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In 2006, Senegal adopted artemisinin-based combination therapy (ACT) as first-line treatment in the management of uncomplicated malaria. This study aimed to update the status of antimalarial efficacy more than ten years after their first introduction. This was a randomized, three-arm, open-label study to evaluate the efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DP) in Senegal. Malaria suspected patients were screened, enrolled, treated, and followed for 28 days for AL and ASAQ arms or 42 days for DP arm. Clinical and parasitological responses were assessed following antimalarial treatment. Genotyping ( msp1 , msp2 and 24 SNP-based barcode) were done to differentiate recrudescence from re-infection; in case of PCR-confirmed treatment failure, Pfk13 propeller and Pfcoronin genes were sequenced. Data was entered and analyzed using the WHO Excel-based application. A total of 496 patients were enrolled. In Diourbel, PCR non-corrected/corrected adequate clinical and parasitological responses (ACPR) was 100.0% in both the AL and ASAQ arms. In Kedougou, PCR corrected ACPR values were 98.8%, 100% and 97.6% in AL, ASAQ and DP arms respectively. No Pfk13 or Pfcoronin mutations associated with artemisinin resistance were found. This study showed that AL, ASAQ and DP remain efficacious and well-tolerated in the treatment of uncomplicated P. falciparum malaria in Senegal.

We here analyze data from the first year of an ongoing nationwide program of genetic surveillance of Plasmodium falciparum parasites in Senegal. The analysis is based on 1097 samples collected at health facilities during passive malaria case detection in 2019; it provides a baseline for analyzing parasite genetic metrics as they vary over time and geographic space. The study’s goal was to identify genetic metrics that were informative about transmission intensity and other aspects of transmission dynamics, focusing on measures of genetic relatedness between parasites. We found the best genetic proxy for local malaria incidence to be the proportion of polygenomic infections (those with multiple genetically distinct parasites), although this relationship broke down at low incidence. The proportion of related parasites was less correlated with incidence while local genetic diversity was uninformative. The type of relatedness could discriminate local transmission patterns: two nearby areas had similarly high fractions of relatives, but one was dominated by clones and the other by outcrossed relatives. Throughout Senegal, 58% of related parasites belonged to a single network of relatives, within which parasites were enriched for shared haplotypes at known and suspected drug resistance loci and at one novel locus, reflective of ongoing selection pressure. Senegal has initiated a national sentinel surveillance program for malaria parasite genetics. Here, the authors report data from the first year of the program and use it to investigate local malaria incidence, patterns of transmission, and genetic loci under selection.

Background From August to October 2022, a therapeutic efficacy study of Niger’s first-line antimalarial, artemether-lumefantrine (AL), was conducted in four sites (Aderbissinat, Boboye, Aguié, and Baban Tabki) to evaluate its therapeutic efficacy and investigate for molecular markers of antimalarial drug resistance. Methods Children aged 5 to 15 years old with uncomplicated malaria were assessed in a 28 day in vivo efficacy study. Genotyping using three markers ( msp1, msp2 and the PolyA microsatellite) and match counting using the WHO three-out-of-three algorithm, were used to distinguish recrudescences from new infections. A two-out-of-three algorithm was also utilized as a sensitivity analysis. Results PCR uncorrected and corrected efficacy results at day 28 were calculated. Resistance markers were analysed by next-generation sequencing. Uncorrected treatment efficacies were 62.0% (95% CI 54–74) in Aderbissinat, 95.4% (95% CI 91–100) in Aguié, 98.7% (95% CI 96–100) in Boboye, and 50.6% (95% CI 42–62) in Baban Tabki. After PCR correction, AL efficacy was 100%, 97.5%, 100%, and 93.5%, respectively. Marker analysis revealed a high prevalence of S108N, C59R, and N51I mutations in the pfdhfr gene, and S436A and A437G mutations in the pfdhps gene. No validated or candidate pfkelch13 mutations were observed. Conclusion In all four sites evaluated, AL retains therapeutic efficacies above the 90% WHO-recommended threshold using the primary three-out-of-three match criteria. In Aguié and Baban Tabki, efficacy remained above the threshold with certain match criteria and statistical approaches but fell below the cutoff using two-out-of-three matching and per-protocol methods, suggesting emerging efficacy concerns in southern parts of the country.

