Hospital In Dakar Research Articles

ASSOCIATION CANCER DU SEIN ET GROSSESSE : A PROPOS DE 28 CAS

The association of breast cancer and pregnancy is defined as the occurrence of breast cancer during pregnancy or the year following delivery. In this classic definition, most teams also associate cancers that are seen after an abortion or a stopped pregnancy. It is the first cancer associated with pregnancy. Objectives : Describe the epidemiological, diagnostic and prognostic profile of patients and evaluate their management. Methodology : Retrospective study of 28 patients with breast cancer discovered during pregnancy or the year following delivery or abortion, collected at the Joliot Curie Institute of Aristide le Dantec Hospital in Dakar during the period from 1 January 2000 to 31 December 2007. Results : The frequency of the association was 2.9%, the mean age of 33.7 years. The average age of pregnancy was 4 months with extremes of 1 and 8 months. Large multiparas predominated (42.9%). The most common finding was that of the breast nodule (35.7%), clinical size T4 was the most common (64.3%), N2 lymph node status was the most frequently found (42.9%) and Stage IIIB was most prevalent (57.1%). A heterogeneous hypoechoic image was found in 3 cases. Invasive ductal carcinoma was found in 8 patients (28.6%). In neo-adjuvant chemotherapy L1, the CMF protocol was the most prescribed (39.3%). Breast surgery was performed in 42.9% of our patients. The therapeutic interruption of pregnancy was necessary to start the medical treatment in 3 cases. The tumor was grade SBR II in 25% of cases. Overall survival at 5 years was 18%. Conclusion : This study shows that the association is rare, the patients come late, the diagnosis is difficult, the therapeutic indications are limited by the constraints of the association. Our results are pejorative as shown by the overall survival at 5 years.

Clinical, Surgical and Prognostic Aspects of Uterine Myomatosis at Pikine National Hospital in Dakar

Clinical, Surgical and Prognostic Aspects of Uterine Myomatosis at Pikine National Hospital in Dakar

T145. Electroclinic study of temporal epilepsy in Fann Teaching Hospital, Dakar-Senegal

Introduction Temporal epilepsy is the most frequent partial epilepsy, with a polymorphous semiology. Our aim is to illustrate electrical and clinical features of temporal epilepsy in a sample of patients. Methods We conducted a prospective and descriptive study in neurological department of Fann teaching hospital in Dakar, including patients with temporal epileptic abnormalities on electroencephalogram. We collected semiological, electroencephalographic, brain imaging, and therapeutic data, and the disease evolution under treatment. Results There were 46 patients aged from 2 years and half to 53 years. Familial history of epilepsy was found in 18.84% and febrile seizures in 8.69%. Most of the patients have had first fit before the age of 10 years. A triggering factor was reported in 28.26% of cases. The most constant clinical signs were secondary motor disorders, which were predominant among electroencephalographic motives. Temporal semiology was most of the time consisting in psychical signs (67.39% of patients) but also automatic activities (52.17%), conscience obnibulation, aphasic disorders, and vegetative manifestations. Brain imaging was rarely available. 32.61% of subjects had stopped their medication because of several reasons. The medications we used were Phenobarbital (Gardenal), sodium valproate (Depakine), carbamazepine (Tegretol) and clonazepam (Rivotril). Evolution was favourable for the majority. Conclusion Clinical polymorphism of temporal epilepsy can lead to ignoring the diagnosis, which has to be mentioned each time we face psychical or sensorial troubles, particularly if evolving by fits.

Extranodal natural killer/T-cell lymphoma, nasal type, in Senegal.

The distribution of extranodal NK/T-cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub-Saharan Africa, despite the precocity of Epstein-Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal. A 5-year retrospective review of all patients with histopathological, immunohistochemical, and in situ hybridization proven cutaneous lymphomas RESULTS: We collected seven cases corresponding to a frequency of 1.4 cases per year. ENKTCL accounted for 10.5% of all cutaneous lymphomas, ranking second after T-cell lymphomas. Men were predominantly affected (M : F ratio of 6), and the mean age was 38.5 years ± 4.06. The mean time before consultation was 7.3 months. The lymphomas affected primarily the nasal cavity in five cases and the skin in two cases. At admission, six patients had nasal mucosa involvement, which was isolated in three cases, associated with cutaneous lesions in three cases and lymph node involvement in three cases. CD56 was positive in only one case, and Eber transcribed RNA of EBV was expressed by in situ hybridization in all patients. To our knowledge, we have reported the first and largest series of ENKTCL in Sub-Saharan Africa. Our study shows an intermediate prevalence between that reported from Asia, Latin America, and the West. It was also noted a young age of patients, a prolonged diagnostic delay, a frequent negativity of CD56 marker, and a very poor prognosis of the disease in our region.

