Diagnosis and management of benign ovarian tumors at the Ignace Deen Maternity Hospital of Conakry University Hospital in Guinea

Background: Benign ovarian tumors are a common reason for consultation and intervention in gynecology. The objective of this was to describe the clinical, ultrasonographic, histological and therapeutic aspects of benign ovarian tumors in the department.Methods: This is a retrospective and descriptive study of three years and six months from January 1, 2016, to June 30, 2019, which focused on the records of women-operated during this period of benign ovarian tumors.Results: The incidence of benign ovarian tumors was 12.58%. The circumstances of discovery were dominated by disorders of the menstrual cycle (35.05%) followed by infertility (20.78%), the sensation of a pelvic mass (19.48%), and pelvic pain. (15.58%). The ultrasound report was in favor of a serous cyst in 74% of cases, a mucoid cyst in 14% of cases, a dermoid cyst in 9% and an endometriotic cyst in 3%. Histology revealed a serous cystadenoma in 70.13% of the cases, a mucinous cystadenoma in 16.88% of the cases, a mature poly tissue teratoma in 9.09% of the cases and an endometrial cyst in 3.90 % of the cases. Cystectomy was the most performed surgical procedure (71%).Conclusions: Benign ovarian tumors are common in our practice. The most common histological forms were serous and mucinous cystadenomas. Conservative treatment has been practiced in the majority of cases

Outcome of surgical management of genital prolapse in the obstetric gynecology department of the Ignace Deen Hospital in Conakry, Guinea

Background: Each year several patients are operated on for genital prolapse in our department, but no study has yet been done to analyse the results. The objective of this study was to highlight the operating techniques used and to analyse the anatomical and functional outcomes.Methods: It was an observational, longitudinal, prospective and descriptive study which took place over a period of 2 years in the department of obstetrics and gynecology of the Ignace Deen hospital de Conakry in Guinea. This study focused on patients operated on in the department for genital prolapse.Results: During the study period, 67 patients underwent genital prolapse surgery in the department. The operating techniques used are the triple perineal operation or, associated with colposuspension and/or Richter or Mc Call, Richardson's operation, Rouhier's operation and promonto-fixation. This study recorded in the follow up a case of recurrence of hysterocele one year after a Richardson operation, a correction of all digestive and sexual functional disorders and a correction of 81.25% of functional urinary disorders. The intraoperative complications were a rectal wound, two bladder wounds and three cases of hemorrhage requiring blood transfusion. The post-operative results were good in 98.5% of the cases.Conclusions: The lower approach is the main route used for surgical treatment of prolapse. The anatomical and functional results obtained are encouraging

Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea

Background: The frequency of caesarean sections (CS) increased dramatically in the world over the last twenty years. The objective of this study was to evaluate caesarean section practices based on Robson classification in an urban referral hospital in Conakry, GuineaMethods: We conducted a cross-sectional study of 2,266 birthing records collected at the maternity ward of the Coronthie Communal Medical Center in Conakry, from January 1st to December 31st 2016. We included in the study all women who had a caesarean section and whose medical records were complete. Robson's classification was used to classify women into 10 groups based on maternal and fetal characteristics. The relative size of each group, its gross caesarean section rate as well as its contribution to overall caesarean section rate and the main caesarean section indications were calculated.Results: In 2016, 769 caesarean sections were performed out of 2,266 deliveries, corresponding to a hospital section rate of 33.9%. Groups 5 (11.0%), 1 (4.8%), and 3 (4.3%) of the Robson classification were the most contributors to registered hospital caesarean section rate. The main indications for caesarean section were uterine scar in group 5 and acute fetal distress in groups 1 and 3.Conclusions: The systematic reference to the Robson classification could help to identify and avoid the relative indications of the caesarean section in urban Guinea. Besides, increasing induction of labor and strengthening providers’ capacities in emergency obstetric and newborn care services could contribute to reduce caesarean section rates in Guinea

Aspects Epidemiologiques, Cliniques, et Prise en Charge Chiryrgivale des Fibromyomes Uterins au Service de Gynecologie -Obstetrique de l’Hopital National Ignace Deenchu de Conakry 2022

