ABSTRACT
ABSTRACT Introduction: In Africa, where access to diagnosis and treatment of hemophilia is the lowest in the world, prophylaxis is rarely used in preference to on-demand treatment. There are limited data of prophylaxis treatment from sub-Saharan Africa. The aim of this study was to evaluate clinical outcomes and inhibitor development in people with hemophilia receiving low-dose prophylaxis (LDP) in a sub-Saharan African setting. Methods: We conducted a three-year prospective study. A once or twice weekly prophylaxis regimen of 25 IU/kg of rFVIIIFc or 30 IU/kg of rFIXFc was given to Hemophilia A and B, respectively. We evaluated clinical outcomes and inhibitors occurrence, determined by screening and titration using the Nijmegen technique. Results: A total of 15 patients were included in the LDP regimen. The mean age was 6.3 years (1.5 - 10). A significant reduction was noted in the annualized bleeding rate, from 7.53 to 1.33 (p = 0.0001); the annualized joint bleeding rate passed from 3.6 to 1.4 (p = 0.001) and the proportion of severe bleeding, from 86.1% to 16.7% (p = 0.0001). The Hemophilia Joint Health Score (HJHS) moved from 9.6 to 3.4 (p = 0.0001) and the Functional Independence Score in Hemophilia (FISH) improved from 25.8 to 30.9 (p = 0.0001). School absenteeism decreased from 7.33% to 2.59%. Adherence to prophylaxis was 89.5% versus 60%. Consumption was 580 IU/kg/year versus 1254.6 IU/kg/year before and after prophylaxis, respectively. Incidence of inhibitors was 23% (3 /13 HA). Conclusion: The LDP in Hemophilia improves the clinical outcome without a surplus risk of inhibitor development. Using extended half-life clotting factor concentrates (CFCs) is better for prophylaxis in resource-limited countries, as they allow better compliance in treatment.
Subject(s)
Humans , Hemophilia B , Africa , Disease Prevention , Hemophilia A , SenegalABSTRACT
Cet article s'intéresse aux rôlesdes perceptionssocio-économiquesdansl'adhésion et lerecours à la Couverture Maladie Universelle(CMU)à Ziguinchor. En effet, la CMU est un programmenationald'assurance santé lancé en 2013 par le gouvernement du Sénégal. Ce programme s'appuie sur les mutuelles communautaires de santé pour s'étendre et se développer. La CMU offre aux populations exclues du système de protection sociale un accès financier aux soins et structures de santé par le moyen d'une assurance santé subventionnéepar l'Etat.S'appuyant sur une enquête par questionnaire auprès de 150 chefs de ménage, l'étude montre que les facteurs socio démographiques n'ont pas d'effet sur l'adhésion à la Couverture maladie Universelle à Ziguinchor. Au contraire, cette recherche montre d'une part qu'il y a un lien entre l'existence de besoins de soins dans le ménage et l'adhésion et d'autre part, lesdimensions socio-économiquessont très importantes pour l'adhésion et le recours aux services de la Couverture Maladie Universelle.
This article focuses on the roles of socio-economic perceptions in adherence to and use of Universal Health Coverage(UHC)in Ziguinchor. Indeed, the UHCis a national health insurance program launched in 2013 by the government of Senegal. This program relies on community health mutuals to expand and develop. It offers populations excluded from the social protection system financial access to health care and structures through subsidized health insurance.Based on a questionnaire survey of 150 heads of household, the study shows that socio-demographic factors have no effect on adherence to Universal Health Coverage in Ziguinchor. On the contrary, this research shows on the one hand that there is a link between the existence of care needs in the household and adherence and on the other hand, the socio-economic dimensions are very important for adherence. and the use of UniversalHealth Coverage services.
