[Relationships between the dental arches measurements and the peak nasal inspiratory flow (PNIF): a cross sectional study on 78 Senegalese teenagers]

INTRODUCTION

Upper airways obstruction can result in the reduction of the transversal dimensions of the maxillary arch which affect the vertical and the sagittal dimensions. The PNIF measure is an objec- tive and cheap way to assess the upper airways permeability. The aim of this study was to determine the relationship between PNIF and dental arch sizes.

MATERIALS AND METHODS

Seventy eight patients (40 girls and 38 boys) age ranged 10-15 years were included in this cross sectional study. The PNIF was measured with a Youlten peak flow meter (Clement Clarke International, London, United Kingdom). The sagittal, vertical and transversal dimensions of the dental arches were evaluated on dental casts with a digital caliper (Mitutoyo Corporation, Tokyo, Japan). T test was used to assess differences in PNIF and dental arches variables between subjects grouped according to sex (male and female). The Pearson's correlation coefficient was used to analyze the relationship between the dental arches sizes and the PNIF. The significance was set at p < 0.05.

RESULTS

PNIF rate was higher in girls than in boys but the difference was not significant. There were sexual dimorphism regarding the anterior and total lengths of the upper arch, the total length of the lower arch and the maxillary intermolar width which are significantly more important for boys (p respectively equal to 0.05; 0.03; 0.04 and 0.04). The PNIF was significantly and negatively correlated with the total length of the upper arch (r = -0.25). The others measurements did not show significant correlation with PNIF.

CONCLUSION

Others parameters are needed to complement the peak nasal inspiratory flow rate for the respiratory disorders related dental arches sizes abnormalities diagnosis.

Ultrastructural study of the male gamete of Glossobothrium sp. (Cestoda: Bothriocephalidea: Triaenophoridae) a parasite of Schedophilus velaini (Perciformes: Centrolophidae) in Senegal

This paper describes the ultrastructure of the male gamete of Glossobothrium sp. (Bothriocephalidea: Triaenophoridae). The mature spermatozoon of Glossobothrium sp. is filiform and possesses two axonemes, a single helicoidal crested body, a parallel nucleus, parallel cortical microtubules and granules of glycogen. In Glossobothrium sp. we describe for first time a 200-250 nm thick crest-like body in the Bothriocephalidean. The anterior part of the spermatozoon exhibits a ring of 27 electron-dense cortical microtubules encircling the first axoneme. This structure persists until the appearance of the second axoneme. When the ring of electron-dense cortical microtubules disappears, the spermatozoon exhibits two bundles of thin cortical microtubules. The posterior part of the spermatozoon contains the posterior extremity of the second axoneme, the posterior extremity of the nucleus and few cortical microtubules. Soon nucleus disappears and the axoneme is disorganized. Thus the posterior extremity of the spermatozoon of Glossobothrium sp. exhibits only singlets produced by the disorganization of the doublets of the second axoneme and few cortical microtubules. This type of posterior extremity of the mature spermatozoon has never been described previously in the Triaenophoridae.

[Preventive measures and the strife against nosocomial infection]

The nosocomial Infections are associated to an increase of the morbidity, of the mortality and costs. Their frequency stay on raised in our service of cares. Then it is recommended and broadly admitted what each hospital must dispose of a unity of nosocomial infections prevention and to dispose a staff specially vested in those duties. Of the fact the nosocomial infections frequency in reanimation, an imported part of the activity of this specialized staff will have to run out in services of intensive cares. The principal nosocomial infections feature observed is being directly or indirectly associated to engineerings of acting as invasives deputy used to palliate a vital lapse. Of a general manner, all sharp grave affection, as anything severe traumatism (accidental or surgical) drag a capacities reduction of defense against the infection, component so important factors of nosocomial infections installations. Preventive measures pass by the engineerings respect of hands hygiene, the harbour of clean conformable dress, the measures respect of isolation (septic or preventive), the cares grading, the upkeep of the hardware and the bedroom, the respect of the circuit of the linen salts and lastly the sorting and the losses management of activity of cares. For that it must a policy of strife against nosocomial infections with the placing in place of operational unities of hygiene in all hospitals and the redynamisation of the committee of strife against nosocomial infections already existed in different public establishments of health.

Rainfall triggered dynamics of Aedes mosquito aggressiveness

Inspired by Davidson method of estimating daily survivals of a structureless population of mosquitoes, we present a model which describes the behavior of floodwater mosquitoes in terms of emergence functions following a rainfall event, blood feeding frequency and parous stages, and survival at various stages. As a generalization of the Davidson formula, we have developed an approach for dealing with the dynamics of structured population of mosquitoes, and derived various formulas allowing assessment of demographic parameters like durations of gonotrophic cycles and (apparent) daily survivals. The method was subsequently applied to field data of floodwater mosquitoes Aedes vexans arabiensis, potential vectors of Rift Valley fever in West Africa, collected during the 2003 rainy season in Barkedji, Senegal. We found that mosquitoes emerged about 3 to 4 days following an efficient rainfall, and mosquito emergences, described by a bell shaped function, lasted for about 2 days. The mean duration of the gonotrophic cycle was 3 days and the apparent daily survival about 0.87.

