[One step surgery for severe African endocrine exophtalmia: clinical case]. / Chirurgie en un temps d'une exophtalmie basedowienne africaine sévère: présentation d'un cas clinique.

INTRODUCTION: The association hyperthyroidism-exophtalmia is pathognomonic of the Graves disease. Classically, the treatment is based on a pluridisciplinary step-by-step approach with a precise chronology. In some African places, these optimal conditions are not present. When confronted to such particular situations, it can be proposed to treat surgically at the same time the endocrine disease and the ophthalmologic complications. OBSERVATION: The authors report the case of a 42-year-old women suffering of a great thyreotoxic goiter with severe bilateral exophtalmia, treated by thyroidectomy and orbital decompression in the same session with a good result after 18 months. DISCUSSION: This non-conventional approach can be useful in particular situations when the medical environment is not optimal. It permits the radical treatment of their disease and improves the prognosis of patients with poor capacities for survey.

[Contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis]. / Apport du test Xpert MTB/Rif dans le diagnostic de la tuberculose toute forme a Saint-Louis.

INTRODUCTION: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. MATERIALS AND METHOD: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. CONCLUSION: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.

INTRODUCTION: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. MATÉRIELS ET MÉTHODE: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. RÉSULTATS: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. CONCLUSION: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

[Endoscopic features of esophageal cancer in Dakar, Senegal: study of 76 observations]. / Aspects endoscopiques du cancer de l'oesophage à Dakar (Sénégal): étude de 76 observations.

OBJECTIVE: In response to the lack of cancer register and paucity of publications on esophageal cancer in Senegal, this retrospective descriptive single-center study was undertaken to determine epidemiological, clinical, endoscopic and histological features of the disease at a digestive endoscopy center in Dakar. PATIENTS AND METHOD: Reports describing upper digestive tract endoscopy procedures performed at the Aristide Le Dantec Teaching Hospital in Dakar between January 2006 and December 2009 were reviewed. Cases involving histologically confirmed esophageal cancer were compiled and patient data including age, sex, and indication for endoscopy as well as endoscopic and histological findings were analyzed. RESULTS: A total of 78 reports were collected including 76 patients with suitable data for analysis. Esophageal cancer accounted for 0.97% of upper digestive tract endoscopy procedures performed. Mean patient age was 49 years and the sex-ratio was 1.9. The main indication for endoscopy was dysphagia (92.1%). The most frequent endoscopic finding involved budding lesions with (42%) or without (29%) ulceration. The most common location was the middle third of the esophagus (50%). The most frequent histological type was squamous cell carcinoma (92.1%). CONCLUSION: Esophageal cancer observed at the endoscopy center of the Aristide Le Dantec Teaching Hospital in Dakar mainly affects young male adults. Lesions are generally located in the middle third of the esophagus and corresponded to squamous cell cancer. There is a need to establish a cancer register and to conduct multicentric studies to gain insight into risk factors for esophageal cancer in Senegal.

[Seroprevalence of HBsAgs in patients with rheumatoid arthiritis in a hospital setting in Senegal]. / Séroprévalence de l'antigène HBs au cours de la polyarthrite rhumatoïde en milieu hospitalier Sénégalais.

