Low-Cost Hourly Ambient Black Carbon Measurements at Multiple Cities in Africa.

There is a notable lack of continuous monitoring of air pollutants in the Global South, especially for measuring chemical composition, due to the high cost of regulatory monitors. Using our previously developed low-cost method to quantify black carbon (BC) in fine particulate matter (PM2.5) by analyzing reflected red light from ambient particle deposits on glass fiber filters, we estimated hourly ambient BC concentrations with filter tapes from beta attenuation monitors (BAMs). BC measurements obtained through this method were validated against a reference aethalometer between August 2 and 23, 2023 in Addis Ababa, Ethiopia, demonstrating a very strong agreement (R2 = 0.95 and slope = 0.97). We present hourly BC for three cities in sub-Saharan Africa (SSA) and one in North America: Abidjan (Côte d'Ivoire), Accra (Ghana), Addis Ababa (Ethiopia), and Pittsburgh (USA). The average BC concentrations for the measurement period at the Abidjan, Accra, Addis Ababa Central summer, Addis Ababa Central winter, Addis Ababa Jacros winter, and Pittsburgh sites were 3.85 µg/m3, 5.33 µg/m3, 5.63 µg/m3, 3.89 µg/m3, 9.14 µg/m3, and 0.52 µg/m3, respectively. BC made up 14-20% of PM2.5 mass in the SSA cities compared to only 5.6% in Pittsburgh. The hourly BC data at all sites (SSA and North America) show a pronounced diurnal pattern with prominent peaks during the morning and evening rush hours on workdays. A comparison between our measurements and the Goddard Earth Observing System Composition Forecast (GEOS-CF) estimates shows that the model performs well in predicting PM2.5 for most sites but struggles to predict BC at an hourly resolution. Adding more ground measurements could help evaluate and improve the performance of chemical transport models. Our method can potentially use existing BAM networks, such as BAMs at U.S. Embassies around the globe, to measure hourly BC concentrations. The PM2.5 composition data, thus acquired, can be crucial in identifying emission sources and help in effective policymaking in SSA.

Sex differences in Black Veterans with PTSD: women versus men have higher sympathetic activity, inflammation, and blunted cardiovagal baroreflex sensitivity.

PURPOSE: Post-traumatic stress disorder (PTSD) is associated with greater risk of incident hypertension and cardiovascular disease (CVD). Inflammation and autonomic derangements are suggested as contributing mechanisms. Women and Black adults have higher CVD risk associated with stress; however, whether there is a sex difference in autonomic and inflammatory mechanisms among Black individuals with PTSD is not known. We hypothesized that Black women with PTSD have higher inflammation, sympathetic nervous system (SNS) activity and impaired baroreflex sensitivity (BRS). METHODS: In 42 Black Veterans with PTSD (Women, N = 18 and Men, N = 24), we measured inflammatory biomarkers, continuous blood pressure (BP), heart rate (HR) and muscle sympathetic nerve activity (MSNA) at rest and during arterial BRS testing via the modified Oxford technique. RESULTS: Groups were matched for age and body mass index (BMI). Resting BP was similar between groups, but HR was higher (76 ± 12 vs. 68 ± 9 beats/min, p = 0.021) in women compared to men. Although women had lower PTSD symptoms severity (57 ± 17 vs. 68 ± 12 a.u.), resting MSNA (27 ± 13 vs. 16 ± 5 bursts/min, p = 0.003) was higher in women compared to men, respectively. Likewise, cardiovagal BRS was blunted (p = 0.002) in women (7.6 ± 4.3 ms/mmHg) compared to men (15.5 ± 8.4 ms/mmHg) while sympathetic BRS was not different between groups (p = 0.381). Black women also had higher (p = 0.020) plasma levels of interleukin-2 (IL-2). CONCLUSION: Black women with PTSD have higher resting HR and MSNA, greater impairment of cardiovagal BRS and possibly higher inflammation. These findings suggest a higher burden of autonomic and inflammatory derangements in Black women compared to Black men with PTSD.

Symptom severity impacts sympathetic dysregulation and inflammation in post-traumatic stress disorder (PTSD).

