The association of lung ultrasound images with COVID-19 infection in an emergency room cohort

Lung ultrasound could facilitate the triage of patients with suspected COVID‐19 infection admitted to the emergency room. We developed a predictive model for COVID‐19 diagnosis based on lung ultrasound and clinical features. We used ultrasound to image the lung bilaterally at two anterior sites, one and two hands below each clavicle, and a posterolateral site that was the posterior transverse continuation from the lower anterior site. We studied 100 patients, 31 of whom had a COVID‐19 positive reverse transcriptase polymerase chain reaction. A positive test was independently associated with: quick sequential organ failure assessment score ≥1; ≥3 B‐lines at the upper site; consolidation and thickened pleura at the lower site; and thickened pleura line at the posterolateral site. The model discrimination was an area (95%CI) under the receiver operating characteristic curve of 0.82 (0.75–0.90). The characteristics (95%CI) of the model’s diagnostic threshold, applied to the population from which it was derived, were: sensitivity, 97% (83–100%); specificity, 62% (50–74%); positive predictive value, 54% (41–98%); and negative predictive value, 98% (88–99%). This model may facilitate triage of patients with suspected COVID‐19 infection admitted to the emergency room.

The value of post-operative antibiotic therapy after laparoscopic appendectomy for complicated acute appendicitis: a prospective, randomized, double-blinded, placebo-controlled phase III study (ABAP study)

BACKGROUND

Approximately 30% of appendectomies are for complicated acute appendicitis (CAA). With laparoscopy, the main post-operative complication is deep abscesses (12% of cases of CAA, versus 4% for open surgery). A recent cohort study compared short and long courses of postoperative antibiotic therapy in patients with CAA. There was no significant intergroup difference in the post-operative complication rate (12% of organ/space surgical site infection (SSI)). Moreover, antibiotic therapy is increasingly less indicated for other situations (non-complicated appendicitis, post-operative course of cholecystitis, perianal abscess), calling into question whether post-operative antibiotic therapy is required after laparoscopic appendectomy for CAA.

METHODS/DESIGN

This study is a prospective, multicenter, parallel-group, randomized (1:1), double-blinded, placebo-controlled, phase III non-inferiority study with blind evaluation of the primary efficacy criterion. The primary objective is to evaluate the impact of the absence of post-operative antibiotic therapy on the organ/space surgical site infection (SSI) rate in patients presenting with CAA (other than in cases of generalized peritonitis). Patients in the experimental group will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, a placebo for ceftriaxone (2 g/24 h in one intravenous injection) and a placebo for metronidazole (1500 mg/24 h in three intravenous injections, for 3 days). In the control group, patients will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, antibiotic therapy (ceftriaxone 2 g/24 h and metronidazole 1500 mg/24 h for 3 days). In the event of allergy to ceftriaxone, it will be replaced by levofloxacin (500 mg/24 h in one intravenous injection, for 3 days). The expected organ space SSI rate is 12% in the population of patients with CAA operated on by laparoscopy. With a non-inferiority margin of 5%, a two-sided alpha risk of 5%, a beta risk of 20%, and a loss-to-follow-up rate of 10%, the calculated sample size is 1476 included patients, i.e., 738 per group. Due to three interim analyses at 10%, 25%, and 50% of the planned sample size, the total sample size increases to 1494 patients (747 per arm).

TRIAL REGISTRATION

Ethical authorization by the Comité de Protection des Personnes and the Agence Nationale de Sécurité du Médicament: ID-RCB 2017-00334-59. Registered on ClinicalTrials.gov (NCT03688295) on 28 September 2018.

