Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Objectives: To assess the clinical particularities and management of Graves’ disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients’ attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves’ disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.

Colorectal Cancers in Mauritania: Clinical Aspects and Treatment

The aim of our study was to determine epidemiological, clinical and therapeutic profile of colorectal cancers in Mauritania. Patients and Methods: It was a retrospective multicentric study conducted over 5 years in Nouakchott National Hospital Centre and in private clinics of Mauritania. All cases of colorectal cancers histologically confirmed were included. The Astler and Coller classification was used to classify lesions by level of extension. Results: 225 patients were included with a sex ratio (M/F) of 1.39, an average age of 52.3 years. Location of the lesion was rectal (37.7%) and colonic (62.3%). Clinical manifestations were dominated by rectal bleeding (26.9%), occlusive syndrome (16.5%) and transit disorders (11.6%). Endoscopic lesions were of stenosing (45.2%), ulcero-burgeoning (39%), ulcerous (7.5%) and burgeoning (4.7%) types. Histological profiles were adenocarcinoma (88.9%), carcinoma (3.1%) and lymphoma (2.6%). The work-up for extension revealed metastasis in 33.6% of cases. These were stage B (49%) and C (36%) among the 95 cancers that received the Astler and Coller classification. The treatment was curative (80.83%) and palliative (19.16%). Conclusion: Colorectal cancer is a reality in Africa. However, its diagnosis still remains delayed, which increases the prognosis, hence the need to promote screening tests.

Cardiothyreosis: Risk Factors and Clinical Profile

Introduction: The diagnosis of cardiothyreosis is based on the presence of the association of thyrotoxicosis and various cardiovascular disorders such as heart failure, coronary artery disease, rhythm or conduction disorders. Data are limited on this entity in Africa which a frequency of 10% to 33% among hyperthyroidism. We aimed to evaluate these risk factors and describe its diagnostic features in Abass Ndao Hospital Center of Dakar. Patients and Methods: It was a descriptive and analytical cross sectional study conducted from 1 January 2010 to 31 December 2014, including all cases of hyperthyroidism with cardiothyreosis. Epidemiological data, cardiovascular risk factors and characteristics of cardiothyreosis were evaluated. Results: 150 cases of cardiothyreosis were collected with a prevalence of 9.8% among 1517 hyperthyroidism. Mean age was 42.6 ± 9 years and sex ratio 0.33. It was a Graves’ disease in 82.2% of cases. Time limit of cardiothyreosis appearance was 27 ± 41 months and cardiothyreosis was inaugural in 46.6%. Electrocardiogram showed an arrhythmia (38.7%), coronary insufficiency (8%). On echocardiography assessment, impairment of left ventricular ejection fraction (LVEF) was found in 18.5%. Of these, it was 34.7% of arrhythmia, 8.6% of coronary insufficiency and 65.2% of heart failure. Among patients with pulmonary artery hypertension (PAH) (57.3%), there were a rhythm disorder (38%), coronary insufficiency (5.6%) and heart failure (78.8%). Female gender was the only one at risk of arrhythmia (p = 0.01) and impaired of left ventricular ejection fraction (p = 0.007). Existence of a free T4 > 50 pmol/L (p = 0.05) were only at risk of developing pulmonary artery hypertension. Conclusion: Cardiothyreosis is a significant complication. These discovery methods call for more early diagnosis and appropriate treatment. Female gender and severity of thyrotoxicosis seem to precipitate the clinical picture. Echocardiography remains an indispensable tool for assessing cardiac consequences.