Hôpital Aristide Le Dantec

Abstract Background This study aimed to investigate the occurrence, antimicrobial resistance profiles, and genetic characteristics of extended-spectrum beta-lactamase (ESBL)-producing E. coli in wastewater collected in Dakar, Senegal. Methods A total of 48 wastewater samples were collected during both the dry and wet seasons (May–December 2019) and analyzed for E. coli and ESBL-producing E. coli concentrations using TBX agar with and without cefotaxime supplementation. Antimicrobial susceptibility testing (AST) and ESBL confirmation were performed using the Kirby-Bauer disc diffusion method and the double-disk synergy test, and polymerase chain reaction (Endpoint PCR) assays were performed to identify ESBL genes and determine phylogenetic groups. Results All samples (n = 48) carried ESBL-producing strains. The concentrations of ESBL-producing E. coli ranged from 1.36 × 10⁴ to 3.30 × 10⁵ CFU/100 mL, whereas the ratio of ESBL-producing E. coli among the total E. coli population varied between 0.20% and 16.33%. All the 107 isolated ESBL-producing E. coli strains were multidrug resistant (MDR), with 100% resistance to beta-lactams (ampicillin, ticarcillin, cefalotin, cefotaxime, ceftazidime, cefepime, aztreonam) and high resistance rates to non-beta-lactam antibiotics, including ciprofloxacin (77.57%). Notably, no resistance was observed to imipenem. Molecular analysis identified CTX-M-type genes in all isolates, with bla CTX-M-1 group (89.71%) and bla CTX-M-8 group (88.78%) being the most prevalent. The bla CTX-M-15 variant, a subgroup of bla CTX-M-1, was detected in 96.88% of bla CTX-M-1 positive isolates. Additionally, bla TEM (31.77%) and bla OXA-1 (34.57%) were detected, while bla SHV and bla CTX-M-25 were absent. Phylogenetic analysis of 107 isolates revealed a diverse distribution across four phylogroups: A (37.38%), D (22.43%), B1 (14.02%), and B2 (5.67%). The predominance of phylogroup A, often associated with commensal strains, suggests fecal contamination as a primary source. However, the significant presence of phylogroup D, which is linked to extraintestinal infections, raises concerns about the dissemination of potentially pathogenic strains. Conclusion This study highlights the high prevalence of ESBL-producing E. coli in wastewater in Dakar. The detection of MDR strains, particularly those carrying CTX-M-15 and belonging to pathogenic phylogroups, underscores the urgent need for comprehensive surveillance, improved wastewater treatment, and public health interventions to mitigate the spread of antibiotic resistance in Senegal.

Total Knee Arthroplasty (TKA) is a highly beneficial intervention for the management of severe knee osteoarthritis. Recently introduced in our region, its practice is becoming increasingly common. We performed TKA on 35 knees in 32 patients, comprising 27 women and 5 men. The mean age was 61.92 years. The mean duration of osteoarthritis progression was 6.6 years. A medial parapatellar approach was utilized for all patients. The prostheses were posterior-stabilized (PS) for 32 knees (91.4%) and anatomic for 3 knees (8.6%). The posterior-stabilized prostheses were cemented with a fixed bearing, whereas the anatomic prostheses were uncemented with a mobile bearing. The mean operative time was 1 hour 57 minutes (range: 1h30 – 2h30). The mean time for surgical wound healing was 23.61 days (range: 20–35). The mean duration of knee brace usage was 56.3 days (range: 45–60). The mean duration of ambulation with crutches was 51.46 days (range: 30–60). The mean radiographic angles (alpha, beta, gamma, and delta) were within the normal range. The mean IKS Knee Score was 83.12/100, and the mean IKS Function Score was 79.69/100, with a mean follow-up of 2.5 years. Regarding complications, delayed wound healing was observed in one patient. One case of surgical site infection with patellar osteitis occurred in an HIV-positive patient; antiviral treatment led to resolution of the infection without recurrence at 9 years of follow-up for this implant. One case of knee stiffness with flexion blocked at 80 degrees and one case of prosthetic loosening at one-year follow-up were noted. Total knee arthroplasty is a valuable intervention that allows for pain relief and the restoration of good knee function.

