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Diagnostic and Therapeutic Challenges of De Quervain Thyroiditis in Sub-Saharan Africa: Illustration with Two New Cases in Dakar  [PDF]
Abdoulaye Leye, Ngoné Diaba Diack, Nafy Ndiaye, Ameth Dieng, Daouda Thioub, Yakham Mohamed Leye
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2017, DOI: 10.4236/ojemd.2017.712019
Abstract: Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.
Carbimazole Drug-Induced Hepatitis during Treatment of Graves’ Disease: About Four Cases at Dakar Teaching Hospital  [PDF]
Abdoulaye Leye, Michel Assane Ndour, Nafy Ndiaye Sarr, Ngoné Diaba Diack, Yakham Mohamed Leye, Dominique Emmanuel Faye
Open Journal of Internal Medicine (OJIM) , 2017, DOI: 10.4236/ojim.2017.74010
Abstract: Introduction: Mostly reported common side effects of carbimazole are cutaneous allergies and severe agranulocytosis. However, hepatotoxicity is rarely described. Thus, we report four observations of carbimazole drug-induced hepatitis during the treatment of Graves’ disease, which imputability is likely and probably an immuno-allergic mechanism. Observations: They were four women whose average age was 43 years, with extreme ages of 32 and 54. Patients were monitored and treated with carbimazole in doses contained between 40 mg and 60 mg per day. Clinical manifestations of liver injury were mainly dominated by cholestatic jaundice, found in 100% of our patients. A painful sensitivity of the right hypochondrium was concomitant with jaundice for two patients. The jaundice time to onset after the beginning of treatment with carbimazole varies between 1 month and 6 months. They all had acute hepatitis. The biological assays used to determine the type of liver injury showed, in all cases, a mixed, cholestatic and cytolytic hepatitis. Therapeutically, in all patients, carbimazole was stopped as soon as the suspicion of its incrimination in the occurrence of liver damage was set up. They all had a substitution of carbimazole with benzylthiouracil. Evolution was favorable for all patients, after therapeutic substitution. It was marked by disappearance of jaundice and normalization of the liver biological parameters within a maximum delay of two months after stopping carbimazole use. Conclusion: Treatment with synthetic antithyroid drugs, particularly carbimazole that is most widely used in our regions, requires clinical and biological monitoring. This surveillance, which is often difficult in Africa because of the limited economic resources, can lead to the occurrence of side effects such as potentially serious drug-induced hepatitis, but which has been favorable in our observations.
Knowledge, Attitudes and Practices Survey in Management of Type 2 Diabetes by General Practitioners in Dakar  [PDF]
Abdoulaye Leye, Nafy Ndiaye, Ngoné Diaba Diack, Michel Assane Ndour, Biram Codou Fall, Yakham Mohamed Leye, Papa Ousseynou Mane
Journal of Diabetes Mellitus (JDM) , 2017, DOI: 10.4236/jdm.2017.74024
Abstract: 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%
Electrocardiographic Changes in Patients with Type 2 Diabetes Multicenttic Cross Sectional and Descriptive Study in Dakar  [PDF]
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
Open Journal of Internal Medicine (OJIM) , 2017, DOI: 10.4236/ojim.2017.73007
Abstract: 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.
Adult Onset Still’s Disease in Tropical Area: Illustration of Diagnostic and Therapeutic Difficulties from 3 Senegaleses Observations  [PDF]
Nafy Ndiaye, Ngoné Diaba Diack, Michel Assane Ndour, Biram Codou Fall, Ghislain De Chacus, Daouda Thioub, Ameth Dieng, Yakham Mohamed Leye, Abdoulaye Leye
Open Journal of Internal Medicine (OJIM) , 2017, DOI: 10.4236/ojim.2017.74014
Abstract: 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 delay may lead to severe complications and death.
Screening of Peripheral Artery Disease by Systematic Measurement of Ankle-Brachial Index among Diabetic Patients in Dakar  [PDF]
Abdoulaye Leye, Nafy Ndiaye, Ngone Diaba Diack, Michel Assane Ndour, Ameth Dieng, Daouda Thioub, Awa Fall, Samira Elfajri, Yakham Mohamed Leye
Journal of Diabetes Mellitus (JDM) , 2017, DOI: 10.4236/jdm.2017.74027
Abstract: Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p =
Assessment of the Podiatric Risk on Diabetics in Dakar Hospital Area: Cross-Sectional Study in Regard to 142 Patients  [PDF]
Abdoulaye Leye, Ngone Diaba Diack, Yakham Mohamed Leye, Nafy Ndiaye, Alex Bahati, Ameth Dieng, Daouda Thioub, Ma?mouna Senghor, Maouly Fall, Samira Elfajri
Journal of Diabetes Mellitus (JDM) , 2018, DOI: 10.4236/jdm.2018.81001
Abstract: The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teaching Hospital in Dakar with the assessment of foot risk on admitted diabetic patients as our main objective. Methods: It was about a prospective cross-sectional, descriptive and analytic study done on 18 months period. Results: Overall, 142 patients were gathered. The average age was 56.22 years and the sex-ratio was 0.67. 87.2% of the patients were running type 2 diabetes. The capillary blood glucose and glycated hemoglobin were respectively around 3.24 g/L and 9%. High Blood Pressure was found in 62% of cases. The type of footwear most used by our patients was sandals (96.3%). Also, 30.6% of patients walked barefoot. Prior ulceration and/or amputation were noted in 30% of cases. During the foot examination, a lesion was found in 15.5% of patients. Loss of monofilament sensitivity was about 66.7%. The Ankle-Brachial Index (ABI) less than 0.9 was recorded in 34% of patients and at least a quarter of patients were posteriorly tibial pulselessness. The gradation of the foot risk according to the International Working Group of the Diabetic Foot (IWGDF) was established as follow:
Management of Multiple Endocrine Neoplasia Type 2A (MEN 2A): Diagnostic and Therapeutic Concerns with the First Documented Senegalese Family  [PDF]
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
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2018, DOI: 10.4236/ojemd.2018.81004
Abstract: 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 MEN 2A case imposes genetic survey allowing the screening of other cases in the family and the establishment of a preventive strategy.
Management of Pheochromocytoma in Dakar: Diagnostic and Therapeutic Advances throughout 16 Cases  [PDF]
Abdoulaye Leye, Nafy Ndiaye, Yakham Mohamed Leye, Amadou Fall Cisse, Ngoné Diaba Diack, Michel Assane Ndour, Ameth Dieng, Daouda Thioub, Baidy Sy Kane, Alex Bahati, Alpha Omar Touré, Cherif Mohamed Dial, Pape Saloum Diop
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2018, DOI: 10.4236/ojemd.2018.81003
Abstract: Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.
Adenopathies in Internal Medicine Etiological Profile and Diagnostic Limits  [PDF]
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
Open Journal of Internal Medicine (OJIM) , 2017, DOI: 10.4236/ojim.2017.73009
Abstract: 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 pyomyositis in 1 patient. The difficulties encountered were mainly the inaccessibility of certain complementary examinations and the delay in obtaining the results. CONCLUSION: Adenopathies are a very common reason for consultation in internal medicine. This study allowed us to draw up the etiological profile of adenopathies in our practice but also to identify the main difficulties which are among other things the inaccessibility of certain complementary examinations.
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