Precision measurement of the fundamental vibrational frequencies of tritium-bearing hydrogen molecules: T2, DT, HT

High-resolution coherent Raman spectroscopic measurements of all three tritium-containing molecular hydrogen isotopologues T2, DT and HT were performed to determine the ground electronic state fundamental Q-branch (v = 0 → 1, ΔJ = 0) transition frequencies at accuracies of 0.0005 cm-1. An over hundred-fold improvement in accuracy over previous experiments allows the comparison with the latest ab initio calculations in the framework of non-adiabatic perturbation theory including nonrelativisitic, relativisitic and QED contributions. Excellent agreement is found between experiment and theory, thus providing a verification of the validity of the NAPT-framework for these tritiated species. While the transition frequencies were corrected for ac-Stark shifts, the contributions of non-resonant background as well as quantum interference effects between resonant features in the nonlinear spectroscopy were quantitatively investigated, also leading to corrections to the transition frequencies. Methods of saturated CARS with the observation of Lamb dips, as well as the use of continuous-wave radiation for the Stokes frequency were explored, that might pave the way for future higher-accuracy CARS measurements.

A rare case of non-traumatic rupture of spleen secondary to Plasmodium ovale malaria

Objective

Plasmodium ovale malaria occurs mainly from mild form of malaria. We present a rare case of a splenic rupture secondary to complication of Plasmodium ovale malaria.

Clinical presentation

A 41-year-old female from Mali admitted to intensive care unit with hemorrhagic shock secondary to splenic rupture. A laparoscopic exploration was performed and patient received a massive blood transfusion for a hemodynamic stabilization. The diagnosis of malaria was confirmed by a blood smear test indicating the presence of P. ovale. A treatment of injectable Quinine was initiated with a positive outcome.

Conclusion

Although usually considered as a cause of a mild form of malaria, P. ovale may be responsible for a ruptured spleen which can lead to a state of life- threatening hemorrhagic shock.

[Diagnostic performance of imaging examinations in acute non-traumatic abdominal pain in the radiology department of the Kaolack Regional Hospital]

AIM

The aim of this work was to evaluate the diagnostic performance of imaging examinations in the presence of acute non-traumatic abdominal pain.

MATERIALS AND METHODS

This was a prospective, cross-sectional and descriptive study over 6 months in the radiology and medical imaging department of the Kaolack Regional Hospital, including any patient received for acute non-traumatic abdominal pain with informed consent in whom the etiological diagnosis is supported by an imaging examination. We investigated the etiologies of acute abdominal pain and compared the imaging findings with surgical exploration. Our data were analyzed using SPSS 24.0 and Excel 2013 with a coefficient of significance of less than 5%.

RESULTS

106 patients were enrolled. The mean age was 32 years and the gender-ratio was 1.52 in favour of women. Acute abdominal pain was diffuse in 25.5% of patients and localized in 74.5%, of which 18.9% were at right iliac fossa.Abdominal X-ray was performed alone in 4 patients (3.8%), ultrasound alone in 46 patients (43.3%) and abdominal CT scan in 34 patients (32%). CT was combined with ultrasound in 6 patients (5.7%) and with abdominal X-ray in 16 patients (15%). The initial clinical diagnosis was corrected in 49.1% of patients. The sensitivity of the imaging compared to the final diagnosis retained was 96.2%.

CONCLUSION

Imaging represents a turning point in the management of patients with acute non-traumatic abdominal pain by providing better diagnostic guidance and avoiding serious complications and unnecessary interventions.

[Evaluation of Physical Integrity and Biological Efficacy of Two Types of LLINs Aged 5 to 36 Months Sampled in 11 Districts of Senegal]

The long-lasting insecticidal nets (LLINs) have been promulgated to compensate the low re-impregnation rate of conventional mosquito nets. Today, the cornerstone of the fight against malaria vectors is based on a large distribution of these LLINs for universal coverage. Despite this promotion, the question of their effective life in operational conditions remains unresolved. Between September and October 2013, a survey was conducted in 11 districts of Senegal where LLINs were sampled and routed to the laboratory for assessing their physical integrity and biological effectiveness. A total of 207 LLINs that were sampled in the 11 districts have been monitored during this study. Our results showed that Olyset® Net and PermaNet® 2.0 are the most represented brands in the districts. These two major brands have a good biological efficiency providing a high rate of knockdown despite their failing physical integrity.

