Usefulness of Dried Blood Spots (DBS) to perform hepatitis C virus genotyping in drug users in Senegal.

The aim of this pilot study was to analyze the Hepatitis C Virus (HCV) genotypes circulating in Senegal among Drug User (DUs), using Dried Blood Spots (DBS) as RNA source for molecular assays. Heroin and/or cocaine users (n = 506) were recruited in Dakar from April to July 2011, using a Respondent Driven Sampling (RDS) method. DBS preparation consisted of five drops of whole blood from finger applied to a Whatman paper card. HCV infection was screened by the detection of anti-HCV antibodies, using a rapid immune-chromatographic test. HCV RNA was quantified on anti-HCV positive DBS, using the Abbott RealTime HCV® Genotyping was performed on DBS with detectable viral load with Versant® HCV Genotype 2.0 Assay (LiPA) and Abbott RealTime HCV Genotype II assay®. Among the 506 participants, 120 were tested as positive for anti-HCV antibodies and their samples were analyzed for HCV RNA viral load and genotype. Out of the 120 DBS tested, HCV RNA was detected on 25 (20.8%). The median viral load was 15,058 IU/ml (ranging from 710 to 766,740 IU/ml). All positive DBS were suitable for the genotyping assay, that showed a predominance of genotype 1 (21/25) including 16 genotypes 1a and 5 genotypes 1b. HCV genotype 1 prevails in a DU population in Dakar. DBS could be useful for HCV RNA genotyping, but optimal storage conditions should required avoiding RNA impairment. Acknowledging this limitation, DBS could be a great interest for detecting and genotyping HCV viremic patients. J. Med. Virol. 89:484-488, 2017. © 2015 Wiley Periodicals, Inc.

[Role of eldest in a destructured family context: clinical case report from Fann Hospital in Dakar, Senegal]. / La position d'aîné a l'epreuve d'un contexte familial déstructurant: une observation au CHU de Fann a Dakar.

In a Senegalese family, the role of the eldest, i.e. the one who must lead the way, is particularly difficult. The eldest is the only one required to excel and wield power in the family. To ensure his status and maintain his identity, the elder must be acknowledged as such by the father, mother, and younger siblings. The purpose of this report is to describe a case demonstrating the psychological frailness associated with elder status. The patient developed depressive breakdown when his mother dismayed by his professional failure ceased to acknowledgement his status and implicitly disqualified him. Discussion includes the psychopathological dimension revolving mainly around an Oedipal relationship with the father.

[Ensuring continuity of care at the time of COVID-19: challenges for the Dakar Integrated Support Center for Addictions]. / Assurer la continuité des soins au temps de la COVID-19 : défis pour le centre de traitement des addictions à Dakar.

The COVID-19 pandemic has an impact on health systems, whose modes of adaptation and response on the ground are still poorly documented and are evolving. The Dakar Integrated Support Center for Addictions (CEPIAD) has been implementing risk reduction since 2014, particularly with drug users. The COVID-19 pandemic and related public health measures were an obstacle to its attendance by patients, in particular due to movement restriction. In addition to the implementation of individual and collective preventive measures in the center, CEPIAD has experimented "take-home" for methadon that is generally provided daily through directly observed treatment. The center has also taken care of amnestied incarcerated cannabis users. Several aspects of this experience, perceived positively, could be relevant outside the pandemic context.

[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.

[Profile of patients admitted for myocardial infarction at the emergency reception facility of Principal Hospital in Dakar, Senegal]. / Profil des patients admis pour infarctus du myocarde au service d'accueil des urgences de l'Hopital Principal de Dakar.

