Biomedical subjects
Publications and source records attributed to E H Sidibe.
A 43-year-old patient, known for infertility for ten years, presented hypogonadism (low libido, impotence, low testosteronemia) with hypergonadotropism (high FSH contrasting with low LH) and a tumor syndrome of the sella turcica. The biological, immunohistochemical and clinical features of gonadotropic adenoma are presented.
Menopause occurs earlier in African women than European or American women. Multiple parity in a short period of time is the main reason. The myths and beliefs about this stage of life of the African woman are largely unknown. Symptoms do not vary greatly from those observed elsewhere, but social, economic and nutritional factors may influence the biological pattern. For some authors, the incidence of breast cancer does not decline at this age as it does in western countries. For other authors, 50% of breast cancers occur during the post-menopause period, revealing an aggressive form of the disease. Exceptional uterine cancers have also been observed. Osteoporosis is apparently milder in African women. This observation should be examined in more detail.
Pheochromocytoma is a catecholamine-secreting neoplasm of chromaffin tissue. The most common symptom is hypertension but there are incidentally discovered forms at imaging. From 1981 to 1998, the authors observed nine pheochromocytomas through three hospitals in Dakar. This study included seven male and two female patients. The average age was 31.61 years. Hypertension was present in 77% of the cases. Headache, palpitations and sweating were the authors most frequent symptoms, occuring in 55% of cases. Measurement of vanillyl mandelic acid level in six cases and urinary metanephrines in three cases made the diagnosis. There were six adrenal and three extra adrenal pheochromocytomas with two malignant tumors features. In our countries, measurement of urinary metanephrines and computed tomography processing may improve detection of pheochromocytomas.
Pheochromocytoma is one of the main curable etiologies of high blood pressure, although its diagnosis and therapeutic management can be problematical: an incorrect diagnosis or inappropriate treatment may lead to fatal complications. This disease was exceptionally uncommon in the 1950s, and 30 years later about 30 cases had been reported; however, since 1981 there has been a progressive increase in the incidence of pheochromocytoma (48 documented cases in Africa). In Africa, this disease has two particular characteristics: the gravity of the clinical symptoms, mainly due to the physiological and pharmacological effects of catecholamines which as a result of this disease are stored and liberated at very high rates; and the ectopic site in a number of cases. To facilitate the diagnosis of pheochromocytoma improved clinical investigation is therefore advocated, but the necessary medical equipment is not always available in Africa. On this continent, the ectopic factor confirms the observations made in the early 1980s, and should be taken into consideration in the diagnosis and management of this disease.
The authors have reported five cases of end stage diabetic nephropathy. Thi growing disease has began to reduce vital prognosis of Black african insulin independent diabetic. So, economic and social problem for their resolution (hemodialysis, kidney graft) is going to appear.
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This work has been conducted on 162 subjects, aged over 60 years, living in Senegal, investigated in the Departement of Biophysics and Nuclear Medecine of Dakar for suspicion of dysthyroidism. The levels of T3, T4 and TSH US hormones were determined by a radio-immunological method. This technique, exhibiting good functionnal sensitivity and its high specificity, is likely to be beneficial to the diagnosis of dysthyroidisms. Besides, this experiment leads us to consider that the dosage of TSH remains an useful first intention examination for the old patients and could notably improve the screening of dysthyroidisms with a decrease in the cost of the investigation. However, because of the therapeutical implications, some biological profiles schould be interpreted cautiously. The equipment for the determination of the free fractions (T3 and T4) with the brought additional accuracy could allow to dismiss some diagnostci uncertainties.
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Literature review shows that in the African Sub-Sahara, prevalence of diabetic retinopathy is between 15 and 52%, the main age being the fifties (between 45.5 and 53.25 years in our cases); after 5 years of diabetes evolution (8.45 +/- 6.93 years in our cases) men being two to three fold more affected than women; non insulin dependent diabetes representing 77% and insulin dependent diabetes 23%. The type of retinopathy is usually mixed, both edematous and ischemic (88% being non proliferative). Retinopathy concerned mainly non obese, non insulin dependent diabetics in our cases. Risk factors are poor glycemic control and arterial hypertension. Diabetes duration was the sole and most evident risk factor. Diabetes duration was 5.28 +/- 5.28 years when retina was normal and reached 8.58 +/- 5.33 years for Stage II and 12.8 +/- 6.31 years for retinopathy Stage III and 16.75 +/- 7.25 years for retinopathy Stage IV. These factors, delayed diagnosis and diabetes progression in Africa justify improvement of diabetes care by multidisciplinary team to prevent blindness.
Ischemic necrosis of the antehypophysis is still observed in developing countries. Its prevalence is unknown, but a significant number of the patients are young women. Traditions of home delivery and lack of obstetrical facilities are the main risk factors. The clinical manifestations are often quite typical but atypical signs including neuropsychiatric ore water metabolism disorders are observed. The delay to onset of overt disease can be very long. Ischemic necrosis of the antehypophysis should be entertained as a possible diagnois in women with hypopituitarism.
