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Biomedical subjects

M Fall

Publications and source records attributed to M Fall.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Impact of antimalarial drug accessibility on malarial morbidity and chloroquine resistance. A study carried out in Touba (Senegal)].

In Touba, more important accessibility to antimalarial drugs and their uncontrolled use let to assure that the rate of malarial morbidity would be lower there than in other place in Senegal whereas the rate of chloroquine resistance would be higher. A checking survey of these assumptions has been carried out from october 15 to november 10, 1995 in Touba's health center. Among 227 feverish subjects investigated, 111 were Plasmodium falciparum carriers. Malarial bouts accounted for 48.9% of the feverish fits observed and for the major cause of consultation during the rainy season. These figures are higher than those usually observed in urban environment. Conversely, the rate of chloroquine resistance is lower than those observed in urban zones, since the therapeutic efficacy of chloroquine on Plasmodium falciparum was 100% in that survey.

Adolescent↗
PubMed1997

An evaluation of a nurse-led ear care service in primary care: benefits and costs.

BACKGROUND: Nurses trained in ear care provide a new model for the provision of services in general practice, with the aim of cost-effective treatment of minor ear and hearing problems that affect well-being and quality of life. AIM: To compare a prospective observational cohort study measuring health outcomes and resource use for patients with ear or hearing problems treated by nurses trained in ear care with similar patients treated by standard practice. METHOD: A total of 438 Rotherham and 196 Barnsley patients aged 16 years or over received two self-completion questionnaires: questionnaire 1 (Q1) on the day of consultation and questionnaire 2 (Q2) after three weeks. Primary measured outcomes were changes in discomfort and pain; secondary outcomes included the effect on normal life, health status, patient satisfaction, and resources used. RESULTS: After adjusting for differences at Q1, by Q2 there was no statistical evidence of a difference in discomfort and pain reduction, or differential change in health status between areas. Satisfaction with treatment was significantly higher (P = 0.0001) in Rotherham (91%) than in Barnsley (82%). Average total general practitioner (GP) consultations were lower in Rotherham at 0.4 per patient with an average cost of 6.28 Pounds compared with Barnsley at 1.4 per patient and an average cost of 22.53 Pounds (P = 0.04). Barnsley GPs prescribed more drugs per case (6% of total costs compared with 1.5%) and used more systemic antibiotics (P = 0.001). CONCLUSIONS: Nurses trained in ear care reduce costs, GP workload, and the use of systemic antibiotics, while increasing patient satisfaction with care. With understanding and support from GPs, such nurses are an example of how expanded nursing roles bring benefits to general practice. Nurses trained in ear care reduce treatment costs, reduce the use of antibiotics, educate patients in ear care, increase patient satisfaction, and raise ear awareness.

Adult↗
PubMed1997

[Tetralogy of Fallot. Anatomo-clinical, prognostic and therapeutic features].

Between Feb. 1992 and Aug. 1995 during a prospective study Tetralogy of Fallot (TF) has been diagnosed in 34 children among 207 with congenital heart disease (CHD). Our purpose is to assess prevalence of TF among CHD, to analyse clinical and paraclinical aspects in patients with TF and to point out associated abnormalities in that disease. In all patients diagnosis was made by echocardiography-Doppler (ATL MK 600). In our patients with CHD, TF represent the third abnormality encountered accounting for 16.49% after ventricular septal defect (30.9%) and persistent ductus arteriosus (18.8%). Mean age of patients with TF is 8.36 years. History showed cardiopathy in the family of one patient. The brother had persistent ductus arteriosus. In our patients with TF, clubbing is present in 70.58% of the cases, cyanosis in 79.41% and squatting in 76.47%. Anoxic spells are present in six patients. On chest x-ray mean cardio-thoracic ratio is 0.57 +/- 0.076. On ECG mean QRS axis is +121 +/- 22.91 degrees. In one patient with Cornélia Delange syndrome TF is associated with complete endocardial cushion defect. Mean follow-up is 332,42 days. Endocarditis on the pulmonary valves is present in one case. Four patients died after complications. Because of poor clinical tolerance and complications, surgery is indicated for all our patients. Only 7 patients underwent surgery. Two of them were operated in Dakar. There was two postoperative complications, one patient had brain abscess which necessitate reoperation, and the other had hypertension in the right ventricle and atrial right to left shunt. Our study shows that TF is an important nosologic group. In our country this frequent malformation have a poor prognosis in the majority of cases because late detection and frequent complications. Because palliative surgery for TF is now available in Senegal prognosis of the patients is going to improve. Future Development of open heart surgery will offer a corrective approach for patients with TF in Senegal.

