Profile of Extra-Pulmonary Tuberculosis in Internal Medicine

Introduction: Tuberculosis is an infectious disease that mainly affects the lung. Extrapulmonary localizations are a reason for hospitalization in our health facilities. The objective of this study was to describe the epidemiological, clinical, paraclinical and evolutionary aspects of extra pulmonary tuberculosis (EPT) at the Abass Ndao Hospital Center. Patients and Methods: This was a descriptive cross-sectional study conducted over a period of 11 years (January 1, 2010 to December 30, 2021). All patients with extrapulmonary tuberculosis hospitalized in the department of internal medicine during the recruitment period were included. Results: Fifty-two (52) patients were collected. The year 2019 recorded the most cases 23.08% (n = 20). The mean age of the patients was 40.56 ± 18.24 years. The age group 20 - 34 years 42.31% (n = 22) was the most represented. Females were in the majority 61.54% (n = 32) with a sex ratio (M/F) was 0.63. Housewives were in the majority 40.38% (n = 21). 60.87% of the cases (n = 14) came from a health facility. 38.46% of the cases had been infected. 21.74% (n = 9) were smokers. The reasons for consultation were dominated by fever (67.44%), AEG (62.79%) and cough (41.86%). Eighteen patients (40.91%) had fever. The mean time to consultation was 77.37 ± 90.3 days with extremes of 3 and 365 days. The median was 45 days. More than half of the patients 61.90% (n = 26) had anemia. Positive retroviral serology was noted in 21.43% of cases. All patients had a CRP greater than 6. More than half of the patients 51.92% (n = 27) had multifocal tuberculosis. The peritoneum 44.23% (n = 23) was the main organ affected. The average hospital stay was 9.8 ± 4.9 days with extremes of 1 and 19 days. All patients had received the protocol in force at the national level. Death was noted in 4 patients (9.52%). Conclusion: EPT is characterized in our context by a notorious diagnostic difficulty due to the multiplicity of clinical presentations, the complexity of explorations, and the problems of differential diagnosis notably with other granulomatosis, systemic lupus and cancers. This difficulty is reflected in the low rate of diagnosis with a paraclinical argument of certainty and in the long diagnostic delays.

Epidemiological Aspects of Obesity, Overweight and Cardiovascular Risk Factors at Associes in Semi-Urban Areas (Case of Sébikotane)

Introduction: Obesity and overweight are a public health problem. The general objective was to determine the epidemiological aspects of obesity, overweight and associated risk factors in a semi-urban environment. Patients and Methods: This was a cross-sectional, descriptive study conducted on November 28 and 29, 2023 in Sébikotane. It focused on volunteers for screening for chronic non-communicable diseases. Epidemiological and clinical data were evaluated. Results: One hundred and twenty-nine cases of obesity were recorded (28%). Two hundred and eighty-two cases were overweight or obese (61.3%). The mean age was 49.55 years, with a standard deviation of 12.41 years. The age group [40 - 49 years] was the most representative, with 85 cases (30.1%), and the majority were female, with 264 cases (93.6%). Primary education was the most common, with 75 cases (46.3%). Grade 1 obesity concerned ninety-seven cases (75.2%), and diabetes was present in thirty cases (23%). Hypertension was present in ninety-five cases (33.7%). Obesity was more marked in the age group [40 - 49 years] with 45 cases (36%). Conclusion: Obesity and overweight are a major cause of morbidity and mortality. The development and implementation of a prevention and management program is essential.

