Pleuropulmonary manifestations of amebiasis

Amibiasis is the third leading cause of death due to parasitic infections in the world. Amibiasis is endemic in the warm regions of the world with deficient hygiene and socio-economic situations. Entamoeba histolytica is the causal agent of invasive amibiasis, unlike Entamoeba dispar which is not a pathogen for humans. Amibian colitis and amibian abscess of the liver are the most frequent intestinal and extra-intestinal manifestations. Pleuropulmonary complications almost always occur in patients with a liver abscess, the intrathoracic contamination via transphrenic dissemination predominating. Respiratory signs are inaugural in 80% of the cases. Pleuropulmonary ambiasis designates the localization of the amibian infestation, but the clinical expression may vary: pneumonia, lung abscess, pleurisy, hepatobronchial fistulization and more infrequently pulmonary embolism. The preferential localization is the right hemithorax related to abscess in the right lobe of the liver. Left lobe abscesses lead to left-sided pleuropulmonary complications with the risk of rupture into the pericardium. Chocolate-colored pus from a pleural or abscess puncture or vomitus strongly suggests the diagnosis, which is confirmed by highly-positive serology. Metronidazole is the treatment of choice, providing cure without sequellae. In Africa, mortality and morbidity due to ambiasis are high. In Abidjan, 92% of cured patients have sequella, and mortality reaches 15%, the consequence of late diagnosis.     

La pathologie malformative de l’ouraque: A propos de 12 cas colligés au service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar,Sénégal

Objectivesto report the epidemiological aspects, diagnosis and treatment of urachal anomalies.Patients and methodsWe conducted a retrospective study in Pediatric Surgery department of Hospital Aristide Le Dantec for a period of 15 years. The parameters studied were the prevalence, sex, age, reason for consultation, clinical, paraclinical, treatment, hospital stay and evolution of urachal anomalies.ResultsWe collected 12 cases of malformative diseases of the urachus, for a prevalence of 0.8 cases/year. Our sample consisted of seven boys and five girls with a sex-ratio of 1.4. The mean age was 1.6 years. We noted a predominance of fistulas of the urachus with 8 cases. Drainage of fluid from the umbilicus was the most common sign in 8 cases. Fistulography was requested for two patients and confirmed the diagnosis of fistula of the urachus. In other cases the diagnosis was made intraoperatively. Surgical treatment was performed in 10 patients and consisted of a laparotomy followed by resection of urachal tissue including a collar of the bladder dome. one case was observed for regression of symptoms. After a mean of 6 months the evolution was marked by the occurrence of an evisceration of infectious origin, three cases of wound infection and two deaths.ConclusionsAnomalies of the urachus are rare in our service. The male is most affected. Drainage of fluid from the umbilicus is the most common sign. Ultrasound should be systematic in the preoperative evaluation and treatment should be surgical.     

Flaccid paraplegia revealing an adenoma of Conn: a case report

We report the case of Conn's adenoma in a 36-year-old woman, revealed by low extremities weakness. The patient had hypertension at 170/90 mmHg. Her initial potassium level was low i.e., 1.5 mmol/L. The diagnosis, confirmed by hormonal investigation, showed an elevation of plasma aldosterone and lower plasma renin activity. Abdominal MRI revealed a lesion in left adrenal gland, measuring 1.8 cm in diameter and taking contrast in periphery, compatible with an adrenal adenoma. The patient underwent a left laparospic adrenalectomy and microscopic examination confirmed the diagnosis. The postoperative course was uneventful with normalization of serum potassium level and blood pressure.     

Prevalence and determinants of hypertension and associated cardiovascular risk factors: data from a population-based,cross-sectional survey in Saint Louis,Senegal

Background

The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population.

Methods

Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometric measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3.

Results

The prevalence of hypertension was 46% (95% CI: 43.4–48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001).

Conclusion

We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.     

Hépatotoxicité tardive à l’imatinib chez une patiente de 44 ans

Imatinib mesylate is currently used in the treatment of chronic myeloid leukemia (CML), advanced gastrointestinal stromal tumors, and Philadelphia chromosome-positive acute leukemia. Hepatotoxicity is a rare but potentially serious complication of treatment with imatinib.We report the case of a 44-year-old woman treated by imatinib mesylate (Gleevec®) for CML who was admitted to our institution with severe acute hepatitis two years and nine months after the initiation of treatment. The outcome was favorable after stopping the drug, with normalization of serum aminotransferase activity after 6 months. It is recommended that liver function is regularly monitored during treatment with imatinib. With the ascencion of liver function tests, treatment should be discontinued.     

4e Conférence internationale sur les envenimations par morsures de serpent et piq?res de scorpion en Afrique : Dakar, 25–29 avril 2011

The authors present a summary of the proceedings and the recommendations of the Fourth International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, held from 25 to 29 April 2011 in Dakar. After a two-day workshop for Senegalese health personnel on the most relevant aspects of the management of envenomations, about 270 participants met to share their experiences in the field. Nearly a hundred oral and poster presentations were made on the epidemiology of snakebites and scorpion stings in Africa, the composition and action of venoms and the manufacture and use of antivenoms. The last day was devoted to an institutional debate involving experts, representatives of national health authorities and concerned professionals (physicians, pharmacists, nurses and traditional healers) as well as members of the pharmaceutical industry to discuss and elaborate a set of recommendations. It was agreed that it is necessary to improve knowledge of the epidemiological situation by case reporting. Quality control of antivenoms and procedures for their registration at the level of national health authorities should aim at improving the distribution of safe and effective antivenoms in peripheral health centers for the better assessment of victims. It was also recommended that adequate training should be provided for health personnel in all aspects of medical management of envenomations. Equitable distribution of funding and the establishment of a network of African experts were also discussed in the conference.