Introduction: Le syndrome de Gougerot-Sjögren (SGS) est une épithélite auto-immune caractérisée par une infiltration lymphocytaire TCD4+ prédominante, intéressant essentiellement les glandes salivaires et lacrymales exprimant la xérostomie et la xérophtalmie. Le score ESSPRI (European League Against Rheumatism) dédié aux malades permet d’évaluer l’activité de ces symptômes C’est ainsi que, nous nous sommes fixés comme objectif d’évaluer la qualité de vie dans le SGS primitif avec le questionnaire SF-36. Patients et méthode: Il s’agissait d’une étude cas-témoins, réalisée dans le service de Rhumatologie du CHU Aristide Le Dantec de Dakar entre Avril 2022 et juin 2024. Nous avons inclus des patients atteints de SGS primitif (bras 1) et des sujets sains (bras 2) ayant tous renseigné le questionnaire SF-36. Le diagnostic de la maladie de Sjögren reposait sur la confrontation d’arguments épidémiologiques, cliniques, paracliniques en accord avec les critères de classification de l’ACR-EULAR de 2016. Résultats: Cent cas de SGS primitifs ont été appariés avec 100 témoins sains, dont dans chaque bras, 86 femmes et 14 hommes. L’âge médian était respectivement de 53 ans (extrêmes : 20-85) chez les patients et 52,5 ans (extrêmes : 20-84) chez les témoins. Le syndrome sec oculaire et / ou buccal était constant, Il était associé à une atteinte articulaire (forme arthro-glandulaire) dans 80% des cas. La biopsie des glandes salivaires accessoires retrouvait un grade 3 ou 4 de Chisholm et Mason dans 88% des cas. L'ESPRI (European League Against Rheumatism) conclut à des symptômes non supportables dans 86,76% chez les cas index. Les auto-anticorps anti-SSA étaient positifs dans 17/78 cas (21,80%). Conclusion : Notre étude montre une altération significative de la qualité de vie des patients dans toutes les dimensions du SF-36 par rapport aux témoins sains. Cette altération de la qualité de vie était plus marquée dans les domaines RP (rôle physique) santé perçue limitation due à l’état physique; BP(body pain) douleur physique et GH(général health avec des scores inférieurs à 50 sur 100. Introduction: Sjögren's syndrome (SGS) is an autoimmune epithelitis characterized by a predominant TCD4+ lymphocyte infiltration, mainly involving the salivary and lacrimal glands expressing xerostomia and xerophthalmia. The ESSPRI (European League Against Rheumatism) score dedicated to patients makes it possible to evaluate the activity of these symptoms. Thus, we have set ourselves the objective of evaluating the quality of life in primary SGS with the SF-36 questionnaire. Patients and method: One hundred cases of primary SGS were matched with 100 healthy controls, including 86 women and 14 men in each arm. The median age was 53 years (range: 20-85) in patients and 52.5 years (range: 20-84) in controls, respectively. The dry ocular and/or oral syndrome was constant, it was associated with joint involvement (arthro-glandular form) in 80% of cases. Biopsy of the accessory salivary glands found a grade 3 or 4 Chisholm and Mason grade in 88% of cases. The ESPRIT (European League Against Rheumatism) concludes that symptoms are unbearable in 86.76% of index cases. Anti-SSA autoantibodies were positive in 17/78 cases (21.80%). Results: One hundred cases of primary SGS were matched with 100 healthy controls, including 86 women and 14 men in each arm. The median age was 53 years (range: 20-85) in patients and 52.5 years (range: 20-84) in controls, respectively. The dry ocular and/or oral syndrome was constant, it was associated with joint involvement (arthro-glandular form) in 80% of cases. Biopsy of the accessory salivary glands found a grade 3 or 4 Chisholm and Mason grade in 88% of cases. The ESPRIT (European League Against Rheumatism) concludes that symptoms are unbearable in 86.76% of index cases. Anti-SSA autoantibodies were positive in 17/78 cases (21.80%). Conclusion: Our study shows a significant impairment in patients' quality of life in all dimensions of SF-36 compared to healthy controls. This alteration in the quality of life was more pronounced in the domains of PR (physical role), perceived health, limitation due to physical condition; BP (body pain) physical pain and GH (general health with scores below 50 out of 100.

