<strong>Introduction:</strong><span style="font-family:""><span style="font-family:Verdana;"> The first case of the novel coronavirus (COVID-19) pandemic in Cameroon wa...<strong>Introduction:</strong><span style="font-family:""><span style="font-family:Verdana;"> The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. </span><b><span style="font-family:Verdana;">Overall objective: </span></b><span style="font-family:Verdana;">To describe and understand the clinical burden of patients managed for COVID</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">19 in pregnancy or post-partum at the DGOPH.</span><b><span style="font-family:Verdana;"> Methodology:</span></b><span style="font-family:Verdana;"> Cross</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">sectional and descriptive study covering four months—March 24</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> to July 24</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet.</span><b><span style="font-family:Verdana;"> Results: </span></b><span style="font-family:Verdana;">A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%</span></span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">39</span><span style="font-family:""> </span><span style="font-family:Verdana;">years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were</span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%.</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.</span></span>展开更多
Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) i...Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon and its contribution to the fight against cervical cancer in our context. Method: This is a retrospective cross-sectional study of 99 colposcopies after which 71 exploitable biopsies were retained at the Douala for a period of 1year (December 1, 2019-December 1, 2020). The nomenclature of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) was used. Results: Mean age of the participants was 44 years, mostly multiparous (80%). Cytological abnormalities were the main reference pattern. During the examination 22% of colposcopies were found to be normal, 37% of TAG 1-2A, 31% of TAG 2B-C, and 5% suspected of cancer. After histological analysis of biopsies guided by colposcopy, we found 42% (30/71) of Cervical Intraepithelial Neoplasia (CIN) 1, 15.5% (11/71) of CIN 2 - 3, and 24% (17/71) cancer. Upon analysis of the diagnosed CIN1/CIN2-3/Cancers, we noted a concordance with colposcopy in 62% (23/37), 37% (10/27) and 85% (6/7) respectively. Colposcopic performance in the detection of high-grade lesions and above was 36% (26/71), with a sensitivity of 92.86%, specificity 83.33%, PPV 78.79% and NPV 94.59%. Conclusion: Despite the difficult socioeconomic context, colposcopy retains all its importance in the diagnosis of precancerous lesions of the uterine cervix. With the imminent putting in place of a national health policy, the goals 90-70-90 by 2030 of the World Health Organization for the fight against cervical cancer can be achieved in our sub-Saharan African countries.展开更多
Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children ...Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths (18.7%) and 17 cases (9.9%) with neurological sequelae before discharge. Conclusion: The incidence of acute bacterial meningitis remains high in our context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitis. The mortality rate was high with poor prognosis factors such as age less than 12 months, delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial hypertension. Focus should be placed on strengthening the routine immunization on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.展开更多
Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with ret...Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with retrolective data collection. All patients who underwent laparoscopy for infertility with a complete file were recruited. Data were collected on a pre-established form and analyzed with Microsoft Excel 2007 software. Results: Six hundred and thirty-three women, representing 6.9% of gynecologic operations, underwent laparoscopic surgery during the study period. Infertility accounted for 69.8% (442 cases) of the indications. Four hundred and fifteen files were analyzed. The commonest intraoperative findings were: tubo-peritoneal adhesions (71.6%), hydrosalpinx with distal tubal occlusion (41.5%), peri-hepatic adhesions (22.4%), uterine fibroids (20.2%) and tubal phimosis (14.0%). Adhesiolysis, neosalpingostomy and fimbrioplasty were the commonest surgical gestures. At the end of the procedure, the best tube was staged as favorable in 57.6% of our patients. A complication rate of 4.3% was observed. Conclusion: Infertility is the main indication for laparoscopic surgery in our setting. The main operative findings are tubo-peritoneal adhesions and hydrosalpinx. The most practiced tubal surgical gesture is neosalpingostomy. Half of the recruited women have a favorable stage for the best tube. The complication rate is low.展开更多
Objective: To describe the clinical and therapeutic aspects of rape against females in a tertiary level hospital, Yaoundé, Cameroon. Methods: This was a cross-sectional study with a retrolective collection of dat...Objective: To describe the clinical and therapeutic aspects of rape against females in a tertiary level hospital, Yaoundé, Cameroon. Methods: This was a cross-sectional study with a retrolective collection of data, concerning the female patients with a clinical diagnosis of rape received from January 1st 2008 to December 31st 2012. Results: Rape was confirmed at physical examination in 131 cases. The rape victim survivals were mostly aged less than 20 years (85/131;64.9%), unmarried (127/131;97.0%), with no income (95/131;72.5%) and had no university education level (110/131;83.9%). The aggression commonly took place during the night (68/131;51.9%), at the victim’s or aggressor’s home (70/131;53.4%), with physical constraint (73/131;55.8%), by an unknown aggressor (88/131;67.2%). A vaginal penetration was reported by 97.0% of the victims (127/131) while 12.2% of them (16/122) had an anal ingress. Condom usage was uncommon during rape (3/131;2.3%). Vulvar and vaginal lesions were encountered in 32.8% of the cases (43/131). Only 27.5% (36/131) of the victims were prescribed an emergency contraception, while antiretroviral prophylaxis was administered to 46.6% (61/131) of them. Conclusion: These data might be useful for prevention of rape. The clinical management of survival victims of rape needs to be improved.展开更多
Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a c...Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clinical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Complete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.展开更多
<strong>Ba</strong><span style="font-family:Verdana;"><strong>ckground:</strong></span><span><span><span style="font-family:""><span st...<strong>Ba</strong><span style="font-family:Verdana;"><strong>ckground:</strong></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> A novel viral respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for a worldwide pandemic. The effects of this new disease in pregnant women and newborns are actually not well known. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We investigated the clinical features and outcomes of four neonates born to mothers with a s</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">evere form of COVID-19 and a positive RT-PCR for SARS Co-V2 in Douala Gynaeco-Obstetric and Pediatric Hospital (Cameroon) from April 20 to June 5, 2020. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All four mothers were symptomatic and had a positive RT-PCR for SARS CoV-2 from nasopharyngeal swab on admission. All of them delivered prematurely through cesarean section because of severe respiratory distress and one died shortly after delivery. The four premature male infants were born between 30 weeks and 35 weeks 2 days of gestation and had birth weights ranging from 1090 g to 2950 g. All infants had 1-minute Apgar scores that ranged from 7 to 8 and 5-minute Apgar scores varying between 8 and 9. They were isolated from their mothers immediately after birth and received formula feeding. Three of the four infants were tested using nasopharyngeal swab specimens for RT-PCR 24 to 48 hours after birth and were negative for COVID-19. All the infants were treated in a dedicated area at the neonatal care unit and presented with mild respiratory distress on admission with a Silverman score that varied between 2 and 4/10. During their hospitalization, all the infants also presented with jaundice and underwent phototherapy. Three of them had anemia with hemoglobin levels ranging from 105 to 123 g/L requiring for blood transfusion. The hospital stay varied between 3 and 48 days. Three infants were discharged healthy and one died. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This case series suggests the possibility of poor maternal and neonatal outcomes in case of severe COVID-19 in mothers. It also suggests that severe COVID-19 in pregnant women may be a risk factor for prematurity for the newborns. It is crucial to screen pregnant women, to implement infection prevention, control measures and to provide close monitoring of neonates born to mothers with a severe form of COVID-19.</span></span></span></span>展开更多
Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complicati...Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.展开更多
Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of fe...Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.展开更多
<strong>Introduction: </strong>Pregnancy is a physiologic state associated with decreased immunity, and the use of medical imaging modalities with ionizing radiation must be justified as potential benefits...<strong>Introduction: </strong>Pregnancy is a physiologic state associated with decreased immunity, and the use of medical imaging modalities with ionizing radiation must be justified as potential benefits must outweigh the risk of any harm. However, in the wake of SARS-CoV-2 virus pandemic, chest computed tomography (CT) is necessary to assess the severity of the disease. The objective of this study was to compare the chest CT findings of pregnant and non-pregnant women with SARS-CoV-2 viral pneumonia at a tertiary hospital setting. <strong>Materials and Methods: </strong>This was a cross-sectional, retrospective, descriptive study of admission records of pregnant and non-pregnant patients aged 15 - 49 years during a three (3) months period (April-July 2020) in DGOPH. Logistic regression was used to search for predictors of lung involvement during COVID-19. <strong>Results:</strong> A total of 31 patient files were studied of which 9 (29%) were those of pregnant women. The pregnant women mostly had a combination of lung ground-glass opacities and consolidation on CT compared to the non-pregnant women (7 out of 9 cases, 77.8%, vs. 6 out of 22 cases, 22.7%;p = 0.01). The group of pregnant women had more than 3 affected lobes (50.0% vs. 22.7%, p = 0.04) with a middle lobe predilection (77.8% vs. 31.8%, p = 0.02). CT predictors of COVID-19 pneumonia in the group of pregnant women after the multivariable logistic regression analysis were the presence of nodules (aOR = 13.9;95% CI: 1.25 - 134.2;p = 0.032) and linear bands of interlobular septal thickening (aOR = 17.8;95% CI: 1.46 - 217.6;p = 0.024). <strong>Conclusion: </strong>In this study, the chest CT of pregnant women with COVID-19 pneumonia revealed mostly a combination of findings compared to non-pregnant women, with more affected lobes. These findings suggest the likelihood of a greater CT severity of COVID-19 pneumonia among pregnant women and therefore the need for timely and appropriate management.展开更多
Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenanc...Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.展开更多
Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major...Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.展开更多
Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) ...Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) of Ouagadougou. Patients and Methods: We retrospectively studied all children aged from three to fifteen years old who were diagnosed with renal failure (RF) in the Department of Medical Pediatrics, from January 1, 2011 to December 31, 2013. RF was defined by a glomerular filtration rate (GFR) less than 80 mL/min/1.73m<sup>2</sup>, estimated by the formula of Pottel et al., which ignored the size that was rarely found in the medical records. The department constantly lacked pediatric blood pressure monitors or urinary strips. Results: In total, 119 cases of RF (3.3% of all admissions) were collected. They were about acute RFs (ARFs), chronic RFs (CRFs), and Unclassified RFs (URFs), respectively in 28.6%, 2.5% and 68.9% of cases. The overall average age of patients was 6.7 ± 3.4 years old. The average GFR was 35.2 ± 22.2 mL/min/1.73m<sup>2</sup>. The mechanism of ARF was presumed to be organic in 26 cases (76.5%). The most common presumed etiology was malaria (47.9%). Twelve patients (10.1%) died. Conclusion: RF was common at the PUHC-CDG but it was unclassified in over half of the cases. The diagnosis was based on the estimation of the GFR by Pottel et al.’s formula which was a good alternative to the Schwartz’s formula. The improvement of human and material resources would certainly help for a screening and characterization of RF at the PUHC-CDG.展开更多
