Fann University Hospital Center

Dakar, Senegal

Fann University Hospital Center

Dakar, Senegal
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PubMed | University of Ziguinchor, iop University, Fann University Hospital Center and Aix - Marseille University
Type: Journal Article | Journal: Surgical and radiologic anatomy : SRA | Year: 2016

To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC).We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects.At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes.The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

De Beaudrap P.,Montpellier University | Thiam M.,Laboratoire Of Bacteriologie Virologie | Diouf A.,Multisectorial AIDS Program | Toure-Kane C.,Laboratoire Of Bacteriologie Virologie | And 7 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

Background: In 1998, Senegal launched one of Africa's first antiretroviral therapy (ART) programs. Since then, the number of treated patients in Africa has substantially increased thanks to simplification in treatment management. Although good outcomes over the first years of ART have been observed in sub-Saharan Africa, little is known about the long-term (.5 years) risks of virological failure and drug resistance and about second-line treatment response. Methods: Patients from the ANRS-1215 cohort in Senegal, started with either one nonnucleoside reverse transcriptase inhibitor or indinavir, a first-generation nonboosted protease inhibitor, followed for .6 months and having .1 viral load (VL) measurement were included. Virological failure was defined as 2 consecutive VL measurements .1000 copies/mL. Results: Of the 366 patients included, 89% achieved a VL ,500 copies/mL. The risk of virological failure at 12, 24, and 60 months was 5%, 16%, and 25%, being higher in younger patients (P = 0.05), those receiving a protease inhibitor-containing regimen (P = 0.05), and those with lower adherence (P = 0.03). The risk of resistance to any drug at 12, 24, and 60 months was 3%, 11%, and 18%. After virological failure, 60% of the patients were switched to second-line treatments. Although 81% of the patients achieved virological success, the risk of virological failure was 27% at 24 months, mostly in patients with multiple resistances. Conclusions: In this cohort, virological outcomes for first-line treatments were good compared with those from high-resource settings. However, the rate of virological failure for second-line treatment was high, probably because of accumulation of resistances. Copyright © 2012 by Lippincott Williams & Wilkins.

Balestre E.,French Institute of Health and Medical Research | Eholie S.P.,Center Hospitalier University Chu Of Treichville | Lokossue A.,Center Hospitalier University Chu Of Treichville | Sow P.S.,Fann University Hospital Center | And 6 more authors.
AIDS | Year: 2012

Objective: To assess the effect of aging on the immunological response to antiretroviral therapy (ART) in the West African context. Methods: The change in CD4 T-cell count was analysed according to age at the time of ART initiation among HIV-infected patients enrolled in the International epidemiological Database to Evaluate AIDS (IeDEA) Collaboration in the West African region. CD4 gain over 12 months of ART was estimated using linear mixed models. Models were adjusted for baseline CD4 cell count, sex, baseline clinical stage, calendar period and ART regimen. Results: The total number of patients included was 24 107, contributing for 50 893 measures of CD4 cell count in the first year of ART. The baseline median CD4 cell count was 144 cells/μl [interquartile range (IQR) 61-235]; median CD4 cell count reached 310 cells/μl (IQR 204-443) after 1 year of ART. The median age at treatment initiation was 36.3 years (10th-90th percentiles = 26.5-50.1). In adjusted analysis, the mean CD4 gain was significantly higher in younger patients (P < 0.0001). At 12 months, patients below 30 years recovered an additional 22cells/μl on average [95% confidence interval (CI) 2-43] compared to patients at least 50 years. Conclusion: Among HIV-infected adults in West Africa, the immunological response after 12 months of ART was significantly poorer in elderly patients. As the population of treated patients is likely to get older, the impact of this age effect on immunological response to ART may increase over time. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Diouf A.,Fann University Hospital Center | Cournil A.,IRD Montpellier
Bulletin de la Societe de Pathologie Exotique | Year: 2014

Among the patients of the cohort still followed after a median of 9 years of antiretroviral treatment (ART), 37% had lipodystrophy, 28% had hypertension and 14% presented with diabetes. This study confirms the association between stavudine and lipodystrophy particulary lipoatrophy and shows that a longer duration of ART was associated with the presence of diabetes. These results highlight the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings. © 2014, Springer-Verlag France.

Diop-Ndiaye H.,Laboratoire Of Bacteriologie Et Virologie | Toure-Kane C.,Laboratoire Of Bacteriologie Et Virologie | Leye N.,Laboratoire Of Bacteriologie Et Virologie | Ngom-Gueye N.F.,Fann University Hospital Center | And 3 more authors.
AIDS Research and Human Retroviruses | Year: 2010

To evaluate the presence of drug resistance mutations in antiretroviral-naive patients in Dakar (Senegal), cross-sectional studies were conducted since the circulation of ARVs in the country. Protease and RT genes were sequenced in 96 baseline samples from patients included in the Senegalese Initiative for Antitretroviral Access treatment between 1998 and 2001 and for 104 samples from naive, recently diagnosed patients in 2003, 2005, and 2007. Phylogenetic analysis showed a predominance of CRF02-AG [128/200 (64%)] and a high genetic diversity with 10 other variants and 25 URFs. Analysis for the presence of drug resistance mutations according to the WHO SDRM 2009 list showed a prevalence of 4.16% for nucleoside inhibitors and 1.04% for protease inhibitors at the start of the structured Senegalese ART initiative and 1.9% for protease inhibitors at the time of scaling up. The prevalence in untreated patients remains low and stable, below 5% after 10 years of ARV circulation. Copyright 2010, Mary Ann Liebert, Inc.

