Aristide Le Dantec University Hospital Research Articles

Direct 16S/ITS rRNA Gene PCR Followed by Sanger Sequencing for Detection of Mycetoma Causative Agents in Dakar, Senegal: A Pilot Study Among Patients with Mycetoma Attending Aristide Le Dantec University Hospital.

Mycetoma can be caused either by fungi or aerobic Actinomycetes. A precise identification of the causal agents is critical for the therapeutic outcome. Thus, this study aimed to identify the pathogens of mycetoma using 16S/ITS rRNA gene polymerase chain reaction (PCR) followed by Sanger sequencing directly on grains. In sum, 32 samples including 15 black grains, 12 red grains, and five white/yellow grains collected from patients with mycetoma at the Aristide Le Dantec University Hospital in Dakar, Senegal, between October 2014 and September 2020 were submitted to PCR/sequencing. For black grain eumycetoma, the ITS rRNA region was targeted. Similarly, the 16S rRNA gene was targeted for red grain actinomycetoma. These two regions were targeted in parallel for white/yellow grains, which could be of either bacterial or fungal origin. The age of the patients ranged from 14 to 72years with a mean age of 36 ± 14years. Thirteen (86%) of the 15 samples with black grains, were successfully sequenced with only one established eumycetoma pathogen, Madurella mycetomatis identified in 11 (73%). Cladosporium sphaerospermum was identified in one sample. For the 16S rRNA sequencing of red grains, a 58.3% (7/12) success rate was obtained with Actinomadura pelletieri identified in six samples. Among the five samples sequenced twice, the 16S rRNA allowed us to identify the causative agent in 2 cases, A. madurae in one, and A. geliboluensis in the other. The ITS rRNA identified 3 fungi, of which none was a mycetoma agent. Overall, direct 16S/ITS rRNA sequencing of the grains for detecting and identifying mycetoma pathogens was successful in 59.4% of cases. Fungi, led by M. mycetomatis, were the predominant pathogens identified. Two probable new mycetoma agents, C. sphaerospermum, and A. geliboluensis were identified and both deserve to be confirmed in further studies.

Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test

The Triglyceride-Glucose (TyG) index is a marker used to assess insulin resistance which is associated with the occurrence of gestational diabetes. The aim of this study is to determine the benefit of the TyG within the diagnosis of insulin resistance in pregnant women in an orally induced hyperglycaemia test. This study was conducted at the Department of Biochemistry, at Aristide le Dantec University Hospital in collaboration with the department of gynaecology. Women with fasting blood glucose < 0.92 g/L at 12 weeks of age benefited from the OGTT 75 test following the WHO protocol. The TyG index was calculated using the formula: Ln [fasting triglyceridemia (mg/dL) × fasting blood glucose (mg/dL)]/2. Data were analysed using SPSS v.26 and a p< value of 0.05 was considered statistically significant. A total of 102 patients were included in the study with a mean age of 29± to 5.9 years. The OGTT 75 test was positive in 24 women (23.5%) with a predominance in the third trimester (19.4%). TyG values were significantly higher in women with gestational diabetes (8.76, ±0.5vs8.2±, 0.5; p<0.0001), in contrast to the HOMA index (6.43, ±16.8, ±1.15±, 0.9; p=0.138). The AUC of the ROC curve for the TyG-H0, TyG-H1 and TyG-H2 indices were 0.808 (95% CI)=0.70-0.92), 0.808 (95% CI)=0.698-0.918), 0.818 (95% CI)=0.70-0.93, respectively. For the HOMA-IR index, the AUC was 0.799 (95% CI = 0.69-0.91). The cut-off value for the TyG-H<sub>1</sub> index was 9.5 with a sensitivity and specificity of 79.2% and 71.8%, respectively. The TyG index is a better way to assess the level of insulin resistance in pregnant women than using the HOMA index, especially after the first hour of a glucose load of 75g.

