[Epidemiological, clinical and etiological profile of tinea capitis in adult patients in Dakar, Senegal]. / Profil épidémio-clinique et étiologique des teignes du cuir chevelu chez l'adulte à Dakar (Sénégal).

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

[Leg ulcers in sickle cell disease: A retrospective study of 40 cases]. / Ulcères de jambe au cours de la drépanocytose: étude rétrospective de 40 cas.

BACKGROUND: In Africa, studies primarily devoted to chronic leg ulcer due to sickle cell disease are rare. The objectives of the study were to determine the epidemiology, diagnosis and progression of chronic leg ulcers in sickle cell disease. PATIENTS AND METHODS: A 5-year multicentre, retrospective study was conducted in three university hospitals in Dakar. We included all patients with chronic leg ulcers occurring in a setting of sickle cell disease. RESULTS: We identified 40 cases of chronic leg ulcers associated with sickle cell disease, representing 3.4% of the current population of sickle cell patients in our institutions. The average patient age was 25.9 years and the sex ratio was 2.33. Chronic leg ulcer was the presenting feature enabling diagnosis of sickle cell disease in one third of the cases. The average time to consultation from onset was 5.4 years. Pain was reported in 22 cases (48%). Ulcers were isolated in 76% and multiple in 24% of cases. The most common site was the medial malleolus (39%). A CBC allowed identification of anaemia in 35 cases. Haemoglobin electrophoresis was performed and homozygous sickle cell SS disease was identified in 39 cases and heterozygous SC disease in 1 case. Local treatments included physiologic serum, topical antibiotics and skin grafting. Systemic treatment included supplementation with folic acid in all patients, blood transfusion in 16 cases, vasodilators in 11 cases and antibiotics in 25 cases. The outcome was favourable in 61.8% of cases. DISCUSSION: In Dakar, sickle cell disease is a common cause of chronic leg ulcer and is frequently revealed by chronic leg ulcer.

[Familial congenital hypomagnesemia revealed by neonatal convulsions]. / Convulsions néonatales révélant une hypomagnésémie congénitale familiale.

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.

[Intratarsal triamcinolone acetonide injection for treatment of refractory chronic tropical endemic limboconjunctivitis (TELC): experience at Aristide-Le-Dantec university hospital in Dakar]. / Injection intratarsale de triamcinolone acétonide dans le traitement des formes graves de la limboconjonctivite chronique endémique des tropiques (LCET) : expérience du CHU Aristide-Le-Dantec de Dakar.

PURPOSE: To evaluate the efficacy of intratarsal triamcinolone acetonide (TA) injection versus dexamethasone ointment in the treatment of refractory chronic tropical endemic limboconjunctivitis (TELC). PATIENTS AND METHODS: This one-year prospective study enrolled 20 patients with refractory TELC. One millilitre containing 40 mg TA was injected intratarsally on the most affected eye and dexamethasone ointment applied in the fellow eye. Efficacy was judged by clinical criteria according to a specially designed scale for the study. Statistical analysis was carried out using Fisher's chi(2) test and Student's t test with comparisons of the means of paired samples. RESULTS: In both cases, symptoms improved in all patients, as early as the following day or week, and clinical signs improved from the second week through the first month after injection, with an effective dose of 1 mL TA and three weeks of dexamethasone, with no recurrence at three months. Efficacy of the ointment alone was less (33.3-75%) than that with injection (90.9-100%) and could only be maintained after the first month by repeated application. CONCLUSION: Intratarsal TA injection, relatively easy and well-tolerated by patients, may be a better alternative to dexamethasone ointment in the treatment of refractory TELC.

Antidiabetic properties of aqueous barks extract of Parinari excelsa in alloxan-induced diabetic rats.

The aqueous extract of the Parinari excelsa barks at doses of 100 and 300 mg/kg/day for 7 days has a significant antihyperglycemic effect on alloxan-induced diabetic rats. At the same dose the acute oral administration of aqueous extract of the P. excelsa barks (100 and 300 mg/kg) induced a significant decrease of blood glucose on glucose-loaded normoglycaemic rats. Our results seem to confirm the rational bases for its use in traditional medicine.

[Local anesthesia in children's ocular surgery]. / Anesthésie loco-régionale dans la chirurgie oculaire de l'enfant.

