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Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18–71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

Item does not contain fulltext BACKGROUND: The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. METHODS: An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy. RESULTS: The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive). DISCUSSION: The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.

Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal.This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0.We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology.Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

Objective: The study tested whether childhood cognitive ability moderates type 2 diabetes polygenic risk manifestation in older age. Methods: In 940 relatively healthy people (mean age 69.55 ± 0.85), we tested whether self-reported diabetes and hemoglobin HbA1c (HbA1c) levels were predicted by diabetes polygenic risk, cognitive ability measured about 60 years earlier, and their interaction. Polygenic risk scores aggregated the small effects of up to nearly 121,000 single-nucleotide polymorphisms (SNPs). Participants' cognitive ability was measured nearly 60 years earlier, at age 11. Results: Both polygenic risk and childhood cognitive ability significantly predicted diabetes diagnosis. Polygenic risk interacted with cognitive ability (p = 0.02), predicting HbA1c levels more strongly in people with below-median cognitive ability (effect r = 0.21) than in people with above-median cognitive ability (effect r = 0.10). The interaction term was not significant for self-reported diabetes (p = 0.34), although the genetic risk-diabetes association showed a tendency of being stronger among those with below-median cognitive ability. Conclusions: Higher premorbid cognitive ability may provide some environmental protection against the manifestation of type 2 diabetes genetic risk. This information may improve early identification of diabetes risk and inform intervention development.

Research of cardiac involvement in patients with rheumatoid arthritis can prevent complications and place in a logical secondary prevention. The objective of this study was to investigate the echocardiographic parameters in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations.We conducted a descriptive cross-sectional study, which included prospectively from outpatients in the internal medicine department of university hospital center Aristide Le Dantec in Dakar, Senegal, with a diagnosis of rheumatoid arthritis without clinically evident cardiovascular disease. It focused on a sample of 73 patients of both sexes aged at least 18 years. Following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, rheumatoid factors: Latex and Waaler-Rose, anti-CCP, antinuclear factors and anti-ENA antibodies), ECG, echocardiography standard. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables.A total of 73 patients with rheumatoid arthritis without obvious cardiac events and meeting the criteria of definition of the ACR 1987 were included in the study. The mean age was 44.17±14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93±4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). The abnormalities found in Doppler echocardiography were dominated by diastolic LV dysfunction (42.46%), increased left ventricular mass in 35.61%. Valvular leaks of variable grades were highlighted regarding all orifices but were rarely significant.The realization of echocardiography in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations helps to highlight cardiovascular abnormalities related to the natural course of the disease.

Congenital heart diseases are one of the major cardiovascular diseases in developing countries. Most prevalence studies were based on clinical examination of children with echocardiographic confirmation of suspected cases and underestimate its prevalence. The objective of this study was to investigate the prevalence of congenital heart disease in "daara" (Koranic schools) in the city of Dakar and its suburbs on the basis of clinical examination and Doppler echocardiography in school children. This cross-sectional survey was carried out from 9(th) August to 24(th) December 2011, and included a population of 2019 school children aged 5 to 18 years in 16 selected "daaras" under the Academic Inspectorate of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were recorded in a validated questionnaire. A p0.05 was considered to be statistically significant in bivariate analysis. 2 019 school children were included out of which 60.1% were male (sex-ratio: 0.66). The average age was 9.7 years (± 3.3 years). 18 cases of congenital heart diseases were detected being a prevalence of 8.9 per 1 000 (95 % CI: 1.8 to 7.9). This included 6 cases of inter-atrial septal aneurysm, 5 cases of peri-membranous ventricular septal defects, 4 cases of patent ductusarteriosus and 3 cases of tetralogy of Fallot. Factors correlated with the presence of congenital heart disease were ageless than 8 (p0.001) and residence in the suburbs of Dakar (p0.001). We also detected 10 cases of rheumatic valvular disease, a prevalence of 4.9 per 1 000 (95% CI: 2.4 to 9.1). Our study shows a high prevalence of congenital heart diseases, which is almost identical to the WHO estimates and that ultrasound screening is more sensitive than clinical screening. Reducing the prevalence of these diseases requires implementation of appropriate policies, focusing on awareness and early detection.

We outline an approach to pesticide risk assessment that is based upon surveys of pesticide use throughout West Africa. We have developed and used new risk assessment models to provide, to our knowledge, the first detailed, geographically extensive, scientifically based analysis of pesticide risks for this region. Human health risks from dermal exposure to adults and children are severe enough in many crops to require long periods of up to three weeks when entry to fields should be restricted. This is impractical in terms of crop management, and regulatory action is needed to remove these pesticides from the marketplace. We also found widespread risks to terrestrial and aquatic wildlife throughout the region, and if these results were extrapolated to all similar irrigated perimeters in the Senegal and Niger River Basins, they suggest that pesticides could pose a significant threat to regional biodiversity. Our analyses are presented at the regional, national and village levels to promote regulatory advances but also local risk communication and management. Without progress in pesticide risk management, supported by participatory farmer education, West African agriculture provides a weak context for the sustainable intensification of agricultural production or for the adoption of new crop technologies.

