Serum total periostin is an independent marker of overall survival in bone metastases of lung adenocarcinoma

More than 35% of lung adenocarcinoma patients have bone metastases at diagnosis and have a poor survival. Periostin, a carboxylated matrix protein, mediates lung cancer cell dissemination by promoting epithelial-mesenchymal transition, and is involved in bone response to mechanical stress and bone formation regulation. This suggests that periostin may be used as a biomarker to predict survival in lung cancer patients. Serum periostin was assessed at diagnosis in a prospective cohort of 133 patients with lung adenocarcinoma of all stages. Patients were divided into localized and bone metastatic groups. Both groups were matched to healthy controls. Survival analysis and Cox proportional hazards models were conducted in the total population and in bone metastatic group. The median serum periostin level was higher in bone metastatic (n = 67; median: 1752 pmol/L) than in the localized group (n = 66; 861 pmol/L; p < 0.0001). Patients with high periostin (>median) had a poorer overall survival in the whole population (33.3 weeks vs. NR; p < 0.0001) and the bone metastatic group (24.4 vs. 66.1 weeks; p < 0.001). In multivariate analysis, patients with high periostin had increased risk of death (HR = 2.09, 95%CI [1.06-4.13]; p = 0.03). This was also found in the bone metastatic group (HR = 3.62, 95%CI [1.74-7.52]; p = 0.0005). Immunohistochemistry on bone metastasis biopsies showed periostin expression in the bone matrix and nuclear and cytoplasmic staining in cancer cells. Serum periostin was an independent survival biomarker in all-stage and in bone metastatic lung adenocarcinoma patients. IHC data suggest that periostin might be induced in cancer cells in bone metastatic niche in addition to bone microenvironment expression.

Synthetic biology as driver for the biologization of materials sciences

Materials in nature have fascinating properties that serve as a continuous source of inspiration for materials scientists. Accordingly, bio-mimetic and bio-inspired approaches have yielded remarkable structural and functional materials for a plethora of applications. Despite these advances, many properties of natural materials remain challenging or yet impossible to incorporate into synthetic materials. Natural materials are produced by living cells, which sense and process environmental cues and conditions by means of signaling and genetic programs, thereby controlling the biosynthesis, remodeling, functionalization, or degradation of the natural material. In this context, synthetic biology offers unique opportunities in materials sciences by providing direct access to the rational engineering of how a cell senses and processes environmental information and translates them into the properties and functions of materials. Here, we identify and review two main directions by which synthetic biology can be harnessed to provide new impulses for the biologization of the materials sciences: first, the engineering of cells to produce precursors for the subsequent synthesis of materials. This includes materials that are otherwise produced from petrochemical resources, but also materials where the bio-produced substances contribute unique properties and functions not existing in traditional materials. Second, engineered living materials that are formed or assembled by cells or in which cells contribute specific functions while remaining an integral part of the living composite material. We finally provide a perspective of future scientific directions of this promising area of research and discuss science policy that would be required to support research and development in this field.

Insulin therapy in childhood type 1 diabetes: Knowledge and practice in Senegal

INTRODUCTION

Childhood type 1 diabetes (T1D) is a chronic condition with serious repercussions on both the quality of life of the child and the family. Insulin therapy is the cornerstone of optimal blood sugar control. The main objective of our study was to assess the level of knowledge of physicians about insulin therapy in diabetes.

METHODS

This was a multicenter survey over a period of 5 months (from March 5 to August 2, 2018). It took place in five reference university hospital centers in the Dakar region.

RESULT

The number of doctors interviewed in our study was 82, 47.6% of whom were confirmed pediatricians or pediatricians in the process of specialization. The number of years of experience in the field of diabetes was on average 3 years. Fast-acting regular insulins were recommended by 75.6% of doctors and mixtures of insulin (intermediate and rapid-acting) by 50% of doctors. Overall, 91% of doctors recommend a variation in insulin injection sites. The "basal bolus" treatment regimen with insulin analogs was recommended by 50% of doctors, while 31.7% recommended it with human insulin. Regarding adapting insulin doses for leisure and sports activities, more than half (54.9%) of the doctors had to reduce the doses.

