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Biomedical subjects

B Wade

Publications and source records attributed to B Wade.

At least 19 recordsLinked to original sources
PubMed2003

[Cardiac pacing in West Africa: feasibility, problems, and perspectives].

BACKGROUND: The frequency of conductive trouble is not know in West-Africa where the evacuation to Europe and the cardiology institute of Abidjan has been for long time the only possibility to implant stimulators. We analyse our experience, the problems ant the perspectives. METHODS: Over a three year period 92 patients (47 men, 45 women) were implanted using new (47%) or a recycled pacemaker. The technique used was essentially endoveinous (sub-clavicular puncture) except 2 children. The medium length of treatment was 24 months. RESULTS: Syncope was noticed at the entrance in most 50% of cases. The degenerative etiology was dominant in 85%. Most cases (87%) used the VVI mode. Complications comprised 3 leads deplacements, 5 infections, 1 pacemaker syndrome and 1 death by mesenteria ischemia. Seven patients died later without any relation of cardiac pacing. CONCLUSION: Despite an intrinsically high cost, pacemaker implantation is feasible and useful in selected indications in developing countries.

Adolescent↗
PubMed2003

[Listeria disease. The first 2 cases reported at the Principal Hospital of Dakar].

Infection disease due to Listeria monocytogenes, which is a ubiquitous positive Gram bacillus to the essentially alimentary transmission, listeriosis happens on patients presenting an immunodeficiency. The authors report the two first cases of listeriosis diagnosed at Hopital Principal de Dakar. The first case was observed on a 73 years old man, hospitalised for a feverish coma scored at 9 using Glasgow scale, with neither meningitis syndrome, nor sign of neurological localisation. The analysis of the RLC reveals a hypercytosis at 126 GB/mm3, with prevailing neutrophile polynuclears, a hyperproteinorachia at 3.2 g/l. The culture of the RLC was sterile but the blood culture showed the presence of L. monocytogenes. The other paraclinical tests has revealed a glycaemia at 2.45 g/l, an imporant hepatic cytolisis with ASAT at 13 N and ALAT at 20 N. The patient was also presenting a cerebromeningitis and hepatic listeriosis on a diabetic field. The second case was observed on a 58 years old patient admitted for headaches, fever and an important degradation of the general state with an emaciation of 17 kg in 5 months. The physical screening revealed a bad general state, a fever at 38 degrees 2 and was without other particularity. The analysis of the RLC showed a hyperproteinorachia at 1.35 g/l with neither hypercytosis nor germ at the culture. Haemoculture isolated Listeria monocytogenes. HIV serology was positive. CD4 were counted to 61/mm3. and the viral charge was at 110.000 copies / mm3. The patient was presenting a Listeria monocytogenes at meningo-encephalitis on HIV-1 field. stade B of the CDC classification. This ubiquitous anthropozoonosis should be searched through early haemocultures before antibiotherapy. in case of long lasting fever, endocarditis, meningo-encephalitis, localised infections on children. pregnant women, diabetic persons, and people infected with HIV and some others presenting immunity troubles.

Aged↗
PubMed2001

[Malaria prevention in the army: experience in senegal].

The Senegalese army has acquired extensive experience in malaria prophylaxis in Sub-Saharan Africa. Until the early 90s, chloroquine-based drug prophylaxis was routinely administered during the transmission season. Currently this policy has been abandoned inside the country in favor of early treatment of infection. This change was made possible by the presence of qualified staff in all barracks. For extraterritorial interventions in Sub-Saharan Africa, drug prophylaxis is still used since most of the Senegalese population lives in the Sahelian zone without immunity to malaria and most host countries are in areas of high transmission. Treatment protocols have been defined in function of Plasmodium drug sensitivity in each country. For all West African nations except Nigeria, the protocol involves a combination of choroquine and proguanil at a dose of 300 mg per week and 200 mg per day respectively. For Central African nations in the south and east as well as for Nigeria, either mefloquine at a dose of 250 mg per week or doxycycline at a dose of 100 mg per day are used. Although acceptance has been slow, use of impregnated bednets is now an integral part of the prevention strategy. The insecticide used inside the country is deltametrin, but other products may be used during extraterritorial operations depending on vector sensitivity in the facilities host country. Vector control by spraying of insectides in and eliminating larval deposits is also an important part of the prevention strategy used by the Senegalese army which maintains a mobile unit for that purpose.

