RESUMO
INTRODUCTION: The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. MATERIALS AND METHODS: This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. RESULTS: Were collected 18 cases of gastroschisis (11 males and 7 females). The mothers were on average 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The term of pregnancy was on average 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Complications were dominated by respiratory distress (28.3%) and sepsis (22.2%). The mean delay of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). CONCLUSION: Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.
RESUMO
INTRODUCTION: The challenge facing developing countries is the availability of methods for rapid and accurate diagnosis of tuberculosis. Some molecular techniques offer this advantage, so we used GeneXpert MTB / RIF test in the diagnosis of extra-pulmonary tuberculosis to evaluate its performance compared with conventional methods. METHODS: Between 2010 and 2015, 544 extrapulmonary clinical specimens were collected and analyzed by microscopy, culture and GeneXpert. The evaluation of antitubercular susceptibility testing was performed using the MGIT 960 system. Genotype MTBDRplus was used to confirm the cases of rifampicin resistance detected by the GX system. RESULTS: The study population included 544 patients, 55.15% men and 44.85% women. Patients age ranged from 1-92 years with the majority in the 18-45 age group. The sensitivity and the overall specificity of microscopy was 43.86% and 98.36%, 94.74% and 97.95% for GeneXpert® respectively (95% CI). There were two discrepant rifampicin-resistant results between GeneXpert test and phenotypic method. Among these cases MTBDRplus test results showed 100% agreement with those of the MGIT 960. CONCLUSION: This study shows that the GeneXpert test exhibits high sensitivity for routine diagnosis of extra-pulmonary tuberculosis and should be used instead of microscopy. The cases of rifampicin resistance detected by GeneXpert should be confirmed by other molecular testing methods before initiating treatment.
