Evaluation des complications cardiaques chez les hémodialysés chroniques de Dakar

Introduction: L'évaluation cardiovasculaire est essentielle en hémodialyse périodique car les affections cardiovasculaires sont la première cause de mortalité chez les hémodialysés chroniques. Nous avons conduit cette étude afin de déterminer la prévalence et le type des différentes complications cardiovasculaires et d'identifier les principaux facteurs de risque cardiovasculaire. Méthodes: Il s'agissait d'une étude rétrospective de 4 ans portant sur les dossiers de patients traités au moins 6 mois en hémodialyse et ayant des explorations cardio-vasculaires comportant une radiographie du thorax de face, un électrocardiogramme et une échographie cardiaque. Les données épidémiologiques, cliniques, paracliniques, les aspects évolutifs des complications cardiaques ont été recueillies pour chaque patient retenu. Résultats: Trente huit dossiers de patients ont été inclus dans cette étude. L'âge moyen était de 52 ans ± 12,85 et le sex-ratio H/F de 1,53. Les complications cardiovasculaires étaient dominées par l'hypertrophie ventriculaire gauche (71,05 %), la maladie coronaire (34,21%), l'insuffisance cardiaque congestive (18,42%), Calcifications vasculaires (5,78 %), les troubles du rythme (7.89%), les fuites valvulaires mitrales (44,73%), tricuspidiennes (42,10%) et les accidents vasculaires cérébraux hémorragiques (5,26%). L'incidence moyenne de l'HVG était de 81% chez les patients hypertendus. Au cours de cette étude, 27 patients avaient poursuivi l'hémodialyse et 11 étaient décédés dont 6 de causes cardiovasculaires (54,55%). Conclusion: L'hémodialyse est une technique d'épuration qui expose les patients à de multiples complications cardiovasculaires.Pan African Medical Journal 2016; 23: 4

Scleroderma renal crisis in tropical region: two senegalese cases

Scleroderma renal crisis (SRC) is defined as the new onset of accelerated arterial hypertension and /or rapidly progressive oliguric renal failure during the course of systemic sclerosis. It is a rare but life-threatening complication. This formerly serious complication has got a considerable brighter outlook since the introduction of angiotensin converting enzyme inhibitors (ACE) however the mortality is still remaining high. We report two cases of SRC which to our knowledge are the firsts described in Dakar. They were two women aged 45 and 32 years, one of them was previously following for systemic sclerosis. Both of them had malignant hypertension associated with rapidly progressive renal failure, the other was put under corticosteroid therapy four months before SRC occurrence. The histological and laboratory finding showed thrombotic microangiopathy. The height blood pressure returned to normal value after treatment with ACE inhibitors. The final outcome was undesirable with the death of one after two months due to the hemodialysis discontinuation and persistence of renal failure in the other.Keywords: Scleroderma renal crisis, corticosteroids, thrombotic microangiopathy, Daka

Vascular access in Senegalese patients starting chronic haemodialysis

Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of  haemodialysis and examined the factors associated with its use. Methods: We conducted a cross-sectional study from 1 June 2021 to 2 October 2021 among patients on chronic haemodialysis in 10 centres in the Dakar and Thiès regions. Clinical and laboratory data were collected from medical records and also via patient interviews. Results: The patients (n = 543) had a median age of 50 years [interquartile range (IQR) 40–62 years] and 50.6% were male. The socio-economic level was low in two-thirds of cases. The median duration of haemodialysis was 40 (IQR 17–76) months. Hypertension was noted in 92% and diabetes in 13%. Hypertensive kidney disease was the cause of kidney failure in 33%. Only 47 patients (9%) had started dialysis using an arteriovenous fistula. Factors associated with its use at haemodialysis initiation were socio-economic level (OR 0.48; 95% confidence interval (CI) 0.25–0.94 for low socio-economic level) and duration of pre-dialysis follow-up by a nephrologist for >4 months (OR 7.82; 95% CI 3.05–26.50). In 65% of prevalent patients, the vascular access used was an AVF, a tunnelled central venous catheter in 28%, an arteriovenous graft in 2% and a temporary central venous catheter in 4.4%. Conclusions: The proportion of Senegalese patients with an AVF at the start of haemodialysis was low. AVF use was associated with socio-economic level and pre-dialysis follow-up by a nephrologist for >4 months

