Le Dantec Hospital Research Articles

Outcomes of radical prostatectomy in patients with prostate cancer at the Aristide Le Dantec University Hospital

Le but était d´évaluer les résultats carcinologiques de la prostatectomie radicale. Il s´agissait d´une étude rétrospective monocentrique au service d´urologie-andrologie de l´Hôpital Aristide Le Dantec de Dakar du 1er juin 2010 au 31 mai 2016. Nous avons colligé 60 cas de prostatectomie radicale par voie rétropubienne associée à un curage ganglionnaire ilio-obturateur. Après la prostatectomie radicale (PR), le taux d’antigène prostatique spécifique (PSA) était indétectable (<0,1 ng/ml) chez 20 patients (33,3%). Onze malades (18,3%) qui avaient une récidive biochimique, ont une hormonothérapie complémentaire. Une réponse a été obtenue après instauration du traitement avec un taux de PSA total redevenu indétectable après un suivi de 8 mois. La durée moyenne de la survie globale était de 17,5 mois avec une médiane de 9,49. Le taux de survie globale cumulé à 1 an, 3 ans et 4 ans étaient respectivement de 42,4, 13,6 et 6,8%. La durée moyenne de la survie sans récidive était de 17,3 mois avec une médiane de survie sans récidive biochimique qui était de onze (11) mois. La durée moyenne de la survie spécifique était de 8,1 mois avec une médiane de 3 mois. Les marges de résection étaient positives chez sept (7) patients soit un taux de 11,6%. Quatre(4) patients avaient un envahissement ganglionnaire. La prostatectomie radicale indiquée dans quelques cas dans notre pratique, est une méthode thérapeutique efficiente avec de bons résultats carcinologiques.

Portal Thrombosis: Clinical, Etiological and Therapeutic Aspects in the Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar (Senegal)

Background: Portal thrombosis (PT) is a rare pathology. Its prevalence is estimated at 1%. Its consequences depend on the acute or chronic nature, the extent of the clot and the etiology. In Sub-Saharan Africa, very few studies have been devoted to it. Patients and Method: The objective of our work was to determine the prevalence of PT and to describe its clinical and etiological presentation as well as its therapeutic management in the Hepato-gastroenterology department of the Aristide Le Dantec hospital in Dakar. This was a retrospective, longitudinal and descriptive study during the period from January 1, 2012, to December 31, 2018. It included all patients followed in ambulatory or inpatient, who presented a PT objectively determined by a medical imaging examination (ultrasound and/or CT scan). Age, gender, clinical and radiological aspects, proposed treatments and etiology of PT were collected. Results: We collected 71 observations. The prevalence of PT was 1.9%. The mean age of the patients was 41 years 15 and 75 years. A predominance of men was found with a sex ratio of 2.73. The clinical manifestations were dominated by abdominal pain (74.6%), ascites (35.7%) and gastrointestinal bleeding (25.4%). Imaging allowed the diagnosis to be made in 50 patients on ultrasound and 21 patients on abdominal CT scan. PT was acute in 5 patients and chronic in 66 patients. Thrombosis was complete in 71.4% of cases and extended to the spleno-mesaraic venous trunk and the superior mesenteric vein in 2.8% and 8.4% respectively. Etiological research found cirrhosis complicated by hepatocellular carcinoma in 67.6% of cases, cirrhosis with cruoric thrombosis in 21.1% of cases, a combined protein C and S deficiency in 1.4% of cases. No aetiology was objectified in 9.9% of cases. Treatment with beta-blockers was initiated in 32 patients. Anticoagulant treatment was performed in one patient. Evolutionarily, no recurrence of bleeding was noted. In the anticoagulated patient, PT remained stable; however, there was no portal vein recanalization. During follow-up, mortality was 74.6% and was related to the underlying pathology in all patients. Conclusion: PT has a prevalence of 1.9% in the Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar. The chronic form is very dominant and degenerated cirrhosis is the first etiology.