The "pouch" of the Douglas's pouch

Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.

Vascular expression of annexin A2 in lupus nephritis

AIMS

To evaluate vascular expression of annexin A2 (ANXA2) and its subunit S100A10 in lupus nephritis (LN).

METHODS

The present histological study included 14 patients with LN and 11 controls (patients with non-lupus kidney diseases). Kidney biopsies from patients with lupus were scored for lupus glomerulonephritis (according to the International Society of Nephrology/Renal Pathology Society 2003 classification) and vascular lesions (such as microthrombi and antiphospholipid syndrome nephropathy (APSN)). ANXA2 and S100A10 expression in glomerular and peritubular capillaries was evaluated by immunohistochemistry on tissue sections. The staining intensity score ranged from 0 (no expression) to 4 (intense expression).

RESULTS

In patients with LN, the median age (range) at first kidney biopsy was 36 (18-49). Vascular lesions were observed in six patients (including two with APSN). We observed intense expression of ANXA2 in glomerular and peritubular capillaries while expression of S100A10 was weaker. However, one of the patients with APSN showed strong S100A10 expression. Patients with LN and controls differed significantly in terms of S100A10 expression in peritubular capillaries. We also observed a statistical difference between patients who had LN with renal vascular lesions and those without renal vascular lesions in terms of ANXA2 expression in peritubular capillaries.

CONCLUSIONS

The presence of vascular lesions in LN appears to be associated with significant differences in the vascular expression of ANXA2. Vascular expression of ANXA2 was somewhat higher in LN. Vascular expression of S100A10 was somewhat lower in LN (except one of the two patients with APSN). Further studies of ANXA2's putative value as a biomarker of active LN or of vascular lesions in LN are required.

Stroke and periodontal disease in Senegal: case-control study

OBJECTIVE

To determine the periodontal factors associated with stroke in melanodermic subjects in Senegal.

STUDY DESIGN

Case-control study.

METHODS

One hundred and twenty cases and 120 controls were included in this study. Cases had been diagnosed with stroke by a neurologist, with the diagnosis confirmed by scanner. Controls had never had any type of stroke. Data were collected regarding sociodemographic characteristics, lifestyle behaviours, general history, type of stroke (ischaemic or haemorrhagic) and periodontal parameters [plaque index, papillary bleeding index, pocket depth, clinical attachment loss, Community Periodontal Index of Treatment Needs and periodontitis (defined by clinical attachment loss >2 mm and pocket depth >3 mm)]. Logistic regression analysis was performed using R software to isolate a final model after adjustment for the 5% threshold.

RESULTS

All periodontal characteristics were more common among cases than among controls. Periodontitis (odds ratio 1.58, 95% confidence interval 1.1-3.022) and periodontal parameters were significantly associated with stroke, adjusted for hypertension, sedentary lifestyle, and the interaction between periodontitis and age.

CONCLUSIONS

Periodontal disease is associated with stroke in the Senegalese population. Prospective longitudinal studies should be undertaken to improve understanding.

Accuracy of impedance cardiography for evaluating trends in cardiac output: a comparison with oesophageal Doppler

BACKGROUND

Impedance cardiography (ICG) enables continuous, beat-by-beat, non-invasive, operator-independent, and inexpensive cardiac output (CO) monitoring. We compared CO values and variations obtained by ICG (Niccomo™, Medis) and oesophageal Doppler monitoring (ODM) (CardioQ™, Deltex Medical) in surgical patients.

METHODS

This prospective, observational, single-centre study included 32 subjects undergoing surgery with general anaesthesia. CO was measured simultaneously with ICG and ODM before and after events likely to modify CO (vasopressor administration and volume expansion). One hundred and twenty pairs of CO measurements and 94 pairs of CO variation measurements were recorded.

