Contribution of the Urine Dipstick to Urinary Tract Infection Diagnosis among Children in Two Hospitals in Cotonou-Benin

Introduction: Urinary tract infections are a daily concern in pediatric nephrology with long-term risks for high blood pressure and renal failure. The purpose of this study was to determine the contribution of a urine dipstick (UD) to the diagnosis of urinary infections among children at the CNHU-HKM and the Lagoon Mother and Child University Teaching Hospital (CHU-MEL) of Cotonou. Patients and Methods: This study is a cohort, descriptive and analytical study focused on children with suspected urinary infections in the pediatric units of the CNHU-HKM and CHU-MEL of Cotonou from March 25 to August 25, 2015. Results: Two hundred and four children out of a total of 5125 admitted children (4%) presented with at least one clinical sign of a urinary tract infection. Children under 36 months of age were predominant (41%). The main clinical signs of urinary infections were fever (60.8%) and urinary disorders (38.2%). The urinary dipstick test was positive in 145 children (71.2%). A urinary tract infection was confirmed by urine culture in 38 children (18.6%). In cases with leucocyturia- and nitrituria-positive urine dipstick tests, the sensitivity was estimated to be 13.2%, and the specificity was 95.2%, with a negative predictive value (NPV) of 82.8%. Only when the leucocyturia test was positive, the sensitivity was 76.3%, and the specificity was 31.9%. When the leucocyturia test was negative, the specificity was estimated to be 94%, and the sensitivity was 83% in the nitrituria-positive cases and 15.8% in the nitrituria-negative cases. The main isolated pathogens were Escherichia coli (n = 21) and Klebsiella pneumoniae (n = 14). Conclusion: In our environment, a negative leucocyturia test may help exclude urinary tract infections in most cases.

The Determinants of Fatal Outcomes during Severe Malaria in Children at the HKM University Teaching Hospital of Cotonou-Benin

Introduction: Malaria particularly affects children in sub-Saharan African countries. This study aimed to investigate the factors associated with death in cases of severe childhood malaria to better understand the determinants of death in these children. Patients and Methods: This cohort, descriptive and analytical study was conducted from April 1 to August 15, 2015, at the CNHU-HKM pediatric clinic in Cotonou. Recruitment was exhaustive for all patients under 15 years of age who were admitted for severe malaria, as confirmed by thick smear microscopy. Results: Among the 1774 admitted patients, 449 had severe malaria caused by Plasmodium falciparum (i.e., a hospital frequency of 25.31%). The age group most affected consisted of children younger than 60 months of age (73%);female predominance was noted. The lethality rate of malaria was 13.1% (n = 59). The factors associated with death were coma (p = 0.032), poor convulsive status epilepticus (p = 0.08) and bacterial co-infection by gram negative bacteria (p = 0.021) with respectively correlations coefficient of 0.003, 3.940 and 2.424. Conclusion: Reduction of the malaria mortality rates in Benin hospitals will depend on appropriate management of poor prognostic factors, such as coma, bacterial co-infection and convulsive illness.

Usefulness of a Clinico-Biological Francois’Score in the Diagnosis of Acute Appendicitis:Experience of the University Hospital Center of Parakou,Benin

Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of Fran?ois’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated Fran?ois’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2;category 2, score between -6 and 2;category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1;19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies.

Dementia and Diabetes Mellitus in Porto-Novo: Frequency and Determining Factors

Background: Chronic hyperglycemia promotes the development of degenerative diseases such as dementia. Our objective is to study dementia in diabetic patients in a hospital environment in Porto-Novo. Methods: This is a cross-sectional, prospective study with a descriptive and analytical aim that took place from May 18 to September 18, 2017, i.e. 4 months. The study population consists of all diabetic patients who consulted in the internal medicine departments of the Oueme-Plateau Teaching Hospital and at Saint Gérard clinic in Porto-Novo during the study period and who gave their enlightened consent. Results: The study included 246 patients with a mean age of 56.47 ± 11.97 years. There were 172 (69.9%) women, i.e. a sex ratio of 0.43. Diabetes had been known for less than 10 years in the majority (67.9%). Type 2 diabetics were in the majority (95.5%). Of the 246 patients, 42 (17.1%) had a Mini Mental State Examination (MMSE) less than or equal to 24. Of these 42 patients, 32 met the DSM V (Diagnostic and Statistical Manual disorders, 5th edition) criteria for dementias, i.e. a frequency of 13.0%. Of the 32 demented patients, 21 (65.6%) had vascular dementia and 34.4% had degenerative dementia. We did not note a mixed etiology. Dementia was severe in 15.6% of cases. In multivariate analysis, only age (OR = 10.09;95% CI [4.19 - 24.27];p < 0.001), arterial hypertension (OR = 7.10;95% CI [1.92 - 26.22];p = 0.003), and alcohol consumption (OR = 3.95;95% CI [1.29 - 12.15];p = 0.017) were statically associated with the onset of dementia in our diabetic patients. Conclusion: Screening for dementia should be systematic in diabetics, especially at old age.