OBJECTIVE: The aim of the study was to determine the prevalence of AF in the cardiology department of the Hospital Principal of Dakar, then to evaluate the clinical, paraclinical, etiological and evolutionary profiles of AF and finally to identify the limits of its management in our context.
METHODS: This was a retrospective, descriptive, analytical, mono-centric study carried out at Hospital Principal of Dakar from January 2019 to August 2021. Were included, all patients admitted for atrial fibrillation, or patients who presented an atrial fibrillation during hospitalization, confirmed by electrocardiogram or long-term electrocardiographic recording during the study period.
RESULTS: The prevalence of atrial fibrillation during the period of our study compared to the hospital population was 7.71%, with a sex ratio of 1.03. The mean age was 67.88 ± 14.09 years. We noted that 83.64% of patients had at least one cardiovascular risk factor, with 56.36% suffering from hypertension, 50.91% of sedentary person and 23.64% of diabetics. Clinically, 92.72% of the patients were symptomatic, with dyspnea predominating (70.91%). Cardiac arrhythmia was present in 85.45% of patients, and congestive heart failure in 47.27%. Long-term electrocardiographic recording was performed in 10 patients, showing 50% of paroxysmal atrial fibrillation. Sixty-three patients (57.27%) had permanent AF, twenty-three patients (20.91%) had persistent AF, fourteen patients (12.73%) had long-term persistent AF and ten patients (9.09%) had paroxysmal AF. Transthoracic echocardiography showed 57.27% of left atrial dilatation and 72.3% of reduced left ventricular ejection fraction. Etiologies for cardiac causes were dominated by dilated cardiomyopathy (21.82%), followed by ischemic heart disease (17.27%). In terms of treatment, the most commonly used molecule was bisoprolol (38.18%), followed by digoxin (21.81%). Anticoagulants were used in 85.46% of cases. Acenocoumarol alone was used in 69.09% of patients. Drug-induced cardioversion was attempted in 2 patients without success, and 4 patients benefited from external electric shock with 3 successes. Most patients had a favorable outcome, but 34.54% suffered hemodynamic complications (18.18%) and thromboembolic ones as well (16.36%). In-hospital mortality in our series was 20%. It was significantly related to heart failure, with a left ventricular ejection fraction < 35% (p < 0.001).
CONCLUSIONS: Atrial fibrillation is serious because of its hemodynamic, thromboembolic and rhythmic complications. The high mortality is explained by the underlying condition, but also by the delay in management with late diagnosis and, above all, the unavailability of ablation procedures in our context.

Pseudofolliculitis barbae (PFB) is a chronic inflammatory skin disease favoured by shaving. It is particularly common among black Africans belonging to certain socio-professional categories who are obliged to shave. Its aesthetic and professional damage is very significant. However, very few data are available for this condition, especially in Sub-Saharan Africa.
To determine the epidemiological and clinical aspects, and the risk factors associated with the occurrence of PFB in Dakar.
This was a descriptive cross-sectional study conducted in March 2019, including 655 police students at the National Police Academy in Dakar, all of African descent and with curly hair, who were required to shave weekly and agreed to participate in this study. The diagnosis of PFB was clinically based. Data analysis was processed using Epi-info version 6.0 software. Pearson\'s chi-square test was used for bivariate analysis with a significance threshold of p < 0.05. The Odds Ratio, with its 95% confidence interval, was used to determine the risk factors.
Among the 655 officers, 254 had PFB, with a prevalence of 38.8%. The prevalence of PFB was 43.7% in men (242 men out of 554) and 11.9% in women (12 women out of 101). The average age of patients with PFB was 26.80 years (± 2.59), ranging from 22 to 36 years. The age of onset of PFB was between 18 and 20 years for the majority (39.8%), with a mean age of onset of 22.2 years (± 3.6). PFB lesions were pruritic in 84.6% of cases, papular in 96.8%, and/or pustular in 60.2%. The submandibular region was the most affected site (69.8%). Complications were noted in 90.1% of cases in the form of post-inflammatory hyperpigmentation (87%) and keloid scars (3.1%). The risk factors associated with PFB were male sex (p<0.0001; OR=5.7; CI95% [3.07-10.75]), family history of PFB (p<0.0001; OR=5; CI95% [3.35-7.37]), keloid-prone skin (p<0.0001; OR=2.9; CI95% [1.63-4.96]), association with acne keloidalis nuchae (p<0.0001; OR=8.8; CI95% [5.55-14.08]), use of a single-blade razor (p<0.0001; OR=2.5; CI95% [1.69-3.70]), use of a fixed-head razor (p<0.0001; OR=1.8 CI95% [1.28-2.77]), shaving against the grain (p<0.0001; OR = 6.3; CI95%= [4.33-9.08]), non-use of shaving products (p = 0.009; OR = 1.5; CI95%= [1.06-2]) and waxing (p<0.004; OR=2.7; CI95% [1.33-5.77]). On the other hand, the use of clippers (p<0.0001; OR = 0.5 CI95% [0.33-0.65]), pre-shave products (p<0.0001; OR = 0.4 CI95% [0.29-0.61]) and the use of razors with movable heads (p<0.0009; OR = 0.2 CI95% [0.17-0.35]) were protective factors against PFB.
Our study confirms the high incidence of PFB in this population of black men of African descent. A genetic abnormality revealed by shaving must be evoked in the occurrence of PFB. Further genetic and immunohistochemical studies would be needed to support this hypothesis.