PURPOSE: Present a Senegalese experience of local anesthesia in children's ocular surgery. PATIENTS AND METHODS: We conducted a retrospective study on 309 patients under 15 years of age, operated on in our department from June 1998 to December 2002. The type of anesthesia, general or local, was noted. The latter consisted in a retrobulbar and/or a peribulbar injection, with 4 ml of 50% of lidocaine 2% and bupivacaine mixture. RESULTS: Local anesthesia was given to 38.8% of patients, who had a mean age of 11.51 years, with a sex ratio of 2.4. The mean age of patients operated on with general anesthesia was 4.6 years. No complications were noted in the local anesthesia group. One operation was postponed because of lack of cooperation. In this group of operated patients, 62.5% had a cataract surgery, 16.7% a corneal laceration suture, and 10.0% mutilating surgery. COMMENTS: Because of our working conditions, local anesthesia, more than a choice, is almost obligatory. Our study shows that local anesthesia in children's ocular surgery has many advantages and few disadvantages. However, this study is limited because of a lack of information on the anesthesia and postoperative reactions. A prospective study based on a questionnaire completed by the anesthesiologist and the surgeon at the end of surgery will be necessary. CONCLUSION: Ocular surgery under local anesthesia is possible in children as young as 10 years of age. Good psychological preparation of the patient and the presence of the parents, from the consulting room to operating room, are required.

[Histopathological effects of neem products on larvae of Culex quinquefasciatus (Say, 1823) (Diptera: Culicidae)]. / Effets histopathologiques des produits du NEEM (Azadirachta indica, A. JUSS) sur les larves de Culex quinquefasciatus (Say, 1823) (Diptera: Culicidae).

INTRODUCTION: Histopathological studies relating to last instars larvae of mosquitoes treated with neem products are very few. The objective were to study the action of Neem products on larvae mosquitoes of Culex quinquefasciatus. MATERIALS AND METHODS: The neem products (Neemix, Formulated neem oil, Pure neem oil and Neem powder) are tested on 4 instars larvae of Culex quinquefasciatus. Moribund and witness larvae were fixed, for histopathologic study. RESULTS: The results showed the following facts: an intestinal epithelium, a bross border, a fat body and others tissues are normals at the level of the untreated larva; Fat body and muscle are not touched during the treatment of the larva with Pure neem oil; Intestinal epithelial cells slightly hypertrophied with beaches of lysis on the level of the larva treated with Neem powder; a lysis of the microvilli of brush border on the level of the witness-solvent; a destruction of the epithelial cells recorded in larva treated with a Neemix; a disappearance of the food column and a destruction of the epithelial cells remarked on the level of the larva treated with Formulated neem oil. CONCLUSION: The neem products used in this study have a Larvaecidal action on Culex quinquefasciatus larvae.

[The therapeutic itinerapy of epileptics admitted by the Electoencephalographic Laboratory at CHU Dakar]. / Itineraire thérapeutique des malades recus dans le laboratoire d'eeg du CHU de Fann.

In Senegal, as in other under developed countries, the delays before seeking medical treatment are long varying from 2 to 12 according to studies. This is related to the fact that in traditional African communities, prejudices and believes delayed medical management which is seeked after failure of traditionnal treatments. The objectives of this study concerning therapeutic itinerary of epileptics in the EEG laboratory at the Neurology Department at CHU in Dakar were to evaluate the average latency of medical consultation and to identify the recourse path by patients receiving antiepileptic treatment. We conducted from March to may 2001, a cross disciplinary study, with a sample size of 212 patients. 79.2% of patients were less than 30 years old. They first seek treatment in hospitals in 36.8%, traditional practionners in 35.8%, health centers in 23%, and private clinics in 4%. The average delay of treatment in modern structures was by 13.4 +/- 4.7 months. The towards the healers was linked to faulty beliefs in 61.8% of the cases, lack of information (22.4%), or a lack of financial means (2.6%). The patients were refeared to traditional healers in 6.7% of the cases for reasons of confidence in traditional medecine. The orientation to neurology clinic was recommended by health personal in 83% of the cases, family (14.6%), or the healer (1.4%). The long and difficult journey of epileptics in Senegal remains marked by exclusion, absence or delay of medical attention.

[Diffculties in medico-social management of tuberculosis in Pneumology Departement of Fann University Teaching Hospital]. / Difficultés dans la prise en charge médico-sociale de la tuberculose a la clinique de Pneumologie du CHU de Fann.

This prospective study included all the patients who, during the month of September 1995, were admitted for pulmonary baclliferous tuberculosis to the Pneumology Clinic of the Fann University Hospital, Dakar. The patient's escorts and the health personnel were also included in this study. The aim of the study was to find the different socio-economic and health factors impeding the hospitalization of tuberculosis patients in the Pneumology Clinic of Fann University Hospital. 22 members of the health team, 209 patients aged between 15 and 65 years and 209 escorts were interviewed. Out of the 10% of tuberculosis patients with HIV seropositivity, 80% admitted not to have informed their spouses of their infection. The decision to be admitted was made by the patient himself in 54.4% of cases and by his family in 45.5% of cases. Late admittance with regards to the beginning of symptoms was due to the recourse to traditional medicine in 43.7% of cases, wrong diagnosis in 24%, ignorance in 19.3% and, in 13% of cases, due to inappropiate anti tuberculosis treatment. Despite the fact that anti tuberculosis medicine was free of charge, each patient or his family spent an average sum of 87,500 CFA F (US dollar 175) for a month's admission (the minimal salary (SMIG) in Senegal is 32,000 CFA F (US dollar 64), and 40% of the patients and escorts had difficulties making this payment. 9 patients were judged to be poor by 25.7% of the patients and 8.7% found relations with the health personnel difficult. The escorts deplored the lack of toilets (only 1 out of 4 was functional), the time worn facilities, the overcrowding as well as the irregularity and poor quality of the hospital meals. The entire health team deplored the lack of adequate personnel and 30% of them deplored the lack of hygiene of some patients and escorts. Taking financial charge of tuberculosis patients at the Pneumology Clinic of the Fann University Hospital requires an increased financial effort from the State (rehabilitation of the facilities, recruitment of medical and paramedical personnel, improved meals) harmonisation on a national scale of anti tuberculosis therapeutic protocoles and an Information-Education-Communication (IEC) programme on tuberculosis and hygiene.