This retrospective study was carried out from January 2005 to December 2006 to ascertain the profile of patients admitted for treatment of myocardial infarction (MI) in a modern emergency reception facility (ERF) in Sub-Saharan Africa. Diagnosis of MI was based on clinical presentation, electrocardiography (persistent ST-segment depression), and laboratory findings (measurement of troponine T and CPK MB). Study data included epidemiological parameters (including risk factors and interval between onset of symptoms and admission), clinical and paraclinical findings, therapeutic modalities (including any prehospital management), complications at the time of admission, and mortality within the first five days. Men accounted for 77% of the 52 consecutive patients hospitalized for MI during the study period. Mean age was 59 years. Risk factors included hypertension in 46% of cases, tobacco use in 40%, and diabetes in 21%. The mean interval for management was approximately 29 hours with only 5 patients receiving care within the first 6 hours. Chest pain was the main reason for coming to the ERF (86%). The location of pain was anterior in 58% of cases and inferior in 37%. Diagnosis was confirmed by laboratory findings in 96% of patients. Ten patients benefited from transportation by ambulance and four patients underwent thrombolysis before hospitalization. Complications at the time of admissions included cardiovascular collapse (n=3), acute pulmonary edema (n=13), and arrhythmia (n=6). Eleven patients (21%) died within the first five days. These findings confirm the need to educate the population in an effort to reduce the interval for management, to develop prehospital medical care, and to increase the availability of coronary artery revascularization modalities to improve the prognosis of MI in the acute phase.

[Diabetes mellitus in sub-Saharan Africa: epidemiological aspects and management issues]. / Le diabète sucré en Afrique subsaharienne aspects épidémiologiques, difficultés de prise en charge.

In contradiction with long-standing conventional wisdom that it is a rich country's disease, diabetes mellitus is increasingly a major concern in developing countries, especially in sub-Saharan Africa. Care facilities have not kept pace with the sharp increase in diabetes mellitus. The WHO has predicted a worldwide rise in the prevalence of diabetes that is expected to affect 300 million people by 2025. This progression is more flagrant in developing countries particularly in sub-Saharan Africa. In these countries, the expansion of diabetes is part of a broader epidemiological transition from transmissible diseases to non-transmissible diseases. A number of factors are causing this transition including aging of the population, sedentary lifestyle, and obesity. Aside from obesity, arterial hypertension is the main cardiovascular risk factor associated with diabetes. Alone or in association with other risk factors, diabetes mellitus accounts for high morbidity especially due to cardiovascular and kidney complications. Management in sub-Saharan Africa faces a number of issues: poor understanding of the extent of the problem, high cost of medications, socio-economic setting that is poorly suited to maintaining a proper diabetic diet, and limitations in infrastructure and personnel. The rapid increase in the prevalence of diabetes mellitus in sub-Saharan Africa is a serious challenge. There is an urgent need to obtain accurate figures about the extent of the pandemia as a basis for training an adequate number of health care personnel and implementing sufficient resources to allow local management. Meeting this challenge will require enhancement of the awareness and participation of all players involved in public health.

[Important pericardial effusions: apport of echocardiography guided pericardocentensis: about 30 consecutive cases]. / Péricardites liquidiennes abondantes: apports de la péricardocentése echoguidée: a propos de 30 cas consécutifs.

INTRODUCTION: Western countries have good mastery of abundant pericardial effusion while in Africa this still raises some problems regarding diagnosis and therapy. The aim was to see to what extent echo guided pericardiocentesis could contribute in severe cases. METHODS: All patients with abundant pericardial effusion diagnosed by echocardiography with or without compression were considered in a prospective study. They experienced a pericardiocentesis. Some patients did undergo an additional surgical biopsy. The liquid was preliminarily submitted to chemical, bacteriological, cytological analysis. Tissues were observed through an anatomic pathology in biopsy. Heart tuberculosis was diagnosed through histology for following therapeutic testing. RESULTS: Thirty consecutive patients aged 37 in average were included. The sex ratio was 3.75. Prior to draining off, 3 neoplasies (2 of lung bronchitis, 1 of cervix ), 1 leukaemia, 2 extra pericardium tuberculosis and 1 amoebic abscess were diagnosed . Clinical occurrence: the most frequent case, besides the tampon (10 cases, i.e. 30%), was isolated pericardial effusion associated or not with an alteration of the global state (13 cases, i.e. 4%). The average quantity of liquid extracted was 600c c which provoked a kind of haemorrhage in 18 cases, i.e. 60%. Tuberculosis was the major aetiology: 15 cases e i 50% out of which 4 were HIV positive. Three additional surgical biopsies were carried out. Seven patients died. CCONCLUSION In addition to its diagnostic contribution, echo guided pericardiocentesis offers an alternative to endoscopy surgery.

