The Prevalence of Female Genital Bilharziasis (FGB) in the Northern Region of Senegal

Introduction: Female Genital Bilharzia (FGB) is a pathology secondary to infection by Schistosoma haematobium. It is one of the neglected tropical diseases, capable of causing infertility, difficulties in childbirth and even cervical cancer. It represents a real public health problem. We therefore conducted a study in the maternity ward of the Saint-Louis regional hospital, with the overall aim of determining the prevalence of FBG in patients undergoing colposcopy. The specific objectives were to define the patient profile, and to compare colposcopic images with the World Health Organization (WHO) atlas. Methodology: We conducted a descriptive, analytical cross-sectional study of all colposcopic images taken at the maternity ward of the Saint-Louis regional hospital from August 1, 2018, to September 30, 2020, i.e. 25 months. The images were compared with the BGF images described in the WHO atlas. Results: We collected 178 colposcopy images. FBG images numbered 50, or 28%. The mean age of the patients was 44.5 years ±11.4 at the extremes of 18 and 78 years. Mean gestational age was 4.69 ± 2.72. Among patients with a bilharzian lesion on the cervix, visual acid inspection (VIA) was negative in 60% of cases (p = 0.007, Odd Ratio = 3.6 (1.49 - 9.07)). Conclusion: the results of our study show that FBG is a reality in our daily practice. It occurs in adult, multigestating, non-occupational women whose examination reveals a negative visual inspection with acetic acid (VIA). Healthcare providers therefore need to be trained in the recognition of lesions associated with genital bilharziasis, and public awareness needs to be raised.

Schistosomal(bilharzial)polyps:Travel through the colon and beyond

Schistosomiasis(bilharziasis)is a major neglected tropical disease.It is endemic in many tropical and subtropical communities.Schistosomal polyps(S.polyps)are not uncommon presentation of this infection.Although the colon is the most commonly affected organ,many other organs are affected.S.polyps are associated with a variable range of morbidity independent of the Schistosomal infection.S.polyps are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic areas.This review aimed to increase awareness of practitioners,especially gastroenterologists,for this peculiar type of polyps caused by this neglected infection hence improving patient outcomes.Web-based search of different databases was conducted for the literature focusing the development of S.polyps in the colon and other organs with analysis of the clinical manifestations,diagnosis and treatment.The following key words were used in the search,“Schistosomiasis”OR“Bilharziasis”AND“Polyps”OR“Polyp”AND“Colon”OR“Small intestine”OR“Duodenum”OR“Stomach”OR“Esophagus”OR”Gallbladder”OR”Pharynx”OR“Larynx”OR“Trachea”OR”Urinary bladder”OR“Ureter”OR“Renal Pelvis”OR“Urethra”.All publication types including case reports,case series,original research,and review articles were retrieved and analyzed.S.polyps are not infrequent presentation of acute or chronic Schistosomal infection.S.polyps are described in many organs including the bowel,genitourinary tract,skin,gallbladder and the larynx.Presentation of S.polyps is variable and depends on the site,number as well as the polyp size.The relationship of S.polyps to malignant transformation is a matter of discussion.Presence of S.polyps is sometimes the only manifestation of Schistosomiasis.Small polyps can be treated medically with praziquantel,while large accessible polyps are amendable for endoscopic excision through different polyp resection techniques.However,huge,complicated,non-accessible and suspicious polyps are indicated for surgical management or advanced endoscopic resection when appropriate.Clinicians and endoscopists should be aware about these facts when treating patients living in,immigrated from or visiting endemic areas.

Renal Colic: Epidemiological, Clinical Etiological and Therapeutic Aspects at the Urology Department of the National Reference General Hospital of N’Djamena (Chad)

