Stroke and periodontal disease in Senegal: case-control study.

OBJECTIVE: To determine the periodontal factors associated with stroke in melanodermic subjects in Senegal. STUDY DESIGN: Case-control study. METHODS: One hundred and twenty cases and 120 controls were included in this study. Cases had been diagnosed with stroke by a neurologist, with the diagnosis confirmed by scanner. Controls had never had any type of stroke. Data were collected regarding sociodemographic characteristics, lifestyle behaviours, general history, type of stroke (ischaemic or haemorrhagic) and periodontal parameters [plaque index, papillary bleeding index, pocket depth, clinical attachment loss, Community Periodontal Index of Treatment Needs and periodontitis (defined by clinical attachment loss >2 mm and pocket depth >3 mm)]. Logistic regression analysis was performed using R software to isolate a final model after adjustment for the 5% threshold. RESULTS: All periodontal characteristics were more common among cases than among controls. Periodontitis (odds ratio 1.58, 95% confidence interval 1.1-3.022) and periodontal parameters were significantly associated with stroke, adjusted for hypertension, sedentary lifestyle, and the interaction between periodontitis and age. CONCLUSIONS: Periodontal disease is associated with stroke in the Senegalese population. Prospective longitudinal studies should be undertaken to improve understanding.

[Epilepsy and reproductive health: Senegalese cohort]. / Épilepsie et santé de la reproduction : cohorte sénégalaise.

INTRODUCTION: Epilepsy is a public health problem in Senegal and Africa because of its severity and its social importance. It occurs at any age sparing no sex. It can influence sexual life and reciprocally. Our aims were to study the effects of antiepileptic drugs on the sexual lives of women with epilepsy, the influence of these drugs on pregnancy and breastfeeding. METHODS: We conducted a prospective study from 1st March to 31st August 2011 in the neurological department of the Fann-Dakar teaching hospital Senegal. Only women with epilepsy were included. RESULTS: We collected 120 patients aged 16-64years with a mean age of 30.58years, 45% married, 44.16% were uneducated preponderant. All patients were taking antiepileptic drugs, 89.16% was alone. Fifty-five percent of our patients had epilepsy for at least 6years; 45.83% had generalized epilepsy; 44.17% of partial seizures. In our cohort, 64.16% were under phenobarbital, 69.16% had good adherence. As side effects of drugs, 90% had sexual problems. Seventy-five percent enjoyed an active sex life. A decrease in the number of sex per week for the disease [31/55=56.66%] was noted. In addition, 51.17% were using contraception, including 38.7% of oral kind and 64.86% had noticed an increase in seizure frequency during their pregnancies. Of the 74 women who had contracted a pregnancy, 41.89% had premature infants, 16.21% have made abortions and 61.17% had psychosocial life affected. DISCUSSION AND CONCLUSION: People with epilepsy often experience sexual problems that may be caused by epilepsy, antiepileptic and/or reactions of the partner and the other facing the diagnosis of epilepsy.

[Management of neurological emergencies in developing country: example of Senegal]. / Prise en charge de l'urgence neurologique dans un pays en développement : exemple du Sénégal.

Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.

Cost of achieving HbA1c and weight loss treatment targets with IDegLira vs insulin glargine U100 plus insulin aspart in the USA.