CONCLUSION

This study enabled us to assess the level of knowledge of insulin therapy among doctors caring for children with diabetes in Senegal, which proved to be limited. We recommend the reinforcement and follow-up of training on the management of T1D for providers at the different facilities.

Wrist opener splint: An effective way to treat chronic wrist flexion contracture

In Senegal, patients are seen an average of 16 months after their injury in a specialized hand and upper limb surgery department. Because of this lengthy delay, these patients have severe functional sequelae, such as wrist flexion contracture, averaging 45 degrees in our case series (range, 35 to 90 degrees). After reviewing the literature, we did not find any splint that was well suited to these patients. Inspired by the general splinting rules set out by Schultz, MacConaill and Brand, we constructed a volar/dorsal splint to reduce these contractures. We have been using this serial static splint for 2 years. We performed a prospective study of 17 wrists to evaluate its therapeutic benefit, describe its use and outline its optimal application.

Pearl Millet Genetic Traits Shape Rhizobacterial Diversity and Modulate Rhizosphere Aggregation

Root exudation contributes to soil carbon allocation and also to microbial C and energy supply, which subsequently impacts soil aggregation around roots. Biologically-driven soil structural formation is an important driver of soil fertility. Plant genetic determinants of exudation and more generally of factors promoting rhizosphere soil aggregation are largely unknown. Here, we characterized rhizosphere aggregation in a panel of 86 pearl millet inbred lines using a ratio of root-adhering soil dry mass per root tissue dry mass (RAS/RT). This ratio showed significant variations between lines, with a roughly 2-fold amplitude between lowest and highest average values. For 9 lines with contrasting aggregation properties, we then compared the bacterial diversity and composition in root-adhering soil. Bacterial α-diversity metrics increased with the "RAS/RT ratio." Regarding taxonomic composition, the Rhizobiales were stimulated in lines showing high aggregation level whereas Bacillales were more abundant in lines with low ratio. 184 strains of cultivable exopolysaccharides-producing bacteria have been isolated from the rhizosphere of some lines, including members from Rhizobiales and Bacillales. However, at this stage, we could not find a correlation between abundance of EPS-producing species in bacterial communities and the ratio RAS/RT. These results illustrated the impact of cereals genetic trait variation on soil physical properties and microbial diversity. This opens the possibility of considering plant breeding to help management of soil carbon content and physical characteristics through carbon rhizodeposition in soil.

Usefulness of Dried Blood Spots (DBS) to perform hepatitis C virus genotyping in drug users in Senegal

The aim of this pilot study was to analyze the Hepatitis C Virus (HCV) genotypes circulating in Senegal among Drug User (DUs), using Dried Blood Spots (DBS) as RNA source for molecular assays. Heroin and/or cocaine users (n = 506) were recruited in Dakar from April to July 2011, using a Respondent Driven Sampling (RDS) method. DBS preparation consisted of five drops of whole blood from finger applied to a Whatman paper card. HCV infection was screened by the detection of anti-HCV antibodies, using a rapid immune-chromatographic test. HCV RNA was quantified on anti-HCV positive DBS, using the Abbott RealTime HCV® Genotyping was performed on DBS with detectable viral load with Versant® HCV Genotype 2.0 Assay (LiPA) and Abbott RealTime HCV Genotype II assay®. Among the 506 participants, 120 were tested as positive for anti-HCV antibodies and their samples were analyzed for HCV RNA viral load and genotype. Out of the 120 DBS tested, HCV RNA was detected on 25 (20.8%). The median viral load was 15,058 IU/ml (ranging from 710 to 766,740 IU/ml). All positive DBS were suitable for the genotyping assay, that showed a predominance of genotype 1 (21/25) including 16 genotypes 1a and 5 genotypes 1b. HCV genotype 1 prevails in a DU population in Dakar. DBS could be useful for HCV RNA genotyping, but optimal storage conditions should required avoiding RNA impairment. Acknowledging this limitation, DBS could be a great interest for detecting and genotyping HCV viremic patients. J. Med. Virol. 89:484-488, 2017. © 2015 Wiley Periodicals, Inc.