Pseudoaneurysm of the left ventricle is a rare late complication of myocardial infarction. So-called non-coronary forms have been described in young people. In this context, we report three cases. Mr. M.B., aged 20, consulted for chest pain associated with palpitations. Cardiovascular examination found a pulsatile, expanding precordial bulging and a mesocardiac systolo-diastolic murmur. We noted a sinus rhythm with ventricular extrasystoles on ECG. The chest radiograph showed cardiomegaly and aneurysmal deformation of the left lower heart border. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mrs. O.B., aged 23, was admitted for biventricular heart failure and in whom the examination found a systolic murmur in the apical area. ECG showed a regular sinus tachycardia, left atrial and ventricular hypertrophy. The chest radiograph showed cardiomegaly and aneurysmal deformation of left middle and lower heart borders. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mr. I.S., aged 24, admitted for the management of congestive heart failure. The patient had non-specific laboratory inflammatory signs, a sinus tachycardia and extrasystoles on the ECG. Chest radiography showed a discontinuation at the posterior arch of the sixth rib, a cardiomegaly and a neurismal dilatation of the left lower heart border. Doppler echocardiography showed a large apical pseudoaneurysm of the left ventricle.

Dear Sirs, Ataxia telangiectasia (A-T) is a rare, autosomal recessive disorder of childhood characterized by progressive cerebellar ataxia, telangiectasia, and immune defects, and is caused by mutations in the ataxia-telangiectasia mutated (ATM) gene [1]. The incidence of the disease is about 1 in 40,000 to 100,000 births [2]. A-T has been reported worldwide [3], but reports of this disease in Africa are rare and generally limited to clinical description. We describe a Malian family with parental consanguinity (Fig. 1a) and three of ten children presenting with cerebellar symptoms in early childhood. Two patients, 14- and 10-year-old boys, had normal births and development until age 2, when they presented with progressive gait difficulty, including difficulty stopping when running and falls. They both later developed slurred speech, weakness, and decreased coordination of the upper extremities. No sensory or bladder difficulty was noted. Family history was remarkable for a grandfather who died at age 75 and had balance problems since he was a teenager. Fig. 1 Pedigree and genetic features of the family. a Pedigree of the family showing consanguinity, and unaffected (white) and affected (black) individuals. b Sequencing shows a homozygous T7985A mutation (asterisk) in ATM. c ATM protein alignment in various ... Neurological examination of both patients showed an ataxic gait, markedly reduced hand coordination, and nystagmus on fixation and lateral gaze. They had slight distal weakness and atrophy in the lower legs. Reflexes were normal to reduced, and the Babinski sign was absent. The older brother had scoliosis. Cardiologic examination and testing were normal. Brain CT scan showed cerebellar atrophy with prominent cisterna magna. Vitamin E and beta and gamma tocopherol serum levels were normal. Genetic testing for Friedreich's ataxia was negative. A follow-up clinical assessment showed oculomotor apraxia, ocular telangiectasia, and square wave jerks. The parents noted that the patients had recurrent diarrhea and upper respiratory infections. These new findings were in favor of ataxia telangiectasia (Table 1). Additional blood testing showed high alphafetoprotein (AFP) levels and low IgA, IgE, and IgG2 levels. Also, aspartate and alanine aminotransferases (AST, ALT), and C-reactive protein (CRP) were elevated in the two patients, suggesting liver dysfunction. Genetic analysis of the ATM gene identified a novel homozygous single-nucleotide substitution at position c.7985T > A (Fig. 1b), predicting the amino acid substitution V2662D. Five available unaffected siblings did not have this sequence variant. The V2662 residue lies in a predicted ATP binding domain [3] and is conserved across a broad range of vertebrate species (Fig. 1c). In addition, this non-conservative amino acid change yields a score of –3 according to the BLOSUM 62 substitution matrix [4], and was not found in 100 ethnically matched controls, suggesting that the mutation found here is likely deleterious. Table 1 Summary of clinical and laboratory findings in patients More recently, the parents noticed that their 2-year-old son also had an ataxic gait. His AFP levels were elevated, but he had no telangiectasias. This highlights the usefulness of AFP testing in the diagnosis of A-T, as previously discussed [5]. Recurrent upper respiratory infections due to immune deficiency [6] occur in ataxia telangiectasia, but the two older patients also presented with frequent diarrhea, which may represent an associated infectious disease specific to the region in Mali where the patients live. Increased cancer susceptibility has been associated with A-T [7], however, hemato-oncological examination showed no signs of malignancy in our patients. In addition, abdominal and inguinal echography showed no tumors. Although cases of A-T have been reported in populations with African ancestry [3, 8] and in North Africa [9–11], reports of this disease in sub-Saharan Africa have been limited to clinical characterization [12, 13]. We report here genetically confirmed A-T with a novel mutation in this region, and add to the global spectrum of this disease. Our study shows that hereditary neurological diseases may not be uncommon in this region of Africa, although limited expertise and lack of diagnostic tools might lead to their underestimation and neglect.

This study compared erythrocyte changes between a group of subjects with sickle cell trait (SCT) and controls (subjects without hemoglobinopathy) during a soccer game in two conditions: with and without hydration. Erythrocyte deformability of subjects was assessed by the coefficient of erythrocyte rigidity (Tk) which was calculated before and after football match. Our results showed a significant increase in erythrocyte rigidity (Tk) in SCT at the end of physical activities without hydration; however when water was provided ad libitum their Tk decreased significantly, reaching values of controls. And adequate hydration is recommended in subjects with sickle cell trait during and after exercise.

