Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

Profile of the Blood Count among People Living with HIV Monitored at the Institute of Social Hygiene and the Aristide Le Dantec Hospital in Dakar

Introduction: The human immunodeficiency virus (HIV) is a pandemic of concern to the World Health Organization. It is all the more worrisome because if not properly managed, it can be responsible for several complications, including abnormal blood counts. These abnormalities may also be related to treatment. Objectives: The main objective of this study is to show that adequate antiretroviral therapy can correct various abnormalities exerted by HIV on patients’ blood counts. The specific objective is to determine all the abnormalities we can see in blood count before and during HIV treatment. Materials and Methods: Our study was conducted in the hematology laboratory and the dermatology departments of the Aristide Le Dantec Hospital and the Institute of Social Hygiene. It took place from December 2009 to October 2011. It is a retrospective descriptive and analytical study involving HIV-positive patients (HIV 1 and 2) and under antiretroviral treatment (at least six months of treatment). We included 110 patients in the study. Blood counts were performed at the hematology laboratory of the Aristide le Dantec hospital using a KX21 automaton. Each patient received three blood counts during the first six months of treatment (M0, M3 and M6). A univariate analysis was performed to determine the profile of the abnormalities of the blood count and the chi 2 test was used and a threshold of p 0.05 was considered significant. Results: The mean age of the patients was 38.6 ± 8.6 years (extremes of 18 and 64 years) with a sex ratio of 0.42 (77 females and 33 males). The prevalence of anemia was 80% (n = 88) at M0, 53, 63% at M3 (n = 59), and 38.20% at M6 (n = 42) (p = 0.02). We noted a favorable evolution with treatment. For the other abnormalities, the evolution was favorable for leukopenia (p = 0.011) and thrombocytopenia (p = 0.007). Conclusion: Our study showed a correction of blood count abnormalities in PLHIV with antiretroviral treatment.

Contribution to the Study of Diabetic Kidney Disease in a Sub-Saharan Environment: An Example of the Aristide Le Dantec University Hospital in Dakar

Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and dialysis admission. Few studies are available in Sub-Saharan Africa. The objective of this work was to study the epidemiological, clinical, diagnostic and therapeutic characteristics of DKD in our context. Patients and Methods: We conducted an observational, exhaustive and retrospective study focusing on diabetic patients seen in consultation or hospitalized in the Nephrology Department of at the Aristide Le Dantec University Hospital in Dakar during a period of 5 years from January 1, 2017 to December 31, 2021. Results: Of 4735 patients seen during the study period, 491 had DKD, i.e. a hospital prevalence of 10.36%. The average age was 59.1 ± 11.4 years with a sex ratio of 0.95. Type 2 diabetes predominated with 93.4%. The average duration of diabetes was 11.5 ± 7.6 years. Diabetes was associated with high blood pressure in 78.81% of cases, dyslipidemia in 23.2% of cases, active smoking in 6.7% of cases and obesity in 1.6% of cases. Renal failure was the main reason for referral 72.3%. One hundred and forty-eight patients (30.1%) had uncontrolled diabetes. Macroalbuminuria was found in 64.8% and microalbuminuria in 18.7% of cases. One hundred and eighty-five patients (37.7%) were in Stage V of kidney disease and 137 patients were in Stage III (18.1% in Stage IIIb and 9.8% in Stage IIIa). Diabetic nephropathy was the main etiology at 61.30%. Nephropathy was mixed (diabetic and hypertensive) in 18.12 cases. Renin-angiotensin-aldosterone system (RAAS) blockers were prescribed in 83.5% of patients. Conclusion: The different etiologies encountered during the study show the diversity of diabetic kidney disease. Diabetic nephropathy is not the only kidney damage that can occur in diabetics in our context.

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.

Prognostic Aspects of Lupus Nephritis at Aristide Le Dantec University Hospital in Dakar

Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal failure, lymphopenia, nephrotic syndrome, glomerular sclerosis, arteriosclerosis, interstitial infiltration and tubular atrophy. Conclusion: The risk conferred by nephropathy is greater for proliferative glomerulonephritis;it is also correlated with the presence of persistent nephrotic syndrome or severe renal failure.

Pulmonary Hypertension in Chronic Hemodialysis Patients at Aristide Le Dantec University Hospital

Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).