ASPECTS EPIDEMIOLOGIQUES ET DIAGNOSTIQUES DES MALFORMARTIONS CONGENITALES OBSERVEES DANS DEUX SERVICES DE CHIRURGIE A DAKAR

Congenital malformations pose a real social, economic, coding and prognosis problem in our developing countries. Objectives. To list congenital malformations in two surgical departments of the University Hospital of Dakar and to search for etiological factors. Patients and methods. This was a prospective study in which we collected 100 cases of congenital malformations in a pediatric population during 13 months (January 2013 to January 2014) in the Neurosurgery Department of the Fann University Hospital and the Pediatric Surgery Department of the Aristide Le Dantec University Hospital. Epidemiological and diagnostic parameters were studied. Results. The most represented age group was that of children aged 0 to 4 years (n=87) with an average age of 1.47 years, the predominance of males was clear 68% with a sex ratio of 2.19. The notion of consanguineous marriage was reported in (61%) of cases with (57%) of cases of 2nd degree and (4%) of cases of 3rd degree. Wolofs were the most affected by congenital malformations (42%). The Dakar region was the most represented (37%). The socioeconomic level was low in (75%) of cases. In (93%) of cases, the parents of malformed children said they had no dea about the problem. The congenital malformations encountered were mainly hydrocephalusand visceral diso rders. We noted (13%) of deaths in our study. Conclusion. malformations are of multifactorial origin, which makes it necessary to set up a register of congenital malformations in order to monitor the prevalence, to detect rapidly variations in the frequency of an anomaly and to identify teratogenic factors. Key words: congenital malformations, hydrocephalus, visceral malformations, etiological factors, Dakar

Evaluation of the Management of Gastroschisis in Aristide Le Dantec University Hospital Center in Dakar: A Cross Sectional Study.

The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. Eighteen cases of gastroschisis (11 males and 7 females). The mothers' mean age were 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The mean gestation age were 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Main complications were respiratory distress (28.3%) and sepsis (22.2%). The mean duration of return of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.

Quality assessment of malaria microscopic diagnosis at the Aristide Le Dantec University Hospital of Dakar, Senegal, in 2020

BackgroundFollowing WHO guidelines, microscopy is the gold standard for malaria diagnosis in endemic countries. The Parasitology-Mycology laboratory (LPM) is the National Reference Laboratory and is currently undergoing ISO 15189 accreditation. In this context, we assessed the performance of the laboratory by confirming the reliability and the accuracy of results obtained in accordance with the requirements of the ISO 15189 standards. This study aimed to verify the method of microscopic diagnosis of malaria at the LPM, in the Aristide Le Dantec hospital (HALD) in Dakar, Senegal.MethodsThis is a validation/verification study conducted from June to August 2020. Twenty (20) microscopic slides of thick/thin blood smear with known parasite densities (PD) selected from the Cheick Anta Diop University malaria slide bank in Dakar were used for this assessment. Six (6) were used to assess microscopists’ ability to determine PD and fourteen (14) slides were used for detection (positive vs negative) and identification of parasites. Four (4) LPM-HALD microscopists read and recorded their results on prepared sheets. Data analysis was done with Microsoft Excel 2010 software.ResultsA minimum threshold of 50% concordance was used for comparison. Of the twenty (20) slides read, 100% concordance was obtained on eight (8) detection (positive vs negative) slides. Four (4) out of the six (6) parasite density evaluation slides obtained a concordance of less than 50%. Thirteen (13) out of the fourteen (14) identification slides obtained a concordance greater than 50%. Only one (1) identification slide obtained zero agreement from the microscopists. For species identification a concordance greater than 80% was noted and the microscopists obtained scores between 0.20 and 0.4 on a scale of 0 to 1 for parasite density reading. The microscopists obtained 100% precision, sensitivity, specificity and both negative and positive predictive values.ConclusionThis work demonstrated that the microscopic method of malaria diagnosis used in the LPM/HALD is in accordance with the requirements of WHO and ISO 15189. Further training of microscopists may be needed to maintain competency.

Pyonephrosis: epidemiological, clinical, and therapeutic aspects at Aristide Le Dantec University Hospital Centre (Dakar)

Pyonephrosis: epidemiological, clinical, and therapeutic aspects at Aristide Le Dantec University Hospital Centre (Dakar)

Chronic leg ulcers in Senegal: Epidemiological and etiological study on 154 cases

