Introduction: The SARS-CoV-2 infection is a major public health emergency. Several risk factors are involved in the occurrence of respiratory distress that can lead to death despite resuscitation measures. Objectives:...Introduction: The SARS-CoV-2 infection is a major public health emergency. Several risk factors are involved in the occurrence of respiratory distress that can lead to death despite resuscitation measures. Objectives: The aim of this study was to describe the epidemiological, clinical, paraclinical, therapeutic, and evolution profile of patients infected with SARS-CoV-2 hospitalized at the CTE of Saint-Louis (Senegal) during the first two waves. Patients and Methods: We conducted a retrospective, cross-sectional, descriptive, and analytical study that included all patients hospitalized at the ETC of Saint-Louis (Senegal) with SARS-CoV-2 infection from March 2020 to April 2021. Results: A total of 358 cases were collected, 256 (71.5%) during the first wave and 102 (28.5%) during the second wave. The mean age was 49.5 years (19.5). There was a male predominance (58.4%), with a sex ratio of 1.4. Hypertension was the main comorbidity, with 87 cases (24.3%). The most common functional signs were cough in 194 cases (54.2%), dyspnea in 143 cases (40%) and ageusia in 134 cases (37.4%). Thoracic CT scans were performed on 20 patients (5.6%), with severe involvement (50% - 75%) observed in 50% of cases. Hydroxychloroquine-azithromycin was prescribed to 351 patients (98%). Overall, 338 (94.4%) recovered and 17 (4.7%) died. In multivariate analysis, factors associated with death were male sex [OR = 2.645;95% CI: 1.530 - 4.785;p = 0.011], age 60 years [OR = 1.039;95% CI: 0.564 - 1.914;p = 0.002], the presence of comorbidities [OR = 2.171;95% CI: 0.564 - 3.429;p = 0.033], SpO2 (ambient air) 95% [OR = 2.061;95% CI: 0.616 - 3.827;p = 0.03], acute respiratory distress syndrome (ARDS) [OR = 0.635;95% CI: 0.316 - 1.275;p = 0.001], severe form [OR = 1.664;95% CI: 0.298 - 2.478;p = 0.016], occurrence of complications [OR = 0.521;95% CI: 0.287 - 0.944;p = 0.032], high creatinine levels [OR = 2.061;95% CI: 1.616 - 3.827;p = 0.026], and lymphopenia [OR = 0.485;95% CI: 0.370 - 0.636;p = 0.001]. Conclusion: In our series, infection with S展开更多
Introduction: COVID-19 is a global public health emergency that can cause acute respiratory distress syndrome. In countries where tuberculosis (TB) is endemic, coinfection of COVID-19 and TB is often encountered, whic...Introduction: COVID-19 is a global public health emergency that can cause acute respiratory distress syndrome. In countries where tuberculosis (TB) is endemic, coinfection of COVID-19 and TB is often encountered, which increases the risk of developing severe forms of COVID-19. Objectives: The aim of this study was to determine the prevalence of COVID-19/TB coinfection at the Epidemic treatment center (ETC) in Saint-Louis (Senegal) and to describe the epidemiological, clinical, paraclinical, and outcome profile of co-infected patients. Patients and Methods: This is a retrospective, cross-sectional, descriptive cohort study based on the records of COVID-19/ TB co-infected patients who were hospitalized at the ETC in Saint-Louis (Senegal) over an 18-month period from March 2020 to September 2021. Results: Out of a total of 454 hospitalizations, we collected records of 9 patients co-infected with COVID-19/TB, resulting in a prevalence of 2%. The study included patients with a median age of 34 years (range: 10-86 years), with a male predominance (7 cases) and a sex ratio of 3.5. The majority of patients (88.9%) had severe forms of COVID-19. Dyspnea and cough were reported in all patients (100%). Pulmonary TB was the most frequent localization, with 9 cases. The diagnosis of COVID-19 was confirmed by nasopharyngeal PCR in all patients (100%). Bacilloscopy was positive in 3 out of 5 cases. One patient tested positive for GeneXpert<sup>?</sup> MTB/RIF without rifampicin resistance. All patients were prescribed the hydroxychloroquine-azithromycin combination and anti-tuberculosis treatment. Out of the nine patients, four recovered (44.4%) and five died (55.5%). Conclusion: COVID-19/TB coinfection had a low prevalence in our cohort, but was associated with a high mortality due to the frequent occurrence of severe forms of the disease.展开更多
Introduction: Female Genital Bilharzia (FGB) is a pathology secondary to infection by Schistosoma haematobium. It is one of the neglected tropical diseases, capable of causing infertility, difficulties in childbirth a...Introduction: Female Genital Bilharzia (FGB) is a pathology secondary to infection by Schistosoma haematobium. It is one of the neglected tropical diseases, capable of causing infertility, difficulties in childbirth and even cervical cancer. It represents a real public health problem. We therefore conducted a study in the maternity ward of the Saint-Louis regional hospital, with the overall aim of determining the prevalence of FBG in patients undergoing colposcopy. The specific objectives were to define the patient profile, and to compare colposcopic images with the World Health Organization (WHO) atlas. Methodology: We conducted a descriptive, analytical cross-sectional study of all colposcopic images taken at the maternity ward of the Saint-Louis regional hospital from August 1, 2018, to September 30, 2020, i.e. 25 months. The images were compared with the BGF images described in the WHO atlas. Results: We collected 178 colposcopy images. FBG images numbered 50, or 28%. The mean age of the patients was 44.5 years ±11.4 at the extremes of 18 and 78 years. Mean gestational age was 4.69 ± 2.72. Among patients with a bilharzian lesion on the cervix, visual acid inspection (VIA) was negative in 60% of cases (p = 0.007, Odd Ratio = 3.6 (1.49 - 9.07)). Conclusion: the results of our study show that FBG is a reality in our daily practice. It occurs in adult, multigestating, non-occupational women whose examination reveals a negative visual inspection with acetic acid (VIA). Healthcare providers therefore need to be trained in the recognition of lesions associated with genital bilharziasis, and public awareness needs to be raised.展开更多
Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluat...Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluate access to care for patients with chronic kidney disease (CKD) in northern region of Saint-Louis. Methodology: In a cross-sectional survey, we included non-dialyzed CKD patients aged ≥20 years who attended outpatient nephrology clinic at University Hospital of Saint-Louis between January 1st and January 31st 2018. Access to care was measured using a questionnaire that integrated dimensions such as availability, geographic and financial accessibility, convenience, acceptability, effectiveness of care and quality of information. Socio-demographic and clinical data were also collected and analyzed with Epi Info 7. Results: Among 97 surveyed patients, 90 were included (response rate of 92.8%). Patients’ mean age was 35.2 years (20 - 89 years) and 55% were male. Only 30% of patients had health coverage either by the government, or private insurance or community health insurance. Access to care was rated as globally low by 73% of participants. However, we noticed some variations according to dimensions of access. Geographical accessibility and convenience of delivered care were good for the majority of patients, while financial access and acceptability of care were considered as very limited. Bivariate analysis showed that acceptability and effectiveness of care were linked to CKD stage while the quality of patients’ information was correlated with their educational level. Furthermore, health coverage was also associated with financial accessibility of care but not with its availability. Conclusion: This study showed that access to care is poor for majority of patients with CKD in Saint-Louis. Identification of the main barriers will help define appropriate strategies to achieve universal access to quality renal care.展开更多
Introduction: Cardiac tumors in children are rare. Most are discovered in children under one year of age. Echocardiography is the basic examination for the screening, it allows their detection from the fetal stage. Ob...Introduction: Cardiac tumors in children are rare. Most are discovered in children under one year of age. Echocardiography is the basic examination for the screening, it allows their detection from the fetal stage. Observation: She was a 14-year-old patient with no known history of pathology. She was admitted to our department for the exploration of dyspnea and chest pain. At her admission, she had stable hemodynamics. At cardiac auscultation, heart sounds were muffled. The EKG recorded a sinus rhythm, and negative T-waves from V1 to V4. The chest X-ray showed cardiomegaly and a dense, rounded, heterogeneous left hilar opacity, well limited. Echocardiography objected to a great intrapericardial mass in front of the left cardiac cavities compressing part of the left atrium and left ventricle associated with an important pericardial effusion. The CT scan found a heterogeneous pericardial suspected myxoma mass. The pathological examination confirmed pericardial teratoma. The patient had an excision of the pericardial mass. The evolution after surgery was favorable. Conclusion: Intra-pericardial teratomas are benign tumor. Complete removal of the tumor is curative and without recurrence.展开更多
Background: Cardiovascular Disease (CVD) has become the largest and most common cause of Non-Communicable Diseases (NCD) related deaths worldwide, accounting for more than 50%. In Senegal, a few studies...Background: Cardiovascular Disease (CVD) has become the largest and most common cause of Non-Communicable Diseases (NCD) related deaths worldwide, accounting for more than 50%. In Senegal, a few studies done on the topic showed a low prevalence of acute coronary syndrome in hospital settings. In the city of Saint-Louis in Northern Senegal, there is little epidemiological data on Acute Coronary Syndrome (ACS) and no study specifically concerned with ST-segment Elevation Myocardial Infarction (STEMI) has been carried out to date. With this in mind, we conducted a study that focused on the analysis of STEMI patients hospitalized in the Cardiology Department of the Regional Hospital of Saint-Louis. The aim of our study was to collect and analyze the epidemiological aspect of STEMI. Results: There were 39 cases of STEMI, (i.e. 82.29% of ACS), giving a hospital prevalence of 8.21%. There was a slight male predominance with a male to female ratio of 1.05. The average age of our patients was 62.93 years ranging from 38 to 90 years. The average time between the onset of pain and arrival at the hospital was 50 hours, ranging from 1 hour to 720 hours. Patients received within the first 12 hours made up 66% (n = 26) of our population, among them, 80.76% (n = 21) (i.e. 53.84% of STEMIs) were able to benefit from thrombolysis. All thrombolysis was performed with Streptokinase. The mean time to thrombolysis was 6 hours ranging from 1 hour and 45 minutes to 11 hours. Arterial hypertension was the most frequent cardiovascular risk factor in our popular with a 43.6% prevalence, followed by diabetes (33.33%), then active smoking (23%). Chest pain was the most frequent symptom, reported in 34 patients (87.17%). The lesions on the Electrocardiogram (EKG) were located in the anterior territory in 64% of the cases (n = 25), in the inferior territory in 28% of the cases (n = 11), in the circumferential territory in 5% of the cases (n = 2), and lateral territory in 5% of the cases (n = 2). Twenty-five patients had a transthor展开更多
