Difficultés Diagnostiques et Evolution en Milieu Tropical D’un Cas de Maladie de Destombes Rosai - Dorfman (DRD)

La maladie de DRD est une histiocytose sinusale avec lymphadénopathie massive, rare, bénigne et d’étiologie encore inconnue. Sa symptomatologie se résume le plus souvent (90%) à de volumineuses adénopathies (ADP) cervicales. En milieu tropical, elle peut prêter à confusion avec une tuberculose ganglionnaire (TB). Cet article rapporte le cas d’une fillette de 9 ans référée pour une ADP latéro-cervicale gauche, inflammatoire. Ce tableau avait fait suspecter une TB ganglionnaire et pris en charge par un médecin de sa localité. La biopsie ganglionnaire faite, confirmait un mois après le diagnostic de maladie de DRD. La forme ganglionnaire peut prêter à confusion avec une TB en milieu Tropical. Les moyens limités retardent le diagnostic et la prise en charge. La biopsie ganglionnaire doit être systématique. DRD disease is sinus histiocytosis with massive lymphadenopathy, rare, benign of yet unknown etiology. Its symptomatology is most often paralleled (90%) to voluminous cervical lymph adenopathies (ADP). In tropical area, it can be confusing with ganglionic tuberculosis (TB). This article can give an example of a 9 year-old girl who was referred to us for a ADP latero-cervical lymph on her left side, inflammation. This situation raised suspect of a ganglionic TB and was treated by a doctor in her area. The lymphatic biopsy confirmed, one month after, the diagnosis of DRD disease. The ganglionic form may be confusing with tropical TB. The limited means delay the diagnosis and the treatment. Lymphatic biopsy should be systematic

Puerperal uterine inversion managed by the uterine balloon tamponade

The uterine inversion is a rare and severe puerperal complication. Uncontrolled cord traction and uterine  expression are the common causes described.We report a case of uterine inversion stage III caused by poor management of the third stage of labor. It was about a 20 years old primigravida referred in our unit for postpartum hemorrhage due to uterine atony. After manual reduction of the uterus, the use of intra uterine balloon tamponade helped to stop the hemorrhage. The uterine inversion is a rare complication that may cause maternel death. The diagnosis is clinical and its management must be immediate to avoid maternal complications.Key words: Uterine inversion, postpartum hemorrhage, uterine balloon tamponad

Evaluation De La Denutrition Chez Les Enfants Ages De 2 A 60 Mois Hospitalises Aux Services De Pediatrie Des Hopitaux De Ziguinchor (Senegal)

Introduction: Malnutrition is a public health problem in developing countries. The prevalence of malnutrition at the national level hardly reflects the reality in hospitals. It is in this context that we assessed the nutritional status of children from 2 months to 5 years hospitalized in the pediatric ward of the regional hospital and the Ziguinchor Peace Hospital. Materials and methods: This was a prospective study from June 1 to October 30, 2016. Children aged 2 to 60 months, hospitalized in one of the two services, were included. Children with esdato-ascetic syndrome were not included. Epidemiological, anthropometric data, and associated diagnosis were studied. Results: We included 114 children (70 boys and 44 girls). The average age was 21.9 months [4-59]. Forty-two point one percent (42.1%) of infants <6 months were breastfed exclusively with breast milk. The weaning of children was done early in 55.3%. The mean age of mothers was 26.6 years [17-38]. The socioeconomic level was low in 62.3% of cases. The prevalence of malnutrition averaged 35.5% for underweight; 32.9% for wasting and 32.0% for stunting. Acute respiratory infections (ARI) and acute gastroenteritis were the most common associated conditions. Mean hospital stay was 8 days ± 009 [3-28]. About two thirds of the patients (n = 72) had a hospital stay of more than 7 days. Malnutrition was significantly associated with multiparity, low socioeconomic status, hospital stay of more than 7 days and infectious diseases. Conclusion: Infections and a hospital stay longer than a week are factors favoring malnutrition in children from 2 months to 5 years

Bowel Anastomoses: Manual or Mechanical

An anastomosis is a connection between two tubular anatomical structures. Anastomoses have been a great surgical challenge from antiquities to modern times. Main research on the manual techniques and healing processes of digestive anastomoses took place during the 19th century. They were later improved by the advent of mechanical devices in the early 20th century. For both types of anastomoses, local and general conditions required for a good healing are the same. Many devices, both for manual and mechanical anastomoses have been developed. The devices’ uses depend on their availability, surgeons usual practice and the relative difficulty of the anastomosis. The debate is still lively about the advantages and the potential inconveniences of one technique versus the other in regards to many parameters such as operating time and the incidence of anastomotic leakage

Evaluation of the use of birth control followed in women's hospital regional Saint Louis (Senegal) in 2014