Survey on Knowledge of Cardiovascular Disease Risk Factors in the Dakar Region

Introduction: Non-communicable diseases constitute a major public health problem, due to their morbi-mortality. The aim was to study knowledge of cardiovascular risk factors among residents of Dakar. Patients and Methods: This was a descriptive cross-sectional study. Our investigations were recruited over a six-month period (October 17, 2021 to March 21, 2022). Results: Two hundred and twenty-six (226) patients were enrolled. The mean age was 45.9 years. The under-40 age group was the most represented with 37.2%. There were 129 men (57.1%), giving a male/female sex ratio of 1.33. The highest level was represented by 159 people (70.4%). Those who responded (heart disease) were in the majority (38.1%). Hypertension was the most common CVD for 101 people (44.7%). One hundred and ninety (190) people (84%) knew the risk factors for CVD. Good knowledge of risk factors concerned 103 people (54.2%). Obesity was the best-known risk factor in 156 cases (69%). The media was the most important source of information for 121 people (53.5%). Hypertensives were the most represented with 8.4%. One hundred and thirty (130) people (57.5%) had previously paid attention to these FDRCVs. Awareness campaigns were the most effective means of communication for 170 cases (75.2%). Sixteen (16) people (35.6%) were taking antihypertensive medication. Walking was the most popular physical activity for 102 people (45%). People with a balanced diet were in the majority, with 174 respondents (77.0%). Conclusion: NCDs are a major cause of morbidity and mortality. It is essential to develop and implement a prevention and management program.

Profile of Autoimmune Polyendocrinopathies at the Medical Clinic II of the Abass Ndao Hospital: About 40 Cases

Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.

Prevalence of Depression and Anxiety in Patients with Autoimmune Disease: A Comparative Study with a Diabetic Population

Introduction: Systemic diseases are a variety of heterogeneous autoimmune and/or autoinflammatory diseases and syndromes usually affecting multiple systems and resulting from immune system dysregulation. We evaluated risk factors for depression and anxiety in an autoimmune disease cohort compared with diabetic patients. Patients and Methods: We conducted an observational, cross-sectional, case-control survey comparing two groups: individuals with connective tissue disease (CTD) and diabetic controls who were followed within three Dakar University hospitals during the period from April to June 2023. Results: The sample comprised 106 participants, of whom 51 (48%) had CTD and 55 (52%) served as diabetic controls. In the CTD group, the majority had lupus (19) and rheumatoid arthritis (23). The CTD patients had a mean age of 41.0 years (SD 16.9), while the diabetic patients had a mean age of 55.9 years (SD 11.7), with a significant difference observed (p Conclusion: Compared to a chronic disease, devastating in Africa and evolving over the long term, autoimmune diseases are more strongly and more frequently associated with anxiety and depression. This is a factor to be taken into account in the holistic management of these patients.

Profile of Female Hyperandrogenism at the Medical Clinic II: About 19 Cases

Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1st, 2019 to August 31st, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.

Primary Hyperparathyroidia at the Abass Ndao Hospital Center: About 29 Cases

Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutionary aspects. Materials and Methods: This was a cross-sectional, descriptive study, conducted over 5 years (from January 01, 2018 to December 31, 2022) at the National Abass Ndao Hospital Center and including all confirmed cases of primary hyperparathyroidism. Results: Twenty-nine patients were included with a female predominance (86.20%) and an average age of 48.10 ± 18.93 years. The discovery of hyperparathyroidism was fortuitous in 79.31% of cases. The main clinical manifestations were osteoarticular (62%) and urinary (34.5%). On average, serum calcium measured was 109.2 ± 7.92 mg/l, corrected serum calcium 111.3 ± 6.25 mg/l, urinary calcium 421.9 ± 96.45 mg/24h and parathormone at 145 ± 159.71 pg/ml. Among the patients, 25 had hypercalcemia (86.2%) and all had 24-hour hypercalciuria. The diagnosis was retained in view of the elevated parathyroid hormone (PTH) values in all patients. Cervical ultrasound objectified a parathyroid adenoma in 27.58% of cases and 12 patients or 46.2% had presented a scintigraphy in favor of a parathyroid adenoma. We found 01 cases of multiple endocrine neoplasia type 2. Bone densitometry performed in 10 patients found osteoporosis in 60% of cases (6 patients) and osteopenia in 40% of cases (4 patients). Surgical treatment was performed in 12 patients (41.4%). The histology of the surgical specimens was in favor of a parathyroid adenoma in all cases. Among the operated patients, the evolution was marked by a cure rate of 100%. Conclusion: The symptomatology of primary hyperparathyroidism remains mainly osteoarticular and urinary. Surgery has proven its effectiveness in our series. We insist on the systematic dosage of calcemia especially in women over 50 years and the promotion of morphological explorations.