[Clinical and psychopathological postpartum depression: eleven Senegalese cases report]. / Aspects cliniques et psychopathologiques de la dépression du postpartum: rapport d'une série de onze cas sénégalais.

INTRODUCTION: The postpartum depression is a frequent puerperium psychiatric disorder. The authors study the clinical, therapeutic and evolutionary aspects of the postpartum depression among eleven Senegalese women. MATERIAL AND METHOD: They examined the medical reports and hospital registers of eleven patients belonging to a sample of 52 women presenting psychic disorders of the puerperality. The diagnosis was made by using the International Classification of the Diseases. RESULTS: The symptoms of depression were irritability, bad concentration, multiple somatic complaints, of insomnia of drowsiness, loss of the usual interests. All the patients profited from psychotherapy and have received chemotherapy with antidepressant treatment associated tranquillizing in six cases. They improved from 29 to 43 days after their admission. CONCLUSION: The pregnancy and the childbirth, the parity, personal history of the patient, their social environment and the cultural representations of maternity are factors of depression of the postpartum. The antidepressant is always essential in the treatment.

[Pulmonary arterial hypertension revealing pseudolymphoma associated with Sjogren's syndrome]. / Hypertension arterielle pulmonaire revelant un syndrome de Gougerot-Sjorgen primitif dans sa forme pseudolymphomateuse.

INTRODUCTION: The authors related a right heart failure related to a primitive pulmonary arterial hypertension without past medical. METHODS AND RESULTS: This diagnosis has been noticed on the cardiac catheterism as well as the cardiac echography (no shunt). Two years later systemic anomalies such as polyarthritis and salivary glands disease were noticed. The Biopsy revelated a primitive Gougerot-Sjorgen pseudolymphomas syndrom. CONCLUSION: Three years under conventional treatment were a failure as the evolution of the disease resulted to death.

HIV and other sexually transmitted diseases among female prostitutes in Kinshasa.

In 1988, 1233 prostitutes from different geographic areas of Kinshasa participated in a cross-sectional survey on HIV infection and other sexually transmitted diseases (STDs). Despite relatively good knowledge about AIDS and STDs, the reported preventive behaviour was poor. Only 12% of the women reported regular use of condoms, while greater than 50% of the women reported regular use of antibiotics and 38% reported doing nothing specific to prevent STDs. Thirty-five per cent of the women were HIV-positive compared with 27% in a similar survey in Kinshasa in 1986. The prevalence of other STDs was very high, ranging from 5% for genital ulcer disease (GUD) to 23% for gonococcal infection. HIV-positive women were older than HIV-negative women (26.9 versus 25.4 years; P less than 0.001), had a significantly lower level of reported condom use (9 versus 14%, P = 0.009), and reported more frequent use of antibiotics to prevent STDs (55 versus 42%, P = less than 0.001). The prevalence of syphilis, gonorrhoea, chlamydial infection and trichomoniasis was not higher in HIV-positive women compared with HIV-negative women. However, HIV-positive women had a higher prevalence of GUD (9 versus 3%, P less than 0.001), antibodies against Haemophilus ducreyi (82 versus 57%, P less than 0.001), antibodies against herpes simplex virus type 2 (96 versus 76%, P less than 0.001), condylomata accuminata (5 versus 1%, P = 0.003) and cytologic evidence of human papilloma virus on Papaniclaou cervical smear (11 versus 5%, P = 0.006). This study confirms the high incidence of HIV and other STDs among prostitutes in Africa.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombotic effect of a recombinant von Willebrand factor, VCL, on nitrogen laser-induced thrombus formation in guinea pig mesenteric arteries.