Identification of Candida Species Circulating in Dakar using Multiplex Nested PCR

Background: In most developing countries, laboratory identification of Fungi belonging to the genus Candida is often problematic. The germ test tube known as Blastese test, which is the most used has the limitation that it only differentiates the C. albicans complex from other Candida complexes. Not only it is important to know the involvement of other species in the occurrence of fungal infections, but also the difference in sensitivity to the azoles used in the treatment of these fungal infections makes it necessary to identify the Fungi at the species level. The objective of this study was to identify by multiplex nested PCR the Candida species isolated in the laboratory of Parasitology and Mycology of Aristide Le Dantec Hospital, Senegal. Methodology: Candida isolates were obtained from patients who were admitted to the laboratory of Parasitology and Mycology with suspected fungal infections. After identification by conventional methods, isolates were preserved in a storage medium and kept at -20°C. Species identification was performed by nested PCR. Results: A total of 42 yeast isolates were collected after culture on Sabouraud medium, among which 10 (24%) from vaginal swabs and 32 (76%) from patients suffering from superficial mycoses (skin and nails). C. albicans represented 68% and nonCandida albicans (NAC) species 32%. The distribution of the NAC species was as follows: C. parapsilosis (group I and II) 17% (8), C. tropicalis 8.5% (4), C. kefyr 4.25% (2) and C. lusitaniae 2.15% (1). Mixed infection with two species represented 17.39% of the isolates. Conclusion: This study shows that other Candida species are common in Dakar, although their identification is not routinely performed in most laboratories. Thus, it is necessary to improve the technical facilities in these diagnostic laboratories.

Impact of the Covid-19 Pandemic on the Prolongation of the Management of Myocardial Infarctions Seen Late: A Cross-Sectional Study of 25 Cases Collected in the Cardiology Department of the Aristide Le Dantec Hospital in Dakar (Senegal)

Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, which has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years. Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30 s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06 h 30 min before the COVID-19 pandemic and 42 h06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14 h 30 min before the Covid-19 pandemic and 27 h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.

Coronary Angiography: Indications, Results and Cost-Effectiveness in the Diagnosis of Stable Angina Pectoris in Two Hospitals in Senegal

Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years; men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%; diabetes was 34.27%; dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel; 28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36; 95% CI, 1.05 - 5.29; p = 0.036); male gender (OR, 1.6; 95% CI, 0.72 - 3.57; p = 0.24); diabetes (OR, 2.14; 95% CI, 0.96 - 4.75; p = 0.06) and necrosis Q waves (4.75; CI, 0.98 - 23.09; p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

Inventory of Radiation Protection in Hospitals of Level III in Senegal

The aim of this study was to evaluate the level of protection of employees who are exposed to radiation in a level III hospital establishment. It was a descriptive cross-sectional survey of six months’ duration, involving eight level III Hospitals (Aristide Le Dantec, Fann, Hoggy, Hear, Abass Ndao, Pikine, Touba, and Thies) in Senegal. Sixty-one of the one hundred questionnaires were recovered (overall response rate of 61%). The population of the study was mainly female (54.1%). The average age was 38.57 with extremes ranging from 23 to 65 years old. In the places where ionizing radiation sources are handled, only at the Aristide Le Dantec Hospital did we find a “competent person in radiation protection”. This explained the lack of a classification of employees and work areas. Forty out of sixty-one (73.77%) had no knowledge of the basic principles of radiation protection (justification, optimisation, dose limitation) and had not ever taken radiation holidays. For radiovigilance, exposure time limits to ionizing radiation concerned only 29/61 or 47.54% of the study population. The inverse square law of distance was known by only 40 workers, of whom 15 had no compliance. We found the presence of dosifilms in only 7/61 or 11.47% of the workers. On the other hand, the use of lead aprons was well established and concerned 57/61 workers, i.e., 93.44%. In sum, ionizing radiation causes adverse health effects. The absence of a good radiation protection culture in Senegal requires the presence of at least 4 to 5 competent persons in radiation protection for quality training of workers in radiobiology, radiopathology and radiation protection.