De Beaudrap P.,Ird Institute Of Recherche Pour Le Developpement | Diouf A.,Fann University Hospital Center | Bousso Niang K.,Fann University Hospital Center
Bulletin de la Societe de Pathologie Exotique | Year: 2014

In 1998, the cohort ANRS 1215 was launched in Senegal with one of the first African antiretroviral treatment programs. Four hundred forty four HIV-infected adults started on ART were included between 1998 and 2004, and followed up to 2010. Mortality before 6 months was 15.6/100 person-year (PY) and associated to the initial disease severity. It decreased to 3.36/100 PY thereafter. The cumulative risks of virologic failure at 60 months and of drug resistance at 48 months were 25% and 16%, respectively. © 2014, Springer-Verlag France.

Farnarier G.,Marseille University Hospital Center | Gueye L.,Fann University Hospital Center
Epilepsies | Year: 2010

EEG remains the first-line diagnostic tool in epileptology. Each reference hospital should include a dedicated room with at least one video-EEG apparatus and the possibility of performing sleep studies. Polygraphy shows the correlation between EEG and EMG; EMG and evoked potentials are useful in myoclonic epilepsies. Tropical climate may pose problems for the material, protection being adequate in institutions, but not in rural areas. Prejudice and beliefs may delay diagnosis, EEG and treatment of epilepsy. Information, education and communication programs have led the progress in the knowledge of traditional healers and of the community. When economic possibilities are limited, and needs are high, neurophysiological material is not a priority, but the cost of investment and use must be compared to the cost of neglected disease. Procedures must be financially accessible to patients. The reliability of neurophysiological procedures depends on the quality of recordings and interpretation, which implies an adequate training in technology and in EEG symptomatology in correlation with clinical data. Complements of training are necessary for medical and paramedical actors. The scarcity of neurologists implies that general practioners be implicated in the care of patients with epilepsy. Specific training for EEG technicians is also advisable. Two factors may influence brain electrogenesis in tropical countries and lead to particular responses: the organization of sleep and the lesser response to ILS stimulation in the dark skinned population. In large African hospitals, epilepsy accounts for at least 50% of EEG indications. Tropical diseases, in particular parasitic, may translate into EEG changes that may be specific. Nonepileptic, psychogenic seizures are sometimes mistaken for epilepsy. Various strategies have been adopted for the management of epilepsy in rural areas: specialized clinics moving to the countryside, networks of specially trained general practioners, organization of access to drugs, all these measures have shown their efficacy. The level of equipment depends on political choices and priorities, but the main challenge is to obtain the best possible adequation between what should be done and what is possible, a function of local possibilities.

This article describes and analyzes the attitudes towards the risk of sexual transmission of HIVand childbearing among PLHIV who have received antiretroviral therapy for ten years and the attitudes and representations of health care professionals who conduct their medical follow-up. The results highlight the contradictions between the magnitude of the social advantages of motherhood for women living with HIVand the reluctance among health care professionals to support them. In a context where the pressure to bear children is strong, the biomedical system that supports childbearing for PLHIVon ARVs should be readapted without failing to also address men living with HIV. © 2014, Springer-Verlag France.

The aim of this qualitative study was to describe and analyze representations of therapeutic failure and the medical and social responses proposed by health care professionals and patients receiving follow-up in the ANRS cohort 1215 in Senegal from 1999 to 2010. Patients’ medical histories show that therapeutic failures are related to complex multifactorial situations, resulting from factors attributable to patients (adherence failure related to various psychosocial problems) but also to health care structures (organization of the health system, training for health care professionals and availability of biological exams and appropriate drugs). Both patients and health care staff recognize these causes. The incidence of the onset of therapeutic failures should be regarded as an indicator of the quality of care provided. Further thought should be given to how well health care systems function when changes occur in these rates. © 2014, Springer-Verlag France.

Claros P.,Clinica Claros Otorrinolaringologia y Cirugia Plastica Facial | Ahmed H.,Fann University Hospital Center | Claros A.,Clinica Claros Otorrinolaringologia y Cirugia Plastica Facial
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2016

Introduction: Osteomyelitis of the frontal sinus is a rare clinical entity and generally occurs as a complication of trauma to the forehead or frontal sinusitis. It can be responsible for life-threatening complications, as the first symptoms may appear to be minor. Early diagnosis and appropriate management to prevent central nervous system complications significantly reduce the morbidity and mortality. Case report: The authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus. Discussion: The diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage. © 2015 Elsevier Masson SAS.

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