Study of oro-dental injuries during seizures in Senegalese children with epilepsy]

The objectives of this study were to study the prevalence of oral traumatisms and their relationship to epileptic seizures in Senegalese children. This study was undertaken in the Children's National Hospital of Dakar and deal with children with epilepsy. Sotf tissues and the teeth traumatisms that have occurred during epileptic seizures were recorded. We have also studied the relationship between the frequency of the seizures and the oral soft and hard tissues traumatisms. One hundred and eight children aged from 5 to 15 years with 67 boys and 41 girls with an average age of 8.16+/-2.86 years were enrolled. Several types of epileptic seizures were observed during which 44.5% of the children presented oral traumatisms of soft tissues (27.8%) and the teeth (16.7%). There is no significant relationship between the number of seizures and the frequency of the dental traumatisms (p = 0.352). The tooth fractures are the lesions most frequently noticed and are observed in 24.4% of the children. The traumatisms of the maxillary central incisors account for 38% of the traumatisms, followed by the canines (2.7%) and the molars (1.9%). The lower central incisors are the least affected. The traumatisms of soft tissues were observed in 27.8% of the children: the lips are more often affected (44%), followed by the tongue (30%), the association between lip and tongue (18%) and the cheeks (8%). There is no significant relationship between the number of seizures and the frequency of the traumatisms of soft tissues (p = 0.35).     

The dual role of necrostatin-1 in Parkinson’s disease models

Neuronal cell death is the main hallmark of Parkinson’s disease(PD).It is an irreversible process promoted by neurotoxins and/or genetic mutations.Different types of cell death have been associated with PD.The mechanisms by which neurons decide to specific type of cell death remain elusive.However,it is well known that cell death can be either programmed or not.Apoptosis is a programmed cell death that involves the release of cytochrome c from damaged mitochondria to cytosol and the activation of caspases leading to nuclear condensation.Necrosis is a caspase-independent cell death characterized by a gain in cell volume,rupture of plasma membrane and leak of cell contents,inflammation,and affects neighbouring cells.It was classified as a nonprogrammed cell death,but there are types of necrotic death triggered by a protein activation cascade,including necroptosis.     

Primary prevention with cotrimoxazole for HIV-1-infected adults: results of the pilot study in Dakar, Senegal

OBJECTIVES: To assess the efficacy and tolerance of chemoprophylaxis with cotrimoxazole compared with placebo among HIV-1-infected adults. DESIGN: Randomized, double-blind, placebo-controlled clinical trial in the urban community of Dakar, Senegal. METHODS: Eligibility criteria were age greater than 15 years, HIV-1 or HIV-1 and HIV-2 dual seropositivity, CD4 cell count lower than 400 copies/mm3, no progressive infection, no previous history of intolerance to sulphonamide, lack of severe anemia or neutropenia, and renal or hepatic failure. Written informed consent was obtained. Recruited patients received 80 mg of trimethoprim and 400 mg of sulphamethoxazole daily or a matching placebo. The main outcomes were survival and the occurrence of clinical events defined as Pneumocystis carinii pneumonia, cerebral toxoplasmosis, bacterial pneumonia, infectious enteritis, bacterial meningitis, urinary tract infection, bacterial otitis and sinusitis, and pyomyositis. RESULTS: Between September 1996 and March 1998, 297 patients were screened, and 100 were randomized in the study. Demographic, clinical, and biological characteristics of the two groups were similar as was the mean length of follow-up (7.7 months for the cotrimoxazole group vs. 8.0 months for the placebo group). There was no significant difference between the two groups in survival (hazard ratio = 0.84; 95% confidence interval [CI]: 0.36-1.94) in the probability of severe event occurrence, defined as death or hospital admission (hazard ratio = 1.10; 95% CI: 0.57-2.13), or in the probability of clinical event occurrence (hazard ratio = 1.19; 95% CI: 0.55-2.59). Adjustment for initial CD4 cell count did not change these results. A low dose of cotrimoxazole was tolerated well clinically as well as biologically; only one treatment interruption occurred as the result of a moderate cutaneous eruption (grade 2). CONCLUSION: Our study does not show a beneficial effect of chemoprophylaxis with low-dose cotrimoxazole on survival or occurrence of opportunistic or nonopportunistic infections for HIV-1-infected patients in Dakar, Senegal.     

Dynamic In Situ Cytometry Uncovers T Cell Receptor Signaling during Immunological Synapses and Kinapses In Vivo

Upon antigen recognition, T?cells form either static (synapses) or migratory (kinapses) contacts with antigen-presenting cells. Addressing whether synapses and kinapses result in distinct T?cell receptor (TCR) signals has been hampered by the inability to simultaneously assess T?cell phenotype and behavior. Here, we introduced dynamic in?situ cytometry (DISC), a combination of intravital multiphoton imaging and flow cytometry-like phenotypic analysis. Taking advantage of CD62L shedding as a marker of early TCR signaling, we examined how T?cells sense TCR ligands of varying affinities in?vivo. We uncovered three modes of antigen recognition: synapses with the strongest TCR signals, kinapses with robust signaling, and kinapses with weak signaling. As illustrated here, the DISC approach should provide unique opportunities to link immune cell behavior to phenotype and function in?vivo.     

Aspects cliniques et pronostiques des cancers du sein triple négatifs à l’unité de sénologie du CHU Le-Dantec de Dakar

Objectives

To determine the epidemiological and clinical characteristics, prognosis, and therapeutic modalities of triple negative breast cancer.

