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Outcome of Unclassified Inflammatory Rheumatism: Observation of 7 Cases in Dakar

Open Journal of Internal Medicine 2022年第1期12卷 22-28页

作者： Awa Cheikh Ndao Faye Atoumane Diagne Nafissatou fall biram codou Dia Diatou Gueye Dia Amadou Diop Diop Mohamed Sow Maïmouna Kane Baïdy Sy Boundia Djiba Pouye Abdoulaye Cheikh Anta Diop University Dakar Senegal Gaston Berger Saint-Louis University Dakar Senegal Department of Internal Medicine in Aristide Le Dantec Hospital Dakar Senegal

Introduction: Unclassified inflammatory rheumatism is persistent inflammatory arthralgias with or without synovitis without sufficient classification criteria for an inflammatory rheumatism or a well-defined connective disease. Their outcome is variable and has been little studied in Africa. We report the epidemiological, paraclinical and evolutionary characteristics of seven cases of indeterminate polyarthritis. Material and Method: From January 2012 to May 2021, we selected all the files of patients followed up for unclassified inflammatory rheumatism and in whom a precise diagnosis was retained during the course of the disease. The diagnosis of unclassified inflammatory rheumatism was retained after biological, immunological and radiological explorations without specificities. Our study took place in the Internal Medicine Department of Aristide Le Dantec Hospital (HALD). Results: Seven cases out of 274 consulted were collected. They consisted of seven women with an average age of 39 years at the time of the first consultation (extremes: 19 and 67 years). All seven patients presented with inflammatory polyarthralgia or non-deforming, non-erosive peripheral polyarthritis, without extra-articular manifestations. A biological inflammatory syndrome was present in all seven patients. Autoantibodies (rheumatoid factor, ANA, anti-ENA and ACPA) were negative in all patients. The first-line treatments in all seven cases were hydroxychloroquine (200 - 400 mg/day) and prednisone (5 - 10 mg/day). Methotrexate was added in 3 cases. During follow-up, 2 cases progressed to Polyarthritis Rheumatoid (PR) after 3 and 4 years. Two cases progressed to Sjögren’s syndrome after 4 and 5 years. Two patients progressed to systemic scleroderma after 5 and 8 years. One patient progressed to lupus after 5 years. Conclusion: Regular follow-up is essential in IAN. It allows the early diagnosis of IJR or a well-differentiated connective tissue disease and ensures adequate management, especially

关键词： Rheumatic Unclassified Rheumatoid Arthritis Connective Tissue Disease

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Electrocardiographic Changes in Patients with Type 2 Diabetes Multicenttic Cross Sectional and Descriptive Study in Dakar

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Open Journal of Internal Medicine 2017年第3期7卷 64-73页

作者： Michel Assane Ndour Leye Abdoulaye fall biram codou Leye Yakham Mohamed Ndiaye Nafy Diack Ngoné Diaba fall Aichetou Mbaye Alassane Diao Maboury Diop Moreira Therese Department of Internal Medicine/Endocrinology National Pikine Hospital Center Dakar Senegal Department of Cardiology Center Hospital Aristide le Dantec Dakar Senegal Department of Cardiology National Hospital Center of Grand Yoff Dakar Senegal Department of Internal Medicine Center Hospital Aristide le Dantec Dakar Senegal Faculty of Medicine of Cheikh Anta Diop University of Dakar Dakar Senegal