[Kangaroo mother care for low birth weight infants at Albert-Royer National Children Hospital Center of Dakar]

INTRODUCTION

Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal.

MATERIAL AND METHODS

This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0.

RESULTS

We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology.

CONCLUSION

Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

[Relationship between bizygomatic width and the size of maxillary anterior teeth among young Senegalese black people recruited in army]

INTRODUCTION

Prosthetic teeth size and placement must be in perfect harmony with the bucco-facial structures for a successful and esthetic removable prosthesis. This study aimed to determine among young Senegalese black people facial index estimating maxillary central incisor width and distance between canine points starting from bizygomatic width.

PATIENTS AND METHODS

621 black Senegalese participated to this transversal study. Measurements were made using anthropometric slide caliper and electronic slide caliper. The comparative analysis was carried out by the test t of Student. The correlative analysis used the chi-square test. The risk of error was fixed at 5%.

RESULTS

Positive correlations were found between variables. Distance between canine points was significantly (p = 0.000) correlated to bizygomatic width and central incisor width. Using bizygomatic width, the average dividing factors to estimate central incisor width and distance between canine points were respectively 15.13 and 3.75.

CONCLUSION

Distance between canine points and central incisor width can be given starting from bizygomatic width, as guide of selecting maxillary anterior prosthetic teeth width.

[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.

[Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital]

OBJECTIVES

To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety.

PATIENTS AND METHODS

This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates.

RESULTS

Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%.

CONCLUSION

The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

[Using routine information system data to assess maternal and perinatal care services in Mali and Senegal (QUARITE trial)]

BACKGROUND

In sub-Saharan Africa, problems of access to relevant and high-quality facility-based statistics hinder the assessment of safe motherhood programs. The objective of this study was to assess the quality of data collected in referral hospitals in Mali and Senegal after the routine information system (RIS) was strengthened.

METHODS

This was a multicenter observational study conducted during the pre-intervention period of a randomized controlled trial (trial QUARITE). The RIS was strengthened based on technical, organizational and behavioral factors. We included all women who gave birth in the 46 referral hospitals from October 1, 2007 to October 30, 2008. The completeness, completion and accuracy rates were monitored every 3 months in each hospital. The cost of investment needed to strengthen the existing RIS was also determined.

RESULTS

The mean completeness rate ranged from 94 to 97% depending on the study period. The completion and accuracy rates increased during the study period from 72% and 79% to 87% and 93%, respectively (significant differences). The average investment per hospital was less than 1% of state subsidies for public hospitals.

CONCLUSION

Strengthening the existing information system has set up an economically and technologically appropriate system for monitoring maternal and perinatal health in Senegal and Mali. We encourage policy makers and researchers from countries with limited resources to invest in RIS to improve and monitor the performance of health systems.

[Obstetric care in Mali: effect of organization on in-hospital maternal mortality]

BACKGROUND

Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali.

METHODS

This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models.

RESULTS

The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa=0.59; 95% CI=0.34-0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome.

CONCLUSION

Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality.

[Epidemiology of the resistance of Mycobacterium tuberculosis to antituberculosis drugs at the main hospital in Dakar, Senegal. A 4-year retrospective study (2000-2003)]

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.

[Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004)]

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).

[Giant intradiploic infratentorial epidermoid cyst]

Epidermoid cysts are benign, uncommon lesions (1% of all intracranial tumors). Their localization is intradiploic in 25% of cases, and exceptionally subtentorial. We report here a rare case of giant intradiploic infratentorial epidermoid cyst. A 74-year old patient presented with recent diplopia and sindrome cerebellar. CT scan and MR imaging revealed a giant osteolytic extradural lesion of the posterior fossa (5.2 cm x 3.8 cm) with a small area of peripheral enhancement after contrast injection. Retrosigmoid suboccipital craniectomy allowed a satisfactory removal of the tumor, followed by an acrylic cranioplasty. The outcome was good. Neuropathological examination confirmed an epidermoid cyst. We review the literature and discuss our case.

