Introduction: This study aimed to assess the prevalence of Intra-dialytic hypotension (IDH) accor... more Introduction: This study aimed to assess the prevalence of Intra-dialytic hypotension (IDH) according to the European Best Practice Guidelines (EBPG) definition in relation to the number of haemodialysis sessions and the number of chronic haemodialysis patients and to identify its associated factors. Patients and Methods: We conducted an observational, multicentre and looking-forward study of descriptive and analytical purposes over a 4-week period. The study included all patients with regular chronic haemodialysis with at least two sessions per week and a duration of 180 minutes, who consented to participate in the study and were over 15 years of age. Data collection was done with pre-established forms. The following data were collected: blood pressure before each session, at 30, 60, 120, 180 and 240 minutes of each session; socio-demographic data; dialysis data; clinical, paraclinical, therapeutic data and nursing interventions. Results: The mean age of the patients was 43.84 ± 12.10 years. Among 568 haemodialysis sessions recorded in 50 patients, IDH was noted in 12 haemodialysis sessions, representing a prevalence of 2.11%. Fatigue was found in 5 sessions with IDH episodes (41.66%) followed by yawning (25%), nausea ± vomiting (16.66%) and cramps (16.66%). As nursing interventions, Trendelenburg position and normal saline administration were performed in all IDH episodes. High blood pressure, inter-dialytic weight gain greater than 3 kg, Uf/H > 10 ml/kg/H, anaemia and hypoalbuminaemia were associated with the occurrence of IDH. Conclusion: The prevalence of IDH according to the EBPG definition is low. However, it is an important cause of morbidity and mortality, especially cardiovascular involvement, and the factors associated with its presence have been clearly identified.
Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension contin... more Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension continues to be a topic of debate. The objectives of this study were 1) to evaluate the performance of hemodialysis center BP measurements (routine and standardized BP measurements) in the diagnosis of ambulatory BP in chronic hemodialysis patients using 44h ambulatory BP monitoring (44h-ABPM) as the reference measurement; 2) to compare the performance of standardized and routine BP measurement; and 3) to evaluate the concordance between the values measured at the hemodialysis center and the BP values at 44h-ABPM. Methods In this 23-month case control study including 56 patients followed in the hemodialysis units of Aristide Le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP), BP was measured by 3 methods: i) an automated measurement (OMRON®) carried out by health professional called routine BP measurement (RBPM) in pre and post dialysis; ii) the mean of five automated measure...
Introduction: The occurrence of renal impairment in multiple myeloma is a major turning point in ... more Introduction: The occurrence of renal impairment in multiple myeloma is a major turning point in the evolution of this incurable malignant hemopathy. This is the main prognostic factor and more and more authors report its major impact on the long-term overall survival of these patients. The aim of this study was to describe the prognosis and to determine the prognostic factors of renal involvement in multiple myeloma in Senegal. Patients and method: This was a multicenter, retrospective descriptive and analytical study lasting 7 years, involving 133 patients with renal impairment during follow-up. Predictive factors, prognosis and treatment outcome of hematologic and renal response were studied at 3 months, 6 months and 1 year of follow-up. Results: One-year survival was observed in 17% of patients. It was conditioned by renal prognosis, hyperbeta2- microglobulinemia and anaemia. Renal prognosis was negatively influenced by hyperprotidemia, proteinuria and advanced age. Patients tre...
Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and cort... more Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and corticosteroid resistance and the therapeutic options are numerous and have limited effectiveness. The objective of our study was to assess our practice in this lesion. Patients and Methods: We carried out a retrospective study of patients treated for primary FSGS the period January 1, 2010 to September 30, 2018. The clinical pathological, therapeutic and evolutive characteristics were studied. Results: Fifty-eight patients were included in the study. The average age was 30.74 ± 11.35 years and the sex ratio (M/F) was 2.41. Edema was found in 86.2% and hypertension in 37.9%. The average creatinine was 20.17 ± 16.06 mg/l and the average GFR according to MDRD was 82.43 ± 69.06 ml/min/1.73 m 2. The average albumin level was 15.11 ± 5.78 g/l and the 24-hour proteinuria was 7.8 ± 3.79 g/24 h. Nephrotic syndrome was the main indication for renal biopsy in 84.48% and the classic form of FSGS was found in 90.9%. The average initial corticosteroid dose was 62.68 ± 10.04 mg/d and the average duration of regression was 11.78 ± 7.40 months. Forty-five patients (77.6%) were corticosensitive (27.6% complete remission and 50% partial remission). Corticosteroid resistance was observed in 19% and corticosteroid dependence in 11.1%. The proportion of relapse was 33.3% within an average of 15.4 ± 9.1 months. Cyclosporine was no longer prescribed as a second-line treatment in 8 patients. Infectious complications were more found in 19%. Two patients had progressed to ESRD and we noted 2 death cases. The male gender was correlated with the occurrence of a relapse. However, the impact of certain factors such as hypertension, proteinuria, hematuria and GFR level has not been demonstrated. Conclusion: The evolution of primary FSGS is unpredictable, often
Introduction: Psychiatric disorders are characterized by the complexity of their psychodynamic me... more Introduction: Psychiatric disorders are characterized by the complexity of their psychodynamic mechanisms and the inadequacy of therapeutic means. This work aims to study the risk factors of psychotic pathologies in Dalal Xel hospital of Fatick. Materials and Methods: This is a cross-sectional, retrospective, study carried out between 02 June and 21 July 2014 in the Dalal Xel mental health center in Fatick. All patients hospitalized in this facility were included between November 2003 and April 2014 and their medical records were retrieved. Simple logistic regression was used to analyze the data. Results: Of the 7274 patient records collected, the average age was 34.3years (±20.32), men were the majority at 61.2% and 57.6% were from rural areas. Serer represented 39.6% of cases. The 34.9% were out of school. Psychotic forms were mostly represented (56.8%). The main factors related to psychosis after adjustment are age between 16 and 40years (OR=6,5 [5,0-8,5]), marriage (OR=0.7 IC=[0.6-0.8]), the death of the father (OR=1.3 IC=[1.1-1.5]), the death of the mother (OR=1.4 IC=[1.1-1.9]). Conclusion: Psychotic disorders are influenced by the socio-family experience of the individual. Marriage, orphan status and family support have been identified as risk factors in psychosis, hence the importance of involving the family in patient follow-up and in the development of mental health policies.
We report a case of a 66-year-old female patient with ischemic cardiomyopathy, who was referred i... more We report a case of a 66-year-old female patient with ischemic cardiomyopathy, who was referred in Nephrology Department for the management of a renal impairment associated-severe hyponatremia, hypokalemia and hypochloremia that occurred after vomiting episodes evolving since 1 month. On admission, the patient was calm with a psychomotor retardation occurring in a context of moderate dehydration. Arterial blood gas analysis outlined a severe metabolic alkalosis. An extra-renal cause of these metabolic disorders was retained on the basis of a metabolic alkalosis not featuring an HBP and the urinary ionogram revealing low urine sodium, potassium and chlorine. The seriousness of the clinical course was made by the underlying cardiomyopathy condition, hypocalcemia, severe consistent hypokaliemia and compensatory hypoventilation. The evolution was unremarkable after 4 days of hydro-sodium deficit correction with potassium chloride adjunction. It featured a drowsiness disappearance and a good temporal-spatial orientation. The clinical examination revealed a good general condition associating a good hydration and hemodynamic state. The lab findings showed a normal plasma sodium levels and increased kalemia and chloremia. Upper digestive endoscopy outlined a hiatal hernia associated-erosive bulbitis indicating an eradicator treatment of Helicobater pylori based on a double dose of PPI (Omeprazole 20 mg) and dual antibiotic therapy (Amoxicillin and Clarithromycin) combined with domperidone.
Introduction: Hungry bone syndrome (HBS) is a complication of hyperparathyroidism surgical manage... more Introduction: Hungry bone syndrome (HBS) is a complication of hyperparathyroidism surgical management characterized by deep hypocalcaemia and hypophosphatemia secondary to a massive influx of calcium to an avid bone. Observations: We report the cases of two (2) patients dialysed for chronic kidney disease (CKD) whose initial nephropathy is a hypertensive nephropathy. They posed the problem of CKD-mineral bone disorder (CKD-MBD) fibrous osteitis type with intact parathyroid hormone (PTH) up to 40N for which a subtotal parathyroidectomy (PTX) was performed with postoperative biological anomalies in favour of the diagnosis of hungry bone syndrome. Conclusion: HBS still intervenes on osteopathies of intense turnover. Its treatment is difficult, based on prolonged calcium and vitamin D supplementation. However, perioperative therapeutic protocols settlement seems essential in order to minimize the risks of its occurrence.
