Prevalence and associated factors of schistosomiasis among pregnant women in northern Senegal.

BACKGROUND: Schistosomiasis remains a public health concern worldwide. It is responsible for more than 240 million cases in 78 countries, 40 million of whom are women of childbearing age. In the Senegal River basin, both Schistosoma haematobium and Schistosoma mansoni are very prevalent in school-age children. However, there is a lack of information on the burden of schistosomiasis in pregnant women, which can cause complications in the pregnancy outcome. This study aimed to determine the prevalence and associated factors of schistosomiasis in pregnant women. METHODS: We conducted a prospective cross-sectional study of pregnant women attending antenatal clinics at the health center of the Senegalese Sugar Company and at the hospital of Richard Toll between August and December 2021. The urine and stool samples collected were examined using microscopy techniques and quantitative polymerase chain reaction (qPCR) to detect the presence of S. haematobium and S. mansoni. The urines were previously tested using urine reagent strips to detect hematuria and proteinuria. Socio-demographical, clinical, and diagnostically data were recorded by the midwife and the gynaecologist. The data were analyzed using a logistic regression model. RESULTS: Among the 298 women examined for the infection by microscopic, 65 (21.81%) were infected with urogenital schistosomiasis, 10 (3.36%) with intestinal schistosomiasis, and 4 (1.34%) were co-infected with both types of schistosomiasis. Out of the 288 samples tested by qPCR, 146 (48.99%) were positive for S. haematobium, 49 (35.51%) for S. mansoni and 22 (15.94%) for both species (co-infection). Pregnant women having microscopic haematuria and proteinuria were significantly more infected (p < 0.05). CONCLUSION: This study has revealed a high prevalence of schistosomiasis in pregnant women in Senegal. The qPCR allowed us to detect more cases compared to the microscopy. There is a need to conduct more studies to understand the real burden of the disease and to set up a surveillance system to prevent pregnancy-related complications.

Cytobrush and cotton swab as sampling tools for molecular diagnosis of female genital schistosomiasis in the uterine cervix.

Female genital schistosomiasis (FGS) caused by Schistosoma haematobium is a neglected chronic parasitic disease. Diagnosis relies mainly on a colposcopy, which reveals non-specific lesions. This study aimed to assess the performance of two sampling methods for the molecular diagnosis of FGS in the uterine cervix. We conducted a descriptive cross-sectional study in women of reproductive age in Saint Louis, Senegal, who presented for cervical cancer screening. Cotton swab and cytobrush samples were collected from the cervix and examined by real-time PCR. The PCR results obtained using the cotton swabs were compared with those obtained using cytobrush. Of the 189 women recruited, 56 (30%) were found to be positive for S. haematobium infection via real-time PCR. Women aged 40-54 years were predominantly infected (45%) followed by those aged 25-39 years (36%). Numerically more PCR-positive specimens were identified using cytobrush sampling. Of the 89 women who underwent both cytobrush and cotton swab sampling, 27 were PCR-positive in the cytobrush sampling vs 4 in the swab sampling. The mean Ct-value was 31.0 ± 3.8 for cytobrush-based PCR vs 30.0 ± 4.4 for swab-based PCR. The results confirm that real-time PCR can detect Schistosoma haematobium DNA in the uterine cervix. The next step will be to compare PCR with the other diagnostic methods of FGS.

Gangrene of the abdomen secondary to spontaneous extraperitoneal bladder rupture: A case report.

Spontaneous bladder rupture is a rare condition, and its diagnosis has evolved over time. The clinical presentation is variable and nonspecific, with prognosis depending on the patient's condition and early recognition. We report a case of spontaneous bladder rupture complicated by abdominal wall gangrene managed in our center. The purpose of this report is to update the knowledge available on this disease.

[Giant lipoma of the back: a case report and litterature review]. / Lipome géant du dos: rapport de cas avec revue de la littérature.

Lipoma is a benign soft tissue tumour. It is a benign proliferation of mature adipocytes. It is described as giant when its weight exceeds 1 kg or its diameter exceeds 5 cm. Functional and aesthetic impairment may be a major reason for surgical excision. It can be located everywhere, but it mainly occurs in the posterior segment of the chest. We here report a case of giant lipoma of the left posterior-superior segment of the chest.

Hepatitis E Virus Seroprevalence and Associated Risk Factors in Pregnant Women Attending Antenatal Consultations in Senegal.