Prognostic Aspects of Lupus Nephritis at Aristide Le Dantec University Hospital in Dakar

Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal failure, lymphopenia, nephrotic syndrome, glomerular sclerosis, arteriosclerosis, interstitial infiltration and tubular atrophy. Conclusion: The risk conferred by nephropathy is greater for proliferative glomerulonephritis; it is also correlated with the presence of persistent nephrotic syndrome or severe renal failure.

Evaluation of the Short, Medium and Long-term Prognosis of Pulmonary Embolism

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.

Cutaneous leishmaniasis in Senegal: a series of 38 cases at the Aristide Le Dantec University Hospital in Dakar.

Our aims were to study the epidemiological, clinical, and parasitological aspects of cutaneous leishmaniasis in the dermatology department of the Aristide Le Dantec hospital. This retrospective study reviewed records of cases treated over a 4-year period (from April 2010 through April 2014) at the HALD Dermatology department. The study included all patients with cutaneous leishmaniasis during the study period. The diagnostic criteria were clinical, parasitological, and histological. The study included 38 patients, corresponding to 9.5 cases per year. Patients' average age was 25 years (4-65 years) and the sex ratio was 1.6. The mean time from symptom outset to consultation was 3.2 months. The disease was located in limbs in 23 cases (63.8%), the face in 6 cases (16.6%), and disseminated in 9 (19.6%). The clinical presentation was ulcerated and crusted in 17 patients (44.7%), sporotrichoid in 13 (28.9%), pseudo-lepromatous in 4 (10.5%), and lupoid in 3 cases (7.9 %). It included warts, mucosa, and tropical sores (Aleppo boils) in all cases. We observed 3 cases associated with HIV; one had a pseudo-lepromatous presentation and resulted from immune restoration syndrome, while two patients had clinical forms of associations: ulcerative and crusted lesions associated with mucosal leishmaniasis in a 55-year-old patient, and cutaneous ulcerative, lupoid, and crusted multifocal (cutaneous, medullary, and lymph nodes) lesions in a 4-year-old infected with Leishmania infantum. Crusted ulcerative cutaneous leishmaniasis is the predominant form of cutaneous leishmaniasis. Infection with HIV can be an important factor in clinical and parasitological atypia.

The Knowledge, Attitudes and Practices of Diabetics on Physical Activity at the Marc Sankale Center of Dakar

Introduction: The objective of that study was to evaluate diabetics knowledge, attitudes and practices on physical activity. Patients and Methods: That study has concerned 200 diabetics at Marc Sankale antidiabetic Center of Abass Ndao Hospital in Dakar. Women represent 76% with a sex ratio M: F0.13. The average age is 54 years with extremes of 4 to 84 years. The housewives are 29% and among them 15% haven’t any professional activity. 45.07% of the population is illiterate. In our study, 63.13% of patients have low socio economic level. In our series, the majority of patients is type 2 diabetes (89.5%). The diabetes evolution time is about 8 years inferior to 7% in 84 patients. In our study obesity is noted in 17.20% of cases. The HTA is present in 56% of cases. 54% of the studied population presents a dyslipidemia. Physical activity is practiced in 81% of patients. In our study the doctor’ advice motivates the half of our patients to practice physical activity (62.26%). The lack of time (43.2%) and volution (8.1%), the useless character of physical activity (2.7%) and the patients’ health state 45.9% are the obstacles to the practice of physical activity. The average frequency of physical activity practiced by patients is about 4 times a week with extremes ranging from 1 to 7 stages a week. The average time of activity practiced by patients is 39.72% with extremes ranging from 10 to 150 mn. 87% of patients practice physical activity at least 3 times a week. The main risks noted from intense physical activity in diabetics are hypertension 39.0%, ortestic hypertension 3.0%. In the contrary 58.8% of patients ignore the answer. Conclusion: Our study demonstrates the ignorance of diabetics on physical activity. Therefore it would be necessary to reinforce the training mainly therapeutic education in the patients taken into account.

