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).

What is the nutritional status of your patients suffering from strokes.

Strokes can significantly affect the autonomy and the ability of the patient to feed properly. Malnutrition after strokes increases the length of stay in hospital, increases mortality and aggravates disability. Nutritional support is a therapeutic that can be useful in the management of strokes and during the rehabilitation period. It may help to reduce the occurrence of complications due to the physical dependence associated with this condition. The objective of our study was to evaluate, through a questionnaire, the opinion of prescribing doctors working in the Department of Neurology of The FANN National Teaching Hospital in Dakar. The interest of the question resides in the fact that the Center does not have a dedicated nutritionist for inpatients. This was an opinion poll about their concerns about the nutritional status of patients in the therapeutic projects they propose during the stroke. The type of the chosen opinion poll was elementary, type random. The questionnaire was individual and consisted of five items of single-response and multiple-choice questions. The results of this study reveal that while the nutritional status of patients with limited autonomy in the service was a concern in the intentions of the prescribers, in practice it was not taken into account in therapeutic projects. To date, no structured protocol is available in cases of proven nutritional deterioration in patients. Nutritional management must be integrated into the overall management of Neurology patients, particularly in elderly victims of strokes.

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

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

[Tuberculosis in the elderly: Epidemiology and outcomes of ambulatory followed-up in Abidjan]. / La tuberculose du sujet âgé : épidémiologie et devenir des patients suivis en ambulatoire à Abidjan.

BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.

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

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

[Passive correction of an anterior open bite related to non-nutritive sucking habits: report of a case]. / Correction passive de l'infraclusion antérieure associée une Habitude de Succion Non-Alimentaire (HSNA): rapport de cas.

The term anterior open bite refers to a vertical space between the upper and lower front teeth in maximum intercuspation. This malocclusal trait can accompany many malocclusions of the Angle's classification. Two types of anterior open bite have been described: skeletal and dental open bite. The latter may have Non Nutritive Sucking Habits (NNSH) as causal factor and is deemed to aggravate without treatment. This article presents an interceptive approach based on the use of a fixed passive appliance interfering with sucking habit. It consists of a crib soldered to bands adjusted to the maxillary first permanent or temporary second molars. The device was globally well accepted by the patient and has been effective in breaking the sucking habit and subsequently in closing the bite after only 5 month. When psychological approach is not effective, a fixed deterrent device may be recommended for weaning children off nonnutritive sucking habits.

[Meningoencephalitis due to Morganella morganii: a case report]. / Méningoencéphalite à Morganella morganii : à propos d'un cas.

A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.

[Prevalence Of Periodontal Recessions In The Odontology Department Of The Bamako Hospital Infirmery (Ihb)]. / Prevalence Des Recessions Parodontales Dans Le Service D'Odontologie De L'Infirmerie Hopital De Bamako (Ihb).

Periodontal or gingival recession is the term used to characterize the apical displacement of the marginal gingiva on the surface of the root beyond the enamel junction. THE OBJECTIVE: of this study was to determine the prevalence of periodontal recession in the Dentistry Department of the Bamako Hospital Infirmary. METHOD: This study was carried out in the dentistry department of the Bamako Hospital Infirmary over a 3-month period from January 15 to April 15, 2020. The inclusion criteria concerned patients who came for consultation in the department. A survey sheet comprising socio-demographic and clinical variables was developed for this purpose. RESULTS: The prevalence of periodontal recession was 23.64%. Men were the most represented with 63.9%. Oral hygiene was fair with 42.62%, 36% of periodontal recessions were shallow and narrow. Miller's Class I and Class II recession types were the most represented with 41%. The incisors were the most affected with a rate of 29.64%. At the community level, adequate awareness and education in maintaining oral hygiene should prove successful in the long term.

La récession parodontale ou gingivale est le terme utilisé pour caractériser le déplacement apical de la gencive marginale à la surface de la racine au-delà de la jonction amelocementaire. L'OBJECTIF: de cette étude était de déterminer la prévalence de la récession parodontale dans le service d'Odontologie de l'Infirmerie Hôpital de Bamako. MÉTHODE: Cette étude a été réalisée dans le service d'odontologie de l'Infirmerie Hôpital de Bamako sur une période de 3 mois du 15 janvier au 15 Avril 2020. Les critères d'inclusion concernaient les patients venus en consultation dans le service. Une fiche d'enquête comportant les variables sociodémographiques et les variables cliniques a été élaborée à cet effet. RÉSULTAT: La prévalence de la récession parodontale était de 23,64%. Les hommes étaient les plus représentés avec 63,9%. L'hygiène bucco-dentaire était passable dans 42,62% des cas et 36% des récessions parodontales étaient peu profondes et étroites. Les types de récession de classe I et II de Miller étaient les plus représentés avec 41%. Les incisives étaient les plus touchées avec un taux de 29,64%. Au niveau communautaire une sensibilisation et une éducation adéquate en matière de maintien de l'hygiène buccale s'avère bénéfique à long terme.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]. / Myélopathie aiguë transverse après injection de benzathine-benzyl pénicilline: une observation à Dakar (Sénégal).