RESULTS

The CO variations measured by ICG correlated with those measured by ODM [r=0.88 (0.82-0.94), P<0.001]. Trending ability was good for a four-quadrant plot analysis with exclusion of the central zone (<10%) [95% confidence interval (CI) for concordance (0.86; 1.00)]. Moderate to good trending ability was observed with a polar plot analysis (angular bias: -7.2°; 95% CI -12.3°; -2.5°; with radial limits of agreement -38°; 24°). After excluding subjects with chronic obstructive pulmonary disease, a Bland-Altman plot showed a mean bias of 0.47 litre min(-1), limits of agreements between -1.24 and 2.11 litre min(-1), and a percentage error of 35%.

CONCLUSION

ICG appears to be a reliable method for the non-invasive monitoring of CO in patients undergoing general surgery.

The relationship between metformin therapy and sleep quantity and quality in patients with Type 2 diabetes referred for potential sleep disorders

AIMS

Given that sleep disorders are known to be related to insulin resistance, and metformin has favourable effects on insulin resistance and on ventilatory drive, we sought to determine whether metformin therapy was related to sleep variables in a group of patients with Type 2 diabetes.

METHODS

We performed a retrospective, observational study of our centre's database for patients referred for potential sleep disorders and then compared metformin-treated patients with those not treated with the drug. All study patients had undergone the same standard polysomnographic procedure. A multivariate analysis was performed to establish whether or not there was an independent relationship between metformin use and sleep variables (after adjusting for age, gender, BMI, neck circumference, cumulated risk factors and insulin use).

RESULTS

We studied 387 patients (mean ± sd age: 58.4 ± 10.8 years), of whom 314 had been treated with metformin. Total sleep time and sleep efficiency were higher in metformin-treated patients than in patients not treated with metformin [total sleep time: 6 h 39 min vs. 6 h 3 min, respectively (P = 0.002); sleep efficiency: 77.9 ± 12.3 vs. 71.5 ± 17.2%, respectively (P = 0.003)]. These differences persisted after adjustment for covariates and were observed even although metformin users had a higher BMI than did non-users (median 37.5 vs. 34.8 kg/m(2) ; P = 0.045).

CONCLUSION

We showed that metformin therapy is associated with a longer sleep duration and better sleep efficiency. Randomized clinical trials are needed to confirm metformin's favourable effect on sleep quality and quantity.

[Dental health status of 15 year-old schoolchildren in Comoros]

The epidemiological situation of decay evolves differently in the world. In industrialized countries, prevalence has declined significantly due to preventive measures, while in developing countries many studies have shown that caries was increasing. The aim of this study was to assess the state of dental health of schoolchildren aged 15 in Grand Comore (Comoros). This was a descriptive cross-sectional study on 15 year-old schoolchildren in colleges in Grande Comore who agreed to be examined. Four hundred schoolchildren were chosen by a stratified sampling weighted according to the area of living. Three groups of indicators of dental caries were used: the components D, M and F, the average DMFT and prevalence. The WHO modified questionnaire for the assessment of dental health was used to collect data; continuous data were compared by Student t test and qualitative ones by Chi-square test. Fifty two percent of schoolchildren were male and 63.5% lived in urban area. From the 888 teeth bearing the stigmata of decay, 83.2% were decayed, 12.5% missed and 4.3% filled. These components of DMF were associated with sex (p = 0.039) and not with area (p = 0.12). The 2.22 DMFT average was not associated with sex (p = 0.58) neither with area (p = 0.57). The caries prevalence was higher in rural than in urban areas (p = 0.001) and was not associated with sex (p = 0.61). These results suggest that schoolchildren need decay treatments. The dental programs will have much more success when they will be integrated into more comprehensive programs to promote schoolchildren health.