Management of Pheochromocytoma in Dakar: Diagnostic and Therapeutic Advances throughout 16 Cases

Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.

Study of the Right Heart of High-Level African Adult Athletes: Electrocardiographic and Echocardiographic Aspects

Despite the growing interest in athlete’s right ventricle and various work carried out, many uncertainties are remaining. The interest of this work resides in the determination of the particularity in right heart of the black athlete subject. We conducted a prospective study from August to October 2016 in the cardiology department of Aristide Le Dantec University Hospital in Dakar. The included patients were divided according to the sporting practice as enduring, resistant and non-athletes. The parameters studied were electrocardiographic (atrial or ventricular hypertrophies), echocardiographic: dimensions of the right cavities, systolic and diastolic functions of the right ventricle. We included 58 subjects: 38 athletes including 28 endurance and 10 resistance and 20 non-athletes. The average age of the endurance athletes was 21.9 ± 3, 75 years, 26.30 ± 4.64 in resistance ones and 24.10 ± 1.89 in the non-athletic group. Two cases of first-degree atrioventricular block were recorded in athletes. On the echocardiographic point, the atrium surfaces, as well as the transverse diameter, were greater in athletes, especially in the endurance group. The mean diameters of the admission chamber and those of the right ventricular flush chamber were larger in the group of endurance athletes. It was the same for the annular and sagittal basal mean diameters of the RV as well as the RV/LV ratio. The anterior wall of the right ventricle was larger in athletes compared to non-athletes. The vena cava was greater in athletes, the pulmonary arterial pressure higher in resistance ones.

Cardiopulmonary Bypass Complications in a West African Country (Senegal)

Although cardiopulmonary bypass (CPB) has simplified open heart surgery, it causes adverse effects on the body’s systems. This study aims to report the complications related to CPB at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a 24 months period (from January 2015 to December 2016). All adult and children patients who underwent open heart surgery using CPB machines were included in this study. 193 patients were eligible during this study’s period. Patients' mean age was 23 ± 15 years (range, 2–65), and 52% were female patients. Two complications were observed during CPB. One case of hemolysis and one case of an impossible weaning from CPB. Post-CPB complications were allocated as follows: hematological complications (88.5%) followed by cardiovascular (56%), pleuropulmonary (22.4%), septicemia (4%), renal (3%), systemic inflammatory response syndrome (SIRS) (2%) and neurologic (1%) complications. The overall hospital mortality was 5%. One (1) patient died intra operatively and nine (9) patients in the intensive care unit. The morbidity and mortality related to CPB in our cardiac surgery center is superimposed to those of the literature.

Bacteremia: Profile and Antibiotic Resistance at the Infectious and Tropical Diseases Clinic in Fann Hospital, Dakar, Senegal

The main objective of our study was to perform a situational analysis of bacteremia diagnosed at the Clinic of Infectious Diseases Fann University Hospital in Dakar. This was a retrospective, descriptive study based on the records of patients hospitalized for bacteremia from January 1, 2013 to December 31, 2014. Epidemiological, clinical, biological, therapeutic and evolutionary variables were collected. Data analysis was done using Stata/SE software version 12.1. Seventy-nine cases of bacteremia were reported in 1922 hospitalized patients at a proportion of 4.1%, and 86 bacterial strains were isolated. The median age was 43 years [IQR: 32; 53]. The main comorbidities found were HIV infection (73%) and high blood pressure (22.2%). Hyperleukocytosis was found in 20 cases (25.32%). The average level of Protein C Reactive was 83.90 ± 56.08 mg/L. Blood culture was monomicrobial in 74 cases (93.7%). The most common isolated bacteria were coagulase-negative staphylococci (23.1%), followed by Pseudomonas aeruginosa/spp (15.1%), Staphylococcus aureus (10.5%), Escherichia coli and Acinetobacter spp (8.1%). Isolated strains had low resistance to Imipenem, Vancomycin and Fusidic Acid. In monotherapy or in combination, the mostly used antibiotic was Ceftriaxone. The average duration of antibiotherapy was 10.40 ± 5.39 days. Thirty-three patients (41.8%) had died. Cases of bacteremia present a high mortality. Isolated bacterial strains are becoming more resistant to the antibiotics available in our clinic. As a result, the rationalization of their use is adamant.