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[A prospective longitudinal study of coma in the intensive care unit in an African setting: case of Dakar, Senegal]. / Etude longitudinale prospective des comas en milieu neurologique africain: expérience de Dakar, Sénégal.

Little is known on coma in neurological intensive care unit (NICU) in the setting of developing country in Sub-Saharan Africa. The aim of this study was to determine the morbi-mortality and survival of coma in the NICU of Dakar, Senegal. We carried out a prospective longitudinal study in the NICU of the teaching hospital of Fann in Dakar during a period of 15 months (with 12 months of inclusion) on comatose patients. Were included all patients presenting with a Glasgow score inferior to 9. Standard biological analyses were prescribed for each patient while CT scan was performed if indicated. Daily evaluation was done and complications recorded. Each patient was followed for at least 3 months. Survival was determined by the Kaplan Meier method. 345 patients were admitted in the NICU and 169 were included (48,99 %). The mean age of the patients was 58.04 +/- 17.55 years with a sex ration of 0.92. The mean time from installation of disorders and initial consultation was 47.30 +/- 138.34 hours. Etiologies were vascular disease (71 %), status epilepticus (9.47 %), meningoencephalitis (8.88 %) and metabolic disorders (8.88 %). The mean duration of hospitalization was 8.89 +/- 9.53 days associated with a mortality rate of 82.25 % for the same period. Survival at day 90 was 10.65 %. Mortality was related to infectious condition (28.4 %), renal failure (14.78 %), cardiovascular failure (13.61 %), cerebral engagement (12.43 %), multivisceral failure (11.24 %), pulmonary embolism (1.18 %) and unknown cause (18.34 %). In conclusion, coma is associated with a high mortality rate in our context and suggests that early consultation, a good control of vascular risk factors and better management of infectious condition should reduce this impact.

Bruxisme et réhabilitation prothétique fixée: à propos d'un cas au CHU-CNOS de Bamako / Bruxism and fixed prosthetic rehabilitation: about a case at the CHU-CNOS of Bamako

Les effets de l'occlusion dentaire sur le système postural suscitent un grand intérêt notamment dans les domaines de la médecine dentaire, de la neurologie et de la médecine du sommeil. On distingue le bruxisme primaire qui survient en l'absence de pathologie organique ou secondaire, lié à une cause connue. Le bruxisme peut créer des symptômes liés à une surcharge de l'appareil manducateur, avec notamment une dégradation dentaire plus ou moins avancée, des douleurs de l'articulation temporo-mandibulaire, une modification physique (square face, perte de la DVO), des troubles alimentaires etc. Le traitement peut avoir plusieurs objectifs, interceptif (gouttière de désocclusion, kinésithérapie, thérapies pharmacologiques et les approches cognitivo-comportementales) pour limiter les effets destructeurs du bruxisme et où par réhabilitation prothétique dans les cas où la perte tissulaire devient importante au niveau dentaire. Le but de cet article est de rapporter un cas clinique d'une patiente avec une perte importante de tissus dentaires suite au bruxisme chez qui un appareillage prothétique a été réalisé

The effects of dental occlusion on the postural system arouse great interest especially in the fields of dentistry, neurology and sleep medicine. A primary bruxism occurs without any underlying organic cause while a secondary bruxism is linked to a known cause. Bruxism results in symptoms related to an overload of the masticatory apparatus, namely an advanced dental deterioration, pain in the temporomandibular joint, a physical change (square face, loss of vertical dimension of occlusion), and eating disorders, etc… the interceptive treatment may include opening gutter, physiotherapy, pharmacological therapies and cognitive-behavioral approaches with different objectives. . It allows to limit the destructive effects of bruxism. Prosthetic rehabilitation is required when the loss of tissue becomes important at the dental level. Here is a case report of a 47-year-old male patient with a bruxism related significant loss of dental tissue treated with a prosthetic device. Keywords: bruxism; occlusion, prosthetic device.

