Acute Thoracic Syndrome in Children: Epidemiological, Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar Senegal

Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.

Pneumothorax in Children: Epidemiological Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar

Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often associated with a favoring factor. When it is large, it can affect the life expectancy. The objective of our study was to determine the epidemiological, diagnostic and evolutionary aspects of pneumothorax in children aged 0 to 15 years, hospitalized at the Albert Royer National Children’s Hospital in Dakar. This is a retrospective descriptive study of patient records followed at the Albert Royer National Children’s Hospital (CHNEAR) for the management of a pneumothorax during the period from 2020 to 2022. During our study, 15 patients were hospitalized for pneumothorax, with an average annual incidence of 7.5 cases per year. The sex ratio (H/F) was 2.03. The average age was 3.7 years. Chest pain was present in 27% of patients, dyspnea was found in 93%, and cough in 87% of patients. All patients underwent chest radiography and the location of the pneumothorax was predominant on the right in 60% of cases. Thoracic drainage was performed in 93.3% of patients associated with etiological treatment. The average length of hospitalization was 27.8 days with a cure rate of 86.7% and a recurrence rate of 13.3%.

Bacteriological Profile of Acute Respiratory Infections in Children: About a Prospective Study at the Albert Royer Hospital in Dakar

Introduction: Acute Respiratory Infections (ARI) is a global public health priority. It is the leading cause of childhood morbidity and mortality, especially in developing countries. The main objective of this work was to look mainly at the bacteriological aspects of ARI in children in Senegalese hospitals. Methodology: We have been conducted a prospective descriptive mono-centric study over a period of one year (from July 1, 2017 to June 30, 2018) at the Albert Royer National child hospital in Dakar. A multiplex PCR (protein chain reaction) has been performed on nasopharyngeal swabs taken from all patients. This technique (viral RNA transcribed into DNA, then the DNA of the different pathogens is simultaneously amplified in the same tube by PCR Fast-tract®, multiplex). Results: During the study period, 109 patients were included. The hospital prevalence of acute respiratory infections was 3.7%. The mean age was 23.7 months with extremes between 1 month and 144 months. Peaks of consultations were found in the months of August, March and April with 22%, 15.6% and 12.8% respectively. Fever, respiratory distress and pulmonary condensation syndrome were the main signs found in our patients. Bacteriology was positive in 82.6% of samples and the most frequently found bacteria were Streptococcus pneumoniae in 38.5%, Haemophilus influenza b in 32.1% and Moraxella catarrhalis in 25.7%. Pneumonia was the main diagnosis, found in 61 cases, a prevalence of 59.9%. The average length of hospitalization was 10 days. Lethality was 1.8% or 2 cases. Conclusion: Acute Respiratory Infections in children still remains a public health problem in developing countries;children under 5 years of age are the most affected hence the need to strengthen ARI control programs. The identification of germs is indispensable in treatment and epidemiological surveillance in our regions.

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.

Indications and Results of Parotidectomies in the Orl Department of the Idrissa Pouye General Hospital in Dakar. Concerning 31 Cases

Introduction: The parotid tumors are benign or malignant, primary or secondary neoformations developed at the expense of the parotid gland. The aim of the present study was to describe the indications and results of parotidectomies in the ENT department of the Idrissa Pouye General Hospital in Dakar. Patients & Methods: We conducted a retrospective study between January 1, 2004 and December 31, 2012, including all patients who had been consulted for a parotid tumor with or without histological evidence collected in the otolaryngology and anatomy-pathology department of the Idrissa Pouye General Hospital in Dakar. Results: We collected 31 patient files. The mean age was 47.45 years, with extremes of 16 and 74 years. Females predominated, with a sex ratio of 0.82. Swelling of the parotid region was the main reason for consultation in 100% of cases. Parotidectomy was the most frequently performed procedure, accounting for 41.93%. Benign tumors accounted for 72% of cases, the majority being pleomorphic adenomas (50%). The outcome was favorable in 67.74% of cases. Conclusion: Management of parotid tumors at HOGIP would be improved by informing and educating patients to consult early, and by upgrading the technical platform.

