Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

The potential for quality assurance systems to save costs and lives: the case of early infant diagnosis of HIV.

OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.

OBJECTIFS: L'intensification du dépistage au point des soins (DPS) pour le diagnostic précoce du VIH chez le nourrisson (DPVN) pourrait réduire le grand écart dans le dépistage des nourrissons. Cependant, un DPVN DPS sous-optimal pourrait avoir un impact limité et des coûts évitables potentiellement élevés. Cette étude modélise la rentabilité d'un système d'assurance qualité pour traiter les performances des tests et les interruptions de dépistage, dues par exemple à des ruptures de stock, au Kenya, au Sénégal, en Afrique du Sud, en Ouganda et au Zimbabwe, avec des épidémies variables du VIH et des systèmes de santé différents. MÉTHODES: Nous avons modélisé une qualité de DPVN soulevée par le système d'assurance qualité à partir de niveaux sous-optimaux: c'est-à-dire des taux d'erreurs de diagnostic de 5%, 10% et 20% et des interruptions des tests de DPVN en mois, à des performances optimales ininterrompues (sensibilité de 98,5%, spécificité de 99,9%). Pour chaque pays, nous avons estimé l'impact sur un an et la rentabilité (en USD/DALY évitée) de scénarios améliorés pour éviter les infections à VIH manquées et les coûts inutiles de traitement du VIH pour les diagnostics faux positifs. RÉSULTATS: Les coûts modélisés sur un an d'un système national d'assurance qualité DPS vont de 69.359 USD en Afrique du Sud à 334.341 USD au Zimbabwe. Au niveau des pays, les systèmes d'assurance de la qualité pourraient potentiellement éviter entre 36 et 711 infections manquées (c'est-à-dire des faux négatifs) par an et des coûts de traitement inutiles entre 5.808 et 739.030 USD. CONCLUSIONS: Le modèle estime que l'ajout de systèmes d'assurance qualité efficaces permet de réaliser des économies dans quatre des cinq pays au cours de la première année. Le lancement de l'assurance qualité nécessite un investissement initial, mais fournira un retour sur investissement positif dans les cinq ans en évitant les coûts des diagnostics erronés et serait encore plus efficace s'il était mis en œuvre dans plusieurs applications de DPS.

[Dermatofibrosarcoma protuberans of the face: Long term patient of a follow up].

We report the case of a patient 40 years old affected by a facial tumour diagnosed as a dermatofibrosarcoma protu­berans. He has been followed in our clinic for the last 22 years. He got a recurrency after 11 years and after an other surgery he his actually free of disease. The purpose of this article is to evaluate the tumoral recurrency and the long term follow up.

[Post operative Caldwell-Luc procedure maxillary cyst: Report of a case]. / Syndrome post Caldwell Luc: à propos d'un cas.

Rare complication of radical surgery (Caldwell Luc procedure) of the maxillary sinus, maxillary cyst can occurred several years after. We describe the case of a patient 56 years old, who came to our consultationfor repeated pain in the right maxillary region with moderate facial asymmetry. In her history we noted a previous sinus surgery (Caldwell Luc) more than 10 years before. The imaging showed an expansive process filled with proteinic tissue of the posterior wall of the maxillary. With the history of the former surgery, we suspected the existence of a mucocele. She underwent an endonasal surgery and the pathological examination of the specimen revealed an intra osseous cyst lined with ciliated respiratory type mucosa post surgery of the maxillary sinus. The diagnosis of a maxillary cyst complicating a Caldwell Luc was established based on the results obtained with the clinico-radiological and pathological results.

[Venous thrombosis and bilateral arterial occlusion of lower limb revealing HIV infection]. / Thrombose veineuse et occlusion artérielle bilatérale des membres inférieurs révélant une infection par le VIH.

Human immunodeficiency virus (HIV) infection can cause vascular complications. This is most often of lower limb venous thrombosis. Rare cases of limb ischemia indicative of HIV infection have been described.We report a case of venous thrombosis of the left lower limb and bilateral lower arterial ischemia revealing an HIV infection in a patient of 44 years. The CD4 count was 195/mm(3). Investigations on coagulation were not realized. The patient was amputated both his legs.

