Prévalence et facteurs de risque de la mauvaise observance au traitement anti-épileptique à Dakar- Sénégal

Introduction: 80 % à 90 % of epileptics don’t receive adapted treatment in developing countries. Treatment gap was esteemed in Dakar 2003 to 23,4% with a prevalence of 14,2 0/00. This  study  would  evaluate factors influencing the quality of antiepileptic drugs adherence.Participants and methods: We did a transversal study during 8 months (November 2009 - June 2010) in a suburban hospital and the university teaching hospital of Fann in Dakar. It concerns more than 400 persons with epilepsy between 15 and more years old, using antiepileptic drugs since more than 3 months.Results: Epilepsy was followed since 6 – 20 years for 46 % of patients and 67,6 % of seizures was generalized with a majority of one seizure per month and 19 % patients was seizure free since 2 years. 83,9% of patients used one antiepileptic drug since principally 3 years in 40,2%. 92,9 % patients could access easily to AEDs, but 15,3% didn’t used it as prescribed.Conclusion : The prevalence of nonadherence to antepileptic treatment was 69,8% with statistical link with age, study level, profession, memory trouble, seizures frequency, stress, afraid to be dependant of treatment, hope of healing.Introduction : On estime que 80 à 90% des épileptiques ne reçoivent pas de traitement approprié dans les PED. Le treatment gap à Dakar, a été estimé en 2003 à 23,4 % pour une prévalence de 14,2 0/00. Notre étude tente d’évaluer les facteurs pouvant influencer la qualité de l’observance au traitement antiépileptique.Participants  et  méthodes : Etude  transversale  de  8 mois (Novembre 2009 - Juin 2010) dans un hôpital périphérique de la banlieue de Dakar et un hôpital universitaire, concernant plus de 400 personnes épileptiques âgés de 15 ans et plus, sous MAE depuis plus de 3 mois. Résultats : L’épilepsie évoluait entre 6 à 20 ans pour 46 % des patients et 67,6 % des crises étaient généralisées avec une fréquence majoritaire d’une crise par mois et avec 19 % de patients libres de crises depuis 2 ans. 83,9% des patients était sous monothérapie dont 65,2 % en prise unique, et durait depuis mois de 3 ans chez 40,2%. 92,9 % des patients avait un accès aisé aux MAE mais 15,3% ne suivaient pas les prescriptions médicales.Conclusion : La prevalence de mauvaise observance était de 69,8% avec une liaison statistique avec l’âge, le niveau d’étude, la profession, les troubles de la mémoire, la fréquence des crises, la polythérapie, la fatigue, le stress la peur de devenir dépendant du traitement et l’espoir de guérison

Fractures diaphysaires déplacées de l’avant-bras chez l’enfant : aspects épidémiologiques, cliniques et thérapeutiques

Le but de notre étude était d’évaluer les résultats de la prise en charge orthopédique des fractures diaphysaires déplacées de l’avant-bras chez l’enfant. Cinquante six patients ont été pris en charge pour fractures diaphysaires déplacées de l’avant-bras entre janvier 2009 et juin 2010. L’âge moyen des patients était de 7,03 ans (extrêmes : 30 mois et 14 ans) et le sex ratio était de 4/1. Trente et un patients  résidaient dans la ville de Dakar. Le délai moyen de consultation était de 9,85 heures (extrêmes : 30  minutes et 100 heures). Les accidents ludiques représentaient 53,6% des causes de fractures. Le choc indirect (chute avec réception sur la main) était le principal mécanisme (76,8%). La fracture intéressait  le membre dominant dans 51,7%. L’ouverture cutanée était associée dans 2 cas. Les  fractures    intéressaient les 2os de l’avantbras et étaient situées sur le 1/3 moyen dans 66% des cas. Les fractures en bois vert représentaient plus de la moitié des cas (58,9%). La réduction était initialement non  satisfaisante dans 9 cas. Les déplacements secondaires sous plâtres et les cals vicieux avaient été  observés respectivement chez 11 et 2 patients. Avec un recul moyen de 8 mois la pronosupination était jugée satisfaisante chez 27 patients et 6 avaient une limitation dont 2 nécessitant une reprise  chirurgicale. Le traitement orthopédique des fractures diaphysaires déplacées de l'avant-bras chez l'enfant est une indication toujours d'actualité dans notre contexte car il donne des résultats satisfaisants.Mots clés : fractures avant-bras, enfant, traitement orthopédique.The aim of this study was to assess the outcome of the orthopedic management of displaced diaphyseal forearm fractures in children. Fiftysix patients were treated for displaced diaphyseal fractures of the forearm between january 2009 and june 2010. The mean age of patients was 7.03 years (range: 30 months and 14 years) and the sex ratio was 4/1. Thirty-one patients resided in the city of Dakar. The average time of consultation was 9.85 hours (range: 30 minutes and 100 hours). The recreational accidents represented 53.6% of the causes of fractures. The indirect impact (fall with reception on hand) was the main mechanism (76.8%). The fracture interested the dominant limb in 51.7%. Skin opening was associated in 2 cases. Fractures interested the 2  bones of the forearm and were located on the medial third in 66% of cases. Greenstick fractures accounted for more than half (58.9%). The reduction was initially  unsatisfactory in 9 cases. Secondary displacement in plaster and malunion were observed respectively in 11 and 2 patients respectively. With a mean of 8 months the pronosupination was satisfactory in 27 patients and 6 had a limitation of which 2 required reoperation. Conservative treatment of displaced diaphyseal fractures of the forearm in children is an indication still relevant in our context because it gives satisfactory results.Key words: fractures forearm, child, orthopaedic treatment

