Osgood Schlatter Disease: Study of 2 Observations in Conakry, Guinea

Introduction: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee, 20 to 30% of young growing athletes suffer from this pathology, described by Osgood and Schlatter in 1903. Objective: To report 2 observations and review the literature. Observation 1: This was a 14-year-old Guinean teenager, Halpoular, living in Conakry, a right-handed footballer who presented with a painful swelling of the right knee that looked mechanical, whose father had HLA B27 positive ankylosing spondylitis. X-ray of the right knee showed fragmentation of the anterior tibial tuberosities, and ossicle with edema of the patellar tendons at stage 4 according to Ehrenbord and Lagergren (1961). Thus, the disease of OSD is retained, He received 120 mg of diclofenac, 20 mg omeprazole for 1 month and the cessation of sports activity, the evolution was favorably marked by the regression of pain. Observation 2: A 16-year-old girl, initials M.L.T, Guinean, residing in Coyah (Republic of Guinea), a handball player, consulted for intense pain (VAS: 8/10) in her knees after a violent shock received when she hit the post. The physical examination found a painful, soft swelling at the anterior tibial tuberosity of the right knee, the rest of the examination was normal. The X-ray of the right knee shows fragmentation of the anterior tibial tuberosity, and ossicle with edema of the patellar tendon at stage 4 according to Ehrenbord and Lagergren 1961, thus the OSD disease is retained, the treatment instituted was 120 mg of diclofenac, the cessation of sports activity which gives a good evolution (EVA at 2/10). Conclusion: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee in young growing athletes, resolving at rest.

Emergency C-Section on Multi-Scar Uterus: Maternal and Fetal Prognosis at the Nianankoro Fomba Hospital in Segou, Mali

Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.

Ankylosing Spondylitis in a West African Hospital

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.

Maternal and Perinatal Prognosis of Artificial Induction of Labor with Misoprostol at the Reference Health Center of Commune 2 in Mali

Introduction: The artificial induction of labor is increasingly common. Objective: Evaluate the maternal-fetal prognosis of artificial induction with misoprostol at the referral health center of the commune II. Methods: This is a cross-sectional, prospective, descriptive and analytical study which took place from September 1, 2019 to December 31, 2020. Included in the study were pregnant women carrying an evolving or terminated single-fetal pregnancy of at least 28 WA in cephalic presentation on a healthy uterus. The trigger has been made with 50 μg misoprostol administered sublingually into the posterior vaginal fornix. The dose was renewed as needed every 6 hours, until sufficient uterine contractions were obtained without exceeding 200 μg. Results: The frequency of artificial induction of labor was 1.25%. Indications were dominated by premature rupture of membranes (29.8%), overdue (19.1%), high blood pressure (19.1%), suitability of pregnant women (14.9%) and terminated pregnancies (10.6%). The vaginal delivery rate was 85.1% The Apgar score was greater than or equal to 7 in 83.3% of cases at the 1stminute. Maternal morbidity was marked by postpartum hemorrhage due to uterine atony in 4.3% cases. No maternal and neonatal deaths were noted. Conclusion: Induction of labor with misoprostol is a safe and effective method if careful selection of patients is made.

Epidemiological Clinical Aspects and Medical Management of Sexual Assault in the Region of Ségou in Mali

Introduction: Sexual assault is an act of a sexual nature perpetrated on another person without their consent. Goal: To describe the epidemio-clinical aspects and the medical management of sexual assault in the Segou region. Methodology: This was a retro-prospective descriptive study from September 2010 to September 2018 on the alleged female victims of sexual assault registered in the Gynecology and Obstetrics departments of the hospital and the sanitary quarters of Ségou. Results: We recorded 107 cases of sexual assault out of 47,729 gynecological consultations, representing a hospital prevalence of 0.22%. The victims were between 10 and 15 years old in 48.59% of the cases. Students were the most represented with 53.27% (57/107) of cases. Genito-genital contact was recorded in 90.65% (97/107) of cases. Vulvo-perineal lesions were present in 44.86% (48/107) of survivors. Hymenial deflowering was the most frequent traumatic genital lesion accounting for 43.70% (21/48) of old cases and 27.00% (13/48) of recent cases. Sexual assault was committed by a single individual in 60.75% (65/107) of cases and by a friend of the victim in 21.5% (23/107) of cases. The survivors had consulted within 24 hours of the sexual assault in 53.27% (57/107) of the cases, the treatment was medical in 68.22% (73/107) and medical-surgical in 4.7% (5/107), post-exposure prophylaxis to the Human Immunodeficiency Virus (HIV) was performed in only 26.16% (28/107) of survivors. Conclusion: Sexual assault remains a concern although its frequency is low. This scourge mainly affects children and adolescents, and the lesions are mainly genitals.