Background: To evaluate the use of contraceptive methods among women followed at Saint Louis Health Centre.Methods: This was a descriptive cross-sectional study of all recue clients in the Obstetrics and Gynecology department of the Regional Hospital of St. Louis. She ran from 1 January 2014 to 31 December 2014, 12 months.Results: The mean age was 28.8 years. The most common demographic characteristics were the Wolof ethnic group (64.5%), married the marital status (97.9%), they were not in school in 46.3%. The main sources of information on the use of contraception were health workers in 80.3%, friends and relatives (8.5%) followed by husbands (2.5%), the media represented 6 0% and 0.1% posters. The injection method was the most used method (42.8%) followed by implants (36.2%), pills (14.9%) and tubal ligation (4.4%). The IUD was the least used method with 1.7% of use. The main reasons given by women were spacing births (70.6%), to avoid unwanted pregnancy (3.90%), avoid early pregnancies (1.20%) and of other unspecified reasons in 24.3%. In this study, no accidental pregnancy was reported. Indeed, 79.4% of women had respected the monitoring schedule of monitoring visits. They had abandoned contraception in 23.5%.Conclusions: This study shows the achievements and shortcomings in relation to the nature and completeness of the information provided. Strengthening the awareness and training will reduce missed opportunities for family planning, and indirect; reduce the rate of unmet need for FP in our country

Evaluation de L’efficacite et de L’acceptabilite de la Prise en Charge Ambulatoire de la Malnutrition Aigue Chez les Enfants Vivants Avec le Vih (Evvih) Au Centre Hospitalier Regional De Ziguinchor (Chrz)/ Senegal

Objectif : La malnutrition aigüe est fréquente chez les enfants infectés par le VIH. L’objectif de notre travail était d’évaluer l’efficacité et l’acceptabilité des protocoles de récupération nutritionnelle ambulatoire basés sur les aliments prêts à l’emploi (ATPE) chez les EVVIH. Matériel et méthodes : Il s’agissait d’une étude prospective, réalisée à la pédiatrie du CHRZ du 7 janvier au 31 Septembre 2018. Ont été inclus les EVVIH, âgés de 6 mois à 19 ans présentant une malnutrition aigüe modérée ou sévère sans complication. Le suivi était bimensuel jusqu’à l’atteinte du poids cible. Un bilan clinico-biologique et anthropométrique, la délivrance des ATPE et la mesure de l’observance aux prescriptions étaient réalisés. Résultats : Douze enfants vivants avec le VIH ont été inclus dont 3 MAS et 9 MAM sur un total de 25 enfants suivis soit une prévalence de 48%. Le sexe ratio (1,4) en faveur des garçons. L’âge médian (9,5 ans). Ils étaient sous ARV dans 92% des cas. La moitié des patients avait un âge > à 10 ans. La toux était le symptôme le plus retrouvé (67%) suivie de la diarrhée (58,3%), des vomissements (8,3%), une otite moyenne chronique (8,3%). La charge virale au début de l'étude a montré (5cas < 50 copies, 3cas < 5000 copies, 4cas > 15 000 copies). Le taux d'hémoglobine était < 10g/dl dans 92% des cas. Un problème d'observance de la prise d'ATPE a été noté dans 58,3%. Onze enfants ont atteint leur poids cible. Nous n’avons pas noté de perdu de vu ni d’hospitalisé. Conclusion : Les ATPE bien que efficaces, pausent souvent un problème d’acceptabilité. On gagnerait à améliorer le gout et la présentation pour permettre une meilleure observance. Objective: Acute malnutrition is common in children with HIV infection. The objective of our work was to evaluate the efficiency and acceptability of ambulatory nutritional recovery protocols (ATPE) based on ready-to-use food) in HIV-positive children (EVVIH). Methods: This was a prospective study, conducted at the pediatrics of the regional hospital center of Ziguinchor (CHRZ) from January 7th to September 31st, 2018. We included all HIV-positive children (EVVIH), aged between 6 months and 19 years with relatively acute or severe malnutrition without complication. The follow-up was done every two months until target weight was reached. A clinic-biological and anthropometric report, the issuing of ATPE and the measurement of compliance with prescriptions were carried out. Results: We chose 12 children living with HIV, including 3 MAS and 9 MAM out of a total of 25 children followed, with a prevalence of 48%. The sex ratio (1.4) was in favor of boys. The medium age was (9.5 years). They were under ARV in 92% of cases. Half of the patients were > 10 years old. Coughing was the most common symptom (67%) followed by diarrhea (58.3%), vomiting (8.3%), medium chronic otitis (8.3%). The viral affection at the beginning of the study showed (5cases <50 copies, 3cases <5000 copies, 4cases> 15,000 copies). The hemoglobin level was <10g / dl in 92% of cases. A problem of respect of ATPE taking was noted in 58.3%. Eleven children reached their target weight. We did not notice any loss ofsight and no child was hospitalized. Conclusion: Although the ATPE are efficient, they often cause a problem of acceptability. It would be better to improve the taste and the presentation to allow a better observance