Post-traumatic stress disorder (PTSD) is associated with a greater risk of incident hypertension and cardiovascular disease. Inflammation, impaired baroreflex sensitivity (BRS) decreased parasympathetic nervous system (PNS) and overactive sympathetic nervous system (SNS) activity are suggested as contributing mechanisms. Increasing severity of PTSD symptoms has been linked to greater cardiovascular risk; however, the impact of PTSD symptom severity on inflammation and autonomic control of blood pressure has not yet been explored. We hypothesized that increasing PTSD symptom severity is linked to higher inflammation, greater SNS activity, lower PNS reactivity and impaired BRS. Seventy Veterans participated in this study: 28 with severe PTSD ((Clinical Administered PTSD Scale (CAPS) > 60; S-PTSD), 16 with moderate PTSD (CAPS ≥ 45 ≤ 60; M-PTSD) and 26 Controls (CAPS < 45; NO-PTSD). We recorded continuous blood pressure (BP), heart rate (HR) via EKG, heart rate variability (HRV) markers reflecting PNS and muscle sympathetic nerve activity (MSNA) at rest, during arterial baroreflex sensitivity (BRS) testing via the modified Oxford technique, and during 3 min of mental stress via mental arithmetic. Blood samples were analyzed for 12 biomarkers of systemic and vascular inflammation. While BP was comparable between severity groups, HR tended to be higher (p = 0.055) in S-PTSD (76 ±â€¯2 beats/min) than in Controls (67 ±â€¯2 beats/min) but comparable to M-PTSD (70 ±â€¯3 beats/min). There were no differences in resting HRV and MSNA between groups; however, cardiovagal BRS was blunted (p = 0.021) in S-PTSD (10 ±â€¯1 ms/mmHg) compared to controls (16 ±â€¯3 ms/mmHg) but comparable to M-PTSD (12 ±â€¯2 ms/mmHg). Veterans in the S-PTSD group had a higher (p < 0.001) combined inflammatory score compared to both M-PTSD and NO-PTSD. Likewise, while mental stress induced similar SNS and cardiovascular responses between the groups, there was a greater reduction in HRV in S-PTSD compared to both M-PTSD and NO-PTSD. In summary, individuals with severe PTSD symptoms have higher inflammation, greater impairment of BRS, a trend towards higher resting HR and exaggerated PNS withdrawal at the onset of mental stress that may contribute to cardiovascular risk in severe PTSD.

Simulating the impact of varying vegetation on West African monsoon surface fluxes using a regional convection-permitting model.

This study assessed the sensitivity of the West African climate to varying vegetation fractions. The assessment of a such relationship is critical in understanding the interactions between land surface and atmosphere. Two sets of convection-permitting simulations from the UK Met Office Unified Model at 12 km horizontal resolution covering the monsoon period May-September (MJJAS) were used, one with fixed vegetation fraction (MF-V) and the other with time-varying vegetation fraction (MV-V). Vegetation fractions are based on MODIS retrievals between May and September. We focused on three climatic zones over West Africa: Guinea Coast, Sudanian Sahel, and the Sahel while investigating heat fluxes, temperature, and evapotranspiration. Results reveal that latent heat fluxes are the most strongly affected by vegetation fraction over the Sahelian and Sudanian regions while sensible heat fluxes are more impacted over the Guinea Coast and Sudanian Sahel. Also, in MV-V simulation there is an increase in evapotranspiration mainly over the Sahel and some specific areas in Guinea Coast from June to September. Moreover, it is noticed that high near-surface temperature is associated with a weak vegetation fraction, especially during May and June. Finally, varying vegetation seems to improve the simulation of surface energy fluxes and in turn impact on climate parameters. This suggests that climate modelers should prioritize the use of varying vegetation options to improve the representation of the West African climate system.

[Lung cancer in Dakar, Senegal]. / La cancer bronchique a Dakar, Sénégal.

A prospective, multicenter was conducted in all specialized centers in the city of Dakar. The objective was to describe the epidemiology to assess the management of lung cancer. 45 patients were included. The sex ratio M/F = 8. The average age of patients was 57.5 years. Smoking was found in 84.4% of cases. The average time for consultation after the onset of symptoms was 6 months. The average time to diagnosis was 2 months. Two out of three patients (66%) had seen beyond the stage III B. Improved diagnostic performance for early diagnosis of cancer is needed. Emphasis should be on prevention through tobacco control.