Digital connectivity depends not only on infrastructure, but also on the material devices used to access networks. This study examines electronic devices’ availability and prices in Saint-Louis, a mid-sized Senegalese city, to address the lack of empirical research on African digital markets. With data on material connectivity being scarce, this paper provides a baseline description as grounds for future research. Using a participatory mapping approach over three weeks in September 2024, the research assessed the range, condition, and distribution of smartphones across central and neighborhood markets. Descriptive statistics and spatial analysis illustrate key trends. Results show a market heavily structured around second-hand smartphones, where device quality and prices adjust to economic power. Imported second-hand devices are often high-end, with prices above many new items of cheaper brands, while locally used items have much depreciated prices compared to either new or imported second-hand ones. Market locations are widespread for common items and clustered for specialized devices, consistent with central place theory. By documenting the material foundations of digital communication, this study provides new empirical evidence on African urban device markets and highlights the need to consider material access alongside infrastructure in digital connectivity debates.

Background Genetic surveillance of the Plasmodium falciparum parasite shows great promise for helping National Malaria Control Programmes (NMCPs) assess parasite transmission. Genetic metrics such as the frequency of polygenomic (multiple strain) infections, genetic clones, and the complexity of infection (COI, number of strains per infection) are correlated with transmission intensity. However, despite these correlations, it is unclear whether genetic metrics alone are sufficient to estimate clinical incidence. Methods This study examined parasites from 3147 clinical infections sampled between the years 2012–2020 through passive case detection (PCD) across 16 clinic sites spread throughout Senegal. Samples were genotyped with a 24 single nucleotide polymorphism (SNP) molecular barcode that detects parasite strains, distinguishes polygenomic (multiple strain) from monogenomic (single strain) infections, and identifies clonal infections. To determine whether genetic signals can predict incidence, a series of Poisson generalized linear mixed-effects models were constructed to predict the incidence level at each clinical site from a set of genetic metrics designed to measure parasite clonality, superinfection, and co-transmission rates. Results Model-predicted incidence was compared with the reported standard incidence data determined by the NMCP for each clinic and found that parasite genetic metrics generally correlated with reported incidence, with departures from expected values at very low annual incidence (< 10/1000/annual [‰]). Conclusions When transmission is greater than 10 cases per 1000 annual parasite incidence (annual incidence > 10‰), parasite genetics can be used to accurately infer incidence and is consistent with superinfection-based hypotheses of malaria transmission. When transmission was < 10‰, many of the correlations between parasite genetics and incidence were reversed, which may reflect the disproportionate impact of importation and focal transmission on parasite genetics when local transmission levels are low.

Fasting glucose (FG) and glycated hemoglobin A1c (HbA1c) perform sub-optimally in people of African origin, especially in individuals with sickle-cell trait (SCT). The purpose of this study was to compare the relationships between HbA1c, FG, and fructosamine in individuals from Senegal with and without SCT. HbA1c, FG, and fructosamine were measured in 203 adults from Senegal (100 control: 45 with type 2 diabetes (T2D); 103 SCT: 51 with T2D). Significant, positive correlations were observed between HbA1c and FG, fructosamine and FG, and fructosamine and HbA1c in both groups. The limits of agreement were inappropriately large in both groups for the Bland-Altman plots of HbA1c and FG (control: -95.97 to 83.97%; SCT: -115.9 to 91.52%), fructosamine and FG (control: -100.6 to 99.89%; SCT: -105.6 to 100.6%), and fructosamine and HbA1c (control: -52.03 to 38.98%; SCT: -88.04 to 71.41%). In both groups, the greatest proportion of subjects were considered above the clinical cut-point for hyperglycemia when fructosamine was used as the criterion (control: 33%; SCT: 44.6%), and the lowest percentage of subjects were classified as over the clinical cut-point when HbA1c was used as the criterion (control: 21%; SCT: 27.7%).Substantial disparities between HbA1c, FG, and fructosamine were observed in both groups, and these differences were exaggerated in the SCT group. Therefore, these three biomarkers should not be considered to be interchangeable measures of glycemic control. These biomarkers should be used thoughtfully, and special care should be taken when using them in individuals with SCT.

