RESUMEN
A prospective study was carried out in two tertiary hospitals in Dakar to determine the main causes of sputum acid-fast bacillus (AFB) smear-negative pneumonia in HIV-infected patients. All clinical and microbiological records were reviewed by experts. Seventy patients were finally enrolled. Most of them were hospitalized at an advanced stage of AIDS. The median CD4 cell count was 62/mm(3) and the median body mass index (BMC) was 18 kg/m(2). Thirty-one patients (44 %) were known as seropositive for HIV infection prior to admission. Radiological opacities were localized in 70 % of patients and diffuse in 21 %. Fiberoptic bronchoscopy was performed in 50 patients (71 %). A definite or probable diagnosis was obtained in 55 patients (79 %). Bacterial pneumonia (usually due to Enterobacteriaceae and Pseudomonas aeruginosa), tuberculosis, Pneumocystis pneumoniae and other causes (Kaposi's sarcoma, atypical mycobacteria) were diagnosed in 67 %, 24 %, 5 %, and 13 % of these patients respectively. In conclusion, pneumonia of bacterial origin and tuberculosis can be incriminated in the majority of cases of AFB negative pneumonia observed in HIV patients in Dakar.
Asunto(s)
Infecciones por VIH/complicaciones , Hospitalización , Neumonía Bacteriana/microbiología , Árboles de Decisión , Humanos , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/etiología , Neumonía Bacteriana/terapia , Estudios Prospectivos , SenegalRESUMEN
A retrospective study was carried out from January 2000 to December 2003 to assess the resistance of Mycobacterium tuberculosis to antituberculosis drugs and the impact of this on the treatment result. Two hundred and two patients' files were studied (average age: 36 years; sex-ratio: 1.7). Pulmonary localisation (85.7%) or extrapulmonary localisation (14.3%). HIV status is negative (71.3%), positive (10.8%) or unknown (17.9%). The overall recovery rate is 60.7% (61.4% in HIV-; 46.1% in HIV+), the rate of treatment failure is 2.7% (1.1% in HIV-; 15.4% in HIV+), the death rate due to tuberculosis is 6.3% (2.3% in HIV-; 23.1% in HIV+), and the rate of patients who disappeared from the system is 30.3% (35.2% in HIV-; 14.2% in HIV+). Hepatotoxicity that occurred during treatment is observed in 14.3% of cases (recovery: 56.2%; failure: 6.2%; lost from the system: 18.8%). Eighty-four percent of patients never received antituberculosis treatment (group A) versus 15.8% of patients who had already received one or more antituberculosis drugs (group B). The rates of resistance to isoniazid are 6.4% (A) and 12.5% (B), to rifampicin 1.7% (A) and 12.5% (B), to ethambutol 0.5% (A) and 0% (B), to streptomycin 24.1% (A) and 46.8% (B). The percentage of multiresistant strains is 1% in patients not treated previously and 11% in those who had already received antituberculosis treatment. When the patients are carriers of a strain that is responsive to the treatment administered, the recovery rate is 64.2% versus 46.7% in patients whose strain is resistant to at least one of the treatments administered.
Asunto(s)
Antituberculosos , Infecciones por VIH/epidemiología , Huésped Inmunocomprometido , Mycobacterium tuberculosis , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Etambutol/administración & dosificación , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Hospitales Universitarios/estadística & datos numéricos , Humanos , Isoniazida/administración & dosificación , Masculino , Pruebas de Sensibilidad Microbiana , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , Estudios Retrospectivos , Rifampin/administración & dosificación , Senegal/epidemiología , Estreptomicina/administración & dosificación , Insuficiencia del Tratamiento , Resultado del Tratamiento , Tuberculosis/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiologíaRESUMEN
Nocardiosis is a rare disease that is difficult to diagnose. Pulmonary forms are most common in association with a variety of nonspecific symptoms. Up to now isolation of the offending species, i.e., Nocardia aroensis, has been reported only once during the first description in Japan. The purpose of this article is to report the second world case of isolation of the Nocardia aroensis in a 50-year-old immunocompetent African woman.
Asunto(s)
Pulmón/microbiología , Nocardiosis/diagnóstico , Antibacterianos/uso terapéutico , Femenino , Humanos , Inmunocompetencia , Persona de Mediana Edad , Nocardia/genética , Nocardia/aislamiento & purificación , Nocardiosis/tratamiento farmacológico , Reacción en Cadena de la Polimerasa , SenegalRESUMEN
During a mission in ex-Yugoslavia between 2001 and 2004, three French soldiers were sent home because of right pneumopathy, right pleurisy after appendicectomy, haemoptysis and liver haematoma, respectively. They previously were stationed in Africa and/or South America. The initial diagnosis was quickly modified: pleuropulmonary manifestations of amoebic hepatic abscess in two cases, and pleuropulmonary amoebiasis in the last case. The outcome was favourable with standard anti-amoebic treatment. The reports illustrate the possibility of hepatic amoebiasis with local pleuropulmonary manifestations and an exceptional case of pleuropulmonary amoebiasis with hepatobronchial fistula. The authors report this experience because it demonstrates that amoebiasis in European countries remains an often forgotten diagnosis. Although known for a long time in developing countries, amoebiasis in the military or in tourists should be systematically considered.