Les calcifications metastatiques representent une complication parfois severe de l´insuffisance r... more Les calcifications metastatiques representent une complication parfois severe de l´insuffisance renale chronique terminale. Leurs consequences cardiovasculaires ont ete associees a l´augmentation de la morbi-mortalite. Nous rapportons l´observation d´une malade presentant une hyperparathyroidie tertiaire complique de calcifications cardiovasculaires dont l´evolution a ete fatale conduisant au deces de la patiente. La prevention constitue la meilleure arme therapeutique et la parathyroidectomie (PTX) pourrait utiliser comme traitement de sauvetage.
Objectives: This study aimed to evaluate the efficacy of Rituximab in the management of idiopathi... more Objectives: This study aimed to evaluate the efficacy of Rituximab in the management of idiopathic membranous nephropathy (IMN) based on the following criteria: (I) Biological remission at three months (M3) and six months (M6); (II) change in mean proteinuria (24PU), mean serum albumin, and mean serum creatinine at M3 and M6; (III) and side effects. Methods: This retrospective descriptive and analytical study included patients with histologically confirmed IMN with positive plasma anti-PLA2R antibodies who received at least one dose of Rituximab after six months of follow-up without spontaneous remission. Patients with unexplainable records were not included. Results: A total of five patients (P1, P2, P3, P4, and P5), including four males and one female were analyzed. The mean age was 44.20 ± 23.14 years. All patients had IMN type 2. At inclusion, the mean albuminemia, mean creatinine, and mean 24hPU levels were 15.56 ± 5.27 g/L, 6.54 ± 1.13 g/24h, and 17.3 ± 7.60 mg/L, respectively...
Introduction: This study aimed to assess the prevalence of Intra-dialytic hypotension (IDH) accor... more Introduction: This study aimed to assess the prevalence of Intra-dialytic hypotension (IDH) according to the European Best Practice Guidelines (EBPG) definition in relation to the number of haemodialysis sessions and the number of chronic haemodialysis patients and to identify its associated factors. Patients and Methods: We conducted an observational, multicentre and looking-forward study of descriptive and analytical purposes over a 4-week period. The study included all patients with regular chronic haemodialysis with at least two sessions per week and a duration of 180 minutes, who consented to participate in the study and were over 15 years of age. Data collection was done with pre-established forms. The following data were collected: blood pressure before each session, at 30, 60, 120, 180 and 240 minutes of each session; socio-demographic data; dialysis data; clinical, paraclinical, therapeutic data and nursing interventions. Results: The mean age of the patients was 43.84 ± 12.10 years. Among 568 haemodialysis sessions recorded in 50 patients, IDH was noted in 12 haemodialysis sessions, representing a prevalence of 2.11%. Fatigue was found in 5 sessions with IDH episodes (41.66%) followed by yawning (25%), nausea ± vomiting (16.66%) and cramps (16.66%). As nursing interventions, Trendelenburg position and normal saline administration were performed in all IDH episodes. High blood pressure, inter-dialytic weight gain greater than 3 kg, Uf/H > 10 ml/kg/H, anaemia and hypoalbuminaemia were associated with the occurrence of IDH. Conclusion: The prevalence of IDH according to the EBPG definition is low. However, it is an important cause of morbidity and mortality, especially cardiovascular involvement, and the factors associated with its presence have been clearly identified.
Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension contin... more Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension continues to be a topic of debate. The objectives of this study were 1) to evaluate the performance of hemodialysis center BP measurements (routine and standardized BP measurements) in the diagnosis of ambulatory BP in chronic hemodialysis patients using 44h ambulatory BP monitoring (44h-ABPM) as the reference measurement; 2) to compare the performance of standardized and routine BP measurement; and 3) to evaluate the concordance between the values measured at the hemodialysis center and the BP values at 44h-ABPM. Methods In this 23-month case control study including 56 patients followed in the hemodialysis units of Aristide Le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP), BP was measured by 3 methods: i) an automated measurement (OMRON®) carried out by health professional called routine BP measurement (RBPM) in pre and post dialysis; ii) the mean of five automated measure...