Prolactin Adenomas in Senegal: Epidemiological, Diagnostic and Therapeutic Aspects of 89 Cases

Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study conducted from 1 January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals and the endocrinology department of the Abass Ndao Hospital. Results: We included 89 patients, representing a prevalence of 36.7% among all cases of pituitary adenoma. The mean age was 35.6 ± 10 years and the sex ratio was 0.34. The mean time to consultation was 27.1 ± 29 months. Clinical symptoms were dominated by gonadotropic disorders represented by galactorrhoea (71 cases, 79.8%), amenorrhoea (61 cases, 68.5%), and infertility in the couple (31 cases, 34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%, including 57 cases of headache (64%), 34 cases of visual disorders (38.2%) and 8 patients with a dysmorphic syndrome (8.9%). Imaging revealed a macroadenoma in 68.5% (61 cases) and extension of the adenoma in 11 patients (12.4%). The hormonal profile was isolated lactotropic hypersecretion (80 cases, 89.9%) and mixed in 9 cases (including concomitant secretion of GH in 8 cases and ACTH in 1 case). All patients had initially benefited? from dopaminergic agonist-based medical treatment. Pituitary surgery was effective in 45 patients (50.6%), including 44 cases by transsphenoidal approach. Postoperative incidents included transient diabetes insipidus (77.7%) and cerebrospinal fluid leakage (20%). We noted 7 cases (7.9%) of death presenting with a tumour syndrome (100%), a macro-adenoma (85.7%), having undergone pituitary surgery (42.9%). The factors significantly associated with prolactinoma were young age (p Conclusion: This series also demonstrates the impact of prolactin adenomas on reproductive function. Delayed diagnosis explains the predominance of macroadenomas, which are a source of pre- and post-operative complications.

Profile of Biermer’s Disease at the Medical Clinic II Abass Ndao Hospital Center: About 57 Colliged Cases

Introduction: Biermer’s disease is an autoimmune cause of anemia characterized by malabsorption of vitamin B12. It is often accompanied by other autoimmune pathologies. The objective was to study its profile in patients followed in the internal medicine department of the Abass Ndao hospital center. Methods: This was a retrospective and descriptive study of patients followed for Biermer’s disease from January 1, 2014 to December 31, 2019 (5 years). Results: 57 cases were collected, an incidence of 5.4 in the internal medicine department. The sex ratio was 0.58, an average age of 56.4 years. The circumstances of discovery were dominated by anemic syndrome (87.7%), dermatological (33.3%), digestive (29.8%), neurological (20%) pathologies. The specific signs to Biermer’s disease were digestive manifestations in 70.2% (including 30% Hunter’s glossitis), neurological manifestations in 36.8% (including 17.5% paresthesias), palmoplantar melanoderma in 68.4%. The mean hemoglobin level was 6.8 g/dL with a mean corpuscular volume of 110.7 fl. The myelogram reported megaloblastosis in 100% of the cases. The mean serum vitamin B12 level was 100 pg/ml. The anti-intrinsic factor antibody assay performed in 50 patients was positive in all cases. Upper digestive endoscopy showed an aspect of fundic atrophy in 69%. Histology showed intestinal metaplasia in 2 patients. An autoimmune disease was associated in 21% of cases. All patients had received treatment with vitamin B12 (51 patients took intramuscularly and 6 oral treatment). The course was favorable in all cases with a complete correction of the anemia. Conclusion: Biermer’s disease is a reality in Senegal. Its clinical and biological characteristics can be superimposed on the data in the literature. His prognosis under treatment is good whatever the route of administration of vitamin B12.

