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L'abcès de la thyroïde est une maladie très rare en raison de sa situation anatomique et de la physiologie de la glande. Il survient la plus part du temps sur un terrain d'immunodépression. Le diagnostic est facile mais on y pense pas souvent et repose sur l'échographie. L'examen bactériologique permet de retrouver le germe responsable. Nous rapportons le cas d'un patient mauritanien vivant dans ledit pays et qui avait consulté pour une tuméfaction cervicale antérieur douloureuse associée à une fièvre. Le diagnostic était posé à l'échographie et confirmé par l'examen anatomopathologique du liquide de ponction, sans étiologie retrouvée à la bactériologie. L'évolution était marqué par une régression des symptômes sous antibiothérapie, avec une normalisation de la structure de la glande après 2 mois.

Objective: To compare the clinical manifestations observed in AIDS patients infected with HIV2 and HIV1 infection.Methods: The medical records of AIDS patients hospitalized between January 1986 and July 1997 at the Department of Infectious Diseases of Fann Hospital, Dakar, were reviewed.Results: 599 hospitalizations (76%) were HIV1 seropositive patients, 137 (17%) were HIV2 seropositive patients and 54 (7%) were patients serologically dually reactive to HIV1 and HIV2. There was no significant difference in medium CD4 lymphocyte count between patients with HIV1 and HIV2 infection. Chronic diarrhoea and diarrhoea caused by bacterial infections were more frequently observed in HIV2-infected individuals. Oral candidiasis and chronic fever were more often noted in patients with HIV1 infection. Bacterial and cryptococcal meningitis was only observed among patients with HIV1 infection.Conclusions: Certain clinical differences were observed comparing AIDS patients with HIV1 and those with HIV2 infection. As there is no clear physiopathological explanation for these differences, additional studies with larger numbers of AIDS patients are needed to determine whether these differences are real. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Le but de notre étude était de déterminer le profil clinique et évolutif des lésions de la peau et des parties molles des sujets diabétiques suivis à la salle de pansement. METHODES: il s'agissait d'une étude observationnelle descriptive et analytique menée du 1er janvier au 31 décembre 2017 à la salle de pansement du centre Marc Sankale de Dakar. Notre étude a porté sur les sujets diabétiques ayant consultés à la salle de pansement. RESULTATS: au total, 37173 actes de soins ont été enregistrés au centre Marc Sankale. Les activés de soins à la salle de pansement représentaient 16418 cas soit une prévalence de 14,16%. L'âge moyen était de 56,6 , 12 ans et le sex ratio (H/F) de 0,88. Le diabète de type 2 prédominait (78,97%) et la durée moyenne du diabète était de 8,06 , 7,9 ans. La glycémie capillaire moyenne était de 2,4 , 1 g/l. La neuropathie diabétique était présente chez 72,33% des cas. Les lésions se situait aux membres dans 93,98% (1185 cas). Les lésions les plus représentatives étaient l'ulcère (46,76%), l'abcès (13,46%), le phlegmon (13,20%), la gangrène (8,41%), l'érysipèle (3,78%), le mal perforant (3,53%), l'intertrigo (3,95%). Les lésions étaient infectieuses (61,41), non infectieuses (33,50%), vasculaires pures (1,57%) et Mixtes (3,70%). Sur les 1189 patients 7,57% avaient présentés une ostéite. Les germes retrouvés étaient des bactéries grams positifs (12,70%), grams négatifs (23,80%). L'amputation était corrélée à la topographie de la lésion (p=0.00), au type de lésion (p=0.000), à l'ancienneté du diabète (p=0,02), au type de diabète (p=0,008), à la présence d'ostéite (p=0,006). L'amputation etait mineur (43,33%), et majeur (37,43%). Nous avons enregistré 70 décès (5,89%). CONCLUSION: les lésions de la peau et des tissus mous restent dominées par le pied diabétique. La mortalité est non négligeable et le risque d'amputation était statistiquement corrélé à la topographie, au type de lésion, à l'ancienneté et le type de diabète et à l'existence d'ostéite.

Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current-required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

For more than two years after the emergence of COVID-19 (Coronavirus Disease-2019), significant regional differences in morbidity persist. These differences clearly show lower incidence rates in several regions of the African and Asian continents. The work reported here aimed to test the hypothesis of a pre-pandemic natural immunity acquired by some human populations in central and western Africa, which would, therefore, pose the hypothesis of an original antigenic sin with a virus antigenically close to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To identify such pre-existing immunity, sera samples collected before the emergence of COVID-19 were tested to detect the presence of IgG reacting antibodies against SARS-CoV-2 proteins of major significance. Sera samples from French blood donors collected before the pandemic served as a control. The results showed a statistically significant difference of antibodies prevalence between the collected samples in Africa and the control samples collected in France. Given the novelty of our results, our next step consists in highlighting neutralizing antibodies to evaluate their potential for pre-pandemic protective acquired immunity against SARS-CoV-2. In conclusion, our results suggest that, in the investigated African sub-regions, the tested populations could have been potentially and partially pre-exposed, before the COVID-19 pandemic, to the antigens of a yet non-identified Coronaviruses.

In West Africa, research on the hepatitis E virus (HEV) is barely covered, despite the recorded outbreaks. The low level of access to safe water and adequate sanitation is still one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Herein, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A consecutive and non-redundant recruitment of participants was carried out over the period of 5 months, from March to July 2021. A total of 1227 consenting participants attending antenatal clinics responded to a standard questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. The overall HEV seroprevalence was 7.8% (n = 96), with 0.5% (n = 6) and 7.4% (n = 91) for HEV IgM and HEV IgG, respectively. One of the participant samples was IgM/IgG-positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer’s instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p < 0.0001), by the regularity of income (p = 0.0043), and by access to sanitation services (p = 0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental, and behavioral aspects for a better management of HEV infection in Senegal.

The study aimed to analyse the challenges and solutions for maintaining the continuity of essential health services during the COVID-19 pandemic in Francophone West Africa. A cross-sectional study involving the managers of Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) and vaccination programmes in Francophone West Africa was designed. The challenges that limited the supply and use of RMNCAH services included: lack of standardized guides and procedures for appropriate care, limited knowledge of health workers on the new coronavirus disease, lack of diagnostic materials and kits, ineffective organization of services, anxieties of health workers and populations, and postponement of immunisation mass campaigns. The solutions proposed to address these challenges, included better organization of services to respect the physical distance, provision of adapted guides and care procedures, enhanced communication, training of health workers, effective use of social media and information and communication technologies. This study showed that the managers of RMNCAH programmes are aware of the challenges that could limit the supply and use of essential services during the COVID-19 pandemic.