Isonatraemic haemodialysis in the management of salt and water overload: a crossover trial at an academic hospital in Dakar, Senegal

Introduction: The aims of this study were to assess the impact of isonatraemic haemodialysis on reduction of interdialytic weight gain (IDWG) and blood pressure (BP) as well as its tolerability in our study population. Methods: This crossover trial, at the Aristide Le Dantec University Hospital in Senegal, was conducted on 32 patients with kidney failure who were stable on treatment with chronic haemodialysis. In the initial “control phase”, patients had nine haemodialysis sessions with a dialysate sodium (Na+) concentration (Na+ dialysate) of 138 mmol/L. The serum Na+ set point (SP) for each patient was calculated from three predialytic mid-week values. In the second phase, the “individualized phase”, patients had nine haemodialysis sessions with Na+ dialysate equal to their SP. Results: The mean age of the patients was 55.5 ± 12.1 years, with a male/female ratio of 1.3 and the most common cause of kidney disease was hypertension (47%). Mean predialytic serum Na+ concentration was 135.8 ± 1.9 mmol/L, with a mean intra-individual coefficient of variation of 2%. Mean interdialytic weight gain (IDWG) was 1.9 kg and 1.8 kg in the control and individualized phases, respectively (P = 0.75). A reduction in postdialytic systolic blood pressure (BP) was observed during the individualized phase (P = 0.04). A similar trend was noted in pre- and intradialytic BP but this was not statistically significant. Apart from headaches, which were more common in the individualized phase (P = 0.04), isonatraemic haemodialysis was well tolerated. Conclusions: IDWG as well as pre- and intradialytic BP were unaffected by isonatraemic haemodialysis. Postdialytic BP was significantly reduced. Introduction: Les objectifs de cette étude étaient d’évaluer l’impact de l’hémodialyse isonatrémique sur la réduction de la prise de poids inter-dialytique (PPID) et de la pression artérielle (PA) ainsi que sa tolérance dans notre population d’étude. Méthodes: Cet essai croisé a été mené au centre hospitalier universitaire Aristide Le Dantec de Dakar (Sénégal) chez des patients hémodialysés chroniques. Durant la première phase dite « phase contrôle », les patients ont eu neuf séances d’hémodialyse avec une concentration de sodium dans le dialysat (Na+ dialysat) de 138 mmol/L. Le set-point (SP) de la natrémie a été calculé pour chaque patient et correspondait à la moyenne de 3 natrémies pré-dialytiques en milieu de semaine. Durant la deuxième phase dite « phase individualisée », les patients ont eu neuf séances d’hémodialyse avec du Na+ dialysat égal à leur SP. Résultats: Trente-deux patients ont été inclus. L’âge moyen était de 55,5 ± 12,1 ans avec un ratio homme/femme de 1,3 et la néphropathie initiale la plus fréquente était l’hypertensive (47%). La natrémie pré-dialytique moyenne était de 135,8 ± 1,9 mmol/L, avec un coefficient de variation intra-individuel moyen de 2 %. La PPID moyenne était de 1,9 kg et 1,8 kg dans les phases de contrôle et individualisé, respectivement (P = 0,75). Une diminution de la PA systolique post-dialytique a été observée au cours de la phase individualisée (P = 0,04). Une tendance similaire sans significativité statistique a été notée sur les PA pré- et intra-dialytiques. Hormis les céphalées, plus fréquentes pendant la phase individualisée (P = 0,04), l’hémodialyse isonatrémique a été bien tolérée. Conclusions: La PPID, les PA pré- et intra-dialytiques n’ont pas été affectées par l’hémodialyse isonatrémique. La PA post-dialytique était significativement réduite

Nodule de Soeur Marie-Josèphe révélateur de carcinomes digestif et ovarien: à propos de 4 cas

Le nodule de Soeur Marie-Josèphe est une métastase ombilicale d'une tumeur le plus souvent intra-abdominale. C'est un signe clinique rare dont l'incidence est de 1-3% de toutes les néoplasies abdomino-pelviennes, avec un pronostic péjoratif du fait de son retard diagnostique. Nous rapportons quatre observations d'une métastase cutanée ombilicale révélatrice d'un adénocarcinome dont deux pancréatiques, un gastrique et un d'origine ovarienne. Le but de notre travail est de montrer à travers ces quatre cas cliniques, l'intérêt de l'imagerie (tomodensitométrie, échographie) et de la biopsie dans la démarche diagnostique. A travers ces quatre observations nous insistons aussi sur les difficultés diagnostiques et thérapeutiques que pose cette tumeur dans nos pays à ressources limitées.Pan African Medical Journal 2015; 2