To assess the antithrombotic effectiveness of blocking the platelet glycoprotein (GP) Ib/IX receptor for von Willebrand factor (vWF), the antiaggregating and antithrombotic effects were studied in guinea pigs using a recombinant fragment of vWF, Leu 504-Lys 728 with a single intrachain disulfide bond linking residues Cys 509-Cys 695. The inhibitory effect of this peptide, named VCL, was tested in vitro on ristocetin- and botrocetin-induced platelet aggregation and compared to the ADP-induced platelet aggregation. In vivo, the antithrombotic effect of VCL was tested in a model of laser-injured mesentery small arteries and correlated to the ex vivo ristocetin-induced platelet aggregation. In this model of laser-induced thrombus formation, five mesenteric arteries were studied in each animal, and the number of recurrent thrombi during 15 min, the time to visualization and time to formation of first thrombus were recorded. In vitro, VCL totally abolished ristocetin- and botrocetin-induced platelet aggregation, but had no effect on ADP-induced platelet aggregation. Ex vivo, VCL (0.5 to 2 mg/kg) administered as a bolus i.v. injection inhibits risocetin-induced platelet aggregation with a duration of action exceeding 1 h. The maximum inhibition was observed 5 min after injection of VCL and was dose related. The same doses of VCL had no significant effect on platelet count and bleeding time.(ABSTRACT TRUNCATED AT 250 WORDS)

The antithrombotic effect of aurin tricarboxylic acid in the guinea pig is not solely due to its interaction with the von Willebrand factor-GPIb axis.

Commercial aurin tricarboxylic acid (ATA) has been reported to interfere specifically with von Willebrand factor-glycoprotein Ib (vWF-GPIb) axis. This study was designed to explore the antithrombotic effects of ATA by examining its effects on guinea pig platelet function in vitro, in vivo and ex vivo. In vitro, addition of various concentrations of ATA to platelet-rich guinea pig plasma totally inhibited ristocetin-induced platelet aggregation, as expected. Unexpectedly, however, ATA similarly inhibited the aggregation induced by ADP, PAF, collagen, I-BOP (a thromboxane A2/prostaglandin H2 analogue) and arachidonic acid. In vivo, the antithrombotic action of ATA was assessed in a model of acute platelet-dependent guinea pig mesenteric artery thrombosis triggered by laser-induced intimal injury. As the thrombotic response of arteries to such injury is a spontaneous cyclic recurrent process, 5 arteries in each animal were consecutively studied for 15 min each after i.v. bolus injection of 5, 7.5 or 10 mg/kg of ATA, which reduced the number of recurrent thrombi per artery in a dose-dependent manner. The highest dose of 10 mg/kg induced maximal inhibition of thrombus formation (72%, p < 0.001) 5 min after injection. Ex vivo, platelet aggregation was assessed in blood samples taken before and after i.v. bolus injection of 10 or 15 mg/kg ATA. Ten mg/kg significantly inhibited collagen-induced aggregation, and 15 mg/kg, the aggregation induced by ristocetin, ADP, PAF, collagen, I-BOP and arachidonic acid. The results of the in vivo studies confirmed that ATA is an effective antithrombotic agent. In the in vitro and ex vivo studies, ristocetin-induced platelet aggregation confirmed that ATA interacts with the vWF-GPIb axis, and suggests that the final common pathway of the aggregation induced by other agents tested consists of fibrinogen binding to the platelet GPIIb/IIIa receptor. We conclude that ATA interferes with vWF binding to GPIb, that it may interact with fibrinogen binding to GPIIb/IIIa, and that it might possess potent antithrombotic properties in platelet-mediated thrombosis.

Determination of serum levels of thirteen human immunodeficiency virus-suppressing drugs by high-performance liquid chromatography.