In this work, we investigated the impact of different polyelectrolytes (polyacrylic acid, polystyrene sulfonate, dextran sulfate, and chondroitin sulfate) on lysozyme properties when they form colloidal complexes. To this aim, we characterized (i) the size and stability of the different polyelectrolyte-lysozyme complexes upon addition of NaCl (different concentrations) by diffusion light scattering, and (ii) the structure and accessibility of lysozyme active site in such complexes by fluorescence quenching and time resolved fluorescence analysis. We then used these results to explain the antibacterial activity variations among colloidal complexes and compared with free lysozyme. Our findings show that colloidal complexes that are more prone to swelling (i.e., lysozyme complexed with polystyrene sulfonate) are less stable upon salt addition. In these colloids, the enzymatic site is also more accessible. However, the antibacterial activity does not depend on the swelling properties because no large structural modification of the active site occurs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Fasting glucose (FG) and glycated hemoglobin A1c (HbA1c) perform sub-optimally in people of African origin, especially in individuals with sickle-cell trait (SCT). The purpose of this study was to compare the relationships between HbA1c, FG, and fructosamine in individuals from Senegal with and without SCT. HbA1c, FG, and fructosamine were measured in 203 adults from Senegal (100 control: 45 with type 2 diabetes (T2D); 103 SCT: 51 with T2D). Significant, positive correlations were observed between HbA1c and FG, fructosamine and FG, and fructosamine and HbA1c in both groups. The limits of agreement were inappropriately large in both groups for the Bland-Altman plots of HbA1c and FG (control: -95.97 to 83.97%; SCT: -115.9 to 91.52%), fructosamine and FG (control: -100.6 to 99.89%; SCT: -105.6 to 100.6%), and fructosamine and HbA1c (control: -52.03 to 38.98%; SCT: -88.04 to 71.41%). In both groups, the greatest proportion of subjects were considered above the clinical cut-point for hyperglycemia when fructosamine was used as the criterion (control: 33%; SCT: 44.6%), and the lowest percentage of subjects were classified as over the clinical cut-point when HbA1c was used as the criterion (control: 21%; SCT: 27.7%).Substantial disparities between HbA1c, FG, and fructosamine were observed in both groups, and these differences were exaggerated in the SCT group. Therefore, these three biomarkers should not be considered to be interchangeable measures of glycemic control. These biomarkers should be used thoughtfully, and special care should be taken when using them in individuals with SCT., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To evaluate the cost-effectiveness of self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to health-worker-administered intramuscular DMPA (DMPA-IM) in Senegal and to assess how including practice or demonstration injections in client self-injection training affects estimates., Study Design: We developed a decision-tree model with a 12-month time horizon for a hypothetical cohort of 100,000 injectable contraceptive users in Senegal. We used the model to estimate incremental costs per disability-adjusted life year (DALY) averted. The analysis derived model inputs from DMPA-SC self-injection continuation and costing research studies and peer-reviewed literature. We evaluated the cost-effectiveness from societal and health system perspectives and conducted one-way and probabilistic sensitivity analyses to test the robustness of results., Results: Compared to health-worker-administered DMPA-IM, self-injected DMPA-SC could prevent 1402 additional unintended pregnancies and avert 204 maternal DALYs per year for this hypothetical cohort. From a societal perspective, self-injection costs less than health worker administration regardless of the training approach and is therefore dominant. From the health system perspective, self-injection is dominant compared to health worker administration if a one-page instruction sheet is used and one additional DMPA-SC unit is used for training and is cost-effective at $208 per DALY averted when two additional DMPA-SC units are used. Sensitivity analysis showed estimates were robust., Conclusions: Self-injected DMPA-SC averted more pregnancies and DALYs and cost less from the societal perspective compared to health-worker-administered DMPA-IM and hence is dominant. Using fewer DMPA-SC units for practice or demonstration improves cost-effectiveness of self-injection from the health system perspective., Implications: Evidence from Senegal shows that self-injection of DMPA-SC can be dominant or cost-effective from both health system and societal perspectives relative to DMPA-IM from health workers even if women practice injecting or health workers demonstrate with one or two DMPA-SC units. Evidence on whether practice or demonstration is required for client training would be useful., (© 2019 The Authors.)