PURPOSE: Rheumatoid arthritis is the most common chronic inflammatory joint disease in adults. In Senegal, where biotherapy is unavailable, treatment of RA relies on a combination of glucocorticoids and disease-modifying antirheumatic drugs (DMARD). Since DMARD, particularly methotrexate, induce hepatotoxicity pretreatment assays of serum transaminase and albumin levels, as well as serological tests for the hepatitis B and C viruses is recommended. Hepatitis B virus (HBV) infection is endemic in Africa, particularly in Senegal. The purpose of this study was to assess the seroprevalence of the HBV surface antigen (HBsAg) for HBV in 258 patients with RA in Senegal as a basis for defining the least hepatotoxic DMARD for these patients and ensuring the most suitable monitoring. METHOD: This retrospective study was based on a review of the medical records of patients examined between January 2005 and December 2009 at the rheumatology outpatient clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal. All patients met the American College of Rheumatology criteria for RA. RESULTS: A total of 258 patients were tested for HBsAg. Tests were positive in 6 for a seroprevalence of 2.3%. All 6 positive patients were women with a mean age of 48.7 years (range, 16-79 years). Transaminase levels were normal in 5 patients. In the remaining patient, ASAT level elevation were twice normal and ALAT was normal. No patients had clinical evidence of liver disease. CONCLUSION: HBsAg seroprevalence in our population of patients with RA was lower than in the general population of Senegal: 2.3% versus 15%-18%. No evidence indicated that HBVinfection produced specific features in patients with RA. Based on these findings, widespread use of methotrexate in optimal dosages appears safe in patients with RA in Senegal. Treatment should be accompanied by careful attention to HBV prevention.

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.

[Helicobacter pylori and gastroduodenal lesions in Dakar, Senegal]. / Helicobacter pylori et pathologie gastroduodenale a Dakar (Sénégal).

INTRODUCTION: The bacteriological characteristics of Helicobacter pylori (HP) vary in function of time and place. The aim of this study was to update histological and bacteriological feature of HP infection in patients presenting gastroduodenal lesions in Dakar, Senegal. PATIENTS AND METHOD: This prospective study included patients with gastroduodenal lesions managed over a 6-month period in a digestive endoscopy center in Dakar. In all cases gastric biopsy was performed to obtain specimens for histological diagnosis according Sydney modified classification and HP culture with antibiogram. RESULTS: A total of 158 patients were included. Mean patient age was 48.7 years and the sex-ratio was 1.2. Endoscopic lesions were ulcer in 88 cases, gastritis in 54 cases and tumors in 16. Histological examination demonstrated chronic gastritis in 100% of cases, inflammatory activity in 79.1%, metaplasia in 78.5%, gastric atrophy in 41.1%, adenocarcinoma in 7.6%, dysplasia in 5.7%, and MALT lymphoma in 2.5% with presence of HP in 72.8% of cases. Cultures were positive for HP in 65.8% of cases. Antibiograms indicated that HP was sensitive to amoxicilline in 100% of cases, clarithromycine in 96.6%, ciprofloxacine in 84.1%, and métronidazole in 29.5%. CONCLUSION: Chronic gastritis is a constant feature of gastroduodenal lesions in Dakar. Histology combined with culture showed HP infection in 78.5% of cases. The antibiotic sensitivity of HP in Dakar has changed over the past decade.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]. / Apport de la coloscopie dans le diagnostic des rectorragies à Dakar (Sénégal).

INTRODUCTION: Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal. PATIENTS AND METHODS: This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed. RESULTS: A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%). CONCLUSION: Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Epidemiological, Clinical And Radiological Profile Of Positive Microscopy Pulmonary Tuberculosis (PMPT) At The Regional University Hospital Of Saint-Louis]. / Profil Epidemiologique, Clinique Et Radiologique De La Tuberculose Pulmonaire A Microscopiepositive (TPM+) Au Centre Hospitalier Regional Universitaire De Saint-Louis (CHRU SL).

Pulmonary tuberculosis is still a global scourge, especially in developing countries, despite the control measures that have been in place for decades. The aim of this work was to describe the epidemiological, clinical radiological and evolutionary aspects of PMPT at the Saint-Louis Regional Hospital Center. This was a retrospective descriptive study on 191 PMPT files, hospitalized in the medical department from January 1, 2016 to December 31, 2017. PATIENTS AND METHOD: Were included in the study, all cases of pulmonary tuberculosis proved by the presence of bacillus Koch on direct examination of sputum. Were excluded from the study, cases of pulmonary tuberculosis with negative microscopy and cases of pulmonary tuberculosis in patients younger than 14 years. RESULTS: Of 1417 hospitalizations, 191 patients had a PTPM. The average age was 36.5 years with extremes of 14 to 81 years. The sex ratio was 2.2 in favor the male. Fishermen were the most affected with 34% of cases. A family tuberculosis was noted in 61 patients. One hundred and forty-six new PMPT cases were noted. CONCLUSION: Positive microscopy pulmonary tuberculosis remains a public health problem in Senegal. Much work remains to be done in Saint-Louis, which a region with a high burden of tuberculosis.