In December 2023, we observed through hospital-based surveillance a severe outbreak of enterovirus D68 infection in pediatric inpatients in Dakar, Senegal. Molecular characterization revealed that subclade B3, the dominant lineage in outbreaks worldwide, was responsible for the outbreak. Enhanced surveillance in inpatient settings, including among patients with neurologic illnesses, is needed.

To determine the etiology of cervico-vaginal infections by cytobacteriology and the efficacy of qPCR for the diagnosis of sensitive strains such as Streptococcus agalactiae, Borrelia crocidurae, Chlamydia trachomatis, Neisseria gonorrhoeae and Treponema pallidum.
This prospective cross-sectional study was performed between January and September 2021 in 346 women who were examined for cervico-vaginal infection at the Hôpital Principal de Dakar (HPD). Cytobacteriological (direct examination, agar culture) and molecular analyses were performed.
Vaginal flora imbalances predominated, with a rate of 72.3%. The proportion of type IV vaginal flora was 46.5%. Of the 199 germs isolated, Candida albicans (25.1%), Ureaplasma urealyticum (17.6%), S. agalactiae (7.8%), Gardnerella vaginalis (6.6%) and nonalbicans Candida (5.5%) were the main pathogens responsible for cervico-vaginal infections in patients. Among women tested for mycoplasma, U. urealyticum was identified in 43.3% of patients. Among those tested for C. trachomatis, the proportion of infected women was low (4%). The prevalence of C. albicans was higher in pregnant women (38.3%) than in nonpregnant women (19.2%). S. agalactiae strains showed high resistance to certain beta-lactam antibiotics (pristinamycin 100%, gentamycin 100%, ampicillin 92.5% and cefalotin 85.2%) and to a glycopeptide antibiotic (vancomycin 100%). The Staphylococcus aureus strain had good sensitivity to antibiotics except gentamycin (100%) and kanamycin (100%). The enterobacteria tested were all sensitive to phenicols, carbapenems, cephalosporins and aminoglycosides. However, E. coli showed high resistance to tetracycline. The different methods showed low prevalences of C. trachomatis and N. gonorrhoeae, so comparisons Test RapidChlamydia/qPCR for C. trachomatis and culture/qPCR for N. gonorrhoeae were not possible. For S. agalactiae, on the other hand, qPCR was more advantageous than culture. The χ2 test showed a significant difference (Yates χ2 = 33.77 and p = 1-7) for the diagnosis of S. agalactiae. S. agalactiae qPCR had a sensitivity of 40.7%, a specificity of 94%, and positive and negative predictive values of 36.7% and 94.9% respectively, as well as a kappa = 0.33.
The methods applied enabled us to identify the pathogens that cause cervicovaginal infections. The results suggest that qPCR may be an alternative, at least for the diagnosis of S. agalactiae. However, culture remains indispensable for studying antibiotic sensitivity. In order to improve patient care, molecular techniques need to be integrated into the HPD testing toolbox. To broaden the repertoire of pathogens to be diagnosed by qPCR, targeted comparison studies will be needed to increase the probability of encountering infected individuals.

Accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, however the development of hepatic abscesses secondary to digestive perforation by a foreign body is rare. We report the case of pyogenic hepatic abscesses secondary to gastric perforation by a fishbone complicated by acute peritonitis. A 53-year-old patient was admitted to our hospital with the main complaints: diffuse abdominal pain with vomiting in a context of fever and physical asthenia. A painful febrile hepatomegaly with jaundice was objectified, as well as a non-specific biological inflammatory syndrome. An initial abdominopelvic CT scan revealed multifocal liver abscesses. Faced with the initial therapeutic failure associating parenteral antibiotic therapy and abscess drainage, a second abdominal CT scan identified a foreign body straddling the antropyloric wall and segment I of the liver.A xypho-pelvic midline laparotomy was performed with nearly 200 cc of peritoneal fluid coming out. A fishbone approximately 5 cm long was extracted by laparotomy, followed by gastric closure with omentum, peritoneal cleansing and drainage. Symptomatic adjuvant treatment was initiated, including a proton pump inhibitor (Pantoprazole). He also benefited from transfusion support in the face of anemia. Antibiotic therapy was continued for a total of 2 weeks after surgery. The evolution was favorable with follow-up imaging at 3 months, showing complete resorption of the hepatic abscesses.