Introduction: Diabetes is a leading cause of chronic kidney disease in the world. During the next decade, its burden is expected to increase in Africa with potential complications such as chronic kidney disease. Howev...Introduction: Diabetes is a leading cause of chronic kidney disease in the world. During the next decade, its burden is expected to increase in Africa with potential complications such as chronic kidney disease. However, epidemiology and risk factors of diabetic kidney disease are poorly described at population level. This study aimed to determine prevalence of diabetic kidney disease (DKD) in adult diabetics living in Saint-Louis, northern Senegal. Methods: A cross-sectional study including diabetic patients followed-up aged ≥18 years during a five-year period (2013-2018) in Saint-Louis. Clinical and biological parameters were collected during annual community-based mass screening. Diabetes was defined as fasting blood glucose ≥ 1.26 g/L confirmed by a second lab dosage. DKD was defined as persistence of albuminuria ≥ 30 mg/24h and/or estimated glomerular filtration rate (eGFR) 2. Data were analyzed with Stata 12.0. Results: We included a total of 1310 diabetic patients among whom 3.7% (95% CI = 1.4% - 9.8%) presented DKD. Their mean age was 46.2 ± 11.8 years and sex-ratio was 0.7. Micro-albuminuria and macro-albuminuria were present respectively in 59.2% and 18.4% of patients with DKD and half of them had a normal eGFR. Before the survey 89.8% of patients with DKD were not aware of their renal disease and only four of them had seen a nephrologist. After multivariate analysis, age (OR = 1.5;95% CI = 1.1 - 3.4), duration of diabetes (OR = 1.2;95% CI = 1.6 - 4.4) and hypertension (OR = 2.5;95% CI = 1.4 - 4.6) were associated with the presence of DKD in diabetic patients while no significant association was not found with gender, blood glucose level, smoking and familial history. Conclusion: DKD is a frequent complication in diabetic adult population living in Saint-Louis. Early detection and management should be promoted in order to prevent progression to end-stage renal disease.展开更多
Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the f...Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the framework of ectroprosopia. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">This is a case report of Gravida 3 Para 3, 32 years old and without a history of abortion, with a history of normal vaginal birth which occurs during labor latency with active movements of the fetus present and cardiac activity on auscultation with pinard stethoscope. The uterine height was 32 cm with well palpated fetal poles. Ultrasound examination confirms the presence of normal cardiac activity with a poorly responsive fetus. After labor management, she gave birth 3 hours after admission to the maternity ward of a living newborn male weighing 2800 g with an Apgar score of 4/10 at the first minute and 2/10 at the fifth minute. He died 10 minutes later at the maternity hospital of the Saint-Louis regional hospital center, in northern Senegal. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Holoprosencephaly is certainly rare but remains the most common structural congenital anomaly of the brain with a complex and multifactorial pathogenesis. Early perinatal diagnosis and determination of severity are important to inform parents of the possibilities of a future life. The voluntary termination of pregnancy is an option but remains prohibited in the country to this day for these indications.展开更多
<strong>Introduction:</strong> Systemic Autoimmune Diseases (SAID) long considered very rare in Africa are increasingly the subject of publications. The objective of this work is to identify the difficulti...<strong>Introduction:</strong> Systemic Autoimmune Diseases (SAID) long considered very rare in Africa are increasingly the subject of publications. The objective of this work is to identify the difficulties in the management of these pathologies in an internal medicine department in northern Senegal by analyzing the epidemiological, clinical-biological, therapeutic and evolutionary aspects of SAID. <strong>Methods:</strong> This was a descriptive cross-sectional study carried out in the internal medicine department of the Saint-Louis University Hospital Center. Included were all the files of patients followed in outpatient and/or hospitalization for autoimmune diseases according to the criteria of the American College of Rheumatology, during the period from January 2017 to December 2020. The data were analyzed using SPSS software version 21.0. As the study was descriptive, no statistical test was performed. <strong>Results: </strong>Out of 3800 patients, 70 presented SAID, <i>i.e. </i> a hospital prevalence of 1.8%. Polyarthritis was the first reason for consultation in 97% followed by skin manifestations in 8%. The patients had positive anti-nuclear autoantibodies in 88% of cases. Rheumatoid arthritis was the predominant condition (71%) followed by systemic lupus erythematosus (SLE) (15%) and undifferentiated autoimmune diseases in 10%. Eleven percent (11%) of patients had an associated autoimmune disease. Corticosteroids were used in the treatment of these conditions in 97% of cases and methotrexate was the most prescribed immunosuppressant (54%). Thirty-two percent (32%) of patients are lost to follow-up. <strong>Conclusion:</strong> SAID are diverse and under diagnosed;they are characterized by diagnostic delay above all linked to access to specialists and sometimes to the high cost of paraclinical examinations, in particular immunology. Treatment remains based primarily on corticosteroid therapy and conventional immunosuppressants in the face of the unavailability of biotherapies.展开更多