Soil bacterial diversity responses to root colonization by an ectomycorrhizal fungus are not root-growth-dependent

The hypothesis tested in this present study was that the ectomycorrhizosphere effect on the bacterial community was not root-growth-dependent. The impacts of ectomycorrhizal infection (Pisolithus albus COI007) and a chemical fertilization to reproduce the fungal effect on root growth were examined on (1) the structure of bacterial community and (2) fluorescent pseudomonad and actinomycete populations in the mycorrhizosphere of Acacia auriculiformis using both culture-independent and culture-dependent methods. A. auriculiformis plants were grown in disinfested soil in pots with or without addition of the ectomycorrhizal fungus or N/P/K fertilization (to reproduce the fungal effect on root growth) for 4 months and then transferred to 20-L pots filled with nondisinfested sandy soil. The fungal and fertilizer applications significantly improved the plant growth after 4-month culture in the disinfested soil. In the nondisinfested cultural substrate, these positive effects on plant growth were maintained. The total soil microbiota was significantly different within the treatments as revealed from DNA analysis [denaturing gradient gel electrophoresis (DGGE)]. The structure of fluorescent pseudomonad populations was also affected by fungal and fertilizer applications. In contrast, no qualitative effect was observed for the actinomycete communities within each treatment, but fungal inoculation significantly decreased the number of actinomycetes compared to the fertilizer application treatment. These results show that the mycorrhizosphere effect is not root-growth-dependent but is mainly due to the presence of the ectomycorrhizal fungus and more particularly to the extramatrical mycelium.

Unusual form of neurocysticercosis associated with HIV infection

Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV-infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell-mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV-infected man and discuss the potential interactions between T. solium and HIV infections.

[Effectiveness of syndromic approach for management of urethral discharge in Senegal]

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

[Self-destructive behavior in African adolescents]

The purpose of this study was to analyze self-destructive behavior in adolescents in Senegal. Based on four case reports the authors stress the central importance of family breakdown in the process leading to this behavior as opposed to the first descriptions implicating an offense against the honor of the group. The vulnerability of teenagers in the absence of structural initiation is also advanced. Systematic intervention may be recommended in such cases.

[Our experience with laminectomy in the treatment of spinal cord disease caused by cervical arthrosis: apropos of 42 cases]

Cervical spondylotic arthRosis may lead to a myelopathy and the question which can rise is: posterior surgical decompression is adequate regarding the others surgical technics discussed? In this paper the authors describe the postoperative results of 42 patients who have been operated on by laminectomy from 1971 to 1995 at Fann Hospital in Dakar. The median age was 42 years and the median delay between the onset of neurological disorders and operation was 5.9 months. All patients showed symptoms of spinal cord and root disturbances. Neuro-imaging studies with plan X-rays and myelography reveal arthrosis and the impact of this arthrosis on nervous system. With a follow up of 6 months we found a mortality rate of 4.7% (two cases of death), 66.8% of good results and 28.5% of fail. Eighteen months post surgery results were respectively 52.3% and 45.7% of good and poor results. The complications of the laminectomy were peri operative hemorrhage (19%); sepsis (21.4%); spine cord traumatic injuries (9.5%) spondylolisthesis (4.7%). Laminectomy has been found to improve "spine syndrome"; paresthesia; fasciculations, and sensory deficits. Also three level laminectomy and surgery which can take place before six months are good prognosis factors. The authors stressed on laminectomy because of our low medical care situations particularly that no other surgical procedures through the modern literature leads to better results.

[Frequency of relapse among hospitalized patients at the psychiatric department]

The study aims to assess the epidemiology of relapse occurrence among inpatients at the Department of Psychiatry of Fann Teaching Hospital, in Dakar. A retrospective and prospective study was conducted from inpatients records during the year 1998. Demographic and disease related datas were collected and analyzed using a microcomputer with WHO/CDC Epi Info 6.0 software. Among the inpatients, 160 presented a relapse representing a prevalence rate of 40.8%. The most incriminated diseases were: schizophrenia and mood trouble (56.3% and 28.7% respectively). Relapses occurs more during the first admission and decreased with readmission. As a real public health problem, there is a need for better management of all psychiatric disease to prevent relapsus: early and efficient health care, social and familial integration.

