Les syndromes coronaires aigus à Dakar: aspects cliniques thérapeutiques et évolutifs

Introduction: Ce travail a pour objectifs d'étudier les aspects épidémiologiques et cliniques, les   différentes modalités de prise en charge, et l'évolution des syndromes coronaires aigus à Dakar. Méthodes: Il s'agit d'une étude prospective concernant une cohorte de patients hospitalisés au niveau des services de cardiologie de l'hôpital Principal de Dakar et de l'hôpital Aristide Le Dantec pour un syndrome coronaire aigu entre le 01 Septembre 2005 et le 31 Août 2006. Résultats: Durant la période d'étude, 59 patients avaient présenté à l'admission un syndrome coronaire aigu, soit une prévalence hospitalière de 4,05%. L'âge moyen était de 57,1 ± 3,5 ans. L'indice moyen des facteurs de risque était de 3,56 ± 1,7. Quatre vingt onze pour cent (91%) des patients avaient au moins deux facteurs de risque cardio-vasculaires. Les délais moyens d'arrivée et de prise en charge étaient  respectivement de 53,2 ± 21,3 heures et 3,4 ± 1 heures. L'analyse des tracés électrocardiographiques  associée au dosage des troponines, avait permis de retenir les diagnostics d'infarctus du myocarde avec sus-décalage persistant du segment ST chez 89,8% patients, d'infarctus du myocarde sans sus-décalage du segment ST chez 5,1% patients, et d'angor instable dans 5,1% des cas. La mortalité hospitalière était de 15,25% et la mortalité à un mois de 18,64%. Conclusion: Au Sénégal, les syndromes coronaires aigus sont caractérisés par un âge de survenue  relativement jeune chez des patients polyfactoriels et une lourde mortalité. C'est dire tout l'intérêt d'une prévention primaire efficace par la lutte contre les facteurs de risque cardio-vasculaires.Key words: Syndromes coronaires aigus, facteurs de risque cardio-vasculaires, Daka

Caractérisation de la Dynamique des Peuplements Ligneux du Centre Nationale de Recherches Agronomiques de Bambey (Diourbel/Sénégal)