Background: The true scale of renal insufficiency (RI) in Sub-Saharan Africa remains unknown due to the lack of national registries. The aim of this study is to describe the epidemiological characteristics of renal in...Background: The true scale of renal insufficiency (RI) in Sub-Saharan Africa remains unknown due to the lack of national registries. The aim of this study is to describe the epidemiological characteristics of renal insufficiency in urban areas in Saint Louis of Senegal. Materials and Methods: It is an observational, cross-sectional and descriptive study. The study was conducted during 27 days starting from 3 to 30 May 2010. All senegalese residents of Saint Louis (older than 15 years at the time of the study) in whom creatinine clearance was performed were included in the study. The sampling method used was a systematic random sampling, stratified cluster. The survey was designed by an expert comitee based on STEPS survey of the World Health Organization. RI was defined as a glomerular filtration rate (GFR) 2. Results: Among 1424 people initially selected a final selection of 1416 was made. The sex ratio was 0.45. The mean age was 43.4 ± 17.8 years. The overall prevalence of renal insufficiency according to MDRD (Modification of diet in renal disease) formula was 181 cases or 12.7%. The mean age of the people with renal insufficiency was 47.6 ± 17.4 years. Renal insufficiency was correlated to height blood pressure (p = 0.01) and Physical inactivity (p = 0.0001). The prevalence of renal insufficiency was higher in diabetics (71.4%) and obese people (66.6%) than in non-diabetics (64.9%) and non-obese people (56.5%), although the difference was not statistically significant. Dyslipidemia and smoking were not correlated to the risk of occurrence of IR. Conclusions: This study reports the increasing magnitude of RI and its risk factors in the city of Saint Louis in Senegal. It is imperative to establish à national prevention strategies to avoid the dizzying growth of this scourge.展开更多
Introduction: The metabolic syndrome is characterized by an aggregate of metabolic disorders whose coexistence in the same individual can correspond on the one hand to a common pathophysiological mechanism and on the ...Introduction: The metabolic syndrome is characterized by an aggregate of metabolic disorders whose coexistence in the same individual can correspond on the one hand to a common pathophysiological mechanism and on the other hand to expose the subject to an increased risk of cardiovascular diseases. The prevalence of the metabolic syndrome is increasing rapidly in both developed and developing countries, but has been poorly described in sub-Saharan Africa. Most of them reported the components of the metabolic syndrome only in isolation. Methods: This cross-sectional study carried out on a cohort of 76 patients followed at the Sait-louis regional hospital used the definition criteria of the International Diabetes Federation. Results: The average age of our patients is 56.92 with extremes ranging from 32 to 80 years old. The sex ratio is 0.49. The average duration of diabetes progression is 68 months. The prevalence of the metabolic syndrome in this population is 67.1%. Abdominal obesity and high blood pressure are the most commonly found criteria. Abdominal obesity was the most associated component of MS in both sexes followed by high blood pressure. We found relatively weak data for dyslipidemia, especially hypertriglyceridemia. HypoHD is dyslipidemia more found in our cohort: in 45% of women and 21% of men. Conclusion: The management of the metabolic syndrome therefore requires fighting against all the factors that compose it, the first of which is the accumulation of visceral fat. Lifestyle modification is the first priority for these patients facing a society where the reduction of physical activity and the enrichment of the fat diet are becoming more and more important.展开更多
Goiters account for a very high prevalence disease. In Senegal, surgery is a very important part of the management. Our aim is to determine indications and results of thyroidectomies at the regional hospital of St. Lo...Goiters account for a very high prevalence disease. In Senegal, surgery is a very important part of the management. Our aim is to determine indications and results of thyroidectomies at the regional hospital of St. Louis. Patient and Method: We conducted a descriptive retrospective study over a period of 6 years on 81 records. All patients who underwent thyroidectomy during the study period were included. Computer software EPI INFO and Excel were used for collection and processing of data. Results: The average age of our patients was 40 years with a sex ratio at 0.05. The determination of TSH found 88.9% in euthyroid, 1.2% in hypothyroidism and 9.9% in hyperthyroidism. Thyroid ultrasound was performed in 97.5% of patients. Surgically, gestures performed were divided between the lobo-isthmectomies (43.1%), subtotal thyroidectomy (9.8%), total thyroidectomy (46.91%). The postoperative course was uneventful in all patients. The histology was benign in 88.9% of surgical specimens and found adenocarcinoma in 11.1%. Conclusion: Our study confirms the predominance of female thyroid pathology. The thyroidectomy which is getting better codified occupies an important place in the management. It offers the advantage around the problem of therapeutic non-compliance and also stockouts in our region.展开更多
