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Introduction: Fatigue fractures are secondary to excessive, unusual, repeated mechanical stress, occurring on healthy bone. Bone scintigraphy (BS) with 99mTc-HMDP is an excellent means of diagnosis. We report a case of stress fracture of the calcaneus with scintigraphic diagnosis, in a marathon runner. Patient and Methods: He is a 40-year-old athlete in overtraining with right calcaneal pain on running, intense at first, moderate in the middle and then persistent after exercise. The interrogation found no trauma to the right foot and the x-ray of the foot was without abnormality. The so 3 phases were performed following an injection of 564 MBq of 99mTc-HMDP, with a SPECT gamma camera. Results: Bone scintigraphy found in the early phase, hyper-perfusion and hyper-fixation of the right calcaneal region compared to its left counterpart and in the bone phase persistence of focal hyperfixation opposite the right calcaneus. This scintigraphic aspect of the right calcaneus in an overtrained marathon runner, in a painful context and in front of a normal X-ray, made us evoke a fracture of fatigue. A complementary CT scan performed two days after the BS was without abnormality. Conclusion: Fatigue fractures are micro-fractures generally not noticed on radiography and CT. BS due to its high sensitivity is an excellent or the best tool for the early diagnosis of stress fractures.

Background Anopheles gambiae s.s. and An. coluzzii, two major malaria vectors in Africa, exist in the nature as two incipient, sympatric or allopatric species. In most of their sympatric areas, the reproductive isolation between these two distinct species is thought to be the main barrier to hybridization. However, in Senegal, barriers to the gene flow seems to be leaky in some areas with relatively higher than expected hybridization rates. Here, we characterized the swarming behavior of these two species to investigate its role in the observed high hybridization.Methods The study was carried out in the south and center of Senegal during the 2018 rainy season. Swarms were surveyed at sunset towards the lightest part of the sky, about 0.5–4 m above the ground. Once located, swarm were collected using a net. Indoor resting populations were also collected during the same period from each sentinel village by pyrethrum spray catch earlier the morning. All specimens collected were identified morphologically followed by PCR to estimate the frequency of the two species and female hybrids.Results Results showed that An. gambiae swarmed mainly over bare ground whereas An. coluzzii swarms over various objects forming a dark-light contrast with the ground. The height of swarms varied between 0.5 to 2.5 meters and the swarming duration was about 10 minutes. Start of swarming was mainly correlated with sunset and no mixed swarms were found in areas of sympatry despite the high level of hybridization rate (2.4% − 4.4%).Conclusion As found elsewhere in West Africa, swarming site segregation is an important pre-mating reproductive barrier between An. coluzzii and An. gambiae in Senegal. No link was found between swarming behavior and hybridization, but the lack of mixed swarms may be the result of low number of samples obtained in the sympatric area.

Introduction Le traitement des hyperthyroidies par l’iode radioactif est un traitement simple, efficace, peu couteux et bien tolere. Il est prescrit aux Etats-Unis en premiere intention dans 50 a 75 % des cas, sauf pour les sujets jeunes ou il ne represente que 30 % des options. En Europe, il est plus utilise en deuxieme intention apres les antithyroidiens de synthese (ATS). Cependant, sa disponibilite et sa prescription dans les pays en voie de developpement, en particulier en Afrique noire, restent encore faibles. Introduite au Senegal en 2016, l’iodotherapie occupe une place de plus en plus importante. Nous rapportons a travers ce travail le bilan preliminaire de l’unique service de medecine nucleaire du Senegal dans la prise en charge de l’hyperthyroidie par l’iode 131. Patients et methodes Il s’agit d’une etude retrospective ayant interesse 66 patients atteints d’hyperthyroidie ayant ete traitee par l’I-131 au service de medecine nucleaire de l’hopital general de Grand Yoff de Dakar. L’iratherapie a ete realisee apres consentement eclaire de tous les patients. Une forte dose ablative etait preconisee chez tous les patients afin de reduire le risque d’echec therapeutique. Une surveillance clinicobiologique etait preconisee a 3,6 et 18 mois chez tous les patients. Resultats Il s’agit de 57 femmes (86,36 %) et 9 hommes (13,64 %) d’âge moyen 43,5 ans (18–75 ans). La maladie de Basedow etait l’etiologie la plus frequente (92,43 %), suivie de l’adenome toxique (4,54 %) et du goitre multinodulaire toxique (3,03 %). L’iratherapie a ete proposee en deuxieme intention, c’est-a-dire apres echec du traitement medical chez tous les patients, a l’exception de deux cas : en premiere intention chez une patiente et apres intolerance aux ATS dans l’autre cas. La dose d’I-131 administree etait en moyenne de 15,47 mCi (10–20 mCi). Aucun effet secondaire en rapport avec l’iodotherapie n’a ete observe. Le taux de reponse favorable a 3 mois etait de 60,41 % (33,33 % en hypothyroidie et 27,08 % en euthyroidie). A 6 mois, nous avons note 84,79 % de satisfaction (45,66 % en hypothyroidie et 39,13 % en euthyroidie) contre 15,21 % de persistance d’hyperthyroidie (dont 6,52 % fruste). Conclusion L’efficacite de l’iode radioactif, en particulier les doses ablatives dans le traitement des hyperthyroidies, n’est plus a demontrer. Tenant compte de notre contexte socioeconomique, l’iratherapie devrait etre un traitement de choix des hyperthyroidies avec un bon rapport qualite/prix et une excellente tolerance.