Human immunodeficiency virus (HIV) infection can cause vascular complications. This is most often of lower limb venous thrombosis. Rare cases of limb ischemia indicative of HIV infection have been described.We report a case of venous thrombosis of the left lower limb and bilateral lower arterial ischemia revealing an HIV infection in a patient of 44 years. The CD4 count was 195/mm(3). Investigations on coagulation were not realized. The patient was amputated both his legs.

Massive pulmonary embolism is a life threatening pathology with a high mortality over 20%. Thrombolysis is one of therapy ways that leads to a lower rate of death. The aim of the study is to show interest, limits and complications of thrombolytic therapy in massive pulmonary embolism.This descriptive study presents 8 cases of pulmonary embolism admitted to the Cardiology Division of Grand-Yoff from March 2003 to March 2006. All cases confirmed by Tomodensitometry (TDM) with massive pulmonary embolism were included in this study.We used thrombolytic only in 8 cases of massive pulmonary embolism about 32. In-hospital prevalence was 25%. The average age was 49.8 ± 19.1 (from 15 to 72) and sex-ratio 0.33. Seven patients had a moderate clinical probability Well's score and one of them 1 had a high clinical probability. The clinical signs were: cardio-vascular collapse (7 cases), syncope (1) and cardio-vascular arrest. The electrocardiogram showed a sub-epicardial ischemia (4 cases), a right bundle branch block and a Mac Ginn White's sign. Two patients had a right-basal opacification at the chest X ray. The echocardiography found 5 cases of right ventricular dilatation, 1 case of paradoxal septum, 1 case of multiple thrombi in the right ventricule. The TDM confirmed diagnosis with 3 cases of bilateral pulmonary embolism, 1 case of pulmonary aneurysm. The treatment used thrombolytic : 1,500,000 IU of streptokinase, sympathomimetic drugs, anticoagulation with heparins and vitamin K antagonists.

Allelic variation (rs738409C→G) in adiponutrin (patatin-like phospholipase domain-containing protein 3, PNPLA3) has been associated with hepatic steatosis and liver fibrosis. The physiologic impact of the PNPLA3 G allele may be exacerbated in patients with severe obesity. In this study, we investigated the interactions of PNPLA3 rs738409 with a broad panel of metabolic and histologic characteristics of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH) in patients with medically complicated obesity.Consecutive patients undergoing bariatric surgery were selected for a prospective study. They underwent extensive laboratory and histologic (liver biopsy) assessment, as well as evaluation of rs738409 polymorphism by TaqMan assay.Only 12 (8.3%) of the 144 patients had normal liver histology, with 72 (50%) NASH, of whom 15 (10.4% of total patients) had fibrosis stage 2-3. PNPLA3 GG genotype correlated positively (P0.05) with serum levels of alanine aminotransferase (ALT), asparate aminotransferase (AST), glucose, fibrinogen, and insulin-dependent diabetes mellitus, homeostasis model assessment-insulin resistance, and presence of NASH. Multivariate analysis indicated that PNPLA3 rs738409 G versus C allele remained an (independent) risk factor for NASH, in addition to CK-18145 IU/l, glucose100 mg/dl, and C-reactive protein (CRP)0.8 mg/dl. The probability of NASH increased from 9% (no risk factor) to 82% if all four risk factors were present.In this cohort of patients with medically complicated obesity, PNPLA3 rs738409 G allelic expression is associated with hepatic (NASH) and nonhepatic complications of obesity, such as insulin resistance. These novel findings may be related to a greater impact of PNPLA3 variant in magnitude and scope in patients with severe obesity than in less obese populations. Further studies are needed to characterize the nature of these associations.

Permanent cardiac pacing is a technique whose indications have increased in the last 20 years. As with any foreign body, pacemaker implantation is associated with the risk of infection. The objective of this study was to describe the clinical, paraclinical and treatment options of infections secondary to pacemaker implantation at the Cardiology Department of the Aristide le Dantec Teaching Hospital (CHU Aristide le Dantec) in Dakar, Senegal.We conducted a retrospective study over a period of three years (from January 2005 to December 2007) during which pacemaker implantation was carried out in 107 patients. All patients with local and/or systemic signs of infection were included in our study.The prevalence of infection in patients with pacemakers was 5.6% in our series and infection occurred in three women and three men, with a mean age of 66.2 years (range 23-83). The delay time for the onset of clinical signs of infection was 6.6 months, with a range of eight days to 12 months. The clinical signs were externalisation of the pacemaker with suppuration (five cases), fever (one case) and inflammatory signs (one case). Factors favouring the occurrence of infection were co-morbidity (four cases), pre-operative length of stay (average eight days), use of temporary cardiac pacing (three cases), the number of people in the theatre (average 4.5), postoperative haematoma (one case) and repeating the surgical procedure (three cases). Staphylococcus epidermidis (two cases), Staphylococcus aureus (two cases) and Klebsiella pneumonia (one case) were the organisms isolated at the local site. Transthoracic echocardiography showed no objective signs of endocarditis. The treatment was antibiotic therapy for an average duration of 50.4 days after debridement of the infected site (six cases). We noted four recurrences at six months and one death from sepsis at 12 months.Infections secondary to pacemaker implantation are rare but serious. Their management is difficult and requires the removal of the implanted material, hence the importance of prevention of infection, or the removal and re-implantation of the pacemaker at another site in cases of infection. This is particularly important in our region where pacemakers are very expensive.

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.