Pathological Fractures in Chronic Hemodialysis Patients in a Teaching Hospital in Senegal: Prevalence and Associated Risk Factors

Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.

Infection in Multiple Myeloma: Microbiological Profile and Prognosis in Senegalese Patients

Introduction: Infections are additional factors of morbidity and mortality in multiple myeloma (MM), and the current recommendation is antibiotic prophylaxis. In sub-Saharan Africa, few data on infectious complications of MM are available. We aim to describe the microbiological features of infections in MM, and their impact on survival in Senegalese patients. Methods: A retrospective (January 2005-January 2022), analytic, multicenter study on infections in patients followed for MM (IMWG criteria) in Senegalese clinical hematology services. The socio-epidemiological, diagnostic, microbiological, evolutionary and survival aspects were analyzed. Results: The study included 106 patients with multiple myeloma who had an infection at admission or during the treatment. Ten patients have the comorbidity (hypertension, lupus, type 2 diabetes). These patients had 136 infectious events identified at diagnosis (79.2%) or during chemotherapy (20.8%). The sites of infection are lung (42.6%), urinary (29.4%), dermatological (6.6%), digestive (5.2%), osteoarticular (4.4%), ear, nose and throat (3.7%), central nervous system (1.5%), or without site. We recorded 26.4% of patients with multi-site infections. The causal pathogens are bacteria (Gram-negative bacilli: 22.1%;Gram positive bacilli: 9.5%, Mycobacterium tuberculosis: 13.3%), parasitique (plasmodium falciparum 6.6%), viruses (SARS-COV2: 2.9%, VZV: 2.2%) and fungal (2.9%). Survival was reduced in patients who had an infection at the time of multiple myeloma diagnosis (p: 0.189) and those who had multiple infectious foci (p: 0.011). Conclusion: Infections in multiple myeloma are more frequent at diagnosis. The germs are varied and mostly bacteria, particularly gram-negative bacteria, and Kochs bacillus. Our study reveals that multiple infectious foci are a poor prognosis factor. It is necessary to evaluate the infectious risk early, and to adopt an antibiotic prophylaxis based on our tropical environment.

Overview of Adrenals Tumors in Dakar Hospitals

Introduction: Adrenal tumours (AT) are commonly encountered in clinical practice. For any patient presenting an adrenal mass, there are two crucial points to consider: is the adrenal mass malignant and is it hormonally active? The objective of our study was to evaluate the epidemiological, diagnostic, therapeutic, and evolutionary aspects of AT in a developing country. Methodology: We conducted a retrospective study spanning 17 years (from January 2005 to October 2022) in four Dakar hospital services. We included all patient medical records with explored AT. Results: AT was diagnosed in 35 patients who had a mean age of 36.62 years (range: 12-79), and a female predominance (26 women to 9 men). Among these patients, 17.2 % had incidental AT. Hypertension was the commonest presenting symptom in 27 patients (77%), which was associated with Mnards triad in 14 patients (40%). Abdominal pain was reported by 20 patients (57%), and 14 presented with an abdominal mass. Among the patients, 29 had functional AT: 22 with pheochromocytoma, 5 with primary hyperaldosteronism, and 2 with hypercortisolism. Imaging evaluations revealed that 33 patients had unilateral AT and one had bilateral AT. Tumour sizes varied, 5 patients had tumours 10 cm. Two patients presented with metastases. The therapeutic approach involved adrenalectomy in 32 patients. Perioperative complications were observed in five patients, including haemorrhage (two patients), hypotension (two cases), and hypertensive crisis (one case). One patient with bilateral pheochromocytoma developed acute adrenal insufficiency postoperatively, followed by abdominal herniation. Histopathological examination confirmed pheochromocytoma in 21 patients, Conns adenoma in 5, adrenocortical carcinoma in 3, cortisol adenoma in 2, and adrenal cyst in 1 patient. Non-functional AT included adrenocortical carcinoma (three patients), adrenal cyst (one patient), and pheochromocytoma (two patients). After a one-year follow-up, 29 patients with benign tumours had favourable outcomes, while death occurred within six months of diagnosis in five cases. A patient who had bilateral pheochromocytomas, with complications, died before surgery. Conclusion: In our practice, AT are predominantly pheochromocytomas, being typically diagnosed when they become symptomatic large tumours and, due to this large size, laparotomy is the preferred surgical approach. Unfortunately, the prognosis for malignant tumours is poor.