Introduction : L’objectif était d’étudier les aspects épidémiologiques, cliniques, et la prise en charge chirurgicale des fibromyomes utérins au service de gynécologie-obstétrique de l’hôpital national Ignace Deen du CHU de Conakry en 2022. Méthodologie: Il s’agissait d’une étude descriptive transversale, allant du 1er Mai au 30 octobre 2022 soit une période de six (6) mois. Ont été étudié les variables épidémiologiques, cliniques et la prise en charge. Les données ont été collectées à l’aide de la fiche d’enquête préétablie et prétestée. Le logiciel SPSS version 21 a été utilisé pour l’analyse des données. Résultats : les interventions chirurgicales pour fibromyome utérin ont occupé 55,47% (76/137) des activités chirurgicales pour pathologie gynécologique. L’âge moyen de nos patientes était de 38,38 ±9 ans avec les extrêmes 22 et 70 ans, la tranche d’âge la plus représenté était celle de 31-39 ans avec la proportion de 43,40%. Les nullipares étaient les plus représentées 48,68% (37/76). Il s’agissait des femmes non scolarisées 42,10% (32/76), en foyer 73,30% (56/76), exerçant une profession libérale 40,80% (31/76). Cliniquement, le volume utérin simulant une grossesse de 12- 20 SA était le motif de consultation le plus représenté 72,40% (55/76), puis la ménorragie 28,53% (55/76), la classification de FIGO à l’échographie a été réalisée dans 9,21% (7/76). Utérus polymyomateux était l’indication opératoire la plus rependue 65,79% (50/76), le traitement conservateur (myomectomie) a été dans 64,47% (49/76) des cas, par contre le taux d’hystérectomie n’était pas négligeable 35,52% (27/76) et les complications per opératoires ont été marquées par l’hémorragie (23,15%). Le nombre moyen de noyaux myomateux énucléés était de 7.  Il y a une effraction accidentelle de la cavité utérine chez 15 patientes (15,78%). L’anémie était la complication post opératoire immédiate la plus fréquente dans 5,26% (4/76) des cas et la transfusion sanguine a été réalisée chez 43,40% de nos malades. Aucun décès n’a été enregistré.  Conclusion : Le traitement conservateur pour la prise en charge du fibromyome utérin constitue une option salutaire pour les femmes en âge de procréer.   Introduction: This paper focuses on studying the epidemiological, clinical aspects, and surgical management of uterine fibromyomas in the Gynecology-Obstetrics Department of the Ignace Deen National Hospital of the Conakry University in 2022. Methodology: This was a cross-sectional descriptive study, running from May 1 to October 30, 2022, within a period of six (6) months. Epidemiological, clinical, and management variables were studied. The data was collected using the pre-established and pre-tested survey form. SPSS version 21 software was used for data analysis. Results: Surgical interventions for uterine fibromyoma occupied 55.47% (76/137) of surgical activities for gynecological pathology. The average age of our patients was 38.38 ±9 years with the extremes of 22 and 70 years. The most represented age group was that of 31-39 years with the proportion of 43.40%. Nulliparous women were the most represented (48.68% (37/76)). These women were not in school (42.10% (32/76)), in households (73.30% (56/76)), and exercising a liberal profession (40.80% (31/76)). Clinically, the uterine volume simulating a pregnancy of 12-20 weeks was the most represented reason for consultation (72.40% (55/76)), which is followed by menorrhagia (28.53% (55/76)). The FIGO classification at Ultrasound was performed in 9.21% (7/76). Polymyomatous uterus was the most common operative indication (65.79% (50/76)), while conservative treatment (myomectomy) was in 64.47% (49/76) of cases. On the other hand, the rate of hysterectomy was not negligible (35.52% (27/76)) and intraoperative complications were marked by hemorrhage (23.15%). The average number of enucleated myomatous nuclei was 7. There was an accidental break-in of the uterine cavity in 15 patients (15.78%). Anemia was the most frequent immediate postoperative complication in 5.26% (4/76) of cases, and blood transfusion was performed in 43.40% of our patients. No deaths were recorded. Conclusion: Conservative treatment for the management of uterine fibromyoma constitutes a beneficial option for women of childbearing age

Facteurs de Risque, Epidémiologie et Prise en Charge de la Grossesse Extra-utérine Rompue (GEUR) au Service de Gynécologie et d’Obstétrique de l’Hôpital National Ignace Deen du CHU de Conakry en 2022

