Ureteroscopie Retrograde: Expérience de l’Hôpital Général Grand Yoff de Dakar

But: Présenter les résultats de la pratique de l’urétéroscopie à l’Hôpital Général Grand Yoff (HOGGY) de Dakar (Sénégal).Sujets et méthodes: Il s’agit d’une étude descriptive de 91 urétéroscopies effectuées dans le service d’Urologie de l’Hôpital Général Grand Yoff de janvier 2012 à décembre 2013. Les variables de l’étude étaient l’indication, l’âge, la nature de l’urétéroscopie associées ou non au laser, les résultats de la lithotripsie.Résultats: Sept urétéroscopies diagnostiques et 84 urétéroscopies thérapeutiques ont été effectuées. L’âge moyen des patients était de 44,7 ans + - 13,9 ans. L’urétéroscope semi rigide a été utilisé dans 43 cas, l’urétéroscope souple dans 15 cas, l’urétéroscope rigide dans 9 cas. La topographie du calcul était pyélique dans 30 cas, lombaire dans 28 cas, pelvienne dans 13 cas, calicielle dans 10 cas et iliaque dans 3 cas. Le nombre de calcul fragmenté au laser était de 87 calculs. Les complications étaient dominées par les fausses routes dans 8 cas. Le succès global de l’urétéroscopie était de 85,7%.Conclusion: La pratique courante de l’urétéroscopie constitue un défi pour l’urologue en Afrique subsaharienne. Elle est devenue le traitement de choix de la lithiase de la voie excrétrice supérieure.Mots clés: ithiase; Urétéroscopie; Laser; Sonde JJEnglish AbstractObjective: To present the results of the ureteroscopy at the GrandYoff General Hospital (Hoggy) in Dakar (Senegal).Subjects and methods: This is a descriptive study of 91 ureteroscopy procedures performed at the Urology department of Grand Yoff General Hospital from January 2012 to December 2013. The variables of the study were indication, age, type of ureteroscopy associate or no laser, results of lithotripsy.Results: Seven diagnostic ureteroscopy and 84 therapeutic ureteroscopy were done. The average age of the patients was 44.7 years + - 13,9 years. Semi-rigid ureteroscope was used in 43 cases, flexible ureteroscope in 15 cases and rigid ureteroscope in 9 cases. The location of the stones was renal pelvis in 30 cases, upper ureter in 28 cases, distal ureter in 13 cases, calix in 10 cases and middle ureter in 3 cases. The number of laser (Nd:Yag) fragmented stones was 87. Complications were dominated by false passages in 8 cases. The overall success of endoscopic treatment was 85.7%.Conclusion: The current practice of endoscopic treatment for upper urinary tract stone is quite challenging to the urologist practising in sub- Sahara Africa. The effectiveness and lesser morbidity of laser lithotripsy has made it the treatment of choice for upper urinary tract stones.Keywords: Lithiasis; Ureteroscopy; Laser; JJ sten

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal

BACKGROUND: Coverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed ~400 000 oral HIV self-tests (HIVST) in Côte d'Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors. METHODS: A phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression. RESULTS: Between March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague). The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25-34, aOR: 0.37 [95%CI: 0.30-0.44], and 26% for 35 years or more, aOR: 0.28 [0.21-0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47-0.77], and 29% for higher education, aOR: 0.33 [0.25-0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40-0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59-2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08-1.60]). CONCLUSION: ATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa

Insecticide Resistance Profiling of Anopheles coluzzii and Anopheles gambiae Populations in the Southern Senegal: Role of Target Sites and Metabolic Resistance Mechanisms.