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.

Epidemiological Profile of Chronic Kidney Disease at the General Hospital of National Reference of N’Djamena (Chad)

Introduction: Chronic renal failure is a disease that affects many patients worldwide and increasingly in Africa. At the end of 2003, about 1.1 million people were suffering from End-Stage Renal Disease (ESRD) and were treated with periodic dialysis [12]. In Africa, CKF represents 2% to 10% of hospital admissions and is responsible for 4% to 22% of deaths [14]. So, this study is conducted for the first time in Chad, with the aims to determine the prevalence of CKD. Methods: This was a retrospective, descriptive and analytical study over a period of 12 months from April 29, 2011 to April 28, 2012. All patients with chronic renal failure regardless of etiology and stage of chronic kidney disease were included in the study. Chronic renal failure was defined as a glomerular filtration rate below 60 ml/min/1.73m (MDRD) for more than 3 months. This study was conducted in several departments of the National General Reference Hospital (NGRH) of N’Djamena. Result: Among 2039 inpatients, 195 patients had chronic renal failure, as a frequency of 9.6%. The average age of our patients was 51 ± 16.8 years, ranging from 11 to 85 years. Male predominance was noted to be 59% of men against 41% of women. We noted that high blood pressure accounted for 66.2% (N = 129) of cases, diabetes in 48.2% (N = 94), alcoholism in 28.7% (N = 56), smoking in 14.9% (N = 29) and the association alcoholism-smoking in 19.5% (N = 38). Hypertension was the leading cause of chronic renal failure (66.2%). All patients had a serum creatinine and creatinine clearance was assessed. Among them, we noted 57 patients (29%) with end-stage renal failure. The average calcium and phosphate serum were 1.8 mmol/l and 1.6 mmol/l, respectively. We noted that 120 patients as 61.5%, currently took herbal medicine. 48 out of 57 of our patients with ESRD as 24.6% of patients in the study had received replacement therapy (hemodialysis) with 12.5% of deaths. Conclusion: Chad, who compiled the first study with 195 patients at the General Hospital of N’Djamena National Reference over a period of one year has objectified a prevalence of chronic renal failure of 9.6%.

Rare Etiology of Reversible Hypokinetic Dilatated Heart Disease in Infants: Bland-White-Garland Syndrome (ALCAPA)

Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.

Complications Related to the Insertion Technique of Jadelle® Contraceptive Implants

Introduction: Contraceptive implants are one of the most effective methods of birth spacing. Jadelle® implants consist of two strands that are easy to insert and remove. Although their effectiveness is no longer in question, their use (insertion) requires a surgical procedure with the corollary possibility of complications. These are mainly insertions that are too deep (in the arm muscle), vascular and nerve damage. Material and Methods: Our study focused on complications related to implant insertion. It was a descriptive and retrospective study over thirty-four months, from October 2016 to July 2019, and concerned all patients seen in consultation and who presented a complication related to the insertion of contraceptive implants in the Department of Gynecology and Obstetrics of the National Hospital of Pikine. Results: We collected nine complications managed at the Gynecology and Obstetrics Department of the Centre Hospitalier National de Pikine from 2016 to 2019. These were insertions that were too deep with sometimes nerve damage, infection or incident during anesthesia. The operative procedures were based on the type of complication. Conclusion: Although Jadelle® has the advantage of having only 2 rods compared to its predecessor Norplant®, its use is also conditioned by insertion and removal procedures which may experience complications.

Indications and Results of Lower Gastrointestinal Endoscopy in a Regional Hospital Center in Senegal

Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital center in Senegal. Patients and Methods: We conducted a descriptive retrospective study from September 1st, 2017, to September 30, 2018 at the gastrointestinal endoscopy unit of the regional hospital center of Thiès. All patients received for lower gastrointestinal endoscopy and whose reports were usable, were included. In the reports, we collected and analyzed sociodemographic data, indication and results of the endoscopic examination. Results: We included 250 patients. There were 140 men (sex ratio 1.27). The average age was 42 years [range 1 - 92 years]. There were 37 colonoscopies (14.8%), 51 rectosigmoidoscopies (20.4%) and 162 anorectoscopies (64.8%). The patients were from the region of Thiès in 82% of cases. In most cases, they were most often referred by general practitioners (22.8%) and surgeons (20.8%). The main indications were rectal bleeding (36.8%), hemorrhoidal disease (23.2%) and proctalgia (11.6%). Hemorrhoidal disease (63.6%), anal fistula (14%) and tumors (8.8%) were the most common pathologies. Conclusion: Admitted patients at the gastrointestinal endoscopy unit of the regional hospital center of Thiès have many indications as well as pathologies. Anal pathology is dominated by hemorrhoidal disease.