[Mental confusion and multifocal lymphatic and pulmonary tuberculosis. A case report]

This report describes a case of mental confusion associated with ongoing adenitis and pulmonary tuberculosis in a 20-year-old man with no history of psychiatric disorders. Diagnosis was based on clinical and laboratory findings. Tranquillizers improved mental status and antituberculosis treatment was administered before referring the patient to an internal medicine department. The authors emphasize the rarity of these cases in the Senegalese medical literature and discuss possible diagnostic pitfalls.

[Cost analysis of psychiatric health care at the University Hospital of Fann (Senegal)]

In the current senegalese context, marked by a political will of autonomisation of health services, is proves very important to study the costs of the services provided in hospitals. Our study, which consists in a retrospective analysis of accounting archives of the psychiatric department of Fann Hospital during the year 1998, had the following objectives: determine the costs related to the functioning of the service of psychiatry, according to the source of financing, determine the average cost of the main services provided by the psychiatric department, analyze the recovery of the cost of these services. The operating costs of the psychiatric department came to 86.824.477 FCFA in 1998. 88% of the total amount were brought by the State and the remaining 12% came from community participation. The average cost of hospitalization in Clinique Moussa Diop was 91.398 F CFA. For the former patients the visit cost 6.664 F CFA; for the outpatients the price was 12,886 F CFA. The average cost of a child psychiatric visit was 8.140 F CFA and 28 days of hospitalization in the same service cost 354.825 F CFA. The share supported by the community participation is in general largely covered by the current fees in spite of the high cost of these services.

[Intraspinal abscess and HIV infection: a case report]

The intramedullary abscess (I.M.A.) is an uncommon and heavy etiology of intramedullary mass syndrom. Since the first description by HART in 1830, about 82 cases have been reported in literature and in one case, it was associated to H.I.V. infection. The authors report a new case in a 52 years old Senegalese man with per operative diagnosis of I.M.A. and post operative diagnosis of H.I.V. infection. They set up difficulties of pre operative diagnosis, and poor results of treatment in such an association. Also they discuss pathogeny and share Magnetic Resonance Imaging (R.M.I.) studies in management.

[Cauda equina compression: report of 20 cases]

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

[Spinal cord injuries in Senegal: 16 cases]

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

[Spinal neurinomas and neurofibromas in Senegal]

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

[Apropos of 1 attempted suicide with a fire arm in an adolescent]

This is the presentation of an adolescent's clinical case who tried to commit suicide with a fire arm during a depressive crisis. An emphasis is placed on the family interaction model and on a more global approach of the patient's personality. The authors underlined some of the problems raised by the diagnostic approach linked to the delirious syndrome, full of psychotic elements: themes of persecution, mystico-religious themes associated with impulsive escapade, all of them going with a depressive state. They gave also an important place to a pluridisciplanary treatment in those particular stages of crisis.

[Prevention of infection in a surgical environment in the regional hospitals of Senegal]

This study evaluated the attitudes and practices of the personnel with respect to the prevention of nosocomial infections in a hospital environment. We carried out a qualitative survey of all categories of personnel between July 1998 and March 1999, at the five regional hospitals in Senegal (Thiés, Kaolack, Saint-Louis, Diourbel, and Louga). Data were collected in two ways: using a questionnaire to evaluate knowledge and by observing the attitudes and practices of the personnel. Hands were rarely washed before and after each procedure and surgical washing was often performed in poor conditions. The decontamination of soiled equipment was ineffective. Reusable instruments were washed directly with bare hands or by individuals wearing used surgical gloves. The equipment used for sterilization was dilapidated and unsuitable and the norms for sterilization were seldom respected. Circulation in the region of the operating theatre was disorganized, if not anarchic. The personnel had a high risk of contamination from blood. Biomedical waste was not decontaminated: it was collected poorly and disposed of directly into the environment. None of the sites visited had a program of waste incineration. In conclusion, at the sites visited, there is a high risk of nosocomial contamination during care and the reuse of equipment, for both the staff and the patients treated.

