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Biomedical subjects

B Diatta

Publications and source records attributed to B Diatta.

At least 19 recordsLinked to original sources
PubMed2005

[Role of Musca domestica in the transmission of multiresistant bacteria in the centres of intensive care setting in sub-Saharan Africa].

OBJECTIVE: The houseflies (Musca domestica -MD) are involved in the transmission of the diseases of the faecal danger in subsaharan Africa. What is their role in the transmission of multiresistant bacteria in an intensive care setting in Dakar? TYPE OF STUDY: Descriptive, forward-looking. MATERIALS AND METHODS: The study was conducted from May 1 to September 30, 2003. During this period a flytrap was put above every patient carrier of BMR (methicillin resistant Staphylococcus, extended spectrum beta-lactamases-enterobacteria, ticarcillin resistant Pseudomonas). Caught MD were carried to the microbiology laboratory and incubated in heart-brain broth at 37 degrees C for 18 hours. Then selective gelose platers were used for identification of bacteria. Comparison of antibiotic sensitivities of bacteria isolated from MD and from the patients was made. RESULTS: Out of 441 hospitalized patients, 26 were colonised or infected by BMR. Human pathogenic microorganisms were obtained from 99 out of 120 flies. Seventeen of those flies were carried of BMR. Six among these 17 flies had BMR with sensitivity profile and phenotype of resistance identical to those of the patients under the trap with birdlime. More 3 MD carried BMR BLSE not found on our patients. CONCLUSION: This study shows that the MD can carry BMR. Their participation in the crossed transmission, between patients, of multiresistant bacteria in intensive care setting, must be discussed. The eradication of the MD in our Africa subsaharan services must be looked for.

Adolescent↗
PubMed2004

[Abstract envenomation by the African puff adder (Bitis arietans): value of intracompartmental pressure measurement].

The purpose of this report is to describe a case of severe snake bite with envenomation by an African puff adder (Bitis arietans). Presenting symptoms warranted administration of antivenon upon admission. The patient's general condition improved. However bite-related trauma caused extensive phlyctenuar edema of the lower extremity with a high risk of compartimental syndrome due to hardening and compression. Due to the high risk for postoperative infection at our facility, aponevrotomy to relief pressure was not undertaken immediately. Instead management consisted in close surveillance with repeated measurement of peripheral pulses by Doppler ultrasound and of intracompartimental pressure. The outcome was favorable without need for aponevrotomy. This case demonstrates the value of intracompartimental pressure measurement in cases involving this type of envenomation in function of available technical facilities.

Adult↗
PubMed2000

Hemodynamic aspects and oxygenation variables in severe malaria of adults in Africa.

OBJECTIVES: Study of the hemodynamic profile and oxygenation variables in severe malaria to determine whether they are identical to those observed in severe bacterial infections. DESIGN AND SETTING: Prospective study in an intensive care unit of a West African hospital. PATIENTS AND PARTICIPANTS: Two groups of adult patients hospitalized for severe malaria according to WHO criteria, a control group (n = 13) with systemic vascular resistance of 800 dyne s(-1) cm(-5) or higher and a hyperkinetic group (n = 16) with a level lower than 800 dyne s(-1) cm(-5). Twenty-nine patients participated in this study (19 semi-immune, 10 nonimmune). INTERVENTIONS: Before hemodynamic study a loading dose of quinine formiate was administered: 20 mg/ kg intravenously for 4 h. Artificial ventilation was used in the case of persistent hypoxemia. MEASUREMENTS AND RESULTS: The hemodynamic study with Swan-Ganz catheter was performed after filling with 1,000 ml lactated Ringer's solution. From a clinical and a biological standpoint there was no difference between the two groups except for creatine phosphokinase, which was significantly higher in the hyperkinetic group: 2404 +/- 3654 vs. 1,898 +/- 1,828 IU/l. Hemodynamic and oxygenation variables showed a significant difference in cardiac index (6.1 +/- 1.2 vs. 3.9 +/- 1.21 min(-1) m(-2)), systemic vascular resistance (536 +/- 143 vs. 1098 +/- 170 dyne s(-1) cm(-5)), oxygen delivery (645 +/- 163 vs. 482 +/- 186 ml min(-1) m(-2)), and oxygen extraction (23 +/- 9 % vs. 34 +/- 14 %). Oxygen extraction was negatively correlated with oxygen delivery in the control group but not in the hyperkinetic group. Eight of 10 nonimmune patients (80 %) were in the hyperkinetic group versus 8 of 19 semi-immune patients (42 %; p < 0.05). Nine patients in the hyperkinetic group (69 %) and seven of the control group (46 %) died (NS). CONCLUSIONS: In contrast to severe bacterial infections, severe malaria does not always induce hyperkinetic-type hemodynamic changes. Such changes are observed mostly in nonimmune subjects.