Objective: To evaluate the 12-month total direct costs (medical and nonmedical) of delivering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) under three strategies - facility-based administration, community-based administration and self-injection - compared to the costs of delivering intramuscular DMPA (DMPA-IM) via facility- and community-based administration., Study Design: We conducted four cross-sectional microcosting studies in three countries from December 2015 to January 2017. We estimated direct medical costs (i.e., costs to health systems) using primary data collected from 95 health facilities on the resources used for injectable contraceptive service delivery. For self-injection, we included both costs of the actual research intervention and adjusted programmatic costs reflecting a lower-cost training aid. Direct nonmedical costs (i.e., client travel and time costs) came from client interviews conducted during injectable continuation studies. All costs were estimated for one couple year of protection. One-way sensitivity analyses identified the largest cost drivers., Results: Total costs were lowest for community-based distribution of DMPA-SC (US$7.69) and DMPA-IM ($7.71) in Uganda. Total costs for self-injection before adjustment of the training aid were $9.73 (Uganda) and $10.28 (Senegal). After adjustment, costs decreased to $7.83 (Uganda) and $8.38 (Senegal) and were lower than the costs of facility-based administration of DMPA-IM ($10.12 Uganda, $9.46 Senegal). Costs were highest for facility-based administration of DMPA-SC ($12.14) and DMPA-IM ($11.60) in Burkina Faso. Across all studies, direct nonmedical costs were lowest for self-injecting women., Conclusions: Community-based distribution and self-injection may be promising channels for reducing injectable contraception delivery costs. We observed no major differences in costs when administering DMPA-SC and DMPA-IM under the same strategy., Implications: Designing interventions to bring contraceptive service delivery closer to women may reduce barriers to contraceptive access. Community-based distribution of injectable contraception reduces direct costs of service delivery. Compared to facility-based health worker administration, self-injection brings economic benefits for women and health systems, especially with a lower-cost client training aid., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Chronic lymphocytic leukemia (CLL) is a mature B-cell neoplasm characterized by the expansion of CD5-positive lymphocytes in peripheral blood. While CLL is the most common type of leukemia in Western populations, the disease is rare in Africans. Hence, clinical and laboratory data and studies of CLL in Sub Saharan populations have been limited. The aims of this study were to analyze the characteristics of senegalese patients with CLL at the time of the diagnosis and to identify the correlation between clinical characteristics (Binet stage) with age, gender, laboratory parameters and chromosomal abnormalities., Methods: In this study, we investigated the clinical and laboratory characteristics of CLL in Senegal. A total of 40 patients who had been diagnosed with CLL during the period from July 2011 to April 2015 in Senegal were evaluated. Cytology and immunophenotype were performed in all patients to confirm the diagnosis. The prognosis factors such as Binet staging, CD38 and cytogenetic abnormalities were studied. The statistical analysis was performed using STATA version 13 (Stata college station Texas). Each patient signed a free and informed consent form before participating in the study., Results: The mean age was 61 years ranged from 48 to 85. There were 31 males and only 9 females (sex ratio M : F = 3,44). At diagnosic, 82.5 % of the patients were classified as having advanced Binet stages B or C. The prognosis marker CD38 was positive in 28 patients. Cytogenetic abnormalities studied by FISH were performed in 25 patients, among them, 68 % (17 cases) had at least one cytogenetic abnormality and 28 % had 2 simultaneous cytogenetic abnormalities., Conclusion: Africans may present with CLL at a younger age and our data suggest that CLL in Senegal may be more aggressive than in Western populations.

Background: Since 2000, the Global Alliance for Vaccines and Immunization (GAVI) and WHO have supported the introduction of the Pneumococcal Conjugate Vaccine (PCV) in the immunization programs of developing countries. The highest pneumococcal nasopharyngeal carriage rates have been reported (40-60%) in these countries, and the highest incidence and case fatality rates of pneumococcal infections have been demonstrated in Africa., Methods: Studies concerning nasopharyngeal pneumococcal carriage and pneumococcal infection in children less than 5 years old were conducted in Dakar from 2007 to 2008. Serotype, antibiotic susceptibility and minimum inhibitory concentrations were determined. In addition, among 17 overall publications, 6 manuscripts of the Senegalese literature published from 1972 to 2013 were selected for data comparisons., Results: Among the 264 children observed, 132 (50%) children generated a nasopharyngeal (NP) positive culture with Streptococcus pneumoniae. The five most prevalent serotypes, were 6B (9%), 19 F (9%), 23 F (7.6%), 14 (7.6%) and 6A (6.8%). Fifteen percent of the strains (20/132) showed reduced susceptibility to penicillin and 3% (4/132) showed reduced susceptibility to anti-pneumococcal fluoroquinolones. Among the 196 suspected pneumococcal infections, 62 (31.6%) Streptococcus pneumoniae were isolated. Serogroup 1 was the most prevalent serotype (21.3%), followed by 6B (14.9%), 23 F (14.9%) and 5 (8.5%). Vaccine coverage for PCV-7, PCV-10 and PCV-13, were 36.2% (17/47), 66% (31/47) and 70.2% (33/47) respectively. Reduced susceptibility to penicillin and anti-pneumococcal fluoroquinolones was 6.4% and 4.3%, respectively, and the overall lethality was 42.4% (14/33)., Conclusions: This study confirms a high rate of carriage and disease caused by Streptococcus pneumoniae serotypes contained within the current generation of pneumococcal conjugate vaccines and consistent with reports from other countries in sub-Saharan Africa prior to PCV introduction. Antimicrobial resistance in this small unselected sample confirms a low rate of antibiotic resistance. Case-fatality is high. Introduction of a high valency pneumococcal vaccine should be a priority for health planners with the establishment of an effective surveillance system to monitor post vaccine changes.