Asunto(s)
Fístula Bronquial/parasitología , Entamoeba histolytica , Absceso Hepático Amebiano/diagnóstico , Hígado , Adulto , Amebiasis/diagnóstico , Antiprotozoarios/uso terapéutico , Fístula Bronquial/tratamiento farmacológico , Fístula Bronquial/cirugía , Países en Desarrollo , Fístula del Sistema Digestivo/parasitología , Entamoeba histolytica/aislamiento & purificación , Humanos , Hígado/parasitología , Absceso Hepático Amebiano/tratamiento farmacológico , Absceso Hepático Amebiano/cirugía , Enfermedades Pulmonares Parasitarias/diagnóstico , Masculino , Personal Militar , Derrame Pleural/parasitología , Resultado del TratamientoRESUMEN
Tuberculous spondylitis is the most common form of musculoskeletal tuberculosis. However, extraspinal manifestations have been described with tuberculosis of the wrist, femur, foot or shoulder, as in the patient presented. Because of an often-indolent clinical presentation, the diagnosis is delayed and antituberculous treatment is not able to prevent serious bone destruction.
Asunto(s)
Dolor de Hombro/etiología , Tuberculosis Osteoarticular/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Senegal , Tuberculosis Osteoarticular/tratamiento farmacológicoRESUMEN
Posters have become an essential tool for dissemination of study findings at medical meetings. By presenting a quick snapshot, posters can be an effective means of communicating the main findings of the research quickly and of stimulating rewarding exchanges with the people in attendance. Success depends on catching and holding the attention of passing attendees long enough to establish contact and share knowledge and experience. The purpose of this article is to provide a few guidelines and techniques for preparing and presenting effective and clear research posters at scientific meetings.
Asunto(s)
Recursos Audiovisuales , Congresos como Asunto , Investigación Biomédica , HumanosRESUMEN
Nosocomial Infection (NI) is also observed in healthcare facilities in non-Western countries. The purpose of this report is to describe the findings of a survey undertaken to evaluate hygiene procedures implemented at the "Hopital Principal" in Dakar, Senegal and to assess perception and awareness of nosocomial risk among the hospital staff. A total of 264 healthcare workers were interviewed. Mean age was 39 years (range, 18-60) and the sex ratio was 1.3 (150 men/114 women). Sixty (22.7%) had university degrees, 106 (40.2%) had secondary school diplomas, 50 (18.9%) had attended middle school, and 13 (4.9%) had no schooling. Analysis of interview data showed that 56.1% (157/264) defined NI as infection acquired at the hospital but that only 9.8% (n=26) knew that a minimum 48-hour delay was necessary to distinguish nosocomial from community acquired infection. While understanding about NI was correlated with education level, data showed that 1 out of 3 physicians (13/39) failed to give the exact definition. Hand contact was cited as the second route of transmission. Isolation precautions were understood by 22.7% of personnel (60/264). Systematic handwashing was reported by 363% (96/264) but observation demonstrated that it was not performed properly regardless of the category of personnel. Care protocols were understood by 54.6% of persons interviewed (144/264). A hygiene-training course had been attended by 52.2% (n=138). Two thirds of the staff (69.7%: 54/264) was able to identify the hygiene nurse. Ninety-eight health care providers (37.1%) were familiar with the CLIN (Comités de Lutte contre les Infections Nosocomiales).
