Facteurs associés à l'hospitalisation prolongée et à la mortalité au niveau du service de néphrologie de l'hôpital Aristide Le Dantec de Dakar / Factors associated with prolonged hospitalization and mortality in the nephrology department of the Aristide Le Dantec hospital in Dakar

Introduction : L'hospitalisation en néphrologie n'avait pas fait l'objet de plusieurs études au Sénégal et les données sont limitées. Notre travail avait pour but de déterminer les facteurs associés à l'hospitalisation prolongée et à la mortalité en néphrologie. Patients et méthodes : Il s'agissait d'une étude observationnelle prospective de 5 mois incluant tous les patients hospitalisés dans le service durant au moins 24H. La durée d'hospitalisation (la période allant du jour d'admission dans la chambre d'hospitalisation au jour de sortie du patient) était dite prolongée si > 12 jours. Résultats : Quatre-vingt-dix-neuf patients ont été analysés durant cette période avec une durée moyenne en hospitalisation de 11,14 ± 9,89 jours. L'âge moyen était de 45,22 ± 18,03 ans avec un sex-ratio (H/F) de 0,62. Les anomalies biologiques étaient : l'hyponatrémie (62,36%), l'hypokaliémie (23,91%), l'hypocalcémie (25%), l'hyperphosphatémie (51,21%), l'anémie (92,30%), la CRP élevée (90,90%) et l'hypoalbuminémie (80,76%). La protéinurie moyenne était de 3,38 ± 3,35 g/24h avec 34,61% de protéinurie néphrotique. La mortalité hospitalière était de 25,25%. En analyse univariée, l'hospitalisation prolongée était associée à l'âge ≤ 45 ans (p = 0,018), aux patients non dialysés chroniques (p=0,034), à la transfusion sanguine (p=0,008) tandis que la mortalité était liée à l'âge de plus de 45 ans (p=0,032), le diabète (p=0,014), l'hypokaliémie (p=0,045) et l'hospitalisation prolongé (p=0,007). En analyse multivariée, les patients présentant des œdèmes et ceux ayant été transfusés avaient respectivement 2,89 et 3,9 fois plus de risque d'avoir une hospitalisation prolongée. Les patients diabétiques avaient 4,63 fois plus de risque de décès et ceux ayant été hospitalisés de plus de 12 jours avaient 0,14 fois de risque de décès. Conclusion : La durée d'hospitalisation était relativement prolongée avec une mortalité élevée. Cependant l'impact de certains facteurs a été démontré permettant ainsi de réduire la durée d'hospitalisation et le nombre de décès.

Introduction: Hospitalization in nephrology had not been the subject of several studies in Senegal and the data are limited. Our work aimed to determine the factors associated with prolonged hospitalization and mortality in nephrology. Patients and methods: This was a 5-month prospective observational study including all patients hospitalized in the department for at least 24 hours. The duration of hospitalization (the period from the day of admission to the hospital room to the day of the patient's discharge) was said to be prolonged if > 12 days. Results: Ninety-nine patients were analyzed during this period with an average hospital stay of 11.14 ± 9.89 days. The mean age was 45.22 ± 18.03 years with a sex ratio (M/F) of 0.62. The biological abnormalities were: hyponatremia (62.36%), hypokalemia (23.91%), hypocalcemia (25%), hyperphosphatemia (51.21%), anemia (92.30 %), elevated CRP (90.90%) and hypoalbuminemia (80.76%). The mean proteinuria was 3.38 ± 3.35 g/24h with 34.61% nephrotic proteinuria. Hospital mortality was 25.25%. In univariate analysis, prolonged hospitalization was associated with age ≤ 45 years (p = 0.018), chronic non-dialysis patients (p = 0.034), blood transfusion (p = 0.008) while mortality was related to age over 45 (p=0.032), diabetes (p=0.014), hypokalaemia (p=0.045) and prolonged hospitalization (p=0.007). In multivariate analysis, patients with edema and those who had been transfused were respectively 2.89 and 3.9 times more likely to have prolonged hospitalization. Diabetic patients had a 4.63 times greater risk of death and those who had been hospitalized for more than 12 days had a 0.14 times greater risk of death. Conclusion: The duration of hospitalization was relatively prolonged with high mortality. However, the impact of certain factors has been demonstrated, thus making it possible to reduce the duration of hospitalization and the number of deaths

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

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

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

Profil épidémiologique, clinique et radiologique de la tuberculose pulmonaire A microscopie positive (TPM+) au centre hospitalier régional universitaire de Saint-Louis (CHRU SL)

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

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1 patients in Fann Teaching Hospital in Dakar]. / Efficacité et tolérance de l'association ténofovir-lamivudine-éfavirenz chez les patients VIH-1 à la clinique des maladies infectieuses du CHNU de Fann à Dakar.