INTRODUCTION: la tuberculose pulmonaire demeure encore un fléau mondial en progression surtout dans les pays en voie de développement, malgré les actions de lutte mises en place depuis des décennies. Le but de ce travail était de décrire les aspects épidémiologiques, cliniques radiologiques et évolutifs de la TPM (+) au centre hospitalier régional de Saint-Louis. Il s'agissait d'étude descriptive rétrospective portant sur 191 dossiers de TPM+, hospitalisés au service de médecine du 1er Janvier 2016 au 31 Décembre 2017. Étaient inclus dans l'étude, tous les cas de TPM+ prouvée par la présence de BAAR à l'examen direct des crachats. Étaient exclus de l'étude les patients de moins de 14 ans, les cas de TPM(-) Résultats : Sur 1417 hospitalisations, 191 patients avaient une TPM+. L'âge moyen était de 36,5 ans avec des extrêmes de 14 à 81 ans. Sex-ratio de 2,2. Les pêcheurs étaient les plus touchés avec 34 % des cas. Un contage tuberculeux familial était noté chez 61 malades. Cent quarante six nouveaux cas de TPM(+) ont été notés. Conclusion : la TPM(+) demeure un problème de Santé Publique au Sénégal. Beaucoup d'efforts restent à faire dans la région de Saint-Louis à forte charge de tuberculose.

[Autoimmune cholangitis or seronegative biliary cirrhosis: report of one case]. / Cholangite auto-immune ou cirrhose biliaire séronégative: une observation chez un homme.

INTRODUCTION: Auto-immune cholangitis appears by a table of cholestatic jaundice without anomalies of the hepatic bile ducts. It is a primitive biliary cirrhosis without antimitochondrial antibodies. This disease is reported at adult women in 90 % of cases. We report a 59 years old man case. OBSERVATION: The patient was admitted for a diffuse melanodermy, a physical asthenia and a slimming which preceded 4 months by a pruritus with cholestatic jaundice. Biology showed a normal rate of transaminase. Alkaline phosphatases and direct bilirubine were high. Hepatitis (B and C) and HIV serologies were negative. Abdominal ultrasound showed a homogeneous liver. There were no dilations of the bile ducts. Antimitochondrial antibodies were negative and the histological examination confirms diagnosis. CONCLUSION: Progress was good with ursodesoxycholic acid even if interval is short (5 months of evolution).

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]. / Les pneumopathies interstitielles diffuses non specifiques au cours des connectivites: à propos de 7 observations à Dakar.

INTRODUCTION: The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases. CASES: We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy. CONCLUSION: Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

[Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV-1 infection: first Senegalese case report]. / Syndrome d'infiltration lymphocytaire diffuse ou DILS associé a une infection par le VIH -1: premier cas Sénégalais.

