Inflammatory breast cancer: features and outcomes in a breast unit in Dakar, Senegal

Background: The aim of this study was to determine clinical features and outcomes of patients with inflammatory breast cancer (IBC) treated in our breast unit.Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, in which a breast unit was created since 2007. All women with diagnosis of inflammatory breast cancer in our Breast Unit between January 2010 and December 2013 were included in this study. The diagnosis of IBC was made clinically using the American Joint Committee on Cancer (AJCC) and confirmed histologically. The follow-up cut-off for this data set was December 31st, 2014. All analyses for this study were performed using SPSS software (version 20.0).Results: Between 2010 and 2013, 22 women with breast cancer who met eligibility criteria were included out of 161 patients followed for breast cancer leading to a frequency of 13.6%. The median age at diagnosis was 43.4 years (26-79 years). Mean time to diagnosis was 4 months. The mean time to recurrence was 11.2 months. This recurrence was observed in 45.5% of cases. The median overall survival was 13.3 months (CI 95% 8.576-18.526), the survival rate was 31.8%.Conclusions: This series shows a high frequency of inflammatory breast cancer. These tumours are very aggressive with a very poor prognosis

Dyslipidemia, obesity and other cardiovascular risk factors in the adult population in Senegal

Introduction: According to the WHO, 50% of deaths worldwide (40.1% in developing countries) are due to chronic non-communicable diseases (NCDs). Of these chronic NCDs, cardiovascular diseases remain the leading cause of death and disability in developed countries. The Framingham study has shown the importance of hypercholesterolemia as a primary risk factor. In Senegal, the epidemiology of  dyslipidemia and obesity are still poorly understood due to the lack of comprehensive studies on their  impact on the general population. This motivated this study to look into the key epidemiologic and socio-demographic determinants of these risk factors. Methods: It was a cross-sectional descriptive epidemiological survey which included 1037 individuals selected by cluster sampling. Data were collected using a questionnaire following the WHO STEPwise approach. Socio-demographic, health and biomedical variables were collected. P value Results: The average age was 48 years with a female predominance (M: F of 0.6). The literacy rate was 65.2% and 44.7% of participants were from rural areas. The prevalence of hypercholesterolemia, hyperLDLemia, hypoHDLemia, hypertriglyceridemia and mixed hyperlipidemia were 56%, 22.5%, 12.4%, 7.11% and 1.9% respectively. One in four was obese (BMI> 30kg/m2) and 34.8% had abdominal obesity. The main factors significantly associated with dyslipidemia were obesity, urban dwelling, physical inactivity and a family history of dyslipidemia. Conclusion: The prevalence of dyslipidemia, obesity and other risk factors in the population was high needing immediate care for those affected and implementation of prevention strategies.Key words: Dyslipidemia, obesity, cardiovascular, risk factors, Saint Loui

A hospital based case control study of female breast cancer risk factors in a Sub-Saharan African country

Background: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer.Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 age-matched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects.Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation.Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons

Improving fetal dystocia management using simulation in Senegal: midterm results

Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects

In vitro vasorelaxation mechanisms of bioactive compounds extracted from Hibiscus sabdariffa on rat thoracic aorta

<p>Abstract</p> <p>Background</p> <p>In this study, we suggested characterizing the vasodilator effects and the phytochemical characteristics of a plant with food usage also used in traditional treatment of arterial high blood pressure in Senegal.</p> <p>Methods</p> <p>Vascular effects of crude extract of dried and powdered calyces of <it>Hibiscus sabdariffa </it>were evaluated on isolated thoracic aorta of male Wistar rats on organ chambers. The crude extract was also enriched by liquid-liquid extraction. The various cyclohexane, dichloromethane, ethyl acetate, butanol extracts obtained as well as the residual marc were subjected to Sephadex LH-20 column chromatography. The different methanolic eluate fractions were then analyzed by Thin Layer (TLC) and High Performance Liquid Chromatography (HPLC) and their vascular effects also evaluated.</p> <p>Results</p> <p>The H. Sabdariffa crude extract induced mainly endothelium-dependent relaxant effects. The endothelium-dependent relaxations result from NOS activation and those who not dependent to endothelium from activation of smooth muscle potassium channels. The phytochemical analysis revealed the presence of phenolic acids in the ethyl acetate extract and anthocyans in the butanolic extract. The biological efficiency of the various studied extracts, in term of vasorelaxant capacity, showed that: Butanol extract > Crude extract > Residual marc > Ethyl acetate extract. These results suggest that the strong activity of the butanolic extract is essentially due to the presence of anthocyans found in its fractions 43-67.</p> <p>Conclusion</p> <p>These results demonstrate the vasodilator potential of <it>hibiscus sabdariffa </it>and contribute to his valuation as therapeutic alternative.</p

