EPILEPTIC SEIZURES REVEALING STURGE WEBER'S DISEASE IN A TROPICAL ENVIRONMENT: STUDY OF EIGHT CASES

In sub-Saharan Africa (SSA), the etiological factors of epilepsy are multiple and phacomatoses, in particular Sturge weber's disease, are rarely reported due to under-medicalization and insufficient multidisciplinary care. We carried out a retrospective study of 216 patients hospitalized for recurrent epileptic seizures between 2015 and 2022 in the neurology and pediatrics department of the University Hospital Center of Conakry, among whom eight (8) patients were identified for Sturge Weber's disease in order to reassess this pathology from a clinical and paraclinical point of view in a tropical environment. Sturge Weber's disease was retained in eight (8) on the presence of symptomatic partial epileptic seizures (age 6 months to 14 years) with frequency of status epilepticus, homonymous lateral hemiparesis linked to occipital involvement, piriform calcifications on imaging and ocular disorders. The delay in consultation and medical care revealed severe mental deterioration in our patients. This study shows a stereotyped clinical picture in a context of aggravation of signs related to a delay in multidisciplinary management. These results are important for the diagnostic, therapeutic and prognostic discussion.

Breast and Cervical Cancer Screening among US and non US Born African American Muslim Women in New York City

PURPOSE

Health disparities related to breast and cervical cancer among African American and African-born Muslim women in the United States have been identified in previous literature. Our study aimed at exploring the breast and cervical screening rates and factors that influence this population's disposition to adhere to cancer screening exams.

METHODS

Mixed methods were used to collect data with African American and African-born Muslim women in New York City. Data were collected from a total of 140 women; among them, 40 participated in four focus groups.

FINDINGS

Focus groups revealed nine themes: healthcare practices; lack of knowledge/misconceptions; negative perceptions and fear; time; modesty; role of religion; role of men; role of community; stigma and shame. Among 130 women who reported their cancer screening status, 72.3% of those age 21 and over were adherent to cervical cancer screening; 20.0% never had a Pap test. Among women age 40 and over, 80.2% reported adherence to recommended mammogram; 12.8% never had one. Among women under age 40, 52.2% had their last clinical breast exam (CBE) less than three years ago. Among women age 40 and over, 75.0% were adherent to yearly CBE.

CONCLUSIONS

While rates of screenings were above the national average and higher than expected, specific barriers and facilitators related to religious and health beliefs and attitudes that influence the decision to adhere to screening were revealed. These factors should be further explored and addressed to inform future research and strategies for promoting regular breast and cervical cancer screenings.

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014

Background

Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the “blank” countries without systematic data.

Methods

Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance.

Results

A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs.

Conclusion

The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-2060-7) contains supplementary material, which is available to authorized users.

[Consequences of hysterectomy at the national- hospital of Pikine in Dakar]

BACKGROUND

Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy.

METHODS

That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery.

RESULTS

Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases.

CONCLUSION

Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.

[Neurological complications of chronic alcoholism: study of 42 observations in Guinea]

Neurologic disorders related to chronic alcoholism in traditional areas of Guinea are frequent, but reports about them are rare. We conducted the first study in Guinea on this subject and retrospectively collected 42 cases of neurologic manifestations related to alcoholism over a 7-year period. The standard findings of the literature were confirmed in our population: peak frequency after the age of 40 years (82.8%) and clear male overrepresentation (M/F sex ratio: 13/1). All the standard signs and symptoms are reported, with a clear predominance of alcoholic polyneuropathy and hepatic encephalopathy. The study of nutritional status by both body mass index (BMI) and the Detsky criteria showed that these patients were severely malnourished. The brain MRI was a crucial contribution for diagnosing the standard central nervous system complications of alcoholism: Gayet Wernicke encephalopathy, Marchiafava-Bignami disease, Korsakoff syndrome, central pontine myelinolysis, and cerebellar degeneration.

[Neurological disorders related to vitamin B12 deficiency in prisons in Guinea: a 22-case study]

Neurological disorders related to vitamin B12 deficiency are common in prisons of tropical Africa. We collected 22 cases (20 men and 2 women). They all showed vitamin B12 deficiency associated with neurological signs that were represented by sclerosis combined with bone marrow (n = 9), peripheral neuropathy (n = 6), cerebellar syndrome (n = 2), a pyramidal syndrome of the lower limbs (n = 4) and optic neuropathy (n = 1). Laboratory tests showed a mean hemoglobin concentration of 7.2 ± 1.5 g/dl, mean 104 ± 28 fl, macrocytic anemia in 10 patients. Biermer's disease was identified in 9 patients, 3 patients showed the syndrome of non dissociation of vitamin B12, a gastrectomy in 2 patients and no etiology was identified in 8 patients.