INTRODUCTION: The "Diffuse Infiltrative Lymphocytosis Syndrome" [DILS] is a seldom complication and even very particular case of HIV-1 infection, characterized by a merely syndrome and a systemic symptomatology superimposable to the figure met during the Gougerot-Sjögren Syndrome. GSS is nevertheless underlied by a lymphocyte infiltrate composed mainly of TCD8+ lymphocytes, while in the Gougerot-Sjögren syndrome (GSS), the lymphocyte infiltrate is essentially composed of TCD4+ lymphocytes. Despite the antiquity and significance of the HIV/AIDS pandemic, the DILS is not according to our knowledge individualized in the African literature. OBSERVATION: We are reporting a case revealed by a polyarthritis associated among others with a merely syndrome and a HIV-1 infection in a 32 years old Senegalese patient. Her CD4 rate was 327/mm3 and her viral load 17052. The biopsy of the accessory salivary glands showed a 4 grade lymphocite sialoadenitis according to Chisholm classification. The investigation of rheumatoid factors et anti-nuclear antibodies was negative. Under prednisone, hydroxychloroquine, methotrexate and tritherapy treatment, the evolution was favourable with a current return of 2 years. The rarity of DILS has pushed us to study its epidemiological, clinical, paraclinical, physiopathological and therapeutical aspects.

[Clinical and endoscopic features of solitary rectal ulcer syndrom in the digestive endoscopy unit of Hospital Aristide Le Dantec in Dakar]. / Aspects cliniques et endoscopiques du syndrome de l'ulcère solitaire du Rectum dans l'unité d'endoscopie digestive du CHU A. Le Dantec de Dakar: à propos de 11 cas.

INTRODUCTION: The solitary rectal ulcer syndrome is a rare disease. In Africa only few studies have been held on this subject. The aim of this study was to determine the epidemiological, clinical and endoscopic aspects of this syndrome in the digestive endoscopy unit of hospital Aristide Le Dantec in Dakar. PATIENTS AND METHOD: It was a retrospective study based on all the cases of solitary rectal ulcer regarding to the conclusion of endoscopic examination from January 1994 to June 2002. All the patients without histological confirmation were excluded. RESULTS: We had recruited 11 cases among 4250 endoscopic exam (0.26 %). The mean age was 40 years (extreme 23 to 63 years). Female to male ratio was 1.75 with 4 males and 7 females patients. The main indications of endoscopic examination were frequently associated and were dominated by intermittent bleeding (8 cases) chronic constipation (6 cases) and false chronic diarrhea with muco hemorrhagic discharge (4 cases). The mean duration of the symptoms was 5 years. Ulcers were ovoid or circular. Their mean diameter was 8 mm and they were located 8 cm above the anal margin. The lesion was unique in 55 % of the cases and concerned the anterior wall of the rectum in 74% of the cases. There was an internal rectal prolapse in 54% of the cases. CONCLUSION: The solitary rectal ulcer syndrome is not frequent in the endoscopy unit of hospital Aristide Le Dantec in Dakar. It affects mostly young adult female. The symptoms are chronic and non specific. In tropical areas the disease is frequently misdiagnosed as colic amoebiasis.

[Current aspects of systemic lupus erythematosus in Dakar. About 74 cases]. / Aspects actuels du lupus erythemateux systemique a Dakar. A propos de 74 observations.

INTRODUCTION: previously reported studies on systemic lupus erythematosus in Senegal were more then ten years old and reported few cases of patients. Our objectives were to update epidemiological, clinical, laboratory and evolutive aspects of systemic lupus erythematosus throughout a study of 74 patients. PATIENTS AND METHODS: we conducted a retrospective study in the internal medicine and the dermatology units of the university teaching hospital Aristide Le Dantec from January 1993 to December 2002. All patients with systemic lupus erythematosus according to the ACR criteria were included. Those who didn't meet ACR criteria were excluded. RESULTS: we included 74 patients; their mean age was 32 years and the sex ratio 0.1 (male to female). At the entry general symptoms were constants, and cutaneous signs were found in 96% of cases, joints signs in 58.1% and renal sign in 56.8%. Haematological and immunologic abnormalities were nearly constant. All the patients received corticosteroids and in 35.71% they had in addition immunosuppressive drugs. Shorts term evolution was satisfactory. At the medium term 27.02% of the patients were lost and 10.81% of them died. CONCLUSION: currents aspects of systemic lupus erythematosus in Dakar are improved by the early diagnosis when the disease is pauci-symptomatic and by the use immunosuppressive drugs in association with corticosteroids.

