Pronostic de l’accident vasculaire cerebral hemorragique chez des patients hospitalises a la clinique des neurosciences Ibrahima Pierre Ndiaye, Dakar, Senegal en 2018

Introduction : Les accidents vasculaires cérébraux hémorragiques (AVCH) représentent 10 à 20 % de l‘ensemble des AVC dans les pays industrialisés. En Afrique, la fréquence est élevée avec des taux allant de 28% à 60%. Ils sont souvent de pronostic réservé.Objectif : L‘objectif de notre travail était d‘évaluer le pronostic à court terme de tous les patients hospitalisés pour AVCH à la clinique de neurosciences Ibrahima Pierre Ndiaye du CHNU de Fann.Méthode : Il s‘agit d‘une étude transversale, allant du 1er janvier 2018 au 31 décembre 2018, chez des patients hospitalisés qui remplissaient les critères de diagnostic d‘AVCH.Résultats : Sur un total de 483 dossiers d‘AVC, 132 cas d‘AVCH ont été répertoriés soit une fréquence de 27,3 %. L‘âge moyen des patients était de 59,2 ans avec un écart type à 13. Ils étaient de sexe masculin (57,6%), admis après 48 heures (42,4%) avec comme antécédents l‘HTA (67,5%), la dyslipidémie (28%) et le diabète (12,1%). La mortalité à 30 jours était de 35,6%. Le score ICH moyen était de 1,1. La mortalité était de 31,3% pour un score ICH à 1. Le trouble de la vigilance et le siège sous tentoriel de l‘hématome, l‘hyperglycémie à l‘admission, l‘engagement cérébral sous falcoriel et les complications de décubitus étaient associés de manière statistiquement  significative à la mortalité à 30 jours.Conclusion : Dans notre étude un score ICH bas était associé à une mortalité élevée.   English title: Prognosis of hemorrhagic stroke in hospitalized patients at the Ibrahima Pierre Ndiaye Neurosciences Clinic, Dakar, Senegal In 2018 Background: Hemorrhagic strokes account for 10 to 20% of all strokes. In Africa, the frequency is high with rates ranging from 28% to 60%. Prognosis is often reserved. Objective: The aim of this study was to evaluate the short-term prognosis of patients hospitalized for hemorrhagic stroke at the Ibrahima Pierre Ndiaye Neurosciences clinic of CHNU de Fann. Methodology: It was a cross sectional study, from January 1st 2018 to December 31th 2018, in hospitalized patients who met the diagnostic criteria for hemorrhagic stroke. Results: Of a total of 483 stroke cases, 132 cases of hemorrhagic stroke were reported, a proportion of 27.3%. The mean age of the patients was 59.2 years with a standard deviation of 13. They were male (57.6%), admitted after 48 hours (42.4%) with a history of hypertension (67.5%), dyslipidemia (28%) and diabetes (12.1%). The 30-day fatality rate was 35.6%. The mean ICH score was 1.1. The fatality rate was 31.3% for an ICH score of 1. Loss of consciousness, infra-tentorial hematoma, hyperglycemia on admission, subfalcine herniation and decubitus complications were statistically significantly associated with 30-day mortality. Conclusion: In our study a low ICH score was associated with high mortality

Maladie de Krabbe : a propos d’un cas

Introduction Le diagnostic d’une maladie lysosomiale est utile surtout dans les familles à risque en vue d’effectuer un conseil génétique. Nous rapportons l’observation d’un enfant vu pour la première fois à 13 mois, pour une perte progressive des acquisitions psychomotrices. Dans ses antécédents on notait une consanguinité parentale de premier degré. L’imagerie par résonance magnétique cérébrale révélait des hypersignaux diffus bilatéraux et symétriques periventriculaires, des noyaux lenticulaires et des noyaux dentelés du cervelet sur les séquences T2 et Flair associés à des hyposignaux T2 des thalamus. Le dosage de la Bêta galatocérébrosidase chez l’enfant et les deux parents a permis de faire le diagnostic de maladie deKrabbe.Conclusion Une maladie métabolique doit être recherchée de parti pris chez tout enfant présentant une régression progressive des acquisitions psycho-motrices mais l’insuffisance du plateau technique en Afrique limite considérablement les possibilités diagnostiques

Modelling radiation-induced cell cycle delays

Ionizing radiation is known to delay the cell cycle progression. In particular after particle exposure significant delays have been observed and it has been shown that the extent of delay affects the expression of damage such as chromosome aberrations. Thus, to predict how cells respond to ionizing radiation and to derive reliable estimates of radiation risks, information about radiation-induced cell cycle perturbations is required. In the present study we describe and apply a method for retrieval of information about the time-course of all cell cycle phases from experimental data on the mitotic index only. We study the progression of mammalian cells through the cell cycle after exposure. The analysis reveals a prolonged block of damaged cells in the G2 phase. Furthermore, by performing an error analysis on simulated data valuable information for the design of experimental studies has been obtained. The analysis showed that the number of cells analyzed in an experimental sample should be at least 100 to obtain a relative error less than 20%.Comment: 19 pages, 11 figures, accepted for publication in Radiation and Environmental Biophysic

Qualite de vie apres un accident vasculaire cerebral au Senegal: a propos de 50 cas