Background: Our aim was to establish the epidemiological and etiological profile of chronic leg ulcers (CLUs) in Senegal. Methodology: We conducted a retrospective, descriptive, analytical study at the Dermatology Department of Aristide Le Dantec University Hospital Center (HALD) in Dakar from January 2008 to January 2018 (10 years). Data was entered in Excel and analyzed with Epi Info 7. Results: We recorded 154 cases. The sex ratio was 1.75. The main causes were vascular in 69 cases (44.8%), infectious in 29 (18.8%), and sickle cell disease in 15 (9.7%). Etiology has not been identified in 23 patients (15.1%). Vascular origin was venous in 64 cases (92% of vascular causes) without any statistical link with sex (p = 0.408), arterial in 3 (4%), and mixed in 2 (3%). Conclusion: In Senegal, LCUs are predominantly observed in young males. Causes are dominated by venous insufficiency, followed by infection. Key words: Chronic leg ulcer, Venous insufficiency, Senegal

Contribution of mammography in the diagnosis of breast tumours at the senology unit of the chu aristid le dantec hospital

Introduction: In Senegal, breast cancer is the second most common cancer in women after cervical cancer.1 It is responsible for a high mortality rate of around 70% after five years,2 as in many other developing countries. Mammography plays an important role in the screening and diagnosis of breast diseases. The unfavourable conditions in our regions are at the origin of the inaccessibility and unavailability of this diagnostic tool. Objectives: The objective of our study was to evaluate the availability, accessibility and use of mammography in the diagnosis of breast diseases in the Senology Unit of the University Hospital Aristide Le Dantec in Dakar. Materials and methods: This was a descriptive and analytical cross-sectional study of 120 patients followed at the Senology Unit of the Aristide Le Dantec University Hospital in Dakar, during the period from 1 January 2010 to 31 December 2014. The parameters studied were: the socio-economic profile of women, the geographical distribution of functional mammography centres, the time taken to perform mammography, its cost, its quality and its contribution to diagnosis. Results: In our study, the majority of patientes lived in the suburbs of Dakar (67.5%). The average age was 44.2 years. More than half (54.2%) had no regular source of income. The rate of use of mammography was 8.9%. The average cost was 48,944 FCFA. The average time taken to carry out a mammogram after it was prescribed was 28.8 days. In 76.6% of cases, mammography was performed for diagnostic purposes. In no case was an additional examination performed. As regards the quality of the mammographic examination, in 17.5% of cases the usual marking was not respected and the transparency of the images was not optimal in 26.6% of cases. The validity criteria were not met in 18.3% of the results and the American College of Radiology (ACR) BIRADS classification was used in 95 patients (79.2%). Payment before the examination was carried out was in cash in the majority of cases (70.8%). However, the difference in cost was significant according to the type of imaging centre (p = 0.015). Conclusion: Mammography was characterised by the unavailability of centres, a fairly long time to carry out the examination and a lower quality of the examinations.

ACCES A LA DIALYSE ET LETALITE DES PATIENTS INSCRITS SUR LA LISTE D’ATTENTE D’HEMODIALYSE DU CENTRE HOSPITALIER UNIVERSITAIRE ARISTIDE LE DANTEC

SummaryIntroduction: The aims of this study were to evaluate the lethality and access to dialysis of patients registered on the hemodialysis waiting list of the Aristide Le Dantec University Hospital Center and to identify their associated factors at the time of registration.Patients and methods: A retrospective, descriptive and analytical study used the register on the hemodialysis waiting list over a period from January 2014 to December 2018. Lethality and access to dialysis were calculated and socio-demographic and economic factors were considered as potential associated factors.Results: Seven hundred and fifty-one (751) files were included. Dakar was the region of origin in 67.93%. The average age was 48.15±15.21 years with a sex ratio of 1.02. The socio-economic level was low in 85.41%. Ten patients had joined a social protection system (1.64%). Patients were reachable in 83.36%, case fatality was 49.66% and access to dialysis was 16.24%. Registration before January 2016 was associated with access to dialysis (OR=10.8 [5.03-23.18]). Registration before January 2016 (OR=1.90[1.29-2.80]), age over 65 (OR=2.35[1.31-4.21]) and low level socio-economic (OR=1.81[1.10-3.19]) were associated with lethality.Conclusion: Access to dialysis in a public structure in Senegal remains low and lethality before access to dialysis is associated with low socio-economic level and advanced age. The decentralization of dialysis centers has made it possible to improve these proportions.. Keywords: dialysis, accessibility, public hospital, limited resources, Senegal