Adolescents with Disorders of Sex Development: A 3-Year Psychosocial Follow-Up Before and After Gender Reassignment

Objectives: Psychosocial interventions have been increasingly proven to play a key role in a holistic team-oriented approach to disorders of sex development (DSD) care. This article examined the influence of cultural and religious factors on the acceptance of the decision for gender-reassignment surgery. Next, how this patient accepted herself and her body image, and invested in her femininity, was analyzed. Methods: The study is based on a 3-year follow-up (from 2013 to 2015) of an adolescent with 46,XX DSD, in the mental health department of FANN National University Hospital in Dakar, Senegal. The patient and his/her parents and other family members underwent 12 sessions of counseling and supportive psychotherapy before and after surgical treatment. On average, each session lasted 55 min. Results: Raised as a boy until the age of 15, the patient initially refused surgical intervention. The parents were also confused, owing to the societal preference for males and the fear of stigmatization. The role of the grandfather was instrumental in the counseling and supportive psychotherapy, as he attributed a masculine and religious given name to the child. The postsurgical anatomy reduced the patient’s distress. However, the psychic integration of her bisexuality was ambivalent and accompanied by depressive feelings and intense dream activity. Feminine socialization and environmental learning, conditioned by Wolof traditions and upbringing, were some constraints that affected postgender reassignment outcomes. Conclusion: While gender reassignment affects the patient, but it can even more profoundly affect the parent of that is the same sex to whom as the child’s sex has been as identified at birth. Counseling and supportive therapy should take into account cultural constraints and transformations within and across the psychological developmental stages.

Assessment of the Podiatric Risk on Diabetics in Dakar Hospital Area: Cross-Sectional Study in Regard to 142 Patients

The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teaching Hospital in Dakar with the assessment of foot risk on admitted diabetic patients as our main objective. Methods: It was about a prospective cross-sectional, descriptive and analytic study done on 18 months period. Results: Overall, 142 patients were gathered. The average age was 56.22 years and the sex-ratio was 0.67. 87.2% of the patients were running type 2 diabetes. The capillary blood glucose and glycated hemoglobin were respectively around 3.24 g/L and 9%. High Blood Pressure was found in 62% of cases. The type of footwear most used by our patients was sandals (96.3%). Also, 30.6% of patients walked barefoot. Prior ulceration and/or amputation were noted in 30% of cases. During the foot examination, a lesion was found in 15.5% of patients. Loss of monofilament sensitivity was about 66.7%. The Ankle-Brachial Index (ABI) less than 0.9 was recorded in 34% of patients and at least a quarter of patients were posteriorly tibial pulselessness. The gradation of the foot risk according to the International Working Group of the Diabetic Foot (IWGDF) was established as follow: grade 0 (58%), grade 1 (9.8%), grade 2 (14.3%), grade 3 (17.3%). The presence of neuropathy (OR 12. 162 [3.368 - 43.923]; p = 0.000), plantar keratosis (OR 2.87 [1.119 - 7.399]; p = 0.024) and the absence of pulse perception (OR 9.00 [3.205 - 25.414]; p = 0.000) were significant associated factors of foot injury occurrence on our patients. Conclusion: The prevention of diabetic foot in emerging countries is accessible by a systematic clinical examination of all diabetic feet and the awareness of adapted footwear.

Return to Sport after ACL Reconstruction using Hamstring Tendon: Analyzing 51 Cases from Maltas Hospital in Dakar

The anterior cruciate ligament (ACL) rupture is a frequent lesion in athletes. It is incompatible with the practice of high-level sport, especially pivot and contact-pivot ones. The purpose of the ACL reconstruction is to allow the athlete to resume the practice of same sport at the same level. The study involved 51 sports patients operated for ACL reconstruction at the Order of Malta’s Hospital center in Dakar during the period from 1 January 2011 to 31 May 2014. The average age of patients was 26.3 years with a male predominance (92.15%). These were professional athletes in 37.25%, amateur in 31.37%, and leisure in 31.37% of the cases. The sport was contact-pivot in 96.6% of the cases, mainly football. The objective functional evaluation was performed using the Lysholm-Tegner scale and laximetry using the GNRB arthrometer. The overall sporting recovery rate was 96% with 54.9% recovery in the same sport at the same level. Professional athletes were 42 times more likely to resume the same sport at the same level as amateurs. Recovery times were 4.7 months for line sports, 9.2 months for pivot / contact-pivot and 11.3 months for the resumption of competition. These delays were shorter for professionals with a return to pivot sport at 8 months. Apprehension and fear of a new injury were the main reason for sport's downtime or decline. Functional and anatomical results were good with a mean Lysholm score of 91% and a GNRB differential of 2.87. No independent factor was predictive of returning to sport at the same level. Returning to sports activity is very likely after an ACL ligamentoplasty, but the return to the same sport at the same level is more uncertain, in the order of 55% despite satisfactory anatomical and functional results, confirming the important role of other factors such as psychological coaching and sport-specific rehabilitation.