Seizures in Children under Five in a Pediatric Ward: Prevalence, Associated Factors and Outcomes

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Touré. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (malaria, meningitis). The appropriate course of action was the administration of diazepam rectally.

Management of Trauma to the External Genitalia at the Nianankoro-Fomba Hospital in Segou Mali

Trauma to the male genitalia is not very common and mainly affects a young population. There is probably a particular instinct in men to defend their external genitalia;indeed, in the flaccid state, the penis is little exposed, and fairly well protected and its mobility allows it to move with the impact of trauma and thus reduce the vulnating force. Open trauma is rare, as is testicular dislocation, the most common being closed trauma. Testicular trauma is an uncommon accident that affects young people. Trauma is most often caused by road and traffic accidents. Animal bites are rare, as is genital self-mutilation related to a psychiatric disorder. Surgical exploration is the rule except in cases of moderate testicular trauma. Our objective was to report our experience in an emergency context where treatment is poorly codified and to review the literature. We recorded four patients with external genitalia trauma managed in the urology department from April 2013 to March 2022. Our patients were children with open genitalia trauma following a traffic accident, scrotal injuries were encountered in three patients, and additional penile injuries in one patient. All patients were treated surgically. The follow-up was straightforward.

Clinico-Pathological Profile of Malignant Abdominal Tumors in Children: Experience of the Pediatric Oncology Unit in Bamako

Introduction: the objective was to describe the epidemiological and histological aspects of malignant abdominal tumors in children. Methodology: This was a descriptive, cross-sectional study conducted from January 1, 2017 to December 31, 2018. We included all patients aged 0 to 15 years with histologically confirmed abdominal malignancies. Results: We collected 46 files of malignant tumors of the abdomen (35% of pediatric cancers). The majority of patients were under 5 years old (65%). The sex ratio was 1.7. They were generally from disadvantaged socio-economic backgrounds (67%). The average consultation time was 50 days. The main reasons for consultation were abdominal mass (48%), pain (17%) or distension (9%). The mass was large, hard (89%), immobile (71%) and painful (46%). Malnutrition was found in 80% of patients. The mass was retro-peritoneal in 63% of cases and renal in 54%. It was solid in 94% of cases and heterogeneous in 76% of cases. The assay for tumor markers was not performed. Anemia was present in all patients. Fine needle aspiration was performed in 43%, biopsy in 37% and myelogram in 15% of cases. spinal cord involvement was observed in 28% of Burkitt’s cases. The main cancers diagnosed were nephroblastoma (52%), Burkitt’s lymphoma (26%) and neuroblastoma (13%). Stage 1 and stage 2 were frequent in 20% and 22% of cases, respectively;36% of cases were not staged. The average duration of chemotherapy was 11 weeks. Total resection was performed in 30% of cases. The outcome of the patients was marked by total remission in 65%. Conclusion: Abdominal malignancies are very common in children. The diagnosis of certainty is late in our context.

Para Testicular Pseudotumeurs of Calcified Gait: A Case Report from the Nianankoro Fomba Segou Hospital (Mali)

Fibrous tumors of para testicular location are extremely rare benign tumors. The diagnosis of benignity, which allows a conservative treatment, will be made intraoperatively in front of the macroscopic aspect with well enucleable nodules and confirmed by the extemporaneous anatomopathological examination. We report a case of multiple calcified paratestinal pseudotumors in a 25-year old patient with no particular history, whose benignity was proven by the histology of the operative parts. Our objective was to discuss, from this observation and a review of the literature, the diagnostic and therapeutic aspects of these tumors.