Sjögren's Syndrome: Emergence of a New Paraneoplastic Syndrome? About 5 Cases

Introduction: Gougerot-Sjögren’s syndrome (GSS) is a systemic autoimmune disease with malignant transformation to non-Hodgkin’s lymphoma (NHL) as its most formidable complication. There are few associations described in the literature with other solid tumours. We report 5 cases of SGS associated with solid tumours. Methodology: This was a retrospective, descriptive study conducted in the Rheumatology Department of the Aristide Le Dantec University Hospital in Dakar from January 2006 to December 2020. Results: Over the period we collected 5 cases. They were divided into 3 men and 2 women with a mean age of 73.4 years (51-83 years). The average diagnostic delay was 158.4 months or 13 years (120-240 months). The tumour occurred during the evolution of the GSS in 3 cases while the GSS occurred during the evolution of the tumour in 2 cases. The associated tumours were prostate cancer in 3 cases, ovarian cancer in 2 cases and colon cancer in 1 case. Paraneoplastic hyperuricaemia was present in 2 patients. The evolution was marked by death in 2 patients. Conclusion: We report in our study 5 observations of SGS associated with solid tumors.

Contribution to the Study of Diabetic Kidney Disease in a Sub-Saharan Environment: An Example of the Aristide Le Dantec University Hospital in Dakar

Contribution to the Study of Diabetic Kidney Disease in a Sub-Saharan Environment: An Example of the Aristide Le Dantec University Hospital in Dakar

Nephrology Department, Aristide Le Dantec University Hospital

Hypertension is a major public health problem. Parenchymal nephropathy is the leading cause of secondary hypertension, with glomerulopathy leading the way. In sub-Saharan Africa

Hypertensive Nephropathy: Prevalence, Patient’s Profiles and Evolution in a University Hospital at Dakar

Background: Hypertensive nephrosclerosis is chronic impact of high blood pressure on the kidney. The objective of this study was to determine prevalence, clinical presentation, and evolution of hypertensive nephrosclerosis in patients admitting in our service. Patients and Methods: We performed a retrospective, descriptive and analytical study in nephrology department of Aristide Le Dantec University Hospital in Dakar during a period of 05 years. Patients with long-term hypertension, hypertensive retinopathy, left ventricular hypertrophy, and progressive kidney failure were included. Results: 461 patients were included. Hospital prevalence was 7.7%. Mean age was 56.95±13.23 years and sex ratio was 1.07. Uncontrolled high blood pressure has been found in 400 patients. Mean systolic blood pressure was 168.34 ± 27.57 mmHg. Mean diastolic blood pressure was 97.28±19.59 mmHg. On the urine dipstick, 44 patients had proteinuria (<2cross). Mean GFR, was 22.02±17.78 ml/min. Antihypertensive treatment was administered as bitherapy in 232 patients (50.3%). On admission, 47 patients (10.2%) had already started dialysis. At 12 months, 406 patients were regularly followed. Blood pressure was normal in 138 patients and serum creatinine decreased in 74 patients. Advanced age (p=0.0001) and female gender (p =0.0001) were correlated with a low level of GFR. The high 24 hours proteinuria level was unfavorable factor on GFR (p = 0.004). Conclusion: This study shows a high prevalence of hypertensive nephropathy in our study population. His evolution to end stage of kidney disease is inevitable, hence the importance of prevention and early management of hypertension in black subjects

Uterine inversions of tumor origin in two cases at the Joliot Curie Institute at the Aristide Le Dantec University Hospital Center

INTRODUCTION: Non-puerperal uterine inversions are a rare situation. Indeed, 85% of uterine inversions are puerperal. We
 report two cases observed at the Joliot Curie Institute of the Aristide le Dantec University Hospital. OBSERVATIONS: It was about a 39-year-old primigravida and a 47-year-old seventh gestational patient, who had a stage 4 of uterine inversion picture in relation to uterine sarcoma and uterine myoma respectively. The diagnosis was suspected at the clinic due to the absence of palpation of the uterus. Confirmation was made on medical imaging and intraoperatively. Management was radical with a total hysterectomy with bilateral adnexectomy via the vaginal and abdominal routes. However, in the first patient with sarcoma, surgery combined bilateral pelvic lymphadenectomy and was preceded by chemotherapy. CONCLUSION: Non-puerperal uterine inversion is a rare situation. Its treatment is essentially surgical. However, it is important to look for an etiology and in the case of a tumor to ensure that the mass is a cancer or not because the management and prognosis depend on it.

