Biomedical subjects
Publications and source records attributed to A Niang.
Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.
BACKGROUND: Smoking represents a major threat to public health, being responsible for considerable morbidity and mortality. We undertook this study to establish the prevalence of smoking among personnel at the Centre Hospitalier National de Fann, their smoking habits and the attitude of staff to the problems caused by smoking as well as their understanding of their role in promoting smoking cessation. METHODS: A prospective study was undertaken between February and April 2004 in which a standardised, anonymous, self-completion questionnaire in French was administered to 262 medical and paramedical staff at the CHN de Fann. RESULTS: The response rate was 95%. The biggest single group of respondents came from the infectious diseases service (24.5%). 63% of participants were paramedical and 54% of respondents were male. The mean age of respondents was 39.2 for men and 35.9 for women. 11.6% were smokers and 13.3% were ex-smokers. The mean age of ex-smokers was 43.8 years with a male/female ration of 7.25 to 1. Among the ex-smokers 51.7% had stopped smoking within the last 10 years with health problems the most commonly cited reason for quitting (24.2%), followed by guilt (21.2%). Smokers had a mean age of 38.6 with a male to female ratio of 8.6 to 1. Mean age at which they had started to smoke was 14.3 for women and 21 for men with a mean duration of smoking of 21 in women and 17 in men. 96.6% smoked cigarettes with 31% smoking > 20 cigarettes per day. 75.9% of our smokers had tried to quit at least three times. 86.2% wished to stop but only 48.3% considered getting medical and or psychological support to help them to quit. The Fagerström score showed a high level of dependency in 27.6% of smokers. More than half the total population studied (65.6%) thought that healthcare workers should help others to stop smoking and 75.5% thought that they had influence to do this. CONCLUSION: Healthcare workers in Senegal have an opportunity and a responsibility to promote smoking cessation. Legislative proposals and smoking cessation clinics should help to combat the tobacco epidemic.
INTRODUCTION: Tobacco smoking is truly a modern plague. The WHO estimates that there are 1.3 billion smokers worldwide, about a third of the world's population. In various studies in Senegal the prevalence of smoking has varied between 16 and 36%. The risks associated with smoking are well established. However it is also well established that 'knowledge of risks alone is not sufficient to modify behaviour.' We undertook a study to assess knowledge of the risks of smoking among patients admitted to The Pulmonology Clinic of the Centre Hospitalier National de Fann de Dakar. PATIENTS AND METHODS: All patients admitted to the clinic between 1st December 2003 and 31st May 2004 were enrolled into this prospective, cross-sectional study. A questionnaire in French was administered together with the Fagerstrom test of clinical addiction. RESULTS: Of 343 patients admitted 75 (22%) were smokers. Only 2 (2.6%) of the smokers were female. As in previous studies, smoking was associated with social disadvantage. 34.7% of smokers had attended school to primary level only and 33.3% had had no schooling at all. Mean age of starting smoking was 16 (range 9 to 38 years). The monthly cost of smoking to individuals was estimated at between 2 and 45% of the Guaranteed Minimum Wage (SMIG). 44% of smokers also consumed alcohol and 2.6% smoked cannabis. More than two thirds of patients (68%) thought that smoking caused ill health. The majority of subjects (93.3%) had stopped smoking, at least since admission, though 6.7% continued to smoke. Previous consumption was estimated as a mean of 20 pack-years. Nicotine dependence was defined as medium in 37 patients (49.3%). CONCLUSION: Certain diseases such as malaria, tuberculosis and AIDS exist at endemic levels producing considerable morbidity and mortality. We should not allow the epidemic of smoking to continue. Collective action, particularly by pneumologists is required.
Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.
INTRODUCTION: Improvement of dentofacial appearance is often the main motives of patient seeking orthodontic treatment. However perception of aesthetic and orthodontic treatment need may be different among populations of different cultural background. The aim of the present study was to compare the perception of aesthetic and orthodontic treatment need between Caucasian (French) and African (Senegalese) MATERIALS AND METHOD: In the present study the perception of the attractiveness of 98 colours photographs of dentitions were assessed by 34 Caucasian and 31 African lay judges by mean of a Power Point presentation. Each slide were displayed for evaluation during 20 seconds RESULTS: The two populations share the same perception of orthodontic aesthetic with respect to some occlusal traits. However they diverge in their appreciation of 70% of the dentitions with midline diastemas. There were also significant differences in the perception of orthodontic treatment need with the Caucasian judges suggesting treatment more often than Africans. CONCLUSION: The results are discussed in term of accessibility in orthodontic treatment in association with socioeconomic status.
INTRODUCTION: Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case. CASE REPORT AND DISCUSSION: A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning. CONCLUSION: TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.
