ABSTRACT
Zenker's diverticulum is a rare and generally benign condition. Its occurrence in a hemodialysis patient has therapeutic and prognostic implications and is a risk factor for mortality and morbidity due to its complications, such as protein-energy malnutrition and pneumonitis. We here report a case of Zenker's diverticulum diagnosed in a chronic haemodialysis patient. The study involved a 61-year-old female patient admitted with upper gastrointestinal bleeding associated with dysphagia. Physical examination showed alteration of general condition and the patient reported an average weight loss of 5 kg in 3 months. Esophagogastroduodenal transit was characterized by dilatation of the cervical esophagus, appearing as a large heterogeneous niche whose upper pole was at the level of the pharyngoesophageal junction. The diagnosis of Zenker's diverticulum was retained. Diverticulectomy by cervical incision was performed. The patient died due to inhalational lung disease in the early postoperative period. Zenker diverticulum is a rare, generally benign disease, but in patients undergoing chronic haemodialysis, it increases mortality and morbidity.
Subject(s)
Deglutition Disorders/etiology , Gastrointestinal Hemorrhage/etiology , Renal Dialysis , Zenker Diverticulum/diagnosis , Fatal Outcome , Female , Humans , Middle Aged , Risk Factors , Zenker Diverticulum/physiopathology , Zenker Diverticulum/surgeryABSTRACT
INTRODUCTION: Hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal. METHODS: Between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels ≥ 10 IU/l) were considered as seroprotected against HBV. RESULTS: During the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb ≥ 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb ≥ 100 IU/L. CONCLUSION: Our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal.