Introduction: Renal colic is a medico-surgical emergency in which complicated forms could progress to renal failure and nonfunctional kidney. The objective of our study is to describe the epidemiological, diagnostic and therapeutic aspects of renal colic at the urology department of the NGRH. Methods: This was a prospective study involving 101 patients followed up for renal colic. The study spanned from July 2015 to July 2016 at the urology department of the NGRH. Results: A total of 101 patients suffering from renal colic were enrolled in the study giving a prevalence of 5.1%. The mean age was 38.89 years with a standard deviation of 14.5 years and a sex ratio of 1:3. Flank or lumbar pain of crushing type (45.5%), constant and of severe intensity (61.4%) were the most frequent clinical characteristics. The plain abdominal radiography (Kidney-Ureter-Bladder) coupled with ultrasonography had a 100% sensitivity for the etiological diagnosis of renal colic. Urinary lithiasis was the most frequent cause with 73.3%. Uroculture revealed a urinary tract infection in 44 patients (43.6%). The most frequent germ isolated on the culture was Escherichia coli (27.7%). Renal function was abnormal in 34 patients (33.7%). Medical treatment was composed of analgesics, NSAIDs and antispasmodic representing 93.1%. Percutaneous nephrostomy was performed in 6.9%. Pyelolithotomy was the most frequently performed surgical procedure and was done in 11 patients that are 39.3%. Fifty seven patients (56.4%) got healed without sequelae;6 cases (5.9%) of recurrence and 2 deaths (2%) were recorded. Conclusion: Renal colic is common in urology. Urinary lithiasis was the major cause in our series. Renal function could be endangered in case of late management.

Etiology and Management of Complete Acute Urinary Retention in Urology Department in N’Djamena, Chad

Goal: To study the epidemiological, clinical, etiological, characteristics and ensure earlier management of complete acute urine retention (CAUR) in the urology department of N’Djamena in Chad. Patient and Method: It was a retrospective descriptive study of a sample of 606 patients during the period ranging from November 2008 to December 2010. The patients were consulted first in urology or referred by a colleague for a CAUR. The diagnosis was confirmed by an earlier clinical examination. The patients have benefited from a urine evacuation before looking for the etiologies. Results: We managed a sample of 606 patients suffering from CAUR. Average age was 60 years old with extremes of 1 month and 100 years. There were more patients in the ranks of 60 years and more (n = 436;71.94%). Men were more than women in the proportion of 583/25, and 63.20% of the patients lived In N’Djamena. The benign prostatic hypertrophia was the first cause of CAUR, followed by urethral stricture, urinary infection, lithiasis of the lower urinary tract, adenocarcinoma of the bladder, hymen imperforation in young girls, bilharzias, paraphimosis and ovenbird necrosis. The bladder catheterization was the most urgent gesture done in 61.71%, followed by open cystostomy. In the second case, etiological treatment was done as: open prostatic surgery (n = 306), urethral reconstitution (n = 58), cystololithotomia (n = 54), dilatation of urethral conduct (n = 54), hymenostomia (n = 6). Conclusion: CAUR was the first symptom which motivated the consultation in the department of urology in N’Djamena the main problem of public health in Chad.

Primary Bladder Adenocarcinoma: A Five-Year Retrospective Clinicopathologic Study of 42 Cases in Egyptian NCI (2010-14)

Aim: Globally, primary adenocarcinoma (AC) accounts for only 0.5% - 2% of bladder cancer (BC). Bilharziasis predisposes to AC in ~10% of BC in endemic regions. The aim was to study the clinicopathologic characteristics of this rare entity and define prognostic elements influencing disease-free (DFS) & overall survival (OS). Patients & Methods: A retrospective analysis of 42 cases of primary bladder AC presented to the National Cancer Institute of Egypt (NCI-E) during a five-year period (2010-2014), clinicopathologic profiles, management and survival were assessed. Results: The mean age was 55.5 years ± 9.77 with male predominance. Hematuria, bilharziasis & urachal type experienced in 88%, 35.7% & 4.8%, respectively. Radical surgery was employed in 64.3%. Metastatic disease (stageIVB) found in 14.3%, initially. Eleven patients (26.2%) received palliative chemotherapy for their advanced or metastatic disease, objective response rates (ORR) were 0% & 100% for those received gemcitabine/platinum & capecitabine/oxaliplatin, respectively. The 5-year DFS & OS rates were 40.7% & 27%, respectively. DFS was significantly enhanced in patients having GII, negative nodes (pN0) and absence of hydronephrosis (p = 0.001, 0.011 & 0.047, respectively). Presentation with hematuria, pN0 & stage II was linked significantly with longer OS (p = 0.007, 0.037 & < 0.001, respectively). Tumour grade & clinical stage were independent prognostic factors affecting DFS & OS, respectively on multivariate analysis. Conclusions: Notable reduction in incidence of bladder AC in Egypt is mostly due to decline in bilharzial infection. Tumor grade & clinical stage are independent prognostic factors for DFS & OS, respectively. Still no agreement about the role of adjuvant radiotherapy or chemotherapy, however, protocols employed for colorectal cancer seem to be profitable in advanced and metastatic cases. Further larger scale studies are needed to define the hazard factors, molecular characterises and optimal management of this rare type of BC.