In West Africa, research on the hepatitis E virus (HEV) is barely covered, despite the recorded outbreaks. The low level of access to safe water and adequate sanitation is still one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Herein, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A consecutive and non-redundant recruitment of participants was carried out over the period of 5 months, from March to July 2021. A total of 1227 consenting participants attending antenatal clinics responded to a standard questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. The overall HEV seroprevalence was 7.8% (n = 96), with 0.5% (n = 6) and 7.4% (n = 91) for HEV IgM and HEV IgG, respectively. One of the participant samples was IgM/IgG-positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer's instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p < 0.0001), by the regularity of income (p = 0.0043), and by access to sanitation services (p = 0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental, and behavioral aspects for a better management of HEV infection in Senegal.

[Superior mesenteric artery syndrome in gastric cancer: a case report]. / Syndrome de la pince aorto-mésentérique sur cancer gastrique: à propos d'un cas.

Superior mesenteric artery syndrome or Wilkie syndrome is due to the compression of the third duodenum between the superior mesenteric artery and the aorta. It causes acute or chronic upper bowel occlusion. Abdominal CT scan facilitates the diagnosis. Severe malnutrition is its main etiological factor. Medical treatment can be based on aspiration of gastric contents and parenteral nutrition. If this fails, surgery is necessary. We here report the case of a 46-year-old patient, with a history of smoking, presenting with profuse postprandial bile and food vomiting. He had had weight loss of 7% over a period of 6 months. Upper GI endoscopy revealed non-stenotic antro-pyloric tumour mass. Histological examination showed poorly differentiated tubular gastric adenocarcinoma. Staging was without any peculiarity and allowed for the detection of superior mesenteric artery syndrome at an angle of 8°C. The patient received parenteral nutrition for 10 days, followed by inferior pole gastrectomy and gastrojejunal anastomosis (omega loop). The postoperative course was uneventful. Adjuvant chemotherapy was indicated.

Cystic mesenteric lymphangioma: A case report.

INTRODUCTION: Cystic lymphangioma is a benign malformative tumor. The abdominal localization is rare. The diagnosis is not easy in preoperative period. The surgery is the choice in the abdominal and symptomatic localization. PRESENTATION OF CASE: We report a 26 years old women. She consulted with left hypochondrial pain. The exam found left hyphochondrial swelling with 10 cm of diameter. The biologic screeming was normal. The ultrasound showed a multiloculated cyst which measured 130*80 mm. the CT scan showed a mesenteri cyst mass measured 15 cm. A fine needle aspiration cytology guided by abdominal ultrasound was realized and the cytology doesn't show malignant cell. A median laparotomy found a mesenteric cystic mass measured 15 cm of diameter. A resection was realized. The histologic exam membranous fibrosis cyst limited by an endothelium. CONCLUSION: Mesenteric localization of cyst lymphagioma is rare. The surgery is safe and efficiency for the treatment.

[Complicated Meckel diverticula: about 15 cases]. / Diverticules de Meckel compliqués: à propos de 15 cas.

We conducted a retrospective study of 15 patients with complicated Meckel diverticula treated in the emergency surgery at the Aristide Le Dantec Hospital, Dakar, over a period of 13 years (January 2003-June 2016). The study included 10 men and 5 women, whose average age was 27.8 years, ranging between 1 months and 73 years. The two main circumstances of detection were occlusive syndrome and peritoneal irritation. Emergency laparotomy allowed clinicians to affirm the involvement of Meckel diverticulum in the clinical picture. In the case of occlusion, the mechanism was always a flange. Ten patients had intestinal necrosis with perforation at the time of diagnosis. All 15 patients underwent segmental resection of the intestine with elimination of the diverticulum. This resection was followed by immediate anastomosis in 12 cases. The morbidity was constituted of 2 cases of fistulas and 2 cases of postoperative peritonitis. A case of death due to septic shock was reported. Three patients had heterotopic mucosa, including gastric heterotopia, colic heterotopia and an association between colic heterotopia and gastric heterotopia in the same patient. The complications of Meckel diverticula are digestive emergencies requiring early and adapted surgical treatment. This is characterized by a non-negligible morbidity.

[Feasibility and relevance of safety checklist in the central operating block at the Regional Medical Center, Saint Louis, Senegal]. / Faisabilité et pertinence de la check-list de sécurité au bloc opératoire central du Centre Hospitalier Régional de Saint Louis du Sénégal.