BackgroundIn 2022, approximately 56.5% of adults and 47.1% of children and adolescents were affected by Helicobacter pylori (H. pylori) infection in Africa, and clarithromycin-resistant H. pylori (CRHp) strains have become global priority pathogens. Therefore, this study aimed to conduct the first comprehensive systematic review and meta-analysis of CRHp in Africa.MethodsThis investigation was conducted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (The PRISMA 2020). Literature search of electronic databases (Google Scholar, African Journals Online, ResearchGate, PubMed, Embase, and Scopus) was performed using keywords “clarithromycin”, “Helicobacter pylori”, “African country name”, “mutation in the 23S rRNA”.ResultsSixty-five studies involving 5,313 H. pylori strains isolated over 26 years (1997–2022) from 23 African countries were included in this study. The samples from which CRHp was isolated included gastric biopsy (60/63; 95%), and stool (4/63; 6%). The pooled prevalence of CRHp in Africa was 27% (95% CI: 22, 33). There was a steady trend in the prevalence of CRHp isolated in Africa over the 26 years (R2 = 0.0001, p = 0.92, slope coefficient of -0.05x). Ten types of 23S rRNA mutations (conferring clarithromycin resistance) were identified, and included mainly A2143G (465 H. pylori strains out of 1178 tested) and A2142G (344 H. pylori strains out of 1027).ConclusionTo enhance the accuracy and validity of surveillance data for H. pylori in Africa, there is an urgent need for implementing standardized microbiological methods for resistance detection. The prevalence of CRHp reported in this study was very similar to the overall global prevalence and there is a need for more representative studies on CRHp in Africa. While waiting for this, the treatment of H. pylori infections must be based on the guidelines of the AHMSG first Lagos consensus.

ABSTRACTAcute respiratory infections (ARI) are a health priority, especially in countries with limited resources. They are a major cause of morbidity and mortality, especially among children and the elderly. In Senegal, the endemic circulation of respiratory viruses other than influenza has been demonstrated. However, there is a paucity of data exploring the genetic diversity of these viruses based on whole‐genome sequencing. In this study, we present data on the genetic diversity of respiratory viruses in children under 15 years old in Senegal, including an overview of the different pathogens detected. Between November 2022 and November 2023, we collected nasopharyngeal swabs from children seen in curative consultations for symptoms of acute respiratory infections. Of the 156 children included, 73.7% tested positive for at least one pathogen. The most frequently detected virus was rhinovirus (50.0%), followed by influenza B (41.6%) and human parainfluenza virus type 3 (7.6%). Combinations of rhinovirus/influenza B, human parainfluenza virus type 2/human parainfluenza virus type 4, and rhinovirus/influenza B/adenovirus were the most frequently identified. A statistically significant association was detected between some of the viruses detected. A high genetic diversity of respiratory viruses circulating in children was revealed. The strains were phylogenetically close to various strains circulating worldwide, suggesting a global circulation of respiratory viruses. Our study provides the first complete genome sequences of human parainfluenza viruses type 2, 3, 4 and human bocavirus from Senegal and thus contributes to the enrichment of international databases on sequences from Senegal and underlines the importance of sequencing in the dynamics of pathogen circulation.

Objectives: This study, conducted as part of the "My Measure Month" program in collaboration with the French Society of Hypertension, aimed to investigate the prevalence of hypertension, emphasize the importance of measuring blood pressure. Methodology: This was an observational and cross-sectional study conducted over one month in the outpatient department of a center specialized in hypertension management. The study included patients aged over 18 years. We examined hypertension data (duration, treatments, compliance) and cardiovascular risk factors. Blood pressure was measured. Three measurements were taken at one-minute intervals. In the bivariate analysis, a p-value ≤ 0.05 was considered statistically significant. Results: The prevalence of hypertension was 45.6%. Hypertension was more frequent in women (54.2%), and the most represented age group was 50 to 70 years, with a prevalence exceeding 70% in patients over 70 years old. In our sample, 13% of patients not previously known to be hypertensive had elevated blood pressure readings. Successive measurements showed variations in hypertension grades, with a progressive decrease in patients with grade II and III hypertension. Among hypertensive patients, 93% had no coverage for their medications. Most patients were on pharmacological treatment, but a significant proportion remained uncontrolled (36.2%), especially those on dual therapy. Bivariate analysis showed that age ≥ 65 years, smoking, dyslipidemia and heart failure were significantly associated with hypertension. Conclusion: An integrated strategy for prevention, screening, and treatment is crucial to reduce the burden of hypertension in this population, improve the quality of life for hypertensive patients.