BACKGROUND: Compared with basal-bolus insulin therapy (insulin glargine U100 plus insulin aspart), IDegLira has been shown to be associated with similar improvements in HbA1c, with superior weight loss and reduced hypoglycemia in patients with type 2 diabetes. The present analysis evaluated the cost per patient with type 2 diabetes achieving HbA1c-focused and composite treatment targets with IDegLira and insulin glargine U100 plus insulin aspart (≤4 times daily). METHODS: The proportions of patients achieving treatment targets were obtained from the treat-to-target, non-inferiority DUAL VII study (NCT02420262). The annual cost per patient achieving target (cost of control) was analyzed from a US healthcare payer perspective. The annual cost of control was assessed for eight prespecified endpoints and four post-hoc endpoints. RESULTS: The number needed to treat to bring one patient to targets of HbA1c <7.0% and HbA1c ≤6.5% was similar with IDegLira and insulin glargine U100 plus insulin aspart. However, when weight gain and/or hypoglycemia were included, the number needed to treat was lower with IDegLira. IDegLira and insulin glargine U100 plus insulin aspart had similar costs of control for HbA1c <7.0%. However, cost of control values were substantially lower with IDegLira when the more stringent target of HbA1c ≤6.5% was used, and when patient-centered outcomes of hypoglycemia risk and impact on weight were included. CONCLUSION: IDegLira was shown to be a cost-effective treatment vs insulin glargine U100 plus insulin aspart for patients with type 2 diabetes not achieving glycemic targets on basal insulin in the USA.

Childhood arterial ischemic stroke in Senegal (West Africa).

Etiological factors of childhood ischemic stroke depend on the epidemiological context. The purpose of this study was to determine the risk factors, the clinical and radiologic features, and the outcome of arterial ischemic stroke in a case series of Senegalese children. We carried out a retrospective registry-based study on arterial ischemic stroke in children hospitalized in the neurology department of Fann Teaching Hospital and Albert Royer Children's Hospital, from January 2005 to December 2015. We enrolled 116 cases with an age range from 2 months to 18 years. The mean age at stroke occurrence was 71.5 months. The most common manifestations were hemiparesis (84%), aphasia (19%), and partial motor seizures (10%). The middle cerebral artery was the most affected (81%). Risk factors were predominantly sickle cell disease (38%), embolic heart disease (9%), and anemia (3%). Twenty-eight percent of patients were lost to follow-up, 62% had neurological impairments, and 4% died. Secondary prevention was based on antithrombotic agents. Prevention must be prioritized and public health actions need to focus on sickle cell disease, rheumatismal disease, anemia, and related disorders. It will be necessary to set up policies that fight against consanguineous marriage, endemic infections, and argue for better nutrition.

[The management of cerebrovascular events in Senegal]. / Prise en charge des accidents vasculaires cérébraux au Sénégal.

OBJECTIVES: Because of its acuteness and rapid progress to irreversible injury, stroke is a dramatically high priority medical emergency. The purpose of this prospective study was to ascertain the average time limit for primary management of stroke victims referred to the Senegalese national medical center considered as the final link within the country's healthcare organisation. PATIENTS AND METHODS: We reviewed the files of 170 patients aged 25-90 (average 61+/-13 years). The sex ratio was 0.68. Seventy percent of the patients resided in the nation's capital, Dakar. RESULTS: Most of the patients were referred to a medical center late. Admission was before the 6th hour for only one patient and none of the patients were admitted before the 3rd hour. Late treatment was related to the remoteness of medical centers. Among patients residing in Dakar, the first visit occurred between 6 and 24 hours for 30p.cent versus 7.8 p.cent for patients residing in rural areas of the country. Educational level and socio-economic status had no effect on late treatment. None of the patients were given prehospital care. Treatment was essentially symptomatic in patients with hemorrhagic stroke. Anticoagulants or anti-platelet agents were prescribed for patients with ischemic stroke. Only 29.4 p.cent of patients were given rehabilitation care. Mortality was 50.6 p.cent and the rate of dependency 41.7 p.cent. CONCLUSION: In Senegal, stroke victims receive care too late. This situation arises because of insufficiency of human and material resources and inaccessibility to care centers.

[Functional prognosis of stroke in countries in the process of development: Senegal]. / Pronostic fonctionnel des accidents vasculaires cérébraux dans les pays en voie de développement: Sénégal.

