Factors Associated with Foot Lesions in Diabetic Patients at Saint-Louis Hospital (Senegal): A Case-Control Study Protocol.

INTRODUCTION: Diabetes prevalence has increased over the past years. In Senegal, this prevalence is 4% in the general population. However, the region of Saint-Louis (in the north of the country) has the highest rate with 10.4%. The main prognosis problem is the occurrence foot lesions that can lead to lower-limbs amputation. Diabetic foot is a real public health issue, due to its economic burden and its serious repercussions on patients, leading to poor quality of life. The objective of this case-control study is to identify factors associated with foot lesions in diabetic patients. METHODS AND ANALYSIS: It will be a case-control study from January to December 2021. The patients will be recruited from the departments of general surgery, internal medicine, and emergency. An univariate then multivariate analysis (logistic regression) will allow us to select the variables associated with foot lesions in our study population. The parameters included in the logistic regression will be those with a p < 0.20 in the univariate analysis. Finally, a binary logistic regression analysis (with the calculation of Odds Ratios (OR) with confidence intervals (CI)) according to the backward stepwise method will identify the factors independently associated to foot lesions in diabetic patients. ETHICS AND DISSEMINATION: This research protocol will be submitted to the Ethics Committee of our institution for approval. The knowledge of factors causing diabetic foot will help to communicate with policymakers to raise the awareness in our community. Finally, it will help to prevent lower limb amputations. HIGHLIGHTS: Diabetes is the leading cause of non-traumatic lower-limb amputation in the world.The region of Saint-Louis (Senegal) has the highest prevalence of diabetes.Controlling factors associated with foot lesions in diabetic patients can prevent from amputation.

Profile of Patients with Gallstone Disease in a Sub-Saharan African General Surgery Department: A Retrospective Cohort Study Protocol.

INTRODUCTION: Gallstone disease is a disorder characterised by the formation of stones in the biliary tract. It is the most common biliary condition accounting for more than 98% of all gallbladder and biliary tract disorders. In Africa, previous studies have shown a relative rarity of this condition with a prevalence less than 5%; since it is between 2 and 5 times higher in other continents. A good knowledge of the profile of patient with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. To our knowledge, there was no previous study about gallstone disease in this region even if there is a high prevalence of metabolic factors of gallstone disease. METHODS: This study objective is to describe the epidemiological, diagnostic and therapeutic profile of patients with gallstone disease at the Department of General Surgery of Saint-Louis Hospital (Senegal). It will be a single-centre retrospective cohort study in a period of 5 years (January 2015 - December 2020). The patients' record of the department of general surgery will be consulted and the patient contacted if there are missing data. Patients with gallstone disease diagnosed with imaging (ultrasonography and/or CT scan) regardless the presentation (asymptomatic, biliary colic, cholecystitis, common bile duct lithiasis, angio-cholitis, pancreatitis) will be included. Adults and paediatric patients will be enrolled. Patient records lacking sufficient data will be excluded. Studied parameters will be epidemiological, clinical, paraclinical and therapeutic aspects. ETHICS AND DISSEMINATION: Anonymity and confidentiality of information collected in patients will be respected. This research protocol will be submitted to the Ethics Committee of our institution for approval. The knowledge of the profile of patients with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment. Finally, it will help to reduce the burden of gallstone disease. HIGHLIGHTS: Gallstone disease is the most common biliary tract conditionTo our knowledge, there was no previous study about gallstone disease in this region even if there is a high prevalence of risk factors of gallstone disease (sickle cell disease, diabetes, obesity, hypercholesterolemia)Good knowledge of the profile of patients with gallstone disease in a surgical setting could allow to reduce gallstone disease complications and to tailor better the treatment.

Penetrating Heart Injury due to Screwdriver Assault.

Penetrating heart injuries cause wounds in the cardiac chambers. Most of them are due to gunshot or stabbing by knives. Screwdriver is an uncommon weapon. Authors report a case of stab wound by screwdriver, treated at cardiovascular center in Dakar. This is a 16-year-old boy who experienced physical aggression. He was assaulted with a screwdriver and had stab wound on the anterior wall of the chest. Physical examination showed a screwdriver penetrating the sternum bone over a right angle. He had a mild pericardial blood effusion and a right ventricle wound 5 mm in diameter with transection of the right coronary vein. The screwdriver was removed without cardiopulmonary bypass (CPB) and the ventricle wound repaired by direct suture of stitches reinforced with Teflon pledgets. The right coronary artery was ligated. Postoperative period was free of events. Screwdriver is uncommonly used as a weapon. It is a dangerous device because of its rigid structure and narrow tip.

[Results of surgical treatment for pulmonary aspergilloma]. / Résultats du traitement chirurgical de l'aspergillome pulmonaire à Dakar.