Introductionl'hyperuricémie augmente la morbi-mortalité cardiovasculaire au cours du diabète de type 2 (DT2). L'objectif de cette étude était de déterminer la prévalence de l'hyperuricémie asymptomatique dans une population de diabétique de type 2 ainsi que ses déterminants.Méthodesil s'agissait d'une étude transversale menée au Centre Hospitalier National de Pikine et au Centre Hospitalier Abass Ndao (Dakar, Sénégal). Elle concernait des diabétiques de type 2 suivis en ambulatoire sans antécédents et/ou symptomatologie de goutte. Des prélèvements à jeun étaient effectués pour le dosage des paramètres métaboliques (acide urique, HbA1c, exploration lipidiques, magnésémie).Résultatsnous avions inclus 90 patients. Les patients étaient âgés en moyenne de 59,6 ± 8,8 ans. Il s'agissait de 24 hommes et 66 femmes. Le diabète évoluait depuis 5 ans en moyenne avec une médiane d'HbA1c à l'inclusion à 7,2%. La prévalence de l'hyperuricémie était de 31,1% (n=28). Après analyse multivariée, les facteurs indépendamment associés à l'hyperuricémie étaient le sexe masculin (odds ratio ajusté ORa: 3,9, IC à 95%: 1,3-12,1; p=0,015), un DFG inférieur à 60ml/min (ORa: 7,7, IC à 95%: 1,2-48,3; p=0,029). Une corrélation positive et significative était retrouvée entre le taux de triglycérides et l'uricémie (r=0,5; p< 0,001). La magnésémie était inversement corrélée à l'uricémie (r=-0,3; p=0,051).Conclusionl'hyperuricémie est fréquente chez les diabétiques de type 2. Il est nécessaire de la dépister en particulier chez le sujet de sexe masculin, présentant une altération de la fonction rénale et/ou une hypertriglycéridémie.

IntroductionLe but de notre étude était de déterminer le profil clinique et évolutif des lésions de la peau et des parties molles des sujets diabétiques suivis à la salle de pansement.MéthodesIl s'agissait d'une étude observationnelle descriptive et analytique menée du 1er janvier au 31 décembre 2017 à la salle de pansement du centre Marc Sankale de Dakar. Notre étude a porté sur les sujets diabétiques ayant consultés à la salle de pansement.RésultatsAu total, 37173 actes de soins ont été enregistrés au centre Marc Sankale. Les activés de soins à la salle de pansement représentaient 16418 cas soit une prévalence de 14,16%. L'âge moyen était de 56,6 ± 12 ans et le sex ratio (H/F) de 0,88. Le diabète de type 2 prédominait (78,97%) et la durée moyenne du diabète était de 8,06 ± 7,9 ans. La glycémie capillaire moyenne était de 2,4 ± 1 g/l. La neuropathie diabétique était présente chez 72,33% des cas. Les lésions se situait aux membres dans 93,98% (1185 cas). Les lésions les plus représentatives étaient l'ulcère (46,76%), l'abcès (13,46%), le phlegmon (13,20%), la gangrène (8,41%), l'érysipèle (3,78%), le mal perforant (3,53%), l'intertrigo (3,95%). Les lésions étaient infectieuses (61,41), non infectieuses (33,50%), vasculaires pures (1,57%) et Mixtes (3,70%). Sur les 1189 patients 7,57% avaient présentés une ostéite. Les germes retrouvés étaient des bactéries grams positifs (12,70%), grams négatifs (23,80%). L'amputation était corrélée à la topographie de la lésion (p=0.00), au type de lésion (p=0.000), à l'ancienneté du diabète (p=0,02), au type de diabète (p=0,008), à la présence d'ostéite (p=0,006). L'amputation etait mineur (43,33%), et majeur (37,43%). Nous avons enregistré 70 décès (5,89%).ConclusionLes lésions de la peau et des tissus mous restent dominées par le pied diabétique. La mortalité est non négligeable et le risque d'amputation était statistiquement corrélé à la topographie, au type de lésion, à l'ancienneté et le type de diabète et à l'existence d'ostéite.

Le pyoderma gangrenosum (PG) est une dermatose neutrophilique non infectieuse rare souvent méconnue. Il se présente généralement par des ulcérations cutanées inflammatoires, très douloureuses et d'évolution rapide. Il est fréquemment retrouvé dans un contexte de néoplasie, de pathologies inflammatoires digestives, rhumatologiques et/ou hématologiques. Son diagnostic est très souvent tardif après de multiples échecs thérapeutiques. Nous rapportons un cas de pyoderma gangrenosum dont le diagnostic n'a pas été criant. Un patient a été admis dans notre service pour une lésion dermatologique persistante et d'évolution défavorable malgré les débridements et l'administration d'antibiotiques. Il était suivi pour un cancer de la prostate, une hypertension artérielle et un asthme. Du fait des anomalies biologiques observées telles qu'une hyperleucocytose à polynucléaires neutrophiles avec myélémie à myélocytes et métamyélocytes, sans blastose sanguine et une anémie normochrome normocytaire, une leucémie myéloïde chronique a été évoquée chez ce patient. Elle a par la suite été infirmée devant les différents examens complémentaires non concluants. C'est ainsi que le diagnostic de PG a été évoqué et confirmé à l'examen anatomopathologique montrant un aspect histopathologique d'un tissu de granulation concordant avec un pyoderma gangrenosum et une absence de signe histologique de malignité. L'institution d'un traitement à base de corticothérapie a abouti à la guérison.