[Smoking among students at the School of Health and Social Development and the Health Service Institute in Senegal]. / Le tabagisme chez les élèves de l'Ecole de Développement Sanitaire et Social et de l'Institut Santé Service.

We have undertaken a transverse study of smoking among students at the National School of Health and Social Development (ENDSS) and the Health Service Institute (ISS) in Senegal. 683 out of 1142 students were questioned. 609 (89%) replied, of whom 313 (52%) were at the ENDSS and 293 (48%) at the ISS. Senior technical students were most strongly represented at 37.8%, followed by student nurses (27.4%) and midwifery students (23.3%). There were more women (n=378) than men with a sex ratio of 0.61. The average age of the population was 27.5 +/- 6.8 years (range 15 to 58). The average age was 26.2 +/- 5.6 years in the women and 29.6 +/- 8 in the men. The group aged 25-34 was significantly the most affected in both men and women (p=0.0000). The population comprised 502 non-smokers (82.4%), 62 ex-smokers (10.2%) and 45 smokers (7.4%).We found variable alcohol consumption in 119 subjects (19.2%) and 5 students admitted using cannabis. The 62 ex-smokers made up 10.2% of the population. The average age was 31.4 years. 25 ex-smokers (40.3%) drank alcohol, with a sex ratio of 1.95. The reasons for stopping smoking were illness and guilt in 27.4% of cases respectively, economic in 24.2%, medical statements on the effects of smoking on health in 17.7% and personal wishes in only 11.3%. The smokers, numbering 45 (7.4%), had an average age of 27.6 +/- 6.6 years with a sex ratio of 2 (p=0.00000). The age of starting smoking was 20.7 +/- 4.2 years for the women and 19.9 +/- 2.9 years for the men. The latter had smoked for an average of 9.2 years. Cigarettes were used by the great majority of smokers. It was associated with alcohol consumption in 35.6% and cannabis in 11.1% of cases. In the men the motives for starting smoking were stress (60%), pleasure (55.2%) and social influence (53.3%). By contrast, among the women, the two main reasons were stress and fashion in 60% (p=0.04). Our students smoked mostly in public places and in their homes. 34 smokers (75.6%) wished to stop (p=0.02) but only 27 of them expressed the need for medical or psychological support to do this. Dependence, quantified by the Fagerström Score, was medium (score 5-6) in 60% (n=27) and strong (score 7-10) in 31.1% (n=14).The estimated monthly cost of smoking increased with the degree of dependence. It was, on average, 12,143 F CFA (18.5euro) in cases of high dependence, representing 37% of the minimum wage in Senegal which is 33000F CFA (50euro). The students understood well the diseases caused by smoking (whether they were smokers, ex-smokers or non-smokers). These comprise mainly pulmonary diseases (96.2%) and cardio-vascular diseases (78.3%) All the recommended methods of the fight against smoking presented in the media, the publicity, national anti-smoking campaigns, personal contact and consultation, received more than 60% of favourable opinions among the total population studied.

[Behavior and attitudes towards smoking among student midwives in Libreville]. / Comportements et attitudes des élèves sages-femmes de Libreville vis-à-vis du tabagisme.

BACKGROUND: The midwife, in taking on a public health role, is one of the most important resources for the prevention of smoking and in helping smoking cessation among women of childbearing age thanks to their numerous contacts with pregnant women. With this in mind, we conducted a study among student midwives to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHOD: This was a descriptive cross-sectional study conducted from 15 January to 15 February 2018 using a self-administered questionnaire and included the student midwives of the University of Health Science at Libreville (Gabon). RESULTS: A total of 188 student midwives completed the questionnaires (70.7% of students of the 1st year, 15.0% of students of the 2nd year and 14.3% of students of the 3rd year). Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking in pregnancy and its role in the development of complications for the mother and foetus. Overall, 17.1% of student midwives think that smoking is responsible for the occurrence of ectopic pregnancies, 20.3% believe it is responsible for retro-placental haematoma, 17.6% for premature rupture of the membranes. The prevalence of smoking was 11.1% and was most frequent in 2nd year students (25.0%) and 3rd year students (14.8%) (P<0.023). The mean age of beginning smoking was 19.0±4.4 years. The main initiating factors were peer influence (28.6%), pleasure (19.0%) and stress (14.3%). Nicotine dependence was weak to moderate among 48.8% of smokers and absent in 52.2%. CONCLUSION: Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking to complications of pregnancy. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

Sequelae of thoracic tuberculosis: manifestations and patients'quality of life.