In the central western Senegal, malaria transmission has been reduced low due to the combination of several effective control interventions. However, despite this encouraging achievement, residual malaria transmission still occurring in few areas, mainly ensured by An. arabiensis and An. melas. The resurgence or the persistence of the disease may have originated from the increase and the spread of insecticide resistance genes among natural malaria vectors populations. Therefore, assessing the status and mechanisms of insecticides resistance among targeted malaria vectors is of highest importance to better characterize factors underlying the residual transmission where it occurs. Malaria vectors were collected from three selected villages using nocturnal human landing catches (HLC) and pyrethrum spray collections (PSC) methods. An. gambiae s.l. specimens were identified at the species level then genotyped for the presence of kdr-west (L1014F), kdr-east (L1014S) and ace-1R mutations by qPCR. An. arabiensis (69.36%) and An. melas (27.99%) were the most common species of the Gambiae complex in the study area. Among An. arabiensis population, the allelic frequency of the kdr-east (22.66%) was relatively higher than for kdr-west mutation (9.96%). While for An. melas populations, the overall frequencies of both mutations were very low, being respectively 1.12% and 0.40% for the L1014S and L1014F mutations. With a global frequency of 2%, only the heterozygous form of the G119S mutation was found only in An. arabiensis and in all the study sites. The widespread occurrence of the kdr mutation in both An. arabiensis and An. melas natural populations, respectively the main and focal vectors in the central-western Senegal, may have contributed to maintaining malaria transmission in the area. Thus, compromising the effectiveness of pyrethroids-based vector control measures and the National Elimination Goal. Therefore, monitoring and managing properly insecticide resistance became a key programmatic intervention to achieve the elimination goal where feasible, as aimed by Senegal. Noteworthy, this is the first report of the ace-1 mutation in natural populations of An. arabiensis from Senegal, which need to be closely monitored to preserve one of the essential insecticide classes used in IRS to control the pyrethroids-resistant populations.

Introduction La maladie de Basedow, cause la plus frequente d’hyperthyroidie, est liee a la presence d’anticorps anti-recepteur de la TSH. Il s’agit d’une pathologie auto-immune, 5 a 10 fois plus frequente chez les femmes que chez les hommes, survenant a n’importe quel âge. La clinique associe les signes de thyrotoxicose et les signes specifiques de la maladie (ophtalmopathie et myxœdeme pretibial). Sur le plan biologique, une concentration de la TSHus abaissee, une T4 et/ou une T3 elevee confirme le diagnostic. L’echographie et la scintigraphie sont parfois utiles pour distinguer la maladie de Basedow des autres causes d’hyperthyroidie. Lorsque la clinique et la biologie sont incompletes et/ou l’echographie discordante, la scintigraphie est d’une grande utilite. Nous rapportons l’apport de la scintigraphie dans le diagnostic d’un cas de Basedow avec discordance entre la clinique, la biologie et l’echographie. Observation Patiente de 32 ans, senegalaise, ayant consulte un cardiologue devant un tableau de thyrotoxicose faite de palpitations, amaigrissement, nervosite, thermophobie, asthenie, insomnie et chute de cheveux. On ne retrouve pas d’exophtalmie, ni de myxœdeme. Un bilan biologique realise retrouve une hyperthyroidie tres fruste avec legere baisse de la TSHus a 0,30 μUI/mL (0,35–4,94), T4L et T3L normales. Referee chez un endocrinologue, l’echographie est prescrite et ne milite pas en faveur de la maladie de Basedow avec une thyroide de taille normale siege, de nodules basilaires bilateraux quasi symetriques dont le droit spongiforme est classe EU-TIRADS 2. Devant ce contexte clinicobiologique incomplet et une echographie discordante, la scintigraphie est alors demandee en complement. La scintigraphie thyroidienne realisee au service de medecine nucleaire de l’hopital general de Grand Yoff (Dakar, Senegal) apres injection de 171 MBq de pertechnetate de sodium retrouve une hyperfixation diffuse et homogene du radiotraceur compatible avec une maladie de Basedow. La patiente est ainsi mise sous antithyroidiens de synthese a faible dose. L’evolution est alors favorable sur le plan clinique et biologique (TSH, T4 et T3 normales aux controles a 1 et 2 mois). Conclusion Le diagnostic classique de la maladie de Basedow est clinicobiologique et secondairement echographique. Cependant, devant une discordance de ces dernieres et vu le caractere operateur dependant de l’echographie, la scintigraphie peut etre d’un apport considerable.