[Pulmonary hypertension revealing systemic diseases: two Senegalese case reports]. / Hypertension arterielle pulmonaire revelant des connectivites: a propos de deux observations Senegalaises.

INTRODUCTION: Pulmonary hypertension (PH) is a complication of autoimmune diseases which worsen the prognosis. In Senegal, a few cases of PH have been previously reported in patients with systemic sclerosis. CASE REPORTS: We report two cases of patients with PH that revealed autoimmune diseases (Sharp' syndrome and Sjögren syndrome). Epidemiological, clinical, evolutive and laboratory data were analyzed. Evolution of disease was favourable for one patient and fatal for the other. CONCLUSION: These two cases show necessity of early diagnosis of systemic diseases in our countries. PH should be screened in each patient with autoimmune disease before installation of irreversible pulmonary arterial lesions that respond to treatment. New therapy used in idiopathic PH are not yet accessible for our patients.

[Lupus nephritis in Senegal: study of 42 cases]. / La néphropathie lupique au Sénégal: a propos de 42 cas.

INTRODUCTION: Renal involvement determines the prognosis of systemic lupus erythematosus. The aims of this study were to precise clinical, laboratory, therapeutic and evolutive aspects of lupus nephritis in Senegal in order to improve its management. PATIENTS AND METHODS: According to ACR criteria we included all patients presenting a systemic lupus erythematosus followed in internal medicine and in the dermatology services of university teaching hospital Aristide le Dantec of Dakar from January 1993 to December 2002. All the patients who didn't have a lupus nephritis defined by the existence of more than 0.5 g/24 h of proteinuria and or hematuria were excluded. RESULTS: The prevalence of lupus nephritis was 56.75% among 74 patients with systemic lupus erythematosus. Mean age was 29.6 years and sex ratio 0.13 (male to female). There was a nephritic syndrome in 45.23% of the cases and renal insufficiency in 37.71%. Renal biopsy performed in 52.38% of cases showed predominantly WHO classes IV and V. The key treatment was corticotherapy while immunosuppressive were used in 35.71%. The short term evolution was favourable but in the medium term, many patients were lost or followed up irregularly. CONCLUSION: To improve the management and the prognosis of lupus nephritis in Senegal it is necessary to make patients with a systemic lupus erythematosus sensitive to it and to make systematically urine tests aiming the screening for an early diagnosis of lupus nephritis. In addition we should have aggressive policies in order to lower the costs of immunosuppressive therapy and haemodialysis.

[A mild blackwater fever]. / Une fièvre bilieuse hémoglobinurique de gravite moyenne.

We report a highly probable case of moderately severe blackwater fever. A French woman, living in Guinea Bissau, was used to taking self-medication halofantrine for malaria. On this occasion, she felt unusual chills and pyrexia after a non documented bout of malaria, followed by nausea, then jaundice with dark-red urines despite another treatment with halofantrine. A sepsis was eliminated by two negatives thick peripheral blood drop examinations. Hemolysis was noted with 8.1 g/dl of hemoglobin, Coombs positive, and LDH at 1,452 IU/l, associated to renal failure with 34 ml per minute of clearance. The outcome was favourable with rehydration. Blackwater fever has been described with the three aminoalcohols, but mainly in severe presentations. Clinicians are not familiar with this disease, even though it has major therapeutic implications: quinine, halofantrine, and mefloquine become strictly contra-indicated. Moderate forms may be unknown, and this observation should be taken into account to prevent mistreatment in future patients.

[Primary arterial pulmonary hypertension and sildenafil: a case report from Dakar]. / Hypertension artérielle pulmonaire primitive et sildénafil: a propos d'un cas a Dakar.