Introduction: The resting electrocardiogram is generally called upon in the evaluation of cardiovascular risk in diabetics. Thus we proposed in this work to evaluate electrocardiographic changes in patients with type 2 diabetes. Methods: This was a cross-sectional and descriptive observation that took place from 1 January 2014 to 1 October 2014 in the Internal Medicine/Endocrinology Departments of Pikine National Hospital and Cardiology National Hospital of Grand-Yoff. Results: One hundred (100) patients consisted of 43 male and 57 female diabetics. The sex ration male/female ratio was 0.7. The average age was 58.3 years. Men were twice as likely to be active as women. Rhythm disorders were noted in 20% of patients, 13% of whom were women. Right atrial hypertrophy was found in 11% of patients and left hypertrophy in both men and women (25%). Wolf-Parkinson White syndrome was present in 2% of patients. A complete right bundle block was present in 11% of patients. Primary repolarization disorders were noted in 17% of patients and secondary in 18% of patients, postero-diaphragmatic necrosis in 14% of patients, real posterior necrosis in 2% of patients, extensive anterior necrosis in 15% of patients. The QT interval was lengthened in 21% of patients including 14 women. Left ventricular hypertrophy was present in 33% of patients and right ventricular hypertrophy was found in 10% of patients. The bivariate analysis showed that electrocardiographic abnormalities were more correlated with the association of certain risk factors such as hypertension and dyslipidemia, the feminine gender, but also the poor glycemic balance. On the other hand, physical activity and treatment had a protective effect. Conclusion: The ECG is certainly insufficient for an exhaustive exploration of the heart of the diabetic patient, but still very useful in our conditions of exercise to improve the care of our patients.

关键词： Diabetes ECG Heart Dakar Cardiovascular Disease

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Haemorrhagic Lupus: A Diagnosis Emergency, Report about 6 Cases

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Open Journal of Internal Medicine 2021年第4期11卷 231-237页

作者： fall biram codou Walah Dimitri Dieng Mouhamed Diaw Bamba Tode Johanita Gaye Ahmadou Salane Aly Ndao Awa Cheikh Cisse Amadou fall Sow Maimouna M. A. Ndour Djiba Boundia Kane Baidy Sy fall Seynabou Leye Abdoulaye Pouye Abdoulaye Ndongo Souhaibou Department of Internal Medicine at DalalJamm Hospital Dakar Sénégal Department of Internal Medicine at Dantec Hospital Dakar Sénégal Department of Internal Medicine at Pikine Hospital Dakar Sénégal Department of Hematology at DalalJamm Hospital Dakar Sénégal

Introduction: Haemorrhagic manifestations rarely represent the mode of onset of lupus and are a therapeutical and diagnosis emergency. We report 6 cases of haemorrhagic manifestations disclosing lupus. Patients and methods: It’s about a retrospective, descriptive and multicentric study ranged from 1st January 2014 to 5th January 2019. Were included in the study all cases of lupic disease revealed by hemorrhagic disorders, recorded in 3 Internal Medicine Departments in Dakar: DalalJamm, Dantec, Pikine. The diagnosis of lupus was made on the basis of the 1997 modified classification criteria of ACR for SLE. Results: We gathered 6 cases of women affected by lupic disease. The mean age was 32 years old with extremes ranged from 17 to 56 years. According to haemorrhagic disorders, the diagnosis of lupus was automatically made in 5 of the cases and it took 6 months to confirm the last one. Haemorrhagic features were ruled by purpura (3/6 cases) and nose-bleeding associated with gumbleeding (2/6 cases), epistaxis and melena (1/6 case), hypermenorrhea (1/6 case), cerebral haematoma (1/6case). Cutaneous (5/6), articular (4/6), renal (2/6) and serous (2/6) disorders specially represented the other manifestations. Biological findings showed cytopenia with 3 cases of anaemia, 1 case of leucopenia and 6 cases of thrombopenia. The average of the platelet count was at 20,000 cells/mm3 with extremes ranged from 1000 to 35,000 cells/mm3. Thrombocytopenia was related to autoimmune thrombocytopenic purpura in 3 cases, to Evans’ syndrome in 2 cases, to macrophage activation syndrome in 1 case. Immunological investigations found the presence of antinuclear antibodies (1/6), anti-dsDNA (2/6) and anti-Sm (4/6). All patients received a bolus of Solumedrol followed by an administration of Prednisone at a dosage of 1.5 mg/kg (3 cases) and 1 mg/kg to the other patients. A transfusion of platelet concentrates was performed for all of them. The evolution was favorable in 4 cases. Two

关键词： Haemorrhagic Lupus Emergency

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Adenopathies in Internal Medicine Etiological Profile and Diagnostic Limits