Aim of the Study: The aim is to analyse the epidemiological, clinical and CT aspects of hydrocephalus in children. Method: This was a cross-sectional descriptive study with retrospective collection from 1 June 2021 to...Aim of the Study: The aim is to analyse the epidemiological, clinical and CT aspects of hydrocephalus in children. Method: This was a cross-sectional descriptive study with retrospective collection from 1 June 2021 to 31 December 2022 within the radiology department of Charles De Gaulle Pediatric Teaching Hospital in Ouagadougou, Burkina Faso. The study included the records of patients with hydrocephalus who underwent cerebral computed tomography within this radiology department. Results: Hydrocephalus is due to a disorder of the hydrodynamics of the cerebrospinal fluid causing an increase in the volume allocated to this fluid in the brain and being accompanied by an increase in the pressure of this fluid. Its diagnosis is established by Doppler ultrasound or MRI prenatally, transfontanellar ultrasound in newborns and young children whose fontanel is permeable and by CT or MRI in older children, who can also determine the etiology. MRI remains an imaging technique that is less available and less accessible than CT in developing countries like ours. In Burkina Faso, MRI is only available in two private health facilities. The objective of this study was to describe the epidemiological, clinical and computed tomography aspects of hydrocephalus in children at the Charles de Gaulle pediatric teaching hospital in order to contribute to the diagnostic assessment and better management of this pathology. Over 19 months, 105 cases of hydrocephalus were recorded out of a total population of 115 children, or an average of 6 cases per month. The mean age was 17.52 months, with extremes of 03 days and 13 years, and the sex ratio was 1.38. Macrocrania, convulsions and psychomotor retardation were the main clinical signs, with rates of 49%, 34% and 30% respectively. On cerebral CT scan, hydrocephalus was triventricular (41.90%), tetraventricular (40%), and predominantly non-communicating (60%), with a mean Evans score of 0.53. The aetiologies were malformations in 34.28% of cases, tumours in 10.47% and infections in 5.71%. Among the malformations, Arnold Chiari II syndrome associated with spina bifida and Dandy Walker syndrome were the most common, accounting for 25% each. Tumour causes were dominated by craniopharyngioma and astrocytoma, each accounting for 27.30% of cases. Conclusion: The incidence of hydrocephalus was high in our study. In the absence of MRI (due to its unavailability and inaccessibility), CT revealed hydrocephalus that was predominantly tri- and tetraventricular, and predominantly non-communicating.展开更多
Introduction: Cardiovascular disease represents a major public health burden worldwide. Research and management of risk factors contribute to the prevention of these diseases. The aim of this study was to assess the p...Introduction: Cardiovascular disease represents a major public health burden worldwide. Research and management of risk factors contribute to the prevention of these diseases. The aim of this study was to assess the prevalence of dyslipidemia in the biochemistry unit of the Charles De Gaulle Pediatric University Hospital (CHUP-CDG) in Ouagadougou. Material and Methods: This was a descriptive and analytical cross-sectional study, with retrospective data collection from January 1, 2020 to December 31, 2022. Patients of all ages who performed a lipid panel in the CHUP-CDG biochemistry unit during the study period have been included. Results: A total of 2872 patients have been included. The mean age of the study population was 27.72 ± 19.51 years and the M/F sex ratio was 0.81. Among the patients, 22.84% had at least one dyslipidemia. The prevalences of hypercholesterolemia, hypo-HDL cholesterolemia and hyper-LDL cholesterolemia were 11.57%, 49.19% and 57.50% respectively. Hypertriglyceridemia and mixed hyperlipidemia were present in 9.04% and 2.08% of patients. Hypercholesterolemia was significantly more frequent in the female sex (p = 0.0077);hyper-LDL cholesterolemia (p = 0.0255) and mixed hyperlipidemia (p Conclusion: The relatively high prevalence of dyslipidemia in the study indicates a worrying situation. It would therefore appear essential to extend the search for risk factors nationwide, particularly those that can be modified, in order to reduce morbidity and mortality linked to cardiovascular disease.展开更多
BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To i...BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To investigate the effectiveness and safety of teduglutide in clinical practice in Argentina with a 24-week follow-up.METHODS This non-interventional multicentre cohort study included consecutive patients(aged≥1 years)with SBS who were dependent on parenteral support(PS)and received≥1 dose of teduglutide according to currently approved indications.RESULTS The study population(n=45)included 21 adult and 24 pediatric patients.The proportion of adult and pediatric patients who showed clinical response(defined as a≥20%reduction in weekly PS volume)after 24 weeks of treatment was 90.4%[95%confidence interval(CI):69.6%-98.8%]and 83.3%(95%CI:62.6%-95.2%),respectively.Overall,12 patients(26.6%;95%CI:14.6-41.9)were weaned from PS support at the 24-week assessment,6(28.5%;95%CI:11.5-52.1)in the adult cohort,and 6(25%;95%CI:9.7-46.7)in the pediatric cohort.Only baseline PS requirement was inversely associated with weaning from PS(P=0.025).The most frequently reported treatmentemergent adverse events(TEAEs)were mild to moderate abdominal pain and abdominal distension(16.6%;and 9.5%,respectively).None of the reported TEAEs led to treatment discontinuation.CONCLUSION This prospective real-world study demonstrated the effectiveness and safety of teduglutide in adult and pediatric patients with SBS in Argentina.The clinical response observed in both adults and pediatric patients was greater than that reported in phase 3 trials and was consistent with the results of other real-world studies.展开更多
Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within ...Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes.A more advanced form of NAFLD,nonalcoholic steatohepatitis,includes inflammation and liver cell injury,progressive to cryptogenic cirrhosis.NAFLD has become the most common cause of chronic liver disease in children and adolescents.The recent rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide.NAFLD is strongly associated with abdominal obesity,type 2 diabetes,and dyslipidemia,and most patients have evidence of insulin resistance.Thus,NAFLD shares many features of the metabolic syndrome(MetS),a highly atherogenic condition,and this has stimulated interest in the possible role of NAFLD in the development of atherosclerosis.Accumulating evidence suggests thatNAFLD is associated with a significantly greater overall mortality than in the general population,as well as with increased prevalence of cardiovascular disease(CVD),independently of classical atherosclerotic risk factors.Yet,several studies including the pediatric population have reported independent associations between NAFLD and impaired flow-mediated vasodilatation and increased carotid artery intimal medial thickness-two reliable markers of subclinical atherosclerosis-after adjusting for cardiovascular risk factors and MetS.Therefore,the rising prevalence of obesity-related MetS and NAFLD in childhood may lead to a parallel increase in adverse cardiovascular outcomes.In children,the cardiovascular system remains plastic and damage-reversible if early and appropriate interventions are established effectively.Therapeutic goals for NAFLD should address nutrition,physical activity,and avoidance of smoking to prevent not only end-stage liver disease but also CVD.展开更多
AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GE...AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP values are differentiated in normal and abnormal, whereas abnormal values point towards gastroesophageal reflux (GER) as the origin of symptoms. We analyzed the correlation and the concordance of the diagnostic classification of these 3 SAA parameters.RESULTS: Evaluating the GER-irritability association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 39.2% of the infants. When irritability was taken as a symptom, there was only a poor inter-parameter association between SI and SSI, and between SI and SAP (Kendall’s tau b = 0.37, P < 0.05; Kendall’s tau b = 0.36, P < 0.05, respectively). Evaluating the GER-cough association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 52.2% of the patients. When cough was taken as a symptom, only SI and SSI showed a poor inter-parameter association (Kendall’s tau b = 0.33, P < 0.05). CONCLUSION: In infants investigated for suspected GERD with pH/MII-monitoring, SI, SSI and SAP showed a poor inter-parameter association and important dis-agreements in diagnostic classification. These limitations must be taken into consideration when interpreting the results of SAA in infants.展开更多
Purpose:The purpose of this study was to examine the associations between adherence to the 24-Hour Movement Guidelines and all-cause and cause-specific mortality in a large Spanish prospective cohort.Methods:We analyz...Purpose:The purpose of this study was to examine the associations between adherence to the 24-Hour Movement Guidelines and all-cause and cause-specific mortality in a large Spanish prospective cohort.Methods:We analyzed data from 14,288 participants of the Seguimiento Universidad de Navarra(SUN)Project,followed for a mean of 12.8 years(mean baseline age=38.3 years;60.1%women).Data were collected at baseline and through biennial follow-up questionnaires(up to 10 waves,depending on year of entry).The participants self-reported 24-h movement behaviors at baseline and were categorized based on the number of guidelines met(0-3).Behaviors were assessed at baseline only;changes in adherence during follow-up were not accounted for.Cox proportional hazards models were used to estimate hazard ratios(HRs)for all-cause and cause-specific mortality,adjusting for sociodemographic,lifestyle,and clinical covariates.Results:Meeting a greater number of 24-Hour Movement Guidelines at baseline was associated with a progressively lower risk of all-cause mortality.Compared with those meeting none,the multivariable-adjusted HRs were 0.52(95%confidence interval(95%CI):0.33-0.82)for meeting 1 guideline,0.47(95%CI:0.30-0.73)for meeting 2 guidelines,and 0.44(95%CI:0.28-0.71)for meeting all 3 guidelines.Only adherence to the physical activity guidelines was independently associated with a significantly lower mortality risk(HR=0.70;95%CI:0.55-0.89).A reduced risk was also observed for cancer and other-cause mortality among those meeting 2 or more guidelines.Conclusion:Adherence to the 24-Hour Movement Guidelines at baseline,particularly physical activity,was associated with a lower risk of mortality.Promoting an integrated approach to movement behaviors may be an effective strategy for improving population health and longevity.展开更多
Background: Breast cancer is the most common cancer in the world, as well as in Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The number of pathologists in the country is as few as seven f...Background: Breast cancer is the most common cancer in the world, as well as in Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The number of pathologists in the country is as few as seven for a population of about 26 million. The diagnostic performances of diagnostic modalities other than histology—clinical breast examination (CBE), imaging and fine needle aspiration and cytology (FNA)—in our context are not known. Study Objectives: Our objectives were to estimate the proportions of cases managed with mammography, breast ultrasound and FNA and to estimate the sensitivity, specificity, positive and negative predictive values, and accuracy of CBE, mammography, breast ultrasound and FNA;using histology as reference. Study Methodology: The study was cross-sectional and analytical, and was carried out at the Yaoundé General Hospital. It lasted twelve months, April 2015 through March 2016 and covered the period January 2010 to February 2016. Using histology as reference, we calculated measures of diagnostic accuracy for all four modalities using the statistical methods of Galen and Gambino. Results: We recruited 107 cases, 105 females (98.1%) and 02 males. We had 112 breast lumps, 106 malignant (94.6%) and 6 benign. The mean lump size was 61.1 mm. The most frequently used diagnostic tool after CBE was FNA (49.1%), while the diagnostic accuracies were 76.8%, 79.1%, 82.9%, and 82.0% for CBE, breast US, mammography and FNA. Conclusion: The four baseline diagnostic modalities for breast cancer are used sub-optimally and FNA appears to be the most commonly used in our setting after CBE. We recommend that FNA should be considered for diagnosis as appropriate but a negative result should not stop the quest for histological elimination of presence of malignancy.展开更多
