Une lesion cutanée persistante non cicatricielle depuis 3 ans: le pyoderma gangrenosum

Le pyoderma gangrenosum (PG) est une dermatose neutrophilique non infectieuse rare souvent méconnue. Il se présente généralement par des ulcérations cutanées inflammatoires, très douloureuses et d'évolution rapide. Il est fréquemment retrouvé dans un contexte de néoplasie, de pathologies inflammatoires digestives, rhumatologiques et/ou hématologiques. Son diagnostic est très souvent tardif après de multiples échecs thérapeutiques. Nous rapportons un cas de pyoderma gangrenosum dont le diagnostic n'a pas été criant. Un patient a été admis dans notre service pour une lésion dermatologique persistante et d'évolution défavorable malgré les débridements et l'administration d'antibiotiques. Il était suivi pour un cancer de la prostate, une hypertension artérielle et un asthme. Du fait des anomalies biologiques observées telles qu'une hyperleucocytose à polynucléaires neutrophiles avec myélémie à myélocytes et métamyélocytes, sans blastose sanguine et une anémie normochrome normocytaire, une leucémie myéloïde chronique a été évoquée chez ce patient. Elle a par la suite été infirmée devant les différents examens complémentaires non concluants. C'est ainsi que le diagnostic de PG a été évoqué et confirmé à l'examen anatomopathologique montrant un aspect histopathologique d'un tissu de granulation concordant avec un pyoderma gangrenosum et une absence de signe histologique de malignité. L'institution d'un traitement à base de corticothérapie a abouti à la guérison

Permanences et mutations dans les terroirs rizicoles de Basse-Casamance (Sénégal)

International audienceWest Africa undergoes, since more than about forty years, a degradation of the agricultural landscapes. The strong climatic variability of these last decades is one of determining factors of these transformations. It is translated by a decrease of the precipitation and an important case of the periods of rainfall deficit repercussions of which are obvious on the agrarian systems. The rice soils of Low Casamance, a beautiful example of the «agrarian civilizations» of western Africa, translate the current dynamics in the "Rivers of the South". These spaces, which concentrate numerous human activities, present strong natural and socioeconomic constraints, which have consequences on the rice systems. The analysis of the rice soils of Low Casamance, by an approach of the landscapes combining geospatial data and field works, shows dynamics contrasted between the rice activity and its environment biophysics and socioeconomic.L'Afrique de l'Ouest subit, depuis plus d'une quarantaine d'années, une dégradation des paysages agricoles. La forte variabilité climatique de ces dernières décennies est un des facteurs déterminants de ces transformations. Elle se traduit par une diminution des précipitations et une importante occurrence des périodes de déficit pluviométrique dont les répercussions sont manifestes sur les systèmes agraires. Les terroirs rizicoles de Basse-Casamance, emblématique des "civilisations agraires" d'Afrique de l'Ouest, traduisent les dynamiques en cours dans les "Rivières du Sud". Ces espaces, qui concentrent de nombreuses activités humaines, présentent de fortes contraintes naturelles et socioéconomiques qui ont des conséquences sur les systèmes rizicoles. L'analyse des terroirs rizicoles de Basse-Casamance, par une approche des paysages combinant des données géospatiales et des travaux de terrain, montre des dynamiques contrastées entre l'activité rizicole et son environnement biophysique et socio-économique. L'analyse des photographies aériennes et des images Google Earth, en particulier, fait apparaître un recul des terroirs rizicoles induit par la forte variabilité climatique, la salinisation et l'acidification des eaux et des terres, et par l'insuffisante main d'oeuvre liée à l'exode des jeunes qui se traduit par le manque d'entretien des digues de protection des parcelles rizicoles. Elle révèle ainsi l'existence de fortes interactions entre activités agricoles, écosystèmes exploités et environnement socio-économique

Management of pituitary adenoma: Preliminary experience with endoscopic endonasal transphenoidal surgery in a developing country. Example of Senegal about 180 cases