Anemia↗
PubMed1997

[Complete D-transposition of the great vessels diagnosed late in a 10-month infant. Rashkind manoeuvre].

We report a first documented case in Senegal with simple transposition of the great arteries diagnosed in a 2 months old girl treated by Rashkind atrioseptostomy. Our patient benefited from clinical examination, ECG (15 derivations), chest X ray and standard laboratory tests. Pulsed-Doppler, two dimensional and TM echocardiography have been performed with an ATL MK 600 echocardiograph. Cardiac catheterism, angiocardiography and Rashkind procedure have been realized in our Department. These data are discussed and compared to the literature. At admission this patient presents with major cyanosis and polypnea. At examination, there is a 3/6 murmur at the left sternal border and a subclavicular continuous murmur. Laboratory tests showed metabolic acidosis and severe hypoxemia. Chest x-ray showed a cardio-thoracic ratio at 0.64 with increased pulmonary vascular markings. ECG showed right ventricular hypertrophy. Echocardiography-Doppler revealed ventriculo-arterial discordance with restrictive atrial septal defect and persistent ductus arteriosus. Rashkind procedure was followed by an increased aortic saturation. After 6 weeks there was an improvement of cyanosis and cardiac failure. Diagnosis of transposition of the great arteries is actually easier with development of ultrasonography which is useful when performed by experienced cardiologist. Spontaneous prognosis of this malformation is very poor. Rashkind atrioseptostomy is an important step for the initial treatment of transposition of the great arteries in terms of survival before open heart surgery.

Cardiac Catheterization↗
PubMed1997

[Newborn infant with macrosomia: etiologic factors and perinatal complications].

A retrospective study conducted between january 1st and december 31st 1993 allowed for the identification and comparison of 100 cases of new born with macrosomia accounting for 1.34% of birth. Males constitute the majority of those cases (60%) and the average weight found is 4212 g. Foetal complications are in the main made of lesions of the brachial plexus (9%). Hypoglycemia is found in 4% of cases. These complications are more frequent in forceps assisted deliveries or cesareans (P < 0.05). Obesity (20%), Fat child related past history (15%), Maternal diabetes (5%) are the most common risk factors. We therefore advocate a more effective prevention of foeto-pelvic disproportions through a close supervision of pregnancy among women at risk.

Adult↗
PubMed1996

Positive ice-water test: a predictor of neurological disease?

The urinary bladder is equipped with a reflex system including cold receptors of the bladder wall and having reflex pathways partly separate from the normal micturition reflex. The ice-water test involves cooling of the bladder wall with ice-cold saline solution. In the neurologically intact adult the test is negative. A positive test indicates overt or occult neuropathy. In this report, examples are given of patients presenting with bladder symptoms and a positive test but initially lacking signs of a neurological condition. During follow-up, various neurogenic diseases appeared. It is suggested that a positive ice-water test may represent a negative prognostic urodynamic sign along with a potential risk for neurogenic disease to come.

Adult↗
PubMed1996

Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurements.

A group-comparative study to assess pelvic floor muscle function using vaginal cones, vaginal digital palpation, and vaginal pressure measurements in 30 women suffering from genuine stress urinary incontinence and in an age-matched group of continent women was undertaken. Vaginal digital palpation score and vaginal pressure during active contraction were greater (p < 0.001) in continent women (1.9 +/- 0.1 and 8.6 +/- 0.7 cm H2O, respectively) as compared with incontinent women (1.0 +/- 0.1 and 4.1 +/- 0.4 cm H2O, respectively). Continent women were able to retain a vaginal cone of greater weight (6.3 +/- 0.4; n = 9, weight ranging from 10 to 90 g) than women suffering from stress incontinence (4.7 +/- 0.5; p < 0.001). There was a better correlation between all three techniques of assessing pelvic floor function in continent as compared with incontinent women, especially in the comparisons involving vaginal cones. (Vaginal pressure measurement-vaginal digital palpation, r = 0.86/0.75; vaginal pressure measurement-vaginal cones. r = 0.57/0.10; vaginal digital palpation-vaginal cones, r = 0.60/0.18.) In some women, especially those with incontinence, heavy cones were retained in spite of a weak pelvic floor due to the transverse position of the cone in the vagina which was verified radiographically.

Adult↗
PubMed1996

[Congenital heart disease surgery in Senegal. Indications, evaluation and perspectives].