The emergence and spread of insecticide resistance among the main malaria vectors is threatening the effectiveness of vector control interventions in Senegal. The main drivers of this resistance in the Anopheles gambiae complex (e.g., An. gambiae and Anopheles coluzzii) remains poorly characterized in Senegal. Here we characterized the main target site and metabolic resistances mechanisms among the An. gambiae and An. coluzzii populations from their sympatric and allopatric or predominance area in Senegal. Larvae and pupae of An. gambiae s.l. were collected, reared to adulthood, and then used for insecticides susceptibility and synergist assays using the WHO (World Health Organisation) test kits for adult mosquitoes. The TaqMan method was used for the molecular characterization of the main target site insecticide resistance mechanisms (Vgsc-1014F, Vgsc-1014S, N1575Y and G119S). A RT-qPCR (Reverse Transcriptase-quantitative Polymerase Chaine Reaction) was performed to estimate the level of genes expression belonging to the CYP450 (Cytochrome P450) family. Plasmodium infection rate was investigated using TaqMan method. High levels of resistance to pyrethroids and DDT and full susceptibility to organophosphates and carbamates where observed in all three sites, excepted a probable resistance to bendiocarb in Kedougou. The L1014F, L1014S, and N1575Y mutations were found in both species. Pre-exposure to the PBO (Piperonyl butoxide) synergist induced a partial recovery of susceptibility to permethrin and full recovery to deltamethrin. Subsequent analysis of the level of genes expression, revealed that the CYP6Z1 and CYP6Z2 genes were over-expressed in wild-resistant mosquitoes compared to the reference susceptible strain (Kisumu), suggesting that both the metabolic resistance and target site mutation involving kdr mutations are likely implicated in this pyrethroid resistance. The presence of both target-site and metabolic resistance mechanisms in highly pyrethroid-resistant populations of An. gambiae s.l. from Senegal threatens the effectiveness and the sustainability of the pyrethroid-based tools and interventions currently deployed in the country. The Kdr-west mutation is widely widespread in An. coluzzii sympatric population. PBO or Duo nets and IRS (Indoor Residual Spraying) with organophosphates could be used as an alternative measure to sustain malaria control in the study area

QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali

<p>Abstract</p> <p>Background</p> <p>Maternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel.</p> <p>Methods/Design</p> <p>This is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1) Educational outreach visits; and 2) the implementation of facility-based maternal death reviews.</p> <p>The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of resources and the satisfaction surveys administered to the health personnel, will allow us to measure results before, during, and after the intervention. The overall rate of maternal mortality measured in hospitals during the post-intervention period (Year 4) is the primary outcome. The evaluation will also include cost-effectiveness.</p> <p>Trial Registration</p> <p>The QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658 <url>http://www.controlled-trials.com/</url>.</p

Malaria training for community health workers in the setting of elimination: a qualitative study from China

Background: Continuous training of health workers is a key intervention to maintain their good performance and keep their vigilance during malaria elimination programmes. However, countries progressing toward malaria elimination have a largely decreased malaria disease burden, less frequent exposure of health workers to malaria patients, and new challenges in the epidemiology of the remaining malaria cases. Moreover, competing health priorities and usually a decline in resources and in political commitment also pose challenges to the elimination programme. As a consequence, the acceptability, sustainability, and impact of malaria training and education programmes face challenges. However, little is known of the perceptions and expectations of malaria training and education programmes of health workers being engaged in countries with malaria elimination programmes. Methods: This qualitative study provides information on perceptions and expectations of health workers of malaria training programmes from China, which aims to malaria elimination by the year 2020. This study was embedded into a larger study on the challenges and lessons learned during the malaria surveillance strategy in China, involving 42 interviews with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels from Gansu province (northwestern China) and Jiangsu province (southeastern China). Results: In the context of an increasing number of imported malaria cases in China, the majority of respondents emphasized the necessity and importance of such programmes and complained about a decreasing frequency of training courses. Moreover, they called for innovative strategies to improve the implementation and sustainability of the malaria training programmes until the elimination goal has been achieved. Perceptions and expectations of health workers from different health centres were quite different. Health workers from higher-level facilities were more concerned about technical training aspects, while health workers from periphery of the health system expected to receive more training on field work coordination and on specific public health actions with regard to case detection and focus investigation. Conclusions: There is need to guarantee an ongoing good training of health workers in China on malaria aspects until the year 2020 and probably beyond

Evaluation of Group Genetic Ancestry of Populations from Philadelphia and Dakar in the Context of Sex-Biased Admixture in the Americas