The Acute Angle Closure Crisis in Senegalese Melanodermas: Epidemiological and Clinical Aspects of 24 Cases

Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10e. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .

How a Cancer Registry Was Set Up in Senegal: An Example to Follow for a Developing Country

Objectives: Senegal, with the support of WHO, had begun the establishment of a National Cancer Registry in 2009, although it had been at a standstill since 1969;the objective of this work was to test the reliability of data collection tools and feasibility stages necessary for the validation of media before the establishment of a national cancer registry. Methodology: We conducted a non-exhaustive preliminary study over a period of three months from the first of January to 31 March 2010 at four major hospitals in Dakar at the time. Results: Two hundred and eighty-nine cases had been identified: 44% of men (n = 127) and 56% of women (n = 162) with a sex ratio of 0.8. The ages ranged from 20 to 90 years with an average of 50 years. The main diagnostic mode was essentially histological, with 76% of cases (n = 219). The most frequent locations were: ORL (ENT meaning Ear, Nose and Throat) with 25% of cases, liver 7% and bronchopulmonary 4.5% of cases. In men, liver cancer was the most common location and women for cervical cancer with 16%. Squamous cell carcinoma was the most common histological type with 68% of cases followed by adenocarcinoma with 22% of cases. Thirty-eight percent of patients were classified as stage III and IV. A quarter of our patients had received palliative treatment. In contrast, 15 (15%) had received chemotherapy and 4% had received radiotherapy. Data collection was satisfactory. Conclusion: Cancer is a reality in Senegal but it remains underdiagnosed. The materials made it possible to make the cancer registry effective throughout the country.

What Impact on Phenotype for Patients with Karyotype 46, XX DSD SRY Positive at CHU Dantec in Senegal: About 5 Cases?

Background: In disorders of sexual differentiation, sexual development may not conform to the chromosomal structure, thus forming different types of abnormalities. Among these abnormalities is syndrome 46, XX DSD where most patients are female phenotype with clitoral hypertrophy that can go to complete masculinization especially in the presence of the SRY gene. Objective: The goal of this work is to demonstrate a relationship between the genotype and the phenotype in five patients karyotype 46, XX with the presence of the SRY gene. Methodology: The study involves five patients referred to the laboratory under suspicion of sexual development anomalies. The diagnosis took place through hormonal and echography examinations, a classic cytogenetic study (Barr chromatin and karyotype) and an amplification of the SRY gene located on the Y chromosome. The resulting PCR products were sent for sequencing. Results: Based on the results of clinical and paraclinical tests carried out it was found clitoral hypertrophy, the presence of clitoris penis for some, presence of normal penis for others. In addition, echography revealed a lack of female internal genitalia (P2, P3), and a presence of testicles (P3, P4, P5). Genetic analysis (chromosomal and molecular) showed a karyotype 46, XX SRY (+) for all patients. New mutations were found c.246 T > A, p.82 Asn82Lys and c.171 G > C, p.57 Gln57His. Conclusion: In our study, we were able to correlate each DSD with karyotype 46, XX to a pathology such as 46, XX DSD testicular, 46, XX DSD with clitoral hypertrophy and ovotestis 46, XX. The next step will undoubtedly be the integration of other molecular techniques (genotyping, FISH, CGH or even the CGH array) to further genetic exploration.