INTRODUCTION: Safety checklist (CL) in the operating block is a quality tool which allows to reduce perioperative morbidity and mortality. That is one of the French National Health Authority requirements for the certification procedure of healthcare institutions. This study aimed to conduct a quantitative and qualitative evaluation of the use of this tool in the central operating block at the Regional Medical Center in Saint Louis. METHODS: A prospective evaluation of the indicators for monitoring the practical use of the checklist and the contribution to the improvement of surgical practices in the operating block at the Regional Medical Center in Saint Louis was initiated since the launch of this study in March 2016. RESULTS: CL utilization rate was 75%, compliance rate was 60%; information rate was 99% for the pre-induction items, 93% for the pre-incision items and 88% for the postoperative items. Only 73% of analyzed CL were filled with an effective oral communication according to the three items. CL helped to detect hardware failures and/or adverse events in 15% of cases. No patient's identification or operated side error were objectified in our study. CONCLUSION: CL contributes in the development of the culture of patient's safety in the operating block and has led to the establishment of a risk mapping in the operating block. Nevertheless, while important, it shouldn't be considered a magic tool to avoid errors but integrated into the improvement in health care quality with other programs such as the reporting of adverse events and the the review of morbidity and mortality.

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.

INTRODUCTION: Les traumatismes du diaphragme comprennent les ruptures et les plaies du diaphragme. Leur incidence varie entre 0,8 % et 15 %. Elles sont très souvent méconnues malgré les techniques performantes d'imagerie médicale. Leur prise en charge chirurgicale reste controversée. La mortalité de cette pathologie est liée aux lésions associées. Le but de notre étude était d'apprécier l'incidence des lésions diaphragmatique dans les traumatismes thoraco-abdominaux, et de discuter les aspects épidémiologiques, diagnostiques et thérapeutiques. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective sur 21 ans allant du 1er janvier 1994 au 30 juin 2015. Cette étude a été réalisée au Service de Chirurgie Générale de l'Hôpital Aristide Le Dantec de Dakar. Etaient inclus dans cette étude tous les patients qui présentaient une lésion diaphragmatique consécutive à un traumatisme abdominal et/ou thoracique ouvert ou fermé. RÉSULTATS: Durant cette période d'étude, nous avons reçu 1535 patients victimes de traumatisme thoracique et/ou abdominal. Il s'agissait de 859 cas de contusions et 676 cas de plaies thoraciques et/ou abdominaux. Notre étude portait sur 20 cas de lésions diaphragmatiques (1,3 %). Le sex-ratio était de 4. L'âge moyen était de 33 ans. Les agressions par arme blanche représentaient 60 % (12 cas). L'incidence des lésions diaphragmatiques était de 2,6 %. La plaie cutanée était de siège thoracique dans 60 % (7 cas). La radiographie du thorax était contributive dans 45 % (9 cas). Le diagnostic de lésion diaphragmatique était préopératoire dans 45 % (9 cas). La brèche diaphragmatique siégeait à gauche dans 90 % (18 cas) et la taille moyenne était de 4,3 cm. Le geste chirurgical avait consisté en une réduction des viscères herniés et une suture du diaphragme par des points en « X ¼ dans 85 % (17 cas). Le drainage thoracique était systématique. Le taux de morbidité était de 10 % et la mortalité de 5 %. CONCLUSION: Leur diagnostic est difficile. Elles siègent le plus souvent à gauche. Leur traitement est chirurgical et la voie d'abord préférentielle est la laparotomie.

[Maternal Mortality At The Centre De Sante Roi Baudouin (Dakar - Senegal): About 308 Cases]. / Mortalite Maternelle au Centre de Sante Roi Baudouin de (Dakar ­ Senegal): à propos de 308 cas.