Introduction: L’accident vasculaire cérébral (AVC) constitue une cause majeure de mortalité et de handicap chez les survivants. La qualité de vie dépend de la nature du handicap et de sa perception par le patient, son entourage et la communauté.Objectif: Notre objectif était d’évaluer le handicap après un AVC et d’apprécier son retentissement sur la qualité de vie des patients victimes.Patients et Méthodes: Nous avons mené une étude prospective, longitudinale de février 2008 à mai 2009, à la clinique neurologique de FANN. Les patients étaient vus à la phase initiale de l’AVC et 6 mois après et soumis à un questionnaire comportant plusieurs items relatifs à la nature de l’accident vasculaire cérébral, le vécu psychoaffectif et socioprofessionnel, l’index de Barthel a été utilisé chez tous les malades.Résultats: Nous avons colligé 50 patients âgés de 15 à 82 ans, avec une sex-ratio de 1,27. L’accident était ischémique dans 70%, hémorragique dans 30% des cas. 66% des patients avaient un index de Barthel entre (60-100), 6% étaient entre (0-20). Le score était meilleur chez les jeunes (15ans-34ans) qui avait tous un index entre (60-100). Par ailleurs 50% des patients de la tranche supérieure à 75ans étaient dans l’intervalle (60-100). Les AVCH avaient des Meilleurs résultats avec 73,3% à un index entre (60-100). seul 12% ont été réinsérés, sur le plan professionnel. 54,05%, n’ont pas noté de changement dans leur vie conjugale. Sur le plan familial, 56% ne notaient aucun changement. Une grande partie de notre série 44% acceptaient bien leurs  déficits,. 70% ne faisaient plus d’activités de temps libre.Conclusion: La qualité de vie est un concept multidimensionnel qui incorpore outre la santé physique les aspects mentaux et sociaux de la maladie.Mots clés: AVC, qualité de vie, SénégalEnglish Title: Quality of life after stroke in Senegal: about 50 casesEnglish AbstractIntroduction: Stroke is a major cause of mortality and disability in survivors. The quality of life depends on the nature of disability and its perception by the patient, his or her environment and community. The aim of this study was to assess disability after stroke and its impact on quality of life of patients (victims).Patients And Methods: We conducted a prospective, longitudinal study from February 2008 to May 2009, at the Neurological Clinic of Fann. Patients were seen at the initial phase of stroke and 6 months later and answered a questionnary containing 13 items like nature of stroke disability psychological emotional and socioprofessional filds. The index of barthel was used at all the patient’s.Results: We collected, were like this 50 patients aged 15-82 years with a sex ratio of 1.27. The accident was ischemic in 70% of cases, hemorrhagic in 30% of cases. 66% had a Barthel index between (60-100), 6% were between (0-20). The score was significantly better in young series (15-34), which all have a Barthel index between (60-100), more over 50% of patients in the portion above 75 years were in the range (60 - 100). Hemorragic stroke had the best results with 73.3% a Barthel index between (60-100). On a professional level, only 12% patients were rehabilitated. 54.05% didn’t notice any change in their marital life. On the home front, 56% noted any change. A large part of our series 44% accepted although their deficits. 70% didn’t have any more free time activities.Keywords: quality of life, stroke, Senega

Disrupted circadian oscillations in type 2 diabetes are linked to altered rhythmic mitochondrial metabolism in skeletal muscle

Funding: The authors are supported by grants from the AstraZeneca SciLifeLab Research Programme, Novo Nordisk Foundation (NNF14OC0011493, and NNF17OC0030088), Swedish Diabetes Foundation (DIA2018-357), Swedish Research Council (2015-00165 and 2018-02389), the Knut and Alice Wallenberg Foundation (2018-0094), the Strategic Research Programme in Diabetes at Karolinska Institutet (2009-1068), the Stockholm County Council (SLL20170159), and the Swedish Research Council for Sport Science (P2019-0140). B.M.G. was supported by fellowships from the Novo Nordisk Foundation (NNF19OC0055072), the Wenner-Gren Foundation, an Albert Renold Travel Fellowship from the European Foundation for the Study of Diabetes, and an Eric Reid Fund for Methodology from the Biochemical Society. N.J.P. and L.S.-P. were supported by an Individual Fellowship from the Marie Skłodowska-Curie Actions (European Commission: 704978 and 675610). X.Z. and K.A.E. were supported by NIH R01AR066082. N.J.P. was supported by grants from the Sigurd och Elsa Goljes Minne and Lars Hierta Memorial Foundations (Sweden). We acknowledge the Beta Cell in-vivo Imaging/Extracellular Flux Analysis core facility supported by the Strategic Research Program in Diabetes for the usage of the Seahorse flux analyzer. Additional support was received from the Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen (NNF18CC0034900). The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent research center at the University of Copenhagen, partially funded by an unrestricted donation from the Novo Nordisk Foundation. We acknowledge the Single-Cell Omics platform at the Novo Nordisk Foundation Center for Basic Metabolic Research for technical and computational expertise and support. Schematics are created with BioRender.com.Peer reviewedPublisher PD

Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial)

BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care) was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. METHODS/DESIGN: The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a), open colectomy with fast track program (b), laparoscopic colectomy with standard care (c), and laparoscopic surgery with fast track program (d). Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm) can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8). With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36) questionnaire and social functioning can be detected. DISCUSSION: The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in patients having segmental colectomy for malignant disease