Subject(s)
Humans , Male , Female , Surveys and Questionnaires , Universal Health Coverage , Community-Based Health Insurance , Insurance, Health , Senegal , Patient ComplianceABSTRACT
Abstract Objective We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL. Methods In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8. Results The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (< 30%) percentage was correlated with Binet stage B/C (p= 0.0009), CD38 expression (p= 0.039), unmutated IGVH status (p= 0.0009) and presence of cytogenetic abnormalities (for del 13q, p= 0.0012, while for other cytogenetic aberrations, p= 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r= -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p= 0.41) or gender (median, 19% for males vs. 20% for females; p= 0.76). Conclusion When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Leukemia, Lymphocytic, Chronic, B-Cell , Prognosis , SenegalABSTRACT
Propomos uma reflexão sobre o acolhimento da urgência subjetiva e a orientação de jovens originários da África subsaariana nos serviços da rede de proteção da infância francesa. A partir do acompanhamento clínico de uma adolescente de origem senegalesa, realizado durante um ano em um centro de acolhimento de jovens menores não acompanhados da família e em situação de migração, apresentaremos os pilares de uma práxis psicanalítica realizada nestas condições. Em um segundo momento, abordaremos um caso clínico no qual a urgência subjetiva se apresenta pelo viés da perplexidade como resposta a violações sexuais, errância e exílio vividos em um percurso migratório. Finalmente, refletiremos sobre a apropriação do estrangeiro-íntimo como potencialidade de reedição narrativa e produção de ancoragens diante do trauma
Proponemos una reflexión sobre la acogida de la urgencia subjetiva y la orientación de los jóvenes del África subsahariana en los servicios de la red francesa de protección a la infancia. A partir del seguimiento clínico de una adolescente de origen senegalés, realizado durante unaño en un centro de acogida de menores no acompañados en situación migratoria, presentaremos los pilares de una práctica psicoanalítica realizada en estas condiciones. En un segundo momento, abordaremos un caso clínico en el que la urgencia subjetiva se presenta a través del sesgo de la perplejidad como respuesta a las violaciones sexuales, vagabundeos y exilios vividos en un trayecto migratorio. Finalmente, reflexionaremos sobre la apropiación del íntimo-extraño como potencial de reedición narrativa y producción de anclas ante el trauma
We propose a reflection on the reception of subjective urgency and the orientation of young people from sub-Saharan Africa in the services of the French child protection network. Based on the clinical follow-up of an adolescent of Senegalese origin, carried out for one year in a reception center for young minors unaccompanied by their family and in a migration situation, we will present the pillars of a psychoanalytic practice carried out in these conditions. In a second moment, we will approach a clinical case in which the subjective urgency presents itself through the bias of perplexity as a response to sexual violations, wandering and exile experienced in a migratory path. Finally, we will reflect on the appropriation of the foreign-intimate as a potential for narrative re-editing and production of anchors in the face of trauma
Nous proposons une réflexion sur l'accueil de l'urgence subjective et l'orientation des jeunes d'Afrique subsaharienne dans les services du réseau français de protection de l'enfance. A partir du suivi clinique d'une adolescente d'origine sénégalaise, réalisé pendant un an dans un centre d'accueil pour mineurs non accompagnés en situation migratoire, nous présenterons les piliers d'une pratique psychanalytique menée dans ces conditions. Dans un second temps, nous aborderons un cas clinique dans lequel l'urgence subjective se présente à travers le biais de la perplexité comme réponse aux violations sexuelles, errances et exils vécus dans une trajectoire migratoire. Enfin, nous réfléchirons à l'appropriation de l'intime-inconnu comme potentiel de réédition narrative et de production d'ancres face au trauma
Subject(s)
Humans , Female , Adolescent , Adolescent , User Embracement , Human Migration , Exposure to Violence/ethnology , Adverse Childhood Experiences , Patient Care Team , Psychoanalysis , Senegal , Migrant-Receiving SocietyABSTRACT
The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).
Subject(s)
Cesarean Section , Vaginal Birth after Cesarean , Pregnancy, Twin , Senegal , Pregnancy Outcome , Perinatal DeathABSTRACT
Senegal having a significant prevalence of socially differentiated oral diseases, oral health literacy (OHL), an individual and social resource, should be considered alongside a remedial response. This work aimed to analyze women's OHL characteristics. A cross-sectional study on 315 women in Pikine County was carried out, using the Oral Health Literacy-Adult Questionnaire (OHL-AQ) for the OHL data collection and a questionnaire for the women's socioeconomic characteristics data. These women had an OHL average score of 6.5±3.1 and a median of 6. Among them, 56.5% had a seemingly low OHL level, a little over 68.9% had a score above the median as regards the "listening, communication and understanding" aspect, 58.4% to "decision making", 55.2% to "understanding numbers" and 33% to "reading and understanding". According to a multivariate analysis, secondary and higher educated women (p<0.001) with an active social network (p<0.023), in a wealthy household (p<0.0001) and of nuclear household type (p<0.036) had a higher OHL level. Women in Pikine have low OHL and are from working- class households. Therefore, oral health policies must take into account the women's social network contribution to the OHL improvement.