[Prevalence and clinical aspects of puerperal mental disorders at the University Hospital Center of Dakar]

This is a contribution to the survey on psychiatric disorders of puerperality. We are particularly interested in the clinical signs and the ethiopathogenical facts of psychiatric disorders of the post-partum which appear-in our point of view-to be the main point on which we could probably act to reduce the effect of the disease. It is a retrospective survey going from January, 1st 1992 to December, 31st 1996. Here are included all the female patients whose age is more than 15, hospitalised during survey period and who presented a mental pathology linked with puerperality in accordance with diagnosis criterions of World Health Organization. In 1 627 hospitalisations, there were 658 women among whom 52 presented puerperality psychical disorders, that's meaning 7.9% of the female patients hospitalised in psychiatry, with an average age of 24.5 years. Concerning the classification of the diseases, the acute delirious psychosis and the depressive disorders are more important with respectively 56% and 19% of the sample. 92% of the women gave birth by the vaginal normal way and 61.5% presented disorders in the first week following their delivery. The married women are 94%. Concerning their occupations, 98% are house keepers. 52% are primiparas and 48% are multiparas. Psychical disorders of puerperality are frequent in Dakar. Acute psychosis and mood disorders are the main clinical aspects. The management of the future mother to her new roles by health education and prenatal check-ups in health centers by skilled and appropriate personnal is necessary.

Polyphasic characterization of rhizobia that nodulate Phaseolus vulgaris in West Africa (Senegal and Gambia)

Fifty-eight new isolates were obtained from root nodules of common bean (Phaseolus vulgaris) cultivated in soils originating from different agroecological areas in Senegal and Gambia (West Africa). A polyphasic approach including both phenotypic and genotypic techniques was used to study the diversity of the 58 Rhizobium isolates and to determine their taxonomic relationships with reference strains. All the techniques performed, analysis of multilocus enzyme electrophoretic patterns, SDS-PAGE profiles of total cell proteins, PCR-RFLP analysis of the genes encoding 16S rRNA and of the 16S-23S RNA intergenic spacer region (ITS-PCR-RFLP), auxanographic tests using API galleries and nodulation tests lead to the consensus conclusion that the new rhizobial isolates formed two main distinct groups, I and II, belonging to Rhizobium tropici type B and Rhizobium etli, respectively. By MLEE R. etli and group II strains showed several related electrophoretic types, evidencing some extent of internal heterogeneity among them. This heterogeneity was confirmed by other techniques (ITS-PCR-RFLP, SDS-PAGE and host-plant-specificity) with the same nine distinct strains of group II showing some differences from the core of group II (54 strains).

[Intracranial meningiomas. The Dakar experience apropos of 79 cases]

We report our experience with 79 intracranial meningiomas operated on between 1960 and 1995 in Dakar Senegal. In our geographical region issues concerning diagnosis, therapy and clinical course are still a topic of debate due mainly to the lack of high-performance technical units. All patients were admitted with evident symptoms. The classically described prevalence was not found in this series. Thirty-one cases presented intracranial hypertension with or without a focal syndrome which evidenced a motor deficit in 32 cases and irritative lesions in 24. External bulging of the meningioma was observed in a large number of cases (11.4%). Until 1994, angiography was the only available means of diagnosis. Mortality was high (30 cases) and results depended on delay to surgery, tumor localization and operative conditions. Our results have been improving over the years but cannot be sustained unless the technical unit is upgraded.

[Dorsal cord compression by aspergilloma. Apropos of a case]

Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.

[Women among a population at a psychiatric service in Senegal (psychosocial aspects)]

From a psychiatric consultation of women, the authors have tried to bring up the psychosocial aspects being very much influenced by the cultural context. They have discovered two profiles of these sort of women, they are either, married women under the stress of uncontrolled child-birth and are very much influenced by local tradition or are women being at a turning points of their life; adolescence, premenopause, and menopause. The authors have a well demonstrated the primordial role they take as natural (helpers) aids when a member of the family gives evidence of mental disorder.

[Caudal regression syndrome associated with Klippel-Feil syndrome]

In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.