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Aim: We aimed to present a rare case of pseudotumoral tuberculosis of the cervix. Introduction: Tuberculosis has many localizations. Urogenital and particularly cervical involvement is rare. Case Presentation: Our observation concerned a case of pseudotumoral tuberculosis of the uterine cervix simulating a cancer. The clinical signs were pelvic pain and metrorrhagia, which were non-specific. The ulcerative-bourgeons appearance of the cervix was suggestive of cancer. Histology allowed the diagnosis to be made by showing an inflammatory granuloma and the absence of malignant cells. Despite the absence of bacteriological evidence, the clinical, biological, and histological presumptive arguments and the good therapeutic response made it possible to correct the diagnosis. The prognosis of our patient was mainly functional due to the risk of infertility. Conclusion: The interest of this observation lay in the rarity of this tuberculosis localization, especially in an immunocompetent subject, and the predominant place of histology.

International audience; The occurrence of malaria resurgences could threaten progress toward elimination of the disease. This study investigated the impact of repeated renewal of long-lasting insecticide-treated net (LLIN) universal coverage on malaria resurgence over a period of 10 years of net implementation in Dielmo (Senegal). A longitudinal study was carried out in Dielmo between August 2007 and July 2018. In July 2008, LLINs were offered to all villagers through universal campaign distribution which was renewed in July 2011, August 2014, and May 2016. Malaria cases were treated with artemisinin-based combination therapy. Two resurgences of malaria occurred during the 10 years in which LLINs have been in use. Since the third renewal of the nets, malaria decreased significantly compared with the first year the nets were implemented (adjusted incidence rate ratio) (95% CI) = 0.35 (0.15-0.85), during the ninth year after net implementation). During the tenth year of net implementation, no cases of malaria were observed among the study population. The use of nets increased significantly after the third time the nets were renewed when compared with the year after the first and the second times the nets were renewed (P < 0.001). The third renewal of nets, which took place after 2 years instead of 3 years together with a higher use of LLINs especially among the young, probably prevented the occurrence of a third malaria upsurge in this village.

Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.

Introduction: Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). Materials and Methods: This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded; they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, i.e. in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. Results: Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. Conclusion: Autoimmune thyroiditis is common in our daily practice in Senegal; it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.

International audience

Background A detailed understanding of the contribution of the asymptomatic Plasmodium reservoir to the occurrence of clinical malaria at individual and community levels is needed to guide effective elimination interventions. This study investigated the relationship between asymptomatic Plasmodium falciparum carriage and subsequent clinical malaria episodes in the Dielmo and Ndiop villages in Senegal. Methods The study used a total of 2792 venous and capillary blood samples obtained from asymptomatic individuals and clinical malaria datasets collected from 2013 to 2016. Mapping, spatial clustering of infections, and risk analysis were performed using georeferenced households. Results High incidences of clinical malaria episodes were observed to occur predominantly in households of asymptomatic P falciparum carriers. A statistically significant association was found between asymptomatic carriage in a household and subsequent episode of clinical malaria occurring in that household for each individual year (P values were 0.0017, 6 × 10–5, 0.005, and 0.008 for the years 2013, 2014, 2015, and 2016 respectively) and the combined years (P = 8.5 × 10–8), which was not found at the individual level. In both villages, no significant patterns of spatial clustering of P falciparum clinical cases were found, but there was a higher risk of clinical episodes Conclusion The findings provide strong epidemiological evidence linking the asymptomatic P falciparum reservoir to clinical malaria episodes at household scale in Dielmo and Ndiop villagers. This argues for a likely success of a mass testing and treatment intervention to move towards the elimination of malaria in the villages of Dielmo and Ndiop.

Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the risk of undesirable effects linked sometimes to the habits of prescription of the doctors. Patients and Methods: In order to study the prescription modalities of this treatment, we conducted a cross-sectional, multicentric and descriptive study from June 1st, 2017 to August 1st, 2017, over a period of 2 months. It involved a questionnaire given to medical specialists of all medical specialties and practicing in the University Hospital of Dakar. Results: 170 doctors were interviewed. Dermatologists and internists were mostly found 19.4% and 18.8% or 33% and 34% doctors. Systemic autoimmune diseases alone accounted for 48% of prescription reasons. Prednisone was prescribed in 88% of cases. The immunosuppressive dose of 1 mg/kg was most often prescribed. Practitioners very heterogeneously prescribe most adjuvant measures to prolonged systemic corticosteroid therapy. Thus, the recommendation of a low-sodium diet (38% of physicians), and the systematic prescriptions of proton pump inhibitors (44.7% of physicians) and vitamin-calcium supplementation were frequently performed by physicians (34% of physicians). While the low carbohydrate diet was advocated by less than a quarter of doctors and the prevention of pneumocystosis and osteoporosis were rare (respectively 61% and 52% of prescribers did not). Conclusion: The global analysis of the habits of our medical specialists concerning the use of long-term glucocorticoids reflected a diversity of indications, heterogeneity of practices, with certain habits not in accordance with the usual recommendations.

Introduction: Venous thromboembolic disease (VTE) is a real public health problem worldwide. The practice guide produced periodically by the American College of Chest Physicians (ACCP) has become the international standard. However, thromboprophylaxis remains underused. Methodology: We carried out a descriptive cross-sectional study. The goals of that study were to evaluate the effectiveness of the practice of thromboprophylaxis in the various medical services of the Dakar Public Hospitals. Our investigation was conducted for two weeks in September 2017. Results: 160 patients were included (81 men and 79 women) in our series, with male predominance: sex ratio of 1.02. The average age was 48. Infectious pathologies were the predominant clinical pictures (35% of cases). The thromboembolic risk factors (RF) mainly found were represented by prolonged bed rest, followed by cardiovascular (RF): age greater than 60 years (31.2%), hypertension (8.8%), obesity (4.4%) and diabetes (3.8%). The thromboembolic RF of patients hospitalized in these medical services has been evaluated empirically. We noted a lack of use of the VTE risk assessment scores. 40.9% (n = 56) of patients received overall VTE prophylaxis, a rate corresponding to almost half of those at risk (51.4%). This result reflects an under-use of thromboprophylaxis in the Dakar medical environment and a low level of adherence by practicians to the guidelines on VTE prophylaxis. Conclusion: It is therefore recommended to develop a national strategy to assess patients at risk for VTE, as well as measures to educate and inform doctors about the appropriate forms of thromboprophylaxis.

Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjogren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.

Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value < 0.05. Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p < 0.001) and uricemia (p < 0.001) were significantly higher in patients. The level of HDL cholesterol (p = 0.028) was lower in cases. Thus, low HDL cholesterolemia (p = 0.001), hypertriglyceridemia (p < 0.001), and hyperuricemia (p = 0.043) were more common in the cases. Renal failure was associated with systemic lupus erythematosus (p < 0.001). Difference in LDL-cholesterol (p = 0.103), hypertension (p = 1) and metabolic syndrome (p = 1) between cases and controls was not significant. Obesity and overweight were predominant in controls (p = 0.028). Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.

We report four observations of myasthenia gravis associated with other autoimmune diseases. Myasthenia gravis can be associated with all autoimmune diseases with a predominance of dysthyroidism. Among the autoimmune diseases associated with myasthenia gravis in our series, there were associations with hyperthyroidism, sjogren syndrome, Biermer’s disease. You would have to know how to look for another autoimmune disease in front of all myasthenia gravis by looking for the slightest sign of appeal that could point you towards another pathology.