Le Sénégal, à l’instar des autres pays sahéliens, est confronté à la dégradation de ses espaces forestiers due à un ensemble de facteurs tels que : les défrichements agricoles, les feux tardifs, l’exploitation anarchique, etc. Ce phénomène est plus accentué dans la région de Diourbel où l’un des très rares poumons verts se trouve dans le site du Centre National de Recherches Agronomiques de Bambey (CNRA). Cette étude avait comme objectifs de caractériser et d’estimer le potentiel des ligneux dans cette formation forestière dans le but de donner formuler des recommandations. Un inventaire systématique sur 103 placettes de 50 X 50 m a été réalisé en 2018. Les paramètres recherchés ont été : la richesse spécifique, la densité du peuplement, la surface terrière, le volume de bois, le couvert aérien, la régénération, la structure horizontale et verticale, les observations sur l’émondage, le vieillissement, etc. Ainsi, 28 espèces appartenants à 13 familles ont été recensées. Les familles des Mimosaceae (28,57%) et des Combretaceae (17,86%) dominent la végétation. Pour les individus adultes, la densité est de 98 individus/ha, dominée par Acacia seyal, tandis que la régénération s’élève à 581 plantules/ha, dominée par Combretum aculeatum. La surface terrière du peuplement est estimée à 2,12 m2/ha, le couvert aérien (3223,08 m2/ha) et le volume (13,83 m3/ha). La distribution du peuplement par classe de diamètre et de hauteur révèle la prédominance de la strate arbustive. Les observations ont montré la présence de pratiques anthropiques qui pourraient contribuer à la régression de la dynamique du peuplement par la diminution du couvert végétal et la disparition de certaines espèces (Deterium microcarpum, Pterocarpus erinaceus et Sterculia setigera) constatée dans cette formation.  Ces résultats montrent l’urgence de mettre en place une stratégie de gestion en étroite collaboration avec les communautés pour la conservation et la restauration du couvert végétale de cette formation boisée de 149 ha.   Senegal, like other Sahelian countries, is faced with the degradation of its forest areas due to a combination of factors such as agricultural clearing, late fires, uncontrolled logging, etc. This phenomenon is more pronounced in the Diourbel region, where one of the very few green lungs is located on the site of the Centre National de Recherches Agronomiques Bambey (CNRA). This phenomenon is more pronounced in the Diourbel region, where one of the very few green lungs can be found on the site of the “Centre National de Recherches Agronomiques de Bambey” (CNRA). The objectives of this study were to characterize and estimate the potential of woody species in this forest formation, to formulate recommendations. A systematic inventory of 103 50 x 50 m plots was carried out in 2018. The parameters investigated were: species richness, stand density, basal area, wood volume, aerial cover, regeneration, horizontal and vertical structure, observations on pruning, aging, etc. A total of 28 species belonging to 13 families were inventoried. Among these families, Mimosaceae (28,57%) and Combretaceae (17,86%) dominate the vegetation. The density of adult trees is 98 individuals/ha, dominated by Acacia seyal, while regeneration amounts to 581 seedlings/ha, dominated by Combretum aculeatum. The basal area of the stand is estimated at 2.12 m2/ha, the aerial cover (3223.08 m2/ha), and the volume (13.83 m3/ha). The distribution of the stand-by diameter and height class reveals the predominance of the shrub layer. Observations revealed the presence of human practices that could be contributing to the decline in stand dynamics through the reduction in plant cover and the disappearance of certain species (Deterium microcarpum, Pterocarpus erinaceus, and Sterculia setigera) observed in this formation. These results show the urgent need to implement a management strategy in close collaboration with the communities to conserve and restore the plant cover of this 149 ha woodland formation

Caractérisation et Evolution du Peuplement Ligneux du Bois de Boulogne du Centre Nationale de Recherches Agronomiques (CNRA) de Bambey (Diourbel/Sénégal)

Le Sénégal à l’instar des autres pays sahéliens, est confronté à la dégradation de ses espaces forestiers dû à un ensemble de facteurs tels que : les défrichements agricoles, les feux tardifs, l’exploitation anarchique, etc. Des travaux d’inventaires ont été réalisés dans la formation boisée (Bois de Boulogne) du Centre National de Recherches Agronomiques de Bambey. L’étude vise à évaluer le potentiel ligneux du Bois soumis à forte pression anthropique dans le but de donner des recommandations. Un inventaire systématique sur 103 placettes de 50 X 50 m est réalisé en 2018. Les paramètres recherchés sont : la richesse spécifique, la densité, la surface terrière, le volume, le couvert aérien, la régénération, la structure horizontale et verticale, les observations sur l’émondage, le vieillissement, etc. Ainsi, 28 espèces de 13 familles ont été recensées. Mimosaceae et Combretaceae domine la végétation. Pour les individus adultes, la densité est de 98 individus/ha, dominée par Acacia seyal, tandis que la régénération s’élève à 581 plantules/ha, dominée par Combretum aculeatum. La surface terrière du peuplement est estimée à 2,12 m2/ha, le couvert aérien (3223,08 m2/ha) et le volume (13,83 m3/ha). La distribution du peuplement par classe de diamètre et de hauteur révèle la prédominance de la strate arbustive. Les observations ont montré la présence de pratiques anthropiques. Cette étude a permis de recenser la flore du Bois, d’évaluer le potentiel ligneux et de remarquer l’anthropisation, d’où la nécessité de mettre en place une stratégie de gestion pour la conservation et la restauration du couvert végétale.   Senegal, like other Sahelian countries, is faced forest degradation due to a combination of factors such as: agricultural clearings, late fires, uncontrolled logging, etc. Inventory work has been carried out in the woodland formation (Bois de Boulogne) of the Centre National de Recherches Agronomiques de Bambey. The aim of the study was to assess the woody potential of the Bois, which is under heavy human pressure, with a view to making recommendations. A systematic inventory on 103 plots of 50 X 50 m is carried out in 2018. The parameters sought are: species richness, density, basal area, volume, aerial cover, regeneration, horizontal and vertical structure, observations on pruning, ageing, etc. A total of 28 species from 13 families were recorded. Mimosaceae and Combretaceae dominate the vegetation. Adult density is 98 individuals/ha, dominated by Acacia seyal, while regeneration is 581 seedlings/ha, dominated by Combretum aculeatum. Stand basal area is estimated at 2.12 m2/ha, aerial cover (3223.08 m2/ha) and volume (13.83 m3/ha). Stand distribution by diameter and height class reveals the predominance of the shrub layer. Observations revealed the presence of anthropogenic practices. This study enabled us to survey the flora of the wood, assess its woody potential and note its anthropization, hence the need to implement a management strategy for the conservation and restoration of the plant cover