Congenital malformations of the gastrointestinal tract in neonates at aristide le dantec university hospital in Dakar: Concerning 126 cases.

Objective:Congenital malformations of the gastrointestinal tract are one of the major causes of neonatal mortality, especially in developing countries. The aim of this study is to assess the overall management of gastrointestinal malformations.Patients and Methods:The study design is monocentric and retrospective. It includes all newborns aged 1–28 days with malformations of the gastrointestinal tract between 1st January 2014 and 31st December2018, at the Paediatric Surgery Department of Aristide Le Dantec University Hospital in Dakar. Data were collected by studying patient's records and surgical procedures.Results:During the five-year study, 405 newborns with congenital anomalies were admitted to our hospital. A total of 126 newborns were diagnosed with gastrointestinal tract malformations. The incidence was 25.2 cases a year. The sex distribution was 74 boys (58.7%) and 52 girls (41.2%). The mean age at diagnosis was 7.4 ± 3.2 days. Two cases were diagnosed antenatal (1.59%). The mean time to post-natal diagnosis was 6.5 ± 2.1 days. The most common malformation was oesophageal atresia with 43 cases (34.1%). The average time between diagnosis and surgery was 48 h. Out of the 126 cases, 77 (61.1%) received surgery and 49 (38.9%) died before surgery. The main causes of pre-operative death were intricate and dominated by lung infections (42.9%). Among the 77 newborns, who received surgery, 38 (%) had a simple post-operative course, 39 (50.6 %) died. Post-operative deaths were dominated by anaesthetic complications (30.8%), lung infections (46.1%). The overall mortality was 69.8% (n = 88).Conclusion:The low socio-economic status, poor pre-natal diagnosis, prematurity, post-natal diagnostic delay, obsolete medical equipment and the lack of neonatal intensive care units were identified as the major factors for high mortality in neonates with gastrointestinal tract malformations in a developing country.

Pulmonary Hypertension in Chronic Hemodialysis Patients at Aristide Le Dantec University Hospital

Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).

Real-Time PCR Assay for the Detection of Dermatophytes: Comparison between an In-House Method and a Commercial Kit for the Diagnosis of Dermatophytoses in Patients from Dakar, Senegal.

Background. PCR assays have been developed for the diagnosis of dermatophytes, yet data in African populations are scarce. Objective. This study aimed to compare two PCR assays for the diagnosis of dermatophytosis in outpatients at the Aristide Le Dantec University Hospital in Dakar, Senegal. Patients and methods. A total of 105 samples, including 24 skin, 19 nail and 62 hair samples collected from 99 patients were included in this study. Each sample was subjected to conventional diagnosis (CD), including direct microscopy and culture, and two real-time PCR assays: one in-house (IH)-PCR, used at the University Hospital of Marseille and the Eurobio Scientific commercial kit (CK): designed for the specific detection of six dermatophytes not including Microsporum audouinii. Results. Of the 105 specimens, 24.8%, 36.2% and 20% were positive by CD, IH-PCR and CK-PCR, respectively. The IH-PCR and CK-PCR exhibited 88.9% and 65.4% sensitivity, respectively. With a 36.6 diagnostic odd ratio and 1.41 needed to diagnose, the IH-PCR displayed better diagnostic indices than the CK-PCR. It is notable that, when considering the species that it claims to detect, when it came to skin and nail samples, CK-PCR sensitivity increased to 77%. Conclusions. The pan-dermatophyte IH-PCR performed better in the diagnosis of dermatophytosis in this African population than the CK-PCR, which is not designed to detect M. audouinii. Nevertheless, both assays exhibited similarly good diagnostic indices for tinea corporis and tinea unguium, both of which are localisations where M. audouinii is more rarely involved than in tinea capitis.