Population history can be reflected in group genetic ancestry, where genomic variation captured by the mitochondrial DNA (mtDNA) and non-recombining portion of the Y chromosome (NRY) can separate female- and male-specific admixture processes. Genetic ancestry may influence genetic association studies due to differences in individual admixture within recently admixed populations like African Americans.We evaluated the genetic ancestry of Senegalese as well as European Americans and African Americans from Philadelphia. Senegalese mtDNA consisted of approximately 12% U haplotypes (U6 and U5b1b haplotypes, common in North Africa) while the NRY haplotypes belonged solely to haplogroup E. In Philadelphia, we observed varying degrees of admixture. While African Americans have 9-10% mtDNAs and approximately 31% NRYs of European origin, these results are not mirrored in the mtDNA/NRY pools of European Americans: they have less than 7% mtDNAs and less than 2% NRYs from non-European sources. Additionally, there is <2% Native American contribution to Philadelphian African American ancestry and the admixture from combined mtDNA/NRY estimates is consistent with the admixture derived from autosomal genetic data. To further dissect these estimates, we have analyzed our samples in the context of different demographic groups in the Americas.We found that sex-biased admixture in African-derived populations is present throughout the Americas, with continual influence of European males, while Native American females contribute mainly to populations of the Caribbean and South America. The high non-European female contribution to the pool of European-derived populations is consistently characteristic of Iberian colonization. These data suggest that genomic data correlate well with historical records of colonization in the Americas

Les lésions des organes génitaux externes par arme à feu. A propos de six observations à l'Hôpital A. Le Dantec, Dakar, Sénégal

No Abstract. African Journal of Urology Vol. 12(1) 2006: 55-5

Le carcinome épidermoïde de l\'urètre masculin

No Abstract. African Journal of Urology Vol. 11(3) 2005: 230-23

Priapism: clinical aspects and etiologyLe Priapisme: particularités cliniques et étiologiques

Objective: To evaluate the clinical, etiological and therapeutical aspects of priapism. Patients and Methods: Sixty-three patients were retrospectively studied regarding their age, the time elapsed between onset of the condition and presentation at the hospital, their medical and surgical history, additional examinations such as blood count and hemoglobin electrophoresis, treatment modalities and outcome of treatment. Results: The mean age of the patients was 22,4 years (range: 3-68 years). The time elapsed between onset of the condition and presentation at the hospital ranged from 4 hours to 41 days. Two patients (3,2%) presented about 6 hours after the onset of priapism, while 80,9% presented more than 24 hours later. Hemoglobin electrophoresis revealed sickle-cell disease in 29 (46%) patients. In two patients, priapism occurred after intracavernous injection of vasoactive drugs. The patients were treated medically and/or surgically. Immediate penile flaccidity after treatment was obtained in 53 cases (84,1%). At a mean follow-up of 8 months 51 patients could be evaluated; 23 of them (45,1%) reported a satisfactory erection. Fibrosis of the corpora cavernosa occurred in 24 (38.1%) patients. Conclusion: Priapism represents a urologic emergency which in Africa is commonly associated with sickle-cell disease. A timely and adequate treatment in our environment is rendered difficult due to the fact that most patients present very late. This situation can only be changed by an improvement of the socio-economic situation and a large-scale education of the population as well as the establishment of a larger number of specialized medical and health centers.Resume Objectif : L\'objectif de ce travail était d\'étudier les particularités de cette affection sur les plans clinique, étiologique et thérapeutique. Patients et Méthode : Il s\'agit d\'une étude rétrospective portant sur 63 patients. Les paramètres étudiés ont été: l\'âge, le délai écoulé avant la consultation, les antécédents médicaux et chirurgicaux, les examens complémentaires avec essentiellement un hémogramme et une électrophorèse de l\'hémoglobine ainsi que les modalités et résultats du traitement. Résultats : L\'âge moyen des patients était de 22,4 ans avec des extrêmes de 3 et 68 ans. Le délai entre le début des troubles et le traitement variait de 4 heures à 41 jours. Deux patients (3,2%) ont consulté avant la 6ième heure alors que 80,9% ont consulté après les 24 premières heures. L\'électro-phorèse de l\'hémoglobine a permis de retrouver 29 (46%) patients drépanocytaires. Chez 2 patients, le priapisme était survenu après injection intra-caverneuse de drogues vasoactives. La prise en charge des patients a été médicale et/ou chirurgicale. Sur le plan local, une fibrose des corps caverneux a été retrouvée chez 24 patients (38,1%) après un recul moyen de 8 mois. Sur la même période, 51 patients étaient évaluables sur le plan de la fonction érectile et 23 patients (45,1%) estimaient avoir une érection satisfaisante. Conclusion: Le priapisme constitue une urgence urologique qui en Afrique présente certaines particularités telles que la fréquence de l\'étiologie drépanocytaire et les délais de consultation prolongés. Cette prise en charge passe également par l\'information, l\'éducation, le relèvement du niveau socio-économique des populations et la multiplication de structures sanitaires spécialisées. African Journal of Urology Vol. 11(3) 2005: 186-19