For many patients, a history of tuberculosis is synonymous with disabling sequelae, impaired quality of life, and high morbidity and mortality. This retrospective study reviewed the files of patients hospitalized for sequelae of thoracic tuberculosis during 2017, to assess its various manifestations and their impact on quality of life. Of the 176 patients included, 75 % were aged from 35 to 65 years. They were predominantly male, with a sex ratio of 3.76. The socioeconomic level was mostly low (70 %). Only one episode of tuberculosis sufficed to cause sequelae in 89.8 % of cases. Smoking was often noted (52.3 %). Functional signs were dominated by coughs (90.3 %) and dyspnea (72.7 %). Pulmonary sequelae with fibrous scarring were observed in 52.2 % of the patients. Bacterial and/or viral superinfection was the leading cause of hospitalization (50 %). The death rate during hospitalization was 19 %. An improvement followed by discharge was observed for 81 %, 14.2 % of them with chronic respiratory insufficiency. In all, 13.28 % of the discharged patients died within the 6 months that followed. The sequelae of thoracic tuberculosis should be considered as long-term chronic conditions and deserve the same treatment.

Neonatal ophthalmia in Mali.

A newborn 3 hours old newborn presented bilateral eyelid edema with erythema and inflammatory hypertrophy of the palpebral conjunctiva. PCR of the conjunctival swabbing showed the presence of Chlamydia trachomatis DNA. Treatment with erythromycin suspension 125 mg/5 ml was initiated, supplemented by topical application of oxytetracycline ointment 1% and Azyter eye drops.

Sympathoexcitation and impaired arterial baroreflex sensitivity are linked to vascular inflammation in individuals with elevated resting blood pressure.

Elevated Resting Blood Pressure (ERBP) in the prehypertensive range is associated with increased risk of hypertension and cardiovascular disease, the mechanisms of which remain unclear. Prior studies have suggested that ERBP may be associated with overactivation and dysregulation of the sympathetic nervous system (SNS). We hypothesized that compared to normotensives (≤120/80 mmHg), ERBP (120/80-139/89 mmHg) has higher SNS activity, impaired arterial baroreflex sensitivity (BRS), and increased vascular inflammation. Twenty-nine participants were studied: 16 otherwise healthy individuals with ERBP (blood pressure (BP) 130 ± 2/85 ± 2 mmHg) and 13 matched normotensive controls (mean BP 114 ± 2/73 ± 2 mmHg). We measured muscle sympathetic nerve activity (MSNA), beat-to-beat BP, and continuous electrocardiogram at rest and during arterial BRS testing via the modified Oxford technique. Blood was analyzed for the following biomarkers of vascular inflammation: lipoprotein-associated phospholipase A2 (Lp-PLA2), E-selectin, and intercellular adhesion molecule 1 (ICAM-1). Resting MSNA burst frequency (22 ± 2 vs. 16 ± 2 bursts/min, P = 0.036) and burst incidence (36 ± 3 vs. 25 ± 3 bursts/100 heart beats, P = 0.025) were higher in ERBP compared to controls. Cardiovagal BRS was blunted in ERBP compared to controls (13 ± 2 vs. 20 ± 3 msec/mmHg, P = 0.032), while there was no difference in sympathetic BRS between groups. Lp-PLA2 (169 ± 8 vs. 142 ± 9 nmol/min/mL, P = 0.020) and E-selectin (6.89 ± 0.6 vs. 4.45 ± 0.51 ng/mL, P = 0.004) were higher in ERBP versus controls. E-selectin (r = 0.501, P = 0.011) and ICAM-1 (r = 0.481, P = 0.015) were positively correlated with MSNA, while E-selectin was negatively correlated with cardiovagal BRS (r = -0.427, P = 0.030). These findings demonstrate that individuals with ERBP have SNS overactivity and impaired arterial BRS that are linked to biomarkers of vascular inflammation.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

[Clinical, biological and radiological spectrum of newly diagnosed pulmonary tuberculosis]. / Profil clinique, biologique et radiologique des nouveaux cas de tuberculose pulmonaire au Centre Hospitalier Universitaire de Fann-Dakar.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.