OBJECTIVES: - To determine the epidemiologic profile and private clinics of the cases of maternal mortality at the centre de santé Roi Baudouin.- To identify the etiologies of the cases of maternal death at the centre de santé Roi Baudouin; - To determine the assumption of responsibility of the cases of maternal death at the centre de santé Roi Baudouin. MATERIAL AND METHODS: It was about a longitudinal descriptive retrospective study relating to 308 cases of maternal death from January 1998 to December 2005 at the centre de santé Roi Baudouin; de Guédiawaye, in suburbs of Dakar. We had included in the study all the patients died during the time of the gravido-puerperality during the study period. The studied parameters related to the socio-epidemiologic data, the clinical data on the pregnancy and the childbirth, the quality of the assumption of responsibility, the causes of maternal death and the forecast neonatal. The data were analyzed with the software Epi information-version 6. RESULTS: The ratio of maternal death was of 615.8 per 100.000 live births. The Middle Age of the deaths was 28.4 years with extremes of 14 and 52 years. The average gestity was of 4 with extremes of 1 and 25. As for the parity, it was of 3.9 with extremes of 1 and 22. The multipares were the section most concerned, followed first calf cows. A woman on four had made more than 3 antenatal consultations. The majority of our patients were evacuated (53.6%), but only 18.2% of the patients had profited from a medicalized transport. The reasons for evacuation were dominated by the vasculo-renal haemorrhages (49%) and syndromes (19%). The majority of the patients (n=234) had been confined, that is to say 76% of the cases; by natural way (45%) and Caesarean (32%). The patients had died of direct obstetrical causes in 80%, the indirect causes accounted for only 17,5%. The obstetrical causes death were dominated by the abrupto placentae, the haemorrhage of the postpartum and the uterine rupture. The maternal death was associated in more half of the cases of a fetal death (51.3%). The maternal age, the parity, the quality of the antenatal consultations, the hemorrhagic pathology coupled with the way of childbirth influenced occurred of maternal death. CONCLUSION: Maternal mortality remains a major concern at the centre de santé Roi Baudouin. The reduction of this mortality passes by operation correct 24 hours a day hours of the other ONEC centers of the area of Dakar, the availability of blood and its derivatives and the creation of a functional service of intensive care.

OBJECTIFS: - Déterminer le profil épidémiologique et clinique des cas de décès maternel au centre de santé Roi Baudouin.- Identifier les étiologies des cas de décès maternel au centre de santé Roi Baudouin.- Déterminer la prise en charge des cas de décès maternel au centre de santé Roi Baudouin. MATERIEL ET METHODES: Il s'agissait d'une étude rétrospective descriptive longitudinale portant sur 308 cas de décès maternel de janvier 1998 à décembre 2005 au centre de santé Roi Baudouin de Guédiawaye, en banlieue Dakaroise. Nous avions inclus dans l'étude toutes les patientes décédées dans la période de la gravido-puerpéralité durant la période d'étude. Les paramètres étudiés sont co les données socio-épidémiologiques, les données cliniques sur la grossesse et sur l'accouchement, la qualité de la prise en charge, les causes de décès maternel et le pronostic néonatal. Les données ont été analysées avec le logiciel Epi info-version 6. RESULTATS: Le ratio de mortalité maternelle est de 615,8 pour 100.000 naissances vivantes. L'âge moyen des décès est de 28,4 ans avec des extrêmes de 14 et 52 ans. La gestité moyenne est de 4 avec des extrêmes de 1 et 25. Quant à la parité, elle est de 3,9 avec des extrêmes de 1 et 22. Les multipares constituent la tranche la plus concernée, suivies des primipares. Une femme sur quatre a fait plus de 3 consultations prénatales.La majorité de nos patientes ont été évacuée (53 ,6%), mais seules 18,2% des patientes ont bénéficié d'un transport médicalisé. Les motifs d'évacuation sont, les hémorragies (49%) et les syndromes vasculo-rénaux (19%). La majorité des patientes (n=234) ont accouché, soit 76% des cas; par voie naturelle (45%) et par césarienne (32%). 80% des patientes sont décédées de causes obstétricales directes , les causes indirectes ne représentaient que 17,5%. Les causes obstétricales décès étaient dominées par l'hématome rétroplacentaire, l'hémorragie du post-partum et la rupture utérine. Le décès maternel est associé dans plus de la moitié des cas d'une mort fœtale (51,3%). L'âge maternel, la parité, la qualité des consultations prénatales, la pathologie hémorragique couplée à la voie d'accouchement ont influencé influençaient la survenue de décès maternel. CONCLUSION: La mortalité maternelle reste une préoccupation majeure au centre de santé Roi Baudouin. La réduction de cette mortalité passe par le fonctionnement correcte 24 heures sur 24 heures des autres centres de Soins Obstétricaux Néonatals d'Urgence de la région de Dakar, la disponibilité du sang et de ses dérivés et la création d'un service de soins intensifs fonctionnel.