Introduction. Le processus d’initiation de l’arthrose relève de plusieurs facteurs parmi lesquels l’obésité occupe une place importante expliquant l’individualisation récente du concept d’arthrose métabolique. Nos objectifs étaient d’évaluer le statut pondéral des patients arthrosiques en milieu de Médecine Interne au Sénégal et d’analyser les éventuelles comorbidités associées à l’arthrose. Patients et méthodes : Une étude transversale et descriptive, de juin 2016 à février 2017, a inclus les patients suivis pour une arthrose primitive quel qu’en soit la localisation aux services de Médecine Interne de l’Hôpital Aristide Le Dantec et de l’Hôpital Principal de Dakar. Les données sociodémographiques, les aspects de l’arthrose, les mesures anthropométriques et les comorbidités ont été recueillis et analysés à l’aide du logiciel Sphinx Plus2 Excel. Résultats : Cent quatorze patients ont été inclus ; leur âge moyen était de 60,16 ans (extrêmes de 39 et de 94 ans) avec un sex-ratio de 0,16 (98 femmes). La localisation de l’arthrose était le genou (71,9 %), le rachis (50 %), l’épaule (5 %), la hanche (4 %), les pieds (3 %) et les mains (3 %). L’IMC moyen était de 28,97 Kg/m2 avec 30,7 % des patients en surpoids et 33,1 % en obésité. L’obésité était notée chez 47 % des patients atteints de gonarthrose et 35,5 % de lombarthrose. L’obésité abdominale concernait 64 % des femmes et 30 % des hommes. L’hypertension artérielle, le diabète et l’hypercholes-térolémie étaient observés respectivement chez 42, 10 et 6 % des patients. Conclusion : la surcharge pondérale, l’obésité et les autres facteurs de risque cardiovasculaires sont des situations fréquentes chez les patients arthrosiques vus dans les services de Médecine Interne au Sénégal. Ces constatations rappellent l’importance des mesures hygiéno-diététiques dans la prise en charge et la prévention de l’arthrose.

Background The association of macrophage activation syndrome and primary Sjögren’s syndrome has been rarely reported in the literature. We report the first observation of this association in Africa, south of the Sahara, and we discuss the diagnosis and therapeutic challenge. Case presentation A 26-year-old Mauritanian and Berber woman was followed for primary Sjögren’s syndrome. After a voluntary cessation of her usual background treatment, she was admitted to our department for an outbreak of her illness. A clinical examination revealed anemic syndrome, peripheral polyarthritis, coughing rales at both pulmonary bases, and fever at 39.5 °C. On biologic examination, there was bicytopenia with anemia at 5.70 g/dl, lymphopenia at 796/mm3, a biological inflammatory syndrome with a sedimentation rate at 137 mm in the first hour, C-reactive protein at 97 mg/l, hyperferritinemia at 1778 mg/l (9 normal value), and hypergammaglobulinemia at 20.7 g/l of polyclonal appearance. The triglycerides were 1.95 g/l (1.4 normal value) and the lactate dehydrogenase level was 491 IU/l (1.5 normal value). Cytological examination of a medullary puncture revealed an image of hemophagocytosis. An infectious screening was negative. Thoracic computed tomography showed non-specific interstitial lung disease. A diagnosis of macrophage activation syndrome complicating primary Sjögren’s syndrome was selected with a probability of 97.2%, according to H-Score. The evolution was favorable under a treatment including etoposide (VP-16). Conclusion Macrophage activation syndrome is a rare entity, rarely reported during primary Sjögren’s syndrome. Its spontaneous evolution is invariably fatal. There is no consensus on therapeutic treatment. Etoposide is a therapeutic option especially in forms refractory to corticosteroid therapy.

International audience; Vaginal self-sampling and human papillomavirus (HPV) DNA testing can be useful tools for women with limited access to health care living in sub-Saharan Africa. To assess the feasibility and acceptability of vaginal self-sampling and high-risk HPV prevalence in two villages of central Senegal, women were asked to self-sample vaginal swabs for HPV detection in May, 2016. Vaginal swabs were collected from 133 women and were tested for HPV genotyping. The acceptability rate of vaginal self-sampling was 98.5%, and 99.2% of the women (133/134) used the device correctly. The quality of self-sampling was satisfactory in 100% of the samples; 10.5% of the samples were positive for HPV, including 6% with high-risk HPV types and 4% with low-risk HPV types. This preliminary study indicates that vaginal self-sampling is a valuable strategy for high-risk HPV detection and cervical cancer screening in a population of women not attending gynecologic screening in rural areas of Senegal.