OBJECTIVE: To evaluate the functional outcome in patients followed in the department of neurology of Dakar for stroke. MATERIALS AND METHOD: Prospective longitudinal observational study from August 2003 to May 2005 included inpatients or outpatients with stroke one month or less from entry confirmed by computed tomography scan. Patients were followed monthly for 12 months. At each visit, data on functional autonomy measured by the Barthel index and the treatments received were collected. RESULTS: One hundred and seventy patients aged 25 to 90 years (mean 61+/-13 years) were evaluated. The sex ratio was 0.68. A total of 64.7% of strokes involved ischemic cerebral vascular accidents and 35.3% hemorrhagic vascular accidents. Right hemiplegia was present in 55.9%, left hemiplegia in 42.9% and bilateral paresis in 1.2% of patients. A total of 28.8% of patients died between d0 and d30, 50.6% within one year. At entry, the Barthel score was greater than 60 in only 4.7% of patients. After one-year follow-up, 58.3% of the patients had a Barthel score greater than 60, 19.1% had a score between 20 and 40 and 22.6% a score between 40 and 60. Only 53.5% received rehabilitation care. The parameters significantly associated with a functional recovery were age less than 55 years (P<0.05), hemorrhagic vascular accident as opposed to ischemic vascular accident (P<0.05), and earlier rehabilitation care under qualified personnel (P<0.01). DISCUSSION: Our study shows an important rate of mortality during the first year following stroke and the rather young age of our population. The parameters associated with a better functional recovery are comparable to most of the data in the literature. The results of our study suggest that it is possible to improve functional prognosis after stroke by setting measures of prevention of the risk factors and rehabilitation in the early management of hemiplegia.

[Prognosis of stroke in department of neurology of Dakar]. / Pronostic des accidents vasculaires cerebraux au service de neurologie de Dakar.

INTRODUCTION: The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar. MATERIALS AND METHODS: This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months. RESULTS: The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects. CONCLUSION: Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

Prognosis of spontaneous hemorrhagic stroke in people under 55 in Senegal, a developing country in Africa: a series of 53 cases.

Strokes occur increasingly frequently in people aged 55 years or younger and present a problem of management and therefore of prognosis. The objective of this study was to determine the prognostic factors associated with hemorrhagic stroke in this population in Senegal. This retrospective study concerns 53 patients aged 16 to 55 years, hospitalized for hemorrhage stroke in the neurological department of Fann Teaching Hospital during 2010. The patients' mean age was 42.1 years (16 to 55 years) and the sex ratio 1.30 in favor of women. Hypertension was found in 62% of the patients, and 11% had a history of stroke. Hemiplegia was observed in 76%, associated more or less with impairment of consciousness (43%) and language (38%). Intraparenchymal hematomas were principally supratentorial (78%); only 15% were subtentorial (10% cerebellar and 5% in the brainstem). During the acute phase of hemorrhage, glycemic levels were high among one third of the patients. The mortality rate in our series was 43% and was highest among those of impaired consciousness and abnormal glycemic, cholesterol, and creatinemia levels. Neuropsychological sequelae occurred in 47% of all patients, including 83% of the survivors. Hemorrhagic stroke in people aged 55 years or younger is a public health problem. In view of the high mortality rate, effective control requires prevention of its risk factors and increased awareness of the danger of these factors and of the warning signs of stroke.

[Ito hypomelanosis: Four case reports]. / Hypomélanose d'Ito : à propos de 4 cas.

Ito hypomelanosis is a rare neurocutaneous condition. We report on four observations in infants aged between 8 and 20 months. They all presented with epilepsy, psychomotor delay, and diffuse hypomelanosis. The electroencephalograms showed diffuse irritative abnormalities. Brain imaging was normal in two infants and showed hemispheric atrophy in another case. Despite antiepileptic treatment and physical therapy, no significant progression was noted and all children continued to have drug-resistant epilepsy and psychomotor delay.

Gross and histopathological findings in synovial membranes of pigs with experimentally induced Mycoplasma hyosynoviae arthritis.