Two high-performance liquid chromatographic methods using UV detection are presented for the determination of two different groups (A and B) of drugs used in the suppression of human immunodeficiency virus (HIV). Group A is comprised of six nucleosidic reverse transcriptase inhibitors, viz. zalcitabine, lamivudine, stavudine, didanosine, zidovudine and ziagen. Group B consists of seven drugs four of which are protease inhibitors (PIs) and three of which are non-nucleosidic reverse transcriptase inhibitors (NNRTIs). The PIs are: indinavir, nelfinavir, saquinavir and ritonavir. The NNRTIs are: nevirapine, delavirdine and efavirenz. Groups A and B require separate aliquots of serum for extraction and must be chromatographed separately.

Determination of volatile bases in seafood using the ammonia ion selective electrode: collaborative study.

Nine collaborating laboratories tested a combination of 23 seafood samples for volatile bases using an ammonia ion selective electrode. Results were reported as mg NH3/100 g fish, but the method reflected levels of both ammonia and trimethylamine, which permeated the ammonia membrane. The 23 samples were broken down into 8 blind duplicate pairs, 2 Youden matched pairs, and 3 single samples covering fresh to spoiled product ranging from 8 to 82 mg NH3/100 g. Seven species were evaluated: Atlantic cod, squid, Atlantic halibut, gray sole, monkfish, dogfish, and Atlantic mackerel. The ammonia electrode assay was performed on an aqueous homogenate consisting of 95 mL distilled water and 5.0 g sample tissue. Alkaline ion strength adjusting solution (2 mL) was added to the homogenate to liberate ammonia that was sensed by the ion specific electrode and measured on a precalibrated portable meter. Repeatability standard deviations (RSDr) ranged from 4.2 to 17%; reproducibility standard deviations (RSDR) ranged from 8.8 to 21%. A standard ammonium chloride solution was provided to all laboratories to spike 3 different samples at 10 mg NH3/100 g. Recoveries of added ammonia as ammonium chloride for fresh, borderline, and spoiled samples were 88.6, 107, and 128%, respectively.

Rapid determination of volatile bases in fish by using an ammonia ion-selective electrode.

A simple and rapid method using an ammonia ion-selective electrode (ISE) to measure volatile bases in fish is proposed. Accuracy and precision were determined with 5, 10, 20, and 30 ppm NH3 standard solutions. Ammonia values obtained with the method correlate strongly with total volatile basic nitrogen (r2 = 0.88). Recoveries of added ammonia to homogenized fish samples ranged from 83.7 to 96.0%. Responses of the probe to trimethylamine (TMA), calculated as NH3 (mg/100 mL), ranged from 74.9 to 91.7%. These findings indicate that the probe measured TMA as well as ammonia. Storage trials on 8 fish species illustrated that the results obtained with the ISE method reflected nitrogen concentrations based on total volatile base (TVB) analysis. This procedure may be used in lieu of the traditional TVB method for on-site rapid screening of fish.

Synthesis of thiaazaheterocycle nucleoside analogues.

The syntheses of thiazinone, thiazinedione and thiazolinone base modified nucleoside analogues have been discussed in both the deoxy- and ribosyl series. Both inter- and intramolecular N-glycosylations were evaluated.

[Cardiac insufficiency in the African cardiology milieu]. / Insuffisance cardiaque en milieu cardiologique africain.

OBJECTIVE: The aim of this study is to determine the frequency, the aetiologies and the hospital mortality of heart failure in African developing countries. METHODS: A prospective study rolled over six months in African urban hospital including 170 patients, middle age 50 years old suffering from heart failure. They underwent clinical, paraclinical cardiac examination. RESULTS: Heart failure represented 37.7%. Main cardiac failure risks were: hypertension: 76 cases (45%), diabetes mellitus: 20 cases (11.8%). General heart failure is noted at the entrance in 67.6% with cerebral attack in 5%. EKG showed left ventricle hypertrophy in 108 patients (63.5%) and atrial fibrillation in 28 patients (16.6%). Valvular heart diseases and hypertension are the main aetiologies respectively: 76 cases (45%) and 58 cases (34%). In 10 cases (6%) the aetiology is unspecified. Hospital mortality concerned 44 patients (25.9%). CONCLUSION: Heart failure is grave and frequent in developing countries where there is no cardiac surgery. Prevention is possible: fighting against articular rheumatism and control hypertension.