Introduction : urgence gynécologique fréquente, découverte fortuite aux urgences médicales et ou chirurgicales dans un tableau d’anémie. L’objectif de ce travail était d’étudier les facteurs de risque, épidémiologie, et prise en charge de la grossesse extra-utérine rompue au service de gynécologie et d’obstétrique de l’hôpital national Ignace Deen du CHU de Conakry en 2022. Méthodes : il s’agissait d’une étude descriptive transversale à recrutement rétrospectif. Elle a été menée au service de gynécologie et d’obstétrique de l’hôpital national Ignace Deen du CHU de Conakry du 1er janvier  2019 au 31 Décembre 2022 soit une période de trois ans. Ont été étudiées les variables se rapportant aux facteurs de risque, épidémiologie, et la prise en charge de la GEUR dans notre contexte de travail. Nous avons utilisé le logiciel Excel pour l’analyse des données. Résultats : fréquence de la GEUR dans notre étude était 1,26 % sur l’ensemble des interventions gynécologiques, les tranches d’âge les plus représentées étaient celles de 20-24 ans et 30-34 ans dans 32,69%, plus de la moitié était célibataire 69,23%, sans profession, non scolarisé respectivement 64,23% et 42,31%, primipares dans 49,04%.  Parmi les facteurs de risque (FDR) retrouvés dans notre série, figuraient les antécédents de :  l’infection génitale 46,15%, les fausses couches spontanées 10,58%, la contraception par microprogestatif 16,34%. La prise en charge a été exclusivement chirurgicale (100%), associée à la transfusion sanguine comme moyen de réanimation dans 95,16%. Conclusion : la grossesse extra-utérine rompue est une urgence médicochirurgicale fréquente, le diagnostic précoce traine les pas dans les pays à faibles ressources.   Introduction : a frequent gynecological emergency, discovered incidentally in medical and/or surgical emergencies in the setting of anemia. The aim of this study was to investigate the risk factors and management of ectopic pregnancy in the gynecology and obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital in 2022. Methods : This was a descriptive study with retrospective recruitment. It was conducted at the gynecology and obstetrics department of the CHU Ignace Deen national hospital in Conakry from January 1, 2019 to December 31, 2022, a three-year period. Variables relating to risk factors, epidemiology and management of GEUR in our working context were studied. We used Excel software for data analysis. Results : The frequency of GEUR in our study was 1.26% of all gynaecological procedures, the most represented age groups were 20-24 and 30-34 years with 32.69%, more than half were single 69.23%, without profession, not in school respectively 64.23% and 42.31%, primiparous in 49.04%.  Among the risk factors found in our series were a history of : genital infection 46,15%, spontaneous miscarriage 10.58%, microprogestogen contraception 16.34%. Management was exclusively surgical (100%), associated with blood transfusion as a means of resuscitation in 95.16% Conclusion : Ruptured ectopic pregnancy is a frequent medico-surgical emergency, early diagnosis is lagging behind in low-resource countries

Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections

Maternal colonisation and early-onset neonatal bacterial sepsis in The Gambia, West Africa: a genomic analysis of vertical transmission.

OBJECTIVES: To define bacterial aetiology of neonatal sepsis and estimate prevalence of neonatal infection from maternal genital tract bacterial carriage among mother-newborn pairs. METHODS: We carried out a cross-sectional study of newborns with clinical sepsis admitted to neonatal wards of three hospitals in The Gambia. Neonatal blood cultures and maternal genital swabs were obtained at recruitment. We used whole-genome sequencing (WGS) to explore vertical transmission for neonates with microbiologically confirmed bloodstream infection by comparing phenotypically matched paired neonatal blood culture and maternal genital tract bacterial isolates. RESULTS: We enrolled 203 maternal-newborn pairs. Two-thirds (67%; 137/203) of neonates presented with early-onset sepsis (days 0 - 6 after birth) of which 26% (36/137) were due to a clinically-significant bacterial pathogen. Blood culture isolates from newborns with early-onset sepsis due to Staphylococcus aureus (n=5), Klebsiella pneumonia (n=2), and Enterococcus faecalis (n=1), phenotypically matched their maternal genital tract isolates. Pairwise SNV comparisons showed differences of 12 - 52 SNVs only between maternal and newborn Staphylococcus aureus isolates, presumably representing vertical transmission with a transmission rate of 14% (5/36). CONCLUSIONS: We found low prevalence of vertical transmission of maternal genital tract colonisation in maternal-newborn pairs for early-onset neonatal sepsis in west African context. Identifying infection acquisition pathways among newborns is essential to prioritise preventive interventions, which could be targeted at mother or infection control in the hospital environment, depending on the major pathways of transmission

Protein profiling in hepatocellular carcinoma by label-free quantitative proteomics in two west african populations.