Low Socio-Economic Level: A Major Obstacle to Therapeutic Observation (Survey of 125 Diabetic Patients)

Introduction: Diabetic patients adhering to their treatment are less likely to face complication from their disease. For this reason, we studied the compliance of diabetics with their treatment. Materials and Method: This was a comprehensive cross-sectional study of adherence in diabetic patients. All patients meeting the inclusion criteria were enrolled in the study. This study took place at a private pharmacy called “pharmacy Elhadj Seydou Nourou Tall” located in the city of Pikine during the period from April 1 to September 30, 2019. Results: In total, the study population was composed of 125 diabetics;frequency of 8.47%. The average age was 62.5 years and there were more women (58.4%). Of the patients, 87% had a low socioeconomic level and 72% a low educational level. Only 65.6% of the patients knew their diabetes type. Even though 97.6% of the patients were confident in the treatment but due to financial reasons 20.8% did not adhere to the prescribed treatment and 16.8% to their diets. Moreover, 15.2% of the patients had changed the dosage of the prescribed medication, 44.4% had forgotten to take their medication regularly. 78.4% of them thought they were taking too much medication. No factors were found to be statistically associated with poor adherence, but the proportion of poor adherence patients was higher in patients over 60 years of age, with low socio-economic status and low education. Conclusion: Low socio-economic status is the main barrier to good adherence. Recommendations have been formulated to improve this adherence.

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Introduction: Urinary tract infection (UTI) is a major public health problem because of its morbidity and mortality. It occurs with increased frequency during diabetes. The objective of this work was to study the frequency and etiologies of urinary tract infections in diabetics hospitalized at the department of medicine of Abass Ndao Hospital. Patients and Methods: This work was a cross-sectional, descriptive, and analytical study conducted from January 01, 2018, to December 31, 2018. It focused on hospitalized diabetic patients with urinary tract infection. Epidemiological, clinical, and evolutionary data of UTI were evaluated. Results: One hundred and twenty-eight (128) diabetic patients had a cytobacteriological urine exam (CUE). 44 of who had a positive CUE (34.4%). The age group [60 - 69] years was the most represented (31.8%). Women predominated (61.4%) with a sex ratio (m/f) of 0.63. Abdominal pain was the most frequent reason for consultation, followed by polydipsia. Fever was recorded in 21 patients (47.7%). Type 2 diabetes was found in most patients (70.5%). Glycemia above 2g/l was found in 34 patients (89.5%). Anemia accounted for more than half of the patients with 29 cases (65.9%). Leukocytosis was noted in 28 patients (63.6%) and a positive CRP in 33 patients (75%). An increase in urea-creatinine was noted in 23 cases (52.3%). The results of the CUE revealed Escherichia coli as predominant (43.2%, n = 19), followed by Candida with 22.7% (n = 10). Antibiotic therapy was given to all patients. The mostly used antibiotic in the treatment of UTI was Cefotaxime 27.3% (n = 12). Older age and female gender were associated with the presence of E. coli. Four (4) deaths were recorded (9%). They were all male over the age of 65. Conclusion: UTI in diabetes is an important cause of morbidity and mortality. The development and implementation of a prevention and management program are essential.