Mitral Valve Replacement in Senegal (West Africa): Indication and Short-Term Outcomes

The West African countries have infrequent Cardiac Surgery Centers. Mitral valve replacement (MVR) from such countries raises important postoperative preoccupations. The aim of this study is to report indication and short-term outcomes of MVR at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a period of 19 months (From January 2015 to July 2016). All patients with MVR associated or not with tricuspid valve repair were included in this study. Seventy-three (73) patients were eligible. The mean follow-up was 4.2 ± 4 months (range, 1-12). The mean age was 30.4 ± 13 years (range, 9–64). There were 74% of female patients, 53% were in New York Heart Association class III. Preoperative diagnoses were mitral stenosis (31.5%); mitral regurgitation (37%) and mixed mitral disease (31.5%). Crystalloid cardioplegia was performed in 92%, mean CPB time was 79 ± 21 min, mean cross clamp time was 58 ± 15.6 min. Mitral valve exposure was performed by left atriotomy (93%); 99% of mechanical prosthesis was performed. Tricuspid valve repair was performed concomitantly in 48% of patients. Overall Hospital mortality was 8%. Postoperative complications were low output syndrome (19%), pneumonia (12%), surgical wound infection (8%), Pleural effusion (7%). During follow-up, no valve-related morbidity and mortality was recorded. Mechanical valve replacement in Senegal has acceptable early outcomes in terms of morbi-mortality. Preoperative diagnoses were represented in equivalent proportions by mitral stenosis; mitral regurgitation and mixed mitral disease. Our complications were predominantly low output syndrome and pleura pulmonary disorders.

Characteristics of Liver Abscess in Department of Infectious Diseases at Fann Teaching University Hospital in Dakar, Senegal

Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.

Intradialytic Hypertension: Prevalence and Associated Factors in Chronic Hemodialysis Patients in Senegal

Introduction: Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmHg in the post-dialysis period as compared to the pre-dialysis one. It is an important factor of morbidity and mortality in hemodialysis patients. The aim of our study is to assess the prevalence and associated factors of intradialytic hypertension. Patients and methods: This is a descriptive and analytical cross-sectional study that was conducted over a period of 3 weeks in the hemodialysis units of Aristide Le Dantec Hospital in Dakar and Regional Hospital Center in Ziguinchor. Chronic he-modialysis patients who are at least 18 years old and agreed to participate in study have been included. Patients who did not have 4 measures or those who decided to withdraw from the study were excluded. Intradialytic hypertension was restrained by an increase in systolic blood pressure immediately after the hemodialysis session > 10 mmHg compared to that recorded before session, with a repetition of this phenomenon for at least 4 hemodialysis sessions. Results: Our study included 539 hemodialysis sessions for 93 hemodialysis patients with a mean age of 48.72 ± 14.06 years and a sex ratio (M/F) of 1.21. The mean duration of dialysis was 64.22 ± 45.63 months. Hypertensive nephropathy was significantly common, noted in 38.7% (36 patients). Mean inter dialytic weight gain was 2.04 ± 1.06 kg, and the average dry weight was 62.71 ± 13.69 kg. The average hemoglobin level was 9.27 ± 1.91 g/dl. The mean albumin level was 35.4 ± 7.48 g/l. Nineteen (19) patients were administered erythropoietin stimulating agents (20.4%), and 59 patients were given antihypertensive drugs (63.4%). An elevation of more than 10 mmHg of post-dialysis BP compared to pre-dialysis was noted in 179 sessions, which is 33.2 per 100 hemodialysis sessions. IDH was noted in 21 patients, which represents 22.6%. The factors associated with IDH were as follows: high post-dialysis pulse pressure (PP) (p = 0.0008), pre-dialysis systolic-diastolic hypertension (p = 0.004), pre-dialysis pure systolic hypertension (p = 0.01), post-dialysis hypertension (p = 0.02), and hypoalbuminemia (p = 0.049). Conclusion: Although recognized for many years, the intradialytic hypertension is often neglected. However, it is common in our cohort of chronic hemodialysis with several associated factors. Its management is essential and will necessarily pass through adequate management of the blood volume.

