Presentation of a case of Bruton type primary agammaglobulinemia in Guinea

X-linked agammaglobulinemia (XLA) is a rare genetic disease caused by a mutation in the Bruton tyrosine kinase (BTK) gene. It is characterized by a profound deficiency of B cells and a decrease in all classes of immunoglobulins (Ig). We report one case in a 3-year-old boy seen for recurrent acute otitis media, perineal abscess, oligoarthritis. The serum immunoglobulin (Ig) assay showed an IgG level of 0.6g/l. IgM and IgA are indosable. Marrow immunophenotyping showed an absence of precursor B less than 1%. Molecular biology confirmed Burton's disease (stop mutation, C37C) in exon 2 of the BTK gene. Treatment with intravenous immunoglogulin was started

Management of pituitary adenoma: Preliminary experience with endoscopic endonasal transphenoidal surgery in a developing country. Example of Senegal about 180 cases

Introduction: Endoscopic endonasal transsphenoidal surgery is currently the gold-standard therapeutic approach for pituitary adenomas. Although being spread worldwide, the endoscopic endonasal approach for pituitary adenomas is recently implemented in Senegal.This study aimed to report our results and the complications observed in the context of an under-equipped facility. Materials and methods: We conducted a retrospective study including all patients with a pituitary adenoma treated who underwent endonasal transsphenoidal resection under a single endoscopic approach from January 2014 to May 2022, in the Neurosurgery Department of Fann National Hospital Centre, Dakar. All patients were assessed according to clinical, radiological, and endocrinological criteria. They all were operated by the same team with an average follow-up of 24 months. Results: In this series of 180 patients, including 57.7 % women and 42.3% men with a mean age of 44.8 years (extremes of 18 and 76 years), the visual deficit was the most frequent onset symptom (69.4 %), followed by clinical forms of hormone hypersecretion (30.5 %). Twelve cases of pituitary apoplexy and 1 case of incidentaloma were reported. The most frequent tumors were non-functional tumors (61.6 %). Among the functional adenomas, the most frequent was prolactinoma (15.5 %). Regarding tumor size, 75 % were macroadenomas, 15.5 % were microadenomas, and 9.5 % were giants. Cavernous sinus invasion (Knosp grade ≥ 3) and suprasellar extension were noted in 14.4 % and 53.3 %, respectively. The resection was total in 80 % of cases, subtotal in 18.8 %, and partial in 1.2 %. Partial improvement of sight was observed in 91.1% and endocrine hypersecretion remission in 76.6 %. As for complications, the most frequent was transient diabetes insipidus (32.7 %). Conclusion: Despite the scanty resources, our results are similar to the best-reported series and strengthen scientific evidence on the efficacy and safety of performing this technique in an under-equipped setting context

Tech Neck Syndrome: A global epidemic of the modern era among students at the University of Abomey Calavi in Benin

Context and Objective: “Tech neck” is a recent term used to describe neck pain related to smartphone use. It is a health problem that has been increasing considerably since the last decade. The objective of this study was to determine the prevalence of Teck Neck syndrome among young students at the University of Abomey Calavi, in order to highlight the different factors that contribute to the occurrence of this condition. Patients and Method: This is a prospective descriptive study with consecutive sampling conducted over a period of 3 months. The study involved 1,835 young students at the University of Abomey Calavi in Benin, 850 of whom had symptoms of Tech Neck.Epi Data 3.1 software was used for data entry and R software for statistical analysis. Proportions were calculated for qualitative variables. Quantitative variables were expressed as mean ± standard deviation. The Wilcoxon test was used to compare means. The significance level was set at risk alfa = 0.05. A p-value < 0.05 was considered statistically significant. Results: For 421 (49.52%) of the participants, their symptoms would be caused by prolonged neck flexion when writing messages. Of the 1835 students, 1368 (74.55 %) reported constant communication by telephone message. In this study, 55.91 % and 89.43 % of participants respectively stated that they could not determine how often they handled their smartphone within 1 h and 24 h. None of the participants kept their neck straight when writing a message. Conclusion: The Tech neck syndrome is a health problem that has increased considerably over the last decade, especially among students, due to the misuse of NICT

Refractory cervical dystonia, unresolve issue and therapeutic challenge: Follow-up of a case with surgical denervation combined with conservative treatments