INTRODUCTION: We report our experience of using sildenafil in treatment on primary arterial pulmonary hypertension. PATIENT: This case concern a 38 years old senegalese woman. She was hospitalised for global cardiac failure with right signs predominance and grade IV dyspnea related to pulmonary hypertension. RESULTS: No evident cause of the pulmonary hypertension had been found after explorations. Adding sildénafil to her symptomatic treatment provided fast favourable evolution quantified by clinical test and Doppler-ultrasound heart examination. However the patient died three month later by cerebral hemorrhage due to overdose of antivitamine K. CONCLUSION: We suggest using sildenafil in the treatment of primary arterial pulmonary hypertension on the way going to cardio-pulmonary transplantation.

[Hemorrhoids in Dakar: epidemiological, clinical and endoscopic aspects of 168 cases]. / Aspects epidemiologiques, cliniques et endoscopiques de la maladie hemorroidaire a Dakar. A propos de 168 cas.

INTRODUCTION: haemorrhoidal disease symptoms lead frequently to medical consultation. The aims of our study were to determine its epidemiological, clinical and endoscopic characteristics in Dakar. PATIENTS AND METHODS: we conducted a prospective multicentric study in the hospitals and in the private offices with endoscopic unit in Dakar from November 2nd 2003 to July 31 2004. A questionnaire with clinical and epidemiological features was applied to patients who presented haemorrhoid to the endoscopic exam. We included those who accepted the questionnaire. RESULTS: We recruited 168 patients. The mean age was 39.6 years. The sex ratio was 1.66 (male to female). The mean duration of symptoms was 6 years (range 1 month - 32 years). The symptoms that lead to medical visit were mainly: rectal haemorrhage (50.5%), anal pain (23.2%), constipation (13.1%) and anal tumefaction (9.5%). At the anamnesis the most frequently symptoms noted were constipation (80.4%), anal tumefaction (74.4%), anal pain (73.8%), rectal haemorrhage (64.9%) and anal pruritus (58.3%). The haemorrhoids were internal in 116 cases and external in 52 cases. According to the endoscopic classification, 35% of patients were at the first stage, 43% at stage II, 18% at stage III and 4% at the stage IV. An anitis was noted in 29.1% cases. We noted as associated lesions 18 fistulas and 15 anal fissures. CONCLUSION: The epidemiological, clinical and endoscopic characteristics of haemorrhoidal disease in Dakar are similar to those described in medical literature.

[Prescription of morphinics in the management of pain in Dakar teaching hospitals]. / La prescription des morphiniques dans la prise en charge de la douleur dans les centres hospitalo-universitaires de Dakar.

The correct management of pain is one of the most frequent problems in a daily medical practice. To achieve this goal physicians have to use many drugs. Among these drugs morphinics represent a special category with specific rules of administration. To assess the use of morphinics in the management of pain in Dakar teaching hospitals and to determine the reasons of under or over prescription, we carried out this study A questionnaire was sent to 200 medical doctors in two teaching hospitals in Dakar between February and April 1999. The response rate was 89.5% (179). According to 73.2% of medical doctors who answered the questionnaire, pain frequently leads to consultation but surprisingly only 14 physicians (7.8%) recognize a regular use of morphinics while 70.1% of them prescribe morphinics exceptionally Morphinics are mainly used to control pain in cancerology (37.2%) and post-operative pain (21.3%). The main reasons to explain the under-use of morphinics were: the fear of respiratory side-effects of morphinics (35.3%), the ignorance of prescription rules (23.5%). The training regarding prescription of morphinics was provided during medical studies and only 10 out of the medical doctors had an adequate postgraduate training in this domain. As expected 51.4% of physicians thought that their training during medical studies was inadequate. To improve the management of pain in our country we recommend a better training of medical doctors during medical studies and the promotion of postgraduate seminars on the use of these molecules. The legislation and rules of administration must be cleared and these drugs should be more available in drugstores and hospital pharmacies. All of these modifications are necessary to help medical doctors to overcome the fear of morphinics for a better management of pain in our country.