Hepatic Cirrhosis: Diagnostic and Prognosis in Internal Medicine

Introduction: Cirrhosis is a public health problem and the causes are dominated by viral hepatitis and alcoholism. Deaths due to cirrhosis represented 2.4% of deaths worldwide in 2017. The aim of this work was to study the diagnostic and prognosis of cirrhosis at the department of internal medicine of the Abass Ndao hospital center. Patients and Methods: This is a retrospective, descriptive study, carried out on the basis of patient files followed from May 1, 1999 to February 28, 2018 (19 years) and included all patients for whom the diagnosis of cirrhosis was accepted. The diagnosis of cirrhosis was made on the basis of clinical, biological and ultrasound (portal hypertension, signs of hepatocellular insufficiency, a diffuse heterogeneous aspect, and irregularity of the liver contours). Results: 60 patient files were listed with an average age of 46.9 years, a sex ratio of 2.2 and alcoholism in 11.7% of the cases. The reasons for consultation were dominated by an increase in the size of the abdomen (55%), lose weight (50%). On physical examination, it was a hepatomegaly (43.3%) and jaundices (33.3%). Exploration of liver function showed a cholestasis (48%), a cytolysis (58%) and a hepatocellular insufficiency (46.2%). Anemia was found in (24%). The abdominal ultrasound found in all cases a dysmorphic, heterogeneous liver with irregular contours. Hepatic atrophy was found in 20%. Among the 34 patients who underwent upper gastrointestinal endoscopy, they were grade 2 to 3 esophageal varicose vein in 67.6%, an erosive gastropathy in 29.4%. The etiology was viral hepatitis B in 45%, alcoholism in 11.7% and undetermined in 43.3%. A hematemesis complicated the evolution in 16.7%. Carcinomatous degeneration was found in 5% and 16.7% of the patients had died. Conclusion: our experience with cirrhosis was marked by advanced forms at the stage of complications. The viral etiology B remains dominant. Prevention will involve early detection and vaccination.

Effect of the Covid-19 Pandemic on Prenatal Consultations for Pathological Pregnancies at the Maternity Unit of Abass Ndao Hospital, Dakar, Senegal

Introduction: The COVID-19 pandemic has led to changes in health systems. The objective was to assess the effect of Covid-19 on the frequency of prenatal consultations (PNCs) for pathological pregnancies at the Abass NDAO Hospital Centre. Materials and Methods: This was primarily a retrospective study conducted at the Abass NDAO Hospital maternity ward. The target was the medical records of women followed for a pathological pregnancy at maternity from July 2019 to November 2020. Second, the department’s qualified staffs were asked about their experiences with the Covid-19 pandemic. Data collection was carried out between October 2021 and February 2022. Results: A total of 690 prenatal charts for pathological pregnancy were collected: 375 (54%) before the pandemic compared to 315 during Covid-19 (46%). The average age of women was 28.15 years. The age group 25 and 35 was the most represented (36.81%). Reasons for consultation were dominated by threats of premature delivery (51%), followed by severe pre-eclampsia (14%) and premature membrane rupture (11%), respectively. The frequency of prenatal consultations (PNCs) was inversely related to pandemic dynamics and significant monthly variations were observed. Qualified health personnel were midwives (71.40%) and gynecologists (28.60%). During the pandemic, more than the majority of staff (67%) worked 3 days a week, and 24% of health workers 5 days. The majority of staff (60%) reported experiencing overwork during the pandemic. Non-compliance with consultation days was noted in 38% of health providers. Protective equipment was not provided to 14% of the staff. Staff difficulties during prenatal consultations were fear of occupational exposure (12%) and patient reluctance (88%). Conclusion: The Covid-19 pandemic is having a major impact on prenatal consultations for pathological pregnancies at Abass NDAO Hospital. Effective measures must be taken to avoid the consequences of maternal mortality and the functioning of the structure.

Morbi Infectious Mortality of Diabetics Hospitalized at the Medical Clinic of Abass Ndao Health Center