Cervical dystonia is the most common focal dystonia affecting adults. It frequently causes postural control problems, neck pain and spasm attacks of the cervical musculature. One of the surgical options available is selective cervical denervation. We report the case of a 32-year-old patient with cervical dystonia refractory to conservative treatment and an injection of botulinum toxin A, which was finally completed by bilateral selective cervical denervation, with considerable regression of cervical spasm at 16 months post-operatively.The clinical presentation of cervical dystonia includes abnormal movements or postural changes of the head, neck and shoulders caused by involuntary contractions of the cervical muscles. When the spasmodic attacks are recurrent, they can cause real handicaps for the patient. The causes of the disease and its pathophysiological mechanism are still poorly understood. There are a number of treatment options, including pharmacological therapy and surgery in cases of therapeutic failure. Repeated intramuscular injections of botulinum toxin are the first-line treatment. Some conservative measures such as physiotherapy are also used, although there is little literature on these approaches.Selective peripheral denervation is currently the main surgical treatment for refractory cervical dystonia. A combination of conservative treatment with BT-A injection and denervation appears to be an effective treatment option

Results of conservative treatment of malignant sylvian infarction: a prospective cohort study from the Conakry University Hospital Center: Résultats du traitement conservateur de l’infarctus sylvian malin : étude de suivi longitudinal réalisée au Centre hospitalier universitaire de Conakry

Context and objective. Little is known about the impact of conservative treatment of malignant sylvian infarction (MSI), a specific type of ischemic stroke that generally affects the entire territory of the middle cerebral artery (MCA). This study aimed to evaluate the effect of conservative treatment of patients suffering from MSI.&nbsp;Methods. This was a prospective cohort and descriptive study including consecutive patients who were hospitalized in the Neurology Department for MSI confirmed by brain imaging, over a period of six 6 months from October 24, 2019 to April 24, 2020.&nbsp;Results. The MSI represented 25 cases (11.7 %) of 329 strokes recorded. Their average age was 59.1 ± 17.7 year with a female preponderance. Disorder of consciousness was found in all patients. The mean time of admission in hours was 77.1 ± 73.8 hours (extreme of 7 – 360 hours). Hypertension, diabetes and smoking were found as vascular risk factors in our patients. The Glasgow coma scale (GCS) was ≤ 8 in one patient and ≥ 8 in 24 other patients. The average National Institutes of Health Stroke Scale (NIHSS) score was 17.5 (extremes of 15 – 20); and 96 % of patients had a score between 16 and 20. The brain CT scan revealed a hemispheric infarction with edema and mass effect on the median structures. Inhalation pneumopathy, buttock and/or heel pressure ulcer, and pulmonary embolism were the most common complications. With the conservative treatment, the mortality rate was 68 %. The NIHSS ≥ 17 and/or GCS ≤ 8 score within three days of the vascular event and hypoxemia was a poor prognostic factor in 86.6 % of cases.&nbsp;Conclusion. Conservative treatment of MSI is associated with poor prognosis with a high mortality rate especially in the absence of surgery. Contexte et objectif. L’impact réel du traitement conservateur de l’infarctus sylvien malin (ISM), type spécifique d’accident ischémique cérébral &nbsp;du territoire de l’artère cérébrale moyenne (ACM) n’est pas clairement déterminé. L’étude visait à en évaluer le résultat chez 25 patients (âge moyen&nbsp;: 59,1 ±17,7 ans) admis pour cette affection.&nbsp;Méthodes. Cette enquête descriptive et prospective a analysé les données des patients consécutifs, admis &nbsp;au service de Neurologie pour un ISM confirmé par TDM cérébrale, pendant la période d’étude. Résultaats. Sur un total de 329 cas d’AVC, l’ISM a constitué 11,7%, avec une prépondérance féminine.Le trouble de conscience était présent chez tous , avec un délai moyen d’admission de 77,1 ± 73,8 heures. L’hypertension artérielle, le diabète et le &nbsp;tabagisme étaient les principaux facteurs de risque cardiovasculaires retrouvés. Le score&nbsp; de Glasgow (GCS) était ≤ 8 chez un patient et ≥ 8 chez &nbsp;les 24 autres. Le score de National institutes of health stroke scale (NIHSS) moyen est de 17,5 (extrêmes de 15 – 20) ; et presque tous les patients (96%) avaient un score compris entre 16 – 20. La TDM cérébrale a montré un infarctus hémisphérique avec un œdème et effet de masse sur les structures médianes. Les complications les plus fréquentes étaient respectivement&nbsp;: la pneumonie d’inhalation, &nbsp;l’escarre fessier et/ou talonnier, et l’embolie pulmonaire. Le taux de mortalité a été de 68% dans la série. &nbsp;un score &nbsp;NIHSS ≥ 17 et/ou GCS ≤ 8 endéans les trois premiers jours d’admission et l’hypoxémie étaient des prédicteurs d’un mauvais pronostic. &nbsp;Conclusion. Le pronostic vital réservé et le taux élevé de mortalité de ce traitement justifient le renforcement du plateau technique&nbsp; neurochirurgical dans cette institution