Profil De L’asthmatique Admis Au Centre Hospitalier National Universitaire De Fann (CHNU) A Dakar (Senegal)

Au Sénégal, la prévalence de l’asthme n’est pas encore évaluée. Les caractéristiques sociodémographiques, épidémiologiques et la provenance des patients asthmatiques consultés au Centre Hospitalier National Universitaire (CHNU) de Fann demeurent peu connues. Cet article contribue à la connaissance du profil des patients asthmatiques admis au CHNU. Il s’est agi d’une étude rétrospective, prospective et transversale à avisée analytique associant l’approche quantitative et qualitative qui s’est déroulée de janvier 1999 à août 2017 à la clinique de pneumologie du CHNU. La population d’étude était constituée des asthmatiques reçus en consultation. Les paramètres analysés concernent les caractéristiques de la population étudiée (âge, sexe, profession et statut matrimonial). Au total 296 patients asthmatiques, soit 36,5% d’hommes contre 63,5% de femmes, ont été enregistrés avec un âge médian qui était de 35 ans. 234 répondants à la variable catégorie socioprofessionnelle, étaient composés de ménagères (24,8%), d’élèves et d’étudiants (20,1%), de commerçants (17,5%), de bureaucrates (6,8%), de personnel de santé (6%) et d’enseignants et de maîtres coraniques (3,8%). A cela s’ajoutait, des ouvriers (3,8%), des couturiers (3,4%), des coiffeurs (3%), des chauffeurs (2,6%), des agriculteurs et éleveurs (2,6%), des mécaniciens et garagistes (1,3%), des pêcheurs et marins (1,3%), des restaurateurs et restauratrices (1,3%) et d’autres (1,7%). Selon le statut matrimonial, 54,3% étaient des mariés, 42,7% de célibataires et 3% de divorcés. Parmi les 296 asthmatiques, 250 résidaient en milieu urbain dakarois. Les antécédents se résumaient sur les signes et les symptômes des patients avec de la toux (34%), de la dyspnée expiratoire nocturne (34%), des expectorations nummulaires (18%) et des crises d’asthme (14%). Le profil des patients asthmatiques présente une population jeune avec une prédominance féminine. In Senegal, the prevalence of asthma has not yet been assessed. The socio-demographic, epidemiological and provenance characteristics of asthmatic patients consulted at the National Hospital University Center (CHNU) remain little known. This article contributes to the knowledge of the profile of asthmatic patients admitted to the CHNU. This was a retrospective, prospective and cross-sectional, analytical wise study combining the quantitative and qualitative approach which took place from January 1999 to august 2017 at the CHNU pulmonology clinic. The study of asthmatics received in consultation. The parameters analyzed relate to the characteristics of the population studied (age, sex, profession and marital status). A total of 296 asthmatic patients, or 36.5% male versus 63.5% female, were registered with a median age of 35 years. 234 respondents to the socio-professional category variable, were made up of housewives (24.8%), pupils and students (20.1%), traders (17.5%), bureaucrats (6.8%), health personnel (6%) and koranic teachers and teachers (3.8%). In addition, workers (3.8%), dressmakers (3.4%), hairdressers (3%), drivers (2.6%), farmers and ranchers (2.6%), mechanics and mechanics (1.3%), fishermen and sailors (1.3%), restaurateurs and restorers (1.3%), and others (1.7%). According to marital status, 54.3% were married, 42.7% were single and 3% were divorced. Among the 296 asthmatics, 250 resided in an urban Dakar environment. The history was summarized by the signs and symptoms of patients with cough (34%), nocturnal expiratory dyspnea (34%), sputum (18%) and asthma attacks (14%). The profile of asthmatic patients presents a young population with a female predominance

Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1–2 trial

SummaryBackgroundSpinal stereotactic body radiation therapy (SBRT) is increasingly used to manage spinal metastases, yet the technique's effectiveness in controlling the symptom burden of spinal metastases has not been well described. We investigated the clinical benefit of SBRT for managing spinal metastases and reducing cancer-related symptoms.Methods149 patients with mechanically stable, non-cord-compressing spinal metastases (166 lesions) were given SBRT in a phase 1–2 study. Patients received a total dose of 27–30 Gy, typically in three fractions. Symptoms were measured before SBRT and at several time points up to 6 months after treatment, by the Brief Pain Inventory (BPI) and the M D Anderson Symptom Inventory (MDASI). The primary endpoint was frequency and duration of complete pain relief. The study is completed and is registered with ClinicalTrials.gov, number NCT00508443.FindingsMedian follow-up was 15·9 months (IQR 9·5–30·3). The number of patients reporting no pain from bone metastases, as measured by the BPI, increased from 39 of 149 (26%) before SBRT to 55 of 102 (54%) 6 months after SBRT (p<0·0001). BPI-reported pain reduction from baseline to 4 weeks after SBRT was clinically meaningful (mean 3·4 [SD 2·9] on the BPI pain-at-its-worst item at baseline, 2·1 [2·4] at 4 weeks; effect size 0·47, p=0·00076). These improvements were accompanied by significant reduction in opioid use during the first 6 months after SBRT (43 [28·9%] of 149 patients with strong opioid use at baseline vs 20 [20·0%] of 100 at 6 months; p=0·011). Ordinal regression modelling showed that patients reported significant pain reduction according to the MDASI during the first 6 months after SBRT (p=0·00003), and significant reductions in a composite score of the six MDASI symptom interference with daily life items (p=0·0066). Only a few instances of non-neurological grade 3 toxicities occurred: nausea (one event), vomiting (one), diarrhoea (one), fatigue (one), dysphagia (one), neck pain (one), and diaphoresis (one); pain associated with severe tongue oedema and trismus occurred twice; and non-cardiac chest pain was reported three times. No grade 4 toxicities occurred. Progression-free survival after SBRT was 80·5% (95% CI 72·9–86·1) at 1 year and 72·4% (63·1–79·7) at 2 years.InterpretationSBRT is an effective primary or salvage treatment for mechanically stable spinal metastasis. Significant reductions in patient-reported pain and other symptoms were evident 6 months after SBRT, along with satisfactory progression-free survival and no late spinal cord toxicities.FundingNational Cancer Institute of the US National Institutes of Health

The effect of immigration status on racial differences in health insurance coverage, access to care, and utilization in the United States

Background. Lack of coverage, lack of access, and failure to utilize health care services have all been linked to dismal health outcomes in the US. Such consequences have been a longstanding challenge that US minorities are faced with, in the context of a health care system believed to be lacking efficiency and equity. National population surveys in the US suggest that the number of uninsured approaches 50 millions, while some concerns and suspicions are raised by opponents to the growing number of foreign born US residents, many of whom are Hispanic. Research shows that race is a significant predictor of lack of coverage, access, and utilization, while age, gender, education, and income are also linked to these outcomes. We investigated the potential effect of immigration status or duration in the US on the association between coverage, access, use, and race. Methods. Using National Health Interview Survey (NHIS) data of 2006, we selected 22, 667 individuals of Non-Hispanic Black, Hispanic, and Non-Hispanic White descent, at least 18 years of age, US-born and foreign-born who reported their duration of residence in the US. Through complex sample survey logistic regression analysis, we computed odds ratios, beta coefficients, and 95% confidence intervals using models which excluded then included immigration status. Results. Although a significant predictor of the outcomes, immigration status did not change the relationship between each of the dependent variables (coverage, access, utilization), and the factor race, while adjusting for age, gender, education, and income. Our results show that Hispanics were least likely to have coverage (OR=.58; 95% CI[.49, .68]), access (OR=.62; 95% CI[.50, .76]), and to utilize services (OR=.60; 95% CI[.46, .79]) followed by Non-Hispanic Blacks, and Non-Hispanic Whites. These results were not changed by stratification, or the inclusion of interaction terms to eliminate the potential effect of relationships between independent variables. Recent immigrants (\u3c5 years in US) were 0.12 times less likely to be insured, but also 0.26 times less likely to utilize services (p\u3c0.001), and in addition they represented only 7.3% of the uninsured and 1.9% of the US population in 2006. Furthermore, 12% of the Non-Hispanic White population in the US was not covered, and 65% of the uninsured individuals were US-Born Citizens. Other predictors of lack of coverage, access and use were age below 45, male gender, education at high school or below, and income of less than $20,000. Conclusion. This investigation shows that the high percentage of uninsured was not directly caused by Hispanics, and immigration status alone could not explain racial differences in coverage, access, and utilization. An immigration reform may not be the solution to the healthcare crisis, and more specifically, will not stop the increase in the number of uninsured in the US, nor reduce the cost of health care. As a better alternative, universal health insu rance coverage should be considered, when aiming to eliminate racial disparities, and to solve the health care crisis. Keywords. health insurance, coverage, access, utilization, race, immigration, disparities