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Open Journal of Internal Medicine 2017年第3期7卷 80-96页

作者： Michel Assane Ndour Atoumane Faye Abdoulaye Leye Boundia Djiba Maimouna Sow Sy Baydi Kane Ngoné Diaba Diack fall codou biram Yakham Mohamed Leye Mouhamed Dieng Nafy Ndiaye Léa Marie Kabou Abdoulaye Pouye Department of Internal Medicine/Endocrinology National Pikine Hospital Center Dakar Sénégal Department of Internal Medicine Center Hospital Aristide Le Dantec Dakar Sénégal Department of Hematology Center Hospital Aristide Le Dantec Dakar Sénégal

INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitted for adenopathy in order to identify their specificities. METHODS: This was an observational study of a transverse and descriptive type, which took place from 1 July 2015 to 30 June 2016 in the internal medicine department of the Aristide Le Dantec national hospital in Dakar. RESULTS: We identified 84 patients, consisted of 46 male and 38 female. The sex ratio was 1.2. The mean age was 37.5 years. The consultation period was on average 2 months with extremes of 1 month and 1 year. The mean hospital stay was 29. 2 days with extremes of 1 week and 2 months. The etiologies found were classified into 6 groups. Hemopathies (30.9%) were dominated by acute leukemia in 8 patients (9.52%), non-Hodgkin’s lymphoma in 9 patients (9.5%), Hodgkin’s disease in 5 patients (5.9%). Chronic lymphocytic leukemia was retained in 3 patients (3.5%) and Castleman disease in 1 patient. Systemic diseases (11.9%) were divided into lupus disease in 4 patients and rheumatoid arthritis in 4 patients, one case of Sj?gren’s syndrome and one case of sarcoidosis. Infections were very frequent in our study, found in 34 patients (40.4%). Tuberculosis was more frequent (27.3%). The association with HIV was noted in 4 patients. The other infections were pyogenic in 3 patients (3.5%), HIV in 6 patients (7.1%), Borrelia and toxoplasma in 1 patient respectively. Cancers (8.3%) were metastatic of primary tumors including the esophagus, lung, prostate, cavum, stomach, pancreas and breast, one case each. One patient presented lymphadenopathy with inguinal localization, the etiology of which was found to be thrombophlebitis of the right lower limb. The hystiocytic pathologies (3.5%) were all related to lymphohystiocytic activation syndrome (LHAS) secondary to tuberculosis in 2 patients and pyomyo

关键词： Adenopathy Etiologies Dakar Diagnostic Limits

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Knowledge, Attitudes and Practices Survey in Management of Type 2 Diabetes by General Practitioners in Dakar

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Journal of Diabetes Mellitus 2017年第4期7卷 294-301页

作者： Abdoulaye Leye Nafy Ndiaye Ngoné Diaba Diack Michel Assane Ndour biram codou fall Yakham Mohamed Leye Papa Ousseynou Mane Internal Medicine and Endocrinology Department Teaching Hospital of Pikine Dakar Senegal

Introduction: Considering the global burden of diabetes and lack of specialist in diabetology in our subsaharian area, general practitioners (GPs) play a major role as first referent for care of diabetic people. The aim of this work was to describe knowledge, attitudes and practices of GPs related to management of type 2 diabetes. Patients and Methods: It was about a transversal and descriptive survey held between July 14, 2015 and November 1st, 2015 in the medical districts and public corporations of health of Dakar in Senegal. Results: The population of study was made of 107 males and 40 females GPs. The majority (82.8%) was graduated since less than five years. Hygienic and dietetic measures (HDM) were known and commonly recommended by 77.60% of GPs in their daily practice. The caloric intakes were known by 21.1%. The 30 min of physical activity per day three times in the week was advised by 91.20%. Monotherapy with metformine associated with HDM was prescribed by 76.90%. Bitherapy with metformine and sulfonylureas associated to HDM were prescribed by 39.50%. Concerning insulin therapy, mixed insulin twice daily associated with rapid insulin before lunch was prescribed by 49.7%. Use of rapid acting insulin with three injections before each meal was prescribed by 36.10%. Treatment of the other cardiovascular risk factors was addressed by 97.30%. Smoking cessation was advised by 37.40%. Use of sweetened drink and intravenous glucose were most adopted in case of hypoglycemia, and use of glucagon was adopted by 23.10%. To improve the diabetic retinopathy 61.2% of GPs recommended tight control of other cardiovascular risk factors. Rigorous glycemic control and regular physical activity were recommended for painful neuropathy beside analgesics. Smoking cessation was also recommended by 61.90% for that. Against obstructive arterial disease of the lower extremities, tight control of blood pressure was recommended by 69.40% Conclusion: It comes out from these results the