[Contribution to the study of the anti-inflammatory activity of Moringa oleifera (moringaceae)]. / Contribution a l'etude de l'activite anti-inflammatoire de moringa oleifera (moringaceae).

Moringa oleifera is a bush of African savannah, used in folk Medicine for the treatment of rheumatic and articulary pain. We have tested the anti-inflammatory action of an aqueous extract of root in rats with weight between 120 and 160 g. We administered per os either distilled water (control group), the aqueous root extract (750 mg/kg or 1000 mg/kg) or indomethacin (10 mg/kg) 30 min before an oedema was induced in the rat-paw by subcutaneous injection of carrageenin. The rat-paw volume was measured 1, 3 and 5 hours after injection of carrageenin. At a dose of 750 mg/kg the Moringa oleifera treatment significantly inhibited the development of oedema at 1, 3 and 5 hours (reduction by 53.5, 44.6 and 51.1% respectively). Increasing the dose of Moringa oleifera to 1000 mg/kg did not increase the inhibitory effect on oedema development at 1 and 3 hours, whereas this dose potentiated the oedema at 5 hours. Treatment with indomethacin significantly inhibited the development of oedema 1, 3 and 5 hours (49.1, 82.1 and 46.9% respectively). These findings indicate that an aqueous root extract of Moringa oleifera at 750 mg/kg reduces the carrageenin induced oedema to similar extent as the potent anti-inflammatory drug indomethacin. Moreover, these results provide further evidence that the roots of Moringa oleifera contain anti-inflammatory principle that may be useful in the treatment of the acute inflammatory conditions.

[Vascular parkinsonian syndrome in 21 case studies, two of which were anatomic]. / Syndromes parkinsoniens vasculaires à propos de 21 observations dont 2 cas anatomiques.

A clinicopathological study of parkinsonian syndrome witch occurred after stroke, is done by the authors. That is a retrospective study concerning 2 anatomic cases from 21 vascular parkinsonism. All the patients were admitted in the clinique neurologique de Fann from 1970 to 1990. They were 15 men and 6 women. Their age ranged between 45 to 75 years (mean 59.66). The 2 autopsied cases had lesions located in the thalamus as the superior part and a discreet cortical atrophy in the one case, and in the other case, we can see similar lesions in the right external capsule and in the inferior part of the putamen. Another lesion of haemorrhage infarct was located in the left temporal lobe. The locus niger was macroscopically normal in the 2 cases. Anatomical lesions observed have been localized in the putamen and in the external capsule in the associatical cerebral cortex in the second case and in the first one, lesions are located in the thalamus and in the cortex. These lesions were not well correlated with neurological signs. The different clinical aspects are discussed. From this study, it results that arterial damages associated with hypertension and atheromatosis might touch dopaminergic structures responsible of parkinsonism with sometime good sensitivity to levodopa.

[Hepato-protective effect of a plant from the Senegalese pharmacopoeia: Tinospora bakis (Menispermaceae)using and in vitro model]. / Etude de l'effet hepato-protecteur d'une plante de la pharmacopée sénégalaise: Tinospora bakis (Menispermaceae) à partir d'un modèle in vitro.

The aim of this study is to appreciate hepatoprotective properties of lyophilized aqueous extract of Tinospora bakis roots. We used hepatocytes isolated from rats and intoxicated by CCl4. Before and after intoxication cells were treated with different concentrations of Tinospora bakis extract. (1 mg to 4 mg/ml). Protection of cells was evaluated by the decrease of intracellular enzymes release (LDH and ASAT). The impact of time on the cytoprotection was also studied. From each rat we isolated 185.4 millions +/- 71.5 hepatocytes. The percent of ASAT and LDH release was significatively decreased when we compared treated and no treated hepatocytes suggesting cells protection. This cytoprotection is dose independent but is more effective for long course treatment. These results show the direct protection of isolated hepatocytes by Tinospora bakis extract.