文摘<strong>Introduction:</strong><span style="font-family:""><span style="font-family:Verdana;"> The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. </span><b><span style="font-family:Verdana;">Overall objective: </span></b><span style="font-family:Verdana;">To describe and understand the clinical burden of patients managed for COVID</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">19 in pregnancy or post-partum at the DGOPH.</span><b><span style="font-family:Verdana;"> Methodology:</span></b><span style="font-family:Verdana;"> Cross</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">sectional and descriptive study covering four months—March 24</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> to July 24</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet.</span><b><span style="font-family:Verdana;"> Results: </span></b><span style="font-family:Verdana;">A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%</span></span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">39</span><span style="font-family:""> </span><span style="font-family:Verdana;">years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were</span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%.</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.</span></span>
文摘Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon and its contribution to the fight against cervical cancer in our context. Method: This is a retrospective cross-sectional study of 99 colposcopies after which 71 exploitable biopsies were retained at the Douala for a period of 1year (December 1, 2019-December 1, 2020). The nomenclature of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) was used. Results: Mean age of the participants was 44 years, mostly multiparous (80%). Cytological abnormalities were the main reference pattern. During the examination 22% of colposcopies were found to be normal, 37% of TAG 1-2A, 31% of TAG 2B-C, and 5% suspected of cancer. After histological analysis of biopsies guided by colposcopy, we found 42% (30/71) of Cervical Intraepithelial Neoplasia (CIN) 1, 15.5% (11/71) of CIN 2 - 3, and 24% (17/71) cancer. Upon analysis of the diagnosed CIN1/CIN2-3/Cancers, we noted a concordance with colposcopy in 62% (23/37), 37% (10/27) and 85% (6/7) respectively. Colposcopic performance in the detection of high-grade lesions and above was 36% (26/71), with a sensitivity of 92.86%, specificity 83.33%, PPV 78.79% and NPV 94.59%. Conclusion: Despite the difficult socioeconomic context, colposcopy retains all its importance in the diagnosis of precancerous lesions of the uterine cervix. With the imminent putting in place of a national health policy, the goals 90-70-90 by 2030 of the World Health Organization for the fight against cervical cancer can be achieved in our sub-Saharan African countries.
文摘Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths (18.7%) and 17 cases (9.9%) with neurological sequelae before discharge. Conclusion: The incidence of acute bacterial meningitis remains high in our context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitis. The mortality rate was high with poor prognosis factors such as age less than 12 months, delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial hypertension. Focus should be placed on strengthening the routine immunization on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.
文摘Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with retrolective data collection. All patients who underwent laparoscopy for infertility with a complete file were recruited. Data were collected on a pre-established form and analyzed with Microsoft Excel 2007 software. Results: Six hundred and thirty-three women, representing 6.9% of gynecologic operations, underwent laparoscopic surgery during the study period. Infertility accounted for 69.8% (442 cases) of the indications. Four hundred and fifteen files were analyzed. The commonest intraoperative findings were: tubo-peritoneal adhesions (71.6%), hydrosalpinx with distal tubal occlusion (41.5%), peri-hepatic adhesions (22.4%), uterine fibroids (20.2%) and tubal phimosis (14.0%). Adhesiolysis, neosalpingostomy and fimbrioplasty were the commonest surgical gestures. At the end of the procedure, the best tube was staged as favorable in 57.6% of our patients. A complication rate of 4.3% was observed. Conclusion: Infertility is the main indication for laparoscopic surgery in our setting. The main operative findings are tubo-peritoneal adhesions and hydrosalpinx. The most practiced tubal surgical gesture is neosalpingostomy. Half of the recruited women have a favorable stage for the best tube. The complication rate is low.
文摘Objective: To describe the clinical and therapeutic aspects of rape against females in a tertiary level hospital, Yaoundé, Cameroon. Methods: This was a cross-sectional study with a retrolective collection of data, concerning the female patients with a clinical diagnosis of rape received from January 1st 2008 to December 31st 2012. Results: Rape was confirmed at physical examination in 131 cases. The rape victim survivals were mostly aged less than 20 years (85/131;64.9%), unmarried (127/131;97.0%), with no income (95/131;72.5%) and had no university education level (110/131;83.9%). The aggression commonly took place during the night (68/131;51.9%), at the victim’s or aggressor’s home (70/131;53.4%), with physical constraint (73/131;55.8%), by an unknown aggressor (88/131;67.2%). A vaginal penetration was reported by 97.0% of the victims (127/131) while 12.2% of them (16/122) had an anal ingress. Condom usage was uncommon during rape (3/131;2.3%). Vulvar and vaginal lesions were encountered in 32.8% of the cases (43/131). Only 27.5% (36/131) of the victims were prescribed an emergency contraception, while antiretroviral prophylaxis was administered to 46.6% (61/131) of them. Conclusion: These data might be useful for prevention of rape. The clinical management of survival victims of rape needs to be improved.