Subject(s)
Humans , Oral Health , Health Literacy , Senegal , Women , Dentists, Women , LiteracyABSTRACT
Introduction: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. Matériels et méthode : étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. Résultats : Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. Conclusion: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire
Introduction: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. Materials and method: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. Results: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. Conclusion: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis
Subject(s)
Tuberculosis , Diagnosis , Lung Diseases , SenegalABSTRACT
Objectifs :Évaluer l'apport de la TDM thoracique dans le diagnostic des patients suspects de COVID-19en comparaison avec la technique de référence (RT-PCR) et déterminer l'impact médico-économique de la COVID-19 au service de radiologie du CHU de Fann. Matériels et méthodes: Il s'agissait d'une étude rétrospective, descriptive sur une période de 4 mois allant du 1er avril au 31 Juillet 2020, au service de radiologie du CHU de Fann.Ont été inclus les patients reçus pour suspicion clinique de COVID-19, qui avaient eu une TDM thoracique et un prélèvement naso-pharyngé par écouvillonnage pour RT-PCR, soit au total 314 patients. Nous avons étudié les données épidémiologiques, cliniques, les images évocatrices de COVID-19 (opacités en verre dépoli, condensation, topographie lésionnelle), existence ou non d'une embolie, les anomalies en faveur de surinfection, les lésions associées, l'impact sur la fréquentation des différentes modalités etl'impact sur les recettes. Résultats:L'âge médian était de 62 ans et le sex-ratio 1,61. La fièvre a été présente chez 7 patients (2,23%); la toux chez 17 patients (5,41%); la dyspnée chez 30 patients (9,55%) et un syndrome de détresse respiratoire chez 63 patients (20,07%). La clinique n'a pas été précisée chez 163 patients (51,91%). La TDM thoracique était normale chez 20 patients (6,37%), évocatrice de COVID-19 chez 274 patients (87,26%) et non évocatrice de COVID-19 chez 20 patients (6,37%). La RT-PCR était positive chez 125 patients soit 39,80%. La sensibilité et la spécificité de la TDM étaient respectivement de 91,2% et 15,34%. La valeur prédictive positive, la valeur prédictive négative et le taux de précision étaient respectivement de 42%, 72,5% et 45,5%. La baisse du taux de fréquentation était de 59% en radiographie standard, 55% en échographie, 24% au scanner et 87% en mammographie. Dans notre étude on a noté une baisse de 40% des recettes au second trimestre de 2020 comparativement au premier trimestre. Conclusion: La TDM thoracique a une bonne sensibilité pour le diagnostic de la COVID-19. De ce fait, elle peut être considérée comme un outil principal pour la détection des lésions pulmonaires évocatrices de pneumonie COVID-19. Les impacts médico-économiques de la COVID-19 ont été considérables.
Subject(s)
Humans , Male , Female , Mass Chest X-Ray , Reverse Transcriptase Polymerase Chain Reaction , COVID-19 , Senegal , EconomicsABSTRACT
Contexte et objectifs. L'hydrocèle conduit dans ses formes évoluées à un retentissement psycho-social, économique et anatomique. Les objectifs de l'étude étaient de décrire les aspects cliniques et le devenir sous traitement de l'hydrocèle vaginale de l'adulte (HVA). Méthodes. Etude documentaire descriptive réalisée, au Centre hospitalier régional Amadou Sakhir Mbaye (CHRASM) de Louga, Sénégal ayant enrôlé des patients de 19 ans et plus présentant une hydrocèle, opérée selon la même technique entre janvier 2011 et décembre 2017. L'opération a consisté en une résection de la vaginale à 0,5 cm du testicule suivi d'hémostase au bistouri électrique, sans surjet hémostatique. Résultats. 1538 patients ont été opérés dont 69 pour HVA (4,5 %) et trente-neuf (n=39) d'entre eux étaient retenus. Leur âge moyen était 61,7 ± 21,3 ans. Le principal motif de consultation était : l'aspect volumineux et inesthétique des bourses. Un total de 48 unités d'hydrocèle ont été opérées : droites (n=19), gauches (n=11) et bilatérales (n=9). La vaginale était épaissie pour l'ensemble des cas. Les suites opératoires ont été simples. Aucun décès. À six mois, les patients étaient satisfaits, aucune récidive. Conclusion. HVA est une pathologie relativement courante dans notre pratique. La résection de la vaginale avec hémostase au bistouri électrique sans surjet hémostatique est une technique sûre et efficace