Africa↗
PubMed2001

[Spiral volumetric CT angiography in the diagnosis of pulmonary embolism in Senegal].

Authors relate spiral CT scan in pulmonary embolism about four cases : such as the surgical aspect, peri partum cardiomyopathy, cardiovascular collapsus, chest pains. In all cases spiral volumetric CT angiography Scan confirmed the diagnosis. So spiral CT scan proves to be a precious diagnosis tool that facilitates of multicentric study of pulmonary embolism. However, its effectiveness in the detection of isolated and segmentary embolism requires a thorough evaluation.

Adult↗
PubMed2001

[Descriptive study of complicated hypertension. Experience of the Principal Hospital of Dakar].

We included in a six month-period 85 patients concerned about complicated high blood pressure. Hypertension represented 33% of 276 admissions for cardiovascular cases. Among the 55 men and 30 women concerned, average age was 57 years-old. Male to female ratio was 1,8. Cardiovascular risk factors were determined as follows: obesity: 18 cases (21%), cigarette smoking: 27 cases (32%), diabetes mellitus: 11 cases (13%), hypercholesterolaemia: 44 cases (52 %). Kidney was damaged in 36 patients (42%). Seventy patients (82%) with systolic dysfunction in 21 cases (30%) presented a left ventricular hypertrophy. Malignant hypertension was noted in 13 cases (15%). Eighteen patients (21%) had stroke and 9 died (10,5%). Drugs association was needed to control hypertension. As for everywhere in Africa, complicated hypertension is the main cause to admission for cardiovascular disease in our day-to-day practice. National preventive measures should help for systematic detection process and adequate management.

Adult↗
PubMed2000

[A case of hepatic Loeffler's syndrome].

INTRODUCTION: During nematode infection transit of the microorganism in the lung may be associated with transient infiltration lesions accompanied by marked eosinophilia. In the invasion stage of the disease maturation and sexual differentiation of schistosomules is restricted to portal vessels. Liver ultrasonography may show concomitant abnormalities. EXEGESIS: Eosinophilia was diagnosed in a 36-year-old man residing in Central Africa. Clinical examination, chest X-ray and biology were normal. Liver ultrasonography showed numerous hypoechoic lesions, up to 3 cm in diameter. Ultrasonography-directed biopsy demonstrated infiltration of both portal vessels and liver sinusoids, with sometimes microabcesses. No parasite was found in either blood, stool, or rectal biopsy. Immunoelectrophoresis and hemagglutination showed positive bilharziosis serology, whereas serology for other helminthiases was negative. Four months after treatment eosinophilia was still high, liver ultrasonography was normal, and hemagglutination was negative. CONCLUSION: The transient shistosomules maturation-related liver abnormalities detected by ultrasonography should be differentiated from the laying phase of the disease.

Adult↗
PubMed1998

[Cardiac manifestations of polymyositis. Apropos of 2 Senegalese cases].

INTRODUCTION: Polymyositis cardiac involvement varies between 37% and 70%. EXEGENESIS: The authors report two cases of polymyositis with myocardial involvement observed in Senegal; the first case is a cardiac failure revealing an acute polymyositis occurring in a 44-year-old woman; the second case is a 34-year-old woman who had polymyositis with tachycardia and dyspnea: in the two cases echocardiography showed a left ventricular concentric hypertrophy with preserved systolic function and altered diastolic function; clinical and echocardiographic resolution were obtained by corticosteroid medication. CONCLUSION: Myocardial localization is the most common polymyositis cardiac involvement; clinical symptomatology is rare (3.3% to 6%). sometimes revealing polymyositis; electrocardiographic abnormalities are found in 18% to 81% cases and echographic abnormality in 42% cases; cardiac involvement is of bad prognosis.