As part of an initiative aimed at reducing maternal and child mortality, Senegal implemented a policy of free Cesarean section (C-section) since 2005. Despite the implementation, C-section rates have remained low and significant large disparities in access, particularly in major cities such as Dakar. This paper aims to assess C-section rates and examines socioeconomic inequalities in C-section use in the Dakar region between 2005 and 2019. This study incorporates data from various sources, including the health routine data within District Health Information Software 2 (DHIS2) platform, government statistics on slum areas, and data from Demographic and Health Surveys (DHS). A geospatial analysis was conducted to identify locations of Comprehensive emergency obstetric and Newborn Care (CEmONC) services using the Direction des Travaux Géographiques et Cartographiques (DTGC) databases and satellite imagery from the Google Earth platform. The analytical approach encompassed univariate, bivariate, and multivariate analyses. The C-section rate fluctuated over the years, increasing from 11.1% in 2005 to 16.4% in 2011, declined to 9.8% in 2014, and then raised to 13.3% in 2019. The wealth tertile demonstrated a positive correlation with C-sections in urban areas of the Dakar region. Geospatial analyses revealed that women residing in slum areas were less likely to undergo C-section deliveries. These findings underscore the importance of public health policies extending beyond merely providing free C-section delivery services. Strategies that improve equitable access to C-section delivery services for women across all socioeconomic strata are needed, particularly targeting the poor women and those in urban slums.

BACKGROUND: There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death.
METHODS: In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model.
RESULTS: The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively.
CONCLUSIONS: This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices.

The prevalence of cardiovascular risk factors in the general population has been poorly studied in developing countries. The purpose of this study was to evaluate the prevalence of cardiovascular risk factors in a population group in Senegal (the imams). We conducted a cross-sectional and descriptive observational study from April 18th to May 2nd, 2015. Any subject acting as an imam, member of the association of imams and ulamas of Dakar, was included. The study population was quite old, with a mean age of 67.05 ± 12.35 years. The socio-economic level was quite low in the overall population. The prevalence of risk factors was much higher among unpaid imams. The survey revealed a high prevalence of cardiovascular risk factors, with dyslipidemias as a major contributing risk factor observed in 80% of cases. The prevalence of other risk factors was: sedentary lifestyle (74.6%), hypertension (56.7%), diabetes (17%), obesity (10.4%) and metabolic syndrome (19.4%). Risk factor combinations were common and 74.6% of the imams surveyed had at least three cardiovascular risk factors. Global cardiovascular risk was low to moderate in 76.66% of cases, high and very high in 23.33% of cases. This survey showed, on the one hand, a high prevalence of cardiovascular risk factors in imams and, on the other hand, that these risk factors are not often known to subjects. It is imperative to promote studies for the prevention of cardiovascular risk factors.

Lithopedion is a rare condition secondary to retention and calcification of an unrecognized intra-abdominal (usually ectopic) pregnancy after a fetal death, which occurred after three months of gestation. It accounts for 1.5%-2% of cases of ectopic pregnancy. We report the case of a 72-year-old nulligravida woman who died about 72 h after being kicked in the abdomen during a fight. At autopsy, an intra-abdominal calcified fetus, acute generalized peritonitis, and ileal perforation were observed. The estimated gestational age of the fetus was 37 weeks (based on femur length) and the lithopedion had a weight of 750 g and a size of 15 × 12 × 9 cm. The age of menopause and the duration of retention are not known. This is the first case of this entity identified in Senegal.

Bacteremia is associated with high lethality in HIV-infected patients. The widespread use of cotrimoxazole prophylaxis and misuse of antibiotics promote antibacterial resistance. Only few studies have considered this issue in HIV-infected patients. Thus, the objective of this study was to describe the etiology and antibacterial susceptibility patterns of bloodstream isolates in patient living with HIV.
This is a retrospective cross-sectional and descriptive study conducted at the clinic of Infectious and Tropical Diseases of Fann university hospital from March 2013 to December 2016. Data were collected from patients\' files according to a pre-establish survey form made of demographic, clinical, bacteriological and biological parameters.
Seventy-four cases of bacteremia were registered, 51.4% of which in women. Participants\' median age was 45 years old [18-73 years old] and average CD4 count 83.3 cells/μl. The most commonly isolated bacteria were coagulase negative staphylococci (14%) followed by Escherichia coli (10%) and Klebsiella pneumoniae (10%). Rates of methicillin resistance for coagulase negative staphylococci and Staphylococcus aureus were 35.7% (5/14) and 22% (2/9), respectively. The most frequent ESBL producing germs were Escherichia coli 50% (5/10), Klebsiella pneumoniae 40% (4/10) and Enterobacter sp 25% (2/8). Pseudomonas sp were the most (22.2%) germs resistant to carbapenems.
The result of this study advocates the need for ongoing surveillance of antibacterial resistance in HIV-infected patients and empirical antibiotic therapy based on surveillance data.