In Senegal, congenital heart diseases (CHD) raise important issues. Their late detection makes more complicated the non yet resolved issue of the medico-surgical care. 108 patients with congenital heart diseases have been studied prospectively from February 1992 to May 1994. Epidemiological, clinical, paraclinical data are analysed. Prognosis and treatment are discussed. Congenital heart diseases represent 1% of the outpatient cardiovascular pathology. Diagnosis of the malformation based on echocardiography shows that most of congenital heart diseases are ventricular septal defect (25%); followed by Tetralogy of Fallot (13%). Average age of the patients is 6.86 years. 31% of the cases have heart failure. ECG is abnormal in 103 patients. On the radiologic side, average cardio-thoracic ration is 0.61. Because of heart failure, pulmonary hypertension and hypoxia, the spontaneous prognosis is cautious in 71 patients (66%) who should receive surgical treatment. Among them, 5 patients non operated died and 10 (14%) have been operated. Among the 10 patients who got surgery, 3 with wide persistent ductus arteriosus got in Dakar. All these patients have excellent operative results. In Senegal, only close heart surgery is available and prognosis of the vast majority of patients, including those with valvular and coronary heart diseases, is very cautious. Intervention of Europe-based aid organizations for evacuation is not useful. It is very important to promote, in Senegal, open heart surgery.

Adolescent↗
PubMed1996

[Rupture of a sinus of Valsalva aneurysm into the right ventricle. A case report in the cardiology clinic at the University Hospital Center of Dakar].

We report a case with ruptured aneurysm of the sinus of Valsava into the right ventricle, diagnosed during heart failure in a 22 years old patient. Etiology and prognosis based on our observation and the literature are discussed. Our patient benefited from clinical examination, ECG (15 derivations), pulmonary X ray and standard laboratory test. Pulsed-Doppler and contrast echocardiography have been realized with an ATL MK 600 echocardiograph. These data are discussed and compared to the literature. Cardiac examination revealed a continuous murmur predominantly diastolic 5/6 and an increase of peripheral artery pulsatility. Chest x-ray showed cardiomegaly and ECG bilateral atrial and left ventricular hypertrophy. Two-dimensional echocardiography revealed the diastolic prolapse of an aneurysmal right coronary sinus in the right ventricle. The rupture was confirmed by contrast echocardiography and pulsed-Doppler. Rupture which is a major complication of aneurysm of the sinus of Valsava, is the usual feature of detection. The consequences of rupture are heart failure and pulmonary edema. Our observation shows that conventional Doppler and contrast echocardiography are important for diagnosis and follow-up of aneurysm of the sinus of Valsava. Aortography, hemodynamic and angiocardiographic data, are also important for a precise diagnosis and the detection of associated malformations when pre-operative investigations of aneurysm of the sinus of valsava are needed.

Adult↗
PubMed1995

Toward a new classification of overactive bladders.

Based on a large retrospective series, this study compares the International Continence Society's (ICS) classification of overactive bladders and a functional subtyping of our own, founded on clinical and urodynamic parameters. Functionally identical symptoms and urodynamic patterns were found within the Detrusor Hyperreflexia as well as the Unstable Detrusor categories. There are strong arguments for a revision of the current ICS classification system.

Adult↗
PubMed1995

The ice-water test in the diagnosis of detrusor-external sphincter dyssynergia.

The ice-water test (IWT) implies rapid intravesical infusion of 100 ml of sterile ice-water during continuous pressure measurement and registration of fluid leakage. In a typical positive test, there is fluid leakage around the catheter(s) during the peak of detrusor contraction elicited by cold stimulation. Seventy-six patients, the majority with different forms of spinal disorders and a clinical and urodynamically suspected detrusor-external sphincter dyssynergia, were subjected to cystometry, needle electromyography (EMG) and an ice-water test. Detrusor-external sphincter dyssynergia was found in 44 (59%) patients and 41 of them had a positive IWT. A positive test with a high detrusor pressure indicates detrusor-external sphincter dyssynergia whereas the contrary applies to the negative test. Eighteen patients who responded to cold stimulation with detrusor contraction but without fluid leakage, called positive non-leakage IWT, all presented detrusor-external sphincter dyssynergia according to EMG. In this situation, the cheap, non-invasive and simple IWT can replace a needle EMG study.

Adolescent↗
PubMed1995

Clinical and urodynamic effects of intravesical capsaicin treatment in patients with chronic traumatic spinal detrusor hyperreflexia.