Asunto(s)
Competencia Clínica , Infección Hospitalaria/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Control de Infecciones , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal de Hospital , Riesgo , SenegalRESUMEN
Les infections nosocomiales (IN) n'epargnent pas les etablissements de sante des pays non-occidentaux. La mise en place de procedures d'hygiene et l'etude des structures de representation du risque nosocomial chez les soignants ont fait l'objet d'une enquete parmi le personnel de l'hopital Principal de Dakar. La population etudiee a une moyenne d'age de 39 ans (18-60 ans) avec un sex-ratio de 1;3 (150H/114F). Soixante personnes ont fait des etudes superieures (22;7); 106 ont un niveau secondaire deuxieme cycle (40;2); cinquante ont un niveau secondaire premier cycle (18;9) et treize n'ont pas ete scolarisees (4;9). L'analyse des entretiens a montre que si 56;1(157/264) du personnel interroge definissent les IN comme acquises a l'hopital; ils ne sont que 26 (9;8) a connaitre le delai minimum de 48 heures qui permet de distinguer le caractere communautaire du nosocomial. Si le niveau de connaissance est proportionnel au niveau d'etude; on note toutefois que pres d'1/3 (13/39) des medecins n'en ont pas donne la definition exacte. Le manu-portage n'est donne que comme 2eme cause de transmission d'infection; l'isolement geographique et technique est connu par 22;7(60/264) du personnel; le lavage des mains systematique est theoriquement effectue par 36;3(96/264) des soignants mais l'enquete d'observation a montre que celui ci n'etait pas conforme quelque soit la categorie de personnel. Les protocoles de soins sont connus par 54;5(144/264) des personnes interrogees; un enseignement d'hygiene a ete suivi par 138 (52;2) soignants. L'infirmiere hygieniste est identifiee par les 2/3 du personnel (69;7soit 184/264); le CLIN est correctement defini et connu par 98 soignants (37;1)
Asunto(s)
Infección HospitalariaRESUMEN
AIM: Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). METHODS: In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. RESULTS: During 1 year, 38 patients were enrolled (23 males, mean age=36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (<1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (12-24 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. CONCLUSION: In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE.
Asunto(s)
Antituberculosos/uso terapéutico , Derrame Pleural/tratamiento farmacológico , Tuberculosis Pleural/tratamiento farmacológico , Adulto , Causas de Muerte , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Linfocitosis/patología , Masculino , Derrame Pleural/patología , Estudios Retrospectivos , Senegal , Resultado del Tratamiento , Prueba de Tuberculina , Tuberculosis Pleural/diagnósticoRESUMEN
The PubMed search engine is an essential tool to stay abreast of the latest medical literature on specific topics. While the basic search techniques are common knowledge, the ability to use medical subject headings properly is an essential in obtaining valuable references. The purpose of this article is to explain what medical subject headings are and how they can be used to improve the results of reference searches in PubMed.
Asunto(s)
Almacenamiento y Recuperación de la Información/métodos , Almacenamiento y Recuperación de la Información/normas , Medical Subject Headings , PubMedAsunto(s)
Recuento de Leucocitos , Fiebre Tifoidea/sangre , Adolescente , Femenino , Humanos , Masculino , Valores de Referencia , Razón de MasculinidadRESUMEN
Management of type II diabetes in sub-Saharan Africa presents a number of aspects that must be analyzed successively. Regarding the continent of Africa, implementing a strategy to control diabetes will require extensive information and education campaigns not only for health care workers but also for the general population as well as the creation of adequate infrastructure to optimize the availability of treatment. Regarding care modalities in Africa, the overall principles of management are the same as anywhere in the world. However these modalities must be adapted to the sociocultural environment of the patient. Objectives must be simplified without compromising the scientific requirements. Regarding patients, African perceptions about the disease are very different from those taught in Western schools. The different ethnocultural components of the disease must be recognized in order to optimize overall patient management.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Adulto , África del Sur del Sahara/epidemiología , Complicaciones de la Diabetes/prevención & control , Femenino , Política de Salud , Humanos , Hipertensión/epidemiología , Masculino , Educación del Paciente como Asunto , Prevención PrimariaRESUMEN
La prise en charge du diabete de type 2 enAfrique subsaharienne presente des particularites qui doivent etre analysees en plusieurs etapes. Au niveau du continent africain : les grands axes de lutte contre le diabete en Afrique comporteront necessairement la mise en place de vastes plans d'information et d'education des professionnels de sante et de la population en general; ainsi que la creation d'infrastructures suffisantes en assurant une disponibilite optimale des traitements .Au niveau des soignants : les principes de prise en charge globale sont les memes que partout ailleurs dans le monde. Ils doivent etre adaptes au contexte socioculturel du patient. Les objectifs doivent etre simples mais repondre aux exigences scientifiques. Au niveau du patient : la realite de la maladie telle qu'elle est percue par le malade africain est bien differente de ce que qui est enseigne dans les facultes occidentales. Les differentes composantes ethnoculturelles de la maladie doivent etre reconnues pour optimiser la prise en charge globale du patient
Asunto(s)
ObesidadRESUMEN
Development of antiparasite medications over the last 15 years has greatly reduced the number of treatment failures for intestinal helminthiasis. Benzimidazole derivatives, ivermectine, praziquantel and triclabendazole are easy to use, well tolerated and generally curative. First-line treatment are currently so reliable that failure should lead first to investigation of possible "false failure" causes such as misdiagnosis, poor identification of the parasite, inadequate or incorrect treatment, and repeat contamination, before concluding that genuine parasite resistance is involved and that alternative therapy is needed. Nitazoxanide is an alternative treatment for fascioliasis and teniasis. Albendazole can be beneficial for taeniasis and strongyloidiasis. Metronidazole can be effective for fascioliasis. Artemisinine derivatives are useful for schistosomiasis. Combined therapies are necessary for refractory ankylostomiasis.