[Cancrum oris in children infected by HIV in the Conakry Teaching Hospital: 5 cases]

The objectives of this study were to describe the clinical and therapeutic aspects in 5 children with cancrum oris infected by HIV. Patients aged between 4 and 6 years, were recruited between February 1999 and May 2004. The cancrum oris was in all cases located in the commisuro-jugal or in the jugal regions. Oral manifestations of HIV encountered were: candidosis and cervical lymphadenopathy. Medical treatment based on antibiotic (Ampiciline-100 mg/kg/day taken in 3 injections intravenously; Metronidazole 40 mg/kg/day in 3 injections per day intravenously) combined with conservative surgery has reduced the massive destruction of the tissues and get a healing of wounds by second intention. With the advanced stage of AIDS, all patients died of opportunistic infection in the absence of the possibility of anti-retroviral treatment.

[Mechanisms of action of acetonic and hexanic extracts of leaves of Vernonia colorata (Willd.) Drake (Composeae) on blod glucose regulation]

INTRODUCTION

This study aimed to investigate the mechanism of action of acetonic and hexanic extracts of the leaves of Vernonia colorata on blood glucose regulation.

MATERIALS AND METHODS

Experiments were performed in normoglycaemic, type 1 and 2 diabetic rats. The effects of acetonic and hexanic extracts on blood glucose were evaluated. The antagonism effect of hexanic extract on the decrease of blood glucose induced with glibenclamide and metformin was also tested.

RESULTS

The hexanic extract of the leaves of V. colorata (HELVC) dose dependently increased the blood glucose in normoglycaemic rats. At the dose of 30 and 100 mg/kg, the glycaemia varied from 0.84 +/- 0.02 to 1.11 +/- 0.10 g/l and 0.68 +/- 0.02 to 1.31 +/- 0.30 g/l (p<0.05, n = 5). Such glibenclamide, the acetonic extract of the leaves of V. colorata (AELVC) induced hypoglycaemia in normoglycaemic rats. The HELVC prevents significantly the AELVC and glibenclamide induced hypoglycaemia. The chronic administration of the AELVC and HELVC as well as glibenclamide in type 1 diabetic rats did not change significantly the level of blood glucose. In type 2 diabetic rats, the single dose administration of metformin (300 mg/kg, per os) decreased the glycaemia which is completely prevented by a HELVC pretreatment.

CONCLUSION

These results suggest that: i) The respective hypo- and hyperglycaemic effects of AELVC and HELVC require the presence of the pancreatic beta cells. ii) The AELVC would act by a sulfonylurea-like mechanism as glibenclamide to induce an hypoglycaemic effect.

[Skin tuberculin test (STT) for screening tuberculosis in contacts of tuberculosis patients]

INTRODUCTION

Many studies have underlined the theorical and practical role of Skin Tuberculin Test (STT) as an important tool for the diagnosis and for the screening of tuberculosis in the population.

PATIENTS AND METHOD

This prospective study evaluated STT in 51 smear positive tuberculosis patients and 108 contacts tuberculosis patients apparently in a good health condition. Twenty seven patients have disappeared before the end of the study and 7 patients were excluded for non suitable results. So we analysed only 73 cases.

RESULTS

The mean age was 34 years, with extreme of 1 and 77 years. There were 33 male and 40 female patients for a sex-ratio of 0,8. BCG vaccination scar was found in 64% of patients. We calculated the Body-Mass-Index and we found a proteinocaloric malnutrition (BMI<18,5) in 30%. The mean diameter of STT induration was 12,3mm with extremes of 7 and 20mm. Considering a STT < 7 mm as negative, 4 patients (5%) had a negative STT and 69 (95%) a positive STT. 13 of these 69 patients had a STT > 15mm. The age group of the 10 to 50 years had more positive STT. Meanwhile, according to the sexe and to the nutritional status, there was no statistical difference. All patients with a negative STT received BCG vaccination after 2 months of follow-up. Those with STT>15mm were examinated and had a chest X-ray the day of their enrolment, at the second month and at the sixth month and we didn't find any evolutive tuberculosis.

