Is it necessary to conduct trials with trimethoprim-sulphamethoxazole amongst HIV-infected individuals in Africa?
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Biomedical subjects
Publications and source records attributed to M Badiane.
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In order to describe the presenting features at diagnosis and complications of hemophilia in Dakar, we conducted a study of hospital records between October 1991 and January 1993. Twenty-five cases of hemophilia were identified. We found that only 4% of our patients were diagnosed in the first 6 months of life whereas 64% of patients were diagnosed between 6 months and 5 years of age, 32% were detected between 5 years and 14 years of age. The presenting feature at diagnosis was external bleeding in 60% of cases and internal bleeding in 40%. 92% of cases were hemophilia type A and only 8% hemophilia type B. 56% of patients had mild hemophilia, 40% moderate and only 4% severe disease. Hemophiliac arthropathy was present on radiography in 76%. Complications were dominated by repeated joint bleeding, which was present in 92% of patients, and repeated hematomas (80% of patients). A functional handicap was present in 60% of cases. 12% of transfused hemophiliacs developed an inhibitor and 4% of patients were HIV positive. Greater awareness of hemophilia amongst the medical community as well as continued efforts to improve care for hemophiliacs in Senegal are necessary.
AIMS: Study of Diabetic arteriopathies Arteriopathies in cervico encephalic arteries and lower limbs were detected both with Echography and Doppler flow velocity waveform analysis from 60 treated patients. They were shared into 34 women (57%) and 26 men (43%). Patients age varied between 39 and 77 years. 85% were non insulin dependent versus 15% insulin dependent patients. 36 patients (60%) presented arterial abnormalities, 14 of which (23.33%) were located in the lower limbs, 19 (31.66%) in the carotid arteries, and 3 (7%) in both carotid arteries and the lower limbs. Arteriopathies were found in medium aged patients (40-60 years). Arteriopathies are often noted in medium aged diabetics. The prevalence of lesions were relatively higher in supra-aortic trunks (36%) than in lower limbs arteries (28%). They are distal in lower limbs and constitute a factor of diabetes prognosis. The sensitivity and the less expensive cost of ultrasonor methods give a first choice to these technics in the patients following up and prevention of vascular complications of diabetes in Africa.
Amoebic liver abscess is the most frequent location of the extra-intestine amibiasis with an epidemio-endemic repartition in our areas. We are reporting in this study the main echographic patterns that can be found. 117 documents were collected and studied between 1982 and 1988 in the main hospitals of Dakar (SENEGAL). Most of the patients were young, the range of age being between 25 and 55 years old and 83% of them, were male. The diagnosis of the amoebic liver abscess was evocated on the basis of the following clinical and biological symptoms: 54.38% of painful haetomegaly, 42.10% of pleuro-pulmonary and digestive signs, 3.50% of long lasting isolated fever, non specific biological sign of inflammation, 74.57% of positive hemaglutination test. An echographic test was performed before the anti-parasitic treatment with an echotomograph PHILIPS SDR 1500 in real time using a probe of 3 MHZ. The amoebic abscess of liver was detected by the echography in all cases. The unique abscess (83.10%) was the most frequent form. It was localized in the right liver (64%) and had an heterogeneous echostructure (55.70%). The hypo-echogeneous form (36.50%) was the earlier stage of the collecting abscess. The liquid form (07.80%) was observed in the latter stages of the disease. Some difficulties to determine the amoebic abscess may appear when primitive liver cancer or pyogensus abscess are present. In these cases it is necessary to analyse the liquid of ponction to be affirmative.
Because of frequency and seriousness of myelo radicular complications of narrow lumbar canal, the authors studied its radiological and anatomical measurements in order to specify the standards for senegalese negro african. For that purpose, they collected samples of 21 lumbosacral spines from new cadavers through medico legal necropsies. Pieces have been first X rayed, then treated. They measured the antero posterior diameter of vertebral corpse, the anterio posterior diameter of vertebral canal, the narrowest transversal diameter of vertebral corpse and the inter pedicular distance. The authors found no significant differences between radiological and anatomical measurements, but the latest changed from one stage to another. The variations also were not important comparatively to standards established by two authors.