Epidemiological and Clinical Aspects of Autoimmune Dysthyroidism in Internal Medicine at Aristide Le Dantec Hospital

Introduction: Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). Materials and Methods: This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded; they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, i.e. in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. Results: Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. Conclusion: Autoimmune thyroiditis is common in our daily practice in Senegal; it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.

Road traffic injuries among children in Dakar, Senegal

Background: Road traffic injuries (RTI) are a major public health problem and contribute significantly to the global burden. The aim of this study was to assess the frequency of RTIs in children and to determine their socio-demographic and lesional characteristics.Patients and methods: This was a retrospective and descriptive study over a two-year period from January 2015 to December 2016 conducted at the Department of Paediatric Surgery at the Aristide Le Dantec Hospital in Dakar. Included were all children under the age of 16 victims of a RTI. We studied various parameters relating to the victims (sex, age, education) and the accident (location andtime of occurrence of the accident, circumstances and mechanism, duration of admission to the emergency unit, localization and type of lesion). The data was entered and processed using Microsoft Office Word and Excel 2010 software.Results:Among the 425 cases received, 62.6% were boys and 37.4% girls. The average age of the children was 7.7 years. RTIs occurred mainly in pedestrian (63.8%) who wanted to cross the road. There were more accidents in the city-center area (64.9%) and during afternoons (61%). Lesions of the soft parts (wounds, contusion and decay) were predominated (89.6%) followed by fractures. Theupper limbs were the main locations of trauma.Conclusion: RTIs are common among children in Dakar. Boys crossing roads are the largest number of victims. Soft tissue trauma predominates and is mainly found on the thoracic limbs.

Effect of Prednicarbate On the Hyper Proliferation of the Granulation Tissue of Traumatic Wounds During Directed Healing: A Prospective Observational Study

Background: The directed scarring of traumatic wounds in a surgical department often encounters drifts. During the proliferation phase, the granulation tissue can become excessive, blocking re-epithelialization and dooming a skin graft. To cope with this, healthcare teams often use topical corticosteroids such as Prednicarbate which is a nonhalogenated corticosteroid which does not pass into the systemic circulation. Purpose: The aim of this study is to describe the in vivo effect of Prednicarbate on the hyper proliferation of granulation tissue in trauma wounds and burns during directed scarring. Methods: A prospective observational study was carried out on patients admitted consecutively to the Orthopaedic and Trauma Surgery Department of Aristide le Dantec Hospital in Dakar. The application of 0.25% prednicarbate was twice daily on the hyperprofiltration areas of the wound bed of consenting patients. Demographic, clinical, therapeutic data and changes in granulation tissue were collected. Results: 12 patients participated with an average age 41.5 ± 18.94 years and a female to male sex ratio of 3/1. Domestic accidents were the most common wound occurrence in 7 cases. After at least 3 applications, the modifications observed were as follows: the proportion of hyper-budding surface was reduced by 3% on average. In 8 cases, the bed turned pink, with a texture changing from smooth to granite in 10 cases. A regression of the edema of the bed was observed in all the cases and the level of the bed of the wound which initially known epidermal, became epidermal in 10 cases. In 10 cases, the start of epidermal migration was observed from the skin edges. In 9 cases, or 75% of cases, it took just 1 tube to see a reduction in granulation tissue. Conclusion: Prednicarbate is a non-halogenated corticosteroid which is of interest in reducing the excessive proliferation of granulation tissue in traumatic wounds. By normalizing the level of granulation tissue, it promotes epidermal migration and the epithelialization phase.

A twenty-eight-year laboratory-based retrospective trend analysis of malaria in Dakar, Senegal.