Rocio (ROCV), Saint Louis encephalitis (SLEV) and West Nile (WNV) are Flavivirus (Flaviviridae) probably carried by birds and transmitted by Culex mosquitoes. We show here a review on infections of the central nervous...Rocio (ROCV), Saint Louis encephalitis (SLEV) and West Nile (WNV) are Flavivirus (Flaviviridae) probably carried by birds and transmitted by Culex mosquitoes. We show here a review on infections of the central nervous system by St. Louis Encephalitis, Rocio and West Nile Flaviviruses in Brazil, 2004-2014. In the last 10 years, serologic surveys in horses showed high proportions of seropositive animals which point out that SLEV and ROCV have circulated infecting horses in west-central, southeast and other regions of Brazil and that WNV has been introduced into Brazil and circulates mostly in Pantanal region. However humans infected by WNV have not been reported. In the State of Sao Paulo: SLEV was isolated from a case clinically diagnosed as dengue in 2004;in 2006, 6 SLEV patients including 3 cases of menigoencephalitis were reported in the middle of a large epidemic of dengue type 3;and in 2008, 1 patient with acute febrile illness that was IgM-positive for dengue was found infected by SLEV by detection of the virus genome. In 2010, ROCV genome was detected in the cerebrospinal fluids of 2 patients from the northern region with meningoenchephalitis and also AIDS. This was the first report of infections by ROCV in the last 34 years and curiously, it occured more than 2000 km from where the virus was firstly found. It is necessary to improve the surveillance of SLEV, ROCV and WNV in Brazil.展开更多
文摘Introduction: The SARS-CoV-2 infection is a major public health emergency. Several risk factors are involved in the occurrence of respiratory distress that can lead to death despite resuscitation measures. Objectives: The aim of this study was to describe the epidemiological, clinical, paraclinical, therapeutic, and evolution profile of patients infected with SARS-CoV-2 hospitalized at the CTE of Saint-Louis (Senegal) during the first two waves. Patients and Methods: We conducted a retrospective, cross-sectional, descriptive, and analytical study that included all patients hospitalized at the ETC of Saint-Louis (Senegal) with SARS-CoV-2 infection from March 2020 to April 2021. Results: A total of 358 cases were collected, 256 (71.5%) during the first wave and 102 (28.5%) during the second wave. The mean age was 49.5 years (19.5). There was a male predominance (58.4%), with a sex ratio of 1.4. Hypertension was the main comorbidity, with 87 cases (24.3%). The most common functional signs were cough in 194 cases (54.2%), dyspnea in 143 cases (40%) and ageusia in 134 cases (37.4%). Thoracic CT scans were performed on 20 patients (5.6%), with severe involvement (50% - 75%) observed in 50% of cases. Hydroxychloroquine-azithromycin was prescribed to 351 patients (98%). Overall, 338 (94.4%) recovered and 17 (4.7%) died. In multivariate analysis, factors associated with death were male sex [OR = 2.645;95% CI: 1.530 - 4.785;p = 0.011], age 60 years [OR = 1.039;95% CI: 0.564 - 1.914;p = 0.002], the presence of comorbidities [OR = 2.171;95% CI: 0.564 - 3.429;p = 0.033], SpO2 (ambient air) 95% [OR = 2.061;95% CI: 0.616 - 3.827;p = 0.03], acute respiratory distress syndrome (ARDS) [OR = 0.635;95% CI: 0.316 - 1.275;p = 0.001], severe form [OR = 1.664;95% CI: 0.298 - 2.478;p = 0.016], occurrence of complications [OR = 0.521;95% CI: 0.287 - 0.944;p = 0.032], high creatinine levels [OR = 2.061;95% CI: 1.616 - 3.827;p = 0.026], and lymphopenia [OR = 0.485;95% CI: 0.370 - 0.636;p = 0.001]. Conclusion: In our series, infection with S
文摘Introduction: COVID-19 is a global public health emergency that can cause acute respiratory distress syndrome. In countries where tuberculosis (TB) is endemic, coinfection of COVID-19 and TB is often encountered, which increases the risk of developing severe forms of COVID-19. Objectives: The aim of this study was to determine the prevalence of COVID-19/TB coinfection at the Epidemic treatment center (ETC) in Saint-Louis (Senegal) and to describe the epidemiological, clinical, paraclinical, and outcome profile of co-infected patients. Patients and Methods: This is a retrospective, cross-sectional, descriptive cohort study based on the records of COVID-19/ TB co-infected patients who were hospitalized at the ETC in Saint-Louis (Senegal) over an 18-month period from March 2020 to September 2021. Results: Out of a total of 454 hospitalizations, we collected records of 9 patients co-infected with COVID-19/TB, resulting in a prevalence of 2%. The study included patients with a median age of 34 years (range: 10-86 years), with a male predominance (7 cases) and a sex ratio of 3.5. The majority of patients (88.9%) had severe forms of COVID-19. Dyspnea and cough were reported in all patients (100%). Pulmonary TB was the most frequent localization, with 9 cases. The diagnosis of COVID-19 was confirmed by nasopharyngeal PCR in all patients (100%). Bacilloscopy was positive in 3 out of 5 cases. One patient tested positive for GeneXpert<sup>?</sup> MTB/RIF without rifampicin resistance. All patients were prescribed the hydroxychloroquine-azithromycin combination and anti-tuberculosis treatment. Out of the nine patients, four recovered (44.4%) and five died (55.5%). Conclusion: COVID-19/TB coinfection had a low prevalence in our cohort, but was associated with a high mortality due to the frequent occurrence of severe forms of the disease.