Quality of hydro-alcoholic products used in Senegal: pilot study

Antisepsis and disinfection have always played an important role in the fight against infectious diseases. The use of these products has been effective in breaking the chain of transmission of microorganisms. Today, with the advent of COVID-19, the main recommendations are, among other things, physical distance and the use of antiseptic products, including hydro-alcoholic products. In Senegal, with poor regulations on the acquisition and distribution of antiseptics and disinfectants, this situation has led to a proliferation of antiseptics and disinfectants on the national market. this work aimed to study the quality of hydroalcoholic products found in the trade. We evaluated ten samples of hydro-alcohol products collected during the month of March 2020. Physical and microbiological controls were performed at the National Drug Control Laboratory. The alcohol content of the samples ranged from 63 to 85% and were consistent with WHO recommendations except for samples E3 and E5. The pH values varied between 4.02 and 6.64 and the densities of the hydro-alcoholic gel samples ranged from 0.84 to 0.92 g/cm3; E2, E4, E5, E6 samples had densities greater than 0.89 g/cm3. The samples of hydro-alcoholic products all conformed to the sterility test and no microbiological contamination was observed. Antimicrobial activities of the hydro-alcoholic samples tested ranged from 58.3 to 100% with two samples showing no activity (E2 and E5). In view of the results of this study, it would be relevant to expand and deepen investigations by a significant increase in the number of samples and by carrying out as complete an analysis as possible

Le syndrome de la pince aorto-mésentérique chez l’enfant : à propos d’un cas primitive

Le syndrome de la pince aorto-mésentérique résulte de la compression du troisième duodénum entre l’artère mésentérique supérieure et l’aorte. Elle détermine un tableau d’occlusion intestinale haute aiguë ou chronique. Nous faisons une revue de la littérature à partir d’un cas de syndrome de la pince aorto- mésentérique. Il s’agit d’un nourrisson de 16 mois suivi pour des vomissements alimentaires évoluant  depuis l'âge de 03 mois et rebelles au traitement médical. Il s’agit de vomissements postprandiaux tardifs d’apparition intermittente, améliorés par la position de décubitus ventral. Le bilan radiologique  composé d’une radiographie de l’abdomen sans préparation, d’un transit oeso-gastroduodénal (TOGD) et d’un angioscanner a permis d’aboutir au diagnostic d'obstruction extrinsèque et incomplète du 3ème duodénum par la pince aorto-mésentérique. Une dérivation interne par duodéno-jéjunostomie sur anse en oméga a permis de contourner l’obstacle vasculaire avec des suites simples. Le TOGD de contrôle du 9ème jour postopératoire a montré une bonne perméabilité de l’anastomose duodéno-jéjunale. Les  vomissements ont disparu et on note un gain pondéral de 2 kg en 3 mois. Les vomissements chroniques chez le nourrisson sont d’étiologies variées. L’obstacle siégeant au 3ème duodénum est le plus souvent dû à une pince aorto-mésentérique. Malheureusement ce diagnostic est  rarement porté surtout en Afrique probablement du fait de l’insuffisance des moyens diagnostiques en  particulier dans les zones reculées. Le traitement peut être fait par les moyens chirurgicaux ou nutritionnels.Key words: Syndrome de la pince aorto-mésentérique, duodéno-jéjunostomie, artère mésentérique supérieure, enfan

Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial.