[Familial tuberculosis: tracing the contacts of an infectious case]. / Tuberculose familiale: dépistage parmi les sujets contacts autour d'un cas index contagieux.

INTRODUCTION: This is a prospective study of 30 cases of smear positive pulmonary tuberculosis, with at least two sputum positive members of the family, seen in the respiratory clinic between January 2003 and June 2004. METHODS: They constitute the index cases who represent 3.5% of the cases of tuberculosis (n=850) and 2.9% of hospital admissions (n=1034) during the same period. Four patients were HIV positive. In the family circle, all contacts received an intradermal tuberculin test (IDTT) of 10 IU and/or a chest x-ray and/or sputum examination for AFB. RESULTS: Of the 601 contacts 359 (60%) had a positive IDTT with a mean diameter of 13 mm. Active pulmonary tuberculosis was found in 16 contacts giving a prevalence of 2.7% and an incidence of 4.5% (16/359). 67% of the contacts were adults aged 16-87 with a mean age of 35 years. The IDTT was positive with a mean diameter of 12.3 mm. The chest x-ray was abnormal in 40 adults (16.7%) and sputum examination confirmed pulmonary tuberculosis in 14 cases. 33% of the contacts were children (n=119) aged from 3 months to 15 years with the majority (85%) aged under 10. The IDTT was positive with a mean diameter of 12 mm and the chest x-ray was abnormal in 22 cases (18.5%). Two children of 15 years had active tuberculosis. CONCLUSION: The contacts identified were treated according to the tuberculosis protocol of Senegal (2RHEZ/6EH) with the intensive phase dispensed in hospital. It is of major importance therefore to develop effective strategies of information, education, diagnosis and management for cases of infectious pulmonary tuberculosis.

[Tuberculosis in the mother and child]. / La Tuberculose dans le couple mère-enfant.

INTRODUCTION: Tuberculosis is a scourge in our region; it is particularly dangerous in young children, above all those of tuberculous mothers. The object of this study is to evaluate the prevalence of tuberculosis in the children of tuberculous mothers and to determine how to increase their chances of survival and healthy development. METHODS: Between 1 January and 31 July 2002, 45 women were admitted to hospital with a child of less than 5 years. They received (mothers and children) an intradermal tuberculin test (IDTT) of 10 i.u., chest x-ray, and sputum examination for the mothers. RESULTS: 45 women (aged from 18 to 45 years) were hospitalised for sputum positive tuberculosis, an average IDTT of 13 mm and a high bacterial load (1 to>10 bacilli/hpf). Almost all (96%) presented with cavitating parenchymatous disease. We found no cases positive for HIV. Progress was satisfactory in 43 mothers treated with SRHZ. There were 2 deaths. In the children who were systematically examined, 82% (37) were less than 20 months old, there were 23 boys (51%), and 26 children (58%) were symptomatic at the first consultation. All the children were breast fed, explaining their admission with their mother. Evidence of tuberculous contact was found, 6 times with the father and 4 times with the grandparents. The most common physical signs were fever (92%) cough and weight loss (77%), malnutrition (69%). The IDTT was positive in 38/45 (84.5%) and pustular in 16/38 (42%). The chest x-ray was normal in 16/45 (35.6%), revealed mediastinal adenopathy in 19/29 (65.5%), accompanied by ipsilateral ventilatory problems in 11/29 (38%) and by parenchymal involvement in 3/29 (10.3%). Progress was satisfactory in 44 children on antituberculous treatment (RHE). There was one death on account over severe malnutrition. CONCLUSION: Treatment of tuberculosis in the mother and child is a guarantee of recovery for the mother and healthy development for the child. S: streptomycin, R: rifampicin, H: isoniazid, E: ethambutol, Z: pyrazinamide.