Adult↗
PubMed1999

[Chloroquine poisoning with respiratory distress and fatal outcome].

Chloroquine poisoning can cause life threatening cardiovascular disturbances. We report three cases of suicide with chloroquine causing acute respiratory insufficiency from pulmonary oedema with lethal outcome, despite a treatment with diazepam, epinephrine and mechanical ventilation.

Adolescent↗
PubMed1999

[Evaluation of acute renal insufficiency in Dakar].

The acute renal failure (ARF) is a serious complication occurring commonly in gravidic toxemia. The aim of this retrospective study was to evaluate the treatments wed on patients presenting an ARF and hospitalized in the Dakar hemodialysis centers and emergency service of Hospital Principal. These patients should be aged over 15 years at present no history of chronic renal failure. The diagnosis of ARF was based on the presence of a creatinine clearance value < or = 80 ml/mn, a creatinemia > 176.8 mo/l, an azotemia > 9.99 mmol/l. Thirty patients aged form 16 to 56 years were studied, they were 6 males and 24 females. Among them, 22 (73.33%) present anuria, 5 (16.7%) were in oligo anuria, and 3 (10%) had a normal diuresis. An aetiologic treatment was instituted whenever necessary. The other treatments consisted in dietary measures, hydroelectrolytic balance, blood transfusion, diuretic therapy, and hemodialysis. All anuric patients had a diuretic regimen. Ten of them had recovered a diuresis, 16 underwent hemodialysis in a mean time of 4 days. None of latter recovered renal function 5 patients developed Chronic renal failure and 11 died, mainly by infectious complications. Acute renal failure has until now a poor prognosis in our regions because of a certain management delay. This management should include a guide and adequate volume replacement, and eventually diuretic therapy, and dialysis as soon as possible.

Acute Kidney Injury↗
PubMed1998

[Tropical myositis].

Tropical pyomyositis (TP) is a microbial infection involving one or more skeletal muscles that rapidly leads to abscess. The most common infectious agent is Staphylococcus aureus. Since muscle tissue is highly resistant to infection, occurrence of TP is contingent upon one or more compromising factors such as trauma, skin lesions, parasitosis, or malnutrition. HIV infection is currently a major factor in the occurrence of TP. While Staphylococcus aureus accounts for 80% of cases, other microbial agents have been identified including gram-positive cocci and gram-negative bacilli. TP is endemic in intertropical zones of Africa and Latin America and in island areas of the Pacific Ocean. However a growing number of non-tropical cases have been reported in association with AIDS. The most frequent presentation is single-muscle involvement in the thighs, calves, and buttocks. The symptomatic phase or suppurative phase is almost always associated with hyperthermia. The infected muscle indurates prior to development of characteristic fluctuance. Hemocultures are seldom positive but needle aspiration may confirm diagnosis. Ultrasound imaging can allow early detection. Severe sepsis or cardiovascular, renal, or pleuropulmonary complications are observed in 10% of cases. Treatment is antibiotic therapy with penicillin M and surgical drainage or needle puncture of abscess cavities. Prognosis is generally favorable even in HIV-infected patients.

Diagnosis, Differential↗
PubMed1997

[Re-expansion pulmonary edema after excision of an intrathoracic tumor].

We report an acute respiratory insufficiency following the removal of a large intrathoracic fibroma (3.1 kg) in a 6 year-old child, caused by a re-expansion pulmonary oedema (unilateral oedema occurring within one hour after expansion). This oedema improved rapidly and was followed by a well-tolerated pleural effusion. This complication is due to discrepancy between a small lung and a large thoracic cavity, due to the prolonged time course of the tumor growth. These oedemas are caused by rapid lung re-expansion, the volume of the removed tumor and the depth of postoperative pleural suction. The value of positive-end expiratory pressure is discussed.