Background Severe acute malnutrition (SAM) is a major public health problem affecting children under the age of five in many low- and middle-income countries, and its resolution would contribute towards achieving the several sustainable development goals. The etiology of SAM is pluri-factorial, including delayed maturation of the gut microbiota, suboptimal feeding practices and dysfunctional breastfeeding. The recent serendipitous detection of Listeria monocytogenes in the breast milk of Malian women, in contrast to French women, suggests a possible association with SAM. Methodology/ Principal findings To investigate the possible association of L. monocytogenes carriage in breast milk and SAM, a case-control study was performed in Senegal, with subjects recruited from two areas. Using 16S amplicon sequencing, a culture independent method, 100% (152/152) of the mothers were positive for L. monocytogenes in their breast milk while qPCR analysis gave lower recovery rates. Interestingly, after enrichment in Fraser broth and seeding on PALCALM agar, all 10 isolated strains were isolated from the milk of 10 mothers who had SAM children which also had a significantly increased relative abundance of L. monocytogenes (0.34 (SD 0.35) vs 0.05 (SD 0.07) in controls, p, Author summary Severe acute malnutrition is a global public health issue which greatly impacts childhood mortality rates. Although still not fully understood, the multi-factorial pathology of severe acute malnutrition has been associated, among other factors, with sub-optimal feeding practices (including dysfunctional breastfeeding) and an altered gut microbiota. The serendipitous detection of Listeria monocytogenes in the breast milk of Malian women has raised the possibility of its involvement in the pathogenesis of severe acute malnutrition. To investigate this possibility, the presence of L. monocytogenes was assessed in a cohort of lactating Senegalese women, both mothers of healthy children as well as those of severely malnourished children using culture-dependent and independent methods. Our study confirms the previously unsuspected presence of L. monocytogenes in the breast milk of Senegalese women, which is increased in the milk of mothers of severely malnourished children. Moreover, breast milk samples from the mothers of healthy children more frequently induced a potent inhibition of L. monocytogenes than those from the mothers of severely malnourished children. An inhibition was also achieved using potential probiotics, Lactobacillus and Streptococcus species, isolated from breast milk. Our study reveals the previously unsuspected carriage of L. monocytogenes in the breast milk of West African women, which is associated with severe acute malnutrition. The inhibitory effect of human selected lactic acid bacterial species against L. monocytogenes might provide new therapeutic and inexpensive options to prevent and treat this neglected public health issue.

La paralysie périodique hypokaliémique thyrotoxique est une complication rare de l'hyperthyroïdie. Plus souvent rapportée chez les sujets asiatiques, elle est peu décrite dans la population noire. Son mécanisme peu élucidé, serait lié à une hyper activité de la pompe Na+/K+. Nous présentons deux cas de cette affection survenant chez des sujets noirs africains. La présentation clinique était identique chez les deux malades. Elle était faite d´une paralysie musculaire proximal des membres inférieurs. Cette paralysie était associée à une hypokaliémie sévère et survenait chez des patientes suivies pour maladie de Basedow sans autre pathologie associée. L´évolution a été rapidement favorable sous supplémentation potassique. Le traitement de l´hyperthyroïdie a permis d´éviter les récidives. Ces observations montrent l´importance d´évoquer le diagnostic de paralysie périodique hypokaliémique thyrotoxique malgré la rareté dans la population noire africaine.

Background: Bacterial vaginosis is a very common vaginal disorder, with a gynaeco-obstetrical impact, but remains poorly understood. Current antibiotic treatment most often fails. Our objective was to exhaustively map the bacterial community present in bacterial vaginosis and normal flora, using not only a molecular approach but also a highly efficient culture approach, culturomics. Vaginal bacterial diversity was evaluated using both strategies for 24 Caucasian French women, including 7 cases of bacterial vaginosis, and 10 rural Senegalese women, including 5 cases of bacterial vaginosis. An additional 16 specimens (three cases of bacterial vaginosis and 13 normal flora) obtained during the follow-up visits of five French women with bacterial vaginosis were analysed using metagenomics.Results: The combination of culturomics and metagenomics reveals the richness and diversity of vaginal microbiota. Our data demonstrated that compared to healthy women, those with bacterial vaginosis present a shift in vaginal flora. The microbiota of the bacterial vaginosis group can be easily distinguished from that of healthy group by their increased bacterial diversity, abundance of Bacteroidales and Leptotrichiaeceae, and depletion of Proteobacteria and Lactobacillaceae species. In addition, a complex of 10 genera was associated with bacterial vaginosis: Gardnerella, Atopobium, Snethia, Aerococcus, Prevotella, Gemella, Facklamia, Porphyromonas, Mycoplasma, and Urinacoccus. Overall, the microbial population detected in bacterial vaginosis flora was largely similar to the bacterial communities found in gut microbiota. The two approaches showed a diverse vaginal microbiota that was largely non-overlapping, with only 146 common species. Furthermore, culturomics extends the repertoire of human-associated bacteria with the isolation of 27 new bacterial species.Conclusions: This study provides the most representative topology of the vaginal microbiota of normal flora and bacterial vaginosis and suggests the transplantation of gut microbiota into the vagina during bacterial vaginosis. Several sets of clinically relevant anaerobic bacteria and new species were also isolated from the human vagina, confirming that some previously “uncultivated” species may be cultivated using an appropriate strategy. Exhaustive characterisation of vaginal microbiota will enable a better understanding and management of bacterial vaginosis. Obtaining isolates will allow us to explore the bacterial interactions of the vaginal microbiota and will serve as a basis for the potential development of bacteriotherapy to prevent or treat vaginal dysbiosis.