The aim of this investigation was to describe the gross and histopathological findings in synovial membranes of pigs with experimentally induced Mycoplasma hyosynoviae arthritis and in synovial membranes of non-infected pigs of the same age. Experimental intravenous or intranasal inoculation or contact exposure with M. hyosynoviae induced arthritis in 13- to 17-week-old pigs. The acute to subacute arthritis was characterized by increased amounts of serohaemorrhagic, serofibrinous or mahogany coloured synovial fluid combined with edema and hyperaemia, followed by yellow to brownish discoloration and moderate villous proliferation of the synovial membrane. In the chronic phase moderate fibrosis was seen, but no periarticular or articular cartilage involvement. The acute to subacute histopathological characteristics were edema, hyperaemia, variable hyperplasia of synovial lining cells, increased density of subsynovial cell populations, diffuse and perivascular infiltration with lymphocytes, plasma cells and macrophage-like cells, fibrinous material, mild to moderate villous hypertrophy and mild to moderate fibrosis in chronic cases. The morphogenetic changes during the course of the infection may be described as follows: An acute preimmune phase with inflammatory changes and synovial membrane reactions dominates the first week of the infection. By the second and third week, the peak of the immune phase with masses of plasma cells and lymphocytes is seen. By 7 weeks, there is healing with moderate fibrosis. Mild ongoing reactions or recurrence of arthritis, perhaps related to persistence of mycoplasma antigens, may be seen in later phases and local antibody production may be important in this infection.

Typing of Pasteurella multocida from haemorrhagic septicaemia in Danish fallow deer (Dama dama).

Isolates of Pasteurella multocida ssp. multocida (n = 31) from a Danish population of fallow deer which succumbed to haemorrhagic septicaemia during 1992 1993 and isolates from the palatine tonsils of apparently healthy fallow deer from the same area (n=6) were typed and compared with P. multocida from other sources. Plasmids were net observed in the fallow deer strains and one unique pattern was observed by ribotyping using HindIII and by pulsed-field gel electrophoresis using SanlI as restriction endonuclease. All Danish fallow deer isolates belonged to serotype B:3,4. On restriction endonuclease analysis using HhaI as restriction endonuclease, all had a profile identical to that of a fallow deer isolate from the United Kingdom: profile 0033 of Wilson et al. On restriction endonuclease analysis using HpaII as restriction endonuclease, the Danish fallow deer isolates had a unique profile, designated 0062, which differed slightly from that of a fallow deer isolate from the United Kingdom. P. multocida from other animal species were genotypically different from the fallow deer isolates. It is concluded that a specific clone of P. multocida was responsible for the outbreak of haemorrhagic septicaemia among Danish fallow deer. A carrier rate of 27% was demonstrated among apparently normal animals from the same population.

Acute disseminated Aspergillosis in a cow with special reference to penetration and spread.

Acute disseminated aspergillosis caused by Aspergillus fumigatus is reported in a 4-year-old cow given broad spectrum antibiotics and anti-inflammatory therapy. All stomach compartments were infected and hyphal invasion of gastric blood vessels was the probable source of generalization to the liver, lung and kidneys. Throughout the Peyer's patches of the jejunum there were acute necrotic foci with Aspergillus hyphae and similar foci occurred in the corresponding mesenteric lymph nodes. This points to the Peyer's patches being a portal of entry for A. fumigatus to the lymphatic system of the intestine.

The occurrence of fungi in bovine tissues in relation to portals of entry and environmental factors.

