Indications and Results of Lower Gastrointestinal Endoscopy in a Regional Hospital Center in Senegal

Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital center in Senegal. Patients and Methods: We conducted a descriptive retrospective study from September 1st, 2017, to September 30, 2018 at the gastrointestinal endoscopy unit of the regional hospital center of Thiès. All patients received for lower gastrointestinal endoscopy and whose reports were usable, were included. In the reports, we collected and analyzed sociodemographic data, indication and results of the endoscopic examination. Results: We included 250 patients. There were 140 men (sex ratio 1.27). The average age was 42 years [range 1 - 92 years]. There were 37 colonoscopies (14.8%), 51 rectosigmoidoscopies (20.4%) and 162 anorectoscopies (64.8%). The patients were from the region of Thiès in 82% of cases. In most cases, they were most often referred by general practitioners (22.8%) and surgeons (20.8%). The main indications were rectal bleeding (36.8%), hemorrhoidal disease (23.2%) and proctalgia (11.6%). Hemorrhoidal disease (63.6%), anal fistula (14%) and tumors (8.8%) were the most common pathologies. Conclusion: Admitted patients at the gastrointestinal endoscopy unit of the regional hospital center of Thiès have many indications as well as pathologies. Anal pathology is dominated by hemorrhoidal disease.

Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

Cervical Spine Cord Injury Associated with Klippel-Feil Syndrome: A Case Report

Background: Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. Aim: The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. Case presentation: A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. Conclusion: Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.