The study of different ethnic groups living in the same physical environment provides the opportunity to examine interaction of genetic and environmental factors in the aetiology of diabetes mellitus. In rural New Caledonia, the prevalence of diabetes was higher in part-Polynesians than in Melanesians: males - 6.6 versus 0.5%; females - 6.3 versus 3.5% respectively. The prevalence of abnormal glucose tolerance (impaired glucose tolerance and diabetes) was 11.5 and 15.7% in part-Polynesian males and females, respectively, and 4.7 and 9.2% in Melanesian males and females. Mean age and degree of obesity in these ethnic groups were sufficiently similar to suggest that these factors played no significant role in the difference in diabetes prevalence. Furthermore, adjustment of relative risk of impaired glucose tolerance and diabetes for age and obesity indicated that the modest differences between groups were not responsible for the observed variation in diabetes prevalence. The differences in prevalence of impaired glucose tolerance and diabetes between Melanesians and part-Polynesians may be genetically determined, although the role of certain environmental factors other than obesity, e.g. differences in physical activity or qualitative aspects of diet, cannot be excluded.

Adult↗

PubMedDate not supplied

Antibodies to HIV2 in genital secretions.

In order to study the local immune response to HIV2, three exclusively heterosexual, infected West African patients were selected: one male with full blown AIDS, one female with ARC and one healthy HIV2-carrier female. Sera and genital secretions were obtained and tested for anti-HIV2 IgG and IgA antibodies by Western blotting. In semen and in vaginal secretions, IgG antibodies directed against all viral antigens were detected. In comparison with the IgG response, local IgA antibody response was less intense and heterogenous. Two out of 3 patients had local antibodies of the IgA class directed against the envelope glycoprotein GP105. Such antibodies of both the IgG and IgA classes in genital secretions could play a protective role in heterosexual transmission of HIV2.

AIDS-Related Complex↗

PubMedDate not supplied

[The value of laparoscopy. Results of 600 studies performed in an internal medicine department at the General Hospital of Dakar].

600 laparoscopic examinations were performed in an Internal Medicine Department of the general Hospital Dakar (Senegal) from 1984 to 1989 in 402 males and 198 females aged from 7 to 82 years. This examination of simple and quick procedure well tolerated under simple premedication, should be performed only after diffusion of the pneumoperitoneum, per- foration being the major risk. Even if liver cell carcinoma and cirrhosis represent more than an half of the examined cases (52%) due to their high frequency, exploration of peritoneal pathology is the best indication for laparoscopy. Thanks to laparoscopy, 68 tuberculosis, 28 peritoneal carcinomatosis and 11 infectious peri-hepatitis were diagnosed. It remains a major examination perfectly adapted to studies of the so-frequent hepato-peritoneal pathology in Black Africa]

Adolescent↗

PubMedDate not supplied

[Mucous diaphragm of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the General Hospital of Dakar. Relationship with the Kelly-Paterson or the Plummer-Vinson syndrome].

At the occasion of 15,000 high endoscopies performed during the past 5 years at the general Hospital of Dakar (Senegal) 38 mucous diaphragms of cervical esophagus were discovered. 36 patients are Black Senegalese; 29 females and 9 males with a mean age of 37. Dysphagia was present 29 times and anemia 22 times. Endoscopies diagnosis is easy, putting into light a mucous diaphragm at the level or immediately below Killian mouth. 18 of these cases have been classified as Kelly-Paterson syndrome. Performed in 30 patients, the treatment consists in breaking down the mucous diaphragm with an endoscope. It is difficult to keep on endoscopic monitoring, although it is essential because the risk of cancerisation.

Adolescent↗

PubMedDate not supplied

[Pseudomembranous colitis after antibiotic therapy associated with the presence of Entamoeba histolytica histolytica. Apropos of 2 cases].

The authors report on two cases of pseudomembranous colitis (P.M.C.) developed in two Senegalese women of 38 and 36 years, and discovered at the 4th and 5th day respectively of an antibiotherapy based on ampicillin. In these two observations, cysts of Entamoeba histolytica histolytica were found in both feces and biopsies. They recall the circumstances of the occurrence, diagnosis techniques and treatment. They underline the unfrequency of this disease in Africa south of Sahara and they discuss the correlation with amoebiasis colitis. One has to keep in mind the possibility of a P.M.C. during any antibiotherapy, and consequently to have a rectoscopy to perform. Such an exploration is enough to pose a diagnosis. In day to day practice it is not necessary to show clearly the specific germ Clostridium difficile or its entero-toxin. To stop any antibiotherapy is required and beneficial. Metronidazole or Vancomycin are the best drugs in this case.