Focal Segmantal Glomerulosclerosis: Epidemiological, Clinico-Biological, Pathological, Etiological, Therapeutic and Evolutionary Profiles in Dakar

Introduction: Focal Segmental Glomerulosclerosis (FSGS) corresponds to a clinicopathological syndrome, manifested by generally abundant proteinuria associated with hyaline deposits on part of certain glomeruli and sparing other glomeruli, with effacement of the pedicels. The general objective was to determine the prevalence of FSGS, and to give its profiles;epidemiological, clinical, biological, pathological, etiological, therapeutic and evolutionary of FSGS. Materials and Methods: This is a retrospective analytical study over a period of six years extending from January 1, 2010 to December 31, 2015 patients aged 16 or over who were hospitalized or received consultations during the study period for primary or secondary segmental and focal hyalinosis. Patients whose records were incomplete or unusable were not included in the study. Results: We have 16.54% with 158 cases of FSGS out of 6945 patients received and/or hospitalized. Of the 955 kidney biopsies distributed, the incidences of HSF were;10.15%;14.04%;15%;17.64%;20.11%;19.58% respectively in 2010;2011;2012;2013;2014 and 2015, i.e. an annual increase of around 1.25%. Renal-type edemas were found in 93.3%, the first reason for hospitalization. And ninety-six people had impaired kidney function, or 61%. The average of 24-hour proteinuria was 6.4 ± 3.69 g/24 hours. The extremes were 0.37 and 18.50 g/24h. Patients had nephrotic proteinuria in 84.86%. Non-specific FSGS or NOS (Not Other Specificities) was found in 62 cases or 39.24%, collapsing FSGS in 48 cases or 30.40%. FSGS with found causes was associated with fibrosis in 5/35 cases. Collapsing FSGSs followed by NOS FSGSs were the most corticosteroid-resistant. The evolution of the FSGS reveals that every 8 months the proteinuria decreases by half. Conclusion: Segmental and focal hyalinosis requires histological confirmation and the epidemiological, clinico-biological, etiological, therapeutic and evolutionary profiles depend on the histological (pathological) type. Other works on the risk factors for occurrence and the contribution of electron microscopy in the primary and secondary diagnosis of segmental and focal hyalinosis are desired.

Lesions Superimposed by Traditional Medicine on Renal Biopsies in Senegal

Traditional African medicine products are responsible for kidney damage that baffles both nephrologists and pathologists. Renal biopsies reveal acute or chronic inflammatory changes that cannot be explained by the progressive stage of the basic lesion of the nephropathy. The aim of this study is to analyze the lesions superimposed on 73 kidney biopsies from patients who took traditional herbal medications to treat the symptoms of kidney disease.

Characterization of Bleeding and Laboratory Phenotype in Hemophilia A Carriers: A Cross-Sectional Study in Benin

Background: In Africa, hemophilia is underdiagnosed and carriers have long been considered free from bleeding symptoms. However, recent research has begun to reveal hemostatic abnormalities and bleeding manifestations in carriers of hemophilia A, particularly due to excessive inactivation of normal X chromosomes. Objective: To describe the bleeding symptoms and hemostatic abnormalities in carriers of hemophilia A (HA) in Benin. Methods: This study was conducted as a prospective cross-sectional investigation between April 2021 to March 2022. The study population consisted of identified through pedigrees of persons with hemophilia A being treated in various hospitals in Benin. Data were collected through interviews conducted by trained physician and each carrier underwent a biological workup. Results: A total of 71 hemophilia A carriers were included and 38 of whom were obligatory carriers. Thirty-one carriers (43.7%) reported abnormal bleeding symptoms. Menorrhagia has (71%) being the most important manifestation, followed by bleeding during or after childbirth (45.2%). Among the 71 carriers, 45 were of reproductive age. Of whom 22 (48.8%) had a Higham score exceeding 100. Activated partial thromboplastin time was prolonged in 7 carriers (9.9%). The mean activity factor VIII:C (FVIII:C) levels were 68.8 ± 34.9 IU/dL. The average FVIII:C level in obligatory carriers was 56.9% and among potential carriers, the average FVIII:C level was higher at 80.4%. However twelve female carriers (16.9%) had FVIII:C levels < 40%. The FVIII:C/FvWAg ratio was below 0.7 in 73.2% of female drivers. Obligatory carriers (p = 0.00003) and FVIII;C/FvWAg ratio = 0.003) were statistically associated with abnormal bleeding symptoms, while blood group O (p = 0.0002) and FVIII/FvWAg ratio = 0.0016) were associated with a higher risk of menorrhagia. Conclusion: In Benin, carriers of haemophilia A present bleeding symptoms and haemostatic abnormalities. Further studies on a larger number of carriers are needed to better characterize and manage these patients.