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

Evaluation de l’état hydrique chez les patients hémodialysés chroniques : une étude transversale monocentrique: Assessment of the hydration status in chronic hemodialysis patients: a single-center cross-sectional study

Context and objective. For many practitioners, blood pressure is the main indicator of the hydration status of the chronic hemodialysis patient. The objective of this study was to assess the extent to which bioimpedance analysis (BIA) can assist in determining acute changes in fluid volume during the hemodialysis session. Methods. This was a 9-week longitudinal study. The total body water (TBW) was measured with a BIA analyzer, before and after 6 successive sessions. The ΔWeight was compared to the ΔTBW by calculating the P/V ratio (ΔWeight/ΔTBW) with the assumption that the dry weight is reached when P/V = 1. Results. The measurements made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis) were reproducible. There was no statistically significant difference between ΔTBW and ΔWeight. However, at the individual level, significant differences had been observed. Using hypertension as a marker for a state of hyperhydration, a 31.8% agreement was noted between the P/V ratio and hypertension. Conclusion. Although the loss of water predicted by the BIA did not always correspond to the weight loss, BIA is a technique that can be used to assess the variations in TBW during the hemodialysis session in patients. Contexte et objectif. La pression artérielle est pour de nombreux praticiens, l’indicateur principal du statut hydrique du patient hémodialysé chronique. L’objectif de la présente étude était d’évaluer dans quelle mesure l’analyse d’impédance bioélectrique (BIA) pourrait aider à la détermination des variations aigues du volume hydrique au cours de la séance d’hémodialyse. Méthodes. Il s’agissait d’une étude de suivi longitudinal sur 9 semaines. Le volume total d’eau (VTE) a été mesuré par BIA, avant et après 6 séances. Le ΔPoids a été comparé au ΔVTE par le calcul du ratio P/V (ΔPoids / ΔVTE) dans l’hypothèse que le poids sec est atteint lorsque P/V = 1. Résultats. Les mesures faites chez 22 patients (46,6 ans, 54,5% hommes, 92,3 mois en dialyse) étaient reproductibles. Il n’y avait pas de différence statistiquement significative entre le ΔVTE et le ΔPoids. Cependant à l’échelon individuel des différences importantes étaient observées. En utilisant l’hypertension artérielle (HTA) comme marqueur d’un état d’hyperhydratation, une concordance de 31,8% était notée entre le ratio P/V et l’HTA. Conclusion. Bien que la perte d’eau prédite par la BIA ne corresponde pas toujours à celle du poids, la BIA est une technique qui peut être utilisée pour évaluer les variations du VTE au cours de la séance d’hémodialys

Décentralisation De La Dialyse Au Sénégal : Expérience D’1 An Du Centre De Tambacounda A l’Est Du Pays

Hemodialysis has made numerous and significant progress in recent decades resulting in life expectancy increase (thirty or forty years). The aim of our study was to assess the treatment of acute and chronic hemodialysis in the reference center of Tambacounda. Patients and methods: This was a prospective study over a one-year period (April 2013 to March 2014) in the hemodialysis center of the regional hospital of Tambacounda, 450km away from Dakar. The study focused on epidemiological, clinical, paraclinical and scalable data. Results: Fifty-nine patients were involved in the study. The sex ratio was 0.85 (32F/ 27M). The mean age was 41.3 years [12-72 years old]. Nineteen patients were on dialysis treatment for acute renal failure (ARF) (32.2%) and 40 were chronic hemodialysis patients (67.79%). Fifty patients were under emergency dialysis (84.7%) including 17 in intensive care (28.8%). Most chronic hemodialysis patients had 3 sessions per week (98.3%). Only 9 patients were monitored in nephrology prior to dialysis (22%). Thirty-two patients had a femoral double-lumen catheter (54.23%), 6 patients used ordinary double- lumen jugular catheters (10.17%) and 3 received tunneled jugular catheters (5.09%). Eighteen patients had functional arteriovenous (AV) fistula (18.51%). The mean hemoglobin was 7 g/dl. Only 11 patients had erythropoietin-based therapy. In acute renal impairment there were 8 deaths (42.10%), whereas in chronic renal failure the fatality rate was 18.8% (n = 9). Conclusion: Our study has demonstrated the benefits of decentralizing dialysis treatment in the provinces. However there is a need to implement the accompanying measures, such as the availability of some essential medicines for all hemodialysis patients, and equipment of intensive care units

Mass testing and treatment for malaria followed by weekly fever screening, testing and treatment in Northern Senegal: feasibility, cost and impact.