关键词： Knowledge Attitudes Practices Diabetes General Practitioners

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Adult Onset Still’s Disease in Tropical Area: Illustration of Diagnostic and Therapeutic Difficulties from 3 Senegaleses Observations

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Open Journal of Internal Medicine 2017年第4期7卷 135-143页

作者： Nafy Ndiaye Ngoné Diaba Diack Michel Assane Ndour biram codou fall Ghislain De Chacus Daouda Thioub Ameth Dieng Yakham Mohamed Leye Abdoulaye Leye Internal Medicine Department Teaching Hospital of Pikine Dakar Senegal

Introduction: The Adult Onset Still’s Disease (ASD) is a systemic auto-inflammatory affection of unknown cause seldom described in sub-Saharan Africa. We report 3 observations of ASD illustrating the diagnostic and therapeutic difficulties of this affection in our areas. Observation 1: Our first patient is a 56 years old schoolteacher presenting an ASD in its chronic articular form. She had been followed for an inflammatory arthralgia for 10 years and of the pharyngal pains without exact diagnosis. She presented ASD’s criteria of Yamaguchi and of Fautrel. The prednisone was begun at the dose of 0.8 mg/kg/day with fast appearance of a progressive muscular weakness. Use of methotrexate at a rate of 15 mg per week, associated with low dose of prednisone was effective in long-term without any flare of the disease so far. Observation 2: Our second patient is a 30 years old dressmaker presenting an ASD in its complicated systemic form of lymphohistiocytic activation syndrome. She validated the criteria of Yamaguchi and Fautrel for ASD. She also presented resistance to corticosteroid therapy. The evolution was marked by a hospital-acquired septicemia and a multi-organ failure leading to death. The diagnosis was retrospectively confirmed after that, with the low level of the glycosylated ferritin serum value. Observation 3: The third patient is a 22 years old Guinean student who presented prolonged fever and inflammatory polyarthralgia without articular deformation. He had been misdiagnosed for ASD with diagnostic wandering of several months. He was treated successfully with prednisone after set up of ASD diagnosis according common criteria. Corticosteroid therapy was stopped after 8 months without any relapse noted so far. Conclusion: Caring for ASD is difficult in our context mainly because of high cost of several explorations needed to set up its exact diagnosis while making differential one. Evolution under corticosteroid therapy is usually favorable but diagnostic dela

关键词： Still’s Disease Diagnosis Treatment Tropical Area

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Management of Multiple Endocrine Neoplasia Type 2A (MEN 2A): Diagnostic and Therapeutic Concerns with the First Documented Senegalese Family

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Open Journal of Endocrine and Metabolic Diseases 2018年第1期8卷 29-37页

作者： Abdoulaye Leye Ngone Diaba Diack Michel Assane Ndour Nafy Ndiaye Yakham Mohamed Leye biram codou fall Malick Ndiaye Abdoul Karim Daher Ahmed Tall Lemrabott Boucar Diouf Internal Medicine/Endocrinology department. Teaching Hospital of Pikine/Dakar ENT Department. Fann Teaching Hospital/Dakar Nephrology Department. Le Dantec Teaching Hospital