The aims of this work are to study the nursery futures during idiopathic myocardiopathy of peripartum (IMPP), to measure the prevalence of thromboses and spontaneous contrast during the IMPP and to determine their evolution.It is about a longitudinal exploratory study carried out with the Aristide-Le-Dantec teaching hospital of Dakar, beginning January 2001 to November 2004, having included 33 patients.The average age of the patients was 26 years; the average pregnancy was of 3.39 gestures. The signs of cardiac insufficiency were constant and four patients (12%) had presented an ischemic cerebral vascular accident. We had raised an auricular case of fibrillation and tachycardia atrial multifocal. The transthoracic echography (ETT) noted an aspect of hypokinetic myocardiopathy dilated with deterioration of the systolic function of the left ventricle, a thrombus in ten patients (30.3%) and a spontaneous contrast in two cases (6%). The transoesophageal echocardiography (ETO) was superposable with the ETT with regard to dimensions of the cardiac cavities and the presence of thrombus but its sensitivity was higher (100% against 66%) with regard to the detection of contrasts spontaneous. All the patients had the treatment of a congestive heart failure associated to an anticoagulant treatment. The evolution was marked by an improvement of the heart failure. The thrombus and spontaneous contrast had disappeared in all the patients. The absence of anaemia and the presence of spontaneous contrast (p=0.003) were correlated with the presence of thrombosis (p=0.05).The idiopathic myocardiopathy of the peripartum is a relatively frequent affection in zone Soudano-Sahelian. Occurrence of thromboses is frequent at the time of this affection. Our study confirms the superiority of the echocardiography transoesophageal in the detection of intracardiac spontaneous contrast. The evolution can be favourable subject to a rigorous care and a regular surveillance.

Shaping canal is one of the most important steps in endodontic treatment. It allows the cleaning solutions to reach the totality of the canal and to control any infection of the canal system. To achieve this goal is not without difficulty with the steel instruments, because of their rigidity. Recently, the Nickel Titanium instruments were introduced in Endodontics, to allow a setting form technically simplified and faster The aim of this study was to evaluate the duration of the canal shaping with the Pro Taper system.This exploratory study was carried out in Conservative Odontology and Endodontics service (OCE) of the department of Odontology of Faculty of Medicine, Pharmacy and Odonto-Stomatology of the University CheikhAnta Diop of Dakar in 2006. Sixty nine root canals (50 teeth) were shaped with ProTaper.The results showed that an average time of 17.35 minutes was necessary for the shaping of the long canals against 15.38 minutes for the middle canals and 14.29 minutes for the short canals. The average duration of canal shaping of the one-root teeth is 13.76 minutes and 17.77 minutes for the plural root teeth.Taking into account the necessity of maintaining the teeth on the arcade during long year; include that we have now to respect imperatively the biological principles during the canal shaping in a restricted duration to realize a dense and hermetic canal obturation of the canal system in the same meeting. The Pro Taper system is so a reliable means.

Infantile cortical hyperostosis (ICH) or Caffey-Silverman disease is affection that attained skeleton most frequently flat bones, contiguous fasciae and muscles. We reported the case of a 3 months old female infant of Mauritanian origin, referred for recurrent osteitis of the left clavicle. The present complaints are incessant snivelling and functional disability of the left upper limb. Examination showed clavicular and mandibular swelling, without fever. Biological check-up showed inflammatory signs. Radiographies showed cortical thickening of the left clavicle and mandible. Interest of such an observation is in the rarity of this affection, its originality as for the striking age limitation, in the disconcerting but suggestive symptomatology, at least in the classical sites and in the possibility of its antenatal diagnosis.

Western countries have good mastery of abundant pericardial effusion while in Africa this still raises some problems regarding diagnosis and therapy. The aim was to see to what extent echo guided pericardiocentesis could contribute in severe cases.All patients with abundant pericardial effusion diagnosed by echocardiography with or without compression were considered in a prospective study. They experienced a pericardiocentesis. Some patients did undergo an additional surgical biopsy. The liquid was preliminarily submitted to chemical, bacteriological, cytological analysis. Tissues were observed through an anatomic pathology in biopsy. Heart tuberculosis was diagnosed through histology for following therapeutic testing.Thirty consecutive patients aged 37 in average were included. The sex ratio was 3.75. Prior to draining off, 3 neoplasies (2 of lung bronchitis, 1 of cervix ), 1 leukaemia, 2 extra pericardium tuberculosis and 1 amoebic abscess were diagnosed . Clinical occurrence: the most frequent case, besides the tampon (10 cases, i.e. 30%), was isolated pericardial effusion associated or not with an alteration of the global state (13 cases, i.e. 4%). The average quantity of liquid extracted was 600c c which provoked a kind of haemorrhage in 18 cases, i.e. 60%. Tuberculosis was the major aetiology: 15 cases e i 50% out of which 4 were HIV positive. Three additional surgical biopsies were carried out. Seven patients died. CCONCLUSION In addition to its diagnostic contribution, echo guided pericardiocentesis offers an alternative to endoscopy surgery.