Introduction: The occurrence of renal impairment in multiple myeloma is a major turning point in ... more Introduction: The occurrence of renal impairment in multiple myeloma is a major turning point in the evolution of this incurable malignant hemopathy. This is the main prognostic factor and more and more authors report its major impact on the long-term overall survival of these patients. The aim of this study was to describe the prognosis and to determine the prognostic factors of renal involvement in multiple myeloma in Senegal. Patients and method: This was a multicenter, retrospective descriptive and analytical study lasting 7 years, involving 133 patients with renal impairment during follow-up. Predictive factors, prognosis and treatment outcome of hematologic and renal response were studied at 3 months, 6 months and 1 year of follow-up. Results: One-year survival was observed in 17% of patients. It was conditioned by renal prognosis, hyperbeta2- microglobulinemia and anaemia. Renal prognosis was negatively influenced by hyperprotidemia, proteinuria and advanced age. Patients tre...
Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and cort... more Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and corticosteroid resistance and the therapeutic options are numerous and have limited effectiveness. The objective of our study was to assess our practice in this lesion. Patients and Methods: We carried out a retrospective study of patients treated for primary FSGS the period January 1, 2010 to September 30, 2018. The clinical pathological, therapeutic and evolutive characteristics were studied. Results: Fifty-eight patients were included in the study. The average age was 30.74 ± 11.35 years and the sex ratio (M/F) was 2.41. Edema was found in 86.2% and hypertension in 37.9%. The average creatinine was 20.17 ± 16.06 mg/l and the average GFR according to MDRD was 82.43 ± 69.06 ml/min/1.73 m 2. The average albumin level was 15.11 ± 5.78 g/l and the 24-hour proteinuria was 7.8 ± 3.79 g/24 h. Nephrotic syndrome was the main indication for renal biopsy in 84.48% and the classic form of FSGS was found in 90.9%. The average initial corticosteroid dose was 62.68 ± 10.04 mg/d and the average duration of regression was 11.78 ± 7.40 months. Forty-five patients (77.6%) were corticosensitive (27.6% complete remission and 50% partial remission). Corticosteroid resistance was observed in 19% and corticosteroid dependence in 11.1%. The proportion of relapse was 33.3% within an average of 15.4 ± 9.1 months. Cyclosporine was no longer prescribed as a second-line treatment in 8 patients. Infectious complications were more found in 19%. Two patients had progressed to ESRD and we noted 2 death cases. The male gender was correlated with the occurrence of a relapse. However, the impact of certain factors such as hypertension, proteinuria, hematuria and GFR level has not been demonstrated. Conclusion: The evolution of primary FSGS is unpredictable, often
Introduction: Psychiatric disorders are characterized by the complexity of their psychodynamic me... more Introduction: Psychiatric disorders are characterized by the complexity of their psychodynamic mechanisms and the inadequacy of therapeutic means. This work aims to study the risk factors of psychotic pathologies in Dalal Xel hospital of Fatick. Materials and Methods: This is a cross-sectional, retrospective, study carried out between 02 June and 21 July 2014 in the Dalal Xel mental health center in Fatick. All patients hospitalized in this facility were included between November 2003 and April 2014 and their medical records were retrieved. Simple logistic regression was used to analyze the data. Results: Of the 7274 patient records collected, the average age was 34.3years (±20.32), men were the majority at 61.2% and 57.6% were from rural areas. Serer represented 39.6% of cases. The 34.9% were out of school. Psychotic forms were mostly represented (56.8%). The main factors related to psychosis after adjustment are age between 16 and 40years (OR=6,5 [5,0-8,5]), marriage (OR=0.7 IC=[0.6-0.8]), the death of the father (OR=1.3 IC=[1.1-1.5]), the death of the mother (OR=1.4 IC=[1.1-1.9]). Conclusion: Psychotic disorders are influenced by the socio-family experience of the individual. Marriage, orphan status and family support have been identified as risk factors in psychosis, hence the importance of involving the family in patient follow-up and in the development of mental health policies.