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), given each month during the transmission season, is recommended for children living in areas of the Sahel where malaria transmission is highly seasonal. The recommendation for SMC is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. This study was done to determine the effectiveness of SMC in Senegalese children up to ten years of age. METHODS AND FINDINGS: SMC was introduced into three districts over three years in central Senegal using a stepped-wedge cluster-randomised design. A census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. A pharmacovigilance system was put in place to detect adverse drug reactions. Fifty-four health posts were randomised. Nine started implementation of SMC in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. In the first year of implementation, SMC was delivered to children aged 3-59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. Cluster sample surveys at the end of each transmission season were done to measure coverage of SMC and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net (ITN) use. Entomological monitoring and assessment of costs of delivery in each health post and of community attitudes to SMC were also undertaken. About 780,000 treatments were administered over three years. Coverage exceeded 80% each month. Mortality, the primary endpoint, was similar in SMC and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [SMC: no SMC] was 0.90, 95% CI 0.68-1.2, p = 0.496). A reduction of 60% (95% CI 54%-64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test (RDT) and a reduction of 69% (95% CI 65%-72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. In areas where SMC was implemented, incidence of confirmed malaria in adults and in children too old to receive SMC was reduced by 26% (95% CI 18%-33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% CI 21%-35%, p < 0.001). One hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in SMC areas, showing a reduction in the incidence rate of severe disease of 45% (95% CI 5%-68%, p = 0.031). Estimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in SMC areas were 68% (95% CI 35%-85%) p = 0.002 in 2008, 84% (95% CI 58%-94%, p < 0.001) in 2009, and 30% (95% CI -130%-79%, p = 0.56) in 2010. SMC was well tolerated with no serious adverse reactions attributable to SMC drugs. Vomiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. The average cost of delivery was US$0.50 per child per month, but varied widely depending on the size of the health post. Limitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. CONCLUSIONS: SMC substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. Introduction of SMC was associated with an overall reduction in malaria incidence in untreated age groups. In many areas of Africa with seasonal malaria, there is a substantial burden in older children that could be prevented by SMC. SMC in older children is well tolerated and effective and can contribute to reducing malaria transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT00712374

Impact of genetic diversity on biological characteristics of Usutu virus strains in Africa

Usutu virus (USUV) previously restricted to Africa where it caused mild infections, emerged in 2001 in Europe and caused more severe infections among birds and humans with neurological forms, suggesting an adaptation and increasing virulence. This evolution suggests the need to better understand USUV transmission patterns for assessing risks and to develop control strategies. Phylogenetic analysis conducted in Africa showed low genetic diversity of African USUV strains except for one human and the USUV subtype (USUVsub) strains, which exhibited a deletion in the 3′UTR and nucleotide substitutions throughout the genome. Here we analyzed their viral replication in vitro in mosquito and mammalian cells, and vector competence of Culex quinquefasciatus, compared to a reference strain. Growth kinetics of the different strains showed comparable replication rates however variations in replication and translation efficiency were observed. Vector competence analysis showed that all strains were able to infect Culex quinquefasciatus the main peridomestic Culex species in Africa, with detection of USUV viral genomes and infectious particles. Dissemination and transmission were observed only for USUVsub, but infectious particles were not detected in Culex quinquefasciatus saliva. Our findings suggest that genetic variability can affect USUV in vitro replication in a cell type-dependent manner and in vivo in mosquitoes. In addition, the results show that Culex quinquefasciatus is not competent for the USUV strains analyzed here and also suggest an aborted transmission process for the USUVsub, which requires further investigations