Direct medical costs of cervical cancer treatment at the Joliot Curie Institute in Dakar, Senegal: Coûts directs médicaux du traitement du cancer du col de l’utérus à l’Institut Joliot Curie de Dakar, Sénégal

In 2020, the global incidence of cervical cancer was estimated at 604,127 of which 117,316 cases were diagnosed in Africa. Within the same year in Senegal, there were 1,937 reported cases with 1,312 deaths. The direct medical costs of cancer treatment are not known in Senegal, whereas it is necessary to estimate the costs of treating these diseases so as to ensure their proper management.This study aims to estimate the direct medical costs of treating cervical cancer at the Joliot Curie Institute. It is a retrospective study conducted on patients diagnosed with cervical cancer between January and December 2018 at the Joliot Curie Institute. A survey was conducted on patients and their relatives by questionnaire and semi-structured interviews in order to estimate the direct medical cost of the treatment. Averagely, this cost was estimated at $4,209,204 with a minimum of$999,998 and a maximum of 9,686,300 over an average period of 19 months. Twenty-eight percent of this cost was for chemotherapy; 15 percent for diagnosis; and 23 percent for surgery. Radiation therapy and prescription expenses accounted for 6% and 11% respectively. Other procedures accounted for 17%. The level of education of patients influenced this direct medical cost (p=0.05). Résumé En 2020, l’incidence du cancer du col de l’utérus au niveau mondiale était estimée à 604 127  cas, dont 117 316 personnes ont été diagnostiquée en Afrique. Au Sénégal, l’incidence du cancer du col de l’utérus s’élevait à 1 937 cas la même année, avec 1 312  décès. Les coûts directs médicaux du traitement des cancers ne sont pas connus au Sénégal. Pour une bonne prise en charge de ces maladies, il est nécessaire d’estimer leurs coûts. Cette étude vise à estimer les coûts médicaux directs de traitement du cancer du col de l’utérus à l’Institut Joliot Curie. C’est une étude rétrospective menée sur des patientes diagnostiquées d’un cancer du col de l’utérus entre Janvier et Décembre 2018 à l’Institut Joliot Curie. Une enquête par questionnaire et des entretiens semi-structurés ont été faits auprès des personnes malades et de leurs proches afin de reconstruire le coût direct médical. Le coût moyen direct médical estimé du traitement de cancer du  col de l’utérus était  de 4 209.204 avec un minimum de 999.998 $et un maximum de 9 686.300$ sur une durée moyenne de 19 mois. Ce coût était constitué de 28 % de la chimiothérapie&nbsp;; de 15 % du diagnostic et de 23 % de la chirurgie. Les coûts de la radiothérapie et les médicaments sur ordonnance représentaient respectivement 6 % et 11 %. Les autres actes constituaient 17 %. Ce coût médical direct était&nbsp; lié au niveau d’étude (p=0,05). Mots clés&nbsp;: Cancer du col de l’utérus, coûts médicaux directs, patientes

Lithological Architecture and Petrography of the Mako Birimian Greenstone Belt, Kédougou-Kéniéba Inlier, Eastern Senegal