Adult↗

PubMedDate not supplied

[Acute disseminated lupus erythematosus in Ivory Coast (apropos of 9 cases)].

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.

Acute Disease↗

PubMedDate not supplied

[Human immunodeficiency virus infections (HIV-1 and HIV-2) in Dakar. Epidemiologic and clinical aspects].

The authors report on the results of an investigation carried out on 109 HIV seropositives ascertained by the Dakar Central Hospital between February 20, 1987 and May 31, 1988. These seropositives affected 44 patients with AIDS (0.78% of admitted patients) and 65 seropositive people of which 43 blood donors (1.35% of donors). Both viruses are present in about equal number: 50 HIV1 seropositives, 44 HIV2 seropositives, and 15 composite seropositives. Sex-ratio is 3,9 in favour of males; this figure is nearer to the one observed in Europe and North American than the one observed in Central Africa where there is equality between both sex. Clinical patterns are dominated by a bad general status: lost of weight, fever, diarrhea, polyadenopathiae, pneumopathiae, meningoencephalitis. Kaposi's sarcoma and cryptococcal meningitis have been observed only four times. Development of the infection lead to death for 12 patients during the 16 months of the investigation. Both viruses are responsible for an equal immunodepression, leading to the same potential severity. Immunodepression might be acquired more slowly with HIV2, so strongly suggesting an incubation apparently lasting more.

AIDS Serodiagnosis↗

PubMedDate not supplied

[Rectocolonic polyps in Senegal. Results of 1500 lower endoscopies carried out at the Dakar General Hospital].

57 polyps were discovered during 1,500 low endoscopies, and 24 of them were adenoma. In the same period of time, 26 proctocolitic adenocarcinomas were found. Adenomatous polyps appear to be 5 times less frequent in Senegal than in industrialized countries and frequency of colitic cancer should be of the same frequency, that is far less negligible. Even if proctocolitic cancer does not set up any Public Health problems one could envisage systematic screening of polyadenoma in every patient aged more than 40. Proctosigmoid being the seat of most adenoma, fibrosigmoidoscopy appears well adapted to this kind of screening because it does not require any preparation, it is easy to perform and well accepted.

Adolescent↗

PubMedDate not supplied

[Value of ultrasonically-guided liver puncture biopsy in the diagnosis of primary liver cancer. Apropos of 84 cases].

Ultrasonographicaly guided fine needle aspiration of liver was performed in 84 patients having a confirmed HCC. This technics utilizes a CHIBA type fine needle, after blood coagulation tests have been checked. Out of 84 fine needle aspirations performed: 64 were positive (76,2%), 9 negative (10,7%), 11 (13,19%) were questionable (6) or nonanalysable (5). It is ascertained that the sensibility of this technics is over 75%. It should be possible to improve it by repeating such an exam in previously negative patients. The causes of failure are discussed. Tolerance of the technics is good. It is attraumatic, and of very easily performance. No accident, no mishap was noted.

Adolescent↗

PubMedDate not supplied

[Early congenital syphilis (7 cases observed in Bangui Hospital Central African Empire) (author's transl)].

In an infant of good condition, skin changes, anemia, hepato-splenomegalia and more over radiological osseous changes are symptoms of great value which are to be confirmed by a serological test of the baby and its mother. Treatment is very effective but it would be better to protect the foetus by an early detection and treatment of the syphilitic pregnant woman.

Antigens, Bacterial↗

PubMedDate not supplied

[Incidence of biliary lithiasis in African urban areas (Abidjan): a little known pathology?].

The rarity of cholelithiasis in black Africa is a very classical concept that must be called in question again. With the exception of pigmentary lithiasis frequently found in patients with an homozygous haemoglobinopathy, genetic as well as environmental (particularly food related) factors explain in part the low frequency of cholelithiasis with cholesterol gallstones in Africa. Yet the true incidence of cholelithiasis is too often unappreciated. Before the use of ultrasonography, only symptomatic cholelithiasis were detected, usually by the surgeon (19 cases admitted during a 6 years period in the Internal Medicine Department at Treichville University Hospital, Abidjan). The practice of ultrasonography will ease the detection of asymptomatic cholelithiasis. Since ultrasonography has been set up at Treichville University Hospital, 30 cholelithiasis of which 21 were asymptomatic have been detected during an 8 months period, a high detection level of course for a so-called rare disease.

Adolescent↗