Electrocardiographic and echocardiographic abnormalities in patients with cirrhosis due to viral hepatitis B: about 60 cases reported in the Hepatogastroenterologic Department at the Aristide Le Dantec Hospital in Dakar (HALD)

L’objectif de cette étude est d’évaluer les anomalies électrocardiographiques et échocardiographiques chez les patients atteints de cirrhose virale B et identifier leurs déterminants. Il s’agissait d’une étude prospective sur 8 mois aux services de d’Hépato-Gastroentérologie et de Cardiologie de l’hôpital Aristide Le Dantec de Dakar. Tous les patients atteints de cirrhose B virale et n’ayant pas de cardiopathie pré existante connue ont été inclus. Nous avons collecté et analysé les données épidémiologiques, cliniques, biologiques, échographiques, endoscopiques, électrocardiographiques et échocardiographiques (2D et Doppler) de tous les patients. Les données ont été saisies sur tableau Excel 2007 et analysées à l’aide du logiciel Sphinx version 5. La comparaison des variables a été faite par les tests de Chi 2 standard et Fisher. Le seuil de significativité a été arrêté à p< 0,05 pour ces 2 tests statistiques. Soixante patients ont été inclus. La prévalence de la cirrhose virale B était de 3,4%. L’âge moyen était de 41 ans et le sex ratio de 1,6 (37 hommes). La cirrhose était classée Child-Pugh B chez 29 patients (49%), Child-Pugh C et Child Pugh A respectivement chez 20 patients (33%) et 11 patients (18%). Les anomalies électrocardiographiques les plus fréquentes étaient l’hypertrophie ventriculaire gauche et l’allongement de l’intervalle QTc objectivés respectivement chez 27 patients (45%) et 24 patients (40%). L’analyse statistique a montré une association entre l’intervalle QTc prolongé et la gravité de la cirrhose (p = 0,01, RR = 2, IC = 0,24 à 0,341). Les anomalies échocardiographiques étaient dominées par la dilatation ventriculaire gauche (58,3%) et l’hyperdébit cardiaque (43,3%) avec un débit moyen de 6,05 l/min. L’analyse stastistique mettait en évidence une association significative entre la gravité de la cirrhose et l’hyperdébit cardiaque (p = 0,003; IC: 95% (de 2,883 à 38,58; RR = 2). Au total, 14 patients (23,3%) avaient une cardiomyopathie cirrhotique latente. La cirrhose virale B peut induire des anomalies cardiaques diverses et variées. Ces anomalies sont morphologiques et/ou électrophysiologiques et leur gravité semble corrélée à la sévérité de la cirrhose.

Evaluation of the use of Home Emergency in a Sub-Sahara African hospital: Example of the Hospital Principal in Dakar.

Overloaded emergency departments are common around the world. This prospective, descriptive, and analytical study evaluates the reasons for emergency room use and describes the severity of the patients' conditions and how they reach the emergency department. It took place at the emergency department of the principal hospital of Dakar (the Armed Forces Teaching Hospital) over a one-week period (from August 23 to August 30, 2016) and included a sample of 219 patients of both sexes aged 15 years and older. Data were collected about social and demographic characteristics, reasons for choosing the emergency department rather than other care, time of day, day of the week, accessibility, means of transport, diagnosis, and severity. More than half of patients (55%) were men, with a mean age of 42 +/- 18. Only 10% of patients lived within 5km of the hospital. Most (84.5%) came from the Dakar region and lived between 5 and 35km from the hospital. Most patients reached the hospital by their own means (83%). Only 2% were transported by the public emergency ambulance service. The reasons for choosing the emergency unit were the opportunity for additional tests in 41.1% of cases; the desire to be hospitalized in 26.9%; fear of death in 26.5%, no waiting list in 14.2%, and lack of money in 11% of cases. Patients in truly serious condition accounted for only 5% of cases. Most (88%) returned home after stabilization, 12% were hospitalized, and 0.5% died. Good practices, good organization, and improved complementarity between public, private, and emergency services are needed to reduce the use of the latter.