In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.
Abstract Despite the use of several effective control interventions in the central western Senegal, residual malaria transmission still occurring in some hotspots. In order to better understand the factors associated with this situation to better tailor targeted control actions, it is critical to unravel environmental and geographical factors underlying the persistence of the disease in study hotspot villages. Hotspots villages were defined as those reporting more than six indigenous malaria cases during the previous year. A total of ten villages, including seven hotspots and three non-hotspots, were surveyed. All potential mosquito breeding sites identified in and around the tenth study villages were regularly monitored between 2013 and 2017. This monitoring concerned the presence of anophelines larvae and the collection of epidemiological, hydrogeological, topographical and biogeographical data. Throughout the study area, the number of larval breeding sites inventoried and monitored over the study period ranged from 50 to 62. They were higher, with no significant difference, in hotspot sites than in non-hotspot sites for each year of monitoring with 62.3% (56/62) in 2013, 90.9% (50/55) in 2014, 90.3% (56/62) in 2015 and 86% (43/50) in 2017 (Fisher’s exact test; p = 1). The Hotspot villages were mostly characterized by saline or moderately saline hydro-morphic and halomorphic soils allowing water retention and a suitable presence of potential larval breeding sites. Whereas non-hotspot villages are characterized mainly by a high proportion of extremely permeable sandy-textured soils due to their porosity, which reduces water retention. The annual number of confirmed malaria cases was corelated relatively with the frequency and extent of breeding sites. Malaria cases were much more higher in the hamlets located near to the breeding sites of An. gambiae s.l then gradually decreases with their remoteness. This study has shown that the dynamics of larval breeding sites by their longevity, stability, proximity to houses and their positiveness rate for the presence of Anopheles larvae could be a determining factor in the persistence of malaria hotspots in central western Senegal. The results of this study shed more light on the environmental factors underlying the residual transmission and should make it possible to better organize vector control interventions for malaria elimination in west-central Senegal.
In the central western Senegal, malaria transmission has been reduced low due to the combination of several effective control interventions. However, despite this encouraging achievement, residual malaria transmission still occurring in few areas, mainly ensured by An. arabiensis and An. melas. The resurgence or the persistence of the disease may have originated from the increase and the spread of insecticide resistance genes among natural malaria vectors populations. Therefore, assessing the status and mechanisms of insecticides resistance among targeted malaria vectors is of highest importance to better characterize factors underlying the residual transmission where it occurs. Malaria vectors were collected from three selected villages using nocturnal human landing catches (HLC) and pyrethrum spray collections (PSC) methods. An. gambiae s.l. specimens were identified at the species level then genotyped for the presence of kdr-west (L1014F), kdr-east (L1014S) and ace-1R mutations by qPCR. An. arabiensis (69.36%) and An. melas (27.99%) were the most common species of the Gambiae complex in the study area. Among An. arabiensis population, the allelic frequency of the kdr-east (22.66%) was relatively higher than for kdr-west mutation (9.96%). While for An. melas populations, the overall frequencies of both mutations were very low, being respectively 1.12% and 0.40% for the L1014S and L1014F mutations. With a global frequency of 2%, only the heterozygous form of the G119S mutation was found only in An. arabiensis and in all the study sites. The widespread occurrence of the kdr mutation in both An. arabiensis and An. melas natural populations, respectively the main and focal vectors in the central-western Senegal, may have contributed to maintaining malaria transmission in the area. Thus, compromising the effectiveness of pyrethroids-based vector control measures and the National Elimination Goal. Therefore, monitoring and managing properly insecticide resistance became a key programmatic intervention to achieve the elimination goal where feasible, as aimed by Senegal. Noteworthy, this is the first report of the ace-1 mutation in natural populations of An. arabiensis from Senegal, which need to be closely monitored to preserve one of the essential insecticide classes used in IRS to control the pyrethroids-resistant populations.
RESUME Introduction. Le cancer broncho-pulmonaire primitif est un probleme de sante publique peu etudie au plan anatomopathologique au Senegal. Le but de notre travail etait de decrire le profil epidemiologique et histologique de ce cancer dans ce contexte. Methodologie. Il s’agit d’une etude retrospective incluant tous les cas de cancer broncho-pulmonaire primitif, diagnostiques dans les laboratoires d'anatomie et de cytologie pathologique de Dakar, sur une periode de 5 ans. Resultats. Nous avons recense 161 patients dont 86,2 % d’hommes. Les sujets âges de 60 ans et plus (50%) et ceux provenant de la population active (44,1%) etaient les plus touches. Les fumeurs actifs representes 87,5% des cas renseignes, dont un nombre moyen de paquets-annee chiffre a 42,9. Les biopsies constituaient l’essentiel des prelevements (96,3%). Le type histologique predominant etait l’adenocarcinome (45,3%). Il touchait davantage les femmes (64,3%), essentiellement âgees. Conclusion. Le cancer broncho-pulmonaire primitif au Senegal touche autant les sujets âges que la population active, surtout tabagique et se caracterise par une predominance des adenocarcinomes affectant plus les femmes âgees. Il est souvent diagnostique a un stade inoperable. La prevention primaire, le diagnostic precoce et l’etude des facteurs de risque et alterations moleculaires sont de mise. ABSTRACT Introduction. Primary bronchopulmonary cancer is a public health problem, and its histological features are largely unknown in Senegal. The aim of our study was to describe the epidemiology and the histological aspects of this cancer in our country. Methods. This was a cross sectional retrospective study carried out between January 2013 and December 2017, including all cases of primary bronchopulmonary cancer, diagnosed in the anatomy and pathological cytology laboratories in Dakar. Results: We recruited 161 patients, 86.2% of whom were men. Those aged 60 and over (50%) and those from the active population (44.1%) were the most affected. Active smokers represented 87.5% of the reported cases, with an average number of pack-years of 42.9. Biopsies made up the bulk of the samples (96.3%). The most common histological type was adenocarcinoma (45.3%), which most affected women (64.3%) who were usually elderly. Conclusion: Primary bronchopulmonary cancer in Senegal affects both the elderly and the active population, especially tobacco users. Adenocarcinoma is the most common histology and is affects more commonly older women. It is often diagnosed at an inoperable stage. Primary prevention, early diagnosis and study of risk factors and molecular alterations are essential.
Suite aux difficultes economiques qu'ont connu les pays du tiers-monde en general et les pays d'Afrique Noire en particulier, les bailleurs de fonds tels que la Banque Mondiale (BM), le Fonds Monetaire International (FMI) vont inciter ces pays a adopter les Programme d'Ajustement Structurel (PAS) afin de reequilibrer leurs depenses publiques.
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