We conducted a study to evaluate the efficacy and tolerance of the tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving TDF-3TC-EFV combination between 2007 and 2011. Collected data was analysed using EpiInfo™ version 6.04. One hundred patients were included, with an average follow-up duration of 27 months and 19 days (± 21 months and 14 days).We observed an average increase in body weight of about 8 kg per annum, with an average rise in CD4 count of 100/mm(3) by the end of the second year. A reduction in viral load with 71% of patients in therapeutic success at 24 month of treatment was noted. Ninety-two patients presented with at least one side effect, mostly being Grade 1 or 2 (96.36%). Neurological (24 patients) and digestive (20 patients) complaints comprised the commonest reported side effects. Four patients had adverse effects severe enough to warrant a change in treatment regimen, principally due to renal insufficiency. Thirteen subjects died. Patients receiving TDF-3TC-EVF combination therapy need rigorous surveillance because this combination, although efficient, is not without significant adverse effects.

[Knowledge, behaviors and practices among ironworkers about tetanus in Senegal]. / Connaissances, attitudes et pratiques a propos du tétanos chez les ferronniers a Dakar, Sénégal.

Tetanus is still a major health problem in Sénégal. In order to understand some of these reasons, we conducted a study. The aim of this study is to assess ironworkers' knowledge, behaviors and practices about tetanus. This knowledge, behaviors and practices survey was carried out in ironworks of two neighborhoods of Dakar from April 5 to May 10, 2008. 41 ironworks were identified and 32 agreed to participate in the study. In this ironworks, 120 ironworkers were interviewed. Their average age was 29 years +/- 15, education in French schools was low and 78.3% of them had a source of information. Despite some inaccuracies, most ironworkers were aware of tetanus (97.5%), severity (93.3%), causes (89.2%). However 35% did not evaluate the risk of tetanus and almost all the ironworkers or 96.7% had no preventive measures after injury. Moreover, no ironworker was fully immunized against tetanus. In some occupations at risk, awareness of tetanus should be increased by all available channels and methods emphasizing the importance of prevention.

[Tolerance study of a triple first-line antiretroviral combination zidovudine, lamivudine and efavirenz in Dakar, Senegal]. / Etude de la tolérance d'une trithérapie antirétro- virale de première intention associant zidovudine, lamivudine et efavirenz à Dakar, Sénégal.

This study aimed at describing the side-effects reported in patients infected with HIV-1 treated initially by the association zidovudine, lamivudine and efavirenz between 2002 and 2007 in the Regional Centre of Clinical Research and Training in Dakar as part of the cohort of the Senegalese Initiative Access to Antiretroviral. Adverse effects were entered and analysed using the software Epi Info version 6.04. The average age of the patients was 38 years old. During the follow-up (average = 741 days), adverse effects were reported 75 times and 39 patients were concerned. The most frequent type of side-effects was neuropsychiatric (47%), digestive (20%) and dermatological (16%). They were severe in 13% of cases and severe anaemia was noted in eight cases. These required a change of therapy in 19%, mainly for severe anaemia (15%). The association zidovudine, lamivudine and efavirenz doesn't seem to induce severe side-effects. Nevertheless, considering the frequency of neuropsychiatric side-effects and severity of hematological side-effects, attention should be paid to neuropsychiatric and blood examination of patients undergoing this combination antiretroviral therapy.

[Nontyphoidal Salmonella bacteremia cases in AIDS patients in a Dakar University Hospital (Senegal)]. / Etude descriptive des bactériémies àSalmonella non typhi chez les patients infectés par le VIH au CHU de Dakar (Sénégal).

OBJECTIVES: This study had for aim to describe epidemiological, clinical and bacteriological aspects of nontyphoidal Salmonella bacteremia in patients with AIDS in the Dakar University Hospital Infectious Diseases Clinic. METHOD: This study was made on data recorded between 1January1996 and 31December2005. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Screening for strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Sixty-two cases of nontyphoidal Salmonella bacteremia were recorded in AIDS patients as follows: Salmonellaenteritidis bacteremia (32 cases), Salmonellatyphimurium bacteremia (11 cases), and Salmonella spp bacteremia (11 cases). The strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin plus clavulanic acid in at least 92% of the cases. Only 79% of them were susceptible to cotrimoxazole. The lethality rate was 55%. DISCUSSION: This lethality rate of nontyphoidal Salmonella bacteremia is high in AIDS patients. Therefore, the priority should be put on prevention and, in patients with AIDS, on food hygiene measures, antiretroviral treatment and efficient chemoprophylaxis. This should prove efficient to reduce incidence of nontyphoidal Salmonella bacteremia.