Introduction: Endoscopic endonasal transsphenoidal surgery is currently the gold-standard therapeutic approach for pituitary adenomas. Although being spread worldwide, the endoscopic endonasal approach for pituitary adenomas is recently implemented in Senegal.This study aimed to report our results and the complications observed in the context of an under-equipped facility. Materials and methods: We conducted a retrospective study including all patients with a pituitary adenoma treated who underwent endonasal transsphenoidal resection under a single endoscopic approach from January 2014 to May 2022, in the Neurosurgery Department of Fann National Hospital Centre, Dakar. All patients were assessed according to clinical, radiological, and endocrinological criteria. They all were operated by the same team with an average follow-up of 24 months. Results: In this series of 180 patients, including 57.7 % women and 42.3% men with a mean age of 44.8 years (extremes of 18 and 76 years), the visual deficit was the most frequent onset symptom (69.4 %), followed by clinical forms of hormone hypersecretion (30.5 %). Twelve cases of pituitary apoplexy and 1 case of incidentaloma were reported. The most frequent tumors were non-functional tumors (61.6 %). Among the functional adenomas, the most frequent was prolactinoma (15.5 %). Regarding tumor size, 75 % were macroadenomas, 15.5 % were microadenomas, and 9.5 % were giants. Cavernous sinus invasion (Knosp grade ≥ 3) and suprasellar extension were noted in 14.4 % and 53.3 %, respectively. The resection was total in 80 % of cases, subtotal in 18.8 %, and partial in 1.2 %. Partial improvement of sight was observed in 91.1% and endocrine hypersecretion remission in 76.6 %. As for complications, the most frequent was transient diabetes insipidus (32.7 %). Conclusion: Despite the scanty resources, our results are similar to the best-reported series and strengthen scientific evidence on the efficacy and safety of performing this technique in an under-equipped setting context

Evaluation of agreement between hemoglobin A1c, fasting glucose, and fructosamine in Senegalese individuals with and without sickle-cell trait

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Increased Prevalence of Type 2 Diabetes–Related Complications in Combined Type 2 Diabetes and Sickle-Cell Trait

International audienceOBJECTIVE: The prevalence of type 2 diabetes (T2D) is rapidly increasing in sub-Saharan Africa, where sickle cell trait (SCT) is also frequent. Although SCT is generally considered a benign condition, evidence suggests that SCT could exaggerate vascular dysfunction in T2D. However, it remains unclear whether SCT could increase the risk of the development of T2D complications. Therefore, this study was conducted to determine whether T2D complications were more prevalent among Senegalese individuals with SCT and T2D than among those with T2D only. RESEARCH DESIGN AND METHODS: Rates of hypertension, retinopathy, peripheral neuropathy, peripheral artery disease, and impaired renal function as well as arterial stiffness, blood rheology, and concentrations of plasma advanced glycation end products (AGEs) and cytokines were compared between groups of Senegalese individuals with combined SCT and T2D (T2D-SCT) (n = 60), T2D (n = 52), SCT (n = 53), and neither T2D nor SCT (control) (n = 56). Human aortic endothelial cell (HAEC) expression of inflammatory and adhesion factors was measured after treatment with tumor necrosis factor-α and subjects' plasma. Effects of AGE inhibition or tiron on HAEC expression of E-selectin were measured. RESULTS: Retinopathy, hypertension, and reduced renal function were more prevalent, and arterial stiffness, blood viscosity at high shear rates, and thixotropic index were higher, in the SCT group compared with the other groups. Multivariable analysis showed that plasma AGE concentration was significantly associated with arterial stiffness. E-selectin expression was elevated in HAECs treated with T2D-SCT plasma compared with the other groups, but AGE inhibition reversed this. CONCLUSIONS: SCT could potentially augment the risk of the development of T2D-related complications, including retinopathy, nephropathy, and hypertension

Inverse Estuaries in West Africa: Evidence of the Rainfall Recovery?

International audienceIn West Africa, as in many other estuaries, enormous volumes of marine water are entering the continent. Fresh water discharge is very low, and it is commonly strongly linked to rainfall level. Some of these estuaries are inverse estuaries. During the Great Sahelian Drought (1968-1993), their hyperhaline feature was exacerbated. This paper aims to describe the evolution of the two main West African inverse estuaries, those of the Saloum River and the Casamance River, since the end of the drought. Water salinity measurements were carried out over three to five years according to the sites in order to document this evolution and to compare data with the historical ones collected during the long dry period at the end of 20 th century. The results show that in both estuaries, the mean water salinity values have markedly decreased since the end of the drought. However, the Saloum estuary remains a totally inverse estuary, while for the Casamance River, the estuarine turbidity maximum (ETM) is the location of the salinity maximum, and it moves according to the seasons from a location 1-10 km downwards from the upstream estuary entry, during the dry season, to a location 40-70 km downwards from this point, during the rainy season. These observations fit with the functioning of the mangrove, the West African mangrove being among the few in the world that are markedly increasing since the beginning of the 1990s and the end of the dry period, as mangrove growth is favored by the relative salinity reduction. Finally, one of the inverse estuary behavior factors is the low fresh water incoming from the continent. The small area of the Casamance and Saloum basins (20,150 Water 2020, 12, 647 2 of 25 and 26,500 km² respectively) is to be compared with the basins of their two main neighbor basins, the Gambia River and the Senegal River, which provide significant fresh water discharge to their estuary