We report a case of a 66-year-old female patient with ischemic cardiomyopathy, who was referred i... more We report a case of a 66-year-old female patient with ischemic cardiomyopathy, who was referred in Nephrology Department for the management of a renal impairment associated-severe hyponatremia, hypokalemia and hypochloremia that occurred after vomiting episodes evolving since 1 month. On admission, the patient was calm with a psychomotor retardation occurring in a context of moderate dehydration. Arterial blood gas analysis outlined a severe metabolic alkalosis. An extra-renal cause of these metabolic disorders was retained on the basis of a metabolic alkalosis not featuring an HBP and the urinary ionogram revealing low urine sodium, potassium and chlorine. The seriousness of the clinical course was made by the underlying cardiomyopathy condition, hypocalcemia, severe consistent hypokaliemia and compensatory hypoventilation. The evolution was unremarkable after 4 days of hydro-sodium deficit correction with potassium chloride adjunction. It featured a drowsiness disappearance and a good temporal-spatial orientation. The clinical examination revealed a good general condition associating a good hydration and hemodynamic state. The lab findings showed a normal plasma sodium levels and increased kalemia and chloremia. Upper digestive endoscopy outlined a hiatal hernia associated-erosive bulbitis indicating an eradicator treatment of Helicobater pylori based on a double dose of PPI (Omeprazole 20 mg) and dual antibiotic therapy (Amoxicillin and Clarithromycin) combined with domperidone.
Introduction: Hungry bone syndrome (HBS) is a complication of hyperparathyroidism surgical manage... more Introduction: Hungry bone syndrome (HBS) is a complication of hyperparathyroidism surgical management characterized by deep hypocalcaemia and hypophosphatemia secondary to a massive influx of calcium to an avid bone. Observations: We report the cases of two (2) patients dialysed for chronic kidney disease (CKD) whose initial nephropathy is a hypertensive nephropathy. They posed the problem of CKD-mineral bone disorder (CKD-MBD) fibrous osteitis type with intact parathyroid hormone (PTH) up to 40N for which a subtotal parathyroidectomy (PTX) was performed with postoperative biological anomalies in favour of the diagnosis of hungry bone syndrome. Conclusion: HBS still intervenes on osteopathies of intense turnover. Its treatment is difficult, based on prolonged calcium and vitamin D supplementation. However, perioperative therapeutic protocols settlement seems essential in order to minimize the risks of its occurrence.
Les calcifications metastatiques representent une complication parfois severe de l´insuffisance r... more Les calcifications metastatiques representent une complication parfois severe de l´insuffisance renale chronique terminale. Leurs consequences cardiovasculaires ont ete associees a l´augmentation de la morbi-mortalite. Nous rapportons l´observation d´une malade presentant une hyperparathyroidie tertiaire complique de calcifications cardiovasculaires dont l´evolution a ete fatale conduisant au deces de la patiente. La prevention constitue la meilleure arme therapeutique et la parathyroidectomie (PTX) pourrait utiliser comme traitement de sauvetage.
Objectives: This study aimed to evaluate the efficacy of Rituximab in the management of idiopathi... more Objectives: This study aimed to evaluate the efficacy of Rituximab in the management of idiopathic membranous nephropathy (IMN) based on the following criteria: (I) Biological remission at three months (M3) and six months (M6); (II) change in mean proteinuria (24PU), mean serum albumin, and mean serum creatinine at M3 and M6; (III) and side effects. Methods: This retrospective descriptive and analytical study included patients with histologically confirmed IMN with positive plasma anti-PLA2R antibodies who received at least one dose of Rituximab after six months of follow-up without spontaneous remission. Patients with unexplainable records were not included. Results: A total of five patients (P1, P2, P3, P4, and P5), including four males and one female were analyzed. The mean age was 44.20 ± 23.14 years. All patients had IMN type 2. At inclusion, the mean albuminemia, mean creatinine, and mean 24hPU levels were 15.56 ± 5.27 g/L, 6.54 ± 1.13 g/24h, and 17.3 ± 7.60 mg/L, respectively...
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