International audienceThe new lithological and petrographic data obtained in the Mako sector are analyzed in the light of the geochemical data available in the literature. It consists of ultramaic, mafic rocks of tholeiitic affinities associated with intermediate and felsic rocks of calc-alkaline affinities and with intercalations of sedimentary rocks. The whole unit is intruded by Eburnean granitoids and affected by a greenschist to amphibolite facies metamorphism related to a high grade hydrothermalism. It consists of: (i) ultramafic rocks composed of a fractional crystallization succession of lherzolites, wehrlites and pyroxenites with mafic rock inclusions; (ii) layered, isotropic and pegmatitic metagabbros which gradually pass to metabasalts occur at the top; (iii) massive and in pillow metabasalts with locally tapered vesicles, completely or partially filled with quartzo-feldspathic minerals; (iv) quarzites locally overlying the mafic rocks and thus forming the top of the lower unit.This ultramafic-mafic lower unit presents a tholeiitic affinity near to the OIB or N-MORB. It represents the Mako Ophiolitic Complex (MOC), a lithospheric fragment of Birimian lithospheric crust.The upper unit is a mixed volcanic complex arranged in the tectonic corridors. From bottom to top it comprises the following: (i) andesitic, and (ii) rhyodacitic and rhyolitic lava flows and tuffs, respectively. They present a calc-alkaline affinity of the active margins.Three generations of Eburnean granitoids are recognized: (i) early (2215-2160 Ma); (ii) syn-tectonics (2150-2100 Ma) and post-tectonics (2090-2040 Ma). The lithological succession, geochemical and metamorphic characteristics of these units point to an ophiolitic supra-subduction zone

Inactive hepatitis B carriers: outcomes of patients followed at hôpital principal de Dakar, Senegal

The evolutive profile of inactive HBV carriers is variable. Patients can remain inactive, or may evolve into chronic active hepatitis or hepatocellular carcinoma. Aim: to describe the long-term outcome of chronic hepatitis B inactive carriers followed at Hôpital Principal de Dakar. This is a retrospective study including all inactive HBV carriers, followed since 2001, and with regular monitoring of at least 5 years. Transaminases, viral load and screening for hepatocellular carcinoma were performed every 6 to 12 months. We included 52 patients. The mean follow-up was 76.2 months (60-162), the mean age 36 years (13-62 years) and the sex ratio 0.93 (25 men, 27 women). Four patients (7.7%) had an ALT above the normal. Eleven patients (21.1%) had persistently elevated viral load greater than 2000 IU/ml, while in three cases (5.8%), this increase was transient. Twenty-six patients (50%) had a detectable viral load, but still below 2000 IU/ml. Twelve patients (23.1%) had an undetectable viral load for the duration of monitoring. Eleven patients (21.2%) underwent liver biopsy. The activity or fibrosis were minimal in all cases (A or F = 1) or absent (A or F = 0). Only four patients (7.7%), had HBs seroconversion after a follow-up of six, seven and ten years. There was no focal lesion or cirrhosis detected during the follow-up. After a follow-up of at least 5 years, inactive HBV carriers remain inactive in 92.3% of cases. Their evolutive profile is characterized by an absence of elevated liver enzymes but with fluctuations of the viral load. HBs seroconversion rate is low and the risk of progression to hepatocellular carcinoma almost nil

Validity and reliability of a Turkish Brief Pain Inventory Short Form when used to evaluate musculoskeletal pain

WOS: 000396266900006PubMed ID: 27472857BACKGROUND: The Brief Pain Inventory (BPI) is both a questionnaire and an outcome measure that is used widely in clinical trials to assess pain associated with many conditions. The BPI Short Form has been extensively translated into foreign languages. The aim of this study was to assess the validity and reliability of a Turkish Brief Pain Inventory Short Form (BPI-TR) to evaluate musculoskeletal pain. METHODS: In total, 297 patients with musculoskeletal pain participated in the study. Demographic characteristics and brief medical histories were recorded. Pain intensity was assessed using a visual analogue scale (VAS) and quality-of-life was assessed using the Short Form 36 (SF-36). Pain was evaluated using the BPI-TR in all patients. Internal consistency and test-retest analysis were used to assess reliability. The internal consistency of the scale items was assessed by calculating Cronbach's a value, which was expected to be > 0.7. The criterion validity of the BPI-TR was assessed by correlation with VAS scores. RESULTS: Pain intensity, pain interference, and other components of the Turkish version were consistent with validity thereof. Cronbach's a was 0.84 for pain intensity and 0.89 for pain interference. The extent of BPI-TR and VAS correlation was statistically significant. CONCLUSIONS: The BPI-TR may be used for assessment of musculoskeletal pain

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Purpose Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. Patients and Methods Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. Results Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. Conclusion Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed