Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic ab...Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, MELD, MELD-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, MELD, and MELD-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, MELD-Na may be effective for predicting in-hospital mortality.展开更多
Introduction: Food allergies are on the constant increase worldwide. Among them is peanut allergy, which also affects children. The aim of this study was to determine the profile of peanut sensitization in children at...Introduction: Food allergies are on the constant increase worldwide. Among them is peanut allergy, which also affects children. The aim of this study was to determine the profile of peanut sensitization in children attending a pneumo-allergology consultation. Methods: This was a cross-sectional study, which ran from January 1, 2018, to December 31, 2022, on children sensitized to peanuts seen in pneumo-allergology consultations at the Teaching Hospital Campus of Lomé. Results: The sample included 137 children aged 3 months to 18 years. The frequency of peanut sensitization was 25.3%. The mean age of patients was 6.3 ± 4.3 years (minimum 6 months and maximum 18 years). The 6 months to 5 years age group was the most represented (43.1%). The sex ratio was 1.3. The main reasons for consultation were rhinorrhea (67.9%), sneezing (36.5%) and cough (35.8%). Allergic rhinitis was identified as a personal history in 75.2% of patients. Peanut allergy was manifested as rhinorrhea (62.5%), asthma (26.8%) and eczema (8.9%). The risk of onset of symptoms within 15 - 30 minutes was 1.87 times (p = 0.001, CI = [1.2 - 2.1]) for peanuts consumed in roasted form with shell. Severe clinical signs such as Quincke’s Edema and anaphylactic shock were found in 1.4% of cases. Conclusion: Peanut allergy was common in children. Severe clinical signs were rare.展开更多
Introduction: The commonest maxillofacial fractures involve the mandible. Age can be considered among influential factors. Aim of the Study: To compare mandibular fractures between children and adults from the beginni...Introduction: The commonest maxillofacial fractures involve the mandible. Age can be considered among influential factors. Aim of the Study: To compare mandibular fractures between children and adults from the beginning up to the treatment in Senegal. Patients and Method: A three-year retrospective study was conducted in a university hospital. The medical records of patients admitted for maxillofacial injuries were reviewed. Patient and injury-related variables including age, gender, etiology, average consultation delay, anatomic location of fracture and treatment were compared up to age of 15 and beyond that. Results: Considering 272 casualties, maxillofacial fractures were less frequent among children than adults (36.7% and 59.7%) and were mainly mandibular (90.1% and 91.4%). Male predilection (sex ratio of 2.4 and 4.9) was twice (2) as pronounced from the age of 16. The average consultation delay was two (2) times shorter for children. Road traffic accidents which predominated among children (33.9%) had comparable frequency (32.3%) although they were outnumbered by assault (37.6%) among adults. Fractures occurred mainly on the corpus (90.1% and 90.4%), particularly on parasymphysis (40.1%) up to the age of 15, whereas angle fractures increased (8.5% to 19.6%) and joint damage decreased afterwards. Intra-oral orthopedic procedures (91.2% and 92.6%) in which mandibular retention splints were more common (37.3%) up to the age of 15 then arch ligatures (49%) were then widely favored. Conclusion: Differences relating to the distribution of causes but also to the anatomic location on the corpus and to the choice of intra-oral orthopedic procedures within overall similarities between children and adults regarding the male predilection, the frequency of road traffic accidents, the mandibular injuries, but also the school therapeutic attitude consisting of favoring the orthopedic option.展开更多
Background: Human African trypanosomiasis (HAT) occurs in three historical foci in the Central African Republic. Objective: To describe the morbi-mortality of childhood HAT in rural Central African Republic with the a...Background: Human African trypanosomiasis (HAT) occurs in three historical foci in the Central African Republic. Objective: To describe the morbi-mortality of childhood HAT in rural Central African Republic with the aim of early management. Methods: Descriptive and analytic cross-sectional study conducted from January 1, 2017 to March 30, 2018 at Nola prefectural hospital. This study was included all children seen as outpatients and/or hospitalized in the pediatric wards, in whom the diagnosis of HAT was confirmed. Statistical analysis was performed using Epi-info software. Results: Forty children were included from Bilolo (60%), Nola (30%) and Salo (10%). The sex ratio was 0.66 with a median age of 8.65 ± 12.48 years. Fever (82.5%), nocturnal insomnia (75%), daytime somnolence (67.5%), headache (65%), polyarthralgia (62.5%), convulsions 52.5% (n = 21), tremor (27.5%), trypanidism (7.5%) and delirium (2.5%) were the main functional signs. Examination signs were adenopathy (52.5%), paresthesia (30%), decreased cutaneous-abdominal reflexes (25%) and osteoarticular reflexes (17.5%), hyperesthesia (20%), extrapyramidal hypertonia (15%) and depression (2.5%). The children were in the lymphatic-blood phase in 65% of cases, and meningoencephalitis in 35%. Pentamidine was administered in 65% of cases. Four children died and 6 had neurological sequelae. There was an association between age under 5, Bilolo’s focus, the children’s history and the severity of the disease. Age under 5, gender, household, children’s activity, history and occurrence of sequelae were also associated. Conclusion: HAT remains a permanent threat to Central African children. Any clinical presentation combining long-term infectious signs and unexplained neurological or neuropsychological disorders must be treated with caution.展开更多
Introduction: Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor arising from striated muscle cells. It accounts for 60% - 70% of malignant mesenchymal tumors and 5% of pediatric cancers. Two-thirds of these canc...Introduction: Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor arising from striated muscle cells. It accounts for 60% - 70% of malignant mesenchymal tumors and 5% of pediatric cancers. Two-thirds of these cancers are diagnosed in children under 6 years of age, with a slight male predominance. Materials and Methods: This is a retrospective descriptive study of 10 cases of RMS collected in the pediatric hematology and oncology department of the Oujda university hospital, over a 5-year period, running from January 2018 to December 2022. Results: The median age at diagnosis was 3 years, with a sex ratio of 1. The mean time to diagnosis was 2 months. The most common site was the head and neck (50%), followed by the genitourinary tract (20%), the extremities (20%) and finally the abdomen (10%). The most frequent mode of discovery was a mass or swelling found in 90% of patients (all sites included), followed by exophthalmos in 30% of cases. At the diagnostic stage, CT scans were performed in 70% of cases and MRI in 5 patients (50%). Histological diagnosis was determined by immunohistochemical pathology in all our patients, with a predominance of embryonal (70%) versus alveolar (20%) and spindle cell types (10%). All patients underwent an extension workup, and a cervico-thoraco-abdominopelvic CT was performed in all patients (100%);MRI was performed in 2 patients (20%);lymph node involvement was present in 5 patients (50%). Metastases at the time of diagnosis were noted in only 1 patient (10%), who simultaneously presented with two metastatic sites;testicular and abdominal wall. Sixty percent of patients presented with advanced disease (high risk) and 40% with standard risk. Chemotherapy was used in all patients (100%), with upfront tumor resection performed in 40%. Fifty percent of patients received radiotherapy at a mean dose of 43 Gy, with the orbit the most frequently irradiated area (30%). All patients underwent CTscan and/or MRI and/or ultrasound surveillance. Follow-up during and after treatment was marked by complete remission in 8patients, loss of sight in one patient, and one patient died as a result of progressive disease. Conclusion: RMS is a malignant tumor of striated muscle. The epidemiological and clinical features of this tumor in our study are generally similar to those described in the literature. Management of these tumors requires multidisciplinary collaboration involving oncopediatric, radiologist, pediatric surgeon, pathologist and radiotherapist.展开更多
Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the s...Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.展开更多
Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmati...Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.展开更多
文摘Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, MELD, MELD-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, MELD, and MELD-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, MELD-Na may be effective for predicting in-hospital mortality.
文摘Introduction: Food allergies are on the constant increase worldwide. Among them is peanut allergy, which also affects children. The aim of this study was to determine the profile of peanut sensitization in children attending a pneumo-allergology consultation. Methods: This was a cross-sectional study, which ran from January 1, 2018, to December 31, 2022, on children sensitized to peanuts seen in pneumo-allergology consultations at the Teaching Hospital Campus of Lomé. Results: The sample included 137 children aged 3 months to 18 years. The frequency of peanut sensitization was 25.3%. The mean age of patients was 6.3 ± 4.3 years (minimum 6 months and maximum 18 years). The 6 months to 5 years age group was the most represented (43.1%). The sex ratio was 1.3. The main reasons for consultation were rhinorrhea (67.9%), sneezing (36.5%) and cough (35.8%). Allergic rhinitis was identified as a personal history in 75.2% of patients. Peanut allergy was manifested as rhinorrhea (62.5%), asthma (26.8%) and eczema (8.9%). The risk of onset of symptoms within 15 - 30 minutes was 1.87 times (p = 0.001, CI = [1.2 - 2.1]) for peanuts consumed in roasted form with shell. Severe clinical signs such as Quincke’s Edema and anaphylactic shock were found in 1.4% of cases. Conclusion: Peanut allergy was common in children. Severe clinical signs were rare.
