Study of the Management of Children with Major Sickle Cell Disease in Pediatric Emergencies at the Gabriel Toure University Hospital

Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and methods: This was a prospective study over 12 months in sickle cell children aged 6 months to 15 years. Results: The frequency of sickle cell disease was 4.67% with 71.1% of SS form. The age range of 60 - 120 months predominated with 43.4% and the sex ratio 1.4. Vaso-occlusive crises (VOC) were the most frequent reason for consultation (50.6%) and osteoarticular pain was the main symptom followed by fever and pallor with respectively 67.5%, 60.2%, 39.8%. The pain subsided in less than 72 hours in 39.8% and hyper hydration was performed in 85.1% of patients. Analgesic treatment was given in 90.4%, antibiotic therapy in 51.8% and phenotyped red blood cells transfusion was performed in 36.1%. The average duration of treatment was 10 days. Conclusion: Vaso-occlusive crisis remains the main reason for consultation in sickle cell disease children at Gabriel Toure University Hospital. The management consisted, in addition to the correction of the triggering factors, of hyper hydration and the administration of analgesics and blood products.

Study of Cerebral Vascular Accidents in Children with Sickle Cell from 6 Months to 15 Years of Age at the Gabriel Toure University Hospital Center

Sickle cell disease is a hereditary disease that remains a public health problem in Mali. Our objective was to study strokes in children with sickle cell disease aged from 6 months to 15 years in the pediatrics department of the Gabriel Toure university hospital center. This was a retrospective descriptive study from April 1, 2019 to March 31, 2021 and prospective from April 1, 2021 to April 30, 2022, i.e. 3 years, which took place in the Pediatrics department of the Gabriel Toure university hospital center. During this study, we identified 22 cases of stroke among 714 children with sickle cell disease. The frequency of stroke in this population is 3.08%. The age group from1 to 5 years was the most affected with 40.9%. The average age of the patients was 7 years with extremes ranging from 1 year to 15 years and a median of 5 years. The male gender was predominant with 54.5%, for a sex ratio of 1.2. Headaches were the most common neurological antecedents (63.5%). Half of the patients were diagnosed with sickle cell disease after the onset of the stroke. The installation of the deficit was progressive in 54.5% of cases. Consciousness disorders were the most frequent reason of consultation (27.2%), followed by convulsions (18.1%). The most common neurological signs were impaired consciousness and hemiparesis with 45.5% each. The stroke was ischemic in 100% of cases. There were 95.5% of SS forms and 4.5% of Sβ0thalassemia forms. Our patients had a hemoglobin level less than 7 g/dl in 57.1% of cases and between 7 and 9 g/dl in 42.8% of cases and hyperleukocytosis (leukocytes > 10,000/mm3) in 95.4% of cases. The Sylvian artery was the most affected (45.5%). The fatality rate was 22.7%.

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.

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.

Epidemiologic Features of the First Flare of Ne-phrotic Syndrome in Children in Bamako Pedi-atric Hospitals

Introduction: The most frequent glomerular pathology in children, nephrotic syndrome (NS) is a cosmopolitan affection. It is an immunological disease and certain environmental factors, in particular viral infections and allergens, influence its occurrence. The climatic and environmental differences coupled with the frequency of infectious pathologies signing the African particularity and the absence of data in Mali on this affection, motivated us to carry out this work. Objective: To study the epidemiological aspects of nephrotic syndrome in hospitalized children aged 0 - 15 years. Patients and Methods: This was a descriptive prospective study from January 1 to December 31, 2021 in the Pediatrics Department of the University Teaching Hospital (UTH) Gabriel Touré, anational pediatric reference service in Mali. Diagnostic confirmation was provided by biology. Results: In one year, 120 children were hospitalized for nephrotic syndrome with a sex ratio of 2.75. Male exclusivity was observed at the ages of one year, eight years and 14 years and a reversal at 13 years (sex-ratio = 0.33). The median age was 6 years for an average age of 6.4 years ± 2.4 years with extremes ranging from one year to 14 years. The first attack of nephrotic syndrome occurred outside the classic age (>10 years) in 16.67%. Nephrotic syndrome is observed throughout the year with two peaks in summer (July to September) and winter (December to February). Many ethnic groups were affected by this condition with a high frequency among ethnic groups where endogamy is common. All patients were melanoderms. No cases of NS were recorded in Caucasian children from Northern Mali. The patients came from Bamako in 47.5% of cases. Two brothers from the same siblings had had their first attack of nephrotic syndrome the same year, ten months apart. Conclusion: Nephrotic syndrome in pediatric hospitals of Bamako occurs at a median age of six years all along the year with a summer and winter peaks. It is more observed in ethnic groups where the practice of endogamy is common and concerns melanoderm children.