文摘Introduction: Female Genital Bilharzia (FGB) is a pathology secondary to infection by Schistosoma haematobium. It is one of the neglected tropical diseases, capable of causing infertility, difficulties in childbirth and even cervical cancer. It represents a real public health problem. We therefore conducted a study in the maternity ward of the Saint-Louis regional hospital, with the overall aim of determining the prevalence of FBG in patients undergoing colposcopy. The specific objectives were to define the patient profile, and to compare colposcopic images with the World Health Organization (WHO) atlas. Methodology: We conducted a descriptive, analytical cross-sectional study of all colposcopic images taken at the maternity ward of the Saint-Louis regional hospital from August 1, 2018, to September 30, 2020, i.e. 25 months. The images were compared with the BGF images described in the WHO atlas. Results: We collected 178 colposcopy images. FBG images numbered 50, or 28%. The mean age of the patients was 44.5 years ±11.4 at the extremes of 18 and 78 years. Mean gestational age was 4.69 ± 2.72. Among patients with a bilharzian lesion on the cervix, visual acid inspection (VIA) was negative in 60% of cases (p = 0.007, Odd Ratio = 3.6 (1.49 - 9.07)). Conclusion: the results of our study show that FBG is a reality in our daily practice. It occurs in adult, multigestating, non-occupational women whose examination reveals a negative visual inspection with acetic acid (VIA). Healthcare providers therefore need to be trained in the recognition of lesions associated with genital bilharziasis, and public awareness needs to be raised.
文摘Introduction: Patients with chronic diseases, especially kidney diseases, frequently use the health care system and free dialysis policies are being implemented in many countries in Africa. This study aimed to evaluate access to care for patients with chronic kidney disease (CKD) in northern region of Saint-Louis. Methodology: In a cross-sectional survey, we included non-dialyzed CKD patients aged ≥20 years who attended outpatient nephrology clinic at University Hospital of Saint-Louis between January 1st and January 31st 2018. Access to care was measured using a questionnaire that integrated dimensions such as availability, geographic and financial accessibility, convenience, acceptability, effectiveness of care and quality of information. Socio-demographic and clinical data were also collected and analyzed with Epi Info 7. Results: Among 97 surveyed patients, 90 were included (response rate of 92.8%). Patients’ mean age was 35.2 years (20 - 89 years) and 55% were male. Only 30% of patients had health coverage either by the government, or private insurance or community health insurance. Access to care was rated as globally low by 73% of participants. However, we noticed some variations according to dimensions of access. Geographical accessibility and convenience of delivered care were good for the majority of patients, while financial access and acceptability of care were considered as very limited. Bivariate analysis showed that acceptability and effectiveness of care were linked to CKD stage while the quality of patients’ information was correlated with their educational level. Furthermore, health coverage was also associated with financial accessibility of care but not with its availability. Conclusion: This study showed that access to care is poor for majority of patients with CKD in Saint-Louis. Identification of the main barriers will help define appropriate strategies to achieve universal access to quality renal care.
文摘Introduction: Cardiac tumors in children are rare. Most are discovered in children under one year of age. Echocardiography is the basic examination for the screening, it allows their detection from the fetal stage. Observation: She was a 14-year-old patient with no known history of pathology. She was admitted to our department for the exploration of dyspnea and chest pain. At her admission, she had stable hemodynamics. At cardiac auscultation, heart sounds were muffled. The EKG recorded a sinus rhythm, and negative T-waves from V1 to V4. The chest X-ray showed cardiomegaly and a dense, rounded, heterogeneous left hilar opacity, well limited. Echocardiography objected to a great intrapericardial mass in front of the left cardiac cavities compressing part of the left atrium and left ventricle associated with an important pericardial effusion. The CT scan found a heterogeneous pericardial suspected myxoma mass. The pathological examination confirmed pericardial teratoma. The patient had an excision of the pericardial mass. The evolution after surgery was favorable. Conclusion: Intra-pericardial teratomas are benign tumor. Complete removal of the tumor is curative and without recurrence.