Guillain-Barré Syndrome (GBS) in Children, the Experience of Senegal

Introduction: GBS is a rare condition in children. The risk factors for GBS are present in Africa;however, the majority of studies reported are case series. The objective of our work was to evaluate the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of GBS cases. Material and Method: This was a prospective longitudinal study, lasting 24 months between November 2019 and November 2021. All patients aged 2 - 18 years diagnosed with GBS according to the Brighton criteria (level 2) were included in our study. Patients with incomplete or unexploitable records were excluded. Results: Over a 24-month period, 16 cases of GBS were collected. These included 12 boys (75%) and 4 girls (25%). The demyelinating form (ADIP) was found in 9 children (43.75%) and the axonal form in 7 patients (37.5%), 5 of whom had pure motor involvement (AMAN) and 2 with sensory-motor involvement (AMSAN). Corticosteroid therapy was more effective in treating pain and in demyelinating forms. Three deaths were noted and all had AMAN. Conclusion: GBS poses a management problem in our context of a country with limited resources. Corticosteroid therapy has been shown to be effective in the treatment of pain and demyelinating forms of the disease and should be considered for use in GBS.

Pleomorphic Nasopharyngeal Liposarcoma: An Aggressive Tumor

Nasopharyngeal liposarcoma is an extremely rare clinical entity. Less than ten cases have been reported in the literature. It mainly occurs in humans. The non-specificity of the clinical and radiological signs explains the difficulty of the diagnosis confirmed by anatomopathological and immunohistochemical examinations. Its pathogenesis remains obscure and often correlates with genetic abnormalities. Pleomorphic liposarcoma is its rarest subtype, remarkable for its aggressiveness and rapidity of growth. Complete surgical excision remains the treatment of choice. We report a case of liposarcoma whose diagnosis was made during histological examination coupled with immunohistochemistry. .

CT Scans and Delays in Diagnosis of Stroke in Senegal’s Regional Hospitals: A Multicenter Study of 655 Cases

Stroke represents the 2nd cause of mortality and 1st cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the mortality in the department of neurology in the capital city, Dakar. Objective: To specify the types of stroke and to evaluate diagnostic delays in Senegal’s regional hospitals. Materials and Methods: This was a retrospective, cross-sectional, descriptive, multicentric study for 4 years (from 2014 to 2017) including any patient presenting a clinical suspicion with a CT scan confirmation of stroke in one of the 9 regional hospitals in Senegal with a recruitment period of 6 months per hospital. CT scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2 hospitals and 2 slices in 1 hospital. We studied the types and location of strokes, the associated signs and the time from stroke onset to admission and the time from admission to CT scan. Results: 655 patients were retained including 322 men and 333 women for an M/F ratio of 0.96. The average age was 63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of cases involving the middle cerebral artery in 73% of cases and hemorrhagic in 24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of cases. The delay between the onset of the deficit and admission was less than 6 hours in 10.6% of patients. The time between the onset of stroke and admission to hospital was specified in 416 patients (63.5%) of the study population, it was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for 29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the time was precise in 459 patients (70%), it was less than 6 hours in 37.9%, between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. Conclusion: CT is central to the diagnosis of stroke in rural areas. However, there is a significant delay in diagnosis and management.

Congenital Cyanogenic Heart Disease in Children: About 420 Cases in Africa

Congenital cyanogenic heart disease (CCHD) is a malformation of the heart and large vessels characterized by an oxygen desaturation in the arterial blood, responsible for cyanosis. The general objective was to study the profile of CCHD in Senegalese hospitals. This is a retrospective study carried out over a period of 8 years (January 1, 2010 - December 31, 2017) and including all children aged 0 to 16 years followed for a CCHD. The hospital prevalence was 0.87% for 420 cases collected. The sex ratio was 1.44 and the average age at diagnosis was 16 months. First degree parental consanguinity was noted in 36 cases (30.78%). The main reasons for consultation were breathing difficulty in 242 cases (57.62%) and fever in 136 patients (32.36%). Apart from cyanosis, the clinical signs were dominated by the heart murmur in 313 cases (74.7%), tachycardia in 283 cases (67.38%) and digital hippocratism in 162 cases (38.57%). Cardiomegaly was found in 239 patients (83.36%). The main types of CCHD were tetralogy of Fallot and transposition of the large vessels. In biology, 206 patients (49.05%) presented polyglobulia. A complete surgical cure was carried out in 22 patients (5.24%). Complications were anoxic crisis (52 cases) and hemorrhagic syndrome (17 cases). There were 97 deaths (28.28%) during hospitalization. The diagnosis of CCHD is late in our country and surgical management is poor explaining the high mortality.