Early Management of Nephroblastoma: A Single-Center Study in a Sub-Saharan African Country

Introduction: Nephroblastoma is the most common renal cancer in pediatrics. The aim of this study was to describe the epidemiological, clinical, histological characteristics and the immediate outcome of patients with nephroblastoma. Methodology: This was a cross-sectional study of 18 cases of unilateral nephroblastoma, carried out in the pediatric oncology unit (UOP) of the CHU Gabriel Touré from January 2015 to December 2016. Results: The mean age of the patients was 33 months old. The sex ratio was 0.63. The average consultation time was 3 months. A case of malformation syndrome (aniridia and mental retardation) had been observed. The main reason for consultation was abdominal mass (100%) associated with deterioration of general condition (44%), pain (44%) and fever (17%). Stage I accounted for 61% and stage II 39%. The postoperative histological classification made it possible to find the high-risk blastematous type (33%), the regressive type of intermediate risk (11%) and the stromal type of intermediate risk (45%). Toxicities (haematological and digestive) were minimal. The 3-year overall survival was 90%. Conclusion: This study is characterized by the predominance of stages I and II and the fairly large percentage of histology at intermediate risk. These results are above all the result of multidisciplinary collaboration.

Familial Forms of Spondyloarthritis Study of 100 Senegalese Multiplex Families

Introduction: Spondyloarthritis (SpA) comprises a group of chronic inflammatory rheumatic diseases characterized by predominant axial involvement. These include ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel diseases (IBD), SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), juvenile spondyloarthritis (JSPA), and undifferentiated SpA. Their exact cause is unknown but is believed to stem from a combination of factors. The first familial forms were described by de Blécourt et al. in 1961. The objective was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of familial forms of SpA and in particular, to prove the severity of the disease in family members compared to index cases in the rheumatology department of the Aristide Le Dantec University Hospital in Dakar. Methodology: This was a prospective, cross-sectional and descriptive study with an analytical aim on patients with the familial form of spondyloarthritis defined by the existence of at least one other family member with SpA outside the propositus, collected within the Aristide Le Dantec rheumatology department in Dakar over a period of 10 years between January 2012 and December 2021. There were two phases of study, the first of which consisted of collecting index cases with miserly SpA and the second of which consisted of family screening after consent. The data analysed were epidemiological, clinical, paraclinical, therapeutic and evolving. Results: Out of 100 families of 1905 members, 667 SpA patients included, i.e. a prevalence of 35%, including 225 (33.73%) men and 412 women (61.17%), i.e. a ratio of 1.8. The mean age at diagnosis among relatives was 26.3 years (range 13 and 80 years), 47.14 years among the propositus, in whom the mean age at onset was 36.26 years and that of relatives 49.9 years in the first degree, 15 years in the second degree and 1 year in the third degree. The time to diagnosis was 11.20 years in the first degree, 2.5 years in the second degree, 1 year in the third degree and 10.88 years in the case of the proposes. The number of marriages in families was 420 of which 116 were consanguineous (consanguinity rate 27.62%), 19% among the propositus. HLA-B27 positive in 92% of the proposers and 33.43% in the families;70% of the propositus had an inflammatory syndrome and 17.54% in the families;87% of sacroilliitis in the propositus and 5.54% in the families. Clinical forms were dominated by undifferentiated SpA (338 cases) and APS (295 cases). The average BASFI was 3.23 on D0;2.59 in the 3rd month and 1 in the 6th month for the propositus versus 2.55 at D0;1.86 at the 3rd month and 1.55 in the 6th month in the families. Average BASDAI was 3.92 at D0;3.12 at the 3rd month and 2.07 at the 6th month in the propositus and 3 at D0;2.21 at the 3rd month and 1 at the 6th month in the families. Autoimmune associated conditions were 18 cases, degenerative 24 cases, autoinflammatory 2 metabolic cases 18 cases. They all received: NSAIDs, methotrexate, salazopyrine (11 cases) and anti-TNF-α (1 case). The evolution was generally favourable. Conclusion: SpA is on the rise in Senegalese hospitals, frequent in young people, SPA and undifferentiated SpA are the most frequent, management is essentially based on conventional care, and the disease is less severe in family members than index cases.