IntroductionHealth facility-based records offer a rich source of information to understand trends and changes in malaria cases over time. This study is aimed at determining the changes in malaria occurrence over the last 28 years, from 1989 to 2016 in Dakar, Senegal.MethodsLaboratory suspected and confirmed malaria records from 1989 to 2016 were reviewed from the laboratory registers of the Laboratory of Parasitology and Mycology of Aristide Le Dantec Hospital. Interrupted time series (ITS) analysis was used to estimate the changes by comparing malaria cases post-intervention (2006–2016) with that of the pre-intervention (1989–2005) period.ResultsA total of 5,876 laboratory confirmed malaria cases were reported out of 29,852 tested cases, with total slide positivity rate (SPR) of 19.7%. Malaria case counts exhibited a fluctuating trend with major peaks occurring in the years 1995 and 2003 with SPR of 42.3% and 42.5%, respectively. Overall, a remarkable decline in the total number of laboratory confirmed malaria cases was observed over the last 28 years. P. falciparum was almost the only reported species, accounting for 99.98% of cases. The highest SPR was observed in the age group of under five years during the pre-intervention period while this shifted to the age group of 6–15 years old for the subsequent years. Two major malaria peak seasons were observed: one in September during the pre-intervention period and the other in November for the post-intervention period. The ITS analysis showed a dramatic decline of 83.6% in SPR following the scale-up of interventions in 2006.ConclusionA remarkable decline in laboratory confirmed malaria cases in Dakar over 28 years was observed. The period of rapid decline in malaria SPR coincided with the scale-up in interventions beginning in 2006 with the introduction of ACTs, followed by the widespread introduction in 2008 of bed nets treated with insecticides. Robust surveillance data should be maintained in the context of malaria elimination efforts.

Mondor’s disease of the breast concerning two cases collected in the Senology unit of the Gynecological and Obstetric Clinic of Aristide Le Dantec Hospital

Mondor’s disease of the breast concerning two cases collected in the Senology unit of the Gynecological and Obstetric Clinic of Aristide Le Dantec Hospital

Sudden death in Dakar

Sudden adult death is an instantaneous or rapid death of natural, unexpected or unexpected origin. As a public health issue, the global incidence of sudden death would be 20100 per 100,000 population.The main objective of our study was to assess the incidence of sudden death in Dakar. The specific objectives were to establish the epidemiological profile of sudden death, identify the circumstances of its occurrence and the medical and surgical causes, and identify the factors associated with sudden deaths from cardiovascular causes.It is an observational, descriptive, retrospective study covering a period of 5 years, from January 1, 2014 to December 31, 2018. Included in the study were all records of adults (18 years of age and over) who died suddenly, in a health facility or outside it and were autopsied in the morgues of Aristide le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP).We found 1133 cases of sudden adult death, or 28 % of autopsies. The annual average was 226.6 cases. Our series consisted of 918 men and 215 women, for a sex ratio of 3.27. The sudden death of the adult was predominantly cardiovascular in origin with 561 cases or 49.5 %. The MI occurred on average at 51.95 years of age with 164 males (84.5 % of MIs) and 30 females (15.5 % of MIs). With regard to pulmonary causes, pulmonary tuberculosis was the leading cause of pulmonary origin with 66 cases or 26.2 %. For digestive causes, generalized acute peritonitis (GAP) was the most frequent cause with 29 cases (38.7 %).The prevention of sudden death is essentially based on cardiovascular disease treatment and prevention. The African context has to deal with weak health promotion, a failure of pre-hospital care and the daily difficulties of hospital care.

Geographical distribution of mycetoma cases in senegal over a period of 18years.