Background Hepatocellular Carcinoma is the third most common cause of cancer related death worldwide, often diagnosed by measuring serum AFP; a poor performance stand-alone biomarker. With the aim of improving on this, our study focuses on plasma proteins identified by Mass Spectrometry in order to investigate and validate differences seen in the respective proteomes of controls and subjects with LC and HCC. Methods Mass Spectrometry analysis using liquid chromatography electro spray ionization quadrupole time-of-flight was conducted on 339 subjects using a pooled expression profiling approach. ELISA assays were performed on four significantly differentially expressed proteins to validate their expression profiles in subjects from the Gambia and a pilot group from Nigeria. Results from this were collated for statistical multiplexing using logistic regression analysis. Results Twenty-six proteins were identified as differentially expressed between the three subject groups. Direct measurements of four; hemopexin, alpha-1-antitrypsin, apolipoprotein A1 and complement component 3 confirmed their change in abundance in LC and HCC versus control patients. These trends were independently replicated in the pilot validation subjects from Nigeria. The statistical multiplexing of these proteins demonstrated performance comparable to or greater than ALT in identifying liver cirrhosis or carcinogenesis. This exercise also proposed preliminary cut offs with achievable sensitivity, specificity and AUC statistics greater than reported AFP averages. Conclusions The validated changes of expression in these proteins have the potential for development into high-performance tests usable in the diagnosis and or monitoring of HCC and LC patients. The identification of sustained expression trends strengthens the suggestion of these four proteins as worthy candidates for further investigation in the context of liver disease. The statistical combinations also provide a novel inroad of analyses able to propose definitive cut-offs and combinations for evaluation of performance

Cervical human papillomavirus infection and squamous intraepithelial lesions in rural Gambia, West Africa: viral sequence analysis and epidemiology

The development of effective strategies against cervical cancer in Africa requires accurate type specific data on human papillomavirus (HPV) prevalence, including determination of DNA sequences in order to maximise local vaccine efficacy. We have investigated cervical HPV infection and squamous intraepithelial lesions (SIL) in an unselected cohort of 1061 women in a rural Gambian community. Squamous intraepithelial lesions was diagnosed using cytology and histology, HPV was typed by PCR-ELISA of DNA extracts, which were also DNA sequenced. The prevalence of cervical HPV infection was 13% and SIL were observed in 7% of subjects. Human papillomavirus-16 was most prevalent and most strongly associated with SIL. Also common were HPV-18, -33, -58 and, notably, -35. Human papillomavirus DNA sequencing revealed HPV-16 samples to be exclusively African type 1 (Af1). Subjects of the Wolof ethnic group had a lower prevalence of HPV infection while subjects aged 25–44 years had a higher prevalence of cervical precancer than older or younger subjects. This first report of HPV prevalence in an unselected, unscreened rural population confirms high rates of SIL and HPV infection in West Africa. This study has implications for the vaccination of Gambian and other African populations in the prevention of cervical cancer

Temporal and spatial analysis of the 2014-2015 Ebola virus outbreak in West Africa

West Africa is currently witnessing the most extensive Ebola virus (EBOV) outbreak so far recorded. Until now, there have been 27,013 reported cases and 11,134 deaths. The origin of the virus is thought to have been a zoonotic transmission from a bat to a two-year-old boy in December 2013 (ref. 2). From this index case the virus was spread by human-to-human contact throughout Guinea, Sierra Leone and Liberia. However, the origin of the particular virus in each country and time of transmission is not known and currently relies on epidemiological analysis, which may be unreliable owing to the difficulties of obtaining patient information. Here we trace the genetic evolution of EBOV in the current outbreak that has resulted in multiple lineages. Deep sequencing of 179 patient samples processed by the European Mobile Laboratory, the first diagnostics unit to be deployed to the epicentre of the outbreak in Guinea, reveals an epidemiological and evolutionary history of the epidemic from March 2014 to January 2015. Analysis of EBOV genome evolution has also benefited from a similar sequencing effort of patient samples from Sierra Leone. Our results confirm that the EBOV from Guinea moved into Sierra Leone, most likely in April or early May. The viruses of the Guinea/Sierra Leone lineage mixed around June/July 2014. Viral sequences covering August, September and October 2014 indicate that this lineage evolved independently within Guinea. These data can be used in conjunction with epidemiological information to test retrospectively the effectiveness of control measures, and provides an unprecedented window into the evolution of an ongoing viral haemorrhagic fever outbreak.status: publishe