文摘Background: Cardiovascular Disease (CVD) has become the largest and most common cause of Non-Communicable Diseases (NCD) related deaths worldwide, accounting for more than 50%. In Senegal, a few studies done on the topic showed a low prevalence of acute coronary syndrome in hospital settings. In the city of Saint-Louis in Northern Senegal, there is little epidemiological data on Acute Coronary Syndrome (ACS) and no study specifically concerned with ST-segment Elevation Myocardial Infarction (STEMI) has been carried out to date. With this in mind, we conducted a study that focused on the analysis of STEMI patients hospitalized in the Cardiology Department of the Regional Hospital of Saint-Louis. The aim of our study was to collect and analyze the epidemiological aspect of STEMI. Results: There were 39 cases of STEMI, (i.e. 82.29% of ACS), giving a hospital prevalence of 8.21%. There was a slight male predominance with a male to female ratio of 1.05. The average age of our patients was 62.93 years ranging from 38 to 90 years. The average time between the onset of pain and arrival at the hospital was 50 hours, ranging from 1 hour to 720 hours. Patients received within the first 12 hours made up 66% (n = 26) of our population, among them, 80.76% (n = 21) (i.e. 53.84% of STEMIs) were able to benefit from thrombolysis. All thrombolysis was performed with Streptokinase. The mean time to thrombolysis was 6 hours ranging from 1 hour and 45 minutes to 11 hours. Arterial hypertension was the most frequent cardiovascular risk factor in our popular with a 43.6% prevalence, followed by diabetes (33.33%), then active smoking (23%). Chest pain was the most frequent symptom, reported in 34 patients (87.17%). The lesions on the Electrocardiogram (EKG) were located in the anterior territory in 64% of the cases (n = 25), in the inferior territory in 28% of the cases (n = 11), in the circumferential territory in 5% of the cases (n = 2), and lateral territory in 5% of the cases (n = 2). Twenty-five patients had a transthor
文摘Introduction: Diabetes is a leading cause of chronic kidney disease in the world. During the next decade, its burden is expected to increase in Africa with potential complications such as chronic kidney disease. However, epidemiology and risk factors of diabetic kidney disease are poorly described at population level. This study aimed to determine prevalence of diabetic kidney disease (DKD) in adult diabetics living in Saint-Louis, northern Senegal. Methods: A cross-sectional study including diabetic patients followed-up aged ≥18 years during a five-year period (2013-2018) in Saint-Louis. Clinical and biological parameters were collected during annual community-based mass screening. Diabetes was defined as fasting blood glucose ≥ 1.26 g/L confirmed by a second lab dosage. DKD was defined as persistence of albuminuria ≥ 30 mg/24h and/or estimated glomerular filtration rate (eGFR) 2. Data were analyzed with Stata 12.0. Results: We included a total of 1310 diabetic patients among whom 3.7% (95% CI = 1.4% - 9.8%) presented DKD. Their mean age was 46.2 ± 11.8 years and sex-ratio was 0.7. Micro-albuminuria and macro-albuminuria were present respectively in 59.2% and 18.4% of patients with DKD and half of them had a normal eGFR. Before the survey 89.8% of patients with DKD were not aware of their renal disease and only four of them had seen a nephrologist. After multivariate analysis, age (OR = 1.5;95% CI = 1.1 - 3.4), duration of diabetes (OR = 1.2;95% CI = 1.6 - 4.4) and hypertension (OR = 2.5;95% CI = 1.4 - 4.6) were associated with the presence of DKD in diabetic patients while no significant association was not found with gender, blood glucose level, smoking and familial history. Conclusion: DKD is a frequent complication in diabetic adult population living in Saint-Louis. Early detection and management should be promoted in order to prevent progression to end-stage renal disease.
文摘Cyclopia is a rare genetic defect. It is the most severe form of alobar holoprosencephaly, characterized by the fusion of the two orbits and is linked to the lack of development of the frontal bud falling within the framework of ectroprosopia. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">This is a case report of Gravida 3 Para 3, 32 years old and without a history of abortion, with a history of normal vaginal birth which occurs during labor latency with active movements of the fetus present and cardiac activity on auscultation with pinard stethoscope. The uterine height was 32 cm with well palpated fetal poles. Ultrasound examination confirms the presence of normal cardiac activity with a poorly responsive fetus. After labor management, she gave birth 3 hours after admission to the maternity ward of a living newborn male weighing 2800 g with an Apgar score of 4/10 at the first minute and 2/10 at the fifth minute. He died 10 minutes later at the maternity hospital of the Saint-Louis regional hospital center, in northern Senegal. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Holoprosencephaly is certainly rare but remains the most common structural congenital anomaly of the brain with a complex and multifactorial pathogenesis. Early perinatal diagnosis and determination of severity are important to inform parents of the possibilities of a future life. The voluntary termination of pregnancy is an option but remains prohibited in the country to this day for these indications.
文摘<strong>Introduction:</strong> Systemic Autoimmune Diseases (SAID) long considered very rare in Africa are increasingly the subject of publications. The objective of this work is to identify the difficulties in the management of these pathologies in an internal medicine department in northern Senegal by analyzing the epidemiological, clinical-biological, therapeutic and evolutionary aspects of SAID. <strong>Methods:</strong> This was a descriptive cross-sectional study carried out in the internal medicine department of the Saint-Louis University Hospital Center. Included were all the files of patients followed in outpatient and/or hospitalization for autoimmune diseases according to the criteria of the American College of Rheumatology, during the period from January 2017 to December 2020. The data were analyzed using SPSS software version 21.0. As the study was descriptive, no statistical test was performed. <strong>Results: </strong>Out of 3800 patients, 70 presented SAID, <i>i.e. </i> a hospital prevalence of 1.8%. Polyarthritis was the first reason for consultation in 97% followed by skin manifestations in 8%. The patients had positive anti-nuclear autoantibodies in 88% of cases. Rheumatoid arthritis was the predominant condition (71%) followed by systemic lupus erythematosus (SLE) (15%) and undifferentiated autoimmune diseases in 10%. Eleven percent (11%) of patients had an associated autoimmune disease. Corticosteroids were used in the treatment of these conditions in 97% of cases and methotrexate was the most prescribed immunosuppressant (54%). Thirty-two percent (32%) of patients are lost to follow-up. <strong>Conclusion:</strong> SAID are diverse and under diagnosed;they are characterized by diagnostic delay above all linked to access to specialists and sometimes to the high cost of paraclinical examinations, in particular immunology. Treatment remains based primarily on corticosteroid therapy and conventional immunosuppressants in the face of the unavailability of biotherapies.