Social inequality and antenatal care: impact of economic welfare on pregnancy monitoring in Senegal

AIM

To explore the links between antenatal care (ANC) non-attendance and economic welfare. METHOD AND SUBJECT: This was a cross-sectional, descriptive and analytical study of women aged 15 to 49 years living in Senegal in 2005. Data were from the Demography and Health Survey using a two-stage random sampling procedure. Participants were classed by quintile using an economic well-being score based on housing characteristics and ownership of sustainable goods. The quality of ANC was determined from the number of visits, the qualification of the person delivering care, and content (counseling, weight, height and blood pressure measurements). Logistic regression was used for data analysis.

RESULTS

A total of 6927 women were surveyed. Mean age was 28.15 years (±2.6); 20.3% were primiparous; 61.2% resided in rural areas; 70.0% had received no education. Each of the first four economic quintiles included about 20% (19.2% to 21.5%) of the participants while 16.9% were in the fifth (richest) quintile. A total of 457 women (6.6%) did not undergo any ANC visit. ANC non-attendance increased with parity, decreased with education level and was higher in rural areas than in urban areas, OR=7.2 (95% CI [5.1-10.1]). It decreased with increasing economic well-being: OR=0.6 [0.47-0.75] 2nd quintile vs. 1st, OR=0.02 [0.01-0.05] 5th quintile vs. 1st, p<0.05 overall.

CONCLUSION

Economic welfare plays a major role in determining use of ANC. The only way to solve health problems is to reduce inequalities. The solution to this problem is beyond the scope of health but concerns an overall economic program involving the entire community, including policy-makers.

[Digestive pathology and oral condition in the rural populations of the Ferlo in Senegal]

The aim of this work was to study the association between dental and periodontal status and digestive pathology in the Ferlo populations in Senegal.

METHOD

This was a cross sectional study involving 300 people living in the area of the Ferlo in the Centre East of Senegal. Selected individuals must be over the age of 15 years and resided in the area. Cluster sampling helped recruit individuals. Collected information related to digestive pathology (yes or no), periodontal status (plate index, inflammation, bleeding, loss of attachment, the depth of pocket and the CPITN.) Dental status was evaluated by the DMFT. The data analyzed with software R and the Student's t test used to compare the averages of the indices in both groups at the threshold of 5%. Multivariate logistic regression analysis was used to isolate the final model with a threshold of 5%.

RESULTS

Averages of dental and periodontal index were broadly equal in both groups (sick and not sick). The DMF and missing teeth were significantly associated with the digestive pathology after adjustment on gender, age, BMI, marital status, the number of cigarettes smoked and the depth of pocket.

CONCLUSION

This study revealed a significant association between dental status and digestive pathology. The comprehensive care of patients therefore raises the interest of collaboration between surgeons, dentists and gastroenterologists for effective and adequate treatment.

Postpartum coccydynia: a case series study of 57 women

BACKGROUND

Although childbirth is a well-known cause of coccydynia, this condition has not been studied previously.

AIM

To explore the characteristics of postpartum coccydynia and identify risk factors.

DESIGN

A case series study.

SETTING

A specialist coccydynia clinic in a department of physical medicine in a university hospital.

METHODS

A series of 57 women suffering from postpartum coccydynia was analyzed and compared with a control group of 192 women suffering from coccydynia due to other causes. Dynamic radiography enabled a comparison of the coccygeal mobility in the two groups.

RESULTS

7.3% of the cases of coccydynia in female patients seen in our clinic were related to childbirth. The pain appeared as soon as the patient adopted the sitting position after delivery. The deliveries had often been performed with instruments (forceps deliveries: 50.8%; vacuum-assisted deliveries: 7.0%) or were spontaneous but described as "difficult" (12.3%). Luxation of the coccyx was observed in 43.9% of the cases and 17.0% of the controls. Fracture of the coccyx was involved in 5.3% of the cases. A body mass index >27 and ≥2 vaginal deliveries were associated with a higher prevalence of luxation of the coccyx.

CONCLUSION

Postpartum coccydynia is often associated with a difficult delivery, with the use of forceps in 50.8% of cases. Luxation and fracture of the coccyx are the two most characteristic lesions.

CLINICAL REHABILITATION IMPACT

Our results bring a better knowledge and should allow a better management of this specific etiology of coccydynia.