CONCLUSION

According to these results, we can conclude that STT is not an important test for the screening of pulmonary tuberculosis in contact patients. Clinical examination, chest X-ray and sputum smear remain very important for the diagnosis. Despite these results, STT remain the only validated technic between the different tuberculin tests. Its interest was twofold: the research of an acquired immunity against tuberculosis after BCG immunisation and it is clinical test for the diagnosis of tuberculosis in children.

[Healing activity of methanolic extract of the barks of Spathodea campanulata Beauv (Bignoniaceae) in rat experimental burn model]

Spathodea campanulata Beauv. (Bignoniaceae) is widely distributed through Africa and found in particular in Cameroon and Senegal. It is used in traditional herbal medicine for the treatment of ulcers, filaria, gonorrhea, diarrhea and fever. S. campanulata was also known in Cameroon traditional medicine to have a healing activity in burn wounds. The aim of the present study was to assess the burn healing effectiveness of the methanolic extract of the barks of S. campanulata ointment (MEBSCO) in comparison to those of Centella asiatica and Peru's balm in experimental burn model in rats. Experimental burn was made in rat under chloral anaesthesia with electric iron (200 degrees C) on the right and left side of the medianus line. Topical applications of MEBSCO (2%, 10% and 49%) dose-dependently decreased the score damage of the burn site. Treatment with 10% and 49% of MEBSCO varied the score damage from 5 to 1 +/- 0.4 and 5 to 0.2 +/- 0.5 (p < 0.05, n = 5) respectively, at day 15 after experimental burn. As well as C. asiatica (1%) and Peru's balm (1%) ointments, MEBSCO (10% and 49%) induced a complete burn healing on the 19-20th post burn day. This study shows for the first time, the burn healing effectiveness of MEBSCO in experimental burn model. It also provides a rational use of the S. campanulata barks in traditional medicine to promote burn healing.

[Preliminary study of the association of tuberculosis and pregnancy: about 9 cases]

From June 1668 to June 2002, we have studied at the Pneumology Clinic of Fann Hospital, pulmonary tuberculosis among 9 pregnant women. The average age was 26 years old and the consultation's delay was 5 months. All our patients had a productive cough and an evening fever coupled with a thoracic pain and a deterioration of the general condition in 7 patients (77.7%). The dyspnea and the heamoptisis were a consultation motive for 44.4% and 33.3% of the patients. The evolution of pregnancies was 29 weeks. They had all benefited from the intradermal reaction with tuberculin (IDRT) with an average diameter of 11.7 mm; it was negative in one patient. The bacilloscopy systematically done was negative in 2 patients. At the front thoracic radiography, we have found basal lesions unilateral in more than half of the cases and excavated in 44.4% of cases. They benefited from an antitubercular treatment (Rifampicine (R) + Isoniazide (H) + Pyrazinamide (Z) with a good clinical, biological, bacteriological and radiological progression. From the obstetrical point of view, there was an abortion after 5 months, 2 premature deliveries between the 7th and the 8th month and 6 normal deliveries at 9 months. Babies born from bacillary mothers systematically received an antitubercular treatment with breast feeding. In conclusion, pregnant women with pulmonary tuberculosis essentially pose a therapeutic problem, requiring a good collaboration between the lung specialist, the gyneco-obstetrician and the pediatrician. It could be more hazardous not to act early in treating a pregnant women with pulmonary tuberculosis.

[Late occurrence of first epileptic seizures: a 42-case series]

Late occurrence of epilepsy is common in tropical areas. This report describes a series of 42 cases of late epilepsy collected over a three-year period. Findings were consistent with the literature: highest incidence in young age groups, predominance of partial symptomatic epilepsy, and wide spectrum of etiologies. The most frequent etiology was tumoral disease followed by vascular and infectious disease. Brain CT scan and electro-encephalography were highly useful for identification of clinical and etiological entities.