Mycetoma is a pathological process in which fungal or actinomycotic agents of exogenous origin produce grains. In the absence of data on the global burden, it is important to map mycetoma cases, which are useful to implement control strategies. The objective of this study was to map mycetoma cases diagnosed in Senegal over a period of eighteen years. The cases of mycetoma identified in the laboratory of Mycology at Aristide Le Dantec Hospital were extracted from the notebooks; information on the dates of collection, geographical origin and fungal agent identified was entered in Excel and analysed. Three hundred and thirty-seven cases of mycetoma were diagnosed from 1993 to 2016 at Aristide Le Dantec Hospital. Mapping shows that overall, the western zone presented the majority of cases 47% (120), followed, respectively, by the central zone 32% (80), the northern zone 18% (47) and the southern zone 2% (6). However, over the years, this distribution is different with a decrease in cases from the periods 1993-2000 and 2011-2016 of 19% in the western and a progressive increase of cases in northern and central zones of, respectively, 13% and 14%. In the 1990s, the cases were predominant in Dakar, Louga and Diourbel. During 2011-2016, Thies, Diourbel, Fouta and Louga presented more cases. The spatial distribution of mycetoma in Senegal changed over the years, most frequent in the west of the country, and during 1993 to 2000, mycetoma is now more common in the north.

Epidemiological and Clinical Profile of Patients with Blunt Abdominal Trauma at Aristide Le Dantec Hospital of Dakar

Epidemiological and Clinical Profile of Patients with Blunt Abdominal Trauma at Aristide Le Dantec Hospital of Dakar

Analysis of Cesarean Section Indications According to the Robson Classification in Surgical Maternities in Dakar, Senegal: About 9185 Cases

Background: The caesarean section rate remains relatively high in the surgical maternity hospitals in Dakar and the indications for scarred uterus are still high. The management of induced prematurity for maternal pathologies still poses real problems in Dakar. The aim of our study is to compare the Caesarean section rate in the different surgical facilities in Dakar. We used the ROBSON's classification to evaluate the indications for Caesarean section in surgical maternity hospitals in Dakar. Methods: This was a descriptive and analytical prospective study which took place from January 1^st to December 31^st 2019 in 10 surgical maternity hospitals in Dakar (University hospital Aristide Le Dantec, National Hospital Center of Pikine, Municipal Hospital Center Abass NDAO, Principal Hospital of Dakar, Youssou Mbargane DIOP Hospital in Rufisque, Ouakam Military Hospital, Grand Yoff General Hospital, Gaspard Kamara Health Center, Nabil Choucair Health Center, Roi Baudoin Hospital Center) and which included all patients who delivered by caesarean section. Indications for Caesarean section were classified according to ROBSON's 10 group classification. The parameters studied were age, frequency, indications for Caesarean section in these surgical maternity hospitals and, Apgar score at five minutes and, birth weight. Data collection was done through birth records and registers, on-call diaries and integrated into a database developed with Sphinx software. Statistical analysis was done using SPSS software. Results: During the period of the study we recorded 35287 deliveries with 9185 Caesarean sections, i.e. a frequency of 26%. The average age of the patients was 29 years. Indications for Caesarean section in Dakar surgical maternity hospitals were dominated by group 5 (28.4%) according to Robson's classification. Group 10 in Robson's classification was predominant in the maternity hospitals of University hospital Aristide Le Dantec (23.3%) and Municipal Hospital Center Abass NDAO (22.5%). Group 5 was found in the maternity units of the Gaspard Kamara Health Center (32.3%), Nabil Choucair Health Center (39%), Principal Hospital of Dakar (26.4%), Youssou Mbargane Hospital Diop Hospital in Rufisque (31.4%), Roi Baudoin Hospital Center (29.8%), Grand Yoff General Hospital (32%), Ouakam Military Hospital (34.2%), and, National Hospital Center of Pikine (27.9%). 4 facilities had a caesarean section rate higher than 30% (University hospital Aristide Le Dantec 35.6%, Youssou Mbargane Diop Hospital in Rufisque 32.03%, Municipal Hospital Center Abass Ndao 32.01% and, National Hospital Center of Pikine 30.45%). The average birth weight of new-borns was 2943 grams, with an average Apgar score of 8 at the fifth minute. The post-op care was simple. Conclusion: The caesarean section rate remains relatively high in the surgical maternity hospitals in Dakar and the indications for scarred uterus are still high.