Prévalence et sensibilité aux antibiotiques de Neisseria gonorrhoeae chez les professionnelles du sexe et les patients IST au Niger

Le but de l'etude etait d'estimer la prevalence des infections a Neisseria gonorrhoeae et d'evaluer la sensibilite aux antibiotiques des souches; en vue d'une revision eventuelle du traitement par approche syndromique des ecoulements genitaux au Niger. De juillet a decembre 2007; un depistage systematique a ete effectue chez des professionnelles du sexe (PS) dans 5 localites; et des patients consultant pour IST a Niamey. Parallelement a l'examen microscopique apres coloration de Gram; les prelevements endocervicaux ou uretraux ont ete mis en culture sur gelose chocolat Polyvitex (bioMerieux); avec/sans inhibiteurs VCN; en atmosphere humide; sous 5-10CO2; pendant 1 a 2 jours. Les colonies suspectes sont identifiees sur galerie API NH (bioMerieux) et les antibiogrammes realises. Le gonocoque n'a ete isole que chez 0;68(5/739) des PS. Aucune souche n'a ete obtenue chez les 20 patientes IST; contre 2 chez les 9 cas d'uretrite masculine. Chacune des souches est resistante a au moins un des antibiotiques recommande par l'OMS dans l'approche syndromique. Cinq produisent une penicillinase et 2 une beta-lactamase a spectre elargi. Avec cette relative rarete des isolats et l'existence de resistance a au moins un des antibiotiques preconises; seule une surveillance microbiologique de routine permettra une collecte suffisante de souches pour avoir des donnees fiables necessaires a une revision de protocole

[Periodontal status and diabetes: evaluation of 80 patients with diabetes mellitus in Conakry Teaching Hospital]. / Evaluation de l'etat parodontal au cours au diabète : a propos de 80 patients au CHU Donka de Conakry.

INTRODUCTION: Dental and periodontal diseases are frequent in diabetics. Few studies were carried out on oral pathologies of the diabetics in Africa. The objective of this study was to assess periodontal conditions in a population of diabetics followed in a hospital environment by comparing them with non diabetics. PATIENTS AND METHOD: In a cross-sectional study realized from January to April 1999, 80 diabetic patients followed in the Service of Endocrinology were compared to 35 non-diabetic patients, chosen among the patients attending in the Service of Internal medicine of the Donka Teaching Hospital in Conakry in the same period. Both groups were compared according to the simplified oral hygiene index (OHIS) and community periodontal index of treatment needs (CPITN). RESULTS: There was no difference between diabetics and nondiabetics according to the OHIS. Diabetics CPITN index was higher compared to non-diabetics (p = 0.019). In diabetics, scores of CPITN increase significantly with duration of diabetes mellitus (p = 0.019). Also correlation was found between OHIS and the duration of diabetes. Glycemic control was significantly correlated with OHIS (p < 0.001) and CIPTN (p < 0.001). CONCLUSION: Diabetic patients have more periodontal treatment need than controls. Better collaboration between diabetologist and odontostomatologist is needed to preserve the oral health of diabetics.

Low malaria morbidity in a cohort of Senegalese children with free access to health structures.

We report the impact of the free access to health facilities on malaria morbidity in children from two to 15 years old, during a malaria transmission season in Niakhar, Senegal. Between July and December 2002, 227 malaria attacks occured in 566 children. Only one case of severe malaria was observed and no death has been reported. Our results demonstrate furthermore that easier access to health facilities and to early treatment is playing a key role in malaria control.

CCR5 receptor expression is down-regulated in HIV type 2 infection: implication for viral control and protection.