In a single case review the authors recapitulate the different methods for the presentation of sacro-ilial infectious and underscore imagery techniques which are of prime importance in diagnostic work. X-rays can only reveal advanced sacro-ilial bone joint lesions which are under-evaluated. In the absence of HI-Tech imagery, surgical biopsy must be widely recommended to identify the germ and allow early diagnosis.
Fourteen cases of spinal meningiomas were reviewed. There were 5 males and 9 females, with an average age of 40 years who underwent surgical treatment at the Neurosurgical Division of Dakar University Teaching Hospital. The thoracic spine was involved in 10 cases. The location of the tumor in the spinal canal was epidural in 6 cases and subdural in 8 cases. 7 patients (50%) had marked improvement or stabilization: 4 patients died and in 3 cases, a recurrence was noted. The authors emphasize diagnostic difficulties encountered in the epidural forms.
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This report covers the first case of Seckel's syndrome diagnosed at Dakar UHC. It concerns the main type of bird head nanism. The interesting thing about this observation is that it is associated with hepatoma. Would this be just a coincidence, or could the two afflictions be connected?
This study draws on 48 Asthma files of which 68.7% were of allergic origin, and has led to the following conclusions: Ketotifene is particularly active on mainly allergic asthma, and 72.7% of the results obtained were good. the younger the asthma, the more effective the product effectiveness is greater where the sickness is recent and the patient not on medication the economy in corticoids is significant: 60% on average, it can attain 100%. On the other hand, the medicine has little effect on mainly non-allergic asthma, such as infectious asthma, late asthma and the recurrence of former asthma, all difficult to treat. One author stresses that results improve as etiological factors diminish. While awaiting the fruit of progress and research in providing other medicine to conclusively conquer asthma, Ketotifene constitutes a new, choice weapon for the therapeutic arsenal ranged against the causes of this sickness.
A case of systemic sclerodermy mainly affecting the lungs is presented. For a long time the diagnostic was incorrect. The case is all the more interesting since the patient had worked in iron mines and unproved pneumoconiosis had been diagnosed. Treatment basically with corticotherapy and oxygenotherapy, with D-penicillamine added, produced a satisfactory outcome to the attack and definite improvements in the cutaneous lesions.
Systematic, non-suppurate, acute pneumopathies (PANSS) or acute, clear-cut, lobary pneumonia (PFLA) constitute a pathology in babies aged 0-1 years. The clinic found 83.3% of these little patients to be feverish, dyspneic and suffering from a dry cough. 85% of the cases presented the alveolary filling syndrome with acric bronchogramme. After a 3 day apyrexy period on penicillin, the evolution was favourable in 83.4% of the cases.
In neuro-paediatry, echography is one of the easiest examinations to conduct. It is one of the most bearable, least traumatic and most informative. Furthermore, by utilizing the fontanelle window, brain structure can be discerned. In the light of these 75 observations, the authors establish echo-anatomical correlations and diagnostic strategy.
Echography must, henceforth, be considered a method of investigation in Scrotum pathology. It is certainly of interest for diagnosis and close supervision of this pathology--this is the recommendation of the authors following 46 observations correlating echographical aspects with anatomopathological results.
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The high rate of pleuropulmonary afflictions in children makes this pathology a daily concern for the practitioner in both industrialized and developing countries. This study concerns 150 patients aged between 0 and 15 years admitted to the Infectious Illnesses Unit at Dakar (Fann) U.H.C. between January 1st, 1985 and December 31st, 1987. The following observations are made: in this Unit, a morbidity of 1.7% has been recorded for pleuro-pneumopathies, which occur throughout the year with high points in January and during the rainy season; the 0-5 year age group is the most affected, with a sex ratio of 1/2 for males; hospitalization, which can be long, averages 8 days; a combination of measles and whooping cough, present in 36.6% of the cases, provides a prime breeding group for pleuro-pneumopathies; in 77% of the cases, recovery requires at least 20 days, partly because of delay in consultation. 10% require more than 30 days; the small proportion of patients vaccinated (14% completely treated) underlines the need for publicity and mass health education. Clinical polymorphism is normal; however, 80% of the children were found to be hyperthermic while (only) 6% show a productive cough. From a radiological point of view, suppurated afflictions are the most numerous, with a majority of alveolar or mixed attacks. Treatment produced generally satisfactory results in 83.7% of the cases.