COVID-19 Infection and Homozygous SS Sickle Cell Disease in Children: About Two Cases in Ziguinchor/Senegal

The World Health Organization declared that corona virus diseases-19 (COVID-19) is a public health emergency. The COVID-19 pandemic is more likely to cause disaster in developing area including West Africa due to limited medical resources. COVID-19 reportedly causes severer conditions in adults with advanced age and in patients with underlying comorbidities including sickle cell anemia. We recently experienced two pediatric patients with sickle cell disease (SS), who had COVID-19. We here highlight the difficulties of management and the severity of COVID-19 infection in children with homozygous sickle cell SS.

Assessment of Insulin Therapy in 281 Children and Adolescents with Type 1 Diabetes in Senegal

Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the management of type 1 diabetes. Methodology: This was a retrospective study including patients followed for type 1 diabetes (T1DM) in hospital between April 2018 and December 2020. Results: 281 patients were included. The mean age was 14.22 years. The mean age at diagnosis was 11.28 years. Ketoacidosis was the main mode of discovery of diabetes at 51.6%. Premix and rapid insulins were most commonly used at 84.7% and 82.9% respectively, most often in combination. The most commonly used treatment regimen was three injections/day in 82.5% of cases. The average daily insulin dose was 0.62 IU/Kg/dr. Of the patients, 219 (78%) were self-monitoring of blood glucose. The average number of blood glucose checks was 1.78 per day. 76 patients (27%) went days without an insulin injection and up to 7 days in 51% of cases. The main reasons were forgetfulness, therapeutic errors and stock-outs. Hypoglycaemia was observed in 14.2%. The average glycated haemoglobin was 10%. Conclusion: Despite the efforts made, there are still challenges to improve access to insulin. The reinforcement of therapeutic education on insulin therapy is essential for a better quality of life of diabetic children and adolescents.

Management and Outcome of Ureteropelvic Junction Obstruction in Senegalese Children

Introduction: The ureteropelvic junction obstruction is a rare congenital malformation of the upper urinary tract. We report its management and outcome at Senegal’s main pediatric surgical department. Patients and Methods: We conducted a descriptive review of all patients managed in our pediatric surgical department at Albert Royer National Children’s Hospital Centre from January 1st, 2013 to December 31st, 2017. Results: Thirty patients were included in our study. The mean age was three years. Males were more affected (sex ratio of 2.75). The prenatal diagnosis was made in 23% of cases using prenatal ultrasonography. An abdominal mass was the circumstance of discovery in 36% of cases, and lumbar contact and renal sloshing were found in 66% of cases. There was no renal function impairment in 93% of cases. Urinary tract infection occurred in 50% of cases. Ultrasonography (100%) and urinary computed tomography (56%) were used to diagnose. A temporary nephrostomy was performed in 23% of cases, and as definitive treatment, an open Anderson-Hynes procedure was performed in 96% as a nephrectomy was made in a patient. Early postoperative complications were encountered in 56% of cases: urinary tract infection (36%), surgical site infection and anastomotic stenosis (6% both), and urinoma and textiloma (both in 3%). A patient died from sepsis. After a mean follow-up of 12 months, no additional complication was reported. Conclusion: Ureteropelvic junction obstruction was frequently diagnosed late, and its management carried unneglectable morbidity in our environment. A laparoscopic approach would be a solution to improve its outcome.