Rapidly rising cases with Omicron in Senegal.

•Omicron variant continues to progress in Senegal with the appearance of new contaminations.•IRESSEF detected the first positive case of the Omicron variant on Friday, December 3, 2021.•Since this date, the number of Omicron variant infections has increased over the weeks.•Molecular surveillance of the Omicron variant is carried out in real time to inform the medical authorities.

[Portal cavernoma at child about two observations]. / Cavernome portal chez l'enfant a propos de deux observations.

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Nous rapportons deux observations de cavernome portal diagnostiqué successivement à Bamako et à Dakar. Le premier est un enfant de 6 ans de sexe masculin admis dans le service pour ascite et douleurs abdominales. L'examen clinique notait une pâleur cutanéo-muqueuse modérée, une asthénie. Le bilan biologique retrouvait une anémie modérée normochrome normocytaire avec une fonction pancréatique perturbée tandis que les fonctions rénales et hépatiques étaient conservées. Le scanner abdominal réalisé après deux échographies abdominales peu contributives, objectivait des signes en faveur d'un cavernome portal avec varice péri-splénique et gastrique. Le second est un enfant de 8 ans de sexe masculin né d'un mariage non consanguin et issu d'une grossesse suivie avec accouchement prématuré. Il est le 3e enfant de sa fratrie et scolarisé. On retrouve dans ses antécédents pathologiques une notion de prématurité ayant nécessitée un séjour en néonatologie avec cathétérisme ombilical et des douleurs abdominales à répétition. L'enfant a commencé à se plaindre de douleurs abdominales récurrentes vers l'âge de 6 ans. Douleurs de siège péri ombilical sans réveil nocturne dans un contexte de constipation chronique d'allure fonctionnelle. Il a fait un épisode abdominal aigu justifiant une hospitalisation en chirurgie pour suspicion d'appendicite. A l'admission les paramètres cliniques (poids, taille, température, périmètre crânien et température) étaient dans les normes pour l'âge. L'échographie abdominale prescrite à cet effet était évocatrice de cavernome porte, confirmé par la suite par la tomodensitométrie abdominale.

Obstructive sleep apnoea and perioperative complications in bariatric patients.

BACKGROUND: The objective of this study was to determine the relationship between perioperative complications and the severity of obstructive sleep apnoea (OSA) in patients undergoing bariatric surgery who had undergone preoperative polysomnography (PSG). METHODS: The records of 797 patients, age >18 yr, who underwent bariatric operations (442 open and 355 laparoscopic procedures) at Mayo Clinic and were assessed before operation by PSG, were reviewed retrospectively. OSA was quantified using the apnoea-hypopnoea index (AHI) as none (≤ 4), mild (5-15), moderate (16-30), and severe (≥ 31). Pulmonary, surgical, and 'other' complications within the first 30 postoperative days were analysed according to OSA severity. Logistic regression was used to assess the multivariable association of OSA, age, sex, BMI, and surgical approach with postoperative complications. RESULTS: Most patients with OSA (93%) received perioperative positive airway pressure therapy, and all patients were closely monitored after operation with pulse oximetry on either regular nursing floors or in intensive or intermediate care units. At least one postoperative complication occurred in 259 patients (33%). In a multivariable model, the overall complication rate was increased with open procedures compared with laparoscopic. In addition, increased BMI and age were associated with increased likelihood of pulmonary and other complications. Complication rates were not associated with OSA severity. CONCLUSIONS: In obese patients evaluated before operation by PSG before bariatric surgery and managed accordingly, the severity of OSA, as assessed by the AHI, was not associated with the rate of perioperative complications. These results cannot determine whether unrecognized and untreated OSA increases risk.

[Prevalence of halitosis in patients with dental prostheses in Senegal]. / Prevalence de l'halitose chez des patients sénégalais porteurs de prothèses dentaires.