Parkinsonian dysarthria can alter oral communication of the patients in the long-term. Subthalamic nucleus (STN) stimulation represents an interesting therapeutic option, although it does not seem to improve axial signs, of which dysarthric speech. The objective of our study was to contribute to the evaluation of STN stimulation effects on speech impairment and in particular on pneumophonic coordination: this latter parameter can be assessed indirectly by evaluating the temporal progression of the intraoral pressure (IOP) during the expiratory phase; thus, IOP represents the transient expression of subglottal pressure (SGP).Using a dedicated system (EVA2), 20 parkinsonian patients were recorded in ON and OFF STN stimulation conditions in order to evaluate IOP on three measurement points (2nd, 4th and 6th consonants P) during realization of the sentence "Papa ne m'a pas parlé de beau-papa" ("Daddy did not speak to me about daddy-in-law") which corresponds to a breath group. Eleven control subjects were recorded in parallel in order to define reference measurements.STN stimulation improved significantly IOP at the level of the initial measurement points (2nd P and 4th P), with an effect of convergence at the level of the third point (6th P) where the difference between OFF and ON STIM conditions was not significant any more. In addition, the performance of the patients ON STIM remained much lower than that of the control subjects.Our results raise the significant concept that IOP measurement can be regarded as a relevant indicator for dysarthria in Parkinson's disease. They also show that the improvement of pneumophonic coordination by STN stimulation is restricted to the initial period of the expiratory phase, confirming again the mitigated and controversial effect of STN stimulation on axial signs.

During a study, the authors observed clinical and ultrasound evidence of "ventricular dysfunction during acute fever" due to ue to "severe acute myocarditis" supports therapeutic management since 4/8 patients in this study were infected either by Chlamydia (CT and especially CP) or by Mycoplasma pneumoniae, that are both sensitive to antimicrobial therapy using macrolides. Five of 8 patients presented coinfection with 2 and even 3 infectious agents (CP-enterovirus-adenovirus).

The aim of this study was to evaluate the antibacterial effectiveness of 2.5% sodium hypochlorite on endocanal bacteria related to the time contact Within root canal.110 teeth were prepared and inoculated with Enterococcus feacalis. All teeth were irrigated with a same volume and exposed a period ranging 1 to 10 min. Canals were sampled before and after time contact.All time reduced the number of bacterial cells within the root canal (p0.05). There was no significant difference after the time contact of 3 min (p0.05). Lack of effectiveness might be caused by irrigant to reach microorganism in dentinal tubules.

The follow-up of performances and the prevention about possible incidents at the athletes make necessary the medical supervision in physical training. The aims of this study are to estimate the effect of a precompetition training program in athletes' body composition, and cardiovascular modifications (in clinical examination and electrocardiogram)Ten athletes (3 men and 7 women; mean age of 23.6 +/- 3.16 years) of Dakar international Athletics' Center are subjected to a training on a period of 2 months in aerobic dominant followed by a period of 3 months in anaerobic dominant. At the beginning and the end of training program, an electrocardiogram is recorded after blood pressure (BP) measure in lying and standing posture and heart rate (HR) take. The weight, height and cutaneous folds are measured to calculate the body fat percentage, fat body mass, fat-free mass and body mass index. Every athlete has performed the Ruffier test Comparisons are realized by the paired t-test, statistically significant for a p value0,05 RESULTS: Significant declines after training interest HR (79.2 +/- 14.7 vs 63.2 +/- 10.25 beat min(-1); p0.001), systolic BP in standing posture (11.8 +/- 0.44 vs 10.6 +/- 0.96 mmHg; p= 0.02), and Ruffier index (4.4 +/- 3.28 vs 2.23 +/- 1.62; p= 0.048) whereas the fat-free mass increased (53.14 +/- 8.41 vs 54.16 +/- 9.67 kg; p= 0.046). At the electrocardiogram, the number of athletes having sinusal bradycardia is crossed from 1 to 4; there is no modification as for the two cases of uncomplete right bundle-branch block and the pre-existent left ventricular hypertrophy. Negative T waves in V1 and V2 leads are present in one athlete before training and in two others after.The impact of the specific training on body is real, interesting more the cardiovascular system.

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

The non carious cervical lesion (NCCL) is a loss of tooth tissue at the neck of affected teeth that is unrelated to tooth decay. They are commonly encountered in clinical practice and present in a variety of forms. The purpose of this paper is to determine the prevalence of the NCCL in a Senegalese population. From 655 patients, 112 with cervical lesions were identified i.e. a global prevalence of 17.10%. The prevalence rate for abrasion was reported to be 77.70%, 12.50% for abfraction and 9.80% for erosion. Etiological factors were studied for abrasion and erosion. 54% of the patients with abrasion used their toothbrush horizontally. For erosion, only external factors were identified: consumption of acidic drinks (9 patients) or alcohol (1 patient) and professional environment (1 patient). Dentists should consider these lesions in their daily practice.

The sickle cell trait is a genetic abnormality of red blood cells. It is due to the mutation of a parental gene, which rest Its to the substitution of glutamic acid by valin on beta globin chain of haemoglobin. The possibility for sickle cell trait carriers (SCT) to present any disturbance during predominantly anaerobic and aerobic exercises is unclear. Ten (10) subjects with sickle cell trait and 10 subjects control were studied during exercise test on cycloergometer. They were all students of the National Institute of Popular Education and Sport of Dakar. The mean of environmental temperature was 26 degrees C and humidity was 60 to 80%. After haematological analysis, a submaximal muscular exercise for one hour with 75% of maximal heart rate was done. We have determined heart rate, blood pressure, rectal and skin temperature during exercise. Haematological parameters shown any significant difference between the two groups. No significant difference was found in cardiocirculatory variables during maximal exercise in cycloergometer between control group and sickle cell trait group. The two groups have done submaximal exercise during 1 hour without particular difficulty. We have not observed a significant difference between the two groups in cardiovascular variables, rectal and skin temperature during exercise, and after 3 minutes of rest. These results show that subjects with SCT have physical capacity comparable with control subjects during a sub maximal exercise for 1 hour. We can assure that subjects with SCT in our country may participate in sports competition, as well as normal subjects (HbAA).