文摘Background: The true scale of renal insufficiency (RI) in Sub-Saharan Africa remains unknown due to the lack of national registries. The aim of this study is to describe the epidemiological characteristics of renal insufficiency in urban areas in Saint Louis of Senegal. Materials and Methods: It is an observational, cross-sectional and descriptive study. The study was conducted during 27 days starting from 3 to 30 May 2010. All senegalese residents of Saint Louis (older than 15 years at the time of the study) in whom creatinine clearance was performed were included in the study. The sampling method used was a systematic random sampling, stratified cluster. The survey was designed by an expert comitee based on STEPS survey of the World Health Organization. RI was defined as a glomerular filtration rate (GFR) 2. Results: Among 1424 people initially selected a final selection of 1416 was made. The sex ratio was 0.45. The mean age was 43.4 ± 17.8 years. The overall prevalence of renal insufficiency according to MDRD (Modification of diet in renal disease) formula was 181 cases or 12.7%. The mean age of the people with renal insufficiency was 47.6 ± 17.4 years. Renal insufficiency was correlated to height blood pressure (p = 0.01) and Physical inactivity (p = 0.0001). The prevalence of renal insufficiency was higher in diabetics (71.4%) and obese people (66.6%) than in non-diabetics (64.9%) and non-obese people (56.5%), although the difference was not statistically significant. Dyslipidemia and smoking were not correlated to the risk of occurrence of IR. Conclusions: This study reports the increasing magnitude of RI and its risk factors in the city of Saint Louis in Senegal. It is imperative to establish à national prevention strategies to avoid the dizzying growth of this scourge.
文摘Introduction: The metabolic syndrome is characterized by an aggregate of metabolic disorders whose coexistence in the same individual can correspond on the one hand to a common pathophysiological mechanism and on the other hand to expose the subject to an increased risk of cardiovascular diseases. The prevalence of the metabolic syndrome is increasing rapidly in both developed and developing countries, but has been poorly described in sub-Saharan Africa. Most of them reported the components of the metabolic syndrome only in isolation. Methods: This cross-sectional study carried out on a cohort of 76 patients followed at the Sait-louis regional hospital used the definition criteria of the International Diabetes Federation. Results: The average age of our patients is 56.92 with extremes ranging from 32 to 80 years old. The sex ratio is 0.49. The average duration of diabetes progression is 68 months. The prevalence of the metabolic syndrome in this population is 67.1%. Abdominal obesity and high blood pressure are the most commonly found criteria. Abdominal obesity was the most associated component of MS in both sexes followed by high blood pressure. We found relatively weak data for dyslipidemia, especially hypertriglyceridemia. HypoHD is dyslipidemia more found in our cohort: in 45% of women and 21% of men. Conclusion: The management of the metabolic syndrome therefore requires fighting against all the factors that compose it, the first of which is the accumulation of visceral fat. Lifestyle modification is the first priority for these patients facing a society where the reduction of physical activity and the enrichment of the fat diet are becoming more and more important.
文摘Goiters account for a very high prevalence disease. In Senegal, surgery is a very important part of the management. Our aim is to determine indications and results of thyroidectomies at the regional hospital of St. Louis. Patient and Method: We conducted a descriptive retrospective study over a period of 6 years on 81 records. All patients who underwent thyroidectomy during the study period were included. Computer software EPI INFO and Excel were used for collection and processing of data. Results: The average age of our patients was 40 years with a sex ratio at 0.05. The determination of TSH found 88.9% in euthyroid, 1.2% in hypothyroidism and 9.9% in hyperthyroidism. Thyroid ultrasound was performed in 97.5% of patients. Surgically, gestures performed were divided between the lobo-isthmectomies (43.1%), subtotal thyroidectomy (9.8%), total thyroidectomy (46.91%). The postoperative course was uneventful in all patients. The histology was benign in 88.9% of surgical specimens and found adenocarcinoma in 11.1%. Conclusion: Our study confirms the predominance of female thyroid pathology. The thyroidectomy which is getting better codified occupies an important place in the management. It offers the advantage around the problem of therapeutic non-compliance and also stockouts in our region.
文摘Rocio (ROCV), Saint Louis encephalitis (SLEV) and West Nile (WNV) are Flavivirus (Flaviviridae) probably carried by birds and transmitted by Culex mosquitoes. We show here a review on infections of the central nervous system by St. Louis Encephalitis, Rocio and West Nile Flaviviruses in Brazil, 2004-2014. In the last 10 years, serologic surveys in horses showed high proportions of seropositive animals which point out that SLEV and ROCV have circulated infecting horses in west-central, southeast and other regions of Brazil and that WNV has been introduced into Brazil and circulates mostly in Pantanal region. However humans infected by WNV have not been reported. In the State of Sao Paulo: SLEV was isolated from a case clinically diagnosed as dengue in 2004;in 2006, 6 SLEV patients including 3 cases of menigoencephalitis were reported in the middle of a large epidemic of dengue type 3;and in 2008, 1 patient with acute febrile illness that was IgM-positive for dengue was found infected by SLEV by detection of the virus genome. In 2010, ROCV genome was detected in the cerebrospinal fluids of 2 patients from the northern region with meningoenchephalitis and also AIDS. This was the first report of infections by ROCV in the last 34 years and curiously, it occured more than 2000 km from where the virus was firstly found. It is necessary to improve the surveillance of SLEV, ROCV and WNV in Brazil.