文摘Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clinical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Complete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.
文摘<strong>Ba</strong><span style="font-family:Verdana;"><strong>ckground:</strong></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> A novel viral respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for a worldwide pandemic. The effects of this new disease in pregnant women and newborns are actually not well known. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We investigated the clinical features and outcomes of four neonates born to mothers with a s</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">evere form of COVID-19 and a positive RT-PCR for SARS Co-V2 in Douala Gynaeco-Obstetric and Pediatric Hospital (Cameroon) from April 20 to June 5, 2020. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All four mothers were symptomatic and had a positive RT-PCR for SARS CoV-2 from nasopharyngeal swab on admission. All of them delivered prematurely through cesarean section because of severe respiratory distress and one died shortly after delivery. The four premature male infants were born between 30 weeks and 35 weeks 2 days of gestation and had birth weights ranging from 1090 g to 2950 g. All infants had 1-minute Apgar scores that ranged from 7 to 8 and 5-minute Apgar scores varying between 8 and 9. They were isolated from their mothers immediately after birth and received formula feeding. Three of the four infants were tested using nasopharyngeal swab specimens for RT-PCR 24 to 48 hours after birth and were negative for COVID-19. All the infants were treated in a dedicated area at the neonatal care unit and presented with mild respiratory distress on admission with a Silverman score that varied between 2 and 4/10. During their hospitalization, all the infants also presented with jaundice and underwent phototherapy. Three of them had anemia with hemoglobin levels ranging from 105 to 123 g/L requiring for blood transfusion. The hospital stay varied between 3 and 48 days. Three infants were discharged healthy and one died. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This case series suggests the possibility of poor maternal and neonatal outcomes in case of severe COVID-19 in mothers. It also suggests that severe COVID-19 in pregnant women may be a risk factor for prematurity for the newborns. It is crucial to screen pregnant women, to implement infection prevention, control measures and to provide close monitoring of neonates born to mothers with a severe form of COVID-19.</span></span></span></span>
文摘Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.
文摘Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.
文摘<strong>Introduction: </strong>Pregnancy is a physiologic state associated with decreased immunity, and the use of medical imaging modalities with ionizing radiation must be justified as potential benefits must outweigh the risk of any harm. However, in the wake of SARS-CoV-2 virus pandemic, chest computed tomography (CT) is necessary to assess the severity of the disease. The objective of this study was to compare the chest CT findings of pregnant and non-pregnant women with SARS-CoV-2 viral pneumonia at a tertiary hospital setting. <strong>Materials and Methods: </strong>This was a cross-sectional, retrospective, descriptive study of admission records of pregnant and non-pregnant patients aged 15 - 49 years during a three (3) months period (April-July 2020) in DGOPH. Logistic regression was used to search for predictors of lung involvement during COVID-19. <strong>Results:</strong> A total of 31 patient files were studied of which 9 (29%) were those of pregnant women. The pregnant women mostly had a combination of lung ground-glass opacities and consolidation on CT compared to the non-pregnant women (7 out of 9 cases, 77.8%, vs. 6 out of 22 cases, 22.7%;p = 0.01). The group of pregnant women had more than 3 affected lobes (50.0% vs. 22.7%, p = 0.04) with a middle lobe predilection (77.8% vs. 31.8%, p = 0.02). CT predictors of COVID-19 pneumonia in the group of pregnant women after the multivariable logistic regression analysis were the presence of nodules (aOR = 13.9;95% CI: 1.25 - 134.2;p = 0.032) and linear bands of interlobular septal thickening (aOR = 17.8;95% CI: 1.46 - 217.6;p = 0.024). <strong>Conclusion: </strong>In this study, the chest CT of pregnant women with COVID-19 pneumonia revealed mostly a combination of findings compared to non-pregnant women, with more affected lobes. These findings suggest the likelihood of a greater CT severity of COVID-19 pneumonia among pregnant women and therefore the need for timely and appropriate management.
文摘Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.
文摘Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.
文摘Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) of Ouagadougou. Patients and Methods: We retrospectively studied all children aged from three to fifteen years old who were diagnosed with renal failure (RF) in the Department of Medical Pediatrics, from January 1, 2011 to December 31, 2013. RF was defined by a glomerular filtration rate (GFR) less than 80 mL/min/1.73m<sup>2</sup>, estimated by the formula of Pottel et al., which ignored the size that was rarely found in the medical records. The department constantly lacked pediatric blood pressure monitors or urinary strips. Results: In total, 119 cases of RF (3.3% of all admissions) were collected. They were about acute RFs (ARFs), chronic RFs (CRFs), and Unclassified RFs (URFs), respectively in 28.6%, 2.5% and 68.9% of cases. The overall average age of patients was 6.7 ± 3.4 years old. The average GFR was 35.2 ± 22.2 mL/min/1.73m<sup>2</sup>. The mechanism of ARF was presumed to be organic in 26 cases (76.5%). The most common presumed etiology was malaria (47.9%). Twelve patients (10.1%) died. Conclusion: RF was common at the PUHC-CDG but it was unclassified in over half of the cases. The diagnosis was based on the estimation of the GFR by Pottel et al.’s formula which was a good alternative to the Schwartz’s formula. The improvement of human and material resources would certainly help for a screening and characterization of RF at the PUHC-CDG.