Asunto(s)
Antihelmínticos/uso terapéutico , Helmintiasis/tratamiento farmacológico , Parasitosis Intestinales/tratamiento farmacológico , Albendazol/uso terapéutico , Anquilostomiasis/tratamiento farmacológico , Arteméter , Artemisininas/uso terapéutico , Bencimidazoles/uso terapéutico , Resistencia a Medicamentos , Fascioliasis/tratamiento farmacológico , Nitrocompuestos , Esquistosomiasis/tratamiento farmacológico , Estrongiloidiasis/tratamiento farmacológico , Teniasis/tratamiento farmacológico , Tiazoles/uso terapéutico , Insuficiencia del TratamientoRESUMEN
We report a highly probable case of moderately severe blackwater fever. A French woman, living in Guinea Bissau, was used to taking self-medication halofantrine for malaria. On this occasion, she felt unusual chills and pyrexia after a non documented bout of malaria, followed by nausea, then jaundice with dark-red urines despite another treatment with halofantrine. A sepsis was eliminated by two negatives thick peripheral blood drop examinations. Hemolysis was noted with 8.1 g/dl of hemoglobin, Coombs positive, and LDH at 1,452 IU/l, associated to renal failure with 34 ml per minute of clearance. The outcome was favourable with rehydration. Blackwater fever has been described with the three aminoalcohols, but mainly in severe presentations. Clinicians are not familiar with this disease, even though it has major therapeutic implications: quinine, halofantrine, and mefloquine become strictly contra-indicated. Moderate forms may be unknown, and this observation should be taken into account to prevent mistreatment in future patients.
Asunto(s)
Antimaláricos/uso terapéutico , Fiebre Hemoglobinúrica/diagnóstico , Lesión Renal Aguda , Fiebre Hemoglobinúrica/sangre , Fiebre Hemoglobinúrica/tratamiento farmacológico , Femenino , Guinea , Hemólisis , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: We report our experience of using sildenafil in treatment on primary arterial pulmonary hypertension. PATIENT: This case concern a 38 years old senegalese woman. She was hospitalised for global cardiac failure with right signs predominance and grade IV dyspnea related to pulmonary hypertension. RESULTS: No evident cause of the pulmonary hypertension had been found after explorations. Adding sildénafil to her symptomatic treatment provided fast favourable evolution quantified by clinical test and Doppler-ultrasound heart examination. However the patient died three month later by cerebral hemorrhage due to overdose of antivitamine K. CONCLUSION: We suggest using sildenafil in the treatment of primary arterial pulmonary hypertension on the way going to cardio-pulmonary transplantation.
Asunto(s)
Hipertensión Pulmonar/tratamiento farmacológico , Piperazinas/uso terapéutico , Sulfonas/uso terapéutico , Vasodilatadores/uso terapéutico , Adulto , Femenino , Humanos , Purinas/uso terapéutico , Senegal , Citrato de SildenafilRESUMEN
Hydroxyurea is an antineoplasic agent usually used in myeloproliferative syndromes, but also in other benign pathological circumstances. Several dermatological manifestations have been recognized as being secondary to its prolonged use, of which the leg ulcer. We report an observation. Mrs. L.D, 47 years, were hospitalized on July 14, 2004 for an ulcer of left ankle in a feverish context. She was followed since 2001 for a chronic myelogenous leukaemia, and took hydroxyurea at a rate of 1500 mg per day, with a good clinical and hematologic answer. She presented a painful ulcer compared to the left external malleolus, with purulent bottom, without signs of vascular attack. The hemogram showed a hyperleucocytosis with 24.000 white elements/mm3 with neutrophilic polynucleosis. Pus sample on the ulcer showed Pseudomonas aeruginosa, and the blood culture was negative. The cure was obtained two months after stopping hydroxyurea. The ulcer of leg related to hydroxyurea is a seldom described pathology. Its occurrence imposes the final stop of the treatment.
Asunto(s)
Antineoplásicos/efectos adversos , Hidroxiurea/efectos adversos , Úlcera de la Pierna/inducido químicamente , Antineoplásicos/administración & dosificación , Femenino , Humanos , Hidroxiurea/administración & dosificación , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
A 36-year old immunocompetent male from Senegal with an uneventful history was admitted for exploration of a bullous collection in the posterior mediastinum. Multifocal tuberculosis was diagnosed. Computed tomography-guided drainage removed 600 cc of caseum. The diagnosis as rupture of intrathoracic Pott's abscess complicated by a probably esophageal fistula. The clinical course was rapidly favorable with later development of mediastinal fibrosis. This uncommon case illustrates the contribution of interventional radiology recently developed in the Principal Hospital in Dakar, Senegal.