Epidemiological and Clinical Aspects of Congenital Hydrocephalus in the Neonatal Department of Gabriel TouréTeaching Hospital Bamako Mali

Objective: The aim of our work was to access the epidemiological and clinical aspects of congenital hydrocephalus in the pediatrics department of Gabriel Touré teaching Hospital Bamako. Methods: We conducted a retro and prospective study that ran from January, 1st 2018 to July, 30, 2019. All newborns of 72 hours of life or less with hydrocephalus confirmed by sonography or CT scan were enrolled in this study. Results: During the study period, 5416 patients were hospitalized in the neonatology department. Among them, 39 patients (0.72%) presented congenital hydrocephalus and congenital infectious causes accounted for 25.6%. The sex ratio (M/F) was 1.78. Mothers were housewives and not educated in 79.5% and 64.1% respectively. The parents resided outside Bamako in 61.5% of cases. Prenatal consultations were conducted in 32 patients (82%). Consanguinity between the 2 parents was present in 38.5%. The antenatal diagnosis was made in 8 patients (20.5%). Vaginal delivery was the main mode of birth (67%). The average birth weight was 2930 g (1000 to 5400 g) and the average head circumference was 37.82 cm (26 - 55 cm). In 87.2% of cases, newborns were eutrophic. The main clinical signs were bulging anterior fontanel (46.2%), sunset gaze (20.5%), prominent forehead (48.7%), reduced face (20.5%), enlarged cranial sutures (43.6%), macrocrania (25.6%). Transfontanellar ultrasound and CT scan were performed in 51.3% and 48.7% of cases respectively. Associated malformations were spina bifida in 30.8% of cases followed by Dandy Walker malformation (5.1%), and omphalocele (2.5%). The neurological signs were diminished neonatal reflexes (51.3%), hypotonia (30.8%), motor deficit (38.4%), intracranial hypertension (25.6%), seizures 10.25% and psychomotor delay (43.6%). Surgery was performed in 8 neonates (20.5%). Ventriculo-peritoneal shunt (VPB) was the main treatment. Postoperative complications were infectious (37.5%) and mechanical complications (12.5%). The postoperative mortality rate was 12.5%.The overall mortality was 13 cases (33.3%). Conclusion: The hospital frequency of congenital hydrocephalus in our environment seems low but does not reflect reality.

Epidemiological and Clinical Aspects of Abnormal Movements in Children from 2 Months to 15 Years in the Pediatric Department of Gabriel Toure University Hospital Centre of Bamako

Introduction: Abnormal or involuntary movements correspond to a disorder in the programming and/or execution of movement. They have two characteristics;they are hardly or not at all controlled by the will and occur in the absence of any paralysis. Objective: To determine the epidemiological, clinical and etiological characteristics of abnormal (involuntary) movements in children aged 2 months to 15 years. Patients and Methods: This was a prospective, descriptive study from January 2016 to December 2018 of children aged 2 months to 15 years seen in neuropediatric consultations for abnormal movements. Results: During the study period 1920 children were seen in neuropediatric consultations and 57 presented with abnormal movements, i.e. a frequency of 2.96%. Children aged between 6 and 60 months were the most affected (54.4%). The sex ratio was 1.53. Movement abnormality was the most common reason for consultation (45.7%), followed by apyretic convulsions (28%), and laxity (5.3%). The onset was progressive in 68.4% of children. The main types of abnormal movements were chorea (31.6%), dystonia (26.3%), myoclonus (17.5%), tremor in 10.5%. The causes were infectious (73.68%). Conclusion: Abnormal movements are rare in paediatric practice. They have multiple causes and their management is urgent in certain situations that can jeopardise the future of children.

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.