Tuberculosis in patients undergoing maintenance hemodialysis therapy presents a number of diagnostic and therapeutic challenges. This study was designed to assess the specific diagnostic and therapeutic features of dialysis-associated tuberculosis in a clinical setting. A total of 55 patients were enrolled in this retrospective study over the 5-year period from 1996 to 2000. Diagnostic techniques included questionnaire, clinical examination, chest X- ray, tuberculin skin test, Mycobacterium tuberculosis (MT) screening on biological fluids and tissue biopsy. Tuberculosis was diagnosed in 6 patients (11%). The disease occurred within the first two years after the beginning of hemodialysis. Initial signs were nonspecific, i.e., fever, weight loss, and cough. Tuberculin skin testing was negative in 5 cases. Tuberculosis was located in the lung in 2 cases, pleura in 2 cases, peritoneum in 1, and lymph node in 1. Isolation of the MT and confirmation by tissue biopsy was performed in only one case. Appropriate polychemotherapy was successful in 5 of 6 cases. Morbidity and mortality of tuberculosis in dialysis patients is closely related to early detection and treatment. Therapy is often based on strong presumptive evidence without definitive diagnosis.
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INTRODUCTION: Macrophage activation syndrome (MAS) is a severe complication of chronic rheumatic diseases, particularly juvenile rheumatoid arthritis. However, MAS is rarely described in adult rheumatoid polyarthritis. EXEGESE: We report a case of MAS complicating a seropositive rheumatoid polyarthritis after 20 years of evolution. Pancytopenia with fever, renal failure and hepatic dysfunction revealed the disease that was confirmed by multiple macrophages and monocytes invading the bone marrow specimen. CONCLUSION: Outcome has been spectacular under corticosteroids.
From June 1668 to June 2002, we have studied at the Pneumology Clinic of Fann Hospital, pulmonary tuberculosis among 9 pregnant women. The average age was 26 years old and the consultation's delay was 5 months. All our patients had a productive cough and an evening fever coupled with a thoracic pain and a deterioration of the general condition in 7 patients (77.7%). The dyspnea and the heamoptisis were a consultation motive for 44.4% and 33.3% of the patients. The evolution of pregnancies was 29 weeks. They had all benefited from the intradermal reaction with tuberculin (IDRT) with an average diameter of 11.7 mm; it was negative in one patient. The bacilloscopy systematically done was negative in 2 patients. At the front thoracic radiography, we have found basal lesions unilateral in more than half of the cases and excavated in 44.4% of cases. They benefited from an antitubercular treatment (Rifampicine (R) + Isoniazide (H) + Pyrazinamide (Z) with a good clinical, biological, bacteriological and radiological progression. From the obstetrical point of view, there was an abortion after 5 months, 2 premature deliveries between the 7th and the 8th month and 6 normal deliveries at 9 months. Babies born from bacillary mothers systematically received an antitubercular treatment with breast feeding. In conclusion, pregnant women with pulmonary tuberculosis essentially pose a therapeutic problem, requiring a good collaboration between the lung specialist, the gyneco-obstetrician and the pediatrician. It could be more hazardous not to act early in treating a pregnant women with pulmonary tuberculosis.
Response to therapy of primary focal segmental glomerulosclerosis (FSGS) in adults is poor, most studies demonstrated no response at all. We report our experience from a retrospective study about 22 adults patients. All patients presented proteinuria at admission with a nephrotic syndrome in 86 percent of cases. A high blood pressure was noted in 25 percent. A response to corticosteroid was obtained in 8 patients (36%) with complete remission in 5 cases (23%). Three patients were corticosteroid-dependant, two out of them went in remission under cyclophosphamide in one case and under chlorambucil in the other case. Fourteen patients did not respond to corticosteroids. Eight received cyclophosphamide with partial remission in 4 cases and progression to chronic renal failure (CRF) in 4 cases. The six non-responders did not receive immunosuppressive drugs because of severe CRF in 4 cases. The mean duration of follow-up was 39 months (20-55). The response to corticosteroid of primary FSGS in adults remain low (30%). The use of cyclophosphamide has improved the global remission to 50 percent.
Secondary hyperparathyroidism is defined as autonomic secretion of parathormon (PTH) whose 1-84 fraction level is up to 60 ng/l. The aim of this study was to determine incidence of secondary hyperparathyroidism on patients undergoing hemodialysis in Le Dantec Hospital of Dakar, and describe its diagnostic and therapeutical aspects. Between 22 patients followed in chronically hemodialysis, 11 patients had effective blood test of parathormon. Seven of them had high level of PTH and the other had normal rate. They were 5 men and 7 women with a mean age of 56 years. The mean duration undergoing hemodialysis was 42 months. Clinical signs were rare and non specific, dominated bony pains and anemia. Ectopic calcifications had been found in 3 cases. Hypocalcemia was present in 5 cases and high level of phosphoremia in all cases. The D3 vitamin was at a normal rate in all cases up to 10 ng/ml. Calcium supplementation with 1.5 to 2.5 g/day was effective associated with rich calcium dietary. This level of calcium supplementation appeared too low even though it must be closely estimated because of the possibility of improving ectopic calcifications. At the opposite, D3 vitamin supplementation seems to be unuseful under tropical areas.