Gallstones: Management of the Sickle Cell Child

Gallstone is rare in children; however, sickle cell disease is associated with an increased risk of gallstone formation. We aimed to report particularity of diagnosis and management of gallstones in sickle cell children. We conducted a cross-sectional multicentric study in four hospitals of Dakar, in Senegal, during 18 years. We studied frequency, diagnostic particularities, management, and outcome. Among the 105 pediatric patients managed for gallstones, 87 (82.85%) had sickle cell disease. Among the latter, 18 (17.14%) were asymptomatic. Laparoscopic cholecystectomy was performed in 71 patients (67.62%). Following surgery, sickle cell patients were systematically hospitalized in the intensive care unit for 24 hours. Complications occurred in 7.6% and mortality in 1.9%. Gallstone is frequent in sickle cell children. Its management has good outcomes when taking in account particularities of these patients

Cardiovascular disease and ABO blood-groups in Africans. Are blood-group A individuals at higher risk of ischemic disease?: A pilot study

Background: Since the discovery of the ABO blood group system by Karl Landsteiner in 1901, several reports have suggested an important involvement of the ABO blood group system in the susceptibility to thrombosis. Assessing that non-O blood groups in particular A blood group confer a higher risk of venous and arterial thrombosis than group O. Epidemiologic data are typically not available for all racial and ethnics groups. The purpose of this pilot study was to identify a link between ABO blood group and ischemic disease (ID) in Africans, and to analyze whether A blood group individuals were at higher risk of ischemic disease or not. Methods: A total of 299 medical records of patients over a three-year period admitted to the cardiology and internal medicine department of military hospital of Ouakam in Senegal were reviewed. We studied data on age, gender, past history of hypertension, diabetes, smoking, sedentarism, obesity, hyperlipidemia, use of estrogen-progestin contraceptives and blood group distribution. In each blood group type, we evaluated the prevalence of ischemic and non-ischemic cardiovascular disease. The medical records were then stratified into two categories to evaluate incidence of ischemic disease: Group 1: Patients carrying blood-group A and Group 2: Patients carrying blood group non-A (O, AB and B). Results: Of the 299 patients whose medical records were reviewed, 92 (30.8%) were carrying blood group A, 175 (58.5%) had blood group O, 13 (4.3%) had blood group B, and 19 (6.4%) had blood group AB. The diagnosis of ischemic disease (ID) was higher in patients with blood group A (61.2%) than in other blood groups, and the diagnosis of non-ischemic disease (NID) was higher in patients with blood group O (73.6%) compared to other groups. In patients with blood group B or AB compared to non-B or non-AB, respectively there was no statistically significant difference in ID incidence. Main risk factor for ID was smoking (56.5%), hypertension (18.4%) and diabetes (14.3%). In our study, there was no statistical difference between blood group A and non-A in myocardial infarction (MI) incidence (p = 0.09, 95% CI = 0.99–2.83) but a statistically significant difference between blood group A and non-A in stroke and coronary artery disease (CAD) incidence (p < 0.0001, 95% CI = 1.80–3.37 and p < 0.0001 95% CI = 1.82–3.41 respectively) was found. The incidence of ID in men was significantly higher in blood group A (95% CI = 2.26–4.57, p < 0.0001) compared with non-A group, while there was no statistically significant difference in women (p = 0.35). However, an overall effect was detected to be statistically significant regardless of gender (p < 0.0001). Conclusion: Our study suggests an association between blood group A and ID in sub-Sahara Africans. In African countries, where most of health facilities are understaffed, more rigorous studies with a larger population are needed to give a high level of evidence to confirm this association in order to establish the need to be more aggressive in risk factor control in these individuals