文摘Aim of the Study: The aim is to analyse the epidemiological, clinical and CT aspects of hydrocephalus in children. Method: This was a cross-sectional descriptive study with retrospective collection from 1 June 2021 to 31 December 2022 within the radiology department of Charles De Gaulle Pediatric Teaching Hospital in Ouagadougou, Burkina Faso. The study included the records of patients with hydrocephalus who underwent cerebral computed tomography within this radiology department. Results: Hydrocephalus is due to a disorder of the hydrodynamics of the cerebrospinal fluid causing an increase in the volume allocated to this fluid in the brain and being accompanied by an increase in the pressure of this fluid. Its diagnosis is established by Doppler ultrasound or MRI prenatally, transfontanellar ultrasound in newborns and young children whose fontanel is permeable and by CT or MRI in older children, who can also determine the etiology. MRI remains an imaging technique that is less available and less accessible than CT in developing countries like ours. In Burkina Faso, MRI is only available in two private health facilities. The objective of this study was to describe the epidemiological, clinical and computed tomography aspects of hydrocephalus in children at the Charles de Gaulle pediatric teaching hospital in order to contribute to the diagnostic assessment and better management of this pathology. Over 19 months, 105 cases of hydrocephalus were recorded out of a total population of 115 children, or an average of 6 cases per month. The mean age was 17.52 months, with extremes of 03 days and 13 years, and the sex ratio was 1.38. Macrocrania, convulsions and psychomotor retardation were the main clinical signs, with rates of 49%, 34% and 30% respectively. On cerebral CT scan, hydrocephalus was triventricular (41.90%), tetraventricular (40%), and predominantly non-communicating (60%), with a mean Evans score of 0.53. The aetiologies were malformations in 34.28% of cases, tumours in 10.47% and infections in 5.71%. Among the malformations, Arnold Chiari II syndrome associated with spina bifida and Dandy Walker syndrome were the most common, accounting for 25% each. Tumour causes were dominated by craniopharyngioma and astrocytoma, each accounting for 27.30% of cases. Conclusion: The incidence of hydrocephalus was high in our study. In the absence of MRI (due to its unavailability and inaccessibility), CT revealed hydrocephalus that was predominantly tri- and tetraventricular, and predominantly non-communicating.
文摘Introduction: Cardiovascular disease represents a major public health burden worldwide. Research and management of risk factors contribute to the prevention of these diseases. The aim of this study was to assess the prevalence of dyslipidemia in the biochemistry unit of the Charles De Gaulle Pediatric University Hospital (CHUP-CDG) in Ouagadougou. Material and Methods: This was a descriptive and analytical cross-sectional study, with retrospective data collection from January 1, 2020 to December 31, 2022. Patients of all ages who performed a lipid panel in the CHUP-CDG biochemistry unit during the study period have been included. Results: A total of 2872 patients have been included. The mean age of the study population was 27.72 ± 19.51 years and the M/F sex ratio was 0.81. Among the patients, 22.84% had at least one dyslipidemia. The prevalences of hypercholesterolemia, hypo-HDL cholesterolemia and hyper-LDL cholesterolemia were 11.57%, 49.19% and 57.50% respectively. Hypertriglyceridemia and mixed hyperlipidemia were present in 9.04% and 2.08% of patients. Hypercholesterolemia was significantly more frequent in the female sex (p = 0.0077);hyper-LDL cholesterolemia (p = 0.0255) and mixed hyperlipidemia (p Conclusion: The relatively high prevalence of dyslipidemia in the study indicates a worrying situation. It would therefore appear essential to extend the search for risk factors nationwide, particularly those that can be modified, in order to reduce morbidity and mortality linked to cardiovascular disease.
基金Supported by Takeda Argentina SA,No.TAK-633-4003.
文摘BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To investigate the effectiveness and safety of teduglutide in clinical practice in Argentina with a 24-week follow-up.METHODS This non-interventional multicentre cohort study included consecutive patients(aged≥1 years)with SBS who were dependent on parenteral support(PS)and received≥1 dose of teduglutide according to currently approved indications.RESULTS The study population(n=45)included 21 adult and 24 pediatric patients.The proportion of adult and pediatric patients who showed clinical response(defined as a≥20%reduction in weekly PS volume)after 24 weeks of treatment was 90.4%[95%confidence interval(CI):69.6%-98.8%]and 83.3%(95%CI:62.6%-95.2%),respectively.Overall,12 patients(26.6%;95%CI:14.6-41.9)were weaned from PS support at the 24-week assessment,6(28.5%;95%CI:11.5-52.1)in the adult cohort,and 6(25%;95%CI:9.7-46.7)in the pediatric cohort.Only baseline PS requirement was inversely associated with weaning from PS(P=0.025).The most frequently reported treatmentemergent adverse events(TEAEs)were mild to moderate abdominal pain and abdominal distension(16.6%;and 9.5%,respectively).None of the reported TEAEs led to treatment discontinuation.CONCLUSION This prospective real-world study demonstrated the effectiveness and safety of teduglutide in adult and pediatric patients with SBS in Argentina.The clinical response observed in both adults and pediatric patients was greater than that reported in phase 3 trials and was consistent with the results of other real-world studies.