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

[Survival of comatose stroke victims in a neurological department in Dakar]. / Survie des accidents vasculaires cérébraux comateux à Dakar (Sénégal).

BACKGROUND: In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal. METHODS: This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded. RESULTS: A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9). CONCLUSION: Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.

[Epilepsy in a cohort of Senegalese children]. / Epilepsie dans le contexte neuropédiatrique sénégalais.

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Prognosis of intracerebral hemorrhage with coma in a neurological critical care unit in the tropics]. / Pronostic des hémorragies intracérébrales avec coma dans une unité de neuroréanimation tropicale.

Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

[Vascular aphasias: clinical, epidemiologicaland evolutionary aspects]. / Aphasies vasculaires: aspects cliniques, epidemiologiques et evolutifs.

INTRODUCTION: Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias. MATERIALS AND METHODS: We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year. RESULTS: 55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis. CONCLUSION: Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.

[Epidemiology of stroke at the Clinic of Neurology, Fann University Teaching Hospital, Dakar-Senegal]. / Epidémiologie des accidents vasculaires cérébraux (AVC) à la clinique neurologique du CHU de Fann, Dakar-Sénégal.

OBJECTIVE: Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal. METHODOLOGY: Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done. RESULTS: The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%. CONCLUSION: It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des maladies thyroïdiennes à Bouaké (Côte d'Ivoire) / Epidemiological, clinical, therapeutic and evolutionary aspects of thyroid deseases in Bouake (Ivory Coast)

Contexte : la maladie thyroïdienne représente la plus fréquente endocrinopathie dans le monde après le diabète sucré. En Afrique, elle constitue un véritable problème de santé publique et sa prise en charge est souvent entravée par les moyens d'investigations. Le but était d'étudier le profil des affections thyroïdiennes à Bouaké. Méthodes : il s'agissait d'une étude rétrospective, descriptive, menée dans le service de consultation de Médecine Interne du Centre Hospitalier Universitaire de Bouaké du 1er janvier 2020 au 31 décembre 2021. Elle a porté sur les dossiers de 104 patients suivis pour une pathologie thyroïdienne. Résultats : Sur 2560 patients reçus, la pathologie thyroïdienne concernait 104 patients ; soit une fréquence de 4,1%. Il s'agissait de 93 femmes et 11 hommes avec un sex-ratio (H/F) de 0,12 L'âge moyen était de 42,03 ans ±15 ans. Dans plus de la moitié des cas (55,8%), le délai de consultation était supérieur à 06 mois. Sur le plan fonctionnel, 58 patients (55,8%) présentaient une hyperthyroïdie avec comme principales étiologies la maladie de Basedow (60,3%, n=35) et le goitre multinodulaire toxique (24,1%, n=14). L'hypothyroïdie était retrouvée chez 10 patients (9,6%), le plus souvent post thyroïdectomie (60%). Les goitres et nodules euthyroïdiens étaient retrouvés chez 36 patients (34,6%) dominés par le goitre multinodulaire euthyroïdien (36,1%, n=13) et le goitre simple (27,8%, n=10). Le traitement des hyperthyroïdies reposait essentiellement sur les antithyroïdiens de synthèse dans 96,7%. Seulement 1 patient hyperthyroïdien avait subi une thyroïdectomie. La majorité des patients (82,2%) étaient perdus de vue. Conclusion : La pathologie thyroïdienne au CHU de Bouaké est une maladie fréquente de la femme jeune. Les hyperthyroïdies dominent le tableau des thyréopathies avec comme principale étiologie la maladie de Basedow. On note un taux élevé de perdu de vue, d'où l'intérêt d'une éducation de nos patients.