In Africa, a rise in complications of diabetes mellitus has gone in hand with the growing disease prevalence, clearly demonstrating the importance of assessing complications. Diabetes mellitus constitutes a major financial burden in developing countries in Africa with relatively limited resources. Ketoacidosis is observed in 24% of juvenile diabetes and is the inaugural sign in 76% of all cases, progressing to coma in 34%. Even in type 2 diabetes, acidoketosis occurs in 34% of the cases. Infection is particularly frequent and is often fatal in tropical Africa because of the involvement of Staphyococcus and Gram-negative microorganisms. Hyperleukocytosis and anemia are correlated with ineffective antibiotic therapy. Pulmonary tuberculosis is the ninth most frequent complication of diabetes. Overall mortality is 14.9 per 1000 person-years of diabetes. Mean age at death is 51.6 years for women and 57.6 years for men after a mean 12.5 year disease duration. Thirty percent of all deaths result from acute metabolic complications, infections and stroke. More than half of the patients with insulin-dependent-diabetes have retinopathy. Differences observed in patients with different ethnic origins is linked basically to unfavorable social and economic conditions that worsen the risk of poor blood glucose control. Retinopathy accounts for 32% of all ocular complications, similar to other African data and more generally in ophthalmology centers. The rate of neuropathy is high, reaching 70% in patients with microangiopathy. Impotence concerns 48.7% of the diabetic population with a mean age of 41.4+/-15.5 years. Coronary artery disease had a recognized influence on hemoglobin diseases, particularly when the coronarography is normal. Lower limb arteriopathy is observed in 18% of the diabetic patients.
PURPOSE: Though common in elderly, with poor and masked symptomatology, hyperthyroidism has never been studied in people older than 50 years of age in African countries. METHODS: Of the 300 cases of hyperthyroidism that were observed during this study, 31 belonged to this category. We analyzed the frequency of various parameters, demographic characteristics, motivation for consulting, thyrotoxic syndrome, non thyrotoxic signs, cardiac manifestations, hormonal and scintigraphic characteristics, etiology and etiologic factors, and treatment. RESULTS: The frequency of hyperthyroidism in this population was 10%. Housewives were more numerous, with 20 cases observed in the 31 patients. The main group (13/31) was of rural origin. Signs that predominantly led to consultation were weight loss (23/31), cervical tumor (17/31), and palpitations (12/31). Three major signs were associated with the thyrotoxic syndrome: weight loss (29 cases), tachycardia (27/31), and the existence of tremors in the extremities (22/31). Hormone assays showed that thyroxine (T4) was about 265 +/- 74 nmol/L and triiodothyronine (T3) about 6 +/- 2 nmol/L, at immunoradiometric assay; thyroid-stimulating hormone (TSH) was about 0.17 +/- 0.23 muIU/mL. Eye protrusion predominated in the nonthyrotoxic syndrome, with 25 cases in the 31 patients. Etiologic forms of the disease were composed of 25 Grave's disease, with 22 typical cases. Etiologic factors were various, however without any case of neoplasia. Cardiac complications included two cases of atrial fibrillation. No iatrogenic form of the disease was observed. Mean initial carbimazole dosage was about 34 +/- 8 mg/d. Of the 23 patients, 15 had a favourable outcome. CONCLUSIONS: In this series, the high number of housewives and the patients' rural origin were less characteristic of hyperthyroidism than the Grave's disease etiology. This might be due to the young age of this African population.
Chronic thyreotoxic neuromyopathy was observed in four patients. The first two cases were observed in a 43-year-old woman and a 60-year-old man. In the man, muscle disorders were the first manifestation and in the woman they were preceded by Graves' hyperthyroidism. Muscle signs were seen as functional impotency with amyotrophy of the girdle which was major in the man and minor in the woman. In a third case, a pyramidal syndrome was associated with polyneuropathy in a 28-year old man. Laboratory tests showed hyperthyroidism, neurological signs regressed with antithyroid drug therapy. A fourth case presented as thyrotoxic hypokaliemic periodic palsy in a 37-year-old man who had loss 12 kg over a two month period after a psychological stress. This man then experienced two acute episodes of hypokaliemia and hypotonic tetraplegia. These signs were linked to Graves' hyperthyroidism. Clinical course was good under carbimazole and then radioactive iodine. These four cases illustrate the reality of thyrotoxic neuromyopathies in black Africans.
In insulin-dependent diabetes mellitus, HLA-DR markers are involved, namely DR3, DR4 and DR9 alleles, among black senegalese populations. Studying the different associations of these alleles showed a strong predisposition to insulin-dependent diabetes mellitus with DR3/4 (p > 10(-2); OR = 13.6); DR4/9 (p < 10(-2); OR = 8.32) and DR9/9 (p < 0.05; OR = 7.78). And then it was observed a tendency to an inverse relationship of DR3/4 frequency with age of onset in male patients.
When diabetes has been diagnosed, its classification into different types is traditionally carried out according to clinical criteria. But with arising of new parameters, one of which is C-peptide, and various subtypes of diabetes, it became more difficult. So, in order to improve the accuracy of the classification, 270 diabetic patients and 269 controls, all black senegalese subjects, were submitted to a two-step oral glucose tolerance test (0 and 120 min.) with determination of plasma glucose and C-peptide concentrations. The majority of NIDDM were confirmed at the opposite of IDDM; furthermore, it has been pointed out a group corresponding with impaired glucose tolerance (IGT) among the initial controls. When comparing the two classification modes, before and after plasma C-peptide determination, it appeared statistically significant differences with p values of 10(-4) for both IDDM and NIDDM.
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At the opposite of HLA-DR, HLA-DQ was not well documented in homogeneous negroïd populations. So, 93 IDDM and 115 control patients, all black senegalese people, were studied. The results showed three HLA-DQ IDDM-related susceptibility genotypes and also a high risk conferred by HLA-DR4/DR9 usually described in Mongoloïd people. Furthermore, DR:DQ associations allowed the identification of three IDDM predisposition genotypes, each of them with a characteristic mean age for disease diagnosis.