BACKGROUND NlmCategory: BACKGROUND content: Population-wide interventions using malaria testing and treatment might decrease the reservoir of Plasmodium falciparum infection and accelerate towards elimination. Questions remain about their effectiveness and evidence from different transmission settings is needed. - Label: METHODS NlmCategory: METHODS content: "A pilot quasi-experimental study to evaluate a package of population-wide test and treat interventions was conducted in six health facility catchment areas (HFCA) in the districts of Kanel, Lingu\xC3\xA8re, and Ran\xC3\xA9rou (Senegal). Seven adjacent HFCAs were selected as comparison. Villages within the intervention HFCAs were stratified according to the 2013 incidences of passively detected malaria cases, and those with an incidence\xE2\x80\x89\xE2\x89\xA5\xE2\x80\x8915 cases/1000/year were targeted for a mass test and treat (MTAT) in September 2014. All households were visited, all consenting individuals were tested with a rapid diagnostic test (RDT), and, if positive, treated with dihydroartemisinin-piperaquine. This was followed by weekly screening, testing and treatment of fever cases (PECADOM++) until the end of the transmission season in January 2015. Villages with lower incidence received only PECADOM++ or case investigation. To evaluate the impact of the interventions over that transmission season, the incidence of passively detected, RDT-confirmed malaria cases was compared between the intervention and comparison groups with a difference-in-difference analysis using negative binomial regression with random effects on HFCA." - Label: RESULTS NlmCategory: RESULTS content: "During MTAT, 89% (2225/2503) of households were visited and 86% (18,992/22,170) of individuals were tested, for a combined 77% effective coverage. Among those tested, 291 (1.5%) were RDT positive (range 0-10.8 by village), of whom 82% were\xE2\x80\x89<\xE2\x80\x8920\xC2\xA0years old and 70% were afebrile. During the PECADOM++ 40,002 visits were conducted to find 2784 individuals reporting fever, with an RDT positivity of 6.5% (170/2612). The combination of interventions resulted in an estimated 38% larger decrease in malaria case incidence in the intervention compared to the comparison group (adjusted incidence risk ratio\xE2\x80\x89=\xE2\x80\x890.62, 95% CI 0.45-0.84, p\xE2\x80\x89=\xE2\x80\x890.002). The cost of the MTAT was $14.3 per person." - Label: CONCLUSIONS NlmCategory: CONCLUSIONS content: It was operationally feasible to conduct MTAT and PECADOM++ with high coverage, although PECADOM++ was not an efficient strategy to complement MTAT. The modest impact of the intervention package suggests a need for alternative or complementary strategies

Robust late twenty-first century shift in the regional monsoons in RegCM-CORDEX simulations

AbstractWe use an unprecedented ensemble of regional climate model (RCM) projections over seven regional CORDEX domains to provide, for the first time, an RCM-based global view of monsoon changes at various levels of increased greenhouse gas (GHG) forcing. All regional simulations are conducted using RegCM4 at a 25 km horizontal grid spacing using lateral and lower boundary forcing from three General Circulation Models (GCMs), which are part of the fifth phase of the Coupled Model Inter-comparison Project (CMIP5). Each simulation covers the period from 1970 through 2100 under two Representative Concentration Pathways (RCP2.6 and RCP8.5). Regional climate simulations exhibit high fidelity in capturing key characteristics of precipitation and atmospheric dynamics across monsoon regions in the historical period. In the future period, regional monsoons exhibit a spatially robust delay in the monsoon onset, an increase in seasonality, and a reduction in the rainy season length at higher levels of radiative forcing. All regions with substantial delays in the monsoon onset exhibit a decrease in pre-monsoon precipitation, indicating a strong connection between pre-monsoon drying and a shift in the monsoon onset. The weakening of latent heat driven atmospheric warming during the pre-monsoon period delays the overturning of atmospheric subsidence in the monsoon regions, which defers their transitioning into deep convective states. Monsoon changes under the RCP2.6 scenario are mostly within the baseline variability