Current aspects of pediatric and adult tetanus in Dakar

OBJECTIVE: This retrospective study was undertaken to assess epidemiological and clinical aspects as well as outcome of tetanus cases in patients over 28 days of age, so as to issue recommendations. PATIENTS AND METHODS: This study included patients admitted to the Fann teaching hospital in Dakar from 2001 to 2003. Age, sex, portal of entry, clinical signs, delay from onset to admission, stage and outcome of the tetanus were recorded. RESULTS: 410 cases of tetanus were observed. The sex-ratio was 2.41. The mean age was 20 years [range 2 months-89 years]. Sixty-two percent of the patients were between six and 30 years of age. Most of the patients were workers and craftsmen (58%) or pupils (19%). A wound was the most frequent portal of entry (73%). Tetanus was localized in four out of 406 cases. The global mortality rate was 22%; but it was higher when tetanus was stage III and in case of complications. CONCLUSION: According to these results, it seems necessary to include booster doses in the Expanded Immunization Program, and to implement better prevention strategies targeting people not taken into account in this program. In addition, health care providers should check out the immunization status of their patients and accordingly offer an update or a full course of active immunization.     

Current aspects of Salmonella bacteremia cases in the Ibrahima Diop Mar Infectious Diseases clinic, Fann National Hospital Center (Senegal)

OBJECTIVE: The aim of this study was to describe epidemiological, clinical and bacteriological aspects of Salmonella bacteremia in the Fann university hospital infectious diseases clinic. PATIENTS AND METHOD: This study was carried out on data recorded between January 1, 1996 and December 31, 2003. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Research of strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Fifty five cases of Salmonella bacteremia were recorded as follows: S.Typhi bacteremia (32 cases), S. Paratyphi C bacteremia (4 cases), S. typhimurium bacteremia (9 cases), S. enteritidis bacteremia (32 cases) and S. spp bacteremia (8 cases). All the strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin+clavulanic acid and 90 % of them were susceptible to cotrimoxazole. Bacteremia occurred in 50 HIV infected patients (49%). Salmonella other than Typhi bacteremia were more often present in patients with HIV (81% vs 36% in patients without HIV infection) (P = 0.00001). The lethality rate was 42%. This rate was higher in patients with HIV (56 vs 23% in patients without infection) (P = 0.002). CONCLUSION: The lethality rate of Salmonella bacteremia is high, especially in AIDS patients. Therefore, priority must be given to prevention and chemoprophylaxis with cotrimoxazole should be a good way to reduce the incidence of bacteremia in AIDS patients.     

Plasmodium falciparum transmission blocking immunity in three areas with perennial or seasonal endemicity and different levels of transmission

Plasmodium falciparum transmission blocking immunity (TBI) was investigated in 3 different endemic areas. Reared Anopheles gambiae s.s. were experimentally infected with the blood of gametocyte carriers, either in the presence of autologous plasma (OWN) or after replacement of the OWN plasma with a nonimmune serum of AB blood group (control). Transmission reduction was defined by a lower level of mosquito infection in the OWN batch compared with the control. After controlling for the effect of gametocytemia, the proportion of "transmission reducers" was lower in the town of Yaounde in Cameroon (UC), (14%, N = 75) than in the two rural areas of South Cameroon (RC) (29%, N = 31) and Sénégal (RS) (44%, N = 32). The contribution of TBI relative to the total inhibition of the parasite development (including human, parasite, and mosquito factors) was higher in RS (49.6%) than in RC (12.6%) and UC (9.5%).     

Environmental lead exposure and its relationship to traffic density among Senegalese children: a pilot study

In Senegal, as in many developing countries, traffic density is increasing in urban areas; in Dakar more than 50% of vehicles use gasoline. Yet the extent and real magnitude of the problem has neither been recognized nor assessed in these countries. Systemic data assessment of lead pollution and people's exposure are not well known in Senegal. This study was also designed to determine the impregnation levels of the lead released by the exhaust of cars and the changes of some early biological markers in Senegalese children. Blood lead (BPb) levels showed that all the children enrolled were exposed. However, lead exposure levels (from 34.7 to 145.8 microg/L) were less important for children living in rural areas (60.9+/-18.3 microg/L) than for those living in urban areas (106.7+/-16.9 microg/L). These changes could be correlated to the difference in the automobile traffic between both these regions (P < 0.001). BPb mean levels found in boys were higher than those in girls (P < 0.05). Despite elevated BPb levels, all values for blood zinc protoporphyrin and urine delta-aminolevulinic acid were within physiological ranges. In addition, variations in some biological markers of oxidative stress and renal disorders were seen; however, they must be confirmed by a future epidemiological study.     

Management of children's fever at home in a rural area of Boko (Congo-Brazzaville)

A cross-sectional study on the diagnostic and therapeutic practices of health staff and mothers with regards to carrying for children's fever was carried out from February 27 to March 16, 1995, in the rural district of Boko. The sample was comprised of 630 children aged less than 5 years old, having suffered from fever within the past 15 days and who were treated either at home or in a local health centre with a drug most presently used against malaria. The results compiled from the responses to the questionnaire have shown that the most frequently cited symptoms by mothers are fever (57.8%), asthenia (51.7%), vomiting (10.6%), chills (7.3%) and diarrhea (7.3%). Chloroquine is the most utilised drug at home (61%) and anti-malaria injections are the most frequently used drugs in health centres (51.7%). The medicine is mainly supplied by public drugstores and pharmacies (47.8%) and street vendors (43.2%). Proper management of a fever requires adequate training of health staff and a good level of communication between health workers and their target populations.     

Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip

Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments: a medial compartment for the main tendon and a lateral compartment for the accessory tendon.     

The global campaign against epilepsy in Africa

One of the leading brain disorders in developing countries is represented by epilepsy. It is estimated that 80% of people suffering from epilepsy around the world, reside in developing world such as Africa. Many perinatal and postnatal causes are brain-stressers in people suffering from malnutrition and low economical conditions. This context is characterised by long delay before modern treatment, reduced number and financial inaccessibility to anti-epileptic drugs (AEDs) and limited human and technical resources for epilepsy. Cultural interpretation also contributes to exclude epileptic patients from the educational and productive fields, aggravating the burden they face and favouring a treatment gap estimated to 80%. To fight against this dramatic reality, a partnership has been built between the International League against Epilepsy, the International Bureau for Epilepsy and the World Health Organisation, named the "Global Campaign Against Epilepsy" "Epilepsy Out of the Shadows" to reduce treatment gap and social and physical burden, educate health personnel, dispel stigma, support prevention.