HIV-2 is known to display an attenuated phenotype in vivo with prolonged time to disease and decreased rate of transmission. Observational studies in Senegal have demonstrated protection from HIV-1 infection, although the putative mechanism for immunoprotection remains undefined. We evaluated HIV-2-seropositive women from a cohort of commercial sex workers in Dakar, Senegal and identified individuals with very low surface CCR5 receptor expression on CD4+ T cells. In vitro up-regulation of the CCR5 receptor was readily achieved. Down-regulation of the CCR5 was not correlated with activation markers (HLA-DR), beta-chemokine levels, or plasma viral loads. A correlation was observed with HIV-2-specific CD8+ T cell activity as measured by intracellular cytokine production. We postulate that down-regulation of the CCR5 receptor in HIV-2 infection contributes to slower disease course and to the protective mechanism against HIV-1 superinfection, mediated in part by HIV-2-specific cellular immune responses.

Effect of dwarf (dw) and frizzle (F) genes on the performance of layers under Senegalese conditions.

The influence of sex-linked dwarf (dw) and incompletely dominant frizzle (F) genes on growth, egg production and quality were investigated. The experimental stock comprised 100 chicks of four genotypes: normal feathered, normal size (ffDw): normal feathered, dwarf (ffdw); frizzle, normal size (FfDw); and frizzle, dwarf (Ffdw). The dwarf gene reduced the body weight, shank length, feed intake, egg production and egg weight. The frizzle gene also reduced most of these traits, except for egg production, the interaction between the two genes being positive only for growth traits and egg number. Neither of the two genes significantly influenced egg quality. It was concluded that the dwarf gene may have some practical interest in tropical environments, while more needs to be known about the frizzle gene.

Clinical investigation of a population recently infected with Schistosoma mansoni (Richard-Toll, Senegal).

Following the introduction of large-scale irrigation, an exceptional epidemic of intestinal schistosomiasis occurred in northern Senegal when a non-immune population was exposed to massive infection. Subjects infected with Schistosoma mansoni were followed up parasitologically and clinically from the onset of the epidemic. After the initial evaluation, patients received a health education session and were treated with praziquantel in a dose of 30 mg/kg. One year after this treatment, S. mansoni eggs were found in the stools of 227/301 subjects (75%). Twenty-three per cent of subjects excreted > 400 eggs per gram (e.p.g.) and 11% excreted > 1000 e.p.g. of faeces. Overall, the geometric mean was 191 e.p.g. of faeces in infected individuals. The prevalence of diarrhoea was reduced from 55 to 29%, the prevalence of bloody diarrhoea from 44 to 11% and the prevalence of abdominal discomfort from 66 to 41%. No hepatomegaly was found in these patients either before or one year after treatment. Splenomegaly was reduced from 30% (measured by ultrasound) to 3% (on clinical examination). Morbidity associated with S. mansoni infection was considerably reduced one year after treatment with praziquantel (30 mg/kg).

[Epizootics of pasteurellosis in a semi-intensive breeding farm of indigenous rabbits in Senegal]. / Epizootie de pasteurellose dans un élevage semi-intensif de lapins de race locale au Sénégal.

Epizootic pasteurellosis appeared in a semi-intensive breeding farm (200 animals) of indigenous rabbits in Thiès (ENSA), Senegal, during the 1995 wet season (August to October). It provoked death in 87 animals. Young animals were particularly sensitive to the disease. Nasal discharge, conjunctivitis, eye loss and otitis media and interna were observed in young rabbits while posterior paresis was noted in mature rabbits. Pasteurella multocida, Klebsiella pneumoniae and Pseudomonas aerogenes were identified. An antibiogram revealed the germs were sensitive to chloramphenicol, sulfamethoxazole/trimethoprim and colistin. High temperatures and humidity during the wet season may have contributed to the outbreak of the disease from healthy carriers introduced at the founding of the farm. Colistin and chloramphenicol treatments were administered before vaccinating all rabbits against pasteurellosis.

Preliminary study of urinary schistosomiasis in a village in the delta of the Senegal river basin, Senegal.

Three years after the first cases of urinary schistosomiasis infection were reported in the village of Mbodiene, Senegal, Schistosoma haematobium eggs were found in 87% of the inhabitants of this village; 30% were heavily infected (> 50 eggs per 10 mL urine). The prevalence of infection was very high in all age groups, but children showed more intense infections. No difference between sexes was found. In the special situation of a very high prevalence, test strips for proteinuria and haematuria are not very useful for the individual diagnosis of S. haematobium infection. Six and 12 weeks after treatment with a single dose of praziquantel (40 mg/kg), S. haematobium eggs were found in 25% and 30% of the treated subjects, respectively. Bulinus globosus was identified as intermediate host, but other snail vectors may also play a role. S. mansoni eggs were found in 1% of the population. Both S. haematobium and S. mansoni are spreading in the delta of the Senegal river.