Introduction: Antisynthetase syndrome is an original entity and rare autoimmune myositis and systemic disease, characterized clinically by a wide spectrum of clinical manifestations and the presence of autoantibodies directed against aminoacyl RNAt synthetases. We describe this disease in 03 Senegalese patients. Observations: The first patient was a 49-years-old black woman who was referred in our department after 06-months of follow-up for a misdiagnosis of tuberculosis. The clinical examination revealed polyarthritis, muscle weakness, chronic cough with crackling rales at the pulmonary bases, Raynaud phenomenon and dry syndrome. The second patient, a 21-years-old black woman, had polyarthritis and a progressive muscle weakness. The clinical examination showed also cutaneous signs including an erythema on the dorsal part of the fingers and the presence of the heliotrope erythema on the eyes. The last patient was a 52 years-old black woman. His clinical examination showed polyarthritis, muscle weakness and an appearance of mechanics’ hands. The creatinine phosphokinase was at 6.26 × N, 40.3 × N and 33.64 × N respectively in our patients. The chest computer tomography revealed an interstitial lung disease with a pattern of non-specific interstitial pneumonia in all three patients. The autoantibodies anti-Jo1 was also positive in all patients. The diagnosis of antisynthetase syndrome was retained with an overlap of antisynthetase and Sj?gren’s syndrome in the first observation. The evolution was favourable in our 03 observations with a therapeutic combination including Prednisone-Azathioprine and Kinesitherapy. Conclusion: Antisynthetase syndrome has been exceptionally reported in sub-Saharan Africa. It must be particularly mentioned in front of the triad: myositis, arthritis and interstitial lung disease. The identification of an auto-antibody directed against RNA t synthetases, particularly anti-Jo1, is essential for its diagnosis. Prognosis is related to interstitial lung involvement. The evolution has been favourable in our patients receiving Glucorticoid-Azathioprine combination therapy.

Introduction: The central, psychiatric and peripheral neurological manifestations of lupus are among the most severe visceral disorders and are grouped under the general term of “neuro-psychiatric systemic lupus erythematosus” (NPSLE). We conducted a cross-sectional observational study within our Department of Internal Medicine aimed at describing the clinical and evolutionary aspects of central neurological disorders of SLE, excluding lupus myelopathy. Patients and Methods: This was a retrospective and observational cross-sectional study carried out from 1 January 2015 to 31 October 2017, in the Department of Internal Medicine of Aristide le Dantec University Hospital in Dakar (Senegal). All patients hospitalized during this period who met the 1997 ACR classification criteria of SLE and who presented with a central neuropsychiatric syndrome attributable to SLE (as defined by ACR 1999) were included. Patients with isolated headache, acute myelitis or secondary neurological involvement attributable to a toxic, metabolic, infectious or tumour-related cause were excluded from our study. Results: During the study period, 10 patients with neuropsychiatric lupus involvement were treated at our institution, including 9 women and 1 man; the median age was 29 years (20 - 55 years). Neurological involvement occurred during the course of lupus evolution in 9/10 cases. The median time to SLE evolution was 18 months (0 - 60 months). Neuropsychiatric syndromes as defined by the 1999 ACR were commonly associated and more than half of our patients had multiple neuropsychiatric syndromes. There were 5 cases of confusion syndrome and coma, 4 cases of seizure, 3 cases of psychosis, 2 cases of acute cerebrovascular disease and 1 case of aseptic meningitis. Among the extra-neurological manifestations of SLE, haematological and dermatological involvements were common. Renal involvement affected half of the patients. The other manifestations were: polyarthritis in 3 patients, serositis in 2 patients, 5 cases of fever, 4 cases of deterioration of the general state, and one isolated case of ophthalmological involvement. Therapeutically, 8 patients received a bolus of methylprednisolone and 3 patients received a bolus of cyclophosphamide. Oral corticosteroids and hydroxychloroquine were administered to all patients, and azathioprine was administered in 2 patients. The evolution was favorable in 4 patients, other 2 patients maintained neurological sequelae and 2 patients were transferred to intensive care. Death was recorded in 4 patients. Conclusion: Neuropsychiatric manifestations of lupus are rare and sometimes severe, potentially life-threatening. In our patients, we have identified some of the most severe neurological syndromes according to the ACR nomenclature. The neurological involvement is exceptionally revealing, as these syndromes are often associated and integrated into a systemic context of lupus. The evolution is rapidly unfavorable and requires early diagnosis and optimal management.