Introduction: Multiple endocrine neoplasia (MEN) type 2A is a multiglandular tumor condition inherited in an autosomal dominant manner. It is related to proto-oncogene RET mutation whose analysis is the best technique for family screening. It features in a variable way medullary thyroid cancer (MTC), primary hyperparathyroidism (HPT) and pheochromocytoma. The revealing manifestations of these tumors are often neglected for a long time and the screening should be systematic particularly in a known family context. Methods: After a family tree establishment of a MEN 2A index case, a family survey allowed to diagnose other cases in the family by means of biological, radiological and/or genetic examinations. Results: We report a family form of MEN 2A in a family of three households. In this family 13 people (index case included) were probed out of 34 members. The average age of our patients was 43.54. The sex ratio men/women was 0.85. The simultaneous diagnosis of a primary HPT and a MTC was carried out in our index case and constituted the circumstance of discovery of MEN 2A. The time limit of MEN 2A diagnosis on the other family members was on average 7.7 years. A MTC was recorded in 7 patients. It was asymptomatic in overall cases. A pheochromocytoma was present in only one patient. Primary HPT was found in four patients. Renal lithiasis with recurrent unilateral or bilateral nephritic colic attacks was the main manifestation. Besides the index case, 11 patients had a genetic testing. In 7 patients, a mutation on proto-oncogene RET located on the codon 634 was noted. A surgical care was carried out on 6 patients. We recorded three patients lost to follow-up. A patient died before surgery. In the index case, biological and radiological monitoring found a locoregional residual disease that indicated surgical revision and radiotherapy. Prophylactic thyroidectomy was not performed in any case driven by lack of compliance and/or low income. Conclusion: The discovery of a M

关键词： Multiple Endocrine Neoplasia Pedigree RET Gene Senegal

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Severity of the Rheumatoid Arthritis in Sub-Saharan Africa:Study of 403 Senegalese Observations

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Open Journal of Internal Medicine 2017年第4期7卷 151-159页

作者： Moustapha Niasse Baidy Sy Kane Abdoul Aziz Ndiaye Awa Cheikh Ndao Boundia Djiba Seynabou fall Ngone Diaba Diack Fatimata Bintou Sall Michel Assane Ndour Nafy Diagne Atoumane Faye biram codou fall Souhaibou Ndongo Abdoulaye Pouye Department of Rheumatology Center Hospital Aristide Le DantecDakarSenegal Department of Internal Medicine Center Hospital Aristide Le DantecDakarSenegal University of Bambey BambeySenegal Department of Hematology Center Hospital DalalJammDakarSenegal Department of Internal Medicine/Endocrinology National Pikine Hospital CenterDakarSenegal Department of Hematology Center Hospital Aristide Le DantecDakarSenegal

Introduction: We assess the severity of the rheumatoid arthritis in a Senegalese African black population. Patients and methods: It is a retrospective study achieved in the service of Internal Medicine of Aristide Le Dantec teaching hospital of Dakar between January 2005 and December 2016 in patients suffering from rheumatoid arthritis. We specified for every patient the predictive data of severity of the rheumatoid arthritis. Results: Four hundred and three patients have been gathered (39 men and 364 women), with the mean age of 45.8 years. An active tobacco addiction was noticed in 10 patients. The diagnostic delay was on average of 72 months. Characteristic articular deformations were noticed in 215 patients (53.3%). They were correlated to male (p = 0.038), to age (p = 0.001) and to the activity of the rheumatoid arthritis (p = 0.0445). Systemic manifestations have been observed in 213 cases (52.9%), particularly anemia (50.8%). They were correlated to the anti-CCP antibodies (p = 0.047). The ESR was increased at the first hour in 84.4% of cases (median: 43 mm;extreme: 1and 160). CRP was elevated in 63.71% of cases (median of 12 mg/l;extreme: 1 and 384). The rheumatoid factor was positive in 57.6% of the cases. The anti-CCP antibodies were present in 89.2% of the cases. Articular erosions were objectified in all cases. A DAS 28 superior to 5.1 was noticed in 71% of cases. Conclusion: The rheumatoid arthritis was severe in our study.

关键词： Rheumatoid Arthritis Africa South of the Sahara Senegal

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