Introduction: Diabetes is a public health problem and is exposed to some complications, particularly infectious. The work on this entity remains segmentary in Africa. The objective was to describe the morbi infectious mortality of the diabetics at the Medical Clinic II of Abass Ndao Health Center of Dakar. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted from 01 January 2016 to 31 December 2016. It covered patients with diabetes hospitalized during the study period. Epidemiological data and infectious diseases were evaluated. Results: During the study period, 346 diabetics have respected the inclusion criteria. These were 165 men (47.68%), a sex ratio of 0.91. The mean age was 56.17 years. The age group of [60 - 69 years] accounted for 31.5% and 95.6% of the patients came from the Dakar region. The average age of diabetes was 10.31. Diabetes had been evolving for less than 5 years in 25.15% of patients and inaugural in 11.46%. About 82.36% of our patients had type 2 diabetes. The acute complications of diabetes were ketoacidosis (51.89%), hyperosmolar hyperglycemia (0.58%), and hypoglycemia (1.45%). The mean infections were the skin and soft tissues (54.91%), urogenital infections (16.18%), respiratory infections (14.45%), malaria (3.46), infections of the skin and soft tissues were dominated by the diabetic foot (41.90%). The 125 non-diabetic patients developed 38 infectious pathologies, the main ones being respiratory infections (24.32%), infections of the skin and soft parts (24.32%). HIV infection was observed in 0.28% of diabetics and 8.10% of non-diabetic patients. 93 patients died (15.70%). Fifty-one of them died of infectious diseases (54.8%), 42 non-infectious diseases (45.16%), and subjects aged over 60 years, representing 72.54%. The means of consultation was 30 days. The highest rates of lethality were diabetes (37.41%), acute gastroenteritis (17.64%), and acute pyelonephritis (12.5%). The lethality rates of indeterminate infections and malaria were 10% and 8.33%, respectively. Conclusion: Infection is a significant complication in diabetics not neglectable to diabetes. These discovery patterns call for more early diagnosis and appropriate management to reduce the mortality of diabetics.

Decentralized Management of Diabetes Mellitus by General Patrician

Introduction: In Senegal, the frequency of diabetes mellitus is estimated at 3.2% and its management by the general patrician (gp) is dissatisfied. The objective was to evaluate the decentralized monitoring of diabetes mellitus and other cardiovascular risk factors by a trained general practician. Patients and methods: It was a retrospective, descriptive study conducted from June 1, 2013 to 31 May, 2015 in Dakar, where included the files of subjects with diabetes mellitus regularly followed. The data collected were epidemiological, diagnostic and therapeutic. Results: It was of 125 diabetics patients with a mean age of 56.4 years old. At the inclusion, their diabetes had a mean duration of 6.3 years and a mean average HbA1c of 10.4%. The complications were a neuropathy in 58 cases (46.4%), an arteritis in 46 cases (36.8%), a nephropathy in 16 cases (12.8%) and a retinopathy in 28 cases (22.4%). Other cardiovascular risk factors were an arterial hypertension in 74 cases (59.2%), smoking in 11 cases (8.8%), kidney disease in 16 cases (12.8%), and LDL-cholesterol > 1.6 g/l in 39 cases (31.2%). In total, 87 patients (69.6%) were at high cardiovascular risk and among them, 81.6% had LDL-cholesterol > 1g/l. At inclusion, anti-diabetic treatment was oral mono-therapy in 53 cases (42.4%), an insulin therapy in 49 cases (39.2%). After 12 month of follow-up, the dual therapy anti-diabetic was increased from 13.6% to 34.4%. The others associated drugs were anti-hypertensives in 72 cases (57.6%), statins in 29 cases (23.2%) and anti-platelet agent in 46 cases (36.8%). Only 31.2% of the patients with nephropathy were under the renin angiotensin system blockers. Statins and the anti-platelet agents were prescribed respectively at 25.2% and 47.1% of the 87 patients at high cardiovascular risk. During follow-up, the target HbA1c Conclusion: our study shows the importance and the interest of a trained general practician for the management of non-communicable diseases. However, it would be necessary to strengthen training in the care of other cardiovascular risk factors.