[Antidiabetic activity of the leaves of Vemonia colorata (Wilid.) Drake (Composees) in alloxan-induced diabetic rats]

Vemonia colorata is distributed through Africa (Benin, Cameroon, Senegal, Togo etc...). Its leaves are commonly used by african tradipractitioners for treating diabetes. However, the antidiabetic activity of the leaves of V. colorata had never been investigated in experimental conditions. The present study aimed to test the aqueous extract of the leaves of V. colorata for its effects in normoglycaemic and alloxan-induced diabetic rats in comparison to glibenclamide antidiabetic activity. Such glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) induced a significant hypoglycaemic effect in normoglycaemic rats. The blood glucose varied from 0.77 +/- 0.01 to 0.58 +/- 0.01 g/l (p < 0.05, n = 5). It also reduced significantly the fasting glucose level of the hyperglycaemic rats induced with oral administration of glucose (4 g/kg). In alloxan-induced diabetic rats, glibenclamide (0.2 mg/kg, per os) lowered significantly the blood glucose from 2.40 +/- 0.30 to 0.70 +/- 0.40 g/l (p < 0.05, n = 5). As well as glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) decreased the blood glucose in alloxanic rats from 2.80 +/- 0.10 to 1.00 +/- 0.20 g/l (p < 0.05, n = 5). The aqueous extract of the leaves of V. colorata possesses both hypoglycaemic and antidiabetic effect in normoglycaemic and alloxan-induced diabetic rats. This may indicate the ethnopharmacological basis of the use of V. colorata leaves in traditional medicine for treating diabetes.

[Quadriceps fibrosis following intramuscular injections into the thigh: apropos of 92 cases at the Ignace Deen Central University Hospital in Conakry]

Analysis of 92 cases of quadriceps fibrosis following intramuscular injection into the thigh showed that the most affected age group was 3- to 7-year-old preschool children with a male predominance (68.7%). The most implicated drug (81.7% of cases) was quinine salts after of mean of 2 injections. Stiffness of the knee was the most outstanding clinical sign. In our series, the efficient technique for prompt functional recovery consisted of lengthening the quadriceps tendon by isolated "Z" plasty (56.5% of cases). Administration of drugs in oral, rectal or intravenous forms is the most effective means of prevention.

[Frequency of microalbuminuria during diabetes in Dakar, Senegal]

Nephropathy is one of the complications occuring during diabetes and it is diagnosed via microalbuminuria. From 1992 to 1999, five hundred and eighty seven (587) diabetic patients were recruited and distributed into two groups, A (n = 270) and B (n = 317). Microalbuminuria was determined by immunonephelemetry for group A and immunoturbidimetry for group B. The results showed respectively 15.5% and 20.19% pathological cases in the two groups (NS). Considering the distribution of patients with microalbuminuria according to the type of diabetes, there were 16.12% type 1 and 15.07% type 2 in group A against 22.60% and 18.13% in group B; no statistically significant differences were observed either in the same group or from one group to another. These frequencies might reflect the situation in the nineties; they are lower than those encountered in other populations. Nevertheless monitoring is needed through a regular schedule to prevent nephropathy.

[Atypical neurosyphilis: 28 cases observed at the University Hospital Center of Conakry]

This study describes a series of 28 cases of neurosyphylis presenting atypical oligosymptomatic syndromes involving epileptic attack, chronic headache, peripheral facial paralysis, deafness, isolated optic atrophy, and cerebral ataxia. Diagnosis was based on positive results (VDRL-TPHA) of serological reactions in blood samples and analysis of cerebrospinal fluid showing pleocytosis (mean lymphocyte level, 69%) and elevated protein levels. Epilepsy and chronic headache were the most common clinical manifestations. Brain scan demonstrated low-grade ventricular dilatation associated with nonspecific cerebral atrophy in 8 cases and isolated cerebral atrophy in three. In the remaining 17 cases brain scans were normal.

[Prevalence of diabetic retinopathy at the Dakar University Hospital Center]

The aim of the study is to appreciate the prevalence of diabetic retinopathy among senegalese patients in analyzing age of diagnosis, duration of diabetes, plasma glucose and type of retinopathy. 129 diabetics followed and treated in the diabetic center of internal medicine clinic (Dakar University) were examined by 90 degrees Volk's lens. A determination of plasma c peptide and glucose concentration were performed. 55 (mean age 224. +/- 0.9 years) were insulino-dependent and 74 (mean age of 54.7 +/- 11.4 years) non insulinodependent. On average the duration of diabetes was 5.4 years +/- 5.4 for the former and 6.07 +/- 5.7 for the latter with respectively glucose plasma average 2.60 g/l +/- 0.7 and 1.7 g/l +/- 0.83. Retinopathy was found in 29 patients. So total prevalence was 22.48%, shared in 29.7% for non insulino-dependant and 12.7% for insulino-dependent. In 7 cases the retinopathy was proliferative and non proliferative in 22 cases essentially among non insulino-dependant diabetics. The diabetic retinopathy is one of handicaping complications of diabetics. Its prevalence is strongly linked to the duration of diabetes, glycaemic control and to other risk factors (genetics, glycosylated hemoglobin and high blood pressure).