[Tuberculosis and diabetes]. / Tuberculose et diabète.

INTRODUCTION: We performed a retrospective case control study for the period between 1st January 1999 and 31st August 2004, comparing the radiological appearances of tuberculosis in 100 diabetics to those in patients matched for age and sex, with pulmonary TB alone presenting to The Chest clinic of the National Hospital of Fann. METHODS AND RESULTS: Diabetes was present in 4.7% of the 2116 patients hospitalized for pulmonary tuberculosis during the period of study and occurred more commonly in men (60%) with an average age of 51 years (73%). 82% had type II, non-insulin dependent diabetes. The various types of radiological lesions classically described in tuberculosis were found in nearly identical proportions in the two groups of patients, with parenchymal shadowing the most frequent appearance in both diabetics (N=86) and controls (N=88). Cavitation occurred significantly less frequently in diabetics (72%) than controls (88%) (p=0.04). Where radiological abnormalities were bilateral, they were worse on the left in the diabetics (27% versus 15% in controls). There was a trend for basal lesions to occur more frequently in diabetics (15%) than controls (3%) (p=0.06). CONCLUSION: Mortality was higher in diabetics (18%) than controls (6%), with death generally occurring within the first 24 hours of hospitalization.

[Contribution of the Xpert MTB/RIF to the etiological diagnosis of tuberculous pleurisy]. / Apport de l'Xpert MTB/RIF dans le diagnostic étiologique des pleurésies tuberculeuses.

INTRODUCTION: Performance of the Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in pleural liquid is poorly described. The aim of this study was to determine its usefulness for the etiological diagnosis of a tuberculous pleurisy. PATIENTS AND METHOD: We performed a descriptive cross-sectional study, with analytical design, including all the patients having a unilateral serofibrinous pleurisy, exudative, lymphocytic, and sterile. The diagnosis of pleural tuberculosis was considered based on epidemiological, clinical, paraclinical and therapeutic arguments. The Xpert MTB/RIF of the pleural fluid was carried out among all patients. RESULTS: Pleural tuberculosis was confirmed in 301 patients. The median age was 32years. Our study has included 217 men (72.1%) with a final sex ratio of 2.6. The cost of the pleural biopsy coupled with histology made it practicable in only 90 patients (29.9%) with a yield of 80%. The Xpert MTB/RIF of the pleural liquid was positive in only 10 patients (3.3% of the cases). CONCLUSION: Gene amplification by Xpert MTB/RIF of the pleural liquid is much less effective in establishing the diagnosis of tuberculous pleurisy than pleural biopsy, which remains the gold standard.

[Therapeutic itinerary and radiological features of positive microscopy tuberculosis patients at Centre Hospitalier National Universitaire de Fann (CHNUF), Dakar]. / Itinéraire thérapeutique et caractéristiques radiologiques des patients tuberculeux bacillifères dépistés au centre hospitalier national universitaire de Fann (CHNUF), Dakar.

INTRODUCTION: The long diagnostic delay is responsible for the extension of radiological lesions and spread of TB in the community. These radiological lesions can leave significant scars responsible for respiratory disability. OBJECTIVE: The aim of the study is to characterize radiologic features according to tuberculosis diagnostic delay. METHODS: We conducted a prospective cross-sectional study, about 66 patients with positive sputum. RESULTS: The average diagnostic delay was 16 (±15) weeks; whether 22 (±14.1) weeks in the female gender versus 14.6 (±14.3) weeks in the male gender (P=0.10). The first care use was respectively health centers (62.1%), drugstores (51.9%), and traditional medicine (28.7%). Only 27.2% of patients used the marabouts care. Bilateral radiographic abnormalities in bivariate analysis were associated with consultation at the health center (66.7% versus 33.3%; P<0.031), as is the extension of the lesions (70.2% versus 29.8% RP=1.66 [1.05 to 2.91]; P<0.03). Lake of knowledge of the symptoms of TB was associated with the use of marabouts care (12.5% versus 87.5; PR=0.35 [0.11 to 1.08], P<0.04). CONCLUSION: These results should prompt consideration in an emergency, appropriate control interventions, advocacy, patient information and medical personnel on the reality of tuberculosis to prevent its spread often causing respiratory disability with radological effects.

