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Biomedical subjects

S Fall

Publications and source records attributed to S Fall.

13 recordsLinked to original sources

[Polyarticular gout in young adults: a curable rheumatic disease].

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.

Adult↗

[Senegalese case of thromboangeitis obliterans or Buerger's disease].

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.

Adult↗

Bacterial density and community structure associated with aggregate size fractions of soil-feeding termite mounds.

The building and foraging activities of termites are known to modify soil characteristics such as the heterogeneity. In tropical savannas the impact of the activity of soil-feeding termites ( Cubitermes niokoloensis) has been shown to affect the properties of the soil at the aggregate level by creating new soil microenvironments (aggregate size fractions) [13]. These changes were investigated in greater depth by looking at the microbial density (AODC) and the genetic structure (automated rRNA intergenic spacer analysis: ARISA) of the communities in the different aggregate size fractions (i.e., coarse sand, fine sand, coarse silt, fine silt, and dispersible clays) separated from compartments (internal and external wall) of three Cubitermes niokoloensis mounds. The bacterial density of the mounds was significantly higher (1.5 to 3 times) than that of the surrounding soil. Within the aggregate size fractions, the termite building activity resulted in a significant increase in bacterial density within the coarser fractions (>20 mum). Multivariate analysis of the ARISA profiles revealed that the bacterial genetic structures of unfractionated soil and soil aggregate size fractions of the three mounds was noticeably different from the savanna soil used as a reference. Moreover, the microbial community associated with the different microenvironments in the three termite mounds revealed three distinct clusters formed by the aggregate size fractions of each mound. Except for the 2-20 mum fraction, these results suggest that the mound microbial genetic structure is more dependent upon microbial pool affiliation (the termite mound) than on the soil location (aggregate size fraction). The causes of the specificity of the microbial community structure of termite mound aggregate size fractions are discussed.

Acridine Orange↗

[HIV associated nephropathy syndrome: a case report in Dakar].

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.

AIDS-Associated Nephropathy↗

[Non iatrogenic primary hypothyrodism in adults at Le Dantec Hospital : clinical features, diagnosis and treatment. Review of 19 cases].

The authors report 19 cases of non iatrogenic primary hypothyroidism in adults at Le Dantec Hospital of Dakar. Those cases had been found during a period of 6 years and half in the internal medicine service. The aim was to study clinical features, diagnosis and outcome of patients after treatment. The mean age of patients was 42.2 years with a sex-ratio of 0.33 M/F. The diagnosis delay was around 6,1 years. All patients presented clinical signs of hypometabolism: physical asthenia (63.15%), frilosity (26.3%), bradycardia (47.3%), constipation (36.8%). The cutaneomucal syndrom was composed by myxoedema (73.6%), macroglossia (26.3%), raucousness of voice (26.3%), alopecia (57.9%). Muscle weakness was found in 2 cases and genital troubles in 3 cases. Five patients presented goiter and 9 others had spontaneous thyroid atrophy. All patients presented a high level of TSH associated with decreased level of T4. Anemia was found in 7 cases and hypercholesterolemia in 13 cases. Treatment was based on substitutive hormonotherapy with L-Thyroxin (75 to 250 microg/day). Evolution was favorable after 10 month mean duration of processing. More alertness is necessary on behalf of the practitioners in front of any sign suggesting hypometabolism to reduce the diagnostic delay and prevent complete form of hypothyroidism that might be complicated, by cardiac involvement in particular.

Adolescent↗

Characterization of Vibrio fluvialis-like strains implicated in limp lobster disease.

Studies were undertaken to characterize and determine the pathogenic mechanisms involved in a newly described systemic disease in Homarus americanus (American lobster) caused by a Vibrio fluvialis-like microorganism. Nineteen isolates were obtained from eight of nine lobsters sampled. Biochemically, the isolates resembled V. fluvialis, and the isolates grew optimally at 20 degrees C; none could grow at temperatures above 23 degrees C. The type strain (1AMA) displayed a thermal reduction time (D value) of 5.77 min at 37 degrees C. All of the isolates required at least 1% NaCl for growth. Collectively, the data suggest that these isolates may embody a new biotype. Pulsed-field gel electrophoresis (PFGE) analysis of the isolates revealed five closely related subgroups. Some isolates produced a sheep hemagglutinin that was neither an outer membrane protein nor a metalloprotease. Several isolates possessed capsules. The isolates were highly susceptible to a variety of antibiotics tested. However, six isolates were resistant to erythromycin. Seventeen isolates harbored plasmids. Lobster challenge studies revealed that the 50% lethal dose of a plasmid-positive strain was 100-fold lower than that of a plasmid-negative strain, suggesting that the plasmid may enhance the pathogenicity of these microorganisms in lobsters. Microorganisms that were recovered from experimentally infected lobsters exhibited biochemical and PFGE profiles that were indistinguishable from those of the challenge strain. Tissue affinity studies demonstrated that the challenge microorganisms accumulated in heart and midgut tissues as well as in the hemolymph. Culture supernatants and polymyxin B lysates of the strains caused elongation of CHO cells in tissue culture, suggesting the presence of a hitherto unknown enterotoxin. Both plasmid-positive and plasmid-negative strains caused significant dose-related intestinal fluid accumulations in suckling mice. Absence of viable organisms in the intestinal contents of mice suggests that these microorganisms cause diarrhea in mice by intoxication rather than by an infectious process. Further, these results support the thermal reduction data at 37 degrees C and suggest that the mechanism(s) that led to fluid accumulation in mice differs from the disease process observed in lobsters by requiring neither the persistence of viable microorganisms nor the presence of plasmids. In summary, results of lobster studies satisfy Koch's postulates at the organismal and molecular levels; the findings support the hypothesis that these V. fluvialis-like organisms were responsible for the originally described systemic disease, which is now called limp lobster disease.