Epidemiological, Clinical, Therapeutic and evolutionary Aspects of Children Living with HIV in Guédiawaye, Senegal

Introduction: HIV infection in children is a major public health problem. The objective of this study carried out in the paediatric department of the Centre Hospitalier Roi Baudouin de Guédiawaye, was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of a cohort of children with HIV over a 15-year period and to determine the factors associated with discontinuation of treatment and transition to second-line treatment. Patients and Methods: This was a descriptive and analytical cross-sectional study from August 2004 to December 2019 at the Centre Hospitalier Roi Baudouin de Guédiawaye. Through this study, age at diagnosis, current age, gender, orphan status, therapeutic aspects, status announcement and evolution were evaluated. A total of 129 patient records were studied over a 15-year period (2004-2019). HIV-positive children with profile I represented 93.8% and there was a male predominance with a sex ratio of 1.43. The current mean age of the children was 12.2 ± 4.5 and the median was 14 years. Fatherless and motherless children represented 24.0% and 20.2%, respectively, while both fatherless and motherless children represented 11.6%. The mean age at the start of ARV treatment was 7.6 ± 4.3 years and the median was 7.5 years. The mean age at the start of second-line treatment was 13.7 years with a standard deviation of 2.6 while the median was 13 years. AZT + 3TC + NVP was the most commonly used combination (29.5%) followed by TDF + FTC + NVP (26.2%). The mean age at treatment discontinuation was 13.3 ± 4.3 years while the median was 15 years. More than half of the children (57.0%) (N = 69) were aware of their status. Factors associated with discontinuation were gender (p value = 0.025 and OR = 3.2), orphan status (p value = 0.027 and OR = 3.0) and follow-up time greater than 10 years (p value = 0.013 and OR = 5.6). The mortality rate was 3.9%. Factors associated with transition to second-line treatment were year of inclusion (p value = 0.001 and OR = 15.6), age group (p value = 0.001 and OR = 19.2), orphan status (p value = 0.040 and OR = 2.6), treatment regimen (p value = 0.019 and OR = 5.7), duration of ARV treatment (p value < 0.001 and OR = 38.0) and announcement (p value = 0.002 and OR = 4.7). Conclusion The cohort of HIV-infected children followed up in Guédiawaye remains dominated by adolescents. Orphan status, announcement of status and duration of follow-up are associated with transition to second-line treatment and treatment discontinuation.

Eagle’s Syndrome in Children: A Case Report

Eagle’s syndrome is a collection of symptoms caused by styloid process elongation or calcification of the stylohyoid ligament, measuring more than 2.5 centimeters. It is a radio-clinical entity characterized by a heterogeneous polymorphic symptomatology most often involving headaches, facial pain, dysphagia and a foreign body sensation in the throat. Its management is mainly surgical. It is a rarely diagnosed condition in children. Here we report a typical case of Eagle’s syndrome which was diagnosed in a 14-year-old child with a history of chronic right unilateral pharyngeal discomfort, odynophagia and oropharyngeal foreign body sensation. CT scan showed a long left styloid process. The patient underwent surgical removal of the elongated styloid process externally. The outcome was favorable after surgery.

Does Hearing Impairment Have an Impact on the Children’s Education in Casamance, South of Senegal?

Goal: To determine the impact of deafness on the schooling of children in Casamance and the factors that characterize these repercussions. Patients and Methods: This was a retrospective, cross-sectional and multicenter study carried out in the ENT departments of the peace and regional hospitals of Ziguinchor over a period of 7 years from January 1, 2012 to December 31, 2019. It included hearing impaired children aged 1 to 18. Results: 178 hearing impaired children were collected during the study period. One hundred and forty-seven children were in school (82, 58%), the majority (85.03%) attending formal schools. Fifty-seven children had a speech disorder (32.02%). The average age of screening for deafness was 9 years. Deafness was mild in 53 patients. Thirteen patients had severe deafness. Two patients presented with cophosis. Conclusion: Our study shows that deafness does indeed have an impact on a child’s education in Casamance, but this impact is hardly taken into account.