Evaluation De La Prematurite Superieure Ou Egale A 32 Semaine D’amenorhée A L’hopital Regional De Ziguinchor Au Sud Du Senegal (Afrique De L’ouest)

Introduction: Prematurity is one of the leading causes of neonatal death in Africa. The objective of this work was to assess the preterm birth at the pediatric service of the regional hospital of Ziguinchor. Material and methods: This was a prospective, descriptive and analytical study of the case of hospitalized newborns whose age was between 32 SA to 36SA + 6 days. The study was conducted from May 21, 2013 to May 21, 2014. We included all premature infants at age ≥ 32SA.Those presenting a malformation were not included. We studied maternal socio-demographic, obstetric and neonatal parameters. Results: We have identified 140 newborns out of a total of 342 Preterm births and 2292 maternity births, a prevalence of 40.9% compared to preterm infants and 6.10% in relation to all births. 51.4 percent of mothers came from urban areas, 63.5 percent were between 20 and 34 years of age, not attending school in 45.7 percent, married in 72.9 percent and without work in 94.3 percent. The average gestures represented 3.09 . Arterial hypertension was the most common medical condition (67.7%). The followup was done by a midwife (82.1%) and 23.5% had received at least 4 NPC. Eclampsia and pre-eclampsia (48.9%) and RPM (42.8%) were common obstetric pathologies. The delivery was by caesarian (51.4%), hospital (92.1%), cephalic presentation (80%), with an average weight of 1816.79 g. An RCIU (16.4%), an RPM (61.9%). At birth, a DR (16.4%) was noted due to MMH (43.7%) and transitory tachypnea (50%). Asphyxia was reported in 3.5%. During hospitalization (6.7 days on average), 6.4% had RD caused by infection (77.7%). Other complications were infection (64.4%), hypoglycemia (28.5%), digestive hemorrhage (7.01%). The fatality rate was 7.9% due to infection (63.3%), DR (18%), haemorrhage (9%). The anthropometric measurements at the exit: P 1887.9g, T: 38.3cm, PC: 30.9cm; at 1 month P: 2387.1g, T: 46.6cm, PC: 32.8cm; at 30 months P: 12.1kg, T: 89.5cm, PC: 48.4cm. Conclusion: Moderate preterm birth accounts for almost half of the cases of prematurity in our series. Their optimal management would go through a better obstetric-neonatal collaboration but above all by the installation of kangaroo mother unit

Antibiotic susceptibility profile of Streptococcus pneumoniae isolated from acute respiratory infection in Dakar: a cross sectional study

Streptococcus pneumoniae is a pathogen causing pneumonia, meningitis, otitis and bacteraemia. Nowadays, S. pneumoniae is developing antibacterial resistance, particularly for those with reduced susceptibility to penicillin. The objective of this study was to assess the susceptibility profile of S. pneumoniae strains isolated from acute respiratory infections (ARIs) in children younger than 5 years of age in Dakar, Senegal. S. pneumoniae strains were isolated from broncho-alveolar lavages (BALs), nasopharyngeal swabs, and middle ear secretion from children in the Paediatric Department of Abass Ndao University Teaching Hospital and Paediatric Department of Roi Baudouin Hospital in Dakar, Senegal. The strains were cultivated on Columbia agar supplemented with 5% of horse blood and gentamicin (6 mg/L). Antibiotic susceptibility testing was performed using E-test method. A total of 34 strains of S. pneumoniae were isolated and identified in this study, among them 7 strains (20.58%) showed penicillin-resistance. Antibiotics such as amoxicillin/clavulanic acid (MIC90=0.036 μg/mL), cefuroxim (MIC90=0.38 μg/mL), cefixim (MIC90=1.5 μg/mL), as well as macrolides (azithromycin MIC90=1.5 μg/mL, clarithromycin MIC90=0.125 μg/mL) and fluoroquinolone (levofloxacin MIC90=1 μg/mL, ofloxacin MIC90=2 μg/mL) were mostly active. However, all S. pneumoniae strains were resistant to sulfamethoxazole/trimethoprim (MIC90: 32 μg/mL). Except of S. pneumoniae strains penicillin-resistance or reduced susceptibility, most strains were susceptible to β-lactams antibiotics commonly used in ARI treatment. Continuous surveillance of antimicrobial resistance patterns of pneumococcus strains is still crucial for effective control of ARIs in children