = 0.73) and visceral fat level (P = 0.008 and r = 0.78). Conclusion: The evolution of COPD would be laced with serious cardiovascular complications often fatal. The assessment of nutritional status and endothelial function is fundamental for better management of the disease.

We have previously demonstrated that in endothelium-denuded arteries, S-nitrosation of cysteine residues is a mechanism of formation of releasable nitric oxide (NO) stores, accounting for the long-lasting relaxation induced by S-nitrosating agents like S-nitrosoglutathione (GSNO). Here, we have investigated whether such effects could also be obtained in arteries exhibiting oxidative stress-associated endothelial dysfunction. Rats were implanted or not with a minipump delivering saline or angiotensin II for 14 days. As expected, aorta from angiotensin II-infused rats exhibited increased level of superoxide anions (as evaluated with dihydroethidine as fluorescent probe) and a reduced relaxation to acetylcholine in comparison to saline group. Unlike aortic rings with endothelium from controls, those from angiotensin II-infused rats exhibited persistent hyporesponsiveness to phenylephrine after pre-exposure to GSNO, as well as relaxation upon addition of N-acetylcysteine (NAC, which can displace NO from cysteine–NO residues) or HgCl2 (which cleaves S–NO bonds). In aorta from angiotensin II-infused rats, GSNO also induced a persistent increase in cysteine–NO residues (as determined using anti-cysteine–NO antiserum), which was blunted by NAC and HgCl2. These data indicate that (i) the vasorelaxant influence of releasable NO stores is unmasked by endothelial dysfunction (ii) S-nitrosation of cysteine residues remains an effective mechanism of formation of releasable NO stores in arteries exhibited oxidative stress-associated endothelial dysfunction. Thus, formation of releasable NO stores by S-nitrosating agents allows targeted vasculoprotective effects of NO at sites of endothelial dysfunction.

Resume Au Senegal, la malnutrition demeure un probleme de sante publique avec une prevalence de 20 % dont 5 % de malnutrition severe chez les enfants de zero a cinq ans. L’objectif principal de cette etude etait de discuter l’existence chez ces enfants d’une dysthyroidie induite par les carences multiples, dont celle d’iode et d’evaluer l’impact de ce traitement sur les fonctions thyroidiennes. Materiel et methodes Ont ete inclus dans l’etude soixante-huit enfants repartis de maniere aleatoire en deux groupes suivant l’adjonction ou non d’algues marines hypnea a la supplementation nutritionnelle classique. Pour apprecier a la fois l’etat nutritionnel et biologique et suivre l’evolution sous traitement, les parametres anthropometriques ont ete les rapports : poids/âge (P/A), poids/taille (P/T), taille/âge (T/A), des dosages radio-immunologiques des hormones thyroidiennes libres (T3 libre et T4 libre) et de l’hormone thyreostimulante (TSH) ont ete realises. D’autres parametres biologiques sanguins ont ete mesures parmi lesquels les protides, le magnesium et l’hemoglobine. Resultats Ils ont montre des anomalies biologiques thyroidiennes a type d’hypothyroidie fonctionnelle compensee (9 %) et de syndrome a basse T3 (8,6 %). Le traitement n’a induit ni surcharge iodee, ni dysthyroidie. Conclusion Dans le programme de rehabilitation nutritionnelle, les techniques radioisotopiques in vitro ont permis, d’une part d’etablir la faible prevalence des perturbations de la fonction thyroidienne (17,6 %) a type de syndrome a basse T3 et d’hypothyroidie fonctionnelle compensee, faisant ainsi le diagnostic differentiel et d’autre part, de confirmer l’absence de toute dysthyroidie induite par l’apport iode de l’algue marine hypnea.

Summary : A nutritional rehabilitation trial for severely malnourished children aged 6 to 36 months (weight/height index using Z-score of less than ‐ 3 as the reference mean) was conducted in the poor suburban areas of Dakar, Senegal. Its purpose was to determine the effectiveness of a rehabilitation programme delivered in the home as compared to one provided in a nutritional recovery center (CREN). Ninety-seven children benefited from rehabilitation at home and 51 at the CREN. At the end of two months of rehabilitation and after five months of charting their weight, the average weight gain was better in the group followed at home, but it still remained well under the 50 g/day recommended by WHO. Within the two groups, all of the children stayed underweight, with an average weight/height index Z-score of less than ‐ 2.5 in the group followed at home, and a Z-score of less than ‐ 2.9 in the other group. The

Angiotensin II (Ang II)-induced hypertension is associated with vascular oxidative stress and an endothelial dysfunction. This study examined the role of reactive oxygen species (ROS) and endothelium-derived contracting factors in Ang II-induced endothelial dysfunction and whether these effects are prevented by red wine polyphenols (RWPs), a rich source of natural antioxidants. Rats were infused with Ang II for 14 days. RWPs were administered in the drinking water 1 week before and during the Ang II infusion. Arterial pressure was measured in conscious rats. Vascular reactivity was assessed in organ chambers and cyclooxygenase-1 (COX-1) and COX-2 expression by Western blot and immunofluorescence analyses. Ang II-induced hypertension was associated with blunted endothelium-dependent relaxations and induction of endothelium-dependent contractions in the presence of nitro-L-arginine in response to acetylcholine (Ach). These effects were not affected by the combination of membrane permeant analogs of superoxide dismutase and catalase but were abolished by the thromboxane A(2) (TP) receptor antagonist GR32191B and the COX-2 inhibitor NS-398. The COX-1 inhibitor SC-560 also prevented contractile responses to Ach. Ang II increased the expression of COX-1 and COX-2 in the aortic wall. RWPs prevented Ang II-induced hypertension, endothelial dysfunction, and upregulation of COX-1 and COX-2. Thus, Ang II-induced endothelial dysfunction cannot be explained by an acute formation of ROS reducing the bioavailability of nitric oxide but rather by COX-dependent formation of contracting factors acting on TP receptors. RWPs are able to prevent the Ang II-induced endothelial dysfunction mostly due to their antioxidant properties.

Objective: Previous investigations have indicated that angiotensin II (Ang II)-induced hypertension and endothelial dysfunction are prevented by intake of red wine polyphenols (RWPs). Ang II has also been shown to increase the expression of VEGF and MMP-2, two major pro-inflammatory factors, in vascular diseases. Therefore, the aim of the present study was to determine whether intake of RWPs is able to prevent these effects in rats and, if so, to characterize the underlying mechanism. Methods: VEGF and endothelial NO synthase (eNOS) expression was assessed by immunofluorescence and Western blotting, MMP-2 activity by zymography, and reactive oxygen species (ROS) formation by dihydroethidine. Results: Ang II increased VEGF expression and MMP-2 activity in the aortic wall. Ang II-induced MMP-2 activation is inhibited by NG-nitro-L-arginine and MnTMPyP. Ang II increased the expression of eNOS, the formation of ROS and the nitration of proteins. The stimulatory effects of Ang II on these factors are prevented by RWPs intake. Conclusions: Infusion of Ang II induced vascular expression of VEGF and peroxynitrite-dependent activation of MMP-2, with both effects being prevented by RWPs intake. Thus, prevention of VEGF and MMP-2 expression might be involved in the protective effect of red wine on coronary heart diseases.

Objective: Chronic administration of moderate amounts of red wine has been associated with a protective effect on the cardiovascular system. This study examined whether red wine polyphenols prevent the angiotensin II (Ang II)-induced hypertension and endothelial dysfunction in rats, and, if so, to elucidate the underlying mechanism. Methods: Hypertensive rats were obtained by a 14-day infusion of Ang II. Red wine polyphenols were administered in the drinking water one week before and during the Ang II infusion. Arterial pressure was measured in conscious rats. Ex vivo vascular relaxation was assessed in organ chambers, vascular superoxide anion production by dihydroethidine and vascular NADPH oxidase expression by immunohistochemistry. Results: Ang II-induced hypertension was associated with decreased relaxation to acetylcholine but not to red wine polyphenols. The Ang II treatment also increased vascular superoxide anion production and expression of nox1 and p22phox NADPH oxidase subunits. Intake of red wine polyphenols prevented the Ang II-induced hypertension and endothelial dysfunction and normalized vascular superoxide anion production and NADPH oxidase subunit expression. Red wine polyphenol treatment alone did not affect blood pressure. Conclusion: Intake of red wine polyphenols prevents Ang II-induced hypertension and endothelial dysfunction. Prevention of vascular NADPH oxidase induction and preservation of arterial nitric oxide availability during Ang II administration likely contribute to this effect.

S-Nitrosating nitric oxide (NO) donors like S-nitrosoglutathione (GSNO) induce a persistent inhibition of vascular tone, through the formation of releasable NO stores. In this study, we investigate whether GSNO also induces NO stores-related effects in vessels exhibiting tolerance to glyceryl-trinitrate. Rat aortic rings treated with glyceryl-trinitrate (100 microM for 1 h) exhibited increased level of superoxide and a decrease in NO elevation and relaxation induced by subsequent addition of glyceryl-trinitrate. In glyceryl-trinitrate-treated rings as in controls, pre-exposure to GSNO (1 microM for 30 min) induced a persistent hyporesponsiveness to noradrenaline and a relaxant response to N-acetylcysteine (a low molecular weight thiol which can displace NO from NO stores), both of which being inhibited by guanylyl-cyclase or cyclic GMP-dependent protein kinase inhibitors. These data indicate that GSNO can promote the formation of releasable NO stores in arteries exhibiting increased superoxide level and tolerance to glyceryl-trinitrate. Formation of releasable NO stores is of potential interest to restore the protective effect of NO in organic nitrate-tolerant blood vessels.