Immunosuppressive Treatment of Connective Tissue Disease and Occurrence of Tuberculosis

Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjögren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.

Delays in the management of acute coronary syndroms with ST segment elevation and extending factors: Prospective study about 50 cases in cardiology department of Aristide Le Dantec hospital.

Management of acute coronary syndromes with ST segment elevation (STEMI) is a race again time: time is myocardium». Treatment consist in reperfusion strategy by coronary intervention or thrombolysis. The main objective of this work was to evaluate the time delays of treatment and the extending factors during STEMI. It was a prospective, descriptive and analytic study on 6 months including all patients admitted for STEMI. We studied the time delays and the extending factors. We included 50 patients. The average age was 58,4 years and the sex ratio M/F was 2,5. Chest pain was typical for 39 patients. Mean time delay between pain onset and first medical contact was 12 h16 min. The first medical contact was a general physician for 33 patients and a cardiologist for 8 patients. The average time delay between the first medical contact and an electrocardiogram was 9 h57 min. The main factor of late diagnosis were unavailability of electrocardiograph and absence of prescription of an electrocardiogram. The average time delay between the diagnosis electrocardiogram and admission in cardiology department was 3 h02 min. The transport was the main extending factor. Aspirin and clopidogrel were used respectively for 17 and 10 patients. Among the patients admitted directly in cardiology, the average time delay for a diagnostic electrocardiogram was 30 min. Thrombolysis was performed in 17 patients within an average delay of 2 h11 min. A rupture of streptokinase was the most common extending factor. Twenty-three patients underwent percutaneous coronary intervention with a main time delay between diagnostic electrocardiogram and cath lab of 2 h42 min. The unavailability of medical team was the first extending factor. Factors related to long delay in admission and care are a proof of lack of codified management of STEMI. It is necessary to develop the prehospital emergency medicine, educate population and medical staff.

Hypospadias: Evaluation of Therapeutic Outcomes and Sexual Function in Adulthood in a University Hospital Setting

Background: Hypospadias is a congenital malformation resulting from hypoplasia of the tissues forming the ventral face of the penis. It is associated to variable degrees with an ectopic urethral meatus, a penis curvature and a sapper’s apron foreskin [1]. The incidence of this malformation varies from country to country. It is estimated at 1/300 male births in France and 0.26/ 1000 in Mexico [1]. In Senegal, the prevalence of this malformation is unknown. Hypospadias surgery has improved significantly in recent years due to a better understanding of the anatomy on the one hand and the improvement of the instruments used during surgery on the other (suture material, surgical magnification, urethral catheter of suitable size). In sub-Saharan Africa and particularly in Senegal, hypospadias surgery remains a challenge due to the unavailability of adequate equipment (lack of microsurgical instruments and surgical loupes). Objective: To evaluate the outcomes of the treatment of hypospadias by the different surgical techniques used in our center as well as their sexual function in adulthood. Patients and Methods: This is a retrospective study, including all patients operated for hypospadias between January 2009 and December 2017 in Urology-Andrology department of Aristide Le Dantec hospital. The studied parameters were: frequency, age, clinical and therapeutic aspects, and their sexual function in adulthood after treatment. The outcomes of the treatment were judged good or poor depending of the quality of penile straightening, the aesthetic appearance of the penis, the position of the urethral neo-meatus, the permeability of the urethra and the existence or not of fistula. The sexual function was assessed by the International Index of Erectile Function 15 (IIEF) score. Results: Fifty-five patients were included. The median age was 6 years (P25 = 2.8 and P75 = 13 years). After a mean follow-up of 58 ± 33 months, 81.8% (45) of patients had a good outcome. Duplay-Snodgrass urethroplasty was the most commonly used urethroplasty technique with better results. Complications were noted in 29 patients. The most common were urethral fistula, surgical site infection and urethral neo-meatus stenosis. The sexual function was rated good in one patient and average in the other two (after an average decline of 53 ± 26 months). Conclusion: Urethroplasty according to Duplay Snodgrass was the most used technique in our studies and its outcomes were better compared to the other techniques used.