[Nosocomial ventilator-associated pneumonia in a tropical intensive care unit]

INTRODUCTION

Nosocomial ventilator-associated pneumonia (VAP) occupy an important place among nosocomial infections and are responsible for a very high mortality. The objective of this work was to study epidemiologic, diagnostic and therapeutic aspects of ventilator-associated pneumonia in a tropical Intensive Care Unit and to release an adapted strategy of antimicrobial treatment.

PATIENTS AND METHODS

It is a prospective descriptive study carried out from January to December 2002 in the polyvalent intensive care unit, in collaboration with the laboratory of bacteriology-virology of the CHU Dantec of Dakar. We included all the patients admitted and who presented radiological pulmonary infiltrates appearing after 48 hours of mechanical ventilation, associated to at least 2 clinic or biologic criteria and to a positive tracheal aspirate with a cut off value of 10(4) CFU/ml.

RESULTS

Thirty two cases of VAP have been diagnosed among 446 patients admitted in our ICU. The incidence was 7.16 per 100 admitted patients and 50 per 100 ventilated patients. The reasons for ICU admission were dominated by trauma (44%). Microorganisms responsible of VAP were essentially Gram negative bacilli (GNB), 68% with in head the Pseudomonas. Acinetobacter strains were practically resistant to all usually used antibiotics. The more used antibiotics were gentamicine, 3rd generation cephalosporins and fluoroquinolones. Antibiotic treatment was appropriate in only 13 cases in 26 patients at whom intrinsic antibacterial activities of antimicrobial agents were examined. The mortality rate was of 81%.

CONCLUSION

The improvement of the prognosis of these VAP require preventive measures with protocols of care, a qualified staff, diagnostic means and active antibiotics on the responsible pathogens.

[Diabetic ketoacidosis of the child revealed by a pseudo-surgical acute abdomen. A case report]

Ketoacidosis is a frequent mode of revelation of diabetes of the child. Signs of diabetes are generally unperceived or are badly interpreted by the family entourage. We report a case of diabetic ketoacidosis in an eight-year-old child without particular medical history. The context of discovery was an acute abdomen by gastric dilatation in a severe context of dehydration. Evolution was quickly favourable after medical treatment with disappearance of acute abdominal signs (clinical and radiological). This observation enables us to recall, by the light of a review of the literature, that diabetic ketoacidosis can be revealed by pseudo-surgical acute abdomen and treatment is purely medical.

[Acute chloroquine poisonning in Le Dantec Teaching Hospital]

Chloroquine poisoning is an acute severe drug induce entity increasingly frequent in Senegal. This is due on one hand to its easy accessibility and its conditioning, on the other hand to its frequent use, in the voluntary attempt of ending pregnancy. The aim of this study is to assess the frequency and the severity of such poisoning in a senegalese intensive unit care. We undertook a descriptive retrospective study from January 1998 to December 2003 in the intensive care unit of Aristide Dantec Hospital. All patients admitted for voluntary or accidental acute intoxication to chloroquine were included. The parameters studied were: reason of admission, alledged ingested amount, delay of admission, hemodynamic modifications, therapeutic data and evolution. During the study period, forty-nine cases of chloroquine intoxication were listed out of 239 acute intoxications. Among these 49 cases, 16 files were not processable. These accounted for 1,48% of all admissions during this period. Women were more represented (78.78%). In 90.90% of the cases, the intoxication was voluntary, they were related to suicidal attempt in 57.57% of the cases. The willingness to end a course of a pregnancy was found in 33.33% of the cases. The average age was 22.69 years (11 years - 38 years). The average time of admission was 4 hours. with extremes of 1 and 8 hours. The clinical symptoms were dominated by hemodynamic, neuropsychiatric and respiratory disorders. Toxicological analysis was not carried out. Ionic disorders were dominated by hypokaliémies and electrocardiographic disorders by a widening of QRS. Symptomatic treatment systematic, was based on a vascular filling and the use of adrenalin. evacuation treatment consisted of a systematic gastric "lavage" and the use of activated charcol on (3.03%). Diazepam as treatment antidotic was seldom used. Psychiatric consultation was systematically carried out. Total mortality was 6%. The authors emphasize the nécessaty to: Inform the population on the absence of drugs being able to stop a pregnancy. Think on the urgency need to implement a medical emergency and reanimation departments (SMUR). Create poison control centers in Senegal.

Treatment of silica effluents: ultrafiltration or coagulation-decantation

In the electronics industry, the preparation of silicon plates generates effluents that contain a great amount of colloidal silica. Two processes--decantation and ultrafiltration--are studied with in view the treatment of the effluents released by the firm Rockwood Electronic Materials. The feasibility of each of the two processes is studied separately and their operating parameters optimized. Both processes allow the recovery of a great proportion of the initial effluent (over 89%) as transparent and colorless water that can be reused at the start of a line. In view of the results and of the compared advantages and disadvantages of the two processes, ultrafiltration will be selected for the industrial unit.