Brachial Plexus↗
PubMed1997

Prognostic value of anti-Plasmodium falciparum-specific immunoglobulin G3, cytokines, and their soluble receptors in West African patients with severe malaria.

Forty-one African patients suffering from clinically defined severe malaria were studied in the intensive medical care unit of the main hospital in Dakar, Senegal, West Africa. All of these individuals lived in Greater Dakar, an area of low and seasonal Plasmodium falciparum endemicity. Twenty-seven patients (mean age +/- 1 standard deviation, 19.2 +/- 12.7 years) survived this life-threatening episode, but 14 (30.8 +/- 16.2 years old) died despite initiation of adequate treatment. On the day of admission (day 0) and 3 days later, one to two blood samples (i.e., approximately 10 to 15 ml) were obtained from each subject, and different biological parameters were evaluated in the two groups. Plasma samples were tested for their content in tumor necrosis factor alpha (TNF-alpha), soluble receptors I and II for TNF-alpha (TNF-alpha sRI and TNF-alpha sRII), interleukin-6 (IL-6), IL-6 sR, IL-10, and IL-2 sR. The concentrations of all these cytokines and/or their receptors was significantly elevated in patient plasma samples on day 0, and it rapidly decreased in the group of individuals who survived. By comparison, the mean concentration of the same parameters decreased slowly in the group of patients who died (except for IL-10, which dramatically fell in all patient plasma samples soon after initiation of antimalarial treatment). The TNF-alpha sRI level remained significantly elevated among the patients who died, and the highest levels of soluble TNF-alpha sRI receptor were found among the older patients. Parasite-specific immunoglobulin M (IgM), total IgG, IgG1, IgG2, IgG3, and IgG4 were evaluated by enzyme-linked immunosorbent assay using a crude extract of a local P. falciparum isolate as antigen and human class- and subclass-specific monoclonal antibodies. Parasite-specific IgM, total IgG, and IgG1 were detectable in the plasma samples of most of these African patients, whereas IgG2 and IgG4 mean values were low. The mean level of parasite-specific IgG3 was different (P = 0.024) at day 0, i.e., before initiation of intensive medical care, between the group of the 27 surviving subjects and the group of 14 patients dying of severe malaria. As a consequence, most of the African patients who died had only trace amounts or almost no detectable level of parasite-specific IgG3 at the time of admission. In contrast, the presence of even limited IgG3 activity at day 0 was found to be associated with a significantly increased probability of recovering from severe malaria. Therefore, in our study, both an elevated level of TNF-alpha sRI and absence of IgG3 activity were of bleak prognostic significance, whereas a favorable outcome was usually observed when parasite-specific IgG3 activity was detectable. This finding was strongly suggestive of a prime role for these parasite-specific immunoglobulins in the capacity to help recovery from severe malaria.

Adolescent↗
PubMed1997

[Multiple organ failure syndrome after ovarian hyperstimulation].

Ovarian stimulation is used to treat female infertility, especially in Black Africa where infertility is considered as shameful. Ovarian stimulation can lead not only to multiple pregnancies but also to severe systemic complications such as the one described in this report. Ovarian stimulation using human menopausal gonadotropin led to ovarian hyperstimulation and multiple organ failure in a 28-year-old Senegalese woman. Symptomatic treatment using corticosteroids, abdominal paracentesis to relieve ascites, and fluid expansion failed. Bilateral ovariectomy was performed resulting in permanent sterility. Ovarian stimulation requires close monitoring by ultrasound visualization and measurement of 17 beta-estradiol to allow early detection of complications.

Adrenal Cortex Hormones↗
PubMed1995

[Prognostic value of nutritional indices for digestive tract cancer surgery in the African environment].

Malnutrition occurs in all patients digestive tract cancer and its effects on perioperative mortality have been well documented. However no study has assessed the predictive value of nutritional status within the context of facilities available in Africa. The purpose of this study was to determine the prognostic value of nutritional status for perioperative mortality in patients with digestive tract cancer i Dakar, Senegal. All patients that underwent surgery for digestive tract cancer were included. Preoperative assessment included physical examination (weight, mid-upper arm circumference, triceps skinfold thickness, and theoretical and real weight loss) and laboratory tests (serum albumin and creatinine/height index). The only evaluation criteria that was correlated was mortality at 14 days. Of the 40 patients included, 18 died (45%). In these 40 patients, 240 malnutrition tests were performed revealing 101 criteria of malnutrition. The results of laboratory tests were not correlated with mortality of clinical factors nor with each other. Physical findings were well correlated with each other but only real weight loss was correlated with postoperative mortality which ranged from 10% when weight loss was less than 10% to 100% when weight loss was 40% or higher. These findings emphasize the value of simply assessing real weight loss, which is difficult in Africa, for predicting perioperative mortality in patients with digestive tract cancer. Use of other physical criteria and especially more elaborate laboratory tests was not of further clinical value.