Context and objectives. Adult hydrocele is a relatively common pathology that causes psychosocial, economic and anatomical repercussions. The objectives of this study were to describe the clinical features and the outcome of hydrocele. Methods. This retrospective study included adults operated for hydrocele, in the Department of Urology of Louga Hospital, from January 2011 to December 2017. The operation begins by a scrotal skin incision that is carried down to the parietal tunica vaginalis which is opened and the content aspirated. Parietal tunica vaginalis is excised. Hemostasis is achieved by only electrocoagulation. Testicle is reintegrated, the wound closed without drain and protected by the dressing. Results. 1538 patients underwent surgery including 69 patients (4.5 %) for adult hydrocele. However, 39 out of these 69 patients (61.7 ± 21.3 years) were enrolled in the present study. Thirty-five were married and the others were unmarried (n=4). The main complaints for patients were inesthetic and scrotal swelling, interference and difficulties in socio-professional activities, negative social comments. The mean duration of the hydrocele evolution was 4 years. Operation procedures were done under spinal (n=38) or general anesthesia (n=1). A total of 48 hydroceles were cured including 11 on the left side, 19 on the right side and 9 bilateral. The mean volume aspirated was 600 ml. The tunica vaginalis was thick in all cases and calcified in 15 cases of hydrocele. No complications (hematoma or wound infection) were observed. No deaths or recurrences were recorded. Six months following the surgery, all patients were satisfied. Conclusion. Adult hydrocele is relatively common in the Department of Urology of Louga Hospital. The treatment consisting in excision of the tunica vaginalis, hemostasis by electrocoagulation, without hemostatic running suture is safe, secure and effective.
Subject(s)
Humans , Hemostatics , Adult , Testicular Hydrocele , Senegal , TherapeuticsABSTRACT
Contexte et objectifs. Le devenir des pathologies du canal péritonéo-vaginal (CPV) et de la migration testiculaire chez l'enfant est peu connu. L'objectif de ce travail était de décrire les aspects cliniques et le devenir de ces pathologies. Méthodes. Etude documentaire descriptive portant sur les hernies, hydrocèles, cryptorchidies et torsions du cordon spermatique opérées chez le garçon âgé de 0 à 16 ans, au Centre hospitalier de Louga, Sénégal, de janvier 2018 à décembre 2019. Résultats. 184 dossiers des patients ont été colligés, soit 32,5 % de patients opérés au cours de la période. Leur âge moyen était de 5,4 ± 4,3 ans. Ces pathologies englobaient : hernies inguinales (n=37 dont 3 étranglements), hydrocèles (n=113), cryptorchidies (n=27), testicules oscillants (n=2) et torsions du cordon spermatique (n=5). L'abord a été inguinal dans 96,1 %. Le traitement a consisté en : ligature du CPV, abaissement testiculaire, orchidopexie, orchidectomie. Aucune récidive, atrophie ou fonte testiculaire n'a été observée en trois mois de suivi. Conclusion. La prise en charge en urgence ou non des pathologies du CPV et de la migration testiculaire chez l'enfant est fréquente dans notre pratique, sans complication à courte terme. Le défi réside dans le suivi à long terme en raison des complications tardives
Context and objectives. Little is known about the outcome of patent processus vaginalis and testicular migration pathologies in children. The objectives of this study were to analyze clinical and therapeutic features of these pathologies. Methods. This was a descriptive retrospective study involving boys aged 0 to 16 years, operated for inguinal hernias, hydroceles, cryptorchidisms and testicular torsions, at the Louga Regional Hospital Center, Senegal, from January 2018 to December 2019. Results. 184 patients were recorded, which represented 32.5 % of all patients operated in the same period. Their average age was 5.4 ± 4.3 years. The managed pathologies were: inguinal hernias (n= 37 including 3 incarcerated hernias), hydroceles (n= 113), cryptorchidisms (n= 27), retractile testicles (n=2) and testicular torsions (n= 5). Inguinal approach was performed in 96,1 % of cases. Surgical managements were: ligature of the patent processus vaginalis, relocating the testicle within the scrotum, orchidopexy and orchidectomy. No recurrence, no purulent testicular discharge or testicular atrophy was encountered. Conclusion. Processus vaginalis and testicular migration pathologies are common in our practice. At 3 months of surgical operation, no complication was observed. However, the challenge is long-term follow-up due to late complications