The cancerization of supernumerary breast is uncommon. So when this situation occurs, the diagnosis is often late. Cancers of ectopic breast tissue have been reported in the international literature, but to our knowledge, no cancer after excision of accessory breast gland has been published. This article describes a case of ectopic breast tissue cancer in axillary situation occurring several years after excision and details its specific diagnostic, therapeutic and prognosis.

International audience; The aim of this work is to define over the period 1979-2002 the main synoptic weather regimes relevant for understanding the daily variability of rainfall during the summer monsoon season over Senegal. "Pure" synoptic weather regimes are defined by removing the influence of seasonal and interannual time scales, in order to highlight the day by day variability of the atmospheric circulation. The Self-Organizing Maps (SOM) approach, a clustering methodology based on non-linear artificial neural network, is combined with a Hierarchical Ascendant Classification to compute these regimes. Nine weather regimes are identified using the mean sea level pressure and 850 hPa wind field as variables, and gathered into three classes. Two of these weather regimes represent the classical 3-5-day African easterly waves with a mean wavelength of about 3,000 km. Three others are characterized by a modulation of the semi-permanent trough located along the western coast of West Africa and might be interpreted in terms of the 6-9-day easterly waves. The last four weather regimes are characterized by a more or less strong north-south dipole of circulation. They can be interpreted as a northward/southward displacement of the Saharan Heat Low for two of them, and a filling/deepening of this depression for the other two. The circulation patterns of all these nine weather regimes are very consistent with the associated anomaly patterns of precipitable water, mid-troposphere vertical velocity, outgoing longwave radiation, and finally rainfall. Rainfall distribution is also highlighted over the southwestern area of Senegal.

The association of polymyositis and cancer was first described in 1916, the most frequent cancers being mammary and gynecological for women, bronchopulmonary for men and digestive for both. This article reports a severe paraneoplastic polymyositis associated with breast cancer. The authors discuss its clinical, pathological and therapeutic particularities.

The cancerization of supernumerary breast is uncommon. So when this situation occurs, the diagnosis is often late. Cancers of ectopic breast tissue have been reported in the international literature, but to our knowledge, no cancer after excision of accessory breast gland has been published. This article describes a case of ectopic breast tissue cancer in axillary situation occurring several years after excision and details its specific diagnostic, therapeutic and prognosis.

In to respect the principles of oncological surgery and to reduce the operative morbidity, the authors of this study propose to find the proper place of the laparoscopic-assisted vaginal hysterectomy in the surgery of endometrial carcinomas.Between the 1st of June 2002 and 31 of May 2005, we realize a retrospective and comparative study for 36 laparoscopic-assisted vaginal hysterectomy and 20 laparotomies concerning 56 patients.In primary stages (stages I and II of FIGO), laparoscopic assisted vaginal hysterectomy is as powerful as the laparotomy whereas in more advanced stages, laparotomy was more complete and effective (p=0,07). One conversion case was observed (2.8%) in a context of peritoneal carcinosis (stage IIIc). There was not statistically significant difference about the operatives complications (p = 0.51). On the other hand, the postoperative comfort was so far better in the laparoscopic-assisted vaginal hysterectomy group (p=0.0002). The average delay of followed without relapses was 22,3 months in the laparoscopic-assisted vaginal hysterectomy group versus 23 months in the laparotomy group (p=0.51).Considering these results, the authors retain that, in primary stages (I-II, FIGO), laparoscopic-assisted vaginal hysterectomy represents a real option in the surgery of endometrial carcinoma. On the other hand, the advanced stages should be reserved for laparotomy.

The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses.We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar.The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children.With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.