[Frequency of micoalbuminuria during diabetes in Dakar (Senegal)]

Nephropathy is one of the complications occuring during diabetes diagnosed via microalbuminuria. From 1992 to 1999, five hundred and eighty seven (587) diabetic patients were recruited in groups A (n = 270) and B (n=317). Microalbuminuria was determined by immunonepheletry for A and immunoturbidimetry for B. The results pointed out respectively 15.5% and 20.19% pathological cases (NS). Considering the distribution of patients with microalbuminuria according to the type of diabetes there were 16.12% type 1 and 15.07% type 2 in group A against 22.60% and 18.13% in group B ; no stastically significant differences were observed either in the same group or from one group to another. These frequencies would reflect the situation in the nineties; they are lower than those encountered in other populations. Nevertheless monitoring is needed through a regular schedule to prevent nephropathy.

[Genetic polymorphism of pyruvate dehydrogenase kinase 4 (PDK4), paraoxonase 2 (PON2), and fatty acid binding protein 2 (FABP2) in the NIDDM population of Senegal]

We reported a study about three candidate genes which may be involved in non-insulin dependent diabetes mellitus (NIDDM): Pyruvate Dehydrogenase Kinase 4 (PDK4), Paraoxonase 2 (PON2) and Fatty Acid Binding Protein 2 (FABP2). The reported mutation in the three candidate genes were tested for 179 black subjects from Dakar (Sénégal) by PCR-RFLP techniques. There was no significant difference between both control and NIDDM subjects. The genotype frequency in the senegalese population was quite similar as compared to reported frequency in white populations excepted for PDK4 polymorphism. These results suggest that none of these gene variants is a major NIDDM predisposing locus for the negroid population of Senegal.

[Antidiabetic activity of Zizyphus mauritiana Lam (Rhamnaceae)]

In traditonnal medicine, several plants were used in diabetes treatment. Among them, the aqueous extract from the leaves of Zizyphus mauritiana Lam (Rhamnaceae) was studied. The extract was administrated per os to Wistar rats made diabetics either temporarily by oral glucose tolerance test (first case) or definetely by subcutaneous injection of alloxan (second case). It was observed a striking decrease of the hyperglycemic arrow (p < 0.05) in the first case, with 300 mg/kg administrated 90 minutes before starting the test. In the second case, the results obtained with a dose of 300 mg/kg once or twice a day were identical as those with glibenclamide at 0.2 mg/kg per day. So, the antidiabetic activity of Zizyphus mauritiana Lam was experimentally born out but it has to be standardized for common use.

[Toxocological study of Guiera senegalensis Lam (Combretaceae)]

The study was based on an aqueous extract derived from a 60 degrees ethanolic tincture containing 0.032 g of dry matter per ml. The leaves of Guiera senegalensis Lam (Combretaceae) were collected in December 1991 at Nguekhokh a village within 20 km from Mbour (Senegal). The extract was administered for six months through daily forced-feeling at 2 g/kg to Wistar male and female rats whose weight at the beginning of the experiment tanged between 140 g and 180 g. The urine was analysed during the study and the animals were weighed every four weeks. At the end of the experiment, the animals were slaughtered and various analyses carried out. Haematological features in relation with erythropoiesis, haemoglobinogenesis and leucopoiesis, were studied in relation with renal and hepatic functions; biochemical features too. Some organs (heart, lungs, kidneys, brain, cerebellum, spleen and liver) were removed and examined in order to detect possible lesions following the experiment. Judging by the results, Guiera senegalensis Lam (Combretaceae), as used in the experiment, did not show any significant toxicity.