Mortalite maternelle au centre de sante Roi Baudouin de (Dakar - Senegal) : a propos de 308 cas

Objectifs Determiner le profil epidemiologique et clinique des cas de deces maternel au centre de sante Roi Baudouin -Identifier les etiologies des cas de deces maternel au centre de sante Roi Baudouin ; Determiner la prise en charge des cas de deces maternel au centre de sante Roi Baudouin. Materiel et methodes : Il s'agissait d'une etude retrospective descriptive longitudinale portant sur 308 cas de deces maternel de janvier 1998 a decembre 2005 au centre de sante Roi Baudouin de Guediawaye; en banlieue Dakaroise. Nous avions inclus dans l'etude toutes les patientes decedees dans la periode de la gravido puerperalite durant la periode d'etude. Les parametres etudies sont co les donnees socio epidemiologiques; les donnees cli niques sur la grossesse et sur l'accouchement; la qualite de la prise en charge; les causes de deces maternel et le pronostic neonatal. Les donnees ont ete analysees avec le logiciel Epi info version 6. Resultats: Le ratio de mortalite maternelle est de 615;8 pour 100.000 naissances vivantes. L'age moyen des deces est de 28;4 ans avec des extremes de 14 et 52 ans. La gestite moyenne est de 4 avec des extremes de 1 et 25. Quant a la parite; elle est de 3;9 avec des extremes de 1 et 22. Les multipares constituent la tranche la plus concernee; suivies des primipares. Une femme sur quatre a fait plus de 3 consultations prenatales. La majorite de nos patientes ont ete evacuee (53 ;6 ); mais seules 18;2 des patientes ont beneficie d'un transport medicalise. Les motifs d'evacuation sont; les hemorragies (49) et les syndromes vasculo renaux (19). La majorite des patientes (n= 234) ont accouche; soit 76 des cas ; par voie naturelle (45) et par cesarienne (32). 80 des patientes sont decedees de causes obstetricales directes; les causes indirectes ne representaient que 17;5. Les causes obstetricales deces etaient dominees par l'hematome retroplacentaire; l'hemorragie du post partum et la rupture uterine. Le deces maternel est associe dans plus de la moitie des cas d'une mort fotale (51;3 des patientes sont decedees de causes obstetricales directes; les causes indirectes ne representaient que 17;5). L'age maternel; la parite; la qualite des consultations prenatales; la pathologie hemorragique couplee a la voie d'accouchement ont influence influencaient la survenue de deces maternel. Conclusion : La mortalite maternelle reste une preoccupation majeure au centre de sante Roi Baudouin. La reduction de cette mortalite passe par le fonctionnement correcte 24 heures sur 24 heures des autres centres de Soins Obstetricaux Neonatals d'Urgence de la region de Dakar; la disponibilite du sang et de ses derives et la creation d'un service de soins intensifs fonctionne

[Impact of AQUASOU: a practice-based research program at the Rufisque Health Centre, Senegal]. / Impact d'AQUASOU: un programme de recherche-action au Centre de Santé de Rufisque, Sénégal.

INTRODUCTION: Due to the inadequacy of preventive strategies to reduce maternal and neonatal mortality, the current priority concerns emergency obstetric and neonatal care, as defined in the Improvement of the Quality and Access to Emergency Obstetric Healthcare programme (AQUASOU). The objective of this study was to assess the impact of the AQUASOU programme on improved availability and quality of healthcare in the Rufisque Health District in Senegal. METHODOLOGY: We conducted a qualitative and operational descriptive study evaluating the activities of the AQUASOU programme between May 2004 and December 2007: observation of Prenatal Consultations, supervision of emergency care, organization of "mirror meetings" and medical evacuation audits. The periods before and after setting-up of the programme were compared. RESULTS: These various activities had a real impact on indicators of accessibility and availability of healthcare. A consultation framework based on the principle of feedback control and a "practice review" approach allowed an improvement of the quality of care. The number of deliveries increased by 60%. The annual surgical activity was increased sevenfold and the number of evacuations to more specialised structures was decreased (0.4% versus 9.6%), while evacuations admitted to the local structure increased. The maternal mortality rate decreased from 656 to 435 per 100,000 live births. The stillbirth rate decreased from 51 to 56 per thousand. The leading causes of death were bleeding complications (mortality of 3.7%) and paroxysmal complications of hypertension (mortality of 2.7%).