INTRODUCTION: Bad breath is a disease affecting 25% of the world's population. Despite the widespread nature of this problem, people's knowledge about this condition is poor. OBJECTIVE: The purpose of this study was to determine the prevalence of halitosis in a cohort of 62 Senegalese subjects with dental prostheses. METHODS: Breath analysis was based on measurement of volatile sulfur compounds (VSC) using a halimeter. Halitosis was diagnosed ifVSC level was > or = 125 ppb. RESULTS: Mean VSC level was 157.7 +/- 152.6 ppb. The prevalence of halitosis was of 35.4% overall, 72.7% in persons with fixed dentures and of 27.3% in persons with removable prostheses. CONCLUSION: The relatively high prevalence of halitosis observed in this study indicates a need to enhance patient awareness of daily hygiene measures for dental prosthesis.

[Epidemiological, clinical and ultrasonographic aspects of right-sided infective endocarditis in Senegal: 6 cases]. / Aspects epidémiologiques, cliniques et echographiques des endocardites infectieuses du coeur droit au Sénégal: 6 observations.

Right-sided infective endocarditis accounts for 5 to 10% of endocarditic involvement and usually affects the tricuspid valve. The purpose of this report is to describe epidemiological, clinical and echocardiographical aspects of 6 cases of right-sided infective endocarditis observed in the Cardiology Department of Aristide Le Dantec Hospital in Dakar, Senegal from December 2007 to February 2010. Diagnosis was based on Duke's modified criteria. There were 3 men and 3 women with a mean age of 28.2 years (range: 20 and 43). Five of the 6 patients presented tricuspid endocarditis including one case associated with pulmonary endocarditis. In another case, pulmonary endocarditis was associated with aortic endocarditis. Infective endocarditis was acute in three cases and primary in four. One case of infective endocarditis was observed in a tetralogy of Fallot. Fever was present in 4 cases with an mean temperature of 38.4 degrees C (range, 37.2 to 40 degrees C) and heart failure was present in 5 cases. In 2 patients, blood cultures were positive for Staphylococcus aureus. All patients had leucocytosis with a neutrophilic predominance. Doppler echocardiography depicted vegetations in all cases. Contributing factors included congenital heart disease in 1 case, insertion of a venous catheter in 2 and dental infection in 2. No patient was addicted to intravenous drugs or infected by HIV. Outcomes included one in-hospital death with signs of refractory heart failure. Right-sided endocarditis is often primary and is dominated by the tricuspid involvement. It affects both sexes. Contributing factors include venous catheterization during the postpartum period and dental infection. Prevention requires strict asepsis during venous catheter insertion, treatment of dental infections and improved management of congenital heart disease.

Taxonogenomics description of Bacillus marasmi sp. nov., a new species isolated from the stool sample.

Using the culturomics method, two strains were isolated, identified, and characterised following the taxonogenomics concept. Bacillus marasmi sp. nov. strain Marseille-P3556 (= CSURP3556) is isolated from a 13-month-old girl living in Niger. The phylogenetic tree, phenotypic criteria, and genomic analysis described here clearly show that this bacterium is different from previously known bacterial species withstanding in nomenclature and new members of Bacillus genus.

Taxonogenomics description of Bacillus dakarensis sp. nov., Bacillus sinesaloumensis sp. nov. and Bacillus massiliogabonensis sp. nov., three new species isolated from human stools.

Using microbial culturomics, three Bacillus strains were isolated, identified and characterized following the taxonogenomics strategy. Bacillus dakarensis strain Marseille-P3515T (=CSURP3515), Bacillus sinesaloumensis strain Marseille-P3516T (=CSURP3516), and Bacillus massiliogabonensis strain Marseille-P2639T (=CSURP2639) were isolated from human stool samples. The phylogenetic analysis, phenotypic characteristics and genotypic data presented here prove that these three bacteria are different from previously known bacterial species with standing in nomenclature and represent new Bacillus species.

SiO2 thin film growth through a pure atomic layer deposition technique at room temperature.