PURPOSE: We administered capsaicin, a neurotoxic substance causing a reversible suppression of C fiber afferent neuronal activity, in an attempt to decrease bladder hyperreflexia. MATERIALS AND METHODS: Capsaicin solution (2 mM.) dissolved in 30% alcohol was instilled into the bladders of 10 men with traumatic chronic spinal lesions and left in place for 30 minutes. Effects on bladder function, including response to cold stimulation, were recorded during treatment, immediately after instillation and at followup. RESULTS: Bladder function improved in all but 1 patient, which was expressed as an increase in cystometric capacity and/or a decrease in maximal detrusor pressure. The effects lasted for 2 to 7 months. Immediately after capsaicin administration the ice water test was negative in half of the patients. CONCLUSIONS: The positive effects on bladder function of capsaicin treatment can be explained by the blocking of C fiber afferents. The optimum dose and treatment interval are presently not established. The ice water test might possibly be used as an instrument to monitor the ideal dosage.

Adolescent↗
PubMed1995

Vaginal wall bipedicled flap and other techniques in complicated urethral diverticulum and urethrovaginal fistula.

BACKGROUND: Repair of a urethral diverticulum in females may be a rather simple operation or it may represent an operative challenge, depending on the site of the lesion and previous treatment. Thirty women operated upon during a 15-year-period and with a variety of complicating factors, such as proximal location of diverticula or the presence of a urethrovaginal fistula, were reviewed. A new procedure using a transverse bipedicled vaginal flap to cover the urethral repair was used routinely. STUDY DESIGN: The long-term results were evaluated by clinical, endoscopic, and urodynamic methods. A follow-up postal survey was obtained reporting the presence of urethral pain, incontinence, frequency of micturition, postoperative sexual complaints, and subsequent operations. RESULTS: Repeated operations were rather common. The end result of operative repair was satisfactory in all but three patients, two of whom underwent multiple operations (four and seven times, respectively). These patients were left with residual symptoms of incontinence and recurrent urethral syndrome. However, the majority of patients who were operated upon repeatedly were cured. One patient who had impaired detrusor contractility had a relative urethral stricture. CONCLUSIONS: The successful treatment of complicated diverticula and fistula requires some basic technical steps during repair. When recurrence develops, it is important to interpret carefully urethral pressure profiles, cystometry, and other functional tests.

Adult↗
PubMed1995

[Congenital cardiopathies: anatomo-clinical, prognostic, and therapeutic features apropos of 103 cases seen at the Cardiology Clinic of the Dakar University Hospital Center].

We have studied retrospectively 103 patients with congenital heart disease from july 1989 to december 1991. The mean age is 7.8 years +/- 8.6. Epidemiological factors, clinical, morphological and prognostic data have been reviewed. All the patients had been evaluated with echocardiography based on an anatomical and segmental approach. Sex-ratio is 1.11. Situs is solitus in 101 cases (98%). Atrio-ventricular connexions are concordant in 97 patients (94%). The ventriculo-arterial connexions are concordant in 91 patients (88%). We found an anomaly of the spatial relation between great vessels in 9 cases (8.7%). Echocardiographic diagnosis have been confirmed by catheterism and at surgery in 10 patients, and by post-mortem examination in 2 cases. Isolated ventricular septal defect is the most frequent anomaly (19.4%), followed by Tetralogy of Fallot (17.5%). Only 13 patients among the 75 (17.3%) needing surgery have been operated. Six patients (5.8%) died following complications of the malformation. The prognosis without surgery is poor for the majority of our patients with congenital heart disease. Improved early detection and acquisition of adequate diagnosis technology are needed to realize surgical corrections.

Adolescent↗
PubMed1994

Positive bladder cooling test in neurologically normal young children.

The bladder cooling test, which consists of rapid infusion of 0 to 8C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children 6 months to 13 years old. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test was positive during the first 4 years of life but typically negative in children older than 5 years. These findings indicate that a positive bladder cooling test is an infant reflex response that, with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.

Adolescent↗
PubMed1994

Pressure, volume and infusion speed criteria for the ice-water test.

OBJECTIVE: To define pressure, volume and infusion speed criteria for the ice-water test (IWT). PATIENTS AND METHODS: In this prospective clinical study, cystometry and IWTs were performed in 115 patients. RESULTS: The critical response for a positive IWT was found to be a peak detrusor pressure above 30 cm H2O, with or without fluid leakage. Neither the infusion speed nor the infused volume was critical for the outcome of the test provided that the bladder wall was sufficiently cooled. CONCLUSION: The IWT is a rapid, simple and robust test, whose results are easy to interpret. The test increases the precision of urodynamic diagnosis, especially in patients with an overactive detrusor dysfunction, at a small cost.

Administration, Intravesical↗