INTRODUCTION: Aspergilloma results from the development, inside preexisting pulmonary cavities, of aspergillus spores. It is most commonly manifested by hemoptysis. The goal of this retrospective study is to report our surgical experience of this disease. PATIENTS AND METHODS: From January 2004 to December 2008, 35 patients underwent surgery at the same center for pulmonary aspergilloma. We examined the epidemiological, clinical, paraclinical, therapeutic, and outcome data. RESULTS: The patients' median age was 43.37 years (range: 20-70 years), 28 were male. The average time to consultation was 19.35 months (1-120 months), and all patients had a history of pulmonary tuberculosis. Hemoptysis was the symptom observed most often, in 54.3% of patients, followed by bronchorrhea. Aspergillus serology was positive for 22 patients. The standard radiological image was found in 20 patients. We performed 14 lobectomies, 1 bilobectomy, 1 segmentectomy, 1 bisegmentectomy, 3 lobectomies with segmentectomies, 1 bilobectomy with segmentectomy, and 14 pleuropneumonectomies. In one case, the pulmonary artery was damaged and repaired. The average duration of intensive care was 3.54 days (2-7 days) and of total hospitalization, 17.33 days (7-48). Complications were: empyema (3 cases), a large air leak (1 case), parietal suppuration (5 cases), and pleural effusion, which was drained (3 cases). There was no postoperative mortality. After 35 months (1-72), one case of recurrent hemoptysis by reinfestation was observed. Three patients died of respiratory failure, one at 6 months and the other two at 1 year after the surgery. CONCLUSION: Despite the associated morbidity, surgical treatment of pulmonary aspergilloma must be proposed systematically to these subjects presenting hemoptysis.

Bremia lactucae Infection Efficiency in Lettuce is Modulated by Temperature and Leaf Wetness Duration Under Quebec Field Conditions.

More than 80% of Canadian lettuce production is located in the province of Quebec. Yet most of our knowledge on the epidemiology of lettuce downy mildew (Bremia lactucae) is derived from controlled-condition experiments or field experiments conducted in subtropical climates and, thus, cannot readily be applied to Quebec lettuce production. The influence of temperature and leaf wetness duration on the infection efficiency (IE) of B. lactucae was studied for 4 years (2003, 2004, 2012, and 2013) under field and growth-chamber conditions. IE was defined as the ratio of the number of lesions/leaf to the airborne conidia concentration (ACC). B. lactucae ACC was measured with rotating-arm samplers three times/week. In addition, 72 lettuce trap plants/sampling day were exposed to the potential airborne B. lactucae inoculum and disease intensity was assessed after 7 days of incubation in greenhouse. Under growth-chamber conditions, an ACC of 1 conidium/m3 was sufficient to cause 1 lesion/leaf, and IE ranged from 0.25 to 1.00. Under field conditions, an ACC of 10 to 14 conidia/m3 was required to cause 1 lesion/leaf, and IE ranged from 0.02 to 0.10, except in 2004, when IE ranged from 0.03 to 1.00. IE increased with increasing leaf wetness duration but decreased with increasing temperature. Also, considering an observed average temperature range from 10 to 20°C in the area of Quebec, 2 h of leaf wetness was sufficient for infection by B. lactucae. Therefore, under Quebec lettuce production conditions, a leaf wetness period of 2 h and an ACC of 10 to 14 conidia/m3 can be used as risk indicators to facilitate disease management decisions. Also, under typical Quebec weather conditions, measuring both morning and evening leaf wetness events could be used to improve the reliability of leaf wetness duration as a downy mildew risk indicator. Further research is needed to validate these risk indicators for integration into management strategies.

[Malaria severity criteria and prognostic factors among children in Dakar]. / Critères de gravité et facteurs pronostiques du paludisme chez l'enfant à Dakar.

INTRODUCTION: Severity factors associated with malaria as well as prognostic factors for death were assessed at the Dakar Centre Hospitalier National d'Enfants Albert Royer de Fann (CHNEAR). PATIENTS AND METHODS: A prospective study was carried out from January 1 to December 31, 2007 involving children from 0 to 15 years of age, admitted for plasmodium falciparum malaria with positive thick drop examination, meeting at least one of the WHO 2000 malaria severity criteria. Acidosis was not studied. OUTCOME: The rate of severe malaria cases in our hospital was 6.4%. The sex ratio was 1.4 and the median age of patients at 91 months. A peak was observed during the 4th trimester (75.5%). Convulsions (52.5%) and obtundation (49.4%) were the most common signs of clinical severity while hyperparasitemia and severe anemia ranged at 27.2% and 21.6%, respectively. Lethality was 11.1% and the main death risk factors were young age (p = 0.025), coma (p = 0.007), respiratory distress (p = 0.04), or hypoglycemia (p = 0.001). CONCLUSION: Reducing malaria hospital mortality in Senegal may be obtained by proper management of poor prognostic factors such as coma, respiratory distress, and hypoglycemia.