文摘Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes.A more advanced form of NAFLD,nonalcoholic steatohepatitis,includes inflammation and liver cell injury,progressive to cryptogenic cirrhosis.NAFLD has become the most common cause of chronic liver disease in children and adolescents.The recent rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide.NAFLD is strongly associated with abdominal obesity,type 2 diabetes,and dyslipidemia,and most patients have evidence of insulin resistance.Thus,NAFLD shares many features of the metabolic syndrome(MetS),a highly atherogenic condition,and this has stimulated interest in the possible role of NAFLD in the development of atherosclerosis.Accumulating evidence suggests thatNAFLD is associated with a significantly greater overall mortality than in the general population,as well as with increased prevalence of cardiovascular disease(CVD),independently of classical atherosclerotic risk factors.Yet,several studies including the pediatric population have reported independent associations between NAFLD and impaired flow-mediated vasodilatation and increased carotid artery intimal medial thickness-two reliable markers of subclinical atherosclerosis-after adjusting for cardiovascular risk factors and MetS.Therefore,the rising prevalence of obesity-related MetS and NAFLD in childhood may lead to a parallel increase in adverse cardiovascular outcomes.In children,the cardiovascular system remains plastic and damage-reversible if early and appropriate interventions are established effectively.Therapeutic goals for NAFLD should address nutrition,physical activity,and avoidance of smoking to prevent not only end-stage liver disease but also CVD.
文摘AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP values are differentiated in normal and abnormal, whereas abnormal values point towards gastroesophageal reflux (GER) as the origin of symptoms. We analyzed the correlation and the concordance of the diagnostic classification of these 3 SAA parameters.RESULTS: Evaluating the GER-irritability association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 39.2% of the infants. When irritability was taken as a symptom, there was only a poor inter-parameter association between SI and SSI, and between SI and SAP (Kendall’s tau b = 0.37, P < 0.05; Kendall’s tau b = 0.36, P < 0.05, respectively). Evaluating the GER-cough association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 52.2% of the patients. When cough was taken as a symptom, only SI and SSI showed a poor inter-parameter association (Kendall’s tau b = 0.33, P < 0.05). CONCLUSION: In infants investigated for suspected GERD with pH/MII-monitoring, SI, SSI and SAP showed a poor inter-parameter association and important dis-agreements in diagnostic classification. These limitations must be taken into consideration when interpreting the results of SAA in infants.
文摘Purpose:The purpose of this study was to examine the associations between adherence to the 24-Hour Movement Guidelines and all-cause and cause-specific mortality in a large Spanish prospective cohort.Methods:We analyzed data from 14,288 participants of the Seguimiento Universidad de Navarra(SUN)Project,followed for a mean of 12.8 years(mean baseline age=38.3 years;60.1%women).Data were collected at baseline and through biennial follow-up questionnaires(up to 10 waves,depending on year of entry).The participants self-reported 24-h movement behaviors at baseline and were categorized based on the number of guidelines met(0-3).Behaviors were assessed at baseline only;changes in adherence during follow-up were not accounted for.Cox proportional hazards models were used to estimate hazard ratios(HRs)for all-cause and cause-specific mortality,adjusting for sociodemographic,lifestyle,and clinical covariates.Results:Meeting a greater number of 24-Hour Movement Guidelines at baseline was associated with a progressively lower risk of all-cause mortality.Compared with those meeting none,the multivariable-adjusted HRs were 0.52(95%confidence interval(95%CI):0.33-0.82)for meeting 1 guideline,0.47(95%CI:0.30-0.73)for meeting 2 guidelines,and 0.44(95%CI:0.28-0.71)for meeting all 3 guidelines.Only adherence to the physical activity guidelines was independently associated with a significantly lower mortality risk(HR=0.70;95%CI:0.55-0.89).A reduced risk was also observed for cancer and other-cause mortality among those meeting 2 or more guidelines.Conclusion:Adherence to the 24-Hour Movement Guidelines at baseline,particularly physical activity,was associated with a lower risk of mortality.Promoting an integrated approach to movement behaviors may be an effective strategy for improving population health and longevity.
文摘Background: Breast cancer is the most common cancer in the world, as well as in Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The number of pathologists in the country is as few as seven for a population of about 26 million. The diagnostic performances of diagnostic modalities other than histology—clinical breast examination (CBE), imaging and fine needle aspiration and cytology (FNA)—in our context are not known. Study Objectives: Our objectives were to estimate the proportions of cases managed with mammography, breast ultrasound and FNA and to estimate the sensitivity, specificity, positive and negative predictive values, and accuracy of CBE, mammography, breast ultrasound and FNA;using histology as reference. Study Methodology: The study was cross-sectional and analytical, and was carried out at the Yaoundé General Hospital. It lasted twelve months, April 2015 through March 2016 and covered the period January 2010 to February 2016. Using histology as reference, we calculated measures of diagnostic accuracy for all four modalities using the statistical methods of Galen and Gambino. Results: We recruited 107 cases, 105 females (98.1%) and 02 males. We had 112 breast lumps, 106 malignant (94.6%) and 6 benign. The mean lump size was 61.1 mm. The most frequently used diagnostic tool after CBE was FNA (49.1%), while the diagnostic accuracies were 76.8%, 79.1%, 82.9%, and 82.0% for CBE, breast US, mammography and FNA. Conclusion: The four baseline diagnostic modalities for breast cancer are used sub-optimally and FNA appears to be the most commonly used in our setting after CBE. We recommend that FNA should be considered for diagnosis as appropriate but a negative result should not stop the quest for histological elimination of presence of malignancy.