Objective: Describe the design and implementation of an electronic medical record—E-INTMED—customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users’ needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients’ information. E-INTMED structures patient’s data to provide a clear overview of their medical history and users’ activity performance. E-INTMED makes medical users’ life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.

Background: In Dielmo, Senegal, the widespread use of long lasting insecticidal nets has decreased both the incidence of malaria and the density of the anopheles population. However, persistent low-level malaria transmission may hamper efforts to eliminate the disease. Therefore, continuous monitoring of the vector population is needed in order to improve knowledge of anopheles biting behaviour and to readjust control interventions.Methods: In 2015, anopheles were collected every month for a whole year and each specimen was identified using morphological and molecular techniques. The biting pattern of each species was analysed according to night (7pm–7am) and day (7am–11am) periods, the place of biting and the season. The ELISA CSP technique was used to evaluate the entomological inoculation rate (EIR).Results: An. arabiensis and An. funestus s.s. were found to be the main vectors biting human in Dielmo. Overall, the biting rate was low, at 3.84bites per night (bpn) and 1.27 bites per day (bpd), respectively. The EIR was 2.51 and 5.03 infected bites per year during the night and day, respectively. During the night, the An. arabiensis and An. funestus biting rate was 1.81 bpn and 1.71 bpn, respectively (p=0.80). During daylight hours, their aggressiveness decreased to 0.51 bpd and 0.73 bpd for An. arabiensis and An. funestus, respectively (p=0.30). During the night, depending on the seasons, only An. funestus displayed a significant outdoor biting behaviour both in the rainy and dry seasons, while during the day, no specific trend of indoor or outdoor biting was observed, regardless of the season for both vectors.Conclusion: This study highlighted low level anopheles nocturnal and diurnal biting and the associated risk of malaria transmission. It showed also the influence of the season on the indoor and outdoor biting pattern, indicating that the human population could be exposed all year round to a low level of anopheles bites. Control programs should increase awareness of the use of bed-nets throughout the year, particularly shortly after dawn when people are still indoors.

International audience; BACKGROUND:The widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticide-treated nets (LLINs) has led to an impressive decrease of malaria burden these recent years in Africa. However, some new challenges about the future of malaria control and elimination efforts have appeared. Among these challenges, the loss and-or-the only partial acquisition of anti-Plasmodium immunity among exposed populations lead to an increase of the age at risk of malaria. Indeed, older children and adults may become more vulnerable to malaria. Studies about malaria among adults seemed, therefore, important. This study investigated the evolution of malaria morbidity in adults of Dielmo (Senegal) before and after the implementation of LLINs.METHODS:From August 2007 to July 2015, a longitudinal study involving adults above 15 years old was carried out in Dielmo, where ACT was introduced in June 2006 and LLINs in July 2008. In July 2011 and August 2014, all LLINs were renewed. The presence of each person in the village was monitored daily. Thick smears associated lately with rapid diagnosis test (RDT) and quantitative polymerase chain reaction methods were performed for all cases of fever. To assess malaria prevalence, thick smears and RDT were performed quarterly in all individuals. Malaria risks factors were assessed using negative binomial regression mixed-model based on person-trimester observations.RESULTS:Malaria morbidity among adults has decreased significantly since the implementation of LLINs in Dielmo. However, malaria resurgences have occurred twice during the 7 years of LLINs use. During these malaria resurgences, the overall incidence of malaria among adults was similar to the incidence during the year before the implementation of LLINs (adjusted incidence rate ratio [95% CI] aIRR = 1.04 [0.66-1.64], p = 0.88 and aIRR = 1.16 [0.74-1.80], p = 0.52 during the first and the second malaria resurgence period, respectively). Younger adults were most vulnerable during these malaria upsurges as the incidence of malaria increased significantly among them (χ2 = 5.2; p = 0.02).CONCLUSION:Malaria among adults especially younger adults should deserve more attention in the areas where malaria was previously endemic as they became vulnerable probably because of the partial acquisition and-or-the loss of anti-Plasmodium relative immunity and the non regular use of LLINs.