Patients and methods

It is a retrospective observational study of all cases of breast cancer with hormone receptors and HER-2 negative followed between April 2009 and March 2012. The following were studied: the sociodemographic characteristics of patients, the diagnostic features of triple negative breast cancer, and therapeutic modalities and outcome of followed cases. Data were entered and analyzed using SPSS software, version 19.0.

Results

Twenty-two patients were included. The rate was 33.8% of all breast cancers and 5.7% of breast pathologies recorded during the study period. The average age of patients was 45.4 years. The majority (63.6%) had less than 50 years. A proportion of 59.1% were premenopausal. The mean gravidity was 4 and mean parity 3.6. The mean delay for consultation was 11.1 months. The discovery of a breast mass was the reason for consultation in almost all cases (95.5%). Cancer was locally advanced in 86.3% of cases. Axillary lymph node involvement was present in 68.1% of patients. In 27.3% of cases, there were already secondary locations at the time of diagnosis. Infiltrating ductal carcinoma accounted for 86.4% of histological types. We found 68.2% of grade 3 tumors. In 59% of patients, the initial treatment was neoadjuvant chemotherapy. A clinical response was obtained in 61% of cases. Surgery in all cases was a mastectomy according to Patey-modified technique followed by axillary dissection. Three patients received radiotherapy. The mean time to recurrence was 16.9 months. This recurrence was observed in 27% of cases. The median overall survival was 25 months (from 21.1 to 28.8, CI 95%), and the median survival for metastatic patients was 16.5 months. The survival rate at 5 years was 41%.

Conclusion

This series shows a high frequency of triple negative breast cancer. These tumors are very aggressive with a very poor prognosis. In view of these results, collaboration with research teams in developed countries is needed to better identify triple negative breast cancer in Africa to improve prognosis.     

Evaluation of 4,672 routine prostate biopsies performed in six African countries

Purpose

Prostate cancer (CaP) is the leading cancer diagnosed in Sub-Saharan Africa (SSA). However, relatively little is known about the clinical detection of CaP in SSA. In order to evaluate CaP detection in SSA, we evaluated the outcomes of prostate biopsies under conditions of usual clinical care.

Methods

Retrospective data were collected from 4,672 Black African men, who underwent prostate biopsy in Gaborone, Botswana; Accra, Ghana; Dakar, Senegal Cape Town, South Africa; Wadmedani, Sudan; and Kampala, Uganda. Clinical and pathological characteristics were collected using medical records information for prostate biopsies that were undertaken during the period 2005–2011. Comparison groups of White South Africans (N = 398) who underwent prostate biopsy, and African American (AA; N = 117) and European American (EA; N = 975) men with prostate cancer were also obtained.

Results

Usual biopsy practices varied across SSA centers. The mean age at biopsy was 68.1 years (range: 25–100). The percentage of CaP identified was 11%, 36%, 43%, 48%, 87%, and 94% in Sudan, Senegal, South Africa, Ghana, Botswana, and Uganda, respectively. The Gleason scores 6 and 7 were predominant in Botswana, Senegal, and South Africa while the Gleason scores ≥ 8 were predominant in Sudan and Uganda. Compared to AA and EA, SSA and White South African men had substantially higher Gleason grade disease, and initial PSA at diagnosis was strongly associated with disease aggressiveness.

Conclusions

The knowledge gained from studies of prostate cancer in Africa may in turn improve our understanding of aggressive prostate cancer diagnosed anywhere in the world.     

Capacity building for the modified filarial hydrocelectomy technique in West Africa

To harmonise the technique of filarial hydrocelectomy throughout the West African subregion, training workshops were organized in 10 endemic West African countries involving surgeries on Filarial hydrocele patients (Filariceles). Countries included Ghana, Nigeria, Niger, Burkina Faso, Senegal, Mali, Liberia, Gambia, Sierra Leone and Togo. Patients were recruited by the Filariasis programme managers in all these countries and workshops were done to train surgeons from teaching, government and district hospitals with funding mainly from the West African Filariasis Project. A total of 16 workshops were held in 10 West African Countries, and a total of 500 filarial hydrocele/chylocele cases were operated using the technique of total tunical resection without drainage with excellent postoperative results. The average operating time for a unilateral hydrocele was 45 min to 1h and for bilateral hydrocele was 1? h to 2h depending on the size of the hydrocele .All patients were admitted for a minimum of 5 days postoperative. Training workshops were successfully organized in 10 out of the envisaged 12 west African Countries with 214 surgeons trained. Since 2004 till date the trained surgeons have also operated 2500 filaricele cases bringing it to a total of 3000 cases operated so far. Evaluation studies revealed that the infection rates in one country was initially 60% and then it later dropped to 20% and this was actually attributed to poor follow up by the selected National Coordinator. However complication rates in all the Countries where workshops were done ranged between 5% and 7% made up of infection, haematoma and or delayed wound healing. Recurrence rates have been very low about 3-5% per Country.     

Giant intradiploic infratentorial epidermoid cyst

Epidermoid cysts are benign, uncommon lesions (1% of all intracranial tumors). Their localization is intradiploic in 25% of cases, and exceptionally subtentorial. We report here a rare case of giant intradiploic infratentorial epidermoid cyst. A 74-year old patient presented with recent diplopia and sindrome cerebellar. CT scan and MR imaging revealed a giant osteolytic extradural lesion of the posterior fossa (5.2 cm x 3.8 cm) with a small area of peripheral enhancement after contrast injection. Retrosigmoid suboccipital craniectomy allowed a satisfactory removal of the tumor, followed by an acrylic cranioplasty. The outcome was good. Neuropathological examination confirmed an epidermoid cyst. We review the literature and discuss our case.