Epidemiological Aspects of Cerebrovascular Accidents in the Diabetic:Experience of the Medical Clinic II of the Hospital Center Abass Ndao of Dakar

Introduction: The objective of our study was to describe the socio-demographic characteristics and cardiovascular risk factors (RVFs) of diabetic patients admitted for stroke in a department other than neurology. Methods: Retrospective cross-sectional study over a period of six (6) years (January 2010 and December 2016), performed at the Internal Medicine Department of the Abass Ndao Hospital Center in Dakar. Results: 79 adults with a mean age of 64.67 years, a female predominance (51.89%). The major risk factors found were arterial hypertension in 74.68% of cases, dyslipidemia in 32.35% of cases, smoking in 6.32% of cases. The reasons for consultation were a disorder of consciousness in 27.4% of cases, hemiplegia in 43.3% of cases, headache in 18.98% of cases, vertigo in 8.86% and dysarthria in 10.12% of the cases. Mean systolic blood pressure was 150 mmHg, mean diastolic blood pressure was 86 mmHg. The average blood glucose was 3 g/l. Strokes were associated with left ventricular hypertrophy in 30.55% of cases. Ischemic stroke accounted for 74.68%. The evolution was marked by a death in 20.25% (16) cases. Conclusion: Stroke is a major public health problem. Despite its predominance of women, they (stroke) affected 48.10% of men in our study when we know that in Africa the social activity is based on men. They remain a serious pathology in the diabetic by the high lethality.

Evaluation of Podological Risk at Type 2 Diabetics Tracked at the Mark Sankale Diabetes Center in Dakar

Introduction: The diabetic foot is a real public health problem due to its economic and functional impact with a high risk of amputations. The objective was to determine the podiatric risk of type 2 diabetics according to the classification of the International Working Group on the Diabetic Foot (IWGDF) in order to put in place suitable prevention measures. Patients and Methods: This was a cross-sectional, descriptive and analytical study conducted over 12 months from May 01, 2018 to May 01, 2019 and concerning subjects with type 2 diabetes regularly followed up at the Marc Sankale Center at Abass Ndao Hospital in Dakar. Results: Two hundred (200) patients were collected with an average age of 58.9 ± 10 years, a sex ratio of 0.43. The majority of our patients had diabetes less than 5 years of age (52%) and were on non-insulin medication (63%). The average HbA1c level was 8.1%. Besides diabetes, high blood pressure and dyslipidemia were the most common cardiovascular risk factors in 65% and 25%, respectively. The main podiatric risk factors were: neuropathy (75.5%), arteriopathy (31.5%), deformities (19.5%), history of ulceration (24%) and amputation (2%). Factors associated with the risk of ulceration were: walking barefoot (42%), wearing tight shoes (26.5%), wearing unsuitable socks (46%), gait disturbance (39%), traumatic pedicure (3.5%). The podiatric risk assessment according to the IWGDF grading had identified a podiatric risk foot in 80% of the cases. Depending on the grade of injury, it was a grade 0 (20%), grade 1 (32%), grade 2 (34%) and grade 3 (14%) risky foot. A significant correlation was established between the onset of diabetic foot and age (p p p Conclusion: Podiatric assessment remains an essential point in the fight against complications of diabetes. This study demonstrates the high risk of developing diabetic foot, hence the importance of good grade planning to reduce the impact.

Correlation between Glomerulopathy and Retinopathy in an African Population of Type 2 Diabetics

Introduction: Diabetic microangiopathies are common, but their time to onset in a diabetic patient varies from subject to subject. The aim of our study was to study the correlation between renal and ophthalmic disorders in patients with type 2 diabetes. Patients and methods: This longitudinal, analytical study took place from March 1, 2018 to March 31, 2019 at the Abass Ndao University Hospital Center. It was studying retinal involvement in diabetic patients with glomerulopathy. Results: Of the 100 cases of diabetic glomerulopathy, they are divided into 70 women and 30 men with an average age of 58.2 years. The average duration of diabetes was 6.1 years and their average glycated hemoglobin (HbA1c) was 8.1%. Only 37% of patients had an HbA1c level below 7%. The other cardiovascular risk factors were high blood pressure (HBP) (39%), dyslipidemia (36%), and obesity (15%). Among these patients, diabetic retinopathy was present in 21% of the cases. Retinopathies were more frequent in the group of patients diagnosed with diabetes for less than 6 years (69%) and in patients with chronic renal disease with slightly reduced glomerular filtration rate (GFR) (34%). Conclusion: Our study allowed us to conclude that during the course of type 2 diabetes, the onset of chronic kidney disease does not systematically imply the presence of diabetic retinopathy. It is thus important to make screenings and assessments of systematic complications.