Cross-Reactivity of SARS-CoV-2 Laboratory Diagnostics to Endemic Diseases in Africa: A Diagnostic Accuracy Study

Background: Serology is a great tool to assess the level of immunity against SARS-CoV-2 in settings with limited access to molecular diagnostics. However, African populations displays a particular immunological profile with massive circulation of infectious agents from different aetiologies that can affect assays performance.Methods: We evaluated the OMEGA Diagnostics COVID-19 ELISA-IgG and the ID Screen® SARS-CoV-2-N IgG Indirect in Senegal using a panel of 636 blood samples covering several African-endemic diseases and healthy donors to determine test sensitivity and specificity. The sensitivity panel of sera includes 461 serum samples collected from 91 patients hospitalized for COVID-19 disease. COVID-19 cases were confirmed by qRT-PCR and samples were collected on an interval of three days until viral clearance. In addition, 272 sera obtained from COVID-19 negative individuals were selected from a well-documented biobank of sera collected before the COVID-19 outbreak.Finding: High-cross reactivity have been found in individuals with a history of exposure to Chikungunya, HIV, malaria (Plasmodium falciparum), rheumatoid factor as well as healthy donors with respective specificities of 55%, 41.8%, 70%, 70% and 75%. ELISA experiments with commercial assays targeting either SARS-CoV-2 Nucleocapsid protein and Spike 2 protein or nucleocapsid protein only suggest that cross-reactivity might be directed against Spike 2 protein and not Nucleocapsid protein. Further samples characterisation reveals that anti-malaria IgG is the leading cause of such poor specificities, but exposure to other diseases contributed as well.Interpretation: We anticipate that COVID-19 seroprevalence can be biased if assays are not contextualized. Since malaria is endemic in African settings, we propose that a particular attention must be given in serological surveillance of COVID-19 or anti-SARS-CoV-2 antibodies quantification as vaccines are being rolled out

Hydroxychloroquine and Azithromycin Treatment of Hospitalized Patients Infected with SARS-CoV-2 in Senegal from March to October 2020

International audienceAs of today, little data is available on COVID-19 in African countries, where the case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 hospitalized patients in Senegal from March to October 20202. We described the clinical characteristics of patients and analysed clinical status (alive and discharged versus hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among adult patients who received HCQ plus AZM and those who did not receive this combination. A total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) patients received a combination of HCQ and AZM. Results showed that the proportion of patient discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC 95% (1.09–2.43)). Factors associated with a lower proportion of patients discharged alive were: age ≥ 60 years (OR: 0.55, IC 95% (0.36–0.83)), having of at least one pre-existing disorder (OR: 0.61, IC 95% (0.42–0.90)), and a high clinical risk at admission following NEWS score (OR: 0.49, IC 95% (0.28–0.83)). Few side effects were reported including 2 cases of cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM combinatio