Acute Disease↗
PubMed1998

[Soft tissue eosinophilic granuloma or Kimura's disease: a case report].

Soft tissue eosinophilic granuloma or Kimura's disease is a chronic inflammatory disorder of unknown etiology. It is endemic in the Far East but can occur sporadically in other populations especially Middle Eastern peoples as illustrated by the present case involving a 55-year-old man. Examination 8 years after an initial episode revealed masses in the cheek and submaxillary regions with hypereosinophilia and characteristic histological findings. The usual clinical presentation of Kimura's disease includes subcutaneous nodules with lymph node involvement or presence of tumor in the salivary glands. These clinicopathological findings require differential diagnosis with Hodgkin's lymphoma, dermopathic lymphoma, or Castelman's disease. However, the most difficult distinction involves angiolymphoid hyperplasia with eosinophilia. Final diagnosis requires anatomopathological study. The most frequently encountered histological criteria are preservation of node structure, highly developed germinal centers, eosinophilic infiltration, and presence of numerous postcapillary veinlets. Prognosis is favorable but multiple relapses are possible. Corticosteroid therapy is usually effective but radiation treatment may be necessary in patients with recurrent disease.

Algeria↗
PubMed1998

[Evolutive aspects of systemic lupus erythematosus in Dakar. Apropos of 30 cases].

To determine the characteristics of evolution of systemic lupus erythematosus (SLE), the authors studied 30 cases retrospectively. All were black women aged from 16 to 73 years (with a mean of 30 years) at the time of diagnosis. Dermatological manifestations consisting in discoid lupus or alopecia inaugurated the disease in 12 cases, joint symptoms in 10 cases. Polyarthritis was the most common inaugural manifestation, followed by discoid lupus. Corticosteroids therapy alone or associated to chloroquine or immunosuppressor led to good results; 88% of patients who received treatment had good outcomes in the first 5 months after diagnosis. After this time lapse, 6 cases of complications related to the corticosteroids therapy occurred. After one year, 5 patients presented one or more flare-ups and had to be re-hospitalized; 8 others were lost to the follow-up. The overall mortality rate was 27% (8 cases out of 30). Causes of death were first renal failure (3/8) followed by infectious complications (2/8). The management of SLE could be improved by a close follow-up and providing the patients and their family with adequate information.

Adolescent↗
PubMed1997

[Closed-heart mitral commissurotomy: our experience at the Main Hospital in Dakar].

Confronted with difficulties of medical evacuation to cardiovascular surgical hospitals in Europe, the authors decided to bring up to date closed heart mitral commissurotomy. The aim of the study was to estimate possibility to select patients, to operate them safety to appreciate the results in medium and short time and the intervention's cost. 8 women and 7 men had a closed heart mitral commissurotomy from June 1995 to January 1997 in Dakar Principal Hospital; inclusion criteria were a symptomatic mitral stenosis with area less 1.5 cm2; exclusion criteria were an other valvulopathy, a Wilkin score above 8, a severe pulmonary arterial hypertension, an auricular thrombosis. One patient died on the forth day; a completely regressive hemiplegia was the only complication; 14 patients were clinically very improved: the average mitral area by planimetry form 0.89 cm2 +/- 0.15 became 1.64 cm2 +/- 0.33 and by Hatle formula from 0.82 cm2 +/- 0.12 to 1.71 cm2 +/- 0.37; the intervention cost was in second class 1,000,000 F CFA, in third class 820,000 F CFA. This study shows closed mitral commissurotomy can be realised in an african hospital as Dakar Principal Hospital; short and medium results are good; African surgeons must go on studying this surgical technic.

Adolescent↗
PubMed1996

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