Digestive System Neoplasms↗
PubMed1994

Severe malaria in African adults living in a seasonal endemic area.

OBJECTIVE: This study investigates severe malaria in African adults living in a seasonal endemic area. DESIGN: A prospective study of all adults admitted with severe malaria over 2 consecutive seasons: October 1990 till January 1991 and October 1991 till January 1992. SETTING: ICU (15 beds) of Hôpital Principal, Dakar, Sénégal. PATIENTS: 23 patients: 14 men and 9 women with a mean age of 30 +/- 3 years were included in the study; all fulfilled the 1990 WHO criteria for severe malaria. RESULTS: At admission, 12 patients were comatose (Glasgow Coma Scale < 10), 7 had generalized convulsions. Parasitaemia was 135 +/- 52 x 10(9)/l. Biological indications of severity were as follows: hypophosphataemia < 0.8 mmol/l in 14 cases, serum creatine phosphokinase > 500 IU/l in 15 cases; and PaO2 < 70 mmHg in 5 cases. Serum TNF alpha levels, measured in 16 cases, were increased at 298.4 +/- 63.5 pg/ml, serum levels of IL-6 and IL-2SR were also elevated: 609.5 +/- 304.2 pg/ml and 297.6 +/- 35.6 pg/ml respectively. Circulating IgM and IgG antibodies were found in 14 out of 16 patients. Serum levels of TNF alpha, IL-6 and IL-2SR correlated positively with each other. TNF alpha and IL-2SR were also positively correlated to parasitaemia. Intravenous therapy with quinine at loading dose was favorable in 19 patients. Four patients died during the study, 3 from multiple organ failure. CONCLUSIONS: This work demonstrated that severe malaria in a seasonal endemic area displays original clinical features with a high rate of either cerebral malaria or multiple organ failure.

Adolescent↗
PubMed1991

[Cerebral malaria in non-immune subjects. Current aspects in African endemic areas].

The current clinical and therapeutic aspects of cerebral malaria in non-immune adult subjects living in endemic areas of Africa were evaluated in 10 men (mean age: 40 +/- 11.4 years). On admission, 8 patients had fever, 3 were truly comatose with a Glasgow score of 7 or more. All had negative central venous pressure and only one was in a state of hyperkinetic shock. Respiratory symptoms were present in 8 cases, and jaundice was observed in 8 cases. Three patients has a haemoglobin level lower than 8 g/100 ml, and 8 had thrombocytopenia. Blood creatinine levels above 240 mumol/l and blood bilirubin levels above 50 mumol/l were found in 6 and 8 patients respectively. Plasma creatine phosphokinase was above 500 IU/l in 7 cases, and PaO2 was below 70 mmHg in 7 cases. All patients received quinine, combined with doxycycline in 6 cases. Infectious complications occurred in 5 patients, with 2 septic shocks. Two patients developed acute pulmonary oedema. Five patients died. This study shows that cerebral malaria in non-immune subjects living in endemic areas produces multivisceral deficiency similar to that observed in imported malaria. Its prognosis can be improved by loading doses of quinine and by a better prevention of nosocomial infections.

Acute Kidney Injury↗
PubMed1991

[Heroin-induced acute rhabdomyolysis].

A 24 year ald-man, was admitted in intensive care with coma and shock, 4 hours after intravenous injection of heroin. Awakening was obtained by naloxone. Diagnosis of acute rhabdomyolysis associated with heroin addiction was asserted by association of anury, hyperkalemia, and CPK increase. Recovery was obtained with, however, neurologic after-effects. Pathophysiology of acute rhabdomyolysis associated with heroin addict is obscure. Hypotheses for the cause of the muscle damage include the effects of toxicity (either directly or immunologically mediated) of the drug or an adulterant. However prolonged coma and immobilization in one position with either direct compression of the muscles or occlusions of the regional vascular supply can play a major role.

Acute Disease↗