Ability of stroke volume variation measured by oesophageal Doppler monitoring to predict fluid responsiveness during surgery

BACKGROUND

The objective of this study was to test whether non-invasive assessment of respiratory stroke volume variation (ΔrespSV) by oesophageal Doppler monitoring (ODM) can predict fluid responsiveness during surgery in a mixed population. The predictive value of ΔrespSV was evaluated using a grey zone approach.

METHODS

Ninety patients monitored using ODM who required i.v. fluids to expand their circulating volume during surgery under general anaesthesia were studied. Patients with a preoperative arrhythmia, right ventricular failure, frequent ectopic beats, or breathing spontaneously were excluded. Haemodynamic variables and oesophageal Doppler indices [peak velocity (PV), stroke volume (SV), corrected flow time (FTc), cardiac output (CO), ΔrespSV, and respiratory variation of PV (ΔrespPV)] were measured before and after fluid expansion. Responders were defined by a >15% increase in SV after infusion of 500 ml crystalloid solution.

RESULTS

SV was increased by ≥15% after 500 ml crystalloid infusion in 53 (59%) of the 90 patients. ΔrespSV predicted fluid responsiveness with an area under the receiver-operating characteristic (AUC) curve of 0.91 [95% confidence interval (95% CI): 0.85-0.97, P<0.0001]. The optimal ΔrespSV cut-off was 14.4% (95% CI: 14.3-14.5%). The grey zone approach identified 12 patients (14%) with a range of ΔrespSV values between 14% and 15%. FTc was not predictive of fluid responsiveness (AUC 0.49, 95% CI: 0.37-0.62, P=0.84).

CONCLUSIONS

ΔrespSV predicted fluid responsiveness accurately during surgery over a ΔrespSV range between 14% and 15%. In contrast, FTc did not predict fluid responsiveness.

[Storage at room temperature does not change cisatracurium onset time: a prospective, randomized, double-blind controlled study]

OBJECTIVE

Storage of cisatracurium at room temperature seems to have no effect on its degradation in vitro contrary to the recommendations of storage at +4°C. The purpose of this study was to evaluate the influence of cisatracurium' s storage temperature on its onset time.

STUDY DESIGN

Prospective, randomized, double-blind trial study.

PATIENTS AND METHODS

Thirty patients were enrolled. The control group consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at room temperature and the intervention consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at +4°C. The primary endpoint was to compare cisatracurium onset time depending on the storage temperature.

RESULTS

Cisatracurium onset time was 235 (180-292) seconds in the "room temperature" group vs. 240 (210-292) seconds in the "refrigerated" group. There was no difference between the onset of cisatracurium depending on the temperature of storage (p=0.51). Subgroups analysis in the "room temperature" group did not show any difference in cisatracurium onset depending on whether it was stored at room temperature for one, two or three weeks. Excellent intubation score was obtained for 100% of the patients.

CONCLUSION

This study demonstrated that cisatracurium's storage at room temperature had no influence on its onset time. It provides an argument for the preservation of cisatracurium at room temperature for a period not exceeding 21 days. Monitoring the onset of curarization may increase the quality score of intubation.

Prevalence of necrotizing ulcerative gingivitis and associated factors in Koranic boarding schools in Senegal

BACKGROUND

Necrotizing ulcerative gingivitis is the most common clinical syndrome preceding noma. It is found in developing countries and in malnourished children and especially in deprived groups such as children at Koranic boarding schools. The objective of this study was to determine the prevalence of necrotizing ulcerative gingivitis and factors associated with its occurrence in a boarding school population.

METHODS

This was a cross-sectional study of children in Koranic boarding schools in the city of Touba, Senegal. A multistage sampling strategy was used and 8 out of 17 schools were selected. The variables collected were gender, age, oral hygiene habits, duration of residence, presence of ulcerative gingivitis and plaque, and gingival bleeding index. A logistic regression analysis with R software using the manual procedure down was used to identify factors associated with the dependent variables.