[Cardiac manifestations of polymyositis. Apropos of 2 Senegalese cases]. / Manifestations cardiaques des polymyosites. A propos de deux cas sénégalais.

INTRODUCTION: Polymyositis cardiac involvement varies between 37% and 70%. EXEGENESIS: The authors report two cases of polymyositis with myocardial involvement observed in Senegal; the first case is a cardiac failure revealing an acute polymyositis occurring in a 44-year-old woman; the second case is a 34-year-old woman who had polymyositis with tachycardia and dyspnea: in the two cases echocardiography showed a left ventricular concentric hypertrophy with preserved systolic function and altered diastolic function; clinical and echocardiographic resolution were obtained by corticosteroid medication. CONCLUSION: Myocardial localization is the most common polymyositis cardiac involvement; clinical symptomatology is rare (3.3% to 6%). sometimes revealing polymyositis; electrocardiographic abnormalities are found in 18% to 81% cases and echographic abnormality in 42% cases; cardiac involvement is of bad prognosis.

[Maternal and fetal prognosis of hypertension and pregnancy in Africa (Senegal)]. / Pronostic maternel et foetal de l'association hypertension et grossesse en Afrique sub-saharienne (Sénégal).

OBJECTIVES: The aims of this study were to record the different types of hypertension associated with pregnancy and to assess the incidence of hypertension and its gravity in Senegal. METHODS: Over a two-year period, a cohort of pregnant women with hypertension according to the American working group classification of hypertension and pregnancy, was studied. A group of 47 non hypertensive women were matched for age and parity. Modalities of delivery were studied: maternal death, type of delivery, birth weight. RESULTS: Among 2,400 deliveries, hypertension was observed in 94 women wih, mean age 33 years. The incidence of hypertension was 3.9% and the incidence of preeclampsia was 2.5%. The different types of hypertension were: Type I: 44 (47%), Type II: 16 (17%), Type III: 18 (19%), Type IV: 16 (17%). Echocardiography showed 30 cases of left ventricle hypertrophy with 3 cases of systolic dysfunction. Thirty-five patients had undergone a caesarean. Forty-seven infants had a birth weight below 2,000 g. Maternal mortality was 12.7%, fetal and neonatal mortality was 50%. There was a 21-fold higher chance of caesarean section in hypertensive women (p<4 x 10-4). Neonatal mortality was 36 times higher (p (4 x 10-6) than in the control group with a birth weight lower birth weight 975 g (p<10-6). Women suffering from toxemia gave birth to children having a lower birth weight (-543 g) (p<5.10-3), but, there was no significant difference concerning caesarean (p<7*10-1) maternal, fetal and neonatal mortality (p<9. 10-1) compared with other sub-groups. CONCLUSION: In developing countries, hypertension in pregnant women is a severe condition responsible for disease and handicaps which could be avoidable at little cost through a better policy of detection and good quality multidisciplinary management.

[Cardiac pacing in West Africa: feasibility, problems, and perspectives]. / La stimulation cardiaque définitive en Afrique de l'Ouest: faisabilité, problèmes et perspectives.

BACKGROUND: The frequency of conductive trouble is not know in West-Africa where the evacuation to Europe and the cardiology institute of Abidjan has been for long time the only possibility to implant stimulators. We analyse our experience, the problems ant the perspectives. METHODS: Over a three year period 92 patients (47 men, 45 women) were implanted using new (47%) or a recycled pacemaker. The technique used was essentially endoveinous (sub-clavicular puncture) except 2 children. The medium length of treatment was 24 months. RESULTS: Syncope was noticed at the entrance in most 50% of cases. The degenerative etiology was dominant in 85%. Most cases (87%) used the VVI mode. Complications comprised 3 leads deplacements, 5 infections, 1 pacemaker syndrome and 1 death by mesenteria ischemia. Seven patients died later without any relation of cardiac pacing. CONCLUSION: Despite an intrinsically high cost, pacemaker implantation is feasible and useful in selected indications in developing countries.