Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in ad...Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.展开更多
Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment ...Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm<sup>3</sup> and high viral load at treatment initiation.展开更多
Introduction: Venous thromboembolism disease (VTE) is a common complication of hospitalization. Objective: To assess the practice of thromboprophylaxis in hospitalized patients in the department of medicine. Patients ...Introduction: Venous thromboembolism disease (VTE) is a common complication of hospitalization. Objective: To assess the practice of thromboprophylaxis in hospitalized patients in the department of medicine. Patients and Methods: It is an observational cross-sectional study conducted from 01 February to 31 March 2019 in the medical departments of the Saint Jean de Dieu Hospital of Thies. All the patients hospitalized with at least 18 years of age were included. The thromboembolic risk was assessed with the Padua score and thromboprophylaxis?assessed according to the ACCP 2012 recommendations. Results: One hundred and forty four patients were included. Seventy-one (49.3%) were in the high thromboembolic risk category. The most frequently reported risk factors were mobility impairment (n = 72;50%), age of 70 years or above (n = 35;24.3%), heart failure (n = 23;16%), acute infections (n = 14;9.7%) and cancers (n = 13;9.02%). The prevention of venous thromboembolism was practiced in 25 of the 71 patients with high thromboembolic risk or a rate of 35.2%. Thromboprophylaxis was exclusively drug-based with Enoxaparin. Conclusion: The practice of prophylaxis for VTE was low in the medical departments. Efforts still need to be made to reduce the high rate of thromboembolic complications associated with hospitalization.展开更多
Introduction: HIV resistance to antiretroviral is currently a global concern, and requires increased surveillance in a context of widespread ARV treatment. Objective: To evaluate early warning indicators of HIV resist...Introduction: HIV resistance to antiretroviral is currently a global concern, and requires increased surveillance in a context of widespread ARV treatment. Objective: To evaluate early warning indicators of HIV resistance to ARVs in the Hospital of Tivaouane (Senegal) where viral load was not routinely available. Methods: This is a cross-sectional retrospective study from 2008-2016. The etraction tool (May 2010 version) was used to analyze the EWI. Results: We collected 360 HIV positive patients followed on average for 3.57 years ± 3.02. 2009, 2010 and 2012 recorded 100% ARV prescribing rates. Throughout the study period, the percentage of patients lost to follow-up during the first 12 months of treatment was less than 20%. Virtually, all patients were still under primary ARVT over 12-month treatment. All patients (100%) withdrew their ARV drugs on time. No stock storage regarding various classes of ARVs was noted during the study period. Conclusion: At the end of this study we recommend to maintain regular follow-up of EWI, and combine it with the achievement of viral load.展开更多
Introduction: Malaria, the first parasitical endemic disease in the world, is a serious disease with 407,000 deaths in Africa in 2016. It is the main cause of morbidity and mortality in Senegal [1] [2]. Methods: Our r...Introduction: Malaria, the first parasitical endemic disease in the world, is a serious disease with 407,000 deaths in Africa in 2016. It is the main cause of morbidity and mortality in Senegal [1] [2]. Methods: Our retrospective study carried out from 1st January 2010 to 31 December 2013, at the department of internal medicine in the regional hospital of Thies was aimed at studying the epidemiological, clinical, paraclinical and prognostic profile of severe malaria in the autochthonous adults with 15 years and more. Results: Over this 3-year period, 57 patients were hospitalized in 1275 patients due to severe malaria that is to say a hospital prevalence of 4.47%. The average age was 64.21. A clear male predominance has been observed, around 61% (34/57) against 39% (23/57) with a sex ratio of 1.6. The highest malarial infestation rate was found at the end of the rainy season and at the beginning of the dry season (September to November). The clinical picture which predominates is the neurological affection which represented 33.3% of the cases. The different aspects of this neurological affection were of coma type, convulsion and prostration in 87%;21.7% and 8.6% respectively. The cerebral malaria was associated or not with other symptoms of severity that are anemia in 41.6%;icterus was represented in 21% of the cases, cardio-vascular collapse in 15.8% and hypoglycemia in 5.5% of the cases. The complications were observed during the hospitalization in 73.6% of the cases with the type of bacterial pneumonia (47.6%) and urinary infections (26.2%). The curative treatment was based on quinine salts through intravenous track in 100% of the case with a shift to the Artemisinin combination therapy (ACT) associated with intense care measures. In our study the whole lethality is 17%. Conclusion: The results of our study shows that the severe forms of malaria are still affecting our tropical endemic area, in spite of the prevention efforts made to fight against this plague. This research illustrates the difficulties to provide optimum medical care when combining antimalarial treatment and resuscitative measures in the decentralized reception facilities.展开更多
文摘Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.