In this study, less contaminated and porous SiO2 films were grown via ALD at room temperature. In addition to the well-known catalytic effect of ammonia, the self-limitation of the reaction was demonstrated by tuning the exposure of SiCl4, NH3 and H2O. This pure ALD approach generated porous oxide layers with very low chloride contamination in films. This optimized RT-ALD process could be applied to a wide range of substrates that need to be 3D-coated, similar to mesoporous structured membranes.

Halobacillus ihumii sp. nov., a new bacterium isolated from stool of healthy children living in Mali.

Strain Marseille-Q1234T is a new species from the genus Halobacillus that was isolated in 2019 from a stool sample in a healthy Malian child <5 years old. Cells are Gram-positive and strictly halophilic bacilli. Strain Marseille-Q1234T exhibits 98.46% 16S rRNA gene sequence similarity to Halobacillus naozhouensis strain JSM 071068T (NR_116505.1), the phylogenetically closely related species with standing in nomenclature. Based on the phenotypic and phylogenetic evidence, OrthoANI values and results of the biochemical tests, the new species is named Halobacillus ihumii sp. nov., for which strain Marseille-Q1234T (= CSURQ1234) is proposed as the type strain.

Virgibacillus ihumii sp. nov., a new bacterium isolated from the stool of healthy African children.

During a case-control study on severe acute malnutrition, strain Marseille-Q1233 was isolated. It is a Gram-positive, rod-shaped and halophilic bacillus isolated from a stool sample of Malian child under the age of 5. The fatty acid profile of the strain consisted of C15:0-anteiso and C14:0-iso as major components. Digital DNA-DNA hybridization and average nucleotide identity calculation showed 23.10% and 80.81% similarity respectively between strain Marseille-Q1233 and Virgibacillus siamensis strain Marseille-P2607, the phylogenetically closely related species with standing in nomenclature. On the basis of these results, we report the description of Virgibacillus ihumii sp. nov. strain Marseille-Q1233 as a new bacterial species.

[Measurement of intra-oral pressure as a contributor for the understanding of pneumophonic coordination impairment in Parkinsonian dysarthria]. / Contribution de la mesure de la pression intra-orale pour la compréhension des troubles de la coordination pneumophonique dans la dysarthrie parkinsonienne.

INTRODUCTION: Parkinsonian dysarthria can alter oral communication of the patients in the long-term. Subthalamic nucleus (STN) stimulation represents an interesting therapeutic option, although it does not seem to improve axial signs, of which dysarthric speech. The objective of our study was to contribute to the evaluation of STN stimulation effects on speech impairment and in particular on pneumophonic coordination: this latter parameter can be assessed indirectly by evaluating the temporal progression of the intraoral pressure (IOP) during the expiratory phase; thus, IOP represents the transient expression of subglottal pressure (SGP). PATIENTS AND METHOD: Using a dedicated system (EVA2), 20 parkinsonian patients were recorded in ON and OFF STN stimulation conditions in order to evaluate IOP on three measurement points (2nd, 4th and 6th consonants P) during realization of the sentence "Papa ne m'a pas parlé de beau-papa" ("Daddy did not speak to me about daddy-in-law") which corresponds to a breath group. Eleven control subjects were recorded in parallel in order to define reference measurements. RESULTS: STN stimulation improved significantly IOP at the level of the initial measurement points (2nd P and 4th P), with an effect of convergence at the level of the third point (6th P) where the difference between OFF and ON STIM conditions was not significant any more. In addition, the performance of the patients ON STIM remained much lower than that of the control subjects. CONCLUSION: Our results raise the significant concept that IOP measurement can be regarded as a relevant indicator for dysarthria in Parkinson's disease. They also show that the improvement of pneumophonic coordination by STN stimulation is restricted to the initial period of the expiratory phase, confirming again the mitigated and controversial effect of STN stimulation on axial signs.

Acute circulatory failure in two cardiology departments in Dakar: 44 cases.

INTRODUCTION: Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar. METHODS: This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients. RESULTS: Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance. CONCLUSIONS: Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.