Context: Thyroid disease is the most common endocrinopathy observed in the world. In Africa, thyroid diseases remain a real public health problem and their care is often hampered by the means of investigation. The purpose of this work was to study the profile of thyroid affections in Bouake. Methods: This was a descriptive study with retrospective data collection, carried out over the period from 1 January 2020 to 31 December 2021 at the Internal Medicine consultation at the University Hospital of Bouake. All epidemiological, clinical and therapeutic and evolutionary data from patients followed for thyroid pathology were collected. It focused on the records of 104 patients followed for thyroid disease. Results: Out of a total of 2560 consultations, 104 patients were involved in thyroid pathology, prevalence of 4.1%. They were 93 women and 11 men with a sex ratio of 0.12. The average age was 42.03±15.64 years. In more than half of the patients (55.8%) the evolution of the clinical symptomatology was more than six months. A total of 58 patients (55.8%) had hyperthyroidism. The etiologies of hyperthyroidism were dominated by Grave's disease and toxic multinodular goiter, with 60.3% and 24.1% of hyperthyroidism respectively. Hypothyroidism was confirmed in 10 patients (9.6%), among then 6 (60%) had undergone total thyroidectomy. The multinodular goiter was found in 36 patients and was dominated by multinodular goiter (36.1%) and single goiter (27.8%). The treatment of hyperthyroidism was exclusively with synthetic antithyroid drugs. Hypothyroidism was treated with hormone replacement therapy. The majority of patients (82.2%) were lost in view. Conclusion: The thyroid pathology at the University Hospital Center of Bouake is a frequent illness of the young woman. Hyperthyroidism were frequently found with as main etiology Grave's disease The majority of patients (82.2%) were lost in view hence the interest of patient's education.

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

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

Actualités au cours de l'évolution de l'infection à VIH sida dans un centre de référence: à propos de 327 cas colligés dans le service de médecine interne du CHU de Bouake, Côte d'Ivoire / News during the evolution of HIV/AIDS infection in a reference center about 327 cases collected in the internal medicine department of the Bouake teaching hospital, Ivory Coast

Introduction : Les maladies opportunistes surviennent chez les personnes vivant avec le VIH (PvVIH) dans les situations de prise en charge tardive. En absence de traitements efficace, la multiplication du virus est inévitable et les personnes concernées sont confrontées à une baisse de leur immunité [1]. C'est dans cette situation que des infections opportunistes se déclarent. Objectif: contribuer à une meilleure connaissance des affections opportunistes liées au VIH Méthode : L'étude s'est déroulée dans le service de Médecine Interne du CHU de Bouaké du 1er janvier 2017 au 31 décembre 2020. C'était une étude rétrospective et transversale qui a concerné les dossiers de patients infectés par le VIH hospitalisés dans ledit service. Résultats : L'analyse a noté 327 cas de dossiers complets sur 3815. La prévalence hospitalière était de 8,5%. L'âge moyen était de 36,2 ans et le sex ratio de 0,83. 65,3% des patients n'ont découvert leur statut sérologique que pendant l'hospitalisation dont les motifs étaient dominés par l'altération de l'état général (36,8%) suivi du coma (19,2%). 84,5% des patients avaient le VIH1. Le taux moyen de CD4 était de 50,5% cellules/mm3 . Les affections opportunistes étaient dominées par la tuberculose (41,8% des cas) et la plus létale était la maladie de Kaposi digestif dans 100% des cas. Conclusion: les patients étaient hospitalisés au stade d'altération de l'état général et de coma d'où la forte létalité. La tuberculose était la principale affection opportuniste. Ces résultats montrent avec beaucoup d'intérêt l'importance de la sensibilisation de la population sur le VIH et la nécessité du dépistage précoce.

Introduction: Opportunistic diseases occur in people living with HIV (PvHIV) in situations of late treatment. In the absence of effective treatments, the multiplication of the virus is inevitable and the people concerned are confronted with a drop in their immune defenses [1, 2]. It is in this situation that opportunistic infections occur Objective: to contribute to a better understanding of opportunistic infections linked to HIV. Method: The study took place in the Internal Medicine department of the Bouake University Hospital from January 1, 2017 to December 31, 2020. It was a retrospective and cross-sectional study which concerned the files of patients infected with HIV hospitalized in the said department. Results: The analysis noted 327 cases of complete records out of 3815. The hospital prevalence of 8.5%. The mean age was 36 years and the sex ratio 0.83. 65.3% of patients only discovered their serological status during hospitalization, the reasons for which were dominated by deterioration in general condition (36%) followed by coma (19.2%). 84.5% of patients had HIV1. The average CD4 count was 50.5% cell/mm3. Opportunistic diseases were dominated by tuberculosis (38% of cases) and the most lethal was digestive Kaposi in 100% of cases. Conclusion: Most of our patients were without social security and did not know their HIV status. These patients were hospitalized at the stage of impaired general condition and coma, hence the high lethality observed. The main opportunistic infections were tuberculosis, cerebral toxoplasmosis and digestive mycoses. These results show with great interest the importance of sensitizing the general population on HIV AIDS and the need for early detection of these opportunistic diseases.