文摘Introduction: The commonest maxillofacial fractures involve the mandible. Age can be considered among influential factors. Aim of the Study: To compare mandibular fractures between children and adults from the beginning up to the treatment in Senegal. Patients and Method: A three-year retrospective study was conducted in a university hospital. The medical records of patients admitted for maxillofacial injuries were reviewed. Patient and injury-related variables including age, gender, etiology, average consultation delay, anatomic location of fracture and treatment were compared up to age of 15 and beyond that. Results: Considering 272 casualties, maxillofacial fractures were less frequent among children than adults (36.7% and 59.7%) and were mainly mandibular (90.1% and 91.4%). Male predilection (sex ratio of 2.4 and 4.9) was twice (2) as pronounced from the age of 16. The average consultation delay was two (2) times shorter for children. Road traffic accidents which predominated among children (33.9%) had comparable frequency (32.3%) although they were outnumbered by assault (37.6%) among adults. Fractures occurred mainly on the corpus (90.1% and 90.4%), particularly on parasymphysis (40.1%) up to the age of 15, whereas angle fractures increased (8.5% to 19.6%) and joint damage decreased afterwards. Intra-oral orthopedic procedures (91.2% and 92.6%) in which mandibular retention splints were more common (37.3%) up to the age of 15 then arch ligatures (49%) were then widely favored. Conclusion: Differences relating to the distribution of causes but also to the anatomic location on the corpus and to the choice of intra-oral orthopedic procedures within overall similarities between children and adults regarding the male predilection, the frequency of road traffic accidents, the mandibular injuries, but also the school therapeutic attitude consisting of favoring the orthopedic option.
文摘Background: Human African trypanosomiasis (HAT) occurs in three historical foci in the Central African Republic. Objective: To describe the morbi-mortality of childhood HAT in rural Central African Republic with the aim of early management. Methods: Descriptive and analytic cross-sectional study conducted from January 1, 2017 to March 30, 2018 at Nola prefectural hospital. This study was included all children seen as outpatients and/or hospitalized in the pediatric wards, in whom the diagnosis of HAT was confirmed. Statistical analysis was performed using Epi-info software. Results: Forty children were included from Bilolo (60%), Nola (30%) and Salo (10%). The sex ratio was 0.66 with a median age of 8.65 ± 12.48 years. Fever (82.5%), nocturnal insomnia (75%), daytime somnolence (67.5%), headache (65%), polyarthralgia (62.5%), convulsions 52.5% (n = 21), tremor (27.5%), trypanidism (7.5%) and delirium (2.5%) were the main functional signs. Examination signs were adenopathy (52.5%), paresthesia (30%), decreased cutaneous-abdominal reflexes (25%) and osteoarticular reflexes (17.5%), hyperesthesia (20%), extrapyramidal hypertonia (15%) and depression (2.5%). The children were in the lymphatic-blood phase in 65% of cases, and meningoencephalitis in 35%. Pentamidine was administered in 65% of cases. Four children died and 6 had neurological sequelae. There was an association between age under 5, Bilolo’s focus, the children’s history and the severity of the disease. Age under 5, gender, household, children’s activity, history and occurrence of sequelae were also associated. Conclusion: HAT remains a permanent threat to Central African children. Any clinical presentation combining long-term infectious signs and unexplained neurological or neuropsychological disorders must be treated with caution.
文摘Introduction: Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor arising from striated muscle cells. It accounts for 60% - 70% of malignant mesenchymal tumors and 5% of pediatric cancers. Two-thirds of these cancers are diagnosed in children under 6 years of age, with a slight male predominance. Materials and Methods: This is a retrospective descriptive study of 10 cases of RMS collected in the pediatric hematology and oncology department of the Oujda university hospital, over a 5-year period, running from January 2018 to December 2022. Results: The median age at diagnosis was 3 years, with a sex ratio of 1. The mean time to diagnosis was 2 months. The most common site was the head and neck (50%), followed by the genitourinary tract (20%), the extremities (20%) and finally the abdomen (10%). The most frequent mode of discovery was a mass or swelling found in 90% of patients (all sites included), followed by exophthalmos in 30% of cases. At the diagnostic stage, CT scans were performed in 70% of cases and MRI in 5 patients (50%). Histological diagnosis was determined by immunohistochemical pathology in all our patients, with a predominance of embryonal (70%) versus alveolar (20%) and spindle cell types (10%). All patients underwent an extension workup, and a cervico-thoraco-abdominopelvic CT was performed in all patients (100%);MRI was performed in 2 patients (20%);lymph node involvement was present in 5 patients (50%). Metastases at the time of diagnosis were noted in only 1 patient (10%), who simultaneously presented with two metastatic sites;testicular and abdominal wall. Sixty percent of patients presented with advanced disease (high risk) and 40% with standard risk. Chemotherapy was used in all patients (100%), with upfront tumor resection performed in 40%. Fifty percent of patients received radiotherapy at a mean dose of 43 Gy, with the orbit the most frequently irradiated area (30%). All patients underwent CTscan and/or MRI and/or ultrasound surveillance. Follow-up during and after treatment was marked by complete remission in 8patients, loss of sight in one patient, and one patient died as a result of progressive disease. Conclusion: RMS is a malignant tumor of striated muscle. The epidemiological and clinical features of this tumor in our study are generally similar to those described in the literature. Management of these tumors requires multidisciplinary collaboration involving oncopediatric, radiologist, pediatric surgeon, pathologist and radiotherapist.
文摘Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.
文摘Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.
