Syndrome de West : Profil des patients au chu de Fann Dakar-Senegal

Introduction: Le syndrome de West ou encéphalopathie épileptique avec hypsarythmie est fréquente chez le nourrisson au Sénégal. Son pronostic est étroitement lié à la pathologie sous-jacente .Il est principalement secondaire à des causes périnatales. Patients et méthodes: Il s‘est agi d‘une étude rétrospective réalisée à la Clinique Neurologique du CHU de Fann et à l‘Hôpital national pédiatrique Albert Royer, à Dakar-Sénégal, d‘Avril 2012 à Aout 2018. Sur les dossiers médicaux et les registres de suivi, nous avons recueilli les caractéristiques socio-démographiques, les données cliniques, les données paracliniques, les modalités thérapeutiques, et l‘évolution des patients. Résultats: Nous avons colligé 37 nourrissons avec une prédominance masculine (59%), dont l‘âge moyen au moment du diagnostic était de 8 ± 4mois et l‘âge moyen d‘apparition des spasmes était de 3mois. L‘EEG montrait une hypsarythmie chez tous les patients. Les causes étaient dominées par l‘atrophie cortico- sous corticale (21,62%). En première intention, le traitement associait souvent le valproate de sodium et des corticoïdes (35,13%). La pharmacorésitance nécessitait d‘associer valproate de sodium au vigabatrin (8%). L‘évolution clinique était surtout marquée par un arrêt des crises (24,32%), et une persistance des crises (19%). Discussion et Conclusion: Le syndrome de West est une encéphalopathie épileptique du nourrisson dominé par des spasmes en flexion. Dans notre contexte, les facteurs de risque sont l‘absence de suivi prénatal, la souffrance néonatale, l‘accouchement dystocique. La polythérapie permet d‘arrêter les crises, qui dans certains cas peuvent devenir pharmacorésistantes. L‘imagerie par résonnance magnétique et le bilan génétique sont presque inaccessibles, de même que le vigabatrin dont le cout est élevé. English title: West syndrome: Patient profile at Fann Dakar-Senegal Teaching Hospital Introduction: West syndrome or epileptic encephalopathy with hypsarrhythmia is common in infants in Senegal. Its prognosis is closely related to the underlying pathology. It is mainly secondary to perinatal causes. Patients and methods: This was a retrospective study conducted at the Fann University Hospital Neurological Clinic and at the Albert Royer National Pediatric Hospital in Dakar, from April 2012 to August 2018. On medical records and follow-up registers, we collected socio-demographic characteristics, clinical data, paraclinical data, therapeutic modalities, and patient outcomes. Results: We collected 37 infants with male predominance (59%), whose mean age at diagnosis was 8 ± 4 months and the mean age at the onset of spasm was 3 months. EEG showed hypsarrhythmia in all patients. The causes were dominated by cortico-subcortical atrophy (21.62%). As a first-line treatment, sodium valproate and corticosteroids were often combined (35.13%). Drug resistance required the combination of valproate sodium and vigabatrin (8%). The clinical course was mainly marked by a cessation of seizures (24.32%), and a persistence of seizures (19%). Discussion and Conclusion: West‘s syndrome is an infantile epileptic encephalopathy dominated by flexion spasm. In our context, the risk factors are the absence of prenatal follow-up, neonatal distress, and obstructed labor. Combination therapy can stop seizures, which in some cases may become drug-resistant. Magnetic resonance imaging and gene balance are almost inaccessible, as is vigabatrin, which is expensive

Manifestations electro-cliniques du syndrome de Lennox–Gastaut

Introduction : Le syndrome de Lennox-Gastaut (SLG) est une encéphalopathie épileptique rare. Notre étude consiste à déterminer les caractéristiques électro-cliniques du SLG au centre hospitalier national universitaire de Fann à DAKAR. Méthodologie: Il s’agit d’une étude rétrospective portant sur les dossiers médicaux de juillet 2004 à mai 2015, réalisée à la clinique neurologique et à l’hôpital des enfants Albert Royer. L’âge des enfants, l’âge de début des crises, les antécédents pathologiques, le type de crise, les troubles cognitifs et les tracés EEG ont été recueillis. Ont été inclus dans cette étude, tous les patients présentant de multiples types de crises, partielles ou généralisées ; un retard mental et à l’EEG, des pointes ondes lentes généralisées à la veille et/ou pointes rapides rythmiques pendant le sommeil.Résultats: Nous rapportons cinq cas de SLG de différents âges avec comme antécédents, une épilepsie familiale chez trois enfants et un syndrome de west chez un enfant. Le sex ratio était de 3/2 en faveur du sexe masculin. L’âge de début du SLG se situait typiquement entre 1 et 7 ans chez 4 patients. Les types de crises retrouvées étaient les crises toniques (100%), les absences atypiques (80%), les crises partielles motrices (60%), les crises atoniques (40%) et crises généralisées tonico-cloniques (40%). Aussi, tous les enfants avaient des troubles cognitifs. Les patterns EEG les plus fréquemment retrouvés étaient des décharges de Pointes ondes lentes Conclusion : Le SLG est une encéphalopathie épileptique infantile rare caractérisée par de multiples types de crise, un tracé EEG spécifique et un retard psychomoteur. Les résultats de notre étude concernant le profil électro-clinique se rapprochent de ceux de la littérature. Electro-clinical manifestations of Lennox–Gastaut SyndromeIntroduction: Lennox–Gastaut syndrome (LGS) is an uncommon epileptic encephalopathy. In this study, we tried to determine the clinical and EEG characteristics of patients with LGS in DAKAR Fann teaching hospital. Methods: It is a retrospective study concerning medical folders during July 2004 to May 2015 realized in neurological clinic and Albert Royer children’s hospital. Age, gender, age at seizure onset, seizure type(s), epilepsy risk factors, cognitive disorders and EEG of all patients were registered. We included for this study all patients presenting multiple seizure types, mental retardation and an interictal EEG showing bursts of slow spike-wave complexes during awake and/or generalized paroxysmal fast activity during sleep. Results: We report different age five LGS cases with familial epilepsia in three cases and west syndrome in one case. The sex ratio was 3/2 for male. The age at seizure onset was typically between 1 and 7 years in four patients. The most common seizure type was tonic (100%), followed by atypic absence (80%), partial motor seizures (60%), and atonic seizures (40%) and generalized tonic–clonic seizures (40%). All the five childrens had cognitive disorders. The most common EEG finding was slow spike-wave complexes. Conclusion: LGS is an uncommon epileptic encephalopathy characterized by multiple seizure types, a specific electroencephalographic pattern and psychomotor retardation, beginning in childhood. Our results are  comparable with literature.

Severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou: epidemiological, clinical, therapeutic and prognostic aspects

Background: To study the epidemiological, clinical, therapeutic and prognostic aspects of severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou.Methods: descriptive cross-sectional study with prospective collection from January 1 to December 31, 2018. The variables studied focused on clinical socio-demographic characteristics, treatment and prognosis. The women admitted to the department and meeting the criteria for severe pre-eclampsia were included, more than 20 weeks of amenorrhea with an increase in blood pressure, presence of albumin in the urine and signs of clinical or biological seriousness.Results: Severe pre-eclampsia represented 2.3% of admissions and 3% of deliveries. The clinical profile was that of a young housewife (51.2%), married (72.4%), nulliparous (44.1%) with a pregnancy in the 3rd trimester. Symptoms were dominated by headache (53.5%) and diastolic blood pressure ≥110 mmHg (66.9%), with albuminuria greater than two crosses and hyperuricemia. Magnesium sulfate and clonidine were the most commonly prescribed anticonvulsant and antihypertensive drug, respectively. Cesarean section was performed in 53% of cases.Maternal complications were noted in 57.5% of cases without death. However, the fetus took a heavy toll with 50.7% morbidity and 14% perinatal mortality.Conclusions: Severe pre-eclampsia is responsible for heavy morbidity - perinatal mortality. Improving maternal and fetal prognosis will require compliance with treatment protocols and greater accessibility of care at all levels of the health pyramid.

Caesarean section at Koudougou regional hospital centre: indications and prognosis

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Peer reviewe

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Quality assessment of individual case safety reports in pharmacovigilance in Burkina Faso

Pharmacovigilance is based on individual case safety reports. Our study is intended to be a contribution to good practices by the quality assessment of individual case safety reports sent to the National Center for Vigilance in Burkina Faso. We carried out a cross-sectional study which concerned individual case safety reports sent to the Center between 2009 and 2014. 302 individual case safety reports forms were identified and the rate of notifications per year and per million inhabitants was 2,9. The sex ratio was 0,83 in favor of women and the average age was 14,3. 320 drugs were listed with a predominance of antimalarials (37.8%) and antibiotics (19%). Adverse reactions were mostly cutaneous-allergic (37.9%) and general (25.2%). More than half of individual case safety reports were sent by pharmacists (58.6%) followed by nurses (29.5%) then doctors (6.6%). An analysis of the quality of the files according to WHO criteria gave 25.8% for grade A, 67.2% for grade B and 7% for grade C. The files were transmitted within 15 days in 54% cases. The description of the adverse drug reactions was in accordance with WHO ART terminology in 93.5%. Underreporting is a reality and special attention should be paid to collecting information on adverse drug events

P5 Caractérisation des erreurs médicamenteuses survenues au Centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle en avril 2023

Introduction : Les erreurs médicamenteuses sont fréquentes en néonatologie. Elles sont parfois critiques en situation de prématurité. Le but de la présente étude était de caractériser les erreurs médicamenteuses commises de la prescription à l’administration des traitements des patients admis au centre de néonatologie du CHU pédiatrique Charles de GAULLE.   Matériel et méthodes : il s’est agi d’une étude observationnelle à visée descriptive. Elle s’est déroulée durant le mois d’avril 2023 au centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle (CHUP-CDG). La population d’étude était constituée des nouveau-nés admis pour soins au centre. Résultats : Au total 38 nouveau-nés ont été inclus dans l’étude. Deux cent quatorze (214) prescriptions, 36 préparations ou reconstitutions de médicaments, 54 administrations et 102 délivrances de traitement médicamenteux aux patients ont été analysées. Au total 179 erreurs médicamenteuses ont été identifiées. La prescription et l’administration des médicaments étaient les étapes qui comptaient le plus grand nombre d’erreur avec des proportions de 53,07 % et 40,78 %. La préparation/reconstitution des médicaments et la dispensation des traitements ont été sources d’erreurs médicamenteuses dans des proportions de 1,2% et 5,03%. Les erreurs de dose ont représenté 53,14 % des interventions pharmaceutiques. Selon le degré de réalisation, 41,90 % étaient des erreurs potentielles et la totalité des erreurs médicamenteuses n’avaient pas de conséquences significatives sur la santé des patients. Conclusion : Cette étude a permis détecter et de caractériser les erreurs survenues lors de processus du circuit clinique du médicament au centre de néonatologie du CHUP-CDG. Des renforcements de capacités des acteurs permettront de corriger les insuffisances relevées