Metastatic prostate cancer: clinical aspects and treatment limitations in a university hospital center in Senegal

BackgroundProstate cancer is most often diagnosed at the metastatic stage in many sub-Saharan African countries. The objective of our study is to analyze the management of metastatic prostatic adenocarcinoma based on epidemiological, clinical, therapeutic and evolutionary aspects in developing country context.MethodsRetrospective study collecting 276 patients from January 1st, 2012 to December 31st, 2019 in Aristide Le Dantec University Hospital in Dakar, Senegal. Parameters studied: age, family history of prostate cancer, reasons for consultation, total Prostate Specific Antigen (PSA), anatomic pathology examination, extension assessment, treatment, nadir PSA, castration resistance, and overall survival.ResultsThe average age was 71.4 years. A family history of prostate cancer was noted in 21 patients. Spinal pain was the most noted reason for consultation. The average total PSA level was 1967.1 ng/ml. The majority of patients had moderately differentiated prostate cancer. Bone metastases were the most common. All patients had androgen suppression. A tumor cytoreduction was performed in 89 patients. The average nadir PSA was 193 ng/ml as early as the sixth month. The time to onset of castration resistance ranged from 6 to 30 months. Abiraterone acetate was used in seven patients and docetaxel in 43 patients. The overall survival of the patients was 19.8 ± 1.2 months.ConclusionMetastatic prostate cancer was most often symptomatic at the time of diagnosis. Second-line treatments were rarely used during castration resistance. Overall survival was low.

Usefulness of foot-to-foot bioimpedance analysis for assessing volume status in chronic hemodialysis patients at the Aristide Le Dantec University Hospital (Senegal)

Introduction: Determination of dry weight is one of the daily goals to achieve in hemodialysis. The aim of this study was to validate the use of bioelectrical impedance analysis (BIA) in estimation of dry weight in a population of Senegalese chronic hemodialysis patients. Patients and methods: A 9-week cross-sectional study was carried out at the hemodialysis unit of Aristide Le Dantec University Hospital. Adult patients with no previous hospital history were included. The total body water (TBW) was measured with a single frequency bioelectric impedance foot-to-foot analyzer, before and after six successive hemodialysis sessions. These results were compared with those from clinical measurements with the Watson equation using a Student’s t-test and Bland-Altman analysis. Results: 264 measurements were made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis, 62.7 kg mean dry weight). A significant reduction in weight (ΔWeight = 2.0 ± 1.1 kg; p < 0.0001) and in TBW measured by the BIA (ΔTBWBIA = 3.3 ± 1.0 liters; p < 0.0001)) or calculated by Watson’s equation (ΔTBWWatson = 0.5 ± 0.2 liter; p = 0.0001) was observed. There was a strong linear correlation and agreement between the 2 TBW measurements in pre-dialysis. In post-dialysis the concordance diagram indicated a bias = –2.2 and wide agreement limits. Conclusion: The BIA allows reproducible and reliable measurements and a fair estimate of the TBW in pre-dialysis.

MO1050ACCESS TO DIALYSIS IN PUBLIC HOSPITALS FOR CHRONIC KIDNEY DISEASE PATIENTS: RESULTS FROM THE HEMODIALYSIS REGISTRY WAITING LIST AT ARISTIDE LE DANTEC HOSPITAL IN SENEGAL

Abstract Background and Aims The lethality and cost of chronic kidney disease (CKD) management are high in Senegal. The aim of this study was to evaluate the access in dialysis at Senegalese public’s hospitals. Method This was a retrospective cohort during 4 years (2014-2018) from the hemodialysis registry waiting list at Aristide Le Dantec University Hospital. This registry is composed by: a registration form (social survey and doctor's visa); a written letter addressed to hospital director and the national identity card. From this registry, telephone calls were made to collect data relating to mortality and access to dialysis. Results seven hundred fifty-one (751) files were collected. The mean age of the patients was 48.12 ± 15.28 years with a sex ratio of 1.02. The socioeconomic level was low in 85.40% (521/610) and average in 13.61% (83/610). The geographic origin was rural in 11.15%, semi-urban in 07.54% and urban in 81.31%. Ten patients (1.64%) had medical care coverage. On call, 49.70% (373/751) were died before accessing to public dialysis, 29.70% (223/751) had accessed public dialysis and 04.00% (30/751) didn’t yet need dialysis. Hundred twenty-one (16.10%) were unreachable and 0.50% (4/751) was unknown. Conclusion The lethality of CKD was high. Access to dialysis in public hospital remains problematic in Senegal despite its democratization. Additional efforts are needed for effective management of all patients at dialysis stage.