Dental amalgam is a combination of mercury, silver, tin and copper used in the treatment of the dental decays. Amalgam is used in dentistry since many years. Actually a large discussion held according to environmental pollution and risk of intoxication for the patient and the dentist himself. The aim of our survey concerning 103 dentists was to determine the quantity of mercury used in a year, to see the risks linked with the equipment and the manipulation of amalgam and to study the incoming of the trashes of amalgam. Our results showed that among the dentists: 44.66% used 250 to 500 g of mercury by year, 14.56% used their hands for insertion of amalgam in the cavities, 10.68% used their hands for condensation of amalgam in the cavities, 87.38% throw their amalgam on the trash.

Non carious dental lesions are destructions of dental external surfaces originating from non bacterial cause in opposition to dental caries. We distinguish 5 types of non carious dental lesions: attrition, abrasion, abfraction, erosion and demastication. These lesions may be pathological or physiological. Data dealing with them are not very numerous in the literature. Their study shows a real interest in conservative dentistry because of problems both aesthetic and functional they set We carried out an epidemiological trial in the department of Dakar with as aim providing data on the prevalence of these lesions. Our results have disclosed the following rates of prevalence: 60% of attrition, 25,55% of abrasion, 7,22% of abfraction, 5,55% of demastication and 1,68% of erosion. The results indicate once more the importance of the need for clinical evaluation of those dental lesions.

Hepatitis B is endemic in Senegal. According to many data, the prevalence of this infection in adult population is up 85%. Young children are victims of the intensive circulation of this virus. Indeed, the risk of becoming chronic carrier which can further lead to Hepatocellular Carcinoma, is related to the age at which the infection had been contracted. In this study, we investigated the prevalence of HBV markers in children less than 5 years living in two regions of Senegal: Dakar and Thies. Using specific Elisa methods, HBV markers were determined in 2962 sera of newborns and children: AgHBs, antiHBc, antiHBs for all children; AgHBe and IgM antiHBc for AgHBs carriers. HBV markers were detected in 59.38% of sera; in 39.26% of the samples only one marker was detected: AgHBs (3.18%), antiHBc (36.08%), antiHBs (0.49%). In 20.12% of samples, markers were associated. So, the global prevalence of the infection is 59.38% with the predominance of chronic forms compared to acute one. The rate of chronic carriage is independent of the sex but is influenced by age and geographic area. The post- infection immunization rate is 7.11%. In Senegal Hepatitis B is contracted at the early childhood. The high prevalence of this infection in children under five years emphasize the need for a spread vaccination in this age bracket, since we well know that the risk for them to become chronic carriers is high.

Vemonia colorata is distributed through Africa (Benin, Cameroon, Senegal, Togo etc...). Its leaves are commonly used by african tradipractitioners for treating diabetes. However, the antidiabetic activity of the leaves of V. colorata had never been investigated in experimental conditions. The present study aimed to test the aqueous extract of the leaves of V. colorata for its effects in normoglycaemic and alloxan-induced diabetic rats in comparison to glibenclamide antidiabetic activity. Such glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) induced a significant hypoglycaemic effect in normoglycaemic rats. The blood glucose varied from 0.77 +/- 0.01 to 0.58 +/- 0.01 g/l (p0.05, n = 5). It also reduced significantly the fasting glucose level of the hyperglycaemic rats induced with oral administration of glucose (4 g/kg). In alloxan-induced diabetic rats, glibenclamide (0.2 mg/kg, per os) lowered significantly the blood glucose from 2.40 +/- 0.30 to 0.70 +/- 0.40 g/l (p0.05, n = 5). As well as glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) decreased the blood glucose in alloxanic rats from 2.80 +/- 0.10 to 1.00 +/- 0.20 g/l (p0.05, n = 5). The aqueous extract of the leaves of V. colorata possesses both hypoglycaemic and antidiabetic effect in normoglycaemic and alloxan-induced diabetic rats. This may indicate the ethnopharmacological basis of the use of V. colorata leaves in traditional medicine for treating diabetes.

The maxillary first molar is submitted to frequent endodontic treatment and more over, it presents the highest failure rates, often in relation with his mesio-buccal root. Several studies about failures factors showed implication of root canal anatomy often in relation with the frequency of second canal. However, other failures factors, as the foramen situation, which is very important in endodontic practice, could increase the failure rate. The aim of this study was to determine the foramen situation in Senegalese people. The results showed 63.85% of excentric foramina (83 out of 130). 86% of excentric foramina were located at 1.5mm radiology apex.

The authors report a case of a biventricular thrombus complicating peripartum cardiomyopathy in a 38 years old female. The diagnosis was done by bidimensionnal transthoracic echocardiography which showed 2 thrombi in the apical region of the right ventricle and in the anterior and lateral wall of the left ventricle. With treatment associating salt restriction, diuretics and angiotensin-converting-enzyme- inhibitors, the evolution was good: the thrombi disappeared at the first month for the left ventricular thrombi and after 45 days for the rignt ventricular thrombi. The patient didn't experience any embolic complication.

The authors report the results of a study on patients with chronic cor pulmonale hospitalized in the Departement of Cardiology (Dakar), from 1990 to 1998. The hospital prevalence is 0.9% with a male predominance (73.5%). The clinical signs were dominated by dyspnea and cough. The right heart failure is noted in 85.29% of cases. As far as the biological factor is concerned, it exists an polycythemia about 75% of cases, hypoxia (88.8%), hypercapnia (55.5%) and a respiratory acidoses (55.5%). The spirometry showed in 66% of cases, a mixed syndrom with obstructive predominance. The echocardiography showed in all cases right heart dilatation with pulmonary hypertension. The etiological factors are dominated by tobacco (21 cases). The hospital evolution has been favorable in 19 cases underoxygentherapy, lowdosediuretic, expectorant, bronchodilatators and salt restriction. However, 14 patients have died.

This retrospective study of 118 teeth receiving root canal treatment was conducted to determine the frequence and complications of delayed root canal treatment. Teeth were categorised into prompt treatment group and delayed treatment group according to the length time of treatment; prompt treatment group was defined as a group where root canal treatment was achieved within a period of 4 months or less, and delayed treatments group, a group where period of treatment was greater than 4 months or where canals were never obturated. Two types of complications were studied: postobturation pain and fracture involving tooth extration. The results of this study have shown that 34.5% of treatments were delayed. In this group we found also a higher rate of fractures involving tooth extraction, but the difference was not significant. The results have also shown that disappearance of pain was the essential factors in the frequence of delayed treatment, but the dental chair breakdown had some responsability. As well as in the two groups, the first reason of extractions was fracture and not pain. These results emphasize the necessity of focusing the patient's motivation on the risk of losing the tooth.

Peripartum cardiomyopathy is rare in developped countries, but still frequent in Africa. It is defined as a heart failure occurring during peripartum, without any underlying etiology. Authors present 3 cases showing that heart failure before or after delivery may be due to causes which are frequent in the Sahelian area but generally misdiagnosed. Anemia, hypertension and rheumatic fever were the causes of heart failure in these 3 patients, but they were not apparent when the initial diagnosis was made. These observations emphasize that, despite the complex hypothesis trying to explain heart failure during the peripartum period, one should think about some frequent causes which can be misdiagnosed because of the pregnant state or the heart failure itself.

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

The authors report both Senegalese's cases of subvalvular left ventricular aneurysm (SVLVA). The aim of the study was to describe the clinical and paraclinical aspects of this disease. Mitral regurgitation an heart failure were constant. Beyond cardiomegaly observed in both patients, one of them presented vaulting of the left ventricle. In the two cases, electrocardisgram showed sinus rhythm, and biology an inflammatory syndrome. One patient had also tuberculosis. Transthoracic echocardiography showed an aneurysm situated in a mitral subvalvular position, thrombosed in one case. Medical treatment with furosemid and digoxin has been administrated. One patient received also drugs against tuberculosis. Surgery of aneurysm had not been possible. During the evolution, we have observed persistence of heart failure in one patient. The other one died, probably after a cerebral embolism. Autopsy confirmed the echocardiographic aspects and integrity of myocardium and coronary arteries.

The authors report 2 cases of post myocardial infarction septal-rupture. There were one woman and one man aged respectively of 52 and 69 years. Risk factors were diabetes associated in one case with hypertension, and in the other case with tobacco addict. Both patients presented a ventricular septal defect murmur, and cardiac failure. Myocardial infarction (MI) was inaugural, semi-recent, and concemed interventricular septum or circumference of myocardium. Cardiac enzymes were high. Echocardiography showed a left ventricular apical aneurysm, and septal rupture. An abnormal blood flow pattern from left to right ventricle was visualized at Döppler. Medical treatment of Ml and cardiac failure were administrated. Surgery had not been possible. Both patients died respectively after 36 days and 4 days by cardiogenic shock.

Major thrombocytosis associated with severe anemia is uncommon in pediatrics. We report 9 consecutive cases observed in Albert Royer Children Hospital of Dakar. They were 7 boys and 2 girls 4 to 15 years old (mean age = 10 years). Six patients had a history of geophagia and 3 presented recent emission of worms by the stools. Anemia was clinically well tolerated in all cases. In initial blood count platelet levels varied from 800 10(3) to 1180 10(3)/mm3 (mean = 1032 10(3)/mm3), while hemoglobin level varied from 3.4 to 7.4 g/dl (mean = 4.9 g/dl). Anemia was microcytic, hypochromic and associated with low serum iron level in all patients. We considered the diagnosis of reactive thrombocytosis induced by iron deficient anemia in all cases. Platelet count and red cell indices were progressively normalised with iron treatment and no complication of thrombocytosis was observed. Considering published data, iron deficiency is one of the most frequent causes of reactive thrombocytosis in children. The physiopathologic mechanism, still unknown, could involve cytokines of thrombopoiesis. Reactive thrombocytosis induced by iron deficiency or other factors have usually a benign course and need no specific treatment other than that of the etiology.

Cardiac tumours are rare and are dominated by left atrial myxoma. The authors report 2 cases of left atrial myxoma operated in the Cardiology department of Dakar (Senegal). Clinical signs were heart failure, cardiac sounds mimicking mitral valve disease and alteration of general state. The electrocardiogram showed sinus rhythm in 1 case and atrial flutter in the second case. The chest-x-ray show cardiac enlargement. Diagnosis was suggested by echocardiography and confirmed by anatomy. Evolution was favourable in one case and the other patient died.