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

[Preliminary study of smoking in medical and paramedical staff at the Centre Hospitalier National de Fann Dakar]. / Etude préliminaire sur le tabagisme chez le personnel médical et paramédical du CHN de Fann.

BACKGROUND: Smoking represents a major threat to public health, being responsible for considerable morbidity and mortality. We undertook this study to establish the prevalence of smoking among personnel at the Centre Hospitalier National de Fann, their smoking habits and the attitude of staff to the problems caused by smoking as well as their understanding of their role in promoting smoking cessation. METHODS: A prospective study was undertaken between February and April 2004 in which a standardised, anonymous, self-completion questionnaire in French was administered to 262 medical and paramedical staff at the CHN de Fann. RESULTS: The response rate was 95%. The biggest single group of respondents came from the infectious diseases service (24.5%). 63% of participants were paramedical and 54% of respondents were male. The mean age of respondents was 39.2 for men and 35.9 for women. 11.6% were smokers and 13.3% were ex-smokers. The mean age of ex-smokers was 43.8 years with a male/female ration of 7.25 to 1. Among the ex-smokers 51.7% had stopped smoking within the last 10 years with health problems the most commonly cited reason for quitting (24.2%), followed by guilt (21.2%). Smokers had a mean age of 38.6 with a male to female ratio of 8.6 to 1. Mean age at which they had started to smoke was 14.3 for women and 21 for men with a mean duration of smoking of 21 in women and 17 in men. 96.6% smoked cigarettes with 31% smoking > 20 cigarettes per day. 75.9% of our smokers had tried to quit at least three times. 86.2% wished to stop but only 48.3% considered getting medical and or psychological support to help them to quit. The Fagerström score showed a high level of dependency in 27.6% of smokers. More than half the total population studied (65.6%) thought that healthcare workers should help others to stop smoking and 75.5% thought that they had influence to do this. CONCLUSION: Healthcare workers in Senegal have an opportunity and a responsibility to promote smoking cessation. Legislative proposals and smoking cessation clinics should help to combat the tobacco epidemic.

[Knowledge of the risks of smoking in patients admitted to a respiratory clinic in Senegal]. / Connaissances des risques liés au tabagisme chez des patients hospitalisés à la Clinique de Pneumologie du CHN de Fann de Dakar.

INTRODUCTION: Tobacco smoking is truly a modern plague. The WHO estimates that there are 1.3 billion smokers worldwide, about a third of the world's population. In various studies in Senegal the prevalence of smoking has varied between 16 and 36%. The risks associated with smoking are well established. However it is also well established that 'knowledge of risks alone is not sufficient to modify behaviour.' We undertook a study to assess knowledge of the risks of smoking among patients admitted to The Pulmonology Clinic of the Centre Hospitalier National de Fann de Dakar. PATIENTS AND METHODS: All patients admitted to the clinic between 1st December 2003 and 31st May 2004 were enrolled into this prospective, cross-sectional study. A questionnaire in French was administered together with the Fagerstrom test of clinical addiction. RESULTS: Of 343 patients admitted 75 (22%) were smokers. Only 2 (2.6%) of the smokers were female. As in previous studies, smoking was associated with social disadvantage. 34.7% of smokers had attended school to primary level only and 33.3% had had no schooling at all. Mean age of starting smoking was 16 (range 9 to 38 years). The monthly cost of smoking to individuals was estimated at between 2 and 45% of the Guaranteed Minimum Wage (SMIG). 44% of smokers also consumed alcohol and 2.6% smoked cannabis. More than two thirds of patients (68%) thought that smoking caused ill health. The majority of subjects (93.3%) had stopped smoking, at least since admission, though 6.7% continued to smoke. Previous consumption was estimated as a mean of 20 pack-years. Nicotine dependence was defined as medium in 37 patients (49.3%). CONCLUSION: Certain diseases such as malaria, tuberculosis and AIDS exist at endemic levels producing considerable morbidity and mortality. We should not allow the epidemic of smoking to continue. Collective action, particularly by pneumologists is required.