RESULTS

There were 501 participants and boys made up 92% of the study group. The mean age was 9.3 (sd 4.0) years. The mean of duration residence was 3.4 (sd 1.5) years. The prevalence of necrotizing ulcerative gingivitis was 37% and 81% of children did not use a toothbrush or a chewing-stick. The length of residence, school size, hygiene habits and plaque and bleeding indices were significantly associated with necrotizing gingivitis after adjustment for other variables.

CONCLUSION

It is necessary to develop oral hygiene programs, to establish policies to manage the oral health of children and to improve health and nutrition at Koranic boarding-schools.

[Pregnant women living in areas of endemic fluorosis in Senegal and low birthweight newborns: case-control study]

BACKGROUND

In developing countries, maternal and neonatal mortality is high. Among the causes of death during the neonatal period, low birth weight is crucial. A dose of fluoride beyond 2mg/L causes enamel damage, possibly affecting the fetus. The aim of this study was to search for an association between dental fluorosis in the mother and low birthweight of the newborn.

METHODOLOGY

This was a case-control study performed in an endemic area in Senegal (Diourbel). It included 108 mothers who gave birth to newborns weighing less than 2500 g (cases) and 216 mothers with newborns weighing greater or equal to 2500 g (controls). Data on socio-demographic, lifestyle, history and pregnancy variables were collected. Those related to water consumption during pregnancy and dental fluorosis (Dean's index) were measured. The data were analyzed by R software. Logistic regression was used to identify associations and the statistical significance level was set to 0.05.

RESULTS

The proportions of mothers consuming well water were 62% among cases versus 43.5% among controls. The score 4 of Dean's Index was reported for 25.9% of cases versus 6.9% of controls. The water consumed and the modal score of Dean's Index were significantly associated with the occurrence of low birthweight adjusted for gender, consanguinity, anemia and hypertension.

CONCLUSION

Low birthweight was associated with pregnant women living in endemic areas. Defluoridation programs and access for pregnant women and children to high quality water are necessary in areas of endemic fluorosis.

[Prosthetic rehabilitation: needs in Senegalese dental offices]

Knowledge of dental prosthetic needs will develop strategies for prevention and treatment through a package of individual, community and professional policies. The aim of this study was to evaluate prosthetic needs in Senegalese dental offices. The survey was conducted among people aged 15 years and more attending Senegalese dental clinics. The mean number of missing teeth was 4.4. Only 55.3% of the sample expressed the need for dentures and 81.8% had a diagnosed need for prosthesis. A statistically significant difference was noticed between the needs diagnosed and the expressed needs (p < 0.0001). Finally, this study reveals that the need for prosthetic treatment is real in the Senegalese dental offices.

[Medicinal plants in Senegal and oral diseases: use and interest]

The end of the last century and the present decade is characterized by an evolution of the concept of health and illness in the public domain. The World Health Organization defines traditional medicine as "comprising various practices, approaches, knowledge and beliefs incorporating medicinal herbal, animal and/or mineral, spiritual therapies, applied alone or in combination to maintain well-being and to treat, diagnose or prevent disease. In dentistry, the plants used are numerous. The objective of this work is to describe the herbal medicine used against oral diseases. To conduct this study, 10 articles and theses, a brief, 2 books, 4 reports and 2 clippings on traditional medicine/herbal medicine were consulted. Several African plants, in the form of use, can help relieve or treat dental pain and have positive effects against dental caries and periodontal diseases. The geographic and financial accessibility associated with the lack of qualified personnel are the plants could be an alternative in the management of certain oral diseases.