Congenital Heart Disease in Rural Senegal: A Retrospective Study of 79 Patients

Introduction: Congenital heart disease (CHD) is a malformation of the heart present at birth and resulting from a developmental defect during embryonic life. The aim was to assess CHD in rural areas. Methodology: This is a retrospective study conducted over a period of 2 years in rural Senegal. Results: During the study period, we collected 79 patients with CHD, representing a hospital prevalence of 2.6%. The mean age at diagnosis was 17.05 months and the sex ratio was 1.19. The mean birth weight was 2826 g. The main comorbidities were anaemia (54.43%) and respiratory infections 38 cases (48.10%). Respiratory distress was the most common sign with 98.73%. Radiological cardiomegaly was noted in 86.7%. The most frequent CHD were interventricular septal defect (IVD) 21.51% and atrial septal defect (ASD) 8.86%. No patient was able to receive surgical treatment. Seven children died (8.86%) and 21 children were lost to follow-up (26.58%). On Doppler echocardiography, 16.45% of the patients had pulmonary arterial hypertension (PAH). Conclusion: In light of this work, emphasis should be placed on the quality of antenatal consultations, the quality of management and the regular availability of echocardiography and a cardio-paediatrician in order to reduce morbidity and mortality.

Scapula Fracture in a Child: Report of a Rare Injury

Scapular fracture is exceptional in children, mainly occurring after high-energy trauma. Radiologic investigations help its diagnosis and classification, which determines its management. We report the case of a 14-year-old patient admitted for blunt trauma of the left shoulder after falling from a speeding car. The diagnosis of a displaced fracture of the body of the scapula was made, and non-operative treatment was indicated and carried out for four weeks, followed by physiotherapy for another four weeks. Nine weeks after the trauma, the mobility of the affected shoulder was equivalent to that of the contralateral shoulder.

Persistent Congenital Paraurethral Cyst, a Rare Cause of Dysuria in a Girl

Congenital paraurethral cyst rarely occurs. Its natural history is spontaneous regression, leading to conservative management adoption. We report an exceptional case of a 13-year-old female with a persistent congenital paraurethral cyst, leading to dysuria. We surgically excised the cyst, and the outcomes were unremarkable 20 months postoperatively.

Assessment of Physicians’ Knowledge of Clean Intermittent Urinary Self-Catheterization in an African Country: The Case of Senegal

Introduction: Clean intermittent self-catheterization is the gold standard for the management of urinary retention. But its use remains limited in our practice. Objective: We are conducting this study to assess physicians’ knowledge of its practice in order to promote its promotion. Material and Methods: We conducted a cross-sectional, prospective, descriptive and analytical study in two hospitals in Dakar for two months. The resident doctors were interviewed on the basis of a questionnaire developed based on the recommendations of the French Society of Physical Medicine and Rehabilitation (SOFMER). Results: 54 medical residents returned the questionnaire. 63% of physicians surveyed defined the clean intermittent self-catheterization as a sterile intermittent self-catheterization. 70.9% of the doctors surveyed had cited urinary retention as an indication for the clean intermittent self-catheterization;53.7% advocated sterile gloves for the catheterization;29.6% proposed a frequency of one to two times and 2 to 4 catheterizations per day. 70.4% of doctors recommended indicating Cytobacteriological examination of urine in case of symptoms of urinary tract infection. Antibiotic therapy from the outset was offered by 83.3% of doctors in case of symptoms of urinary tract infection under intermittent self-sounding. 59.3% were unaware of clean intermittent self-catheterization. Discussion and Conclusion: Apart from the indica-tions, the clean intermittent self-catheterization remains unknown by res-ident doctors and its practice remains to be mastered, hence the need to establish a course on its practice at the faculty of medicine.

Abdominal Cerebrospinal Fluid Pseudocyst—A Rare Complication of Ventriculoperitoneal Shunt

An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and vomiting, abdominal distension on examination, as abdominal ultrasound and computed tomography confirm its diagnosis. The treatment involves drainage associated with drain relocation and resection of the pseudocyst’s wall. We report two patients diagnosed with this condition who underwent surgical treatment. The first patient had an unremarkable 12-month follow-up, while the second died on the seventh postoperative day due to intravascular disseminated coagulation. In these patients, the cause has not been identified;however, an infection cannot be ruled out.