The authors perform a prospective study of 15 cases of cardiac tamponade in the Department of Cardiology of the University Hospital of Dakar (Senegal) from January to July 1999. The prevalence of cardiac tamponade is 4 %. The mean age is 33 years. There is no sex predominance. The clinical findings are: class III or IV NYHA dyspnea (86.6 %), pulsus paradoxus (66.6 %), and decrease intensity of the heart sounds (100 %). The electrocardiogram revealed sinus rhythm in 86.6 %, a low voltage of the QRS in all cases, and abnormalities of repolarization, mainly inverted T waves (73.3%). The echocardiography shows circumferential pericardial effusion (66.6 %), a "swinging heart" (53.3 %) and compression of right heart chambers (66.6 %). The main etiology was tuberculosis. The evolution is good after pericardiocentesis, surgical drainage and medical therapy. Cardiac tamponade is cardio-vascular emergency almost always due to tuberculosis with a good outcome if a prompt pericardiocentesis is performed.

Mainly because of rheumatic fever,infective endocarditis (IE) is frequent in our countries and is associated with many diagnostic and therapeutic problems. We perform a retrospective study on 86 cases of IE hospitalized from December 1986 to November 1996. The prevalence of IE is 4.3% and there is a female predominance (the sex ratio is 0.56). The mean age is 26.45+/-13.22 years. 74.4% of the patients have of low socioeconomic status. The mean duration of inhospital stay is 54 days and the average diagnosis retardation is 35 days. The source of infection is found in 19 cases (15 sources are dental). The main clinical signs are: fever (63.9%), anaemia (67.4%) and weight loss (38.3%). The underlying heart disease is mainly due to rheumatic valve regurgitation (95.3%). The blood culture find microbialagent in 12.7%. Echocardiography reveals vegetations in 69.7% of patients. The main complications are : heart failure (47.6%) and stroke (33.7%). The mortality rate is high (30.7%). The treatment is only medical, none of the patients has surgical repair. This study shows that IE is frequent and is associated with many complications and a high mortality rate. These observations amphasize the importance of prevention of rheumatic fever.

The aim of this work is to study the echocardiographic parameters of male trained athletes. It is about a case-control study comparing 3 groups: basketball players, cyclists and not sports healthy subjects. All the subjects benefited from an echocardiography (time motion, two-dimensional and pulse Doppler). The mean age is of 23.5 years for the cyclists group, 24 years for the basketball players and of 26.2 years for the control group. Compared with the control group, the left ventricular telediastolic dimensions, left ventricular mass index and the pulmonary flow velocity are higher in athletes group. The basketball players have a higher left ventricular diameter and parameter of systolic function than cyclists group. The septal diameter is higher in the cyclists group. This study finds some differencies in Senegalese athletes in the characteristics of the standard athletic heart syndrome.

Management of major sickle hemoglobinopathies in industrialized countries has improved significantly over the last few years thanks to strict application of the preventive and curative measures developed as a result of a better understanding of the underlying pathophysiological mechanisms. However patients in Africa have benefited little from progress in the field due to the lack of human and physical resources in sharp contrast with the high prevalence of the disease. The purpose of this study was to analyze problems involved in management of childhood sickle cell disease in Africa based on our experience in a cohort of 556 cases treated over a period of 12 years. The main problems were the same as those encountered in other black African nations, i.e., delayed diagnosis due to a lack of routine neonatal diagnostic screening, difficulty implementing anti-infectious prophylaxis due not only to the high cost of recommended vaccinations not covered by the Expanded Program on Immunization but also to poor compliance with antiobioprophylaxis, and insufficient transfusion facilities hindering application of long-term transfusion protocols when indicated. In addition the high prevalence of digestive-tract parasitosis and malaria raise the need to combine standard preventive measures with routine parasiticidal treatment and malarial prophylaxis adapted to each geographical area. The high frequency of associated iron deficiency requires systematic laboratory testing to identify and treat resulting manifestations during follow-up. An important prerequisite for widespread implementation of appropriate preventive and curative measures in Africa is recognition of sickle cell disease as a priority in public health care policy.

Human Immunodeficiency Virus (HIV) infection prevalence rate is estimated at 1.4% in Senegal, and about 3,000 children could be infected. HIV positive children are followed up since 2000 in Albert Royer Hospital (Dakar, Senegal).To describe clinical and epidemiological aspects of HIV paediatric infection, and to evaluate the implementation of high active antiretroviral therapy in HIV positive children in our country.Over a period of three years, the medical reports of 98 infected patients have been collected, 96% with HIV 1 infection.Most of the patients had a maternally transmitted HIV infection (99%). At their enrollment, the median age was 60 months; malnutrition (79%), persistent lymphadenopathy (65%) and skin lesions (64%) were the common clinical manifestations. Thirty-nine percent of the patients were in class C (CDC) and 81% had CD4 cell countor =25%. Median viral load were 421,852 copies/ml at presentation. Seven infants had a rapid progressive disease with encephalopathy. Thirty-six patients received high active antiretroviral therapy with high observance and good tolerance.This study allowed to define clinical and biological profile of paediatric HIV infection in our country and to update the implementation of high active antiretroviral therapy.