Upper Digestive Lesions Not Linked to Portal Hypertension during Cirrhosis: About 82 Cases in the Hepato-Gastroenterology Department of Aristide Le Dantec Hospital

Introduction: The aim of this study was to determine the frequency of digestive lesions unrelated to portal hypertension during cirrhosis and to look for a possible correlation between these lesions and the severity of chronic liver disease. Material and method: Over a period of 15 months (April 1, 2014 to June 30, 2015), all the records of cirrhotic patients who followed up on an outpatient or inpatient basis in the hepato-gastroenterology department of the Aristide Le Dantec Hospital were collected. The data collected were as follows: age, sex, Child-Pugh severity score, etiology of cirrhosis, indication for endoscopy and endoscopic lesions observed. Results: Data were analyzed from 82 patient records with a mean age of 43 years (range 16 and 79 years) and a sex ratio of 1.4 (54 males). Cirrhosis was classified as Child-Pugh B in 47% of cases and Child-Pugh C in 35% of cases. The etiology was viral B in 75 patients (91.5%), B-D co-infection in 2 cases, and alcoholic in 1 case. The indication for oeso-gastroduodenal endoscopy was a systematic search for signs of portal hypertension in 66 cases (80.4%), upper gastrointestinal haemorrhage in 11 cases (13.4%) and epigastralgia in 6.2% of cases. Endoscopic lesions unrelated to portal hypertension were observed in 61 patients (74.4%). Peptic ulcer was present in 26 patients (31.7%), and congestive gastrobulbitis was observed in 38 patients (46.3%) and erosive gastrobulbitis in 32 patients (39%). Of the 43 upper GI endoscopies with biopsies, Helicobacter pylori was found at histology in 17 cases (39.5%). Eighteen patients (21.9%) had esophageal candidiasis. In multivariate analysis, there was no association between no portal hypertension lesions and the severity of cirrhosis. Conclusion:Upper gastro intestinal lesions unrelated to hypertension were present in 3/4 of cirrhotic patients. Peptic ulcer disease and congestive and erosive gastrobulbitis were the most frequently observed lesions. There was no significant association between non-PTH-related lesions and the severity of cirrhosis.

Senegalese Experience of Keratoplasties in Public and Private Practice (Aristide le Dantec Hospital and Clinique du Cap), Dakar

Introduction: The corneal surface is exposed to many external aggressions which can alter its transparency and regularity. Several keratoplasty techniques have been codified such as transfixing keratoplasty (KT) or deep anterior lamellar keratoplasty (KLAP) or rotational auto graft. Our work was carried out in Senegal, in a context where corneal transplants were not frequently performed. The aim of our study was to report results one year after a keratoplasty. Patients and Method: We conducted a retrospective study of patients who underwent prior transfixing or lamellar keratoplasty or rotational auto graft. It was carried out between the ophthalmological clinic Aristide Le Dantec hospital and the ophthalmological center of Clinique du Cap in Dakar, Senegal. It included all records of patients with postoperative follow-up greater than or equal to 1 year. The parameters studied were anamnestic data, preoperative clinical examination (indication of corneal transplantation) and postoperative results. Results: Twenty-six eyes of 22 patients were identified. The decrease in visual acuity evolved on average for 5 years. The operative indications were mainly represented by results of pillow type keratitis (30.76%), bullous keratopathy (23.08%), and keratoconus (23.08%). Surgery consisted of a transfixing keratoplasty in 84.61%, lamellar in 15.39% of the cases. Comments: The primary objective of keratoplasty is to restore the transparency, it can also help to remedy pain or improve the anatomical and aesthetic prognosis of the eyeball. The benefits of keratoplasty in our context of developing countries are the reduced cost and shorter waiting time vis-à-vis western countries. Conclusion: The results of our study are encouraging for surgery, still practiced on a small scale in our regions.