[Evaluation of preventive care in the dentistry department clinics of the University Cheikh Anta Diop in Dakar]

This was a cross-sectional study of 295 patients treated by dentistry students that aimed to evaluate the preventive care received by patients attending clinics of the dentistry department of the University Cheikh Anta Diop in Dakar. The sociodemographic characteristics of the patients, clinic specialty, patients' brushing technique and the other preventive care was recorded. The study sample comprised 48.5% men and 76.6% adults. Over 32% of the patients were from the conservative dentistry clinic. For 52.2% of the patients, no preventive action was provided. The use of visual aids when teaching oral hygen ne was observed for 17.4% of cases. Attitudes and practices of the dentistry students in relation to care require more vigilance and emphasis on prevention.

[Dental caries in the carceral middle of Dakar]

Oral diseases, mainly tooth decay and periodontal disease, are among the most common conditions in the world. The tooth decay is very prevalent in developing countries and particularly in disadvantaged backgrounds where insecurity and its corollaries prevail. Thus, our study focused on one of these places: the prisons, characterized by deprivation of liberty, monotony, boredom, and the difficult conditions of detention, brief by a total dependence of the detainee. The aim of this study was to determine the DMFT (Decayed, Missing, Filled Teeth) in detainees dwelling in prisons in Dakar. This cross sectional study included 754 detainees aged 18 years and more with a stay exceeding more than a year, in one of the four main prisons of the capital city, Dakar. The majority of detainees was males (90%), aged between 18 and 35 years (63%) and was staying at "Camp penal" (65%). The proportion of inmates with at least one tooth cavity was 81.3%, those with teeth sealed was 26.1% and the prisoners with missing teeth reached 70.6%. The highest average DMFT was noted at "Camp penal" (7.3) among men (6.5) and among inmates aged 36 to 45 years (6.1) with a significant difference. The tooth decay is particularly worrying in the prison population, hence the urgency to establish a programme of prevention and care of oral diseases in this environment.

[Oral benefits for the elderly: results of a one-year implementation of the "Sesame" plan in Senegal]

Among the 650,000 persons aged 60 and over in Senegal, only 30% were receiving social security coverage, divided between the Senegalese Retirement Providence Institute and the National Retirement Fund. To fill the social demand, the government has put in place since 1 September 2006 a plan called "Sesame" which gives people aged 60 and older, free access to certain health services provided in public health. The implementation of this plan creates a lot of comments in the health community. The objectives of this study were to describe the dental benefits offered and to identify the difficulties perceived and experienced by the service provider after one year the "sesame" plan was implemented in Ouakam Health Center dental office, benchmark place of Gerontology in the Dakar North health district in Senegal. The study included two components: quantitative and qualitative terms, respectively, consisting of a retrospective study from sheets review and an interview with the health center service provider. The beneficiaries were a total of 42, mean age 68 years, including 66.7% men. Just over a third (35.7%) resided outside Ouakam. Almost 4/5 of the beneficiaries have suffered dental extractions on 1 to 10 teeth per beneficiary. The proportions of people receiving dentine treatment and curetage were respectively 4.8% and 2.4%. Qualitative data showed that the implementation of the plan was not shared between providers and beneficiaries. The "Sesame" plan is a commendable initiative to encourage and improve.

[Conditions of dental extractions in areas health centers of Senegal]

Dental extraction is a surgical act frequently carried out in the African dental structures. It requires the rigorous respect of the conditions of asepsis and antisepsis. Equipments and anaesthetic and avulsional products must be also sufficient. Our study undertaken among 46 dental services in areas health centers of Senegal aimed to determine the conditions under which dental extractions are carried out. The principle results of our study showed that 93% of dental practitioners wore sterilized gloves. 49% of the dentist's care activity consisted in dental extractions. 50% of the practitioners re-use anaesthetic needles, 2% re-use anaesthetic carpules. We noticed that the dental structures were facing a deficit of materials and products of extraction. Face to the outbreak of serious illnesses as infections of HIV and Hepatitis B, the practitioner and his team must be sensitized and trained to struggle against the transmissible infections and to carry out the dental extraction only if the conditions of asepsis and antisepsis are joined together. A pleading towards the medical authorities must be done to support the services in equipments and periodic renewals of the materials and products of extractions.