The occurrence of fungi in tissue specimens from 72 cattle was examined by culture, histopathology and indirect immunofluorescence staining (IIF). Groups of 12 animals each had been fed either concentrate or roughage and had been housed either in tie stalls, on slatted floors or on deep bedding. Specimens were obtained from the lung, omasum and Peyer's patches of the ileum and corresponding lymph nodes. Both hyphae and spores were made visible by IIF and by combination of IIF, morphology and conventional staining it was possible to differentiate between aspergilli and zygomycetes. In the lungs, aspergilli were detected at the same rate by morphology and IIF, whereas zygomycetes were found nearly twice as often by IIF than by culture. Fungi in pulmonary tissue were most frequent in cattle tied or kept on deep bedding (P < 0.01) as assessed by IIF. Within lymph nodes only spores were found, and Aspergillus fumigatus was the predominant species. Lesions devoid of fungi, especially ulcerations, were observed on the edges of the largest omasal laminae with a notable preference for the aboral third. The localization and histopathology suggested a reflux of acid abomasal contents to be the pathogenic principle. Granulomas with centrally located plant material were found more frequently in cattle fed roughage than in cattle fed concentrate (P = 0.01) and were differentiated from mycotic granulomas.

Congenital tremor type AI: light and electron microscopical observations on the spinal cords of affected piglets.

The histology and ultrastructure of the spinal white matter from the dorsolateral funiculus of the third cervical segment was studied in normal control pigs and pigs whose dams were inoculated with the Weybridge congenital tremor strain of swine fever virus in early pregnancy. Only inoculated sows produced abnormal piglets. These showed congenital tremors and ataxia. The severity of clinical signs was related to the degree of spinal myelin deficiency. Morphologically this was quantified by determination of the thickness of myelin investing axons classed according to their diameter. In clinically affected pigs fewer axons were myelinated than normal. Though the myelin sheath thickness increased with increasing axon diameter in all pigs whether clinically normal or not, the increase was less in moderately affected and much less in severely affected pigs. The deficiency of spinal myelin was probably due to delayed or sub-normal myelination accompanied by paranodal myelin abnormalities, myelin degeneration and remyelination.

Pulmonary intravascular macrophages in the pathogenesis of bovine pulmonary lesions caused by Actinomyces pyogenes.

Rabbit antisera raised against somatic antigens from two strains of Actinomyces pyogenes reacted specifically in a peroxidase anti-peroxidase technique which was developed for the location of the bacteria in formalin-fixed tissues. The technique was applied on experimental murine and spontaneous bovine lesions caused by A. pyogenes. By electron microscopy and immunohistochemistry it was demonstrated that pulmonary intravascular macrophages play a role in the uptake of A. pyogenes from the blood, and in the production of pyaemic pulmonary lesions.

A murine model for the assessment of placental and fetal development in teratogenicity studies.

During normal pregnancy in the mouse, maternal serum levels of the analogues to human schwangerschaftsprotein-1 and alpha-fetoprotein correlate significantly with the growth of the placenta and fetus respectively. This relationship has been utilized in the analysis of the effect of sodium selenite on placental and fetal growth in mice. Moderate doses of sodium selenite did not affect the growth of the placenta and fetus significantly, whereas high doses of selenite resulted in a large percentage of abortions. The protein markers were found to be useful in the prediction of placental and fetal growth, and they are suggested to be of general use in the study of the impact of teratogenic substances, since they reflect the status of the fetoplacental mass during gestation.

Spinal muscular atrophy in calves of the Red Danish dairy breed.

Pathological and genetic aspects of spinal muscular atrophy in Red Danish dairy cattle are described. A total of 312 calves suspected of having the condition was reported in the Danish Bovine Genetic Disease Programme, 162 of them were examined post mortem and spinal muscular atrophy was diagnosed in 82 of these. Seventy-five per cent of the affected calves had bronchopneumonia. The diagnosis of spinal muscular atrophy was based on histopathological examinations of the spinal cord and musculature. The lesions were primarily characterised by degeneration of the spinal cord motor neurons with neuronophagia and denervation muscular atrophy. The ages of the affected calves varied from those recumbent from birth to a 21-week-old calf. All the necropsied cases appeared in a clearly familial pattern and could be traced back to American Brown Swiss bulls.