文摘Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm<sup>3</sup> and high viral load at treatment initiation.
文摘Introduction: Venous thromboembolism disease (VTE) is a common complication of hospitalization. Objective: To assess the practice of thromboprophylaxis in hospitalized patients in the department of medicine. Patients and Methods: It is an observational cross-sectional study conducted from 01 February to 31 March 2019 in the medical departments of the Saint Jean de Dieu Hospital of Thies. All the patients hospitalized with at least 18 years of age were included. The thromboembolic risk was assessed with the Padua score and thromboprophylaxis?assessed according to the ACCP 2012 recommendations. Results: One hundred and forty four patients were included. Seventy-one (49.3%) were in the high thromboembolic risk category. The most frequently reported risk factors were mobility impairment (n = 72;50%), age of 70 years or above (n = 35;24.3%), heart failure (n = 23;16%), acute infections (n = 14;9.7%) and cancers (n = 13;9.02%). The prevention of venous thromboembolism was practiced in 25 of the 71 patients with high thromboembolic risk or a rate of 35.2%. Thromboprophylaxis was exclusively drug-based with Enoxaparin. Conclusion: The practice of prophylaxis for VTE was low in the medical departments. Efforts still need to be made to reduce the high rate of thromboembolic complications associated with hospitalization.
文摘Introduction: HIV resistance to antiretroviral is currently a global concern, and requires increased surveillance in a context of widespread ARV treatment. Objective: To evaluate early warning indicators of HIV resistance to ARVs in the Hospital of Tivaouane (Senegal) where viral load was not routinely available. Methods: This is a cross-sectional retrospective study from 2008-2016. The etraction tool (May 2010 version) was used to analyze the EWI. Results: We collected 360 HIV positive patients followed on average for 3.57 years ± 3.02. 2009, 2010 and 2012 recorded 100% ARV prescribing rates. Throughout the study period, the percentage of patients lost to follow-up during the first 12 months of treatment was less than 20%. Virtually, all patients were still under primary ARVT over 12-month treatment. All patients (100%) withdrew their ARV drugs on time. No stock storage regarding various classes of ARVs was noted during the study period. Conclusion: At the end of this study we recommend to maintain regular follow-up of EWI, and combine it with the achievement of viral load.
文摘Introduction: Malaria, the first parasitical endemic disease in the world, is a serious disease with 407,000 deaths in Africa in 2016. It is the main cause of morbidity and mortality in Senegal [1] [2]. Methods: Our retrospective study carried out from 1st January 2010 to 31 December 2013, at the department of internal medicine in the regional hospital of Thies was aimed at studying the epidemiological, clinical, paraclinical and prognostic profile of severe malaria in the autochthonous adults with 15 years and more. Results: Over this 3-year period, 57 patients were hospitalized in 1275 patients due to severe malaria that is to say a hospital prevalence of 4.47%. The average age was 64.21. A clear male predominance has been observed, around 61% (34/57) against 39% (23/57) with a sex ratio of 1.6. The highest malarial infestation rate was found at the end of the rainy season and at the beginning of the dry season (September to November). The clinical picture which predominates is the neurological affection which represented 33.3% of the cases. The different aspects of this neurological affection were of coma type, convulsion and prostration in 87%;21.7% and 8.6% respectively. The cerebral malaria was associated or not with other symptoms of severity that are anemia in 41.6%;icterus was represented in 21% of the cases, cardio-vascular collapse in 15.8% and hypoglycemia in 5.5% of the cases. The complications were observed during the hospitalization in 73.6% of the cases with the type of bacterial pneumonia (47.6%) and urinary infections (26.2%). The curative treatment was based on quinine salts through intravenous track in 100% of the case with a shift to the Artemisinin combination therapy (ACT) associated with intense care measures. In our study the whole lethality is 17%. Conclusion: The results of our study shows that the severe forms of malaria are still affecting our tropical endemic area, in spite of the prevention efforts made to fight against this plague. This research illustrates the difficulties to provide optimum medical care when combining antimalarial treatment and resuscitative measures in the decentralized reception facilities.