Background: A comprehensive, HIV prevention programme (Projet Sida1/2/3) was implemented among female sex workers (FSWs) in Cotonou, Benin, in 1993 following which condom use among FSWs increased threefold between 1993 and 2008 while FSW HIV prevalence declined from 53.3% to 30.4%., Objective: Estimate the potential impact of the intervention on HIV prevalence/incidence in FSWs, clients and the general population in Cotonou, Benin., Methods and Findings: A transmission dynamics model parameterised with setting-specific bio-behavioural data was used within a Bayesian framework to fit the model and simulate HIV transmission in the high and low-risk population of Cotonou and to estimate HIV incidence and infections averted by SIDA1/2/3. Our model results suggest that prior to SIDA1/2/3 commercial sex had contributed directly or indirectly to 93% (84-98%) of all cumulative infections and that the observed decline in FSWs HIV prevalence was more consistent with the self-reported post-intervention increase in condom use by FSWs than a counterfactual assuming no change in condom use after 1993 (CF-1). Compared to the counterfactual (CF-1), the increase in condom use may have prevented 62% (52-71%) of new HIV infections among FSWs between 1993 and 2008 and 33% (20-46%) in the overall population., Conclusions: Our analysis provides plausible evidence that the post-intervention increase in condom use during commercial sex significantly reduced HIV prevalence and incidence among FSWs and general population. Sex worker interventions can be effective even in medium HIV prevalence epidemics and need to be sustained over the long-term.

Background: Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal., Methodology: This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome., Results: The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE)., Conclusion: This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: The discovery of silent myocardial ischemia in a diabetic placed in a logic of secondary prevention. The objectives of this study were to investigate the echocardiographic parameters of type 2 Senegalese diabetics at high cardiovascular risk and identify those that are predictors of silent myocardial ischemia., Patients and Methods: We conducted a cross-sectional study in 79 diabetic patients at high cardiovascular risk. After clinical examination, we conducted laboratory tests (glucose, creatinine, lipid profile, blood count and blood chemistry panel), ECG, standard echocardiography and dobutamine stress echocardiography looking for silent myocardial ischemia. Data were analyzed using SPSS 17 and echocardiographic parameters determining predictors of silent myocardial ischemia using a multivariate analysis., Results: Seventy-nine with type 2 diabetics at high cardiovascular risk were assessed, including 56 women. The mean age was 58.8±11.8 years (44-72ans). The abnormalities found in echocardiography were dominated by left atrium dilation (72.2%), increased filling pressures of left ventricle and increased left ventricular mass in 62.02% cases respectively. At stress echocardiography, regional wall motion abnormalities were found in 67.1% of patients. These disorders were significantly more frequent in patients who had a dilated left atrium (P=0.0001), increased filling pressures (P=0.001) and high left ventricular mass (P=0.001)., Conclusion: In diabetic patients at high cardiovascular risk, the existence of a dilation of the left atrium to left ventricular hypertrophy or increased filling pressures of the left ventricle may indicate a silent myocardial ischemia., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)