Kangaroo Mother Care and Neonatal Outcomes in the Pediatric Department of CHU Gabriel Toure

Introduction: In Mali, prematurity is currently the leading cause of neonatal morbidity and mortality at the Gabriel Toure Hospital. Kangaroo Mother” care is an efficient and effective alternative care strategy for preterm and low birth weight babies. This study aimed to evaluate the epidemio-clinical and therapeutic profile of premature/hypotrophic newborns admitted to the “Kangaroo-mother” care unit. Material and method: It was a retrospective study from 01/01/2010 to 31/12/2012. Were included all stable preterm with gestational age between 28 - 37 weeks and hypotrophic newborns with a birth weight 10th percentile for gestational age. Results: One thousand and eighty-four patients (n = 1084) were included. The sex ratio was 1.2 (F = 592;M = 492). The mean birth weight was 1300 g (600 g - 2000 g). The mean gestational age was 32.69 (28 - 37). The mean age of the mothers was 24 years (13 - 45 years). Single pregnancies accounted for 85.1%. Discontinuation of care was 56%. Follow-up to 24 months was effective in 14% of patients. Sixteen percent of the patients died (n = 176). The mothers’ lack of schooling (p = 0.03) and birth weight < 1000 g (p = 0.003) were the major factors in the patients’ mortality. Conclusion: The kangaroo-mother care is an alternative means to improve the survival of preterm and low birth weight babies in Mali.

Profile of Newborns Hospitalized for Maternal Fetal Infection and Having a Positive CRP in the Pediatric Department of the Gabriel TouréCHU in Bamako, Mali

Objective: Early bacterial neonatal infection (INBP) or maternofetal infection (early neonatal sepsis) remains a concern of the pediatrician due to diagnostic difficulties and its increased morbidity and mortality. No study has been done in Mali on the profile of newborns admitted for INBP with positive CRP, hence the initiation of this work with the aim of studying the epidemiological, biological and bacteriological profile of newborns with a bacterial maternal-fetal infection. Method: Longitudinal study descriptive (from 27 June to 3 September 2016) which concerned all newborns aged from 0 to 72 hours of life hospitalized for confirmed early bacterial neonatal infection with a positive C-reactive protein (CRP) in the neonatal department of the CHU Gabriel Touré. INBP was defined by the presence of maternal and neonatal infectious risk factors, positivity of CRP with a germ in the blood culture. Results: During the study period we included 244 newborns for probable maternofetal infection and who benefited from the CRP assay, 43 had a positive CRP, i.e. a frequency of 17.62%. The sex ratio was 2.30. The majority had a low birth weight (<2500 g) in 69.8% of cases. Mothers were aged 18 to 35 in 93%. The majority were out of school (43.8%) and housewives in 74.4%. The main reasons for consultations were prematurity and/or low birth weight, respiratory distress and neonatal distress, i.e. 46.5%, 25.6% and 11.6% respectively. Among the 43 newborns with a positive CRP, the blood culture returned positive in 79.1% (n = 34). We deplore 2 deaths (4.7%). The main bacteria were gram-positive cocci (Staphylococcus aureus 53.01% and Streptococccus agalactiae 4.10%), gram-negative bacilli (GNB) type Enterobacteriaceae (Klebsiella pneumoniae 11.25% and E. coli at 5.70%) and non-fermentative GNBs (Pseudomonas aeruginosa 2.80% and Acinetobacter baumannii complex 2.24%). Conclusion: Maternal-fetal infection is a hospital pathology frequently encountered in the neonatal period. Its clinical presentation is dominated by respiratory distress, neurological disorders and low birth weight.

Become Immediate of Newborns Operated in the Neonatology Department of the Hospital and University Center Gabriel Toure of Bamako (Mali)

Neonatal surgical pathologies in developing countries are characterized by high mortality. The aim of this work was to describe the characteristics of the newborn and its surgical pathologies treated in the neonatal department of the Gabriel Touré University Hospital in Bamako (Mali). Patients and method: This is a retrospective study of 626 files of newborns hospitalized over a period of 3 years (January 2016 to December 2018) for a surgical pathology, whether operated on or not. We have studied the etiological, therapeutic and evolutionary aspects. Results: During the study period, we collected 626 patients who had surgical pathology, i.e. a frequency of 5.35%. The average therapeutic consultation time was 2 days with extremes (1 and 30 days). Pathologies of the abdominal wall and digestive tract represented 57.9% (n = 84) followed by pathologies of the spine 26.9% (n = 39). The mean treatment time was 4.5 days. Twenty-three point sixteen (23.16%) newborns could be operated on. The neonatal mortality rate was 12.4% (n = 18). Mortality was postoperative (100%) with a mean time to onset of 5 days. Abdominal wall pathologies were responsible for 8.7% (n = 13) of deaths. Conclusion: Surgical pathologies of the newborn are characterized by delayed treatment with high mortality. Improving their prognosis requires early diagnosis (prenatal diagnosis) and adequate management.