[Assessment of the management of polytrauma patients at Le Dantec Hospital, Dakar]

Traumatisms represent the first reason of death in people less than 40 years in the developed countries. In Senegal, with the growth of urbanization, road accidents are more and more frequent and mortality by polytrauma is raised. The aim of this study was to evaluate the management of polytrauma patients in our hospital and to determine factors of mortality. This prospective study was carried out from January to June 2000 at the surgical emergencies department and the intensive care unit in Le Dantec Teaching Hospital of Dakar. One hundred and six polytrauma patients were taken care of during the study period. The mean age of patients was 30 years. There were 85 men and 21 women. Circumstances of trauma were dominated by road accidents (74.5%) and in 77.4% of cases patients were evacuated without prehospital care. The mean delay from the accident to the arrival at emergencies was 8 hours. Half of the patients presented to the admission a clinical picture of circulatory failure; respiratory distress was also present among 50% of patients and 53.8% of patients had a serious head injury with a Glasgow coma scale lower than 8. The global mortality was 69.8% and 80.6% of these deaths were attributable to serious head injury. Management of trauma patients in Dakar could be improved by setting up a medical transport system and by the improvement of the technical means in the hospitals. These measures, in combination with the prevention of road accidents, will surely allow to reduce the number of accidents, polytrauma and deaths.

[Anesthesia in the surgery of hyperthyroidism at Le Dantec Teaching Hospital]

Authors report a study of 66 patients admitted to the clinic ORL of CHU Le Dantec between 1991 and 2000 for goiter and hyperthyroidism. They evaluate the perioperative management and underline the importance of the medical preparation. The age of patients varied between 15 and 74 years. There were 62 women and 4 men. Fifty three patients presented clinical and biological hyperthyroidism. Thirteen patients had functional hyperthyroidism without clinical signs of thyrotoxicosis. Exophthalmia was present in 20 patients. Twenty one patients have been addressed to the Internal Medicine service for preoperative management of hyperthyroidism. Forty five patients have been operated under general anaesthesia. The medical preparation comprised antithyroid drugs and beta-blockers. We found as complications 3 cases of difficult intubation, 7 cases of peroperative haemorrhage and 1 case of acute thyroid crisis. The anaesthesia for surgery of hyperthyroidism is currently well codified and operative outcome became simple. The medical preparation in case of hyperthyroidism allows to return the patient in euthyroidism and reduces considerably the acute thyroid crisis risk, the most fearsome complication and the most feared of the hyperthyroidism.

[Intensive care management of 28 patients with severe eclampsia in a tropical African setting]

OBJECTIVE

To study the specific management problems of severe eclampsia under tropical latitudes.

STUDY DESIGN

A two years retrospective study in a University hospital in the tropics.

PATIENTS AND METHODS

In all patients admitted for eclampsia between January 1997 et December 1999, the following parameters were studied: age, parity, interval between disease et admission, post-eclampsia Glasgow Coma Scale (GCS), time of occurrence of eclampsia during pregnancy, delivery route, blood pressure data at admission, the occurrence of complications at admission or during hospital stay.

RESULTS

Twenty-eight mainly primiparous patients (mean age: 26 +/- 6) were admitted with an average delay of 8.5 +/- 10.2 hours after the first symptoms. The time of occurrence was prepartum in 6, perpartum in 14 and postpartum in 8 cases. All patients were hypertensive and comatose with an average GCS of 8 +/- 2.2. Twenty patients had been previously intubated and ventilated. Delivery was natural in 22 and by caesarean section in 6 patients. The following complications were found: acute oliguric renal failure (9), HELLP-syndrome (4), cerebral haemorrhage (4), acute lung oedema (3) and acute respiratory distress syndrome (1). Maternal and child mortality were 35 and 42.8% respectively.

CONCLUSION

Eclampsia is a major cause of both maternal and infantile mortality in developing countries. The authors insist that prevention and management require speedy transfers to adapted specialized obstetrical intensive care structures.

[Post traumatic injuries of the duodenum and/or pancreas. Perioperative management]

The duodenal and/or pancreatic lesions rarely occur during abdominal contusions, this, because of the deep and retroperitoneal position of the duodeno-pancreatic entity. These lesions occur mostly in the young adults and occur mostly on violent trauma, hence the high frequency of associated lesions. Their management is well codified and the prognosis depends on the degree of pancreatic damage. The authors reporting of 3 cases of duodenaland or post-traumatic lesion, in a retrospective study. The after therapeutic management necessitated a pre-operative reanimation, simple duodenal suturing in the 3 cases with relearning gastrotomy, alimentation jejenostomy and closing of thepyloric sphincter,with association of cholostomy in one of the cases. The pancreatic lesions of type contusion observed in 2 cases necessitated simple drainage of the pancreatic sector without resection. The evolution was favourable in 2 cases. One case of death was noted in a patient who developed acute pancreatis.