Epidemiological, Clinical and Therapeutic Characteristics of Hypertensive Type 2 Diabetics at the Marc Sankale Center of Dakar

Introduction: High blood pressure (hypertension) and diabetes mellitus are two major risk factors for cardiovascular disease, which is increasing rapidly in Africa and worldwide. Africa has the highest prevalence rate of hypertension in the world, with 46% of adults over the age of 25 with. Hypertension is common in type 2 diabetes and increases cardiovascular risk. The association of these two pathologies has many particularities in the sub-Saharan subject. The work related to this entity in Africa shows a frequency between 30% and 60%. The objective was to describe the epidemiological, clinical and therapeutic characteristics at the Medical Clinic II of the Abass Ndao Hospital Center in Dakar. Patients Methods: This was a cross-sectional, descriptive and analytical study conducted from 01 December 2016 to 31 January 2017. It focused on patients with cardiothyrosis. Epidemiological data, cardiovascular risk factors, and cardiothoracic characteristics were evaluated. Results: 303 cases were recorded with a prevalence of 42%, an average age of 61.63 years, a sex ratio of 0.22. The age group of [60 - 70] years was the most representative at 36.30%. The BMI (Body Mass Index) average was 27.06 kg/m2. Obesity was 25% and 35% were overweight. Dyslipidemia consisting of an increase in LDL cholesterol > 1 g/l in 79%, a hypercholesterolemia in 57%, a decrease in HDL cholesterol in 13.23% and a hypertriglyceridemia in 28%. Patients with three cardiovascular risk factors accounted for 93.72%. The average fasting glucose level was 2.85 g/l. Hyperglycemia was noted in 65%. The glycosylated hemoglobin is greater than 7% in 47%. The duration of diabetes was less than 5 years in 133 patients or 44%. 70% of patients were treated with oral antidiabetic drugs. Insulin was used in 21.1%. Hypertension was mild in 24.1%, moderate in 23.8% and severe in 14.8%. Hypertension treated with monotherapy was 49%, combination therapy was 43%. Converting enzyme inhibitors (CEI) were used in 44%;20% were Calcium inhibitors and 7 were treated by Angiotensin II Receptor Antagonists (ARA). The inhibitor association of the conversion enzyme/calcium inhibitors (CEI/CI) is in 22%. Statins are used in 23%. The degenerative complications concerned four cases of acute edemas of the lower limbs (AELL), four cases of stroke (AVC). 37% had a balance of the blood pressure and among them 19.5% had followed a monotherapy and 33% a combination therapy. Conclusion: The combination of hypertension and diabetes is common in Africa and increases cardiovascular mortality. Training in the management of diabetes and other cardiovascular risk factors is needed.

On Finite Noncommutative Grobner Bases

It is well known that in the noncommutative polynomial ring in serveral variables Buchberger's algorithm does not always terminate.Thus,it is important to characterize noncommutative ideals that admit a finite Grobner basis.In this context,Eisenbud,Peeva and Sturmfels defined a mapγfrom the noncommutative polynomial ring k〈X_(1),...,X_(n)〉to the commutative one k[x_(1),...,x_(n)]and proved that any ideal J of k〈X_(1),...,X_(n)〉,written as J=γ^(-1)(L)for some ideal L of k[x_(1),...,x_(n)],amits a finite Grobner basis with respect to a special monomial ordering on k〈X_(1),...,X_(n)〉.In this work,we approach the opposite problem.We prove that under some conditions,any ideal J of k〈X_(1),...,X_(n)〉admitting a finite Grobner basis can be written as J=γ^(-1)(L)for some ideal L of k[x_(1),...,x_(n)].