Introduction: Systemic diseases have been the subject of few studies in the African literature and have probably been under-estimated. The objective of our study was to specify their spectrum, their epidemiological aspects and diagnostic delay in Internal Medicine Departments of Dakar (Senegal). Material and Method: It was a multicentric retrospective and descriptive study regarding all systemic diseases during 119 months from 1st January 2005 to 30 November 2014 in 5 hospital centers down Dakar. Systemic diseases were retained according to their international consensus criteria. Results: During the studying period, 726 patients were included with 632 women and 94 men (sex ratio of 0.14). The average age was 43.76 years. Inflammatory rheumatoid family history was noted in 10.06% of cases. Rheumatoid arthritis (RA) was the predominant affection, recorded on 564 patients, isolated or associated with other systemic diseases. It was followed in a decreasing order, in the systemic auto-immune diseases sub-groupe, by systemic lupus (56 cases), Sjogren’s syndrome (32 cases), Systemic Sclerosis (26 cases), Idiopathic inflammatory myopathies (21 cases), Undifferentiated connective tissue diseases (20 cases), Anti Phospholipid’s syndrome (6 cases) and Mixed connective tissue disease (6 cases). A diagnosis of systemic vasculitis was recorded in 19 patients. The other systemic affections were represented by systemic sarcoidosis (8 cases), Adult-onset Still’s disease (03 cases), amyloidosis (02 cases) and 02 cases of systemic syndrome associated to immunodeficiency. The mean diagnostic delay duration before the diagnostic was 3.46 years. Conclusion: Systemic diseases in internal medicine are characterized by their diversity, the clear predominance of RA, and significant diagnostic delay.

Background Mosquitoes belonging to the Anopheles gambiae complex are the main vectors of malaria in sub-Saharan Africa. Among these, An. gambiae, Anopheles coluzzii and Anopheles arabiensis are the most efficient vectors and are largely distributed in sympatric locations. However, these species present ecological and behavioural differences that impact their vectorial capacity and complicate vector-control efforts, mainly based on long-lasting insecticidal bed nets (LLINs) and indoor residual spraying (IRS). In this study, the genetic structure of these three species in a Senegalese village (Dielmo) was investigated using microsatellite data in samples collected in 2006 before implementation of LLINs, in 2008, when they were introduced, and in 2010, 2 years after the use of LLINs. Results In this study 611 individuals were included, namely 136 An. coluzzii, 101 An. gambiae, 6 An. coluzzii/An. gambiae hybrids and 368 An. arabiensis. According to the species, the effect of the implementation of LLINs in Dielmo is differentiated. Populations of the sister species An. coluzzii and An. gambiae regularly experienced bottleneck events, but without significant inbreeding. The Fst values suggested in 2006 a breakdown of assortative mating resulting in hybrids, but the introduction of LLINs was followed by a decrease in the number of hybrids. This suggests a decrease in mating success of hybrids, ecological maladaptation, or a lesser probability of mating between species due to a decrease in An. coluzzii population size. By contrast, the introduction of LLINs has favoured the sibling species An. arabiensis. In this study, some spatial and temporal structuration between An. arabiensis populations were detected, especially in 2008, and the higher genetic diversity observed could result from a diversifying selection. Conclusions This work demonstrates the complexity of the malaria context and shows the need to study the genetic structure of Anopheles populations to evaluate the effectiveness of vector-control tools and successful management of malaria vector control. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1992-8) contains supplementary material, which is available to authorized users.