[HLA-markers and diabetic retinopathy in the Senegalese population]

Patients with IDDM often develop severe forms of retinopathy, supposed to be associated to risk factors such as hypertension, poor glycemic control and nephropathy. A controversial intervention of a genetic marker was evoked so as some diabetic patients have retinopathy in the absence of known risk factors. HLA-DR and DQ markers were compared in two groups of patients with IDDM respectively constituted of patients with and without severe retinopathy. HLA typing was carried out by polymerase chain reaction (PCR) and restriction fragments of length polymorphism (RFLP). DR9 (p < 10(-4); O.R. = 8.36) and DQA1*0301 (p < 0.05; O.R = 2.92) alleles were positively associated to diabetic retinopathy, at the opposite of DR3 (p < 10(-3); O.R: 0.01) and DQA1* (p < 10(-9); O.R = 0.15). Furthermore, among the genotypes previously considered as risk markers of IDDM in senegalese people, only DR4: DQA1*0301:DQB1*0302/DR9: DQA1*0301: DQB1*0201 was often observed in retinopathy.

[HLA-DR:DQ genotypes and insulin-dependent diabetes in Senegal]

At the opposite of HLA-DR, HLA-DQ was not well documented in homogeneous negroïd populations. So, 93 IDDM and 115 control patients, all black senegalese people, were studied. The results showed three HLA-DQ IDDM-related susceptibility genotypes and also a high risk conferred by HLA-DR4/DR9 usually described in Mongoloïd people. Furthermore, DR:DQ associations allowed the identification of three IDDM predisposition genotypes, each of them with a characteristic mean age for disease diagnosis.

[Contribution of plasma C-peptide to the classification of sugar diabetes in Dakar, Senegal]

When diabetes has been diagnosed, its classification into different types is traditionally carried out according to clinical criteria. But with arising of new parameters, one of which is C-peptide, and various subtypes of diabetes, it became more difficult. So, in order to improve the accuracy of the classification, 270 diabetic patients and 269 controls, all black senegalese subjects, were submitted to a two-step oral glucose tolerance test (0 and 120 min.) with determination of plasma glucose and C-peptide concentrations. The majority of NIDDM were confirmed at the opposite of IDDM; furthermore, it has been pointed out a group corresponding with impaired glucose tolerance (IGT) among the initial controls. When comparing the two classification modes, before and after plasma C-peptide determination, it appeared statistically significant differences with p values of 10(-4) for both IDDM and NIDDM.

[Insulin-dependent diabetes in Senegal: HLA-DR combinations according to age of onset and sex]

In insulin-dependent diabetes mellitus, HLA-DR markers are involved, namely DR3, DR4 and DR9 alleles, among black senegalese populations. Studying the different associations of these alleles showed a strong predisposition to insulin-dependent diabetes mellitus with DR3/4 (p > 10(-2); OR = 13.6); DR4/9 (p < 10(-2); OR = 8.32) and DR9/9 (p < 0.05; OR = 7.78). And then it was observed a tendency to an inverse relationship of DR3/4 frequency with age of onset in male patients.

DNA polymorphisms of apolipoprotein B in the population of Senegal

Three apolipoprotein B (apoB) genetic polymorphisms, the XbaI, MspI and EcoRI restriction fragment length polymorphisms (RFLPs), were analysed for 221 individuals in Senegal by polymerase chain reaction. Allelic frequency determination revealed that this population has 0.79 XbaI- (X-), 0.96 MspI+ (M+), and 0.89 EcoRI+ (E+). Major genotypes were X-/X- (0.62), M+/M+ (0.92) and E+/E+ (0.80). The XbaI allele frequency is different (p < 10(-9)) from that in Caucasians (0.47) and from that in Mongoloids (0.98). Significant differences between Senegalese and Caucasians, and between Senegalese and Mongoloids were also observed for the EcoRI and MspI alleles of the apoB genes.

HLA-DQ beta 1 typing and non-Asp57 alleles in the aborigine population of Senegal

OBJECTIVE

To investigate, in Senegalese subjects, the frequency of human leukocyte antigen (HLA)-DQ beta 1 alleles and their role in susceptibility to insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

HLA-DQ beta 1 typing was done in 55 IDDM subjects and 118 nondiabetic control subjects by means of polymerase chain reaction restriction fragment length polymorphism.

RESULTS

Alleles bearing a codon for an Asp residue at position 57 in the DQ beta-chain were associated with a significantly lower risk of IDDM. Alleles 0201 and 0302 (Ala57) were positively associated with diabetes, but allele 0501 (Val57) was less frequent in IDDM subjects than in control subjects.

CONCLUSIONS

HLA-DQ beta 1 alleles may be genetic susceptibility markers for IDDM in the Senegalese population, as they are in Caucasian populations.