HIV associated nephropathy syndrome ( HIVAN Syndrome ) is a recently identified entity and no study has been done in Senegal. So we report this observation. A 40 years old black patient was admitted for renal oedema syndrome and immunosuppressive signs. The biological investigations noticed a non-pur nephrotic syndrome and severe renal failure. Ultrasonography showed quite normal kidney sizes with hyper echogenicity and dediferenciation. HIV research was positive with 45 CD4 lymphocytes / mm3. This patient had no known causes of nephrotic syndrome ( diabetis, lupus ,amyloidosis.). So the diagnosis of HIVAN syndrome was determined with the clinical features and the bad outcome. We emphasize on the necessity to think about HIVAN in every black patient presenting a quickly progressive non-pur nephrotic syndrome. We expect prospectives studies to describe the clinical signs and the frequency of HIVAN syndrome in Senegal.
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.
Childhood cancer has often been considered as a problem mainly affecting industrialized countries. In reality more than half of cases occur in developing countries where management and diagnosis are major issues. This retrospective study includes 130 children (0.3% of admissions) between the ages of 0 and 15 years hospitalized for malignant disease at the Principal Hospital in Dakar, Senegal between January 1, 1990 and December 31, 2000. Mean age was 97 months and M/F sex ratio was 1.2. Mean delay for admission was 3 months. The five most frequent cancers, accounting for 75% of cases, were leukemia (n = 28), lymphoma (n = 21), nephroblastoma (n = 21), retinoblastoma (n = 16) and osteochondrosarcoma (n = 10). Treatment was completed in 18% of cases. Half of patient were lost from follow-up. The cure rate was 10% overall and 50% for patients receiving complete treatment. The highest cure rate was achieved for nephroblastoma, i.e., 58% of cases treated. Management of childhood cancer in Africa is confronted with numerous problems, namely, paucity of specialized staff, absence of expert centers, shortage of anticancer drugs, lack of financial resources, and delay in treatment. These factors associated with frequent malnutrition and recurrent infectious diseases, greatly lower cure rates in comparison with industrialized countries.
Chronic renal failure (CRF) is a polymorphic disease whose management need frequently multiple drugs administration and multidisciplinary approach. Thirteen years after the beginning of haemodialysis treatment in Senegal, we aimed to evaluate the management of chronic renal failure in Dakar University Hospital Internal Medicine Department. We analysed retrospectively 243 CRF in patients managed during the last three years in this department. Most of these patients (43.6%) were under 46 years old. The sex ratio (M/F) was 1.31. The clinical symptoms were distributed as follow: high blood pressure (85.6%), anorexia (61.73%), anaemia (83.9%) and pruritus (12.3%). More than one third (37.04%) of patients had a clearance of creatinine under 10 ml/mn, at the diagnosis, and therefore required chronic haemodialysis. Only 8.23% of cases had the opportunity to get a medical treatment. Five machines ware available at this unity). The deficience of dialysis and nephrology personal is obvious in our practice. The majority of CRF patients can not afford the treatment cost. Therefore, medical training, prevention and screening of renal diseases seem to be the best way to solve this public health problem in developing countries.
We report a 30-year-old female admitted for an acute renal failure (ARF) as initial sign of idiopathic membranous glomerulonephritis. Severe ARF needed hemodialysis and renal biopsy after three weeks of evolution. Pathological examination revealed membranous glomerulonephritis mixed focal segmental glomerulosclerosis. Oral corticosteroids with hemodialysis allowed to obtain complete regression of ARF and partial remission of membranous glomerulonephritis. This case report call also to answer the question about existence of "tropical extramembranous glomerulonephritis" described in Dakar, more than twenty years ago.
The Acute Chest Syndrome (ACS) is defined by the association of chest pain with dyspnea, fever, a recent radiological abnormality and hyperleucocytosis. Acute pulmonary complications are the primary cause of mortality in sickle cell patients. We report a 19-year old male patient with homozygous sickle cell anemia who consults for respiratory symptomatology and bone algia. The diagnosis of ACS by left pneumopathy due to pneumococcal infection was based on the clinical tests, chest x-ray and blood culture. The appearance of pneumopathy in patients suffering from sickle cell anemia is explained by the functional asplenia and the inability of phagocyte cells to destruct bacteria. These incidents are triggered by alveolar hypoventilation, fat embolism from bone infarction, infections, pulmonary oedema and thrombosis. The evolution of these ACS by pneumopathy depends on their early diagnosis and treatment but also on the sensitivity of the germs to antibiotics.