Animals↗

[Systemic scleroderma: 92 cases in Dakar].

We performed a retrospective study in order to characterize epidemiological data and signs of systemic scleroderma in Sénégal. All patients with the diagnosis according the ACR's criteria of scleroderma were recruited. We included 92 patients, the mean age was 33 years and sex ratio male to female was 0.19 (15 men and 77 women). There were 8 children in our series (8.9%). The initial complaints were cutaneous manifestations (64%) and Raynaud's syndrome (16.3%). Clinical manifestations at admission were muco-cutaneous (100%), osteo-articular and muscular (59%) and Raynaud's syndrome (57%). Focal hypopigmentation was common (70%). Anti-nuclear antibodies were present in 67.4% of patients. Skin biopsy was contributive in all patients in which it was performed (79 cases). Electrocardiogram was abnormal in 55%, non specific inflammatory syndrome was present in 44% and pulmonary function was abnormal in 52%. Our data suggest that systemic scleroderma is more common in younger people in black population. Disorders of pigmentation are common and Raynaud's syndrome is uncommon.

Adolescent↗

[Diabetic ketoacidosis at an internal medicine service].

Ketoacidosis as usual inaugural manifestation and the high frequency of infectious precipating events have been reported in our department on 1986. These same aspects were found in other African series. In this retrospective study of 34 patients presenting an ketoacidosis and managed from, July 1st 2001 to December 31st 2001, we have evaluated the precipating events, and analysed the evolution in comparison with our previous study. Age range was 15 to 74 years with a mean of 43.9. Sex ratio was 2.4. Ketoacidosis inaugurated the disease in 41.17% of cases. Diabetic type 2 was the most frequent one, with an evolution mean duration of 8.1 years. The presenting picture of admission was varied. In addition to the disturbance of consciousness, dehydratation and compensatory hyperventilation were common. With 82.3% in our series versus 43.22% in previous one, infection remain the main precipating cause in our internal medicine department and in tropical area. The disease course was favorable under therapy in 32 patients (94.1%) versus 64.32% on 1986. This might be explained by the lack of hypoglycemic episodes in this present series. The average hospitalisation duration was 20 days. This fact point out the importance of diabetic patients education and screening programs.

Adolescent↗

[Behçet's disease in Dakar (Senegal): epidemiological and clinical features].

We report epidemiological and clinical characteristics of 17 consecutives patients with Behçet disease during 26 years in Dakar(Sénégal). All the patients were black, with a mean age of 27.5 years (11- 42 years) and the disease was more common between 20 and 30 years. The sex ratio was 2.4 (12 men -5 women). The majority live in cost area (64.7). Clinical features frequencies were as follow muco-cutaneous (94.11%), ocular (58.82%) neurological (47.05%) articular (47.05) psychiatric (41.17%) vascular (35.29%) digestives (11.76%). Epidemiological characteristics of Behçet disease in Sénégal are common however, the important frequency of neuropsychiatrics manifestations is remarkable.

Adolescent↗

The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Collaborative Stroke Audit and Research.

OBJECTIVE: It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation. DESIGN: A two-centre pilot study to assess the feasibility of performing a multicentre randomized controlled trial on this subject. SETTING: Clatterbridge and Aintree Stroke Rehabilitation Units, Merseyside, UK. SUBJECTS: Forty early stroke patients (mean age 67 years) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied. INTERVENTION: A central randomization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient. They were allocated to either an 'encouraged to self-propel' or a 'discouraged from self-propulsion group'. OUTCOME MEASURES USED: Independent outcome assessment was performed by postal questionnaire and telephone interview using the Barthel ADL Scale, Nottingham Extended ADL Scales and the shortened General Health Questionnaire (GHQ-12) at 3 and 12 months. Patient's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital. RESULTS: After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres. No major differences were found between the pilot groups for any of the outcome measures. CONCLUSIONS: A multicentre randomized controlled trial to assess this question is feasible but further work is being conducted before proceeding, to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures.

Aged↗

[Phospholipid levels in exploration of cerebral atherosclerosis in African Senegalese population].

In the investigation of atherosclerosis, cholesterol and its fractions, triglycerides and glucose are more tested than phospholipids. We were interested by this category of lipids in Senegalese suffering from cerebrovascular disease. We did not find differences between healthy and non healthy subjects for the total phospholipids; but the high density lipoprotein phospholipids were significantly lowered in non healthy subjects. This decrease might explain in part, the atherosclerosis strike. Practicians should pay more attention in this lipidic parameter, using the reference values established in Senegalese.

Adult↗

Conjugated estrogens reduce endothelial prostacyclin production and fail to reduce postbypass blood loss.

Intravenous conjugated estrogens correct bleeding times and reduce bleeding in uremia, gastrointestinal telangiectasias, and liver disease. One study found a similar benefit in patients undergoing open heart surgery. The mechanism by which conjugated estrogens improve bleeding times is unknown. We report on the effect of estrogens on endothelial prostacyclin production and bleeding in coronary bypass surgery. In a randomized, double-blind trial, 16 male patients undergoing elective coronary artery bypass surgery received four daily infusions of conjugated estrogens (0.6 mg/kg/day) or placebo, preoperatively. Groups were similar with respect to age, preoperative hemostatic profiles, and pump time. Conjugated estrogens significantly reduced greater saphenous vein endothelial prostacyclin production in the estrogen group compared to control subjects. Postoperative blood loss was not reduced, with a trend toward increased blood loss in the treatment group. We have shown that conjugated estrogens reduce endothelial prostacyclin production and fail to reduce blood loss in coronary bypass surgery.

Blood Loss, Surgical↗