La tuberculose péritonéale: étude rétrospective de 61 cas à l’hôpital Principal de Dakar

Aims

To describe the characteristic features (epidemiological, clinical, paraclinical, therapeutic and evolutive) of peritoneal tuberculosis in Senegal.

Patients and methods

Retrospective study, which included all cases of peritoneal tuberculosis identified at Principal hospital in Dakar between the 1 January 1996 and 30 June 2006.

Results

Sixty-one cases of peritoneal tuberculosis were included in ten years and six months. The mean age of patients was 36 years, and the sex ratio was 0.9. Ascites associated with fever was the most common symptom. The ascitic fluid was exudative in 92.4% and lymphocytic in 90.5%. Peritoneal tuberculosis was isolated in 70.5% of cases and associated with pleural effusion in 21%, lung involvement in 13% and liver involvement in 3.2%. The HIV was positive in 4.5% of patients who were tested. The definite diagnosis was based on laparoscopy associated with peritoneal biopsy showing granulomatous lesions in 70% of cases. The outcome was favourable in all cases after antituberculous therapy.

Conclusion

Peritoneal tuberculosis occurs in young adult with a discrete female predominance in this series. It must be suspected in the presence of any lymphocytic and exudative ascites associated with fever. The definite diagnosis is based on laparoscopy with peritoneal biopsy. The outcome is generally favourable with antituberculous treatment.     

Limit of root canal obturation by gutta percha compaction technique in single rooted teeth. Clinical data apropos of 168 canals]

After the introduction of the lateral compactage of gutta percha in endodontic clinic of OdontoStomatology Institute of Dakar in 1995; the immediate evaluation of the quality and the limit of the canal obturation due to a prospective study on 157 monoradicular teeth so be 168 canals (11 supplementary canals) has shown that 75% of canals are of type I of Vertucci and that the apical limit of security is reached within 80.25% of cases. The manual step back canal preparation (79.17%) and the technique of canal obturation by lateral compactage of gutta percha [(64.88%); Apical limit of security: 59.52%] permit to obtain a densities (95.83%) and homogeneous (79.57%) canal obturation. The indication of gutta percha compactage on monoradicular teeth (hermetic and tridimensional root canal filling) must avail to apical curved roots of lateral incisive, the use of adapted instruments in case of canines (31 mm) and apical stop cone on necrotic pulp teeth.     

Thrombose veineuse et occlusion artérielle bilatérale des membres inférieurs révélant une infection par le VIH

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/mm³. Investigations on coagulation were not realized. The patient was amputated both his legs.     

Management of Acute Postpartum Hemorrhage in Senegal

In Senegal, maternal mortality is 222.9 per 100,000 live births. Acute postpartum hemorrhage (PPH) complicates 3.1 % of all births, 44.2 % of direct causes of maternal deaths, and 33.6 % of all maternal deaths. Major causes include uterine atony, trauma, coagulation disorders, and total or partial retention of the placenta. A newer technique to address acute postpartum hemorrhage is the use of the condom balloon catheter. In Senegal, prevention means following the World Health Organization (WHO) recommendation of active management of the third stage of labor for all women in labor. This practice necessitates close collaboration of a multidisciplinary team comprising obstetricians, midwives, anesthetists, radiologists, and biologists. Obstetric care should be conducted simultaneously with resuscitation.     

Lower levels of the circulating neuropeptide somatostatin in Schistosoma mansoni infected patients may have pathological significance

In recent years, cases of severe morbidity (fibrosis, haematemesis, hepatosplenomegaly, ascites) caused to Schistosoma mansoni infections are on the rise in Northern Senegal. The neuropeptide somatostatin is reported to decrease portal pressure, control variceal bleeding and fibrosis, and reduce Schistosoma-caused clinical morbidity in the rodent model. The aim of this study was to delineate the role of somatostatin in S. mansoni-caused pathogenesis, by studying host levels of somatostatin in the peripheral blood of uninfected and S. mansoni-infected individuals. Subjects from the district dispensary at Richard Toll, in the Medical Region of Saint-Louis, Senegal, infected with S. mansoni and suffering from severe morbidity were selected. A separate group consisted of individuals resident in the same region but uninfected at the time of the study. Significantly lower somatostatin levels were detected in severe morbidity patients, compared with the exposed but uninfected subjects. In patients with schistosomiasis physiological levels of somatostatin may determine disposition of particular individuals towards severe morbidity, as opposed to others. Host pathology can thus be alleviated by the therapeutic ability of somatostatin to treat bleeding oesophageal varices, reduce portal pressure and prevent progression to severe fibrosis.     

Insulin therapy in childhood type 1 diabetes: Knowledge and practice in Senegal

IntroductionChildhood type 1 diabetes (T1D) is a chronic condition with serious repercussions on both the quality of life of the child and the family. Insulin therapy is the cornerstone of optimal blood sugar control. The main objective of our study was to assess the level of knowledge of physicians about insulin therapy in diabetes.MethodsThis was a multicenter survey over a period of 5 months (from March 5 to August 2, 2018). It took place in five reference university hospital centers in the Dakar region.ResultThe number of doctors interviewed in our study was 82, 47.6% of whom were confirmed pediatricians or pediatricians in the process of specialization. The number of years of experience in the field of diabetes was on average 3 years. Fast-acting regular insulins were recommended by 75.6% of doctors and mixtures of insulin (intermediate and rapid-acting) by 50% of doctors. Overall, 91% of doctors recommend a variation in insulin injection sites. The “basal bolus” treatment regimen with insulin analogs was recommended by 50% of doctors, while 31.7% recommended it with human insulin. Regarding adapting insulin doses for leisure and sports activities, more than half (54.9%) of the doctors had to reduce the doses.ConclusionThis study enabled us to assess the level of knowledge of insulin therapy among doctors caring for children with diabetes in Senegal, which proved to be limited. We recommend the reinforcement and follow-up of training on the management of T1D for providers at the different facilities.